O & G Flashcards
Hepatitis B in Pregnancy
C - section doesn’t reduce vertical transmission
Breastfeeding is safe
Chronic or Acute infection = Immunoglobulin and vaccination
All pregnant women offered screening
At what level of anaemia do you treat during the 1st trimester?
<110
At what level of anaemia do you treat in the 2nd/3rd trimester?
<105
At what level of anaemia do you treat anaemia in the post part period?
<100
What is fatal fibronectin?
It is released from the fatal gestational sac. It is linked to an early labour.
Does an elevated fatal fibronectin mean early labour is guaranteed?
No many women go on to deliver at term.
What is expectant management in an ectopic pregnancy?
Reassure Safety Net and reassess bhCG levels in 48 hours
When can expectant management be used in ectopic pregnancies?
Asymptomatic, bhCG <1000, no petal heart beat, <35mm, un ruptured,
Is expectant managment safe with another viable intrauterine pregnancy?
Yes
What is the medical management of a ectopic pregnancy?
Methotrexate + follow up
When can medical management be used in ectopic pregnancy?
<20mm, unruptured, no severe pain, no fatal heart beat, <1000 bhCG, no viable intrauterine pregnancy
What is the surgical management of an ectopic pregnancy?
Salpingectomy or salpingostomy
When is surgical management used in an ectopic pregnancy?
Rupture, >35mm, visible heartbeat
When would you suspect Pre Existing Hypertension in Pregnancy ?
Occurs before 20 weeks with no proteinuria or oedema
When would you suspect Pregnancy induced hypertension?
Hypertension occurring after 20 week but no proteinuria or oedema
What is given to a pregnant lady at increased risk of Pre Eclampsia and from when?
75mg of Aspirin from 12 weeks
What is the most effective form of emergency contraception?
IUD Copper
In what time frame can the IUD Copper coil be used?
Within 5 days of unprotected sex or within 5 days of suspected ovulation.
What is the time frame for Levonogestrel?
Within 72 hours
When do you double the dose of Levonegestrel?
If BMI >26 or >70kg
When can contraception be started in regards to Levonegestrel?
Hormonal contraception can be started immediately after.
What should be done in a women who has taken EllaOne or Uliprital?
If breastfeeding stop for one week
If on hormonal contraception use another form of protection for five days.
What is the time frame of us for EllaOne?
120 hours
What is 1st line for Vaginal Thrush
Single dose oral Fluconazole
When is a Vaginal Pessary or topical considered?
If pregnant or with vulval involvement.
What is Gastroschisis?
Anterior abdominal wall defect lateral to the umbilicus
How is gastroschisis managed?
Vaginal delivery but straight to surgery
What is Exompholus or Omphalocoele?
Abdominal cavity contents protrude out but are covered in amniotic sac
What is the management for omphalocoele?
C section at 37 weeks
Stepwise surgery slowly moving contents back in.
What criteria must a HIV +ve woman have in order to be allowed a vaginal delivery?
Viral load of <50
Antiretroviral
Are pregnant HIV +ve women allowed to breastfeed
No
When are neonatal antivirals required in HIV?
If maternal load is >50 - triple therapy
If maternal load if <50 - Zidovudine
Both given for 4-6 weeks
If a patient has a cervical smear come back as inadequate how should they be treated?
Repeat smear in three months
If a patient has had two smears comeback as inadequate how should they be treated?
Referred for colposcopy
A woman has a suspected DVT in pregnancy how is she managed?
LMWH then investigated
What anticoagulant is used in a DVT in pregnancy?
LMWH
A woman <20 weeks pregnant is exposed to Varicella what is the management?
Immunoglobulin
A woman >20 weeks pregnant is exposed to Varicella what is the management?
Immunoglobulin
Or Acyclovir 7-14 days after exposure
When can Gestational Diabetes be diagnosed?
Fasting >5.6
2 hr >7.8
remember 5678
What is the screening test used in gestational diabetes and when is it used?
Oral Glucose Tolerance Test
Booking and 24-28 weeks
If a pregnant lady presents with a fasting glucose over 7mmol what is her management?
