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PLAB 1 August 2024 > OBS & GYN > Flashcards

OBS & GYN Flashcards

1
Q

Define pathological amenorrhea.

A

Failure to menstruate for at least 6 months.

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2
Q

Classification of amenorrhea?

A

◉ Primary amenorrhea:
◆ Lack of menstruation before the age of 15;
◆ Lack of menstruation before the age of 13 (without breast developments).

◉ Secondary amenorrhea
◆ Cessation of menstrual cycles following the appearance of it.

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3
Q

Causes of amenorrhea?

A

◉ Pregnancy

◉ Hypothalamic
* Most common
* Low BMI
* Excessive exercise
* Low GnRH ⟶ ⬇︎FSH and ⬇︎ LH ⟶ ⬇︎ oestrogen

◉ Polycystic ovarian syndrome

◉ Hyperprolactinaemia
* Pituitary tumors
* Antipsychotic agents
* Hypothyroidism

◉ Premature ovarian failure
* ⬆︎FSH levels

◉ Anatomical problems
* Usually results in primary amenorrhea
* Imperforated hymen
* Mullerian agenesis
* Asherman syndrome

◉ Thyroid problems

◉ Post-pill amenorrhea
* > 6 months amenorrhea after stopping the combined oral contraceptives
* Low-normal levels of oestrogen, FSH, LH
* Mildly raised prolactin

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4
Q

Anaemia of pregnancy

A

◉ First trimester
◆ < 110 g/L

◉ Second trimester
◆ < 105 g/L

◉ Third trimester
◆ < 100 g/L

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5
Q

What is the management of anaemia of pregnancy?

A

Ferrous sulphate.

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6
Q

What are the sympotms (presentation) of antiphospholipid syndrome?

A
  • ≥ 3 unexplained consecutive miscarriages before 10 weeks gestation (1st trimester)
  • ≥ 1 second trimester miscarriages
  • Vascular thrombosis (arterial or venous)
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7
Q

What is the investigation in antiphospholipid syndrome?

A
  • Lupus anticoagulant
  • Anticardiolipin antibody
  • Anti-b₂-gylcoprotein I antibody
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8
Q

Rx of antiphospholipid syndrome?

A
  • Low dose AAS (75 mg)
  • Heparin
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9
Q

What is the cause of Bacterial Vaginosis?

A

◆ Gardnerella vaginalis

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10
Q

Symptoms of Bacterial Vaginosis

A
  • (Homogenous) grey-white discharge
  • Thin and profuse discharge
  • Fishy smell (when KOH added)
  • ⬇︎PH (>4.5)
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11
Q

Rx of Bacterial Vaginosis

A
  • Metronidazole
  • Clindamicine
    ➔ May resolve spontaneously
    ➔ High recurrence rate
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12
Q

OBS & GYN

What are the main risks for cervical cancer?

A

◆ HPV (Human papillomavirus) (HPV 16, 18, 31 and 33).
- Multiple sexual partners
- Smoking
- Immunossupression
- Combined oral contraceptives pills (they don’t wear condoms)

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13
Q

Management of pathological CTG

A

◉ Conservative management
◆ Most initial / appropriate:Change mothers position
◆ Start intravenous fluids

◉ Expedite delivery

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14
Q

Describe the presentation of ectropion

A

➔ The ectocervix (the vaginal part of the cervix) is lined by stratified squamous epithelium.

➔ The endocervix (the bit inside the uterus) is lined with columnar epithelium

➔ The columnar epithelium (marches over) migrates to the outside covering the ectocervix.

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15
Q

What is the cause of ectropion?

A

⬆︎ leves of oestrogen
- Pregnancy
- COCP
- Ovulation phase in young women

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16
Q

Sympotms of ectropion

A
  • Ussually asymptomatic
  • Post-coital bleeding
  • Non purulent discharge
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17
Q

Rx of ectropion

A

If not bleeding, no therapy
* Stop COCP
- Silver nitrate (ablation)
* Cryotherapy
* Diathermy (ablation)

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18
Q

What organisms cause cervicites?

