More O&G Things I Don't Know ;) Flashcards
examples of AD inherited conditions?
marfans
neurofibromatosis
huntingtons
what foods should be avoided to prevent toxoplasmosis?
underpasturised milk
raw meat
soil
what is toxoplasmosis?
parasite that can cause congenital infections eye problems reduced IQ miscarriage still birth
what infection can be picked up from pate?
listeria
what is liver high in?
vitamin A
what is soft cheese associated with?
listeria
caffeine in pregnancy?
> 200 micrograms associated with IUGR and miscarriage
features of foetal alcohol syndrome?
deformed facial features reduced IQ kidney defects ADHD microcephaly flattened philtrum IUGR ongoing short stature deformed fingers heart problems also associated with still birth
routine blood tests in pregnancy at booking?
FBC (check for anaemia) rhesus status syphilis HIV Hep-B
what haemoglobinopathies are screened for at booking?
sickle cell
thalassaemia
optional trisomy screening bloods offered at booking?
PAPP-A and HCG (downs)
AFP, oetradiol and inhibin
1st trimester screening for downs?
PAPP-A
HCG
nuchal thickness on USS
diagnostic tests for downs if deemed high risk of trisomy?
amniocentesis (after 15 weeks)
CVS (11-14 weeks)
routine bloods at 28 weeks?
random glucose
FBC
group and save
look for antibodies?
second trimester screening for downs?
AFP
oestrogen
inhibin??
what trisomies are screened for?
downs (21)
edwards (18)
pataus (13)
features of edwards?
microcephaly micrognathia (small jaw) low set ears hands clenched into fists low set ears mental impairment clubfoot
features of pataus?
microcephaly micrognathia low set ears small, close set eyes (eyes can be absent) cleft lip/palate severe mental retardation extra fingers or toes
biggest risk factor for downs syndrome?
maternal age (increased over 30??, 1 in 100 risk if over 40)
what GI anomalies are screened for at 20 week anomaly scan?
gastroschisis
exomphalos (bowel contents contained within sac)
which has worse prognosis - gastroschisis or exomphalos?
exomphalos
bc its associated with severe genetic defect such as edwards or pataus
also higher risk as more abdominal contents can be outside of body in the sac
can be tested for on amnio or CVS
who should get high dose folic acid (5mg)?
diabetes
obesity
history of neural tube defect
women taking anti-epileptics or nay enzyme inducing drugs
what other vitamin should all pregnant women be taking?
vit D
19 week pregnant woman whos rhesus negative and has PV bleeding, does she need anti D?
yes
who needs anti D?
over 12 weeks, rhesus negative with PV bleeding suggesting a sensitising event
what is a sensitising event?
might be foetal blood cells getting into maternal circulation causing mum to create an immune response to the foetal blood cells
includes miscarriage or termination if after 12 weeks
women with haemolytic disease of newborn in previous pregnancy due to known D antigens requires anti D in next pregnancy?
no
already sensitised in previous pregnancy so already has D antigens so anti-D wont stop immune response
blood test to look for amount of foetal blood cells in mothers circulation to help give right dose of anti-D?
kleinhauers test
done after 20 weeks (as <20 weeks there isnt that much blood so standard anti-D dose will definitely be enough)
are all rhesus negative women without known D-antigens (previous sensitising event) given anti-D routinely?
yes
all get it once or twice just to cover asymptomatic bleeding
if potentially sensitising event occurs they get another additional dose
what ethnicities are associated with sickle cell?
afro caribbean
what ethnicities are associated with thalassaemia?
cypriot eastern mediterranean asian indian middle eastern
is thalassaemia microcytic or macrocytic?
micro
is sickle cell micro or macrocytic?
normocytic
can termination be done if foetus has haemoglobinopathy?
yes
should have counselling with haematology though to make sure they understand the condition
how is foetal anaemia identified if suspected in the feotus?
titres of antibody levels increase which suggests foetal anaemia
look at middle cerebral artery on doppler US to identify waveform suggesting anaemia
presentation?
which part of foetus is presenting at foetus
malpresentation?
any presentation other than vertex
position?
relationship of presenting part to maternal pelvis (eg occiput/sacrum)
lie?
longitudinal/transverse
station?
relationship of foetal presenting part to level of ischial spine (-3 to +2)
engagement?
widest diameter passing pelvic inlet
described in terms of 5ths palpable
how is foetal position determined on vaginal examination?
feel for fontanelles
anterior = 4 bones (diamond shaped)
posterior = 3 bones (triangle shaped)
normal birthing position?
occipito-anterior (facing downwards, towards mothers back)
what is entonox?
nitric oxide + oxygen (gas and air)
out of system within a few breathes
v safe
side effects of opiates?
constipation
itch is common
can cause nausea and vomiting
sedation of mum and baby or resp depression if severe
baby can be bit drowsy and slow to feed (more with v strong opiates like diamorphine)
opiate toxicity reversal?
naloxone
do regional anaesthetics (epidurals) increase rate of C-sections?
no
can have increased risk of assisted vaginal delivery (eg forceps) as reduced sensation can cause women to not be able to push as hard?
can regional anaesthetic be given in community?
no
anaesthetic for emergency C section?
if epidural already in place top it up (denser block)
spinal anaesthetic if nothing in place
why are general anaesthetics higher risk in pregnant women?
higher progesterone causes muscle relaxation and higher risk of aspiration
also higher risk of failed intubation in pregnant women (breast tissue and weight increase)
what does umbilical artery do?
carried deoxygenated blood from foetus to placenta
what does umbilical vein do?
carries oxygenated blood from placenta to foetus
2 arteries and one vein in umbilical cord?
