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13.06.02 General notes

G/P
  • Gravidity – number of times a woman has been pregnant, regardless of outcome
  • Parity - X = (any live or still birth after 24 weeks) | Y = (number lost before 24 weeks)

Post-op management
  • Fluid out should be at least 1/3 of fluid in
  • Hear bowel sounds => Oral input
  • Stitches out
    • 7 days Pfannenstiel
    • 10 days midline
  • 6 weeks of:
    • No lifting
    • No driving
    • No sex

Fitz-Hugh–Curtis syndrome
  • Rare complication of PID
  • Liver capsule inflammation => Adhesions of parietal peritoneum to liver
  • Acute onset, right upper quadrant abdominal pain aggravated by breathing, coughing or movement

Down's screening
  • Try to do before 13.5 weeks 
    • Leave open the possibility of a first trimester termination
    • Harder to do US after that, as baby is mobile
    • US is inaccurate after that
  • S+S
    • Before 15 weeks: 90% sensitivity, 97% specificity
    • Quad test (after 15 weeks): 70% sensitivity, 95% specificity
  • Before 15 weeks (ideally at 11 - 13.5 weeks)
    • Demographics
      • Age, weight, ethnicity, smoking, previous history, previous pregnancies (IVF/natural)
    • Serum biochemistry
      • Beta-HCG, PAPP-A (Pregnancy-associated plasma protein A)
    • Ultrasound
      • CRL, neuchal translucency (use mean of two for monochorionic, measure both for dichorionic)
  • Quad test (after 15 weeks)
    • Alpha-fetoprotein (AFP)
    • Beta-HCG
    • Unconjugated estriol (UE3)
    • Inhibin A
  • CVS
    • Can do after 11 weeks
  • Amniocentesis
    • Can do after 16 weeks
    • Take 1 ml of fluid for each week of gestation
    • Riskier than CVS (risk of infection)
  • Can't use serum markers for multiple pregnancies

12 week scan
  • Viability
  • Multiple pregnancy
  • EDD (from CRL)
  • Neuchal translucency
  • Heart rate
  • Early anomalies (anencephaly, gastroschesis, omphalocoele)


Ovarian cancer
  • Systemic systems
    • Change in bowel habit
    • Change in appetite
    • Abdo pain
  • Check CA-125
    • >35 => USS ovary

Management of DUB
  • Tranexamic acid
  • GnRH analogues
  • Endometrial ablation
  • Progestogens (norethisterone)
  • Mirena
    • Can increase bleeding for 3 months, then decrease
    • Can cover with norethisterone

Asherman's syndrome 
  • Adhesions and/or fibrosis of the endometrium 
  • From trauma to basal layer of endometrium
    • Most often associated with dilation and curettage of the intrauterine cavity



Notes
  • EDD: + 1 year, - 3 months, + 7 days
  • Booking bloods
    • Group, Rh
    • FBC, Iron studies
    • HIV, HepB, Rubella, Syphilis
  • Rifampicin/enzyme inducers => COCP interference
  • Food/Drink irritating to bladder:
    • Tea (inc. green), coffee, hot chocolate, blackcurrant juice, cola, alcohol
    • Citrus fruit, tomatoes
  • Indications for RRT
    • A cidosis 
    • E lectrolyte imbalance 
    • I ngestion 
    • O verload 
    • U raemia
  • "Foetal reduction"
  • 20% of pregnancies => Early pregnancy failure (silent miscarriage/empty sack)
  • Hydrosalpinx
  • Caesarian => Twice the blood loss of vaginal delivery
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