GYN Final Flashcards
Twin Splitting
3 Days (Di-Di)
4-8 Days (Monochorionic / Diamniotic)
8-12 Days (Mono / Mono)
13+ Days (Conjoined Twins)
Thromboembolism in Pregnancy Includes
DVT
PE
Which Clotting factors are increased in pregnancy
5/8/9/10 + Fibrinogen
Decreased Protein S / AT
Which vein is usually affected by DVT in pregnancy
Iliac Vein (Uterine Compression)
Thromboembolism Investigations in pregnancy
Doppler Ultra Sound - DVT
V/Q Scan - PE
VTE Prophylaxis (LMWH)
High Risk - Asap until 6th week PP
3 RF - 28th week until 6th week PP
RF During Birth - Birth until 6th week PP
LMWH / Warfarin Safe in breast feeding ?
Yes
When can LMWH be switched into warfarin
5-7 Days Post Partum
When to discontinue LMWH
Start of Labor
24 Hours before if planned
Massive PE management
IV Unfractionated Heparin
Effect of Intrahepatic Cholestasis of Pregnancy on Fetus
Fetal Morbidity - Fetal Liver cannot remove bile acids - vasoconstriction of placenta
Bile acid levels in Cholestasis of Pregnancy
Mild 11 - 40
Severe 40+
Management of Intrahepatic Cholestasis of Pregnancy
Same day referral
USDA + Vitamin K + Emollients + Antihistamines
Management of cholestasis in severe disease
Fetal Surveillance + Steroids if <34 Weeks (Lung Maturation)
37+ Weeks - C Section
Management of Intrahepatic cholestasis
37+ Weeks - C Section
Severe Disease - C - Section
Risks of cholestasis on baby
Increasing risk of still birth after 37 weeks gestation
Respiratory Distress - Meconium Aspiration
PPH
Preterm labour
Prognosis of cholestasis
Resolves after delivery
Recurs in following pregnancies 90%
Bacteriuria / UTI Management
Nitrofurantoin (1st kine)
Cefalxin or Amoxicillin
Co-amox
Trimethoprin
Pyelonephritis management
Admission + Senior Help
IV Antibiotics (Ceftriaxone)
IV Fluids
Antepartum Hemorrhage
Bleeding after 24 Weeks
Management of Antepartum Hemorrhage
ABCDE + Admit Tranexamic Acid Anti-D CTG Monitoring Not stabilized - C Section
Placenta Previa Risk Factors
Previous PP
Scaring
IVF
Placenta Previa Symptoms
Painless Vaginal Bleeding
Placenta Previa Investigation
Anomaly Scan - 20 Weeks
Rescan at 32 weeks to see if resolved
How many times do we scan in Placenta Previa
Scan at 32 Weeks - Not resolved - Rescan at 36 weeks - not resolved - manage
Placenta Previa Management
Minor - Admit + Await VD
Major - Immediate C Section
<34 W - Corticosteroids
Placenta Grows too deeply into uterine wall
Placenta Accreta
Increta
Myometriumn
Percreta
Through myometrium to serosa and can attach to organ
Management of Accreta
C - Section
Surgical Removal
Antibiotics
Vasa Previa Management
Immediate C Section (Otherwise Death)
Placental Abruption
Separation of placenta from uterine wall
Couvelaire (Woody Uterus) + Vaginal Bleeding + Pain
Placental Abruption
