Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gyn-obs > Intro > Flashcards

Intro Flashcards

1
Q

antal fødsler årligt i DK?

A

60.000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

I hvilken uge er “survival weeks”

A

24 uger, her er overlevelsesraten 24%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Hvor mange kvinder udvikler graviditetsdiabetes

A

2-4% for graviditetsdiabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Hvor mange kvinder udvikler svangerskabsforgiftning

A

Svangerskabsforgiftning 2-4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TIlhører placenta barnet eller moderen og hvorfor er det relevant?

A

Placenta bærer barnets kromosomer, og placenta er derfor noget fetus udvikler for at sikre overlevelse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Hvor meget vejer en nyfødt og en placenta

A

1/6 af barnets vægt, som ofte er ca. 3500 gram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

The three major diseases entitities in obstetrics

A
  • pre elcampsi
  • fetal growth retardation (22% or less)
  • preterm delivery (preterm and extreme preterm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Hvad udveskles mellem mmoder og fetus

A

from mother to fetus

  • nutrients
  • minerals (iron)

from fetus to mother

  • CO2
  • waste products
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Syncytiotrophoblaster proces what?

A
  • hormoner
  • ## DNA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Karakteriser placenta funktioner og vækst

A
  • connection mellem moder og barn
  • filter, cleaning, exchange regulation
  • producerer mange hormoner
  • founded around 6-8 uger
  • primarily grows from week 20 onwards
  • influences maternal metabolism –> GDM (gestitionel diabetes)
  • perfused with 600-800 ml pr min ved fødselstidspunktet
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Opdel placenter i trimestre

A
  1. op til (12-14)
    - organonesis
    - legal abortion
  2. op til (XX)
    - fetal growth
    - survival becomes possible
  3. op til (xx)
    - fetal growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Placentas anatomical issues

A

Placental malformations

  • Tumors
  • cancer like growth: mola, invasive mola, choriocarcinoma
  • locally invasive growth - usually after C-section
    fx by growing into the myometrium or into nabour organs
    Types: accrete placenta, increte placenta, percrete placenta –> bleeding problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Problems with accrete placenta and treatment

A

BLEEDING, up to 20 liters

- surgical treatment: B-lynch, vascular procedures, hysterectomi, removal of involved organs ie the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Risk factors for accrete placenta

A
  • previous surgery in the placenta
  • resection of fibroma
  • previous C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hormones produces by the placenta

A
  • østrogen (E2)
  • progesteron
  • human placenta lactogen (hPl)
  • hCG
  • hPGH (human placenta growth hormone)
  • many more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do they develope GDM

A

Insulin resistance developes for all women during pregnancy

  • makes pregnant woman a bit diabetic
  • mainly from week 20
  • ensures higher level of blood glucose –> as to make the fetus extract glucose

which hormone or substance: unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Beskriv kvinder med DM1 som bliver gravide

A

All receive insulin before preganacy. Around week 19-20 the insulin dosis requirements increases and hits 70% by week 33 and therefore all women af insulin resistant in the last week of pregnancy.

The blood glucose level reaches higher levels and steaper curves and to compensate for that the insulin production increases –> the insulin production is too much for the level of glucose and the fetus will extract the glucose from the blood –> more insulin are produces to compensate –> all women develops a degree of diabetes due to this compensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Beskriv kort preeclampsia

A

2-7% of all pregnancies
Elevated blood pressure (>140/90) and proteinuri (or severe IUGR or severe maternal symptoms or.. sign of end organ damage!)

