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Phase 3A Quiz > Womens Health > Flashcards

Womens Health Flashcards

1
Q

Factors that increase your risk of a cystocele?

A

childbirth, age, obesity, chronic constipation and heavy lifting, chronic coughing, previous pelvic surgery

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2
Q

Signs and symptoms for cystocele

A

Feeling that something has dropped out of your vagina
Leaking urine
Feeling of incomplete emptying of bladder.

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3
Q

Treatment for cystocele

A

Vaginal pessary

Cystocele repair surgery

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4
Q

Diagnostics for Cystocele?

A

Pelvic Exam
Urodynamics
Bladder Function tests

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5
Q

What is a cystocele

A

Weakening of the wall between bladder and vagina. Causing bladder to drop/sag into vagina

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6
Q

What are the weeks for the 3 trimesters?

A

1st - 1 to 12 (3M)
2nd - 13 to 27 (6/7M)
3rd - 28 to 41 (7-9M)

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7
Q

How long before contraceptives becomes effective?

IUD, POP, COC

A

Instant: IUD
2 Days: POP
7 Days: COC, injection, IUS

If not taken on the first day period.

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8
Q

What can reduce the effect of the contraceptive pill?

A

Liver enzymes inducing drugs

Vomiting within 2 hours of taking the COC pill

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9
Q

What happens to BP during pregnancy?

A

BP falls in 1st trimester till 20-24 wks.

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10
Q

When do urinalysis for pre-eclampsia what findings would you expect?

A

Proteinuria (>0.3g/300mg/ 24H)

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11
Q

Define Pre-eclampsia

A

Pregnancy characterised by an onset of high bp and significant amount of protein in the urine.

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12
Q

What is PID?

A

Pelvic Inflammatory Disease - Acute ascending polymicrobal infection of the female gynaecological tract.

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13
Q

What pathogens are commons causes of PID?

A

Chlamydia trachomatis

Neisseria gonorrhoeae

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14
Q

Clinical features of PID?

A 
Lower abdominal pain 
Abnormal vaginal discharge
Fever
Nausea and vomiting
Vaginal discharge w/foul odor 
Dysuria
Lower back paid.
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15
Q

Treatment for PID?

A

Antibiotics
Ceftriaxone(IM) + Doxycycline (Oral 2 weeks)

Sexual contact(s) treatment - STI evaluation + antibiotics

Consider IUD removal - If origin of infection. 
IV Hydration (If needed)
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16
Q

Complications of PID?

A

Infertility (Increased risk with repeated episodes)
Ectopic pregnancy
Tubual damage - fallopian tube

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17
Q

Risk factors for PID?

A 
Prior STI infection - Gonorrhoea, chlamydia
Young age onset of sexual activity. 
Unprotected sex w/multiple partners
PMH of PID 
IUD use
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18
Q

What is IUGR?

A

Intrauterine growth restriction -

When a baby in the womb (fetus) does not grow as expected. The baby is not as big as would be expected for the stage of the mother’s pregnancy (gestational age).

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19
Q

Define Dysmenorrhoea?

A

Period Pains

painful cramping (in the lower abdomen)
occurs shortly before or during menstruation,
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20
Q

What are the types of dysmenorrhoea?

Treatment?

A

Primary - In young females in the absence of any identifiable underlying pelvic pathology. Caused by the production of uterine prostaglandins during menstruation, which causes uterine contractions and pain.

Secondary - Pain caused by underlying pelvic pathology - PID, IUD insertion, Fibroids, Endometriosis

Secondary causes must be excluded before primary diagnosis.

1st Line - Mefanamic Acid / Ibuprofen (NSAIDS)
2nd Line - COCP

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21
Q

RF for dysmenorrhoea?

A

Early age at menarche,
Heavy menstrual flow,
Nulliparity (Haven’t given birth)
FH of dysmenorrhoea.

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22
Q

What must always be considered in females of reproductive age for acute abdominal pain?

A

ECTOPIC PREGNACNY

Primary differential until proven otherwise.

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23
Q

At what time is the greatest risk of an IUCD falling will being rejected?

A

Within 5 Days of fitting IUCD (20%)

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24
Q

What is the Gold Standard investigation for endometriosis?

A

Laparoscopy

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25
Q

What are triple swabs?

A

Three swabs taken in vagina and cervix to look for signs of bacterial infection.

Endocervical charcoal swab - Gonorrhoea
High vag charcoal swab - Trichomonas Vaginalis (protozoa), Candida, BV, Group B strep
Endoservical NAAT swab - Chlamydia & Gonorrhoea

Nucleic acid amplification test (NAAT)

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26
Q

What levels of hCG indicate pregnancy?

A

> > 25 U/L

Takes 2 weeks for hCG levels to be high enough to be detected in your urine.

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27
Q

What Gravida?

A

The number of pregnancies a women has had regardless of the outcomes.

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28
Q

What is Parity?

A

The number of deliveries after 20 weeks gestation

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29
Q

What is the digit system to review a women’s obstetric history?

A

G - Gravida (Total number of pregnancies)
T - Term births (Number delivered 37W+)
P - Preterm births (Number delivered <37W)
A - Abortion (Number of abortions, miscarriages, ectopic pregnancies <20W)
L - Living Children

+1,2,3 etc… = Still Births

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30
Q

Define Antepartum Haemorrhage (APH)?

A

Any vaginal bleeding from 24 weeks gestation until delivery.

2-5% of all pregnancies

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31
Q

Causes for APH?

A

Placental Abruption
Placenta Praevia

Rarer cases - uterine rupture, cervical lesions (polyps), Infection, Trauma, malignancy

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32
Q

Define early pregnancy loss

A

Pregnancy loss before 12 completed weeks.

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33
Q

How is bleeding in early pregnancy defined?

A

Bleeding that occurs within the first 24 weeks of gestation

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34
Q

Define Miscarriage?

A

Pregnancy loss under 24 weeks (20 Weeks WHO)

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35
Q

What is a crown rump length?

A

Length of the foetus from top of its head to the bottom of torso.

Most accurate estimation of gestational age in early pregnancy

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36
Q

What is HDN?

A

Haemorrhagic disease of the newborn - Bleeding disorder of newborn occurring after birth

3 Types - Early, Classic, Late

Early (within 24 hours of birth) - Due to drugs taken by the mum in pregnancy passing through the placenta and inhibiting vitamin K activity.

Classsic (D1-D7) - when babies don’t get enough vitamin K through breast milk.

Late (2-12Wks) - Babies not absorbing vitamin K because of liver disease or not getting enough vitamin K in their feeds.

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37
Q

Risk Factors for HDN?

