Reproduction new Flashcards
1
Q
Spinal & Epidural Anaesthesia , which injection site?
A
L3-L4
2
Q
Pudendal Nerve Block, injection site?
A
Transvaginal (near Ischial Spines)
3
Q
Target space for Spinal & Epidural Anaesthesia
A
Spinal= Subarachnoid
Epidural= Epidural
4
Q
Common use Spinal Anaesthesia
A
C-Section
5
Q
Common use Epidural Anaesthesia
A
Labour Pain
6
Q
Common use Pudendal Nerve Block (2)
A
Episiotomy
Forceps Delivery
7
Q
Key risk with Spinal Anaestheisia
A
Hypotension
8
Q
1st degree Uterine Prolapse
A
cervix remains in vagina
9
Q
2st degree Uterine Prolapse
A
2nd degree at vaginal orifice
10
Q
3rd degree Uterine Prolapse
A
3rd degree outside vagina
11
Q
Uterine Procidentia
A
Uterine Procidentia (entirely outside vagina)
12
Q
Prolapse (3 signs)
A
Dragging sensation
Feeling a lump (vagina opening)
Urinary symptoms (cystocele) stress incontinence
13
Q
Prolapse Tx
A
1st Line = Lifestyle changes
2nd Line= PFE
3rd Line= Ring pessaries
4th Line= Surgical (Sacrospinous Fixation) Common after Hysterectomy
Or
Manchester repair (cervix removed, uterosacral ligaments shortened)
14
Q
Urge Incontinence / overactive bladder Tx
A
1st Line= β Alcohol/caffeine
2nd Line= Bladder Training (6 weeks?)
3rd Line= Oxybutinin (SE falls eldery)/ Oestrogen pessary
NOW Solifenacin not Oxyβ¦
15
Q
Stress Incontinence Tx
A
1st Line= Lifestyle
2nd Line= PFT
3rd Line= Duloxetine (SNRI)
16
Q
Ovary =
Cell linings:
Vagina =
Ectocervix =
Endocervix =
Uterine =
Transition zone = squamo-columnar junction, why important (2)?
A
Vagina = stratified squamous (non-keratinised)
Ectocervix = stratified squamous
Endocervix = columnar (glandular)
Uterine = columnar
Ovary = cuboidal
Transition zone = squamo-columnar junction
Hot spot for dysplasia & neoplastic changes
Also Site of cervical smear
17
Q
Menstrual Cycle
Day 1-14 = X phase [β in what(2)]
Day 14 β 28 = Y phase [β in what(2)]
When does Ovulation occur?
A
Day 1-14 = follicular phase (β FSH & oestrogen)
Day 14 β 28 = luteal phase (β LH & progesterone)
FELP
Ovulation occurs 24-36hours post LH surge
18
Q
Assessing ovulation:
Regular cycle: Check what and what should result show?
Irregular cycle: What test? If withdrawal bleed occurs then what does it mean?
A
Regular Cycle (tested day 21)= Midluteal serum progesterone (>30nmol/L x2 samples)
Irregular cycle: Progesterone challenge test > If withdrawal bleed occurs oestrogen levels are adequate (but Anovulation= PCOS)
19
Q
Assessing ovulation:
Regular Cycles
β Test name?
β Timing: Which day?
β Expected result from test?
A
β Test: Mid-luteal serum progesterone
β Timing: ~Day 21 (assuming a 28-day cycle)
β Expected result: >30 nmol/L (indicates ovulation)
20
Q
Irregular Cycles
β Test name?
β Interpretation:
If withdawal bleed occurs?
No withdrawal bleed?
A
Irregular Cycles
β
Test: Progesterone challenge test
β
Interpretation:
Withdrawal bleed occurs:
Oestrogen is adequate (suggests anovulation due to lack of progesterone, e.g., PCOS).
No withdrawal bleed: Likely low oestrogen (hypogonadotropic hypogonadism or endometrial issues).
21
Q
Buzzword for Kallmans?
(incomplete/absent puberty)
A
Anosmia
22
Q
Factors causing amenorrhoea (4)
A
Anorexia
stress
chronic illness/alcohol misuse prolonged exercise
23
Q
Sheehans (4)
A
Postpartum hemorrhage
Hypopituitarism
Failure to lactate (β prolactin)
Amenorrhoea / oligomenorrhoea (β LH/FSH)
Fatigue, cold intolerance, weight gain (β ACTH, TSH β β cortisol & β thyroid hormones)
24
Q
Rotterdam Criteria PCOS (2+/3 needed)
A
The Rotterdam Criteria
- Oligo/amenorrhoea
- Hyperandrogenism ( hirsutism, increased free testosterone)
- Evidence of polycystic ovaries on USS
(ovarian volume >10ml, >12 follicles)
25
PCOS clinical features (5)
Obesity
hirsutism
acne
cycle abnormalities/infertility
insulin resistance
26
PCOS Tx NOT wanting Family (3)
Lifestyle changes
COCP (dianette if hirsutism)
metformin
27
PCOS Tx WANTING Family (3)
1st Line Clomifene citrate +/- metformin
2nd Line Gonadotrophin therapy
3rd Line IVF/laparoscopic drilling)
28
Comifene citrate PCOS Tx, side effects (4 M's)
Multiple pregnancies
Menopausal symptoms
Massive ovary (OHSS)
Malignancy (ovarian cancer risk)
29
Eflornithin treats what?
(PCOS)
Growth rate of facial hair
30
Premature Ovarian Failure (POF) / Primary Ovarian Insufficiency (POI)
3 key features:
β
Menopause before 40 years β Loss of menstrual periods.
β
High FSH (>30 IU/L) β Due to loss of negative feedback from ovarian estrogen.
β
Low estrogen levels β Causes symptoms of menopause.
31
Causes of POF/POI (4)
Idiopathic (most common) β
Turner Syndrome (XO karyotype) β
Chemotherapy/Radiotherapy β
Autoimmune Diseases (Thyroid disease, Addisonβs disease) β
32
Key features of POF/ POI
π» β Oestrogen = Menopausal-like symptoms:
Hot flushes
Night sweats
Osteoporosis risk
πΈ Atrophic vaginitis
Vaginal dryness
Dyspareunia (painful sex)
𧬠Infertility
Due to reduced ovulation
33
POF/ POI Dx (3)
π FSH > 30 IU/L on two occasions (1 month apart)
π β estrogen levels (confirms ovarian failure)
π Karyotyping (Turnerβs, Fragile X).
