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Phase 3A > Passmed women's health > Flashcards

Passmed women's health Flashcards

1
Q

What are the symptoms of candidiasis in women?

A

Itching, white curdy discharge, sour milk odour, dysuria, superficial dyspareunia

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2
Q

What are the symptoms of candidiasis in men?

A

Soreness, pruritis and redness - red glazed plaques and papules on penis

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3
Q

What is the treatment for candidiasis?

A

Antifungals - fluconazole (oral), clotrimazole (topical)

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4
Q

What is the management of cord prolapse?

A

Immediate delivery of the foetus by caesarean section, knees to chest position to prevent further prolapse, reducing cord into vagina, use of tocolytics (terbutaline) to stop uterine contractions

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5
Q

What are the haemoglobin cut offs for when women should receive iron therapy?

A

First trimester: <110g/L
Second/third: <105g/L
Post partum: <100g/L

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6
Q

What is the test for gestational diabetes?

A

Oral Glucose Tolerance Test

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7
Q

What are the diagnostic thresholds for gestational diabetes?

A

Fasting glucose > 5.6 mmol/L
2-hour glucose > 7.8 mmol/L

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8
Q

What are the treatment guidelines for gestational diabetes?

A

If glucose is <7 mmol/L trial diet and exercise changes
If glucose target not met in 1-2 weeks, start metformin
If glucose targets still not met, add short acting insulin
If glucose > 7mmol/L add insulin

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9
Q

What is the typical presentation of genital herpes?

A

Painful genital ulceration (pruritis), some systemic features, tender inguinal lymphadenopathy

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10
Q

What is the first line investigation for herpes?

A

NAAT - Nucleic Acid Amplification Test

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11
Q

How do you treat genital herpes?

A

Saline bathing, analgesia, oral aciclovir for patients with severe symptoms or frequent exacerbations

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12
Q

Which drugs should be avoided in breast-feeding mothers?

A

ciprofloxacin, tetracycline, chloramphenicol, lithium, benzodiazepines, aspirin, carbimazole, methotrexate, sulfonylureas, amiodarone

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13
Q

What is the first line medical management of post-partum haemorrhage?

A

IV Syntocinon (Oxytocin) followed by ergometrine

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14
Q

What is the definition of a PPH?

A

Loss of >500ml blood after a vaginal delivery

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15
Q

How do you manage a PPH?

A
  • ABC approach, lie woman flat, two peripheral cannulae, group and save, commence warmed crystalloid infusion.
  • rub uterine fundus, catheterisation
  • IV oxytocin, ergometrine, carboprost, misoprostol
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16
Q

If cervical cancer smear test is inadequate, when should the test be repeated?

A

Within 3 months
If two consecutive inadequate samples - colposcopy

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17
Q

What are the risk factors for ectopic pregnancy?

A

PID, pelvic surgery, previous ectopic, endometriosis, IUCD, POP, IVF

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18
Q

What are the primary features of syphilis?

A

Chancre, local lymphadenopathy

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19
Q

What are the secondary features of syphilis?

A

fever, lymphadenopathy, rash, buccal ‘snail track’ ulcers, warts on genitalia

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20
Q

What are the tertiary features of syphilis?

A

Gummas (granulomatous lesions of skin and bones), AAA, paralysis

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21
Q

Which contraceptives should be stopped after age 50?

A

Injectable contraceptives - depo-provera. COCP (for bone mineral density)

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22
Q

How long after exposure should HIV testing be done?

A

4 weeks - can repeat at 12 weeks

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23
Q

What tests are done for HIV?

A

HIV antibodies (ELISA and western blot), p24 antigen

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24
Q

Anal-oral sex is associated with the transmission of which STI?

A

Hepatitis A

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25
Q

What is placental abruption?

A

When the placenta comes away from the uterine wall - usually occurs at 25 weeks and presents with bleeding and abdo pain

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26
Q

What is vasa praevia?

A

When the foetal blood vessels run across or near the internal orifice. These can be easily compromised by rupture of the membranes, causing bleeding.

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27
Q

What are the treatment guidelines for endometriosis?

