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4th Year > RHCN Lecture Notes > Flashcards

RHCN Lecture Notes Flashcards

1
Q

What is 2,3-DPG

A

It is a compound that inhibits the switch from deoxy to oxyhaemoglobin (shifting curve right)

This is helpful because it means blood doesn’t steal oxygen from cells that need it. It means blood only associates with oxygen in the lungs

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2
Q

Why does HbF have a stronger affinity to oxygen than HbA

A

Because it has a weaker affinity with 2,3-DPG (left shift for baby)

Also because in pregnancy the mum makes more DPG (right shift for mum)

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3
Q

what vessels lead from fetus to placenta

A

Semi-deox blood

aorta –> internal iliac –> umbilical arteries

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4
Q

Describe fetal circulation

A 
blood into umbilical vein
over lift via ductus venosus
into RA
2/3 through FO and LA
--> LV aorta and away
1/3 to RV
Into pul artery
Most through ductus arteriosus into aorta
Small amount into lungs
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5
Q

What happens to fetal circulation at birth

A 
Pul vascular resistance drops
Blood from RV goes into lungs
Arteriosis starts shutting down
Increased return to LA from pul veins shuts FO
Ductus venosus constricts
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6
Q

How is fluid in the baby’s lungs removed

A
  1. physical squeezing and spluttering
  2. adrenaline mediates change in respiratory epithelium - switch from secretory to resorbing (via Na+ transport) into pulmonary vessels and lymph
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7
Q

What happens if pul vascular resistance remains high after birth

A

persistent fetal circulation
blood not getting to lungs (hypoxia)
cells not getting oxygen (lactic acidosis)

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8
Q

How do you manage persistent fetal circulation (3)

A
  1. high flow oxygen
  2. inhaled NO (vasodilator to try bring down pul vascular resistance)
  3. inotropes (to force blood into lungs)
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9
Q

What is differential cyanosis

A

When feet are cyanosed but hands are not.
Something that can happen in babies with a PDA.
Happens because the brachiocephalic trunk, left common carotid trunk and the left subclavian trunk is given off proximal to the PDA.

Remember that as a general rule:
L2R shunt = breathless
R2L shunt = blue

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10
Q

How do you manage PDA

A

indomethacin (NSAID)

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11
Q

Why and how do we give vitamin K to newborns

A

breast milk contains insufficient vitamin K - risk of haemorrhagic disease of the newborn

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12
Q

why do babies get neonatal jaundice (4)

A
  1. immature liver enzymes
  2. they have all the HbF to break down
  3. breast milk beta-gluronidase interferes
  4. they are polycythaemic in utero
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13
Q

when is baby jaundice not normal

A

<24hrs
>10 days (term)
>14 days (preterm)

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14
Q

Benefits to baby of breast feeding

A 
From top to toe:
neurocognitive development
IQ is 8.3 better
less ear infection
less lung infection
lower BP later in life
less obesity
less gastroenteritis
10x less NEC
less diabetes
less obesity
less SID
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15
Q

benefits of mum to breastfeeding

A 
less postpartum uterine bleeding
cheaper
allows bonding
burns calories
less breast, ovarian, uterine cancer
less osteoporosis
less arthritis
less heart disease
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16
Q

at what point in feeding session is fat content highest

A

end (because fat globules accumulate in lobules not in ducts in between feeds)

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17
Q

disadvantages of breast feeding

A

slower growth of baby

poorer bone mineralisation (less vit D compared to formula)

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18
Q

APGAR score

A

check elsewhere

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19
Q

preterm birth =

A

<37w

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20
Q

low birth weight
v low birth weight
extreme low birth weight

A

low = <2.5kg
v low = <1.5
extreme low = <1

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21
Q

perinatal vs neonatal death

A 
perinatal = stillbirths + within 7 days
neonatal = 7-28 days
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22
Q

what happens at 24 weeks in gestation in terms of lungs

A

You get canaiculi –> saccules in lungs

You get surfactant

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23
Q

What is apnoea of prematurity and Mx

A

When baby’s brain doesn’t tell it to breathe properly

Mx = caffeine (+ resp support if needed)

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24
Q

Acute and later in life worry with a PDA

A 
Acute = heart failure
Later = chronic lung disease
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25
Q

NEC appearance:

