O & G Flashcards
(230 cards)
1
Q
Hepatitis B in Pregnancy
A
C - section doesn’t reduce vertical transmission
Breastfeeding is safe
Chronic or Acute infection = Immunoglobulin and vaccination
All pregnant women offered screening
2
Q
At what level of anaemia do you treat during the 1st trimester?
A
<110
3
Q
At what level of anaemia do you treat in the 2nd/3rd trimester?
A
<105
4
Q
At what level of anaemia do you treat anaemia in the post part period?
A
<100
5
Q
What is fatal fibronectin?
A
It is released from the fatal gestational sac. It is linked to an early labour.
6
Q
Does an elevated fatal fibronectin mean early labour is guaranteed?
A
No many women go on to deliver at term.
7
Q
What is expectant management in an ectopic pregnancy?
A
Reassure Safety Net and reassess bhCG levels in 48 hours
8
Q
When can expectant management be used in ectopic pregnancies?
A
Asymptomatic, bhCG <1000, no petal heart beat, <35mm, un ruptured,
9
Q
Is expectant managment safe with another viable intrauterine pregnancy?
A
Yes
10
Q
What is the medical management of a ectopic pregnancy?
A
Methotrexate + follow up
11
Q
When can medical management be used in ectopic pregnancy?
A
<20mm, unruptured, no severe pain, no fatal heart beat, <1000 bhCG, no viable intrauterine pregnancy
12
Q
What is the surgical management of an ectopic pregnancy?
A
Salpingectomy or salpingostomy
13
Q
When is surgical management used in an ectopic pregnancy?
A
Rupture, >35mm, visible heartbeat
14
Q
When would you suspect Pre Existing Hypertension in Pregnancy ?
A
Occurs before 20 weeks with no proteinuria or oedema
15
Q
When would you suspect Pregnancy induced hypertension?
A
Hypertension occurring after 20 week but no proteinuria or oedema
16
Q
What is given to a pregnant lady at increased risk of Pre Eclampsia and from when?
A
75mg of Aspirin from 12 weeks
17
Q
What is the most effective form of emergency contraception?
A
IUD Copper
18
Q
In what time frame can the IUD Copper coil be used?
A
Within 5 days of unprotected sex or within 5 days of suspected ovulation.
19
Q
What is the time frame for Levonogestrel?
A
Within 72 hours
20
Q
When do you double the dose of Levonegestrel?
A
If BMI >26 or >70kg
21
Q
When can contraception be started in regards to Levonegestrel?
A
Hormonal contraception can be started immediately after.
22
Q
What should be done in a women who has taken EllaOne or Uliprital?
A
If breastfeeding stop for one week
If on hormonal contraception use another form of protection for five days.
23
Q
What is the time frame of us for EllaOne?
A
120 hours
24
Q
What is 1st line for Vaginal Thrush
A
Single dose oral Fluconazole
25
When is a Vaginal Pessary or topical considered?
If pregnant or with vulval involvement.
26
What is Gastroschisis?
Anterior abdominal wall defect lateral to the umbilicus
27
How is gastroschisis managed?
Vaginal delivery but straight to surgery
28
What is Exompholus or Omphalocoele?
Abdominal cavity contents protrude out but are covered in amniotic sac
29
What is the management for omphalocoele?
C section at 37 weeks
| Stepwise surgery slowly moving contents back in.
30
What criteria must a HIV +ve woman have in order to be allowed a vaginal delivery?
Viral load of <50
| Antiretroviral
31
Are pregnant HIV +ve women allowed to breastfeed
No
32
When are neonatal antivirals required in HIV?
If maternal load is >50 - triple therapy
If maternal load if <50 - Zidovudine
Both given for 4-6 weeks
33
If a patient has a cervical smear come back as inadequate how should they be treated?
Repeat smear in three months
34
If a patient has had two smears comeback as inadequate how should they be treated?
Referred for colposcopy
35
A woman has a suspected DVT in pregnancy how is she managed?
LMWH then investigated
36
What anticoagulant is used in a DVT in pregnancy?
LMWH
37
A woman <20 weeks pregnant is exposed to Varicella what is the management?
Immunoglobulin
38
A woman >20 weeks pregnant is exposed to Varicella what is the management?
Immunoglobulin
| Or Acyclovir 7-14 days after exposure
39
When can Gestational Diabetes be diagnosed?
