Womens health Flashcards
1
Q
How do we split up pregnancy
A
In three phases:
1st, 2nd, 3rd trimester
2
Q
How do we write how many weeks a patient is pregnant
A
x/40
eg 10 weeks pregnant= 10/40
3
Q
What is the pregnancy mortality rate in the UK
A
7/10,000
4
Q
Name the most common cause of mortality in pregnancy
A
Thromboembolism leading to Deep vein thrombosis and pulmonary embolus
5
Q
What is though to lead to a higher risk of maternal death in the future
A
Obesity and rising material age
6
Q
What is the range of a normal pregnancy
A
37-42 weeks
7
Q
How many pregnancies fail in the first trimester
A
1 in4-5 pregnancies fail here
8
Q
What can cause spontaneous miscarriage int eh first trimester
A
Significant genetic abnormalities
9
Q
What increases the risk of pregnancy los
A
Increasing maternal age
10
Q
What is formed by the end of the first trimester
A
All the major organs
11
Q
When is the foetus potentially viable
A
24 weeks
12
Q
What is a miscarriage
A
Pregnancy loss before 24 weeks
13
Q
What is a pregnancy lost after 24 weeks caused
A
intrauterine death (still birth)
14
Q
What is an ectopic pregnancy
A
A pregnancy outside of the uterus
15
Q
How common is ectopic pregnancy
A
Occurs in 1 in 300 pregnancies
16
Q
Where are ectopic pregnancies usually found
A
In the Fallopian tube
17
Q
Give some symptoms of ectopic pregnancy
A
- Extreme nausea
- Abdominal pain
- Vaginal bleeding
18
Q
Are ectopic pregnancies successful
A
No
19
Q
What happens if an ectopic pregnancies is left untreated
A
Will lead to rupture of the Fallopian tube with a potential fatal haemorrhage
20
Q
How are ectopic pregnancies managed
A
Terminated via resection the involved Fallopian tube and or via methotrexate
21
Q
Up to how many weeks is it legal to terminate a pregnancy for social rasosn
A
12-14 weeks
22
Q
Which substances must we advise pregnant mothers to stay away from
A
Tobacco and alcohol
23
Q
How does tobacco affect the foetus
A
Can lead to growth restriction
24
Q
How does alcohol affect the foetus
A
Can cause foetal alcohol syndrome if taken in large amounts
25
When do pregnant mothers usually book appoitnemtns with doctors
12 weeks
20 weeks
babies birth
26
What happens at the 12 week appointment
1. Booking bloods
| 2. 1st Ultrasound
27
What do we aim to find in the 1st scan
1. Dating the foetus
2. Initial screening
3. Viability scan
28
What happens at the 20 week appointment
Look fo anatomy and any serious abnormalities
29
How are most babies delivered
In the hospitals with the help of midwife
30
When might medical intervention be required during birth
1. Elective Caesarian section
| 2. Failure to progress once in labour
31
What do we recommend pregnant women carry with them at all times .
Their obstetric notes
32
What do obstetric notes usually include
1. Contact info of the doctor
2. Blood tests
3. Blood pressure recordings
4. Ante-natal visits documented
33
What common changes occur to women in pregnancy
1. Nausea and vomiting
2. Hypotension
3. Breathlessness (dyspnoea)
4. Anaemia
5. Flow heart murmur
6. Procoagulant state
7. Gastro-oesophageal reflux (GORD)
8. Chloasma or melasma
9. Fluid retention
10. Urinary urgency
11. Skeletal pain
12. Weight gain
13. Haemorrhoids
14. Periodontal disease
34
When is nausea and vomiting worse for pregnant women
Weeks 6-12
35
Why do pregnant women experience nausea and vomiting
Relates to the levels of beta-HCG from trophoblast during placental development
36
What leads to hypertension in pregnant women
Vascular muscular relaxation
37
Which type of hypotension can be a particular problem in pregnant women
Postural hypotension
38
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
39
What is dyspnoea
Breathlessness
40
Why might a pregnant women experience dyspnoea
1. Oxygen demands increase
2. The pattern of cheat movements alters at the uterus enlarges and limits movement of diaphragm
3. Progesterone induces changes that promote respiratory exchange and hyperventilation
41
Why might a pregnant women experience anaemia
Primarily reflects increased circulating volume to meet the needs of the placenta as well as the women
42
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
43
By how much does cardiac output increase during pregnancy
30-50%
44
Pregnancy increases the risk of T________ F_________ and.....
