OBGYN Flashcards
A CTG is showing a single prolonged deceleration with baseline <100/min for >3 minutes. This is occuring in a prolonged labour. What is the management?
Inform senior
Preparation for urgent Category 1 CS
Vasa praevia can present similarly to placenta praevia in that they both have painless vaginal bleeding. What 2 other features would you expect of vasa praevia?
Fetal bradycardia
Membrane rupture
A woman is discovered to be GBS positive; how should this risk to the fetus be managed with respect to delivery?
Intrapartum antibiotics;
IV benpen given asap at start of labour and then 4 hourly until delivery.
Which SSRI is excreted in breast milk and because of it’s longer half life may potentially cause toxicity in babies?
Fluoxetine
(Citalopram is also secreted in breast milk but not thought to be an issue)
What are the antidepressants of choice in women who are breast feeding?
Paroxetine
Sertraline
What are the first and second line options for endometriosis?
NSAIDs and paracetamol
COCP (unless contraindicated e.g. migraine with aura) or POP
GnRH analogue; these act to induce a menopause state; side effects of menopause
What are the symptoms of endometriosis?
Deep dyspareunia
Dysmenorrhoea
Tender nodularity at the posterior vaginal fornix
Worse during the luteal pahse day 15-28 as pain is caused by ectopic endometrial tissue proliferating in response to rising oestrogen levels.
What is the agent of choice for stress incontinence?
Duloxetine
What are the parameters for medical treatment of a uterine fibroid, and what are the medical options?
<3cm in size
Not distorting the uterine cavity
Managing menorrhagia:
IUS
Mefenamic acid
Tranexamic acid
COCP
POP
Injectable progesterone
Shrinking:
GnRH agonists
Surgical options include myomectomy, hysteroscopic endometrial ablation, hysterectomy or uterine artery embolization
What is the first line treatment for menorrhagia?
IUS / Mirena (levonorgestrel)
The NHS now tests for high-risk HPV and then uses that result to define next management in their screening programme. Outline what will happen if a) HPV negative b) HPV positive
HPV negative = normal recall
HPV positive: cytology done.
Cytology ABNORMAL; colposcopy
Cytology NORMAL; repeat smear in 12 months
Cytology ‘inadequate’; repeat in 3 months; 2 consecutive inadequate samples = colposcopy
A woman is 24 weeks pregnant and presents within 24 hours of developing a chicken-pox rash. What is the treatment?
Oral aciclovir
If the woman in <20 weeks, aciclovir should be considered with caution.
Chickenpox exposure can be distressing for pregnant women; what should be done if a pregnant woman is exposed to chickenpox, but she has not developed a rash?
Urgent varicella antibody check.
Oral aciclovir is given as PEP, but it is given at day 7-14 after exposure.
What is adenomyosis and how would it present?
Endometrial tissue embeds in the myometrium.
More common in women >30 who are multiparous.
Dysmenorrhoea
Menorrhagia
Enlarge, boggy uterus
TVUS first line
Similar treatments to fibroids
What happens to uterine fibroids in pregnancy?
They can grow due to the increased oestrogen.
They can grow too large for their blood supply though, and THEN degenerate.
Deep dyspareunia and pelvic pain can indicate this growth.
A girl is taking the COCP. She has missed 2 pills in week 3; what should she be advised to do?
Take missed pill now (1), and finish pills in current pack and start new pack immediately, omitting the pill free interval.
What is the MOA of tamoxifen in breast tissue, and how does it increase the risk of a certain type of other cancer?
Oestrogen receptor antagonist in breast tissues.
At other sites e.g. endometrium it may act as an agonist, therefore a reason for increasing risk of ENDOMETRIAL cancer.
State some risk factors for endometrial cancer:
Excess oestrogen; early menarche, nulliparity, late menopause, unopposed oestrogen e.g. this is why prog is given in HRT
Metabolic syndrome e.g. obesity, DM, PCOS
Tamoxifen
HNPCC
PMS symptoms management:
Moderate = new gen COCP
Severe = SSRIs
A first degree perineal tear is superficial damage with no muscle involvement, and does not require any repair. What is classed as a 2nd, 3rd and 4th degree tear?
