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Gynecology > Exam Qs Oral > Flashcards

Exam Qs Oral Flashcards

1
Q

Who to screen for gestational diabetes

A

Part of screening program = check all pregnant

  • At 24-28 gw
  • At time 0 min (lower than 5,6), 120 min (lower than 7,8) «5,6,7,8»
  • 75 gram glucose
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2
Q

Define preeclampsia

A
  • Original version: after 20 gw, hypertensive disorder (over 140/90) + proteinuria (300mg/24 hrs)
  • Need hypertension + something else (not necessary with proteinuria in new definition)
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3
Q

Postpartum hemorrhage

A

4 T´s

  • Tone: uterine atony is an exclusion diagnosis (after excluding the other T´s)
  • Tissue
  • Trauma
  • Thrombin
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4
Q

Pregnant to emergency 30th gw and bleeding - DDx and what to do

A
  • First: good morning (no anamnesis) + CTG (fast)
  • Placenta previa or placental abruption
  • How to check: First palpate uterus - outer examination/abdomen (if hard - abruption - surgery) (if normal - previa)
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5
Q

Presumptive, probable, definite signs of pregnancy

A
  • Presumptive: signs we can have in pregnant, non-pregnant and men (nausea, vomiting)
  • Probable: in pregnant and non-pregnant (physical changes, pregnancy tests - can be tumor)
  • Definite sign: detecting fetus (US, CTG)
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6
Q

US screenings

A

5 screenings:

  • Type 0: detect pregnancy
  • Type 1: 11 gw +0 days - 13 gw+6 days, screen downs, malformations, detect pregnancy, size
  • Type 2: genetic
  • Type 3: IUGR
  • Type 4: 38 gw, position, size, estimated weight etc
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7
Q

Stages of delivery

A
  • First stage: dilation cervix (9 or 11 hrs, multiparous: half)
  • Second: delivery of fetus (50-60 min, multi: half)
  • Third: delivery placenta (5-15 min, should not be longer than 30 min)
  • Fourth: artificial, 2 hrs observation
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8
Q

Delivery starts - signs

A
  • Regular contractions (every 10 min or more often)

- Rupture of membranes

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9
Q

Folliculogenesis

A

Sperm & egg are both produced in 60-90 days - so the egg that is ovulated is produced 3 cycles before (after spontaneous abortion the whole system is at time zero, so therapy will give pregnancy earliest after 3 months)

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10
Q

Ovulation time

A

24 hrs after LH surge

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11
Q

Hormonogenesis

A

The hormones are produced by the follicles in the ovaries, so a person with ovaries, but no follicles in them, does not produce sexual hormones (e.g Turner syndrome)

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12
Q

Ovulation - chance of getting pregnant

A
  • Sperm lives 48 hrs
  • Egg should be fertilized within ~12 hrs after ovulation (max 24 hrs)
  • So approximately a 3 days window of when intercourse leads to pregnancy
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13
Q

hCG (human chorionic gonadotropin) - pregnancy test

A
  • Urine (yes/no)
  • Serum to know when pregnancy happened - important in ectopic pregnancy, but still do urine tests in emergencies because faster results
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14
Q

Spontaneous abortion %

A
  • 60-70 % of all pregnancies end in spontaneous abortions - many not recognized
  • Clinically detected pregnancies - 10-15 % end in spontaneous abortion
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15
Q

Folic acid

A
  • Daily requirement: 300-500 microgram

- To avoid neural tube defects

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16
Q

Dilution anemia in pregnany

A

Dilution anemia (lower Hgb, Htc) - normal during pregnancy («she´s not anemic»), true anemia is Hgb below 12 g/dl

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17
Q

Leukocytosis in pregnancy

A

Leukocytosis is normal 10000-16000

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18
Q

Proteins in pregnancy

A

Eat and drink as much proteins as possible - at least 65 g/day (for normal growth, development of fetus)

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19
Q

AFP (alphafetoprotein) in pregnancy

A
  • Peak at week 13

- Screening at 16th week for NTD

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20
Q

Arterial blood pressure in pregnancy

A

Does not increase in normal pregnancy! (OBS preeclampsia)

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21
Q

Chadwick´s sign

A

Bluish discoloration of cervix, vagina and labia resulting from increased blood flow. Can be observed spprox 6-8 weeks after congestion as an early sign of pregnancy.

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22
Q

«Mask of pregnancy»

A

Chloasma

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23
Q

Hormone responsible for bone and joint changes during pregnancy

A

Relaxin (source: corpus luteum, ovary, breast etc)

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24
Q

Normal weight gain during pregnancy

A

10-12 kg

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25
Q

Average length of labor

A

Nulliparous: 12-18 hours
Multiparous: 6-8 hours

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26
Q

Ruptured membranes without regular contractions first

A

Increased risk of infection

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27
Q

Stages of partuition

A
  • Phase 0: uterine quiescence
  • Phase 1: preparation for labour
  • Phase 2: process of labor (1st, 2nd, 3rd)
  • Phase 3: recovery
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28
Q

Principles of management of labor

A
  1. Diagnosis of labour
  2. Monitoring the process of labour
  3. Ensuring maternal well-being
  4. Ensuring fetal well-being (CTG)
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29
Q

Criteria for normal labour (8)

A
  1. Spontaneous expulsion
  2. Of a single (twins/triplets «not normal» labour)
  3. Mature fetus (gw 37 - 42)
  4. Presented by vertex
  5. Through the birth canal
  6. Within reasonable time (more than 3, less than 18 hours)
  7. Without complications to the mother
  8. Without complications to the fetus
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30
Q

3 P´s in progress of labour

A
  • Power: uterus (myometrium)
  • Passenger: fetus (head mostly)
  • Passage: pelvis of the mother
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31
Q

Stages of delivery

A
  • First stage: cervical dilation and effacement
  • Second stage: birth
  • Third stage: placental stage
  • Fourth stage: postplacental stage
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32
Q

First stage of delivery

A

Cervical dilation and effacement

  • Contractions (regular, stronger, more frequent, longer)
  • Cervical dilation: latent phase (3 cm), active phase (3-10 cm)
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33
Q

Second stage of delivery

A

Birth, 2 phases:

  • Propulsive phase (ful dilation and presenting part in pelvic floor)
  • Expulsive phase (delivery of fetus)
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34
Q

Third phase of delivery

A

Placental stage (5-20min)

  • 2 phases: Separation and expulsion
  • Check if missing parts of placenta or if hemorrhage (150-250 ml is normal)
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35
Q

Considerations regarding fetal position in labor (4)

A
  1. Lie (longitudinal, transverse, oblique)
  2. Presentation (vertex, breech, transverse, face, brow, shoulder etc)
  3. Attitude or posture (ovoid mass)
  4. Position (left vs right)
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36
Q

Fetal lie

A

Relation of long axis of fetus to that of the mother

  • Longitudinal (99 %)
  • Transverse
  • Oblique (unstable - always become longitudinal or transverse during labor)
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37
Q

Smallest diameter fetal posture

A

Suboccipitobregmatic diameter

38
Q

Leopold maneuvers

A
  1. First maneuver
    Palms at uterine fundus - should feel soft (butt of baby)
    If hard: can be the head due to baby lying in breech presentation
  2. Second maneuver
    Palms on each side on belly
  3. Third maneuver
    Thumb and fingers at lower abdomen
    Movable mass- the presenting part is not engaged
    Differentiation between head and breech
  4. Fourth maneuver
    Examiner faces mothers feet - tips of fingers each hand exerts deep pressure in direction of the axis of the pelvic inlet
    Feel if passes through pelvis(?)
39
Q

Amniotomy

A

No spontaneous rupture of membranes, so we have to artificially rupture it - more rapid labour

40
Q

Amnioscopy

A
  • Check colour (urine like, brown, green, red) and amount of amniotic fluid
  • Meconic amniotic fluid: can be due to hypoxic fetal state
41
Q

True labour

A
  • Regular contractions
  • Intervals shorten
  • Intensity increase
  • Discomfort back/abdomen (?)
42
Q

False labour

A
  • Irregular contractions
  • Intervals remain long
  • Intensity remains unchanged
  • Discomfort is chiefly in lower abdomen
  • Cervix does not dilate
  • Discomfort usually relieved by sedation
43
Q

Heart beat fetus

A

6 weeks

44
Q

Naegele rule

A

Estimate expected delivery

- First day of last menstrual period + 7 days - 3 months

45
Q

Crown-rump length

A

Best to estimate due date

- US first trimester

46
Q

Hegar sign

A
  • Softening in consistency of the uterus

- Uterus and cervix seem to be two separate

47
Q

Piskacek sign

A

Softened prominence of uterus

48
Q

Fetal surveillance

A
  • HR: week 16-19
  • US: from week 5-6
  • Amniotic fluid
  • Fetal movement: week 18-20
49
Q

Fifth Leopold maneuver

A

Zangemeister maneuver

50
Q

Obstetrical hemorrhage groups

A
  1. Early
  2. Late
    - Antepartum
    - Intrapartum
    - Postpartum
51
Q

Causes of early hemorrhage

A
  • Molar pregnancy

- Ectopic pregnancy

52
Q

Causes of late hemorrhage

A
  • Abruptio placentae
  • Placenta previa
  • Postpartum hemorrhage (4 T´s - uterine atony most common)
53
Q

Postpartum hemorrhage definition

A
  • Losing over 500 ml after vaginal delivery

- Losing over 1000 ml after c-section

54
Q

Indication induced abortion

A
  • Non-medical: until 12th gw (18th if crime, misdiagnosis)

- Medical: until 20th gw (24th if laboratory delay)

55
Q

Induced abortion techniques

A

Until gw 6

  • Menstrual aspiration
  • Medical abortion

Until gw 12

  • Cervical dilatation
  • Evacuating pregnancy

Second trimester

  • Medical induction
  • Oxytocin infusion
  • Curettage
56
Q

C-section vs forceps/vaccum

A

First stage of labor: c-section

Second stage of labor: forceps, vacuum - c-section is no longer an option

57
Q

Cephalopelvic disproportion

A

Estimated fetal weight (4500 gr)

Height of mother (under 150 cm)

58
Q

Prerequesite and contraindications of c-section

A

No absolute prerequesite - except that fetal head is not engaged (aka 1st stage labor)

No absolute contraindication

59
Q

Anesthesia in labor

A
  • Vaginal=epidural
  • C-section=spinal
  • Emergency c-section =intratracheal
60
Q

Abdominal incision

A
  • Vertical incision: lower median

- Suprapubic transverse incision: Pfannenstiel

61
Q

Uterine incision

A
  • Classical incision (corporal longitudinal): easier, but seldom used today because all forecoming pregnancies must be delivered by c-section due to rupture risk
  • Transperitoneal cervical transverse (tct incision): mostly used today, least likely place to rupture in later pregnancy
62
Q

HCG levels in different pregnancies

A
  • hCG doubles every 2nd day in normal pregnancy
  • Decreased hCG can be spontaneous abortion
  • Steady slowly increasing hCG indicates extrauterine pregnancy
63
Q

US ectopic tubal pregnancy

A

US ectopic pregnancy: tubal ring (donut) with flow around it

64
Q

Polyhidromnia

A

Over 25 cm

65
Q

Oligohydromnia

A

Less than 5 cm

66
Q

Anhydromnia

A

Less than 3 cm

67
Q

Size of fetus gw 12

A

Man fist

68
Q

Size of fetus gw 26

A

At level of navel

69
Q

Size of fetus gw 34

A

Between navel and xiphoid

70
Q

Big belly causes

A
  • Twins
  • Big baby
  • Polyhydramnios
71
Q

Normal heart beat CTG

A

120-160 bpm

72
Q

Decellerations CTG

A

Over 15 bpm for over 15 seconds = bad prognosis

73
Q

Pearl index different contraceptives

A
  • Oral contraceptive pill: 0.1 – 2.5
  • Emergency contraceptive pill (postcoital): 0.5 – 2.5
  • Intrauterine device: 0.5 - 5.0
  • Operative methods (sterilisation): 0.3 – 6.0
  • Condom: 3 - 28
74
Q

Uterine fundal height

A
  • 20: 2 fingers under umbilicus
  • 24: Umbilicus
  • 28: 2 f above umbilicus
  • 32: 4 f above umbilicus
  • 35: between xyphoid and umbilicus
  • 36: 4 f below xy
  • 37: 3 f below xy
  • 38: 2 f below xy
  • 39: 3 f below xy (descend)
  • 40: 4 f below xy (decend/engage)
75
Q

Normal weight newborn

A

2500-4290 gr

76
Q

Normal length newborn

A

44-54 cm

77
Q

Normal head circumference

A

32-38 cm

78
Q

Normal abdominal circumference

A

17-24 cm

79
Q

Average umbilical cord (length, diameter, helices)

A
  • Length: 55 cm
  • Diameter: 1-2 cm
  • 11 helices
80
Q

Abortion definition

A

Loss of fetus younger than 20 gw

81
Q

Stillbirth definition

A

Delivery of dead fetus over 20 gw (or 350 gr if gw not known)

82
Q

Neonate definition

A

0-28 days

  • Early: first 7 days
  • Late: 8-28 days
83
Q

Infant definition

A

0-365 days

84
Q

Early preterm

A

20-33+6

85
Q

Late preterm

A

34-36+6

86
Q

Postterm

A

Over 42 gw

87
Q

6 fetal movements in labor

A

1) Descent
2) Flexion
3) Internal rotation
4) Extension
5) External rotation
6) Expulsion

88
Q

Station: Floating

A

-5

89
Q

Station: engaged

A

0

90
Q

Station: crowning

A

+5

91
Q

Smallest diameter fetal head (name)

A

Suboccipitobregmatic

Gynecology (4 decks)

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