O&G Flashcards
Advice if taking levonorgesterol or ulipristal as emergency contraception
If vomit in next 3 hours then need to come back and retake
Not 100% effective so need to take pregnancy test if next period over 7 days past expected date
Can affect menstrual cycle- irregular or early bleeding/ spotting
Ectopic risk so if get severe pain in abdo come to A and E
Symptoms to ask about in obstetrics history
Headache
Visual problems
Chest pain
SOB
Nausea and vomiting
Abdo pain
Reduced fetal movements
Urinary symptoms
Vaginal discharge or loss of fluid
Leg swelling
Pruritus
Fatigue, weight loss, fever
What goes into history talking about the current pregnancy
Gestational age
Any scans or screening, what results?
Multiple gestation?
Folic acid?
Have you thought about planning the delivery?
Immunisations?
Have there been any comlpications/unwell?
How been coping?
What goes into asking about previous pregnancies
Gravidity and parity
Clarify what happened in those pregnancies
- if at term- age, weight, method of delivery, complications
Before term
- management used
What goes into gynae part of history in obs history
Cervical screening- last date and result
Previous gynae conditions
Questions about vaginal discharge
Colour
Amount
Consistency
Smell
Questions for dyspareunia
Location- deep or superficial
Duration
Character
Contraception questions for history
What method
Is that what always have used
Plan for children in future
Counselling for miscarriage
Medical gives control over but has side effects
Surgical has associated risks however symptoms go straightaway
Estimated delivery date formulation
(LMP-3 months)+1 year and 7 days
How is shoulder pain a side effect of laparascopy
Gas inserted into abdomen which can irritate the diaphragm
Fever, tachycardia and fetal tachycardia after an episode of urinary incontinence and discharge
Chorioamnionitis
The discharge was waters breaking
Management plan for ovarian torsion
A-E
Pregnancy test
Bloods- G&S, clotting
TVUSS
Surgery referral (cystectomy, detorsion, oophorectomy)
Anti-emetics, analgesia, fluids
How break news about potential cancers
Say that plan is to refer for 2WW as what we want to rule out ovarian cancer
THEN PAUSE
Say that im not saying this is what it is, there are many other things it could be like etc
Counselling on a miscarriage
Say that scan showed your baby has no heartbeat
Counselling for VBAC
Is a safe option the majority of the time however there is a slight risk of uterine rupture
If wish to proceed
- will be carried out in a consultant led unit
- will have elctronic tracing of baby throughout
Investigations to do for contraception
Observations
BMI
STI screen if necessary
Advice if unprotected sex
Emergency contraception
STI check 3 weeks and also 3 months after
Adavantages and disadvantages of depo injection
Very effective
Do not need to remember to take
Return to fertility
Osteoporosis
Weight gain
Must use condoms as no STI protection
Adavantages and disadvantages of depo injection
Very effective
Do not need to remember to take
Ireegular bleeding
Spots and progesterone sx
Must use condoms as no STI protection
Adavantages and disadvantages of COCP
Effective
Side effects uncommon
Ease painful and heavy periods
Small risk of clots
Breast cancer risk
Have to remember to take everyday
Must use condoms as no STI protection
Adavantages and disadvantages of POP
Much smaller chance of clots
Must take same time every day
Irregular bleeding
Acne etc
Must use condoms as no STI protection
Secondary amenorrhoea differentials and questions
Type 1- hypothalamic
- exercise
- stressed
- weight loss
Type 2- PCOS, thyroid, prolactin
- acne
- change in weight
- facial hair
- headache
- palpitations
Type 3- POI
- flushes
- dry vagina
Investigations for amenorrhoea
Bedside
- examination inc visual fields
- observations
- BMI
- pregnancy test
Bloods
- hormone screen
Imaging
- consider hysteroscopy if asherman syndrome
Differentials for dysmenorrhoea
Endometriosis
PID
Fibroids
Copper coil
Adenomyosis
Primary dysmenorrhoea
Cancer
Investigations for dysmenorrhoea
Bedisde
- observations
- BMI
- speculum for swabs and abdominal examination
Bloods
- baseline
Imaging
- TVUSS
Abdo pain differentials
To rule out
- ectopic
- torsion
Other
- miscarriage
- PID
- cyst
- ruptured cyst
- cancer
- mittelschmerz
- period pain
- bartholins
PV bleeding differentials
PID
Breakthrough bleeding
Slipped coil
Miscarraige
Ectopic
Cancer
Ectropion
PV bleeding investigations
Bedside
- observations
- speculum with swabs and abdo examination
- pregnancy test
Bloods
- baseline
Imaging
- TVUSS
Abdo pain investigations
Bedisde
- observations
- examination- speculum including speculum
- pregnancy test
Bloods
- baseline infection looking for
Imaging
- TVUSS
Urogynae differentials
STI/UTI
Atrophic vaginitis
Incontinence
- stress
- urge
- functional from DM
- overflow
Prolapse
Bladder cancer
Urogynae investigations
Bedside
- BMI
- Sims speculum if prolapse
- urine dip and pregnancy test
- speculum for swabs if indicated
- bladder diary
Bloods
- HbA1c
Imaging
- urodynamics if indicated
Primary amenorrhoea differentials
No secondary characteristics
- turners
- hypothalamic including kallmans
Secondary characteristics
- mullerian agenesis
- imperforate hymen
- transverse septum
- thyroid
- prolactin
- PCOS
- CAH and cushings
Primary amenorrhoea investigations
Bedside
- observations
- head to toe examination
- pregnancy test
- karyotyping from saliva swab
Bloods
- hormone screen
Imaging
- TVUSS
Important things to answer in TOP history
Obstetric history
Support at home- ask about partner
ICE
- why doing
- anything particularly worrying about the process
Investigations for TOP
Bedside
- observations
- head to toe
- pregnancy test
Bloods
- beta HCG
- FBC
- U&Es
- group and save
- clotting screen
Imaging
- TVUSS
Counselling for termination of pregnancy
Explain free under NHS and that all records are strictly confidential
Explain that next step is to refer on to specialist clinic where will carry out an assessment of yourself and discuss the options
Then at a later date you will have the procedure
Are you aware of the methods used?
