Obs and Gynae 3 Flashcards
Name some causes of polyhydramnois (4) and oligohydramnios (5)
Poly
1. GDM
2. Duodenal atresia (GI obstruction) baby weeing but not digesting
3. Fetal anaemia (high output HF)
4. Trisomy 21
Oligo
1. Renal agenesis (Potters disease)
2. PPROM
3. IUGR
4 Post-term gestation
5. Pre-eclampsia
RFs for hyperemesis gravidarum
5
- Increase BhCG - TWINS!
- Increase BhCG- trophblastic diease
- Nulliparity
- Obesity
- Family Hx or personal
If somone has had a salphingotomy but still complains of pain/ raised BhCG what should you do next?
- Methotrexate
or - Salpingectomy - use med first if contra-lateral tube pathology
Management of pre-mature ovarian failure (< 40yo)
Combined hormone replacement therapy for all women until 51yo for natural age of meno so prevent osteoperosis and CVD
- Don’t give unopposed oestrogen if still have a uterus due to endometrial cancer
First-line treatment for magnesium sulphate induced respiratory depression
Treatment should be continued until when?
Calcium gluconate
treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)
What do you need to remember if giving preg lad WHO IS DIABETIC steroids in pre-term labour?
Giving steroids can cause hyperglycemia in diabetics therefore close attention should be paid to the BMs.
Hourly measurements and adjust. If hard to control sliding scale according to guidelines
Hyperglycaemia can can cause adverse outcomes to fetus
Management of mastitis
1.
2.
3. 3 indications
4. If allergic
- Continue breastfeeding
- Hot compress + analgaesia
- Flucloxacillin 10-14 days if: infected fissure, symp not improving in 12-24 hours despite milk removal or +ve milk culture
- Pencillin allergic - clarythromycin or erythromycin
Preg anaemia cuts off to give Iron supp
1st trimester
2nd trimester
3rd trimester
1st trimester- <110
2nd trimester- <105
3rd trimester- <100
oral ferrous sulfate or ferrous fumarate
treatment should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished
STEM- continuous dribbling incontinence, what are you thinking?
Vesicovaginal fistulae after prolonged labour and from an area with limited obstetric services. Hole from bladder to vagina
Eclampsia- When should the magnesium infusion be stopped?
Magnesium treatment should continue for 24 hours after delivery or after last seizure
Induction of labour
Bishop scores explained
< …. - indicates that labour is unlikely to start without induction
_>….. - indicates that the cervix is ripe, or ‘favourable’ - there is a high chance
Management
Conservative:
-
Medical NICE GUIDELINES
Bishop <_ …. = (2)
Bishop > … = (2)
< 5 - indicates that labour is unlikely to start without induction
_>8 - indicates that the cervix is ripe, or ‘favourable’ - there is a high chance
Management
Conservative:
- membrane sweep
Medical NICE GUIDELINES
Bishop <_ 6
1. vaginal prostaglandins or oral misoprostol
2. mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
Bishop > 6 = amniotomy and an intravenous oxytocin infusion
What is Mittelschmerz?
Mid cycle pain is very common and is due to the small amount of fluid released during ovulation. Inflammatory markers are usually normal and the pain typically subsides over the next 24-48 hours- pain usually 2 weeks after normal period on ovulation
Admission criteria for hyperemesis gravidarum (3)
management of anti-emetics
1. First-line-
2. Second-line - and a SE!
What anti-emetic is NOT used for more than 5 days and why?
Admission criteria for hyperemesis gravidarum
1. Continued n + v and unable to keep down liquids or oral antiemetics
2. Continued n + v with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
3. A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
management of anti-emetics
1. First-line- antihistamines: oral cyclizine or promethazine
or phenothiazines: oral prochlorperazine or chlorpromazine
2. Second-line - oral ondansetron: ondansetron during the first trimester is associated with a small increased risk of the baby having a cleft lip/palate.
oral metoclopramide or domperidone: metoclopramide may cause extrapyramidal side effects. It should therefore not be used for more than 5 days
Contraceptives - time until effective (if not first day period)
IUD, POP, COC, injection, implant, IUS
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
Management of preg women who may have come in contact with rubella
1,
2,
3.
-
- Discuss with the local Health Protection Unit
- If a woman is however tested at any point and no immunity is demonstrated they should be advised to keep away from people who might have rubella
- non-immune mothers should be offered the MMR vaccination in the post-natal period
MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant
Reasons for needing 5mg for
of folic acid of the standard 400mcg before preg?
