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Finals > OBGYN > Flashcards

OBGYN Flashcards

1
Q

Preterm labour is weeks

A

37

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2
Q

Post-term labour is >? weeks

A

42

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3
Q

How can you work out estimated delivery date

A

1st day of LMP + 9 months and 7 days
OR
1st day LMP + 40 weeks

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4
Q

Trimester 1 is

A

0-12 weeks

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5
Q

Trimester 2 is

A

12-27 weeks

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6
Q

Trimester 3 is

A

27-40 weeks

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7
Q

When can you hear fetal heart beat with doppler

A

From 12 weeks

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8
Q

When can you hear fetal heart beat with Pinard and where do you listen

A

From 24 weeks

Over the anterior shoulder

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9
Q

Describe the position of the uterus and how/when it ascends throughout pregnancy

A

<12 weeks: in pelvis
16 weeks: half way between PS and umbilicus
20-34 weeks: at umbilicus
36 weeks: under ribs

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10
Q

When does the head engage in a) primips b) multips

A

Primips 37 weeks (if not consider placenta previa)

Multips onset of labour

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11
Q

Definition of maternal death

A

During pregnancy or within 42 days of birth

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12
Q

Risk factors assessed for VTE in pregnancy

A 
BMI 30+ (40+ counts as 2)
Age >35
Parity 3+
Smoker
Varicose veins
Pre-eclampsia
Immobility
1st degree with unprovoked VTE
Thrombophilia
Multiple pregnancy
IVF
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13
Q

Aspirin is giving in pregnancy to reduce the risk of what complication?

A

Pre-eclampsia

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14
Q

Risk factors for pre-eclampsia

A 
Hypertensive disease in previous pregnancy
CKD
Autoimmune disease - SLE, APLS
DM
Chronic HTN
First pregnancy
Age 40+
>10 years between pregnancies
BMI 35+
FH of pre-eclampsia
Multiple pregnancy
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15
Q

If a patient is considered high risk for pre-eclampsia what medication do you start, what dose and when

A

Aspirin 75mg OD 12-37 weeks

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16
Q

Indications for OGTT at 26 weeks

A 
BMI >30
Previous baby >4.5kg
1st degree relative with DM
Family origin: South Asian (India, Pakistan, Bangladesh), Chinese, Black Caribbean, African, Middle Eastern (Saudi Arabia, United Arab Emirates, Iraq, Syria, Oman, Qatar, Kuwait, Lebanon, Egypt)
Previous unexplained FDIU
Previous congenital abnormality
PCOS
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17
Q

Indications for OGTT at 16 weeks

A

Previous GDM

Severe PCOS

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18
Q

When should folic acid be taken?

A

3 months before conception and until 12 weeks gestation

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19
Q

What is the normal dose of folic acid

A

400 micrograms

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20
Q

What are some indication for higher dose folic acid (5mg)

A

High BMI
Hx of NTH (personal or FH)
Antiepileptic medication
DM

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21
Q

Risks of alcohol in pregnancy

A

IUGR
Facial abnormalities
Learning abnormalitis

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22
Q

Risks of smoking in pregnancy

A 
LBW
Preterm labour
SIDS
Miscarriage
Neonatal breathing difficulties
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23
Q

Which vitamin should be avoided during pregnancy

A

Vitamin A (>700mcg) - so avoid liver products

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24
Q

How long is maternity leave and how long is maternity pay

A

52 weeks leave

39 weeks pay

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25
Q

When should nausea and vomiting resolve spontaneously by in pregnancy

A

Around 16-20 weeks

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26
Q

Common symptoms in pregnancy

A 
Nausea and vomiting
Constipation
Haemorrhoids
Heartburn
Varicose veins
Vaginal discharge
Backache
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27
Q

Which medication is used to treat vaginal candida during pregnancy

A

Topical Imidazole

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28
Q

How many routine antenatal appointments are offered for a) primips b) multips

A

Primips - 10

Multips - 7

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29
Q

In general, how frequent are antenatal appointments

A

4wkly to 28
2-3wkly to 36
weekly 36+

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30
Q

Appointment weeks for primips

A

<12, 16, 25, 28, 31, 34, 36, 38, 40, 41

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31
Q

Appointment weeks for multips

A

<12, 16, 28, 34, 36, 38, 41

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32
Q

What happens at a booking visit

A 
General advice/info
Risk factors screened for VTE, GDM and Pre-eclampsia
BMI + BP + urine dip
Screening counselling
Assess for DV and FGM
Bloods
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33
Q

What bloods are done at booking

A

HIV, HBV and syphilis
Hb and platelet level
Blood group and antibody status
If family origin questionnaire high risk: sickle cell and thalassaemia.

