Womens Health Flashcards
What is the most common identifiable cause of PCB?
Cervical ectopion - around 33% of cases, common in women on the COCP
What should be given to pregnant women who are epileptic to prevent neural tube defects?
Folic acid 5mg per day starting now
At what age are women first invited for cervical screening and how often does it occur?
25
- Every 3 years from 25-49
-Every 5 years from 50-64
Risk factors for endometrial cancer?
-Nullparity
-Late menopause
-Obesity
-Early menarche
- Unopposed oestrogen
-Diabetes
Tamoxifen
PCOS
What is the investigation for gestational diabetes and when should it be carried out?
Oral glucose tolerance test at 24-28 weeks
Which contraceptive option is effective immediately?
IUD (Copper coil)
What are the diagnostic levels for Gestational Diabetes?
Fasting glucose >= 5.6mmol/L
2-hour glucose >= 7.8mmol/L
“5678”
What are the components of the APGAR score?
Pulse, respiratory effort, colour, muscle tone and reflex irritability
How should umbilical cord prolapse be managed?
Keeping the umbilical cord warm and moist to avoid vasospasm
Time until effective contraceptives?
IUD = Instant
POP = 2 days
COCP, injection, implant and IUS = 7 days
How often are contractions expected in established labour?
5 every 10 minutes
What should fetal baseline rate lie between?
110-160bpm
Normal baseline variability on a CTG?
5-25bpm
What are accelerations in CTG and how often should they occur?
Rise in fetal heart rate of at least 15bpm, lasting 15 seconds or more.
There should be 2 separate accelerations every 15 minutes.
First line drug therapy for stress incontinence?
Duloxetine (SNRI) - increases sphincter tone in filling phase. Pelvic floor exercises should be trialled before this and surgery considered.
What are brisk tendon reflexes associated with?
Pre-eclampsia
Definiton of pre-eclampsia?
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.
High risk factors for pre-eclampsia?
Hypertensive disease in previous pregnancy
CKD
Autoimmune e.g. SLE, APL syndrome
T1/2DM
Chronic HTN
Management of pre-eclampsia?
Emergency secondary care assessment when suspected
Oral labetalol (nifedpine if asthmatic)
Delivering baby is most important management step.
Moderate risk factors for pre-eclampsia?
Primigravida
40 or older
> 10 years since last pregnancy
BMI of 35 or more at first visit
Family history
Multiple pregnancy
Preventative treatment for pre-eclampsia?
Should be given if 1 or more high risk factors or 2 or more moderate: Aspirin 75-150mg daily from 12 weeks til birth
Risk factors associated with placental abruption?
Increasing maternal age
Multiparity
Maternal trauma
Cocaine use
Proteinuric HTN
Previous abruption
Clinical features of placental abruption?
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
Diagnosis of placental abruption?
USS shows retroplacental collection of blood
May have blood or blood stained amniotic fluid coming pv
Categories of C-section?
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
Indications for C-section?
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
What should be given to manage/prevent seizures during eclampsia?
Magnesium sulfate until 24 hours after last seizure or delivery. IV bolus of 4g over 5-10 mins followed by infusion of 1g/hour
Definition of eclampsia?
Development of generalised tonic-clonic seizures in association with pre-eclampsia
Risk factors for ovarian cancer?
Family history - Mutations in BRCA1 or BRCA2 genes
Many ovulations e.g. early menarche, late menopause, nullparity
Indications for induction of labour?
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
Classifications of perineal tears?
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
Risk factors for perineal tears?
Primigravida
Large babies
Precipitant labour
Shoulder dystocia
Forceps delivery
Presentation of vasa praevia?
Rupture of membranes followed by painless vaginal bleeding and fetal bradycardia
Presentation of placenta praevia?
Vaginal bleeding, no pain. Non-tender uterus but lie and presentation may be abnormal
What is used to classify severity of N&V in pregnancy?
Pregnancy-Unique Quantification of Emesis (PUQE) scoring system
When should booking visit be?
8-12 weeks
When should the anomaly scan take place?
18-20+6 weeks
Normal blood findings in pregnancy?
Reduced urea, reduced creatinine, increased urinary protein loss
First line for ectopic pregnancy requiring surgical management?
Laparoscopic salpingectomy and monitoring
What is given for medical management of an ectopic?
Methotrexate
What are the stages of labour?
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
Symptoms of fibroid degeneration during pregnancy?
Low-grade fever, pain and vomiting
Causes of PPH?
4 T’s:
Tone - Uterine atony, most common cause
Trauma - perineal tear
Tissue - retained placenta
Thrombin - coagulopathy
Definition of PPH?
Blood loss of > 500ml within 24 hours of vaginal delivery (primary) or from 24 hours to 6 weeks after delivery (secondary)
Management of breech presentation?
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
When should progesterone levels be taken to confirm ovulation?
7 days before next expected period
First-line management for Menorrhagia?
IUS (Mirena coil)
What should you do when a woman with placenta praevia goes into labour?
Emergency C-Section
When should first dose of anti-d prophylaxis be given to a rhesus negative woman?
28 weeks
At what gestational age is the early scan to confirm dates
10 - 13+6 weeks
Findings in DIC?
Thrombocytopenia
Low fibrinogen
Prolonged PT and PTT
Raised D-dimer
First line non-hormonal treatment for painless heavy menstrual bleeding?
Tranexamic acid
Diagnostic criteria for hyperemesis gravidarum?
5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance
When can the IUS be inserted after childbirth?
Either within 48 hours of birth or after 4 weeks
Drugs used for termination of pregnancy?
Oral mifepristone in combination with misoprostol pv
What age does a child have to be to be unable to consent to sexual intercourse, regardless of if they are Gillick competent?
Under 13
Treatment for endometriosis?
- Simple analgesia
- COCP or progestogen
- referral to secondary care
First line management of eclampsia?
IV Magnesium Sulfate
Diagnostic test for uterine fibroids?
transvaginal USS
Medical treatment to reduce size of fibroids?
GnRH agonists e.g. Leuprolide
Surgical management options for fibroids
Myomectomy
Hysteroscopic endometrial ablation
Hysterectomy
What is the only form of contraceptive not contraindicated in breast cancer?
IUD/Copper coil
Criteria for gestational hypertension?
Over 20 weeks gestation
No proteinuria
BP > 140/90 or increase in booking bp by more than 30/15
Features of mittelschmerz?
Mid-cycle pain
Often sharp onset
Little systemic disturbance
May have recurrent episodes
Usually settles over 24-48 hours
What anticoagulants are contraindicated in pregnancy and what should the mother be switched to?
DOAC’s e.g. rivaroxaban, apixaban are contraindicated
Should be switched to LMWH
Differences between partial and complete hydatidiform mole?
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
Features of invasive mole?
-Invades myometrium
-Tumour-like
-Follows a complete mole
- May resolve spontaneously
- Less aggressive than true cancer
Clinical features of gestational Trophopblastic disease?
-Bleeding in early pregnancy
-Exagg pregnancy symptoms e.g. excessive hyperemesis
-Early-onset pre-eclampsia or hyperthyroidism
-Uterus large for dates
Investigations in trophoblastic disease?
- USS, reveals ‘snowstorm’ appearance
- Serum BhCG grossly elevated
- CXR to exclude mets
Management of trophoblastic disease?
-Suction curettage, with oxytocin infusion
-Histological analysis of tissue
-Hysterectomy if family complete.
Presentation of threatened miscarriage?
-PAINLESS pv bleed before 24 weeks, usually 6-9 weeks
-Bleeding less than menstruation
-CERVICAL OS CLOSED
Presentation of missed/delayed miscarriage?
Gestational sac contains dead fetus before 20 weeks without symptoms of expulsion
May have light pv bleed/discharge
Os is CLOSED
Presentation of inevitable miscarriage?
Heavy bleeding, clots pain
Os is OPEN
Presentation of incomplete miscarriage?
Not all products expelled
Pain and pv bleeding
Os is OPEN
Whirlpool sign on USS is indicative of?
Ovarian torsion
When should external cephalic version be offered in breech babies?
36 weeks gestation (or 37 weeks in multiple pregnancy)
Normal physiological changes to blood pressure in pregnancy?
Falls in first half before rising to pre-pregnancy levels before term
What is hCG secreted by?
Syncytiotrophoblasts
Screening tool for postnatal depression?
Edinburgh scale
Management of PPH?
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
Treatment for PMS?
Mild Sx - lifestyle advice- complex carbs, sleep, exercise)
COCP if not contraindicated
SSRI in severe
Features of placenta praevia?
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
2 Main causes of APH?
Placental abruption and Placenta praevia
What position should be adopted in cord prolapse?
On all fours on knees and elbows
What manouvere should be performed in shoulder dystocia?
McRobert’s manouvere - hyperflex legs to abdomen and suprapubic pressure
Difference between placenta accreta, increta, percreta?
Accreta most common - abnormally adhered to superficial uterine wall
Increta - invades into myometrium
Percreta- invades through uterine serosa into pelvic cavity
Features of HELLP syndrome?
Haemolysis
Elevated Liver enymes
Low Platelets
Serious manifestation of pre-eclampsia
SSRIs for breastfeeding women?
Sertraline and paroxetine
Lynch syndrome causes which cancers?
Its the CEO of cancers (Colon, Endometrial, Ovarian)
How does migraine with aura affect HRT?
Not contraindicated, topical cyclical combined HRT preferred
How long is barrier protection needed when swapping from POP to COCP?
7 days
Antiemetic management in vomiting in pregnancy /hyperemesis gravidarum?
First line - oral cyclazine
2nd line - Ondansetron or domperidone
What drugs are Levonelle and EllaOne and when can they be taken?
Levonelle - levonorgestrel - Within 72 hours of unprotected sex
EllaOne - ulipristal acetate - Within 120 hours (5 days) of unprotected sex
Postpartum psychosis management?
Usually hospitalisation in a mother& baby unit
Maximum time pregnancy test can be positive following a termination?
4 weeks
Medical treatment for PPH caused by uterine atony?
Syntometrine (Oxytocin + ergometrine)
Carboprost and misoprostol
Gold standard investigation for placenta praevia?
Transvaginal USS
What is treatment for irregular bleeding on the implant?
3 months of COCP
Folic acid intake for pregnant women with BMI > 30?
5mg daily until 13th week
When should surgical management be used for ectopic pregnancy
> 35 mm in size
B-hCG > 5000
Fetal heartbeat
First line for infertility in PCOS?
Clomifene
Which medication for hyperemesis gravidarum can cause extrapyramidal effects?
Metoclopramide - if used for longer than 5 days
Medical management of miscarriage?
Vaginal misoprostol alone
When should methotrexate be stopped before conception?
At least 6 months before, for both men and women
When can the COCP be restarted post-partum?
From 21 days post-partum, due to increased VTE risk
Which contraceptive is most associated with weight gain?
Depo-provera, the injectable contraceptive
Risk factors for Hyperemesis Gravidarum?
Multiple pregnancy
Obesity
Epilepsy
Stress
Family Hx
Stages of ovarian cancer?
1 - Tumor confined to ovary
2- Outside ovary but within pelvis
3 - Outside pelvis but within abdomen
4- Distant mets
Which contraceptive is contraindicated in wheelchair users?
The COCP - UKMEC3 risks outweigh benefits
Treatment for vaginal vault prolapse?
Sacrocolpoplexy
Symptoms of chorioamnionitis?
Maternal fever , >38
WBC Raised
Maternal tachycardia >100
Fetal tachycardia >160
Uterine tenderness
Foul smelling vaginal discharge
