obs and gynae Flashcards
first line management for urge incontinence
oxybutynin, anti-muscarinic agent on smooth muscle
management for urge in continence if first line is contraindcated
mirabegron- is a potent and selective agonist of beta-3 adrenergic receptors
management for stress incontinence
duloxetine
pt with a previous history of caesarean and pelvic inflammatory disease presents with delayed third stage of labour what is the diagnosis
hysterectomy in situ
difference between cholestasis of pregnancy and acute fatty liver
acute fatty liver is generalised symptoms and jaundice while cholestasis during pregnancy presents with severe pruritis
difference between IUS and IUD
IUD makes periods heavier, IUS makes them lighter and you can use them in people with hypertension
what do you use for those in a low mood before menstruation but improves after menstruation
new COCP
first and second line for premenstrual syndrome
1) new COCP 2) SSRI
first line treatment for suspected VTE/DVT in pregnancy
LMWH
what should pregnant patients with suspected VTE/DVT be tested for when under 50kg or over 90kg
anti-xa activity and platelet count
What is the UKMEC 1 and 5
no restriction to use the COCP and unacceptable to use the COCP
protocol if you see female genital mutilation
call the police
When do you need to take aspirin during pregnancy
12 weeks till delivery if you have 2 moderate risk factros or 1 high risk of preeclampsia
what does smelly discharge indicate
STI
all patients with secondary dysmenorrhea should….
referred to gynaecology
does PPH look at birth of the baby or the placenta
baby
after how many weeks would you give an immediate ultrasound if there is no fetal heartbeat or reduced movements
28/30
In which two disorders would you find cervical excitation
PID and ectopic pregnancy
What is vaginal bleeding, a firm fixed uterus and maternal shock a sign of
placental abruption
Which of the following have to be stopped during pregnancy: metformin, glicazide
glicazide
Which cancers is COCP a risk factor for
breast and cervical
Which cancer is COCP protective against
endometrial and ovarian
what is the difference between primary and secondary dysmenorrhea
primary is with menustration and secondary is before
pain gets better after period
endometriosis
first line investigation for endometriosis
laproscopic
What are the risk factor for post partum haemorrhage
multiparous, parity over 4, placental abruption, placental pravia, ecclampsia, macrosomia
What is the most common cause of PPH and how is it seen
uterine atophy and high soft uterus
what is the mechanical management of PPH
rubbing the uterus and catheterisation
What is the medical management of PPH
ergoteramine, oxytocin, crabtoperol and tranzexamic acid
What is the surgical management for PPH
intrauterine balloon tamponade, hysterectomy and uterine artery ligation
what is secondary post partum haemorrhage
500ml of blood loss from 24 hours - 12 weeks postpartum
What are the two most common causes of secondary post partum haemorrhage
infection like endometriosis and retained tissue
string of pearls on ultrasound
PCOS
role of clomiphene
stimulant of FSH
which contraception should you not use in high risk of breast cancer, uncontrolled hypertension and migrane without aura
COCP
which contraception can we not use in people with PID or wilsons disease and only use after a screenign or chylamydia and gonorrhoea
mirena
what does FSH over 10 suggest
reduced ovarian follicles
what does FSH over 40 suggest
premature ovarian failure
which contraceptive method acts immediately
IUD
which contraception works after 2 days
progesterone only pill
which contraception works after a week
injection, implant, combined oral contraceptive and IUS
management in pregnany women with VTE prophylaxis
take LWMH until 6 weeks postnatally
treatment for epileptics during pregnancy
lamotrigine
treatment for nausea and vomiting during pregnancy
promethazine
first line treatment for endometriosis
NSAID’s and if this doesnt work give COCP
appendicits pain is unlikely to be of sudden onset
bishops score
Cervical position Posterior Intermediate Anterior -
Cervical consistency Firm Intermediate Soft -
Cervical effacement 0-30% 40-50% 60-70% 80%
Cervical dilation <1 cm 1-2 cm 3-4 cm >5 cm
Fetal station -3 -2 -1, 0 +1,+2
Interpretation
a score of < 5 indicates that labour is unlikely to start without induction
a score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour
first HPV test is high risk but negative and second test is negative
normal recall
first HPV is high risk but negative and second test is that same
repeat smear in 12 months
first HPV is high risk but negative and second test is that same
repeat smear in 12 months
first line management for gestational diabetes
metformin
fasting glucose is still more than 5.6mmol/L on metformin
start insulin
which day on the cycle can an IUD be inserted
any day during the cycle
what to do in a rhesus negative women who is pregnant
one dose anti D immunoglobulin followed by a Kleihauer test
meig’s syndrome
benign ovarian syndrome, pleural effusion and ascietes
why should metoclopromide not be used for more than 5 days
its can lead to increased upper muscle tone or extrapyramidal side effects
medical management for ectopic pregnancy
oral methotrexate
first line treatment for left over products of conception
vaginal misopristol and second line is surgical vaccum
A cut-off of —g/Lshould be used in the postpartum period to determine if iron supplementation should be taken
100
fetal head is not engaged and high
placental praevia
maternal and fetal tachycardia and maternal pyrexia
chorioamnionitis
what are the risk factors for endometrial and cervical cancer
endometrial: polycystic ovarian syndrome
cervical: parity
how does placenta accreta
a woman who has had two previous caesarean sections develops massive bleeding shortly after giving birth
a 30-year-old woman develops a massive post-partum haemorrhage. An emergency hysterectomy is performed. Pathological examination demonstrates that the placenta is attached to the myometrium
painless vaginal bleeding
placental praevia
risk caused by tamoxifen
endometrial cancer
ectopic pregnancy bhcg levels
more than 1500 is ectopic pregnancy
fibroids less than 3cm, not distorting the cavity
less than 3cm medical management like COCP, IUS and mirena, and more than 3cm is a myomectomy
characteristics cervical ectropion
endocervix(columnar part) is exposed outside, excess discharge that is not purulent, can result in post-coital bleeding, increased in those who use COCP and are pregnant,
