Obs and Gynae 4 Flashcards
What layers are cut through in lower segment Caesarian section (8)
- Superficial fascia
- Deep fascia
- Anterior rectus sheath
- Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
- Transversalis fascia
- Extraperitoneal connective tissue
- Peritoneum
- Uterus
What strains of HPV cause cervical cancer?
16, 18
If a patient has the IUD fitted and wants HRT what key info can you give?
The progesterone in the IUD is enough to protect against endometrial cancer risk so they can have just oestrodiol, they do not need combind HRT
State the Rotterdam Criteria
2/3 from:
1. infrequent or no ovulation (usually manifested as infrequent or no menstruation)
2. clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
3. polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)
Catagories of PPH
minor (500–1000 ml)
major (more than 1000 ml)
Major:
- moderate (1000–2000 ml)
- severe (more than 2000 ml)
Abx prophylaxis for GBS, whats given and when?
IV intrapartum Benzylpenecillin to mum only!
Name the risk factors for GDM (5) and if they have 1 when should they be screened?
If they have previously had GDM when should they be screened?
- BMI > 30
- First degree relative with type 1 diabetes
- previous GDM
- previous macrosomic baby (> 4.5kg)
- High prevalence ethnicity
screen OGGT at 24-28 weeks
If have previous GDM- screen at booking and 24-28 weeks
If you seen female genital mutilation what should next step be to do?
if < 18 report this to the police
if > 18 still police
If someone is suffering from vasomotor menopausal symp and dont want any HRT what can you giv them?
SSRI - fluoxetine
Clonidine is also licensed for the treatment of vasomotor symptoms in menopause,
What in the history and exam would mae you think urinary overflow incontinance?
Bladder still palpable after urination, think retention with urinary overflow
monochorionic twin pregnancy- at week uss are you checking for twin-twin transfusion?
TTTS usually occurs in early or mid-pregnancy, thus USS 16 and 24 weeks focus on detecting this condition
After 24 weeks the main purpose of ultrasound examinations is to detect fetal growth restriction.
trans male on testosterone (female at birth) what contraception do you give them?
Copper coil!!
- hormonal are CI
Snow storm appearance
- complete =
molar preg
- complete hydatidiform mole = no foetal parts present and snowstorm appearance is seen on ultrasound
- bleeding early in preg is common
- incomplete hydatidiform mole = NO SNOW STORM and Parts SEEN!
features of Complete hydatidiform mole (4)
- vaginal bleeding
- uterus size greater than expected for gestational age
- abnormally high serum hCG
- ultrasound: ‘snow storm’ appearance of mixed echogenicity
primary PPH time -
secondary PPH time -
primary PPH time - < 24 hours
secondary PPH time - 24 hours - 6 weeks
PPm categories
Normal vaginal
minor =
major - mod =
major - severe =
c-section must be …
minor =500-1000ml
major - mod = 1000-2000ml
major - severe = > 2000ml
c-section must be …
Postpartum haemorrhage (>1000ml)
VBAC
- if going for C-section you must be counselled on subsequent vaginal
- 1/200 uterine scar rupture
- small increased risk of placenta praevia +/- accreta in future pregnancies, and of pelvic adhesions.
- success rate of planned VBAC is 72–75%, however this is as high as 85-90% in women who have had a previous vaginal delivery.
- All women undergoing VBAC should have continuous electronic fetal monitoring by CTG in labour as a change in fetal heart rate can be the first sign of impending scar rupture.
- Risks of scar rupture is higher in labours that are augmented or induced with prostaglandins or oxytocin.
Hyperemisis gravidarum
admit if 1/3 from:
- Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics
- Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
- A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
Hyperemesis gravidarum
for diag
Pregnancy-Unique Quantification of Emesis (PUQE) score for severity
- 5% pre-pregnancy weight loss
- dehydration
- electrolyte imbalance
Hyperemesis gravidarum
management
Conservative (3)
- Admit if warrant
Medical
First line
- class
- 2 eg’s
Second line
- class
- eg and SE
or
- Class
- Eg and SE therefore only use for…
- Admit if warrant
Conservative
- avoid triggers/ odours
- ginger
- P6 acupressure
Medical
1. first line- anti-histamine ie. cyclizine or promethazine
- second line
oral ondansetron (5-HT3 antagonist)
- slight increase of cleft palate
oral metoclopramide
or
domperidone (DA Agonist!)
or metoclopomide might cause EPSE so \DONT USE FOR > 5 days!! - IV hydration +/- K+ hydration
complications of Hyperemesis gravidarum (5)
- acute kidney injury
- Wernicke’s encephalopathy
- oesophagitis, Mallory-Weiss tear
- venous thromboembolism
5 fetal outcome
painful periods - dysmenorrhoea mx
first-line
second-line
first-line = NSAID (mefenamic acid or ibuprofen)
second-line = combined oral contraceptive pills
painful periods - dysmenorrhoea mx
first-line
second-line
first-line = NSAID (mefenamic acid or ibuprofen)
second-line = combined oral contraceptive pills
Primary dysmenorrhoea =
- when?
Features (2)
Secondary dysmenorrhea =
STEM clue on timing!
Causes (4)
management? (1)
Primary dysmenorrhoea =
- no underlying pelvic pathology
- 50% of menstruating women and usually appears within 1-2 years of the menarche.
Features (2)
1. pain typically starts just before or within a few hours of the period starting
2. suprapubic cramping pains which may radiate to the back or down the thigh
Secondary dysmenorrhea =
develops many years after the menarche and is the result of an underlying pathology
STEM- usually starts 3-4 days
Causes include: Endometriosis, Fibroids, adenomyosis, PID, IUD (copper)
ALL GET REFFERRED!
MMR vaccine in preg?
Dont give to anyone preg or trying to get preg
- avoid getting preg for 28 days after MMR
