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o&g Flashcards

1
Q

SGA

A

<10th percentile
symmetrical: TORCH, syndromes, TTTS
asymmetrical: placental insufficiency
maternal and foetal factors
rfs at booking -> 20 weeks foetal biometry –> normal: 2 weekly USS, abnormal: weekly USS + twice weekly doppler
delivery by 37 weeks
20-24 uterine artery doppler

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2
Q

Vasa praevia

A

ROM –> painless PV bleeding –> foetal bradycardia
prophylactic hospitalisation at 30-32 weeks
elective c section at 34-36 weeks
emergency c section during labour
12-24 hours apart corticosteroids

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3
Q

Oligo/ Poly

A

Potters: limb abnormalities, lung hypoplasia, renal agenesis
<2cm/5th percentile; >8cm/95th percentile
ROM is cause
amnioreduction/ cox inhibitors
placental abruption is comp
CTG, USS, Doppler, liquor volume
GORD and resp compromise in mother

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4
Q

LGA

A

molar preg
serum BHCG
foetal biometry, abdo circum , foetal weight
4kg/ 4.5 kg
>24 <36 weeks = if accelerated, OGTT and foetal
>36 weeks gestational OGTT
OGTT
counsel risks of delivery
perineal tears
metartus adductus
diabetes comps

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5
Q

Obstetric Cholestasis

A

PPH
dark urine pale stools, liver symps
weekly LFTs, twice weekly Doppler and CTG
chlorphenamine
no rash
IOL at 37 week
coag screen

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6
Q

Acute liver disease

A

Emergency
immediate delivery regardless of GA
give MgSO4, steroids, glucose, check coagulopathy - may need phasmapharesis
uric acid is high, low glucose
third trimester

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7
Q

Emergency contraception

A

ullipristal = 120 hours, wait 5 days before hormonal (use barrier)
even if within 3 days, if ovulation occured give IUD
can start hormonal contraception immediately after levonelle
if >26 BMI, >70kg - double dose = 3mg
can use IUD within 5 days of ovulation date too
give prophylactic antibiotics if increased risk of STIs

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8
Q

Mastitis/ breast abscess

A

antibiotics started if not imrpoved after 12-24hrs of milk expression, infected nipple fissure, breast milk culture +ve
admit if immunocompromised, septic

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9
Q

PID

A

Fitz-Hugh-Curtis = violin strings
6 months of partners
72 hours then 2-4 weeks
no sex until treatment finished
admit if septic, high fever, oral Ab failed, ectopic, pregnant, abscess
IV gentamicin/ clindamycin
alternative: metronidazole and ofloxacin

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10
Q

Endometriosis

A

subfertility: laporoscopic ablation and endometrioid cystectomy
clear and endometrioid ovarian carcinoma association
IBS and constipation
powder burns, retroverted uterus
3 month trial
give COCP in addition to ablation to stop recurrence

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11
Q

Adenomyosis

A

MRI
linear striations
boggy uterus
multiparous perimenopausal woman
hysterectomy is definite
think c section then heavy painful periods

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12
Q

Fibroids

A

No Mirena if pedunculated
Leiomyosarcoma
uterine artery embolisation - preserve uterus not fertility
>3mm = refer to specialist
irregular bleeding after Mirena for 6 months
no conceiving for 6 months after myomectomy
GnRH agonists only for 3 months
in preg, may affect, mostly can do vaginal, iron supplements
regress post-menopausal
smooth muscle origin = smooth round, gray-white tumours
red degen = severe abdo pain, post partum torsion

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13
Q

Endometrial hyperplasia

A

with atypia/ without atypia (pipelle biopsy/ hysteroscopy after TVUSS)
if without atypia: Mirena, surveillance every 3-6 months
atypia: hysterectomy + BSO
>10mm for premenopausal

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14
Q

Endometrial cancer

A

type 1 is superficial invasion, low grade, PTEN
type 2 is deeper, high grade, p53
stage 1: total abdo hysterectomy + BSO
stage 2: radical hysterectomy + radiotherapy

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15
Q

VIN and vulval cancer

A

Warty/basaloid type: VIN, HPV 16, immunosuppression, smoking
Keratinised: lichen sclerosis
full thickness biopsy
1a = <1mm depth, <2cm size = wide local incision
>1b: radical vulvectomy and bilateral inguinal lymphadenectomy
Figo:
1a/1b
II: lower 1/3rd vagina
III: lower 1/3rd vagina and lymph nodes
IV: upper 1/3rd
IVb: mets
rule out cervical

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16
Q

Ovarian cysts

A

follicular: granulosa, corpus luteal: luteal
<5, 5-7 (yearly USS), >7 (MRI +/- surgery); cystectomy also if multifocal .etc.
if recurrent = COCP
post: RMI > 200 vs <200
<200 = unchanged (CA125, USS 4-6 months), changed (cystectomy), resolved
if bilateral, symptomatic, multifocal, not simple, >5cm = only BSO
BSO + omentectomy + TAH = >200
if rupture: pain relief and observe, if bleeding - can do cautery
LDH = dysgerminoma
aFP = teratoma, yolk sac
bHCG = choriocaricoma, dysgerminoma
MDT!!
luteal in preg

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17
Q

Ovarian carcinoma

A

Epithelial: serous, mucinous, clear cell, endometrioid (malignant)
Germ cell (eosinophils): teratoma mature = benign, immature = malignant), dysgerminoma, choriocarcioma
sex cord: Leydig, granulosa, thecoma, fibroma (Meig’s - spindle shaped fibroblasts)
should not biopsy
carboplatin
in sex cord - chemo not useful
figo: 1a =1 ovary, 1a = both, 1c = capsule ruptured, II: pelvis, III: peritoneum, IV: mets
>=35 = referral
if mass = immediate referral

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18
Q

Cervical cancer and CIN

A

1a = LLETZ/ cone
1b-11a = radical trachelectomy (fertility sparing), radical hysterectomy <=4 if > then chemo
then chemo and radio
koilocytosis
if hysterectomy, follow up 6 and 18 months to check residual cells = vault smear
test for cure = 6 months later, routine recall of 3 years after regardless of age if negative
CIN 1 = 12 weeks
delay to 3 months post partum
if HPV +ve, cytology -ve, repeat 12 months later, if 24 months later still same –> colposcopy
I = cervix, II = upper, III = pelvic wall and lower, IV = mets

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19
Q

BV

A

loss of lactobacilli
Amsel’s = thin white, clue cells, 10% KOH smell, high pH > 4.5
copper IUD

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20
Q

Chlamydia

A

NAAt of first catch urine or vulvovaginal swab
doxy for 7 days
azithromycin in preg/ neonates
cant see under microscopy

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21
Q

General STI counselling

A

STI screen
protection
no sex until treatment complete
contact tracing (6 monts)
impact on partner and pregnancy
follow up

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22
Q

Gonorrhoea

A

ceftriaxone
can do direct microscopy

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23
Q

Trichomonas

A

wet mount
green yellow frothy
high vaginal swab

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24
Q

Candidiasis

A

clotrimazole pessary
HVS microscopy - pseudohyphae

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25
Q

Syphilis

A

takes 3/12 weeks
treponamel pallidum
dark field - dark ground appearance of chancres under microscopy
Jarish-herxheimer - give steroids before benzatheine-pen
IM stat in 1st, 2/3rd = IM, IV in neuro
primary - painless chnacres and local lymphadenopathy
secondary - snail track ulcers, papulonodular rash, condylomata lata
tertiary - gummatous, cardio - aortic regurg, neuro - dementia, labile emotions, lightning pains
non-treponemal - RPR, VDRL
treponemal - EIA
repeat bloods at 6 and 12 weeks
if myalgia - admit mothers after 22 weeks

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26
Q

HSV

A

<26w= 36 weeks to delivery = oral daily + VSD (IV acyclovir intrapartum and neonate)
>26w until delivery = c section + acyclovir
recurrrent - daily until delivery from 36 weeks
SEM, CNS, disseminated
avoid forceps

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27
Q

HPV

A

Keratinised warts = imiquimod cream
Non-keratinised warts = podophyllin/tri-chloro-acetic acid
dermatoscopy

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28
Q

VZV

A

need to check Ig first
if not, give IVIG
if <20 weeks or > 20 weeks, within 10 days exposure, no symps
oral acyclovir if >20 weeks, within 24 hours
foetal specialist unit 16-20 weeks/ 5 weeks after infection
<7 days of delivery/ rash - IVIG to neonate
if neonatal infection = oral acyclovir
congenital: cataracts, microcephaly, limb hypoplasia, IUGR
neonate: purpura fulminans, pneumonia
15 mins contact can be contagious
monitored until after 28 days

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29
Q

Breech

A

high risk vaginal: hyperextended neck, LBW, HBW, footling, foetal compromise
CI for ECV: antepartum haemorrhage in prev 7 days, ROM, indications for c-section, multiple preg, abnormal CTG
36 - nulli. 37 - multi
hands off approach, Pinard - poke politeal bend knees, Loveset - transverse + anterior arm
if head stuck - winging of scapulae
C section -ves: normal c section risks, uterine rupture, placenta accreta .etc.
+ve: better APGAR, perinatal mortality better
tocolytic like terbutaline can improve success rate of ECV

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30
Q

TOP

A

o Pregnancy test
o Scan
o Height, weight, bloods and urine dip with nurse
o STI screen
o Speak with a counsellor regarding your reasons, options available and future contraception
Antibiotics are given to reduce risk of infection
chance of ectopic, 24 hr help line
HSA 1 and HSA 4
expulsion at home, <14 weeks MVA, > 14 weeks dilatation and curetagge
more painful as further along
antiibiotics and painkillers
anti D >10 weeks or any surgical
4 weeks = chorio, ectopic
24-48 hours apart, 10-23 = 36-72, >21 = feticide = digoxin, KCl/ regular interval misoprostol (max 5 doses)
urine preg usually 2 weeks after

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31
Q

DVT

A

CXR, ECG
eleavte legs
USS:
· If -ve and low clinical suspicion à stop anticoagulants
· If -ve and high clinical suspicion à stop anticoagulants and repeat USS on days 3 and 7
Subcutaneous LMWH until at least 6 weeks postnatally and until ≥3 months of treatment
until at ≥24 hours after last dose of LMWH
stop 24 hours before
at term = IV unfractionated
Prevention at 12w BOOKING visit:
· Prolonged use of LMWH (>12 weeks)
· Graduated elastic compression stockings
Graduated elastic stockings should be used initially and worn for 2 years following DVT to prevent post-thrombotic syndrome
· From 12w until 10 days to 6 weeks post-partum ≥4 risk factors, VTE event
· From 28w until 10 days post-partum 3 risk factors
Conservative <3 risk factors
<50, >90

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32
Q

Cancers and COCP

A

protective against endometrial and ovarian
inc risk of breast and cervical

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33
Q

Rubella

A

<12 weeks : CRS - PDA, microcephaly, cataracts
12-20 - chorioreitnetitis - cataracts
>20 weeks - low risk
forcheimer spots
foetal specialist unit and HPU
no MMR
IgM and IgG and PCR
no work until 5 days after rash
TOP if < 16 weeks
parvovirus B19 serology

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34
Q

Obesity

A

> 30
dietician referral
good diet and exercise
anaesthetic review >40
IOL discussion to avoid c-section
5mg folic acid 1 month before conception
150mg aspirin
diabetes screening
from 24 weeks do USS instead of SFH
TVUSS for nuchal translucency instead of transabdo
35 obstetric consutant led
constant foetal monitoring
active management of 3rd stage

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35
Q

bacteriuria and UTI

A

nitrofurantoin, trimethoprim after 12 weeks
IV cefuroxime if admitted otherwise PO cefalexin in pyelonephritis
urinalysis in every antenatal appointment
urine MCS at booking
preterm and pyelonephritis
nitrofurantoin at term = neonatal haemolysis

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36
Q

ectopic

A

no sex for 3 months, no alcohol, sensitive to sun
weekly serum bhcg until negative
pregnancy test after 2 weks
metho CI in surgical requirements, liver disease, intrauterine preg, breastfeeding
>63, 50-63, >50
no kleihauer, 250 IU of anti-D
syncope, fatigue
copper IUD not used if have salpingectomy

