PASSMED OBS AND GYNAE Flashcards
Rubella in pregnancy - non immune ?
-Advise to keep away from people with rubella
-Offer MMR vaccination postnatal period
Down syndrome combined test?
- Decrease PAPPA-A
- Increase in beta-hCG
-Thickened nuchal translucency
RCOG guidance development DVT?
If clinical suspicion of DVT or PE - LWMH commenced
What women on LWMH should be monitored with a specific blood test?
-Women at extreme of body weight <50 or >90
-Complicating factors (renal impairment or recurrent VTE)
What is used to monitor women on LMWH?
Anti-Xa factor
What should be used to monitor women with unfractioned heparin?
APTT
How long to wait after taking ulipristal?
5 days - this is because ulipristal acetate may reduce the effectiveness of hormonal contraception - barrier methods should be used
When can women continue taking the combined pill?
-Must be on established on COCP
-COCP restarted after a pill-free interval
-The missed pill must be later than the first week o fill taking
When refer to midwife led breastfeeding clinic?
If breastfed baby looses >10% birth weight in 1st week life - refer
In preterm rupture of membranes what medication should be given to reduce the risk of RDS?
Corticosteriods such as dexamethasone
(<37 weeks)
-IM dexamethasone
What weeks should magnesium sulphate be given if PPROM?
Women who are less than 34 weeks - foetal neuroprotection
What are results in downs syndrome quadruple test?
-Decreased AFP
-Decreased oestridol
-Increase hCG
-Increase Inhibit A
Combined test vs quadruple test?
-Combined test (11-13+6 weeks)
-Quadruple test (15-20 weeks)
What is measured in combined test?
-HCG -increase
-PAPPA-A - decrease
-Nuchal translucency - thickened
-Edwards (18) and patau (13) syndrome - similar result but HcG tends to be lower
What do results of combined and quadruple test show?
-Lower chance e.g. 1 in 300
-higher chance 1 in 100
If woman has higher chance then what should be offered?
NIPT (screening test) or CVS (diagnostic)
Sensitivity and specificity for NIPT?
very high for trisomy 21 (>99%)
-Measures cell free fetal DNA
Fetus in OP position during labour?
-Delievry possible may be longer and more painful
-Fetal head may rotate spontaneously to OA position
-Augmentation offered if process is slow
-Kielland forceps are associated with most successful outcome - require expertise
-Women will experience an early urge to push in OP than OA
3 types of placenta accreta
-accreta: chorionic villi attachment to myometrium
-Increta: chorionic villi into myometrium
-Percreta: chorionic villi invade through he perimetrium
Breech baby prolonged vaginal delivery?
-Caesaran section
1st line investigation for premature rupture of membranes?
-Careful speculum examination to look for amniotic fluid in posterior vaginal vault
-avoid bimanual risk of infection
When can IUS be inserted after?
within 48 hours of childbirth or 4 weeks after
-4 week after is due to increased rusk of expulsion and lacking data surrounding uterine perforation
What form of contraception should be discontinued >50?
Injectable contraceptives - Depo-provera - associated with loss in bone mineral density
-COCP should also be stopped
What presentation has greatest mortality and morbidity risk?
Footling presentation
-5-20% risk of cord prolapse
What should women with high or moderate risk of preeclampsia take?
75-150mg of aspirin from 12 weeks until brith
When can you take COCP post part?
-wait 21 days risk of venous thromboembolism
When is anomaly scan?
18-20+6 weeks
Medical for PPH?
-IV oxytocin: slow IV injection followed by an IV infusion -syntometrine
-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
When do you need to continuously monitor CTG when in labour?
-suspected chorioamnionitis or sepsis, or temp >38
-Severe hypertension >160/110
-Oxytoxcin use
-Significant meconium
-fresh vaginal bleeding
Painless bleeding, uterus large for date, hyperesmsis?
Hydatifrom mole
Endometritis?
Admit - clindamycin and gentamicin until afebrile for >24 hours
Reduced foetal movements - no heartbeat detected with handheld doppler?
Immediate ultrasound scan
When should fetal movements be established?
-24 weeks gestation
Risk factors for RFM
-Posture (more prominent lying down and less when sitting and standing)
-Distraction (women not as aware of movements)
-anterior placenta prior 28 weeks lesser awareness
-Medication - alcohol and benzodiazepines
-Fetal position (anterior fetal position means movements are less noticeable)
-Obese women
-Oligohydramnios and polyhydramnios can cause reduction in fetal movements
-Fetal size - 29% presenting with RFM have SGA foetus
Refer to fetal medicicine unit?
-If fetal movements have not been felt baby 24 weeks
When is lactational amenorrhea a reliable form of contraception?
-Amenorrhoeic, <6 months, breastfeeding exclusvely
When to give aciclovir to women contact with chicken pox ?
-Present within 24 hours onset of rash and are 20+0 weeks
Post natal depression scale?
Edinburgh postnatal depression scale
>13 indicates depressive illness of varying severity
When can postpartum women take progesterone pill?
immediatley
When do women require contraception post partum?
21 days after giving birth
Pearl index COCP 0.2
every thousand women using contraception 1 year 2 pregnant
Cephalosporins breastfeeding?
considered safe
Umbilical cord prolapse
-can push presenting part of fetes back into the uterus to avoid compression
-minimal handling
-all fours
-retrofillign bladder with 500-700ml saline
Stretococcus agalacticae
-Gram postive
-Cocci in chains
Aspirin breast feeding?
Aspirin avoided in pregnancy - can increase risk of reyes syndrome and also cause metabolic acidosis
What is a serious manifestation of pre-eclampsia?
HELLP syndrome
Postpartum thyroiditis
- Thyrotoxicosis
- Hypothyroidism
- Normal thyroid function (but high recurrence rate in future pregnancy)
What do you treat postpartum thyroiditis with in the thyrotoxicosis stage?
Propranolol
POP take missed pill as soon as possible and advise condom use until pill taking re-established
take missed pull as soon as possible and advise condom use until pill taking reestablished
What is oligohydraminos ?
Deficiency of amniotic fluid during pregnancy - can present with smaller symphysis fundal height
Quantify oligohydramnios
<500ml 32-36 weeks and an amniotic fluid index <5th percentile
starting COCP after taking levonorogestrel?
Can immediately be started
What are the causes of oligohydramnois?
-PROM
-potter sequence (bilateral agenesis + pulmonary hypoplasia)
-Intrauterine growth restriction
-Post-term gestation
-Pre-eclampsia
What are the most effective form of contraception?
Implantable contraceptives very low failure rate 0.05%
Cardiac changes in pregnancy ?
96% have ejection systolic murmur
84% women have third heart sound
-This is because there is increased cardiac output and volume increase which occurs during pregnancy
PPH medical management?
-Palpate the uterine fundus and rub it
-Ensure bladder empty
-Oxytocin 5 iu slow IV or 10 units IM
-Ergometrine 0.5mg slow IV or IM (not women with HTN)
-Oxytocin infusion (40iu in 500ml)
-Carboprost
-misoprostol
When is first dose of anti-D given to rhesus negative women?
28 weeks
Early scan to confrim dates?
10-14 weeks
Anamoly scan?
18-20+6 weeks
What should you measure when giving magnesium sulfate?
-Monitor reflexes and respiratory rate
Women with SLE?
At higher risk of pre-eclmapsie - takle aspirin 12 weeks
BISHOP SCORE <6
-Vaginal prostaglandins or oral misoprostol
-Mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
Bishops score >6
-Amniotomy and an intravenous oxytocin infusion
Transverse lie - amniotic sac not ruptured
- Can perform external cephalic version
IUD switch to COCP
if day 1-5 cycle no contraception needed
Postive hep B mother - neonate vaccination?
Hep B vaccine and 0.5 ml within 12 hours of birth with further vaccine 1-2 months and furtehr vaccine 6 months
AFP down syndrome vs nerual tube defects?
AFP raised in neural tube
AFP decreased in Downs
COCP before surgery?
Stop for 4 weeks and prescribe POP
Quadruple test results
Low AFP, high inhibin A, low eostridol
Raised AFP associated with?
omphalocele
