Obstetrics Flashcards
What times should female hormone testing be done for fertility during her cycle
Serum LH and FSH on days 2-5
Serum progesterone on day 21 or 7 days before the end of the cycle
Anti-mullerian hormone - low level = low ovarian reserve
Thyroid function
Prolactin
What are the pre-testicular causes of infertility
Hypogonadotrophic hypogonadism- low LH and FSH causing low testosterone
Pituitary or hypothalamus issues
Suppression due to stress
Kallman syndrome(delay/ absent puberty with no smell)
What are some testicular causes of infertility
Mumps
Undescended testes
Trauma
Radiotherapy
Chemotherapy
Cancer
What investigations are done for a pregnancy of unknown location?
Serum hCG monitored over time- repeated after 48 hrs
Rise of over 63%- indicates intrauterine pregnancy- repeat USS in 1-2 weeks
Rise of less than 63%- ectopic pregnancy
Fall of more than 50%- miscarriage- pregnancy test again in 2 weeks
What is the criteria for management with methotrexate for an ectopic
-HCG level <5000 IU/L
-Confirmed absence of intrauterine pregnancy
-Follow up needed
-Ectopic mass enraptured
-Adenexal mass<35mm
-No visible heart beat
-No significant pain
How is methotrexate given in Ectopics
IM into bum
Can’t get pregnant for 3 months after
What is the surgical management for an ectopic and when is it used
Done if
-Pain -Adnexal mass>35mm -Visible heart beat -HCG>5000 IU
Can be laparoscopic salpingectomy- first line- removing affected tube
Laparoscopic salpinotomy- avoid removing the tube but remove the ectopic
Anti-D propylaxis is given to Rh -ve women
What are the USS findings in keeping with a miscarriage
CRL is >7mm but no fetal heart beat is found
Repeat this scan in one week to confirm miscarriage
What is the management of a patient less than 6 weeks with vaginal bleeding
Expectant - waiting - USS not helpful here as cannot see Heart beat anyway
Repeat pregnancy test 7-10 days and if negative miscarriage confirmed
What is the management of a patient more than 6 weeks with vaginal bleeding
Refer to early pregnancy
Transvaginal USS
Expectant management
If no risk factors or infection- give 1-2 weeks for miscarriage to occur
Medical
Misoprostal as a vaginal suppository or an oral dose
Surgical
Misoprostal given before
Manual vacuum aspiration - need to be less than 10 weeks
Electric vacuum aspiration
Anti-D given if rhesus positive
How is an incomplete miscarriage managed
Medical - misoprostal
Surgical- evacuation of retained products of conception
What is antiphospholipid syndrome
Antiphospholipid antibodies make the body prone to clotting - hyper coagulable state
Autoimmune condition can be secondary to SLE
Multiple miscarriage and DVT history
Treatment with aspirin and LMWH (enoxaparin)
What hereditary thrombophilias can cause miscarriage
Factor V leiden (most common)
Factor II (prothrombin) gene mutation
Protein S deficiency
When can an abortion before 24 weeks be carried out/ at any time
If continuing pregnancy is greater risk to physical or mental health or mum or baby
Abortion at any time if continuing will risk the woman’s life or substantial risk of physical/ mental abnormalities of child
What is used in medical abortion
Mifepristone- anti progesterone to halt pregnancy and relax cervix
Misoprostol- prostaglandin analogue to stimulate uterine contractions - from 10 weeks onwards additional misoprostal doses are added- every 3 hrs till explosion
Urine pregnancy test 3 weeks after to confirm
What are the two surgical abortion options
Cervical dilation and suction of contents up to 14 weeks
Cervical dilation and evacuation from 14-24 weeks
What is the criteria for hyperemesis gravidarum
-More than 5% weight loss compared with before pregnancy
-Dehydration
-Electrolyte imbalance
PUQE score will give score out of 15
<7- mild
>12- Severe
How is hyperemesis gravidarum management
Antiemetics
1. Prochlorperzine
2. Cyclizine
3. Ondansetron
4. Metoclopramide
Can use omeprazole if acid reflux
Consider admission if
Can’t take oral tablets/ keep anything down
Ketones in urine
>5% weight loss
How do you manage severe hyperemesis gravid arum
IV/IM antiemetics
IV fluids - Normal saline and K
Daily U&Es
Thiamine supplementation
Thromboprophylaxis
What is a complete mole
When two sperm cells fertilise an egg that has no genetic material - sperm combine genetic material
What is a partial mole
Two sperm cells fertilise a normal ovum at once and the ovum has 3 sets of chromosomes - some fetal material may form
What are the symptoms of molar pregnancy
-Severe morning sickness
-Vaginal bleeding
-Increased enlargement of uterus
-Abnormally high bHCG
-Thyrotoxicosis (HCG can mimic TSH and stimulate thyroid)
USS will show snowstorm appearance
How is a molar pregnancy managed
-Evacuation of uterus and histological examination
HCG levels monitored until normal
What does gravida and para mean
Gravida- number of pregnancies
Para- number of times a woman has given birth past 24 weeks
What vaccines should a pregnant woman get
Whooping cough (Pertussis) from 16 weeks
Influenza (flu)
Avoid live vaccines (MMR)
What lifestyle advice is given to a pregnant woman
-Folic acid 400mg
-Vitamin D (10mcg)
-Avoid vit A
-No alcohol
-No smoking
What screening is done at booking
-Blood group, antibodies, Rhesus
-FBC (Anaemia)
-Thalassaemia/ sickle cell
-HIV, hep B, syphillis
-Urine- protein and bacteria
-BP
Risk assessment
-RH -ve
-Gestational diabetes
-FGR
-VTE (give enoxaparin if high risk)
-Pre-eclampsia (give aspirin if high risk)
How is hypothyroidism treated in pregnancy
Levothyroxine needs to be increased during pregnancy by 25-50mcg
As it can cross the placenta
How is hypertension treated in pregnancy
ACE, ARB and thiazide diuretics STOPPED
Labetalol used
CCBs (nifedipine) can be used
Alpha blockers can be used (Doxazosin)
How is epilepsy treated in pregnancy
Epilepsy should be controlled on a single anti-epileptic before pregnancy
Levetriacetam, lamotrigine and carbamazepine- safer in pregnancy
Sodium valproate avoided- neural tube
Phenytoin avoided- cleft lip/palate
How is rheumatoid arthritis treated in pregnancy
Methotrexate contraindicated
Hydroxychloroquine- safe and first line
Sufasalazine - safe
Can use steroids in flare ups
What medications should be avoided in pregnancy
NSAIDs- block prostaglandins - esp in 3rd trimester can cause premature closure of ductus arteriosus - also delay labour
Beta blockers- can use labetalol - FGR, Hypoglycaemia and bradycardia in neonate
ACE and ARB- affect foetal kidneys
Opiates- fetal withdrawn
Warfarin- fetal loss/ malformations
Sodium val- teratogenic neural tube
Lithium- congenital cardiac abnormalities
SSRI’s -Congenital heart defects and withdrawal
Roaccutane- teratogenic
What infections must be avoided in pregnancy
Rubella- maternal infection before 20 weeks - congenital deafness, cataracts, heart disease, learning disability
Chickenpox- fetal varicella syndrome, more severe infection in mother
Exposure to chicken pox - if woman has had chickenpox- safe
If they are not sure- immunity tested and if IgG levels positive- safe
If not immune treat with IV varicella immunoglobulins within 10 days
Listeria - unpasteurised dairy products
CMV/ Congenital toxoplasmosis- this will cause hearing loss, low birth weight, petechial rash, microcephaly and seizure- hepatosplenomegaly
Parovirus B19 - Slapped cheek - miscarriage, hydrops fetalis, maternal preeclampsia
Women with suspected infection
IgM- acute infection
IgG - previous immunity
Rubella antibodies
Zika virus
When are anti-D injections given and what is their purpose
28 weeks and then at birth if baby is rhesus positive
Also given in
Antepartum haemorrhage, amniocentesis and abdo trauma
Kleinhauer test shows how much fetal blood passed into mother circulation
Anti-D injection will destroy foetal RBC to prevent mother’s immune system making her own antibodies against the antigen
