Womens Flashcards
Drugs contraindicated in breast feeding
Abx - Ciprofloxacin, Tetracyclines, chloramphenicol, sulphonimides
psych - litihium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas (gliclazide)
cytotoxic drugs
amiodarone
Urge incontinence Mx
1 - bladder retraining
2 - Oxybutynin/ Tolterodine/ Darifenacin (all these are antimuscarinics and can not be used with Amitriptyline)
3 - Mirabegron (esp in frail elderly)
Stress incontinence Mx
1 - pelvic floor training
2 - duloxetine
3- surgery - tape procedure
Chickenpox exposure in pregnancy (within 10 days of exposure)
1st - check varicella antibodies
a) <20/40 + not immune = VZIG
b) >20/40 + not immune = VZIG/ Aciclovir
Chickenpox confirmed in pregnancy (<24hr rash onset)
> 20/40 = oral aciclovir
<20/40 = oral aciclovir (used with caution)
Hirsutism (PCOS) Mx
COCP
Topical eflornithine
Depo Provera adverse effects
irregular bleeding
weight gain
increased risk of osteoporosis
delayed return to fertility
CONTRAINDICATION: Breast ca
Routine antenatal care 8-12 weeks
Booking visit: general info, obs, bloods, urine dip, urine culture, HIV, Hep B, Syphilis
Routine antenatal care 10-14 weeks
Confirm dates (+ exclude multiple pregnancy)
Nuchal scan - Downs screening (from 11 weeks)
Routine antenatal care 18-21 weeks
Anomaly scan
Routine antenatal care 28 weeks
Routine care: BP, Urine, SFH, second screen for anaemia/ atypical red cell
First Anti-D prophylaxis to rhesus neg women
Routine antenatal care 34/40
second anti D prophylaxis
Routine Antenatal care 36/40
Check position - offer ECV if indicated
Missed COCP rules
Missed 1 pill: take last pill immediately, no emergency contraception required
Missed 2 pills: take last pill immediately, use protection for next 7 days
- If Week 1: emergency contraception should be given
- If Week 2: no emergency
- If Week 3: no pill free interval (go back to back)
Obese (BMI >30) women pregnancy rules
Folic acid 5mg OD until week 13 (first trimester)
Diabetes screen (OGTT) @ 24-28 weeks
BMI >35 = consultant led birth
Cerazette (Desogestrel) MOA
Inhibit ovulation
Gestational diabetes criteria
Fasting glucose >5.6
2 hour glucose >7.8
If fasting glucose >7 = need insulin immediately
HRT complications
Breast Ca (increased with progestogen)
Endometrial Ca (oestrogen-only should not be given with those with uterus)
VTE (increased risk with progestogen) - if high risk for Haem rv)
Stroke
IHD
COCP and endometrial ca relation
COCP is protective against endometrial ca due to progestogen counteracting the oestrogenic effects of endometrial proliferation
Pre-existing hypertension in pregnancy definition
BP >140/90 before 20/40
no proteinuria
If on ACEi pre pregnancy, needs to be stopped and switched (eg labetalol)
Pregnancy induced hypertension definition
BP >140/90 after 20/40
no proteinuria
BP resolves after birth (typically after one month)
pre-eclampsia definition
PIH with proteinuria
Emergency contraception options
1) Levonorgestrel - <72 hrs from UPSI
if vomit <3hrs needs to be taken again
hormone contraception can be started immediately
double dose if BMI >26 (overweight)
2) Ullipristal (EllaOne) - <120hrs from UPSI
hormone contraception can be started 5 days
caution in asthma
breastfeeding should be delayed by one week
3) IUD - copper coil - <120hrs from UPSI
can be kept as long term contraception
Starting POP rules
if first 5 days - can start immediately without extra
if after 5 days - can start immediately with extra protection for 2 more days
STI screening in pregnancy includes (4)
Syphilis
Hep B
HIV
Hep C (only in high risk eg IVDU)
Pelvic inflammatory disease Mx
PO Ofloxacin + PO Metronidazole
OR
IM Ceftriaxone + PO DOxy + PO Metro
Nexplanon (implant) MOA
inhibits ovulation
IUD post partum, when for contraception?