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37
Q

infertility

A

hypogonadotrophic hypogonad, normo nromo = PCOS, hyper hypo, also hypothyroid
previous pelvic/ abdo surgery
asherman’s
septate can be corrected for
varicocoele
lifestyle - acholo, drugs
semen analysis done 3 months apart
mid-luteal progesterone not in POI
if unexplained try another 12 months
ovarian induction = clomiphene (OHS)
intrauterine - mild endo, not responsive to OI
LH and FSH only in irregular periods
can do laporoscoipic dye to check tubal abnormalities

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38
Q

IVF

A

o Women <40 offered 3 cycles of IVF if…
§ Subfertility for 2 years
§ Not pregnant after 12 cycles of artificial/intrauterine insemination
o Women 40-42 offered 1 cycle of IVF if…
§ Subfertility for 2 years and/or not pregnant after 12 cycles of AI
§ Never had IVF
§ No evidence of low ovarian reserve
Informed about additional implications of IVF at this age

if children with another partner, dont give

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39
Q

Contraception

A

COCP: none in first 5 days, any other time 7 days barrier
red risk of ovarian and endometrial
tricyclic or three weeks and 1 week off
stop 4 weeks before surgery switch to POP 2 weeks after
UKMEC
1 pill vs 2 pills missed
POP: immediate protection if switch from COCP, osteoporosis, if not first 5 days, then 2 days barrier
missed = 3 hours
>3 hours late: take missed pill, barrier for 48 hours
if 2 missed: take both and same, emergency if UPS
desogesterel = 12 hours
patch: 48 hours, barrier 7 days, emergency if <5 days of patch free or during
ring
IUS: 7 days after insertion if not 5 days first, 3-5 years
IUD: 10 years, childbirth 48 hours or.4 weeks after , not in menorrhagia
injection: 6-12 months for fertility to return, weight gain and ectopic
implant
never give contraception under 30
cocp: prevent ovulation
pop: thickens cervical
implant, injection, IUS: thickens cervical and prevent ovulation

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40
Q

stopping contraception

A

cocp, injection: continue after 50 years, switch to POP
injection can also be stopped after 2 years amenorrhoea
implant, POP, IUS continued
xondoms stopped 2 years <50, 1 year >50

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41
Q

Twin pregnancies

A

maternal: anaemia, GDM, pre-eclampsia, preterm birth, hyperemesis, DVT
foetal: TTTS
monochorionic: 12, 16 weeks -delivery every 2 weeks
dichorionic: 12, 20, to delivery every 4 weeks
after 24 weeks every 2 weeks to check IUGR - growth scans
monochorionic: 9 antenatal, at least 2 with consultant
dichorionic: 8, at least 2 with consultant
Twin trust support - SOB, abdomen largens, swollen
IPV
laser ablation of vascular anastomoses
hydrops fetalis
if TTTs, deliver by 37 weeks
can offer elective 36 (mono) and 37 (di)
mono - 36-37
di - 37-38

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42
Q

Normal physiological changes

A

Energy: more fat storage, less protein requirement, increased insulin sensitivity
Resp: no change in RR, inc minute ventilation, TV and breathlessness, red FRC
cardio: inc CO, SV, HR, more hypotensive and less peripheral resistance
endo: inc progesterone = reflux and constipation
kidney: inc aldosterone, GFR and reduced creatinine
haem: macrocytosis, dilutional anaemia, thrombocytopaenia, neutrophilia
Kidneys - increased urine output, pee more frequently - not only because of more urine from both foetus and mother but also foetus compressing the bladder and causing the feeling of fullness
If dysuria, haematuria, fever –> UTI
Skin - warm hands, palmar erythema
Advise woman to dress in layer
· Oesophageal sphincter not functioning –> reflux, heart burn
Lying down makes worse - upright after eating for 2 hours
If 3 meals difficult - break down into 6 snacks

Check OXBASE to see if medicines suitable in pregnancy
BUMPS - best use in medicine

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43
Q

Asthma in preg

A

daily foetal movement check by mum after 28 weeks
no carboprost or ergometrine
smoking cessation
continue inhalers
follow up
flu vaccine

44
Q

POI

A

2 FSH >30 4-6 weeks apart
anti mullerian hormone, antral follicular count
DEXA scans
donor oocyte IVF

45
Q

Cervical cerclage

A

11-16 weeks after dating
if less than 25mm on USS between 16 and 24 weeks
LLETZ or cone biopsy, >=3 previous preterm
emergency if 16-28 weeks, unruptured membranes, dilated cervix
CI = infection, bleeding, contractions

