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3a > Womens Health > Flashcards

Womens Health Flashcards

1
Q

What is the most common identifiable cause of PCB?

A

Cervical ectopion - around 33% of cases, common in women on the COCP

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2
Q

What should be given to pregnant women who are epileptic to prevent neural tube defects?

A

Folic acid 5mg per day starting now

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3
Q

At what age are women first invited for cervical screening and how often does it occur?

A

25
- Every 3 years from 25-49
-Every 5 years from 50-64

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4
Q

Risk factors for endometrial cancer?

A

-Nullparity
-Late menopause
-Obesity
-Early menarche
- Unopposed oestrogen
-Diabetes
Tamoxifen
PCOS

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5
Q

What is the investigation for gestational diabetes and when should it be carried out?

A

Oral glucose tolerance test at 24-28 weeks

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6
Q

Which contraceptive option is effective immediately?

A

IUD (Copper coil)

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7
Q

What are the diagnostic levels for Gestational Diabetes?

A

Fasting glucose >= 5.6mmol/L
2-hour glucose >= 7.8mmol/L
“5678”

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8
Q

What are the components of the APGAR score?

A

Pulse, respiratory effort, colour, muscle tone and reflex irritability

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9
Q

How should umbilical cord prolapse be managed?

A

Keeping the umbilical cord warm and moist to avoid vasospasm

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10
Q

Time until effective contraceptives?

A

IUD = Instant
POP = 2 days
COCP, injection, implant and IUS = 7 days

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11
Q

How often are contractions expected in established labour?

A

5 every 10 minutes

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12
Q

What should fetal baseline rate lie between?

A

110-160bpm

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13
Q

Normal baseline variability on a CTG?

A

5-25bpm

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14
Q

What are accelerations in CTG and how often should they occur?

A

Rise in fetal heart rate of at least 15bpm, lasting 15 seconds or more.
There should be 2 separate accelerations every 15 minutes.

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15
Q

First line drug therapy for stress incontinence?

A

Duloxetine (SNRI) - increases sphincter tone in filling phase. Pelvic floor exercises should be trialled before this and surgery considered.

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16
Q

What are brisk tendon reflexes associated with?

A

Pre-eclampsia

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17
Q

Definiton of pre-eclampsia?

A

New-onset hypertension >= 140/90 after 20 weeks of pregnancy AND 1 or more of following:

Proteinuria
Other organ involvement (Renal insufficiency, liver, neuro, haematological, uteroplacental dysfunction.

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18
Q

High risk factors for pre-eclampsia?

A

Hypertensive disease in previous pregnancy
CKD
Autoimmune e.g. SLE, APL syndrome
T1/2DM
Chronic HTN

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19
Q

Management of pre-eclampsia?

A

Emergency secondary care assessment when suspected
Oral labetalol (nifedpine if asthmatic)
Delivering baby is most important management step.

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20
Q

Moderate risk factors for pre-eclampsia?

A

Primigravida
40 or older
> 10 years since last pregnancy
BMI of 35 or more at first visit
Family history
Multiple pregnancy

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21
Q

Preventative treatment for pre-eclampsia?

A

Should be given if 1 or more high risk factors or 2 or more moderate: Aspirin 75-150mg daily from 12 weeks til birth

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22
Q

Risk factors associated with placental abruption?

A

Increasing maternal age
Multiparity
Maternal trauma
Cocaine use
Proteinuric HTN
Previous abruption

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23
Q

Clinical features of placental abruption?

A

Shock out of keeping with visible loss
Pain constant
Tender, tense uterus
Normal lie and presentation
Fetal heart - absent or distressed
Coag problems
Beware pre-eclampsia, DIC (abruption causes release of thromboplastin) , anuria

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24
Q

Diagnosis of placental abruption?

A

USS shows retroplacental collection of blood
May have blood or blood stained amniotic fluid coming pv

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25
Q

Categories of C-section?

A

Cat 1 - immediate threat to mother/baby, delivery within 30 mins. E.g. cord prolapse, major abruption, uterine rupture.

