Obs and gynae

Question 1

What is the action of tamoxifen?

Answer 1

Tamoxifen is an oestrogen receptor antagonist that work against oestrogen receptors (ER +ve) tumours aka hormone receptor positive breast cancer.

Question 2

Side effects of tamoxifen?

Answer 2

• Risk of endometrial cancer (tamoxifen is agonist)
• Risk of DVT, PE
• weight gain
• vaginal bleeding and discharge

Question 3

What are examples of teratogenic drugs?

Answer 3

• Anti-folate agents e.g. Methotrexate and Trimethoprim (cause hydrocephalus, skull defects)
• ACE and ARB causes (fetal renal damage)
• Thiazide diuretic
• Sodium valproate to treat bipolar and prevent migraine (fetal axial and appendicular skeleton)

Question 4

What medication given to chickenpox caused by varicella zoster virus?

Answer 4

Acyclovir.

Chickenpox can cause congenital varicella syndrome in the newborn of a non-immune pregnant woman due to the VSV teratogenic effects including low birth weight.

Question 5

When are the doses of anti-D prophylaxis administered to RH -ve women?

Answer 5

1st dose - 28 weeks

2nd dose - within 72h after birth

Question 6

What is the Mx for postpartum blues?

Answer 6

Postpartum blues describes a transient lability in mood from around 3 days after birth, usually resolving at day 10. It is characterised by irritability, anxiety about parenting skills and tearfulness. Mx is supportive and reassurance of mother, screening at 4-6 weeks and 3-4 months postnatally.

Question 7

What is the Mx for hyperemesis gravidarum?

Answer 7

Severe vomiting with onset before 20 weeks gestation. Requires hospital admission.

Symptoms include: weight loss, vomiting causing ketonuria (lack of nutrition and starvation, from breakdown of fats) and hypokalaemia.

1st line - anti-emetic cyclizine, fluid replacement, potassium chloride for hypokalaemia (due to vomiting), Thromboembolic stockings and heparin due to VTE (immobilisation and pregnancy and dehydration).

Question 8

What is the Mx for pregnant mothers who are at risk of GBS infection?

Answer 8

Mx is with benzylpenicillin (intrapartum Abx during period of birth), mothers with previous GBS infection is a risk factor for future baby developing GBS.

Question 9

Mx for pregnant mothers with less expected cervical dilatation during labour?

Answer 9

1) perform amniotomy (artificial rupture of membranes aka water breaking)
2) oxytocin infusion for uterine contractions.