Obs and Gynae Flashcards
Describe twin to twin transfusion syndrome
2 fetuses share a single placenta. One fetus receives less blood (donor) than the other (recipient) due to anomalies in the network of placental blood vessels. (1 may have fluid overload, other may be anaemic)
When is twin to twin transfusion syndrome tested for antenatally?
16-24 weeks
In what percentage of pregnancies is labour induced?
20%
Give 5 indications for induction of labour
Prolonged pregnancy (1-2 weeks after EDD) PROM with no labour DM in 38 wks+ Pre-eclampsia Rhesus incompatibility
What bishop score suggests that it labour is unlikely to start without induction?
5 or less
What bishop score suggests the cervix is favourable?
8+
What is the preferred method of induction?
Vaginal prostaglandin PGE2
What is a membrane sweep?
An adjunct to induction rather than an actual method of induction
When is membrane sweep offered?
Nulliparous - 40-41 weeks
Parous 41 weeks
What is the most common complication of induction of labour?
Uterine hyperstimulation
Describe uterine hyperstimulation
Prolonged and frequent uterine contractions
What is the treatment for uterine hyperstimulation?
Remove vaginal prostaglandins and stop oxytocin infusion.
Tocolysis with terbutaline
How many weeks can a test be positive for after termination of pregnancy?
4
HCG decreases by 50% every 2 days. Steep decline in 1st 2 weeks, steady decline in next 2 weeks
How many medical practitioners are required to approve a termination?
2
How many medical practitioners are required to do a termination?
1
What method of termination is used in less than 9 weeks gestation?
Mifepristone
48hrs later, prostaglandins
What method of termination is used in 9-13 weeks gestation?
Surgical dilation and suction
What method of termination is used in 15+ weeks gestation?
Surgical dilation and evacuation
OR late medical abortion (mini labour)
Who should be taking 5mg folic acid rather than 400mcg?
- People on anti-epileptics
- People with BMI 30+
- People with partners with NTD, FHx of NTD or previous pregnancy with NTD
- Women with diabetes
What is the gold standard investigation for endometriosis?
Laparsocopy
What would be seen on bloods in PCOS?
High LH (Raised LH:FSH ratio) High insulin
What is the investigation of choice for PCOS?
Pelvic USS
Describe the management of gestational diabetes with fasting glucose less than 7
1-2 weeks trial of diet and exercise
if not improved, add 1-2 weeks metformin
if not improved, add short acting insulin
Describe the management of gestational diabetes with fasting glucose more than 7
Short acting insulin
What is 1st line in symptomatic relief of endometriosis?
NSAIDS/Paracetamol
Is multiparity or nulliparity a RF for placental abruption?
Multiparity
What is amniotic fluid embolism?
When fetal cells/amniotic fluid enters into the mothers bloodstream and causes a reaction.
e.g shivering, sweating, coughing,cyanosis, hypotension, tachycardia
How do you manage amniotic fluid embolism?
Supportively
What maternal blood abnormality of phenytoin associated with?
Folic acid deficiency
What is used for DVT in pregnancy?
LMWH
How do you monitor the action of LMWH
Monitor anti Xa Activity
What is whirlpool sign on USS seen in?
Ovarian torsion
Give 4 contraindications to HRT?
Current/past breast cancer
Any oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
What type of HRT do you give to somebody with a uterus?
Combined - to avoid unopposed oestrogen
What type of HRT do you give to somebody without a uterus?
Oestrogen only
What is lochia?
Passage of blood, mucus and uterine tissue up to 6 weeks after delivery.
If after - investigate with USS
Can hepatitis B be transmitted via breastfeeding?
No! Unlike HIV
How long must methotrexate have been stopped in mum and partner before conception?
6 months
What should be given in PROM?
Antinatal corticosteroids
10 days of erythromycin
They should be admitted for 48hrs
What can shoulder tip pain be associated with?
Ectopic pregnancy - with peritoneal bleeding
What is Fitz Hugh Curtis syndrome?
A complication of PID involving peri-hepatic inflammation
What is Mittelschmerz?
Ovulation pains
What kind of cancer is the COCP protective against
Endometrial Cancer
What should you do when a woman comes in with reduced fetal movements?
- Confirm viability (auscultate with handheld doppler)
2. If viable, CTG
What is an epileptic of choice in pregnancy?
Lamotragine
How does smoking affect the risk of cervical cancer?
