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General Medicine > Obs > Flashcards

Obs Flashcards

1
Q

What is hyperemesis gravidarum

A

Severe or persistent vomiting in pregnancy

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2
Q

How many women are affected by hyperemesis gravidarum

A

2% of pregnancies

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3
Q

Syx of hyperemesis gravidarum

A

Starts between 4-7 weeks - often resolves by 16wks
N+V any time in the day - may be constant
Fluid and electrolyte disturbance
Ketonuria
Nutritional deficiency + weight loss

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4
Q

What makes n+v more common in pregnancy

A

Primigravidae
Multiple pregnancy
Hx of past hyperemesis gravidarum
Younger maternal age

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5
Q

DDX of hyperemesis gravidarum

A 
Hydatiform mole
Pre-eclampsia
GI infection, irritation, ulcer, appendicitis etc
Torted ovarian cyst
drug SE
Raised ICP
diabetes
Bulimia nervosa
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6
Q

Management of vomiting in pregnancy

A 
Ginger 
Wrist acupressure 
Rest
Eat small regular meals
High carbohydrate low fat meals
Avoid foods / smells that trigger syx
Antihistamines
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7
Q

Tx of hyperemesis gravidarum

A

Prochlorperazine
Cyclizine
Metoclopramide

If severe refer to hospital - fluid and electrolyte replacement + nutritional support.

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8
Q

Complications of hyperemesis gravidarum

A

Dehydration
Weight loss
Electrolyte disturbance
Ketosis

Rarely –> wernicke’s encephalopathy, central pontine myelinosis, spontaneous oesophageal rupture.

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9
Q

Can diabetic women have a vaginal birth?

A

Yes

Should be offered elective induction or CS after 38wks

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10
Q

Babies born to diabetic mothers are at risk of what after birth?

A

Neonatal hypoglycaemia

Monitor for 24 hrs after birth.

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11
Q

Diabetic mothers who breast feed are at an increased risk of _________

A

Hypoglycaemia

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12
Q

Average length of a pregnancy

A

40 weeks
280 days
Term = 38-42 weeks

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13
Q

Average cycle length

A

28 days

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14
Q

On what day of a 28day cycle does ovulation occur

A

14th day

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15
Q

How to calculate EDD from LMP

A

Date of LMP + 9m + 7d

If the cycle is >28d also add the difference between 28 and the cycle length.

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16
Q

Feature of past pregnancies which may be relevant to current pregnancy

A 
Recurrent miscarriage
Preterm delivery
Early onset pre-eclampsia 
Abruption
Congenital abnormalities 
Macrosomic baby
Fetal growth restriction 
Unexplained stillbirth
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17
Q

What does gravida mean

A

The number of pregnancies - regardless how they ended

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18
Q

What does parity mean?

A

Number of births > 24 weeks - live or still

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19
Q

Pre-existing diseases which may impact pregnancy

A 
Diabetes mellitus
Hypertension
Renal disease
Epilepsy
VTE disease
HIV
connective tissue disorders
Myasthenia gravis
Myotonic dystrophy
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20
Q

What impact may existing DM have on pregnancy

A 
Marosomia
Fetal growth restriction
Congenital abnormality
Pre-eclampsia 
Stillbirth 
Neonatal hypoglycaemia
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21
Q

What impact may hypertension have on pregnancy

A

Pre-eclampsia

22
Q

What impact may existing renal disease have on pregnancy

A

Worsening renal disease
Pre-eclampsia
Fetal growth restriction
Preterm delivery

23
Q

What impact may existing epilepsy have on pregnancy

A 
Increased fit frequency 
Congenital abnormality (medication)
24
Q

What impact may existing VTE disease have on pregnancy

A

Increased risk of VTE in pregnancy

25
Q

In obs ex - inspect for:

A 
Asymmetry 
Fetal movements
Scars - caesarean, laparotomy, laparoscopy, appendicectomy, cholecystectomy 
Striae gravidarum
Linea nigra
26
Q

In obs ex - palpate for:

A 
Symphysis-fundal height (SFH) + measure 
Number of fetal poles
Fetal lie 
Fetal presentation
Fetal engagement
27
Q

Types of fetal lie

A

Longitudinal
Transverse
Oblique

28
Q

Types of presentation

A

Cephalic

Breech

29
Q

When is a vaginal examination necessary in pregnancy

A

Offensive or excessive discharge
Vaginal bleeding - exclude placenta praevia 1st
Cervical smear
Confirm rupture of membranes

30
Q

When is surfactant production maximal?

What does it do?

A

After 28 weeks

Prevents collapse of small alveoli during expiration

31
Q

What is fetal respiratory distress syndrome

A

Respiratory distress in 1st few hours of life

Due to lack of surfactant in premature infants.

32
Q

Complications of fetal respiratory distress syndrome

A

Hypoxia
Asphyxia
Intraventricular haemorrhage
Necrotizing enterocolitis

33
Q

Functions of amniotic fluid

A

Protect against mechanical injury
Permit fetal movement while preventing limb contracture
Prevent adhesions between foetus and amnion
Permit fetal lung development

34
Q

Symptoms of pregnancy

A

Breast tenderness
Nausea
Amenorrhea
Urinary frequency

35
Q

When may the fetal heart by heard with a Doppler

A

12 weeks

36
Q

Booking investigations include

A 
FBC - anaemia, thrombocytopenia
Blood group + rhesus status
Urinalysis 
Rubella status
Hepatitis B 
HIV
Syphillis
37
Q

What fetal abnormalities are screened for

A

Down’s syndrome
Neural tube defects
Structural congenital abnormalities

38
Q

How is Down’s syndrome screened for

A

Combined test

  • Nuchal translucency scan 11-14 wks
  • HCG levels
  • pregnancy associated plasma protein - A
  • maternal age
39
Q

How are neural tube defects screened for

A

Serum alpha-fetoprotein levels at 15-20 wks

Scan at 18 -20 wks

40
Q

Presentation of amniotic fluid embolism

A

Rapid onset cardiovascular collapse, acute left ventricular failure, pulmonary oedema, disseminated intravascular coagulation, neurological impairment.

Bleeding diathesis 
Tachypnoea
Respiratory distress / Peripheral or central cyanosis
Hypotension	
Bronchospasm
Seizure
Chest pain
41
Q

When may amniotic fluid embolism occur

A 
Termination of pregnancy.
Amniocentesis.
Placental abruption.
Trauma.
Caesarean section.
Delivery - unexpectedly, up to 30 minutes after delivery.
42
Q

Symptoms of placental abruption

A

Abdominal / pelvic pain

Bleeding

43
Q

What name is given to PV bleeding during pregnancy before 24 weeks gestation?

A

Miscarriage

44
Q

Define Antepartum haemorrhage

A

Pv bleeding after 24weeks Gestation.

It can occur at any time until the second stage of labour is complete

45
Q

Causes of antepartum haemorrhage

A 
Placental abruption
Placenta praevia 
Vulval infection / Trauma / Tumour
Cervical infection/ Trauma / Tumour
Vasa Praevia
Uterine rupture
46
Q

What is placenta accreta

A

Placental penetration into the myometrium

47
Q

What is placenta increta

A

Placental invasion into the myometrium

48
Q

What is placenta percreta

A

Where the placenta crosses the uterine wall and invades the peritoneum

49
Q

What is placental abruption

A

Separation of the placenta from the uterus before delivery of the fetus

50
Q

What is vasa praevia

A

= Velamentous cord insertion
Where the placenta has developed away from the attachment of the cord
The vessels divide in the membrane.

51
Q

What is Functional incontinence

A

When the patient is unable to reach the toilet in time

E.g. poor mobility / unfamiliar surroundings.

52
Q

What is potters syndrome

A

Oligohydramnios causes facial deformity, epicanthic folds, low set ears, pulmonary hypoplasia, joint deformity.

General Medicine (25 decks)

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