46
Q

GBS

A

IPA if maternal pyrexia, preterm labour, previous GBS, GBS detected, UTI with GBS
IV benzylpenicillin
if <4hrs of Abx before delivery = monitoring
if > 4hrs no need
moniotor 1hr–>2hr–>every 2 hours for 12 hours
IPA given as soon as labour started then every 4 hourly
1 risk factor –> remain in hospital for at least 24 hours for observations
≥2 risk factors or one red flag à sepsis ABx + septic screen
50% risk of GBS in next preg
If women are going to have swabs for GBS, this should be at 35-37 weeks (or 3-5 weeks before EDD)
if ECS no need
active management is IM oxytocin

47
Q

Herpes

A

28 weeks
6 weeks
oral acyclovir
IV intrapartum to mother and neonate
SEM (blistering vesicular rash and chorioretinitis), CNS (seizures, drowsiness, bulding fontanelle, poor feeding, irritability) disseminated - encephaltiis
if recurrent daily supplement from 26 weeks

48
Q

HIV in preg

A

viral load <50 at 36 = SVD
>50 = ELCS at 38
no breastfeeding
no foetal blood sampling
zidovudine to neonate for 2-4 weeks if <50, if >50 then triple treatment
viral PCR at 6, 12, 18 weeks for neonate
2 x CD4 delivery and booking
8x viral load, every 2-4 weeks, at 36 weeks and after delivery
cabergoline to suppress lactation
immunisations inc BCG
cord clamp immediately
even if not on any HIV therapy, must start from 24 weeks pep

49
Q

Hyperemesis gravidarum

A

vitamin b1 and folic acid
macrocytic anaemia
peak at 9 weeks
hyperthryoid, multiple preg, obesity
IUGR
Mallory Weis
reassess in 24 hours
PUQE-24 score (>=13) - vomiting, retching 7 times or more, nauseated for 6 hours more
ondansetron - cleft palate in 1st trimester

50
Q

epilepsy

A

from 36 weeks vitamin K
28-36 weeks - 4 weekly growth scans
eclampsia if not epilepsy diagnosis
other causes enceph, alcohol withdrawal, SOL
monotherapy, encourage breastfeeding

51
Q

Hypothyroidism

A

increase dose by 25 ug
monitor TFTs in 2 weeks time then every 2-4 weeks, incase need adjusting of dose
6-8 weeks after delivery recheck TFT levels, reduce right after delivery
thyrotoxicosis - propanolol in hyper then levothyroxine in hypothyroid - check 2 monthly TFTs
IUGR, preterm, miscarriage
euthyroid = TSH <4, optimum is 2.5-3

52
Q

Hyperthyroidism

A

propyluracil in 1st as placenta less freely cross, hepatotoxicity ofr mother
carbimazole is 2nd and 3rd; can cause aplasia acutis - patch on head of baby never grows hair, 20–>15–>10
agrunlocytosis in both
WCC, LFTs

53
Q

Bartholins

A

I and D, word catheter
salt eater vath, painkillers, warm compress

54
Q

anaemia

A

o < 110 g/L in 1st trimester
o < 105 g/L in 2nd/3rd trimester
o < 100 g/L postpartum
< 70 g/L – URGENT REFERRAL
recheck in 2-3 weeks after giving trial of iron
group and save at booking
consultant led
booking and 28 weeks check anaemia
foetal - enlarged heart, red foetal movements - <60 foetal Hb

55
Q

baby blues

A

post-partum thyroiditis
Edinburgh post-natal depression scale >12

56
Q

toxoplasmosis

A

sabin feldman dye test
spiramycin
pyrimethamine and sulfadiazine
cataracts, convulsions, intracranial calcifications, hydrocephalus, microcephaly
3rd trimester
toxoplasma gondii

57
Q

parvovirus

A

hydrops fetalis
high output HF
intrauterine blood transfusions
<20 weeks GA
foetal anomaly 4 weeks after and serial 2 week scans
rule out rubella serology as presents similarly

