HD2 Revision2 Flashcards

1
Q

Name 5 risk factors for gestational diabetes

A

Previous gestational diabetes
Family history of diabetes
Previous macrosomic baby
Previous unexplained stillbirth
Obesity
Glycosuria
Polyhydramnios
Large for gestational age in present pregnancy

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2
Q

Explain pathophysiology of gestational diabetes

A

Pregnancy is a state of insulin resistance - gestational diabetes is an extreme of this

Foetus needs glucose to grow: gets from mother

Via the placenta: foetus puts out hormones HPL, cortisol and glucagon that makes the mother insulin resistant, so that she cannot use glucose as readily.

Mother will make more amino acids and fatty acids as a result of insulin resistance and some of these pass through to placenta too.

Glucose is transported to the foetus: causes the foetus to have hyperinsulinaemia

This increases growth of baby as glucose is turned into carbs / fats and birth weight goes up

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3
Q

Name short term [4] and long term [3] potential consequences to the baby of having gestational diabetes

A

Short term:
* Macrosomia
* Neonatal hypoglycaemia
* Shoulder dystocia
* C section liklihood

Long term:
* Obesity
* DMT2
* CVD
* Respiratory distress syndrome
* Polyhydramnios

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4
Q

Which hormones are secreted by the baby that causes insulin resistance in the mother? [4]

A

HPL (Human placental lactogen - causes insulin resistance), hPGF (human placental growth hormone) cortisol and glucagon

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5
Q

What are potential complications for mother of gestational diabetes? [5]

A
  • Pre-eclampsia
  • Infection
  • Thromboembolic disease

Other potential complications:
* Nephropathy
* Retinopathy
* Coronary artery disease
* Poor wound healing
* DMT2 in the future

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6
Q

How do you manage gestational diabetes? [4]

A

Dietary modification: calorie reduction

If not successful in reducing hyperglycemia: give insulin

Can also give metformin: crosses the placenta so also helps treat foetus

Regular ultrasound every 2 weeks to monitor fetal growth

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7
Q

The screening test of choice for gestational diabetes is? [1]

A

The screening test of choice for gestational diabetes is an oral glucose tolerance test (OGTT).

An OGTT is used in patients with risk factors for gestational diabetes, and also when there are features that suggest gestational diabetes:

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8
Q

What type of anaemia normally occurs during pregnancy? [1]

Explain physiology of why anemia occurs in pregnancy [1]

How do you treat? [1]

A

Usually IDA

Blood volume goes up but erythrocyte number doesn’t increase to same extent

Treatment: oral iron tablets

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9
Q

What is the name of this consequence of oligohydramnios? [1]

A

Potters facies / sequence

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10
Q

When is cytomegalovirus (CMV) the biggest risk for a baby? [1]

How does CMV appear histoligically

A

(CMV: 50% of adults are CMV IgG +ve)

Problematic if mother becomes infected during early pregnancy / first trimester

Histologically: owl eye in cells

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11
Q

What are pathological consequences of cytomegalovirus infection in early trimester for baby? [4]

A
  • Sensorineural deafness: Hearing loss; Vision loss
  • Severe intrauterine growth retardation (IUGR)
  • hepatosplenomegaly
  • microcephaly
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12
Q

What score on oral glucose tolerance test would indicate GD fir fasting and at 2 hrs? [2]

A

Normal is:
Fasting: < 5.6 mmol/l
At 2 hours: < 7.8 mmol/l

cutoff for gestational diabetes as simply 5 – 6 – 7 – 8.

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13
Q

What are the 8 types of spontaneous miscarriage [8]

State in each if there is vaginal bleeding or not [8]

A

Complete: vaginal bleeding, both placenta and embryo expelled

Incomplete: vaginal bleeding, embryo commonly lost, placenta retained

Threatened: vaginal bleeding, fetal activity (can be potentially saved)

Missed: embryo and placenta is still in uterus, but embryo is dead. no vaginal bleeding

Recurrent: history of more than 3 spontaneous abortions

Inevitable: vaginal bleeding embryo and placenta are on the way out / coming

Septic (Rare often results from non sterile use pelvic instrumentation)

Therapeutic

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14
Q

Which causative agents commonly cause a septic miscarriage? [3]

Explain why a septic miscarriage occurs [1]

What are causes of septic miscarriage? [2]

A

Usually due to Staph aureus
N. gonorrhea, C. trachomatis

Causes the contents of the uterus to be infected & causes endometritis (so may present with signs of pelvic infection)

Causes:
* Unsafe abortion
* Cervical incompetence

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15
Q

How do you investigate for a spontaneous miscarriage? [3]

A
  • Ultrasound scan: ID if placenta is attached to the uterus
  • Serum BetaHCG indicates that placenta is there (doubles every two-three days) - if placenta not attached to uterus the hCG levels will not rise
  • Rhesus status
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16
Q

Management of miscarriage?
- medical [1]
- surgical [1]
- for rhesus negative women [1]

A

Medical:
* misoprostol - cause the uterus to contract to expel the products of conception that are still there

Surgical:
* Surgical aspiration - gentle suction to remove the pregnancy
* Curettage (spoon-shaped instrument) to remove abnormal tissues.

