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Phase 3a > O&G > Flashcards

O&G Flashcards

1
Q

What are the current antenatal screening programmes

A
  • Sickle Cell and thalassemia
  • Infectious diseases
  • Down’s, Edward’s, and Patau’s syndromes
  • Fetal anomaly scan
  • Diabetic eye
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2
Q

What causes Down’s syndrome

A

Trisomy 21

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3
Q

What causes Edward’s syndrome

A

Trisomy 18

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4
Q

What causes Patau’s syndrome

A

Trisomy 13

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5
Q

What are the newborn screening programmes

A
  • newborn infant physical examination
  • newborn hearing screen
  • newborn blood spot
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6
Q

Unusual genes that effect quality and structure of haemoglobin cause…

A

Haemoblobin variants such as HbS, HbO, HbE

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7
Q

Unusual genes that affect the quantity of haemoglobin cause…

A

Thalassaemias such as α or β thalassaemia

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8
Q

What kind of inheritance do haemoglobin disorders follow

A

Recessive

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9
Q

What are the main symptoms of sickle cell disease

A

Anaemia and episodes of severe pain (sickle cell crisis)

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10
Q

What are people with sickle cell disease at a higher risk of?

A
  • stroke
  • acute chest syndrome
  • blindness
  • bone damage
  • priapism
  • chronic organ damage
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11
Q

β thalassaemias cause …

A

Reduced or absent synthesis of β globin chains -> iron overload

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12
Q

Patients with β thalassemia major require…

A

Lifelong transfusion therapy and chelation therapy to treat complications of iron overload

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13
Q

Who is SCT pathway offered to?

A
  • all pregnant women ideally 8-10 wks
  • biological father IF mother is genetic carrier
  • un-booked women in labour
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14
Q

SCT pathway.
When is prenatal diagnosis made?

A

By 12+6
Results within 5 days

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15
Q

Which ID are included in antenatal screening ?

A
  • HIV
  • Hepatitis B
  • Syphilis
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16
Q

When should babies born with Hep B be vaccinated?

A
  • within 24hrs of birth
  • at 4, 8, 12, and 16 weeks
  • at 12 months
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17
Q

How common is Trisomy 21?

A

Affects about 1 in every 1000 births
Incidence increases with maternal age

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18
Q

Children with Downs Syndrome are at increased risk of…

A
  • childhood leukaemia
  • epilepsy
  • thyroid disorders
  • heart conditions
  • hearing and vision problems
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19
Q

How common is Trisomy 18?

A

Affects about 3 in every 10,000 births (0.03%)
Incidence increases with maternal age

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20
Q

What does T18 cause?

A
  • very low survival rates. Only 10% of babies born alive live past 12 months
  • severe learning disabilities
  • heart defects, problems with resp system, kidneys, and digestive system
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21
Q

How common is Patau’s syndrome

A

2 out of every 10000 live births
Incidence increases with maternal age

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22
Q

T13 is associated with multiple severe fetal abnormalities, including…

A
  • 80% have congenital heart defects
  • Holoprosencephaly (single lobed brain)
  • midline facial defects
  • abdominal wall defects
  • urogenital malformations
  • abnormalities of the hands and feet
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23
Q

T13 survival?

A

Most die before birth, are stillborn, or die shortly after birth

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24
Q

What is the purpose of early scanning?

A
  • confirm viability
  • single or multiple pregnancy
  • estimate gestational age
  • detect major structural abnormalities e.g. anencephaly
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25
Q

What is classed as term

A

37-42 wks

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26
Q

at what wk is induction offered

A

Anything past 41

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27
Q

What are the characteristics of the latent phase of labour?

A
  • contractions may be irregular
  • mucoid plug
  • cervix beginning to efface and dilate about 0-4cm
  • up to 2-3 days
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28
Q

Describe contractions of cervix of first stage of labour

A
  • stronger contractions
  • cervix continuing to efface and dilate up to 10cm
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29
Q

what is the second stage of labour

A

From full dilation to birth of foetus

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30
Q

what is the third stage of labour

A

From birth of foetus to expulsion of placenta

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31
Q

drugs given to stop or slow contractions

A

IM terbutaline

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32
Q

Oxytocin involvement in labour

A

Surge at onset of labour contracts the uterus

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33
Q

Prostaglandins involvement on labour

A

Aid with cervical softening/ripening

Can be used to induce

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34
Q

Oestrogen involvement in labour

A

Surges at labour onset to inhibit progesterone to prepare smooth muscles for labour