58
Q

chickenpox

A

<20 weeks within 10 days - IVIG
>20 weeks within 24 hrs = oral acyclovir
severe = IV acyclovir
underlying immunocompromise = admission in latter half of preg
foetal specialist unit = 16-20 weeks/ 5 weeks after infection
21 days infections vs 28 days with IVIG
acyclovir in neonate if infected at birth
if <7days of birth then IVIG to neonate
want to delay by 7 days ideally
7days acyclovir Tx
opthalmic exam and observe 28 days
§ Eyes (chorioretinitis à cataracts)
§ CNS (microcephaly)
§ MSK (limb hypoplasia, cutaneous scarring)
IUGR

purpura fulmianns in neonate
if the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

59
Q

CMV

A

vanciclovir and ganciclovir
>21W GA, <21d neonate PCR
SNHL, jaundice, hepatosplenomegaly, periventricular calcifications,
opthalmic audiology follow up

60
Q

umbilical cord prolapse

A

tocolytics - terbutaline
dont eant cord spams and hypoxia
CTG
artifiial rupture of membranes can cause

61
Q

PROM

A

if little fluid can discharge
if premature admit until 37 weeks
4 hourly observations and 24hr foetal monitoring
no tests if established labour - straight to labour ward
>15mm preterm birth likely
erythro 10 days before delivery
mag sulph <30w AND labour/ <24 hrs del

62
Q

bacteriuria and UTI

A

bacteriuria assoc with preterm and pyelonephritis
do MCS at booking, urinalysis at every appointment
for pyelo: PO cephalexim OP, IV cefuroxime in admiited
low birthweight
encourage fluid intake

63
Q

haemophilia

A

goose egg bump on forehead
umbilical cord bleeding, guthrie test bleeding, vitamin K injection
avoid IM, NSAIDs, aspirin
high APTT

64
Q

rhesus disease

A

within 72 hours
cord blood analysis if Rh+ve, 500IU within 72 hrs of delivery and in all previously sensitised women
weekly MCA doppler if antibodies at booking
500IU at 28 and 34
or 1500IU at 28 weeks
if continuous bleeding anti D every 6 weeks, Kleihauer every 2 weeks
<12 weeks + heavy painful
>12 weeks vaginal bleeding

65
Q

amniotic fluid embolism

A

delivery +/- hysterectomy
DIC
so repair coagulation - FFP, cryoprecipitate, transfusions
coag screen
placental abruption, IOL, c-section

66
Q

PPH

A

tone -placental praevia, tissue - blood clots, accreta, percetra, incretra, thrombin, trauma
oxy –> erg–>carb–>balloon catheter–>B lynch suture –> hysterectomy
DIC
secondary 24hrs - 6 weeks
catheter to allow uterine contractions

67
Q

ectropion

A

pill, puberty, preganncy
move away from oestrogen cotnraceptives

68
Q

polyps

A

sessile, pedunculated
due to overgrowths of endocervix
unscheduled vaginal bleeding
TVUSS, outpatient hysteroscopy
hysteroscopic polypectomy

69
Q

gestational diabetes

A

within 1 week joint clinic
then 2 weekly vists
6 week postnatal check
discontinue medication immediately after birth

70
Q

FGM

A

urinary incontinence, repeated UTIs
before deinfub - check UTIs give prophylactic abx
if daughter let safeguarding midwife know put in redbook
1=clitorectomy, 2= labior minora and clitorus
should be recorded in notes
safeguarding risk assessment in preg
specialist gynae/ FGM clinic

71
Q

Asherman’s

A

saline hysterosonography - balloon with saline + TVUSS
amenorrhoea, subfertility
hysteroscopic adhesiolysis - increase cavity size through resection, follow up in 3-6 months
place copper IUD and give PO oestrogens and progesterones

72
Q

lichen sclerosis

A

clobetasol for 3 months
white parchment paper
tacrolimus as next line

73
Q

miscarriage

A

missed/ delayed
<6 weeks no need USS, expectant, 1 week preg test, 2 week follow up
if expectant >6 = 1-2 weeks bleeding, 3 weeks preg test, 4 weeks follow up
periods in 4-8 weeks
threatened if bleeding over 14 days/ gets worse come back
always do expectant first

74
Q

cutaneous warts

A

may itch and bleed
imiquimod cream in keratanised
tri-chloro-azetic acid in non-keratinised
both CI in preg
but uslaly no tx, may refer to GUM for STI screening

75
Q

incontinence

A

mixed, overflow - urogynae referral
overactive bladder syndrome
8 contractions TDS for 3 months
urodynamic: detrusor = bladder - IAP
urinary dye studies for vesicovaginal fistula
colposuspension

76
Q

molar pregnancy

A

refer to specialist centre
no sex for 12 months
monthly bHCG until stable for complete
4 weeks later bhCG for partial
3 weeks after Mx preg test
may need methotrexate after surgery if rising levels
anti-D
painless PV bleeding

77
Q

placental abruption

A

come back for weekly USS and check ups
no foetal distress: admit and observe for 48 hrs, aim to deliver 37-38 weeks
foetal distress: c-section
if >36 weeks - deliver (vaginal if no distress, c section if distress)

78
Q

menopause

A

mirena/ hysterectomy
unschedule bleeding for first 3 months
oestrogen SE: breast tenderness, headache
progesterone: fluid retention, mood swings
should subside
>2 years of contraception if <50 and amenorrhoea
>1 yr if >50

79
Q

pre-eclampsia

A

2x LFTs, FBC and U&E’s
3x if severe
4x a day inpatient, eevry 48 hours outpatient
>150 on diacharge community midwife takes measurements
if severe MgSo4 intrapartum, avoid ergometrine, continuous obs, CTG
>30mg =significant protein on PCR
SLE, APLS are autoimmune risk facotrs

80
Q

prolapse

A

hysterectomy in uterine prolapse
anterior colporrhaphy
posteriorcolprrhaphy
sarcocoplexy in vaginal vaunt
ask about HRT use - menopasuek, constipation
rectoceoele = tenesmus, constipation
cystocele - UTI
Shwa’s staging to introitus first stage
topical oestrogen can be used in elderly

81
Q

skin disease

A

polymorphic eruptionn of pregnancy - buttocks and thighs
erythomycin for acne
all late 2nd/3rd trimester
prurigo and PEP = 3rd
pruirtis follivulitis
pemphigus refer to derm no icnrease in pregnancny loss

82
Q

malpresentation

A

Mento means chin so you’re thinking about where the chin lies
Mento anterior is what you want
Want flexed foetus but when neck and head extends becomes brow then face
When brow can palpate supraorbital bridges
When face palpate facial features
Brow = c-section - worried about hyperextension of bone
Face if mento anterior position = mentoposterior = csection
Transverse = c-section, can do ECV but real risk of prolapse

Occipito-anterior > posterior - vaginal possible
Occipito transverse - vaginal possible but may need forceps
Advise epidurals and foetal monitoring

OP cause by weak uterine contraction, flat sacrum, poorly flexed head

83
Q

Labour

A

latent to 4cm then established to 10
1,2 in mutli, 2,3 in nulli
<5 = prostaglandin
<3 = IOL not gonna help
if prolonged and ruptured = oxytocin, if not = ARM
braxton: painless, infreqeunt not cervical change
1,5 minutes
4 hourly exams
crowning when head no longer retracts
breastfeeding in 1st hour
2cm per hour in multiparous

84
Q

IOL

A

causes of prolonged: cephalopelvic disproportion, malpresentation, malposition, epdiural, infrequent uterine contractions
CI: vase praevia, placenta pevia, midline scar
Indciated: prolonged, obstetric cholestatsis, diabetes, pre-eclampsia,preterm rupture, post dates, abnormal CTG
uterine hyperstimulation ?5 over 10, 1 lasting >2, stop infusion/ remove prostaglandins, consider tocolytics
* if the 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
* if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion

85
Q

physiologyical

A

mpre blood to uterus, skin, breats, kdineys
urine output higher but creatinine lower
TV higher but residual capacity lower
HR higher, BP lower, SV and CO higher
oestrdial high, LH and FSH low
GOR
warm peripheries
RR same
macrocytosis, thrombopaenia, neutrophilia, inc fibrinogen