A

Pre-term infant
Forcep delivery, C-section, Ventouse
Bruising during birth
Breathing issues/ Liver issues / poorly at birth
Mothers on - Epileptic meds, anticoagulants, TB mess
Breastfed babies (Formula has fortified vitamin K)

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38
Q

How is HDN prevented

A

Neonates are given IM Vit K once they have been born.

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39
Q

How would you be able to differentiate between the ABDOMINAL pain of uterine contractions and placental abruption.

A

Abruption - Continuous + Constant pain

Contractions - Intermittent pattern

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40
Q

Normal amount of contractions during labour

A

3-4 every 10 mins

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41
Q

What causes abnormalities in uterine contractions?

A

Overdistension of uterus - Polyhydramnios/multiple gestation, Macrosomia

Functional/anatomical distortion of uterus - placenta praevia, fibroids, prolonged labour

Uterine relaxants - Nifedipine, magnesium sulphate, GTN, Terbutaline

Bladder distension - Prevents uterine contractions

Intra-amniotic infection - Chorioamnionitis (from prolonged rupture of membranes)

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42
Q

Define Macrosomia?

A

Newborn who’s much larger than average
>8lbs13oz (>4kg)

BW Above 90th Centile

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43
Q

Define Concealed pregnancy?

Possible involvement of which services?

A

Female through fear, ignorance or denial does not accept or is unaware of the pregnancy in an appropriate way.

Safeguarding Team, Social services, Psychiatric services

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44
Q

What is a still birth?

A

Fetal death at or after 24 weeks of pregnancy. baby born without signs of life.

1 every 200 births

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45
Q

Signs of life after birth?

A 
Crying 
Breathing 
Active body movement 
Heartbeat 
Pulsation of the umbilical cord
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46
Q

How many weeks is considered late presentation to maternity services?

A

20 Weeks

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47
Q

What is precipitous labor?

A

Rapid labor followed by expulsion of fetes <3hrs

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48
Q

What are uterotonics?

Name some?

A

Pharmacological agents used to induce contraction/increase the tonicity of the uterus.

Synthetic oxytocin (Syntocin), Ergometrine (Syntometrine), carboprost (PGF2Alpha), Misoprostol (PGE1)

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49
Q

What is Misoprostol used for?

A

Induce Abortion / Treat PPH

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50
Q

What drugs are used for abortion?

A

Misoprostol + mifepristone

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51
Q

Risk factors for Primary PPH

Before Birth (9) ?
During Labours (7) ?
A

Before Birth

Previous PPH in a pregnancy
BMI > 35
Having had 4+ babies before
Multiple Gestation
South Asian ethnicity
Placenta Praevia 
Placental abruption
Pre-eclampsia and/or high blood pressure
Anaemia

During Labour

Caesarean Section
Induction of Labour
Retained placenta
Episiotomy (a cut to help delivery) 
Forceps or ventouse delivery
Labour >12 hours
Macrosomia
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52
Q

Define Placenta Abruption?

A

Separation of the placenta from the uterine resulting in maternal haemorrhage into the intervening space.

  • Constant Abdo Pain + Vaginal bleeding
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53
Q

What 3 signs indicate the placenta is ready to deliver?

A

Lengthening of the umbilical cord
Gush of blood
Uterus becomes more globular

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54
Q

What are the 3 abnormal placenta implantations?

A

Placenta Accreta (79%) - Chorionic villi attaches to uterine myometrium

Placenta Increta (14%) - Chronic villi invades the uterine myometrium

Placenta Percreta (7%) - Chorionic villi invade the uterine myometrium and serosa and beyond into adjacent organs (e.g. bladder)

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55
Q

What’s Salpingitis?

Most common causation?

A

Inflammation of the fallopian tubes.

Bacterial infection. (STIs- Gonorrhoea, Chylamdia)

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56
Q
  1. Define Amenorrhea?
  2. Define Dysmenorrhea?
  3. Define Menorrhagia?
A
  1. Absence of a period (Menstrual Cessation)
  2. Painful periods (Painful Mensuration)
  3. Heavy Menstrual bleeding (Increased frequency and volume of menstruation)
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57
Q

What is cervical motion tenderness?

A

Pain elicited when the uterine cervix is manipulated during pelvic examination.

Usually indicates inflammatory process in the pelvic organs or adjacent organs.

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58
Q

How much Folic acid should pregnant women or those trying to conceive take?

A

5mg Daily high risk
400mcg OD low risk
-To prevent neurological tubal defects .
-12 weeks

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59
Q

What are the risks of anti-epileptic medications in pregnancy?

A

Teratogenic potential

Anti-epileptic drugs are at a greater risk for low serum folate levels - Higher dose recommended

N.B - However the risk of malignancy outweigh risk of teratogenic fetus potential

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60
Q

What ranges is normal for fetal HR

A

100-160 bpm

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61
Q

Bradycardia FHR

Tachycardia FHR

A

<100/min

>160/min

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62
Q

What are the components of a CTG

A

Variability - Variation of fetal heart rate from one beat to the next. (5-25 bpm normal)

Accelerations - Increase in the baseline FHR >15 bpm for greater than 15 seconds.

Decelerations - Decrease in the baseline FHR >15 bpm for greater than 15 seconds.

Baseline rate - Avg HR of fetus within 10min window

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63
Q

Complications of premature labour/prematurity?

A 
RDS , Chronic Lung disease
Intraventricular haemorrhage
Necrotising enterocolitis 
Feeding problems 
Infection
Hypothermia 
Visual and hearing issues
Increased mortality risk
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64
Q

Management of Pre-Term Labour?

A

<34 weeks
Steroids
Erythromcyin (prevent NEC) = ONLY IF THE MEMBRANES ARE RUPTURED

Tocolytics prevent current pre-term labour

Mag Sulphate

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65
Q

Importance of steroid tx in pre-term labour management?

A

Helps to develop the foetal lungs to mature

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66
Q

Risk factors for gestational DM?

A 
BMI >30
Previous Macrosomic baby 
Prev GDM 
Diabetes FH
Ethnic Minority origin
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67
Q

Diagnostic Criteria for GDM

A

Fasting glucose >5.6mmol/l
Post 2hr glucose >7.8 mol/l

Testing usually done 24-28 weeks (2nd Trimester)

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68
Q

Management for GDM?

A

1WK Referral to diabetes antenatal clinic
Lifestyle and diet modifications
Metformin (+Insulin - BM >7)
BM<7 Diet trial + exercise

Pre-Existing Diabetes

  • Weight loss for high BMI
  • Stopping oral hypoglycaemic agents apart from metformin (commence insulin)
  • Tight glycemic control
  • Treat retinopathy as can worsen
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69
Q

In postpartum women when the earlier you can considered contraception?

