OBGYN Flashcards
(256 cards)
1
Q
Preterm labour is weeks
A
37
2
Q
Post-term labour is >? weeks
A
42
3
Q
How can you work out estimated delivery date
A
1st day of LMP + 9 months and 7 days
OR
1st day LMP + 40 weeks
4
Q
Trimester 1 is
A
0-12 weeks
5
Q
Trimester 2 is
A
12-27 weeks
6
Q
Trimester 3 is
A
27-40 weeks
7
Q
When can you hear fetal heart beat with doppler
A
From 12 weeks
8
Q
When can you hear fetal heart beat with Pinard and where do you listen
A
From 24 weeks
Over the anterior shoulder
9
Q
Describe the position of the uterus and how/when it ascends throughout pregnancy
A
<12 weeks: in pelvis
16 weeks: half way between PS and umbilicus
20-34 weeks: at umbilicus
36 weeks: under ribs
10
Q
When does the head engage in a) primips b) multips
A
Primips 37 weeks (if not consider placenta previa)
Multips onset of labour
11
Q
Definition of maternal death
A
During pregnancy or within 42 days of birth
12
Q
Risk factors assessed for VTE in pregnancy
A
BMI 30+ (40+ counts as 2) Age >35 Parity 3+ Smoker Varicose veins Pre-eclampsia Immobility 1st degree with unprovoked VTE Thrombophilia Multiple pregnancy IVF
13
Q
Aspirin is giving in pregnancy to reduce the risk of what complication?
A
Pre-eclampsia
14
Q
Risk factors for pre-eclampsia
A
Hypertensive disease in previous pregnancy CKD Autoimmune disease - SLE, APLS DM Chronic HTN First pregnancy Age 40+ >10 years between pregnancies BMI 35+ FH of pre-eclampsia Multiple pregnancy
15
Q
If a patient is considered high risk for pre-eclampsia what medication do you start, what dose and when
A
Aspirin 75mg OD 12-37 weeks
16
Q
Indications for OGTT at 26 weeks
A
BMI >30 Previous baby >4.5kg 1st degree relative with DM Family origin: South Asian (India, Pakistan, Bangladesh), Chinese, Black Caribbean, African, Middle Eastern (Saudi Arabia, United Arab Emirates, Iraq, Syria, Oman, Qatar, Kuwait, Lebanon, Egypt) Previous unexplained FDIU Previous congenital abnormality PCOS
17
Q
Indications for OGTT at 16 weeks
A
Previous GDM
Severe PCOS
18
Q
When should folic acid be taken?
A
3 months before conception and until 12 weeks gestation
19
Q
What is the normal dose of folic acid
A
400 micrograms
20
Q
What are some indication for higher dose folic acid (5mg)
A
High BMI
Hx of NTH (personal or FH)
Antiepileptic medication
DM
21
Q
Risks of alcohol in pregnancy
A
IUGR
Facial abnormalities
Learning abnormalitis
22
Q
Risks of smoking in pregnancy
A
LBW Preterm labour SIDS Miscarriage Neonatal breathing difficulties
23
Q
Which vitamin should be avoided during pregnancy
A
Vitamin A (>700mcg) - so avoid liver products
24
Q
How long is maternity leave and how long is maternity pay
A
52 weeks leave
39 weeks pay
25
When should nausea and vomiting resolve spontaneously by in pregnancy
Around 16-20 weeks
26
Common symptoms in pregnancy
```
Nausea and vomiting
Constipation
Haemorrhoids
Heartburn
Varicose veins
Vaginal discharge
Backache
```
27
Which medication is used to treat vaginal candida during pregnancy
Topical Imidazole
28
How many routine antenatal appointments are offered for a) primips b) multips
Primips - 10
| Multips - 7
29
In general, how frequent are antenatal appointments
4wkly to 28
2-3wkly to 36
weekly 36+
30
Appointment weeks for primips
<12, 16, 25, 28, 31, 34, 36, 38, 40, 41
31
Appointment weeks for multips
<12, 16, 28, 34, 36, 38, 41
32
What happens at a booking visit
```
General advice/info
Risk factors screened for VTE, GDM and Pre-eclampsia
BMI + BP + urine dip
Screening counselling
Assess for DV and FGM
Bloods
```
33
What bloods are done at booking
HIV, HBV and syphilis
Hb and platelet level
Blood group and antibody status
If family origin questionnaire high risk: sickle cell and thalassaemia.
34
At how many weeks do you start measuring SFH
25/26 weeks
35
When during pregnancy do you test for anaemia
At booking and 28 weeks
36
At how many weeks do you give the first and second dose of anti-D
28 and 34
37
At how many weeks do you have discussions/plans for delivery
34
38
At how many weeks do you discuss post-natal care
36
39
When can the combined test be performed
11-14 weeks
40
When can the quadruple test be performed
14-20 weeks
41
Which abnormalities does the combined test assess the risk of
Trisomy 21, 18 and 13
42
Which factors are assessed in the combined test
Nuchal transluscency
hCG
PAPP-A
Age
43
Which disorder does trisomy 21 cause
Down syndrome
44
Which disorder does trisomy 18 cause
Edwards syndrome
45
Which disorder does trisomy 13 cause
Patau's syndrome
46
What does the quadruple test assess the risk of
Down syndrome only
47
What is measured in the quadruple test
AFP
Unconjugated estradiol
hCG
Inhibin A
48
When is the anomaly scan performed
18-21 weeks
49
In Down syndrome are PAPP-A, beta-hCG, AFP, Inhibin A and unconjugated estridiol high or low
Unconjugated estridiol, AFP and PAPP-A low
| Inhibin-A and Beta-hCG high
50
When can CVS be carried out
10-13 weeks
51
Risk of miscarriage in CVS
1-2%
52
When can amniocentesis be carried out
15+ weeks
53
Risk of miscarriage in amniocentesis
0.5-1%
54
When can the private non-invasive screening test be carried out
10+ weeks
55
How much does the private non-invasive screening test cost
£400
56
Roughly when would you expect to feel fetal movements
20+ weeks
57
At how many weeks do you give prophylactic anti-D
28 + 34
58
If a patient has a resus sensitising event or +ve cord sample how quickly should you give treatment dose anti-D
Within 72 hours
59
Rhesus sensitising events
```
Any bleed
Miscarriage (including threatened)
TOP
Ectopic
Trauma
Placental abruption
ECV
Amniocentesis
CVS
```
60
When is whooping cough (pertussis) vaccine offered during pregnancy
27-36 weeks
61
Risks of chickenpox in pregnancy
Maternal pneumonia, encephalitis, hepatitis
| Fetal varicella syndrome if <28 weeks, infant shingles if 28-36 weeks, born with chickenpox if after 36 weeks
62
What happens if a pregnancy woman comes into contact with chickenpox
If you’ve had it before you’ll have your antibody levels checked and if low get a booster. If never had it/not sure then seek medical advice if you come into contact with it during pregnancy as will need treatment
63
What can you tell diabetic women how pregnancy will affect their diabetes
Pregnancy causes higher insulin requirements and resistance to insulin
Worsening nephropathy/retinopathy ect
More hypos
May need higher doses of medication
Can only take metformin and insulin during pregnancy
64
Risks that diabetes poses to pregnancy
Increased risk of miscarriages, VTE, infection, rate of induction/CS, congenital malformations (skeletal, cardiac, NTDs), unexplained still birth
Macrosomia, polyhydraminos, shoulder dystocia, stillbirth, neonatal hypoglycaemia
65
Why does maternal hyperglycaemia/DM cause macrosomia
Maternal hyperglycaemia --> fetal hyperglycaemia --> increased fetal insulin = growth factor --> macrosomia
66
Pre-conception advice for diabetic women
Good glycaemic control reduces risk
Higher dose folic acid (5mg)
Retinopathy and nephropathy screens up to date
Medication review
67
How do you diagnose gestational diabetes
Fasting glucose 5.6+ or 2hr post OGTT 7.8+
| OGTT done in morning after overnight fast of 8hrs, then 75gram OGTT and test after 2hrs
68
Blood glucose targets during pregnancy
```
HbA1c <48
Random 4-7
Fasting <5.3
Post-prandial <7.8
Keep above 4 always
```
69
When do you aim to deliver a pregnancy where mum had pre-existing diabetes
37-39 weeks
70
Risks of high BMI in pregnancy
Miscarriage, congenital malformations, GDM, macrosomia, pre-eclampsia, VTE, difficult fetal monitoring in labour, anaesthetic risk, PPH, post-natal infection
71
Risk factors for shoulder dystocia
```
Macrosomia
Raised BMI
DM
IOL
Epidural
Instrumental delivery
```
72
Pre-existing HTN in pregnancy happens before how many weeks?
