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Year 3 Revision > Repro Management Pathways (God help us all) > Flashcards

Repro Management Pathways (God help us all) Flashcards

(97 cards)

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1
Q

Medical management of DUB

A 
Progestrogen (synthetic progesterone)
COPC
NSAIDs
Anti-fibrinolytics e.g. tranexamic acid
Mirena coil
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2
Q

Surgical management of DUB

A

Endometrial resection/ablation

Hysterectomy

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3
Q

What HRT is required after an endometrial ablation and hysterectomy?

A

Endometrial ablation - combined HRT

Hysterectomy - oestrogen only HRT

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4
Q

Indications of intra-uterine insemination

A

Sexual problems
Same sex relationships
Discordant blood borne viruses
Abandoned IVF

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5
Q

Indications for IVF

A 
Unexplained (>2 years duration)
Pelvic disease (endometriosis, tubal disease, fibroids)
Anovulatory infertility (after failed ovulation induction)
Failed intra-uterine insemination (after 6 cycles)
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6
Q

What are the 5 steps in IVF?

A
  1. Down regulation (give GnRH agonist [buserelin] to suppress spontaneous ovulation)
  2. Ovarian stimulation (SC FSH with maybe LH)
  3. Oocyte collection
  4. Fertilisation
  5. Embryo transfer (usually 1)

Would also give progesterone suppositories for 2 weeks then do pregnancy test after 16 days

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7
Q

Management of male infertility

A

Lifestyle advice (common sense)
Treat any specific cause
Intracytoplasmic sperm injection (may require surgical sperm aspiration)
Donor insemination

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8
Q

Medical abortion procedure <10 weeks gestation

A

Mifepristone 200mg PO (progesterone antagonist)
Misoprostol 800mcg PV/SL (24-48 hours later)

Can self-administer misoprostol at home (not if under 16)

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9
Q

Medical abortion procedure >10 week gestation

A

Mifepristone 200mg PO (progesterone antagonist)
Repeated doses of misoprostol 800mcg PV/SL (24-48 hours later, up to 4 doses)

Inpatient procedure

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10
Q

When would MTOP have to be performed in England?

A

20 weeks and over.

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11
Q

Surgical abortion procedure <14 weeks gestation

A

Cervical priming via misoprostol or osmotic dilators
Electric vacuum aspiration (general anaesthetic)
Manual vacuum aspiration (up to 10 weeks, local anaesthetic)

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12
Q

Surgical abortion procedure >14 weeks gestation

A

Cervical priming via misoprostol or osmotic dilators
Dilatation and evacuation
Needs to be done in specialist centre in England

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13
Q

When is antibiotic prophylaxis required for abortion?

A

All surgical termination of pregnancy

Medical termination of pregnancy with increased risk of STI

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14
Q

What is the antibiotic prophylaxis for abortion?

A

7 days 100mg doxycycline BD
OR
1g oral azithromycin and 500mg for 2 days after

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15
Q

What three things do you need to consider prophylaxis for after abortion?

A

Antibiotics
Rhesus iso-immunisation (anti-D to at risk Rhesus negative women)
VTE (high risk get LMWH for 1 week post abortion)

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16
Q

What is the guidance of women receiving hormonal contraception after abortion?

A

Immediately effective if started within 5 days after abortion
If after 5 days:
POP effective after 2 days
CHC/DMPA/SDI/IUS effective after 7 days

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17
Q

What 3 drugs can you use to treat hypertension in pregnancy?

A

Labetalol
Methyldopa (alpha blocker)
(Nifedipine unlicenced but can still use)

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18
Q

Drug management of N&V in pregnancy.

A

Cyclizine

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19
Q

Drug management of UTI in pregnancy.

A

Nitrofurantoin, cefalexin

Trimethoprim in 3rd trimester

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20
Q

Drug management of pain in pregnancy.

A

Paracetamol

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21
Q

Drug management of heartburn in pregnancy.

A

Antacids

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22
Q

Management of pregnant women with significant VTE risk/VTE.

A

LMWH at delivery and up to 7 days post-partum

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23
Q

Definition of highly active anti-retroviral therapy

A

A combination of 3 drugs from at least 2 drug classes to which the virus is susceptible

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24
Q

How long to give PEP to a neonate who’s mother has HIV?

