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Year 4 TCDs > Women's Health > Flashcards

Women's Health Flashcards

1
Q

Outline the 4 main components of palpation during an antenatal examination

A
  1. Fundal height
  2. Foetal poles
  3. Presenting part
  4. Engagement
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2
Q

What is the normal dose fo antenatal folic acid

A

400 mcg

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3
Q

What indications are there for a higher dose of folic acid during pregnancy? (7)

A

A dose of 5 mg should be taken by mothers that:

  1. Hx of previous babies with neural tube defects
  2. Either parent has a neural tube defect
  3. Hx of neural tube defects in the family
  4. Anti-epileptic medication
  5. Diabetes
  6. Obesity
  7. Bowel disease e.g. coeliac or IBD
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4
Q

How is hyperemesis gravidarum diagnosed? (3)

A

Protracted nausea and vomiting of pregnancy in the presence of the following triad:

  1. > 5% pregnancy weight loss
  2. Dehydration
  3. Electrolyte imbalance
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5
Q

Suggest 3 scenarios in which nausea and vomiting of pregnancy should be managed as an inpatient

A
  1. Continuous nausea and vomiting with an inability to keep down oral anti-emetics
  2. Continued nausea and vomiting associated with ketonuria and/ or weight loss >5% of pregnancy weight despite the use of oral anti-emetics
  3. Confirmed or suspected co-morbidity e.g. UTI
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6
Q

Give 2 adverse reactions associated with the use of the anti-emetic agents metoclopramide and the phenothiazines

A
  1. Extrapyramidal symptoms

2. Oculogyric crisis (involuntary upward gaze of the eyes)

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7
Q

What are the first line anti-emetics used for the management of nausea and vomiting of pregnancy? (2)

A
  1. H1 receptor antagonists

2. Phenothiazines

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8
Q

Give an example of a H1 receptor antagonist

A

Loratadine

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9
Q

What is the best form of fluids to be given for rehydration to patients with nausea and vomiting of pregnancy?

A

0.9% saline with additional potassium chloride in each bag

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10
Q

Which supplement should be administered to any women who is admitted to hospital with prolonged vomiting during pregnancy?

A

Thiamine

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11
Q

Name a complimentary therapy that is often helpful in the management of nausea and vomiting of pregnancy

A

Ginger

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12
Q

What are the 4 main types of female genital mutilation?

A

Type 1 - Partial/total removal of the clitoris gland and/or the prepuce/clitoral hood.
Type 2 - Partial or total removal of the clitoris and labia minora
Type 3 - Infibulation
Type 4 - All other harmful procedures to the female genitals for non medical purposes

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13
Q

What is the leading cause of indirect maternal death during or up to six weeks post pregnancy?

A

Cardiac disease

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14
Q

What is the leading cause of direct maternal death during or up to six weeks post pregnancy?

A

Thrombosis and thromboembolism

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15
Q

What is the function of the MEOWS score?

A

An EWS equivalent used for pregnant women from 20 weeks gestation

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16
Q

Classify the drug misoprostol

A

Synthetic prostaglandin E1 analogue

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17
Q

Briefly outline the process of sensitisation with regards to Rhesus disease

A

When a women with RhD negative blood is exposed to RhD positive blood which in turn triggers an immune response

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18
Q

What are the 2 potential dose regimes for anti-D prophylaxis?

A
  1. Single dose between 28-30 weeks

2. 2 dose treatment. First injection at 28 weeks and the second at 34 weeks

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19
Q

Define Gravidity

A

Number of pregnancies a women has had, including current pregnancy

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20
Q

Define Parity

A

Number of births beyond 24wks gestation

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21
Q

Recall Naegele’s rule for calculating an expected date of delivery

A

Add 1 year and 7 days from the date of the last menstrual period and then subtract 3 months

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22
Q

Recall 3 aspects of a SHx that must be addressed in an obstetric history

A
  1. Recreational drug use
  2. Domestic violence
  3. Psychiatric illness- particularly in the post-natal period
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23
Q

Recall 4 aspects of a FHx that must be addressed as part of an obstetric history

A
  1. Multiple pregnancy
  2. Diabetes
  3. Hypertension
  4. Chromosomal or congenital malformations
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24
Q

Briefly describe the palpable points in each of the possible foetal lie positions (3)

A
  1. Longitudinal - Foetal head or breech palpable over the pelvic breach
  2. Oblique - Head or breach is palpable in the iliac fossa and nothing is felt in the lower uterus
  3. Transverse - Foetal poles felt in the flanks and nothing above the brim
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25
Q

Outline the course of the sacrospinous ligament

A

Extends from the lateral margin of of the sacrum and coccyx to the ischial spine

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26
Q

Outline the course of the sacrotuberous ligament

A

Extends from the sacrum to the ischial tuberosity

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27
Q

What are the 4 basic shapes/ variations of the female pelvis?

A
  1. Gynaecoid (50%)
  2. Anthropoid (25%)
  3. Android (20%)
  4. Platypolloid (5%)
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28
Q

Outline and name the 4 suture connecting the bones of the foetal skull

A
  1. Coronal suture - separates the frontal and parietal bones
  2. Sagittal suture - separate the 2 parietal bones
  3. Lambdoid suture - separates the occipital bone from the parietal bones
  4. Frontal suture - separates the 2 frontal bones
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29
Q

Which sutures make up the anterior and posterior fontanelle respectively?

A
  1. Anterior - Coronal and sagittal sutures

2. Posterior - Sagittal and lambdoid sutures

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30
Q

When do beta-HCG levels peak during pregnancy?

A

~ 3 months gestation

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31
Q

Give 3 changes to the physiology of respiration that occur during pregnancy

A
  1. Diaphragmatic breathing
  2. Relative hyperventilation
  3. Increased tidal volume
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32
Q

Outline 3 normal cardiovascular changes that occur during pregnancy

A
  1. Increased cardiac output
  2. Reduced systemic vascular resistance
  3. Reduction in BP
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33
Q

Why is anemia common during normal pregnancy?

A

There is a comparatively much greater increase in plasma volume compared to RBC volume in the vascular system of the mother

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34
Q

Describe 3 haematological changes that occur during normal pregnancy

A
  1. Increased plasma volume (40%)
  2. Increased red cell volume (25%)
  3. Hypercoagulative state due to an increase in clotting factors
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35
Q

What causes the higher incidence of reflux disease in pregnancy?

A

Increasing levels of progesterone act as a muscle relaxant on the muscle of the oesophagus

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36
Q

What 5 tests will be carried out on blood samples taken at a pregnancy booking appointment?

A
  1. Haemoglobin
  2. Platelets
  3. Infections e.g. HIV, syphilis and Hep B
  4. Blood group and antibody status
  5. Sickle cell and thalassaemia

NB. Ideally done <10wks into pregnancy (8-12wks)

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37
Q

When can the ‘quad test’ be carried out and what biomarkers are assessed with this blood test?

A

Can be performed between 14 and 20 weeks gestation. The following biomarkers are assessed:

  1. AFP
  2. Inhibin A
  3. Oestradiol
  4. Beta-HCG
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38
Q

Give 6 risk factors associated with the development of gestational diabetes

A
  1. BMI > 30
  2. Certain ethnic groups: Black African, Indian
  3. FHx of 1st degree relative with gestational diabetes
  4. Polycstic ovarian syndrome
  5. Previous baby >4.5 kg at delivery
  6. Previous gestational diabetes
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39
Q

If gestational diabetes is suspected/ the mother is identified at high risk, at what stage of the pregnancy would a glucose tolerance test be offered?

