GOSH Flashcards
Early medical abortion
less than 63 days (<9 WEEKS)
Late medical abortion
9-24 weeks
Medical method of early abortion <9 weeks
200mg of oral mifepristone - wait 24-48 hours – 400mg oral misoprostol
Medical method of early abortion 7-9 weeks
200mg of oral mifepristone – wait 24-48 hours- 800mg misoprostol given vaginally buccal or sublingual route.
If abortion hasn’t occurred within 4 hours of misoprostol, give a second dose of misoprostol 400mg vaginally or orally
Late medical abortion 9-13 weeks
200mg of oral mifepristone – wait 36-48 hours- give 800mg of misoprostol vaginally.
Max of 4 more doses of misoprostol 400mg can be given at 3 hourly rates.
If abortion doesn’t occur, mifepristone can be repeated 3 hours after last dose of misoprostol and then 12 hours after this dose of mifepristone, misoprostol may be recommended again
(so mifepristone- wait 36-48 hours- misoprostol- misoprostol (option 4x misoprostone)- no abortion-mifepristone- misoprostol)
Late medical abortion 13-24 weeks
200mg of oral mifepristone- wait 36-48 hours- give 800mg misoprostol vaginally, THEN misoprostol 400mg oral or vaginally 3 hourly (to a max of 4 doses)
If abortion doesn’t occur, mifepristone can be repeated 3 hours after last dose of misoprostol and then 12 hours after this dose of mifepristone, misoprostol may be recommended again
(so mifepristone- wait 36-48 hours- misoprostol- misoprostol (option 4x misoprostone)- no abortion-mifepristone- misoprostol)
Pain relief in abortions?
NSAIDS (not paracetamol!)
Some women may require additional narcotic analgesia, particularly after 13 weeks of gestation.
Risks unique to medical abortion compared to surgical abortion
- Unpredictable time to complete the procedure (variable)
- Side effects of drugs such as nausea, vomiting, diarrhoea, headache, dizziness, fever/chills (common)
- Undiagnosed ectopic pregnancy (1 in 7,000) for early medical abortion <10weeks
- Rupture of the uterus/womb (1 in 1000) for late medical abortion >10weeks
Surgical abortion up to 14 weeks?
Vacuum aspiration
- Cervical prep up to 14 weeks: Misoprostol 400mg vaginally 3 hours prior to sugery OR 2-3 hours sublingual prior to surgery (can be done by women or clinician)
- Access to ultrasound during vacuum aspiration is recommended but not routinely required for uncomplicated procedures
- Vacuum aspiration may be performed from 14 to 16 weeks of gestation using large-bore cannulae and suction tubing
Surgical abortion between 15-24 weeks?
Dilation and evacuation.
Need Cervical preparation after 14 weeks
Risks unique to SURGICAL ABORTION that arent in Medical abortion
- Injury to the cervix (1 in 11,000) for VA, 1 in 5,000 for D&E)
- Perforation of the uterus/womb (1 in 6,500 for VA, 1 in 2,500 for D&E)
- Injury to bowel, bladder or serious injury to cervix (very rare)
- Repair of damage to cervix, uterus, bladder, bowel or blood
Chlam treatment
1g oral Azithromycin (single dose)
OR
100mg oral Doxy- 2 x 7/7days
Gonn treatment
250mg IM Ceftriaxone (single dose)
AND
1g oral Azithromycin (single dose)
Genital herpes treatment
FIRST EPISODE: 400mg oral aciclovir 3 x (7-10 days)
REPEAT EPISODES: 800 mg oral aciclovir 2 x (3-5 days)
Paracetamol, ibulprofen, sitz bath
Genital warts treatment
Podophyllotoxin topical (0.5%)- apply to affected area twice a day for 3 days, then no treatment for 4 days. Can repeat this cycle (3 days on, 4 off) up to 4 cycles.
Imiquimod topical (5%)- apply to the affected area three time a week at bedtime for 16 weeks, leave for 6-10 hours before washing off
Syphilis treatment
1.8g IM Benzathine benzylpenicillin (single dose)
What treatments are safe in pregnancy and when breastfeeding for VTE?
Unfractionated heparin
LMWH (ie. Tinzaparin)
-> Heparin and LMWH dont cross the placenta
(NOT Warfarin and only give clot busters if life threatening)
- Only exception for warfarin is for women with mechanical prosthetic heart valves and can give between 12-36 weeks.
Treatments for haemorrhageeeeeesss (there are 5)
Syntocinon- IV 5unit bolus
Syntometrine- IM Bolus
- For third stage of labour
- Combination of Oxytocin 5 units and Ergometrine 500mcg
Misoprostol- PR 800mcg
- Prostaglandin E1
Haemabate (carboprost) - IM 250 mcg
Tranexamic acid - 1g stat iv
- antifibrinolytic
Treatment for ectopic pregnancy
Methotrexate
Which of the following analgesia are safe in pregnancy?
- Paracetamol
- Opiates
- Entonox
- NSAIDS
- Paracetamol= YES
- OPIODS= YES (kinda)- cause neonatal respiratory depression but generally safe inc codeine / diamorphine
- Enonox- YES
- NSAIDS= NO NO NO - miscarriage and malformation in 1st trimester, premature closure of the ductus arteriosus in 3rd trimester e.g. don’t give diclofenac- EXCEPTION IS LOW DOSE ASPIRIN
What do you prescribe for UTI in pregnancy?
Cephalosporins and penicillins safe
(examples of cephalosporins: cefalexin, cefotaxime, meropenem, ertapenem)- BUT avoid co-amoxiclav in pregnancy due to risk of neceroising enterocolitis (NEC) in baby.
- AVOID trimethoprim in 1st trimester
- AVOID nitrofuraton in 3rd trimester (can give in 1st and 2nd)
- AVOID Tetracyclines (tooth decolouration)
Treatment for RTI in pregnancy?
Penicillins and Macrolides are safe.
Treatment for PPROM Preterm Prelabour Rupture of Membranes?
Erythromycin 250mg QDS Oral for 10 days to prevent chorioamnionitis
Treatment for Chorioamnionitis?
Cefuroxime (cephalosporin) 1.5g tds IV
AND
Metronidazole 500mg tds IV