Cat 2 - mother/baby compromise , not immediately life threatening, delivery within 75 minutes

Cat 3 - delivery required but mother/baby stable

Cat 4 - Elective caesarean

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26
Q

Indications for C-section?

A

Absolute cephalopelvic disproportion
Placenta praevia grade 3/4
Pre-eclampsia
Post-maturity
IUGR
Fetal distress in labour
Failure for labour to progress
Placental abruption with fetal distress
Vaginal infection e.g. active herpes
Cervical cancer

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27
Q

What should be given to manage/prevent seizures during eclampsia?

A

Magnesium sulfate until 24 hours after last seizure or delivery. IV bolus of 4g over 5-10 mins followed by infusion of 1g/hour

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28
Q

Definition of eclampsia?

A

Development of generalised tonic-clonic seizures in association with pre-eclampsia

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29
Q

Risk factors for ovarian cancer?

A

Family history - Mutations in BRCA1 or BRCA2 genes
Many ovulations e.g. early menarche, late menopause, nullparity

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30
Q

Indications for induction of labour?

A

Prolonged pregnancy e.g. 1-2 weeks after due date
Prelabour premature rupture of membranes
Diabetic mother > 38 weeks
pre-eclampsia
rhesus incompatibility
Bishop score < 5

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31
Q

Classifications of perineal tears?

A

First degree - superficial damage, no muscle , no repair required

Second degree - injury to perineal muscle but not anal sphincter, requires suturing on ward

Third degree - involving anal sphincter complex, repair in theatre

Fourth degree - involves rectal mucosa, repair in theatre

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32
Q

Risk factors for perineal tears?

A

Primigravida
Large babies
Precipitant labour
Shoulder dystocia
Forceps delivery

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33
Q

Presentation of vasa praevia?

A

Rupture of membranes followed by painless vaginal bleeding and fetal bradycardia

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34
Q

Presentation of placenta praevia?

A

Vaginal bleeding, no pain. Non-tender uterus but lie and presentation may be abnormal

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35
Q

What is used to classify severity of N&V in pregnancy?

A

Pregnancy-Unique Quantification of Emesis (PUQE) scoring system

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36
Q

When should booking visit be?

A

8-12 weeks

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37
Q

When should the anomaly scan take place?

A

18-20+6 weeks

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38
Q

Normal blood findings in pregnancy?

A

Reduced urea, reduced creatinine, increased urinary protein loss

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39
Q

First line for ectopic pregnancy requiring surgical management?

A

Laparoscopic salpingectomy and monitoring

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40
Q

What is given for medical management of an ectopic?

A

Methotrexate

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41
Q

What are the stages of labour?

A

Stage 1 - from onset of true labour to when cervix is fully dilated

Stage 2 - from full dilation to delivery of fetus

Stage 3 - from delivery of fetus to when placenta and membranes have been completely delivered

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42
Q

Symptoms of fibroid degeneration during pregnancy?

A

Low-grade fever, pain and vomiting

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43
Q

Causes of PPH?

A

4 T’s:
Tone - Uterine atony, most common cause
Trauma - perineal tear
Tissue - retained placenta
Thrombin - coagulopathy

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44
Q

Definition of PPH?

A

Blood loss of > 500ml within 24 hours of vaginal delivery (primary) or from 24 hours to 6 weeks after delivery (secondary)

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45
Q

Management of breech presentation?

A

If < 36 weeks many fetuses will turn spontaneously
If still breech at 36 weeks, external cephalic version
If baby is still breech then c-section

46
Q

When should progesterone levels be taken to confirm ovulation?

A

7 days before next expected period

47
Q

First-line management for Menorrhagia?

A

IUS (Mirena coil)

48
Q

What should you do when a woman with placenta praevia goes into labour?

A

Emergency C-Section

49
Q

When should first dose of anti-d prophylaxis be given to a rhesus negative woman?

A

28 weeks

50
Q

At what gestational age is the early scan to confirm dates

A

10 - 13+6 weeks

51
Q

Findings in DIC?

A

Thrombocytopenia
Low fibrinogen
Prolonged PT and PTT
Raised D-dimer

52
Q

First line non-hormonal treatment for painless heavy menstrual bleeding?