A

21 Days

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70
Q

Which stages are ovarian cancer surgically operated?

A

Stages 2-4

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71
Q

Management of Ovarian cancer?

A

Staging laparotomy which involves:
> Midline laparotomy
> Hysterectomy
> Bilateral salpingo-oophrectomy
> Omenectomy
> Lymph node sampling (para-aortic/pelvic nodes)
> Peritoneal washing (saline solution injected into peritoneal cavity and then removed for cytology)

Chemotherapy is recommended for everyone except low-grade stage Ia and Ib.

Stage III and IV cancers may additionally get neoadjuvant chemotherapy.

However, bear in mind how much of the above takes place is decided in an MDT. For instance, a palliative pathway may instead be considered for advanced stage IV ovarian cancers. Or for young women with early disease, the uterus and unaffected ovary may not be removed to preserve fertility.

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72
Q

What is reduced foetal movements?

A

<10 movements in 2 hours

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73
Q

First line investigation for foetal movements?

A

Doppler US

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74
Q

Causes of folic acid deficiency?

A

Phenytoin
Methotrexate
Alcohol excess
Pregnancy

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75
Q

Consequences of folic acid deficiency?

A

Macrocytic, megaloblastic anaemia

Neural tube defects

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76
Q

‘tense woody abdomen’ on clinical examination.

Most likely differential?

A

Placental abruption

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77
Q

Define Placental abruption

A

Separation of normally sited placenta from the uterine wall

  • Maternal haemorrhage into intervening space
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78
Q

Management of placental abruption

A

<36wks

  • Fetal Distress: Immediate C-section
  • No fetal distress:Close observation, steroids, no tocolysis

> 36wks

  • Fetal Distress: Immediate C-section
  • No fetal distress: Deliver vaginally

Fetus dead
-Induce vaginal delivery

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79
Q

Complications of placental abruption on

Mum?
Baby?

A

Mum - Shock, Renal failure, PPH, DIC ]

Baby - IUGR, Hypoxia, Death

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80
Q

What are the 3 types of miscarriage treatments?

Which option is first line?

A

Expectant management, Medical management, Surgical management

Expectant management

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81
Q

What treatment would you give for medical management of an ectopic pregnancy?

A

Oral Methotrexate

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82
Q

Explain expectant management for miscarriage?

A

Waiting for a spontaneous miscarriage

7-14 days.

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83
Q

Medical Management for miscarriage?

A 
Medication to expedite the miscarriage
Vaginal misopristo(Prostaglandin)l + antiemetics and pain relief + Mifepristone (progesterone receptor antagonist)
Bleeding should occur within 24 hrs [Raise with doctor if delayed]

Mifepristone to end the pregnancy, misoprostol to let it out

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84
Q

Surgical Management for miscarriage?

A

Vacuum aspiration (Suction curettage) LA used

Evacuation of retained products of conception
Done under GA

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85
Q

What circumstances would medical or surgical management be preferred for miscarriage?

A

Increased haemorrhage risk
Late first trimester
Unable to have blood transfusion/coagulopthies

Evidence of active infection
Previous traumatic experience associated with pregnancy - miscarriage, stillbirth, APH

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86
Q

Define Hydramnios?

A

Too much amniotic fluid

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87
Q

Name some minor conditions of pregnancy

A 
Itching 
Heatburn 
Thrush (Vaginitis) 
Abdo pain 
Constipation 
Ankle swelling 
Pelvic Girdle Pain 
Carpal tunnel syndrome 
Leg cramps
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88
Q

List the main antenatal appointments/scan

[Hint: 10 Primary / 13 Total]

A

8-12 weeks - Booking visit + Bloods

10-14 weeks - Dating Scan, Multiple gestation check
11 - Downs screen [+Nuchal scan]

16 weeks

20 weeks - Structural anomaly scan / Placenta positioning

28 weeks - Rh blood group Tx (Anti-D) / Anaemia checks

34 weeks - Info on labour

36 weeks - ECV for breech presentations/ Vit K + breastfeeding info

38 weeks

41- Discuss labour plans/Induction of labour(Membrane sweeps)

[25 weeks - Pre-eclampsia check in nulliparous/ Bump (Symphysis-fundal height / USS Fetal Biometry ]
[32 weeks - Low lying placenta re-check ]
[40 weeks - Nulliparous Membrane sweep offering for non labour patients]

Usually 10 Appt Nulliparious / 7 Appts Multiparous

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89
Q

When does the uterus become palpable?

A

12 weeks

Fetal heart can be auscultated

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90
Q

Define Intrapartum?

A

Period from the onset of labor to the end of the third stage of labor.

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91
Q

Which conditions are screened for early in pregancy?
Between 8-12 weeks gestation.

Booking Bloods

A 
Downs syndrome 
Patau 
Edwards syndrome 
Sickle Cell, Thalassaemia
HIV, syphilis, Hep B
Rh Status
Red cell alloantibodies 
Rubella immunity
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92
Q

Quadruple test - What is it?

A

Blood test
4 Protein measure - B-HCG, AFP (Alpha-fetoprotein), Oestriol, Plasma protein A (PAPP-A)
Only screens for downs

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93
Q

When can twins be confirmed?

A

12 week scan

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94
Q

What causes increased nuchal traslucency in fetus?

A

Down’s
Congenital heart defects
Abdo wall defects

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95
Q

What type of infection is Rubella?

Common infective pathogen?

A

Viral infection

Togavirus

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96
Q

Define Polycystic ovary syndrome?

A

Hormonal disorder in which the ovaries produce an abnormal amount of androgens and symptoms of hyperandrogegism is displayed.

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97
Q

Clinical features of PCOS?

A 
Acne
Hirsutism
Infertility
Oligomenorrhoea / Amenorrhoea 
Scalp hair loss/Alopecia
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98
Q

Risk factors of PCOS?

A 
Obesity
Low birth weight / High birth weight 
Fetal androgen exposure
Early Menarche 
FH PCOS
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99
Q

Associated conditions with PCOS?

A 
Type 2 DM / Impaired glucose tolerance
Endometrial cancer / Ovarian cancer
Metabolic syndrome
NAFLD
Mood disorders 
Obstructive sleep apnea
Arterial HTN
Subfertility
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100
Q

Tx for PCOS?

A

Reduction of hyperandrogegism and establish fertility plans

Improve fertility
Weight loss 
Letrozole 
Clomifene (Non-steroidal anti-oestrogen.Increases FSH) 
\+ Metformin
Not desiring fertility 
Weight loss
OCP (Microgynon) - Ehinylestradiol 
Metformin 
Eflornithine cream (Hirsutism) 
Spironolactone
Finesterde -5A Reductase inhibitor
GHRH Agonist -Leuprorelin + Microgynon
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101
Q

Diagnostic Investigations for PCOS?

