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PACES Obs&Gynae Flashcards

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1
Q

What Additional Blood Tests Should a pregnant women testing positive for HIV Have?

A
  • Varicella Zoster
  • Hep C
  • Measles
  • Toxoplasmosis
  • She should be screened for genital infections (at booking an again at 28 weeks)
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2
Q

Postnatal management of
a baby born to an HIV+ mother?

A

All neonates should be treated with anti-retroviral therapy within 4 hours of birth. –> Zidovudine monotherapy for 2-4 weeks

Those at high risk of HIV infection should be treated with HAART. (Highly active anti retroviral therapy)

Infants should be tested for HIV DNA and RNA at 1 day, 6 weeks and 12 weeks of age.
A confirmatory HIV antibody test is performed at 18 months of age.

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3
Q

Which babies should have PCP prophylaxis?

A

Prophylaxis against PCP is recommended only for neonates at high risk of HIV infection.

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4
Q

What is contraindicated intrapartum in HIV+ mothers?

A

Foetal blood sampling

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5
Q

Mode of delivery for HIV+ mothers

A

Women should have elective C section at 38 weeks to prevent ROM

Exception: Vaginal delivery can be considered in women taking HAART with a VL<50 copies at 36 weeks

BUT avoid ARM, invasive foetal monitoring (scalp electrode) or instrumental delivery

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6
Q

Breastfeeding advice in HIV+ women

A

Not to Breastfeed
(breastfeeding if the viral load is low is only recommended in low resources countries therefore not the UK)

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7
Q

Can women HIV+ have ECV

A

Yes if the viral load is <50 copies/mL

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8
Q

Follow up of HIV+ women during pregnancy

A

They will be seen every 2 weeks at the joint HIV and obstetric clinic

Viral load will be monitored every 2-4 weeks + 36 weeks + post delivery

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9
Q

Post natal management of babies at high risk of transmission of HIV

A

Triple ART (zidovudine, lamivudine and nevirapine) for 4 weeks

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10
Q

Anti retroviral treatment in pregnancy

A

All HIV+ women should be offered it regardless of whether they were previously taking it

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11
Q

Vaccinations offered to HIV+ mothers in pregnancy

A

All pregnant women are offered the whooping cough vaccine. Flu vaccine and COVID vaccine

You will also be recommended to have vaccinations for hepatitis B (if you are not immune) and pneumococcus, and the flu vaccine (in the autumn/ winter months).

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12
Q

Is anti-retroviral treatment safe in pregnancy?

A

Anti-retroviral drugs are generally safe but they can sometimes have side effects, including stomach and digestive problems, diabetes, rashes, extreme tiredness, high temperature and breathlessness.

Anti-retroviral treatment itself does not appear to be harmful for babies. Not taking the medication is much more likely to be harmful for your baby, because the risk of passing HIV on to your baby will be much higher.

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13
Q

What is hysteroscopic sterilisation?

A

Insert expanding springs into the tubal ostia via a hysteroscope
This induces fibrosis over 3 months
Additional contraception should be used during this time

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14
Q

How is female sterilisation performed at laparoscopy?

A

Occlude Fallopian tubes with Filshie clips

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15
Q

What advice should be given to women who have had a laparoscopic sterilisation?

A

Additional contraception should be used until the first period after the procedure

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16
Q

Which organism causes thrush

A

Candida albicans

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17
Q

What are some causes of dysmenorrhoea?

A

Endometriosis
Adenomyosis
PID
Fibroids

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18
Q

List some causes of PV bleeding

A

Cancer (endometrial, cervical, ovarian)

Fibroids

Endometriosis

Bloody show

PID

Period

Cervical ectropion

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19
Q

List some types of endometrial cancer

A

Endometrioid:
- Mucinous adenocarcinoma
- Serous adenocarcinoma

Non-endometrioid:
- Clear cell carcinoma

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20
Q

List some risk factors for endometrial cancer

A

Obesity

Nulliparity

Early menarche and late menopause

Unopposed oestrogen therapy

Diabetes mellitus

Tamoxifen

PCOS

HNPCC

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21
Q

How is endometrial cancer treated?

A

Localised disease: total abdominal hysterectomy with bilateral salpingo-oophorectomy

High risk patients may receive post-operative radiotherapy

Progesterone therapy is sometimes used in frail elderly patients who are unfit for surgery

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22
Q

What might you do to high risk patient with endometrial cancer?

A

High risk patients may receive post-operative radiotherapy

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23
Q

Alternative treatment to surgery for frail patients with endometrial cancer

A

Progesterone therapy (Mirena Coil for at least 6 months) is sometimes used in frail elderly patients who are unfit for surgery

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24
Q

How frequently are women offered cervical cancer screening?

A

Every 3 years: 25-49

Every 5 years: 50-64

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25
What are some risk factors for ectopic pregnancy?
Maternal age Previous ectopic pregnancy Pelvic or abdominal surgery PID Termination of pregnancy Smoking Endometriosis Copper IUD
26
What are the types of gestational trophoblastic disease?
Complete and partial mole Invasive mole Choriocarcinom
27
What must you always do with cases of FGM?
Document in the hospital notes If < 18 years, refer to police and social services Explore whether other children are at risk
28
Core features of PTSD (ICD-10)
TRIAD = HYPERAROUSAL, AVOIDANCE, RE-EXPERIENCING 1. An event of exceptionally threatening nature that is likely to cause pervasive distress in almost anyone 2. Symptoms start within 6 months 3. Avoidance of circumstances 4. Intrusive recollection/memories of the event 5. Difficulty remembering some of the event 6.Increased psychological/autonomic sensitivity: hypervigilant, difficulty concentrating, outbursts of anger, poor concentration, difficulty sleeping, startle response
29
Charities for FGM
- Daughters of Eve - NSPCC FGM Helpline - Foundation for Women's Health Research and Development (FORWARD)
30
Why is FGM undertaken?
- To signal that a girl has now become a woman. - To protect a girl’s virginity /to prove she has not had sex before marriage. - To decrease a womans’ sexual desire. - To prepare a girl for marriage. Once FGM has been performed a girl is seen as ready for marriage. - To follow a religious requirement (although there is no evidence to suggest that FGM is required by any religion).
31
Where is FGM most prevalent?
Mali Somalia Sudan Egypt Ethiopia
32
What is the legal situation of FGM in UK?
Mandatory legal DUTY to inform police about suspected FGM in under 18s
33
What is the legal situation of underage marriage in UK?
It is now an offence to cause a child under the age of 18 to enter a marriage in any circumstances, without the need to prove that a form of coercion was used. This includes non-legally binding ‘traditional’ ceremonies which would still be viewed as marriages by the parties and their families.
34
When should an OGTT be performed in women with a high risk of GDM?
24-28 weeks If previous history of GDM, this should be done at 16-18 weeks and a repeat at 24-28 weeks
35
Why should an ultrasound scan be performed at the time of diagnosis of GDM?(3)
Exclude congenital anomaly Assess foetal growth Assess liquor volume
36
Who should review a woman with a new diagnosis of GDM and when should this happen?
Joint diabetes and antenatal clinic within 1 week of diagnosis
37
What is gestational trophoblastic disease?
Spectrum of tumours and tumour-like conditions characterised by proliferation of pregnancy-associated trophoblastic tissue
38
What are the risks associated with intrauterine contraceptive devices?
Uterine perforation (2 in 1000) Ectopic pregnancy (relative not absolute) ( and only for IUD) Infection (in first 20 days) Expulsion (risk is 1 in 20) Abnormal bleeding (IUS: initial frequent bleeding and spotting followed by intermittent light menses; IUD: heavier, longer and more painful)
39
State some risks of HRT
VTE& stroke (but can be avoided if given as a patch or gel) Coronary heart disease if over 60 Breast and ovarian cancer
40
What are the main benefits of HRT?
- Improved vasomotor symptoms - Reduced risk of osteoporosis - Improved genital tract symptoms
41
List some absolute contraindications for HRT (6)
Pregnancy Breast cancer Endometrial cancer Uncontrolled HTN Current VTE Thrombophilia
42
What is the most common gynaecological cancer in women?
Endometrial
43
Which cancers occurring in females have national screening programmes?
Breast Cervical
44
List some non-hormonal treatments for menopause.
