O&G Flashcards
emergency contraception <72 hours after UPSI
levonogestrel
fetal varicella syndrome triad
1) eye defects
2) limb Hypoplasia
3) microcephaly`
pregnant lady comes with chicken pox rash- what to do
start treatment of aciclovir, too late to check IG/give IG
pregnant lady -contact with chicken pox, hx of chicken pox - what to do
check her IGg levels, if low needs top up
emergency contraception <5 days >72 hours
IUcopper D- not mirena
other benefits of COCP for young women
1) treats acne
2) treats irregular periods
only useful contraceptive for HIV
condoms
what virus causes warts on vulva and perineum in young women
HPV 6 and HPV 11
high risk(PMHx DM, past history of large baby, >4.5kg BW, Fhx of GDM) of Gestational diabetes- what screening(
Glucose tolerance test at 20-28 weeks gestation
missed miscarriage key finding
1) no bleeding , sometimes brown discharge
2) no fetal heart activity
missed miscarriage management
- watch and wait
- misoprostol
- ERCP
complete miscarriage definition
any treatment
- bleeding and complete passage of sac and placenta
- no need for D&C
Threatened miscarriage
- vaginal bleeding and cramping
- cervix closed
- watch and wait
incomplete miscarriage
- extremely heavy bleeding and cramps.
- USS showed products of conception
inevitable miscarriage
- increasing bleeding and cramps
- rupture of membranes
- CERVICAL OS IS OPEN- key difference between threatened
70 year old with recurrent UTI and urgency- biopsy showed atrophic vaginitis(thinning of skin around urethra can cause this) treatment
oestradiol cream
why cant you give warfarin to pregnant women
it is teratogenic- crosses into fetus
why is pyelonephritis more common in pregnant women
pregnancy causes dilation of ureters and calyces
symphysis pubis dysfunction key management
explain and reassure it will go away after birth.
dichorionic pregnancy- need to look out for maternal anaemia-what ix
FBC- at 20-24 weeks to assess need for iron supplementation
folic acid 5mg vs 400mcg
5mg- high risk- epileptics.
400mcg-normal
lymphomagranulomavenereum
- organism
- stages
- symptoms
- chlamydia trachomatis
- step 1- painless genital ulcer
- step 2-10 days to 6months later- lymphadenitis(painful lymphadenopathy), proctocolitis(painful defecation) and cervicitis(non-offensive vaginal discharge)
features of severe eclampsia(4)
- severe headache
- visual disturbances
- epigastric pain
- hyper-reflexia/clonus
type of discharge with vaginal candidiasis
thick paste like cheesy discharge
contraindications for progesterone only pill(2)
1) active liver disease
2) active breast cancer
features of congenital rubella(quite a few)- brain size
- heart
- brain function
- liver and spleen
- microcephaly- NOT hydrocephalus
- cataracts
- cardiac lesions
- cerebral palsy
- thrombocytopenia
- jaundice, hepatomegaly and cerebral calcification
number of ulcers for syphillis
one single painless chancre- key way to differentiate from herpes
painless vaginal bleeding >28 weeks
placenta praevia
painful bleeding with shock
placental abruption
exaggerated pregnancy symptoms(severe hyperemesis) + large for dates _+ snowstorm appearance on USS
molar pregnancy/hydatidiform mole
septic pelvic thrombophlebitis
- pain and fever post-partum period
- not respond to initial abx
- responds to heparin + abx
- needs CT/MRI for diagnosis
when is anti d given to rhesus negative mothers(3)
- at 28 weeks
- at 32 weeks
- after circulation contact-amniocentesis, miscarriage/ectopic pregnancy
key things to do for HIV positive pregnancies to reduce transmission
- advise not to breastfeed
- <50copies/ml viral load can have a vaginal delivery. all others should have a c-section after 39 weeks
- should start anti-retroviral therapy
- large pelvic mass that causes urinary urgency
- vaginal bleeding and discharge
- taking tamoxifen
- uterine leiomyosarcoma(malignant growth of myometrium muscle)
- key way to differentiate endometrial CA- endo Ca does not have a mass presentation
CTG - pathological trace, Fetal blood sampling - ph- >7.10- foetal distress and hypoxia. plan
immediate delivery- c section if cervix is not fully dilated
baby with purulent discharge and lid swelling B/L
gonorrhoea
things to avoid for pregnant women with regards to the following:
1) toxoplasmosis
2) listeria
1) toxo- avoid changing cat litter
2) listeria- avoid soft cheese, pate, unpasteurised milk
why is meconium released in utero? what to do?
