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Essie Year 5 > O&G > Flashcards

O&G Flashcards

1
Q

pregnant patient with 2 previous miscarriages and a stillbirth. What is her gravidity and parity?

A

G4 P1+2

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2
Q

pregnant patient at 38+6 weeks. SFH has decreased from 36w visit. Most likely reason?

A

Increase in foetal station

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3
Q

in which situation must you never perform PV examination

A

placenta praevia

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4
Q

what is the foetal fibronectin test used for?

A

predicts probability of preterm labour in next 48h

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5
Q

pelvic girdle pain in pregnancy / symphysis pubis dysfunction? what is it and mx

A

pain due to pressure on pubic symphysis, radiates to thighs and gets worse as pregnancy progresses. Mx: analgesics, pelvic support braces/crutches, physio

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6
Q

different types of speculum

A

cusco’s speculum = beak shaped. sim’s speculum = c shaped, used in surgery and to visualise prolapse

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7
Q

most common cause of primary pph

A

uterine atony

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8
Q

endometritis

A

retained products of conception, resulting in infection post-partum. results in ongoing lochia with unpleasant smell and clots.

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9
Q

how long should you avoid conceiving if you’ve been treated with methotrexate after ectopic?

A

3 months

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10
Q

connective tissue disorders in pregnancy –> complication?

A

congenital heart block

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11
Q

echogenic bowel

A

Down’s syndrome

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12
Q

category 1 c section

A

immediate threat to life of mother/baby, must deliver within 30 minutes of making a decision

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13
Q

category 4 c section

A

elective c/s

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14
Q

kallmann syndrome

A

hypogonadotrophic hypogonadism + anosmia –> low LH, FSH, GnRH

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15
Q

Indications for high dose folic acid

A

BMI>30, antiepileptic drug use, diabetes, fhx/pmhx of neural tube defects, coeliac disease, thalassemia trait

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16
Q

galactocoele

A

occlusion of lactiferous ducts in women who have stopped breastfeeding –> build up of milk –> painless, non-tender lump on breast

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17
Q

combined contraceptive patch

A

cycle lasts 4 weeks. the patch is worn every day and changed every week. on week 4, patch is not worn and there is a withdrawal bleed.

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18
Q

Contraceptive patch: What do you do if at the end of week 1 or 2, there is a delay in changing patch of <48h?

A

change patch ASAP

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19
Q

Contraceptive patch: What do you do if at the end of week 1 or 2, there is a delay in changing patch of >48h?

A

change patch and use barrier contraception for next 7d

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20
Q

when are women who have been treated CIN1/2/3 invited back for a smear

A

6 months after procedure to check the lesion has been adequately treated

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21
Q

Describe antenatal care for women with pre-eclampsia

A

blood and scans every 2 weeks, BP checks 3x/week

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22
Q

Describe intrapartum care for women with pre-eclampsia

A

arrange delivery for 37 weeks, can choose between iol or elective c/s, labour ward with continuous CTG

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23
Q

Describe postpartum care for women with pre-eclampsia

A

observe for 24h, monitor BP 4x/day, discharge but measure BP every 1-2d for up to 2 weeks after discharge. GP review at 2 and 6 weeks to check BP. Wean off medication.

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24
Q

Congenital toxoplasmosis infection presentation

A 
C's
hydrocephalus
intracerebral calcifications
convulsions
chorioretinitis
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25
Q

Toxoplasmosis tx

A

spiramycin for positive mother and negative baby

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26
Q

Secondary PPH timeframe

A

24h - 12 weeks postpartum

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27
Q

routine vaccinations offered to pregnant women

A

influenza + pertussis

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28
Q

Layers that you go through in a lower segment C/S

A

skin, superficial fascia, deep fascia, rectus sheath, rectus abdominalis, transversalis fascia, extraperitoneal tissue, peritoneum, uterus

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29
Q

Where does cervical cancer metastasise to first?

A

pelvic lymph nodes

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30
Q

Where does ovarian cancer metastasise to first

A

para-aortic lymph nodes

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31
Q

HRT is associated with an increased risk in…

A

breast cancer, endometrial cancer, VTE

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32
Q

mode of HRT that is not associated with increased risk of VTE?

