obs and gynae Flashcards
which drugs should be avoided in breastfeeding?
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
what is the most common cause of pph?
uterine atony - failure of adequate uterine contractions
what is the gold standard investigation for suspected endometriosis?
laparoscopy
examination findings in endometriosis?
reduced organ mobility
tender nodularity in posterior vaginal fornix
visible vaginal endometriotic lesions (maybe)
what are the reasons to give 5mg folic acid dose?
DOCTor NTD
Diabetes
Obesity >30 bmi
Coeliac
Thalassaemia traits
or
NTD (fhx or previous preg)
also antiepileptic medx
what are the complications of hyperemesis gravidarum?
wernicke’s encephalopathy
mallory-weiss tear
central pontine myelinolysis
acute tubular necrosis
fetal: small for gestation age, pre-term birth
what should be given for suspected wernicke’s encephalopathy in hyperemesis?
pabrinex (iv vit B and C)
what can be given to manage unscheduled bleeding on nexplanon?
3 months COCP
does the POP need to be withheld after taking emergency contraception?
no - continue taking POP as normal
how long postpartum can smear testing take place?
3 months
what is dribbling incontinence in a patient from an area with limited obstetric services a sign of?
vesicovaginal fistula
how long before surgery should the COCP be stopped?
STOP(4 letters) the COCP (4 letters) 4 weeks before an OP
when should an OGTT at 24-28wks be done for GDM?
- BMI of 30kg/m2
- previous macrosomic baby 4.5kg
- previous GDM
- 1st degree relative with diabetes
- family origin with high prevalence of diabetes (south asian, black caribbean and middle eastern)
in which patients should ogtt be done asap after booking?
pts with previous GDM
how many weeks should folic acid be taken for?
first 12 weeks of pregnancy (maybe beyond)
absolute contraindications for depo?
breast cancer (current = ukmec4, past = ukmec3)
what investigations are done in menorrhagia with pelvic pain/intermenstrual bleeding/postcoital bleeding/abnormal exam findings?
TVUSS
how long after medical TOP can a urine pregnancy test remain positive?
up to 4 weeks post TOP
what is the medical management of miscarriage?
vaginal misoprostol
what are the risk factors for hyperemesis?
- multiple pregnancies
- trophoblastic disease
- hyperthyroidism
- nulliparity
- obesity
(smoking = decreased incidence)
When switching from an IUD to COCP day 1-5 of cycle what additional contraception is required?
no additional contraception is needed if removed day 1-5 of cycle
when switching from IUD to COCP on day 7 onwards of the cycle, what additional contraception is needed?
7 days barrier contraception
what is the first line management for overactive bladder/urge incontinence?
bladder retraining
what is the first line management for stress incontinence?
pelvic floor training
then surgery/duloxetine
what is the first line surgical approach to PPH?
intrauterine balloon tamponade (bakri catheter)
what are the mechanical approaches to tx of PPH?
rubbing uterine fundus
catheterisation to prevent bladder distension and monitor urine output
what are the medical managements of PPH?
IV oxytocin
ergometrine slow IV or IM
carboprost IM (unless asthma)
misoprostol sublingual
what is the management for premature ovarian insufficiency?
combined HRT or combined pill
how is DVT/PE treated in pregnancy?
LMWH
how is a non-metastasised endometrial adenocarcinoma treated in a 76yo?
total abdominal hysterectomy with bilateral salpingo-oopherectomy
important antenatal care points
8 - advise + bloods
10 - dating scan
11 - looks like chromosomes - down’s - NUCHAL
16 - check hb
18 - anomaly scan
28 - 1st dose anti d and check hb
34 - 2nd dose anti d
38 and 41 - routine care = bpm urine dip and sfh
what are the 3 features of meig’s syndrome
benign ovarian tumour
ascites
pleural effusion
how is thrush managed in pregnancy?
clotrimazole pessary (oral antifungals cause cong abnormalities)
what are the features of endometrial hyperplasia?
abnormal vaginal bleeding ie IMB/PMB
what is the most common complication of open myomectomy?
adhesions
how to remember mechanism of action of antiemetics
1,2,3 (CMO)
1. cyclizine - h1 receptors
2. metoclopramide d2 receptor
3. ondansetron 5ht3 receptor
when can the copper IUD be used as emergency contraception?
5 days after upsi or ovulation, whichever is latest
how is PCOS diagnosed?
2/3
- oligomenorrhoea
- clinical and/or biochemical signs of hyperandrogenism
- pcos on USS, oligomenorrhoea or amenorrhoea, and hirsutism
how is chickenpox treated in pregnancy?
> 20wks
-> oral acyclovir if presenting within 24h of rash
nothing if over 24h and no signs of complications
-> VZIG or IV antivirals if pre rash and 7-14 days post exposure
when can COCP be started in breastfeeding mothers postpartum?
6 weeks postpartum
reduces breastmilk vol
how often should HIV+ women have smears?
annually
which are the preferred forms of contraception for women on anti-epileptics?
implant, depo-provera, IUD, IUS
(on lamotrigine - can have POP)
causes of oligohydramnios?
prom
fetal renal probs
iugr
post term gestation pre-eclampsia
how does vasa praevia present?
Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen
what is non invasive prenatal testing?
analysis of fragments of foetal dna in mother’s circ
high spec and sens, no risk miscarriage
how does placenta praevia present?
vaginal bleeding
no pain
non tender uterus
lie and presentation may be abnormal
what is the management for chickenpox in pregnancy <20wks?
VZIG
what is first and second line for hyperemesis?
