Womens Flashcards
cervical screening
a) negative HPV - return to routine testing
b) positive HPV - cytology abnormal -> colposcopy
positive HPV - cytology normal -> repeat in 12 months
B.i) HPV -ve -> return to routing testing
B.ii) HPV +ve -> repeat in 12 months
B.ii.1) HPV -ve -> return
B.ii.2) HPV +ve -> colposcopy
cervical screening
a) negative HPV - return to routine testing
b) positive HPV - cytology abnormal -> colposcopy
positive HPV - cytology normal -> repeat in 12 months
B.i) HPV -ve -> return to routing testing
B.ii) HPV +ve -> repeat in 12 months
B.ii.1) HPV -ve -> return
B.ii.2) HPV +ve -> colposcopy
cervical screening “inadequate”
repeat in 3 months
if still “inadequate” -> colposcopy
hyperemesis gravidum (most common 8-12 weeks) features (3)
weight loss, electrolyte imbalance, dehydration
hyperemesis gravidum Mx
1st - cyclizine/ promethazine
2nd - ondansetron/ metoclopramide
reasons for early referral for infertility (female) after 6 months trying
age >35
amenorrhea
prev STI
prev pelvic surgery
abnormal genital examination
reasons for early referral for infertility (male) after 6 months trying
genital surgery
prev STI
varicocele
significant systemic illness
abnormal genital examination
oligohydraminos (reduced amniotic fluid) causes (5)
premature rupture of membranes
renal agenesis
intrauterine growth retardation
post term gestation
pre eclampsia
indication for induction of labour (5)
prolonged pregnancy (2 weeks post predicted)
premature rupture of membrane
diabetic mother + >38 weeks
pre-eclampsia
rhesus incompatibility
bishop score interpretation (assess whether induction of labour is required)
<5 = needs induction
>7 = unlikely to need induction
methods of inducing pregnancy
1st - membrane sweep
2nd - vaginal prostaglandin (PGE2)
3rd - maternal oxytocin
4th - amniotomy/ cervical ripening balloon
complication of induction of labour
uterine hyperstimulation
Manage uterine hyperstimulation with tocolysis (terbutaline)
gestational diabetes OGTT diagnosis
fasting >5.6
2hr glucose >7.8
gestational diabetes Mx
1st - insulin
pre-existing diabetes in pregnancy Mx
stop oral hyperglycaemics (apart from metformin)
folic acid 5mg/day from pre-conception to 12 weeks
Rhesus negative pregnant women Mx
anti D at 28 and 34 weeks
placental abruption Fx
constant lower abdominal pain, tender tense uterus, normal lie/ presentation
placental praevia Fx
painless vaginal bleeding, non tender uterus, lie/ presentation may be abnormal
urge incontinence Mx
bladder retraining
antimuscarinics - oxybutynin, tolterodine, darifenacin
beta 3 agonist - mirabegron - for “frail old women”
stress incontinence Mx
pelvic floor training
surgery - mid-urethral tape
medical - duloxetine (SNRI)
pregnant women supplements
folic acid 400 mcg + vit D 10mcg per day
pregnant women nausea/ vomiting Mx
promethazine
secondary dysmenorrhea causes and Mx
causes - endometriosis, adenomyosis, pelvic inflammatory disease, copper coil, fibroids
Mx - gynae referral
Moderate contraindication for COCP (UKMEC 3)
> 35 yo + smoke <15/ day
BMI > 35
VTE family Hx
HTN
immobility e.g. wheel chair use
BRCA1/ BRCA2
current gallbladder disease
Complete contraindication for COPD (UKMEC 4)
> 35yo + smoke >15/day
migraine with aura
Hx VTE/ stroke/ IHD
breast feeding < 6 weeks post-partum
uncontrolled HTN
current breast cancer
major surgery with prolonged immobilisation
SLE, Antiphospholipid
Hormone replacement therapy contraindications
Hx breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Hormone replacement therapy risks
VTE
stroke (oestrogen HRT)
IHD
breast ca
ovarian ca
Non HRT menopausal Mx
vasomotor (flushes, sweats) - fluoxetine, citalopram, venlafaxine
high risk groups for pre-eclampsia therefore require aspirin 75mg from week 12 to birth
HTN, CKD, autoimmune disease, diabetes
gestational diabetes Mx
oral labetolol
Contraceptives - time until effective (if not first day period):
instant:
2 days:
7 days:
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
congenital rubella syndrome Fx (triad)
sensorineural deafness
eye abnormality
congenital heart disease
copper coil moa
decreased sperm motility
progestogen only pill moa
mucus thickening
oligohydramnios (<500ml @32 weeks) causes
intrauterine growth retardation
premature rupture of membranes
renal agenesis
post term gestation
pre-eclampsia
mittleschmerz Fx
pelvic pain around ovulation, no PV bleed
chickenpox EXPOSURE in pregnancy (if non immune)
<20 weeks
>20 weeks
< 20 weeks - VZIG
>20 weeks - VZIG or Aciclovir
chickenpox IN pregnancy Mx
Aciclovir (if >20 weeks, if <20weeks use with caution)
gestational diabetes diagnosis OGTT
fasting Glu
