Repro Flashcards
(248 cards)
1
Q
Clinical triad of pre-eclampsia?
A
BP elevated, usually above 140/90
Proteinuria on dipstick or 0.3g or more over 24hrs collection
Oedema of the face/hands/legs/feet
2
Q
Symptoms of pre-eclampsia
5
A
Headache Visual disturbance Vomiting Flash oedema Subcostal pain
3
Q
Antihypertensives safe in pregnancy
3
A
- LABETALOL
- Methyldopa
- Nifedipine
4
Q
Prenatal care in pre-eclampsia
incl. foetal monitoring x4
A
ONCE-ONLY proteinura assessment with dipsticks, if more than 1+, do P:CR or 24 collection
Control BP - almost always labetalol, usually only treat @ 150/100 or more
Measure BP several times per day
Bloods:
Regular U&Es, FBC, bilirubin
Foetal monitoring:
CTG @ diagnosis and weekly
USS foetal growth @ diagnosis
Amniotic fluid volume assessment @ diagnosis
Umbilical artery doppler velocimetry @ diagnosis
Regular assessment of syx
Timing of birth:
Manage conservatively (i.e. not immediate delivery) until 34 weeks unless severe where birth may be offered before
If moderate/mild, offer birth in 24-48hrs where HTN persists to 37+0
REMEMBER STEROIDS IF PRE 36 WEEKS
5
Q
Intrapartum/postpartum antihypertensive use in pre-eclampsia
A
Intra: Monitor BP hourly in mild/mod Monitor BP continuously in severe Continue antihypertensive through labour Recommend operative birth in 2nd stage in severe cases not responding to treatment
Post:
Continue treatment postnatally and consider reducing if achieve below 140/90
6
Q
Maternal complications of eclampsia
8
A
Placental abruption Neurological defecits Aspiration pneumonia HELLP Pulmonary oedema Cardiovascular problems - IHD, stroke, chronic HTN etc. Acute renal failure Death - via DIC, sepsis, stroke etc
7
Q
Risk factors for pre-eclampsia
9
A
Primigravida Extremes of age HTN DM Previous pre-eclampsia Family hx Renal disease Obesity SLE, APLS
8
Q
Clinical signs of pre-eclampsia
5
A
HTN Papilloedema Brisk reflexes Clonus Visual defect HELLP syndrome (Seizure - eclampsia)
9
Q
Foetal complications of eclampsia
3
A
Prematurity - STEROIDS
IUGR
Bronchopulmonary disease
10
Q
What is HELLP syndrome? When may it occur?
A
Haemolysis, elevated liver enzymes, low platelets
As a severe form of pre-eclampsia, patients are at high risk of DIC, abruption, renal failure and pulm oedema
11
Q
Risks associated with pre-existing maternal DM?
6
A
Congen abnormalities Misacarriage Macrosomia as a result of foetal hyperinsulinaemia, predisposed to IUD Polyhydramnios Infection Stillbirth
12
Q
Produce testosterone
A
Leydig cells
13
Q
Form the blood-testis barrier
A
Sertoli cells
14
Q
Days of the menstrual cycle when menses occur
A
1 to 7
15
Q
Causes ovulation
A
Luteal surge, massive rise of LH @ day 14
16
Q
Proliferating stage of menstrual cycle
A
days 7 to 14
17
Q
Follice becomes this after ovulation
A
Corpus luteum
18
Q
Causes proliferation of the endometrium
A
Progesterone
19
Q
Produced by the corps luteum when it forms
A
Progesterone
20
Q
Progesterone stimulates these to be formed in the endometrium
A
Spiral arteries
21
Q
Increases uterine secretions to nourish embryo
A
Progesterone
22
Q
Produced by a blastocyst upon implantation
A
hCG
23
Q
Happens to the corpus luteum if no implantation, and why
A
atrophies and dies, as LH no longer being produced, then means no progesterone and next follicular phase can begin
24
Q
Happens to corpus luteum if implantation occurs
A
hCG resembles LH, so CL can survive and continue to produce
25
Produces progesterone from 2-3 months to delivery
Placenta
26
Biochemical test of ovulation
21 day progesterone
27
2 hormones which surge at ovulation
LH, oestrogen
28
Hormone detected by preg test
hCG
29
Cryptochordism
Undecended testes
30
Primary infertility
Never concieved
31
Secondary infertility
Concieved before but not this time
32
Infertility
failure to conceive after 1 year of regular unprotected sex with no other cause
33
Aspermia
Absence of ejaculate
34
Oligozoospermia
less than 15 mil sperm per mil
35
Azoospermia and causes
```
Absence of sperm in the semen
Primary - problem with testes (likely Leydigs) or secondary testicular failure (higher up the axis)
CFTR mutation
Blockage of the repro tract
Chromosomal abnormality
```
36
Reduced sperm motility important diagnosis
Kartagener syndrome aka primary ciliary dyskinesia
37
3 things that are nor labour
Braxton Hicks contractions: irreg, no increase in frequency or intensit
Show - mucous plug
PROM
38
1st stage of labour
onset of true labour to full dilation (10cm)
39
2nd stage of labour
full cervical dilation (10cm) to delivery of baby
40
3rd stage of labour
delivery of baby to delivery of placenta and membranes
| should happen within 30 mins
41
1st trimester
Last day of last menses to end of week 12
42
2nd trimester
Start of week 13 to end of week 27
43
3rd trimester
Start of week 28 to end of week 40
44
Causes of female infertility
| 5
Ovarian dysfunction - PCOS (androgen excess)
Tubular problem - blockage - test with Hysterosalpingography
Premature ovarian failure (diminished reserve)
Endometriosis - adhesions
PID
45
Causes of male infertility
Pre-testicular (4)
Intrinsic (6)
Post (5)
```
Pre:
Hormonal - impaired secretion of GnRH
Drugs - illicit and chemo, anabolic steroids, spironolactone, phenytoin, sulfasalazine
Alcohol
Coeliac disease
```
```
Intrinsic:
Varicocele
Kleinfelter's - 46XY
Neoplasm
Cryptochordism
Trauma
Hydrocele
```
```
Post:
Vas deferens - obstruction, absence (CF)
Retrograde ejeculation
Hypospadias
Impotence
Infection e.g. prostitis
```
46
Missed miscarriage management
Conservative
Prostaglandins
Surgical
47
Most common ectopic locataion
Ampulla of fallopian tube
48
Period of amenhorroea and +ve preg test with nothing in uterus likely diagnosis
Ectopic
49
Management of ectopic
Methotraxate
| Salpingectomy (tubes preserved)
50
Painless PV bleed in pregnancy most likely cause
Praevia
51
Contraindicated in praevia
PV EXAMINATION
52
Grades of praevia
1 to 4
1. not reaches os
2. reached os
3. partially covering os
4. totally covering os - centrally located
53
Painful PV bleed in pregnancy most likely casue
Abruption
54
Types of abruption
Revealed - blood scapes through os
Concealed - bleed between placenta and uterine wall
Mixed
55
Risk factors for abruption
| 6
```
Pre-eclampsia
Chronic HTN
Multiparity
Polyhydramnios
Cocaine
Smoking
```
56
Complications of abruption
| 4
Maternal shock, collapse - blood loss may be deceptive
Foetal demise
MAternal DIC, renal failure
PPH!!!
57
Management of abruption
```
Live foetus >34 weeks:
Foetus stable - vaginal delivery
may need induction
may need blood products
may need OXYTOCIN
may need STEROIDS
may need ANTI-D
Foetus/mother unstable - emergency CS
```
```
Live foetus <34 weeks:
Foetus stable - conservative
STEROIDS
consider delivery by 37-38 weeks
Foetus/mother unstable -
emergency CS
may need OXYTOCIN
```
Foetal demise:
Mother stable - vaginal delivery
Mother unstable - emergency CS
58
Eclampsia treatment
Emergency delivery of foetus
Magnesium sulphate
Labetalol
59
Causes of APH
| 3
Praevia (30%)
Abruption (30%)
Benign bloody show
60
APH definition
Genital bleeding post 24 weeks and pre-labour
61
IOL definiton
forced commencement of labour through medication or rupture of membranes artificially - amniotomy
62
Bishop score above which IOL unlikely to be required
7 and above
63
Indications for IOL
| 4
```
DM
Term +7
DVT treatment
IUG concerns
Oligohydramnios
```
64
Drug used to initiate contractions and reduce uterine atony
OXYTOCIN
65
Reasons for inadequate progress in labour
| 3
Cephalopelvic dispropotion
Malposition
Malpresentation
66
Determinants of progress
| 3
Cervical effacement
Cervical dilation
Descent of the foetal head
67
Ways to monitor the foetus
| 5
```
Heart auscultation
Foetal movements
CTG
Blood sampling
ECG
```
68
Normal foetal blood pH
> or = to 7.25
69
Contraindications to vaginal delivery
Obstruction - Praevia, masses e.g. cyst, fibroid
| Malpresentation - certain settings
70
Complications of 3rd stage of labour
| 3
PPH
Tear (grades 1-4)
Retained placenta
71
Major postnatal compliactions
| 5
```
PPH - primary and secondary
VTE
Sepsis
Psychiatric disorders
Pre-eclampsia
```
72
Primary PPH definition
>500mls blood loss within 24hrs of delivery
73
Secondary PPH definition
>500mls blood loss from 24hrs post delivery to 6 weeks
74
Causes of primary PPH
4 T's!!! - Tone, Trauma, Tissue, Thrombin
```
Tone
- uterine atony - oxytocin
Trauma
- tears
- uterine rupture
- inverted uterus
Tissue
- retained placenta
Thrombin
- inherited coagulopathies, DIC
```
75
Common teratogens and their effects
| 10
ACEIs - IUGR, renal dysplasia/failure
Alcohol - IUGR, foetal alcohol syndrome, mental retardation
Lithium - various, usually heart and great vessel malformations
Phenytoin/carbamazepine - foetal hydantoin syndrome - cleft lip/palate, depressed nasal bridge, short nose, mental retardation
Sodium valproate - foetal valproate syndrome - high forehead, infraorbital crease or groove, small mouth
Methotrexate - multiple skeletal abnormalities
Doxycycline - affect bone and teeth development
Radiation - microcephaly, mental retardation
Retinoic acid - NTDs e.g. spina bifida
Warfarin - foetal warfarin syndrome
76
Common teratogenic infections and their effects
| 6
CMV - microcephaly, chorioretinitis, mental retardation, deafness
HSV - microcephaly, microphthalmia, retinal dysplasia
Rubella - cataracts, glaucoma, deafness
VZV - skin scarring, muscular atrophy, mental defects
Treponema pallidum - hydrocephalus, deafness
Toxoplasma gondii - microcephaly, mental retardation, chorioretinitis
77
Period of greatest risk to foetus of teratogenicity
Organogenesis - 3-8 weeks
78
COCP mechanisms of action
| 3
Prevents ovulation - prevents LH surge
Temporarily renders endometrium inadequate
Thickens cervical mucus
79
Benefits of COCP
| 3
Increases regularity of menses
May help in menorrhagia
Reduces risk of ovarian and cervical cancer
80
Risks of COCP
| 3
3x increase risk of VTE
Small risk of ischaemic stroke - GREATER IN MIGRAINE WITH AURA - CONTRAINDICATED
Small increase in risk of breast cancer
81
POP mechanism of action
Thickens cervical mucus
82
Major downside of POP
Must be taken in same 3 hour window each day
83
DepoProvera mechanism of action
Mainly prevents ovulation
84
How often is Depo given
Every 12 weeks
85
Benefits of Depo injection
| 2
Good in poorly compliant patients
| 70% amenorrhoeic during treatment
86
Problems with Depo injection
| 4
Only one to cause a delay in return to fertility
Reversible decrease in bone density
Problematic bleeding when it occurs
Weight gain
87
Subdermal implant mechanism of action
Inhibition of ovulation
88
How long does a subdermal implant last?
3 years
89
What are the two forms of intrauterine contraception?
Copper coil - older method, makes periods heavier
| Mirena - FIRST LINE IN MENORRHAGIA
90
3 forms of emergency contraception and their period of effect
Levonorgestrel pill - 72 hours
Ella one pill - 120 hours
Cu ICD - 120 hours
91
Up to what point can TOP be carried out in Scotland?