Thrombus formation and thrombosis- embolism (DVT and PE)
45
How much weight can a women gain during pregnancy
12kg
46
What oral complications can pregnant women experience
1. Plaque induced inflammation often worsens
| 2. Pregnant epulis
47
Give examples of some pre existing lines that may be considered high risk pregnancies
1. Diabetes
2. HIV
3. Renal transplant
4. Systemic lupus erythematous
48
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
49
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
50
Why can sjögrens syndrome be problematic for a foetus
Maternal Ro antibodies can cross the placenta and damage the developing foetal heart
51
Name some significant illnesses that arise in pregnancy for the first time
1. Gestational diabetes mellitus
| 2. Pre eclampsia or eclampsia
52
How common is Pre eclampsia or eclampsia
5-10% pregnancies develop pre eclampsia
53
When does Pre eclampsia or eclampsia usually arise
Most 3rd trimester but may occur in the second
54
What is pre eclampsia characterised by
1. Hypertension
2. Oedema
3. Proteinuria
55
What is proteinuria
Protein lost inappropratley in the urine signifying end organ renal damage due to the HTN
56
What is eclampsia
It is an extension of pre eclampsia characterised by seizures
57
Give some risk factors for Pre eclampsia or eclampsia
1. <20 or >40 years of age
2. Pre existing hypertension
3. Obesity
4. First pregnancy
5. Twin pregnancy
6. Previous pre eclampsia
58
What can Pre eclampsia or eclampsia increase the risk of
Risk of pregnancy related morbidity and mortality
59
What can er prescribe to patients with high blood pressure
Anti hypertensive drugs
60
How do we treat Pre eclampsia or eclampsia
Delivery of the baby is the only intervention that resolves Pre eclampsia or eclampsia
61
Give examples of maternal infections that may lead to significant foetal developmental abnormalities
1. The ToRCH infections
2. Measles
3. Syphilis
62
Name the ToRCH infections
Toxoplasmosis
Rubella,
Cytomegalovirus,
Herpes Zoster Virus
63
How can you get Toxoplasmosis
By eating food infected with cat faeces
64
Name some maternal infections that spread to the baby via vertical transmission
1. HIV
2. Hep B and C
3. Measles
4. HSV
65
How is immunity from rubella usually acquired
1. Previous infection
| 2. Immunisation
66
How is immunity from Varicella Zoster Virus usually acquired
Immunity to VZV is very high and typically reflects childhood chickenpox
67
What can Varicella Zoster Virus cause
Significant developmental abnormalities in the unborn foetus eg blindness, paralysis and seizures
68
When are the e risk from Varicella Zoster Virus greatest
Greatest in the first trimester with 10% babies affected
69
What can chicken pox cause in pregnant mothers
Miscarriage or pre term labour
70
When can we manage Varicella Zoster Virus
Interventions may be useful only if given very early after the infection
71
How is immunity from Herpes Simplex Virus usually acquired
It Is very high and reflects childhood primary herpes infection
72
What can primary HSV infection lead to to
Miscarriage and premature Labour
73
How is immunity from measles usually acquired
1. Previous infection
| 2. MMR vaccine
74
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
75
What does IVF stand for
In-vitro fertilisation
76
What does IVF allow
Ive allows many couples who cannot conceive naturally to have a child together
77
What requirement do couples have to complete before being considered for IVF
Must have been trying to conceive for at least a year
78
What does IVF involve
1. Ovarian hyper stimulation and egg collection
2. Collected eggs are mixed with sperm in Vitro
3. Zygotes are removed from eh Petri dish at the 4 cell cycle and transferred to 4th recipients uterus
79
What is the success rate for IVF
30% per cycle
80
How much does IVF cost
£3000-£4000 per cycle in the private sector
81
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
82
What risks can IVF pose to women
Ovarian hyper stimulation may prove fatal
83
How many zygotes are usually inserted into the mother
2
84
What problems are associated with post natal period
1. Breast feeding breast engorged with milk can be uncomfortable
2. Baby blue and general low Mood
3. Post natal depression
85
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
86
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
87
Give examples of some antibiotics that are considered safe with regards to teratogenicity
1. Penicillins
2. Cephalosporins
3. Erythromycin
88
Which drugs should we be weary of prescribing to pregnant women
1. Metronidazole
| 2. Tetracyclines
89
Why do we avoid prescribing metronidazole in pregnant woman
Cited as potential teratogenic
90
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
91
Name the first choice of analgesia to give to pregnant woman
Paracetamol
92
Which analgesia should be avoided giving to pregnancy women
1. Aspirins
2. NSAIDs
3. COX-2 inhibitors
93
