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GP, obstetrics, psych, paeds > General Obstetrics > Flashcards

General Obstetrics Flashcards

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1
Q

define infertility?

A

unable to conceive after 1 year of unprotected sex

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2
Q

how frequent should couples have sex in order to conceive?

A

sexual intercourse every 48 hrs up to and beyond ovulation

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3
Q

how does clomiphene work in infertility?

A

Competitively antagonises oestrogen receptors in the hypothalamus. This interferes with normal negative feedback mechanisms and increases the release of pituitary gonadotrophins, especially LH, inducing ovulation.

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4
Q

what are some female causes of infertility?

A 
Hypothalamic causes:
Increasing age
Stress
Low weight
Kallman's syndrome

Pituitary issues:
Prolactinoma
Thyroid issues

Iatrogenic:
Radiation

Genetic:
Turner syndrome/Fragile X syndrome

Autoimmune causes
Lupus/RA etc

Diagnosis of exclusion
Idiopathic/PCOS

Anatomical causes:
PID
Adhesions
Mullerian abnormalities
Sexual differentiation issues
Endometriosis
Fibroids
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5
Q

what are main male mechanisms for infertility?

A

azoospermia/oligospermia (not enough sperm)
problems with sperm motility/morphology
anti-sperm antibodies
sexual dysfunction

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6
Q

what are the screening tests available in the first trimester of pregnancy, and what do they screen for?

A

screen for down’s syndrome trisomy 21

the combined first trimester screening test includes

  1. bHCG
  2. PAPP-A
  3. Nuchal translucency test (ultrasound)
  4. Maternal age
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7
Q

what other chromosomal abnormalities can the first trimester screening test screen for?

A

trisomy 18
trisomy 13
XO (turner’s syndrome)

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8
Q

what are the two tests we can offer a pregnant woman that will definitively diagnose chromosomal abnormalities during pregnancy (if you already have a high suspicion of abnormality)?

A

aminocentesis
CVS sampling

–> invasive tests so you must have a high index of suspicion before performing

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9
Q

when is the first screening test performed during pregnancy?

A

at 11 weeks gestation

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10
Q

define preterm baby?

A

infant born before 37 weeks gestation

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11
Q

how do we calculate corrected age for preterm babies? how long should we use this corrected age until?

A

corrected age= actual age- no of weeks premature

use corrected age until 2 yrs old

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12
Q

at what gestation age do we deem a baby ‘viable’?

A

> 24 weeks gestation= viable and can be born preterm

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13
Q

what are the general risks of preterm rupture of membranes?

A

increased risk of preterm labour, chorioamioniitis, and uterine cord prolapse

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14
Q

how might we diagnose preterm rupture of membranes?

A

vaginal speculum examination- fluid in the posterior fornix is suggestive

analyse the fluid looking for alkaline pH, presence of fetal squamous cells and diagnostic phospholipids

administer oral pyridium tablet to mother–> if urine instead of liquour, then it will turn the urine orange

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15
Q

define shoulder dystocia?

A

shoulder dystocia refers to the difficulty in delivering the fetal shoulders after the fetal head has been delivered

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16
Q

define caesarean section?

A

delivery of the contents of the uterus (>20 weeks gestation) via abdominal incision aka laparotomy

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17
Q

what is the standard type of c-section performed nowadays?

A

lower uterine segment caesarean section

–> transverse incision

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18
Q

what are the key management principles when preparing a woman for a c-section?

A
  1. review of maternal obstetric and medical hx or antenatal hx inc allergies etc
  2. obtain consent
  3. discussion with anaesthetist, theatre etc
  4. obtain IV access and order group and hold for blood, coags, FBE etc
  5. position patient in left lateral supine position
  6. auscultate fetal heart- ensure that the baby is still alive
  7. ensure bladder is empty and insert IDC
  8. antibiotic prophylaxis pre-surgery
19
Q

what is the difference between major placenta praevia and minor placenta praevia?

A

major- placenta covers the internal cervical OS

minor- low lying placenta but does not cover the internal OS

20
Q

what is the difference between placenta accreta, placenta increta and placenta percreta?

