Repro Ixs Flashcards
Miscarriage ixs
Fbc, blood group and rhesus status, serum hcg,
definitive diagnosis- transvaginal ultrasound
Gold standard ix for ectopic pregnancy
Trans vaginal ultrasound scan
Molar pregnancy ix and appearance
Uss diagnoses it- snowstorm appearance +/- fetus, theca lutein cysts
Infertility ixs woman
serum progesterone 7 days prior to expected next period. (28 day cycle= day 21): establish ovulation
Tsh
Rubella immunity
Chlamydia screeb
Ensure cervical smear test is up to date
Male infertility ix
Semen analysis
if abnormal repeat in 3 months
min. of 3 days and max of 5 days abstinence required for test
tests to check tubal patentcy
(first line and diagnostic)
Hsg (x-ray procedure to look at uterus and fallopian tubes)
Diagnostic: laproscopy and hyrdrotubation
^ indications: signific pelvic pain etc
When is hysteroscopy done
In cases where suspected endometrial pathology, ie: uterine septum, adhesions, polyp
(camera inserted in vagina and through cervix to view inside uters)
Pcos diagnostic criteria
the Rotterdam criteria state that a diagnosis of PCOS can be made if 2 of the following 3 are present:
- infrequent or no ovulation (usually manifested as infrequent or no menstruation)
- clinical and/or biochemical signs of hyperandrogenism (such as hirsutism, acne, or elevated levels of total or free testosterone)
- polycystic ovaries on ultrasound scan (defined as the presence of ≥ 12 follicles (measuring 2-9 mm in diameter) in one or both ovaries and/or increased ovarian volume > 10 cm³)
ART eligibility
(8)
Stable relationship 2yrs
Female age <40 (<42)
Female bmi 18.5-30
Non smokers
No biological child
No illegal/abusive substances (inc methadone)
Neither partner can have been previously sterilised
Duration unexplained fertility for 2 yrs
Primary genital hsv ix
Swab lesion for hsv-1 and 2 pcr
Recommend full sti screen (chlamydia, gonnorhoea, syphillis, HIV)
Syphillis
non treponemal test + treponemal specific test
fibroids Ix
tv ultrasound
rarely MRI
premenopausal ovarian cysts Ix (1st line and other ixs)
1st: ultrasound scan
MRI, tumour markers CA125 and AFP (embryonal carcinoma),HCG (choriocarcinoma), LDH (dysgerminoma)
post menopausal masses Ix
CT and CA125
Gold standard ix for endometriosis
Laparoscopy
gestational diabetes Ixs
givecut off range for diagnosis
1st line: oral glucose tolerance test
fasting glucose: >=5.6
2 hour glucose: >= 7.8mmol
testing for chlamydia type II
NAAT
> = 55 presenting with post-menopausal bleeding
^what is this a red flag for and what should the management be
endometrial cancer
refer using cancer pathway :
- transvaginal ultrasound scan and consideration of hysteroscopy with endometrial biopsy
when does ectopic pregnancy qualify for surgical management
> 35mm
if it is ruptured
pain
visible heartbeat
HCG>5000
Hypertension definition in pregnant women
> =140/90 on 2 occasions 4 hrs apart
> = 160 systolic once
=140 diastolic once
Proteinuria definition
UPCR>30mmol
(Urine protein creatinine ratio)
when should women with risk factors for gestational diabetes be offered screening test
oral-glucose tolerance test should be offered at 24-28 weeks
if woman has previously had gestational diabetes then offer it straight away and at 24-28 weeks
what score is used to determine if labour can commence
bishops score
<5 = labour is unlikely to start without induction
>/=8 indicates cervix is ripe
placenta praevia investigations
confirm by: TV ultrasound
MRI to exclude placenta accreta
do NOT do digital examination
check anomaly scan
vasa praevia diagnostic test
ultrasound TA and TV with doppler
test to aid diagnosis of epidural abscess
MRI
rubella investigations
IgG specific to rubella and IgM within 10 days of exposure
when is amniocentesis offered
between weeks 15-20
test for persistent pulmonary hypertension of the newborn
measure pre and post ductal O2 sats= 10-20% difference
(pre duct is right arm and head and neck)
hyperemesis gravidarum diagnostic criteria
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
pre-eclampsia diagnostic criteria
blood pressure of systolic 140 or diastolic 90 (or greater) and 1 or more of: proteinuria, organ dysfunction
when does pre-eclampsia occur
> 20 weeks
down syndrome antenatal testing (SCREENING tests):
when can test(s) be done
which test is more accurate
combined test result: 11-13+6 weeks
quadruple test: 15-20 weeks
combined test more accurate
diagnostic test for downs
chorionic villus sampling or amniocentesis
however women will be offered a second screening test called NIPT which is non invasive and has a very high sensitivity and specificity
what are the positive test results for downs syndrome (combined test)
high HCG, low PAPP-A, thickened nucheal translucency
all low except Hcg, H for High
what are the positive test results from quadruple test for downs syndrome
high hcg, high inhibin A, low AFP, low oestriol
screening tool for postnatal depression
the edinburgh scale
scoring system if induction of labour is required
bishop score
cervical cancer screening- if the results are positive
positive hrHPV- refer to cytology.
if cytology abnormal> colposcopy if cytology normal then the test is repeated at 12 monthss.
if hrHPV -ve 12 months later> return to normal recall.
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy
cervical cancer screening- what to do is results are inadquate
if inadequate- refer for another test in 3 months
if inadequate again refer for colposcopy
how often is cervical screening offered in scotland
25-64 yrs every 5 years
preterm labour rupture of the membranes ix
1st line: sterile speculum examination (to look for pooling of the amniotic fluid in the posterior vaginal vault) & avoid digital examination
-if pooling of fluid is not observed NICE recommend testing the fluid for placental alpha microglobulin-1 protein (PAMG-1) (e.g. AmniSure®) or insulin-like growth factor binding protein‑1
ultrasound may also be useful to show oligohydramnios
what can transvaginal ultrasound determine regarding pregnancy
whether pregnancy is intrauterine or ectopic, if there is a foetal heartbeat & the presence of any other abnormalities, such as a subchorionic haematoma
stereotypical PCOS results
raised LH:FSH ratio
testosterone may be normal or mildly elevated
SHBG is normal to low
diagnostic threshold for gestational diabetes
fasting glucose>= 5.6mmol/L
2 hour glucose is >= 7.8mmol/L
reduced fetal movements investigations for woman <24 weeks pregnant
handheld doppler if movements previously felt, otherwise refer to maternity
reduced feotal movements 24-28 weeks ix
handheld doppler
reduced foetal movements >28 weeks ix
1st handheld doppler,
if no foetal heartbeat> immediate ultrasound
if foetal heartbeat present- CTG
when is the anomaly scan performed and what is it for
18-20+6 weeks
Anomaly scan evaluates anatomical structures of the foetus, placenta, and maternal pelvic organs. This allows for careful planning of the pregnancy as well delivery
what is baseline bradycardia feotus
hr <100bpm
baseline tachycardia foetus
hr> 160/min
what does early deceleration mean /indicate
early: deceleration of HR which commences w/ onset of a contraction and returns to normal on completion of contraction
usually normal, can indicate head compression
Late deceleration (ctg) meaning/indication
pathological!
Deceleration of the heart rate which lags the onset of a contraction and does not returns to normal until after 30 seconds following the end of the contraction
Indicates fetal distress e.g. asphyxia or placental insufficiency
Variable decelerations: meaning/indications
Independent of contractions
may indicate cord compression
reassuring CTG:
baseline heart rate
variability
decelerations
Baseline heart rate: 110 to 160 bpm
Baseline variability: 5 to 25 bpm
Decelerations: None or early
Variable decelerations with no concerning characteristics for less than 90 minutes
late deceleration foetus- ix
late decerelation- do foetal sampling. should be ph>7.2
if fetal acidosis consider urgent delivery
normal endometrial thickness
<4mm
how is low molecular weight heparin monitored in DVT (which blood test)
anti-xa activity
what is assessed in bishops score
cervical position
cervical consistentcy
cervical effacement
cervical dilation
fetal station
what should fundal height be
match gestational age from 20 weeks onward- within 1 or 2cm
what are the cut offs for recieving iron therapy in pregnancy
first trimester <110
2nd trimester <105
pospartum <100
how is menapause diagnosed
< 50 years of age AND amenorrhoeic for at least 2 years.
> 50 years of age AND amenorrhoeic for at least 1 year.
chorioamniocentesis tx
IV antibiotics and immediate cesarean
premature ovarian insufficiency tx
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of 51 years
(for symptoms and to protect bones)
what should symphisis fundal height be after 16 weeks
same as gestational age +/- 2
when is a pregnancy test carried out after TOP
3 weeks after.
Most sensitive test for gonnorhoea
NAAT- requires urine or a swab to obtain the genetic materials
HIV Investigations
p24 antigen 1st line as it can detect HIV 1 -4 weeks after infection whereas HIV antibody test can take up to 3 months.
HIV p24 antigen and HIV antibody tet are now standard for diagnosis and screening- reapeat test for confirmation
cervical cancer staging and how is it staged
FIGO staging
Ia, Ib, II, III, IV
Ia- microscopic, confined to cervix
II- invades uterus/upper 2/3rds of vagina
IV- extension of tumour beyond the pelvis or involvement of bladder or rectum
ovarian cancer ix
first CA125, if raised > abdo + pelvic us, if pos > urgently refer
diagnosis usually involves laparotomy.
ovarian cancer staging
Stage 1 Tumour confined to ovary
Stage 2 Tumour outside ovary but within pelvis
Stage 3 Tumour outside pelvic but within abdomen
Stage 4 Distant metastasis
endometritis ix
high vaginal swab, transvaginal ultrasound
endometrial biopsy diagnostic but rarely used.
secondary post parum haemorrage ix
high vaginal swab for infection and tv us to look for retained products of pregnancy
abx tx for secondary pph
and if penicillin allergic
- Antibiotics - co-amoxiclav (co-trimoxazole + metronidazole if penicillin allergic)
when can chorionic villus sampling be carried out
11-14 weeks
when can amniocentesis be carried out
15-20
