Obstetrics and Gynaecology Flashcards
What is the criteria for a diagnosis of gestational diabetes?
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
What is the management of gestational diabetes?
(based on fasting)
If < 7mmol/l: trial of diet and exercise for 1-2 weeks
If >7mmol/l: start insulin
If 6-6.9mmol/l and complications: start insulin
If refusing insulin-> metformin
If metformin not tolerated-> glibenclamide
What is the management of pre-existing diabetes in pregnancy?
1) Weight loss if BMI >27
2) Stop all oral meds except metformin and start insulin
3) Folic acid 5mg/day 12 weeks pre-conception
4) Treat retinopathy as can worsen during pregnancy
What is the commonest type of ovarian cyst?
Follicular cyst
What are the two types of ovarian benign epithelial tumours?
1) Serous cystadenoma
2) Mucinous cystadenoma
What is a type of ovarian germ cell tumour?
Dermoid cyst
What are the two types of physiological/functional ovarian cysts?
1) Follicular cysts
2) Corpus luteum cysts
What is the most common type of ovarian cancer?
Serous carcinoma
What is the treatment of infertility in the context of PCOS?
1) weight reduction if appropriate
2) anti-oestrogen therapies e.g. Clomifene
3) Metformin
4) Gondaotrophins
What is the management of pre-eclampsia?
1st line: labetalol (if asthmatic nifedipine)
Definitive management is delivery of baby
What is the most common causative organism of early-onset sepsis in neonates?
<48hrs since birth:
Group B Streptococcus
What is the most common causative organism of late-onset sepsis in neonates?
> 48hrs since birth:
Staphylococcus epidermidis OR Staphylococcus aureus
What is the antibiotic of choice for intrapartum GBS prophylaxis?
Benzylpenicillin
Who should have intrapartum GBS prophylaxis?
1) If previous GBS
2) If pre-term labour
3) If pyrexia during labour
What medication can be used to suppress lactation when breastfeeding?
Cabergoline (dopamine receptor agonist)
What are causes of oligohydramnios?
premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia
What are causes of primary ammenorhoea?
1) Constitutional delay i.e. a late bloomer, has secondary sexual characteristics
2) Anatomical i.e. mullerian agenesis (patient develops secondary sexual characteristics and has variable absence of female sexual organs)
3) Imperforate hymen (characterised by cyclical pain and the classic bluish bulging membrane on physical examination)
4) Transverse vaginal septae (characterised by cyclical pain and retrograde menstruation)
5) Turner syndrome (XO chromosome)
6) Testicular feminisation syndrome (XY genotype, no internal female organs)
Kallmann syndrome (failure to secrete GNRH)
What are the causes of secondary ammenorhoea?
Pregnancy
Patient is using contraception
Menopause
Lactational amenorrhoea
Hypothalamic amenorrhoea (suppression of GnRH due to stress, excessive exercise, eating disorder)
Endocrinological (hyperthyroidism, polycystic ovary disease, Cushing’s syndrome, hyperprolactinaemia, hypopituitarism)
Premature ovarian failure (autoimmune, chemotherapy, radiation therapy)
Asherman’s syndrome (iatrogenic intrauterine adhesions/cervical stenosis)
At how many weeks should you refer if no fetal movements?
24 weeks
What are safe anti-epileptics in pregnancy?
Lamotrigine
Carbamazepine
Levetiracetam
What is the most common benign ovarian tumour in women under the age of 25 years?
Dermoid cyst (teratoma)
What is the most common cause of ovarian enlargement in women of a reproductive age?
Follicular cyst
What is the most common type of ovarian pathology associated with Meigs’ syndrome?
Fibroma
How long does it take for contraceptives to be effective upon starting?
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
What is Sheehan’s syndrome?
Sheehan syndrome describes hypopituitarism caused by ischemic necrosis due to blood loss and hypovolaemic shock.
Features may include:
agalactorrhoea
amenorrhoea
symptoms of hypothyroidism
symptoms of hypoadrenalism
What is Asherman’s syndrome?
Asherman’s syndrome, or intrauterine adhesions, may occur following dilation and curettage. This may prevent the endometrium responding to oestrogen as it normally would.
What is the management of PPROM?
Admission to ensure not developing chorioamnionitis
10 days erythromycin should be given to all women with PPROM
Antenatal corticosteroids
Delivery at 34 weeks
What are recommended supplements for healthy patient during pregnancy?
Folic acid 400mcg OD (12 weeks prior to 12 weeks into pregnancy)
Vitamin D 10mcg OD (throughout pregnancy)
Medical management of stress incontinence?
Duloxetine
Medical management of urge incontinence?
antimuscarinics are first-line
1) oxybutynin (immediate release)
2) tolterodine (immediate release)
3) darifenacin (once daily preparation)
What to do if pregnant woman unsure of chickenpox history has VZV contact?
Check VZV antibodies
What is the management of POI in those under 51?
HRT or COCP
What is the treatment of Trichomonas vaginalis?
Oral metronidazole
What is the treatment of gonorrhoea?
IM Ceftriaxone
Which cancers does the COCP increase the risk of?
Breast Cancer
Cervical Cancer
Which cancers does the COCP protect against?
Ovarian Cancer
Endometrial Cancer
What are the causes of postpartum haemorrhage?
The causes of PPH are said to be the 4 Ts:
1) Tone (uterine atony): the vast majority of cases
2) Trauma (e.g. perineal tear)
3) Tissue (retained placenta)
4) Thrombin (e.g. clotting/bleeding disorder)
What is the management of PPH?
Mechanical:
1) palpate the uterine fundus and rub it to stimulate contractions (‘rubbing up the fundus’)
2) catheterisation to prevent bladder distension and monitor urine output
Medical:
1) IV Oxytocin
2) Ergometriine slow IV or IM
3) Corborprost IM (unless asthmatic)
4) Carboprost IM
5) Misoprostol sublingual
Surgical:
1st line- Intrauterine balloon tamponade
Which strains of HPV cause cervical cancer?
HPV 16, 18 and 33
What is management of breech baby?
<36 weeks- likely to turn spontaneously
>36 weeks- ECV if >36 weeks in nulliparous and >37 weeks in multiparous
if still breech- planned C-section or vaginal
What results of combined test suggest Down’s Syndrome?
↑ HCG
↓ PAPP-A
thickened nuchal translucency
What are the features of congenital rubella syndrome?
1) Sensorineural deafness
2) Eye abnormalities
3) Congenital heart disease
What is the management of induction of labour?
If Bishop score ≤ 6: Vaginal prostaglandins or oral misoprostol
If >6:
Amniotomy and IV oxytocin infusion
Possible methods:
1) Membrane sweep
2) Vaginal prostaglandins E2 (PGE2)
3) Oral prostaglandin E1
Maternal oxytocin infusion
4) Amniotomy (‘breaking of waters’)
5) Cervical ripening balloon
What is the first line management for shoulder dystocia?
McRoberts manoeuvre (hyperflexion of the maternal legs)
What is the management of PMS?
Mild: lifestyle advice
Moderate: COCP
Severe: SSRI
When is the anomaly scan?
18 - 20+6 weeks
When is the dating scan/nuchal translucency?
11 - 13+6 weeks
When are anti-D doses during pregnancy?
1st dose: 28 weeks
2nd dose: 34 weeks
When is screen for anaemia and atypical red cell alloantibodies?
28 weeks
