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MEDICINE FINALS > O&G > Flashcards

O&G Flashcards

1
Q

What are the risks of HRT?

A
  • Increased risk of breast cancer (especially in combined - although reaches pop’n average 5 years after stopping)
  • Increased risk of endometrial cancer (especially in oestrogen only and eliminated by giving progesterone continuously)
  • increased risk of VTE/stroke
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2
Q

When should women be offered an oral glucose tolerance test for gestational diabetes?

A
  • ASAP after booking for women with prev Gestational diabetes
  • at 24-28 weeks for women with risk factors
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3
Q

What are 5 RF for gestational diabetes?

A

1 BMI of > 30 kg/m²
2 previous macrosomic baby weighing 4.5 kg or above
3 previous gestational diabetes
4 first-degree relative with diabetes
5 family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

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4
Q

What test results would indicate presence of gestational diabetes?

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

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5
Q

How is gestational diabetes managed?

A
  1. fasting PG < 7 then trial of diet and exercise
  2. if targets not met in 2 weeks then start metformin
  3. if targets still not met OR FPG> 7 on test then add short acting insulin
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6
Q

How is pre-existing diabetes managed for pregnant women?

A
  1. weight loss for women with BMI > 27
  2. stop oral hypoglycaemic agents, apart from metformin
  3. commence insulin
  4. folic acid 5 mg/day from pre-conception to 12 weeks gestation
  5. detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts
  6. tight glycaemic control reduces complication rates
  7. treat retinopathy as can worsen during pregnancy
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7
Q

When does obstetric cholestasis typically present?

A

3rd trimester

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8
Q

How is obstetric cholestasis managed?

A

Ursodeoxycholic acid (symptom relief)
+ water soluble vit K if PTT deranged
+ weekly LFT checks

Delivery at 37 weeks!!

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9
Q

What are the risks to the mother of having a baby whilst obese (BMI>30) ? (5)

A

1 miscarriage
2 venous thromboembolism
3 gestational diabetes
4 pre-eclampsia
5 more likely to need C section

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10
Q

What are the risks to a baby of having an obese mother? (BMI>30) (5)

A

1 congenital anomaly
2 prematurity
3 macrosomia
4 stillbirth
5 increased risk of developing obesity and metabolic disorders in childhood

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11
Q

What advice can you give to obese women during pregnancy? (BMI>30)

A

1 - should inform them of increased risk to themself and baby and offer advice on weight loss
2 - obese women should take 5mg of folic acid, rather than 400mcg
3 - all obese women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks

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12
Q

Give 4 risk factors for placental abruption

A

1 cocaine use
2 multiparity
3 maternal trauma
4 increasing maternal age

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13
Q

What clinical features would someone show with placental abruption? (3)

A

1 shock out of keeping with visible loss
2 pain constant
3 tender, tense uterus

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14
Q

How is placental abruption managed?

A

If fetal distress -> CAT 1 C SECTION

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15
Q

How is placental abruption managed?

A

If fetal distress -> CAT 1 C SECTION

<36 wks + no fetal distress = observe + steroids + plan delivery
>36 wks + no fetal distress = vaginal delivery

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16
Q

What is placental abruption?

A

separation of placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

17
Q

What are risk factors for placenta praevia?

A
  • multiparity
  • multiple pregnancy
  • previous caesarean section
18
Q

What clinical features would someone have with placenta praevia?

A

PAINLESS bleeding

19
Q

How would you manage someone with suspected placenta praevia?

A

DON’T DO PV EXAM
- transvaginal USS

20
Q

Give 4 causes of PPH

A

Tone (uterine atony)
Trauma (perineal tear)
Thrombin (clotting disorder)
Tissue (retained placenta)

21
Q

How is PPH managed?

A
  1. ABC
    - 2 peripheral 14 gauge cannulas
    - warmed crystalloid infusion
  2. Mechanical
    - catheter and manual rub of uterus
  3. Medical
    - IV oxytocin/ ergometrine/ carboprost
  4. Surgical
    - intrauterine balloon tamponade
22
Q

What are RF for PPH? (4)

A

1 prev PPH
2 antepartum haemorrhage
3 induction of labour
4 C section

23
Q

What is the Bishop score used for?

A

to help assess whether induction of labour will be required

24
Q

What are the possible methods of induction of labour?

A

Bishop score is ≤ 6
- vaginal prostaglandins or oral misoprostol
(mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean)

Bishop score > 6
- amniotomy and an intravenous oxytocin infusion

25
Q

How would you manage a miscarriage first line?

A

Expectant management
- wait 7-14 days
- safety net and give info what to expect
- if bleeding and pain stopped by 14 days then advise preg test in 3 weeks

26
Q

What is pre-eclampsia?

A

Classically new-onset blood pressure ≥ 140/90 AFTER 20 weeks of pregnancy

AND 1 or more of the following:
- proteinuria
- other organ involvement e.g. renal insufficiency, liver, neurological, haematological, uteroplacental dysfunction

27
Q

What are 3 complications of pre-eclampsia?

A
  • eclampsia
  • IUGR
  • HELLP
28
Q

What is the management for patients at risk of pre-eclampsia?

A

aspirin 75-150mg daily from 12 weeks gestation until the birth

29
Q

Give 2 moderate and 2 high risk factors for pre-eclampsia and what criteria would warrant prophylactic treatment

A

1+ high or 2+ mod

High
- diabetes
- CKD
-current HTN/ HTN in a previous pregnancy
- autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome

Moderate
- first pregnancy
- age 40 years or older
- pregnancy interval of more than 10 years
- BMI of 35
- family history of pre-eclampsia
- multiple pregnancy

30
Q

What is the management for patients WITH pre-eclampsia?

A
  • emergency secondary care referral
  • oral labetalol/nifedipine
  • delivery of baby is ultimate treatment

MEDICINE FINALS (19 decks)

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