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AA Y4 Finals cards NE > Gynaecology - ante natal > Flashcards

Gynaecology - ante natal Flashcards

1
Q

at how many weeks gestation can fetal movements be felt?

A

from 20 weeks

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2
Q

which 2 vaccines are offered to all pregnant women?

A 
whooping cough (pertussis) 
influenza

also COVID now

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3
Q

which vaccines are avoided in pregancy?

A

live vaccines

eg: MMR vaccine

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4
Q

when should folic acid be stopped in pregancy?

A

stop it at 12 weeks

take it from before pregancy to 12 weeks

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5
Q

what does folic acid do?

A

reduce neural tube defects

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6
Q

why should vitamin A supplements be avoided in pregnancy?

A

vit A is teratogenic at high doses

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7
Q

which 2 haem conditions are women screened for at booking appointments?

A

all women: thalassemia

high risk women: sickle cell

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8
Q

if a women is at high risk of pre eclampsia at booking appt, what should be given?

A

aspirin

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9
Q

if a women is at high risk of VTE, what should be given prophylactically?

A

LMWH

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10
Q

what is the 1st line and most accurate screening test for downs?

A

the combined test (done at 11-14weeks)

involves combining results from US and maternal blood tests

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11
Q

describe bHCG and PAPPA values in maternal blood tests indicative of downs?

A

bHCG: high
PAPPA: low

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12
Q

in downs screening, what does the triple test involve?

when is it carried out?

A

3 sets of maternal blood tests:

  • bHCG
  • AFP
  • serum estriol

carried out at 14-20 weeks

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13
Q

what values on the triple test would suggest a downs diagnosis?

A

bHCG: high
AFP: low
serum estriol: low

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14
Q

compare when CVS and amniocentesis can be carried out?

A

CVS: prior to 15 weeks gestation

amniocentesis: after 15 weeks gestation

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15
Q

how does levothyroxine dose need to be adjusted in pregnant women?

A

it needs to be increased

levothyroxine can cross the placental membrane so needs to be increased to compensate for this

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16
Q

which 3 anti-hypertensives need to be stopped during pregancy?

A
  • ACEi
  • ARB
  • Thiazides or thiazide like diuretics
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17
Q

which 3 anti-hypertensives are not known to be harmful in pregancy?

A
  • labetolol
  • CCBs
  • alpha blockers (doxazocin)
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18
Q

what epileptic women do prior to pregnancy ?

A

start taking 5mg folic acid, prior to conception

reduces the risk of neural tube defects

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19
Q

which 3 anti-epileptics are considered safe in pregancy?

A
  • levetiracetam
  • lamotrigine
  • carbamazepine
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20
Q

which anti-epileptic causes cleft palate if taken during pregancy?

A

phenytoin

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21
Q

which antiepilepic do NICE say is contraindicated in girls and women?

A

sodium valproate

due to neural tube defect risk during pregancy

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22
Q

what is the 1st line choice for treating RA during pregancy?

A

hydroxychloroquine

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23
Q

which RA treatment is contraindicated in pregancy?

A

methotrexate

teratogenic, causes miscarriage and congenital abnormalities

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24
Q

name the 2 drugs that are considered safe to use for RA during pregancy?

A
  • hydroxychloroquine

- sulfasalazine

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25
Q

describe 2 effects of NSAIDs on pregancy?

A

effects mostly seen in 3rd trimester:

  • premature closure of the ductus arteriosus
  • delayed labour
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26
Q

why do NSAIDs cause premature closure of DA and delay labour?

A

they inhibit prostaglandins

prostaglandins are required to keep the DA open and also stimulate uterine contractions

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27
Q

name 2 side effects of using ACEi or ARBs during pregancy?

A
  • oligohydramnios

- hypocalvaria (incomplete formation of skull bones

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28
Q

how do ACEi/ARBs cause oligohjydromnios?

