O&G Flashcards
Missed pill rules
‘Traditional’ POPs (Micronor, Noriday, Nogeston, Femulen) - > 3 hours
Desogestrel - >12 hours
- If after these times then need extra barrier protection for 48 hours
COCP
- If a pill is missed, take it as soon as even if it means 2 pills in one day. No barrier protection is required.
- If 2+ missed pills - take the last one as soon as but don’t take more than 2 pills, need barrier protection until had seven pill days in a row (bit more complicated than this but aim to just rememebr this…)
In a smear test if the patient is HPV+ve but cytology is normal, when does it get repeated/ when do they get referred for colposcopy?
Repeat in 12 months, then 12 months again if still +ve
Refer after 3rd +ve result to colposcopy
What is ovarian hyperstimulation syndrome/ how does it present?
Occurs in women undergoing IVF
Clinical presentation:
VTE
Ascites
Vomiting
Oliguria
What are the cancer associations of the COCP?
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
What to do if a pregnant woman is not vaccinated against rubella?
Vaccinate post natally - can’t have during pregnancy as it is a live vaccine. Should avoid potential cases during pregnancy.
What is the latex free condom alternative?
Polyurethane condoms
Diagnostic criteria for gestational diabetes?
Fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
Insulin should be started in the fasting glucose is >= 7 mmol/l. If BM < trial diet/ exercise then metformin. Aspirin should also be considered given the increased risk of pre-eclampsia.
What is Meig’s syndrome?
Bening tumour (fibroma usually) + ascites + pleural effusion
Treatments for infertility in PCOS?
- Clomifene
- Metformin
What condition is a contraindication to ALL forms of hormonal contraceptives?
Breast cancer
How does obstetric cholestasis present?
Obstetric cholestasis = impaired flow of bile
Bile salts deposit in the skin causing pruritus
Deranged LFTs
Which medication can be used in patients with stress incontinence who have not responded to pelvic floor exercises?
Duloxetine
Which days of the menstrual cycle are the most fertile?
8-18
When can breastfeeding be used as a contraceptive?
Exclusively breast feeding
<6 weeks postpartum
Amenorrhoeic
When can the emergency contraceptives be used?
Copper - best one, Up to 5 days after sex.
Ellaone / UPA- up to 120 hours post sex
- Anti-progesterone so can’t use in conjunction with progesterone contraceptive (delay starting or use different emergency method if have used in the past 7 days).
Levonorgestrel - up to 72 hours post sex
- High dose progesterone
The pills can be used more than once in a cycle
What are the options for a medical vs surgical termination of pregnancy?
Medical:
Oral mifepristone (anti-progesterone)
24-48 hours after - oral prostaglandin eg misoprostol or gemeprost
Surgical:
Vacuum aspiration 6-12 weeks
Dilatation and evacuation - 13 - 24 weeks (not done in Scotland)
Give anti - D within 72 hours
Pregnancy test at 2-3 weeks
What is the test and treatment for chlamydia?
NAAT - vulvovaginal swab or first void urine (can also use urehtral swab or rectal swab in MSM)
Tx - doxy 100ng BD 7 days or one off dose of azithromycin
What is the test and treatment for gonorrhoea?
NAAT - vulvovaginal swab or first void urine (throat or rectal stwabs if required)
Urethral swab for culture
Tx - IM ceftriaxone, PO cefixime if IM contraindicated
What are the management options for genital warts?
Topical podophylin
Cryotherapy
Electrocautery
Treatment for syphillis?
IM benpen
Ix and Tx for trichomonas?
High vaginal swab for microscopy
Oral metronidazole - treat partner too
When can you start post exposure prophylaxis?
Start within 72 hours and give for 28 days
What happens at the booking pregnancy visit?
Hb
rhesus antibodies
BBV and infection screen
Urinalysis
Ultrasound - confirm viability and estimate age
What investigations at the 28 week pregnancy appointment?
FBC
Blood group
Rhesus status - give anti D IM to rhesus negative mothers
Random blood glucose
When is the fetal anomaly scan?
18-20+6 weeks
When do you give anti D in pregnancy to rhesus negative mothers?
28 and 34 weeks
When is the down’s screening nuchal scan?
11-13+6 weeks
What changes should you make to patients on levothyroxine in pregnancy?
Increase dose by 25-50mcg in the first trimester
What medications should obese mothers take in pregnancy?
Folic acid and aspirin
How do you manage hypertension in pregnancy?
Lebtalol
or Methyldopa
or nifedipine
NOT ACE.I/ ARBs
Placenta accreta is when the placenta is abnormally adherent to the uterine wall. What are the treatment options?
Prophylactic internal iliac artery balloon
Caesarean hysterectomy
Drug management of PPH?
Uterine massage
IV syntocinon
IV ergometrine (not if hypertensive/ cardiac disease)
IM carboprost
Misoprostol
Tranexamix acid
Which anti-epileptics are a NONO in pregnancy ?
Sodium valproate
Phenytoin
Lamotrigine thought to be safe
Carbamazepine maybe safe
However all safe in breastfeeding. It’s just the barbiturates that should be avoided.
What result in fetal blood sampling indicates the need for immediate delivery?
<7.2
What does APGAR stand for? (NB higher score is better) 0-2 for each category
A - appearance
P - pulse
G - grimace (reflexes)
A - activity (muscle tone)
R - RR
How does necrotising enterocolitis present?
After the baby has had some milk (substrate in the bowel)
Infection of the bowel wall - often fatal
How is RDS managed?
Maternal steroid, surfactant, ventilation
Treatment options for overactive bladder?
Antimuscarinics - Oxybutynin, tolterodine
B3 agonists - mirabegron
Desmopressin
Topical oestrogens
Botox
What are the blood glucose diagnotic criteria and then targets for women with gestational diabetes?
5.6 fasting and 7.8 post glucose for diagnosis (5678)
Pregnant women with GDM should be advised to maintain their CBGs below the following target levels:
fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L
If these targets are not met with diet, exercise and metformin, then insulin should be offered as add-on therapy.
How should women with group B strep bacteriuria be treated during labour?
Intravenous benzylpenicillin given as soon as possible after the start of labour, then at 4-hourly intervals until delivery.
How do you manage pregnant woman with suspected PE?
LMWH first then investigate
What is in the classic triad in congenital rubella syndrome?
sensorineural deafness, eye abnormalities and congenital heart disease.
What is the protein: creatinine ratio that indicates significant proteinuria in pregnancy?
> 30mg/mmol
After delivery, when does a woman require contraception again?
From day 21
What is the hypertension cut off that indicates you should admit a pregnancy woman?
> 160/110
What is androgen insensitivity syndrome?
X-linked recessive
End-organ resistance to testosterone
Genetically male (46XY) but have a female phenotype
May have female external genitalia but undescended testis, primary amenorrhoea as there is no uterus
What is meany by a ‘missed miscarriage’?
Gestational sac containing a dead fetus before 20 weeks without the symptoms of expulsion
When do menopausal women stop needing contraception?
> 50 years, amenorrhoea for >1 year
<50 years, amenorrhoea for >2 years
What is the folic acid advice in pregnancy?
400 micrograms of folic acid per day whilst trying to conceive and once pregnancy, they should continue taking this dose until the 12th week of pregnancy.
In cases where there has been a previous pregnancy affected by neural tube defects or if there is a family history, this dose should be increased to 5 milligrams
What is HELLP syndrome?
Severe form of pre-eclampsia
Haemolysis (H),
Elevated liver enzymes (EL)
Low platelets (LP).
A typical patient might present with malaise, nausea, vomiting, and headache. Hypertension with proteinuria is a common finding, as well as epigastric and/or upper abdominal pain.
What medication is used to suppress lactation when breast feeding cessation is required? Eg baby needs specialist formula feeds
Cabergoline
Dopamine receptor agonist which inhibits prolactin production causing suppression of lactation.
How do you manage a candida nipple infection in a breastfeeding mother?
Miconazole cream applied to the nipple post feed and the oral mucosa of the infant. Breast feeding should be continued during treatment.
When can the POP be started after delivery?
Anytime including in breast feeding and non breast feeding mothers
What is the fasting blood glucose level that indicates the need to skip diet and metformin and go straight to insulin?
Fasting glucose >7
What are the management options for placenta accreta?
Internal iliac artery balloon
Caesarean hysterectomy
