obs + gynae Flashcards
twin
triples
when to offer elective birth
37 dichorionic
36 monochorionic
35 triplets
referral for pre-eclampsia
- BP >160/100
- rise in >30/20 over booking BP
- or >140/90 BP + proteinuira and or symptomatic I intrauterina growth restriction
placental previa
when present weeks?
- low lying placenta
- 28 weeks + painless bleeding
placental abruption
painful vaginal bleeding + shock
PH in foetus to cause immediate C section?
7.19 and below –> C section
as fetal distress
meconium passed in utero?
sign of fetal distress
induce and continuous monitoring
risk of fetal meconium aspiration syndrome so deliver in neonatal unit
Infertility in PCOS
1st line clomifene
2nd line metformin
GONORRHEA
bacteria
SYPHILLIS
CHLAYMIDIA
CEFTRIAXONE IM
gram-negative diplococcus (dripollococus)
more syx - often green/yellow discharge
BEN PEN
DOXYCYCLINE
unless pregnancy as CI so -Azithromycin, erythromycin or amoxicillin
gram-negative bacteria
more asymptomatic
cause ovulation?
LH surge causes ovulation
secondary dysmenorrhea
causes
- develops many years after the menarche
- pain usually starts 3-4 days before the onset of the period.
- referring all patients with secondary dysmenorrhoea to gynaecology for investigation
Causes include:
endometriosis
adenomyosis
pelvic inflammatory disease
intrauterine devices*
fibroids
Emergency contraception
Levonorgestrel
Ulipristal (ellaone)
copper IUD
L- 72 hr UPSI, double over 70kg, can start OCP after. inhibit ovulation and implant
U- 120hrs UPSI - barrier 5d after, inhibit ovulation, caution severe asthma
C- most effective, should be offered to all women, 5 day UPSI or 5 days after likely ovulation - inhibit fertilisation or implantation
turners aka gonadal dysgenesis
Raised FSH/LH in primary amenorrhoea
underdevelopment of secondary sexual characteristics
mrnopause hormones
LH and FSH high
progesterone and oestradiol low
antiemetic in pregnancy 1st line
cyclizine
all breastfeeding women should take
vitamin D tablets
Diagnostic thresholds for gestational diabetes
if not managed with metformin?
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
add insulin - short acting
fibroid management
size dependent?
if surgery what to give before?
For fibroids less than 3 cm, the medical management is the same as with heavy menstrual bleeding:
Mirena coil (1st line) – fibroids must be less than 3cm with no distortion of the uterus or COCP / NSAIDs
For fibroids more than 3 cm, women need referral to gynaecology for medical vs surgical tx
GnRH agonists reduce the size of the uterus prior to surgery
methotrexate and contraception
Methotrexate: must be stopped at least 6 months before conception in both men and women
downs syndrome prenatal test results
nuchal translucency thickened
B-HCG is raised
PAPP-A is low.
pre-eclampsia prophylaxis if had prior
aspirin 75mg od from 12 weeks until the birth of the baby.
premature ovarian failure defined?
The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years
thrush in pregnancy
pessary only no oral fluconazole as CI in pregnancy
when do women need contraception post partum?
Women do not require contraception until day 21 post partum
after this POP advised
spot urine protein:creatinine ratio considered high?
of 30mg/mmol or more is used as the threshold for significant proteinuria in pregnancy.
PPH defnition
management PPH?
blood loss of > 500 ml after a vaginal delivery
step 1 A-E and Iv crystalloid
step 2 mechanical = catheter and palpate on uterus
step 3 medical IV oxytocin or ergometrine
step 4 surgical intrauterine balloon tamponade
diabetics in pregnancy supplements?
- vitamin D 10mcg
- aspirin 75mg 12 weeks
- 5mg folic (400mcg)
Rhesus negative woman -
anti-D at 28 + 34 weeks
Contraceptives - time until effective (if not first day period):
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
Antenatal care: anomaly scan
done at 18-20 + 6 weeks
down’s syndrome screening including the nuchal scan is done at
11-13+6 weeks
surgical management ectopic
what size?
> 35mm, fetal heartbeat
if no fertility risk, salpingectomy preferred (remove whole thing)
More than 35 years old and smoking more than 15 cigarettes/day ?cocp
absolute contraindication to the COCP
placental abruption
uterus may be in spasm and feel firm or ‘woody’
continuous abdominal pain
shock disproportionate to the amount of blood loss
induction of labour related to bishop score
if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion
clonidine
tibolone
menopausal hot flushes or sweats
non hormonal
combined H
The most common ovarian cancer
Serous carcinoma
Placenta praevia
placenta lying wholly or partly in the lower uterine segment
HIGH presenting part
medical management for termination
mifepristone = anti progesterone - stops pregnancy
misoprostol = misoPUSH out
BV
Gardnerella vaginalis
clue cells !!!
tx metronidazole
