Obs & Gynae Flashcards
1
Q
What counselling should be given to a patient with pre-eclampsia?
A
- Adapt the counselling based on severity
- Explain that admission may be needed - at least until blood pressure is controlled
- Explain pre-eclampsia and the risks (early delivery, reduced placental function, IUGR, risks to mother)
- Risk of recurrence → 15%
- Explain treatment - labetalol
- Explain that blood pressure will be monitored closely with regular bloods
- Explain that early delivery may be recommended
2
Q
What cervical smear advice should you give?
A
- Speculum is a ‘small plastic tube’
- Cytology available in 2 weeks, explain role of smear (screen for potentially dangerous changes)
- Mild → HPV test
- Worst → colposcopy
- Inadequate sample x3 → colposcopy
3
Q
What counselling should be given to a patient with (suspected) endometrial hyperplasia?
A
- Explain the diagnosis - abnormal thickening of the endometrium
- Explain that it is taken seriously because of the risk of progression to cancer
- Explain management:
- No atypia: LNG-IUS, review in 3-6 months
- Atypia: total hysterectomy + BSO or medical management (oral progestogens)
- If medical management – endometrial surveillance with biopsy every 3 months
4
Q
What counselling should be given to a patient with (suspected) ovarian cancer?
A
- Risk Factors: age, FHx, obesity, HRT, endometriosis, smoking, DM, nulliparity, early menarche, late menopause
- Protective Factors: COCP, pregnancy and breastfeeding, hysterectomy
- Explain diagnosis
- Explain that further investigations may be necessary
- Explain that definitive management will be surgical with or without chemotherapy
- Side effects of treatment - fatigue, hair loss, neutropenia, peripheral neuropathy etc
5
Q
What counselling should be given to a women with obstetric cholestasis?
A
- Risk Factors: personal or family history of OC, history of liver disease, multiple pregnancy
- Explain diagnosis and risks (stillbirth and premature birth) → need for early delivery
- Explain regular monitoring with twice weekly Doppler/CTG and weekly LFTs
- Advise paying close attention to foetal movements
- Symptomatic treatment with ursodeoxycholic acid and emollients (and maybe vitamin K)
- High recurrence rate (up to 90%)
- Foetal death risk is 2-3%
6
Q
What counselling should be given to women presenting with asymptomatic low-lying placenta?
A
- Explain importance of the finding (increases risk of bleeding)
- Explain that 90% of placentas will move away from the os
- Rescan at 32 weeks and then go from there
- Avoid having sex
7
Q
What counselling should be given to women presenting with placenta praevia and bleeding?
A
- Admit for at least 48 hours (or until bleeding stops)
- Admit until delivery if >34 weeks
- Explain the importance of the finding and that the foetus needs to be monitored
- Explain that prompt delivery needs to be discussed
- Explain the risks of delivery:
- Major blood loss → may require a blood transfusion
- May require a hysterectomy
8
Q
What are the different types of urogenital prolapse?
A
- Risk Factors: multiparity, age, obesity, prolonged second stage of labour, heavy lifting
- Explain the diagnosis
- Explain lifestyle modifications - lose weight, healthy diet, stop smoking
- Explain conservative management
- Explain ring pessary or surgery
9
Q
What counselling should be given to women with hydatidiform mole?
A
- Be sensitive/Breaking bad news
- Explain the risk factors
- Extremities of maternal age
- Prior molar pregnancy
- Prior miscarriages
- Asian heritage
- Explain diagnosis - When foetus doesn’t form properly, and a baby doesn’t develop, instead there is an irregular mass of pregnancy tissue
- Explain risks - can invade and damage other tissues
- Explain immediate management - suction curettage
- Explain follow-up - referral to trophoblastic screening centre to monitor pregnancy hormone levels
- Explain that molar pregnancy doesn’t affect fertility
- Don’t try to get pregnant until after follow-up is complete
- Explain that further treatment may be necessary
10
Q
What are the risk factors of hyperemesis gravidarum?
A
- Risk Factors education
- Previous hyperemesis
- Multiple pregnancy
- First pregnancy
- Obesity
- Explain that it a very severe form of morning sickness
- Medication should help reduce the nausea – antihistamine followed by an antiemetic
- Most patients find that the symptoms improve after about 12-14 weeks
- Stress the importance of adequate fluids and nutrition
11
Q
What are the appropriate investigations for seizures in pregnancy?
A
- Aim for monotherapy
- Risks of congenital abnormality - NTD, facial, cardiac
- Stress that despite these risks, the risks of frequent epileptic seizures are worse
- Take 5mg folic acid (until at least end of 1st trimester) and vitamin K in last month of pregnancy
- Measures taken at delivery to avoid stress - e.g. epidural
- Invite to register to the UK Epilepsy and Pregnancy Register
12
Q
What counselling should be given to women with a baby in a breech presentation?
A
- Risk Factors = uterine malformations, fibroids, placenta praevia, poly/oligohydramnios, foetal anomaly, prematurity
- Explain what breech means
- Offer ECV and explain risks → 50% success rate, placental abruption, foetal distress requiring an emergency CS
- Explain the benefits and risks of vaginal breech and C-section
- Vaginal - if successful, has fewest complications, however, 40% risk of needing an emergency C-section
- C-section - small reduction in perinatal mortality, implications on future pregnancy (placenta praevia, VBAC, uterine rupture)
13
Q
What counselling should be given to a lady considering pregnancy/who is pregnant with HIV?
A
- Explain risk of vertical transmission antenatal, intrapartum and postnatally
- Stress the importance of good compliance with HAART
- Viral load measurement every 2-4 weeks and at 36 weeks
- Viral load <50 copies/mL at 36 weeks = safe vaginal delivery
- Viral load >50 copies/mL at 36 weeks = ELCS
- Explain neonatal treatment with oral zidovudine for 2-4w
14
Q
What counselling should be given to women with overactive bladder syndrome?
A
-
Risk Factors:
- Stress: age, traumatic delivery (forceps), obesity, previous pelvic surgery, children
- Urge: age, obesity, smoking, family history, diabetes mellitus
- Explain diagnosis and mechanism
-
Explain lifestyle measures
- Controlling fluid intake
- Avoiding caffeine
- Losing weight
-
Explain treatment
- Urge: bladder retraining – increase time between going to the toilet
- Stress: pelvic floor training
- Explain further medical and surgical options
15
Q
What counselling should be given to couples who are sub-fertile?
A
- Risk Factors: advanced maternal age, smoking and alcohol use, obesity, irregular periods, STI
- Explain that there is still a chance of getting pregnant naturally - 15% of couples fail to conceive after 1 year
- Explain that you would like to start investigations (blood test looking at hormone levels, USS looking at structure of the uterus and follicle count and HSG if there are risk factors)
- Encourage regular unprotected sex at least every other day (not too much à let sperm count recover)
- Discuss management options depending on likely cause of subfertility
