O+G Flashcards
Ix for menorrhagia
- FBC
- TVUS if abnormal anatomy is indicated
Initial mx of menorrhagia before TVUS is done?
Tranexamic acid
Mx of PROM at 32 weeks?
admit for at least 48 hours + steroids + antibiotics
Time until effective of progesterone only pill if started NOT on first day of cycle?
2 days
Time until effective of COCP if started NOT on first day of cycle?
7 days
Time until effective of implant/injection if started NOT on first day of cycle?
7 days
Lochia - how long is normal?
6 weeks
mx of endometrial cancer with high risk disease
TAH and BSO
post op RADIOTHERAPY
How should a woman who is having elective surgery on COCP be managed?
Stop COCP 4 weeks before surgery
Restart COCP 2 weeks after surgery
1st line Ix in a pt with infertility after 1 year of trying? when should it be done?
What result would worry you?
day 21 progesterone - i.e. 7 days before next period
If not ovulating, it will be <30
High risk factors for pre-eclampsia?
CKD DM Chronic HTN autoimmune disease antiphospholipid syndrome
Moderate risk factors for pre-eclampsia
positive family Hx 1st pregnancy >40yo BMI>30 Multiple pregnancy
A woman at moderate/high risk of pre-eclampsia - how do you treat her?
75mg aspirin OD from 12 weeks
3 types of breech presentation
Frank = hips flexed, knees extended Footling = one leg at the bottom Full = hips and knees flexed
One major risk with breech presentation
Risk of cord prolapse
How to counsel a mother with breech baby at 36 weeks?
Offer ECV (check rhesus status) If still breech - offer elective CS or vaginal delivery
- mode of delivery has no effect on long term health of the baby
- CS is associated with reduced risk of death of the baby during labour and reduced difficulty in early life.
How long does the implant work as effective contraception? Once inserted, is additional contraception needed?
3 years of effective contraception
Additional contraception needed for first 7 days if not inserted before day 5 of cycle
what is asherman’s syndrome?
intrauterine adhesions which can occur after dilatation and curettage
3 aspects of active management of 3rd stage of labour
- Oxytocin 10IU
- Cord clamping between 1-5 mins after delivery
- Controlled cord traction
Tx of obstetric cholestasis
Ursodeoxycholic acid
Complications of obstetric cholestasis
stillbirth risk
Who needs a higher dose of folic acid?
Either partner has NTD/ /previous pregnancy w NTD/FHx of NTD
Anti epileptics Coeliac disease DM Thalassemia trait BMI>30
DEGREES OF VAGINAL TEARS?
1st - within vaginal mucosa
2nd - beyond vaginal mucosa
3rd - Extends to external anal sphincter
4th - Through external anal sphincter into rectal mucosa
Placental abruption
- Symptoms? Signs?
- Mx?
Symptoms: constant painful bleeding
Signs: tender hard uterus
Fetal heart distressed/absent
- Mx: RESUS. Urgent delivery of baby once stable.
Number of antenatal appointments in 1st pregnancy? in subsequent pregnancies?
1st = 10 Subsequent = 7
In subsequent pregnancies, appointments at 25, 31 and 40 weeks appts don’t happen
Sx of vaginal atrophy
PCB + dyspareunia + dryness
Potential problems with IUDs
1 in 20 will be removed, usually in the first 3 months
Can make periods heavier/longer/painful
Small increased risk of STI in first 20 days
Risk of uterine perforation - 1 in 500.
If a woman is found to have CIN II at colposcopy, when should screening next be?
6 months later
What kinda pregnancy is affected by Twin to twin transfusion syndrome?
Monochorionic twin pregnancies
Complications in multiple pregnancies?
Mother: polyhydramnios, gestational HTN, anaemia, antepartum haemorrhage
Fetus: PTL
Mortality
SGA, malformation
How does Mx of mother with multiple pregnancy differ from normal ?
- US for monthly checks
- Weekly antenatal checks after 30 weeks
- More Fe + folate
- 2 obstetricians at labour
- If not born by 38 weeks –> IOL
RFs for shoulder dystocia
Fetal macrosomia
High maternal BMI
GDM
Prolonged labour
2 complications of shoulder dystocia to the mother?
Perineal tears
PPH
Common complication of fibroids in pregnancy? how is it managed?
Red degeneration
V painful, so Mx is rest + analgesia - resolves in a week
RFs for hyperemesis gravidarum?
Multiple pregnancy 1st pregnancy Hyperthyroidism Trophoblastic disease Obesity
Mx of hyperemesis gravidarum
Acute Mx - do they need IV hydration??
