RANDOM OBGYN STUFF

Question 1

What is the most common side effect of the POP and COCP?

Answer 1

irregular menstrual bleeding

Question 2

WHat are the absolute CI to the COCP?

Answer 2

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation

Question 3

What are the relative CI to the COCP?

Answer 3

BMI > 35 kg/m^2*
more than 35 years old and smoking less than 15 cigarettes/day
family history of thromboembolic disease in first degree relatives < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease

Question 4

Describe the ages for cervical screening

Answer 4

If you’re between 25 and 49 and registered with a GP, you’re usually invited for screening every three years. Once you reach 50, you’re invited every five years.

Question 5

What HPV strains cause cervical cancer?

Answer 5

types 16 and 18

Question 6

When is HPV jab given?

Answer 6

12-13 years age (year 8)

Question 7

What is the difference between Gillick competence and the Fraser guidelines?

Answer 7

Gillick = assessing compentency of under 16s
Fraser = specific for contraception

Question 8

What is the management for a woman w bishop score of 3?

Answer 8

do progestin pessary

Question 9

What is the name of the surgical mx of a bartholin’s cyst?

Answer 9

Marsupialization

Question 10

What is the other name of herceptin?

Answer 10

Trastuzumab

Question 11

What is the surgical mx of a cystocele?

Answer 11

anterior wall repair

Question 12

What test is used to check anti-D injection needs to occur?

Answer 12

A Kleihauer test is used to confirm transplacental blood loss from fetus to mother. The test is performed on the mother’s blood; the blood undergoes acid elution and staining.

Question 13

Describe the protocal for sensitising situation. What are these sensitising situations?

Answer 13

Anti-D immunoglobulin should be given as soon as possible (but always within 72 hours) in the following situations:
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

++ NICE (2008) advise giving anti-D to non-sensitised Rh -ve mothers at 28 and 34 weeks

Question 14

What are the possible complications of multiple pregnancy?

Answer 14

Antenatal complications
polyhydramnios
pregnancy induced hypertension
anaemia
antepartum haemorrhage

Fetal complications -
perinatal mortality
prematurity (mean twins = 37 weeks, triplets = 33)
light-for date babies
malformation (*3, especially monozygotic)

Labour complications
PPH increased (*2)
malpresentation
cord prolapse, entanglement
locked twins
vasa praevia 
emergency c-section

Question 15

What is the mx of a pregnant woman with GBS? When is this given ?

Answer 15

IV benzylpenicillin in labour

Question 16

What are important things to note about Levonorgestrel as an emergency contraceptive?

Answer 16

must be taken within 72 hours of unprotected sexual intercourse
single dose of levonorgestrel 1.5mg (a progesterone)
the dose should be doubled for those with a BMI >26 or weight over 70kg
hormonal contraception can be started immediately after using levornogestrel (Levonelle) for emergency contraception

Question 17

What are important things to note about Ulipristal as an emergency contracpetive?

Answer 17

The primary mode of action is thought to be inhibition of ovulation
dose taken as soon as possible, no later than 120 hours (5 days) after intercourse
concomitant use with levonorgestrel is not recommended
Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
caution should be exercised in patients with severe asthma
breastfeeding should be delayed for one week after taking ulipristal.

Question 18

What are important things to note about IUD as an emergency contracpetive?

Answer 18

must be inserted within 5 days of UPSI, or
may be fitted up to 5 days after the likely ovulation date (whichever is later)
may inhibit fertilisation or implantation
prophylactic antibiotics may be given if the patient is considered to be at high-risk of sexually transmitted infection
is 99% effective regardless of where it is used in the cycle - most effective one
may be left in-situ to provide long-term contraception. If the client wishes for the IUD to be removed it should be at least kept in until the next period

Question 19

Describe depot proverra

Answer 19

Given IM every 12 weeks - can be given up to 14 weeks since last dose without extra precautions

The main method of action is by inhibiting ovulation. Secondary effects include cervical mucus thickening and endometrial thinning.

Adverse effects
irregular bleeding
weight gain
may potentially increased risk of osteoporosis: should only be used in adolescents if no other method of contraception is suitable
not quickly reversible and fertility may return after a varying time!!!!!!!

Question 20

Describe the implant

Answer 20

The main mechanism of action is preventing ovulation. They also work by thickening the cervical mucus.

it is the most effective form of contraception
lasts 3 years
doesn’t contain oestrogen so can be used if past history of thromboembolism, migraine etc
can be inserted immediately following a TOP

additional contraceptive methods are needed for the first 7 days if not inserted on day 1 to 5 of a woman’s menstrual cycle
irregular/heavy bleeding is the main problem: this is sometimes managed using a co-prescription of the combined oral contraceptive pill. It should be remembered to do a speculum exam/STI check if the bleeding continues
‘progestogen effects’: headache, nausea, breast pain

Contraindications
UKMEC 3*: ischaemic heart disease/stroke (for continuation, if initiation then UKMEC 2), unexplained, suspicious vaginal bleeding, past breast cancer, severe liver cirrhosis, liver cancer
UKMEC 4**: current breast cancer

Question 21

Describe the IUD and IUS

Answer 21

IUS is also used for menorrhagia

IUD: primary mode of action is prevention of fertilisation by causing decreased sperm motility and survival
IUS: levonorgestrel prevents endometrial proliferation and causes cervical mucous thickening

IUD
can be relied upon immediately following insertion
the majority of IUDs with copper on the stem only are effective for 5 years

IUS
can be relied upon after 7 days
effective for 5 years

Potential problems
IUDs make periods heavier, longer and more painful
the IUS is associated with initial frequent uterine bleeding and spotting.
uterine perforation
infection: there is a small increased risk of pelvic inflammatory disease in the first 20 days
expulsion: risk is around 1 in 20, and is most likely to occur in the first 3 months

Question 22

Describe the COCP

Answer 22

small risk of blood clots
very small risk of heart attacks and strokes
increased risk of breast cancer and cervical cancer

if the COC is started within the first 5 days of the cycle then there is no need for additional contraception. If it is started at any other point in the cycle then alternative contraception for the first 7 days
Options include never having a pill-free interval or ‘tricycling’ - taking three 21 day packs back-to-back before having a 4 or 7 day break.
advice that intercourse during the pill-free period is only safe if the next pack is started on time

Question 23

Describe the POP

Answer 23

if commenced up to and including day 5 of the cycle it provides immediate protection, otherwise additional contraceptive methods should be used for the first 2 days
if switching from a combined oral contraceptive (COC) gives immediate protection if continued directly from the end of a pill packet (i.e. Day 21)

Taking the POP
should be taken at same time everyday, without a pill free break (unlike the COC)

Missed pills
if < 3 hours (desogesterel allows 12 hrs) late: continue as normal
if > 3 hours: take missed pill as soon as possible, continue with rest of pack, extra precautions (e.g. Condoms) should be used until pill taking has been re-established for 48 hours

Question 24

What should be done about missed COCP

Answer 24

If 1 pill is missed (at any time in the cycle)
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
no additional contraceptive protection needed
If 2 or more pills missed
take the last pill even if it means taking two pills in one day, leave any earlier missed pills and then continue taking pills daily, one each day
the women should use condoms until she has taken pills for 7 days in a row.
if pills are missed in week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
if pills are missed in week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval