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Obstetrics Flashcards

1
Q

HR of pre-eclampsia
-1 of/2 of?
___________

Refer when?

Haemolysis (H) - polychromasia and schistocytes
Elevated liver enzymes (EL),
Low Platelets (LP).

Preggers/PP<4w:
A/W - Clonus/HYPERreflexia >160/110
-HA
-Eye dx
-N+V
-pain BELOW RIBS
-Sudden SWELLING
Dx? Tx?
\_\_\_\_\_\_\_\_\_\_
  1. Mx @Pre Eclampsia HR
  2. @booking 8-12w + HR Pre-Ecl, do what?
  3. Refer when?
    __________

What at each ANC?

If dipstix prot 1/+ - - >??

A 
1 of:
CKD
HTN pre-existing
AImmune
DM

2 of: FFM 10 35 40
FHx/First/multiple
10yr interval / BMI 35/+ 40/+yrs
______________

Refer @

  • 160/110 / ProtUria [2+]
  • A:CR >8 / P:CR >30 = significant –> Refer obst

HELP syndrome - IV MgSO4

Preggers/PP<4w = HENPS
-Dx: Pre-Eclampsia -> Tx: 999
___________

@ Pre-Eclampsia HR:
1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40)

  1. @booking 8-12w
    - Asp 75mg W12 –> birth @ HR Pre-Ecl
  2. Refer @:
    - 160/110 / ProtUria [2+]
    -A:CR >8 / P:CR >30 = significant –> Refer obst
    __________

Dipstix/BP @ each ANC

If dipstix prot 1/+ –> Renal Assx:

A:CR >8 /
P:CR >30 =
Significant –> Refer obst

Refer @ 160/110/ ProtUria [2/+]

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2
Q

gHTN VS
Pre-Eclampsia VS
Eclampsia?

MgSO4 induced respiratory depression?

____________________

Ix?

Tx?

A

gHTN >20 weeks w/ >140/90

Pre-Eclampsia :
>20 weeks w/ >140/90 
and 
1/+: ProtUria OR Organ dx 
(Neuro/LF/RF/UtPlacent dx/TCP)

Eclampsia: as above + seizures –> Magnesium sulphate

CaGluconate @ MgSO4 induced respiratory depression?
____________________

Ix: Dipstix/BP @ each ANC

@ Pre-Eclampsia HR:
1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40)

  1. @booking 8-12w
    - Asp 75mg W12 –> birth @ HR Pre-Ecl
  2. Refer @:
    - 160/110 / ProtUria [2+]
    - A:CR >8 / P:CR >30 = significant –> Refer obst
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3
Q

Women < 30 years, YOUNG

‘breast mice’ = discrete, non-tender, HIGHLY MOBILE lumps

What to do if <3cm? >3cm?
___________

Most common in MIDDLE-aged women
‘Lumpy’ breasts which may be PAINful.
-syx ?worsen prior to menstruation
_____________

hard, irregular lump.

There may be associated nipple inversion or skin tethering

Most common Brest cancer?
_____________

Reddening and thickening (may resemble eczematous changes) of the nipple/areola

nipple START -> spreads OUTWARD involving the areola
_______________

Breast anatomy

NLM TLS
_____________

70+M a/w
gradual loss of voice / 6 m

DDx?

Ax?

A

Fibroadenoma
-W+W < 3cm
-Surgical excision @ >3cm
_____________

Fibroadenosis
-FibroadenoSISSSSSS - SISters !!!
(fibrocystic disease, benign mammary dysplasia)
_______________

Breast cancer

Ductal No Special Type>
Lobular >
DCIS > LobCIS
___________

Paget’s disease of the breast - intraductal carcinoma
_________

FROM USMLE BOOK 2019 p635
-NLM TLS

Nipple,
LACTIFerous duct_Major duct = Paget, Abscess, Mastitis, IntraDuct-Papilloma=bloody

TERMinal duct_LOBular unit = Cancers - DCIS etc

Stroma = Fibroadenoma/Phyllodes tumour
_______________

Aphonia = inability to speak.

