Pregnancy Flashcards by Alice MacArthur

UTI Tx choice if symptomatic

If asymptomatic

if the pregnant woman is symptomatic:
- a urine culture should be sent in all cases
- first-line: nitrofurantoin (should be avoided near term - give amox )
- second-line: amoxicillin or cefalexin
trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy

A symptomatic treat too - to avoid risk of pyelonephritis

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When is breast feeding CI

Give 6 drugs

galactosaemia, active HIV

The following drugs should be avoided:
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzos
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

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What is G and P

Gravity - no of times uterus has been preg

Pariety is number of pregnacies carried to successful age (+ = no of pregnancies lost before 24 weeks)

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Who should take aspirin 75-150mg daily from 12 weeks gestation until the birth and why

Known HTN, diabetics, CKD, autoimmune disease (SLE, lupus)

To reduce risk of pre-eclapmpis

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when is booking visit
What bloods are done

8 - 12 weeks

FBC, Rhesus group, Red cell antibodies, haemoglobathy
Hey b, syphillis, HIV
Chalydmyia if <25

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What are 5 DDx of bleeding early preg

Normal
Miscarriage
Ectopic
Polyps/structural
Trophoblastic disease (++hbcg)

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When is anti d give

To a rhesus negative mum + positive baby
At 28 + 34
any event mixing may occur

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What is in the combined screening test -when
What conditions

HCG + PAPPA + nuclear scan
At 11-14 weeks

For downs, 13 or 18

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When and what is in the quadruple test

14 - 20 weeks
AFP, hCG, uE3, inhibin A
Only for downs

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What result is in a positive screen
What are the options (weeks)

1:150
(1:100 risk at 40yearsO

CVS at 11-13+ weeks - 2-4% absorption risk
Amniocentesis >15 weeks

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When would the following be performed
Early USS
Anomoly scan

10 - 13 weeks

18 - 20+6 weeks
- here can spot placenta praverial

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When is Hb checked
What are th cut off for iron supplement

booking and 28 weeks - start of 3rd trim
<110, <105

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How many more extra appointments do first timers get

3 - 25, 31 + 40

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What immunisations can be giving during preg

Influenza
Pertussis at 28-32 weeks

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When can mum be referred for ECV

36 weeks

(Cant really fly past 32 weeks - need doctors note

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When would OGTT be done for those with risk factors for test diabetes

24 - 28 weeks

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What are some of treatment options for N+ V
When does it peak

Ginger, acupressure
Cyclising, promethazine, prochlazeine
9 weeks

Admit if PUQUE >13, ketones, weight loss (hyperemesis)

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What anti-d options for depression in preg

Really aim for high intensity therapy
Risk benefit ration

Fluoxetine safestest SSRI, but sertaline best for BF
TCAs safest

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Itchy rash in palms, if its >36 weeks would consider delivery =>refer

Intrahepatic cholestasis of pregnancy
Diprobase and calamine
Test LFTs if <36weeks

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Itchy papules to lower abdomen and bum, >35 weeks gets

Pruritic uretical papules and plaques of pregnancy
Tx steroids + calamine

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Advice to avoid listeriosis and toxo

Uncooked red meat
Cat litter
Gardening

What would you do if contact or concerns about having rubella or parvoviruses B19

Test IgG and IgM

What are the antihypertenisves options in preg

Inductions for secondary referral

Methyl dopa, nifedipine, labetolol

> 140/90 _ test urine

Risks of preceplampisa
Change in booking BP

Eclampsia and HELP
Increase 30/15 from baseline

How long LMWH if high risk of VTE

6 weeks postpartum 10 days intermiediate risk

What symptoms would you expect in round ligament pain

Lower abdo pain, from uterus into groin Stitch feeling, resolves quickly

When is the post-natal check

6 - 8 weeks

Contraception guide post pregnancy - IVD - POP - COCP

- within 48hours or 28 days later - within 21days (if great, needs 2 days additional if not day 1-5) - wait 6 weeks if breastfeeding (as reduces milk supply)

Some +ve for BF

IQ, OM, leukaemia, obesitiy, new-enetercolitis Mum reduces breast and ovarian ca

Sharp shooting pain after feed + during - ?diagnosis

Nipple thrush - topical miconazole mum + baby, oral fluconazole

Treatment options for dermatitis on breast

Mom eats one for 10days

Post-partum exercise advice

2 weeks post vaginal 6 weeks post c-section Low impact - 150mins/week

What tests for male and female infertility (1/7 couples) what is the ovulation test? What does NHS allow

Rubella status, chlamydia screen, mid luteal prog (7 days pre mense) Day 1 - 5 FSH/LH ? TFT/PRL Males 0 semen analysis 3 courses under 40 yr after 2 years reg intercourse

what vaginal ph would >4.5 indicate

BV or TV 4.5 wouls be physiological or possible candida

Syphillis features 1 - 2 -3

Primary features chancre - painless ulcer at the site of sexual contact local non-tender lymphadenopathy often not seen in women (the lesion may be on the cervix) Secondary features - occurs 6-10 weeks after primary infection systemic symptoms: fevers, lymphadenopathy rash on trunk, palms and soles buccal 'snail track' ulcers (30%) condylomata lata (painless, warty lesions on the genitalia ) Tertiary features gummas (granulomatous lesions of the skin and bones) ascending aortic aneurysms general paralysis of the insane tabes dorsalis Argyll-Robertson pupil

what are the 3 main complications of chalymmida

ectopic preg PID reduced fertility (20%)

what would you use a high VS charcol swab

BV TV - posterior forenix Candiasis (anterio forx)(if need to swab - can also be low vaginal red micropscy swab)

When would you repeat chalmydia testing

3weeks if preg offer repeat testin in 3 months for young people (25) or at risk

first catch urine for men tests for what and rules

chalymida and gon (but gon would need to repeat swab for mc+s if positive) no pee 2 hours before

what might a strawberry cervix with offenisve discharg eindicate Treatment

TV metrondiazole 2g stat or 500mg bd for 5-7days

uritits swab - polymorph leuoleutyes - g-ve intracellular diplocaic - wet prep

NGU (chaly, ureplasma, mycoplasma, HSV, UTI) gon TV

when should you repeat asyym screening in HIV after exposure

3 months

tx of chalmydia

dox 7 days or azithrmy/eryth if preg for 2 days no sex 7 days ater treatment

treatment for confirmed PID

olfaxcin or lev with metro

discharge that isent sexually tramistted

BV, candidiasis, physiological, FB

times when screen for HIV

antenatal + TOP sexual health clinics, TB/hep infections areas 2/1000

risk in UPI with H+ve

1 in 50 (not if oral)

time line for PEP taking CD4 levels of AIDs

within 72hours <200

what is LGV

small papule leading to inguinal LNs, causes by chalymdia in HIV +ve patients

time line to use Acicolvir in gential herpes what type

if within 5 days of infection recurrence self treatment both 1 + 2

HPV numbers that cause warts

6 + 11 16 + 18 = cervical cancer