Fasting >5.6
2 hr >7.8
remember 5678
40
What is the screening test used in gestational diabetes and when is it used?
Oral Glucose Tolerance Test
| Booking and 24-28 weeks
41
If a pregnant lady presents with a fasting glucose over 7mmol what is her management?
Insulin - short acting
42
If a fasting glucose is identified as less than 7 what is trialed. After 1-2 weeks this fails to correct her blood glucose. What would she be switched to?
Lifestyle and dietary advices trailed for 1-2 weeks. If this is unsuccessful then Metformin is used.
43
A pregnant lady who has a fasting glucose between 6.0-6.9 is found on routine scan to show fatal macrosomnia what is her diabetic medication of choice?
Insulin is used first line if any signs of complications
44
Signs of Ovarian Hyperstimulation Syndrome
Increased Oestrogen
Nausea + Vomiting
Fluid Retention -> Weight Gain
Abdominal Discomfort from enlarged ovaries.
45
First Degree Perineal Tear - Classification and Management.
Superficial
| No treatment - clean etc
46
Second Degree Perineal Tear - Classification and Management.
Perineal mucosa and Muscle but no sphincter involvement.
| Managed by trained midwife or clinician.
47
Third Degree Perineal Tear Type A - Classification and Management.
Perineal Mucosa, Muscle and <50% of External Anal Sphincter
| Surgical Repair by Surgeon
48
Third Degree Perineal Tear Type B - Classification and Management.
Perineal Mucosa, Muscle and >50% of External Anal Sphincter
| Surgical repair
49
Third Degree Perineal Tear Type C - Classification and Management.
Perineal Mucosa, Muscle , External Anal Sphincter and Internal Anal Sphincter.
50
Fourth Degree Perineal Tear - Classification and Management.
Perineal Mucosa, Muscle, Both EAS and IAS, Rectal Mucosa
| Surgery
51
Management of Moderate to Severe PMS
COCP 1st line
| SSRI
52
What is the time frame for a Amniotic Fluid Embolism
During and up to 30 minutes after delivery.
53
Management of a Amniotic Fluid Embolism
Supportive management only
54
If someone has been treated for CIN II when should they undergo a cervical smear test again?
6 months - used as a test of cure
55
When should the booking visit be done?
8 - 12 weeks
| ideally <10
56
What is done in the booking visit?
BP, Urine Dipstick, BMI
| Give Folic acid Vitamin D
57
What is screened for in the booking visit?
```
Blood group
Rhesus status
Autoantibodies
Haemaglobinopathies
Hep B
Syphilis
HIV
```
58
What is done between 10-13 weeks?
Early scan for dates + exclude multiple pregnancy
59
What is done at 18 weeks?
Anomaly scan
60
What is done at 28 weeks?
Routine Care
Second anaemia and antibody screen
Anti D prophylaxis is rhesus -ve
61
Management of chicken pox exposure in any pregnant lady?
Check for antibodies prior to treatment
62
A pregnant lady <20 weeks , who has had no vaccine or exposure to chicken pox identified on antibody testing. Has been exposed what is the management?
Immunoglobulin ASAP
63
A pregnant lady >20 weeks gestation has been exposed to chicken pox. After testing for antibodies it is found she is not immune. What is the management?
Immunoglobulin or acyclovir after 7-14 days post exposure
64
If a pregnant lady is presenting with chickenpox what is the management?
Seek specialist advice. Usually acyclovir if >20 weeks
65
In a FtM transgender man taking testosterone what kind of contraception in contraindicated?
COCP as the oestrogen can counteract the testosterone reducing its effect.
66
Strawberry Cervix, Offensive yellow green frothy discharge
Trichomonas Vaginallis
67
What screening tests does a woman undergo if she is has had previous gestational diabetes?
OGTT at booking and 24-28 weeks
68
List medications that should be avoided in pregnancy?
Tetracylines
ACEi
Statins
69
Levels required for Iron Supplementation
First trimester - <110
Second and Third Trimester - <105
Postpartum <100
70
If iron levels don't improve after 2 weeks of iron therapy what should happen?
Further investigations for an other cause
71
If someone during their first week of COCP misses two. What should they do?
Take both pills and use contraception for 7 days
| Emergency contraception is needed
72
If someone on their second week of COCP misses two pills what should they do?
