GYN Final

Question 1

Twin Splitting

Answer 1

3 Days (Di-Di)
4-8 Days (Monochorionic / Diamniotic)
8-12 Days (Mono / Mono)
13+ Days (Conjoined Twins)

Question 2

Thromboembolism in Pregnancy Includes

Answer 2

DVT

PE

Question 3

Which Clotting factors are increased in pregnancy

Answer 3

5/8/9/10 + Fibrinogen

Decreased Protein S / AT

Question 4

Which vein is usually affected by DVT in pregnancy

Answer 4

Iliac Vein (Uterine Compression)

Question 5

Thromboembolism Investigations in pregnancy

Answer 5

Doppler Ultra Sound - DVT

V/Q Scan - PE

Question 6

VTE Prophylaxis (LMWH)

Answer 6

High Risk - Asap until 6th week PP
3 RF - 28th week until 6th week PP
RF During Birth - Birth until 6th week PP

Question 7

LMWH / Warfarin Safe in breast feeding ?

Answer 7

Yes

Question 8

When can LMWH be switched into warfarin

Answer 8

5-7 Days Post Partum

Question 9

When to discontinue LMWH

Answer 9

Start of Labor

24 Hours before if planned

Question 10

Massive PE management

Answer 10

IV Unfractionated Heparin

Question 11

Effect of Intrahepatic Cholestasis of Pregnancy on Fetus

Answer 11

Fetal Morbidity - Fetal Liver cannot remove bile acids - vasoconstriction of placenta

Question 12

Bile acid levels in Cholestasis of Pregnancy

Answer 12

Mild 11 - 40

Severe 40+

Question 13

Management of Intrahepatic Cholestasis of Pregnancy

Answer 13

Same day referral

USDA + Vitamin K + Emollients + Antihistamines

Question 14

Management of cholestasis in severe disease

Answer 14

Fetal Surveillance + Steroids if <34 Weeks (Lung Maturation)

37+ Weeks - C Section

Question 15

Management of Intrahepatic cholestasis

Answer 15

37+ Weeks - C Section

Severe Disease - C - Section

Question 16

Risks of cholestasis on baby

Answer 16

Increasing risk of still birth after 37 weeks gestation
Respiratory Distress - Meconium Aspiration
PPH
Preterm labour

Question 17

Prognosis of cholestasis

Answer 17

Resolves after delivery

Recurs in following pregnancies 90%

Question 18

Bacteriuria / UTI Management

Answer 18

Nitrofurantoin (1st kine)
Cefalxin or Amoxicillin
Co-amox
Trimethoprin

Question 19

Pyelonephritis management

Answer 19

Admission + Senior Help
IV Antibiotics (Ceftriaxone)
IV Fluids

Question 20

Antepartum Hemorrhage

Answer 20

Bleeding after 24 Weeks

Question 21

Management of Antepartum Hemorrhage

Answer 21

ABCDE + Admit
Tranexamic Acid
Anti-D
CTG Monitoring
Not stabilized - C Section

Question 22

Placenta Previa Risk Factors

Answer 22

Previous PP
Scaring
IVF

Question 23

Placenta Previa Symptoms

Answer 23

Painless Vaginal Bleeding

Question 24

Placenta Previa Investigation

Answer 24

Anomaly Scan - 20 Weeks

Rescan at 32 weeks to see if resolved

Question 25

How many times do we scan in Placenta Previa

Answer 25

Scan at 32 Weeks - Not resolved - Rescan at 36 weeks - not resolved - manage

Question 26

Placenta Previa Management

Answer 26

Minor - Admit + Await VD
Major - Immediate C Section
<34 W - Corticosteroids

Question 27

Placenta Grows too deeply into uterine wall

Answer 27

Placenta Accreta

Question 28

Increta

Answer 28

Myometriumn

Question 29

Percreta

Answer 29

Through myometrium to serosa and can attach to organ

Question 30

Management of Accreta

Answer 30

C - Section
Surgical Removal
Antibiotics

Question 31

Vasa Previa Management

Answer 31

Immediate C Section (Otherwise Death)

Question 32

Placental Abruption

Answer 32

Separation of placenta from uterine wall

Question 33

Couvelaire (Woody Uterus) + Vaginal Bleeding + Pain

Answer 33

Placental Abruption