obstetrics and gynae Flashcards
What are the criteria for HELLP syndrome?
H - haemolysis (high bilirubin, low serum haptoglobin, anaemia)
EL - elevated liver enzymes (ALT 2x normal)
LP - low platelets (<100)
What are the criteria for hyperemesis gravida?
- <20 weeks gestation
- intractable vomitting + more than 5% pre pregnancy weight loss/ dehydration/electrolyte disturbance/hospital admission
what to do if symptoms of miscarriage and the USS show no heartbeat, gestational sac <25cm and crown rump length <7mm?
re-scan in 7-10 days as could just be normal pregnancy that is too early to scan
for how long can you do expectant management of miscarriage before you need to move to medical/surgical?
14 days
when is anti-D prophylaxis required in miscarriage?
rh -ve mother and more than 12 weeks
rh -ve mother and surgical management at any weeks
what are risk factors for ectopic pregnancy?
smoking, previous ectopic, tubal issues, PID
what is the surgical management of ectopic pregnancy?
salpingectomy if normal contralateral tube
salpingotomy (but risky for molar)
what is a complete molar pregnancy? what is the management ?
2 x paternal genes and no egg
snowstorm appearance
always needs surgical evac + referral to molar centre + no pregnancy for 6 months post negative HCG or 12 months if they had chemo
what is a partial molar pregnancy? what is the management?
2x paternal genes + 1 maternal genes
medical management if large foetal tissue + referral to molar centre + no pregnancy for 6 months post negative HCG or 12 months if they had chemo
what are the complications of fibroids?
anaemia, degeneration, torsion, infection and very rarely transformation to leiomyosarcoma
what is the investigation of choice for fibroids?
TVUSS
what is the managment of fibroids?
if under 3cm and no distortion of cavity
- 1 = mirena
- 2 = tranexamic and mefenamic acid
- 3 = COC/POP
if over 3cm
- tranexamic acid + mefenamic acid
- 2 = mirena
- 3 = COC/POP
- 4 = myomectomy
what should you do prior to a myomectomy?
GnRH analogues for 3 months prior to myomectomy
How do you manage simple ovarian cysts in a pre menopausal woman?
- no need for ca125
- if asymptomatic : less than 5mm discharge, 5-7mm repeat USS in 1 year, if more than 7mm surgery
- if symptomatic: surgery
how do you manage complex ovarian cysts (multilobed, solid parts) in a pre-menopausal woman?
- ca125
(if less than 200 then benign issue, if more than refer to gynae onc MDT) - AFP, bHCG, LDH if under 40 years old and if abnormal then refer to gynae onc MDT
how do you manage ovarian cysts in a post menopausal woman?
calculate the RMI (USS features x menopausal status x ca125
If <200 then low risk. If <5cm and simple then repeat USS in 3 months. If complex cyst then surgery.
If >200 then high risk. Gynae MDT and CT chest, abdo, pelvis
what are the ultrasound features counted in an RMI
multilobulated cysts, solid areas, mets, ascited, bilateral lesions
1 feature = 1 point
2-5 features = 3 points
how do you score for menopausal status in a RMI
pre menopausal = 1
post menopausal = 3
what ages are HPV test offered (cervical smear)
25-64
what is the criteria for menopause?
cessation of menstruation for more than 1 year
what HRT do you need if you have a uterus? how about if you don’t have a uterus?
uterus = oestrogen and progesterone
no uterus = oestrogen only
what is a cystocele?
prolapse of anterior wall of vagina
what is a rectocele?
prolapse of the posterior wall of the vagina
what is a vaginal vault prolapse?
top of vagina prolapses following a hysterectomy
what is the most common symptom of a prolapse?
feeling of heaviness and dragging
what examinations should be done in a suspected prolapse?
abdo exam ( to look for any masses) then vaginal exam
what are the management options for prolapse?
- conservative (lifestyle, pelvic floor exercises, vaginal oestrogen)
- pessaries
- surgical (anterior repair, posterior repair, sacrospinous fixation, laparoscopic sacrohysteroplexy, colposclesis)
what is a requirement for colposcleisis?
need to be sexually inactive
what is the staging criteria for prolapses?
0 = no prolapse 1 = leading edge is -1cm from introitus 2 = leading edge is -1cm - +1 from introitus (bascially at hymen) 3 = leading edge is +1cm or below (outside the vagina) 4 = complete vaginal eversion (procidentia)
what is the management for stress incontienence?
- conservative (pelvic floor)
- surgery (bulking agents, fascial slings, colposuspension)
- medical - duloxetine
what is the management for urge incontinence?
- lifestyle (caffeine reduction, smoking)
- medical ( tolterodine, mirabegron, desmopressin)
what is the common presentation of lichen sclerosis?
- post menopausal lady with extremely itchy vagina with white rash in figure of eight pattern.
- 40% will have another autoimmune condition
what is the management of lichen sclerosis?
dermovate (highly potent steroid)
what are the most likely complications 0-24hrs post op?
- haemorrhage
- pre-existing infection ie UTI, penumonia
what are the most likely complications 24hr - 5 days post op?
- infection
- thrombosis
- direct injury (ureters commonly in gynae surgery)
what are the most likely complications 7-14 days post op?
- infection
- thrombosis
- indirect injury (AVN secondary to diathermy)
what is the differences and similarities between BV and trichomonas vaginalis?
BV = white thin discharge + clue cells trichomonas = frothy yellow/green discharge + strawberry cervix
Both = vaginal ph >4.5, smelly discharge, managed with metronidazole
when is the booking appointment?
8-12 weeks (ideally 10) where they do initial bloods, BP, urine dip
when is the dating scan?
10-14 weeks (usually 12)
when is down’s screening?
11-14 weeks
when is the anomaly scan?
18-21 weeks (usually 20)
when is anti-D prophylaxis given?
28 weeks
when is presentation of baby checked and external cephalic version offered?
36 weeks
at what gestation should all women with a BMI over 30 be offered screening for gestational diabetes?
24-28 weeks
what is the order of methods for induction of labour?
1st = membrane sweep 2nd = vaginal prostaglandins 3rd = amniotomy + oxytocin
what does tamoxifen increase your risk of
Venous thromboembolism
