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
2
Q
What causes Down’s syndrome
A
Trisomy 21
3
Q
What causes Edward’s syndrome
A
Trisomy 18
4
Q
What causes Patau’s syndrome
A
Trisomy 13
5
Q
What are the newborn screening programmes
A
- newborn infant physical examination
- newborn hearing screen
- newborn blood spot
6
Q
Unusual genes that effect quality and structure of haemoglobin cause…
A
Haemoblobin variants such as HbS, HbO, HbE
7
Q
Unusual genes that affect the quantity of haemoglobin cause…
A
Thalassaemias such as α or β thalassaemia
8
Q
What kind of inheritance do haemoglobin disorders follow
A
Recessive
9
Q
What are the main symptoms of sickle cell disease
A
Anaemia and episodes of severe pain (sickle cell crisis)
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
11
Q
β thalassaemias cause …
A
Reduced or absent synthesis of β globin chains -> iron overload
12
Q
Patients with β thalassemia major require…
A
Lifelong transfusion therapy and chelation therapy to treat complications of iron overload
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
14
Q
SCT pathway.
When is prenatal diagnosis made?
A
By 12+6
Results within 5 days
15
Q
Which ID are included in antenatal screening ?
A
- HIV
- Hepatitis B
- Syphilis
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
17
Q
How common is Trisomy 21?
A
Affects about 1 in every 1000 births
Incidence increases with maternal age
18
Q
Children with Downs Syndrome are at increased risk of…
A
- childhood leukaemia
- epilepsy
- thyroid disorders
- heart conditions
- hearing and vision problems
19
Q
How common is Trisomy 18?
A
Affects about 3 in every 10,000 births (0.03%)
Incidence increases with maternal age
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
21
Q
How common is Patau’s syndrome
A
2 out of every 10000 live births
Incidence increases with maternal age
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
23
Q
T13 survival?
A
Most die before birth, are stillborn, or die shortly after birth
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
25
What is classed as term
37-42 wks
26
at what wk is induction offered
Anything past 41
27
What are the characteristics of the latent phase of labour?
- contractions may be irregular
- mucoid plug
- cervix beginning to efface and dilate about 0-4cm
- up to 2-3 days
28
Describe contractions of cervix of first stage of labour
- stronger contractions
- cervix continuing to efface and dilate up to 10cm
29
what is the second stage of labour
From full dilation to birth of foetus
30
what is the third stage of labour
From birth of foetus to expulsion of placenta
31
drugs given to stop or slow contractions
IM terbutaline
32
Oxytocin involvement in labour
Surge at onset of labour contracts the uterus
33
Prostaglandins involvement on labour
Aid with cervical softening/ripening
Can be used to induce
34
Oestrogen involvement in labour
Surges at labour onset to inhibit progesterone to prepare smooth muscles for labour
35
Ways to induce
- balloon catheter (safer)
- prostaglandins
36
role of prolactin
Induce milk production in mammary glands
37
Why might induced labour be more painful for the mother than spontaneous labour
Production of β endorphins
38
at what week should baby be in a cephalic position
34wks
39
Why might foetus struggle to get into cephalic position
- oligohydramnious
- fibroids
40
What is oligo/poly hydramnious
Oligohydramnois = decreased amniotic fluid for gestational age
Polyhydramnious = increased amniotic fluid for gestational age
41
where do contractions begin
Fundus (palpate top of fundus for length and strength)
42
what is important to feel between contraction
relaxed abdomen
43
What is the most common pelvis type
Gynecoid
- wide sacrum
- straight side walls
- blunt ischial spines
- wide suprapubic arch
44
order of mechanisms of labour
descent > flexion > internal rotation > extension > restitution > external rotation > delivery of body
45
What encourages descent
Increased abdominal muscle tone
Increased contraction
46
what point in the pelvis do you refer to in descent
Ischial spine
47
SROM
Spontaneous rupture of membranes
48
ARM
Artificial rupture of membranes
49
normal amniotic fluid
Mostly clear, straw colour
Not offensive smell
50
What is the risk to the baby if meconium present
Aspiration > infection
51
red amniotic fluid?
Antepartum haemorrhage
52
what are the benefits of delayed cord clamping
- 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
what makes up a cord
A vein and two arteries
54
what two membranes that make up placenta
Amnion and chorion
55
Examples of holistic non invasive analgesia - non medical
- tens machine
- water immersion
-aromatherapy
- massage
- hypnobirthing
56
Medical analgesia
- Entanox (Gas and Air)
- Paracetamol
- Codeine
57
Opioid analgesi
- diamorphine
- pethidine
- remifentanyl
58
what is in an epidural
Bupivacaine and fentanyl
59
Ectopic pregnancy risk factors
- 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
Ectopic pregnancy symptoms
- PV bleeding
- Abdominal pain, typically to one side
- Shoulder tip pain
- Dizziness
- Sometimes none at all
61
Ectopic pregnancy diagnosis
USS +/- bHCG
62
Scan signs of tubal ectopic
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
what is a pseudo sac
Fluid filled cystic sac present in 20% of cases in uterine cavity
64
ectopic pregnancy conservative management criteria
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
Ectopic pregnancy conservative management
- repeat hCG on day 2, 4, 7
66
What is the medical management of ectopic pregnancy
Methotrexate
67
Ectopic pregnancy medical management criteria
*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
Methotrexate contraindications
- thrombocytopaenia
- hepatic or renal dysfunction
- immunocompromised
- breastfeeding
- peptic ulcer disease
69
When is surgical management first line for ectopic
*Have significant pain
*Adnexal mass >35mm
*Live ectopic
*HCG >5000
*Signs of rupture
*Haemodynamic instability
70
Define a complete miscarriage
- usually present following PV bleeding (heavier than a period)
- may remove pregnancy tissue / products of conceptions on examination
- USS will show empty uterus
71
describe incomplete miscarriage
- 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
Incomplete miscarriage: If <35mm can offer…
Conservative, medical or surgical under local anaesthetic
73
Incomplete miscarriage: if >35mm can offer…
Surgical under GA or medical management in hospital
74
how are delayed miscarriage diagnosed
On transvaginal scan
Requires visualisation of gestation sac, yolk sac, and foetal pole, with CRL >7mm with no foetal heart activity
75
What is a molar pregnancy
Type of gestational trophoblastic disease
76
describe the 2 types of molar pregnancy
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
How are molar pregnancies diagnosed
USS
Visualisation of an irregular echobright area containing multiple cysts - bunch of grapes sign
78
Describe ovarian torsions
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
how might ovarian torsion present
- severe abdo pain
- N/V
- often non specific
80
Definitive management of ovarian torsion
Surgical
- detorsion is preferred
- may require oophrectomy if ovary is necrotic
81
what is pelvic inflammatory disease
Infection of the female reproductive system:
*Uterus
*Fallopian tubes
*ovaries
82
PID symptoms
Often asymptomatic but
- pelvic pain
- dyspareunia
- dysuria
- IMB/PCB
- change to vaginal discharge
83
RF of PID
- UPSI
- IUS/IUD
- multiple sexual partners
84
causes of PID
Bacterial infection, usually sexually transmitted e.g. chlamydia, gonorrhea, or mycoplasma
85
treatment of PID
14 days antibiotics:
IM ceftriaxone single dose AND PO metronidazole and doxycycline
86
Define antepartum haemorrhage
Bleeding from anywhere within the genital tract after the 24th week of pregnancy
87
Identifiable causes of antepartum haemorrhage
*Low Lying placenta / placenta praevia.
*Vasa praevia
*Minor/Major abruption
*Infection
88
When are placenta praevia diagnosed
20 wk scan
89
Management of placenta praevia
*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
Management of major bleed placenta praevia
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
Define vasa praevia
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
Management of vasa praevia if diagnosed antenatally
Elective c section at 37 wks
93
Define the types of morbidly adherent placenta
Accrete at myometrium
Increta in the myometrium
Percreta past the myometrium
94
Management of all percreta ….
cescarian hysterectomy
95
define placental abruption
Premature separation of the placenta from the uterine wall
96
diagnosis of placental abruption
-Woody-hard, tense uterus
-Fetal distress
-Maternal shock out of proportion to bleeding
97
Complications following APH
*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
Define pre-eclampsia
Hypertension + proteinuria
99
Define severe pre-eclampsia
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
What is HELLP syndrome
Hemolysis, elevated liver enzymes, low platelets
101
Severe pre eclampsia management
*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
Define eclampsia
Onset of seizures in a woman with pre-eclampsia
103
immediate management of eclampsia
*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
What is the leading direct cause of maternal death in the UK
Sepsis
105
sepsis RF specific to pregnancy
*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
Sepsis management first hr
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
Describe cord prolapse
- cord is presenting first
- exposure of cord leads to vasospasm
108
Risk factors of cord prolapse
*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
Cord prolapse management
Emergency - 999/buzzer
Elevate presenting part: fluid into bladder via catheter, trendelenburg position, etc
Alleviate pressure on cord
110
Define shoulder dystocia
Failure for the anterior shoulder to pass under the symphysis pubis after deliver of the foetal head
111
Shoulder dystocia risk factors
*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
Shoulder dystocia management
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
Shoulder dystocia maternal complications
* PPH
* Extensive vaginal tear (3rd and 4th degree)
* Psychological
114
Shoulder dystocia neonatal complications
* Hypoxia
* Seizures
* Cerebral palsy
* Injury to brachial plexus
115
Define primary and secondary post partum haemorrhage
Primary = Within 24 hours of delivery, blood loss > 500mls
Secondary = After 24 hours and up to 12 weeks post delivery
116
PPH causes
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
PPH risk factors
- Big baby
- Nulliparity and grand multiparity
- Multiple pregnancy
- Precipitate or prolonged labour
- Maternal pyrexia
- Operative delivery
- Shoulder dystocia
- Previous PPH
118
what medications can be used to manage PPH
- sytocinon
- ergometrine
- haemobate
- tranexamic acid
119
Role of sytocinon in PPH management
Activation of receptors by oxytocin -> intracellular calcium release -> myometrium contraction
120
Role of ergometrine in PPH management
Direct stimulation of of uterine muscle -> increase force and frequency of contractions
121
role of haemobate in PPH management
Works on prostaglandin F receptor sites in uterine muscle to increase contraction
122
Specific questions in a sexual health Hx
- past GU history
- antibiotics in last month
- last sexual inter course
- regular/casual partner
- male/female
- common use
- type of sexual activity
123