- Alpha agonists (clonidine) - Beta-blockers (propranolol) - SSRIs (fluoxetine) Symptomatic: lubricants, osteoporosis treatments
45
List some causes of subfertility.
PCOS Idiopathic Male factor Surgery/chemotherapy Adhesions Endometriosis Blocked Fallopian tubes
46
List some causes of premature ovarian insufficiency. (5)
- Chromosomal abnormalities (e.g. Turner's syndrome, fragile X) - Autoimmune disease (e.g. hypothyroidism, Addison's, myasthenia gravis) - Enzyme deficiencies (e.g. galactosaemia, 17a-hydroxylase deficiency) - Chemotherapy or radiotherapy - Infections (e.g. TB, mumps, malaria, varicella)
47
Causes of secondary amenorrhoea
Hypogonadotrophic hypogonadism (e.g. Sheehan’s syndrome) PCOS Asherman’s syndrome Low BMI Cervical stenosis Physiological: lactational, pregnancy Aetiology of secondary amenorrhoea Usually due to HPO axis dysfunction: S → {{c1::Stress}} T → {{c2::Tumour (Pituitary)}} O → {{c3::Over-exercise and weight loss == Hypothalamic Hypogonadism}} P → {{c4::Psychiatric: anorexia nervosa}} Other causes T → {{c5::Thyrotoxicosis}} A → {{c6::Asherman's syndrome: adhesions}} M → {{c7::Menopause (early)}} P → {{c8::PCOS}} O → {{c9::Ovarian tumour}} N → {{c10::Neonatal → post-pregnancy and breast-feeding}}
48
What is the definition of a miscarriage?
Pregnancy that ends spontaneously before 24 weeks gestation
49
List some causes of recurrent miscarriage.
Antiphospholipid syndrome Cervical abnormalities Foetal chromosomal abnormalities Uterine malformations Thrombophilia
50
Most common site of the fallopian tube for ectopic pregnancies
The ampullary portion of the tube, where over 80% of ectopic pregnancies occur
51
The site where an ectopic pregnancy is more likely to burst?
Isthmus
52
List some common side-effects of sex hormones.
Progestogenic – depression, PMS, bleeding, acne, weight gain Oestrogenic – headache, nausea, breast tenderness
53
Can you describe some methods of male and female sterilisation?
Female – Filshie clips, transcervical sterilisation involving hysteroscopic placement of micro-inserts, hysterectomy Male – vasectomy
54
Risk factors for vaginal prolapse
Obesity Chronic cough Chronic constipation Post-menopausal Connective tissue disorders
55
Which complex of muscles makes up the bulk of the perineum
Levator ani
56
Which muscles make up the levator ani?
Puborectalis Pubococcygeus Iliococcygeus
57
What are the four categories of uterine prolapse?
Stage 1: cervix is in the upper half of the vagina Stage 2: cervix is at the introitus Stage 3: cervix protrudes out of the introitus Stage 4: procidentia – uterus is outside the vagina Treated conservatively with pelvic floor exercises, wt loss, less constipation and avoiding heavy lifting. MEdically with oestrogen cream and pessary Surgically depending on the prolapse.
58
Which blood test would you do if you suspected anti-phospholipid syndrome?
Lupus anticoagulant Anticardiolipin antibodies Diagnosis requires 2 positive results at least 12 weeks apart
59
How can a miscarriage be managed medically?
Vaginal misoprostol Analgesia and anti-emetic
60
What is a uterine fibroid?
Leiomyoma – benign tumour arising from the smooth muscle
61
What is a dangerous complication of fibroids in pregnancy?
Red degeneration
62
What are the three types of fibroid?
-Submucous Intramural Subserosal
63
What agent may be used to reduce the size of the fibroid in preparation for surgery?
Injectable GnRH agonist --> not sure if they do this anymore
64
What is the difference between a complete and partial mole?
Complete: empty egg is fertilised by 2 sperm or 1 sperm that duplicates. Produces a mass of cells with no foetus Partial: normal ovum gets fertilised by 2 sperm. An abnormal foetus starts to form but it cannot survive of develop into a baby
65
What can be given to ripen the cervix before suction and curettage?
Prostaglandins
66
What is the incidence of molar pregnancy?
1 in 600 --> it's 590 if you want to be exact
67
What are the different types of FGM?
Type 1: clitoroidectomy Type 2: clitoroidectomy with partial or total removal of the labia minora with or without removal of the labia majora Type 3: infibulation (stitching to narrow the vagina) Type 4: any other non-medical procedures to the external genitalia (e.g. piercings, cauterisation)
68
What are some complications of pelvic inflammatory disease?
Infertility Ectopic pregnancy Chronic pelvic pain Sepsis Fitz-Hugh-Curtis syndrome
69
What is the difference between a high vaginal swab and an endocervical swab?
Endocervical – chlamydia and gonorrhoea High vaginal – anaerobes (e.g. BV)
70
What are the high risk types of HPV?
16 and 18
71
Name an HPV vaccine and the types of HPV covered by it.
Gardasil – 6, 11, 16 and 18
72
What are some causes of antepartum haemorrhage?
Placental abruption Placenta praevia Placenta accreta Vasa praevia Cervical ectropion Trauma
73
What are some risk factors for placental abruption
Previous placental abruption Smoking C-sections Cocaine use Pre-eclampsia
74
Investigations for suspected placenta abruption
- Observations - Pregnant Abdomen Examination - CTG - Ultrasound - Speculum - Kleihauer Test: can be performed to determine the extent of fetomaternal mixing of the blood so that a sufficient dose of anti-D can be given - FBC, coagulation screen and 4 units of blood cross-matched
75
What are the steps in the management of a patient with hyperemesis gravidarum?
1st line: antihistamines (promethazine or cyclizine) 2nd line: ondansetron or metoclopramide Alternative: P6 acupressure, ginger If severely dehydration: admit for IV rehydration, thiamine supplementation and thromboprophylaxis
76
What triad of features defines hyperemesis gravidarum?
More than 5% pre-pregnancy weight loss Electrolyte imbalance Dehydration
77
Which treatment option can be used if the patient fails to respond to several anti-emetics
Steroids
78
How long does normal morning sickness tend to last?
It gets better by around 14 weeks
79
If the symptoms of HG persist into the second and third trimesters, are there any additional aspects of management that you might offer?
Serial scans to monitor foetal growth
80
How can preterm premature rupture of membranes be prevented in high-risk women?
Prophylactic vaginal progesterone Cervical cerclage
81
If pooling of amniotic fluid is not observed on examination of a woman with suspected PPROM, which other test could be conducted?
IGF binding protein-1 test or placental alpha-microglobulin-1 test
82
Which organisms are typically implicated in chorioamnionitis?
GBS E. coli
83
How would a patient with PPROM but no signs of infection be managed?
Monitor for signs of infection Offer oral erythromycin 250 mg QDS for a maximum of 10 days or until the patient is in established labour Do NOT use tocolysis (increases risk of infection) Decision to deliver depends on balance of risk of prematurity and risk of maternal/foetal infection if delivery is delayed
84
How can women at high-risk of pre-eclampsia be managed during pregnancy?
75 mg OD aspirin from 12 weeks until birth Indications: diabetes mellitus, autoimmune disease, hypertensive disease during previous pregnancy, chronic hypertension, chronic kidney disease
85
List some risk factors for pre-eclampsia.
First pregnancy Multiple pregnancy History of PET Age > 40 yrs BMI >35 > 10 year pregnancy interval
86
Gestational diabetes is defined as
Fasting plasma glucose > 5.6 mmol/L 2-hour OGTT > 7.8 mmol/L
87
risks of gestational diabetes and why it needs to be controlled
Foetal: macrosomia, polyhydramnios, neonatal hypoglycaemia, shoulder dystocia, congenital defects, miscarriage, later risk of T2DM and obesity Maternal: traumatic delivery due to macrosomia, increased risk of T2DM, increased future risk of gestational diabetes (50%), pre-eclampsia
88
What is the target level of plasma glucose in a patient with GD?
Fasting plasma glucose < 5.3 mmol/L 2-hour post-meal < 6.4 mmol/L
89
How should sexual contacts of someone with PID be treated?
Single dose azithromycin 1 g
90
Which antibiotic regimen is recommended for PID?
- Intramuscular ceftriaxone 250 mg immediately +oral doxycycline 100 mg twice a day for 14 days + metronidazole 400 mg twice a day for 14 days.
91
What is the treatment of PMS?
Mild -> Lifestyle such as sleep better or exercise more and stop smoking. Smaller more meals with complex carbohydrates Moderate -> COCP Severe -> SSRIs

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