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Oishi's 5th year flashcards > Hard to recall O&G > Flashcards

Hard to recall O&G Flashcards

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1
Q

What syndrome do anti-epileptics during pregnancy cause?

A 
Fetal Hydantoin Syndrome:
IUGR
Microcephaly
Cleft palate
Mental retardation
Hypoplastic fingernail defects
Distal limb deformities
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2
Q

Causes of omphalocele?

A

Trisomy 13
Trisomy 18
Exomphalos-macroglossia-gigantism syndrome

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3
Q

Most likely cause for DIC in a pregnant woman?

A

Placental abruption

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4
Q

4 features of isoimmunisation in a fetus?

A
  1. Erythroblastosis fetalis with haemolytic anaemia and erythroblasts on blood film
  2. Jaundice and hepatosplenomegaly
  3. Kernicterus
  4. Hydrops fetalis
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5
Q

What structures are at risk of damage following sacrospinous fixation for Tx of vaginal vault prolapse?

A

Sciatic nerves

Pudendal vessels

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6
Q

What nerve can be damaged by the lithotomy position and in abdomino-pelvic surgery?

A

Femoral nerve

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7
Q

When is pregnancy does breast enlargement and darkening occur?

A

12 weeks

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8
Q

Fetal indications for IOL?

A 
Post-due date
Fetal growth restriction
Certain diabetic pregnancies
Deteriorating haemolytic disease
Deteriorating fetal abnormalities
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9
Q

Maternal indications for IOL?

A

Pre-eclampsia
Deteriorating medical conditions
If Tx for malignancy needed

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10
Q

Why does shoulder tip pain occur?

A

Free intraperitoneal fluid irritating diaphragm

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11
Q

What kind of incontinence can alpha-adrenergic blockers cause?

A

Stress incontinence

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12
Q

Symptoms of PMS?

A
  1. Psychological: depression, anxiety, mood swings
  2. Behavioural: aggression
  3. Physical: breast tenderness, abdo bloating
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13
Q

Causes of hypogonadotrophic hypogonadism?

A

Kallman syndrome

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14
Q

Clinical features of Kallman syndrome

A 
Absent/delayed puberty
Hyposmia/anosmia
Colour blind
Unilateral kidney agenesis
Cleft lip
Bimanual synkinesia
Primary amenorrhoea
Cryptorchidism
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15
Q

Hormone profile in Kallman syndrome?

A

Low GnRH
Low FSH
Low LH
Low oestradiol

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16
Q

Causes of primary hypogonadism?

A

Klinefelter’s

Turner’s syndrome

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17
Q

Hormone profile in primary hypogonadism?

A

High GnRH
High FSH
High LH
Low oestradiol

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18
Q

Hormone profile in secondary hypogonadism?

A

High GnRH
Low FSH
Low LH
Low oestradiol

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19
Q

What does incomplete fusion of the paramesonephric ducts result in?

A

Bicornuate or septate uterus

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20
Q

When should HIV+ve women not on ART start meds while pregnant?

A

Start combined ART by 24 weeks and continue life long

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21
Q

First line Mx of severe allergic rhinitis in pregnancy?

A

Oral loratadine

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22
Q

During pregnancy what happens to tidal volume and minute ventilation?

A

They both increase

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23
Q

Features on congenital rubella syndrome?

A 
Sensorineural deafness
Congenital heart defects - paten ductus arteriosus
Congenital glaucoma
Cataracts
Microcephaly
Hepatosplenomegaly and jaundice
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24
Q

Definition of polyhydramnios?

A

AFI >95th centile (2-3L or 25cm of amniotic fluid)

