gynae - bleeding in first trimester

Question 1

what are your differentials

Answer 1

miscarriage
ectopic pregnancy
the most ‘important’ cause as missed ectopics can be potentially life-threatening
implantation bleeding
a diagnosis of exclusion
miscellaneous conditions
cervical ectropion
vaginitis
trauma
polyps

Question 2

sx suggestive of ectopic

Answer 2

pain and abdominal tenderness
pelvic tenderness
cervical motion tenderness

Question 3

over 6 weeks with bleeding what should happen

Answer 3

TVUS

Question 4

tranxaemic acid given when

Answer 4

to manage heavy bleeding periods

Question 5

normal period blood loss

Answer 5

ome medical definitions of blood loss during a period are: A normal period is a blood loss between 30 and 40 ml (six to eight teaspoonfuls)

Question 6

What definition is used to classify bleeding as ‘abnormally heavy’

Answer 6

what the woman classes to be heavy

Question 7

when do surgical manage an ectopic

Answer 7

over 35mm
visible heart beat
BHCG over 5000
need to do salpingectomy.
conside salpingotomy in women with risk factors for infertility ( aroudn 1 in 5 require methotrexate or salpinectomy too)

Question 8

when medical management of methotrexate for ectopic

Answer 8

under 35mm
BHCG under 1500
need to attend follow up - no fetal HB

Question 9

risk factors for ectopic

Answer 9

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)

Question 10

first 6 weeks how fast does BHCG rise in ectopic

Answer 10

doubles every 2 days up to 6 weeks then every 4

Question 11

Fetal fibronectin (FFN) is a test that can identify the women with symptoms of preterm labor who are most at risk for preterm birth.

if psotive means what

Answer 11

birth near in 2w potentially - so preppped and given thing slike steriods 22-34 weeks as risk of complciations so tested

Question 12

diagnostic criteria for hyperemesis gravidarum

Answer 12

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

Question 13

why should aspirin be avoided in breastfeeding

Answer 13

risk of reye syndrome - liver and brain swelling

Question 14

A woman who is 22 weeks pregnant presents with abdominal pain on the right side of her abdomen. On examination she has abdominal tenderness on the right side and urine dipstick is normal. White blood cells are raised at 18.5 * 109/l

Answer 14

appendiciits

Question 15

A woman who is 8 weeks pregnant presents with abdominal pain and vaginal bleeding. On examination she is tender in the right iliac fossa and suprapubic region. Speculum examination shows an open cervical os. Ultrasound confirms an intrauterine pregnancy.

Answer 15

inevitable miscarriage.

Question 16

gestaional htn

Answer 16

Gestational hypertension: This is incorrect, gestational hypertension is defined as high blood pressure after 20 weeks in the absence of proteinuria or further organ damage. Due to the new onset presence before 20 weeks, this indicates chronic hypertension as the more suitable answer.

Question 17

hypersegmented neutrophils in preg what anemia

Answer 17

megaloblastic so must be folate

Question 18

what is tx for VTE prophylaxis

what should you measure if in the extremities of weight

Answer 18

Routine measurement of peak anti-Xa activity for patients on LMWH for treatment of acute VTE in pregnancy or postpartum is not recommended except in women at extremes of body weight (less than 50 kg and 90 kg or more)

Question 19

when should a woman receive oral iron therapy in 1st trimester

Answer 19

110

Question 20

when should a woman receive oral iron therapy in 2nd trimester

Answer 20

105

Question 21

when should a woman receive oral iron therapy in 3rd trimester

Answer 21

100

Question 22

CI to VBAC - vaginal birth after c section

Answer 22

contraindications include previous uterine rupture or classical caesarean scar

Question 23

A 12-year-old girl comes with her mother to surgery. She is requesting the combined oral contraceptive (COC) pill as she has recently started a relationship with an 18-year-old man who she met at the local games arcade, although she has not yet had sex with him. You discuss the age difference but her mother states that she has met the boyfriend and says he treats her daughter well. Both the girl and her mother insist that they do not want anyone else involved. What is the most appropriate course of action?

Answer 23

Immediately phone local child protection lead and refer to social services

Children under the age of 13 years are not able to consent to sexual intercourse and hence any sexual activity would be regarded as rape under the law. This is one situation under the GMC guidelines where you are compelled to break confidentiality

Question 24

breech at risk of

Answer 24

DDH - USS of hips even if ortalinis and barlows are normal