Womens health Flashcards
What happens to BP in the first half of pregnancy?
Falls
How long do different contraceptives take to be effective?
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
Doses of folic acid used in pregnancy?
400mcg unless risk then 5mg
IUD id copper or mirena?
Device is copper
Non-hormonal treatment for vasomotor symptoms of menopause?
SSRIs
For how long after birth do you not need contraception?
21 days
What fluid level is defined as oligohydramnios and what are the cuases?
<500ml
premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia
Timetable of antenatal appointments?
8 - 12 weeks (ideally < 10 weeks)
- Booking visit
- general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
- BP, urine dipstick, check BMI
- Booking bloods/urine
- FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
- hepatitis B, syphilis
- HIV test is offered to all women
- urine culture to detect asymptomatic bacteriuria
10 - 13+6 weeks
- Early scan to confirm dates, exclude multiple pregnancy
11 - 13+6 weeks
- Down’s syndrome screening including nuchal scan
16 weeks
- Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron
- Routine care: BP and urine dipstick
18 - 20+6 weeks
- Anomaly scan
25 weeks (only if primip) - Routine care: BP, urine dipstick, symphysis-fundal height (SFH)
28 weeks
- Routine care: BP, urine dipstick, SFH
- Second screen for anaemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
- First dose of anti-D prophylaxis to rhesus negative women
31 weeks (only if primip) - Routine care as above
34 weeks
- Routine care as above
- Second dose of anti-D prophylaxis to rhesus negative women*
- Information on labour and birth plan
36 weeks
- Routine care as above
Check presentation - offer external cephalic version if indicated
- Information on breast feeding, vitamin K, ‘baby-blues’
38 weeks
- Routine care as above
40 weeks (only if primip)
- Routine care as above
- Discussion about options for prolonged pregnancy
41 weeks
- Routine care as above
- Discuss labour plans and possibility of induction
Diagnostic criteria for hyperemesis gravidarum?
- 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalance
Smear results what to do if HPV +ve but cytology normal?
Repeat in 1 year,
If the repeat test is now hrHPV negative they can return to normal recall.
If the repeat test is still hrHPV positive and cytology is still normal they should have a further repeat test 12 months later. This is the case for the patient in the scenario.
If the second repeat test at 24 months is negative for hrHPV, they can return to normal recall.
If the second repeat test at 24 months is positive for hrHPV, they should be referred for colposcopy.
How to interpret smear results?
Cytology only done if HPV +ve
If no HPV - normal recall
if HPV +ve but normal cytology the repeat in 12 months (twice)
If cytology abnormal then - colposcopy
If inadequate then repeat within 3 months and if inadequate again then colposcopy
Management of women who have previously had gestational diabetes?
Women who have previously had gestational diabetes should have an oral glucose tolerance test as soon as possible after booking
Recurrent thrush treatment?
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
Depot provera contraception SEs?
Weight gain and risk of osteoporosis
Issues with abx and COCP - what advice should you give?
Only need to worry if its an enzyme inducing abx (rifampicin)
Management of PCOS?
Generally:
- Weight loss
- COCP if needs contraception
Hirsuitism and ACNE
- a COC pill may be used help manage hirsutism. A third generation COC which has fewer androgenic effects or co-cyprindiol which has an anti-androgen action. May carry an increased risk of venous thromboembolism
- if doesn’t respond to COC then topical eflornithine may be tried
- spironolactone, flutamide and finasteride may be used under specialist supervision
Infertility:
- Weight loss (specialist management)
- Clomifene is superior to metformin
- Gonadotrophins
Bishops score use and result meaning?
Used to calculate if will go into labour
<8 unlikely
>8 likely
If inducing labour what is first line?
Membrane sweep
then vaginal prostaglandins
then oxytocin or rupture of membranes or ‘cervical ripening balloon’
First line treatment for mennorhagia?
Mirena coil
cervical excitation indicates what?
Pelvic inflammatory disease, ectopic pregnancy, ovarian torsion
What drugs should be avoided in breast feeding?
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone
Management of gestational diabetes?
