CLINICAL MANAGEMENT COPY Flashcards
Incidence of choriocarcinoma in the UK
1 in 50,000 pregnancies
How many pregnancies are twins?
How many of special care inits are twin babies?
1 in 70
15%
How many twins are born <37 weeks and <32 weeks?
50%
10%
Is there evidence for cervical cerclage or progesterone to prevent pre-term delivery
NO
What is perinatal mortality like for twins in comparison to non-twin babies
3 times greater perinatal mortality
What type of drug is clavulinic acid
beta-lactamase inhibitor. Without this a lot of penicillins can be broken down by beta-lactamase.
Which anti-epileptic drugs are STRONG/mild inducers of cytochrome P450
Inducers:
phenytoin
carbamazepine
phenobarbital
Topiramate
Inhibitors:
Sodium valproate
sodium valproate
lamotrigine
keppra
pregabalin/gabapentin
benzos
CRAP GPs - inducers
- Carbamazepine
- Rifampicin
- Alcohol
- Phenytoin
- Grisiofolvin
- Phenopbarbitols
- s
SICKFACES.com - inhibitors
- Sodium
- Isoniazid
- Cimetidine
- Ketoconazole
- Fluconazole
- Acohol
- Chloramphencol
- Erythromycin
- Sulfonamides
- Ciprofloxacin
- Omeprazole
- Metronidazole
What are the changes in the blood during pregnancy?
Increased coagulability
Reduced platelets
Increased fibrinogen
Increased ESR
What is the leading cause of direct maternal death in pregnancy
PE
What is the leading cause of indirect maternal death in pregnancy?
Cardiovascular disease.
BIGGEST CAUSE OVER ALL. Accounts for >25%
What is the incidence of PE in pregnancy?
absolute risk?
1.3/1000
1-2/1000
How much of VTE in pregnancy is PE vs DVT
PE = 10-20%, the rest are DVT
If you are pregnant vs non-pregnant, how much more likely to get a VTE are you?
4-6 times more likely
How many women who get a VTE in pregnancy have an inherited thrombophilia?
40%
Which anti-epileptic has the worst teratogenic profile. Especially in which trimester?
sodium valproate
First trimester
How many pregnancies does gestational diabetes occur in?
2-5% of all pregnancies
If a patient has had chemo - when can she start to try and conceive agin?
After 1 year
Give the percentages of how likely the following would progress into cancer:
endometrial hyperplasia without atypia (simple and complex)
with atypia
Without overall - <5% in 20 years
Simple EH without atypia 1%
Complex EH without atypia 4%
WITH atypia = 30% risk in 20 years
Atypia assoaicted with concomitant endometrial Ca at hysterectomy in up to 43%
Risk factors for endometrial Ca
obesity
prolonged oestrogen - early menarchy, late menopause, unopposed oestrogen HRT
nulliparity
PCOS
tamoxifen
Immunosuppression
For EH without atypia: how is it treated? Surveillance?
Progestogens:
IUS first line. Oral alternative but not as good.
Conservative treatment means less liekly to regress
surveillance = every 6 months
Can do hysterectomy if treatment doesn’t work
What to do is patients with EH with atypia decline surgery
can do IUS/progesterone PO
Which infections do we screen for antenatally
hepB
HIV
syphilis
In whom is cell salvage recommended
where >1500ml blood loss is anticipated
In whom is recombinant EPO recommended
end-stage renal failure
How to manage a non-haematinic deficiency anaemia in pregnancy
transfusion.
How long can patients with PCOS be treated with clomifene
max 6 months
What are the grades of ovulation disorders?
1 = stress, low BMI, high exercise
2 = PCOS
3 = ovarian failure
How is ovulation disorder 1 managed?
Reduce exercise, BMI >19, can pulse gonadotrophins with LH surge
How is ovulation disorder 2 managed?
First line = clomifene or metformin or both
Second line = laparoscopic drilling, gonadotrophins
How is ovulation disorder 3 managed?
IVF with egg donation
What is the diagnostic criteria for GDM
Fasting glucose = >5.6
2 hour glucose = >7.8
What is the advice regarding hba1c for those planning to get pregnant
aim for <48
if >86 - pregnancy not advised!!
Which contraceptive pill can be used for acne?
Needs to be combined.
Should aim to be anti-androgenic rather than androgenic.
