2obgyn Flashcards
(12 cards)
A 19-year-old woman who is 9 weeks into her first pregnancy is seen in the early pregnancy assessment unit with vaginal bleeding. Her ultrasound scan confirms a viable intrauterine pregnancy. However, the high vaginal swab has isolated group B streptococcus (GBS). How should she be managed?
intrapartum IV benzylpenicillin
cholestasis of pregnancy vs acute fatty liver
The most likely diagnosis is cholestasis of pregnancy as demonstrated by severe itching, jaundice, obstructive LFTs, normal WBC and no evidence of coagulopathy. 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).
A 27-year-old woman undergoes a vaginal delivery at 39 weeks gestation, delivering her third child. The newborn weighed 3.6 kg, and the pregnancy was uncomplicated with no prolonged labour. She opted for physiological management of the third stage of labour and had a spontaneous vaginal delivery.
After the placenta was delivered, she continued to bleed. Three hours later, she is found pale, clammy, and unresponsive with a large pool of blood on the floor. On examination, the uterus is palpated high above the umbilicus.
Which option is the most likely underlying cause?
inadequate uterine contractions - uterine atony is the commonest cause of PPH by far
A 29-year-old woman goes into labour. The midwife examines her and states that the head is now at the level of ischial spine. What terminology is used to describe the head in relation to the ischial spine?
station
engagement is how far down the head is in the pelvis
endometrial cancer RF
nulliparity
not smoking - smoking is protective
downs vs omphalocele AFP
downs = low
omphacloecle = high
Ci in breastfeeding drug
amiodarone
carbamazepine and sodium valproate safe in breast-feeding?
yes
An 18-year-old woman is assessed in the urgent gynaecology clinic due to concerns about her period being 3 weeks overdue. She has been experiencing very mild abdominal cramping but no other symptoms.
A transvaginal ultrasound is performed and shows an adnexal mass of 28mm with no visible heartbeat, consistent with an extrauterine pregnancy.
How should this patient be managed?
Methotrexate is correct. This patient has an ultrasound-proven ectopic pregnancy which needs urgent management. As the adnexal mass is < 35mm, has no detectable heartbeat and has not ruptured, this patient can be managed medically according to NICE, as the pain they are experiencing is not severe.
causes of decreased variability on CTG
The most common explanation for short episodes (< 40 minutes) of decreased variability on CTG is that the foetus is asleep.
Other causes of decreased variability in foetal heart rate on CTG are due to maternal drugs (such as benzodiazepines, opioids or methyldopa - not paracetamol), foetal acidosis (usually due to hypoxia), prematurity (< 28 weeks, which is not the case here), foetal tachycardia (> 140 bpm, again not the case here) and congenital heart abnormalities.
A 37-year-old woman presents with six months of episodic low mood and fatigue, beginning two weeks before her period and resolving within a few days of menstruation.
During these episodes, she misses work and social events due to low mood and hopelessness. She has since separated from her partner. Despite exercise and dietary changes, her symptoms persist.
She has no medical history but smokes 25 cigarettes daily. Her BMI is 27 kg/m², and she denies suicidal ideation or self-harm.
Which option is the best next step?
sertraline during 14 days before period starts
The COCP is contraindicated in this patient due to her being over 35 years old and smoking more than 15 cigarettes per day,
