O&G Flashcards
What is the first-line management option for molar pregnancy?
Suction curettage
What is the most appropriate treatment option for a patient with CIN II who has completed their family?
Large loop excision of the transformation zone (LLETZ)
What investigation should be requested in pregnant women who have been exposed to Parvovirus B19?
Maternal IgM
How should a pregnancy be monitored if the patient develops parvovirus B19 infection?
Foetal ultrasound with Doppler of the middle cerebral artery fortnightly until delivery
Which scoring system is used to determine the likelihood that a patient has ovarian cancer and which factors does it take into account?
Risk of Malignancy Index
CA-125 + Menopause Status + Ultrasound Findings
Under what conditions can medical terminations of pregnancy be safely carried out at home?
If < 10 weeks’ gestation, the misoprostol can be taken at home 24-48 hours after having the mifepristone administered in a clinical setting
List the absolute contraindications for vaginal birth after C-section.
Previous classical C-section
Previous uterine rupture
Other absolute contraindications to vaginal birth (e.g. placenta praevia)
Which antihypertensive is most appropriate in the management of moderate gestational hypertension in a patient with severe asthma?
Nifedipine
What is the first-line treatment option for venous thromboembolism in pregnancy?
Low Molecular Weight Heparin (e.g. enoxaparin) until at least 6 weeks’ postnatally and for a minimum of 3 months.
Describe the classical presentation of an ectopic pregnancy.
Lower abdominal pain (usually the right or left iliac fossa)
Vaginal bleeding
If the ectopic ruptures, patients may also complain of shoulder tip pain and may present after collapsing.
Which diabetes medications are most appropriate to use during pregnancy?
Insulin and Metformin
Outline the criteria used to define hyperemesis gravidarum.
Severe dehydration
Weight loss (> 5% compared to pre-pregnant weight)
Electrolyte disturbance
Describe the clinical features of amniotic fluid embolism.
Chest pain
Sudden-onset dyspnoea
Seizures
Cardiac arrest
Massive postpartum haemorrhage
What are the two main causes of posterior vaginal wall prolapse?
Rectocele (low)
Enterocele (higher)
These can be distinguished with a DRE - a finger in the rectum will be seen to bulge into a rectocele but not into an enterocele
At what age does suspected menopause no longer require investigation?
Over the age of 45 years
List some pregnancy-related complications associated with hypothyroidism.
Miscarriage
Preterm delivery
Congenital hypothyroidism
Pre-eclampsia
The presence of which constituent of amniotic fluid would give rise to a positive ROM plus® test?
Insulin-like Growth Factor Binding Protein-1
What initial test is used to investigate foetal anaemia?
Doppler Ultrasound (assess blood flow through the foetal middle cerebral artery)
What is the likely cause of recurrent first trimester miscarriage in a patient with a normal pre-pregnancy transvasginal ultrasound scan?
Balanced Chromosomal Translocations
When should pregnant women be screened for anaemia?
At booking and at 28 weeks’ gestatio
What clinical features are classically associated with uterine fibroids?
Heavy menstrual bleeding
Subfertility
Symptoms begin at some point after menarche (i.e. periods are not heavy from the start)
What is the most important surveillance tool used to monitor a foetus that is small-for-gestational-age?
Umbilical Artery Doppler
What are the main clinical features of placental abruption?
Sudden-onset severe lower abdominal pain
Vaginal bleeding (though this could also be ‘concealed’)
Tender, woody uterus
Maternal haemodynamic instability
How does cord prolapse normally manifest?
Usually associated with an abnormal lie
Rupture of membranes is promptly followed by rapid foetal compromise (due to a constriction of umbilical blood flow)
How does shoulder dystocia tend to manifest?
Failure to progress in the second stage of labour
NOTE: more likely to occur in macrosomic babies
Which cause of puerperal sepsis is associated with the highest mortality?
Group A Streptococcus
What is the most important initial investigation to perform in a patient with suspected puerperal sepsis?
Blood Cultures
How is puerperal sepsis managed?
