Women's Health Flashcards
What are the subdivisions of the first stage of labour?
Latent stage - from beginning of contractions to cervical effacement (~4cm dilated)
Active stage - cervical effacement to full dilation
When does the first stage of labour start and finish?
Onset of labour till the cervix is fully dilated
What is cervical effacement?
Thinning and stretching of cervix
The internal os and cervical canal is incorporated into uterus
Ideally, how quickly does the cervix want to dilate?
1cm per hour
When does the second stage of labour begin and end?
Begins when cervix is fully dilated
Ends when baby is delivered
What are the subdivisions of the second stage of labour and describe them?
Propulsive phase - fully dilated to head at pelvic floor
Exclusive phase - irresistible desire to ‘bear down/push’ to delivery of baby
What happens in the third stage of labour?
Expulsion of placenta and membranes
How long should the second stage of labour last?
<2 hours if no epidural
How long should the third stage of labour last?
<30 minutes
What is cervical dilation?
Increased diameter of the external os
What is operculum (‘show’)?
Blood stained mucous discharge (the plug of mucous from the cervical canal)
Occurs in 2/3 pregnancy in early labour
What is ‘waters breaking’?
Rupture of the membranes
75% occur after cervix is >9cm dilated
What is the difference in the cervix between a nulliparous and multiparous woman?
Nulliparous have a more tubular cervix
Multiparous have a more open/expanded cervix
What problems might you get in a primigravid mother?
Inefficient uterine contraction
Prolonged labour
Risk of cephalopelvic disproportion and foetal trauma
What is a risk in multigravid mother that has previously had a NVD?
Risk of uterine rupture
In which primigravid women is inefficient uterine contraction more common?
Very young (teenagers) Older (>40)
What rate of contractions can cause foetal distress?
More than 5 contractions in 10 minutes
What is caput?
Oedema of the scalp due to pressure of the head against the rim of the cervix
What is moulding?
Overlapping of the vault bones, altering the shape of the skull so the engaging diameters become shorter
What is engagement?
Descent of the biparietal diameter through the pelvic brim
When is the head of the foetus engaged?
When it is at the level of the ischial spines (not more than 2/5ths can be felt abdominally)
What is the lie of the baby?
Relation of the long axis of the foetus to that of the mother
Can be longitudinal, oblique or transverse
What is presentation?
The part of the foetus that is in the lower pole of the uterus
Can be cephalic, vertex or breech
What is the attitude of the foetus?
Posture of the foetus’ head
Can be flexion, deflexion or extension
What is meant by the position of the foetus?
Relationship of the presenting part of the foetus to the mother
What is the denominator?
Describes the position of the baby with respect to the mothers pelvis.
Eg left occipito posterior, right occipito lateral, direct occipito anterior
What is the normal denominator of the foetus?
Direct occipito anterior
What is the station of the foetus?
Relationship of the head to the ischial spines
What is fifths palpable per abdomen?
On examination, the amount of the head felt above the pubic symphysis and is expressed in fifths
What are the five steps of the mechanism of a normal birth?
Engagement and descent Flexion Internal rotation Extension External rotation
What is syntocinon?
Synthetic oxytocin
What is oxytocin important in?
Effacement and stimulating uterine contraction
Neuromodulator of brain
What is syntocinon used for?
Inefficient uterine contractions
Postpartum haemorrhage
What does oxytocin cause?
Short rhythmic contractions
What is ergometrine used to treat?
Postpartum haemorrhage
What does ergometrine cause?
Tetanic contractions (prolonged spasms)
How quickly does ergometrine act?
IV - 40 seconds
IM - 6 minutes
What are the main side effects of ergometrine?
Nausea
Vomiting
Hypertension
What is syntometrine?
Combination of syntocinon (10iu) and ergometrine (500mcg)
What is syntometrine used for?
Active management of the third stage of labour - speeds up delivery of placenta to reduce blood loss
Give an example of a prostaglandin E2 analogue and when would you use it.
Dinoprostone - induce labour
What does prostaglandin E2 do in labour?
Ripens and effaces cervix
What is gravidity?
The number of times a woman has been pregnant
What is parity?
The number of times a woman has given birth to a foetus with a gestational age of 24 weeks or more (regardless of alive or stillbirth)
What is a risk in giving syntocinon?
Cause rupture of uterus (less likely in primigravid)
What does meconium signify?
That the foetus may be in distress
When is the triple test for Down’s syndrome conducted?
Between 15 and 20 weeks
What is measured in the triple test?
Alpha-feta protein
Beta-hCG
Unconjugated oestradiol
What tends to happen to pre-existing conditions during pregnancy?
1/3 improve
1/3 stay the same
1/3 deteriorate
What does hypertension during pregnancy predispose to?
Pre-eclampsia
When can pre-eclampsia develop?
Anytime after 20 weeks, usually in the last trimester (after 26 weeks)
What are the characteristic clinical features of pre-eclampsia?
Hypertension
Proteinuria
With/without oedema
When might a woman develop gestational hypertension?
Anytime after 20 weeks
What is a complete molar pregnancy?
An egg with no genetic information is fertilised by a sperm and grows to become a lump of tissue, not a foetus
What is a partial molar pregnancy?
An egg with no genetic information is fertilised by 2 sperm, and the placenta develops to become the molar growth
Why do molar pregnancies need to be evacuated quickly?