A

Between 26-28 weeks

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40
Q

Suggest 7 ‘sensitising events’ which may occur in Rhesus negative women

A
  1. Spontaneous miscarriage
  2. Termination of pregnancy
  3. Invasive procedures
  4. Traumatic events
  5. Placental abruption
  6. Foeto-maternal haemorrhage
  7. Blood transfusions
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41
Q

What is the dose of ‘prophylactic anti-D’ administered to women + when is it administered?

A

Given at 28 wks - 1500 iu dose

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42
Q

The ‘combined test’ tests for which genetic abnormalities?

A
  1. Down’s syndrome - trisomy 21
  2. Edward syndrome - trisomy 18
  3. Patau syndrome - trisomy 13
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43
Q

Newborn blood spots screen should ideally occur when?

A

Day 5 post birth

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44
Q

What is the definition of maternal death?

A

Death whilst pregnant or within 42 days of birth

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45
Q

Give 3 reasons for the increasing incidence of pre-existing disorders of pregnancy

A
  1. Better management of medical disorders
  2. Higher reproductive expectations
  3. Increasing maternal age
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46
Q

Maternal hypertension is associated with which foetal risk

A

Poor growth

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47
Q

Give 2 disease processes which are known to improve during pregnancy?

A
  1. Rheumatoid arthritis

2. Multiple sclerosis

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48
Q

What value is diagnostic for gestational diabetes? (2)

A

Fasting glucose ≥ 5.6mmol/L

OR

2 hour glucose ≥ 7.8mmol/L

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49
Q

Antenatal anti Xa monitoring can be used for the monitoring thrombophilia associated VTE in pregnancy. What levels should be aimed for?

A

NB/ Test that does not use exogenous antithrombin should be used
Should aim for 4 hourly peak levels of 0.5-1 iu/ml

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50
Q

Outline the 5 principle characteristic features of a warfarin embryopathy

A
  1. Hypoplasia of the nasal bridge
  2. Congenital heart defects
  3. Ventriculomegaly
  4. Agenesis of the corpus callosum
  5. Stippled epiphyses
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51
Q

Give 5 complications associated with continued warfarin therapy during pregnancy

A
  1. Warfarin embryopathy
  2. Spontaneous miscarriage
  3. Stillbrith
  4. Neurological problems in the baby
  5. Foetal and maternal haemorrhage
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52
Q

Can warfarin be used by breastfeeding mothers?

A

Yes. Though requires monitoring due to increased risk of postpartum haemorrhage

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53
Q

Give 3 examples of heritable thrombophilias

A

Deficiency in:

  1. Antithrombin
  2. Protein C
  3. Protein S
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54
Q

Give 3 examples of anti-phospholipid antibodies

A
  1. Lupus anticoagulant
  2. Anticardiolipin
  3. Beta-2-Glycoprotein-1 antibodies
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55
Q

Give 3 risk factors for VTE that can present in the 1st trimester of pregnancy

A
  1. Hyperemesis
  2. Ovarian hyperstimulation syndrome
  3. IVF pregnancy
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56
Q

What agents should be used for antenatal and postnatal VTE prophylaxis?

A

LMWH

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57
Q

When is it necessary to monitor the platelet count in women on VTE prophylaxis?

A

If they have a Hx of prior exposure to unfractionated heparin

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58
Q

If unfractionated heparin is used after caesarian section, for what period of time should the platelet count be monitored for?

A

Every 2-3 days from days 4-14 or until the heparin is stopped

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59
Q

Why should dextran be avoided antenatally and intrapartum?

A

Risk of anaphylactoid reaction

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60
Q

Are NOAC’s currently recommend for use when breastfeeding?

A

No + they should be avoided in pregnant women

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61
Q

Name 4 disorders that increase the risk of pre-eclampsia during pregnancy

A
  1. Diabetes
  2. Hypertension
  3. Renal disease
  4. SLE
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62
Q

Why is Propylthiouracil contra-indicated in pregnancy?

A

Associated with severe liver disease in some pregnancies

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63
Q

What is the ‘safest’ epileptic drug for women of childbearing age?

A

Lamotrigine - however does still have an association with an increased incidence of congenital malformations

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64
Q

Is trimethoprim contra-indicated in pregnancy?

A

Contraindicated in the 1st trimester as it interferes with the folic acid pathway. Considered safe to use in later pregnancy

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65
Q

Why are NSAIDS contraindicated in most pregnancies?

A

Increased risk of Oligohydramnios and premature closure of the foetal ductus arteriosus

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66
Q

What risk is associated with the continued use of SSRI’s during pregnancy?

A

If taken during the 1st trimester there is an increased risk of congenital heart defects in the foetus

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67
Q

When should Nitrofurantoin be avoided during pregnancy?

A

At term >36/40 due to association with haemolytic anemia

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68
Q

Why is carbimazole contraindicated in pregnancy?

A

Associated with aplasia cutis if taken in the 1st trimester of pregnancy

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69
Q

Why are ACE inhibitors contraindicated during pregnancy?

A

Avoided in second and third trimester due to increased risk of foetal renal damage

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70
Q

What are the target blood sugar levels aimed for during pregnancy for women with diabetes?

A

Fasting - 3.5-5.5. mmol/L

Post meal - < 7.1. mmol/L

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71
Q

Give 7 risk factors associated with an increased risk of shoulder dystocia

A
  1. Macrosomia
  2. Diabetes in pregnancy
  3. Previous shoulder dystocia
  4. Raised BMI
  5. Induction of labour
  6. Epidural
  7. Instrumental delivery
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72
Q

What is the main risks associated with a LSCS prior to 39/40? (2)

A

Increased incidence of ARDS in neonate + higher rates of admission to NICU

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73
Q

Outline 6 pregnancy risks associated with obesity

A
  1. Miscarriage
  2. Congenital malformations
  3. PET
  4. GDM
  5. Macrosomia
  6. VTE
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74
Q

Outline the 3 components of the pathophysiology of diabetes in pregnancy

A
  1. Increased insulin resistance
  2. Reduced glucose tolerance
  3. Reduced renal tubular threshold for glucose
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75
Q

Give 3 effects of pregnancy on a patient’s pre-existing diabetes

A
  1. Increasing doses of insulin will be required throughout the pregnancy
  2. Worsening nephropathy and/or retinopathy
  3. Increase in hypoglycaemic attacks
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76
Q

What is the pathopneumonic congenital malformation associated with diabetes during pregnancy?

A

Sacral agenesis

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77
Q

What is the Pederon Hypothesis?

A

Effect of diabetes on pregnancy:
Maternal hyperglycaemia leads to foetal hyperglycaemia.
This causes elevated insulin levels in the foetal bloodstream which serves to accelerate growth and lead to macrosomia

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78
Q

What is the clinical consequence of macrosomia in a foetus?

A

Can lead to polyhydramnios which in turn can lead to preterm labour or cord prolapse

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79
Q

What is polyhydramnios?

A

Excessive accumulation of amniotic fluid during pregnancy

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80
Q

Give 4 complications of pregnancy associated with macrosomia?

