Czech Gynaecology and Obstetrics Board Exam flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Physiological anaemia of pregnancy

Plasma volume increases about 40–50% while red cell mass rises only 20–25%, lowering haemoglobin by dilution. In the second and third trimester haemoglobin below 105 g/L is abnormal and warrants iron studies.

Combined first-trimester screening

Performed at 11+0 to 13+6 weeks using nuchal translucency, free beta-hCG, PAPP-A and maternal age. Detects roughly 85–90% of trisomy 21 cases at a 3–5% false-positive rate.

Gestational diabetes diagnostic thresholds

A 75 g oral glucose tolerance test at 24–28 weeks is diagnostic if fasting glucose is at least 5.1 mmol/L, one-hour glucose at least 10.0 mmol/L, or two-hour glucose at least 8.5 mmol/L.

Anti-D prophylaxis schedule

RhD-negative non-sensitised women receive anti-D immunoglobulin around 28 weeks, within 72 hours of delivery, and after abortion, amniocentesis or antepartum bleeding to prevent alloimmunisation.

Preeclampsia diagnostic criteria

Hypertension at least 140/90 mmHg after 20 weeks plus proteinuria at least 300 mg per 24 hours, or hypertension with maternal organ dysfunction such as thrombocytopenia, renal, hepatic or neurological involvement.

Magnesium sulphate in eclampsia

Loading dose 4 g intravenously over 20 minutes, then 1 g per hour infusion. Monitor respiratory rate, reflexes and urine output; calcium gluconate is the antidote for toxicity.

Antenatal corticosteroids

Betamethasone 12 mg intramuscularly twice, 24 hours apart, given between 24+0 and 34+0 weeks to accelerate fetal lung maturity and reduce respiratory distress syndrome, intraventricular haemorrhage and neonatal death.

Late decelerations on CTG

Decelerations that begin after the contraction peak and recover after it ends, reflecting uteroplacental insufficiency. With reduced variability they require immediate intrauterine resuscitation and expedited delivery.

Shoulder dystocia manoeuvres

Start with McRoberts manoeuvre and suprapubic pressure, then attempt internal rotation, posterior arm delivery or all-fours position. Fundal pressure and excessive traction are contraindicated because they worsen impaction.

Postpartum haemorrhage first-line treatment

Uterine massage, oxytocin 5 IU slow intravenous or 10 IU intramuscular, tranexamic acid 1 g intravenously within 3 hours, then ergometrine, carboprost or misoprostol if bleeding continues.

Operative vaginal delivery prerequisites

Full cervical dilatation, engaged head at or below station zero, known fetal position, empty bladder, adequate analgesia, no cephalopelvic disproportion, and an experienced operator prepared to abandon the attempt.

Risk of malignancy index

RMI equals CA-125 multiplied by menopausal status score and ultrasound score. Values above 200–250 indicate high risk of ovarian malignancy and prompt referral to a gynaecological oncology centre.

FIGO staging of cervical cancer

Staging is clinical but imaging and pathology may be incorporated. Stage IB1 tumours are 2 cm or less, IB2 are over 2 cm to 4 cm, and IB3 are over 4 cm in greatest dimension.

Endometrial cancer risk factors

Obesity, unopposed oestrogen exposure, diabetes, nulliparity, tamoxifen use and Lynch syndrome increase risk. Postmenopausal bleeding requires endometrial biopsy and transvaginal ultrasound.

Complete hydatidiform mole

Usually 46,XX with entirely paternal chromosomes, absent fetal tissue, markedly elevated beta-hCG and a snowstorm ultrasound appearance. Follow beta-hCG to zero and treat plateau or rise with chemotherapy.

PALM-COEIN classification

Classifies abnormal uterine bleeding into structural causes (polyp, adenomyosis, leiomyoma, malignancy) and non-structural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not otherwise classified).

Endometriosis diagnosis and treatment

Ectopic endometrial tissue causing dysmenorrhoea, deep dyspareunia and infertility. Laparoscopy with histology confirms diagnosis; treatment includes NSAIDs, hormonal suppression, GnRH agonists and surgical excision.

POP-Q staging

Pelvic organ prolapse quantification uses six defined points and three measurements. Stage I is more than 1 cm above the hymen, stage II is within 1 cm, stage III beyond 1 cm, stage IV complete eversion.

Polycystic ovary syndrome criteria

Rotterdam criteria require two of three: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound. Treatment includes lifestyle change, metformin, letrozole or clomiphene.

Ovarian hyperstimulation syndrome prevention

Use a GnRH antagonist protocol with agonist trigger, freeze all embryos, give cabergoline, and avoid hCG luteal support in high-risk women with many follicles or high oestradiol.

WHO anovulation groups

Group I is hypogonadotropic with low FSH, group II is normogonadotropic typically due to PCOS, and group III is hypergonadotropic ovarian failure requiring donor oocytes.

Urodynamic stress incontinence

Involuntary urine leakage during filling cystometry when abdominal pressure rises, without a detrusor contraction. It confirms the diagnosis before continence surgery such as a tension-free vaginal tape.

Apical prolapse repair

Sacrospinous fixation or sacrocolpopexy corrects uterine or vault prolapse. Vaginal hysterectomy with McCall culdoplasty is an alternative when the uterus is removed.

TURP syndrome in hysteroscopy

Absorption of hypotonic distension fluid during monopolar hysteroscopic resection causes dilutional hyponatraemia, hypervolaemia, confusion and seizures. Fluid deficit limits are 750 mL for hypotonic and 1000 mL for saline media.

Laparoscopic entry techniques

Closed Veress needle entry is common, but open Hasson entry is preferred after previous abdominal surgery, in obesity or suspected adhesions. Palmer's point is used when the umbilicus is unsuitable.

Bacterial vaginosis diagnosis

Amsel criteria require three of four: thin grey discharge, vaginal pH above 4.5, positive whiff test, and clue cells on microscopy. Treatment is metronidazole or vaginal clindamycin; partners are not treated.

Chlamydia trachomatis treatment

Doxycycline 100 mg twice daily for seven days or azithromycin 1 g single dose, with partner notification and testing. Untreated infection causes pelvic inflammatory disease, ectopic pregnancy and tubal infertility.

Syphilis in pregnancy

Screen with VDRL or RPR and confirm with treponemal tests. Treat with benzathine penicillin G 2.4 million IU intramuscularly to prevent congenital syphilis; penicillin allergy requires desensitisation.

Second-trimester anomaly scan

Performed at 18–22 weeks to assess fetal anatomy, placental localisation, amniotic fluid volume and cervical length. It detects major structural anomalies and informs further prenatal diagnosis.

Umbilical artery Doppler

Absent or reversed end-diastolic flow indicates severe placental insufficiency and fetal hypoxia. Management depends on gestational age and may require delivery after corticosteroids.

Abortion legislation in Czech Republic

Termination on request is legal up to 12 weeks of gestation after counselling and a waiting period. Later termination is permitted only for genetic or serious maternal indications under statutory conditions.

Perimortem caesarean section

In maternal cardiac arrest beyond 20 weeks, perform manual left uterine displacement and start perimortem caesarean within 4–5 minutes if resuscitation fails, to improve maternal and fetal survival.