20 weeks
92
2 drugs used in medical TOP
Misoprostol
| Mifepristone
93
Normal upper limit for abortion
24 weeks
94
Normal upper limit for medical abortion
10 weeks
95
Law under which abortion is legal in the UK
The Abortion Act 1967
96
Two key conditions of the abortion act
The abortion is carried out in a hospital or licensed clinic
Two doctors agree that continuing with the pregnancy would be more harmful to the physical or mental health of the pregnant woman or any existing children of her family than if the pregnancy was aborted
97
Conditions under which an abortion can be carried out after 24 weeks
It is necessary to save the woman's life; or
It will prevent grave, permanent injury to the physical or mental health of the pregnant woman; or
There is substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.
98
Classical findings of vulvovaginal candidiasis (thrush)
| 3
Fissuring
Erythema with satellite lesions
Discharge - may be cottage-cheese like or simply more than usual
99
Treatment for candidiasis
Clotrimazole
| Fluconazole
100
Condition which may be asymptomatic in 50% of cases or in some produce a watery grey, fishy discharge
Bacterial vaginosis (BV)
101
Diagnostic findings in BV
Characteristic hx - grey/yellow watery/fishy discharge
| Thin homogenous discharge
102
Commonest cause of abnormal vaginal discharge
BV
103
Treatment for BV (and trichomoniasis)
Metronidazole
104
Causative organism in 90% of candidiasis
Candida albicans
105
Risk factors for candidiasis
```
DM
Steroid use
Pregnancy
Immunosupression
HIV
```
106
Causative organism in BV
No organism, it's an imbalance of native bacteria
107
STIs which can be transmitted by genital contact alone
Scabies
Pubic lice
Warts - HPV 6&11
Herpes - HSV 1&2
108
Virus and subtypes which cause genital warts
HPV, 6&11
109
4 most common STIs worldwide
1. Chlamydia trachomatis
2. Neisseria gonorrhoea
3. Syphilis
4. Trichomonas vaginalis
110
4 components of management in a patient presenting with STI-like symptoms
A good history
Partner notification where appropriate
HIV testing where appropriate
Health promotion
111
7 questions to ask in a sexual history
1. last contact
2. casual or regular partner
3. male or female
4. nature of sex
5. condoms?
6. other contraception
7. nationality of contact
112
6 questions to risk assess man re sexual history
1. ever contact with man
2. ever injected drugs
3. sexual contact with person who has injected drugs
4. sexual contact with anyone from outside the UK
5. medial treatment outside the UK
6. involvement with the sex industry
113
Percentage of chlamydia cases that are asymptomatic
85
114
Signs and symptoms when chlamydia case is not asymptomatic
| 5
```
Cervical discharge - cloudy/yellow
Friable cervix
Postcoital or intermenstrual bleeding
Penile discharge
Vaginal discharge - odourless mucoid
```
115
Investigation for chlamydia
Nucleic acid amplification test
116
Treatment for chlamydia
Azithryomycin
OR
Doxycycline (not in pregnancy)
117
Men or women more likely to be asymptomatic in gonorrhoea
Women
118
Most common gonorrhoeal symptoms in men
Dysuria
Urethral irritation
Urethral discharge
119
Ethnic risk factor for gonorrhoea
Black ancestry
120
Appearance of gonorrhoea on gram staining
Gram-negative diplococci
121
Stains positive in gonorrhoea culture
Chocolate agar
122
Test for gonnorhoea
Fluid culture
| Nucleic acid amplification test
123
Gonorrhoea treatment
Cefotaxime
AND
Azithromycin
124
Define PID
Acute ascending polymicrobial infection of the female gynaecological tract that is frequently associated with Neisseria gonorrhoeae or Chlamydia trachomatis
125
3 pelvic examination finding criteria for PID
Cervical excitation
Uterine tenderness
Adnexal tenderness
126
Risk factors for PID
Previous PID
Previous chlamydia/ gonorrhoea
High risk sexual behaviour
127
Causes of acute pelvic pain
| 14
```
Ectopic
PID
Appendicitis
Degenerating uterine fibroid
Abruption
Miscarriage
Ovarian abscess
Ovarian torsion
Ovarian cyst rupture
Corpus luteal cyst rupture
Endometriosis
UTI/Pyelonephritis
Cystitis
Dysmenorrhoea
```
128
Complications of chlamydia
| 4
PID
Infertility
Ectopic
Reactive arthritis
129
Complications of gonorrhoea
| 5
```
Chronic pelvic pain
Infertility
PID
Ectopic pregnancy
Reactive arthritis
```
130
Common signs of PID outwith the clinical criteria
| 5
```
Lower abdominal pain
Fever
Nausea
Vomiting
Vaginal or cervical discharge
```
131
Investigative options in PID
| 9
```
FBC, WCC
Smear
ESR
Secretion culture
TVUSS
Pelvic CT
Pelvic MRI
Laparoscopy
Biopsy
```
132
Treatment of PID
```
Mild to mod:
Ceftriaxone
AND
Doxycycline
+/-
Metronidazole
AND
Treatment of sexual contacts
```
Severe:
Hospital admission and IV antibiotics
133
What might you have to consider doing in the management of PID?