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34
Q

At how many weeks do you start measuring SFH

A

25/26 weeks

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35
Q

When during pregnancy do you test for anaemia

A

At booking and 28 weeks

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36
Q

At how many weeks do you give the first and second dose of anti-D

A

28 and 34

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37
Q

At how many weeks do you have discussions/plans for delivery

A

34

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38
Q

At how many weeks do you discuss post-natal care

A

36

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39
Q

When can the combined test be performed

A

11-14 weeks

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40
Q

When can the quadruple test be performed

A

14-20 weeks

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41
Q

Which abnormalities does the combined test assess the risk of

A

Trisomy 21, 18 and 13

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42
Q

Which factors are assessed in the combined test

A

Nuchal transluscency
hCG
PAPP-A
Age

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43
Q

Which disorder does trisomy 21 cause

A

Down syndrome

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44
Q

Which disorder does trisomy 18 cause

A

Edwards syndrome

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45
Q

Which disorder does trisomy 13 cause

A

Patau’s syndrome

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46
Q

What does the quadruple test assess the risk of

A

Down syndrome only

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47
Q

What is measured in the quadruple test

A

AFP
Unconjugated estradiol
hCG
Inhibin A

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48
Q

When is the anomaly scan performed

A

18-21 weeks

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49
Q

In Down syndrome are PAPP-A, beta-hCG, AFP, Inhibin A and unconjugated estridiol high or low

A

Unconjugated estridiol, AFP and PAPP-A low

Inhibin-A and Beta-hCG high

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50
Q

When can CVS be carried out

A

10-13 weeks

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51
Q

Risk of miscarriage in CVS

A

1-2%

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52
Q

When can amniocentesis be carried out

A

15+ weeks

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53
Q

Risk of miscarriage in amniocentesis

A

0.5-1%

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54
Q

When can the private non-invasive screening test be carried out

A

10+ weeks

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55
Q

How much does the private non-invasive screening test cost

A

£400

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56
Q

Roughly when would you expect to feel fetal movements

A

20+ weeks

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57
Q

At how many weeks do you give prophylactic anti-D

A

28 + 34

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58
Q

If a patient has a resus sensitising event or +ve cord sample how quickly should you give treatment dose anti-D

A

Within 72 hours

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59
Q

Rhesus sensitising events

A 
Any bleed
Miscarriage (including threatened)
TOP
Ectopic
Trauma
Placental abruption
ECV
Amniocentesis
CVS
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60
Q

When is whooping cough (pertussis) vaccine offered during pregnancy

A

27-36 weeks

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61
Q

Risks of chickenpox in pregnancy

A

Maternal pneumonia, encephalitis, hepatitis

Fetal varicella syndrome if <28 weeks, infant shingles if 28-36 weeks, born with chickenpox if after 36 weeks

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62
Q

What happens if a pregnancy woman comes into contact with chickenpox

A

If you’ve had it before you’ll have your antibody levels checked and if low get a booster. If never had it/not sure then seek medical advice if you come into contact with it during pregnancy as will need treatment

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63
Q

What can you tell diabetic women how pregnancy will affect their diabetes

A

Pregnancy causes higher insulin requirements and resistance to insulin
Worsening nephropathy/retinopathy ect
More hypos
May need higher doses of medication
Can only take metformin and insulin during pregnancy

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64
Q

Risks that diabetes poses to pregnancy

A

Increased risk of miscarriages, VTE, infection, rate of induction/CS, congenital malformations (skeletal, cardiac, NTDs), unexplained still birth
Macrosomia, polyhydraminos, shoulder dystocia, stillbirth, neonatal hypoglycaemia

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65
Q

Why does maternal hyperglycaemia/DM cause macrosomia

A

Maternal hyperglycaemia –> fetal hyperglycaemia –> increased fetal insulin = growth factor –> macrosomia

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66
Q

Pre-conception advice for diabetic women

A

Good glycaemic control reduces risk
Higher dose folic acid (5mg)
Retinopathy and nephropathy screens up to date
Medication review

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67
Q

How do you diagnose gestational diabetes

A

Fasting glucose 5.6+ or 2hr post OGTT 7.8+

OGTT done in morning after overnight fast of 8hrs, then 75gram OGTT and test after 2hrs

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68
Q

Blood glucose targets during pregnancy

A 
HbA1c <48
Random 4-7
Fasting <5.3
Post-prandial <7.8
Keep above 4 always
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69
Q

When do you aim to deliver a pregnancy where mum had pre-existing diabetes

A

37-39 weeks

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70
Q

Risks of high BMI in pregnancy

A

Miscarriage, congenital malformations, GDM, macrosomia, pre-eclampsia, VTE, difficult fetal monitoring in labour, anaesthetic risk, PPH, post-natal infection

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71
Q

Risk factors for shoulder dystocia

A 
Macrosomia
Raised BMI
DM 
IOL
Epidural
Instrumental delivery
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72
Q

Pre-existing HTN in pregnancy happens before how many weeks?

A

<20 weeks

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73
Q

Pregnancy induced hypertension and pre-eclampsia occur after how many weeks into the pregnancy?

A

> 20 weeks

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74
Q

Difference between pregnancy induced hypertension and pre-eclampsia

A

Proteinuria in pre-clampsia, none in pregnancy induced hypertension

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75
Q

Diagnostic criteria for pregnancy induced hypertension

A

> 20 weeks gestation
BP 140/90 on 2 occasions
No proteinuria
No pre-existing hypertension

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76
Q

Diagnostic criteria of pre-eclampsia

A 
>20 weeks gestation
BP 140/90 on 2 occasions plus one of;
Proteinuria
Systemic involvement (high Cr, high LFTs, RUQ pain, neuro or haem involvement)
Fetal growth restriction
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77
Q

What pre-eclampsia symptoms do you tell women at risk to look out for

A 
Severe headache
Blurred vision/flashes
Severe RUQ/subcostal pain
Vomiting
Sudden swelling of face/hands/feet
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78
Q

Which medications are used to lower blood pressure in pregnancy

A

Labetalol
Nifedipine
Hydralazine

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79
Q

Features of HELLP syndrome

A

Haemolysis
Elevated liver enzymes
Low platelets

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80
Q

Management of pre-eclampsia

A

Lower BP
Manage post-partum fluid balance (pulmonary oedema mortality)
Prevent/control seizures - magnesium sulphate infusion

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81
Q

Anaemic Hb levels for each trimester of pregnancy

A

1st <110
2nd <105
3rd <100

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82
Q

How do you treat anaemia in pregnancy

A

Ferrous sulphate/fumarate trial for 2 weeks

Continue for 3 months after Hb returns to normal and for 6 weeks post partum to replenish stores

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83
Q

Which diabetic meds are safe in pregnancy

A

Metformin

Insulin

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84
Q

Which is the safest anti-epileptic med during pregnancy

A

Lamotrigine

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85
Q

When can Trimethoprim and Nitrofurantoin be used in pregnancy

A

Trimethoprim after the 1st trimester

Nitrofurantoin before the 3rd trimester

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86
Q

What fetal abnormality can SSRIs cause

A

Congenital heart defects

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87
Q

Are NSAIDs safe in pregnancy

A

No - risk of oligohydraminos and premature closure of ductus arteriosus

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88
Q

A soaked sanitary pad is roughly how much blood loss

A

100ml

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89
Q

Differentials for antepartum haemorrhage

A 
Ectropion
PV infection
Premature labour
GU cancer
Vaginal/rectal fissure/abrasion
Placental abruption
Placenta previa
Vasa previa
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90
Q

4 T’s of causes for PPH

A

Tone
Tissue
Trauma
Thrombus

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91
Q

Which number do you call to activate the obstetric haemorrhage pathway

A

2222

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92
Q

How can you try to stop bleeding in an obstetric haemorrhage

A 
Bimanual compression
Empty bladder - insert foley catheter
Syntocinon/Ergometrine IV max 2 doses
Syntocinon infusion
Misoprostol sublingual/rectal, can repeat after 20 mins
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93
Q

Primary PPH occurs how soon after birth?

A

Within 24 hours of birth

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94
Q

Secondary PPH occurs when?

A

24 hours - 12 weeks after birth

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95
Q

How many ml is a minor/moderate/major/massive PPH

A

Minor 500
Moderate 1000
Major 15000
Massive 2000

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96
Q

Most common causes of secondary PPH

A

Retained products
Infection
Dysfunctional uterine bleeding

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97
Q

Medications used in primary PPH management

A 
Syntocinon
Ergometrine
Syntometrine
Misoprostol
Carboprost
Tranexamic acid
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98
Q

Describe the hormonal pathway involved in menstruation

A

Hypothalamus releases GnRH –> pituitary releases LH + FSH which act on the ovaries to cause estrogen release and follicle maturation

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99
Q

Describe the follicular phase of menstruation

A

FSH, follicles mature, graafian follicle produces estrogen which thickens endometrium and thins cervical mucus. Oestrogen initially suppresses LH until threshold then sudden spike of LH day 12. 24-48hrs after LH surge follicle ruptures and releases secondary oocyte which quickly matures into ootid then mature ovum which enters fallopian tube.