A
  1. Induction of labour
  2. Dysfunctional labour
  3. Shoulder dystocia
  4. PPH
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81
Q

Recall the four T’s pneumonic for the 4 most common causes of PPH (Post Partum Haemorrhage)

A
  1. Tone - uterine atony
  2. Trauma - laceration, inversion,
  3. Tissue - Retained tissue or invasive placenta
  4. Thrombin - coagulopathy
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82
Q

For women with pre-existing diabetes, how is the increased risk of preeclampsia managed during pregnancy?

A

Aspirin 75 mg once daily - should be started before 12 weeks and continued throughout the pregnancy

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83
Q

What delivery advice should be given to mothers with pre-existing diabetes?

A

Should be offered elective delivery by 37-38+6

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84
Q

How does the EFW (estimated foetal weight) influence the consideration of an elective LSCS?

A

Women with diabetes - EFW > 4.5kg consider elective LSCS. Non diabetic pregnancies the EFW should be > 5kg

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85
Q

Babies of diabetic mothers should have their blood sugars checked how frequently after delivery?

A

Baby should be fed within 30 minutes of birth and then BM checked 2-4 hours after birth. This should be repeated until pre-meal BMs are maintained at 2 mmol/L or more

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86
Q

In an uncomplicated diabetic pregnancy, how often should serial scans be performed?

A

Every 4 weeks, from 28 weeks

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87
Q

What is the most common cause of anemia in pregnancy?

A

Iron deficiency

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88
Q

How is anemia defined during pregnancy and postpartum?

A

First trimester - Hb < 110 g/L
Second and third trimesters - Hb < 105 g/L
Postpartum - Hb <100 g/L

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89
Q

What is the APGAR score?

A 
A quick test to assess the health of an infant. The components of the assessment are:
A - Appearance 
P - Pulse 
G - Grimace 
A - Activity 
R - Respiration
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90
Q

What is the RDA for iron intake in the later stages of pregnancy?

A

27 mg per day

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91
Q

Give 4 contraindications to IV iron therapy

A
  1. History of anaphylaxis/ serious adverse reactions
  2. 1st trimester of pregnancy
  3. Active acute or chronic bacteraemia
  4. Decompensated liver disease
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92
Q

When should IV iron be considered as a therapy when a pregnant women presents with anemia?

A

Women who present after 34 week gestation with a confirmed iron deficiency anemia and a Hb <100 g/L

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93
Q

What medication + dose is used in the 3rd stage of labour as a prophylactic agent for PPH when delivering vaginally?

A

Oxytocin 10 iu by intramuscular injection

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94
Q

What is the dose and purpose of administration of Oxytocin to women delivering by caesarian section?

A

Dose: 5 iu by slow IV injection
Purpose: Used to encourage contraction of the uterus and to decrease blood loss

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95
Q

For a women delivering by caesarian section who is at increased risk of PPH, what is the pharmacological management?

A
  1. Oxytocin - 5 iu IV

2. Tranexamic acid - 0.5-1 g IV

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96
Q

Is Nifedipine a uterine stimulant or relaxant?

A

Relaxant

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97
Q

Is Turbutaline a uterine stimulant or relaxant?

A

Relaxant

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98
Q

Is Atosiban a uterine stimulant or relaxant?

A

Relaxant

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99
Q

Is Prostin a uterine stimulant or relaxant?

A

Stimulant

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100
Q

Is indomethacin a uterine stimulant or relaxant?

A

Relaxant

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101
Q

Is magnesium a uterine stimulant or relaxant?

A

Relaxant

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102
Q

What is the difference between pregnancy induced hypertension and pre-eclampsia?

A

Pre-eclampsia is defined as proteinuria in addition to hypertension, where as there is no proteinuria associated with pregnancy induced hypertension

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103
Q

What is the definition of Pre-eclampsia?

A

Hypertension after 20 weeks of pregnancy with associated proteinuria

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104
Q

How is pre-eclampsia diagnosed clinically?

A

> 140/90 BP readings on two separate occasions at least 4 hours apart
In addition to:
Proteinuria >300mg/ 24 hrs or >30mg/mmol on spot test protein/creatine ratio

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105
Q

Give 5 risk factors for the development of pre-eclampsia during pregnancy?

A
  1. First pregnancy
  2. Previous pre-eclampsia
  3. > 40 years of age
  4. > 35 BMI
  5. Multiple pregnancy
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106
Q

Name 3 anti-hypertensives that can be used in the acute treatment/ management of pre-eclampsia

A
  1. Labetalol
  2. Nifedipine
  3. Hydrallazine
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107
Q

Name the medication used to prevent ‘fits’ in pre-eclampsia

A

Magnesium sulphate

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108
Q

What are the 3 clinical components of HELLP syndrome seen in severe cases of pre-eclampsia

A
  1. Haemolysis
  2. Elevated liver enzymes
  3. Low platelets
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109
Q

Define the term: ‘small for gestational age’

A

A foetus that is born with a birth weight less than the 10 centile on an infant growth chart

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110
Q

Define the term: ‘Foetal growth restriction’

A

Failure of the foetus to reach its pre-determined growth potential due to pathology

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111
Q

Suggest 3 potential causes of impaired maternal oxygen carrying

A
  1. Heart disease
  2. Smoking
  3. Haemoglobinopathies
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112
Q

Suggest 3 potential causes of maternal vascular disease

A
  1. Pre-existing hypertension
  2. Diabetes
  3. Autoimmune disorders
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113
Q

Suggest 4 potential causes of placental damage

A
  1. Smoking
  2. Thrombophilia
  3. PET
  4. Autoimmune diseases
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114
Q

Give 4 recognised long term implications for a foetus born small for gestational age

A
  1. Learning difficulties
  2. Failure to thrive and short stature
  3. Cerebral palsy
  4. Type 2 diabetes
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115
Q

Give 3 complications associated with premature birth

A
  1. Necrotising enterocolitis
  2. HIE and associated sequelae
  3. Chronic lung disease
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116
Q

What 3 measurements are used to estimate a foetal weight from a USS?

A
  1. Abdominal circumference
  2. Head circumference
  3. Femur length
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117
Q

What calculation is used to produce an EFW (estmiated foetal weight)?

A

Hadlock calculation

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118
Q

Recall the components of the APGAR scoring system

A 
A - Appearance 
P - Pulse 
G - Grimace
A - Activity
R - Respiration
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119
Q

Recall the different scores available for the ‘appearance’ section of the APGAR scoring system

A

0 - Blue/ Pale
1 - Acrocyanosis
2 - Pink

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120
Q

Recall the different scores available for the ‘ Pulse ‘ section of the APGAR scoring system

A

1 - < 100 bpm

2 - > 100 bpm

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121
Q

Recall the different scores available for the ‘grimace’ section of the APGAR scoring system

A

0 - Absent
1 - Feeble
2 - Strong cry

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122
Q

Recall the different scores available for the ‘activity’ section of the APGAR scoring system

A

0 - Absent
1 - Some flexion
2 - Full movement

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123
Q

Recall the different scores available for the ‘ respiration’ section of the APGAR scoring system

A

0 - Absent
1 - Weak
2 - Strong

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124
Q

What is the classic triad of symptoms associated with pre-eclampsia?

A
  1. Hypertension
  2. Proteinuria
  3. Oedema
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125
Q

What is the first line pharmacological treatment for moderate to severe hypertension in pregnancy?

A

Labetalol

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126
Q

For women with moderate to severe hypertension during pregnancy, what are the NICE targets for systolic and diastolic blood pressure control?

