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Phase 3a Medicine > OBS AND GYNAE LECTURES > Flashcards

OBS AND GYNAE LECTURES Flashcards

1
Q

What is a normal birth:

A

One that is spontaneous in onset, low risk at the start of labour and remaining so throughout the labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy. After birth, both mother and infant are well.

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2
Q

What are the 3 stages of birth:

A

Latent
Effacement
Engagement

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3
Q

What is involved in the latent phase?

A
  • Consists of irregular contractions
    • The period lasts between 6 hours to 2-3 days.
    • The Cervix effaces in this period and thins. This shows a mucoid plug
    • In this phase women are told to stay at home: rest, keep hydrated and have paracetamol.
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4
Q

What is involved in the effacement phase?

A
  • This process starts in the fundus (pacemaker) and involves the retraction and shortening of the muscle fibres.
    • This builds an amplitude for labour
    • The foetus is eventually forced down and puts pressure on the cervix
    • After full effacement the cervix undergoes dilation originally at 5cm and eventually 10cm.
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5
Q

What is involved in engagement of the foetus?

A
  1. The head is mobile above the symphysis pubis
    1. The head accommodates a full width of fiver fingers above the symphysis pubis
    2. Head is 2/5 above symphysis pubis
      Head accommodates two fingers above the symphysis pubis
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6
Q

What is presentation?

A

Presentation: the anatomical part of the foetus that presents its self first through the birth canal. You want the head to flexed and at its narrowest par of the head.

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7
Q

What is a lie?

A

Lie: relationship between the long axis of the foetus and the long axis of the uterus

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8
Q

What is attitude?

A

Attitude: whether the baby is presenting as flexed or deflexed

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9
Q

What is engagement?

A

Engagement: widest part of the presenting part passed through the brim of the pelvis.

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10
Q

What is station?

A

Station: relationship between the lowest presenting part and the ischial spines.

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11
Q

What is active labour deemed as?

A

4cm dilation with regular frequent contractions

The process is progressive

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12
Q

What are 4 methods used for pain relief?

A
  • Psychological methods: - - Psychological methods: imagery, relaxation and hypnobirthing
    • Sensory methods: hydrotherapy and TENS
    • Birth environment
    • Complementary: massage, acupuncture and reflexology etc.
    • Water birth: reduces pain and the use of regional analgesia.
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13
Q

What are 3 commonly used medications in pregnancy?

A

Entonox
Opiates
Epidural

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14
Q

What are the 8 factors of mechanisms of labour

A

Mechanism of labour:

- Descent 
- Flexion 
- Internal rotation 
- Crowning 
- Extension 
- Reitution 
- Internal restitution of shoulders  - Lateral flexion
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15
Q

What is competency?

A

Legal term use to indicate that a person has the ability to make and be held accountable for their decision

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16
Q

What are some RF for developing HTN in pregnancy?

A
  • Young females
    • Black population
    • Multifetal pregnancy
    • Hypertension
    • Renal
  • Collagen Vascular diseas
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17
Q

When is it classed as gestational Hypertension

A

After 20 weeks

18
Q

When is it pre-eclampsia?

A

after 20 weeks

19
Q

What are 3 of the clinical test criteria for Pre-Eclampsia?

A
  • Imparied liver function tests
    • Thrombocytopenia <100,000
    • Intrauterine growth restriction
      Oligohydramnios
20
Q

What is the treatment of acute severe hypertension in pregnancy?

A
  • Systolic >160 mm Hg or diastolic >105 mm Hg
    • Parenteral hydralazine
      Oral nifedipine use with caution
21
Q

What are some tests for menorrhagia?

A

FBC
TV ultrasound
Endometrial biopsy if older than 45 yrs
Hysteroscopy

22
Q

What is climacteric?

A
  • Climacteric: years before menopause associated with menopause symptoms but still menstruating
23
Q

When in early pregnancy how do you measure the gestation of a baby?

A

foetal crown to rump.

24
Q

What is classed as a small for date baby?

A

Less than 2.5 kg

25
Q

What is classed as a large for date baby?

A

More than 5 kg

26
Q

What is the biggest cause of post natal death?

A

Being Premature i.e.

Being born before 37 weeks

27
Q

What are 4 consequences f being born prematurely?

A
  • Developmental Delay
    • Visual Impairment
    • Chronic Lung Disease
      Cerebral palsy
28
Q

What are some RF to being born early?

A
  • Previous Pre term Birth
  • Maternal Infection
  • Multiple Gestations
  • Race (higher in BME)
  • Smoker
  • Low age
  • Low SE
29
Q

What are some primary, secondary and tertiary prevention for pre-term babies?

A
  1. Primary prevention: reducing population risk, smoking and STD prevention, prevention of multiple pregnancies, planned pregnancy and physical/sexual activity advice.
    1. Secondary prevention: screening via transvaginal cervical ultrasound (to look at cervical length) and qualitative foetal fibronectin test. This allows screening of asymptomatic high risk women or manage to with a cervix <3cm

Tertiary prevention: treatment after diagnosis. Aim is to reduce morbidity and mortality. From having prompt diagnosis and referral, giving antibiotics and corticosteroids is necessary

30
Q

What two screening methods can you use on pre term labour?

A

TV cervical US

Fibronectin test

31
Q

What is the treatment for pre term delivery?

A

Progesterone injection

Pessary

32
Q

What does progesterone do to the endometrium and uterus?

A
  • Proliferation, Vascularisation and Differentiation of endometrium
    • Increases maternal ventilation
      Promotes glucose deposition in fat store
33
Q

What does failed endovascular invasion lead to?

A
  1. Pre-eclampsia
  2. Premature Birth
  3. Foetal Growth Restriction
  4. Placental Abruption
  5. Recurrent Miscarriage
34
Q

Why is a foetus not rejected by the host?

A

Syncitiotropblast
MHC-negative)

Does not induce any systemic maternal T- or B-cell response

35
Q

What is the balance of TH1 to TH2 in a non pregnant lady

What is it like in pregnancy?

What is it like in IUGR or pre-eclampsia

A

Balanced

TH2 bias

Balanced

36
Q

What antibody does breast milk include?

A

Ig A

37
Q

What is the principle nutrient for a foetus?

A

Glucose

38
Q

What are the post prandial glucose levels like in early pregnancy?

A

Early pregnancy – lower; maternal glycogen synthesis, fat deposition

39
Q

What are the post pradial plasma glucose levels like in late pregnancy

A

Late pregnancy – higher; maternal insulin resistance – glucose sparing for fetus?

40
Q

What can induce pregnancy? Decrease of what hormone?

A

Progesterone

41
Q

How does oxytocin induce pregancy?

A

By elevating Ca2+

Phase 3a Medicine (9 decks)

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