Obs and Gynae Flashcards
what is the tissue sample in CVS?
placenta
what are the two surgical approaches to CVS?
transabdominal or transcervical
what is the timeframe for CVS
11 - 14 weeks
what is the CSV risk of miscarriage?
1%
what is the next step following inconclusive result from CVS in antenatal diagnosis?
wait for a few weeks until amniocentesis is possible
what information is gained at the first trimester USS?
- multiplicity (and chorion/amnion status)
- gestational age
- viablility of pregnancy
- gross anatomical abnormalities
- nuchal translucency
what information is gained at the 20 week structural abnormality scan?
- further examines foetal anatomy
- site of placenta
- sex of foetus
what pre-natal diagnoses require amniocentesis?
- inborn errors of metabolism
- foetal infection
- rhesus isoimmunisation
is anti-D given during amniocentesis?
yes
what serum markers are involved in the triple test?
what is added for the quadruple test?
triple = AFP, uE2, beta-HCG
quad = + inhibin
what is roughly the false positive rate for triple/quadruple screen?
5%
when during pregnancy is foetal echo performed?
offered to all mothers?
second trimester
only in cases with high risk for cardiac abnormality
- diabetes type 1
- congenital heart disease
- epilepsy
- teratogenic medication
- previous child with cardiac abnormality
when is uterine artery doppler performed?
20 - 24 weeks
high resistance with notching on uterine artery doppler suggests higher risk for which conditions?
pre-eclampsia and growth restriction
enhanced monitoring is indicated
what are the indication for antenatal foetal blood sampling?
investigation of
- foetal hydrops
- parvovirus infection
- bloodtyping prior to transfusion
- haemolytic disease/alloimmune thrombocytopenia
which NSAID is particularly useful in dysmenorrhoea?
mefenamic acid
what hormonal options are available for treatment of dysmenorrhoea?
COCP, oral/depot progestogens, Mirena coil
what is/was the classical definition of menorrhoea ?
> 80 mL blood loss per period
difficult to quantify so dianosis now made more on history given
what is the risk of malignancy index? (equation)
RMI = U x M x CA125
U = USS score
M = menopause score
what factors contribute to the USS score in the risk of malignancy index?
multiloculation
solid areas
ascites
bilateral lesions
a simple, unilateral, unilocular cyst on USS is seen
likely diagnosis?
what should the follow up be? advice to patient?
simple ovarian cyst
supportive management, pain relief
USS follow up in 3-4 months, where we expect 50% to resolve on their own
risk of torsion! red flags, advise to attend A&E
what is the earliest a CTG can be used?
32 weeks (confidently)
what are maternal indications for CTG?
pain, PET, diabetes, antepartum haemorrhage
what are foetal indications for CTG?
- IUGR
- prematurity
- oligohydramnios
- multiple pregnancy
- breech presentation
what is normal range for foetal HR on CTG?
110 - 160
foetal tachycardia on CTG suggests what?
- hypoxia/foetal distress
- maternal infection
- beta-agonist use
4.
what is the serious concern with baseline bradycardia on CTG?
what are some other causes?
severe foetal distress from placental abruption or uterine rupture
hypotension, maternal sedation, post-maturity, hypoxia
prolonged HR <90 bpm on CTG suggests what?
known as ‘prolonged deceleration’ = impending foetal demise
should be acted on without delay
normal reduced variability lasts how long? what is the aetiology?
<40 mins, foetal sleep
after how long does reduced variability become a problem?
>90 mins
what is the physiological mechanism of early decelerations?
reflection of increased vagal tone in response to elevated foetal intracranial pressure during contractions
‘shouldering’ of variable decelerations refers to what?
worrying or reassuring?
aceleration on either side of variable decelerations
reassuring
typical variable decelerations are a reflection of what physiolocial process?
cord compression during uterine contraction
especially in oligohydramnios
what is the criteria for atypical/late decelerations to become non-reassuring?
present >50 % of contractions for >30 mins
with FBS during labour, what are the important values and their impact on management?
pH > 7.25 = normal. Labour should continue
pH 7.20 - 7.25 = borderline. Repeat pH in 30 - 60 mins
pH < 7.20 = abnormal. Needs delivery
what is the treatment for vaginal candidiasis?
topical imidazole and oral fluconazole
Canesten duo
treatment of trachomoniasis?
metronidazole
what factors contribute to the increased risk of cholestasis in pregnancy?
progesterone - biliary stasis
oestrogen - increases cholesterol:bile salt ratio (lithogenicity)
in acute pyelonephritis during pregnancy, what worrying symptom may the woman complain of that can be cautiously dismissed?
uterine tightening
what is a usual treatment for UTI in pregnancy?
consult local guidelines…
cephradine, amoxicillin
what are the best biochemical descriminants of acute fatty liver of pregnancy from HELLP syndrome?
high uric acid
hypoglycaemia
what is the maternal mortality rate of acute fatty liver of pregnancy?
20%
what is the classic localisation for pruritis in obstetric cholestasis?
palms and soles
what are the treatments of obstetric cholestasis?
what do each of them do?
chlorphenamine - anti-itch
ursodeoxycholic acid - reduse serum bile acids
vitamin K - correct any clotting abnormalities before labour
what are the 4 main malpresentations in descending order of frequency?
breech, shoulder, face, brow
what is done post-natally for women with GDM?
further OGTT 6 weeks later to make sure it’s not become T2DM
what is the additional vitamin requirement for pregnant women with pre-existing T2DM?
5 mg/day folic acid, rather than 0.4 mg/day
what are the indications for 5 mg/day folic acid?
preexisting T2DM, epilepsy (& relevant medication), previous FH NTDs, coeliac diseaes, sickle cell anaemia
what diabetic medications is allowed in pregnancy?
ONLY insulin and metformin
are statins safe in pregnancy?
no
are ARBs safe in pregnancy?
no
what is the advice for babies following GDM?
feed as soon after delivery as possible
every 2-3 hours thereafter
keep warm
monitor capillary glucose before feeds that shouldn’t fall below 2 mmol/L
other than symptomatic relief, what are the benefits of HRT?
bone protection
reduces risk of developing CRC
delay in onset of Alzheimer’s
what are the risks of HRT?
increases risk for breast and endometrial CA, ovarian CA
VTE and stroke
what are the absolute contraindications for HRT?
what are the relative contraindications?
absolute: CA endometrium, suspected pregnancy, liver disease, thrombophilia
relative: HTN, personal/family history of VTE, breast CA
what are the symptoms of menopause?
hot flushes, night sweats, sleep disturbance
vaginal dryness/atrophy, UTIs, menstrual disturbance
loss of libido
headache and palpitations
mood disturbance and loss of temper
what is the HRT for perimenopausal women with uterus in situ?
cyclical COCP at the lowest dose possible for the shortest time possible
cyclical: oestrogen for 28 days, with progestogen for last 12 days of cycle
they will have post-P2 withdrawal bleed
maximum duration of treatment = 5 years
what are the indications for moving a woman from cyclical HRT to continuous HRT?
whichever comes first:
- not bleeding for more than one year (completion of menopause)
- reaching 54 years old
what is the HRT for a woman who has been amenorrhoeic for >1 year?
continuous combined replacement therapy
oestrogen and progesterone together all the time
how frequently is the review for women on HRT?
6 monthly
what is the HRT indicated for a woman who has had a hysterectomy?
what is the benefit in terms of risk profile versus normal treatment?
oestrogen-only HRT
?testosterone for libido
reduced risk of breast CA versus combinded HRT
what medication is given in preterm labour to reduce risk of cerebral palsy and protect gross motor function?
magnesium sulphate
what is the first line tocolytic?
what is the second line tocolytic?
class of drugs and an example for each
calcium-channel blocker - nifedipine
oxytocin receptor agonist - atosiban
do not offer beta-adrenoceptor agonists
what is the dose for antenatal steroids in preterm labour?
12 mg betamethasone IM
two doses 24 hours appart
when is it appropriate to consider/offer antenatal steroids
24(0) - 35(6)
which antibiotic should not be given in P-PROM due to its association with NEC?
co-amoxiclav
which antibiotic should be given as prophylaxis in P-PROM?
PO erythromycin 250 mg QDS
up to 10 days or until labour is established
evidence from ORACLE trial show short-term respiratory function, chronic lung disease and major neonatal cerebral abnormality were all reduced with this course of antibiotics
what are the signs of chorio-amnionitis in P-PROM women?
maternal pyrexia, offensive smelling discharge, foetal tachycardia (CTG)
treatment for simple lactational mastitis is conservative
what are the indications for antibiotics?
what are the antibiotics?
infected nipple fissure, symptoms not improving after 12-24 hours following effective milk removal, positive breast milk culture
PO flucloxacillin 250 mg QDS
penallergic: PO erythromycin 250 mg QDS
in the combined test, along with NT what are the blood markers measured routinely?
