Women's Health Flashcards
Understand the role of the anaesthetist in the care of a pregnant woman.
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Understand the issues specifically relevant to anaesthesia in pregnancy.
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Describe the key components and rationale for pre-pregnancy counselling.
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Describe the key components and rationale for the first antenatal visit.
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Describe the key components and rationale for subsequent antenatal visits.
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Explain the principles behind planning the timing and mode of delivery.
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Describe the possible causes of congenital abnormalities.
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Understand the tests used to detect abnormalities.
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Distinguish between screening and diagnostic tests.
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Appraise the advantages and disadvantages of antenatal screening and diagnostic tests.
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Describe the options available when a congenital abnormality is detected.
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Recognise the difference between primary and secondary prevention of abnormalities and can provide examples of both.
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List the risk factors for shoulder dystocia in the antenatal period.
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Recognise the signs of shoulder dystocia in labour.
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Describe how to manage shoulder dystocia in an emergency situation.
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Describe the indications for caesarean section.
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Distinguish between an elective and an emergency caesarean section.
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Outline the process of a caesarean section operation.
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List the possible complications of a caesarean section, both in the short and longer term.
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Appraise the advantages and disadvantages of caesarean section for both the mother and baby.
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Consider a differential diagnosis for antepartum haemorrhage (APH).
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Differentiate between placenta praevia and abruption placentae from history and clinical examination findings.
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Appreciate the need for teamwork in the management of antepartum haemorrhage (APH).
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Describe the principles of assessing metal well-being antenatally and in labour.
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Explain the principles of managing the situation where tests of metal well-being indicate acute severe metal compromise.
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List the differential forms of hormonal contraception available.
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State the main method of action for each form of hormonal contraception.
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List the main contraindications for combined hormonal contraception, intrauterine systems and implants.
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Discuss the advantages and disadvantages of all forms of hormonal contraception.
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Discuss the factors that contribute to a difference in efficacy between perfect use and typical use for hormonal contraception.
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Explain how BhCG levels correlate to the progression of normal and abnormal pregnancy in the first trimester.
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Describe the pathophysiology, diagnosis and management of hyperemesis gravidarum.
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Describe the pathophysiology, diagnosis and management of miscarriage and molar pregnancy.
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Describe the pathophysiology, diagnosis and management of ectopic pregnancy.
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Compare and contrast the basic diagnostic capabilities and limitations of ultrasonography in the first trimester of pregnancy.
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Describe the spectrum of psychological reactions to early pregnancy loss and complications and appraise the efficacy of early interventions that may reduce long term sequelae.
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List three to four common presenting symptoms each for endometriosis and adenomyosis.
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Explain the roles of investigations/tests used to diagnose endometriosis and adenomyosis.
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Describe the medical and surgical treatments that are currently available and the impact of desire for pregnancy on these choices.
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Discuss the impacts of autonomy and quality of life on a patient’s choice of treatment.
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Describe what is happening to the foetus in utero that is important for survival after birth.
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Describe the causes of heavy menstrual bleeding (6).
- Dysfunctional Uterine Bleeding (DUB; 60%; no organic pathology)
- Systemic Causes (e.g. endocrine, bleeding disorders, liver disease)
- Uterine and Local Causes (adenomyosis, fibroids, polyps, infection, carcinoma)
- Iatrogenic
- Pregnancy Complications
- Trauma
Discuss the approach to evaluation of heavy menstrual bleeding, including the principles of gynaecological history and examination.
History
- First menarche (perimenarcheal- ?anovulatory)
- Regularity of cycle (irregular or long- ?anovulatory)
- Last Normal Menstrual Period (LMNP; consider pregnancy or anovulation)
- Quantify blood loss (days of bleeding + no. of heavy days, no. of pads/tampons, layers of protection, clots/flooding,
- Post-coital and inter-menstrual bleeding (suggests local cause)
- Dysmenorrhoea or dyspareunia (may suggest endometriosis, adenomyosis, infection)
- Symptoms of anaemia
- Endocrine symptoms
- Bleeding disorder (
- Last Pap smear (cervical cancer)
- Medications
- Impact on life
Examination
- Vital signs: BP, postural drop, pulse, diaphoresis
- Systemic: pallor, endocrine disturbance (tremor, eye findings, skin, gore, acne, BMI), bruising, petechiae, bleeding mucosal surfaces
- Abdominal: mass
- Speculum:
- Bimanual:
Outline the medical and surgical management options for heavy menstrual bleeding under differing clinical circumstances.
