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4th Year GOSH > GOSH MANAGEMENT > Flashcards

GOSH MANAGEMENT Flashcards

1
Q

SFD/Reduced Foetal Movements

>28 weeks

A

Auscultation –> CTG

USS – abdo circumference, foetal weight (within 24 hours), amniotic fluid volume (determine whether SFGA), biophysical profile

RFM –> lie on left for 2 hours - < 10 movements –> ANDU

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2
Q

PPROM?

A

Admit for 24-48 hours - examination, bloods, swabs

Steroids – Betamethasone 12mg IM (2 doses 24 hours apart)

Abx – Erythromycin 250mg QDS 10 Days

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3
Q

IUGR?

A

Weekly umbilical artery Doppler and 2 weekly growth scans

Daily CTG if Doppler abnormal

BP/urine checks

Delivery at 37 weeks or earlier if significant maternal or foetal compromise

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4
Q

Pre-eclampsia?

A

Investigations
o Urine PCR (confirm diagnosis)
o Serial BP, FBC, U+E, LFTs and clotting
o Umbilical artery Doppler and daily CTG if abnormal

Antihypertensives – Labetolol, methyldopa, nifedipine

Delivery at 34-36 weeks – Steroids if < 34 weeks

Magnesium sulphate (prophylactic use)

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5
Q

Hyperemesis?

A

IV rehydration
Antiemetics (cyclizine/promethazine/steroids)
Vitamin B supplementation
Growth scans (IUGR)

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6
Q

Gestational diabetes?

A

Diet/exercise for 2 weeks - if not working –> Metformin/Insulin - regular self-monitoring

Folic Acid 5mg until 12 weeks, Aspirin 75mg from 12 weeks

Scans
o Growth scans + liquor volume – 4 weekly from 28 weeks onwards
o Anomaly/specialist cardiac USS

Urine PCR every 4 weeks

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7
Q

Preterm labour?

A

Investigations = foetal state (CTG/USS), likelihood (foetal fibronectin, TV USS cervical length), infection (HVS, CRP, FBC)

Steroids

Tocolytics – Nifedipine/Atsodiban (no more than 24 hours)

If chorioamnionitis - IV abx and immediate delivery

Abx for delivery if risk of GBS

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8
Q

Placenta Praevia

A

APH - NO VAGINAL EXAMINATION UNTIL AFTER A SCAN

Admit at 37 weeks or anytime if bleeding – maintain IV access and keep blood available

Anti D for Rhesus -ve women

Elective caesarean at 39 weeks

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9
Q

Placental Abruption

A

APH - NO VAGINAL EXAMINATION UNTIL AFTER A SCAN

Admission

IV fluids – consider transfusion

Anti D for Rhesus -ve women

Delivery
o > 37 weeks – Induce if no foetal distress, urgent C-section if foetal distress
o < 34 weeks – steroids
o Can be managed conservatively if no foetal distress and abruption minor – monitor on ward.

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10
Q

Primary PPH?

A 
Atonic Uterus
o	Ergometrine IV bolus
o	Syntocinon infusion 
o	Prostaglandins if no response
o	May need examination under anaesthesia +/- laparotomy

Genital Tract Trauma – repair

Persistent Bleeding
o Rusch balloon, brace suture, uterine artery embolization

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11
Q

Endometritis? (secondary PPH)

A

Investigations = FBC, CRP, HVS, blood cultures

Co-amoxiclav or Cefuroxime and Metronidazole

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12
Q

Other secondary PPH?

A

Vaginal swabs,, FBC, X-match

USS

Abx

Evacuation retained products (ERPC)

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13
Q

Eclampsia

A

ABC –> recovery position, bloods (FBC, U+E, coag – HELLP)

Magnesium sulphate/diazepam to stop fits

Magnesium sulphate infusion

Stabilise blood pressure and maternal condition –> deliver baby

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14
Q

Pulmonary Embolus

A

ABCDE, O2, ABG, CXR, ECG

V/Q scan

Anticoagulate during remainder of pregnancy and post-partum
o LMWH – tinzaparin, enoxaparin
o NOT warfarin

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15
Q

Menorrhagia?

A

Not trying to conceive
1st line = Mirena IUS;
2nd line = COCP;
3rd line = GnRH agonists

Trying to conceive
1st line = Tranexamic acid/Mefanamic acid;
2nd line = Progestogens

Surgery
Endometrial ablation; Uterine artery embolization; Hysterectomy

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16
Q

Irregular periods?

A

1st line = IUS or COCP

2nd line = Progestogens

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17
Q

Dysmenorrhoea?

A

1st line = NSAIDs or COCP

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18
Q

PCOS? (increased risk of diabetes and endometrial cancer)

A

Weight reduction

COCP – need 3-4 bleeds per year to protect endometrium

Antiandrogens – Cyproterone acetate/Spironolactone – conception must be avoided. Topical eflonithine for facial hirsutism.

Metformin - ↓insulin levels –> ↓androgens and hirsutism

19
Q

Endometriosis? (mimic pregnancy)

A

Medical

NSAIDs
COCP (not older women or smokers – back to back pills)
Progestogens (endometrial and ovarian suppression)
GnRH Analogues (only 6 months due to bone demineralisation)

Surgical

Laparoscopic ablation, resection or cystectomy/oophorectomy
Hysterectomy (last resort)

20
Q

PID?

