obs Flashcards
what Heps are screened for at the booking visit
b and c
the booking visit should happen when
before youre 10 weeks pregnant
what is the naegele’s rule
predicts an estimated due date based on the onset of the womans last menstrual period - add 9 months and 7 days
what is placental praevia
when the placenta is low lying in the uterus and covers all or part of the cervix
when is the anomaly scan carried out
20 weeks
patua is trisomy
13
edwards syndrome is trisomy
18
what can be used to give risk of trisomy
neuchal thickness
what detects fetal DNA fragments from a sample of blood taken from the mother
NIPT
what carries a greater miscarriage rate out fo amniocentesis and CVS
CVS
what can be perforomed earlier - amniocentesis or CVS
CVS
2nd trimester trisomy screening uses what biochemical markers
AFP
hCG
UE3
Inhibin A
what tests is baby is rh positivie
cord blood testing
what should be takne if got high risk of pre eclampsia
aspirin
abortion is certified under what form
HSA1 form
what is clause C of HSA1 form
continuing pregnancy would involve greater risk than terminating to effects on mother
what is clause E of HSA1 form
substantial risk that baby could suffer from being seriously handicapped
how is mifepristone and misoprstol taken
misoporstol is taken 24-48hrs after mifepristone
if there is a VTE risk from abortion what can be used as prophylaxis
LMWH
can contraceptions be started soon after abortion
yes almost all can. Immediately effective if started within 5 days of abortion
what method is used for the diagnosis and surveillance of a small for gestational age fetus
US
if early delivery is indicated what may be offered
steriods and or magnesium sulphate
what weight is considered large for gestational age
greater than 4.5kg
signs of multiples pregancy
high AFP
large for dates uterus
multiple fetal poles
management of polyhydramnios
IOL by 40 weeks
if got hypothyroidism and become pregnant what needs to be done
levothyroxine needs to be increaseed during pregnancy
when should women with epilepsy start taking folic acid
before conception
what can cause cleft lip and palate in babies
phenytoin
what is first line for RA in pregnancy as methotrexate is contraindicated
Hydroxychloroquine
the symptoms of what often improve during pregnancy
RA
what is the screening test of choice for gestational diabetes
oral glucose tolerance test
gestational diabetes usually disappers as soon as when
the placenta is deliverd
The D antigen is found where
on red blood cells
when is anti D given to all rehsus negative mothers
at 28 weeks
features of obstetric cholestasis
pruritus - often more intense on hands and feet
jaundice
blood show what in obstetric cholestasis
abnormal LFTs and raised bile acids
what can be given in obstetric cholestasis
ursodeoxycholic acid
how is rubella trasmitted
respiratory droplets
lymphadenopathy classicaly post auricular can be seen in
rubella
what is the investigation for rubella
bloods - as there is a rubella specific antibody
what are the features of congenital rubella syndrome
congential deafness, cataracts and heart disease
Koplik spots are white spots inside the mouth that can be seen in
measles
what is typically transmitted by unpasteurised dairy products, processed meats and contaminated foods
listeria
management of listeria
ampicillin and gentamicin
preg woman are to avoid what foods due to listeria
unpasteurised milk, soft cheese and smoked seafood
acute toxoplasmosis during pregnancy is treated with
spiramycin
what is the triad of congenital toxoplasmosis
intracranial calcifiction, hydrocephalus and chorioretinitis
zika virus is spread by what animal
mosquito
what is first line for UTI in pregnancy
1/2nd trimester - Nitrofurantoin
3rd trimester- Trimethroprim
tense shiny abdomen is a sign of
polyhydramnios
what is the management fro majority of women with polyhydramnios
none
what is low level of amniotic fluid during pregnancy
oligohydramnios
definition of a miscarriage
loss of a pregnancy at less than 24 weeks gestation
what is the time that seperates early from late miscarriage
13 weeks
what is a missed miscarriage
the uterus still contains foetal tissue but the foetus is no longer alive
main presentig symptom of miscarriage is
vaginal bleeding
what are surgical management of miscarriages
manual vacuum aspiration and electric vacuum aspiration
recurrent miscarriage is defined if have
3 or more pregnancy losses
management of recurrent miscarriage in anti phospholipid syndrome
low dose aspirin and fragmin injections
abnormal form of pregnancy in which a non viable fertilised egg implants in the uterus or tube
molar pregnancy
difference between complete and partial mole
complete- occurs when 2 sperm cells fertilise an ovum that contains no genetic material
partial- occurs when 2 sperm cells fertilise a normal ovum
what moles have a higher risk of developing into choriocarcinoma
complete moles
what moles then has 3 sets of chromosomes
partial
what give the grape like appearnace of molar pregnancy
overgrowth of placental tissue with chorionic villi swollen with fluid
symptoms of molar preg
hyperemesis, hyperthyroidism and early onset pre-eclampsia
the fundus can be greater than dates on abdo palpitation in
molar pregnancy
if b-hCG levels dont fall after evacuation of molar pregnancy then what should you suspect
malignant choriocarcinoma
pregnancy should be avoided for how long after a molar pregnancy
1 year
light brownish bleeding could be
implantation bleeding - timing is about 10 dyas post ovulation and sign pregnancy soon emerge. it is often mistaken for a period
what is a chorion
a membrane surrounding the embryo
management of chorionic haematoma
usually self limiting and resolve
what hormone during pregnancy is thought to be responsible for nausea and vomiting
hCG
what is hyperemesis gavidarum
vomiting excessively altering quality of life
where is the most common site for an ectopic pregnancy
fallopian tube
shoulder tip pain can be a symptom in
ectopic pregnancy
gold standard for ectopic
transvaginal US
free fluid in pouch of douglas can suggest
ectopic
management of ectopic pregnacy if patient is acutely unwell
Laparascopic salpingectomy (removal of tube)
what can be medical management in ectopic if woman is stable , low levels of BhCG and ectopic is small and not ruptured
methotrexate
what hormone makes the uterus contract and promotes prostaglandin production
estrogen
what hormones initiates and sustains contraction
oxytocin
what happens in the first stage of labour
mild irregular uterine contraction
and cervix ddilates
what happens in the second stage of labour
start with complete dilation of the cervix to delivery of the baby
when is labour considered prolonged
- In nulliparous women it is considered prolonged if it exceeds 3 hours if there is regional analgesia, or 2 hours without
- In multiparous women it is considered prolonged if it exceeds 2 hours with regional analgesia or 1 hour without
3rd stage of labour
delivery of baby to explusion of placenta and fetal membranes
what active management is done in the 3rd stage of labour to lower risk of post partum haemorrhage
oxytocic drugs and controlled cord traction
what type of pelvis is the most suitable for childbirth
gynaecoid
what is meant by engagement
passage of the widest diameter of the presenting part to a level below the plane of pelvic inlet
what is the period of repair and recovery after birth called
puerperium
what are false labour - contraction thats aim is to prepare the body for birth and they are irregular and do not increase in frequency or intensity
braxton hicks contractions
in labour whats the spacing of contractions
evenly spaced and then time between them gets shorter and shorter
what score is used to determine if it is safe to induce labour
bishops score
what is a graphic record used to assess progress of labour
partogram
what can be administered as part of active management in third stage
syntometerine (ergometrine maleate and oxytocin)
epidural associated wit
longer second stage of labour
oral opiate analgesia in preg
codeine phosphate
most common reason for failure to progress in labour
deflexion of the fetal head
what is failure to progress defined as
Defined as <2cm dilation in 4 hours in nulliparous women, and <2cm dilation in 4 hours or slowing in progress in multiparous women
these are characteristics of foetal hypoxia:
loss of accelerations, repetitive deeper and wider decelerations, rising fetal baseline heart rate, and loss of variability
what does an elective c section mean
its planned
what is an operative vaginal delivery
use of an instrument to aid delivery of the foetus