In general the third generation progesterones are anti-androgenic.
The second generation ones tend to be androgenic.
2nd generation = Lenonorgestrel, norethisterone = ANDROGENIC
3rd generation = desogestrel
ethinylestradiol is the oestrogen.
A good choice would be ethinylestradiol/desogestrel
desogestrel is what is in the POP cerazette
What are the MC criteria for COCP?
MEC 1 = no restriction
MEC 4 = absolute contraindication
Give examples of MEC 4 criteria for COCP
BMI >35
Age >35 and active smoker >15/day
Current breast Ca
Previous VTE
<6 weeks postpartum (breast feeding)
<3 weeks post-partum (not breastfeeding)
Systolic BP >160
Diastolic BP >100
Stroke
IHD
Vascular surgery
Significant cadio abnormalities eg ToF
Cardiomyopathy with impaired cardiac function
Positive antiphospholidid antibodies
Abnormal clotting e.g. factor 5 leiden
Hepatocellular carcinoma
Migraine with aura
AF
What stimulates milk ejection in response to suckling
oxytocin
what maintains galactopoesis
prolactin
What stimulates lactogenesis
prolactin
What stimulates alveolar development in the breast?
prolactin, progesterone, oestrogen, HPL
Contraindications for atrificial rupture of membranes
Known HIV
High presenting part (risk of cord prolapse)
caution if presenting part isn’t the head or there is polyhydramnios
placenta previa
vasa previa
preterm labour
What is a primary and secondary PPH and what are the grades?
Primary - >500ml within 24h
Secondary - >500ml 24h-12 weeks post partum
Mild = 500-1000ml
Moderate = 1000ml-2000ml
Severe = >2000ml
Describe which fluid/blood products you might give in PPH
Initially up to 2L crystalloid whilst waiting for blood
WITH NO BLOOD RESULTS:
Initially 4 units PRC
Followed by considering 4 units FFP if haemostasis not achieved
WITH BLOOD RESULTS:
If prolonged APTT/PT and ongoing haemorrhage then give 12-15ml/kg of FFP
If APTT/PT >1.5x normal then may need to give more FFP
Platelets - give if <75 and still bleeding (1 pool)
Fibrinogen - trigger level of 2 - if below this give cryoprecipitate
Are most RF for PPH known?
No
Who gets oxytocin and how in birth
vaginal delivery - 5-10 units IM
C-section 5 units IV
How much do prophylactic oxytocics reduce risk of PPH by
60%
What percentage of patients who are allergic to penicillin are also allergic to cephalosporins
0.5-6.5%
Examples of macrolides, how do they work?
erythromycin, azithromycin
Peptidyltransferase inhibitor
Examples of quinolones, how do they work?
ciprofloxacin
DNA gyrase inhibitor
Examples of tetracyclines
doxycycline
Bind to the 30s subunit on ribosoes
After birth how long does it take for the cervix to constrict again?
7 days
After birth how long does it take for the uterus to involve again?
4-6 weeks
After birth how long does it take for the vagina to gain tone again?
4-6 weeks
After birth how long does it take for the lochia flow to cease?
3-6 weeks
After birth how long can you get after pains for?
2-3 days
Describe the staging of cervical Ca
1A:
1a1 = stromal invasion of <3mm
1a2 = stromal invasion of <5mm
1B:
1B1 = stromal invasion >5mm but whole tumour <2cm
1B2 = stromal invasion >5mm but whole tumour <4cm
1B3 = stromal invasion >5mm but whole tumour >4cm
2A: Invades upper 2/3 vagina with no parametrial involvement
2A1 = <4cm dimension
2A2 = >4cm dimension
2B: With parametrial involvement but not up to pelvic side wall
3A: Involves lower vagina but no pelvic side wall
3B: extension to pelvic wall and/or hydronephrosis/kidney damage
3C: para-aortic or pelvic lymph node involvement
3C1 = pelvic only
3C2 = para-aortic
4A = local organ invasion
4B = distant organ invasion
Treatment for 1a1 cervical Ca
LLETZ +- hysterectomy. AS LONG AS THERE IS NO LVSI
Treatment for 1a2 cervical Ca
Risk of lymph node spread so radical hysterectomy + pelvic node dissection
If want to preserve fertility can do:
- radical trachelectomy
- LLETZ and lymph node dissection
Definition of hyperemesis
Pregnancy weight loss of 5% with metabolic disturbance (ketones/urea)
Usually starts before week 12 HAS to start before week 22
What are signs of shoulder dystocia
Prolonged second stage
Fetal head retracting when tight against the vulva (turtle-neck sign)
Difficult delivery of the face and neck
Failure of restitution of the fetal head
Describe the stages of the birthing process
Engagement - when the largest diameter of fetal head passes through the largest diameter of the pelvis - head in OCCIPITO-TRANSVERSE position
Descent - presenting part moves inferiorly due to pelvic contractions
Flexion - when head makes contact with the pelvis the neck flexes allowing for the presenting part to become smaller
Rotation - head rotates to occipito-anterior for delivery of the head
Crowning - when the head no longer retracts during contractions
External rotation - when head is out and then rotates 90 degrees so that shoulders are in an anterior-posterior position
Downward traction - to help delivery of anterior shoulder
Upward traction - to help delivery of posterior shoulder
Restitution = rotation of the shoulders to be align with the head when head is external
Management of shoulder dystocia
Help!
