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Year 5 😊✌🏼 > O&G 3 > Flashcards

O&G 3 Flashcards

1
Q

How many pregnancies are affected by hypertensive disorders?

A

8-10%

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2
Q

what proportion of pregnancies affected by pre-eclampsia?

A

1.5-7.7%

4.1% in first pregnancy
1.7% in second pregnancy

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3
Q

what % stillbirths is associated with pre-eclampsia?

A

5%

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4
Q

Red flags in pre-eclampsia

A
  • visual changes (e.g. flashing lights)
  • headaches (due to cerebral edema)
  • brisk reflexes, clonus (?cause)
  • edema
  • RUQ pain (due to perihepatic edema)
  • decreased urine output
  • uterine size small for dates
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5
Q

Is pre-eclampsia familial?

A

yes

FH is a risk factor

a sister affected is the strongest association

the more severe and the earlier it occurs in pregnancy the more likely it i to be familial

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6
Q

What should you do if a pregnant woman’s urine dip is positive for protein?

A

send to lab to quantify

send a PCR (protein:Creatinine ratio)

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7
Q

What PCR finding is significant?

A

> 30 mg/mmol

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8
Q

what level of protein in 24h urine is considered to be significant?

A

0.3g

(this is equivalent to 300 mg of protein per 24h)

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9
Q

what specimen is used for PCR?

A

urine

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10
Q

What happens to the GFR in pregnancy?

A

increases

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11
Q

What happens to ALP in pregnancy and why?

A

it is raised due to placental production

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12
Q

How does nifedipine lower BP?

A

it is a calcium channel blocker

causes vasodilation

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13
Q

How does methyldopa decrease BP and what is an associated risk + how is it overcome??

A

it is an alpha agonist which prevents vasoconstriction

risk of postnatal depression

should be stopped within 2 days of delivery and changed to another agent

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14
Q

how does hydralazine lower BP and what is an associated risk + how is it overcome?

A

IV drug which causes vasodilatation

can cause rapid hypotension

therefore is often given after a bolus of colloid.

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15
Q

What proportion of pregnancies are affected by eclampsia?

A

2.7 in 10,000

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15
Q

HELLP

A

haemolysis
elevated liver enzymes (raised ALT)
low platelets

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16
Q

what are the complications of HELLP?

A
  • capsular liver haematoma
  • liver rupture
  • DIC
  • ………
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17
Q

Incidence of HELLP syndrome

A

2 in 100,000 pregnancies

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18
Q

Complications of pre-eclampsia

A

maternal:
- seizures
- acute renal failure
- liver dysfunction
- coagulation abnormalities
- death (causes: include intracranial haemorrhage, cerebral infarction, cerebral oedema, acute respiratory distress syndrome and pulmonary oedema, hepatic rupture, and hepatic failure/necrosis)

fetal: placental abruption, IUGR, preterm delivery, stillbirth, and neonatal death

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19
Q

Which viruses can cause maternal complications in pregnancy?

A
  • influenza
  • VZV
  • Hep E
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20
Q

Which viruses increase the risk of miscarriage?

A

rubella
measeles
hep E

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21
Q

Which viruses are teratogenic?

A

VZV
Zika

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22
Q

Which viruses cause IUGR/prematurity?

A

rubella
CMV

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23
Q

Which viruses cause congenital disease?

A

CMV
HSV

24
Q

Which viruses in pregnancy cause persistent infection?

A

HIV
Hep B/C

25
Q

Can you use opioids when breastfeeding?

A

Codeine - no

can consider weaker opioids like tramadol or dihydrocodeine

26
Q

Can you take aspirin when breastfeeding?

A

no

27
Q

How high is the risk of cord prolapse in footling breach presntation?

A

5-20%

28
Q

Can you spread Hep B and HIV via breastfeeding?

A

HIV - yes

Hep B - no

29
Q

Questions to ask a pregnant woman with asthma?

A
  • current treatment
  • symptoms and sx control
  • peak flow record
  • any previous hospital admissions? Any requiring ICU?

measure peak flow at appointment

30
Q

What advice to give pregnant women with asthma?

A
  • avoid triggers
  • cease smoking
  • don’t stop asthma meds during pregnancy
31
Q

When is the foetus dependent on mum’s thyroid hormones?

A

up to 12w

32
Q

Risks associated with hypothyroidism in pregnancy?

A

miscarriage
reduced intelligence
neurodevelopment delay
brain damage

33
Q

Thyroid disease - do you need to monitor TFTs in pregnancy?

A

Yes, every TM

use pregnancy-adjusted values (they differ in the different trimesters).

34
Q

What is the commonest cause of hyperthyroidism in pregnancy?

A

Graves’ disease

35
Q

What are causes of hyperthyroidism in pregnancy?

A

Graves disease (95%)
drugs
multinodular goitre
thyroiditis

36
Q

Drugs for hyperthyroidism in pregnanct

A

propylthiouracil should be continued

Carbimazole can be used from 2nd TM onwards.

beta blockers may be required.
Surgery is rarely necessary.

37
Q

Complication (1) of hyperthyroidism in pregnancy to the neonate and how it occurs?

A

neonatal thyrotoxicosis occurs in 1%

due to transplacental passage of thyroid antibodies.

38
Q

What causes neonatal thyrotoxicosis?

A

Transplacental passage of thyroid antibodies.

39
Q

Sx of neonatal thyrotoxicosis

A

tahcycardia
arrhythmia
heart failure
systemic and pulmonary HTN
weight loss
diarrhoea
sweating
+/- goitre

mortality 12-20%

40
Q

What twins can be affected by twin-to-twin transfusion syndrome?

A

monochorionic

41
Q

How do conjoined twins form?

A

later splitting of the inner cell mass (after the formation of the primitive streak?)

if happened before 13d, they would be monozygotic twins

42
Q

outcomes for monozygotic twins dependent on time of splitting

A

<3 days will be diamniotic dichorionic
3-8 d will be monochorionic diamniotic
9-12 d will be monochorionic monoamniotic

43
Q

What mutation is seen in virtually all high grade serous adenocarcinomas of the ovary?

A

p53

44
Q

Commonest malignant ovarian cancer

A

high grade serous adenocarcinoma

45
Q

BRCA1 and BRCA2 roles

A

These genes encode proteins that play important roles in DNA repair (homologous recombination).

46
Q

Mutatation advantage in high grade serous adenocarcinoma (ovary) in terms of BRCA

A

Current data suggests that BRCA2 mutations confer an overall survival advantage compared with either being BRCA-negative or having a BRCA1 mutation in high-grade serous ovarian cancer.

47
Q

When is Ca-125 elevated?

A

CA-125 is used as a tumor marker for epithelial ovarian cancer but can also be elevated in endometriosis, cirrhosis, and malignancies (e.g., uterine leiomyoma).

48
Q

What is the situation above and below the arcuate line?

A

Above: the anterior layer of the rectus sheath comprises the fused aponeuroses of the external and internal oblique muscles, whereas the posterior later comprises the fused aponeuroses of the internal oblique and transverses abdominis muscles.

Below: the aponeuroses of all 3 muscles fuse to form the anterior later of the sheath. The rectus muscle rests only on the thin transversalis fascia.

49
Q

What are the risks associated with BV in pregnancy?

A

chorioamnionitis

preterm labour

50
Q

Mx of BV

A

metronidazole 400 mg BD for 5th-7 days

alt:
intravaginal metronidazole / clindamycin gel

advice: avoid vaginal douching and excessive genital washing should be avoided.

51
Q

Monitoring in obstetric cholestasis

A

LFTs and bile acid levels every 1/52 until delivery

measure LFTs 6w PP to ensure resolution

LFTs should be normal 10 d PP

FU @ 8w

52
Q

success rate of VBAC

A

72-75%

Increased number of successful VBAC -> greater success with further VBAC

2nd VBAC ~80%
3rd VBAC ~90%

53
Q

How high is the risk of uterine rupture in VBAC?

A

1 in 200

increased to 1 in 100 when syntocinon is used.

54
Q

Down’s syndrome: quadruple test result

A

↓ AFP
↓ oestriol
↑ hCG
↑ inhibin A

55
Q

classical triad seen in vasa praevia

A

rupture of membranes
followed by painless PV bleeding
fetal bradycardia

56
Q

What are the complications of PPROM?

A

Maternal: chorioamnionitis

Foetal: prematurity, infection, pulmonary hypoplasia

57
Q

What does PPROM stand for?

A

premature prelabour ROM

Year 5 😊✌🏼 (53 decks)

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