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Finals > Obs & Gynae > Flashcards

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
Q

What medication is given in pre-eclampsia, and what is the alt if c/i?

A

Labetalol
If asthmatic- nifedipine

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24
Q

What nerve injuries is most commonly seen as a complication to shoulder dystocia?

A

Erb palsy- waiter tip position
C5 and 6 roots are damaged

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25
Q

What is the recommended treatment regimen for PID?

A

Doxycycline + metronidazole for 14 days + IM ceftriaxone
(covers n. gonorrhoea, chlamydia, anaerobic and gram -ve bac)

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26
Q

How is placental accreta managed?

A

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.

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27
Q

How is the third stage of labour actively managed?

A

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

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28
Q

What is HELLP and how does it present?

A

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

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29
Q

What are the maternal and fetal complications of HELLP?

A

Maternal:
Organ failure
Placental abruption
DIC
Fetal:
IUGR
Preterm delivery
Neonatal hypoxia

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30
Q

What are the stages of labour?

A

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

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31
Q

What are the risk factors for cord prolapse?

A

Breech presentation
Unstable lie
Artificial rupture of membranes
Polyhydramnios
Prematurity

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32
Q

How is cord prolapse managed?

A

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

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33
Q

What are the maternal and fetal risk factors for shoulder dystocia?

A

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)

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34
Q

What are the possible maternal and fetal complications of shoulder dystocia?

A

Maternal: 3/4th degree tears, PPH
Fetal: humerus or clavicle #, brachial plexus injury, hypoxic brain injury

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35
Q

What is the immediate management of shoulder dystocia?

A

Call for help
Ask mother to stop pushing
Avoid downwards traction of fetal head
Consider episiotomy

36
Q

What are the first line manoeuvres in shoulder dystocia?

A

McRoberts manoeuvre- knees to chest and stop pushing
Combine with suprapubic pressure

37
Q

What are the absolute c/i for IOL?

A

Major placenta praevia
Vasa praevia
Cord prolapse
Transverse lie
Active primary genital herpes
Previous classical c/s

38
Q

What are the methods of IOL and when are they done?

A

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
Q

What are the complications of IOL?

A

Failure of induction
Uterine hyperstimulation
Cord prolapse
Infection
Pain
Uterine rupture(rare)

40
Q

What are the risk factors for PROM/PPROM?

A

Smoking
Previous PROM
PV bleed during pregnancy
Lower genital infection
Amniocentesis
Polyhydramnios
Multiple pregnancy
Cervical insufficiency

41
Q

What are the tests for PROM?

A

Actim-PROM (IGFBP-1)
Amnisure (PAMG-1)

42
Q

What is the management for P/PROM?

A

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
Q

What are the possible complications of PROM?

A

Chorioamnionitits
Oligohydramios
Neonatal death- prem, sepsis, pulmonary hypoplasia
Placental abruption
Umbilical cord prolapse

44
Q

How is PROM defined?

A

PROM is defined as rupture of membranes > 1 hour prior to the onset of labour occurring ≥ 37 weeks gestation

45
Q

What are the post partum contraception options?

A

Barrier
IUD within 48 hrs of delivery, or 4 weeks postpartum
COCP if not breast feeding, and at least 3 weeks postpartum

46
Q

What organism causes GBS (group b strep)in pregnancy?

A

Streptococcus agalactiae (group b strep)

47
Q

How is GBS (group b strep)in pregnancy investigated and managed?

A

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
Q

What are the risk factors for GBS (group b strep)in pregnancy?

A

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
Q

What are the risk factors for cervical cancer?

A

HPV 16 and 18
Early first sex
Multiple partners
Smoking
HIV
Non compliance with cervical screening

50
Q

What are the stages of cervical screening?

A

Test for HPV
If +ve do liquid based cytology
If abnormal cytology (borderline or dyskaryosis) do colposcopy with acetic acid and iodine stain

51
Q

When is cervical screening offered?

A

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
Q

What is done if colposcopy reveals high grade dysplasia?

A

Treated then and there with LLETZ biopsy
If extending into the cervical canal, a cone biopsy can be done

53
Q

What are the complications of LLETZ?

A

Inc risk of miscarriage and pre term delivery

54
Q

What are the risk factors for ovarian cancer?

A

Obesity
Early menarche/late menopause
Nulliparity
Unopposed oestrogen e.g. Tamoxifen
Family history
Previous breast or ovarian cancer
BRCA ½
Endometriosis

55
Q

What are the risk factors for endometrial cancer?

