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WOMENS EXTRA CONDITIONS Flashcards

1
Q

1* AMENORRHOEA
What is primary amenorrhoea?

A

Absence of menstruation by –
- 14y if no secondary sexual characteristics (more indicative of a chromosomal abnormality)
- 16y with secondary sexual characteristics (breast buds)

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2
Q

1* AMENORRHOEA
What is the difference between hypogonadotrophic hypogonadism and hypergonadotrophic hypogonadism?

A
  • Deficiency in gonadotrophins (LH + FSH) stimulating ovaries due to abnormal hypothalamus or pituitary means they do not respond by producing sex hormones (oestrogen)
  • Gonads fails to respond to stimulation of gonadotrophins meaning no negative feedback + increasing amounts of FSH/LH
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3
Q

1* AMENORRHOEA
What are some causes of hypogonadotrophic hypogonadism?

A
  • Constitutional delay (temporary delay, no pathology, ?FHx)
  • Hypopituitarism
  • Kallmann’s (failure to start puberty + anosmia)
  • Excessive exercise, dieting or stress causes hypothalamic failure
  • Endo = Cushing’s, prolactinoma, thyroid
  • Damage (cancer, surgery)
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4
Q

1* AMENORRHOEA
What are some causes of hypergonadotrophic hypogonadism?

A
  • Turner’s syndrome XO
  • Congenital absence of ovaries
  • Previous damage to gonads (torsion, cancer, infections like mumps)
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5
Q

1* AMENORRHOEA
What are some other causes of primary amenorrhoea and how may they present?

A
  • Congenital adrenal hyperplasia (tall, deep voice, facial hair)
  • Androgen insensitivity syndrome (46XY but female phenotype)
  • Congenital malformations of genital tract (if ovaries unaffected = secondary sexual characteristics but no menses)
  • Gonadal dysgenesis (no ovaries or uterus form)
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6
Q

1* AMENORRHOEA
What are some first line investigations for primary amenorrhoea?

A
  • Examination = signs of puberty, PV exam, BMI, visual fields
  • FBC + ferritin (anaemia), U+E for CKD, anti-TTG for coeliac, urinary beta-hCG crucial
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7
Q

1* AMENORRHOEA
What hormonal blood tests would you do for primary amenorrhoea?

A
  • FSH + LH (low or high)
  • TFTs, prolactin (if indicated)
  • Free androgens raised in PCOS, AIS + CAH
  • Insulin-like growth factor I used for screening for GH deficiency
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8
Q

1* AMENORRHOEA
What other investigations may be useful for primary amenorrhoea?

A
  • XR of wrist to assess bone age + Dx constitutional delay
  • Pelvic USS for structural causes
  • ?MRI head if pituitary
  • Karyotyping for Turner’s syndrome, AIS
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9
Q

1* AMENORRHOEA
What is the management of…

i) constitutional delay?
ii) ovarian causes (PCOS, damage/absence of ovaries)
iii) genital tract abnormalities?
iv) pituitary tumour?
v) stress?

A

i) May only require reassurance + observation
ii) COCP can induce regular menstruation + prevent Sx of oestrogen deficiency
iii) Surgery
iv) Surgery, chemo, radio or bromocriptine if prolactinoma
v) CBT, healthy weight gain, stress reduction

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10
Q

1* AMENORRHOEA
What is the management of hypogonadotrophic hypogonadism?

A
  • Pulsatile GnRH can induce ovulation, menstruation + potentially fertility
  • COCP if pregnancy not wanted to replace sex hormones, induce regular menstruation + prevent Sx of oestrogen deficiency
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11
Q

2* AMENORRHOEA
What is secondary amenorrhoea?
What is oligomenorrhoea?

A
  • Previously normal menstruation ceases for >3m in a non-pregnancy woman
  • Where menses are >35d apart (up to 6m), can be ovarian normality but exclude PCOS
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12
Q

2* AMENORRHOEA
What are the causes of secondary amenorrhoea?

