1
Q
→ triggers ovulation.
A
Rising oestradiol (from dominant follicle) leads to LH surge
2
Q
Temperature before ovulation
A
Slight drop in basal body temp just before ovulation.
3
Q
Secondary amenorrhoea: The
A
cessation of menstruation in a woman with previous menses for:
≥3 months (previously regular cycles)
≥6 months if history of oligomenorrhoea
3
Q
Causes of Primary Amenorrhoea
With normal secondary sexual characteristics:
A
Constitutional delay (family history)
Endocrine: Thyroid dysfunction, hyperprolactinaemia, Cushing’s
Androgen insensitivity syndrome
3
Q
Causes of Secondary Amenorrhoea
With hyperandrogenism:
A
PCOS
Cushing’s syndrome
4
Q
Causes of Primary Amenorrhoea
With absent secondary sexual characteristics:
A
Gonadal failure (Hypergonadotropic hypogonadism) ⭐Hypothalamic causes (Hypogonadotropic hypogonadism)Pituitary causesConstitutional delay of pubertyEnzyme defects / steroid synthesis defects
4
Q
Primary amenorrhoea: No menstruation by:
A
15 years with secondary sexual characteristics
13 years if no secondary sexual characteristics
5
Q
Pelvic USS pcos
A
> 12 follicles or >10cm³ ovarian volume suggests PCOS
5
Q
FSH/LH
A
FSH/LH – elevated in ovarian failure - Turner’s syndrome
FSH/LH – high in premature ovarian insufficiency, low in hypothalamic causes
6
Q
Associated Conditions turners
A
Hypothyroidism common - affects 1/3rd patients (Hashimoto’s)
Coarctation of the aorta, VSD
Horseshoe kidney
Infertility
7
Q
Management turners
A
Growth hormone, oestrogen replacement
8
Q
Raised LH:FSH ratio
A
Pcos
9
Q
Rotterdam Criteria (2 of 3)
A
Oligo/amenorrhoea
Hyperandrogenism (clinical or biochemical)
Polycystic ovaries on USS
10
Q
Management pcos
A
COCP for acne/hirsutism
Weight loss
Clomifene for fertility
Metformin may be used
11
Q
Amenorrhoea + low FSH/LH + recent stress/weight loss
A
Hypothalamic dysfunction
12
Q
Amenorrhoea + high FSH in woman <40 →
A
Premature ovarian failure
13
Q
Primary amenorrhoea + normal breast development + absent uterus →
A
Androgen insensitivity syndrome
14
Q
Investigations gdm
A
If no risk factors: OGTT at 24–28 weeks
If risk factors: OGTT at booking and 24–28 weeks
15
Q
Diagnostic Criteria gdm
A
Fasting glucose > 5.6 mmol/L
OGTT (2hr) > 7.8 mmol/L
💡Tip: GDM = 5, 6, 7, 8
16
Q
Management of GDM
A
If fasting BM < 7
Trial of diet and exercise for 2 weeks
If inadequate → start metformin
If inadequate on metformin → add insulin
If fasting BM > 7
(or if 6.1–6.9 + macrosomia/hydramnios)
Start insulin immediately
17
Q
Management of Pre-existing Diabetes in Pregnancy
A
Stop all oral hypoglycaemics
Continue metformin
Start insulin
Prescribe:
Folic acid 5mg OD until 12 weeks (NTD risk)
Aspirin 75mg OD from 12 weeks (pre-eclampsia risk)
Anomaly scan at 20 weeks with 4-chamber heart view
18
Q
Blood Glucose Targets in Pregnancy
A
Fasting: ≤ 5.3 mmol/L
1 hour post-meal: ≤ 7.8 mmol/L
2 hour post-meal: ≤ 6.4 mmol/L
19
Q
Dating scan:
A
11–14 weeks
20
Q
Anomaly scan
A
18–21 weeks
21
Combined Screening Test
10–13 weeks)
Nuchal translucency
Serum PAPP-A and β-hCG
Estimates risk of:
Trisomy
22
Further Testing if High Risk (>1:150)
Non-invasive prenatal testing (NIPT)
If NIPT = High chance → offer diagnostic testing:
CVS (<13 weeks)
Amniocentesis (>15 weeks)
23
Cvs amniocentesis
CVS (<13 weeks)
Amniocentesis (>15 weeks)
24
Booking Visit (Usually by 10 weeks)
Check BP + urine dip - recheck at each appointment
FBC, blood group, Rh status
Screen for:
GDM (if RFs)
Pre-eclampsia (start aspirin from 12 weeks if indicated)
25
28-Week Visit
Offer Anti-D to all Rh-negative women
Repeat Anti-D at 31–34 weeks if using 2-dose regimen
26
Antenatal Supplements
Folic acid:
400 micrograms daily for all women
5mg if high risk (e.g. diabetes, AEDs, obesity, Hx of NTD)
Vitamin D: 10 micrograms (400 IU) OD
Avoid Vitamin A supplements (risk of teratogenicity)
27
Placental Abruption types
Revealed: PV bleeding is visible.
Concealed: Cervical os closed → blood trapped in uterus → abdominal pain and shock.
