Obs Gynae Flashcards
what are the moderate risk factors in pre-eclampsia?
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy
what are the high risk factors of pre-eclampsia?
- hypertensive disease in a previous pregnancy
- chronic kidney disease
- autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
- type 1 or type 2 diabetes
- chronic hypertension
what management is used to reduce risk of hypertensive disorders in pregnancy with >=1 high risk or >=2 moderate risk factors?
75-150mg aspirin daily from 12 weeks gestation until birth
what is the treatment of choice in VTE prophylaxis in pregnancy?
LMWH (enoxaparin) - switch DOAC to LMWH
when does gestational hypertension occur?
after 20 weeks- no oedema, no proteinuria
At which week should you refer to an obstetrician for lack of fetal movements?
24 weeks
what are the 3 stages of labour?
stage 1: from the onset of true labour to when the cervix is fully dilated (10cm)
stage 2: from full dilation to delivery of the fetus
stage 3: from delivery of fetus to when the placenta and membranes have been completely delivered
what is used for diagnosis of placenta praevia
transvaginal uss
what are 2 contraindications of Vaginal birth after Caesarean (VBAC)
uterine rupture
classical cesarean scar (vertical)
Pregnant woman with a previous VTE history- management
LMWH throughout pregnancy until 6 weeks postnatal
define pre-eclampsia
new-onset BP ≥ 140/90 mmHg after 20 weeks AND ≥ 1 of proteinuria, organ dysfunction
what are CI of HRT?
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
In young adults with septic arthritis, what is the most common organism found?
Neisseria gonorrhoeae
what is a presentation in pregnancy related to parvovirus B19?
hydrops fetalis
causing anaemia due to viral suppression of fetal erythropoiesis → heart failure secondary to severe anaemia → the accumulation of fluid in fetal serous cavities (e.g. ascites, pleural and pericardial effusions)
treated with intrauterine blood transfusions
when is Lactational amenorrhoea a reliable form of contraception?
amenorrhoeic, baby <6 months, and breastfeeding exclusively
when can COCP be used post partum?
after 3 weeks
when can IUD or IUS be inserted after childbirth
within 48 hours or after 4 weeks
How long do implantable contraception last?
3 years
Up to what period following intercourse is levonorgestrel licensed to be used?
up to 72 hours
which is the most effective form of emergency contraception and not affected by BMI?
copper IUD
define placenta praevia
placenta lying in lower uterine segment
what are the grades of placenta praevia
I - placenta reaches lower segment but not the internal os
II - placenta reaches internal os but doesn’t cover it
III - placenta covers the internal os before dilation but not when dilated
IV (‘major’) - placenta completely covers the internal os
define placenta abruption
separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space
what are the risk factors for placental abruption
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
what is the mx of gestational diabetes
if fasting plasma glucose <7: offer trial diet and exercise, if not met in 1-2 weeks- metformin
if still not met- add insulin to metformin
if fasting plasma glucose >7 insulin
if fasting plasma glucose 6-6.9 and evidence complications (macrosomia, hydramnios) start insulin
what medication can be used in GDM in pts not tolerating metformin (or decline insulin)
glibenclamide (sulfonylureas)
what is the folic acid regime in pts with pre-existing DM (in GDM)
5mg a day from preconception to 12 weeks gestation
what are tocolytics used for
delay preterm (slows/ stops uterine contractions)
what are the causes of PPH
Tone (uterine atony): the vast majority of cases
Trauma (e.g. perineal tear)
Tissue (retained placenta)
Thrombin (e.g. clotting/bleeding disorder)
which location would an ectopic be greatest risk of rupture?
isthmus
what should be prescribed alongside SSRI and NSAID?
PPI- GI bleeding risk
what is the investigation of choice in ectopic pregnancy?
TV USS
when to stop COCP/ HRT before surgery?
4 weeks before surgery
what is the combined test for down’s syndrome?
11-13+6 weeks
(increased) HCG, (decreased) PAPP-A, thickened nuchal translucency
what is the quadruple test for down’s syndrome?
15-20 weeks
alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
2 down, 2 up
what are the bp patterns in normal pregnancy physiology?
blood pressure usually falls in the first trimester (particularly the diastolic), and continues to fall until 20-24 weeks
after this time the blood pressure usually increases to pre-pregnancy levels by term
how long is mirena coil licensed for as HRT and contraception?
4 years as HRT, 5 years as contraception
what are the high risk factors for neural tube defect (folic acid)
either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
the woman is obese ([BMI] of 30 kg/m2 or more).
