genitourinary - obstetrics

Question 1

Pre treatment with this drug can FACILITATE the process of medical abortion

Answer 1

Mifepristone

Question 2

MOA Mifepristone

Answer 2

pretreatment with this can facilitate process of medical abortion
it sensitises uterus to subsequent administration of a PG (misoprostol) and therefore abortion can occur in shorter time and a lower dose of PG

Question 3

This prostaglandin is given by mouth, buccally, SL, or vaginally to induce medical abortion following sequential use with mifepristone. It is also used for cervical priming before surgical abortion

Answer 3

misoprostol

Question 4

this PG is administered vaginally as pessaries and is licensed for medical induction of abortion in 2nd trimester; also licensed to soften and dilate cervix before surgical abortion in early pregnancy

Answer 4

gemeprost

Question 5

Which PG drug is licensed for medical induction of abortion in 2nd trimester

Answer 5

gemeprost

Question 6

Which PG drug is licensed to soften and dilate cervix before surgical abortion in early pregnancy

Answer 6

gemeprost

Question 7

This is used (unlicensed) for the prevention of miscarriage and should be offered after a woman with an intra0uterine pregnancy confirmed by a scan has vaginal bleeding, if they have previously had a miscarriage

Answer 7

vaginal micronised progesterone

Question 8

If fetal heartbeat is confirmed, how long should you continue vaginal micronised progesterone for? (for the prevention of miscarriage, it is offered following vaginal bleeding in females with intra-uterine pregnancy confirmed by a scan, if they have prev had miscarriage)

Answer 8

continue until 16 completed weeks of pregnancy

Question 9

in pregnant females with antiphospholipid syndrome who have suffered recurrent miscarriage, you can give the following 2 under specialist supervision only

Answer 9

low dose aspirin + prophylactic dose of LMWH = may decrease risk of fetal loss

Question 10

for medical. management of missed miscarriage, these two can be offered UNLESS gestational sac has already been passed

Answer 10

mifepristone [unlicensed use] followed by misoprostol [unlicensed use] may be offered

Question 11

you can offer mifepristone [unlicensed use] followed by misoprostol [unlicensed use] for the medical management of missed miscarriage UNLESS

Answer 11

gestational sac has already been passed

Question 12

This PG may be used for the medical management of miscarriage

Answer 12

misoprostol unlicensed use

Question 13

this immunosuppressant is used for the management of ectopic pregnancy

Answer 13

systemic MTX unlicensed

Question 14

Preterm prelabour rupture of membranes (P‑PROM): prevention of intra-uterine infection - which abx? (1st line and alt)

Answer 14

Erythromycin.
Alternative if oral erythromycin is contra-indicated or unsuitable: consider an oral penicillin for up to 10 days or until established labour, whichever is sooner.

Question 15

What can you give as an alt to cervical cerclage in pregnant females with either Hx spontaneous preterm birth (up to 34+0 weeks of pregnancy) or loss (from 16+0 weeks of pregnancy onwards), and a short crevice, to reduce risk of preterm birth

Answer 15

prophylactic progesterone

if only one of these risk factors, consider use of prophylactic progesterone

Question 16

When should you initiate prophylactic progesterone treatment, and how long should you continue it for?

(as alternative to cervical cerclage in pregnant females with either hx spontaneous preterm birth (up to 34+0 weeks of pregnancy), or loss (from 16+0 weeks of pregnancy onward), and a short cervix, to reduce the risk of preterm birth)

Answer 16

Treatment with progesterone should be initiated between 16+0 and 24+0 weeks of pregnancy, and continued until at least 34 weeks.

Question 17

myometrial relaxants - what are tocolytic drugs used for?

Answer 17

Tocolytic drugs postpone preterm labour and they are used with the aim of reducing harm to the child.

Question 18

Discuss the use of nifedipine (unlicensed), and oxytocin receptor antagonist (e.g. atosiban) as an alternative

Answer 18

Females between 24+0 and 33+6 weeks of gestation who have intact membranes and are in suspected or diagnosed preterm labour can be given nifedipine [unlicensed use] for tocolysis.