28
Tender, woody uterus
Placental Abruption
29
Management Placental Abruption
Maternal resuscitation and transfusion
Foetal distress → emergency C-section
No foetal distress:
> 37 weeks → induce labour
< 37 weeks → admit, give corticosteroids
30
diagnostic test of choice
Placenta Praevia
Transvaginal ultrasound (TVUS
31
Management Placenta Praevia
If identified during routine scanning, TVUS follow-up is recommended at 32 and 36 weeks
Planned C-section at 36–37 weeks to reduce risk of severe bleeding
Corticosteroids for fetal lung maturation
32
Triad Vasa Praevia
Following rupture of membranes
Painless vaginal bleeding
Foetal bradycardia/distress
33
Vasa Praevia management
Planned C-section at 34–36 weeks
Corticosteroids for fetal lung development
34
ROM + painless bleeding + fetal distress →
vasa praevia
35
Placenta praevia diagnosed at 20-week scan → repeat TVUS at
32 and 36 weeks
Planned C-section at 36–37 weeks
36
gold standard for diagnosis and treatment.Asherman's Syndrome
Hysteroscopy
37
Woman with history of D&C and new-onset amenorrhoea or infertility → think
Asherman's Syndro
38
unilateral, medially protruding swelling at 4 or 8 o’clock position
Bartholin's Cyst
39
Surgical mx options Bartholin's Cyst
Incision and drainage: for painful or infected cysts
Word catheter: placed after drainage to allow continuous drainage and reduce recurrence risk
Marsupialisation: surgical creation of a new ductal opening, typically for recurrent cysts
40
soft, pitting oedema that crosses suture lines,
Caput succedaneum
41
Cephalohaematoma is due to
subperiosteal bleeding
Can cause complications like jaundice
42
Cephalohaematoma mx
Resolves over weeks to months
May lead to complications: jaundice (due to haemolysis), infection, or calcification
43
Most common cancer in women
Breast Cancer
invasive ductal carcinoma is most common overall
44
Screening: mammography
every 3 years for women aged 50–70
45
Referral (2WW criteria)
Breast lump in age >30
Unexplained axillary lump in age >30
Age >50 with unilateral nipple changes
Peau d’orange or other suspicious skin changes
<30 with lump – consider non-urgent referral
46
Assessment: Triple Assessment
Breast Cancer
History & examination
Imaging
<40: Ultrasound - due to denser breast tissue making mammography less sensitive
40: Mammogram (2 views)
Biopsy – core biopsy or FNA
47
ER+ premenopausal):
Tamoxifen (ER+ premenopausal): blocks oestrogen receptors
48
Tamoxifen adr
SEs: hot flushes, VTE risk, menstrual disturbance
49
Aromatase inhibitors (
postmenopausal – anastrozole, letrozole): block peripheral conversion to oestrogen
50
Trastuzumab (Herceptin)
monoclonal antibody for HER2+ BC
Cardiotoxic - echocardiogram before, during and after
51
NHS Breast Screening
Women aged 50–70
Mammography every 3 years
52
Painless breast lump in woman >30 →
2WW referral
53
Erythematous, scaly nipple →
Paget’s disease of the nipple
54
Family history of early BC or male BC →
refer to genetics
55
Types of Breech:
Frank breech – hips flexed, knees extended (most common)
Complete breech – hips and knees both flexed
Footling breech – one or both feet presenting first
56
Management breech <36 weeks gestation
No intervention needed – likely to spontaneously rotate to cephalic
57
Management breech≥36 weeks (nulliparous) or ≥37 weeks (multiparous)
Offer ECV to turn foetus manually
External cephalic version (ECV) attempts to turn the foetus to a cephalic (head-first) position by applying gentle pressure on the pregnant abdomen to manually rotate the foetus.
The success rate is approximately 60%.
Safer vaginal birth if successful
58
Failed ECV
Decision between:
Planned C-section (safer for baby)
Vaginal breech delivery (may be safer for mother)
59
Breech in
Rhesus-negative mothers
ECV is an indication for anti-D prophylaxis
Prevents rhesus sensitisation (maternal antibodies against foetal RBCs)
60
Complications breech
Foetal head entrapment
Umbilical cord prolapse
Birth trauma (e.g. brachial plexus injury)
Perinatal asphyxia
61
most common subtype breech
Frank breech, hips flexed, knees extended →
62
Rhesus-negative + ECV →
give anti-D
63
Failed ECV + breech + primiparous →
likely C-section
64
Method – Step 1: HPV Primary Screening
A cervical smear is taken and tested for high-risk HPV (hrHPV)
If hrHPV negative → return to routine recall
If hrHPV positive → sample undergoes cytology (cellular analysis)
64
Management based on cytology results:
hrHPV positive + cytology abnormal → refer to colposcopy
hrHPV positive + cytology negative → repeat hrHPV test at 12 months
65
Screening ProgrammeCervical Cancer
Women aged 25–64
Frequency
Ages 25–49: every 3 years
Ages 50–64: every 5 years
66
At 12-month repeat: hpv cytology
hrHPV negative → return to routine recall
hrHPV positive → repeat hrHPV test again at 24 months
At 24-month repeat:
hrHPV negative → return to routine recall
hrHPV positive → refer to colposcopy
Any abnormal cytology at 12 or 24 months → refer to colposcopy
66
Most cervical cancers are
squamous cell carcinomas caused by high-risk HPV (types 16 and 18)
67
Cervical smear and pregnancy
If delayed due to pregnancy, smear should be performed 12 weeks post-partum
67
Hpv Symptomatic women should be
referred to gynaecology, not for screening
68
Woman aged 30–45 with post-coital and intermenstrual bleeding
suspect cervical cancer
68
D-dimer is not useful in
Pregnancy
68
Venous Thromboembolism in Pregnancy
Pathophysiology
Increased clotting factors (VII, VIII, X, fibrinogen)
Decreased protein S
Venous stasis from IVC compression
69
Friable cervix on exam with contact bleeding
refer 2WW
70
Suspected DVT pregnancy
compression duplex ultrasound
71
Suspected PE:pregnancy
If DVT symptoms present
duplex US
If positive → treat as PE without CTPA (can avoid radiation risk)
If no DVT symptoms → CTPA or V/Q after discussion
72
CTPA: increased risk of
breast cancer risk (~10% increase)
73
V/Q: increased risk of
childhood cancer ri
74
Thyrotoxicosis
First trimester
2nd nd 3rd
propylthiouracil (due to teratogenicity of carbimazole)
Second and third trimester: switch to carbimazole (due to hepatotoxicity risk of PTU)
Aim: keep maternal thyroxine in upper third of normal
75
Hypothyroidism in Pregnancy
Monitor TSH every trimester and 6–8 weeks post-partum
Increase levothyroxine dose by ~50% during pregnancy
76
Obstetric Cholestasis (Intrahepatic Cholestasis of Pregnancy) time
Typically third trimester
77
Itching with elevated bile acids ≥19 µmol/L
Obstetric Cholestasis (Intrahepatic Cholestasis of Pregnancy)
78
Complications and Delivery Timing
Obstetric Cholestasis (Intrahepatic Cholestasis of Pregnancy)
Mild (19–39): background stillbirth risk → aim delivery by 40 weeks
Moderate (40–99): increased risk stillbirth after 38 weeks → delivery at 38–39 weeks
Severe (≥100): higher risk stillbirth→ consider delivery at 35–36 weeks
79
Symptom relief: Obstetric Cholestasis (Intrahepatic Cholestasis of Pregnancy)
Symptom relief: emollients, chlorphenamine
80
Acute Fatty Liver of Pregnancy (AFLP) time nd cause
Acute hepatic failure from fat accumulation in hepatocytes
Most common in third trimester
81
Acute Fatty Liver of Pregnancy (AFLP) management
Urgent delivery
82
Polymorphic Eruption of Pregnancy (PEP) aka
pruritic urticarial papules and plaques of pregnancy (PUPPP)
83
Starts in abdominal striae as pink papules → urticarial plaques
Pep or puppp
84
Pep or puppp management
Antihistamines
Topical corticosteroids (oral if severe)
Resolves after delivery
85
Pemphigoid Gestationis
Pathophysiology
An autoimmune, blistering rash of pregnancy
An IgG autoantibody (called PG factor) develops and targets BP-180 proteins within the basement membrane between the epidermis and dermis
86
Starts around umbilicus in second or third trimester
Pemphigoid Gestationis
87
Pemphigoid Gestationis management
Topical corticosteroids if mild
Systemic corticosteroids if severe
88
Hyperthyroid in pregnancy →
PTU in first trimester, switch to carbimazole later
89
Itchy palms/soles + raised bile acids in late pregnancy →
obstetric cholestasis
90
ALT > 500 + third trimester + acute hepatitis signs
→ acute fatty liver
91
Umbilical-centred itchy blistering rash →
think pemphigoid gestationis
92
Very itchy rash in striae, no blisters →
think polymorphic eruption
93
most effective forms of contraception as they are not user-dependent.
