obgynPM Flashcards
(46 cards)
HIV smear
annual cervical cytology
A 24-year-old woman presents to her GP 8 days after giving birth. She complains of a persistent pink vaginal discharge which is ‘smelly’. On examination her pulse is 90 / min, temperature 38.2ºC and she has diffuse suprapubic tenderness. On vaginal examination the uterus feels generally tender. Examination of her breasts is unremarkable. Urine dipstick shows blood ++. What is the most appropriate management
admit to hospital. This patient is showing clear signs of puerperal sepsis (postpartum infection), which is a potentially serious condition requiring immediate hospital assessment. The clinical features supporting this diagnosis include pyrexia (38.2°C), tachycardia (90/min), malodorous lochia (vaginal discharge), uterine tenderness, and suprapubic tenderness. The presence of blood on urinalysis is also consistent with the immediate postpartum period. Puerperal sepsis remains a leading cause of maternal mortality in the UK, and NICE guidelines emphasise the importance of prompt recognition and treatment.
bishop score interpretation
A Bishop score less than 5 generally means induction will likely be necessary. A score above 9 indicates labour will likely occur spontaneously.
pregnancy bp requiring admission
Pregnant women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed
admit for observation with labetolol or nifedipine
adenomyosis classic pt
multiparous women towards the end of their reproductive years.
is a 26 year old with 7mm endometrium normal
yes
normal endometrial thickness in pre menopausal women
Normal endometrial thickness in premenopausal women:
- During menstruation: 2-4mm
- Early proliferative phase (day 6-14): 5-7mm
- Late proliferative: up to 11 mm
- Secretory phase: 7-16 mm
postmenopausual endometrial thickness
4-5 is okay
mifepristone moa
Mifepristone is a progesterone receptor antagonist → weakening of attachment to the endometrial wall + cervical softening and dilation + induction of uterine contractions
gestational HTN vs mild pre eclampsia
pre eclampsia MUST have proteinuria after 20 weeks
Intrahepatic cholestasis of pregnancy increases the risk of
Intrahepatic cholestasis of pregnancy increases the risk of stillbirth; therefore induction of labour is generally offered at 37-38 weeks gestation
Important for meLess important
when can you not trial diet and exercise in gestational DM
If at the time of diagnosis of gestational diabetes, the fasting glucose level is >= 7 mmol/l immediate insulin (plus or minus metformin) should be started
air travel
air travel is not recommended beyond 37 weeks gestation with an uncomplicated, singleton pregnancy, or 32 weeks in uncomplicated, multiple pregnancy.
If the flight is longer than 4 hours, compression stocking are recommended. If additional DVT risk factors are present, LMWH injections on the day of the flight and for several days afterwards may be advised.
can a lady have a vaginal delivery with HIV viral load of 30?
HIV in pregnancy: vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks
An antiretroviral infusion is most commonly used in the case of a caesarean section when a pregnant woman has a viral load greater than 50 copies/mL.
what should be done prior to induction of labour
bishop score
emergency contraception in a woman declining copper IUD
Levonorgestrel must be taken within 72 hours of UPSI
1.5mg
A 26-year-old woman comes to see her GP after complaining of weight gain, hair loss, constipation and feelings of being cold all the time. She is also amenorrhoeic and struggled to breastfeed after birth. She has no significant past medical history but during her daughter’s birth she suffered from a large amount of blood loss and subsequent hypovolaemic shock which required a 6 weeks hospital stay.
Which of the following conditions is the most likely cause of these symptoms?
sheehans syndrome
22 weeks pregnant lady with chickenpox management
Pregnant women ≥ 20 weeks who develop chickenpox are generally treated with oral aciclovir if they present within 24 hours of the rash
VZIG if under 20 weeks
can cervical ectropion cause discharge
yes
COCP and cervical ectropion
COCP makes cervical ectropion more common
All patients with secondary dysmenorrhoea need to be
referred to gynaecology for investigation
what to try before GnRH analogue in endometriosis
POP
A 29-year-old female requests emergency contraception. She had unprotected sexual intercourse 7 days ago. Her LMP was 16 days ago, her cycle is usually 30 days. She was using condoms intermittently for contraception and takes no regular medications.
copper IUD - within 5 days of sex OR 5 days of likely ovulation
if she menstruated 16 days ago, and ovulated on day 14 then likely she ovulated 2 days ago
is smoking a pre ecamplsia risk
no