PAPP-A and beta-HCG
what are the cut off values for anaemia in pregnancy by trimester?
1st - 110 g/L
2nd - 105 g/L
3rd - 100 g/L
when are pregnant women screened for aneamia?
booking bloods and 28 weeks
what is the prescription for a woman presenting with primary genital herpes in the last 6 weeks of pregnancy?
PO aciclovir 400 mg TDS until delivery
what are the main risks of VBAC?
- uterine rupture (c. 1 in 200)
- blood transfusions and endometritis
- vaginal injury
- maternal mortality (2-3 in 10,000)
- hypoxic ishaemic encephalopathy (8 in 10,000)
- early PPH
what are the maternal risks of elective repeat cesaerian section?
- infection, bleeding, damage to adjacent structures
- less likely to succeed at VBAC next time
- placenta praevia/accreta in subsequent pregnancy
- longer hospital stay
- less in control of your birth, longer wait for skin-to-skin and breastfeeding
- pain and immobility
what are the foetal risks for elective repeat cesaerian section?
- foetal respiratory morbitidy
- lacterations
- ?bonding/breastfeeding affected
what is a topical medication that can be given for hirsuitism?
eflornithine
contraindicated in pregnancy and breastfeeding
what medication should be avoided during breast feeding?
- aspirin
- sulphonylureas
- carbimazole
- ciprofloxacin
- benzodiazepines
- lithium
- sulphonamides
- tetracyclines
- amiodarone
- cytotoxic drugs
- painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
- the bleeding is often less than menstruation
- cervical os is closed
- complicates up to 25% of all pregnancies
classification?
threatened miscarriage
- a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
- mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
- cervical os is closed
missed (delayed) miscarriage
- heavy bleeding with clots and pain
- cervical os is open
inevitable miscarriage
- not all products of conception have been expelled
- pain and vaginal bleeding
- cervical os is open
incomplete miscarriage
what is the differential for PMB?
endometrial adenocarcinoma until proven otherwise
then: tamoxifen, T2DM, PCOS, late menopause, high oestrogen levels
cottage-cheese vaginal discharge means…
candida albicans vaginitis
Thrush
what is a short-term management strategy for control of menorrhagia?
norethisterone 5 mg tds
rapidly stops menstrual bleeding
when should a serum progesterone be taken when investigating subfertility?
7 days before the expected start of the next period
abdominal ultrasound reveals a boggy uterus with subendometrial linear striations
prescription for c. trachomatis or n. gonorrhoeae urogenital infection?
ceftriaxone 500 mg IM as a single dose
azithromycin 1 g PO as a single dose
which is more likely to be malignant:
- simple, unilocular ovarian cyst
- complex multilocular ovarian cyst?
complex
what is the management of a <35 y/o woman with a simple, 3mm ovarian cyst on USS?
repeat USS in 8-12 weeks
it should have regressed on its own by then but if it persists then consider referral to gynae
how do you classify PPH?
500-1000 mL = minor haemorrhage
>1000 mL = major haemorrhage
what is the age definition of premature ovarian failure?
younger than 40 years old
what is the counselling for HRT effect on breast CA?
- in the Women’s Health Initiative (WHI) study there was a relative risk of 1.26 at 5 years of developing breast cancer
- the increased risk relates to duration of use
- breast cancer incidence is higher in women using combined preparations compared to oestrogen-only preparations
- the risk of breast cancer begins to decline when HRT is stopped and by 5 years it reaches the same level as in women who have never taken HRT
does magnesium sulphate just prevent or prevent and treat seizures?
prevent and treat
if termination is not achieved with MgSO4 then consider BZD (midazolam) for termination of acute seizure
is trimethoprim safe in breastfeeding?
yes
what are the antibiotics indicated for puerperal endometritis?
IV clindamycin and gentamicin until afebrile for >24 hours
are systemic corticosteroids safe in breastfeeding?
yes
A 28 -year-old is found to have an ectopic pregnancy at 10 weeks gestation. She undergoes surgical management of the ectopic with a salpingectomy. She is known to be rhesus negative. What is the recommendation with regard to anti-D?
anti-D should be given
In surgical management of an ectopic pregnancy then Anti-D immunoglobulin should be administered.
