Obs flashcards
What initially produces BHCG? What does this do?
Trophoblast -> maintains corpus luteum -> keeps secreting progesterone
What takes over progesterone secretion from corpus luteum? When?
Placenta - day 7-8
Most common cause of a miscarriage?
Chromosomal abnormality - sporadic not recurring
Management of a miscarriage
Medical
-Prostaglandin (mifepristone) good for incomplete miscarriage
Surgical
-Evacuation of retained produces of conception (ERPC) under anaesthetic via vacuum
Causes of recurrent miss carriage?
Antiphospholipid antibodies (will have anticardiolipin antibodies)
Chromosomal defects
Anatomical
-Uterine abnormalities -> more commonly with late miscarriages
Infection
Usual Hx / What might be found OE of ectopic
Lower abdo pain -> scanty, dark vaginal bleeding
-starts cockily -> constant
Cervical excitation
Tachycardia
How is a mole removed? Mx after?
Suction curettage
- > serial blood and HCG levels monitored
- > chemo if persistent trophoblastic disease
Complications of auxiliary surgery for breast Ca?
Lymphoedema
Which hormonal therapy for breast Ca can only be used in post menopausal women?
Aromatase inhibitors - Eg arimidex
[work in similar way to taxmoxifen]
4 types of breast surgery? When would you use each?
1- lumpectomy
- small tumour relative to breast
- not under nipple
- Can give pre op radiotherapy to shrink
2-Mastectomy
- large tumour / under nipple
- more than one Ca
- Can have reconstructive either immediate / delayed
3- Axillary
4- Reconstructive
- implants
- lat Dorsi flap / TRAM flap
- nipple reconstruction
When would you offer chemo fro breast?
Those with poor prognosis
When would you offer radiotherapy for breast ca?
Always after lumpectomy
- can be used to shrink ca
- can be used after mastectomy
3 types of benign breast lump
Noduality
-lumpy breasts
Fibroadenoma
-common in young
Small and motile
1/3 better, 1/3 same / 1/3 grow
Cyst
- 40-60 usually
- Aspirate
What pre conceptual care and cousilling can be offered
Cervical smear Rubella status - immunise Diabetes - control glucose Medication changes for pregnancy Folic acid Lifestyle
Fetal / maternal complications of gestational diabetes?
Fetal Macrosomia Pre term labour Birth trauma Congenital abnormalities - neural tube / CHD
Maternal
Hypertension / pre eclampsia
UTI
Worsening of. Pre existing IHD, retinopathy, neuropathy
Pregnancy CO and vascular resistance? What does the increased flow do?
40% in CO (stroke volume / HR)
50% decrease in systemic vascular resistance
Produces a ejection systolic murmur in 90% of women
L axis shift on ECG
Low risk cardiac lesions? High risk? Mx?
Low - ASD,VSD, mitral / aortic incompetence
High - Aortic stenosis, Pulm HTN, coarctation, prosthetic valves
Mx
MDT
Monitor fluid balance and fetal growth
->avoid Heart failure
What happens to asthma in pregnancy ?
Often get exacerbation in 3rd trimester
Hypo/hyperthyroidism in pregnancy?
Hypo - replacement with thyroxine
Hyper
Maternal risk - Thyroid crisis & cardiac failure
Fetal risk - Throtoxicosis due to thyroid stimulating autoantibodies (graves)
Mx - Propythiouracil
Post partum thyroiditis is common and increased if graves / DM
Maternal / fetal risks of epilepsy ?
Maternal - increased seizures
SUDEP - due to not taking meds
Fetal - Abnormalities from taking meds
- inheritance of epilepsy
- Hypoxia during maternal seizure
Preconception changes in epilepsy
Planned pregnancy
As few drugs as possible at lowest dose possible and avoid valproate
High dose folic acid
MDT management
Autoantibodies in antiphospholipid? Features? Mx?
Anticardiolipin
Thrombosis -> miscarriage
-IUGR
-pre-eclampsia
Aspirin and LMW heparin
VTE increases 6 fold during pregnancy due to increased clotting factors, reduced fibrinolytic activity and changes in blood flow.
Risk factors for VTE?
Conservative prophylaxis?
Maternal age
BMI
Operative delivery
Prothrombin conditions Eg antiphospholipid syndrome
Good hydration and mobilisation
[can use LMW heparin in high risk]
If the mother has developed rhesus isomminization, how do you detect fetal anaemia and manage?
Doppler assessment
Blood transfusion via umbilical vein
When is a baby low birth weight? Very low?
<2500g
<1500
Extremely <1000
Eg of 1/2/tertiary prevention of prematurity ?
1 population risk - STI, smoking
2 Assess cervical length at 20weeks via TVUS -> cervical clergage
Treat BV / polyhydroaminos
3 - Tocolysis, corticosteroids
When is a fetus small for dates ?
<10th centile for gestation
Physiological / maternal / placental / fetal causes for small for dates ?
Low maternal height / weight
Nulliparity
Disease eg renal
Maternal infection - TORCH
Smoking
Pre-eclampsia
Multiple pregnancy
Placenta previa / abruption
Chromosomal abnormalities
Infection - TORCH
Decrease in fetal movements indicates?
Late sign that the fetus is distressed
3 methods of fetal surveillance
Kick chart
US assessment of growth
-Head circumference, abdo circumference, liquor volume
Umbilical artery Doppler waveforms
Mx of small for dates fetus with absent end-diastolic flow
steroids (if <34wks) and Csecion if distress
Usual gestation for whether identical twins share a placenta or not
<3days - separate placentas and aminons
4-8 - Same placenta different amnions
Monitoring labour use?
Partogram
Fetal HR, colour of liquor, decent, maternal obs
When would you not give oxytocin in augmentation of slow labour?
Previous c section
Maternal / fetal consequences of prolonged labour?
Maternal
- uterine rupture, PPH, infections, perineal trauma
- dehydration / hypoglycaemia
Fetal (Hypos)
Hypoglycaemia, hypothermia, hypoxia
How many epidurals work
85-92%
Only method of analgesia that allows women to be pain free? Disadvantages? Major complications?
Epidural
Need increased midwife supervision
Loss of bladder sensation -> urinary retention -> detrussor damage
Major complications
Puncture of dura -> CSF leakage and headache
Anaesthetic into CSF -> total spinal analgesia and resp paralysis
CIs to epidural
Sepsis
Coagulopathy
Fetal distress
Antepartum haemorrhage
Level of injection for epidural / spinal
Between L4/5
