Obs and Gynae Flashcards
(135 cards)
1
Q
Describe twin to twin transfusion syndrome
A
2 fetuses share a single placenta. One fetus receives less blood (donor) than the other (recipient) due to anomalies in the network of placental blood vessels. (1 may have fluid overload, other may be anaemic)
2
Q
When is twin to twin transfusion syndrome tested for antenatally?
A
16-24 weeks
3
Q
In what percentage of pregnancies is labour induced?
A
20%
4
Q
Give 5 indications for induction of labour
A
Prolonged pregnancy (1-2 weeks after EDD) PROM with no labour DM in 38 wks+ Pre-eclampsia Rhesus incompatibility
5
Q
What bishop score suggests that it labour is unlikely to start without induction?
A
5 or less
6
Q
What bishop score suggests the cervix is favourable?
A
8+
7
Q
What is the preferred method of induction?
A
Vaginal prostaglandin PGE2
8
Q
What is a membrane sweep?
A
An adjunct to induction rather than an actual method of induction
9
Q
When is membrane sweep offered?
A
Nulliparous - 40-41 weeks
Parous 41 weeks
10
Q
What is the most common complication of induction of labour?
A
Uterine hyperstimulation
11
Q
Describe uterine hyperstimulation
A
Prolonged and frequent uterine contractions
12
Q
What is the treatment for uterine hyperstimulation?
A
Remove vaginal prostaglandins and stop oxytocin infusion.
Tocolysis with terbutaline
13
Q
How many weeks can a test be positive for after termination of pregnancy?
A
4
HCG decreases by 50% every 2 days. Steep decline in 1st 2 weeks, steady decline in next 2 weeks
14
Q
How many medical practitioners are required to approve a termination?
A
2
15
Q
How many medical practitioners are required to do a termination?
A
1
16
Q
What method of termination is used in less than 9 weeks gestation?
A
Mifepristone
48hrs later, prostaglandins
17
Q
What method of termination is used in 9-13 weeks gestation?
A
Surgical dilation and suction
18
Q
What method of termination is used in 15+ weeks gestation?
A
Surgical dilation and evacuation
OR late medical abortion (mini labour)
19
Q
Who should be taking 5mg folic acid rather than 400mcg?
A
- People on anti-epileptics
- People with BMI 30+
- People with partners with NTD, FHx of NTD or previous pregnancy with NTD
- Women with diabetes
20
Q
What is the gold standard investigation for endometriosis?
A
Laparsocopy
21
Q
What would be seen on bloods in PCOS?
A
High LH (Raised LH:FSH ratio) High insulin
22
Q
What is the investigation of choice for PCOS?
A
Pelvic USS
23
Q
Describe the management of gestational diabetes with fasting glucose less than 7
A
1-2 weeks trial of diet and exercise
if not improved, add 1-2 weeks metformin
if not improved, add short acting insulin
24
Q
Describe the management of gestational diabetes with fasting glucose more than 7
A
Short acting insulin
25
What is 1st line in symptomatic relief of endometriosis?
NSAIDS/Paracetamol
26
Is multiparity or nulliparity a RF for placental abruption?
Multiparity
27
What is amniotic fluid embolism?
When fetal cells/amniotic fluid enters into the mothers bloodstream and causes a reaction.
e.g shivering, sweating, coughing,cyanosis, hypotension, tachycardia
28
How do you manage amniotic fluid embolism?
Supportively
29
What maternal blood abnormality of phenytoin associated with?
Folic acid deficiency
30
What is used for DVT in pregnancy?
LMWH
31
How do you monitor the action of LMWH
Monitor anti Xa Activity
32
What is whirlpool sign on USS seen in?
Ovarian torsion
33
Give 4 contraindications to HRT?
Current/past breast cancer
Any oestrogen sensitive cancer
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
34
What type of HRT do you give to somebody with a uterus?
Combined - to avoid unopposed oestrogen
35
What type of HRT do you give to somebody without a uterus?
Oestrogen only
36
What is lochia?
Passage of blood, mucus and uterine tissue up to 6 weeks after delivery.
If after - investigate with USS
37
Can hepatitis B be transmitted via breastfeeding?
No! Unlike HIV
38
How long must methotrexate have been stopped in mum and partner before conception?
6 months
39
What should be given in PROM?
Antinatal corticosteroids
10 days of erythromycin
They should be admitted for 48hrs
40
What can shoulder tip pain be associated with?
Ectopic pregnancy - with peritoneal bleeding
41
What is Fitz Hugh Curtis syndrome?
A complication of PID involving peri-hepatic inflammation
42
What is Mittelschmerz?
Ovulation pains
43
What kind of cancer is the COCP protective against
Endometrial Cancer
44
What should you do when a woman comes in with reduced fetal movements?
1. Confirm viability (auscultate with handheld doppler)
| 2. If viable, CTG
45
What is an epileptic of choice in pregnancy?
Lamotragine
46
How does smoking affect the risk of cervical cancer?
2X more likely
47
What are the 3 stages of postpartum thyroiditis?
1. Thyrotoxicosis
2. Hypothyroidism
3. Normal thyroid
48
How is postpartum thyroiditis managed?
Propanolol for symptom control
49
How many days of abstinence must there be to do semen analysis?
3-5 days
50
What are the guidelines if a semen analysis comes back as abnormal?
Repeat the sample In 3 months. If it is still abnormal, refer to secondary care
51
What is the first line tocolytic agent in pre-term labour
Oral Nifedipine
52
What is the definition of a prolonged second stage of labour?
3hrs+ from full dilation
53
What is the next appropriate step in delivery during prolonged second stage of labour?
Forceps delivery
54
What is the treatment to prevent miscarriage in anti phospholipid syndrome?
Aspirin and LMWH
55
What is the advice around anti-epileptics and breastfeeding?
Most anti-epileptics can be used during breastfeeding - don't change them
56
After non-pharmacological uterine compression and catheterisation - what is the 1st line pharmacological management of PPH?
IV Syntocinon (5 Units)
57
If a child loses more than 10% of birth weight in the 1st week, what do you do?
Refer to midwife led breastfeeding clinic
58
How does ovarian cancer initially spread?
Local invasion within the pelvic region
59
What 2 investigations can diagnose PPROM?
1. Speculum
| 2. USS to look for oligohydramnios
60
What definition is used to classify bleeding as 'abnormally heavy'
An amount a woman considers to be excessive
61
When are smear tests offered 3 yearly?
25-49 years
62
When are smear tests offered 5 yearly?
50-64 years
63
When do you stop receiving cervical screening invitations?
64 years+
64
What can be used in patients with stress incontinence where pelvic floor exercises haven't worked?
Duloxetine
65
What drugs can be used in urge incontinence
Oxybutinin (antimuscarinic)
| Mirabegron (beta-3-agonist)
66
What should be done where there is diagnostic uncertainty surrounding incontinence?
Urodynamic studies
67
What is the drug of choice for medical management of ectopic pregnancy?
Methotrexate
68
What are the guidelines on pregnant women less than 20wks that have been exposed to chickenpox?
1. Check for varicella antibodies
| 2. If not immune, give varicella-zoster immunoglobulin ASAP - effective up to 10 days post exposure
69
What are the guidelines on pregnant women more than 20wks that have been exposed to chickenpox?
1. Check for varicella antibodies
| 2. If not immune, give VZIG or antivirals (acyclovir) 7-14 days after exposure
70
What imaging technique is preferred in diagnosing adenomyosis?
MRI Pelvis
71
How should you treat women that are 20wks+ that develop chicken pox rash?
Oral acyclovir within 24hrs of rash
72
What ovarian pathology is associated with Meigs' syndrome?
Fibroma
73
What is the ideal management of atypical endometrial hyperplasia in post menopausal women?
Total hysterectomy with bilateral saplingo-oophorectomy due to risk of malignant progression
74
When is the anomaly scan?
18-20+6 weeks
75
When is the early scan to confirm dates?
10-13+6 wks
76
What is the surgical management of an ectopic pregnancy?
Salpingectomy
If there is contralateral tubal damage, offer salpingotomy
77
Define premature ovarian failure
The onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years
78
Why is cervical ectropion more common with COCP use?
Higher oestrogen levels
79
Where is the most common location of an ectopic pregnancy?
Ampulla of the Fallopian tube
80
What investigation is used to diagnose premature ovarian failure and menopause?
FSH Level - which will be high
81
What should be avoided in UTI in the 3rd trimester?
Nitrofurantoin
82
What should be avoided in the 1st trimester?
Trimethoprim (teratogenic in 1st trimester)
83
How does trimethoprim work?
It inhibits dihydrofolate reductase and interferes with folate metabolism (hence 1st trimester contraindication)
84
What is the main symptom of urinary overflow incontinence?
Bladder still palpable after urination
| retention with urinary overflow
85
What is the most common ovarian cancer?
Serous carcinoma (epithelial)
86
What is the commonest type of ovarian cyst?
Follicular cyst
87
When should patients treated for CIN1, CIN2 and CIN3 next be offered cervical screening?
6 months after treatment for a test of cure cervical sample in the community
88
How often should women with HIV be followed up as part of the cervical screening programme?
Every year (annual cervical cytology)
89
What is the 1st line management in lactation mastitis?
Conservative management - analgesia and encourage breastfeeding
90
What should be done if symptoms of lactational mastitis do not improve after 12-24 hours?
Administer antibiotics.
Flucloxacillin or erythromycin - continue to breastfeed
91
How can moderate PMS be treated?
New generation COCP e.g. Yasmin
92
How can severe PMS symptoms be treated?
SSRI continuously OR just during the luteal phase
93
What contraception is contraindicated in patients undergoing testosterone therapy?
COCP as oestrogen can antagonise the effect of testosterone
94
What is used to classify the severity of nausea and vomiting in pregnancy?
Pregnancy-Unique Quantification of Emesis (PUQE) scoring system
95
What is the recurrence rate of postnatal psychosis ?
25-50%
96
What is the management of painless bleeding with no risk factors for ectopic pregnancy before 6 weeks gestation?
Expectant management.
They should do a repeat urine pregnancy test after 7-10 days and return if it is positive. A negative pregnancy test confirms miscarriage.
97
What is the management of bleeding in more than or equal to 6 weeks gestation?
Referral to EPAU
98
What should be done if late decelerations are seen on CTG?
Urgent fetal blood sampling
99
What medication may be given to reduce the size of uterine fibroids?
GnRH agonist (e.g. Leuprolide)
100
What type of contraception is contraindicated in previous obstetric cholestasis?
COCP - intrahepatic cholestasis worsens with multiple pregnancies and can recur with menstruation and oestrogen treatment
101
How should you give misoprostol in medical management of miscarriage up to 7 weeks?
Orally
102
How should you give misoprostol in medical management of miscarriage after 7 weeks?
Vaginally
103
What is the treatment for magnesium sulfate overdose?
Calcium Gluconate
104
What is 1st line medical therapy in PCOS?
Letrozole
| Not clomiphene due to adverse effects on endometrial and cervical mucous
105
What is caput succedaneum?
A puffy swelling that usually occurs over the presenting part and crosses suture lines in a neonate
106
What is the advice around the COCP and surgery?
Stop 4 weeks before surgery and restart 2 weeks after surgery
107
What is the course of action if GBS is detected via high vaginal swab in early pregnancy?
Intrapartum IV Benzylpenicillin only
108
What is the advice about the MMR vaccine and pregnancy?
It should not be given to women that are pregnant or attempting to become pregnant
109
Ectopic pregnancy in which location is most associated with an increased risk of rupture?
Isthmus
110
What terminology is used to describe the head in relation to the ischial spine?
Station
111
What does a station of +2 mean?
The head is 2cm below the ischial spine
112
What is the management of ectopic pregnancy if there is foetal heartbeat?
Surgical management - salpingectomy or salpingostomy
113
What is the threshold BHCG level where surgical management should be considered?
1500+
114
What is the only effective treatment for large fibroids causing problems with fertility?
Myomectomy
115
What is the most common cause of pulmonary hypoplasia?
Congenital diaphragmatic hernia
116
What is the treatment for vaginal vault prolapse?
Sacrocolpopexy
117
When should cervical screening in pregnancy be delayed to?
3 months post partum
118
What is the most likely diagnosis in an older woman with labial lump and inguinal lymphadenopathy?
Vulval carcinoma
119
How many days after birth is contraception not required?
21 days
120
What is post term delivery a significant risk factor for?
Meconium aspiration
121
When is the anomaly scan?
18-20+6 weeks
122
Which HPV strains increase risk of cervical cancer?
16 and 18
123
What is the first choice antibiotic in UTI in pregnancy?
Nitrofurantoin (avoid at term) 100mg for 7 days
124
When is the early scan to confirm dates?
10-13+6 weeks
125
What is Asherman's Syndrome?
Characterised by intrauterine adhesions commonly as a result of previous uterine surgery such as dilation and curettage. It can lead to obstruction of the menstrual outflow tract which presents as 2y amenorrhoea
126
What blood tests should women with severe pre-eclampsia have?
U&E, FBC, transaminases and bilirubin three times per week
127
What is the threshold viral load for vaginal delivery in HIV positive mothers?
viral load less than 50
128
What is used to treat Fitz-Hugh-curtis syndrome?
Ceftriaxone, doxycycline and metronidazole
129
Which types of twins are associated with the greatest risk of complications?
Monochorionic-Monoamniotic Twins
130
What is the treatment for meconium aspiration syndrome?
Admission to NICU for oxygen and antibiotic therapy
131
How should asymptomatic bacteriuria be managed in pregnancy?
Oral Abx
132
What is naegele's rule?
The method of calculating the estimated delivery date in the FIRST antenatal appointment. Add 9 months to the LMP plus 7 days
obstetric ultrasound is usually performed at 12 weeks to establish the gestational age of the pregnancy more accurately
133
In twin to twin transfusion syndrome, which twin is more likely to survive until birth?
The donor twin
134
Which malignancy is tamoxifen a risk factor for?
Endometrial cancer
135
What is the diagnostic triad for hyperemesis gravidarum?
5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalance
