Repro

Question 1

When do we start doing CTGs ?

Answer 1

27 weeks - before then it is common to look abnormal

Question 2

How do we interpret ctgs?

Answer 2

DR C BRAVADO

DR - determine risk eg small baby
c - contractions - present? Spontaneous/augmented (oxytocin)/regular/how many in 10 mins - labour (3/4 in 10 mins)
BR - Baseline fetal heart rate - 120 normal
A - accelerations
V - variability
D - decelerations
O - overall impression

Question 3

Reassuring values - Hr and variability on ctg

Answer 3

HR - 110-160
Variability- 5-25bpm

Question 4

Acceleration and deceleration amount on a ctg

Answer 4

15bpm change - last for at least 15 seconds

5bpm = 1 little box
15 sec = half a box

Question 5

What is shouldering on a ctg and is it reassuring?

Answer 5

When there is a quick increase in heart rate before and after a deceleration

Question 6

What is one of the most important part of ctg to look at?

Answer 6

Variability

Question 7

Sinusoidal ecg means what

Answer 7

NEEDS delivery ASAP

sign if bleeding

Question 8

What does terbutaline do?

Answer 8

Slows down contractions (tar sp= slow)

Question 9

What is the greene climeric scale and when do we use it?

Answer 9

Menopause symptoms and severity

Used to monitor and decide what hrt therapy

Question 10

Still having periods, but menopause symptoms do we begin treatment?

Answer 10

Yes

Question 11

Following gnhr analogues will periods resume?

Answer 11

Yes

Question 12

Vaginal estrogen do we still give progesterone?

Answer 12

No as such a low dose

Question 13

Hrt risks

Answer 13

VTE
cardiovascular
Breast cancer

Question 14

Why do we get urinary in continuance in menopause

Answer 14

Due to atrophy (same embryological tissues as vag so same atrophy)

Can give topical oestrogen

Question 15

anaemia
pain mnestrual cycle

Question 16

3 criteria for hypernemesis gravidarum

Answer 16

5% weight loss
Dehydration (ketones)
Electrolyte imbalance (hypokalaemia)

Question 17

What do we need to exclude before we can diagnose hypernemesis gravidarum ?

Answer 17

Gi - peptic ulcers, cholecystitis, gastroenteritis, hepatitis, pancreatitis, uti/pyelonephritis, metabolic conditions, neurological condition/drug induced

Question 18

Green vs yellow vommitting

Answer 18

Green is obstruction (lower down so has bile)
Yellow is some problem higher up

Question 19

Electrolyte abnormalities in hypernemesis gravidarum

Answer 19

Hyponatraemia
Hypokalaemia
Thiamine low

Question 20

Low thiamine can lead to what and what wou,d. e the symptoms

Answer 20

Wernikes emcephalopathy
Opthalmiokagia
Ataxia
Confusion

Question 21

What scoring system can we use for hypernemesis?

Answer 21

PUQE score to determine severity

Question 22

Hypernemesis gravidarum treatment

Answer 22

No complications:
PUQE 3-12: antiemetics, lifestyle and dietary changes
PUQE 13: thiamine, antiemetics, normal saline and potassium. Ambulatory day care until no ketouria. No ketones in uria = discharge.

Complications = inpatient. No antiemetics = steroids. MDT. VTE prophylaxis

Question 23

Why don’t we give dextrose in hypernemesis gravidarum?

Answer 23

It can ,sad to wernikes encephalopathy

Question 24

Can iron exacerbate nausea and vommitting?

Answer 24

Yes

Question 25

First line antiemetics + hypermisis

Answer 25

1. Cyclizine 50mg PO/IM/IV 8hrly
2. Prochlorperazine 5-10mg 6-8 hourly PO. Am also be given PR
3. Promethazine 12.5-25mg 4-8hrly
4. chlorpromazine 10-25g 5+6 hourly po. Also can be given PR

Question 26

When do we want to avoid giving ondansatron?

Answer 26

First trimester - can lead to congenital anomalies