34
POF/POI
Management & Why Itβs Needed
Goals of Mx:
Replace missing oestrogen to β risk of:
β
Osteoporosis
β
CVS
β
Severe menopausal symptoms (e.g. hot flushes, vaginal dryness)
Tx: Combined HRT (or COCP) (if uterus present) AND IVF if want baby
π Monitoring:
DEXA scan (bone health)
CV risk profile (BP, lipids)
Psychological wellbeing (screen for anxiety/depression)
35
Which 2 STI's give PID
(MOST COMMON) Chlamydia trachomatis
Neisseria gonorrhoeae
36
PID PC (5)
πΉ BILATERAL Pelvic pain
πΉ Fever
πΉ Deep dyspareunia
πΉ Vaginal discharge β often purulent
πΉ Cervical excitation (Chandelier sign)
37
Short-Term Complications of PID (3)
1. Tubo-ovarian abscess
2. Peritonitis
=========================
3. Fitz-Hugh-Curtis Syndrome β
β
Presents with right upper quadrant (RUQ) pain
β
"Violin string" adhesions seen between the liver and peritoneum
38
Long term complications of PID (3)
Chronic pelvic pain
infertility
ectopic pregnancy
39
Hydrosalpinx meaning?
A distally blocked fallopian tube filled with serous fluid due to previous PID.
40
Endometriosis (5)
β
Cyclic Dysmenorrhoea
β
Menorrhagia
β
Dyspareunia
β
Dyschezia
β
Chronic Pelvic Pain
41
Endometriosis leads to what type of cycsts?
Which tool to see Cysts?
Chocolate cysts (old blood)
USS
42
Endometriosis Gold Standard Dx
Laparoscopy
43
Endometriosis Tx
Tx:
1st line= 3 months Nsaids /paracetamol
2st Line = COCP/mirena IUS
3nd Line= GnRH agonist
4rd Line= Laparoscopic ablation
44
Adenomyosis (4)
Older women (35-50 years)
Enlarged, boggy, and tender uterus
"Venetian blind" shadowing
Non-cyclical, constant pelvic pain
45
1Β° Dysmenorrhoea, why and what Tx
NO PELVIC PATHOLOGY
Teens// INCREASED WHAT!?
Due to increased endometrial prostaglandins
Tx: Mefenamic acid/ibuprofen
46
2Β° Dysmenorrhoea (4)
PELVIC PATHOLOGY
(20s-40s)
**PAFE **
PID
adenomyosis
fibroids
Endometriosis
47
Pain that develops after years β
If HMB + dysmenorrhoea β
If dyspareunia + infertility + cyclical pain β
If pelvic pain + discharge + fever β
Pain that develops after years = Secondary Dysmenorrhoea π¨
If HMB + dysmenorrhoea β Think adenomyosis or fibroids πΈ (bogy+ tender))
If dyspareunia + infertility + cyclical pain β Endometriosis π©Έ
If pelvic pain + discharge + fever β PID π¦
48
Causes of menorrhagia (HMB)
(pathological/organic ) (5)
Von **W**illebrand Disease
**E**ndometrial Hyperplasia
**F**ibroids (Leiomyomas) β Most common benign uterine tumor, causes heavy irregular bleeding.
**A**denomyosis (bogy)
**P**COS
49
Non-Organic Causes (Dysfunctional Uterine Bleeding - DUB)
menorrhagia
1. Anovulatory DUB (85%)
(puberty & perimenopause).
2. Ovulatory DUB (15%) 35-45 years
Estrogen unopposed by progesterone
50
menorrhagia Tx
1st line: Mirena IUS
2nd line: Tranexamic acid
3rd line: IM progestogens
Surgery: Endometrial resection/ablation, hysterectomy, uterine artery embolisation
51
π‘ MCQ Exam Strategy menorrhagia
β
If menorrhagia + irregular cycles β
β
If menorrhagia + heavy + tender uterus β
β
If menorrhagia + large uterus with irregular contour β
β
If menorrhagia since menarche + bruising β
β
If perimenopausal + obesity β
π‘ MCQ Exam Strategy menorrhagia
β
If menorrhagia + irregular cycles β PCOS / thyroid disease
β
If menorrhagia + heavy + tender uterus β adenomyosis
β
If menorrhagia + large uterus with irregular contour β fibroids
β
If menorrhagia since menarche + bruising β VW disease
β
If perimenopausal + obesity β endometrial hyperplasia
52
Young, female, +ve HCG, abdo pain/collapse =
Abdo distension, βclothes donβt fitβ, SOB =
adenoma + ascites + pleural effusion=
cOCP + increased discharge =
Contact bleeding/dyspareunia/ weight loss=
Fat, acne, oligomenorrhoea =
Young, female, +ve HCG, abdo pain/collapse = ectopic pregnancy (donβt forget appendicitis!)
Abdo distension, βclothes donβt fitβ, SOB = ovarian tumour
adenoma + ascites + pleural effusion= Meigg Syndrome
cOCP + increased discharge = ectropion
Contact bleeding/dyspareunia = cervical cancer
Fat, acne, oligomenorrhoea = PCOS
53
What meets at SCJ?
What occurs at TZ?
β
SCJ = The line where columnar and squamous epithelium meet.
β
TZ = The area where squamous metaplasia occurs (high risk for HPV-related CIN/cervical cancer).
54
TZ changes due to which 3 factors?
Exacerbated by increased oestrogen
COCP
pregnancy
55
What happens when the endocervical columnar epithelium is exposed to the acidic vaginal environment?
triggers squamous metaplasia,
columnar cells replaced by squamous epithelium.
56
Cervical Ectropian discharge (2)
Clear
non-smelling vaginal discharge
57
Risk factors for Cervical Cancer (5)
Naughty Naughty
HPV 16+18
increased sexual partners
vulnerable SC junction in early reproductive life
no use of condoms
smoking
58
What differentiates CIN from invasive cervical cancer β
Basement membrane is intact in CIN.
59
Cervical Screening Pathway
π Age 25-50 β Every x years
π Age 50-64 β Every y years
What are X and Y?
π Age 25-50 β Every 3 years
π Age 50-64 β Every 5 years
60
Smear test result Normal
Return for screening in 3-5 years
61
Low-grade dyskaryosis (CIN 1)
Repeat smear in 6 months (up to 2 times)
62
High-grade dyskaryosis (CIN 2/3)
Needs urgent colposcopy & biopsy (higher risk of progression to cancer).
63
Cervical cancer testing
if Symptomatic?
if HPV+ve, normal cytology?
if HPV+ve, abnormal cytology?
colposcopy
return 12 months later
colposcopy
64
CIN 1 (Low-grade) β Abnormal cells in the basal 1/3 of epithelium
π Most regress on their own
π Plan: Repeat biopsy in 6 months
65
CIN 2 or 3 (High-grade) β Abnormal cells extend to middle 1/3 or full thickness
Mx
π¨ Management:
β
LLETZ (Large Loop Excision of the Transformation Zone) cold coaguation/ cryotherapyβ First-line treatment.
β
Alternative treatments: Laser ablation or cryotherapy.
66
β
Test of cure of Recurrent CIN =
π 6 months after treatment, do a Smear + HPV test
β οΈ If either is positive β Refer for Colposcopy
67
PCB + IMB + abnormal discharge in a sexually active woman = suspect ??
PCB + IMB + abnormal discharge in a sexually active woman = suspect cervical cancer.
68
Cervical Cancer
Early-stage (1a-1b) = Which Tx
============================
Advanced-stage (2+) = Which Tx
Early-stage (IA1βIB1)
IA1 (microinvasive): Cone biopsy may be enough (esp. if fertility desired)
IA2βIB1:
β- Fertility desired β Radical trachelectomy
β- No fertility desired β Radical hysterectomy
Advanced-stage (IB2 or II+)
Cisplatin-based chemoradiotherapy
NO surgery once bulky or locally advanced
Metastatic (IVB) β Add Bevacizumab (anti-VEGF) to chemo
69
75-95% of cervical cancers are what type of carcinoma?
β
Squamous cell carcinoma
70
Adenocarcinoma (HPV 18)
Significance of this?
Adenocarcinoma (HPV 18) = Worse prognosis than SCC
71
Endometritis (Infection of the Endometrium)
3 symptoms
''FFF''
Postpartum **Fever**
**Foul**-Smelling Lochia
Uterine Tenderness **(FUNDUS)**
72
Causes Endometritis
Infective (2)
Non-infective (2)
Infective:
postpartum (After C-Section)
post-procedure
Non-infective:
IUD
RPOC
73
Endometritis (Tx)
Chat GPT
Broad-spectrum antibiotics
(e.g., IV clindamycin + gentamicin if postpartum)
74
Endometrial Polyps (3)
πΉ Intermenstrual Bleeding
πΉ Benign Overgrowth
πΉ Polypoid Mass on Ultrasound
75
Endometrial Polyps Dx and Def. Dx
Transvaginal ultrasound (TVUSS) (first-line)
Hysteroscopy + Biopsy (definitive diagnosis)
76
Endometrial Hyperplasia (Precursor to Cancer) (3)
Unopposed Estrogen
Postmenopausal Bleeding
Atypia = High Cancer Risk
77
Endometrial Hyperplasia (Precursor to Cancer)
Risk Factors (Linked to High Estrogen Exposure) (4)
POET
P β PCOS
Chronic anovulation β no progesterone to balance estrogen
O β Obesity
Fat tissue = aromatase β converts androgens to estrogen
E β Estrogen-only HRT
Without progesterone β continuous endometrial stimulation
T β Tamoxifen
SERM = blocks breast estrogen but stimulates uterus
78
Endometrial Hyperplasia (Precursor to Cancer) Dx and Def. Dx
1st Line
TVUSS β Assess endometrial thickness (4mm> CANCER)
Def Dx.
Hysteroscopy + Biopsy (definitive test)
79
Endometrial Hyperplasia (Precursor to Cancer) Tx (3):
Reduce what?
Which therapy?
Definitive?
Reduce estrogen exposure
Progestin therapy (e.g. Mirena IUS, oral progestins)
Hysterectomy (if atypical hyperplasia or high-risk)
80
Hyperplasia without atypia = Give What? (want baby also)
Hyperplasia with atypia = Do What?
Hyperplasia without atypia = Give Progestins (want baby also)
Hyperplasia with atypia = Hysterectomy
81
Risk Factors for Endometrial Cancer (5)
Mnemonic: "ON PET"
β
Obesity β Aromatase in fat tissue
converts androgens β estrogen
β
Nulliparity β No pregnancy = more estrogen exposure
β
PCOS β Chronic anovulation = Unopposed estrogen
β
Early menarche, late menopause β Longer lifetime estrogen exposure
β
Tamoxifen β Selective estrogen receptor modulator (SERM), acts as an estrogen agonist in the endometrium
82
What does COCP protect and risk against
COCP protective for endometrial + Ovarian
COCP Risk= Breast + Cervical
83
FIGO Staging of Endometrial Cancer (Simplified, but total= 4 stages)
Tx
Stage 1 β
Stage 3+ β
Stage 1 β Hysterectomy + Bilateral Salpingo-Oophorectomy (BSO)
Stage 3+ β Add Chemotherapy Β± Radiotherapy
Platins!
84
Investigations Endometrial Cancer Ix and Def. Ix
****β Transvaginal USS β Endometrial thickness **>4mm** in **postmenopausal women is concerning**
β Def. Diagnosis
β Hysteroscopy + Endometrial Biopsy
GOLD Sx
Pipelle Biopsy
85
Endometrial Cancer:
Type 2 (Estrogen-Independent) (4)
WORSE
Poorly Differentiated/ prognosis
p53 mutation
Thin, older postmenopausal women
are you SEROUS
86
Endometrial Cancer Tx (2)
β Hysterectomy + Bilateral Salpingo-Oophorectomy (removal of uterus, fallopian tubes, ovaries).
β +/- Radiotherapy & Chemotherapy (platin + paclitaxel) if high-risk or advanced disease.
87
Who usually gets Fibroids (3)
Black women
β Oestrogen stuff
β Obesity
88
Fibroids PC (3)
irregular shaped
FLUBBER
Menorrhagia (Heavy Periods) (High yield)
Bulky uterus (mass effect)
Reproductive age women
89
Red Degeneration (rapid fibroid growth)
2 issues from it?
Tx?
Venous thrombosis
ischemia.
Tx = Bed rest+ Analgesia
90
Fibroids Ix (1)
Ix for checking what is affecting fertility (1)
1st Line Ix:
Transvaginal Ultrasound (TVUSS)
MRI if further characterization needed
π Key Exam Tip: TVUSS confirms diagnosis; **hysteroscopy can assess submucosal fibroids affecting fertility.**
91
Fibroids Tx
1st Line
Sypmtoms
Definitive
Large Fibroids?
1st Line : Menorrhagia β Mirena IUS
Symptomatic fibroids β Myomectomy (if fertility is desired),
Definitive: Hysterectomy
<3cm and no distortion= Mirena / NSAIDS
>3cm= Referral
Large fibroids β UAE / GnRH agonists (pre-surgery shrinkage)
92
Adenomyosis (3)
πΉ Enlarged Boggy Uterus
πΉ Dysmenorrhea (Painful Periods)
πΉ Heavy Menstrual Bleeding (HMB)
Older woman (35-50)
93
Adenomyosis Ix and Def. Ix (2)
1st Line Ix: TVUSS
MRI is more sensitive
Def. Ix (histology)
94
Tx for Adenomyosis (1)
and Cure (1)?
1st Line : Mirena IUS
Hysterectomy is the only cure!
95
Ovarian Cancer 5 Risk Factors
Increasing age (postmenopausal)
Nulliparity & infertility
Early menarche / Late menopause
Obesity
Family Hx (BRCA1/2, Lynch syndrome/HNPCC)
96
Ovarian Cancer Protective Fx
COCP
97
Subtypes of Ovarian Cancer (4)
**Germ** Cell Tumors (Young Women)
**Epithelial** Tumors (MOST COMMON)
**Metastatic** Ovarian Cancer
**Sex** Cord-Stromal Tumors (Hormone-Producing)
98
Ovarian Cancer
MOST COMMON Type AND Subtype
Epithelial (Serous carcinoma)
Serous carcinoma often linked to BRCA1/2 and spreads early.
99
Subtypes of Ovarian Cancer
Germ Cell Tumors (Young Women)
BUZZWORD, and age
Teratomas (Dermoid Cyst )= Most common ovarian tumor in young women (<25).
100
Subtypes of Ovarian Cancer
ex Cord-Stromal Tumors (Hormone-Producing)
(3 subtypes)
101
Metastatic Ovarian Cancer β Krukenberg Tumour (3)
Bilateral ovarian masses
Signet-ring cells on histology
β Think Krukenberg tumour
(metastasis from gastric cancer)
102
HNPCC (Lynch Syndrome) (3 buzzwords)
Ovarian
endometrial
colorectal cancer risk (MMR gene defect)
103
Meigs Syndrome (3)
TRIAD
Ovarian fibroma
Ascites
Pleural effusion (resolves after tumor removal)
104
Krukenberg Tumor (1)
Metastatic gastric cancer to ovaries (signet-ring cells)
105
Theca/Leydig β Androgen β Virilization
What is protective
β
COCP is protective!
106
Ovarian Cancer -PC (4)
"Old Women Feel Bothered"
"Old Women Feel Bothered"
Old β Postmenopausal
Weight loss
Feeling full (early satiety)
Bloating
107
Tumor Marker
Ovarian Cancer
Bowel Cancer
Pancreatic Cancer
Breast Cancer
CA-125 Ovarian Cancer
CEA Bowel Cancer
CA 19-9 Pancreatic Cancer
CA 15-3 Breast Cancer
108
Ovarian Cancer Ix
and key findings (4)
Transvaginal Ultrasound (TVUSS)
adnexal mass with ascites
thick septations
solid-cystic areas
Bilateral ovarian masses are more concerning for cancer
109
Risk of Malignancy Index (RMI)
RMI> xxx = HIGH RISK
What is xxx
Key Exam Tip: RMI >250 = HIGH RISK β Refer for specialist assessment
110
Ovarian Cancers Tx (2)
Early: hysterectomy + BSO + omentectomy
Advance: Debulking
Chemo: Carboplatin + Paclitaxel
111
Bartholinβs cyst (3)
soft
PAINLESS labial swelling
4 and 8 O'Clock
112
Bartholinβs abscess (3)
tender
warm
hard
113
Bartholinβs cyst Tx (2)
1st Line= Conservative
2nd Line= Sitz Bath
114
Bartholinβs Abscess Tx (1)
Marsupialization
115
Lichen Sclerosus (2)
White atrophic patches
INTENSE itching
116
Normal Vaginal Flora eg
Lactobacillus β Maintains what ?
acidic vaginal pH (3.8β4.5)
117
most common cause of thrush (90%)?
Candida albicans
118
The clinical condition caused by Candida albicans overgrowth.
Candida thrush (vulvovaginal candidiasis)
119
Candida Thrush (4)
β
Thick, white, cottage cheese-like discharge
β
Severe vaginal itching
β
No odor
β
Vaginal pH remains normal (<4.5)
120
Candida Thrush R.F (4)
Antibiotic use (disrupts Lactobacillus)
COCP/Pregnancy
Obesity & Diabetes
Immunocompromised states (HIV, steroids, chemotherapy)
121
Bacterial Vaginosis (BV) is caused by ?
β Gardenella Vaginalis
β lactobacillus
122
Candida Thrush 1st Line Tx
and Recurrent
β
First-line (non-pregnant):
Oral fluconazole 150 mg, single dose
If Ci's β
β Clotrimazole 500 mg pessary
β + topical clotrimazole for vulval symptoms
π€° If pregnant:
Topical treatment only
β Clotrimazole pessary Β± cream
β β Avoid oral fluconazole
π Recurrent candidiasis:
Oral fluconazole long course
β E.g. 150 mg every 3 days for 3 doses, then weekly for 6 months
123
Bacterial Vaginosis (BV)
What type of discharge?
Odour?
What pH?
β
Thin, watery, grey/white discharge
β
Fishy odor (worse after sex or during menstruation)
β
Increased vaginal pH (>4.5, alkaline environment)
124
Microscopy for Bacterial Vaginosis (BV) shows
Microscopy: Clue cells (epithelial cells coated with bacteria)
Whiff test: Fishy odor with KOH application
125
Whiff test for BV
Whiff test: Fishy odor with KOH application
126
BV (1st Line Tx)
Oral metronidazole (7 days)
127
If pH is normal, it's likely xxx. If pH is high + fishy smell, think yyy
What is xxx and yyy
If pH is normal, it's likely Candida.
If pH is high + fishy smell, think BV.
128
Chlamydia (3)
Gram -Ve
Asymptomatic
post-coital bleeding
dysuria
CC- Cocobaslius
129
**G**onorrhoea
What type of discharge?
What type of cell?
Which D.P Link?
Thick, yellow-green pus-like purulent discharge
gram-negative diplococci
**S**eptic arthritis
130
Syphilis (3)
Bacterial
Painless ulcer (chancre)
rash on palms & soles
Argyll Robertson pupil
131
HPV (3)
Viral
Genital warts, HPV 6, 11
cervical cancer
koilocytes
132
Herpes simplex 2 (3)
Viral
Painful vesicles
multinucleated giant cells
recurrent outbreaks
133
HIV/Hep B/C
Viral
Chronic infection
immunosuppression
vertical transmission
134
Trichomonas vaginalis
What type of discharge(1)?