2hr Glu
fasting glucose >5.6
2-hour glucose level >7.8
‘5678’
primary dysmennhorea (painful menstruation) Mx
1st - NSAIDs - mefenamic acid, ibuprofen, naproxen
2nd - COCP (if not trying to conceive)
meigs syndrome Fx (3)
benign ovarian tumour (fibroma), ascites, pleural effusion
premature ovarian insufficiency Fx
menopausal Fx - hot flushes, sweats
infertility
secondary amenhorea
raised FSH + LH
low oestrodiol
placenta praecia Fx
pathological position of placenta in lower segment
Fx - painless PV bleed, closed cervical os
drugs contraindicated in breast feeding
ciproflxocin, tetracycline, chloramphenicol
lithium, benzo
aspirin
carbimazole
amiodarone
methotrexate
sulfonylureas
polycystic ovarian syndrome blood resutls
high LH and androgens (testosterone, oestrodiol)
shoulder dystocia Mx
1st - McRobert’s manouvre - flexion/ abduction of mother’s hips
Down’s screening dates
11 - 13+6 weeks
Anomaly scan dates
18 - 20+6 weeks
Reasons for surgical Mx of ectopic pregnancy (salpingectomy/ salpingotomy)
> 35mm
visible foetal heartbeat
abdominal pain
bHCG >5000
contraceptive patch missed patch Mx
delay >48 hrs - change patch immediately, use barrier method for 7 days
varicella foetal syndrome Fx
hypoplasia, microcephaly, dye defects
menorrhagia Mx
contraception not required - mefenamic acid/ transexamic acid
contraception required - IUS (Mirena), COCP
group B strep in pregnancy Mx
prophylactic PO benpen - pyrexia during labour (>38), previous GBS
Mx - IV benzylpenicillin intrapartum
post natal depression screening tool name
Edinburgh scale
Down’s syndrome combined test results
raised HCG
reduced PAPP-A
thickened nucal translucency
endometriosis Mx
1st - NSAIDs, paracetamol
2nd - COCP
fibroids Mx
> 3cm myomectomy (surgical removal) + GnRH for shinkage
<3cm IUS (medical)
eclampsia Mx
IV magnesium sulphate
gestational diabetes Mx
1st - fasting glucose > 5.6 but <7.0 - lifestyle modification for 2 weeks
2nd add metformin
3rd add insulin
IF fasting glucose > 7.0 - start insulin
risk of unopposed oestrogen (eg oestrogen only HRT)
endometrial Ca
reasons for expectant Mx of ectopic pregnancy
absence of symptoms
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
perineal tears
first
second
third
fourth
1st - superficial, no repair required
2nd - perineal but not anal sphincter, suture repair on ward
3rd - perineum and anal sphincter, surgical repair
4th - perineum, anal sphincter and rectal mucosa, surgical repair
Hyperthyroidism Mx in pregnancy
1st trimester (<12 weeks) - propylthiouracil
2nd trimester (>12 weeks) - Carbimazole
COCP Missed pill Mx
1 pill missed - take pill now, resume normal pill taking
>1 pill missed - take pill now, resume normal pill taking, condoms next 7 days
a) if in first 7 tablets of pack - need emergency contraception
b) if last 7 tablets of pack - omit pill free interval
POP missed pill Mx
take missed pill
condoms 2 days
Menopausal hot flushes Mx other than HRT
citalopram/ clonidine/ gabapentin
Physiological changes in pregnancy
raised prolactin
raised plasma levels
raised cardiac output (SV + HR)
raised RR + tidal volume increase
Hb falls (due to dilution)
BP falls (normalised by term)
adenomyosis Fx
ectopic endometrial tissue within myometrium
heavy, painful, irregular periods
pre-menstrual pelvic pains
adenomyosis Ix
MRI
confirmation on histology
adenomyosis Mx
tranexamic acid
Hormonal contraception/ GnRH
surgery - uterine artery embolisation/ hysterectomy
Sheehans syndrome
postpartum hypopituitiarisum due to blood loos/ hypovolaemia during childbirth
Fx - failure to lactate, fatigue, amennhorrea
Asherman’s syndrome (intrauterine adhesions) Fx
often post Dilation and Currette (D&C) procedure - dilated cervix to currette/ scrape uterus to remove retained products post pregnancy
Genital ulcers causes
painful vs painless
painful - Chancroid (haemophilus ducreyi)
painless - lymphogranuloma venereum (chlamydia), syphilis (treponema pallidum)
Syphilis (Treponema pallidum) Mx
Benzylpenecillin
Listeriosis
causes
Mx
causes - prepared meat (eg hot dogs, deli meat), dairy, unwashed veg, seafood
Mx - Amoxicillin and Gentamicin
Menorrhagia Mx
1st - Mirena (IUS)
2nd - tranexamic acid/ NSAIDs/ COCP
3rd - norethisterone
surgical - endometrial ablation (<10cm)/ uterine artery embolisation (>10cm)/ hysterectomy
Bishop score (PEDSS) - indicated the success rate of induction
position of cervix
Effacement (length)
dilatation
softness (consistency)
station of foetus
Female infertility check - mid luteal cycle progesterone
7 days prior to ovulation
normally day 21 of 28 day cycle
Placental abruption Fx
tense tender uterus
PV bleeding
fetal distress
