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obstetrics and gynaecology 2 - use this one > master deck > Flashcards

master deck Flashcards

1
Q

early pregnancy symptoms?

A

tiredness
nasuea
breast tenderness

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2
Q

… is the commonest complication in early pregnancy

A

miscarriage

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3
Q

… % of clinical pregnancies end is miscarriage

A

20%

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4
Q

risk factors for miscarriage?

A
  1. maternal age over 35
  2. smoking
  3. structural uterine abnormalities
  4. history of miscarriage
  5. hormonal dysfunction
  6. exposure to teratogens
  7. contraceptive device in situ
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5
Q

define threatened miscarriage?

A

bleeding, cramps, but baby is okay

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6
Q

define spontaneous miscarriage?

A

embryo passed out of uterus

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7
Q

define complete miscarriage?

A
  • endometrial thickness <15 mm, cramping bleeding
  • need to have IU gestation sac (IUGS) previously to make diagnosis
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8
Q

define incomplete miscarriage?

A
  • endometrial thickness > 15 mm (still tissue in uterus), cramping or bleeding
  • need to have IU gestation sac previously to make diagnosis
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9
Q

define inevitable miscarriage?

A
  • cervical os open and ongoing bleeding, heaving bleeding
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10
Q

define consecutive miscarriage?

A

3 spontaneous miscarriage

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11
Q

symptoms and signs of miscarriage?

A

vaginal bleeding
abdo cramps
loss of pregnancy symptoms
no symptoms

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12
Q

presentation of miscarriage ?

A

bleeding on wiping is common
cervical excitation may suggest ectopic pregnancy

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13
Q

investigations of miscarriage ?

A

transvaginal ultrasound
- may qualify as pregnancy of uncertain viability if borderline – come back in 10-14 days and repeat ultrasound

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14
Q

how can miscarriage be diagnosed on ultrasound ?

A

transvaginal ultrasound
1. embryo > 7mm and no cardiac pulsation
2. gestational sac > 20 mm and mopey (no yolk sac or embryo)

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15
Q

management options for miscarriage?

A
  1. conservative
    - exclude signs of infection
    - follow-up scans every 2 weeks
    - generally move to medical or surgical after one or 2 weeks in reality
    - very important to counsel patients on signs to be aware of (heavy bleeding), may need emergency ERCP
    - can take paracetamol, nurofen at home
  2. medical
    - 80-91% success rate
    - can take at home, will have bleeding and pain, but should settle in 1 or 2 days
    - nausea, vomitting, headache
    - mifepristone (progesterone antagonist, taken in hospital) followed by misoprostol (prostaglandin analogue - contracts uterus) 36 hrs later
  3. surgical: ERPC or manual vacuum aspiration (MVA)
    - suspicion of molar pregnancy
    - cytogenetic sampling is required for recurrent miscarriage
    - large gestational sac - higher risk of hemorrhage
    - allergies to tablets
    - risks include: hemorrhage, infections, incomplete evacuations, uterine perforation, cervical tears, asherman’s syndrome
    - misoprostol before surgery to soften cervix
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16
Q

follow-up for miscarriage?

A

urine pregnancy test 14 days post for hug levels - less than 1000 is successful

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17
Q

how may someone with an ectopic pregnancy present ?

A

shoulder tip pain/peritonitis
fainted/collapse
small amount of bleeding
vital signs usually normal unless ruptured

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18
Q

risk factors for ectopic pregnancy?

A
  1. previous pelvic inflammatory disease
  2. history of IVF
  3. tubal surgery
  4. infertility
  5. smoking
  6. increased maternal age
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19
Q

management of ectopic pregnancy?

A
  1. stable patient - monitor HCG until under 20. if HCG low at the start then 88% will resolve on their own
  2. medical
    - methotrexate IM injection: need to check renal and liver profile prior to ir
    - must be stable patient and will need follow-up. HCG on day 4 and 7, follow until less than 20
  3. surgical
    - unstable patients
    -laparoscopy or laparotomy
    - salpingostomy or salpingectomy (needed for rupture
    - follow- up Hcg
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20
Q

management of rupture ectopic pregnancy?

A

ABCs
get help
take bloods (type and crossmatch)
surgery

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21
Q

women who had a ectopic pregnancy what is required ?

A
  1. next pregnancy requires early scan to rule out ectopic
  2. future fertility
  3. need anti-D in rhesus negative
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22
Q

what are obstetrical complications of T1DM (maternal) ?

A
  1. HTN, PET and related hypertensive disease
  2. worsening of complications of T1DM: retinopathy, neuropathy, UTI, cardiac disease
  3. miscarriage
  4. hypoglycaemia (
  5. DKA
  6. hyperglycaemia
  7. complicated labour; induction/CS
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23
Q

what are fetal complications of T1DM?