A

transdermal patch

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33
Q

Lichen sclerosus Mx

A

1) wash with emollient soap substitute instead of regular soap, avoid irritants (laundry detergent/tight clothing), 2) highly potent steroids, 3) calcineurin inhibitors, 4) biopsy if no improvement after tx

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34
Q

focused questions to ask in obstetric cholestasis

A

jaundice, pale stools, dark urine, FLAWS

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35
Q

Mx in obstetric cholestasis

A

Immediate Mx: aqueous creams, ursodeoxycholic acid to reduce bile acids/itching, cool baths, loose clothing.
Antenatal care: weekly LFTs + bile acid tests. some women may have CTG and more frequent ultrasound scans; under consultant obstetrician led antenatal care.
Delivery: IOL at 37 weeks under consultant led team with continuous CTG, 6-8 week post-partum check up.

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36
Q

complications of obstetric cholestasis

A

stillbirth, prematurity, meconium

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37
Q

intracytoplasmic sperm injection vs intrauterine insemination

A

intracytoplasmic sperm injection = injecting sperm directly into egg cell; intrauterine insemination = injecting sperm cell into uterus (don’t do this if problem with tubal patency)

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38
Q

Levonorgestrel C/I

A

BMI>26/body weight>70kg, in which case give double dose (3mg instead of 1500 micrograms)

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39
Q

congenital CMV infection presentation

A

jaundice
microcephaly
periventricular calcification
chorioretinitis

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40
Q

VTE during pregnancy Mx

A

LMWH until 6 week postnatally

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41
Q

Cal-exner bodies

A

found in granulosa cell ovarian tumours; “call your gran”

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42
Q

Urge incontinence - who should be cautious about giving antimuscarinics to?

A

avoid antimuscarinics in elderly frail women due to increased risk of falls. Give beta agonist instead, eg mirabegron.

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43
Q

definition of prolonged active stage in nulliparous and multiparous women?
How does having an epipdural change this definition?

A

nulliparous = >3h, multiparous =>2h. This is an indication for instrumental delivery.

Having an epidural adds 1h to the above.

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44
Q

Low platelets in pregnancy - ddx?

A

gestational thrombocytopenia, ITP

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45
Q

when does gestational thrombocytopenia present?

A

3rd trimester

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46
Q

when does ITP present?

A

1st trimester

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47
Q

Neville Barnes forceps vs Kielland’s forceps

A

Neville Barnes forceps = can ONLY be used in OA position, CANNOT be used to rotate position.
Kielland’s forceps = CAN be used to rotate baby to OA position.

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48
Q

Why are Kielland’s forceps rarely used?

A

risk of perineal tears and need for episiotomy

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49
Q

Pregnancy of Unknown Location Mx

A

two beta Hcg readings 48h apart. If there is an increase of >63%, pregnancy is viable so do TVUSS 7-14d later.
Between 50% decrease and 63% increase = ectopic.
< 50% decrease = miscarriage.

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50
Q

Major indications for aspirin

A

diabetes, CKD, pre-existing HTN, autoimmune disease

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51
Q

What measurements are decreased in pregnancy?

A

Hb, platelets, protein S

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52
Q

When can IUS/IUD be inserted post-partum?

A

within 48h of delivery or after 4 weeks

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53
Q

Define uterine hyperstimulation

A

5 or more contractions in 10mins

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54
Q

Uterine hyperstimulation Mx

A

if due to excess prostaglandins, give tocolytics.

if due to syntocin infusion, stop infusion/reduce dose.

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55
Q

Hypothyroidism in pregnancy Mx

A

bHCG cross reacts with TSH receptors on thyroid so there is a physiological increase in T4 in pregnancy. To mimic this, increase levothyroxine dose by 25 micrograms a day.

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56
Q

Mg sulphate toxicity presentation

A

respiratory depression, arrhythmias, loss of deep tendon reflexes

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57
Q

Mg sulphate toxicity Mx

A

10ml 10% calcium gluconate

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58
Q

Lambda sign

A

triangular wedge shape of placenta on USS. indicates dichorionic twin pregnancy.

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59
Q

polymorphic eruption in pregnancy

A

benign, self-limiting
pruritis that spares umbilicus
lesions become confluent

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60
Q

Pruritic urticarial papules and plaques (PUPP)

A

itchy striae

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61
Q

Most common cause of secondary PPH

A

endometritis

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62
Q

Mx for babies born from HIV pregnancy

A

wash baby as soon as delivered
give oral zidovudine within 4h of birth + for 4-6 weeks
check for HIV at birth, discharge, 6 weeks, 12 weeks.

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63
Q

Herpes simplex in pregnancy Mx

A

if infected in 1st/2nd trimester, give course of oral aciclovir then again from 36 weeks onwards until delivery; vaginal delivery possible provided sores have healed by then.
if infected in 3rd trimester, give oral aciclovir and elective C/S advised.

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64
Q

proteinuria without hypertension in pregnancy > 20 weeks

A

1) if symptoms of UTI / leukocytes or blood in urine, suspect UTI and send for urine MC&S
2) if protein 1+, reassess in 1 week, safetynet, do a protein creatinine ratio
3) if protein 2+, urgent same day assessment

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65
Q

itchy bumpy rash that spares the umbilicus

A

polymorphic eruption of pregnancy

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66
Q

after a molar pregnancy, how long should the woman be told to avoid pregnancy after the beta-HCG has returned to normal?

A

6 months

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67
Q

supplement given in severe hyperemesis gravidarum

A

thiamine

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68
Q

Bartholin’s cyst vs abscess

A

painless vs painful!

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69
Q

C/S is routinely offered

A

when HIV with/without concurrent infections
Breech where ECV has failed
Multiple pregnancy where first baby is breech
Primary genital herpes infection in third trimester
Placenta praevia major

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70
Q

CTG baseline variability

A

5-25 bpm

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71
Q

CTG accelerations

A

rise of fetal heart rate of >15bpm for at least 15s

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72
Q

What measurement is used on USS for dating?

A

crown rump length. if >14 weeks, biparietal diameter.

EDD is used unless USS date differs by >1 week

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73
Q

Passage of baby through pelvis - name stages

A

descent, engagement, neck flexion, internal rotation into OA, neck extension, external rotation, lateral flexion

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74
Q

Describe menstrual cycle

A

FSH stimulates growth of 6-12 follicles.
As follicles mature, granulosa cells produce oestrogen, which inhibits LH and FSH.
Eventually only 1 follicle matures fully, the rest undergo atresia.
Oestrogen levels continue to rise, causing rise in FSH and surge in LH.
This stimulates release of egg from follicle.
Remaining corpus luteum releases progesterone, reaching a peak at day 21.

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75
Q

Twin to twin transfusion syndrome

A

one twin gains at the other’s expense. in monochorionic pregnancy.
Therapeutic amniocentesis can be used to reduce amniotic fluid pressure.

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76
Q

Foetal station of 0

A

Presenting part is level with the ischial spines

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77
Q

Bishop’s score at which labour is unlikely to be imminent

A

<5

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78
Q

Gold standard test for tubal patency

A

laparoscopy and dye

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79
Q

Bloody show

A

mucus-like vaginal bleeding, indicates preparation for labout

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80
Q

how is anti-D given following sensitising events?

A

<20 weeks, give 250IU anti-D. >20 weeks, give 500IU anti-D. Given IM asap after event, ideally within 72h.

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81
Q

Braxton Hicks contractions

A

feels like real contraction but uterus just contracts sporadically in pregnancy. Relieved by warm baths, time, rest, changing activities, drinking water.

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82
Q

How does uterine rupture present?

A

CTG abnormalities, maternal tachycardia, hypotension, shock

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83
Q

Why does uterine hyperstimulation cause foetal distress?

A

not enough time in between contractions to allow adequate blood flow to foetus

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84
Q

Uterine rupture Mx

A

immediate laparotomy to deliver baby

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85
Q

How does atosiban work?

A

competitive inhibition of oxytocin by binding to myometrial receptors

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86
Q

How do beta agonists work? e.g., terbertuline, salbutamol, ritodrine

A

stimulate beta receptors on myometrial cell membranes, reducing intracellular Ca levels, inhibiting contraction

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87
Q

PID with fever Mx

A

IV abx

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88
Q

Headache after delivery dx

A

post dural puncture headache

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89
Q

define premature ovarian insufficiency

A

menopause before 40yo

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90
Q

POI Mx

A

HRT to take until age 51yo

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91
Q

When does active labour begin?