A
  • Pregnancy (most common), breastfeeding, menopause (physiological)
  • Iatrogenic (contraception)
  • Hypothalamic/pituitary
  • Ovarian causes (PCOS, POI)
  • Thyroid, uterine pathology (Asherman’s)
  • Excessive exercise, stress or eating disorders
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13
Q

2* AMENORRHOEA
What are the hypothalamic or pituitary causes of secondary amenorrhoea?

A
  • Sheehan’s syndrome = pituitary necrosis following PPH
  • Pituitary tumour like prolactinoma leading to hyperprolactinaemia which prevents GnRH
  • Trauma, radiotherapy or surgery
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14
Q

2* AMENORRHOEA
How does excessive stress or eating disorders cause secondary amenorrhoea?

A
  • Hypothalamus reduces GnRH in times of stress > hypogonadotrophic hypogonadism to prevent pregnancy in adverse situations
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15
Q

2* AMENORRHOEA
What hormonal tests would you do in secondary amenorrhoea?

A
  • Urine/blood beta-hCG
  • High FSH (POI)
  • Low FSH/LH (hypgonadotrophic hypogonadism)
  • High LH or LH:FSH ratio suggests PCOS
  • Free androgen raised in PCOS
  • Mid-luteal (day 21) progesterone to check ovulation happened
  • Prolactin + TFTs if indicated
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16
Q

2* AMENORRHOEA
What other investigations may you do in secondary amenorrhoea?

A
  • Pelvic USS to Dx PCOS
  • MRI head if ?pituitary tumour
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17
Q

2* AMENORRHOEA
What is the management of…

i) hyperprolactinaemia?
ii) hypothalamic failure?

A

i) Bromocriptine or cabergoline (dopamine agonists)
ii) GnRH replacement

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18
Q

CERVICAL ECTROPION
What is cervical ectropion?
What is it associated with?

A
  • Columnar epithelium of endocervix extends out to ectocervix
  • Endocervix cells more fragile so prone to trauma + to bleed (post-coital)
  • High oestrogen > young women, COCP, pregnancy
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19
Q

CERVICAL ECTROPION
How does cervical ectropion present?

A
  • Increased vaginal discharge
  • Abnormal PV bleeding (IMB + PCB)
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20
Q

CERVICAL ECTROPION
How does cervical ectropion present on speculum?

A
  • Well-demarcated border between redder, velvety columnar epithelium extended from os + pale pink squamous epithelium of ectocervix
  • ‘Red ring’ around cervical os (transformation zone)
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21
Q

CERVICAL ECTROPION
What is the management of cervical ectropion?

A
  • Problematic bleeding = cauterisation (silver nitrate or cold coagulation during colposcopy)
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22
Q

POI
What is premature ovarian insufficiency (POI)?

A
  • Premature menopause before the age of 40
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23
Q

POI
What are some causes of POI?

A
  • Majority idiopathic
  • Iatrogenic (chemo/radio, oophorectomy)
  • Autoimmune (coeliac, T1DM)
  • Genetic (FHx, Turner’s)
  • Infections (mumps, TB, CMV)
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24
Q

POI
What is the clinical presentation of POI?