A
  • Chlamydia
  • Neisseria gonorrhoeae
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19
Q

Symptoms of cervicites

A
  • Usually asymptomatic
  • Vaginal discharge
  • Lower abdominal pain
  • Intermenstrual bleeding
  • Post coital bleeding
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20
Q

Regarding the following test:
Vulvovaginal swab for Nucleic Acid Amplification Test (NAAT)

When is this test performed (to diagnose what conditions)?

A
  • Chlamydia
  • Gonorrhoea
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21
Q

How is the diagnosis of cervicites made?

A

Step 1
- Vulvovaginal swab NAAT

—> If positive for gonorrhoea then step 2:

Step 2
- “Endocervical swab” & ‘high vaginal swab’ for culture

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22
Q

What is the investigation done in Ectropion?

A
  • Colposcopy: red ring around the cervical os.
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23
Q

What is the organism that causes chickenpox?

A

Varicela zoster virus.

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24
Q

Describe the (infectious) risk period for neonatal varicella.

A

If the mother develops chickenpox:
- 7 days before given birth
- 7 days after given birth

—> IVIG given to neonate.

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25
Q

What is the treatment for neonatal varicella?

A

IVIG.

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26
Q

What is the time period risk of infection for Fetal Varicella Zoster?

A

Before 20 weeks gestation.

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27
Q

What are the (fetal) symptoms for fetal varicella zoster?

A
  • Skin scarring
  • Microphtalmia (eye defects)
  • Limb hypoplasia
  • Microcephaly
  • Learning disabilities
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28
Q

What is the investigation in Bacterial Vaginosis

A

Microscopy:
- Positive whiff test
- Clue cells positive

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29
Q

In a pregnant patient

What is the management for chickenpox WITHOUT RASH development?

A

STEP 1
- Check if exposure was within the exposure period.
- If yes, then proceed to step 2.

STEP 2
- If patient is immunocompetent:
* Check for past history of varicella
* If past history is positive, then varicella IgG serology is not required.

  • If patient is immunocompromised:
  • Varicella IgG serology REGARDLESS of past hx of varicella.

STEP 3
- If patient doesn’t have varicella IgG antibodies: Aciclovir FROM DAY 7 after exposure (not before).

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30
Q

What is the exposure period for chicken pox?

A
  • 2 days before the rash develops
  • To 5 days after the rash appeared or until vesicles dried and crusted.
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31
Q

In a pregnant patient

What is the management for chickenpox WITH RASH development?

A

Aciclovir

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32
Q

Describe what is chorioamnionitis.

A

Infection caused after rupture of the membranes (prolonged) —> ascending of vaginal bacteria —> infection of the chorion and amnion membranes of fetus.

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33
Q

What are the risk factors for chorioamnionitis

A
  • Prolonged labour
  • Internal/Invasive monitor of labour
  • Multiple vaginal exams
  • Amniotic fluid with meconium
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34
Q

Symptoms of chorioamnionitis

A
  • Fever
  • Tachycardia
  • Abdominal pain
  • Uterine tenderness
  • Fetal distress
  • Foul smelling amniotic fluid
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35
Q

Management of chorioamnionitis

A

IV antibiotics

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36
Q

What is the cause of Trichomoniasis?

A

Trichomonas vaginalis.

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37
Q

What are the symptoms of trichomoniasis?

A
  • Frothy yellow - green discharge
  • Smelly odour
  • Itching
  • Strawberry cervix
  • Motile organisms
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38
Q

Rx of trichomoniasis

A

Metronidazole.

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39
Q

What is the cause of candidiasis (vulvovaginal)?

A

Candida albicans.

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40
Q

What are the symptoms of genital candidiasis?

A
  • White cheese like discharge
  • No smell (odourless)
  • Itching
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41
Q

What is the Rx of candidiasis?

A

Clotrimazole.

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42
Q

What is the reccomended contraception for menorrhagia in a young woman NOT sexually active?

A

IUS

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43
Q

What is the reccomended contraception for dysmenorrhoea?

A

NSAID’s:
* Mefenamic acid.

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44
Q

Sexually active women

What is the reccomended contraception for menorrhagia, dysmenorrhoea, fibroids (not distorting the uterine cavity)?

A

► IUS mirena (levonorgestrel IUS).

< 20 YO
* COCP
* POP
* Implant

Woman with sickle cell disease
* Depo-provera IM

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45
Q

What is the reccomended emergency contraception?

A

Within 72h
* Levonelle pill

Within 120h
* IUD
* Ellaone pill

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46
Q

Which contraception has the lowest pearl index?

A

Etonegestrel implant (Nexplanon).

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47
Q

What is the absolute contraindication of COCP?

A

Migraine with aura.

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48
Q

Short term and easy reversible

What is the recommended post-partum contraception?

A

► POP (progesterone only pill)
* To be given at 6 week post birth.

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49
Q

Describe the STEP BY STEP management for menorrhagia.

A

First line:
* Levonorgestrel-releasing intrauterine system (MIRENA)

Second line:
* Tranexamic acid
OR
* NSAIDS
OR
* COCP

Third line
* Norethisterone
OR
* Injected long acting progestogens

➔ When to pick endometrial ablation
* Family completed
* Low hemoglobin

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50
Q

What are the symptoms of acute fatty liver of pregnancy?

A

➔ Same as HELLP syndrome

Except:
* No haemolysis
* Ammonia
* Hypoglycaemia

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51
Q

What is the management of eclampsia?

A

► MgSO4

Loading dose
* 4-6g IV + 100ml normal saline (5-15min).

Maintenance
* 1g infusion per hour over 24h

Recurrence seizures
* Bolus of 2-4g

► Delivery at the earliest

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52
Q

Describe MgSO4 toxicity

A

⬆︎ MgSO4 plasma [.]
* Decreased urinary output
* QRS widening
* QT interval prolongation

10 mEq/L
* Loss of deep tendon reflexes

15 mEq/L
* Atrioventricular block
* Respiratory arrest

25 mEq/L
* Cardiac arrest

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53
Q

Obs & Gyn

What is the therapeutic range for magnesium sulfate?

A

4 - 8 mEq/L.

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54
Q

Obs & Gyn

Management of MgSO4 toxicity?

A
  • Stop MgSO4 infusion
  • Calcium gluconate 1g over 10 min.
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55
Q

Symptoms of ectopic pregnancy?

A
  • Lower abdominal pain
  • Vaginal bleeding
  • Amenorrhoea (6-8weeks)
  • Shoulder tip pain (due to peritoneal bleeding)

Located usually on the fallopian tubes.

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56
Q

What are the risk factors for ectopic pregnancy?

A
  • Pelvic inflammatory disease
  • Previous ectopic
  • Endometriosis
  • Previous tubal surgery
  • Assisted reproductive treatments
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57
Q

What is the management of ectopic pregnancy?

A

Medical management:
➔ Methotrexate
* Haemodynamically stable
* No significant pain
* Fetal mass < 35mm with no heartbeat
* Serum hCG < 5000 IU/L

Surgical management:
➔ Laparatomy
* Haemodynamically unstable
* Pain
* Ruptured ectopic
* Visible heartbeat
* Cannot come for a follow up

➔ Laparascopy: if haemodynamically STABLE.

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58
Q

Symptoms of endometrial cancer

A
  • Post menopausal bleeding
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59
Q

Risk factors of endometrial cancer

A
  • Nulliparity
  • Early menarche
  • Late menopause
  • Obesity
  • PCOS
  • Tamoxifen (antiestrogen used in breast cancer)
  • Unopposed oestrogen (HRT, adding progestogen ⬇︎ the risk)
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60
Q

What is the investigation done in endometrial cancer?

A

First line
* Transvaginal ultrasound
* Endometrium > 4 mm thickness (proceed to following step)

Definitive diagnosis
* Hysteroscopy with endometrial biopsy

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61
Q

Describe what is endometriosis.

A

Endometrial tissue outside the uterine cavity.

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62
Q

Symptoms of endometriosis

A
  • Chronic pelvic pain
  • Dysmenorrhoea
  • Deep dyspareunia
  • Infertility
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63
Q

What is the investigation done in endometriosis (ENDOMETRIAL TISSUE OUTSIDE THE UTERUS)?

A

Gold standard
- Laparascopy (diagnosis and treatment ablation)

➔ Transvaginal ultrasound often normal

64
Q

Causes of female infertility?

A
  • Tubal damage due to PID.
  • Ovulation failure.
  • Unexplained.
65
Q

What is the investigation done in female infertility?

A

1. Mid-luteal progesterone
- Taken 7 days prior to expected menstruation date
- Day 21 on a 28 day cycle.

2. FSH
3. LH
4. Hysterosalpingogram (HSG)
5. Laparoscopy (tubal patency)

66
Q

Differential diagnosis of female infertility.

A

PCOS
- FSH: normal
- LH: high
- Oestradiol: normal to mild elevation
- Prolactin: normal to mild elevation

Premature ovarian failure
- FSH: high
- LH: high
- Oestradiol: low
- Prolactin: normal

Prolactinoma
- FSH: decreased
- LH: decreased
- Oestradiol: decreased
- Prolactin: very high

Sheehan’s syndrome
- FSH: low
- LH: low
- Oestradiol: low
- Prolactin: low

Turner syndrome
- FSH: high
- LH: high
- Oestradiol: very low
- Prolactin: normal

67
Q

Describe the different fibroid locations.

A

Submucosal fibroids
- Beneath the endometrium, bulges into the uterine cavity.

Intramural fibroids
- Most common
- Within the uterine wall

Subserosal fibroids
- Outside of the uterus wall

68
Q

What is the management of asymptomatic fibroids?

A
  • Annual follow up to monitor size.
  • If rapid growth or suspected malignancy investigate
69
Q

What is the management of fibroids with menorrhagia?

A

First line:
* MIRENA (if no uterine distortion)

Second line:
* Tranexamic acid
OR
* NSAIDS
OR
* COCP

Third line
* Norethisterone
OR
* Injected long acting progesterones

70
Q

What is the management of fibroids with SEVERE menorrhagia?

A

Ulipristal acetate.

71
Q

What is the SURGICAL management of fibroids with menorrhagia?

A
  • Hysterectomy
  • Myomectomy
  • Uterine artery embolization
  • Endometrial ablation (fibroids < 3cm)
72
Q

Describe the time period for cervical screening

Testing for cytology and HPV

A

25 - 49 yo:
- Every 3 years

50 - 64:
- Every 5 years

73
Q

Describe the time period for breast screening.

A

50 - 70 YO
Every 3 years.

74
Q

Describe the cervical screening step by step.

HR-HPV

A

Step 1 HR-HPV test:
- If negative:
◆ Routine recall (25-49 every 3 years, 50-64 every 5 years).
- If positive:
◆ Cytology triage

Step 2 HR-HPV + ➜ Cytology triage:
- If cytology normal:
◆ Re-test HR-HPV in 12 months.
- If cytology abnormal:
◆ Colposcopy referral

75
Q

What is the step by step management of genital herpes on a pregnant woman on the 1st and 2nd trimester?

A

1st episode of genital herpes:
- Aciclovir 400 mg 3x/day for 5 days;
- From the 36th week: aciclovir 400 mg 3x/day until birth;
- C-section birth.

Recurrent genital herpes:
- Risk of neonatal herpes is low for vaginal birth.
- From the 36th week: aciclovir 400 mg 3x/day until birth.

76
Q

What is the step by step management of genital herpes on a pregnant woman on the 3rd trimester?

A

1st episode of genital herpes:
- Aciclovir 400 mg 3x/day until birth;
- C-section birth.

Recurrent genital herpes:
- Risk of neonatal herpes is low for vaginal birth.
- From the 36th week: aciclovir 400 mg 3x/day until birth.

77
Q

What is the screening time for gestational diabetes?

A

24 - 28 weeks.

78
Q

How is the diagnosis of gestational diabetes done?

A

Oral glucose tolerance test:
Fasting: ≥ 5.6 mmol/L
2h glucose level: ≥ 7.8 mmol/L

79
Q

How is the treatment of gestational diabetes done?

A

Fasting glucose < 7mmol/L:
- Diet and exercise;
- Monitor glucose at home 4x/day (fasting and 1h post meals);
- Offer metformin if glucose ⬆︎ after 1-2 weeks.