- newly diagnosed women should be seen in a joint diabetes and antenatal clinic within a week
- women should be taught about self-monitoring of blood glucose
- advice about diet (including eating foods with a low glycaemic index) and exercise should be given
if the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered
- if glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started
- if glucose targets are still not met insulin should be added to diet/exercise/metformin
- gestational diabetes is treated with short-acting, not long-acting, insulin
if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started
if the plasma glucose level is between 6-7 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered
glibenclamide should only be offered for women who cannot tolerate metformin or those who fail to meet the glucose targets with metformin but decline insulin treatment
When should you give the MMR to a pregnant woman if she wants it?
Postnatally if she is not immune
Hormone bloods in menopause?
raised FSH, LH levels
e.g. FSH > 40 iu/l
low oestradiol
e.g. < 100 pmol/l
What age would you say menopause was premature?
<40
When do patients with secondary dysmenorrhoea need to be referred to gynaecology?
Always
Examples of antimuscarinic meds?
Solifenacin, tolterodine and oxybutynin
UKMEC 4 absolute contraindication to COCP rules with age and smoking?
More than 35 years old and smoking more than 15 cigarettes/day
Methods of abortion as per length on pregnancy?
less than 9 weeks: mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins to stimulate uterine contractions
less than 13 weeks: surgical dilation and suction of uterine contents
more than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
Management of PMS?
mild symptoms can be managed with lifestyle advice
apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)
examples include Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg)
severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)
this may be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length)
Management of BGS (group b strep) in pregnancy?
women who’ve had GBS detected in a previous pregnancy should be informed that their risk of maternal GBS carriage in this pregnancy is 50%. They should be offered intrapartum antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive
if women are to have swabs for GBS this should be offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date
IAP should be offered to women with a previous baby with early- or late-onset GBS disease
IAP should be offered to women in preterm labour regardless of their GBS status
women with a pyrexia during labour (>38ºC) should also be given IAP
benzylpenicillin is the antibiotic of choice for GBS prophylaxis
Presentation of placental abruption?
shock out of keeping with visible loss pain constant tender, tense uterus normal lie and presentation fetal heart: absent/distressed coagulation problems beware pre-eclampsia, DIC, anuria
Does placenta praevia present with abdo pain?
No
What is adenomyosis?
extension of endometrial tissue into the uterine myometrium.
- presents with dysmenorrhoea
How often is smear testing?
Age 25 years: first invitation.
Age 25-49 years: screening every 3 years.
Age 50-64 years: screening every 5 years.
How do contraceptive agents prevent pregnancy?
Combined oral contraceptive pill
- Inhibits ovulation
Progestogen-only pill (excluding desogestrel)
- Thickens cervical mucus
Desogestrel-only pill
- Primary: Inhibits ovulation
- Also: thickens cervical mucus
Injectable contraceptive (medroxyprogesterone acetate) - Primary: Inhibits ovulation
Implantable contraceptive (etonogestrel)
- Primary: Inhibits ovulation
- Also: thickens cervical mucus
Intrauterine contraceptive device
- Decreases sperm motility and survival
Intrauterine system (levonorgestrel)
- Primary: Prevents endometrial proliferation
- Also: Thickens cervical mucus
Which HPV viruses are associated with cancer and which warts?
16 and 18 cancer (and 33)
11 and 6 are warts
Higher is worse
Patients with diabetes (T1 or 2) - what changes to drug therapy during pregnancy?
take aspirin 75mg daily from 12 weeks gestation to reduce the risk of pre-eclampsia.
5mg folic acid daily, whilst trying to conceive until 12 weeks gestation
If above 50 y/o and on contraception what contraception needs to be stopped/switched?
Oestrogen methods - i.e. COCP and depo-provera
When should you remove the IUD for <50 and >50 women
> 50 after 1 year of amennorhoea
<50 after 2 years of amenorrhoea
Phases of the menstrual cycle?
Menstruation 1-4
Follicular phase (proliferative phase) 5-13
Ovulation 14
Luteal phase (secretory phase) 15-28
A surge in what hormone leads to ovulation?
LH