revision feb Flashcards
blood pressure over 160 what is likely to happen if preg
admitted for observation for signs of developing pre eclampsia
fetal fibronectin (fFN) test
A fetal fibronectin test can either be positive or negative. If the test is negative, there are no traces of fetal fibronectin in your vaginal fluid. If your result is positive, it means your vaginal fluid contains fetal fibronectin. This tells your provider that you’re at risk for premature birth.
A 24 year-old lady with type 1 diabetes presents to the maternity department at 25+3 weeks gestation with tightenings and a thin watery discharge. Her pregnancy so far has been uncomplicated and all scans have been normal. She has well controlled diabetes by using an insulin pump.
A speculum examination is performed and no fluid is noted, the cervical os is closed. A fetal fibronectin (fFN) test is performed which comes back as 300 (positive).
What is the most appropriate management?
Admit for 2 doses IM steroids and monitor BMs closely, adjusting pump accordingly
ving a positive result means that the obstetric team can optimise everything, in case the lady does go into premature labour. This includes ensuring neonatal intensive care are aware, and administering steroids to help with neonatal lung maturity. As this lady is at high risk of premature labour, and is currently experiencing tightenings, it would be incorrect to discharge the patient without any further monitoring.
fetal fibrinectin released from where
gestational sac
A 27-year-old woman complains of an offensive ‘musty’, frothy, green vaginal discharge. On examination you an erythematous cervix with pinpoint areas of exudation.
mx
oral met - trich
A 22-year-old woman presents with a thin, purulent, and mildly odorous vaginal discharge. She also complains of dysuria, intermenstrual bleeding and dyspareunia. A swab shows a Gram-negative diplococcus.
mx
Im cef
1st line for menorrhagia
IUS - mirena
how long can mirena be in for
8 years
bishop score over 8 what do you do
cervix ripe and is favourable to jsut reasure and monitor for active labour
A 36-year-old woman has a telephone consultation with her GP, complaining that her periods have become more painful over the last year. She has had to miss work due to the pain. She also feels her periods have become heavier as she has started leaking through her tampons. She now uses 6 tampons each day.
She has three children, all of which were uncomplicated vaginal births.
what condition
adenomyosis
PCOS is a common disorder, which is often complicated by chronic anovulation and hyperandrogenism.
what are the 6 long term complications of PCOS
Subfertility
Diabetes mellitus
Stroke & transient ischaemic attack
Coronary artery disease
Obstructive sleep apnoea
Endometrial cancer
A 29-year-old primigravida woman is taken for an emergency caesarean section following cardiotocography indications of fetal distress and hypoxia. She is at 30 weeks gestation.
Her baby is successfully delivered and taken to the neonatal intensive care unit (NICU) and given oxygen due to difficulties with breathing.
A couple of weeks later, the baby is still in NICU and during an ophthalmological examination, there is an absent red reflex bilaterally and retinal neovascularisation.
What is the most likely diagnosis?
retinopathy of prematurity
retinopathy of prematurity develops after baby given what and why
oxygenation - Over-oxygenation can cause retinal vessel proliferation which can lead to a loss of the red reflex and neovascularisation seen in the examination.
bilateral
sx of retinoblastoma
Although it is a cause for absent red reflex, it would most likely be unilateral. It would also be replaced with a white pupil (leukocoria) and be associated with strabismus.
when expectant mx is not suitable in miscarriage
infection or increased risk of haemorrhage
post medical mx of miscarriage when should preg test be done
3 weeks post
A 17-year-old girl who is nine weeks pregnant has a surgical termination of pregnancy. She feels well a few hours after the procedure. Which of the following risks is most common following a TOP?
infection - 10% cases - abx given to reduce risk
Which of the following is the most likely cause of this decreased variability? on ctg
foetus is sleeping - normally under 40 minutes if over worry
other cx of decreased variability in foetal hr is due to maternal drugs benzos, opiods, methyldopa, foetal acidosis, prematurity and foetal tachy an congenital heart abnormalities
To confirm ovulation:
when measure
Take the serum progesterone level 7 days prior to the expected next period
rf placental abruption
ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
avoid what food in preg
cooked liver - high level s vit a - defects 0 specifically retinol
Women who have been admitted with hyperemesis gravidarum are generally given
Admit for IV saline with potassium replacement
threatened misscarriage presents how
Painless per-vaginal bleeding and a closed cervical os
risk of DVT need HRT
give transdermal
Which one of the following is the most appropriate regarding the management of the GBS risk?
Prescribe intrapartum intravenous benzylpenicillin
Only the mother should be prescribed the antibiotic as the child has not shown signs of neonatal sepsis.
what is sheehan syndrome
Sheehan’s syndrome is a complication of severe postpartum haemorrhage (PPH) in which the pituitary gland undergoes ischaemic necrosis which can manifest as hypopituitarism. The most common physical sign of Sheehan’s syndrome is a lack of postpartum milk production and amenorrhoea following delivery. Diagnosis of Sheehan’s is by inadequate prolactin and gonadotropin stimulation tests in patients with a history of severe PPH.
If analgesia doesn’t help endometriosis then the
combined oral contraceptive pill or a progestogen should be tried