A

Tranexamic acid

53
Q

Diagnostic criteria for hyperemesis gravidarum?

A

5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance

54
Q

When can the IUS be inserted after childbirth?

A

Either within 48 hours of birth or after 4 weeks

55
Q

Drugs used for termination of pregnancy?

A

Oral mifepristone in combination with misoprostol pv

56
Q

What age does a child have to be to be unable to consent to sexual intercourse, regardless of if they are Gillick competent?

A

Under 13

57
Q

Treatment for endometriosis?

A
  1. Simple analgesia
  2. COCP or progestogen
  3. referral to secondary care
58
Q

First line management of eclampsia?

A

IV Magnesium Sulfate

59
Q

Diagnostic test for uterine fibroids?

A

transvaginal USS

60
Q

Medical treatment to reduce size of fibroids?

A

GnRH agonists e.g. Leuprolide

61
Q

Surgical management options for fibroids

A

Myomectomy
Hysteroscopic endometrial ablation
Hysterectomy

62
Q

What is the only form of contraceptive not contraindicated in breast cancer?

A

IUD/Copper coil

63
Q

Criteria for gestational hypertension?

A

Over 20 weeks gestation
No proteinuria
BP > 140/90 or increase in booking bp by more than 30/15

64
Q

Features of mittelschmerz?

A

Mid-cycle pain
Often sharp onset
Little systemic disturbance
May have recurrent episodes
Usually settles over 24-48 hours

65
Q

What anticoagulants are contraindicated in pregnancy and what should the mother be switched to?

A

DOAC’s e.g. rivaroxaban, apixaban are contraindicated
Should be switched to LMWH

66
Q

Differences between partial and complete hydatidiform mole?

A

Partial mole: Triploid , 2 sperms 1 egg, more common, rarely malignant
Complete: less common, no fetal tissue, sperm fertilises empty egg, diploid, 10% risk of malignancy

67
Q

Features of invasive mole?

A

-Invades myometrium
-Tumour-like
-Follows a complete mole
- May resolve spontaneously
- Less aggressive than true cancer

68
Q

Clinical features of gestational Trophopblastic disease?

A

-Bleeding in early pregnancy
-Exagg pregnancy symptoms e.g. excessive hyperemesis
-Early-onset pre-eclampsia or hyperthyroidism
-Uterus large for dates

69
Q

Investigations in trophoblastic disease?

A
  • USS, reveals ‘snowstorm’ appearance
  • Serum BhCG grossly elevated
  • CXR to exclude mets
70
Q

Management of trophoblastic disease?

A

-Suction curettage, with oxytocin infusion
-Histological analysis of tissue
-Hysterectomy if family complete.

71
Q

Presentation of threatened miscarriage?

A

-PAINLESS pv bleed before 24 weeks, usually 6-9 weeks
-Bleeding less than menstruation
-CERVICAL OS CLOSED

72
Q

Presentation of missed/delayed miscarriage?

A

Gestational sac contains dead fetus before 20 weeks without symptoms of expulsion
May have light pv bleed/discharge
Os is CLOSED

73
Q

Presentation of inevitable miscarriage?

A

Heavy bleeding, clots pain
Os is OPEN

74
Q

Presentation of incomplete miscarriage?

A

Not all products expelled
Pain and pv bleeding
Os is OPEN

75
Q

Whirlpool sign on USS is indicative of?

A

Ovarian torsion

76
Q

When should external cephalic version be offered in breech babies?

A

36 weeks gestation (or 37 weeks in multiple pregnancy)

77
Q

Normal physiological changes to blood pressure in pregnancy?

A

Falls in first half before rising to pre-pregnancy levels before term

78
Q

What is hCG secreted by?

A

Syncytiotrophoblasts

79
Q

Screening tool for postnatal depression?

A

Edinburgh scale

80
Q

Management of PPH?

A

1st line - uterine massage and catheter
2nd line - oxytocin, carboprost, ergimetrine (if BP normal)
3rd line - balloon tamponade, B-lynch suture, ligation of uterine or internal iliac arteries
Hysterectomy is last resort

81
Q

Treatment for PMS?

