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53 Cards in this Set
- Front
- Back
Fasting glucose target DM and pregnant |
5.6 |
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1h post meal glucose target DM and pregnant |
7.8 |
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2h post meal glucose target DM and pregnant |
6.4 |
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First line for hyperemesis gravidarum |
Antihistamines (promethazine) |
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Medical management of missed miscarriage |
Vaginal misoprostol + antiemetics + pain relief |
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If mum gets singles, does it affect the baby |
No |
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Do you treat varicella in pregnancy |
Yes. Give Aciclovir |
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If mum has HIV, what do you give her in labour and when? |
Zidovudine infusion started 4h before delivery |
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Quadruple test for downs (14-20 weeks) |
(high) Inhibin A (High) BHCG (Low) AFP (Low) Unconjugated oestriol (And woman's age) |
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Over what age can you keep in the IUD til you no longer need contraception |
>40 For the IUS, it's >45 and no periods on the IUS, then you can keep it in til you no longer need contraception |
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What must you strongly advise if you give the contraceptive patch |
Don't smoke The risk of stroke is high because 60% more oestrogen in the patch than the COCP! |
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What combined hormonal contraception can be used if you have IBD |
Vaginal ring Bypasses first pass metabolism |
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How long must female barrier methods be left in after sex |
6h at least |
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Difference between preimplantation genetic diagnosis and screening |
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Difference between ABx for mastitis in lactating and non-lactating women |
Non-lactating - co-amox Lactating - flucloxicillin |
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What injections could you give to a mother who has APH and is awaiting surgery |
corticosteroids if the baby if less than 34 weeks gestation Anti-D should be given to Rhesus- negative mothers |
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Define APH |
Bleeding PV after 24 weeks (but before the onset of labour). |
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Describe the USS timeframe for placenta praevia When should you admit and when should you do a C section (assuming no APH) |
Low lying placenta seen at routine 20 week scan Rescan at 32 weeks to see if it's still low If still low, scan fortnightly until 36 weeks At 37 weeks, if the placenta remains low, she should be admitted and elective C-section performed at 39 weeks. |
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What does placenta praevia with previous Caesarean put you at risk of |
Placental abruption (as the scar is low-lying) |
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When do you go the postpartum DM test if they had GDM |
6w It's a GTT that you do to test |
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When are the extra USS for GDM |
28w and every 4w from then |
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What is a normal weight increase when pregnant if healthy BMI What's most of that weight from? |
11-16kg Blood volume! |
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What does oestrogen do in pregnancy |
Simulates prolactin release Breast growth Protein synthesis |
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When does the placenta start to produce progesterone |
After 35 days of gestation |
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What does progesterone do in pregnancy |
Reduces smooth muscle excitability (vasculature, uterus, gut, ureters) Raises body temperature Counters prolactin |
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Why does the follicle with the most FSH receptors become dominant |
Because more FSH-Rs mean more aromatase and therefore more oestrogen made. |
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What does the rise in oestrogen do in the menstrual cycle |
Causes surge of LH and FSH which cause ovulation Optimises chances of FERTILISATION by making mucus more hospitable to sperm, spiral arteries emerge, thicken functional layer of endometrium |
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After the LH surge and ovulation, what does the corpus luteum do |
Theca cells produce progesterone due to low LH Granulosa cells produce inhibin due to low FSH (which decreases FSH which decreases oestrogen) |
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What does progesterone do in the menstrual cycle |
Makes uterus receptive to IMPLANTATION Negative feedback to decrease LH and FSH |
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Do you screen everyone for GDM with a GTT |
No, just people who had GDM before, had previous big baby, BMI >30 or 1st degree FH of DM (I think you pick up the others from the urine dip, and send them for GTT) |
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When do you give routine anti-D if Rh -ve pregnancies |
28 and 34w |
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Postnatally, what should you do for a Rh -ve mother |
Check blood Rh group of baby Do Kleihauer test on mum (especially important in stillbirth as cause may have been transplacental haemorrhage) Then give anti-D within 72h Check maternal blood every 48h to determine clearance of cells and need for continuing anti-D |
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When should anti-D be given in unsuccessful pregnancies and after procedures of Rh -ve women (within ? hours) |
Within 72 hours Any TOP Evacuation of hydatiform mole Miscarriage after 12w Threatened miscarriage after 12w Ectopic pregnancy if managed surgically APH Amniocentesis etc. External cephalic version |
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Why do we not do amniocentesis earlier |
Increased risk of talipes, resp problems and death |
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What does a nuchal thickness of 2.5mm Vs 3.5mm make you think of |
>2.5 downs >3.5 cardiac issues eg heart failure for whatever reason, or congenital malformations Nuchal thickness often looks thick in monochorionic twins but it's false positives The greater the extent of FNT, the greater the risk of abnormality. |
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What decreases PAP-A |
Smoking (also increases inhibin) Downs |
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What is high (hi) in down syndrome |
HCG Inhibin (hi) |
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If someone had GBS in previous pregnancy |
Either Offer IV ABx prophylaxis Or testing in pregnancy (35-37w) then ABx if positive |
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Regardless of GBS status, maternal IV ABx prophylaxis (BenPen) should be offered to... |
Women in preterm labor Pyrexial during labor GBS+ve in previous pregnancy Previous baby with GBS |
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If swab isolated GBS in PPROM, what ABx would you give |
Penicillin and clindamycin |
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How short is a short cervix Treatment? |
<25mm at <24 weeks Progesterone Cerclage (can also put in if history-indicated by 3 or more preterm births/late miscarriages) |
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What's the usefulness of foetal fibronectin |
Check for in PPROM. If negative, rules out labour (But if positive, doesn't rule in labour) |
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When is the time limit for putting in a cerclage |
24w Or you risk ROM |
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When would you NOT give PROPHYLACTIC ABx in preterm LABOUR |
When the membranes haven't ruptured There's an increased risk of cerebral palsy! But if something needs TREATING then give ABx, despite intact membranes |
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What are the indications for tocolytics? Name some |
To delay delivery in preterm labour so that you can give steroids or transfer woman to neonatal unit If there's cord prolapse Nifedipine Atosiban (MgS) |
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If, after 24-48h observations, a woman with PPROM isn't in labour and doesn't have a temperature, what should you do |
Send them home and they much take their temperature every 4h They have bi-weekly FBC & CRP measurements Aim to deliver at 34 weeks (They must finish their 10 day course of erythromycin) |
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The OCP is protective for which cancers? |
Endometrial Ovarian |
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What is normal endometrial thickness |
<4mm |
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When would you send for a scan rather than a 2ww for suspected endometrial ca |
If >55 With unusual discharge +Haematuria Or +thrombocytosis! Or with haematuria +Low Hb Or +thrombocytosis Or +high bgl |
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Difference between treatment of endometrial hyperplasia with atypoa, and stage I endometrial cancer |
Hysterectomy for EHWA With bilateral salpingo-oophorectomy for stage I cancer (and radio if Ib or worse) |
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Postnatally, what should you do for the baby of an Rh -ve mother |
Take cord blood for: FBC grouping Direct coombs test (will tell you if there are Abs on baby's rbc's) |
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High risk of pre-eclampsia (CHAD) |
CKD HTN during previous pregnancies AI diseases (SLE, antiphospholipid) DM |
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What are absolute CIs for tocolytics |
Chorioamnionitis Foetal death or lethal abnormality Condition needing immediate delivery, of course |