An oxytocin receptor antagonist (such as atosiban) is an alternative if nifedipine is contra-indicated or unsuitable.

Question 19

What is tocolysis?

Answer 19

Tocolysis is an obstetrical procedure carried out with the use of medications with the purpose of delaying the delivery of a fetus in women presenting preterm contractions

Question 20

What drugs can be given for tocolysis for females between 24+0 and 33+6 weeks of gestation who have intact membranes and are in suspected or diagnosed preterm labour? (2)

Answer 20

nifedipine unlicensed
alternative if CI or unsuitable: oxytocin receptor antagonist e.g. atosiban

Question 21

True or false - B2 agonists salbutamol and terbutaline are recommended for inhibiting uncomplicated preterm labour

Answer 21

False
no longer recommended

Question 22

Why are beta2 agonists salbutamol and terbutaline sulfate are no longer recommended for inhibiting uncomplicated preterm labour?

Answer 22

Use of high-dose short acting beta2 agonists in obstetric indications has been associated with serious, sometimes fatal cardiovascular events in the mother and fetus, particularly when used for a prolonged period of time.

Question 23

When can dexamethasone (unlicensed indication) be offered?

Answer 23

Depending on the stage of pregnancy, individual circumstances, and the balance of risks and benefits, corticosteroids such as dexamethasone [unlicensed use] may be offered to females who are in suspected or established preterm labour, or who are having a planned preterm birth, or who have preterm prelabour rupture of membranes (P‑PROM).

Question 24

Depending on the stage of pregnancy, individual circumstances, and the balance of risks and benefits,

THIS

may be offered to females who are in suspected or established preterm labour, or who are having a planned preterm birth, or who have preterm prelabour rupture of membranes (P‑PROM).

Answer 24

corticosteroids such as dexamethasone [unlicensed use]

Question 25

What can be offered for neuroprotection of the baby, in females who are in established preterm labour or who are having a planned preterm brith within 24 hours (depending on stage of pregnancy and individual circumstances)

Answer 25

Magnesium sulfate [unlicensed use]

Question 26

When can you use magnesium sulfate [unlicensed use] in obstetrics?

Answer 26

Magnesium sulfate [unlicensed use], for neuroprotection of the baby, may be offered to females who are in established preterm labour or who are having a planned preterm birth within 24 hours (depending on the stage of pregnancy and individual circumstances).

Question 27

if pharmacological method of induction is considered suitable, offer one of these 2 for females with Bishop score of 6 or less

Answer 27

offer dinoprostone or misoprostol

Question 28

In which women can you offer dinoprostone or misoprostol if pharmacological method of induction is considered suitable?

Answer 28

females with Bishop score of 6 or less

Question 29

If pharmacological method of induction is considered suitable for females with Bishop score of more than 6, what can you give? And what should you monitor?

Answer 29

Oxytocin may be offered in conjunction with amniotomy. Uterine activity must be monitored carefully and hyperstimulation avoided. Large doses of oxytocin may result in excessive fluid retention.

Question 30

What can be given for induction of labour following intra-uterine fetal death in females with no uterine scarring

Answer 30

Mifepristone [unlicensed use], followed by either misoprostol [unlicensed use] or dinoprostone [unlicensed use]

Question 31

true or false - active management of the third stage of labour reduces risk of PP haemorrhage

Answer 31

true

Question 32

Prevention and treatment of haemorrhage - what is given by IM injection (unlicensed) on delivery of the anterior shoulder or, at the latest, immediately after baby is delivered

Answer 32

prophylactic oxytocin

Question 33

What may be given IM in the absence of hypertension or other CI for prevention and treatment of haemorrhage? (on delivery of anterior shoulder, or at the latest, immediately after baby is delivered for prevention and treatment of haemorrhage

Answer 33

Ergometrine with oxytocin

Question 34

True or false - oxytocin alone causes more nausea, vomiting and hypertension than when given with ergometrine malate

Answer 34

False
it causes less of these symptoms alone

Question 35

Oxytocin drugs are used to treat PP haemorrhage caused by uterine atony. Treatment options include

Answer 35

oxytocin
ergometrine mealate
or a combination of the two

alternatives: carboprost, misoprostol (unlicensed)