+ 2 buzzwords
Frothy green discharge
Strawberry cervix
motile trophozoites
135
Scabies (3)
Parasite πͺ³
Itchy burrows
interdigital spaces
permethrin
136
Crabs (Pubic lice)
Parasite πͺ³
Severe itching
visible lice
nits on hair
137
Chlamydia PC, Male (3)
Urethritis (discharge, dysuria)
orchiditis
proctitis (MSM).
138
Chlamydia PC, Female (3)
Mucopurulent cervicitis,
PCB/IMB
dyspareunia.
139
Most common cause of PID (1)
Chlamydia
140
Neonatal Conjunctivitis
Gonorrhoea
Days Onset after birth?
Discharge?
Days Onset after birth: 5-14 days
Discharge: Purulent, severe
141
Neonatal Conjunctivitis
Chlamydial
Days Onset after birth?
Discharge?
Days Onset after birth: 2-5 days
Discharge: Watery discharge
142
Fitz-Hugh-Curtis Syndrome (3)
πΉ RUQ Pain (Perihepatitis, liver capsule inflammation)
πΉ Violin String Adhesions (Between liver and peritoneum)
πΉ PID Complication (Often due to Chlamydia trachomatis or Neisseria gonorrhoeae)
π Key Exam Clue: "RUQ pain in a sexually active woman with PID symptoms" β Think Fitz-Hugh-Curtis Syndrome! π
143
Reiterβs Syndrome (Reactive Arthritis)
Which STI?
**C**hlamydia
C-ant see, C-ant pee, C-ant C-limb a tREA
144
Chlamydia Ix
Male
Female
Tx
NAATs = Gold standard
1st pass urine in males (initial not mid stream)
VULVO VAGINAL in females
Doxycycline 100mg BD 7/7 = First-line treatment.
145
Gonorrhoeae, gram what?
Gram-negative diplococci (kidney beans!)
146
Gonorrhoeae discharge, M & F?
Male discharge = Purulent green
Female discharge =Often mild/absent discharge
BUT maybe have dysuria, IMD, OR may be asymptomatic
147
Gonorrhoeae Ix
Male First-pass urine sample (NAATs)
Female Vulval vaginal + NAATs/PCR
NAATs (Nucleic Acid Amplification Tests) = Gold standard
148
Gonorrhoeae Tx
IM Ceftriaxone 500mg single
149
Syphilis , what causes it and shape
Treponema pallidum
a spirochaete (spiral-shaped bacteria).
150
Stage 1 (1Β°)
Syphilis (2)
Painless chancre (ulcer) at infection site (genitals, anus, mouth)
local lymphadenopathy
151
Stage 2 (2Β°)
Syphilis (3)
β
Copper-colored palmar-plantar rash (classic)
β
Snail track ulcers in mouth
β
Patchy alopecia
152
Stage 3 (Latent) Syphilis (1)
β
No symptoms, can last for years
153
Stage 3 Syphilis (3Β°) (3)
β
Neurosyphilis: Argyll-Robertson pupil (accommodates but doesn't react)
β
Cardiovascular syphilis (aortic aneurysm, aortitis)
Tabes Dorsalis
154
Syphilis early stages Ix (1Β° & 2Β°)
Microscopy (Best for Early Stages)
Dark field microscopy β
Detects Trep. pallidum in 1Β° & 2Β° lesions
155
Routine screen syphilis (1)
AND
Confirm syphilis (1)
1st line/Routine: ELISA (Ig G/M... Screening) = Confirm syphilis diagnosis
CONFIRM/Gold standard: TPPA (specific)
156
Monitor response to treatment to syphilis (2)
Serology VDLR / RPR
157
Syphilis Tx
If pen allergy?
β
First-line: IM Benzathine Penicillin (single dose)
β
If allergic to penicillin: Doxycycline (2 weeks)
158
Genital warts, caused by?
HPV 6 + 11
159
Genital warts (4) Clinical
white
rough
raised
not painful
160
Genital warts (3) Tx
Tx:
1st Line: Cryotherapy
podophyllotoxin cream (ci in pregnancy)
low yield: imiquimod cream
161
Genital herpes cause(1), and PC (4)
HSV2
Blisters/ulcers on external genitalia
pain
dysuria
local lymphadenopathy
162
Genital herpes Dx
Swab vesicles > PCR
163
Genital herpes Tx
Oral aciclovir + lidocaine topical 5%
164
Trichomonas vaginalis caused by?
Flagellated Protozoal parasite
165
Trichomonas vaginalis PC (4)
Purulent, frothy green discharge
musty odour
irritation and itch
strawberry spots
166
Trichomonas vaginalis Dx (1)
Tx (1)
Dx: High Vaginal Swab for microscopy
Tx: Oral metronidazole
167
No contact tracing for (5) Genital warts, herpes, BV, thrush, prostatitis
STIs with short incubation ,how long contact tracing?
STIs with latency =, How long contact tracing?
NCT: Genital warts, herpes, BV, thrush, prostatitis
STIs with short incubation (Chlamydia, Gonorrhoea, Trichomonas)= WEEKS/MONTHS
STIs with latency (Syphilis, HIV) =, How long contact tracing? MONTHS/YEARS
168
Contact tracing
Syphilis 1 (1Β°) β
Syphilis 2 (2Β°) β
Syphilis 1 (1Β°) β 3 months
Syphilis 2 (2Β°) β 24 months
169
CTG Interpretation
Baseline Rate
Normal (Reassuring)?
Abnormal (Concerning)
Normal (Reassuring) FHR
110-160 BPM <110 (Bradycardia)
Abnormal (Concerning)
>160 (Tachycardia)
170
CTG Interpretation
Baseline Variability
Normal vs Abnormal (Concerning)
Normal FHR Baseline Variability
5-25 BPM
Abnormal (Concerning)
<5 BPM (Reduced) or >25 BPM (Saltatory)
171
CTG Interpretation
Accelerations
Normal vs Abnormal (Concerning)
Present (Good Sign)
Abnormal (Concerning)
Absent (May indicate fetal hypoxia)
172
CTG Interpretation
Decelerations
Normal vs Abnormal (Concerning)
Normal
Early
Abnormal
Late (Placental Insufficiency)
Variable (Cord Compression)
173
CTG Interpretation
When to take action
Abnormal 2+ abnormal features
late decels
bradycardia
reduced variability
174
Fetal Blood Sampling (FBS)
Interpretation:
pH >7.25 β
pH 7.2 - 7.25 β
pH <7.2 β Acidosis β
pH >7.25 β Normal, continue monitoring.
pH 7.2 - 7.25 β Borderline, repeat in 30 min.
pH <7.2 β Acidosis β Immediate delivery (C-section needed).