Fasting glucose ≥ 7mmol/L:
- Insulin (with or w/out metformin)
- Diet and exercise.

NO WEIGHT LOSS!

80
Q

What are the symptoms of molar pregnancy?

A
  • Hyperemesis (due to ⬆︎ hCG);
  • Painless 1st trimester vaginal bleeding;
  • Uterus large for date.
81
Q

What are the investigations in molar pregnancy?

A
  • βhCG: ⬆︎⬆︎
  • USS: snowstorm/grapes
  • Large theca lutein cysts
82
Q

What is the management of molar pregnancy?

A
  • Suction curettage;
  • Monitor urine and serum hCG twice a week until normal values.
  • Chemo if choriocarcinoma or ⬆︎⬆︎ βhCG even after uterive evacuation.
83
Q

When can a woman conceive again after molar pregnancy?

A

6 months:
- after normalisation of hCG.

12 months:
- after completing chemo

Contraception: oral or barrier.

84
Q

What are the indications for the use HRT?

A

After menopause:
- Hot flashes
- Night sweats
- Mood and sleep disturbances
- Headaches

Early menopause:
- HRT until 51 years of age
- Prevents osteoporosis
- Cardio protective

85
Q

What are the risks associated with HRT?

A
  • Breast cancer
  • Endometrial cancer (if not given progestogen)
  • Ovarian cancer
  • Thromboembolism
  • Stroke
86
Q

Which is the safest HRT on a patient with:
- Migraines
- Risk of clots
- Risk of stroke
- Smoker

A

Transdermal HRT.

87
Q

Systemic HRT

When to use Oestrogen-only HRT?

A
  • Hysterectomy
  • IUS

No need for progestone to protect the endometrial lining.

88
Q

In what situations is advisable to take combined HRT?

Both oestrogen and progestorone.

A
  • Intact womb.
  • To prevent against endometrial cancer.
89
Q

Combined HRT

When to use sequential/cyclical HRT?

A
  • Early menopause
  • Still bleeding
  • First 14 days oestrogen only
  • Later 14 days oestrogen & progestorone.
90
Q

Combined HRT

When to use continuous HRT?

A
  • Menopausal women for > 12 months
  • Continuous oestrogen & progestorone
91
Q

What is the investigation done in hyperemesis gravidarum?

A
  • Electrolytes
  • Ketonuria
92
Q

What is the treatment of hyperemesis gravidarum?

A
  • Normal saline + K⁺

1st line antiemetics:
- Cyclizine
- Prochlorperazine
- Promethazine
- Chlorpromazine
- Doxylamine with pyridoxine

2nd line antiemetics:
- Metoclopramide
- Ondaserton
- Domperidone

3rd line antiemetics:
- Corticosteroids

Other medications:
- Thiamine (wernick encephalophathy)
- LMWH

93
Q

Symptoms of intrahepatic cholestasis of pregnancy.

A
  • Pruritus 2nd and 3rd trimester, worse at night (w/out rash)
  • Bile acid ≥ 19 micromols
94
Q

Investigation in intrahepatic cholestasis of pregnancy

A
  • Bile acids > 19
  • LFT’s.
95
Q

Rx of constipation in pregnancy.

A
  • Isphagula (small hard stools)
  • Lactulose (when stools remain hard)
  • Senna (stools soft but difficult to pass)
96
Q

Obs & Gyn

Management of stress incontinence

A
  • Pelvic floor exercise
  • Surgical tape procedure
  • Duloxetine (non surgical candidates)
97
Q

Obs & Gyn

Management of urge incontinence

A
  • Bladder retraining (increase time in between need to void);
  • Anti-muscarinic agents (oxybutin, tolterodine)
98
Q

Define threatened miscarriage.

A
  • Vaginal bleeding
  • Fetal heart present
  • Cervical os closed
  • Little to no pain.
99
Q

Define missed miscarriage.

A
  • Fetus is dead but retained;
  • Cervical os is closed.
100
Q

Define inevitable miscarriage.

A
  • Heavy bleeding and clots;
  • Cervical os is opened.
101
Q

Define incomplete miscarriage.

