GOSH MCQs Flashcards
High risk of NTDs should take 5mg rather than 400mcg of folic acid. Who are they?
either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
Bloods and urine sampe in pregnancy: what happens to: urea? creatining? urinary protein loss?
INCREASED PERFUSION TO THE KIDNEYS: reduced urea in serum reduced creatining increased urinary protein loss (protein increase to >300 mg/24 hours versus >150 in non-pregnant patients for an abnormal reading(
Hb decreases due to dilution
physiology in pregnancy: what happens to... liver? (3) urinary system? (4) blood? (4)
- ALP rised 50%
- albumin falls
- liver blood flow stays the same
- increased blood flow 30%
- GFR increases
- salt and water reabsoption increased
- ruinary protein loss increases
- rise in fibrinogen and Factors VII, VIII, X
- fibrinolytic activity is decreased - returns to normal after delivery (placental suppression?)
Enlarged utuerus affects venous return. what tyhree things does this cause?
ankle oedema, supine hypotension and varicose veins
When to give anti D? (2)
28 weeks (and do blood allloantibody screen at the same time)
then 6 weeks later do nd injectiion (34 weeks)
as lasts 6 weeks
how many ANC visits if nuli and multiparous?(2)
when is urine culture/dip done? (1)
what 3 things comprise routine care in ANC?
- 10 for nuli
- 7 for multi
culture at booking to detect asymptomatic bactiuria
dip at every other visit
- BP
- urine dip
- SFH
methotrexate:
can men/women have it during pregnancy? (1)
what about NSAIDs? (1)
teratogenic
both dont have it 6 months before concieving
NSAIDs may be used until 32 weeks but after this time should be withdrawn due to the risk of early close of the ductus arteriosus
What food to avoid in pregnancy? (1)
what supplements? (3)
- Liver should be avoided in pregnancy as it contains high levels of vitamin A, a teratogen.
- listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
- salmonella: avoid raw or partially cooked eggs and meat, especially poultry
- it D
- folic acid 400mcg
- iron supplement if LOW only
- AVOID VITAMIN A
Post-partum thyroiditis:
what are the stages? (3)
treatment? (2)
Thyrotoxicosis–>
hypothyrodisim–>
normal thyroid function
the thyrotoxic phase is not usually treated with anti-thyroid drugs as the thyroid is not overactive. Propranolol is typically used for symptom control
the hypothyroid phase is usually treated with thyroxine
Radical trachelectomy
also called radical cervicectomy. This operation involves removing the cervix, the upper part of the vagina and surrounding supporting tissues. Often lymph nodes in the pelvis are often removed to check whether cancer has spread beyond the cervix. This option also preserves fertility but would only be indicated for IA2 tumours.
finding of ruptured ectopic on bimanual exam? (3)
abdominal tenderness cervical excitation (also known as cervical motion tenderness) adnexal mass:
what is nucal translucency increased in
Downs
due to increased congenital heart defects
basicualyl oedema in the baby building up! (lymphatic accumulation)
Chicken pox in pregnancy: waht to do?
IF SHE IS UNSURE IF SHE HAS HAD CHICKEN POX
(if she has had it then do nothing!)
Chickenpox exposure in pregnancy - first step is to check antibodies
Chickenpox infection during the first 20 weeks of pregnancy can cause foetal varicella syndrome. In the second of third trimester chickenpox can cause severe maternal disease. In late pregnancy infection (near delivery) there is a risk of neonatal varicella.
- given varicella-zoster immunoglobulin (VZIG) as soon as possible
if presents with rash then give oral aciclovir
best imaging technique for diagnosing adenomyosis
MRI
- best for most gynae stuff, eg ovarian stuff, CT useless! (remember the reg complaining they found abnormal ovary on CT)
realistically TVUSS best next diagnostic tool
(CT lacks the ability to differentiate different tissue types.)
Rovsings sign? when to do it? (2)
RIF pain
RIF pain when push on left
do to find appendicitis (rule out/in)
what triggers ovarian torsion
exercise
FIGO stands for?
staging used in?
(International Federation of Gynecology and Obstetrics)
- cervical
- ovary
- endometrial
- vulval etc
AFP:
raised in?
decreasedin?