2nd; perineal muscle involvement but NOT anal sphincter.
3a <50% External Anal Sphincter involvement
3b >50% EAS
3c IAS involvement
4 rectal mucosa involvement
Describe the management of perineal tears.
2nd degree = suture on ward
3rd degree = repair in theatre
4th degree = repair in theatre
The normal dose of preconception folic acid is 0.4 mg OD. Some women are at increased risk of NTD and require a higher dose. Who are these women (6) and what dose do they require?
5mg
Previous child with NTD
Diabetes mellitus
Women on antiepileptics
BMI >30
HIV positive taking cotrimoxazole
Sickle cell disease
What organism may present with a ‘strawberry cervix’, what other features may it have and how is it managed?
Trichomonas vaginalis = strawberry cervix
Also ‘musty’, frothy, green vaginal discharge.
Treat with ORAL METRONIDAZOLE
What is Amsel’s criteria, and how should a positive result be treated?
For diagnosis of bacterial vaginosis.
3 out of 4 should be present.
Thin, white, homogenous discharge
Clue cells
Vaginal pH >4.5
Positive whiff test / fishy odour
Treat with ORAL METRONIDAZOLE
What are the layers of tissue between the skin and the baby that must be cut through during a CS?
Superficial and deep fascia
Anterior rectus sheath
Rectus abdominis (pushed aside)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
Discuss the increased risk / protective ability of the COCP for 4 different types of gynaecological cancers.
PROTECTIVE AGAINST: ovarian and endometrial
INCREASES RISK OF: cervical and breast
When is acute fatty liver of pregnancy most likely to occur, and give some clinical features.
3rd trimester or immediately after delivery
Abdo pain
N&V
Headache
Jaundice
Hypoglycaemia
Severe = pre-eclampsia
ALT >500
Obstetric cholestasis occurs in 1% of pregnancies and is generally seen in the 3rd trimester. What are some clinical features, and how is it managed?
Raised bilirubin
Pruritis often in palms and soles
NO RASH
Ursodeoxycholic acid is used for symptomatic relief
Weekly LFTs
Induction at 37 weeks
Most common benign ovarian tumour in women under 25:
Dermoid / teratoma
Most common cause of uterine enlargement in women of reproductive age?
Follicular cyst
And also most common type of ovarian cyst
What does the Pearl Index describe?
Efficacy of hormonal contraceptives.
It described the number of pregnancies that would be seen if 100 women were to use that method of contraception for 1 year.
Describe the different category types of CS.
Cat1 - immediate threat to life, should be done within 30 minutes.
Cat2 - maternal or fetal compromise not immediately life threatening (within 75 mins)
Cat3 - delivery required but everyone is stable
Cat4 - elective
Contraindicatins to VBAC:
Previous uterine rupture
Classical (vertical) caesarean scar
What are the diagnostic thresholds for gestational diabetes?
Fasting >5.6
2 hour >7.8
If fasting <7 , trial diet and exercise and then metformin
If fasting >=7 then initiate insulin straight away
When should pregnant women be advised to avoid flying?
> 37 weeks if no additional risk factors
> 32 weeks if multiple pregnancy
Mutations in the BRCA1 and BRCA2 genes increase risk of which cancers?
Breast
Ovarian
Treatment of moderate PMS:
New generation COC, e.g. containing drospirenone
What are the stages of postpartum thyroiditis and how is it usually managed?
- Thyrotoxicosis
2.Hypothyroidism - Normal thyroid function, but has high recurrence rate in future pregnancies
Propanolol for symptom control of thyrotoxicosis.
Hypothyroid phase = thyroxine.
A transgender man is taking testosterone, which contraceptive options are not available to him?
Anything containing oestrogen, as can antagonist the effects of testosterone therapy.
You need to establish a woman’s mid-luteal progesterone levels. When should the test be taken in regards to her menstrual cycle?
7 days before the end of the regular cycle.
Which type of surgical management is first line for an ectopic pregnancy in a woman who has no other risk factors for infertility?
LAPAROSCOPIC SALPINGECTOMY
