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O&G Flashcards

1
Q

How manage an OP head presentation

A

Likely will spontanoeusly rotate however if needs rotating after long labour ideally use kielland forceps

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2
Q

What is sign on examination of cocaine use causing placental abruption

A

Dilated pupils
Hyperreflexia

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3
Q

What give for hypermagnesaemia in after mag sulph

A

Calcium gluconate

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4
Q

How are ovarian masses managed

A

Assess on TVUSS whether any M features of cysts
If any M features then refer under 2WW
If
- under 50mm then can rescan in 3 months
- 50-70mm rescan in a years time
- over 70mm consider MRI or surgery

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5
Q

What do if premenopausal woman has an ovarian mass with any complex features of mass

A

Refer to gynae oncology and measure AFP, LDH and HCG

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6
Q

When refer for RFM

A

24 weeks

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7
Q

How long after a medical termination of pregnancy is pregnancy test expected to be positive

A

4 weeks- if longer suggests trophoblastic disease or retained products of conception

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8
Q

Causes of cervical tenderness

A

PID
Ectopic

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9
Q

What are sections to abortion act

A

2 doctors in good faith agree
A- continuing would risk life of pregnant woman
B- necessary to prevent grave physical or mental health risk of mother
C- pregnancy not exceeded 24 weeks and continuance would involve risk of injury to physical or mental health of mother
D- not exceedd 24 weeks and would involve risk to mental/physical health of existing children
E- born handicapped

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10
Q

Before 9+0 weeks what are options with regards to medical abortion options

A

Can do mifepristone and misoprostol at same time or with interval
- bleeding worse with together
- more likely to fail if together

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11
Q

Difference in prep for surgical abortion

A

All doxycycline 3 days, LMWH for 7 days and anti-D if Rh negative over 10 weeks
Before 14 weeks= oral misoprostol 1 hour before or sublingual misoprostol
14-19 weeks= osmotic dilators or vaginal misoprostol
19-23+6 weeks= osmotic dialtors and mifepristone both the day before

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12
Q

When is pregnancy test given post abortion

A

Medical up to 10+0 weeks
Is a multilevel pregnancy test which can measure HCG levels

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13
Q

Management of vaginal bleeding pre 6 weeks pregnant

A

Send home if no previous ectopic
Ask to do pregnancy test in 7 days
Return if positive or still bleeding or pain develops
If negative likely will have miscarried

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14
Q

What to do about anti-epileptics when breastfeeding

A

Any are fine except barbiturates

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15
Q

What type of C-section do if breech noticed whilst in labour

A

Category 2 C-section

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16
Q

What is regime for intrapartum antibiotics for GBS

A

Given at start then at 4 hourly intervals

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17
Q

When can COCP be started postnatally

A

3 weeks if not breastfeeding
6 weeks if are

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18
Q

How treat UTI if breastfeeding

A

Trimethoprin

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19
Q

What is combined test result for edwards

A

Low oestriol and HCG

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20
Q

If have been detected as having GBS in pregnancy what is management post natally

A

Stay in hospital for 24 hours to monitor

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21
Q

If woman comes in with menorrhagia, what may prompt to do hysteroscopy or TVUSS

A

Hysteroscopy
- persistent intermenstrual bleeding
TVUSS
- dysmenorrhoea
- bulky uterus

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22
Q

What is synctocinon vs synctometrine

A

Synctocinon= oxytocin
Synctometrine= synctocinon and ergometrine

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23
Q

What can iliac fossa pain with onset with exercise suggest

A

Ruptured ovarian cyst
Ovarian torsion

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24
Q

If has laparoscopy which is unremarkable but dye studies show blocked tubes, what is diagnosis

A

PID as endometriosis would appear on laparoscopy

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25
Q

What is other name for balloon catheter used in PPH

A

Bakri catheter

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26
Q

When when going from Cu IUD to COCP what extra contraception needed

A

In first 5 days do not need condoms
If any other times barriers for 7 days

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27
Q

When should ubilical hernias be referred

A

2 years

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28
Q

How assess viable intrauterine pregnancy on TVUSS

A

First assess if heartbeat
If is not, see if foetal pole
If there is measure CRL
If not measure gestational sac

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29
Q

If have done USS and shown no heartbeat but is a foetal pole, how interpret CRL

A

TVUSS
- Over 7mm then miscarriage likely so check with someone for viability or return in 7 days to rescan
- If under 7mm repeat in 7 days
Abdo USS
- record CRL and repeat in 14 days

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30
Q

If no foetal pole how assess gestational sac

A

TVUSS
- if over 25mm then check viability with someone or rescanin 7 days
- if under repeat in 7 days
Abdo USS
- record length and repeat in 14 days

