Obstetrics Flashcards
Explain gravidity?
any current pregnancy
every preceding pregnancy (regardless if twin etc, and includes miscarriages, terminations)
explain parity?
number of pregnancies that have reached 24 weeks
twins = one parous event
suffixed by numberof miscarriages and terminations
how estimate date of delivery?
add one year + 7 days to last menstrual period
which hormone can cause reflux in pregnancy?
Progesterone (uterine relaxing and other smooth muscle relaxing e.g. oesophageal sphincter)
management of eclampsia?
seizures in pre-eclamptic patient
BP - IV hydralazine + fluid restriction
seizure - IV magnesium sulphate
what is miscarriage? and management options?
Loss of pregnancy in under 24 weeks
Expectant management up to 14 days
Medical = misoprostol
Surgical = evacuation of uterus
management options for ectopic?
1st line = Expectant - twice weekly HCG and weekly US (no pain, HCG dropping, empty uterus)
Medical = Methotrexate (HCG <3000)
Surgical = salpingectomy is removal, salpingotomy is preserved.
Molar pregnancy types?
HCG - irreg bleeding, hyperemesis, hyperthyroidism
Complete - Diploid, 46XX (paternal), US ‘snowstorm’
Partial - Triploid, 2 sperm + one egg, foetal parts
No pregnancy for at least 6 months post normal HCG
Fibroids presentation
50% asymptomatic, HMB, dysmenorrhea, pressure effects, infertility
if postmenopausal rule out cancer first!
1/1000 malignant change to leiomyosarcoma
1st line management of heavy menstrual bleeding?
Mirena coil - if no identified pathology and fibroids <3cm
Tranexamic acid and/or NSAIDs - if fibroids 3cm or more and awaiting further management!
what should be given for 3 months pre-op for fibroids?
GnRH analogues
Management of ovarian cysts?
Simple pre-menopausal = >7cm or symptomatic = removal
Complex pre-menopausal = do CA125 (raised refer to oncology)
Post-menopausal cyst = always abnormal
- CA 125 + US
Cervical screening age group?
25-64 year olds (99% of cervical cancers due to HPV)
Negative HPV - recall 5 years
Positive HPV - Cytology
- cytology negative - repeat HPV 12 months
- cytology positive - colposcopy
Menopause and management?
45 - 55 years
oligomenhorrea as oestrogen levels lower
hot flushes, night sweats, joint/muscle pain, vaginal dryness, mood change
loss of muscle strength, higher risk of osteoperosis, and heart disease.
HRT:
- combined if uterus present
- oestrogen only if no uterus
staging of prolapse?
each stage is in relation to leading edge of prolapse in relation to hymen:
stage 0 = nil
stage 1 = -1cm or above
stage 2 = -1cm and +1cm
stage 3 = +1cm or below but without complete eversion
stage 4 = complete eversion (procedentia)
