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3a Obs and Gynae > Obs and Gynae Emergencies > Flashcards

Obs and Gynae Emergencies Flashcards

1
Q

What is an ectopic pregnancy?

A

Pregnancy that occurs when the fertilised egg implants outside of the uterus

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2
Q

Where is the most common location of an ectopic pregnancy?

A

Fallopian tubes

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3
Q

What investigations might you do for a suspected ectopic pregnancy?

A

UPT (urine pregnancy test)
BHCG (Human chorionic gonadotropin)
USS

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4
Q

What is the medical management for ectopic pregnancy?

A

IM methotrexate to stop pregnancy growing.

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5
Q

1 in_ pregnancies end in loss during pregnancy or birth

A

4

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6
Q

1 in _ pregnancies end in miscarriage

A

5

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7
Q

Miscarriage in the s_____ loss of foetus under __ weeks

A

spontaneous
24

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8
Q

What happens to bHCG to indicate early pregnancy loss?

A

bHCG levels decrease by over 50% in 48 hours

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9
Q

What is a molar pregnancy?

A

Gestational trophoblastic disease

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10
Q

What does complete mole refer to?

A

Single sperm or 2 sperm fertilize an egg that has lost its DNA

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11
Q

What does a partial molar refer to?

A

Two sperm fertilizing one egg that has it’s DNA

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12
Q

What is the colloquial term for molar pregnancy sign on USS

A

Bunch of grapes

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13
Q

What does an USS of molar pregnancy show?

A

Irregular echobright area containing multiple cysts

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14
Q

What is the management of molar pregnancy?

A

Surgical only
Send POC (products of conception) for histology

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15
Q

What is a complication of molar pregnancy?

A

Developing into choriocarcinoma (rare cancer)

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16
Q

What is ovarian torsion?

A

When the ovary (and sometimes fallopian tubes) twists on the vascular and ligamentous supports

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17
Q

Ovarian torsion can cause blockage of blood flow to the ____

A

ovary

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18
Q

How does ovarian torsion present itself?

A

Severe abdo pain
N&V

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19
Q

What imaging is used for suspected ovarian torsion?

A

USS, enlarged ovary

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20
Q

How is ovarian torsion managed?

A

Surgical emergency - detorsion or oophrectomy (removal of ovary)

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21
Q

What does PID stand for?

A

Pelvic Inflammatory Disease

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22
Q

What is PID?

A

Infection within the female reproductive system (uterus, fallopian tubes, ovaries)

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23
Q

What are risk factors for PID?

A

Multiple sexual partners
Unprotected sex
IUD use

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24
Q

What causes PID?

A

Bacterial infection
Often chlamydia or gonorrhoea

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25
Q

How is PID managed?

A

Swabs
14 days antibiotics (stat IM ceftriaxone single dose plus PO metronidazole and doxycycline)

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26
Q

What is antepartum haemorrhage?

A

Bleeding from anywhere within the genital tract AFTER 24th week of pregnancy

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27
Q

What are some causes of antepartum haemorrhage?

A

Low lying placenta
Vasa Praevia (foetal vessels run close to cervical Os)
Minor/major abruption
Infection

28
Q

What is low lying placenta

A

Also called placenta praevia

Part of the placenta has implanted into the lower segment
Can cover the Cervical Os

29
Q

How is low lying placenta diagnosed?

A

20 week anomaly USS

Repeat at 32 weeks

30
Q

How is low lying placenta managed?

A

Safety netting for pain/bleeding
Avoid sex
If recurrent bleeding then admit until delivery

Elective C-section at around 37 weeks

31
Q

What is Vasa Praevia?

A

Where the foetal vessels are coursing through the membranes over the internal cervical os and below the foetal presenting part, unprotected by placental tissue or the umbilical cord.

32
Q

True or false: Vasa Praevia carries a major risk to the mother

A

False
But major foetal risk

33
Q

What is the risk of vasa praevia?

A

If the membrane ruptures then there is risk of major foetal haemorrhage with mortality of 60%

34
Q

How is Vasa praevia managed?

A

Steroids (help foetus lungs to develop for C-section)
C-section at 34-37 weeks (earlier if bleeding and indicated)

35
Q

What is placental abruption?