Anti D to rhesus negative women

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17
Q

How do you ID cervical incompetence

A

Funnel shaped cervix on ultrasound

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18
Q

How do you manage cervical incompetence? [1]

A

Transvaginal cerclage: Ring of stiches around cervix

(In a transvaginal cerclage (TVC), doctors sew the cervix closed, usually during the 13th or 14th week of pregnancy. At 36 weeks, the stitches are taken out so the woman can deliver her child naturally)

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19
Q

How would person with ectopic pregnancy present? [6]

A
  • Women of reproductive age
  • Positive pregnancy test/ Amenorrhoea 4-10 weeks
  • PV bleeding
  • Low abdominal pain - in right or left iliac fossa
  • Collapse +/- shoulder tip pain
  • Beta hCG is lower that normal (because no placenta in the uterus)
  • No products of conception in the uterus
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20
Q

Define Gestational trophoblastic disease (GTD)

What is a partial mole? [1]

What is a monospermic complete mole? [1]

What is a dispermic complete mole? [1]

A

GTD: When the trophoblastic tissue that forms part of the blastocyst proliferates more aggressively than normal

Partial mole: two sperm fertilse an egg creating 69 chromosome

Monospermic mole: maternal chromosomes are lost AND paternal chromosomes double up to make 46 chromosome

Dispermic complete mole: maternal chromosomes are lost AND fertilisation by two sperm: 46 chromosome

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21
Q

Explain pathophysiology of complete molar pregnancy: GTD

How do you treat? [2]

A

Complete molar pregnancy: entirely paternal tissue

No fetal tissue at histology - just placenta.

Effectively a tumour:
* surgical removal - but 15% molar tissue remains in deeper tissues of the womb so:
* need chemotherapy to remove abnormal cells

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22
Q

Define placenta praevia [1]

What are the two types [2]

A

When placenta is inserted into lower segment of the uterus after 24 weeks

Major = covers cervix and internal os
Minor = marginal <2cm from internal os

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23
Q

Describe pathophysiology of pre-eclampsia

What are effects of pre-eclampsia? [2]

A

Normal spiral artery in placenta should widen – slows blood flow so nutrient exchange can occur

Pre-eclampsia this doesn’t happen. Spiral arteries stay narrow: goes in at high pressure.

This causes oxidative stress in the placenta, and the release of inflammatory chemicals into the systemic circulation, leading to systemic inflammation and impaired endothelial function in the blood vessels.

Causes: fetal growth restriction or pre-term birth

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24
Q

Explain the pathophysiology behind Hyperemesis Gravidarum

When does it peak? [1]

A

Correlates closely with hCG levels: which is what controls placental development.

hCG may stimulate oestrogen production from ovary causing vomiting and nausea

May be caused by vitamin B6 (Pyridoxine) deficiency (vit. B supplements cause reduction in symptoms)

Peaks at about 12 weeks

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25
Q

Why might hyperemesis gravidarum cause hosptialisation? [4]

A
  • Dehydration
  • Electrolyte imbalance
  • ketosis
  • weight loss
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26
Q

Name and explain the MoA of the anti-emetics you would use to treat hyperemesis gravidarum [4]

A
  • Prochlorperazine (stemetil)
  • Cyclizine: histamine H1 receptor antagonist
  • Ondansetron: Blocks 5HT-3 in chemical trigger zone/vomiting centre
  • Metoclopramide: Blocks D2 in chemical trigger zone/vomiting centre
  • Vitamin B6
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27
Q

Name 5 reasons for bleeding in early pregnancy [5]

What is prognosis for bleeding in early pregnancy? [2]

A
  • Cervical insensitivity
  • Infection
  • Molar pregnancy
  • Subchorionic haemorrhage
  • Implantation bleeding

50% will settle
50% will:
Miscarry (spontaneous abortion)
Have an ectopic pregnancy
Have trophoblastic disease (hydatidiform mole)
Have problems in late pregnancy

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28
Q

State in each type if the cervix is opened or closed

A
29
Q
A
30
Q

Recurrent miscarriage:

How many consecutive miscarriages needed to be classified? [1]

What investigations would you use for recurrent miscarriage? [3]

A

3 or more consecutive miscarriages before week 20

Investigations:
* Autoimmune + thrombophilia screen
* Karyotyping
* Pelvic US scan

31
Q

What is twin to twin transfusion? [1]

Which type of pregnancy does it occur in? [1]

How do you treat? [1]

A

which twins share unequal amounts of the placenta’s blood supply resulting in the two fetuses growing at different rates.

Only affects mono-chorionic pregnancies

Treat with laser ablation on the anastomosing vessels

32
Q

Explain what a partial molar pregnancy is [1]

Explain how a partial molar pregnancy occurs [1]

How do you treat? [1]

A

Happens when two sperm fertilise the egg at the same time- one set of chromosomes from the mother and two sets from the father: 69 chromosomes

Some fetal tissue might be seen within the molar tissue

Treatment:
Surgery to remove molar tissue - 1% have some remaining abnormal cells which require chemotherapy

33
Q

Explain what placental abruption is and the pathophysiology behind it

How serious is a placental abruption? [1]

A

Blood accumulates behind the placenta: causes uterus to be hard / wood & the placenta comes away from uterine wall

Obstetric emergency!

34
Q

How is placental abruption treated?

If the baby is dead? [1]
If no fetal or maternal distress? [1]

A

Deliver baby

Fetal distress: Urgent lower segment caesarean section

If the baby is dead: Coagulopathy likely, Induce labour when safe

If no fetal or maternal distress:
Steroids and observe

35
Q

Where does trophoblast invasion occur to in normal pregnancy? [1]

Define what placenta Accreta/increta/percreta are [3]

How do you treat if maternal / fetal compromise at more than 37 weeks? [3]

A

Normal pregnancy: trophoblast invasion stops at the spongiosus layer of the decidua basaslis.

Accreta –chorionic villi attach to myometrium rather than restricted within decidua basalis. Most common

Increta – chorionic villi invade myometrium

Percreta – chorionic villi invade through perimetrium

Treatment:
* Emergency Caesarean plus hysterectomy
* Methotrexate
* Close pelvic vessels

36
Q

Management of pre-eclampsia:

What BP should you aim for? [1]

What drugs do you use to stabilise mothers BP? [2]

Which anti-hypertensives & anticonvulsants would you use for acute [2] and chronic treatment? [2]

A
  • BP aim: less than 135 / 85 mmHG
  • Stabilise mothers BP: aspirin (from week 12 to birth); calcium supplementation (from week 20 onwards)
  • Acute treatment:
    Labetalol – alpha and beta blocker / antagonist
    Hydralazine
  • Chronic management
    Methyldopa – alpha 2 agonist (feeds back and stops noradrenaline being released)
    Nifedipine - CCB
37
Q

What is velamentous insertion of umbilical cord into placenta?

A

complication that happens when the umbilical cord from a fetus doesn’t insert into the placenta correctly.; instead it goes into amniotic sac

causes compression of own bloody supply

38
Q

Which syndrome may pre-eclampsia lead to? [1]

What are the symptoms of this syndrome? [3]

A

Woman with this condition may develop the HELLP syndrome

This is characterised by haemolysis (raised LDH), elevated liver enzymes and low platelets.

39
Q

Which condition can pre-eclampsia lead to? [1]

How can you prevent progession to this ^? [1]

What is the only definitive treatment for pre-eclampsia? [1]

A

A complication of pre-eclampsia includes progression to eclampsia, which should be prevented by administration of magnesium sulphate.

The only definitive treatment for pre-eclampsia is delivery

40
Q

If a women has endometriosis and pain when defecating, where are the locations that might get likely accumulation of blood from the extra-pelvic endometrial tissue? [2]

A

Pouch of Douglas
Bowel

41
Q

Diagnosis [2] and prophylactic for congenital toxoplasmosis? [3]

A

Diagnosis: PCR of amniotic fluid / maternal serology
Give prophylactic in mother:
- Pyrimethamine
- sulfadiazine
- folinic acid

42
Q

HSV 1 and HSV 2 causes which type of pathologies? [2]

A

HSV-1: coldsores
HSV-2: genital herpes

43
Q

Treatment for HSV-2? [1]

Prognosis if left untreated in baby? [1]

A

Acyclovir

65% chance of mortality if left untreated !

