Pregnancy Flashcards
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
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
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)
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
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
What are 5 DDx of bleeding early preg
Normal
Miscarriage
Ectopic
Polyps/structural
Trophoblastic disease (++hbcg)
When is anti d give
To a rhesus negative mum + positive baby
At 28 + 34
any event mixing may occur
What is in the combined screening test -when
What conditions
HCG + PAPPA + nuclear scan
At 11-14 weeks
For downs, 13 or 18
When and what is in the quadruple test
14 - 20 weeks
AFP, hCG, uE3, inhibin A
Only for downs
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
When would the following be performed
Early USS
Anomoly scan
10 - 13 weeks
18 - 20+6 weeks
- here can spot placenta praverial
When is Hb checked
What are th cut off for iron supplement
booking and 28 weeks - start of 3rd trim
<110, <105
How many more extra appointments do first timers get
3 - 25, 31 + 40
What immunisations can be giving during preg
Influenza
Pertussis at 28-32 weeks
When can mum be referred for ECV
36 weeks
(Cant really fly past 32 weeks - need doctors note
When would OGTT be done for those with risk factors for test diabetes
24 - 28 weeks
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)
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
Itchy rash in palms, if its >36 weeks would consider delivery =>refer
Intrahepatic cholestasis of pregnancy
Diprobase and calamine
Test LFTs if <36weeks
Itchy papules to lower abdomen and bum, >35 weeks gets
Pruritic uretical papules and plaques of pregnancy
Tx steroids + calamine
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