A

placenta accreta- placenta is adherent to myometrium
placenta increta- placenta has invaded into the myometrium
placenta percreta- placenta has invaded through the myometrium to surrounding structures

21
Q

what is cervical ectropium

A

eversion of the endocervix exposes columnar epithelium to the vagina

22
Q

define vasa praevia?

A

fetal vessels in the membrane are below the fetal presenting part over the internal cervical os

23
Q

define recurrent miscarriages?

A

3 or more consecutive miscarriages

24
Q

where anatomically are ectopic pregnancies most likely to occur?

A

in the fallopian tubes

25
Q

define pregnancy of unknown location

A

PUL = positive pregnancy test with no signs of intra/extrauterine pregnancy on transvaginal sonography

26
Q

define ectopic pregnancy?

A

any pregnancy occurring outside the uterus

27
Q

what are the general clinical features on history associated with ectopic pregnancies?

A

acute low abdominal pain with vaginal bleeding

+/- shoulder tip pain +/- acute abdomen +/- hypotension/fainting

28
Q

what are the ddx of abdominal pain in early pregnancy?

A 
appendicitis
UTI
ectopic pregnancy
ovarian cyst
renal colic
musculoskeletal cause
gastroenteritis
29
Q

what does PAPP-A stand for?

A

pregnancy associated plasma protein A

30
Q

what does cfDNA stand for?

A

cell free fetal DNA

31
Q

what do we mean by ‘soft marker’ of Down’s syndrome?

A

A soft marker is a physical characteristic of the Down syndrome phenotype detectable with ultrasound which does not in itself pose any health risk to the fetus.

32
Q

when is the u/s for the second trimester performed in pregnancy?

A

between 18-22 weeks gestation

33
Q

what is the first line medication option for hyperemesis gravidarum? what are some other management options?

A

pyridoxine vitamin B6= first line

+/- anti-emetics

corticosteroids for refractive cases

hospital admission for IV fluids and TPN for severe cases

34
Q

what is the difference between APH and miscarriage and show causing vaginal bleeding during pregnancy/labour?

A

APH generally refers to > 20 weeks gestation before onset of labour

miscarriage refers to pregnancy loss before 20 weeks gestation

if bleeding occurs around labour then more likely to be a show rather than APH

35
Q

what is the surgery for cervical insufficiency?

A

cervical cerclage

36
Q

a lady who you suspect is at risk of preterm labour has a fetal fibronectin test at 29 weeks gestation. It comes back positive. what is the implications of this result?

A

A positive test between 24 and 36 weeks’ is associated with a positive predictive value for delivery within 7 days of about 15 to 30%.

37
Q

what antibiotic is commonly used for prolonged rupture of membranes to prevent risk of infection?

A

ampicillin or amoxicillin

38
Q

what is the risk of classical caesarean section vs LUSCS?

A

classical c-section has a higher risk of uterine rupture in subsequent pregnancies

39
Q

when is a hysterectomy indicated during a c-section for delivery of a baby?

A

in the case of uncontrolled primary haemorrhage or placenta accreta

40
Q

what does VBAC stand for?

A

vaginal birth after caesarean section

41
Q

what is your stepwise medical management of hyperemesis gravidarum?

A

Mild to moderate cases:

  1. pyridoxine
  2. H1 antagonist
  3. antihistamine like phenergan
  4. oral anti-emetics like metoclopramide and stemitil

severe refractive cases

  1. ondanestron orally
  2. IV antiemetics
  3. prednisolone
42
Q

define hyperemesis gravidarum

A

persistent vomiting and nausea during pregnancy associated with 5% maternal weight loss, dehydration, ketonuria and electrolyte imbalance

43
Q

for which women do we give intrapartum antibiotics?

A

For prevention of early onset Group B Streptococcus (GBS) infection

• For women at risk of chorioamnionitis or other bacterial infection is suspected – E.g. fever

> 38 on one occasion or > 37.5 on two occasions.

  • Rupture of membranes > 18 hours.
  • For women with cardiac lesions susceptible to infective endocarditis.

GP, obstetrics, psych, paeds (55 decks)

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