86
Q

listeriosis

A

miscarriage, preterm birth, meconium staining
IV amoxicillin
sepsis, meningitis

87
Q

cardiac disease

A

NYHA
peripartum cardiomyopathy: volume cant keep up with CO
arryhtmias can increase rish
GUCH
no problems if acyanotic, and if cuyanotic and treated
no ergometrine
2nd stage short with elective ventouse/ forceps
if rlly bad then ELCS - NYHA III and IV
epidural
echo at booking and 28 weeks
LMWH in arrhythmias
HDU
cardiologist follow up
avoid IOL

88
Q

toxic shock syndrome

A

exotoxin from strep and staph
wounds, tampons
GI symps, desquamation, erythrodermic rash all over body macular
spesis protocal
clindamycin

89
Q

RFM

A

established by 24
felt by 20
>28 = concern
70% prognosis
may do USS despite normal CTG if concerned
if recurrent check genetil abnormalities
praevia, obesity, oligo/poly
if not felt by 24 = referral to maternal foetal medicine unit
USS looks at abdo circum, weight and amniotic fluid

90
Q

PMS

A

if severe SSRI and CBT and lifestyle advuce - preventing social and professional

91
Q

PCOS

A

> 10cm3, 12cycts, 2-9cm3 one cyst
annual BP, 6 monthly weight
OGTT in pregnancy
2-6 days of menstrual cycle give clomipehen
eflornithine worsens acne
BMI>35 = IUS
co-cyprindiol better anti-androgenic but inc risk of clots
give oral medroxyprogesterone if havent bled in a couple months to induce a withdrawal bleed for cirrect interpretation - 14 days

92
Q

when to start taking folic acid

A

before conception

93
Q

Which is not a common cause for oligomenorrhoea?

A

copper IUD

94
Q

According to the NICE guidelines, when is it inappropriate to use ultrasound appearances of the ovaries to make a diagnosis of PCOS?

A

during adolescence

95
Q

During the evaluation of secondary amenorrhea in a 24-year-old woman, hyperprolactinaemia is diagnosed. Which of the following conditions could cause increased circulating prolactin concentration and amenorrhea in this patient?

A

stress

96
Q

Sarah has recently given birth to baby girl Flora 3 months ago. She describes her birth to be traumatic as operative delivery was required due to delay in progress of second stage of labour. She is now presenting with significant low mood, low energy, disturbed sleep, lacking appetite, irritable and having difficulty with her concentration. Otherwise she has bonded well with her baby, and is breast feeding. There is no establish risk to self, baby or others at present.

What is the most suitable treatment for her?

A

sertraline

97
Q

Clara is a 34-year-old female who has developed manic symptoms following the delivery of her first baby 3 years ago. Now she and her partner present to the pre-conception clinic, anxious to find out the chance of her mental health illness relapse in future pregnancies?

A

1 in 2

98
Q

According to the NICE guidelines, when is it inappropriate to use ultrasound appearances of the ovaries to make a diagnosis of PCOS?

A

adolescence

99
Q

CIN

A

CIN 1 is conservative
if +ve HPV ithe colposocpy in 6 weeks otherwise routine recall
CIN2 and 3 colposcopy in2 weeks and treat
test of cure after 6 months
inadeuqate within 6 weeks colposcopy
if hysetrectomy then 6 and 18 motnhs smear
after test of cure retunr to routien recall but 3 years regardless of age

100
Q

labour inducing techniques

A

if not fully dilated = ARM and reassess in 2 hours
then may need oxytocin
if not dilating then vaginal gel/ pessary
if filly dilated and head is low = ventouse
if high = forceps
both OA
forceps need episiotomy

101
Q

bacterial vaginosis

A

can cause preterm birth and late miscarriage
potassium hydroxide

102
Q

pain relief

A

In general NSAIDs avoided because renal agenesis but can give ibuprofen as low secretion into breastmilk
Coedine should be avoided in 3rd trimester close to delivery due to resp depression
May be able to prescribe co-codamol but don’t co give with paracteamol as overdose

103
Q

pain and fluid in pouch of douglas

A

mittelschmerz
fluid means mid cycle

104
Q

epilepsy contraceptive

A

progesterone only

105
Q

what endocrine disease causes early menopause

A

addisons disease

106
Q

post hysterectomy, high BMI

A

oestrogen patch

107
Q

hrt perimenopausal

A

3 monthly for irregular
monthly for regular

specialties (4 decks)

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