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When should anti-D be given in Rh - mothers?
- 28 and 32 weeks.
- In ectopic pregnancy.
- When high risk of transplacental haemorrahge e.g. CVS, external cephalic version, amniocentesis, foetal blood sampling, abdo trauma.
- all surgical and medical terminations unless already known to have anti-D.
- threatened miscarriage after 12 weeks but not before.
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When is amniocentesis carried out and what is the loss rate?
- 10-13 weeks 5%
- 16% 0.5% (standard time)
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When is CVS conducted?
after 10 weeks (ealier than amniocentesis). loss rate is 4%, can be used to 20 weeks were cordocentesis is then used.
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What is post partum thyroiditis?
- 5%.
- occurs around 4 months post partum. thyroid destruction releases thyroxine with a transient hyperthyroid stage (manage with beta blockers as antithyroid drugs wont work) followed by hypothyroidism. This should be monitored for 6 months. Mx can be given. 90% have antiperoxidase antibodies.
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first line for malaria in pregnancy?
quinine. safe first trimester. beware of hypoglycaemia. AVOID DOXYCYCLINE.
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Why should asymptomatic bacteriuria be treated in pregnancy?
dilatation of calyces and ureteres means 25% will go on to develop pyelonephritis. If present after 2 MSUs treat with amoxicillin or cefalexin. 2nd line nitrofurantoin.
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How is RA managed in pregnancy?
- often remits.
- methotrexate contraindicated.
- sulfasalazine can be used with extra folate.
- azathioprine may cause IUGR
- NSAIDS can be used first and second trimester only.
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SLE management in pregnancy?
- azathioprine and hydroxychloroquine.
- Aspirin 75mg prior to conception and continued throughout pregnancy.
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How is antiphospholipid syndrome managed in pregnancy?
- 75mg aspirin daily
- enoxaparin 40mg sc OD from foetal heart identification at 6 weeks to 36 weeks or throughout if previous history of VTE.
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How does uterine torsion present?
uterus rotates 30 degrees to right in 80% of normal pregnancies. if this is >90 degrees in mid-late pregnancy there is abdo pain, shock, tense uterus, urinary retention (twisted urethra). fibroids, adnexal masses or congenital abnromalty is often present. Dx at laparotomy. deliver.
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Describe the medical and surgical management of uterine fibroids
fibroids are leimyomas. ostreogen dependant so worse in pregnancy and on pill. atrophy after menopause. cause menorrhagia, infertility, pain and mass (can be felt abdominally or press on bladder).
- MEDICAL: mirena
- hysterectomy
- LHRH analogues to cause a reversible menopausal state eg goserelin. raloxifene or tibolone (HRT) can be given for bone risk.
- surgical: myomectomy (surgical shelling out of fibroid) - treatment of choice in infertility.
- interventional radiology to emolize fibroids (can resolve menorrhagia but not always availabe).
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What are normal findings on foetal CTG?
- 110-160BPM
- variability of >5 bpm.
- At least 2 accelarations over trace (30 mins) that are >15bpm. (common response to noise or other stimuli).
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When do you admit pre-eclampsia?
- BP rise >30/20 from booking BP.
- 160/100
- 140/90 + PROTEINURIA or if growth restriction.
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Management of severe pre-eclampsia?
- hydralazine IV
- or methyldopa or labetalol.
- magnesium sulphate prophylactically to prevent siezures or given for seizures.
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main pregnancy complication of fibroids
- red degeneration.
- thrombosis of vessels and haemorrhage into fibroid.
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When is the booking visit?
8-12 weeks
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When is Down's screening including nuchal scan?
11-13+6 weeks.
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What is mefenamic acid and what is it used for in gyny?
- NSAID.
- used to relieve dysmenorrhia and also in Mx of menorrhagia.
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How should delivery in HIV be managed?
- zidovudine infusion 4h before elective C section.
- All women on HAART from 28-32 weeks. \
- zidovudine for neonate for 6 weeks.
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Causes of hyperechogenic bowel of USS?
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Management of intrahepatic cholestatis of pregnancy?
JAUNDICE IN SECOND HALF OF PREGNANCY.
- vitamin K 10mg PO OD for mother and 1mg IM for baby at birth.
- ursodeoxylcholic acid for pruritis and abnormal LFTs.
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Management of chlamydia?
obligate intracellular organism.
- doxy or azithro.
- amox or erythro in pregnancy.
- contact partners from last 4 weeks for men and 6 months for women.
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Ix for trichomonas?
- motile flagellates on wet film.
- symptoms: wet fishy, bubbly thin discharge. exclude gonorrhoea as often co-exists.
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Ix for BV?
- pc: fishy discharge. often no pruritis, pain.
- 10% potassium hydroxide give positive whiff test (of ammonia).
- Stippled epithelial clue cells seen on wet microscopy with increased bacteria e.g. gardnerella and decreased lactobacillae. vaginal pH is increased >4.5.
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Describe the staging system (1-4) of cervical cancer.
- 1 - cervix
- 2 - local spread (upper 2/3rd of vagina)
- 3 - distant spread (lower 1/3rd of vagina and pelvic wall)
- 4 - outside pelvis.
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How does the CIN classification relate to histology seen on a smear?
- CIN I - mild dysplasia
- CIN II - moderate dysplasia
- CIN II - severe dysplasia (carcinoma in situ)
- These are all pre-malignant disease. Carcinoma in situ is pre-invasive.
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Causes of hypergonadotrophic hypogonadism?
ie. raised FSH, LH and low oestrogen.
- Turners syndrome
- ataxia telangiectasia
- myotonic dystrophy
- chemo causing ovarian cytotoxicity
- menopause or premature ovarian failure.
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