More O&G Things I Don't Know ;) Flashcards
1
Q
examples of AD inherited conditions?
A
marfans
neurofibromatosis
huntingtons
2
Q
what foods should be avoided to prevent toxoplasmosis?
A
underpasturised milk
raw meat
soil
3
Q
what is toxoplasmosis?
A
parasite that can cause congenital infections eye problems reduced IQ miscarriage still birth
4
Q
what infection can be picked up from pate?
A
listeria
5
Q
what is liver high in?
A
vitamin A
6
Q
what is soft cheese associated with?
A
listeria
7
Q
caffeine in pregnancy?
A
> 200 micrograms associated with IUGR and miscarriage
8
Q
features of foetal alcohol syndrome?
A
deformed facial features reduced IQ kidney defects ADHD microcephaly flattened philtrum IUGR ongoing short stature deformed fingers heart problems also associated with still birth
9
Q
routine blood tests in pregnancy at booking?
A
FBC (check for anaemia) rhesus status syphilis HIV Hep-B
10
Q
what haemoglobinopathies are screened for at booking?
A
sickle cell
thalassaemia
11
Q
optional trisomy screening bloods offered at booking?
A
PAPP-A and HCG (downs)
AFP, oetradiol and inhibin
12
Q
1st trimester screening for downs?
A
PAPP-A
HCG
nuchal thickness on USS
13
Q
diagnostic tests for downs if deemed high risk of trisomy?
A
amniocentesis (after 15 weeks)
CVS (11-14 weeks)
14
Q
routine bloods at 28 weeks?
A
random glucose
FBC
group and save
look for antibodies?
15
Q
second trimester screening for downs?
A
AFP
oestrogen
inhibin??
16
Q
what trisomies are screened for?
A
downs (21)
edwards (18)
pataus (13)
17
Q
features of edwards?
A
microcephaly micrognathia (small jaw) low set ears hands clenched into fists low set ears mental impairment clubfoot
18
Q
features of pataus?
A
microcephaly micrognathia low set ears small, close set eyes (eyes can be absent) cleft lip/palate severe mental retardation extra fingers or toes
19
Q
biggest risk factor for downs syndrome?
A
maternal age (increased over 30??, 1 in 100 risk if over 40)
20
Q
what GI anomalies are screened for at 20 week anomaly scan?
A
gastroschisis
exomphalos (bowel contents contained within sac)
21
Q
which has worse prognosis - gastroschisis or exomphalos?
A
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
22
Q
who should get high dose folic acid (5mg)?
A
diabetes
obesity
history of neural tube defect
women taking anti-epileptics or nay enzyme inducing drugs
23
Q
what other vitamin should all pregnant women be taking?
A
vit D
24
Q
19 week pregnant woman whos rhesus negative and has PV bleeding, does she need anti D?
A
yes
25
who needs anti D?
over 12 weeks, rhesus negative with PV bleeding suggesting a sensitising event
26
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
27
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
28
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)
29
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
30
what ethnicities are associated with sickle cell?
afro caribbean
31
what ethnicities are associated with thalassaemia?
```
cypriot
eastern mediterranean
asian
indian
middle eastern
```
32
is thalassaemia microcytic or macrocytic?
micro
33
is sickle cell micro or macrocytic?
normocytic
34
can termination be done if foetus has haemoglobinopathy?
yes
| should have counselling with haematology though to make sure they understand the condition
35
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
36
presentation?
which part of foetus is presenting at foetus
37
malpresentation?
any presentation other than vertex
38
position?
relationship of presenting part to maternal pelvis (eg occiput/sacrum)
39
lie?
longitudinal/transverse
40
station?
relationship of foetal presenting part to level of ischial spine (-3 to +2)
41
engagement?
widest diameter passing pelvic inlet
| described in terms of 5ths palpable
42
how is foetal position determined on vaginal examination?
feel for fontanelles
anterior = 4 bones (diamond shaped)
posterior = 3 bones (triangle shaped)
43
normal birthing position?
occipito-anterior (facing downwards, towards mothers back)
44
what is entonox?
nitric oxide + oxygen (gas and air)
out of system within a few breathes
v safe
45
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)
46
opiate toxicity reversal?
naloxone
47
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?
