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Year 5 > O&G > Flashcards

O&G Flashcards

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1
Q

Cord Prolapse types

A

Occult- alongside baby

Overt- cord below baby

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2
Q

Risk Fx for cord prolapse

A 
What stops head being in pelvis??
Premature 
Breech
Abnormal lie
Polyhydramnosis
Grand multifarious 5+ labours 
Placenta prévia
Second twin
artificial rupture of membranes
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3
Q

Managing cord prolapse

A

Relieve pressure with position and manually elevate
Bladder catheterise and fill to elevate baby head
Tocolytics to stop contractions

Squished and cooling so will vasospasm avoid!

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4
Q

Signs of cord prolapse

A

Feral decels on Ctg

Feral bradycardia

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5
Q

Risk fx shoulder dystocia

A 
Maternal
Induction of labour 
Bmi >30
Diabetes 
Previous SD
Prolonged labour first or 2nd stage
Instrumented 
Augmented (syntocinon)

Fetal
Macrosomia (>5kg c section. 4.5kg discuss.

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6
Q

Pelvis shape at risk of shoulder dystocia

A

Out of gynacoid, anthropoid, platypelloid, Android:

Platypelloid and anthropoid

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7
Q

Complications of shoulder maternal and fetal

A

Maternal:Perineal tear

Baby: Baby clavicle and thumb fx
Contusion
Brachial plexus injury

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8
Q

Major causes of postpartum haemorrhage

A

4 T

Tone- uterine atony

Trauma- lower genital tract lac, anal sphincter injury

Tissue/ retained placenta

Thrombin- coagulopathy

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9
Q

Time for secondary PPH

A

24h-6weeks

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10
Q

Mx PPH

A 
Help
A-E
Treat cause
If trauma compress
Tissue remove and check clots
Thrombin give products
Tone bimanual compression and uterotonics
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11
Q

Causes of retained placenta

A

Uterine atony
Multiple pregnancy
Placenta accrete

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12
Q

Amniotic fluid embolisation risks

A 
Oxytocin
C section
AVB
Stillbirth
Polygydramnosis 
None ...
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13
Q

Signs amniotic fluid embolism

A

Tachy hypertensive fluid overloaded (cough, pulmonary oedema)

Maternal collapse (left lateral displacement)

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14
Q

How many mls a min does perimortem c section give mum

A

500ml a minute!!

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15
Q

Positioning in shoulder dystocia

A

McRoberts will already be in lithotomy

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16
Q

Which maternal conditions is ergometrine used in active management of 3rd stage labour

A

Severe hypertension

Severe cardiac disease

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17
Q

Manoeuvres in SD

A

Axial traction sideways

Delivery 6o clock posterior arm

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18
Q

Active management of 3rd stage vs 60mins definition of retained placenta

A

30mins if active 60mins if not

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19
Q

If woman needs transferred during cord prolapse what position

A

Left tilt in ambulance

All 4s is best when still

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20
Q

Cut off time by CS after CPR

A

4mins after collapse baby 5-6 mins after commenced CPR

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21
Q

Induction of labour

Augmentation

A

Use oxytocin

Start labour
Slow: 1:10 slow progress - give hormone

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22
Q

Terbutaline

A

Use if wait for theatre in cord prolapse

Delay contractions

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23
Q

Medical promotion of uterine contraction

A

Syntocinon
Ergometrine
Carboprost
Misoprostol

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24
Q

Reversible causes of collapse in pregnancy

A

Hypoxia hypothermia hyperkalaemia hypokalaemia hypovlycaemia

Toxin tension tamponade thrombus

Eclampsia (Mg toxicity) and ICH
Amniotic fluid embolism

Ie more bleeding risk and relative hypovolaemia
Peripartum cardiomyopathy, MI, aortic dissection
PE and other emboli
Suicide