  • Ax:
    1. Recurrent Laryngeal Nerve palsy (TT/Tumour)
    2. PSYCHOgenic
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4
Q

Tender lump around the AREOLA+/-
-GREEN CREAMY nipple discharge

MENOPAUSE age #51yrs
?breast duct Dilatation

If ruptures –> local inflammation,
aka PLASMA CELL MASTITIS
____________

BLOOD stained discharge

HyperPLASTIC lesions #Epithelial prolife @ large mammary ducts
___________

Obese women, LARGE breasts
-TRAUMA

Initial inflammatory response, firm and round –> develop into a hard, IRREGULAR breast lump
___________

More common in LACTATING women
-Red, hot tender swelling
__________

HALO sign @ mammograms
MENSTRUAL cycle VARIATION
- Uncomfortable fluctuant breast mass

___________

Young SMOKER
-Mammillary duct FISTULA
-abscess Inflammation
__________

@BREASTFEEDING: bact enter skin-cracks -> RISK bacterial infection
Dx? Tx?
? is most common pathogen.

A

Mammary duct ectasia
-Dilatation of the LARGE breast ducts
__________

Duct papilloma

NOT malignant or premalignant
_________

Fat necrosis

Rare and may mimic breast cancer so further investigation is always WARRANTED!!!!!!
__________

Breast abscess
-LACTATING women
-Fluclox + I+D
________

Breast cyst
-HALO sign @ mammograms

Needs excision - risk of breast cancer!!!
-AS OPPOSED TO I+D cos the fkn shell stays in there which you need remove
__________

PERIDUCTAL mastitis
-ABx, I+Drain
___________

Lactational mastitis

  • FLUCLOX and continue breastfeeding
  • S Aureus is most common pathogen.
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5
Q

Pre-existing HTN - stop which antihypertensives?

Anti-HTN TX is not necessary if BP..??

chronic HTN >? / ? + NOT taking aHTN tx =
Start on which meds? Target?

METHYLDOPA during preg
stopped within ? days of birth
cos of ?

physiological dropORrise in BP
@EARLY pregnancy??

Ix + Tx after w12?
\_\_\_\_\_\_\_\_\_\_\_\_\_
Physiologic changes @preggers
-rises?
-drops?
A

ACE/ARB/Thiazide

Stop anti-HTN tx if BP < 110/70/Syx low BP

chronic HTN >140/90 + NOT taking aHTN tx = LNM<135/85
labetalol > nifedipine > methyldopa –> Target < 135/85

METHYLDOPA during preg
stopped within 2 days of birth
cos of DEPRESSION

physiological DROP in BP
@EARLY pregnancy??

Ix: Dipstix/BP @ each ANC

@ Pre-Eclampsia HR:

  1. Consultant-led @ PrEcl HR (1CHAD/2FFM10/35/40)
    - PRE-EXISTING PART OF CHAD mnemonic
  2. @booking 8-12w
    - Asp 75mg W12 –> birth @ HR Pre-Ecl
  3. Refer @:
    - 160/110 / ProtUria [2+]
    -A:CR >8 / P:CR >30 = significant –> Refer obst
    _____________

Physiologic changes @preggers

  • rises: everything else
  • drops: Hb + BP
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6
Q
  1. If >20w w/ NEW ProtUria + no HTN - Ddx?
  2. @PP:
    had pre-Ecl + NOT had anti-HTN tx =
    BP measured ??d after birth
  3. @PP:
    had pre-Ecl + HAD anti-HTN tx =
    BP check/?-?d after birth for ?weeks
  4. @PP BP > ? / ? start anti-HTN tx

postnatal period:

  • not breastfeeding = ?? tx
  • breastfeeding =
    1. ? // ?/? @black
    2. ? + ?
    3. +/- ?/?
gHTN/chrHTN = BP check:
check 
-day ?
-day ?
-days ?

R/V BP meds @ ? wks postnatally
Postnatal review ? weeks

Target BP: ? / ?

A
  1. probable UTI –> MSU –>
    f/u 1wk + cephalex/amoxi/pivmecillinam
  2. @PP:
    had pre-Ecl + NOT had anti-HTN tx =
    BP check 3–5d after birth
  3. @PP:
    had pre-Ecl + HAD anti-HTN tx =
    BP check/1-2d after birth for 2 weeks
  4. @PP BP > 150/100 start anti-HTN tx

postnatal period:

  • not breastfeeding = normal HTN tx
  • breastfeeding = E/NAm ENAtLab
    1. enalapril // nifedipine/amlodipine @black
    2. enalapril + nifedipine
    3. +/- atenolol/labetalol
gHTN/chrHTN = BP check:
check 
-day 1 
-day 2
-days 3–5 (x1)

R/V BP meds @ 2wks postnatally
Postnatal review 6-8 weeks

Target BP: 140/90

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7
Q

TNM breast staging

What chemo you give to node +?
What chemo you give to node -?

