Knowledge revision - O&G Flashcards
What are the important parts of a Gynae history?
o LMP
o Painful periods, bleeding after sex/between periods
o Last cervical smear
o Sexual history inc STI testing
What is a miscarriage?
Spontaneous loss of an intra-uterine pregnancy before 24 weeks
What is the most common cause of early miscarriage (before 13 weeks)?
Chromosomal abnormality
What is the most common cause of late miscarriage (between 13 and 24 weeks)?
Cervical incompetence
What are the two key examination/investigations to diagnose miscarriage?
Speculum examination and TV USS
What are the management options for miscarriage?
Surgical - MVA/surgical evac
Medical - misoprostol
Expectant
What follow-up is required in expectant management of miscarriage?
Preg test 3 weeks later – if positive, need to investigate for retained POC
Give some potential causes of recurrent miscarriage.
Genetics
Thrombophilia
Endocrine disorders
Structural abnormalities
TOP is legal up til what gestation?
23+6 weeks
What legislation are TOPs conducted under?
Abortion Act 1967
Under what circumstances can terminations of pregnancy be offered?
Where continuing the pregnancy involves a greater risk for the physical or mental health of the woman or her existing children
What are the two main options for TOP?
Medical or surgical
How are medical abortions conducted?
Mifepristone (anti-progestogen)
Misoprostol (prostaglandin analogue) 1-2 days later
What are the two surgical abortion options?
MVA and surgical evac
At what gestations can MVA and surgical evac be performed?
o MVA – usually up to 14 weeks
o Surgical evac – usually 14-24 weeks
In which circumstances should Anti-D be given in TOP?
Rh -ve woman AND
Surgical abortion or medical abortion > 10 weeks
What is the first screening test available for Down’s Syndrome?
Combined test
When can the combined test be administered?
10-14 weeks
What is involved in the combined test?
o Maternal age
o bHCG
o PAPP-A
o Nuchal translucency (NT)
What is involved in the quadruple test?
o Maternal age
o AFP, bHCG, inhibin-A, uE3
When can the quadruple test be administered?
14 - 20 weeks
What is the quoted miscarriage rate for CVS/amniocentesis?
1 in 200
What is usually recommended in high-risk of Down’s syndrome pregnancies?
NIPT
What are the main methods of emergency contraception?
Levonorgestrel
UPA
Copper IUD
How long after UPSI can Levonorgestrel be used?
Within 72 hours
How long after UPSI can UPA be used?
Within 5 days
How long after UPSI can Copper IUD be used?
Within 5 days of UPSI or within 5 days of estimated date of ovulation
What is the most effective method of emergency contraception?
Copper IUD
‘Fishy smelling white/watery PV discharge’ suggests…
BV
What is the treatment for BV?
Metronidazole
‘Thick, white itchy PV discharge’ suggests…
Thrush/candidiasis
How is thrush treated?
anti-fungal – clotrimazole cream/pessary or single fluconazole tablet
How are chlamydia and gonnorhoea investigated?
Swabs for NAAT testing
What is the treatment for chlamydia?
doxycycline 100mg twice a day for 7 days
What is the treatment for gonorrhoea?
Single dose IM ceftriaxone
Trichomonas vaginalis is treated with…
Metronidazole
How is syphillis diagnosed?
Blood test - antibody
How is syphillis treated?
Single dose IM Penicillin
Painful, blistering genital lesions suggests…
Genital herpes
Which type of HSV is most associated with genital herpes?
HSV-2
How is breech presentation managed?
Most women offered ECV at 37 weeks if still breech, or planned c-section - can have SVD if counselled regarding risks
What are the management options for ectopic pregnancy?
Expectant
Medical
Surgical
Which women with ectopic pregnancy may be offered expectant management?
Clinically stable
GS < 35mm
bHCG < 1000
Which women with ectopic pregnancy should be offered surgical management first-line?
Significant pain
Adnexal mass > 35mm
Foetal heartbeat on USS
bHCG > 5000
What are the initial management options for PPH?
Mechanical
Medical - oxytocin/ergometrine
Surgical - intra-uterine balloon
What is the advice in the case of one missed COCP pill?
take as soon as realise - protected
What is the advice in the case of two or more missed COCP pill?
Use extra contraception for 7 days
Only use emergency contraception if missed in week 1
What is the advice for missed POP?
Take as soon as realise
Not covered for next 2 days - use extra contraception
