obgynPM Flashcards
HIV smear
annual cervical cytology
A 24-year-old woman presents to her GP 8 days after giving birth. She complains of a persistent pink vaginal discharge which is ‘smelly’. On examination her pulse is 90 / min, temperature 38.2ºC and she has diffuse suprapubic tenderness. On vaginal examination the uterus feels generally tender. Examination of her breasts is unremarkable. Urine dipstick shows blood ++. What is the most appropriate management
admit to hospital. This patient is showing clear signs of puerperal sepsis (postpartum infection), which is a potentially serious condition requiring immediate hospital assessment. The clinical features supporting this diagnosis include pyrexia (38.2°C), tachycardia (90/min), malodorous lochia (vaginal discharge), uterine tenderness, and suprapubic tenderness. The presence of blood on urinalysis is also consistent with the immediate postpartum period. Puerperal sepsis remains a leading cause of maternal mortality in the UK, and NICE guidelines emphasise the importance of prompt recognition and treatment.
bishop score interpretation
A Bishop score less than 5 generally means induction will likely be necessary. A score above 9 indicates labour will likely occur spontaneously.
pregnancy bp requiring admission
Pregnant women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed
admit for observation with labetolol or nifedipine
adenomyosis classic pt
multiparous women towards the end of their reproductive years.
is a 26 year old with 7mm endometrium normal
yes
normal endometrial thickness in pre menopausal women
Normal endometrial thickness in premenopausal women:
- During menstruation: 2-4mm
- Early proliferative phase (day 6-14): 5-7mm
- Late proliferative: up to 11 mm
- Secretory phase: 7-16 mm
postmenopausual endometrial thickness
4-5 is okay
mifepristone moa
Mifepristone is a progesterone receptor antagonist → weakening of attachment to the endometrial wall + cervical softening and dilation + induction of uterine contractions
gestational HTN vs mild pre eclampsia
pre eclampsia MUST have proteinuria after 20 weeks
Intrahepatic cholestasis of pregnancy increases the risk of
Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation
Important for meLess important
when can you not trial diet and exercise in gestational DM
If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l immediate insulin (plus or minus metformin) should be started
air travel
air travel is not recommended beyond 37 weeks gestation with an uncomplicated, singleton pregnancy, or 32 weeks in uncomplicated, multiple pregnancy.
If the flight is longer than 4 hours, compression stocking are recommended. If additional DVT risk factors are present, LMWH injections on the day of the flight and for several days afterwards may be advised.
can a lady have a vaginal delivery with HIV viral load of 30?
HIV in pregnancy: vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks
An antiretroviral infusion is most commonly used in the case of a caesarean section when a pregnant woman has a viral load greater than 50 copies/mL.
what should be done prior to induction of labour
bishop score
emergency contraception in a woman declining copper IUD
Levonorgestrel must be taken within 72 hours of UPSI
1.5mg
A 26-year-old woman comes to see her GP after complaining of weight gain, hair loss, constipation and feelings of being cold all the time. She is also amenorrhoeic and struggled to breastfeed after birth. She has no significant past medical history but during her daughter’s birth she suffered from a large amount of blood loss and subsequent hypovolaemic shock which required a 6 weeks hospital stay.
Which of the following conditions is the most likely cause of these symptoms?
sheehans syndrome
22 weeks pregnant lady with chickenpox management
Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with oral aciclovir if they present within 24 hours of the rash
VZIG if under 20 weeks
can cervical ectropion cause discharge
yes
COCP and cervical ectropion
COCP makes cervical ectropion more common
All patients with secondary dysmenorrhoea need to be
referred to gynaecology for investigation
what to try before GnRH analogue in endometriosis
POP
A 29-year-old female requests emergency contraception. She had unprotected sexual intercourse 7 days ago. Her LMP was 16 days ago, her cycle is usually 30 days. She was using condoms intermittently for contraception and takes no regular medications.
copper IUD - within 5 days of sex OR 5 days of likely ovulation
if she menstruated 16 days ago, and ovulated on day 14 then likely she ovulated 2 days ago
is smoking a pre ecamplsia risk
no
pre eclampsia risks
The following are risk factors that should be determined:
Aged 40 years or older
Nulliparity
Pregnancy interval of more than 10 years
Family history of pre-eclampsia
Previous history of pre-eclampsia
Body mass index of 30kg/m^2 or above
Pre-existing vascular disease such as hypertension
Pre-existing renal disease
Multiple pregnancy
How often should T1DM check glucose in pregnancy
Pregnant patients with type 1 diabetes should monitor their blood glucose levels closely. They should test their levels multiple times during the day
Daily fasting, pre meal, 1 hour post meal and bedtime
Cervical cancer screening: if smear inadequate then repeat in
3 months
when should a man stop methotrexate
6 months pre conception
female also
obese wheelchair user contraception (PID)
The injectable contraceptive may not be ideal due to its potential to cause weight gain, which is a concern for this patient given her obesity
The contraceptive implant
post partum psychosis recurrence rate
25-50%
T1DM patient becomes pregnant, pre eclampsia prophylaxis
A woman at moderate or high risk of pre-eclampsia should take aspirin 75-150mg daily from 12 weeks gestation until the birth
A 35-year-old woman presents concerned because she has not had a period in 6 months. She also reports feeling increasingly fatigued and having worsening mood swings. She last had sex more than 3 weeks ago and uses condoms regularly. She has two children and does not wish to have further children in the future. Her last cervical smear result 2 years ago was unremarkable. Her observations and abdominal examination are both normal. Blood tests demonstrate a raised FSH level, normal thyroid function and prolactin results, and a negative serum HCG result.
What should be the next investigation?
Premature ovarian insufficiency should not be diagnosed on the basis of one raised FSH level - a further sample should be taken 4-6 weeks
delayed return of fertility contraception
Because Depo-Provera lasts up to 12 weeks, it can take several months for the body to return to the normal menstrual cycle and hence delay fertility. For this reason, it is the least appropriate method for this woman who wants to return to ovulatory cycles immediately.
most common treatable cause of recurrent first trimester miscarriage?
The correct answer is antiphospholipid syndrome (APS), which is the most common treatable cause of recurrent first trimester miscarriage.
A 28-year-old woman presents to her GP with intermenstrual bleeding and dyspareunia. She does not use any hormonal contraceptives. After ruling out a sexually transmitted infection and fibroids, she is referred to colposcopy where she is diagnosed with a grade 1A squamous cell carcinoma of the cervix. She is married and hopes to have children in future.
Which treatment option is most appropriate for this woman’s cancer?
Women with stage IA cervical cancer may be considered for a cone biopsy with negative margins if they wish to maintain their fertility
A 49-year-old patient presents with hot flushes and mood swings. She has no previous medical history or family history. She has been amenorrheic since her Mirena (levonorgestrel) coil was placed 2 years ago. She would like to consider HRT with the least side effects.
oestrogen patch - already has progesterone from mirena
Second screen for anaemia and atypical red cell alloantibodies
28 weeks
Urine culture to detect asymptomatic bacteriuria
8-12 weeks
scans 8-16 weeks
scans 18 - 41 weeks
Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than
5 days due to the risk of extrapyramidal effects
A 23-year-old woman who is 24 weeks pregnant presents to the emergency department with a 48-hour history of epigastric pain and severe headache, that has increased in severity. On examination, she has a heart rate of 110 beats/min, a respiratory rate of 21 /min, a temperature of 36.8ºC, mild pitting oedema of the ankles and brisk tendon reflexes.
Given the likely diagnosis of pre-eclampsia, what is the most important sign to elicit?
brisk tendon reflexes
A 22-year-old lady presents to the general practitioner for advice about her current contraception, microgynon 30. She went away for a few days this week and forgot to bring her pill packet resulting in her missing pills. The last pill she took was 76 hours ago, and she is unsure what to do now. The missed pills were from week 3 of her pack and she has not missed any other pills this month. She has had intercourse in the last week for which she did not use barrier contraception. What advice should you give her?
take 2 pills today, finish pack and omit pill free interval
does not need emergency contraception
COCP missed pills when to use emergency contraception
Week 1 : take emergency pills
Week 2 : no need emergency pills
Week 3 : no need emergency pills and omit pill free interval
A 24-year-old woman is having a telephone consultation with her GP to discuss contraceptive advice. She has been taking the combined oral contraceptive pill (COCP) for the past 3 weeks and is currently on her honeymoon. She had unprotected sexual intercourse the previous night and realised she forgot to take her pill yesterday. Prior to this, she has taken all her scheduled pills and is due to have a week off from taking the pill next week.
Which option is the most appropriate advice for the GP to provide?
take missed pill asap, no additional contraception required continue packet as normal
