obs and gynae Flashcards
when do you start contraception after taking levonorgestrel emergency pill
can start it immediately after
up to what week in pregnancy is considered a miscarriage
up to 24 weeks
what marks the end of the first stage of labour
cervix dilated to 10cm
what is the most common cause of postpartum pyrexia
endometritis
first line menorrhagia
IUS
tx of baby losing >10% weight in first week of life
refer to midwife led breastfeeding clinic
fluids given in hyperemesis gravidarum?
saline + potassium as hypokalaemia is common
rf for perineal tears
primigravida
large babies
precipitant labour
shoulder dystocia
forceps delivery
which form of HRT does not increase the risk of VTE
transdermal HRT
most common cause of early onset neonatal sepsis
group B strep
what consideration is important before prescribing metocloperamide for hyperemesis gravidartum
avoid use for more than 5 days as risk of acute dystonia
ie extrapyramidal side effects
HB cut off for post partum females
<100g/L
first line medical mx of infertility in PCOS
clomifene
metformin is second line !!
combined test for downs syndrome
nuchal transparency
beta HCG
PAPPA
quadruple test for downs syndrome
AFP
unconjugated oestriol
human chorionic gonadotrophin
inhibin A
moderate RF for pre-eclampsia
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
high RF for pre-eclampsia
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
when should a pregnant lady be prescribed aspirin for pre-eclampsia risk reduction
if >1 high risk factors
>2 moderate RF
in labour, when can an external cephalic version be attempted?
if the amniotic sac hasnt ruptured and isnt in active labour (>4cm dilated)
most common cause of vulval itching?
contact dermatitis
admission criteria for hyperemesis G?
Failure of oral antiemetics to control symptoms, ketonuria and weight loss (>5% of pre pregnancy body weight)
mx of pregnant woman with previous VTE hx
LMWH throughout pregnancy until 6 weeks postnatal
how many days barrier contraception needed when switching from POP to COCP
7 days
side effect of GNRH agonist
loss of bone mineral density
hot flashes
vaginal dryness
thresholds for OGTT and fasting glucose in gestational diabetes
fasting >5.6
OGTT >7.8
routine recall for smear for diff age groups?
Age 25–49 years — screening every 3 years
Age 50–64 years — screening every 5 years
treatment for premenstrual syndrome
drospirenone-containing COC taken continuously
abx for PPROM
10 days erythromycin
management for magnesium sulphate induced respiratory depression
calcium gluconate
which cancer is at higher risk when prescribing a progesterone and oestrogen HRT
Breast
if not started on first day of period, ho long does it take the diff types of contraceptive to be effective?
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
most common type of ovarian cancer
serous carcinoma
blood glucose targets gestational diabetes
FBG <5.3
OGTT <6.4
if not met with diet/exercise - start insulin
flying and pregnancy?
dont if:
- >37 weeks, singleton, uncomplicated
>32 weeks twin preg
if longer than 4 hours = compression stockings advisable
if VTE risk -> LMWH may be needed
non-hormonal treatment for menorrhagia
Painless menorrhagia - Tranexamic acid
PainFul menorrhagia - MeFenamic acid
placental abruption <36 weeks with no signs of fetal distress -> MX?
admit and admin steroids
no tocolysis
threshold to deliver will depend on gestation
placental abruption >36 weeks -> MX?
if distress = c section
no distress = vaginal delivery
contraceptive patch advise
Contraceptive patch regime: wear one patch a week for three weeks and do not wear a patch on week four
for first 3 weeks wear every day then can be changed weekly
if delayed change more than 48 hours in 1st or 2nd week then change immediately, use barrier contraception 7 days, if UPSI in last 5 days = emergency
placenta percreta
the chorionic villi invade through the perimetrium
BP target for hypertension in pregnancy
135/85
results for trisomy testing
Low alpha fetoprotein (AFP)
Low oestriol
High human chorionic gonadotrophin beta-subunit (-HCG)
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency
high inhibin A
what is sheehans syndrome
postpartum hypopituitarism
- ischaemic necrosis of the pituitary gland following PPH
symptoms
- lack of menstruation and lactation
- hypothyroidism
why do fibroids grow in pregnancy
due to increased oestrogen levels which drives its growth
how to estimate a mid-luteal date for progesterone testing
7 days before end of regular cycle
indications of CTG tracing during delivery
suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
severe hypertension 160/110 mmHg or above
oxytocin use
the presence of significant meconium
fresh vaginal bleeding that develops in labour - this was a new point added to the guidelines in 2014
which contraception shoudl be used in caution with asthma
ulipristal -> ella one
what week is earliest ECV can be offered
36 weeks
Rokitansky protuberance on abdominal US indicates what pathology?
