OBGYN Flashcards
Levonorgestrel can Be taken
Within seventy two hours of unprotected sexual intercourse
How does uli pristal work
Inhibits Ovulation
When can ullipristal still be taken
No later than a hundred and twenty hours after unprotected intercourse
Big caution for ulliprisyal
Asthms
When can an IUD be used as a form of emergency contraception
Must be inserted within five days of unprotected sexual intercourse
If a woman presents after five days, then an r u d may be fitted up 25 days after the likely ovulation dates ie fourteen days
What is nexplanon
Subdormal contraceptive which slowly releases protester on hormone
Works by preventing ovulation
Adverse effects of nexplanon
A regular or heavy bleeding
Headache nausea breast pain
When is the early scan to confirm dates
10 - 13+6 weeks
When can I u d be relied on for contraception after insertion
Immediately
When can I us be relied upon for contraception following insertion
After seven days
The most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation is
increased risk of endometrial cancer
COCP UKMEC 3
more than 35 years old and smoking less than 15 cigarettes/day
BMI > 35 kg/m^2*
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
COCP UKMEC4
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
risks of HRT
Venous thromboembolism: a slight increase in risk with all forms of oral HRT. No increased risk with transdermal HRT.
Stroke: slightly increased risk with oral oestrogen HRT.
Coronary heart disease: combined HRT may be associated with a slight increase in risk.
Breast cancer: there is an increased risk with all combined HRT although the risk of dying from breast cancer is not raised.
Ovarian cancer: increased risk with all HRT.
NICE (2008) advise giving anti-D to non-sensitised Rh -ve mothers at
28 and 34 weeks
Medical management of urge urinary incontinence
antimuscarinics are first-line
NICE recommend oxybutynin (immediate release), tolterodine (immediate release) or darifenacin (once daily preparation)
mirabegron (abeta-3 agonist) may be useful if there is concern about anticholinergic side-effects infrail elderly patients
Medical management of stress incontinence
duloxetinemay be offered to women if they decline surgical procedures
a combined noradrenaline and serotonin reuptake inhibitor
mechanism of action: increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
Contraception is not required until when postpartum
Day twenty one
The RCOG has produced guidelines suggesting the following classification of perineal tears:
first degree: superficial damage with no muscle involvement - do not require any repair
second degree: injury to the perineal muscle, but not involving the anal sphincter - requiresuturing
third degree : injury to perineum involving theanal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
require repair in theatreby a suitably trained clinician
fourth degree: injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa
When is the anomaly scan
18 - 20+6 weeks
In continental screening when is the downs syndrome screening performed
11 - 13+6 weeks
What cancers is COCP protective against
cOc - prOtective against Ovarian and endOmetrial cancer
Which contraceptives inhibit ovulation
COCP
Despgertrel pill but not other POP
Injectable + implantable
Levenogestrel
Ullipristal
How does IUS work
Prevents endometrial proliferation
how does POP work
Thickens cervical mucus
Endometriosis management
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens e.g. medroxyprogesterone acetate should be tried
Premature ovarian Insufficiency management
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)
it should be noted that HRT does not provide contraception, in case spontaneous ovarian activity resumes
Drugs to be avoided in breastfeeding
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
Follicular cyst features
Commonest typer of ovarian cyst
Commonly regress after several menstrual cycles
Serous cystoadenoma features
the most common benign epithelial tumour which bears a resemblance to the most common type of ovarian cancer (serous carcinoma)
bilateral in around 20%
Mucinous cydtoadenoma
second most common benign epithelial tumour
they are typically large and may become massive
if ruptures may cause pseudomyxoma peritonei
Corpus luteum cyst features
during the menstrual cycle if pregnancy doesn’t occur the corpus luteum usually breaks down and disappears. If this doesn’t occur the corpus luteum may fill with blood or fluid and form a corpus luteal cyst
more likely to present with intraperitoneal bleeding than follicular cysts
Who is screened for cervical ca and how often?
25-49 years: 3-yearly screening
50-64 years: 5-yearly screening
When is medical or surgical management of miscarriage indicated
increased risk of haemorrhage
previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage)
evidence of infection/
Medical management of miscarriage
Vaginal misoprostol
First line management of miscarriage
waiting for 7-14 days for the miscarriage to complete spontaneously
If expectant management is unsuccessful then medical or surgical management may be offered
Ix reduced fetal movements
Initially, handheld Doppler should be used to confirm fetal heartbeat.
If no fetal heartbeat detectable, immediate ultrasound should be offered.
If fetal heartbeat present, CTG should be used for at least 20 minutes
Secondary dysmenorrhoea cause and mx
endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids
Clinical Knowledge Summaries recommend referring all patients with secondary dysmenorrhoea to gynaecology for investigation.
Bishop score interpretation
a score of < 5 indicates that labour is unlikely to start without induction
a score of ≥ 8 indicates that the cervix is ripe, or ‘favourable
Indications induction of labour
prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery
prelabour premature rupture of the membranes, where labour does not start
maternal medical problems
diabetic mother > 38 weeks
pre-eclampsia
obstetric cholestasis
intrauterine fetal death
Induction labour options
if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion
