obgyn FM learner FP notebook Flashcards
name 6 contraindications to combined OCPS
<4 weeks postpartum & breastfeeding
-Smoker >15cigs/day and >35 yo
-thrombophilia
-CAD
-acute VTE
-hx VTE and not anticoagulated
-current breast ca
-severe cirhosis
-migraine with aura
how many days post coitus is the copper IUD effective as an emergency contraception?
7 days
Which emergency contraceptives are less effective in patients with elevated BMI?
hormonal emergency contraceptives
what is the first choice emergency contraception for women with BMI > 30?
copper IUD
what is the first hormonal emergnecy contraception choice for women with BMI over 30?
ulipristal acetate
what are the general IUD contraindications?
PID
Unexplained bleeding
Abnormal uterine anatomy
Pregnancy
Cervical Cancer
contraindications specific to the LNG IUD?
severe liver disease (ca, tumour, cirhosis), breast ca
contraindications specific to the copper IUD?
wilsons disease
copper allergy
anemia
menorhagia
what are some non-contraceptive indications for the LNG-IUS?
On label - AUB, heavy menstrual bleeding
Off label - dysmenorhia, endometriosis, adenomyosis, endometrial protection (HRT, hyperplasia, polyps)
how does the copper IUS effect rates of uterine cancer?
reduces risk of endometrial cancer
what are some IUD side effects?
Both - prolonged bleeding, irregular bleeding, postcoital bleeding, dyspareunia
LNG IUS - hair loss, acne, headache, bloating, functional ovarian cysts
Copper - excessive bleeding, dysmenorrhia
which type of IUD is immediately protective against pregnancy?
copper
(LNG-IUS takes 7 days)
what are the contraindications for the subdermal implant?
-pregnancy
-undiagnosed vaginal bleeding
-breast ca
-liver tumour
-lupus +antibodies
what is the ON LABEL uses for the DMPA (progesterone shot) other than contraception?
endometriosis
risks of DMPA?
-delayed return to fertiliy (50% at one year, 90% at two years)
-BMD reduction
what are some DMPA side effects?
-irregular bleeding/amenorhea
-weight gain (10-25%) of patients
-hormonal SE - headache, acne, breast tenderness
what is your differential diagnosis for dysmenorrhea?
-primary dysmenorhhea
-secondary dysmenorrhea: endometriosis, adenomyosis, uterine myoma, PID, pelvic adhesions, IBS, IBD, interstitial cystitis
non-pharm options for management of dysmenorrhea?
-regular exercise
-heated pads
-ginger during the first 3-4 days of menses
pharm management of dysmenorrhea?
-tylenol
-NSAIDS
-cOCPs
-progestin regimes (IUS)
risk factors for uterine leiomyomas (fibroid)?
-nulliparity
-obesity
-family hx
-HTN
complications associated with uterine fibroids?
-IDA
-infertility
-slight risk of miscarriage, preterm labour, abruption, IUGR
-fibroids in lower uterus can increase risk of fetal malpresentation, C/S, post partum hemorrhage
what risks increase with maternal age in pregnancy?
-spontaneous pregnancy loss
-chromosomal abnormalities
what risks increase with paternal age in pregnancy?
-spontaneouos pregnancy loss, AD conditiions, autism spectrum disorder, schihzophrenia
what is the most common reversible cause of male infertility?
a varicoceole
what age is considered premature menopause?
<40
which group can be safely started on menopause hormonal therapy?
women <60, with menopause < 10 years ago
name non-hormonal medications for menopausal symptoms
-SSRIs
-SNRIs
-gabapentin
-clonidine
define menopause
1 year of amenorrhea caused by declining ovarian reserve, or as the onset of vasomotor symptoms in people with iatrogenic amenorrhea.
which route of hormone therapy for menopause is associated with lower risk of VTE?
transdermal
In a patient with CIs to HT, list three lifestyle treatments for urogenitary symptoms
-kegels
-regular sexual activity (increases blood flow)
-lubricant
-vaginal moisturizers
what is the standard dose of rhogam? and the time frame in which it is given?
300 mcg
within 72 hours of bleed
uterine bleeding with a live IUP & closed cervix =
threatened abortion
Which pregnancies get rhogam with a bleeding exposure?
PV bleeding in a woman who is RH neg and >= 12 weeks gestation
bleeding + open cervix + no products passed =
inevitable abortion
management of a threatened abortion
expectant
bleeding + open cervix + some tissue passed =
incomplete abortion
bleeding + complete sac passed + open cervix =
complete abortion
management of threatened abortion =
expectant - FU with OB in 3-4 days
management of inevitable abortion
-expectant, misoprostal, or D+C, +/- oxytocin
at how many weeks gestation can you see a heart beat on transvaginal US?
6 weeks
when is the GBS screening in pregnancy?
at 35-37 weeks
what is the name of the score that predics cervical favourability for delivery?
Bishop score (>6)
After a c-section, how long should someone wait until their next conception?
18 mo
conception during active IBD episode increases which risks…
miscarriage, premature delivery, still birth, low birth weight
what should women on thyroid supplementation do once pregnant?
increase their dose by 30%
what extra supplement shoulder smokers take during pregnancy?
extra 35 mcg vit C daily
what is a normal amount of fetal movements in someone over 26 w gestation?
6 movements/2 hour period
what is considered a decreased cervical length?
<25 mm at 16-24 weeks
how is a decreased cervical length managed?
vaginal progesterone
how is the prenatal OGTT performed?
-at 24-28 weeks, non fasting 50g OGCT given
what is an abnormal result with the 1 hr 50g OGTT
7.8 mmol/L or above
If a patient has a OGTT with a result of <7.8mmol/L what is the next step?
negative, no further workup
If a patient has an OGTT with a result of 11.1 mmol/L or above, what does this mean?
diagnostic of GDM
If a patient has a 1hr OGTT with a result from 7.8-11, what is the next step?
order a 75 g OGTT
When should a mom who had GDM be rescreened for diabetes?
Between 6 weeks - 6 months, with 75g OGGT
what extra monitoring do patients with GDM need during pregnancy?
Fetal growth evaluations every 3-4 weeks, then weekly NST at 36 weeks (+more if other risks)
what is a normal endometrial stripe thickness?
<5mm
what colour is the discharge commonly seen in BV?
thin off white with fishy odour
what what pH does BV or trichomonas occur?
pH > 4.5
what colour is the discharge with trichomonas?
thin, yellow-green, frothy, malodorous
what is the discharge like in candida vaginitis?
thick cottage cheese
at what pH does a candida vaginitis occur?
Normal pH - 3.8-4.5
which type of vaginitis requires treatment of the sexual partner?
trichomonas
treatment of BV
-metronidazole or clindamycin
treatment of trichomonas
-metronidazole PO (intravaginal is not enough) and treat partner
treatment of BV
oral or vaginal metronidazole
what is considered recurrent vulvovaginitis?
4 or more episodes a year
Diagnostic criteria for PCOS?
AT least TWO of the THREE:
-menstrual cycle irregularities
-hyperandrogenism (clinic or biochemical)
-polycystic ovaries on US
how many years from menarche should you ideally wait before diagnosing PCOS?
8 years, due to initial menstrual irregularities which may settle
