Women's Health - Obstetrics

Question 1

Split the spectrum of postnatal depression into 3

give timings post birth

Answer 1

baby blues - 1st week after birth
postnatal depression- 3 months after birth
puerperal psychosis - few weeks (2-3) after birth

Question 2

Explain Baby Blues

Symptoms

Answer 2

affect 50% women, especially first-time mother.

sx:
- mood swings
-low mood
-anxiety
-irritability
-tearfulness

Question 3

Why might Baby Blues happen?

Answer 3

significant hormone changes

recovery from birth

fatigue and sleep deprivation

responsibility of caring for neonate

establishing feeding

any other events

Question 4

How long do symptoms last and what is tx?

Answer 4

mild sx

few days
resolve within 2 weeks of delivery

no tx

Question 5

Triad of postnatal depression

Answer 5

low mood

anhedonia (lack of pleasure in acitivities)

low energy

cognitive impairement

Question 6

how long should postnatal depression symptoms last before diagnosing?

Answer 6

at least 2 weeks

Question 7

treatment of postnatal depression

Answer 7

mild - additional support,self-help, follow up GP

Moderate - SSRI/TCA and CBT/IPT

Severe: specialist psychiatry, mother+baby unit rarely

Question 8

What is the screening scale for postnatal depression?

Answer 8

Edinburgh postnatal depression scale

assesses how mother felt over past week.

10 qus
total 30 pts.

10 or more is postnatal depression

Question 9

What psychotic symptoms are experienced for puerperal psychosis?

Answer 9

delucions
hallucintions
depression
mania
confusion
thought disorder
infanticide
cognitive impairement

Question 10

treatment for puerperal psychosis?

Answer 10

admit to mother and baby unit

hospitalise for safety of mother and child.

cbt

antidepressants,antipsychotics, mood stabilisers

Electroconvulsive therapy (ECT)

Question 11

What is a mother and baby unit?

Answer 11

specialist unit for pregnant and women given birth in last 12 months.

mother and baby stay together and bond.

supported care for both.

Question 12

How to manage mental health concerns during pregnancy?

Answer 12

perinatal mental health services

Question 13

potential complication of SSRI in pregnant women?

presentation:
symptoms:
tx:

Answer 13

neonatal abstinence syndrome.

presents 1st few days postnatal.

sx:
irritability
poor feeding.

supportive mx.

Question 14

pathophysiology of postnatal depression

Answer 14

hormonal changes

fluctuations in oestrogen and progesterone levels

psychosocial stressors.

Question 15

pathophysiology of puerperal psychosis?

Answer 15

unknown
hormonal fluctuations
genetic predisposition
sleep deprivation

Question 16

What is electroconvulsive therapy?

Answer 16

used for severe medication-resistant and psychotic depression.

course of tx : twice weekly for 4 weeks.

general anaethesia
electrods on pts head
electrical current administer
short generalised seizure triggered - 30secs

side effects:
headache
muscle aches
short-term memory loss

Question 17

Tell me the process of making a baby

Answer 17

fertilisation: sperm meets egg in fallopian tube = zygote

zygote to uterus down from fallopian. divides to blastocyte.

blastocyte implants in endometrium.

blastocyte embeds and develops into embryo.

cells differentiate. 8 weeks becomes fetus.

9 months fetus grows in uterus, nourished by placenta via umbilical cord.

contractions push baby through cervical os and out of vagina.

cervical os gradually dilates

Question 18

What is an ectopic pregnancy?

Answer 18

life threatening obs emergency

fertilised ovum implants outside uterine cavity: MC fallopian tube (97%)

other sites:
- ovary
-cervix
-abdominal cavity
-entrance to fallopian tube (cornual region)

Question 19

Risk Factors for Ectopic Pregnancy (EP)

Answer 19

Previous EP
Previous Pelvic Inflammatory Disease
Previous surgery to fallopian tubes
Intrauterine devices (coils)
Older Age
Smoking - impaired tubal function and ciliary beat frequency.

endometriosis

tubal surgery - salpingectomy, tubal ligation, reconstructive surgery impairs tubal function.

ART LIKE IVF

Question 20

how can endometriosis cause ectopic pregnancy?

Answer 20

presence of endometrial tissue outside uterine cavity can cause tu

Question 21

What is pelvic inflammatory disease commonly caused by?

Answer 21

chlamydia trachomatis

Neisseria gonorrhoeae

RF for ectopic pregnancy

leads to tubal inflammation, damage and impaired motility.

Question 22

Pathophysiology of ectopic pregnancy

Question 23

Clinical Features of Ectopic Pregnancy

Answer 23

typical presentation: female hx of 6-8 weeks amenorrhoea, later presents with lower abdo pain and later develops vaginal bleeding.

lower abdo pain: due to tubal spasm, 1st sx, constant unilateral pain

vaginal bleed: less than normal period. poss dark brown

hx of recent amenorrhoea: typically 6-8 weeks from start of last period. if longer then other cause: inevitable abortion.

peritoneal bleeding: cause shoulder tip pain. pain on defacation/tenesmus secondary to blood pooling in pouch of douglas

dizziness, fainting or syncope

sx of pregnancy eg breast tenderness

Question 24

Ix -Ectopic Pregnancy

Answer 24

Serum hCG level : viability of pregnancy./ single value not diagnostic. slower than expected rise/decline suggests it. Discriminatory zone (1500-2000 mIU/mL)

TVUS: transvaginal ultrasonography. high res visual of uterus,adnexa.

Abdominal Ultrasonography - when TVUS CI’D. lower sensitivity/specificity.

Doppler Ultrasonography - colour/power supplements TVUS - detect blood flow in trophoblastic tissue of ectopic pregnancies.

Question 25

on a tvus what would be suggestive of ectopic pregnancy?

Answer 25

adnexal mass
extrauterine gestational sac
complex adnexal fluid colleciton.

empty uterine cavity
absense of intrauterine gestational sac
the above 2 in prescence of high hCG level.