Obs&Gynae Flashcards
1
Q
What are the two types or urinary incontinence?
A
Stress incontinence
Overactive bladder
2
Q
What 5 things could you advise to conservatively manage urinary incontinence?
A
- Pelvic floor (stress)
- weight loss
- smoking cessation
- reduce caffeine intake
- avoid constipation
3
Q
What may trigger leakage for someone with stress incontinence?
A
laughing/coughing/exercise
4
Q
What are 3 key symptoms of someone with overactive bladder?
A
- urgency
- frequency
- nocturia
5
Q
what are 4 risk factors for urinary incontinence/prolapse?
A
- increasing age
- obesity
- smoking
- parity
6
Q
What does gravidity mean?
A
number of pregnancies (regardless of outcome)
- INCLUDES CURRENT PREG
7
Q
What does parity mean?
A
no of deliveries after 24 wks regardless of outcome
8
Q
What are 2 risk factors for ovarian cancer?
A
- FH (BRCA1/BRCA2 gene)
2. many ovulations (early menarche/late menopause/nulliparity)
9
Q
What is the classic symptom of endometrial cancer?
A
postmenopausal bleeding
10
Q
What are 3 risk factors for endometrial cancer?
A
- obesity
- many ovulations (late menopause/early menarche etc)
- PCOS
11
Q
Mutations of the BRCA2 gene are likely to increase the risk of which 2 cancers?
A
- breast cancer
2. ovarian cancer
12
Q
Nulliparity is a risk factor for which 3 cancers?
A
- ovarian cancer
- endometrial cancer
- breast cancer
13
Q
What are the characteristics of preeclampsia?
A
- BP >140/90mmHg
- After 20 weeks
- With proteinuria
14
Q
What are 5 potential complications of preeclampsia to the mother?
A
- eclampsia
- cerebrovascular accident
- HELLP
- pulmonary oedema
- liver/renal failure
15
Q
What are 3 potential complications of preeclampsia for the foetus?
A
- Fetal growth restriction
- Placenta abruption
- Fetal mortality
16
Q
What are 5 risk factors for preeclampsia?
A
- HTN disease in prev pregnancy
- chronic kidney disease
- pre-existing HTN
- diabetes
- nulliparity
17
Q
How would you confirm the diagnosis of preeclampsia?
A
- urine protein measurement (PCR)
2. sFlt-1:PIGF ratio assay
18
Q
What is HELLP?
A
Haemolysis
Elevated Liver enzymes
Low Platelets
19
Q
When is preeclampsia considered ‘early onset’?
A
Before 34 weeks
- typically foetus is growth restricted
20
Q
Give 4 symptoms preeclampsia could present as?
A
- headache
- drowsiness
- epigastric pain
- nausea/vomiting
21
Q
How do you treat eclampsia?
A
Magnesium sulphate and intensive surveillance for other complications
22
Q
Which signs/symptoms would you expect to see if HELLP syndrome was present?
A
- Dark urine
2. Epigastric pain
23
Q
What complication would you expect to see more commonly in early onset preeclampsia than late onset?
A
Foetal growth restriction
24
Q
How would you reduce the risk of preeclampsia in vulnerable patients?
A
Low dose aspirin (75mg) started before 16wks
25
When would you give antihypertensives for preeclampsia? Which would you prescribe?
If BP >150/100mmHg
- labetalol
- second line: nifedipine
26
Where is the most common place for an ectopic pregnancy to grow?
Fallopian tubes - specifically ampullary
27
What could increase the risk of having an ectopic pregnancy? (4)
1. prev ectopic
2. prev fallopian tube surgery
3. PID
4. IVF
28
What are 4 of the most common symptoms of ectopic pregnancies?
1. abdominal pain
2. pelvic pain
3. amenorrhoea
4. vaginal bleeding (dark)
29
Which 3 symptoms would suggest intraperitoneal loss in a pt with ectopic pregnancy?
1. syncope
2. shoulder tip pain
3. tachycardia
30
Why are ectopic pregnancies hard to diagnose?
Often present with atypical symptoms
31
What is the initial management of a suspected ectopic?
1. pregnancy test
2. observations
3. abdo exam
4. speculum
5. bloods+cannulate (BHCG/group and save/FBC)
6. transvaginal ultrasound
32
What is the medical management for ectopic pregnancy?
single dose methotrexate
33
What are the 4 indications for treatment with methotrexate in ectopic pregnancy?