LARCs (not user-dependent):
Intrauterine: Levonorgestrel IUS (e.g. Mirena), Copper IUD
Progestogen-only implant (e.g. Nexplanon)
94
Levonorgestrel IUS (LNG-IUS) adr
Risk of expulsion: 1 in 20
Hormonal: acne, breast tenderness, mood changes
Cramping, irregular bleeding or amenorrhoea
95
Progestogen-only Implant adr
Unscheduled, irregular, sometimes heavy bleeding
Reduced efficacy with enzyme inducers
96
Lamotrigine nd chc
Not an inducer but interacts with CHC (lowers lamotrigine levels → seizure risk)
CHC contraindicated
POP may raise lamotrigine levels → increased SEs
97
Progestogen-Only Pill (POP)
Missed if >3 hrs late
Missed if >3 hrs late (12 hrs for desogestrel, 24 hrs for drospirenone)
Advice:
Take missed pill ASAP
Use barrier for 48 hrs
Emergency contraception if sex since missed dose or within 48 hrs of restarting
98
Combined Oral Contraceptive Pill (COCP)
Missed = >24 hrs late
1 missed pill: take it ASAP, no precautions needed
2+ missed:
Take one ASAP
Barrier precautions for 7 days
If missed from 1st 7 pills → emergency contraception
If from last 7 pills → skip pill-free week
99
Vomiting & Diarrhoea nd hormone contraceptive
Vomit within 3 hrs → take another
If D&V >24 hrs → follow missed pill rules
Use barrier method during illness + 7 days after
100
Investigations Dysmenorrhoea
Pelvic ultrasound to identify fibroids, adenomyosis, endometriosis.
High vaginal/endocervical swabs to exclude STIs.
Pregnancy test to exclude pregnancy-related causes.
101
Management of Primary Dysmenorrhoea
1st line: NSAIDs (ibuprofen, naproxen, mefenamic acid).
Alternative 1st line if not trying to conceive: Hormonal contraception (e.g. COCP) for 3–6 months if contraception is acceptable.
Add paracetamol if required, or use paracetamol alone if NSAIDs contraindicated.
If treatment is ineffective: Combine NSAID + hormonal contraception
102
gold standard for definitive diagnosis ( endometriosis
Laparoscopy
103
Management endometriosis
Refer for specialist assessment.
Pain management:
Trial of paracetamol and/or NSAID.
Hormonal therapy: COCP, POP, implant, Mirena IUS, or depot injections.
Surgery in secondary care if medical management fails.
104
Adenomyosis diagnostic investigations
MRI pelvis: enlarged uterus with thickened myometrium.
105
Investigations ectopic
Transvaginal ultrasound — first-line diagnostic investigation.
Serum beta-hCG — to guide management decisions.
106
Expectant Management criteria
Clinically stable
Pain free
Decreasing serum hCG, which were initially < 1500 IU/L
Able to attend for close follow-up
107
Medical Management criteria ectopic
No significant pain
Clinically stable (no haemodynamic compromise)
Unruptured ectopic pregnancy
Adnexal mass < 35mm
No visible fetal heartbeat
Serum hCG < 1500 IU/L
Able to attend follow-up
108
Medical Management ectopic
1st Line: Single-dose methotrexate
Important advice: Avoid pregnancy for 3 months after treatment due to teratogenicity.
109
Surgical Management
Indications: ectopic
Unable to return for follow-up
Significant pain
Adnexal mass > 35mm
Visible fetal heartbeat
Serum hCG > 5000 IU/L
Haemodynamic instability
110
Surgical Management
Ectopic
Salpingectomy (preferred if the contralateral tube is healthy)
Salpingotomy (consider if there is a risk to future fertility e.g., previous ectopic, PID, abdominal surgery)
111
All Rhesus-negative women undergoing surgical treatment must
receive anti-D immunoglobulin.
112
Pain + PV bleeding + positive pregnancy test
Shoulder tip pain
Ectopic
113
Stable, small ectopic (<35mm) + low hCG (<1500) →
consider methotrexate.
114
Significant pain, foetal heartbeat or hCG > 5000 →
laparoscopic surgical management.
115
Emergency Contraception most effective
copper IUD
Ulipristal acetate (UPA-EC) is more effective than levonorgestrel (LNG-EC) at delaying ovulation.
116
Copper Intrauterine Device (Cu-IUD) Timing
insert within 120 hours (5 days) of UPSI, or up to 5 days after the earliest likely ovulation
117
Contraindications to Copper Intrauterine Device (Cu-IUD)
unexplained vaginal bleeding, known/suspected pelvic infection, current STI, post-septic abortion, current pelvic inflammatory disease
118
Ulipristal Acetate (ellaOne®) – dose nd mechanism
30mg single dose
Progesterone receptor modulator delays or inhibits ovulation
More effective than LNG-EC between 0–120 hours after UPSI
Should be taken ASAP after UPSI, ideally within 120 hours
119
Ulipristal Acetate (ellaOne®) –not suitable if
Already ovulated (ineffective)
Concurrent use of liver enzyme inducers (PCBRASS drugs)
Severe uncontrolled asthma on oral glucocorticoids
Effectiveness could theoretically be reduced if a woman has taken progestogen prior to taking UPA-EC (e.g. missed pill).
120
Levonorgestrel dose nd mechanism
Progestogen that delays ovulation
Licensed for use within 72 hours of UPSI (some guidelines say up to 96 hours but effectiveness decreases with time)
1.5mg single dose
Double dose (3mg) is recommended if >70kg or >BMI 26kg/m2
If on enzyme inducers and declines Cu-IUD: Double dose (3mg) can be considered
121
Ovulation uncertainty
Choosing the EC Method
If mid-cycle UPSI (days 12–16 of a 28-day cycle), advise strongly towards Cu-IUD.
If early (days 1–10) or late cycle, oral EC is reasonable but explain reduced efficacy if ovulation has occurred.
122
Choosing the EC Method
Enzyme inducers
Avoid UPA-EC.
Offer Cu-IUD.
If Cu-IUD not possible: consider double-dose LNG (3mg), but advise on reduced efficacy.