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31
Q

How is pseudosac excluded

A

Presence of eccentrically located hypoechoic structure with a double decidual sign

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32
Q

How to manage pregnancy of unknown location

A

Take HCG 48 hours apart
If increase over 63% then intrauterine- USS in 7-14 days to confirm
If greater than 50% decrease do pregnancy test in 2 weeks - return if positive
If between 50 decrease and 63% increase come back in 24 hours for full review by early pregnancy

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33
Q

Management of threatened miscarriage

A

Tell them that if bleeding still there in 14 days return or gets worse return
If disappears continue with antenatal care
If history of miscarriage give vaginal progesterone until week 16

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34
Q

When do pregnancy test in medical miscarriage management

A

3 weeks
If positive return
if negative is complete

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35
Q

How does expectant management of ectopic work

A

Measure HCG at day 2, 4 and 7
Looking for fall of over 15%
If after day 7 still decreasing repeat weekly
If not a decrease of over 15% at any time then reassess

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36
Q

A 16-year-old girl attends accident and emergency complaining of mild vaginal spotting. Her serum beta hCG is 4016mIU/mL. She is complaining of severe left iliac fossa pain and stabbing sensations in her shoulder tip but are stable. Next investigation

A

TVUSS

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37
Q

Woman with twin pregnancy has really bad abdominal pain

A

Ruptured cyst

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38
Q

Management of bleeding post termination bleeding

A

If well do bloods to check if inflammatory response
If unwell A-E and TVUSS to look for retained products of conception

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39
Q

What is the crown rump length

A

The distance between top of head to most inferior part/ bottom of their buttocks

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40
Q

What increases cardiac output in pregnancy

A

Increase HR
Increase stroke volume

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41
Q

Acute presentation of sheehans syndrome

A

Headache and visual defect
Agalactia

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42
Q

What is difference between anterior and posterior tongue tie

A

Both are due to short frenulums
Can either be at the back or front
If cant see frenulum then likely problem is posterior

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43
Q

Which NSAID give when breastfeeding

A

Ibuprofen

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44
Q

What do when depression a clear focus in menopause history

A

CBT

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45
Q

What is given intraoperatively in hysterectomy to precent infection

A

Co-amox

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46
Q

Management of nipple cracks

A

Advise to keep expressing milk but avoid feeding until heals

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47
Q

Management of vulvodynia

A

Paracetamol/ibuprofen
Amitryptyline
Gabapentin

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48
Q

Classification of prolapses

A

1- cervix 1cm above hymen
2- cervix between 1cm above and 1cm below hymen
3- cervix reaches introitus
4- cervix extends out of introitus

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49
Q

When are CTGs used in labour

A

High risk
- DM
- SGA
Fever
Meconium
Synctocinon

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50
Q

Severe LIF pain with fever in post menopausal woman

A

Diverticulitis

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51
Q

Loin pain, tenderness and unwell in pregnant woman

A

Pyelonephritis- treat with cefalexin

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52
Q

Lung changes in pregnancy

A

Increased tidal volume
Increased minute ventilation
Gives feeling of breathlessness

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53
Q

Severe mittelschmerz presentation

A

Fever
Abdo pain
Fluid in pouch of douglas

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54
Q

If post subfertility screen, hormones, semen and STI screen negatove what do

A

If suspected underlying disease like endometriosis then laparoscopy and dye
If unclear do hysterosalpingography

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55
Q

What is in foetal hydantoin syndrome

A

IUGR
Hypoplastic nails
Cleft lip/palate
Microcephaly
Limb problems

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56
Q

What are haematometra and haematocolpos

A

Blood in uterus and cervix respectively

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57
Q

Features of congenital syphilis

A

Blood stained rhinitis
Hepatitis
Meningitis
Hitchinson teeth- small widely spaced teeth
Saddle nose deformity
Anterior bowing of shins
Symmetrical knee swelling
Perisoteal reactions

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58
Q

What are more common in a 20smt old cervical polyps or cancer

A

Polyps

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59
Q

How can BMI affect HRT administration method

A

If over 30 use dermal

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60
Q

What is risk of using nitrofurantoin near term

A

Neonatal haemolysis

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61
Q

Analogous male cells of granulosa and theca cells

A

Granulosa- sertoli
Theca- leydig

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62
Q

How can atrophic vaginitis present

A

Urinary like stress incontinence
Dyspareunia
Vaginal bleeding

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63
Q

Where does ovarian pain get referred

A

Peri umbilical area

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64
Q

Medications which cause stress incontinece

A

Alpha blockers like doxazoxin

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65
Q

When during pregnancy do diabetics get their retinal screening

A

24-28 weeks

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66
Q

What is it when have irregular bleeding in first few years after menarche

A

ANNOVULATORY dysfunctional uterine bleeding

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67
Q

How often is ECV successful

A

60%

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68
Q

When consider third line options for shoulder dystocia

A

After 5 minutes

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69
Q

What does active management involve

A

Synctocinon after delivery of anterior shoulder
EARLY clamping and cutting of cord, over 1 minute after delivery but less then 5 minutes
Controlled cord traction after signs of placental separation
DONE TO REDUCE PPH RISK