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100
Q

Describe the luteal phase of menstruation

A

LH + FSH turn the ruptured follicle into the corpus luteum which produces progesterone – makes endometrium receptive, increases estrogen production, negatively feeds back on LH+FSH. When they fall the corpus luteum degenerates so drop in progesterone that causes menstruation.

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101
Q

When in the menstrual cycle are women most fertile

A

5 days before and 1-2 days after ovulation

Or within the 9 days after the end of the period

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102
Q

Ovulation occurs on roughly which day of the menstrual cycle

A

13

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103
Q

Differentials for heavy menstrual bleeding

A 
Dysfunctional uterine bleeding
Fibroids
Endometriosis
PID
Endometrial/cervical polyps
Adenomyosis
PCOS
Endometrial cancer
Contraception
Coagulopathy
Hypothyroidism
104
Q

Indications for hysteroscopy

A 
>45 with abnormal bleeding
Infertility
Menstrual disorders
Lost IUD
Persistent IMB
PCB
Enlarged uterus
Pelvic mass
PMB
105
Q

Medications used to manage heavy menstrual bleeding in women who want to have children

A

Tranexamic acid
Methanamic acid
Take while you’re bleeding

106
Q

Hormonal medications/devices used to manage heavy menstrual bleeding

A

1st line is Mirena coil
Progesterone only pill
COCP
Depot injection

107
Q

What are the medications used to shrink uterine fibroids

A

Ulipristal acetate - 3 month course, check LFTs

Gonadotopin releasing hormone analogues - Goserelin acetate injection

108
Q

Surgical treatments of fibroids for women who still want children

A

Hysteroscopic resection of fibroids

Myomectomy

109
Q

Surgical treatments of fibroids for women who don’t want future pregnancies

A

Endometrial ablation
Uterine artery embolisation
MRI guided percutaneous laser ablation
Hysterectomy

110
Q

Differentials of bleeding in early pregnancy

A 
Implantation bleed
Miscarriage
Ectopic
Cervical ectropion/polyp/malignancy
Genital tract trauma
Molar pregnancy
111
Q

Describe the type of bleed you get due to implantation

A

Light, short lived, bleeding/spotting, dark with a pink/brown tint, 6-12 days after conception (near when next period is expected)

112
Q

Early miscarriage happens during what period of gestation

A

0-12 weeks

113
Q

Late miscarriage happens during what period of gestation

A

12-24 weeks

114
Q

Causes and risk factors for miscarriage

A

Chromosomal abnormalities
Cervical incompetence
Fetal malformations
Smoking, alcohol, cocaine, stress, previous TOP, previous miscarriage, age, chronic maternal illness, uterine malformations, high BMI

115
Q

USS diagnostic criteria of miscarriage

A

CRL >7mm with no FH

Sac >25mm with no contents

116
Q

What is a threatened miscarriage

A

Pregnancy confirmed
PV bleed
Cervix closed
USS shows viable pregnancy

117
Q

What % of threatened miscarriages lead to successful pregnancies

A

90%

118
Q

What is an inevitable miscarriage

A

Pregnancy confirmed
PV bleed + abdo pain
Cervix open
POC not passed yet

119
Q

What is a complete miscarriage

A

All POC have passed
Cervix now closed
USS shows empty uterus

120
Q

What is incomplete miscarriage

A

PV bleeding and pain
Cervix open
Some tissue passed, some remains in uterus

121
Q

What is a missed/delayed miscarriage

A

Asymptomatic
Cervix closed
No POC passed
USS shows non viable pregnancy

122
Q

What is a blighted ovum

A

Missed miscarriage where development stopped before the embryonic pole was visible. Gestational sac may continue to grow

123
Q

What is a septic miscarriage

A

Miscarriage + sepsis (fever, significant abdo tenderness)

124
Q

How many miscarriages count as recurrent

A

3+

125
Q

How much should b-hCG increase by in a normal pregnancy

A

Double every 48hrs

Reached max 100,000) at 10 weeks then decreases

126
Q

What level of b-hCG indicated gestational sac should be visible on transvaginal USS

A

> 1500 (roughly 5 weeks gestation)