Treat an underlying cause (e.g. endocrine cause) if one exists
Medical Therapy
- Non-Hormonal
- PG inhibitors (restores imbalance of endometrial PGs)
- Antifibrinolytics (inhibits clot breakdown) - Hormonal
- OCP
- Depot provera
- Other (e.g. Danazol, GnRH analogues)- second line, side effects - Procedural
- Mirena IUCD
Surgical Therapy (used if medical treatments fail, and if fertility not desired)
- Endometrial Ablation
- Laser, Roller ball diathermy, transcervical endometrial resection
- Thermal balloon, Microwave ablation, Heated saline
- 90% reduction in bleeding, TEMPORARY
- 60% satisfaction at 5 years - Hysterectomy
- Total or subtotal +/- oophorectomy
- Vaginal, abdominal or laparoscopically assisted
Describe the symptoms and signs of pre-eclampsia and eclampsia as well as the biochemical and haematological changes that may occur in association with these diagnoses.
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Outline the current understanding regarding the aetiology and pathophysiology of pre-eclampsia.
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Describe the possible maternal and foetal effects of pre-eclampsia.
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Describe the factors which may determine the decision to deliver and timing of delivery in cases of pre-eclampsia/eclampsia.
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Outline the principles of clinical management of pre-eclampsia/eclampsia.
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List the drugs that are commonly used in the management of pre-eclampsia/eclampsia and their side effects.
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Describe the methods available to monitor foetal well-being in cases of pre-eclampsia/eclampsia.
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Outline the post-natal management of the mother with pre-eclampsia.
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Understand the issues specifically relevant to indigenous women in pregnancy and gynaecological care.
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Understand the role of the Aboriginal liaison officer in the care of a woman seeking obstetric or gynaecological care.
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Understand the reasons for augmentation and induction of labour.
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Distinguish between augmentation and induction of labour.
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Describe the methods available for augmentation and induction of labour.
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Appraise the advantages and disadvantages of inducing labour.
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Understand the indications for an instrumental delivery.
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Describe the requirements for an instrumental vaginal delivery.
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Describe the devices available for instrumental delivery.
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Describe the risks to the mother and baby of an instrumental delivery.
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Appreciate the clinical public health significance of infectious diseases in pregnancy.
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Describe the preventative measures offered by antenatal screening.
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Understand the impact of maternal infection on the infant.
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Describe the differential diagnoses and appropriate tests to diagnose infection.
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Describe the principles of management of infections in pregnancy.
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Explain where to obtain expert assistance in complicated infections in pregnancy.
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Appreciate the boundaries of natural fertility.
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Understand common pathologies in subfertile individuals and partnerships.
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Take a medical history and perform a clinical examination relevant to fertility.
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Understand useful tests used to assess aetiology of infertility.
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Describe the interventions of IVF, ICSI and PGD.
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Describe the principles of intrapartum analgesia.
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Describe the principles of anaesthesia for operative birth.
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Understand the need for a team approach to manage women in labour.
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Describe the physiology of the first, second and third stages of labour.
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Understand the physical and emotional demands of labour on women and have an approach to the assessment and management of normal labour.
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Recognise the potential for foetal distress in labour and understand the principles of foetal surveillance in labour.
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Understand how to assess and document progress in labour.
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Explain the implications of IUGR with respect to the short and long term consequences.
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Appreciate the importance of IUGR diagnosis.
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Describe the principles of management of IUGR.
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List the most common problems encountered in the puerperium.
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Define puerperal sepsis and list the most common types of infections, most common organisms and discuss diagnosis and management strategies.
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Define secondary postpartum haemorrhage and the most common causes and outline medical and surgical approaches to its management.
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Recognise postnatal depression and psychosis.
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List specific complications after caesarean section and vaginal delivery.
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Understand the importance of post part haemorrhage and be able to actively manage the third stage of labour.
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Know how to recognise, diagnose and manage puerperal sepsis.
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Be able to manage a request for post part contraception.
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Describe the major medical diseases contributing to maternal mortality.
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Describe the physiological changes associated with normal pregnancy.
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Understand how pregnancy impacts on women with pre-existing medical disease.
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Understand which cardiac lesions pose the greatest risk in pregnancy.
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Provide basic pre-pregnancy counselling to a woman with cardiac disease.
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Outline the principles of management during pregnancy and labour of women with cardiac disease.
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Understand the approach to management of women with a past history of, or current, thromboembolism.
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Explain the principles of diagnostic imaging as applied to the pregnant mother.
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Explain the principles of how to perform effective resuscitation in a pregnant woman.
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Define the terminology used in menopause.
Menopause: Perimenopause: Menopause Transition: Postmenopause: Early Menopause: Premature Ovarian Insufficiency:
List the core symptoms of menopause.
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Describe the health risks associated with menopause.
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Take a reproductive history and menopause history from a patient.
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