Corrections Flashcards by Esme Cosham

1st line mx of 1ary dysmenorrhoea?

NSAIDs e.g. mefanamic acid

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Is aspirin contraindicated in breastfeeding?

Yes

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Urge to push in OA vs OP positioning?

Generally, women will experience an earlier urge to push in OP than OA.

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What is indicated if Bishop’s score is ≤6?

vaginal prostaglandins or oral misoprostol

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What is indicated if Bishop’s score is >6?

amniotomy and an IV oxytocin infusion

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Why is nitrofurantoin contraindicated in breastfeeding?

it can induce haemolysis in infants with G6PD deficiency

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Is trimethoprim contraindicated in breastfeeding?

No - safe to use

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What is the most common cause of puerperal pyrexia?

Endometritis

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What is the 1st line antihypertensive in pregnant women with asthma?

Nifedipine

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When is aspirin given to reduce the risk of pre-eclampsia in pregnancy?

≥ 1 high risk factors

≥ 2 moderate factors

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Give some moderate risk factors for pre-eclampsia

1st pregnancy
age ≥40 y/o
pregnancy interval of more than 10 years
BMI ≥35
FH of pre-eclampsia
multiple pregnancy

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Give some high risk factors for pre-eclampsia

hypertensive disease in a previous pregnancy
CKD
autoimmune disease, such as SLE or APS
type 1 or type 2 diabetes
chronic hypertension

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At what BMI should women be given high dose folic acid (5mg)?

> 30

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What is the medication of choice in suppressing lactation when breastfeeding cessation is indicated?

Cabergoline

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Is a FH history of Wilson’s a contraindication to the copper IUD?

No - only a personal history

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When should the serum progesterone level be taken?

7 days prior to the next expected period

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Urethral discharge in chlamydia vs gonorrhoea?

Chlamydia –> clear/cloudy

Gonorrhoea –> green/yellow

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When should women be referred to a maternal fetal medicine unit if foetal movements have not yet been felt?

By 24 weeks

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What is hCG secreted by?

Syncytiotrophoblasts

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How long is the mirena IUS licensed for use as the progesterone component of HRT?

4 years

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What is Raloxifene?

SERM, used to:

1) lower the risk of breast cancer if you have a high or moderate risk of developing it

2) prevent and treat bone thinning (osteoporosis)

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What are 4 mx options for ovulation induction?

1) Excercise & weight loss

2) Letrozole

3) Clomiphene citrate

4) Gonadotropin therapy

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1st line for ovulation induction in patients with PCOS?

Exercise & weight loss

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1st line medical therapy for ovulation induction in patients with PCOS?

Letrozole (aromatase inhibitor)

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Define PPH

Blood loss >500ml after vaginal delivery

How soon after childbirth can the implant be inserted?

Any time after childbirth

Describe the different classification of perineal tears

1st degree: - superficial damage with no muscle involvement - do not require any repair 2nd degree: - injury to the perineal muscle, but not involving the anal sphincter - require suturing on the ward by a suitably experienced midwife or clinician 3rd degree: - injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS) 3a: less than 50% of EAS thickness torn 3b: more than 50% of EAS thickness torn 3c: IAS torn require repair in theatre by a suitably trained clinician 4th degree: - injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa - require repair in theatre by a suitably trained clinician

Which contraception is contraindicated in those on testosterone therapy?

Those containing oestrogen only

Mx of stage 1A tumours in cervical cancer?

Gold standard --> hysterectomy +/- lymph node clearance Maintaining fertility --> cone biopsy with negative margins

Mx of stage 1B tumours in cervical cancer?

radiotherapy with concurrent chemotherapy is advised

When is investigation required in lochia?

If it persists beyond 6 weeks --> get US

Role of foetal fibronectin?

Helps maintain the attachment of the amniotic sac to the uterine lining during pregnancy

Role of testing foetal fibronectin?

The test measures the level of fFN in vaginal fluid. A level of 50 ng/ml or higher between 22 and 35 weeks is associated with an increased risk of preterm delivery.

What does grossly elevated oestradiol concentrations with suppressed LH/FSH and raised prolactin indicate?

Pregnancy

Is the IUD or IUS affected by enzyme inducers?

No (but the implant is!)

Around 1 in 5 women who undergo a salpingotomy for an ectopic pregnancy require further treatment. What does this further treatment involve?

Methotrexate +/- salpingectomy

Risk factors for placental abruption?