Deepest vertical pool >8cm

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25
What type of cysts do molar pregnancies cause?
Bilateral theca lutein cysts
26
Pathogenesis of ovarian stromal hyperthecosis?
Hyperplasia of ovarian stroma with clusters of luteinising cells within
27
Features of ovarian stromal hyperthecosis?
Increased androstenedione and testosterone = virilism and hirsutism Conversion of androgen to oestrogen in peripheries = endometrial hyperplasia and AUB
28
Tx for ovarian stromal hyperthecosis?
Pre-menopausal: COCP + lifestyle measures | Post-menopausal: bilateral oophorectomy
29
What is the histological appearance of fibroids?
Smooth muscle bundles in a whorled appearance
30
Define true intersex
Individual who carries both male and female gonads
31
Define pseudointersex
Individual has phenotype and secondary sexual characteristics different to what is defined by their karyotype and gonads. Can be male or female intersex
32
Explain male intersex, it's most common cause and how it would present
46XY and testes Phenotypically female Presents with primary amenorrhoea Most common cause is complete androgen insensitivity
33
Explain female intersex, it's most common cause and how it would present
46XX and ovaries Phenotypically male Most common cause is congenital adrenal hyperplasia
34
Features of fragile X syndrome
``` Narrow face Large ears Large testicles Mental retardation Developmental delay ```
35
Inheritance of fragile X syndrome?
X-linked dominant
36
What syndrome does warfarin use in 1st trimester cause?
Conradi-Hunermann syndrome
37
Clinical features of Conradi syndrome (warfarin in 1st trimester)?
``` Saddle nose Frontal bossing Short stature Epiphyseal stippling Optic atrophy Cataracts ```
38
Which trimester is warfarin safe in?
2nd
39
What does warfarin increase risk of in 3rd trimester?
fetal or neonatal haemorrhage
40
Monitoring for diabetes in PCOS
If OGTT shows impaired glucose tolerance: Annual OGTT | If OGTT normal: Annual random fasting glucose
41
Another name for leydig cell tumour?
Hilus cell tumour
42
Features of leydig cell tumours?
Virilisation
43
Features of McCune-Albright syndrome?
Bone and ovarian cysts Cafe au lait spots Precocious puberty
44
Tx for McCune-Albright syndrome?
Cyproterone acetate (anti-androgenic progestogen)
45
What enzyme is deficient in congenital adrenal hyperplasia?
21-hydroxylase
46
Explain 46XY gonadal dysgenesis and how it might present
Phenotypically female Mullerian structures present but gonad may remain a streak Delayed puberty as gonads do not function
47
Explain 5-alpha reductase deficiency
``` XY Mutation in SDR5A2 gene Testes but cannot virilise Fetus has ambiguous genitalia Infertile ```
48
What karyotype is Turner's syndrome?
46XO
49
Clinical features of Turner's syndrome?
* Poor growth * Short stature * Webbing of the neck * Wide carrying angle due to in-turned elbows * Short fourth metacarpals or metatarsals * Delayed/absent pubertal development * Primary amenorrhoea
50
What medical conditions are associated with Turner's syndrome?
``` o Coarctation of the aorta o Inflammatory bowel disease o Sensorineural and conduction deafness o Renal anomalies o Endocrine dysfunction e.g. thyroid disease ```
51
What effect does 21-hydroxylase deficiency on the hormone pathway?
No cortisol and aldosterone | Increased adrenal androgens
52
Tx of nipple thrush?
2% miconazole cream for 14 days | Can put in infants mouth if >4 months old
53
Examination findings of tongue tie?
Limited tongue movements - not past lips or up and down A heart-shaped notch forms when you try to lift tongue In posterior tongue tie the frenulum is not visible
54
UTI Tx in pregnancy?
Nitrofurantoin 100mg modified release BD for 7 days (avoid at term - neonatal haemolysis) Alternative amoxicillin or cephalexin
55
When to offer ELCS to women with HIV? Indications?
38 weeks HIV co-infection with Hep C Zidovudine monotherapy Women on HAART with viral load >50copies/ml
56
Why is aspirin contra-indicated in breast-feeding?
Risk of Reye's disease in newborn
57
What does the progesterone challenge test involve and show?
Medroxyprogesterone acetate 5mg TDS for 5/7 | Positive = vaginal bleeding --> functioning endometrium and outflow tract
58
Oral tx for acne and hirsuitism in PCOS? | Topical tx for hirsutism?
PO Cyproterone acetate | Topical eflornithine cream
59
What percentage of complete molar pregnancies go on to become invasive?
15%
60
How long does vulvodynia need to have lasted for by definition?
3 months
61
Which subset of menopausal women is fluoxetine contra-indicated in?
Breast cancer CURRENTLY receiving tamoxifen
62
Molar pregnancies are strongly associated with dysfunction of which gland?
Thyroid
63
Describe the path of the pudendal nerve
1. Leaves pelvis through greater sciatic foramen between piriformis and coccygeus 2. Crosses ischial spine 3. Re-enters pelvis via lesser sciatic foramen 4. Enters Alcock's canal on lateral wall of ischiorectal fossa with internal pudendal vessels
64
How to locate the pudendal nerve trunk?
1cm below and medial to ischial spine
65
How long can you wait for the placenta to deliver?
1 hour | Give adjuncts of IM syntocinon and breastfeeding to stimulate its expulsion
66
WHO breastfeeding recommendations?
Initiate in first hour of infant's life (in babies born to mothers with DM should be within 30 mins) Exclusive breastfeeding for 6 months Combination of foods and breastfeeding up to 2 years and beyond
67
What is used to induce multiple ovulatory events in an IVF cycle?
Human menopausal gonadotrophin + clomiphene citrate | Adjunct: FSH
68
Thyroxine recommendations in pregnant women with hypothyroidism?
Increase levothyroxine by 25mcg asap even if euthyroid | Check TFTs in 2 weeks
69
Histology of condylomata?
HPV 6 and 11 Basilar hyperplasia Binucleated and multinucleated cells
70
The most common type of incontinence in women?
Stress
71
When do women who have had Tx in colposcopy need to be reassessed?
Test of cure in 6 months | If normal - recalled in 3 years regardless of age
72
In complete androgen insensitivity syndrome why do the uterine structures not develop?
The undescended testes produce anti-Mullerian hormone
73
Karyotype of Klinefelter's?
47,XXY
74
Features of Klinefelter's?
``` Tall stature Hypogonadism - infertility Gynaecomastia Sparse facial/axillary/pubic hair Delayed motor and language development ```
75
What do Klinefelter's phenotypically present with genitalia wise?
Normal male external genitalia
76
What is the role of 5-alpha reductase?
Converts testosterone to more potent dihydrotestosterone which drives sexual development
77
What Tx should babies born to mothers with HIV receive?
First dose of ART within 4 hours of birth | Continue until 4-6 weeks
78
When should babies born to mothers with HIV have blood PCR tests?
``` Within 2 days of birth At discharge 6 weeks 12 weeks 18 months ```
79
What is the most common cause of neonatal metabolic disorder?
Hypoglycaemia
80
When should BMs be checked in infants born to mothers with diabetes?
2-4 hours after birth
81
Where does each invasive cancer first metastasise to? 1. Cervical 2. Ovarian 3. Vulval 4. Endometrial
1. Pelvic lymph nodes along the iliac arteries 2. Para-aortic lymph nodes 3. Superficial inguinal lymph nodes 4. Iliac artery lymph nodes
82
What test is diagnostic of antiphospholipid syndrome?
Lupus anticoagulant +/- anti-cardiolipin antibody
83
Features of antiphospholipid syndrome?
``` Recurrent or atypical venous thrombosis Arterial thrombosis Recurrent miscarriage/late fetal loss Pre-eclampsia IUGR Thrombocytopenia ```
84
Anticoagulation during pregnancy with antiphospholipid syndrome?
Low dose aspirin + LMWH
85
Define unprovoked vulvodynia
Chronic vulvovaginal pain lasting at least 3 months
86
1st line Tx of unprovoked vulvodynia?
Amitryptyline
87
Define uterine hyperstimulation syndrome
>6 contractions every 10 mins | <60s between contractions
88
Where do the gonads descend from during embryological life?
T10 vertebral level
89
Where does pain from ovaries or testes get referred to?
T10 - umbilicus
90
How does Addison's disease cause premature menopause?
Steroid cell auto-antibodies cross-react with theca interna/granulosa layers of ovarian follicles
91
Number of miscarriages and % chance or successful subsequent pregnancy
1: 85% 2: 75% 3: 60%
92
How does lichen planus present?
Purple/red plaques usually on labia with central erosion | Overlying lacy, white, striated patch
93
What is a krukenburg tumour?
Gastric carcinoma which has metastasised to ovary
94
Histology of krukenburg tumour?
Signet ring cells
95
Most common ovarian tumour in over 50 year olds? | In 20-50 year olds?
Serous adenocarcinoma | Mucinous cystadenoma
96
When do Hep B vaccinations for infants born to mothers with hep B occur?
Birth 4 weeks 8 weeks 1 year
97
Indications for ELCS?
``` HIV Primary genital herpes in 3rd trimester Placenta praevia major Twin pregnancy where first baby is breech Singleton breech at term after ECV fails ```
98
What is normal baseline fetal heart rate?
110-160bpm
99
Causes of fetal tachycardia?
``` Hypoxia Anaemia (fetal) Fetal distress Maternal pyrexia Chorioamnionitis Exogenous beta-agonist use ```
100
Cause of baseline fetal bradycardia?
``` Severe fetal distress - secondary to abruption or rupture Hypotension Maternal sedation Post-dates OP or transverse position Hypoxia ```
101
What is normal variability?
5-25bpm
102
How many accelerations would you expect to see normally antenatally?
At least 2 accelerations every 15 mins
103
Define an acceleration
Increase in fetal HR by 15bpm for at least 15sec
104
What do variable decelerations suggest?
Cord compression
105
What do late decelerations suggest? | Causes?
``` Fetal distress - asphyxia, hypoxia, placental insufficiency Causes: - maternal hypotension - pre-eclampsia - uterine hyperstimulation ```
106
Describe a sinusoidal trace and what it indicates
10mins of smooth wave baseline with no variability | Suggests fetal anaemia/hypoxia
107
How can you tell if a fetus is OP?
Anterior - diamond shaped fontanelle | Posterior - Y shaped fontanelle
108
In which anatomical location does fertilisation occur?
Ampulla of fallopian tube
109
What is the max dose of prostaglandin for IOL?
6mg/day
110
Complications of IOL + augmentation of labour?
``` Failure of induction Uterine hyperstimulation Nausea, vomiting and diarrhoea Water intoxication Uterine rupture ```
111
Which measurement is most reliable indicator of gestational age in first trimester? When should you switch to head circumference?
Crown-rump length | Once it is above 84mm
112
Which measurement is used to calculate gestational age after 14 weeks
Bi-parietal diameter or head circumference
113
Cytologically describe features of dyskaryotic cells in CIN
Anaplasia Increased nuclear:cytoplasmic ratio Hyperchromatism Multinucleation
114
Symptoms of listeria infection in pregnancy?
``` Fever Headache Malaise Back ache Abdo pain Pharyngitis Conjunctivitis ```
115
Sequelae of listeria infection in pregnancy?
Miscarriage Still birth Preterm delivery Neonatal listeriosis (50% mortality)
116
Tx of listeria infection?
High dose penicillin
117
Risk of parvovirus in 2nd trimester?
Hydrops fetalis
118
Define engagement
When less than 2/5ths of the head can be palpated abdominally
119
What is the maximum number of contractions associated with traction that should be used in instrumental delivery before EMCS
3
120
Which forceps can be used if fetus is OP
Kielland's forceps
121
when can chorionic villus sampling take place?
11-14 weeks
122
What are the most common type of twins?
Dizygotic dichorionic diamniotic
123
What is the most common type of monozygotic twin?
Monozygotic monochorionic diamniotic
124
Requirements for twin-to-twin transfusion syndrome?
Must be monochorionic
125
When does twin-to-twin transfusion syndrome most commonly occur?
Monozygotic monochorionic diamniotic
126
What is the main hormone produced by the corpus luteum?
Progesterone
127
Infectious causes of miscarriage? (TORCH)
``` Toxoplasmosis Other infection Rubella CMV HIV ```
128
Main causative pathogens of chorioamnionitis?
E coli Streptococcus Enterococcus faecalis
129
Which term describes transition from left occipitotransverse position to OA position as head passes through pelvis?
Internal rotation
130
Define gravida
Number of times woman has been pregnant regardless of gestation at delivery
131
Define parity
Number of deliveries including all live births (even <24 weeks) and stillbirths after 24 weeks 1st number: any birth after 24 weeks 2nd number: all pregnancies up to 24 weeks which did not result in live birth
132
What is the gold standard test for tubal patency?
Diagnostic laparoscopy and dye test
133
What does a fundal placenta increase risk of?
Uterine inversion
134
What is the by-product of female gametogenesis?
polar body
135
What does T sign indicate?
Monochorionic twins
136
What does lambda sign indicate?
Dichorionic twins
137
Explain Naegele's rule
LMP + 7days + 9 months
138
Components of APGAR score?
``` Appearance Pulse Grimace Activity Respiration ```
139
What does obstetric cholestasis increase risk of?
Preterm birth Respiratory distress syndrome - meconium aspiration Fetal death
140
Define the 4 categories of C-section
1. Immediate threat to life of woman or fetus (30 mins) 2. Maternal/fetal compromise but not immediately life threatening (30-75 mins) 3. No maternal/fetal compromise but requires early delivery 4. At a time to suit woman and health care services
141
What does being able to ballot the fundus and a heartbeat above the umbilicus suggest?
Breech position
142
Which movement occurs during crowning of the head?
Extension
143
Down's syndrome screening - what is considered a positive result?
risk above 1:250
144
List 2 frequent risks of C-section
1. Persistent wound and abdo discomfort | 2. Increased risk of c-section in later pregnancies
145
How long does spermatogenesis take?
64 days
146
Explain the 5 steps of spermatogenesis.
1. Primordial germ cells into spermatagonia 2. Spermatagonia into primary spermatocytes (46 chromosomes) 3. Primary spermatocytes into secondary spermatocytes (23 double stranded chromosomes) 4. Secondary spermatocytes into spermatids (23 single chromosomes) 5. Spermatids into spermatozoa (mature)
147
Define asthenospermia
Poorly motile sperm
148
Define azoospermia
Complete absence of sperm
149
Define oligospermia
Low sperm count
150
Define teratospermia
Morphologically defective
151
Define leucospermia
Infection in sperm
152
What does VBAC increase risk of?
Uterine rupture (risk increases if oxytocin used)
153
Most common cause of secondary PPH? Time frame for secondary PPH?
Infection followed by retained products | 24 hours - 12 weeks
154
Which hormone promotes proliferation of glandular and stromal elements of the endometrium?
Oestradiol
155
Where is oestradiol secreted?
Ovary
156
Which type of ovarian tumours cause pseudomyxoma perotonei?
Mucinous
157
When should labour be induced in each of: MCMA MCDA DCDA?
MCMA: 32 - 33+6 weeks MCDA: 36 - 36+6 weeks DCDA: 37 - 37+6 weeks
158
Which vaccinations are offered in pregnancy?
Whooping cough | Seasonal flu/influenza
159
How many cycles of IVF should women <40 be offered under NICE guidelines?
3
160
Criteria for IVF <40 under NICE guidelines?
1. Unable to get pregnant through regular unprotected sex for 2 years 2. Unable to get pregnant after 12 cycles of artificial insemination
161
How many cycles of IVF should women aged 40-42 be offered under NICE guidelines?
1
162
Criteria for IVF aged 40-42 under NICE guidelines?
1. Unable to get pregnant through regular unprotected sex for 2 years 2. Unable to get pregnant after 12 cycles of artificial insemination 3. Never had IVF before 4. No evidence of low ovarian reserve 5. They've been informed of the additional implications of IVF and pregnancy at this age
163
Is it safe to breastfeed with Hep B?
Yes
164
Causes of oligohydramnios?
``` premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia ```
165
What does the combined test for Downs involve?
Nuchal translucency (>6mm) PAPPA A beta hcg
166
What does the quadruple test involve? When is it applicable?
``` Unconjugated oestradiol hCG AFP Inhibin A 15-20 weeks ```
167
What are obese women recommended to take?
5mg folic acid | 10mg Vit D
168
Routine antenatal screening for which 3 diseases?
Hep B Syphilis HIV
169
How much does stroke volume increase by in pregnancy?
30%
170
In HIV pregnant women what should be avoided?
Forceps Amniocentesis Fetal blood sampling
171
With herpes infection of genitalia - how many weeks are required between infection to clear and vaginal delivery to be possible rather than caesarean?
6 weeks
172
Absolute contraindications to ECV?
Multiple pregnancy APH Major uterine abnormality Ruptured membranes
173
What does SLE in pregnancy increase risk of?
``` Spontaneous miscarriage Fetal death Pre-eclampsia Preterm delivery Fetal growth restriction ```
174
Features of Pruritic urticarial papules and plaques of pregnancy (PUPPP)? AKA polymorphic eruption of pregnancy
Itchy rash which appears on stretch marks late in pregnancy Spares umbilicus Can extend to buttocks and limbs and lesions often become confluent
175
Features of Pemphigoid gestationis?
blistering condition that starts in the umbilicus and spreads
176
Features of Prurigo gestationis?
excoriated papulitic rash of the trunk and extensor surfaces of upper limbs and shoulders with abdominal sparing.
177
Features of Impetigo herpetiformis?
blistering condition that always presents with a febrile illness and if not treated early can lead to maternal and fetal death
178
In pregnancy what are the blood glucose targets before and after eating in a diabetic?
before every meal the blood sugar should be less than 5.5μmol/L 1 hour after a meal less than 7.8μmol/L.
179
What is another term for a blighted ovum and what would you see on USS?
Anembryonic pregnancy USS: gestational sac with no developing embryonic pole or yolk sac development
180
By 6 weeks what should you see on USS?
Fetal pole and fetal heart
181
If at 6 weeks you see a yolk sac what does it suggest and what is the next step?
Pregnancy of unknown viability | Repeat TVUS in 10-14 days
182
What does a pseudosac represent and what dx is it suggestive of?
decidualized reactive tissue | Suggests ectopic pregnancy
183
What is the risk of bladder injury in c section?
1 in 1000
184
What type of cancer are patients with pcos at higher risk of?
Endometrial
185
When is risk of VTE highest in people on HRT?
In first year
186
Chance of ovarian cancer with RMI <50?
3% --> watchful waiting advised
187
What is triptorelin?
a gonadotrapin-releasing hormone agonist that creates a temporary artificial menopause by reducing the FSH and LH levels.
188
When is it useful to use triptorelin and how long for
Before laparoscopy for 6 months in patients with severe endometriosis
189
What is the main function of progesterone?
enhance endometrial receptivity
190
Tx for severe PMS?
``` SSRIs Vit B6 Improved diet and exercise CBT Combined OCP ```
191
Tissues cut through during episiotomy?
Vaginal membrane Perineal membrane Bulbospongiosus Superficial transverse perineii (STP)
192
CTG sensitivity and specificity
high sensitivity | low specificity
193
Absolute contraindications to epidural?
``` Uncontrolled hypotension Allergies to anaesthetics Systemic infection Skin infection over epidural site Coagulopathy ```
194
Branches of the pudendal nerve?
``` inferior anal nerve inferior haemorrhoidal nerve perineal nerve dorsal nerve of clitoris posterior labial nerve ```
195
Findings in DIC?
``` increased PT increased APTT decreased platelets increased bleeding time active haemorrhage ```
196
Complications of toxoplasmosis in pregnancy for neonate?
Classic triad: intracranial calcifications, chorioretinitis, hydrocephaly macro- or microcephal convulsions long-term neurodevelopmental delay
197
Which procedure carries the greatest risk of haemorrhage in the newborn?
Prolonged ventouse delivery
198
What is looked at in semen analysis and what are the normal ranges?
1. Volume 1.5 - 6mL 2. pH 7.2 - 8 3. Morphology normal >4% 4. Motility normal >50% 5. Count >15 million/mL
199
Markers of pelvic outlet?
inferior margin of the pubic symphysis (pubic arch) ischial tuberosities (left and right, sometimes called the ischial spines) tip of coccyx
200
What nerve supplies the labia majora?
Posterior labial artery from internal pudendal artery
201
How to calculate RMI?
USS x menopause x CA125 USS (1 point out of 5 for each concerning feature) post-menopause x3
202
What drug is used to reverse magnesium sulphate induced respiratory depression?
Calcium gluconate
203
Factors increasing risk of miscarriage?
``` Increased maternal age Smoking in pregnancy Consuming alcohol Recreational drug use High caffeine intake Obesity Infections and food poisoning Health conditions, e.g. thyroid problems, severe hypertension, uncontrolled diabetes Medicines, such as ibuprofen, methotrexate and retinoids Unusual shape or structure of womb Cervical incompetence ```
204
When should LMWH Tx for DVT in pregnancy be monitored and using which test?
Women at extremes of body weight Co-morbidities e.g. renal impairment Test used: Anti-Xa activity
205
When should prophylactic VTE therapy be recommended?
4+ risk factors = immediate prophylaxis | 3 risk factors = from 28 weeks
206
List some of the risk factors for VTE prophylaxis
``` Age > 35 Body mass index > 30 Parity > 3 Smoker Gross varicose veins Current pre-eclampsia Immobility Family history of unprovoked VTE Low risk thrombophilia Multiple pregnancy IVF pregnancy ```
207
When is a Kleihauer test required?
Any sensitisation event after 20 weeks
208
Swift's mnemonics to remember Down's, Edward's and Patau's?
Down’s is “HIgh” (↑hCG ↑inhibin) Edwards - “HE is low” (↓hCG ↓estriol) Patau is high (↑AFP)
209
Causes of increased AFP?
Patau Neural tube defects (meningocele, myelomeningocele and anencephaly) Abdominal wall defects (omphalocele and gastroschisis) Multiple pregnancy
210
Causes of decreased AFP?
Down's syndrome Trisomy 18 Maternal diabetes mellitus
211
Suspected endometritis Tx and what to do?
Admit | IV clindamycin and gentamicin until afebrile for >24hours
212
What are the glucose targets for self-monitoring pregnant women with gestational or pre-existing diabetes?
Fasting: 5.3mmol/L 1 hour after meal: 7.8mmol/L 2 hours after meal: 6.4mmol/L
213
What are some symptoms of TTTS a mother should look out for and why might they occur?
Any sudden increases in the size of their abdomen and/or any breathlessness, which may be the result of polyhydramnios affecting the recipient twin
214
Causes of increased nuchal translucency?
Down's Congenital heart defects Abdominal wall defects
215
long term complications of hysterectomy with anterior posterior repair?
enterocele | vaginal vault prolapse
216
When is continuous CTG monitoring in labour warranted?
Suspected chorioamnionitis/sepsis or temp of 38+ Severe HTN 160/110+ Oxytocin use Presence of significant meconium Fresh vaginal bleeding that develops during labour
217
Which scan allows you to determine gender of a baby?
Fetal anomaly scan
218
Indications for fetal echocardiography in second trimester?
Mother with congenital heart disease Mother with T1DM Mother with epilepsy on certain meds Previous child with congenital heart defect that required surgical correction Inadequate/abnormal view of heart on routine second trimester scan High-risk NT result
219
What feature is seen on CTG during fetal sleep?
Reduced variability
220
In fetal blood sampling what pH is considered normal and can allow labour to continue?
pH >7.25
221
What is a borderline result in fetal blood sampling and what does it mean in terms of management?
pH 7.2 - 7.25 | Repeat pH needed in 30-60mins
222
What is an abnormal result in fetal blood sampling and what does it mean in terms of management?
pH <7.2 confirms fetal compromise | Immediate delivery
223
Use of what drug in preterm labour is associated with necrotising enterocolitis?
Co-amoxiclav
224
What happens to RR during pregnancy?
Stays the same
225
What happens to renal blood flow during pregnancy?
Increases
226
What happens to albumin during pregnancy?
Decreases
227
What must the bishop score be minimum to consider ARM?
5
228
Features of fetal varicella syndrome?
Skin scarring Neuro defects Eye defects Limb hypoplasia
229
What is the venous drainage of the right ovary?
IVC
230
What are the 3 parts of the broad ligament?
Uterus: mesometrium Uterine tube: mesosalpinx Ovary: mesovarium
231
Which morning after pill does not interact with the progesterone only pill?
Levonorgestrel (Levonelle)
232
During labour, what is required for easy passage into mid-cavity of the pelvis?
Flexion
233
What stage of labour is when the levator ani muscles help the head move into the OP position?
Internal rotation
234
What term describes when the head moves into alignment with the shoulders before they are delivered?
External rotation (restitution)
235
How does cancer of the fallopian tube present?
Intermittent abdo pain relieved by sudden watery discharge
236
What does a posterior chin on delivery mean?
Emergency C section - can't deliver vaginally due to large occiput
237
What drug is preferred in tx of hyperthyroidism when breastfeeding?
Propylthiouracil
238
What hormone is produced in peripheral adipose tissue?
Oestrone
239
If division of the embryo occurs at <3 days after fertilisation what type of twins are produced?
Monozygotic dichorionic diamniotic
240
If division of the embryo occurs at 4-8 days after fertilisation what type of twins are produced? What type are produced after 8 days?
Monozygotic monochorionic diamniotic | Monochorionic monoamniotic
241
What measurement can provide info regarding fetal neurological status and tone?
Biophysical profile
242
RFs for vulval cancer?
Lichen sclerosus HPV (16) Smoking Immunosuppression
243
Most common type of vulval cancer and what is it associated with?
Squamous cell carcinoma - lichen sclerosus
244
RF for vaginal cancer?
DES (diethyltilbestrol use in maternal pregnancy)
245
What kind of vaginal cancer do teenagers get and why?
Clear cell adenocarcinoma due to DES
246
What kind of vaginal cancer do older women get?
Squamous cell carcinoma
247
Which syndromes is PAPP-A low in?
Down's Edward's Patau's
248
Which type of contraception is least affected by enzyme inducers?
Depo-provera
249
What are we specifically looking for in PET bloods?
FBC - low platelets LFTs - high ALT U&Es - high creatinine
250
What % of shoulder dystocia is corrected with McRobert's?
90%
251
NICE cut offs for oral iron supplementation in pregnancy?
Booking visit <11g/dL | 28 weeks <10.5g/dL