4 weeks post partum
or during c section
Vaginal Candidiasis (thrush)
1st - oral fluconazole (contraindicated if pregnant)
2nd - Clotrimazole pessary
Methotrexate in breastfeeding? safe or contraindicated
contraindicated
COCP UKMEC 4 (risk unacceptable)
> 35yo + smoking >15 cigarettes/day
migraine with aura
PMH VTE
PMH CVA/ IHD
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation (if planning surgery to switch to POP 4 weeks prior to surgery)
positive antiphospholipid antibodies (e.g. in SLE)
COCP UKMEC 3 (disadvantages outweigh advantages)
(7)
> 35yo + smoke <15 cig/day
BMI > 35 kg/m^2
FHx VTE < 45 years
controlled hypertension
immobility e.g. wheel chair use
carrier of known gene mutations associated with breast cancer (e.g. BRCA1/BRCA2)
current gallbladder disease
Missed POP rules
1) if >3 hrs late [unless Desogestrel/ Cerezette (12 hrs)]
- missed pill taken asap + next pill taken normal time (can take 2 at once but should not take more than 2 in one day)
- additional contraceptive precautions (eg condoms) for 48 hours
- emergency contraception if UPSI during missed pill period or within 48 hours of restarting
Urge incontinence Mx
1st - bladder retraining
2nd - Oxybutynin/ Tolterodone/ Darifenacin
3rd - Mirabegron (use instead of Oxybutynin for frail elderly)
Stress incontinence Mx
1st - Pelvic floor training
2nd - Surgery - tape procedures
3rd - duloxetine
What treatment is given for Group B strep prophylaxis during labour
IV Benzylpenicillin (during, not before, labour)
Group b strep prophylaxis indications (during labour)
Prolonged rupture of membranes
previous siblings with GBS
maternal pyrexia
Premature birth?
Depo-provera SE (4) and contraindications
SE/
irregular bleeding
weight gain
increase risk of osteoporosis
delay in return to fertility
Contraindication/
current breast Ca UKMEC 4
past breast Ca UKMEC 3
Iron deficiency anaemia in Pregnancy levels and treatment
Treat with oral iron with the following cut offs
1st trimester - <110
2nd - <105
3rd - 100
Continue iron for three months after corrected levels
PCOS biochemistry results
raised LH: FSH ratio
testosterone normal or slightly raise
sex binding hormone globulin normal or low
Rhesus negative women management
Anti-D at 28 and 34 weeks OR Single dose Anti D at 28 weeks only
Starting COCP rules
first 5 days of cycle- no barrier contraception
after 5 days or cycle - need barrier contraception for 7 days
Screening for gestational diabetes criteria (5) - OGTT ASAP and 24-28 weeks (if first test normal)
BMI >30
Hx macrosomia weight >4.5kg (9.9ibs)
Hx gestational diabetes
1st degree relative with diabetes
Ethnicity - Asian, African, Middle east
Vaginal thrush (candidiasis) Mx
1st Oral Fluconazole
2nd Vaginal Clotrimoxazole pessary (if unable to take oral eg pregnancy)
How long after emergency contraception can hormone contraception be started
- Levonorgestrel
- Ullipristal
Levonorgestrel - immediately
Ullipristal - 5 days
Contraceptives time till effective
IUD
POP
COCP/ implant/ injection/ IUS
IUD - instant
POP - 2 days
COCP - 7 days
Postpartum thyroiditis criteria (3)
<12 months post partum
Clinical features of hypothyroid
TFTs only
Three stages + Mx of postpartum thyroiditis
1 - thyrotoxicosis - propranolol for symptoms, no treatment for hyperthyroid required
2 - hypothyroid - levothyroxine
3 - euthyroid - high recurrence in future pregnancies
UKMEC 4 criteria for POP (2)
current pregnancy
<5years Breast Ca
Menorrhagia Mx
1st - IUS (Mirena)
2nd - COCP
3rd - Depo
If no need for contraception - tranexamic acid/ mefenamic acid
If need for urgent cessation of bleeding - Norethisterone
Starting POP rules
If first 5 days - start immediately, no protection required
if after 5 days - start immediately, protection required for 2 days
Hep B in Pregnancy, Mx of newborn
Newborn - Vaccine +/- Immunoglobulin (if mother does not have immunity)
Complications of gestational diabetes
Maternal(2)
Neonate (5)
Maternal - polyhydramnios, preterm labour
Neonatal - macrosomia, hypoglycaemia, respiratory distress syndrome, shoulder dystocia, HYPOMag/ Calc
Lactation Mastitis Mx
1st - supportive - analgesia, warm compress, continue breast feeding
2nd - Antibiotics (Fluclox 500mg qds 14/7 or Erythromycin 500mg qds 14/7) if:
- Sx do not resolve after 24hrs or are worsening after 12hrs
- Nipple fissure infected
- Positive blood culture
3rd - Co-Amox (broad spec) if still no improvement >48 hours
Physiological/ Functional ovarian cysts
- Follicular
- Corpus Luteum
Follicular - most common
Corpus Luteum - can fill with blood/ pus
Dermoid cyst teratoma median age
Median age 30 (most common benign tumour under 30)
Meigs syndrome (3)
Benign Ovarian tumour (usually fibroma)
Ascites
pleural effusion
Rhesus prevention in pregnancy
Test for D Antibodies in all Rh -ve at booking
Give Anti-D to ALL Rh -ve at 28 and 34 weeks
When to give Anti D Immunoglobulin (8)
delivery of Rh+ve baby
any termination of pregnancy
miscarriage >12/40
ectopic pregnancy surgically managed (medical Mx not required)
External Cephalic Version
Amniocentesis/ CVS/ fetal blood sampling
Abdominal trauma - eg RTA
Antepartum haemorrhage
Starting HRT
Uterus in situ? - yes -> combined HRT
- no -> Oestrogen only
Perimenopausal - Cyclical
Menopausal - Continuous
Hx of VTE - yes -> topical preparation
Mirena coil in situ for contraception - Oestrogen only (as progesterone from coil)
Most common ovarian cyst
serous cystadenoma
Semen analysis time requirements
Abstain for 2-5 days
deliver sample within 1 hour
Trans contraception
Male (female at birth)
Female (male at birth)
Male (female at birth) - condoms
Female (male at birth) - copper IUD
COCP risks
VTE
heart attacks, strokes
breast, cervical Ca
HRT Contraindications (4)
Current or past Breast ca
Oestrogen sensitive Ca
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
HRT Risks (increase risk of…) (5)
VTE - no risk with transdermal
Strokes
IHD
Breast Ca
Ovarian Ca
Menopause Mx without HRT
Vasomotor - fluoxetine, citalopram, venlafaxine
Vaginal dryness - vaginal lubricant, vaginal oestrogens
Psychological - CBT, antidepressant
Intrahepatic Cholestasis in Pregnancy Mx
Induction of labour at 37-38 weeks
Ursodeoxycholic acid - started by obs
vitamin k supplement
Vitamin supplements recommended during pregnancy (2)
Folic acid 400mcg for 12 weeks
Vitamin D 10mcg throughout pregnancy
Post partum mental health Mx
Baby blues/ postnatal depression
- reassurance and support
- Fluoxetine (SSRI) if severe (OK in breast feeding)
Puerperal psychosis
- Urgent admission
Cervical screening whilst pregnant
delay screening 3 months post partum
Newborn to mother with Hep B
Hep B vaccine + Hep B Immunoglobulin
Contraceptives in Epilepsy
UKMEC 1: IUD, IUS, Depo
UKMEC 2: implant
UKMEC 3: POP, COCP (therefore do not use Disad > adv)
Vaginal discharge DDx
Candida - creamy cottage cheese, no odour
Bac Vaginosis - grey discharge, fishy smell
Trichomantis - strawberry cervix
Meig’s syndrome (3)
Ovarian tumour (usually Fibroma)
Ascites
Pleural effusion
Most common Ovarian tumour
- under 25
- 18-40 (reproductive age)
Under 25 - Dermoid cyst (teratoma)
Reproductive age - Follicular cyst
Depot contraception main side effect
reduced bone mineral density
Cyclical breast pain Mx
Ibuprofen, bra support, analgesia
Vaginal prolapse score (POP-Q )
Stage 0: no prolapse
Stage 1: more than 1 cm above the hymen
Stage 2: within 1 cm proximal or distal to the plane of the hymen
Stage 3: more than 1 cm below the plane of the hymen but protrudes no further than 2 cm less than the total length of the vagina
Stage 4: there is complete eversion of the vagina
Non Lactational Mastitis Mx
Co-Amoxiclav 625mg TDS 10-14 days
vaginal lichen sclerosis Mx
top steroid