- raised= NTD
- low= Downs
How to managed slow progression in stage 1?
particularly seen in primiparous
send home with analgesia
giving oxytocin and artificially ruutirng will just increase chance of C-section as they need to be fully dilated
Inadequate progression in first stage of labour is due to what possible three things? (3)
Passenger
Passages (fibroids/cervical dystocia)
Power
in second stage same causes!
so a labour may be poorly progressing if contractions are regular but the baby is just in the wrong position
(–> fetal head not engaged, slow progress, haematuria, head poorly applied to cervix)
cervical dystocia is the cervix effervesces but fails to dilate because of severe scaring/rigidity/old cone biopsy
What to do if normal pH on fetal blood sampling?
repeat every 30-60 minutes anyway if abnormal CTG persists
What to do in uterine hyperstimulation?
i.e. when you’ve given too much oxytocin
stop infusion
tocolytic e.g. terbutaline temporarily
throughout labour a slightly downward slope in pH is expected and should be assessed with the labour progression
complication of giving opiates during labour for baby
- can imapct breast feeding
- causes fetal bradycardia
brow presentation
13.5cm
incomparable with vaginal delivery
must –> C section or face presentation or normal
apart from >42 weeks (offered dafter 41 weeks), when else is induction of labour common?
PROM
(induce at 37 weeks after rupture as longer the gap between PROM and labour the higher the chance of chorioamnionitis
also
- fetal macrosomia in the absence of diabetes
- FGR
- per eclampsia/ HTve disorders
- PROM
- intrahepatic cholestasis of pregnancy
- twins >38 weeks
- deteriorating maternal illness
normal delivery process
engagement descent flexion internal rotation extension restitution external rotation delivery of the shoulders
perianal tear- what symptoms do they cause
external= foecal urgency internal= incontinence
When should ventouse never be used?
which operative delivery is more likely to fail?
<34 weeks as cephalhaematoma and intracranial haemorrhage
face or breech presentation
ventouse higher failure rate
BUT
less likely to perineal tear, less pain relief needed and less likely to have significant pain and need regional/general anesthesia
–> failed ventous can try forceps then –> c section
to use operative delivery make sure the operator is EXPERIENCED and you know the fetal lie of the baby
National Childbirth Trust
national consumer group represing the veiws of women on maternity care
Prolactin:
where released from?
when does it increase?
anterior pituitary
in 3rd trimester 15* higher than normal levels
Hormones:
what hormone induces cervical remodelling? (1)
regulates uterine blood flow via endothelial effects? (1)
what is released from posterior pituitary? (2)
prostglandins
cotisol
ADH and oxytocin
haematological cahnges:
what rises due to increased production of placental isoform?
what increases by 50% to lead to hypercoagulable state?
alkaline phosphatase
ALP
Your liver is one of the main sources of ALP, but some is also made in your bones, intestines, pancreas, and kidneys. In pregnant women, ALP is made in the placenta.
fibrinogen
what is taken at booking thena again at 28 weeks
FBC
What is a biophysical profile?
CTG + Ultrasound
The BPP measures your baby’s heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid around your baby
Diseases caused by cloncal expansion of trinucleotide repeats?
Klinefelter’s chromosomes?
huntingdons, fragile X, Fredierchs ataxia, myotonic dystrophy
XXX
Prenatal testing:
fetal alloimmunue thrombocytopenia test? (1)
most suriable test for X_linked disorder? (1)
- cordocentesis
- free foteal DNA
woman 34 weeks with severe abdo pain andbleeding and clots? top differential
placetnal abruption
SEVERE ABDO PAIN and BLEEDING= ABRUPTION
~50% have high blood pressure (which can contribute to the abruption) so BP may be high despite blood loss
Malpresentation: which women admit to antenatal ward at term? (1) what is frank breech? what is footing breech? what is complete breech?
unstable lie
- legs up
- foot first
- legs tucked in
hydration and use of compression stockings in pregnancy will help prevent..
fainting
Multiple pregnancies:
death of co-twin in 25% of cases?
delivery of monozygotic monoamniotic twins?
monzygotic twins
- delivery elective CS at 32-34 weeks
when does pre eclampsia develop?
