obstetrics Flashcards
which contraception is associated most with weight gain
injection - depo-provera
best short-term contraception for after birth
POP
at increased risk of VTE following childbirth so avoid COCP
how many days is it until each contraception is effective (if not taken/inserted on first day of period)?
instantly: IUD
2 days: POP
7 days: COCP, injection, implant, IUS
COCP and cancer risk
increased risk of breast and cervical
decreased risk of ovarian and endometrial
COCP 1 missed pill
take the last pill even if it means taking 2 in one day
then continue taking pills daily, one each day
no further action is needed
COCP - if 2 or more pills are missed in week 1
consider emergency contraception if UPSI in pill-free week or in week 1
use condoms or abstain until she has taken pills for 7 days in a row
COCP - if 2 or more pills are missed in week 2
after 7 consecutive days of taking the COCP there is no need for emergency contraception
use condoms or abstain until she has taken pills for 7 days in a row
COCP - if 2 or more pills are missed in week 3
finish pills in current pack, then start a new pack omitting the pill free period
use condoms or abstain until she has taken pills for 7 days in a row
when should a double dose of levonorgestrel be used for emergency contraception?
BMI >26 or weight >70kg
mode of action of implant
inhibition of ovulation
absolute contraindications for COCP
breastfeeding <6 week postpartum migraine w aura hx of VTE, stroke or ischaemic heart disease current breast cancer >35 years smoking >15/day any clotting disorders
contraception for trans male (female at birth)
avoid COCP
copper IUD does not interfere with hormonal treatments (i.e. testosterone)
POP, implant and injection are thought not to interfere with hormones
contraception for trans female (male at birth)
advise to use condoms
how long does IUS last
5 years
how long does IUD last
5-10 years
delay in changing patch
<48h - change patch and no further precautions needed
>48h - change immediately and use barrier protection for 7 days
necessary criteria for lactational amenorrhoea to be reliable method of contraception
- amenorrhoeic
- baby <6 months
- breastfeeding exclusively
POP missed pills, what is the ‘safe’ window (i.e. no further action required)
desogestrel (Cerazette) has a 12 hours missed pill window
the rest have a 3 hour window
ABX safe in breastfeeding
Penicillins
Cephalosporins
Trimethoprim
ABX contraindicated in breastfeeding
Ciprofloxacin
Tetracyclines
Sulphonamides
risk factors for 2nd trimester miscarriage
Age >35 years
Prev miscarriages
Chronic health conditions
Smoking, heavy alcohol use, illicit drug use
Invasive prenatal genetic tests, e.g. amniocentesis
Large cervical cone biopsy
risk factors for placenta accreta
prev. C section
Placenta praevia
Bishop score <5 indicates…
Bishop score >=8 indicates…
< 5 - labour is unlikely to start without induction
≥ 8 - cervix is favourable and there is a high chance of spontaneous labour, or response to interventions made to induce labour
mx if placenta praevia grade III/IV (i.e. covers os)
elective C section at 36-37 weeks
which contraception should be avoided in menorrhagia
IUD
vaccines offered to pregnant women
pertussis
influenza
rash in pregnancy with periumbilical sparing
polymorphic eruption of pregnancy
what is methotrexate used for in obstetrics
medical mx of ectopic pregnancy
what is misoprostol used for
termination of pregnancy (along with mifepristone causes uterine contractions)
miscarriage
what is mifepristone used for
termination of pregnancy along with misoprostol
when does passage of lochia normally cease
4-6 weeks postpartum
ultrasound if persists beyond 6 weeks
mx if a woman had group B strep in a previous pregnancy
maternal IV ABX prophylaxis during labour
when should a woman with pre-eclampsia be admitted
all need an emergency secondary care assessment
if BP is >=160/110mmHg they should be admitted and observed
mx of cord prolapse
presenting part of the foetus should be pushed back into the uterus
tocolytics may be used
if cord is beyond introitus keep warm and moist but do not push back in
ask patient to go onto all fours
blistering rash in pregnancy
pemphigoid gestationis
infections screened for at antenatal appointments
hep B
HIV
syphilis
causes of raised AFP in prenatal screening
neural tube defects
abdominal wall defects
multiple pregnancy
causes of reduced AFP in prenatal screening
Down’s syndrome
trisomy 18
maternal diabetes
next mx step if late decelerations present on CTG
foetal blood sampling
contact w chickenpox <20 weeks not immune no rash
VZIG within 10 days
contact w chickenpox >20 weeks not immune no rash
VZIG or antivirals 7-14 days after exposure
contact w chickenpox and develops rash
oral aciclovir within 24 hours of rash
which beta-hCG is used to measure for ectopic
urine beta-hCG
when is magnesium sulphate given in pre-eclampsia
severe hypertension
eclampsia (seizure)
if birth is planned within 24h
concern that eclampsia may develop
mx to stop smoking in pregnancy
- behavioural therapy
2. nicotine replacement therapy
when is screening for Down’s performed
11-13+6 weeks
what organism causes group B strep
Streptococcus agalacticae
causes of increased nuchal translucency
Down’s syndrome
congenital heart defects
abdominal wall defects
time until effective IUD (if not first day period)
instantly
time until effective POP (if not first day period)
2 days
time until effective COC, injection, implant, IUS (if not first day period)
7 days: COC, injection, implant, IUS
when is contraception needed postpartum
no contraception is needed until 21 days postpartum unless relying on lactational amenorrhoea
when can external cephalic version be attempted
> 36 weeks of pregnancy and early labour provided amniotic sac has not ruptured and patient is not in active labour
if in active labour and transverse lie is found do emergency c-section