- previous abruption - HTN/pre-eclampsia - ruptured membranes (prolonged or premature) - polyhydramnios - uterine injury (i.e. trauma to the abdomen) - multiple pregnancy - older age - cocaine & smoking - chorioamnionitis & other infections

The requirements for instrumental delivery: FORCEPS

F - fully dilated O - OA position (preferable) R - ruptured membranes C - cephalic presentation E - engaged presenting part i.e. head at or below the ischial spines (mustn't be palpated abdominally) P - pain relief S - sphincter (bladder) empty

components of 'foetal station' in the Bishop's score?

0: -3 1: -2 2: -1,0 3: +1, +2

Is lithium safe in breastfeeding?

What size uterine fibroid can be manage medically instead of surgically?

<3cm (as long as not distorting uterine cavity) e.g. IUS, TXA, COCP

1st line mx of magnesium sulphate induced respiratory depression?

Calcium gluconate

Mx of amniotic fluid embolism?

Supportive mainly

Patients on DOACs should be swapped to what in pregnancy?

LMWH

Foetal engagement vs station?

Engagement: When the largest part of the baby's head enters the pelvis Station: The baby's position relative to the ischial spines

What does a foetal station of 0 indicate?

the baby's head is at the bottom of the pelvis, or fully engaged.

When should women with multiple pregnancies avoid flying?

>32 weeks

What class of medication is tolterodine?

Antimuscarinic

When is oxytocin given for active mx of 3rd stage of labour?

After delivery of the anterior shoulder.

What is the genotype in androgen insensivity syndrome?

47XXY The child is genotypically male but presents as female phenotypically.

When should a VTE risk assessment be done in pregnancy?

At the booking visit (and on any subsequent hospital admission).

Mx of pregnant women with a previous VTE history?

Automatically considered high risk and requires LMWH throughout the antenatal period.

The assessment at booking should include risk factors that increase the womans likelihood of developing VTE. Name some of these risk factors

- Age >35 - BMI >30 - Parity >3 - Smoker - Gross varicose veins - Current pre-eclampsia - Immobility - Family history of unprovoked VTE - Low risk thrombophilia - Multiple pregnancy - IVF pregnancy

What is the treatment of choice for VTE prophylaxis in pregnancy?

LMWH

How many risk factors warrant immediate treatment with LMWH continued?

4 or more

How long should LMWH prophylaxis be continued for in pregnancy?

Until 6 weeks postnatal

At what age gestation would you expect the fundal height to increase by 1cm a week?

From 24 weeks gestation Concern if more/less than 1cm a week

What are the 2 SSRIs of choice in breastfeeding?

1) sertraline 2) paroxetine

High risk factors for pre-eclampsia?

1) hypertensive disease in previous pregnancy 2) CKD 3) autoimmune disease e.g. SLE, APS 4) type 1 or 2 diabetes 5) chronic HTN

Mx of all patients with secondary dysmenorrhoea?

need to be referred to gynaecology for investigation

Transvaginal or transabdominal US when assessing foetal movements?

Transabdominal is recommended

Are cephalosporins in breastfeeding considered safe to use?

Yes

How does an epidural affect BP during labour?

Can reduce BP

What is the most common ovarian cancer?

Serous carcinoma (epithelial)

What is the commonest type of ovarian cyst?

Follicular cyst

What are is the most common type of BENIGN ovarian tumour?

Serous cystadenoma bears a resemblance to the most common type of ovarian cancer (serous carcinoma)

What are the 2 types of benign ovarian epithelial tumours?

1) serous cystadenoma 2) mucinous cystadenoma

Is coagulopathy a contraindication to an epidural?

Yes

Are all pregnant women offered screening for hepatitis B?

Yes (booking scan)

Mx of babies born to mothers who are chronically infected with hepatitis B or to mothers who've had acute hepatitis B during pregnancy?

Babies should receive a complete course of vaccination + hepatitis B immunoglobulin

Does caesarean section reduces vertical transmission rates in hep B?

No - little evidence

Can Hep B be transmitted via breastfeeding?

No (in contrast to HIV)

What does a high voiding detrusor pressure with a low peak flow rate indicate?

Bladder outlet obstruction --> can result in overflow incontinence

What is the most risky form of breech presentation?

Footling presentation

What classic triad is seen in vasa praevia?

Rupture of membranes followed by: 1) painless vaginal bleeding 2) foetal bradycardia

COCP containing what may be helpful in PMS?

Drospirenone

In what form is steroids given in prematurity?

Dexamethasone

Risk factors for gestational diabetes?

1) BMI >30 2) previous macrosomic baby (≥4.5kg) 3) previous gestational diabetes 4) 1st degree relative with diabetes 5) family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

When are nulliparous vs multiparous women typically offered ECV?

Nulliparous: 36w Multiparous: 37w

How are ovarian cancers which are stage 2-4 primarily treated?

Surgical excision