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