2X more likely
What are the 3 stages of postpartum thyroiditis?
- Thyrotoxicosis
- Hypothyroidism
- Normal thyroid
How is postpartum thyroiditis managed?
Propanolol for symptom control
How many days of abstinence must there be to do semen analysis?
3-5 days
What are the guidelines if a semen analysis comes back as abnormal?
Repeat the sample In 3 months. If it is still abnormal, refer to secondary care
What is the first line tocolytic agent in pre-term labour
Oral Nifedipine
What is the definition of a prolonged second stage of labour?
3hrs+ from full dilation
What is the next appropriate step in delivery during prolonged second stage of labour?
Forceps delivery
What is the treatment to prevent miscarriage in anti phospholipid syndrome?
Aspirin and LMWH
What is the advice around anti-epileptics and breastfeeding?
Most anti-epileptics can be used during breastfeeding - don’t change them
After non-pharmacological uterine compression and catheterisation - what is the 1st line pharmacological management of PPH?
IV Syntocinon (5 Units)
If a child loses more than 10% of birth weight in the 1st week, what do you do?
Refer to midwife led breastfeeding clinic
How does ovarian cancer initially spread?
Local invasion within the pelvic region
What 2 investigations can diagnose PPROM?
- Speculum
2. USS to look for oligohydramnios
What definition is used to classify bleeding as ‘abnormally heavy’
An amount a woman considers to be excessive
When are smear tests offered 3 yearly?
25-49 years
When are smear tests offered 5 yearly?
50-64 years
When do you stop receiving cervical screening invitations?
64 years+
What can be used in patients with stress incontinence where pelvic floor exercises haven’t worked?
Duloxetine
What drugs can be used in urge incontinence
Oxybutinin (antimuscarinic)
Mirabegron (beta-3-agonist)
What should be done where there is diagnostic uncertainty surrounding incontinence?
Urodynamic studies
What is the drug of choice for medical management of ectopic pregnancy?
Methotrexate
What are the guidelines on pregnant women less than 20wks that have been exposed to chickenpox?
- Check for varicella antibodies
2. If not immune, give varicella-zoster immunoglobulin ASAP - effective up to 10 days post exposure
What are the guidelines on pregnant women more than 20wks that have been exposed to chickenpox?
- Check for varicella antibodies
2. If not immune, give VZIG or antivirals (acyclovir) 7-14 days after exposure
What imaging technique is preferred in diagnosing adenomyosis?
MRI Pelvis
How should you treat women that are 20wks+ that develop chicken pox rash?
Oral acyclovir within 24hrs of rash
What ovarian pathology is associated with Meigs’ syndrome?
Fibroma
What is the ideal management of atypical endometrial hyperplasia in post menopausal women?
Total hysterectomy with bilateral saplingo-oophorectomy due to risk of malignant progression
When is the anomaly scan?
18-20+6 weeks
When is the early scan to confirm dates?
10-13+6 wks
What is the surgical management of an ectopic pregnancy?
Salpingectomy
If there is contralateral tubal damage, offer salpingotomy
Define premature ovarian failure
The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years
Why is cervical ectropion more common with COCP use?
Higher oestrogen levels
Where is the most common location of an ectopic pregnancy?
Ampulla of the Fallopian tube
What investigation is used to diagnose premature ovarian failure and menopause?
FSH Level - which will be high
What should be avoided in UTI in the 3rd trimester?
Nitrofurantoin
What should be avoided in the 1st trimester?
Trimethoprim (teratogenic in 1st trimester)
How does trimethoprim work?
It inhibits dihydrofolate reductase and interferes with folate metabolism (hence 1st trimester contraindication)
What is the main symptom of urinary overflow incontinence?
Bladder still palpable after urination
retention with urinary overflow
What is the most common ovarian cancer?
Serous carcinoma (epithelial)
What is the commonest type of ovarian cyst?
Follicular cyst
When should patients treated for CIN1, CIN2 and CIN3 next be offered cervical screening?
6 months after treatment for a test of cure cervical sample in the community
How often should women with HIV be followed up as part of the cervical screening programme?
Every year (annual cervical cytology)
What is the 1st line management in lactation mastitis?
Conservative management - analgesia and encourage breastfeeding
What should be done if symptoms of lactational mastitis do not improve after 12-24 hours?
Administer antibiotics.
Flucloxacillin or erythromycin - continue to breastfeed
How can moderate PMS be treated?
