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Y5 Gynae & Obstetrics > Passmed 2 > Flashcards

Passmed 2 Flashcards

1
Q

At what gestation do foetal movements occur

A

18-20

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2
Q

At what gest do you refer to foetal medicine unit if no foetal moevemnts are present

A

24 weeks

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3
Q

what are RF for hyperemesis

A 
first pregnancy
multiple pregnancies
trophoblastic disease
hyperthyroidism
obesity
Asian 
PMH/FH
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4
Q

what findings on uss are diagnostic of miscarrigae

A

crown-rump length greater than 7mm with no cardiac activity is diagnostic of a miscarriage

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5
Q

what are factors for continous CTG in labour

A

e following are present or arise during labour;
suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
severe hypertension 160/110 mmHg or above
oxytocin use
the presence of significant meconium
fresh vaginal bleeding that develops in labour

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6
Q

what are the FRASER guidelines

A
  1. Person UNDERSTANDS advice
  2. Person CANNOT BE PERSUADED to inform parents
  3. Person likely to begin or continue having sex WITHOUT treatment
  4. Unless person does not receive contraception, mental and physical health is likely to suffer
  5. Person’s best interest requires them to receive contraceptive advice with / wihtout consent
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7
Q

What are MEC4 criteria for COCP

A 
>35 and smoker (>15) 
migraine with aura 
PMH DVT/PE <45 yo 
PMH stroke /IHD
Uncontrolled HTN 
Breast cancer 
Breast feeding AND <6week pp
Recent surgery with prolonged immob
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8
Q

What are MEC3 for COCP

A 
IMmobility 
>35 + smoker (<159 
migrainwe, no aura 
FH DVT/PE <45 
Controlled HTN
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9
Q

what med can you give to suppress lactation

A

cabergoline

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10
Q

explain classifications of third degree teara

A

3a: less than 50% of the thickness of the external anal sphincter is torn
3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact
3c: external and internal anal sphincters are torn, but anal mucosa is intact

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11
Q

When is lactational amenorrhoea effective as birth control

A

Only effective if:

  • in the 6 months after birth
  • FULL amenorrhoea
  • fully/almost fully breastfeeding
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12
Q

how does haemochromatosis cause amenorrhoea

A

deposits iron in hypothalamus and ovaries

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13
Q

What is the diagnostic test for haemochromatosis

A

iron studies

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14
Q

When do you deliver dichorionic vs monochorionic

A

dichorionic: 37 weeks
monochorionic: 36 wks

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15
Q

How do you manage labour in a woman with infibulation (aka clasp circumcision)

A

ANTERIOR episiotomy during second stage of labour

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16
Q

How can you calculate delivery date based on woman’s LMP

A

Naegele’s rule:

LMP + 1 yr + 7 days - 3 months

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17
Q

When do you review a woman with expectant management of miscarriage

A

Discharge with review in 2 weeks

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18
Q

How do you safety net a woman managed with expectant mx of miscarriage

A

Return to early pregnancy unit if

  • heavy bleeding /bleeding not lighter in 2 weeks
  • sx infection (fever, discharge)
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19
Q

what women is expecant mx of miscarriage NOT appropriate in

A
  • increased risk of haemorrhage (e.g. late first timerster, bleeding disorder)
  • previous adverse/traumatic event in pregnancy (e.g. miscarriage, stillbirth, APH)
  • Increased risk from effect of haemorrhage (e.g. cannot have blood transfusion)
  • evidence of infection
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20
Q

what meds do you give. for. medical mx of miscarriagew

A

vaginal misoprostol

+ antiemetics + pain relief

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21
Q

What should a patient undergoing medical mx of miscarriage expect

A

nausea vomiting pain diarrhoea

vaginal bleeding

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22
Q

when should a woman take a pregnancy test after medical mx of miscarriage

A

3 weeks later

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23
Q

absolute contraindications for HRT

A 
suspected pregnancy 
current breast cancer 
endometrial cancer 
active liver disease
uncontrolled HTN 
known curent VTE 
thrombophilia
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24
Q

side effects of HRT

A

same as usual side effects of oestrogen and prog

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25
Q

what are two risks of HRT you should counsel pt on

A
  • slightly increased risk of breast cancer (within 5 years of stopping use risk disappears)
  • risk of VTE and stroke (very small, similar to OCP)
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26
Q

What conditions can you investigate with saline infusion sonography

A

Submucosal fibroids

Endometrial polyps

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27
Q

List the ix for fibroids

A 
FBC - anaemia 
TVUSS - submucous, small intramural
TAUSS - large intramural, subserosal 
Saline infusion sonographjy 
MRI 
Hysteroscopy
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28
Q

What are risk factors for ovarian cancer?

