Obs and Gynae

FSH due to no negative feedback from oestrogen

dysmenorrhea, dysapenuria, infertility

hyperemesis gravidum

oxytocin

sFlt:PIGF

HELLP, eclampsia, cerebral haemorrhage, ARDS, AKI, end-organ damage, stillbirth, amurosis fugax

abdominal pain, vomiting, bleeding, hyperthyroidism, large uterus

misprostol - medical
surgical - aspiration of products

relaxes LOS sphincter; increases risk of GORD
slows gastric emptying and emptying of gall bladder - cholelithiasis

cataracts, hearing loss, blueberry muffin rash, congenital heart defects; PDA etc.

nifedipine - vasodilation
mgso4 - neuroprotection before 32 weeks
prostaglandins - delay contractions
indomethacin - NSAID; decrease amniotic fluid

haemolytic disease of the newborn; haemolytic anemia hydrops fatalis and kernicterus

intrauterine transfusion, early cord clamping, phototherapy and heart failure drugs

Rh at 30 weeks 1500 IU IM and 500 IU 72 hours after any sensitization events

polyhydramnios

failure of the anterior pituitary gland - failure to lactate, lethargy

lambda sign

always dichorionic diamniotic

Ix, then either amnioreduction (reduces the amniotic fluid), increases risk of infections and placental abruption, or Indomethacin (NSAID) reduces the foetal urine output

foetal causes; congenital/congestive heart failure, anencephaly, congenital nephrotic syndrome, duodenal atresia, spina bifida, gestational diabetes, twin pregnancy, Rh incompatability

IUGR, renal obstruction e.g. posterior urethral valves, potter syndrome, prune belly syndrome, post-term, placental insufficiency

hypothyroidism, also brought by antithyroid drugs in hyperthyroidism

yes it causes infertility

hypercoagulative, even post-partum (pueripartum) - increased risk of DVT and thromboembolism (heparin/warfarin)

bromcriptine

secondary amenorrhea

this is a result of the increased growth in size of the anteiror piruitary resulting in ischemia causing deficiency in GH, LH, FSH, ACTH and TSH, it can occur as a result of PPH - permanent effect' lifelong hormone replacement therapy

no therefore acromegaly (macrosomia - diabetes) cannot occur in the foetus

10.5

iron deficiency followed by thalassemia

absence of menses for 12 consecutive months

vasovagal - palpitations, hot flushes and irritability
urogenital - dryness, itching, incontinence and recurrent UTIs

at 51 years

5 years

hypothyroidism

increased risk of endometrial cancer, post-menopausal bleeding (polyps, malignancy; cervical/endometrial/ovarian, atrophic vaginitis - GSM), osteoporosis (less than 2.5), no cardioprotective risk - increased risk of cardiovascular events

TSH, 5-HIAA, FSH, transvaginal US (assess endometrial thickness and any polyps), biopsy - pipelle/GA, bimanual examiantion and speculum, bone density - DEXA

HRT - oestrogen (oestradiol); in hysterectomy, oestrogen and progesterone - uterus intact

transdermal e.g. creamsels/pessariesings - reduce risk of VTE
oral
implants - not that common

malignancy; breast/endometrial, active VTE, HTN

SSRIs, gabapentin

to increase libido/prevent post-menstrual bleeding and it is stopped if there is post-menstrual bleeding

refers to increased BP >140/90mmHg after 20 weeks of gestation characterised by proteinuria or end-organ damage due to abnormal formation of spiral vessels of the placenta resulting in increased vascular resistance and reduced fetal-placental flow

chronic - prior to pregnancy (<20 weeks) - primary or secondary
gestational - after 20 weeks, no proteinuria
pre-eclampsia

proteinuria, oedema, visual disturbances, upper abdominal pain - liver, nausea and vomiting, headaches, brisk reflexes

eclampsia - new onset tonic-clonic seizures without an underlying neural cause and post-ictal phase
cerebrovascular haemorrhage
amenurosis fugax
renal failure
SIRS
ARDS
pulmonary failure
HELLP

foetal - pre-maturity, IUGR, placental rupture, stillbirth

this results in low plateletes, haemolysis and high LFTs - dark urine, high LDH and anemia
Mx - platelets and FFPs and treatment of pre-eclampsia

FBC, LFTs, urea and electrolytes - increased urea and creatinine due to decreased urine output, foetal US and doppler (12 weeks+), SFlT:PIGF ratio

this is an emergency where there are new onset tonic clonic seizures due to degredation of pre-eclampsia requiring immediate delivery of the baby

labetolol - 1st line, nifedipine
MgSO4 - for preventitive seizures
fluid and electroyte correction
delivery and dexamethasone is premature to help with development of foetal lungs

aspirin 75mg

smoking, diabetes, previous pre-eclampsia, multiple pregnancies, overweight, nullipiarity, >40 years, CKD, A/I disease, family history

early onset - less than 34 weeks; more severe and increases risk of FGR
late onset - after 34 weeks - less severe

red and velvety tissue

post-coital bleeding

CIN and cervical ectopion

friable and bleeding cervix, purulent and bloody discharge

osteoporosis

snowstorm appearance

abnormally high `

methotraxate/salpingectomy/salpingotomy

vaginal bleeding, lower abdominal pain radiating to shoulder, dizziness (blood loss), RIF/LIF pain, cervical motion tenderness

the serum HCG does not double after 48 hrs

abnormally high HCG, enlarged abdomen, hyperthyroidism, vaginal bleeding

third trimester

coarcation of aorta, pulmonary hypertension, Marfan's syndrome, peripartum cardiomyopathy

primary - 4 Ts; uterine atony, trauma e.g. C-section, episiotomy, macrosomy, thrombin - coagulopathies e.g. VWd, haemophilias, DIC e.g. eclampsia, tissue remnants e.g. placenta acreta
secondary RIP - endometritis (infection - antibiotics), tissue retention, involution of placental site

refers to excessive bleeding in the 24 hours after delivery
secondary - from 24 hours to 12 weeks after

refers to bleeding after 20-24 weeks gestation mainly from placenta previa (bright sudden bleeding, no abdominal pain and foetal distress) and placenta abruption (sudden dark bleeding, back/abdominal pain and foetal distress - decelerations on CTG)

immunisation - allows maternal antibodies to cross
production of hormones - beta HCG (similar to TSH - in hydratiform mole high BHCG leads to hyperthyroidism), HPL, progesterone and oestrogen
nutrients - fatty acids and glycogen
gaseous exchange
metabolism

placenta accreta - the inability of the chorionic villi to embed in the myometrium
placenta increta - the chorionic villi implant in the myometrium
placenta percreta - the chorionic villi implant in the neighbouring organs as well

primary - in first 24 hours leading to heavy bleeding e.g. atony, retained placental fragments
secondary - in first 2 weeks e.g. retained placental haemorrhage and endometritis

IV broad spectrum antibiotics in the first hour

ERPC

fever and abdominal pain

heavy bleeding and a tender and boggy uterus

oxytocin (uterotonics)