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Obstetrics and Gynaecology > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

1
Q

What is pre-eclampsia?
What is eclampsia?
What is the prevalence of pre-eclampsia?

A

Hypertension >140/90
Proteinuria >0.3g
eclampsia - tonic clonic siezures
5-10% of woman

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2
Q

What is the effect of pre-eclampsia on the fetus?

A

Growth restriction
Pre-term delivery
Death

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3
Q

What are the effects of pre-eclampsia on the mother?

A 
Liver failure
Renal failure 
HELLP syndrome 
Placental abruption 
Death
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4
Q

What is the pathology of pre-eclampsia?

A

Failure of trophoblast invasion within the spiral arteries leading to uteroplacental ischaemia

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5
Q

What are the symptoms of pre-eclampsia?

A 
May be asymptomatic
Headache, malaise, vomiting
RUQ pain 
Visual disturbance
Swollen legs
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6
Q

What investigations would you do for pre-eclampsia?

A

Serial BP
Urinalysis
FBC, U and E, LFT’s, group and save

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7
Q

How do you treat pre-eclampsia?

A

Delivery of fetus is curative
Mag sulphate prevents seizures
Steroids for fetal lung maturity
Antihypertensives - labetalol

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8
Q

What are the risks of diabetes on the mother?

A

Diabetic nephropathy and retinopathy may get worse
Higher miscarriage risk
Pre-eclampsia risk higher

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9
Q

What are the risk factors for pre-eclampsia?

A 
History of pre-eclampsia
Multiple pregnancy (twins etc)
Obesity
First baby 
Over 40 or under 18
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10
Q

What are the risks of diabetes on the fetus?

A 
Macrosomia
Shoulder dystocia 
neonatal Hypoglycaemia 
Polyhydramnios
Strict glycaemic control and induction at 38-39 weeks is advised
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11
Q

What are the risks of epilepsy in pregnancy?

A

Anti-epileptics are teratogenic and increase risk of neural tube defects, cleft palate and heart defects
Folic acid must be taken

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12
Q

What are the problems with anaemia in pregnancy?

A

Associated with LBW and preterm delivery
Increased risk of PPH
FBC done at booking and 28 weeks to avoid

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13
Q

What are the risks of VTE in pregnancy?

A

Foetal - thrombophillia
Mother - leadung cause of maternal death
Anticoagulation by LMWH is given to those with current DVT or those with risk factors/c section

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14
Q

When is HIV most damaging in pregnancy?

A

The late third trimester, delivery and breastfeeding

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15
Q

what is the HIV transmission rate?

A

25-30% but reduced to less than 2% with ART

mothers will have a C section and be told not to breastfeed

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16
Q

What is the risk of rubella in pregnancy?

A

First trimester risk
Mother - maculopapular rash, lymphadenopathy and arthritis
Fetus - sensorineural deafness, CHD, developmental delay

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17
Q

How is the risk of rubella in pregnancy reduced?

A

No treatment if infected

Management is prevention with rubella vaccine in teenage girls

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18
Q

What does CMV cause during pregnancy?

A

All trimesters affected

Can cause IUGR, microcephaly, developmental delay

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19
Q

What is the significance of 25% of woman having group B strep in the genital tract?

A

There is a risk of fetal infection once the membranes have ruptured
Neonatal GBS disease –> pneumonia, sepsis and death

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20
Q

How do we prevent neonatal GBS disease?

A

Give IV benzylpenicillin to carriers when in labour

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21
Q

What tests are done in the first trimester?

A

Combined test for nuchal translucency and PAPP-a

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22
Q

What tests are done in the 2nd trimester?

A

AFP, oestriol and inhibin

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23
Q

What is done if downs syndrome is suspected?

A

An anomaly USS in the 2nd trimester

24
Q

What is the pathology of rhesus disease?

A

This occurs when Rh- mothers have a Rh+ baby. if there is mixing of the blood e.g. placental abruption, invasive procedures e.g. amniocentesis, miscarriage, maternal IGM antibodies are produced to the fetal Rh antigen and in future pregnancies IgG (which crosses the placenta) is produced and causes haemolytic disease of the fetus

25
Q

How is rhesus disease prevented?

A

Giving all Rh- mothers anti D IgG antinatally and at sensitising events and after delivery
Fetuses affected may need in utero blood transfusion

26
Q

What are the risks of multiple pregnancy?

A 
Miscarriage
Hyperemesis
Anaemia
Pre-eclampsia
Gestational diabetes
Preterm labour
IUGR
IUD
Twin-twin transfusion syndrome
Malpresentation
27
Q

What are some causes of IUGR?

A

Pre-eclampsia
Maternal drugs/alcohol
Maternal smoking
Fetal infection

28
Q

What are some causes of IUD (intrauterine death)?

A 
Chromosome abnormalities
Infection 
Twin-twin transfusion syndrome
Rhesus disease
Pre-eclampsia
Placental abruption
29
Q

What are the main causes of vaginal bleeding during pregnancy?

A 
Placental abruption
Placenta praevia
Vasa praevia 
Miscarriage 
Ectopic pregnancy 
Cervical mass
30
Q

What is placenta praevia and how does it present?

A

When the placenta partially or wholly lies over the lower uterine segment
It may be asymptomatic or have PAINLESS PV bleeding
Low lying placenta can be identified on USS at 20 wees but many will migrate up
Delivery is by C section

31
Q

What is placental abruption and how does it present?

A

When the placenta prematurely separates from the uterine wall
Cause can be trauma related or pre-eclampsia and smokers
Presents with PAINFUL PV bleeding with abdominal pain and a woody, hard uterus
Vaginal delivery may be achieved

32
Q

What is done at 10-13 weeks pregnancy?

A

Booking scan, lifestyle advice
BP/urinalysis
HIV/toxoplasmosis/syphilis/hepatitis screen and rubella susceptability
Down’s syndrome screening

33
Q

What causes preterm labour?

A 
Low maternal BMI
Polyhydramnios
Acute illness
Previous preterm delivery
Smoking
34
Q

What rate should a fetal heartbeat be?

A

Between 110 and 160 BPM

35
Q

What are the indications for induction of labour?

A 
Pre-labour membrane rupture
Suspected IUGR
Intrauterine death 
Maternal request 
Gestational diabetes
36
Q

How is labour induced?

A

Vaginal prostaglandins and an oxytocin infusion

Artificial rupture of membranes

37
Q

How can breech babies be treated?

A

External cephalic version (ECV), if failed then C section

38
Q

What is shoulder dystocia?

A

An obstetric emergency

Where there are additional manouvres needed to release the shoulders after downward traction has failed

39
Q

What are the risk factors for shoulder dystocia?

A 
Previous dystocia
Gestational diabetes
Macrosomia 
High BMI
IOL 
Oxytocin
40
Q

What are the causes of PPH?

A

Tone - reduced uterine tone
Trauma - tears
Tissue - retained placental tissue
Thrombin - clotting problem

41
Q

What are the symptoms of PPH?

A

PV bleeding, tachycardia, hypotension

42
Q

What is the treatment of PPH?

A

Tocolytics, fluid resuscitation, uterine massage
Uterine artery ligation or embolisation
Hysterectomy

43
Q

What are the normal ‘baby blues’?

A

Tearfulness and anxiety, 50% of first deliveries

usually resolves by day 3

44
Q

What is postnatal depression?

A

Depressive symptoms related to pregnancy and childbirth
10-15% of mothers
Treat with antidepressants
Most cases resolve

45
Q

What is puerperal psychosis?

A

Severe mental health problem within first 4 weeks of birth
Hallucinations and irrational ideas towards baby
Needs psychiatric admission

46
Q

What is a miscarriage?

A

Pregnancy loss before 24 weeks

Usually due to chromosome abnormalities

47
Q

What can cause recurrent (3+) miscarriages?

A

Antiphospholipid syndrome

Parental chromosome problems

48
Q

What is a threatened miscarriage?

A

Pain and bleeding with a closed cervical OS and viable pregnancy on USS

49
Q

What is an inevitable miscarriage?

A

Pain and bleeding with an open cervical OS

50
Q

What is a missed miscarriage?

A

When symptoms and signs are minimal and diagnosis is on USS

51
Q

What is an incomplete miscarriage?

A

When there are retained POC on USS

52
Q

What is a complete miscarriage?

A

Cervical OS closed, no RPOC

53
Q

What is an ectopic pregnacy?

A

A pregnancy where implantation is not in the uterus (usually the fallopian tube)

54
Q

What are risk factors for ectopic pregnancy?

A 
Previous ectopic pregnancy
Pelvic Inflammatory Disease
Tubal surgery 
IUCD
IVF
55
Q

What are the S+S of ectopic pregnancy?

A

Lower abdominal pain, light PV bleeding, syncope, TVUSS will diagnose and patients will have high hCG and progesterone

56
Q

What is the treatment of ectopic pregnancy?

A

Methotrexate IM if haemodynamically stable

Surgical salpingostomy

57
Q

How are terminations of pregnancy performed?

A

Surgical 1st trimester - vacuum aspiration
Surgical 2nd trimester - dilatation and evacuation
Medical - mifepristone and misoprostol (if over 20 weeks feticude with intracardiac potassium)

Obstetrics and Gynaecology (7 decks)

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