Pre-eclampsia rarely happens before the 20th week of pregnancy. Most cases occur after 24 to 26 weeks, and usually towards the end of pregnancy. Although less common, the condition can also develop for the first time in the first 6 weeks after birth
woman at 20 weeks with cervical length of 2cm and funneling of the membranes is what?(1)
what does cervial length mean? (1)
inevitable misscarriage due to
cervical insufficiency- could try cervical clercage
The cervical length (CL) is obtained by measuring the endocervical canal from the internal cervical os to the external cervical os. The normal cervix should be at least 30 mm in length. Cervical incompetence is variably defined, however, a cervical length of <25 mm at or before 24 weeks is often used.
risk of appendectomy in pregnancy
preterm
Fetal fibronectin (fFN)
Fetal fibronectin (fFN) is used to test pregnant women who are between 22 weeks and 35 weeks of pregnancy and are having symptoms of premature labor. The test helps predict the likelihood of premature delivery within the next 7-14 days.
treatment obstructive cholestasis
ursodeoxycholic acid
engagement
when widest part of the presenting part has successfully passed through the pevlic outlet
what is the time between onset of labour and 3-4cm dilation called
latent phase (FIRST STAGE- latent)
Mechanism of labour:
1- after head deliveres through the vulva, it immediately aligns with the fetal shoulders
2- occuput escapes from under sympysis pubis wich actsas a fulcrum
3- widest part of the presenting part passed through pelvic inlet
- restitution
- extension
- engaement
Interventions in second stage:
- multigravida induction at 42/40 is brow presentation
- not progressing
- brow= 13cm therefore incompatible with vaginal delivery –> ICSC
difference kielland forceps and nevilee barnes forceps?
kielland= rotate
neville barnes= just pull
NOTe you cant do ventouse <34 weeks!
Cesarean complications
- distention and pain but normal vitals
- distension and pain with tachycardia and febrile
1- ileus
2- bowel injury
risk of failure to complete third stage
uterine inversion
position for cord proplapse? (1)
when does cord prolapse commonly occur? (1)
The correct position for women who have a cord prolapse is on all fours, on knees and elbows
straight after rupture of membranes
–> CS
Risk factors for cord prolapse include: prematurity multiparity polyhydramnios twin pregnancy cephalopelvic disproportion abnormal presentations e.g. Breech, transverse lie placenta praevia long umbilical cord high fetal station
maternal pyrexia, maternal tachycardia, and fetal tachycardia
chorioamnionitis in women with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia
best investigation for placenta previa
TVUS
The RCOG recommends the use of transvaginal ultrasound as it improves the accuracy of placental localisation and is considered safe.
It’s screened for at routine 20wk antenatal check using transabdominal USS, but if presenting with symptoms, or if transabdominal USS shows decreased internal os-placenta distance, TVUS is gold-standard.
when should magnesium be stopped for eclampsia
Magnesium treat should be started in woman with high risk severe pre-eclampsia, or those with eclampsia. It should be continued for 24 hours after delivery or after last seizure,
PPH
ABC including two peripheral cannulae, 14 gauge
bimanual stimulation of uterus for contraction.
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
if medical options failure to control the bleeding then surgical options will need to be urgently considered
the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
when should you referr for never feeling fetal movements
If fetal movements have not yet been felt by 24 weeks, referral should be made to a maternal fetal medicine unit
when does gestational diabetes occur frokm
20 weeks
antiepileptic drugs in pregnancy
Breast feeding is acceptable with nearly all anti-epileptic drugs
(apart from maybe sodium valporate)
It is advised that pregnant women taking phenytoin are given vitamin K in the last month of pregnancy to prevent clotting disorders in the newborn
gestational diabetes management:
if >7
if <7 fasting glucose?
If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l immediate INSULIN (plus or minus metformin) should be started
If <7 but >5.6 then lifestyle management, then 2 weeks later remeasure glucose and start on METFORMIN
- First line: lifestyle factors
- Second line: add metformin
- Third line: add insulin
(add each if fasting glucose not <5.6mmol/L with 2 weeks
don’t use other types; Glibenclamide should be offered to women with GDM who fail to achieve their blood glucose targets with metformin, or in those who decline insulin therapy.
when is gestational hypertension diagnosed
> 20 weeks
gestational DIABETES is different- just any diagnosed in pregnancy
CTG measured from..