A
  • Not all conception products have been expelled.
102
Q

Define complete miscarriage.

A
  • Heavy bleeding and clots;
  • Complete expulsion of all products of conception;
  • USS: empty uterine cavity.
103
Q

What are the rules for missed COCP pills?

A

◉ 1 pill is missed:
- Take the pill ASAP even if 2 pills are taken on the same day;
- Continue with the rest of the pack as usual;
- No additional contraception needed.

◉ 2 pills missed:
- Take the pill ASAP even if 2 pills are taken on the same day;
- Continue with the rest of the pack as usual;
- No UPSI until COCP have been taken for 7 days in a row.

► When were the pills missed?
◆ Pill free week: emrgency contraception if UPSI.
◆ Week 1: emergency contraception if UPSI.
◆ Week 2: No need for emergency contraception.
◆ Week 3: No need for emergency contraception + omit free pill week.

104
Q

What are the rules for missed POP pills?

A

◉ Traditional POP’s:
➜ > 3h late (> 27h since last pill):
- Take the missed pill ASAP
- Continue with the pack AT THE USUAL TIME.
- No UPSI on the next 48h.
- If UPSI occurred after missed pill ⟶ emergency contraception.

◉ Cerazette (desogestrel):
➜ > 12h late (>36h from last pill):
- Take the missed pill ASAP
- Continue with the pack AT THE USUAL TIME.
- No UPSI on the next 48h.
- If UPSI occurred after missed pill ⟶ emergency contraception.

105
Q

What is the dose of folic acid taken in pregnancy and for how long?

For all women.

A
  • 400 mcg/day for the first 12 gestational weeks.
106
Q

In which conditions is acid folic increased (in pregnant women)?

What is the dose?

A

Dose:
- 5 mg daily for the first 12 gestational weeks.

Conditions:
- BMI > 30
- DM
- On antiepileptic medication
- Previous pregnancy with neural tube defect
- Family hx of neural tube defect
- Personal hx of neural tube defect

1st three condition more important.

107
Q

In which conditions is acid folic taken throrought the pregnancy?

What is the dose?

A
  • Sickle cell disease
  • Thalassemia
  • Thalassemia trait

➜ 5mg/daily for the entire gestation.

108
Q

How is ultrasound diagnosis of miscarriage done?

A

Crown to rump lenght miscarriage:
- ≥ 7 mm
- No heartbeat

Gestational sac:
- ≥ 25 mm
- No fetal pole

109
Q

What are the contraception methods influenced by hepatic enzyme inducers?

A
  • COCP
  • POP
  • Implants
110
Q

What are the contraception methods SAFE when taken with hepatic enzyme inducers?

A
  • Mirena
  • Copper IUD
  • Depo-provera injections
111
Q

What are the hepatic enzyme inducers drugs?

A

CRAP GPs
- Carbamazepine
- Rimfapicine
- Alcohol (chronic)
- Phenytoin
- Griseofulvin
- Phenorbabitone
- Sulfonylureas

112
Q

Risk factors for ovarian cancer?

A
  • ⬆︎ age
  • Gene mutation BRCA1 and BRCA2
  • Family hx
  • Nulliparity
  • Obesity
  • Smoking
113
Q

Protective factors against ovarian cancer.

A
  • COCP
  • Pregnancy
114
Q

Symptoms of ovarian cancer?

A

➔ Patient > 50 YO
- Vague abdominal symptoms
- Abdominal distension
- Bloating
- Early satiety
- Loss of apetite
- Pelvic pain

115
Q

What is the step by step management of ovarian cancer?

A

1st step:
- Abdominal examination

2nd step:
➜ Normal abdominal examination:
- Test CA-125
- If CA-125 ≥ 35UI/ml ⟶ urgent abdominal and pelvis USS
- If USS abnormal ⟶ GYN urgent referral.

➜ Abnormal abdominal examination
- Ascites, pelvic, abdominal mass.
- GYN urgent referral.

116
Q

What is the cause of PID?

