o&g Flashcards
How long does Nexplanon progesterone contraceptive implant last for?
3 years
What is the timing of use of the drugs in pregnancy:
(a) trimethoprim
(b) nitrofurantoin
(a) AVOID trimethoprim in early pregnancy
(b) AVOID nitrofurantoin in late pregnancy
When is trimethoprim teratogenic in pregnancy
First trimester
- avoid during early pregnancy
When should nitrofurantoin be avoided in pregnancy
Near term (late pregnancy)
If trimethoprim and nitrofurantoin cannot be used in pregnancy, what can treat the UTI
cefalexin
Aromatase inhibitors (e.g. anastrozole) may cause what major side effect
osteoporosis
Selective oestrogen receptor modulators (SERMs) e.g. tamoxifen increase the risk of what cancer
Endometrial cancer
- also increases risk of VTE, vaginal bleeding, amenorrhoea
all pregnant and breastfeeding women should take a daily supplement of what vitamin
Vitamin D
Women trying to conceive through to 12 weeks gestation should take what dose of folic acid
400mcg
5mg if epilepsy, neural tube defects, or diabetes
The symphysis-fundal height (SFH) is measured from the …. to the … in centimetres
It should match the gestational age in weeks to within 2 cm after 20 weeks, e.g. if 24 weeks then the a normal SFH = 22 to 26 cm
From the top of the pubic bone to the top of the uterus
The symphysis-fundal height (SFH) is from the top of the pubic bone to the top of the uterus in centimetres.
After how long should the SFH match the number of weeks?
After 20 weeks gestational age
The SFH should then match GA in weeks plus/minus 2cm, e.g. at 20 weeks = 18-22cm
first line medication for hypertension in pregnancy
labetalol
women who are at high risk of developing pre-eclampsia should take what medicine from 12 weeks until baby is born
aspirin 75mg OD
Combined oral contraceptive pill increases the risk of which 2 cancers and decreases the risk of which 2 cancers
- Increases the risk of breast and cervical cancer
2. Decreases the risk of ovarian and endometrial cancer
What is the treatment for group B streptococcus (GBS) found in vaginal swabs and urine during pregnancy?
Intrapartum IV benzylpenicillin
Women who have had a previous baby infected with GBS are offered what in future pregnancies
Intrapartum IV benzylpenicillin in future pregnancies
Which HPV are most commonly associated with cervical cancer
16, 18, 33
6 and 11 develop genital warts
tamoxifen can be used in oestrogen receptor positive, HER negative breast cancers in pre and peri-menopausal women. what is used if the woman is post-menopausal?
Anastrozole
for oestrogen receptor positive breast cancer in POST menopausal women
what treatment is used for HER positive, oestrogen receptor negative breast cancer?
Trastuzumab (herceptin)
8 absolute contraindications (UKMEC4) to COCP
- > 35 years and >15cigs/day
- Migraine with aura
- History of VTE/genes
- History of stroke/IHD
- Breast feeding <6 weeks post-partum; or 21 days if not breastfeeding
- Uncontrolled HTN
- Breast cancer
- Major surgery
When is the COCP stopped before major surgery, and restarted after
Stopped 4 weeks before surgery
Restarted 2 weeks after
- vaginal discharge - offensive, green
- vulvovaginitis
- strawberry cervix
- pH >4.5
- can cause urethritis in men
What is the pathogen
Trichomonas vaginalis
highly motile flagellated parasite STI. Micro shows motile trophozoites.
What is the treatment for trichomonas vaginalis STI
Oral metronidazole
What is the pH in bacterial vaginosis and trichomonas
> 4.5
What daily supplements does the NHS currently advise all women take during pregnancy (in the absence of additional risk factors)?
folic acid 400mcg for the first 12 weeks, and vitamin D 10mcg throughout pregnancy
Contraceptives - time until effective (if not on first day of period):
- Copper IUD
- POP
- COCP, implants, injection, Mirena IUS
- IUD - immediately
- POP - 2 days
- COCP, implants, IUS - 7 days
treatment for vaginal candidiasis
clotrimazole cream/pessary if they are pregnant. Thrush cannot be treated with oral fluclonazole if they are pregnant.
Routine recall for cervical smear if recent smear was negative for
(a) ages 25-49
(b) ages 50- 65
(a) Every 3 years
(b) Every 5 years
2 cervical smears that are inadequate samples 3 months apart requires..
colposcopy
women who are at high risk of developing pre-eclampsia should take 75mg aspirin OD from 12 weeks until baby is born. what are the 4 high risk groups?
- previous pregnancy induced HTN
- Autoimmune disorders e.g. SLE or antiphospholipid disorder
- Diabetes
- Chronic kidney disease
When do you need to refer painful periods (dysmenorrhoea) to gynae
Secondary dysmenorrhoea i.e. develops after many years after menarche to look for cause
Secondary dysmenorrhoea typically develops many years after the menarche and is the result of an underlying pathology. What are 4 causes
- endometriosis
- PID
- adenomyosis
- fibroids
what breast cancer drug increases the risk of endometrial cancer
tamoxifen
what is the classic symptom of endometrial cancer
post menopausal bleeding
Many ovulations will increase the risk of ovarian cancer as it increases oestrogen levels. Therefore what 3 risk factors will increase ovulations
- Early menarche
- Late menopause
- No children
n. b. these are same for endometrial cancer.
also BRCA1/BRCA2
Pregnant women with gestational DM should be advised to maintain their blood glucose below the following target levels:
fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L
combined HRT is used in patients with a uterus (no history of hysterectomy) because systemic oestrogen only HRT increases risk of…
endometrial cancer
also ovarian cancer risk increases with number of ovulations
perimenopausal (<12 months since last period) HRT treatment
combined cyclical HRT
combined continuous HRT is used in women >12 months since last period, and with uterus
menopause is defined as what time frame after last menstrual period
12 months
If the contraceptive patch change is delayed greater than 48 hours, what should be done?
Change patch immediately
Barrier method needs to be used for 7 days
Combined test for chromosomal disorders is is done between 11-13+6 weeks. The triple/quad test is done 15-20 weeks. What results in Down’s syndrome would be shown?
- Thickened nuchal transulency
- High serum b-hCG
- Low PAPP-A
- Low AFP
- Low oestriol
It is advised that pregnant women taking phenytoin are given what to prevent clotting disorders in the newborn
vitamin K
urinary incontinence which occurs when laughing/coughing is called stress incontinence.
Initial investigations are bladder diary for min 3 days,
vaginal examination, Kegel exercises, urine dip MC&S, urodynamic studies
what is the treatment for stress incontinence?
- pelvic floor muscle training
- surgery - retropubic mid urethral tape procedures
- if do not want surgery, duloxetine
what is the treatment for overactive bladder/urge incontinence (i.e. detrusor overactivity)
- bladder retraining for at least 6 weeks - to increase interval between weeing
- medication - antimuscarinics e.g. oxybutynin (IR), tolterodine (IR) or once daily darifenacin
- If old lady and frail and unable to tolerate antimuscarinics, try mirabegron (b3 agonist)
Hormone replacement therapy for menopause is contraindicated in what 4 criteria
- Current/past breast cancer
- Any oestrogen dependent cancer
- Undiagnosed vaginal bleeding
- Untreated endometrial hyperplasia
