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1
Q

Why cant you give nitrofurantoin to pregnanct women in their 3rd trimester?

what are the alternative Abs for treating a UTI?

A

It increases the risk of haemolytic anaemia in the baby

Amoxicillin or ceftriaxone

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2
Q

why is ibruprofen contraindicated in pregnancy?

A

crosses the placenta and increases the risk of kidney problems in baby

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3
Q

Lithium risks to the baby

A

Ebsteins anomaly
congenital heart defect where the tricuspid valve is in the wrong place resulting in abnormally large RA and small RV

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4
Q

Which anti-epileptics are CI in pregnancy and why

A

sodium valporate and carbamazepine

teratogenic and can result in spina bifida

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5
Q

what are the risks of taking SSRIs in pregnancy

A

1st trimester -> congenital heart defects

3rd trimester -> inc risk of persistent pulmonary hypertension in the newborn

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6
Q

UKMEC3 scenarios

A

> 35 and smokes <15/day
wheelchair bound/ immobility
BMI >35
FHx of VTE in 1st degree relatives <45
current gallstones
carrier of BRCA1/2 gene
controlled HPTN

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7
Q

UKMEC4 scenarios

A

> 35 and smokes >15/day
uncontrolled HPTN
history of breast cancer
history of VTE
History of stroke or IHD
migraine with aura
breastfeeding and postpartum <6weeks
positive antiphospholipid antobodies
major surgery

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8
Q

Drugs considered safe in breastfeeding

A

Antibiotics: penicillins, trimethoprim, cephalosporins

anti-epileptics: sodium valporate, carbamazepine

anti-depressants: TCAs

antipsychotics

glucocorticoids

thyroxine

asthma: salbutamol, theophyllines

b-blockers

warfarin/heparin

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9
Q

Drugs contraindicated in breastfeeding

A

antibiotics: chloramphenicol, ciprofloxacin, sulphonamides, tetracycline
Lithium
benzodiazapines
aspirin
carbimazole
methotrexate
sulphonyureas
amiodarone

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10
Q

risks to mother and fetus in epilepsy during pregnancy

A

mother:
increased plasma volume may mean lesser effect of medications and inc risk of seizures

lowered seizure threshold with excessive tiredness and hyperemesis

fetus:
increased risk of congenital abnormalities with anti-epileptic drugs. risk increases with multiple meds
esp valporate and carbamazepine

risk of fetal hypoxia in prolonged seizures

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11
Q

management of epilepsy in pregnancy

A
  • MDT management with obstetrician and neurologist
  • aim for a single drug regime with wither lamotragine or phenytoin

-5mg folic acid preconception-12weeks to minimise neural tube defects

-monitor of drug plasma levels

-detailed anomaly scan and fetal echo at 18-20 weeks for cardiac abnormalities

-serial growth scans every 4 weeks from 28-36wks gestation

-vitamin K at 36 weeks and IM to baby at birth as anticonvulsants can inhibit clotting factor production

-anticonvulsant medication deemed safe in breast feeding

counselling:
- advise to take medication as risk of fetal hypoxia if have a prologed fit
- if last fit was >2yrs then could consider stopping medication
- advise to take showers over baths to reduce risk of drowning if have a fit

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12
Q

Exposure to chicken pox when pregnant

A

if mother has had chickenpox in the past then she is ok

if cant remember then test for VZ Ig

if non-immune:
<20 weeks, >20wks and NO rash –> VZIG (effective for up to 10days post contact)
- avoid contact with other pregnant women and neonates for 4 weeks

> 20 weeks presenting with a rash –> oral acyclovir (800mg 5 a day for 7 days)
avoid contact with other pregnant women and neonates until all the lesions have crusted over

-arrange referral to fetal medicine specialist
-post natal neonatal ophthalmic examination
-if infection occurs at term, planned delivery should be delayed until 7 days post clearance of lesions (allows passive transfer of Abs to fetus)