252
Who is intracytoplasmic sperm injection suitable for?
Low sperm count (oligospermia) | Problems maintaining erection/ejaculation
253
Who is intrauterine insemination suitable for?
Azoospermia (no sperm) If a partner has an infectious disease e.g. HIV If there is high risk of transmitting a genetic disorder Same sex couples
254
If a woman develops chicken pox during pregnancy when should she be referred to fetal medicine?
5 weeks after infection
255
Which emergency contraception requires a doubling of dose in patients >70kg or BMI >26?
Levonorgestrel
256
When to offer ECV?
At 36 weeks for nulliparous women | At 37 weeks for multips
257
When does red degeneration typically present?
Mid second trimester
258
Risk factors for vasa praevia?
Multiple pregnancy | IVF
259
1st line tx for endometrial hyperplasia without atypia?
LNG-IUS
260
If a patient with an IUD requires tx for PID when should they be reviewed?
After 72 hours - if symptoms have not improved consider removing IUD
261
If previous GDM when to have ogtt?
OGTT asap after booking visit | If no GDM at booking then another OGTT at 24-28 weeks
262
Ix for women with pre-existing T1 or T2DM in pregnancy?
HbA1c at booking | Renal and retinal assessment
263
Features of listeria infection in pregnancy?
Spontaneous abortion Premature Pustular skin lesions Neonatal meningitis and sepsis
264
When is rubella most likely to undergo vertical transmission?
8-10 weeks (90%)
265
Features of rubella infection in a pregnant woman?
Rash Fever Lymphadenopathy
266
Features of congenital CMV?
``` IUGR Chorioretinitis Periventricular calcifications Sensorineural deafness Microcephaly ```
267
Time frame for vacuum aspiration?
10-14 weeks
268
Time frame for dilatation and evacuation?
After 14 weeks
269
Risks of NSAIDs in pregnancy?
PPHN Premature ductus arteriosus closure Oligohydramnios
270
Which USS findings contribute to RMI?
``` Multiloculated cysts Solid areas Bilateral lesions Ascites Intra-abdominal mets ```
271
Next step for patients with a high RMI?
CT or MRI for staging
272
Steps in managing major PPH?
1. IV/IM syntocinon 2. IM carboprost 3. Balloon tamponade 4. B-lynch suture 5. Hysterectomy
273
Features of congenital syphilis?
Skeletal abnormalities Hepatosplenomegaly Rhinitis
274
Tx of syphilis in pregnancy?
IM benzathine penicillin
275
Indications for tx for lactational mastitis and how long/what is tx for?
Persistent symptoms after 12-24hrs of effective milk removal Nipple fissures Systemically unwell 10-14 days of flucloxacillin
276
What are Call-Exner bodies and what are they pathognomonic of?
Eosinophilic fluid filled spaces between granulosa cells | Granulosa cell tumours
277
Who do granulosa cell tumours usually present in and symptoms?
Pre-pubertal girls - precocious puberty | Post-menopausal women - PMB
278
Most common type of malignant germ cell tumour and features?
Dysgerminoma Young girls Associated with hypercalcaemia and excess beta-hCG
279
Alternative to metformin in GDM if not tolerated?
Glibenclamide
280
Risks of polyhydramnios?
Preterm delivery Cord prolapse Placental abruption Malpresentation
281
Definition of oligohydramnios?
AFI <5cm
282
Risks of oligohydramnios?
Stillbirth Limb contractures Incomplete lung maturation
283
Indications for planned C-section?
``` Breech at term Multiple pregnancy Placenta praevia Suspected morbidly adherent placenta Women with HIV not on ART or viral load >400copies/mL Women with HIV and Hep C Women with primary HSV in 3rd trimester ```
284
What is a severe obstetric cholestasis classed as? When should they be delivered?
Bile acids >40micromol/L | 36 weeks
285
RFs for endometritis?
Prolonged rupture of membranes Prolonged labour C section PPH
286
Surgical mx for urge incontinence?
Botox injections Percutaneous tibial nerve stimulation Sacral nerve stimulation Augmentation cystoplasty
287
Define prolonged second stage of labour
Active second stage of more than 1 hour in multips and more than 2 hours in nullips
288
Requirements for delivery with neville barnes forceps? (FORCEPS)
``` Fully dilated OA position Ruptured membranes Cephalic presentation Engaged presenting part Pain relief adequate Sphincter (empty bladder) ```
289
Which instruments can be used to rotate a baby in OP position? Which is most successful?
Ventouse | Kielland forceps - most successful
290
How low does gestational thrombocytopenia platelet count usually go? And when does it usually occur?
70x10(9)/L | 3rd trimester
291
When does ITP usually occur in pregnancy? What is the risk? Tx?
1st trimester Risk = neonatal thrombocytopenia - intracranial haemorrhage Tx = steroids or IVIG
292
Minimum platelet count for epidural? | Minimal platelet count for safe delivery?
Epidural = 70x10(9)/L | Safe delivery = 50x10(9)/L
293
After what beta-hCG level are intrauterine pregnancies usually visible? How many weeks is this?
1000 - 1500IU/L
294
What BMI during pregnancy warrants referral to obstetric anaesthetist?
>40kg/m(2)
295
How often should women with monochorionic twin pregnancy have USS scans?
USS every 2 weeks from 16 weeks onwards
296
How often should women with dichorionic twin pregnancy have USS scans?
USS every 4 weeks from 20 weeks onwards
297
How can TTTS before 26 weeks be treated?
Fetoscopic laser ablation of communicating vessels
298
What problem occurs only in monochorionic twins?
TTTS | Selective growth restriction
299
When should GBS swabs be done if indicated?
35-37 weeks or 3-5 weeks before elective delivery
300
What is the bladder neck anchored to in colposuspension?
Cooper's ligament
301
Triad in amniotic fluid embolism?
Acute hypoxia Hypotension Coagulopathy
302
RFs for amniotic fluid embolism?
C section Advanced maternal age Multiple pregnancy APH
303
Dosing regimen for antenatal steroids?
2 doses of 12mg IM betamethasone 24 hours apart
304
Features of magnesium sulphate toxicity?
Decreased RR Arrhythmia Loss of deep tendon reflexes
305
Stages of endometrial cancer?
1. In uterus only 2. Connective tissue of cervix but not outside uterus 3. Beyond uterus and cervix but not beyond pelvis 4. Beyond pelvis
306
In primary genital herpes during pregnancy what is the tx?
1st/2nd trimester: PO aciclovir from 36 weeks and expectant vaginal delivery 3rd trimester: PO aciclovir from 36 weeks and c section Within 6 weeks of due date: Start PO aciclovir immediately
307
RFs for prolapse?
``` Childbirth Old age Obesity Long term constipation Heavy lifting ```
308
Clauses of abortion act?
A: Risk to mother's life B: Termination will prevent serious injury to physical/mental health of mother C: <24 weeks and continuing is risk to physical/mental health of mother D: <24 weeks and risk to existing children/family E: Child would be handicapped F: Save mother's life
309
What is BV in pregnancy associated with?
Preterm labour | Chorioamnionitis
310
Appearance of endometrioma on TVUSS? | CA125?
Echogenic "ground glass" appearance | Often raised
311
Advice for women on whether they are experiencing reduced fetal movements?
Lie on left side Count movements for 2 hours If <10 then contact maternity unit asap
312
When is planned vaginal delivery possible in HIV patients?
Viral load <50 copies/mL at 36 weeks
313
Where should medical termination be done at 12+ weeks gestation?
Clinical setting
314
MOA of misoprostol?
Cervical ripening | Uterine contractions
315
MOA of mifepristone?
Breakdown of endometrium
316
CIN1 where are the dysplastic cells?
Within lower 1/3rd of epithelium
317
When should LLETZ be offered?
Patients with CIN2, CIN3 and CGIN
318
Why are GnRH agonists e.g. goserelin acetate limited to 3 months of use?
They cause a significant reduction in bone mineral density
319
Alternative to GnRH agonist but what is the main side effect?
``` Ulipristal acetate (progesterone antagonist) Liver damage ```
320
Major RFs for pre-eclampsia?
``` CKD HTN in previous pregnancy Autoimmune disease - SLE, APS DM Chronic HTN ```
321
Moderate RFs for pre-eclampsia?
``` Primip Multip MAternal age >40 Pregnancy interval >10 years BMI >35 FH of pre-eclampsia ```
322
How is dx of premature ovarian insufficiency diagnosed?
2x FSH >30IU/L taken 4-6 weeks apart
323
PCOS hormone findings?
Elevated LH and FSH LH:FSH ratio >1 Elevated testosterone Reduced SHBG
324
4 parameters used to calculate estimated fetal weight?
Abdo circumference Head circumference Femur length Biparietal diameter
325
Tx for molar pregnancy?
Suction curettage followed by serial beta-hCG measurements
326
Thyroxine requirements in first trimester/planning to get pregnant people on replacement?
Increase levothyroxine by 25mcg per day
327
Tx for ovarian cyst accident/rupture?
Admit for observation and analgesia Pain should settle in 4-6 hours Repeat TVUSS if ongoing bleeding
328
Twins gravidity and parity?
Counts as 1 gravidity (single pregnancy even if 2 fetuses) | Counts as 2 parity (2 babies are born)
329
How do RFs for VTE influence prophylaxis?