127
Q

What are the 3 main management options of a miscarriage

A

Expectant
Medical
Surgical

128
Q

Describe the expectant management of a miscarriage

A

Varies, can take days/weeks
May bleed for several weeks
May pass POC or they may be reabsorbed
Follow up sacn at 2-3 weeks

129
Q

Describe the medical management of a miscarriage

A

If <10 weeks just Misoprostol (uterine contractions)

If >10 weeks usually Mifepristone first (stops pregnancy hormones) then misoprostol

130
Q

Describe the surgical management of a miscarriage

A

Manual vaccum aspiration or dilation and curettage

131
Q

What part of the fallopian tube do ectopic pregnancies most commonly occur in

A

Ampulla

132
Q

Management options for ectopic pregnancies

A

Conservative if <6weeks, asymptomatic, falling hCG
Methotrexate
Salingotomy
Salpingectomy

133
Q

How long after Methotrexate for ectopic can you try to get pregnant again

A

3 months

134
Q

Differentials of PV discharge

A 
Bacterial vaginosis
Candida
Chlamydia
Gonorrhea
Trichomonas vaginalis
Foreign body
Cervical polyps
Genital tract malignancy
Genital tract fistula
135
Q

Itch, frothy yellow discharge and ‘strawberry cervix’ are associated with which STI

A

Trichomonas vaginalis

136
Q

What is included in an asymptomatic sexual health screen

A

Self swab for chalmydia and gonorrhea

Bloods for HIV and syphilis

137
Q

When is cervical screening performed

A

Every 3 years from age 25-49

Every 5 years from age 50-64

138
Q

Describe the result possibilities for cervical smear

A

Low grade - which can be borderline or moderate

High grade - which can be moderate or severe

139
Q

If routine smear shows no dyskariosis but is HPV positive what do you do

A

Repeat smear in 1 year

140
Q

If a smear result shows low grade dyskariosis how do you decide whether or not to send for colposcopy

A

Send for colposcopy if it is HPV positive as well

141
Q

Management of a biopsy result of CIN1

A

No treatment

Repeat smear in 1 year

142
Q

Management of biopsy result CIN3

A

Large loop excision of the transformation zone

143
Q

After a LLETZ procedure when do you re-smear as a ‘test of cure’

A

6 months

144
Q

What does ‘HPV triage’ mean

A

It means that all smears that are reported as borderline or mild (low grade) dyskariosis will be tested for HPV. If positive they will be referred to colposcopy, if negative they will return to routine recall

145
Q

PV discharge that is grey/white and thin/watery, fishy odour and clue cells on microscopy. What is the likely organism/infection

A

Bacterial vaginosis

146
Q

Normal labour is delivery at how many weeks

A

37-42

147
Q

Describe the 1st stage of labour

A

Contractions cause cervical changes
Subdivided into latent and active phase
Latent - contractions not regular/established, <4cm
Active - contractions regular and established, >4cm

148
Q

When does the 1st stage of labour end

A

When the cervix is 10cm dilated

149
Q

As you progress through the 1st stage of labour what happens to contractions

A

They last longer, are more frequent and are stronger
Latent phase 30 second contractions every 5-30 mins
Active phase 1min contractions every 3-5 mins
Transition phase into the 2nd stage of labour they are 60-90 second contractions every 30 seconds-2 mins

150
Q

What is the dilation rate for a primip

A

1cm every 2 hours

151
Q

What is the dilation rate for a multip

A

1cm every 1 hour

152
Q

What does the second stage of labour refer to

A

Delivery of the baby

153
Q

What does the third stage of labour refer to

A

Delivery of the placenta

154
Q

Describe the mechanisms of deliver

A

Descent
Engagement - station 0
Neck flexion + internal rotation into the occipitoanterior position so shoulders are in line with the widest part
Head passes below pubic symphysis - station +4
Head extension and delivery of the head
Restitution - head externally rotates
Shoulder externally rotated into the AP plane
Delivery of the anterior shoulder by gentle downward traction
Delivery of the posterior shoulder by gentle upward traction

155
Q

Signs of placental separation

A

Uterus contracted
Cord lengthening
Blood trickle

156
Q

Describe how the 3rd stage of labour can be actively managed

A 
Oxytocin IM
Check for signs of separation
Clamp and cut the cord
Apply upward pressure on the uterus to prevent inversion and downward traction on the cord until it's at the vulva then upward traction
Examine for trauma
Examine the placenta
157
Q

What is engagement of the head and how can you tell

A

Largest diameter of the head into the largest diameter of the pelvis
When the head is 3/5ths palpable or less

