Obs Gynae Flashcards

1
Q

what are the moderate risk factors in pre-eclampsia?

A

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

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2
Q

what are the high risk factors of pre-eclampsia?

A
  • 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
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3
Q

what management is used to reduce risk of hypertensive disorders in pregnancy with >=1 high risk or >=2 moderate risk factors?

A

75-150mg aspirin daily from 12 weeks gestation until birth

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4
Q

what is the treatment of choice in VTE prophylaxis in pregnancy?

A

LMWH (enoxaparin) - switch DOAC to LMWH

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5
Q

when does gestational hypertension occur?

A

after 20 weeks- no oedema, no proteinuria

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6
Q

At which week should you refer to an obstetrician for lack of fetal movements?

A

24 weeks

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7
Q

what are the 3 stages of labour?

A

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

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8
Q

what is used for diagnosis of placenta praevia

A

transvaginal uss

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9
Q

what are 2 contraindications of Vaginal birth after Caesarean (VBAC)

A

uterine rupture
classical cesarean scar (vertical)

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10
Q

Pregnant woman with a previous VTE history- management

A

LMWH throughout pregnancy until 6 weeks postnatal

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11
Q

define pre-eclampsia

A

new-onset BP ≥ 140/90 mmHg after 20 weeks AND ≥ 1 of proteinuria, organ dysfunction

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12
Q

what are CI of HRT?

A

Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

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13
Q

In young adults with septic arthritis, what is the most common organism found?

A

Neisseria gonorrhoeae

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14
Q

what is a presentation in pregnancy related to parvovirus B19?

A

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

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15
Q

when is Lactational amenorrhoea a reliable form of contraception?

A

amenorrhoeic, baby <6 months, and breastfeeding exclusively

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16
Q

when can COCP be used post partum?

A

after 3 weeks

17
Q

when can IUD or IUS be inserted after childbirth

A

within 48 hours or after 4 weeks

18
Q

How long do implantable contraception last?

19
Q

Up to what period following intercourse is levonorgestrel licensed to be used?

A

up to 72 hours

20
Q

which is the most effective form of emergency contraception and not affected by BMI?

A

copper IUD

21
Q

define placenta praevia

A

placenta lying in lower uterine segment

22
Q

what are the grades of placenta praevia

A

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

23
Q

define placenta abruption

A

separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

24
Q

what are the risk factors for placental abruption

A

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)

25
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
26
what medication can be used in GDM in pts not tolerating metformin (or decline insulin)
glibenclamide (sulfonylureas)
27
what is the folic acid regime in pts with pre-existing DM (in GDM)
5mg a day from preconception to 12 weeks gestation
28
what are tocolytics used for
delay preterm (slows/ stops uterine contractions)
29
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)
30
which location would an ectopic be greatest risk of rupture?
isthmus
31
what should be prescribed alongside SSRI and NSAID?
PPI- GI bleeding risk
32
what is the investigation of choice in ectopic pregnancy?
TV USS
33
when to stop COCP/ HRT before surgery?
4 weeks before surgery
34
what is the combined test for down's syndrome?
11-13+6 weeks (increased) HCG, (decreased) PAPP-A, thickened nuchal translucency
35
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
36
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
37
how long is mirena coil licensed for as HRT and contraception?
4 years as HRT, 5 years as contraception
38
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).