Obg (Passmed) Flashcards
Pregnant women: with a BP above 160/110 immediate next step? (query: Pre-eclampsia
Admit to hospital and observe
- arrange same day admission
- after this: start patient of medication: Labetalol, if asthmatic= use Nifedipine
- definitive step: delivery of baby
Most common site of ectopic pregnancy?
Ampulla of the fallopian tubes
- However: most dangerous if in isthmus area
Vitamin B12 deficiency most specific test to get diagnosis?
Intrinsic Factor Antibodies
NB: also predisposes you to Gastric cancer
1st step in management for Post-partum Haemorrhage (PPH)?
After ABC approach, palpate uterus (uterine massage)
- assess what could be the potential cause first? uterine atony: risk factors= Induction of labour, multiple pregnancy (twins for example)
Ectopic Pregnancy management:
Need surgery: - Salpingectomy(removal of one or both fallopian tubes) IF mass is more than 35mm, and a visible heart beat is present on Transvaginal Ultrasound.
- only go for Salpingotomoy surgery if fallopian tubes need to be saved for eg. infertility issues.
- Investigation of choice and to confirm diagnosis: Transvaginal Ultrasound
Gestational Diabetes: Blood glucose targets and management=
- Fasting: 5.3 mmol/L: anything above= start insulin
Endometriosis: (gold-standard diagnostic test)?
- Laparoscopy (is diagnostic) however 1st line is often: Transvaginal Ultrasound
NB Presents with: - Dysmenorrhoea a few days before period, deep dyspareunia, subfertility
Mx: 1st line) NSAIDS/paracetamol for symptomatic relief
2nd line) COCP/progestogen
Secondary treatments:
- GnRH analogues: induces a pseudomenopause due to low oestrogen levels.
Medical termination of pregnancy: (Abortion) medical mx-
- Oral Mifepristone and vaginal Misoprostol
- first take MiFepristone and then take Prostaglandins eg. Misoprostol.
Management for: Pregnant woman with previous VTE history?
Start Low molecular weight heparin (eg. Dalteparin): throughout pregnancy and until 6 weeks postnatal.
NB: DOACs and Warfarin should be AVOIDED in pregnancy.
Atrophic Vaginitis: Mx+Adjunct treatment
- 1st line) Oestrogen Cream
- Lubricants and Moisturisers=useful as adjuncts
- Condition causes vaginal dryness, dyspareunia and occasional spotting
In case of unknown pregnancy location: bHCG levels more than 1500 indicates?
Ectopic Pregnancy
- examination findings: Abdominal tenderness, cervical excitation, adnexal mass
Characteristic features of Endometriosis?
Deep pelvic pain, dysmenorrhoea, dyspareunia and sub-fertility, could also present with a fixed, retroverted uterus + young age around 30yrs old
Fibroid presentation:
- Common pelvic tumour in women
- Px: abnormal uterine bleeding, pelvic pressure and pain+reproductive dysfunction
Cancers associated with: Tamoxifen (given for oestrogen positive breast cancer)
Endometrial Cancer:
- Classical symptom= Postmenopausal bleeding
- Be suspicious in all women over 55 years
Inv:
- 1st line investigation: Trans-Vaginal Ultrasound
- Hysteroscopy with endometrial biopsy
Mx: main treatment= of Endometrial cancer= surgery
Diagnosing criteria for Gestational Diabetes?
- Fasting Glucose: more than 5.6 mmol/L, if more than 7= immediately start insulin
- 2 hour Glucose: more than 7.8 mmol/L
NB: remember by (5678 mnemonic)
Umbilical cord Prolapse mx:
1st Step: Correct position= ask mother to go on all 4’s (on knees and elbows)
2nd) Prepare for immediate c-section
- Tocolytics could be used to reduce uterine contractions
- Is a Obstetric emergency
Stress Incontinence Mx:
- Pelvic Floor Exercises
- Duloxetine
NB: for Urge Incontinence
- Bladder retraining exercises
- Oxybutynin
STI: Trichomonas Vaginalis
- Presents with a strawberry/erythematous cervix, offensive/green frothy vaginal discharge
Mx: With Metronidazole (BV=Bacterial Vaginosis is also treated by this)
Ovarian Cancer Risks:
- Early Menarche as ovarian cancer is hormonal in nature
- Family History
- Late menopause
- Nulliparity
Diagnosis: Laparotomy (surgical incision into abdominal cavity)
Pregnant patients with T1 diabetes: how often monitor glucose levels?
- DAILY: fasting, pre-meal, 1 hour post-meal and bedtime (need regular monitoring)
- Diabetes medication: STOP Gliclazide
PPH management: in order
1st: ABCDE approach
2nd: compress uterus and catheterise patient
3rd: then give IV oxytocin
Other meds to give=
- Ergometrine: unless history of hypertension
-Carboprost: unless history of asthma
1st line surgical option: Intrauterine Balloon Tamponade
Medical Mx. for ectopic pregnancy?
Methotrexate
Management for pregnant women with BP more than 160/110?
Admit into hospital and observe
- Labetalol/ if asthmatic: Nifedipine
Management for woman at moderate/high risk of pre-eclampsia?
Start Aspirin 75-150mg daily from 12wks until birth
Mx of chickenpox in preg?
- if less than 20wks gestation= varicella zoster immunoglobulin
- If more than 20 weeks gestation= Oral Aciclovir
PPH definition: (Including blood volume)-
- Blood loss of more than 500mL after delivery
Pelvic inflammatory disease+RUQ pain diagnosis?
Perihepatitis (Fitz-Hugh Curtis Syndrome
Which anaemia is associated with having lemon tinge to skin?
- Pernicious (vit b12) Anaemia
Gestational Diabetes diagnosis levels:
- Fasting Glucose: more than 5.6 mmol/L
-2 hour Glucose: more than 7.8 mmol/L
If fasting levels is more than 7: give Insulin
complications: Macrosomia
Trichomonas Vaginalis (STI) Mx?
- Oral Metronidazole
- Presents with strawberry cervix, discharge: Green-yellow colour frothy
what does PID(Pelvic Inflammatory Disease) increase the risk of?
- Ectopic Pregnancy
Pelvic Inflammatory disease presentation?
- Dyspareunia
- Bleeding in between periods
- Lower abdominal tenderness
-Vaginal discharge
Mx. of ectopic: in presence of foetal heartbeat?
Need to do: Surgical Management!
- Salpingectomy
Iron deficiency anaemia blood profile?
1) Transferrin: Low
2) Ferritin: Low
3) TIBC (total iron binding capacity): High
If prescribing a SSRI+NSAID, then what else needs to be added?
- PPI: Omeprazole
