Womens health Flashcards
How do we split up pregnancy
In three phases:
1st, 2nd, 3rd trimester
How do we write how many weeks a patient is pregnant
x/40
eg 10 weeks pregnant= 10/40
What is the pregnancy mortality rate in the UK
7/10,000
Name the most common cause of mortality in pregnancy
Thromboembolism leading to Deep vein thrombosis and pulmonary embolus
What is though to lead to a higher risk of maternal death in the future
Obesity and rising material age
What is the range of a normal pregnancy
37-42 weeks
How many pregnancies fail in the first trimester
1 in4-5 pregnancies fail here
What can cause spontaneous miscarriage int eh first trimester
Significant genetic abnormalities
What increases the risk of pregnancy los
Increasing maternal age
What is formed by the end of the first trimester
All the major organs
When is the foetus potentially viable
24 weeks
What is a miscarriage
Pregnancy loss before 24 weeks
What is a pregnancy lost after 24 weeks caused
intrauterine death (still birth)
What is an ectopic pregnancy
A pregnancy outside of the uterus
How common is ectopic pregnancy
Occurs in 1 in 300 pregnancies
Where are ectopic pregnancies usually found
In the Fallopian tube
Give some symptoms of ectopic pregnancy
- Extreme nausea
- Abdominal pain
- Vaginal bleeding
Are ectopic pregnancies successful
No
What happens if an ectopic pregnancies is left untreated
Will lead to rupture of the Fallopian tube with a potential fatal haemorrhage
How are ectopic pregnancies managed
Terminated via resection the involved Fallopian tube and or via methotrexate
Up to how many weeks is it legal to terminate a pregnancy for social rasosn
12-14 weeks
Which substances must we advise pregnant mothers to stay away from
Tobacco and alcohol
How does tobacco affect the foetus
Can lead to growth restriction
How does alcohol affect the foetus
Can cause foetal alcohol syndrome if taken in large amounts
When do pregnant mothers usually book appoitnemtns with doctors
12 weeks
20 weeks
babies birth
What happens at the 12 week appointment
- Booking bloods
2. 1st Ultrasound
What do we aim to find in the 1st scan
- Dating the foetus
- Initial screening
- Viability scan
What happens at the 20 week appointment
Look fo anatomy and any serious abnormalities
How are most babies delivered
In the hospitals with the help of midwife
When might medical intervention be required during birth
- Elective Caesarian section
2. Failure to progress once in labour
What do we recommend pregnant women carry with them at all times .
Their obstetric notes
What do obstetric notes usually include
- Contact info of the doctor
- Blood tests
- Blood pressure recordings
- Ante-natal visits documented
What common changes occur to women in pregnancy
- Nausea and vomiting
- Hypotension
- Breathlessness (dyspnoea)
- Anaemia
- Flow heart murmur
- Procoagulant state
- Gastro-oesophageal reflux (GORD)
- Chloasma or melasma
- Fluid retention
- Urinary urgency
- Skeletal pain
- Weight gain
- Haemorrhoids
- Periodontal disease
When is nausea and vomiting worse for pregnant women
Weeks 6-12
Why do pregnant women experience nausea and vomiting
Relates to the levels of beta-HCG from trophoblast during placental development
What leads to hypertension in pregnant women
Vascular muscular relaxation
Which type of hypotension can be a particular problem in pregnant women
Postural hypotension
What do we need to be careful in regards to positioning a pregnant women
Do not lay them on their back especially in the later stages of the pregnancy as the uterus will compress major blood vessels
What is dyspnoea
Breathlessness
Why might a pregnant women experience dyspnoea
- Oxygen demands increase
- The pattern of cheat movements alters at the uterus enlarges and limits movement of diaphragm
- Progesterone induces changes that promote respiratory exchange and hyperventilation
Why might a pregnant women experience anaemia
Primarily reflects increased circulating volume to meet the needs of the placenta as well as the women
What does a flow heart murmur reflect in a pregnant
Reflects hyper dynamic circulation as the heart works harder to pump the increased circulating volume
By how much does cardiac output increase during pregnancy
30-50%
Pregnancy increases the risk of T________ F_________ and…..