- sign of fetal distress
- deliver the baby- induction with continuous CTG
- if CTG is abnormal will need c-section
what to do about a breech pregnancy with regards to delivery
- offer an elective c -section at 39-40
- offer emergency if in labour
assisted delivery vs c-section- when to push for c-section
when cervix is not dilated to 10
what to do if not delivering after term
- membrane sweep and book for induction in maternity unit
uk peri natal mortality rate definition
the number of still births and early neonatal deaths per 1000 live births and still births
neonatal mortality rate
total number of neonatal deaths per 100 live births
PCOS biochemical markers(fsh/LH ratio)
LH:FSH ratio high( more cysts giving out LH)
menopause will have more LH
what is the commonest cause of maternal death in the uk
PE
first-line rx for menorrhagia who is trying to get pregnant
tranexamic acid
first line treatment for dysmenorrhea associated with menorrhagia
mefenamic acid
RF for PMS
- hysterectomy with ovary conservation
- POP contraception
management of pms
- lifestyle changes
- COCP
what type of HRT still produces a monthly bleed
continuous oestrogen and cyclical progesterone
antibiotic class that is safe to give in pregnancy
- penicillins
- cephalosporins
HIV, prolonged rupture of membranes, retained products of conception, obesity, diabetes, manual removal of the placenta, extremes of productive age are risk factors for what post -partum.
Endometritis
endometritis is 10 times more common after?
C-section
symptoms of endometritis
fever, tachycardia, abdo pain, vaginal discharge and post partum haemorrhage accompanied by general malaise
Primary Post partum Haemorrhage
- when
- most common cause
upto 24 hours after delivery
Uterine atony
Secondary Post-partum Haemorrhage
- when
- most common cause and key investigation
- 24 hours-12 weeks post partum
- retained placental tissue
- USS
prophylaxis for preclampsia(reduces occurence, reduces perinatal mortality, reduces IUGR)
when to start
Aspirin(from 12 weeks)
supplementation for pregnancy normal patient
folic acid 400mcg and Vit D 10mcg
CTG- worrying signs
late deceleration- foetal distress(asphyxia/placental insufficiency)
Variable deceleration-cord compression
baseline bradycardia(HR<100)-increased fetal vagal tone, maternal beta blockeir use
Baseline tachycardia(HR>160)- maternal pyrexia, chorioamnionitis
unique signs of ovarian hyperstimulation syndrom
jaundice, ascites, anuria
severe- thromboemoblism, acute respiratory distress syndrome
baby blues management
reassurance
other complications of pre-eclampsia(extra-gynae)
intracerebral haemorrhage,
pulmonary oedema
after 20 weeks, symphysis-fundal height in cm= gestation in weeks
same gestation in weeks
grop b strep other name
streptococcus agalactiae
biggest issue with smoking in pregnancy
increased risk of pre-term labour
simple cyst follow up- premenopausal
repeat USS in 8-12 weeks
postmenopausal women - cysts
needs referral to gynaecology for assessment as a physiological cyst is unlikely
treatment of breastmilk related candida
- continue breastfeeding
- topical miconazole cream to nipple and oral mucosa of infant
commonest ovarian cyst
follicular cyst
hyperemesis gravidarum triad
1) 5% pre-pregnancy weight loss
2) dehydration
3) electrolyte imbalance
key issue with unopposed oestrogen
endometrial cancer
antenatal cytomegalovirus infection
cerebral calcification, microcephaly, sensorineural deafness.
parvovirus B19 antenatal infection
hydrops fetalis