1. no significant pain
2. unruptured ectopic with mass <35mm and no heartbeat
3. no intrauterine pregnancy on scan
4. serum hCG <1500 IU/L
34
What are 2 things you would want to check and 1 thing you would tell the patient when giving methotrexate?
1. Check baseline LFT/EGFR function
| 2. tell pt they need to use contraception for next 3-6 months
35
Which hormone stimulates the production of milk?
Prolactin
36
What is the role of oxytocin in breastfeeding?
Causes contraction of myoepithelial cells surrounding mammary alveoli resulting in milk ejection
37
Which combination of maternal and fetal Rh statuses could risk Rhesus disease?
Rh-negative mother and Rh-positive baby
38
Give 4 cases in which Anti-D immunoglobulin should be given to mother?
1. delivery of Rh +ve baby (live/stillborn)
2. any ToP
3. miscarriage if gestation >12 wks
4. abdo trauma
39
What triad of symptoms would lead to a hyperemesis gravidarum diagnosis?
1. 5% pre-pregnancy weight loss
2. dehydration
3. electrolyte imbalance
40
What is the first line medical management for hyperemesis gravidarum?
1. antihistamine e.g. PROMETHAZINE or CYCLIZINE
41
Where is beta HCG produced?
placenta - synctiotrophoblast
42
What is the role of beta HCG?
1. supports ovarian corpus luteum
| 2. corpus luteum then secretes progesterone that supports endometrium lining
43
Which 6 physiological effects does progesterone have on a pregnant woman?
1. decreased BP
2. constipation
3. ureteral dilation
4. bladder relaxation
5. biliary stasis
6. increased tidal volume
44
Why may pregnant women be more likely to develop anaemia?
Increased plasma volume disproportionate to increased RBC volume
45
Which 5 blood count results would you expect to be physiologically increased in pregnancy?
1. WCC
2. platelets
3. ESR
4. cholesterol
5. fibrinogen
46
Which 3 blood test results would you expect to be physiologically decreased in pregnancy?
1. albumin
2. urea
3. creatinine
47
Give 4 physiological changes caused by oestrogen in pregnancy?
1. spider naevi
2. palmar erythema
3. skin pigmentation
4. stimulate growth of myometrium
48
Why does glucose tolerance decrease in pregnancy?
1. altered carb metabolism
| 2. antagonistic effects of human placental lactogen, progesterone and cortisol
49
What are 3 risk factors for developing gestational diabetes in pregnancy?
1. BMI>30
2. prev gestational diabetes
3. 1st degree relative with diabetes
50
Why might the foetus develop hyperinsulinemia if mother is diabetic?
1. glucose is transported across the placenta, but not insulin
2. if mother's blood glucose is high this can cause fetal hyperglycaemia
3. the fetus increases its insulin levels to compensate
51
Give 4 complications of foetal hyperinsulinemia
1. macrosomia
2. organomegaly
3. polyhydraminos
4. increased rate of pre-term delivery
52
What is the management for gestational diabetes?
1. Lifestyle
2. metformin
3. regular blood glucose monitoring
53
Why would you expect the cardiac output to increase in pregnancy?
1. activation of renin-angiotensin aldosterone system
2. results in increased plasma volume
3. which in turn INCREASES STROKE VOLUME
54
Which 3 physiological changes happen to the urinary system during pregnancy?
1. increased renal perfusion
2. increased protein loss
3. increased salt/water reabsorption
55
When are a couple considered 'subfertile'?
If they haven't conceived after a year of regular unprotected intercourse
56
What is the difference between primary and secondary subfertility?
```
Primary = female has never conceived
secondary = female has previously conceived (even if it ended in miscarriage etc)
```
57
What are the main causes for subfertility?
1. anovulation (30%)
2. male factor (25%)
3. Tubal factor (25%)
4. Unexplained (25%)
58
What preconception advice would you give to a couple trying to get pregnant? (5)
1. intercourse 2-3x a week
2. folic acid 0.4mg
3. smoking cessation
4. quit drinking
5. Lose weight if BMI>30
59
What specific advice would you give to men trying to get pregnant? (3)
1. don't overheat testicles (think lorry driver)
2. quit smoking/alcohol
3. folic acid supplement
60
What test would you carry out as a GP to see if female is ovulating?
Mid-luteal progesterone level, 7 days before subsequent menstruation i.e. day 21 of 28 day cycle (expect to be above 30)
61
What criteria need to be met to diagnose PCOS?
