Obstetrics & Gyanecology

Question 1

Hyperemesis Gravidarum

Answer 1

• Quantify N&V (how many times a day)
  
  • blood?
  • bile?
• Heartburn?
• Abdominal Pain?
• Bowels?
• Urinary?
• FLAWS
• Hyperthyroidism Symptoms?
• Functional Impairment → eat/drink; work; distress

DDx

1. ​Gastroenteritis
2. UTI
3. Surgical → appendicitis, pancreatitis
4. Gynae → ectopic, ovarian cyst
5. Endocrine → DKA, addison’s

Investigations

• ABCDE & Obs
• Dehydration/GI Loss picture on Bloods
• Pregnancy test
• Urine Dip (ketones and UTI)
• LFTs → transaminases increased in 50%
• TFTs
• Pelvic USS → intra-uterine pregnancy, viability, molar pregnancy, trisomy, multiple gesttion, hydrops foetalis

Management

• 0.9% saline IV rehydration (cerebral oedema)
• KCL electrolyte correction
• Daily U&Es
• Cyclizine/Chlorpromazine (if N&V persists)
• PPIs
• Prednisolone if severe
• B1 supplementation
• Thromboprophylaxis → LMWH & TED stockings

Question 2

PCOS + MoA of Metformin

Question 3

Pulmonary Embolism in Pregnancy

Question 4

Contraception → HTN + Obese

Question 5

Ectopic Pregnancy

Answer 5

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Question 6

VBAC

Answer 6

• Successful VBAC → fewest complications and shorter hospital stay
• 75% success rate
• Predictors of success → previous vaginal delivery, ↑ maternal height, <40 years, BMI <30
• VBAC @ 40 weeks (ERCS @ 39)

Contra-Indications

1. Uterine rupture
2. Classical C-section scar
3. Consultation supervision needed if > 2 C-S
4. Contra-indication to vaginal delivery

Risks (VBAC)

Maternal

1. 1/200 uterine rupture
2. Anal sphincter injury
3. Emergency C-S/Instrumental delivery risk

• Foetal*
  1. 8/10,000 Hypoxic Ischaemic Encephalopathy

Risks (C-S)

Maternal

1. Want MORE PREGNANCIES → VBAC (increased risk of subsequent C-S)
2. Longer recovery time

• Foetal*
  1. Respiratory → Transient Tachypnoea of the Newborn

Question 7

What are the risk factors for GBS infection?

Answer 7

1. your baby is born preterm (before 37 completed weeks of pregnancy) – the earlier your baby is born, the greater the risk
2. you have previously had a baby affected by GBS infection
3. you have had a high temperature or other signs of infection during labour
4. you have had any positive urine or swab test for GBS in this pregnancy
5. your waters have broken more than 24 hours before your baby is born

Question 8

Substances Used in Colposcopy?

Answer 8

• Acetic Acid
• Lugol’s Iodine

Question 9

Hypothyroidism and Fertility?

Answer 9

• Hypothyroidism can have a direct effect on these hormones: a deficiency in thyroxine (T4) leads to lower levels of FSH and LH in the blood.
• Some studies have found that subfertile women - those who haven’t conceived after a year of regular, unprotected sex - tend to have higher levels of TSH and increased rates of hypothyroidism than women who conceive without difficulty.
• In addition, pregnancy rates tend to be lower in women with raised TSH levels
• Once a woman falls pregnant, the thyroid’s job continues by contributing to the normal growth of the baby in a number of ways, including the transfer of crucial thyroxine from the mother to the baby through the placenta.
• ‘Thyroid hormones affect the growth of your baby’s brain early on during the pregnancy. Abnormal circulating thyroid hormone levels in the mother during pregnancy are associated with poor pregnancy outcomes such as miscarriage.’

Question 10

Hypothyroidism Symptoms?

Answer 10

1. Lethargy
2. Weight Gain
3. Heat Intolerance
4. Constipation
5. Dry Skin and Hair
6. Menorrhagia

Treatment = Levothyroxine

Question 11

Fertility Counselling?

Answer 11

• How long?
• Frequence, Difficulties, Pain and Method of SEX
• Symptoms
  
  • PCOS
  • Discharge
  • Menstrual periods
  • Prolactinoma –> nipple discharge
  • Hypothyroidism
  • PID
  • Anorexia Nervosa
  • Fibroids
  • Endometriosis
• Full Gynae/Obs History
• Has partner had any other children (ICSI = intra-cytoplasmic sperm insertion)

Investigations

• Semen analysis
• Serum progesterone @ 7 days prior to expected next period

Counselling

• Folic Acid
• BMI 20-25
• Regular Sex = 2-3 days
• Smoking/Drinking

Question 12

Foetal Varicella Syndrome

Answer 12

Question 13

Foetal Alcohol Syndrome

Answer 13

FAS

• Facial Hypoplasia/Forebrain Malformation
• Attention Deficit Disorder/Altered Joints
• Short Stature/Septal Defect

Question 14

P.E. in Pregnancy?

Answer 14

• compression duplex ultrasound for symptoms of DVT (if this is confirmed you no longer need to assess for a PE –> can just treat)
• ECG and Chest X-Ray (only if these don’t show anything –> CTPA)
  
  • ECG = S1Q3T3
• If suspicion of PE but not DVT –> V/Q scan
  
  • childhood cancer risk
• Before LMWH –> FBC, U&E, LFTS and Coagulation Screen
• If P.E. is clinically suspected –> start LMWH IMMEDIATELY
• Treat w LMWH until 6 weeks post-partum OR until 3 months of treatment in total
• Stop LMWH 24 hours before surgery (and 4 hours after spinal anaesthesia)