Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction Pathology > Complications of Pregnancy > Flashcards

Complications of Pregnancy Flashcards

1
Q

Definition of abortion/spontaneous miscarriage

A

Termination/loss of pregnancy before 24 weeks gestation with no evidence of life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of spontaneous miscarriage

A 
threatned
inevitable 
incomplete
complete
septic 
missed (early foetal demise)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Definition of threatned miscarriage

A

Bleeding from the gravid uterus before 24 weeks gestation when there is a viable foetus and no evidence of cervical dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Definition of an inevitable miscarriage

A

Abortion becomes inevitable if the cervix has already begun to dilate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Definition of incomplete miscarriage

A

Only partial expulsion of the products of conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is there a risk of after an incomplete miscarriage?

A

Ascending infection into the uterus which can spread throughout the pelvis (septic abortion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Definition of complete miscarriage

A

Complete expulsion of all the products of conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Definition of septic miscarriage

A

After incomplete abortion then risk of ascending infection which can spread throughout the pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Presentation of threatened miscarriage

A

Vaginal bleeding and pain
Viable pregnancy
Closed cervix on speculum examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Presentation of inevitable miscarriage

A

Viable pregnancy
Open cervix
Bleeding that may be heavy +/- clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Presentation of missed miscarriage (early foetal demise)

A

No symptoms possibly
Bleeding/brown loss vaginally
Gestational sac seen on scan
No clear foetus (empty gestational sac) or a foetal pole with no foetal heart seen in the gestational sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Presentation of an incomplete miscarriage

A

Most of the pregnancy expelled out but some of the products remaining in the uterus
Open cervix
Vaginal bleeding (may be heavy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presentation of complete miscarriage

A

Passed all products of conception
Cervix has closed
Bleeding has stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Causes of spontaneous miscarriage

A

Abnormal conceptus (genetic, chromosomal, structural)
Uterine abnormality (congenital, fibroid)
Cervical incompetence (primary - born with it or secondary - treatment to the cervix due to a bad smear i.e. iatrogenic)
Maternal increasing age
Maternal diabetes
Maternal SLE
Maternal thyroid disease
Maternal infection e.g. appendicitis
Hormonal imbalances (corpeus luteum, progesterone level lower)
Unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Treatment of missed miscarriage

A

Conservative
Prostaglandins (misoprostol)
SMM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does SMM stand for?

A

Surgical management of miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment of an inevitable miscarriage if the bleeding is really heavy

A

Evacuation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Treatment of septic abortion

A

Antibiotics

Evacuate uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Definition of ectopic pregnancy

A

Pregnancy implanted outside the uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Most common site of ectopic pregnancy

A

Ampulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How common is an ectopic pregnancy?

A

1 in 90 pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Risk factors for ectopic pregnancies

A 
History of PID
Previous tubal surgery/scarring 
previous ectopic pregnancy 
Assisted conception (IVF)
Mirena or copper coil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Presentation of ectopic pregnancy

A

period of amenorrhoea (wih +ve urine pregnancy test)
vaginal bleeding
pain in abdomen
GI or urinary symptoms
If has ruptured, usually features of hypovolaemic shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Investigations of ectopic pregnancy

A

History and examination
- pain more prominent on one side

Serum BhCG levels
- increased levels in pregnancy by 66% ish and serially track levels over 48 hour intervals

USS

  • No intrauterine gestational sac
  • empty uterine cavity
  • May see adnexal mass (outside uterine cavity)
  • fluid in pouch of douglas

Serum progesterone levels
- viable IU pregnancy levels >25ng/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Treatment of ectopic pregnancy

A

Methotrexate
Surgical - mostly laparoscopically (Salpingectomy)
Conservative

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When is surgery indicated in the treatment for ectopic pregnancy?