I.e. If you just remember T2, T4c, T4d
__________

Preg woman >20w till 4w PP
w/ BP >140/90 has: HENPS (end organ dx)

HA
Eye dx
N+V
pain BELOW RIBS
Sudden SWELLING

Advice?
_______________

Intrahepatic cholestasis of preg increased risk of ??

Tx?

A

T1 <2cm
T2 2-5cm
T3 >5cm

T4a skin
T4b CW
T4c skin + CW

T4d INFLAMM

FEC-D chemo = for node +ve, and that

FEC chemo = for node -ve that requires chemo
______________

Hospital.

Refer @ 160/110 / ProtUria [2/+]
______________

Intrahepatic cholestasis of preg increased risk of PREMATURITY

Induce @ 37w +
USDA +
Vit K

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8
Q

Preggers -Rubella IgG not detected - advice?

12 week PREG meet f2f >15 mins relative with shingles.
PMH: chickenpox

12 week PREG meet f2f >15 mins relative with shingles.
PMH: NOOOO chickenpox

pregnant woman develops chickenpox >20w

pregnant woman develops chickenpox <20w

A

Keep away from anyone w/ rubella
Advise risks
MMR PoooooST-NATALLY

Reassure her. No further action

check varicella ABs + VZIG

> 20 w = ORAL Aciclovir <24hr of rash

< 20 w = ?consider ORAL aciclovir

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9
Q

Folate and Vit D doses @ preg?

GBS tx?

A

Folic acid 400 micrograms OD
Vit D 10 micrograms once a day

INTRApartrum IV BenPenG

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10
Q 
1. Small: Brain, Eyes, Limbs
micro:
cephaly --> learning disabilities
ophthalmia),
limb --> hypoplasia
  1. Ear, Eye, Heart dx
    - Ear: Sensorineural DEAF,
    - Eye: Microphthalmia, SALT-pepp CHORIOret, Cataract

-CongenHD

HSM+Rash

A
  1. sBEL: Fetal Varicella - brain eyes limbs
    -small limbs
    LIKE A CHICKEN-(pox)
    ha ha get it…
  2. EEH: Congen Rubella - ear eye heart

sensorineural = cmv + rubella

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11
Q

Avoid which drugs @ breastfeed:

Post-term pregnancy definition? Mx?
- High Risk of?
____________

Preg:

ACEi ?

Cocaine ?

Valproate/Carbemaz = ?

Phenytoin = ?

Warfarin courmarins = ?

Di-Ethyl-Stil-BESTROL @mum = ?

Isotret = ?

Misoprostol = ?

Thalidomide - ?

A 
V - Aspirin/Amiodarone
I - chloramphen/Quinolone/Sulfonamide/Tetras/Fungals - selenium, flucon, itracon
N - MTX/Cytotoxics
D - LITHIUM/BENZOs
I - LITHIUM/BENZOs
C - LITHIUM/BENZOs
A - MTX/Carbimazole
TE - SUs

Post-term = beyond 42 w –>
INDUCE > WW
-High Risk of Meconium Asp

Preg:

ACEi = iuGR, iuRenal-Insuff, Oligohydramnios

Cocaine = small brain, limb dx, urine-tract dx

Valproate/Carbemaz = NTDs

Phenytoin = Hydantoin Syndrome = craniofacial dx

Warfarin courmarins = skeletal dx

Di-Ethyl-Stil-BESTROL @mum = vaginal adenocarcinoma in kid 14 yrs later

Isotret = CNS/Craniofacial/Cardiac dx

Misoprostol = Moebius Syndrome - cranial nerve dx

Thalidomide - limb dx

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12
Q

Oligohydramnios definition? Ax?

Shoulder dystocia tx?

A

Oligohydramnios
< 500ml @ T3
AFI < 5th centile

Renal agenesis / ACEi
IUGR
PROM/Pre-Ecl/Post-term>42w

Shoulder dystocia: MESZ
McRoberts’ - flexion and abduct
Episiotomy, Symphysiotomy,
Zavanelli / Rubin Wood’s Corkscrew

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13
Q

PPHemorrhage tx
_________________________

Premature labour tx?

After W?
symphysis-fundal
height in cm = ??