Take both pills alongside using other contraception for 7 days.
73
If someone of their 3rd week of COCP misses two pills what should they do?
Take both pills and use extra contraception for 7 days
| Miss out pill free period
74
Which kind of Progesterone only pill has a 12 hour window compared to a 3 hour window?
Cerazette (desogestrel)
75
In a POP if someone has missed their three hour window what should they do?
Take pill ASAP and use contraception for 48 hours.
76
What is the management in premature rupture of membranes?
Admit for 48 hours
Antibiotics - erythromycin 10 days
Steroids
Deliver if >34 weeks
77
Menopausal
Tender lump
Green discharge
Smoker
Mammary duct ectasia
78
Nipple Bloody discharge
Duct Papilloma
79
When would you offer GBS prophylaxis and what is it?
Previous GBS
| Benzylpenicillin
80
When is Benzypenicillin given if they are GBS negative?
Preterm labour
81
Day 21 ( or 7 days before end of cycle) progesterone level
<16 - repeat then refer
16-30 - repeat
>30 - ovulation
82
Vaginal delivery in a previous C section
Only if previous C section was a low incision - over 2 is contraindicated
75% success rate
Aim for >37 week gestation
83
Indication for forcep delivery
```
Cephalic presentation
Cervix fully dilated
Ruptured membranes
Engaged presentation
Empty bladder
```
84
Persistent Abdominal pain with vaginal bleeding post C section
Endometritis - Antibiotics required
85
If GBS is found asymptomatically on a swab in a patient who's had no previous GBS infection before. What is the management?
Intrapartum Benzylpenicillin is required.
86
Hepatic adhesions with a history of Pelvic Inflammatory Disease
Fitz Hugh Curtis Syndrome
87
If a child present at breach during C section or Vaginal delivery what must they undergo?
6 week hip USS
88
Signs of neonatal hypoglycaemia
```
Autonomic dysfunction - tachycardia, apnoea, hypothermia
Jittery
Irritant
Hypotonic
Seizures
```
89
Management of neonatal hypoglycaemia
Mild and transient - ensue good feeding and monitor
| Severe or symptomatic - Neonatal referral + IV 10% dextrose
90
In duct ectasia if the discharge is causing distress what is the management ?
Microductectomy - young
| Total Duct excision - old
91
Management of Placental Abruption
<36 weeks - stable no foetal distress - admit + steroids + no tocolytics
- foetal distress - C Section
>36 weeks - stable no foetal distress - Vaginal delivery
- Distress - C Section
Foetal death - induce vaginal delivery
92
Cervical smear during pregnancy
If previously normal wait till 12 weeks post partum
| If abnormal - ask for specialist advice
93
What can be used to medical shrink fibroids?
GnRH
94
Patch contraceptive guidelines
<48 - replace immediately and no extra contraception is needed
>48 -change + 7 days of cover
- UPSI during that time or within last 5 days - emergency contraception is needed
95
In a lady who is under 35 and presenting with a simple ovarian cyst what is the management?
Repeat USS in 8-12 weeks
96
In any post menopausal women with an ovarian cyst on USS what is the management?
Refer regardless of size or nature
97
What treatment is used in keratinised genital warts?
Cryotherapy
98
What treatment is used in non keratinised fleshy genital warts?
Podophyllum
99
What is diagnostic of a miscarriage on transvaginal USS?
Crown rump length >7mm + no foetal heart beat
100
What should be given to the mother if their breastfeeding child develops a cows milk protein intolerance?
Vitamin D and calcium
101
What is the management of anyone over 30 with a suspicious breast lump?
Referral
102
Bishops score
<5 - spontaneous labour unlikely
| >8 - spontaneous labour likely - no need for induction
103
Induction of labour
```
Membrane - nulliparous 40 and 41 weeks or Multiparous 41 weeks - can be done by midwife
Vaginal Prostaglandin
Maternal oxytocin
Membrane rupture
Cervical balloon
```
104
Name a tocolytic drug used in cervical overstimulation
Terbutaline
105
What the commonest breast cancer immunologically?
HER2 -ve
| ER / PR +ve
106
Prior to breast cancer surgery a woman, with no palpable axillary lymph nodes, should undergo what other investigation?