A

1st line - NSAIDS or paracetamol the POP/COCP
2nd line - GnRH agonist
3rd line - androgens

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28
Q

What is the terminiolgy used to describe the baby’s head in relation to the ischial spine?

A

Station
0 = at level of ischial spine
-2 = 2cm above
+2 = 2cm below

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29
Q

Which score is used to assess whether induction of labour is required?

A

Bishop score

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30
Q

What are the methods for induction of labour?

A

Membrane sweep (finger passed through cervix to separate membranes from decidua), vaginal prostaglandin E2, oral prostaglandin E1, maternal oxytocin infusion, amniotomy (breaking of waters), cervical ripening balloon

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31
Q

What methods of induction should be used based on bishop scoring?

A

If <6 - vaginal prostaglandins/oral misoprostol
if >6 amniotomy and IV oxytocin

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32
Q

What are the risk factors for hyperemesis gravidarum?

A

Increased levels of beta-hCG (multiple pregnancies, trophoblastic disease), nulliparity, obesity, family history

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33
Q

When should someone be referred for nausea and vomiting in pregnancy?

A
  • unable to keep down liquids and antiemetics
  • ketouria
  • weight loss > 5% of body weight
  • comorbidity
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34
Q

What are the first line medical treatments for hyperemesis gravidarum?

A

Antihistamines - cyclizine, promethazine
Phenothiazines - prochlorperazine
Doxylamine and pyridoxine (vitamin B6)

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35
Q

How much folic acid should women at increased risk of neural tube defects take?

A

5mg (all women should take 400mcg)

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36
Q

Which factors put pregnant women at risk of having a child with neural tube defects?

A

Previous child with NTD, diabetes mellitus, antiepileptic meds, obese, HIV +ve taking co-trimoxazole, sickle cell

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37
Q

What are the common causes of folic acid deficiency?

A

phenytoin, methotrexate, pregnancy, alcohol excess

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38
Q

What does the factor V leiden mutation cause?

A

Activated protein C resistance - predisposes to venous thromboembolism - increases risk of DVT

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39
Q

How soon after delivery can someone start the COCP?

A

After 3 weeks - due to increased risk of venous thromboembolism. Should not be used in breastfeeding mothers. Absolute contraindication if breastfeeding and <6 weeks postpartum

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40
Q

How soon after delivery can someone start the POP?

A

Any time postpartum - even when breastfeeding

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41
Q

How soon after delivery can the IUD or IUS be inserted?

A

Within 48 hours of childbirth or after 4 weeks

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42
Q

What are the potential complications of twin pregnancies?

A

polyhydramnios, hypertension, anaemia, haemorrhage, prematurity, malformation, cord prolapse

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43
Q

What is the definitive treatment for delayed placental delivery in patients with placenta accreta?

A

Hysterectomy

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44
Q

What is Sheehan’s syndrome?

A

postpartum hypopituitarism - reduction in the function of the pituitary gland following ischaemic necrosis due to hypovolaemic shock following birth

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45
Q

How long does it take for the POP to become effective?

A

2 days, if started after first 5 days of cycle. immediately when taken during first 5 days.

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46
Q

What advice should be given about missed pills for POP?

A

if < 3 hours late, take pill and continue as normal
if > 3 hours late, take missed pill as soon as possible and use other method of contraception until pill taking has been re-established for 2 days
For Cerazette its 12 hours

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47
Q

What is the definition of menorrhagia?

A

An amount of blood that the person considers to be excessive

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48
Q

What is the appropriate investigation for a UTI?

A

Urine dipstick in women < 65 with no risk factors for complicated UTI
Urine culture for women > 65. men, catheterised patients

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49
Q

What are the clinical features of a lower urinary tract infection?

A

Dysuria, urinary frequency, urgency, cloudy/smelly urine, lower abdo pain, low-grade fever

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50
Q

How much folate should be used in the first 12 weeks of a typical pregnancy?

A

400ug

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51
Q

How much folate should people at a high risk of having a child who develops a NTD take?

A

5mg

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52
Q

Which factors put people at high risk of having a child with a NTD?

A
  • If either partner has a NTD, family history, previous pregnancy
  • antiepileptic drugs, coeliac disease, diabetes, thalassaemia
  • BMI > 30
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53
Q

How long after pregnancy can the contraceptive implant be implanted?