- ANTIHISTAMINES (Promethazine = 1st line)
Complications of hyperemesis
- Mallory-Weiss tear
- Central pontine myelinolysis
- Acute tubular necrosis
- Wernicke’s
Foetus: SGA, PTL
Name 4 Abx completely contraindicated in breastfeeding women
Ciprofloxacin
Chloramphenicol
Tetracycline
Sulphonamides
Which psych drugs can’t be used in breastfeeding women?
Lithium
Benzos
Mx of a woman with GBS bacteriuria during pregnancy?
IV Abx prophylaxis after the start of labour, then every 4 hours until delivery
PTL - what should be given IV?
Benzylpencillin for GBS prophylaxis
If low lying placenta is found at anomaly scan - what do you do next?
Rescan at 34 weeks
If still low at 34 weeks –> rescan every 2 weeks
If still low at 37 weeks offer elective CS
Recommended medication for postnatal depression?
Paroxetine (fluoxetine half life is too long)
in pre-eclampsia, at how many weeks gestation can you consider same day delivery?
34 weeks
Why avoid eating liver in pregnancy?
High vitamin A levels
Which medication used in urge incontinence is avoided in older women
Oxybutynin
From what day post partum can a woman get pregnant again?
day 21 post-partum
What form of contraception can a woman use after having a child?
if <6weeks postpartum: POP
from 6 weeks: POP or COCP
5 causes of oligohydramnios
- IUGR
- Premature ROM
- Fetal renal probs
- Post-term gestation
- Pre-eclampsia
medical management of missed miscarriage
- Vaginal misoprostol
- Anti-emetics + analgesia
- Safety net: go to dr if no bleeding within 24 hours
Expectant management of missed miscarriage?
- watch and wait: will bleed for 7-14 days.
- Safety net: fever, discharge,
Causes of fetal tachycardia on a CTG
maternal pyrexia
Chorioamnioniitis
Hypoxia
Prematurity
Causes of fetal bradycardia on a CTG
Fetal distress e.g. Asphyxia, placental insufficiency
Expectant management of ectopic pregnancy - why is this rarely used? What happens?
Rarely used because the patient MUST be asymptomatic
- Monitor closely for 48 hours - if b-hCG starts to rise OR Sx manifest –> requires intervention
USS shows Ectopic pregnancy with a fetal heartbeat. best course of mx?
Surgical Mx
USS shows Ectopic pregnancy of size 37mm. Best course of Mx?
> 35mm –> surgical mx
Conservative management of urge incontinence?
Bladder retraining - i.e. increasing time intervals between voiding
1st line treatment for a fibroid?
Mirena
RFs for placenta praevia
Multip
parity
previous CS
BNF advise re use of SSRIs in pregnancy?
Avoid due to risk of congenital malformations, unless the benefits outweigh the risks.
How can SSRIs affect the first trimester
congenital heart defects
3 Disadvantages of injectable progesterone
Delayed reversal (12m) Irregular bleeding, weight gain
what class is venlafaxine + duloxetine?
SNRI
Menorrhagia without underlying pathology in a woman who doesn’t need ongoing contraception - management?
Tranexamic or mefanamic acid
Menorrhagia without underlying pathology in a woman who needs ongoing contraception - management? give options 1 2 3
- IUS
- cocp
- long acting progestogens
Though withdrawal - what is it? why so important?
it is a 1st rank sx of schizophrenia
- believes thought is removed by an external force
1st line med for GAD? How do you counsel the patient
sertraline
- Gets worse before it gets better - risk of suicidal ideation + self harm
- WEEKLY review for ONE month
Need for contraception after menopause?
> 50yo: required for 12 months after LMP
<50yo: required for 24 months after LMP
how to detect haemolytic disease of thenewborn on USS?
What Ix can confirm this?
Mx?
Detected by oedema + ascites
- Doppler will detect fetal anaemia + Fetal blood sampling will show anaemia, reticulocytes etc
- Mx with fetal blood transfusion (w USS guidance) +/- post part phototherapy, early IVIG
Management of delivery in woman with pre-eclampsia at 33 weeks gestation + no fetal distress?
Defer delivery and give corticosteroids in a specialist unit. Review in 24 hours
Mx of a 33 week gestation woman with eclampsia?
Deliver - emergency CS
Drugs given in PPROm
- 10 days Erythromycin
- Prophylactic steroids
1st and 2nd line treatment for endometriosis
- NSAIDs/paracetamol
- COCP/progestogens
Medical management of inevitable miscarriage?
What else should be co-administered?
Misoprostol + antiemetics + analgesia
Medical management of an ectopic?
Methotrexate
What is adenomyosis? How is it best visualised?
- Endometrial tissue in ovary
- MRI pelvis
In PCOS, which hormones are elevated?
LH:FSH ratio
Testosterone
Sharp pain on one side of abdomen after intercourse/strenuous exercise.
USS shows free fluid in pelvic cavity
Ovarian cyst rupture
Dx of GDM?
- fasting glucose
- 2hr OGTT
Mx of GDM with fasting glucose of 6.5 and a large for dates baby?
if fasting is 6-6.9, and there is macrosomia/polyhydramnios –> INSULIN TX
Pregnant women who require high dose folic acid?
- prev NTD
- BMI>30!!!
- antiepileptic drugs
- malabsorptive disease
- DM
- thalassemia trait
2 step mx of chroioamnionitis?
- IV broad spec Abx
- IOL
(if <34 weeks, give steroids)
Fitz Hugh Curtis syndrome
PID + liver capsule infection “violin strings”
Combined test measures…?
Nuchal translucency
b-hCG (high in downs)
PAPP-A (low in downs)
quadruple test measures…?
Nuchal translucency
- Oestriol (low)
- AFP (low)
- b-hCG (high)
- inhibin A (high)
biggest RF for cord prolapse
Amniotomy
Clue cells
Bacterial vaginosis
Strawberry cervix
Trichomonas
Tx of trichomonas vaginalis?
Metronidazole (oral)
Mx of pregnant woman at booking with previous VTE?
LMWH immediately and continue until 6 weeks postpartum
Pre-conception Advice to a couple taking methotrexate for RA
BOTH stop methotrexate for 3 months before trying
Ideal position of woman with cord prolapse
Prone + on knees + elbows
Ovarian tumour associated with endometrial cancer
Granulosa cel tumour
Effect of COCP on risk of cervical cancer?
Increased risk
Which forms of contraception require special consideration if giving to a woman >40yo
COCP
Depot
3 main criteria (of which you only need 2) for PCOS?
Polycystic ovaries Irregular periods (long cycles) Hyperandrogenism
Mx of a baby to a mother with +ve HBsAg
Vaccinate (3 shots) + IVIG
If anti-HBc +ve, what does this mean
The patient has been exposed to legit HBV either currently or in the past
Routinely screened for infections in booking?
HIV
Hep B
Syphilis
Bacteriuria
Treatment of vaginal vault prolapse
Sacrocolpoplexy
How to confirm a miscarriage on TVUS?
No fetal heartbeat +
- Fetal pole >7mm
- gestational sac >25mm
4th degree perineal tear?
Rectal mucosa :O
cut off beta hCG level for medical management of an ectopic
<1500
Pseudomyxoma peritonei is a complication of what
Mucinous cystadenoma
2nd line for dysmenorrhea (after NSAIDs)
cocp
Common breast lump seen in woman who recently stopped breastfeeding, who feels generally well
Galactocele
a BP which is an absolute contraindication to COCP?
160/95
RFs for VTE which may indicate antenatal LMWH?
previous VTE = this alone is enough!
BMI>30 Smoker Age >35 Gross varicose veins Immobility 1st deg relative w unprovoked VTE
preg related: current PET
Parity >3
Multip
IVF
Ovarian cancer staging
1: confined to one or both ovaries
2: within the pelvis
3: within the abdomen
4: beyond the abdomen
Important investigations for secondary amenorrhoea
BETA GO PRO AND check EAST THYROID
beta-hcg gonadotrophin Prolactin Androgens Estradiol TFTs
Tx of vasomotor sx of menopause?
SSRI or venlafaxine
List the major risk factors for PET
Prev HTN/PET in pregnancy
CKD
T1 or T2DM
Antihpospholipid/SLE/autoimmune condition
UKMEC4
- Current breast cancer
- Prev history of VTE/stroke/IHD
- Uncontrolled hypertension
- Migraine w aura
- Smoking >15 and >35yo
Contraception in >50yo
- COndoms ?
- COCP?
- Depot?
- POP?
- IUS?
- Condoms: stop 1 year after amenorrhoea
- COCP: recommend stopping at 50yo
- Depot: stop at 50yo
- POP and IUS: can continue! stop at 55 years
value of Hb which indicates anaemia at booking?
<11
abx treatment of trichomonas
Oral metronidazole 2g stat
Chlamydia - abx treatment? give 2 options
Doxy for 7 days
or
Oral azithromycin 1g stat
Gonorrhoea - abx treatment?
IM Ceftriaxone + azithromycin STAT