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Finals Studying - Condensed > Obs & Gynae > Flashcards

Obs & Gynae Flashcards

1
Q

how many hrs post LH surge does ovulation occur

A

24-36h

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2
Q

proliferative phase of uterine cycle runs alongside what part of the menstrual cycle

A

follicular phase

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3
Q

secretory phase of the uterine cycle runs alongside what part of the menstrual cycle

A

luteal phase

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4
Q

normal menstrual loss

A

10-80ml

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5
Q

metorrhagia

A

intermenstrual bleeding

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6
Q

amenorrhoea

A

absence periods >6m

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7
Q

oligomenorrhoea

A

intervals > 35d

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8
Q

Mx DUB

A
  1. Mirena IUS
    cOCP
    POP

Non-hormonal - Tranexamic acid

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9
Q

normal vaginal pH

A

3-4

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10
Q

bacteria causing BV

A

gardnerella vaginosis

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11
Q

Ix BV

A

clinical Dx
or
HVS

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12
Q

clue cells on microscopy

A

BV

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13
Q

Mx vaginal candida if preg

A

only Topical Mx

no oral fluconazole

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14
Q

what is trichomonas vaginalis

A

PARASITE (got this wrong in CAP)

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15
Q

presentation trichomonas

A

strawberry cervix
musty smelling
frothy discharge

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16
Q

Ix trichomonas vaginalis

A

HVS

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17
Q

cause of chlamydia

A

chlamydia trachomatis

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18
Q

presentation chlamydia

A

asymptomatic (70% women, 50% men)
or
urethritis (M), discharge (F)

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19
Q

Ix chlamydia

A

F - endocervical swab

M - first pass urine

for PCR/NAAT (always do gonorrhea test too)

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20
Q

why is PCR/NAAT the test for chlamydia

A

chlamydia doesn’t stain with gram stain

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21
Q

Mx chlamydia

A

either:

doxycycline 7d
or
azithromycin 1g oral single dose

both are 1st line, using doxy more now

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22
Q

Ix gonorrhoea

A

F - endocervical swab

M - first pass urine

for PCR/NAAT (always do chlamydia test too)

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23
Q

disadvantage of PCR/NAAT

A

doesn’t give sensitivities

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24
Q

what is gonorrhoea

A

gram negative diplococcus

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25
Q

cause of syphilis

A

treponema pallidum

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26
Q

shape of syphilis

A

spirochaete

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27
Q

stages of syphilis

A
  1. painless chancre
  2. “the great imitator” - lymphadenopathy, rash on palms, soles, trunk
  3. gummas - small lesions on skin and bones, cardio + neuro complications
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28
Q

Ix syphilis

A

swab for dark ground microscopy

Screening: ELISA test (combined IgM and IgG)
TPPA: specific
VDRL: non-specific, used for monitoring

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29
Q

Mx syphilis

A

IM penicillin

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30
Q

HPV causing genital warts

A

6+11

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31
Q

Mx genital warts

A
  1. solitary - cryotherapy, multiple - podophyllotoxin cream

2. Imiquimod (aldara)

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32
Q

Ix genital herpes

A

swab of ulcer for PCR

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33
Q

Mx pubic lice (crabs)

A

malathion lotion

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34
Q

RF for endometrial Ca

A

obesity
unopposed oestrogen
nulliparity

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35
Q

protective factors for endometrial Ca

A

smoking

combined pill

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36
Q

genetic predisposition to endometrial Ca

A

Lynch syndrome

  • autosomal dominant
  • also colon ca
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37
Q

Mx endometrial Ca

A

total hysterectomy + bilateral salpingo-oophrectomy

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38
Q

presentation fibroids

A

bulky uterus
menorrhagia
subfertility

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39
Q

Ix fibroids

A

TVUs

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40
Q

Mx fibroids if fertility desired

A

Medical:
leuprorelin (GHRH agonist)
IUS

Surgical:
myomectomy

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41
Q

Mx fibroids if fertility not desired

A

Endometrial ablation
Uterine artery embolization
Hysterectomy

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42
Q

complication of fibroids

A

red degeneration:

haemorrhage into the tumour, most commonly happens in pregnancy

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43
Q

what is adenomyosis

A

presence of endometrial tissue in the myometrium

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44
Q

presentation adenomyosis

A

menorrhagia
dysmenorrhea
boggy, tender uterus

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45
Q

Mx adenomyosis

A

Hormonal Tx:
GNRH agonists, POP, Mirena, COC

Only definitive Tx: hysterectomy

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46
Q

presentation endometriosis

A 
cyclical abdo pain 
dyspareunia 
dysmenorrhea 
menorrhagia 
subfertility
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47
Q

Ix endometriosis

A

laparoscopy

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48
Q

Mx endometriosis

A

cOCP, IUS

laser ablation

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49
Q

cOCP and increased discharge - Dx?

A

ectropion

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50
Q

meigs syndrome

A

adenoma + ascites + pleural effusion

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51
Q

HPV types cervical Ca

A

16 & 18

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52
Q

if a womas has symp suspicious of cervical Ca - Ix?

A

straight for colposcopy

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53
Q

smear shows mild dyskaryosis - what do you do

A

rpt smear 6m

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54
Q

smear shows moderate dyskaryosis - what do you do

A

refer colposcopy

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55
Q

smear shows severe dyskaryoisis - what do you do

A

urgent refer colposcopy

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56
Q

Mx CIN 1

A

observe

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57
Q

Mx CIN II

A

LLETZ

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58
Q

Mx CIN III

A

LLETZ

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59
Q

woman has had Tx for CIN - what do you do next

A

rpt smear and HPV test in 6m

  • if -ve, go back to routine recall every 3y
    if +ve, another colposcopy and follow up yrly for 5y
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60
Q

presentation of cervical ca

A

abnormal bleeding

  • post-coital
  • post-menopausal
  • brownish or blood stained discharge
  • contact bleeding
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61
Q

Mx cervical ca

A

radical hysterectomy
+
radiotherapy/chemotherapy

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62
Q

radical hysterectomy

A

removal of uterus, cervix and upper vag

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63
Q

hysterectomy

A

removal of uterus and cervix

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64
Q

cell type of cervical ca

A

SCC

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65
Q

risk factors ovarian ca

A

nulliparity
many cycles (early menarche, late menopause)
BRCA 1 and 2
increased age

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66
Q

protective factors for ovarian ca

A

COC pill

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67
Q

ovarian tumours arising from serous epithelium

A

serous
endometroid
mucinoid
clear cell

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68
Q

ovarian tumours arising from germ cells

A

teratoma (dermoid cyst) - BENIGN

choriocarcinoma
yolk sac - MALIGNANT

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69
Q

ovarian tumours arising from stroma

A

these are the hormone secreting tumours

granulosa - oestrogen
theca - androgen
fibroma (benign) - meig’s syndrome

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70
Q

most common cancers to mets to ovary

A

breast
pancreas
stomach
GI

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71
Q

tumour marker ovarian ca

A

CA125

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72
Q

Ix ovarian Ca

A
  1. CA125
  2. USS/CT
  3. CEA (to exclude GI primary)
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73
Q

risk of malignany index - ovarian Ca

A

menopausal status x US score x CA125

RMI > 250, refer to gynae

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74
Q

Mx ovarian ca

A

total hysterectomy + bilateral salpingoophrectomy + omental removal

chemo

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75
Q

pathophysiology of PCOS

A

Excess LH
- stimulates over production of androgens

and

Insulin Resistance
- suppresses hepatic production of SHBG which increase amount of circulating free androgens

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76
Q

presentation PCOS

A

oligomenorrhoea or amenorrhoea
hirsutism or acne
obesity
insulin resistance

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77
Q

Rotterdam criteria

A

must meet 2/3 for Dx of PCOS:

1 .oligo- or amenorrhoea

  1. clinical or biochemical signs of ++ androgens
  2. polycystic ovaries on US
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78
Q

Mx PCOS

A
  1. wt loss, metformin
  2. if pt doesn’t desire pregnancy: OCP, dianette
  3. if pt does want pregnancy: clomifene +/- metformin
  4. for hirsutism: eflornithine cream/laser
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79
Q

location of Bartholin’s glands

A

4 and 8 oclock positions

- deep to the posterior aspect of the labia majora

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80
Q

difference in presentation of Bartholin’s cyst and Bartholin’s abscess

A

cyst - soft, fluctuant, non-tender

abscess - hard, non-fluctuant, tender, surrounding cellulitis

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81
Q

Mx Bartholin’s cyst or abscess

A

marsupialisation

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82
Q

lichen sclerosis presentation

A

atrophic white patches
itch
fusion of clitoral hood, vaginal opening

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83
Q

Mx lichen sclerosis

A

topical steroids

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84
Q

Mx urge incontinence

A

reduce caffeine/alcohol
bladder training
muscarinic antagonists - oxybutynin, solifenacin, tolteridine
oestrogen pessary

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85
Q

Mx stress incontinence

A

lifestyle changes
pelvic floor training
duloxetine
rarely surgery

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86
Q

urethrocele

A

prolapse: urethra into vagina

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87
Q

rectocele

A

prolapse: rectum into vagina

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88
Q

enterocele

A

prolapse: small bowel into vagina

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89
Q

cystocele

A

prolapse: bladder into vagina

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90
Q

Mx of prolapse if incidental finding

A

pelvic floor work

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91
Q

Mx prolapse if old lady, multi morbidity and procidentia

A

pessary

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92
Q

grades of uterine prolapse

A
  1. into vagina
  2. at vaginal orifice
  3. outside vagina
  4. procidentia - entirely outside vagina
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93
Q

vaginal vault

A

vaginal prolapse

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94
Q

Mx vaginal vault prolapse

A

sacrospinous fixation
or
hysterectomy

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95
Q

what cancers does cOCP increase risk of

A

breast

cervical

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96
Q

what cancers does cOCP decrease risk of

A

endometrial

ovarian

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97
Q

UKMEC4 for cOCP

A 
>35 and smoking >15/day
uncontrolled HTN 
migraine with aura Hx of VTE/stroke/IHD
breast ca 
breastfeeding and <6w post-partum
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98
Q

mode of action of cOCP

A

inhibits ovulation

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99
Q

effect of epilepsy medicines on cOCP

A

reduce function of cOCP, as they are CytP450 inducers,

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100
Q

mode of action of POP

A

thickens cervical mucus

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101
Q

how many hrs is the window for a missed POP

A

3h

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102
Q

if missed POP pill >3h ago - what do you do

A

take asap and advise condom using until pill-taking been re-established for 48h

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103
Q

mode of action of implant

A

inhibits ovulation

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104
Q

mode of action of IUS

A

prevents endometrial proliferation/implantation

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105
Q

s/e of IUD

A

heavier periods

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106
Q

s/e of depo

A

prolonged return of fertility

increases appetite

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107
Q

mode of action of depo

A

inhibits ovulation

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108
Q

premature menopause

A

<40y

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109
Q

early menopause

A

<45y

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110
Q

late menopause

A

> 54 y

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111
Q

criteria for menopause

A

> 1y amenorrhoea

FSH >30 IU/L

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112
Q

who gets oestrogen only HRT

A

post-menopausal women

NO UTERUS

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113
Q

who gets combined sequential HRT

A 
any of:
peri-menopausal women 
<54y
<1y amenorrhoea
and WITH A UTERUS
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114
Q

who gets combined continuous HRT

A 
any of:
post-menopausal women 
>54y 
>1y amenorrhoea 
and WITH A UTERUS
115
Q

Mx hot flushes in menopause

A

clonidine (alpha blocker)

116
Q

why are women with a uterus not given oestrogen only HRT

A

increased risk of endometrial ca

117
Q

Mx vaginal dryness and atrophy in menopause

A

oestrogen creams

118
Q

what is tibolone

A

an alternative to CC HRT

119
Q

levonorgestrel

A

emergency contraception

take within 72h

120
Q

ulipristal acetate

A

emergency contraception

take within 120h

121
Q

test for HIV

A

HIV Antibody Test

  • ELISA
  • Ab usually become +ve 4-6w after infection

p24 Antigen test
- positive between 1-4w after infection

122
Q

ring enhancing lesions CT

A

cerebral toxoplasmosis (HIV)