A

High oestrogen

  • early menarche
  • late menopause
  • nullip
  • tamoxifen
  • obestiy
  • cigarette smoking
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29
Q

What are protective factors for ovarian cancer

A
  • COCP
  • multip
  • tubal lig
  • salpingectomy, hysterectomy
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30
Q

What two genes are associated with ovarian cancer

A

BRCA

Lynch

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31
Q

What cancers does BRCA cause

A

Breast, ovarian, pancreatic

prostate in men

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32
Q

What cancers does Lynch cause

A

Ovarian, endometrial, colorectal

33
Q

How do you manage pt with BRCA

A

COCP (reduced ovarian cancer by 50%)

As soon as family is complete: bilateral salpingo-oophorectomy

34
Q

List all sx of ovarian cancer

A
  • abdominal bloating, increased abdo girth
  • early satiety
  • pelvic pain
  • change in bowel and bladder habit, urinary sx
  • backache
  • FLAWS
35
Q

What two complications of ovarian cancer can you pick up on examination

A

Ascites

Pleural effusion

36
Q

what kind of ovarian tumours produce sex hormones?

A

SEX CORD STROMAL TUMOURS:
- Granulosa cell tumours (inhibin)
. Sertoli leidig (androgens)

37
Q

what symptoms occur with sex cord stromal tumours?

A 
Manifestations of excess sex hormone production!! 
- irregular menstrual bleeding 
- postmenopausal bleeding 
- precocious puberty 
-
38
Q

What investigation do you need to determine FIGO staging for endometrial cancer

39
Q

What percentage of endometrial hyperplasia SIMPLE prpgresses to cancer?

A

<5% progressed to cancer over 20 years

40
Q

What percentage of endometrial hyperplasia complex progress to cancer

A

20% per annum

41
Q

Explain ft of 1A cervical cancer and how it iis treated

A

MICROSCOPIC

remove surgically with clear margins

42
Q

Explain how cervical cancer 1B-4 is treated

A

If localised: Wertheim’s hysterectomy (radical hysterectomy + bilat pelvic node resection)

If fertility sparing: radical trachelectomy (cervix + upper vagina + pelvic nodes)

If tumour is beyond cervix: radiotherapy

43
Q

what is the presentation of lichen planus on the vagina

A

Pruritic, purple, polygonal papules

44
Q

when is ovarian cyst rupture most likely to occur

A

during physical exercise e.g. a run, sexual intercourse

45
Q

who do you offer OGTT in, and when

A

if risk factors are present: 24-28 weeks

if prior history of GDM: 16-18 weeks and repear at 24-28 weeks

46
Q

when do you use TVUSS in pregnancy

A

early pregnancy <12 weeks
examining the cervix later in pregnancy
identifying lower edge of placenta
women with lots of adipose tissue

47
Q

When do you use TAUSS in pregnancy

A

pregnancy >12 weeks

48
Q

WHen can you use CRL for dating until 1

49
Q

What can you use for dating from 14-20 weeks

A

FOETAL BIOMETRY (measurements on USS)

HC, BPD, FL

50
Q

when can gestational age no longer be calculated by USS

A

> 20 weeks

51
Q

what is the biggest risk with MCMA twins?

A

cord entanglement

52
Q

How do you manage a mum with MCMA pregnacy

A

Admit from 28 weeks
CTG daily (for signs of cord compression
Deliver by CS 32-34 wks

53
Q

when would you give mag sulph for neuroprotection if PTL

A

between 24 and 34 weeks if IN PRETERM LABOUR or having planned preterm birth within 24 hours

offer 23-30
consider 30-34

54
Q

How do you manage HELLP syndrome

A

IV mg sulph
+ anti HTN therapy

NOT DEX

55
Q

what BP must you aim for if HTN/PET in pregnancy

56
Q

explain complications of PPROM

A

To foetus:

  • prematurity > NEC, RDS et c
  • infection > sepsis
  • low fluid volume > lung hypoplasia, face and limb deformity
57
Q

What is prom

A

Prelabour ROM

so rupture of membranes before the onset of labour at >37 weeks

58
Q

How do you manage PROM

A

Monitor and wait 24 hours
Most women will go into labour spontaneously
if not, offer IOL

59
Q

when does acute fatty liver of pregnancy typically occur

A

third trimester

60
Q

what are fts of acute fatty liver of pregnancy

A

Jaundice
Abdominal pain (commonly in right upper quadrant)
Nausea and/or vomiting
Malais, Fatigue

Oliguria

Tachycardia, Fever

Disseminated Intravascular Coagulation

61
Q

what is the main problem of AFLOP

A

metabolic acidosis (due to damaged hepatocytes) > foetal morbidity aand mortality

62
Q

How do you manage AFLOP

63
Q

What is outcome of quadruple test for Down’s

A

low AFP
low oestriol
high beta hCG
high inhibin A

64
Q

what are sensitisation events for anti D

A

Antepartum haemorrhage
Placental abruption
Abdominal trauma
External cephalic version
Invasive uterine procedures such as amniocentesis and chorionic villus sampling
Rhesus positive blood transfusion to a rhesus negative woman
Intrauterine death, miscarriage or termination
Ectopic pregnancy
Delivery (normal, instrumental or Caesarean section)

65
Q

What is the risk of having GBS again if positive in prior pregnancy? what should you do for these women?

A

Risk is 50%

Offer

  • intrapartum prophylactic abx
  • testing in late pregnancy
66
Q

Who do you give intrapartum antibiotic prophylaxis to

A
  • prior GBS baby
  • incidental detection of GBS in current pregnancy
  • GBS bacteriuria
  • maternalpyrexia
  • prolonged ROM >18 h
  • Premature
67
Q

How do you manage woman with high HIV viral load in delivery

A

Antiretroviral therapy (both antenatally and intrapartum)
IV zivodudine
Deliver by elective C section

68
Q

How do you manage infant born to HIV positive mother

A

Immediate cord clamping
Bathe baby
Give zivodudine 4-6 weeks after birth
Advice to not breastfeed

69
Q

What is testing of HIV like in baby born to HIV positive mother, so what should you do?

A

Neonates will test positive for HIV antibodies due to passive transfer from mother

So use PCR direct viral amplification - at birth, 3 weeks, 6 weeks, 6 months

70
Q

Can a woman breastfeed if HIV positive? how is this affected by her viral load?

A

She CANNOT breastfeed REGARDLESS of viral load

unless in developing country, where baby would be at risk of starvation/death

71
Q

How do you manage Hep B to prevent vertical transmission

A

GIve Hep B immunoglobulin immediately after birth

Give Hep B vaccine at birth, 1 momth, 6 months

72
Q

what must you do in labour if CTG is suspicious

A 
Repositionp mother 
IV fluids 
Reduce / stop oxytocin 
Correct any epidural related hypotension 
Continue CTG observation
73
Q

What must you do in labour if CTG is pathological

A

IMMEDIATE VAGINAL EXAMINATION - eclude malpresentation or cord prolapse

  • if fully diiated: instrumental delivery is possible
  • if not fully dilated: FBS. If FBS abnormal: delivery immediately. If FBS normal, continue labour but repeat samples every 30-60 mins. if CTG abnormalities persist
74
Q

What foetal pH indicates foetal compromise

A

pH <7.2

7.2 to 7.25 is borderline

75
Q

what are the 3 indications for induction of labour

A
  • Prolonged pregnancy max 41+5
  • Prelabour ROM (if >37wks, induce in 24h; if <34wks, conservative)
  • PET and other maternal HTN, OC, other deteriorating maternal illness
76
Q

what are CONTRAindications for synctocinon during labour

A
  • VBAC
  • Intact membranes (risk of amniotic fluid embolus)
  • Obstruction
77
Q

what is vasa previa bleeding always preceded by

78
Q

At what gestation do you reassess for placenta previa

A

32 weeks

and 36 weeks

Y5 Gynae & Obstetrics (34 decks)

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