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O+G Year 5 > Misc O&G > Flashcards

Misc O&G Flashcards

1
Q

Where in the skin does an implantable contraceptive go?

A

Subdermal, usually non dominant arm just over triceps

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2
Q

What is the implantable contraceptive and what’s in it?

A

Nexplanon - contains progesterone

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3
Q

How long does the implantable contraceptive last?

A

3 years

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4
Q

2 practical features of the implantable contraceptive?

A

Radio-opaque for location if impalpable Designed to prevent deep infection

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5
Q

What is the main mechanism of action of the implantable contraceptive?

A

Inhibit ovulation - also thickens cervical mucus

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6
Q

When should implantable contraceptive ideally be inserted in cycle and what if not done then?

A

D1-5 - need additional contraceptive for first 7d if not done then

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7
Q

Main side effect with implantable contraceptive? 3 other minor ones?

A

Irregular or heavy bleeding Also headache, breast pain, nausea

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8
Q

What test looks for fetal Hb in mum and should therefore be used in some cases for APH ?rhesus disease?

A

Kleihauer test

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9
Q

What med is first line for UTI in first trimester?

A

Nitrofurantoin

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10
Q

What risk is associated with using nitrofurantoin in late pregnancy or while breast feeding?

A

Causing haemolysis in G6PD babies

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11
Q

How often is the depo-provera injection required?

A

Every 12 weeks

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12
Q

What cancer risk is reduced by COCP use?

A

Ovarian

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13
Q

What 2 viruses typically cause genital warts?

A

HPV6 and 11

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14
Q

2 options for first line treatment of genital warts?

A

Topical podophyllin for multifocal non-keratinised lesions Cryotherapy for solitary keratinised lesions

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15
Q

How long does the IUD take to work for contraception and what is its main mechanism of action?

A

Instantly - toxic to ovum and sperm

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16
Q

How long does the POP take to work if not started in first 7d of cycle?

A

2 days

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17
Q

How long do most contraceptives require extra cover for if not started within the first 7d of contraceptive cycle? What are the 2 main exceptions?

A

7d Exceptions are IUD (instantly) and POP (2 days)

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18
Q

How does uterine inversion present?

A

Pain, bleeding and shock post partum with non-palpable fundus and vaginal mass

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19
Q

What manoeuvre is used for uterine inversion?

A

Johnson manoeuvre

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20
Q

How long are all women covered for after giving birth by natural contraception? Why is this?

A

21 days In theory earliest can conceive is at 28 days but sperm can survive for 7d so need contraception from day 21

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21
Q

When can you use an IUD postpartum and why not before this?

A

28 days - not before due to uterine perf risk

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22
Q

What is placenta membranacea?

A

Placenta develops as a thin membrane around the entire surface of the chorion

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23
Q

What is velamentous insertion of the cord? What is it associated with?

A

Umbilical cord enters into the fetal membranes outside the placental margin, and then travels within the membranes (between chorion and amnion) to the placenta Associated with twin pregnancies and risk growth dissonance and of previa

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24
Q

What is the main risk factor for developing vasa previa?

A

Velamentous cord insertion

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25
Q

What is the spectrum of abnormal placental villous adherence?

A

Placenta accreta - attached to myometrium but not invasive Placenta increta - some invasion of myometrium Placenta percreta - full penetration through myometrium/serosa

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26
Q

Is ciprofloxacin okay in breastfeeding?

A

No

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27
Q

What 2 things constitute normal fetal monitoring in labour?

A

Intermittent ausculation - every 15 minutes for at least 1 minute, and after contractions Contraction monitoring every 15 minutes

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28
Q

What is first line for suspected uterine atony causing PPH?

A

Mechanical measures e.g. uterine massage

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29
Q

Management of HBV infection in mum and child?

A

Newborn needs HBV vaccine within 12 hours of birth if at high risk Test mum for HBsAg - if positive, also needs HBIG

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30
Q

What are the three times HBV vaccine is given to at risk babies?

A

Within 12 hours of birth 1-2m 6m

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31
Q

When is ECV offered for multiparous women?

A

37 weeks

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32
Q

Management of ovarian cysts less than 5cm with simple appearance on USS in young woman?

A

Conservative - rescan at 8-12 weeks, refer if persists/symptomatic

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33
Q

What is the only AED that might be contraindicated in breastfeeding mothers?

A

Barbiturates

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34
Q

Management of retained products of conception/pregnancy?

A

Examination under anaesthesia and IV Abx

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35
Q

What is the main complication of termination of pregnancy and in what proportion is this seen in?

A

Haemorrhage - 10%

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36
Q

Why would you avoid oxytocin for multiparous women with arrested first stage of labour? What is the risk?

A

Unlike in nulliparous unlikely to be inefficient uterine activity and may in fact be malpresentation, risking uterine rupture

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37
Q

What cardiac defect is associated with Turners syndrome?

A

Bicuspid valve and aortic stenosis

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38
Q

When is mum at highest risk for congenital rubella syndrome?

A

If exposed within first 8-10 weeks of pregnancy, rare after 16 weeks

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39
Q

Main features of congenital rubella syndrome?

