obs+gynae

Question 1

rfs for DVT in preg

Answer 1

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

Question 2

reversal agents for unfrac hep // LMWH // warfarin

Answer 2

protamine sulfate
irreversible
FFP or prothrombin complex concentrate

Question 3

abx for endometritis

Answer 3

IV clindamicin and gentamicin (until fever has stopped for more than 24hrs)

Question 4

mx for major PPH

Answer 4

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

Question 5

rfs to hyperemesis gravidarm

Answer 5

nulliparity, GTD, personal Hx, obesity, hyperthyroid, multiple prenancy

Question 6

when is HGE most common

Answer 6

starts 4-7th week, peak 9th, then resolve by 20th

Question 7

rfs for breech

Answer 7

maternal : uterine abnormalities, fibroids, placental anormlaities (praevia, increta, percreta, acreta)
foetal : multiple gestation, premature, macrosomina, polyhydraminos, oligohydraminos

Question 8

contraindications for ECV

Answer 8

antepartum haemorage, ruptured membranes, previous cs, major uterine abnormalitu, multiple preg, abnormal ctg

Question 9

complications of medical / surgical TOP

Answer 9

medical - uterine rupture if late, sevre bleeding, failure to terminate, infection

surgical - uterine perforation, bleeding, infection, failure to terminate, cervical trauma

Question 10

assessing PPROM/PROM

Answer 10

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)

Question 11

rfs for PPROM

Answer 11

maternal : trauma, smoking/drugs, UTI, APH, uterine abnoramlity, previous
fetal : polyhydraminos, multiple preg

Question 12

DM in preg

Answer 12

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

Question 13

delivery with GDM

Answer 13

IOL between 35-36+6wks , no later than 40+6wks

monitor cap glucose every hour during labour and maintain 4-7mmol/L

Question 14

mx of HIV in preg

Answer 14

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

Question 15

risks of pre-eclampsia / HTN on preg

Answer 15

early delivery, reduced placental function, IUGR, risks to mother

Question 16

rfs of placental praevia

Answer 16

increased maternal age, multiple pregnancy, previous uterine surgery, IVF, previous placental praevia, smoking

Question 17

bleeding with placenta praevia

Answer 17

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

Question 18

congential varicella vs neontal varicella syndrome

Answer 18

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

Question 19

mx of PID

Answer 19

• 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

Question 20

safeguarding qs for sexual acitivity in <18yo

Answer 20

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”?

Question 21

surgical mx for stress incontinence

Answer 21

burch colposuspension = stitch neck of bladder higher up
// bulking agents within urethral wall to provide more force

Question 22

surgical mx for prolapse

Answer 22

uterine prolpase - vag hysterectomy +/- vaginal sacrospinous fixation with suture

vault prolpase - sacrocolpopexy (abdo/lap) with mesh

anterior / posterior colporrhaphy

Question 23

FIGO for ovarian ca

Answer 23

1 - within ovaries
2 - outside ovaries but within pelvis
3 - outside pelvis within abdomen
4 - distant mets

Question 24

benefits and risks of HRT

Answer 24

PROS : reduce sx, prevent osteoporosis

CONS : risk of breast cancer, increase risk of VTE

Question 25

CI for hormonal therapy for menopause

Answer 25

undiagnosed vag bleedining, preg
breast cancer, sevre liver disease, history of VTE, current thrombophilia

Question 26

SEs of HRT

Answer 26

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

Question 27

mx of threatened misscarriage

Answer 27

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.