A

Straight after birth

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54
Q

How long does the contraceptive implant last?

A

3 years

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55
Q

What are the contraindications of getting a contraceptive implant?

A

Ischaemic heart disease, stroke, breast cancer, liver cirrhosis, liver cancer

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56
Q

What is adenomyosis?

A

The presence of endometrial tissue within the myometrium

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57
Q

What are the features of adenomyosis?

A

Dysmenorrhoea, menorrhagia, enlarged, boggy uterus

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58
Q

What is the management of adenomyosis?

A

Tranexamic acid to manage menorrhagia, GnRH agonists, uterine artery embolisation, hysterectomy

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59
Q

What are the features of HELLP syndrome?

A

Haemolysis, elevated liver enzymes, low platelets.

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60
Q

What is the cut off Hb levels for iron supplementation in pregnancy?

A

115 in non-pregnant women, 110 in 1st trimester, 105 in 2nd and 3rd trimester and 100 after childbirth

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61
Q

Can pregnant women have MMR vaccines?

A

NO - it is a live attenuated vaccine, it should not be given to pregnant women or women trying to get pregnant (28days before pregnancy)

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62
Q

What is the first line treatment of heavy menstrual bleeding in someone trying to get pregnant?

A

Tranexamic acid

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63
Q

What should you do if you miss one COCP?

A

Take the last pill even if it means taking two pills in one day, then carry on as normal - no additional contraceptive protection needed

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64
Q

What should you do if you miss 2 or more COCP in week 1?

A

week 1: emergency contraception if unprotected sex, take last missed pill, use other protection until they have taken pills for 7 days

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65
Q

What should you do if you miss 2 or more COCP in week 2?

A

Take last missed pill, no need for emergency contraception

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66
Q

What should you do if you miss 2 or more COCP in week 3?

A

Finish the pills in current pack and then start a new pack the next day, take the last missed pill

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67
Q

What is the recurrence rate of postpartum psychosis?

A

25-50%.
0.2% chance of postpartum psychosis in the general population

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68
Q

What percentage of women experience postnatal depression?

A

60-70% have the baby blues (day 3-7)
10% have postnatal depression (starts around a month after birth)

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69
Q

What medication can be used to reduce uterine contractions in umbilical cord prolapse?

A

Terbutaline - a tocolytic drug

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70
Q

What is exomphalos?

A

When the abdominal contents of a foetus protrude through the anterior abdominal wall, but are covered in an amniotic sac

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71
Q

Which cancer does progesterone increase the risk of?

A

Breast cancer

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72
Q

Which cancer does unopposed oestrogen increase the risk of?

A

Endometrial cancer

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73
Q

Which antibiotic is used to treat group B strep in expectant mothers?

A

Benzylpenicillin

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74
Q

What is the management of pregnant women with new onset hypertension and pedal oedema?

A

Emergency admission to hospital to look for pre-eclampsia

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75
Q

What is the management of chicken pox in pregnancy?

A

Oral aciclovir if > 20 weeks
If exposure to varicella-zoster but no symptoms - give Iv Ig VZ asap

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76
Q

How is a diagnosis of PCOS made?

A

Rotterdam criteria - any two of
- oligomenorrhea, anovulation
- hyperandrogenism - clinical or biochemical signs
- polycystic ovaries on US scan

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77
Q

What condition should be suspected in an enlarged boggy uterus?

A

adenomyosis (endometrial tissue embedded in the myometrium)

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78
Q

When should you assess the APGAR scores in a baby?

A

1 and 5 mins of age
If it is low, repeat again at 10 mins

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79
Q

What investigations should be done for a suspected ovarian malignancy?

A

Seru CA-125, alpha fetoprotein, beta HCG, cystectomy

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80
Q

Where is beta HCG made?

A

It is first produced by the embryo and then the placental trophoblast. Secreted by the syncytiotrophoblasts, acts to prevent disintegration of the corpus luteum

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81
Q

What do you do for <24hr old baby with jaundice?

A

Measure serum bilirubin within 2 hours - under 24hrs it’s always pathological

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82
Q

What hypertension medication should be stopped in pregnancy?

A

ACE-I or ARB - change to labetalol

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83
Q

What is the most common cause of postmenopausal bleeding?

A

Vaginal atrophy

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84
Q

What is the guidance for the management of women over 55 with postmenopausal bleeding?

A

Should be investigated by transvaginal ultrasound within 2 weeks (suspected endometrial cancer)

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85
Q

What is a normal depth of endometrial lining thickness in post-menopausal women?

A

< 5mm

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86
Q

What are the features of postpartum thyroiditis?

A

Autoimmune thyroiditis. Three stages: thyrotoxicosis, hypothyroidism, normal thyroid function.
Thyrotoxicosis phase treated with propanolol.

87
Q

What can be given to counteract the effects of the Nexplanon implant?

A

COCP

88
Q

What happens with smears in pregnancy?

A

They are postponed to at least 12 weeks post delivery if previous normal smears.
If abnormal past smear, seek specialist advice. Smear can be done mid-trimester

89
Q

In transgender males on testosterone therapy, which methods of contraception are contraindicated?

A

COCP - any other methods containing oestrogen as it interferes with testosterone. (POP is thought to be okay)

90
Q

Can ondanestron be used in pregnancy?

A

Yes, but is associated with an increased risk of cleft palate if used in the 1st trimester

91
Q

What is the vertical response rate for Hep B without intervention?

A

20%

92
Q

Can a mother with Hep B breastfeed her newborn?

A

Yes

93
Q

Who is offered screening for hep B?

A

All pregnant women

94
Q

What is the screening tool for postnatal depression?

A

Edinburgh scale

95
Q

What is the treatment for large fibroids when trying to concieve?

A

myomectomy

96
Q

What drug is used for the medical management of an ectopic pregnancy?

A

Methotrexate

97
Q

What is lochia?

A

The normal vaginal bleeding that occurs for the first 2 weeks following birth (vaginal or C-section), usually red bleeding followed by brown

98
Q

What type of delivery should you do in a woman with placenta previa over cervix?

A

C-section at 37-38 weeks if within 2cm of cervix
Rescan at 32 weeks

99
Q

When should you do continuous CTG monitoring in labour?

A

suspected sepsis, 38 degrees +, hypertension 160/110, oxytocin use, meconium, fresh vaginal bleeding during labour

100
Q

What do you need to know about GBS?

A

universal screening for GBS should not be offered to all women
the guidelines also state a maternal request is not an indication for screening
women who’ve had GBS detected in a previous pregnancy should be informed that their risk of maternal GBS carriage in this pregnancy is 50%. They should be offered intrapartum antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive
if women are to have swabs for GBS this should be offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date
IAP should be offered to women with a previous baby with early- or late-onset GBS disease
IAP should be offered to women in preterm labour regardless of their GBS status
women with a pyrexia during labour (>38ºC) should also be given IAP
benzylpenicillin is the antibiotic of choice for GBS prophylaxis

101
Q

How do you manage an ectopic pregnancy?

A

> 35mm or bHCG > 5,000 or ruptured - manage surgically
Medical management if <1,500
expectant if - <35mm, bHCG <1000, no fetal heartbeat

102
Q

When can you give IUD after abortion?

A

Immediately

103
Q

What is the first line treatment of pre-eclampsia?

A

Labetalol (nifedipine in asthmatics)
Deliver baby as soon as possible

104
Q

When is the booking visit?

A

8-12 weeks

105
Q

When is the nuchal scanning for downs syndrome available?

A

11-13+6 weeks

106
Q

When is the foetal anomaly scan done?

A

18-20+6 weeks

107
Q

What are the signs of retinopathy of prematurity?

A

Absent red reflex and retinal neovascularisation

108
Q

How long after a termination of pregnancy can a urine pregnancy test remain positive?

A

up to 4 weeks. bHCG decreases by 50% every 2 days

109
Q

What position should a woman be moved to in cord prolapse?

A

all fours

110
Q

What SSRIs are used in breastfeeding women?

A

Sertraline or paroxetine are the SSRIs of choice in breastfeeding women

111
Q

How do you use a contraceptive patch?

A

Change patch weekly with one week break after 3 weeks

112
Q

What are the features of intrahepatic cholestasis of pregnancy?

A

Pruritis worse on palms, soles and abdomen, raised bilirubin

113
Q

What is the first line treatment intrahepatic cholestasis of pregnancy?

A

Ursodeoxycholic acid, vitamin K

114
Q

What is vaginal discharge in trichomonas vaginalis?

A

Frothy and greenish-yellow

115
Q

What is a tocolytic?

A

A uterine muscle relaxant drug

116
Q

What are the features of macula degeneration on fundoscopy?

A

well-demarcated red patches
Anti-vascular endothelial growth factor

117
Q

What factors would qualify women for an OGTT at 24-28 weeks?

A

BMI above 30 kg/m²
Previous macrosomic baby weighing 4.5 kg or more
Previous gestational diabetes
Family history of diabetes (first‑degree relative with diabetes)
An ethnicity with a high prevalence of diabetes

118
Q

How long after giving birth do women require contraception?

A

21 days

119
Q

What is the advice regarding methotrexate and trying to concieve?

A

Men and Women should stop methotrexate 6 months before trying to conceive

120
Q

What is the definition of pre-eclampsia?

A

New onset high BP > 140/90 after 20 weeks of pregnancy and proteinuria or other organ involvement

121
Q

Can you have a normal vaginal delivery after a C-section?

A

Yes at >37 weeks, if it is one previous c-section and was a transverse low uterine incision.
Contraindications: uterine rupture, longitudinal scar

122
Q

What percentage of women need further treatment following a salpingotomy for ectopic pregnancy?

A

20% - methotrexate and/or salpingectomy

123
Q

What is the treatment of vaginal candidiasis?

A

Oral fluconazole - 1st line
Clotrimazole pessary if pregnant

124
Q

When should you give anti-D prophylaxis in termination of pregnancy?

A

After 10 weeks, in women who are rhesus negative

125
Q

Can you breastfeed with mastitis?

A

Yes

126
Q

What analgesia can you not take if breastfeeding?

A

Aspirin

127
Q

What blood pressure reading in pregnancy requires admission to hospital?

A

160/110mmHg

128
Q

What are the glucose values for diabetes?

A

Gestational diabetes can be diagnosed by either a:
fasting glucose is >= 5.6 mmol/L, or
2-hour glucose level of >= 7.8 mmol/L
‘5678’

129
Q

How long does it take for the COCP and POP to work?

A

POP - 2 days (or immediately if within first 5 days of period)
COCP - 7 days

130
Q

What medications are used for infertility in PCOS?

A

Clomifene - 1st line
Metformin

131
Q

What investigation should be used to assess reduced foetal movements if doppler is not picking up heartbeat?

A

Ultrasound

132
Q

What conditions alter alpha-feto protein levels?

A

raised in neural tube defects, multiple pregnancy, abdo wall defects.
decreased in downs syndrome and diabetes

133
Q

What anticoagulants can be taken by pregnant people?

A

Heparin

134
Q

How often should people with type 1 diabetes test blood glucose levels during pregnancy?

A

Daily fasting, pre-meal, 1-hr post meal and bedtime

135
Q

What is a third degree tear?

A

Injury to the perineum that involves the anal sphincter complex

136
Q

What is the first line treatment of menorrhagia in women not trying to conceive?

A

IUS

137
Q

Which condition is usually described as a ‘bulky’ uterus?

A

Fibroids

138
Q

What is the best measure of ovulation?

A

Day 28 progesterone levels

139
Q

What medication do you give to patients at high risk of developing pre-eclampsia (one high risk factor or two moderate risk factors?

A

Low dose aspirin from 12 weeks

140
Q

What are the high risk factors for pre-eclampsia?

A

hypertension in previous pregnancy, hypertension, autoimmune disease, diabetes

141
Q

What are the moderate risk factors for pre-eclampsia?

A

first pregnancy, age > 40, pregnancy interval > 10yrs, BMI > 35, FH of pre-eclampsia, multiple pregnancy

142
Q

What cancers does the COCP modify the risk of?

A

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

143
Q

What do you do if a pregnant woman’s BP is over 160/110?

A

Admit to hospital

144
Q

What are the NICE guidelines for induction of labour?

A

Bishop score < 6 = membrane sweep then vaginal prostaglandins
Bishop score > 6 = amniotomy and IV oxytocin

145
Q

What is the main complication of induction of labour?

A

Uterine hyperstimulation

146
Q

What is the management of a ?ectopic?

A

Refer immediately to early pregnancy assessment unit

147
Q

What causes amenorrhea in very active women?

A

Hypothalamic hypogonadism

148
Q

Can you give trimethoprim in pregnancy?

A

No - but you can give in breastfeeding

149
Q

Which medication is associated with endometrial hyperplasia?

A

Tamoxifen

150
Q

What is the most common site on an ectopic pregnancy?

A

Ampulla of fallopian tubes

151
Q

Which vaccine is offered to women between 16-32 weeks?

A

Pertussis and Influenza

152
Q

What is the safest form of contraception in patients with the BRACA mutation?

A

copper coil

153
Q

How often should HIV positive patients attend cervical smears?

A

Annually

154
Q

What are the UKMEC 4 conditions for the COCP?

A
  • 35+ and smoking more than 15 cigarettes a day
  • migraine with aura, history of thrombosis/stroke/IHD, breast feeding <6 weeks post partum, uncontrolled hypertension, breast cancer, major surgery with immobilisation, antiphospholipid antibodies
155
Q

How long before major surgery should you stop taking the COCP?

A

4 weeks

156
Q

What is the risk to the baby associated with intrahepatic cholestasis of pregnancy?

A

Stillbirth - induction of labour is offered at 37-38 weeks

157
Q

which types of HPV are most associated with cervical cancer?

A

16 and 18

158
Q

What factors increase the risk of developing cervical cancer?

A

HPV - 16 and 18
smoking
HIV
early first intercourse, many sexual partners
high parity
lower socioeconomic status
combined oral contraceptive pill*

159
Q

An ectopic pregnancy in which area is at most risk of rupture?

A

Isthmus

160
Q

Which medication can be used to suppress lactation?

A

Cabergoline - dopamine receptor agonist - prevents prolactin secretion

161
Q

What are the symptoms of fibroid degenerationin pregnancy?

A

Low grade fever, pain, vomiting

162
Q

What are ashermans and sheehans syndrome?

A

Ashermans - adhesions
Sheehans - shock induced hypopituitarism

163
Q

What does it mean if the pearl index is 0.2?

A

For every 1000 women using this form of contraception, 2 become pregnant per one year

164
Q

What antibiotic used in patients with a late onset group B strep in a previous pregnancy?

A

Intrapartum Benzylpenicillin

165
Q

What is the triad of wernickes encephalitis?

A

Ataxia, confusion, nystagmus

166
Q

What are some causes of wernickes encephalopathy?

A

Alcoholism, severe vomiting

167
Q

How do you treat wernickes encephalopathy?

A

IV pabrinex - vitamins B and C

168
Q

What is the first line investigation for suspected endometrial cancer?

A

Transvaginal ultrasound

169
Q

What is the first line medication used to improve infertility in PCOS?

A

Clomifene

170
Q

What test can you use to identify ROM?

A

IGF binding protein 1 test or PAMG-1

171
Q

What fluids are given to women with hyperemesis gravidarum?

A

IV 0.9% saline with potassium

172
Q

What is the management for someone with a bishop score greater than 6?

A

Amniotomy and IV oxytocin infusion

173
Q

What investigation do you need to do for ?stress incontinence?

A

Urinalysis to rule out UTI and diabetes

174
Q

What is the gold standard investigation for endometriosis?

A

laparoscopy

175
Q

How much folic acid should women with epilepsy take?

A

5mg

176
Q

What medications are used in a medical termination of pregnancy?

A

oral Mifepristone and vaginal prostaglandins (misoprostal)

177
Q

What do you need to monitor in patients on magnesium sulfate?

A

urine output, reflexes, respiratory rate and oxygen saturations

178
Q

In pregnant women with a VTE history, when do you start VTE prophylaxis?

A

Throughout pregnancy until 6 weeks postnatal (LMWH)

179
Q

What antibiotics should be given in women with PPROM?

A

Oral erythromycin for 10 days

180
Q

What antibiotics are given to women who are pyrexic during labour?

A

Benzylpenicillin

181
Q

The levels of which hormone are checked to confirm menopause?

A

FSH (raised significantly in menopause)

182
Q

Which hormone level is measured to confirm ovulation?

A

Day 21 progesterone

183
Q

At what gestation should you refer to an obstetrician for lack of foetal movements?

A

24 weeks - 24 kicking the door

184
Q

What is the management of placental abruption?

A

Admit and give IV corticosteroids - if less than 36 weeks and baby is alive

185
Q

What should you give women with PPRoM?

A

IM corticosteroids to reduce risk of respiratory distress syndrome

186
Q

What is the first stage of labour?

A

From the onset of labour to when the cervix is fully dilated (10cm)

187
Q

What is a threatened miscarriage?

A

painless bleeding, usually before 24 weeks, cervical os is closed

188
Q

What is a missed/delayed miscarriage?

A

A gestational sac with a dead foetus without symptoms of expulsion. cervical os is closed, may have some light bleeding

189
Q

What is an inevitable miscarriage?

A

heavy bleeding with clots and pain, cervical os is open

190
Q

What is an incomplete miscarriage?

A

not all products of conception have been expelled, pain and vaginal bleeding. cervical os is open

191
Q

What is the first-line management of a woman who comes in with reduced foetal movements?

A

Handheld doppler - to check for foetal heart beat - if no heartbeat - immediate ultrasound

192
Q

Which gynae disease presents with deep dyspareunia and menorrhagia?

A

Endometriosis

193
Q

What is the first line treatment of thrush/candidiasis?

A

1 day of oral fluonazole

194
Q

What repair in required in different types of perineal tears?

A

1st degree - no repair
2nd degree - repair on ward
3rd and 4th degree - repair in theatre

4th = both sphincters plus rectal mucosa
3rd = one or both sphincters
2nd = perineal muscle
1st = no muscle damage

195
Q

What is the treatment for fibroids in women trying to retain fertility?

A

Myomectomy

196
Q

How do you work out the foetal position in the pelvis?

A

occiput anterior = back of baby’s head against front of mum anatomically (belly)
occiput posterior = back of baby’s head against mum’s bum
Left = occiput towards the left of mum’s body as she is looking down at her pelvis

197
Q

What is the treatment for magnesium sulfate induced respiratory depression?

A

Calcium gluconate

198
Q

What foods should be avoided in Pregnancy?

A

Liver (high vit A), unpasteurised cheese, raw meat and seafood

199
Q

If a pregnant woman is not immune to rubella what is the management?

A

Tell them to stay away from anyone with rubella and give MMR in the postnatal period

200
Q

What is the diagnostic triad of hyperemesis gravidarum?

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

201
Q

How long do you give magnesium sulfate for in eclampsia?

A

24hrs after delivery/last seizure

202
Q

How long must lochia be present for to indicate an ultrasound?

A

6 weeks

203
Q

What do late decelerations indicate?

A

foetal distress - asphyxia, placental insufficiency

204
Q

If a snow-storm appearance is seen on ultrasound, what is the diagnosis?

A

Complete hydatidiform mole

205
Q

When can external cephalic version be offered?

A

36 weeks (37 weeks if multiparous)

206
Q

What drug do you give in an active 3rd stage of labour?

A

oxytocin - after delivery of the anterior shoulder

207
Q

How long should category 1 and 2 C-sections happen within?

A

1 - 30 mins
2 - 75 minutes

208
Q

When should you do an oral glucose tolerance test in someone with prexisting diabetes who has got pregnant?

A

24-28 weeks

209
Q

What happens to blood pressure in pregnancy?

A

falls in first half of pregnancy before rising to pre-pregnancy levels before term

210
Q

When can women air travel during pregnancy?

A

Up to 37weeks if uncomplicated singleton
up to 32 weeks if twins

211
Q

What SSRI do you give in breastfeeding women?

A

Paroxetine/sertraline

212
Q

How long after Ullipristal can you take COCP?

A

5 days

213
Q

What is the management of mastitis?

A

Flucloxacillin and continue breastfeeding

Phase 3A (14 decks)

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