158
Q

What is assessed in APGAR scoring

A

Appearance - blue/pale, just extremities blue, pink
Pulse - absent, <100, >100
Grimace - absent, minimal response to stimulation, prompt response to stimulation
Activity - absent, flexion, active
Respiration - absent, slow/irregular, vigorous cry

159
Q

At how many minutes do you measure APGAR score

A

1 and 5 mins

160
Q

Common causes of a low APGAR score

A

Difficult birth
CS
Fluid aspiration

161
Q

Indications for CTG

A

Maternal tachycardia, pyrexia, suspected sepsis, abdo pain, hypertension, suspected pre-eclampsia
Significant meconium
PV bleed
Delayed 1st or 2nd stage
Oxytocin use
Contractions over 60 seconds or more than 5 of them in 10 mins

162
Q

What is the mneumonic used to assess CTG tracings

A

DR C BRAVADO

163
Q

What does DR C BRAVADO stand for

A 
Define risk
Contractions
Baseline rate
Variability
Accelerations
Decelerations
Overall
164
Q

Describe a normal CTG

A

100-160 bpm
Variability 5-25
No/early decelerations

165
Q

What are the 4 grades/types of placenta previa

A

Low lying
Marginal
Partial
Complete

166
Q

Scans for placenta previa

A

If 20 week scan shows placenta previa then have another scan (TV) at 32 weeks (most will have resolved). If still low at 32 weeks have another scan (TV) at 36 weeks. If still low will likely need to plan for CS

167
Q

Differentials of abdo pain in pregnancy

A 
Preterm labour
Placental abruption
Chorioamnionitis
Acute fatty liver of pregnancy
Pre-eclampsia
GI cause - appendicitis, pancreatitis, peptic ulcer ect
GU cause - stones, adnexal torsion, cystitis
Fibroid torsion
168
Q

Clinical features of placental abruption

A 
Bleeding
Abdo pain
Woody hard uterus
Fetal compromise
Maternal shock
169
Q

What can you test for to try to rule out likely pre-term labour

A

Fetal fibronectin levels in vaginal secretions

170
Q

How can you manage pre-term labour

A

Steroids for lung maturity - Betamethasone
Tocolytics to reduce contractions - Nifedipine, Atosiban, Indomethacin
MgSO4 for fetal neuroprotection
Inform the neonatal team

171
Q

How long roughly should the second stage of labour last in a) primips b) multips

A

a) 3 hours

b) 2 hours

172
Q

What do you have to check before performing operative vaginal delivery

A

No more than 1/5th of the head palpable abdominally

Leading point of the skull is below the ischial spines

173
Q

What are the advantages/disadvantaged of Ventouse vs forceps

A

Ventouse less trauma to perineum/vagina but more likely to fail and to cause cephalohaematoma

174
Q

How long after c-section do you need LMWH for

A

6 weeks

175
Q

What % of women under the age of 40 will conceive within 2 years of trying

A

90%

176
Q

To maximise chances of conceiving how often should you advise couples to be having sex

A

2-3 times per week

177
Q

Primary vs secondary infertility

A

Secondary if they have conceived in the past

178
Q

What is the most common female disease that causes infertility

A

PCOS

179
Q

What test can you do to assess if a woman is ovulating or not

A

Mid-luteal (day 21) progesterone (will be raised if ovulating)

180
Q

What can be used as a marker for ovarian reserve

A

Anti-Mullerian Hormone (AMH)

181
Q

Name of the scan to assess fallopian tube pregnancy

A

Hysterosalpingogram

182
Q

What does low, normal and high FSH/LH indicate in infertility testing

A

Low suggests hypothalamic or pituitary pathology
Normal suggests oocytes present but folliculogenesis may be impaired
High suggests reduced ovarian reserve/oocytes

183
Q

3 tests that can indicate ovarian reserve

A

AMH
FSH
Antral follicle count

184
Q

How can you assess if a woman is ovulating

A

If she has a regular cycle

Mid-luteal progesterone

185
Q

FSH + LH high, Oestradiol low

A

Premature ovarian failure

186
Q

FSH + LH + Oestradiol all low

A

Hypothalamic or pituitary cause

187
Q

FSH normal + LH raised + Oestradiol normal

A

PCOS

188
Q

What medication can be used for anovulation

A

Clomiphene citrate

Can also try Metformin, Gonadotrophins

189
Q

Clinical features of ovarian hyperstimulation syndrome

A 
Ascites
Effusions
Nausea and vomiting
Abdo tenderness
VTE risk
190
Q

Which class of medication can be used to aid fertility in women with ovulatory disorders secondary to hyperprolactinaemia