123
If vomiting occurs within 3 hours of oral EC,
repeat the dose.
124
Post-menopausal bleeding is
endometrial cancer until proven otherwise.
unexplained PV bleeding >12 months after menstrual cessation.
125
Most common gynaecological malignancy;
Endometrial Cancer
oestrogen-dependent
126
Women ≥55 years with post-menopausal bleeding →
urgent 2WW referral.
127
Women <55 years with post-menopausal bleeding →
"consider"urgent 2WW referral.
128
Women ≥55 years → consider direct access pelvic ultrasound if:
Unexplained vaginal discharge plus:
first presentation
thrombocytosis
visible haematuria
Visible haematuria plus anaemia or thrombocytosis or hyperglycaemia.
129
Foetal Alcohol Syndrome triad
microcephaly, growth retardation, characteristic facial abnormalities.
130
Foetal Alcohol Syndrome Facial abnormalities:
Short palpebral fissures
Epicanthal folds
Low nasal bridge
Smooth/indistinct philtrum
Thin upper lip
Low-set or abnormally shaped ears
131
Ultrasound shows a classic "snowstorm” or "bunch of grapes" appearance.
Gestational Trophoblastic Disease
132
spectrum of GTD includes:
Complete mole
Partial mole
Choriocarcinoma
Placental site trophoblastic tumour
133
Symptoms of hyperthyroidism in gtd (due to
β-hCG cross-reactivity with TSH receptor)
134
Investigations gtd
Transvaginal ultrasound:
“Snowstorm” or “bunch of grapes” appearance
No identifiable foetus in complete mole
Serum β-hCG:
Markedly raised, much higher than expected for gestational age
Histology:
Hydropic villi, trophoblastic hyperplasia (diagnostic post-evacuation)
135
Management gtd
Uterine evacuation by suction curettage under general anaesthetic
Serial serum β-hCG monitoring until normal for 6 consecutive months
Contraception advised during follow-up (avoid pregnancy while β-hCG is monitored)
Chemotherapy (e.g. methotrexate) if:
β-hCG plateau or rise
Histology confirms invasive mole or choriocarcinoma
Placental site trophoblastic tumour often requires surgical resection
136
1st trimester bleeding + uterus large for dates + hyperemesis + very high β-hCG
Gtd
137
GBS screening
UK does not offer routine GBS screening; risk-based strategy is followed instead.
138
Streptococcus agalactiae)
Gbs
139
Detection gbs
Routine antenatal screening is not recommended in the UK.
GBS is often identified incidentally:
Urine culture during antenatal screening
High vaginal/rectal swab during investigations for other symptoms
Positive GBS culture during the current pregnancy warrants intrapartum prophylaxis.
140
Risk Factors for Neonatal GBS Disease
Previous baby affected by GBS
GBS bacteriuria or positive swab in current pregnancy
Maternal fever during labour (≥38°C)
Preterm labour (<37 weeks)
Prolonged rupture of membranes (>24 hours)
141
Management
🧪 Positive GBS culture or previous GBS-affected baby:
IV antibiotics during labour:
1st line: Benzylpenicillin
Begin as soon as labour starts or membranes rupture
Continue every 4 hours until delivery
142
GBS bacteriuria >10⁵ CFU/mL: management
Treat at time of diagnosis:
Oral amoxicillin for asymptomatic bacteriuria
PLUS: IV antibiotics in labour (as above)
143
GBS in urine →
treat now and give IV antibiotics during labour
144
Previous baby with GBS infection →
IV antibiotics in all future labours
145
Labour with prolonged rupture or maternal fever →
give IV antibiotics
146
Hydrops fetalis is defined as
abnormal accumulation of fluid in two or more foetal compartments, such as:
147
Immune Hydrops (Alloimmune Haemolysis)
Rh incompatibility
most commonly anti-D antibodies).
148
Non-Immune Hydrops (NIHF) Haematologic Causes
Alpha thalassaemia major (Hb Barts)
Clue: Southeast Asian descent, early losses.
Mechanism: No alpha chains → ineffective Hb → hypoxia, anaemia.
149
Cardiac Causes Non-Immune Hydrops (NIHF)
Structural congenital heart disease
Clue: Bradycardia/tachycardia or abnormal foetal echocardiogram.
150
Infectious Causes Non-Immune Hydrops (NIHF)
Parvovirus B19 Aplastic anaemia due to red cell aplasia.
TORCH infections:Toxoplasmosis, Other (syphilis), Rubella, CMV, Herpes
151
Flu-like illness, hepatosplenomegaly, intracranial calcifications.
TORCH?
152
Genetic/Chromosomal Causes Non-Immune Hydrops (NIHF)
Turner Syndrome (45,X) and Noonan Syndrome
Mechanism: Lymphatic dysplasia → fluid accumulation.
153
Elevated MCA peak systolic velocity (MCA-PSV)
Suggestive of foetal anaemia
154
Rh-ve mother, second pregnancy, no anti-D →
Think alloimmune haemolysis
155
Southeast Asian family history + recurrent early losses →
Suspect alpha-thalassaemia
156
MCA Doppler raised →
Suggests foetal anaemia
157
>5% pre-pregnancy weight loss
Hyperemesis Gravidarum
158
Hyperemesis Gravidarum complications
Can result in Wernicke’s encephalopathy if not treated appropriately
159
Hyperemesis Gravidarum
1st Line Antiemetics
oral antiemetics and reassess after 24–72 hours:
Cyclizine
Promethazine
Prochlorperazine
Chlorpromazine
Doxylamine/pyridoxine (Xonvea) – the only licensed treatment for nausea/vomiting in pregnancy (prescribe depending on local formulary)
160
2nd Line Options (if inadequate response), consider:
Hyperemesis Gravidarum
Switch to one of the following:
Metoclopramide – max 5 days (risk of extrapyramidal side effects)
Domperidone – max 7 days (risk of cardiac side effects)
Ondansetron – max 5 days; advise re. small increased risk of cleft lip/palate if used in 1st trimester
Combination Therapy
If monotherapy is ineffective:
161
3rd Line: Hyperemesis Gravidarum
Corticosteroids
Offer oral prednisolone 40–50 mg daily only if all antiemetic combinations fail
Taper to the lowest effective maintenance dose
Prescribe in addition to antiemetics
Monitor blood pressure and screen for diabetes mellitus during treatment
162
to prevent Wernicke’s encephalopathy in prolonged vomiting
Thiamine (e.g. Pabrinex):
163
Early pregnancy with severe vomiting, weight loss, and ketonuria →
Think hyperemesis
164
Hypertension in pregnancy is defined as
BP >140/90 mmHg, or a rise of 30 systolic / 15 diastolic.
165
recommended in women with high or moderate risk factors for pre-eclampsia.
Aspirin 75–150 mg daily from 12 weeks
166
first-line treatment for BP >160/110 mmHg. Pregnancy
Labetalol
167
definitive cure for pre-eclampsia
delivery
168
Pre-existing Hypertension
Diagnosed prior to pregnancy or before 20 weeks gestation
169
Pregnancy-Induced Hypertension (PIH)
Diagnosed after 20 weeks gestation without proteinuria
Usually resolves post-partum
170
Pre-eclampsia
Hypertension after 20 weeks + Proteinuria (>0.3g/24h or ≥1+ on dipstick)
May be associated with oedema or systemic features
171
Risk Factors for Pre-eclampsia
High Risk (any one = offer aspirin 75–150 mg from 12 weeks until delivery)
Hypertension in a previous pregnancy
Chronic hypertension
Chronic kidney disease
Type 1 or 2 diabetes
Autoimmune disease (SLE or antiphospholipid syndrome)
172
Moderate Risk (2 or more = offer aspirin as above)
First pregnancy
Age ≥ 40 years
Pregnancy interval ≥ 10 years
BMI ≥ 35 kg/m²
Family history of pre-eclampsia
Multiple pregnancy
173
Maternal complications Pre-eclampsia
Eclampsia (seizures)
Cerebral haemorrhage
HELLP syndrome
Heart failure
Multi-organ failure
174
Severe Pre-eclampsia if
BP > 170/110 mmHg
Significant proteinuria (++ or +++)
Headache
RUQ/epigastric pain
Visual disturbance
Hyperreflexia
Papilloedema
Blood markers
Platelets < 100 x10⁹/L
Elevated ALT/AST
175
Antihypertensive therapy
BP ≥ 160/110 mmHg:
1st Line: Oral labetalol
Alternatives: Nifedipine or hydralazine
176
Severe Pre-eclampsia mx
Start magnesium sulfate
177
Management eclampsia
Magnesium sulfate 4 g IV bolus, followed by 1 g/hour infusion
178
HELLP
Haemolysis
Elevated Liver enzymes
Low Platelets
179
overactive bladder (OAB) syndrome
urgency, frequency, and nocturia due to involuntary detrusor contractions.
180
Stress Incontinence management
Step 1: Supervised pelvic floor muscle training
Step 2:
Refer to urogynaecology for consideration of surgical management
Duloxetine may be offered if the woman prefers drug treatment instead of surgery
181
Urgency Incontinence management
Step 1: Bladder training (minimum 6 weeks)
Step 2: If symptoms persist, offer either:
Antimuscarinics: oxybutynin, tolterodine, darifenacin
Avoid oxybutynin in older women due to cognitive side effects
Mirabegron (beta-3 agonist): alternative if antimuscarinics contraindicated
182
Overflow Incontinence mx
urinary retention, often from bladder outflow obstruction or detrusor muscle underactivity,
Refer to specialist services
183
Bishop Score
Cervical dilation
Effacement (length)
Station
Consistency
Position
Score interpretation:
≤6 = Unfavourable cervix (requires prostaglandin)
>6 = Favourable cervix (proceed to ARM + oxytocin)
184
Methods of Induction
Membrane Sweep_initiate labour within 48 hours.
Dinoprostone (PGE2) Used if Bishop score ≤6
Amniotomy (ARM) + IV Oxytocin Used if Bishop score >6 (favourable cervix)
185
Complications induction
Uterine hyperstimulation
Foetal distress
Failed induction → emergency caesarean
Increased risk of instrumental delivery
186
Post-dates pregnancy:
Offer induction between 41+0 and 42+0 weeks
187
Bishop Score ≤6 →
prostaglandin (dinoprostone)
188
Bishop Score >6 →
amniotomy and oxytocin
189
salt and pepper" retina)
chorioretinitis
Congenital Rubella Syndrome
190
Congenital Rubella Syndrome
Sensorineural deafness (most common feature)
Ocular abnormalities: cataracts, chorioretinitis ("salt and pepper" retina)
Cardiac defects: patent ductus arteriosus (PDA)
CNS: microcephaly
Hepatosplenomegaly
Blueberry muffin rash (extramedullary haematopoiesis)
191
Blueberry muffin rash
extramedullary haematopoiesis)
Congenital rubella syndrome
192
Assessment and Management Congenital Rubella Syndrome
Notify health protection team immediately - Rubella is a notifiable disease
If woman is IgG negative: advise avoidance of exposure, and offer MMR vaccine postnatally
IgM positive confirms recent infection
Refer to obstetrics immediately if rubella is confirmed
193
Risk by gestational age:Congenital Rubella Syndrome
<10 weeks: 90% risk of CRS
11–20 weeks: risk of CRS declines with gestation
20 weeks: reassure, risk of congenital rubella is negligible
194
Prevention of Varicella in Exposed Pregnant Women
Step 1: Risk Assessment
History of prior varicella or vaccination - if certain - reassure
Step 2: Serology
If uncertain immunity or from tropical/subtropical countries (more likely to be seronegative): check VZV IgG levels
If IgG positive: patient is immune → reassure
If IgG negative: non-immune → proceed to post-exposure prophylaxis (below)
195
Post-Exposure Prophylaxis (Updated 2024)
Varicella Zoster Virus in Pregnancy
1st line: Oral antivirals (aciclovir or valaciclovir) to be given from day 7 to 14 post-exposure
If contraindicated: VZIG can be offered (effective up to 10 days post-exposure)
196
Management of Active Chickenpox During Pregnancy
Oral aciclovir if presenting up to 24 hours from rash onset and >20 weeks gestation
Also 'consider' aciclovir before 20 weeks after discussion w/ specialist
Severe disease: IV aciclovir is required
197
Referral and Follow-up Varicella Zoster Virus in Pregnancy
Foetal medicine referral at 16–20 weeks or 5 weeks post-infection - detailed US
Consider amniocentesis for varicella DNA PCR only after lesions have resolved
198
Congenital Toxoplasmosis causes
through contact with cat faeces or undercooked meat.
Advise to (1) avoid contact w/ cat faeces - someone else in household to clean litter box etc. (2) eat well-cooked meat and avoid raw/cured meats
199
Chorioretinitis
Hydrocephalus
Intracranial calcification
Congenital Toxoplasmosis
200
🦠 Congenital Cytomegalovirus (CMV)
Clinical Features
Intrauterine growth restriction
Microcephaly and neurodevelopmental delay
Sensorineural hearing loss
Visual loss
Seizures
201
Rubella before 10 weeks gestation:
90% risk of CRS
202
Blueberry muffin rash
think rubella
203
VZV IgG negative pregnant woman
offer oral antivirals (aciclovir) between day 7–14 after exposure
204
Toxoplasmosis triad
chorioretinitis, hydrocephalus, intracranial calcifications
205
Infertility mcc
The most common cause in women is ovulatory dysfunction; in men, sperm abnormalities.
206
Ovulatory disorders
Hypogonadotropic hypogonadism:
Stress, excessive exercise, eating disorders (hypothalamic amenorrhoea)
Kallmann syndrome (anosmia is a common exam clue)
PCOS
Hyperprolactinaemia (e.g. prolactinoma, drug-induced)
Ovarian failure (suggested by raised FSH/LH, low oestradiol)
Other: thyroid dysfunction, Cushing’s syndrome, CAH, chronic illness
207
Drugs causing male infertility
sulfasalazine, anabolic steroids)
208
When to start investigations for fertility
After 12 months of regular UPSI (2–3 times/week)
Earlier if:
Female age > 36 - begin after 6 months
Oligo-/amenorrhoea
Known history of PID, endometriosis, or male factor risk
209
Female investigations infertility
Mid-luteal phase progesterone (confirms ovulation)
7-days before the expected period:
Gonadotrophins (FSH/LH) on day 2–4:
Low: hypothalamic cause
High: ovarian failure
Prolactin and TFTs
STI screen
Tubal patency test____hysterosalpingogram /If there is a history - diagnostic laparoscopy and dye -
210
Management Options infertility
Medical: clomifene, gonadotrophins
Surgical: management of tubal disease, endometriosis
Assisted conception: IUI, IVF, ICSI
211
IVF patient + bloating, ascites, oliguria
Ohss
Ascitis/pleural effusion/hydrothorax/vte
212
key test to confirm ovulation and should be performed in all women for infertility
Mid-luteal progesterone
213
Anosmia + amenorrhoea → think
Kallmann syndrome
214
increased LH:FSH ratio and oligomenorrhoea, acne
Pcos
215
Pregnant woman with UTI →
send MCS and give 7-day course
Nitrofurantoin 100mg BD 1st line
Always repeat culture after treatment
216
Nitrofurantoin 100 mg BD for 7 days
Avoid at .....why
Term risk of neonatal haemolysis)
Egfr <45
217
2nd line options: preg uti
Amoxicillin 500 mg TDS for 7 days
Cefalexin 500 mg BD for 7 days
218
contraindicated in pregnancy
Trimethoprim
219
Meigs Syndrome triad
benign ovarian fibroma, ascites, and pleural effusion.
220
Management Meigs Syndrome
Surgical resection of the ovarian fibroma
Resolution of ascites and pleural effusion typically occurs post-operatively
221
Premature vs menopause =
under 40 years
Early = 40–45 years.
222
No uterus? Hrt?
Oestrogen only
223
Hrt Uterus intact. LMP < 1 year ago
Sequential combined HRT
224
Hrt Uterus intact. LMP > 1 year ago -
Continuous combined HRT
225
1st line for isolated genitourinary syndrome of menopause (GSM).
Vaginal oestrogen i
226
Genitourinary Syndrome of Menopause:
Vaginal dryness, soreness, itching
Dyspareunia
Post-coital bleeding
On exam: pale, dry vaginal walls with contact bleeding
227
Diagnosis Menopause
Clinical diagnosis if classic symptoms in a woman > 45
FSH measurement is not essential in typical cases, but can aid diagnosis in specific situations:
228
Fsh menopause
Age > 45 with atypical symptoms
Age 40–45 if early menopause suspected
Age < 40 with suspected premature ovarian insufficiency
FSH > 30 IU/L on 2 occasions, 6 weeks apart → ovarian insufficiency
229
Women may remain fertile up to 2 years following their LMP, so contraception counselling is essential:
Women < 50: use contraception for 2 years after LMP
Women > 50: continue for 1 year after LMP
Options:
POP can be used alongside cyclical HRT
COCP can be used in < 50s as alternative to HRT, but switch to POP after 50
230
Duration of hrt
Continue as long as needed for symptom relief
Most commonly it's taken for 2 to 5 years
Premature menopause: continue until at least age 51 (reduce risk of osteoporosis etc.)
231
NOT associated with increased VTE risk
Transdermal oestrogen is preferred - unlike oral, it is NOT associated with increased VTE risk
232
Contraindications to HRT
History of breast ca
History of endometrial cancer or untreated endometrial hyperplasia
Undiagnosed PV bleeding or breast lump
History of VTE or thrombophilia
Arterial thromboemolic disease: Ischaemic heart disease, stroke, or angina
Active liver disease
Pregnancy
233
Side Effects hrt
Oestrogen: breast tenderness, bloating, fluid retention
Progestogen: mood changes, acne, breast pain
Irregular bleeding, especially with continuous combined HRT in first 4–6 months
234
Non-Hormonal Alternatives
Vasomotor symptoms
SSRI/SNRI: fluoxetine, paroxetine, venlafaxine
Clonidine
Gabapentin
CBT
235
Management of Genitourinary Syndrome of Menopause
1st Line: Low-dose vaginal oestrogen
2nd Line: Oral ospemifene (SERM)
Vaginal moisturisers and lubricants can be used alone or with vaginal oestrogen
236
Refer to gynaecology if fibroids are
> 3 cm or there are pressure symptoms
237
Management
No identified pathology / fibroids < 3 cm / adenomyosis
1st line: LNG-IUS
2nd line:
Non-hormonal: Tranexamic acid or NSAIDs
Hormonal: COCP or cyclical progestogen
238
Fibroids > 3 cm
Refer to gynaecology
Options include myomectomy, uterine artery embolisation
239
Red degeneration of Fibroids commonly occurs during
second or third trimester of pregnancy
240
Bulky tender uterus with heavy bleeding
adenomyosis
241
Pressure symptoms and irregular uterus
fibroids
242
Miscarriage is the spontaneous loss of pregnancy before
24 weeks.
243
Missed miscarriage
foetus not viable, no symptoms
244
Threatened miscarriage –
PV bleeding, closed cervix, viable pregnancy
245
Inevitable miscarriage
open os with bleeding, pregnancy non-viable
246
Incomplete miscarriage
retained products of conception (POC)
247
Complete miscarriage
all POC expelled
248
Investigations miscarriage
Transvaginal ultrasound is 1st line
May show no heartbeat or no foetal pole
Consider beta-hCG and FBC if heavy bleeding
249
Management Overview miscarriage
If unstable or high bleeding – admit or refer EPAU urgently
If < 6 weeks with mild bleeding and no pain – consider expectant management with urine pregnancy test in 7–10 days - return if positive or bleeding continues/pain develops --> EPAU
250
Threatened Miscarriage. Management
If foetal heartbeat seen with closed cervix, and the woman has vaginal bleeding and has previously had a miscarriage
Vaginal progesterone 400 mg BD until 16 weeks
251
Missed or Incomplete Miscarriage management 1st-line
Expectant Management (1st line)
Suitable if low risk and no infection, haemorrhage or adverse history
Repeat urine pregnancy test at 3 weeks
Refer if ongoing symptoms or positive test
252
Medical Management Missed or Incomplete Miscarriage
Indicated if symptoms persist > 14 days or high-risk features
Missed miscarriage:
200mg oral mifepristone → 800mcg misoprostol 48h later (oral, vaginal or sublingual)
Incomplete miscarriage:
Single 600–800mcg misoprostol (oral, vaginal or sublingual)
Advise pregnancy test after 3 weeks
253
Painless PV bleeding + foetal heartbeat →
threatened miscarriage
Vaginal progesterone 400 mg BD until 16 weeks
254
Open cervix + bleeding →
inevitable miscarriage
255
Rh-negative woman undergoing surgical management →
give anti-D
256
90% of ovarian cancers are
epithelial in origin, most commonly serous carcinomas.