A

when cervix has dilated to 4cm

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92
Q

Abortion act clause A

A

continuing pregnancy has greater risk of harm to mother and existing children than terminating it & pregnancy <24weeks

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93
Q

UTI in pregnancy 2nd line Mx

A

cefalexin/amoxicillin

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94
Q

Endometrioma on USS

A

ground glass appearance

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95
Q

Abortion act clause B

A

risk of serious harm to physical/mental health of mother, can have TOP at any point

96
Q

Abortion act clause C

A

mother’s life is at risk, can have TOP at any point

97
Q

Abortion act clause D

A

continuing pregnancy has greater risk to baby and would cause it to be severely handicppaed

98
Q

Side effect of progesterone implant

A

irregular bleeding

99
Q

What is nexplanon

A

progesterone implant

100
Q

What is preferred imaging in PE in pregnant women

A

V/Q scan has lower radiation dose than CTPA

101
Q

Target glucose levels in GDM

A

fasting <5.3, 1hr<6.4, 2hr <7.8

102
Q

Induction of labour steps

A

prostaglandin pessary for 24h, vaginal prostaglandin gel for 6h x2, rupture of membranes with amnihook, if labour has not started 2h after ROM –> start IV syntocin infusion

103
Q

what murmur is common if pregnancy

A

soft systolic murmur due to dilatation across tricuspid valve

104
Q

DOACs in pregnancy

A

discontinue due to teratogenic effects, replace with LMWH

105
Q

when would you start to feel baby move?

A

16-24 weeks

106
Q

when should you worry if woman has not felt baby kicking yet

A

24 weeks

107
Q

probability that a pregnancy will miscarry

A

common!

1 in 5 miscarry

108
Q

Booking appointment by 10 weeks

A 
Initial contact
folate up to 12 weeks
vit D daily
smoking + alcohol cessation advice
BMI, BP, urine dip
bloods - anaemia, blood group, rhesus state, red cell alloantibodies, haemoglobinopathies
Screen for HIV/hep B/syphillis
Offer down's syndrome screen
109
Q

Dating scan 10-14 weeks

A

finalise gestational age + EDD
viability
singleton/multiple pregnancy
can include NT scan

110
Q

16 weeks appointment

A

Review test results
BP, BMI, urine dip
can have influenza/pertussis vaccine
OGTT if hx of previous GDM

111
Q

20 week anomaly scan

A 
structural anomalies
placenta position
gender 
growth 
amniotic liquor volume
112
Q

28 week appointment

A

BMI, BP, urine dip, SFH
if risk factors for GDM, offer OGTT
1st dose of anti-D (500IU)

113
Q

34 week appointment

A

BP, BMI, urine dip, SFH
2nd dose of anti-D (500IU)
give info on labour + discuss birth plan

114
Q

what additional antenatal appointments do nulliparous women have?

A

25, 31, 40 week appointments with GP to review BP, BMI, urine dip, SFH

115
Q

36 week appointment

A

BP, BMI, urine dip, SFH

give info on breastfeeding, vitamin K for newborn, care for baby, post-natal issues

116
Q

38 week appointment

A

BP, BMI, urine dip, SFH

discuss prolonged pregnancy

117
Q

41 week appointment

A

BP, BMI, urine dip, SFH

offer membrane sweep + IOL

118
Q

TOP mx

A

Abx prophylaxis + anti-D

< 9 weeks = mifepristone + misoprostol at home
>9 weeks = mifepristone + misoprostol in clinical setting
<14 weeks = vacuum aspiration under local
>14 weeks = dilatation + evaucation under GA

119
Q

why would women prefer medical TOP over surgical

A

not under anaesthetic so feel more in control of situation

120
Q

why would women prefer surgical TOP over medical

A

under anaesthetic so unaware of events

121
Q

what happens after a TOP

A

2 week F/U to check: whether abortion is complete, infection, mental health, advice about contraception + sexual health

122
Q

TOP Ix

A

basic obs, urine dip, pregnancy test, STI screen

bloods - group/save, rhesus state, cross match

123
Q

does TOP affect fertility

A

most women don’t have any complications + fertility is not affected. A small number with complications (severe infection/damage eg) may have their fertility affected

124
Q

can girls under 16yo consent to TOP without parental consent?

