Anatomy, Physiology and Embryogenesis Flashcards
1
Q
A
2
Q
What % of pregnancies miscarry in first trimester?
A
15-20%
3
Q
What is the diagnosis?
A
Trisomy 18
4
Q
What is he diagnosis?
A
47 XXY
5
Q
What is the diagnosis?
A
Patau’s syndrome
Trisomy 13
6
Q
What is the diagnosis?
A
Monosomy X
Turner’s syndrome
7
Q
What are the features of Patau’s?
A
Cleft lip and palate
Development of nasal palate
Not compatible with reaching term
8
Q
What is a feature of Edward’s syndrome?
A
Rocker bottom feet
Heart defects
Anencephaly
9
Q
Is Kleinfelter male or female?
A
Male with some intersex features
10
Q
Abnromalities of fertilisation: If there is more paternal material than maternal in fertilisation, what is this called?
A
Molar pregnancy aka Gestational trophoblastic disease
11
Q
What are the clinical features of molar pregnancy?
A
Measure large for dates - increased proliferation of trophoblasts of the bplacenta
PV bleeding
Must explain that this is not a viable pregnancy
12
Q
What is a US feature of molar pregnancy?
A
Snow storm appearance
13
Q
Abnormalities at implantation: what is shown?
A
Ectopic pregnancy - 98% will implant in fallopian tubes
14
Q
Abrnomalities at implantation: what is placenta praevia?
A
Placenta implanted wholly or in part into the lower part of the uterus
15
Q
What are the abnormalities of placental depth?
A
16
Q
What is early detachment of the placenta called?
A
Placental abruption
17
Q
What are the clinical features of placental abruption?
A
Pain
Tense ‘woody’ uterus
Bleeding - may be ‘concealed’ by enlarging uterus
18
Q
What are the risk factors for placental abruption?
A
- Pre-eclampsia
- HTN
- Abdominal trauma
- Cocaine
- Smoking
19
Q
Describe urogenital development.
A
20
Q
Describe genital development.
A
21
Q
What is shown?
A
Blind ending fallopian tube - not full development.
Mullerian duct abnormality
22
Q
A
23
Q
What is shown?
A
Biconate uterus - associated with mscarriage in later life
24
Q
What is shown?
A
25
What is shown?
Vaginal atresia - usually present at 12yr
26
What is shown?
Hematocolpos - dilated blood filled vagina
27
Failure of Mullerian duct fusion
28
Wolffian duct OR mesonephric duct (as these then go on to give rise to genital system)
29
30
Additional shunts in circulation - clinical problems if they persist
31
What is the goal of the ductus arteriosus?
Bypasses blood from non-functional lungs
Right to left shunt
32
When does the DA close? What structures are found around it?
33
What is the direction of shunt in PDA?
Left to right
34
How do you close the PDA? How do you keep it open and when?
Indomethacin (NSAID) to close PDA
In TGA - keep open by giving prostaglandins
35
What is the goal of the foramen ovale? What % do not close and what is the clinical problem?
Right to left shunt
36
What is the goal of the ductus venosis?
Bypass liver and go straight to heart - shunts 30%
Umbilical vein (blood from placenta) bypasses IVC
3-7 days closes and forms ligamentum venosus
37
What is the umbilical cord formed of?
2 arteries - carries deoxygenated blood
1 vein - oxygenated blood
38
What is the purpose of the ductus venosus in pregnancy?
Shunts 30% of blood past the fetal liver
39
What happens to umbilical cord post-natally? What does the umbilical vein become?
Closes 3-7 days post-natal
Umbilical vein --\> **round ligament/ligamentum teres**
40
What is the use of umbilical vein in pre-term?
Takes longer to close in pre-term infants so can be used as a site for central line and be catheterised as shown below
41
What do the umbilical arteries regress to form? What is the use of these?
MediaL umbilical ligaments
These are used as a laparoscopic landmark
42
What do the allantoic duct/urachus regress to become?
MediaN umbilical ligaments
43
How long post-natally can you take blood from the umbilical arteries for?
Until 1 week old - used like arterial line
44
Ductus arteriosus
45
Ductus venosus
46
Umbilical vein
47
MediaN umbilical ligament arises from allaNtoic duct
48
What is GTD in terms of malignancy?
This is a molar pregnancy which is a pre-malignant stage
49
What are the different incisions used in Obs and Gynae?
50
What is this a consequence of?
Inferior and superior epigastric vessels damage
51
Why might you use Palmer's point and where is it?
**Laparoscopy to avoid adhesions**
* Advocated by French gynaecologist Raoul Palmer in the 1940s because visceral-parietal adhesions are rarely found here*
* Gynaecologists still favor this entry site when intra-abdominal adhesions are likely, especially in patients with a history of significant adhesions or multiple previous pelvic surgeries*
52
What is the widest diameter of the pelvic inlet?
Transverse diameter between arcuate lines (13sm)
The vertical line between sacral promontory and pubic symphysis is 11cm
53
What are the landmarks of the pelvic outlet?
54
In delivery, what is the positioning of the head?
There is twisting according to the sizes of the pelvic inlet and outlet
55
Where does the pudental nerve travel?
56
How is pudental nerve block done?
57
When is episiotomy done?
NOT done prophylactically
Performed during second stage of labour (usually instrumental delivery) under pudendal block to enlarge opening and avoid tearing damage to:
* anal sphincter (incontinence)
* perineal body (reduce postpartum pelvic floor dysfunction)
* reduce blood loss (muscles well supplied)
60o angle from midline
Postnatally sutured up
58
What should you avoid in episiotomy?
Perineal body - prolapse may result
Bartholin's glands - these usually provide lubrication
59
What are the parts of the levator ani? What is their function? What does damage cause?
Levator ani muscles support urethra, vagina, and rectal canal
Damage can result in: urinary stress incontinence, anal incontinence, pelvic organ prolapse (POP)
60
61
46 XX
Epmpty ovum - replication of the sperm causes 46 XX
Snowstorm appearance is characteristic of a complete mole than the partial mole which is why it is not 69 XXY
62
What are the layers dissected during Caesarean?
* 1. Skin
* 2. Fat
* 3. Rectus sheath
* 4. Rectus
* 5. Parietal peritoneum
* 6. Visceral peritoneum
* 7. Uterus muscular layer
63
What is the HPG axis?
64
What is the pattern of FSH, LH, progesterone and oestrogens during the menstrual cycle?
65
What is the purpose of LH, FSH, etradiol, progesterone?
LH - androgen production and ovulation
FSH - oestrogen production and recruitment of follicles
Estradiol - preparation of endometrium for implantation and 2o sexual characteristics
Progesterone - maintenance of pregnancy and inhibits lactation
66
What are the patterns of hormones in pregnancy?
67
What hormone drop are most symptoms of menopause associated with?
Oestrogen
Menopause - no periods for a year
68
What is premature ovarian insufficiency?
Irregular periods and infertility in patients ~35-40yrs +/- menopausual symptoms
69
What are the causes of POI?
90% unknown cause but often have family history
Can also be caused by chemo/radiotherapy; Fragile X syndrome; Turner syndrome; thyroiditis; Addison disease; viral infections
70
How do you diagnose POI and what is the management?
Diagnosis: measure FSH twice 4-6 weeks apart, should be high on both occasions
Treatment:
* HRT/COCP for bone health and menopausal symptoms
* ART (inc egg donation + IVF) for fertility
71
Is LH or FSH higher in PCOS?
72
How is PCOS diagnosed? What criteria is used? What are the long term complications?
73
Posterior rectus sheath (we are below the articuate line)
74
Coccyx
75
Perineal body
*You do it at 60 degress to avoid Bartholin's glands too*
76
Cystocele
77
Is premature ovarian failure the same as premature ovarian insufficiency?
Yes - moving away from failure now
78
Progesterone
79
Corpus luteum --\> placenta
80
3 - Menopause - last period 1 year ago independent of other symptoms.
81
Stroke
The rest are all associated with PDA
82
Prior to instrumental delivery
83
Estradiol (oestrogen)
84
How soon after conception is hCG detected in the serum? What is it secreted by?
8 days after CONCEPTION
Syncytiotrophoblasts - its main role is to mainatin corpus luteum and prevent its disintegration
85
What is the pattern of hCG levels during pregnancy? When do levels peak?
hCG levels double approx. every 48 hours in the first few weeks of pregnancy
Levels peak at around 8-10 weeks gestation.
