O&G

Question 1

How is gestational HTN defined?

Answer 1

New onset HTN after 20/40
- >140/90
- severe if >160/110
With no significant proteinuria

Question 2

What are the markers of severe pre-eclampsia?

Answer 2

• Seizure/recurrent headache
• visual scotoma
• N&V
• Epigastric pain
• Oliguria with severe HTN
• Deteriorating bloods
  Or if severe HTN (>160/110) and proteinuria

Question 3

What is the treatment for severe pre-eclampsia?

Answer 3

• MgSO4 4g IV over 5-15mins then 1g/hr infusion for 24 hours
• Restart 24hrs if fits.
• Rx recurrent fits with further 2-4g IV Mg
• Rx HTN with IV labetolol

Question 4

What are the recommendations around FGM?

Answer 4

Only females from high risk area or background should be asked
Record findings of FGM in pts clinical notes
Females over 18 do not need to be referred to social services and the police but should be offered support and relatives (esp <18) at risk identified.
Children with st of FGM should be reported to the police and child safeguarding implemented. Info shared with GP and health visitor.

Question 5

How long after sex can Levonelle (levonorgestrel) be given?
And what time of post dose vomiting should prompt another dose?

Answer 5

Within 72 hrs of intercourse

If vomit within two hours, repeat dose

Question 6

How soon after intercourse is ellaOne (ulipristal) required for emergency contraception?
And when should a repeat dose be given if vomiting?

Answer 6

120hrs (5days)

If vomits within 3 hours, give repeat dose

Question 7

What are the relative contraindications for copper IUD?

Answer 7

Can be given to prevent pregnancy 5 days from intercourse (ovulation)

Avoid if: untreated STI, abnormal womb, unexplained intermenstrual bleeding or dyspareunia.

Question 8

What are the management options for tubal ectopic pregnancies?

Answer 8

Emergency Sx if unstable

Surgery if any of: sig. pain, adnexal mass >35mm, feral HR on US, hCG>5000

Medical - all of: no pain, adnexal mass<35mm, no heartbeat, hCG<1500 (consider <5000).

Expectant - all of: no pain, <35mm, no heartbeat, hCG <1000

Question 9

When should patients with STI’s be admitted?

Answer 9

Clinically severe ds
Surgical emergency cannot be excluded
No response to oral Rx
Turbo-ovarian abscess
Pregnancy

Question 10

What are the outpatient treatment options in STI?

Answer 10

IM ceftriaxone 1g single dose
Oral doxy 100mg BD for 14 days
Oral metronidazole 400mg BD for 14d
Or
Oral ofloxacin 400mg BD for 14 days
Oral metronidazole 400mg BD 14 days
Or
Oral metronidazole 400mg BD 14 days