A

Systolic - < 150 mmHg

Diastolic - 80-100 mmHg

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127
Q

What is the treatment dose of magnesium sulphate used in the management of severe pre-eclampsia?

A

Loading dose of 4g IV over 5 minutes followed by an infusion of 1g/hr over 24 hrs

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128
Q

What is the most commonly used opioid for labour analgesia?

A

Pethidine - Meperidine

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129
Q

Give 3 signs of magnesium toxicity

A
  1. Loss of tendon reflexes (due to neuromuscular blockade)
  2. Respiratory depression
  3. Cardiac arrest
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130
Q

What is synctocinon?

A

Synthetic oxytocin

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131
Q

After birth APGAR scores should be taken (at least) at which 3 intervals?

A
  1. 1 minute
  2. 5 minutes
  3. 10 minutes
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132
Q

What is the ‘normal’ BP cut off in pregnancy?

A

< 140/90

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133
Q

During pregnancy spinal arteries undergo remodelling to become what?

A

High capacitance, low resistance vessels

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134
Q

Pelvic ultrasound should be offered to any women with HMB and any one of which other criteria? (3)

A
  1. Uterus palpable on abdominal examination
  2. Hx or exam suggestive of a pelvic mass
  3. Inconclusive or difficult physical examination in patients who are obese
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135
Q

What are the 3 indications for ulipristal acetate listed in the BNF?

A
  1. Pre-operative treatment of moderate to severe symptoms of uterine fibroids
  2. Intermittent treatment of moderate to severe uterine fibroids
  3. Emergency contraception
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136
Q

Give 2 non-hormonal treatment options for fibroids >3cm in diameter

A
  1. NSAIDS

2. Tranexamic acid

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137
Q

Give 4 hormonal pharmacological options for the treatment of fibroids >3cm in diameter

A
  1. Ulipristal acetate
  2. LNG-IUS
  3. Combined hormonal contraception
  4. Cyclical oral progestogens
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138
Q

Which form of contraception can result in heavier periods?

A

Copper coil

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139
Q

Recall 6 factors that must be addressed when taking a Hx from a women with abnormal vaginal bleeding

A
  1. The women’s age
  2. Bleeding regularity
  3. Other symptoms that may be associated with fibroids
  4. PMH i.e. bleeding disorders, thyroid dysfunction
  5. Detailed medication Hx including forms of contraception
  6. Any family hx of coagulation disorders
140
Q

Give 6 red flag symptoms that would warrant a 2 week wait referral from an assessment of a women presenting with menstrual dysfunction

A
  1. Age >45 years
  2. Intermenstrual bleeding
  3. Postcoital bleeding
  4. Postmenopausal bleeding
  5. Abnormal examination findings e.g. pelvic mass or lesion on cervix
  6. Treatment failure after 3 months
141
Q

Peaking levels of which hormone result in ovulation?

A

Luteinising hormone

142
Q

What is the most common cause of ovulatory dysfunction seen in women of reproductive age?

A

PCOS - Polycystic ovarian syndrome

143
Q

What is the most common indication for hysterectomy?

A

Fibroids

144
Q

What are the 3 main histological types of fibroids?

A
  1. Intramural
  2. Subserosal
  3. Submucosal
145
Q

Give an example of a GnRH agonist

A

Gonadorelin

146
Q

Give an example of a prostaglandin synthetase inhibitor

A

Indomethacin

147
Q

What is first line treatment for menorrhagia according to NICE guidelines?

A

Mirena IUD

148
Q

What is the diagnostic tool of choice for a tubal ectopic pregnancy?

A

Transvaginal ultrasound

149
Q

What is a caesarian scar pregnancy?

A

An ectopic pregnancy implanted in the myometrium at the site of a previous caesarian section scar

150
Q

What is a heterotopic pregnancy?

A

Rare complication of pregnancy in which both an extra-uterine and intra-uterine pregnancy occur simultaneously

151
Q

Name 4 ‘fertility reduction factors’

A
  1. Previous ectopic pregnancy
  2. Contralateral tubal damage
  3. Previous abdominal surgery
  4. Previous pelvic inflammatory disease
152
Q

When should a women have her blood group and antibody status checked during pregnancy?

A
  1. At booking appointment

2. 28 weeks gestation

153
Q

Briefly outline the pathophysiology of placenta praevia

A

Condition occurs when the baby’s placenta partially or totally covers the mother’s cervix. This can lead to extensive bleeding throughout pregnancy and during birth.

154
Q

Recall the specification for transfusion of red cells during pregnancy

A

Compatible:

  1. ABO -
  2. Rhesus D -
  3. K - (Kell - )
155
Q

What is the ratio of FFP to red cells that should be administered during a major obstetric haemorrhage?

A

12-15 mls/ kg FFP should be administered for every 6 units of red cells

156
Q

When should platelets be administered when managing an obstetric haemorrhage?

A

Consider transfusion at 75 10^9/l as you should aim to keep the platelet count above 5010^9/ml during active bleeding

157
Q

What additional test should be carried out in women of reproductive age presenting to A+E with ? PE ?

A

FAST scan to rule out intra-abdominal bleeding from a ruptured ectopic pregnancy before any thrombolysis is given

158
Q

After what time frame do the symptoms of an ectopic pregnancy usually begin to manifest?

A

~ 6-8 weeks after the last menstrual period

159
Q

What are the 3 most commonly reported symptoms associated with an ectopic pregnancy?

A
  1. Abdominal and/ or pelvic pain
  2. Amenorrhea
  3. Vaginal bleeding
160
Q

What percentage of ectopic pregnancies are thought to be completely asymptomatic?

A

~ 7%

161
Q

Define the term miscarriage

A

Loss of an intrauterine pregnancy < 24 weeks gestation

162
Q

What is the difference between an early and late miscarriage?

A

Early - Pregnancy loss before 12 weeks gestations

Late - Pregnancy loss between 12-24 weeks gestation

163
Q

Suggest 4 infections which may lead to miscarriage

A
  1. Listeria
  2. Toxoplasmosis
  3. Varicella zoster virus
  4. Malaria
164
Q

What is the leading cause of miscarriage, accounting for ~ 50% of cases?

A

Chromosomal abnormalities

165
Q

What are the 2 criteria required for a diagnosis of a miscarriage?

A
  1. Crown-Rump length of embryo at least 7mm with no foetal heart action
  2. Mean sac diameter of 25 mm gestational sac with no yolk sac or embryo present
166
Q

Define the term ‘threatened miscarriage’

A

Women presenting with vaginal bleeding in addition to a confirmed pregnancy/ positive pregnancy test

167
Q

Define the term ‘Inevitable miscarriage’

A

Cervix of a pregnant women is visibly open on speculum examination - this suggests a miscarriage is imminent

168
Q

What is the most common location for an ectopic pregnancy?

A

Fallopian tube - Ampulla

169
Q

Give 5 risk factors associated with an increased incidence of ectopic pregnancy

A
  1. Previous PID
  2. Smoking
  3. Prior tubal surgery
  4. Hx of infertility
  5. Assisted reproductive techniques
170
Q

Why does pain from ectopic pregnancy usually present around 6-7 weeks gestation?

A

Trophoblastic tissue has grown to a sufficient size to begin to stretch the fallopian tube in which it is embedded.