- Obesity > 30 BMI
- Either partner has had a neural tube defect or previous preg neural tube defect
- On anti- epileptic drugs
- Coeliac disease
- Diabetic
- Thalassaemia
Treatment of intra-uterine fibroids
If not trying to get preg
1. IUD
2. COCP
If trying to get pregnant
1. Painless = tranexamic acid
2. Painful = mefanamic acid
3.
In a molar preg what will you see very high on bloods and how des this effect TSH and T3/T4
- V high b-hCG!
B-hCG stimulates thyroid to produce more T3 and T4 so present as thyrotoxicosis.
As a result -ve feedback shows LOW TSH!
GBS
If youre eligable for abx when is it given and what is given?
what makes you eligible for abx?
When do you test?
Give in preterm labour regardless of their GBS status.
- benzylpenicillin
- Previous preg with GBS infection (%)% chance of again)
Test- offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date
IT CANNOT BE REQUESTED!
Varicella zoster and preg
Exposed to chicken pox
Have chicken pox
Exposed to chicken pox:
- If unsure if ever had it- check immunoglobulins!
- If no antibodies and < 20 weeks: Immediate IV immunoglobulins
- If no antibodies and > 20 weeks: Aciclovir or Iv Ig but 7-14 days AFTER EXPOSURE!
If mum has chicken pox: SEND ON!
- > 20 weeks = oral aciclovir if she presents within 24 hours of rash, send on
- < 20 weeks = aciclovir with caution, send on
Have chicken pox
What is the earliest week that an ECV can be done in:
- nulliparous
- muliparous
absolute contraindications to ECV: (6)
- nulliparous - 36 weeks
- muliparous - 37 weeks
- where caesarean delivery is required
- antepartum haemorrhage within the last 7 days
- abnormal cardiotocography
- major uterine anomaly
- ruptured membranes
- multiple pregnancy
Examples indications for a category 1 caesarean (5)
caesarean section is done within … of making the decision
- suspected uterine rupture
- major placental abruption
- cord prolapse
- fetal hypoxia (late decelerations on CTG)
- persistent fetal bradycardia
30 minutes
At what BP should you Arrange emergency secondary care assessment for any woman in whom pre-eclampsia is suspected
women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed
Engagement and station are essentially the same thing but described with relation to different points of reference.
Engagement is an abdominal palpation finding- When the widest part of the baby enters the pelvic rim or inlet
Station is a vaginal examination finding- used to describe the head in relation to the ischial spine. The station is ‘0’ when the head is directly at the level of the ischial spines, if the station was describes as -2, it would be 2cm above the ischial spines, and it was +2 it would be 2cm below the ischial spine.
7 discrete sequences of delivery :
Engagement.
Descent.
Flexion.
Internal rotation.
Extension.
Restitution and external rotation.
Expulsion.
Women who have been admitted with hyperemesis gravidarum with electrolyte changes are given what fluid?
generally given IV normal saline with added potassium as hypokalaemia is common
Im
Which endocrine blood finding is keeping with the diagnosis of Turner’s syndrome
Raised FSH/LH in primary amenorrhoea - consider gonadal dysgenesis (e.g. Turner’s syndrome)
Gonadal dysgenesis causes an increase in FSH/LH by the negative feedback cycle to try to compensate for the lack of oestrogen and progesterone produced by the ovaries.
Potentially sensitising events in pregnancy: (10)
when do you give anti-d?
Ectopic pregnancy
- Evacuation of retained products of conception and molar pregnancy
- Vaginal bleeding < 12 weeks, only if painful, heavy or persistent
- Vaginal bleeding > 12 weeks
- Chorionic villus sampling and amniocentesis
- Antepartum haemorrhage
- Abdominal trauma
- External cephalic version
- Intra-uterine death
- Post-delivery (if baby is RhD-positive)
to non-sensitised Rh -ve mothers at 28 and 34 weeks
When should you screen for GDM in someone who has had a diagnosis of GDM in a previous preg?
Women with gestational diabetes in a previous pregnancy should be offered an OGTT as soon as possible after booking and subsequently at 24-28 weeks
what do you treat PE with in preg?
Suspected PE in pregnant women with a confirmed DVT: treat with LMWH first then investigate to rule in/out
What would dictate doing Chorionic villous sampling over amniocentesis or vice versa
Amniocentesis is usually performed from week 15 onwards
Chorionic villous sampling between 11 weeks and the end of the 13th week
obvs amniocentesis is much more invasive so take that into account
what would you see on blod for PCOS? (3)
- raised LH:FSH ratio
- testosterone may be normal or mildly elevated
- SHBG is normal to low
enlarged, boggy uterus → ?
adenomyosis
Woman aged > 30 years with dysmenorrhoea, menorrhagia,
if somone has just started the implant and had heavy irreg bleeding, what can you do?