Removal of IUD
134
Complications of PID
| 4
Where associated with/caused by chlamydia/gonorrhoea complications are as per untreated cases of those infections
Infertility
Tubo-ovarian abscess
Chronic pain
Ectopic
135
Causes of ano-genital lumps/bumps
| 13
```
Vulval cysts
Vaginal cysts
Fordyce sports
Varicosities
Ingrown hairs
Skin tags
Lichen sclerosis
PPP
Lichen planus
Genital herpes
Genital warts (HPV 6&11)
Molluscum
Normal anatomical variations
```
136
Symptoms of genital herpes
```
Vulval irritation and pain
Fever
Groin swelling
Vaginal discharge
Blisters which go on to ulcerate
```
137
Medication which suppresses symptoms of genital herpes
Aciclovir
138
Risk factors for genital herpes
HIV infection
Immunosupression
High risk sexual behaviour
139
Often first symptom in women with primary genital herpes
Dysuria
140
Investigations for genital herpes
Viral culture
| HSV PCR
141
Nerves supplying the bladder and their nerve roots
Hypogastric T10-12
Pelvic S2-4
Pudendal S2-4
142
3 types of FUI
Stress
Urgency
Mixed
143
Risk factors for FUI
| 6
```
PREGNANCY
CHILDBIRTH
Menopause
Increasing age
Increasing parity
Prev surgery
```
144
Management of FUI
Pelvic floor training 60-70% cure
LIFESTYLE - smoking, weight, alcohol, caffeine
Pharmacological - Duloxetine
Surgery - tape, culposuspension, slings
145
Percentage of parous women with some degree of prolapse
50
146
Main support of anterior vaginal wall
Pubocervical fascia
147
Risk factors for prolapse
| 7
```
PARITY
AGE
OBESITY
Forceps delivery
Macrosomia
Prolonged second stage
Heavy lifting
```
148
Vaginal symptoms of prolapse
Bulging/protruding
Pressure
Heaviness - "something coming down"
Difficulty with tampons
149
Urinary symptoms of prolapse
Incontinence
Frequency/urgency
Week stream
150
Bowel symptoms of prolapse
Incontinence
Flatus
Incomplete emptying/straining
Urgency
151
Assessment of prolapse
```
Exclude masses
QOL assessment
POPQ SCORE
USS/MRI
Urodynamics
```
152
Management of prolapse
Lifestyle
Physio
Pessaries
Surgery - hysterectomy may be indicated
153
Score for assessing baby's status immediately after delivery, maximum score, score below which baby needs specialist paediatric care and oxygen
APGAR
10
7
154
Parameters measured on partogram
| 11
```
Temperature
BP
Urine dipstick results
Maternal HR
Foetal HR
Cervical dilation
Drugs and fluid balance
Contractions
Liquor description
Head moulding
Head engagement
```
155
What is CTG? What is being measured?
Cardiotocograph(y)
| Foetal heart rate and the strength of contractions
156
Definition of foetal bradycardia
Baseline HR of <100bpm
157
Nerve roots damaged in Erb's palsy
C5&6
158
Definition of menopause
Amenorrhoea for at least 12 months in a woman aged 45 or over
159
Average age of menopause in the UK
51
160
Definition of foetal tachycardia
Baseline HR of above 160
161
Rough time of ovulation in a 28-day cycle
Day 14
162
What is an alternative treatment of hot flushes where HRT is contra-indicated? Where might this be the case
SSRI
| In a woman with history of VTE/stroke etc
163
Causes of postcoital bleeding in pre-menopausal women
| 6
```
Cervical ectropion
Infection e.g. cervicitis secondary to chlamydia
Cervical or endometrial polyps
Vaginal cancer
Cervical cancer
Trauma
```
164
Define precocious puberty
Development of secondary sexual characteristics before 8 years in girls and 9 years in boys
165
Scale describing secondary sexual characteristics
Tanner staging
166
Affects 3-7 year old girls, may be green/yellow offensive discharge, vaginal soreness/itching and/or red 'flushing' around the vulva and anus
Vulvovaginitis
167
Management of vulvovaginitis
Conservative treatment and improvement of perineal hygiene
168
Management of labial adhesions
Oestrogen cream only if symptomatic, rarely surgery where cream fails and symptoms persist
169
Cause of 40% of cases of adolescents presenting with chronic pelvic pain
Endometriosis
170
Symptoms of endometriosis
Pelvic pain
Deep dyspareunia
Dysuria
Subfertility
Dyschezia
Dysmenorrhoea
Bladder and bowel symptoms
171
3 places endometriosis commonly occurs
Ovaries
Uterosacral ligaments
Rectovaginal septum
172
Classic appearance and nickname of endometriomas
Chocolate-like appearance due to altered blood, so called chocolate cysts
(endometriosis)
173
Best way to confirm endometriosis (with experience)
Diagnostic laparoscopy
174
Management of endometriosis
```
COCP
NSAIDs
GnRH analogues
If endometrioma - surgery
Hysterectomy if all else fails
```
175
Causes of abnormal uterine bleeding (there's a mnemonic)
PALM.COEIN
Polyps
Adenomyosis
Leiomyoma
Malignancy/hyperplasia
Coagulopathies - vWD, platelet dysfunction, low platelets
Ovulatory dysfunction - PCOS, thyroid, anovulatory cycles or disturbed cycles - disturbance of oestrogen feedback mechanism/axis
Endometrial - endometritis, molecular disturbances
Iatrogenic - hormonal contraception, anticoagulants, IUDs
Not yet classified - Undiagnosed pregnancy complications, trauma, smoking, foreign body
176
Define secondary amenorrhoea
Absence of menstruation for more than 6 months
177
Causes of secondary amenorrhoea
Physiological - pregnancy, breastfeeding, anorexia
| Pathological - hypothalamic dysfunction, thyroid, PCOS
178
Investigations for secondary amenorrhoea
Preg test, LH, FSH, prolactin, USS
179
Definition of miscarriage
Loss of pregnancy before 24 weeks
180
Definition of recurrent miscarriage
3 consecutive pregnancy losses
181
Things to test for in recurrent miscarriage
APLS antibodies, chromosome abnormalities and PCOS
182
Definition of hyperemesis gravidarum
Persistent vomiting beginning before 20 weeks
183
Complications of hyperemesis
| 3
Encephalopathy
Renal failure
Hepatic failure
184
Management of cord prolapse
| 5
Tocolytics to reduce cord compression
Push presenting part of the foetus back into the uterus
Have patient go onto all fours
Do not push the cord back into the uterus
Immediate CS
185
Drug used as second line after oxytocin in major PPH
Carboprost
186
Normal variability on CTG
5-25bpm
187
Drug and class which reduced the size of the uterus pre surgery
Leuprolidel, GnRH analogue
188
HbA1c target when planning pregnancy
48
189
Risk factor for endometrial hyperplasia
Tamoxifen
190
Molar pregnancy - painful or painless?