``` 4+ = immediate LMWH until 6 weeks post partum 3 = LMWH from 28 weeks until 6 weeks post partum ```
330
Main counselling point for women taking progestogens as part of HRT?
Increased risk of breast cancer and VTE
331
Main SE of Nexplanon? (Implant)
Irregular menstrual bleeding
332
What is the most effective form of contraception?
Nexplanon
333
What is a beads on string sign on USS suggestive of?
chronic salpingitis, with mural nodules appearing as 'beads' and the relatively-thin wall appearing as 'string'
334
Components of Bishop score?
``` Cervical position Cervical consistency Cervical effacement Cervical dilation Fetal station ```
335
Describe the normal stage 1 of labour (2 parts)
latent phase = 0-3 cm dilation, normally takes 6 hours | active phase = 3-10 cm dilation, normally 1cm/hr
336
Complications of hyperemesis?
``` Wernicke's encephalopathy Mallory-Weiss tear central pontine myelinolysis acute tubular necrosis fetal: small for gestational age, pre-term birth ```
337
Effect of smoking on hyperemesis?
Associated with decreased incidence
338
Life threatening complications of OHSS?
Hypovolaemic shock Acute renal failure Venous or arterial thromboembolism
339
Presentation of OHSS?
ascites vomiting and diarrhoea high haematocrit
340
Which fertility medication is most associated with OHSS?
GnRH agonists
341
SEs of clomiphene?
``` hot flushes (30%) abdominal distention and pain (5%) nausea and vomiting (2%) ```
342
Definition and Tx for recurrent vaginal candidiasis?
4+ episodes in a year induction-maintenance regime of oral fluconazole induction: oral fluconazole every 3 days for 3 doses maintenance: oral fluconazole weekly for 6 months
343
How should bleeding with no pain a woman who is <6 weeks pregnant be managed?
Expectantly These women should be advised: to return if bleeding continues or pain develops to repeat a urine pregnancy test after 7–10 days and to return if it is positive a negative pregnancy test means that the pregnancy has miscarried
344
Time periods for colposcopy referral?
When abnormal cytology is high-grade dyskaryosis (moderate or severe), women should be offered colposcopy within 2 weeks If inadequate results, borderline results, or low-grade dyskaryosis (mild), they should receive an appointment within 6 weeks
345
When should Negative hrHPV not return to normal recall?
the test of cure for individuals who treated for CIN1, CIN2, or CIN3 (6 months) Untreated CIN1 follow-up for incompletely excised CGIN/stratified mucin producing intraepithelial lesion (SMILE) or cervical cancer follow-up for borderline changes in endocervical cells
346
Tx for ovarian cancers which are stage 2-4?
Primary: Surgical excision Secondary: Chemo
347
Positive pregnancy test after TOP - when to refer?
4 weeks after TOP indicates incomplete abortion or persistent trophoblast
348
Safer alternative to oxybutynin in elderly women at risk of falls?
solifenacin tolterodine mirabegron
349
How long is the mirena licensed for in use as contraception in HRT?
4 years
350
What is placenta praevia associated with?
high presenting part or abnormal lie as a direct consequence of the low lying placenta
351
Ovarian cancer ix? Exception?
1. CA125 2. If raised - urgent USS 3. Referral to gynae Exception = abdo mass palpable - refer to gynae urgently
352
Normal additional HS in pregnancy?
3rd HS Ejection systolic murmur Forceful apex
353
Criteria for diagnosing a miscarriage on TVUSS?
crown-rump length greater than 7mm with no cardiac activity
354
Recurrence rate of postnatal psychosis?
25-50%
355
RFs for cord prolapse?
``` prematurity multiparity polyhydramnios twin pregnancy cephalopelvic disproportion abnormal presentations e.g. Breech, transverse lie placenta praevia long umbilical cord high fetal station ARM - MOST COMMON ```
356
Tx for gonorrhoea?
IM ceftriaxone | If sensitivity known give PO ciprofloxacin 500mg
357
Tx for chlamydia?
PO doxycycline 100mg bd
358
Fundal height growth normal range?
<24 weeks = 2cm a week | >24 weeks = 1cm a week
359
Antidepressant of choice if breastfeeding?
Sertraline or paroxetine
360
Indications for fetal blood sampling?
pathological CTG in labour (cervix dilated >3 cm) | suspected acidosis in labour (cervix dilated >3 cm)
361
Contraindications to fetal blood sampling?
Maternal infection (HIV, hepatitis, HSV) Fetal bleeding disorders (haemophilia) Prematurity (<34 weeks of gestation) Acute fetal compromise (prolonged fetal bradycardia of >3 minutes) Acute event (cord prolapse/abruption/uterine rupture) Clinical picture suggests birth should be expedited
362
Interpretation of fetal blood sampling results?
pH: - ≥7.25: Normal FBS result. Repeat after 1 hour if CTG remains the same - 7.21–7.24: Borderline FBS result. Repeat after 30 minutes - ≤7.20: Abnormal FBS result. Consider delivery Lactate: - normal: <4.1mmol/L - borderline: 4.2-4.8mmol/L - abnormal: >4.9mmol/L
363
Which stages of cervical cancer can you offer radical hysterectomy and removal of pelvic lymph nodes?
Stage IB to IIA | Technically for earlier stages too
364
first-line non-hormonal treatment for menorrhagia?
Tranexamic acid
365
Most common benign ovarian tumour in women under the age of 25 years?
Dermoid cyst
366
Post partum thyroiditis mx?
Beta blockers not anti thyroid drugs
367
Time frame for primary PPH?
<24 hours
368
What structures would you see week by week on TVUSS to confirm a pregnancy/determine PUL?
``` 4 weeks - gestational sac 5 weeks - gestational sac + yolk sac 6 weeks - fetal pole with heart beat 7 weeks - amniotic membrane 8 weeks - brain structure, limb buds ```
369
What tests should be done for all pre-menopausal women with complex ovarian cysts?
serum CA-125, LDH, αFP and βHCG
370
Measurements in routine 2nd trimester fetal biometry?
BPD head circumference (HC) AC femur length (FL)
371
When is the Fetal biophysical profile score assessed and what are the components? Number the abnormal findings
Fetal breathing: 1. absent 2. no breathing for ≥20 seconds within 30 mins Fetal tone: 1. slow extension with return to partial flexion 2. absent fetal movement Fetal movement: 1. <2 episodes of body/limb movements within 30 mins Amniotic fluid volume: 1. abnormal if the largest pocket is <2x2 cm CTG: 1. <2 accelerations 2. acceleration <15bpm in 20 mins
372
What is an abnormal Fetal biophysical profile score?
4/10 6/10 is borderline and must be repeated to exclude fetus being asleep as the cause 8-10 is normal
373
List women who should take 5mg dose of folic acid
``` Previous child with NTD Diabetes mellitus Women on antiepileptic Obese (body mass index >30kg/m²) HIV +ve taking co-trimoxazole Sickle cell ```
374
What to do if 1 COCP missed at any point in cycle
take the last pill even if it means taking two pills in one day and then continue taking pills daily, one each day no additional contraceptive protection needed
375
What to do if 2 COCP missed in week 1 (day 1-7)
Take last pill (even if 2 on one day) | Emergency contraception if sex in pill free interval or week 1
376
What to do if 2 COCP missed in week 2 (day 8-14)
Take last pill (even if 2 on one day) | Don't need emergency contraception
377
What to do if 2 COCP missed in week 3 (day 15-21)
Take last pill (even if 2 on one day) Finish pills in current pack Omit pill free break and start new pack next day
378
Definition of PPH? What constitutes major PPH?
The loss of 500 ml or more of blood from the genital tract within 24 hours of the birth of a baby Major = >1000ml blood loss
379
Layers cut through in a c section?
``` Superficial fascia Deep fascia Anterior rectus sheath Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba) Transversalis fascia Extraperitoneal connective tissue Peritoneum Uterus ```
380
Which cells secrete bHCG? What is its role?
syncytiotrophoblasts | acts to maintain the production of progesterone by the corpus luteum in early pregnancy
381
when do women experience an earlier urge to push - in OP or OA?
OP
382
When to follow up ovarian cysts?
Simple ovarian cyst 50-70mm in diameter - yearly USS | Larger simple cyst - MRI or surgery
383
Define primary amenorrhoea
No periods by 15yrs with normal secondary sexual characteristics No periods by 13yrs with no secondary sexual characteristics
384
Window for taking desogestrel?
12 hours
385
Interpretation of serum progestogen in fertility testing?
<16nmol/l: Repeat, if consistently low refer to specialist 16-30nmol/l: Repeat >30nmol/l: Indicates ovulation
386
When to consider early referral to fertility services?
Female: - Age >35 - Amenorrhoea - Previous pelvic surgery - Previous STI - Abnormal genital examination Male: - Previous genital surgery - Previous STI - Varicocele - Significant illness - Abnormal genital examination
387
What tx can you not give trans patients on testosterone therapy?
Oestrogen
388
Which patients should receive a special cardiac scan and when does it happen?