A

they can both cross the placenta and reduce production of urine in the fetus, and therefore amniotic fluid

this causes oligohydramnios

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29
Q

how does neonatal abstinence syndrome present?

A

irritability, tachypnoea, high temps and poor feedings

usually presents between 3-72 hours

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30
Q

what are the most common congenital malformations that warfarin can cause ?

A

craniofacial problems

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31
Q

what congenital abnormality does lithium during pregancy cause?

describe this anomaly

A

ebstein’s anomaly

tricuspid valve is displaced, causing a larger RA and smaller RV

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32
Q

in which trimester is lithium most dangerous?

A

1st trimester

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33
Q

is lithium okay when breastfeeding?

A

no- can enter breastmilk so contraindicated if breastfeeding

34
Q

1st trimester use of which SSRI has increased risk of congenital malformations?

A

paroxetine

35
Q

what does 3rd trimester use of SSRIs have increased risk of in the newborn?

A

persistent pul hypertension

36
Q

name the 4 complications to the newborn in congenital rubella syndrome?

A
  • congenital deafness
  • congenital cataracts
  • congenital heart disease
  • learning disability
37
Q

how should chickenpox be treated in a pregnant women?

A

if <20 weeks: IV varicella Ig

if >20 weeks: oral acyclovir

38
Q

what is the classic triad of features in congenital toxoplasmosis?

A

intracranial calcification
hydrocephalus
chorioretinits (inflammation of the chorioid and retina)

39
Q

what is slapped cheek syndrome or erythema infectiosum also known as?

A

parvovirus B19

40
Q

name 4 complications that can occur in pregnant women in the 1st and 2nd trimesters?

A
  • fetal death
  • severe fetal anaemia
  • hydrops fetalis
  • maternal pre-eclampsia like syndrome
41
Q

what is hydrops fetalis?

A

fetal heart failure

42
Q

how does anti D medication work to prevent rhesus sensitivity?

A

the anti D medication attaches itself to the fetal blood that is in maternal circulation

the anti D medication destroys the fetal blood cells before the mum can recognise it as foreign

if the mum doesn’t recognise it as foreign, then she won’t create antibodies against it

43
Q

when are anti-D injections given?

A

28 weeks gestation

at birth (if baby’s blood group found to be positive)

44
Q

what test is used after any sensitising event to assess how much fetal blood has passed into the mothers blood?

A

Kleihaeuer test

45
Q

what is the 1st line Ix for preterm pre labour rupture of membranes?

A

speculum examination

to look for pooling of amniotic fluid in the posterior vaginal vault

46
Q

what should be given in PPROM to reduce the risk of chorioamnionitis?

A

oral erythromycin for 10 days

47
Q

which procedure to deliver a baby carries the greatest risk of haemorrhage to the newborn?

A

prolonged ventouse delivery

48
Q

when should aspirin be taken in women at high risk of pre eclampsia?

A

from 12 weeks gestation until birth

49
Q

how are placental abruptions managed when the fetus is alive, <36 weeks and not showing signs of distress?

A

admit and administer steroids

50
Q

what is the 1st line treatment for magnesium sulphate induced respiratory depression?

A

calcium gluconate

51
Q

what 3 features would increase suspicion of placenta praaevia?

A
  • high presenting part
  • painless PV bleeding
  • abnormal fetal lie
52
Q

what is a common cause of macrocytic anaemia in pregancy?

A

folic acid deficiency

53
Q

how should the hyperthyroid phase of postpartum thyroiditis be treated?

A

propranolol

not anti-thyroid drugs

54
Q

why do molar pregnancies cause signs and symptoms of thyrotoxicosis ?

A

molar pregnancies cause high hCG

hCG has a similar structure to TSH, FSH and LH

the hCGG stimulates the thyroid gland to produce thyroxine

55
Q

in gestational diabetes, what must the fasting glucose level be greater than to start insulin immediately?

