Obstetrics & Gynaecology Flashcards
1
Q
HMB/AUB
Best for later conception
A
Mirena (LNGIUS) 1st
Cocp 2nd
Pop: no, causes irregular 🩸
2
Q
Patient ectopic pregnancy, wants to continue contraception.
Best choice
A
LARC
POP/ COCP : small risk of ectopic
3
Q
Most important factor for Labor progress
A
Uterine contractions
1st phase: latent : irregular contractions/cervical efface and dilation
Active: regular contractions, cervix 3-4cm, descent of head
4
Q
Abd pain following cough /sneeze
Tender and
CTG normal
A
Rectus sheath hematoma
*Diastasis rectus: painless , swelling at any pt midline ,📈 on abd pressure
5
Q
PV 🩸 with suspected ectopic,which is very important sign for emergency
A
Shoulder tip pain
: irritated phrenic nerve by blood in peritoneal cavity
6
Q
Dysmenorrhoea 1° mngt
A
NSAIDs 1st
OCP: given if contraception is planned or NSAIDs contraindicated
7
Q
CTG information
A
Baseline heart rate
Variable heart rate
Acceleration
Deceleration : early/variable/prolonged/late
8
Q
Abnormal CTG
A
HR outside range
Poor variability
Deceleration are variable/prolonged
9
Q
Pregnancy loss, keen for conception
A
Immediately
10
Q
ITP pregnancy
Steroid or ivIG
A
If platelet<30,000 or symptomatic>30,000
11
Q
ITP
A
Advised 70-100,000 plt count for safe regional anaesthesia
* gestational thrombocytopenia occurs 10%but plt count usually
70,000
12
Q
Girls puberty development
A
Order:
Breast bud>growth spurt>axillary/pubic hair>menses
13
Q
Tanner female
General
A
1: none
2: boobs and pubes
3: acne,axilla, height
4.menses
5. Adult
14
Q
Tanner breast
A
|-No : none
||-Body : bud
|||-Elevates : breasts elevated
|V-2 mountains in : secondary mound
V-Adulthood : adult size
15
Q
HMB/AUB
A
Ovulatory: regular, structural;fibroids, endometriosis,polyp
Anovulatory : hormonal; PCOS, hypo or hyperthyroidism, hyperprolactinemia, Cushing
16
Q
Best Ix for Ovulatory HMB
A
TVS
17
Q
Non reassuring CTG Mx
A
Call help
O2
Left lateral
IV fluids bolus
Stop oxytocin infusion
Continuous CTG monitoring
Kiv tocolysis
If all done : still not improving
Fetal scalp sampling
Finally: Urgent Lscs
18
Q
Reassuring CTG
A
Normal fhr :110-160
Good variability:6-25bpm
Age appropriate acceleration
No late or variable deceleration
19
Q
Female infertility
A
Hormonal
Blocked tubes
Adhesion uterine
Thick cervical mucus
20
Q
Male infertility
A
Semen abnormality
Obstructive causes
Ejaculatory failure
21
Q
Ocp protection
A
Cool : colon
OCP : ovary
protects
U: uterine
22
Q
Ocp risk
A
Be : breast
careful : cervical
23
Q
Atrophic vaginitis Sx
A
5 years post menopause
Dyspareunia: atrophic vaginal epithelium
Dysuria: chronic, thinning of bladder and urethral epithelium due to low estrogens
24
Q
Tx atrophic vaginitis
A
Lubricant
Estrogen cream
25
COCP
contraindications
Active breast ca
Smoker age> 45
DVT
Migraine
Thrombophilia
HPT BP> 160/110
DM with nephropathy
Liver disease
SLE
APS
IHD
26
Cord prolapse CTG finding
Variable deceleration
Fetal brady
27
Risk of PE in pregnancy
Highest: past PE
Chronic HPT
28
Most common cause of low milk production
Decreased frequency of breastfeeding
(-)!peptide increased when reduced feeding,so reduced synthesis of milk production
29
Prolonged deceleration in CTG in induced labor
Syntocinon causing uterus hyperstimulation is common cause. Cease syntocinon if no improvement with other measures
30
Fetal bradycardia
Vs prolonged deceleration
PD: drop in fhr from baseline >90s to 5 minutes
FB: fhr <90/min for > 5minutes
31
Lichen sclerosis vagina
Clobetasone 1st line
Calcineurin (-)
32
Varicella contact in pregnancy
Unknown immune status
Check IgG level
Give ivIG if negative
33
Post coital bleeding
Patient on high estrogen phase during ovulation/on OCP cause?
