Obstetrics & Gynaecology Flashcards
Anti-epileptic drugs and breastfeeding:
Acceptable
Drugs contraindicated in breast feeding:
Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides, aspirin, methotrexate, amiodarone
Risk factors for neural tube defects:
History of NTD
Obesity, diabetes, coeliac disease, thalassemia trait
Anti-epileptic drugs
Indications for surgical management of ectopic pregnancy:
Visible heartbeat
Size >35 mm
Pain
hCG >5,000IU/L
Rhesus negative woman, when to give vaccine:
Anti-D at 28 + 34 weeks
Missed POP, what to do after 3 hours with traditional POPs and after 12 hours with desogestrel (cerazette):
Take missed pill ASAP, take next one at usual time. Condoms should be used until pill taking has been re-established for 48 hours
Management of severe pre-menstrual syndrome:
SSRIs
Unilateral dull ache intermittent or during intercourse, may cause abdominal swelling or pressure effects on the bladder:
Ovarian cyst
Treatment for ated group B streptococcus (GBS) in pregnancy:
Intrapartum intravenous benzylpenicillin
Treatment for menopausal symptoms in patient with Mirena
Estradiol, Mirena can provide the progesterone component of HRT for 4 years
Treatment for pre-eclampsia in asthma:
Nifedipine, labetalol if not asthmatic
Positive HPV smear, negative citology, negative smear at 12 months later:
Return to routine recall.
25-49 years, every 3 years. 50-65 years, every 5.
Diagnostic thresholds for gestational diabetes:
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
Capillary blood glucose targets in GDM:
Fasting: 5.3mmol/L
AND
1 hour postprandial: 7.8 mmol/L or
2 hours postprandial: 6.4 mmol/L
Labour, Bishop <=6 after membrane sweep:
Vaginal prostaglandins or oral misoprostol
Labour, Bishop >6
Amniotomy and oxytocin infusion
Vaginal candidiasis treatment:
Oral fluconazole 150 mg as a single dose first-line, clotrimazole 500 mg intravaginal pessary if oral contraindicated
Recurrent vaginal candidiasis, 4x or more per year, treatment:
Induction: oral fluconazole every 3 days for 3 doses
Maintenance: oral fluconazole weekly for 6 months
2 or more COCP pills missed in weeks 1, 2, and 3:
abstain from sex until she has taken pills for 7 days in a row.
week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
- week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
- week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
Contraceptives that may decrease bone mineral density
Depo provera
Treatment for vaginal candidiasis in pregnancy:
Clotrimazole pessary, oral fluconazole contraindicated because of congenital abnormalities
SSRIs of choice in breastfeeding women
Sertraline or paroxetine
First-line contraception for women with idiopathic menorrhagia:
Levonorgestrel intrauterine system
Need for contraception after the menopause:
- 12 months after the last period in women > 50 years
- 24 months after the last period in women < 50 years
Test to confirm menopause (and premature ovarian failure):
FSH
Exercise caution with what type of patients when prescribing ulipristal?
Severe asthma
Treatment for stress incontinence who don’t respond to pelvic floor muscle exercises and decline surgical intervention
Duloxetine
Intrauterine system (levonorgestrel) mode of action
Inhibits endometrial proliferation
Progestogen-only pill (excluding desogestrel) mode of action
Thickens cervical mucus
Treatment for secondary dysmenorrhea:
Refer to gynae
Third-stage labour, loss of 700 mls, next step after IV crystalloids:
Compress uterus and catheterise
Suspected PE in pregnant women with a confirmed DVT, treatment:
LMWH first then investigate to rule in/out
Pregnant women ≥ 20 weeks, presents with chickenpox rash of less than 24 h, treatment:
Oral aciclovir
Secondary menorrhagia, no symptoms of underlying pathology, requires contraception: first and second line:
IUS
COCP
First line treatment for:
Urge incontinence
Stress incontinence
Urge: bladder retraining
Stress: pelvic floor muscle training
Perineal muscle tear after delivery, degree and treatment
2nd degree, suture in ward
Tear to perineum involving any anal sphincter after delivery, treatment and degree
3rd degree, suture in theatre
First and second line treatment for pelvic inflammatory disease:
first-line: stat IM ceftriaxone + followed by 14 days of oral doxycycline + oral metronidazole
second-line: oral ofloxacin + oral metronidazole
Pregnant, fasting glucose of 6.8 mmol/L, treatment:
Diet and exercise for 1-2 weeks. If targets not met, start metformin
Gestational diabetes: if the fasting plasma glucose is < 7 mmol/l a trial of diet and exercise should be offered for 1-2 weeks.
If >7, insulin.
Combined oral contraceptive pill and risks of cancer:
Increased risk of breast and cervical cancer
Protective against ovarian and endometrial cancer
22 weeks pregnant, exposure to chickenpox, unknown vaccination status:
Urgent blood test to check for varicella antibodies.
Antivirals or VZIG (if available) should be given at days 7-14 post-exposure, not immediately
If not immune, either varicella-zoster immunoglobulin (VZIG) or aciclovir can be given to a pregnant woman >20 weeks.
Less than 20 weeks pregnant and not immune, only VZIG would be offered.
Alternative for oral metronidazole in bacterial vaginosis:
Topical metronidazole or clindamycin
Drugs that can cause erythema nodosum
Penicillins, sulphonamides, COCPs
26 weeks pregnant with heavy vaginal bleeding. Rhesus negative. Sensitisation management?
Anti-D followed by Kleihauer test. Kleihauer test for all sensitising events after 20 weeks.
Most common cause of breast abscess in lactation:
Staph aureus
Pharmacological measure for stress incontinence:
Duloxetine
What is Meig’s syndrome:
Benign ovarian tumour (usually a fibroma) associated with ascites and pleural effusion
Common adverse effect of Progestogen-only pill
Irregular bleeding
