Obs and gynae Flashcards
Management of fibroids? What about if affecting fertility?
medical GnRH agonists may reduce the size of the fibroid but are typically used more for short-term treatment due to side-effects such as menopausal symptoms (hot flushes, vaginal dryness) and loss of bone mineral density
anti-progestogens also used
surgical optioms:
myomectomy
hysteroscopic endometrial ablation
hysterectomy
uterine artery embolization
The only effective treatment for large fibroids causing problems with fertility is myomectomy if the woman wishes to conceive in the future
What are the features of turners syndrome?
short stature
shield chest, widely spaced nipples
webbed neck
bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
primary amenorrhoea (will have high LH and FSh like menipause)
cystic hygroma
high-arched palate
short fourth metacarpal
multiple pigmented naevi
lymphoedema in neonates (especially feet)
hypothyroidism and autoimmune associated
horseshoe kidney: the most common renal abnormality in Turner’s syndrome
What is the criteria for secondary amenorrhoea and what age are you diagnosed with primary amenorrhoea?
secondary i.e. the patient has had no periods for >6 months but has had periods in the past.
Primary amenorrhoea is diagnosed if the patient if the patient has not had a period by the time they are 14 with no secondary sexual characteristics, or over 16 if secondary sexual characteristics are present.
What is the criteria for gestational diabetes? How is this managed?
gestational diabetes is diagnosed on OGTT with either:
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
if fasting glucose is < 7 mmol/l do trial diet/ exercise –> retest 1-2 weeks —> if not normal add metformin –> add in long-acting insulin if still not in range
if fasting glucose level is >= 7 start insulin
if glucose between 6-6.9 + evidence of complications eg macrosomia or hydramnios, start insulin
Who should take a high dose of folic acid and or how long in pre-pregnancy?
normal risk take 400mcg of folic acid until 12th week of pregnancy
women at higher risk of child with NTD take 5mg folic acid from before conception until 12th week
High risk if:
either partner has NTD, had previous pregnancy with NTD, or family history NTD
the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
woman’s BMI >30
When is OGTT done in pregnancy? What groups get it?
Get test if previously had gestational diabetes, large baby, BMI over 30, fhx diabetes/ ethnicity ass. with diabetes
: OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.
Caput succedaneum vs cephalohaematoma
caput succedneum- resolves in days, DOES crosss sututre lines
cephalohaematoma- does NOT cross suture lines, takes months to go
What is the first line management of infertility in PCOS?
Clomifene
What is first line treatment for chlamydia? 2nd line? What about in pregnancy?
doxycycline (7 day course) if first-line
Azithryomycin 2nd line
Azithromycin, erythromycin or amoxicillin may be used to treat Chlamydia in pregnancy
How long does it take for contraception to be effective?
Unless 1st day of period:
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
How is breech position managed in pregnancy?
if < 36 weeks: many fetuses will turn spontaneously
if still breech at 36 weeks NICE recommend external cephalic version (ECV)- this has a success rate of around 60%. The RCOG recommend ECV should be offered from 36 weeks in nulliparous women and from 37 weeks in multiparous women
if the baby is still breech then delivery options include planned caesarean section or vaginal delivery
Who is at risk of pre-eclampsia in pregnancy (moderate vs high)? What is done to mitigate this risk?
Moderate risks: 1st pregnancy, >40 yrs, pregnancy interval >10 yrs, BMI >35, fhx pre-eclampsia, multiple pregnancy
High risk: HTN in prev pregnancy or chronic HTN, diabetic, SLE
A woman with 2 moderate or 1 high risk of pre-eclampsia should take aspirin 75-150mg daily from 12 weeks gestation until the birth
What would be the expected symphysis-fundal height for someone?
After 20 weeks, symphysis-fundal height in cm = gestation in weeks
What is Meig’s syndrome?
Meigs’ syndrome is a benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion
What should Anti-D immunoglobulin be given?
In rh-ve mother if:
delivery of a Rh +ve infant
TOP
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma
Obstetric cholestasis vs acute fatty liver of pregnancy?
obstetric cholestasis - itchy - linked to premature birth
acute fatty liver - ACUTE, severe, N+V, abdo pain
HTN vs pregnancy induced HTN vs pre-eclampsia?
HTN: Before 20 weeks BP > 140/90 mmHg
PIH: after 20 weeks
Pre-eclampsia: proteinuria/ oedema
What is the most alarming feature on a CTG?
Late decelerations
Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contractionIndicates fetal distress e.g. asphyxia or placental insufficiency
What are the blood tests that are associated with down syndrome in pre pregnancy screening?
High nuchal translucency, inhibin a and beta hcg, low alpha feta protein, oestriol and papp-a
Low - alpha pappa oestrogen (alpha male, oestrogen- think hormones)
How do you manage chickenpox exposure in pregnancy?
when exposure to chickenpox has occurred, prophylaxis depends on the mother’s immunity status. If had before is OK.
If there is doubt re past chicken pox infections arrange an urgent blood test to check for varicella antibodies.
If not immune, give aciclovir if between 7-14 days post exposure.
Mx of ectopic pregnancy?
Expectant management - if <35mm + beta hcg <1000 + no heartbeat + no sx
Methotrexate: If <35mm + beta-hCG <1500 + no signficiant pain + no fetal heartbeat
Surgical mx if - >35mm or beta hCG >5000
Lap saphigotomy: Tries to preserve tube eg if issues with fertility
Lap saphingectomy: removes whole tube - best chance of getting rid of ectopic
Mx of pre-eclampsia/ eclampsia?
PO labetalol to lower BP 1st line, 2nd line eg if asthmatic is nifedipine
At 34 weeks - delive if pre-eclampsia - steroids before
Intravenous magnesium sulphate used if severe/ eclmapsia starts. Can cause resp depression
Androgen insensitivty vs CAH?
androgen insensitivity (previously testicular feminisation syndrome). This is a condition in which the patient is genetically male (46XY), but phenotypically female. Feminisation is a result of increased oestradiol levels, which lead to breast development. No periods develop.
Congenital adrenal hyperplasia presents early, causes ambiguous genitalia and other symptoms of adrenal insufficiency, such as arrhythmias and vomiting.
Mx of PPH?
bimanual uterine compression to manually stimulate contraction
IV oxytocin and/or ergometrine
IM carboprost
intramyometrial carboprost
PR misoprostol
surgical intervention such as balloon tamponade, B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
