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Obstetrics and Gynaecology > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

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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?

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A

An anomaly USS in the 2nd trimester

24
Q

What is the pathology of rhesus disease?

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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
How is rhesus disease prevented?
Giving all Rh- mothers anti D IgG antinatally and at sensitising events and after delivery Fetuses affected may need in utero blood transfusion
26
What are the risks of multiple pregnancy?
``` Miscarriage Hyperemesis Anaemia Pre-eclampsia Gestational diabetes Preterm labour IUGR IUD Twin-twin transfusion syndrome Malpresentation ```
27
What are some causes of IUGR?
Pre-eclampsia Maternal drugs/alcohol Maternal smoking Fetal infection
28
What are some causes of IUD (intrauterine death)?
``` Chromosome abnormalities Infection Twin-twin transfusion syndrome Rhesus disease Pre-eclampsia Placental abruption ```
29
What are the main causes of vaginal bleeding during pregnancy?
``` Placental abruption Placenta praevia Vasa praevia Miscarriage Ectopic pregnancy Cervical mass ```
30
What is placenta praevia and how does it present?
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
What is placental abruption and how does it present?
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
What is done at 10-13 weeks pregnancy?
Booking scan, lifestyle advice BP/urinalysis HIV/toxoplasmosis/syphilis/hepatitis screen and rubella susceptability Down's syndrome screening
33
What causes preterm labour?
``` Low maternal BMI Polyhydramnios Acute illness Previous preterm delivery Smoking ```
34
What rate should a fetal heartbeat be?
Between 110 and 160 BPM
35
What are the indications for induction of labour?
``` Pre-labour membrane rupture Suspected IUGR Intrauterine death Maternal request Gestational diabetes ```
36
How is labour induced?
Vaginal prostaglandins and an oxytocin infusion | Artificial rupture of membranes
37
How can breech babies be treated?
External cephalic version (ECV), if failed then C section
38
What is shoulder dystocia?
An obstetric emergency | Where there are additional manouvres needed to release the shoulders after downward traction has failed
39
What are the risk factors for shoulder dystocia?
``` Previous dystocia Gestational diabetes Macrosomia High BMI IOL Oxytocin ```
40
What are the causes of PPH?
Tone - reduced uterine tone Trauma - tears Tissue - retained placental tissue Thrombin - clotting problem
41
What are the symptoms of PPH?
PV bleeding, tachycardia, hypotension
42
What is the treatment of PPH?
Tocolytics, fluid resuscitation, uterine massage Uterine artery ligation or embolisation Hysterectomy
43
What are the normal 'baby blues'?
Tearfulness and anxiety, 50% of first deliveries | usually resolves by day 3
44
What is postnatal depression?
Depressive symptoms related to pregnancy and childbirth 10-15% of mothers Treat with antidepressants Most cases resolve
45
What is puerperal psychosis?
Severe mental health problem within first 4 weeks of birth Hallucinations and irrational ideas towards baby Needs psychiatric admission
46
What is a miscarriage?
Pregnancy loss before 24 weeks | Usually due to chromosome abnormalities
47
What can cause recurrent (3+) miscarriages?
Antiphospholipid syndrome | Parental chromosome problems
48
What is a threatened miscarriage?
Pain and bleeding with a closed cervical OS and viable pregnancy on USS
49
What is an inevitable miscarriage?
Pain and bleeding with an open cervical OS
50
What is a missed miscarriage?
When symptoms and signs are minimal and diagnosis is on USS
51
What is an incomplete miscarriage?
When there are retained POC on USS
52
What is a complete miscarriage?
Cervical OS closed, no RPOC
53
What is an ectopic pregnacy?
A pregnancy where implantation is not in the uterus (usually the fallopian tube)
54
What are risk factors for ectopic pregnancy?
``` Previous ectopic pregnancy Pelvic Inflammatory Disease Tubal surgery IUCD IVF ```
55
What are the S+S of ectopic pregnancy?
Lower abdominal pain, light PV bleeding, syncope, TVUSS will diagnose and patients will have high hCG and progesterone
56
What is the treatment of ectopic pregnancy?
Methotrexate IM if haemodynamically stable | Surgical salpingostomy
57
How are terminations of pregnancy performed?
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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