2 main methods
- medical where give mifeprostone which stops pregnancy from continuing and then a second one a few days later which will cause the pregnancy tissue to be expelled
- surgical where place a tube into womb and remove the pregnancy
Breathless differentials in pregnancy
PE
Infection
Pneumothorax
Cardiac problems
Anaemia
Asthma
Questions for breathlessness in pregnancy
When breathless at
Chest pain
Haemoptysis
Cough
PE
- rfx
- leg pain
- haemoptysis
Anaemia
Rfx for VTE in pregnanc
Pregnancy
- stasis
- over 35
- procedures
- pre-eclampsia
Inherited
- just say them
Acquired
- previous VTE
- obesity
- flight
- cancer
- sepsis
How manage heparin during labour
Speak to someone ASAP as soon as start contracting as need to stop heparin
Incidence of someone with HIV vertically transmitting to baby
No intervention- 30%
Intervene - under 1%
Investigations if HIV identified in pregnancy
Bedside
- observations
- pregnant abdo exam
- urine dip
- swabs for STIs
Bloods
- baseline etc
- viral load, CD4, genotype of foetus
- syphyllis and hepatitis antibodies
Questions to ask in HIV in pregnancy history
Infection screen
Previous history
Travel
Partners screen who have had sex with
Support at home
Investigations for NVP
Bedside
- observations
- examination looking for signs of dehydration- sunken eyes, mucous membranes, CRT
- abdo examination looking for causes of vomiting
- neuro examination
- pregnant abdo exam
- urine dip
- BMI
Bloods
- FBC, U&Es, LFTs, Beta HCG, TFTs
Imaging
- if not had booking do TVUSS to exclude molar
Management of HGV
Fluids
Anti-emetics
Thiamine
LMWH
Investigations for reucrrent miscarriages
Karyotype parents
Genetic analysis of tissue
Bloods- diabetes, TFTs, APL screen
TVUSS
Questions to ask in later pregnancy
Itching
Headache
Swelling
Visual problems
Secondary post partum haemorrhage questions
How much have you been bleeding
Light headed or short of breath
Fever
Pain
Discharge
Pregnancy history especially labour
Sexually active
Pain on urinating and stool
Investigations for secondary post partum haemorrhage
As actively bleeding A-E
- sats and lung exam
- c= BP, HR and ECG
- able to converse
- E= examine vagina with speculum and HVS
Bloods
- FBC, U&Es, LFTs, clotting screen, group and save
- blood cultures
Imaging
- TVUSS to rule out retained products of conception
Counselling for SGA
As you know we have done the scan to check babys well which I can confirm they are doing, they have a strong heartbeat. Now one of the other things that we do is to check their size to see how they are growing and the scan today has shown that baby is a little bit smaller than we would expect for this number of weeks.
So what does this mean? In some cases this is completely normal for some babies to be a bit smaller just like with us adults some of you r friends will be tall and some will be small. What does worry us a little bit is when baby is small because their growth has been restricted for some reason or another and as a result they are not able to reach their biggest potential size. This occurs in a number of scenarios, it can be due to infections, problems with baby itself or most of the time when baby isnt getting all the necessary nutrients and oxygen
Complications of SGA
Stillbirth
NEC
Imapired neurodevelopment
Hypoglycaemia
Later in life= metabolic syndrome
Investigations for SGA
Bedside
- observations
- pregnant abdo exam
- urine dip
- saliva karyotyping
Bloods
- screen infections
Imaging
- TVUSS
- doppler