A

assess Gillick competence (ability to sufficiently understand info + make an informed decision)
see if you can encourage her to tell her parents
if you feel that their physical/mental health is likely to suffer w/o TOP + it is in their best interests, then 2 doctors can decide + go ahead

125
Q

questions to ask when woman is interested in COCP

A

BMI, hx of migraines with aura, smoking, breast cancer, gall bladder/liver disease, risk factors for VTE

126
Q

Disadvantages of COCP, POP, patch, implant, injection, IUD, IUS

A 
COCP = minor side effects are nausea/headache/mood changes, rare but increased risk of clots/cervical cancer/breast cancer
POP = no major disadvantages, may have unpredictable bleeding
patch = may have skin reaction
implant = irregular bleeding
injection = weight gain
IUD = invasive, heavier/more painful periods possible
IUS = invasive
127
Q

Prolapse Ix

A

general physical examination + BMI
abdo exam to look for masses
resp exam to look for anything that might precipitate prolapse, eg persistent cough
pelvic exam –> bimanual + sims speculum exam, ask to cough to assess extent of prolapse

128
Q

risk factors for cervical cancer

A

smoking, COCP, high number of sexual partners, immunodeficiency

129
Q

hyperemesis gravidarum

A

general examination looking for clinical sx of dehydration
basic obs
urine pregnancy test + urine dip for ketones/UTI
compared pre pregnancy weight with current weight
bloods - FBC, U&Es, LFTS, TFTs
pelvic USS to confirm intrauterine viable pregnancy

130
Q

Fibroid degeneration mx

A

self-resolves, paracetamol, best rest, oral fluids

if pain is severe, can admit for opioid analgesia

131
Q

how do fibroids affect pregnancy

A

can cause malpresentation of baby or obstruct labour –> c-section may be indicated

132
Q

when is expectant mx indicated in ecptopic

A

bhcg<1000, asymptomatic, no intrauterine pregnancy

133
Q

expectant mx in ectopic

A

twice weekly F/U until bHCG<20

134
Q

when is medical mx indicated in ectopic

A 
no significant pain
unruptured ectopic
mass < 35mm
no visible heart beat
serum bHCG<1500
able to return to F/U
135
Q

medical mx in ectopic

A

single dose methotrexate, return to F/U to check bHCG at day 4, day 7 and 1x/week until -ve

136
Q

when is surgical mx indicated in ectopic

A 
ruptured 
significant pain
bhcg>5000
mass > 35mm
fetal heart beat detected
unable to return for F/U
137
Q

PCOS complications

A

infertility
insulin resistance + pregnancy
heart disease
sleep apnoea

138
Q

PE Mx

A

LMWH to take during pregnancy until 6 weeks post-partum

139
Q

intrapartum mx in women taking LMWH

A

stop LMWH 24h before delivery if planned or as soon as delivery begins

140
Q

postpartum mx in women taking LMWH

A

warfarin can be given 5d post-partum, warfarin/LMWH safe during breastfeeding, joint review with obstetrics + haematology post-partum,

141
Q

probability that a VBAC is successful

A

75%

25% will need emergency C/S

142
Q

C/I for VBAC

A

longitudinal C/S scar
more than 2 C/S
breech
placenta praevia

143
Q

risks of VBAC

A

small risk of uterine rupture, infection, haemorrhage

144
Q

benefits of VBAC

A

shorter hospital stay
quicker recovery
reduced risk of neonatal resp distress

145
Q

Ovarian cancer mx

A

total abdominal hysterectomy + bilateral salpingo-oophorectomy
examine all peritoneal surfaces, biopsies of pelvic and para-aortic lymph nodes, consider infracolic omentectomy if indicated
chemotherapy if stage 2 or above

146
Q

tests to complete when suspecting PID

A 
pregnancy test
urinanalysis + culture
vaginal wet mount with pH
NAAT testing for chlamydia + gonorrhoea
CRP/ESR
147
Q

outpatient abx for PID

A

IM ceftriaxone single dose
PO doxycycline 14d
PO metronidazole 14d

148
Q

inpatient abx for PID

A

IV doxycycline

IV cefoxitin

149
Q

complications in PID

A

infertility, ectopic, chronic pelvic pain

150
Q

counselling for PID

A

infection (often UTI/STI) which has spread to the organs in your reproductive system
usually outpatient abx regimen
if no improvement within 72h, admit for IV abx
discuss contact tracing, safe sex, barrier contraception