Axillary Node USS -> if positive they should have a lymph node biopsy
107
If prior to surgery a woman is found to have palpable lymph nodes and or positive metastases on lymph node biopsy. How does this change her management?
She should undergo axillary node clearance.
108
If a woman is found to have no palpable lymph nodes or nothing on her sentinel node biopsy what is her management in surgery?
She should undergo sentinel node biopsies.
<3 positive - no axillary node clearance
>3 positive - axillary node clearance
109
What are some indications for a mastectomy?
Multifocal lesion
Large tumour in small breast
DCIS >4cm
Centrally located tumour
110
What are some indications for a wide local excision?
DCIS <4cm
Peripherally located tumour
Single tumour
111
Indications for radiotherapy in breast surgery
Anyone who has had a wide local excision
Mastectomy - T3/4
Four or more positive axillary nodes
112
Endocrine and biological therapy in breast cancer
Tamoxifen - Pre or Peri menopausal women - ER +ve
Lestrozole or anastrozole - Post menopausal women - ER +ve
Trastuzumab - HER2 +ve
113
What should be taken alongside tamoxifen?
Contraceptive
114
When should trastuzumab be avoided?
Any heart disease
115
What chemotherapy is used in higher grade breast cancer with auxiliary node involvement?
FEC - D
| 5-fluorouracil, epirubicin, cyclophosphamide and docetaxel
116
How often should someone with HIV undergo cervical cytology?
Every year
117
Primary Dysmenorrhoea - diagnosis and management
No underlying pathology - started soon after menarche
Pain occurs just before period
NSAIDs and Mefenamic acid -> COCP
118
Secondary Dysmenorrhoea - diagnosis and management
Started years after menarche
Pain occurs days before period
Endometriosisn Adenomysosis, PID, IUD, fibroids
NSAIDs + refer to gynaecology
119
What is done between 11-13 weeks
Down syndrome scan including nuchal thickness
120
What is done at 16 weeks gestation?
Info on anomally scan
121
When do primiparous women receive extra routine care?
25 weeks
| 31 weeks
122
What is done at 34 weeks?
Second anti D prophylaxis
| Information on labour and birth plan
123
What is done at 36 weeks
Check presentation and offer external cephalic presentation
124
What is offered at 41 weeks
Possibility of induction
| Membrane sweep
125
What is offered at 40 weeks
Routine care
Discuss plans for prolonged pregancy
Membrane sweep if primiparous
126
What is the inheritance of rhesus D?
Rhesus D +ve is inherited in an Autosomal Dominant fashion
127
How does a mother develop Anti D IgG antibodies?
A rhesus -ve mother becomes sensitised if they have a rhesus +ve child and there is exposure to the foetuses blood.
128
How do Anti D antibodies affect the foetus?
These can cross the placenta and cause extravascular haemolysis
Hydrops faetalis, kernicterus, HF all develop due to products of extravascular haemolysis
129
When should a rhesus -ve be offered Anti D prophylaxis?
Routine 28 and 34 weeks
Within 72 hours if -
delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma
130
What test can be used to determine rhesus status?
Coombs
| Kleinhauer test - used if exposed during 2/3 trimester after Anti D is given
131
Eczematous pruritic rash
Atopic eruption of pregnancy
Commonest rash during pregnancy
No treatment
132
Last trimester
| Pruritic rash occurring within abdominal striae
Polymorphic eruption of pregnancy
Emollients
Topical steroids
Oral steroids
133
How long post termination of pregnancy can a urinary pregnancy test remain positive for?
If it is still positive after this time frame what may it indicate?
4 weeks post termination is normal
| After 4 weeks consider incomplete termination or trophoblastic disease
134
Management of menorrhagia
Asymptomatic thickening on TVUSS - periodic review
IUS first line - especially if looking for contraception - avoid in distortion
NSAID -> mefenamic acid -> tranexamic acid -> COCP -> oral progesterone -> injectable progesterone
135
When is someone with a positive pregnancy test referred immediately to an early pregnancy assessment clinic?
Any abdominal pain, cervical motion pain or pelvic tenderness
> 6 weeks + Bleeding
136
When is someone with a positive pregnancy test and bleeding not referred?
<6 weeks + no pain + no risk factors for ectopic pregnancy
Told to return if
Bleeding continues and pain develops
Repeat pregnancy test in 7-10 days time is still positive
137
Can ulliprastal be used more than once in a menstrual cycle?
yes
138
Contraception time scales till effective if not stated on the first day of the period.
IUD - Immediatly
POP - 48 hours
COCP, Implant, Injection, IUS - 7 days
139
Down syndrome Screening
Combined Test 10-13 weeks - bhCG + PAPP-A + Nuchal thickness
14-20 weeks - if missed appointment - AFP, unconjugated estradiol, bhCG, inhibin A
Down syndrome shows low PAPP-A AFP Inhibin A Estradiol
- high bhCG
140
Layers cut through in C section
```
Skin
Superficial Fascia
Deep Fascia
Anterior Rectus Sheeth
Rectus Abdominus muscle - stretch using hands
Transversalis Fascia
Extraperitoneal connective tissue
Peritoneum
Uterus
```
141
What is classed as reduced foetal movements?
Less than ten within two hours
142
How is reduced foetal movements managed?
Hand held Doppler is first line
- +ve for heart beat -> cardiotocogram for 20 mins
- -ve for heart beat - USS
143
If there have been no foetal movements by 24 weeks what is the management?
Referral to foetal medicine
144
If a pregnant ladies urinalysis came back with trace 1+ amounts of glucose. What is your management?
Reassure and recheck next assessment
OGTT if - 1+ glucose on two separate occasions
- 2+ glucose on one occasion
145
bhCG
detected as early as day 8
| Secreted by syncytiotrophoblasts
146
When are breast fibroadenomas excised?
If over 3cm or causing significant distress or discomfort
147
Criteria for admission with Hyperemesis Gravidum
Unable to tolerate food drink or oral antiemetic
5% body weight loss or Ketonuria
Unable to take medication for underlying health condition
148
Management of hyperemesis gravidum
First line - Cyclizine or Promethazine
Second line - ondansetron - increased cleft palate risk
- metaclopramide - used for less than five days due to extrapyramidal effects
149
VTE in pregnancy
Previous VTE - LMWH from presentation to 6 weeks postpartum
| At risk of a VTE - LMWH from 28 weeks to 6 weeks postpartum
150
Management of placental praevia
Low lying at 20 weeks -> rescan at 34 weeks
Low lying at 34 weeks - Grade I/II rescan every two weeks
36/37 weeks with grade III/IV at 37/38 weeks elective C section
- grade 1 attempt normal vaginal delivery
Known placental praevia with spontaneous labour ->emergency C section
151
Only hormonal contraception not affected by Liver Enzyme Inducers or Inhibitors
Depo Provera
152
Why is depo provers not offered to women over 50?
Reduces bone density
153
How long should menopausal women be on contraception for?
If under 50 = 2 years after last period
| If over 50 = 1 year after last period
154
A lady with premature ovarian failure should be offered what?
HRT or COCP until 51
| Ovarian failure is not an effective method of contraception
155
Indications for a CTG
```
Temperature >38 or sepsis or chariomanionitis
Severe hypertension >160
Oxytocin se
Significant Meconium
Fresh vaginal bleeding during labour
```
156
CTG Basics
Loss of variability - <5 a minute - premature or hypoxia
>160bpm - maternal pyrexia, chorioamnionitis, hypoxia
<100bpm - increased foetal vagal tone i.e maternal beta blockers
Early Decelerations - reassuring
Late decelerations - if doesn't return to baseline after 30 seconds - foetal distress
Variable Decelerations - no link to contractions - chord compression
157
Medications which are safe to breast feed with.
Penicillin, Cephalosporins, trimethropin, steroids, levothyroxine, sodium valproate, salbutamol, theophylline, TCA, Antipsychotics (not clozapine), B blocker, warfarin, heparin, digoxin
158
Medication to avoid in breast feeding
Ciprofloxacin, Tetracyline, Chloramphenicol, Sulph..., Lithium, BDZ, Aspirin, Carbimazole, Methotrexte, Sulfonylurea, Amiodarone
159
What is the wiff test?
Adding alkali to bacterial vaginosis creates a strong fishy smell
160
Endometriosis management
NSAID -> COCP or progestogens
Refer to secondary care -> Goserelin
-> surgery - increases fertility
161
Do you stop metformin when adding insulin in pregnancy?