Cervical ectropion
34
Listeriosis in food to avoid in pregnancy
Soft cheese
35
1.Premature ovarian failure
Diagnostic?
2.Keen for conception tx
1)2 FSH levels 1 month apart
High (in menopausal range )
Serum estradiol Low
2) Tx: MRT
36
Autoimmune oophoritis causing premature ovarian failure
LH will be high
37
Premature ovarian failure keen for contraception
Rx?
OCP
38
2° amenorrhea
Causes
1. PCOS
2. Premature ovarian failure
3. Hyperprolactinemia
4. Functional/exercise induced
39
PPROM 26wk-35wk
Aim
For fetal maturity:
Steroid given in 24 hours
Tocolysis in that period
NICU back-up
USG: liquor adequacy
Abx: IV erythromycin
WBC/CRP:2-3 days
CTG: 2-3 days
All okay 👍>>> discharge with advise
40
Ix for PPROM
1. Speculum:fluid at fornix
2. CTG
3. High &low vaginal swab
4. USG : liquor adequacy
41
Chorioamnionitis ∆
Criteria
Maternal fever
+ 2 of the following
Maternal tachycardia
Uterine tenderness
Foul smell discharge 🤢
Fetal tachycardia
WBC >15,000
CRP> 40
42
Measles infected pregnant women
Observation only
MMR contraindicated
43
Exposed to Measles patient in pregnant women
If no symptoms, give NHIG !
44
Measles pregnant women
Notify and contact tracing
Observation of patient
45
Measles complications
Preterm Labor
Spontaneous abortion
Maternal morbidity
Pregnancy loss
46
Abruptio placenta most common finding
PV 🩸 bleeding 80% of cases
Abd pain 70%
47
PROM after intercourse
Pooling of fluid at posterior fornix
Nitrazine
Amnisure
48
PROM> 18 hours
Start Abx !!!
Prevent chorioamnionitis !!!
49
Rubella exposure to pregnancy 1st trimester
Check serology IgG and IgM stat
If IgG> 10 : no further action
50
Rubella incubation period
14-23 days
Early testing before 7 days or within 21 days need repeat IgM testing for susceptible ones
51
Once serology IgM+
Termination of pregnancy
52
Maternal tachycardia and hypotension with disproportionate small amount PV 🩸
Abruptio placenta
53
Unstable abruptio
ABC
Cross match
USG
54
Dysmenorrhoea not relieved with NSAIDs or OCP
Ix
TVS 1st choice
TAS: virgin
55
Post coital bleeding
Normal cervical screening
<30 yrs
OCP: cervical ectropion
Cervicitis: chlamydia + discharge
>30y yrs
Polyp
56
Primary amenorrhea presentation
Ix
+ secondary sexual character : USG
- secondary sexual character: hormonal studies
57
Ovarian dysgenesis
(Turners)
1. No /abnormal breast
2. Poor streak ovaries
3. FSH 📈
58
Mullerian
1. Normal breast /pubic/ axillary
2. FSH LH normal
3. Abnormal uterus/vagina/cervix
59
Androgen insensitive
Normal breast
Absent pubic and axillary hair
Absent uterus
60
The following tests are considered basic for all patients with primary amenorrhea
* priority based on presentation
:
Pregnancy test (to exclude pregnancy prior to first menstruation)
Pelvic ultrasound (complementary to physical exam)
FSH (and LH)
Thyroid stimulating hormone (TSH)
Prolactin
61
Decision for which test in 1 amenorrhea based on Tanner
Breasts are an endogenous assay for estrogen. Breast development consistent with a Tanner stage of II or greater indicates the presence of estrogen and ovarian function (although it could be insufficient or prematurely failed). With breasts present, the next step is always checking for the presence or absence of a uterus, its anatomy and possible defects, vagina, and hymen. If there is no breast development, FHS (and LH) comes first
62
Incarcerated uterus
Cervix stuck between pushed upwards pushing on bladder & urethra>>> voiding issue
USG for ∆
63
Reassuring CTG
Observe and continue monitoring
64
Non reassuring CTG / abnormal CTG
Fetal scalp blood sampling
65
Non reassuring CTG
Variability of FHR <3 bpm ( N: 6-25)
HR: 100-109/min
Variable deceleration non complicated
66
Abnormal CTG
FHR<100/min or > 170/min
Variability<3 or absent
Deceleration>3 mins/ late/complicated variables
67
Hematoma at episiotomy site
<3cm: ice pack & analgesia
> 3 cm: evacuate under Anesthesia
68
VZIG passive immunization
Within 96 hrs of exposure
69
Acyclovir in pregnancy
As prophylaxis in 2nd term pregnancy / developed sx
70
Otosclerosis
Avoid OCP,give IUCD
71
Emergency contraceptive , most important q?
Date of last unprotected Si
72
Women contraindicated for COCP needs med for menopausal SX
SSRI: fluoxetine
73
Bright red spot pv , tender uterus, fever Day5 post partum
Retained POC
74
Fever, tender uterus, malodorous and green discharge of lochia
Endometritis ( Day 5 onwards)
75
HSIL (CIN 2/3) In 3rd trimester
Colposcopy now ( safe)
76
Invasive cervical cancer
Viable fetus, steroid for lung maturity and expedite delivery
Previable : mother decides to forego pregnancy, tx m mother
77
Colpocopy : no abnormality but smear CIN 2 ( HSIL)
Cone biopsy
78
High dose folic acid 5mg
1. Patients on anti epileptic
2. Family history / personal HX of NTD
3. Type1 or 2 DM
4. BMI> 35
79
Uterine bleeding> step wise approach
Determine ovulatory vs anovulatory:
1. FBC
2. USG : TVS preferred
3. Endometrial thickness+: sampling
80
Cervical motion tenderness
PID
Ectopic pregnancy
81
PID
Mx
Cervical swab
Abx
82
Ovarian teratoma
Solid mass <10 cm
Young woman
Asymptomatic or mild symptoms
Adnexal mass
83
OCP with high BP
Stop OCP and reassess BP, estrogen cessation might bring down BP
84
Gardnerella Vaginalis
MCC bacterial vaginosis
Thin, greyish, malodorous discharge
85
Calendar method contraception
Abstinence
-6 days from earliest day of ovulation
+2 days after last day of ovulation
Ovulation: always 14th day
86
Cycle 26- 30 days
Abstinence start: 12 -6 =day 6
Ends: day 18
87
Previous Lscs + prolonged active phase of 1st phase risk
Uterine rupture
88
Unstable lie
Multipara
89
GDM post delivery monitoring
2 yearly OGTT
90
Yaz/Yasmin tablet
Estrogen + Drospirenone (helps with wt loss esp water retention)
91
EBV in pregnancy
Reassure, TCA if SX develops
Small risk to foetus, early Labor,SGA
92
Migraine with Vomiting
Mild: pcm
Mod to severe: codeine+ metoclopramide (Vomiting 🤮 part)
93
Sudden pain getting up chair/sneeze
Round ligament pain
Common in 2md trimester
94
Amenorrhea after gynae procedure
Adhesions
TVS 1st Ix
95
USG done in PV 🩸 mainly
To find out cause of bleeding
Not for fetal viability
96
Pregnant, frontal headache, hypotension diplopia
Pituitary apoplexy
(Adenoma hemorrhage,sudden)
97
Abnormal lie at term
1st : USG TRO placenta Previa/polyhydramnios/ multiple gestation
Attempt ECV
98
Patient with primary pulmonary hypertension wants conceive
Contraindicated, mother risk
99
DVT treatment post partum
and safe for BF
Warfarin
100
Warfarin in 1st trimester
Fetal Warfarin Syndrome :
Facial anomalies,
Nasal hypoplasia
Chondrodysplasia punctata
Short fingers, hypoplasia finger nails
Intellectual disability
Low birth weight
101
Warfarin 2nd trimester
Mental retardation
Optic atrophy
Dandy Walker
102
DVT on LMWH nearing term
Switch to unfractioned heparin
(safe for regional anaesthesia)
103
Duration to restart LMWH/Unfractioned heparin post SVD and LSCS in DVT patient
SVD: 4-6 hrs
LSCS: 6-12 hrs
104
If epidural catheter removed, when can restart LMWH?
24 hours after removal
105
Reason for DVT in pregnancy
Reduced protein S and protein C
And
Increased activity factor V and VII
106
PE in pregnancy
Best Ix
V/Q perfusion scan
107
Hypothyroidism in pregnancy
Frequency to check?
•Requirement increase by 30%
•Check 4-6weeks 1st half pregnancy
1x 26-32 weeks
108
Mom insist on LSCS despite no indication
Refer obstetrician for 2nd opinion
109
Urine retention with
Mass below umbilicus in pregnant women
Incarcerated uterus
110
Rhesus - mother
Give Rhogam at 28 weeks and 34th week routinely
111
Rh - 1st trimester /2nd trimester procedure or precipitating events
Eg: D&C, amniocentesis, CVS, abortion
Give immediate Rhogam
112
Post partum Rh -ve
Give Rhogam within 72 hrs
113
Kleihaeur Betki test
Check fetomaternal blood mix level to determine extra dose Rhogam need to be given
114
Mother already developed anti d antibodies
No need Rhogam
115
MCC of PPH
Uterine atony
Reason:
Polyhydramnios/ multiple gestation/macrosomia/prolonged Labor
116
Antiepileptic in pregnancy, how to withdraw
•Depends on type of epilepsy
•EEG finding
•Seizure free period
•Neurological deficits +/-
•Past HX of relapse upon withdrawal
117
Lifelong epilepsy Rx
Juvenile myoclonic epilepsy
118
Period of free from withdrawal antiepileptic before conception
6 months
119
Uterine rupture vs abruptio
Uterine less tender,less tone, FHR far decreased in uterine rupture
120
Post partum GDM check ✔️
1. 1 day post delivery: RBG
2. Before discharge: 4 point BG level ( 1 fast, 3 2hrs after meals)
2. GP : OGTT 75gm at 6wk and 12 wk
121
HIV mother
Contraindications
Breastfeeding
122
Reduce risk of HIV to newborns
1.Mother on ART
2.Intrapartum Zidovudine
3.Neonatal ART
4. Elective LSCS
123
LSCS for HIV mother
Rx for art
Give Zidovudine 3 hrs before op
124
Intrapartum avoidance in HIV
No foetal scalp sampling
No amniotomy
No episiotomy
No forceps
125
Rubella vaccine for non immune planning to conceive
Duration
3 months
126
Herpes simplex virus in pregnancy
Near term with active lesion need Rx
Consider LSCS: active lesion or rupture of membranes
Newborn treated if signs+ or viral culture+
127
Herpes simplex risk 1° vs recurrent
1° higher risk
128
MRT rx
Within 2 years of cessation:
Estrogen+ 12 days MPA
After 1 - 2yrs : continuous estrogen + MPA
129
PCOS
Most accurate ix
Testosterone level
(Hyperandrogenism)
130
Bartholin cyst
<3cm: warm compress
> 3cm: surgery
a. Incision and drainage
b. Marsupialisatiom: recurrent
c. Word catheter
131
PMS
Diagnostic criteria
Rx
•5 days before menses for 3 cycles
•Somatic and affective SX
Rx (Stepwise):
CBT
NSAIDs
OCP : ovulation suppression reduction SX
132
PMDD
∆ criteria
Rx
Severe form PMS lasting 12mth
Rx: SSRI
133
Mastalgia from PMS rx
Fluid retention from PMS rx
Danazol & EPO ( initial)
Spironolactone
134
General stepwise approach in PMDD
1. CBT, vitamin, relaxation
Trial for 2-3 cycles, 8f fail then consider SSRI on intermittent basis or daily depending on response
135
Rhogam not indicated for rh - mom
Threatened abortion<12 weeks
136
Duration of Rhogam in maternal circulation
6 weeks
137
Valvular heart disease which is most threatening for pregnancy
MS
138
Ovarian cancer
Concept
>ovulation,more risk of cancer
Nulliparous,early menarche,late menopause,
139
Postpartum fever
140
Bacterial vaginosis Rx in pregnancy
1st line: Clindamycin 300mg BD X 7 days
2nd line: Metronidazole 400mg TDS X 7 days
141
Endometrial thickness normal
2mm-4mm
142
UPT + ,empty uterus on USG
False +
Ectopic pregnancy
Very early pregnancy
Complete abortion
143
GDM evaluation in non risk pregnancy
OGTT Btw 24 -28 weeks
144
GDM evaluation in high risk
Score>> 2
2 hour 75g OGTT NOW !!!
145
Hypertension in pregnancy
Medications
Hypertensive Mom's Need Love
Hydralazine: acute
Methyldopa : ••• 1st line
Nifedipine
Labetolol : acute
146
Steroids in PPROM
Given between 26 wk-34 wk
147
PPROM< 23 week
Induce Labor
Or bed rest TCA once Labor SX begins
148
Tocolysis indication
& contraindications
Refer table
149
Tocolysis agent
1st : nifedipine
2nd: salbutamol
150
Nifedipine/ salbutamol contraindicated eg. Mitral Stenosis with early contractions
Give oxytocin antagonists
Atosiban
151
Seat belt trauma with marks seen on abdomen
bruises over the abdomen this patient should be considered as having significant abdominal trauma and observation for a minimum of 24 hours, should be considered.
152
Fetal Fibronectin
Interpretation?
Criteria?
Absent: unlikely to deliver next 7 days ( high negative predictive value).
Candidates with intact membrane, os < 3cm & GA 22wk-34w6d
153
Cervical incompetence
∆ 3 criteria
•2 /> pregnancy loss after 12wk POG
•cervical dilator size 9 can be easily passed & no snapping on withdrawal
• cervical thickness<25mm and dilation of os >3cm before 24wk of gestation
154
Cervical length screening done for
2x btw 14wk-24 wk for:
1. Past HX of preterm babies
2. Suspected cervical incompetence
3. Multiple gestation
4. HX of cone biopsy
155
Normal cervical length
40mm
34wk: 34mm
Iess than above in less than 24 wk is a predictor for early preterm labor
156
Cervical cerclage
When to do?
Based on HX:
•12wk-14wk:
Hx pregnancy loss >2 after 12 weeks with shortened cervix
loss is earlier than previous pregnancy
USG based:
•14wk -26 weeks: progressive effacement of cervix on serial USG & external os is closed
Rescue based:
Cervical os> 2cm but no contractions
Effacement> 50 %
Membrane bulging at os
Pelvic pressure
157
Hyperprolactinemia causing infertility.
