new HTN - headache - visual disturbance - swelling - RUQ pain - HELLP

womens health Flashcards by Nicholas Prescott

what is red degeneration and how does it present?

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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what symptoms occur in Meig’s syndrome?

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

Pleural effusion

Ascites

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main risk factor for Cervical cancer

HPV !! (16 + 18)

Dont forget that HPV is transmitted sexually

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risk factors for vulval cancer

HPV
lichen sclerosis
age

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presentation and diagnosis of a hydatidiform mole

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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diagnosis of GU prolapse

Sims speculum

bimanual exam (exclude pelvic masses)

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bishops score- factors and interpretation

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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describe normal CTG

- 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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raised/ decreased HR on CTG

raised- maternal pyrexia, chorioamnionitis, hypoxia, prematurity

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

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loss of baseline variability on CTG

prematurity/ hypoxia

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causes of late decelerations on CTG

foetal distress- asphyxia/ placental insufficiency

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cause of variable decelerations on CTG

cord compression

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what is a complete miscarriage

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

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

<12 weeks:

mifepristone
then misoprostol 36-48h later

> 12 weeks:
- vaginal misoprostol

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when can surgical management be used in a miscarriage

<13 weeks

plus give anti-D

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Complications of gestational diabetes

SMASH

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

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

aspirin at 12 weeks

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Sx of pre-eclampsia

new HTN

headache
visual disturbance
swelling
RUQ pain
HELLP

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Tx of moderate and severe pre-eclampsia

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

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

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What Hypertension meds must be AVOIDED during pregnancy

ACE inhibitors
ARB’s
thiazide-like diuretics

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what hypertensive meds are SAFE in pregnancy

labetalol (not all beta blockers though)

CCB’s

Alpha blockers (doxazosin)

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what anti-epileptics are safe during pregnancy?

lamotrigine
carbamazepine
levetiracetam

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what anti-epileptics must be avoided and why?

sodium valporate- neural tube defects and developmental delay

Phenytoin- cleft lip and palate

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

safe:

hydroxychloroquine
sulfasalazine
corticosteroids

not safe:
- Methotrexate

risks of SSRI use in first and 3rd trimester

1st- congenital heart defects 1st- paroxetine- liked with congenital malformations 3rd- persistent pulmonary HTN

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

Mullerian duct

presentation of imperforate hymen

cyclical pelvic pain cramping but without vaginal bleeding !!

complication of imperforate hymen

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

features of prolactinoma

- bitemporal hemianopia - amenorrhoea - osteoporosis and fractures - galactorrhoea - headaches - vaginal dryness

treatment of prolacitnoma

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

Tx of PPH

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

presentation of Sheehan's syndrome

decreased lactation (due to low prolactin) amenorrhoea (decreased FSH, LH) Adrenal insufficiency/ crisis (low cortisol) Hypothyroidism

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

sertraline and paroxetine

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

continuous incontinence during day and night with a history of surgery

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

dye testing

when is VTE prophylaxis used in pregnancy?

from 28 weeks if 3 risk factors are present first trimester if more than 3 risk factors

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

booking and again after birth LMWH- enoxaparin, dalteparin and tinzaparin prophylaxis stopped during labour !! and continued after (unless PPH)

How is VTE in pregnancy diagnosed?

DVT- doppler PE- Chest X ray, ECG definitive ! = CTPA, VQ scan cannot use D-dimer as this is raised anyway in pregnancy

when are women screened for anaemia during pregnancy?

booking 28 weeks

normal haemoglobin concentrations at: - booking - 28 weeks - post-partum

booking- >110g/L 28 weeks >105g/L post-partum >100g/L

what is the Kleihauer test?

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

UTI in pregnancy- what antitbiotics can be used and when

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

features of group B strep infection in pregnancy (maternal)

UTI Chorioamnionitis- fever, lower abdominal tenderness, foul discharge, maternal/ foetal tachycardia Endometritis- fever, abdo pain, foul discharge

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

deafness (5-7 weeks) cataracts (8-9 weeks) cardiac lesions (5-10 weeks)

congenital defects associated with cytomegalovirus

IUGR Microcephaly Hepatoslenomegaly Thrombocytopenia Jaundice Chorioetinitis

tx of toxoplasmosis (tx of infected mother)

Spiramycin

3 key features of fetal varicella syndrome

in the neonate: - skin scarring - eye defects - neurological abnormalities

Tx of infants with gonorrhoea

cefotaxime and chloramphenicol

what must be given to the mother after an instrumental delivery

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

foetal risk due to a ventrose delivery

cephalohaematoma

foetal risk due to a forceps delivery

facial nerve palsy

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

femoral nerve obturator nerve

failure to progress- 'passage' problems

cephalopelvic disproportion (MOST COMMON CAUSE OF OBSTRUCTED LABOUR) bony tumour of the pelvis soft tissue obstruction- fibroids/ cervical dystocia

failure to progress- 'power' problems

weak uterine contractions- can give oxytocin to help

failure to progress- 'passenger' problems

- malpresentations - twins - macrosomia

most common cause of obstructed labour/ failure to progress

cephalopelvic disproportion (passage and passenger problem)

causes of fetal marcosomia

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