A

SN deafness, cataracts, salt+pepper chorioretinitis, congenital heart disease e.g. PDA, growth retardation

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40
Q

Screening and management of rubella syndrome in mothers?

A

Offer IgG testing at booking for immunity - if not immune, can’t have vaccine (live) so counsel to avoid contact and get MMR postnatally IgM testing for acute infection

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41
Q

Management of women with primary herpes infection at over 28 weeks gestation?

A

Elective CS with aciclovir cover until delivery

42
Q

What can happen to thyroid hormones in molar pregnancy?

A

Mega high BhCG can stimulate thyroid, so can get high T3/4 and low TSH by negative feedback

43
Q

What is the riskiest form of breech delivery and what is the main risk?

A

Footling - risk of umbilical cord prolapse

44
Q

Management of small (under 35mm) ectopic pregnancies? What are the 6 requirements for this?

A

Methotrexate and follow up Must be unruptured, no pain, no heartbeat, no intrauterine pregnancy BhCG must be less than 1500 Patient must attend follow up

45
Q

Management of ectopic pregnancies over 35mm or those otherwise unsuitable for medical management?

A

Laparoscopic salpingectomy/salpingotomy if high risk of infertility

46
Q

What 3 things is hyperechogenic bowel on USS associated with?

A

CF Down’s syndrome CMV infection

47
Q

Management of VZV infection in susceptible pregnant women?

A

VZIG within 10d of significant exposure; of no benefit ir rash started Aciclovir within 24 hours of rash onset

48
Q

Can you have the chickenpox/shingles vaccine during pregnancy?

A

No - live

49
Q

Risks of maternal VZV infection?

A

Mother - 5x more likely to get pneumonitis Fetus - fetal varicella syndrome

50
Q

What is fetal varicella syndrome and when does it occur in terms of maternal infection?

A

If infected before 20 weeks gest - skin scarring, microphthalmia, limb hypoplasia, microcephaly, learning difficulty

51
Q

When is contraception required postpartum? What can you do with the POP?

A

After day 21 - start POP any time after then with additional contraception for first 2d

52
Q

When can you start the COCP post-natally? What does this depend on (breastfeeding vs not)

A

Can start at day 21 if not breastfeeding (immediate) or after with 7d additional cover If breastfeeding can’t use within first 6 weeks, not recommended 6weeks-6m but okay

53
Q

Initial management of shoulder dystocia? What is the first manouevre and how do you do it?

A

Call for help McRoberts Manouevre - flexion and abduction of maternal hips, thighs towards abdomen to increase relative AP angle of pelvis

54
Q

When is lactational amenorrhoea effective? What are the 3 conditions?

A

If solely breastfeeding, amenorrheiac and less than 6 months postpartum

55
Q

What if the initial manouevre for shoulder dystocia doesn’t work? What can you do to help?

A

Apply suprapubic pressure Mum on all 4s Try internal manouevres

56
Q

Management of GBS picked up on high vaginal swab? 2Abx options?

A

Intrapartum IV benpen/clarithro

57
Q

1st line surgical management for uterine atony causing PPH?

A

Intrauterine balloon tamponading

58
Q

What is terbutaline?

A

Tocolytic

59
Q

Initial management of cord prolapse?

A

Elevate presenting part manually PV or by inflating bladder

60
Q

How does levenorgestrel work for emergency contraception?

A

Inhibits ovulation

61
Q

How does CIUD work?

A

Toxic to ovum and sperm

62
Q

How do you adjust day 21 prog for ovulation testing depending on cycle length?

A

Has to be mid-luteal - if 35 d cycle test on 28; if 21d cycle test on 14 etc.

63
Q

What does dribbling incontinence after long labour suggest? Ix for this?

A

Vesico-vaginal fistula Needs urinary dye studies

64
Q

Medication option for TTTS?

A

Indomethacin

65
Q

What should be done for HIV positive women in terms of cervical cancer screening?

A

Screen at diagnosis and then yearly

66
Q

Anti-anaerobe PV medication in pregnancy? What is CI’d?

A

Clotrimazole pessaries okay Oral fluconazole CId

67
Q

3 things associated with increased nuchal translucency?

A

Downs Abdo wall defects Congenital heart defects

68
Q

3 contraceptives unaffected by enzyme inhibitors/inducers?

A

IUD Prog - depo provera IUS

69
Q

What is a Kleihauer test and when should you do it?

A

After 20 weeks for any potentially sensitising event, looks for fetal blood in maternal circulation

70
Q

When is the second screen for anaemia/RBC defects in pregnancy?

A

18-21 weeks

71
Q

When is nuchal scan done?

A

11-14 weeks

72
Q

When is urine culture for asymptomatic bacteriuria done?

A

8-12 weeks

73
Q

What if a woman is due a cervical smear during pregnancy?

A

If previous abnormalities do anyway If no prev abnormalities do at 3+m after pregnancy so easier to interpret results

74
Q

What type of HRT is recommended for within 1 year of LMP?

A

Cyclical combined

75
Q

What are 3 indications for continuous combined HRT?