No it is added on top off
162
Contraceptives and there main function
```
COCP - inhibit ovulation
Desogetrel only pill - inhibit ovulation
POP - Thickens cervical mucous
Depo provera - inhibit ovulation
Implant - inhibit ovulation
IUD - decreases sperm mobility
IUS - prevents endometrial proliferation
```
163
Which type of HRT is preferred?
Cyclical as gives more predictable bleeds
164
In a pregnancy of unknown location what might help you localise it?
bhCG >1500 - might indicate a ectopic
165
What is the definitive management of PPH caused by placental acreta?
Hysterectomy
166
HRT types and breast cancer
Combined Oestrogen and Progesterone = increased risk
| Oestrogen only = reduces risk of breast cancer
167
HRT types and endometrial cancer
Combined = Reduced endometrial cancer
| Oestrogen only = Increased endometrial cancer risk
168
Pre Eclampsia risk factors
```
>40
Nulliparity
>10 years since last pregnant
FH
PMH of preeclampsia
>30 BMI
Vascular disease
Renal disease
Multipregnancy
```
169
History of PPH + signs of pituitary failure
Sheehans
170
History of surgery or trauma to internal uterus + infertility
Ashermans - uterine adhesions
171
Chlamydia management
Doxycycline 7 days - azithromycin if doxycycline is contraindicated
Men with urethral symptoms - all partners notified 4 weeks prior to onset
Women and asymptomatic men - 6 months prior
All partners who receive a notification are treated with antibiotics whilst awaiting test results
172
Hyperemesis gravidum - managment
1st line =Oral antihistamines - promethazine, cyclizine
| 2nd line = Anti emetics - Ondansetron and Metoclopramide - both carry risks
173
>30 + unexplained breast lump
Urgent referral
174
Cervical screening
Every 5 years from 25 - 64
175
Maternal exposure to parvovirus
Check maternal IgG and IgM - as causes hydrops fetalis
| Intrauterine blood transfusions required for the baby.
176
bhCG rise in ectopic vs viable intrauterine
Ectopic bhCG will increase up to 63%
| Beyond 63% increase it is likely to be due to a viable intrauterine pregnancy.
177
Starting hormonal contraception after emergency contraception.
Ellaone - wait 5 days
| Levonella - start immediately
178
If someone is in the early stages of labour with their amniotic sac still intact and the baby is found to be in a transverse lie. What can be done?
External Cephalic Conversion
179
Endometriosis management
Primary care - Analgesia -> COCP or POP -> refer
| Secondly Care - GnRH analogues or Surgery (best for fertility)
180
When is an APGAR at 10 minutes required?
If score less than 7 at 5 minutes
181
PCOS management
Weight loss and exercise
Fertility - clomifene -> + metformin -> gonadotrophins
Dysfunction - Co Cyprindol, COCP, Metformin
182
Dysmenorrhoea in PCOS
Induce bleed by giving a cyclical progestogen then refer for vaginal USS
If >10mm endometrial thickness -> biopsy to exclude endometrial hyperplasia
If <10mm - COC POP IUS etc
183
Dysmenorrhoea - Management
NSAID or Mefenamic acid
| COCP
184
What are some normal lab findings in pregnancy?
Decreased serum urea
Decreased serum creatinine
Increased urinary protein loss
185
Primary herpes infection during pregnancy - management
Oral acyclovir 400mg TDS till delivery
186
Whats the commonest cause of a reduced variability lasting less than 40 mins?
Foetus sleeping
187
What are some other causes of a reduced variability on CTG?
Maternal opioids BDZ beta blockers
Foetal acidosis due to hypoxia
Prematurity - below 28 weeks
188
Benefits of the subdermal implant?
Most efective method
Effective for three years
Safe for use in VTE and migraine with aura
Can be inserted immediately post TOP
189
Breast and axilla mass + breast augmentation + snowstorm appearance of USS
Breast implant rupture
190
Management of mild PMS
Regular exercise
| Small regular meals rich in complex carbohydrates
191
In a patient avoiding HRT who's main complaint is flushing what can be used?
SSRIs
192
Baby Blues
3-7 day postpartum
Very common
Anxiety and crying
Reassurance and support
193
Post Partum Depression
1 month post partum
1 in 10
Reassure -> sertraline or paroxetine
194
Post partum psychosis
0.2% develop
2-3 weeks postpartum
Admit to mother and baby unit
25-50% recurrence risk
195
What the first line antibiotic for a UTI in breast feeding?