Legs - McRoberts manouver = legs to chest
Pressure - suprapubic pressure
Consider episiotomy
Rotational manouvers - corkscrew OR remove posterior arm
Roll patient to hands and knees
Consider zavanelli or pubic symphisiotomy
What is the worry with shoulder dystocia?
Brachial plexus injury - Erb’s palsy
When can women restart COCP after child birth? Transdermal patch?
after 3 weeks ( due to risk of clots) if not breast feeding
6 weeks if they are breast feeding
after 4 weeks
What type of cancer are most vaginal cancers
Squamous cell carcinoma
How does tranexamic acid work
Inhibits plasminogen activator - this inhibits the ending of thrombosis and fibrin. Can reduce flow by 50%
How does mefanamic acid work
Inhibits prostaglandins. Can reduce flow by up to 25% in 3/4 women
How does heparin work
Activates antithrombin III, inhibits factor Xa
Treatent of mennhoragia?
1st = IUS (levonorgestrel) where >12 months use anticipated
2nd = COCP OR tranexamic acid OR mefanamic acid
3rd = other progesterone only contraception
If menhorragia + dysmennhoria - what treatment?
mefanamic acid rather than tranexamic acid
When can endometrial ablation be used in menhorragia?
Significant impact on life
When fibroids <3cm. Also only if no future pregnancies planned.
When can UAE/myomectomy/hysterectomy be used in menhorragia?
Significant impact on life
When fibroids >3cm. Also only if no future pregnancies planned.
If a patient has high prolactin but low FSH and LH and progesterone and cannot get pregnant what is going on and what is the treatment?
Hyperprolactinaemia.
Causing negative feedback to pituitary and hypothalamus.
Needs investigation for ?pituitary adenoma but drug would be a dopamine agonist like bromocriptine
What effect does dopamine have on prolactin
dopamine reduces prolactin. When there is lots of prolactin that causes dopamine release which negatively feeds back to prolactin release
What is recommended with pre-menopausal women with simple cyst of 5-7cm
Follow up USS in 1 year
NO CA125
Who falls into the high risk catagory for 5mg folic acid
T1DM
Sickle cell
Taking methotrexate
Women on anti-epilpetics
FHx of NTD or previous preg NTD
coeliac disease
What type of of tumour is a fibroid
leiomyoma
What are risk factors for fibroids
obesity
black ethnicity
early periods
age
What are protective factors for fibroids
pregnancy
increasing number of pregnancies
What are the histological features of lichen sclerosis
epidermal thinning
degredation of the basal layer
dermal inflammation
What is the appearance/symptoms of lichen sclerosis?
Who is it most common in?
white atrophic areas
purpura
fissuring
Narrowinf introitus
dyspareunia
post-menopausal women
What are the features of lichen simplex - symptoms and histological
symptoms = fissuring, erosion, thick scaly skin (lichenification), excoriation
histological = epidermal thickening, increased mitosis at basal layer and prikle layer
What are the features of lichen planus?
violacious plaques with Reticular white bits on top - Wickham’s striae
What are the features of VIN?
Histological
lumps and bumps can be white or pigmented.
histological? atypical nuclei of cells in epithelial layer. increased mitosis. loss of surface differentiation.
