Passmed revision Flashcards
At what gestational age would you normally induce a pregnancy?
41 weeks
What are the steps in induction of labour?
- Cervical sweep
- Vaginal prostaglandin
- Artificial rupture of membranes
- Syntocin to induce contractions
Asymptomatic bacteruria in pregnancy?
Should be treated with abx (confirm with 2nd culture).
- Nitrofurantoin (avoid at term), amoxicillin or cefalexin
- Trimethoprim CI as it is a folate antagonist!
All pregnant women should be screened at booking.
Date of Down’s syndrome screening
12 weeks (11-14 wks)
Date of fetal anomaly screening
20 weeks
Treatment of PID
IM ceftriaxone
Doxycycline + metronidazole (14d PO)
Significant chickenpox exposure in pregnancy
Check VZV immunity. If not immune:
- VZV Ig ASAP if <=20wks gestation
- VSV Ig or aciclovir at 7-14 days post-exposure if >20wks
Note that if rash develops, oral aciclovir should be given if it is within 24h of onset. (Give if >20wks, consider if <20wks)
Which antiepileptic is recommended in pregnancy?
Lamotrigine
Carbamazepine, levetiracetam are also less high-risk
Indications for high-dose (5mg) folic acid in pregnancy
- Personal, family hx or previous child with neural tube defects
- Diabetes mellitus (gestational or otherwise)
- On antiepileptics esp. valproate
- On antifolates
- High cell turnover: sickle-cell, coeliac
- BMI >30
When should anti-D antibodies be given, assuming a mother is Rh- and unsensitised?
Prophylactically: 28 weeks (or 28wks / 34 wks)
Otherwise:
- Surgical termination at any gestation
<12wks:
- Heavy, repeated or painful uterine bleeding
- Ectopic or molar pregnancy
>12wks:
- Miscarriage and intra-uterine death
- In-utero interventions (including CVS / amniocentesis)
- External cephalic versions / abdo trauma
- Delivery (if baby is confirmed Rh+ on cord blood sampling)
Phenytoin in renal impairment?
No change (it is metabolised by the liver)
Furosemide in chronic renal impairment?
Increase dose (fewer nephrons, so need higher dose)
Penicillins, cephalosporins and quinolones in renal impairment?
Dose frequency may need to be reduced as they are excreted renally and can accumulate in renal impairment
Antiepileptics in renal impairment?
Most are metabolised by liver so no change needed
Except levetiracetam
What electrolyte derangement is caused by corticosteroids and loop diuretics?
Hypokalaemia
