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Phase 3a- flashcards I forget > womens health > Flashcards

womens health Flashcards

1
Q

what is red degeneration and how does it present?

A

ischaemia, infarction and necrosis of the fibroid due to disrupted blood supply

severe abdominal pain, low-grade fever, tachycardia and often vomiting

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2
Q

what symptoms occur in Meig’s syndrome?

A

Ovarian fibroma (a type of benign ovarian tumour)- so an abdominal mass

Pleural effusion

Ascites

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3
Q

main risk factor for Cervical cancer

A

HPV !! (16 + 18)

Dont forget that HPV is transmitted sexually

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4
Q

risk factors for vulval cancer

A
  • HPV
  • lichen sclerosis
  • age
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5
Q

presentation and diagnosis of a hydatidiform mole

A
  • vaginal bleeding in early pregnancy
  • uterine evacuation in early pregnancy
  • exaggerated Sx- hyperemesis gravidarum
  • large uterus for dates
  • very high bhCG levels
  • USS- snowstorm appearance
  • histology
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6
Q

diagnosis of GU prolapse

A

Sims speculum

bimanual exam (exclude pelvic masses)

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7
Q

bishops score- factors and interpretation

A
  • station of foetus/ head
  • cervical length
  • cervical consistency
  • cervical effacement
  • cervical dilation

<5= induction likely needed (unlikely to start spontaneously)

> 8/9= likely to start spontaneously

scored out of 13

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8
Q

describe normal CTG

A 
- Normal CTG
o HR 110-160
o Variability >5bpm
o No decelerations
o Accelerations present - reassuring feature = when baby’s moving
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9
Q

raised/ decreased HR on CTG

A

raised- maternal pyrexia, chorioamnionitis, hypoxia, prematurity

decreases (<100)- increased foetal vagal tone, maternal beta blocker use

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10
Q

loss of baseline variability on CTG

A

prematurity/ hypoxia

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11
Q

causes of late decelerations on CTG

A

foetal distress- asphyxia/ placental insufficiency

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12
Q

cause of variable decelerations on CTG

A

cord compression

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13
Q

what is a complete miscarriage

A

TVUS= crown rump length >7mm, gestational sack >25mm + no foetal heartbeat

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14
Q

medical management of a misacarriage (before and after 12 weeks)

A

<12 weeks:

  • mifepristone
  • then misoprostol 36-48h later

> 12 weeks:
- vaginal misoprostol

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15
Q

when can surgical management be used in a miscarriage

A

<13 weeks

plus give anti-D

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16
Q

Complications of gestational diabetes

A

SMASH

Shoulder dystocia
Macrosomia 
Amniotic fluid excess (polyhydramnios)
Stillbirth 
HTN + neonatal hypoglycaemia
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17
Q

what should be given to women with RF’s of pre eclampsia

A

aspirin at 12 weeks

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18
Q

Sx of pre-eclampsia

A

new HTN

  • headache
  • visual disturbance
  • swelling
  • RUQ pain
  • HELLP
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19
Q

Tx of moderate and severe pre-eclampsia

A

mod (150-159/ 100-109)= labetalol

severe (>160/110)= labetalol and magnesium sulphate

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20
Q

What Hypertension meds must be AVOIDED during pregnancy

A

ACE inhibitors
ARB’s
thiazide-like diuretics

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21
Q

what hypertensive meds are SAFE in pregnancy

A

labetalol (not all beta blockers though)

CCB’s

Alpha blockers (doxazosin)

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22
Q

what anti-epileptics are safe during pregnancy?

A

lamotrigine
carbamazepine
levetiracetam

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23
Q

what anti-epileptics must be avoided and why?

A

sodium valporate- neural tube defects and developmental delay

Phenytoin- cleft lip and palate

24
Q

what drugs used in the management of RA are safe/ unsafe in pregnancy?

A

safe:

  • hydroxychloroquine
  • sulfasalazine
  • corticosteroids

not safe:
- Methotrexate

25
Q

risks of SSRI use in first and 3rd trimester

A

1st- congenital heart defects
1st- paroxetine- liked with congenital malformations

3rd- persistent pulmonary HTN

26
Q

from what embryonic structure does the vagina, cervix, uterus and fallopian tubes develop from?

A

Mullerian duct

27
Q

presentation of imperforate hymen

A

cyclical pelvic pain
cramping
but without vaginal bleeding !!