Thrombus formation and thrombosis- embolism (DVT and PE)
How much weight can a women gain during pregnancy
12kg
What oral complications can pregnant women experience
- Plaque induced inflammation often worsens
2. Pregnant epulis
Give examples of some pre existing lines that may be considered high risk pregnancies
- Diabetes
- HIV
- Renal transplant
- Systemic lupus erythematous
What do we do in a high risk pregnancies
Close monitoring and greater medical care from the outset with close monitoring and greater medical care from the outset to reduce the risks to the women and increase the likelihood of a good outcome from the pregnancy
What can sjögrens syndrome increase the likelihood of in pregnant women
Leads to 1 in 20 risk of permeant heart block in the foetus which persists after birth
Why can sjögrens syndrome be problematic for a foetus
Maternal Ro antibodies can cross the placenta and damage the developing foetal heart
Name some significant illnesses that arise in pregnancy for the first time
- Gestational diabetes mellitus
2. Pre eclampsia or eclampsia
How common is Pre eclampsia or eclampsia
5-10% pregnancies develop pre eclampsia
When does Pre eclampsia or eclampsia usually arise
Most 3rd trimester but may occur in the second
What is pre eclampsia characterised by
- Hypertension
- Oedema
- Proteinuria
What is proteinuria
Protein lost inappropratley in the urine signifying end organ renal damage due to the HTN
What is eclampsia
It is an extension of pre eclampsia characterised by seizures
Give some risk factors for Pre eclampsia or eclampsia
- <20 or >40 years of age
- Pre existing hypertension
- Obesity
- First pregnancy
- Twin pregnancy
- Previous pre eclampsia
What can Pre eclampsia or eclampsia increase the risk of
Risk of pregnancy related morbidity and mortality
What can er prescribe to patients with high blood pressure
Anti hypertensive drugs
How do we treat Pre eclampsia or eclampsia
Delivery of the baby is the only intervention that resolves Pre eclampsia or eclampsia
Give examples of maternal infections that may lead to significant foetal developmental abnormalities
- The ToRCH infections
- Measles
- Syphilis
Name the ToRCH infections
Toxoplasmosis
Rubella,
Cytomegalovirus,
Herpes Zoster Virus
How can you get Toxoplasmosis
By eating food infected with cat faeces
Name some maternal infections that spread to the baby via vertical transmission
- HIV
- Hep B and C
- Measles
- HSV
How is immunity from rubella usually acquired
- Previous infection
2. Immunisation
How is immunity from Varicella Zoster Virus usually acquired
Immunity to VZV is very high and typically reflects childhood chickenpox
What can Varicella Zoster Virus cause
Significant developmental abnormalities in the unborn foetus eg blindness, paralysis and seizures
When are the e risk from Varicella Zoster Virus greatest
Greatest in the first trimester with 10% babies affected
What can chicken pox cause in pregnant mothers
Miscarriage or pre term labour
When can we manage Varicella Zoster Virus
Interventions may be useful only if given very early after the infection
How is immunity from Herpes Simplex Virus usually acquired
It Is very high and reflects childhood primary herpes infection
What can primary HSV infection lead to to
Miscarriage and premature Labour
How is immunity from measles usually acquired
- Previous infection
2. MMR vaccine
What can measles cause in pregnant women
Can cause serious illness and increases the risks of miscarriage or premature labour and associated risk to the baby
What does IVF stand for
In-vitro fertilisation
What does IVF allow
Ive allows many couples who cannot conceive naturally to have a child together
What requirement do couples have to complete before being considered for IVF
Must have been trying to conceive for at least a year
What does IVF involve
- Ovarian hyper stimulation and egg collection
- Collected eggs are mixed with sperm in Vitro
- Zygotes are removed from eh Petri dish at the 4 cell cycle and transferred to 4th recipients uterus
What is the success rate for IVF
30% per cycle
How much does IVF cost
£3000-£4000 per cycle in the private sector
Does the NHS cover IVF
In Leeds the NHS will fund only one cycle if the couple has no children and the woman is <40 yrs
What risks can IVF pose to women
Ovarian hyper stimulation may prove fatal
How many zygotes are usually inserted into the mother
2
What problems are associated with post natal period
- Breast feeding breast engorged with milk can be uncomfortable
- Baby blue and general low Mood
- Post natal depression
What problems can we encounter when administrating amide LA to a pregnant mother
Levels of this protein fall in pregnancy meaning that more LA is freely available in the circulation
Greater risk of LA toxicity
What are some things we need to consider in terms of vasoconstrictors and pregnancy
May cause vasoconstriction of the blood vessels of the placenta reducing blood supply to the embryo/ foetus
Give examples of some antibiotics that are considered safe with regards to teratogenicity
- Penicillins
- Cephalosporins
- Erythromycin
Which drugs should we be weary of prescribing to pregnant women
- Metronidazole
2. Tetracyclines
Why do we avoid prescribing metronidazole in pregnant woman
Cited as potential teratogenic
Why do we avoid prescribing Tetracyclines in pregnant woman