A

If it Is close to rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Salpingectomy vs Salpingotomy

A 
Salpingectomy = removal of one or both fallopian tubes
Salpingotomy = incision on the tube, remove pregnancy tissue and leave the tube
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Definition of antepartum haemorrhage

A

Haemorrhage from the genital tract after the 24th week of pregnancy but before the delivery of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Antepartum definition

A

Before delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Causes of antepartum haemorrhage

A 
Placenta praevia 
Placental abruption 
(APH of unknown origin)
Local lesions of the genital tract (including cervical or vaginal e.g. cervix erosions and polyps or thrush infections)
Vasa praevia
Uterine rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Placenta praevia definition

A

Placenta is attached to the lower segment of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Placental abruption definition

A

Placenta starts to separate from uterine wall before the birth of the baby and is associated with retroplacental clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Vasa praevia definition

A

Rupture of foetal blood vessels that sit near the internal opening of the uterus. Blood loss from the foetus can be catastrophic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Treatment of antepartum haemorrhage

A

Sometimes just settles
Attempting vaginal delivery
C section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Treatment for antepartum haemorrhage depends on…

A

Amount of bleeding
General condition of mother and baby
Gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Incidence of placenta praevia

A

1 in 200 pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Placenta praevia is more common in …..

A

multiparous women
multiple pregnancies
previous C section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Classification of placenta praevia

A

Grade I - Placenta encroaching on the lower segment but not the internal cervical OS
Grade II - Placenta reaches the internal OS
Grade III - Placenta eccentrically covers the OS
Grade IV - central placenta praevia = i.e. completely covering the surface of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Pathology of placenta praevia

A

Separation of the placenta causes bleeding as the lower uterine segments forms and the cervix effaces. the blood loss from the venous sinuses in the lower segment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Presentation of placenta praevia

A 
Painless PV bleeding (APH) recurrent
Malpresentation of the foetus
soft, non-tender uterus
Maternal condition correlates with amount of bleeding PV 
Incidental by USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Investigations of placenta praevia

A

Transvaginal USS to locate placental site

MRI (if USS not confirmatory)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What should NOT be done in placenta praevia

A

Vaginal exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Treatment of placental praevia depends on…..

A

Gestation at presentation

Severity of blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Treatment for placenta praevia

A

Caesarean section

Watch for PPH!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Treatment for PPH

A 
Medical (to contract the uterus)
- oxytocin 
- ergometrine
- carbaprost
- tranexamic acid 
Balloon tamponade 
Surgical (sutures)
- B lynch culture 
- Ligation of uterine 
- Iliac vessels 
- Hysterectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Placental abruption is associated with

A

Retroplacental clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Pathology of placental abruption

A

Placenta is in an abnormal site but there is separation from the wall and so bleeding behind the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Factors associated with placental abruption

A 
Pre-eclampsia/hypertension 
Multiple pregnancy 
Polyhydramnios 
Smoking
Cocaine use
Increasing age 
Parity 
Previous abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Types of placental abruption

A

Revealed
Concealed
Mixed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is a revealed placental abruption?

A

Major haemorrhage is apparent externally as blood released escapes through the cervical OS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is a concealed placental abruption?

A

Haemorrhage occurs between placenta and uterine wall. Uterine contents increase in volume and fundal height is larger than would be consistent for gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What can a concealed placental abruption result in?

A

Couvelaire uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is a couvelaire uterus?

A

In concealed placental abruption, in some situations blood penetrates the uterine wall and the uterus appears bruised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is a mixed placental abruption?

A

Concealed and revealed types together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What type of placental abruption is seen in the majority?

A

A mixed placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Presentation of placental abruption

A 
Pain - severe abdominal pain 
Vaginal bleeding (may be minimal)
Increased uterine activity
- tender and irritable uterus 
- having contractions 
Foetal lie is longitudinally with the presenting part fixed in the pelvis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Complications of placental abruption

A

Maternal shock, collapse (may be disproportionate to the amount of bleeding seen)
Foetal death
Maternal DIC, renal failure
PPH (couvelaire uterus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Definition of Pre Term Labour

A

Onset of labour before 37 weeks completed of gestation (259 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Spectrum of pre term labour

A

32-36 weeks = midly preterm
28-32 weeks = very preterm
24-28 weeks = extremely preterm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Types of pre term labour

A

Spontaneous

Induced (Iatrogenic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Incidence of preterm labour in singletons vs multiple pregnancy

A

Singletons = 5-7%

Multiple pregnancy = 30-40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Predisposing factors to preterm labour

A 
Multiple pregnancy 
Polyhydramnios 
APH 
Pre-eclampsia 
Infection e.g. UTI 
Prelabour premature rupture of membranes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Treatment of preterm labour

A

Consider tocolysis to allow steroids/transfer

Steriods unless contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What do tocolysis drugs do?

A

Slow down contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How long can tocolysis drugs be used for?

A

12-24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What do steroids do in preterm labour?

A

Help the babys lungs cope better when it is born

Also allows for transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Neonatal prematurity can result in …..

A 
Respiratory distress syndrome
Intraventricular haemorrhage 
CP 
Nutrition 
Temp control 
Jaundice
Infections
Visual impairment 
Hearing loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Essential/chronic hypertension in pregnancy is commoner in which age of mothers?

A

Older mothers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Definition of Pre-eclampsia

A

Mild Hypertension on two occasions more than 4 hours apart or moderate to severe hypertension on one occasion
PLUS
Proteinuria >300mgm/s 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Risk factors for developing pre eclampsia

A 
First pregnancy 
Extremes of maternal age 
Pre eclampsia in previous pregnancy 
Pregnancy interval > 10 years
BMI > 35
FH of pre eclampsia 
Multiple pregnancy 
Underlying medical disorders (Chronic HTN, pre-existing renal disease, pre-existing diabetes, autoimmune disorders like SLE)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Maternal complications of pre-eclampsia

A 
Eclampsia 
Severe HTN leads to cerebral haemorrhage, stroke
HELLP
DIC
Renal failure
Pulmonary oedema and cardiac failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What does HELLP stand for?

A

Haemolysis, elevated liver enzymes, low platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What does DIC stand for?

A

Disseminated intravascular coagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Foetal complications of pre eclampsia

A

Impaired placental perfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What does impaired placental perfusion lead to?

A

IUGR
Foetal distress
Prematurity
increased PN mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Symptoms/Signs of Pre eclampsia

A 
Headache
Blurring of vision 
Vomiting 
Epigastric pain 
Pain below ribs
sudden swelling of hands, face and legs
Severe HTN + >3 urine proteinuria
Clonus/brisk reflexes
Papilloedema 
Reduced urine output 
Convulsions (eclampsia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Biochemical abnormalities of pre eclampsia

A

Raised liver enzymes
Bilirubin in HELLP present
Raised urea and creatinine
Raised urate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Haematological abnormalities of pre eclampsia

A

Low platelets
Low haemoglobin
Signs of haemolysis
Features DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Investigations for pre eclampsia

A

Frequent BP checks
Urine protein
Check symptomatology
Bloods (FBC, LFTs, RFTs, coagulation if needed)
Foetal investigations (scan for growth, CTG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Only cure for pre eclampsia

A

Delivery of the baby and the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Treatment of seizures/impending seizures in pre-eclampsia

A

Magnesium sulphate bolus + IV bolus
Control of BP - IV labetolol, hydralazine (if >160/110)
Avoid fluid overload - aim for 80ml/hr for fluid intake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Prophylaxis for pre eclampsia in subsequent pregnancy is …..

A

Low dose aspirin from 12 weeks until delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Women with pre eclampsia are at a higher risk of developing what later in life?

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Effects of diabetes in pregnancy

A 
Insulin requirements of mother increase
Foetal hyperinsulinaemia occurs -> macrosomnia 
More risk of neonatal hypoglycaemia
Increased risk of respiratory distress
Increased risk of foetal cardiac abnormalities 
Miscarriage 
Feotal macrosomnia, polyhydramnios 
Operative delivery 
Shoulder dystocia 
Stillbirth
Increased risk of pre-eclampsia 
Worsening of maternal nephropathy, retinopathy, hypoglycaemia, reduced awareness of hypoglycaemia 
Infections
impaired lung maturity of neonatal 
neonatal hypoglycaemia 
Jaundice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Treatment of Diabetes in pregnancy - Pre-conception

A

Better glycaemic control
Folic acid 5mg
Diet
retinal and renal assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Treatment of diabetes during pregnancy

A

Optimise glucose control
Can continue oral diuretic agents (metformin) but may need to change to insulin for tighter control
Provide treatment for hypos
Labour induced usually 38-40 weeks
C section possible if macrosomnia
Early feeding of baby to reduce neonatal hypoglycaemia
Insulin requirements increase during pregnancy