A

> 7mmol/l

56
Q

compare AFP values in downs and neural tube defects?

A

downs: AFP low

neural tube defects: AFP high

57
Q

what is the downs antenatal screening test composed of?

to be done between 11-13+6 weeks

A

nuchal translucency

bHCG and PAPPA blood tests

58
Q

what weight of the newborn defines macrosomia?

A

4.5kg

59
Q

what is there a significant risk of in macrosomia during birth?

A

shoulder dystocia

60
Q

what are the 2 investigations for a LGA baby?

A

US - exclude polyhydramnios

OGTT- for gestational diabetes

61
Q

what are the 2 investigations for a LGA baby?

A

US - exclude polyhydramnios

OGTT- for gestational diabetes

62
Q

why do diamniotic, dichorionic twin births have the best outcomes?

A

each fetus has their own nutrient supply

63
Q

describe what happens to both foetuses in twin-twin transfusion syndrome?

A

the recipient fetus: gets majority of blood and can become fluid overloaded, with heart failure and polyhydramnios

the donor: growth restriction, anaemia and oligohydramnios

64
Q

what do UTIs in pregancy increase the risk of?

A

main one: preterm delivery

also, low birth weight and pre-eclampsia

65
Q

what on urine dipstick suggest the presence of bacteria in the urine?

A

nitrites

leukocytes (nitrites are more accurate)

66
Q

when are 1st pass and mid stream urine samples used?

A

1st pass: for

67
Q

what is the most common cause of UTI in pregnancy?

A

E.Coli

68
Q

compare the trimesters in which nitrofurentoin and trimethoprim are safe?

A

nitrofurentioin: safe in 1st and 2nd trimester
trimethoprim: not safe in any

if UTI occurs in 3rd trimester, give amoxicillin or cefalexin

69
Q

why is trimethoprim not safe in the 1st trimester?

A

it works as a folate antagonist

if given in 1st trimester, it can cause neural tube defects

70
Q

how long is VTE prophylaxis continued post partum?

A

6 weeks

71
Q

LMWH is given as VTE prophylaxis in pregnancy. name 3 types of LMWH?

A
  • dalteparin
  • enoxaparin
  • tinzaparin
72
Q

at what gestation is the early scan done to confirm dates?

A

10-13+6 weeks

the booking visit is done at 8-12 weeks

73
Q

when is induction of labour usually indicated for intrahepatic cholestasis of pregnancy?

A

37 weeks

74
Q

which conditions are associated with a low AFP?

A
  • downs
  • edwards
  • maternal diabetes
  • maternal obesity
75
Q

what is used to prevent seizures in pre eclampsia and also treat them once they develop?

A

magnesium sulphate

76
Q

what is the 1st step in a women who reports reduced fetal movements?

A

1st line: doppler to confirm fetal heartbeat

77
Q

compare Hep B and HIV when breastfeeding?

A

Hep B: safe to breastfeed

HIV: not safe to breastfeed

78
Q

name one serious manifestation of pre-eclampsia? what does it stand for?

A

HELLP syndrome

Haemolysis
Elevated Liver enzymes
Low Platelets

79
Q

how should pregnant patients with T1DM monitor their BGLs?

A

daily fasting, pre meal, 1 hour post meal and bedtime testing

80
Q

what triad is seen in chorioamnionitis?

A
  • maternal tachycardia
  • fetal tachycardia
  • maternal pyrexia
81
Q

how is group B strep treated in pregancy?

what is given for group B prophylaxis?

A

penicillin and clindamycin

prophylaxis = benzylpenicillin

82
Q

compare the screening tests for downs that can be done at:

a) 11-13+6 weeks
b) 15-20 weeks

A

a) 11-13+6: combined test: U/S + maternal bloods (PAPPA + bHCG)
b) 15-20 weeks: the triple test: bHCG, AFP, serum estriol

AA Y4 Finals cards NE (40 decks)

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