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13
Q

conselling about obesity in pregnancy

A

Preconception:
-Lifestyle/diet and exercise advice
-5mg folic acid –>12wks

risks of obesity in pregnancy:
maternal:
- increased risk of GDM (2-3 fold) (OGTT offered at 24-28wks)

  • increased risk of VTE (9fold)(consider prophylactic LMWH during pregnancy and after)
  • increased risk of gestational HPTN (2-3 fold)
  • inc risk of PPH (2fold)

-vitamin D deficiency –> supplementation

fetal:
- congenital abnormality (60% inc risk) eg NTD
- prematurity (20% inc risk)
- macrosomia and shoulder dystocia (3fold)
- stillbirth (2fold)

advice:
- hospital birth
- encourage vaginal birth but advise on possible complications and risk of EMCS
- weight loss throughout pregnancy

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14
Q

managament for GDM

A

diagnosis
fasting>5.6, 2hr post OGTT >7.8

  • joint antenatal and diabetes clinic 1 week after diagnosis and then every 2 weeks

-self BM measurements before and after each meal. aim for <5.6 preprandial and <7.8 post prandial

1st line (fasting <7mmol) - lifestyle changes

2nd line (targets not met 2 weeks after lifestyle changes) - metformin

3rd line (targets not met with lifestyle and metformin)
- insulin

NB: if fasting glucose >7 at diagnosis offer insulin straight away

birth no later than 40+6wks

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15
Q

drugs CI in pregnancy

A

ACEi, ARBs, thiazides, ibruprofen

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16
Q

High and moderate risk RFs in pre-eclampsia

A

HIGH RISK
previous pregnancy with pre eclampsia or HPTN
pre-existing maternal conditions (HPTN, DM, SLE, renal disease)

MODERATE RISK
primigravid
age >40
pregnancy interval >10 years
BMI >35
FH of pre-eclampsia
multiple pregnancy

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17
Q

when to offer aspirin in pregnancy

A

pre-eclampsia prophylaxis:
1 high risk RF or 2 moderate risk RF

Offer from12/40 GA until delivery

75-150mg OD

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18
Q

when to admit someone with high BP

A

severe HPTN >160/100
symptoms- eg. headache, dizziness, changes in vision, abdo pain
reduced fetal movements
abnormal bloods- deranged LFTs, U&Es, low Plts, anaemia

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19
Q

Management of someone admitted to the ward with signs of pre-eclampsia

A

MONITOR
- BP every 30 mins
- urine dip daily
- bloods (FBC, U&Es, LFTs)
- CTG

MEDICATION
- IV labetelol
- steroids if <34 weeks
- severe PET: MgSO4 –> delivery within 24hrs

DELIVERY
-aim for 37weeks
- maternal choice of delivery but advise on labour ward
- conitinuous BP 4x day for at least 24hrs
- 1-2day BP for 2 weeks post discharge

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20
Q

first degree tear

A

Tear limited to the superficial perineal skin or vaginal mucosa only

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21
Q

second degree tear

A

Tear extends to perineal muscles and fascia, but the anal sphincter is intact (episiotomy is anatomically classified as second degree)

Stitch on ward by midwife

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22
Q

third degree tear

A

3a: extends to perineal muscles, fascia and less than 50% of the anal sphincter

3b: extends through the perineal muscles, fascia and more than 50% of the anal sphincter- but the internal sphincter remains intact

3c: Extends through the perineal muscles, fascia and the external and internal anal sphincter. The anal mucosa is intact

repair in theatre by reg

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23
Q

Fourth degree tear

A

Perineal skin, muscle, anal sphincter and anal mucosa are torn

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24
Q

Management of toxoplasmosis in pregnancy

A

PREVENT: avoid contact with cats/ kittens, raw meat, wash hands after touching soil

INVESTIGATIONS
infection suspected send maternal blood sample to specialised toxoplasmosis lab
if +ve then amniocentesis >14wks