A

Diagnosis of exclusion

  • Pregnancy Test - Urine/B-HCG
  • Serum 17-hydroxyprogesterone (Adult onset Adrenal hyperplasia)
  • Hyperprolactinaemia/Prolactinoma (Serum Prolactin)
  • Thyroid disease (TSH levels)
  • Hypogonadotrophism
  • Impaired glucose tolerance/Diabetes (OGTT)
  • Dyslipidaemia (Cholesterol levels, LDLS, HDLs)
  • Outlet obstruction (TVUS)
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102
Q

3 Criteria used for PCOS classification?

A

Rotterdam Criteria
1. Amenorrhoea/Oligomenorrhoea (Menstural irregularity)/Anovulation
2. Hyperandrogenism - Clinical/Biochemical signs
3. Polycystic ovaires (TVUS) - >12 / Increased ovarian volumes >10cm3
Diagnosis of exclusion

2/3 - Rotterdam crieteria

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103
Q

WHAT IS FTP IN PREGNANCY?

A

Failure to progress - Labor slows and delays delivery of the baby.

104
Q

Define Slow labour

A

Failure of the cervix to dilate by 2 cm in 4 hours or a slowing of progress for multiparous women

105
Q

What is slow progress in active labour call.

A

Primary dysfunctional labour

106
Q

What’s a partogram?

A

Record of labour - Notes key information about fetus and mum to monitor labour progress.

Obs -BP, HR, FHR, Temp
Time 
Contractions 
Drugs/Fluids 
State of Membrane - Intact, Clear, Meconium stained 
Urine analysis
107
Q

What could Meconium present before 38 weeks gestation?

A

Listeriosis

Bile secondary to bowel obstruction

108
Q

Contraindications of epidural?

A

Patient refusal
Active maternal haemorrhage
Maternal septicaemia / Untreated febrile illness
Infection at or near needle insertion site
Maternal coagulopathy (inherited or acquired)
Severe Spinal abnormality

109
Q

Side Effects of epidural?

A

Immediate
Hypotension
Urinary retention

Delayed
Localised Backache
Post dural headache
Leg weakness

110
Q

Reason for Meconium stained liquor ?

A

Early maturation of foetus GI system.

Possible signs of foetal distress

111
Q

Define presentation?

A

The part of the foetus’s body that leads the way out through the birth canal (Maternal pelvis)

112
Q

Define Lie and position?

A

Lie - Relationship between long axis of fetus and mother (longitudinal, transverse or oblique)
Position - Position of the fetal head as it exits the birth canal. (Ocipito-anterior, posterior/transverse)

113
Q

What is an episiotomy

A

An incision that widens the opening of the vagina to help with delivery

114
Q

Define labour?

A

Onset of regular and painful contractions associated with cervical dilation and descent of the presenting part.

115
Q

What monitoring should be done during labour?

[6 Points]

A

FHR monitoring - Every 15 minutes / Contious CTG
Contractions monitored - Every 30 min
Maternal obs - BP. Temp, Pulse rate
Vaginal examination - Every 4 hours to check of labour progression
Maternal urine- Checked for ketones and protein every 4 hours?

116
Q

What is the symphysis-fundal height?

What is considered normal?

A

Measurement of distance between symphysis pubis and top of uterine fundus to assess fetal growth

Match the gestational age in weeks to within 2 cm. 24wks == 22-26cm

Usually begins between 26-28wks

117
Q

What are the fundal height landmarks in weeks?

A

Pubic symphysis - 12 to 14 wks
Umbilicus - 20 to 22 wks
Xiphoid process of sternum - 36 to 40 weeks

118
Q

What could a smaller or larger expected fundal height suggest?

A 
Multiple pregnancy 
Macrosomia
Polyhydramnios 
Oligohydraminos 
Slow fetal growth (IUGR)
119
Q

Signs of true labour?

A

Shedding Mucus plug -seals the opening of the cervix
Rupture of membranes
Shortening and dilation of cervix
Regular painful uterine contractions (Shorter intervals)

120
Q

What scoring criteria can be used to decide whether induction of labour is necessary?

A

Bishop Score

Cervical Position, consistency, effacement, dilation and fetal station

<5 Spontaneous Labour unlikely without induction
>9 Spontaneous Labour likely

121
Q

Name the forms of emergency contraception?

A

Emergency hormonal contraception - Levonorgestrel (1.5mg) / Ulipristal (30mg)
[Within 72 hrs / 120]

IUD - Inserted within 5 days of incident

122
Q

What are contraindications for emergency hormonal contraception?

A

Malabsorption diseases - Crohn’s
Enzyme inducing drugs - Rifampicin

Ulipristal More C/I
Severe hepatic dysfunction
PPI drugs
Breastfeeding - Avoid for 7 days
Poorly controlled asthma - corticosteroids
123
Q

Contraindications of Copper IUD?

A

Uterine fibroids
Suspected UTI / PID
-Tested for chlamydia and gonorrhoea prior to insertion

124
Q

How long does an IUD last?

A

5-10 yrs

125
Q

What age of is a women not legally considered to be able to consent to sexual activity?

A

Under 13 years of age.

Immediate safeguarding team referral

126
Q

What risk is increased in a women following insertion of an IUD?

A

ECTOPIC PREGNANCY

Watch for late period >5days
Reduced bleeding + Severe Lower abdominal pain

127
Q

Whats the main difference between and IUS and IUD?

A

IUS - Hormonal

IUD - Non-hormonal

128
Q

For Missed or Incomplete miscarriage what medical management would be given.

A

Misopristol ONLY

129
Q

What is law around abortion?

A

Only be done before 24 weeks

Two registered medical practitioners must sign a legal document.
ONLY a registered medical practitioner can perform an abortion. IN AN NHS HOSPITAL / LICENSED PREMISES

130
Q

Methods of abortions based on gestation age?

A

<9 Weeks: Mifepristone + Misopristol
<13 Weeks: Surgical dilation + Suction of uterine contents
>15 Weeks: Surgical dilation + Evacuation of uterine contents

131
Q

If a patient vomits after taking the morning pill.

WHAT IS THE NEXT STEPS?

A

Within 3 hours
-Take another dose ASAP (Levonorgestrel / Ulipristal)

Vomiting - The contraception may not have been fully absorbed.

132
Q

Names of hormonal contraceptives

A 
Ella One (Ulipristal acetate) 
Levonelle (Levonorgestrel)
133
Q

Morning after pill in a woman with a BMI > 30 (Levernogestrel)

WHAT DO YOU DO ?

A

Double the dose

Double dose for those with a BMI >26 / weight over 70kg

134
Q

Contraindications for COCP?