instruments used to delivery foetus
forceps and ventouse
frank breech is when
both legs are up
All women in the UK with an uncomplicated breech pregnancy at term should be offered
external cephalic version, provided there are no contraindications
antidepressant of choice in pregnancy
sertraline
what antipsychotics have best evidence of being safe in pregnancy
olanzapine , quetiapine
why should you avoid lithium in pregnancy
its secreted into breast milk
what is classed as post partum haemorrhage
loss of greater than 500ml of blood within 24hrs
4 T’s causes of post partum haemorrhage
tone, tissue, trauma and thrombin
most common cause of post partum haemorrhage
tone - refers to uterine atony
what is uterine atony
This is where the uterus fails to contract adequately following delivery, due to a lack of tone in the uterine muscle
tissue is one of the 4 T’s. what does it refer to
retention of placental tissue which prevents the uterus from contracting
these are:
bimanual compressor to stimulate uterine contraction, foley catherter to empty bladder, oxytocin, intrauterine balloon tamponade
treatment of uterine atony in post partum haemorrhage
management for tissue in PPH
- Administer IV oxytocin, manual removal of placenta with regional or general anaesthetic, and prophylactic antibiotics in theatre
- Start IV oxytocin infusion after removal
what is the most common cause of secondary PPH
post partum endometritis
antibiotic for secondary PPH
co-amoxiclav
3rd degree perineal tear involves
anal sphincter
second degree perineal tear involves
perineal skin and muscle but not anal sphincter
4 degree perineal tear involves
anal epithelium/mucosa
what perineal tears need management
3rd and 4th
what can be done to prevent perineal tears
episiotomy
when is antepartum haemorrhage defined as
bleeding from 24weeks gestation before the end of the second stage of labour
most common causes of antepartum haemorrhage
placental abruption and placenta praaevia
what is placental abruption
separation of a normally implanted placenta from the wall of the uterus
severe continuous abdo pain and woody hard uterus can be
placental abruption
what is placental praaevia
when the placenta lies directly over the internal os
what is associates with an increased risk of placental praaevia
c section
is there pain with placental praaevia
no
what should you not perform until you exclude placenta praaevia
vaginal exam
what is placenta accreta
when placenta is abnormally adherent to the uterine wall
what generally causes no symptoms during pregnancy although may be vaginal bleeding in third trimester
placenta accreta
severe abdo pain and shoulder tip pain
uterine rupture
what is vasa praaevia
Unprotected fetal vessels traverse the membranes below the presenting part over the internal cervical os
clinical feature of vasa praevia
sudden dark red bleeding during labour
what is given in high risk women to prevent pre eclampsia
aspirin
what is the only cure for pre eclampsia
birth
what is eclampsia
occurrence of convulsions in a pre- elliptic woman in the absence or neurological or metabolic cause
eclampsia is more common in what age group
teenagers
what kind of seizure is it in eclampsia
Tonic clonic
what can be given to stop seizure in eclampsia
IV mag sulphate
when might you roll the patient onto her hands and knees
shoulder dystocia
McRoberts manoeuvre can be used for
shoulder dystocia
amniotic fluid embolism is when
amniotic fluid enters maternal circulation
what is a differential of headache in pregnancy
dural venous sinus thrombosis
management of dural venous sinus thrombosis
LMWH
management for PE in pregnant woman
LMWH then warfarin from 5th post natal day
non engaged presenting part should alert to possibility of
cord prolapse
management of cord prolapse
immediate delivery
management for sepsis in pregnancy
- IV co-amoxiclav within the ‘golden hour’ +/- gentamicin depending on severity, + clindamycin if sore throat (GAS)
what is chorioamnionitis
Inflammation of the amniochorionic (fetal) membranes of the placenta, typically in response to microbial invasion
when might you suspect chorioamnionitis
if fever greater than 39 degrees during labour
what is the most common cause of acute fatty liver of pregnancy
long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD)deficiency in the fetus