Sepsis 6
What Rhesus prophylaxis should be offered to a RhD positive mother who is having a sensitising event in their first pregnancy?
None - RhD prophylaxis is not required if the mother is RhD positive
For further information:
NICE guideline on routine anti-D prophylaxis: https://www.nice.org.uk/guidance/ta156/chapter/2-Clinical-need-and-practice
BCSH guideline for the use of anti-D immunoglobulin: https://onlinelibrary.wiley.com/doi/full/10.1111/tme.12091
What are the aims of the first ultrasound scan conducted during a pregnancy between 10 and 13+6 weeks’ gestation?
Detect multiple pregnancies
Assess gestational age based on crown-rump length
Measure nuchal translucency
What combination of results in the combined test would suggest that the foetus is at high risk of having Down syndrome?
Nuchal translucency > 6 mm
High hCG
Low PAPP-A
What should be offered to a patient who is identified as having a pregnancy that is at high risk of being affected by Down syndrome between 15 and 20 weeks’ gestation?
Amniocentesis
For further information:
RCOG green-top guideline on amniocentesis and chorionic villus sampling https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_8.pdf
What should be offered to a patient who is noted to have a symphysis fundal height that is lower than expected twice in a row?
Ultrasound Scan to Estimate Foetal Size
What testing should be offered to a pregnant patient who has had a previous pregnancy affected by gestational diabetes mellitus?
Oral glucose tolerance test at booking and at 24-28 weeks
What is the most common cause of secondary postpartum haemorrhage?
Endometritis
What is a category 1 C-section?
Highest priority C-section which is conducted because there is an immediate threat to the life of the woman or foetus
How should a mild microcytic anaemia identified in pregnancy be treated?
Oral Iron Supplementation
What feature of the history can help distinguish fibroids from endometriosis?
Fibroids may have a more acute history (i.e. not since menarche)
Endometriosis is more commonly associated with painful periods
What is a Bartholin’s cyst?
A swelling beside the vaginal introitus that is caused by blockage of the duct arising from Bartholin’s gland
It can become infected forming a Bartholin’s abscess which is exquisitely tender
What is uterine inversion?
Inversion and prolapse of the uterine fundus
It can cause significant haemodynamic instability and requires urgent correction
What measure can be taken to augment the contractions of a patient whose membranes have ruptured and is failing to progress in the second stage of labour?
Oxytocin Infusion
What are the main advantages of the levonorgestrel intrauterine system?
Effective immediately
Long-acting and reversible
Usually makes periods lighter and less painful
How does obstetric cholestasis manifest?
Obstructive pattern on liver function tests
Pruritus (mainly affecting the hands and feet)
Jaundice
What are the grounds of the abortion act?
GAP DECK BACK
Ground A: That the continuance of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated.
Ground B: That the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.
Ground C: That the pregnancy has not exceeded its 24th week and that continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman.
Ground D: That the pregnancy has not exceeded its 24th week and that continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing children of the family of the pregnant woman.
Ground E: That there is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
Ground F: To save the life of the pregnant woman.
Ground G: To prevent grave permanent injury to the physical or mental health of the pregnant woman.
For further information:
Government website page on the abortion act and statistics https://www.gov.uk/government/statistics/abortion-statistics-for-england-and-wales-2020/abortion-statistics-england-and-wales-2020
How should uncomplicated lactational mastitis be managed?
Encourage continued breastfeeding from both breasts
Once identified, what is the first step in assessing a perineal tear?
Perform a digital rectal examination to assess involvement of the anal sphincter complex
What are the risks to the expecting mother of developing a urinary tract infection during pregnancy?
Increased risk of ascending infection resulting in pyelonephritis
How does neonatal herpes simplex manifest?
There are three main forms:
Skin, eyes and mouth (SEM) disease
Central nervous system disease
Disseminated diseases
What is the most common cause of early-onset sepsis?
Group B Streptococcus
Which combination of agents can be used to maximise the chances of fertilisation in a patient with polycystic ovarian syndrome and irregular, unpredictable periods?