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25
Ccx of pre eclampsia
``` ICH Placental abruption and DIC Eclampsia HELLP Renal failure Pulmonary oedema Acute respiratory arrest ```
26
Fetal Ccx pre eclampsia
``` IU growth restriction Oligohydrannios Hypoxia due to placenta insufficiency Placental abruption Premature ```
27
Management of hypertension
Moderate BP 150-160 oral labetolol Severe >180 oral/iv labetolol oral nifedipine IV hydralzine High dependency check BP every 15mins/30mins
28
Management eclamptic seizure
Left lateral position uterus O2 Iv Mg sulfate 4g in 5min to load Reduce cerebral vasospasm If severe and birth is planned or after fit Continue for 24h
29
Why monitor urine output following MGSO4 in eclampsia
Renal excretion and risk of toxicity in oliguria
30
What to monitor when giving MGSO4
Urine out Deep tendon reflexes Hrly RE INDICATE TOXICITY -> arrest
31
Managing MGSO4 toxicity
AE STOP IT IV calcium gluconaye 10ml 10% Tube and ventilate
32
Signs of pre eclampsia
Severe HA Epigastric pain BP and Urine
33
Contraindications for LMWH
Vw disease Severe liver disease Severe renal disease (egfr <30 as its Renal elimination)
34
Sx of uterine fibroids
``` Heavy menstrual bleed Abdo swelling Pressure Subfertile Difficult pregnancy (miscarriage and red degeneration) Pain = Tortion ``` ? Mass
35
Signs of PID
``` Pyrex > 38C Abdo distension and tender RUQ? Suggests peri hepatic inflam = Fitz-Hugh-Curtis Rebound and guarding Discharge on speculum Tender VA ```
36
Ix PID
``` Iron Bhcg FBC CRP MSU Swabs TVU (tubo ovarian abscess) Laparoscopy ```
37
Rx PID
Empirical ABx Cef 500mg IM stay then oral doxy 100mg bD + metronidazole 400mg Can give oral oflox Pain relief Refer GU med
38
Diagnosis ovarian cyst
US | CA125 CEA hCG aFP
39
Rx ovarian cyst
<6cm and no Sx can conservatively manage ?Ca125 and scan >6cm remove
40
Types of ovarian cyst
1: Functional
41
Sx endometriosis and diagnosis
Dysmenorrhoea Dysparenuria Pelvic pain Sun fertile Fixed tender retroverted uterus TVU CA125 often up lap + biopsy
42
Rx endometriosis
Conservative NSAID Progesterone COCP Mirena GnRH analogue prior to surgery Can cauterise may need cystectomy
43
Ovarian Cyst accidents and Ix
Tortion Rupture Haemorrhage Infection bhCG MSU FBC CRP CA125 TV US
44
Pathophys of HPV and cancer
Subtype 16 and 18 Enters cell and release proteins E6 and E7 Keep it in the cell and then bind p53 and Rb Leaves cells open to unchecked proliferation Interferes at the transitional zone leading to CIN and SCC
45
HPV vaccine schedule
2 injections or 3 if delayed to 15 GARDISAL covers 6,11,16 and 18 Protects against cervical vulval anal and warts 12-13 years
46
Ix if abnormal cervix on visualisation
Punch biopsy and large loop excision of transformation zone (LLETZ) Refer Colposcopy
47
Cervical cancer appearance
Acetowhite Punctated Mosaic Abn vessels
48
Rx CIN
Cold coagulation / cryotherapy | LLETZ laser excise
49
Sx cervical cancer
Unscheduled bleeding Offensive discharge Obstructive uropaphy Supraclav node
50
Staging cervical ca
FIGO Includes examination under anaesthesia (bimanual/PR) MRI Sizing stage 1 Stage 2 involvement of upper vaginal 11b = parametrium III: lower 1/3 vagina b= pelvic wall/hydronephrosis IV: spread
51
Treatment options cervical cancer
LLETZ Trachectomy HYSTERECTOMY ? Nodes Radical hysterectomy stage 1b and 2a Chemorad /NACT May need urostomy
52
Risk fx vulval cancer
``` Smoking HPV ALTERRED IMMUNE Age Lichen sclerosis ```
53
