Obs and Gynae Flashcards
what is fibroid degeneration?
when a fibroid cuts off its own blood supply
what ways can a cyst cause acute abdomen?
torsion, rupture and haemorrhage
what is adenomyosis?
endometrial glands grow in the myometrium
what is a myomectomy?
surgical removal of fibroids from the uterus
what nodes does ovarian cancer spread to?
directly to the para-aortic nodes
what is the embryological origin of the round ligament?
the gubernaculum
what is a granulose cell tumour?
stromal tumour of ovary
how does a granulose cell tumour present?
Heavy periods intermenstrual bleeding acute abdomen precocious puberty pelvic mass endometrial cancer
what is a sub-total hysterectomy?
just removing the body of the uterus
what is a total hysterectomy?
removing the body of the uterus and the cervix
what is the lifetime risk of a sexually active women acquiring genital HPV infection?
8 in 10
- extremely common
- extremely transmittable (mucosa to mucosa so can even be by touch)
the COCP is a risk factor for endometrial cancer?
false, it is protective
true or false: heart failure can raise Ca125
true
why is adipose tissue considered an endocrine organ?
it converts androgens to oestrogens
what does a snowstorm appearance on US suggest
a molar pregnancy
name some features associated with ectopic pregnancy:
shock (in ruptured ectopic pregnancy) peritonism vaginal bleeding positive pregnancy test cervical excitation tenderness shoulder tip pain
what is the nerve supply to the diaphragm?
C3,4,5 (keeps your diaphragm alive)
what is a threatened miscarriage?
Bleeding in early pregnancy but no evidence yet that pregnancy is not viable. usually a foetal pole and heart beat seen.
how would you diagnose an inevitable miscarriage?
Clinical diagnosis
Internal cervical os is opened
Caffeine limit during pregnancy?
<200 micrograms
1 cup of coffee a day
> 200 = risk of miscarriage and IUGR
Name some routine blood tests taken in every pregnancy at booking:
Serum antibodies
Syphillis, HIV, hepatitis B
Sickle and thalassaemia
Blood type
When would be screen for gestational diabetes?
Previous large babies or carrying large baby Family history of diabetes Previous gestational diabetes BMI >30 Higher risk ethnicity Signs or symptoms Polyhydramnios
What trisomies are screened for?
Trisomy 21
Trisomy 13
Trisomy 18
What is the largest risk factor for Down syndrome?
Increased maternal age
What is Trisomy 18?
Edwards Syndrome
What is Trisomy 13?
Patau’s Syndrome
Purposes of booking scan?
Measure crown rump length to estimate time of delivery
Determine chorionicity
Determine viability of pregnancy
Look for significant obvious abnormality?
What is observed at anomaly scan?
Cleft lip Brain development Size of head Skull formed in tact (no form of neural tube defects) Check spine for neural tube defects Ensure limbs work and a good length Look at feet to check for talipes Bladder Cord insertion Measure tummy Check kidneys are developing See where placenta is
What medication may prevent spina bifida and anencephaly?
5mg Folic acid
Who would be recommended high dose 5mg folic acid?
Previous baby with neural tube defect High risk (obese, on enzyme inducer, diabetic)
When should folic acid be started?
3 months before contraception
How many women are rhesus negative?
15% of women
What ethnicity is associated with sickle cell disease?
Afro-carribean and African
what ethnicity is associated with Thalassaemia?
Cypriot, eastern mediterranean, asian, indian and middle eastern
Define presentation
What is the presenting part? usually head - cephalic
Define postion
what what is the baby lying ?
Normal = occipito-anterior.
Can be occipito-posterior or orccipito-transverse
Define malpresentation
anything presenting that is not the head.
Higher risk of cord prolapse and foetal distress.
<36 weeks it is entirely normal - baby moves about a lot.
Define station
Where presenting part of baby is within the pelvis. Felt vaginally
Define engagement
How much of the of the foetal head is palpable abdominally
When assessing the cervix in pregnancy , what are you looking for?
Dilatation Length of cervix Station of presenting part Consistency Position
What are the signs on vaginal examination of obstruction?
Oedema of the foetal head (caput)
Moulding
What are the signs on vaginal examination of obstruction?
Oedema of the foetal head (caput)
Moulding
Haematuria in mother
Foetal distress
what is entonox
Nitrous oxide and oxygen
Safe and short acting
Can give you nausea and vomitting
side effects of opioids:
Constipation Nausea Respiratory depression Itch Sedation Urinary retention
how to reverse respiratory depression from opioid?
naloxone
ductus arteriosus shunts pulmonary artery to descending….
Aorta
to bypass the lungs
ductus venous shunts umbilical vein to …
IVC
to bypass the liver
Category 1 C section
Immediate threat to life of baby or mum. Baby must be delivered in 30 minutes.
Category 2 C section
Needs emergency delivery but not immediate threat to life
Category 3 C section
Scheduled c section that is needed but no foetal maternal compromise
Category 4 C section
Elective, planned, time suits woman
Can women choose an elective C section as a birth option?
Yes
but need to be counselled as risks
How many women have C sections?
1/4
Methods of inducing:
Membrane sweep
Give vaginal propess (prostoglandin)
Give balloon that mechanically dilate cervix
Syntocinon if no uterine contractions started using above
How common is induction?
1/5 labours are induced
What are the names of the 3 foetal cardiac shunts?
Foramen ovale, ductus venosus, ductus arteriosus
What prep happens in 3rd trimester?
Surfactant production
Accumulation of glycogen- liver, muscle and heart Accumulation of brown fat – between scapulae and around internal organs
Swallowing amniotic fluid
causes of respiratory distress in infants?
Surfactant deficiency Infection Pthorax Cardiac condition Metabolic acidosis TTN
Causes of respiratory distress in infants?
Surfactant deficiency Infection Pthorax Cardiac condition Metabolic acidosis TTN
Give some examples of autosomal dominant conditions?
Huntingtons, Marfans, Neurofibromatosis
Give some examples of x linked recessive conditions?
Duchenne muscular dystrophy
Haemophilia A
Give some examples of autosomal recessive conditions?
Cystic Fibrosis
Sickle cell sydnrome
Taysachs
what is toxoplasmosis?
a parasite causing congenital infections (miscarriage, still birth, seizures, learning disability)
What is toxoplasmosis carried in?
raw meat, cat faeces, soil, unpasteurised milk
Why would we advise pregnant women to avoid liver?
it contains vitamin A which is teratogenic
Why would we advise pregnant women to avoid unpasteurised milk?
risk of TB and toxoplasmosis
Why do we advise pregnant women to avoid soft cheese?
risk of listeria
Why would we advise women to stay away from shark/tuna/swordfish?
contains mercury which is teratogenic and potentially causes mental disability in offspring
Why would we tell pregnant women to avoid Pate?
potentially undercooked meat and risk of listeria
What vitamins are recommended in pregnancy?
Folic acid
Vitamin D
Alcohol in pregnancy is associated with:
Deformed facial features
Attention deficit disorder
Reduced IQ
Kidney defects
What are PAPPA, HCG and nuchal translucency?
1st trimester screening. OFFERED but not routine
What are oestradiol, AFP and inhibin?
2nd trimester screening
Risks of rubella in pregnancy?
Neonatal cataracts, deafness, learning disability, heart defects and miscarriage i contracted <20 weeks
Any bleeding after 12 weeks, in someone who is Rh-ve, what do we do?
Give Anti D to try mop up any foetal maternal haemorrhage. This is because if not the mum will produce an immune response to the foreign antigen.
What is a ‘sensitising even’t for rhesus -ve women?
TOP Abdominal trauma CVS or amnio Miscarriage APH
What does a Kleihauer test do?
Measures number of foetal maternal haemorrhages and ensures we dose Anti D appropriately
Methods for operative vaginal delivery?
Forceps
Ventouse
Requirement for vaginal deliver?
Fully dilated
Head below spines
Describe the difference between the anterior fontanelle and the posterior fontanelle
Anterior fontanelle = 4 sutures run from it therefore it is a DIAMOND shape
Posterior fontanelle = 3 sutures run from it therefore is a TRIANGLE shape
what function does feeling the fontanelles have?
determining foetal position during a vaginal examination
Why is general anaesthetic higher risk in a pregnant women?
progesterone effects during pregnancy relaxes ligaments. There is a higher risk of aspiration due to relaxed GOS, increased weight and breast tissue means high risk of failed intubation.
When may general anaesthetic be chosen above spinal?
QUICKER! used in emergencies when you don’t have the 15 minutes to wait for spinal anaesthetic to take
What does ‘two big blue eyes, one big red mouth’ help you remember?
There are 2 umbilical arteries carrying deoxygenated blood from foetus to placenta.
There is 1 umbilical vein carrying oxygenated blood from placenta to foetus
Foramen ovale shunts left to right….
atrium
what is the function of the placenta
Gas exchange
Transfer of nutrients to foetus
Waste product transport from foetus
Transfer of IgG
What is the transition of circulation at delivery?