26 weeks
below that doppler
steroids forpreterm
12mg betamethason IM, two doses, 24hr apart
period of effectiveness starts after 24 hours and the first dose and last for 7 days
abruption<36 weeks
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
molar pregnnacy and hCG/ T4/TSH levels
hCG high, T4 high, TSH low
Molar pregnancies are characterised by significantly high levels of beta hCG for gestational age, and are therefore used as a tumour marker of gestational trophoblastic disease. The biochemical structure of beta hCG is very similar to that of luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH). That being said, high levels of beta hCG can stimulate the thyroid gland to produce thyroxine (T4), and then triiodothyronine (T3). This can result in signs and symptoms of thyrotoxicosis. High levels of T4 and T3 have a negative feedback effect on the pituitary gland to stop secretion of TSH, causing and overall reduction in TSH levels.
Which one of the following is the most common cause of 1st trimester recurrent spontaneous miscarriage
antiphospholipid antibody
Pre-eclampsia symptoms
headache hyperreflexia odeama visual changes epigastric pain
placental abruption and reflexes
hyperreflexia
babys lungs matured from
36 weeks
management abruption:
fetus <36
fetus >36
Fetus alive and < 36 weeks
fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
post-partum haemorrhage (PPH)
A-E,fluids and cross-match
bimanual uterine compression
initially use Syntocinon 5 Units by slow IV injection (this is in addition to the IM synt you’d get after baby comes anyway) This should then be
followed by ergometrine (contraindicated in hypertension) and then a Syntocinon infusion. Carboprost (contraindicated in asthma) and then misoprostol 1000 micrograms rectally are then recommended. If pharmacological management fails then surgical haemostasis should be initiated.
normal changes in heart sounds in pregnancy
- third heart sound
- perihperal oedema
- ejection systolic murmur
- forceful apex beat
definition primary PPH
Postpartum haemorrhage is defined as blood loss of 500 ml or more within 24 hours of the BIRTH OF A BABY
Postpartum haemorrhage estimated over 1000mls of blood loss is classified as major postpartum haemorrhage.
placenta accreta- risk factors (2)
definitive management
Previous caesarean-section
Previous pelvic inflammatory disease
The definitive management of such a patient is hysterectomy with the placenta left in-situ [1]. This is because the attempts to actively remove the placenta can cause significant haemorrhage.
SFH normal measurememt:
what is a ‘normal’ length? (1)
how do you measure? (2)
when is SFH useless? (3)
It should match the gestational age in weeks to within 2 cm after 20 weeks, e.g. if 24 weeks then the a normal SFH = 22 to 26 cm
from pubic sympsis as bony landmark, measure up
measure with ruled UPSDIE DOWN to prevent unconscious bias (you unconsciously measure it the right size)
- BMI high
- multiple pregnancies
- polyhydaminos
(i. e. obviously stretched uterus)
when is aspirin started for preventing pre eclampsia
12-14 weeks till birth
1/5ths rue:
what is 1/5 or less?
instrumental delivery
if >1/5 you CAN’T do an instrumental
Doppler:
how to make sure you feels foetal HR rather than anything else? (2)
- palpate mums pulse: shouldnt be at exact same time as mums pulse or you are just feeling mums!
- ‘wooshing’ is the PLACENTAL beat
remember can feel foetal HR at different points depending on babys position
on examination, how to make sure you don’t miss anything
EXPOSE EVERYWHERE
lift up penis/testes
vernix
waxy white substance found coating the skin of newborn human babies
(baby moisturiser)
melasma
a tan or dark skin discoloration. Melasma is thought to be caused by sun exposure, genetic predisposition, hormone changes, and skin irritation.
(get it in pregnancy)
signs of pregnancy on tummy examination? (3)
palpation of pregnancy uterus at:
6 weeks?
20 weeks?
26 weeks?
40 weeks?
reasons for being larger than supposed to be? (3)
- pregnancy belly
- linea nigra
- striae (stretch marks)
6= cant feel it 20= umbilicus 26= below ziphisternum 40= drops due to engagement after both goes straight down to umbilicus
(if larger than it should be could be due to fibroids (enlarge due to pregnancy hormones!), multiple pregnancy, polyhydraminos)
Candida:
what classifies reccurent? (1)
what to check if pt has recurrent candida? (5)
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
PCOS:
treatment if cant concieve?
- weight management
clomifene citrate or
metformin[8] or
a combination of the above
- Clomiphene – ovulation induction – stimulate FSH & LH release > development and maturation of ovarian follicle > corpeus luteum development >pregnancy
- Insulin resistance -> hyperinsulinaemia -> androgen excess -> arrest in antral follicular development -> anovulation.
Metformin treats insulin resistance and hyperinsulinaemia, therefore allowing follicular development and subsequent ovulation
Risk factors of ovarian torsion (4)
gold standard for diagnosis?
ovarian mass: present in around 90% of cases of torsion
being of a reproductive age
pregnancy
ovarian hyperstimulation syndrome
LAPROSCOPY (but will see whirldpool on abdo US)
fever may be seen in a minority (possibly secondary to adnexal necrosis)
Vaginal examination may reveal adnexial tenderness
Molar pregnancy: complete mole is made up of...? (1) incomplete mole? (1) features on bHCG? (1) how is it treated? (1)
A complete hydatidiform mole occurs when all of the genetic material comes from the father. There will be no foetal parts present and snowstorm appearance is seen on ultrasound. Vaginal bleeding early in pregnancy is often the presenting feature.
Incomplete hydatidiform mole occurs due to two sets of paternal chromosomes and one set of maternal chromosomes. There are often foetal parts present and snowstorm appearance is not seen on ultrasound.
bHCG likely to be VERY HIGH
–> hyperemesis gravidarum
uterus size greater than expected for gestational age
However, note that bHCG is raised in hydatidiform mole and this would also be raised in multiple gestation.
needs SURGICAL MANAGEMENT to resect it all and –> histology
referral to Sheffield for monitoring
monitoring of bHCG for months after
cant get pregnant for months after
Cervical smears:
what happens if you keep getting ‘inadequate’ results? (2)
If a smear test result comes back as ‘inadequate’ the patient will be asked to return for a repeat test within 3 months. If the second test is also ‘inadequate’, the patient will require colposcopy testing.
The NHS has now moved to an HPV first system, i.e. a sample is tested for high-risk strains of human papillomavirus (hrHPV) first and cytological examination is only performed if this is positive.
When do you next need a smear after colposcopy? (1)
The follow-up of patients who’ve previously had CIN is complicated but as a first step, individuals who’ve been treated for CIN1, CIN2, or CIN3 should be invited 6 months after treatment for a test of cure repeat cervical sample in the community.
Fertility treatment:
what to do if sperm analysis abnormal?
If a semen sample is abnormal, a repeat test should be arranged, ideally 3 months later
Ectopic:
when can expectant managemtn be used? (5)
what does it entail? (1)
if satisfies all the criteria:
- <35mm
- unruptured
- asymptomatic
- no fetal heartbeat
- B-hCG<1,000
closely monitor patinet over 48 hours and if B-hCG levels risk or symptoms manifest then perform an intervention
Ectopic:
when can medical management be used? (5)
what does it entail? (1)
- <35mm
- unrupture, no pain
- no heartbeat
- b-hCG< 1,5000
methotrexate
why is smoking a risk factor for HPV
immunocompriised- body can’t clear the virus itself as easy
Colposcopy:
how quick should referral be?
When abnormal cytology is high-grade dyskaryosis (moderate or severe), women should be offered colposcopy within 2 weeks. For those with inadequate results, borderline results, or low-grade dyskaryosis (mild), they should receive an appointment within 6 weeks as a standard.
which cancer does progesterone increase risk fo
breast
combined HRT, therefore, increases risk of breast
Group II WHO anovulation category:
what pattern of sex hormone levels will be seen on blood testing?
Forms of ovulation induction? (4)
normal gonadotropins, normal oestrogen
In order of use:
1- loose weight
2- letrozole: armoastase inhibitor (reduces the negative feedback causing increases in FSH and thus increases follicular development)
3- clomiphene citrate ( selective estrogen receptor modulator (also known as SERMs), which acts primarily at the hypothalamus, blocking the negative feedback effect of estrogens. This subsequently leads to an increase in gonadotropin-releasing hormone (GnRH) pulse frequency and therefore FSH and LH production, stimulating ovarian follicular development
4- gonadotropin therapy: tends to be used more for group I ovulatory dysfunction (for PCOS only considered after others failed as increased risk multiple pregnancy and hyperstimualtion syndrome)
Class 1 (hypogonadotropic hypogonadal anovulation) - notably hypothalamic amenorrhoea (5-10% of women) Class 2 (normogonadotropic normoestrogenic anovulation) - polycystic ovary syndrome (80% of cases) Class 3 (hypergonadotropic hypoestrogenic anovulation) - premature ovarian insufficiency (5-10% of cases).
Endometrial cancer:
age group most common in? (1)
Risk factors for endometrial cancer?
post-menopausal
BUT around 25% occur post menopause
- women >= 55 years who present with postmenopausal bleeding should be referred using the suspected cancer pathway
unopposed oestrogen:
obesity nulliparity early menarche late menopause unopposed oestrogen. The addition of a progestogen to oestrogen reduces this risk (e.g. In HRT). The BNF states that the additional risk is eliminated if a progestogen is given continuously diabetes mellitus tamoxifen polycystic ovarian syndrome hereditary non-polyposis colorectal carcinoma
Endometrial cancer: first line investigation? (1) what is a normal endometrial thickness? (1) what investigation done to confirm? (1) treatment? (2)
TV USS
<4mm
hysteroscopy with endometrial biopsy
localised disease is treated with total abdominal hysterectomy with bilateral salpingo-oophorectomy. Patients with high-risk disease may have post-operative radiotherapy
progestogen therapy is sometimes used in frail elderly women not consider suitable for surgery
which cancer is smoking PROTECTIVE of
endometrial
what to do if <18 gets FGM
report to police
contraction of detrousor muscle of bladder is controlled by..
muscarinic cholinergic receptor
Can’t spit
Can’t shit
Can’t pee
Can’t see
myomectomy
a surgical procedure to remove uterine fibroids — also called leiomyomas
What are women with PCOS at particular risk of when undergoing IVF?
ovarian hypersensitiviey syndrome
I thought of it as in PCOS you already have increase in ovarian cysts and if you give them a stimulant then that increases the cysts more and increases the risk of ovarian hyperstimulation syndrome
2 symptoms of cervical ectropion? (2)
risk factros? (3)
vaginal discharge
post-coital bleeding
a/w
OCP
pregnancy
pubery
routine recall fo cervical smears
5 years is correct because this is routine recall for someone between 50-65 years of age
cervical smear:
when to refer to colposcopy if HPV positive
if HPVpositive 3 tests in a row even if cells show no dyskaryosis
(i.e. HPV +ve, repeat in12 months and HPV +ve again, then 12 months later still HPV positive)
most common site of tube for ectopics? (1)
where most likely to rupture? (1)
AMPULLA
isthmus
Hysterectomy:
common long term complcaition
If you think of the top of the vagina as a church roof, the anterior repair will prevent a cystocoele (bladder prolapse) and the posterior repair will prevent a rectocoele (rectum prolapse) but the top (‘vault’) can still fall down’ hence vaginal vault prolapse can still occur!
Urinary retention may occur acutely following hysterectomy, but it is not usually a chronic complication.
risk factors of ectopics
Risk factors (anything slowing the ovum’s passage to the uterus)
damage to tubes (pelvic inflammatory disease, surgery)
previous ectopic
endometriosis
IUCD
progesterone only pill
IVF (3% of pregnancies are ectopic)
when to take cervical smear if pregnancy
wait until 12 weeks post-partum for her cervical smear
how does gynaecology cancers spread?
local->abdominal organs->lymph->haem->seedling
cells of cervical ectropion
On the ectocervix there is a transformation zone where the stratified squamous epithelium meets the columnar epithelium of the cervical canal.
(i.e. increased columnar epithelium on the ectocervix
Which of the following investigations is the best measure of ovulation?
PROGESTERONE 7 days after OVULATION (the luteal phase)
The follicular phase of the menstrual cycle can be variable, however, the luteal phase (after ovulation) remains constant at 14 days.
The serum progesterone level will peak 7 days after ovulation has occurred. Therefore, in a 35-day cycle the follicular phase will be 21 days (ovulating on day 21), luteal phase 14 days. Therefore, the progesterone level will be expected to peak on day 28 (35-7).
Risk malignancy index (RMI) prognosis in ovarian cancer is based on
The RMI is the pre-surgical prognostic criteria recommended by NICE, and is based on CA125 levels, menopausal status, and ultrasound score.
management of missed or incomplete miscarriage
in the event of a MISSED or INCOMPLETE miscarriage use MISOPRISTOL ALONE for medical management.
Miso = Missed
mis’o (or) = missed or incomplete
termination of pregnaancy
miFepristone - First
miSoprostol - Second
prostgkandin
treatment recurrent thrush
An induction-maintenance regime of oral fluconazole should be considered for recurrent vaginal candidiasis