A 
Investigations
o	Abdo exam, speculum + bimanual 
o	All the swabs/HIV syphilis bloods/urine dipstick
o	Temperature
o	FBC/U+E/CRP/LFTs

Ceftriaxone 250mg IM stat
Doxycycline 100mg BD PO 14 days
Metronidazole 400mg BD PO 7-14 days (if suspected vaginitis)

21
Q

Miscarriage? (Incomplete, inevitable, missed)

A

Medical
Misoprostol

Surgical
Evacuation of uterus (under GA)

22
Q

Ectopic pregnancy?

A

Medical
Methotrexate IM – if < 3cm in size, no FH seen on scan.

Surgical
Salpingectomy (usually laparoscopic)

23
Q

Fibroids?

A

Medical
1st line = Tranexamic acid; NSAIDs; Progestogens
GnRH analogues – to shrink before surgery

If small/intramural and causing menorrhagia - COIL

Surgical
Hysteroscopic resection of fibroids
Hysterectomy
Myomectomy – preserves fertility
Uterine artery embolisation – effect on fertility unclear
24
Q

Stress incontinence?

A

• Conservative
Pelvic floor muscle training

• Medical
Duloxetine

• Surgical
TVT/TOT; Colposuspension = old-fashioned

25
Q

Urge incontinence?

A

• Conservative
Avoiding caffeine, fluid intake etc
Bladder training – educaton, timed voiding, +ve reinforcement

• Medical
Anticholinergics (oxybutynin) – dry mouth, constipation etc
Oestrogens (if post-menopausal)
Botulinum Toxin A – paralyses muscle

26
Q

Infertility?

A

Investigations

Infection - chlamydia, rubella
Egg – FSH, LH + oestradiol (day 1-5) mid-luteal serum progesterone
Sperm – semen analysis
Where they meet – USS, hysterosalpingogram, lap + dye

Management

Group 1 (hypogonadotrophic hypogonadism) – increase weight, moderate exercise levels.
Group 2 (PCOS) – clomifene, metformin (no ↑multiple prego), gonadotrophins (↑multiple prego), ovarian diathermy.
Group 3 (premature ovarian insufficiency) – referral to various specialists, fertility treatment (egg donation), HRT
o	Intrauterine insemination/IVF
27
Q

Termination of pregnnacy?

A

• Medical
Mifepristone and Misoprostol (< 9 weeks)

• Surgical
Manual vacuum aspiration (9-12 weeks, continuous sedation)
Surgical evacuation (7-15 weeks, under GA)
Dilatation/evacuation (15-18 weeks, under GA)
Surgical evacuation without feticide (19-22 weeks)
Surgical feticide (22-24 weeks – KCl to stop foetal heart)

28
Q

Menopause?

A

HRT

Oes + prog (if no hysterectomy) - oestrogen protects against osteoporosis and alleviates vasomotor symptoms.

Regulates irregular bleeding. Reduces Protective against bowel cancer, alzheimers. Makes skin and hair look better.

Risk of breast ca, VTE and CVD.

If bleed in last 12 months - cyclical –> withdrawal bleed. Continuous if not.

29
Q

Contraindications to HRT?

A

Current breast/endometrial ca, undiagnosed vaginal bleeding, thrombosis, breast mass, acute liver disease

Endometriosis, fibroids, fam or past hx breast cancer/thrombotic disease

30
Q

Endometrial hyperplasia? (>5mm)

A

With atypical cells - hysterectomy

Without atypical cells - high dose progestogens (oral or oral + mirena)

31
Q

Chlamydia?

A

Azithromycin 1g stat (safe in pregnancy
OR
Doxycycline 100mg BD 1/52 (not safe in pregnancy)

Partner notification
No sex until both partners finished course

32
Q

Gonorrhoea?

A

Ceftriaxone 500mg IM stat

Azithromycin 1g PO stat (cover for chlamydia too + guards against resistance)

33
Q

BV?

A 
Metronidazole 400mg PO BD 7/7
OR
Clindamycin 300mg BD 7/7
OR 
Tinidazole 2g stat
34
Q

TV?

A

Metronidazole 400mg PO BD 7/7

Abstain until both partners treated

35
Q

Candida?

A

Clotrimazole (canesten – topical antifungal) BD until symptoms resolved

36
Q

Lichen Planus/Lichen Sclerosis

A

Planus = self-limiting

Sclerosis = potent topical steroid  follow-up long term due to risk of malignant transformation

37
Q

Scabies/Pubic Lice

A

Topical Permethrin – treat all household/sexual contacts

38
Q

Lymphogranuloma Venerum

A

Doxycycline 100mg BD

39
Q

Epididymo-Orchitis

A

STI cause likely –> Ceftriaxone 250mg IM stat and Doyxcycline 100mg PO 2/52

STI cause unlikely (enteric) –> Ofloxacin 200mg PO BD 2/52
or
Ciprofloxacin 500mg PO BD 10 days

40
Q

Neonatal pnuemonitis?

A

Erythromycin

41
Q

Herpes simplex?

A

Aciclovir 400mg TDS 5 days

42
Q

Genital warts?

A

Ablative – cryotherapy, podophyllotoxin cream/solution (teratogenic), electrocautery

Immune modulation – imiquimod 5% cream

Surgical – cutterage, excision, debulking

Smoking cessation

43
Q

Syphilis?

A

< 2 YEARS
Benzathine penicillin 2.4MU IM stat
Doxycycline in penicillin allergic

> 2 YEARS
3x IM ben pen 1 week apart

4th Year GOSH (23 decks)

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