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Medicine > Obs > Flashcards

Obs Flashcards

1
Q

Ovarian Hyperstim Synd Patho

A 
Ovarian Stim (FSH/LH) => Maturation of mutiple follicles, 
hCG given (Trigger final maturation) => 
Excess VEGF => Oedema, Ascites, HypoVol, Act of RAAS
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2
Q

Ovarian Hyperstim Mx

A

PO/IV Fluids (Colloids),
Monitor UO,
Paracentesis,
LMWHep (Prevent VTE)

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3
Q

Ectopic Location + Sx

A

(Fallopian tubes, Ovaries, Cervix, Abdo):

Constant lower Abdo Pain (+/- Vag bleeding)

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4
Q

Ectopic Ix

A

(Abdo Pain/Vag bleeding and (+) Preg test => EPAU)

TV-USS,
hCG (Should double every 48hrs):
Increases but < 63%: Ectopic
Decreases > 50%: Miscarriage

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5
Q

Ectopic Mx

A

Expectant (Nat termination w/ reg f/ups)

Med (IM Methotrexate – cannot get pregnant again for 3 months)

Surg:
Salpingectomy: Removal of Fallopian tubes,
Salpingotomy: Removal of just Ectopics

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6
Q 
Miscarriage Def + Types
Early
Late
Missed
Inevitable
Threatened
A

Spontaneous TOP < 24wks

Types:
Early: < 12wks, Late: 12-24wks
Missed: No Sx
Inevitable: Vag bleed w/ Open Cervix
Threatened: Vag bleed w/ Closed Cervix
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7
Q

Miscarriage Ix

A

TV-USS to confirm

hCG: Decrease > 50% in 48hrs

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8
Q

Miscarriage Mx:
< 6wks
> 6wks

A

< 6wks:
Expectant (Wait, Repeat Preg test)

> 6wks:
Expectant (Wait, Repeat Preg test),
Med (Misoprostol: PG Analogue => Softens cervix + Stim Uterine contractions),
Surg (Manual/Electric Vacuum Asp)

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9
Q

TOP Legal Req

A

< 24wks:​
If continuing involves an Increased risk to Physical/Mental health of mother or existing children​

At any time:​
If continuing risks the life of the mother​
Prevent “grave permanent injury”​
Substantial risk child would be handicapped​

​
(Requires 2 Med practitioners​)

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10
Q

Med method for TOP

A

Mifepristone (Anti-Prog): Halts Pregnancy​

Misoprostol (PG Analogue): Softens cervix + Stim Uterus ​

(> 10wks: additional Misoprostol doses every 3hrs until expulsion)​

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11
Q

Surg method for TOP

A

Cervical priming (Misoprostol, Mifepristone, Dilators)​:
< 14wks: Suction​
> 14wks: Evacuation w/ forceps​

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12
Q

Anti-D Rules

A

Must be given to all mothers w/ Ectopics, Miscarriages, TOPs

Given at 28, 34 wks

Given w/in 72hrs of any Sensitisation event

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13
Q

Hyperemesis Gravidarum Patho + Admission Criteria

A

Rise in b-hCG => N+V

Criteria:
Dehydrated/Electro Imbalance
Unable to keep down Fluids/Meds
Lost > 5% Body weight (from Pre-Preg)
Ketones on Dipstick
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14
Q

Hyperemesis Gravidarum Mx

A 
IV Antiemetics (Cyclizine, Prochlorperazine) 
IV Fluids (+ KCl) w/ Daily U+E monitoring 
Thiamine Supp (Prevent Def) 
Thromboprophylaxis (Ted Stockings, LMWHep)
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15
Q

Molar Preg Sx + Patho

A

Abnormally High b-hCG =>
More Severe N+V
Thyrotoxicosis (Mimics TSH)
Rapid Uterus Enlargement, Vag Bleeding + HT

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16
Q

Molar Preg Ix

A

Pelvic USS (Snowstorm)
b-hCG
TSH, T3/4

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17
Q

Molar Preg Mx

A

Uterine Evacuation (+/- Metastases: ChemoTx)

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18
Q

Preg Lifestyle Advice: Supplements, Avoid, Exercise, Sex, Travel

A

Take folic acid 400mcg from before pregnancy to 12 weeks (reduces neural tube defects)
Take vitamin D supplement (10 mcg or 400 IU daily)
Avoid vitamin A supplements and eating liver or pate (vitamin A is teratogenic at high doses)
Don’t drink alcohol when pregnant (risk of fetal alcohol syndrome)
Don’t smoke
Avoid unpasteurised dairy or blue cheese (risk of listeriosis)
Avoid undercooked or raw poultry (risk of salmonella)
Continue moderate exercise but avoid contact sports
Sex is safe
Flying increases the risk of venous thromboembolism (VTE)
Place car seatbelts above and below the bump (not across it)