A

Smoking >15 cigarettes per day

Migraine with aura

135
Q

Unexplained vaginal bleeding contraindicates which types of contraceptions?

A

IUD & IUS

136
Q

Contraindications for Injectable contraceptives?

Side effects of injectables?

A

Current breast cancer

S/E
Weight gain. 
Irregular bleeding. 
No quick reversal, pre-fertility level delayed. 
Increased osteoporosis risk.
137
Q

What type of contraceptive is the Mirena coil?

A

IUS

Levonorgestrel 20 mcg/24 hrs

138
Q

Adverse effects for ICDs?

A

Periods heavier, longer and more painful - IUD

Initial frequent uterine bleeding and spotting - IUS

139
Q
  1. What is the recommended treatment for a women who is at moderate/high risk of pre-eclampsia?
  2. How long are women with pre-eclampsia at risk of seizures?
A
  1. 75mg-150mg of aspirin daily from 12 weeks to delivery.

2. Up until day 5 postpartum [ Following this day they can be deemed ‘safe’]

140
Q

Risk factors for neural tube defects?

Advice given?

A 
Prev preg. w/ neural tube defect 
FH history of neural tube defect on either parent side 
Diabetes 
Smoking 
Obesity 
Anti-epileptic medication
Sickle-cell disease
High AFP

5mg Folic acid from pre-conception till week 12 gestation

141
Q

Women with hypothyroidism?

A

25mcg increase in medication (levothyroxine). Natural increase in T4 till week 12 is not present - Fetal thyroid development at risk

Testing Schedule
Repeated TFTs 2 weeks after the increase.
Each trimester levels checked.
2-6 post partum
Pre-conception/Early after pregnancy confirmation

Risks

  • Developing gestational diabetes
  • Placental abruption
142
Q

Risk factors for miscarriage?

A

M - Multiple pregnancy/ Maternal disease(Autoimmune e.g. SLE)
I - Infection (Salmonella, Listeria, CMW, HSV, BV)
S - S(Cytotoxic drugs) - Poisons
C - Cervical incompetence (late miscarriage)
A - Anatomical anoaly (uterine septum)
R - Rise age of MUM
R - Radiation
I - implantation of placenta abnormal - (Placenta previa, IUD)
A - Abruption of placenta
G - Genetic abnormality in fetus
E - Endocrine (PCOS, DMT, Thyroid disease, Luteal insufficiency

143
Q

Name some teratogenic drugs?

A

TERATOWA

T-Third Element (Lithium), Tetracylines
E-Epileptic drugs (Valproate, Phenytoin, Carbamazepine)
R-Retinoids (Vit A)
A-ACE-I
T-Thalidomide
O-Oral contraceptives
W-Wafarin
A-Alcohol
144
Q

Define Enterocele?

A

Wall of the small intestines descends into the lower pelvic cavity and pushes into the upper vaginal wall.

145
Q

Define Procidentia?

A

When uterus and cervix protrude from the introits, resulting in thickened vaginal mucous and ulceration.

146
Q

What are the stages of the Pelvic Organ Prolapse Quantification?

A

Stage 0 - No prolapse demonstrated

Stage 1 - Cervix prolapses > 1cm above the hymen level

Stage 2 - Most distal prolapse is between 1cm above and 1cm below the level of the hymen

Stage 3 - Most distal portion of prolapse protrudes >1cm below the hymen but no >2cm than total vaginal length
(Not all of the vagina has prolapsed)

Stage 4 - Complete eversion of the vagina

147
Q

Which Cells produce androgens?

A

Theca Cells

148
Q

Define Molar Pregnancy?

hydatidiform mole

A

Abnormal form of pregnancy in which a non-viable fertilised egg implants in the uterus and will fail to come to term. Characterised by the abnormal growth.

Very Rare - <1/700 pregnancies

Very high hCG levels
Nausea and EXCESSIVE VOMITING
Trophoblastic disease (Cystic components)
Snowstorm Pelvic US appearance (Intrauterine mass + Cystic components)

149
Q

What are the risks of pessaries?

A

Ulceration - Need to be changed every 6 months

150
Q

Recently Diagnosed Chlamydia.
What is treatment?

Treatment for pregnant women?

A

(1) Doxycycline 100mg bd for seven days (contraindicated in pregnancy)
(2) Azithromycin 1g orally as a single dose, followed by 500mg OD for two days

Azithromycin 1g orally as a single dose.

151
Q

First Line treatment for Allergic Rhinitis in pregnant women?

A

Loratadine

152
Q

What Phase of the menstraul cycle does PMS occur?

A

Luteal phase

153
Q

Define Fibroids?

3 Main symptoms of Fibroids?

A

benign tumour of muscular and fibrous tissues (Usually myometrium in uterus)

Pain
Menorrhagia
Sub-Infertility

154
Q

What is Premature Ovarian Failure?

A

Early onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years.

Raised FSH, LH levels
Secondary Amenorrhoea
Infertility
Vasomotor symptoms - Hot flushes / Night Sweats

155
Q

What drug therapy can be used to treat Stress incontinence?

A

Duloxetine - Increases sphincter tone during the filling phase of urinary bladder function.

Drug therapy once - Pelvic floor exercises have been tried

156
Q

HPV Infection

A

HPV - Infection which targets keratinocytes of the skin and mucous membranes.

6 & 11 - Non-carcinogenic [Causes genital warts]

16,18,33 - Carcinogenic high risk factor for cervical cancer

157
Q

IV antibiotic used for prophylaxis against GBS?

A

IV Benzylpenicillin / Clindamycin (if allergic)

Recommended in all women who have had a previous child with ear/late onset GBS diseases. (50% future child risk)

Women who develop pyrexia during labour >38deg

Women who are in pre-term labour

158
Q

What is considered a low birthweight infant

A

<2500g (2.5kg)

159
Q

Risk factors for GBS infection

A

Premeturity
PROM
Previous sibling GBS infection
Maternal pyrexia during labour

160
Q

Risk factors of placenta abruption?

A 
Substance misuse -e.g. cocaine 
Multiparity 
Maternal trauma
Increasing maternal age 
Proteinuric hypertension
161
Q

Clinical features for Placenta abruption?

A

Constant Pain
Tender, tense uterus
Fetal heart - absent/distressed

162
Q

[FILLLLL]

Physiological Changes in pregnancy?

Systems 
CVS
Resp
GU
GI
A

CVS
-Increased Blood Volume

[FILLLLL]

163
Q

DDX Post-Menopausal Bleeding

A 
Vaginal atrophy 
Cervical polyps
Endometrial polyps
Endometrial hyperplasia 
Cervical ca
Endometrial ca
Ovarian ca
Vulval ca
Trauma
164
Q

Define Menopause

A

Cessation of menstruation

  • No menstrual periods for 12 consecutive months (no other biological or physiological cause)
  • No longer able to get pregnant naturally
  • 45 to 50
165
Q

What Anti-hypetensives should be used in pregnancy?

