Passmrcog Flashcards
1
Q
Pcos - what level of testosterone would lead you to look for other causes?
A
> 5nmol
2
Q
Treatment of overactive bladder in frail elderly
A
Tolterodine (immediate release)
Or Darifenacin (once daily preparation)
3
Q
Chlamydia in pregnancy treatment
A
Amoxicillin TDS 7/7
Erythromycin
Azithromycin 1g stat (if can’t give others)
4
Q
Risk of hysterectomy in placenta praevia
A
11%
5
Q
Pathognomic USS sign of TOA
A
Cogwheel sign
6
Q
TB treatment in pregnancy - what supplement should you give?
A
Pyridoxine 10mg OD
7
Q
Risks of early onset neonatal GBS
A
Overall incidence 0.57/1000 births in UK
Incidence in term infants without risk factors is 0.2/1000 births
Risk of EOGBS if GBS in previous pregnancy 0.9/1000 births
Risk of EOGBS if GBS in current pregnancy 2.3/1000 births
Risk of EOGBS if intrapartum pyrexia (>38oC) is 5.3/1000 births
8
Q
Normal amniotic fluid production in singleton pregnancy
A
increases progressively until 33 weeks of gestation, with a plateau between 33 and 38 weeks before declining
9
Q
Transient Neonatal Myasthenia Gravis
A
20% infants of mothers with MG
Symptoms within 12 hours - 4 days
Usually resolves spontaneously within 3-4 weeks
Due to maternal abs crossing placenta
10
Q
Percentage of stillbirths no cause found
A
50%
11
Q
Background risk of VTE in non-contraceptive users who are not pregnant
A
2 per 10,000 women per year
12
Q
Risk of future ectopic having had one ectopic
A
18.5%
13
Q
Risk of future ectopic following treatment for ectopic
A
18.5%
14
Q
Rate of shoulder dystocia following previous shoulder dystocia
A
10 fold higher
15
Q
Molar pregnancy hcg follow up
A
If hcg normal within 56 days of pregnancy - follow up = 6 months post uterine evacuations
If not, follow up = 6 months from normalisation of hcg
16
Q
Incidence of hirsuitism in UK
A
10%
17
Q
Presenting diameters
A
Vertex - 9.5cm - suboccipitobregmatic
Deflected OP - 11.5 - occipitofrontal
Brow - 13.5 - mentovertical
Face - 9.5cm - submentobregmatic
18
Q
recommended baseline biochemical test for hyperandrogenism in PCOS
A
Free androgen index = total testosterone / SHBG x 100
19
Q
Features of miscarriage on TVUS
A
CRL>7 and no FH
MSD>25mm and no fetal pole
20
Q
Pre-testicular male infertility features and causes
A
Hypogonadotrophic Hypogonadism
FSH low
Hypothalamic disease
Kallmans
Prader-Willi
CHARGE
Pituitary pathology
Tumours - pituitary
Brain injury inc iatragenic
Acquired
Steroid abuse
Raised prolactin
21
Q
testicular male infertility features and causes
A
Hypergonadotrophic Hypogonadism
FSH raised
Genetic
Kleinfelters
Noonan’s
Cryptorchidism
Acquired
injury
varicocele
tumours
chemo/xrt
idiopathic
22
Q
Post-testicular male infertility features and causes
A
FSH Normal
Congenital
Congenital absence of the vas deferens
CF
Youngs
Acquired
Infection
Vasectomy
Sperm dysmotility
Immotile cilia syndrome
Maturation defects
Immunological infertility
Globozoospermia
Sexual dysfunction
23
Q
Risk of bowel injury in laparoscopy
A
0.4 per 1000
24
Q
Cyst follow up
A
<50mm no follow up required
50-70mm yearly ultrasound
>70mm consider further imaging or surgical intervention
25
Management of GTD
Complete mole = 46XX
Mx = smm
Partial mole = 69XXY
Mx = smm unless over 15/40 then mmm
26
Uterine perforation rates at ERPC/hysteroscopy
ERPC for PPH 5.1 to 5.7%
Curretage intrauterine adhesions 0.07 - 1.8%
TOP 0.4 - 0.6%
Hysteroscopy for PMB 0.2% - 2%
27
Rubella
Incubation period
Miscarriage rate
Rate of congenital rubella
Incubation 12-24 days, 14 days average
20% miscarriage rate
90% rate of congenital rubella if <11/40
20% if 11-16/40
0% if >20/40
28
1st line treatment for myasthenia graves in pregnancy
Pyridostigmine = ACh esterase inhibitor
29
Risk if vertical transmission of parvovirus
<15 weeks gestation - 15%
15 - 20 weeks - 25%
Term - 70%
30
Risk of 3/4th degree tears with forceps
Without epis= 22.7%
With epis = 6%
31
What gestation is fetus at greatest risk of ionising radiation?
10-17 weeks
32
Changes in blood composition during pregnancy
- platelets
- coag factors
- fibrinogen
- ESR
Decreased platelets
Increased coag factors
Increased fibrinogen
Increased ESR
33
Hepatic adenoma risk
Increased risk with COCP use
Highest risk of haemorrhage/rupture in third trimester
- lifetime risk bleed 27%
- lifetime risk rupture 17%
Risk malignant transformation 5%
34
Chemo for GTD
Women with FIGO scores less than or equal to 6 treated with single-agent intramuscular methotrexate alternating daily with folinic acid for 1 week followed by 6 rest days
Women with FIGO scores greater than or equal to 7 are treated with intravenous multi-agent chemotherapy.
35
Treatment for hyperthyroid in pregnancy
PTU
36
Timings of GBS testing
35-37 weeks
3-5 weeks prior to expected delivery
37
Risk of male sterilisation failure
1 in 2000
38
Prevent of stillbirth with chromosomal abnormality
6%
39
Most common complication of acute fatty liver
Renal impairment
40
Percentage of babies needing nicu after fully CS
Percentage needing nicu after AVB
11%
6%
41
Incidence of breast cancer in pregnancy
1 in 3000
42
Autonomic dysreflexia
Assoc with spinal cord injury above T6
Presents with hypertension and Brady
43
Risks following death of one monochorionic twin
Death 15%
Neuro abnormality 25%
44
Treatment for toxoplasmosis
Spiramycin if suspected
pyrimethamine/sulfadiazine if confirmed on amnio
45
Number to treat calculation
- CS to prevent Fecal incontinece
- Cs for breech to prevent adverse outcome
- cs for breech to prevent neonatal death
- IOL to prevent stillbirth
1/(experiemental event rate-control event rate)
- 167
- 30
- 175-400
- 1040
46
Zika incubation period
7-18 days
47
Monitor of diabetes in beta thalassemia
Serum fructosamine
48
Fetal loss with appendicitis
Simple: 1.6%
Peritonitis: 6%
Perforation: 36%
49
% of woman with radiation cystitis following pelvic radiotherapy
Symptoms?
26% women surviving beyond 5 years
Urgency, dysuira, haematuria
50
Incidence of erbs palsy in shoulder dystocia
2-16% case
<10% permenant
51
Indications for cervical cerclage
CL<25mm plus
1. Hx spont PTL or midtrimester loss
2. PPROM in prev pregnancy
3. Hx of cervical trauma
52
% Risk post CS:
Infection
Bleeding
Hosp admissions
Pain
Infection 6%
Bleeding 5 in 1000
Hosp admissions 5%
Pain 9%
53
Max dose of lidocaine 1%
Half life?
3ml/kg
2 hours
54
Perinatal mortality rates with:
SVB breech
SVB cephalic
ELCS
2.0/1000 with planned vaginal breech birth
1.0/1000 with planned vaginal cephalic birth
0.5/1000 with caesarean section after 39+º weeks
55
Onset of postpartum psychosis
50% symptom onset day 1-3
Majority within 2 weeks
56
POP failure rate with perfect use
3 in 1000
57
POP method of action
Thickening cervical mucus
Desogestrel = inhibits ovulation
58
What percentage of CIN 1 and 2 lesions will regress spontaneously
>50% within 2 years
59
What layers does CIN2 effect
Basal 2/3 of cervix
60
How many years for CIN 2/3 to progress to cancer ?
What percentage will progress to cancer within 10 years if left untreated
15-25years
<2.5%
61
Feature needed for expectant management of ectopic
<30mm on scan with no heartbeat
Hcg <1500
62
At what gestational age do placental changes prevent significant passage of maternal thyroxine across the placenta?
12 weeks
63
Which serum marker if abnormal is assoc with oligohydramnios
Low unconjugated estrogen
64
Risk of emergency CS following ecv
1 in 200
65
For women who had gestational hypertension in a previous pregnancy whats the risk of hypertensive disorders in future pregnancies:
PIH
PET
Any HTN
Gestational hypertension 11-15%
Pre-eclampsia 7%
Any hypertensive disease 22%
66
Steps for management of PPH due to atony
1. Palpate and rub uterine fundus to stimulate contractions (rubbing up the fundus)
2. Ensure bladder is empty (leave Foley catheter in situ)
3. Oxytocin 5 iu by slow IV injection* (may have repeat dose)
4. Ergometrine 0.5 mg by slow IV or IM injection (contraindicated in women with hypertension)
5. Oxytocin infusion (40 iu in 500 ml isotonic crystalloids at 125 ml/hour)
6. Carboprost 0.25 mg by IM injection repeated at intervals of not less than 15 minutest (maximum 8 doses - caution in asthmatics)
7. Misoprostol 800 micrograms sublingual.
67
What % patients undergoing CS for placenta praevia will require further laparotomy
7.5%
68
What is the most common cause of spontaneous miscarriage and implantation failure in those undergoing IVF
Aneuploidies
69
success rate of VBAC in patients with previous CS for labour dystocia
64%
70
Injury to branches of which of the following vessels is responsible for a supralevator haematoma
Uterine artery branches in broad ligament
71
Semen analysis
Volume
pH
Sperm conc
Total number
Total motility
Vitality
Normal morphology
Semen analysis
Volume 1.5ml
pH >7.2
Sperm conc 15mill
Total number 39mill
Total motility 40% mobile, 32% progressive motility
Vitality 58%
Normal morphology 4%
39 million sperm meet to concentrate on 15 dances, 40 got moves, 32 try, 58 come alive but only 4 look normal
72
Chance of conceiving spontaneously with expectant management within 12 months in unexplained subfertility
74%
73
Average cycle fecundity without treatment in women with unexplained subfertility %
1.3-4.1%
74
Male infertility in CF
Cause?
What percent affected?
Congenital absence of vas deferens
98%
75
What percentage of subfertile couples will have unexplained infertility
30-40%
76
What is the surface cell protein composition of uterine natural killer cells?
CD56bright/CD16-
77
What is the surface cell protein composition of peripheral natural killer cells?
CD56 dim/CD16+
78
Nexplanon
Failure rate
% discontinuing due to side effects of...
% amenorrhoea
0.05% failure rate
20% discontinue due to heavy/irregular bleeding
20% amennorhoea
79
**VTE risk with contraception per 10,000**
Non-contraceptive users, not pregnant
CHC
Pregnancy
Non contraceptive users and not pregnant=2 per 10,000
CHC containing ethinylestradiol plus levonorgestrel, norgestimate or norethisterone=5-7 per 10,000
CHC containing etonogestrel (ring) or norelgestromin (patch)=6-12 per 10,000
CHC containing ethinylestradiol plus gestodene, desogestrel or drospirenone=9-12 per 10,000
Pregnancy=10 per 10,000
80
Cyclical HRT inhibits ovulation in what percentage of patients?
