O&G Passmed Flashcards by Sami al-balasmeh

Drug that causes increased risk of placental abruption

Cocaine

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Foetal consequences of maternal rubella infection

SN deafness
cataracts
congenital heart defects
growth retardation
cerebral palsy

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Contraceptives and their methods of action

COCP
- Inhibits ovulation
POP
- Thickens cervical mucus
Desogestrel only pill
- Inhibits ovulation, also thickens mucus
Injectable contraceptive (medroxyprogesterone acetate aka Provera)
- Inhibits ovulation, also thickens cervical mucus
Implantable contraceptive (etonogestrel)
- Inhibits ovulation, also thickens cervical mucus
Intrauterine contraceptive device
- Decreases sperm motility and survival
Intrauterine system (levonorgestrel)
- Prevents endometrial proliferation, also thickens cervical mucus

EMERGENCY CONTRACEPTIVES
Levonorgestrel - inhibits ovulation
Ulipristal - inhibits ovulation
Intra-uterine device - Toxic to sperm and ovum, also inhibits implantation

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COCP: Cancer risks

Increases risk of breast and cervical (the oens we screen for). Also more risk of cervical ectropion
Decreases risk for ovarian and endometrial cancer

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Abdo trauma in pregnancy, no other signs, all else appears normal. RX?

Blood type and RhD testing

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Management of uterine fibroid <3cm

medical treatment (e.g. IUS, tranexamic acid, COCP)

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Struggling to conceive for 12 months, mild endometriosis

Try for another 12 months

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Risk factors for placenta praevia

multiparity
multiple pregnancy
embryos are more likely to implant on a lower segment scar from previous caesarean section

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Placenta praevia: features

shock in proportion to visible loss
no pain
uterus not tender
lie and presentation may be abnormal
fetal heart usually normal
coagulation problems rare
small bleeds before large

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Suitable contraception for women taking carbamezapine

Copper IUD
Carbamezapine is an enzyme inducer, so something without hormones is preferred
However, if heavy bleeding is an issue, give Mriena (IUS)

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Management of endometriosis

COCP if not wishing to conceive (taken every day)

Referral to fertility services and laparoscopic adhesiolysis if wishing to conceive

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Continuous dribbling incontinence after birth

Vesicovaginal fistulae suspected

Urinary dye studies

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Unsure of diagnosis for incontinence or plans for surgery

urodynamic studies

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Pearl index

Used for contraception

Number of women who become pregnant if 100 women use that contraceptive for 1 year

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Woman on microgynon 30, missed one tablet and had sex last night

Reassure, no action needed
If 2 or more pills missed
- Take last pill (even if 2 in one day) and abstain from sex until 7 days of consecutive pill taking

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Second screen for anaemia and atypical red cell alloantibodies

28 weeks

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Nuchal scan

11-16+6 weeks

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Emergency contraception options

Levonorgestrel 1.5mg stat - 84% effective within 72hrs
Ulipristal (ellaOne), 30mg, up to 120hrs
IUD: within 5 days, 99% effective, can be left in for long term

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First line medication to restore normal ovulation in PCOS

metformin or Clomifene

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Pregnant women, contact with chickenpox, unsure if she had it before. No other symptoms

Check varicella antibodies

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Contraceptive associated with weight gain

Medroxyprogesterone acetate

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Contraindicated drugs during breastfeeding

antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulphonylureas
cytotoxic drugs
amiodarone
clozapine

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Causes of primary post partum haemorrhage

Causes can be grouped into the 'four T's':
tone (atonic uterus, most common)
tissue (retained placenta)
trauma
thrombin (coagulation abnormalities)

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What normally happens to maternal blood pressure in pregnancy

Falls in first half of pregnancy before rising to pre-pregnancy levels before term

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Management of menorrhagia

Investigations - FBC - Transvaginal ultrasound if symptomatic or abnormal pelvic exam findings Rx (no contraception needed) - Mefenamic acid 500mg tds or tranexamic acid 1g tds - try these drugs whilst referring Rx (needs contraception) - intrauterine system (mirena) first line - COCP - Long acting progestogens Norethisterone 5 mg tds can be used as a short-term option to rapidly stop heavy menstrual bleeding.

1 day post c-section, pain and heavy vaginal bleeding and heavy, offensive lochia and boggy, poorly contracted uterus

Retained products of conception (take care to remove all placental membranes during C section) Exam under anaesthesia to remove the products

vaginal candidiasis in pregnancy

clomitrazole pessary

abdo discomfort, distension, nausea and vomiting after egg retrieval for IVF

Ovarian hyperstimulation syndrome Caused by use of HCG in maturation of follicles Treat with fluid replacement and thromboprophylaxis

vasa previa features

PROM followed by Painles PV Bleeding and Foetal bradycardia

management of atonic uterus

ABC Bladder epmtying, uterine massage IV ergometrine bolus Ocytocin infusion

management of epilepsy in pregnancy

Lamotriogine

uterine tenderness, rupture of the membranes with a foul odour of the amniotic fluid and maternal signs of infection (for example tachycardia, pyrexia, and leukocytosis).

Chorioamnionitis

Next step for late decellerations on CTG

Foetal blood sampling (apparently)

Appropriate drug before fibroid surgery

GnRH analogues to reduce size

breastfeeding woman. Tender, erathematous breast. No other abnormalities

Mastitis, usually caused by milk stasis | Continue breastfeeding, simple analgesia and warm compresses

Which causes a big delay in returning to normal fertility after stopping

Progesterone only injection (takes up to 12 months)

Bishop's score of 4 is calculated. What treatment is most suitable?

PGE2 vaginally to induce labour

Vaginal discharge after UTI treatment

Candida

Rx of simple cyst on USS

Repeat in 12 weeks, if still there refer to gynae

Mother had pervious group B strep infection. Additional Rx:

Intrapartum antibiotics

Medication to reduce risk in pregnant women with history of pre-eclampsia

low dose aspirin

cyclical pain but no bleeding, concerns periods haven't started yet

Imperforate hymen

Which drug should be administered to the mother to reduce the chance of respiratory distress syndrome in the newborn?

Dexamethasone

37 weeks pregnant, fainting and sudden severe abdo pain, hypotension and tachycardia. Cold on examination

Placental abruption

HRT recommendations

Cyclical combined HRT if LMP is less than 1 year ago Continuous combined if: - Taken cyclical combined for >1yr - LMP was >1yr ago - LMP was >2yrs ago if menopause before 40

Which methods of contraception should be discontinued once a woman reaches 50

Depo-provera (injectivle contraceptive) | COCP

Sudden onset iliac fossa pain, nausea and vomiting

``` Ovarian torsion (usually coincides with exercise) Miscarriage (follows a period of amenorrheoa) ```

Complications of PCOS

``` Subfertility Diabetes mellitus Stroke & transient ischaemic attack Coronary artery disease Obstructive sleep apnoea Endometrial cancer ```

Comlications of pre-eclampsia

fetal: prematurity, intrauterine growth retardation eclampsia haemorrhage: placental abruption, intra-abdominal, intra-cerebral cardiac failure multi-organ failure

When do post-menopausal women still need contraception

when <50YO

hormone measured at day 21 to test for ovulation

Progesterone

term used to describe the head in relation to the ischial spine

Station

Pregnant women exposed to VZV and is not immune. Next step

VZIG ASAP

At what point in her menstrual cycle can the IUD be inserted?

Any time

Sudden collapse soon after rupture of membranes

Amniotic fluid embolism

Rx for simple fibroids to retain fertility

Myomectomy

Contraceptives - time until effective (if not first day period):

instant: IUD 2 days: POP 7 days: COC, injection, implant, IUS

combination of menorrhagia, subfertility and an abdominal mass

Fibroids

Rokitansky's protuberance.

teratoma (dermoid cyst)

Confirmed extopic pregnancy, no pain or other symptoms, bHCG<1500. Ectopic <35mmFirst line Rx

Methotrexate, as long as willing to attend follow up | Failing any of these criteria, laparosopic salpingectomy

16 weeks gestation, painless PV bleeding, morning sickness, SOB Ultrasound revealed a solid collection of echoes with numerous small anechoic spaces. What is the most likely diagnosis?

Hydatoform mole (molar pregnancy)

The following results would be expected in a trisomy 21 (Down's syndrome) pregnancy:

- High bHCG - Low PAPP-A, AFP, Oestriol - Thickened nuchal translucency

complication of vaginal hysterectomy

Vaginal vault prolapse

Sheehan's syndrome: Pathology

Sheehan's syndrome (otherwise known as postpartum hypopituitarism) is a reduction in function of the pituitary gland following ischaemia necrosis due to blood loss and hypovolaemic shock following birth.

Cervical screening programme for HIV Positive women

Annual cervical cytology

increased nuchal translucency. Other than Down's syndrome, which one of the following is most associated with this finding?

congenital heart defects

Risk factors for placenta accreta

Placenta accreta describes the attachment of the placenta to the myometrium, due to a defective decidua basalis. As the placenta does not properly separate during labour there is a risk of post-partum haemorrhage. Risk factors previous caesarean section placenta praevia

9 weeks pregnant, the high vaginal swab has isolated group B streptococcus (GBS). How should she be managed?

Intrapartum IV benzylpenicilin

Foods to avoid in prenancy

Liver (contains Vit A) and other Vit A supplements as Vitamin A is teratogenic

UKMEC classification system (contraception options)

UKMEC 1: a condition for which there is no restriction for the use of the contraceptive method UKMEC 2: advantages generally outweigh the disadvantages UKMEC 3: disadvantages generally outweigh the advantages UKMEC 4: represents an unacceptable health risk

O&G Passmed Flashcards

(70 cards)