Obs/gynae

Question 1

Post-Partum mental health conditions

Answer 1

Edinburgh postnatal depression scale: Max of 30

Baby blues: 3-7 days, common in first pregnancy, anxious and tearful, just reassure

Postnatal depression: within a month, peaks at 3 months, similar to depression, CBT, SSRI(sertraline/paroxetine) if severe

Puerperal psychosis: usually within 2-3 weeks, severe mood swings(like bipolar) and hallucinations(like schizo), need admission, 25-50% chance of recurrence for future pregnancies

Question 2

COCP contraindications

Answer 2

Absolute: 
Migraine with aura
Active breast cancer
Age > 35 and smokes > 15 a day
History of VTE, stroke, IHD
Uncontrolled HTN
Major surgery with immobilisation (stop 4 weeks before)
Post- partum < 6 weeks if breast feeding

Relative
BMI >35
Age>35 and smokes but < 15 a day
Migraine without aura
Family History of VTE in first degree < 45 years old
Controlled HTN
Immobility

Question 3

Adenomyosis

Answer 3

Ectopic endometrial tissue in the myometrium

Caused by previous trauma such as C- section, termination, multiple pregnancies

Px: Secondary dysmenorrhea(NICE: all secondary dysmenorrhea needs to be referred to gynae ), menorrhagia(heavy bleed), pelvic pain

Ix: MRI is gold standard

Tx: GNRH agonists, hysterectomy

Question 4

Chlamydia

Answer 4

Most common STI in UK

Dx: male urine sample
Female Vulvovaginal swab
For NAAT

Tx: 1st line: doxycycline for 7 days
2nd line: azithromycin 1g OD and 500 mg OD for 2 days
3rd: erythromycin

Question 5

Placenta praevia

Answer 5

Low lying placenta

Risk factors:
multiparity
Multiple pregnancies
Previous C-section

Presents with PAINLESS PV bleed after 24 weeks

Dx: often pick up at 20 weeks scan(trans abdominal)
Need trans-vaginal to accurately assess the position

Grade

1. Not touching the internal os
2. Touching but not covering os
3. Covering when not dilated but not covering when dilated
4. Completely covering( major)

Tx:
Re scan at 34 weeks- if still there and grade 1/2 then re scan every 2 weeks until 36-37 weeks then
if grade 3/4 elective C-section
If grade 1 try vaginal

If known placenta praevia and goes into labour- emergency C-section

Question 6

Placental abruption

Answer 6

Separation of placenta from uterus prematurely

PAINFUL PV bleeding after 24 weeks, but actually blood loss might be more as a lot are concealed, tender uterus on palpation

Question 7

Vasa praevia

Answer 7

Foetal vessels close to the interval os

These vessels run in the membrane so are prone to rupture when membrane rupture such as in artificial rupture of membrane

Can cause foetal distress and high mortality