Obstetrics Flashcards
(31 cards)
Explain gravidity?
any current pregnancy
every preceding pregnancy (regardless if twin etc, and includes miscarriages, terminations)
explain parity?
number of pregnancies that have reached 24 weeks
twins = one parous event
suffixed by numberof miscarriages and terminations
how estimate date of delivery?
add one year + 7 days to last menstrual period
which hormone can cause reflux in pregnancy?
Progesterone (uterine relaxing and other smooth muscle relaxing e.g. oesophageal sphincter)
management of eclampsia?
seizures in pre-eclamptic patient
BP - IV hydralazine + fluid restriction
seizure - IV magnesium sulphate
what is miscarriage? and management options?
Loss of pregnancy in under 24 weeks
Expectant management up to 14 days
Medical = misoprostol
Surgical = evacuation of uterus
management options for ectopic?
1st line = Expectant - twice weekly HCG and weekly US (no pain, HCG dropping, empty uterus)
Medical = Methotrexate (HCG <3000)
Surgical = salpingectomy is removal, salpingotomy is preserved.
Molar pregnancy types?
HCG - irreg bleeding, hyperemesis, hyperthyroidism
Complete - Diploid, 46XX (paternal), US ‘snowstorm’
Partial - Triploid, 2 sperm + one egg, foetal parts
No pregnancy for at least 6 months post normal HCG
Fibroids presentation
50% asymptomatic, HMB, dysmenorrhea, pressure effects, infertility
if postmenopausal rule out cancer first!
1/1000 malignant change to leiomyosarcoma
1st line management of heavy menstrual bleeding?
Mirena coil - if no identified pathology and fibroids <3cm
Tranexamic acid and/or NSAIDs - if fibroids 3cm or more and awaiting further management!
what should be given for 3 months pre-op for fibroids?
GnRH analogues
Management of ovarian cysts?
Simple pre-menopausal = >7cm or symptomatic = removal
Complex pre-menopausal = do CA125 (raised refer to oncology)
Post-menopausal cyst = always abnormal
- CA 125 + US
Cervical screening age group?
25-64 year olds (99% of cervical cancers due to HPV)
Negative HPV - recall 5 years
Positive HPV - Cytology
- cytology negative - repeat HPV 12 months
- cytology positive - colposcopy
Menopause and management?
45 - 55 years
oligomenhorrea as oestrogen levels lower
hot flushes, night sweats, joint/muscle pain, vaginal dryness, mood change
loss of muscle strength, higher risk of osteoperosis, and heart disease.
HRT:
- combined if uterus present
- oestrogen only if no uterus
staging of prolapse?
each stage is in relation to leading edge of prolapse in relation to hymen:
stage 0 = nil
stage 1 = -1cm or above
stage 2 = -1cm and +1cm
stage 3 = +1cm or below but without complete eversion
stage 4 = complete eversion (procedentia)
Stress incontinence management?
lifestyle (weight), pelvic floor training, incontinence ring
Medical: vaginal oestrogen, duloxetine (last line)
surgical: fascial slings, colposuspension
Overactive bladder management?
weight, caffeine, bladder retraining
medical: vaginal oestrogen, anti-cholinergics, Mirabegron, desmopressin (nocturia)
[watch for dry mouth + constipation in anticholinergics]
Surgical: Botox
Lichen sclerosis + management?
Severe itch. 40% autoimmune association.
Dermovate (very potent steroid)
what peaks at day 14?
LH
produced by dominant follicle?
Oestrogen
causes follicles to mature?
FSH
Produced by corpus luteum + peaks during luteal phase?
progesterone
accelerations and decellerations?
15 beats for 15 secs
late deceleration indicates hypoxia (doesn’t rise at least 20s after contraction)
subgaleal vs cephalo-haematoma vs caput succedaneun
sub-galeal bad all over the head (trauma)
Firm and over one fontanelle (periosteum)
Caput secondum - widespread swelling but fine