2/3 of the Rotterdam Criteria
1. oligo/amenorrhoea
2. PCO on USS
3. clinical/biochemical sign of hyperandrogenism
62
What physical signs might you notice in someone with PCOS? (4)
1. acne
2. obesity
3. hirsutism
4. alopecia
63
What can be offered to females with PCOS to address subfertility?
1. clomifene/metformin
| 2. laparoscopic ovarian drilling/ gonadotrophins
64
Which key hormonal changes take place in patients with PCOS? (4 -big q)
1. Raised levels of LH
2. Raised ovarian androgen production
3. Insulin resistance -> hyperinsulinemia
4. Excess adrenal androgens -> reduced SHBG -> excess free androgen levels
65
The GP carries out a test for FSH in a female struggling to get pregnant. What would a low FSH suggest and how would you treat? (5)
1. hypothalamic hypogonadism
5. Kalman's
Tx = gonadotrophins / normalise weight
66
The GP carries out a test for FSH in a female struggling to get pregnant. What would a high FSH suggest and how would you treat?
Menopause/ovarian failure
Tx = donor egg
67
The GP carries out a test for LH in a female struggling to get pregnant. What would a high LH suggest and how would you treat?
PCOS
Tx = clomifene/metformin
ovarian drilling/ gonadotrophin
68
Which infectious disease would you want to check for in a subfertile couple?
Rubella
69
What happens on days 1-4 of the menstrual cycle?
MENSTRUATION
| - endometrium is shed once hormonal support is withdrawn
70
What happens on days 5-13 of the menstrual cycle?
PROLIFERATIVE PHASE
1. pulses of GnRH from hypothalamus stimulate FSH and LH which induce follicular growth
2. The follicles produce oestradiol which causes endometrium to proliferate and supress FSH production such that only one follicle matures
3. As oestradiol levels rise they weirdly reach a positive feedback which leads to LH surge which causes ovulation
71
What happens on day 14-28 of the menstrual cycle?
LUTEAL PHASE
1. follicle becomes corpus luteum
2. corpus luteum produces relatively more PROGESTERONE than oestrogen which peak 7 days after ovulation
3. glands swell/blood supply increases
4. If corpus luteum not fertilised then it will fail and hormonal support is withdrawn leading to endometrium breakdown.
72
What are the causes of abnormal uterine bleeding?
```
PALM COEIN
(structural)
Polyps
Adenomyosis
Leiomyomas (fibroids)
Malignancy
```
```
(non-structural)
Coagulopathy
Ovulatory dysfunction
Endometrial
Iatrogenic
Not yet specified
```
73
What would a high/low antimullerian hormone result tell you?
```
High = PCOS
Low = ovarian failure
```
74
How would you check the tubal patency of a subfertile female?
Hysterosalpingogram
OR
if high risk then laparoscopy/dye test
75
Give 2 hypothalamic causes of subfertility.
1. Hypothalamic hypogonadism
| 2. Kallmann's syndrome
76
You see a pt who runs ultra marathons and is severely underweight and struggling to get pregnant. What could be the cause? and treatment?
Hypothalamic hypogonadism
- reduction in hypothalamic GnRH causes reduced stimulation of FSH/LH and in turn reduced osetradiol levels.
Tx = normalise body weight
77
How does Kallmann's cause subfertility?
GnRH neurones fail to develop
- FSH/LH production not stimulated
- oestradiol production not stimulated
- anovulation
78
Give 2 pituitary causes of subfertility
1. hyperprolactinaemia
| 2. Sheehan's syndrome
79
How does hyperprolactinaemia cause subfertility?
excess prolactin secretion REDUCES GnRH release
80
How is hyperprolactinaemia treated? What is the mechanism of the Tx?
Bromocriptine
- dopamine agonist
- dopamine inhibits prolactin release
81
Give an adrenal cause of subfertility
Adrenal hyperplasia (excess androgens)
82
Give 2 ovarian causes of subfertility
1. PCOS
| 2. Premature ovarian failure
83
What hormone changes take place in premature ovarian insufficiency/failure?
1. ovary fails and stops oestradiol and inhibin production
2. FSH/LH levels RISE
3. AMH produced by follicles very low
84
What is the best way to measure ovarian reserve?
Anti mullerian hormone (AMH)
| - because it is produced in the ovary
85
What are the long term risks of PCOS? (5)
1. infertility
2. miscarriage
3. obesity
4. diabetes
5. endometrium Ca
86
When would you recommend a subfertile couple begin assisted conception? (5)
1. After 2 years of trying
2. tubal blockage
3. endometriosis
4. male factor subfertility
5. unexplained subfertility
87
What are the two options for assisted conception?
