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