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Obstetrics and Gynaecology > Clinical Aspects of O+G > Flashcards

Clinical Aspects of O+G Flashcards

1
Q

What form of imaging is predominantly used in O+G?

A

US

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2
Q

Evaluate the different imaging modalities which may be used in pregnancy.

A

• X-Ray

  • Away from pelvis, negligible
  • Avoid radiation of breast tissue and uterus

• MR
- No evidence of harm

• CT (+ CTPA)

  • Increased risk (10%) of breast cancer
  • Relative risk is 1.1x

• V:Q Scan

  • No established risk
  • Lower sensitivity and specificity cf CTPA

• US

  • No direct harm
  • False positive risks e.g. ovarian cysts of unknown significance  anxiety or unnecessary intervention
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3
Q

State 3 things which may be looked for when ultrasound scanning the uterus.

A

• Uterine anomalies – bicornuate uterus
• Uterine tumours – fibroids
• Cervix – length predictor for onset of labour
- Important if premature/late miscarriage
• Uterine artery blood supply – predictor for pre-eclampsia

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4
Q

State 5 things a healthcare worker may be looking for when imaging a foetus with ultrasound.

A
  • ‘Alive’ or not
  • Location: IU/Ectopic
  • Size of foetus (Crown-Rump Length – CRL)
  • Number of foetuses and type
  • Anatomical structures

• Foetal anomaly screening (18-21 weeks): head/cerebral hemispheres/lateral ventricles/cerebellum/foetal face/limbs/hands/feet/diaphragm/kidneys and bladder/spine

• Growth: Abdominal and head circumference/femur length + Estimated foetal weight
• Wellbeing: Liquor volume and Foetal blood flow measurements (blood flow; absent flow in diastole ≈ high placental resistance)
- Can check Middle Cerebral Artery (foetal anaemia or hypoxia) or Ductus Venosus (reversal of wave form in pre-terminal hypoxia)
• Presentation (cephalic vs breech or transverse vs oblique)
• Position of head in labour (e.g. if occiputs transverse before using forceps)

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5
Q

Describe antenatal care.

A

Medical care provided to detect and manage pre-existing maternal/foetal disorders that may affect the pregnancy or foetal wellbeing.

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6
Q

Outline what is done at an antenatal booking visit.

A
  • Full history, full examination
  • Fundal height should be taken (cm)
  • Blood tests: ABO, Rhesus, STI screening, HBV, HCV, ßhCG and PAPP-A
  • Early pregnancy US scan: viability, number of foetuses, gestation, nuchal translucency
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7
Q

Which blood tests are conducted at the booking visit?

A

• Blood tests: ABO, Rhesus, STI screening, HBV, HCV, ßhCG and PAPP-A

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8
Q

What does the early pregnancy scan look at?

A

viability, number of foetuses, gestation, nuchal translucency

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9
Q

When is the booking visit scheduled for?

A

12/40

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10
Q

Upon follow-up visits, what is conducted?

A
  • Full history, full examination
  • Fundal height should be taken (cm), Liqor volume, foetal lie, presentation, foetal HR
  • Mid-pregnancy scan (20 weeks): microencephaly, short limbs, brain anomalies, cardiac anomalies; placental position
  • Quadruple blood tests: ßhCG, AFP, inhibin-A, unconjugated estriol (uE3)
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11
Q

When is the Quadruple test scheduled for?

A

around 20 weeks

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12
Q

What does the Quadruple test assess?

A

uE3
AFP
ßhCG
Inhibin-A

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13
Q

When is the mid-pregnancy scan indicated?

A

• Mid-pregnancy scan (20 weeks): microencephaly, short limbs, brain anomalies, cardiac anomalies; placental position

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14
Q

What does the mid-pregnancy scan look for?

A

microencephaly, short limbs, brain anomalies, cardiac anomalies; placental position

Most are seen after 20 weeks however cardiac abnormalities are seen after 12 weeks

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15
Q

What is the risk threshold for investigating the risk of Down Syndrome in a foetus.

A

1 in 250

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16
Q

Describe CVS and the risks.

A

= Removal of chorionic villi cells from placenta to genetically analyse (12 weeks onwards)
- Miscarriage rate of 2% (2/100)

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17
Q

Describe Amniocentesis and the risks.

A

Removal of amniotic fluid from the uterus to genetically analyse cells (15 weeks onwards)
- Miscarriage rate of 1% (1/100)

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18
Q

Describe pre-implantation genetic diagnosis.

A

Genetic test using FISH on embryo prior to re-implanting. This requires ART such as IVF.

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19
Q

Evaluate the benefits and drawbacks of PIGD.

A

Benefits:

  • Assurance
  • Less likely to require TOP

Drawbacks:

  • Invasive
  • Costly
  • Risk of multiparity
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20
Q

State the indications for PIGD.

A
  • Parental chromosomal abnormality
  • Robertsonian translocation
  • Reciprocal translocation
  • X-linked disorders
  • Genetic disorders
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21
Q

List 3 principles of safe prescribing in pregnancy

A
  • Establish exposure to medication: exposure; gestational age; PMHx; FHx; Check drug information; Background risk
  • Intended continuation/initiation of medication: Benefits > costs; try to avoid 1/3 use; Use drugs known in pregnancy; Absence of data ≠ safety
  • ICE and pre-conception planning/first consultation/background screening + check
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22
Q

List 3 drugs you should not prescribe when breastfeeding.

A 
MTX
Cyclophosphamide
Lithium 
Metronidazole
Chloramphenicol
Aminoglycosie
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23
Q

What if foetotoxicity?

A

toxic functional damage occurring with exposure to medication in later pregnancy

24
Q

What is teratotoxicty?

A

potential for drug cause foetal malformations affecting embryo 3-8 weeks after conception

25
Q

What happens to the plasma drug concentration in pregnancy?

A

Reduced due to reduced absorption and increased elimination

26
Q

What happens to the proportion of free drug in pregnancy?

A

Increased as less bound to albumin (proportionally) - narrow therapeutic window

27
Q

Outline the key aspects of pre-conceptive advice.

A
  • Diet
  • Exercise
  • No alcohol
  • Smoking cessation
  • Weight status
28
Q

What is the recommended calorie intake in pregnancy?

A

• Calories: 2150kcal (1/3; 2/3); 2350kcal (3/3)

29
Q

What is the standard recommended iron intake during pregnancy?

A

• Iron: 10mg daily

30
Q

What is the standard recommended folic acid intake during pregnancy?

A

• Folic Acid: 400mcg

31
Q

What are the indications for increasing Folic Acid intake during pregnancy?

What dose should this be?

A

PMHx NTD - Paternal or maternal
FHx NTD
OHx NTD
Diabetic

5mg

32
Q

What is the standard recommended vitamin D intake during pregnancy?

A

• Vitamin D: 10mcg

33
Q

What is the standard recommended vitamin C intake during pregnancy?

A

• Vitamin C: 70mcg

34
Q

What is the standard recommended vitamin A intake during pregnancy?

A

< 600mcg

35
Q

State 5 foods you should avoid in pregnancy.

A
  • Soft cheeses
  • Soft blue cheese
  • Raw eggs
  • Raw meat
  • Pate
  • Liver (too much vitamin A)
  • Game (lead pellets)
36
Q

What is an unplanned pregnancy?

A

Fertilisation in the absence of desire to conceive through sexual intercourse

37
Q

Outline the Legal Abortion Act 1967.

A

State of law with balance between right of foetus and right of woman – not guilty if performed by a medical practitioner: social grounds, grave permanent injury, risk to life, foetal abnormality.

38
Q

How many medical practitioners are required to agree for an abortion?

A

2

39
Q

Does a foetus have a right to life?

A

No, not legally

40
Q

Describe the HSA1 document.

A

certificate A in Scotland. Needs two doctors to sign it.

41
Q

Describe the HSA2 document.

A

certificate B in Scotland. Needs to be completed by the doctor within 24 hours of an emergency abortion.

42
Q

Describe the HSA3 document.

A

must be completed by the doctor and sent to the chief medical officer within 7 days of the abortion taking place.

43
Q

Continuation of pregnancy being a risk to life of the pregnant woman is which ground for ToP?

A

A

44
Q

Prevention of grave permanent danger is which ground for ToP?

A

B

45
Q

Pregnancy being a risk to the physical or mental health of a woman is which ground for ToP?

A

C

46
Q

Pregnancy being a risk to the physical or mental health of existing children is which ground for ToP?

A

D

47
Q

If it was necessary to save the life of a woman in an emergency situation, what ground for ToP is this?

A

F

48
Q

If it was necessary to prevent grave permanent injury to the physical or mental health of the woman in an emergency ToP, which ground is this?

A

G

49
Q

If there is a substantial risk that the child would be born with a serious disability, what ground for ToP is this?

A

E

50
Q

Outline conscientious objection in ToP.

A
  • Doctors can object out of personal beliefs/values
  • Needs to be explained and passed on to another doctor
  • Cannot discriminate
  • Cannot refuse in an emergency (F, G)
51
Q

State 3 things that should be discussed at referral to ToP.

A

• Discuss: certainty/ alternatives/ US Scan/ Complete Hx/ Methods

52
Q

Describe Surgical ToP

A

Process of intervening to retrieve a developing foetus from the uterus either by vacuum aspiration (6-12 weeks) or dilatation and evacuation (13-24 weeks) which is usually done under local anaesthetic.

53
Q

Outline the benefits of surgical ToP.

A
  • Quick
  • Complete abortion verified
  • On hospital grounds
  • IUD insertion
54
Q

Describe medical ToP.

A

Process of intervening to end the life of a foetus by administration of medication such as mifepristone (anti-progesterone steroid) and misoprostol (PGE analogue) which enable sensitisation to the contractions, ripens cervix and stimulates uterine contractions

55
Q

Outline the benefits of medical ToP.

A
  • No instrumentation required
  • Less risk of iatrogenic injury
  • Controlled by woman
56
Q

State 3 potential complications of ToP.

A
  • Haemorrhage
  • Infection
  • Pain
  • Incomplete procedure
  • Uterine perforation
  • Cervical trauma
  • Anaesthetic complications
  • Ongoing pregnancy
  • Uterine rupture
57
Q

Give 3 examples of drugs which are teratogenic.

A 
NSAIDs
Trimethoprim
Erythromycin
Sodium valproate
Warfarin

Obstetrics and Gynaecology (8 decks)

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