Types Vulval cancer
Most SCC | Also adeno/melanoma/BCC etc
54
Types of vulval cancer and histology
Usual (thick, high nuclear to cytoplasm, mitotic figures) Warty (multinucleate cells, koliocytes Basaloid (less differentiated and high N:C) Differentiated (enlarged keratinocytes thick epidermis)
55
Sx VIN
``` Pruritis Pain Ulcer Leukoplakia Lump ASx Labia majora, minora and posterior fourchette ```
56
Rx VIN
Surgery - radial? Laser? Ablation- chemo (imiquimod) Laser Photodynamic
57
Complications o inguinofemoral lymphadenectomy
Wound breakdown increase | Cellulitis / erisipalis
58
Male factors in subfertility
AZOO: 1- Obstructive azoospermia - not getting into ejaculate ?CF 2- NON OBSTRUCTIVE (testicular failure or small volume ?XXY 3- no spermatic Emed is in hypogonadotrophic hypogonadism
59
Female factors in subfertility
1- Ovulatory Regular cycle? Check mid luteal pg day 21 Amenorrhoea- HPG (HP failure rate ?tumoir ?BMI) HP dysfunction (PCOS, prolactin up, thyroid) Fertilisation Implantation
60
Rx PCOS
BMi Clomifene (SERM) Letrozole (aromatise inhibitor) Metformin Ovarian drilling ART
61
Ix incontinance
``` Abdo and bimanual Vaginal inspection (bivalve, speculum, ?prolapse ?atrophy ? Fistula ? Ulcer Cough - leak? ``` Urine dip and culture Bladder diary Cystoscope and renal imaging Urodynamic in those with failed conservative, before surgery, rx complications
62
Manage incontinance
``` Lifestyle, PR, bladder retrain ABx Anticholinergics (oxybutanin, solfenacin B3 agonist Duloxetine ``` Surgery - sling, colposuspension,
63
Side fx anticholinergics
Dry mouth eyes and constipation
64
Components of a partogram
``` Dilation Descent in relation to ischial spines Frequency on contractions Status of membranes and ?blood/meconium Drugs and fluids Maternal HR Baby HR ```
65
Indicators of a problem on partogram
Alert and action
66
What does progression of labour depend on?
Power Passenger Passage
67
Management of failure to progress
Artificial rupture of membranes Oxytocin infusion Instrument delivery C section
68
Fetal varicella syndrome
Skin scar eye defect limb hypoplasia neuro (microcephaly cortical atrophy mental restriction)
69
Pep for newborn drug
Zidovudine within 4h birth for 4 weeks. Avoid breastfeeding risk 5-20%.
70
Antenatal and postnatal findings haemolytic disease of newborn
Ante: polyhydramnios, thick placenta, hydrops (subcut oedema, pleural and pericardial effusion, ascites, hepatosplenomegaly), death Post: jaundice, hepatosplenomrgaly, kernicterus, hypoglycaemia
71
Pathology of maternal rhesus-ve group +ve fetus
Maternal IgG crosses placenta and destroys fetal RBC
72
Preventing rhesus disease
Blood transfusion | AntiD prophylaxis
73
When is AntiD required
``` After ectopic After molar After termination <12 week vaginal bleed which is heavy <12 week medical or surgical management of miscarriage Sensitising event post 12 week ``` After delivery testing of infant cord and mat blood
74
Derm disease in pregnancy
``` Acne Psoriasis Infection (candida, varicella, warts) Atopic eruption AI (SLE, pemphigus)- pemphigus gestationis Obstetric cholestasis ```
75
Atopic eruption of pregnancy types and appearance
Exzematous- rough and red. Face, neck and creases. Prurigo- bumps widespread
76
Manage atopic eruption of pregnancy
``` Aqueous cream Topic steroid Antihis Narrow band UVB ORAL steroids ```
77
Polymorphic eruption of pregnancy site and rx
Lower abdomen and striae. Umbilical soaring. Self care, emollient, moderate topical CS, antihis for sleep (itch ie chlorphenamine