``` 18-23 weeks FH of congenital abnormalities Maternal DM or connective tissue disease Antiepileptics/antidepressants Increased nuchal translucency Multiple pregnancy ```
389
What are the 4 purposes of the fetal anomaly scan?
Reproductive choice (TOP) Prepare parents (disability/non-viability) Manage birth in specialist centre Intrauterine therapy
390
SCD screening in high risk vs low risk areas?
High risk: blood test | Low risk: family origin questionnaire
391
Thalassaemia screening?
All pregnant women
392
When are fathers offered screening of SCD/thalassaemia?
If pregnant woman is a carrier
393
What can be offered before fetal blood sampling if pathological CTG?
Fetal scalp stimulation - should see accelerations in response
394
When to measure fetal HR in labour?
Low risk: Immediately after a contraction for 1 minute every 15 mins
395
Rule of 3 for fetal brady on CTG?
* 3 minutes: call for help * 6 minutes: move to theatre * 9 minutes: prepare for assisted delivery * 12 minutes: aim to deliver baby
396
Causes of prolonged brady on CTG?
``` cord compression cord prolapse epidural and spinal anaesthesia maternal seizure rapid fetal descent ```
397
What is the most useful predictor of fetal wellbeing in SGA foetuses ?
Fetal heart rate variation
398
Monitoring with epidural?
Continuous CTG for 30 mins after establishment/bolus BP every 5 mins for 15 mins after establishment/bolus Assess sensory block hourly
399
Max time after full dilation a woman with an epidural can be in labour for before giving birth?
4 hours
400
How long should pushing be delayed for with an epidural?
1 hour
401
What does active mx of 3rd stage of labour mean?
routine use of uterotonic drugs - 10IU oxytocin deferred clamping and cutting of the cord (1-5mins) controlled cord traction after signs of separation of the placenta
402
When to advise change from physiological to active mx of 3rd stage?
haemorrhage | the placenta is not delivered within 1 hour of the birth of the baby
403
Complications of IUGR?
still birth PTL intrapartum foetal distress - birth asphyxia, meconium aspiration post-natal hypoglycaemia neurodevelopmental delay risk type 2 diabetes and HTN in adult life
404
Major RFs for IUGR?
``` Maternal age >40 Smoker >11cigs/day Cocaine Daily vigorous exercise Previous SGA baby Chronic HTN DM Renal impairment Antiphospholipid syndrome Low PAPPA ```
405
Which contraceptives can be given to women on enzyme inducers?
Depot medroxyprogesterone acetate LNG-IUS Copper IUD
406
Lamotrigine and COCP interaction?
May reduce seizure control
407
RFs for breech presentation?
``` Uterine malformation Placenta praevia Polyhydramnios/oligohydramnios Fetal abnormality (chromosomal/CNS malformation) Prematurity ```
408
What abx are given intraoperatively during a TAH?
IV Co-amoxiclav
409
When do women first feel fetal movements?
Primip 20 weeks | Multip 16-18 weeks
410
Most common cause of excess clear non-itchy discharge?
Ectropion
411
How is progress in labour after ARM assessed?
Vaginal exam 2 hours later
412
Thresholds for considering early birth in pre-eclampsia?
inability to control maternal BP despite using 3 or more classes of antiHTNs maternal pulse oximetry <90% progressive deterioration in liver function, renal function, haemolysis, or platelet count ongoing neurological features, such as severe intractable headache, repeated visual scotomata, or eclampsia placental abruption reversed end-diastolic flow in the umbilical artery doppler velocimetry, a non-reassuring cardiotocograph, or stillbirth
413
Mild, moderate and severe pre-eclampsia classifications?
Mild: 140-149/90-99mmHg Moderate: 150-159/100-109mmHg Severe: >160/>110
414
When should mothers with diabetes deliver?
37-38+6 weeks
415
Retinal scans in mothers with diabetes - when?
Booking Normal: Repeat at 28 weeks Abnormal: Repeat at 16-20 weeks
416
Extra scans for serial growth measurement and amniotic fluid measurement in diabetes?
``` 28 weeks 32 weeks 36 weeks If don't deliver between 37 and 38+6 weeks: 38 weeks 39 weeks ```
417
How can you differentiate between PCOS and CAH since both have ovarian cysts?
CAH has high serum 17-hydroxyprogesterone
418
What is a luteoma of pregnancy and how does it present?
Benign solid ovarian tumour Arises only in pregnancy & disappears after delivery Virilisation
419
When is surgical mx of TOP first line?
After 14 weeks If preferred by the woman Medical TOP failed
420
When should BP be checked again if a woman in antenatal clinic is found to have a high bp?
In 20 mins If elevated - 2 further readings 4hrs apart If still high admit for monitoring
421
What gestation can amniocentesis take place from?
15 weeks
422
Risk of miscarriage amniocentesis vs CVS?
Amniocentesis: 1% CVS: 1.5-2%
423
ECTOPIC mnemonic for RFs for ectopic?
``` Endometriosis/previous ectopic Contraception - IUD/POP/implant Tubal surgery Other abdo surgery PID Infertility Tx Can't find cause (50%) ```
424
When should women with GDM have their glucose checked after pregnancy?
6-13 weeks fasting blood glucose
425
What is haematometra?
retention of blood in the uterus
426
Lichen sclerosis tx?
Emollients High potency steroid ointments (clobetasol propionate) Topical Calcineurin inhibitors (Tacrolimus)
427
Which increases risk of vulval cancer - lichen sclerosis or planus? When would you biopsy?
Lichen sclerosis | If not responding to tx
428
Lichen planus tx?
Topical steroids (clobetasol) Oral steroids Consider ciclosporin
429
Most likely cause of azoospermia?
Varicocoele
430
Normal dose of folic acid in pregnancy?
400mcg
431
Indications for intrauterine fetal transfusion?
Severe fetal anaemia usually due to red cell immunisation and parvovirus B19 infection in pregnancy
432
When can the ureters be damaged during gynae surgery/Csection?
When the uterine pedicle is being tied off
433
How much does IUI increase chances of pregnancy?
10 to 20 percent chance of getting pregnant with each IUI cycle
434
First investigations for hyperprolactinaemia?
First: TFTs for hypothyroidism Chronic renal failure Pregnancy Second: MRI for pituitary adenoma
435
Which hormone increases the most in pregnancy?
Oestriol
436
What is a common side effect of laparoscopy that women should be warned about?
Shoulder tip pain due to CO2 inflation
437
RCOG classification of OHSS?
Mild: abdo pain + bloating Moderate: + N&V + ascites on USS Severe: + clinical ascites + oliguria + Hct>45% + hypoproteinaemia Severe: + VTE + ARDS + anuria + tense ascites
438
Normal and abnormal apgar score?
5-minute Apgar score: 7–10 = reassuring 4–6 = moderately abnormal 0–3 = low
439
Which organs are involved in fetal blood production?
<20 weeks: liver | >20 weeks: bone
440
Rotterdam criteria for PCOS?
1. Oligo/amenorrhoea 2. Clinical/biochemical signs of hyperandrogenism 3. PCOS on USS: at least 12 follicles in 1 ovary measuring 2-9mm in diameter/ovarian volume >10ml
441
Trichomoniasis Ix findings?
High vaginal pH | Ovoid mobile parasites on wet saline mount
442
3 CTG categories?
Reassuring: all features normal Suspicious: 1 non-reassuring feature Pathological: 2+ non-reassuring/1+ abnormal
443
4Ts of PPH?
1. Tissue (retained products) 2. Tone (uterine atony) 3. Trauma (episiotomy/perineal tears) 4. Thrombin (DIC)
444
Which patients should get baseline TFTs in pregnancy?
``` Current thyroid disease Previous thyroid disease FH of first degree relative with thyroid disease Autoimmune - coeliac T1DM and T2DM ```
445
POPQ stages for urogenital prolapse?
Stage 1: cervix prolapses >1cm above hymen (within vagina) Stage 2: cervix prolapses between 1cm above and below hymen (to introitus) Stage 3: prolapse >1cm below hymen but no further than 2cm less than total vagina length Stage 4: complete eversion of vagina outside introitus Procidentia: Uterus and cervix protrude from introitus and ulceration!
446
Causes of secondary dysmenorrhea?
``` o endometriosis o adenomyosis o PID o intrauterine devices o fibroids ```
447
Contra-indications to expectant management of miscarriage?
* Increased Haemorrhage risk - late in 1st trimester * Adverse trauma with previous pregnancy * Coagulopathy * Infection
448
When to scan during expectant mx of miscarriage?
If after 7-14 days there is no bleeding or continued bleeding If after 3 weeks pregnancy test still positive
449
1st and 2nd line analgesia in pregnancy?
1st line = paracetamol | 2nd line = codeine phosphate
450
1st and 2nd line Tx of prolactinoma?
1st line = dopamine agonist (cabergoline/bromocriptine) | 2nd line = trans-sphenoidal surgery
451
Tx of Women with Hb <100g/l in the postpartum period?
100–200mg elemental iron for 3 months
452
Tx of anaemia in pregnancy?
Trial oral iron supplements for 2 weeks Once Hb is in the normal range supplementation should continue for 3 months and at least until 6 weeks postpartum to replenish iron stores
453
What ferritin level in pregnancy indicates oral iron supplementation?
<30μg/l
454
Tx for UTI in pregnancy?
1st line = nitrofurantoin 2nd line = amoxicillin/cefalexin Can use these all for asymptomatic bacteriuria
