year 5 obs and gynae Flashcards
Trophoblastic disease is hydatiform mole are risk factors for
hypermesis grvidarum
what other tx in addition to saline 0.9% for hypermemis can we give
IV vit b and C - pabrinex - prevent wernickes
uterus size greater than expected for gestational age and abnormally high serum hCG
complete hydatiform mole
Menorrhagia, anaemia, bulk-related symptoms e.g. bloating/urinary frequency →? uterine fibroids how to manage
COCP
is Undiagnosed vaginal bleeding is a contraindication for hrt
yes
A 49-year-old patient presents with hot flushes and mood swings. She has no previous medical history or family history. She has been amenorrheic since her Mirena (levonorgestrel) coil was placed 2 years ago. She would like to consider HRT with the least side effects
oestrogen patch
The patient requires combined HRT as she has a uterus, so requires progesterone for protection of the endometrial lining against estrogen. However, the patient has a Mirena coil in situ, which is the only form of contraception licensed to be used as the progesterone component in HRT. It is licensed for 4 years if used as HRT.
Therefore the patient only requires oestrogen preparation only.
Transdermal oestrogen such as patches and gels do not have an increased risk of deep vein thrombosis, compared to oral oestrogen preparations
when do you give SSRI in premenstrual syndrome
Sertraline during the 14 days before her period starts
SSRIs, either continuously or during the luteal phase, may help premenstrual syndrome
lutueal phase is second half of the menstrual cycle
how much vit d should pregnant women be taking
10micrograms of vitamin D
first-line eclampsia
MgSO4
treatment should continue for 24 hours after last seizure or delivery (around 40% of seizures occur post-partum)
risk factor for placental abruption
ABRUPTION:
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
A woman at moderate or high risk of pre-eclampsia should take
aspirin 75-150mg daily from 12 weeks gestation until the birth
difference between cholestasis or acute fatty liver of preg
Clinically, cholestasis of pregnancy is characterised by severe pruritis, whereas acute fatty liver of pregnancy has predominantly non-specific symptoms (e.g. malaise, fatigue, nausea
how low should hb be in a patient with postpartum bleeding to detmine iron supplementation
A cut-off of 100 g/Lshould be used in the postpartum period to determine if iron supplementation should be taken
PPH mx
mechncial - palpate fundu s
medical - IV oxytocin , ergometrine IM , ( not asthma), misoprostol sublingual, surgical , intrauterine balloon tamponade then suuture and ligaton - hysterectomy is life saving
when does placenta prevaemia occur
2nd and 3rd trimester
vasa preaevia triad
Vasa praevia would typically present with sudden and potentially severe vaginal bleeding, rupture of membranes and fetal bradycardia
If a breastfed baby loses > 10% of birth weight in the first week of life what do you do
referral to a midwife-led breastfeeding clinic may be appropriate
At what gestation is further investigation required if there are not foetal movements felt by this time?
24weeks
Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with
oral aciclovir if they present within 24 hours of the rash
The requirements for instrumental delivery can be easily remembered by the mnemonic FORCEPS:
Fully dilated cervix generally the second stage of labour must have been reached
OA position preferably OP delivery is possible with Keillands forceps and ventouse. The position of the head must be known as incorrect placement of forceps or ventouse could lead to maternal or fetal trauma and failure
Ruptured Membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines the head must not be palpable abdominally
Pain relief
Sphincter (bladder) empty this will usually require catheterization
what is bishops score
Evaluating cervical readiness for labour
What normally happens to blood pressure during pregnancy?
Falls in first half of pregnancy before rising to pre-pregnancy levels before term
Bishop score is ≤ 6
Vaginal PGE2 or oral misoprostol is the preferred method of induction of labour
puerperal sepsis (postpartum infection)
temp over 38 following 14 days post delivery
cx
urinary tract infection
wound infections (perineal tears + caesarean section)
mastitis
venous thromboembolism
Management
if endometritis is suspected the patient should be referred to hospital for intravenous antibiotics (clindamycin and gentamicin until afebrile for greater than 24 hours)
abx of choice in GBS
Benzylpenicillin
what do you need to monitor when giving magnesium in eclmapsia
Respiratory rate
as risk of resp depression
in cord prolapse - if the cord is past the level of the introsius can you put it back in
For the management of cord prolapse, the presenting part of the fetus may be pushed back into the uterus to avoid compression. Tocolytics may be used. If the cord is past the level of the introitus, it should be kept warm and moist but should not be pushed back inside.
no
all fours
tocolytics
retrofilling of the bladder
induction of labour
sweep, vag prost, oral prost, oxytoicn, amniotomy, baloon ,
under 6 vag
over 6 -amnitomy or infusion
pph list of things to do
mechnical - rub
medical - oxytocin, ergom, carbopost, srugical - ballon, b lynch suture , ligation of ialiac and uterine
hysterectomy if uncontrolled
Premature ovarian insufficiency should not be diagnosed on the basis of one raised FSH level - a further sample should be taken when
4-6 weeks later
management of POI
hormone replacement therapy (HRT) or a combined oral contraceptive pill should be offered to women until the age of the average menopause (51 years)
mx endometriosis
Nsaid and paracetoalm
COCP or progesterone only
GnRH analogues - low oestoegne levels - although fertility rates redue
surgery - lap excision/ablation
Ovarian cystectomy (for endometriomas) is also recommended
is candida a clinical dx
yes
incomplete and missed mscarriage differ how in mx
missed need both mifepristone and misoprosti
incomplete only misoprostol
if metoclopramide is used in preg how long should it be used for
Metoclopramide is an option for nausea and vomiting in pregnancy, but it should not be used for more than 5 days due to the risk of extrapyramidal effects
omplications of PPROM
fetal: prematurity, infection, pulmonary hypoplasia
maternal: chorioamnionitis
what should be given at PPROM and when is delivery consideed
oral erythromycin should be given for 10 days
antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
34 weeks
spontanoeus bacterial peritonitis - gastro q
e.coli
what single lab finding y