78
Risks of pemphagoid gestationis
Fetal growth restrict Blistering of inane Secondary infection Due to IgG binding BM
79
Polyhydramnios clinical suspicious
Large for dates Tense abdomen Unable to feel foetal pets Amniotic fluid index >90th centiles by measuring single deepest vertical pool
80
Risks and associations of polyhydramnios
``` Placental abruption Malpresentation Cord prolapse Large for dates C section PPH Premature Perinatal death ```
81
Associations with oligonydramnios
``` Poor outcome Prolonged pregnancy Ruptured membranes IUGR Fetal renal congenital abnormalities Hypoxia in cord compression ```
82
Risk fx for gestational diabetes
FHx BMI >30 Previous macrosomic baby Previous GDM
83
Pro pregnancy hormones and factors vs pro labour
Preg: progesterone, NO, catecholamines, relaxin Labour: oestrogen, oxytocin, PGs (promote cervical ripening and uterine contractility from COX -> arachnidonic acid) , CRH, inflam mediators (IL8, TNfa, IL6 -> pro inflammatory TF and cervical ripening)
84
Cervical ripening
Cervix softens and effaces PG increase this by inhibiting Collagen synthesis and stimulating collagenase (via fibroblasts) to break down the collagen in the cervix
85
Bishop score
Cervical ripening
86
Induction of labour- methods
Unfavourable bishop score <=6 PGs (PGE2 gel in posterior forbid). Artificial rupture when score >6. Can cause GI upset. Favourable ARM and syntocinon with CTG
87
Pain relief in labour
``` Mat support (less analgesia) Environmental (music mobilisation) Birth pool Education Inh analgesic entonox Systemic opioid diamorphine with antiemetic unless delivery within 4h Pidendal analgesia Regional (epidural can prolong 2nd stage and incidence of instrumental delivery; spinal for theatre pt General ```
88
Puerperal Pyrexia
Usually genital tract ie endometritis or UTI ?breast ?DVT MSSU and swabs
89
Management genital warts
Podophyllotoxin caution in pregnancy Imiquimod Cryotherapy Leave 12/12
90
Smelling discharge
Bacterial vaginitis
91
Bacterial vaginosis
Reduced lactobacilli and more Gardenerella vsginalis Alkaline discharge smell worse after sex as more alkaline!!! Associated with preterm labour Ix: vagina wall pH swab alkaline />4.5 with Amsels criteria DDx: candida (itch)/ trichimonas (discomfort) Rx: metronidazole 5d (no alcohol)
92
Trichomonas
Flagellated protozoan 30% have co-infection with gonorrhoea and chlamydia Detrimental to pregnancy Malodorous discharge and dysparenuria
93
Unprotected anal and oral intercourses male male
CT/NG NAAT throat rectum and urine
94
Rx gonorrhoea
Ceftriaxone
95
Candida
Sx: itch, pain, discharge, dysparenuria Swelling, fissure, discharge, vulvovaginitis Rx- clotrimazole pessary and ? Fluxonazole tablet unless risk of pregnancy (pessary)
96
Tertiary syphilis
Gummma CV neuro Post chacre ... rash (2ary)
97
Clinical indicators HIV
``` Thrombocytopenia CIN2 Recurrent shingles Recurrent bac pneumonia Dementia STI ```
98
When to not medically manage ectopic
``` HD unstable >3.5cm Pain ++ Intrauterine pregnancy Can’t be followed up post methotrexate ``` Choice 1500-5000 with no pain, Unruptured, smaller than 35mm, no heartbeat, no intrauterine Give anti D Ig if R-ve
99
Rx PPROM
``` Ix = FBC and CRP USS CTG Doppler Rx= steroids, erythromycin 10d/till delivery (whatever is sooner) ```
100
Complications of PPROM
Mat Fetal

Year 5 (11 decks)

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