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19
Q

Antenatal Screening/Appt’s

A

< 10wks: Booking Appt
8-12wks: Booking Scan, Downs Screen (Combined test)
18-20wks: Anomaly Scan, Downs Screen (Triple, Quadruple test)
24-28wks: Gest DM Screen (OGTT)
28wks: Anti-D given
34wks: Anti-D given
36wks: Assess Fetal Lie + Presentation

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20
Q

Downs Screening at 8-12wks:

A

Combined Test:
Nuchal Translucency (> 6mm: +)
b-hCG (High: +)
PAPA (Low: +)

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21
Q

Downs Screening at 18-20wks

A

Triple Test:
b-hCG (High: +)
aFP (Low: +)
Serum Oestradiol (Low: +)

Quadruple Test:
b-hCG (High: +)
aFP (Low: +)
Serum Oestradiol (Low: +)
Inhibin A (High: +)

Anomaly Scan

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22
Q

HypoTh in Preg

A

Increase Levothyroxine by 25-50 micrograms (30-50%)

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23
Q

HT in Preg

A

Labetalol (Avoid in Asthma),
Nifedipine,
(Avoid ACEi/ARBs, Thiazides)

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24
Q

Epilepsy in Preg

A

Single AED before becoming Preg (Levitiracetam, Lamotrigine, Carbamazepine)

5mg Folic Acid daily (Pre-conceptually – 12wks Gest)

Avoid Na+Valproate, Phenytoin

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25
Q

Med Contra in Preg - 8

A 
NSAIDs
ACEi/ARBs
Warfarin 
Lithium
AED's (Na+Valproate)
Methotrexate
Opiates
Retinoids
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26
Q

Pre-eclampsia Def

A

New onset high blood pressure (S140/D90) after 20 weeks of pregnancy w/:​

Proteinuria (> 300mg/day)​
Organ dysfunction (AKI, Liver, Neuro, Haem)​
Uteroplacental dysfunction​

​

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27
Q

Pre-eclampsia Sx + Signs

A

Hypertension, Proteinuria​
Oedema (Peripheral, Facial)​, Ascites
Severe (Frontal)​ headache, Vision problems​
Epigastric/Chest pain​, Vomiting​

Cloudy urine​, Reduced urine output​
Hyperreflexia, Clonus​

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28
Q

Pre-eclampsia Mx:
Prevention
Conservative

A

Prevention: ​
Adcal-D3 (Ca2+ Supplements)​
Aspirin 75-150mg (Started from 12wks - Birth in women w/ Risk F)​

Conservative:​
Weight/Diet Mx​
Birth-timing (some births may need to be induced early)​

29
Q

Pre-eclampsia Tx

A 
Ongoing: ​
Labetalol (beta-blocker), 
Nifedipine (CCB), 
Methyldopa (Anti-sympathetic)​
(Avoid ACEi and other Diuretics​)

Emergency:​
(If < 34wks: IM Betamethasone)​
AED: IV Mg-sulphate (Prevent seizures)​
Cure: Delivery​

30
Q

Gest DM Risk F

A

Previous Gest DM/Macrosomia/Shoulder Dystocia
BMI > 30
FHx of DM/BAME
Glu on Urin Dip

31
Q

Gest DM Screening:
Fasting
2hrs

A

Any Risk F =>
OGTT 24-28wks: 75mg Glu drink
Fasting: > 5.6mmol
2hrs: > 7.8mmol

32
Q

Gest DM Mx:
Fasting < 7mmol
Fasting > 7mmol/Macrosomia
Monitoring

A

If fasting Glu < 7mmol: Diet + Exercise

If fasting Glu > 7mmol/Macrosomia: Metformin,
+/- Insulin, (Glibenclamide: Sulfonylurea)

(Reg Blood Glu + USS monitoring every 4wks):
Fasting: < 5.3mmol
2hrs: < 6.4mmol

33
Q

Pre-existing DM Mx

A

Metformin, Insulin Safe
5mg Folic Acid
Planned Delivery at 37-39wks w/ VRII during Labour

Aim for fasting Glu: 5.3mmol

(Retinopathy screening at booking clinic + 28wks)

34
Q

Obstet Cholestasis Sx

A

Jaundice, (Dark Urine, Pale Stools),

Pruritus (Palms + Soles)

35
Q

Obstet Cholestasis Ix

A

LFTs (Deranged – Placenta => Raised ALP),

Raised Bile Salts

36
Q

Obstet Cholestasis Mx

A

Ursodeoxycholic Acid (dissolves stones)
(Anti-histamines, Emollients: Reduce Pruritus)
(If PT raised: Vit K)
Planned Delivery at 37wks

37
Q

Acute Fatty LD of Preg Patho + Sx

A

Fetus unable to breakdown fatty acids => Accumulation in mothers Liver

Jaundice,
Abdo Pain,
Ascites,
N+V

38
Q

Acute Fatty LD of Preg Ix

A

LFTs (Raised ALT/AST, BiliR)
Deranged Clotting w/ Low Plt’s
Raised WBCs

39
Q

Acute Fatty LD of Preg Mx

A

Delivery + Tx of Acute Hepatitis

40
Q

Breech Presentation Mx:
< 36wks
> 36wks Nulli/> 37wks Multi

A

< 36wks:
Watch+wait (Left to turn Spontaneously)

> 36wks Nulliparous/> 37wks Multiparous:
(ECV): SC Terbutaline (beta-Agonist) => Tocolysis + Press on Abdo to turn Fetus
(If ECV Fails: Vag-delivery +/- C-Section)

41
Q

Stillbirth Def, Ix + Mx

A

(Intrauterine Fetal death after 24wks)

Ix: USS (Diagnose fetal death)

Mx: 
Rh(-) require Anti-D (+ Kleihauer test) 
Vag delivery: 
Expectant (Await natural delivery) 
IOL: PO Mifepristone (Anti-Prog) + Vag/PO Misoprostol (PG)

Dopamine Agonist (Cabergoline): Suppress Lactation

42
Q

Preterm Prophylaxis:
Cerv Length < 25mm
Previous Premature birth/Cerv Trauma w/ Cerv Length < 25mm
Cerv Dil w/out ROM

A

If Cerv length < 25mm (at 16-24wks):
Vag Prog

If previous Premature birth/Cerv trauma w/ Cerv length < 25mm (at 16-24wks): 
Cerv cerclage (Stitches)

If Cerv dilation w/out ROM (at 16-28wks):
Rescue Cerv cerclage

43
Q

Preterm Premature ROM Ex + Ix

A

Pooling of Amniotic Fluid w/in Vag (Speculum Ex)

Raised IGF-BP1/Placental alpha-Microglobulin-1 (present in Amniotic Fl)

44
Q

Preterm Premature ROM Mx

A

Abx (Prevent Chorioamnioitis): Erythromycin 250mg QDS 10 days

IOL at 34wks

45
Q

IOL Scoring

A 
CTG, 
Bishop Score ( >8: Favourable): 
Position (Ant, Mid, Post) 
Consistency (Soft, Firm) 
Effacement (80% - 30%) 
Dilation (> 5cm – Closed) 
Station (+2 - -3)
46
Q

IOL Options

A

Memb sweep (If > EDD)
Vag Prog (Dinoprostone)
Cerv ripening balloon
Artificial Rupt of Memb (w/ IV Oxytocin)
(PO Mifepristone + Misoprostol: IUFD – TOP, Ectopics, Miscarriage, Stillbirth)

47
Q

Preterm Labour w/ Intact Memb Features

A

Reg, Painful contractions w/ Cerv dilation
Cerv length < 15mm on TV-USS
(+) Fetal Fibronectin: > 50ng/L

48
Q

Preterm Labour Mx

A

Fetal monitoring (CTG)
If btw 24-34wks: Tocolysis (Nifedipine) => 48hr Delay
2x IM Betamethasone
IV Mg Sulphate (given w/in 24hrs of Del when < 34wks):
(Monitor for maternal Mg2+ Toxicity: Hypoventilation, HypoT, Absent reflexes)
Delayed cord clamping/cord milking (Increase Fetal blood Vol + Hb)

49
Q

Uterine Hyperstimulation Cause + Sx

A

Caused by Vag Prog

Contractions are prolonged (> 2min) + frequent (> 5 in 10mins) => Fetal distress

50
Q

Uterine Hyperstimulation Mx

A

Remove Vag Prog,
Stop IV Oxytocin Infusion,
(Tocolysis w/ Terbutaline)

51
Q

CTG Worrying Signs

A

(DR: Define Risk):

C: Prolonged + Frequent Contractions

BR: BradyC (< 100), TachC (> 160)

V: Reduced variability (<5bpm in > 50mins), Increased Variability (>25bpm in > 25mins), Sinusoidal

(A: Always reassuring)

D: Late decelerations (Fall at peak of contractions), Prolonged decelerations (> 3mins)

52
Q

Prolonged Fetal BradyC Mx

A

3mins: Call for Help
6mins: Move to Theatre
9mins: Prepare for delivery
12mins: Deliver (by C-Section + w/in 15mins)

53
Q

Fail to Progress (S1) Def + Mx

A

Delay in 1st Stage: (< 2cm dilation w/in 4hrs, Slowed progress in Multiparous):

Record Cerv dilation on Partogram (If crosses alert-line: Amniotomy)

54
Q

Fail to Progress (S2) Def + Mx

A

Delay in 2nd Stage: (Act pushing > 2hrs in Nulliparous/> 1hr in Multiparous):

IV Oxytocin => Stim Uterine contractions

55
Q

Fail to Progress (S3) Def + Mx

A

Delay in 3rd Stage: (> 60mins w/ Physiological Mx/> 30mins w/ Act Mx/PPH):

IV Oxytocin 10 IU => Stim Uterine contractions w/ Controlled cord traction

56
Q

Cord Prolapse Mx

A

Emergency C-section (+/- Tocolysis w/ Terbutaline)

Change position (On all 4’s: prevent compression)

57
Q

Shoulder Dystocia Mx:

A

Episiotomy
McRoberts Manoeuvre (Knees to Chest w/ Post Pelvic tilt)
Press to Ant shoulder (via Suprapubic Abdo)
Rubin’s Manoeuvre (Push from w/in Vag)
Woods Screw Manoeuvre (Rotate Post shoulder back while pushing Ant shoulder from w/in Vag)
Zavanelli Manoeuvre (Push Fetus -> Vag, Emergency C-Section)

58
Q

Perineal tears Mx:

A

1:
Watch+wait

2/3/4: 
Sutures 
Broad-spec Abx 
Laxatives (Prevent constipation), 
PT (Prevent Incontinence)
59
Q

Perineal Tears Class

A

1: Epithelium
2: Perineal M
3: Anal Sphincter
4: Rectum

60
Q 
C-section Risks:
Gen Surg
Postpartum
Maternal
Fetal
A

Gen Surg risks:
Inf, Bleeding, Pain, VTE, Damage to Abdo organs (+/- => Adhesions, Hernias, Ileus)

Post-partum complications (PPH, Wound Inf/Dehiscence)​
Maternal risks (Increased risk of future of Uterine rupture/Placenta praevia/C-sections​)
Fetus risks (Lacerations, Tachypnoea​)
61
Q

Placental Abruption Sx

A 
Sudden-onset, Severe (continuous) Abdo pain​
Tender, hard Uterus/Abdo​
Vag bleeding/APH (Can be delayed until labour: Clots)​
Shock (HypoT, TachyC)​
Abnormal CTG (Fetal distress)​
62
Q

Placental Abruption Mx

A

ABCDE
4 Units Xmatch/O(-) Blood
Steroids (=> Lung development) at 32wks​
Planned C-section 34-36wks (w/ active Mx of PPH)​

63
Q

Primary PPH Def + Causes

A

Def:​
Bleeding w/in 24hrs of Birth​

Causes:​
Tone (Uterine Atony: fail to contract)​
Trauma (Perineal tear, Uterine tear)​
Tissue (Retained Placenta)​
Thrombin (Bleeding D)​
64
Q

PPH Mx:
Mech
Med
Surg

A

Mech:​
Uterine rub (=> contractions)​
Catheterisation (w/ bladder distension)​

Med:​
Oxytocin Infusion (40 Units in 500ml)​
IV Tranexamic acid​

Surg:​
Intra-uterine balloon tamponade​
B-lynch Suture​
Uterine A ligation (+/- Hysterectomy)​

​

65
Q

Secondary PPH Def + Causes

A

Def:​
Bleeding 24hrs – 12wks after birth​

Causes:​
Retained Prod of Conception​
Inf (Endometritis)​

66
Q

Secondary PPH Ix + Mx

A

Invest:​
USS​
High-Vag/Endocervical Swabs​

Mx:​
Surg (Remove RPOC)​
Abx ​

67
Q

Uterine Rupture Def + Mx

A

(Separation of Myometrium +/-Serosa from Peritoneum)

Mx: (Obstetric Emergency): 
Resus w/ blood transfusion 
Stop bleeding 
Emergency C-section  
Repair Uterus (+/- Hysterectomy)
68
Q

Chickenpox in Preg Mx

A

Check VZV Antibodies:
(If AB’s: No further Tx)
If no AB’s:
If no Sx but Exp w/in 10 days: VZV Immunoglobulins
If > 20wks Gest + w/in 24hrs onset of vesicular rash: PO Aciclovir

Medicine (13 decks)

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