1st choice of Rx
2nd choice of Rx
1st: Bromocriptine, to shrink and correct the prolactin level.
Fertility can be attempted at this 👉 point
If medical fails to correct
MRI to locate tumor and surgical resection
158
2 elements given in pregnancy
Folic acid: 12 weeks before conception upto end of 1st trimester
Iodine: throughout pregnancy
159
Breastfeeding contraindicated
Breast abscess
160
Women with sudden onset severe headache,slurred speech and dysarthria
∆ ?
Ix ?
SAH
CT scan
161
HPV screening
2 years after 1st SI
Or age of 25 years
Whichever is later
Done every 5 years
162
LSIL repeat 1 year still LSIL
Next step?
Colposcopy
163
HSIL treated, next step?
Rpt colposcopy and cytology 4-6 mth
Then repeat annually till 2 consecutive results of cytology and colposcopy are NEGATIVE
Negative>>>> 5 yearly basis
164
HX of Abruptio Placenta
Recurrence is a worry,
Frequency of screening increased 3 month before the timing of previous Abruptio occurred
165
CVS best timing
10-12 weeks for chromosomal abnormality
166
Neutral tube defect
18-20week
167
Maternal serum triple test for
Down Syndrome
Timing?
Test?
15-18weeks
Alpha fetoprotein
Beta hcG
Oestriol
168
Amniocentesis
15-18 weeks
For chromosomal abnormality
169
Parvovirus B19 exposure to pregnancy
1st step
Check serum IgG
If + no need to worry
If negative : check IgM
If both IgG negative, IgM negative
Repeat testing 2 weeks for IgM
170
Parvovirus B19 risk to foetus
Foetal hydrops ( high risk throughout pregnancy)
171
Parvovirus mother + infected
1-2weekly USG monitoring of foetus next 6-12 weeks looking for hydrops foetalis
If Hydrops + >>> cord sampling & intrauterine blood transfusion
172
Hydrops foetalis pathophysiology
Fetal anemia~~ hypoxia~~low hepatic/renal blood flow~~~RAAS activated~~increase blood volume~~increase lymphatic flow~~ fluid accumulation
173
Uterine leiomyoma keen for conception (large fibroid)
GnRH analogue ( best medical therapy ) for 3/12 then myomectomy
174
GBS sepsis risk
√ Preterm labor
√ ROM > 18 hours
√ Current GBS bacteruria
√ Maternal pyrexia intrapartum and within 24 hr post partum
√ Past HX of GBS sepsis
175
GBS urine culture+ antenatal
Tx with abx
1st : cephalexin
2nd: nitrofurantoin
3rd: Augmentin
176
GBS vaginal swab + antenatal
No need treatment for mother
Treatment aimed during Labor only - prevent neonatal sepsis !!!