257
1st line investigation Ovarian Cancer
CA125
If CA125 > 35 - urgent transvaginal pelvic ultrasound
258
Initial assessment ovarian ca
If ascites or pelvic/abdominal mass is found
refer via 2-week wait (suspected cancer pathway).
259
1st line investigation ovarian torsion
1st line investigation:TVUS
260
whirlpool sign"
TVUS
May show the "whirlpool sign" (twisted pedicle).
Ovarian torsion
261
First-line test: Investigations pid
Pregnancy test – to exclude ectopic pregnancy
Endocervical swabs – for CT, NG, MG
262
Outpatient Regimens (BASHH) PID
IM ceftriaxone 1g stat + PO doxycycline 100mg BD + PO metronidazole 400mg BD for 14 days
Alternatives:
PO ofloxacin + metronidazole for 14 days
PO moxifloxacin for 14 days (esp. if M. genitalium)
263
M. genitalium)
PO moxifloxacin for 14 days (esp. if M. genitalium)
264
Inpatient Regimens pid
IV ceftriaxone + IV doxycycline (followed by PO doxycycline + metronidazole)
OR IV clindamycin + IV gentamicin (followed by PO clindamycin + metronidazole)
265
Postpartum Haemorrhage defined as
blood loss > 500 mL after vaginal delivery or > 1000 mL after caesarean section.
266
secondary PPH occurs between
24 hours and 12 weeks postpartum.
267
four Ts:
Tone, Trauma, Tissue, Thrombin.
268
Management Postpartum Haemorrhage
Mechanical: bimanual uterine massage.
Medical:
IV oxytocin
IV ergometrine (avoid in hypertension)
IM carboprost (avoid in asthma)
Sublingual misoprostol
Tranexamic acid (if < 3 hours since bleeding started)
Surgical:
Intrauterine balloon tamponade
Uterine artery embolisation or ligation
Hysterectomy if bleeding uncontrolled
269
IV ergometrine (avoid in
Htn
270
IM carboprost (avoid in
Asthma
271
Placenta Accreta
Implantation of the placenta beyond the endometrium, and into the myometrium
272
Placenta Accreta management
Planned caesarean section
Uterus-preserving surgery or hysterectomy
273
Investigations Secondary PPH
Pelvic ultrasound to assess for retained products
High vaginal/cervical swabs
FBC and CRP if infection suspected
274
Sudden heavy bleeding after delivery → think
uterine atony.
275
Boggy uterus on palpation → manage
massage + IV oxytocin.
276
Delayed bleeding + offensive lochia + fever
suspect endometritis.
277
PPROM is rupture of membranes before
37 weeks gestation and prior to onset of labour.
278
PPROM management
💊 Management
Antibiotics
Erythromycin 250 mg QDS for 10 days or until labour (whichever is sooner)
Avoid co-amoxiclav due to risk of necrotising enterocolitis in neonate
Corticosteroids
Indicated if gestational age is 24+0 to 33+6 weeks
Either:
Betamethasone 12 mg IM, two doses 24 hours apart
OR Dexamethasone 6 mg IM, four doses 12 hours apart
Expectant Management
For most women between 24+0 and 33+6 weeks gestation
Monitor for signs of chorioamnionitis and foetal distress
Delivery
Consider delivery at 34+0 to 36+6 weeks depending on risks and condition
Immediate delivery if:
Evidence of chorioamnionitis
Foetal compromise
Labour starts spontaneously
279
Avoid co-amoxiclav in PPROM due to
risk of necrotising enterocolitis in neonate
280
Complications PPROM
Chorioamnionitis
Neonatal sepsis
Cord prolapse
Preterm labour and delivery
Pulmonary hypoplasia (especially with very early PPROM)
281
No uterine contractions, but leaking fluid + high temp + uterine tenderness →
chorioamnionitis
282
Round Ligament Pain common in
second trimester, especially between 12–22 weeks.
283
The round ligaments connect
uterine horns to the labia majora via the inguinal canal.
284
Management Round Ligament Pain
Reassurance
Rest and postural adjustments
Avoid sudden movements
Maternity support belts
Simple analgesia (e.g. paracetamol)
285
Round Ligament Pain dd
Pubic Symphysis Dysfunction
286
Pregnant woman, 2nd trimester, sudden groin pain triggered by movement →
Round Ligament Pain
287
Waddling gait + pubic tenderness Aggravated by walking or hip abduction
Pubic Symphysis Dysfunction
288
Sheehan Syndrome caused by
pituitary infarction secondary to severe postpartum haemorrhage.
Leads to hypopituitarism,
289
Investigations Sheehan Syndrome
Clinical history of severe postpartum haemorrhage or hypotension.
Hormonal profile:
Low cortisol, TSH, free T4, LH, FSH, oestradiol, and prolactin
MRI pituitary may show an empty sella or pituitary atrophy.
290
Sheehan Syndrome mx
Lifelong hormone replacement tailored to deficiencies:
Hydrocortisone or prednisolone for adrenal insufficiency
Levothyroxine for secondary hypothyroidism
Oestrogen and progesterone if premenopausal
Growth hormone replacement in selected cases
Educate patients on adrenal crisis and the need for steroid cover during illness or surgery.
Regular endocrine follow-up to adjust therapy.
291
Woman with history of PPH, failure to lactate, fatigue, amenorrhoea → suspect
Sheehan Syndrome
292
Secondary hypothyroidism and adrenal insufficiency
suggest pituitary cause.
293
turtle sign.
retraction of foetal head against the perineum after delivery.
294
Shoulder dystocia management
Call for immediate help and initiate manoeuvres:
1st line: McRoberts manoeuvre: hyperflex maternal hips onto the abdomen to rotate the symphysis and flatten the sacrum.
RCOG: “McRobert’s is a simple, rapid and effective intervention and should be performed first”
Suprapubic pressure: apply continuous or rocking pressure just above the pubic bone.
