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Obs & Gynae Flashcards

Obs - Gynae -

1
Q

What are the conservative and medical management options for urge UI?

A

Bladder retraining for at least 6 weeks
Antimuscarinics- oxybutynin, tolterodine, darifenacin
B3 agonist- mirabegron

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2
Q

What are the conservative and medical management options for stress UI?

A

Pelvic floor muscle training
Noradrenaline and serotonin reuptake inhibitor SNRI- Duloxetine (if surgical procedures declined)

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3
Q

What should be monitored when commencing a pt on magnesium sulphate?

A

Reflexes
Resp rate (depression can occur, calcium gluconate is used in this case)

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4
Q

What medication and dose is given in eclampsia? Over what period of time?

A

IV magnesium sulphate 4g over 5 mins
Followed by infusion at 1g/hour until 24 hours after last seizure or delivery

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5
Q

What are the possible complications of intrahepatic cholestasis of pregnancy?

A

Stillbirth
Recurrence in subsequent pregnancies

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5
Q

What is the most likely diagnosis in a pregnant woman presenting with intense pruritus of the palms, soles and abdomen? And what will bloods show?

A

Intrahepatic cholestasis of pregnancy
Raised bilirubin

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5
Q

How is intrahepatic cholestasis of pregnancy managed?

A

Induction of labour at 37-38 weeks
Ursodeoxycholic acid
Vit K supplements

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6
Q

Where are ectopic pregnancies most commonly located/

A

Ampulla

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7
Q

What location of ectopic pregnancy most increases the risk of rupture?

A

Isthmus

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8
Q

What is done if cervical smear comes back as ‘inadequate’?

A

Repeat in 3 months

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9
Q

What is done if cervical smear comes back as ‘inadequate’, twice?

A

Colposcopy is indicated

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10
Q

What is a second degree perineal tear and what is the management?

A

Injury to perineal muscle, sparing the anal sphincter
Suturing on the ward

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11
Q

What is a first degree perineal tear and what is the management?

A

Superficial damage, no muscle involvement
Does not require repair

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12
Q

What is a third degree perineal tear and what is the management?

A

Injury to the perineal muscles, involving the anal sphincter (external +/- internal)
Repair in theatre

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13
Q

What is a fourth degree perineal tear and what is the management?

A

Injury to the perineal muscles, involving the anal sphincter AND the rectal mucosa
Repair in theatre

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14
Q

What are the risk factors for perineal tears?

A

Primigravida
Large babies
Precipitant labour (less than 3hrs labour)
Shoulder dystocia
Forceps delivery

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15
Q

What are the possible complications of breech presentation?

A

Cord prolapse -most important to know
Feral head entrapment
PROM
Birth asphyxia
Intracranial haemorrhage

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16
Q

When is external cephalic version offered? Why?

A

From 37 weeks in breech presentation
Breech babies are likely to revert to cephalic presentation before ~32-35/40

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17
Q

What are the possible complications of ECV?

A

Transient fetal heart abnormalities
Fetal bradycardia
Placental abruption
Need for emergency c/s

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18
Q

What is the most common type of breech presentation?

A

Frank/extended breech
Flexed legs at hip, extended at knee

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19
Q

What are the risk factors for breech presentation? maternal and fetal

A

Maternal:
Multiparity
Uterine malformations
Fibroids
Placenta praevia
Fetal:
Prematurity
Macrosomia
Polyhydramnios
Twin pregnancy or more
Structural abnormality e.g. anencephaly

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20
Q

How is the placenta accreta spectrum classified?

A

Placenta accreta- adherence directly to superficial myometrium but does not penetrate the muscle
Placenta increta- the villi invade into but not through the myometrium
Placenta percreta- the villi invade through the full thickness of the myometrium to the serosa

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21
Q

What are the possible complications of the placenta accreta conditions?

A

Risk of severe postpartum bleeding- due to retained placenta
Preterm delivery
Uterine rupture- esp in percreta

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22
Q

What are the risk factors for placenta accreta?

