exam mix Flashcards
RF for GDM
Family history Obesity Black ethnicityPrevious GDMPrevious 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)2. Metformin 3. Add insulin
GDM risks
MacrosomiaNeonatal hypoglycaemia Traumatic birth Perinatal death
Chronic hypertension in pregnancy
HTN <20 weeks
Gestational hypertension
> 20weeks hypertension| NO proteinuria
Pre-Eclampsia
HTN >20 weeksPROTEINURIA Resolves 6 weeks post partum
Urine dipstick proteinuria
PCR >30| ACR > 8
Pre eclampsia risk factors
>40 yo Obesity Multiple pregnancy 1st pregnancyPrevious pre eclampsia
Pre eclampsia complications
Placental abruption Eclampsia HELLPFoetal growth restriction
Pre eclampsia medications
LabetalolNifedipineMethyldopa
Seizure prevention in pre eclampsia
IV magnesium sulphate
VTE Management
LMWH (enoxaparin)At least 3 monthsAt least 6 weeks post partumAt least until end of pregnancy
Which VTE drugs to avoid in pregnancy?
Warfarin DOACs (rivaroxaban, apixaban)
Obstetric cholestasis
No rashItchingAbnormal 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 & VAbdominal painJaundice-always 3rd trimester-
HELLP
Haemolysis (LDH)Elevated Liver (ALT AST) Low Platelet
Placenta praevia management
If bleed: Admit Steroids 24-36th weekDelivery (C section)
Placental abruption symptoms
Severe abdominal painVaginal bleedingTense rigid abdomen
Risk factors for placental abruption
HypertensionSmokingCocaineMultiple pregnancy
Placental abruption management
Delivery
Placenta praevia - where does placenta attach?
Deep into myometrium
1* post partum haemorrhage causes
4 TsToneTraumaThrombinTissue (retained)
Preventing PPH routine
Prophylactic uterotonics 1st IM Oxytocin2nd IM Syntometrine (if high risk)+ Tranexamic acid
IM Syntometrine contraindications
HTN
Major PPH management
Bimanual compression IV oxytocin 5UIV/IM ergometrine 0.5mgOxytocin infusionIM Carboprost 0.25mgSublingual Misoprostol 800ugSurgical / Balloon tamponade
First stage of labour rate
1cm - 2h
2nd stage of labour length
Nulliparous: 3hMultiparous: 2h
Membrane sweep
Trying detach the membranes from inner cervix - 40+ weeks
Induction of labour
Membrane sweep24h later: prostaglandin pessaryProstaglandin gel/tablet Artificial rupture of membranesSyntocinon
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 immunoglobulin2nd: 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 lossElectolyte disturbance Dehydration PUQE sforę
Antiemetics in pregnancy
1) cyclizine, prochlorperazine, promethazine, chlorprimazine| 2) metoclopramide, domperidone, ondasetron
Ectopic - expectant management
No pain< 35mmNo heartbeat hCG < 1000
Ectopic - Medical management
PAIN< 35mmhCG < 1500 No heart beatIM METHOTREXATE
Ectopic - surgical management
PAIN> 35 mmhCG > 5000 Salpingectomy / salpingotomy
Threatened miscarriage
HeartbeatPain, bleedingOs closed
Inevitable miscarriage
No heartbeatPain, bleedingOs Open
Incomplete miscarriage
Retained products of conceptionPain, bleedingOs 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 aspirationSurgical management
Antiphospholytic syndrome triad
Recurrent miscarriage ThrombocytopeniaVTE
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 heavy5-10 y Sterile inflammation
Implant
Prevents ovulation 3 years Irregular period
Patch
Weekly 3 weeks, 1 week offSkin sensitivity Similar to COCP
Kallman syndrome
- hypogonadotrophic hypogonadism| - reduced or absent sense of smell (anosmia)
PCOS
PCOS on USS >12 cysts in 1 ovaryHyperandrogenism Anovulation
Estrogen only
-> endometrial cancer
HRT
VTESTROKEBREAST 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 suspiciousHysteroscopy 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 500mgPO Docycycline 100mg BD 14dPO Metronidazole 400mg BD 14d
PID management in penicillin allergy
PO Ofloxacin + Metronidazole 14d
Urge incontinence management
1) bladder retraining 6w2) oxybutynin, tolterodine3) 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
NAME?
Cytology Abnormal: colposcopyNormal: 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 36w3rd term: acyclovir until delivery1st ever episode in 3rd term: C Section
HIV in pregnancy
Check viral load 2-4 weeksAnd 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 moodAnhedonia (usual things don’t bring happiness)Lack of energy- for at least 2 weeks
Beck’s triad
HopelessWorthlessHelpless
High risk of suicide
Anticipation actsPreventing discoveryCareful planningSuicide noteViolent method
GAD Mx
GAD must be >6mthHigh dose SSRIBenzodiazepines
OCD management
Exposure and Response PreventionOr SSRI or after 12 weeks, Clomipramine, or alt SSRI
Schizophrenia triad
Auditory hallucinationsAbnormal thoughtsDelusions
Auditory hallucinations
Thought echo3rd 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