<20 weeks
73
Pregnancy induced hypertension and pre-eclampsia occur after how many weeks into the pregnancy?
>20 weeks
74
Difference between pregnancy induced hypertension and pre-eclampsia
Proteinuria in pre-clampsia, none in pregnancy induced hypertension
75
Diagnostic criteria for pregnancy induced hypertension
>20 weeks gestation
BP 140/90 on 2 occasions
No proteinuria
No pre-existing hypertension
76
Diagnostic criteria of pre-eclampsia
```
>20 weeks gestation
BP 140/90 on 2 occasions plus one of;
Proteinuria
Systemic involvement (high Cr, high LFTs, RUQ pain, neuro or haem involvement)
Fetal growth restriction
```
77
What pre-eclampsia symptoms do you tell women at risk to look out for
```
Severe headache
Blurred vision/flashes
Severe RUQ/subcostal pain
Vomiting
Sudden swelling of face/hands/feet
```
78
Which medications are used to lower blood pressure in pregnancy
Labetalol
Nifedipine
Hydralazine
79
Features of HELLP syndrome
Haemolysis
Elevated liver enzymes
Low platelets
80
Management of pre-eclampsia
Lower BP
Manage post-partum fluid balance (pulmonary oedema mortality)
Prevent/control seizures - magnesium sulphate infusion
81
Anaemic Hb levels for each trimester of pregnancy
1st <110
2nd <105
3rd <100
82
How do you treat anaemia in pregnancy
Ferrous sulphate/fumarate trial for 2 weeks
| Continue for 3 months after Hb returns to normal and for 6 weeks post partum to replenish stores
83
Which diabetic meds are safe in pregnancy
Metformin
| Insulin
84
Which is the safest anti-epileptic med during pregnancy
Lamotrigine
85
When can Trimethoprim and Nitrofurantoin be used in pregnancy
Trimethoprim after the 1st trimester
| Nitrofurantoin before the 3rd trimester
86
What fetal abnormality can SSRIs cause
Congenital heart defects
87
Are NSAIDs safe in pregnancy
No - risk of oligohydraminos and premature closure of ductus arteriosus
88
A soaked sanitary pad is roughly how much blood loss
100ml
89
Differentials for antepartum haemorrhage
```
Ectropion
PV infection
Premature labour
GU cancer
Vaginal/rectal fissure/abrasion
Placental abruption
Placenta previa
Vasa previa
```
90
4 T's of causes for PPH
Tone
Tissue
Trauma
Thrombus
91
Which number do you call to activate the obstetric haemorrhage pathway
2222
92
How can you try to stop bleeding in an obstetric haemorrhage
```
Bimanual compression
Empty bladder - insert foley catheter
Syntocinon/Ergometrine IV max 2 doses
Syntocinon infusion
Misoprostol sublingual/rectal, can repeat after 20 mins
```
93
Primary PPH occurs how soon after birth?
Within 24 hours of birth
94
Secondary PPH occurs when?
24 hours - 12 weeks after birth
95
How many ml is a minor/moderate/major/massive PPH
Minor 500
Moderate 1000
Major 15000
Massive 2000
96
Most common causes of secondary PPH
Retained products
Infection
Dysfunctional uterine bleeding
97
Medications used in primary PPH management
```
Syntocinon
Ergometrine
Syntometrine
Misoprostol
Carboprost
Tranexamic acid
```
98
Describe the hormonal pathway involved in menstruation
Hypothalamus releases GnRH --> pituitary releases LH + FSH which act on the ovaries to cause estrogen release and follicle maturation
99
Describe the follicular phase of menstruation
FSH, follicles mature, graafian follicle produces estrogen which thickens endometrium and thins cervical mucus. Oestrogen initially suppresses LH until threshold then sudden spike of LH day 12. 24-48hrs after LH surge follicle ruptures and releases secondary oocyte which quickly matures into ootid then mature ovum which enters fallopian tube.