Rubin manoeuvre: apply pressure on the posterior aspect of the anterior shoulder to rotate it.
Wood’s screw manoeuvre: rotate posterior shoulder using internal pressure to release anterior shoulder.
Delivery of posterior arm: gently bring out posterior arm to reduce bisacromial diameter.
Gaskin manoeuvre: move mother to all fours position.
Consider episiotomy if internal manoeuvres are difficult.
295
McRoberts manoeuvre:
hyperflex maternal hips onto the abdomen to rotate the symphysis and flatten the sacrum.
296
Rubin manoeuvre
apply pressure on the posterior aspect of the anterior shoulder to rotate it.
297
Wood’s screw manoeuvre
rotate posterior shoulder using internal pressure to release anterior shoulder.
298
Gaskin manoeuvre
move mother to all fours position.
299
Fetal Complications Shoulder dystocia
Brachial plexus injury (Erb's palsy)
Fractures (clavicle or humerus)
Hypoxic-ischaemic injury or neonatal death
300
Maternal complications Shoulder dystocia
Postpartum haemorrhage
Perineal tears (including third/fourth degree)
Uterine rupture (rare)
301
Turtle sign after head delivery →
shoulder dystocia.
First step is always McRoberts + suprapubic pressure.
302
Thyroid fluctuations in Pregnancy
Pregnancy increases thyroid binding globulin (TBG), leading to raised total T4, but free T4 remains unchanged.
hCG can weakly stimulate TSH receptors, leading to transient reduction in TSH in early pregnancy.
303
Monitoring Thyroid in Pregnancy
Check TSH levels:
Once per trimester
8 weeks postpartum
Target: TSH should remain within trimester-specific reference ranges.
304
Levothyroxine Use
in pregnancy and breastfeeding
Safe in pregnancy and breastfeeding.
Pregnancy increases thyroxine requirements — usually due to higher TBG and metabolic demands.
As soon as pregnancy is confirmed in a woman with stable hypothyroidism:
Increase levothyroxine by 25–50 mcg daily (e.g. 125 mcg → 175 mcg).
This should be done immediately, without waiting for TFT results.
305
Most common cause of respiratory distress in the newborn.
Ttn
Caused by delayed clearance of foetal lung fluid.
Onset within the first few hours of life.
Tachypnoea > 60 breaths/min
306
307
Risk Factors ttn
Caesarean section (especially elective)
Prematurity (especially 34–37 weeks)
Precipitous (very rapid) labour
308
Investigations ttn
Chest X-ray may show:
Hyperinflated lungs
Prominent pulmonary vasculature
Fluid in interlobar fissures
Possible small pleural effusions
309
Ttn management
Supportive:
Oxygen to maintain SpO₂
Nasal CPAP in more severe cases
Monitoring and reassurance for parents
Self limiting - symptoms typically resolve by 24–72 hours.
310
Term baby born by elective caesarean → tachypnoea and grunting within 2 hours →
Ttn → resolves within 3 days.
311
Management
Uterine Prolapse
Pelvic Floor Muscle Training,,Pelvic floor exercises (Kegel exercises)
Pessary Devices ,,Vaginal ring pessary used to support prolapsed organs
Surgical Management
312
Surgical Management Uterine Prolapse
Vaginal wall repair (colporrhaphy)
Uterine suspension procedures:
Sacrospinous fixation
Uterosacral ligament suspension
Sacrohysteropexy (mesh or native tissue)
Hysterectomy (vaginal or abdominal) if childbearing is complete or prolapse is severe
313
Elderly postmenopausal woman with vaginal bulge, urinary frequency and incomplete voiding.
Prolapse
314
Something coming down” sensation
Prolapse
315
UA is not appropriate if on
Liver inducing drugs
316
Atopic eruption of pregnancy
Occurs earlier in pregnancy (first or second trimester) and presents with eczema-like or papular lesions,
317
Chignon
Temporary swelling due to vacuum-assisted (ventouse) delivery; crosses sutures and resolves within hours
318
US is the 1st-line for breast ca inv in women aged
<40 years and during pregnancy and lactation"
319
functional hypothalamic amenorrhoea, a subtype of
hypogonadotropic hypogonadism.
The mechanism involves suppression of the hypothalamic–pituitary–ovarian (HPO) axis
320
painless bleeding after membrane rupture with foetal bradycardia
Vasa previa
321
non-hormonal therapy for hot flushes when HRT is contraindicated.
Venlafaxine, a SNRI is
322
Antimuscarinics
tolterodine, darifenacin, oxybutynin (beware in frail/elderly patients at risk of cognitive/physical decline)
323
Whicj hormonal method not affected by enzyme induction
Progestogen-only injectable contraception (e.g. Depo-Provera)
324
Women at high risk of NTD - 5 mg OD
RFs: Prev. child with NTD, AEDs, DM, coeliac, Sickle, thalassaemia, BMI > 30.
325
progesterone receptor modulator
Ulipristal acetate
326
According to NICE , any woman presenting with persistent or frequent:
Abdominal distension/bloating,
Early satiety,
Pelvic or abdominal pain, or
Urinary urgency/frequency
should have CA125 checked
If CA125 ≥35 IU/ml, then arrange urgent (within 2 weeks) TV ultrasound of abdomen and pelvis.
327
intrahepatic cholestasis of pregnancy (ICP).
Management
The mainstay of management is supportive care, monitoring bile acids and LFTs, and planning delivery based on bile acid levels:
19–39 µmol/L → deliver by 40 weeks
40–99 µmol/L → deliver at 38–39 weeks
≥100 µmol/L → deliver at 35–36 weeks
328
C.HiC” — “Cat Hits to Child's brain”
Cats = source of Toxoplasma)
C → Chorioretinitis
H → Hydrocephalus
C → Calcifications (Intracranial)
329
FBM > 7 (or >6.1 and complicated pregnancy)
(1) Insulin therapy.
330
supervised pelvic floor exercises for at least
3 months
331
most common cause of secondary (late) postpartum haemorrhage
Endometritis
MSRA
flashcards
Decks in class (27)
# Cards
-
MEDICINE228
-
Antibiotics31
-
Ent149
-
Psychiatry59
-
Contraception49
-
Gynae95
-
Ortho1
-
Cardio304
-
Resp120
-
Derma278
-
Ophthal180
-
Endocrine322
-
Metabolic58
-
Gastro343
-
Surgery168
-
Infectious Diseases269
-
Hematology242
-
Rheumat + Musculoskeletal497
-
Rheumat + Musculoskeletal 264
-
Pediatrics389
-
Pharma254
-
Psychiatry168
-
Respiratory247
-
Uro101
-
Renal175
-
Obgyn340
-
Neuro269