A

4 weeks

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25
Drugs included in PrEP
Tenofovir | Disoproxil/emtricitabine
26
PrEP eligibility criteria
MSM condomless anal sex with 2+ partners in last year and likely in next 3 months Rectal bacterial STI in last year Partner of someone with HIV VL >50
27
What prophylactic treatment is given for women at high risk of pre-eclampsia, and what are the risk factors?
Apirin 75mg daily from 12 weeks until birth Risk factors: Hypertensive disease during previous pregnancy CKD Autoimmune disease Diabetes Chronic hypertension
28
Management of cervical shock.
Remove products from cervix IV fluid resuscitation Uterotonics may be required
29
Management of pregnancy in patient with anti-phospholipid syndrome or thrombophilia.
Low dose aspirin | Daily LMWH injections
30
Management of patient with ectopic pregnancy who is well and compliant with follow up visits
Watchful waiting
31
Management of ectopic pregnancy in woman who is stable, has low bhCG and the ectopic is small and unruptured
Medical management: | Methotrexate
32
Management of ectopic pregnancy in woman who is acutely unwell
Surgery (salpingotomy/salpingectomy)
33
Molar pregnancy management
Surgical and tissue for histology | Follow up with molar pregnancy services
34
Chlamydia management in pregnancy
Erythromycin Amoxicillin Test of cure at 3 weeks
35
When should you give anti-D to a rhesus negative pregnant lady?
Any surgery
36
First line medications for hyperemesis gravidarum
Cyclizine Prochlorperazine Both IV or IM
37
Second line medications for hyperemesis gravidarum
Ondansetron (serotonin inhibitor) Metoclopramide XONVEA UK
38
Supplementary medications for hyperemesis gravidarum
Thiamine/pabrinex Ranitidine and PPI (omeprazole) Oral prednisolone tapered
39
Management of large for dates delivery with no diabetes
Do not do induction of labour
40
Management of polyhydramnios
Counsel patient (increased risk in labour) Serial USS IOL by 40 weeks
41
Management of twin-to-twin transfusion syndrome (TTTS)
Before 26 weeks - fetoscopic laser ablation After 26 weeks - amnioreduction/septostomy Deliver between 34-36 weeks
42
When would you do a caesarian section in multiple pregnancy?
Triplets or more | Mono-chorionic mono-amniotic twins
43
What is the HbA1C target for type 1 and 2 diabetes pre-pregnancy?
48mmol/mol
44
At what HbA1c should pregnancy be avoided?
Above 86 mmol/mol
45
What drugs should you give if planning a pre-term pregnancy and why?
``` Steroids (foetal lung maturity) Magnesium sulphate (some protection against cerebral palsy) ```
46
Should you change asthma therapy in pregnancy?
No, the drugs are safe (can even take during labour)
47
Management of VTE risk in the perpuerium?
LMWH Switch to warfarin on 5th post-natal day 6 weeks-3 months therapy
48
Management of anti-phospholipid syndrome that has previously caused pregnancy complications
Low dose aspirin and LMWH
49
After what gestation should you offer induction of labour?
42 weeks
50
Management of foetal distress
``` Change maternal position IV fluids Stop syntocinon Scalp stimulation Consider tocolysis (terbutaline s/c) Maternal assessment Foetal blood sampling Operative delivery ```
51
What are the conditions that must be met to do an operative vaginal delivery?
Cervix must be fully dilated | Head below ischial spine
52
Indications for instrumental delivery
Delay (failure to progress stage 2) Foetal distress These are main ones but there are a few others
53
Management of anti-phospholipid syndrome that has previously caused pregnancy complications
Low dose aspirin and LMWH
54
Management of pre-eclampsia
Antenatal screening Treat hypertension Maternal and foetal surveillance Timing of delivery
55
Prophylactic management of women with risk factors for pre-eclampsia
150mg aspirin started before 16 weeks
56
When would you treat hypertension in pregnancy and what is the target?
If BP >150/100 regardless of aetiology | Aim for 140-150/90-100
57
Does treating hypertension in pregnancy decrease risk of pre-eclampsia?
No
58
First line drugs for hypertension in pregnancy?
Methyldopa Labetolol Nifedipine SR
59
Second line drugs for hypertension in pregnancy?
Hydralazine | Doxazosin
60
When should you deliver a baby in pre-eclampsia?
``` If at term Inability to control BP Rapidly deteriorating biochem/haematology Eclampsia Other crisis Foetal compromise (US/CTG) ```
61
Prophylactic/treatment of eclamptic seizures
Magnesium sulphate (loading dose then infusion) If further seizures administer 2g If persistent seizures consider diazepam IV
62
What medication should you give in labour with pre-eclampsia and what should you not give and why?
``` Give epidural (lowers blood pressure) Don't give ergometrine (increases blood pressure) ```
63
Management of peurperal psychosis
``` Emergency admission to specialised mother-baby unit Antidepressants Antipsychotics Mood stabilisers ECT ```
64
Management of mild-moderate post-natal depression.
Self help | Counselling
65
Management of moderate-severe post-natal depression.
Psychotherapy Anti-depressants Maybe admission
66
Lowest risk SSRIs in pregnancy
Sertraline | Fluoxetine
67
Lowest risk TCAs in pregnancy
Imipramine | Amitriptyline
68
Are atypical or typical antipsychotics safer in pregnancy?
Typical
69
Is lithium safe in breastfeeding?
No
70
Placental abruption management
Resuscitate mother Assess and deliver the baby Manage complications
71
Placenta praevia management
Admit for at least 24 hours until bleeding has ceased Anti-D if rhesus negative Steroids if not at term TED stockings Prevent and treat delivery Delivery plan at/near term Give magnesium sulphate if planning delivery early
72
When to do c-section or vaginal delivery in pregnancy?
C-section - if placenta covers os or <2cm from os | Vaginal - placenta >2cm from os and no malpresentation
73
Placenta accreta management
``` Prophylactic internal iliac artery balloon Caesarean hysterectomy Blood loss >3l expected OR Conservative management ```
74
Vasa praevia management
Steroids Consider inpatient management if risk of preterm birth Delivery by elective c-section 34-36 weeks If ante-partum haemorrhage do emergency c-section Send placenta for histology
75
What do you give in active management of the 3rd stage of labour?
Syntocinon/syntometrine IM/IV
76
What are the drugs you would use in post-partum haemorrhage and what do they do?
``` Syntocinon - oxytocin analogue Ergometrine Carboprost/haemabate Misoprostol (all contract uterus) Tranexamic acid (anti-fibrinolytic) ```
77
What are the non-medical parts of managing post-partum haemorrhage?
Uterine massage (bi-manual compression) Insert Foley catheter for tamponade Examination under anaesthesia if persistent bleeding
78
What can interventional radiology and surgery do to control post-partum haemorrhage?
``` Radiology - arterial embolisation Surgical: Undersuturing Brace sutures (B-lynch) Uterine artery ligation Internal iliac artery ligation Hysterectomy ```
79
Management of cord prolapse
Immediate delivery (caesarean or forceps) Tocolytics Maternal positions to relieve pressure
80
Management of amniotic fluid embolus
Supportive ITU
81
Shoulder dystocia management
``` Call for help Evaluate for episiotomy Legs to chest (McRoberts' manoeuvre) Suprapubic pressure Remove posterior arm Roll patient on to hands and knees ```
82
Breech presentation management
If not in labour can do external cephalic version (ECV) | Obstetric input
83
Prolapse management
Conservative (stop smoking, lose weight, stop straining, exercise/physio) Pessaries Surgery (depends on type of prolapse)
84
How long should women try lifestyle advice before referring to physio for prolapse?
3 months
85
What is the non-pharmacological management of menopause?
Lifestyle advice (diet, weight loss, exercise idk why this would help lol) Caffeine and alcohol intake reduction (reduces hot flushes) CBT Mindfulness
86
Management of menorrhagia in menopause.
``` Mefenamic acid (NSAID) Tranexamic acid Progesterones IUS Endometrial ablation Hysterectomy ```
87
What are the contra-indications for HRT?
``` Breast cancer Undiagnosed abnormal vaginal bleeding Endometrial cancer Pregnancy Active thrombo-embolic disorder Recent MI Active liver disease Porphyria cutanea tarda ```
88
If women aren't suitable for HRT, what can they be given to help with menopause symptoms?
Clonidine (for flushing) SSRIs Vaginal lubricants (regelle, yes, sylk)
89
Ovarian germ cell cancer management
Fertility sparing | Unilateral salpingoophrectomy with maybe chemo
90
Non-germ cell ovarian cancer management
Stage 1A - only surgery | The rest - chemo and surgery
91
What all needs to be removed in ovarian cancer surgery for staging?
Total abdominal hysterectomy Bilateral salpino-oophrectomy Infracolic omentectomy (retroperitoneal lymph node assessment)
92
Should you give neo-adjuvant chemo before operating on stage III-IV ovarian cancer?
Yes | Better progression free and overall survival
93
What can be used to medically manage fibroids?
GnRH analogues Mirena coil Progesterones
94
What are the 3 main chemotherapy drugs used in gynae malignancy?
Cisplatin Carboplatin (paclitaxel less important?)
95
At what stage does cervical cancer need chemoradiotherapy?
Ib2 and above
96
When would cervical cancer be treated with palliative intent?
If it has spread out of the pelvis
97
Radial scar management
Excise or sample extensively by vacuum biopsy

Year 3 Revision (70 decks)

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