100
Describe the luteal phase of menstruation
LH + FSH turn the ruptured follicle into the corpus luteum which produces progesterone – makes endometrium receptive, increases estrogen production, negatively feeds back on LH+FSH. When they fall the corpus luteum degenerates so drop in progesterone that causes menstruation.
101
When in the menstrual cycle are women most fertile
5 days before and 1-2 days after ovulation
| Or within the 9 days after the end of the period
102
Ovulation occurs on roughly which day of the menstrual cycle
13
103
Differentials for heavy menstrual bleeding
```
Dysfunctional uterine bleeding
Fibroids
Endometriosis
PID
Endometrial/cervical polyps
Adenomyosis
PCOS
Endometrial cancer
Contraception
Coagulopathy
Hypothyroidism
```
104
Indications for hysteroscopy
```
>45 with abnormal bleeding
Infertility
Menstrual disorders
Lost IUD
Persistent IMB
PCB
Enlarged uterus
Pelvic mass
PMB
```
105
Medications used to manage heavy menstrual bleeding in women who want to have children
Tranexamic acid
Methanamic acid
Take while you're bleeding
106
Hormonal medications/devices used to manage heavy menstrual bleeding
1st line is Mirena coil
Progesterone only pill
COCP
Depot injection
107
What are the medications used to shrink uterine fibroids
Ulipristal acetate - 3 month course, check LFTs
| Gonadotopin releasing hormone analogues - Goserelin acetate injection
108
Surgical treatments of fibroids for women who still want children
Hysteroscopic resection of fibroids
| Myomectomy
109
Surgical treatments of fibroids for women who don't want future pregnancies
Endometrial ablation
Uterine artery embolisation
MRI guided percutaneous laser ablation
Hysterectomy
110
Differentials of bleeding in early pregnancy
```
Implantation bleed
Miscarriage
Ectopic
Cervical ectropion/polyp/malignancy
Genital tract trauma
Molar pregnancy
```
111
Describe the type of bleed you get due to implantation
Light, short lived, bleeding/spotting, dark with a pink/brown tint, 6-12 days after conception (near when next period is expected)
112
Early miscarriage happens during what period of gestation
0-12 weeks
113
Late miscarriage happens during what period of gestation
12-24 weeks
114
Causes and risk factors for miscarriage
Chromosomal abnormalities
Cervical incompetence
Fetal malformations
Smoking, alcohol, cocaine, stress, previous TOP, previous miscarriage, age, chronic maternal illness, uterine malformations, high BMI
115
USS diagnostic criteria of miscarriage
CRL >7mm with no FH
| Sac >25mm with no contents
116
What is a threatened miscarriage
Pregnancy confirmed
PV bleed
Cervix closed
USS shows viable pregnancy
117
What % of threatened miscarriages lead to successful pregnancies
90%
118
What is an inevitable miscarriage
Pregnancy confirmed
PV bleed + abdo pain
Cervix open
POC not passed yet
119
What is a complete miscarriage
All POC have passed
Cervix now closed
USS shows empty uterus
120
What is incomplete miscarriage
PV bleeding and pain
Cervix open
Some tissue passed, some remains in uterus
121
What is a missed/delayed miscarriage
Asymptomatic
Cervix closed
No POC passed
USS shows non viable pregnancy
122
What is a blighted ovum
Missed miscarriage where development stopped before the embryonic pole was visible. Gestational sac may continue to grow
123
What is a septic miscarriage
Miscarriage + sepsis (fever, significant abdo tenderness)
124
How many miscarriages count as recurrent
3+
125
How much should b-hCG increase by in a normal pregnancy
Double every 48hrs
| Reached max 100,000) at 10 weeks then decreases
126
What level of b-hCG indicated gestational sac should be visible on transvaginal USS
>1500 (roughly 5 weeks gestation)
127
What are the 3 main management options of a miscarriage
Expectant
Medical
Surgical
128
Describe the expectant management of a miscarriage
Varies, can take days/weeks
May bleed for several weeks
May pass POC or they may be reabsorbed
Follow up sacn at 2-3 weeks
129
Describe the medical management of a miscarriage
If <10 weeks just Misoprostol (uterine contractions)
| If >10 weeks usually Mifepristone first (stops pregnancy hormones) then misoprostol
130
Describe the surgical management of a miscarriage
Manual vaccum aspiration or dilation and curettage
131