Trimethropin
| AVOID - nitrofurantoin as G6PD risk
196
PPH management
IV syntocinin -> IV ergometrine -> IM carboprost -> Intrauterine Balloon Tamponade
197
Placenta accreta
Chorionic villi are attached to myometrium
198
Placenta Increta
Chorionic villi invade into myometrium
199
Placenta Percreta
Chorionic villi invade into perimetreum
200
Vaso Praevia
Painless vaginal bleeding
Ruptured membranes
Foetal bradychardia
201
AFP and defect in utero
AFP raised in neural tube defects
| AFP reduced in Down syndrome
202
What can be used to stop lactation in certain circumstances?
Cabergoline - if still birth baby death etc
203
If someone with a known coagulopathy has a miscarriage how should this be managed.
Medically with vaginal misoprostol
204
Miscarriage management
Expectant is first line - 7-14 days watch and wait
Medical - vaginal misoprostol
Surgical - if signs of sepsis of haemodynamic instability
205
Management of a suspected ovarian cancer if an abdominal mass is felt.
Urgent gynaecology referral
Skip USS
Take CA125 but don't wait for results
206
Placental abruption risk
```
A = Abruption previously
B = BP -high or preeclampsia
R = Ruptured membranes
U = Uterine injury
P = Polyhydramnios
T = Twins
I = Infection in uterus
O = Older than 35
N = Narcotic use - cocaine amphetamine etc
```
207
When is treatment initiated in antiphospholipid syndrome?
Aspirin from positive urinary pregnancy test
| LMWH from positive heart beat on USS
208
History of endometriosis + acute abdomen + free fluid in pelvis + recent period or negative pregnancy test.
Ruptured endometrioma
209
What may happen post successful treatment of syphilis and how is this managed?
Jarisch Herxheimer reaction - acute febrile reaction
Reassure that is subsides after 24 hours and provide paracetamol
Admit if seriously unwell
210
Cause of pulmonary hypoplasia
Oligohydramnios
211
Management of a molar pregnancy
Surgical curetage
| Hysterectomy if completed their family
212
Post molar pregnancy what surveillance is undertaken.
Partial molar - hCG done 4 weeks after - if normal = no surveillance
Complete molar - monthly hCG for at least 6 months
213
Molar pregnancy
Partial - some embryonic tissue
Complete - no embryonic tissue
Risk of choriocarcinoma transformation and local invasion
214
Mastitis managment
Ensure effective milk expression and analgesia
| Antibiotics if - failure to resolve 12-24 hours after advice, fissure in the nipple, positive culture
215
A pregnant lady on phenytoin should receive what extra care?
Vitamin K for the last month
216
What tocolytic is first line in preterm labour?
Nifedipine -beware can cause maternal hypotension
217
Bleeding for two weeks post birth.
Initially bright red but now a darker brown
Heavier in C-sections
Lochia
Completely normal - discharge and safety net
Return if - starts to smell, amount increases,
218
Management of an complex ovarian cyst
Ca125 AFP bHCG and elective cystectomy
| FNA isn't done as this can facilitate the spread of the cancer
219
After the 7 days of antibiotics in a UTI what else should be done? Pregnant
A urine culture should be sent as a test of cure
220
What is the commonest ovarian cyst?
Follicular
221
Which ovarian cyst is most likely to bleed?
Corpus Luteum cyst
222
Whats the commonest epithelial ovarian tumour?
Serous cystoadenoma
223
Complications associated with Mucinous Cystadenoma
Rupture can cause a pseudomyxoma peritoni
| Have the potential to become massive - compress surrounding organs
224
Guidance around emergency contraception and vomiting
If vomiting has occurred within 3 hours of taking another dose is required.
225
What test is indicated in recurrent vaginal Candidas?
Test for diabetes
226
Breast cancer screening
50 -75 years - mammogram every 3 years
227
How long is the IUS effective for?
5 years
228
How long is the IUD effective for?
5-10 years
229
In an a c section what should be given to the mother?
Omeprazole - helps reduce risk of aspiration pneumonia
230
What becomes first line for management of miscarriage over 12 weeks?
Medical - vaginal misoprostol