What are the risk factors for Small gestational age
Previous SGA baby
Obesity, smoking, diabetes, exisiting HTN, pre-eclampsia, mother over 36, multiple pregnancies, antepartum haemorrhage, antiphospholipid synd
What is the management for a foetus that is SGA
Low risk women- symphysis fundal height measured from 24 weeks
High risk women- serial growth scans with umbilical artery doppler and amniotic fluid volume
Identify underlying cause
When growth is static on growth chart- early delivery with corticosteroids and planned C-section
What are the causes and risks associated with a baby that is LGA. What is the management
Causes: Constitutional, maternal diabetes, macrosomia, maternal obesity/ rapid weight gain, overdue, male baby
Risks: Shoulder dystocia, failure to progress, perineal tears, instrumental/Csection, postpartum haemorrhage, uterine rupture
Neonatal hypoglycaemia, obesity in childhood, type 2 diabetes in adulthood
Management: USS to exclude polyhydraminos, OGTT for gest Diabetes
What is the management of a UTI in pregnancy
7 days of nitrofurantoin 1st and 2nd trimester
Amoxicillin or cefalexin
Avoid trimethoprim in first semester - folate antagonist
What is the management for anaemia in pregnancy
Iron supplementation - ferrous sulphate 200mg 3x daily
B12 deficiency - test for pernicious anaemia (intrinsic factor antibodies), Give IM hydroxycobalamin or oral cyanocobalamin
Folate deficiency- folic acid 5mg
When is VTE prophylaxis given to a pregnant woman
at 28 weeks if there are 3 risk factors
First trimester if there are four or more risk factors
Given enoxaparin
Risk factors- smoking, parity >3, over 35, BMI>30, low mobility, pre-eclampsia, varicose veins, fam history, thrombophilia, IVF
How is a DVT/PE in pregnancy managed?
Enoxaparin (LMWH) for remainder of pregnancy and 6 weeks postnatally or 3 months in total (whichever is longer)
What is the triad of pre-eclampsia
Hypertension
Oedema
Proteinuria
Happens after 20 weeks gestation
Abnormal formation of spiral arteries of placenta causes high vascular resistance
What are the risk factors for pre-eclampsia
High risk
-Pre-existing HTN
-Previous HTN in pregnancy
-Autoimmune condition- SLE
-Diabetes
-CKD
Moderate risk
-Over 40
-BMI>35
->10 yrs since last pregnancy
-First pregnancy
-Fam history
Women given aspirin from 12 weeks if they have one high risk factor or more than one moderate risk factor
What are the symptoms of pre-eclampsia
Headache, visual disturbance, nausea and vomiting, epigastric pain (liver swelling), oedema, reduced urine output, brisk reflexes
How is pre-eclampsia diagnosed
Systolic above 140
Or diastolic above 90
PLUS
-Proteinuria (1+>)
-Organ dysfunction (raised creatinine, high LFTs, seizures, haemolytic anaemia, thrombocytopenia)
-Placental dysfunction (FGR or abnormal dopplers)
Proteinuria= Urine protein:creatinine ratio > 30
Urine albumin:creatinine ratio> 8
How is pre-eclampsia / eclampsia managed
Pre-eclampsia
Labetalol (1st line)
Nifendipine (2nd line)
IV magnesium sulphate given during labour and 24 hrs after to prevent seizures
early birth with corticosteroids given
Eclampsia
IV magnesium sulphate
IV hydralazine
Fluid restriction
What is HELLP syndrome
Complication of pre-eclampsia
-Haemolysis
-Elevated Liver enzymes
-Low platelets
What are the risk factors for gestational diabetes and when should they get an oral glucose tolerance test
Previous gestational diabetes
Previous macrocosmic baby (>4.5kg)
BMI>30
Ethnic origin
Fam history of diabetes (1st degree)
OGTT between 24-28 weeks
also get an OGTT if
-Large for dates foetus
-Polyhydraminos
-Glucose on urine dip
What is a OGTT and what are the values for gestational diabetes
75g glucose drink- blood sugar done fasting and 2 hrs after
5,6,7,8 easy to remember cut off
Normal results
Fasting- lower than 5.6
2 hrs- lower than 7.8
Above these is gestational diabetes
How is gestational diabetes managed?