87
Q

Risk factors for gestational diabetes

A

Increased BMI > 30
Previous macrosomia baby >4.5kg
Previous GDM
FH of DM
High risk groups for developing DM e.g. Asians
Polyhydramnios
Big baby currently in pregnancy
Recurrent glycosuria in current pregnancy
GDM associated with some increased in maternal or foetal complications

88
Q

Screening for gestational diabetes

A

If risk factor
HbA1c
OGTT

89
Q

Treatment for gestational diabetes

A

Control blood sugars (diet, insulin, metformin)
Post delivery - check OGTT 6 to 8 weeks
Yearly check of HbA1c/blood sugars as increased risk for developing DM

90
Q

Virchows triad

A

Stasis
Vessel wall injury
Hypercoagulability

91
Q

Why is there a risk of thrombo-embolism in pregnancy?

A

It is a hypercoagulable state (to protect the mother against bleeding post delivery)

92
Q

What happens in the blood to make pregnancy a hypercoagulable state?

A

Increased fibrinogen, factor VIII, VW factors, Platelets
Decrease in natural anticoagulants -> antithrombin III
Increase in fibrinolysis

93
Q

Vircows triad in respect to pregnancy

A
  1. STASIS - progesterone and effects of enlarging uterus cause increases stasis
  2. HYPERCOAGULABILITY - hypercoagulable state in pregnancy
  3. VESSEL WALL INJURY - maybe vascular damage at delivery/ caesarean section
94
Q

Increased risk of VTE seen in …..

A 
Older mothers 
Increasing parity 
smokers 
IVDU 
PET 
increased BMI
Dehydration - hyperemesis 
Decreased mobility
Infections 
FH of VTE
Sickle cell disease
Operative delivery/prolonged labour
Haemorrhage, blood loss > 2L
Previous VTE not explained by predisposing factors
Those with thrombophilia
95
Q

Prophylaxis of VTE in pregnancy

A

TED stockings
Increased mobility
Hydration
Prophylactic anticoagulation if increased risk factors

96
Q

Presentation of VTE

A 
Pain in calf
Increased girth of affected leg
Calf muscle tenderness
Breathlessness
Pain on breathing
Cough 
Tachycardia 
Hypoxic 
Pleural rub
97
Q

Investigations of VTE

A

ECG
Blood gases
Doppler V/Q lung scan
CTPA

98
Q

Treatment of VTE

A

anticoagulation

99
Q

Effects of progesterone on the uterus

A

Thickens the lining
Changes the cells
Turns the endometrium into decidua

100
Q

What happens when the endometrium is turned into a decidua?

A

Increases vascularity
Between glands and vessels the stromal cells enlarge and become procoagulant -> stops bleeding
Monthly shredding occurs here and is akin to falling of leaves from a decidual tree

101
Q

Another name for the egg

A

Chorion

102
Q

Where are trophoblast cells found?

A

On the outside of a fertilised egg

103
Q

What do trophoblast cells produce?

A

Beta human chorionic gonadotrophin (B-hCG)

104
Q

Function of BhCG

A

It is to keep and stimulate the corpeus luteum to produce progesterone throughout pregnancy, and stops the decidua from shredding

105
Q

Clinical implication of BhCG

A

Forms the basis of pregnancy tests

106
Q

What do trophoblast cells do once the fertilised egg is buried into the decidua?

A

Stem off to invade mothers blood vessels and (eventually) link those vessels up with those of the foetus, so try to turn into placental cells to form the placenta

107
Q

Where are the decidual stromal cells found?

A

Between the vessels (foetal and maternal)

108
Q

What is the function of the decidual stromal cells?

A

The cells are procoagulant and stop the trophoblast cells causing too much bleeding when they invade the mothers blood vessels

109
Q

How is the forerunner of the placenta eventually formed?

A

Chorionic villi, covered by trophoblast cells, are bather in the mothers blood, forming the forerunner of the placenta

110
Q

Why are ectopic pregnancies predisposed to haemorrhage and rupture?

A

Lack of decidual layer

Small size of tube

111
Q

A major anomaly of Downs Syndrome

A

Duodenal atresia

112
Q

What does macrosomnia of babys in mothers with DM predispose the baby to?