TREATMENT
refer to fetal medicine unit for USS every 2 weeks
mother- spiromycin (2-3g OD for 3 weeks)
baby- sulfadiazine, pyrimethamine, folonic acid for 1 year

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25
Q

management of Rubella in pregnancy

A

not routinely screened for in the UK anymore

RF- unvaccinated mother

INVESTIGATIONS
serum IgM- active infection
serum IgG- previous immunity

TREATMENT
Refer to fetal medicine unit for 1-2weekly monitoring

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26
Q

Management of CMV in pregnancy

A

INVESTIGATIONS
serology, signs of CMV infection on USS

TREATMENT
Refer to fetal medicine for regular check ups
no prenatal treatment available
valganciclovir PO 8g OD to baby at birth for 6 months

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27
Q

management of HIV in pregnancy

A

Routinely screened for at booking

INVESTIGATIONS
(if known positive) Viral load and CD4 count every 2-4 weeks
F/U every 1-2 weeks

MANAGEMENT
joint HIV and obstetrician care
maternal ART ASAP
PEP to baby immediately at birth- zidovudine for 2-4 weeks

AT DELIVERY
viral load <50copies/mL- vaginal delivery ok
>50copies/mL- C/S advised

NO BREASTFEEDING

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28
Q

Management of HSV in preganancy

A

painful genital ulcer- high risk when first occurrence

INVESTIGATIONS
swab of ulcer for PCR

TREATMENT
1st-2nd trim- 400mg aciclovir TDS for 5 days + 400mg OD from 36wks- delivery –> vaginal okay
3rd trim- 400mg aciclovir TDS until delivery –> C/S advised
if vaginal give IV aciclovir intrapartum and to baby

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29
Q

management of HBV in pregnancy

A

joint ID/hepatologist and obstetrician care

maternal tenofovir
baby at birth - HBIg within 24hrs + HB vaccine at birth, 4 weeks and 12 months

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30
Q

management of listeriosis in pregnancy

A

admission to hospital

IV amoxicillin 2g every 6 hours for 14days

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31
Q

Managament of a UTI in pregnancy

A

asymptomatic or symptomatic - 50mg nitro QDS for 7 days

not resolved after 48hrs or near term:
amoxicillin 500mg TDS for 7 days or cefalexin 500mg BD for 7 days

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32
Q

management of syphilis in pregnancy

A

Refer to GUM
IM benzylpenicillin BD for 14 days

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33
Q

Complications of toxoplasmosis infection in pregnancy

A

In vitro
IUGR
intracranial calcification
hydrocephalus or microcephalus

birth
CHD
blindness -chorioretinitis
neurological defects

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34
Q

complications of CMV infection in pregnancy

A

At birth:
hepatitis
hepatosplenomegaly
microcephaly
SGA

Long term
sensory neural hearing loss
neurological disabilities

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35
Q

complications of rubella infection in pregnancy

A

infection <12wks- discuss TOP as severe congenital defects likely
12-20- some form of defect likely
>20wks- unlikely

at delivery:
microcephaly
cataracts
CHD: PDA, VSD, PS
sensory neural hearing loss

long term:
learning disabilities
DM
thyroiditis

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36
Q

complications of listeria monocytogens infection in pregnancy

A

paralysis
seizures
cerebral palsy
learning difficulties
blindness
CHD
renal problems

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37
Q

complications of VZV infection in pregnancy

A

maternal:
pneumonitis
encephalitis
hepatitis
death (rare)

baby:

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38
Q

complications of parvovirus B19 infection in pregnancy

A

hydrops fetalis

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39
Q

complications of syphilis in pregnancy

A

Hutchinson teeth, blindness, deafness, rashes

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40
Q

describe the antenatal screening for downs

A

Who would it be offered to?
- offered to all women
- high risk: increased age, FHx
- includes screen for pataus and edwards
- all free on NHS

When would it be offered
NIPT- (private:7-10 weeks, NHS: offered if higher risk after integrated test)- maternal blood
1. 10-13 weeks: combined test- looks at the chance of having T21/18/13. maternal age, bHCG, PAPP-A and NT (>3.5)
(CRL needs to be between 45-84mm to be eligible)

  1. 15-20: Quadruple screen
    InhibinA, BHCG, UE3, AFP
  2. Integrated test- combines the results of the combined and quadruple test

((NB: smoking can affect the results, the quadruple test has a higher false positive result than the combined and the intesgrated has the lowest false positive result)

  1. CVS- 11-14wks
  2. Amnioscentesis 15-20

interpretation of the results

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41
Q

Obesity in pregnancy managament

A

BMI >35
- OGTT at 24-28 weeks
- Vitamin D 10mg OD
- 5g folic acid preconception -12 weeks
- anaestetic review
- higher risk of marosomia, GDM, dystocfia, PPH
- post-natal thromboprophylaxis

42
Q

physiological changes in pregnancy

A
  • marked increase in fibrinogen
  • increase in fVII,X and XII
  • stroke volume increases by 30
  • plasma volume increases disproportionately to red cell mass resulting in relative anaemia
  • rise in AFP
  • soft systolic flow murmur due to dilation across tricuspid valve
43
Q

effects of warfarin in pregnancy

A

teratogenic
most in 1st trim but also CI in 2nd and 3rd

1st
vertebral calcinosis
nasal hypoplasia
brachydactyly

later
cerebral deformities
eye problems

44
Q

Mx of PE in pregnancy

A

Ix:
ECG, CXR
FBC, U&Es, clotting screen, LFTs
USS of leg if DVT suspected
V/Q scan or CTPA

80mg enoxaparin (LMWH) BD

45
Q

cut off for normal protein creatinine ratio

A

<30

46
Q

when should a fetal pole and heart beat be detected on USS

A

6 weeks

47
Q

causes of secondary amenorrhoea

A

Pregnancy
thyroid disorders
anorexia/ low BMI
hyperprolactinaemia (prolactinoma, dopamine antagonist drugs)
PCOS
POI
sheehans syndrome

48
Q

Causes of primary amenorrhoea

A

Turners
hypogonadism
hypopituitarism
low BMI
CAH

49
Q

Investigations for amenorrhoea

A

primary-
examine genitalia, sex hormones, height and weight, karyotyping

secondary
urine pregnancy test
TFTs
Prolactin
LH/FSH
androgens
medication review
MRI brain

50
Q

when should anti-D injections be given in the antenatal period?

A

weeks 28 and 34

and any sensitising event such as trauma, antenatal bleed, amnioscentesis, CVS, ECV, delivery

51
Q

types of breech and how common is it

A

20% babies breech at 28 weeks. by term most of these move to cephalic spontaneously and only 3% are left as breech.

flexed (complete)
- both legs flexed at the hip and knees and baby apears to be ‘crossed legged’

extended (frank)
- both legs flexed at the hips and extended at the knees (so legs are straight up)
- most common

footling
- one or both legs extended at the hip so the foot is presenting first
- most dangerous to deliver

52
Q

Management of breech at >37

A

counselling
Understand the mothers wishes. is she very keen for a vaginal delivery or C/S

ECV
- try to move the position of the baby from the outside of abdomen
- give anti-D to Rh-ve mothers
- approx 50% success rate (slightly less if first baby, more if not)
risks: fetal distress, placental abruption –> emergency C/S 1/200 chance
- Contraindications: ruptured membranes, multiple pregnancy(except for second twin), placenta praevia, PV bleed, footling breech

breech vaginal delivery - must be in hospital
4/10 will need an EMCS
- hands off approach
- continuous CTG
- risk of fetal hypoxia/ distress

53
Q

RFs for breech and complications

A
  • polyhydramnios/ oligohydramnios
  • obstructive fibroids
  • low lying placenta
  • multiparity

complications
- chord prolapse

54
Q

differentials for menorrhagia

A

dysfunctional uterine bleeding
fibroids
adenomyosis
endometriosis (more dysmenorrhoea than menorrhagia)

bleeding disorders
hypothyroidism
obesitty

55
Q

indications for taking 5mg folate preconception-12weeks

A

anti-epileptic drugs
BMI >30
coeliac
diabetes
thalassaemia traits

56
Q

what are the different types/ severities of spina bifida

A

Spina bifida occulta
Incomplete fusion of the vertebrae, but with no herniation of the spinal cord
May be visible only as a small tuft of hair overlying the site

Meningocele
Incomplete fusion of the vertebrae, with herniation of a meningeal sac containing CSF
Visible prominence at the site, but usually covered by skin

Myelomeningocele
Incomplete fusion of the vertebrae with herniation of herniation of a meningeal sac containing CSF and spinal cord.
Usually accompanied by other defects such as hydrocephaly or Chiari malformation
Visible prominence at the site, with exposed meninges

57
Q

causes of polyhydramnios

A

GDM/ DM
fetal renal problems
oesophageal atresia
twin twin transfusion syndrome
diaphragmatic hernia
chromosomal abnromalities

58
Q

complications of polyhydramnios

A

maternal
increased risk of needing C/S
increased pressure so hightened sx eg. GORD, urinary sx, stretch marks
respiratory distress

fetal
chord prolapse
breech/ unstable lie
PROM
Preterm labour
abruption

59
Q

features of a partogram and when is it used

A

In active stage of first stage of labour (>6cm dilated)
Time
Temp
BP
Urine (K, G, P, B) - all every 4 hrs
HR- maternal (every 30mins) and fetal
Contractions (check every hr, measure no of contractions in 10 minutes)
Dilation- PV exam every 4 hrs aiming for 1cm/hr in prim, 2cm/hr in multiparous. failure to progress if half that rate
Station- in relation to ischial spine
Liquor- blood stained: abruption, clear: SROM, meconium stained
Position- of anterior fontanelle
Moulding- of fontanelles
Caput
Drugs given
Oxytocin rate

60
Q

reassuring CTG features

A

Baseline rate- 110-160bpm
variability - 5-25bpm
accelerations inc in HR by >15bpm for >15seconds
decels- non or early

61
Q

non-reassuring CTG features

A

baseline rate 100-109bpm or 161-180bpm

variability <5bpm for 30-50mins or >25bpm for 15-25 mins

variable decelerations with shoulder accelerations
prolonged decels for 3-5minutes

62
Q

pathological CTG

A

baseline rate <100 or >180

variability <5bpm for >50mins or >25bpm for >25mins

variable decels with no shouldering
prolonged decels for >5mins
failure to return to BRa
sinosoidal
biphasic W shape

63
Q

causes of fetal tachycardia

A

hypoxia
hyperthyroidism
chorioamnionitis
fetal/maternal anaemia

64
Q

causes of fetal bradycardia

A

prolonged cord compression
cord prolapse
hypothyrodism
epidural/ spinal anaesthesia
maternal seizure

100-120 could be normal for post dates

65
Q

causes of reduced variability

A

fetal sleeping (no longer than 40mins)
acidosis
fetal tachycardia
drugs- opiates, benzos, MgSo4
prematuriy
congenital heart disease

66
Q

mechanism of early decelerations

A

uterine contracture causes increased ICP in fetus leading to increase vagal tone which lowers the HR

67
Q

causes of variable decelerations

A

oligohydramnios
umbilical cord compression

68
Q

causes of late decelerations

A

maternal hypotension
PET
uterine hyperstimulation

69
Q

causes of sinosoidal rhythm

A

severe fetal hypoxia
severe fetal anaemia
feta/ maternal haemorrhage

70
Q

why is hypotension an absolute CI to epidural?

