UKOM SpOG flashcards

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

Naegele rule

Estimated due date is calculated from the first day of the last menstrual period plus 280 days, adjusted for cycle length. Ultrasound crown-rump length at 7-13 weeks gives the most accurate dating.

Folic acid dose

400 micrograms daily from preconception until 12 weeks. A 5 mg dose is used for women with BMI 30 or more, diabetes, epilepsy on antiepileptics, or previous neural tube defect.

Combined screening test

Performed at 11+2 to 14+1 weeks using nuchal translucency, free beta-hCG, and PAPP-A to estimate risk of trisomy 21, 18, and 13.

Pre-eclampsia definition

New hypertension after 20 weeks with proteinuria (protein:creatinine ratio over 30 mg/mmol) or maternal organ dysfunction such as renal, hepatic, neurological, or haematological involvement.

Placenta praevia

Placenta covering or near the internal cervical os, causing painless vaginal bleeding and a soft uterus. Digital vaginal examination is avoided; delivery is usually by caesarean.

Placental abruption

Premature separation of the placenta causing painful bleeding, a tense uterus, and fetal distress. Ultrasound sensitivity is low, so diagnosis is clinical.

Twin-twin transfusion syndrome

Complication of monochorionic twins with unequal placental sharing, causing polyhydramnios in one sac and oligohydramnios in the other. Monochorionic twins need scans every 2 weeks.

Partogram action line

A line drawn 4 hours to the right of the alert line on the partogram. Crossing it indicates slow progress and prompts obstetric review, amniotomy, or oxytocin augmentation.

Shoulder dystocia sequence

Start with McRoberts manoeuvre and suprapubic pressure, then internal rotational manoeuvres, then all-fours position, and finally cleidotomy or Zavanelli manoeuvre.

Active third stage

Use of 10 IU intramuscular oxytocin, controlled cord traction, and uterine palpation after delivery. It reduces postpartum haemorrhage compared with expectant management.

Primary postpartum haemorrhage

Blood loss over 500 mL after vaginal birth or 1000 mL after caesarean birth within 24 hours. Causes are uterine tone, trauma, retained tissue, and coagulopathy.

Secondary postpartum haemorrhage

Bleeding from 24 hours to 12 weeks after birth, most often due to retained placental tissue or endometritis. Manage with antibiotics and ultrasound-guided evacuation if needed.

Puerperal psychosis

Severe psychiatric illness usually starting within 2 weeks of birth, with confusion, delusions, and risk of infanticide. It requires urgent psychiatric admission and is distinct from depression.

Cervical cancer screening

Liquid-based cytology with HPV testing. HPV-positive women with abnormal cytology go to colposcopy; HPV-negative low-grade changes return to routine recall.

Endometrial cancer presentation

Postmenopausal bleeding is the classic symptom. Transvaginal ultrasound showing endometrial thickness over 4 mm warrants endometrial biopsy to exclude malignancy.

Risk of malignancy index

Score combining CA-125, menopausal status, and ultrasound findings used to triage adnexal masses for referral to a cancer centre before surgery.

BRCA risk-reducing surgery

Bilateral salpingo-oophorectomy offered to BRCA1 carriers at 35-40 years and BRCA2 carriers at 40-45 years, after childbearing is complete, to reduce ovarian and breast cancer risk.

PCOS Rotterdam criteria

Two of three: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology on ultrasound. Other causes must be excluded.

Ovarian reserve tests

Antral follicle count and anti-Mullerian hormone are the best predictors of ovarian response to stimulation. Day-3 FSH is less reliable and varies between cycles.

Ovarian hyperstimulation syndrome

Complication of ovulation induction with enlarged ovaries, ascites, and haemoconcentration. Mild cases need oral fluids; severe cases need admission and thromboprophylaxis.

Premature ovarian insufficiency

Loss of ovarian function before age 40. Hormone replacement is given at least until the normal age of menopause to protect bone and cardiovascular health.

POP-Q staging

Pelvic organ prolapse quantification. Stage 1 is more than 1 cm above the hymen, stage 2 within 1 cm of the hymen, and stage 3 more than 1 cm beyond the hymen.

Stress urinary incontinence

Leakage on effort, sneezing, or coughing due to urethral sphincter weakness. First-line treatment is pelvic floor muscle training for at least 3 months.

Obstetric anal sphincter injury

Third-degree tears involve the anal sphincter, fourth-degree also involve the anal epithelium. Repair by an experienced clinician with follow-up reduces long-term incontinence.

Bacterial vaginosis

Clue cells, thin grey discharge, and a fishy odour with potassium hydroxide. It is not sexually transmitted and is treated with metronidazole.

Pelvic inflammatory disease

Treat empirically with ceftriaxone plus doxycycline plus metronidazole. Remove an intrauterine device only if there is no improvement after 48-72 hours.

Emergency contraception options

Levonorgestrel 1.5 mg up to 72 hours or ulipristal acetate up to 120 hours. A copper intrauterine device is the most effective option and can be used up to 5 days.

Umbilical artery Doppler

Absent or reversed end-diastolic flow indicates severe placental insufficiency and fetal compromise, prompting consideration of delivery after corticosteroids and specialist review.

Middle cerebral artery Doppler

Peak systolic velocity over 1.5 multiples of the median suggests fetal anaemia, as in rhesus disease. A falling pulsatility index suggests fetal hypoxia with brain-sparing.

Preterm prelabour rupture of membranes

Confirm by speculum examination and avoid digital examination. Give erythromycin and antenatal corticosteroids, and plan delivery by 37 weeks if labour does not start.

Eclampsia treatment

Magnesium sulphate 4 g intravenous loading then 1 g/hour, monitoring reflexes, respiratory rate, and urine output. Calcium gluconate is the antidote for magnesium toxicity.

Perimortem caesarean delivery

Performed within 4-5 minutes of maternal cardiac arrest after 20 weeks if there is no return of circulation, to improve maternal and fetal survival.