New generation COCP e.g. Yasmin
How can severe PMS symptoms be treated?
SSRI continuously OR just during the luteal phase
What contraception is contraindicated in patients undergoing testosterone therapy?
COCP as oestrogen can antagonise the effect of testosterone
What is used to classify the severity of nausea and vomiting in pregnancy?
Pregnancy-Unique Quantification of Emesis (PUQE) scoring system
What is the recurrence rate of postnatal psychosis ?
25-50%
What is the management of painless bleeding with no risk factors for ectopic pregnancy before 6 weeks gestation?
Expectant management.
They should do a repeat urine pregnancy test after 7-10 days and return if it is positive. A negative pregnancy test confirms miscarriage.
What is the management of bleeding in more than or equal to 6 weeks gestation?
Referral to EPAU
What should be done if late decelerations are seen on CTG?
Urgent fetal blood sampling
What medication may be given to reduce the size of uterine fibroids?
GnRH agonist (e.g. Leuprolide)
What type of contraception is contraindicated in previous obstetric cholestasis?
COCP - intrahepatic cholestasis worsens with multiple pregnancies and can recur with menstruation and oestrogen treatment
How should you give misoprostol in medical management of miscarriage up to 7 weeks?
Orally
How should you give misoprostol in medical management of miscarriage after 7 weeks?
Vaginally
What is the treatment for magnesium sulfate overdose?
Calcium Gluconate
What is 1st line medical therapy in PCOS?
Letrozole
Not clomiphene due to adverse effects on endometrial and cervical mucous
What is caput succedaneum?
A puffy swelling that usually occurs over the presenting part and crosses suture lines in a neonate
What is the advice around the COCP and surgery?
Stop 4 weeks before surgery and restart 2 weeks after surgery
What is the course of action if GBS is detected via high vaginal swab in early pregnancy?
Intrapartum IV Benzylpenicillin only
What is the advice about the MMR vaccine and pregnancy?
It should not be given to women that are pregnant or attempting to become pregnant
Ectopic pregnancy in which location is most associated with an increased risk of rupture?
Isthmus
What terminology is used to describe the head in relation to the ischial spine?
Station
What does a station of +2 mean?
The head is 2cm below the ischial spine
What is the management of ectopic pregnancy if there is foetal heartbeat?
Surgical management - salpingectomy or salpingostomy
What is the threshold BHCG level where surgical management should be considered?
1500+
What is the only effective treatment for large fibroids causing problems with fertility?
Myomectomy
What is the most common cause of pulmonary hypoplasia?
Congenital diaphragmatic hernia
What is the treatment for vaginal vault prolapse?
Sacrocolpopexy
When should cervical screening in pregnancy be delayed to?
3 months post partum
What is the most likely diagnosis in an older woman with labial lump and inguinal lymphadenopathy?
Vulval carcinoma
How many days after birth is contraception not required?
21 days
What is post term delivery a significant risk factor for?
Meconium aspiration
When is the anomaly scan?
18-20+6 weeks
Which HPV strains increase risk of cervical cancer?
16 and 18
What is the first choice antibiotic in UTI in pregnancy?
Nitrofurantoin (avoid at term) 100mg for 7 days
When is the early scan to confirm dates?
10-13+6 weeks
What is Asherman’s Syndrome?
Characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction of the menstrual outflow tract which presents as 2y amenorrhoea
What blood tests should women with severe pre-eclampsia have?
U&E, FBC, transaminases and bilirubin three times per week
What is the threshold viral load for vaginal delivery in HIV positive mothers?
viral load less than 50
What is used to treat Fitz-Hugh-curtis syndrome?
Ceftriaxone, doxycycline and metronidazole
Which types of twins are associated with the greatest risk of complications?
Monochorionic-Monoamniotic Twins
What is the treatment for meconium aspiration syndrome?
Admission to NICU for oxygen and antibiotic therapy
How should asymptomatic bacteriuria be managed in pregnancy?
Oral Abx
What is naegele’s rule?
The method of calculating the estimated delivery date in the FIRST antenatal appointment. Add 9 months to the LMP plus 7 days
obstetric ultrasound is usually performed at 12 weeks to establish the gestational age of the pregnancy more accurately
In twin to twin transfusion syndrome, which twin is more likely to survive until birth?
The donor twin
Which malignancy is tamoxifen a risk factor for?
Endometrial cancer
What is the diagnostic triad for hyperemesis gravidarum?
5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance
