O&G Flashcards
When is anti D given
to rh negative mothers at 28 and 34w or whenever risk of maternal-foetal blood mixing
what happens to hb during preg
drops
dating scan is when
11-14w
anomaly scan is when
18-21 weeks
What screen is done around time of dating scan
combined screen for Down’s, Edwards and Pataus
USS+blood (hCG and PAPP-A) + maternal age
What is an alternative to combined screening
quadruple screen (for down’s only using hcg, AFP, inhibin A and oestriol)
In this case the anomaly scan would be used for Edwards and Pataus.
Does the combined/quad screening give you a specific chance?
No just more or less than 1/150
If you get higher chance in the screenings what are your options
NIPT
OR
diagnostic tests-
1) CVS at 11-14 weeks
2) amniocentesis at 15-18 weeks
both have chance of miscarriage
after this terminate or continue
What vaccines do pregnant women get
flu
rubella at 20-32 weeks
Pertussis 16-32 weeks
rx for obstetric cholestasis
ursodeoxycholic acid and induce at 37 weeks
snowstorm on USS is
molar pregnancy
risk of molar pregnancy
can get persistent tissue that becomes malignant choriocarcinoma (give MTX)
antiemetics to use in hyperemesis
promethazine or cyclizine
2nd line metoclop/ondansetron
Last resort rx for hyperemesis
corticosteroids
what is defined as low birth weight
<2500g (at whatever gestational age)
what age do you feel foetal movement
18-20 weeks (max is 24 weeks)
definition of prolonged gestation
exceeding 42 weeks
When is induction offered
41-42 weeks
What gestation is PPROM
before 37 weeks
Management of PPROM if evidence of chorioamnionitis
Betamethasone 12mg IM
Deliver
Broad spec abx
Mx of PPROM if no evidence chorioamnionitis
-Admit, observe for 48h then can take their own temp at home.
-Betamethasone 12mg IM - 2 doses 12h apart.
-Abx- erythromycin
-OP monitoring until induction at 34 weeks
When should pre-eclampsia deliver?
34w+
Complication of pre-eclampsia/eclampsia
HELLP syndrome
haemolysis
elevated liver enzymes
low platelets
treatment for HELLP
deliver
what extra monitoring do diabetic mothers need
extra growth scans 28,32,36w
gest diabetes increases risk of what complication during labour
shoulder distocia
VQ scan for PE increases risk of
childhood leukaemia for baby
CTPA for PE increases risk of
breast ca for mum
Treatment for VTE in pregnancy
LMWH
How should a woman with previous VTE be managed
LMWH for 6w post partum
How should a woman with prev recurrnt VTE
or
prev VTE + FHx
be managed
LMWH antenatally and until 6w post partum
How should a woman with 3 persisting risk factors for VTE in pregnancy be managed
LMWH from 28 weeks until 6w postnatal
Woman with 4+ vte risk factors mx
lmwh immediately until 6w postnatal
When should VBAC be offered
singleton who is cephalic at 37weeks
absolute contraindications to VBAC
prior high vertical section
foetal distress
transverse lie
placenta previa
What is the risk in vbac
uterine rupture
What extra medicaiton should preg women with epilepsy get
5mg folic acid
oral vit k in the last 4 weeks
Safest AEDs in pregnancy
carbamazepine and lamotrigine
When is medical mx of ectopic indicated (MTX)
<35mm
HCB <1500
No heartbeat
How long to wait before conception after medically managed ectopic
3 months
UTI treatment in pregnancy
nitro in new
Trimethoprim at term (avoid in 1st trimester - NTD as folate antagonist)
Recurrent miscarriage is how many
3 consecutive
Medical management of miscarriage
mifepristone –> misoprostol
Antiphospholipid ix
lupus anticoagulant
anticardiolipin ab
what type of decels are concerning on a CTG
late
what foetal pH is worrying on blood sampling
<7.20 –> deliver
What are methods of induction
membrane sweep
Vaginal prostaglandin
Amniotomy
IV syntocinon for cervical dilatation
When is external cephalic version done
36 weeks in nullip
37w multip
Management of slow progress in labour
ARM
Syntocinon
C section
If fully dilated- assisted vaginal delivery (forceps etc)
Mx shoulder distocia
McRoberts
Suprapubic pressure
Episiotomy
Rotate anterior shoulder
Deliver posterior arm
Break clavicle
Emergency C section
Preterm labour is defined as what gestation
<30 weeks
Mx preterm labour if membranes ruptured
No tocolysis
Coticosteroids
MgSO4
Consider infection
Mx preterm labour if membranes intact
Nifedipine for tocolysis
corticosteroids
MgSO4
How to differentiate antepartum haemorrhage vs threatened miscarriage
+ or - than 24 weeks
What does a ‘woody’ uterus indicate
placental abruption
mx bleeding placenta previa
inpatient until delivery
C section at 39 weeks
What is each type of vaginal tear
1st- vaginal walls
2nd- perineum
3rd- ext anal sphincter
4th - int anal sphincter/rectal mucosa
what drug might be used in the active mx of 3rd stage of labour
syntometrine/Ergometrine
when can IUS be inserted after birth
within 48h
OR
after 4 weeks
Need for contraception after the menopause
12 months after the last period in women > 50 years
24 months after the last period in women < 50 years
when can u restart hormonal contraception with levornogesterel
immediately
when can u restart hormonal contraception with ullipristal
5 days
if given IUD for emergency contraception and they want it out, when can it be removed
until after next period
Down’s is suggested by what on combined test
↑ HCG, ↓ PAPP-A, thickened nuchal translucency
second pregnancy but had prev gestational diabetes- when to do OGTT?
ASAP
hyperemesis gravidarum diagnostic triad
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
When to time a blood test to check for ovulation
serum progesterone level 7 days prior to the expected next period (‘mid luteal’)
which women should take aspirin in pregnancy from 12 weeks
1 high risk for pre eclampsia or 2 moderate risk
Moderate risk factors for pre eclampsia
-first pregnancy
-age 40 years or older
-pregnancy interval of more than 10 years
-body mass index (BMI) of 35 kg/m² or more at first visit
-family history of pre-eclampsia
-multiple pregnancy
High risk factors for pre eclampsia
-hypertensive disease in a previous pregnancy
-chronic kidney disease
-autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
-type 1 or type 2 diabetes
-chronic hypertension
GDM mx if the fasting plasma glucose level is < 7 mmol/l
a trial of diet and exercise should be offered
GDM mx if the fasting plasma glucose level is > 7 mmol/l
Insulin
When else to offer insulin in GDM?
evidence of complications such as macrosomia or hydramnios
previous group b strep baby , next birth should recieve what?
intrapartum IV benpen
spot urine protein:creatinine ratio of ?mg/mmol or more is used as the threshold for significant proteinuria in pregnancy
30
when are women with pre-eclampsia likely to be admitted and observed
BP >160/110
Blood results in PCOS
chronically elevated LH –> increases androgen production–> these are converted to oestrogen peripherally which perpetuate chronic anovulation.
Chronically supressed FSH (no cyclical rise and fall)- new follicular growth continuously stimulated but not to the point of full maturity
SHBG decreased, so circulating testosterone is increased
Low FSH and LH indicates
hypogonadismH
High FSH and LH indicates
menopause/prem ovarian failure
High LH, low FSH indicates
PCOS
PCOS rx
COCP
Medical mx for urge incontinence
anticholinergics- oxybutynin, solifenacin
PID rx
doxy
cef IM
met
What is Fitz Hugh Curtis syndrome
RUQ pain- perihepatitis secondary to PID
what type of ovarian cyst may become huge
mucinous cystadenoma
Medical termination of pregnancy what to give
mifepristone then in 48 hrs misoprostol
HRT if have no periods
oestrogen and progest daily
HRT if have periods
oestrogen daily
progesterone on last 14 days of cycle (or last 14 days every 3 months if irreg periods)
IF start COCP on day 1 of period, when is it effective
immediately
IF start COCP on not day 1 of period, when is it effective
7 days
When is POP effective
day 1-5 of cycle immediately
any other day- 2 days
When is post vasectomy semen analysis done
12 weeks after and after 20 ejaculations
chlamydia rx
single dose azithro
7 days doxy
gonorrhoea rx
IM cef and 1g azithro po
gonorrhoea micro appearance
gram -ve diplococcus
trichomonas rx
metro stat or 5-7 days (longer course only for men)
clue cells indicates what
BV
Penile issue
-white plaques
-red papules
-can’t retract foreskin
-fissures around foreskin
candidal banalitis
painless mucocutaneous lesions on penis that looks like psoriasis, associated with reiters syndrome
circinate balanitis
poorly demarcated plaques of thickened skin on scrotum or labia majora
lichen simplex
pale, atrophic genital skin with erosions, telangectasia, adhesions, loss of architecture
lichen sclerosis
lichen sclerosis has risk of what
SCC
white lacy papules and itching
lichen planus
syphilis rx
benpen
is chancre painful?
NO
Management of hot flushes if they dont want hormones
SSRI/SNRI
Endometriosis rx
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried
Consider GnRH analogue (to ‘induce menopause’) or surgery
If forget to change contraceptive patch what to do
If the contraceptive patch change is delayed greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days.
symptoms of ovarian hyperstimulation syndrome in IVF
vomiting
ascites
oliguria
VTE
Recurrent thrush regime
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
Coag findings in Von Willebrand
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin
alternative condom in latex allergy
Polyurethane
What menopause treatment may cause irreg bleeding within the first 12 months
tibolone
UKMEC 3 for COCP
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
UKMEC4 for COCP
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
Early referral for infertility criteria (6m rather than 1 y)
Female
Age >35
prev pelvic surgery
Prev STI
amenorrhoea
abnormal genital exam
Male
prev genital surgery
prev STI
varicocele
sig systemic illness
abnormal genital exam
Cervical excitation is found in
pelvic inflammatory disease and ectopic pregnancy.
After 20 weeks, symphysis-fundal height in cm should =
gestation in weeks
Simple ovarian cyst on USS management
Repeat ultrasound in 12 weeks.
What is Meigs syndrome
Meigs’ syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion
Most common benign ovarian tumour in <25yo
Dermoid cyst (teratoma)
most common cause of ovarian enlargement in women of a reproductive age
follicular cyst
Are follicular or corpus luteum cysts more likely to present with intraperitoneal bleeding
Corpus luteum
Ruptured mucinous cystadenoma can cause
pseudomyxoma peritonei (jelly belly)
most common benign epithelial tumour
Serous cystadenoma
single painless genital lesion
Syphilis
single painful genital lesion
H. ducreyi
Multiple painless genital lesions
HPV warts
Multiple painful genital lesions
herpes simplex
most common ovarian ca
Serous carcinoma
Which emergency contraception can they have if breastfeeding
LNG ok
Ullipristal stop breast feeding for a week
If a pregnant woman is not immune to rubella, she should be offered the MMR vaccination when
in the post-natal period
First line PPH mx
manual compression
IV oxytocin
urge incontinence in frail older woman medication?
avoid oxybutynin
can have mirabegron if concern re anticholinergic SEs
