Women's Health Flashcards
What is Meig’s syndrome triad?
Benign ovarian tumour
Ascites
Pleural effusion
Which drugs should be avoided in breastfeeding?
The following drugs should be avoided: antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
Criteria for hyperemesis gravidarum
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
Management of hyperemesis gravidarum
(1st line) Antihistamines - promethazine
(2nd line) Ondansetron and metoclopramide
How would vasa praevia present?
painless vaginal bleeding + include fetal bradycardia and membrane rupture
Symptoms of vaginal candidiasis & treatment
‘Cottage cheese’, non-offensive discharge
itch, dyspareunia, dysuria
Tx:
- Local: clotrimazole pessary
- Oral: itraconazole
What is endometrial hyperplasia associated with? (e.g. what increases its risk factors)
Endometrial hyperplasia is associated with;
Taking oestrogen unopposed by progesterone Obesity Late menopause Early menarche Aged over 35-years-old Being a current smoker Nulliparity Tamoxifen
what do you give a pregnant woman with high blood pressure + PMH of asthma?
Nifedipine
HRT: unopposed oestrogen increases risk of…
endometrial cancer
If a patient is at moderate risk of pre-eclampsia - from when does she need to commence what medication
Asprin 75mg OD from 12 weeks gestation until birth
What anti-epileptic have the smaller effects on the developing fetus?
Lamotrigine, carbamazepine and levetiracetam
Causes of an increased nuchal translucency include:
Down’s syndrome
congenital heart defects
abdominal wall defects
Patients with continuous dribbling incontinence after prolonged labour should be suspected for having…
vesicovaginal fistula
Do urinary dye study to ix this
First dose of anti-D prophylaxis to rhesus neg women is given at week…
28
Target blood pressure in woman with pre-eclamspia is
NICE recommends that blood pressure is targeted at systolic < 150 mmHg and diastolic 80-100 mmHg.
What type of ovarian tumour is associated with Meig’s syndrome?
Fibroma
In preterm prelabour rupture of membranes, antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome - which steroid should be given?
Dexamethasone
pregnant women with pre-existing diabetes can be treated with
metformin, either alone or in combination with insulin
Women between the ages of 50-64 years have smears every…
5 years
What is the classic uterus positioning in endometrosis
Fixed, retroverted uterus
How do you define PPH?
Postpartum haemorrhage is defined as blood loss of 500 ml or more within 24 hours of the birth of a baby
Risk factors for cervical cancer
smoking human immunodeficiency virus early first intercourse, many sexual partners high parity lower socioeconomic status combined oral contraceptive pill*
Babies born to hep B serology positive woman should be given…
Hep B vaccine & 0.5ml of HBIG within 12 hours of birth with a further hep vaccine at 1-2 months and a further vaccine at 6 months
Risk factor for endometrial cancer
obesity nulliparity early menarche late menopause unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously diabetes mellitus tamoxifen polycystic ovarian syndrome hereditary non-polyposis colorectal carcinoma
More oestrogen -> more endometrial lining and more cancerous
Therefore early and late menopause means more oestrogen
Nulliparity means more oestrogen (PREGNANCY REDUCES OESTROGEN)
(COCP & smoking is protective)
When do you measure ____ in pregnant pts for treatment of VTE and what do you measure?
‘Routine measurement of peak anti-Xa activity for patients on LMWH for treatment of acute VTE in pregnancy or postpartum is not recommended except in women at extremes of body weight (less than 50 kg and 90 kg or more) or with other complicating factors (for example, with renal impairment or recurrent VTE).’
A woman with a previous VTE history is automatically considered high risk and requires low molecular weight heparin throughout the antenatal period
Risk factors for ovarian cancer
Risk factors
family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity
HIV and pregnancy management plan
Maternal antiretroviral therapy
C-section mode of delivery
Neonatal antiretroviral therapy
Infant feeding (bottle feeding)
What would you expect in a trisomy 21 pregnancy?
Low alpha fetoprotein (AFP)
Low oestriol
High human chorionic gonadotrophin beta-subunit (-HCG)
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency
When is the combined test done and when?
At 11-13+6 weeks to screen for autosomal trisomies. This involves PAPP-A and -HCG blood tests along with nuchal translucency measurement by ultrasound
When is the triple test done and when?
16 weeks but is less accurate than the ‘combined test’ and so should only be used when trisomy screening is performed after 14 weeks. It consists of AFP, -HCG and oestriol blood tests.
Endometriosis management
Management depends on clinical features - there is poor correlation between laparoscopic findings and severity of symptoms. NICE published guidelines in 2017:
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia does help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried
If analgesia/hormonal treatment does not improve symptoms or if fertility is a priority the patient should be referred to secondary care. Secondary treatments include:
GnRH analogues - said to induce a ‘pseudomenopause’ due to the low oestrogen levels
drug therapy unfortunately does not seem to have a significant impact on fertility rates
surgery: some treatments such as laparoscopic excision and laser treatment of endometriotic ovarian cysts may improve fertility
Difference between endometrosis vs PID
The key signs and symptoms of endometriosis are cyclical abdominal pain and deep dyspareunia. It can be associated with fertility problems.
Pelvic inflammatory disease can also cause sub-fertility, dyspareunia and pelvic pain, but this pain is not typically associated with menstruation (oligomenorrhoea)
Antimuscarinics examples for bladder incontinence
oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
First line ix of pregnant woman with painless bleeding
Transvaginal ultrasound
Increased AFP
Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis)
Multiple pregnancy
