O&G general lectures

Question 1

what is the overall energy requirement increasde during pregnancy?

Answer 1

14%

Question 2

what is the greatest cause of increased energy demands during pregnancy

Answer 2

physiological processes - 66% increase

Question 3

what is the average % and kg weight increase during pregnancy

Answer 3

25% - mean 12.5kg

Question 4

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

Answer 4

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

Question 5

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

Answer 5

dextro-rotation (to the right - 80%)

Question 6

what does left uterine displacement achieve?

Answer 6

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

Question 7

which hormones cause relaxation of the pelvic joints and ligaments

Answer 7

progesterone and relaxin

Question 8

what are 3 changes seen in the cervix during pregnancy?

Answer 8

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

Question 9

what changes are seen in the breasts during pregnancy?

Answer 9

• 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

Question 10

what skin changes can be seen in pregnancy?

Answer 10

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

Question 11

Where are striae distensae found?

Answer 11

on the medial aspect of the thigh

Question 12

what is the likely cause of striae gravidarum

Answer 12

rupture of subcutaneous elastic fibres

Question 13

why are there pigmentation changes during pregnancy?

Answer 13

due to increased secretion of melanocyte stimulating hormone

Question 14

describe chloasma gravidarum

Answer 14

butterfly pigmentation of the face

Question 15

what changes are seen in the kidneys during pregnancy/

Answer 15

1. increased size
2. hydronephrosis
3. effective renal plasma flow increased

Question 16

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

Answer 16

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

Question 17

why is frequency of micturation increased during pregnancy?

Answer 17

1st trimester = pressure of uterus on bladder

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

Question 18

what is the significance of lowered gastric acidity during pregnancy?

Answer 18

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

Question 19

what is the true name of morning sickness

Answer 19

emesis gravidarum

Question 20

what GI symptoms can pregnant women experience?

Answer 20

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

Question 21

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

Answer 21

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

Question 22

which 3 things are synthesised more by the liver during pregnancy

Answer 22

1. albumin
2. fibrinogen
3. globulin

Question 23

what happens to albumin during pregnancy?

Answer 23

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

Question 24

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

Answer 24

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

Question 25

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

Answer 25

50%

Question 26

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

Answer 26

left ventricular hypertrophy and dilatation

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

Question 27

What ECG changes might you see during pregnancy

Answer 27

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

Question 28

The Virchow’s triad is composed of what?

Answer 28

increased coagulation, venous stasis, endothelial damage,

Question 29

what is Dyspareunia

Answer 29

painful sexual intercourse

Question 30

What are the principal supports of the uterus?

Answer 30

The transverse cervical ligaments (Mackenrodt’s)

Question 31

What are the 3 layers of the uterus?

Answer 31

endometrium, myometrium parametrium

Question 32

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

Answer 32

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.

Question 33

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

Answer 33

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

Question 34

what % of threatened miscarriages go on to miscarry?

Answer 34

25%

Question 35

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

Answer 35

placental abruption

Question 36

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

Answer 36

Appendicitis (or ocnsider acute cholecystitis)

Question 37

What is Sheehan’s syndrome

Answer 37

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

Question 38

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

Answer 38

lack of postpartum milk production and ameonorrhoea following delivery

Question 39

What is the main agent used for induction of labour?

Answer 39

PGE2

Question 40

How can vaginal PGE2 be administered to induce labour?

Answer 40

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)

Question 41

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

Answer 41

Bishop score

Question 42

How do you remember the categories in the Bishop score?

Answer 42

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

Question 43

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

Answer 43

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

Question 44

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

Answer 44

tocolysis

Question 45

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

Answer 45

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

Question 46

describe vasa praevia

Answer 46

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.