28
Q

complication of imperforate hymen

A

endometriosis (as blood cannot leave- can lead to retrograde menstruation)

29
Q

features of prolactinoma

A
  • bitemporal hemianopia
  • amenorrhoea
  • osteoporosis and fractures
  • galactorrhoea
  • headaches
  • vaginal dryness
30
Q

treatment of prolacitnoma

A

meds- dopamine agonists (bromocriptine and cabergoline)- as dopamine inhibits prolactin !!

surgery if fails

31
Q

Tx of PPH

A
  • bimanual uterine compression/ massage
  • IV oxytocin/ ergometrine
  • misoprostol
  • surgery- evacuation, balloon tamponade, hysterectomy
32
Q

presentation of Sheehan’s syndrome

A

decreased lactation (due to low prolactin)

amenorrhoea (decreased FSH, LH)

Adrenal insufficiency/ crisis (low cortisol)

Hypothyroidism

33
Q

what SSRI’s are safe to use in post-natal depression

A

sertraline and paroxetine

34
Q

incontinence- when would you consider a fistula as a possible diagnosis?

A

continuous incontinence during day and night with a history of surgery

35
Q

how can a diagnosis of a urethro-vaginal fistulae be confimed?

A

dye testing

36
Q

when is VTE prophylaxis used in pregnancy?

A

from 28 weeks if 3 risk factors are present

first trimester if more than 3 risk factors

37
Q

when is the VTE risk assessment done and what prophlyaxis is used?

A

booking and again after birth

LMWH- enoxaparin, dalteparin and tinzaparin

prophylaxis stopped during labour !! and continued after (unless PPH)

38
Q

How is VTE in pregnancy diagnosed?

A

DVT- doppler

PE- Chest X ray, ECG

definitive ! = CTPA, VQ scan

cannot use D-dimer as this is raised anyway in pregnancy

39
Q

when are women screened for anaemia during pregnancy?

A

booking

28 weeks

40
Q

normal haemoglobin concentrations at:

  • booking
  • 28 weeks
  • post-partum
A

booking- >110g/L

28 weeks >105g/L

post-partum >100g/L

41
Q

what is the Kleihauer test?

A

tests how much foetal blood has passed into the mothers after a sensitisation event

42
Q

UTI in pregnancy- what antitbiotics can be used and when

A

nitrofurantoin:

  • up to the 3rd trimester
  • in 3rd trimester increased risk of neonatal haemolysis

trimethoprim- do not use in first trimester (folate antagonist so can lead to neural tube defects)

amoxicillin and cefalexin are safe

43
Q

features of group B strep infection in pregnancy (maternal)

A

UTI

Chorioamnionitis- fever, lower abdominal tenderness, foul discharge, maternal/ foetal tachycardia

Endometritis- fever, abdo pain, foul discharge

44
Q

neonatal consequences of rubella infection (depending upon in which week of pregnancy the infection occurs)

A

deafness (5-7 weeks)

cataracts (8-9 weeks)

cardiac lesions (5-10 weeks)

45
Q

congenital defects associated with cytomegalovirus

A

IUGR

Microcephaly

Hepatoslenomegaly

Thrombocytopenia

Jaundice

Chorioetinitis

46
Q

tx of toxoplasmosis (tx of infected mother)

A

Spiramycin

47
Q

3 key features of fetal varicella syndrome

A

in the neonate:

  • skin scarring
  • eye defects
  • neurological abnormalities
48
Q

Tx of infants with gonorrhoea

A

cefotaxime and chloramphenicol

49
Q

what must be given to the mother after an instrumental delivery

A

single dose of co-amoxiclav to reduce risk of maternal infection

50
Q

foetal risk due to a ventrose delivery

A

cephalohaematoma

51
Q

foetal risk due to a forceps delivery

A

facial nerve palsy

52
Q

what nerve injuries can occur in the mother during an instrumental delivery?

A

femoral nerve

obturator nerve

53
Q

failure to progress- ‘passage’ problems

A

cephalopelvic disproportion (MOST COMMON CAUSE OF OBSTRUCTED LABOUR)

bony tumour of the pelvis

soft tissue obstruction- fibroids/ cervical dystocia

54
Q

failure to progress- ‘power’ problems

A

weak uterine contractions- can give oxytocin to help

55
Q

failure to progress- ‘passenger’ problems

A
  • malpresentations
  • twins
  • macrosomia
56
Q

most common cause of obstructed labour/ failure to progress

A

cephalopelvic disproportion (passage and passenger problem)

57
Q

causes of fetal marcosomia

A
  • constitutional
  • DM
  • multi-parity
  • hydrocephalus
  • hydrops fetalis

Phase 3a- flashcards I forget (8 decks)

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