OBG Flashcards
(33 cards)
COCP risks and benefits:
protective: ovarian and endometrial cancer
risk: cervical and breast cancer, also increased risk of stroke
Missed pill rule:
if forget to take the pill between day 8-14 and have taken it correctly 7 days before that= NO emergency contraception is required.
Chickenpox in pregnancy:
Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with oral Aciclovir if they present within 24 hours of the rash
Pre-eclampsia Mx(to correct hypertension):
1st line: would be Labetalol (beta blocker) however this is contraindicated in asthmatics therefore 2nd line) Nifedipine (CCB)
- delivery of baby is most important and definitive step
Pre-Eclampsia presentation (triad):
- new onset hypertension more than 140/90 after 20 weeks gestation
-proteinuria
-oedema
MMR vaccination in preg:
Do not give at any stage of pregnancy
Carboprost medication contraindication:
- Avoid in asthmatics= will cause exacerbate broncho constriction
PPH(Post-partum Haemorrhage) causes (4):
-Tone (uterine atony)
-Trauma (eg. perineal tear
-Tissue (retained placenta)
-Thrombin (clotting/bleeding disorder)
PPH 1st line surgical Mx:
Intrauterine balloon tamponade
Order of PPH medical intervention drug:
if uterine atony:
1) IV oxytocin (to start uterine contractions), to stop contractions= give tocolytics
2) IM carboprost (but avoid in asthmatics)
3) IV/IM ergometrine: avoid if hypertension
4) Misoprostol (sublingual)
Prescribing folic acid in preg:
Give 5mg daily(high dose not 400 micrograms) if obese(BMI more than 30 or is on anti-epileptics)
Abdominal pain in pregnancy:
Adenomyosis 1st line inv:
Transvaginal ultrasound
- presents with heavy, painful bleeding, enlarged boggy uterus
Mx: Definitive: Hysterectomy, tranexamic acid
History: sharp abdominal pain, fever, no bleeding, vomiting, multiple large fibroids
Fibroid red generation
ddx: if ovarian torsion=would have risk factors such as ovarian cyst in history
Threatened miscarriage= would have vaginal bleeding
HELLP Syndrome:
Haemolysis, Elevated liver enzymes, low platelets, serious manifestation of pre-eclampsia
Ddx: Obstetric cholestasis= intense pruritus, rise in serum bile acids
Differences between Placenta accreta, increta and percreta:
Accreta: Attach to the myometrium, rather than being restricted within the decidua basalis
Increta: Invade into myometrium
Percreta: Invade through the perimetrium
Asherman’s syndrome:
amenorrhoea due to intra-uterine adhesions= after trauma from miscarriage and childbirth
Sheehan’s syndrome:
Pituitary and PPH cause
Endometriosis gold standard Inv:
- Laparoscopy
Presents with: dysmenorrhea (cyclical) and dyspareunia
Mx: with NSAIDS/paracetamol or progestogen
Secondary: GnRh analogues
Ectopic Pregnancy:
Px: Lower abdominal pain that is referred to shoulder, vaginal bleeding, lack of GI symptoms and positive pregnancy rest
- Risk factors: Endometriosis, progesterone only pill, damage to tubes(eg. by pelvic inflammatory disease)
Urinary incontinence management:
- Urge incontinence: when coughing/sneezing= Bladder retraining, oxybutynin
- Stress incontinence: Pelvic floor exercises, duloxetine
Expectant Mx. in an ectopic pregnancy (criterias)=
1) Unruptured embryo
2) less than 35mm in size
3) have no heartbeat
4) be Asymptomatic
5) have a bcg level of less than 1000 and declining
Threatened miscarriage px:
painless vaginal bleeding, closed cervical os.
Hyperemesis Gravidarum mx:
Mx: admit for IV saline+potassium replacement as patient could be in hypokalaemic from all the vomiting.
