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Leeds MBCHB Year 4 GOSH > General obstetrics > Flashcards

General obstetrics Flashcards

1
Q

GnRH is released from ? and acts on ?

A

Hypothalmus and acts on anterior pituitary

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2
Q

GnRH stimulates the release of?

A

LH and FSH

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3
Q

What cells secrete oestrogen

A

Theca granulosa cells

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4
Q

Staging for puberty ?

A

Tanner

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5
Q

What provides negative feedback for LH and FSH

A

Oestrogen

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6
Q

What can affect age of puberty

A

Fat (aromatase in adipose tissue)

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7
Q

Skin changes in pregnancy and cause

A

Increased melanocyte stimulating hormone

Melasma, linea nigra

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8
Q

What produces hCG

A

synctiotiotrophoblast

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9
Q

Causes of raised hCG

A

Twins and molar pregnancy

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10
Q

hCG main function

A

Maintain corpus luteum (which produces progesterone)

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11
Q

Where is progesterone produced after 5 weeks?

A

Placenta (instead of corpus luteum)

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12
Q

Oestrogen function: (4)

A

Breast tissue development
Growth and development of female sex organs
Blood vessels in uterus
Development of endometrium

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13
Q

Progesterone function: (3)

A

Thicken and maintain endometrium
Thicken cervical mucus
Increase body temperature

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14
Q

oligohydramnios meaning

A

Low amniotic fluid levels

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15
Q

Meigs syndrome

A

Triad of ascites, benign ovarian tumour (fibroma) and pleural effusion

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16
Q

Drugs ending in -relin and function

A

GnRH agonist

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17
Q

Drugs ending in -relix

A

GnRH antagonist

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18
Q

Goserelin class

A

GnRH agonist

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19
Q

Mnemonic for CTG reading

A

DR C Bravado

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20
Q

Degarelix class

A

GnRH antagonist

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21
Q

G? P? Patient is pregnant and had one previous baby

A

G2 P1

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22
Q

G? P? Patient is currently pregnant and had two previous deliveries

A

G3 P2

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23
Q

Gravity and parity

A 
Gravity = number of times pregnant
Parity = number of times pregnant past 24 week
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24
Q

What is Mendelson’s syndrome

A

Aspiration of gastric juices into maternal lungs during analgesia in child birth

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25
Q

Methods for labour induction (3)

A

Vaginal prostoglandins
Amniotomy
Membrane sweep

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26
Q

How do prostaglandins induce labour

A

Ripen cervix and help smooth muscle of uterus contract

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27
Q

Drug to increase strength and frequency of contractions

A

Syntocinon (artificial oxytocin)

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28
Q

When is membrane sweep offered to most women

A

40 and 41 weeks to nulliparous

41 weeks to multiparous

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29
Q

Score to access cervical ripeness

A

Bishops

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30
Q

Bishops score cut offs (2)

A

7 or above: cervix is ripe

Less than 4: labour is unlikely to progress naturally

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31
Q

Common complications of IOL

A

failure (15% - give further cycle), uterine hyper stimulation (5% - give tocolytic agent like terbutaline), pain, infection, further intervention, rupture

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32
Q

OVD meaning

A

Operative vaginal delivery. Use of instrument to aid delivery

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33
Q

Terbutaline

A

Treats uterine hypersensitivity. Tocolytic.

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34
Q

Two types of OVD

A

Ventouse and forceps

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35
Q

Complications of forceps use

A

Higher rate of 3/4 degree tear

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36
Q

When would you expect delivery after pushing begins (time to use OVD)

A

2 hours in NP

1 hour in MP

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37
Q

Pre-requisites for instrument delivery

A

Fully dilated, ruptured membranes, cephalic presentation, metal head at ischial spine, empty bladder

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38
Q

P-PROM vs PROM

A

P-PROM is before 37 weeks

PROM is after 37 weeks (takes longer than 1 hour to then enter labour)

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39
Q

Stage 1 of labour

A

Onset of true contractions till 10cm dilation

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40
Q

Latent phase of labour

A

0 to 3cm dilation - progressing at 0.5cm an hour

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41
Q

Active phase of labour

A

3-7cm dilation - progressing at 1cm an hour

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42
Q

What are Braxton-hicks contractions

A

Occasional irregular that do not indicate labour

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43
Q

What is the “show” in labour

A

Plug of mucus leaves cervix

44
Q

Ergometrine

A

Contracts uterus to treat post partum haemorrhage. Commonly given with Oxytocin

45
Q

Folate dose in low/ high risk

A

400 mcg. 5 mg

46
Q

Mx of women with previous GBS delivery

A

Offer intrapartum antibiotic prophylaxis. Benzyl penicillin

47
Q

Loss of CTG variability?

A

Prematurity or hypoxia

48
Q

When does Anti-D injections need to be given?

A

Mum Rhesus -ve and at any sensitising event: birth, miscarriage <12 weeks, abdominal trauma, PV bleeding

49
Q

3 risk factors for placental abruption

A

Increasing maternal age
Multiparity
Maternal trauma

50
Q

Drug of choice to reduce fetal resp problems in PPROM

A

Dexamethasone

51
Q

Main risks of mother having uncontrolled GDM (3)

A

Shoulder dystocia, macrosomia, neonatal hypoglycaemia

52
Q

RF for GDM

A 
BMI <30
Previous hx
Previous macroscopic baby
Ethnic (black, Middle Eastern, south Asian)
Family hx
53
Q

GDM results range

A

Fasting <5.6

OGTT <7.8 (at two hours)

(5678)

54
Q

GDM management in patients with fasting BM <7

A

Diet and exercise

55
Q

GDM management in patients with fasting BM>7

A

Insulin (+/- metformin)

56
Q

Which vaccines offered in pregnancy and which should be avoided?