- antihistamines - cyclizine or promethazine
- ondansetron (slight inc risk cleft lip/palate) and metaclopramide (<5d)
what is the primary mechanism of action of the implant?
inhibits ovulation
(also thickens cervical mucus)
what gestation should referral be made to FMU if no fetal movements are felt?
24wks
timings for cat 1,2,3 sections
1 - 30 mins
2 - 75 mins
3 - no specific time limit
what is the acute tx for cluster headaches?
100% o2 and subcut triptan
what is seen on imaging in normal pressure hydrocephalus?
ventriculomegaly out of proportion to sulcal enlargement
what is the mechanism of action of controlled hyperventilation in raised ICP?
reduces blood CO2
-> induces cerebral vasoconstriction
what are the features of pituitary apoplexy?
sudden onset headache
visual field defects
evidence of pit. insufficiency - eg hypotension
(it is a sudden enlargement of a pituitary tumour 2o to haemorrhage or infarction
what medication can be used to reduce the number of relapses in MS?
moabs eg natalizumab
how soon after ullipristal acetate (ellaone) should regular hormonal contraception be resumed?
5 days
what extra contraception is needed when switching from POP to COCP?
7 days barrier
what extra contraception is needed when switching from COCP to POP?
2 days barrier
which cause of APH presents with painLESS bleeding?
placenta praevia (PPP = painless placenta praevia)
how does BV present?
- thin, white/grey homogenous discharge
- clue cells on micro: stippled vaginal epithelial cells
- vag pH >4.5
- positive whiff test (KOH) - fishy odour
how is BV treated?
oral metronidazole
how does trichomonas vaginalis present?
offensive, yellow/green, frothy discharge
vulvovaginitis
strawberry cervix
how is trichomonas vaginalis treated?
oral metronidazole
how does gonorrhoea present?
thin, purulent mildly odorous vaginal discharge
dysuria, IMB, dyspareunia
gram neg diplococcus swab
how is gonorrhoea managed?
IM ceftriaxone
what are the missed pill rules for COCP if only 1 pill is missed?
take last pill even if it means taking 2 in one day
no additional contraception needed
what are the missed pill rules for COCP if 2 or more pills are missed?
- take last pill, leave any earlier ones
- use condoms until re-established for 7 days
- if pills missed wk1 - emergency contraception
- if pills missed week 2 no need
- if pills missed week 3 omit pill-free interval
what drug reverses respiratory depression caused by magnesium sulphate?
calcium gluconate
what is the most common type of ovarian pathology associated with Meigs’ syndrome?
fibroma
what is the most common benign ovarian tumour in women under the age of 25 years?
dermoid cyst (teratoma)
what is the most common cause of ovarian enlargement in women of a reproductive age
follicular cyst
how long before POP becomes effective?
48h
how soon post partum can COCP be prescribed if not breastfeeding?
21 days
due to inc risk VTE
which medication increases the risk of endometrial hyperplasia?
tamoxifen
what is used for VTE prophylaxis in pregnant women?
(if prev VTE)
- lmwh throughout pregnancy
- until 6wks PP
what indicates a need for aspirin during pregnancy? (75-150mg daily from 12wks)
≥ 1 high risk factors
≥ 2 moderate factors
what are high risk factors for htn in pregnancy?
hypertensive disease in a previous pregnancy
chronic kidney disease
autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension
what are moderate risk factors for htn in pregnancy?
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy
at what CRL would you expect to see cardiac activity?
over 7mm
what are hepatic adhesions specific for?
fitz-hugh-curtis syndrome - complication of PID
what medication is used to suppress lactation?
cabergoline
what is the first line tx for primary dysmenorrhoea?
NSAIDs eg mefenamic acid
what is an example of a tocolytic?
terbutaline
important things on CTG
VEAL CHOP
Variable decels - cord compression
Early decels - head compression
Accelerations - okay
Late decels - placental insufficiency
how does ovarian cancer spread initially?
local spread within the pelvis
when should women with autoimmune conditions (eg SLE, APS) take aspirin?
12wks - term - higher risk of PET
what is the advice for pregnant women who havent had MMR vaccine regarding rubella?
advise of risks
advise stay away from anyone with rubella
what type of insulin is used in GD?
short acting only
which gynae medication can cause falls in the elderly?
oxybutynin
what type of contraception can people who have had gastric sleeve/bypass surgery not use?
no oral contraception - lack of efficacy
what are the indications for admission in hyperemesis?
continued n+v with ketonuria and/or wt loss greater than 5% despite tx with oral antiemetics
which blood test is used to monitor treatment of DVT treatment?
anti-Xa (tx with LMWH)
which contraceptives can women on enzyme inducing antiepileptics be on?
IUD, IUD, depo
which contraceptives can women on lamotrigine be on?
POP, implant, depo, IUD, IUS (ie not COCP)
what is adenomyosis?
endometrial tissue in myometrium
more common in multiparous women towards end of repro years
- dysmenorrhoea
- menorrhagia
- enlarged, boggy uterus
mgt - gnrh agonists, hysterectomy
what TFTs would you expect in molar pregnancy?
high beta -> stimulates thyroid to produce T4 then T3 -> negative feedback on pituitary causing reduction in TSH
what is medical TOP at less than 9 weeks?
mifepristone then vaginal prostaglandins 48h later
what is medical TOP at less than 13 weeks?
surgical dilation and suction of uterine contents
what is medical TOP at more than 15 weeks?
surgical dilation and evacuation of uterine contents or late medical abortion (induces ‘mini-labour’)
which HPV viruses cause cervical cancer?
16, 18 and 33
what is the surgical management for vaginal vault prolapse (post hysterectomy)?
sacrocolpoplexy
what secretes hcg?
syncytiotrophoblasts
