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MSRA > Women's health > Flashcards

Women's health Flashcards

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

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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

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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

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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)

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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

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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

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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

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8
Q

10-14 wk scan preg

A

Early scan to confirm dates, exclude multiple pregnancy

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9
Q

11 - 13+6 weeks preg

A

Down’s syndrome screening including nuchal scan

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10
Q

When is anti D given

A

28
34

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11
Q

What acne tx should be avoided in pregnancy

A

adapalene and tretinoin

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12
Q

MOA of desogestrel)

A

Inhibits ovulation
POP

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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.

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14
Q

Biggest RF for umbilical cord prolapse

A

Artificial aminotomy

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15
Q

Treatment of primary dysmenorrhea

A

Mefanfamic acid (NSAIDs)

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16
Q

COCP before surgery

A

Stop 4 weeks before and switch to POP

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17
Q

Which contraceptions should be stopped at 50

A

COCP and depot

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18
Q

Which contraceptions can be continued beyond 50

A

Implant, POP, IUS

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19
Q

Size of SF height after 20w

A

After 20 weeks, symphysis-fundal height in cm = gestation in weeks

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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

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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

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22
Q

Mx of acute fatty liver of preg

A

Supportive then deliver

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23
Q

Sx of AFLP

A

abdominal pain
nausea & vomiting
headache
jaundice
hypoglycaemia
severe disease may result in pre-eclampsia

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24
Q

MOA of intrauterine system (levonorgestrel)

A

Primary: Prevents endometrial proliferation
Also: Thickens cervical mucus

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25
Q

MOA of Implantable contraceptive (etonogestrel)

A

Primary: Inhibits ovulation
Also: thickens cervical mucus

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26
Q

MOA Of emergency contraception

A

Contraceptive Mode of action
Levonorgestrel Inhibits ovulation
Ulipristal Inhibits ovulation
Intrauterine contraceptive device Primary: Toxic to sperm and ovum
Also: Inhibits implantation

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27
Q

Severe pre-eclampsia classification

A

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

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28
Q

Mx of pre eclampsia

A

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

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29
Q

methods of contraception is proven to be associated with weight gain

A

Depot

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30
Q

Mx of ectopic pregnancy

A

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

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31
Q

Expectant mx of ectopic preg

A

Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed.

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32
Q

Rules of emergency contraception

A

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

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33
Q

Cause of oligohydraminos

A

premature rupture of membranes
Potter sequence
bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post-term gestation
pre-eclampsia

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34
Q

Definition of oligohydraminos

A

less than 500 mL at 32-36 weeks’ gestation:

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35
Q

Gestational diabetes dx

A

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

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36
Q

Gestational diabetes mx

A

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

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37
Q

Menstruation cycle phases

A

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

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38
Q

POP missed pill

A

‘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

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39
Q

CI to COCP

A

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)

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40
Q

COCP and cancer

A

increased risk of breast and cervical cancer
protective against ovarian and endometrial cancer

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41
Q

Endometriosis sx

A

Chronic pelvic pain
Dysmenorrhoea - pain often starts days before bleeding
Deep dyspareunia
Subfertility

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42
Q

Cervical excitation

A

Cervical excitation is found in both pelvic inflammatory disease and ectopic pregnancy.§

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43
Q

Types of miscarriage

A

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

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44
Q

PCOS fertility aid

A

Infertility in PCOS - clomifene is typically used first-line

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45
Q

When able to stop contraception

A

after 1 year of amenorrhoea if aged over 50 years, 2 years if the woman is aged under 50 years

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46
Q

When to start labetalol

A

systolic > 140 mmHg or diastolic > 90 mmHg

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47
Q

Increases risk of down in combined test

A

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).

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48
Q

What is quad test and when doe sit happen

A

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

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49
Q

When able to start POP after birth

A

Immediately
Breastfeeding or not

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50
Q

Who cannot take ullipristal

A

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

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51
Q

pre eclampsia definition

A

new-onset hypertension after 20 weeks’ gestation with proteinuria (≥0.3g/24h) or other maternal organ dysfunction.