A

Whooping cough (from 16 weeks) and flu

Live vaccines

57
Q

Medical name for stretch mark

A

striae gravidarium (silvery fine ones -> albicans)

58
Q

Screening tool for post natal depression

A

Edinburgh Scale

(PHQ-9) can also be used

59
Q

Two drugs that cause folic acid deficiency (non ABX)

A

Phenytoin and methotrexate

60
Q

Chorioamnionitis triad

A

Fetal tachycardia, maternal tachycardia, maternal pyrexia

61
Q

Chorioamnionitis main risk factor

62
Q

Dates for miscarriage (early vs late)

A

0-24 weeks

Early: 0-13 and much more common

63
Q

Hormone that induces cervix remodelling

A

Prostoglandins

64
Q

Hormone that regulates blood flow through endometrium

A

XXX Cortisol

65
Q

Tripple test contains:

A

HCG, AFP, estriol

66
Q

Vessel that shunts blood from away from liver

A

Ductus venosus

67
Q

What can be performed first: amniocentesis or CVS

68
Q

PAPP-A in trisomy 18 and 21 levels

69
Q

Treatment of hyperthyroidism in post delivery women

A

Betablockers not anti thyroid medication

70
Q

Downs syndrome in combined test

A

bHCG high, PAPP-A low (not very low), tick nuchal

71
Q

What position must a breech baby be in for delivery?

A

Back/ sacrum must remain anterior

71
Q

What position must a breech baby be in for delivery?

A

Back/ sacrum must remain anterior

72
Q

At what bHCG level are you likely to see pregnancy on USS

73
Q

Ectopic diagnosis by bHCG levels

A

Less than 66% rise every 48 hours (should double)

74
Q

Miscarried lady with retained products in cervix presents with hypotension and tachycardia

A

Products in cervical Os can cause vasovagal response

speculum and remove

75
Q

Blood pressure changes in second trimester

A

Hypotension

76
Q

+++ in pregnant urine -> what else with urine

A

PCR urine - greater than 30 is bad

Could do 24hour urine sample

77
Q

SFH in pre-eclapsia

78
Q

40% of eclampsia happens where?

A

Postpartum

79
Q

PAAP-A is low -> what drug

A

Asprin to prevent pre eclampsia

80
Q

Should you ask about smears in Obstetrics bleeding/ pain

A

YES!! 1 in 6000 cervix ca

81
Q

What does oestrogen do to uterus

A

Endometrial proliferation (multiply and spread)

82
Q

PMB investigations

A

TV USS then hysteroscopy and biopsy

83
Q

Endometritis pattern of bleeding

A

heavy light then heavy

?? check??

84
Q

How does endometritis feel on exam and how to treat

A

Boggy and tender

Co-amox

85
Q

Should you do a bi manual in SROM

A

NO as infection risk

86
Q

fFN test is for

87
Q

Augumentation

A

Start of oxytocin

88
Q

Consequence of mum becoming sensitised to rh in future pregnancies

How to test

A

Haemolytic disease of newborn

Direct Coombs test

89
Q

SPD symptoms

A

Pain/ discomfort around pubic symphysis, lower back pain, side-side gate

90
Q

Test to see how much fetal blood is in mothers blood during a possible sensitisation event?

A

Kleihauer test

91
Q

Drug to prevent preterm labour

A

Vaginal progesterone

92
Q

When is cervical cerclage used

A

?pre term labour to keep cervix shut

93
Q

Three phases of labour

A

Latent: 0-3
Active: 3-7
Transition 7-10

94
Q

What type of contractions in latent phase and how quick is progression

A

Irregular and 0.5cm per hour

95
Q

Do Braxton Hicks contractions indicate the start of labour

96
Q

CTG baseline rate

97
Q

Where is a ‘low lying placenta’

A

Within 20mm of Os

98
Q

3 main causes of APH

A

Placenta previa
Placenta abruption
Vasa previa

99
Q

First line treatment for PCOS pts who cannot conceive

100
Q

Rare complication of ovarian induction

A

Ovarian hyperstimulation syndrome

101
Q

Ovarian hyperstimulation syndrome signs (3)

A

Hypovolemic shock, acute renal failure, VTE

102
Q

Ovarian hyperstimulation syndrome symptoms

A

Abdo pain, DandV, weight gain, decreased urine output, DVT

103
Q

Ergometrine and carboprost contraindications

A

Ergometrine - HTN

Carboprost - asthma

104
Q

Minimum time between pregnancies

A

12 months - preterm birth, low birth weight

105
Q

Likely organism in pregnancy to cause baby to have: seizure, hydrocephalus, hearing and visual issues

A

Toxoplasma Gondii

106
Q

Medical management of a miscarriage

A

Misiprostol alone!

Not mifepristone

Leeds MBCHB Year 4 GOSH (10 decks)

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