40%
81
LNG-IUD
Failure rate
Perforation rate
Expulsion rate
Infection risk
Risk of ectopic if ectopic occurs
Failure rate <1%
Perforation rate 1-2:1000
Expulsion rate 1:20
Infection risk 1:100 for 3/52 after insertion
Risk of ectopic if pregnancy occurs 1:20
82
Women over 40, % of unplanned pregnancies
20%
83
Women over 40, % of pregnancies ending in TOP
28%
84
Incidence of mitochondrial disorders
1 in 6500
85
Incidence of premature ovarian failure in <40yo
1%
86
Cu-IUD
Pregnancy rate
- within 1st year
- over 5 years
Perforation rate
Expulsion rate
Infection risk
Risk of ectopic if ectopic occurs
Pregnancy rate
- within 1st year 0.6-0.8%
- over 5 years 1-2%
Perforation rate 1-2:1000
Expulsion rate 1:20
Infection risk 1:100 for 3/52 after insertion
Risk of ectopic if pregnancy occurs 1:20
87
Stopping contraception around menopause
Age can stop
non-hormonal methods
POP
CHC
depot
Age >55 can stop
If non-hormonal methods
>50: stop 1 year after amennorhoea
<50: stop 2 years after amennorhoea
If POP:
Stop 1 year after 2xFSH>30 taken 6/52 apart
Do not use FSH in <50 to stop contraception
If CHC: stop 2/52 before checking FSH
If depot: stop 1yr before checking FSH
88
Condom effectiveness rate
Male and female typical and perfect use
Male typical use: 83%
Female typical use: 79%
Male condom perfect use: 98%
Female condom perfect use: 95%
89
Diaphragm
Effectiveness rate - typical and perfect
Timing of removal post sex
Timing of application of spermicide
HIV risk
Typical use: 88%
Perfect use: 94%
Remove >6hrs post sex
Apply more spermicide if >3hrs inserted
Noxyl-9 spermicide increase HIV transmission
90
Scoring system for hirsuitism
Ferriman and Gellwey
91
Complications following cervical ca radiotx
Bowel obstruction 14.5%
Fistula 8%
Dyspaerunia 55%
92
Zika primary vector
Aedes mosquito
93
Reduction in fibroid size with GnRH analgoues
36% reduction in fibroid size after 12 weeks
94
VBAC success rates
Planned overall 72-75%
Previous SVB 85-90%
Prev CS for malpresentation 84%
Prev CS for fetal distress 73%
Prev CS for labour dystocia 64%
95
Cu-IUD method of action
1. Prevents fertilisation - toxic effect of Cu on egg and sperm
2. Alters cervical mucus
3. Inflammatory reaction in endometrium
96
CHC method of action
prevents ovulation
97
Depot injection method of action
Prevents ovulation
98
Implant method of action
Prevent ovulation
99
POP
thickens cervical mucus
100
LNG-IUD
1. Prevents implantation by suppressing endometrium and increased endometrial phagocytic cells
2. Thickens cervical mucus
101
Gonnorhoea treatment
1g ceftriaxone IM stat
102
Chlamydia treatment
Doxy 100mg BD for 7/7
103
M. genitalis treatment
Doxy 100mg BD 7/7 then azithro 1g stat + 500mg OD for 2/7
If resistant or complicated: moxifloxacin 400mg OD for 7 or 14 days
104
Trichomonas treatment
metro 400mg bd for 7/7
105
Amsels criteria for BV
3 of 4 of:
1. thin white discharge
2. clue cells on microscopy
3. ph>4.5
4. Fishy small on adding alkali 10% KOH
106
BV
2 eponymous criteria's
Treatment
1. Amsels
2. Hay/Ison = lactobacilli vs gardnerella/mobilluncus dominance
Tx = metro
107
Neonatal herpes - % skin vs disseminated
Mortality and neuro morbidity with local skin, local CNS disease and disseminated disease
30% skin, 70% local CNS/disseminated
Skin best prognosis, neurological/ocular morbidity <2%
Local CNS disease - mortality ~6%, neurological morbidity 70%
Disseminated disease - mortality ~30%, neurological morbidity 17%
108
What is the acceptable level of plasma factor VIII and factor IX levels in severe haemophilia pre procedure
0.5iu/ml
109
How often should you cross match blood in placenta praevia and red cell antibodies
Weekly
110
What is the tool for diagnosing IBS
Rome III criteria
111
Parvovirus antibody results
IgG/IgM
IgG +ve / IgM -ve Immune
IgG -ve / IgM -ve Susceptible to infection
Positive for IgM (irrespective of the IgG result) Suggests recent infection
