Learn for sure

Question 1

Indication for venthouse

Answer 1

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

Question 2

Indication for forceps (rather than ventouse)

Answer 2

Maternal - medical conditions complicating labour (ie CV disease)
Unconscious mother or mother unable to push
Fetal -

Question 3

Maternal Indications for section

Answer 3

Two previous LSCS
Placenta praevia
Maternal disease ie fulminating pre-eclampsia
Maternal request with no obstetric indication
Active primary genital herpes
HIV

Question 4

Fetal indications for section

Answer 4

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)

Question 5

Indications for episiotomy

Answer 5

Maternal - FGM, previous perineal repair
Fetal - Instrumental, breech, dystocia, abnormal TG

NB must have adequate analgesia

Question 6

Absolute CI to COCP

Answer 6

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

Question 7

Relative CI to COCP

Answer 7

Fhx thrombosis
Hypertension
Migraine
Varicose veins
Diabetes

Question 8

Criteria for instrumental delivery

Answer 8

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

Question 9

COCP mode of action

Answer 9

inhibit ovulation - decrease GnTphin release = thin EM and no ovulation

Question 10

SE of COCP (oestrogenic and progestogenic)

Answer 10

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

Question 11

Mode of prog only pill

Answer 11

Inc mucus and inhibit ovulation (50%, 95% cerazette)

Continuous use every day 12h window with cerazette

Question 12

SE prog pill

Answer 12

Spotting, depression, acne, dec libido, postmen tension, weight gain, can be used in lactation

Question 13

Depot prog timing

Answer 13

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

Question 14

Absolute CI to IUD

Answer 14

Pregnancy
Undx uterine bleeding
Active or past Hx PID
Breast, EM or cervical cancer

Question 15

IUD method of action

Answer 15

Copper = toxic and blocks implantation
Mirena = stop implantation and fertilisation

Change every 3-5 years, stops dysmenorrhea and menorrhagia too

Question 16

SE IUD

Answer 16

Pelvic infection, menstrual disturbance (HMB or IMB), perforation, ectopic

Question 17

Relative CIs to IUD

Answer 17

Previous ectopic, multiple partners, nulliparous/young, immunocompromised (Copper can increase menstrual loss)

Question 18

Emergency contraception types and how long after is too long

Answer 18

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

Question 19

Indication for non-rotational forceps (Neville-Barnes)

Answer 19

Low cavity (head well below ischial spines)
Mid cavity OA ONLY (at or just below ischial spines)

Question 20

Rotational forceps

Answer 20

Midcavity occipitotransverse or OP (rotation to OA in both cases)

Question 21

Ventouse delivery indications

Answer 21

Low cavity
Mid cavity OA, OT or OP (forceps better for rotation)

Used if maternal effort is good

Question 22

First line Tx for menorrhagia

Answer 22

IUD (90% success) - progestogen release and contraception

Question 23

When to do an EM biopsy

Answer 23

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

Question 24

Define primary amenorrhea

Answer 24

No menstruation by 16

Question 25

Define 2ndry menstruation

Answer 25

Ceases for 6m

Question 26

Define oligorrhea

Answer 26

Cycles between 35d and 6m

Question 27

Asherman’s

Answer 27

Excessive EM curretage

Question 28

Sheehans

Answer 28

Pit necrosis after PPH

Question 29

Primary Dysmenorrhea treatment

Answer 29

NSAIDs or ovulation suppression with COCP

Question 30

Secondary dysmenorrhea characterstic and causes

Answer 30

Pain before and relieved by menstruation

Fibroids, adenomyosis, EMosis, PID, ovarian tumours

Question 31

Metronidazole

Answer 31

Preterm labour

Question 32

Augmentin - (co-amox)

Answer 32

nec enterocolitis and preterm

Question 33

Cycline abx (tetracycline - doxy etc)

Answer 33

Stains teeth

Question 34

Trimethoprim

Answer 34

Folic acid antagonist

Question 35

NSAIDs

Answer 35

closed fetal ductus arteriosis, fetal oliguriua, cerebral haemorrhage

Question 36

Warfarin

Answer 36

Teratogenic

Question 37

Thiazide

Answer 37

Maternal hypovolaemia

Question 38

ACE-I

Answer 38

fetal renal failure, teratogenic

Question 39

Beta-Blockers

Answer 39

IUGR

Question 40

Prednisalone

Answer 40

GDM, hypertension

Question 41

Paroxetine

Answer 41

Teratogenic

Question 42

Lithium and Na valproate

Answer 42

Both teratogenic - cognitive damage with Na val too