PGIM MD ObGyn flashcards

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

Naegele rule

Estimated date of delivery equals the first day of the last menstrual period plus 280 days. Adjust for irregular cycles and confirm with first-trimester ultrasound crown-rump length.

Bishop score

Cervical favourability score using dilatation, effacement, station, consistency, and position. A score of 8 or more predicts successful induction; 6 or less suggests ripening.

Pre-eclampsia aspirin prophylaxis

Offer aspirin 75–150 mg at night from 12 weeks to women at high risk of pre-eclampsia, such as previous pre-eclampsia, chronic hypertension, diabetes, or renal disease.

Magnesium sulphate toxicity monitoring

Monitor respiratory rate, urine output, and deep tendon reflexes during magnesium sulphate infusion. Loss of reflexes, respiratory depression, or oliguria signals toxicity; give calcium gluconate as antidote.

Postpartum haemorrhage first-line uterotonic

Oxytocin is first-line: 5 IU slow intravenous or 10 IU intramuscular after birth. Follow with ergometrine, carboprost, or misoprostol if bleeding continues.

Shoulder dystocia manoeuvres

First-line manoeuvres are McRoberts position and suprapubic pressure. Avoid fundal pressure. Proceed to internal rotational manoeuvres, then all-fours, then cleidotomy or symphysiotomy.

Late decelerations

Late decelerations are repetitive decelerations beginning after the contraction peak and ending after it. They suggest uteroplacental insufficiency and require intrauterine resuscitation and possible delivery.

Gestational diabetes OGTT thresholds

A 75 g oral glucose tolerance test is diagnostic if fasting ≥5.1 mmol/L, 1 hour ≥10.0 mmol/L, or 2 hours ≥8.5 mmol/L. One abnormal value is sufficient.

Anti-D prophylaxis timing

Give anti-D 500–1500 IU at 28 weeks and within 72 hours of delivery to non-sensitised RhD-negative women. Also give after miscarriage, ectopic pregnancy, amniocentesis, or antepartum haemorrhage.

Cephalic presentation at term

About 95% of fetuses are cephalic at term. Breech presentation is more common with prematurity, multiple pregnancy, polyhydramnios, uterine anomaly, or placenta praevia.

Amniotic fluid index ranges

Amniotic fluid index is measured in centimetres by ultrasound. Normal is 5–25 cm; ≤5 cm indicates oligohydramnios and ≥25 cm indicates polyhydramnios.

VBAC eligibility

A trial of labour after caesarean is suitable with one previous lower-segment caesarean, no other uterine scar, no placenta praevia, and immediate theatre access. Success is 60–80%.

HELLP syndrome

HELLP is haemolysis, elevated liver enzymes, and low platelets. Diagnostic features include lactate dehydrogenase >600 IU/L, aspartate aminotransferase >70 IU/L, and platelets <100,000/µL.

Cord prolapse management

Call for help, position the woman knee-chest or Trendelenburg, elevate the presenting part, fill the bladder if needed, and proceed to immediate caesarean delivery.

Preterm labour corticosteroids

Give betamethasone 12 mg intramuscularly twice, 24 hours apart, between 24 and 34 weeks when preterm birth is expected within 7 days. Use tocolysis only to gain time for steroids.

Placenta praevia

Placenta praevia is placental implantation over or near the cervical os. It causes painless antepartum bleeding; avoid digital vaginal examination and deliver by caesarean when indicated.

Cervical cancer FIGO stage IB

FIGO 2018 stage IB is invasive cancer confined to the cervix: IB1 ≤2 cm, IB2 >2 to ≤4 cm, and IB3 >4 cm in greatest dimension.

PCOS Rotterdam criteria

Diagnose PCOS with two of three: oligo-ovulation or anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound. Exclude other causes.

Endometrial cancer risk factors

Risk factors include unopposed oestrogen, obesity, type 2 diabetes, tamoxifen use, nulliparity, and Lynch syndrome. Postmenopausal bleeding is the commonest presenting symptom.

Ovarian torsion

Ovarian torsion presents with sudden severe unilateral pelvic pain, nausea, and vomiting. Doppler flow may be normal. Treat with laparoscopic detorsion and ovarian preservation.

Methotrexate for ectopic pregnancy

Methotrexate 50 mg/m² intramuscularly is an option when the woman is stable, hCG <5000 IU/L, no fetal cardiac activity, mass <4 cm, and no significant haemoperitoneum.

Combined pill contraindications

Avoid combined hormonal contraception with migraine with aura, smoking ≥15/day at age ≥35, prior VTE, blood pressure ≥160/100 mmHg, breast cancer, or severe liver disease.

Emergency copper IUD

A copper intrauterine device inserted within 5 days of unprotected intercourse is the most effective emergency contraception. It also provides ongoing contraception.

Menopause hormone therapy

Use oestrogen alone after hysterectomy, or combined oestrogen and progestogen if the uterus is present. Use the lowest effective dose and review risks annually.

Endometriosis diagnosis

Laparoscopy with direct visualisation and optional biopsy is the gold standard. Medical therapy improves pain but not fertility; surgery is reserved for infertility or refractory symptoms.

Uterine fibroid FIGO types

FIGO type 0–2 are submucosal, type 3–5 intramural, type 6–7 subserosal, and type 8 cervical. Type 0 is completely within the cavity; type 2 is <50% intramural.

Cervical screening with HPV

Primary HPV testing is used from age 30 every 5 years. Colposcopy is indicated for HPV16 or HPV18 positivity or for abnormal cytology.

Postmenopausal bleeding investigation

Transvaginal ultrasound endometrial thickness >4 mm requires endometrial biopsy. About 10% of postmenopausal bleeding is caused by endometrial cancer.

Bartholin abscess treatment

Treat with incision and drainage or Word catheter insertion. Add antibiotics if cellulitis is present. Recurrent cysts may require marsupialisation.

Ovarian cancer tumour markers

CA125 is elevated in many ovarian cancers but is nonspecific. The risk of malignancy index combines CA125, menopausal status, and ultrasound findings to guide referral.

Turner syndrome

Turner syndrome is 45,X or a mosaic variant causing short stature, streak gonads, and primary amenorrhoea. Screen for cardiac and renal anomalies and give oestrogen replacement.

Asherman syndrome

Asherman syndrome is intrauterine adhesion formation after curettage or infection. It causes amenorrhoea, infertility, and recurrent miscarriage. Hysteroscopic adhesiolysis is the treatment.