A 
-BOE-CAB
Bimanual uterine compression
Oxytocin - stim ut contract
Ergotamine(
-5HT/Alpha-adr/Dop=vasc SM constrict -> reduce Uterus BF = less bleed)

Carboprost
Atony = Balloon tamponade
B-lynch UA/Iliac ligation/TAH
________________________

Premature labour:
Admit
Tocolytics and Steds

After W20, S-F height i=
-g.WEEKS +/- 2cm

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14
Q

Fetal defects:

  1. Smoking/cannabis AD
  2. Cocaine
  3. Heroin
  4. Alcohol
A
  1. Smoking
    Alive: READING abiilty reduced /iuGR / Pre-term labour
    Dead: miscariage, stillbirth, SUDS
  2. Cocaine = small brain, limb dx, urine-tract dx
    -mum = PreEcl / Pl.Abruption
    -kid = Prem / Abstinence-syndrome
  3. Abstinence syndrome
  4. Small: head circ / brain
    -Neuro signs

PALPEBRAL fissures Short
VERMILLION border Thin
FILTRUM Smooth

< 10th growth centile

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15
Q

A nurse informs you
30F 38 weeks pregnant. BP 155/90
Prev BP 2 days ago was 152/85

24hr urinary prot excr of 0.7g / 24 hours

Tx?

Target DIASTOLIC BP?
___________________________

Temp > 38ºC <6w after delivery?
-Post-partum period = ?
___________________________

Breast-feeding
Sore nipple
White discharge - candida
Tx???

A

Labetalol

Deliver < 48hrs

Target DIASTOLIC bp = 80-100
_________________

Puerperal pyrexia - admit IVAbx
-Post-partum period = <6wks

__________________

Continue breast feeding + Tx BOTH:

  • Mum - Miconazole cream
  • Baby - Nystatin
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16
Q

A. Booking visit

B. 11 - 13 weeks

C. 28 wks –> 34wks

D. 36 wks

Positive serum AFP/Prev NTD -> USS -> Amniocentesis for AFP/AChi w12 16-20

@HIV, mum viral load < 50 @ w?
-what delivery recommended?
-what should be started 4 hrs b4 c-section?
After birth:
-mum CD4 < 50, what administered to neonate?
-mum CD4 > 50, what administered to neonate?
_____

Pros of BFeed

A 
Abortion/Miscarriage >12w
TransPlacentalHaemorrhageRisk(procedures)
-procedures/abdo trauma/iuDeath
Ectopic
Evac after miscarriage

A. 8-12 wks -

  • Booking
  • overlap w/ Down’s nuchal scan
B. 11-13 
-Down's + Nuchal scan 
-overlap w/ booking
\_\_\_\_\_\_\_\_\_\_
C. 
28 wks
- 1st dose of anti-D prophylaxis @RhNEG 
- 2nd Anemia/AlloAB test @28w
34 wks: 2nd dose of anti-D prophylaxis @RhNEG
\_\_\_\_\_\_\_\_\_\_
D. 36 wks:
-BFeed / Blues / Vit K 
-Presentation (ext ceph version?)
@viral load < 50 @ w36: VAG > C-section 
- IF c-section, then b4 c-section: IV zidovudine
After birth:
< 50: PO zidovudine @neonate
> 50: Triple ART @neonate
\_\_\_\_\_\_\_\_

Mother:

  • BabyBond
  • Reduce BreastCancer / PPH-risk

Kid: i-AIRD

  • Infections
  • Allergy/ IBD / RA / DM 1
17
Q

T1/2 bleed causes?
T3 bleed causes?

  • Bleeding @T1/earlyT2
  • exaggerated syx e.g. HyperEmesis.
  • LARGE 4 dates uterus
  • hCG = high AF!!! = HYPERthyroid
  • ? @USS

Tx????????

Complete V Partial mole?

? % = develop choriocarcinoma
___________

Delayed 3rd stage labour
Pt w/ prev
-PMH: PID
-PSH: c.section / p.praevia

?-types - what invades what?

Tx: ?
_______________

@preggers
•shock OUT OF KEEPING w/ visible loss

•tender, tense, hard woody uterus #CONSTANT-pain

  • lie /presentation - NORM
  • fetal heart: absent/distressed
  • coag dx=DIC / pre-eclampsia
  1. NO fetal distress + <36w
  2. NO fetal distress + >36w
  3. Fetal distress - tx?
    ___________

@preggers
•shock IN PROPORTION to visible loss
•painLESS

  • lie /presentation - ABnormal
  • fetal heart: FINE
  • coag dx=none..

Ix? - what to avoid?!

  1. If low-lying placenta @16-20 week scan
    - rescan at ?weeks
  2. If still present @ ?-weeks and
    grade 1/2 then ?
  3. If high presenting at ?weeks then ?
  4. If high abnormal lie at ?weeks then ?
    _____________

Rupture of membranes –>

  • immediately get vaginal bleeding
  • Fetal BRADYcardia #classically seen
A

T1/2 = Ectopic / Miscarriage-Molar preg
T3 = Praevia / Abruption
_________________

Complete HyDatiDiForm Mole (MOLAR)
Tx = EVAC -> CONTRACEP 12m

-EMPTY egg + 1 sperm –> DNA duplicates –>
COMPLETE=46 chromosomes =
ALL 23x2 male genes
-Honeycomb/Grapes/SNOWstorm @USS

PARTIAL=69 XXX/XXXY

  • haploid egg (23) + 2 sperm (23x2)
  • partial fetal parts

Around 2-3% = develop choriocarcinoma
___________

Accreta

  • delayed labour #3rdstage
  • prev c-sec/praevia/PID

3-types = chorionic villi:-

  • invade PPerimetrium #PPercreta
  • IInvade myometrium #IIncreta
  • AAttach* 2 myometrium #AAccreta

*-instead of decidua basalis #accreta

Tx: hysterectomy w/ placenta left in-situ
___________

P.Abruption - PainFUL PV bleed
-OUT OF KEEPING w/ visible loss
- feta heart fucked + DIC/Pre-Ecl
____________

  1. NO fetal distress + <36w
    - observe+steroids
    - ?adjust delivery threshold
  2. NO fetal distress + >36w
    - vag delivery
  3. Fetal distress - tx?
    -immediate c-section
    _____________

P.Praevia - PainLESS PV bleed

  • IN PROPORTION to visible loss
  • Lie = abnormal

Ix? - what to avoid?!
-TV-USS - avoid PV exam till praevia excluded!!
LLP @W-16-20 = Rescan @w34
-34 + G1/2 = TVUSS/2w
-37 = high-presenting-part/abnormal life = C-SECTION

  1. If low-lying placenta at 16-20 week scan
    - rescan at 34 weeks
  2. If still present at 34 weeks and grade 1/2 then
    - scan every 2 weeks
  3. If high presenting part at 37 weeks then
    - C-section
  4. If abnormal lie at 37 weeks then
    -C-section
    _______________

Vasa praevia
-ROM - >PVbleed + BradyBaby

18
Q

T3 preggers

Pruritic ABDO Striae –> spread
____________________

Pruritic
Umb –> Spread-2-trunk
BLISTERINGGGG

A 
Polymorphic - emollients, top/PO steroids
-Pruritic
-3rd trimester
-ABDO Striae --> spread
-ACE
\_\_\_\_\_\_\_\_\_\_\_

PemphigOOOOOid gestation - PO steds

O looks like fkn belly-button!!!
-and blisters too!!!

19
Q

When take folic acid 5mg instead of 400 mic?

Baby blues - anxious tearful < 1wk

Puerperal Psychosis - mood swings/auditory hallucinations < 2-3 wks

PNDepression tx? < 4-12 wks

Screenin tool measure?

A

NTD pmh/fhx/prevpreg
BMI 30/+, Coeliac, DM, Epilepsy, Thalassaemia

RACE
Reassure - Blues < 1 wk

ADMIT - Psychosis < 2-3 wks

CBT + Sertraline/Parox V Fluox - PND < 4-12 wks

  • Sertraline + Fluoxetine @preg
  • Sertraline @BFeed

Edinburgh Scale is a screening tool for postnatal depression

20
Q 
3. 
Brain CALCification/ SMALL
SENSORI-neural deafness
-ChorioRetinitis (white + RED)
-TCP -iuGR
  • Seizures -HSM
  • Blueberry muffin rash

________________

  1. Brain CALCification,
    -HYDROcephalus
    -Chorioretinitis (white, overlying VIT inflamm)

-Seizures -HSM
-Blueberry muffin rash
?erythema multiforme

Tx?
__________

  1. Ear, Eye, Heart dx

a-EARRR: Sensorineural DEAF,

b-EYEEE: Smaaaall-Eyes
CATARACT/ ACAG
——‘SALT-pepp’ CHORIOret

c-HEARTTT: CongenHeartDx - ?WHICH one?

  • NOOOO Seizures -HSM
  • Blueberry muffin rash
A
  1. CMV

SEEEE-MV
Sensorineural
SMALL brain / plts

sensorineural = cmv + rubella

  • ganciclovir
    ________________
  1. Toxo
    -spiramycin
    -pyrimethamine + sulfadiazine
    _______
  2. Rubella
    - ears, eyes, heart - PDA
21
Q

If baby breech, by when till it turn spontaneously?

What to do if still not turn?

What to do if STILL not turn?

A

< 36 w turn spontaneously

AFTER 36 w = ECV

C-section/Vaginal delivery

Summary: W36 spont -> ECV -> C-sec/Vag

22
Q

Questions about POP - If: miss

  • Cerazette > ? hrs late
  • The rest > ? hrs late

WTF to do?
_____________________

POP cons?

Depot cons?

HRT cons?

Tamoxifen cons?
___________________

Young people - LARC iDIP
Long Acting Reversible Contracep
_________

For breast cancer past/current, what UKMEC + contraceptive legit?

For young, what Long-Acting Reversible Contraceptive is legit? - iDIP

Contraceptives UNaffected by Enzyme-Inducing Drugs?

Despite prog preps leading to obesity,
which prog prep
legit for obesity?
__________

Contraceptive mechanisms
Inhibit ovulation > Thicken cervical mucus < Endomet proliferation

Inhibit ovulation > Thicken cervical mucus
- ?

Endomet proflif > Thicken cervical mucus
- ?

Inhibit ovulation:
- ?
__________________

Copper-IuD mechanism?

Condom latex allergy?

Young people - LARC i-DIP
Long Acting Reversible Contracep
________

Post-pill amenorrhoea stop when?

Contraceptions UNaffected by enzyme inducing drugs?

Contraceptions that work #Time2Action:

  • Now
  • 2d
  • 7d

Contraception for obese ppl?

Sterilisation failure rate:
Female (on top hehe giggity..)
Male
_________

3 Emegency contracep | UPSI | CI? - LIE

@Post-partum - when is emergency contracpetive NOT needed IF have UPSI?

A

Cerazette > 12 hrs late
The rest > 3 hrs late

POP miss = 2UP TC
-2d condom + 
-UPSI < 2-3 days = Emerg contracept 
-Preg Test
-take last pill (even if taking 2 pills)
-cont pills OD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

POP cons: i-WOAH

  1. Irreg periods,
  2. Weight gain, Obesity, Acne, Headache

Depot cons: DOB

  • delayed return 2 fertility
  • obesity
  • BMD low

HRT cons BEV-i
-Breast/Endomet/VTE/incFIBROIDsize

Tamoxifen cons? LEV
LF/Hypertriglyc, Endomet dx, VTE

______________________

yLARC - Implant > Depot / IuS / POP = Low BMD!!
_____________

BC past = 3, current = 4
-Barrier/Copper only

yLARC - Implant > Depot / IuS / POP = Low BMD

Contracept UNaffected by Enzyme-Ind Drugs?
E I D:
IuS - Depot
IuD - Depot

Obesity - POP
_________

Contraceptive mechanisms:

Inhibit ovulation > Thicken cervical mucus < Endomet proliferation

Inhibit ovulation > Thicken cervical mucus
- Depot/Implant/POP

Endomet proflif > Thicken cervical mucus
- IuS

Inhibit ovulation:
- Levonorgestrel / Ella1Ullipristal (CI: BF 1wk wait, Asthma) / COCP
_______________________

Cu-IuD -
Sperm motility / Implantation / TOXIC

Latex allergy - PolyUreThane

yLARC - Implant > Depot / IuS / POP = Low BMD!!
Depot - weight gain / delayed return 2 fertility
____________

Post-pill amenorrhoea - periods return about 6m

Depot
IuS/D

Contraceptions that work:
Now - IuD
2d - POP
7d - COCP / Depot / IuS Implant

Contraception for obese ppl?
-POP

Sterilisation failure rate:
Female - 1/200
Male - 1/2000
_________

  1. Levenorgestrel - < 3d UPSI
  2. IuD - < 5d UPSI / AFTER ovulation
    - IuD > EllaOneUllipristal!!!!!
  3. EllaOneUllipristal - < 5d UPSI

EllaOneUllipristal
BFeed 1 week WAIT
CI = Asthma

< 21d PP - - > UPSI - - >
Not need emerg contra if

23
Q

When contraceptive patch applied and not?

@W1 or 2 end what to do if contraceptive patch change DELAY > 48hrs

If had UPSI during >48hr delay/last 5 days then..??
_________________

@W3-end, patch removal DELAY?

@W4 patch-FREE week END, delay new patch application?

If combined patch started after day 5??

A

W1-3 patch ; W4 = patch free

W1-2: 7UP TC
-7d Barrier
-UPSI @ >48 delay/last 5 days = EMERG CONTRACEP
-Preg test
-Take off patch
-Change ASAP
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

@W3-end, patch removal DELAY?

  • Remove ASAP
  • Cont as normal - new patch @next cycle start

@W4 patch-FREE week END, delay new patch application?
7 DAYS condom
_____________________

Condom 7 days

24
Q

LMP | @MP = contracep till…
< 50
> 50
_____________________

Still bleeding: COCP/Combo | Depot | …
< 50
> 50

IuS - POP - Implant
< 50
> 50

A

LMP | @MP = contracep till…
< 50 - 2 years AFTER LMP
> 50 - 1 years AFTER LMP
_____________________

Still bleeding: COCP/Combo | Depot | …
< 50 - cont till 50
> 50 - NH / IuS - POP / Implant

FSH - check if ?stop <55
FSH > 30 = 1 yr IuS - POP - Implant
FSH - recheck 12 m @ Preeee-MP

IuS/pop/Implant
< 50 - cont till 55
> 50 - cont till 55 / check Bleed Pattern dx –>

25
Q

COCP:
If 1 COCP missed?

If 2 or more COCPs missed generally
____________________

If COCP started after day 5??
____________________

Pill-free week end –> take COCP –> miss 9/+ days:
if UPSI during/after pill-free week

____________________

COCP taking options?
___________

InterMenstrual Bleed Ax?

A

If 1 COCP missed:

  • take last pill (even if taking 2 pills)
  • cont COCPs OD
If 2 or more COCPs missed generally:
-7d condom + 
-take last pill (even if taking 2 pills)
-cont COCPs OD
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

If COCP started after day 5 -
-7d condom
____________________

Pill-free week end –> take COCP –> miss 9/+ days: 7UP TC
-7d condom
-UPSI during/after pill-free week - EMERG contra
-Preg test
-take last pill (even if taking 2 pills)
-cont COCP OD
_________________

Tricycling 3 weeks 1 week off
No pill-free week
________

Depot/POP
iuD
COCP UNDERdosing = breakthrough bleed
Ectropion/Polyps/Cancer

26
Q

If 2 or more COCPs missed generally:

2 COCPs missed in week 1:

2 COCPs missed in week 2:

2 COCPs missed in week 3:
____________________

7 consecutive COCPs missed in any week of pill-taking

A

If 2 or more COCPs missed generally:

  • 7d condom +
  • take last pill (even if taking 2 pills)
  • cont COCPs OD

@week 1:

  • UPSI during/after pill-free-week –> EMERG contracep
  • Preg test

@week 2: chill

@week 3: omit pill-free week
____________________

7 Concsecutive COCPs missed: RCP
-Restart COCP as new user
-7d condom + 
-preg test
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
27
Q

COCP
UKMEC 3 –> 4

Other UKMEC 4s
_________________

BF/PP UKMEC 4/3s?

COCP legit
@PP d21 + NOT BFeed
___________

POP UKMEC 3 + 4

A

Age > 35 + Smoke stop< 1yr/<15perday –> >15/day
BMI > 35
BRCA/Prev BC –> Current BC
Clots VTE FDR (< 45/immobile) –> VTE Current/Past/Dx
Controlled HTN/>140/90 –> Uncontrolled >160/100 / VASC dx
Current GB dx –> major surg IMMOBILE = switch to POP

UKMEC 4
BFeed < 6w pp = cos it reduces milk
Migraine w/ aura = stroke
IHD / LF / Stroke -vasc dc/APLS
Cx / AF / L-RVFail
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
BFeed < 6w PP = 4
PP < 21d + VTE RFs = Y(4) N(3)
PP >21d + VTE RFs = 3
PP 2d - 4w = 3 @ IuS/D
\_\_\_\_\_\_\_\_\_\_\_

POP UKMEC 3 + 4

  • Stroke/IHD/BC past/LF = 3
  • BC current = 4
28
Q

Miscarriage Tx - WMVE

When do Med/Surg Mx?

(remember miscarriage = WMVE, abortion = MMSE 9 13 15)
___________
___________

Abortion tx < 24w
9 13 15 
MM SE
DS 
DE

(Remember miscarriage WMVE, Abortion MMSE)

A

MISCARRIAGE: WMVE

WW < 2w

MED:
Vag MMMisoProstaGlandin - > Ut Contract

SURG:
OP: VVVacuum Asp Suction Curettage
IP: Theatre EEEEEvacuation
__________

Med/Surg Mx @:
-Haemorrhage (late T1/blood dx) 
-Infection
-Prev preg dx
\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_

ABORTION: MMSE

< 9 w: MM

  • 0hrs: MifeProg-ReceptorBlocker
  • 48 hours: MisoProstaGlandin= stim ut contract

< 13 w: DS
Surg dilation + Suction

> 15-24 weeks: DE
Surg dilation and Evac
medical abortion = ‘mini-labour’

> 24 - ILLEGAL MURDERRRRRRRRR

29
Q

Hyperemesis tx

H.Gravidarum triad

Scoring system in H.Gravidarum?

A 
Reassure < 20w = NORMAL / Rest
Avoid triggers
Biscuit
Cold meals
Drink little and often -GINGER
EMETIC - 
1. cyclizine/promethazine
2. metoclop/ondansetron
Refer for IVF @DEHYDRATION

-PUQE N+V score
______________________________

HGravidarum Triad = WED 
-WL 5% PRE-preg - large 4 dates uterus
-Electrolyte imbalance - ketones
-Dehydration 
(not the latter bits like large 4 dates/ketones - just there to help you remember features)
30
Q

MMR CI

BF benefits?

A 
Live vaccine <4w
Ig tx / 3m 
Preg avoid @MMR<4w
Preg avoid @MMR<4w
IC 
Neomycin allergy

Mother:

  • BabyBond
  • Reduce BreastCancer / PPH-risk

Kid: i-AIRD

  • Infections
  • Allergy/ IBD / RA / DM 1
31
Q

Antidepressants in preg/BFeeding:

  • ? @preg
  • ?@BFeed

@preg, serum hcg detected in 98% ppl when?!

@conception, OTC preg test positive after how many days?

@preg, serum hcg detected in 98% ppl when?!

Gravidity? Parity?

A

Antidepressants in preg/BFeeding?

  • Sertraline + Fluoxetine @preg
  • Sertraline @BFeed

OTC->HCG:
OTC preg test positive @day 10
serum HCG detected by day 11

G=total pregnancies

P:
x- births >24w
+
y=pregnancies <24w losses

32
Q

Short Palpebral fissures
Thin Vermillion border
Smooth filtrum

< 10th growth centile

Decr head CIRC
STRUCT brain dx
Neuro signs

A

Fetal Alco Syndrome

33
Q

When to give anti-D @rhesusNEG mums:

If mum had Acne Rosacea, tx?

Preg + Pit.Versicolor, tx?

SLE + Preg - which drug?

A 
Abortion/Miscarriage >12w
TransPlacentalHaemorrhageRisk(procedures)
-procedures/abdo trauma/iuDeath
Ectopic
Evac after miscarriage

Acne Rosacea tx = 8-12 weeks
mild/mod - ltd pap/pust =
-TOP: Ivermectin / Azelaic/Metro @preg/BFeed

mod/severe - ext pap/pust ± plaques
-PO Doxy / Erythro @preg/BFeed
______

Pityriasis versicolor 
Ix: skin scraping MCS
Preg/BFeed CI: Selenium / Flucon/Itracon 
Tx: ASKIF
\_\_\_\_\_\_\_

SLE + Preg - AzothioPREG

34
Q

Bradycardia < 100

Tachycardia > 100

Early Decel

Late Decel

Variable decel

Loss of baseline variablity

A

Bradycardia < 100
-Beta-blocker / vagal tone

Tachycardia > 100
-Infection / Prematurity
___________

Early Decel
-head compression #normal

Late Decel
-asphyxia/placent insuff #hypoxia
___________

Variable decel
-cord comp

Loss of baseline variablity
-Prematurity / Hypoxia

35
Q

Bradycardia < 100
-Beta-blocker / vagal tone

Tachycardia > 100
-Infection / Prematurity

Early Decel
-head compression #normal

Late Decel
-asphyxia/placent insuff #hypoxia

Variable decel
-cord comp

Loss of baseline variablity
-Prematurity / Hypoxia

A

Bradycardia < 100
-Beta-blocker / vagal tone

Tachycardia > 100
-Infection / Prematurity

Early Decel
-head compression #normal

Late Decel
-asphyxia/placent insuff #hypoxia -> DO FETAL BLOOD SAMPLING -> ?c-section

Variable decel
-cord comp

Loss of baseline variablity
-Prematurity / Hypoxia

36
Q

Woman becomes preggers
Somehow develops unilateral facial nerve palsy
APTT fine, no sign of APLS or any other bleed dx…
Dx?

A

Preg -> BELL’S palsy

GI (22 decks)

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