Obs and Gynae Flashcards
What investigations would you do in a woman presenting with menorrhagia?
FBC in ALL women
pelvic exam?
TVS - if symptoms (IMB, PCB, pelvic pain, pressure)
How would you manage menorrhagia?
Depends upon if needing contraception No contraception required - mefenamic acid (particularly in dysmenorrhoea) - tranexamic acid Start both on day 1 of cycle If require contraception - IUS (1st line) - COCP - long-acting progestogens
What is a short-term treatment for menorrhagia?
Northisterone 5mg TDS to rapidly stop menstrual bleeding
What is screened for antenatally?
Sickle cell, alpha and beta thalassaemia Infections Down's Edward's Patau's syndromes Foetal anomaly scan Diabetic eye screening
When is sickle cell and thalassaemia screening offered and to whom? When would you test the father too?
All pregnant women at 8-10 weeks
Test father: If woman is genetic carrier OR if woman too late to get screening test
What questionnaire should be done with sickle cell and thalassaemia screening antenatally?
Family Origin Questionnaire
When are chorionic villous sampling and amniocentesis done?
CVS at 10-12 weeks
Amnio at 15-20 weeks (don’t do amnio before 15 weeks as risk of talipes)
What should be done if prenatal diagnosis shows baby has sickle cell or thalassaemia?
Offer termination OR
refer to paediatric haematologist
When are infections disease antenatal screening offered and what diseases are screened for?
Offered to all pregnant in early pregnancy and to all unbooked women in labour
Re-offer at 20 weeks if declined in early pregnancy
HIV, Hep B, syphilis
How are babies managed whose mothers are screened positive for HepB? Why is it important to screen for Hep B in pregnancy?
Hep B vaccine 24hrs after birth
Then at 4,8,12,16 weeks then 12 months
If baby contracts HepB perinatally, 90% risk of chronic Hep B, but if gets later as a child, risk is much lower.
Can be transmitted vertically, during delivery or during breastfeeding
Increases risk cirrhosis and liver cancer
What are the risks of maternal syphilis in pregnancy?
Can cross placenta and cause stillbirth, miscarriage, preterm labour or congenital syphilis
What tests can be offered to all women to check for Down’s, Edward’s or Patau’s syndromes?
Combined teset
Quadruple test
When is the combined test and what should be offered if miss it?
Combined test = 11-14 weeks (T21/13/18) If missed/no result after 2 attempts: Quadruple test at 14-20 weeks for T21 And 18-21 week scan for T13 and 18 Combined and quadruple offered in twin pregnancies
What is assessed as part of the combined test?
Risk of T21 and risk of T13/18
- Maternal age
- serum biochemical markers: PAPP-A, free bHCG
- USS: Nuchal translucency, crown rump length
What results are given in combined test? What is the cut off for prenatal diagnostic testing?
Results: 2 results, 1 for T21, 1 for T13/18
Individual results in DC twins
Cut off for PND = 1 in 150
What are the purposes of the early pregnancy scan?
Confirm viability EDD - gestational age using CRL CRL and nuchal translucency as part of combined test Multiple or single pregnancy Major structural anomalies
When is the early pregnancy scan and how is it done?
8-14 weeks
Transabdominal USS
When is the quadruple test offered? What does it involve?
Offered to late bookers, or not able to do combined test or obtain NT 14-20 weeks - tests for T21 ONLY, bloods only - alpha feto protein - total bHCG - oestriol - inhibin A Diagnostic testing cut off = 1 in 150 Can't do individual results in DC twins
What occurs in a positive screening test for T21, T13 or T18?
Mother contacted within 3 working days+ offered appointment
Options:
- await anomaly scan at 20 weeks
- Non-invasive prenatal testing (private)
- invasive testing (CVS or ACS) - 0.5-1% miscarriage risk
What is non-invasive prenatal testing?
Private sector but coming into NHS soon
Analyses foetal DNA from maternal blood from 10 wks
For: T21, 18, 13 and gender
99% sensitive - small risk confined placental mosaicism
When is the foetal anomaly scan? What happens if it is not completed?
18+0 to 20+6 weeks
Offer again at 23 weeks if not completed
What occurs if abnormal results of foetal anomaly scan at 20 wks occurs?
Referred to foetal medicine within 3 working days
Report to National Congenital Anomalies and Rare Diseases Register (NCARDR)
Refer to neonatologists, paediatrics etc.
Who is offered diabetic eye screening and when is it offered?
Women who are diabetic and become pregnant offered within 6 weeks of notification of pregnancy
- have early booking appointment and scan
- Diabetic midwives refer to DES
- Maternity diabetic team can access results
What is the puerperium?
Time from delivery of placenta until 6 weeks post-partum