Rarely before week 22

Causes disturbances in the blood thrombotic/hæmostatic balance –> thrombosis –> organ affection (liver, brain, kidneys (proteinuria)) –> Ecalmpsia (fits, convulsions) due to thromber

Deadthly in less developed contries

Etiology: placenta! (paternal influence, ie immunerelated disorder where the mothers immunesystem reacts to the paternal antigenes) - affects the vessels of the placenta to contract and the mothers BP raises in compensation

The treatment is delivery of the placenta (and fetus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Symptoms and findings of eclampsia

A
  • elevated BP + proteinuria at a routine exam (screening!)
  • rapid weight grain, oedema
  • headache, visual distubances, oppressing sensation
  • pain and discomfort located in the live area
  • less fetal movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Blood samples in case of preeclampsia

A

hæmoglobin, ALAT, LDH, creatinin, uric acid

–> due to hemolysis

Low platelet counts –> HELLP syndrome –> Hemolysis, Elevated Liver, Low Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Complications later in life for GDM

A

High risk for developing DM2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Complication later in life for preeclampsia

A

High risk for hypertension and cardiovascular diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is SGA defined

A

When the birthwegit is less than other newborns (less than 2.5%-10% depending on the country)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Define IUGR (intrauterin growth restriction)/ FGR (fetal growth restriction)

A

IUGR = FGR = when the fetus does not reach its genetic potential for growth

FGR is a continues thing while the SGA is a momental status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

The two ways of being little

A

Genetic or pathological reasons

  • SGA: the genetic trait
  • IUGR: the pathological condition

Difficult to differentiate SGA from FGR

22% or less below the average of the gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

FGR etiology

A
  • smoking
  • syndromes, genetics
  • infections
  • elevated BP, preeclampsia
  • maternal diseases (kidney disease, loss of protein, malabsorption, heart conditions and a low saturation,
  • epigenetics
  • unknown

The more the mother gains during the pregnancy, the larger the baby, especially lipids has an influence and at greenland/iceland, babies are bigger due to the intake of fish oils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is essential when evaluating if the baby must be delivered

A
  • flow! (can be measure in the umbilical cord, the head (middle cerebellar arteries) or the liver)
  • biophysical profile (flows, movements, amniotic fluid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Risk of repeated FGR pregnancy

A

20-30%

Depending on if it is isolated FGR or concurrent diseases

  • preeaclempsia
  • chromosomal abberations
  • maternal diseases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

hvad er cephalic presentation

A

Barnet der fødes i position med hovedet først

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Benævn forløbet af en normal fødsel

A
  • dilation and decent of the baby
  • delivering of the baby
  • delivering of the placenta
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Present the stages of the birth

A
  1. stage (latent)
    - dilation (until 10 cm)
  2. stage (active)
    - orificium 10 cm until birth of the child
    - descent and pushing
  3. stage
    - delivering of the placenta (often delivered spontaneously in 15 min)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What to look for at the labor ward

A
  • uterus, contractions
  • fetal size, presentation (cephalic, ?), fetal heart rate
  • vaginal examination (cervix length, position of the cervix, dilation of the orificium, leadnig part (head, butt,?), station (where in the pelvis), rotation of the head, membranes)
  • partogram at “active labor”
  • BP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Describe rotation of the baby during birth

A

looking at one side –> ending up looking at the mothers anal area (child stations of presentation video)
The posterior side are longer than the anterior??

Fingers above...
\+3 = the level of the pelvic floor 
\+2 = the level behind spina ischadia
\+1 = 
0 = 
- 1 =
-2 = mid pelvic level
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is progression in labour depending on

A
  • power (contractions)
  • passage (birth canal)
  • passenger (fetus)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Why is birth a challenge for the baby

A
  • reduced blood flow during contractions (lack of oxygen –> changes in fetal heart rate)

not a problem for a healthy fetus, but a problem in case of growth restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

how to monitor fetal heart rate

A
  • midwife stetoskope
  • doppler UL
  • EFM/CTG (high risk pregnancy, i.e. small baby, preeclampsia)

CTG = kardiotokografi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How to look at a EFM/CTG

A

top: fetal heart rate
bottom: contractions

look for:

  • variability: small occilations
  • de-/accelerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

how to reduce pain non-pharmacological

A
  • antenatal classes for tecniques (fødselsforberedelse)
  • hot water, shower, bath tub
  • acupuncture
  • water papules (bistik)
  • massage
39
Q

how to reduce pain pharmacological

A

Stage 1

  • N2O (lattergas)
  • morphine
  • epidural (walking epidural)
  • spinal analgesia

Stage 2

  • pudendal block
  • infiltration analgesia (suturing the damage in vagina/perineum)
40
Q

Describe epidural side effects

A
  • side effects: no or suboptimal effects, hypotension, fever, urinary retention, puncture of dura (spinal headache), infections in the back
    pros: the most efficient
41
Q

Precautions with epidural

A
  • anticoagulant therapy (LMWH)
  • preeclampsia
  • thrombocytopenia
  • septic infections
  • local infections near point of placement
  • high intracranial pressure??
42
Q

how to score a new born

A
  • APGAR: respiration, heart rate, color, tone, reflexes

0-2 point each, at max 10

43
Q

What can cause a low APGAR score and what tests should be made?

