Maternity and Reproductive Health Flashcards
When to treat with PO iron in pregnancy?
- If pt at risk of iron deficiency anaemia and serum ferritin is <30.
- If anaemic (booking Hb <110 or <105 in 2nd or 3rd trimester)
need 180-200mg elemental iron daily
if 2nd bullet point met should also receive 400mcg of folic acid daily and recheck Hb in 2-3/52-if no improvement then check Vit B12, ferritin and folate.
Most common cause of thrombocytopenia in pregnancy?
Gestational thrombocytopenia-secondary to increased blood volume, increased PLT activation and then clearance.
When should FBC be checked in pregnancy?
At booking (8-12 wks) and again at 28 wks.
Why should women not abruptly stop breastfeeding if they develop mastitis?
increased risk of abscess formation
Why should opioids be used with caution in breastfeeding women?
their presence in breast milk can cause neonatal lethargy, poor feeding, bradycardia and resp depression
*codeine no longer recommended, dihydrocodeine may be used as a safer alternative
What is required for lactational amenorrhoea to be reliable for contraception?
mother must be <6 months post partum
completely amenorrhoeic
almost exclusively on-demand breastfeeding
When can contraception be started after birth?
- immediately after-all except COCP
- POP, progesterone injection and progesterone implant can be started at any time
- Cu coil and mirena can be inserted within 48hrs of birth, if not then after 4 weeks
- COCP UKMEC 4 if breastfeeding and less than 6 weeks post partum. After 6 weeks-UKMEC2, then 1 from 6 months.
- COCP if not breastfeeding, <3 weeks post partum UKMEC 4 if VTE RFs and UKMEC 3 if no other VTE RFs, from week 3 UKMEC 2 if no other VTE RFs, UKMEC 3 if RFs. From 6 weeks post partum not breastfeeding UKMEC 1.
if commenced before 3/52 post partum no additional precautions are required
Which drugs should always be avoided in breastfeeding women?
lithium clozapine retinoids cytotoxic drugs e.g. MTX tetracyclines, ciprofloxacin, chloramphenicol, sulphonamides aspirin carbimazole sulfonylureas amiodarone
If a patient on the COCP misses a pill, when would emergency contraception be required?
if patient has had UPSI in the 1st week of pill taking or in the pill free interval
(2 pills must have been missed)
For how long after a miscarriage, ectopic pregnancy or abortion are women not at risk of pregnancy?
5 days
Cautions/contraindications to Cu-IUD for emergency contraception?
48hrs-4 weeks post partum
distortion of uterine cavity
active infection e.g. PID (if previous PID the Cu-IUD is ok to use)
note higher risk of uterine perforation if breastfeeding
should NOT be inserted if woman may already be pregnant
Cautions/contraindications to ulipristal (single oral 30mg dose) for emergency contraception? (acts to delay ovulation)
severe asthma managed with PO steroids
recent use of PO medication containing progesterone (within last 1 week)
may be less effective if raised BMI or on liver enzyme inducers/PPIs (ulipristal NOT recommended if on liver enzyme inducers)
if breast feeding should bottle feed for 1 week after taking ulipristal
regular hormonal contraception must be delayed by 5 days after taking ulipristal
Cautions/contraindications to levonorgestrel for emergency contraception? (acts to inhibit ovulation) (single 1.5mg dose)
possibly less effective if raised BMI (>26 or weight >70kg) or on liver inducers (use double dose- 3mg)
What is “quick start” hormonal contraception?
starting regular hormonal contraception at any time other than the start of a normal menstrual cycle
regular hormonal contraception can be started immediately after levonorgestrel EC but must be delayed by 5 days after ulipristal
Why must regular hormonal contraception be delayed by 5 days after uliprsital emergency contraception?
because ulipristal interacts with progesterone
When are extra precautions needed if starting regular hormonal contraception?
if started after the first 5 days of the menstrual cycle (or started after 7 days for the mirena)
extra precautions for 2 days if starting POP after first 5 days of menstrual cycle
for 7 days if COCP, progesterone only implant/injection, and mirena
Age of consent to sexual activity as stated by law?
16 years
children 12 years and younger cannot legally consent to any form of sexual activity
How should a woman with lactational mastitis be managed if no sx improvement after 48 hours on flucloxacillin but pt stable (+no signs of breast abscess)?
switch to BS antibiotics e.g. co-amoxiclav or cephalexin
if still not improved after 10-14/7 of Abx then r/f urgently to breast surgeon to r/o breast abscess
Tx of candidates mastitis?
Topical miconazole 2% cream-applied to affected nipple after every feed
Combine with topical hydrocortisone if severely inflamed
Can also combine with topical Abx especially if nipple fissures
If persistent infections and spread into ductal system consider oral fluconazole.
Baby treated with PO nystatin suspension or miconazole 1.25ml gel QDS after feeds
Statin management with regards to pregnancy?
should be stopped in women 3 months prior to conception due to risk of congenital defects
Why is COCP not advised to be used in women taking lamotrigine montherapy?
risk of reduced seizure control
Up to how many days post partum is contraception not required irrespective or any other criteria?
20 days
Which contraceptive methods should not be used for women with unexplained PV bleeding?
Cu-IUD or LNG-IUS if initiating contraception
sterilization
What constitutes UKMEC4 with regards to COCP use for a woman based on age+smoking status?
if age 35 or older and smoking 15 cigarettes or more daily
other UKMEC 4 for COCP:
current breast Ca
breastfeeding and <6 weeks post partum
(UKMEC 3 if <3 weeks post partum and NOT breastfeeding, if >3weeks post partum and not breastfeeding can offer if no other risks for VTE)