What should Aspirin, NSAIDs and COX-2 inhibitors be avoided in pregnant patients
1. Antiplateltt effects
2. May exacerbate fluid retention
3. In third trimester NSAID can lead to premature closure of the ductus arteriosus
94
Can we prescribe Benzodiazepines to pregnant women
No as they are considered teratogenic
95
Will every pregnant woman tell you they are pregnant
no some mat not know as many pregnancies are unplanned
96
What is a rule of thumb regarding treating pregnant women
1. 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
97
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
98
Give examples of women's health unrelated to pregnancy
1. Breast cancer
2. Cervical cancer
3. Endometrial cancer
4. Ovarian cancer
5. Hysterectomy
6. Endometriosis
7. PCOS
99
Name the most common cancer in the uk
Breast cancer
100
How many women annually are diagnosed with breast cancer
49,500 Women
| More than 100 a day
101
Can men get breast cancer
Yes each year 400 men are diagnosed with breast cancer
102
Have breast cancer rates increased or decreased in the last 20 years
Increased by more than 50%
103
Where in the world is there the highest risk of breast cancer
North Europe, north America
104
Is breast cancer fatal
Yes
105
How many people die from breast cancer in the uK
11,500 WOMEN AND 75 MEN
106
In whom is breast cancer most common
8 in 10 breast cancers are diagnosed in women aged 50 years plus
107
Who is most likely to die from breast cancer
More than half of breast cancer deaths are in women aged 70 or over
108
Name the most common cause of death from cancer
Lung then breast
109
Who do we invite for a breast cancer screening
Targets 50-70 year old
| They are invited every 3-5 years
110
Is the breast cancer screening effective
Yes it picks up around 14,000 cases annually
111
What is breast cancer management based on
1. Disease staging
2. Co morbid diseases
3. Patients wishes
112
How can we manage and treat breast cancer
1. Surgery (in most)
2. Radiotherapy
3. Some cancers are hormone sensitive and many patients receive tamoxifen or similar drugs
113
List some risk factors for breast cancer
1. Increasing age
2. Early age art menarche
3. Older age
4. Parity (number of live births)- less is more risk
5. Late menopause
6. Oral contraceptive
7. HRT increases breast cancer risk and lowers sensitivity of mammograms
8. Overweight and obesity increases the risk
9. Alcohol intake
10. Family history
114
What can be protective against breast cancer
Breastfeeding
115
How common is cervical cancer
3200 new cases per year
116
What is the peak age of cervical cancer
30-39 years
117
How many deaths are caused by cervical cancer
890 deaths per year
118
List some risk factors for cervical cancer
1. Tobacco smoking
| 2. HPV especially subtype HPV 16 and 18
119
What is cervical cancer
A SCC of the cervical
120
What is endometrial cancer
It is an adenocarcinoma of the uterine endometrium
121
How common is endometrial cancer
9300 new cases per year
122
How many deaths are caused by endometrial cancer
2200 deaths per year
123
In which age is endometrial cancer most common
55-69 years
124
What can increase the risk of developing endometrial cancer
1. Obesity
2. tamoxifen
3. Combines OCP use
4. Pregnancy
5. Low parity
125
How do we treat endometrial cancer
Perform hysterectomy
126
What is ovarian cancer
Adenocarcinoma of the ovary
127
How common is ovarian cancer
7000 new cases
128
How many deaths are caused by ovarian cancer
4300 deaths per year
129
In which age is ovarian cancer most common
55-74 years
130
List some protective factors for ovarian cancer
1. Pregnancy
2. High parity
3. Breast-feeding
131
What do we mean by parity
Live births
132
What is a hysterectomy
A commonly undertaken surgical removal of the uterus via an abdominal or vaginal approach
133
When might a hysterectomy be indicated
1. Heavy painful, prolonged or irregular periods
2. Due to fibroids
3. Due to malignancy
134
What are fibroids
vey common, leiomyomas (benign overgrowth of uterine muscle) which are mostly asymptomatic but can cause heavy painful irregular periods
135
How common is endometriosis
Affects around 2 million women in the uK
136
At what age is endometriosis most common
25-40
137
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
138
Name the most common symptoms of endometriosis
Pain or discomfort but some women are asymptomatic
139
How can we manage endometriosis
1. NSAIDs for analgesia
2. Hormone manipulaiton
3. Surgery including ablation of foci of endometrial cells
4. Hysterectomy and bilateral
140
What does PCOS stand for
POLYCYSTIC OVARIAN SYNDROME
141
PCOS is commonly diagnosed in women with
1. Anovulatory infertility
2. Oligomenorrhoea
3. Hyperandrogenic problems such as hirsutism and acne
142
What is Anovulatory infertility
failure to ovulate so can’t conceive)
143
What is Oligomenorrhoea
light periods
144
What is PCOS associated with
Obesity
Metabolic syndrom
Type 2 diabetes