151
Q

how common is endometriosis

A

10% of women of reproductive age

152
Q

endometriosis mx

A

analgesia
COCP/POP/IUS
if fertility desired, consider fertility sparing surgery for excision; need to take GnRH agonists for 3m
if fertility not desired, consider hysterectomy + oophorectomy

153
Q

how would you explain endometriosis in counselling

A

the tissue that lines your womb grows in other places, including your ovaries and fallopian tubes

154
Q

what investigation should you avoid in placenta praevia

A

bimanual/vaginal examination!!!

careful speculum examination can be performed to check rupture of membranes / whether cervical os is closed

155
Q

asymptomatic placenta praevia mx

A

rescan at 32 weeks
rescan at 36 weeks
if still present, then book elective C/S for 36-37 weeks

156
Q

symptomatic placenta praevia mx

A 
A to E approach
high flow O2 
2 wide bore cannulae - take bloods for FBC/U&E/CRP/G&S/crossmatch/rhesus state/Kleihauer's/clotting screen, give IV fluids + blood transfusion
continuous CTG monitoring 
give anti-D

if haemodynamically unstable/foetal resp distress –> C/S
if haemodynamically stable –> admit for close monitoring + steroids, discharge if no bleeding for 48h, elective c/s for 36-37 weeks

157
Q

HIV in pregnancy Ix

A 
abdo exam 
bloods - FBC, U&Es, CRP, LFTs
HIV status - viral load, CD4 count, viral genotype resistance pattern
hepatitis screen
STI screen
158
Q

HIV in pregnancy Mx

A

arrange contact with joint obstetrician/HIV specialist clinic every 1-2 weeks
start zidovudine monotherapy if not already on ART
monitor CD4 and viral load
if viral load <50 –> vaginal delivery may be attempted
if viral load >50 –> elective C/S
intrapartum IV zidovudine infusion
wash baby + give zidovudine when born + continue for 4 weeks
check baby for HIV at birth, discharge, 6 weeks, 6 months
DO NOT BREASTFEED!

159
Q

when should you worry about reduced foetal movements

A

no foetal movements for >90 mins

160
Q

mx in the community if reduced foetal movements

A

lie in left lateral position

if <10 felt in 2hrs –> schedule antenatal appointment

161
Q

Ix for reduced foetal movements`

A 
basic obs 
abdominal examination
pelvic examination, including speculum 
foetal doppler USS 
if heartbeat present --> continuous CTG 
if heartbeat absent --> immediate pelvic USS
162
Q

sx of menopause

A 
hot flushes
night sweats
loss of libido
dryness/pain in vagina
irregular/absent periods
difficulty sleeping
headaches
joint pain
163
Q

hot flushes in menopause mx

A

conservative - sleep with windows open, wear loose clothing

medical - SSRI or SNRI

164
Q

atrophic vaginitis mx

A

conservative - lubricants

medical - topical oestrogens

165
Q

describe cyclical HRT

A

monthly - take oestrogen every day + progesterone for last 14 days of month
3 monthly - take oestrogen every day + progesterone for last 14 days of 3 month cycle

166
Q

why is HRT needed

A

reduced vasomotor symptoms

prevents osteoporosis

167
Q

risks of HRT

A

VTE, CVS disease, breast cancer

168
Q

need for contraception during menopause

A

if <50yo, need contraception until >2 years of amennorhea

if >50yo, need contraception until >1 year of amennorhea

169
Q

Risk of uterine rupture in VBAC without syntocin + with syntocin

A

Without syntocin = 1 in 200

With syntocin = 1 in 100

170
Q

Induction of labour in VBAC

A

AVOID prostaglandins
Use mechanical methods, eg balloon inserted for 12h for inflation + cervical dilation
Can use syntocin still with caution

171
Q

Shoulder dystocia

A

Lie bed flat + tell woman to stop pushing
Emergency buzzer + call seniors
External manoeuvres (McRoberts, then apply suprapubic pressure)
Consider episiotomy
Internal manoeuvres (Rubin II, woodscrews, deliver posterior arm)
Repeat manoeuvres on all fours
Consider symphisiotomy/fetal cleidotomy/Zavenellis
Emergency C/S

172
Q

Most common breech presentation

A

Frank (70%) - legs flexed at hip and knees extended

173
Q

Success rate of ECV

A

50%

174
Q

Biphasic decels

A

Non-reassuring

175
Q

Analgesia for instrumental delivery

A

Pudendal nerve block

Local anaesthetic

176
Q

Analgesic ladder

A

Natural methods (breathing exercises, etc) –> entonox –> either epidural or pethidine/morphine IM or IV/PCA using fentanyl

