O&G Flashcards
1
Q
Herpes Mx in PregC
A
labour<6wks=CS aciclovir tds labour>6wks=reassure
Guidelines issued by the Royal College of Obstetricians and Gynaecologists state that women who present with first-episode genital herpes during their third trimester should be managed with daily suppressive oral aciclovir 400mg until delivery. Delivery should be by caesarean section due to a high risk of neonatal HSV (herpes simplex virus) transmission.
2
Q
Headache in PregC (differentials)
A
Migraine-most common Viral meningitis- Cerbral vein thrombosis Subarachnoid Idiopathic intracranial hypetension
3
Q
VZV infx in PregC Tx
A
Test for VZ Abs and give VZIG w/in 10 days
4
Q
External cephalic version (Contraindications)
A
Offered from 36wks (37 in multiparous) Contraindications-Multiple pregnancy, Maj uterine abnorm, antepartum haemorrhage, rupture of membranes,
5
Q
DM Mx postpartum
A
After eating and drinking ~6hrs sliding scale reduced to preprgC doses of insulin
6
Q
SLE in PregC risks
A
Spont Miscarriage, fetal death, PET, Preterm, fetal growth restriction
7
Q
Listeria trasnmission
A
Soft cheese and Pate
8
Q
Toxoplasmosis transmission
A
Cats, faeces
9
Q
Rashes in PrgC
A
Pemphigoid gestationis - Blistering of trunk, spreads from umbilicus PUPP - Abdo stretch marks and periumbilical sparing Prurigo gestationis - trunk+upper limbs abdo sparing Impetigo hepetiformis - blisting and febrile
10
Q
Threatened miscarriage
A
PVB <24wks
11
Q
Missed miscarriage
A
Loss of pregC w/o passage of the products of conception or PVB
12
Q
Septic miscarriage
A
loss of PregC complicated w/ infx of the retained conceptus
13
Q
Incomplete miscarriage
A
loss of PregC w/ PVB and passage of not all of the concptus Tx - med: misoprostol Surg: suction evacuation
14
Q
Complete miscarriage
A
loss of PregC w/ all of products of conception expelled
15
Q
Hyperemis Gravidarum
A
Px - Severe vomiting, dehydration, RF’s - multiple pregC Tx - fluid restoration and anti emetics
16
Q
Fetal pole and fetal heart
A
6 wks
17
Q
Blighted ovum/anembryonic pregC
A
Gestational sac w/o embryonic pole or yolk sac development Mx - 2 scans 10-14/7 apart
18
Q
Ectopic PregC Mx med criteria (4)
A
Criteria: Small ectopic <3cm, no fetal pulse, no clinical compromise, no free fluid in the pouch of douglas, bHCG <3000
Med: Methotrexate IM (+/- another dose 7/7), monitor bHCG on days 4+7. Drop by 15% needed otherwise 2nd dose given
19
Q
HRT risks
A
Inc risk of: Stroke, breat Ca, ovarian Ca, VTE, CAD
20
Q
Epilepsy Mx in PregC
A
Carbamazepine lamotrigine
21
Q
COCP
A
MOA - inhibits ovulation
22
Q
POP
A
MOA - thickens cervical mucus
23
Q
Desogestrel
A
MOA - inhibits ovulation, thickens cervical mucus
24
Q
Injectable contraceptive/medoxyprogesterone acetate
Lasts how long?
A
MOA - inhibits ovulation, thickens cervical mucus
12wks
25
Implantable/etonogestrel/Implanon
MOA - inhibits ovulation, thickens cervical mucus
Lasts 3yrs
26
Itrauterine device
MOA - decreases sperm motility and survival
27
Intrauterine system/levonorgestrel
MOA - prevents endometrial proliferation, thickens cervical mucus
28
Levonorgestrel/Levonelle Emergency conc
MOA - Inhibits ovulation \<72hrs 58% effective (24hrs 95% effective)
29
Ulipristal/ellaOne Emergency conc
MOA - Inhibits ovulation \<120hrs effective condoms until next period
30
IUD Emergency conc
MOA - prevents implantation, spermicidal \<5days after UPSI or expected day of ovulation
31
primary PPH
Def: minor 1000-500ml/maj\>1000 blood loss from the genital tract w/in 24hrs Ax - 4 T's: Tone, Tissue, Trauma, Thrombin
32
Fibroids
Def: benign smooth muscle tumours of the uterus, more common in black women Px - asymp, menorrhagia, lower abdo pain, bloating, urinary Sx, subfertility Ix - transvagianl US Mx - Sx Mx IUS,tranexamic acid, COCP, GnRH, myomectomy, uterine artery embolization
33
Menstrual cycle 6 steps
1. GnRH released from hypothalamus 2. Inc FSH+LH released from ant pit. 3. FSH induces follicular growth creating oestradiol 4. Oestradiol inhibits other follicle development (only one follicle) 5. positive feedback and LH surge causing ovulation 36hrs after surge 6. Luteal phase of follicle (now corpus luteum) increases progesterone, enhancing endometrial receptivity
34
CMV infx in pregC Fetal effects (4)
Deafness IUGR Hydrocephalus Thrombocytopenia
35
DR C BRAVADO
Define risk - prev CS, PET, DM, PVB, IUGR Contractions - Baseline RAte - 110-160, tachy w/pyrexia, brady=distress Variability - 5-25, dec in fetal sleep, prolonged dec=bad Accelerations - 15 for 15s good, w/ contractions Decelerations - early/late/varied (varied=cord compression+oligohydramnios) Overall impression
36
Reiter's syndrome 'can'tx3'
Can't see, can't pee, can't climb a tree conjunctivitis, urethritis, arthritis
37
Rise in this hormone maintains PregC if fertilized
Progesterone
38
Stimulates proliferation of stromal and glandular elements of endometrium
Oestradiol
39
3 P's of labour
Power, passage, passenger
40
3 stages of labour
1. From diagnosis of labour to full cervical dilation 10cm latent (\<4) active (4-10) 2. From full dilation to delivery ~40mins nullips/~20mins multips 3. Delivery of fetus to delivery of placenta
41
Itching and derraged LFT's esp. bile acid. Rsk=Stillbirth, preterm and meconium staining. Tx=induce @ 37-38 + Urodeoxycholic acid
Obstetric cholestasis
42
Ruptured membranes, Offensive pv discharge. Tx- Abx and induction of labour (removal of infx nidus)
Chorioamnionitis
43
Px - Severe vomiting, dehydration, RF's - multiple pregC Tx - fluid restoration and anti emetics
Hyperemis Gravidarum
44
Ax - placental insufficiency Px - Microsomaly and microcephaly (head can be normal if placental insufficiency occurs later in PregC)
IUGR
45
Epx - under 35 Ax - 90% SCC + HPV RF: STI Px - PCB, IMB, deep dyspareunia, crampy lower abdo pain, cerval bleeding on contact Ix - Biopsy for staging Tx - surgical, chemo, radio
Cervical cancer
46
Def: implantation of a fertilized ovum outside of the uterus, mostly tubular Px - 6-8wks amenorrhoea, lower abdo pain, PVB, peritoneal bleeding (shoulder pain), Mx - methotrexate, or surgical
Ectopic PregC
47
Px - pelvic pain, fever, deep dyspareunia, discharge, menstrual irregularities, cervical excitation Tx - IMcef, po doxy, po met
Pelvic inflammatory disease
48
Px - sudden onset unilateral lower abdo pain, N+V, tender adnexa
Ovarian torsion
49
Px - chornic pelvic pain, dysmenorrhoea (pain before period), deep dyspareunia, subfertility, chocolate cyst
Endometriosis
50
Px - pressure/heaviness or bearing down sensation, urinary Sx i.e. incontinence, freq, urge
Urogenital prolapse
51
4 O's: Obesity, O children, Oestrogen unopposed, O sugar (DM)
Endometrial Ca
52
Px - PVB 1st-2nd tri, uterus large for dates, hyperemesis gravidarum, snowstorm, ground glass?, inc hCG
Hydatidiform mole/molar PregC
53
Px - PVB 3rd tri, constant pain, signs of shock/hypovolaemia, woody uterus
Placental abruption
54
Px - PVB 3rd tri, no pain, non tender uterus, no BV
Placenta praevia
55
Ax - fetal bld vessels runs directly in front of presenting part Px - rupture of membranes followed immediately by large PVB, severe fetal distress, CS often not fast enough to save fetus
Vasa praevia
56
CTG normal ranges:
Baseline
Variability
Accelerations
Deeccelerations
Baseline - 110-160
Variability - \>5 beats per minute
Accelerations - present
Decelerations - None
57
Fetal bld sampling indications
Pathological CTG
58
Fetal bld sampling risks/contraindications
Infx - HIV, HepC
Hb abnormalities - immune thrombocytopenia, Haemophilia B
59
Px - Umbilical cord below presenting part.
Important - Cord can become obstructed or spasm, starving the fetus of oxygen
Cord prolapse - Obs emergency
60
Cord prolapse Mx
Mx - Call fro help, IV access, stop woman pushing, elevate presenting part, deliver immediately (Instrumental/CS depending on quickest option)
61
Induction of labour indications (3 categories)
Contraindications (3 absolutes)
Fetal - suspected IUGR, Antepartum haemorrhage, prolonged pregnancy
Materno-fetal - PET, DM
Maternal - social, in utero death
Contraindications - acute fetal compromise,
62
Prostaglandin E2 (PGE2) PV
Induction of labour - starts labour/ripens cervix to allow amniotomy
63
Oxytocin infusion and ARM
Induction of labour
64
CTG sens and spec
High sens low spec
high Sens - 100 people w/ disease 98 will have +ve result
High Spec - 100 people who don't have disease 98 won't have it
65
Inductin of labour w/ intrauterine death
po mifepristone + po/pv misoprostol
66
Epidural contraindications (4)
Hypotension, abnormal lie, placenta praevia, pelvic obsruction
67
Ax - Chorionic vili in contact with the myometrium
Px - Rsk of PPH
Mx - Syntocinon, Balloon tamponade, iliac artery ligation, hysterectomy
Placenta accreta
68
Fetal cariac physiology (6)
Umbilical arteries occluded causing:
Reduced venous return to the right side of the heart
Therfore right atrial pressure closing the foramen ovale
Breathing causes dec pressure in pulmonary circulation=inc rt ventricular output
Pulmonary artery vasodilates
Inc pressure on left side
PDA closes due to rising oxygen levels
69
Large and small villi w/ scallpoed outlines+ trophoblastic hyperplasia
Hydatidiform mole
70
Ext. tender fluctuant swelling on labia minora
71
Mx of urge incontinence
Cons: Bladder retraining min 6wks
Med: Oxybutynin
72
Pretermination assessment
Abx prophylaxis for chlamydia
Contraception discussion
Risks of STOP
Risk of uterine perf is 1 in 300
73
Bonemarks of the pelvic outlet (3)
Pubial arch, ischial tuberosities, coccyx
74
Most inferior aspect of the peritoneal cavity
Pouch of douglas
75
Px - sudden onset epigastric pain, N+V, jaundice, high uric acid, hypoglycaemia, high uric acid
Acute fatty liver of PregC
76
Px - Pain in suprapubic area that radiates to upper thighs and perineum, worse on walking
Smphysis pubis dysfunction
77
Brow presentation
78
DM complicates what % of PregC
2-5%
79
% of babies born from DM mothers \>50th percentile
85%
80
Rsk of major congenital malformation if 1st maternal HbA1c\>10%
25%
81
Rsk of recurrence of gestational DM in future PregC
60%
82
% of women who will develop T2DM in next 10 years (after gestational DM)
50%
83
Perimenopausal woman w/ uterus
Cyclical combined hormone replacement therapy
84
Postmenopausal amenorrhoeic women w/ uterus
Continuous combined hormone replacement therapy
85
Postmenopausal amenorrhoeic woman w/o uterus
Oestrogen-only hormone replacement
86
Osteoporosis Tx
Bisphosphonates
87
Infx prophylaxis in preterm rupture of membranes
Erythromycin
88
Abx assoc w/ necrotizing enterocolitis
Co-amoxiclav
89
Px - severe abdominal pain, cessation of contractions, significant fetal distress, VBAC,
Uterine rupture
90
Px - PVB @ ROM/ARM, CTG abnormalities,no pain
Vasa praevia
91
Resp rate in PregC
Stays the same
92
Hb Conc in PregC
Decreases
93
Renal bld flow in PregC
Increases
94
Albumin changes in PregC
Decreases
95
Heart Rate in PregC
Increases
96
Px - PCB, Wt loss, ealry sexual activity, multiple partners, smoking
Cervical Ca
97
Px - IMB, menorrhagia, bado swelling, bulky uterus, subfertility, dyspareunia
Fibroids
98
Px - Bright red growth of speculum
Mx - avulsed and cauterized
Cervical polyps
99
Absolute contraindications to COCP w/ respect to
VTE
Arterial disease
Migraines
VTE: personal Hx of VTE BMI\>39, 2 of - Fhx, obesity\>30, varicose veins, immobilization
Arterial dis (2 of): Fhx, DM, smoker, HTN, \>35yo, obese
Migraine: migraine wiyth typical aura
100
Anti-D prohylaxis for miscarriage after how many weeks?