Insulin - short acting
If a fasting glucose is identified as less than 7 what is trialed. After 1-2 weeks this fails to correct her blood glucose. What would she be switched to?
Lifestyle and dietary advices trailed for 1-2 weeks. If this is unsuccessful then Metformin is used.
A pregnant lady who has a fasting glucose between 6.0-6.9 is found on routine scan to show fatal macrosomnia what is her diabetic medication of choice?
Insulin is used first line if any signs of complications
Signs of Ovarian Hyperstimulation Syndrome
Increased Oestrogen
Nausea + Vomiting
Fluid Retention -> Weight Gain
Abdominal Discomfort from enlarged ovaries.
First Degree Perineal Tear - Classification and Management.
Superficial
No treatment - clean etc
Second Degree Perineal Tear - Classification and Management.
Perineal mucosa and Muscle but no sphincter involvement.
Managed by trained midwife or clinician.
Third Degree Perineal Tear Type A - Classification and Management.
Perineal Mucosa, Muscle and <50% of External Anal Sphincter
Surgical Repair by Surgeon
Third Degree Perineal Tear Type B - Classification and Management.
Perineal Mucosa, Muscle and >50% of External Anal Sphincter
Surgical repair
Third Degree Perineal Tear Type C - Classification and Management.
Perineal Mucosa, Muscle , External Anal Sphincter and Internal Anal Sphincter.
Fourth Degree Perineal Tear - Classification and Management.
Perineal Mucosa, Muscle, Both EAS and IAS, Rectal Mucosa
Surgery
Management of Moderate to Severe PMS
COCP 1st line
SSRI
What is the time frame for a Amniotic Fluid Embolism
During and up to 30 minutes after delivery.
Management of a Amniotic Fluid Embolism
Supportive management only
If someone has been treated for CIN II when should they undergo a cervical smear test again?
6 months - used as a test of cure
When should the booking visit be done?
8 - 12 weeks
ideally <10
What is done in the booking visit?
BP, Urine Dipstick, BMI
Give Folic acid Vitamin D
What is screened for in the booking visit?
Blood group Rhesus status Autoantibodies Haemaglobinopathies Hep B Syphilis HIV
What is done between 10-13 weeks?
Early scan for dates + exclude multiple pregnancy
What is done at 18 weeks?
Anomaly scan
What is done at 28 weeks?
Routine Care
Second anaemia and antibody screen
Anti D prophylaxis is rhesus -ve
Management of chicken pox exposure in any pregnant lady?
Check for antibodies prior to treatment
A pregnant lady <20 weeks , who has had no vaccine or exposure to chicken pox identified on antibody testing. Has been exposed what is the management?
Immunoglobulin ASAP
A pregnant lady >20 weeks gestation has been exposed to chicken pox. After testing for antibodies it is found she is not immune. What is the management?
Immunoglobulin or acyclovir after 7-14 days post exposure
If a pregnant lady is presenting with chickenpox what is the management?
Seek specialist advice. Usually acyclovir if >20 weeks
In a FtM transgender man taking testosterone what kind of contraception in contraindicated?
COCP as the oestrogen can counteract the testosterone reducing its effect.
Strawberry Cervix, Offensive yellow green frothy discharge
Trichomonas Vaginallis
What screening tests does a woman undergo if she is has had previous gestational diabetes?
OGTT at booking and 24-28 weeks
List medications that should be avoided in pregnancy?
Tetracylines
ACEi
Statins
Levels required for Iron Supplementation
First trimester - <110
Second and Third Trimester - <105
Postpartum <100
If iron levels don’t improve after 2 weeks of iron therapy what should happen?
Further investigations for an other cause
If someone during their first week of COCP misses two. What should they do?
Take both pills and use contraception for 7 days
Emergency contraception is needed
If someone on their second week of COCP misses two pills what should they do?
Take both pills alongside using other contraception for 7 days.
If someone of their 3rd week of COCP misses two pills what should they do?