177
Intrapartum abx for GBS
•Current pregnancy vaginal/rectal swab +
•Current pregnancy bacteruria+
•Past HX of GBS sepsis newborn
•Prolonged ROM>18hrs
•Unknown culture status antenatal
•Maternal fever intrapartum and 24hr post partum
178
CMV + in pregnancy
IgM +
Need to repeat as IgM may stay +ve for 1 year. Need specialist opinion on interpretation
179
CMV infection in pregnancy
Amniocentesis+ USG
Look for PCR of amniotic fluid for CMv, no active treatment but counselling
180
Mother hepatitis C Ab +ve
Check HCV RNA level using PCR to measure viral replication
181
Child with mother of hepatitis C+
Check Hep C 12-18 age and if + to initiate treatment
182
Genital herpes after 30 week of pregnancy
Prophylactic treatment for mother from 36 wk till delivery
PCR at cervix
LSCS mode of delivery
183
Mother with chicken pox
< 7 days before delivery: give varicella IG to Child after birth
> 7 days before delivery: no need VZIG for child at birth
2-28 days after delivery: give VZIG to newborn esp preterm & <1000gm birth wt
184
Triple screening marker
70% sensitivity using maternal serum
Elevated b-HcG
Decreased AFP
Decreased unconjugated estriol
Best done : 15-18 wk
If abnormal: USG to confirm dates for gestation
Amniocentesis is next
185
Best and safe method to ∆ Down Syndrome
Amniocentesis
Used for:
Karyotyping
AFP elevated, Ach elevated in fluid
186
1st trimester trisomy 21 screening
PAPP-A decreased
Nuchal translucency
B- HCG increased
187
Quadruple screening
AFP low
b-HcG high
Estriol low
Inhibin high
188
Sensitivity for trisomy
Triple test: 65-70%
Quadruple:70-75%
Triple test + USG : 70-75%
1st trimester (b-HcG+ PAPP-A : 60-65% + USG (nuchal) : 65-80%
189
Ovarian cyst
Reproductive age group
<3cm: nothing
3-5cm: rpt USG 6-12wk
5-7 cm: rpt USG 6-12wk, then yearly
> 7cm: laparoscopy
190
Best method of contraception for epilepsy patients (esp enzyme inducers)
Mirena (IUCD)
191
OCP on antiepileptic
Use high dose as efficacy drops due to antiepileptic activity as enzyme inducers
192
COCP with slightly high BP , keen to continue oral method
Switch to POP
193
Postinor
Double dose at a time reduces failure rate & side effects
194
POP indication
HPT
DM
Thyroid
Migraine
HX of VTE
Lactation
Superficial thrombophlebitis
Biliary tract disease
195
POP contraindications
PBUHAL
Pregnancy
Breast ca
Undiagnosed genital bleed
HX of ectopic
Active liver dx
Liver cirrhosis
196
Enzyme inducers antiepileptic
Phenytoin/Carbamazepine/phenobarbital
197
Antiepileptic non inducers
Valproic acid
Gabapentin
Lamotrigine
Ethosuximide
198
OCP with breakthrough bleeding
Acceptable duration?
3 months
199
If no improvement after 3 months with erratic PV 🩸 on ocp
Increase dose of oestrogen
200
Women missed OCP or severe AGE > 24 hr
Continue OCP but barrier protection for 7 days
*Efficacy of OCP reduced
201
OCP missed
24-48 hr: take the pill and continue, no need barrier
> 48hr@ 2 pills or more: take one pill now+ barrier method 7 days
202
Emergency contraceptive in OCP
1st 7 days: emergency contraceptive+
8-14 days: no need provided comply earlier
15-21: no need, but omit 7 day break
203
Lactational amenorrhea
Criteria (3)
Exclusive BF
Post partum 6 months
Remain amenorrheic
204
POP use post partum
3-4 weeks
Immediate: only condom
205
Hormonal level indicator that pregnancy has occurred
LH
206
Smoking vs cocaine
Which gives more adverse effects to foetus
Cocaine >>> ICB
207
Fetal alcohol syndrome
∆?
Features?
> 12 standard units daily
Low set ear/long philtrum/microcephaly/
208
Antiepileptic with highest malformations in foetus?
Sodium valproic
But in idiopathic/juvenile myoclonic: use in low dose and explain the effects
209
Drugs with highest CNS effect
Cocaine (ICB)
210
Valproic acid side effects
Orofacial cleft
Cardiac anomalies
Neural tube defect
211
PCOS rx
Non pharma: aimed age <35
wt loss aim for 6 month and reassess
> Age 35
Clomiphene citrate : 1st line
Metformin ( BMI> 30)
212
Maternal Shock disproportionate to the blood loss per vagina post partum
Uterine rupture ! ! !
213
Station of head
214
Patient on MRT, frequency of mammogram
Same as not on MRT
215
MRT with family HX of breast cancer
Yes , can be given
216
MRT in personal HX of breast cancer with estrogen receptor+
Absolute contraindication !!!