455
Tx for pyelonephritis in pregnancy?
1st line oral = PO cefalexin | 1st line IV = cefuroxime
456
Indications for magnesium sulphate tx?
Consider the need for magnesium sulfate treatment, if 1 or more of the following features of severe pre-eclampsia is present: ongoing or recurring severe headaches visual scotomata nausea or vomiting epigastric pain oliguria and severe hypertension progressive deterioration in laboratory blood tests (such as rising creatinine or liver transaminases, or falling platelet count).
457
Surgical mx of stress incontinence?
Colposuspension (open or laparoscopic) Autologous rectus fascial sling Retro-pubic mid-urethral mesh sling (don’t offer first line) Intramural bulking agents
458
What does a bagel sign suggest?
Ectopic pregnancy
459
FSH in PCOS?
Normal
460
Define a prolonged second stage of labour in a nullip with an epidural
3 hours
461
Types of breech?
Frank – the legs are extended up to head, the buttocks are the presenting part Complete – the hips and knees are flexed, buttocks are the presenting part Incomplete – one or both hips are extended, knee or foot is the presenting part Footling (single/double) – one or both legs are fully extended, foot/feet is the presenting part
462
What do NICE recommend in the event with unstable bipolar on lithium becomes pregnant?
Switch meds gradually to an atypical antipsychotic
463
When to offer an ogtt in pregnancy?
``` BMI >30 Previous macrosomic baby Previous GDM First degree relative with DM Ethnic origin with high DM risk ```
464
What is clear fluid followed immediate vaginal bleeding suggestive of?
Vasa praevia
465
RFs for pre-term labour?
overstretching of the uterus: Multiple pregnancy, polyhydramnios Conditions where foetus is at risk: Pre-eclampsia, IUGR, placental abruption Problems with the uterus or cervix: Fibroids, congenital uterine malformation, short or weak cervix, previous uterine or cervical surgery Infection: chorioamnionitis, maternal or neonatal sepsis, bacterial vaginosis, trichomoniasis, Group B Streptococcus, STIs and recurrent urinary tract infections Maternal co-morbidity (for example: Hypertension, diabetes, renal failure, thyroid disease etc.)
466
When can you give an epidural?
Once a woman is in the active first stage of labour
467
Opiate analgesia in labour?
PO codeine phosphate | IM/IV diamorphine
468
What to give neonate if mother is Hep B positive just before labour?
HBV IgG HBV vaccine Both within 24 hours of birth
469
IM anti-emetic in hyperemesis?
IM prochlorperazine
470
Mx of FGM type III in labour?
anterior episiotomy during the second stage of labour under local anaesthetic or regional block
471
Why is CVS performed between 11-14 weeks?
Risk of fetal limb abnormalities if performed before
472
What are the Bishop's score modifiers?
1 point is added to the score for each of the following: Presence of pre-eclampsia Each previous vaginal delivery 1 point is subtracted for each of the following: Post-dates pregnancy No previous vaginal deliveries Premature pre-term rupture of membranes
473
Complete vs partial mole
Complete mole: 1 sperm and an empty egg with no genetic material - no fetal tissue Partial mole: 2 sperm + 1 egg - fetal tissue
474
What is Potter's syndrome?
``` Constellation of signs due to oligohydramnios Pulmonary hypoplasia Clubbed feet Facial deformity Congenital hip dysplasia ```
475
Contraindications to tocolysis?
Greater than 34 weeks gestation Non-reassuring CTG, fatal foetal anomaly or intrauterine death IUGR or placental insufficiency Cervical dilation >4cm Chorioamnionitis Maternal factors: pre-eclampsia, APH, haemodynamic instability
476
Classifiaction of 3rd degree tears?
3a: less than 50% of the thickness of the external anal sphincter is torn 3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact 3c: external and internal anal sphincters are torn, but anal mucosa is intact
477
3 criteria for lactational amenorrhoea to be effective?
1. Complete amenorrhoea 2. >85% of feeds are breast 3. <6 months since birth of baby
478
Which cancer is smoking thought to reduce the risk of?
Endometiral (reduces oestrogen levels)
479
How long does spinal anaesthesia last? Who do we therefore give it to?
1-2 hours | Multips (primips need epidural for longer pain relief)
480
Highest risk of ABO incompatibility?
If mother is O negative
481
Cause of neonatal hydrocephalus?
Maternal rubella infection | Causes aqueductal stenosis
482
What is non-invasive prenatal testing for Down's?
Maternal blood test looking at cell free foetal DNA Being rolled out in the NHS now (fully by June 2021) as a screening tool for Down’s, Edward’s and Patau’s and some can also tell the baby’s sex (you can pay for it privately) MORE accurate than combined test
483
Normal ECG changes in pregnancy?
Flat or inverted T Wave in leads III, V1 and V2 | Q Waves in leads III and aVF
484
Risk of needing emergency c section if trialling vaginal breech delivery? Absolute contraindication to this?
40% risk of needing an emergency C-section | Footling breech
485
Steps in vaginal breech delivery?
1. Delivery of buttocks - if handling needed put thumbs on the sacrum and fingers on ASIS of baby 2. Delivery of legs and lower body - if extended use Pinard's manoeuvre 3. Delivery of shoulders - Lovset's manoeuvre 4. Delivery of head - Mauriceau- Smellie-Veit Manoeuvre
486
What is the least common malpresentation? How do you deliver them?
Brow | C section
487
When is planned C section done for breech babies?
39 weeks
488
Mx of uterine inversion?
summon help, discontinue uterotonic drugs, administer crystalloid aggressively and blood products (as needed), and attempt to manually reposition the uterus by pushing the fundus cephalad along the long axis of the vagina.
489
1st line Tx of PMS?
Exercise CBT Vit B6 Combined new generation pill (cyclical or continuous) Continuous or low dose luteal phase low dose SSRIs
490
Tx for chlamydia in pregnancy?
Azithromycin 1g PO for one day and then 500mg OD for 2 days
491
UKMEC 4 to cocp?
``` <6 weeks post-partum and breastfeeding Age >35 and smoking >15/day Poorly controlled HTN Vascular disease Current or past history of IDH or stroke/TIA History of VTE Immobilisation due to surgery Known thrombogenic coagulopathy or positive for antiphospholipid antibodies Certain cardiac disease Migraine with aura Active breast Ca Severe liver disease or liver Ca ```
492
UKMEC 3 to cocp?
``` Age <35 and smoking <15/day BMI>35 Multiple RF’s for CVD Well-controlled HTN FH of VTE Immobilisation not due to surgery Migraine without aura Known carrier or gene mutations associated with breast CA Undiagnosed breast mass Past Breast Ca Diabetes with vascular disease Current gallbladder disease ```
493
UKMEC 4 to coils?
Post-partum or post-abortion sepsis Endometrial or cervical cancer, gestational trophoblastic disease Undiagnosed vaginal bleeding Active PID or active chlamydia or gonorrhoea Pregnancy Active breast Ca (for IUS only)
494
UKMEC 3 to coils?
Between 48 hrs and 4weeks post-partum Previous ectopic pregnancy Uterine fibroids with distortion of uterine cavity HIV with low CD4
495
Which method of emergency of contraception makes the POP less effective for 5 days?
Levonelle
496
Causes of oligo/azoospermia?
Idiopathic Drug exposure Varicocele Anti-sperm antibodies – may occur after vasectomy reversal Infection Anatomical – congenital absence of vas deferens Cystic fibrosis – causes obstruction Hypothalamic hypogonadism Kallmann’s syndrome – hypogonadotrophic hypogonadism Hyperprolactinaemia
497
How is IVF carried out?
1. Ovulation and Egg collection - Single injection of LH or hCG given 34-38 hours before eggs collected 2. Fertilisation and culture - Eggs and sperm incubated and transferred to growth medium - Grown for 6 days before transfer to uterus - Leftover embryos can be frozen 3. Embryo transfer - Single or double embryo transfer - Can give luteal phase support with progesterone of hCG until 4-8 weeks
498
Risk of miscarriage in threatened miscarriage?
25%
499
Chance of successful VBAC? How does that change if previous successful VBAC?
75% | Increases to 85-80%
500
Largest diameter of fetal skull?
Occipito-frontal – 11cm Suboccipito-bregmatic – 9.5cm Submento-bregmatic – 9.5cm Vertomental – 13cm (brow presentation - too large for vaginal birth) – The pelvic mid-cavity diameters are 11cm in transverse and AP, the pelvic outlet diameters are 11cm transverse and 12.5cm AP (inlet diameters are 13cm T and 11cm AP)
501
Ix if PPROM suspected but no amniotic fluid visualised on speculum?
consider IGFBP-1 (insulin like growth factor binding protein -1) or PAMG-1 (placental alpha microglobulin -1)test
502
Tx of toxoplasmosis in pregnancy? What is added if congenital infection suspected?
Spiramycin | +sulfadiazine and pyrimethamine

Oishi's 5th year flashcards (8 decks)

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