A

the epidural will cause peripheral vasodilation and worsen pre existing hypotension

most anaethesists will pre load pt with 1L IV fluids before giving epidural

71
Q

absolute contraindications for epidural anaesthesia in pregnancy

A

maternal refusal
allergies to anaesthetic agents
sytemic infection
skin infection by epidural site
bleeding disorders
platelet cout <80000
uncontrolled hypotension

72
Q

relative CI to epidural

A

HOCM
aortic stenosis
mitral stenosis

73
Q

where does the pudendal nerve arise from and what are the branches of the pudendal nerve and what do they innovate

A

S2,3 and 4

perineal nerve -> perineal muscles and perineal skin
inferior anal nerve –> external anal sphincter, perianal skin
dorsal nerve of the clitorus –> urethral sphincter

74
Q

physiology of fetal circulation after birth

A

occlusion of the umbilical vessels –> reduces venous return back to the right side of the heart –> reduces right sided arterial pressure –> closure of foramen ovale.

As the fetus starts to breath the pulmonary circulation pressure lowers –> right ventricular output increases

The pulmonary artery vasodilates to allow the new low pressure right sided system to develop
increased flow through pulmonary system leads to more venous return to the left side of the heart –> increased pressure on left side of heart –> closure of the ductus arteriosus

75
Q

difference between urge and stress incontinence

A

urge- detrusor overactivity and bladder oversensitivity causes leakage of urine

stress- increased abdo floor pressure vs decreased pelvic pressure causes leakage of urine on coughing/ laughing/ sneezing/ heavy lifting

76
Q

investigations for incontinence

A
  • abdo/ pelvic exam
  • speculum/ bimanual
  • kegel test
  • urine dip and MSU
  • bladder diary for 3 days (noting exactly when it happens and any triggers)
  • bladder scan- post void residual volume
  • referral to urodynamics
77
Q

management of urge incontinence

A
  1. lifestyle changes
    - avoid caffeine
    - lose weight if BMI >30
    modify fluid intake
  2. bladder retraining exercises (minimum 6 weeks)
  3. anticholinergics
    - eg. oxybutynin (not in >80/ frail), tolterodine, mirabegron
78
Q

management of stress incontinence

A
  1. lifestye changes
    - avoid caffeine
  2. pelvic floor exercises (refer to physiotherapy)
    - 8 contractions, 3x a day for a minimum of 3 months
  3. surgical
    - colposuspension
    - autologous rectal facia sling
79
Q

Pathophysiology of PMS

A

symptoms occuring in the luteal phase of menstrual cycle casued by high progesterone

eg. mood swings, bloating, tearfullness, irritability, breast tenderness, abdo pain
(all progesterone problems)

80
Q

management of PMS

A
  1. psychosocial
    - exercise
    - sleep hygiene
    - CBT
    - vit B6
  2. bio
    - COCP
    - mirena coil
    - SSRIs eg. citalopram
    - oestrodiol patches
    - GnRH analogue + HRT
  3. surgical
    -hysterectomy
81
Q

Management of PCOS

A

weight loss
metformin
COCP

trying to conceive
wt loss +/- metformin
clomifene

82
Q

sensitising events in Rh- woman requiring anti D

A

vaginal bleeding <12 weeks if heavy, painful or persistent
PV bleeding >12 weeks
ruptured ectopic pregnancy
TOP
ERPC
amniocentesis or CVS
antenatal haemorrhage
ECV
intra uterine death
post delivery
at 28 and 34 weeks
abdominal trauma

83
Q

dose of MgSO4 to be given in eclampsia

A

IV bolus of 4g over 5-10 minutes should be given followed by an infusion of 1g / hour

84
Q

what is important to monitor when giving MgSO4

A

reflexes
respiratory rate
O2 sats

if resp depression occurs then calcium gluconate is the Rx

85
Q

layers to cut through during a C/S from skin to uterus

A

Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus

86
Q

rokitasnky’s protuberance is associated with which ovarian tumour?

A

mature teratoma

87
Q

causes of increased nuchal translucency

A

Downs
CHD
abdominal wall defects

88
Q

causes of hyperechogenic bowel

A

cystic fibrosis
downs
CMV infection

89
Q

what should be measured in someone with suspected DVT/ PE started on LMWH in extremes of body weight (<50kg or >90kg)?

A

anti-Xa activity

90
Q

what test is used to detect presence of fetal blood in maternal circulation and how does it work?

A

Kleihaur test

adds acid to maternal blood sample- fetal blood is resistant

91
Q

management of RFM >28 weeks

A
  1. hand held doppler
  2. if no HB detected then immediate USS
    - include: abdo circumference, amniotic fluid volume and estimated fetal weight
  3. if HB present then CTG for 20 mins

if no fetal movements established after 24 weeks then referral to maternal fetal medicine unit

70% of episodes of RFM will be isolated and result in normal uncomplicated pregnancy

92
Q

factors associated with increased risk of miscarriage

A

Increased maternal age
Smoking in pregnancy
Consuming alcohol
Recreational drug use
High caffeine intake
Obesity
Infections and food poisoning
Health conditions, e.g. thyroid problems, severe hypertension, uncontrolled diabetes
Medicines, such as ibuprofen, methotrexate and retinoids
Unusual shape or structure of womb
Cervical incompetence

93
Q

normal lab findings in pregnancy

A

reduced urea
reduced creatinine
increased urinary proteins
dilutional anaemia
thrombocytopenia
neutrophilia
hypercoaguable
raised D-dimer

94
Q

missed pill rules

A

COCP
1 missed pill- take ASAP and no further action required

2 missed pill- take last one missed ASAP and barrier contraception until 7 days of consecutive pills
UPSI in days 1-7 pack -> emergency contraception
in days 8-14 -> no emergency contraception required
days 15-21 -> continue rest of pack then go straight onto new pack omitting pill free week

POP
traditional- <3hrs late take ASAP and no further action, >3hrs take ASAP and barrier for 48hrs

desogestrel (carazette)
<12hrs late take ASAP and no further action
>12 hrs take ASAP and barrier for 48hrs

2 missed pills- take one and barrier for 48hrs

95
Q

Drugs/ scenarios a pt is on that would make the COCP non favourable

A

drug inducing drugs eg. rifampicin, carbamazepine as will lower the effectiveness of the pill

lamotragine- as COCP reduces the effectiveness and will lower the seizure threshold

women who have had bariatric ssurgery as effectiveness is reduced as less absorption

96
Q

positives and negatives of the depo-provera injection

A

positives:
- induces amenorrhoea so useful in pts with painful/ heavy periods
- reduces pain in sickle cell crisis

negatives:
- small risk of wt gain
- can cause irregular periods
- can cause mood swings
- small risk of reduced bone density
- delayed return to fertility up to 1 year

97
Q

dose release of progesterone with the implant

A

60/70mcg/ day –> year 3 25mcg/day

98
Q

risks and benefits of inplanon

A

benefits
- reversible
- good for painful periods
- can induce amenorrhoea
- little/ no risk of VTE
- good for obese, smokers, VTE RFs
- nexplanon is radioopaque

risks
- can cause irregular bleeding
-

99
Q

late injection rules

A

up to 14 weeks
14 weeks +1 late –> 7 days barrier
if UPSI –> emergency contraception + 7 days barrier
NB: not ella one

100
Q

positives and negatives of copper IUD

A

positives:
- non hormonal
- very effective contraception
- lasts 5 years
- not affected by any other medication

negatives:
- cause heavier, more painful periods
- irregular bleeding

101
Q

positives and negatives of copper IUS

A

positives:
- makes periods lighter, less painful or stop altogether
- very effective
- lasts 5 years (mirena)
- protective over endometrial cancer

negatives:
- some reports of acne, breast pain, headache (but lesser extent to systemic progesterone)
- can cause irregular bleeding
- can cause functional cysts

102
Q

risk of expulsion, PID and perforation for IUD/IUSS

A

expulsion 1in 20
PID 1 in 100 up to 4-6 weeks post insertion
perforation 1 in 1000

O&G -IE (1 decks)

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