Take both pills and use extra contraception for 7 days
Miss out pill free period
Which kind of Progesterone only pill has a 12 hour window compared to a 3 hour window?
Cerazette (desogestrel)
In a POP if someone has missed their three hour window what should they do?
Take pill ASAP and use contraception for 48 hours.
What is the management in premature rupture of membranes?
Admit for 48 hours
Antibiotics - erythromycin 10 days
Steroids
Deliver if >34 weeks
Menopausal
Tender lump
Green discharge
Smoker
Mammary duct ectasia
Nipple Bloody discharge
Duct Papilloma
When would you offer GBS prophylaxis and what is it?
Previous GBS
Benzylpenicillin
When is Benzypenicillin given if they are GBS negative?
Preterm labour
Day 21 ( or 7 days before end of cycle) progesterone level
<16 - repeat then refer
16-30 - repeat
>30 - ovulation
Vaginal delivery in a previous C section
Only if previous C section was a low incision - over 2 is contraindicated
75% success rate
Aim for >37 week gestation
Indication for forcep delivery
Cephalic presentation Cervix fully dilated Ruptured membranes Engaged presentation Empty bladder
Persistent Abdominal pain with vaginal bleeding post C section
Endometritis - Antibiotics required
If GBS is found asymptomatically on a swab in a patient who’s had no previous GBS infection before. What is the management?
Intrapartum Benzylpenicillin is required.
Hepatic adhesions with a history of Pelvic Inflammatory Disease
Fitz Hugh Curtis Syndrome
If a child present at breach during C section or Vaginal delivery what must they undergo?
6 week hip USS
Signs of neonatal hypoglycaemia
Autonomic dysfunction - tachycardia, apnoea, hypothermia Jittery Irritant Hypotonic Seizures
Management of neonatal hypoglycaemia
Mild and transient - ensue good feeding and monitor
Severe or symptomatic - Neonatal referral + IV 10% dextrose
In duct ectasia if the discharge is causing distress what is the management ?
Microductectomy - young
Total Duct excision - old
Management of Placental Abruption
<36 weeks - stable no foetal distress - admit + steroids + no tocolytics
- foetal distress - C Section
>36 weeks - stable no foetal distress - Vaginal delivery
- Distress - C Section
Foetal death - induce vaginal delivery
Cervical smear during pregnancy
If previously normal wait till 12 weeks post partum
If abnormal - ask for specialist advice
What can be used to medical shrink fibroids?
GnRH
Patch contraceptive guidelines
<48 - replace immediately and no extra contraception is needed
>48 -change + 7 days of cover
- UPSI during that time or within last 5 days - emergency contraception is needed
In a lady who is under 35 and presenting with a simple ovarian cyst what is the management?
Repeat USS in 8-12 weeks
In any post menopausal women with an ovarian cyst on USS what is the management?
Refer regardless of size or nature
What treatment is used in keratinised genital warts?
Cryotherapy
What treatment is used in non keratinised fleshy genital warts?
Podophyllum
What is diagnostic of a miscarriage on transvaginal USS?
Crown rump length >7mm + no foetal heart beat
What should be given to the mother if their breastfeeding child develops a cows milk protein intolerance?
Vitamin D and calcium
What is the management of anyone over 30 with a suspicious breast lump?
Referral
Bishops score
<5 - spontaneous labour unlikely
>8 - spontaneous labour likely - no need for induction
Induction of labour
Membrane - nulliparous 40 and 41 weeks or Multiparous 41 weeks - can be done by midwife Vaginal Prostaglandin Maternal oxytocin Membrane rupture Cervical balloon
Name a tocolytic drug used in cervical overstimulation
Terbutaline
What the commonest breast cancer immunologically?
HER2 -ve
ER / PR +ve
Prior to breast cancer surgery a woman, with no palpable axillary lymph nodes, should undergo what other investigation?
Axillary Node USS -> if positive they should have a lymph node biopsy
If prior to surgery a woman is found to have palpable lymph nodes and or positive metastases on lymph node biopsy. How does this change her management?
She should undergo axillary node clearance.
If a woman is found to have no palpable lymph nodes or nothing on her sentinel node biopsy what is her management in surgery?
She should undergo sentinel node biopsies.
<3 positive - no axillary node clearance
>3 positive - axillary node clearance
What are some indications for a mastectomy?
Multifocal lesion
Large tumour in small breast
DCIS >4cm
Centrally located tumour
What are some indications for a wide local excision?
DCIS <4cm
Peripherally located tumour
Single tumour
Indications for radiotherapy in breast surgery
Anyone who has had a wide local excision
Mastectomy - T3/4
Four or more positive axillary nodes
Endocrine and biological therapy in breast cancer
Tamoxifen - Pre or Peri menopausal women - ER +ve
Lestrozole or anastrozole - Post menopausal women - ER +ve
Trastuzumab - HER2 +ve
What should be taken alongside tamoxifen?
Contraceptive
When should trastuzumab be avoided?
Any heart disease
What chemotherapy is used in higher grade breast cancer with auxiliary node involvement?
FEC - D
5-fluorouracil, epirubicin, cyclophosphamide and docetaxel
How often should someone with HIV undergo cervical cytology?
Every year
Primary Dysmenorrhoea - diagnosis and management
No underlying pathology - started soon after menarche
Pain occurs just before period
NSAIDs and Mefenamic acid -> COCP
Secondary Dysmenorrhoea - diagnosis and management
Started years after menarche
Pain occurs days before period
Endometriosisn Adenomysosis, PID, IUD, fibroids
NSAIDs + refer to gynaecology
What is done between 11-13 weeks
Down syndrome scan including nuchal thickness
What is done at 16 weeks gestation?
Info on anomally scan
When do primiparous women receive extra routine care?
25 weeks
31 weeks
What is done at 34 weeks?
Second anti D prophylaxis
Information on labour and birth plan
What is done at 36 weeks
Check presentation and offer external cephalic presentation
What is offered at 41 weeks
Possibility of induction
Membrane sweep
What is offered at 40 weeks
Routine care
Discuss plans for prolonged pregancy
Membrane sweep if primiparous
What is the inheritance of rhesus D?
Rhesus D +ve is inherited in an Autosomal Dominant fashion
How does a mother develop Anti D IgG antibodies?
A rhesus -ve mother becomes sensitised if they have a rhesus +ve child and there is exposure to the foetuses blood.
How do Anti D antibodies affect the foetus?
These can cross the placenta and cause extravascular haemolysis
Hydrops faetalis, kernicterus, HF all develop due to products of extravascular haemolysis
When should a rhesus -ve be offered Anti D prophylaxis?
Routine 28 and 34 weeks
Within 72 hours if -
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma
What test can be used to determine rhesus status?
Coombs
Kleinhauer test - used if exposed during 2/3 trimester after Anti D is given
Eczematous pruritic rash
Atopic eruption of pregnancy
Commonest rash during pregnancy
No treatment
Last trimester
Pruritic rash occurring within abdominal striae
Polymorphic eruption of pregnancy
Emollients
Topical steroids
Oral steroids
How long post termination of pregnancy can a urinary pregnancy test remain positive for?
If it is still positive after this time frame what may it indicate?
4 weeks post termination is normal
After 4 weeks consider incomplete termination or trophoblastic disease
Management of menorrhagia
Asymptomatic thickening on TVUSS - periodic review
IUS first line - especially if looking for contraception - avoid in distortion
NSAID -> mefenamic acid -> tranexamic acid -> COCP -> oral progesterone -> injectable progesterone
When is someone with a positive pregnancy test referred immediately to an early pregnancy assessment clinic?
Any abdominal pain, cervical motion pain or pelvic tenderness
> 6 weeks + Bleeding
When is someone with a positive pregnancy test and bleeding not referred?
<6 weeks + no pain + no risk factors for ectopic pregnancy
Told to return if
Bleeding continues and pain develops
Repeat pregnancy test in 7-10 days time is still positive
Can ulliprastal be used more than once in a menstrual cycle?
yes
Contraception time scales till effective if not stated on the first day of the period.