3 months of COCP added
When should you refer to breastfeed clinic if concerned over babies weight?
If a breastfed baby loses > 10% of birth weight in the first week of life then referral to a midwife-led breastfeeding clinic may be appropriate
Interpreting quadruple test:
Edwards
AFP
Unconj Ostrodiol
hCG
Inhibin A
AFP LOW
Unconj Ostrodiol LOW
hCG LOW
Inhibin A —
Interpreting quadruple test:
Downs
AFP
Unconj Ostrodiol
hCG
Inhibin A
AFP LOW
Unconj Ostrodiol LOW
hCG HIGH
Inhibin A HIGH
Interpreting Quadruple test
Neural Tube defect
AFP
Unconj Ostrodiol
hCG
Inhibin A
AFP HIGH
Unconj Ostrodiol —-
hCG —-
Inhibin A —-
post-pertum thyroiditis, when can it present?
Management>
Up to 1 year post-partum
Mx- don’t use anti-thyroid drugs for the hyperthyroid part, just use symptomatic propanalol
Stage 2 of labour
from when until when?
Passive stage =
Active stage =
- Is it more or less painful than passive?
- Normal time…
- If longer than… then consider (1 of 3 from)
From fully dilated to baby delivered
Passive stage = 2nd stage but in the absence of pushing (normal)
Active stage = active process of maternal pushing
- active is less painful than passive as lushing masks the pain
- lasts 1 hour
- I longer than 1 hour consider forceps, vontouse or c-section
- episiotomy may be necessary following crowning
- associated with transient fetal bradycardia
FIGO staging of cervical cancer
IA=
Mx -
IB=
Mx -
II=
Mx -
III=
Mx -
IV=
Mx -
IA= Confined to cervix, only visible by microscopy and less than 7 mm wide
Mx- Gold standard = hysterectomy +/- lymph nodes
To maintain fertilility- Cone biopsy
IB= Confined to cervix, clinically visible or larger than 7 mm wide
mx- Radio + chemo
II= Extension of tumour beyond cervix but not to the pelvic wall
mx- Radio + chemo
III= Extension of tumour beyond the cervix and to the pelvic wall
mx- Radio + chemo
IV= Extension of tumour beyond the pelvis or involvement of bladder or rectum
Mx- Radiation and/or chemotherapy
Palliative chemotherapy may be best option for stage IVB
NICE guidelines on Bishop scoring
<= 6 means
- or…
-
> 6 means (do 2)
<= 6 means
- vaginal prostaglandins or oral misoprostol
- Mech method suh as balloon catheter if they’re risk of hyperstimulation or had previous c-section
- amniotomy and
- intravenous oxytocin infusion
Lochia (mucous and blood post-partum) is normal up until what week?
6 weeks
should be expected to cease after 4-6 weeks.
CTG Interpretation
Normal HR-
Abnormal Features what do they mean
Baseline bradycardia
- what is it?
- (2)
Baseline tachycardia
- what is the rate
- causes (4)
Loss of baseline variability- what does that mean?
- causes (2)
Early deceleration
- What does it mean?
- cause (1)
Late decelerations
- What does it mean?
- cause (2)
Variable decelerations
-What does it mean?
- cause (1)
Normal HR- 160 (100-160)
Baseline bradycardia
- <100
- mum on B-blocker or increased fetal vagal tone
Baseline tachycardia
- Heart rate > 160 /min
- Maternal pyrexia, chorioamnionitis, hypoxia, prematurity
Loss of baseline variability meaning
< 5 beats / min
Prematurity, hypoxia
Early deceleration
- deceleration of HR which starts on the onset of contraction and returns to normal when contraction is completed
- usually fine nd means babies head is compresssed
Late decelerations
- deceleration which lags behind ontraction and doesnt return to normal until 30s following end of contraction
- Indicates fetal distress e.g. asphyxia or placental insufficiency
Variable decelerations
- Independent of contractions
- May indicate cord compression
Station
‘0’ when the head is…
‘0’- head is directly at the level of the ischial spines
-2, it would be 2cm above the ischial spines
+2 it would be 2cm below the ischial spine
Station
‘0’ when the head is…
‘0’- head is directly at the level of the ischial spines
-2, it would be 2cm above the ischial spines
+2 it would be 2cm below the ischial spine