A

If had cyclical combined for a year or more If over one year since LMP If over 2 years since LMP if menopause was under 40

76
Q

What emergency contraceptive pill is fine to use more than once in same cycle? Which isn’t?

A

Levenorgestrel is fine Ulipristal is not

77
Q

What is the most common cause of aortic dissection in young women?

A

Turner’s syndrome

78
Q

What is actually in the quadruple test for downs, what is the other condition and when is this done?

A

Age Plus AFP, BhCG, Inhibin A and oestriol Also tests for spina bifida Done in second trimester if miss combined test (14+2 - 22+6)

79
Q

What screening test is done for downs ideally? What does it involve and when?

A

11+2 - 14+1 weeks Involves maternal age + PAPPA and BhCG + nuchal translucency

80
Q

What is considered high risk for downs based on combined test and what is offered?

A

High risk is over 1/150 Offer CVS (over 11 weeks) or amnio (over 15 weeks)

81
Q

What is the treatment for trichomoniasis?

A

Metronidazole

82
Q

How do you record contractions in a CTG? How long is each square?

A

Number of contractions in 10 mins e.g. 3 in 10; also comment on intensity and duration Each big square is 1 minute so in 10 squares

83
Q

What is a roughly normal fetal HR?

A

110-150

84
Q

What is baseline fetal tachycardia defined as and give 5 differentials?

A

HR over 160: Chrioamnionitis Foetal hypoxia Hyperthyroidism Anaemia (mum or baby) Foetal heart defects

85
Q

What is mild baseline fetal bradycardia defined as? 2 causes?

A

HR 100-120 Post dates or OP/OT position

86
Q

What is severe fetal baseline brady defined as? 5 causes?

A

Less than 80 for over 3 mins Maternal seizures Cord compression Cord prolapse Anaesthesia (spinal, epidural) Rapid fetal descent

87
Q

What is normal baseline variability?

A

10-25bpm

88
Q

What are the 3 outcomes of variability measurement on CTG?

A

Reassuring over 5bpm Non-reassuring less than 5 for 40-90 mins Abnormal less than 5 for over 90 mins

89
Q

6 causes of reduced fetal HR variability? What is most common?

A

Sleeping - most common should last less than 40 mins Foetal hypoxia and acidosis (if accompanied by late decels) Foetal tachy Drugs - mostly opiates, benzos, MgSO4 Prematurity e.g. less than 28 weeks Fetal congenital heart defects

90
Q

What are accelerations defined as? What is normal?

A

HR picking up by 15bpm for over 15s, reassuring if ideally at least 2 per 15 mins and alongside contractions

91
Q

What are the 3 types of decelerations? What is most normal?

A

Early - in line with contractions, stop when they stop - head compression, likely normal Late - prolonged after contraction, suggests cord compression and placental insufficiency (bad) Variable

92
Q

What is good in terms of variable decels? What is more pathological?

A

If shoulders (acceleration before due to umbilical vein compression and after due to release of UA compression) better as suggests fetus responding to cord compression If no shoulders = bad suggests hypoxia

93
Q

What is the worst kind of decel on its own and what does its presence indicate?

A

Late - suggests significant placental insufficiecny and hypoxia so do scalp sampling

94
Q

What is a prolonged deceleration and what does it indicate?

A

Over 2 mins non-reassuring (2-3 mins) Over 3 mins abnormal - urgent scalp sampling and delivery

95
Q

What does a sinusoidal fetal heart CTG trace indicate?

A

Urgent CS - bad outcomes

96
Q

How do you overall categorise a CTG into normal suspiciuos or pathological?

A

Normal = all 4 bits reassuring Suspicious = 1 bit non-reassuring Abnormal = 2 bits non-reassuring or 1 bit abnormal

97
Q

When is birth recommended for pre-eclampsia depending on severity?

A

If severe and refractory consider delivery before 34 weeks, otherwise aim for 34 weeks with steroid cover If mild-moderate hypertension, aim 34-36+6 weeks If diagnosed after 37 weeks, deliver within 24 hours

98
Q

Describe engagement in terms of sinciput and occiput?

A

5/5 palpable = completely above pelvic brim

4/5 = sinciput +++, occiput ++

3/5 = sinciput ++, occiput +

2/5 = just engaged; sinciput +, occiput just palpable

1/5 = engaged; sinciput just palpable

None of head palpable = deeply engaged

99
Q

What is the main recommended medical method of IoL and what is the main risk?

A

Vaginal PGE2 - risk of hyperstimulation/rupture

100
Q

What Bishop score indicates favourability in IoL and what does this suggest?

A

8 or more - suggests either spontaneous labour or response to measures to induce labour

101
Q

What is definitely the right times for prophylactic anti-D if Rh negative?

A

28 and 34 weeks

102
Q

Outline mechanical and medical measures in treating uterine atony in order?

A

Initially uterine massage + drain bladder with Foley cath

Oxytocin bolus

Ergometrine if not CId

Oxytocin infusion

Carboprost (CId in asthma)

Misoprostol

O+G Year 5 (8 decks)

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