1. Intrauterine insemination (IUI)
| 2. In Vitro fertilisation (IVF)
88
What are 5 risks of IVF?
1. multiple pregnancy
2. miscarriage
3. ectopic pregnancy
4. fetal abnormalities
5. ovarian hyperstimulation syndrome
89
What is the difference between primary and secondary amenorrhoea?
Primary = menstruation has not started by age of 16
Secondary = previously normal menstruation ceases for 3 months/more
90
What are the 3 most common pathological causes of amenorrhea?
1. premature menopause
2. PCOS
3. hyperprolactinaemia
91
Give 4 physiological causes of secondary amenorrhea
1. pregnancy
2. lactation
3. menopause
4. drugs
92
How does Sheehan's syndrome cause amenorrhoea?
Severe post partum haemorrhage causes pituitary necrosis -> hypopituitarism
93
What is the most common congenital cause of amenorrhea? How does it present?
Turners syndrome
- missing X chromosome
- short stature
- poor secondary sex characteristics
94
Which outflow tract problems could lead to primary amenorrhea? (2)`
1. imperforate hymen
| 2. transverse vaginal septum
95
Give 4 causes of primary amenorrhoea
1. gonadal dysgenesis (e.g. Turner's)
2. androgen insensitivity syndrome
3. functional hypothalamic amenorrhoea (e.g. 2ry to anorexia)
4. congenital adrenal hyperplasia
96
How would you investigate amenorrhoea? (4)
1. exclude pregnancy with urinary/serum BHCG
2. gonadotrophins level
3. prolactin
4. androgen levels
97
Which condition causes endometrial tissue to break through into myometrium?
adenomyosis
98
What mechanism does misoprostol use to induce termination of pregnancy?
Prostaglandin analogue
| binds to myometrial cells causing strong contractions and cervical ripening
99
What are the main side effects of misoprostol?
- abdo pain
| - diarrhoea
100
Which drug is used alongside misoprostol to terminate pregnancies?
Mifepristone
101
What blood test results would confirm menopause?
- high FSH/LH
| - low oestrogen
102
What is the cause of the end of the menstrual cycle?
The demise of ovarian follicles
103
Can a woman refuse emergency CS for foetal distress?
Yes
| - unborn baby has no rights
104
Give 5 risk factors of obesity during pregnancy to mother?
1. pre-eclampsia
2. VTE
3. gestational diabetes
4. mental health problems
5. PPH
105
Give 4 risks of obesity in pregnancy to the foetus?
1. shoulder dystocia
2. macrosomia
3. stillbirth
4. spina bifida
106
What increases the risk of shoulder dystocia? (4)
1. maternal diabetes
2. large baby
3. maternal obesity
4. prev shoulder dystocia
107
Which manoeuvre can help overcome shoulder dystocia?
McRobert's manoeuvre
108
What does small for gestational age (SGA) mean?
weight of fetus is less than tenth centile for its gestation
109
What is intrauterine growth restriction? (IUGR)
where a fetus has failed to reach its own 'growth potential'.
110
What are risk factors for having a baby with IUGR? (4)
1. smoking
2. maternal stress
3. severe anaemia
4. substance abuse
111
What are the two divisions of SGA babies?
1. normal/constitutionally small
| 2. placenta mediated growth restriction
112
What is placental insufficiency?
When oxygen/nutrients are not sufficiently transferred to the fetus via placenta during pregnancy
113
What is the mechanism behind placental insufficiency?
failure of spiral uterine arteries to transform into large placental vessels
114
What are the consequences of placental insufficiency on the fetus? (2)
1. fetal hypoxemia
| 2. fetal growth restriction
115
What are risk factors for placental insufficiency? (4)
1. maternal hypertensive disorders
2. smoking/alcohol/drugs
3. primiparity
4. advanced maternal age
116
What are the main causes of antepartum haemorrhage? (2)
1. placental abruption
| 2. placenta praevia
117
What is placenta praevia?
When the placenta is implanted in the lower segment of the uterus
118
What are the stages of the labour? (4)
1. Latent phase
2. First stage
3. Second stage
4. Third stage
119
Why does the foetal head initially descend in transverse position?
The transverse diameter is greater than anterior/posterior diameter at PELVIC INLET
120
What are the 8 movements of labour?
