O&G Flashcards
At what week does gonadal differentiation occur?
Week 7
The mesonephric duct is also known as _____ duct, and forms the (male/ female) reproductive system
Wolffian; male
The Mullerian duct is also known as ____ duct, and forms the (male/ female) reproductive system. In the other, it degenerates into the ____
Paramesonephric; female; appendix testis
What are the risk factors for endometrial hyperplasia?
Obesity, PCOS, chronic anovulation, unopposed oestrogen (HRT), tamoxifen, oestrogen-secreting tumours (granulosa cell ovarian Ca), prolonged oestrogen exposure (early menarche, late menopause, nulliparity), genetics (PTEN mutn)
What category of endometrial hyperplasia has the highest risk of progression to endometrial carcinoma?
Complex type with nuclear atypia (30% risk)
True or false: oophorectomy cannot be performed in a vaginal hysterectomy?
True
From where does the uterine artery arise, and describe its course through the pelvis?
It arises from the ant division of the internal iliac artery. It passes medially in the broad ligament to the lateral edge of the uterus, and sends branches in all directions, often forming anastomoses with the ovarian and vaginal arteries
In order to avoid ureteric/ bladder injury, the bladder is reflected (up/down)wards in abdominal hysterectomy and (up/down)wards in vaginal hysterectomy?
Downwards; upwards
List 2 pros & 2 cons of a transverse Pfannenstiel incision
Pros
1) Cosmetically attractive
2) Strong, low risk of herniation
Cons
1) Difficult to extend
2) Access limited to pelvic organs
Thyroid-binding globulin (TBG) levels naturally (increase/ decrease) during pregnancy?
Increase ~2-fold due to increased production (stimulated by oestrogen) & decreased clearance
Oestrogen stimulates hyperplasia of ____ cells in the pituitary
Lactotropic
True or false: during early pregnancy, women can have results consistent with hypothyroidism?
True
ßhCG cross-reacts with TSH-Rs; if hypoTH persists, consider starting low-dose thyroxine
What are the complications of hypothyroidism during pregnancy?
Premature birth, low birth weight, miscarriage, impaired fetal neurocognitive development
For treatment of hyperthyroidism, (PTU/carbimazole) is preferred in the first trimester and (PTU/ carbimazole) should be used thereafter
PTU; carbimazole
For women with a thyroid disorder during pregnancy, TFTs should be checked how many weeks post-partum?
6 weeks
True or false: Cushing’s syndrome in pregnancy is more likely caused by a pituitary adenoma whereas in non-pregnant patients it is more likely an adrenal adenoma
False - the opposite is true
adrenal adenoma 40-50% pregnancy; pit adenoma 30%
List 4 intrapartum complications of obesity:
Any of:
- requirement for IOL & failure of IOL
- C/S
- Complicated or operative vaginal birth
- Shoulder dystocia
- Obstructed labour
- Peripartum death
Provide 3 reasons for why breast feeding is less common in obese mothers
1) Mechanical difficulties
2) Reduced PRL response to suckling
3) Psychological issues
What dose of folate is recommended for obese women?
5mg/d (high-dose)
For a women with healthy pre-pregnancy BMI (18.5-24.9), what is the recommended total weight gain?
11.5-16kg
Definitive diagnosis of nephrotic syndrome during pregnancy requires a ____
24 hour urinary protein excretion
Asymptomatic bacteriuria affects ___% of pregnant women
4-7%
What are the cut-offs for HTN & severe HTN in pregnancy?
BP ≥140/90
Severe if ≥170/110
A diagnosis of pre-eclampsia requires hypertension + one or more of the following:
Proteinuria (urine PCR >0.3mg protein/1mg Cr)
Plasma Cr ≥1.1mg/dL (aka renal impairment)
Liver disease: AST ≥50 IU/L and/or severe epigastric or RUQ pain
Neuro problems: convulsions (eclampsia), hyperreflexia + clonus, severe headaches
Haematologic disturbances: thrombocytopaenia, haemolysis, IUGR
What are the most common causes of post-menopausal bleeding?
Atrophic vaginitis/ endometritis is most common (60-80%)
Endometrial carcinoma in ~10%
Other causes: endometrial hyperplasia, polyps (endometrial/ cervical), cervical cancer, vaginal trauma, exogenous oestrogens
What are the 5-year survival rates of stage I versus stage V endometrial carcinoma?
Stage I: >85%
Stage V: 10-20%
What is the most urgent management required for HELLP syndrome, AFLP and pre-eclampsia?
Urgent delivery of the baby
Usually + ICU admission with supportive care (BP control, blood products/ IV fluid, ± dialysis)
True or false: spider naevi, palmar erythema and peripheral oedema are signs of liver disease in pregnancy?
False - these are all common & normal for pregnancy due to increased oestrogen
(HBV/HCV) is the most common cause of chronic viral hepatitis in pregnancy and has a vertical transmission rate of up to 95%
HBV
Which liver enzyme is produced by the placenta?
ALP
What should be avoided during the intrapartum period/ delivery to reduce the risk of transmission of HBV/ HCV from mother to baby?
Instrumental delivery (e.g. forceps) & fetal scalp clip
True or false: breast feeding is considered to be safe for mothers with HBV or HCV hepatitis?
True
For biliary disease in pregnant women, surgery is preferred in which trimester?
2nd trimester
The most common presentation of Intrahepatic cholestasis of pregnancy (ICP) is a) _______. This is treated with ________.
a) severe pruritus
b) ursodeoxycholic acid (UDCA)
ICP classically presents with severe pruritus of the palms and soles, in the 2nd or 3rd trimester.
UDCA is a secondary bile acid and reduces the itch and risk of preterm delivery.
Oral vitamin K may also be given to reduce the risk of bleeding due to vit K deficiency in ICP
Which of the following is NOT a content of amniotic fluid? Urea, lecithin, fatty acids, alpha fetoprotein, sodium, water, protein
Fatty acids
What are the 4 key functions of the amniotic fluid sac?
1) Mechanical protection
2) Pressure equalisation during uterine contractions
3) Immune protection (amniotic fluid has bactericidal activity)
4) Accommodates fetal growth
What percentage of live births are multiple pregnancies?
3%
Which type of twin pregnancy is higher risk - monozygosity or dizygosity?
Monozygosity
Uncomplicated MCDA twins should be delivered from ___ weeks gestation and uncomplicated DCDA from ____ weeks. Antenatal steroids are given to (MCDA/ DCDA)?
MCDA - 36wks onwards + steroids
DCDA - 37wks onwards
List 3 key ways to differentiate between the different types of miscarriage
1) Clinical signs & symptoms e.g. presence of PV bleeding, abdo pain, early pregnancy symptoms (N&V, breast tenderness)
2) USS findings
3) Cervical dilation
The risk of venous thromboembolism (VTE) increases 8 -fold during pregnancy
8X risk due to
Increased coagulability
Venous stasis
Reduced venous outflow due to compression of IVC or pelvic vein by gravid uterus
What is included in a thrombophilia screen during pregnancy to assess for VTE risk?
Protein C/S/ATIII deficiency Factor V Leiden Activated Protein C resistance Anti-phospholipid antibodies (lupus anticoagulant, anti-cardiolipin Ab, ß2GP1) Prothrombin mutation
What are the VTE risk factors (4) considered to be high risk?
- Prev history of DVT/ VTE
- Family history of VTE
- Thrombophilia
- Antenatal LMWH prophylaxis
True or false: enoxaparin (LMWH) crosses the placenta
False - it does not cross the placenta, and has no evidence suggesting it is teratogenic
What are the risk factors for Pre-eclampsia?
Advanced maternal age High BMI Multiple pregnancy 1st pregnancy; new partner; >10yr interval since last pregnancy Prev pre-eclampsia Pre-existing HTN FHx DM, SLE, Anti-PL syndrome GTD, fetal triploidy
For each of the following medication pairs, select which is contraindicated/ should be avoided during pregnancy: Warfarin/ heparin Paracetamol/ NSAID ß-blocker/ ACEi Sertraline/ Sodium valproate Tetracyclines/ penicillins
Warfarin (category D)
NSAIDs (category C: inhibit PG synthesis, may cause premature closure of ductus arteriosus, fetal renal impairment, inhibit platelet aggregation)
ACEi (category D: in 2nd & 3rd trimester cause renal dysfunction, oligohydramnios, IUFD)
Sodium valproate (category D, contraindicated: causes congenital malformations incl NTD)
Tetracyclines (category D; cause teeth discolouration)
The other drugs in each pair are generally considered safe to use during pregnancy, however as always risk benefit must be calculated
What are the routine tests ordered at the booking-in antenatal visit?
FBC, blood group & maternal antibodies
Serology: HIV, HBV, HCV, syphilis, rubella
Urine MCS
What does the combined first trimester screen (CFTS) involve?
Blood test (PAPP-A and ßhCG) Nuchal translucency on ultrasound
Asymptomatic bacteriuria must be treated during pregnancy because ____ go on to develop symptomatic UTI, which increases the risk of ______
20-30%
preterm labour, low birth weight and perinatal mortality
Acute cystitis in pregnancy is treated with ___ or ____
nitrofurantoin or cefalexin
A pregnant woman presents with fever, tachycardia, a tender uterus and offensive purulent PV discharge, and her membranes have been ruptured for >18 hours. The likely diagnosis is ___
chorioamnionitis
The treatment for chorioamnionitis is _____
IV ampicillin/ amoxicillin + gentamicin + metronidazole
______ is the most common cause of early onset neonatal sepsis
Group B streptococcus (Strep agalactiae)
List the risk factors for early-onset GBS disease (EOGBSD)
GBS colonisation/ bacteriuria in the current pregnancy Prev EOGBSD Maternal temp ≥38 degrees intrapartum Preterm labour ROM>18hrs