177
Q

Meconium stained liquor + abnormal CTG Mx

A

C/S

178
Q

What is labour

A

Contractions + cervical change (effacement + dilation)

179
Q

Describe stage 1 of labour

A 
Latent = cervix dilated up to 4cm 
Active = cervix dilated > 4cm
180
Q

Describe stage 2 of labour

A

Stage that begins when cervix is fully dilated and ends when baby is delivered
Passive (no pushing, baby descends)
Active (pushing)

181
Q

If already contracting, what should you NOT give

A

Prostaglandins due to risk of uterine hyperstimulation

Do ARM if membranes not ruptured yet, otherwise IV syntocin (easier to titrate than prostaglandins)

182
Q

Define delayed third stage of labour

A

> 30 mins after delivery of baby

183
Q

PPH 4Ts Mx

A

Tone - rub up contraction
Tissue - check placenta complete
Trauma - check perineum/vaginal tissue
Thrombin - clotting screen and review hx

184
Q

PPH Mx

A 
Call for help + MOH call 2222 
A to E approach
High flow O2 
2 wide bore IV cannulae 
Take bloods - FBC, U&E, LFTs, G&S, XM, clotting screen 
IV fluids + transfusion when it arrives
Insert catheter 
Uterine massage
Bimanual compression if vaginal delivery 
IV syntometrine / ergometrine 
IM carboprost
Bakri balloon if vaginal
B lynch sutures if C/S 
Uterine artery embolization 
Iliac artery ligation 
Hysterectomy
185
Q

Amenorrhea

A

Absence of periods 6 months

186
Q

Regular periods definition

A

21-35 day cycles

187
Q

Sex hormone binding globulin in PCOS

A

Decreases

188
Q

Safe antiepileptics in pregnancy

A

Lamotrigine

Levetiracetam

189
Q

Normal SFH relative to gestational age

A

Gestational age +/- 2 = normal SFH

190
Q

how long should COCP be discontinued for before/after a major surgery?

A

stop taking it 4 weeks before and resume 2 weeks after major surgery

191
Q

cervical smear due during pregnancy mx

A

delay smear until 12 weeks post partum

192
Q

Meig’s syndrome

A

fibroma
pleural effusion
ascites

193
Q

who is offered group B strep intrapartum abx prophylaxis

A

previous baby with group B strep

group B infection in current pregnancy

194
Q

how to structure HRT PACES counselling

A

1) oestrogen only or combined - do you have a womb? do you have a mirena coil?
2) cyclical or continuous - cyclical if still menstruating, continuous if 1 year of amenorrhoea
3) assess risk factors for HRT

195
Q

how do you know that the head is engaged

A

when the widest diameter of the baby’s head has descended into the pelvis + head is less than 2/5 palpable

196
Q

risk of developing fetal varicella syndrome following maternal varicella exposure before 20 weeks gestation

A

around 1%

197
Q

chickenpox exposure mx in pregnant women without immunity for 1) < 20 weeks 2) >20 weeks

A

1) VZIG injection asap, if rash appears see midwife/gp asap + have oral aciclovir within 24h of onset
2) oral aciclovir day 7-14 after exposure

198
Q

At which point in labour should IM syntocinon be administered

A

when anterior shoulder is delivered

199
Q

after a molar pregnancy, for how long should she be told to avoid pregnancy after the beta-HCG has returned to normal

A

6 months

200
Q

When do you give VZIG for pregnant women

A

<20 weeks and exposed to chickenpox contact, have VZIG asap!

201
Q

When do you give aciclovir to pregnant women? (VZV)

A

> 20 weeks,

1) give aciclovir immediately if they present with a rash
2) give aciclovir 7-14 days after exposure

202
Q

what is ICSI

A

intracytoplasmic sperm injection - when sperm is injected directly into egg
used when there is male factor infertility

203
Q

COCP absolute C/I

A 
>35yo + smoking >15/day 
migraine with aura
hx of VTE / MI / stroke
breastfeeding < 6 weeks post partum
antiphospholid syndrome 
major surgery with prolonged immobilisation 
uncontrolled HTN
204
Q

advice to give someone about barrier contraception when starting COCP

A

if starting the pill on day 1-5 of cycle, it is immediately effective. Otherwise, barrier contraception for first 7 days until effective.

