O&G Flashcards
Components and counselling of a medical abortion
Oral mifepristine taken at the clinic
Vaginal misoprostol taken at home
Follow up
Give supportive advice about what might happen (passage of clots/blood)
Types of surgical abortion
Vacuum aspiration (<14w) (gentle suction) Dilation and evacuation (later) = suction and cutterage to remove any remaining tissue
Rules around abortions
<24w unless risk to mothers life
The reasoning behind = damage to mothers life/mental health/other children
Aspects of O&G Hx
PC
Basic pregnancy questions if relevant
HPC
Previous pregnancies
Any terminations or miscarriages
What is gravidity?
Number of pregnancies
What is parity?
Number of pregnancies past 24w
Key obstetrics questions regarding Sx
Any vaginal bleeding? Any nausea and vomiting? Any itching? Any abdominal pain? Any headache? Reduced foetal movements? Chest pain/SOB ?PE Leg swelling (ruling out DVT)
Types of miscarriage
Complete = passed tissue and os now closed, USS shows no retained tissue Threatened = some bleeding/pain, Os is closed Incomplete = passed some tissue and now pain and os closed Inevitable = os open
Mx of miscarriage
Expectant = wait 7-14 days Medical = Vaginal misoprostol Surgical = Vacuum aspiration if evidence of infection or very painful (risk of haemorrhage)
Stages of labour
1= latent (0-3cm)
1 active = 3-10cm
2 = delivery of the foetus
3 = delivery of the placenta
RF for pre-eclampsia
DIABETES
Previous pre-eclampsia
Multiple pregnancy
Pre-existing renal disease
What does vaginal misoprostol do?
Stimulates uterine contractions
How do you confirm a miscarriage?
TVUSS to look for uterine pregnancy
Features of endometriosis
Abdominal pains
Dysparenuria
Irregular periods
Mx of endometriosis
Analgesia
COCP
GnRH agonists
Endometrial ablation
Symptoms of PID
Unusual discharge
Abdominal pains
RUQP (Fitz-Hugh-Curtis)
Mx of PID
NAAT
IV antibiotics
Analgesia
Features of anti-phospholipid syndrome
Recurrent miscarriages
Recurrent VTE
Lichen planus (webbed rash)
Mx of anti-phospholipid syndrome
Aspirin
Warfarin if still getting recurrent Sx
Ix for anti-phospholipid syndrome
Coagulation Ix
Anti-cardiolipin
Lupus antibodies
Features of pre-eclampsia
Oedema
Headache
High blood pressure
Proteinuria
Mx of pre-eclampsia
Labetalol or if asthmatic -> nifedipine
CTG during labour
Cut off for labetalol in pregnancy
160/110
Risks of pre-eclampsia
Foetal prematurity
Growth retardation
Eclampsia
Haemorrhage
What is eclampsia?
The development of seizures in association with pre-eclampsia
Its caused by cerebral oedema
Mx of eclampsia
Magnesium sulphate
Can cause resp depression in which case give calcium gluconate
Amount of proteinuria to Dx pre-eclampsia
0.3g protein / 24hr
Symptoms of STI
Dysparaenuia Offensive discharge Itching Lesions PID Infertility
Mx of STI
STI screen and referral to STI clinic
NAAT testing
Antibiotics IM or ?course
Azithromycin
Symptoms of ovarian cancer
Abdominal bloating Abdominal pain Urinary symptoms (from pressure)
Ix for ovarian cancer
CA125 (also raised in endometriosis, cysts and PID)
TVUSS
Abdominal ultrasound
Mx of ovarian cancer
Chemotherapy
Surgery
How does the COCP affect cancer rates?
Reduces ovarian and endometrial cancer
Increases breast and cervical cancer
Most common ovarian cancer
Serousadenoma (epithelial)
RF for ovarian cancer
More oestrogen exposure (earlier menarche, tamoxifen, lynch syndrome, BRCA)
Treatment for bacterial vaginosis and trichomonas
Oral metronidazole
Dx of PCOS
12+ cysts in ovary
Hirsuitism
Anovulation/irregular periods
What do you give during labour for GBS
Benpen
Sx and Dx of endometrial cancer
Often post-menopausal vaginal bleeding TVUSS shows thickened endometrium (>5mm) Endometrial biopsy (pipelle biopsy)
Mx of endometrial cancer
Hysterectomy +/- bilateral salpingectomy
Things to measure in amenorrhoea
Brings Oars To Paddle B-HCG Oestrogen Thyroid Prolactin
Cut off in size for ovarian cysts before you do a laparoscopy?
5cm
Mx of post-partum haemorrhage
ABC
Uterine massage
IV syntocinon
IV carboprost (contraindicated in HTN)
Which hormone surges to induce ovulation?
LH
What score on Bishops indicates the need to induce
<5
Which hormone prepares the endometrium?
Progesterone
Mx for PPROM
Inspect the abdomen
CTG
Sterile speculum examination (look at the fluid as well)
If its amniotic, give erythromycin for 10 days or up until labour! Because risk of amniocentesis
At what age range do you give corticosteroids to the mother if premature?
24w-34w
Sx of acute fatty liver of pregnancy
3rd trimester
Systemically unwell
N+V
Anorexia
Mx of acute fatty liver of pregnancy
IV fluids
Dextrose
Mx of gestational diabetes
5mg folic acid at the start then at 12w start aspirin
Refer to gestational diabetes clinic
Mx depends on glucose levels
<7 can give lifestyle and exercise advice for 2w
If doesn’t improve then start insulin
Indications for C-section
Breech
2x previous C-section
Foetal distress
Eclampsia
Things that increase the risk of an ectopic pregnancy
PID
Endometriosis
Previous ectopic
Previous surgery e.g. for cyst removal
What is adenomyosis and what are the symptoms?
