O&G Flashcards
What is the quickstart method for contraception? What is involved? Which methods not suitable for?
Starting outside of 1st 5 days, risk prengnacy. Do urine bHCG on day and repeat in 4 weeks, condoms for 7 days (3 for POP). Not safe for IUD + cyproterone COCPs.
What are the contraindications to the COCP? 9 categories.
6 weeks postpartum, Age >35 + smoking <>15 within 1 year, BMI >35, CVD risk factors (HTN except only in preg, IHD, AF, complicated diabetes), prev VTE or FDR < 45 w VTE or prolonged immobility or known mutations, migraine w aura (old migraines ok), BRCA carrier or breast ca, decomp cirrhosis/current GB disease/liver ca, antiphospholipid antibodies.
What contraception methods are safe in the setting of: postpartum, CVD risk factors, unexplained bleeding, prev breast ca.
PP: Implanon, depot, POP. CVD: Implanon, IUD, POP. Bleeding: COCP, POP. Breast ca: copper IUD only.
What medications can affect the efficacy of the COCP?
Rifampicin, antivirals, St John’s wort, carbamazepine, phenobarbitol, phenytoin, topiramate.
What are suitable contraceptive options for women over 45? How is this monitored?
Age 45 can insert mirena and keep till 55. From 50, avoid COCP and depot. IUD, POP, implanon okay. If no period, check FSH, if >30 can stop contraception in 12mo. Can stop contraception at age 55.
What are 2 forms of POP? How do they work? How long do they take to be effective? What is their window period?
Microlut (levonogestrel) - thick mucus + suppress ovulation 60%. 3 days to start, 3hr window (caution vomiting/diarrhoea). Slinda (drospirenone) - suppress ovulation. 7 days to start, 24hr window.
When is breastfeeding a viable form of contraception?
Amenorrhoea in 98% if 6mo postpartum, baby fully breastfed and no long intervals between feeds (4h day, 6hr night)
What supplements are recommended in early pregnancy?
Folic acid 0.5mg, 5mg if prev/Fhx neural tube defect, GDM, BMI >30, antiepileptic use; 1mo prior and for first 3mo of pregnancy. Iodine 150microg. Vitamin D 400U recommended, check if risk factors.
What tests are recommended in early pregnancy?
FBE, fasting BSL, HIV, Hep B, syphilis, rubella, urine MCS + proteinuria, chlamydia < 25 or high prevalence, genetic carrier screening, CST if due. Hep C if risk factors, Vit D if risk factors, gonorrhea/trichomonas/BV if symptoms/risk, CMV if children around, TFTs if risk.
What tests are done to look for chromosomal abnormalities during pregnancy? When? Risks?
NIPT from 10 weeks. Combined FTS from 9/11 - 13+6, screen for T18, 21 and 13. 2nd trimester screen from week 14. Diagnostic tests are CVS weeks 11-13, amniocentesis from week 15, 1% risk of miscarriage.
Which pregnant women are screening for thyroid disease, vitamin D and iron deficiency?
T: PHx, FHx, autoimmune diseases, prev miscarriage/infertility, goitre. D: dark skin, south lattitude, low sunlight exposure, obesity. I: ATSI, immigrant, vegetarian.
How are back, pelvic pain and N/V managed in pregnancy?
BP: common, fitness/strengthen, panadol. P: strength/stabilise, fitness ball, water based exercise. NV: pyridoxine 12.5mg BD , add doxylyamine 25mg at night. 2ndline :maxalon, ondans, stemetil (cat C)
How are psychotropics in pregnancy counselled - benefits, risks, strategies. Which drugs need an urgent plan?
B: reduce neglect, harm/distress ofmother. R: preterm, congenital abnormalities, IUGR, neonatal adaptation in serotonin. Aim low doses, avoid polypharmacy, avoid abrupt cessation and rec 2nd trimester scan + observation of neonate postpartum. Lithium, carbamazepine, valproate.
What are 4 considerations of SSRIs in pregnancy? Which is safest? Which are least safe and for breastfeeding?
Association w poor growth (not proven), possible teratogen/cardiac malformation/miscarriage (paroxetine, venlafaxine), neonatal adaptation, persistent pulmonary hypertension - very slight risk. Sertraline safest. Fluoxetine highest conc in milk. Don’t start fluoxteine or parox, but may cont if already started, dw patient.