12wks
101
Sensitizing events warranting anti-D prophylaxis (6)
Antepartum haemorrhage
Closed abdominal injury
external cephalic version
invasive prenatal diagnosis
intrauterine procdures
intrauterine death
102
Rheus prophylaxis dose \<20wks
Rheus prophylaxis dose \>20wks
250iu
500iu
103
Commonest (~85%) oestrogen producing tumour
20-30yo
Mucinous adenocarcinoma
104
commenest of all ovarian malignancies
30-40, 30% bilateral, 30% malignant
Serous adenocarcinoma
105
Meig's syndrome
Fibroma
Pleural effusion
Ascites
106
Pseudomyxoma peritonei, jelly belly
Mucinous adenocarcinoma
107
Arise from germ cells and contain ectodermal tissue
Teratoma
108
CIN 2 or 3 Mx
30% will develop into Ca
Ablation (diathermy or cryocautery)
Excision techniques (cone biopsy or large loop excision of transformational zone/LLETZ)
109
Cervical Ca stage \*I and IIA Tx
\*Excluding IA1
(Cevrical Ca stage IA1 Tx)
Wetheim's procedure (Hysterectomy, upper 1/3rd of vagina, parametrium, pelvic lymph nodes +/- ovaries if not young)
(Cone biopsy)
110
Cervical Ca \>IIB Tx
Radio and chemo
111
Cervical Ca stage IB1 Tx maintaining fertility
Radical trachelectomy
112
Maternal jaundice, AST/ALT inc\> ALP+GGT
| (Hepatic picture)
Acute fatty liver of PregC
113
Infx in PregC
Fetal: sensorineural deafness, cataracts, congenital heart disease, LD's HepSplenMeg, microcephaly
Maternal: flu like Sx, rash
Rubella
114
Infx in PregC
Fetal: dermatomal skin scarring, neurological defects, limb hypoplasia, eye defects
Varicella zoster
115
Ovarian venous drainage
Pampiniform plexus in broad ligamnet, ovarian vein, right IVC/left renal vein
116
Vaginal relations
Post
Lat
Ant
Post: Pouch of douglas, rectum, anal canal
Lat: Levator ani, visceral pelvic faschia, ureters
Ant: Base of the bladder, urethra
117
Mesometrium, mesosalpinx, mesovarium
Broad ligament
118
Infundibulum, ampulla, isthmus, uterine part
Fallopian tubes
119
RF: ARM
Cord prolapse
120
Mx of PPH (Atonic uterus)
Cons: Empty bladder, uterine massage,
Med: Oxcytocin infusion, carboprost
Surg: B-lynch suture, uterine artery ligation, hysterectomy
121
Maximum diameter of the head has passed through the pelvic brim
Engagement
122
Movement required for easy passage into the mid cavity
Flexion
123
Levator ani muscles helps the head move into an OP position
Internal rotation
124
Movement causes crowning of the head
Extension
125
Movement that realigns the head w/ the shoulders
Restitution
126
Subfertility, PMHx of surgery
Asherman's syndrome
Adhesion
127
Kielland's foreceps
Rotation
128
Neville-Barnes foreceps
Traction (w/ 3x contractions before CS)
129
Most sensitive parameter to assess fetal growth and detect IUGR
Abdominal circumference
130
Secondary dysmenorrhoea causes/associations
Endometriosis, PID, fibroids, LLETZ
131
Secondary dysmenorrhoea Tx
Cons: Hot water bottle
Medical: NSAIDS (Ibuprofen/mefanamic acid), COCP, depot P
132
Acute fatty liver of PregC vs Obstetric cholestasis
Pain in acute fatty liver
133
Pain in suprapubic area that radiates to upper thighs and perineum, worse on walking
+Mx
Symphysis pubis dysfunction
confirmed by pain on increasing pressure on pubis
Mx - analgesics pelvic support braces
134
Diamond shape
Anterior fontanelle
135
Y shape or triangular
Posterior fontanelle
136
Types of breech (most to least common)
Extended, flexed, footling
137
Beta-agonist tocolytic
Ritodine
Inhibits smooth mucle contractions in an attempt to delay labour
Contraindicated in diabetes and cardiac disease
138
Tx for menorrhagia
1st line
2nd line
3rd line
Surgical
1st line w/ contraception: IUS
2nd line (No contraception): tranexamic acid, NSAIDS (mefanamic acid)
2nd line (w/ contraception): COCP
3rd line: Progestogens, GnRH agonists
Surgical non-sterilizing- polyp removal, endometrial ablation, myomectomy, \*uterine artery embolization
Surgical + sterilizing: Hysterectomy
\*Fertility is reduced but classed as non-sterilizing procedure therefore contraceptives are advised afterwards
139
Risk of malignancy index (RMI) calculation
U\*M\*CA125
U=ultrasound score
M=menopausal staus
RMI\>250 referred
140
Cervical tumour staging
0: Carcinoma in situ
I:lesion confined to cervix
II: Invasion into upper vagina but not pelvic wall
III: Invasion of lower vagina/pelvic wall, or causing ureteric obstruction
IV: Invasion of bladder or rectal mucosa
141
Intermittent abdo pain relieved following sudden watery discharge
Fallopian tube carcinoma
142
Hx of dilation and curettage (TOP), adhesions
dyspareunia, amenorrhoea, oligomenorrhoea, infertility
Asherman's syndrome
143
Secondary menorrhoea (6 causes)
Gonadal failure: premature ovarian failure
Pituitary dysfunction: pituitary tumour
Physiological causes: stress, travel and wt changes can reduce GnRH
Endocrine dysfunction: hypothyroidism
oestrogen metabolism dysfunction: anorexia nervosa
144
Booking visit (6)
Info
BP
BMI
Urine dip + culture
Bloods: FBC, Rhesus, alloantibodies, Hbopathies, HepB, Syhpilis, rubella screen.
HIV
145
Parvovirus B19 inf. What do the following mean:
IgG+ve IgM-ve
IgG-ve IgM+ve
IgG-ve IgM-ve
Immune to parvovirus - reassure
Non-immune recent infx \<4wks - refer to ftal medicine
146
Missed pills POP's
Action \<3hrs
Action \>3hrs
\<3hrs = no action
\>3hrs = take as soon as possible
147
Missed pills cerazette (desogestrel)
\<12hrs
\>12hrs
\<12hrs no action
\>12hrs take as soon as possible
148
Cyclical combined HRT indications
LMP\<1yr ago
149
Continuous combined HRT indications
Taken cyclical combined for 1yr
\>1yr since LMP
\>2yr since LMP in premature menopause (\<40)
150
Continous oestrogen therpay indication
Hysterectomy
151
Non-hormonal Tx for menopausal vasomotor Sx
SSRI's (paroxetine, fluoxetine, citalopram, venlafaxine)
152
Time until contraceptives effective:
IUD
POP
COCP, implant, injection, IUS
IUD: Immediately
POP: 2 days
COCP/Implant/Injection/IUS: 7 days
153
Follicular cyst genesis
Non-rupture of the dominant follicle
Commonly regress
154
Face presentation Mx
Emergency CS
155
Mx of stress incontinence
Cons: Pelvic floor exercises (8contractions 3\*day for min 3mnths)
Med: PV oestrogen/pessary
Surgical: TOT/TVT
156
Antiemetics in hyperemesis gravidarum
Promethazine
157
NSAID effective after CS, contraindicated during pregC
Diclofenac
158
Main Oestrogen secreted by the ovaries prior to meonpause
17beta-Oestradiol
159
Male cell that contains 23 single chromosomes prior to spermiogenesis
Spermatid
160
Male cell that contains 46 double-structured chromosomes
Primary spermatocyte
161
PE Mx
Enoxaparin 80mg BD
162
Single episode of brown stained vaginal discharge
Atrophic vaginitis
2014 feedback
163
UTI Tx in PregC
Nitro, Trimethoprim, Cefalexin
164
PCOS Tx increasing fertility
Clomiphene
165
Most common cause of male infertility
Varicocele
166
Scrotal pain relieved on lifting
Epididimo-orchitis
167
Fetal effects of Paroxetine
Cardiac abnormalities (VSD's/ASD's)
168
Fetal effects of Fluoxetine
Persistent pulmonary hypertension of the newborn
169
Mx of depressin in PregC
Preffered SSRI in PregC
Slowly withdraw and watchful waiting
Sertraline?
170
Dysmenorrhoea vs Menorrhagia
Mx
Painful vs heavy
Dys: NSAIDs (Ibuprofen/Mefanamic acid), COC preparations, (3rd line POP)
Menorrhagia: NSAIDS (Mefanamic acid/tranexamic) or IUS, COCP, long acting progesterones