Endometrium penetrates the myometrium
Results in abdominal cramps
Bloating before periods
Heavy periods
Mx for adenomyosis
Pain killers
GnRH agonists
Hysterecomy
Gonorrhoea Mx
Ceftriaxone
Chlamydia Mx
Azithromycin and doxy
FIGO staging
1 = confined to cervix 2 = confined to pelvis 3 = invaded nearby tissues 4 = distance invasion
Sx of polyps
Light, intermenstual bleeding -> endometrial
Cervical -> post-coital bleeding
Sx of PUPP
Rash of pregnancy Spares the umbilicus In stretch marks Light pink Hives like rash
Components of APGAR?
How Ready Is This Child? HR RR Irritable Tone Colour
Mx of hyperesmesis gravidarum
Pabrinex
IV hydration
Promethazine
Admit if any electrolyte abnormalities or can’t tolerate fluid/lost a lot of weight
Features of HELLP syndrome
Haemolysis
Elevated liver enzymes
Low platelets
Sx of HELLP syndrome
Fatigue
DIC
RUQP
Features of menopause
Hot flushes
Vaginal dryness
Irritable
Mx of menopause
A natural part of ageing
In the interim as the body adjusts you can give HRT, SSRI, new generation COCP and lubricant
How long without a period until it counts as menopause?
1 year
premature ovarian failure?
40
Ix for premature ovarian failure
All the amenorrhoea Ix (BOTP)
FSH levels
What causes the symptoms in menopause?
Reducing oestrogen levels
Mx of PCOS
COCP
Fertility assistance = clomifene and metformin
Emergency contraception options
Most effective = IUD
Levonorgestrol = < 3 days
EllaOne = < 5 days
Features of implantable contraceptives
Slowly releases progesterone
Lasts for 3 years
Irregular bleeding is a common side effect
Mx of ectopic pregnancy
Methotrexate
Follow up scans
If large or high B-HCG levels need surgical salpinectomy or otomy
Ix for ectopic pregnancy
Pregnancy test
TVUSS
Features of premature labour
Weak contractions
Dilated cervix
Too early along, say 27w
Mx of premature labour
Admit and administer tocolytic drugs such as nifedipine
Give steroids
Risks of prematurity
Necrotising enterocolitis
Increased mortality
Jaundice
Indications for induction of labour
Prolonged pregnancy (41w) PROM Diabetic mother (38w because macrosomia)
Method for induction of labour
Membrane sweep
Intravaginal prostaglandins
Syntocinon (CTG if you are inducing with oxytocin)
Artificial rupture
RF for gestational diabetes
BMI >30
Previous macrosomic baby
Screening for gestational diabetes
If RF -> OGTT
Mx of cervical cancer
Hysterectomy + lymph node clearance
Cone biopsy (increased risk of miscarriage)
Radiotherapy and chemotherapy
HPV risk factors
SMOKING
HIV
High parity
Causes of menorhagia
Fibroids
PID
Dysfunctional uterine bleeding
Hypothyroidism
Symptoms of gonorrhoea
Thin, purulent discharge
Dysuria
Dyspareunia
Intermenstrual bleeding
Sx of herpes
Tingling/burning
Blisters
Dysuria
Mx of herpes
Aciclovir
Symptoms of syphilis
Painless ulcers
Cottage cheese discharge
Low pH
Dx and Mx
Thrush (vaginal candiadis)
Clotrimazole cream
Features of placenta previa
Low lying placenta
Painless, bright red blood loss in the 3rd trimester
Confirm with TVUSS
Features of trichomonas
Green discharge
Frothy
Strawberry cervix
Mx of fibroids
Myomectomy
Ix for fibroids
Examination and USS
Aspects of an infertility Hx
LMP Regular periods Regular sex Partner any issues Testing Previous STI? Structural issues
What is Sheehan’s syndrome?
A complication of severe PPH
The pituitary gland can be damaged leading to necrosis
The patient will present with lack of milk production (due to inadequate prolactin)
Advice for breastfeeding
Ensure a good latch
Feed regularly
Allow the baby to drain the breast (feels soft and empty), this will prevent milk stasis
If blocked duct, keep feeding, this will help to clear it and reduce tenderness
What is the premalignant stage of cervical cancer?
Cervical intraepithelial neoplasia (CIN)
How do HPV 16 and 18 induce cervical cancer?
Inactivate tumour suppressors
At what year are patients invited for a cervical smear?
25yo
Causes of primary amenorrhoea
Turners
CAH
Causes of secondary amenorrhoea
Pregnancy Hypothalamic (stress) Menopause POF Anorexia
Causes of vaginal bleeding
Endometrial cancer Submucosal fibroid Endometrial polyp Endometriosis Adenomyosis
Cervical polp, ectropion or cancer
Management of bleeding from things like fibroids
Mirena coil
Types of urogenital prolapse
Cystocele
Rectocele
Uterine prolapse
Mx of intrahepatic cholestasis of pregnancy
3rd trimester
Itchy
Raised bilirubin
Treat with ursodeoxycholic acid
Clinical features of placental abruption
Shock out of keeping with visible loss
Severe constant pain
Absent foetal heart beat
Tender, tense uterus
Treatment of atrophic vaginitis
Topical oestrogen cream
Vaginal lubricants and moisturisers