112
Investigations following T2 miscarraige
- screen for inherited thrombophilias
- APS screen
- pelvic USS
113
Treatment for mastitis if penicillin allergic
clarithro/erythro for 10-14 days
114
Inheritance of Rokitansky-Küster-Hauser syndrome
autosomal dominant inheritance with incomplete penetrance
115
Prognostic indicators in vulval SCC
nodal status
primary lesion diameter
116
Management of fibroids - reintevention rates of uAE vs surgery
32% vs 4%
117
who is highest risk of complete molar pregnancy
women >45
118
Egg/sperm description of partial molar pregnancy
normal egg is fertilised by two or more sperm
119
Amniocentesis sensitivity for CMV diagnosis
70-80%
120
Associations in pregnancy with raised afp
fetal growth restriction
placental abruption
fetal demise after 24 weeks
preterm delivery
spontaneous miscarriage
121
Associations in pregnancy with raised inhibit A
preterm delivery
gestational hypertension
pre-eclampsia
fetal demise after 24 weeks
fetal growth restriction
122
Associations in pregnancy with low unconjugated oestrogen
Oligohydramnios
Fetal demise after 24 weeks
low birth weight
spontaneous miscarriage
123
Associations in pregnancy with raised b-hcg
preterm delivery
gestational hypertension
pre-eclampsia
fetal demise after 24 weeks
fetal growth restriction
124
Boundaries of paravaginal haematomas
Inferior - pelvic diaphragm
Superior - cardinal ligament
125
Percentage of general population with benign liver lesions
20%
126
Risks at section for placenta praevia
Hysterectomy:
VTE:
Bladder/ureteric injury:
MOH:
Further laparotomy:
Hysterectomy: 11% (27% if previous CS)
VTE: 3%
Bladder/ureteric injury: 6%
MOH: 21%
Further laparotomy: 7.5%
127
Contraindications to cabergoline
PET
Cardiac valvulopathy
Hx if pericardial fibrosis
Hx of puerperal psychosis
Hx pulmonary fibrosis
Hx of retroperitoneal fibrosis
Hypersensitivity to ergot alkaloids
128
Vulval cancer 5 year survival
No LN involvement >80%
Inguinal LN involvement <50%
Iliac and other Pelvic LNs 10-15%
129
Vulval cancer 5 year survival
No LN involvement >80%
Inguinal LN involvement <50%
Iliac and other Pelvic LNs 10-15%
130
Figo vulval cancer stages
1: confined to vulva
1A: <2cm, <1mm deep
1B: >2cm, >1mm deep
2: extends to lower third urethra/vagina/anus with no nodes
3: extends beyond with nodes
3A: upper third urethra/vagina/anus/mucosa or regional LN<5mm
3B: regional LN >5mm
3C: regional LN with extracapsular spread
4A: bones mets, ulcerated LN
4B: distant mets
131
FIGO Stage 1 cervical cancer divisions
1A: invasive carcinoma dx by microscopy, max depth <5mm
1A1: stomal invasion <3mm depth
1A2: stromal invasic >=3 and <5mm depth
1B: invasive carcinoma >=5mm deep, limited to cervix
1B1: >/= 5 mm stromal depth, <2 cm dimension
1B2: >/= 2 cm and < 4cm dimension
1B3: >=4cm dimension
132
Cervical cancer FIGO stages 2-4
2: beyond uterus, but not to pelvic side wall or lower 1/3 vagina
2A: upper 2/3 vagina but not parametrium (A1<4cm, A2>=4cm)
2B: parametrium
3A: lower 1/3 vagina
3B: pelvic side wall +/- hydronephrosis/renal failure
3C1: pelvic LNs
3C2: paraaortic LNs
4A: pelvic organs
4B: distant mets
133
Rates of urinary incontinence postpartum
17-32%
134
Time taken for fibroids to return to pre-treatment size after stopping GnRH analogues
4-6 months
135
Risk of vault prolapse following hysterectomy
Hysterectomy for prolapse: 11.6%
Hysterectomy for other benign disease: 1.8%
136
Risk of co-existing endmetrial cancer with hyperplasia with atypia
up to 59%
137
hcg testing post salpingotomy
7 days postop
then weekly until negative result obtained
138
Risk of preterm birth by cervical length
<25mm - 25% risk of delivery before 28 weeks
<20mm:
42.4% before 32 weeks
62% before 34 weeks
139
Lifetime risk of ovarian cancer
1.4%
140
Low long should ureteric stents remain in following ureteric injury
6 weeks
141