When is CVS performed?
11 weeks-13+6 weeks
ABSOLUTELY NOT BEFORE 10 weeks
What is the first line for hirsuitism in PCOS for those <19 years or >19 years
<19 years = COCP - co-cyprindiol. This should be stopped 3-4 months after hirsuitism resolves
> 19 years = topical eflorithine
Describe the stagin system of endometrial Ca
1a <50% of myometrium
1b >50% of myometrium
2 invasion cervix but no extension beyond uterus
3a invasion of adnexas/serosa
3b invasion of vagina or parametrium
3c nodal involvement - pelvis (3c1) or paraaortic (3c2)
4a local invasion of other organs e.g. bladder
4b distant invasion of organs or inguinal lymph nodes
What are the survival 5 year % for endometrial Ca stage 1/2/3/4
1 = 85-90%
2 = 65%
3 = 45-60%
4 = 15%
What is the lifetime prevalence of fibroids?
This must be occurence which is about 80%.
How many white women and black women have had a fibroid by age 50?
70% white women, 80% black women
Peak incidence of fibroids
age 40
How many women older than 30 get fibroids
20-50%
What is the gas inflation needed prior to inserting the primary trochar
20-25 mmHg
What is the distension pressure required after trochar inserted
12-15mmHg
What is risk of serious complication in laparoscopy
2/1000
Which criteria is used to diagnose PCOS
rotterdam
Diagnostic criteria for PCOS?
2/3 of:
hirsuitism (physical or biochemical - testosterone
oligomenorrhoea
cytic appearance of ovaries on USS - 12 or more primary follicles or total ovarian volume >10cm3
Does LH or FSH tend to be high in PCOS?
LH
LH:FSH >2
What are the risk factors for acute fatty liver of pregnancy?
multipregnancy
obesity
nulliparity
Also male fetus
Risk is 1:10,000
What are the signs and symptoms and bloods of acute fatty liver of pregnancy?
janudice, abdo pain, fatigue, obesity, male fetus
bloods - LFTs derranged, coagulopathy, hypoglyaemia, hypouricaemia
What are the GDM diagnostic values for: NICE, WHO and modified who
2 hour glucose = ALWAYS 7.8
fasting glucose:
5.6 (NICE)
6.1 (un-modified WHO)
7.1 (modified WHO)
What type of bacteria is gonnorhoea
gram negative aerobic diplococcus
When do mothers typically start to feel fetal movements?
18-20 weeks
How to manage RFM in >28 weeks
CTG
If CTG normal but RFM persists - USS
How to manage RFM in <28 weeks
USS to assess size
doppler to locate fetal heart
At what gestation does the fetus start swallowing
12 weeks
When does the fetus start peeing
10 weeks (800ml/day by term)
Amniotic fluid is mostly urine after 20 weeks
How much surfactant does the fetus produce per day by 3rd trimester
5-10ml/kg/day
What happens to ovarian size in menopause
<2cm2
What is the half-life of oxytocin
5 minutes
What is the half-life of ergometrine
30-120 minutes
What type of receptors does oxytocin bind to?
G-protein-coupled receptors
Treatment of hyperthyroid in pregnancy?
How common is it?
Propylthiouracil - crosses placenta less
NO RADIOIODINE
2/1000 pregnancies
What is saint anthony’s fire
side effect of ergometrine
Ergometrine is an Ergot alkaloid.
St Anthony’s fire = gangrene and convulsive symptoms
Staging of vulval Ca
1 - confined to peroneum
1A = <2cm tumour with <1mm stromal depth
1B = >2cm tumour OR >1mm stromal depth
2 - spread to adjacent structures with no nodes - 1/3 vagina, 1/3 urethra
3 - inguinofemoral nodes
3A - one node >5mm OR 2 <5mm
3B - 2 nodes >5mm OR 3 nodes <5mm
3C - 3 nodes >5mm OR erodes outwith capsule of node
4 - local or distant structures
4A - ulcerated inguinofemoral nodes, bladder, rectum, upper urethra, upper vagina
4B - pelvic lymph nodes or distant mets
Which of the LFTs rises in pregnancy
ALP can triple in third trimester
How many pregnancies experience itching
23%
What is the cause of acute fatty liver of pregnancy
FETAL deficiency of long-chain-3-hydroxy-coA-dehydrogenase
this then leads to an accumulation of toxic liver product that accumulate in the maternal circulation
What is polymorphic eruption of pregnancy
Rash that starts typically in 3rd trimester in first pregnancies.
Papules and plaques appear within striae
How common is a dry mouth with antimuscarinics
1/10
Summarise the treatment for OAB
Before antimuscarinics:
- bladder training
- desmopressin if nocturia
- vaginal oestrogen to treat atrophy
Muscarinics 1st line:
- oxybutynin (1st)
- tolterodone (2nd)
2nd line:
- transdermal anticholinergic
- mirabegron
Adjuvant:
- consider duloxetine for those not wanting surgery
Summarise the treatment for OAB
Before antimuscarinics:
- bladder training
- desmopressin if nocturia
- vaginal oestrogen to treat atrophy
Muscarinics 1st line:
- oxybutynin (1st)
- tolterodone (2nd)
2nd line:
- transdermal anticholinergic
- mirabegron
Adjuvant:
- consider duloxetine for those not wanting surgery
Who do we not give anticholinergics to and why?
Elderly and frail.
Because anticholinergics complete centrally as well as peripherally and therefore can cause confusion/delirium
How does trimethoprim work
dihydrofolate reductase inhibitor
How do tetracyclines work
Bind to 30S subunit of ribosomes to block the binding of amino-actyl TRNA to the site A of ribosomes
Which cancer spreads lymphatically? What is the exception?
carcinoma
Renal cell carcinoma spreads haematogenously
Which cancer spread haematogenously
RCC
choriocarcinoma
sarcoma
Which cancer spreads transcoelomically? What does this mean?
Ovarian
Spreads scross a body cavity by penetrating walls such as peritoneum
what is implantation/transplantation spread of cancer?
During surgery/procedure
What is the average blood loss across one menstrual cycle?
35-40ml
What is the maximum ‘normal’ blood loss in one menstrual cycle?
80ml
Incidence of vascular injury in laparoscopy
0.2/1000
Incidence of bowel injury in laparoscopy
0.4/1000
Define delay of 2nd stage labour in nulliparous and parous women?
Nulliparous:
- suspect at 1 hour
- diagnose delay at 2 hours
Parous:
- suspect at 30 minutes
- diagnose at 1 hour
What to do if delay suspected at second stage labour
?
ARM
What to do if delay confirmed at second stage labour
?
C-section
In how many patients with trichomoniais vaginalis do you see a straeberry cervix?
2%
Treatment of TV?
metronidazole 400-500mg BD - duration depends on sx
Investigation of TV
swab for PCR or wet smear microscopy
Symptoms of TV
How many are asymptomatic?
Investigation?
Treatment?
Up to 50% have no symptoms
up to 70% have discharge - white frothy in only approx 20%
dyspareunia
vaginal soreness
itching
Investigation: PCR, wet smear
Treatment: 7/7 metronidazole
Contact tracing for men/women with chlamydia
Symptomatic men - last 4 weeks
ALL women or asymptomatic men - 6 months. OR if last sexual partner >6 month ago then just them
How many women and men are asymptomatic with chalmydia
women - 80%
men - 50%
When can COCP be started after abortion or miscarriage?
Immediately
Who should get anti-D if aborting
Rhesus negative women >10 weeks pregnant
For women <10 weeks with SURGICAL abortion - consider anti-D
Who gets antibiotics with abortion
can offer it for surgical abortions:
Doxycycline BD 7/7
What lactate level indicates tissue hypoperfusion
> 4
Incidence of OASIS (obstetric and sphincter injury) in multips and nullips and overall
Nullips - 6%
Multips - 1.7%
Overall - 3%
Follow up, examination, drug treatment of OASIS
follow up in 6-12 weeks
PR following repair or following birth of those at risk of OASIS
broad spectrum abx
When starting methotrexate how often do FBC?
every 1-2 weeks
When established can do 2-3 months
Needs to do FBC, renal and liver function (risk of cirrosis, and also can lower cell proliferation so lead to neutropenia and thrombocytopenia)
Treatment of molar pregnancy
methotrexate
What is the max increase in Na over 24h
8-10
What are the compositions of fat/protein/sugar in breast milk?
What about colostrum
Fat 4%, protein 1%, sugar 7%
Colostrum has much higher protein and low sugar
Who should metolopramide not be given to
Those under 19 due to risk of oculogyric crisus
What is an antepartum haemorrhage vs miscarriage
Bleeding >24+0 weeks
miscarriage must happen before 24 weeks
How many miscarriages are in the first trimester
85%
How many women with gonorrhoea will develop PID
15%
What does neutrophil count do during pregnancy
drop
With cholestatic jaundice - how many days post natally would you test LFTs
10 days
How common is obstetric cholesiasis
0.7% pregnancies
What defines obstetric cholestasis
itching with NO rash and derranged LFTs
How is OC investigated
LFTs every 1-2 weeks and 10 days postnatally
What if your patient has an itch but with normal LFTs
Treat the itch?
repeat LFTs in 1-2 weeks as the itch can preceed the abnormal bloods
Ursodeoxycholic acid
What can OC lead to
premature delivery, passage of meconium, PPH, fetal distress
Which is the most common type of ovarian cancer?
EPITHELIAL with highest occurance first:
serous
clear cell
endometrioid
mucinous
Other non-eithelial types: germ cell, sex cord
5 year survival of ovarian Ca
43%
How is ovarian mass assessed?
RMI - risk of malignancy index
Uses: USS appearance, menopausal status and Ca125 to assess risk of malignancy
What are the ultrasound features looked at for RMI
Ascites, multilocular cyst, solid areas, intra-abdominal mets
What is used for the diagnosis of BV
Amsel or nugent criteria
NOT gardnerella vaginalis
What are the stages and symptoms of syphilis
Primary - chancre and lymphadenopathy
Secondary - rash on soles and palms, warts on genetalia
Latent - early <1 year after second stage, late >2 year after second stage
Tertiary - neurosyphilis, cardiosyphilis, gummas
What is the appropriate dose of radiation for breast tissue in CTPA
20 mGy or 20 mSv
Compared to 1 mSv for VQ
What type of cancers are most bladder Ca
Transitional
What is the treatment of pueperal sepsis
Tazocin
Risk factors for pueperal sepsis
obesity
GDM
immunocompromised
cervical cerclage
amniocentesis
C-section
Treatment of gonnorrhoea in prengnancy?
1g IM ceftriaxone OR spectinomycin 2g IM or azithromycin 2g PO
Treatment of gonorrhoea outwith pregnancy?
1g IM ceftriaxone OR ciprofloxacin 500mg PO
Treatment of PID with gonorrhoea OUTPATIENT
doxycycline 100mg BD 14/7
metronidazole 400mg BD 14/7
1g ceftriaxone once off
Inpatient management of PID
2g IM ceftriaxone OD until clinical improvement
doxycycline 100mg BD 14/7
metronidazole 400mg BD 14/7
What are the levels of anaemia in prenancy
2nd trimester <110
3rd trimester <105
Post-partum <100
Which organism causes most UTIs in pregnancy
e.coli
Which antibiotics for UTI in pregnancy?
1st trimester - NO TRIMETHOPRIM
3rd trimester - NO NITROFURANTOIN
What are the two histological features typical of serous and mucinous ovarian tumours?
Serous - Psammoma bodies. Calcium
Mucinous - Mucin vaculoles
Features of turners
1:2500
Most miscarry
Short
No menarchy
Short neck
Broad chest and widely spaced nipples
Teeth problems
Nails that turn upwards
HART - bicuspid aortic valve
Cannot have kids.
What is the risk that VIN will turn into vulval carcinoma
15%
Describe the various methods of laparoscopic entry
palmers - RUQ - avoids suspected adhesions in the midline. Can be used in any weight
Varess needle - only used for normal weight patients due to difficulty (obese) and risk of vascular injury (very thin)
Hassan - Dissection and blunt insertion of trochar. Can be used in any weight
What is pre eclampsia
BP >140 with 1 of the following:
- proteinuria (2+ dipstick) or P:C >30
- renal involvement
- liver involvement - LFT >40
- low platelets
- convulsioms
- ureteroplacental dysfunction such as IUGR/stillbirth
Features of severe pre-eclampsia requiring admission
severe hypertension >160 or >110 diastolic
ALT >70
Creatinine rise >90
Platelet drop <150
Signs of PE/pulmonary oedema
Fetal compromise
Drug tx for hypertension in prengnacy
1st - labetalol
2nd - nifedipine
3rd - methyldopa
What is polymorphic eruption of pregnancy associated with
multiple gestation pregnancies
rhesus positive
obesity
In which swab infection do you see ‘clue cells’
BV
Which bacteria causes BV?
Type of bacteria?
What change does it cause for the environment?
Gardnerella Vaginalis
Gram-intermediate bacteria
Anaerobic
Causes environment to become alkali
Treatment of BV
7/7 metronidazole
What is the tubal factor infertility rate following single episode PID VS 3 episodes PID
12.5%
50%
Incidence rate and mortality rate of vulval Ca
Who gets it?
How much VIN turns into cancer?
Histology?
What about DES inpregnancy?
roughly:
INCIDENCE - 4/100,000
MORTALITY - 1/100,000
Rare<50
Usual diagnosis around 75
15% VIN turns into cancer
85% are SCC
If DES in pregnancy - clear cell cancer of vulva
How many vulval cancers are SCC
85%
Mean presentation of vulval Ca
- Rare under age 50
What is the first clinical sign of ureteric injury?
Other symptoms?
anuria
flank pain
haematuria
fever
vaginal urine discharge
Raised creatinine
Overall complication risk in hysterectomy?
Haemorrhage risk?
Bowel injury risk?
Ureter/bladder injury risk?
4%
2.3%
0.04%
1%
When is screening for GDM recommended for PCOS patients that are overweight?
Do all patients with PCOS get screened?
24-28 weeks
No, only those over weight or with another RF
What is a tocolytic?
Examples?
Delays delivery
CCB - Nifedipine
Oxytocin antagonists - atosiban
Risk of vulval Ca with lichen sclerosis?
<5% - slightly higher risk
Which gestation can you do a CTG if presenting with RFM?
> 28 weeks
What is risk of serious neonatal infection?
What about if they have prelabour ROM?
0.5%
1%
How to manage PROM if >34 weeks
If PROM >24h then induce if labour hasn’t started
How to manage PROM if <34 weeks
Don’t induce unless clinically indicated such as infection
Gold standard test for Chlamydia
NAAT
Incidence of accreta (including per/in)
Basically who knows but likely somewhere between 1:300 - 1:2000
Risk of accreta with 1/2/3/4/5 previous C-section
Other RF?
3%, 11%, 40%, 61%, 67%
previous accreta, praevia, asherman’s, previous ablation, previous uterine surgery
Most common type of vaginal Ca
SCC
90% of cases
Percentage of patients asymptomatically colonised by candida with pregnancy and non-pregnant women
40%
20%
Tx of candida in pregnancy
topical Imidazole
Most common pathogen in fitz/hugh/curtis syndrome?
What is it?
What can it cause in the neonate?
Chlamydia
Complication of PID - causes a perihepatitis. Inflammation surrounding the liver can cause adhesions.
Opthalmia neonatorum
Azoospermia in tall skinny male with scant pubic hair and small balls?
Kleinfelters
Infertility rate in endometriosis
40%
Grading system for endometriosis?
American society for Reproductive Medicine
1 - superficial and firm lesions
2 - deep lesions at cul-de-sac
3 - ovarian endometriomas
4 - extensive adhesions
What is the relative risk for someone with factor V leiden for VTE in pregnancy
80x more likely than non factor 5 leiden.
80/1000 pregnancies
How do you classify thrombophilias
Which tend to be more severe?
Type 1 = deficiency of anticoag factors
Type 2 = excess of coag factors
TYPE 1 MORE SEVERE
What is factor V leiden?
How many caucasians have it?
How many people with VTE have it?
coagulation factor V resists breakdown = TYPE 2
5% of caucasians
up to 30% of VTE
What are some type 1 thrombophilias
Protein S deficiency, protein C deficiency, antithrombin deficiency
Most common thrombophilia
2nd most common?
Factor V leiden
prothrombin G20210A
Which complication doesnt need to be mentioned with laparoscopy
uterine injury
Who is recombinant EPO used in in pregnancy?
Is it harmful?
those with anaemia of end stage renal failure
No evidence that it is harmful to fetus/neonate/mother
Why do men with CF have azoospermia
Congenital absence of the vas deferens - this is because thick secretions due to mutation in chloride channels cause destruction in utero