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70
Q

If has chosen an induction of labour with intrauterine death what does management depend on

A

If any bleeding, infection or ruptured membranes then c-section or induction
For all other women offer induction, expectant or C-section
If uterine scar with induction then must use mechanical options
If no scar then use mifepristone then misoprostol

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71
Q

What prompts constant CTG usage

A

New onset bleeding
Temp above 38 or suspected infection
Oxytocin use
Presence of meconium

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72
Q

If have given vaginal prostaglandin what do next

A

Reassess in 6 hours
If bishops score under 7 give again

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73
Q

What type of drug is carboprost vs ergometrine

A

Carboprost- oxytocin analogue
Ergometrine- alpha blocker

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74
Q

What analgesia used if epidural contraindicated

A

Remifentanil

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75
Q

In episiotomy what muscle are you trying to avoid

A

Ischiocavernous as involved in sexual function

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76
Q

When consider vaginal delivery in chord prolapse

A

Cervix fully dilated and head engaged
Must use forceps

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77
Q

How are the anterior and posterior fontanelles described

A

Anterior- diamond
Posterior- Y

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78
Q

What is Mazzanti technique

A

When pressure applied on abdomen to help with McRoberts

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79
Q

With SROM what is management

A

Sterile speculum exam or obtain a sample of liquor to test
Offer IOL or expectant management until 24 hours

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80
Q

Shock out of proportion to bleeding and pain postnatally

A

Uterine inversion due to pulling on the round ligament which can cause vagal stimulation

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81
Q

MOA of nifedipine, atosiban and terbutaline

A

Nifedipine- CCB
Atosiban- oxytocin antagonist
Terbutaline- beta 2 agonist

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82
Q

Tests for PPROM

A

Alpha microglobulin-1
Insulin like globulin binding protein-1

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83
Q

What cervical length suggests preterm labour imminent

A

Under 15mm

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84
Q

What is cutoff fibronectin to indicate imminent labour

A

Over 50 suggests labour likely within 48 hours

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85
Q

Generally at what point should women be admitted when theyve started contracting

A

When cervix reaches 4cm dilated or contraactions every 5 minutes

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86
Q

How is vasa praevia best diagnosed

A

Trans vaginal and abdominal USS with colour doppler imaging

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87
Q

What is management of vasa praevia when identified pre rupture of membranes

A

Consider permanent hospitalisation from 32 weeks
Give steroids from 32 weeks
Aim for elective C-section 34-36 weeks

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88
Q

Dose of vitamin D in pregnancy

A

Should take 10mcg/day

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89
Q

Who should have an OGTT based on identification at booking

A

People with family history of DM
Previous baby over 4.5kg
BMI over 30
Ethnicity with high DM prevalence
Previous GDM (has OGTT straight away)

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90
Q

Management of pre-existing DM

A

Ensure low BMI
Good exercise and diet
Folic acid until end of first trimester
Stop all hypoglycaemics except insulin and metformin
Screen for renal and retinal damage within first 3 months

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91
Q

If opt in for congenital syndrome screening what are options

A

If book early then offered between 11 and 13+6 weeks the COMBINED test
Between 14+2 and 20+0 offered QUADRUPLE test

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92
Q

What do at 16 week visit

A

Discuss results of blood tests
- infections
- autoantibodies
- rhesus D
- Hb and folate etc
Treat Hb
Offer vaccinations
- pertussis
- influenza ideally in Oct-jan
Discuss mid-pregnnacy scan

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93
Q

When are second blood taken in pregnancy

A

28 weeks

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94
Q

From when in pregnancy is anti-d required for miscarriage or PV bleeding

A

From 12 weeks for miscarriage

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95
Q

Post natal management of rhesus negative mothers

A

Cord blood taken and coombs test done
Give anti-D

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96
Q

What are causes of high vs low AFP

A

High
- NTD
- pataus
- gastro wall defects
- multiple pregnancy
Low
- maternal DM
- downs
- edwards

