GOSH MCQs Flashcards
High risk of NTDs should take 5mg rather than 400mcg of folic acid. Who are they?
either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD
the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
Bloods and urine sampe in pregnancy: what happens to: urea? creatining? urinary protein loss?
INCREASED PERFUSION TO THE KIDNEYS: reduced urea in serum reduced creatining increased urinary protein loss (protein increase to >300 mg/24 hours versus >150 in non-pregnant patients for an abnormal reading(
Hb decreases due to dilution
physiology in pregnancy: what happens to... liver? (3) urinary system? (4) blood? (4)
- ALP rised 50%
- albumin falls
- liver blood flow stays the same
- increased blood flow 30%
- GFR increases
- salt and water reabsoption increased
- ruinary protein loss increases
- rise in fibrinogen and Factors VII, VIII, X
- fibrinolytic activity is decreased - returns to normal after delivery (placental suppression?)
Enlarged utuerus affects venous return. what tyhree things does this cause?
ankle oedema, supine hypotension and varicose veins
When to give anti D? (2)
28 weeks (and do blood allloantibody screen at the same time)
then 6 weeks later do nd injectiion (34 weeks)
as lasts 6 weeks
how many ANC visits if nuli and multiparous?(2)
when is urine culture/dip done? (1)
what 3 things comprise routine care in ANC?
- 10 for nuli
- 7 for multi
culture at booking to detect asymptomatic bactiuria
dip at every other visit
- BP
- urine dip
- SFH
methotrexate:
can men/women have it during pregnancy? (1)
what about NSAIDs? (1)
teratogenic
both dont have it 6 months before concieving
NSAIDs may be used until 32 weeks but after this time should be withdrawn due to the risk of early close of the ductus arteriosus
What food to avoid in pregnancy? (1)
what supplements? (3)
- Liver should be avoided in pregnancy as it contains high levels of vitamin A, a teratogen.
- listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
- salmonella: avoid raw or partially cooked eggs and meat, especially poultry
- it D
- folic acid 400mcg
- iron supplement if LOW only
- AVOID VITAMIN A
Post-partum thyroiditis:
what are the stages? (3)
treatment? (2)
Thyrotoxicosis–>
hypothyrodisim–>
normal thyroid function
the thyrotoxic phase is not usually treated with anti-thyroid drugs as the thyroid is not overactive. Propranolol is typically used for symptom control
the hypothyroid phase is usually treated with thyroxine
Radical trachelectomy
also called radical cervicectomy. This operation involves removing the cervix, the upper part of the vagina and surrounding supporting tissues. Often lymph nodes in the pelvis are often removed to check whether cancer has spread beyond the cervix. This option also preserves fertility but would only be indicated for IA2 tumours.
finding of ruptured ectopic on bimanual exam? (3)
abdominal tenderness cervical excitation (also known as cervical motion tenderness) adnexal mass:
what is nucal translucency increased in
Downs
due to increased congenital heart defects
basicualyl oedema in the baby building up! (lymphatic accumulation)
Chicken pox in pregnancy: waht to do?
IF SHE IS UNSURE IF SHE HAS HAD CHICKEN POX
(if she has had it then do nothing!)
Chickenpox exposure in pregnancy - first step is to check antibodies
Chickenpox infection during the first 20 weeks of pregnancy can cause foetal varicella syndrome. In the second of third trimester chickenpox can cause severe maternal disease. In late pregnancy infection (near delivery) there is a risk of neonatal varicella.
- given varicella-zoster immunoglobulin (VZIG) as soon as possible
if presents with rash then give oral aciclovir
best imaging technique for diagnosing adenomyosis
MRI
- best for most gynae stuff, eg ovarian stuff, CT useless! (remember the reg complaining they found abnormal ovary on CT)
realistically TVUSS best next diagnostic tool
(CT lacks the ability to differentiate different tissue types.)
Rovsings sign? when to do it? (2)
RIF pain
RIF pain when push on left
do to find appendicitis (rule out/in)
what triggers ovarian torsion
exercise
FIGO stands for?
staging used in?
(International Federation of Gynecology and Obstetrics)
- cervical
- ovary
- endometrial
- vulval etc
AFP:
raised in?
decreasedin?