171
Q

What level of progesterone is associated with a failing pregnancy?

A

< 20 nmol/L

172
Q

What is the average risk of recurrence for an ectopic pregnancy?

A

~10%

173
Q

For a women with a Hx of ectopic pregnancy, what additional scan should be offered?

A

Scan at 7 weeks to ensure the pregnancy is intrauterine

174
Q

What is the most common cause of abnormal vaginal discharge?

A

Bacterial vaginosis

175
Q

Give 2 infective causes of abnormal vaginal discharge in women of reproductive age

A
  1. Bacterial vaginosis

2. Candida

176
Q

Give 3 sexually transmitted infections that can result in abnormal vaginal discharge in women of reproductive age

A
  1. Chlamydia
  2. Gonorrhoea
  3. Trichomonas vaginalis
177
Q

What is the normal vaginal pH?

A

<4.5

178
Q

What are the 4 most common categories of pathogen implicated in pelvic inflammatory disease

A
  1. Neisseria gonorrhoea
  2. Chlamydia trachomatis
  3. Mixed anaerobes
  4. Enteric organisms
179
Q

Name 6 risk factors of pelvic inflammatory disease

A
  1. Previous episode of PID
  2. Multiple partners
  3. Sexual intercourse during menses
  4. Vaginal douching
  5. Bacterial vaginosis
  6. Intrauterine device
180
Q

Give 4 clinical signs associated with pelvic inflammatory disease

A
  1. Pyrexia >38 degrees
  2. Bilateral lower abdominal tenderness (sometimes radiating to the legs)
  3. Adnexal tenderness on bimanual examination
  4. Cervical excitation on vaginal examination
181
Q

Suggest 6 differential diagnoses for pelvic inflammatory disease

A
  1. Ectopic pregnancy
  2. Acute appendicitis
  3. Endometriosis
  4. Irritable bowel syndrome
  5. Complications of an ovarian cyst
  6. Urinary tract infection
182
Q

Cervical screening in England is available to women of what age range?

A

25-64

183
Q

What is the CIN classification used for?

A

Used to categorise the degree of cervical dysplasia i.e. potentially pre cancerous abnormal growth of cells on the surface of the cervix

184
Q

What are the cytoplasmic diameter ratios that define the different grades of dyskaryosis of the cervix?

A

<50% - Low grade dyskaryosis
Between 50-75 % - High grade (moderate)
> 75% - High grade (severe)

185
Q

Roughly what proportion of women are expected to have an abnormal smear result?

A

1 in 20

186
Q

What is the procedure known as LLETZ?

A

Stands for: Large loop excision of the transformation zone (of the cervix). Usually performed under local anaesthetic.

187
Q

Which laboratory tests are performed on a high vaginal swab sample?

A

Microscopy, sensitivity and culture

188
Q

A routine cervical smear reported as HPV positive with normal cytology should have a follow up smear after how long?

A

Repeat smear in 12 months

189
Q

How does oestrogen prepare the uterus for parturition?

A

Increases number of oxytocin receptors during gestation to better facilitate contraction at term

190
Q

What are the 3 main affects of cortisol on the placenta?

A
  1. Decreases release of progesterone
  2. Decreases release of oestrogen
  3. Increases release of prostaglandins
191
Q

What are the 2 main functions of oxytocin during parturition?

A
  1. Stimulates uterine contraction

2. Increases release of prostaglandins

192
Q

What 3 markers are assessed as part of the ‘combined test’ for Down’s syndrome

A
  1. Nuchal translucency
  2. Beta human chorionic gonadotrophin
  3. Pregnancy associated plasma protein A
193
Q

What is external cephalic version?

A

Manual procedure by which a baby presenting in a breach position can be turned from feet first to head first in order to facilitate a normal vaginal delivery

194
Q

An emergency Caesarian section is required by roughly what proportion of women planning a vaginal breech birth?

A

~40%

195
Q

Suggest 5 circumstances in which a vaginal breech birth would carry significant additional risk

A
  1. Hyperextended neck on ultrasound
  2. High estimated foetal weight (more than 3.8 kg)
  3. Low estimated weight (less than tenth centile)
  4. Footling presentation
  5. Evidence of antenatal foetal compromise
196
Q

What is a footling presentation?

A

Breech presentation in which one or both feet enter the birth canal first

197
Q

What length gestation is referred to as ‘full term’ ?

A

37-42 weeks

198
Q

What is the primary reasons for transfer to an obstetric unit from another planned place of birth?

A

Delays during first or second stages of labour

199
Q

What are Braxton-Hicks contractions?

A

Sporadic contraction and relaxation of the uterine muscle - previously referred to as prodromal/ ‘false’ labour pains

200
Q

Give contraindication to artificial rupture of membranes during parturition

A
  1. Breech position

2. Placental previa

201
Q

Define premature rupture of membranes

A

Rupture of the amniotic sac before 37 weeks gestation

202
Q

What marks the transition from the latent to active phase of the first stage of labour?

A

Dilatation of the cervix >3cm

203
Q

Give 2 examples of neural tube defects that are associated with folic acid insufficiency during pregnancy

A
  1. Anencephaly

2. Spina Bifida

204
Q

What is the significance of Vitamin A during pregnancy?

A

Supplementation or excessive consumption ( > 700ug ) is recognised as potentially teratogenic and thus is not advised during pregnancy

205
Q

Give 4 potential complications of abnormal progression of labour

A
  1. Obstructed labour
  2. Dehydration
  3. Exhaustion
  4. Rupture of the uterus
206
Q

What are the 3 clinical indications of poor progression of labour?

A
  1. Delay in cervical dilatation ( <2cm in a 4 hour period) or descent of the presenting part of the foetus
  2. Signs of foetal compromise
  3. Foetal malpresentation, multiple gestations or uterine scars
207
Q

Recall 5 causes of abnormal labour

A
  1. Dysfunctional uterine activity
  2. Cephalopelvic disproportion
  3. Malpresentations
  4. Abnormality of the birth canal
  5. Foetal compromise
208
Q

Recall the ‘3 P’s ‘ that describe the dependent variables of labour

A
  1. Powers - efficacy of uterine muscle contraction
  2. Passenger - size of the foetus as well as its presentation and position
  3. Passage - Anatomy of the uterus, cervix and bony pelvis
209
Q

What is the principle clinical feature associated with foetal compromise?

A

Thick/ tenacious meconium staining of the amniotic fluid that is either dark green, bright green or black

210
Q

What is placenta accreta?

A

Complication of pregnancy in which the placenta grows too deeply into the uterine wall. This results in significant blood loss and difficulty passing the placenta in the third stage of labour

211
Q

Name 2 hormones that can increase the risk of uterine rupture

A
  1. Oxytocin - in a multiparous mother

2. Prostacyclin

212
Q

Define a complete uterine rupture

A

Direct communication of the uterine cavity and the peritoneal cavity

213
Q

Define an incomplete uterine rupture

A

Uterine cavity is separated from the peritoneal cavity by a thin layer of peritoneum

214
Q

Define primary postpartum haemorrhage

A

> 500mls blood loss within 24hrs of delivery

215
Q

Define secondary postpartum haemorrhage

A

Any significant blood loss between 24 hrs and 6 weeks post delivery

216
Q

What are the 3 components of the clinical assessment of a patient with a postpartum haemorrhage?