What are 3 points of discussion in an unplanned pregnancy?
Confidential unbiased nondirective counselling, screen for abuse, 1800myoptions for information.
What are 6 causes of early pregnancy bleeding? What investigations are done?
Implant bleed (2wk from ovulation), miscarriage, ectopic, cervical or vaginal (infection, ca, polyp), uterine infection, perigestational haemorrhage. Rarely molar pregnancy. Serial bHCG (48-72hr) transvaginal U/S (visible if bHCG >1500/2000), blood group/antibodies.
What are 7 minor and major causes of antepartum haemorrhage? Definition and other ddx?
Min: marginal placental bleed, cervical ectropion, blood-stained show. Maj: placental abruption, placenta praevia, vasa praevia, uterine rupture. Bleed >20wk. DDx: UTI, haemorrhoid.
How is an antepartum haemorrhage managed?
Lie supine w lateral tilt, IV access, rapid fluid resus (may need blood), monitor vitals + FHR + CTG, do U/S before any speculum/digital exam incase of praevia.
What are the risk factors + sx for placenta praevia and placental abruption?
PP: prev c-section/uterine surgery, prev praevia, advanced age. Painless bleeding. PA: trauma, smoking, cocaine, HTN, PROM. Bleeding, tenderness and possible contractions.
What are the risk factors for pre-eclampsia? Risks of pre-eclampsia?
RF: prev preeclampsia, HTN, pre-existing diabetes, SLE, antiphospholipid syndrome, obesity, CKD. M: seizures, renal failure, DIC, pulmonary oedema, HELLP. F: IUGR, preterm delivery, death.
Consider aspirin from 12 weeks.
What is pre-eclampsia? What are severe symptoms? What tests are indicated?
New HTN after 20 weeks + involvement of renal/haem/liver/neuro or pulm oedema or IUGR. Headache, visual changes, RUQ pain, altered mental status, dyspnoea/oedema. Ix: FBE, UEC, LFT, urine ACR, U/S.
What is gestational hypertension vs chronic hypertension? How is this managed in pregnancy?
HTN after 20 weeks or before. Screen for preeclampsia. 1st line: labetalol, methyldopa
What are 12 things to consider in a 6 week post partum check?
Pregnancy complications, labour/delivery, perineal tears, lochia, breastfeeding, bowel/urinary issues, sleep, mood - EDPS, return to exercise (walk, avoid high impact 3mo), sex - contraception, cervical screening, rubella ok in breastfeed but delay 6mo from transfusion.
Post partum endometritis - timing, DDx, tests, mx.
Within 1 week, infected RPOC, PID ?septic aborption. Ix: U/S, blood cultures, endocervical swab MCS + PCR (C, G, Myco). Rx: augmentin or bactrim + metro. Severe: IV gent, metro, amoxicillin.
What are 4 signs of adequate breast milk supply? What can help?
Growth (150g per week, birth weight by 2w), 5-8 wet nappies, passing stool at least once per day, settled between feeds with good tone/skin. Hold skin to skin, breastfeed freq (2-3h), review attachment, express after feeds, lactation consultant, rarely domperidone (EPSE, long QT).
What are 6 causes of pain with breastfeeding? How is the most common managed?
Thrush, mastitis, milk blister/white spot, blocked duct, dermatitis, poor attachment/trauma - lanolin cream, panadol, avoid tight bra, review attachment/lactation consultant, feed from other side first, rest for 1-2 feeds: pump from affected side.
Lactational mastitis - 4 nonpharm mx, pharm mx and indication.
Breastfeed as usual (feed from affected first to drain), covered cold packs 10min/hr, gentle massage to axilla for lymphatics (no deep/firm), lactation consultant review attachment. If systemically unwell or not improve in 48hr, fluclox/diclox 5-10d. Keflex if allergy, clinda if severe.
How is breastfeeding reduced - wean and post abortion?
Aim to drop feeds per day by 1 per week, express only for comfort but avoid excess. In abortion, cabergoline 1mg stat + tight bra.
Symptoms/signs of nipple thrush and management.
Burning stinging pain, persists after feed, tender to light touch. Pink/shiny nipple or flaky. Baby: daktarin QID then D (2wk). Mum: oral fluconazole 3 doses over 1 week then oral nystatin TDS and daktarin gel to nipple QID for 1 week.