What part of the fallopian tube do ectopic pregnancies most commonly occur in
Ampulla
132
Management options for ectopic pregnancies
Conservative if <6weeks, asymptomatic, falling hCG
Methotrexate
Salingotomy
Salpingectomy
133
How long after Methotrexate for ectopic can you try to get pregnant again
3 months
134
Differentials of PV discharge
```
Bacterial vaginosis
Candida
Chlamydia
Gonorrhea
Trichomonas vaginalis
Foreign body
Cervical polyps
Genital tract malignancy
Genital tract fistula
```
135
Itch, frothy yellow discharge and 'strawberry cervix' are associated with which STI
Trichomonas vaginalis
136
What is included in an asymptomatic sexual health screen
Self swab for chalmydia and gonorrhea
| Bloods for HIV and syphilis
137
When is cervical screening performed
Every 3 years from age 25-49
| Every 5 years from age 50-64
138
Describe the result possibilities for cervical smear
Low grade - which can be borderline or moderate
| High grade - which can be moderate or severe
139
If routine smear shows no dyskariosis but is HPV positive what do you do
Repeat smear in 1 year
140
If a smear result shows low grade dyskariosis how do you decide whether or not to send for colposcopy
Send for colposcopy if it is HPV positive as well
141
Management of a biopsy result of CIN1
No treatment
| Repeat smear in 1 year
142
Management of biopsy result CIN3
Large loop excision of the transformation zone
143
After a LLETZ procedure when do you re-smear as a 'test of cure'
6 months
144
What does 'HPV triage' mean
It means that all smears that are reported as borderline or mild (low grade) dyskariosis will be tested for HPV. If positive they will be referred to colposcopy, if negative they will return to routine recall
145
PV discharge that is grey/white and thin/watery, fishy odour and clue cells on microscopy. What is the likely organism/infection
Bacterial vaginosis
146
Normal labour is delivery at how many weeks
37-42
147
Describe the 1st stage of labour
Contractions cause cervical changes
Subdivided into latent and active phase
Latent - contractions not regular/established, <4cm
Active - contractions regular and established, >4cm
148
When does the 1st stage of labour end
When the cervix is 10cm dilated
149
As you progress through the 1st stage of labour what happens to contractions
They last longer, are more frequent and are stronger
Latent phase 30 second contractions every 5-30 mins
Active phase 1min contractions every 3-5 mins
Transition phase into the 2nd stage of labour they are 60-90 second contractions every 30 seconds-2 mins
150
What is the dilation rate for a primip
1cm every 2 hours
151
What is the dilation rate for a multip
1cm every 1 hour
152
What does the second stage of labour refer to
Delivery of the baby
153
What does the third stage of labour refer to
Delivery of the placenta
154
Describe the mechanisms of deliver
Descent
Engagement - station 0
Neck flexion + internal rotation into the occipitoanterior position so shoulders are in line with the widest part
Head passes below pubic symphysis - station +4
Head extension and delivery of the head
Restitution - head externally rotates
Shoulder externally rotated into the AP plane
Delivery of the anterior shoulder by gentle downward traction
Delivery of the posterior shoulder by gentle upward traction
155
Signs of placental separation
Uterus contracted
Cord lengthening
Blood trickle
156
Describe how the 3rd stage of labour can be actively managed
```
Oxytocin IM
Check for signs of separation
Clamp and cut the cord
Apply upward pressure on the uterus to prevent inversion and downward traction on the cord until it's at the vulva then upward traction
Examine for trauma
Examine the placenta
```
157
What is engagement of the head and how can you tell
Largest diameter of the head into the largest diameter of the pelvis
When the head is 3/5ths palpable or less
158
What is assessed in APGAR scoring
Appearance - blue/pale, just extremities blue, pink
Pulse - absent, <100, >100
Grimace - absent, minimal response to stimulation, prompt response to stimulation
Activity - absent, flexion, active
Respiration - absent, slow/irregular, vigorous cry
159
At how many minutes do you measure APGAR score
1 and 5 mins
160
Common causes of a low APGAR score
Difficult birth
CS
Fluid aspiration
161
Indications for CTG