A
  • Chlamydia
  • Neisseria gonorrhea
117
Q

Risk factors for PID

A
  • < 25 YO
  • New / multiple sexual partners
  • Previous STI’s
  • IUD’s
  • Uterine instrumentation
118
Q

Symptoms of PID?

A
  • Lower abdominal pain
  • Dyspareunia
  • Vaginal bleeding
  • Purulent vaginal / cervical discharge
  • Fever
  • Cervical motion tenderness
119
Q

Rx of PID?

A

Outpatient
Option A
- Single dose of 1g of ceftriaxone IM / 500 mg ceftriaxone IM
+
- Oral doxycycline 100 mg / twice a day for 14 days
+
- Metronidazole 400 mg / twice a day for 14 days

Option B
- Oral metronidazole + oral ofloxacin for 14 days.

Inpatient:
Option A
- Ceftriaxone IV +Doxycycline IV + Oral metronidazole

Option B
- IV metronidazole + IV ofloxacin

120
Q

What is placenta abruption?

A
  • Premature separation of the placenta before birth;
  • Bleeding can be concealed (behind the placenta);
  • Bleeding can be through the cervix.
121
Q

What are the risk factors for placenta abruption?

A
  • Pre-eclampsia
  • Multiparity
  • Trauma
  • Cocaine
  • Smoking
122
Q

What is the management for placenta abruption?

A
  • Fluid resuscitation
  • Blood transfusion
  • C-section and delivery
123
Q

Describe what is placenta praevia?

A

When the placenta lies in the lower uterine segment (entirely or partially).

124
Q

What are the symptoms for placenta praevia?

A
  • Painless vaginal bleeding
  • Abnormal fetal lie
125
Q

What is the management for placenta praevia?

A
  • Continuous monitoring
  • C-section
126
Q

What is the investigation done in placenta praevia?

A
  • Speculum exam
  • Transvaginal USS.

Digital cervical exam NOT DONE!!

127
Q

DDx of antenatal haemorrhage.

A

Placenta praevia:
- CTG no fetal distress;
- Painless bleeding
- Blood is from maternal circulation

Placenta abruption:
- CTG with fetal distress
- Painful bleeding (might be absent if concealed).

Vasa praevia:
- CTG with fetal distress (fetoplacental circulation)
- Painless bleeding

128
Q

What are the symptoms of PCOS?

A
  • Oligoamenorrhea
  • Subfertility
  • Hirsutism
  • Acne
  • Obesity
  • Hyperglicemia
  • Acanthosis nigricans
  • Alopecia
129
Q

What investigation is done in PCOS?

A
  • ⬆︎LH:FSH
  • ⬆︎ Testosterone
  • USS: Multiple cysts in the ovaries or ↑ ovarian volume.
130
Q

What is the management of PCOS?
- Fertility improvement
- Fertility/Pregnancy
- Regular periods
- Hyperglycaemia
- Last line

A
  • Fertility improvement: weight loss
  • Fertility: Clomifen
  • For regular periods: COCP
  • Hyperglycaemia: Metformin
  • Last line: laparascopic ovarion drilling
131
Q

When can COCP be used postpartum?

A

Not breastfeeding: ≥ 6 weeks

Breastfeeding: ≥ 6 months

< 6 weeks: risk of clots.
>6 and < 6 months: ⬇︎ breast milk.

132
Q

Postpartum contraception

Woman who is not breastfeeding.

When should contraception be initiated?

A
  • 3 weeks (21 days).
  • NOT COCP (> 6 weeks only).

< 6 weeks: risk of clots.

133
Q

Postpartum contraception

When can IUS/IUD be inserted after birth?

A
  • Within 48h postpartum
    OR
  • After 28 days postpartum

Risk of uterine perforation.

134
Q

What ACEi antihypertensives are safe postpartum?

A
  • Enalapril.
135
Q

Post-pill amenorrhea

After how long should the patient wait before investigations can be done?

136
Q

What investigations are done in post-pill amenorrhea?

A
  • FSH: normal
  • LH: Normal
  • Oestrogen: normal
  • Thyroid function: normal
  • Prolactin: slightly elevated
137
Q

What is the treatment of post-pill amenorrhea?