A

Dopamine agonists

191
Q

What are the 3 main types of assisted conception

A

Intrauterine insemination
IVF: In-vitro fertilisation
ICSI: Intracytoplasmic sperm injection

192
Q

Diagnostic criteria for PCOS

A

Need 2 of 3 features: Oligo/anovulation,
Clinical or biochemical signs of hyperandrogenism
Polycystic ovaries

193
Q

Clinical features of PCOS

A 
Onset in adolescence,
Oligo/amenorrhoea, infertility
Obesity/metabolic syndrome
Hirsutism, androgenic alopecia
Acne vulgaria, oily skin, acanthosis nigricans (hyperpigmented velvety plaques usually in axilla or neck)
194
Q

Confirmatory test for endometriosis

A

Laparoscopy

195
Q

Ovarian cancer marker

A

CA 125

196
Q

The RMI (risk of malignancy index) is used to assess for which type of cancer

A

Ovarian

197
Q

What are the 3 features used to asses the RMI score

A

CA125
Menopausal status
USS score

198
Q

Which medication class can worsen stress incontinence

A

Alpha blockers (e.g. Doxazocin)

199
Q

Is AFP high or low in neural tube defects

A

High

200
Q

Is AFP high or low in Downs syndrome

A

Low

201
Q

If a baby is still breech at 36 weeks what do you do

A

Refer for ECV

202
Q

A Bishop score of ? indicates that labour is unlikely to start without induction

A

< 5

203
Q

A Bishop score of ? indicates that labour will most likely commence spontaneously

A

> 9

204
Q

3 causes of increased nuchal translucency

A

Down’s syndrome
Congenital heart defects
Abdominal wall defects

205
Q

The following results would be expected in a trisomy 21 (Down’s syndrome) pregnancy:

A

Low alpha fetoprotein (AFP)
Low oestriol
High human chorionic gonadotrophin beta-subunit (-HCG)
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency

206
Q

Organism that causes bacterial vaginosis

A

Gardnerella vaginalis

207
Q

Features of vaginal discharge caused by BV infection

A

Thin
White
Really offensive fishy smell

208
Q

Clue cells (stippled vaginal epithelial cells) on microscopy indicate which infection

A

Bacterial vaginosis

209
Q

Management of bacterial vaginosis

A

Oral Metronidazole for 5-7 days

Can use topical metronidazole or clindamycin as alternatives

210
Q

Diagnostic test for endometriosis

A

Laparoscopy

211
Q

Diagnostic imaging for adenomyosis

A

MRI pelvis

212
Q

What is adenomyosis

A

The presence of endometrial tissue within the myometrium. It is more common in multiparous women towards the end of their reproductive years.

213
Q

Symptoms of adenomyosis

A

Dysmenorrhea
Menorrhagia
Enlarged, boggy uterus

214
Q

Criteria for an ectopic pregnancy to be managed expectantly

A

1) An unruptured embryo
2) <30mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <200IU/L and declining

215
Q

Maximum gestation for abortion

A

24 weeks

216
Q

The methods used to terminate pregnancy depending on gestation

A

Less than 9 weeks: mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins to stimulate uterine contractions
Less than 13 weeks: surgical dilation and suction of uterine contents
More than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)

217
Q

First line treatment for urge incontinence

A

Bladder retraining

218
Q

First line treatment for stress incontinence

A

Pelvic floor exercises

219
Q

Definition of primary post-partum haemorrhage (minor and major)

A

The loss of 500ml or more from the genital tract within 24 hours of the birth of a baby
Minor = 500-1000
Major = >1000

220
Q

Diagnostic criteria for hyperemesis gravidarum

A
  1. 5% pre-pregnancy weight loss
  2. Dehydration
  3. Electrolyte imbalance
221
Q

Pre-conception advice to optimise chance of conception

A

Optimise underlying medical conditions
Healthy BMI (19-30)
Stop smoking, alcohol, recreational
Sex every 2 days (2-3 times a week) from 6 days before ovulation and until 2 days after
Folic acid
Up to date with smears
Full immunisation history - including Rubella

222
Q

Causes of infertility

A

Ovulatory problems - PCOS, premature ovarian failure, thyroid
Tubal - adhesions, obstructions (endometriosis, salpingitis)
PCOS
Hyperprolactinaemia
Hypergonadotrophic hypogonadism
Lifestyle factors
Decreased sperm quantity or quality