Four weekly USS from 28-36 weeks
-Fasting glucose<7- diet and exercise 1-2 weeks then metformin then insulin
-Fasting glucose >7- insulin and metformin
-Fasting glucose >6 and macrosomnia (or other complication)- insulin and metformin
How is pre-exisitng diabetes managed in pregnancy
5mg folic acid
Retinopathy screening
Planned delivery between 37 and 38+6 weeks
Sliding scale insulin regime during labour for type 1 diabetics- detrose and insulin infusion
What is the treatment for neonatal hypoglycaemia
Regular glucose checks and frequent feeds
Aim to keep blood sugars above 2
If they fall lower- IV dextrose or NG tube feeding
What are the symptoms of obstetric cholestasis
Itching to palms of hands - and soles of feet - reduced outflow of bile acids
Fatigue
Dark urine
Pale greasy stool
Jaundice
NO RASH
Will have abnormal LFTs and raised bile acids (ALP will always be raised in pregnancy)
What is the management of obstetric cholestasis
Ursodeoxycholic acid
Emollients and antihistamines for itch
Sometimes prothrombin time can be deranged so may also give water soluble via K - bile acids usually help absorb Vit K so this can cause deficiency
Early delivery after 37 weeks
What is the cause and symptoms of Acute Fatty Liver of Pregnancy. How is it managed
LCHAD deficiency in fetus- impaired fatty acid processing in placenta
Acute hepatitis symptoms- fatigue, nausea and vomiting, jaundice, abdo pain, anorexia, ascites
Bloods: Elevated ALT and AST
-Raised bilirubin, WBC, deranged clotting (INR and PTT)
-Low plts
Emergency- prompt delivery
What are the top 3 causes of antepartum haemorrhage
Placenta praevia, placental abruption and vasa praevia
What is placental praevia and what are the risk factors associated
Placenta is attached in lower part of uterus, lower than foetus presenting part
Low lying placenta
Or placenta praevia (covering the internal cervical OS)
Risk factors
previous C-section
Previous placenta praevia
Older age
Maternal smoking
Structural abnormalities (fibroids)
IVF
20 week anomaly scan can see this
Can also have painless vaginal bleeding around 36 weeks
How is placenta praevia managed
Repeat transvaginal USS at 32 and 36 weeks
Corticosteroids between 34 and 35+6 due to preterm delivery risk
Planned delivery between 36-37 weeks
Emergency C section if premature labour or antenatal bleeding
What are the features and risk factors of vasa praevia
Fetal vessels are exposed outside the umbilical cord and placenta (umbilical arteries and umbilical vein) travel across the internal cervical OS
Risk factors
Low lying placenta
IVF pregnancy
Multiple pregnancy
Can be diagnosed on USS or antepartum haemorrhage
Also detected during labour- dark red bleeding when waters break
What is the management of vasa praevia
If asymptomatic
Corticosteroids from 32 weeks
Elective C-section from 34-36 weeks
When antepartum haemorrhage occurs- emergency C-section
What are the risk factors and presentation of placental abruption
Risk factors
Previous abruption
Pre-eclampsia
Bleeding in early pregnancy
Trauma (dom violence)
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine, amphetamine use
Presentation
Sudden onset severe abdo pain
Vaginal bleeding (antepartum haemorrhage)
Shock (hypotension, tachycardia)
CTG abnormalities
Woody abdomen - large haemorrhage
How is antepartum haemorrhage categorised
Minor haemorrhage- less than 50mls blood loss
Major haemorrhage- 50-1000ml blood loss
Massive haemorrhage- 1L blood loss or more and signs of shock
What is the management of placental abruption
Emergency
ABCDE
CTG monitoring
Emergency C-section
Crossmatch 4 units of blood
Anti-D prophylaxis
Active management of third stage to reduce risk of postpartum haemorrhage
What are the different types of placental attachment issues
Placenta accreta- attaches to the surface of the myometrium
Placenta increta- imbeds INTO the myometrium deeply
Placenta percreta- invades past the myometrium and perimetrium
What are the risk factors, presentation and management of placenta accreta
Risk factors
Previous placenta accrete
Previous endometrial curettage
Previous C section
Multigravida
Increased maternal age
Placenta praevia
no symptoms- maybe some bleeding - diagnosed on USS usually
Can cause post partum haemorrhage
Management
MDT
Planned delivery 35-36 weeks - C-section with
Hysterectomy
Uterus preserving surgery
Expectant management - high risk infection and bleeding
What is an ECV
Can be done at 37 weeks in previous birth women and 36 weeks in first born
Turn foetus from breech to cephalic
Tocolysis given to relax uterus
Rhesus D neg women will need anti-D
What is the management of stillbirth
USS to diagnose intrauterine fetal death
Rh D prophylaxis
Vaginal birth - induction (mifepristone and misoprostal) or expectant management
Dopamine agonists to surpress lactation after birth - cabergoline
What are the main causes of cardiac arrest in pregnancy
Obstetric haemorrhage
Pulmonary embolism
Sepsis leading to metabolic acidosis and septic shock
What are the main causes of obstetric haemorrhage
Ectopic pregnancy (early)
Placental abruption (also concealed)
Placenta praevia
Placenta accrete
Uterine rupture
What is aortocaval compression and how do you prevent it
After 20 weeks uterus can compress the IVC and aorta
Compression of IVC reduces blood returning to heart (venous return) - decreased cardiac output and hypotension can cause cardiac arrest
Place woman in left lateral position
What tests and management are done in preterm prelabour rupture of membranes
Speculum exam to look for pooling of amniotic fluid
Insulin like growth factor binding protein
Placental alpha microglobin-1
Management
Propylactic antibiotics - erythromycin 250mg four times daily for 10 days
Induction of labour from 34 weeks
What is the management of preterm labour
Fetal monitoring
Tocolysis with nifedipine - between 23-33+6 weeks to delay delivery
Antenatal cortcosteroids before 35 weeks - reduce respiratory distress syndrome
IV magnesium sulphate - protect fetal brain- within 24 hrs delivery in less than 34 weeks baby
When is labour induced
Between 41 and 42 weeks or if
Prelabour rupture of membranes
Fetal growth restriction
Pre-eclampsia
Obstetric cholestasis
Existing diabetes
Intrauterine fetal death
Score of more than 8 in Bishop score indicates successful induction of labour
What are the options for labour induction
Membrane sweep- finger in cervix to begin process within 48 hrs - not a full method of induction
Vaginal prostaglandin E2- pessary- releases prostaglandins over 24 hrs
Cervical ripening balloon- silicone balloon inflated to dilate cervix
Oral mifepristone and misoprostal if intrauterine foetal death
Monitoring with CTG and bishop score
What are the features of uterine hyper stimulation
Individual contractions lasting more than 2 mins in duration
More than 5 uterine contractions every 10 mins
Can cause uterine rupture, fetal distress
Management
Remove vaginal prostaglandins and stop oxytocin infusion
Tocolysis with terbutaline
What are some indications for continuous CTG monitoring
Sepsis
Maternal tachycardia
Meconiium
Pre-eclampsia (BP >160/110)
Fresh antepartum haemorrhage
Delay in labour
Oxytocin use
Extreme maternal pain
What is the function of ergometrine
Given to stimulate smooth muscle contraction for delivery of placenta and reduce post part bleeding- can be used in third stage and to prevent/ treat postpartum haemorrhage
Can cause HTN, vomiting , diarrhoea and angina- avoid in eclampsia
synometrine- oxytocin and ergometrine for prevention or treatment of PPH
What is the function of terbutaline
Suppress uterine contractions
Used in tocolysis during uterine hyper stimulation in induction of labour
What is the function of carboprost
Prostaglandin analogue given as deep IM injection during PPH when ergometrine and oxytocin are inadequate
Avoid in patients with asthma
What is the function of tranexamic acid
Antifibrinolytic to reduce bleeding
Prevention and treatment of PPH
What is the management of umbilical cord prolapse
Umbilical cord descends below fetal presenting part into vagina- risk of cord compression and fetal hypoxia
Risk when foetus is lying abnormally
Management with emergency C-section
How is shoulder dystocia managed
Presents with turtle neck sign- head goes back into vagina - difficulty delivering the face and head - failed restitution- head faces downwards and doesn’t turn sideways
Management
Episiotomy
McRoberts manoeuvre- posterior pelvic tilt - hyeprflexion of mother at hip
Pressure to anterior shoulder - press on suprapubic region
Rubin’s manoeuvre - reach into vagina
Wood’s screws manoeuvre- performed during a rubins
Zavanelli manoeuvre- push head back in and go to section
What risks are associated with the various types of instrumental deliveries
Ventouse- suction cup- cephalohaematoma
Forceps- Facial nerve palsy and facial paralysis, bruising and fat necrosis
Femoral or obturator nerve damage to mother
What are the different degrees of perineal tears
1st degree- limited to frenulum of labia minor and superficial skin
2nd degree- including perineal muscles but not anal sphincter
3rd degree- anal sphincter but not rectal mucosa
4th degree- rectal mucosa
3rd and 4th need repair in theatre
How is a post partum haemorrhage classified
Atleast 500ml blood loss after vaginal delivery
1L blood loss after C-SECTION
Minor PPH- under 1L
Major PPH- over 1L (moderate 1-2 and severe <2)
Primary PPH- within 24 hrs of birth
Secondary PPH- 24 hrs to 12 weeks
What are the causes of PPH
4T’s
Tone
Trauma
Tissue
Thrombin
How is a PPH managed
ABCDE- two large cannulas, Bloods, group and cross match 4 units, warmed IV fluids, oxygen, FFP when clotting abnormalities)
Activate major haemorrhage protocol- 4 units of crossmatched blood or O negative
What medical and mechanical and surgical treatment is used in a PPH
Rubbing uterus to stimulate uterine contraction
Catheterisation
Oxytocin- 40 units in 500mls , ergometrine, carboprost, miso-rostov, trxnexamic acid
Intrauterine balloon tamponade
Blynch suture
Uterine artery ligation
Hysterectomy
What is the treatment of secondary PPH
USS for retained products
Endocervical and high vaginal swabs for infection
Surgical evaluation for retained products
Antibiotics for infection
What are the two key causes of sepsis in pregnancy
Chorioamnionitis - infection of chorioamniotic membranes and amniotic fluid
Abdo pain, uterine tenderness, vaginal discharge
UTIs
How is maternal sepsis managed
Monitoring on MEOWS chart
Blood cultures, lactate
Urine dip and culture, high vaginal swab
Continuous maternal and fetal monitoring
Emergency C section under GA
Broad spectrum antibiotics- tazocin + gent or amoxicillin, clindamycin and gent
What are the risk factors, features and management of amniotic fluid embolism
Amniotic fluid passes into mothers blood- similar to anaphylaxis
Risk factors
Increasing maternal age, induction of labour, C-section, multiple pregnancy
Presents around the time of labour
Symptoms like anaphylaxis
Supportive treatment
ABCDE
What are the features and management of uterine rupture
Main risk factor is previous C-section
Vaginal birth post C-section
Previous uterine surgery
Increased BMI
High parity
Increased age
Induction of labour
Oxytocin use
Presents with acutely unwell mum and abnormal CTG
Abdo pain, bleeding, no uterine contractions,hypotension, tachycardia
Management - emergency c-section and hysterectomy
What are the features of uterine inversion
fundus of uterus drops through uterine cavity and cervix - uterus turns inside out
postpartum haemorrhage and collapse
Johnson manoeuvre - push the fundus back
Hydrostatic methods- inflate the uterus
Surgery
What are the rules around contraception after childbirth
Lactational amenorrhoea is effective for up to 6 months if fully breastfeeding
POP and implant are safe and can be started any time after birth
COP needs 6 weeks postpartum before starting
What is the presentation and management of post partum endometritis
Foul smelling discharge, bleeding getting heavier, sepsis, fever, abdo/ pelvic pain
Vaginal swabs, urine culture
USS to rule out products of conception
Broad spectrum abx
How are postpartum retained products of conception managed
Evacuation of products in surgery under GA
Cervix widened with dilators and vacuum aspiration and curettage
Complications- endometritis and ashermans syndrome (adhesions within uterus)
What are the time scales for postnatal mental health issues
Baby blues- first week or so
Post natal depression- 3 months after
Puerperal psychosis- a few weeks after birth
Edinbrugh postnatal depression scale- score>10 indicates post natal depression
What are the features and management of mastitis
Breast pain and tenderness
Erythema of breast tissue
Nipple discharge
Fever
Complication of breast feeding - staph aureus infection
Flucloxacillin first line or erythromycin
Milk sample for culture and sensitivies
Continue breast feeding
What are the features and treatment of candida of the nipple
Often after a course of abx
Cracked skin
Sire nipples bilaterally, nipple tender and itchy, cracked and flaky, white patches in baby mouth
Topical miconazole 2% after each feed and
Nysatin for baby
What are the features of post party thyroiditis and how is it managed
3 stages
1.Thyrotoxicosis (first 3 months)
2. Hypothyroid (3-6 months)
3. Back to normal within 1 yr
Signs and symptoms of hypo or hyper
Management
Symptomatic control of thyrotoxicosis and hypothyroid
