Obstetrics + Gynaecology Flashcards
What is the standard testing regime for downs syndrome in pregnancy?
Combined test done between 11 - 13 + 6 weeks
Nuchal translucency, serum BHCG, PAPP A
What result of the combined test suggests an increased risk of downs syndrome?
High HCG, Low PAPP A, Thickened nuchal translucency
What screening test for down syndrome is offerred to women who book later in pregnancy?
Quadruple test
- AFP, Unconjugates oestriol, Human chorionic gonadotrophin and inhibin A
In pre natal testing for downs syndrome what is classed as higher or lower chance?
Low chance - 1 in 150 or more
High chance 1 in 150 or less
What test is offerred to women who have a higher chance of down syndrome on initial prenatal screening?
Non invasive prenatal screening (NIPT)
What is the triad of symptoms in pre eclampsia?
New onset hypertension (over 140/90 after 20 weeks of pregnancy)
Proteinuria
Oedema
What is the formal definition of pre eclampsia
New onset hypertension (over 140/90 after 20 weeks of pregnancy)
Proteinuria
Other organ involvement - renal, liverm neurological
Risk factors for pre eclampsia
Hypertension in a previous pregnancy, CKD, Autoimmune disease, diabetes, Existing hypertension,
Also - age over 40, pregnancy interval of more than 10 years, high BMI, family history, multiple pregnancy
What medication can be given to reduce the risk of pre eclampsia?
Aspirin 75mg OD
When is aspirin advised during pregnancy to reduce risk of pre eclampsia
Women with more than 1 high risk factor or more than 2 moderate risk factors
What level of proteinuria is considered significant in pregnancy?
over 30mg/mmol
Over what blood pressure in late pregnancy is a women usually admitted for inpatient care (according to NICE guidelines)?
160/110
What is the first line drug treatment for pre eclampsia?
Labetalol
Management of obstetric cholestasis
Induction of labour at 37 - 38 weeks
Ursodeoxycholic acid
Vitamin K
What causes obstetric cholestasis
Impaired flow of bile causing a build up of bile salts which are then depositied in the skin and placenta.
Mathod of induction of labour if bishop score less than 6
Vaginal prostoglandins or oral misoprostol
Induction of labour if bishop score over 6
Amniotomy and IV oxytocin
When is external cephalic version performed
After 36 weeks
Medication for stress incontinence
Duoloxetine
Most common type of ovarian cyst
Follicular cyst
How long is additional contraception needed after implant insertion
7 days if not inserted on day 1 of the menstrual cycle
What are the criteria for expectant management for an ectoptic pregnancy
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
Management of post partum haemmorhage
Mechanical - uterine palpation + catheterisation
IV oxytocin
Ergometrine
Carboprost IM
Misoprostol
Surgical managment
Diagnosis of gestational diabetes
Fasting glucose over 5.6
2 hour glucose over 7.8
Management of gestational diabetes
If fasting glucose less than 7 2 week trial of diet and excercise. If targets not met within 1 - 2 weeks of altering diet and excercise then metformin should be added
If not met - insulin (short acting)
If fasting glucose at the time of diagnosis is over 7 then insulin should be started
If fasting glucose less than 7 but there is evidence of complications then insulin should be started
Definition of oligohydramnios
Less than 500ml amniotic fluid at 32 - 36 weeks and an AFI less than 5th percentile
Most common type of overian cancer
Serous carcinoma
What does the bishop score include
Cervical position
Cervical consistency
Cervical effacement
Cervical dilatation
Foetal station
A score of less than 5 indicated labour is unlikely to start without induction
How long after UPSI can ella 1 be used
5 days (120 hours)
How long after upsi can levonorgester be taken
72 hours
Definition of premature ovarian failure
The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years’.