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52
Q

When should infertility be investigated

A

<35 12 months
>35 6 months

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53
Q

Mx of premature menopause

A

hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)

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54
Q

How often can you get the depot

A

Evert 3 months

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55
Q

Folic dose in pregnancy

A

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

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56
Q

Mx of secondary dysmenorrhea

A

Referral to gynae

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57
Q

Tx of candidal infection with BF

A

Carry on BF and treat mother and baby

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58
Q

When should progesterone be measured

A

7 days before expected menstruation

59
Q

Time of effectiveness of contraception

A

instant: IUD
2 days: POP
7 days: COC, injection, implant, IUS

60
Q

Tx of menopause if HRT CI

A

SSRI

61
Q

Supplements prior to pregnancy

A

Vit d 10mcg
Folic 400mcg

62
Q

Mx of patient with fibroids wanting to conceive

A

Myomectomy

63
Q

Management of menorrhagia secondary to fibroids

A

Want contraception
levonorgestrel intrauterine system (LNG-IUS)

64
Q

Mx of prev delivery with GBS

A

IAP benxylpenicillin

65
Q

When should you get anti D

A

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
Q

Cervical cancer interpretation

A

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
Q

Changes in epilepsy medication when breastfeeding

A

No changes required

68
Q

What is given prior to surgery for fibroid

A

GnRH inhibitor

69
Q

Medication to cease breastfeeding

A

Carbogeline

70
Q

Perineal tears grading

A

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
Q

Second screen for anaemia and atypical red cell alloantibodies

A

28 w

72
Q

Nuchal scan timing

A

11-14w

73
Q

Urine culture to detect asymptomatic bacteriuria

A

8-12w

74
Q

Ovarian cancer RF

A

family history: mutations of the BRCA1 or the BRCA2 gene
many ovulations*: early menarche, late menopause, nulliparity

75
Q

Screening for postnatal depression

A

Edinburgh tool

76
Q

Mx of pyrexia and suprapubic tenderness post delivery

A

Endometritis
Admit to hospital

77
Q

What age should you feel the baby move at

A

24 weeks- no movements by this- referral

78
Q

Treatment of BV, TV, chlamydia and gonorrhoea

A

BV- metronidazole
TV- met
Chlamydia- doxy
Gon- IM cef

79
Q

Referral for ovarian cyst

A

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
Q

When to test for Gestational diabetes

A

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
Q

Mx of PPROM

A

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
Q

Who should take aspirin during pregnancy

A

≥ 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
Q

Interpretation of bishop score

A

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
Q

Bishop score

A

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
Q

CI to HRT

A

Current or past breast cancer
Any oestrogen-sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia

86
Q

Pregnant lady without MMR

A

If a pregnant woman is not immune to rubella, she should be offered the MMR vaccination in the post-natal period

87
Q

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.

A

Turner syndrome
High FSH/LH

88
Q

Increased risk of HPV

A

smoking
human immunodeficiency virus
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*

89
Q

UPSI after day 14 of cycle

A

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
Q

When to give insulin over metformin for Gest diabetes

A

Gestational diabetes - insulin should be commenced if fasting glucose level is >= 7 mmol/l insulin at the time of diagnosis

91
Q

Premature labour mx

A

Tocolytics (Terbutaline, nifedipine, MgSO4) and steroids

92
Q

Which virus causes cervical cancer

A

HPV 16,18

93
Q

Commonest ovarian cyst

A

Follicular

94
Q

Chocolate cysts

A

Endometriotic cyst

95
Q

Most common ovarian cancer

A

Serous carcinoma

96
Q

Dermoid cysts

A

Usually lined with epithelial tissue and hence may contain skin appendages, hair and teeth

Torsion is more likely than with other ovarian tumours

97
Q

If 1st cervical smear +ve for HPV

A

if 1st repeat smear +ve- repeat at 12 months -if still hrHPV +ve → repeat smear 12 months later (i.e. at 24 months)

98
Q

Methotrexate with conceiving

A

Stop 6 months before

99
Q

Most common type of ovarian pathology associated with Meigs’ syndrome

A

Fibroma

100
Q

Most common benign ovarian tumour in women under the age of 25 years

A

Dermoid cyst

101
Q

Latex allergy - which condoms

A

polyurethane condoms

102
Q

Contraception abs CI in BF

A

COCP
drastically reduces breast milk volume.

103
Q

Mx of baby in breech position

A

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
Q

Meds that should be avoided in BF

A

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone

105
Q

Mx of vaginal candidasis

A

oral fluconazole 150 mg as a single dose first-line
clotrimazole 500 mg intravaginal pessary - if preg

106
Q

Ovarian hyperstimulation syndrome sx

A

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
Q

POP and antibiotics

A

No interaction

108
Q

Varicella exposure during preg defects on child

A

Scarring of the skin, limb hypoplasia, microcephaly and eye defects

109
Q

CMV, parvovirus and rubella exposure baby sx

A

CMX- cerebral calcification
microcephaly
sensorineural deafness.

Rubella- deafness
congenital cataracts
cardiac complications.

Parvovirus B19 - hydrops fetalis
Death.

110
Q

Mx of PPH

A

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
Q

Late vs early decelerations

A

Early- Usually an innocuous feature and indicates head compression

Late- Indicates fetal distress

112
Q

Fetal HR on Cardiotocography

A

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
Q

Endometrial cancer RF

A

excess oestrogen
nulliparity
early menarche
late menopause

metabolic syndrome
obesity
diabetes mellitus
polycystic ovarian syndrome

tamoxifen
hereditary non-polyposis colorectal carcinoma

114
Q

Mx of menopause with mirena

A

Estradiol

115
Q

RF for abruption

A

proteinuric hypertension
cocaine use
multiparity
maternal trauma
increasing maternal age

116
Q

UPSI and forgotten to change patch

A

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
Q

Cervical smeer

A

25-49 years: 3-yearly
50-64 years: 5-yearly

118
Q

Day to measure LH and progesterone

A

LH-14
Progesterone -21

119
Q

Recommended anti epileptic in preg

A

Lamotrigine, carbamazepine and levetiracetam are known to have the smallest effects on the developing foetus

120
Q

SSRI for BF women

A

Sertraline or paroxetine are the SSRIs of choice in breastfeeding women

121
Q

Ruptured ectopic sx

A

amenorrhoea, abdominal pain and vaginal bleeding in combination with shoulder tip pain
Cervical excitation

122
Q

Most common epithelial cell tumour

A

Serous cystadenoma

123
Q

IUD, Mirena, Nexplanon duration

A

IUD- 10 years
Mirena- 5 years
Nexplanon -3 years

124
Q

COCP missed pill rules

A

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
Q

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

A

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
Q

What should you monitor whilst on a Mg infusion

A

monitor reflexes + respiratory rate

127
Q

Scenario where implant is advisable over IUS

A

Fibroids distorting cavity

128
Q

Cervical smear in HIV women

A

Offered annually

129
Q

Smoking risks in pregnancy

A

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
Q

Mx of woman with bleeding, rhesus negative

A

Anti D and followed by Kleihauer test.

131
Q

Mx of recurrent vaginal thrush

A

induction: oral fluconazole every 3 days for 3 doses
maintenance: oral fluconazole weekly for 6 months

132
Q

Meds worsening stress incontinence

A

Alpha blockers
Doxa

133
Q

Dysfunctional uterine bleeding

A

menorrhagia in the absence of underlying pathology

134
Q

Test to confirm early menopause

A

FSH

135
Q

Obstetric cholestasis vs AFLP

A

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
Q

HIV management in pregnancy

A

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
Q

Mx of hyperemesis

A

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
Q

How is premature ovarian failure defined?

A

The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years

139
Q

When is continuous CTG monitoring warranted in labour

A

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
Q

What contraceptives may decrease bone mineral density in women?

A

Depot

141
Q

Timing of tests for Downs

A

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
Q

Resting tremor and increased upper limb tone on new medication for hyperemesis

A

Metoclopramide

143
Q

PMS management

A

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
Q
A

MSRA (8 decks)

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