O&G Flashcards
RFs for pre-eclampsia
- Aged 40 years or older
- Nulliparity
- Pregnancy interval of > 10 years
- Family history of pre-eclampsia
- Previous history of pre-eclampsia
- BMI of 30kg/m^2 or above
- Pre-existing vascular disease such as hypertension
- Pre-existing renal disease
- Multiple pregnancy
which anti-emetic has slight increased risk of cleft palate if taking in 1st trimester
ondanestron
The most common cause of ovarian enlargement in women of a reproductive age
follicular cyst
Most common benign ovarian tumour in women under the age of 25 years
dermoid cyst (teratoma)
diagnosis in a female with postmenopausal bleeding (PMB)
endometrial cancer until proven otherwise
What is the most common cause of pruritus vulvae?
contact dermatitis
The most common ovarian cancer
serous cystadenoma
what is mefenamic acid used for
NSAID so primary dysmenorrhoea
what is tranexamic acid used for
menorrhagia
mx of missed miscarriage
mifepristone
misoprostol 48hrs later
mix of incomplete miscarriage
misoprostol
If ruptures may cause pseudomyxoma peritonei
Mucinous cystadenoma
up to how many weeks can you terminate child with anencephaly
any time
mx of prolapse
- first degree: pelvic floor exercises
- pessary ring
- urogynae referral for 3rd degree, failed PFEs, severe incontinence = surgery
induction of labour
- Endovaginal prostaglandin gel is a method of cervical ripening prior to induction
- Membrane sweeps encourage normal labour but are not a recognised induction method on their own
Mx of third stage of labour
- oxytocin
cervical screening when pregnant
wait until 3 months PP
pre-menstrual syndrome mx
- 1st: COCP
- 2nd: SSRI
features of uterine fibroids
- menorrhagia
- bulk-related symptoms
lower abdominal pain: cramping pains, often during menstruation
bloating - urinary symptoms, e.g. frequency, may occur with larger fibroids
- subfertility
- rare features: polycythaemia secondary to autonomous production of erythropoietin
Mx of menorrhagia secondary to fibroids
- levonorgestrel IUS: cannot be used if there is distortion of the uterine cavity
- NSAIDs e.g. mefenamic acid
tranexamic acid - combined oral contraceptive pill
- oral progestogen
- injectable progestogen
Treatment to shrink/remove fibroids
Medical
- GnRH agonists may reduce the size short-term treatment due to side-effects such as menopausal symptoms and loss of BMD (gosrelin)
Surgery
- myomectomy: preserve fertility
- hysteroscopic endometrial ablation
- hysterectomy
- uterine artery embolization
Mx of PPRom
- erythromycin 10 days or until in established labour, whichever is sooner
- offer steroids (dex or betamethasone) if between 24 and 33+6 weeks 12mg 2 IM injection 12hrs apart for organ maturation
- can give tocolytics to ensure steroids are given
examples of tocolytics
- atosiban
- nifedipine
- salbutamol and terbutiline
- indomethacin
indications for cervical cerclage
- TVUS between 16+0 and 24+0 weeks show a cervical length of 25 mm or less, and who have had
either: - preterm prelabour rupture of membranes (P-PROM) in a previous
pregnancy - a history of cervical trauma.
when to do cervical cerclage
- For prophylaxis, inserted between 12 and 14 weeks
- “Rescue cerclage” until 23 weeks
- Cerclage electively removed at 37 weeks
which embryonic structure forms the vas deferns
Wolffian duct
what is the risk of taking unopposed oestrogen in HRT
increased endometrial cancer
increased cancer risk with progesterone HRT
breast cancer
what is the aim of treating rhesus negative pt with anti D
prevent hydrops in future pregnancies
which ART technique is not suitable for tubal subfertility
IUI
complete molar pregnancy US sign
snowstorm appearance
first line antibiotic in 1st/2nd trimester
nitrofurantoin
where are bartholin’s glands located on a clock face
4 and 8 o clock
what can be done to prevent shoulder dystocia
McRoberts manoeuvre
on what day in a 30 day cycle should mid luteal progesterone be measured
day 23 (7 days before end of cycle normal is day 21 of 28 cycle)
system used to diagnose PCOS
Rotterdam criteria
1st intervention to stop PPH
rub up uterine contraction
Trichomonas vaginalis
- STI
- protozoa parasite
- yellow/green frothy discharge
- strawberry cervix
- Mx metronidazole
what meds to give in PPH due to uterine atony
- oxytocinh IM
- ergometrine
- if unresponsive give carboprost
how many phases in menstrual cycle
2
follicular (day 1-14 up until ovulation)
luteal (day 15-28 ovulation to start of menstruation)
what happens in follicular phase
- FSH stimulates further development of the secondary follicles.
- increasing amounts of oestradiol (oestrogen) = negative feedback effect on the pituitary gland, reducing the LH and FSH
- cervical mucus to become more permeable, allowing sperm to penetrate the cervix around the time of ovulation
- LH spikes just before ovulation (egg released) can cause pain
what happens in luteal phase
- after ovulation, the follicle that released the ovum collapses and becomes the corpus luteum.
- corpus luteum secretes high levels of progesterone, which maintains the endometrial lining.
- This progesterone causes the cervical mucus to become thick and no longer penetrable.
UTI abx safe for breastfeeding
trimethoprim
Ectopic pregnancy in which location is most associated with an increase risk of rupture?
isthmus
mx of inevitable miscarriage
- expectant
- medical (misoprostal or methotrexate)
- dilatation and curettage if haemodynamically unstable
Mx of mothers who have had a previous baby affected by early- or late-onset GBS
intrapartum benzylpenicillin (increased risk for other babies)
haemoglobin cut-offs in normal, early/late pregnancy and post partum for iron supplementation
- 115 for non-pregnant women
- 110 in early pregnancy (1st)
- 105 in later pregnancy (2nd/3rd)
- 100 after childbirth
types of perineal tear
- 1st degree: Small tears affecting only the skin
- 2nd degree: affecting the muscle of the perineum and the skin. These usually require stitches.
- 3rd degree: injury to the perineum involving the anal sphincter complex but sparing the mucosa
- 4th degree: injury to the perineum involving the anal sphincter complex and rectal mucosa
when giving magnesium sulfate for eclampsia what do you need to monitor
- reflexes
- Resp rate (to check for no no evidence of respiratory depression)
contraindication to ulipristal acetate
asthma
mx of hyperemesis gravidarum
IV normal saline with added potassium as hypokalaemia is common