A
  1. Pulse, BP and Temp recordings
  2. Palpation of the uterus for tenderness
  3. Endocervical swab sent for MC and S
217
Q

Define ‘retained placenta’

A

Failure to deliver placenta with 30 minutes of foetus

218
Q

What are the 3 components of the clinical management of uterine atony?

A
  1. Abdominal massage/ bi-manual compression
  2. B-Lynch sutures
  3. Administer synctocinon IV 30 iu (uterotonic)
219
Q

Define placenta accreta, increta and percreta respectively

A

Accreta - Invasion of the myometrium but does not penetrate the entire thickness
Increta - Further penetration but not entire thickness
Percreta - Entire penetration of the myometrium

220
Q

What is uterine inversion during labour?

A

Fundus of the uterus descends through the cervix during the 3rd stage of labour due to traction on the cord before the placenta has separated

221
Q

Briefly describe the pathophysiology of an amniotic fluid embolism?

A

Amniotic fluid enters the maternal circulation causing acute cardiorespiratory compromise and DIC

222
Q

Give 5 indications for an emergency C-Section

A
  1. Cord prolapse
  2. Failure to progress
  3. Foetal distress in the 1st stage of labour
  4. Antepartum haemorrhage
  5. Transverse lie in labour
223
Q

What is the transverse incision of choice for an emergency C-section?

A

Joel Cohen incision

224
Q

What are the specifications of a Joel Cohen incision?

A

Straight skin incision, 3cm above the symphysis pubis

225
Q

What are the 7 stages of birth for a foetus during delivery?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
  7. Expulsion
226
Q

Define ‘engagement ‘ of the feotus’ head

A

If 2/5 of the foetal head is palpable above the pelvic brim then the head is said to be engaged

227
Q

Suggest 6 risk factors for malpresentation

A
  1. Prematurity
  2. Multiple pregnancy
  3. Abnormalities of the uterus e.g. fibroids
  4. Partial septate uterus
  5. Abnormal foetus
  6. Placenta praevia
228
Q

What are the functions of the hormone relaxin?

A
  1. Loosens the pelvic ligaments
  2. Opens the pelvic outlet by loosening the pubic symphysis
  3. Dilates the cervix during labour
229
Q

What is a charcoal transport swab?

A

An endocervical swab used to test for gonorrhoea

230
Q

Give 4 potential complications of bacterial vaginosis on pregnancy

A
  1. Late miscarriage
  2. PROM
  3. Preterm birth
  4. Post-partum endometritis
231
Q

What are the 3 clinical signs of placental separation?

A
  1. Uterus should be well contracted
  2. Lengthening of the cord
  3. Small trickle of blood observable
232
Q

What is the definition of shoulder dystocia?

A

Vaginal cephalic delivery that requires additional obstetric manoeuvres to deliver the foetus after the head has delivered and gentle traction has failed

233
Q

Recall 4 potential clinical signs of shoulder dystocia that should routinely be observed for

A
  1. Difficulty with delivery of the face and chin
  2. The head remaining tightly applied to the vulva or retracting (turtle-neck sign)
  3. Failure of restitution of the foetal head
  4. Failure of shoulders to descend
234
Q

What is the first intervention that should be tried in the event of shoulder dystocia during parturition?

A

McRobert’s Manoeuvre

235
Q

What are the 2 principle clinical complications associated with shoulder dystocia?

A
  1. Post Partum Haemorrhage

2. Third and Fourth degree perineal tears

236
Q

Differentiate between the types of perineal tear

A

First degree - small tears in the skin that usually heal quickly without treatment
Second degree - affects the muscle of the perineum and the skin; usually requires stitches
Third and Fourth degree - Tears extend deeper into the muscle and affect the muscles of the anal sphincter; requires surgical repair

237
Q

What is trichomonas vaginalis?

A

Flagellated protozoan - mostly seen as a sexual transmitted infection

238
Q

Suggest 4 potential causes of ascending cervical infection which may lead to pelvic inflammatory disease

A
  1. Endometritis
  2. Salpingitis
  3. Oophritis
  4. Tubo-ovarian abscess
239
Q

What volume of blood loss constitutes ‘significant blood loss’ in vaginal delivery and caesarian section respectively?

A

Vaginal delivery > 500mls

Caesarian Section > 1000mls

240
Q

What is the predominant cause of postpartum haemorrhage?

A

Uterine atony

241
Q

What physiological changes marks the start of labour?

A

Cervical dilation and effacement

242
Q

What is the correct order for the cardinal foetal movements during labour?

A
  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. External rotation
  7. Expulsion
243
Q

What are the 3 main components of the active management of the third stage of labour?

A
  1. Cutting the umbilical cord
  2. Controlled cord traction
  3. Oxytocin IM
244
Q

What are the 4 general categories of the causes of pre-term labour?

A
  1. Uterine bleeding
  2. Stretching of the uterus
  3. Bacteria or inflammation
  4. Physical or psychological stress
245
Q

Suggest 2 causes of uterine bleeding which may trigger preterm labour

A
  1. Placenta previa

2. Placental abruption

246
Q

Recall 2 tests which may potentially be helpful in predicting the risk of preterm delivery

A
  1. Cervical length

2. Foetal fibronectin

247
Q

What cervical length is considered predictive of an increased risk of preterm labour?

A

Cervix <20mm measured by transvaginal ultrasound in the second trimester of pregnancy

248
Q

Give 3 examples of tocolytic drugs that can be used to stop/slow preterm labour

A
  1. Terbutaline
  2. Nifedipine
  3. Indomethacin
249
Q

Give 3 advantages of glucocorticoid administration to a preterm foetus before delivery

A
  1. Accelerates lung maturation
  2. Promotes production of surfactant in order to keep the alveoli patent
  3. Reduce the risk of intraventricular haemorrhage and other complications
250
Q

What is the most commonly used steroid used to treat an immature foetus before birth?

A

Betamethasone

251
Q

What is the course of progesterone supplementation prescribed to mother’s with a previous Hx of preterm births?

A

Course started between 16 and 26 weeks of pregnancy and continues until 36 weeks

252
Q

Name 5 current conditions/ past conditions which may result in ‘deficient endometrium’

A
  1. Uterine scar
  2. Endometritis
  3. Manual removal of placenta
  4. Curettage
  5. Submucous fibroids
253
Q

What is the Kleihauer test?

A

Blood test used to measure the amount of foetal haemoglobin that has pasted from the foetus to the mother

254
Q

What are the 4 principle stages of early placental development?

A
  1. Pre-implantation
  2. Pre-lacunar
  3. Lacunar
  4. Villous
255
Q

What is the average white cell count in second and third trimesters of pregnancy?

A

6000 to 16000 uL

256
Q

What is the average white cell count during labour?

A

20000 uL

257
Q

Suggest 5 obstetric causes of abdominal pain in pregnancy

A
  1. Preterm labour
  2. Placental abruption
  3. Choriamnionitis
  4. Acute fatty liver of pregnancy
  5. Torsion of the pregnant uterus
258
Q

Suggest 6 potential genito-urinary causes of abdominal pain in pregnancy

A
  1. Acute pyelonephritis
  2. Acute cystitis
  3. Ovarian cyst rupture
  4. Adnexal torsion
  5. Renal stones
  6. Ureteral obstruction
259
Q

Suggest 6 alternative causes of abdominal pain during pregnancy

A
  1. Intraperitoneal haemorrhage
  2. Red degeneration of fibrinoid
  3. Trauma to abdomen
  4. Diabetic ketoacidosis
  5. Splenic rupture
  6. Respiratory disease e.g. pneumonia or PE
260
Q

In what percentage of pregnancies does pre-term labour occur?

