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year 3. > Repro Txs > Flashcards

Repro Txs Flashcards

1
Q

Mx for ovulation supression

A

1st line: yasmine and eloine COC
-GnRH agonists
- Danazol (gnrh inhibitor)
-Oestrogen
- bilateral oopherectomy and hysterectomy with add back oestrogen only

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2
Q

breech presentation management

A

primiparous- external cephalic version (ECV) at 36 weeks
multiparous- ECV at 37

if not worked/ contraindicated- casarean

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3
Q

Cervical shock tx

A

Removing product from cervix

(Sometimes IV and uterotonics required)
(complication of miscarriage)

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4
Q

Threatened miscarriage tx

A

Micronised progesterone
(to try and prevent a true miscarriage)

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5
Q

Molar pregnancy management
how long must pregnancy be avoided afterwards

A

Surgical-(uterine evacuation) and tissues sent for histology to ascertain type

pregnancy should be avoided for 1 year after

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6
Q

Bacterial vaginosis tx
(and avoid…)

A

Metronidazole oral/gel

Avoid alcohol

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7
Q

Chlamydia
and If pregnant

A

doxycycline is first line

if pregnant: azithromycin/erythromycin/ amoxicillin

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8
Q

Hyperemesis gravidarum management

A

saline + potassim chloride (fluid replacement)
IV or IM antiemetics
thiamine + folic acid
TED stocking and LMWH

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9
Q

what anti-emetics are used for nausea and vomiting in pregnancy (& for hyperemesis gravidarum)

and their side effects

A

first line: antihistamines- oraal cylizine or promethazine-
end in zine

2nd: oral ondansetron (SE 1st trim, cleft palate)
oral metoclopramide or domperidone:
(meto SE- extrapyramidal, do not use for longer than 5 days)

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10
Q

Lifestyle advice for infertility

A

Stop smoking (and don’t replace with other nicotine products)
Bmi 18.5-30
Reduce/stop alcohol
Moderate caffeine
Stop recreation drugs/methadone for at least 12 months
Folic acid

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11
Q

Pcos infertility tx

A

1st line: clomifene citrate / tamoxifen +/- metformin

2nd: gonadotrophin injections (risks multiple pregnancy, overstimulation) (basically LH and FSH injections)
Needs supervision

3rd : laproscopic ovarian diathermy

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12
Q

Clomifene resistence

A

Add metformin

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13
Q

Male infertility treatment

A

Ivf
…

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14
Q

Blocked fallopian thbes tx

A

IVF

Sometimes if it is a very small blockage u can cannulate and open it

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15
Q

Pregnancy of unkown location

A

Expectant management (will resolve itself)
Medical- methotrexate

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16
Q

How long should a women wait to conceive after methotrexate management

A

6 months

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17
Q

Ruptured cyst

A

premenopausal: conservative unless hypovolaemic shock

postmenopausal: laparoscopy

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18
Q

Pelvic inflammatory disease management

A

oral ofloxacin + oral metronidazole
or
IM ceftriaxone + oral doxy + oral metronidazole
(IV ceft if very severe)

Advice she use barrier contraception as IUD removal should be considered

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19
Q

Bartholins abscess/cyst tx

A

Conservative if small cyst

Antibiotics broad spectrum- if infected and systemically unwell

usually treated with:
-Word catheter
-Marsupialization

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20
Q

TOP missed miscarriage medical tx

A

Mifepristone orally + bucall/sublingual/ vaginal misoprostol 24-48 hrs later

all women should be offered antiemetic and pain relief
Dose/frequency dependant on gestation

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21
Q

surgical abortion management

A

(under anaesthesia)

misoprostol/osmotic dilators given before

up to 13+6 weeks:
-Electric vacuum aspiration
-Manual vacuum aspiration

> 14wks
-Dilatation and evacuation

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22
Q

incomplete miscarriage medical tx

A

single dose of misoprostol (vaginal, oral or sublingual)

all women should be offered anti-emetics and pain relief

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23
Q

choosing type of TOP (termination of pregnancy)

A

medical or surgical offered up to and including 23+6 weeks

after 9 weeks medical abortions become less common (as inc risk of seeing products of conception pass and dec success rate)

<10 weeks medical abortions usually done at home

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24
Q

What is screening must all women undergo for TOP

A

STI screening,
VTE risk screening- if high risk give LMWH after abortion. if v high risk give before +/- continue

Contraception consultation and offered contraception

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25
Q

who receives antibiotic prophylaxis at time of abortion and regimen

A

those undergoing surgical TOP (STOP)

those undergoing MTOP with an increased risk of STI (if screening not performed/results unavailable)

regimen= 7 days doxcy

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26
Q

rhesus isoimmunisation who to treat at time of abortion

A

if rhesus d negative and at risk, higher gestation and surgical procedure increases risk

anti D is the tx

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27
Q

Diagnosing gonnococcal urethritis on microscopy

A

Gram negative intracellular diplococci- gonnococcal urethritis (gonnorhea)

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28
Q

Primary genital hsv tx
When to admit

A

Aciclovir tx 400mg 3x a day 5 days
+ supportive tx

Admit if urinary retention/ cant swallow

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29
Q

Syphillis tx

A

Benzathine penicillin

No sex
…

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30
Q

Lichen schlerosus tx

A

1- genital skin care: gentle wash (dermovate(, avoid tight clothing, irritabts etc
- apply emollient

2- super potent topical steroid- 12 week regimen (30g tube) then on an as required basis

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31
Q

When would a cystectomy be carried out

A

If cyst is >5cm
(As there is risk of torsion)

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32
Q

PMS tx mild

A

regular frequent balanced meals rich in complex carbohydrates

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33
Q

pms moderate symptoms

A

COCP

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34
Q

severe PMS tx

A

SSRI- continuously or just during the luteal phase

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35
Q

mx of gestational diabetes: fasting glucose >5.6 & <7

A

1st: trial of diet and exercise,
2nd: if targets not met within 1-2 weeks + metformin
3rd: ADD (not switch) short acting insulin if targets not met after a further 1-2 weeks

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36
Q

what are the blood glucose targets for women with gestational diabetes

A

fasting: </= 5.3mmol

2 hours postprandial: 6.4 mmol/L

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37
Q

gestational diabetes tx: >7mmol

A

1st; start short acting insulin immediately

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38
Q

what kind of insulin used for gestational diabetes

A

short acting!

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39
Q

Atypical endometrial hyperplasia tx

A

pre-menopausal- hysterectomy -
post menopausal- hysterectomy + bilateral salphingo-oopherectomy

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40
Q

simple endometrial hyperplasia- w/o atypia tx

A

high dose progestogens with repeat sampling in 3-4 months.

levonorgestrel intra-uterine system may be advised

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41
Q

neiserria gonorrhoeae 1: what agar, type of bacteria

A

requires chocolate agar to grow

gram negative diplococci

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42
Q

neisseria gonorrhoeae II antibiotic tx

A

1st line: Ceftriaxone IM single dose

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43
Q

chlamydia trachomatis II tx

A

doxcy or azithromycin

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44
Q

women with vulva-vaginal atrophy (from menopause) tx

A

vaginal oestrogen.
can be used in combination with HRT or be the alternative to HRT for women who it is contraindicated in

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45
Q

women with premature ovarian insufficiency tx (<40)

A
  • give HRT till the average age of menopause (51)
  • CHC (continuously) could be considered as alternative unless CI
  • HRT does not add risks compared to women without POI
  • continue with contraception
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46
Q

Women with early menopause (40- 44) tx

A
  • consider strongly giving HRT till the average age of menopause (51)
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47
Q

when can contraception be stopped in women aged 40-49

A

-2 years after last “natural” menstrual period or
- 2 years after 2 results of FSH of ≥ 30 IU/l, taken at least 4-6 weeks apart

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48
Q

when can contraception be stopped in women >/=50

A

-1 year after last “natural” menstrual period or
-1 year after 1 result of FSH of ≥ 30 IU/l

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49
Q

when can contraception be stopped >/=55

A

Age ≥ 55: contraception can be stopped even if still having periods

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50
Q

when would you give transdermal HRT over oral HRT

A

increased VTE risk or BMI >30
transdermal always preferred

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51
Q

management of menorrhagia secondary to fibroids
(1st, second and third line)

A

1: levonorgestrel intrauterine system (LNG-IUS) (mirena coil)
- useful if the woman also requires contraception
- cannot be used if there is distortion of the uterine cavity

2nd: NSAIDs e.g. mefenamic acid

3rd: tranexamic acid

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52
Q

surgical management of ectopic pregnancy

A

salpingectomy

2nd: salpingotomy (rf for infertility eg contralateral tube damage)

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53
Q

hirsutism and acne in PCOS tx

A

1st: third generation COC / co-cyprindol

2nd: topical elfornithine

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54
Q

Pregnant women with epilepsy: principles of management

A

pregnant women should continue anti-epileptics
Folic acid, 5mg daily

avoid valproate,
if taking phenytoin + vit k
carbamezapine considered least teratogenic

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55
Q

Hypertension tx for pregnant women
(and what to avoid)

A

1st line: labetolol
2nd: methyldopa/nifedpine

Avoid ace/arb
Beta blockers MAY inhibit foetal growth

If >160/110bp then ADMIT and OBSERVE

(Bp falls during 2nd trimester)

56
Q

Nausea and vomiting preganant women tx
(first line only)

A

Cyclizine first line

57
Q

UTI pregnant women tx

A

1st line: nitrofurantoin
2nd: amox/ cefelaxin

58
Q

1st line treatment for pain in pregnant women

A

paracetomol

59
Q

who requires VTE prophylaxis during pregnancy?

what is the VTE prophylaxis

A

2 or more risk factors:
obesity, age >35yrs, smoking, para>3

prophylaxis tx: LMWH at delivery and up to 7 days post partum

60
Q

Tx of venous thromboembolism in pregnancy
and what to avoid

A

therapeutic dose of low molecular weight heparin

avoid warfarin (teratogenic early, risk of haemorraghe late)

61
Q

Who gets pre eclampsia prophylaxis and what is the treatement

A

75-100mg aspirin daily

Women with one high risk or 2 moderate risk factors (eg. Over 40)

62
Q

active management of third stage of labour

A

prophylactic administration of syntometerine

1ml ampoule: 500micrograms ergometrine maleate & 5IU oxytocin

cord claming and cutting
controlled cord traction
bladder emptying

63
Q

plan for delivery placenta praevia

A

C/section : If placenta covers os or <2cm from cervical os
Vaginal delivery if placenta>2cm from os and no malpresentation

64
Q

antepartum haemorraghe general tx

A

Kleihauer test (check if there has been blood transfusion)( only if rhesus negative), if test is += Anti-D

give corticosteroids if risk of preterm birth and <34 weeks

rescus if necessary,
admit for obs etc

Antepartum haemorrhage= bleeding from the genital tract >24 weeks pregnancy, prior to delivery of the fetus

65
Q

antibiotic management of suspected sepsis
and if penicillin allergic pregnant woman

A

IV co-amoxiclav within “golden hour” +/- gentamicin depending on severity and clindamycin if sore throat (GAS)

Clindamycin + gent if penicillin allergic

66
Q

antibiotic management of septic shock in pregnant woman

A

Tazocin , clindamycin + gentamicin

67
Q

GBS risk (previous baby infected with GBS)/detected in pregnancy management; management

A

antibiotic prophylaxis

1st: Benzylpenicillin

2: Clindamycin

68
Q

post partum endometritis tx (not penillin allergic)

A

Treatment with co-amoxiclav +/- surgical evacuation of uterus if significant RPOC (retained products of pregnancy)

69
Q

post partum endometritis tx if penicillin alergic

A

Co-trimoxazole +metronidazole

+/- surgical evacuation of uterus if sig.fig. RPOC

70
Q

epidural abscess tx

A

Vancomycin, metronidazole and cefotaxime +/- surgical decompression (if no response or neurological concerns)
drain abscess

71
Q

placental abruption tx <36 weeks and fetus alive

A

fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

72
Q

placental abruption tx >36 weeks and fetus alive

A

fetal distress: immediate caesarean
no fetal distress: deliver vaginally

73
Q

1st line tx for magnesium sulfate induced respiratory depression

A

calcium gluconate

74
Q

chicken exposure management vs
chicken pox management
(in pregnancy)

A

exposure:
1st line- oral aciclovir 7 days after exposure for 7 days.
2nd (varicella zoster immunoglobulins)

chicken pox:
give aciclovir if >20 weeks and woman presents within 24h of onset of rash

75
Q

treatment for Persistent Pulmonary Hypertension of the newborn

A

Ventilation, O2, nitric oxide, sedation inotropes

if above fails: ECLS machine (mechanical lung)

76
Q

ectopic pregnancy:
criteria for expectant management

A

size <35mm
hcg <1000IUL
asymptomatic

77
Q

ectopic pregnancy:
criteria for medical management

A

size<35mm
hcg <1500IUL
no significant pain

not suitable if there is another intrauterine pregnancy

78
Q

ectopic pregnancy:
surgical management criteria

A

if its ruptured or
size >35mm/
pain/
foetal heartbeat/
hcg>5,000IUL

79
Q

post partum haemorraghe tx (overview)

A

1st: ABCE and IV warmed crystalloid
2nd: (mechanical) rub uterine fundus and catheterise
3rd:medical uterotonics etc
4th line: intrauterine tamponade

80
Q

post partum haemorrhage- medical management

A

IV oxytocin
ergomotine IV-unless hx of hypertension
carboprost IM- unless hx of asthma
misoprotol subingual