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97
Q

When monitor TFTs if hypothyroid and pregnant

A

2 weeks after a dose change
Once a trimester

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98
Q

Risks of using NSAIDs in pregnancy

A

PPHN
Oligohydramnios
Premature closure of DA

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99
Q

If metformin is not tolerated in GDM what use instead

A

Glibenclamide- sulphonylurea

100
Q

What is association of phenytoin in pregnancy

A

Cleft lip

101
Q

Best way of assessning EDD before and after 14 weeks

A

Before 14- crown rump length
After 14- Biparietal diameter

102
Q

If refuse induction of labour at 42 weeks what is needed

A

Twice weekly CTG and USS

103
Q

Triple test for downs

A

High bHCG
Low AFP
Low oestriol

104
Q

What is most appropriate method for monitoring SGA

A

Doppler of umbilical artery

105
Q

If SFH is noted to be faltering, what is next thing do

A

USS to estimate foetal size

106
Q

Management if epileptic has seizure during labour

A

IV lorazepam
Second line IV phenytoin and tocolysis

107
Q

What are indications to do an USS to estimate foetal size

A

SFH faltering
SFH below 10th centile

108
Q

Differentiating acute fatty liver and HELLP

A

Anaemia only in HELLP
Hypoglycaemia in acute fatty liver

109
Q

If pregnant or peuperal comes in with suspicion of DVT what do

A

LMWH and duplex USS

110
Q

What do if pregnant or peuperal woman has come in with DVT suspicion and duplex USS negative despite high suspicion

A

Treat anyway and rescan on days 3 and 7

111
Q

If pregnant or peuperal woman comes in with PE and DVT signs what do

A

ECG and CXR with treatment
Duplex USS

112
Q

If pregnant or peuperal woman has comes in with DVT and PE signs with positive duplex what do

A

No further investigations needed

113
Q

If pregnant or peuperal woman has comes in with PE and no DVT signs what do

A

CTPA or V/Q

114
Q

What can be used to treat polyhydramnios

A

Indomethacin

115
Q

What is biggest risk factor for stillbirth

A

IUGR

116
Q

If refuse insulin what offer

A

Glibenclamide

117
Q

Management of candida

A

1 dose oral fluconazole then return if still bad
Can use intravaginal or topical clotrimzole
Fluconazole CI use itraconazole
If aged 12-15
- refer to GUM
- topical clotrimazole cream

118
Q

Management of recurrent candida, BV and herpes

A

Candida- over 4x a year
Induction and maintenance regime
Induction- 3 doses of fluconazole, 1 every 3 days
Maintenance- fluconazole once a week for 6 months

BV- 4x a year
Give metronidazole gel or refer to gum

HSV-6
1st line- encourage bathing technique measures
2nd line- if fewer than 6 times a year can offer aciclovir for episodic treatment
if over 6 can offer suppressive therapy every day

119
Q

Which bacteria often colonises in BV

A

Gardnerella vaginalis
Mycoplasma hominis

120
Q

Management of persistent BV

A

Use alternative tx to one already used like if used pill use intravaginal

121
Q

Management of HSV genitally

A

Ideally refer to GUM
If refused give aciclovir

122
Q

Management of ectopic if intrauterine pregnancy

A

Medical mx contraindicated

123
Q

Management plan for uncomplicated chlamydia infection

A

1st line- encourage bathing technique measures
2nd line- if fewer than 6 times a year can offer aciclovir for episodic treatment
if over 6 can offer suppressive therapy every day
Test of cure 6/12 later

124
Q

Dissemninated gonococcal disease presentation

A

Polyarthritis
Vasculitic rash
Fever

125
Q

What is cobblestoned appearance of cervix seen in

A

Chlamydia

126
Q

What is most likely cause of bartholins abscess

A

E coli

127
Q

Chandelier sign

A

What is most likely cause of bartholins abscess

128
Q

What becomes corpus luteum

A

Non-dominant follicles

129
Q

How does ulipristal acetate work

A

Progesterone receptor modulator which inhibits ovulation

130
Q

When need to double the dose of levonorgestel

A

BMI over 26
Weight over 70kg
On liver induces such as carbamezapine and rifampicin

131
Q

What do for contraception if take a teratogenic drug like sodium valproate

A

Use a highly efficient method like Cu-IUD, LNG-IUS or progestogen injection
+
Advise to use barrier protection
OR
If want to use other method like combined hormone contraception or progestogen MUST use barrier protection

132
Q

What contraception avoid if unexplained vaginal bleeding

A

Intrauterine device and system
Progestogen implant or injection

133
Q

What do if miss 2 or more COCP

A

Take 2 on a day and discount other missed ones
Use condoms until taken pills for 7 days
If on week 1- consider emergency contraception if UPSI
If week 2- no need for emergency contraception
If week 3- finish the pack and then omit pill free period