Pulmonary vascular resistance drops. Systemic vascular resistance rises. Oxygen tension rises. Circulating prostaglandins drop. Duct constricts. Foramen ovale closes.
What is hypoxic ischaemic encephalopathy?
Lack of oxygen, causing cell death and resulting neurological deficit
3 most important factors in the first three hours of life?
Thermoregulation
Glucose homeostasis
Glucose homeostasis in babies?
Separation from placental glucose supply,
Use of glycogen stores.
Ability to use ketones as brain fuel
Hypoglycaemia in babies risk factors:
Prematurity <37 weeks Maternal diabetes Maternal B blockers Hypothermia Hyperinsulinism
Why is jaundice r common in babies?
physiological breakdown breakdown of foetal haemoglobin
what is kernicterus
rare neurological disorder characterised by excessive levels of unconjugated bilirubin in the blood
What are the benefits of breast milk?
Bonding/positive mental health Transfer of immunoglobulins Decreased risk of adult co-morbidities Decreased risk of SIDS Protective against breast, ovarian cancer and heart disease for mum
What is variability on a CTG?
Upper and lower aspect of the base rate
What are accelerations on a CTG?
> 15 bpm above base rate.
A sign of health
What are decelerations of a CTG?
> 15 bpm below the base rate.
What do contractions on a CTG show?
How many - not how strong!
What are early decelerations?
Normal - physiological.
Sign that the head is getting compressed in contractions
What are variable decelerations?
All appear different. Can be physiological (cord being compressed) but if they persist can be a sign of foetal distress
What are late decelerations?
Always PATHOLOGICAL and a sign of foetal distress. DELIVER
What is the risk in pre-eclampsia?
Eclampsia - a fit
Initial assessment of pre-eclampsia?
ABCDE - don’t forget glucose
Treatment of pre-eclampsia?
Labetalol and nifedipine orally
What counts as severe pre-eclampisa?
> 160/110
How do we treat severe pre-eclampsia?
IV labetolol or hydralazine.
MGSO4 for seizure protection.
Fluid restriction.
With treatment of pre-eclampsia, what BP are we aiming for>
130/85
What is the ultimate treatment for pre-eclamapsia?
Delivery
Why don’t we give ergometrine in pre-eclampsia?
Increases BP
If someone has suffered from pre-eclampsia, what would we do in their next delivery plan?
Make them take aspirin from 12 weeks.
What are the signs of cerebral irritation in pre-eclampsia?
Conus, confusion, hyper reflexia, agitation
Causes of bleeding >24 weeks gestation?
Placenta praevia Placental abruption Vasa praevia Ectropion Infection Trauma Uterine rupture
How does placenta praevia present?
Painless PV bleed
How does placental abrution present?
Painful bleed but can be painful and concealed
How does vasa praevia present?
Small PV bleed at time of ruptured membraned with acute and severe foetal distress
How do we try avoid blood transfusions in obstetrics?
Optimise Hb in pregnancy - treat anaemia and active 3rd stage to reduce chance of PPH
In an emergency, what type of blood can be used universally
O -ve
What type of blood products are used?
RBC's Platelet Cryoprecipitate FFP Cell salvage
What causes a pregnancy to be small for dates?
Wrong dating Idiopathic Multiple pregnancy TORCH infections Placental dysfunction Foetal anaemia Genetic syndromes
What causes a pregnancy to be large for dates?
Wrong dating
What are the risks of a small for dates baby?
Still birth
Foetal distress
Risk of pre-term delivery
What are large for dates babies at an increased risk of?
Obstruction in labour Shoulder dystocia Maternal trauma from tears Sphincter injury PPH
What are twins at higher risk of?
Anaemia Stillbirth Foetal abnormalities PPH Operational delivery Gestational diabetes Pre-eclampisa IUGR
What is the highest risk type of twins?
Monochorionic as they share a placenta. Can develop twin to twin transfusion
Causes of PPH:
- Tone
- Tissue (some placenta left behind)
- Trauma (perineal or cervix tears)
- Thrombin (coagulopathy occurs or clotting disorder)
How do we treat tone caused PPH?
Uterotonics (oxytocin, ergometrine, carboprost, misoprostal) and empty bladder.
How do we treat tissue caused PPH?
Empty uterus
How do we treat trauma caused PPH?
Identify bleed and stop it surgically
How do we treat thrombin caused PPH?
Treat cause of coagulopathy and replace factors