A
  • Secondary amenorrhoea (or irregular) + typical peri-menopause Sx before age 40
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25
POI What are some investigations for POI?
- Clinically = menopausal Sx in woman <40y with 4m of amenorrhoea - FSH level = >25IU/L on 2 samples >4w apart - Hypergonadotrophism + hypoestrogenism
26
POI What are the complications of POI?
- Higher risk of conditions due to lack of oestrogen > CVD, stroke, osteoporosis, dementia + cognitive impairment + Parkinsonism
27
POI What is the management of POI?
- HRT imperative until at least average age of menopause to reduce risks - HRT or COCP can be used
28
POI What is the difference between traditional HRT and COCP in POI?
- Traditional HRT associated with lower BP than COCP - COCP may be more socially acceptable if younger + acts as contraceptive
29
POI Are there the same risks of HRT in POI as in menopause?
- No increase in breast cancer risk as women normally produce these hormones at that age - Slight increased risk of VTE but reduced by transdermal patch
30
FGM What is female genital mutilation (FGM)?
- All procedures involving partial or total removal of female external genitalia or injury to female organs for non-medical reasons, often pre-pubertal
31
FGM What is the WHO classification for the types of FGM?
- 1 = partial or total clitoridectomy - 2 = excision - 3 = infibulation - 4 = all other non-medical harmful procedures incl. pricking, piercing, incising
32
FGM What is... i) excision? ii) infibulation?
i) Partial or total removal of clitoris + labia minora ± excision of labia majora ii) Narrowing/closing of vaginal orifice with creation of a covering seal (stitch labia together)
33
FGM What are some potential reasons for FGM?
Based on customs – - It will bring status + respect to family (social norm) - Rite of passage + being part of woman - Preserves girls' virginity so acceptable for marriage - Cleanses + purifies girl with perceived religious requirement
34
FGM What are some acute complications of FGM?
- Pain - Bleeding - Infection (BBV) - Sepsis - Swelling - Urinary retention
35
FGM What are some chronic complications of FGM?
- Dyspareunia - Dysmenorrhoea - Infertility + pregnancy issues - Keloid scar - Haematocolpos (period backs up in uterus as cannot be released) - PTSD
36
FGM What is the initial management of suspected or confirmed FGM?
- Report ANY FGM in <18 to police + Record in notes (consider in >18 after risk assessment e.g. others at risk like unborn children) - Educate pts + relatives that FGM is illegal + health consequences - Services = social, safeguarding, paeds, counselling, FGM specialists
37
FGM What is the overall management of FGM?
- De-infibulation by specialist in FGM in some type 3 to try restore function - Re-infibulation may be requested after childbirth but this is illegal
38
MACROSOMIA What is... i) large for gestational age (LGA)? ii) macrosomia?
i) Estimated foetal weight above the 90th centile for their gestational age ii) Baby with a weight >4kg regardless of gestational age
39
MACROSOMIA What are the causes of macrosomia?
- Constitutionally large or familial (parental height + weight) - Maternal diabetes, previous macrosomia, obesity or rapid weight gain - Overdue - Male baby
40
MACROSOMIA What are some complications of macrosomia?
- Maternal = failure to progress, perineal tears, instrumental/c-section, PPH, uterine rupture (rare) - Foetal = shoulder dystocia, neonatal hypoglycaemia, obesity in childhood + later life
41
MACROSOMIA How do you diagnose and manage macrosomia?
- OGTT to screen for diabetes - SFH + EFW from USS to plot on growth chart + >90th centile = Dx - Regular growth scans to assess progress + check amniotic fluid index levels to exclude polyhydramnios - Most vaginal delivery, consider c-section if v large or signs of distress
42
CHORIOAMNIONITIS What is chorioamnionitis? What is a major factor in the condition?
- Acute inflammation of amnion + chorion membranes due to ascending bacterial infection in setting of membrane rupture - PPROM
43
CHORIOAMNIONITIS What is the clinical presentation of chorioamnionitis?
- Uterine tenderness - Evidence of foetal distress on CTG - Foul odour, purulent/offensive PV discharge (yellow/brown) - Maternal infection (fever, abdo pain, maternal + foetal tachycardia)
44
CHORIOAMNIONITIS What are some investigations for chorioamnionitis?
- FBC, CRP (raised WCC + CRP) - Swabs (high + low vaginal swabs), MSU - USS for foetal presentation, EFW + liquor volume
45
CHORIOAMNIONITIS What is the management of chorioamnionitis?
- Steroids <34w - Deliver foetus (whatever gestation, often c-section) - IV Abx
46
INFECTIONS + PREGNANCY What is Parvovirus? What are the adverse effects? What is the management?
- Parvovirus B19 can give viral Sx then 'slapped cheeks' (erythema infectiosum) - Worse <20w = suppresses foetal erythropoiesis causing anaemia + foetal hydrops, death, pre-eclampsia-like (mirror) syndrome in women - Maternal IgM + IgG, supportive, refer to foetal medicine to monitor
47
INFECTIONS + PREGNANCY What is toxoplasmosis? How is it spread? What is the clinical presentation? What is the management
- Toxoplasma gondii protozoan - Cat poo, eating infected meat - Glandular fever-like illness (fever, rash, eosinophilia) - TORCH screen (IgM + IgG), proven infection use spiramycin
48
INFECTIONS + PREGNANCY What is the management of Hep B in pregnancy?
- Babies born to Hep B +ve mothers should be vaccinated within 24h of birth as well as other times recommended on vaccination schedule - No breastfeeding transmission in contrast to HIV
49
INFECTIONS + PREGNANCY What are the risks of rubella in pregnancy? What is the management?
- Congenital rubella syndrome in first 8–10w (sensorineural deafness, CHD like PDA + PS, congenital cataracts, cerebral palsy) - Live vaccines like MMR avoided in pregnancy (offer postnatally if no immunity), avoid contacts
50
INFECTIONS + PREGNANCY What is the management of HIV in pregnancy?
- Normal vaginal delivery if viral load <50 copies/ml if. not c-section (IV zidovudine 4h before) - Neonatal zidovudine PO if maternal viral load <50 if not triple ART, both for 4–6w - Breastfeeding C/I
51
ASTHMA + PREGNANCY What are the complications of asthma in pregnancy?
- Foetal growth restriction due to inadequate placental perfusion - Premature delivery (usually due to maternal deterioration)
52
ASTHMA + PREGNANCY What is the management of asthma in pregnancy?
- Optimise control pre-conception - All drugs for asthma safe - Risk of exacerbation, esp in third trimester as baby grows it can press up on lungs > in asthma attack, prioritise mum
53
ACUTE FATTY LIVER What is acute fatty liver of pregnancy?
- Rapid accumulation of fat within the hepatocytes that occurs in the third trimester of pregnancy - Rare cause of hepatitis in pregnancy
54
ACUTE FATTY LIVER What is the clinical presentation of acute fatty liver in pregnancy?
Vague Sx like – - Abdo pain - N+V - Jaundice - Anorexia - Ascites
55
ACUTE FATTY LIVER What is the management of acute fatty liver?
- LFTs show elevated liver enzymes, esp. ALT - Stabilise, admit + deliver foetus as high risk of liver failure + mortality (for both)
56
THYROID + PREGNANCY How common is hyperthyroidism in pregnancy? How does hyperthyroidism present? What are some complications?
- Uncommon, often improves after 1st trimester - May present with excessive vomiting - Maternal = thyroid crisis with cardiac failure - Foetal = thyrotoxicosis due to transfer of thyroid stimulating antibodies
57
THYROID + PREGNANCY What is the management of hyperthyroidism in pregnancy?
- Propylthiouracil is choice in 1st trimester (associated with maternal hepatic injury) - Carbimazole C/I until 2nd trimester as causes foetal abnormalities - If mother has stimulating antibodies, monitor foetal growth with USS
58
THYROID + PREGNANCY Is hypothyroidism in pregnancy common? What is the prognosis of untreated hypothyroidism in pregnancy? What is the management?
- Yes - Early foetal loss + congenital hypothyroidism leading to impaired neurodevelopment - Aim for adequate replacement with levothyroxine (safe), especially in 1st trimester
59
THYROID + PREGNANCY What is post-partum thyroiditis?
3 stages – - Thyrotoxicosis (3m) - Hypothyroidism (3–6m) - Normal thyroid function Sx control of thyrotoxicosis, treat hypothyroidism with levothyroxine Just need TFTs to Dx if within 12m of giving birth + Sx
60
EPILEPSY + PREGNANCY What pre-conception advice should be given for women with epilepsy?
- 5mg folic acid - Determine if medication required or if it can be rationalised - Aim for monotherapy > carbamazepine + lamotrigine safest - Valproate can cause NTD + phenytoin can cause cleft lip + palate
61
PREMATURITY What are the WHO definitions of prematurity?
- Birth before 37w - Extreme preterm = <28w - Very preterm = 28–32w - Mod-late preterm = 32–37w (term >37w)
62
PREMATURITY When are babies considered non-viable?
- <24w so if no signs of life = no resus - From 24w chances improve so full resus
63
PREMATURITY What are the classifications of prematurity?
- Spontaneous (70%) = PPROM, cervical weakness, amnionitis - Iatrogenic = induced due to some complication
64
PREMATURITY What are the risk factors of prematurity?
- 50% none - Multiple pregnancy - Complications (IUGR, pre-eclampsia) - APH - Previous cervical surgery - Previous preterm - Polyhydramnios - Infection - Maternal diseases
65
PREMATURITY What is the clinical presentation of prematurity?
- Persistent uterine activity WITH change in cervical dilatation ± effacement - Preterm labour with intact membranes if no ruptured amniotic sac - Increase or change in PV discharge or bleeding
66
PREMATURITY What are the investigations for prematurity?
- Speculum (assess cervical dilatation, look for amniotic fluid) can Dx if <30w - TVS if >30w to measure cervical length (<15mm + contractions = Dx) - OR foetal fibronectin (Actim Partus, acts as glue between chorion + uterus + found in vagina during birth) test >50ng/ml = early labour
67
PREMATURITY What are the complications of prematurity?
- Maternal = infection - Neonatal = necrotising enterocolitis, apneoa of prematurity, RDS, intraventricular haemorrhage, retinopathy of prematurity, jaundice, hearing issues, chronic lung disease
68
PREMATURITY What is the prophylaxis for prematurity and how do they work?
- Progesterone gel or pessary decreases activity of myometrium + prevents cervix remodelling in preparation for delivery - Cervical cerclage = ≥1 sutures to strengthen + keep cervix closed - 'Rescue' cerclage to halt delivery
69
PREMATURITY What are the indications for... i) progesterone prophylaxis? ii) cervical cerclage? iii) 'rescue' cerclage?
i) Cervical length <25mm on TVS at 16–24w ii) Cervical length <25mm on TVS at 16–24w, previous premature birth or cervical trauma (colposcopy, cone biopsy) iii) Cervical dilatation without ROM at 16–27+6 with no infection, bleeding or contractions
70
PREMATURITY What is the acute management of prematurity?
- Senior obs + neonate input - Foetal monitoring (CTG) - Tocolytics - Corticosteroids - IV magnesium sulfate - Consider delayed cord clamping or cord milking (increases circulating blood volume + Hb in baby)
71
PREMATURITY What are tocolytics? Why are they used? Who for? Examples?
- Drugs to delay uterine contractions - Administer 2x steroids or transfer to more specialist unit (with neonatal ICU) - Those 24–33+6w - CCBs like nifedipine or oxytocin receptor antagonist like atosiban if C/I, terbutaline (SABA)
72
PREMATURITY What are corticosteroids used for? Who for? Give examples
- Aids surfactant production so helps develop + protect baby's lungs - Those <34w - Dexamethasone, betamethasone
73
PREMATURITY What is magnesium sulfate used for? What is the regime?
- Neuroprotection + reduced risk of cerebral palsy - Bolus + infusion for up to 24h or until birth in <34w
74
PROLONGED PREGNANCY What is a prolonged pregnancy? What are some investigations?
- Pregnancy exceeding 42w from LMP - USS assessment of growth + amniotic fluid volume - Daily CTGs after 42w + Advised to report any decreased foetal movements
75
PROLONGED PREGNANCY What are some complications of prolonged pregnancy for the foetus?
- Macrosomia (+ dystocia) - Oligohydramnios - Reduced placental perfusion - May have meconium stained liquor (foetal distress), beware of aspiration as can cause severe pneumonitis
76
PROLONGED PREGNANCY What are the maternal complications of prolonged pregnancy? What is the management?
- Anxiety, more interventions (induction, operative delivery) - Confirm EDD, offer one membrane sweep at 41w + induction at 41–42w to prevent this
77
AMNIOTIC EMBOLISM What is an amniotic fluid embolism?
- Amniotic fluid/foetal cells enter mother's blood stream causing an immune reaction from the mother's immune system > systemic illness
78
AMNIOTIC EMBOLISM What are some risk factors for amniotic fluid embolism? Presentation?
- Increasing maternal age + ARM - Often around time of labour + delivery but can be postpartum - Sx = SOB, sweating, anxiety, seizures, haemorrhage - Signs = hypoxia, tachycardia + hypotension, may lead to cardiac arrest
79
AMNIOTIC EMBOLISM What is the management of amniotic fluid embolism?
- Supportive + requires involvement from critical care (maternal A-E resus)
80
MATERNAL SEPSIS What is sepsis? What is septic shock? What is the importance of sepsis?
- Life-threatening organ dysfunction from dysregulated host response to infection - Persistent tissue hypoperfusion despite adequate fluid replacement - One of top direct causes of maternal death in UK
81
MATERNAL SEPSIS What are some causes of sepsis?
- Pyelonephritis - Chorioamnionitis - Wound infection (c-section, episiotomy) - GBS - Pneumonia - Cellulitis - Basically any infection
82
MATERNAL SEPSIS What are some risk factors for sepsis?
- Immunosuppressed - Obesity - DM - Hx of pelvic infection - Amniocentesis + CVS - Cervical stitch - Prolonged ROM (>18h in prems, >24h in term)
83
MATERNAL SEPSIS What is the clinical presentation of sepsis?
- Pyrexia OR hypothermia, rigors, non-blanching rash - Tachycardia + hypotension (shock) - Oliguria, hypoxia, impaired consciousness - Failure to respond to treatment
84
MATERNAL SEPSIS What are the investigations for maternal sepsis?
- Monitor Maternal Early Obstetric Warning Score (MEOWS) - Warning signs of sepsis (3Ts white with sugar)
85
MATERNAL SEPSIS What are the warning signs of sepsis?
3Ts white with sugar – - Temp <36 or >38 - Tachycardia >90bpm - Tachypnoea >20bpm - WCC >12 or <4 - Hyperglycaemia >7.7mmol/L in absence of diabetes
86
MATERNAL SEPSIS How can maternal sepsis be prevented?
- All pregnant ladies get seasonal flu vaccine - Broad-spec IV Abx then alter with sensitivities - Involve senior team + experts early - SEPSIS 6 within first hour - Consider delivery + VTE prophylaxis
87
MATERNAL SEPSIS What are the SEPSIS 6 components?
BUFALO (3 in, 3 out) – - Blood cultures (out) - Urine output by catheter (hourly, out) - Fluids resus (IV, in) - Abx (IV broad-spec, in) - Lactate (ABG, out) - Oxygen (high flow SpO2 >94%, in)
88
MATERNAL SEPSIS What is puerperal pyrexia? What are the causes? What is the management
- Temp >38 in first 14d postpartum - Endometritis #1, UTI, mastitis, wound infections, VTE - Endometritis = hospital for IV Abx (clindamycin/gent) until afebrile >24h
89
MATERNAL SEPSIS What is the clinical presentation of endometritis? What can cause it? How should you investigate it?
- Foul-smelling discharge or lochia, bleeding gets heavier or does not improve with time, lower abdo pain - Commonly after c-section (give prophylactic Abx), can be caused by STIs - Vaginal swabs + urine MC&S
90
PUERPERIUM What is the puerperium? What does it involve?
- Delivery of placenta to 6w following birth - Return to pre-pregnant state, initiation/suppression of lactation + transition to parenthood
91
PUERPERIUM What is the postnatal period?
- Period under which woman + baby are still under midwife care, usually at least 10d + for as long as midwife feels necessary
92
PUERPERIUM What is... i) maternal death? ii) direct maternal death? iii) indirect maternal death?
i) Death of a woman during or up to 6w after her pregnancy (may or not have been aggravated by pregnancy) ii) Mother dying as a result of an obstetric complication iii) Mother dying as a result of a pre-existing disease or disease that developed during pregnancy, but not as a direct obstetric cause
93
PUERPERIUM What are some direct and indirect causes of maternal death?
- Direct = VTE (#1), haemorrhage, HTN disorders, suicide - Indirect = cardiac disease
94
PUERPERIUM What are some major and minor post-natal problems?
- Major = sepsis, PPH, pre-eclampsia, VTE, uterine prolapse, breast abscess, MH issues - Minor = fatigue, anaemia, mastitis, baby blues
95
PUERPERIUM What changes happen during the puerperium?
- Big decrease in serum placental hormones (hPL, hCG, oestrogen + progesterone) - Uterus involutes from 1kg > 100g + cervix firm after 3d - Decidua is shed as lochia - Milk replaces colostrum after 3d - Breast engorgement (swollen, red + tender) after 3d
96
PUERPERIUM What are the different types of lochia?
- Rubra (red) 0–4d (blood cervical discharge, meconium) - Serosa (yellow) 4–10d (mucus, exudate, foetal membrane, WBCs) - Alba (white) 10–28d (cholesterol, fat, leukocytes, mucus)
97
PUERPERIUM What is the difference between colostrum and breast milk?
- Colostrum at birth = yellow fluid, first form of milk with high proteins (IgA, lactoferrin), low sugar + fat - Milk = lactose, protein, fat + water
98
PUERPERIUM What is the physiology of breast feeding?
- Baby suckles so sensory impulses from nipple > brain - Prolactin secreted by ant. pit > breasts via blood + lactocytes produce milk - Oxytocin secreted by post. pit > breasts via blood causes myometrial cell contraction to expel milk
99
PUERPERIUM When else is prolactin secreted and why?
- More at night - Suppresses ovulation - Levels peak after feed to produce more for next feed
100
PUERPERIUM What stimulates oxytocin secretion? What hinders it?
- Sight, sound + smell of baby (conditioned over time) - Hindered by anxiety, stress + pain
101
PUERPERIUM What is lactoferrin?
- Multifunctional protein in milk but loads in colostrum - Regulates iron absorption in intestines + delivery of iron to cells - Prevention against infections - Regulation of bone marrow function + boosts immune system
102
PUERPERIUM What are some drug contraindications in breastfeeding?
- Abx (ciprofloxacin, tetracyclines, chloramphenicol) - Psych drugs (lithium, BDZs) - Amiodarone, aspirin - Carbimazole, methotrexate - Sulfonylureas - Cytotoxic drugs
103
PUERPERIUM What are the pros + cons of breast feeding?
- Readily available good nutrition, cheaper, contraceptive effect, decrease childhood infections (gastroenteritis), decrease in necrotising enterocolitis - Feed more often, uncomfortable + pain (mastitis)
104
PUERPERIUM What contraception can be offered to women?
- POP + implant safe in breastfeeding, start any time - COCP UKMEC4 <6w + UKMEC2 >6w, avoid in breastfeeding - IUD/IUS inserted <48h OR >4w but is UKMEC3 between
105
PUERPERIUM What is mastitis? What can cause it?
- Inflammation of breast tissue - Obstruction of ducts + accumulation of milk (prevent by expressing regularly) - Infection enter at nipple>duct (commonly S. aureus)
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PUERPERIUM How does mastitis present? What can it lead to?
- Breast pain + tenderness, erythema, local inflammation - Breast abscess if untreated
107
PUERPERIUM How does breast abscess present? What is the management?
- Unilateral erythema, tenderness, fever, palpable mass + tender/enlarged LNs in axilla - Requires surgical incision + drainage
108
PUERPERIUM What is the management of mastitis?
- Milk MC&S if ?infection - Analgesia - Continue feeding or expressing - Flucloxacillin 10–14d if systemically unwell, nipple fissure, Sx>24h, infection
109
SHEEHAN'S SYNDROME What is Sheehan's syndrome?
- Drop in circulating blood volume leads to avascular necrosis of the pituitary gland - Ischaemia + infarction of anterior pituitary cells as supplied by hypothalamo-hypophysial portal system which is susceptible to rapid drops in BP after PPH
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SHEEHAN'S SYNDROME How does Sheehan's syndrome present? What is the management?
- Reduced lactation (lack of prolactin) - Amenorrhoea (lack of LH + FSH > HRT) - Hypothyroidism (lack of TSH > levothyroxine) - Adrenal insufficiency (lack of ACTH > hydrocortisone)

B TO REVISE - PHASE 3A (9 decks)

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