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35
Q

Ways to induce

A
  • balloon catheter (safer)
  • prostaglandins
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36
Q

role of prolactin

A

Induce milk production in mammary glands

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37
Q

Why might induced labour be more painful for the mother than spontaneous labour

A

Production of β endorphins

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38
Q

at what week should baby be in a cephalic position

A

34wks

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39
Q

Why might foetus struggle to get into cephalic position

A
  • oligohydramnious
  • fibroids
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40
Q

What is oligo/poly hydramnious

A

Oligohydramnois = decreased amniotic fluid for gestational age
Polyhydramnious = increased amniotic fluid for gestational age

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41
Q

where do contractions begin

A

Fundus (palpate top of fundus for length and strength)

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42
Q

what is important to feel between contraction

A

relaxed abdomen

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43
Q

What is the most common pelvis type

A

Gynecoid
- wide sacrum
- straight side walls
- blunt ischial spines
- wide suprapubic arch

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44
Q

order of mechanisms of labour

A

descent > flexion > internal rotation > extension > restitution > external rotation > delivery of body

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45
Q

What encourages descent

A

Increased abdominal muscle tone
Increased contraction

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46
Q

what point in the pelvis do you refer to in descent

A

Ischial spine

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47
Q

SROM

A

Spontaneous rupture of membranes

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48
Q

ARM

A

Artificial rupture of membranes

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49
Q

normal amniotic fluid

A

Mostly clear, straw colour
Not offensive smell

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50
Q

What is the risk to the baby if meconium present

A

Aspiration > infection

51
Q

red amniotic fluid?

A

Antepartum haemorrhage

52
Q

what are the benefits of delayed cord clamping

A
  • allows baby time to transition to extra uterine life
  • increase in blood cells, iron, and stem cells aiding in growth and development for up to 6 months
  • reduced need for inotropic support
53
Q

what makes up a cord

A

A vein and two arteries

54
Q

what two membranes that make up placenta

A

Amnion and chorion

55
Q

Examples of holistic non invasive analgesia - non medical

A
  • tens machine
  • water immersion
    -aromatherapy
  • massage
  • hypnobirthing
56
Q

Medical analgesia

A
  • Entanox (Gas and Air)
  • Paracetamol
  • Codeine
57
Q

Opioid analgesi

A
  • diamorphine
  • pethidine
  • remifentanyl
58
Q

what is in an epidural

A

Bupivacaine and fentanyl

59
Q

Ectopic pregnancy risk factors

A
  • Previous ectopic pregnancy​​
  • Tubal damage – e.g. PID, previous STI, sterilisation​
  • History of infertility or assisted reproductive techniques​
  • Smoker​
  • Age over 35​
  • Use of IUD/IUS or POP
60
Q

Ectopic pregnancy symptoms

A
  • PV bleeding​
  • Abdominal pain, typically to one side​
  • Shoulder tip pain​
  • Dizziness​
  • Sometimes none at all
61
Q

Ectopic pregnancy diagnosis

A

USS +/- bHCG

62
Q

Scan signs of tubal ectopic

A

Adnexal mass moving separately to the ovary (sliding sign) comprising a gestational sac containing a yolk sac​ / fetal pole (with or without a heartbeat)

63
Q

what is a pseudo sac

A

Fluid filled cystic sac present in 20% of cases in uterine cavity

64
Q

ectopic pregnancy conservative management criteria

A

Pt must:
- be clinically stable
- be pain free
- tubal ectopic diagnosis <35mm, no heartbeat
- hCG <1000 iu/L
- be able to return for follow up

65
Q

Ectopic pregnancy conservative management

A
  • repeat hCG on day 2, 4, 7
66
Q

What is the medical management of ectopic pregnancy

A

Methotrexate

67
Q

Ectopic pregnancy medical management criteria

A

*Have no significant pain and be clinically well​
AND​
*Unruptured tubal ectopic with an adnexal mass <35mm with no visible FH​
AND​
*Serum hCG <1500​
AND​
*Do not have an intrauterine pregnancy​
AND​
*Can return for follow-up

68
Q

Methotrexate contraindications

A
  • thrombocytopaenia
  • hepatic or renal dysfunction
  • immunocompromised
  • breastfeeding
  • peptic ulcer disease
69
Q

When is surgical management first line for ectopic

A

*Have significant pain​
*Adnexal mass >35mm​
*Live ectopic​
*HCG >5000​
*Signs of rupture​
*Haemodynamic instability

70
Q

Define a complete miscarriage

A
  • usually present following PV bleeding (heavier than a period)
  • may remove pregnancy tissue / products of conceptions on examination
  • USS will show empty uterus
71
Q

describe incomplete miscarriage

A
  • diagnosed on USS (usually mixed echoes within uterine cavity)
  • if no prev IUP seen on USS, will require serial bHCG monitoring to ensure failing IUP
72
Q