Percentage of babies thy are breech at:
28 weeks
Term
28 weeks - 20%
Term - 3-4%
142
Enzyme inducing AEDs
Phenobarbital
Phenytoin
Carbamazepine (Tegretol®)
Topiramate
Oxcarbazepine
Philip found carbohydrates too overly inducing
143
What percentage of EH without atypia regress back to normal endometrium
75%-80%
144
Chance of a successful pregnancy outcome with open transabdominal cervical cerclage
85%
145
Aspirin moderate risk factors
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy
146
What proportion of ectopics are interstitial
2-5%
147
Indication for desmopressin in incontinence
Contraindications
Nocturia
>65, hypertension
148
Chance of GBS colonisation if GBS in a previous pregnancy
50%
149
Percentage of women who are GBS carriers
20-40%
150
Which AED does COCP lower levels of resulting in increased seizure prequency
Lamotrigine
151
Lifetime risks of endometrial cancer
-Normal weight
-Obese
3%
10%
152
What gestation should you stop these biologics and are they safe for BF:
- etanercept:
- infliximab
- Adalimumab
- certolizumab
- etanercept: stop prior to T3
- infliximab: stop prior to 16/40
- Adalimumab: stop prior to T3
- certolizumab: safe all trimesters
All safe for BF
153
Incidence of 3/4th degree tears:
- overall
- primip
- multip
- multip with previous 3/4th test:
- overall 2.9%
- primip 6%
- multip 1.7%
- multip with previous 3/4th tear 7.2%
154
% of patients with spinal cord injury who have worsening spacicity
12%
155
Histological findings in lichen sclerosis
Epidermal atrophy
sub-epidermal hyalinization
deeper inflammatory infiltrate
156
Positive kleihauer, doses of anti-D dependent on volume
Fetal leak up to 4ml = 500IU anti-D
Then 125IU/ml fetal red cells
157
CS and placenta praevia risk
No previous CS: 1 in 400, 0.25%
1 previous: 1 in 160, 0.6%
2 previous: 1 in 60, 1.6%
3 previous: 1 in 30, 3.3%
4 previous: 1 in 10
158
Benefits of rescue cerclage
Delay birth by 5 weeks
2-fold reduction in chance of birth <34/40
159
Most common liver lesion in pregnancy
USS features
Incidence in healthy individuals
Hepatic haemangioma
well circumscribed and hyperechoic
10%
160
incidence of endometrial cancer amongst patients diagnosed with granulosa cell tumour of the ovary
10%
161
Antibody levels at which to refer to FMU
- anti-D
- anti-C
- anti-K
- anti-E
Frequency of monitoring
What do FMU do
- anti-D >4
- anti-C > 7.5
- anti-K - if detected
- anti-E - if anti-c present
Every 4 weeks to 28 weeks then every 2 weeks
Weekly MCA - if > 1.5 multiples of median then consider invasive tx
162
What should you check in vulval detmatitis?
What % of patients with vulval dermatitis have a deficiency in this?
Ferritin
20%
163
How many days background radiation is one cxr equivalent to
10
164
Ovarian cancer risk with HRT
Increased by 1 per every 1000 women taking HRT
165
Risk of VTE with HRT
Risk of VTE increased 2-3 fold with PO HRT
166
Proportion of live births amongst women with CF
Prematurity rate
80%
25%
167
Flying in pregnancy
1. When not to fly beyond
2. Time when need special measures
3. Special measures
1. Single>37/40, twins>32/40
2. <4hrs= no special measures, >4hrs=special measures
3. TEDS, hydrate, in seat exercise every 30 mins, regular walks
168
Contraindications to flying in pregnancy
Severe anaemia (hb <7.5 g/dl)
Recent haemorrhage
Otitis media and sinusitis
Serious cardiac or respiratory disease
Recent sickling crisis
Recent gastrointestinal surgery
Bone fracture, where significant leg swelling may occur in flight
169
What BMI is a risk factor for abruption
Low BMI
170
Timing of 1st smear after CIN treatment
6 months
If negative —> 3yearly
If positive —> colp
171
Risk of molar pregnancy if one previous molar
1 in 80
172
What is the risk of a baby developing fetal varicella syndrome (FVS) if the mother develops chickenpox during the first 20 weeks of pregnancy and does not receive VZIG?
2.8%
If receives it then is nearly 0%
173
Anaphylaxis risk with VZIG
<0.1%
174
What percentage of twin pregnancies deliver before 37 weeks
50%
175
incidence of umbilical cord prolapse:
- overall
- in breech presentation
0.1-0.6%
1%
176
Incidence of ectopic pregnancy in the UK
1.1% or 11 in 1000
177
Associations with cord prolapse
Multiparity
Low birthweight (< 2.5 kg)
Preterm labour (< 37+0 weeks)
Fetal congenital anomalies
Breech presentation
Transverse, oblique and unstable lie
Second twin
Polyhydramnios
Unengaged presenting part
Low-lying placenta
178
Therapeutic targets for massive blood loss
Hb greater than 80 g/l
Platelet count greater than 50
PT and APTT <1.5x normal
Fibrinogen greater than 2 g/l
179
What percentage of patients with stage 1 ovarian cancers have an elevated CA125?
55%
180
accepted background cumulative dose of ionising radiation during pregnancy?
50mGy or 5rad
181
When should you perform amniocentesis for CMV diagnosis
At least 6 weeks after maternal infection
After 21 weeks gestation
182
Risks of developing cancer in complex endometrial hyperplasia
4 yrs
9 yrs
19 yrs
In 4 years: 8%
In 9 years: 12.4%
In 19 years: 27.5%
183
Rate of concomitant carcinoma in complex endometrial hyperplasia
Up to 43%
184
Minor risk factors for SGA
How many mean more scans
Scan timings
Age >35
IVF pregnancy
BMI <20
BMI 25-35
Smoker 1-10 cigs
Previous PET
Pregnancy interval <6/12 or >60/12
3 or more --> uterine artery doppler
If normal --> scan at 36/40
If abnormal --> serial growth scans
185
Major risk factors for SGA
How many mean more scans
Scan timings
Age >40
Maternal/paternal SGA
Cocaine
Overexercise
Previous SGA baby
Smoker >10/day
Chronic HTN
Diabetic vascular disease
Renal impairment
APS
Heavy PVB
Low Papp-a (<0.4)
186
What do you give if fibrinogen <2
2 pools cryoprecipitate
187
Trigger level for giving platelets in haemorrhage
How many pools
<75
1 pool
188
MOH and FFP
1. After how many units RBC should you give FFP and how much?
2. If prolonged APTT/PT, how much FFP do you give?
1. After 4 units blood transfused --> give 4 pools FFP
2. 12-15ml/kg
189
When is the anomaly scan
18+0 to 20+6
190
When is combined screening
10+0 to 14+1 weeks
191
Contraindications to EllaOne
uncontrolled asthma
severe hepatic impairment
192
Risk of future placenta praevia if placenta praevia
23 in 1000
or 2.3%
193
Associations with VIN
- undifferentiated
- differentiated
undifferentiated = high risk HPV
differentiated = lichen sclerosis
194
most common reasons for converting from laparoscopic to open transabdominal cerclage
Bleeding from uterine vessels
Poor views due to morbid obesity
195
Incidence of endometriosis
10-15% (same as endometriosis)
196
Miso regimes for IUD by dates
<26+6 weeks 100µg 6 hourly
≥27+weeks 25-50µg 4 hourly
197
Risk of haemorrhage requiring transfusion in hysterectomy for benign conditions
2.3%
198
Components of FIGO scoring for GTN
Age
Antecedent pregnancy (Mole, abortion, Term)
Interval months from end of index pregnancy to treatment
Pre-treatment serum hCG (iu/l)
Largest tumour size, including uterus (cm)
Site and number of metastasis
Previous failed chemo
199
Risk of progression to cancer with EH over 20 years
Without atypia: <5% over 20 years.
With atypia: 25-30%
200
Risk of GBS colonisation
50% if had previously
20-40% women carriers
201
Risk of vascular injury at laparoscopy
0.1-0.2 per 1000
202
203
NNT for IAP for preventing GBS in
- PROM
- intra partum fever
- 595
- 208
204
Tool for investigating patient safety incident
London protocol
205
When should you perform deinfibulation of FGM
13-20 weeks
206
NNT IAP to prevent GBS
595
207
NNT IAP to prevent GBS if maternal temp >38
208
208
Autopsy alone provides classification of death in what percentage of stillbirths
46%
209
Drugs to start if stop lithium
Antipsychotic eg. quetiapine
210
Mortality rates in sepsis
Severe sepsis with acute organ dysfunction = 20-40%
Septic shock = 60%
211
Approximately what percentage of women will have vaginal discharge within 12 months of UAE
16%
212
Incidence of pelvic pain following TOA
12% after one episode
30% after two episodes
67% after three or more episodes
213
