OBGYN Flashcards
(41 cards)
A CTG is showing a single prolonged deceleration with baseline <100/min for >3 minutes. This is occuring in a prolonged labour. What is the management?
Inform senior
Preparation for urgent Category 1 CS
Vasa praevia can present similarly to placenta praevia in that they both have painless vaginal bleeding. What 2 other features would you expect of vasa praevia?
Fetal bradycardia
Membrane rupture
A woman is discovered to be GBS positive; how should this risk to the fetus be managed with respect to delivery?
Intrapartum antibiotics;
IV benpen given asap at start of labour and then 4 hourly until delivery.
Which SSRI is excreted in breast milk and because of it’s longer half life may potentially cause toxicity in babies?
Fluoxetine
(Citalopram is also secreted in breast milk but not thought to be an issue)
What are the antidepressants of choice in women who are breast feeding?
Paroxetine
Sertraline
What are the first and second line options for endometriosis?
NSAIDs and paracetamol
COCP (unless contraindicated e.g. migraine with aura) or POP
GnRH analogue; these act to induce a menopause state; side effects of menopause
What are the symptoms of endometriosis?
Deep dyspareunia
Dysmenorrhoea
Tender nodularity at the posterior vaginal fornix
Worse during the luteal pahse day 15-28 as pain is caused by ectopic endometrial tissue proliferating in response to rising oestrogen levels.
What is the agent of choice for stress incontinence?
Duloxetine
What are the parameters for medical treatment of a uterine fibroid, and what are the medical options?
<3cm in size
Not distorting the uterine cavity
Managing menorrhagia:
IUS
Mefenamic acid
Tranexamic acid
COCP
POP
Injectable progesterone
Shrinking:
GnRH agonists
Surgical options include myomectomy, hysteroscopic endometrial ablation, hysterectomy or uterine artery embolization
What is the first line treatment for menorrhagia?
IUS / Mirena (levonorgestrel)
The NHS now tests for high-risk HPV and then uses that result to define next management in their screening programme. Outline what will happen if a) HPV negative b) HPV positive
HPV negative = normal recall
HPV positive: cytology done.
Cytology ABNORMAL; colposcopy
Cytology NORMAL; repeat smear in 12 months
Cytology ‘inadequate’; repeat in 3 months; 2 consecutive inadequate samples = colposcopy
A woman is 24 weeks pregnant and presents within 24 hours of developing a chicken-pox rash. What is the treatment?
Oral aciclovir
If the woman in <20 weeks, aciclovir should be considered with caution.
Chickenpox exposure can be distressing for pregnant women; what should be done if a pregnant woman is exposed to chickenpox, but she has not developed a rash?
Urgent varicella antibody check.
Oral aciclovir is given as PEP, but it is given at day 7-14 after exposure.
What is adenomyosis and how would it present?
Endometrial tissue embeds in the myometrium.
More common in women >30 who are multiparous.
Dysmenorrhoea
Menorrhagia
Enlarge, boggy uterus
TVUS first line
Similar treatments to fibroids
What happens to uterine fibroids in pregnancy?
They can grow due to the increased oestrogen.
They can grow too large for their blood supply though, and THEN degenerate.
Deep dyspareunia and pelvic pain can indicate this growth.
A girl is taking the COCP. She has missed 2 pills in week 3; what should she be advised to do?
Take missed pill now (1), and finish pills in current pack and start new pack immediately, omitting the pill free interval.
What is the MOA of tamoxifen in breast tissue, and how does it increase the risk of a certain type of other cancer?
Oestrogen receptor antagonist in breast tissues.
At other sites e.g. endometrium it may act as an agonist, therefore a reason for increasing risk of ENDOMETRIAL cancer.
State some risk factors for endometrial cancer:
Excess oestrogen; early menarche, nulliparity, late menopause, unopposed oestrogen e.g. this is why prog is given in HRT
Metabolic syndrome e.g. obesity, DM, PCOS
Tamoxifen
HNPCC
PMS symptoms management:
Moderate = new gen COCP
Severe = SSRIs
A first degree perineal tear is superficial damage with no muscle involvement, and does not require any repair. What is classed as a 2nd, 3rd and 4th degree tear?
2nd; perineal muscle involvement but NOT anal sphincter.
3a <50% External Anal Sphincter involvement
3b >50% EAS
3c IAS involvement
4 rectal mucosa involvement
Describe the management of perineal tears.
2nd degree = suture on ward
3rd degree = repair in theatre
4th degree = repair in theatre
The normal dose of preconception folic acid is 0.4 mg OD. Some women are at increased risk of NTD and require a higher dose. Who are these women (6) and what dose do they require?
5mg
Previous child with NTD
Diabetes mellitus
Women on antiepileptics
BMI >30
HIV positive taking cotrimoxazole
Sickle cell disease
What organism may present with a ‘strawberry cervix’, what other features may it have and how is it managed?
Trichomonas vaginalis = strawberry cervix
Also ‘musty’, frothy, green vaginal discharge.
Treat with ORAL METRONIDAZOLE
What is Amsel’s criteria, and how should a positive result be treated?
For diagnosis of bacterial vaginosis.
3 out of 4 should be present.
Thin, white, homogenous discharge
Clue cells
Vaginal pH >4.5
Positive whiff test / fishy odour
Treat with ORAL METRONIDAZOLE
