Learn for sure Flashcards
(42 cards)
Indication for venthouse
Maternal - delay in 2nd stage of labour due to maternal exhaustion (NB venthouse requires adequate contractions and maternal effort still)
Fetal - abnormal CTG or slow progress in 2nd phase due to fetal malposition
Indication for forceps (rather than ventouse)
Maternal - medical conditions complicating labour (ie CV disease)
Unconscious mother or mother unable to push
Fetal -
Maternal Indications for section
Two previous LSCS
Placenta praevia
Maternal disease ie fulminating pre-eclampsia
Maternal request with no obstetric indication
Active primary genital herpes
HIV
Fetal indications for section
Breech
Twins if first twin isnt cephalic
Abnormal CTG or fetal blood sample in 1st phase
Cord prolapse
Delay in first stage of labour (eg due to malpresentation or malposition)
Indications for episiotomy
Maternal - FGM, previous perineal repair
Fetal - Instrumental, breech, dystocia, abnormal TG
NB must have adequate analgesia
Absolute CI to COCP
Pregnancy Breastfeeding Arterial or venous thrombosis Liver disease Undx vaginal bleeding Hx of oestrogen dependent tumour Recent hydatidiform mole Smoker >35 BMI >40 migraine with aura
Relative CI to COCP
Fhx thrombosis Hypertension Migraine Varicose veins Diabetes
Criteria for instrumental delivery
Adequate analgesia
Fetal head either 1/5 or 0/5 palpable on abdo exam
Vag exam: cervix fully dilated, head at level of ischial spines or below, known fetal position - note presence of caput or moulding
Adequate maternal effort and regular contractions if using venthouse
Empty bladder for forceps
COCP mode of action
inhibit ovulation - decrease GnTphin release = thin EM and no ovulation
SE of COCP (oestrogenic and progestogenic)
O: breast tender, HA, N, weight gain, inc mucus, HTN
P: depression, acne, bleed/amen, libido, postmen tension
But protects against fibroids, EM and OV cancer and cycle control
Mode of prog only pill
Inc mucus and inhibit ovulation (50%, 95% cerazette)
Continuous use every day 12h window with cerazette
SE prog pill
Spotting, depression, acne, dec libido, postmen tension, weight gain, can be used in lactation
Depot prog timing
Provera - 3mthly - irreg bleed start then amen (BD drops 2-3y then stabilises)
Noisterat - 8 weekly
Nexplanon - 3y implant under LA, irreg bleed 1y no bone drop
Absolute CI to IUD
Pregnancy
Undx uterine bleeding
Active or past Hx PID
Breast, EM or cervical cancer
IUD method of action
Copper = toxic and blocks implantation Mirena = stop implantation and fertilisation
Change every 3-5 years, stops dysmenorrhea and menorrhagia too
SE IUD
Pelvic infection, menstrual disturbance (HMB or IMB), perforation, ectopic
Relative CIs to IUD
Previous ectopic, multiple partners, nulliparous/young, immunocompromised (Copper can increase menstrual loss)
Emergency contraception types and how long after is too long
Levonelle - prevents ovulation and fertilisation (24h 95% success, 58% in 72)
Ulipristal - prevents ovulation, up to 120h
IUD - up to 5d PC
All just one dose
Indication for non-rotational forceps (Neville-Barnes)
Low cavity (head well below ischial spines) Mid cavity OA ONLY (at or just below ischial spines)
Rotational forceps
Midcavity occipitotransverse or OP (rotation to OA in both cases)
Ventouse delivery indications
Low cavity
Mid cavity OA, OT or OP (forceps better for rotation)
Used if maternal effort is good
First line Tx for menorrhagia
IUD (90% success) - progestogen release and contraception
When to do an EM biopsy
EM thickness >10mm premen, >4mm post >40y HMB and IMB USS suggests polyp Before IUS insertion if cycle irregular Prior to ablation (ablation = tissue not viable for analysis) Bleeding has caused acute admission
Define primary amenorrhea
No menstruation by 16