223
Q

Infertility tests: FSH + LH + Oestradiol are all low

A

Hypothalamic or pituitary cause

224
Q

Infertility tests: FSH is normal, LH is raised and Oestradiol is normal

A

PCOS

225
Q

Infertility tests: FSH + LH are high and Oestradiol is low

A

Premature ovarian failure

226
Q

What tests are used to assess ovarian reserve

A

AMH, FSH, antral follicle count

227
Q

Test for ovulation

A

 Mid-luteal progesterone: 7 days before expected period (day 21 of 28 day cycle) failure to rise indicates anovulation

228
Q

How are the fallopian tubes and uterus assessed during infertility investigation

A

Hysterosalpinography (dye into uterus and XR)
Sonohysterosalpingography (fluid into uterus and USS)
TV USS
Women thought to have comorbid conditions (PID, endometriosis, previous ectopic) are offered diagnostic laparoscopy and dye. Can treat at the same time.

229
Q

Medical treatment options for infertility

A

Clomifene or Tamoxifen to induce ovulation
Metformin for PCOS
Gonadotrophins may be offered to women with clomifene-resistant anovulatory infertility. They are also effective in improving fertility in men with hypogonadotropic hypogonadism
Pulsatile gonadotrophin-releasing hormone and dopamine agonists are other treatments that induce ovulation. Dopamine agonists can be considered for women with ovulatory disorders secondary to hyperprolactinaemia.

230
Q

Surgical management options for infertility

A

Tubal microsurgery/catheterisation
Surgical ablation/laparoscopic resection of endometriosis or adhesions
Surgical corrections of epididymal blockage

231
Q

Types of assisted conception

A 
Intrauterine insemination
IVF
ICSI - intracytoplasmic sperm injection
Donor insemination
Oocyte donation
232
Q

Features of ovarian hyperstimulation syndrome

A 
Abdo bloating
Abdo pain
Nausea and vomiting
If severe:
Oliguria
Generalised oedema
Abdo pain/distention caused by enlarged ovaries and acute ascites 
Hydrothorax, VTE, respiratory distress syndrome
233
Q

Possible complications of assisted conception

A

Ovarian hyperstimulation syndrome
Ectopic
Pelvic infection
Multiple pregnancy

234
Q

Grades of placenta previa

A

1 - low lying
2 - marginal (minor)
3 - partial
4 - complete (major)

235
Q

Management of placenta previa

A

If seen at 20 week scan, book for scans at 32 and 36 weeks as TV USS
If still present at 36 weeks plan for CS
Safety net antepartum bleeding, pre-term labour

236
Q

Risk factors for breech presentation

A 
Twins
Oligo/polyhydramnios
Fibroids
Placenta previa
Pelvic tumour/deformities
237
Q

Management options for breech presentation

A

ECV at 36 weeks
Vaginal breech delivery
CS

238
Q

Contraindications to ECV

A

Twins
Antepartum haemorrhage
Previous CS

239
Q

Risks of ECV

A

Cord entanglement
Abruption
Induction

240
Q

Biggest risk of a baby in transverse lie at term

A

Cord prolapse

241
Q

Trisomy 13

A

Patau’s syndrome

242
Q

Trisomy 18

A

Edward’s syndrome

243
Q

Trisomy 21

A

Down’s syndrome

244
Q

When is the combined screening test

A

12 weeks (11-14)

245
Q

When is the quadruple screening test

A

16 weeks (15-20)

246
Q

What does the combined test measure

A

Nuchal translucency
hCG
PAPP-A

247
Q

What does the quadruple test measure

A

AFP
Unconjugated estriol
Beta-hCG
Inhibin A

248
Q

Conditions screened for in a) combined test b) quadruple test

A

A) Patau’s, Edward’s, Down’s

B) Down’s

249
Q

What gestation is the private antenatal non-invasive screening test available from

A

10 weeks

250
Q

Ratio classed as high risk from the antenatal chromosomal screening

A

> 1:150

251
Q

Combined test - is each marker high/low in Down’s syndrome

A

PAPP-A low
hCG high
NT high

252
Q

Quadruple test - is each marker high/low in Down’s syndrome

A

AFP low
uE3 low
hCG high
Inhibin high

253
Q

When can CVS be performed

A

11-14 weeks

254
Q

When can amniocentesis be performed

A

15+ weeks

255
Q

Does CVS or amniocentesis have a lower miscarriage rate

A

Amniocentesis

256
Q

Antenatal trisomy screening - how long until patient gets results

A

Usually within 2 weeks if low risk, within 3 working days if high risk

Finals (32 decks)

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