134
Q

If develop irregular bleeding on progesterone implant or injection what is management

A

Rule out other causes like STIs
Then can initiate COCP

135
Q

MOA of the different contraceptives

A

LNG-IUS= prevent proliferation of the endometrium and thicken cervical mucous
Desogestrel= prevent ovulation
Injectable and implantable= inhibits ovulation and thickens cervical mucous
Older POP= thicken cervical mucous

136
Q

How does DM, HTN and multiple CVD risk factors affect smoking

A

DM
- any fine however if vascular disease then avoid combined
If multiple
- avoid injectable and combined
HTN
- controlled avoid combined and if uncontrolled avoid injectable too

137
Q

What is placenta accreta vs increta

A

Accreta- through basal decidua into superficial myometrium
Increta into myometrium

138
Q

Management of asymptomatic placenta praevia at 32 weeks

A

Treat as outpatient
- safety net about bleeding and sex
Give steroids at 34-36 weeks
Re-scan at 36 and deliver within a week if still placenta praevia

139
Q

Management of someone with recurrent bleeding from low-lying placenta/placenta praevia

A

Tailor between hospitilisation and outpatient based on distance to hospital from home, transport, bleeding episodes and haem results
Can admit steroids prior to 34 weeks
Deliver 34-36 weeks

140
Q

When and how should deliver if placenta praevia

A

If asymptomatic 36-37 weeks
If bleeding and risks of preterm then 34-36+6
Ideally C-section but can consider vaginal if low lying and asymptomatic

141
Q

Management of placenta accreta

A

MDT approach
Planned c-section at 35-36+6
Trained memebers of team
Blood products present

142
Q

Resus for a minor PPH

A

A-E- assess for shock
LIE flat
IV access and take bloods for FBC, clotting
Infused warmed crystalloid
Obs every 15 mins

143
Q

Fluids used for major PPH

A

2L isotonic crystalloid then 1.5L colloid

144
Q

How is PPH prevented

A

If no risks and vaginal
- oxytocin IM 10units
If risks
- ergometrine-oxytocin unless HTN
If c-section
- oxytocin slow infusion

145
Q

When do you transfuse platelets in PPH

A

If below 75

146
Q

Management of suspected endometritis

A

Admit to hospital
High vaginal and endocevical swabs
IV clindamycin and gentamicin

147
Q

What drugs should be avoided if breastfeeding

A

Abx- Tetracyclines, chloramphenicol, sulphonamides
Lithium
Benzos
Aspirin
Carbimazole
Sulphonylureas
Amiodarone
Chemo

148
Q

What happens if rhesus positive baby born to negative mother

A

500IU within 72 hours
Kleihauer test

149
Q

Cerebral venous thrombosis presentation, investigation and management

A

Severe headache but can get blurred vision
MRI
IV heparin

150
Q

Who is at high risk for pre-eclampsia and needs aspirin from week 12 of pregnancy

A

If 1 of
- HTN during previous pregnancy
- CKD
- DM
- autoimmune condition

If 2 of
- family history of pre-eclampsia
- 10 year gap between pregnancy
- multiple pregnancy
- over 40
- BMI over 35

151
Q

Chronic HTN management in pregnancy

A

Stop thiazides, ARB and ACEi
Continue old treatment unless under 70/110
If over 90/140 start labetalol
CI use nifedipine
Both CI use methyldopa
Give aspirin from week 12 and offer PIGF past week 20 to check for pre-eclampsia
Measure every 2-4 weeks

152
Q

Postnatal mangement if someone with chronic HTN or gestational HTN has given birth

A

Measure BP daily for first 2 days
Once between 3-5 days
Keep below 140/90

153
Q

Management of gestational HTN

A

If 140/90-159/109 then refer to be seen within 24 hours by obstetrician- use pharmacological agents to reduce below 135/85
If over 160/110 then admit immediately and treat until below 160/110- measuring every 15-30 mins

154
Q

How are people with gestational HTN monitored

A

Weekly
- BP
-Urine dip
- FBC, LFT and renal function
Every 2 weeks
- USS

155
Q

Who should be offered placental growth factor

A

Everyone with gestational HTN or chronic HTN post 20 weeks
If low indicates high risk of eclampsia

156
Q

How can risk prediction in pre-eclampsia be assessed

A

PREP-S prediction model

157
Q

If pre-eclampsia how are you monitored

A

If treated as outpatient for mild pre-eclampsia
- BP every 48 hours
- FBC, LFTs, renal function 2x a week
- fetal USS every 2 weeks

If in patient for severe
- FBC, LFTs, renal function 3x a week

158
Q

Management plan for premature labour

A

Determine if rupture of membranes
If no rupture just dilation and contractions
- admit for tocolytics and steroids (in case goes into labour)
If rupture
- admit
- steroids if before 34 weeks
- mag-sulphate if before 30
- erythomycin until delivery/10 days
- contact neonatologist

159
Q

What do with delivery in pre-eclampsia

A

If before 36 weeks continue with surveillance and consider antenatal steroids unless
- sats less than 90
- failure to control BP with 3 anti-hypertensives
- placental abruption
- continuining deterioration of symptoms and blood results
If after 36+6 then deliver within 48 hours

160
Q

What do if no fetal movements felt by 24 weeks

A

Referral to foetal medicine unit

161
Q

Causes of oligohydramnios

A

Premature rupture of membranes
IUGR
Post-term gestation
Pre-eclampsia
Potter sequence
Posterior urethral valve

162
Q

Who is regular US surveillance to measure cervical length indicated in

A

History of preterm birth or spontaneous loss in second trimester but cervical length over 25mm
If found to go under 25mm pre 24 weeks then do TV cerclage

163
Q

Who is vaginal progesterone indicated in for prevention of preterm birth

A

History of spontaneous preterm birth or miscarriage in second trimester

164
Q

How should ICP be monitored

A

1 week after initial blood tests then on individual basis

165
Q

When give birth with ICP

A

Depends on levels of bile acids
If 19-39: by 40 weeks
If 39-100: 38-39
Over 100: 35-36

166
Q

If have asymmetrical IUGR how are monitored

A

USS every 2 weeks
Doppler USS twice weekly

167
Q

If develop chorioamnionitis after PPROM how manage labour

A

Induce in 24 hours

168
Q

Antibiotic choice if allergic to penicillin in GBS IAP

A

If non-severe allergy use a cephalosporin
If severe use vancomycin

169
Q

What do if prelabour rupture of membranes and GBS status is positive

A

Before 34 weeks expectant management
After 34 weeks can expedite delivery
If after 37 immediate induction

170
Q

Management of herpes infection in pregnancy

A

In first and second trimester
- treat with oral acyclovir unless encephalitis
- for delivery treat from 36 weeks with aciclovir until delivery
If in third trimester
- aciclovir until delivery and should be C-section

171
Q

How is parvovirus confirmed in pregnancy then what is management

A

2 positive IGM readings
Infection takes 6 weeks to affect baby
Therefore referral to foetal medicine within 4 weeks to do an USS of the middle cerebral artery every 2 weeks

172
Q

Management of UTI in pregnancy first 2 trimesters

A

First line- nitrofurantoin for 7 days
Second line (no response in 48 hours or contraindicated)- cephalexin, amoxicillin

173
Q

How manage refusing a c-section with HSV

A

IV infusion of aciclovir during the pregnancy and close liason with neonatologist

174
Q

In HIV vaginal delivery, what is not recommended

A

Prolonged rupture of membranes
Artificial rupture of membranes

175
Q

What suggests foetal anaemia on middle cerebral artery USS

A

Elevated peak systolic velocity

176
Q

Management of chickenpox if breastfeeding

A

Aciclovir within 24 hours of onset of rash

177
Q

Are IAP given for GBS if C-section

A

No unless rupture of membrane or preterm

178
Q

What antibiotics if get PID in pregnancy

A

IV erythomycin and ceftriaxone

179
Q

Management if varicella infection around the time of birth

A

Try to give birth at least 7 days after onset of rash
If give birth within 7 days then give baby VZIG
If in 7 days post natal then give infant VZIG

180
Q

In HIV vaginal delivery, what is not recommended

A

Prolonged rupture of membranes
Artificial rupture of membranes

181
Q

Hepatitis B vaccine schedule if born to positive mother

A

One within 12 hours of birth
One at 1-2 months
One at 6 months

182
Q

Management of feto-foetal transfusion syndrome

A

Refer to feotal meicine for ablation of interconnecting vessels

183
Q

When are twins recommended to be born

A

Dichorioic diamniotic- 37
Monochorionic diamniotic- 36
Monochorionic monoamniotic- 32-33+6

184
Q

What causes pansystolic murmur in pregnancy

A

Dilation of tricuspid valve

185
Q

Which conditions reduce in severity over pregnancy

A

MS and rheumatoid arthritis

186
Q

What needs to be done to AEDs during pregnancy

A

Increase the dose

187
Q

How does pruritic urticarial papules and plaques of pregnancy present

A

Itchy rash starting on stretch marks and spreading anywhere with umbilical sparing
Starts at end of pregnancy

188
Q

How does pemphigoid gestationis present

A

Itchy rash which starts in the umbilicus that can develop into blisters

189
Q

How does prurigo gestationis present

A

Rash of the trunk and arms with abdominal sparing

190
Q

How does impetigo herpetiformis present

A

Blistering skin condition with cocontaminat febrile illness

191
Q

Postnatal management of pre-eclampsia

A

If over 160/100 then have to stay in
If over 150/100 then must be monitored every 2 days
If less than 150/100 checked weekly and weaned off anti-hypertensives
If less 130/80 can stop anti-hypertensives

192
Q

Post natal management of GDM

A

If new onset GDM- stop all medications after birth, offer fasting glucose 6 weeks after
If T1DM- put on sliding scale and when starts eating again give pre-pregnancy dose
If T2DM- can resume metformin but avoid others

193
Q

At 6 weeks postnatal how interpret fasting glucose

A

If under 6- repeat annually
If 6-6.9- At high risk of developing DM so offer lifestyle interventions
Over 7- initiate testing for T2DM

194
Q

What drugs can use for vasomotor symptoms in menopause that are not HRT

A

SSRI- fluoxetine, citalopram
SNRI- venlafaxine
Clonidine (alpha 2 agonist)
Gabapentine

195
Q

Genitourinary symptoms management in menopause

A

1st -Vaginal oestrogen
2nd- increase dose
3rd- opsemifene

196
Q

Contraindications to HRT

A

Breast cancer currently or in past
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Active liver disease
Thrombophilic
Previous VTE
Oestrogen dependant cancer history

197
Q

Can you have HRT with prior VTE

A

Only if being actively anti-coagulated

198
Q

Management of premenstrual syndrome

A

Mild
- lifestyle- exercise, small meals 2-3 hours apart, stop smoking alcohol
Moderate
- COCP
Severe
- SSRI for luteal phase or continuous

199
Q

What are at risk adolescents for PCOS

A

Girls who do not quite meet the criteria for PCOS diagnosis

200
Q

How manage at risk girls for PCOS

A

Start on the COCP then before 8 years post menarche withdraw the COCP for 3 months and assess if is hyperandrogenin anovulation

201
Q

Then need to assess endometrial thickness in PCOS

A

If less than 1 period every 3 months

202
Q

Amenorrhoea management in PCOS

A

prescribe cyclical progestogen for 14 days to induce a withdrawal bleed and then refer for TVUSS
If over 10mm get sampling
If normal then offer either low dose COC, cyclical progestogen or LNG-IUS depending on whether wants withdrawal bleeds or has acne etc
If does not wish to have any of these then refer to specialist where will be offered USS every 6-12 months
Weight loss also useful

203
Q

Management of pain in primary dysmenorrhoea

A

Mefanemic acid and paracetamol
2nd line COCP
3rd line can use POP or Mirena

204
Q

What are spiral arteries

A

Supply the endometrium

205
Q

Investigations for primary amenorrhoea

A

TSH
FSH/LH
Prolactin
Testosterone
TVUSS

206
Q

What do if prolactin 500-1000
Primary amenorrhoea investigation

A

Repeat

207
Q

How to manage amenorrhoea caused by excess exercise, weight loss or stress

A

Refer all to endocrinologist to rule out pituitary tumour
If ruled out
Excess exercise- reduce exercise and refer to sports physician if possible
Stress- manage stress
Weight loss- dietician or relevant services if ED

208
Q

When refer to gynae for secondary amenorrhoea

A

POI in under 40
Recent uterine or cervical surgery suggesting asherman or endometritis
Infertility

209
Q

How to daignose asherman syndrome

A

Hysteroscopy

210
Q

Management of vulvovaginitis

A

Good hygiene
Wear cotton undergarments

211
Q

Management plan if unprovoked vulvodynia

A

First line- amitryptylline
Second line- gabapentin or pregabalin

212
Q

What type of drug is mefanemic acid

A

Prostaglandin inhibitors

213
Q

In PMS, how give the COCP

A

Omit pill free period

214
Q

What defines primary dysmenorrhoea

A

It occurs within 1 year of menache

215
Q

What is best drug for dysmenorrhoea if dont want to take a pill every day

A

Mefanemic acid as can be given as a short course

216
Q

How to interpret mid luteal progesterone

A

Under 16- repeat and refer if chronically low
16-30- repeat
Over 30- normal indicating ovulation

217
Q

Which contraceptives cause infertility after removal

A

Injectable- a year
Dermal and vaginal ring a few months

218
Q

Management of mild and moderate OHSS

A

As an outpatient
- paracetamol
- oral fluids
- monitor every 2-3 days
- can do paracentesis if need to in outpt setting with USS