They can develop into choriocarcinomas
What is spontaneous miscarriage?
Spontaneous loss of pregnancy prior to viability (before 23 weeks and 6 days)
When do the majority of miscarriages occur?
First trimester (upto 12 weeks)
What is the cause of the majority of first-trimester miscarriages?
Chromosomal abnormalities
What is a threatened miscarriage?
Bleeding in early pregnancy
What is an incomplete miscarriage?
The products of conception remain in the uterus
What is a silent miscarriage?
The embryo or foetus has died but a miscarriage has not yet occurred
How many miscarriages must you have to be considered to have recurrent miscarriages?
Three consecutive
What medical management is there for a miscarriage?
Mifepristone with misoprostol (prostaglandin)
How would an ectopic pregnancy present?
Pain
5-8 weeks amenorrhea
Scanty brown vaginal bleeding
Tenderness
What are the clinical features of a miscarriage?
PV spotting
Pain
Hyperemesis
What can cause subfertility?
Ovulation disorder Sperm dysfunction Tubal disease Endometriosis Coital failure Uterine abnormalities
What do ovulatory disorders tend to involve?
Hypothalamic-pituitary-ovarian axis
Name some hypothalamic causes of ovulation disorders.
Eating disorder
Stress
Excessive exercise
Underweight
What are some ovarian causes of ovulatory disorders?
Polycystic ovarian syndrome
Primary ovarian failure
What classified PCOS?
Having 2 of the following criteria:
Hyperandrogenism
Oligo-ovulation/anovulation
Polycystic ovaries of ultrasound
What is the treatment of ovulatory disorders that cause subfertility?
Ovulation induction, mainly by oestrogen anatgonists or gonadotropins
What are the risks of ovulation induction?
Multiple pregnancies, eg twins
What can cause sperm dysfunction that leads to subfertility?
Primary failure, eg failure of sperm production
Obstruction, eg congenital
What are the fertility treatments for sperm dysfunction?
Intrauterine insemination
Donor insemination
IVF
What can causes tubal disease leading to subfertility?
Infection
Inflammation
Trauma/Post op
Sterilisation
What infections can causes tubal disease?
Chlamydia
Gonorrhoea
What is the main inflammatory cause of tubal disease?
Endometriosis
What are the treatment options for subfertility caused by tubal disease?
Tubal surgery
Ablation of endometriosis
IVF
What are uterine fibroids?
Benign growth of smooth muscle of uterus
What are the different types of fibroids?
Subserosal fibroids
Intramural fibroids
Submucosal fibroids
What symptoms occur with fibroids?
Menorrhagia
Dyspareunia
Urinary frequency and urgency
May suffer miscarriages
What are the treatments for fibroids?
Medication for symptoms, eg. NSAIDs, OCP
Surgery, eg. myomectomy (remove fibroid), hysterectomy
What is an ovarian cyst?
Collection of fluid surrounded by a thin wall within an ovary
What can ovarian cysts be sub classified into?
Epithelial
Stromal cell tumours
Germ cell tumours
Mixed/metastatic
In reference to a gynaecological history, what is kappa?
The number of days she bleeds over the cycle length, eg. k=6/28
For menorrhagia, what is it important to know?
Kappa
Last smear (when and results)
Parity
Contraceptive use (which one)
What is the difference between primary and secondary dysmenorrhea?
Primary - not associated with an organic disease or psychological cause
Secondary - linked with a cause, eg endometriosis, PID
What are the most common causes of menorrhagia?
Dysfunctional uterine bleeding
Fibroids
What would make a diagnosis of dysfunctional uterine bleeding more likely than fibroids in menorrhagia?
A normal sized painless uterus on examination
How does tranexamic acid treat menorrhagia?
An antifibrinolytic that you take during menstrual cycle.
Reduces blood loss by approx 50%
Do oral progestogens have a role in the treatment of menorrhagia?
No - not in regular menorrhagia
What is mefenamic acid and how is it useful in menorrhagia?
An NSAID
Good to reduce heavy bleeding and dysmenorrhea
What can mefenamic acid be used in conjunction with?
Tranexamic acid
What are the effects of the combined oral contraceptive pill in menorrhagia?
Reduce bold loss by 20-30%
Improves dysmenorrhea
What are the effects of the (mirena) coil in treatment of menorrhagia?
Reduce blood loss by up to 90%
At 1 year, 30% are amenorrhoeic
What is the treatment for menorrhagia patients who are very anaemic and bleeding continuously?
GnRH agonist or high dose progestogen to achieve amenorrhoea quickly
When are surgical options applicable to menorrhagia?
When patient is sure family is complete and there is failure of medical treatment
What are the three types of HRT?
Oestrogen only
Sequential HRT (14 days oestrogen, followed by 14 days O & P)
Continuous O & P
Which patients are applicable for oestrogen only HRT?
Have had hysterectomy
Which patients are applicable for sequential HRT?
Still have uterus and are in peri-menopause
Which patients are applicable for continuous combined HRT (O & P)?
Patients who are at least 1 year after menopause
What are the advantages of HRT?
Elimination of hot flushes, night sweats and vaginal dryness
Protects against osteoporosis
What are the disadvantages of HRT?
Small increase in breast cancer and VTE
What is classified as post-menopausal bleeding?
Vaginal bleeding more than 12 months after LMP
What are uterine fibroids also known as?
Uterine leiomyomas