123
Q

kaposis sarcoma cause

A

HHV8

124
Q

kaposis sarcoma presentation

A

purple papules on skin

125
Q

Ix pneumocystis pneumonia

A

bronchoalveolar lavage and immunoluorescence

126
Q

Mx pneumocystis pneumonia

A

high dose co-trimoxazole

127
Q

if man has -ve ELISA test 4w after potentially contracting HIV, what do you do

A

rpt ELISA test in another 2m - can take up to 12w to develop Ab, even tho most men develop in 4-6w

128
Q

when should implant ideally be inserted

A

in day 1-5 of cycle

  • if not, need to use additional contraception for 7d
129
Q

why should oxybutynin be avoided in frail old ladies1

A

increased risk of falls

130
Q

2nd line medical Mx in urge incontinence

A

Mirabegron

131
Q

what can be used as a short term option to rapidly stop heavy bleeding

A

Norethisterone 5 mg tds

132
Q

most common cause of diarrhea in HIV pts

A

cryptosporidium

133
Q

latest time that HIV post exposure prophylaxis can be given

A

72h

134
Q

hormone that makes uterus contract

A

oestrogen

135
Q

hormone that settles the uterus

A

progesterone

136
Q

hormone that initiates contractions

A

oxytocin

137
Q

ideal position of baby coming out

A

suboccipito bregmatic

138
Q

stages of labour

A

1 - 0-10cm dilation
2 full dilation to delivery of baby
2 delivery of the placenta

139
Q

CTG components

A

DR C BRAVADO

Define Risk 
Contraction 
Baseline RAte
Variability
Accelerations 
Decelerations 
Overall impression
140
Q

Contractions in CTG

A

no. in 10 mins

1 big sq = 1 min

141
Q

Baseline Rate in CTG

A

average HR in 10min

normal 110-150

142
Q

Variability in CTG

A

variation from 1 beat to the next

normal 10-25bpm

143
Q

Accelerations in CTG

A

Increase in FHR by 15bpm for >15secs

144
Q

Decelerations in CTG

A

Decrease in FHR by 15bpm for >15secs

145
Q

Early deceleration on CTG

A

start and end with the contraction - physiological

146
Q

Variable deceleration on CTG

A

no relation to the contraction, variable duration - pathological

147
Q

Late decelerations on CTG

A

start with the contraction, end after the contraction - pathological

148
Q

what do late decels indicate

A

fetal distress e.g. asphyxia or placental insufficiency

149
Q

what do variable decels indicate

A

cord compression

150
Q

define miscarriage

A

fetal loss <24w

151
Q

threatened miscarriage

A

pregnany test +ve
fetal HB present
some bleeding, pain minimal
CLOSED os

152
Q

inevitable miscarriage

A

pregnancy test +ve
pain, bleeding
OPEN os

153
Q

incomplete miscarriage

A

pregnancy test -ve
++ pain, ++ bleeding, +/- septic
products of conception at os
OPEN os

154
Q

complete miscarriage

A

pregnancy test -ve
cessation of bleeding
no products at os
CLOSE os

155
Q

missed miscarriage

A

pregnancy test -ve
no fetal heart on USS
no evidence of expulsion

156
Q

Medical Mx of miscarriage

A

misoprostol (makes uterus contract) - prostaglandin

157
Q

Surgical Mx of miscarriage

A

give misoprostal before - softens cervix and dilates it to reduce surgical trauma
surgical evacuation of uterus

158
Q

Do all women who have a miscarriage get anti-D

A

no - only rhesus -ve women undergoing surgical Mx

159
Q

most common site for ectopic pregnancy

A

ampulla of uterine tube

160
Q

Ix ectopic pregnancy

A

diagnostic laparoscopy
B-hCG
serum USS

161
Q

Mx ectopic pregnancy

A

stable -
IM methotrexate or laparoscopic salpingectomy/salpingotomy

unstable -
laparotomy

162
Q

when can an ectopic pregnancy be managed expectantly

A

low B-hCG
no symptoms
tubal ectopic <35mm
no fetal heartbeat

163
Q

complete hydatiform mole

A

egg has lost its DNA, so entirely paternal DNA (46XY)

164
Q

partial hydatiform mole

A

egg fertilized by 2 sperms (69 XXY)