A

Previous termination of pregnancy
Dilatation and curettage
Previous c/s
Advanced maternal age
Placenta praevia
Uterine structural defects

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23
What medication is given in pre-eclampsia, and what is the alt if c/i?
Labetalol If asthmatic- nifedipine
24
What nerve injuries is most commonly seen as a complication to shoulder dystocia?
Erb palsy- waiter tip position C5 and 6 roots are damaged
25
What is the recommended treatment regimen for PID?
Doxycycline + metronidazole for 14 days + IM ceftriaxone (covers n. gonorrhoea, chlamydia, anaerobic and gram -ve bac)
26
How is placental accreta managed?
Difficult to diagnose antenatally so usually presents with complications, and is managed safest with c/s and hysterectomy. If fertility preservation is important, a placental resection may be attempted.
27
How is the third stage of labour actively managed?
Controlled cord traction Oxytocin can cause this stage to last 5-10 mins instead of 30. If retained placenta- manual removal or curettage may be done
28
What is HELLP and how does it present?
Pregnancy complication characterised by haemolysis, elevated liver enzymes and low platelets Manifests during the third trimester: Headache N+V Epigastric or RUQ pain Blurred vision Peripheral oedema
29
What are the maternal and fetal complications of HELLP?
Maternal: Organ failure Placental abruption DIC Fetal: IUGR Preterm delivery Neonatal hypoxia
30
What are the stages of labour?
First: Regular contractions and progressive uterine dilation up to 10cm latent is 0-3cm active is 3-10cm (1cm/hr or 2cm/hr) Second: Full dilatation until delivery Third: After delivery of baby, until delivery of placenta
31
What are the risk factors for cord prolapse?
Breech presentation Unstable lie Artificial rupture of membranes Polyhydramnios Prematurity
32
How is cord prolapse managed?
Avoid handling the cord Left lateral position or knee to chest position (takes pressure off cord) Consider tocolysis e.g. terbutaline to relax uterus and take the pressure off the cord Deliver via c/s if possible
33
What are the maternal and fetal risk factors for shoulder dystocia?
Maternal: Prolonged second stage of labour Previous shoulder dystocia Augmentation of labour with oxytocin/IOL Assisted vaginal delivery BMI>30 DM Fetal: Macrosomia Secondary arrest(labour stops due to malposition)
34
What are the possible maternal and fetal complications of shoulder dystocia?
Maternal: 3/4th degree tears, PPH Fetal: humerus or clavicle #, brachial plexus injury, hypoxic brain injury
35
What is the immediate management of shoulder dystocia?
Call for help Ask mother to stop pushing Avoid downwards traction of fetal head Consider episiotomy
36
What are the first line manoeuvres in shoulder dystocia?
McRoberts manoeuvre- knees to chest and stop pushing Combine with suprapubic pressure
37
What are the absolute c/i for IOL?
Major placenta praevia Vasa praevia Cord prolapse Transverse lie Active primary genital herpes Previous classical c/s
38
What are the methods of IOL and when are they done?
Membrane sweep- offered at 40 and 41 weeks gestation Vaginal prostaglandins- ripens the cervix, required if Bishop score<4 Amniotomy- Amnihook and syntocinon given if cervix if rip i.e. Bishop score>/=7
39
What are the complications of IOL?
Failure of induction Uterine hyperstimulation Cord prolapse Infection Pain Uterine rupture(rare)
40
What are the risk factors for PROM/PPROM?
Smoking Previous PROM PV bleed during pregnancy Lower genital infection Amniocentesis Polyhydramnios Multiple pregnancy Cervical insufficiency
41
What are the tests for PROM?
Actim-PROM (IGFBP-1) Amnisure (PAMG-1)
42
What is the management for P/PROM?
For all: high vag swab for GBS, if GBS +ve clindamycin/penicillin during labour >36/40: Wait 24 hrs for natural labour, if not the IOL 34-36: Prophylactic erythromycin 10 days. IOL and delivery. Steroids if less than 35 wks <34: Prophylactic erythromycin. Steroids. Aim expectant until 34/40
43
What are the possible complications of PROM?
Chorioamnionitits Oligohydramios Neonatal death- prem, sepsis, pulmonary hypoplasia Placental abruption Umbilical cord prolapse
44
How is PROM defined?
PROM is defined as rupture of membranes > 1 hour prior to the onset of labour occurring ≥ 37 weeks gestation
45
What are the post partum contraception options?
Barrier IUD within 48 hrs of delivery, or 4 weeks postpartum COCP if not breast feeding, and at least 3 weeks postpartum
46
What organism causes GBS (group b strep)in pregnancy?
Streptococcus agalactiae (group b strep)
47
How is GBS (group b strep)in pregnancy investigated and managed?
No screening, so those with risk factors are offered intrapartum prophylactic abx e.g. penicillin Can be tested 3-5 wks before delivery date or at 35-37 wks gestation
48
What are the risk factors for GBS (group b strep)in pregnancy?
Previous GBS culture in current or previous pregnancy Previous birth causing neonatal GBS infection (chance of recurrence is 50%) Pre term labour PROM Intrapartum fever >38 Chorioamnionitis
49
What are the risk factors for cervical cancer?
HPV 16 and 18 Early first sex Multiple partners Smoking HIV Non compliance with cervical screening
50
What are the stages of cervical screening?
Test for HPV If +ve do liquid based cytology If abnormal cytology (borderline or dyskaryosis) do colposcopy with acetic acid and iodine stain
51
When is cervical screening offered?
First invitation age 25 3 yearly 25-49 5 yearly 50-65 (must be left at least 3 months to repeat smear, or to do postpartum)
52
What is done if colposcopy reveals high grade dysplasia?
Treated then and there with LLETZ biopsy If extending into the cervical canal, a cone biopsy can be done
53
What are the complications of LLETZ?
Inc risk of miscarriage and pre term delivery
54
What are the risk factors for ovarian cancer?
Obesity Early menarche/late menopause Nulliparity Unopposed oestrogen e.g. Tamoxifen Family history Previous breast or ovarian cancer BRCA ½ Endometriosis
55
What are the risk factors for endometrial cancer?
(excessive oestrogen = overstim endometrium) Obesity Early menarche/late menopause Nulliparity PCOS Unopposed oestrogen e.g. Tamoxifen Previous breast or ovarian cancer BRCA ½ Endometrial polyps Diabetes Mellitus Parkinson’s
56
What factors are protective for endometrial cancer?
Continuous combined HRT COCP Smoking Physical activity
57
What factors are protective for ovarian cancer?
COCP Pregnancy Breast feeding Hysterectomy Oophorectomy
58
What are the risk factors for vulvar cancer?
HPV Herpes Simplex Virus Type 2 Smoking Immunosuppression Chronic vulvar irritation Conditions such as Lichen Sclerosus
59
What are the risk factors for ectopic pregnancy?
Damage to tubes (pelvic inflammatory disease, surgery) Previous ectopic Endometriosis IUCD Progesterone only pill IVF (3% of pregnancies are ectopic)
60
What are the risk factors for placenta praevia?
PREVIOUS C/S PMH of placenta praevia Previous uterine surgery Multiple pregnancy Smoking High parity Inc maternal age Curettage to the endometrium after miscarriage or termination
61
What are the risk factors for placental abruption?
Previous placental abruption Hypertension inc. pre eclampsia Substance misuse Smoking SROM Bleeding in first trimester Abdo trauma Abnormal lie Multiple preg
62
What are the complications of placental abruption?
PPH DIC Hypovolaemic renal failure Chronic anaemia
63
What can cause HELLP syndrome?
Pre eclampsia Antiphospholipid syndrome
64
What is the 1st, 2nd and 3rd trimester?
First- up to 13 wks Second 13-27 wks Third >27wks
65
Give examples of tocolytic agents
Terbutaline Magnesium sulphate Nifedipine Indomethacin
66
What are the complications of PCOS?
Metabolic disorders, such as impaired glucose tolerance and type 2 diabetes Cardiovascular disease Obstructive sleep apnoea Infertility Recurrent miscarriage Pregnancy complications - Pre-eclampsia - Gestational diabetes Endometrial cancer Psychological disorders, such as - Anxiety - Depression
67
How is PCOS diagnosed?
Rotterdam criteria: 2 of 3 for dx Hyperandrogenism- physical features or biochem (raised FAI, raised LH:FSH at D1-3) Oligo/amenorrhoea US- 12 or more follicles, or ovarian vol >10cm3
68
How is PCOS managed?
For regular periods: COCP, Cyclical POP For acne: COCP, retinoids For hirsutism: Hair removal, anti androgens (spironolactone, finasteride) To conceive: BMI<30 Referral to fertility clinic Folic acid Clomifene +/- metformin Lap ovarian drilling
69
What are the complications of Clomifene?
Hyperstimulation syndrome Multiple pregnancies Ovarian cancer (limited to 6 cycles)
70
What are the causes of premature ovarian insufficiency?
Idiopathic- most common Iatrogenic e.g. chemotherapy Autoimmune e.g. coeliac disease, adrenal insufficiency, type 1 diabetes or thyroid disease Genetic e.g. Turner’s syndrome Infections e.g. mumps, tuberculosis or cytomegalovirus
71
What conditions that may occur in premature ovarian insufficiency?
Cardiovascular disease Stroke Osteoporosis Cognitive impairment Dementia Parkinsonism
72
What are the different types of fibroids?
Submucosal Intramural Subserosal
73
How is BV treated?
Metronidazole
74
How does BV present?
Most commonly, asymptomatic Can present with fishy, offensive smelling discharge
75
What is the most common causative organism of BV?
Gardnerella vaginalis
76
How is vaginal candidiasis managed?
Oral antifungal- fluconazole or itraconazole
77
What are the risk factors for developing gestational diabetes mellitus?
Obesity GDM in previous pregnancies First degree relative with diabetes Previous fetus >4kg
78
What are the risk factors for pre eclampsia?
Nulliparity Previous pre eclampsia Obesity Advanced maternal age FMH of pre eclampsia Multiple gestation Antiphospholipid syndrome
79
Why is vaginal examination never performed in a large antepartum haemorrhage?
May provoke massive haemorrhage
80
Define placental abruption
Separation of placenta from the lining of the uterus
81
What are the possible complications of gestational diabetes mellitus?
Congenital defects Prematurity Shoulder dystocia Polyhydramnios Sudden fetal death
82
What is the mechanism behind macrosomia in diabetic pregnant women?
Increased fetal glucose leads to increased fetal insulin, leading to increased fat deposition
83
What organic medical diagnosis should be considered in women presenting with depressive symptoms post partum
Post partum thyroiditis
84
How do women increase their oxygen intake during pregnancy?
Increased tidal volume
85
What are the 4 features of a CTG that represent a reassuring trace?
HR 110-160 Variability of more than 5 beats per minute Presence of accelerations Absence of decelerations
86
Below what fetal pH is a c/s indicated?
Below 7.20
87
How many antenatal appointments should a pregnant nulliparous and multiparous woman have?
First preg- 10 Second preg- 7
88
Outline when antenatal visits take place and why
<10 wks - booking visit 11-14 wks - US for amount of pregnancies and dating, and combined test 18-20 wks - US for abnormalities and placental location 24 wks 28 wks - Anti D given 36 wks - Fetal lie
89
What results on quadruple test suggest a diagnosis of Down's syndrome?
Low AFP and oestriol High b hCG and Inhibin A

Finals (8 decks)

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