womens health Flashcards
what cancer is nulliparity a risk factor for?
endometrial
what is primary amenorrhoea?
menstruation has never begun
By 13 years when there is no other evidence of pubertal development
By 15 years of age where there are other signs of puberty, such as breast bud development
causes of primary amenorrhoea
hypogonadotrophic hypogonadism
hypergonadotrophic hypogonadism
kallmann’s
Turner’s
congenital adrenal hyperplasia
androgen insensitivity syndrome
structural problems- imperforate hymen, vaginal agenesis, FGM
what is hypogonadotrophic hypogonadism?
Hypogonadotropic hypogonadism involves deficiency of LH and FSH, leading to deficiency of the sex hormones (oestrogen)
causes of hypogonadotrophic hypogonadism
Hypopituitarism
Damage to the hypothalamus or pituitary
cystic fibrosis or inflammatory bowel disease
Excessive exercise or dieting
Constitutional delay in development
growth hormone deficiency, hypothyroidism, Cushing’s or hyperprolactinaemia
Kallman syndrome
what is hypergonadotrophic hypogonadism?
Hypergonadotropic hypogonadism is where the gonads fail to respond to stimulation from the gonadotrophins (LH and FSH). Without negative feedback from the sex hormones (oestrogen), the anterior pituitary produces increasing amounts of LH and FSH. Consequently, you get high gonadotrophins (“hypergonadotropic”) and low sex hormones (“hypogonadism”)
causes of hypergonadotrophic hypogonadism
damage to the gonads- ovarian torsion, cancer, mumps
congenital absence of ovaries
Turners syndrome
mechanism of action of oxybutynin
anti-muscarinic
features of Sheehans syndrome
amenorrhoea
reduced lactation
adrenal insufficiency/ addisons crisis
hypothyroidism
investigations done in suspected infertility (female)
measure serum progesterone on day 21/ 7 days from next expected period
3 key features in meigs syndrome
a benign ovarian tumour
ascites
pleural effusion
drugs to avoid when breastfeeding
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
presentation of Intrahepatic cholestasis of pregnancy (also known as obstetric cholestasis)
pruritus - may be intense - typical worse palms, soles and abdomen
clinically detectable jaundice occurs in around 20% of patients
raised bilirubin is seen in > 90% of cases
management of intrahepatic cholestasis of pregnancy
induction of labour at 37-38 weeks
ursodeoxycholic acid
vitamin K supplementation
if risk factors for pre eclampsia present what should we offered and till when?
aspirin 75-150mg daily from 12 weeks gestation until the birth
risk factors of a breech presentation
uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality (e.g. CNS malformation, chromosomal disorders)
prematurity (due to increased incidence earlier in gestation)
risk factors for shoulder dystocia
fetal macrosomia (hence association with maternal diabetes mellitus)
high maternal body mass index
diabetes mellitus
prolonged labour
what is included in the bishop score?
Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Fetal station
bishop score interpretation
a score of < 5 indicates that labour is unlikely to start without induction
a score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour
induction of labour- stages
membrane sweep
prostaglandin E2 infusion
oxytocin infusion
amniotomy
cervical ripening balloon
complication of induction of labour
uterine hyperstimulation- the main complication of induction of labour
refers to prolonged and frequent uterine contractions - sometimes called tachysystole
potential consequences
intermittent interruption of blood flow to the intervillous space over time may result in fetal hypoxemia and acidemia
uterine rupture (rare)
pregnancy- obesity- what 2 things are different during the pregnancy (monitoring and medication)?
obese women should take 5mg of folic acid, rather than 400mg for the 1st trimester
all obese women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks
downs syndrome screening- combined test results and when is this done
these tests should be done between 11 - 13+6 weeks
Down’s syndrome is suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency
downs syndrome screening- triple and quadruple tests- when is this done and what is included?
triple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin
quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin-A
causes of oligohydramnios
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia
GBS prophylaxis- what antibiotic is used?
benzylpenicillin
which SSRI’s are safe during pregnancy?
sertralline and paroxetine
contraceptives- time until effective
Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
Trichomonas treatment
oral metronidazole
Gestational diabetes- management if fasting glucose >7
insulin +/- metformin
how long does a mirena coil last
5 years
breast cancer screening
mammorgram every 3 years 50-70
medical management of termination of pregnancy
mifepristone and prostaglandins
oestrogren receptor +ve breast cancer- pre and post- menopausal management
pre= tamoxifen
post= aromatase inhibitors (anastrazole)
medical management of a missed miscarriage
vaginal misoprostol
how long is lactational amenorrhoea a viable contraceptive for?
6 months- providing they are amenorhhoeic + breastfeeding exclusively
side effect of POP
irregular bleeding