2 umbilical arteries
1 umbilical vein
where is foramen ovale?
between atria
shunts blood left to right in foetus
ductus arteriosus shunts blood from where to where?
pulmonary artery to descending aorta (to bypass the lungs)
where does ductus venosus shunt blood?
from umbilical vein to IVC to bypass liver
features of normal CTG?
HR 100-160
accelerations (2 per hr but can be none during period of foetal sleep)
variability (5-25)
either no decelerations or early decelerations (in time with contractions) in labour
how long does foetus sleep?
around 40 min
ie no accelerations, reduced variability for up to 40 mins can be normal if baby is asleep
variable decelerations (happening at different times) are a sign of what?
cord compression
can be a sign of hypoxia if persisting over 90 mins
what are late decelerations?
starts at height of contraction
falls after contraction has ended
dont returnt to base rate
what are late decelerations associated with?
foetal hypoxia
normal rate of contractions?
up to 5 in 10 mins (more = hyperstimulation)
what is reduced variability associated with?
hypoxia
can be a sign of opiate use
can be a sign baby is asleep (if present for up to 40 mins)
how must baby be delivered if cord prolapsed?
c section
symptoms of pre-eclampsia?
headache
oedema
abdo pain (epigastric or RUQ specifically)
can have hyper-reflexia, confusion etc if oedema in brain)
how is mild pre-eclampsia treated in community?
labetalol
nifedipine
how is severe pre-eclampsia (>160) managed?
IV labetalol = first line
IV hydralazine = second line
IV magnesium sulphate may be used if possible eclampsia (seizure) suspected
magnesium toxicity?
hyporeflexia can be first sign
low resp rate
reduced consciousness
arrhythmia
how can magnesium toxicity be reversed?
calcium gluconate
fluid balance in pre-eclampsia?
fluid restrict to reduce oedema
kidneys loosing protein = less oncotic force = fluid leaks out = oedema
when should you definitely deliver baby in severe pre-eclampsia?
if severe and woman is at term (37+ weeks)
how quick does pre eclampsia disappear?
takes up to 4 weeks (can still have fits)
what medication can be given in next pregnancy (after 12 weeks) to reduce risk of pre-eclampsia if woman had previous pre-eclampsia?
aspirin (150mg taken at night)
higher risk of pre-eclampsia again if had it in prev pregnancy
blood tests in suspected pre-eclampsia?
FBC (Hb and platelet) U&Es coagulation (HELLP syndrome) LFTs urate
HELLP syndrome?
complication associated with pre-eclampsia
- haemolysis
- elevated
- liver enzymes
- low
- platelets
foetal risks of pre-eclampsia?
IUGR
abruption
still birth
pre-term delivery
causes of bleeding >24 weeks (antepartum heamorrhage)?
placenta praevia
placental abruption
vasa praevia
others: ectropion, infection, trauma, rupture etc
bleeding in placenta praevia vs abruption?
praevia = painless abruption = painful, can be concealed
signs of vasa praevia
minor bleed when membranes rupture
painless
causes severe foetal distress
how long does group and save last?
72 hrs
universal blood used in emergency?
O-
blood products used?
red cells (if massive)
platelets
cryo
fibrinogen
causes of polyhydramnios?
idiopathic
diabetes +/- macrosomnia
foetal abnormality (swallowing problem such as oesophageal atresia, thorax mass compressing)
neuro problem
anything causing increased foetal urine output (anaemia, hypercirculation, tumours)
what does increased fluid around one twin indicate?
twin to twin transfusion syndrome
causes of oligohydramnios?
spsontaneous rupture of membranes IUGR (Placenta not working) potters syndrome (no kidneys?) anything causing reduced foetal urine output congenital infection
investigations in polyhydramnios?
GTT antibodies serology middle cerebral artery doppler examine placenta
types of twins?
monochorionic monoamniotic
monochorionic diamniotic
dichorionic diamniotic
safest twins to carry?
dichorionic diamniotic
main risk in monochorionic twins?
twin to twin transfusion syndrome (high risk)
how is type 1 diabetes affected in pregnancy?
gets worse
higher risk of DKA, hypos, worsening of micro/macrovascualar complications
risks to foetus in diabetic mothers?
macrosomnia PPH shoulder dystocia pre-eclampsia IUGR (can go either way) stillbirth miscarriage neural tube defects foetal heart problems higher HbA1c = higher risk of foetal anomalies
main cause of PPH?
uterine atony
how is each cause of PPH managed?
tone = uterotonics tissue = theatre for removal trauma = stitch it up (can be done under LA if appropriate) thrombin = treat cause
types of uterotonic management?
fundal massage empty bladder oxytocin infusion (ok to repeat) ergometrine carboprost misoprostol
which uterotonic are all women offered at delivery routinely to reduce risk of PPH?
oxytocin
surgical management of PPH if meds not working?
intrauterine balloon
laparotomy - brace suture, artery ligation, hyterectomy (last resort)
uterine artery embolisation
combined test in pregnancy?
done between 11-14 weeks tests for downs, edwards and pataus uses - maternal age - US (nuchal translucency and CRL) - maternal serum biochemical markers (PAPP-A, bHCG)
normal nuchal translucency/thickness?
<3.5mm
increased in downs
second trimester screening in pregnancy?
only screens for downs
consists of
- maternal blood test between 14-20 weeks
- USS (fetal head circumference)
- maternal age
if head circumference more than 101mm, blood sample taken for quadruple test
what does quadruple test consist of?
bHCG
AFP
inhibin A
uE3 (unconjugated oestriol)
which is more sensitive, first or second trimester screening?
first
second only really used if woman books too later for 1st trimester screening or is unable to get 1st trimester screening for some reason