IUD - Immediatly
POP - 48 hours
COCP, Implant, Injection, IUS - 7 days
Down syndrome Screening
Combined Test 10-13 weeks - bhCG + PAPP-A + Nuchal thickness
14-20 weeks - if missed appointment - AFP, unconjugated estradiol, bhCG, inhibin A
Down syndrome shows low PAPP-A AFP Inhibin A Estradiol
- high bhCG
Layers cut through in C section
Skin Superficial Fascia Deep Fascia Anterior Rectus Sheeth Rectus Abdominus muscle - stretch using hands Transversalis Fascia Extraperitoneal connective tissue Peritoneum Uterus
What is classed as reduced foetal movements?
Less than ten within two hours
How is reduced foetal movements managed?
Hand held Doppler is first line
- +ve for heart beat -> cardiotocogram for 20 mins
- -ve for heart beat - USS
If there have been no foetal movements by 24 weeks what is the management?
Referral to foetal medicine
If a pregnant ladies urinalysis came back with trace 1+ amounts of glucose. What is your management?
Reassure and recheck next assessment
OGTT if - 1+ glucose on two separate occasions
- 2+ glucose on one occasion
bhCG
detected as early as day 8
Secreted by syncytiotrophoblasts
When are breast fibroadenomas excised?
If over 3cm or causing significant distress or discomfort
Criteria for admission with Hyperemesis Gravidum
Unable to tolerate food drink or oral antiemetic
5% body weight loss or Ketonuria
Unable to take medication for underlying health condition
Management of hyperemesis gravidum
First line - Cyclizine or Promethazine
Second line - ondansetron - increased cleft palate risk
- metaclopramide - used for less than five days due to extrapyramidal effects
VTE in pregnancy
Previous VTE - LMWH from presentation to 6 weeks postpartum
At risk of a VTE - LMWH from 28 weeks to 6 weeks postpartum
Management of placental praevia
Low lying at 20 weeks -> rescan at 34 weeks
Low lying at 34 weeks - Grade I/II rescan every two weeks
36/37 weeks with grade III/IV at 37/38 weeks elective C section
- grade 1 attempt normal vaginal delivery
Known placental praevia with spontaneous labour ->emergency C section
Only hormonal contraception not affected by Liver Enzyme Inducers or Inhibitors
Depo Provera
Why is depo provers not offered to women over 50?
Reduces bone density
How long should menopausal women be on contraception for?
If under 50 = 2 years after last period
If over 50 = 1 year after last period
A lady with premature ovarian failure should be offered what?
HRT or COCP until 51
Ovarian failure is not an effective method of contraception
Indications for a CTG
Temperature >38 or sepsis or chariomanionitis Severe hypertension >160 Oxytocin se Significant Meconium Fresh vaginal bleeding during labour
CTG Basics
Loss of variability - <5 a minute - premature or hypoxia
> 160bpm - maternal pyrexia, chorioamnionitis, hypoxia
<100bpm - increased foetal vagal tone i.e maternal beta blockers
Early Decelerations - reassuring
Late decelerations - if doesn’t return to baseline after 30 seconds - foetal distress
Variable Decelerations - no link to contractions - chord compression
Medications which are safe to breast feed with.
Penicillin, Cephalosporins, trimethropin, steroids, levothyroxine, sodium valproate, salbutamol, theophylline, TCA, Antipsychotics (not clozapine), B blocker, warfarin, heparin, digoxin
Medication to avoid in breast feeding
Ciprofloxacin, Tetracyline, Chloramphenicol, Sulph…, Lithium, BDZ, Aspirin, Carbimazole, Methotrexte, Sulfonylurea, Amiodarone
What is the wiff test?
Adding alkali to bacterial vaginosis creates a strong fishy smell
Endometriosis management
NSAID -> COCP or progestogens
Refer to secondary care -> Goserelin
-> surgery - increases fertility
Do you stop metformin when adding insulin in pregnancy?
