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1
Q

BMI >35

A

CHC 3

Pre-eclampsia moderate factor

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2
Q

BMI 30+

A

COC 2 (until BMI 35 then 3)

5mg folic acid
LMWH risk factor (1 point)
GDM risk factor -> OGTT

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3
Q

Pre-eclampsia aspirin indications

A

1x high risk or 2x moderate. Take 75-150g from 12 weeks until delivery

High risk (3): hypertension, autoimmune disease (DM/SLE/APS etc), CKD

Moderate (5): primip/>10yr interval, twins, FHx, Age >40, BMI >35

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4
Q

LMWH Prophylaxis

A

3x RF = 28/40 until 6 weeks postnatal
4+ RF = start ASAP until 6 w postnatal

RFs: 
age >35, BMI >30, parity >3, 
smoker, varicose veins, immobility, low risk thrombophilia
FHx unprovoked VTE
Twins, PET, IVF
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5
Q

Sperm studies - sperm counts/concentration

A

Nomal = >15 million copies/ml

Oligo: <15
Severe oligo: <5
Azoo: 0

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6
Q

Sperm studies

  • Volume
  • pH
  • morph
  • motility
  • vitality
A
  • > 1.5 ml
  • pH >7.2
  • > 4% normal forms
  • > 32% normal motility - less = asthenospermia
  • > 58% live spermatozoa

pH similar to blood
1.5 ml, 15m copies/ml
1/3 moving well
2/3 live

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7
Q

OHSS (mild/mod/severe/critical)

A

Mild: <8cm, abdo discomfort
Mod: 8-12cm, nausea and vomiting, US ascites
Sev: >12cm, clinical ascites/hydrothorax, hct 44, low albumin, oliguria

Critical:
critical ascites/hydrothorax, ARDS, VTE, hct 55, wcc >25, anuria

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8
Q

Ovulated progesterone

A

> 30

If 16-30 test again, <16 repeat - can rpt until period starts if irreg cycles

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9
Q

Rx of premature ejaculation

A

Conservative measures

SSRI - dapoxetine (priligy) has special license

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10
Q

Sexual assault evidence

A

Fingers - 0.5 days (12 hrs)
Mouth - 2 days (incl biting, kissing or oral penetration)
Anus - 3 days
Vagina - 7 days

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11
Q

Most common ToP complication

Most common ToP ground

A

Infection (10%)
Failure/perf/haemorrhage 1%

Ground C 95% (harm to woman)

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12
Q

Type of ToP

A

Medical anytime - at 9 week would bleed for 2 weeks
MVA 7-14 weeks
D&E >14 weeks (+ prep cervix with mifepristol)
Abx cover for both surgical options

Take preg test after 4 weeks - if positive do TVUSS

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13
Q

ToP

  • contraception
  • anti-D
A
  • can start any contraception immediately. Contraception started after day 5 needs cover with condoms. Quick start if before day 5.
  • anti D in surgical or medical >10+0
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14
Q

CTG categories

A

Normal
Suspicious - any single non-reassuring feature –> need senior midwife OR obstetrician
Pathological - any single abnormal feature OR more than one non-reassuring feature –> need senior midwife AND obstetrician. Consider FBS/birth etc.

Any acute brady or since decel >3min –> expedite birth

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15
Q

CTG Heart rates

A

Reassuring: 110-160
Non-reassuring: 100-110 or 160-180
Abnormal: <100, >180

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16
Q

CTG variability

A

Normal 5-25

Non-reassuring >25 for 15-25 mins, <5 for 30-50 min

Abnormal >25 for >25 mins, <5 for >50 min

Sinusoidal always abnormal

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17
Q

Decelerations (Late)

A

Never normal

Non-reassuring: In more than half of contractions for <30 mins (and no fetal/mat compromise)

Abnormal: For > 30 minutes (or less if fetal/maternal compromise)

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18
Q

Decelerations (variable)

A

Reassuring: if less than 90 minutes and no concerning features

Non-reassuring:
WITHOUT conc. char. –> more than 90 mins.
WITH conc. char. –> In over half for less than 30, or less than half for >30 minutes

Abnormal: In over half contractions for >30 minutes WITH concerning characteristics

Concerning features = last for >60s each, reduced variability, does not return to baseline, W shaped.