175
β
What Baseline FHR is normal?
β
What BPM Variability is reassuring?
β
Accelerations =
β
Decelerations =
β
Late decels, means what?
Ix β ?
β
If fetal pH <7.2, xxx is needed.
β
Variable decels = What happens?
β
What Baseline FHR is normal? 110-160 BPM is normal.
β
What BPM Variability is reassuring. 5-25 BPM
β
Accelerations = Good
Decelerations need assessment.
β
Late decels means? Ix Placental insufficiency β Fetal blood sampling.
β
If fetal pH <7.2, C-section is needed.
β
Variable decels = Cord compression (bad if prolonged).
176
Threatened Miscarriage (2)
Closed cervix
HB present
177
Inevitable Miscarriage (3)
Open cervix
Heavy bleeding
pain
178
Incomplete Miscarriage (3)
Open cervix
Clots
retained POC
179
Complete Miscarriage (3)
Closed cervix
No retained POC
uterus small
180
Ectopic pregnancy
Triad
Amenorrhoea (missed period for >4 weeks)
Lower abdominal pain (adnexal pain, unilateral)
Vaginal bleeding (often dark brown, spotting)
181
Ruptured ectopic (3)
Hypovolemic shock
collapse
shoulder tip pain
182
Ectopic pregnancy
Ix 1st line and
Gold standard
1st line= transvaginal ultrasound scan (TVUSS)
Gold standard= Diagnostic Laparoscopy
183
Unruptured Ectopic
Medical Mx
if hCG <1500 IU/L
no fetal heartbeat
mass <3.5 cm
IM Methotrexate (1st-line)
184
Unruptured Ectopic
Surgical Mx
if hCG >5000 IU/L
mass >3.5 cm
Laparoscopic Salpingotomy
Laparoscopic Salpingectomy
185
Shoulder tip pain + collapse = Ruptured ectopic
Tx
Emergency laparotomy
Salpingectomy
Salpingostomy
186
Molar Pregnancy (5)
Rapidly enlarging uterus (> gestational age)
"Doughy" uterus on palpation
Severe hyperemesis gravidarum
Painless vaginal bleeding (brownish spotting or grape-like tissue passage)
+++ HCG (>100,000 IU/L)
187
Molar Pregnancy Ix
Transvaginal Ultrasound (TVUSS) β "Snowstorm" appearance
188
β
Molar Pregnancy Mx =
β
Monitor Ξ²-hCG post-treatment to detect what?
β
Avoid pregnancy for 6 months to track what?
β
Persistent hCG elevation β Tx
β
Molar Pregnancy Mx = Suction evacuation is 1st-line treatment.
β
Monitor Ξ²-hCG post-treatment to detect malignant transformation (Choriocarcinoma).
β
Avoid pregnancy for 6 months to track hCG trends.
β
Persistent hCG elevation β Start chemotherapy (Methotrexate).
189
What is Placental Abruption?
Premature separation
Painful dark bleeding **(can be bright)**
**Woody Uterine tenderness
**
Fetal distress
Risk factors β Includes hypertension, trauma, smoking, or previous abruption.
190
2 types of Placental Abruption
Concealed Abruption (more severe)
Revealed
191
Placental Abruption (4)
Severe, constant abdominal pain
Woody hard uterus
Fetal distress on CTG
192
Placental abruption vs. Placenta previa:
Placenta previa bleeding?
Placental abruption bleeding?
Placenta previa β Painless bright red bleeding
Placental abruption β Painful dark red bleeding + uterine tenderness (can be bright)
193
RF for Placental abruption (4)
1οΈβ£ Previous Placental Abruption β π¨ Biggest predictor (Recurrent risk ~15%)
2οΈβ£ Preeclampsia & Hypertension β π¨ Strong association (impaired placental blood flow)
3οΈβ£ Trauma (e.g., MVA, domestic violence, falls) β π¨ Direct placental shearing
4οΈβ£ Thrombophilia (clotting disorders) β π¨ Hypercoagulability increases risk of placental infarction & separation
194
Placent abruption Dx
Clinical (based on syptoms)
195
Placent abruption Tx
Immediate C-section
196
What is Placenta Previa?
Placenta previa occurs when the placenta is implanted in the lower uterine segment, covering or partially covering the cervical os
197
Placenta Previa Minor / Major
Minor (Type 1&2)
Major (type 3&4)
198
Placenta Previa Key Clinical Features (4)
β
Painless vaginal bleeding β Classic presentation in the 2nd/3rd trimester
β
Soft, non-tender uterus (unlike placental abruption, which is firm & tender)
β
CTG usually normal
β
Malpresentation (e.g., breech, transverse lie) due to abnormal placental placement
199
Placenta Previa Ix
π― Transvaginal Ultrasound (TVUSS) is gold standard
DVE IS CONTRAINDICATED β Can worsen bleeding
200
Placenta Previa RF (3)
β
Previous C-section (STRONGEST risk factor)
β
Previous placenta previa
β
Multiple pregnancy
201
Placenta Previa Mx
No bleeding:
Clue-How far from OS
If BLEEDING:
Consider what then do what?
If NO bleeding:
Plan for delivery at C-section (if placenta is β€2cm from os)
**Consider steroids for fetal lung maturity** if <36 weeks
Tocolytics (e.g., terbutaline) can be used to stop contractions temporarily
πΉ If BLEEDING:
Consider major hemorrhage protocol
Emergency C-section if maternal/fetal compromise
202
Placenta Accreta Spectrum (Invasive Placenta Conditions)
Placenta accreta β Adheres to myometrium
Placenta increta β Invades into myometrium
Placenta percreta β Invades through myometrium (can reach bladder!)
203
Group B Septicaemia (3)
fever
tachycardia
respiratory distress
204
The 4 T's: Causes of PPH π©Έ
PPH is commonly caused by one of these four factors:
1οΈβ£ Tone (90%) β Uterine atony (most common cause)
2οΈβ£ Tissue β Retained products of conception
3οΈβ£ Trauma β Genital tract injury
4οΈβ£ Thrombin β Coagulation disorders
Conditions like DIC, HELLP syndrome, or clotting disorders can prevent normal blood clotting.
205
Definition & Classification of PPH (3)
π Primary PPH = Blood loss β₯ 500 mL within 24 hours of birth.
π Major PPH = > 1000 mL blood loss.
π Secondary PPH = Blood loss occurring between 24 hours and 12 weeks postpartum (often due to retained placenta or infection).
206
What is high yield cause of PPH? Tx?
