Obs/ gyne take home Flashcards
safe antihypertensives?
safest anti epileptics in pregnancy?
safest anti rheumatoid drugs?
Pre-existing HTN: stop aRB/ ACEi. labetolol/ nifedipine (asthmatics) and hydralizine
lamotrigine, carbemazepine, keppra
sulfasalaine and hydroxychloroquine. stop methotrexate 6 months before conception
Postnatal HTN management?
PV bleed at 6-9 weeks? (painless vs painless?
when to stop NSAIDS?
enalapril / nifedipine/ amlodipine (in black) then labetalol
6-9 weeks common is ectopic (painful), painless is missed miscarriage/ threatened miscarriage
NSAids - stop at 32 weeks due to closing of ductus arteriosus
Test to rule out pre-eclampsia in weeks 20-35?
folic acid proph?
eclampsia tx during delivery?
complication of this?
Placental growth factor (blood test). low is likely to be eclampsia
all 400mcg until 12 w
high risk for NTD - 5mg
HRF: BMI 30+, DM, antiepileptic drugs, thallasaemia trait, FH/ partner NTD
mgso4 bolus then infusion. risk resp depression - monitor UO, reflexes, O2, RR. give calcium gluconate as tx
Definition of gestational hypertension
Dx of eclampsia?
how can we rule out eclampsia?
=
<20weeks 140/90 or increased of 15/30 from booking date.
After 20W - pregnancy induced.
20w+ with 140/90 HTN and feature of proteinuria/ organ dysfunction or placental dysfunction.
rule out - placental growth factor at 20-53w
GDM dx?
screening?
target values - FBG/ pos prandial?
tx of gdm?
complications of pregnancy DM?
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
screening - boooking and 24-28 weeks
targets:
fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L
tx: if 7+ at dx, start insulin. if <7, trial 1 weeks diet+exercise, then offer metformin the insulin
macrosomia hypoglycaemia, polycythaemia, low Ca, low Mg, shoulde rdystocia, - erb’s palsy
Eclampsia prophylaxis?
75mg Aspirin from 12 weeks if 1x high RF (CKD/DM/HTN/autoimmune) or 2 x moderate RF (FH/ multip/ first pregnancy/ 40+, BMI 35+, 10yrs+last pregnancy)
HIV positive pregnant woman care
antivirals to fetus?
No breast feeding
Vaginal delivery if < 50 viral load
Offer antiretrovirals to everyone
If C/S - give antiretroviral IV 4 hrs before (zidovudine
baby give orally if <50, or triple ART 4-6 weeks
Induction of labour summary?
BISHOP score factors?
PEDSS
when likely to progress naturally?
when is sweep?
BISHOP - includes cervical dilation, effacement, consistency (softness), position, fetal station.
(PEDSS)
<5 - unlikely to progress naturally. 9+ natural.
40-41w - do sweep
6 or less - vaginal E2 or misoprostol
6 or more can do amniotomy/ IV oxytocin infusion
Drugs to avoid breast feeding?
Avoid all listed- can cause quite toxic breastmilk
Aspirin
Amiodarone
Lithium
Carbimazole
Chloramphenicol
Quinalone
Tetracycline
Benzos
Methotrexate
Down’s syndrome screening including nuchal scan (timeline). what does this involve?
if woman presents after 12 weeks how do you screen? what tests?
what does high chance/ low chance mean?
Week 11-13+6
(downs and nuchal, trippl test - downs is high hcg, low PAPPA, thick translucency, edwards is lower HCG)
if later, can do quadruple test at 15-20 weeks
high chance results - < 1 in 150 chance. you do Non invasive second screen or amnioscentesis or CVS
low chance result is more than 1 in 150 chance ( 1 in 300)
Early scan to confirm dates, exclude multiple pregnancy
Week 10-13+6
continuous abdominal pain
shock disproportionate to the amount of blood loss, uterus spasm firm or ‘woody’
the fetus hard to feel and auscultate
Plancental abruption
What situations to give anti D?
ectopic pregnancy managed medically?
tests for baby?
CI to ECV?
Rh +ve infant delivered to rh neg mother
termiantion/miscarriage at 12 weeks+
ectopic pregnancy - surgical mx (not if methotrexate is used)
ECV
antepartum haemorrhage
amniocentesis, CVS, fetal blood sampling
abdominal trauma
rh neg baby born - do chord blood from mum and do COoms, fbc, blood group, kleihauer test
ECV CI: where caesarean delivery is required
antepartum haemorrhage within the last 7 days
abnormal cardiotocography
major uterine anomaly
ruptured membranes
multiple pregnancy
abdominal fullness, early satiety, 55+, increased urine urgency?
RF?
Protective?
Commone types?
Ovarian cancer sus - if CA125 35+, refer for USS.
RF: nulip, early menarche, late menses, BRCA1,2
protective: COCP, diagnostic lap,
Common: epithelial, serous cystadenoma
COCP protective against and RF for?
coc goes on cervix and breast
RF for breast ca and cervical ca
Protective against endometrial and ovarian
Post menopausal bleed, dad has a history of Colorectal cancer.
DX?
RF?
Protective?
Ix?
Endometrial cancer
RF: Nulip, early menarch, late menopause, PCOS, DM, obese, HNPCC
Protective: smoking, COCP, IUS (mirena), cyclic progesterones, Multip
IX: USS endometrial thickness 4+ - do hysteroscopy and biopsy. FIGO staging, surgery +- radiotherapy
Black woman presents to fertility clinic with menorrhagia, deep dysparenuria?
Uterine fibroids:
Need TV USS
SX tx: progesterone, COCP, mirena,
fertility protective: mymectomy
Pain 4 days before period is due at 30 YO, yrs after normal periods. cX?
Secondary dysmenorrhoea
endometriosis
adenomyosis -large, boggy uterus
pelvic inflammatory disease-fever cervix excitation, dysfunctional bleed
intrauterine devices*
fibroids-low fertility, deep pain
Ectopic pregnancy -when would you do medical management, what does it involve?
BHCG <1500, foetus <35mm, no heartbeat no risk of rupture, if no other intrauterine pregnancy. Give methotrexate and F/U.
when to manage ectopic pregnancy surgically?
35mm+, 5000+bHCG,
neural tube defects test?
USS
test is USS not enough?
anencephaly form 12 w/ spina bifida 16-20 weeks
amnioscentesis to take aFP at 16 weeks
Down’s syndrome screen?
combined at 12 weeks
anomaly at 18-20+6
first dose of anti D for Rhesus negative women?
2nd dose?
28 weeks and 34 weeks
Secondary amenohrea cx?
no sx of androgen excess: hyperprolactinaemia: metoclopramide/ phenothiazines/
premature ovarian failure (FSH 20+), post pill amen
androgen excess: pcos (LH >FSH), cushings syndrome, pituitary failure (TSH low, t4 low)