Maternal tachycardia, pyrexia, suspected sepsis, abdo pain, hypertension, suspected pre-eclampsia
Significant meconium
PV bleed
Delayed 1st or 2nd stage
Oxytocin use
Contractions over 60 seconds or more than 5 of them in 10 mins
162
What is the mneumonic used to assess CTG tracings
DR C BRAVADO
163
What does DR C BRAVADO stand for
```
Define risk
Contractions
Baseline rate
Variability
Accelerations
Decelerations
Overall
```
164
Describe a normal CTG
100-160 bpm
Variability 5-25
No/early decelerations
165
What are the 4 grades/types of placenta previa
Low lying
Marginal
Partial
Complete
166
Scans for placenta previa
If 20 week scan shows placenta previa then have another scan (TV) at 32 weeks (most will have resolved). If still low at 32 weeks have another scan (TV) at 36 weeks. If still low will likely need to plan for CS
167
Differentials of abdo pain in pregnancy
```
Preterm labour
Placental abruption
Chorioamnionitis
Acute fatty liver of pregnancy
Pre-eclampsia
GI cause - appendicitis, pancreatitis, peptic ulcer ect
GU cause - stones, adnexal torsion, cystitis
Fibroid torsion
```
168
Clinical features of placental abruption
```
Bleeding
Abdo pain
Woody hard uterus
Fetal compromise
Maternal shock
```
169
What can you test for to try to rule out likely pre-term labour
Fetal fibronectin levels in vaginal secretions
170
How can you manage pre-term labour
Steroids for lung maturity - Betamethasone
Tocolytics to reduce contractions - Nifedipine, Atosiban, Indomethacin
MgSO4 for fetal neuroprotection
Inform the neonatal team
171
How long roughly should the second stage of labour last in a) primips b) multips
a) 3 hours
| b) 2 hours
172
What do you have to check before performing operative vaginal delivery
No more than 1/5th of the head palpable abdominally
| Leading point of the skull is below the ischial spines
173
What are the advantages/disadvantaged of Ventouse vs forceps
Ventouse less trauma to perineum/vagina but more likely to fail and to cause cephalohaematoma
174
How long after c-section do you need LMWH for
6 weeks
175
What % of women under the age of 40 will conceive within 2 years of trying
90%
176
To maximise chances of conceiving how often should you advise couples to be having sex
2-3 times per week
177
Primary vs secondary infertility
Secondary if they have conceived in the past
178
What is the most common female disease that causes infertility
PCOS
179
What test can you do to assess if a woman is ovulating or not
Mid-luteal (day 21) progesterone (will be raised if ovulating)
180
What can be used as a marker for ovarian reserve
Anti-Mullerian Hormone (AMH)
181
Name of the scan to assess fallopian tube pregnancy
Hysterosalpingogram
182
What does low, normal and high FSH/LH indicate in infertility testing
Low suggests hypothalamic or pituitary pathology
Normal suggests oocytes present but folliculogenesis may be impaired
High suggests reduced ovarian reserve/oocytes
183
3 tests that can indicate ovarian reserve
AMH
FSH
Antral follicle count
184
How can you assess if a woman is ovulating
If she has a regular cycle
| Mid-luteal progesterone
185
FSH + LH high, Oestradiol low
Premature ovarian failure
186
FSH + LH + Oestradiol all low
Hypothalamic or pituitary cause
187
FSH normal + LH raised + Oestradiol normal
PCOS
188
What medication can be used for anovulation
Clomiphene citrate
| Can also try Metformin, Gonadotrophins
189
Clinical features of ovarian hyperstimulation syndrome
```
Ascites
Effusions
Nausea and vomiting
Abdo tenderness
VTE risk
```
190
Which class of medication can be used to aid fertility in women with ovulatory disorders secondary to hyperprolactinaemia
Dopamine agonists
191
What are the 3 main types of assisted conception
Intrauterine insemination
IVF: In-vitro fertilisation
ICSI: Intracytoplasmic sperm injection
192
Diagnostic criteria for PCOS
Need 2 of 3 features: Oligo/anovulation,
Clinical or biochemical signs of hyperandrogenism
Polycystic ovaries
193
Clinical features of PCOS
```
Onset in adolescence,
Oligo/amenorrhoea, infertility
Obesity/metabolic syndrome
Hirsutism, androgenic alopecia
Acne vulgaria, oily skin, acanthosis nigricans (hyperpigmented velvety plaques usually in axilla or neck)
```
194
Confirmatory test for endometriosis
Laparoscopy
195
Ovarian cancer marker
CA 125
196
The RMI (risk of malignancy index) is used to assess for which type of cancer
Ovarian
197
What are the 3 features used to asses the RMI score
CA125
Menopausal status
USS score
198
Which medication class can worsen stress incontinence
Alpha blockers (e.g. Doxazocin)
199
Is AFP high or low in neural tube defects
High
200
Is AFP high or low in Downs syndrome
Low
201
If a baby is still breech at 36 weeks what do you do
Refer for ECV
202
A Bishop score of ? indicates that labour is unlikely to start without induction
< 5
203
A Bishop score of ? indicates that labour will most likely commence spontaneously
> 9
204
3 causes of increased nuchal translucency
Down's syndrome
Congenital heart defects
Abdominal wall defects
205
The following results would be expected in a trisomy 21 (Down's syndrome) pregnancy:
Low alpha fetoprotein (AFP)
Low oestriol
High human chorionic gonadotrophin beta-subunit (-HCG)
Low pregnancy-associated plasma protein A (PAPP-A)
Thickened nuchal translucency
206
Organism that causes bacterial vaginosis
Gardnerella vaginalis
207
Features of vaginal discharge caused by BV infection
Thin
White
Really offensive fishy smell
208
Clue cells (stippled vaginal epithelial cells) on microscopy indicate which infection
Bacterial vaginosis
209
Management of bacterial vaginosis
Oral Metronidazole for 5-7 days
| Can use topical metronidazole or clindamycin as alternatives
210
Diagnostic test for endometriosis
Laparoscopy
211
Diagnostic imaging for adenomyosis
MRI pelvis
212
What is adenomyosis
The presence of endometrial tissue within the myometrium. It is more common in multiparous women towards the end of their reproductive years.
213
Symptoms of adenomyosis
Dysmenorrhea
Menorrhagia
Enlarged, boggy uterus
214
Criteria for an ectopic pregnancy to be managed expectantly
1) An unruptured embryo
2) <30mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <200IU/L and declining
215
Maximum gestation for abortion
24 weeks
216
The methods used to terminate pregnancy depending on gestation
Less than 9 weeks: mifepristone (an anti-progestogen, often referred to as RU486) followed 48 hours later by prostaglandins to stimulate uterine contractions
Less than 13 weeks: surgical dilation and suction of uterine contents
More than 15 weeks: surgical dilation and evacuation of uterine contents or late medical abortion (induces 'mini-labour')
217
First line treatment for urge incontinence
Bladder retraining
218
First line treatment for stress incontinence
Pelvic floor exercises
219
Definition of primary post-partum haemorrhage (minor and major)
The loss of 500ml or more from the genital tract within 24 hours of the birth of a baby
Minor = 500-1000
Major = >1000
220
Diagnostic criteria for hyperemesis gravidarum
1. 5% pre-pregnancy weight loss
2. Dehydration
3. Electrolyte imbalance
221
Pre-conception advice to optimise chance of conception
Optimise underlying medical conditions
Healthy BMI (19-30)
Stop smoking, alcohol, recreational
Sex every 2 days (2-3 times a week) from 6 days before ovulation and until 2 days after
Folic acid
Up to date with smears
Full immunisation history - including Rubella
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Causes of infertility
Ovulatory problems - PCOS, premature ovarian failure, thyroid
Tubal - adhesions, obstructions (endometriosis, salpingitis)
PCOS
Hyperprolactinaemia
Hypergonadotrophic hypogonadism
Lifestyle factors
Decreased sperm quantity or quality
223
Infertility tests: FSH + LH + Oestradiol are all low
Hypothalamic or pituitary cause
224
Infertility tests: FSH is normal, LH is raised and Oestradiol is normal
PCOS
225
Infertility tests: FSH + LH are high and Oestradiol is low
Premature ovarian failure
226
What tests are used to assess ovarian reserve
AMH, FSH, antral follicle count
227
Test for ovulation
Mid-luteal progesterone: 7 days before expected period (day 21 of 28 day cycle) failure to rise indicates anovulation
228
How are the fallopian tubes and uterus assessed during infertility investigation
Hysterosalpinography (dye into uterus and XR)
Sonohysterosalpingography (fluid into uterus and USS)
TV USS
Women thought to have comorbid conditions (PID, endometriosis, previous ectopic) are offered diagnostic laparoscopy and dye. Can treat at the same time.
229
Medical treatment options for infertility
Clomifene or Tamoxifen to induce ovulation
Metformin for PCOS
Gonadotrophins may be offered to women with clomifene-resistant anovulatory infertility. They are also effective in improving fertility in men with hypogonadotropic hypogonadism
Pulsatile gonadotrophin-releasing hormone and dopamine agonists are other treatments that induce ovulation. Dopamine agonists can be considered for women with ovulatory disorders secondary to hyperprolactinaemia.
230
Surgical management options for infertility
Tubal microsurgery/catheterisation
Surgical ablation/laparoscopic resection of endometriosis or adhesions
Surgical corrections of epididymal blockage
231
Types of assisted conception
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Intrauterine insemination
IVF
ICSI - intracytoplasmic sperm injection
Donor insemination
Oocyte donation
```
232
Features of ovarian hyperstimulation syndrome
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Abdo bloating
Abdo pain
Nausea and vomiting
If severe:
Oliguria
Generalised oedema
Abdo pain/distention caused by enlarged ovaries and acute ascites
Hydrothorax, VTE, respiratory distress syndrome
```
233
Possible complications of assisted conception
Ovarian hyperstimulation syndrome
Ectopic
Pelvic infection
Multiple pregnancy
234
Grades of placenta previa
1 - low lying
2 - marginal (minor)
3 - partial
4 - complete (major)
235
Management of placenta previa
If seen at 20 week scan, book for scans at 32 and 36 weeks as TV USS
If still present at 36 weeks plan for CS
Safety net antepartum bleeding, pre-term labour
236
Risk factors for breech presentation
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Twins
Oligo/polyhydramnios
Fibroids
Placenta previa
Pelvic tumour/deformities
```
237
Management options for breech presentation
ECV at 36 weeks
Vaginal breech delivery
CS
238
Contraindications to ECV
Twins
Antepartum haemorrhage
Previous CS
239
Risks of ECV
Cord entanglement
Abruption
Induction
240
Biggest risk of a baby in transverse lie at term
Cord prolapse
241
Trisomy 13
Patau's syndrome
242
Trisomy 18
Edward's syndrome
243
Trisomy 21
Down's syndrome
244
When is the combined screening test
12 weeks (11-14)
245
When is the quadruple screening test
16 weeks (15-20)
246
What does the combined test measure
Nuchal translucency
hCG
PAPP-A
247
What does the quadruple test measure
AFP
Unconjugated estriol
Beta-hCG
Inhibin A
248
Conditions screened for in a) combined test b) quadruple test
A) Patau's, Edward's, Down's
| B) Down's
249
What gestation is the private antenatal non-invasive screening test available from
10 weeks
250
Ratio classed as high risk from the antenatal chromosomal screening
>1:150
251
Combined test - is each marker high/low in Down's syndrome
PAPP-A low
hCG high
NT high
252
Quadruple test - is each marker high/low in Down's syndrome
AFP low
uE3 low
hCG high
Inhibin high
253
When can CVS be performed
11-14 weeks
254
When can amniocentesis be performed
15+ weeks
255
Does CVS or amniocentesis have a lower miscarriage rate
Amniocentesis
256
Antenatal trisomy screening - how long until patient gets results
Usually within 2 weeks if low risk, within 3 working days if high risk