HAART is used to treat HIV and is a combination of how many drugs
3
emergency hormonal contraception only does what
temporarily delay ovulation
combined hormonal contraception protects against what cancer
ovarian and endometrial
risk of depot contraception
may decrease peak bone mass
weight gain is even more common with what contraception
depot
contraception if got breast cancer
avoid any hormonal contraception and go for the copper coil or barrier methods
in cervical or endometrial cancer what contraception should you avoid
intrauterine system ie Mirena coil
Wilsons disease patients should avoid what contraception
copper coil
what is the contraception of choice in the epileptic population
the injection
when does fertility return after childbirth
21 days
do breastfeeding woman need contraception
no if fully breastfeeding and amenorrhoeic
what contraception are considered safe in breastfeeding though
progesterone only pill and implant
when can a copper could or intrauterine system (eg Mirena) not be inserted between
48hrs after birth to 4 weeks
what drugs do not cross the placenta
large molecular weight ones eg heparin
when should be having folic acid in pregnancy
3 months prior and 3 months of pregnancy
is insulin safe in pregnancy
yes
what diabetic medication is not safe in pregnancy and should be switched to insulin
sulfonyureas
Blood pressure in pregnancy falls during which trimester
2nd
can you give warfarin in pregnancy
NO
roaccuane is highly teratogenic, what is the drug name
isotretinoin
can you give nsaids in pregnancy
generally avoided unless really necessary so give paracetamol for pain
scanning what must the patient have a full bladder
transabdominal scanning
what scanning requires patient to have an empty bladder
transvaginal
what is a Xray screening procedure
Hysterosalpingography
example of when Hysterosalpingography made be used
For assessment of tubal patency in patients with infertility
a child under what age cannot consent to any sexual activity
13
how much fish should preg woman have
2-3 servings per week
should woman in the Uk with HIV breast food
no
how does progesterone affect milk production
inhibits milk production
can you overfeed a breastfeed baby
no
what is the first form of milk produces by the mammary glands immediately following delivery of the newborn
colostrum
what is engorgement
painful swelling of the breasts
the greater sciatic foramen is separated from the lesser sciatic foramen by the
sacrospinous ligament
what muscles splits up the greater sciatic foramen
piriformis
4 things in the lesser sciatic Forman
Internal pudendal artery and vein
Pudendal nerve
Obturator interns tendon
Nerve to obturator internus
what is divided into superficial and deep pouches
perineum
perineal muscles are supplied by
pudendal nerve
what covers the superior aspects of the pelvic organs
parietal peritoneum
majority of the arteries of the pelvis and perineum arise from what artery
internal iliac - exception are gonadal and superior rectal
what anastomoses with uterine artery
ovarian and vaginal artery
drainage into what vein goes to the hepatic portal system
superior rectal
sacrospinous and sacrotuberous both come from the sacrum and attach where
spinous- ischial spine
tuberous- ischial tuberosity
the pelvic cavity is more. — in females
shallow
what muscle maintains faecal continence
puborectalis
what is the deepest layer of the pelvic floor
pelvic diaphragm
examples of what deep perineal pouch contains
urethra, bulbourethral glands in males, NVB for penis/clitoris
what is in between the deep and superficial perineal pouch
perineal membrane
examples of things the superficial perineal pouch contains
female erectile tissue, greater vestibular glands (Bartholin’s glands)
muscles in superficial perineal pouch
ischiocavernous, bulbospongiosus
superficial transverse perineal
in a sacrospinous fixation there is risk of injury to what structures
pudendal NVB and sciatic nerve
urogenital and reproductive systems arise from
mesoderm
sexual differentiation occurs from how many weeks
7
female development occurs in the abscence of what transcription factor
SRY
Persisitant Mullerian Duct syndrome presents with
uterus, vagina and testes
what happens in the proliferative phase of menstruation
stratum basalts proliferates and this thickens the thickness of the endometrium
