Exam Flashcards
RF for GDM
Family history Obesity Black ethnicity Previous GDM Previous macrosomic baby
Screening for GDM
Glycosuria
Fasting plasma glucose 5.6
OGTT at 2h 7.8
GDM plasma glucose >7 management
Insulin
GDM plasma glucose <7 management
- Diet exercise (2 weeks)
- Metformin
- Add insulin
GDM risks
Macrosomia
Neonatal hypoglycaemia
Traumatic birth
Perinatal death
Chronic hypertension in pregnancy
HTN <20 weeks
Gestational hypertension
> 20weeks hypertension
NO proteinuria
Pre-Eclampsia
HTN >20 weeks
PROTEINURIA
Resolves 6 weeks post partum
Urine dipstick proteinuria
PCR >30
ACR > 8
Pre eclampsia risk factors
>40 yo Obesity Multiple pregnancy 1st pregnancy Previous pre eclampsia
Pre eclampsia complications
Placental abruption
Eclampsia
HELLP
Foetal growth restriction
Pre eclampsia medications
Labetalol
Nifedipine
Methyldopa
Seizure prevention in pre eclampsia
IV magnesium sulphate
VTE Management
LMWH (enoxaparin)
At least 3 months
At least 6 weeks post partum
At least until end of pregnancy
Which VTE drugs to avoid in pregnancy?
Warfarin DOACs (rivaroxaban, apixaban)
Obstetric cholestasis
No rash
Itching
Abnormal LFT (raised ALP)
Complication of obstetric cholestasis
Preterm birth (check weekly LFT)
Obstetric cholestasis management
Weekly LFT
Urodeoxycholic acid
Acute fatty liver of pregnancy symptoms
N & V
Abdominal pain
Jaundice
-always 3rd trimester-
HELLP
Haemolysis (LDH)
Elevated Liver (ALT AST)
Low Platelet
Placenta praevia management
If bleed:
Admit
Steroids 24-36th week
Delivery (C section)
Placental abruption symptoms
Severe abdominal pain
Vaginal bleeding
Tense rigid abdomen
Risk factors for placental abruption
Hypertension
Smoking
Cocaine
Multiple pregnancy
Placental abruption management
Delivery
Placenta praevia - where does placenta attach?
Deep into myometrium
1* post partum haemorrhage causes
4 Ts Tone Trauma Thrombin Tissue (retained)
Preventing PPH routine
Prophylactic uterotonics
1st IM Oxytocin
2nd IM Syntometrine (if high risk)
+ Tranexamic acid
IM Syntometrine contraindications
HTN
Major PPH management
Bimanual compression IV oxytocin 5U IV/IM ergometrine 0.5mg Oxytocin infusion IM Carboprost 0.25mg Sublingual Misoprostol 800ug Surgical / Balloon tamponade
First stage of labour rate
1cm - 2h
2nd stage of labour length
Nulliparous: 3h
Multiparous: 2h
Membrane sweep
Trying detach the membranes from inner cervix - 40+ weeks
Induction of labour
Membrane sweep 24h later: prostaglandin pessary Prostaglandin gel/tablet Artificial rupture of membranes Syntocinon
1st stage latent dilatation rate
0-3cm /6h
1st stage active length
3-10cm
1cm/hr
Antibodies in haemolytic disease of a newborn
IgG
Sensitising events treatment
1st term: 250 u anti-D immunoglobulin
2nd: 250 u in 72h of event + Kleihauer test
3rd: 500 u in 72h + Kleihauer test
Kleihauer test
Quantifies how much foetal blood is in maternal circulation
Hyperemesis gravidarum
> 5% weight loss
Electolyte disturbance
Dehydration
PUQE sforę
Antiemetics in pregnancy
1) cyclizine, prochlorperazine, promethazine, chlorprimazine
2) metoclopramide, domperidone, ondasetron
Ectopic - expectant management
No pain
< 35mm
No heartbeat
hCG < 1000
Ectopic - Medical management
PAIN
< 35mm
hCG < 1500
No heart beat
IM METHOTREXATE
Ectopic - surgical management
PAIN
> 35 mm
hCG > 5000
Salpingectomy / salpingotomy
Threatened miscarriage
Heartbeat
Pain, bleeding
Os closed
Inevitable miscarriage
No heartbeat
Pain, bleeding
Os Open
Incomplete miscarriage
Retained products of conception
Pain, bleeding
Os Open
Complete miscarriage
Empty uterus
Closed Os
Missed miscarriage
No heartbeat
Asymptomatic
Miscarriage Medical management
Vag misoprostol
Pain relief
Antiemetic
Surgical management of miscarriage
Manual vacuum aspiration
Surgical management
Antiphospholytic syndrome triad
Recurrent miscarriage
Thrombocytopenia
