Obs & Gynae Flashcards
What is the first line medication in pregnancy induced HTN?
Oral labetolol
Which medications may be used in a patient with pregnancy induced HTN who also has asthma?
Oral nifedipine/methyldopa/hydralazine
Those at risk of gestational diabetes should have what test conducted at what gestation?
OGTT at 24-28 weeks
What is the drug of choice for reversing magnesium sulphate induced respiratory depression?
Calcium gluconate
In an ongoing eclamptic seizure, what medication should be given, how much and over how long?
IV bolus magnesium sulphate over 10-15 minutes
What is the main risk factor for developing hyperemesis gravidarium?
Increased beta-hCG levels, via multiparity or trophoblastic disease (e.g. molar pregnancy)
Which type of pregnancy may increase the risk of developing hyperemesis gravidarum?
Molar or multiple
What immediate medication should be administered in cases of eclampsia?
Magnesium sulphate
When are the 2 doses of prophylactic anti-D given in rhesus negative pregnant women?
28 and 34 weeks
Name 4 potentially sensitising events in pregnancy for rhesus negative women
Any of:
Amniocentesis, chorionic villus sampling, vaginal bleeding > 12 weeks, ectopic, external cephalic version, IUD, evacuation of retained products of conception, molar pregnancy, antepartum haemorrhage, abdominal trauma
What is the standard dose of folic acid for pregnancy? How long should this be taken for?
400mcg daily, taken ideally before conception up until 12 weeks gestation
What is the dose of folic acid utilised in high risk pregnancies?
5mg per day, ideally from before conception up until 12 weeks gestation
What mode of labour should be offered to women with intrahepatic cholestasis of pregnancy and why?
Induction at 37-38 weeks, as intrahepatic cholestasis of pregnancy increases risk of stillbirth
Which LFT can be normally raised in pregnancy?
ALP
Which prophylactic antibiotic should be given for GBS and for how long?
Oral erythromycin for 10 days
At what gestation should external cephalic version be offered if baby is in breech presentation?
36 weeks
What is the most common risk factor for development of placenta accreta?
Previous C section
How long after a decision has been made to perform a:
1. Category 1 C section
2. Category 2 C section
Should they be carried out?
- 30 minutes
- 75 minutes
McRoberts manoeuvre is often used to treat what?
Shoulder dystocia
The Zavanelli manoeuvre involves what?
Replacement of head into canal and delivery via emergency C section, in cases of shoulder dystocia
Shoulder dystocia is associated with with maternal complication?
Gestational diabetes
A pregnant women with 4 or more risk factors for VTE should have what treatment initiated, until when?
LMWH immediately until 6 weeks post natal
A pregnant women with 3 risk factors for VTE should have what treatment initiated, until when?
LMWH from 28 weeks gestation to 6 weeks post natal
A history of VTE in a pregnant women indicates the need for what treatment until when?
LMWH immediately until 6 weeks post natal
Give 2 examples of LMWH
Dalteparin, enoxaparin
PPH is defined as blood loss over what?
500ml
Which PPH medication should be avoided in cases complicated by hypertension?
Ergometrine
Which PPH medication should be avoided in cases complicated by asthma?
Carboprost
What is first line treatment in PPH?
Oxytocin 5iu slow IV injection
Misoprostol is given for PPH via which route?
Sublingual
What is the most common cause of PPH?
Uterine atony
- NB uterus may be palpated high above umbilicus in cases of uterine atony
What is the brand name of oxytocin used for PPH?
Syntocinon
Terbutaline has what effect on the uterus?
Reduce contractions
Placental abruption is associated with use of which recreational drug?
Cocaine
How should we manage cases of placental abruption which are:
1. Complicated by foetal distress?
2. Under 36 weeks and no foetal distress
3. Over 36 weeks and no foetal distress?
- Cat 1 C
- Observe + steroids
- Vaginal delivery
Amenorrhoea is classed as failure to establish menstruation by what age, in girls with:
1. Secondary sexual characteristics
2. No secondary sexual characteristics
- 15
- 13
High or low levels of prolactin may cause secondary amenorrhoea?
High
How do NSAIDs work?
Inhibit prostaglandin production
Which form of intrauterine device may cause dysmenorrhoea?
Copper
What is the quantification of heavy menstrual bleeding?
Over 80ml per menses
What are the most likely causes of an enlarged uterus which is:
1. Diffuse
2. Irregular
- Adenomyosis
- Fibroids
What is the only effective treatment for fibroids causing problems in fertility?
Myomectomy
Goserelin (Zoladex) is an example of what type of drug?
GnRH analogues
What is first line for infertility in PCOS?
Clomiphene
At what stage of life is adenomyosis most common?
When approaching menopause
What is the first line medical treatment for PMS?
COCP +/- sertraline
Raised LH/FSH in cases of primary amenorrhoea is suggestive of what as underlying cause?
Gonadal dysgenesis
In secondary amenorrhoea, low levels of gonadotrophins are suggestive of what cause of the amenorrhoea?
Hypothalamic
Primary amenorrhoea with features of cyclical pelvic pain and bloating is suggestive of what as the diagnosis?
Imperforate hymen
What levels of markers may be seen in PCOS for:
1. LH:FSH ratio
2. Prolactin
3. SHBG
- Raised LH:FSH
- Normal to elevated prolactin
- Normal to low SHBG
Which ratio may be elevated in PCOS patients?
LH:FSH
How do GnRH analogues reduce fibroid size?
By decreasing oestrogen exposure
What is considered first line contraceptive treatment for menorrhagia?
Mirena coil
What is first line contraceptive treatment for endometriosis patients?
COCP
Fill in the blank:
Bishop score of under __ indicates labour unlikely to start without induction
5
How is dinoprostone administered? When is it used?
Vaginal pessary used in induction of labour
Stage 1 of labour is divided into latent and active phase, determined by dilatation of how many cm?
1. Latent
2. Active
- 0-3cm
- 3-10cm
Stage 3 of labour describes what?
From delivery of foetus to complete delivery of placenta and membranes
Bleeding is classed as antepartum haemorrhage from how many weeks gestation?
24
Surgical intervention for ectopic pregnancy is required in sizes over what?
35mm
What age range is offered cervical screening in the UK?
25-64
Beta hCG levels of over what indicate the need for surgical management of an ectopic?
5000IU/L
Medical management of ectopic pregnancy is achieved via what?
Methotrexate
What is the upper limit for termination of pregnancy gestation?
24 weeks
We should give anti-D in patients having an abortion over how many weeks?
10
Which agents are used for medical management of termination of pregnancy?
Mifepristone followed by misoprostol 48 hours later
What is the first line treatment for BV?
Oral metronidazole for 5-7 days
Clue cells on microscopy suggest what?
BV
Bacterial vaginosis presents with what kind of pH?
Raised
What treatment should be given to pregnant women who develop:
1. BV
2. Thrush
- BV - oral metronidazole 5-7 days (same as non pregnant)
- Topical clotrimazole 500mg pessary (oral C/I)
What is the definitive treatment for ovarian torsion?
Laparoscopy
What is the most common causative organism in BV?
Gardnerella
What is the first line treatment in PID?
IM ceftriaxone stat + 14 days oral doxycycline + oral metronidazole
Right upper quadrant pain in a patient with a history of PID suggests what complication has occurred?
Perihepatitis / Fitz-Hugh Curtis Syndrome
Fill in the blank:
All women over the age of __ with PMB should be urgently referred for ultrasound to investigate for __
55
Endometrial cancer
Cervical ectropion is most common in women taking what medication?
COCP
Which rheumatological disorder can lead to recurrent miscarriages?
Antiphospholipid syndrome (APS)
How should ovarian cysts that are 5-7cm be managed?
Annual TV USS
How should ovarian cysts over 7cm be managed?
MRI with/without surgical intervention
Which medication can help prevent formation of new ovarian cysts?
COCP
Premature ovarian insufficiency occurs in women under what age?
40
Which hormones are raised in premature ovarian failure?
FSH and LH
Fill in the blank:
To diagnose premature ovarian failure, FSH levels must be above __ on 2 blood samples taken __ apart
30IU/L
4-6 weeks
Which medication can be used for vasomotor symptoms in menopause?
Clonidine
The combined oral contraceptive pill has a protective effect against which 2 reproductive cancers?
Endometrial and ovarian
Normal endometrial thickness is defined as under how many mm?
4
Which 3 types of HPV are the biggest risk for developing cervical cancer?
16, 18, 33
Which 2 HPV subtypes are not associated with cancer? What are they associated with instead?
6 and 11, genital warts
CA 19-9 is associated with what?
Pancreatic cancer
What is the most common identifiable cause of postcoital bleeding?
Cervical ectropion
PID most commonly increases the risk of what pregnancy complication?
Ectopic
Anastrozole is an example of what type of medication?
Aromatase inhibitor
Aromatase inhibitors decrease levels of what hormone?
Oestrogen
Aromatase inhibitors are associated with what side effect?
Osteoporosis
What is first line for prevention of PET, from what gestation?
Low dose aspirin 75-150mg daily from 12 weeks gestation
A patient with PET and a past medical history of asthma should receive what treatment?
Nifedipine
What is the most common liver disease of pregnancy?
Intrahepatic cholestasis
Name the 3 treatment elements for intrahepatic cholestasis of pregnancy?
- Ursodeoxycholic acid
- Weekly LFTs
- Induction at 37 weeks
Elevated ALT levels plus jaundice in pregnancy is suggestive of what?
Acute fatty liver
How is acute fatty liver of pregnancy managed?
Supportive management
