obs+gynae Flashcards
rfs for DVT in preg
Smoking
Parity ≥ 3
Age > 35 years
BMI > 30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
Family history of VTE
Thrombophilia
IVF pregnancy
reversal agents for unfrac hep // LMWH // warfarin
protamine sulfate
irreversible
FFP or prothrombin complex concentrate
abx for endometritis
IV clindamicin and gentamicin (until fever has stopped for more than 24hrs)
mx for major PPH
call for help: midwife and anesthatist, consultant obs, haematologist
A-Es (oxygen mask 15l, blood transfusion, blood products, keep pt warm)
2 large bore cannula
FBC, coagulation, U+Es, LFTs
cross match (4U), ECG etc
massage the uterus –> oxytocin IV 10U –> ergometrin (HTN, ashtma NO) –> carboprost (no asthma) –> take to theatre and examine in anathesia –> balloon tamponade –> ligate artery through Blynch suture –> hysterectomy
rfs to hyperemesis gravidarm
nulliparity, GTD, personal Hx, obesity, hyperthyroid, multiple prenancy
when is HGE most common
starts 4-7th week, peak 9th, then resolve by 20th
rfs for breech
maternal : uterine abnormalities, fibroids, placental anormlaities (praevia, increta, percreta, acreta)
foetal : multiple gestation, premature, macrosomina, polyhydraminos, oligohydraminos
contraindications for ECV
antepartum haemorage, ruptured membranes, previous cs, major uterine abnormalitu, multiple preg, abnormal ctg
complications of medical / surgical TOP
medical - uterine rupture if late, sevre bleeding, failure to terminate, infection
surgical - uterine perforation, bleeding, infection, failure to terminate, cervical trauma
assessing PPROM/PROM
1) speculum exam - pooling of fluid, os
2) is os closed, >30wks, contractions - TVUSS cervical length (>15mm means labour likely)
3) insulin like growth factor binding protein -1 // placental alpha microglobulin 1
4) FFN (present >34wks)
rfs for PPROM
maternal : trauma, smoking/drugs, UTI, APH, uterine abnoramlity, previous
fetal : polyhydraminos, multiple preg
DM in preg
effect of preg on DM : increased n+v, risk of hypoglycaemic ep, tighter control required, more dose
effect of DM on preg : risk of stillbirth miscarriage, pre-eclampsia, NTD, macrosomnia, infection, operation
delivery with GDM
IOL between 35-36+6wks , no later than 40+6wks
monitor cap glucose every hour during labour and maintain 4-7mmol/L
mx of HIV in preg
2x CD4 count (baseline and delivery)
8x viral load (2-4wks, 38wks, delivery)
mother) continue ART, mode of delivery determined via viral load (if <50 then vag delviery, if >50 ELCS at 38wks)
ELCS if HIV/HCV co infection, >50 or on intrapartum zidovudine)
avoid breast feeding - cabergoline to stop breastmilk forming
fetus) cord clamped asap once born, bathed, zidovudine monotherapy 2-4wks or 4wk PEP if high risk
all vaccinations are given and then check for HIV at 6 and 12wks
risks of pre-eclampsia / HTN on preg
early delivery, reduced placental function, IUGR, risks to mother
rfs of placental praevia
increased maternal age, multiple pregnancy, previous uterine surgery, IVF, previous placental praevia, smoking
bleeding with placenta praevia
A-E assessment: large bore cannular, IV fluids
bloods - FBC, group and save, consider cross match, anti-D and Kleiher test
scans : CTG >27wks , umbilical artery doppler every 2wks, growth scan
IOL if fetal compromise
until bleeding stops and monitor for 48hrs
congential varicella vs neontal varicella syndrome
CVS - (antepartum transmission but 13-20wks is only 2%risk) - chorioretinitis, microcephaly, limb hypoplasia, heaptitis)
NVS - (maternal infection 7days before and after birth) - mild disease, pneumonia, skin lesions, hepatiits
mx of PID
- assess pt - if septic/ fever >38 admit
- outpt mx = IM stat ceftriaxone, oral doxycicline and metronidazole 14days
- inpatient = IV cefotixitin, IV doxycycline
others: STI screening, contact tracing, avoid sex a week after finish tx, remove any IUD
safeguarding qs for sexual acitivity in <18yo
Who is their partner?
How old is the partner?
Where did they meet?
When did the relationship become sexual
How many sexual partners do they have/have they had?
When did they become sexually active?
Are they being forced into having sex”?
surgical mx for stress incontinence
burch colposuspension = stitch neck of bladder higher up
// bulking agents within urethral wall to provide more force
surgical mx for prolapse
uterine prolpase - vag hysterectomy +/- vaginal sacrospinous fixation with suture
vault prolpase - sacrocolpopexy (abdo/lap) with mesh
anterior / posterior colporrhaphy
FIGO for ovarian ca
1 - within ovaries
2 - outside ovaries but within pelvis
3 - outside pelvis within abdomen
4 - distant mets
benefits and risks of HRT
PROS : reduce sx, prevent osteoporosis
CONS : risk of breast cancer, increase risk of VTE
CI for hormonal therapy for menopause
undiagnosed vag bleedining, preg
breast cancer, sevre liver disease, history of VTE, current thrombophilia
SEs of HRT
should pass in a couple of weeks starting HRT
oestrogen - breast tenderness, nausea, headache
progesterone - fluid retention, mood swing, depression
unscheduled bleedinging - common in first 3m, more for cyclical but if there is a period of no period and after 6m there is blood, need to investigate futher
mx of threatened misscarriage
if bleeding gets worse, or persists after 14days then have clinical assessment
- if bleeding stops, continue with antenatal care
- if intrauterine preg is confirmed by scan, give vag progesterone twice a day (if miscarriage previously) and continue until 16wks of preg.