81
Q

fibrocystic change management

A

exclude malignancy
reassure
excise if necessary (unusual)

82
Q

fibroadenoma mx

A

if greater than 3xm excise

83
Q

radial scar tx

A

excise or vacuum biopsy

84
Q

duct ectasia management

A

stop smoking
excise ducts- michrodochectomy if young or total duct excision if older

(Duct ectasia is a dilatation and shortening of the terminal breast ducts within 3cm of the nipple. It is common and the incidence increases with age. It typically presents with nipple retraction and occasionally creamy nipple discharge. )

85
Q

1st line tx for uterine fibroids

A

<3cm- IUS for menorrhagia and gnRH analogues to reduce size
>3cm- surgical management eg myomectomy

86
Q

thrush tx (and contraindication) (candidias)
(4)

A

1st line: oral fluconazole single dose
2nd: clotrimazole intravaginal single dose if oral contraindicated
if vulval symptoms too + topical imidazole

if pregnant oral tx contraindicated

87
Q

how long should magnesium sulfate be continued for seizure pregnancy

A

24 hours after delivery or last seizure- whichever is later

88
Q

intrahepatic cholestasis of pregnancy management

A

ursodeoxycholic acid

INDUCTION OF LABOUR AT 37-38 WEEKS ( as inc risk of still birth)

vit k supplementation

89
Q

Preterm prelabour rupture of the membranes

A

(preterm- before 37 weeks)

oral erythromycin should be given for 10 days

antenatal corticosteroids

delivery should be considered at 34 weeks of gestation

90
Q

current breast cancer is a contrindication for which contraceptives

A

all hormonal contraceptives

91
Q

rhesus negative woneb- when should she recieve anti D

A

at 28 weeks and 2nd dose at 34 weeks

92
Q

Treatment to shrink/remove fibroids

A

medical- gnrh agonists

surgical- myomectomy, hysteroscopic endo ablation, hysterectomy
uterine atery embolisation

93
Q

what advice should be given, regarding folate supplementation, to women hoping to concieve

A

Women should be encouraged to take folic acid 400mcg OD 3 months before conception up to 12 weeks gestation

94
Q

stress incontinence tx (3 lines of management)

A

1st: pelvic floor muscle training

2nd: surg procedures

3rd: duloxetine

95
Q

urge incontinence tx
include if frail/elderly

A
  1. bladder retraining
    antimuscarinics: oxybutnin
    mirabegron- if frail/elderly
96
Q

non HRT menapause vasomotor symptoms tx

A

SSRIs
fluoxetine/citalopram or venlafaxine (SNRI)

97
Q

mode of delivery, labour in women with HIV

A

vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started four hours before beginning the caesarean section

98
Q

neonatal antiretroviral therapy

A

zidovudine orally to the neonate if maternal viral load is <50 copies/ml.

Otherwise triple ART for 4-6 weeks.

99
Q

what are the haemoglobin cut offs for tx- non preg, early preg, late preg, after childbirth

A

115 for non-pregnant women, 110 in early pregnancy, 105 in later pregnancy, and 100 after childbirth

100
Q

when can COC be given after labour

A

never before day 21 post partum due to risk of vte

if breast feeding: 6 weeks - 6 months postpartum

if inc risk of VTE then not in the first 6 weeks

101
Q

what contraception can be given immedietely after labour

A
  • progesterone only pill
  • implant
  • injection
  • condoms

(IUS and IUD but not after 48 hours.)

102
Q

when can IUD/IUS be given post partum

A

within 48 hours after labour
or
4 weeks later

103
Q

what type of drug is cabergoline

A

long acting dopamine agonist

104
Q

Fetal transverse lie management

A

<36 weeks- no management

> 36 weeks- external cephalic version of foetus- offered in all cases of vag delivery
or
elective caesarean

cant do ECV if membranes have ruptured

105
Q

when is induction of labour offered to women with intrahepatic cholestasis

A

37-38 weeks

106
Q

when do postpartum women require contraceptives

A

not required before day 21 postpartym. earliest date of ovulation is day 28

107
Q

when must levonogestrel be taken regarding emergency contraception

A

within 72 hours of unprotected sexual intercourse

108
Q

emergency contraception: ulipristal (progesterone receptor modulator)- when can it be taken and contraindications

A

no later than 120 hours after intercourse (5 days)
*caution with those with severe asthma

109
Q

if bishop score is 6 or less management

A

vaginal prostoglandins/ oral misprostol

balloon catheter if higher risk of hyperstimulation/previous caesarean

110
Q

if bishop score is greater than 6 management

A

amniotomy and IV oxytocin infusion

111
Q

> 37 weeks women with pre-eclampsia + mild/moderate hypertension tx

A

delivery within 24-48 hours

consider magnesium sulphate if birth is planned within 24 hours or if there is a concern that the woman may develop eclampsia

112
Q

primary dysmenorrhoea tx

A

(painful periods)

1st line: NSAIDs eg mefenamic acid/ibuprofen.

2nd line:COCP

113
Q

Pregnant women uti tx

A

1st line: niturofurantoin
2nd- amox or cefalexin

7 day course!!! (3 in non pregnant)

114
Q

perineal tears tx

A

1st degree- no repair required

2nd degree- suture on ward by midwife or clinician

3rd: repair in theatre by clinicial

4th: same^

115
Q

what is the only fibroid treatment which maintains fertility

A

myomectomy

116
Q

what ovarian cysts, found on imaging, require referral to gynaecology (5)

A

-irregular solid tumour
-ascites
-at least 4 papillary structures
- irregular multilocular sold tumour growth with largest diameter >/= 100mm
- very strong blood flow

117
Q

which medication can be used to supress lacation

A

cabergoline- dopamine agonist

118
Q

what is category 1 caesarean

A

caesarean for mother where there is an immediate threat to the life of the mother or baby

delvery wtihin 30 mins of making decision

119
Q

what is category 2 caesarean

A

maternal or fetal compromise which is not immediately life-threatening
delivery of the baby should occur within 75 minutes of making the decision

120
Q

prophylaxis for anti -D, who gets it and when

A

all women who are rhesus negative whether sensitised or not get anti- d prophylaxis at
-28 weeks
&
-34 weeks

121
Q

endometriosis tx

A

first line: NSAIDs and/or paracetamol
second: COCP or POP
3rd: GnRH analogues

(^all symptomatic relief)

122
Q

endometriosis: tx for women trying to concieve

A

laparoscopic excision or ablation of endometriosis plus adhesiolysis as this has been shown to improve the chances of conception. Ovarian cystectomy (for endometriomas) is also recommended

123
Q

cord prolapse tx

A
  • presenting part of fetus may be pushed back into uterus to avoid compression
  • if cord is past level of intoitus- minimal handling, keep warm and moist- to prevent vasospasm
    -get patient to go on all fours
    -tocolytics (reduce contractinos)
    -retrofill bladder

cesarean- unless cervix fully filated and head is low- instrumental delivery.

124
Q

suspected PE pregnant women with confirmed DVT management

A

treat with LMWH first then investigate to rule in/out

125
Q

when should post exposure prophylaxis chickenpox be given

A

day 7-day 14

126
Q

if pregnant women has chicken pox treatment

A

oral aciclovir within 24 hours of onset of rash
(if <20 weeks consider aciclovir with caution)

127
Q

Second stage labour management

A
  • forceps if possible
  • caesarean otherwise (inc risk of mortality/morbidity)

Oxcytocin can be used only if there is a problem with contrations

128
Q

Genital warts tx

A

1st: topical podophyllum or cyrotherapy (solitary warts better for cyrotherapy)

2nd: iniquimod

129
Q

Genital herpes- what hsv is it and tx

A

Hsv 1/2

General: saline bathing, analgesia, lidocaine (anaesthetic)

  • oral aciclovir - frequent exacerbations
130
Q

What organisms are genital warts

A

Human papilloma virus 6 & 11

131
Q

What organisms assoc with cervical canver

A

Human Papilloma virus -16, 18, 33

132
Q

cervical cancer tx

A

1A- hysterectomy +/- lymph node clearance.
- maintain fertility: cone biopsy w/ negative margins

1b - radiotherapy + chemo or radical hyst w/pelvic lymph node dissection

II & III- radiation + chemo

IV- radiation +/ or chemo, possibly palliative chemo.

133
Q

HRT key points

A

topical over oral

if menapause has not been reached/perimenopausal then: cyclical/sequential
(post menopausal- continuous)

if patient has a uterus then combined is required

134
Q

pre-labour rupture of the membranes management and what is it

A

PROM- rupture of the membranes pre labour and >37 weeks.

mx- induce labour if it has not spontaneously occured after 24 hours

if infection/foetal compromise immedietley induce or caesarean may be necessary

135
Q

pcos cocp tx rule

A

cocp have a widthdrawal bleed once every 3 months to reduce risk of endometrial hyperplasia

136
Q

antiphosphoilipid synrome in pregnancy tx

A

low dose aspirin as soon as pregnancy is confirmed

lmwh as soon as fetal heart is seen on us- discontinue at 34 weeks

year 3. (32 decks)

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