48
can regional anaesthetic be given in community?
no
49
anaesthetic for emergency C section?
if epidural already in place top it up (denser block)
| spinal anaesthetic if nothing in place
50
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)
51
what does umbilical artery do?
carried deoxygenated blood from foetus to placenta
52
what does umbilical vein do?
carries oxygenated blood from placenta to foetus
53
2 arteries and one vein in umbilical cord?
2 umbilical arteries
| 1 umbilical vein
54
where is foramen ovale?
between atria
| shunts blood left to right in foetus
55
ductus arteriosus shunts blood from where to where?
pulmonary artery to descending aorta (to bypass the lungs)
56
where does ductus venosus shunt blood?
from umbilical vein to IVC to bypass liver
57
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
58
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
59
variable decelerations (happening at different times) are a sign of what?
cord compression
| can be a sign of hypoxia if persisting over 90 mins
60
what are late decelerations?
starts at height of contraction
falls after contraction has ended
dont returnt to base rate
61
what are late decelerations associated with?
foetal hypoxia
62
normal rate of contractions?
up to 5 in 10 mins (more = hyperstimulation)
63
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)
64
how must baby be delivered if cord prolapsed?
c section
65
symptoms of pre-eclampsia?
headache
oedema
abdo pain (epigastric or RUQ specifically)
can have hyper-reflexia, confusion etc if oedema in brain)
66
how is mild pre-eclampsia treated in community?
labetalol
| nifedipine
67
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
68
magnesium toxicity?
hyporeflexia can be first sign
low resp rate
reduced consciousness
arrhythmia
69
how can magnesium toxicity be reversed?
calcium gluconate
70
fluid balance in pre-eclampsia?
fluid restrict to reduce oedema
| kidneys loosing protein = less oncotic force = fluid leaks out = oedema
71
when should you definitely deliver baby in severe pre-eclampsia?
if severe and woman is at term (37+ weeks)
72
how quick does pre eclampsia disappear?
takes up to 4 weeks (can still have fits)
73
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
74
blood tests in suspected pre-eclampsia?
```
FBC (Hb and platelet)
U&Es
coagulation (HELLP syndrome)
LFTs
urate
```
75
HELLP syndrome?
complication associated with pre-eclampsia
- haemolysis
- elevated
- liver enzymes
- low
- platelets
76
foetal risks of pre-eclampsia?
IUGR
abruption
still birth
pre-term delivery
77
causes of bleeding >24 weeks (antepartum heamorrhage)?
placenta praevia
placental abruption
vasa praevia
others: ectropion, infection, trauma, rupture etc
78
bleeding in placenta praevia vs abruption?
```
praevia = painless
abruption = painful, can be concealed
```
79
signs of vasa praevia
minor bleed when membranes rupture
painless
causes severe foetal distress
80
how long does group and save last?
72 hrs
81
universal blood used in emergency?
O-
82
blood products used?
red cells (if massive)
platelets
cryo
fibrinogen
83
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)
84
what does increased fluid around one twin indicate?
twin to twin transfusion syndrome
85
causes of oligohydramnios?
```
spsontaneous rupture of membranes
IUGR (Placenta not working)
potters syndrome (no kidneys?)
anything causing reduced foetal urine output
congenital infection
```
86
investigations in polyhydramnios?
```
GTT
antibodies
serology
middle cerebral artery doppler
examine placenta
```
87
types of twins?
monochorionic monoamniotic
monochorionic diamniotic
dichorionic diamniotic
88
safest twins to carry?
dichorionic diamniotic
89
main risk in monochorionic twins?
twin to twin transfusion syndrome (high risk)
90
how is type 1 diabetes affected in pregnancy?
gets worse
| higher risk of DKA, hypos, worsening of micro/macrovascualar complications
91
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
```
92
main cause of PPH?
uterine atony
93
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
```
94
types of uterotonic management?
```
fundal massage
empty bladder
oxytocin infusion (ok to repeat)
ergometrine
carboprost
misoprostol
```
95
which uterotonic are all women offered at delivery routinely to reduce risk of PPH?
oxytocin
96
surgical management of PPH if meds not working?
intrauterine balloon
laparotomy - brace suture, artery ligation, hyterectomy (last resort)
uterine artery embolisation
97
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)
```
98
normal nuchal translucency/thickness?
<3.5mm
| increased in downs
99
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
100
what does quadruple test consist of?
bHCG
AFP
inhibin A
uE3 (unconjugated oestriol)
101
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
