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Flashcards in High Yield PACES Deck (35):
1

High vaginal swabs

Candida albicans

Bacterial vaginosis

Trichomonas vaginalis

2

Endocervical swabs

Chlamydia trichomatis

Neisseria gonorrhoea

3

Cervical screening intervals

25-49 years = 3-yearly

50-64 years = 5-yearly

>65 only those who have not been screened or had recent abnormal tests

4

Candida albicans

High vaginal swab

Thick curdy discharge

Mycelilal filaments on microscopy

Clotrimazole cream or oral fluconazole 150mg stat

5

Bacterial vaginosis

High vaginal swab

Fishy odour

Whiff test +ve

Clue cells

Alkaline pH

Metronidazole 400mg bd for 5–7d or 2g stat

OR

Clindamycin cream 2% cream 5g nocte pv for 1wk

6

Trichomonas vaginalis

High vaginal swabs

Strawberry cervix

green discharge

Flagellated protozoa

Metronidazole 400mg bd for 5–7d or 2g stat

7

Chlamydia tracomatis

Endocervical swab

Largely asymptomatic

NAAT test

Azithromycin stat (1 g)
OR
Doxycyline (oral doxycycline 100mg bd for 7 days)

8

Neisseria gonorrhoea

If asymptomatic—send self-taken vulvovaginal swab for NAAT

If symptomatic—send endocervical swab ± rectal ± pharyngeal swab (as appropriate) for NAAT and M,C&S to confirm diagnosis


Largerly asymptomatic

Purulent discharge

Dysuria

Post-coital bleeding

Ceftriaxone 500mg IM as a single dose + Azithromycin 1g stat po

9

Fetal blood sampling

pH >7.25 --> Repeat in 1 hour

pH 7.21-7.24 --> Repeat in 30 minutes

pH <7.2 --> Expedite delivery

10

Edinburgh Scale

Post-natal depression

10 point questionnaire

Score >/13 = depression

11

Stillbirth

Death of fetus >24 weeks

12

Neonatal death

Early = 7 days

Late = 7-28 days

13

Perinatal mortality

Sum of stillbirths + early neonatal death / 1000 births

14

Maternal mortality rate

Number of maternal deaths / 100,000

~9 / 100,000 in UK

During OR Within 42 days of pregnancy ending

15

Late maternal death

>42 days - 1 year

16

The Abortion Act 1967

Two doctors

Following Reasons:

A: risk to life of women greater vs not-pregnant

B: necessary to prevent grave permanent injury to physical/mental health

C: greater risk to physical/mental health of women vs not-pregnant

D: greater risk to physical/mental health of existing children vs not-pregnant

E: risk that child will suffer from physical or mental abnormalities / seriously handicapped

F: save the life of the pregnant women

G: To prevent grave permanent injury to physical/mental health to pregnant women

17

Section 37 Human Fertilisation and Embryology Act 1990

Time limit is 24 weeks under grounds C and D
C: greater risk to physical/mental health of women vs not-pregnant

D: greater risk to physical/mental health of existing children vs not-pregnant

Without time limit: A, B and E
A: risk to life of women greater vs not-pregnant

B: necessary to prevent grave permanent injury to physical/mental health

E: risk that child will suffer from physical or mental abnormalities / seriously handicapped

18

Fraser Guidelines

<16 prescribed contraception

1. understand information
2. cannot be persuaded to inform parents
3. likely to continue to have intercourse regardless
4. unless they receive contraception, physical or mental health of individual likely to suffer
5. it is in the young person's best interests

19

Fraser vs Gillick competence

Fraser = contraception specific

Gillick = consent in general

20

Medications for CS

During
IV antibiotics

Ranitidine / PPI --> reduce risk of aspiration


Post
10 days LMWH
= Clexane (Enoxaparin)
Prophylaxis of deep-vein thrombosis especially in surgical patients, by subcutaneous injection, moderate risk, 20 mg (2000 units) approx. 2 hours before surgery then 20 mg (2000 units) every 24 hours

21

Embryo splits at 4-7 days

MCDA

22

Embryo splits at 13 days

Conjoined twins

23

Embryo splits at 3 days

DCDA

24

Embryo splits at 8-12 days

MCMA

25

Medical Abortion

Regardless of gestation
200mg Mifepristone oral

Wait 24-48 hours

Misopristol only thing that changes
400micorgrams vs 800 micrograms

26

PPROM Antibiotics

Erythromycin 250mg 4 times/day

27

IM steroids for Preterm

Two doses of betamethasone 12 mg, given intramuscularly 24 hours apart

OR

Four doses of dexamthasone 6 mg, given intramuscularly 12 hours apart.

28

Test for ROM

Alpha fetoportein

Insulin-like growth factor binding protein 1

29

Nitrofurantoin in pregnancy

Use first two trimesters

Avoid at term --> neonatal haemolysis

30

Trimethorpim in pregnancy

Avoid first trimester --> Folate antagonist

31

Tibolone

Combines oestrogenic and progestogenic activity with weak androgenic activity

It is given continuously, without cyclical progestogen

32

Conditions which all pregnant women should be offered screening

Anaemia
Bacteriuria
Blood group, Rhesus status and anti-red cell antibodies
Down's syndrome
Fetal anomalies
Hepatitis B
HIV
Neural tube defects
Risk factors for pre-eclampsia
Rubella immunity
Syphilis

The following should be offered depending on the history:

Placenta praevia
Psychiatric illness
Sickle cell disease
Tay-Sachs disease
Thalassaemia

33

Vaccinations that can be given in pregnancy

Hep B
Pneumococcal
Pertussis
Influenza

34

Criteria for Zidovudine

CD4 >350
VL < 100,000

Otherwise --> HAART

35

HIV in pregnancy delivery

CS at 38 weeks

Unless, VL <50 on HAART at 36 weeks --> VD