Anti-D is not required in circumstances where a medical management (methotrexate) of the ectopic has been used, nor for treatment of pregnancy of unknown location.
at what stage post partum can you offer intrauterine devices for contraception?
minimum 4 weeks post partum
what is the first line therapy for a symptomatic fibroid?
Mirena - levonorgestrel-releasing intrauterine system
other options: TXA, COCP
what medication is used short term before myomectomy to treat symptoms and shrink the size of the tumour?
GnRH analogue (continuous)
how long after starting copper IUD can it be relied upon for for contraception?
immediately
how long after starting progesterone-only pill can it be relied upon for contraception?
2 days
how long after starting COCP can it be relied upon for contraception?
7 days
does hydatidiform mole usually present with abdominal pain?
no
what are the stages of ovarian cancer?
1 - tumour confined to ovary
2 - tumour within pelvis
3 - tumour outside pelvis but within abdomen
4 - distant metastasis
what is the normal course of blood pressure in pregnancy?
- blood pressure usually falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks
- after this time the blood pressure usually increases to pre-pregnancy levels by term
what should be measured in the blood to monitor therapy with LMWH in pregnancy?
anti-Xa activity - not aPTT
what is the prinicple pathology being monitored for on USS between 16 and 24 weeks of a MCDA twin pregnancy?
twin-to-twin transfusion syndrome
what is the principle pathology being monitored by USS after 24 weeks of a MCDA twin pregnancy?
IUGR
a woman with ischaemic heart disease asks for COCP..
what is the recommendation?
COCP is absolutely contraindicated
what are the symptoms of hyperemesis gravidarum?
nausea, vomiting, hypersalivaition, dehydration, weight loss, anorexia
try to quantify impact on quality of life
what differentials should you consider with hyperemesis gravidarum?
molar pregnancy
UTI
acute abdomen
thyrotoxicosis
gastroenteritis
medication/drugs
what investigations should you order in hyperemesis gravidarum?
-
urine - quantify ketones, MSU
- ’+ ketones’ = ketonuria
- Blood - U&E, FBC, glucose, betaHCG
- USS - viable, intrauterine pregnancy, exclude molar pregnancy
consider TFTs, LFTs, amylase, ABG
what are the admission criteria for hyperemesis gravidarum?
unable to keep food/water down
ketonuria and/or weight loss >5% despite antiemetics
potential/confirmed comorbidity
what are the antiemetics effective in hyperemesis gravidarum?
cyclizine, prochlorperazine, ondansetron, metaclopramide
what are two CAM therapies that can be offered in mild cases of hyperemesis gravidarum?
ginger and acupuncture
other than antiemetics, what medication should be considered in hyperemesis gravidarum?
ranitidine
anti-WE: thiamine, slow NaCl 0.9% infusion
severe: corticosteroids
what is the main differentiating factor in the history between placenta praevia and placental abruption?
abdominal pain
what are the components of the bishop score?
what is the interpretation of the bishop score?
cervix - position (0-2), consistency (0-2), effacement (0-3), dilatation (0-3)
foetal station (0-3)
bishop <5 - will need induction
Bishop >9 - labour will occur spontaneously
what medication is used in the symptomatic management of obstetric cholestasis?
ursodeoxycholic acid to bind to bile satls in circulation
induction typically at 37 weeks
what are the indications for continuous CTG monitoring during labour?
- sepsis or severe chorioamionitis, temp >38 degC
- severe hypertension >160/110 mmHg
- oxytocin induction
- new vaginal bleeding
- presence of significant meconium
what are the medications given in major PPH?
ergometrine, syntocinon (together as syntometrine)
carboprost
COCP, 1 missed pill at any time in cycle
take the last pill even if it means taking 2 pills in one day
continue as normal
no additional/emergency contraception needed
COCP missed 2 pills in week 1
sex in the pill-free period
take last pill even if it means taking 2 pills in one day and carry on normal cyclinc
emergency contraception will be needed
use condoms until you have taken pill for 7 consecutive days
COCP missed 2 pills in week 2
sex in the pill-free period
take the last missed pill even if it means taking 2 pills in one day
condoms should be used until she has taken the pill for 7 consecutive days
no emergency contraception is required
COCP missed 2 pills in week 3
sex in the pill-free period
take the last missed pill even if it means taking 2 pills in one day
when this packet finishes, skip the break and continue to the next packet without a break
use condoms until she has taken the pill for 7 consecutive days
no emergency contraception is required
after what gestation should the SFH match the gestational age?
20 weeks
during LCSC, what are the layers between skin and uterus?
- Superficial fascia
- Deep fascia
- Anterior rectus sheath
- Rectus abdominis muscle
- Transversalis fascia
- Extraperitoneal connective tissue
- Peritoneum
menorrhagia in a woman who requires contraception..
what are the options?
- levonorgestrel-releasing intrauterine system
- COCP
- depo-provera injection (or equivalent)
can zopiclone be given to breastfeeding mothers?
no - present in breast milk
which antiepileptics are best in pregnancy?
lamotrigine, carbemazepine and levetiracetam
what is the mangement of cord prolapse?
- tocolysis
- patient on all fours
- push presenting part back into uterus, do not move the cord
- immediate caesarian section
what is the schedule for delivering depo-provera?
injection every 12 weeks, can extend to 14 weeks without the need for extra precaution
what is the effect of COCP on different cancer risks?
increased - breast and cervix
decreased - ovarian and endometrial
how do you give carboprost in PPH?
1st i.m.
2nd intramyometrial
what comes after syntometrine and carboprost (intramyometrial)
misoprostol PR
what is the target blood pressure antihypertensive therapy in PET?
systolic <150 mmHg
diastolic 80-100 mmHg
what is the pattern of serum markers seen with downs syndrome on antenatal scren?
NT and bHCG elevated
everything else reduced (PAPP-A, uE2, AFP)
what is the contraindication for ergometrine in 3rd stage labour?
hypertension
A 33-year-old primigravida woman of 32 weeks gestation presents to the Emergency Department with premature rupture of membranes. There have been no complications of the pregnancy so far and the woman is normally fit and well. How is she best managed?
admit for 48 hours
antibiotics (erythromycin, or penicillin and clindamycin if GBS +ve)
steroids for lungs to develop as this is premature
what is the treatment for multiple, non-keratinized genital warts?
topical podophyllum
2nd line - imiquimod
at what gestation is serum betaHCG detectable?
8 days
what is the first thing to do in a pregnant woman exposed to VZV?
check immunity with VZV Ig
how long post-exposure do you have to administer VZIG if required?
10 days
in what time period is aciclovir useful n VZV ?
up to 24 following onset of rash
what features (other than painless bleeding) would suggest vasa praevia versus placenta praevia?
rupture of membrane and foetal bradycardia
what gestation is normal for head to engage with pelvis?
37 weeks
though with nulliparous woman can occur right before labour
at what gestation is same day delivery for pre-eclampsia become an available option?
after 34 weeks
how long does the implant last?
what is the PEARL index?
3 years
0.7 in 100 women-years
what is the advice for women on COCP with a planned upcoming surgery?
stop the pill 4 weeks before and start 2 weeks after surgery to prevent thromboembolic disease
how early following birth can you insert Cu-IUCD?
why?
28 days postpartum
increased risk of uterine perforation
is smoking a risk factor for PET?
no
what is the time course for putting in Cu-IUCD following termination/miscarriage?
1st or 2nd trimester can be placed immediately
must wait 4 weeks pootpartum in 3rd trimester/at term
what is the grading of placenta praevia?
I - in lower segment
II - partially covers internal os
III - covers internal os only before dilation
IV - completely covers internal os
what is the radical procedure for late cervical cancer?
Wertheim hysterectomy
removal of uterus, parametrium, upper 1/3 vagina and pelvic node clearance
what are the complications of PET?
eclampsia
foetal -
prematurity and IUGR
maternal -
bleeding: intracranial/intraabdominal, abrupto placenae, DIC, HELLP
cardiac failure, multi-organ failure
how many antenatal visits should a woman expect during pregnancy?
nulliparous - 10
subsequent pregnancies - 7 (if uncomplicated)
what is the timeframe for Down’s screening with NT available?
11 - 13+6 weeks
what antenatal visits are only for nulliparous women?
25, 31 and 40 weeks
nothing special done at these visits, just check on patient
25 week measure SFH for first time, at 40 weeks discuss postdate induction potentially
what is the brand name of combined contraceptive patch?
Evra (only patch licenced in UK)
is metronidazole safe for use in pregnancy?
yes
but when treating BV, avoid 2g stat dose and offer 400 mg BD for 5-7 days
what are the two things you should council when starting depo provera?
fertility can take >1 year to retun after stopping
small but significant decrease in bone density which will recover after stopping
what social factor is associated with a decreased risk of HG?
smoking
what is a sensible medication to be given first line for HG?
promethazine (antihistamine)
what is the biggest risk of TOP?
infection, that can occur in up to 10% of cases
antibiotic prophylaxis should be given around the procedure
what is the typical presentation of vulval intraepithelial neoplasia?
VIN - single whilte plaques that may be itchy but do not ulcerate
what is the WHO definition of perinatal mortality?
stillbirth from 22 weeks gestation plus neonatal death until 7 days postpartum
what are the causes of hyperechogenic bowel on antenatal scan?
cystic fibrosis
down’s syndrome
CMV infection
what are the long term complications of PCOS?
subfertility
metabolic - T2DM, CAD, stroke & TIA
associated obstructive sleep apnoea
endometrial CA
which method of contraception is most proven to be associated with weight gain?
depo provera
what is the schedule for booking visit and dating scan?
booking visit between 8-12 weeks, ideally before 10 weeks
dating scan between 10-13+6 weeks
down’s screening is 11-13+6 weeks (inc measuring NT)
what are the contraindications for the medication in atonic uterus + PPH?
ergometrine - hypertension
carboprost - asthma
oxytocin & misoprostol have no contraindications in this scenario
do you give anti-D for PV bleed before 12 weeks gestation?
only if heavy, persistent or painful
what is the most specific physical sign for PET?
brisk tendon reflexes
what are the indications for surgical management of ectopic pregnancy?
gestational sac >35 mm
bHCG >1,500 IU/L
pain
what are the conditions for medical management of ectopic pregnancy?
ectopic <35 mm
bHCG <1,500 IU/L
pregnancy is excluded from uterus
no pain
must be willing to attend follow-up
for COCP, what history with regards to breast CA are cautions and contraindications?
current Hx breast CA - UKMEC 4
carrier of known gene mutations associated with breast CA - UKMEC 3
what is the treatment for vaginal candidiasis?
LOCAL - co-trimoxazole 500 mg PV stat
SYSTEMIC - fluconazole 150 mg PO stat; or
itraconazole 200 mg PO bd for 1 day
if pregnant, can only use local therapy
what are the associations with increased nuctal translucency?
Down’s syndrome
congenital heart defects
congenital abdominal wall defects
what is the indication for Kleihauer test?
any sensitising event after 20 weeks
always give anti-D dose empirically
do you eventually get regular bleed with progesterone implant (nexplanon)?
less than 1/4 women eventually get regular bleeding
what is done at the 28 week antenatal visit?
second screen for anaemia and alloimmunisation
first dose prophylactic anti-D
(give iron is Hb <10.5)
what is done at the 34 week antenatal visit?
second dose prophylaxic anti-D
information on labour and birth plan to be given
which is the POP that has extended cover if she missed the pill?
Cerazette - desogestrel
up to 12 hours late she doesn’t have to take action
what is the screening programme for ovarian cancer?
there is none
what happens to resp rate during pregnancy?
nothing
what happens to ESR and CRP during pregnancy?
ESR up, nothing to CRP
what is the consideration of a woman with hypertension asking for contraception?
uncontrolled HTN - COCP UKMEC 4
controlled HTN should consider other options rather than COCP
what are the rules for anti-D in early pregnancy?
miscarriage alone before 12 weeks does not need anti-D
miscarraige + ERPC before 12 weeks needs anti-D
threatened miscarriage after 12 weeks needs anti-D
termination (medical or surgical) at any point needs anti-D
what is the dose of anti-D ?
when should it be given?
before 20 weeks - 250 IU
after 20 weeks - 500 IU
give as early as possible, definitely within 72 hours
what is the frequency of induction of labour in UK?
15-25% of all labour
what must be done for a woman at 42 weeks who refuses IoL or C section?
returns to labour ward for 2x weekly CTG monitoring and USS looking for:
AFI & uterine artery doppler
what is the rate of progression for the first stage of labour?
at least 2 cm every 4 hours
what are the two options for failure to progress in the first stage of labour?
AROM (using small hook on VE)
or oxytocin infusion
what are the complications of augmentation/induction of labour?
failure
uterine hyperstimulation (>7 contractions in 10 mins)
N&V
uterine rupture
