Contraception Flashcards
What is the upper limit of gestation for abortion
24 weeks
how many medical practitioners are required for an abortion
2 registered medical practitioners
emergency - one
When is anti-D prophylaxis given before an abortion?
women who are rhesus D negative and are having an abortion after 10+0 weeks’ gestation
What is the medical option for abortion?
mifepristone (anti-progestogen)
48hrs later:
misoprostol (prostaglandins)
What test must be carried out after medical abortion, and when?
multi-level pregnancy test (detects level of hCG)
2 weeks after
What is antepartum haemorrhage?
vaginal bleeding from 24wk gestation
what is placenta praevia?
placenta is attached to the lower uterine segment, which makes it more susceptible to haemorrhage
What are the key risk factors for placenta praevia?
previous caesarian section
high parity
M.age >40
multiple pregnancy
previous placenta praevia
Hx endometritis
curettage to endometrium after miscarriage/termination
How does placenta praevia present
painless vaginal bleeding
no uterus tenderness
may be spontaneous or provoked by mild trauma (sex, vaginal examination)
How is suspected placenta praevia investigated?
ultrasound scan
NOT digital vaginal exam (could provoke bleed)
What are the investigations for ovarian cancer?
CA125 blood test
++ –> urgen US AP
palpable abdo/pelvic mass –> urgent referral to gynae
Which conditions are pregnant women offered screening for?
Anaemia
Bacteriuria
Blood group, Rhesus status and anti-red cell antibodies
Down’s syndrome
Fetal anomalies
Hepatitis B
HIV
Neural tube defects
Risk factors for pre-eclampsia
Syphilis
The following should be offered depending on the history:
Placenta praevia
Psychiatric illness
Sickle cell disease
Tay-Sachs disease
Thalassaemia
What is the first line management of vaginal candidiasis?
- oral fluconazoe 150mg
- IVag pessary clotrimazole 500mg
if vulval sx - add topical imidazole to regumen
if pregnant - only topical/pessary (no oral)
How is recurrent vaginal candidiasis managed?
BASHH define recurrent vaginal candidiasis as 4 or more episodes per year
compliance with previous treatment should be checked
confirm the diagnosis of candidiasis
high vaginal swab for microscopy and culture
consider a blood glucose test to exclude diabetes
exclude differential diagnoses such as lichen sclerosus
consider the use of an induction-maintenance regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
What is the only contraindication to depo provera (injectible contraceptive)?
current breast cancer