219
Q

When admit with OHSS

A
  • are unable to achieve satisfactory pain control
  • are unable to maintain adequate fluid intake due to nausea
  • show signs of worsening OHSS despite outpatient intervention
  • are unable to attend for regular outpatient follow-up
  • have critical OHSS
220
Q

Normal ranges for male sperm factors

A

Motility- at least 50% should have normal motility
Morphology- over 4% good morphology
Sperm count- over 15 million is good sperm count
Volume- over 1.5 ml

221
Q

How does clomiphene regime work

A

In oligomenorrheic women give a progestogen for 10 days and anticipate a withdrawal bleed. Once this happens give clomiphene on day 2 of the period and continue for 5 days
It is most effective when patient on period

222
Q

How manage infertility in PCOS in GP

A

If BMI over 25 recommend weight loss
Ask to have regular sex for 2 years then can refer to fertility clinic for clomiphene etc

223
Q

What does dyskaryosis mean

A

Hyperchromatic nucleus or irregular nuclear chromatin

224
Q

How is normocytic anaemia managed in pregnancy

A

Trial of oral iron for 2 weeks
If no improvement then further tests

225
Q

When do multiple pregnancy women have blood tested

A

Booking and 28 weeks
On top of this have at 20-24

226
Q

What causes severe suprapubic pain post operation

A

Urinary retention

227
Q

Leading maternal cause of death

A

Suicide

228
Q

How are contractions assessed on CTG

A

Less than 5 in 10 minutes= white
5 or more in 10 minutes, hypertonus = amber

229
Q

How is baseline foetal HR determined

A

Looking at mean foetal HR over last 10 minutes

230
Q

How is foetal HR assessed on CTG

A

White- baseline between 110-160
Amber- 100-109, can’t determine base line or increase of HR over 20 since start of labour or review 1 hour ago

231
Q

How deal with HR 100-109 but has been stable throughout whole labour with normal accelerations and decelerations

A

Manage as normal labour

232
Q

How is variability of CTG assessed

A

Measure the difference in HR between highest and lowest HR in a minute segment in between contractions

233
Q

How manage an absence of variability

A

Low threshold for expediting

234
Q

How assess variability on a CTG

A

White- 5-25 beats per minute
Amber- fewer than 5 BPM for 30-50 minutes, more than 25 for up to 10 minutes
Red- fewer than 5 BPM for more than 50 minutes, more than 25 beats per minute for 10 minutes, sinusoidal pattern

235
Q

When need to get an urgent review by obstetrician for consiering expediting delivery when reduction in variability of under 5 minutes

A
  • combined with intrapartum rfx
  • combined with rise in foetal HR
236
Q

What are decelerations defeined as

A

Reduction in foetal HR by over 15 lasting at least 15 seconds

237
Q

What defines repetitve decelerations

A

If occur in over 50% of contractions

238
Q

How are decelerations classified

A

White- No decelerations, early decelerations, variable decelerations
Amber decelerations- repetitive variable decelerations with any concerning characteristics for less than 30 minutes, variable decelerations with any concerning characteristics for more than 30 minutes,
repetitive late decelerations for less than 30 minutes
Red- repetitive variable decelerations with any concerning characteristics for more than 30 minutes,
repetitive late decelerations for more than 30 minutes, acute bradycardia, or a single prolonged deceleration lasting 3 minutes or more

239
Q

What are early vs late decelerations

A

Early= slowing with onset early in contraction and returns to baseline by end of contraction
Late= slowing after onset of contraction and low point more than 20 seconds after peak of contraction

240
Q

What is hypertonus

A

Contraction lasting over 2 minutes

241
Q

What are accelerations defined as

A

Increase in HR over 15 lasting over 15s

242
Q

How deal with accelerations on CTGs

A

Sign of normal and healthy baby, no concern

243
Q

What makes a CTG suspicious vs pathological

A

Suspicious= 1 amber feature
Pathological= 1 red or 2 amber

244
Q

Neonatal care of baby

A

APGAR at 1 and 5 minutes
Record time of first respiration
Ensure skin to skin ASAP
Dry and wrap in a towel
Initiate feeding within I hour
After 1 hour measure head circumfrence ,weighing and bathing

245
Q

Care of babies in presence of meconeum

A

Assess HR, tone and RR
If abnormal use laryngoscope to remove meconeum
If healthy admit to neonatal ward with observations at 1,2,4,6,8,10,12 hours

246
Q

Management of baby born after prelabour rupture of membranes 24 hours pre labour

A

Keep baby in for 12 hours
Assess at 1, 2, 6 and 12 hours

247
Q

Varicella exposure in 7 days post partum

A

Give VZIG only if mum not immune

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