Women's health Flashcards
(144 cards)
1
Q
What should be given in third stage of labour
A
10 IU oxytocin by IM injection
Ergometrine should not be given in the presence of hypertension
2
Q
Mx of chickenpox exposure pregnancy
A
f there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies
oral aciclovir (or valaciclovir) is now the first choice of PEP for pregnant women at any stage of pregnancy
antivirals should be given at day 7 to day 14 after exposure, not immediately
3
Q
Mx of chickenpox in pregnancy
A
oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash
if the woman is < 20 weeks the aciclovir should be ‘considered with caution
4
Q
Primary vs secondary amenorrhoea causes
A
Primary
gonadal dysgenesis (e.g. Turner’s syndrome) - the most common causes
congenital malformations of the genital tract
functional hypothalamic amenorrhoea (e.g. secondary to anorexia)
congenital adrenal hyperplasia
imperforate hymen
Secondary
hypothalamic amenorrhoea (e.g. secondary stress, excessive exercise)
polycystic ovarian syndrome (PCOS)
hyperprolactinaemia
premature ovarian failure
thyrotoxicosis*
Sheehan’s syndrome
Asherman’s syndrome (intrauterine adhesions)
5
Q
Menorrhagia tx
A
Does not require contraception
either mefenamic acid 500 mg tds (particularly if there is dysmenorrhoea as well) or tranexamic acid 1 g tds.
Mirena if contraception
6
Q
Ix and mx of endometriosis
A
laparoscopy is the gold-standard investigation
NSAIDs and/or paracetamol are the recommended first-line treatments for symptomatic relief
if analgesia doesn’t help then hormonal treatments such as the combined oral contraceptive pill or progestogens
7
Q
8-12 week booking preg
A
BP, urine dipstick, check BMI
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria
8
Q
10-14 wk scan preg
A
Early scan to confirm dates, exclude multiple pregnancy
9
Q
11 - 13+6 weeks preg
A
Down’s syndrome screening including nuchal scan
10
Q
When is anti D given
A
28
34
11
Q
What acne tx should be avoided in pregnancy
A
adapalene and tretinoin
12
Q
MOA of desogestrel)
A
Inhibits ovulation
POP
13
Q
MOA of Nexplanon
A
Releases the progestogen hormone etonogestrel.
They are typically inserted in the proximal non-dominant arm, just overlying the tricep.
The main mechanism of action is preventing ovulation. They also work by thickening the cervical mucus.
14
Q
Biggest RF for umbilical cord prolapse
A
Artificial aminotomy
15
Q
Treatment of primary dysmenorrhea
A
Mefanfamic acid (NSAIDs)
16
Q
COCP before surgery
A
Stop 4 weeks before and switch to POP
17
Q
Which contraceptions should be stopped at 50
A
COCP and depot
18
Q
Which contraceptions can be continued beyond 50
A
Implant, POP, IUS
19
Q
Size of SF height after 20w
A
After 20 weeks, symphysis-fundal height in cm = gestation in weeks
20
Q
Intrahepatic cholestasis of pregnancy sx
A
pruritus, often in the palms and soles
no rash (although skin changes may be seen due to scratching)
raised bilirubin
21
Q
Mx of intrahepatic cholestasis
A
ursodeoxycholic acid is used for symptomatic relief
weekly liver function tests
women are typically induced at 37 weeks
22
Q
Mx of acute fatty liver of preg
A
Supportive then deliver
23
Q
Sx of AFLP
A
abdominal pain
nausea & vomiting
headache
jaundice
hypoglycaemia
severe disease may result in pre-eclampsia
24
Q
MOA of intrauterine system (levonorgestrel)
A
Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus
25
MOA of Implantable contraceptive (etonogestrel)
Primary: Inhibits ovulation
Also: thickens cervical mucus
26
MOA Of emergency contraception
Contraceptive Mode of action
Levonorgestrel Inhibits ovulation
Ulipristal Inhibits ovulation
Intrauterine contraceptive device Primary: Toxic to sperm and ovum
Also: Inhibits implantation
27
Severe pre-eclampsia classification
hypertension: typically > 160/110 mmHg and proteinuria as above
proteinuria: dipstick ++/+++
headache
visual disturbance
papilloedema
RUQ/epigastric pain
hyperreflexia
platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome
28
Mx of pre eclampsia
women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed
Oral labetalol, Nifedipine (e.g. if asthmatic) and hydralazine may also be used
29
methods of contraception is proven to be associated with weight gain
Depot
30
Mx of ectopic pregnancy
Expectant
<35mm
Asymptomatic
NO heartbeat
hCG <1,000IU/L
Medical
<35mm
Unruptured
hCG <1,500IU/L
Not suitable if intrauterine pregnancy
Surgical
>35mm
Can be ruptured
hCG >5,000U
Pain
31
Expectant mx of ectopic preg
Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed.
32
Rules of emergency contraception
Levonorgestrel
must be taken within 72 hours of unprotected sexual intercourse (UPSI)
the dose should be doubled for those with a BMI >26 or weight over 70kg
hormonal contraception can be started immediately after using levornogestrel (Levonelle) for emergency contraception
Ulipristal
30mg oral dose taken as soon as possible, no later than 120 hours after intercourse
Ulipristal may reduce the effectiveness of hormonal contraception. Contraception with the pill, patch or ring should be started, or restarted, 5 days after having ulipristal. Barrier methods should be used during this period
33
Cause of oligohydraminos
premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia
34
Definition of oligohydraminos
less than 500 mL at 32-36 weeks' gestation:
35
Gestational diabetes dx
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
36
Gestational diabetes mx
if the fasting level is < 7 mmol/l a trial of diet and exercise should be offered
if not met within 1-2 weeks of altering diet/exercise metformin should be started
if glucose targets are still not met insulin should be added to diet/exercise/metformin
gestational diabetes is treated with short-acting, not long-acting, insulin
if at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started
if between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered
37
Menstruation cycle phases
Menstruation
Days1-4
Follicular phase (proliferative phase) Days 5-13
follicles develop in the follicular phase under the influence of FSH
Proliferation of endometrium
FSH results in the development of follicles which in turn secrete oestradiol
When the egg has matured, it secretes enough oestradiol to trigger the acute release of LH. This in turn leads to ovulation
Ovulation
Days 14
Luteal phase (secretory phase)
Days 15-28
Progesterone secreted by corpus luteum rises through the luteal phase.
High body temp
38
POP missed pill
'Traditional' POPs (Micronor, Noriday, Nogeston, Femulen)
If less than 3 hours late
no action required, continue as normal
Cerazette (desogestrel)
If less than 12 hours late
no action required, continue as norma
IF >3/13hrs
take the missed pill as soon as possible. If more than one pill has been missed just take one pill. Take the next pill at the usual time, which may mean taking two pills in one day
continue with rest of pack
extra precautions (e.g. condoms) should be used until pill taking has been re-established for 48 hours
39
CI to COCP
more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation
positive antiphospholipid antibodies (e.g. in SLE)
40
COCP and cancer
increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer
41
Endometriosis sx
Chronic pelvic pain
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility
42
Cervical excitation
Cervical excitation is found in both pelvic inflammatory disease and ectopic pregnancy.§
43
Types of miscarriage
Threatened
painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
cervical os is closed
Missed (delayed) miscarriage
a gestational sac which contains a dead fetus before 20 weeks without Pain is not usually a feature
cervical os is closed
Inevitable miscarriage
heavy bleeding with clots and pain
cervical os is open
Incomplete miscarriage
not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open
44
PCOS fertility aid
Infertility in PCOS - clomifene is typically used first-line
45
When able to stop contraception
after 1 year of amenorrhoea if aged over 50 years, 2 years if the woman is aged under 50 years
46
When to start labetalol
systolic > 140 mmHg or diastolic > 90 mmHg
47
Increases risk of down in combined test
11 - 13+6 weeks
↑ HCG, ↓ PAPP-A, thickened nuchal translucency
If a woman has a 'higher chance' results she will be offered a second screening test (NIPT) or a diagnostic test (e.g. amniocentesis or chorionic villus sampling (CVS).
48
What is quad test and when doe sit happen
if women book later in pregnancy the quadruple test should be offered between 15 - 20 weeks
quadruple test: alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A
Low AFP, oestradiol
High bHCG, inhibit
49
When able to start POP after birth
Immediately
Breastfeeding or not
50
Who cannot take ullipristal
caution should be exercised in patients with severe asthma
breastfeeding should be delayed for one week after taking ulipristal. There are no such restrictions on the use of levonorgestrel
51
pre eclampsia definition
new-onset hypertension after 20 weeks' gestation with proteinuria (≥0.3g/24h) or other maternal organ dysfunction.
52
When should infertility be investigated
<35 12 months
>35 6 months
53
Mx of premature menopause
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)
54
How often can you get the depot
Evert 3 months
55
Folic dose in pregnancy
5mg in first trimester if
BMI of more than 30 kg/m²
diabetes, sickle cell disease (SCD), thalassaemia trait
coeliac disease
anti-epileptic medication
personal or family history of NTD
who have previously given birth to a baby with an NTD
56
Mx of secondary dysmenorrhea
Referral to gynae
57
Tx of candidal infection with BF
Carry on BF and treat mother and baby
58
When should progesterone be measured
7 days before expected menstruation
59
Time of effectiveness of contraception
instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS
60
Tx of menopause if HRT CI
SSRI
61
Supplements prior to pregnancy
Vit d 10mcg
Folic 400mcg
62
Mx of patient with fibroids wanting to conceive
Myomectomy
63
Management of menorrhagia secondary to fibroids
Want contraception
levonorgestrel intrauterine system (LNG-IUS)
64
Mx of prev delivery with GBS
IAP benxylpenicillin
65
When should you get anti D
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma
66
Cervical cancer interpretation
Positive hrHPV
samples are examined cytologically
if the cytology is abnormal → colposcopy
if the cytology is normal (i.e. hrHPV +ve but cytologically normal) the test is repeated at 12 months
if the repeat test is now hrHPV -ve → return to normal recall
if the repeat test is still hrHPV +ve and cytology still normal → further repeat test 12 months later:
If hrHPV -ve at 24 months → return to normal recall
if hrHPV +ve at 24 months → colposcopy
67
Changes in epilepsy medication when breastfeeding
No changes required
68
What is given prior to surgery for fibroid
GnRH inhibitor
69
Medication to cease breastfeeding
Carbogeline
70
Perineal tears grading
first degree
superficial damage with no muscle involvement
do not require any repair
second degree
injury to the perineal muscle, but not involving the anal sphincter
require suturing on the ward by a suitably experienced midwife or clinician
third degree
injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
require repair in theatre by a suitably trained clinician
fourth degree
injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa
require repair in theatre by a suitably trained clinician
71
Second screen for anaemia and atypical red cell alloantibodies
28 w
72
Nuchal scan timing
11-14w
73
Urine culture to detect asymptomatic bacteriuria
8-12w
74
Ovarian cancer RF
family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity
75
Screening for postnatal depression
Edinburgh tool
76
Mx of pyrexia and suprapubic tenderness post delivery
Endometritis
Admit to hospital
77
What age should you feel the baby move at
24 weeks- no movements by this- referral
78
Treatment of BV, TV, chlamydia and gonorrhoea
BV- metronidazole
TV- met
Chlamydia- doxy
Gon- IM cef
79
Referral for ovarian cyst
a conservative approach may be taken for younger women (especially if < 35 years) as malignancy is less common. If the cyst is small (e.g. < 5 cm) and reported as 'simple' then it is highly likely to be benign.
A repeat ultrasound should be arranged for 8-12 weeks and referral considered if it persists.
Postmenopausal women
any postmenopausal woman with an ovarian cyst regardless of nature or size should be referred to gynaecology for assessment
80
When to test for Gestational diabetes
the oral glucose tolerance test (OGTT) is the test of choice
women who've previously had gestational diabetes: OGTT should be performed as soon as possible after booking and at 24-28 weeks if the first test is normal.
NICE also recommend that early self-monitoring of blood glucose is an alternative to the OGTTs
women with any of the other risk factors should be offered an OGTT at 24-28 weeks
81
Mx of PPROM
admission for 48 hrs
oral erythromycin should be given for 10 days
antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
delivery should be considered at 34 weeks of gestation
82
Who should take aspirin during pregnancy
≥ 1 high risk factors
≥ 2 moderate factors
Take from 12w until delivery
High risk
hypertensive disease in a previous pregnancy
chronic kidney disease
autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension
Moderate
first pregnancy
age 40 years or older
pregnancy interval of more than 10 years
body mass index (BMI) of 35 kg/m² or more at first visit
family history of pre-eclampsia
multiple pregnancy
83
Interpretation of bishop score
if the Bishop score is ≤ 6
vaginal prostaglandins or oral misoprostol
mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
if the Bishop score is > 6
amniotomy and an intravenous oxytocin infusion
84
Bishop score
Cervical position
Posterior Intermediate Anterior -
Cervical consistency
Firm Intermediate Soft -
Cervical effacement
0-30% 40-50% 60-70% 80%
Cervical dilation
<1 cm 1-2 cm 3-4 cm >5 cm
Fetal station
-3 -2 -1, 0 +1, +2
85
CI to HRT
Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
86
Pregnant lady without MMR
If a pregnant woman is not immune to rubella, she should be offered the MMR vaccination in the post-natal period
87
Patient is short, showing no signs of development of secondary sexual characteristics and has widely spaced nipples. A systolic murmur was also noted to be present under the left clavicle.
Turner syndrome
High FSH/LH
88
Increased risk of HPV
smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*
89
UPSI after day 14 of cycle
Ulipristal and levo won't work well as inhibit ovulation
IUD best option here
IUD- Within 5 days of the earliest estimated date of ovulation if more than 5d UPSI
90
When to give insulin over metformin for Gest diabetes
Gestational diabetes - insulin should be commenced if fasting glucose level is >= 7 mmol/l insulin at the time of diagnosis
91
Premature labour mx
Tocolytics (Terbutaline, nifedipine, MgSO4) and steroids
92
Which virus causes cervical cancer
HPV 16,18
93
Commonest ovarian cyst
Follicular
94
Chocolate cysts
Endometriotic cyst
95
Most common ovarian cancer
Serous carcinoma
96
Dermoid cysts
Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth
Torsion is more likely than with other ovarian tumours
97
If 1st cervical smear +ve for HPV
if 1st repeat smear +ve- repeat at 12 months -if still hrHPV +ve → repeat smear 12 months later (i.e. at 24 months)
98
Methotrexate with conceiving
Stop 6 months before
99
Most common type of ovarian pathology associated with Meigs' syndrome
Fibroma
100
Most common benign ovarian tumour in women under the age of 25 years
Dermoid cyst
101
Latex allergy - which condoms
polyurethane condoms
102
Contraception abs CI in BF
COCP
drastically reduces breast milk volume.
103
Mx of baby in breech position
if < 36 weeks: many fetuses will turn spontaneously
if still breech at 36 weeks- external cephalic version (ECV)
The RCOG recommend ECV should be offered from 36 weeks in nulliparous women and from 37 weeks in multiparous women
if the baby is still breech then delivery options include planned caesarean section or vaginal delivery
104
Meds that should be avoided in BF
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
105
Mx of vaginal candidasis
oral fluconazole 150 mg as a single dose first-line
clotrimazole 500 mg intravaginal pessary - if preg
106
Ovarian hyperstimulation syndrome sx
Mild
* Abdominal pain
* Abdominal bloating
Moderate
* Nausea and vomiting
* Ultrasound evidence of ascite
Severe
* Oliguria
* Haematocrit > 45%
* Hypoproteinaemia
Critical
* Thromboembolism
* Acute respiratory distress syndrome
* Anuria
* Tense ascites
107
POP and antibiotics
No interaction
108
Varicella exposure during preg defects on child
Scarring of the skin, limb hypoplasia, microcephaly and eye defects
109
CMV, parvovirus and rubella exposure baby sx
CMX- cerebral calcification
microcephaly
sensorineural deafness.
Rubella- deafness
congenital cataracts
cardiac complications.
Parvovirus B19 - hydrops fetalis
Death.
110
Mx of PPH
mechanical
palpate the uterine fundus and rub it to stimulate contractions ('rubbing up the fundus')
catheterisation to prevent bladder distension and monitor urine output
medical
IV oxytocin: slow IV injection followed by an IV infusion
ergometrine slow IV or IM (unless there is a history of hypertension)
carboprost IM (unless there is a history of asthma)
111
Late vs early decelerations
Early- Usually an innocuous feature and indicates head compression
Late- Indicates fetal distress
112
Fetal HR on Cardiotocography
Baseline bradycardia
Heart rate < 100 /min
Increased fetal vagal tone, maternal beta-blocker use
Baseline tachycardia
Heart rate > 160 /min
Maternal pyrexia, chorioamnionitis, hypoxia, prematurity
Loss of baseline variability
< 5 beats / min
Prematurity, hypoxia
113
Endometrial cancer RF
excess oestrogen
nulliparity
early menarche
late menopause
metabolic syndrome
obesity
diabetes mellitus
polycystic ovarian syndrome
tamoxifen
hereditary non-polyposis colorectal carcinoma
114
Mx of menopause with mirena
Estradiol
115
RF for abruption
proteinuric hypertension
cocaine use
multiparity
maternal trauma
increasing maternal age
116
UPSI and forgotten to change patch
If the contraceptive patch change is delayed greater than 48 hours, the patch should be changed immediately and a barrier method of contraception used for the next 7 days
117
Cervical smeer
25-49 years: 3-yearly
50-64 years: 5-yearly
118
Day to measure LH and progesterone
LH-14
Progesterone -21
119
Recommended anti epileptic in preg
Lamotrigine, carbamazepine and levetiracetam are known to have the smallest effects on the developing foetus
120
SSRI for BF women
Sertraline or paroxetine are the SSRIs of choice in breastfeeding women
121
Ruptured ectopic sx
amenorrhoea, abdominal pain and vaginal bleeding in combination with shoulder tip pain
Cervical excitation
122
Most common epithelial cell tumour
Serous cystadenoma
123
IUD, Mirena, Nexplanon duration
IUD- 10 years
Mirena- 5 years
Nexplanon -3 years
124
COCP missed pill rules
If 1 pill is missed (at any time in the cycle)
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day
If 2 or more pills missed
week 1 (Days 1-7): emergency contraception should be considered if she had unprotected sex in the pill-free interval or in week 1
week 2 (Days 8-14): after seven consecutive days of taking the COC there is no need for emergency contraception*
if pills are missed in week 3 (Days 15-21): she should finish the pills in her current pack and start a new pack the next day; thus omitting the pill free interval
125
38 weeks pregnant with BP of 152/85 mmHg. A 24-hour urine collection is requested which shows a urinary protein excretion of 0.7g / 24 hours mx
pregnant women who have mild or moderate gestational hypertension, are more than 37 week pregnant, and are showing signs of pre-eclampsia, should be recommended to give birth within 24 - 48 hours.
126
What should you monitor whilst on a Mg infusion
monitor reflexes + respiratory rate
127
Scenario where implant is advisable over IUS
Fibroids distorting cavity
128
Cervical smear in HIV women
Offered annually
129
Smoking risks in pregnancy
Increased risk of miscarriage (increased risk of around 47%)
Increased risk of pre-term labour
Increased risk of stillbirth
IUGR
Increased risk of sudden unexpected death in infancy
130
Mx of woman with bleeding, rhesus negative
Anti D and followed by Kleihauer test.
131
Mx of recurrent vaginal thrush
induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months
132
Meds worsening stress incontinence
Alpha blockers
Doxa
133
Dysfunctional uterine bleeding
menorrhagia in the absence of underlying pathology
134
Test to confirm early menopause
FSH
135
Obstetric cholestasis vs AFLP
OC- raised LFT, ALP more so
Bilirubin raised- no pain
AFLP- pain , nausea, vomiting, jaundice and signs of encephalopathy elevated liver enzymes (AST & ALT), hypoglycaemia, coagulopathy (prolonged prothrombin time/INR), hyperbilirubinaemia and evidence of renal dysfunction.
136
HIV management in pregnancy
Antiretroviral therapy
Mode of delivery
vaginal delivery- 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
Neonatal antiretroviral therapy
zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml.
Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.
No breast feeding
137
Mx of hyperemesis
first-line medications
antihistamines: oral cyclizine or promethazine
phenothiazines: oral prochlorperazine or chlorpromazine
Second- ondansetron
Metoclopramide- should not be used for more than 5d
138
How is premature ovarian failure defined?
The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years
139
When is continuous CTG monitoring warranted in labour
suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
severe hypertension 160/110 mmHg or above
oxytocin use
the presence of significant meconium
fresh vaginal bleeding that develops in labour
140
What contraceptives may decrease bone mineral density in women?
Depot
141
Timing of tests for Downs
The combined test which includes the nuchal scan is done at 11-13+6 weeks.
If the patient requests the screening later in the pregnancy, either the triple or quadruple test should be offered between 15 and 20 weeks.
If a woman has a 'higher chance' results she will be offered a second screening test (NIPT) or a diagnostic test (e.g. amniocentesis or chorionic villus sampling (CVS).
142
Resting tremor and increased upper limb tone on new medication for hyperemesis
Metoclopramide
143
PMS management
moderate symptoms may benefit from a new-generation combined oral contraceptive pill (COCP)
severe symptoms may benefit from a selective serotonin reuptake inhibitor (SSRI)
this may be taken continuously or just during the luteal phase (for example days 15-28 of the menstrual cycle, depending on its length)
144
