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My 5th year O&G > O&G general lectures > Flashcards

O&G general lectures Flashcards

1
Q

what is the overall energy requirement increasde during pregnancy?

A

14%

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2
Q

what is the greatest cause of increased energy demands during pregnancy

A

physiological processes - 66% increase

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3
Q

what is the average % and kg weight increase during pregnancy

A

25% - mean 12.5kg

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4
Q

What is the increase in protein intake for pregnant women (in g)

A

+30g / day - so about 75g/day

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5
Q

what is the term for the common position of the uterus?

A

dextro-rotation (to the right - 80%)

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6
Q

what does left uterine displacement achieve?

A

HELPS VENOUS RETURN AND CARDIAC OUTPUT BY REDUCING AORTTO-CAVAL COMPRESSION

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7
Q

which hormones cause relaxation of the pelvic joints and ligaments

A

progesterone and relaxin

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8
Q

what are 3 changes seen in the cervix during pregnancy?

A
  1. oedema and cnogestion - becomes softer
  2. mucus plug forms (operculum) which closes the cervical canal, useful for preventing ascending infections
  3. increased secretion from glands
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9
Q

what changes are seen in the breasts during pregnancy?

A
  • increased size and vascularity
  • warm, tense, tender
  • increased pigmentation of the nipple and areola
  • secondary areola appear
  • montgomery tubercules appear on the areola - dilated sebaceous glands
  • colostrum like fluid is expressed at the end of the 3rd month
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10
Q

what skin changes can be seen in pregnancy?

A
  1. striae gravidarum
  2. striae distensae
  3. pigmentation - linea nigra and chloasma gravidarum (butterfly pigmentation of the face)
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11
Q

Where are striae distensae found?

A

on the medial aspect of the thigh

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12
Q

what is the likely cause of striae gravidarum

A

rupture of subcutaneous elastic fibres

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13
Q

why are there pigmentation changes during pregnancy?

A

due to increased secretion of melanocyte stimulating hormone

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14
Q

describe chloasma gravidarum

A

butterfly pigmentation of the face

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15
Q

what changes are seen in the kidneys during pregnancy/

A
  1. increased size
  2. hydronephrosis
  3. effective renal plasma flow increased
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16
Q

what is the cause of dilatation of the ureters during pregnancy?

A

atony of ureteric muscle + hydro-ueter due to laxin and progesterone

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17
Q

why is frequency of micturation increased during pregnancy?

A

1st trimester = pressure of uterus on bladder

late in pregnancy = engagement of the head pressing on maternal bladder

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18
Q

what is the significance of lowered gastric acidity during pregnancy?

A

means iron is not absorbed as well, which can result in iron deficiency anaemias during pregnancy - so may need to take suppements

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19
Q

what is the true name of morning sickness

A

emesis gravidarum

20
Q

what GI symptoms can pregnant women experience?

A
  1. increased salivation
  2. altered taste (related to cravings)
  3. increase in appetite and thirst
  4. heart burn
  5. constipation
21
Q

what risk must you think about (GI) if anesthetizing a pregnant lady

A

the gastric emptying is delayed, which increases the risk of aspiration

22
Q

which 3 things are synthesised more by the liver during pregnancy

A
  1. albumin
  2. fibrinogen
  3. globulin
23
Q

what happens to albumin during pregnancy?

A

reduced by 20-40%, partially dilutional effect due to increased total blood volume (contributes to most of the fall in total serum protein)

24
Q

by how much does HR increase by during pregnancy and why/

A

15-20% due to vasodilation and reduced TPR and increased CO

25
Q

how much does CO incrase by by the 3rd trimester?

A

50%

26
Q

how does the heart adapt to the huge increase in cardiac output during pregnancy?

A

left ventricular hypertrophy and dilatation

upward displacement of the diaphragm - apex moves up and left `

27
Q

What ECG changes might you see during pregnancy

A

Left axis deviation
depressed ST segments
inversion/flattening of T wave in lead 3

  • remember, all due to the upward displacement of the diaphragm, causing apex to move anteriorly and left
28
Q

The Virchow’s triad is composed of what?

A

increased coagulation, venous stasis, endothelial damage,

29
Q

what is Dyspareunia

A

painful sexual intercourse

30
Q

What are the principal supports of the uterus?

A

The transverse cervical ligaments (Mackenrodt’s)

31
Q

What are the 3 layers of the uterus?

A

endometrium, myometrium parametrium

32
Q

What investigations should you do if you have a clinical suspicion of endometrial cancer?

A

Full history
Examination of the pelvic area- bimanual. Refer to gynae for further tests - transvaginal ultrasound - looking for thickness of endometrium and increased vascularity. Perform endometrial biopsy and send for histology.

33
Q

what do you need to know in order to diagnose what type of miscarriage it is?

A
  1. USS to check if still a fetal heart beat
  2. size of the uterus
  3. os open or closed
34
Q

what % of threatened miscarriages go on to miscarry?

A

25%

35
Q

A woman who is 33 weeks pregnant presents with vaginal bleeding, which she describes as being like a period. She also has constant, lower abdominal pain. On assessment her blood pressure is 90/60 mmHg and pulse is 110/min

A

placental abruption

36
Q

A woman who is 22 weeks pregnant presents with abdominal pain on the right side of her abdomen. On examination she has abdominal tenderness on the right side and urine dipstick is normal. White blood cells are raised at 18.5 * 109/l

A

Appendicitis (or ocnsider acute cholecystitis)

37
Q

What is Sheehan’s syndrome

A

A complication of severe postpartum hemorrhage (PPH) in which the pituitary gland undergoes ischaemic necrosis which can manifest as hypopituitarism

38
Q

What is the most common sign of Sheehan’s syndrome?

A

lack of postpartum milk production and ameonorrhoea following delivery

39
Q

What is the main agent used for induction of labour?

A

PGE2

40
Q

How can vaginal PGE2 be administered to induce labour?

A

either 1 cycle of controlled release vaginal pessary which is released over 24h,

one cycle of vaginal PGE2 tablets or gel: one dose, followed by a second dose after 6 hours if labour is not established (up to a maximum of two doses)

41
Q

What is used to assess whether or not induction of labour is necessary/

A

Bishop score

42
Q

How do you remember the categories in the Bishop score?

A

Call PEDS For Parturition = Cervical Position, Effacement, Dilation, Softness; Fetal Station.

43
Q

What blood tests would you need to do 3X a week in a woman diagnosed with moderate pre-ecclampsia

A

kidney
function, electrolytes, full
blood count,
transaminases, bilirubin

44
Q

What should be considered if uterine hyperstimulation occurs in induction of labour?

A

tocolysis

45
Q

Which of the following conditions is a medical indication for routine

delivery by caesarean section?

A. Hepatitis C virus

B. Preterm labour

C. Previous lower segment caesarean section

D. Twin pregnancy with first twin breech and second twin cephalic

E. Twin pregnancy with first twin cephalic and second twin breech

A

D. Twin pregnancy with first twin breech and second twin cephalic

46
Q

describe vasa praevia

A

The umbilical vessels travel away from the placenta through the membranes and then overlie the cervical os. Vessels can then tear, especially during cervical dilation, leading to rapid blood loss of fetal circulation - fetal mortality very high but little risk to mother. Delivery must be expedited, normally with a C section, and neonate may need transfusion.

My 5th year O&G (3 decks)

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