A

Premature separation of the placenta from the uterine wall

36
Q

What are the 2 types of placental abruption?

A

Concealed
Revealed haemorrhage

37
Q

How does placental abruption present itself?

A

Woody-hard
Tense uterus
Foetal distress
Maternal shock, out of proportion bleeding

38
Q

How is placental abruption managed if after 37 weeks?

A

Emergency c-section and steroids

39
Q

What is Cord prolapse?

A

The presenting part is the cord following rupture of the membrane

40
Q

Why does cord prolapse pose a risk?

A

Leads to vasospasm and can cause increased risk of foetal morbidity and mortality from hypoxia

41
Q

What are risk factors for cord prolapse?

A

Premature rupture of membranes
Polyhydramnios (increased levels of amniotic fluid)
Long umbilical cord
Foetal malpresentation
Multiparity (more than one baby)

42
Q

How is cord prolapse managed?

A

Trendelenburg position (feet above head)
Constant foetal monitoring
Alleviate pressure on cord
Transfer to theatre and prepare for delivery

43
Q

What is pre-eclampsia?

A

Hypertension in pregnancy with proteinuria

44
Q

How does pre-eclampsia present?

A

Severe headache
Visual disturbances
Clonus
Liver tenderness
Abnormal liver enzymes
Platelet count falls to under 100

45
Q

How is pre-eclampsia managed?

A

Stabilise blood pressure to under 140/90

46
Q

What is 1st line med for pre-eclampsia

A

Labetalol

47
Q

What is the 2nd line med for pre-eclampsia?

A

Nifedipine

48
Q

What investigations are needed to diagnose pre-eclampsia?

A

Bloods (platelets, renal and liver function)
Urine dip (proteinuria)

49
Q

What is eclampsia?

A

Onset of seizure in a women with pre-eclampsia

50
Q

True of false: seizure in pregnancy is epilepsy until proven otherwise

A

False
Seizure in pregnancy is eclampsia until proven otherwise

51
Q

How is eclampsia managed?

A

IV MgSO4, 4mgs given over 5 minutes
Followed by infusion of 1g/hour for 24 hours

Then treat cause of htn

52
Q

What is the leading cause of maternal death in the UK?

A

Sepsis

53
Q

What are steps taken to prevent sepsis in pregnancy?

A

Seasonal flu and Covid immunisations

54
Q

What does BUFALO stand for in management of sepsis?

A

Blood cultures
Urine output monitoring and catheter insertion
Fluid resus (IV)
Antibiotics (IV)
Lactate (take VBG/ABG)
Oxygen

55
Q

What is shoulder dystocia?

A

Failure for the anterior shoulder to pass under the symphysis pubis after delivery of the foetal head

56
Q

Shoulder dystocia is an i_______ e______

A

intrapartum emergency
High risk of maternal morbidity and foetal mortality and morbidity.

57
Q

What are some risk factors for shoulder dystocia

A

Macrosomia (large baby)
Maternal DM (again, larger baby)
Previous shoulder dystocia
Post maturity
Prolonged 1st and 2nd stage of labour
Instrumental delivery

58
Q

What does HELPERRR stand for in shoulder dystocia?

A

Help (call for help)
Elevate for episiotomy
Legs into McRoberts
Pressure (suprapubic pressure)
Enter pelvis
Rotational manoeuvres
Remove posterior arm
Replace head and delivery by C-section if required

59
Q

What is an episiotomy?

A

vaginal wall cut to create more space

60
Q

What is the McRoberts position?

A

Legs flexed onto abdomen to rotate pelvis, align sacrum and open birth canal

61
Q

What are the maternal complications of shoulder dystocia?

A

PPH
3rd/4th degree tear
Pyschological distress

61
Q

What are the foetal complications of shoulder dystocia?

A

Hypoxia
Fits
Cerebral palsy
Injury to brachial plexus

62
Q

What is the definition of post-partum haemorrhage?

A

Blood loss of over 500mls following delivery

63
Q

How does Sytocinon work in PPH management?

A

Activation of receptors by oxytocin triggers release of calcium from intracellular stores, leading to myometrial contraction

64
Q
A

3a Obs and Gynae (3 decks)

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