A

5-12%

261
Q

What is the value of a negative foetal fibronectin test?

A

Highly predictive (98% predictive value) that the patient is unlikely to go into labour within the next 7-10 days

262
Q

What is the course of Betamethasone used to induce foetal lung maturity?

A

12 mg in 2 doses spaced 24 hrs apart

263
Q

Define Couvelaire uterus

A

Obstetric emergency caused by placental abruption. Bleeding penetrates through the uterine myometrium and into the peritoneal cavity

264
Q

What is the principle risk factor associated with uterine rupture?

A

Previous Hx of C-Section

265
Q

Give 3 risk factors associated with operative vaginal delivery

A
  1. Primiparous women
  2. Supine and lithotomy positions
  3. Epidural anaesthesia
266
Q

Recall the components of DR C BRAVADO for the structured assessment of a CTG

A 
DR- Define risk 
C - Contractions 
BRA - Baseline rate 
V - Variability 
A - Acceleration 
D - Decelerations
O - Overal impression
267
Q

Name 3 maternal medical conditions that may make a pregnancy high risk

A
  1. Gestational diabetes
  2. Hypertension
  3. Asthma
268
Q

Give 8 obstetric complications which make a pregnancy high risk

A
  1. Multiple gestation
  2. Post-date gestation
  3. Previous Caesarian section
  4. Intrauterine growth restriction
  5. Premature rupture of membranes
  6. Congenital malformations
  7. Oxytocin induction/ augmentation of labour
  8. Pre-eclampsia
269
Q

What 2 aspects of CTG contractions should be reported on?

A

Durations and intensity

270
Q

Define foetal tachycardia

A

Baseline heart rate greater than 160 bpm on CTG

271
Q

Suggest 5 potential causes of foetal tachycardia

A
  1. Foetal hypoxia
  2. Chorioamnionitis
  3. Hyperthyroidism
  4. Foetal or maternal anaemia
  5. Foetal tachyarrhythmia
272
Q

Define foetal bradycardia

A

Baseline heart rate less than 100 bpm on CTG

273
Q

Give 2 scenarios in which it is normal to have a foetal baseline heart rate between 100-120 bpm

A
  1. Postdate gestation

2. Occiput posterior or transverse presentations

274
Q

Define severe prolonged foetal bradycardia

A

Baseline heart rate < 80 bpm for more than 3 minutes - indicative of severe hypoxia

275
Q

Suggest 5 possible causes of severe prolonged foetal bradycardia

A
  1. Prolonged cord compression
  2. Cord prolapse
  3. Epidural or spinal anaesthesia
  4. Maternal seizures
  5. Rapid foetal descent
276
Q

What is the normal variation of baseline variability on CTG?

A

5-25 bpm

277
Q

What are the 3 categories of baseline variability used when describing a CTG?

A
  1. Reassuring
  2. Non - reassuring
  3. Abnormal
278
Q

What is the criteria for the ‘reassuring’ category of baseline variability on CTG?

A

Baseline variability of 5-25 bpm

279
Q

What are the criteria for the ‘non-reassuring’ category of baseline variability on CTG?

A

At least one of the following:

  • Less than 5 bpm for between 30 and 50 minutes
  • More than 25 bpm for between 15-25 minutes
280
Q

What are the criteria for the ‘abnormal’ category of baseline variability on CTG?

A

At least one of the following:

  • Less than 5bpm for more than 50 minutes
  • More than 25 bpm for more than 25 minutes
  • Sinusoidal
281
Q

Suggest 6 potential causes of reduced variability on CTG

A
  1. Foetal sleeping ( this should last no longer than 40 minutes)
  2. Foetal acidosis
  3. Foetal tachycardia
  4. Drugs (Benzos, opiates, methyldopa, magnesium sulphate)
  5. Prematurity (<28 weeks)
  6. Congenital heart abnormalities
282
Q

Give 4 drugs which may cause reduced variability on CTG

A
  1. Opiates
  2. Benzodiazepines
  3. Methyldopa
  4. Magnesium sulphate
283
Q

Define ‘acceleration’ on CTG

A

Abrupt increase in the baseline foetal heart rate of greater than 15 bpm for greater than 15 seconds

284
Q

What causes early decelerations of the foetal heart rate?

A

As uterine contractions occur, foetal intracranial pressure temporarily increases which in turn increases vagal tone

285
Q

What is the most common cause of variable decelerations on CTG?

A

Umbilical cord compression

286
Q

What does late deceleration on CTG indicate?

A

Insufficient blood flow to the uterus and/or placenta –> fetal hypoxia + acidosis

287
Q

Suggest 3 potential causes of reduced uteroplacental blood flow

A
  1. Maternal hypotension
  2. Pre-eclampsia
  3. Uterine hyperstimulation
288
Q

Define a prolonged deceleration on CTG

A

A deceleration that lasts more than 3 minutes

289
Q

A sinusoidal CTG pattern indicates one or more of which 3 adverse events?

A
  1. Severe foetal hypoxia
  2. Severe foetal anaemia
  3. Foetal/ maternal haemorrhage
290
Q

When should operative vaginal delivery be abandoned?

A

No evidence of progressive descent with moderate traction during each contraction or where delivery is not imminent following 3 contractions of a correctly applied instrument by an experienced operator

291
Q

Recall 6 different methods of disimpaction of the foetal head from the pelvis

A
  1. Foetal pillow
  2. Use of non-dominant hand
  3. Walking towards anaesthetist
  4. Vaginal disimpaction
  5. Reverse breech extraction
  6. Tocolytics
292
Q

Describe the process of ‘engagement’ of the foetal head during labour

A

Foetal head enters the pelvic inlet in an occipitotransverse position

293
Q

Describe the process of ‘Descent and flexion’ of the foetal head during labour

A

Head descends into the mid-cavity and flexes as the cervix dilates

294
Q

Describe the process of ‘internal rotation’ of the foetal head during labour

A

Foetal head rotates through 90 degrees in the mid-pelvis into a an occipitoanterior position (remaining flexed)

295
Q

What are the 2 criteria that must be satisfied in order to perform an operative vaginal delivery?

A
  1. No more than 1/5 of the foetal head should be palpable abdominally
  2. Leading point of the skull should not be above the ischial spines
296
Q

Define the term sub-fertility

A

Unwanted delay of 2 years in achieving conception despite regular unprotected sexual intercourse

297
Q

What is the role of FSH in the menstrual cycle?

A

Encourages follicular development and alongside LH , stimulates the granulosa cells of the dominant follicle to produced oestrogen

298
Q

Recall the 3 stages of the uterine cycle

A
  1. Menstruation - Day 1-4
  2. Proliferative phase - Day 5-13
  3. Secretory phase - Day 14 - 28
299
Q

Name the most reliable biomarker for estimating ovarian reserve

A

AMH - Anti-Mullerian Hormone

300
Q

A women must have at least 2 of which 3 criteria in order to be diagnosed with polycystic ovarian syndrome?

A
  1. Irregular menses
  2. Evidence of androgen excess (e.g. hirsutism, acne)
  3. Polycystic ovaries
301
Q

Name 2 medications that can be used to induce ovulation in a patient with PCOS

A
  1. Metformin

2. Clomiphene

302
Q

What are the 2 main clinical tests used to assess the patency of the fallopian tubes?