Major PPH (>1000mL Blood Loss) Tx
If ongoing bleeding despite uterotonics β Reason?
β Tone (Uterine Atony) is the #1 cause β First-line treatment = uterine massage + IV oxytocin.
β Blood loss >1000 mL is serious β Needs immediate resuscitation.
If ongoing bleeding despite uterotonics
β Consider retained tissue, trauma, or clotting issues.
207
1st Degree Perineal tear
Superficial tear involving skin, vaginal mucosa, frenulum of labia minora
Midwife repair
208
2nd Degree Perineal tear
Extends into perineal muscles and fascia but spares anal sphincter
Midwife repair
209
3rd Degree Perineal tear
3a
3b
3c
Involves external anal sphincter
Obstetrician repair
β 3a: Partial tear of anal sphincter (<50% thickness)
β 3b: Partial tear of anal sphincter (>50% thickness)
β 3c: Internal anal sphincter also torn
210
4th Degree Perineal tear
Involves rectal mucosa (full thickness tear)
Obstetrician repair
211
Diagnostic Criteria (UK NICE Guidelines):
Fasting glucose (FG) >
2-hour post-OGTT >
Fasting glucose (FG) > 5.6 mmol/L
2-hour post-OGTT > 7.8 mmol/L
212
G.D Effects on the Baby πΆ (5)
1οΈβ£ Macrosomia (Big Baby) β Risk of shoulder dystocia (needs McRoberts Maneuver)
2οΈβ£ Organomegaly
3οΈβ£ Polycythaemia
4οΈβ£ Polyhydramnios
5οΈβ£ Postnatal Hypoglycaemia
213
G.D Tx
1st Line= Lifestyle changes
2nd Line= Metformin
3rd Line= Metformin + Insulin
214
Pre-Existing Hypertension π
β
Cx (2)
β
Dx (2)
β
Rx (3)
β
Cx: Before pregnancy or <20 weeks gestation
β
Dx: β₯140/90 mmHg (2x), or Diastolic >110 mmHg (severe)
β
Rx:
Pre-eclampsia
IUGR (small baby)
Placental abruption β Fetal distress
215
β
Tx (if BP >150/100 mmHg)
Ci's?
1st line: Labetalol, Nifedipine, Methyldopa
Avoid ACEi/ARBs! β Teratogenic
π¨ Key Contraindications:
Labetalol β Avoid in asthma (Ξ²-blocker effect can worsen bronchospasm)
Methyldopa β Avoid in depression (can worsen symptoms)
216
Pregnancy-Induced Hypertension (PIH)
β
BP criteria
β
Key Differentiator for Pre-eclampsia
β
Resolves when?
β
BP >140/90 after 20 weeks of pregnancy
β
No proteinuria or other pre-eclampsia symptoms!
β
Resolves within 6 weeks postpartum
217
Pre-eclampsia Dx (3)
Hypertension + Proteinuria Β± Oedema (>20 weeks)
Proteinuria = PCR >30 mg/mmol or >300 mg/24h
218
Pre-eclampsia red flags (5)
Red flags:
RUQ pain (liver involvement)
Headache, visual changes (brain swelling, risk of eclampsia)
Hyperreflexia
nausea/vomiting
219
Pre Eclampsia Mx
πΉ Mild β
πΉ BP >150/100 β
πΉ Risk of eclampsia? β
πΉ Definitive Tx =
π If <34 weeks & delivery needed β
Pre Eclampsia Mx
πΉ Mild β Admit, monitor BP, urine, bloods
πΉ BP >150/100 β Treat with Labetalol (or Nifedipine if asthma)
πΉ Risk of eclampsia? β Give Mg Sulphate
πΉ Definitive Tx = Delivery
π If <34 weeks & delivery needed β Give steroids (fetal lung maturity)
220
Eclampsia = Tonic-Clonic Seizure π¨
Tx
Eclampsia = Tonic-Clonic Seizure π¨
Tx: Mg Sulphate 4g IV + Urgent Delivery!
221
If high risk of Pre Eclampsia β Tx
If high risk β Give Aspirin 75mg from 12 weeks
222
HELLP Syndrome =
Pre-eclampsia + Hemolysis + Liver damage + Low Platelets π¨
223
Downs typical First-line Combined Test
(11-13+6 weeks)
HIT APE
(7)
β¬οΈ Markers Increased (UP) β Think "HIT"
π’ H β hCG (Human Chorionic Gonadotropin) πΌ
π’ I β Inhibin A πΌ
π’ T β Thickened Nuchal Translucency πΌ
π Markers Decreased (DOWN) β Think "APE"
π΄ A β AFP (Alpha-Fetoprotein) π½
π΄ P β PAPP-A (Pregnancy-Associated Plasma Protein A)
π΄ E β Estriol (Unconjugated Estriol, uE3) π½
224
If women book late (15-20 weeks), alternative tests:
Triple test:
Quadruple test:
Triple test: AFP + Ξ²-HCG + UEβ
Quadruple test: AFP + Ξ²-HCG + UEβ + Inhibin A
225
High risk for Down Syndrome
Screening (1)
DIAGNOSTIC (2)
Screening= NIPT (accurate, non- invasive)
Diagnostic =
Chorionic Villus Sampling (CVS) 11-13+6 weeks
Amniocentesis >15 weeks
226
π« Absolutely Avoid in Pregnancy (5)
β Sodium Valproate (Neural tube defects)
β Warfarin (Facial & brain defects)
β ACE Inhibitors (Kidney & growth defects)
β Tetracyclines (Teeth & bone issues)
β Isotretinoin (Accutane) (Severe malformations)
227
β
Safer Alternatives:
Sodium Valproate:
Warfarin
tetracyclines
β Lamotrigine (for epilepsy, with high-dose folic acid)
β LMWH (e.g., enoxaparin) instead of warfarin
β Penicillins & cephalosporins instead of tetracyclines
228
β
COCP protects against what? (2)
β
HRT (oestrogen-only) β Increases risk of what? (2)
β
COCP protects against what? (2)
ovarian & endometrial cancer but slightly increases breast cancer risk
β
HRT (oestrogen-only) β Increases risk of what? (2)
ovarian & endometrial cancer risk
229
CTG VEAL CHOP
VEAL CHOP
Variable decelerations --> Cord compression
Early decelerations --> Head compression
Accelerations --> Okay!
