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o&g odd guideliens high yield? > lol > Flashcards

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1
Q

bile acid over what diagnostic of OC?

A

> 19

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2
Q

risk of stillbirth if BA > 100

A

3.4%

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3
Q

risk of stillbirth in OC increases with?

A

serum total bile acid conc

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4
Q

SFH measured from?

A

24wks

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5
Q

rule for SFH?

A

gestational age =/- 2cm

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6
Q

single SFH <10th centile or serial measurements show slow or static growth?

A

growth scan

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7
Q

when may SFH be inaccurate?

A

BMI >35
large fibroids
polyhydramnions

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8
Q

if SFH measurement is innacurate?

A

routine growth scans - 32/36/40 wks

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9
Q

what is considered SGA

A

<10th centile estimated fetal weight

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10
Q

what is more likely to be IUGR

A

<3rd centile (estimated fetal weight)

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11
Q

EFW 3-10th centile with normal dopplers

A

scan every 2 weeks with dopplers

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12
Q

EFW <3rd centile normal dopplers?

A

1 weekly scans (growth every 10-14 days and dopplers weekly)

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13
Q

EFW <10th centile with doppler abnormalities?

A

twice weekly CTG & dopplers

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14
Q

EFW 3-10th centile with normal dopplers - when do u deliver?

A

39-40 wks

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15
Q

EFW <3rd centile with normal dopplers - when to deliver?

A

37-38 wks

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16
Q

what PAPP-a is a RF for SGA/IUGR

A

PAPP-a <5th centile

may need additional growth scans 32, 36, 40 wks

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17
Q

transient gestational HTN definition

A

develops at any gestation and resolves without treatment during pregnancy

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18
Q

gestational HTN defintiion

A

develops >20 weeks without features of pre-eclampsia

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19
Q

definition of HTN in pregnancy

A

> =140/90, based on average of at least 2 measurements

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20
Q

how to do the 2 measurements for HTN

A
  • if severe (>160/110) repeat within 15 mins
  • otherwise repeat in at least 4hrs or on 2 consequeitve outpatient visits
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21
Q

definition of pre-eclampsia?

A

20 wks onwards
1) proteinuria >300mg per day or PCR >30mg/mmol
2) organ dysfunction: AKI, Liver, Neuro, Haematological
3) Uteroplacental dysfunction (eg. IUGR)

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22
Q

sx of severe pre-eclamspia

A

headache
visual disturbance
epigastric pain
n&v
sudden swelling of face, hands or feet