VTE
Antiphospholipid syndrome screen
Lupus anticoagulant
Anticardioliptin antibodies
Medical TOP
Mifepristone
Misoprostol
+ >22 feticide
Surgical TOP <14 w
Vacuum aspiration
Surgical TOP 14-24 weeks
Dilation and Evacuation
Complete mole
Sperm + empty egg = 46XX
Partial mole
2x sperm + egg = 69 XXY
Depot - characteristics
Weight gain
Slow return to fertility
Every 12-14 weeks
COCP
Prevents ovulation
Makes period lighter
Quickly reversible
POP
Thickens mucus
Irregular period
Small window for taking
Hormonal coil
Lasts 3-5 y
Thins endometrium
Lighter, less painful period
Copper coil
Work immediately
Makes period more heavy
5-10 y
Sterile inflammation
Implant
Prevents ovulation
3 years
Irregular period
Patch
Weekly 3 weeks, 1 week off
Skin sensitivity
Similar to COCP
Kallman syndrome
- hypogonadotrophic hypogonadism
- reduced or absent sense of smell (anosmia)
PCOS
PCOS on USS >12 cysts in 1 ovary
Hyperandrogenism
Anovulation
Estrogen only
-> endometrial cancer
HRT
VTE
STROKE
BREAST CANCER
Clomiphene
Stimulates egg release in PCOS to improve fertility
metformin also improves fertility
Diagnosis of premature ovarian insufficiency
2x FSH >30
4-6 weeks apart
Ovarian cancer symptoms
Bloating
Constipation
Urination trouble
PM
Ovarian cancer diagnosis
CA 125
Endometrial cancer diagnosis
TVUSS >4mm suspicious
Hysteroscopy biopsy
Mx: high dose progesterone
Cervical cancer symptoms
Postcoital bleeding
Intermestrual bleeding
Cervical cancer diagnosis
HPV 16/18
Check for CIN Cervical Intraepithelial Neoplasia
HPV -
Routine screening in 3 years
HPV +
Normal CIN
Re test in 1 year
HPV +
Abnormal
Invite for colposcopy
PID treatment
IM Ceftriaxone STAT 500mg
PO Docycycline 100mg BD 14d
PO Metronidazole 400mg BD 14d
PID management in penicillin allergy
PO Ofloxacin + Metronidazole 14d
Urge incontinence management
1) bladder retraining 6w
2) oxybutynin, tolterodine
3) mirabegron (b3 agonist)
4. SNS, botox, PTNS
Stress incontinence management
- Pelvic floor exercise 3 mth
2. Duloxetine SNRI
Syphilis in pregnancy
FGR
Mx IM Benzathine Penicillin
VZV in pregnancy
Neonatal varicella - cutaneous scarring, FGR, Limb hypoplasia
+HPV management
Cytology
Abnormal: colposcopy
Normal: 12mth test
If +HPV and cytology normal at 12 month follow up
Repeat in 12months
If +HPV and cytology abnormal at 12 month follow up
Colposcopy
Inadequate sample cytology
1x return in 3 mth
2x colposcopy
<20 w pregnant exposure to VZV
Check varicella antibodies
If negative, IVIG in 10 days
<20 w pregnant with VZV
Aciclovir
> 20 weeks pregnant with VZV
Acyclovir within 24h of rash
> 20 weeks pregnant with VZV exposure
If not immune: give VZIG or acyclovir 7-14 days post exposure
HSV in pregnancy
1-2nd term: acyclovir from 36w
3rd term: acyclovir until delivery
1st ever episode in 3rd term: C Section
HIV in pregnancy
Check viral load 2-4 weeks
And at 36w
Vaginal if <50 at 36w
C section in HIV pregnancy
IV zidovudine (+ART to everyone as usual) Avoid breastfeeding
Hep B in pregnancy
Vax + HBIG in 12h
Vax at 1 month, 6 months
Core symptoms of depression
Low mood
Anhedonia (usual things don’t bring happiness)
Lack of energy
- for at least 2 weeks
Beck’s triad
Hopeless
Worthless
Helpless
High risk of suicide
Anticipation acts Preventing discovery Careful planning Suicide note Violent method
GAD Mx
GAD must be >6mth
High dose SSRI
Benzodiazepines
OCD management
Exposure and Response Prevention
Or
SSRI
or after 12 weeks, Clomipramine, or alt SSRI
Schizophrenia triad
Auditory hallucinations
Abnormal thoughts
Delusions
Auditory hallucinations
Thought echo
3rd person voice
Running commentary
Abnormal thoughts
Thought insertion / withdrawal / broadcasting
Delusions
False fixed belief held despite evidence
Paranoid schizophrenia
Delusions and hallucinations
Hebephrenic schizophrenia
Disorganised mood, inappropriate, childlish