A
  • hypoxia
  • sickness such as?

pH and SBE: a. umb. and v. umb

44
Q

How long to wait for placenta delivery before manually removing it

A

60 minutes

45
Q

Post partum observations

A
  • uterus contractions
  • bleeding (up to 500 ml)
  • injuries, lacerations, haematomas,
  • temperatures
  • lactation
46
Q

Devision among the fetal presentations

A

Normal

  • cephalic (95%)
  • occiput anterior (90%)

Abnormal (the fetus does not present as occiput anterior at term)

  • abnormal cephalic presentation (occiput posterior “stjernekigger”)
  • breech (legs/butt first)
  • transverse/oblique

Deflexions: parietal, brow, face

Risk: prolonged labor/operative delivery

47
Q

Desribe the breech presentation

A

4% at term
25% in week 30

Causes:

  • FGR
  • uterine anomaly
  • oligo/poly hydraamnoin
  • malformation of the fetus
  • decreased muscle tone

Associated risk:
- perinatal mortality and morbiditet increased, independent of mode of delivery
- planned vignal delivery vs C-section – perinatal mortality and morbidty increased
- planned vaginal delivery on strict criteria
OBS hypoxia

Solution:
- try to turn the baby from gestational age 36 (success rate 40-50%)
The risk of this for acute C-section is <1%

48
Q

What is the breech challenge

A

The largest part of the baby is delivered lastly –> arrest of the baby –> suffocation of the baby

49
Q

What is the breech challenge

A

The largest part of the baby is delivered lastly –> arrest of the baby –> suffocation of the baby

Hence most babies in breech position is delivered by C-section

50
Q

Which 2 types of women exists at the birth ward

A

nulliparae and multiparae

51
Q

Causes of prolonges labour

A

Power
- dystocia (oxytocin might help)

Passeger
- mechanical disproportion (fetal magnus, abnormal presentation

Passage
- contracted pelvis (unusual in DK but is often due to malnutritun in 3. world countries)

52
Q

Define prolonged labour

A
  1. stage
    - a dilation less 2 cm over 4 hours (from 4-6 cm)
  2. stage (descent)
    - caput has not reached the pelvic floor in 3 hours
  3. stage (pushing)
    - the baby is not delivered in 2 hours
53
Q

How to diagnose prolonged labour

A

Using a partogram with station of presenting part and orificium dilation (SE SLIDE OG EKSEMPEL)

54
Q

Treatment of prolonged labour

A

power problem: labour augmentation oxytoscin

Passengar problem - operative delivert - vaginal or CS

55
Q

How to decide is operative vaginal delivery is possible

A

Is a natural vaginal delivery possible?

  • orificium is fully dilated
  • hear beneath the interspinal level

Accept from the mother

56
Q

Operative delivery by vacuum options

A

metal cup or silicone cup or foreceps

57
Q

how to perform a cuum extraction

A

pull only during contraction

max 3-4 contraction / 10–15 min

Risk of shoulder dystocia and anal shincter rupture

STOP if the baby does not follow

58
Q

Define shoulder dystocia

A

the anterior……..

59
Q

risk factors for shoulder dystocia

A

big baby
maternal DM
prolonged labour
turtle sign

60
Q

How to manage shoulder dystocia during labours

A
  • get more space by moving the mother’s legs
  • rotate
  • diminish the size of the shoulders by compressing from the outside
  • deliver the posterior arm first by catching it
61
Q

Causes of maternal mortality

A
  • severe bleeding
  • obstructied labour
  • infection
  • unsafe abortion
  • eclampsia
62
Q

Where do women bleed from and what do the body do to compensate

A

placenta –> contraction of uterus (compression of vessels) and hypercoagulation

63
Q

why do women bleed doo much

A

Atony (insufficient contraction) (70%)
lesions (20%)
retained tissue (10%)
coagulopati (1%)

(rarely because of lack of coagulation)

64
Q

How much do they bleed

A

> 500 ml: 17 %
1000 ml: 6%
1500 ml: 3%
2000 ml: 2%

“2% bleeding more than 2 liters” –> transfusion!

65
Q

Risk factors for bleeding

A
  • gemelli (mere end én baby)
  • placenta previa
  • previous C-section
  • para 6
  • previous postpartum haemorrage
66
Q

How to manage PPH

A
  • prophylaxis for high risk patients: syntocinon (decreases bleeding by 60%)
  • early diagnosis: measure the blood
  • compress the uterus from the outside, bimanual compression, aorta compression, balloon compression
  • medications i.v. (oxytocin, Metergin)
  • trendelenburg
  • O2
  • transfusion (0 rh neg) or crystalloider –> blood-FFP-trombocytter –> if severe bleeding tranexamic acid and fibrinogen
  • move to OP

WATCH FOR INCREASING PULSE RATE

67
Q

OP options as treatment for bloodloss

A
  • B-lynch (suture around the uterus) (risk of ischemia in the uretus afterwards)
  • ligating aa uterina
  • stepwise devasculation of the uterus
  • ligating aa iliacae interna
  • embolisation
  • hysterectomi
68
Q

Global challenges associated with C-sections

A
  • maternal mortality
  • adaopting western principles
  • TOL after CS-risk (scar will detach)
  • many children
69
Q

What is the C-section frequency

A

20% in DK, 15% world wide

70
Q

Indications for CS (fetal)

A

planned: FGR/placental insufficiens, transverse/breech presentation
acute: hypoxia (CTG, pH, lactate), prolapse umbilical cord, placental abruption, uterine rupture

71
Q

Indications for CS (maternal)

A

Prior to labour:

  • severe preeclampsia
  • placenta previa
  • previous uterine operation
  • CS >1

During labour:

  • dystocia
  • disproportion
  • maternal request (often due to a complicated first delivery or a previous CS)
72
Q

Maternal complications to CS (acute)

A
  • mortality <1 pr year in DK
  • reoperation because of bleeding <1%
  • venous thrombosis <1%
  • organ lesion (bladder/ intestines) <1%
  • infections incl. UTI 10%
  • wound infections 2%
  • uterine rupture in the next labour 0,5%
73
Q

Maternal complications to CS (long term)

A
  • adhesions
  • placenta previa
  • placenta accreta/percreta (placenta forløser sig ikke korrect og kan vokse ind i omkringliggende væv)
  • pregnancy implantation in CS scar
  • endometriosis
74
Q

Fetal complications to CS

A
  • no rise in level of catecholamines (som hjælper respirationen og at presse væske ud af lungerne) —> respiratory problems –> CPAP
  • no contact with bacteria from the maternaI GI tract –> influence on immune system are unclear
75
Q

Which week is the most optimal for a CS

A

week 39

76
Q

Analgesia for CS

A

Spinal - epidural
- safest and the mother experiences to give birth

GA
- risk of aspiration and risk in case of AK-treatment

77
Q

Why dont we like to put pregnant women in GA

A

Big abdomen and never have an empty stomach –> aspiration

78
Q

Describe uterine rupture (incidence, preparations and warning signs)

A

incidence 0,5%

TOL after CS demands: an organisation ready to act immediately, informed consent, intensive monitoreirn of mother and fetus

warning signs: CTG changes(!!!), pain, sudden dissapearance of contractions, ……. (SE SLIDE)

79
Q

What is the incidence of PPH > 1 liter

A

6-9%

80
Q

Anovulation, infertilitet og blødningsforstyrrelser skyldes enten…

A

Abnorm FSH/LH sekretion eller ovarial defekt med abnorm dannelse af modne follikler

81
Q

Hvilket hormon måles som markør for den reproduktive alder og bruges i forbindelse med fertilitetsbehandling

A

Antimüllersk hormon (AMH)

Meget lavt ved kvinder som har ophørt eller reduceret ovariefunktion og højt hos ptt med PCOS

82
Q

Symptomer på PCOS

A

Anovulation med oligomenore eller amenore, hirsutisme, acne og sebore. Ofte overvægt.

83
Q

Diagnostiske kriterier ved PCOS

A

Rotterdam kriterierne:

  1. Oligo- eller anovulation
  2. Klinisk eller biokemisk tegn på hyperandrogenæmi
  3. Polycystiske ovarier
84
Q

Factors affecting lung deposition in asthma

A
  1. compliance
  2. particle size
  3. speed of inspiration
  4. integrity of airways
  5. proper inhaled device technique
85
Q

Diff til astma

A
  • CF
  • kronisk atelektase
  • vocale cord dysfunction
  • tumor/granulomer i lungerne pga kompression
  • non-CF bronkoektasi
  • kroniske lungesygdomme hos børn (interstitielle lungesygdomme, emfysem, allergisk alveolitis, postinfektiøst bronkiolitis, pulmonal hemosiderosis,
  • neonatale pulmonale sygdomme (kongenitale malformationer, bronkopulmonaldysplasi)
  • primær immundefekt
  • andre øvre luftvejs sygdomme
86
Q

Anamnese ved mistanke om artritis hos børn

A

Diurnal variation

  • morning stifness
  • day to day variation
  • pain (during rest? when active? sudden movement?, minor trauma?)
  • decreased insurance (need for rest)

Any changes observed?

  • swollen joint?
  • awareness of joint?
  • redness?
87
Q

Redness of joint

A
  • septisk arthritis
  • reactive arthritis
  • familiar Mediterranean fever
  • systemtisk JIA
88
Q

Hyppigste reumatiske sygdomme i barndommen

A
  • Autoimmune sygdomme (SLE, juvenil dermatomyositis, sclerodermi)
  • Juvenil idiopatisk artritis (HYPPIGST)
  • Pain syndromes
  • Vasculitis (henoch schønlein purpura, kawasaki, GPA, MPA)
  • Autoinflammation (monogenic fever syndromes)
  • Knoglesygdomme (kroniske non-infektion, osteomyelitis)
89
Q

Diff diagnoser for JIA

A
  • infektiøs artritis (aureus, h influenzae, borreliosis)
  • postinfektiøs artritis (prygenes, campylobacter, coxitis simplex)
  • autoimmune sygdomme (SLE, juvenil dermatomyositis)
  • vasculitis (Kawasaki, henoch-schønlein purpura, Wegener)
  • orthopediske (calve-perthes sygdom, epifysiolysis)
  • non-inflammatoriske (growing pain, hypermibilitet)
  • malignitet (leukæmi , neuroblastom, knogletumor)
  • haematologiske (hæmofili, thalassæmi, seglcelleanæmi)
  • andre (sarcoidosis, familiær Mediterranean fever, reumatisk feber)
90
Q

Hvad kan ses på røntgen af ektremiteter ved leukæmi

A

Leuchemic bands ved epifyseskiverne

91
Q

Hvor mange subkategorier inddeles JIA i

A

7

  • oligo (1-4 joints) (50%)
  • poly (>5 joints) (20%)
  • systemtisk (m feber) (15%)
  • psoriasis artitis (10%)
  • enthesitis related (10%)
  • unidentified (10%)
92
Q

Symptomer på systemisk JIA

A
  • quotidian feber >14 dage (sav-takket temperaturkurve, max 39C)
  • fluctuating macular exanthema
  • genelized lymphadenopathy
  • hepato/splenomegali
  • pericarditis/pleuritis
  • arthritis, atralgia, myalgia
  • anæmi, træthed, profuse sweating
  • hypersedimentation, leukocytosis, trombocytosis
93
Q

Inddeling af polyarticular JIA

A
  • RF-negativ (20%)

- RF-positiv (5%)

Gyn-obs (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions