OB/GYN Flashcards
1
Q
pre eclampsia definition
A
new HTN in pregnancy after 20 weeks gestation
2
Q
pathology pre eclampsia
A
endothelial cell damage and vasospasm, which can affect the foetus and almost all matenal organs
3
Q
mild PE
moderate PE
severe PE
A
Mild = proteinuria and mild/moderate HTN
Moderate = proteinuria and 160/110
Severe = proteinuria and any HTN before 34 weeks or with maternal compliocations
4
Q
Early and late PE
A
Early = <34 weeks
Late = >34 weeks
5
Q
features PE
A
Headache
Epi pain
Visual disturbances
Oedema
None until later stage
6
Q
Maternal compliations PE
A
Eclampsia
CVAs
liver/renal failure
HELLP
Pulmonary oedema
7
Q
Foetal complications PE
A
FGR
Abruption
Foetal morbidity and mortality
8
Q
Pre ec prevention
A
Aspirin if <16 weeks and increased risk
9
Q
Threatened miscarriage
A
Bleeding but foetus still alive, Os closed
10
Q
Inevitable miscarriage
A
heavy bleeding, cervical os open
11
Q
Incomplete miscarriage
A
some foetal parts passed
12
Q
Complete miscarriage
A
all foetal tissue passed
13
Q
Septic miscarriage
A
contents of uterus infected
14
Q
Missed miscarriage
A
Foetus has not developed or has died but not recognised until bleeding occurs
15
Q
Endometriosis definition
A
Presence and growth of tissue similar to endometrium outisde the uterus
16
Q
RF endometriosis
A
Nulliparous
White
FHx
Reproductive age group
Retrograde menstruation
17
Q
S+S endometriosis
A
Cyclical pelvic pain
Dysmennorhoea
Deep dyspareunia
Subfertility
Dyschezia
Tenderness/thickeneing behind uterus or adnexa
18
Q
Ix endometriosis
A
Laparoscopy
Transvaginal USS
MRI if deeply infiltrating
19
Q
Mx endometriosis
A
Pain relief
The pill
GnRH agonists
Mirena coil
Laparoscopic surgery
Hysterectomy
20
Q
Aetiology endometrial cancer
A
Obesity
T2DM
Nulliparity
Late menopause
Oestrogen only HRT
Unopposed oestrogen
21
Q
S+S endometrial cancer
A
Post menopausal bleeding
Abnormal bleeding
Abnormal discharge
Haematuria
Anaemia
22
Q
Ix endometrial cancer
A
Transvaginal USS
Endometrial biopsy
Hysteroscopy
23
Q
Mx endometrial caner
A
Surgery = hysterectomy +/- pelvic LN
Radiotherapy = adjuvant
Progesterone therapy
24
Q
Cervical cancer aetiology
A
High risk HPV
25
Vulval cancer sx
itching and soreness
Persistent lump
Bleeding
Pain on passing urine
26
Ovarian cancer presentation
No Sx
Bloating/IBS
Abdo pain/discomfort
Change in bowel habit
Urinary frequency
Bowel obstruction
27
Obstetric cholestasis
Characterised by otherwise unexplained pruritus and abnormal LFTs +/- raised bile acids
28
Obstetric cholestasis causes/RF
later pregancy (28 weeks)
Increased oest and prog levels
genetics
South Asian
Hep C
Multiple preg
OC previously
Gallstones
29
Obsetric cholestasis presentation
Pruritus (palms and soles)
Fatigue
Dark urine
Pale greasy stools
Jaundice
30
Complications OC
Sudden stillbirth
Meconium passage
PPH
31
OC Ix
LFTs
Bile acids
Rise in ALP with no other abnormal LFTs = placental production
32
Mx OC
Ursodeoxycholic acid (UCDA)
Emollients
Antihistamines
Vitamin K 10mg/day from 36 weeks
LFTs weekly and 10 days after delivery
33
Gestational diabetes definition
Carbohydrate intolerance diagnosed in pregnancy which may or may not resolve after pregnancy
34
Complications GDM
Large for date foetus
Macrosomia
Shoulder dystocia
Congenital abnormalities
Polyhydramnios
Neonatal hypoglycaemia
35
RF GDM
Previous GDM
Previous macrosomic baby
BMI >30
Ethnic origin
FHX diabetes (1st degree)
36
When to screen for GDM
OGTT 24-28 weeks gestation
In morning after fasting = drink 75g glucose
Normal results are <5.6mmol/l fasting and <7.8mmol/l at 2 hours
37
GDM Mx
4 weekly USS from 28 - 36W
Fasting glucose <7, trial diet and exercise then met then insulin
Above 7 metformin
above 6 plus macrosomia start insulin and metformin
Delivery 37-39W
* 1st line
Diet management
* 2nd line
If targets not met with 1st line after 1-2 weeks, offer metformin (insulin if contraindicated)
Insulin if pre-meal glucose >6 OR 1hr post-prandial glucose >7.5
* 3rd line
Targets not met with 1+2 then add insulin
* Fasting glucose 6-6.9 and complications
Immediate insulin +/- metformin and die
38
Targets for GDM blood sugars
Fasting 5.3
1h after meal 7.8
2h after meal 6.4
39
Pre existing DM
Folic acid pre pregnancy
Sliding scale needed in delivery
Planned delivery
Retinopathy screening
40
Shoulder dystocia
Anterior shoulder of baby becomes stuck behind the pubic symphysis of the pelvis
41
Causes of shoulder dystocia
Macrosomia secondary to GDM
Previous dystocia
Obesity
42
Presentation dystocia
Failure of restitution
Turtle neck sign
43
Mx dystocia
McRoberts manoeuvre = hyperflexion of hips
Suprapubic pressuer
Episiostomy
Rubins = reach into vagina put presure on anterior shpilder
wood screw = rotate baby
44
Dystocia complications
Foetal hypoxia (cerebal palsy)
Brachila plexus injury and bells palsy
Perineal tears
PPH
45
HTN meds that should be stopped in pregnancy
- ACEi
- Angiotensin receptor blockers
- Thiazide diuretics
46
HTN meds safe in pregnancy
- Labetalol
- CCB
- Alpha blockers
47
What can undertreated or untreated hypothyroidism in pregnancy cause
- Miscarriage
- Anaemia
- Small for gestational age
- Pre-eclampsia
48
Dose of levothyroxine in pregnancy
- Needs to be increased by 25-50mcg (30-50%)
- Titrated based on TSH level = measured every 6 weeks
- TSH lowers in pregnancy which is why dose increased
49
Safe epilepsy drugs
- Levetiracetam, lamotrigine, carbamazepine
- SV avoid
- Phenytoin avoid (cleft)
50
What is vasa praevia
- Foetal blood vessels run in the membranes in front of the presenting part
- Vessels are placed over internal cervical os, before the foetus. therefore outside the protection of the cord or placenta
51
Vasa praevia presentation
- Painless, moderate vaginal bleeding at the rupture of the membranes
- Severe foetal distress
- USS
- Antepartum haemorrhage
- DVE = pulsating foetal vessels seen in membranes through dilated cervix
52
VP management
- Immediate C section
- Asymptomatic - corticosteroids 32 weeks, elective CS
53
Type 1 and 2 VP
- Type 1 = foetal vessels are exposed as a velamentous umbilical cord
- Type 2 = foetal vessels are exposed as they travel to an accessory placental lobe
54
When induction is offered
- Prelabour ROM
- Foetal growth restriction
- Pre eclampsia
- Obstetric cholestasis
- DM
- IUFD
- Bishop score 8 or more
55
Prostaglandin induction
- PGE2 inserted into vagina
- Stimulated cervix and uterus to cause osnet of labour
56
Amniotomy +/- oxytocin
- ARM then oxytocin infusion started within 2 hours if labour not ensued
57
CRB
- Silicone balloon insetred into cervix and gently inflated to dilate
58
Why incidence of VTE is increased in pregnancy
- Blood clotting factors are increased
- Fibrinolytic activity reduced
- Blood flow altered
- Stagnation of blood and hypercoagulable states
59
RF VTE in pregnancy
- Smoking
- Parity >3
- Age >35
- BMI >30
- Reduced mobility
- Multiple pregnancy
- Pre ec
- Varicose veins
- FHx
- Immobility
- IVF
60
Pulmonary embolus
- Chest pain and dyspnoea
- Tachy, raised RR and JVP
- CXR, ABG and CT
- CTPA or VQ
61
Prophylaxis DVT/PE
- from 28 weeks if 3 RF
- 1st trimester if 4+ RF
- LMWH continued throughout antenatal and for 6 weeks post
- Temporarily stopped in labour
- Mechanical if contraindicated LMWH = pneumatic compression, anti-embolism stockings
62
DVT
- Unilateral
- Calf swelling
- Dilated superficial veins
- Tender calf
- Oedema
- Colour change
- Ix = doppler USS
63
Mx VTE
- LMWH started immediately, before confirming diagnosis
- Massive PE and haemodynamic compromise = unfractioned heparin, thrombolysis, surgical embolectomy
64
Risks of UTI in pregancy
- Preterm delivery
- Low birth weight
- Pre ec
65
Asymptomatic bacteriuria
- Bacteria in urine with no Sx
- Tested routinely throughout pregnancy
66
UTI S+S
Lower
- Dysuria
- Suprapubic pain
- Frequency
- Urgency
- Haematuria
Pyelo
- Fever
- Loin, suprapubic or back pain
- Vomiting
- Haematuria
- Renal angle
67
Urine dipstick
- Nitrites
- Leukocytes
- Nitrites
68
Causes of UTI
- E coli most common
- Klebsiella
69
Mx UTI
- 7 days abx
- Nitrofurantoin (avoid in 3rd trimester)
- Amoxicillin
- Cefalexin
- Trimethoprim avoid in early pregnancy
70
Cord prolapse
- After rupture of membranes, UC descends below presenting part
71
RF cord prolapse
- Preterm labour
- Breech
- Polyydramnios
- Abnormal lie
- Twins
- amniotomy
72
Mx cord prolapse
- Pushed up by finger
- Tocolytics can be given (terbutaline)
- All fours
- Immediate CS
73
Uterine rupture
- Muscle layer of uterus (myometrium) ruptures
- Incomplete = perimetrium remains intact
- Complete = perimetrium ruptures and contents of uterus released into peritoneal cavity
74
FR uterine rupture
- Previous CS = scar is a point of weakness
- Previous surgery
- BMI
- Parity
- Age
- Induction
75
Rupture presentation
- Acutely unwell mother
- Abnormal CTG
76
Rupture Mx
- Maternal resuscitation with fluids and blood required
- Emergency CS
- Repair or removal of uterus
77
Uterine inversion
- Fundus inverts into uterine cavity
- Haemorrhage, pain and shock
- Brief attempt to push fundus up into vagina
- Replacement with hydrostatic pressure run past a clenched fist at the introitus into the vagina
78
Rubella in pregnancy
- Congenital rubella syndrome caused by maternal infection
- Pregnant women should not be given MMR vaccine as it is live = need before or after
Features of rubella syndrome
- Congenital deafness
- Congenital cataracts
- Congenital heart disease
- Learning disability
79
Chickenpox/VZV
- Foetal varicella syndrome = growth restriction, microcephaly, scars, hypoplasia
- Severe neonatal varicella infection
- Treat with IV varicella immunoglobulins
80
Features of congenital CMV
- Growth restriction
- Microcephaly
- Hearing loss
- Vision loss
- LD
- Seizures
81
Triad of features of congenital toxoplasmosis
- Intracranial calcification
- Hydrocephalus
- Chorioretinitis
82
Complications of parovirus in pregnancy
- Miscarriage
- Severe foetal anaemia
- Hydrops fetalis
- Maternal pre ec like syndrome
83
Congenital zika syndrome
Microcephaly
Foetal growth restriction
Ventriculomegaly
84
HSV in pregnancy
- Neonatal infection rare but high mortality
- Vertical transmission at delivery
- CS recommended
- Exposed neonates given acyclovir
85
Neonatal effects HIV
- Stillbirth
- Pre ec
- Growth restriction
- Prematurity
- Vertical transmission
86
Group B strep
- Causes severe illness
- Vertical transmission can be prevented by high dose IV penicillin throughout labour
- RF = previous, positive culture, preterm labour, ROM >18hrs, maternal fever
87
Toxoplasmosis
- Causes LD, convulsions, spasticity's and vision issues
- Spiramycin started
- Vertical transmission confirmed = pyrimethamine and sulfadiazine with folinic acid
88
Grounds for TOP
A = continuing would risk life of woman more
B = necessary to prevent permanent injury to physical or mental health
C = not exceeded its 24th week and continuance would be greater risk
D = not exceeded 24th week and continuance would be greater to children
E = risk that if child would suffer physical or mental abnormalities as to be seriously handicapped
89
Legal requirements for TOP
- 2 registered medical practitioners
- Registered practitioner in an NHS or approved hospital
90
Medical TOP
- Mifepristone = anti-progestogen = halts pregnancy and relaxes cervix
- Misoprostol = prostaglandin analogue = binds to prostaglandin receptors and activates them = soften cervix and stimulate contractions
- Used together mif then miso 36-48hrs later
- Rh -ve women should have anti D 10 w or above
91
Surgical TOP
- Cervix prepared first = misoprostol, mifepristone or osmotic dilators
- Dilation and suction
- Dilation and forcep evacuation
92
Complications TOP
- Haemorrhage
- Infection
- Uterine perforation
- Cervical trauma
93
Adenomyosis definition
Presence of endometrial tissue inside the myometrium
- Associated with endometriosis and fibroids
94
Adenomyosis S+S
Painful heavy periods, regular
Dyspareunia
1/3 asymptomatic
Exam = uterus mildly enlarged and tender
95
Adenomyosis Ix
- TVUSS
- MRI
96
Adenomyosis Mx
No contraception wanted
- TXA when no associated pain
- Mefenamic acid when associated pain
Contraception
- Mirena coil
- COP
- Progesterone's
97
Atrophic vaginitis
- Dryness and atrophy of the vaginal mucosa related to lack of oestrogen
- Occurs in women entering menopause = oestrogen falls and mucosa is thinner, less elastic, dry
98
AV S+S
- Itching and dryness
- Dyspareunia
- Bleeding due to localised inflammation
Exam
- Pale mucosa
- Thin skin
- Reduced folds
- Erythema and inflammation
- Dryness
- Sparse pubic hair
99
AV Mx
- Lubricant
- Topical oestrogen
100
Causes of infertility
- Ovulation issues
- Male factor problems
- Sperm unable to reach egg = tubal, coital, cervical
- Implantation
101
General advice for fertility
- 400mcg folic acid a day
- Health = BMI, smoking, alcohol
- Intercourse every 2-3 days
102
Primary care Ix infertility
- BMI
- Chlamydia screen
- Semen analysis
- Female hormone testing
- Rubella immunity
103
Missing 1 pill when the pill is >24hrs late
<72hrs since last pill was taken
- Take missed pill ASAP even if 2 in 1 day
- No extra protection needed
104
Missing >1 pill (>72hrs since last pill)
- take most recent pill ASAP
- Additional contraception for 7 days
- if days 1-7 emergency contraception
- 8-14 no emergency contraception
- 15-21 no emergency contraception and back to back
105