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19
Q

Johnson’s maneouvre

A

Uterine inversion - push it back up

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20
Q

O’sullivan’s maneouvre

A

Uterine inversion - Warm saline into vagina (2nd line)

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21
Q

Salmon patch

A

vascular birth mark, self resolve

stork mark/angel’s kiss

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22
Q

SSRI 3rd trim

A

Persistent pulm HTN

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23
Q

Pertussis in pregnancy and neonate

A

Vaccine 16-32 weeks

Neonate infected: notifiable disease, Rx macrolide + admission

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24
Q

Time allowed for 2nd stage labour

A

2nd stage = from 10cm dilated to delivery of baby
Passive then active.
Nullip: 1 + 2
Multip: 1 + 1

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25
Green nipple discharge and tender lump
Duct ectasia
26
Nipple discharge watery and bloody, no lumps or skin changes
Duct papilloma
27
Sertoli-Leydig ovarian tumour
benign, androgen producing, ass.w. Peutz JEgher (bleeding in GI tract and cancers)
28
Most common ovarian tumour (benign=
Serous cystadenoma (fallopian tube type ciliated cells)
29
Yolk sac tumour
AFP | Schiller Duval bodies
30
Exomphalos associations
Chromosomal issues e.g. Beckwith Wiedeman (large tongue, everything too big), T21 Renal and cardiac problems
31
Tamoxifen interactions
Paroxetine and fluoxetine TamoXifen interacts with the SSRIs with Xs in them - X is cross like cross reacting They reduce effectiveness by inhibiting an enzyme
32
STI treatments not pregnant + (in pregnancy in brackets): Chlamydia Gonorrhoea Syphilis PID TV BV
Chlamydia - PO doxy (erythromycin/azithro/amox) Gonorrhoea - IM ceftriaxone single dose (same?), PO alternative = cefixime and azithro Syphilis - IM benpen single dose (same), PO alt = doxy PID - IM ceftriaxone + 14 days of doxy + metronidazole, alt. PO ofloxacin+metronidazole (?) TV + BV - metronidazole 5-7d (same)
33
Chlamydia contact traing
Women - sexual partners last 6 months Men - Asymptomatic - same as women - Symptomatic - last 4 weeks (before sx onset) Can resume sex 7 days after partner treated
34
Syphilis treated -> what reaction can happen?
Jarisch-Herxheimer reaction Release of toxins from dying bacteria - Rx supportive only The old Hex gave Ja syphilis
35
Lovseht's maneuvre
Breech - arms extended, rotate body 180° clockwise then 180° anticlockwise
36
Mauriceau-Smellie-Veit Maneouvre
Breech - once body delivered if head extended stick finger in mouth and other and back of neck to flex head. Baby cam smellie your finger in their mouth
37
TTTS common time of Dx
16-22 wks ~around anomaly scan Warn re sudden SPB/increase in abdo size Indomethacin to reduce UO and reduce PTL NT predictive of complications in MC twins
38
Fetal movements
Usually start 18-20 weeks 24wks no movement -> FMU Felt movements then stop even if only 18 wks then -> doppler/US/FMU Usually increase until 30 weeks then plateau If <10 movements over 2 hours when >28/40 --> assessments
39
Increased NT
T21 Cardiac defects Abdo wall defects Increased complications in MC twins
40
Hypoechogenic bowel
CCC: CF Chromosomal T21 CMV infection
41
IUGR causes
Symmetrical: Infections (TORCH), Trisomy 21, external agents e.g. alcohol, SGA constitutional. Earlier onset. Asymmetrical: Uteroplacental insufficiency (PET/HTN/APL etc) or malnutrition. Start 3rd trimester. Smoking can do both.
42
Cardiac changes in pregnancy
Increased CO, SV, blood volume | Reduced SVR, BP (by 30/15, lowest in 2nd trim, unless hypertensive, back to normal by term)
43
New proteinuria with or without hypertension - what should you do?
Admit for observation
44
Severity categories for PET
Mild: 140/90 Mod: 150/100 Severe: 160/110, OR starts <34 weeks, OR maternal complications
45
Monitoring of PET patients
Twice weekly BP + urinalysis USS every 2-4 weeks Urate deranged before U&E - better marker of renal function Rx: Labetalol (BEWARE IF ASTHMA PATIENT) 2nd nifedipine Continue MgSO$ until 24 hours post-delivery or last seizure whichever is later
46
Maternal antibody testing and what to do if positive at booking
Routine for all: booking and 28 weeks. Give Anti-D routinely at 28 weeks as well (+/- 34 weeks) If positive at booking: - Check monthly until 28 weeks - then twice weekly after 28 weeks.e
47
Folic acid 5mg
``` NFT history (Previous spina bifida baby, FHx on mat/pat side incl parents) BMI >30 Medical conditions (DACT): - DM - Anti-epileptics/anti-retrovirals - Coeliac - Thalassemia/SCC ```
48
Antenatal corticosteroids
12mg betamethasone x2, 24 hours apart OR 12mg dexamethasone x2, 24 hours apart (or 4 doses of 6mg 12 hours apart)
49
GDM Risk factors (any one --> OGTT)
BMI >30 Ethnicity south asian/middle-eastern/caribbean Prev GDM/FHx GDM Prev unexplained stillbirth or macrosomia (>4.5kg) Previous GDM - do OGTT after booking and again at 28 wks
50
Pre-existing diabetes monitoring in pregnancy
Fortnightly until 34 weeks then weekly (joint endo/obs contact) Growth scans 28+32+36
51
Pre-existing DM renal and retina monitoring
Renal: U&E and ACR at booking if not in last 3 months --> Protein >0.5g/day / ACR >30 / Cr >120 --> referral Retina: Within 3 months before preg OR at booking Recheck at 16-20wks if retinopathy Recheck at 28 weeks in all Passmed: "Retinopathy check every trimester"
52
Labour timing and DM
T1/T2: Before 39/40 (Offer IOL/ELCS at 37-38+6) Uncomplicated GDM: Before 41/40 (latest 40+6)
53
Post-natal GDM follow up
Fasting glucose at 6 week check <6 = Not diabetic. >7 = likely T2 diabetic If you do HbA1c >39 = not diabetic, >48 = diabetic Then annual HbA1c
54
First line long acting insulin in pregnant diabetics
Isophane but can use detemir/glargine if well controlled
55
Target BMs (fasting, 1hr, 2hr)
5.3 --> 7.8 --> 6.4
56
RA and pregnancy
Use sulfasalazine / HCQ Anaesthetist involvement NSAIDs ok until 32 weeks Can use low dose steroids if needed
57
Thyroid and pregnancy
Hypo - monitor 6 wkly, increase levo dose 50% Hyper - Rx propothyouracil. Can casue neonatal goitre + thyrotox. Post-partum thyroiditis: beta blockers only
58
Placenta praevia
Often noted at 20 week scan Rescan 34 weeks - IF severe then plan ELCS at 37-38 weeks If grade I can scan after 2 weeks to determine mode of delivery - If still only grade I can consider NVD
59
Barnum's maneuver (also known as Jacquemier's)
Posterior shoulder delivery in shoulder dystocia
60
Dysgerminomas - tumour markers - associations
Most common germ cell tumour hCG and LDH Turner’s syndrome

DRCOG (3 decks)

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