Obstetrics and Gynaecology

Question 1

Chronic HTN – pre-existing HTN or HTN onset <20w
Pregnancy induced HTN (PIH) – HTN onset >20w
Pre-eclampsia – PIH + proteinuria (>0.3g/24h)
Eclampsia – pre-eclampsia + tonic-clonic seizures
HELLP syndrome - Haemolysis, Elevated Liver enzymes and Low Platelets

Tx: stop ACEi/ARBs and offer labetalol (or nifedipine or methyldopa), if pre-eclampsia then aspirin 75-150mg from 12w until birth, if eclampsia MgSO4 until 24h after delivery or last seizure (reversal agent is calcium gluconate)

Question 2

HRT

Answer 2

Uterus intact + LMP <12mo – oral sequential combined oestrogen + progestogen (Elleste-Duet 1mg or 2mg) or patch sequential combined oestrogen + progestogen (Evorel Sequi)
#1 estradiol with norethisterone
Uterus intact + LMP >12mo – oral continuous combined oestrogen + progestogen (Elleste-Duet Conti), patch continuous combined oestrogen + progestogen (Evorel Conti), tibolone
Post-hysterectomy – oral or patch oestrogen (Elleste-Solo) or tibolone
#1 estradiol
Post-menopausal osteoporosis – alendronic acid or risedronate sodium
Vasomotor symptoms in someone that can’t take HRT – clonidine
Menopausal atrophic vaginitis – topic vaginal oestrogen (pessary or ring)

Question 3

Risks of HRT

Answer 3

Breast cancer, endometrial cancer, ovarian cancer, VTE (stop 4-6 weeks before surgery), stroke, CAD