A

Intrauterine death (IUD)

113
Q

Acute chorioamnionitis definition

A

Acute inflammation with neutrophils present in the membranes (chorioamnionitis), cord and foetal plate of the placenta

114
Q

Pathology of acute chorioamnionitis

A

Perineal or perianal bacteria ascend vaginally and get into the amniotic sac

115
Q

Presentation of acute chorioamnionitis

A 
Mother
- ill 
- fever
- raised neutrophils
- can be well 
Baby 
- IUD
- ill in first days of life
- CP later on in life
116
Q

How does the ascending infection in acute chorioamnionitis affect the babys brain?

A

Neutrophils produce ‘cytokine storm’ which activates some brain cells, which then get damaged by the normal hypoxia of labour

117
Q

When does the withdrawal hit the baby is the mother is on heroin vs methadone?

A

Heroin => immediate withdrawal

Methadone => later withdrawal

118
Q

When the mother is addicted to opiates, the pregnancy often proceeds well if the mother does what?

A

If she eats properly

119
Q

Conditions associated with cyclical abdominal pain

A

Endometriosis

Imperforate Hymen

120
Q

What heart rate is defined as foetal tachycardia?

A

> 160bpm

121
Q

Most common cause of PPH

A

Uterine atony

122
Q

Definition of uterine atony

A

The uterus fails to contract after the delivery of the placenta

123
Q

What heart rate is defined as fetal bradycardia?

A

<100 bpm

124
Q

What is the cervical os?

A

Opening in the lower part of the cervix between the uterus and the vagina

  • internal os
  • external os
125
Q

Definition of recurrence miscarriage

A

3 or more miscarriages

126
Q

What is the most common cause of miscarriage?

A

Foetal chromosomal abnormality

127
Q

If someone is passing clots, what does this indicate?

A

A miscarriage

128
Q

If someone is passing small amounts of blood, what does this indicate?

A

An ectopic pregnancy

129
Q

If you can see the foetal heart on transvaginal scan, what is the chance of miscarriage?

A

< 50 %

130
Q

How to tell difference between ectopic pregnancy or complete miscarriage on scan

A

BhCG levels

- redo after 48 hours and if the levels have come down = complete miscarriage

131
Q

If the serum progesterone is < 20, what does this indicate?

A

Likely to be a failing pregnancy

132
Q

What on the scan indicates a delayed/missed miscarriage?

A

Foetal pole but no heart OR

Foetal sac but no foetus

133
Q

What is the most important aspect in the management of miscarriage?

A

Psychological help

134
Q

Types of management of miscarriage

A
  1. SMM
  2. Medical
  3. Expected
135
Q

Which of the types of management of miscarriage have the highest rate of infection?

A

SMM

136
Q

What are the risks of having an increased age of mum?

A 
Increased risk of foetal chromosomal abnormalities
Increased risk to the mother
- placenta praevia 
- pre eclampsia
- DVT
Contractions in labour not as effective
Stillbirth risk
137
Q

What BhCG level indicates a viable foetus on USS?

A

> 1500

138
Q

What is a heterotopic pregnancy?

A

A rare complication of pregnancy in which both extra-uterine (ectopic pregnancy) and intra uterine pregnancy occur simultanoeusly

139
Q

Risk factors for heterotopic pregnancy

A

Same for ectopic pregnancy

140
Q

Treatment of heterotopic pregnancy

A

Salpingectomy or salinpingotomy

141
Q

What is a molar pregnancy?

A

An abnormal form of pregnancy in which a non viable fertilized egg implants in the uterus and will fail to come to term. It grows into a mass in the uterus that has swollen chorionic villi

142
Q

What is the growth grown in molar pregnancy called?

A

Hydatidiform mole

143
Q

Types of molar pregnancy

A

Complete

Partial

144
Q

What is a complete molar pregnancy?

A

There is a mass of abnormal cells with NO foetal parts

145
Q

What is a partial molar pregnancy?