Incomplete miscarriage: If <35mm can offer…

A

Conservative, medical or surgical under local anaesthetic

73
Q

Incomplete miscarriage: if >35mm can offer…

A

Surgical under GA or medical management in hospital

74
Q

how are delayed miscarriage diagnosed

A

On transvaginal scan

Requires visualisation of gestation sac, yolk sac, and foetal pole, with CRL >7mm with no foetal heart activity

75
Q

What is a molar pregnancy

A

Type of gestational trophoblastic disease

76
Q

describe the 2 types of molar pregnancy

A

Complete mole caused by a single (90%) or two (10%) sperm fertilising an egg which has lost its DNA

Partial molar pregnancy occurs when the father supplies 2 sets of chromosomes, but mothers chromosomes are also present (e.g. 2 sperm fertilising an egg)

77
Q

How are molar pregnancies diagnosed

A

USS

Visualisation of an irregular echobright area containing multiple cysts - bunch of grapes sign

78
Q

Describe ovarian torsions

A

Occurs when the ovary, and sometimes the fallopian tube twists on its vascular and ligament outs supports

Blocks adequate blood flow to the ovary

79
Q

how might ovarian torsion present

A
  • severe abdo pain
  • N/V
  • often non specific
80
Q

Definitive management of ovarian torsion

A

Surgical
- detorsion is preferred
- may require oophrectomy if ovary is necrotic

81
Q

what is pelvic inflammatory disease

A

Infection of the female reproductive system:
*Uterus
*Fallopian tubes
*ovaries

82
Q

PID symptoms

A

Often asymptomatic but
- pelvic pain
- dyspareunia
- dysuria
- IMB/PCB
- change to vaginal discharge

83
Q

RF of PID

A
  • UPSI
  • IUS/IUD
  • multiple sexual partners
84
Q

causes of PID

A

Bacterial infection, usually sexually transmitted e.g. chlamydia, gonorrhea, or mycoplasma

85
Q

treatment of PID

A

14 days antibiotics:
IM ceftriaxone single dose AND PO metronidazole and doxycycline

86
Q

Define antepartum haemorrhage

A

Bleeding from anywhere within the genital tract after the 24th week of pregnancy

87
Q

Identifiable causes of antepartum haemorrhage

A

*Low Lying placenta / placenta praevia.
*Vasa praevia
*Minor/Major abruption
*Infection

88
Q

When are placenta praevia diagnosed

A

20 wk scan

89
Q

Management of placenta praevia

A

*Advise to present if pain / bleeding
*Advise to avoid sexual intercourse
*If recurrent bleeds may require admission until delivery and ensuring has cross-match in date
*Remember to give anti-D if Rh negative
*Elective LSCS around 37/40

90
Q

Management of major bleed placenta praevia

A

ABCDE
Two 14/16 G cannulas, IV fluids (crystal loud), X match 6 units, inform senior team and pads ASAP

*Examination
* - General and abdominal
* - Vaginal (avoid digital examination)
* - ? USS (check 20 week scan)
*Fetal monitoring (CTG) +/- delivery
*Steroids if < 34 weeks gestation (To mature baby’s lungs)

91
Q

Define vasa praevia

A

Fetal vessels coursing through the membranes over the internal cervical os and below the fetal presenting part, unprotected by placental tissue or the umbilical cord

No major maternal risk, but major fetal risk

92
Q

Management of vasa praevia if diagnosed antenatally

A

Elective c section at 37 wks

93
Q

Define the types of morbidly adherent placenta

A

Accrete at myometrium
Increta in the myometrium
Percreta past the myometrium

94
Q

Management of all percreta ….

A

cescarian hysterectomy

95
Q

define placental abruption

A

Premature separation of the placenta from the uterine wall

96
Q

diagnosis of placental abruption

A

-Woody-hard, tense uterus
-Fetal distress
-Maternal shock out of proportion to bleeding

97
Q

Complications following APH

A

*Premature labour/delivery
*Blood transfusion
*Acute tubular necrosis (+/- renal failure)
*DIC - disseminated intravascualr coagulopathy
*PPH!
*ITU admission
*ARDS (secondary to transfusion)
*Fetal morbidity (hypoxia) and mortality

98
Q

Define pre-eclampsia

A

Hypertension + proteinuria

99
Q

Define severe pre-eclampsia

A

Hypertension + proteinuria

and at least one of:
* Severe headache
* Visual disturbances e.g. blurring/flashing lights
* Papilloedema
* Clonus
* Liver tenderness
*Abnormal liver enzymes
*Platelet count falls to < 100 x 109/litre

100
Q

What is HELLP syndrome

A

Hemolysis, elevated liver enzymes, low platelets

101
Q

Severe pre eclampsia management

A

*Stabilise blood pressure (labetalol, nifedipine, methyldopa)
*Check bloods including platelets, renal and liver function
*Magnesium sulphate if applicable e.g. hyperreflexia
*Monitor urine output (fluid restrict to 80 mls per hour)
*Treat coagulation defects
*Fetal wellbeing (CTGs, USS for fetal growth)
*Delivery

102
Q

Define eclampsia

A

Onset of seizures in a woman with pre-eclampsia

103
Q

immediate management of eclampsia

A

*IV MgSo4 4gms given over 5 minutes, followed by an infusion of 1 g/hour maintained for 24 hours

*Treat hypertension (labetalol , nifedipine , methyldopa, hydralazine)

*Stabilise mum first, then deliver baby

104
Q

What is the leading direct cause of maternal death in the UK

A

Sepsis

105
Q

sepsis RF specific to pregnancy

A

*Vaginal discharge
*History of pelvic infection
*History of group B Strep infection
*Amniocentesis and other invasive procedures
*Cervical cerclage
*Prolonged spontaneous rupture of membranes
*Group A Strep infection in close contacts / family members

106
Q

Sepsis management first hr

A

SEPSIS SIX
1) O2 as required to achieve SpO2 over
4%
2) Take blood cultures
3) Commence IV antibiotics
4) Commence IV fluid resuscitation
5) Take blood for Hb, lactate (+glucose)
6) Measure hourly urine output

107
Q

Describe cord prolapse

A
  • cord is presenting first
  • exposure of cord leads to vasospasm
108
Q

Risk factors of cord prolapse

A

*Premature rupture membranes
*Polyhydramnios (i.e. a large volume of amniotic fluid)
*Long umbilical cord
*Fetal malpresentation (e.g. if baby’s head not down)
*Multiparity
*Multiple pregnancy

109
Q

Cord prolapse management

A

Emergency - 999/buzzer
Elevate presenting part: fluid into bladder via catheter, trendelenburg position, etc
Alleviate pressure on cord

110
Q

Define shoulder dystocia

A

Failure for the anterior shoulder to pass under the symphysis pubis after deliver of the foetal head

111
Q

Shoulder dystocia risk factors

A

*Macrosomia (most cases occur in normally grown babies)
*Maternal diabetes
*Previous shoulder dystocia
*Disproportion between mother and fetus
*Postmaturity and induction of labour
*Maternal obesity
*Prolonged 1st or 2nd stage of labour
*Instrumental delivery

112
Q

Shoulder dystocia management

A

H – Call for help (emergency buzzer)
E – Evaluate for episiotomy
L – Legs in McRoberts (resolves 90%)
P – Suprapubic pressure
E – Enter pelvis
R – Rotational manoeuvres
R – Remove posterior arm
(R – Replace head and deliver by LSCS -Zavanelli)

113
Q

Shoulder dystocia maternal complications

A
  • PPH
  • Extensive vaginal tear (3rd and 4th degree)
  • Psychological
114
Q

Shoulder dystocia neonatal complications

A
  • Hypoxia
  • Seizures
  • Cerebral palsy
  • Injury to brachial plexus
115
Q

Define primary and secondary post partum haemorrhage

A

Primary = Within 24 hours of delivery, blood loss > 500mls

Secondary = After 24 hours and up to 12 weeks post delivery

116
Q

PPH causes

A

The four ‘T’s
- Tissue: ensure placenta complete (MROP)
- Tone: ensure uterus contracted (uterotonics)
- Trauma: look for tears (repair)
- Thrombin: check clotting (transfusion RPC/ CP/ FFP)

117
Q

PPH risk factors

A
  • Big baby
  • Nulliparity and grand multiparity
  • Multiple pregnancy
  • Precipitate or prolonged labour
  • Maternal pyrexia
  • Operative delivery
  • Shoulder dystocia
  • Previous PPH
118
Q

what medications can be used to manage PPH

A
  • sytocinon
  • ergometrine
  • haemobate
  • tranexamic acid
119
Q

Role of sytocinon in PPH management

A

Activation of receptors by oxytocin -> intracellular calcium release -> myometrium contraction

120
Q

Role of ergometrine in PPH management

A

Direct stimulation of of uterine muscle -> increase force and frequency of contractions

121
Q

role of haemobate in PPH management

A

Works on prostaglandin F receptor sites in uterine muscle to increase contraction

122
Q

Specific questions in a sexual health Hx

A
  • past GU history
  • antibiotics in last month
  • last sexual inter course
  • regular/casual partner
  • male/female
  • common use
  • type of sexual activity
123
Q
A

Phase 3a (1 decks)

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