205
Q

you have found an ovarian cyst on TVUSS. when should you refer to gynae?

A

if the cyst is irregular shaped or multilocular

if there is strong blood flow/ascites

206
Q

mx of simple cysts in pre menopausal women

A

pregnancy test + TVUSS then rest of mx depends on size of cyst
<5cm = discharge
5-7cm = yearly TVUSS to monitor for changes
>7cm = MRI +/- surgery

207
Q

mx of complex cysts in pre menopausal women

A

serum CA-125, αFP, βHCG, LDH

cystectomy

208
Q

raised AFP in pregnancy

A

omphalocoele

209
Q

low AFP in pregnancy

A

Down’s syndrome
Edward’s syndrome
maternal obesity
maternal DM

210
Q

when can you do forceps

A

fully engaged head

fully dilated

211
Q

lochia expected time period

A

up to 6 weeks

212
Q

mx of simple/complex cysts in post menopausal women

A

Ca-125 + RMI calculation (Ca-125 + TVUSS findings + menopausal status)

213
Q

best ix for obstetric cholestasis

A

LFTs

214
Q

when can COCP not be used post-partum

A

must not be used 3 weeks post-partum

must not be used for 6 weeks post-partum if breastfeeding

215
Q

when can POP be used post-partum

A

can be used at any time after day 21 post-partum

additional contraception needed for 2 days

216
Q

When is LMWH given

A

4+ risk factors or previous VTE = throughout pregnancy until 6 weeks post partum
3 risk factors = 28 weeks until 6 weeks post partum
2 risk factors = for 10 days post partum

217
Q

Surgical options for stress incontinence

A

bulking agent
colposuspension
rectal fascia sling
mid urethral tape

218
Q

Surgical options for urge incontinence

A

botulinum injection
sacral nerve stimulation
cystoplasty
urinary diversion

219
Q

breastmilk jaundice vs breastfeeding jaundice

A

breast milk jaundice = cause unknown, assoc. w/ glucoronidase + break down of bilirubin
breastfeeding jaundice = due to decreased breastmilk intake

220
Q

examples of category 1 C/S indications

A 
cord prolapse
uterine rupture
major placental abruption
foetal hypoxia
foetal bradycardia
221
Q

when should you delivery by for a category 2 c section

A

within 75 mins

222
Q

Which contraception causes a delay in returning to normal fertility?

A

progesterone only injectable

223
Q

pms mx

A

1) lifestyle advice
2) cocp
3) ssri

224
Q

incontinence ix

A

urine dipsticks + culture
vaginal examination to exclude pelvic organ prolapse
bladder diary (for at least 3 days)
urodynamic studies are indicated if there is diagnostic uncertainty

225
Q

conditions for IUS in fibroids

A

fibroids must be <3cm and not distorting uterine cavity

226
Q

woman presents to GP with persistent smelly pink discharge post-partum and is also pyrexic. mx?

A

refer to hospital for IV abx (gentamycin + clindamycin)

227
Q

what maintains the production of progesterone by the corpus luteum in early pregnancy

A

bhcg produced by synctiotrophoblasts

228
Q

rash in pregnancy that does not spare the umbilicus

A

pemphigoid gestationis

229
Q

MoA of progesterone implant, injection, desogesterel

A

inhibits ovulation

thickens cervical mucus

230
Q

MoA of classic POP

A

thickens cervical mucus

231
Q

MoA of IUD as emergency contraception

A

prevents implantation + spermicide

232
Q

MoA of IUS

A

thickens cervical mucus

thins endometrium

233
Q

when do you start intervening during the active first stage of labour

A

when cervical dilation <2cm every 4hrs, look at frequency and strength of contractions. Intervene if needed.

234
Q

TVUSS process

A

look for fetal heart beat
look for foetal poles for crown rump length
look for gestational sac

235
Q

at which size of the crown rump length should you be able to hear foetal heart beat?

A

> 7mm

if no heart beat heard and >7mm, possible miscarriage so get 2nd opinion or rescan

236
Q

at which size of the gestational sac should you be able to see a foetus

A

> 25mm

if no foetus seen and GS>25mm, possible miscarriage so get 2nd opinion or rescan

Essie Year 5 (4 decks)

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