OBS & GYNAE 2 Flashcards
Who is adenomyosis most common in?
Multiparous women in 30-50s
What is adenomyosis?
Endometrial tissue within the myometrium
Investigations for PCOS?
Pelvic USS
FSH, LH, prolactin, TSH, testosterone, SHBG
Check for impaired glucose tolerance
Lipid screen (can cause dyslipidaemia)
To rule out alternative causes - TFT,
Diagnostic criteria for PCOS?
Rotterdam criteria: if 2 of the following 3 are present…
- infrequent/no ovulation
- clinical/biochemical signs of Hyperandrogenism
- polycystic ovaries: >=12 follicles in 1 or both ovarian or increased ovarian volume >10cm
When would you see cardiac activity on USS?
From 6 weeks
If it can’t be identified with a crown rump length of =>7mm = embryonal demise
Patch cycle
3 weeks: patch worn every day and changed once a week
For the fourth week the patch is not worn = withdrawal bleed
What should you do if a pt delayed their contraceptive patch change at the end of week 1 or 2?
If delay in changing the patch is <48hrs = change immediately and no further precautions
If >48 hrs = change immediately and barrier contraception for 7 days. Consider emergency contraception if they had sexual intercourse in the last 5 days
What should you do if a pt delayed their contraceptive patch removal at the end of week 3?
Remove asap
New patch applied on the usual cycle start day for next cycle even if withdrawal bleed is occur b
No additional contraception
What should you do if a pt delayed their contraceptive patch application at the end of their patch-free week?
Additional barrier contraception for 7 days
Pharmacological Tx of urge incontinence in elderly frail pts?
Mirabegron instead of oxybutinin or tolteriodine to avoid anticholinergic SE
MOA mirabegron
Beta 3 agonist
Which women should take 5mg folic acid?
Either partner has NTD, previous preg with NTD, FHx of NTD
Woman taking AED, has coeliac, diabetes or thalassemia trait
BMI >=30
Risk factors shoulder dystocia?
Macrosomia
High maternal BMI
DM
Prolonged labour
McRobert’s Manoeuvre?
flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen
this rotation increases the relative anterior-posterior angle of the pelvis and often facilitates a successful delivery.
Which SSRIs are best for postpartum period?
Sertraline
Paroxetine
How does vasa praevia present?
ROM -> immediate vaginal bleeding
Foetal bradycardia
When can expectant management be done for ectopic pregnancy?
Size <35mm
Unruptired
Asymptomatic
No foetal heartbeat
HCG<1000
Medical management of ectopic pregnancy?
Methotrexate
What should you do if a pregnant woman presents with bp >160/110?
Admit to hospital
Features of ovarian torsion?
Sudden onset deep colicky abdominal pain with vomiting - can be on 1 side radiating to leg/back
Vaginal exam = adnexial tenderness
Risk factors for ovarian torsion?
Ovarian mass
Reproductive age
Preg
Ovarian hyperstimulation syndrome
Normal blood lab findings in pregnancy?
Hb falls
Increase in coagulant activity
Rise in fibrinogen and factors 7,8,10
Platelets fall
WCC rises
ESR rises
GFR increases
When does IUS become effective after insertion?
7 days
When can IUS be given in a pt who has fibroids?
If fibroid is <3cm and not distorting the uterine cavity
Placenta accreta?
chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis
Placenta increta?
chorionic villi invade into the myometrium
Placenta percreta?
chorionic villi invade through the perimetrium e.g. attach to bladder
