Round-up Yeehah!

Question 1

What questions need to be asked for PV bleeding?

Answer 1

How heavy is the bleeding - how does it compare to a period
Any unusual discharge
Have you had a pregnancy test?
Any pain - where is it? what is it like? pain during sex?

Question 2

What percentage of pregnancies are ectopic?

Answer 2

1%

Question 3

RF for ectopic?

Answer 3

Previous surgery - tubal. sterilisation?
Uterine contraceptives
PID
Chlamydia
Smoking
IVF
Previous ectopic pregnancy

Question 4

What is PV bleeding before 24 weeks gestation? after?

Answer 4

Before = threatened miscarriage
After = Antepartum haemorrhage

Question 5

Plan for suspected ectopic?

Answer 5

Pregnancy test and urine dip
Ultrasound
Serum HCG (>1500)

Question 6

What do you need to have done to make a diagnosis of PUL (pregnancy of unknown location)?

Answer 6

Ultrasound

Question 7

In PUL what would a HCG rise of <66% every 48hrs indicate?

Answer 7

Ectopic pregnancy between 6-10 weeks

Also consider filed pregnancy

Question 8

How can you tell the ectopic pregnancy is threatening?

Answer 8

Signs of peritonitis

/ shock

Question 9

Management of ectopic pregnancy?

Answer 9

Salpingectomy
Salipingotomy if only 1 tube
Methotrexate

Question 10

When would the mothers and babies blood mix?

Answer 10

Delivery
Amniocentesis
External cephalic version
Trauma
Ruptured ectopic
antepartum haemorrhage

Question 11

What week gestation do foetal movements start to be felt?

Answer 11

20 weeks

Question 12

Symptoms of pre-eclampsia?

Answer 12

Headache
Visual disturbance
Epigastric pain
Swelling
Vomiting

Signs = clonus, brisk reflexes, oedema, high BP, low SFH, proteinuria (PCR - urinary to creatine ration = >30 for proteinuria)

Question 13

Management of pre-eclampsia?

Answer 13

To prevent eclampsia = delivery (NB. 40% eclampsia occurs post-partum)
Do examination to see mode of delivery e.g. if fully dilated do instrumental delivery

Monitor bloods - will indicate HELLP syndrome (heamolysis, elevated liver enzymes, low platelet count)

BP control - labetalol/nifedipine
Magnesium sulphate as prophylaxis

Question 14

Questions for PB bleeding at 35 weeks?

Answer 14

Pain? (placental preavia = painless, placental abruption = painful)
How much blood? Post coital?
Contractions? - could be a bloody show
Foetal movements?
Last smear
Antenatal notes - specifically placental position (scan at 20 weeks)

Question 15

What is vasa praevia?

Answer 15

Foetal blood loss

Question 16

Who is placental more dangerous for, the mother or the foetus?

Answer 16

Foetus

Results in a hard ‘woody’ uterus on palpation (spasms) - can be hidden abruption so this is an important sign

Question 17

Most common cause of post-menopausal bleeding?

Answer 17

Atrophic vaginitis

But worry about endometrial cancer

Question 18

RF for endometrial cancer?

Answer 18

Diabetes
Obesity
Late menopause
Early menarche
PCOS
Nulliparity
Tamoxifen

Question 19

Why is PCOS a state of unopposed oestrogen?

Answer 19

Follicles –> FSH –> ovaries –> estrogen

Question 20

Investigations of PMB?

Answer 20

USS (thickened endometrium - should be <4mm)

Hysteroscopy and endometrial biopsy

Question 21

Management of atrophic vaginitis?

Answer 21

Give oestrogen - look up how

Question 22

Causes of PPH?

Answer 22

Retained products of conception

Endometritis (give co-amoxilav postnatally, cefuroxime + metronidazole antenatally)

Question 23

Fluid loss from vagina in pregnant women?

Answer 23

PROM/PPROM
Threatened preterm labour
UTI
PV bleeding
Vaginal infection
physiological discharge

Question 24

Plan for PPROM?

Answer 24

Steroids +/- tocolytics