Can cause yellow/ brown/ grey discolouration of mineralised tissues including teeth and bone if the foetus is exposed to the drugs which cross the placenta
Name the first choice of analgesia to give to pregnant woman
Paracetamol
Which analgesia should be avoided giving to pregnancy women
- Aspirins
- NSAIDs
- COX-2 inhibitors
What should Aspirin, NSAIDs and COX-2 inhibitors be avoided in pregnant patients
- Antiplateltt effects
- May exacerbate fluid retention
- In third trimester NSAID can lead to premature closure of the ductus arteriosus
Can we prescribe Benzodiazepines to pregnant women
No as they are considered teratogenic
Will every pregnant woman tell you they are pregnant
no some mat not know as many pregnancies are unplanned
What is a rule of thumb regarding treating pregnant women
- Avoid non urgent oral health care in the first trimester
2. Oral healthcare can be safely undertaken in the 2nd and 3rd trimesters but positioning on chair may be difficult
How can we position pregnant women in their 2nd or 3rd trimester
The left lateral decubitus position with the right buttock and hip elevated by 15 ̊ reduces aorto-caval compression
Give examples of women’s health unrelated to pregnancy
- Breast cancer
- Cervical cancer
- Endometrial cancer
- Ovarian cancer
- Hysterectomy
- Endometriosis
- PCOS
Name the most common cancer in the uk
Breast cancer
How many women annually are diagnosed with breast cancer
49,500 Women
More than 100 a day
Can men get breast cancer
Yes each year 400 men are diagnosed with breast cancer
Have breast cancer rates increased or decreased in the last 20 years
Increased by more than 50%
Where in the world is there the highest risk of breast cancer
North Europe, north America
Is breast cancer fatal
Yes
How many people die from breast cancer in the uK
11,500 WOMEN AND 75 MEN
In whom is breast cancer most common
8 in 10 breast cancers are diagnosed in women aged 50 years plus
Who is most likely to die from breast cancer
More than half of breast cancer deaths are in women aged 70 or over
Name the most common cause of death from cancer
Lung then breast
Who do we invite for a breast cancer screening
Targets 50-70 year old
They are invited every 3-5 years
Is the breast cancer screening effective
Yes it picks up around 14,000 cases annually
What is breast cancer management based on
- Disease staging
- Co morbid diseases
- Patients wishes
How can we manage and treat breast cancer
- Surgery (in most)
- Radiotherapy
- Some cancers are hormone sensitive and many patients receive tamoxifen or similar drugs
List some risk factors for breast cancer
- Increasing age
- Early age art menarche
- Older age
- Parity (number of live births)- less is more risk
- Late menopause
- Oral contraceptive
- HRT increases breast cancer risk and lowers sensitivity of mammograms
- Overweight and obesity increases the risk
- Alcohol intake
- Family history
What can be protective against breast cancer
Breastfeeding
How common is cervical cancer
3200 new cases per year
What is the peak age of cervical cancer
30-39 years
How many deaths are caused by cervical cancer
890 deaths per year
List some risk factors for cervical cancer
- Tobacco smoking
2. HPV especially subtype HPV 16 and 18
What is cervical cancer
A SCC of the cervical
What is endometrial cancer
It is an adenocarcinoma of the uterine endometrium
How common is endometrial cancer
9300 new cases per year
How many deaths are caused by endometrial cancer
2200 deaths per year
In which age is endometrial cancer most common
55-69 years
What can increase the risk of developing endometrial cancer
- Obesity
- tamoxifen
- Combines OCP use
- Pregnancy
- Low parity
How do we treat endometrial cancer
Perform hysterectomy
What is ovarian cancer
Adenocarcinoma of the ovary
How common is ovarian cancer
7000 new cases
How many deaths are caused by ovarian cancer
4300 deaths per year
In which age is ovarian cancer most common
55-74 years
List some protective factors for ovarian cancer
- Pregnancy
- High parity
- Breast-feeding
What do we mean by parity
Live births
What is a hysterectomy
A commonly undertaken surgical removal of the uterus via an abdominal or vaginal approach
When might a hysterectomy be indicated
- Heavy painful, prolonged or irregular periods
- Due to fibroids
- Due to malignancy
What are fibroids
vey common, leiomyomas (benign overgrowth of uterine muscle) which are mostly asymptomatic but can cause heavy painful irregular periods
How common is endometriosis
Affects around 2 million women in the uK
At what age is endometriosis most common
25-40
How do endometriosis causing cells behave
They behave as if they would inside the uterus and therefore shed blood during the menstrual cycle
These trapped tissues lead to pain, swelling and bleeding wherever they are migrated to
Name the most common symptoms of endometriosis
Pain or discomfort but some women are asymptomatic
How can we manage endometriosis
- NSAIDs for analgesia
- Hormone manipulaiton
- Surgery including ablation of foci of endometrial cells
- Hysterectomy and bilateral
What does PCOS stand for
POLYCYSTIC OVARIAN SYNDROME
PCOS is commonly diagnosed in women with
- Anovulatory infertility
- Oligomenorrhoea
- Hyperandrogenic problems such as hirsutism and acne
What is Anovulatory infertility
failure to ovulate so can’t conceive)
What is Oligomenorrhoea
light periods
What is PCOS associated with
Obesity
Metabolic syndrom
Type 2 diabetes