A

Labetalol (B-Blockers)
If C/I - CCB (Nifedipine) /

Methyldopa (alpha-antagonis) - C/I - In Depression

When women are considering getting pregnant they should seek changing anti-hypertensive drug classes to preferred ones.

166
Q

Fetal Malformations from ACE-I?

A

Renal agenesis
IUGR
Prematurity

167
Q

When is screening for Down’s Syndrome carried out?

A

11+ 0 and 13+6 weals

Combined test - Blood Test + Ultrasound (Nuchal translucency)
Blood Test - PAPP-A + B-HCG

Down’s (B-Hcg +++, PAPP-A - - - )

168
Q

What Quadruple Test?
When does it happen
What things does it check for?

A

Checks your chances of having a baby born with Down’s syndrome.
15/16 weeks
aFP (Baby), Inhibin A (made by placenta), Unconjugated Oestriol (Placenta + baby liver), Total HCG (Placenta)

Low, Low, Raised, Raised - Associated with downs

ONLY CHECKS FOR DOWNS NOT EDWARDS/PATAU

169
Q

What further test does a high risk downs syndrome women need for diagnostic results?

A

Amniocentesis / Chorionic villous sampling (Karyotype of Fetus)

170
Q

What conditions do combined-test screen for?

A

Edwards (T18)
Patau (T13)
Downs (T21)

171
Q

Postnatally what BP Values would allowed cessation of Anti-hypertensive medication in

A

<130/180

172
Q

Risk Factors for Ectopic Pregnancy?

A

E - Previous Ectopic/ Endometriosis
C - Contraception (IUCD, POP)
T - Tubual surgery
O - Other surgery ( Appenicectomy, laparotomy)
P - PID
I - Infertility Treatment (IVF, etc ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀)
C - Unknown cause

173
Q
  1. What day does FSH usually peak in the menstrual cycle ?
A
  1. Day 3
174
Q
  1. Pre-Eclampsia RF?
  2. What tests are useful in monitoring pre-eclampsia in pregnancy?
  3. Target BP range for women with Pre-Eclampsia?
  4. What BP value requires admission
A 
1st Pregnancy 
>40 YO
Pregnancy interval> 10 yrs
BMI >35
FH of Pre-eclampsia 
Multiple pregnancies
  1. BP, Bloods, Urinalysis, Fetal growth scans, CTG
  2. <150/100 / <140/90 - End organ damage
  3. > 160/110 [Severe]
175
Q
  1. TREATMENT FOR ECLAMPSIA?
  2. Why are reflexes monitored?
  3. What should be avoided in 3rd labour phase
A

OBSTETRIC EMERGENCY

  • URGENT ADMISSION
  • IV MAGNESIUM SULPHATE (Vasodilation action), Loading dose then infusion (4g/5-15min —> 1g/hr/24H)
  • STRICT MONITORING OF (BP, HR, RR, URINE OUTPUT, REFLEXES, CTG
    2. Magnesium toxicity
    3. Ergometrine (IM/IV Syntocinion)
176
Q

What does liquor volume tell you?

A

Fetal kidney function

177
Q

Signs and symptoms of Pre-Eclampsia?

A 
Headache -Frontal 
Visual disturbance (Flashing lights/blurring) 
Oedema - Face, hands, feet
Epigastri/RUQ Pain 
Nausea 
Vomiitng 
FGR / IUGR
178
Q
  1. Define SGA?

2. Define IUGR ?

A
  1. Estimated Fetal Weight (EFW) / abode circumference <10th centile
  2. Failure of fetus to achieve its predetermined growth potential
    (Growth falling across centiles/reduced growth velocity)
179
Q

Define Eclampsia?

  1. How would you check for organ dysfunction?
A

Occurrence of 1/more generalised convulsion and/or coma in the background of pre-eclampsia and absence of other other neurologic conditions

Seizure within Pregnancy / 10 days of delivery with at least two of:
Proteinuria
Thrombocytopenia
Raised AST/ALT

  1. FBC (low platelets, hb)
    U+E (Raised urea, creatinine, rate)
    LFTs (Raised ALT, AST)
180
Q

Complications of Pre-eclampsia?

  1. Mother
  2. Fetus
A
  1. AKI, DIC, ARDS, Cerebrovascular haemorrhage, Future increased HTN risk, Death
  2. SGA, IUGR, Placental abruption, Prematurity
181
Q

What separates gestational HTN from pre-eclampsia

A

Pre-eclampsia has proteinuria.

182
Q

When does gestational htn start to develop?

A

After 20 weeks - Transient/Chronic

Anything <20wks - Pre-exisiting HTN

183
Q

Most common cause of post menstrual bleeding?

A

Vaginal atrophy

184
Q

Causes of hyperprolactinaemia?

Investigations?

A

P - Pregnancy
I - Iatrogenic (OCP - containing oestrogen, Cushing syndrome, Dopamine antagonist -e.g Metoclopramide for N/V)
T - Tumours of the pituitary gland, Hypothyroidism

Pituitary MRI
Visual fields test
Bloods - TFT, Prolactin level, FSH and LH

185
Q

Treatment of prolactinoma causing Amenorrhoea?

A

MACRO (>10MM) OR MICRO (<10MM ) largest dimension

  1. Dopamine Receptor Agonist (Bromocriptine/Cabergoline) - Tumour should shrinks + restoration axis
  2. Surgery - If patient presents with visual defects or doesn’t medical management doesn’t work
    50% reoccurrence rate w/surgery.
186
Q

Out of all contraceptive methods which is the most effective?

A

Progesterone implant

187
Q

Whats the earliest a women can get pregnant postpartum?

A

3 Weeks

188
Q

Define ectopic pregnancy?

A

Extrauterine pregnancy in which which the egg implants itself outside of the uterus and grows.

Non-viable pregnancy

189
Q

Symptoms of Macroprolactinoma?

A

GAIL PHD

G-alactorrhea
A-menorrhoea
I-mpotence (Men)
L-ethargy

P-ressure effects of tumour on head
H-air loss (Secondary sexual)
D-epression

190
Q

What are the expected cervical dilation for

A. Nulliparous

B. Multiparous

A

A. 1cm per hr

B. 1.5-2cm per hr

191
Q

What is defined as active phase of labour?

A

3cm to full cervical dilation (10cm)

192
Q

3 Stages of labour?

A
  1. Initiation of regular contractions to full effacement and dilation of cervix to 10cm

Latent/Active Phase

  1. Period from full dilation of the cervix to delivery of the feus
  2. Delivery of the conception products (placenta, membranes) following fetal delivery.
193
Q

How often should CTG be monitored in second phase of labour?

A

Every 5 minutes or after every contraction.

194
Q

Term delivery?

A

37 - 42 weeks gestation

195
Q

Management for vaginal/Perineal tears?

A

1st - very small, no stitching, naturally heals (No muscle involvement)
[SKIN ONLY]

2nd - Skin, back of the vagina and perineum muscles torn - needs stitches
[Perineum]

3rd - Skin, back of vagina, muscles, partially/complete extension through anal sphincter -STITCHES
[ANAL Sphincter Complex Involvement]

4th - SAME AS 3RD + Extends into rectum breaching anal mucosa (Continuous opening from vagina and external sphincter)
STITCHES
[ASC + Anal Epithelium]

196
Q

What’s a Laparoscopy?

A

Surgical procedure which examines the organs inside the abdomen.
Small incisions in the pelvis/abdomen

197
Q

What incision is common in C-Sections?

A

Pfannenstiel Incision (Bikini Line/Suprapubic) - incision made at the pubic hairline.

198
Q

Uses for Syntocinion?

A

Synthetic version of oxytocin (Stimulates contraction of uterus)

Used in 3rd Stage of labour -Active management
Induction of labour

199
Q

What is considered normal endometrial thickness?

A

<5mm (4-5)

> 5 Abnormal - Possible RF for Ca

200
Q

What is considered protective for endometrial Ca?

A

combined oral contraceptive pill and smoking

201
Q

What is a hysteroscopy?

A

Inspection of the uterine cavity by endoscopy with access through the cervix.

202
Q

Define recurrent miscarriage?

Causes?

A

3 or more consecutive spontaneous abortions.

Antiphospholipid syndrome (Autoimmune disorder)
Smoking
Parental chromosomal abnormalities
Uterine abnormalities (uterine septum)
Endocrine disorders - PCOS, (Poorly controlled DMT/Thyroid disorders)

203
Q

What is an adnexal mass?

A

Gynae Adenexa (Parts adjoining organ) - uterus, the ovaries, the Fallopian tubes, and the ligaments that hold the uterus in place

Growth that occurs in or near the uterus, ovaries, fallopian tubes, and the connecting tissues

204
Q

Risk factors for perineal tears?

A 
Shoulder Dystocia 
Primigravida 
Large Baby
Precipitant labour (Childbirth following a rapid labour)   
Forceps delivery
205
Q

On a Nuchal scan:

  1. What causes increased nuchal translucency?
  2. What causes a hyperchogenic bowel?
A
  1. Down’s syndrome, Congenital heart defects, abdominal wall defects
  2. Cystic fibrosis, Down’s syndrome, CMV Infection
206
Q

VTE Risk factors in pregnancy?

A 
Age >35
BMI >30
Parity >3 
Multiple gestation
Smoker 
Current pre-eclampsia
FH VTE / PMH VTE
Immobility 
IVF pregnancy
low risk thrombophiilia

4+ RF = Treatment with LMWH

207
Q

What precautions are taken for women with high VTE risk status?

A

LMWH (dalteparin) throughout 28wks until 6W postnatal (3+RF)
4> RF = Ongoing Dalteparin from 1st Trimerster

ON delivery admission
Ted stockings + Dalterparin

208
Q

Define threatened miscarriage?

A

Vaginal bleeding and an ongoing pregnancy (signs of fetal life)

209
Q

Define inevitable miscarriage?

A

Cervix begins to dilate

210
Q

Define incomplete miscarriage?

A

Passage of some, but not all of the products of conception.

211
Q

Define complete miscarriage?

A

All products of conception are expelled from the uterus

212
Q

Define missed miscarriage?

A

Fetus dies in utero but is not expelled

213
Q

Define an an anembryonic miscarriage?

A

Type of ‘missed’ miscarriage where embryonic development fails at a very early stage. Sac continues to develop but no fetal parts on ultrasound.

214
Q

Define septic miscarriage?

A

Complication of incomplete miscarriage in which an intrauterine infection occurs.

215
Q

Percentages of live birth following a miscarriage?

For 1, 2, 3 miscarriages

A

1 - 85
2 -75
3 -60

216
Q

What are the complications of Rubella infection that’s passed on from pregnancy to the child?

A

Triad:
Sensorineural hearing loss
CHD (PDA)
Congenital Glaucoma and cataracts

217
Q

Dilutional Anaemia in pregnancy

CAUSE?

A

Normal MCV, Hb Low

Rise in in Plasma volume (50%) so RBCs are diluted out.

218
Q

If a Pregnant women has Iron deficiency anemia what would the blood results show?

A

Microcytic anaemia - Low MCV, Low Hb

Treatment Iron Supplements - Ferrous Sulphate

219
Q

Classic sign of poor latching?

A

Breast noise clicking when feeding

220
Q

Signs of good latching?

A 
Less visible areola
Wide open mouth
Rolled out lips
Chin touching the breast and free nose
Visible + audible swallowing sounds
221
Q

Baby displays with white patches in the mouth after breastfeeding

What condition?

Management

A

Oral Thrush - Secondary to nipple thrush(fungal infection)

Topical Antifungal cream (Miconazole) - Nipples after every feed + Cream to infants mouth

222
Q

Signs of Nipple Thrush (Fungal infection)?

A

Sharp pain
Worsening pain after feeds
Bilateral erythema

223
Q

Name the TORCH Pathogens that cause infection and severe congenital abnormalities?

A

Toxoplasmosis
Rubella
CMV
HSV

Carried through the bloodstream of mum to baby in the uterus .

224
Q

Define Chorionamnionitis?

A

Infection of the membranes (Chorion, amnion) and/or amniotic fluid surrounding fetus

225
Q

Investigations and Management for chorionamnionitis?>

A 
Investigations 
Clinical Signs + WCC (Increase) 
Fever
ROM
Fluid leakage
Uterine tenderness
Elevated maternal HR >100bpm 
Elevated FHR >160bmpm 
Increased

Treatment

  • Abx (Gentamicin, clindamycin, ampicillin)
  • Induce delivery
  • Afebrile status for 24hrs prior to discharge
226
Q

Pregnant women presents with Herpes in the 1st/2nd Trimester

MANAGEMENT UNTIL BIRTH

A

Treat the primary infection with Acyclovir

PROPHYLATYIC ACICLOVIR DAILY FROM 36 WEEKS UNTIL EXPECTANT DELIVERY

227
Q

PRIMARY HERPES INFECTION DURING LABOUR

ACTION?

A

Emergency C-Section + IV Aciclovir

228
Q

Causes of Rhesus Incompatibility (Isoimmunisation) to fetus?

A

1 - Hepatosplenomegaly + Jaundice
2 - Kernicterus
3 - Hydrops fettles (gross oedema)
4 - Erythoblasts on peripheral blood smear, haemolytic anaemia + erythroblastosis fettles.

229
Q

Most common causes of postcoital bleeding?

A

Cervical Abnormality - Cervical ectropion, polyps, infection, neoplasia

230
Q

Cervical cancer red flags?

A

Postcoital/intermenstral bleeding, vaginal discharge in the ABSCENCE of infective symptoms

Non-specific pelvic pain & dyspareunia

231
Q

Next steps if CERVICAL ABNORMALITY DETECTED on speculum exam?

A

Urgent Colposcopy referral - 2 weeks

Large cervical polyp/cervical ectropion - Gynae clinic referral from primary care.

NAD + Neg STI Swabs + Symptoms still persisting - 6 to 8 week colposcopy referral

232
Q

Cervical Smear Screening age + frequency?

Primary function of test?

A

25 to 49 - Repeated every 3 years

Cytological abnormalities - HPV infection, Maligancy, dyskaryosis (abnormal nucleus/cervical epithelial tissue)

233
Q

What blood test is most specific for iron deficiency anaemia in pregnancy?

What points should FBC be taken to assess anaemia?

A

Ferritin <30ug/l

(<15ug/l -normal population)

Booking appt + 28 weeks

234
Q

Treat for Anaemia during pregnancy?

A

Oral Iron supplementation + regular checks to see affect on anaemia.

(Any symptomatic normocytic/microcytic anaemia sufficient for treatment)

235
Q

4 Classical symptoms of Endometriosis?

DIPS

A

Deep dyspareunia
Infertility
Pelvic Pain (cyclical)
Secondary dysmenorrhoea

236
Q

Cellulitis Treatment?

A

Oral flucoxacillin / erythromycin (pen allergy)

237
Q

What measures should be taken if a mother has had a previous GBS infection?

A

Intrapartam IV Abx

Prev GBS infection in pregnancy = Increase risk of 50% in next pregnancy
Swabs - (35 weeks+)
Prophylaxis Abx - Benzylpenicillin [Given women in preterm labour]

GBS+ve + Unaffected baby
IAP / Swab + IAP (If +ve)

Baby prev infective with GBS
IAP

238
Q

What is vertical transmission?

A

Transmission of disease from parent to offspring.

e.g HIV-1,

239
Q

What treatment must occur in a neonate who’s MUM HAS HEP B OR HAS BEEN INFECTED BY HEP B?

A

Hep B immunoglobulin + Complete course of vaccination

240
Q

Define puerperal pyrexia?

Causes?

Treatment?

A

Temp > 38ºC in the first 14 days following delivery

Endometritis
VTE
Mastitis
UTI
Wound infection (C-section + perineal tears)

IV Abx - Cindamycin and gentamicin until afebrile for greater than 24 hours

241
Q

Define Oligohydramnios?

A

Reduced Amniotic fluid
AFI <5th Percentile/ <500ml (32-36 weeks)

Causes 
PROM 
Pre-eclampsia
IUGR
Fetal renal problems - renal agenesis (Missing kidney 1/2 at birth) 
Post term gestations
242
Q

Tocolytic example?

A

Suppressant of premature labour. Helps to prolong pregnancy.

MG Sulphate.

243
Q

Contraindications for ECV?

A

Recent APH
Ruptured membranes
Uterine abnormalities
Previous C-section.

244
Q

What should a Normal CTG look like?

A

Accelerations present,
Variability >5bpm,
No decelerations,
HR 110-160

Variability should be 5-25bpm
Decelerations are normal on contractions, but must resolve after.

245
Q

Management for shoulder dystocia?

HINT: HELPERR

A
  1. Additional HELP called
  2. Evaluate for EPISIOTOMY (+_/ Usually done after Leg to mcroberts)
  3. Leg to MCROBERTS
  4. SupraPUBIC PRESSURE
  5. ENTER: rotational manoeuvres
  6. REMOVE the POSTERIOR arm
  7. ROLL pt to hands and knees (ALL FOURS)

HELPERR

246
Q

What are the layers you go through when making incisions for a C-Section?

A 
Anterior rectus sheath 
Rectus abdominis 
Transversals fascia
Extraperitoneal connective tissue
Peritoneum 
Uterus
247
Q

What’s the most common cause of cord-prolapse?

A

Artificial Amniotomy (ARM)

248
Q

What hormone inhibits prolactin prolactin production?

A

Dopamine.

249
Q

most common cause of infection after childbirth?

A

Endometritis.

Can lead to secondary PPH

250
Q

What bloods results usually indicate DIC in pregnancy?

A

Elevated PT
Elevated aPTT
Low platelets
Low fibrinogens

251
Q

Which oestrogen derivative increases the most during pregnancy?

A. Oestriol
B. Oestrogen
C. Oestrone

A

A - Oestriol

252
Q

When can HCG be first detected in maternal blood?

What rate does HCG level increase by in first couple of weeks?

When do levels peak?

A

HCG can be detected in the maternal blood as early as day 8 after conception.

Doubles every 48hrs

Levels peak 8-10 wks

253
Q

Explain what’s involved in:

  1. Direct Coombs Test ?
  2. Indirect Coombs Test ? [1st trimester]
  3. Kleinbauer Test? [ 2nd/3rd trimester]
A

Direct Coombs: Investigation used to look for autoimmune haemolytic anaemia,

Indirect: Test antenatally to detect antibodies in the maternal blood that can cross the placenta and result in haemolytic disease of the newborn.

Kleihauer is used after a sensitising event to see if fetomaternal haemorrhage has occurred and volume of blood to help calculate Anti-D

254
Q

Bishop Score Markers?

A

<4 Spontaneous labour less likely to occur
>8 Labour likely to occur

score ≤5: PGE2
score >5: amniotomy +- Oxytocin if labour doesn’t begin

< 3 : IOL unlikely to be successful
<=5 : IOL with PV prostaglandin gel (should start labour or ripen cervix)
6-8 : AROM (amniotomy ± oxytocin infusion if labour does not begin)
>=9 : labour likely to occur spontaneously

255
Q

What week can you attempt ECV in

  1. Breech presentation?
  2. Transverse presentation?
A
  1. 36 Weeks

2. 32 weeks

256
Q

Polyhydraminous volume criteria?

A

> 2/3L of amniotic fluid

257
Q

Which blood test can be used to indicate start of menopause?

A

FSH (Increases in level)

Phase 3A Quiz (7 decks)

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