Medroxyprogesterone acetate for 10 days (to induce a withdrawal bleed)
Start clomiphene on day 2 of the period and continue for 5 days
Measure serum progesterone on day 21 to check whether the patient has ovulated
This cycle can be repeated a maximum of 6 times
What cellular component does iodine bind to when used as a stain during colposcopy?
Glycogen
Abnormal cells lack glycogen so remain yellow whereas normal cells will turn dark brown
Define gestational hypertension.
Blood pressure (BP) ≥140/90 mmHg on two occasions (at least 4 hours apart) during pregnancy after 20 weeks’ gestation in a previously normotensive patient, without the presence of proteinuria or other clinical features suggestive of pre-eclampsia.
What should be administered in patients with confirmed preterm labour without rupture of membranes?
Tocolytic (e.g. nifedipine)
Steroids (e.g. betamethasone)
Magnesium sulfate (may be considered in preterm labour for neuroprotection)
What options should be offered to patients with a background of mid-trimester pregnancy loss who are noted to have a short cervix (< 25 mm) at 16-24 weeks’ gestation?
Prophylactic Cervical Cerclage
Vaginal Progesterone
What is lichen planus?
Inflammatory skin condition that typically presents with the development of polygonal violaceous macules. It can affect the vulva and perianal region leading to discomfort, itching and dyspareunia.
The disease can also affect the oral mucosa and may be described as a ‘cobweb-like’ white markings known as Wikham striae.
How should a pregnant patient who is over 20 weeks’ gestation presenting within 24 hours of the onset of a chickenpox rash be treated?
Oral Aciclovir
What are the different types of third degree perineal tear?
3a: Less than 50% of external anal sphincter with internal anal sphincter intact
3b: More than 50% of external anal sphincter with internal anal sphincter intact
3c: Involving both the internal and external anal sphincter
Resources: RCOG
https://www.rcog.org.uk/en/patients/tears/tears-childbirth/
What is the first-line treatment option for gonorrhoea?
Ceftriaxone 500 mg IM STAT
Resources
BASHH
https://www.bashhguidelines.org/current-guidelines/urethritis-and-cervicitis/gonorrhoea-2018/
Notes
https://onedrive.live.com/redir?resid=C28D595D8C9DB2B6%21243&authkey=%21AF9HooYf1VVgiNM&page=View&wd=target%28Gynaecology.one%7Cd54dd729-2ce3-2a4a-996d-419214d1c9a4%2FGenitourinary%20Problems%7Cda1b2539-6435-f841-b4a1-7086f90bde75%2F%29
What are the main features of antiphospholipid syndrome?
Recurrent venous thromboembolism
Thrombocytopaenia
Recurrent miscarriage
Resources:
Osmosis: https://www.osmosis.org/learn/Antiphospholipid_syndrome
Which autoantibodies are associated with antiphospholipid syndrome?
Anticardiolipin Antibody
Lupus Anticoagulant
Anti-beta 2 Glycoprotein 1 Antibody
Resources:
Osmosis: https://www.osmosis.org/learn/Antiphospholipid_syndrome
What can be given to patients with antiphospholipid syndrome to reduce the risk of miscarriage?
Aspirin and Low Molecular Weight Heparin
Resources:
https://www.osmosis.org/learn/Antiphospholipid_syndrome
How does the levonorgestrel intrauterine system exert its contraceptive effects?
Thickens cervical mucus
Thins the endometrium
Creates a hostile environment for sperm
Prevents ovulation (only in some cases)
What is the most appropriate treatment option for a patient with a normal BMI who is struggling to conceive because of polycystic ovarian syndrome?
Clomiphene
What is the most appropriate surgical management option for a patient with painful periods due to endometriosis who is trying to conceive?
Laparoscopic Excision or Ablation with Adhesiolysis
How should a patient with a cervical smear that tests positive for high risk HPV with cytological evidence of mild dyskaryosis be managed?
Non-Urgent Referral for Colposcopy
What is the best treatment option for systemic menopausal symptoms in a post-menopausal patient with a uterus?
Continuous Combined HRT
What advice should be given to someone that is in week 2 of their patch cycle and has forgotten to change the patch for 3 days?
Change patch immediately and use barrier methods for next 7 days
Emergency contraception may be needed if the patient had unprotected sexual intercourse in the preceding 5 days
How should endometrial hyperplasia without atypia in a post-menopausal woman be managed?
Levonorgestrel Intrauterine System
What is the first-line treatment option for moderate premenstrual syndrome?
Combined oral contraceptive pill
What is the most appropriate surgical management option for a patient with painful periods due to endometriosis who is trying to conceive?
Laparoscopic Excision or Ablation with Adhesiolysis
How should a patient with a cervical smear that tests positive for high risk HPV with cytological evidence of mild dyskaryosis be managed?
Non-Urgent Referral for Colposcopy
What is the best treatment option for systemic menopausal symptoms in a post-menopausal patient with a uterus?
Continuous Combined HRT
What advice should be given to someone that is in week 2 of their patch cycle and has forgotten to change the patch for 3 days?
Change patch immediately and use barrier methods for next 7 days
Emergency contraception may be needed if the patient had unprotected sexual intercourse in the preceding 5 days
How should a Bartholin’s abscess be managed?
Broad-spectrum antibiotics
Marsupialisation or Balloon catheter insertion
How should endometrial hyperplasia without atypia in a post-menopausal woman be managed?
Levonorgestrel Intrauterine System
What is the first-line treatment option for moderate premenstrual syndrome?
Combined oral contraceptive pill
What is a suitable treatment option for urge incontinence in a frail, elderly patient who has failed to respond to bladder retraining?
Mirabegron (beta-3 agonist)
What happens to tidal volume in pregnancy?
Increases by 30-35%
What is the first-line treatment option for a symptomatic UTI in a pregnant patient in their second trimester?
7-day course of Nitrofurantoin
How should a first episode of genital herpes in the second trimester be managed?
Oral aciclovir from 36 weeks’ gestation until spontaneous vaginal delivery.
How should vasa praevia be managed?
Emergency C-section if diagnosed in early labour
If identified antenatally, should aim for elective C-section at around 34-36 weeks in asymptomatic women
List some common medications that are contraindicated in pregnancy?
Tetracycline antibiotics
Chloramphenicol
Sulphonamides
Ciprofloxacin
Lithium
Benzodiazepines
Aspirin
Carbimazole
Methotrexate
Cytotoxic drugs
Amiodarone
Codeine phosphate
Which combined test results are associated with a pregnancy being at high risk of Down syndrome?
High Nuchal Translucency, High β-hCG, Low PAPP-A
List some associated features of gestational trophoblastic disease.
Hyperemesis gravidarum
Hyperthyroidism
List some factors that deem a pregnancy high risk and, therefore, requires aspirin prophylaxis.
Previous pregnancy affected by hypertensive disease
Chronic kidney disease
Autoimmune diseases (e.g. SLE, antiphospholipid syndrome)
Diabetes mellitus
Chronic hypertension
Describe the presentation of lactational mastitis.
Breast pain, erythema and tenderness
Systemic symptoms (e.g. fever)
What examination finding is suggestive of umbilical cord prolapse?
The umbilical cord is palpated below the presenting part of the foetal head following rupture of membranes.
When is the anomaly scan offered?
18-20 weeks’ gestation
How should chickenpox in women who are over 20 weeks pregnant be treated?
Provided that they are presenting within 24 hours of the onset of symptoms, they should receive a course of aciclovir.
How long should patients who develop a VTE in pregnancy continue anticoagulant treatment for?
Until at least 6 weeks postpartum and for a minimum of 3 months in total.
What is cervical ectropion?
Natural cervical response to oestrogen where the cells of the endocervix appear on the ectocervix. They are fragile and more prone to bleeding following contact. It is more common in young women and women taking the COCP.
How do you define reduced foetal movements?
Maternal perception of reduced foetal movements based on their perception of the baby’s baseline pattern of movement
Which infections are screened for during antenatal screening?
HIV
Syphilis
Hepatitis B
Define complete miscarriage.
A form of miscarriage in which the patient has fully emptied their uterus of the products of conception.
It will present with vaginal bleeding and, upon assessment, the cervical os will be closed and a transvaginal ultrasound scan will reveal an empty uterus.
What viral load is required to consider vaginal delivery in a pregnant patient with HIV?
< 50 copies/mL at 36 weeks’ gestation
When should nulliparous women with a foetus in the breech position be offered external cephalic version?
36 weeks’ gestation
What is the investigation of choice for pregnant women presenting with features of PE and a DVT?
Compression duplex ultrasonography
Which antihypertensives are used in the treatment of hypertension in pregnancy?
1st Line: Labetalol
Alternative: Nifedipine, Methyldopa
How often should monochorionic diamniotic twin pregnancies undergo growth scans?
Monochorionic diamniotic twins should have appointments combined with growth scans every 2 weeks from 16 to 24 weeks, followed by scans at 28, 32 and 34 weeks’ gestation.
What is the first-line management option for stress incontinence?
Pelvic floor muscle training - 8 contractions, 3 times per day for 3 months
What are the diagnostic criteria for hyperemesis gravidarum?
> 5% pre-pregnancy weight loss
Electrolyte imbalance
Clinical evidence of dehydration
What is the first-line treatment option for vulvovaginal candidiasis in pregnancy?
Intravaginal antifungals (e.g. clotrimazole)
How does vulvovaginal candidiasis typically present?
Creamy, white vaginal discharge associated with vulvar itching and soreness
What is the definition of menopause?
Cessation of periods for 12 months in the absence of any other causes amenorrhoea (e.g. being underweight, using contraceptives).
Which complication of pelvic inflammatory disease is characterised by inflammation of the liver capsule?
Fitz-Hugh-Curtis Syndrome
How should lactational mastitis be managed?
Simple analgesia, encourage continued breastfeeding and, if the symptoms have not resolved after 12-24 hours of adequate milk expression, recommend a course of antibiotics (usually flucloxacillin).
In pregnant patients with a background of diabetes mellitus that is treated with insulin, how is their blood glucose concentration managed during labour?
Variable-rate insulin infusion
Which IM injection is administered during the latter stages of labour to facilitate the delivery of the placenta and membranes?
IM Oxytocin
How should placental abruption be managed?
Emergency C-section
Which IM injection is administered during the latter stages of labour to facilitate the delivery of the placenta and membranes?
IM Oxytocin
List some risk factors for placenta accreta.
Previous placenta accreta
Previous C-section
Maternal age
Previous endometrial curettage
What are the clinical features of a molar pregnancy?
Lower abdominal pain
Severe vomiting (hyperemesis gravidarum)
Vaginal bleeding
Large-for-dates uterus
List some contraindications for the ulipristal acetate morning after pill.
Severe asthma
Cervical cancer
Ovarian cancer
Uterine cancer
What is the first-line treatment option for endometrial hyperplasia without atypia?
Levonorgestrel intrauterine system (Mirena® coil)
What are the main subsections of the abortion act?
A: Continuation of the pregnancy would involve risk to the life of the pregnant woman greater than if the pregnancy were terminated.
B: Termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman.
C: The pregnancy has not exceeded its 24th week and the continuation of the pregnancy would involve risk greater than if the pregnancy were termination, of injury to the physical or mental health of the pregnant woman.
D: The pregnancy has not exceeded its 24th week and the continuation of the pregnancy would involve injury to the physical or mental health of any existing child(ren) of the family of the pregnant woman.
E: There is substantial risk that, if the child were born, it would suffer from such physical or mental abnormalities as to be seriously disabled.
Which strains of HPV does the quadrivalent vaccine (Gardasil®) cover?
6, 11, 16 and 18
List some contraindications for taking a smear sample for cervical screening
Menstruation
< 12 weeks postnatal
< 12 weeks post TOP/miscarriage
Vaginal discharge or pelvic infection
How is cervical cancer that is stage IIB-IVA managed in the first instance?
Chemotherapy and Radiotherapy