44
Q

Group B Steptococcus neonatal infection can cause what 4 pathological consequences? [4]

A

Pneumonia
Meningitis
Non-focal sepsis
Death

45
Q

Why does giving treatment for group B Strep not work throughout pregnancy? [1]

When can you give? [1] What drug is used to treat? [1]

A

If treat during pregnancy it just returns lol

Give benzylpenicillin in labour / from week 36

46
Q

Treatment for UTIs? [3]

A

NICE Clinical Knowledge Summaries recommend trimethoprim or nitrofurantoin for 3 days

Treatment:
Penicillin’s
Cephalosporins ( β-lactam antibiotics)
Nitrofurantoin

47
Q

Consequences of untreated Listeria / Listeriosis? [3]

A

Meningo-encaphalitis
Still birth
Neonatal sepsis / meningitis

48
Q

Consequences of congenital syphilis

in early years? [6]

in late years? [6]

A

Early 0-2 years
* Rash
* Rhinorrhoea (mucus full of T.pallidum)
* Osteochondritis
* Perioral fissures
* Lymphadenoapthy
* Pemphigus syphiliticus

Late >2 years
* Hutchinson’s teeth
* Clutton’s joints
* Saber shins
* High arched palate
* Deafness
* Saddle nose deformity
* Frontal bossing

49
Q

Pathological consequences of chlamdyia or gonorrhoea for new born foetus? [2]

A

Ophthalmia neonatorum:
* Unilateral or bilateral watery discharge becomes copious and purulent
* With gonococcal infection less inflamed

Pneumonia

50
Q

Which of the following is caused by chlaymdia and gonorrhoea? [1]

A

Right is chlamdyia

51
Q

When is greatest risk for child during pregnancy of parvovirus B19 infection? [1]

What cell type does parvovirus B19 attack? [1]

A

Biggest risk: 0-20 weeks. 9% of fetal loss

Attacks erythrocytes

Causes fetal anaemia

52
Q

Potential consequences of parvirus B19 infection in pregnancy? [3]

A

Miscarriage or fetal death
Severe fetal anaemia
Hydrops fetalis (fetal heart failure)
Maternal pre-eclampsia-like syndrome

Can also cause fetal anaemia

53
Q

What type of women are at increased risk of COVID-19? [1]

Which pro-inflammatory cytokine does COVID-19 cause to have a negative effect on baby development? [1]

A

At risk if have co-morbidities (c.f. those with no comorbid) - increased risk of death

Increased IL-6: negative developmental effect

54
Q

Which pathology is associated with a molar pregnancy? [1]

A

Hyperemesis gravidarum [1]

55
Q

What does this surgical treatment treat? [1]

A

Cervical incompetence (image is a transvaginal cerclage)

56
Q

What is does the US show? [1]

A

Cervical incompetence

57
Q

Listeria is a gram [] bacteria.
Listeria is [] shaped

A

Listeria is a gram positive bacteria.
Listeria is rod shaped

58
Q

Listeria is a gram [] bacteria.
Listeria is [] shaped

A

Listeria is a gram positive bacteria.
Listeria is rod shaped

59
Q

What does the US depict? [1]

A

placental abruption

60
Q

Name this feature of late congential syphilis [1]

A

Clutton joints
A painless joint effusion in a child, usually in the knee, caused by inflammation of the synovial membranes due to congenital syphilis

61
Q

Name this feature of late congenital syphilis [1]

A

Hutchinson teeth

is a sign of congenital syphilis, which occurs when a pregnant mother transmits syphilis to her child in utero or at birth. The condition is noticeable when a child’s permanent teeth come in. The incisors and molars take on a triangular or peglike appearance.

62
Q

Name this feature of late congenital syphilis [1]

A

Saber shins

63
Q

What is the arrow pointing to? [1]

A

velamentous insertion of umbilical cord into placenta

64
Q

What is the pathology depicted here? [1]

A

velamentous insertion of umbilical cord into placenta

65
Q

Name this early stage congenital syphilis symptom

A

Pemphigus syphiliticus.

66
Q

Name this early stage congenital syphilis symptom

A

Pemphigus syphiliticus.

67
Q

In cases where a mother has potentially come into contact with parvovirus B19, viral serology can be performed:

Parvovirus specific [] antibodies indicate recent infection
Parvovirus specific [] antibodies indicate past infection and therefore immunity.

A

In cases where a mother has potentially come into contact with parvovirus B19, viral serology can be performed:

Parvovirus specific IgM antibodies indicate recent infection
Parvovirus specific IgG antibodies indicate past infection and therefore immunity.

68
Q

The main risk of fetal parvovirus infection is []

A

The main risk of fetal parvovirus infection is fetal hydrops – the abnormal accumulation of fluid in two or more fetal compartments.

69
Q

There is a classic triad of features in congenital toxoplasmosis. What are they? [3]

A

There is a classic triad of features in congenital toxoplasmosis:

Intracranial calcification
Hydrocephalus
Chorioretinitis (inflammation of the choroid and retina in the eye)