A

(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
Q

What factors are protective for endometrial cancer?

A

Continuous combined HRT
COCP
Smoking
Physical activity

57
Q

What factors are protective for ovarian cancer?

A

COCP
Pregnancy
Breast feeding
Hysterectomy
Oophorectomy

58
Q

What are the risk factors for vulvar cancer?

A

HPV
Herpes Simplex Virus Type 2
Smoking
Immunosuppression
Chronic vulvar irritation
Conditions such as Lichen Sclerosus

59
Q

What are the risk factors for ectopic pregnancy?

A

Damage to tubes (pelvic inflammatory disease, surgery)
Previous ectopic
Endometriosis
IUCD
Progesterone only pill
IVF (3% of pregnancies are ectopic)

60
Q

What are the risk factors for placenta praevia?

A

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
Q

What are the risk factors for placental abruption?

A

Previous placental abruption
Hypertension inc. pre eclampsia
Substance misuse
Smoking
SROM
Bleeding in first trimester
Abdo trauma
Abnormal lie
Multiple preg

62
Q

What are the complications of placental abruption?

A

PPH
DIC
Hypovolaemic renal failure
Chronic anaemia

63
Q

What can cause HELLP syndrome?

A

Pre eclampsia
Antiphospholipid syndrome

64
Q

What is the 1st, 2nd and 3rd trimester?

A

First- up to 13 wks
Second 13-27 wks
Third >27wks

65
Q

Give examples of tocolytic agents

A

Terbutaline
Magnesium sulphate
Nifedipine
Indomethacin

66
Q

What are the complications of PCOS?

A

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
Q

How is PCOS diagnosed?

A

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
Q

How is PCOS managed?

A

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
Q

What are the complications of Clomifene?

A

Hyperstimulation syndrome
Multiple pregnancies
Ovarian cancer
(limited to 6 cycles)

70
Q

What are the causes of premature ovarian insufficiency?

A

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
Q

What conditions that may occur in premature ovarian insufficiency?

A

Cardiovascular disease
Stroke
Osteoporosis
Cognitive impairment
Dementia
Parkinsonism

72
Q

What are the different types of fibroids?

A

Submucosal
Intramural
Subserosal

73
Q

How is BV treated?

A

Metronidazole

74
Q

How does BV present?

A

Most commonly, asymptomatic
Can present with fishy, offensive smelling discharge

75
Q

What is the most common causative organism of BV?

A

Gardnerella vaginalis

76
Q

How is vaginal candidiasis managed?

A

Oral antifungal- fluconazole or itraconazole

77
Q

What are the risk factors for developing gestational diabetes mellitus?

A

Obesity
GDM in previous pregnancies
First degree relative with diabetes
Previous fetus >4kg

78
Q

What are the risk factors for pre eclampsia?

A

Nulliparity
Previous pre eclampsia
Obesity
Advanced maternal age
FMH of pre eclampsia
Multiple gestation
Antiphospholipid syndrome

79
Q

Why is vaginal examination never performed in a large antepartum haemorrhage?

A

May provoke massive haemorrhage

80
Q

Define placental abruption

A

Separation of placenta from the lining of the uterus

81
Q

What are the possible complications of gestational diabetes mellitus?

A

Congenital defects
Prematurity
Shoulder dystocia
Polyhydramnios
Sudden fetal death

82
Q

What is the mechanism behind macrosomia in diabetic pregnant women?

A

Increased fetal glucose leads to increased fetal insulin, leading to increased fat deposition

83
Q

What organic medical diagnosis should be considered in women presenting with depressive symptoms post partum

A

Post partum thyroiditis

84
Q

How do women increase their oxygen intake during pregnancy?

A

Increased tidal volume

85
Q

What are the 4 features of a CTG that represent a reassuring trace?

A

HR 110-160
Variability of more than 5 beats per minute
Presence of accelerations
Absence of decelerations

86
Q

Below what fetal pH is a c/s indicated?

A

Below 7.20

87
Q

How many antenatal appointments should a pregnant nulliparous and multiparous woman have?

A

First preg- 10
Second preg- 7

88
Q

Outline when antenatal visits take place and why

A

<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
Q

What results on quadruple test suggest a diagnosis of Down’s syndrome?

A

Low AFP and oestriol
High b hCG and Inhibin A

Finals (8 decks)

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