1. Descent
2. Engagement
3. Flexion
4. Internal rotation
5. Extension
6. Restitution
7. External rotation
8. Delivery of body
121
Which factors encourage the foetal head to descend? (3)
1. increased abdo muscle tone
2. amniotic fluid pressure
3. inc freq and strength of contractions
122
What happens in the engagement stage of labour?
Largest diameter of foetal head descends into pelvis (head 3/5 palpable or less)
123
What happens in the latent stage of labour? (3)
1. contractions begin
2. mucoid plug 'show'
3. cervix begins to efface and dilate (0-4cm)
124
How long can the latent stage of labour last?
2-3 days
125
What happens in the first stage of labour? (2)
* established labour*
1. stronger/more regular uterine contractions
2. cervix continues to efface/dilate to 10cm
126
What happens in the second stage of labour?
Full dilation to birth of foetus
127
What happens in the third stage of labour?
From birth of baby to birth of placenta
128
What causes the foetal head to flex during labour?
Pressure of uterine contractions forces occiput to come into contact with pelvic floor, foetal neck flexes to reduce head circumference
129
By the second stage of labour which position would you expect the foetus to be in?
Expect it to have finished internal rotation
130
What happens during the extension movement of the foetus during labour? (2)
1. Foetal occiput slips beneath suprapubic arch
| 2. foetal head is born, facing maternal back with occiput anterior
131
What happens during the restitution movement of the foetus during labour? (2)
1. head is delivered and shoulders negotiate pelvic outlet
| 2. foetus may naturally align head with shoulders causing foetal head to externally rotate
132
Why do healthcares delay cord clamping? (3)
1. allows baby time to transition to extra-uterine life
2. increase in RBC/iron/stem cells
3. Reduce need for inotropic support
133
What is a first degree perineal tear?
Small tear only affecting skin
134
What is a second degree perineal tear?
Tears affecting muscle of perineum and the skin (require stitches)
135
What is a third degree perineal tear?
tear that extends into anal sphincter
136
What is the first line recommendation for induction of labour?
Membrane sweeping (treated as an adjunct)
137
What is membrane sweeping?
Passing finger through the cervix and rotating it across the wall of the uterus to separate the chorionic membrane from the decidua
138
Which scoring system is used to determine the ripeness of the cervix?
Bishop score
139
What is the preferred method of pharmacological induction of labour?
Vaginal prostaglandin E2 (PGE2)
140
What is the risk of PGE2 in inducing labour?
Uterine hyperstimulation
141
What is a minor PPH?
Blood loss 500-1000ml without clinical shock
142
What is a major PPH?
Blood loss greater than 1000ml and still bleeding OR clinical shock
143
What are risk factors for PPH?
1. multiple pregnancy
2. previous PPH
3. pre-eclampsia
4. episiotomy
144
What is endometriosis?
The presence of endometrial tissue outside of the endometrial cavity
145
What are the three possible causes of endometriosis?
1. retrograde menstruation
2. embolisation
3. metaplasia
146
What is the typical presentation of someone with endometriosis? (5)
1. young
2. cyclical chronic pelvic pain
3. dysmenorrhoea
4. dyspareunia
5. subfertile
147
If a patient with suspected endometriosis also had dyschezia where would you expect endometrial tissue to have grown?
Pouch of Douglas
148
What are risk factors for developing endometriosis? (3)
1. FH of endometriosis
2. nulliparous
3. early menarche
149
What can happen when endometrial tissue grows on the ovary?
Form an endometriomas (chocolate cyst)
| - can rupture causing pain/inflammation
150
What are the three main mechanisms of treating endometriosis pain?
1. abolish cyclicity
2. glandular atrophy
3. address subfertility
151
Which hormonal methods can be used to treat endometriosis?
1. COCP
2. POP
3. Danazol
4. GnRH modulators
152
What is the purpose of COCP in treating endometriosis?
Ovarian suppression
153
What is the purpose of POP in treating endometriosis?
Inhibits growth of endometrium
154
What is the purpose of Danazol in treating endometriosis?
Steroid
- inhibits mid cycle surges of FSH/LH
- prevents steroidogenesis in corpus luteum
155
Why does endometriosis regress during menopause/pregnancy?
It is oestrogen dependent
156
How is endometriosis diagnosed?
Laparoscopy +/- biopsy
157
Give 4 differential diagnoses of endometriosis?
1. adenomyosis
2. chronic PID
3. chronic pelvic pain
4. IBS
158
What would make you suspect adenomyosis over endometriosis in a history of chronic pelvic pain?
Adenomyosis patients tend to be older and multiparous
159
What is chronic pelvic pain?
Intermittent/constant pain in the lower abdo/pelvis for at least 6 months
160
Which organisms are most commonly responsible for PID?
Chlamydia (60%)
| Gonorrhoea
161
If a young lady comes in who's high risk sexually and has RUQ pain, what would you suspect?
Perihepatitis (Fitz-Hugh-Curtis syndrome)
- due to adhesions between liver and anterior abdo wall
162
What is a typical presentation of PID? (3)
1. bilateral lower abdo pain
2. deep dyspareunia
3. abnormal vaginal bleeding/discharge
although often asymptomatic
163
Which signs might you elicit in PID? (4)
1. fever
2. bilateral lower abdo tenderness
3. cervical excitation
4. tachycardia
164
Which investigations would you carry out if you suspected PID?
1. endocervical swab for C&G
2. blood cultures if fever
3. wet-mount vaginal smear (looking for pus cells)
165
Give 3 differential diagnoses of PID
1. ectopic pregnancy (do pregnancy test to rule out)
2. acute appendicitis
3. endometriosis
166
What are late complications of PID? (3)
1. ectopic pregnancy
2. subfertility
3. chronic pelvic pain
167
What are the four main causes of PPH?
1. Tone (lack of uterine tone)
2. Tissue (retained products of placenta)
3. Thrombin (clotting e.g. pre-eclampsia)
4. Trauma (tears)
168
How is PID treated?
With IM ceftriaxone followed by doxycycline + metronidazole
169
What are fibroids?
Leiomyomata
| - benign smooth muscle tumours of the myometrium
170
What are risk factors for having fibroids? (5)
1. increasing age (pre-menopause)
2. black/asian
3. obese
4. affected first degree relative
5. early menarche
171
Why do fibroids regress after menopause?
Fibroids are oestrogen AND progesterone dependent so regress when sex hormones deplete
172
What are the main presentations of fibroids? (4)
1. asymptomatic (50%)
2. menorrhagia
3. erratic bleeding
4. infertility
173
How do you treat fibroids?
1. GnRH agonist
2. Ulipristal acetate
3. myomectomy
174
How would you differentiate between fibroids and adenomyosis?
MRI
175
What are 4 complications of fibroids?
1. torsion of pedunculated fibroid
2. degenerations (red/hyaline)
3. sarcomatous change
4. complicates pregnancy
176
What is a urethrocele?
A prolapse of the lower anterior vaginal wall (involving only the urethra)
177
What is the name for a prolapse of the upper anterior vaginal wall involving the bladder?
Cystocele
178
What is an apical prolapse?
Prolapse of uterus, cervix and upper vagina
179
What is a prolapse of the upper posterior wall of the vagina called?
Enterocele
180
What is a rectocele?
Prolapse of lower posterior wall of the vagina, involving anterior wall of the rectum
181
What are the main causes of prolapse? (4)
1. vaginal delivery/pregnancy
2. menopause
3. pelvic surgery
4. chronic elevated abdo pressure (obesity/cough/constipation)
182
What symptoms would you generally expect with a prolapse?
1. dragging sensation
| 2. vaginal lump
183
How are prolapses managed?
1. weight loss/smoking/physio
2. pessary
3. surgical repair
184
What is the difference between onset of primary and secondary dysmenorrhoea?
Primary = pain starts just before/within a few hours of period
Secondary = pain starts 3-4 days before onset of period
185
What is the first line investigation in post menopausal bleeding?
Transvaginal ultrasound
186
Which pharmcological management can be used during PMS?
SSRI continuously or just during luteal phase (proliferative phase)
187
What are the symptoms of obstetric cholestasis?
Intense itching (without rash) typically worse on palms, soles and abdomen
188
What is the management for obstetric cholestasis? (3)
1. induction of labour at 37-38 weeks
2. ursodeoxycholic acid
3. vit K supplementation
189
What blood results would you expect to see in obstetric cholestasis? (2)
1. elevated bilirubin
| 2. mildly elevated LFTs
190
What is the risk of pregnant people being infected with streptococcus agalactiae?
Causes Group B Strep (GBS) disease in the newborn which can cause pneumonia/meningitis/
191
How does placental abruption usually present? (2)
1. vaginal bleeding
| 2. continuous abdominal pain
192
How is placental abruption managed when the fetus is alive and <36 weeks.
Admit and administer steroids
