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DRCOG > Random Facts > Flashcards

Random Facts Flashcards

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
Q

Green nipple discharge and tender lump

A

Duct ectasia

26
Q

Nipple discharge watery and bloody, no lumps or skin changes

A

Duct papilloma

27
Q

Sertoli-Leydig ovarian tumour

A

benign, androgen producing, ass.w. Peutz JEgher (bleeding in GI tract and cancers)

28
Q

Most common ovarian tumour (benign=

A

Serous cystadenoma (fallopian tube type ciliated cells)

29
Q

Yolk sac tumour

A

AFP

Schiller Duval bodies

30
Q

Exomphalos associations

A

Chromosomal issues e.g. Beckwith Wiedeman (large tongue, everything too big), T21
Renal and cardiac problems

31
Q

Tamoxifen interactions

A

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
Q

STI treatments not pregnant + (in pregnancy in brackets):

Chlamydia
Gonorrhoea
Syphilis
PID

TV
BV

A

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
Q

Chlamydia contact traing

A

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
Q

Syphilis treated -> what reaction can happen?

A

Jarisch-Herxheimer reaction
Release of toxins from dying bacteria - Rx supportive only

The old Hex gave Ja syphilis

35
Q

Lovseht’s maneuvre

A

Breech - arms extended, rotate body 180° clockwise then 180° anticlockwise

36
Q

Mauriceau-Smellie-Veit Maneouvre

A

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
Q

TTTS common time of Dx

A

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
Q

Fetal movements

A

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
Q

Increased NT

A

T21
Cardiac defects
Abdo wall defects
Increased complications in MC twins

40
Q

Hypoechogenic bowel

A

CCC:
CF
Chromosomal T21
CMV infection

41
Q

IUGR causes

A

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
Q

Cardiac changes in pregnancy

A

Increased CO, SV, blood volume

Reduced SVR, BP (by 30/15, lowest in 2nd trim, unless hypertensive, back to normal by term)

43
Q

New proteinuria with or without hypertension - what should you do?

A

Admit for observation

44
Q

Severity categories for PET

A

Mild: 140/90
Mod: 150/100
Severe: 160/110, OR starts <34 weeks, OR maternal complications

45
Q

Monitoring of PET patients

A

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
Q

Maternal antibody testing and what to do if positive at booking

A

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
Q

Folic acid 5mg

A 
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
Q

Antenatal corticosteroids

A

12mg betamethasone x2, 24 hours apart

OR

12mg dexamethasone x2, 24 hours apart (or 4 doses of 6mg 12 hours apart)

49
Q

GDM Risk factors (any one –> OGTT)

A

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
Q

Pre-existing diabetes monitoring in pregnancy

A

Fortnightly until 34 weeks then weekly (joint endo/obs contact)

Growth scans 28+32+36

51
Q

Pre-existing DM renal and retina monitoring

A

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
Q

Labour timing and DM

A

T1/T2: Before 39/40 (Offer IOL/ELCS at 37-38+6)

Uncomplicated GDM: Before 41/40 (latest 40+6)

53
Q

Post-natal GDM follow up

A

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
Q

First line long acting insulin in pregnant diabetics

A

Isophane but can use detemir/glargine if well controlled

55
Q

Target BMs (fasting, 1hr, 2hr)

A

5.3 –> 7.8 –> 6.4

56
Q

RA and pregnancy

A

Use sulfasalazine / HCQ
Anaesthetist involvement
NSAIDs ok until 32 weeks
Can use low dose steroids if needed

57
Q

Thyroid and pregnancy

A

Hypo - monitor 6 wkly, increase levo dose 50%
Hyper - Rx propothyouracil. Can casue neonatal goitre + thyrotox.
Post-partum thyroiditis: beta blockers only

58
Q

Placenta praevia

A

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
Q

Barnum’s maneuver (also known as Jacquemier’s)

A

Posterior shoulder delivery in shoulder dystocia

60
Q

Dysgerminomas

  • tumour markers
  • associations
A

Most common germ cell tumour
hCG and LDH
Turner’s syndrome

DRCOG (3 decks)

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