165
Q

risk with hyatiform mole

A

malignant change to choriocarcinoma

166
Q

Mx hydatiform mole

A

desires fertility - dilation and evacuation

doesn’t desire fertility - hysterectomy

167
Q

causes of placental abruption

A

PET
HTN
cocaine
blunt trauma

168
Q

types of placenta abruption

A

revealed - visible vaginal bleeding

concealed - no vaginal bleeding but collection of blood behind the placenta

169
Q

types of placenta praevia

A

1 - reaches lower uterine segment but doesn’t reach os

  1. reaches internal os but doesn’t cover it
  2. reaches internal os before dilation, but not when dilated
  3. completely covers internal os
170
Q

Mx placenta praevia

A

final US at 36-37w

if grade 1 - vaginal delivery
if grade 3/4 - do c-sec at 37/38w

171
Q

placenta accreta

A

placenta attaches to myometrium

172
Q

placenta increta

A

placenta invades into myometrium

173
Q

placenta percreta

A

placenta invades through myometrium

174
Q

primary PPH

A

loss of >500ml of blood <24h after birth

175
Q

secondary PPH

A

loss of >500ml of blood between 24h and 12w after giving birth

176
Q

Major PPH blood loss

A

> 1500ml

177
Q

4T’s of PPH

A

tone
tissue
thrombin
trauma

178
Q

most common cause of PPH

A

uterine atony (90%) i.e. uterus not contracting to deliver placenta

179
Q

Mx PPH

A
  1. ABC, grey cannula

Medical -

  1. IV oxytocin 10units or IV ergometrine 500mcg
  2. IM carboprost

Surgical -

  1. Intrauterine balloon tamponade
  2. B lynch suture
  3. Ligation of the uterine arteries
  4. If severe and uncontrolled - hysterectomy
180
Q

grade 1 perineal tear

A

superficial, no muscle involvement

181
Q

grade 2 perineal tear

A

involves perineal muscles, spares anal sphincter

182
Q

grade 3 perineal tear

A

perineal muscles and into anal sphincter

183
Q

grade 4 perineal tear

A

perineal muscles, anal sphincter and rectal mucosa

184
Q

who repairs 1st and 2nd degree perineal tears

A

midwives

185
Q

who repairs 3rd and 4th degree perineal tears

A

obstetricians

186
Q

fasting glucose level for Dx of gestational diabetes

A

> 5.6 mmol/L

187
Q

Dx of gestational diabetes

A

oral glucose tolerance test - 75g

188
Q

OGTT level for Dx of gestational diabetes

A

> 7.8 mmol/L

189
Q

Mx gestational diabetes

A
  1. wt loss, diet, exercise
  2. metformin
  3. insulin
190
Q

additional care for gestational diabetes

A

extra scans at 28, 32 and 36w

191
Q

delivery in gestational diabetes

A

37-38w

192
Q

Mx shoulder dystocia in labour

A

mcrobert’s manoeuvre

193
Q

Mx hyperthyroid in pregnancy

A

proplthiouracil

194
Q

Mx hypothyroid in pregnancy

A

increase levothyroxine dose 25-50mcg in 1st trim

195
Q

pre-existing HTN

A

diagnosed prior to pregnancy or diagnosed <20w

>140/90mmHg on 2 occasions
or 
diastolic >110mmHg 
or 
rise of 30/15 mmHg compared to booking BP
196
Q

pregnancy induced HTN

A

diagnosed >20w

resolves within 6w after delivery
no features of PET

197
Q

Mx of HTN in pregnancy

A
  1. labetalol
  2. methyldopa
  3. nifedipine
198
Q

when is Tx of HTN in pregnancy indicated

A

if BP >150/100 mmHg

199
Q

who gets prophylaxis for PET and what is the prophylaxis

A

women with known risk factors

aspirin 150mg daily

200
Q

triad of PET

A
  1. HTN
  2. proteinuria
  3. oedema
201
Q

how much is significant proteinuria in a 24h urine sample

A

> 300mg in a 24h urine sample
or
30 mg/mmol urinary protein:creatinine ratio

202
Q

cause of PET

A

failure of normal trophoblast invasion - results in a high resistance flow

203
Q

Mx of PET

A
  1. ADMIT
  2. Anti HTN - Labetalol
  3. Delivery (prompt)
  4. if risk of eclampsia - magnesium sulphate
204
Q

eclampsia

A

tonic - clonic seuizure

205
Q

Mx eclampsia

A

magnesium sulphate 4mg IV
then infusion of 1g/hr
delivery

206
Q

HELLP syndrome

A

indicates severe PET

Haemolysis
Elevated Liver enzymes
Low Platelets

207
Q

1st trim down’s syndrome screening - timing and what’s included in test

A

booking scan (11 - 13+6 weeks)

  1. maternal age
  2. nuchal translucency
  3. B-hCG
  4. PAPP-A
208
Q

2nd trim down’s syndrome screening - timings and what’s included in test

A

used if women present later for booking (15-20w)

triple test:
AFP, B-hCG, unconjugated oestriol

quadruple test:
AFP, B-hCG, unconjugated oestriol, inhibin A

209
Q

diagnostic testing for Down’s syndrome screening

A

chorionic villus sampling (tests placenta)

amniocentesis (tests amniotic fluid)

maternal fetal blood sampling (better than above 2, but ++ expensive)

210
Q

timing of chorionic villus sampling

A

11 - 13+6w

211
Q

timing of amniocentesis

A

> 15w

212
Q

what do some women receive after diagnostic genetic testing

A

rhesus, if they are -ve

213
Q

dose of folic acid women should be on

A

400mcg from 12w pre-conception

214
Q

dose of folic acid for high risk women

A

5mg

215
Q

Anticonvulsants to avoid in preg

A

AVOID sodium valproate

Give - Lamotrigine

216
Q

Antidepressants to avoid in preg

A

AVOID SSRIs - pulmonary HTN, CVS defects

217
Q

Antibiotics to avoid in preg

A

Tetracyclines - stain bone and teeth

Gentamicin - nephrotoxic and ototoxic

Trimethoprim - folic acid inhibitor, avoid in 1st trim (NTD)

Nitrofurantoin - neonatal haemolysis, avoid 2nd and 3rd trim

Chloramphenicol - CVS collapse (grey baby syndrome)

218
Q

Anticoagulant to avoid in preg

A

Warfarin

219
Q

Anticoagulant safe in preg

A

LMWH

220
Q

why should ACEi/ARB be avoided in preg

A

renal agenesis, IUGR

221
Q

Ix used on US to detect a SGA baby

A

abdomen circumference (used in Tayside)

also:
head circumference
femur length

222
Q

if baby has normal head circumference and small abdo circumference, what does this indicate

A

placental failure

- baby is redirecting blood to brain to compensate

223
Q

if baby has small head circumference and small abdo circumference, what does this indicate

A

chromosomal abnormality

224
Q

use of uterine artery doppler

A

measures placental resistance (i.e. from maternal side)

reduced resistance = normal
increased resistance = invasion hasn’t taken place (“notching”)

225
Q

use of umbilical artery doppler

A

measures blood flow to baby (i.e. fetal side)

normal = flow during systole and diastole
abnormal = absent end diastolic flow
v abnormal = reversed end diastolic flow (pre-terminal)

226
Q

Ix done after umbilical artery doppler if its abnormal

A

middle cerebral artery doppler

- if shows increased flow, means the baby is compensating and these vessels are dilating to get blood to the brain

227
Q

if baby is going to be delivered prem, what does mum get

A

steroids - 2 doses of betamethasone
and
4g Iv magnesium sulphate

228
Q

if umbilical artery doppler abnormal <37w - Mx

A

section

229
Q

if umbilical artery doppler abnormal at term - Mx

A

section

230
Q

if umbilical artery doppler normal at term - Mx

A

VD

231
Q

Mx placenta abruption

A

C-sec

232
Q

most common cause of uterine rupture

A

many C-sections means scare more likely to burst, most commonly happens in labour

233
Q

vasa praevia

A

abnormally sited fetal vessels - they run in the membranes rather than being protected by the placenta.