- raised= NTD
- low= Downs
How to managed slow progression in stage 1?
particularly seen in primiparous
send home with analgesia
giving oxytocin and artificially ruutirng will just increase chance of C-section as they need to be fully dilated
Inadequate progression in first stage of labour is due to what possible three things? (3)
Passenger
Passages (fibroids/cervical dystocia)
Power
in second stage same causes!
so a labour may be poorly progressing if contractions are regular but the baby is just in the wrong position
(–> fetal head not engaged, slow progress, haematuria, head poorly applied to cervix)
cervical dystocia is the cervix effervesces but fails to dilate because of severe scaring/rigidity/old cone biopsy
What to do if normal pH on fetal blood sampling?
repeat every 30-60 minutes anyway if abnormal CTG persists
What to do in uterine hyperstimulation?
i.e. when you’ve given too much oxytocin
stop infusion
tocolytic e.g. terbutaline temporarily
throughout labour a slightly downward slope in pH is expected and should be assessed with the labour progression
complication of giving opiates during labour for baby
- can imapct breast feeding
- causes fetal bradycardia
brow presentation
13.5cm
incomparable with vaginal delivery
must –> C section or face presentation or normal
apart from >42 weeks (offered dafter 41 weeks), when else is induction of labour common?
PROM
(induce at 37 weeks after rupture as longer the gap between PROM and labour the higher the chance of chorioamnionitis
also
- fetal macrosomia in the absence of diabetes
- FGR
- per eclampsia/ HTve disorders
- PROM
- intrahepatic cholestasis of pregnancy
- twins >38 weeks
- deteriorating maternal illness
normal delivery process
engagement descent flexion internal rotation extension restitution external rotation delivery of the shoulders
perianal tear- what symptoms do they cause
external= foecal urgency internal= incontinence
When should ventouse never be used?
which operative delivery is more likely to fail?
<34 weeks as cephalhaematoma and intracranial haemorrhage
face or breech presentation
ventouse higher failure rate
BUT
less likely to perineal tear, less pain relief needed and less likely to have significant pain and need regional/general anesthesia
–> failed ventous can try forceps then –> c section
to use operative delivery make sure the operator is EXPERIENCED and you know the fetal lie of the baby
National Childbirth Trust
national consumer group represing the veiws of women on maternity care
Prolactin:
where released from?
when does it increase?
anterior pituitary
in 3rd trimester 15* higher than normal levels
Hormones:
what hormone induces cervical remodelling? (1)
regulates uterine blood flow via endothelial effects? (1)
what is released from posterior pituitary? (2)
prostglandins
cotisol
ADH and oxytocin
haematological cahnges:
what rises due to increased production of placental isoform?
what increases by 50% to lead to hypercoagulable state?
alkaline phosphatase
ALP
Your liver is one of the main sources of ALP, but some is also made in your bones, intestines, pancreas, and kidneys. In pregnant women, ALP is made in the placenta.
fibrinogen
what is taken at booking thena again at 28 weeks
FBC
What is a biophysical profile?
CTG + Ultrasound
The BPP measures your baby’s heart rate, muscle tone, movement, breathing, and the amount of amniotic fluid around your baby
Diseases caused by cloncal expansion of trinucleotide repeats?
Klinefelter’s chromosomes?
huntingdons, fragile X, Fredierchs ataxia, myotonic dystrophy
XXX
Prenatal testing:
fetal alloimmunue thrombocytopenia test? (1)
most suriable test for X_linked disorder? (1)
- cordocentesis
- free foteal DNA
woman 34 weeks with severe abdo pain andbleeding and clots? top differential
placetnal abruption
SEVERE ABDO PAIN and BLEEDING= ABRUPTION
~50% have high blood pressure (which can contribute to the abruption) so BP may be high despite blood loss
Malpresentation: which women admit to antenatal ward at term? (1) what is frank breech? what is footing breech? what is complete breech?
unstable lie
- legs up
- foot first
- legs tucked in
hydration and use of compression stockings in pregnancy will help prevent..
fainting
Multiple pregnancies:
death of co-twin in 25% of cases?
delivery of monozygotic monoamniotic twins?
monzygotic twins
- delivery elective CS at 32-34 weeks
when does pre eclampsia develop?
Pre-eclampsia rarely happens before the 20th week of pregnancy. Most cases occur after 24 to 26 weeks, and usually towards the end of pregnancy. Although less common, the condition can also develop for the first time in the first 6 weeks after birth
woman at 20 weeks with cervical length of 2cm and funneling of the membranes is what?(1)
what does cervial length mean? (1)
inevitable misscarriage due to
cervical insufficiency- could try cervical clercage
The cervical length (CL) is obtained by measuring the endocervical canal from the internal cervical os to the external cervical os. The normal cervix should be at least 30 mm in length. Cervical incompetence is variably defined, however, a cervical length of <25 mm at or before 24 weeks is often used.
risk of appendectomy in pregnancy
preterm
Fetal fibronectin (fFN)
Fetal fibronectin (fFN) is used to test pregnant women who are between 22 weeks and 35 weeks of pregnancy and are having symptoms of premature labor. The test helps predict the likelihood of premature delivery within the next 7-14 days.
treatment obstructive cholestasis
ursodeoxycholic acid
engagement
when widest part of the presenting part has successfully passed through the pevlic outlet
