Obstetrics Flashcards
what age to refer for infertility
1y if under 36
earlier referral if gynae issues or women older
androgen insensitivity syndrome genetics
AR 46XY
born female - no varies or uterus
primary amenorrhea with boobs or not with boobs
with boobs 15
no boobs 13
meohrrhage treatment
mirena
TXA/NSAIDs/COPC/POP
refer
size if fibroids
over 3cm then refer
primary dysmorhhoea treatment
NSAID
COCP
secondary dysmenorrhea causes
endometriosis
fibroids
IUD
PID
endometriosis treatment
NSAIDS, paracetamol
COCP/POP
refer if trying to conceive
PCOS diagnosis
hypergonadism
infrequent/no periods
polycystic ovaries >12 follicles 2-9mm, or ovarian volumes >10cm
ovarian cancer risk factors
brca1/2 early menarche late menopause no pregnancy
smears
25-49 3 yearly
50-64 5 yearly
24-64 5 yearly in scotland
HPV cervical cancer
16 and 18
endometrial hyperplasia
persistent oestrogen - obese, tamoxifen, PCOS, DM, nill parity
what age do you refer for PMB
over 55
RF for ectropion
preg, COCP
PID treatment
oflaxacin and metro or
IM left and doxy and metro
anti d to be given when
28 and 34 weeks
downs 11-13+6
nuchal thickness and high HCG and low PAPPA
4-20 w bloods
HCG
AFP
inhibin A
unconjug bilirubin
high HCG
low AFP
high inhibin A
low unconjuc bilirubin
prem correction
1year for 32-36w
2y for <32w
prem age
24-26 w
post dates
<42w
OGTT done when
fasting
2h
24-28w
5.6
7.8
treatment for GDM
metformin, insulin
if fasting >7 insulin
cholescystasis treatment
USDCA
induce at 37w
anaemia first trim
2/3rd trim
<11
<10.5
HTN normal BP in first trip and then from 20w
falls then rises at 20-24w
diagnosis for HTN in preg
140/90 or SBP 30 and DBP 15 from booking
preg induced HTN diagnosed when
20 weeks
risk factors 2 for PET
first preg
40yo
10y between pregnancies
BMI >35
FH
MP
risk factors 1 for PET
HTN in preg preg
CKD
AI dx
DM
HTN
treatment for PET risks
aspirin from 12w gestation
HELLP
haemolysis
elevated liver enzymes
low PLT
HIV vag delivery when
babies score
<50 at 36w
>50 then 3x ART and if <50 zidovudine
USS snowstorm
molar pregnancy
APH when
> 24w
placenta preview is what
implanted in lower uterine segment
painless bleeding
placenta accrete is what
invades myometrium
c section before is risk
vasa praevia
bleeding from fatal vessels
causes of PPH
tone
trauma
tissue
trombin
treatment for PPH
uterine massage
IV syntocin
ergometrine - not in HTN/DM
baby blues when
rx
d3-d10
self lim
post natal rep when
treatment
2-6w PN
counselling
sertraline, paroxetine, amitryp/noratryp
puerperal psychosis
2-3w PN
sore cracked nipples treatment
positioning
express milk
engorgement
express before feeds
warm bath
mastitis
simple analgesia
fluclox
raynauds
intermittent pain
heat packs, no caffeine, no smoking
thrush BF
miconazole cream
<4m nystatin
>4m miconazole gel
POF age
FSH done when
<40
4-6w apart >40
when to stop contraception
55
cyclical HRT when
<12m since last period or under 54
continuous HRT when
> 12m since last period of >54
S/E of HRT
VTE
breast cancer
stroke
CHD
endom cancer
when to refer for bleeding on HRT
post 6m bleeding on HRT
follow up for HRTn
3 monthly then annually
GU syndrome for menopause
low dose vaginal oestrogen
moisturisers and lubricant
non HRT treatment
fluoxetine
citalopram
venlafaxine
clonidine
emergency contraception - levonorgestrel
when can you take
dose and for BMI >26 / 70kg
within 72 hours
1.5mg
3mg
can be used more than once in a cycle
ella one when can you take
dose
BF
120 hours
30mg
delay by 1 weeks
protection 5 days
IUD when can you insert
5 days
or 5 days after ovulation
TOP when
23+6 in UK
when to give anti D in TOP
post 10w
DEPO how does it work
how long does it take to work
how often
inhibits ovulation
7 days
13 weeks
when to use depo
day 5 of cycle
side effects of depo
weight gain
osteoporosis
irregular bleeding
delay in fertility returning by 12 m
CI to depo
breast cancer
IUS when to put in
how long to abstain
when PP
7 days of period
7 days abstain
48 hours or over 4 weeks
how long can you have IUS for endometrial protection for HRT
4 years
IU=D when is it effective
immediately effective
implant hormone ?
how does it work
when to put it in
abstain
progesterone
prevent ovulation
5 day
7 days
side effects of implant
irregular bleeding
headache
nausea
breast pain
CI to implant
IHD/ stroke
vag bleeding
liver disease
breast cancer
COCP when to start
abstain
d5
7 days
COCP risks
VTE
stroke
HI
breast cancer
cervical cancer
1 missed pill
2 missed pills and abstain
d1-d7
15-21
take
take last and 7 days
EC
miss pill free weeks
CI to COCP
> 35 and smoker
BMI > 35
migraine
epileptic
POP side effect
irregular periods
when to start POP
how long to abstain
d1-d5
2 days
history of GDM and second pregnancy when to do OGTT
ASAP and at 24-28w
what form of contraception can people with gastric sleeve/bypass NOT have
oral contraceptives
how many days after giving birth is contraception not needed
21 days
rate of failure of female sterilisation
1 in 200