234
Q

presentation vasa praevia

A

membranes rupture, then vaginal bleeding
+
fetal bradycardia

235
Q

Mx vasa praevia

A

urgent c-sec

236
Q

Mx vasa praevia if detected before membranes rupture

A

planed c-sec

237
Q

parity

A

number of pregnancies delivered >24w

238
Q

gravida

A

number of pregnancies

239
Q

what is an ectropion

A

exposure of the columnar epithelium of the endocervix

240
Q

what criteria means ‘high risk’ women for 5mg folic acid dose

A

obese (BMI >40)
twin pregnancy
anti-epileptics
Hx of NTD

241
Q

how much vit D should a women take during preg

A

10mcg

242
Q

how to detect if a woman is smoking during preg

A

CO level test - >4 is significant

243
Q

what is tested for by midwife @ booking scan

A 
Hb + platelets
blood group 
rhesus group 
Hep B, HIV, syphilis 
Hep C - if Hx of drug use 
Blood glucose
244
Q

anomaly scan

A

18-24w

245
Q

if Hx of cardiac probs, when does woman get extra scan

A

28w

246
Q

how many midwife visits does prim mum have

A

10

247
Q

how many midwife visits does mum having 2nd baby or more get

A

7

248
Q

when do rhesus -ve women get their anti-D

A

28 + 34 w

249
Q

prophylaxis of VTE in preg

A

LMWH (dose based on wt)

250
Q

when should LMWH prophylaxis be started in preg in at risk women

A

immediately (i.e. at booking) - if 4 or more risk factors

28w - if 3 or less risk factors

251
Q

how long should prophylactic LMWH be continued for after preg

A

6 weeks - if high risk

10d - if intermediate risk

252
Q

Ix DVT in preg

A

compression duplex US

253
Q

Mx DVT in preg

A 
TEDS
give LMWH 
stop onset at labour 
restart 3h post-op 
continue 3m post-natal
254
Q

Ix PE in preg

A
  1. V/Q scan
255
Q

why are d-dimers not used as PE Ix in preg

A

raised anyway in preg, so not specific

256
Q

why is CTPA not used as PE Ix in preg

A

increased risk of maternal breast ca

257
Q

disadvantage of V/Q scan

A

increased risk of childhood ca

258
Q

timing of baby blues

A

3-10 days

259
Q

timing of post-natal depression

A

2-6 weeks

260
Q

timing of puerperal psychosis

A

<6 weeks

261
Q

cut off in tayside for medical TOP

A

18+6 w

262
Q

cut off in tayside for surgical TOP

A

up to 12w

263
Q

nationwide social acceptable termination cut off

A

23+6 w

264
Q

cut off for TOP if fetal anomaly

A

no cut of f- any gestation

265
Q

Medical Mx of TOP

A

oral mifepristone (anti-progesterone)

then

oral or vaginal misoprostal (prostaglandin) - 24h later

266
Q

follow up for TOP

A

initiate contraception ON SITE prior to discharge

do pregnancy test 2-3w
anti D
counselling

267
Q

location of spermatogenesis

A

Sertoli cells in the seminiferous tubules

268
Q

where is testosterone produced and what is its role

A

Leydig cells - enhance spermatogenesis

269
Q

what pituitary hormone stimulates testosterone production

A

LH

270
Q

azoospermia

A

no sperm in the semen

271
Q

obstructive causes of azoospermia

A

CF, vasectomy

272
Q

non-obstructive causes of azoospermia

A

congenital, infection, genetic, endocrine

273
Q

Ix of male infertility

A
  1. testicular volume, confirm vas deferens present
  2. semen analysis
    if abnormal -
    rpt 6 w later, endocrine profile, chromosome analysis
    then
    testicular biopsy
274
Q

normal testicular volume

A

12-25 ml

275
Q

testes size in obstructive causes of male infertility

A

normal size

276
Q

testes size in non-obstructive causes of male infertility

A

reduced size

277
Q

Mx azoospermia

A

surgical sperm retrieval

and then ICSI (inject sperm into egg)

278
Q

Ix to confirm whether woman is ovulating

A

21d progesterone

(N.B) adjust day for the length of the womans cycle

279
Q

how long do couple need to be trying for until they will be investigated for infertility

A

2y

280
Q

criteria or qualifying for IVF on the NHS

A

no children already
healthy BMI
non-smoker
<42

281
Q

Lambda sign on US

A

dichorionic diamniotic pregnancy

282
Q

T sign of US

A

monochorionic diamniotic pregnancy

283
Q

zygosity definition

A

number of eggs fertilized to produce twins

284
Q

chorionicity definition

A

the membrane pattern of the twins

Finals Studying - Condensed (22 decks)

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