A
  1. growth restriction, placental insufficiency
  2. premature delivery (due to polyhydraminos)
  3. macrosomia/shoulder dystocia/birth trauma
  4. congenital malformations
  5. perinatal mortality (still birth)
  6. hypoglycaemia (requires feeding from mother within an hour to avoid complications
  7. polycythemia, hypocalcemia, hyperbilirubinemia
  8. cardiomyopathy
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24
Q

how does maternal hyperglycaemia affect the fetus ?

A
  1. causes fetal hyperglycaemia, which leads to osmotic diuresis (excessive fetal urine - polyhyraminos) and fetal hyperinsulinemia
  2. fetal hyperinsulinemia causes macrosomia and increased erythropoiesis (causing polycythemia)
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25
Q

preparation for pregnancy T1DM?

A
  1. high dose folic acid 3 months before
  2. HbA1c <6.5%
  3. fasting blood glucose target of 3.5-5.5 mmol/L
  4. review medications
    - discontinue ACEi/ARB
    - avoid statin
    - swap antihypertensives to those safe in pregnancy (labetalol, nicardipine, methyldopa)
  5. get to a normal BMI
  6. screen for microvascular complications, and hypertension
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26
Q

T1DM monitoring during pregnancy?

A

MDT - with endometrial
sugars checked 7 times/day
high dose folic acid given until 12 weeks
aspirin from week 12 to reduce preeclampsia
monitor insulin usage - insulin demand and usage should increase as pregnancy continues - if it is falling, this might be a sign of imminent fetal demise (due to placental insufficiency)
regular scans: 11-14 weeks, then every 2-4 weeks until 36 weeks
**need to be delivered before or at 39 weeks - or earlier depending on complications

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27
Q

how is T1DM managed in Labour?

A

sliding scale insulin
hourly blood glucose
half insulin infusion after placenta delivery, check blood glucose every 2hours

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28
Q

what needs to be done immeditately after delivery in the case of T1DM ?

A

1) breast feed immediately within 1 hour; at increased risk of hypoglycaemia, respiratory distress

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29
Q

what is the definition of preterm labour?

A

onset of labour before 37 weeks
- extreme: before 28 weeks
- very preterm: 28-32 weeks
-moderate to late: 32-37

30
Q

ethology of preterm labour?

A

1) uterine stretch: polyhydraminos, multiple pregnancies, abruption
2) inflammation: UTI, ascending infection
3) cervical weakness
- or short cervix
- if 5mm at 23 weeks - 80% chance of preterm labour
- presents as painless dilation of the cervix +/- precipitous labour
4) iatrogenic (we induce it)
5) idiopathic

31
Q

risk factors for preterm birth?

A
  1. history of preterm birth
  2. multiple pregnancies
  3. cervical surgery (multiple LLETZ or single cone biopsy
  4. low SES
  5. vaginal bleeding in early pregnancy (chorion separates and gets bleeding behind it, source of infection, leads to PPROM and early contractions)
  6. extremes of age and BMI
  7. uterine anomalies
  8. medical conditions (LSE
  9. pre-eclampsia
  10. shorter inter pregnancy intrervals
32
Q

causes of preterm labour?

A
  1. cervical incompétence
  2. abruption
  3. infection
  4. uterine anomaly
  5. placental insufficiency
33
Q

neonatal complications of prematurity?

A
  1. interventricular hemorrhage
  2. retinopathy of prematurity
  3. pulmonary edema/pulmonary hemorrhage
  4. hypothermia
  5. sepsis
  6. necrotizing enterocolitis
  7. respiratory distress syndrome: bronchopulmonary dysplasia and chronic lung disease of prematurity
  8. apnea of prematurity - give caffeine (methylxanthines) to stimulate breathing pattern.
34
Q

what is fetal fibronectin?

A

normally found between uterus and amniotic sac. if it negative unlikely to deliver within the next 7 days

35
Q

what is magnesium sulfate used for?

A
  1. used in pre-eclampsia to raise the seizure threshold
  2. acts a short term tocolytic
  3. reduces the risk of cerebral palsy
  4. given when delivery is expected within 12 hours – before 32 weeks
36
Q

what is atosiban ?

A
  • inhibits oxytocin induced contractions
  • it is a tocolytic (stops contractions)
37
Q

what are the indications for tocolytics ?

A
  1. 24-36 weeks
  2. given to delay for 24 hours (to Give time to deliver steroids, get centre when she can delivery)
38
Q

what can be done to prevent preterm labour?

A
  1. progesterone PV
  2. cervical sutures (cerclage) give at 12-14 weeks
39
Q

risk of hysterectomy?

A
  1. excessive bleeding, need for transfusion
  2. damage to ureters
  3. damage to tubuloinfundibular ligament which contains ovarian artery
  4. general: infection, VTE, bleeding, anaesthetic risks
40
Q

only… % of fibroids are symptomatic

A

25%

41
Q

.. of women in the 50s have fibroids

A

50%

42
Q

treatment options for fibroids?

A
  1. hysteroscopy and resection
  2. progesterone coil
  3. transexamic acid for heavy bleeding relief
  4. myomectomy
  5. Interventional radiology and can embolise fibroid to cut off blood supply
  6. hysterectomy
43
Q

risks of fibroids in pregnancy?

A
  1. preterm birth
  2. growth restriction
  3. later miscarriage
  4. abnormal lie
  5. low fibroid could obstruct cervix
  6. PPH
44
Q

differential for post menopausal bleeding?

A

endometrial hyperplasia/cancer
endometrial polyps
atrophic vaginitis
cervical cancer

45
Q

endometrial cancer is usually what type? what is another subtype

A

adenocarcinoma
papillary serous cancer

46
Q

risk factors for endometrial cancer?

A

early menarche
late menopause
nulliparity
obesity
PCOS
tamoxifen

47
Q

stages of endometrial cancer?

A
  1. confined to the uterus
  2. into the cervix, but not beyond
  3. local spread into the vaginal vault
  4. distant mets
48
Q

investigations for endometrial cancer?

A
  1. transvaginal ultrasound: >3cmm if not on HRT, >5 mm if on HRT
  2. biopsy
    - pipette
    - +/- outpatient hysteroscopy (combined with biopsy, D+C/ablation, insertion of mirena coil
  3. if confirmed
    - CT TAP (staging)
49
Q

surgery for endometrial cancer

A

total abdominal hysterectomy + bilateral salpingophorectomy + bilateral sentinel lymph node biopsy
- follow-up radical if vaginal recurrence +/- chemo/rad if advanced stage

50
Q

risks of ovarian cancer

A

increased number of ovulation
ovulation

51
Q

familial syndromes associated with ovarian cancer ?

A

BCRA1/2
Lynch syndrome (associated with colorectal and endometrial cancer_

52
Q

OCP and tubal ligation is… for ovarian cancer

A

protective

53
Q

classification of ovarian cancer

A
  1. epithelial
  2. sex-cord stromal
  3. germ cell tumour
54
Q

staging of ovarian cancer?

A
  1. one ovary
  2. into the pelvis
  3. into the abdominal cavity
  4. distant mets
55
Q

what is Meigs syndrome?

A

triad of:
- benign ovarian mass
- ascites
- pleural effusion
**both ascites and pleural effusion resolve with resection of the tumour

56
Q

management of ovarian cancer?

A
  1. total abdominal hysterectomy + bilateral salpinogo-oophorectomy, peritoneal washings
  2. omentectomy
  3. chemo: paclitaxel
    - used for cytoreduction before surgery
57
Q

only screening for ovarian cancer?

A

TVUS and Ca-125 in a patient who is BRCA positive

58
Q

investigations for suspected ovarian cancer?

A
  1. ultrasound
  2. CA-125 + CT TAP
59
Q

90% of ectopic pregnancies occur in the …

A

Fallopian tubes

60
Q

investigations for primary amenorrhea?

A
  1. bloods (FSH, LH, +/- estradiol, prolactin, TSH)
  2. Pelvic/transabdominal US
  3. karyotype +/- MRI
61
Q

if primary amenorrhea occurs in the presence of inappropriate secondary sexual characteristics, it is likely a problem with ?

A

HPO axis

62
Q

if primary amenorrhea occurs in the presence of secondary sexual characteristics, it is likely a problem with the anatomy

A

anatomy

63
Q

define precocious puberty?

A

<8 years old
most often central cause

64
Q

contraindications to oral combined contraceptive?

A

migraine with aura
personal or family history of DVT

65
Q

post partum hemorrhage is defined as ?

A

defined as bleeding from the genital tract >500 ml after delivery of the baby
- primary if within 24 hours of delivery

66
Q

pre-pregnancy risk factors for PPH?

A
  1. high parity
  2. persona/family history of coagulopathy
  3. need for anticoagulant
  4. previous PPH
67
Q

antenatal risk factors for PPH?

A

polhydraminos
macrosomia
multiple pregnancy
known placenta accrete
IUD

68
Q

intrapartum risk factors for PPH ?

A

precipitous labour
dystocia
infection
antepartum hemrorhage
instrumental delivery
cesarean section
amniotic fluid embolism

69
Q
A
70
Q
A

obstetrics and gynaecology 2 - use this one (1 decks)

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