  • Abdo film
  • USS
A
  • AXR = distended gut loops, air in portal veins, oedematous gut loops
  • USS = pneumatosis intestinal = pearl like strong of bubbles in gut wall
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26
Q

Why does retinopathy of prematurity occur

A

Vessels grow from optic disc outwards
If premature this hasn’t completed and they complete in a tortuous fashion
prone to bleeding and therefore scarring in first 6 months of life
causing retinal detachment and blindness

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27
Q

Oxygen target with ROP and why

A

<95% because higher oxygen can increase neovascularisation and increase ROP

Also screening from 6-7 weeks with lasering of any badness

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28
Q

diving reflex

A

when oxygen is low

bradycardia and decreased BMR, blood shunts away from peripheries to brain

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29
Q

pathogenesis of brain damage in term infant

Mx

A

Hypoxic ischaemic encephalopathy (macroscopic and microscopic things after reoxygenation). Hypoxia, hypercarbia, cells anaerobically respire –> lactic acidosis (metabolic acidosis)

Occurs first in basal ganglia where demands are highest, hence the tendency for contralateral hemiplegia

Cooling 33.5 for 72hours

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30
Q

pathogenesis of brain damage in pre-term infant

Mx

A

intraventricular haemorrhage
liquefaction
CSF disruption and hydrocephalus
–> periventricular leukomalacia

Maternal corticosteroids reduces chance of IVH Ventriclar washout to prevent disability after IVH has occurred
Magnesium sulphate protect white matter
VP shunt if hydrocephalus present

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31
Q

TORCH syndrome cause and symptoms

A

caused by in utero infection by certain bugs

growth restriction, hepatosplenomegaly, thrombocytopaenia, rash

Toxoplasmosis (protozoan parasite - treat with spiramycin)
Other
Rubella
CMV
Herpes simplex
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32
Q

% mums carrier of GBS
Chance of colonising baby
Chance of baby infection if colonised

A

20-40%
50%
2%

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33
Q

RFs for GBS infection

A

prematurity
prolonged rupture of membranes
previous GBS pregnancy
paternal pyrexia

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34
Q

opisthotonos

A

position in meningism arched back and neck to relieve pressure eon meninges

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35
Q 
Empirical Abx for:
early infection (<48hrs)
late infection (>48hrs)

Where do early infections and late infections come from respectively

A

early = benzyl pen + gent + cefotaxime (if meningitis)

late = fluclox + gent

early = from mum or from PROM

late = nosocomial

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36
Q

Hep B screening programme

A

Screening at booking visit for HBsAg
If + –> test for HBeAg and HBeAb
If Ag+/Ab+ –> 4 doses vaccine
If Ag+/Ab- –> 4 doses vaccine + Hep B immunoglobulin now

Mum has Hep B surface antigen –> Baby gets:

1) Within 12 hours of birth = Hep B vaccine + HBIG
2) Future = Hep B vaccine @ 2 & 6 months

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37
Q

vertical transmission risk of HIV and Hep B

A

HIV = 25% (from placenta, labour or breast milk)

Hep B = 40% (all from placenta, none from breast milk)

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38
Q

transient tachypnoea of newborn:

  • Cause
  • Mx
  • Prognosis
  • CXR appearance
A
  • delayed resorption of fluid from lungs
  • CPAP and oxygen
  • Resolves within a day
  • coarse streaking and fluid in interlobar fissures ‘wet lung’
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39
Q

why is meconium bad for lungs (3)

A
  1. mechanical obstruction
  2. chemical pneumonitis
  3. inactivated surfactant
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40
Q

cause of granuloma as cause of stridor

cause of sub-glottic stenosis as cause of stridor

A

granuloma = follows ET suction

sub-glottic stenosis = follow ET tube placement

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41
Q

stress test
pad test
q-tip test

A

stress test = fill bladder and ask to jump or cough and observe fluid leakage

pad test = same as stress test but weigh pad before and after

q-tip - put q tip in urethra and if it moves a lot when coughing or jumping it indicates weak pelvic floor

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42
Q

stress incontinence
C
M
S

A 
C = pelvic floor exercises and bladder diary
M = duloxetine (SNRI)
S = urethral bulking, mid-urethral slings
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43
Q

urge incontinence
C
M
S

A 
C = bladder diary and bladder retraining
M = antimuscrinics (oxybutnin/tolterodine for less detrusor activity) or sympathetics (mirabegron for more detrusor inhibition)
S = botulinum, detrusor myomectomy
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44
Q

how does menopause increase chance of prolapse

A

reduce elasticity of pelvic floor

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45
Q

% women affected by prolapse at some point

% chance relapse

A

50%

30%

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46
Q

prolapse
C
(no M)
S

A 
L = loose weight, stop smoking
C = pessary, pelvic floor exercises
S = surgical repair or last line is colpcleisis
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47
Q

PID Abx

A

doxy + met + IM ceftriaxone

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48
Q

PID follow up schpiel (5)

A
  1. contact tracing (3m)
  2. treat partner
  3. no sex in 2 week treatment period
  4. follow up in 14 days for re-swab
  5. counselling re pelvic pain, infertility, ectopic, adhesions
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49
Q

OHS Sx

A

mild = enlarged ovaries, ascites, abdo pain

severe = thrombosis, oliguria, pleural effusions, respiratory distress

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50
Q

OHS Mx

A
  1. analgesia
  2. thromboprophylaxis
  3. fluid management
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51
Q

PUL defintion

Mx

A

bHCG 1000-1500 with an empty uterus

conservative (most just fail and resorb)

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52
Q

surgical management of menorrhagia

A

only if fertility not needed:

  • endometrial ablation
  • transcervical resection of endometrium
  • ?hysterectomy
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53
Q

when is surgery needed for firboids

A

> 3cm

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54
Q

surgical options for fibroids

A

uterine artery embolisation

myomectomy

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55
Q

definition of oligomenrohoea

A

> 35 days in between

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56
Q

advice for people with PCOS re. periods

A

have at least 3 a year

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57
Q

gardasil protects against

A

HPV 6, 11, 18, 18

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58
Q

limitations of cervical screening programme

A

rest detect adenocarcinomas well (which are 20%)

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59
Q

typical age for cervical cancer

A

late 20s to early 40s

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60
Q

what is lichen sclerosus

A

pre-cancer stage of vulva

squamous cell hyperplasia

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61
Q

process at colposcopy

A

visualisation of cervix
addition of acetic acid (white bits are bad)
addition of iodine (bits that don’t take up iodine are bad
biopsies may be taken

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62
Q

chemotherapy type in ovarian cancer

A

carboplatin

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63
Q

how does cell free fetal DNA work

A

trophoblastic cells (DNA of fetus) leak into mums blood

This DNA is examined by NIPT or NIPD

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64
Q

What is NIPT

What is NIPD

How many blood samples how often are needed?

A

non invasive prenatal testing. is not diagnostic. used to see if free fetal DNA has any trisomies

non invasive prenatal diagnosis. can be used to detect single gene disorders (Achondroplasia, Duchenne’s). needs two blood samples 1 week apart from 10 weeks

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65
Q

combined screening at 10-14 weeks. why is it called combine?

A

because its blood test and USS

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66
Q

double check you know the results of the combined and quad testing

A

yes

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67
Q

what result does triple testing give you in terms of downs

A 
high risk (>1 in 150)
or low risk. if you want a diagnosis, need invasive testing (amnio or CVS)
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68
Q

what is QFPCR

A

amplification of whatever sample you’ve taken through PCR

replacing karyotyping

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69
Q

what is microarray CGH

A

comparative genomic hybridisation. can see extra or fewer bits of DNA compared to known sample.

can’t see single base pair mutations that sequencing can

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70
Q

what happens to a sample after CVS or amniocentesis

A

QFPCR to detect trisomies

CGH to detect anything else

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71
Q

how long after a sexual assault can forensic sample be retrieved

A

7 days in adults

3 days in children

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72
Q

if a patient comes into A&E having been raped, what do you do

A
  1. Hep B and HIV post-exposure prophylaxis
  2. 1g azithromycin (chla) and 500g ceftriaxone IM (gon)
  3. emergency contraception
  4. psychological coucnelling
  5. call forensic people
  6. collect evidence like clothing, underwear, bedding
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73
Q

3 absolute drug CI

A

lithium
methotrexate
radioactive iodine

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74
Q

do you usually need a higher or lower drug dose in pregnancy and why

A

higher

increased plasma volume
increase renal clearance
increase metabolism

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75
Q

chylamydia
% asymptotic men
% asymticamc women

A 
men = 50% no Sx
women = 70% no Sx
76
Q

types of chylamdial diseases

A 
A-C = trachoma 
D-K = STI
L1-3 = lymphogranuloma venereum
77
Q

Mx for lymphogranuloma venereum

A

doxycycline 3 weeks BD

78
Q

testing for chylmydia

A

endocervical swab for women –> NAAT

first catch urine for men –> NAAT

79
Q

length of contact tracing for chylamydia

A

Sx = 1 month tracing

No Sx = 6 month tracing

80
Q

Abx for epididymis-orchitis

A

same as PID but without metronidazole:

IM ceftriaxone + doxycycline BD 2 weeks

81
Q

urethral strictures STI?

A

gonorrhoea

82
Q

how often if PID bug negative

A

60%

83
Q

most common 3 bugs for PID

A
  1. chylamydia
  2. mycoplasma genitalia
  3. gonorrhoea
84
Q

legal limit for abortion

A

24 weeks

85
Q

cutoff in weeks when you have to do surgical and not just medical

A

14 weeks

86
Q

medical drugs for termination

A

mifepristone (anti-progesterone to ripen cervix)

misoprostol 48 hours later (stimulates min labour)

87
Q

what is hyaline membrane disease

A

aka for RDS (surfactant baby problem)

88
Q

what is erythema toxicum

A

common finding at first NIPE. central papule surrounded by erythema all over. caused by eosinophils,

89
Q

main cause of facial asymmetry after difficult birth

A

facial nerve palsy secondary to forceps. usually resolves

90
Q

choledocal cysts

  • what are they
  • presentation
A

Choledochal cysts (a.k.a. bile duct cyst) are congenital conditions involving cystic dilatation of bile ducts. They are uncommon in western countries but not as rare in East Asian nations like Japan and China

presents as prolonged neonatal jaundice (conjugated hyperbili)

91
Q

biliary atresia presentation and Mx

A

> 2w jaundice (conj hyperbili)

needs op before 6w

92
Q

complications of kernicterus

A

CP
Cerebral deafness
learning difficulties
death

93
Q

how is dose of Anti-D in a sensitising event calculated

A

Kleihauer test - checks for amount of fetal blood din mums blood to see how much extra anti-D is required

94
Q

how do you manage a rhesus -ve baby in a previously sensitised rhesus +ve woman

A

Monitor antibody levels every 2-4 weeks
If rises, check baby for anaemia (by looking at MCA peak systolic velocity)
If baby is becoming anaemic, must do bi-weekly Rh-ve, CMV-ve blood transfusions in to the umbilical vein

95
Q

direct vs indirect coombs test and uses

A

direct = tests for antibodies or complement ON THE SURFACE OF RBCs

  • warm or cold AIHA
  • drug induced haemolytic anaemia
  • alloimmune haemolysis (testing babies blood for haemolytic disease of newborn, transfusion reaction)

indirect = tests for antibodies IN THE SERUM

  • pre-transfusion testing
  • pre-natal testing (For IgG in mums blood that can cross placenta and cause haemolytic disease of newborn)
96
Q

appearance of baby at birth if haemolytic disease of newborn has occured

A

Anaemia
hepatosplenomegaly
severe jaundice

97
Q

diagnosis of periventricular leukomalacia in preterm infant

A

USS through fontanelle

–> echo dense area around ventricles followed later by cystic lesions a few weeks later

98
Q

HIV +ve mum, management:

  • antenatally
  • intrapartum
  • postpartum
A
  • start or continue HAART. test viral load once every trimester, at 36w and at delivery
  • if viral load low and CD4 high, can do vaginal delivery at 36w WITH DOSE of ZIDOVUDINE. Otherwise, plan elective caesarean with intrapartum zidovudine
  • no breastfeeding. give neonatal post-exposure prophylaxis
99
Q

what time is ben pen given for intrapartum prophylaxis of GBS

A

2 hours before delivery

100
Q

average age of:
menarche
menopause

A

12.5

51

101
Q

how is GnRH released

A

in a pulsatile manner to trigger LH/FSH release

102
Q

staging system for breast development

A

Tanner

103
Q

is the follicular phase or luteal phase of a woman menstrual cycle fixed?

A

The luteal phase is fixed (1 week)

the follicular phase varies between women

104
Q

what is gastrulation and neurulation and when do they occur

A

gastrulation = formation of the endoderm, ectoderm and mesoderm = beginning of week 3

neurulation = lateral edges of ectoderm fold to form neural fold and plate = end of week 3

105
Q

by what week have most organs formed and can you call the embryo a fetus

A

week 7

106
Q

Hormones in pregnancy:

  • increases blood to uterus
  • causes muscle and ligament relaxation
  • maintains corpus luteum
  • breast development
A
  • oestorgen
  • progesterone
  • hCG
  • placental lactogen
107
Q

Changes in pregnancy:

- thyroid hormones

A
  • T3/T4 increase, but so does the binding protein
108
Q

low and high doses of folate

A 
low = 400ug
high = 5mg
109
Q

how many antenatal appointments for uncomplicated:

  • nulliparous
  • parous
A

10 appointments

7 appointments

110
Q

What is the Barker hypothesis

A

a hypothesis that says that specific set of conditions during pregnancy will have long tern effect on adult health and risk of associated diseases

111
Q

What foods to avoid during pregnancy

A 
excess vitamin A (liver)
Uncooked foods:
- soft cheese
- raw fish
- honey
112
Q

when is sex CI in pregnancy

A

placenta praevia

ruptured membranes

113
Q

how long is maternity leave

do you have to take it

how long is paternity leave

A

52 weeks total:

26 week ordinary leave
26 weeks additional leave

you must take the first 2 weeks (or 4 if in a factory), but don’t have to take any more

paternity leave is 1-2 weeks

114
Q

time in pregnancy for CVS and amniocentesis

A 
CVS = 11-14 weeks
Amnio = 15+ weeks
115
Q

chance of having a down syndrome baby at:
30y
40y
45y

A 
30y = 1 in 1000
40y = 1 in 100
45y = 1 in 30
116
Q

Do you give anti-D in miscarriage?

A

if >12w, yes

If <12w, only if evac was performed of if it was an ectopic

117
Q

Investigations for recurrent miscarriage

A

Mums blood:
thyroid function
FBC, metabolic screen
antiphospholipid antibodies

Mums anatomy:
Pelvic exam
TV-USS
MRI hysterosalpingogram

Genetics:
parental karyotyping

118
Q

hCG rise in:

  • normal pregnancy
  • ectopic
  • miscarriage
A
  • doubles every 48 hours
  • <66% every 48 hours
  • falls
119
Q

complete vs partial mole

A

partial = normal egg fertilised by 2 sperm - 69 chromosomes from mum and dad

complete mole = egg with no maternal DNA fertilised by 2 sperm - 46 chromosomes all from dad

120
Q

treatment for full blown choriocarcinoma

prognosis

A

chemotherapy

almost 100% cure

121
Q

when does hyperemesis usually start and stop (Estimate)

A

starts around 6 weeks

ends around 14 weeks (can linger)

122
Q

Investigations for hyperemesis

A 
urine dip (ketones)
FBC
U/E (?renal failure)
LFT (?liver failure)
USS (?molar preg)
123
Q

Management of mild vs severe hyperemesis

A

Mild (conservative)

  • eat frequent meals
  • drink fluid between meals

Severe because not tolerating fluid and dehydrated

  • admit and IV rehydrate
  • NBM for 24hours
  • Antiemetic (cyclizine, promethazine)
  • Pabrinex (risk of Wernickes)
124
Q

best laxative for constipation of pregnancy

A

Osmotic laxative = lactulose

125
Q

What condition is carpal tunnel syndrome in pregnancy linked to

A

gestational diabetes

126
Q

what do you do for a woman with essential hypertension on ACEi and a diuretic who is now pregnant

A

Take her off the ACEi (?renal agenesis in baby) and put her on labetolol

Take her off diuretic (reduces plasma volume)

Increase antenatal visits

127
Q

Gestational hypertension management:

  • > 140/90
  • > 160/110
A

labetolol

> 160 = admit to DAU to treat

128
Q

What kills you in pre-eclampsia

A

hypertension –> seizure –> stroke

129
Q

5 high risk factors for pre-eclampsia

4 moderate risk factors

A 
PMHx of PET (7x)
Kidney problems
Chronic hypertension
diabetes
Antiphospholipid syndrome

Nulliparity (or not parous for >10yrs, or new partner)
FHx of PET
BMI >35
Multiple gestation

130
Q

What is the prophylaxis for PET based on RFs

A

1 high or 2 moderates

Aspirin 75mg OD started between 12-16w

131
Q

where is the oedema in PET most likely to occur

A

face

132
Q

Management of PET in terms of delivery

A

Get to 35w –> Deliver
If it gets worse –> deliver
If already 35w+ –> deliver asap

Think about steroids if coming early
Give MgSO4 if severe to prevent seizure

Remember: can’t give ergometrine in hypertension so give just oxytocin if required

133
Q

How long do you keep someone in hospital for after PET

A

5 days to monitor BP and urine

134
Q

Tx of eclampsia AND HELLP

A

MgSO4

ABCDE

135
Q

What happens if you are high risk for gestational diabetes

A

GTT at 26-28w

136
Q

Why can’t you use urinary glucose as a test for gestational diabetes

A

Because the renal threshold for glucose changes and some leaks out anyways

137
Q

Process of GTT? and result that means GDM?

A

Starve over night
Glucose measured
75g glucose drink
Glucose measured again at 2 hours

If baseline >5.6 or if post-drink glucose >7.8 = GDM

138
Q

3 steps of GDM management

A
  1. lifestyle and diet
  2. recheck in 2 weeks then give metformin
  3. recheck in 2 weeks and then insulin

ASPIRIN FOR PET RISK

139
Q

Delivery with GDM

A

IOL at 38w

Caesarean if macrosomia

140
Q

Normal Hb in 1st, 2nd, 3rd trimester

A 
1st = 110+
2nd/3rd = 100+
141
Q

Mx for high, medium and low risk for VTE

How does this Mx change in labour itself?

A

High = LMWH antenatally and for 6 weeks postnatally

Medium = LMWH from 28w to 6 wks postnatally

Low = avoid dehydration

In labour, stop LMWH. If high risk, continue with unfractionated heparin because you can reverse it quicker with protamine sulphate

142
Q

Tx for simple UTI in pregnancy:

  • symptomatic
  • asymptomatic
A

Amoxicillin

Sx = 7d
No Sx = 3d

143
Q

SGA vs IUGR

A

SGA is simply in bottom 10% of size

IUGR is failure of fetus to achieve genetic potential of size

144
Q

Main cause of IUGR

A

compromised uteroplacental flow

145
Q

1
2
3
stages of labour

A

1 = onset to 10cm dilated

2 = delivery of baby

3 = delivery of placenta and membranes

146
Q

During labour frequency of:

  • Obs
  • VE
  • Temp measurement
A
  • Obs = every hour (apart from temp which is 4 hourly)

- VE = every 4 hours

147
Q

Opioid in labour and route?

A

Pethidine IM (takes 15mins)

148
Q

Acidosis cutoff in fetal blood sampling

A

<7.25

149
Q

time lag in a late decel

A

> 15s

150
Q

late vs variable decelerations

A

late = happens with every contraction = always bad

variable = happens with some contractions = sometimes bad

151
Q

when are variable contractions bad

A

when occurring in >50% contractions for >30min

152
Q

what does attitude refer to in baby presentation

A

the amount the neck is flexed

a brow presentation has greatest diameter

153
Q

What two things does a face presentation contraindicate

A

fetal blood sampling

ventouse delivery

154
Q

when do you do ECV

A

36w in nulliparous

37w in multiparous

155
Q

how long should 2nd stage of labour last (10cm-baby delivered)

A

<2hrs in primip

<1hr in multip

156
Q

way to think about failure to progress

A

Power - uterus contracting properly?
Passenger - presentation and lie of baby?
Passage - type of pelvis? android causes failure to progress.

157
Q

Method and escalation steps to induce labour

A
  1. Membrane stretch and sweep

```
2. Vaginal PGE2
6hrs later
3. ARM
(2hrs later)
4. Syntocinon
~~~

158
Q

If you want to do ventouse, can the head be palpable?

A

Yes, but no more than 1/5th palpable

159
Q

definition of puerperium

A

6 weeks following delivery

160
Q

timeline of:

  • postnatal blues
  • postnatal depression
  • postnatal psychosis
A 
blues = 0-2 wk
depression = 6 wk +
psychosis = 1-4 wk +
161
Q

Can you do VE or speculum in placenta praevia

A

Dont do VE

Can do speculum

162
Q

classic presentation of vasa praevia

A

Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen

163
Q

4 major causes of post-partum haemorrhage in order (4 T’s)

A

tone (uterine atony)
tear
thrombin (clotting abnormality)
tissue (retained tissue)

164
Q

Main investigation for:

?PROM

?Preterm labour

A

PROM:

  • speculum to look at cervix
  • AMNIsure/actinPROM test for placental alpha microglobulin

preterm labour:

  • TV-USS for cervical length
  • fetal firbonectin (if negative you can send them home - high NPV)
165
Q

teenage pregnancies increases risk of

A

PET
anaemia
low birth weight

166
Q 
Legal obligation for pre-term infants:
24w +
23w
22w
21w
A 
24w+ = full ICU required
23w = parental preference
22w = comfort care unless research project available, in which case parental preference 
21w = comfort care
167
Q

3 Mx for pruritus vulvae

A

Vulval care
Hydrocortisone
Antihistamine

168
Q

Hirsutism in PCOS Tx

A

In combo with COCP = Cyproterone acetate

Topical for face: eflornithine

169
Q

endometriosis medical management

adenomyosis management

A

endometriosis = NSAIDs + para + COCP

adenomyosis = none really. can wait for menopause. can try normal management of menorrhagia

170
Q

what is a nabothian cyst

A

a retention cyst of the cervix - mucus filled lesion considered normal part of adult cervix. occur as a result ofmetaplastic change. asymptomatic.

171
Q

histology of dyskaryosis:
mild
moderate
severe

A

mild = <1/3 of thickness shows dyskaryosis (hyperchromic nuclei and irregular chromatin). confined too basal 1/3rd

moderate = basal 2/3rds show dyskaryosis

severe = >2/3rds show dyskaryosis

172
Q

FIGO staging

A 
staging for ovarian cancer:
1 = ovary
2 = true pelvis
3 = beyond true pelvis
4 = mets
173
Q

staging for endometrial cancer

A 
1 = endometrium
2 = and cervix
3 = and pelvis
4 = beyond pelvis
174
Q

staging for vulval cancer

A 
1 = vulva
2 = local spread to vagina, anus etc
3 = and lymph nodes
4 = mets
175
Q

When is abortion legal (5 categories)

A 
A = risk of life to mother
B = risk of permanent injury to mother
C = <24wks AND injury to mother mental or physical
D = <24wks AND injury to other siblings 
E = substantial risk of child being born with serious disability

most fall under section C

176
Q

what type of TOP is more common

A

Surgical (90%) compared to only 10% medical (mifi+miso)

177
Q

surgical TOP technique:
<14w
>14w
>22w

A 
<14w = suction
>14w = dilation and curettage
>22w = foeticide
178
Q

Rokitansky syndrome

A

agenesis/hypoplasia of uterus and top 2/3rds of vagina

presents with short vagina and infertility

179
Q

Criteria for diagnosing PCOS

A

Rotterdam criteria:

Need 2/3 for diagnosis:

  • oligomenorrhoea
  • evidence of hyperandrogenism (acne, hirsuitism, alopecia)
  • 12+ follicles on USS
180
Q

definition:

  • oligospermia
  • asthenospermia
A 
oligo = <20 million per ml
astheno = poor motility
181
Q

when is IVF offered on NHS

A

Women under 40 get 2 cycles
women over 40 get 1 cycle

IF

  • trying for 2 years
  • tried 12 cycles of IUI
182
Q

success rate of IVF

A

under 35 = 32%

over 40 = 13%

183
Q

IVF process

A 
COCP suppresses natural cycle
FSH daily injection for 10 days
hCG given to trigger oocyte maturation
USS guided oocyte retrieval 
Semen collected 
IVF
cultured for 3-5 days
1-2 embryos implanted
184
Q

what does clomifene do

A

Increases fertility in PCOS

Clomifene is a nonsteroidal
SERM that inhibits estrogen receptors in the hypothalamus, inhibiting negative feedback of estrogen on gonadotropin release, leading to up-regulation of the hypothalamic–pituitary–gonadal axis.

185
Q

pessary ring advice and follow up

A

We’ll do a VE and size you up. Put it in and wait 30 mins so you can walk around and go tot he toilet with no problems. Then we’ll call you back in 6m to change it and follow up.

4th Year (10 decks)

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