No it is added on top off
Contraceptives and there main function
COCP - inhibit ovulation Desogetrel only pill - inhibit ovulation POP - Thickens cervical mucous Depo provera - inhibit ovulation Implant - inhibit ovulation IUD - decreases sperm mobility IUS - prevents endometrial proliferation
Which type of HRT is preferred?
Cyclical as gives more predictable bleeds
In a pregnancy of unknown location what might help you localise it?
bhCG >1500 - might indicate a ectopic
What is the definitive management of PPH caused by placental acreta?
Hysterectomy
HRT types and breast cancer
Combined Oestrogen and Progesterone = increased risk
Oestrogen only = reduces risk of breast cancer
HRT types and endometrial cancer
Combined = Reduced endometrial cancer
Oestrogen only = Increased endometrial cancer risk
Pre Eclampsia risk factors
>40 Nulliparity >10 years since last pregnant FH PMH of preeclampsia >30 BMI Vascular disease Renal disease Multipregnancy
History of PPH + signs of pituitary failure
Sheehans
History of surgery or trauma to internal uterus + infertility
Ashermans - uterine adhesions
Chlamydia management
Doxycycline 7 days - azithromycin if doxycycline is contraindicated
Men with urethral symptoms - all partners notified 4 weeks prior to onset
Women and asymptomatic men - 6 months prior
All partners who receive a notification are treated with antibiotics whilst awaiting test results
Hyperemesis gravidum - managment
1st line =Oral antihistamines - promethazine, cyclizine
2nd line = Anti emetics - Ondansetron and Metoclopramide - both carry risks
> 30 + unexplained breast lump
Urgent referral
Cervical screening
Every 5 years from 25 - 64
Maternal exposure to parvovirus
Check maternal IgG and IgM - as causes hydrops fetalis
Intrauterine blood transfusions required for the baby.
bhCG rise in ectopic vs viable intrauterine
Ectopic bhCG will increase up to 63%
Beyond 63% increase it is likely to be due to a viable intrauterine pregnancy.
Starting hormonal contraception after emergency contraception.
Ellaone - wait 5 days
Levonella - start immediately
If someone is in the early stages of labour with their amniotic sac still intact and the baby is found to be in a transverse lie. What can be done?
External Cephalic Conversion
Endometriosis management
Primary care - Analgesia -> COCP or POP -> refer
Secondly Care - GnRH analogues or Surgery (best for fertility)
When is an APGAR at 10 minutes required?
If score less than 7 at 5 minutes
PCOS management
Weight loss and exercise
Fertility - clomifene -> + metformin -> gonadotrophins
Dysfunction - Co Cyprindol, COCP, Metformin
Dysmenorrhoea in PCOS
Induce bleed by giving a cyclical progestogen then refer for vaginal USS
If >10mm endometrial thickness -> biopsy to exclude endometrial hyperplasia
If <10mm - COC POP IUS etc
Dysmenorrhoea - Management
NSAID or Mefenamic acid
COCP
What are some normal lab findings in pregnancy?
Decreased serum urea
Decreased serum creatinine
Increased urinary protein loss
Primary herpes infection during pregnancy - management
Oral acyclovir 400mg TDS till delivery
Whats the commonest cause of a reduced variability lasting less than 40 mins?
Foetus sleeping
What are some other causes of a reduced variability on CTG?
Maternal opioids BDZ beta blockers
Foetal acidosis due to hypoxia
Prematurity - below 28 weeks
Benefits of the subdermal implant?
Most efective method
Effective for three years
Safe for use in VTE and migraine with aura
Can be inserted immediately post TOP
Breast and axilla mass + breast augmentation + snowstorm appearance of USS
Breast implant rupture
Management of mild PMS
Regular exercise
Small regular meals rich in complex carbohydrates
In a patient avoiding HRT who’s main complaint is flushing what can be used?
SSRIs
Baby Blues
3-7 day postpartum
Very common
Anxiety and crying
Reassurance and support
Post Partum Depression
1 month post partum
1 in 10
Reassure -> sertraline or paroxetine
Post partum psychosis
0.2% develop
2-3 weeks postpartum
Admit to mother and baby unit
25-50% recurrence risk
What the first line antibiotic for a UTI in breast feeding?
Trimethropin
AVOID - nitrofurantoin as G6PD risk
PPH management
IV syntocinin -> IV ergometrine -> IM carboprost -> Intrauterine Balloon Tamponade
Placenta accreta
Chorionic villi are attached to myometrium
Placenta Increta
Chorionic villi invade into myometrium
Placenta Percreta
Chorionic villi invade into perimetreum
Vaso Praevia
Painless vaginal bleeding
Ruptured membranes
Foetal bradychardia
AFP and defect in utero
AFP raised in neural tube defects
AFP reduced in Down syndrome
What can be used to stop lactation in certain circumstances?
Cabergoline - if still birth baby death etc
If someone with a known coagulopathy has a miscarriage how should this be managed.
Medically with vaginal misoprostol
Miscarriage management
Expectant is first line - 7-14 days watch and wait
Medical - vaginal misoprostol
Surgical - if signs of sepsis of haemodynamic instability
Management of a suspected ovarian cancer if an abdominal mass is felt.
Urgent gynaecology referral
Skip USS
Take CA125 but don’t wait for results
Placental abruption risk
A = Abruption previously B = BP -high or preeclampsia R = Ruptured membranes U = Uterine injury P = Polyhydramnios T = Twins I = Infection in uterus O = Older than 35 N = Narcotic use - cocaine amphetamine etc
When is treatment initiated in antiphospholipid syndrome?
Aspirin from positive urinary pregnancy test
LMWH from positive heart beat on USS
History of endometriosis + acute abdomen + free fluid in pelvis + recent period or negative pregnancy test.
Ruptured endometrioma
What may happen post successful treatment of syphilis and how is this managed?
Jarisch Herxheimer reaction - acute febrile reaction
Reassure that is subsides after 24 hours and provide paracetamol
Admit if seriously unwell
Cause of pulmonary hypoplasia
Oligohydramnios
Management of a molar pregnancy
Surgical curetage
Hysterectomy if completed their family
Post molar pregnancy what surveillance is undertaken.
Partial molar - hCG done 4 weeks after - if normal = no surveillance
Complete molar - monthly hCG for at least 6 months
Molar pregnancy
Partial - some embryonic tissue
Complete - no embryonic tissue
Risk of choriocarcinoma transformation and local invasion
Mastitis managment
Ensure effective milk expression and analgesia
Antibiotics if - failure to resolve 12-24 hours after advice, fissure in the nipple, positive culture
A pregnant lady on phenytoin should receive what extra care?
Vitamin K for the last month
What tocolytic is first line in preterm labour?
Nifedipine -beware can cause maternal hypotension
Bleeding for two weeks post birth.
Initially bright red but now a darker brown
Heavier in C-sections
Lochia
Completely normal - discharge and safety net
Return if - starts to smell, amount increases,
Management of an complex ovarian cyst
Ca125 AFP bHCG and elective cystectomy
FNA isn’t done as this can facilitate the spread of the cancer
After the 7 days of antibiotics in a UTI what else should be done? Pregnant
A urine culture should be sent as a test of cure
What is the commonest ovarian cyst?
Follicular
Which ovarian cyst is most likely to bleed?
Corpus Luteum cyst
Whats the commonest epithelial ovarian tumour?
Serous cystoadenoma
Complications associated with Mucinous Cystadenoma
Rupture can cause a pseudomyxoma peritoni
Have the potential to become massive - compress surrounding organs
Guidance around emergency contraception and vomiting
If vomiting has occurred within 3 hours of taking another dose is required.
What test is indicated in recurrent vaginal Candidas?
Test for diabetes
Breast cancer screening
50 -75 years - mammogram every 3 years
How long is the IUS effective for?
5 years
How long is the IUD effective for?
5-10 years
In an a c section what should be given to the mother?
Omeprazole - helps reduce risk of aspiration pneumonia
What becomes first line for management of miscarriage over 12 weeks?
Medical - vaginal misoprostol
