paassmed Flashcards
T1DM is a risk factor fo pre eclampsia what shuld haev happen at 12 weeks if this is the case
presccribed aspirin
indication for high dose folic acid in preg
women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy
obesity
DM
anitepiletic meds
reduced fetal movements
If a pregnant woman reports reduced fetal movements then handheld Doppler should be used to confirm fetal heartbeat as a first step
Initially, handheld Doppler should be used to confirm fetal heartbeat.
If no fetal heartbeat detectable, immediate ultrasound should be offered.
If fetal heartbeat present, CTG should be used for at least 20 minutes to monitor fetal heart rate which can assist in excluding fetal compromise.
If concern remains, despite normal CTG, urgent (within 24 hours) ultrasound can be used. Ultrasound assessment should include abdominal circumference or estimated fetal weight (to exclude SGA), and amniotic fluid volume measurement
If between 24 and 28 weeks gestation, a handheld Doppler should be used to confirm presence of fetal heartbeat.
If below 24 weeks gestation, and fetal movements have previously been felt, a handheld Doppler should be used.
If fetal movements have not yet been felt by 24 weeks, onward referral should be made to a maternal fetal medicine unit.
most appropriate anti-depressant to commence in breastfeeding women
sertraline or paroxetine
does induction of labour reduce shoulder dystocia
Induction of labour at term can actually reduce the incidence of shoulder dystocia in women with gestational diabetes.
PPH approach to management pre medical and srugical
ABC approach
two peripheral cannulae, 14 gauge
lie the woman flat
bloods including group and save
commence warmed crystalloid infusion
mechanical
palpate the uterine fundus and rub it to stimulate contractions (‘rubbing up the fundus’)
catheterisation to prevent bladder distension and monitor urine output
first line to 5th line pph medicla approach
IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
misoprostol sublingual
there is also interest in the role tranexamic acid may play in PPH
PPH sugical mangemen
surgical: if medical options fail to control the bleeding then surgical options will need to be urgently considered
the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure
women need to take what in preg for how long
Vitamin D 400IU daily throughout the pregnancy, and folic acid 5mg daily for the first 12 weeks of pregnancy
8-12 week booking appoitment for preg what occurs
Booking visit
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria
when do women have Early scan to confirm dates, exclude multiple pregnancy
10-13+6 weeks
Your next patient in an antenatal clinic is a woman who is 30 weeks pregnant. Which of the following findings during your examination would you be concerned with?
Fundal height growth of 2cm per week
The correct answer here is a fundal height growth of 2cm per week. After 24 weeks you would only expect the fundal height to increase by 1cm a week. You would, therefore, be concerned that either there is an unknown multiple pregnancy or the baby is big for dates and further investigations should be carried out.
You would expect the fundus to be palpable at the umbilicus from 20 weeks and at the xiphoid sternum from 36 weeks.
In gestational diabetes, if blood glucose targets are not met with diet/metformin then insulin should be added
2weeks
when do miscarriages needed to be managed medically surgerically
increased risk of haemorrhage
she is in the late first trimester
if she has coagulopathies or is unable to have a blood transfusion
previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage)
evidence of infection
side effect of ovulation induction
Ovarian hyperstimulation syndrome
what is premenstrual syndrome
Premenstrual syndrome (PMS) describes the emotional and physical symptoms that women may experience in the luteal phase of the normal menstrual cycle.
PMS only occurs in the presence of ovulatory menstrual cycles - it doesn’t occur prior to puberty, during pregnancy or after the menopause.
anxiety
stres
fatiue
mood swings
mx of premenstrual syndrome
Options depend on the severity of symptoms
mild symptoms can be managed with lifestyle advice
apart from the usual advice on sleep, exercise, smoking and alcohol, specific advice includes regular, frequent (2–3 hourly), small, balanced meals rich in complex carbohydrates
moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)
examples include Yasmin® (drospirenone 3 mg and ethinylestradiol 0.030 mg)
severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)
this may be taken continuously or just during the luteal phase (for example days 15–28 of the menstrual cycle, depending on its length)
Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency
fibroids
do uterine fiboids grown durign pregnancy
yes - due to increased oestrogen
DIagnosis of PCOS needs 2 out of 3 features:
oligomenorrhoea
clinical and/or biochemical signs of hyperandrogenism
polycystic ovaries on ultrasound, oligomenorrhoea or amenorrhoea, and hirsutism
what hormone are uterine fibriods sensitive too and what happens when they grow
Uterine fibroids are sensitive to oestrogen and can therefore grow during pregnancy. If growth outstrips their blood supply, they can undergo red or ‘carneous’ degeneration. This usually presents with low-grade fever, pain and vomiting. The condition is usually managed conservatively with rest and analgesia and should resolve within 4-7 days.
A 25-year-old woman (G1P1) undergoes a vaginal delivery at 39 weeks gestation, followed by a physiological third stage of labour. In the hours following, she has some brown mucousy vaginal discharge with blood in it, producing approximately 100ml of blood.
On examination, the patient has a GCS of 15, a soft but tender abdomen. Her blood pressure is 132/83 mmHg, her pulse is 86 bpm, her temperature is 36.5C.
What is the most appropriate next step in her management?
provide sanitary pads
A 35-year-old woman presents to her GP with complaints of vaginal itching and a burning sensation in her vagina. She notes that these symptoms worsen during and immediately after sexual intercourse. The patient confirms that she has only one sexual partner and that they use latex condoms for contraception.
What is the most likely underlying cause?
Irritant contact dermatitis
The patient is likely experiencing pruritus vulvae. Potential underlying aetiologies for this symptom include irritant contact dermatitis, atopic dermatitis, seborrhoeic dermatitis, lichen planus, lichen sclerosus, and psoriasis.
puritis vulvae mx
women who suffer from this should be advised to take showers rather than taking baths
they should also be advised to clean the vulval area with an emollient such as Epaderm or Diprobase
clean only once a day as repeated cleaning can aggravate the symptoms
most of the underlying conditions will respond to topical steroids
combined steroid-antifungal may be tried if seborrhoeic dermatitis is suspected
fibroid degeneration presents how
presenting with low-grade fever, pain and vomiting.
In suspected placenta praevia, digital vaginal examination should not be performed before an ultrasound as it may provoke a
severe haemorrhage
methotraxate stopped for both men and women how long before conception
Methotrexate: must be stopped at least 6 months before conception in both men and women
The only effective treatment for large fibroids causing problems with fertility is
myomectomy
when do you get a cervical smear if pregnant
NICE guidelines suggest that a woman who has been called for routine screening wait until 12 weeks post-partum for her cervical smear.
A 45-year-old G3P2 is brought to the emergency department by the paramedics after she suffered a generalized tonic-clonic seizure. Her blood pressure was found to be 190/125 mmHg. The paramedics obtained IV access and also administered intramuscular magnesium sulfate to treat her seizures. She was then put on an IV infusion of magnesium sulfate. On her arrival to the accident and emergency department, her respiratory rate is found to be 10 breaths per minute. You suspect this might be a case of respiratory depression secondary to magnesium sulfate.
What is the drug of choice for reversing respiratory depression caused by magnesium sulphate?
A 45-year-old G3P2 is brought to the emergency department by the paramedics after she suffered a generalized tonic-clonic seizure. Her blood pressure was found to be 190/125 mmHg. The paramedics obtained IV access and also administered intramuscular magnesium sulfate to treat her seizures. She was then put on an IV infusion of magnesium sulfate. On her arrival to the accident and emergency department, her respiratory rate is found to be 10 breaths per minute. You suspect this might be a case of respiratory depression secondary to magnesium sulfate.
What is the drug of choice for reversing respiratory depression caused by magnesium sulphate?