Painless
191
What is the main contributor to amniotic fluid
Foetal passage of urine
192
Preferred treatment for early stage cervical cancer in postmenopausal women
Simple hysterectomy
193
AFP high or low in 1.NTDs, 2.T21
High in NTDs
| Low in T21
194
Period of Down Syndrome testing where nuchal translucency is available
11 to 13+6 weeks
195
Period of booking scan
8-12 weeks
196
The 3 features of Meig's syndrome
Benign ovarian tumour
Ascites
Pleural effusion
197
Period for early scan to confirm dates
10 to 13+6 weeks
198
First and second doses of Anti-D in Rhesus neg women
28 and 34 weeks
199
Things done at booking visit and time window, including bloods
(15+)
8-12 weeks, ideally before 10 weeks
General information - diet, alcohol, smoking, folic acid, vit D, antenatal classes
Basic checks - BP, urinalysis, BMI
```
Bloods -
FBC
Blood group
Rhesus status
Red cell alloantibodies
Haemoglobinopathies
Rubella
Syphilis
Hep B
```
Urine culture for asymptomatic bacteruria
200
Downs screening window including nuchal translucency
11 - 13+6 weeks
201
Second screen for anaemia and red cell alloantibodies
28 weeks
202
Score for risk of baby blues
Edinburgh depression scale
203
First line and second line ovulation inducing dugs used in PCOS
Clomifine
| Metformin
204
Two strongest associations with increased nuchal translucency
Down's
| Congential heart defects
205
Most common cause of recurrent first trimester miscarriage
Antiphospholipid syndrome
206
Classical triad of vasa previa
Rupture of membranes
207
Greatest risk factor for hyperemesis
Twin pregnancy
208
What should be given in women at moderate risk of pre-eclampsia and from when
Low dose aspirin from 12 weeks
209
Definition of premature ovarian failure
Onset of menopausal symptoms and elevated gonadotrophin levels before 40yrs
210
Commonest stage of presentation in endometrial cancer
1
211
Test for Feoto-maternal haemorrhage to determine Anti-D dose
Kleihauer test
212
Initial management of late decelerations
Foetal blood sampling for hypoxia and acidosis
213
What makes up the combined test for down's
Nuchal translucency
bHCG
PAPP-A (pregnancy-associated plasma protein A)
214
Most common benign tumour in women under 25
Dermoid cyst (teratoma)
215
Most common cause of ovarian enlargement in women of a reproductive age
Follicular cyst
216
Most common cause of minimal baseline variability of less than 40 mins duration
Foetal sleeping
217
Uterine tenderness, rupture of the membranes with a foul odour of the amniotic fluid and maternal signs of infection - likely diagnosis
Chorioamnionitis
218
Copper IUD mechanism of action
Toxic to the ovum and the sperm
219
Levonorgesterel emergency contraception mechanism of action
Inhibits ovulation
220
Absolute contraindications to COCP use
| 8
```
Breast cancer
Migraine with aura
Personal history of DVT/PE
Personal history of stroke or IHD
Breastfeeding and postpartum <6 weeks
Over 35 and smoking more than 15 cigarettes per day
Uncontrolled HTN
Recent major surgery and immobilisation
```
221
Age under which a child is always consider incapable of giving consent, regardless of Gillick competence
13
222
Window after giving birth where contraception is not required
21 days
223
Single dose of levonorgesterel
1.5mg
224
Contraindication to all hormonal forms of contraceptive
Breast cancer
225
POP time until effective
2 days
226
COCP, injection, implant, IUS time until effective
7 days
227
IUD time until effective
Immediately
228
Length of normal cycle
28 days
229
2 cancers COCP increases risk of and two it decreases risk of
Increased: breast and cervical
Decreased: ovarian and endometrial
230
Classic blood result triad of DIC
Thrombocytopaenia
Elevtaed PT
Elevated aPTT
231
Time when amniotic fluid embolism most commonly occurs
Following a contraction
232
Most important aspect of management in amniotic fluid embolism
Adequate oxygenation
233
First line drugs in ovarian cancer
Platinum based drugs e.g. carboplatin
234
Gestation when fundus reaches umbilicus
20 weeks
235
Test for women with a risk factor for DM
OGTT 24-28 weeks
236
Drugs used to incur multiple ovulations in IVF patient
| 3
Clomiphene citrate
FSH
Human menopausal gonadotrophin
237
Most accurate blood test and the result in confirming menopause
FSH - elevated
238
Earliest point at which CVS is available
11 weeks
239
Earliest point at which amniocentesis is available
15 weeks
240
Karyotype of Turner's syndrome
45X/45X0
241
Where is GnRH prouced
Hypothalamus
242
What does GnRH stimulate the release of
LH
| FSH, both from the pituitary
243
Pregnancy which progresses beyond this point is considered term
37 weeks
244
Percentage of molar pregnancies which become invasive
15%
245
Best mode of delivery for HRT in women with a history or risk factors for VTE
Transdermal combined patches
246
Breast cancer risk factors
```
Age
Geography
Prev. breast disease incl. benign
Radiation
Obesity
Alcohol
COCP
HRT
```
247
Two main types of breast cancer
Carcinoma in situ
| Invasive carcinoma
248
Commonest cause of blood stained nipple discharge in a younger woman
Intraductal papilloma