A
  • Reassurance
  • Clomiphene (to induce ovulation if wanting to get pregnant).
138
Q

How is the diagnosis of pre-eclampsia made?

A

➜ Hypertension
➜ ≥ 20 weeks gestation
➜ And/or one of the following:

► Protein:Creatinine ratio:
- PCR ≥ 30 mg/mmol

► Albumin:Creatinine ratio:
- ACR ≥ 8 mg/mmol

► 24h urine protein:
- ≥ 0.3 g/24h

139
Q

Management of pre-eclampsia?

A

First line:
- Labetalol oral
- Hydralazine (IV)
- Nifedipine or methyldopa

► MgSO₄
► Delivery

140
Q

Define premature ovarian syndrome.

A
  • Onset of menopausal symptoms;
  • ↑ gonadotropin
  • < 40 years.
141
Q

Investigation done in premature ovarian failure?

A

-⬆︎ FSH: >25 IU/L (Taken 4 weeks apart)
- ⬇︎ Oestradiol

142
Q

Management of premature ovarian failure?

A

HRT until 51 years of age.

143
Q

Describe the different menopause terms.

A

Premature menopause:
- 12 months of amenorrhoea
- < 40 years

Early menopause:
- 12 months of amenorrhoea
- 40 - 45 YO

Menopause:
- 12 months of amenorrhoea
- > 45 YO

Perimenopause:
- Symptoms of menopause
- < 12 months of amenorrhoea

144
Q

When does PMS happen?

A
  • Luteal phase (after ovulation and before menstruation).
145
Q

Management of PMS?

146
Q

Management of ⬇︎ fetal movements.

A

> 28 weeks gestation + mother sure of ⬇︎ fetal movements

First step:
- Fetal hand-held dopller ultrasound
- If visible fetal heartbeat go to next step.

Second step
- CTG

> 28 weeks gestation + mother UNSURE of ⬇︎ fetal movements
- Mother should lie on her side for 2h
- Count fetal movements
- If < 10 ⟶ go to hospital.

147
Q

Explain how does Rhesus negative pregnancy happens.

A
  • Rh negative mother gives birth to Rh positive baby;
  • Antibodies formed cause haemolysis in subsequent pregnancies.
148
Q

Explain the prevention of Rh incompatibility in pregnancy.

A
  • All Rh negative mothers should be tested for anti-D antibody;

Not previously sensitised mothers
-Offer anti-D immunoglobulin at 28 weeks (single dose) or at 28 and 34 weeks (2 doses).

149
Q

Rh incompatibility

When can anti-D immunoglobulin be given within 72h?

A
  • Delivery of Rh positive infant
  • Abortion
  • Miscarriage after 12 weeks
  • Ectopic pregnancy
  • Antepartum haemorrhage
  • Amniocentecis and chorionic villus sampling
150
Q

Name the teratogenic medications.

A
  • Warfarin
  • Methotrexate
  • Sodium valproate
  • Retinoids

Use of contraception whiles taking these drugs.

151
Q

What is the Rx of UTI in pregnant woman?

A

Trimethoprim
- Avoid in the 1st trimester

Nitrofurantoin
- Avoid at term (from 37 weeks)

2nd & 3rd trimester:
- Cefalexin
- Trimethoprim

152
Q

What is drug of choice for pain relief in pregnancy?

A

Paracetamol.

153
Q

Management of postmenopausal UTI?

A

1st line:
- Vaginal oestrogen

2nd line:
- Prophylatic antibiotics

154
Q

Postpartum endometritis Rx

A

IV co-amoxiclav.

155
Q

When are ultrasounds offered thorought the course of an uncomplicated pregnancy.

A

10 - 13 weeks: dating scan
18 - 20 weeks: fetal anomaly scan

156
Q

Nutrional supplements of an uncomplicated pregnancy?

A

Folic acid: 400 mcg per day until 12 weeks.

Vitamin D: 10 mcg/day for the entire pregnancy.

157
Q

Pregnancy trimesters in weeks.

A

- 1st trimester: conception until 12 weeks.
- 2nd trimester: 13 weeks until 27 weeks.
- 3rd trimester: 28 weks to term.

PLAB 1 August 2024 (32 decks)

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