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23
Q

what may bloods show in pre-eclamspia

A

low platelets
raised creatinine
raised transaminases
prolonged clotting time

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24
Q

what may growth scan show in PET

A

fetal grwoth resitrction
abnormal dopplers

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25
what may placental like growth factor show in pre-eclamspia
<100
26
General management of pre-eclampsia
* admit until delivery (esp if >160/.110) - because can progress quickly * BP : lab, nif, methyl * growth scans at diagnosis and then every 2 weeks * prevent/treat seizures
27
what can be used to guide whether u admit for pre-eclamspia or not?
* any concerning features - admit * high risk of adverse events suggested by the fullPIERS or PREP‑S risk prediction models
28
when can FullPIERS be used vs PREP-S?
-fullpiers = any point -prep-s up to 34 wks | adverse outcomes for mom, not baby
29
delivery for PET if <32 weeks
expectant, with care plan
30
delivery if 34-37 wks with PET/
balance maternal and fetal needs
31
PET >37 weeks?
deliver within 24-48hrs
32
severe pre-eclamspia management
* MDT in HDU * control HTN (oral nif, IV lab, IV hydralazine) * fluid balance to avoid fluid overload (restrict to 1ml/kg/hr) * prophylaxis with mag sulph 10% - until 24 hrs post delivery or post-seizure * consider steroids if <34+6 wks and likely deliver in 7 days
33
indications for instrumental?
* fully dilated * failure to progress eg. >2hrs primip or >1hrs multip * fetal distress * maternal exhaustion
34
indciations for C-section
* failure to progress <2cm in 4hrs despite optimal contraction * fetal distress not at full dilatation * cord prolapse * abrutpion/praevia/vasa * malpresentation in labour (breech, transverse, oblique)
35
average length of active labour (from 4cm) in first and second labour
first: 8hrs second: 5 hrs
36
pain relief in labour?
* TEN machine, water, massage * paracetamol, codeine * Entonox (50:50 oxygen, NOS) * pethidine, diamoprhine, remiferantil PCA * epidural
37
cord clamping delayed for?
1min
38
controlled cord traction once?
signs of placental separation
39
signs of placental separation?
* gush of blood * lengthening of cord
40
active management of 3rd stage if no RF for PPH?
10iu syntocinon IM
41
active management 3rd stage risk factors for PPH
syntometrine (5iu synto, 500mcg ergometrine)
42
active maangement of 3rd stage at LSCS?
carbetocin 100mcg over 1minute
43
differenc in appearance of fibroid & polyp on US
fibroid = heterogenous hypoechnoic polyp= hyperechoic (bright)
44
apperance of cervix in polyp vs cancer?
smooth = polyp friable = cancer
45
why fixed retroverted uterus in endoemtriosis?
adhesions pull uterus posteriorly
46
term for when uterus prolapses out of vagina completely
procidentia
47
premenopausal: how to investigate cyst?
* simple cyst on USS <5cm = no further investigation * >5cm = 6 monthly scans to monitor or surgery - can discharge after a year if stable
48
how is pre-menopausal cyst regognition done?
pattern recognition
49
complex cyst in premenopausal?
need tumour markers
50
cysts >5cm have risk of?
torsion, rupture or haemorrhage
51
RMI cut off for referal to oncology?
200
52
RMI <200 * symptomatic * >5cm * complex * bilateral
consider surgery | if not monitor 6 monthly
53
cyst most likely to tort?
dermoid cyst
54
cyst least likely to tort?
endometrioma
55
sudden resoution of ovarian cyst pain means?
necrotic - bad
56
definitive investigation for torsion
laparoscopy
57
management of torsion
detorsion +/- cystectomy
58
when do u induce a bleed in PCOS
if less than 4 periods in a year
59
when do u need a 2nd scan to confirm miscarriage?
* <7mm CRL or <25mm GA with no heartbeat * in 1 week if TVUS * in 2 weeks if trans-abdominal
60
after methotrexate for ectopic dont concieve untiL?
3 months
61
morphology of complete mole?
bunch of grapes, snowstorm
62
morphology of partial mole
may have embryo, cystic enlarged placenta
63
needed to diagnose molar
biopsy
64
prolapse graded in relation to?
hymen
65
prolapse graded with?
POP-Q or Baden-walker
66
how to examine in prolapse
* -sims speculum * in left lateral position and standing * at rest and with pressure (cough or valsalva)
67
lifestyl eadvice for prolapse
* weight loss * avoid heavy lifting * avoid high impact exercise * avoid smoking * avoid constipation * treat chronic cough
68
risks of pessary
* falling out * urinary retention * ulcer * infection
69
investigations for incontinence
* bladder diary * urine dip * post-void volume * consider urodynamics (esp before surgery)
70
if anterior placenta with previous LSCS when do you repeat scan?
28 weeks to rule out morbidly adherent placenta
71
>3.5 mm NT assoc with?
chromosomal abnormalitties & cardiac defects
72
when to deliver if uncomplicated praevia/low lying (no bleeding)
37 wks
73
when to deliver if placenta praevia/low lying with history of PV bleed?
34-37 wks
74
if palcenta >2cm from internal os?
can do vaginal delviery
75
if placenta <2cm from os?
LCSC
76
placenta more likely to move to good position if?
low lying and anterior | less likely if PP and psoterior
77
rh neg mother + rh neg baby?
no anti-D needed
78
anti-D dose given when and what dose
28 wks 1500iu
79
commonest cause of iatrogenic prematurity?
pre-eclampsia
80
pre-eclampsia more common in ?
primips (10%)
81
NSAIDS in pregnancy risk
* closure of ductus * renal dysfucntion * oligohydramnios
82
mnemonic for labour mechanism
Every Day Fine Infants Enter Eager and Excited * engagement * descent * flexion * internal rotation * extention * expulsion * external rotation (restitution)
83
causes of HMB?
PALM COEIN (structural & non) * polyp * adenomyosis * leiomyoma * malginancy & hyperplasia * coagulopathy (VWF) * ovulatory dysfunction (PCOS) * endometial * Iatrogenic (eg. Copper) * not yet classified (thyroid, infection)
84
managemernt of endometrial polyps
hysteroscopy & polpectomy (+ send for biopsy)
85
pre-menopausal women - menorrhagia with thickened endometium on USS persistently >15mm
2 week wait
86
endometrial hyperplasia without atypia?
* high dose prog (mirena, medroxy, norethisterone continuously) * biopsy every 6 months * 2 consequitive negatives - discharge
87
want to maintain fertility in atypical endometrial hyperplasia?
* mirena 6 months - more biopsies -have baby -most do hystereoctomy after

o&g odd guideliens high yield? (1 decks)

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