what happens in the secretory phase of menstruation
glands become coiled with a corkscrew appearance and secrete glycogen
what happens in the menstrual phase
the arterioles in the stratum functionalis undergo constriction, depriving the tissue of blood and causing ischaemia, with restultant tissue breakdown, leakage of blood, and tissue sloughing
broad ligament of the uterus extends between
uterus and lateral walls and floor of the pelvis
walls of the vagina are usually
collapsed
cervical smear needs to sample what area
transformation zone (squamocolumnar junction)
where does fertilisation usually occur
ampullar
apart from gametes what else do the ovaries produce
steriods mainly oestrogen and progestogens
outer shell of the cortex of the ovary is called the
tunica albuginea
the tunica albuginea is covered by a layer of cuboidal cells called the
germinal epithelium
primary follicles are defined by what cells
cuboidal granulosa cells
theca interna will go on to secrete
oestrogen precursors
antrum (fluid filled space) enlarge in what follicle
secondary
the very largest antral follicles are called
Graafian follicles
follicular stigma on ovary indicating
imminent rupture of the follicle
if no implantation occurs the follicles will become
corpus albicans
if implantation occurs, the placenta secretes — which prevents degeneration of the corpus luetum
hCG
paired ovarian arteries arises directly from where
abdominal aorta
ovarian veins drain into
left- left renal vein
right- IVC
lymph from the ovaries drains to
PARA-aortic nodes -CLINICALLY RELEVANT IN OVARIAN MALIGNANCY
what layer of the vagina is thick during reproductive years due to glycogen accumulation
non keratinised stratified squamous epithelium
are there glands in the vagina
There are no glands in the wall of the vagina, but it is lubricated by mucous from the cervical glands and fluid from the thin walled vessels of the lamina propria
to see the position of the uterus how do you palpate the uterus
bimanual
the cervix is the lowest portion of the
uterus
cyst in cervix called
Nabothian cyst
what covers two tubes of erectile vascular tissue (corpora cavernosa)
clitoris
pain from female repro system, the 2 important spinal cord levels are
T11-L2 and S2-S4
cervix and below nerve supply
pudendal (s2-4)
nerve to uterine tubes, uterus, ovaries
T11-L2
spinal cord becomes caudal equine. at what vertebrae
L2
spinal anaesthetic can result in what side effect
hypotension
what can be used as a landmark for the pudendal nerve
ischial spine
superior epigastric artery and inferior is a continuation of
superior- internal thoracic
inferior- external iliac
in laparoscopy and in surgery and near the deep inguinal ring need to avoid cutting
inferior epigastric artery
hysterectomy is removal of the
uterus
in hysterectomy need to be extremely careful to differentiate
ureter and uterine artery
what vermiculates when touched
ureter - the water!
what initiates follicular growth
FSH
what stimulates further development of follicles
LH
progesterone is mainly secreted by the
corpus luteum
what phase comes before ovulation
follicular
what happens to oestrogen and progesterone to stimulate the release of prostaglandins in the menstrual phase
they fall
what sloughs off in menstruation
entire stratum functionalis
normal period blood loss is between
5-80mls
what has the main impact on cycle length
time between menstruation and ovulation
hCG signals the corpus luteum to secrete what
progesterone
what prevents inoculation of corpus luteum
hCG
when do levels of hCG start to fall
12-24 weeks
what decreases uterus contractility
progesterone
if taking iron supplements and become pregnant need to
increase supplements
what 2 things increase contractility of uterus
oestrogen and oxytocin and In turn stimulate prostaglandins
what inhibit milk production
estrogen and progesterone
ductus arteriosus goes to
pulmonary trunk
ductus venosus goes to
liver
most common cause of respiratory distress in late preterm and term infants
transient tachypnoea
babies gut prior to birth is
sterile
what is currenty used for sec determination and trisomy testing
NIPT
when can you surgically terminate pregnancy and would be induction thereafter
before 13 weeks
what is- Used as a first line test for acutely unwell children with a likely monogenetic disorder
NGS