Late decelerations --> Placental Insufficiency
229
cholestasis of pregnancy Tx
Colestyramine/Ursodeoxycholic acid
230
PPH Tx
1st line (physical method)
-bimanual uterine massage
-empty bladder (catheter)
2nd line
-oxytocin
-carboprost
-ergimetrine (not in hypertension)
3rd line (surgical)
-balloon tamponade (do this first in surgical method)
-B-Lynch suture
- ligation of the uterine arteries or internal iliac arteries
Last option
hysterectomy
231
menorrhagia, RAGAPTHAY
Painless menorrhagia - Tx
PainFul menorrhagia - Tx
menorrhagia, RAGAPTHAY = IUS MIRENA
Painless menorrhagia - Tranexamic acid
PainFul menorrhagia - MeFenamic acid
232
β Booking Visit (8-12 weeks) β
β 11-13+6 weeks β
β 15 weeks β
β 18-20+ 6 weeks β
β 28 weeks β
β 36 weeks β
β Booking Visit (8-12 weeks) β Blood tests, urine culture, lifestyle advice.
β 11-13+6 weeks β Downβs syndrome screening (nuchal scan + bloods). Amnicentesis
β 15 weeks β CVS
β 18-20+ 6 weeks β Anomaly scan
β 28 weeks β Anti-D for Rhesus-negative women, anaemia screen.
β 36 weeks β Check fetal presentation, offer ECV if breech.
233
Trans male (assigned female at birth)
Contraception options (3 buzzwords)
β Avoid COC
β Copper IUD = do not interfere with hormone treatments
β POP/Implant/Injection = thought to not interfere with hormones
234
Trans female (assigned male at birth)
Contraception options (2)
β Advise use of condoms
β Hormonal treatments =/= effective contraception
235
1st Stage of Labour
Starts?
Ends?
Latent Phase?
Established/Active Phase?
Starts: Onset of regular contractions
Ends: Cervix dilates to 10 cm
Latent phase (early labor) 0-4cm β Cervical effacement and slow dilation
Established/Active phase β Rapid dilation (usually 4β10 cm)
236
2nd Stage of Labour
Starts?
Ends?
Key Point?
Starts: When the cervix is fully dilated at 10 cm
Ends: With the delivery of the baby
Key point: Crowning (when the babyβs head is visible at the vaginal opening) marks the transition to pushing.
237
3rd Stage of Labour
Starts?
Ends?
Key point?
Starts: After the baby is born
Ends: With the delivery of the placenta
Key point: This stage typically lasts 5-30 minutes. A retained placenta after this time can lead to complications.
238
4th Stage of Labour
Starts?
Ends?
Key Point?
Starts: Immediately after the placenta is delivered
Ends: Typically 1-2 hours post-delivery
Key point: Maternal recovery (monitoring for postpartum hemorrhage, uterine tone, and vital signs).
239
syphilis Ix overview
Early lesions (Primary/Secondary)β
Routine screen? β
Confirm? β
Monitor? β
syphilis Ix overview
Early lesions (Primary/Secondary) β Dark field Microscopy
Routine screen β ELISA
Confirm/specific β TPPA
Monitor β RPR/VDRL
240
FORCEPS for instrument delivery
F: Fully dilated cervix (Second stage of labour reached)
O: OA (Occiput Anterior) position preferred, but OP (Occiput Posterior) is possible with Keillandβs forceps or ventouse. The position of the head must be known to avoid maternal/fetal trauma.
R: Ruptured membranes
C: Cephalic presentation (head-first)
E: Engaged presenting part (head at or below the ischial spines, not palpable abdominally)
P: Pain relief (appropriate analgesia)
S: Sphincter (bladder) empty (may require catheterization)
241
Expectant management of an ectopic pregnancy can only be performed for
(5)
Expectant management of an ectopic pregnancy can only be performed for
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
242
Tx vomiting in Pregnancy
1st Line: cyclizine/ promethazine
2nd Line: Ondastetron (cleft lip/palet)
Metoclopramide (5 days)
(extrapyramidal effects > 5 days)
243
Hb pregnant women cut offs for ANEMIA
Non-pregnant Hb less than
First trimester Hb less than
Second/third trimester Hb less than
Postpartum Hb less than
Theres a nice pattern to the cut offs:
Non-pregnant Hb less than 115 g/l
First trimester Hb less than 110 g/l
Second/third trimester Hb less than 105 g/l
Postpartum Hb less than 100 g/l
244
Induction of labour (using bishops) steps
245
Asherman Syndrome (3)
Intrauterine adhesions
**Post-surgical (e.g. D&C)**
Secondary amenorrhoea
246
Depression scale post partum
baby blues (7 days) (reassure)
postnatal depression ( peaks around 3 months) CBT SSRI
purpeural psychosis ( 2 weeks) ADMISSION MBU
247
Hypogonadotropic Hypogonadism
Vs
Hypergonadotropic Hypogonadism
Hypogonadotropic β low FSH/LH, Kallmann, pituitary
Hypergonadotropic β high FSH/LH, gonadal failure, Turner/Klinefelter
248
endometrial thickness >4mm
Staging?
Mx
1st Line= TVUS
Gold Standard = Pipelle biopsy
Staging= FIGO
TH + BSO
Radio+ Chemo
249
ovarian tortion
Pregnancy test 1st
TVUSS- whirlpool sign
Gold Sx= laparoscopy
250
PID Tx
IM Ceftriaxone+ Oral Doxy+ Oral Metronidazole
PID= COM
251
chlamydia Tx (when Breast Feeding)
Erythromycin
252
Hyperprolactinemia
drug that causes it? `
Tx + MOA?
too much prolactin - PROLACTINOMA`
Risperidone
Tx: Bromocriptine - D2 AGONIST
253
Don't Forget I Easily Ruin Events
Descent
Flexion
Internal rotation
Extension
Restitution
Expulsion
Don't Forget I Easily Ruin Events
Descent
Flexion
Internal rotation
Extension
Restitution
Expulsion
254
π’ Lowest Risk twins?
β
SBA buzzword: βfraternal twinsβ or βtwo placentasβ
π΄ Highest Risk
β
SBA buzzword: βone placenta + one sacβ = big danger
π "Mono-Mono = Maximum risk"
π’ Lowest Risk
Dizygotic (Fraternal) = Dichorionic Diamniotic (DCDA)
2 placentas, 2 sacs = safest
β No risk of twin-twin transfusion syndrome (TTTS)
β
SBA buzzword: βfraternal twinsβ or βtwo placentasβ
π΄ Highest Risk
Monochorionic Monoamniotic (MCMA)
1 placenta, 1 sac
π¨ Risk of:
Cord entanglement
Twin-twin transfusion syndrome (TTTS)
β
SBA buzzword: βone placenta + one sacβ = big danger
π "Mono-Mono = Maximum risk"
