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3 Women's Health EJR > Womens health basics > Flashcards

Womens health basics Flashcards

1
Q

what is the definition of

  • LMP
  • Cycle
  • Parity
  • Gravidity
A

LMP = first day of last normal menstrual period

Cycle = number of days from first day of bleeding to next period e.g. 5/28 is 5 days of bleeding with 28 day cycle

Parity = number of deliveries after 24 weeks incl stillborn, miscarriage, terminations and ectopic pregnancies, if terminated before 24 weeks, ^x

Gravidity = total number of pregnancies inc current pregnancy, regardless of outcome

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2
Q

if someone has 4 children, currently pregnant and has had 2 miscarriages how would that be expressed in GxPn

A

G7P4^+2

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3
Q

what would G4P4 mean

A

pregnant 4 times, gave birth 4 times.

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4
Q

how do you ask if someone has been having heavy periods

A

flooding through pad
clots
frequency of changing pad

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5
Q

what are some abnormal bleeding

A

heavy periods
intermenstrual bleeding
postcoital bleeding

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6
Q

what is dyspareunia

A

painful intercourse

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7
Q

what to clarify in painful intercourse

A

superficial or deep pain

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8
Q

what is the guideline for taking pap smears

A

from 25, every 3 years

till 49 then every 5 till 65 the stop

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9
Q

in gynae history, what to ask about previous pregnancy

A

how many, when, mode of delivery, birth weights

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10
Q

what is naegeles rule, what is it used for

A

to calculate EDD from LMP

LMP + 1 year - 3 mths + 7 days

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11
Q

other way to calculate EDD?

A

crown-rump length

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12
Q

when is booking appointment usually done

A

8 weeks

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13
Q

what are some definitions of high risk pregnancies

A

> 35 age
35 BMI
H/T
difficult pregnancy hx

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14
Q

what blood information is required in obs history

A 
blood type/group
rhesus factor
blood born virus (HIV, HBV)
syphillis
FBC (anaemia)
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15
Q

who are required to go for monthly growth scans

A

high risk pregnancies

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16
Q

what scans are done for low risk pregnancies

A

12 and 20 weeks

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17
Q

when is the first scan done and what does it look for

A

12 weeks
viability dating scan

is baby viable
position of baby
EDD (crown rump length)
number of babies
combined test (13 18 21)
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18
Q

what ways of managing miscarriages are there

A

conservative
medical
surgical

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19
Q

what 5 past medical history are important in Obs history

A 
Diabetes
Epilepsy
Asthma
Thromboembolism/thyroid
Hypertension
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20
Q

what is normal fetal movement like

A

after 20 weeks, fetal movements should be the same throughout, any reduction is abnormal

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21
Q

what is the folic acid recommendation

A

400micrograms for low risk till 13 weeks pregnant

5 miligram for high risk

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22
Q

what is the combined screening

A

scan done 11-14 weeks (can be done during first scan)

look at patau, edwards and downs by nuchal thickness

also bloods assoc with downs - beta hcg and low PAPP-A

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23
Q

what can be done to confirm a positive result from a combined screening

A

chrionic villus sampling

amniocentesis

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24
Q

what scan is done from 18 to 20+6 weeks?

A

anomaly scanning - 11 conditions

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25
Q

what is done during a growth scan

A

est fetal weight via HC, AC, FL
amniotic fluid index
umbilical artery doppler

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26
Q

who gets serial growth scans

A

high risk pregnancies
medical disorders
previous IUGR
multiple pregnancies

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27
Q

what 2 hormones rise in normal labour

A

prostaglandins, estrogen and oxytocin

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28
Q

what is the most common baby head position during birth

A

occiput-anterior

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29
Q

how often are contractions at the maximum during labour

A

5 every 10 mins

30
Q

describe stage 1 2 3 of labour

A

stage 1 onset of labour to full dilatation of cervix (10cm)

stage 2 full dilatation to delivery of baby

stage 3 delivery of baby and placenta

31
Q

describe stage 1 of labour

A

latent phase - irreglar painful contractions, start of cervical changes, up to 4cm dilatation

active phase - regular painful contractions + 10cm dilatation

32
Q

how is stage of descent described using the fifths and ischial spines?

A

before baby head at ischial spines, palpate abdomen to feel for how much of baby head is still above, count in fifths (e.g. 4/5ths of baby head is above)

when baby’s head is at ischial spines, that is zero station, once below is +1 station e.g

33
Q

how are fetuses monitored during labour

A

intermittent auscultation with doppler or pinnard - 1 min, after contraction every 15 minutes for first stage and every 5 mins in second stage

34
Q

what pharmacological options are there for women in labour?

A

paracetamol
entonox
diamorphone
epidurals

35
Q

describe second stage of labour

A

passive second stage - from full dilatation, allow spontaenous descent, don’t push yet.

active second stage, when head is visible, encourage mother to push

36
Q

mechanism of body regarding babies’ positions

A 
descent
flexion
internal rotation
crowning
extension
restitution
internal rotation of shoulders
expulsion
37
Q

what is caput succedaneum

A

temporary swelling of head due to compression by cervix

38
Q

when is the cord cut?

A

after pulsation of cord stops

39
Q

ways that placenta can be delivered

A

physiological or active

40
Q

different degrees of perineal tear

A

1st degree is down to fourchette
2nd is skin, vaginal wall and perineal muscles
3rd includes anal sphincter
4th includes rectum

41
Q

what to inspect the placenta for?

A

is it complete, how many vessels? (3), how many membranes (2), any malformations, histology or cytogenetics

42
Q

most common cause of abnormal labour regarding “powers”

A

inefficient uterine action

hyperactive uterine action

43
Q

how to manage inefficient uterine action?

A

augmentation - ARM, oxytocin

44
Q

common abnormal fetal presentations

A 
OP
OT
brow
face
breech
45
Q

management of different abnormal fetal presentations

A 
OP - instrumental
OT - CS if progress to deep transverse arrest
brow - C section
face - C section if chin is posterior
breech - C section
46
Q

what is deep transverse arrest

A

if baby is stuck in OT position after 1 hour

47
Q

common causes of abnormal labour regarding Passage

A

cephalo-pelvic disproportion (head>pelvis)

48
Q

2 types of forceps

A

rotational and non-rotational

49
Q

where are rotational forceps used?

A

in theatre because failure => csection

50
Q

which instrument is more likely to fail

A

ventouse

51
Q

why can using a ventouse cause jaundice to the baby

A

suction causes bruising on head leading to blood break down and build up of heme

52
Q

what are the indications for isntrumental delivery

A

prolonged 2nd stage leading to maternal exhaustion

fetal compromise

prophylatically in high risk pregnancies

53
Q

what analgesic is given to the mother in a low cavity instrumental delivery

A

pudendal block/local anaesthesia.

low cavity = baby below 0 station

54
Q

prerequisites for instrumental delivery

A

maximum 1/5s head palpable on abdomen

cervix fully dilated

analgesia

consent
empty bladder
consider venue e.g theatre

55
Q

what can be done to reduce instrumental delivery rates

A

midwife encouragement

encourage mobilisation of

mother during labour

altering maternal position

using oxytocin for slow 2nd stage progress

allow longer passive 2nd stage when epidural present

56
Q

definition of inducing labour

A

at least 24 weeks gestation

intact or ruptured membranes, but not active labour

57
Q

maternal indications for induction of labour

A 
abnormal bleeding
GDM/obesity
prolonged pregnancy (41 weeks)
risk to maternal life
preterm-prelabour ruptured membranes
hypertensive d/o
obstetric cholestasis
symphysis pubis dysfunction
maternal request
58
Q

fetal indications for induction of labour

A 
growth restrictions
risk to fetal life
IUGR
isoimmunisation
IUD
post maturity
previous still birth
recurrent reduced fetal movements
59
Q

contraindications of induction of labour

A

active genital herpes/HIV
major placenta praevia
transverse or oblique fetal presentation
prior uterine incisions

60
Q

how to induce labour?

A

membrane sweep
prostaglandin
amniotomy
IV oxytocin

61
Q

what is included in the modified bishops score

A 
dilatation
length of vaginal canal
consistency of cervix
position of cervix
head station
62
Q

what do the scores in the modified bishops score mean

A

less the points the less advance labour

> 9 means labour imminent

63
Q

risks of labour induction

A 
failure can lead to C section
uterine hyperstimulation
infection (chorionamnioitis)
fetal compromise
cord prolapse
post partum haemorrhage
increased analgesic use
64
Q

maternal indications for continuous EFM

A

high risk pregnancies, previous c section

65
Q

fetal indications for continuous EFM

A 
IUGR
oligohydramnios
preterm labour
multiple pregnancies
breech presentations
rhesus iso-immunisation
66
Q

describe DR C BRAVADO

A 
define risk
contractions
Baseline rate
variability
accelerations
decelerations
overall assessment and plan
67
Q

what does variability of baby heart rate indicate

A

working connection between parasymp and symp nervous system

68
Q

what should be done if abnormal CTG

A

fetal scalp blood pH measurement to ascertain hypoxia status

<7,20 is abnormal

69
Q

what is used in customised growth charts?

A

height, weight, ethnicity
previous birth weights

weeks and decile chart

symphisis pubis length

70
Q

in obs hx, what to ask in past gynae hx?

A

contraception
smear history
fertility problems
gynae surgery

71
Q

in obs hx what to ask about in past pregnancy hx?

A 
year of births
weeks gestation
any pregnancy problems
how they were delivered
outcome and birth weight
72
Q

at which stage of labour is the mother encouraged to push?

A

active phase of stage II

3 Women's Health EJR (6 decks)

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