A
  1. Laparoscopy and dye test

2. Hysterosalpingogram

303
Q

Recall 2 mineral deficiencies that have been linked with sub-fertility in women

A
  1. Zinc

2. Magnesium

304
Q

What are the 3 species of chlamydia that cause disease in humans?

A
  1. C.Psittaci
  2. C. Pneumoniae
  3. C. trachomatis
305
Q

What is the most common bacterial STI seen in the UK?

A

Chlamydia

306
Q

Give 4 instances in which an operative vaginal delivery is thought to have a higher incidence of failure

A
  1. Maternal BMI >30
  2. EFW >4 kg or clinically big baby
  3. Occiptio-posterior position
  4. Mid-cavity delivery or when 1/5 foetal head is palpable per abdomen
307
Q

Give 5 major pathogens that have been recognised to cause sepsis in the puerperium

A
  1. Streptococcus pyogenes
  2. E.Coli
  3. Staph. Aureus
  4. Streptococcus pneumoniae
  5. MRSA
308
Q

Give 3 potential medical complications of mastitis

A
  1. Breast abscess
  2. Necrotising fasciitis
  3. Toxic shock syndrome
309
Q

Haemoptysis may be a sign of what form of pneumonia?

A

Pneumococcal pneumonia

310
Q

What are the four Centor criteria for the diagnoses of GAS pharyngitis?

A
  1. Fever
  2. Tonsillar exudate
  3. No cough
  4. Tender anterior cervical lymphadenopathy
311
Q

What is the most likely causative organism for a spinal abscess following spinal anaesthesia?

A

Staph. Aureus

312
Q

Why should NSAIDS be avoided for pain relief in the treatment of sepsis?

A

Impede the ability of polymorphs to fight infection

313
Q

What are the 2 modalities of initial investigation for an ovarian cyst?

A
  1. Serum CA125

2. Transvaginal ultrasound scan

314
Q

What is the RMI scoring tool used for?

A

Risk of Malignancy index - Used to predict the risk that an adnexal mass is malignant

315
Q

What 3 components make up the RMI scoring tool?

A
  1. Transvaginal ultrasound score
  2. Menopausal status
  3. Serum CA125 levels
316
Q

Recall the 5 scoring points on ultrasound when completing an RMI score during the assessment of an adnexal mass

A
  1. Multilocular cysts
  2. Solid areas
  3. Metastases
  4. Ascites
  5. Bilateral lesions
317
Q

What RMU threshold score is used to predict the likelihood of ovarian cancer

A

RMI score > 200 should prompt further management as ovarian cancer is likely

318
Q

What is the most commonly fatal form of gynaecological malignancy in the developed world?

A

Epithelial ovarian cancers

319
Q

Name the 2 most common genetic mutations associated with epithelial ovarian cancers

A
  1. BRCA 1

2. BRCA 2

320
Q

Ovarian carcinomas associated with hereditary BRCA 1 / BRCA 2 mutations are usually of what subtype?

A

High grade serous ovarian carcinomas

321
Q

Women with an uncomplicated pregnancy should be offered induction of labour after what time frame?

A

Beyond 41 weeks gestations in order to reduce the risk of perinatal mortality and the need for caesarian section

322
Q

What modality of parturition is recommend by NICE guidelines for an uncomplicated singleton breech pregnancy at 36 weeks gestation?

A

External cephalic version

323
Q

In women with HIV, Caesarian section should be offered in which 2 circumstances in order to avoid mother to child HIV transmission?

A
  1. Women is not receiving any anti-retroviral therapy

2. Receiving anti-retroviral therapy but viral load > 400 copies per ml

324
Q

What is the effect of HSV infection in the third trimester of pregnancy?

A

The mother should be offered a planned caesarian section in order to reduce the risk of neonatal HSV infection

325
Q

Give 3 risk factors for placenta praevia

A
  1. Previous caesarian section
  2. Assisted reproductive technologies
  3. Maternal smoking
326
Q

Define a low lying placenta

A

Placental edge < 20 mm from the internal os of the cervix

327
Q

What is the clinical consequence of a short cervical length on TVS before 34 weeks gestation? (2)

A
  1. Increased risk of pre-term emergency delivery

2. Massive haemorrhage at caesarian section

328
Q

At what gestation should a pregnant women with a low lying placenta be offered antenatal corticosteroids?

A

Single course therapy between 34-36 weeks gestation

329
Q

What is Bevacizumab ?

A

A monoclonal antibody against vascular endothelial growth factor (VEGF)

330
Q

The levator ani muscle is innervated by which nerve roots?

A

S2, S3 and S4 - as the pudendal nerve

331
Q

What is a rectocele?

A

Prolapse of the posterior vaginal wall

332
Q

What is the standard combination of chemotherapy agents used in the treatment of ovarian cancer? (2)

A
  1. Carboplantin

2. Paclitaxel

333
Q

Name 2 chemotherapeutic agents that act by blocking the action of VEGF in order to prevent angiogenesis

A
  1. Bevacizumab

2. Cediranib

334
Q

Name a PARP inhibitor used in the treatment of ovarian cancer

A

Olaparib

335
Q

What 3 biomarkers should be tested for when investigating the possibility of a germ cell tumour?

A
  1. Lactate dehydrogenase
  2. Alpha- FP
  3. hCG
336
Q

What is the POP-Q examination used for the assessment of?

A

Severity/ degree of organ prolapse

337
Q

Name 4 autosomal dominant genetic conditions that have an association with an increased incidence of gynaecological cancers

A
  1. Lynch syndrome
  2. Cowden syndrome
  3. Peutz-Jeghers syndrome
  4. Li-Fraumeni syndrome
338
Q

Which 3 anatomical structures make up the pelvic floor?

A
  1. Pelvic diaphragm
  2. Perineal membrane
  3. Deep perineal pouch
339
Q

Name the 3 collections of muscle fibres that make up the levator ani

A
  1. Pubococcygeus
  2. Puborectalis
  3. Iliococcygeus
340
Q

What is the most frequently offered surgical treatment for stress urinary incontinence?

A

Midurethral sling

341
Q

Give 6 Risk factors associated with an abnormal foetal lie/malpresentatoin/ malposition

A
  1. Prematurity
  2. Multiple pregnancy
  3. Uterine abnormalities (e.g. fibroids or partial septet uterus)
  4. Foetal abnormalities
  5. Placenta Praviae
  6. Primiparity
342
Q

ECV (external cephalic version) is contra-indicated in what instances? (4)

A
  1. Recent Antepartum haemorrhage
  2. Ruptured membranes
  3. Uterine abnormalities
  4. Previous C-section
343
Q

What are the two most common causes of heavy menstrual bleeding?

A
  1. Fibroids

2. Adenomyosis

344
Q

Name 3 dug types that may alter menstrual bleeding

A
  1. Steroids
  2. Anticoagulants
  3. Cannabis
345
Q

What is the normal thickness of the endometrium?

A

Between 6-12mm

346
Q

Recall 6 six identified risk factors for the development of placenta praevia

A
  1. Multiparity
  2. Previous C -section
  3. Uterine abnormalities
  4. Smoking
  5. Older maternal age
  6. Multiple pregnancy

Year 4 TCDs (16 decks)

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