A

Mild Sx - lifestyle advice- complex carbs, sleep, exercise)
COCP if not contraindicated
SSRI in severe

82
Q

Features of placenta praevia?

A

Shock in proportion to physical loss
No pain
Uterus non-tender
Lie and presentation may be abnormal
Fetal heart normal
Coag problems rare
Small bleeds before large

83
Q

2 Main causes of APH?

A

Placental abruption and Placenta praevia

84
Q

What position should be adopted in cord prolapse?

A

On all fours on knees and elbows

85
Q

What manouvere should be performed in shoulder dystocia?

A

McRobert’s manouvere - hyperflex legs to abdomen and suprapubic pressure

86
Q

Difference between placenta accreta, increta, percreta?

A

Accreta most common - abnormally adhered to superficial uterine wall
Increta - invades into myometrium
Percreta- invades through uterine serosa into pelvic cavity

87
Q

Features of HELLP syndrome?

A

Haemolysis
Elevated Liver enymes
Low Platelets
Serious manifestation of pre-eclampsia

88
Q

SSRIs for breastfeeding women?

A

Sertraline and paroxetine

89
Q

Lynch syndrome causes which cancers?

A

Its the CEO of cancers (Colon, Endometrial, Ovarian)

90
Q

How does migraine with aura affect HRT?

A

Not contraindicated, topical cyclical combined HRT preferred

91
Q

How long is barrier protection needed when swapping from POP to COCP?

A

7 days

92
Q

Antiemetic management in vomiting in pregnancy /hyperemesis gravidarum?

A

First line - oral cyclazine
2nd line - Ondansetron or domperidone

93
Q

What drugs are Levonelle and EllaOne and when can they be taken?

A

Levonelle - levonorgestrel - Within 72 hours of unprotected sex
EllaOne - ulipristal acetate - Within 120 hours (5 days) of unprotected sex

94
Q

Postpartum psychosis management?

A

Usually hospitalisation in a mother& baby unit

95
Q

Maximum time pregnancy test can be positive following a termination?

A

4 weeks

96
Q

Medical treatment for PPH caused by uterine atony?

A

Syntometrine (Oxytocin + ergometrine)
Carboprost and misoprostol

97
Q

Gold standard investigation for placenta praevia?

A

Transvaginal USS

98
Q

What is treatment for irregular bleeding on the implant?

A

3 months of COCP

99
Q

Folic acid intake for pregnant women with BMI > 30?

A

5mg daily until 13th week

100
Q

When should surgical management be used for ectopic pregnancy

A

> 35 mm in size
B-hCG > 5000
Fetal heartbeat

101
Q

First line for infertility in PCOS?

A

Clomifene

102
Q

Which medication for hyperemesis gravidarum can cause extrapyramidal effects?

A

Metoclopramide - if used for longer than 5 days

103
Q

Medical management of miscarriage?

A

Vaginal misoprostol alone

104
Q

When should methotrexate be stopped before conception?

A

At least 6 months before, for both men and women

105
Q

When can the COCP be restarted post-partum?

A

From 21 days post-partum, due to increased VTE risk

106
Q

Which contraceptive is most associated with weight gain?

A

Depo-provera, the injectable contraceptive

107
Q

Risk factors for Hyperemesis Gravidarum?

A

Multiple pregnancy
Obesity
Epilepsy
Stress
Family Hx

108
Q

Stages of ovarian cancer?

A

1 - Tumor confined to ovary
2- Outside ovary but within pelvis
3 - Outside pelvis but within abdomen
4- Distant mets

109
Q

Which contraceptive is contraindicated in wheelchair users?

A

The COCP - UKMEC3 risks outweigh benefits

110
Q

Treatment for vaginal vault prolapse?

A

Sacrocolpoplexy

111
Q

Symptoms of chorioamnionitis?

A

Maternal fever , >38
WBC Raised
Maternal tachycardia >100
Fetal tachycardia >160
Uterine tenderness
Foul smelling vaginal discharge

3a (9 decks)

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