A

An abnormal foetus starts to form but it cannot survive or develop into a baby

146
Q

Presentation of molar pregnancy

A 
Often asymptomatic 
Vaginal bleeding / dark discharge
Swollen abdomen 
Morning sickness 
Hyperemesis 
Pain
147
Q

Investigations of a molar pregnany

A

High BhCG

USS

148
Q

Risk factors for molar pregnancy

A

> 35 y/o or < 20 y/o

Previous molar pregnancy

149
Q

Treatment of a molar pregnancy

A

Suction removal and evacuation
Methotrexate if persistent
Hysterectomy

150
Q

What is a complication that can happen after a molar pregnancy? What is this called?

A

Some abnormal cells can be left in the womb

It is called persistent trophoblastic disease

151
Q

Treatment of persistent trophoblastic disease

A

Chemotherapy

152
Q

What can develop if the cells left behind in a pregnancy become cancerous?

A

Choriocarcinoma

153
Q

What type of molar pregnancy is a choriocarcinoma more common in?

A

Complete

154
Q

A choriocarcinoma can occur after what?

A 
Normal birth 
Miscarriage
Ectopic pregnancy 
Abortion 
Molar pregnancy
155
Q

What is the most common origin of a cholangiocarcinoma?

A

Molar pregnancy

156
Q

Treatment of a cholangiocarcinoma

A

Chemotherapy

157
Q

Pregnancy after treatment for a molar pregnancy

A

Should not get pregnant for 6 months

158
Q

Contraception after treatment for a molar pregnancy

A

Cannot use IUD

Can use any other form of contraception

159
Q

Serum alpha-feto protein (AFP) can be raised in pregnancy due to what?

A

Foetal abdominal wall defects e.g. omphalocele
Neural tube defects e.g. mengiocele
Multiple pregnancy

160
Q

In a women with severe pre-eclampsia or eclampsia, when should the IV magnesium infusion be stopped?

A

24 hours after last seizure

161
Q

Presentation of acute fatty liver of pregnancy

A 
Jaundice
Mild pyrexia
Hepatic LFTs
Raised WBC
Coagulopathy 
Malaise
Fatigue 
Nausea
162
Q

Who is offered expectant management of ectopic pregnancy?

A

Low B-hCG
No symptoms
Tubal ectopic pregnancy < 35mm with no heartbeat

163
Q

Treatment of thrush in pregnancy

A

Clotrimazole pessary

164
Q

Another name for thrush

A

Vaginal candidadis

165
Q

Risk factors for thrush

A 
DM
Drugs
- antibiotics
- steriods
Pregnancy 
Immunosuppression 
- HIV
- Iatrogenic
166
Q

Presentation of thrush

A 
"Cottge cheese" Discharge
Non offensive discharge 
Itch 
Vulvitis
- dysuria
- dyspanureia 
Vulval erythema, fissuring, satellite lesions may be seen
167
Q

Treatment of thrush

A 
Local treatment 
- clotrimazole pessary 
Oral treatment
- itraconazole or fluconazole 
If pregnant then only local treatment can be used
168
Q

What % of preterm deliveries are assosiated with pre term prelabour rupture of membrane?

A

40%

169
Q

Complications of pre term pre labour rupture of membranes

A 
Foetal 
- prematurity
- infection 
- pulmonary hypoplasia
Maternal chorioamniotiis
170
Q

Management of pre term pre labour rupture of membranes

A

Admit
Regular observations to check chorioamniotitis is not occuring
Oral erythromycin for 10 days
Corticosteriods
Delivery should be considered at 34 weeks gestation

171
Q

What does an ovarian torsion look like on USS?

A

Whirlpool sign

Free fluid

172
Q

Definition of oligohydramnios

A

Reduced amniotic fluid

  • less than 500ml at 32 - 36 weeks
  • AFI < 5th percentile
173
Q

Causes of oligohydramnios

A 
Premature rupture of membranes 
Foetal renal problems e.g. renal agenesis 
IUGR
Post term gestation 
Pre eclampsia
174
Q

What should be given to all women with premature prelabour rupture of membranes?

A

10 days erythromycin

175
Q

What is the location of an ectopic pregnancy that has the biggest risk of rupture?

A

Isthmus

176
Q

What is sensitisation?

A

A process whereby foetal red blood cells (RhD-positive) enter the maternal circulation, when the mother is RhD-negative. The foetal maternal haemorrhage (FMH) can cause antibodies to form in the maternal circulation that can haemolyse foetal red blood cells

177
Q

What is a complication of sensitization in subsequent pregnancies?

A

Haemolytic disease of the foetus and newborn

178
Q

How is the risk of sensitisation is reduced in people at risk?

A

Anti-D immunoglobulin

179
Q

What are the potentially sensitizing events in pregnancy?

A 
Ectopic pregnancy 
Evacuation of retained products of conception or a molar pregnancy 
Vaginal bleeding < 12 weeks if heavy, painful or persistent
Vaginal bleeding > 12 weeks
CVS and amniocentesis
APH
Abdominal trauma
External cephalic version 
IUD
Post delivery (if baby RhD positive)
180
Q

In the abscence of a observable sensitising event, when is prophylactic anti-D given to mothers?

A

Previously non sensitised women at 28 and 34 weeks

181
Q

Causes of bleeding in the 1st trimester

A

Spontaneous abortion
Ectopic pregnancy
Hydatiform mole

182
Q

Causes of bleeding in the 2nd trimester

A

Spontaneous abortion
Hydatiform mole
Placental abruption

183
Q

Causes of bleeding in the 3rd trimester

A

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

184
Q

Presentation of hydatiform mole

A

Bleeding in first or second trimester
Exagerated symptoms of pregnancy e.g. hyperemesis gravidarum
Uterus large for dates
Very high serum hCG

185
Q

Define significant proteinuria

A

300 mg > 24 hours
Mild - 1 + on dipstick
Moderate - 2+ on dipstick
Severe - 3 + on dipstick

186
Q

Definition of eclampsia

A

Seizure in the presence of PET

187
Q

What is the issue with a pregnant women on their back?

A

Caval compression

188
Q

What happens to your reflexs in severe PET?

A

Hyperreflexia

189
Q

Blood results in PET

A 
FBC
Urate
HELLP 
- microangipathy 
- haemolytic anaemia
190
Q

What HTN value does it have to be in PET?

A

130 / 86

191
Q

Common causes of proteinuria in pregnancy

A

UTI

Vaginal discharge

192
Q

Does PET have warning signs?

A

Yes

193
Q

BP for severe PET

A

160 / 110

194
Q

Features of severe PET

A 
BP 160/110
3 + protein 
Oliguria < 400ml 
PO
PCO 
CO 
Cerebral neurologial symptoms
195
Q

How does severe PET cause neurological symptoms?

A

Vasospasm due to HTN

196
Q

Risk factors for miscarriage

A 
Older age 
Previous miscarriages
Chronic conditions e.g. uncontrolled diabetes
Uterine or cervical problems 
Smoking / alcohol / drugs
Underweight / overweight 
Invasive prenatal tests
197
Q

What is placenta accreta?

A

Morbidly adherent placenta

198
Q

What is the most common cause of APH?

A

Cervical ectropion

199
Q

What is cervical ectropion a diagnosis of?

A

Exclusion

200
Q

When is vasa praevia most common?

A

When rupturing the membranes

201
Q

Causes of APH

A 
Placenta praevia
Placental abruption 
Early labour
Scar rupture 
UTI
202
Q

How much Rh is given and when?

A

1500 units at 28 weeks if Rh -ve

Extra if sensitising events

203
Q

Why are transvaginal USS scans done?

A

To look at the placenta

204
Q

What do recurrent small bleeds require?

A

Growth scans

205
Q

What is a marginal abruption?

A

Tiny bit of placenta breaks off

206
Q

When is syntocin given?

A

C section

207
Q

When is syntometrin given?

A

Delivery

208
Q

What contraindication does syntometrine have and why?

A

High BP

Ergometrine raised BP

209
Q

Who in C sections gets given tranexamic acid?

A

EBL > 500

210
Q

What does EBL stand for?

A

Estimated blood loss

211
Q

If Lochia persists beyond 6 weeks, what should be done?

A

USS to investigate the possibility of RPOC

212
Q

When can magnesium be stopped in eclampsia?

A

24 hours after delivery or 24 hours after last seizure

213
Q

What test is given to rheus negative women after they get their 28 week dose of anti D?

A

Kleihaur test

214
Q

Classic triad of vasa praevia

A

Rupture of membranes
Painless vaginal bleeding
Foetal bradycardia

Reproduction Pathology (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions