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Sheff 3a > Obs flashcards > Flashcards

Obs flashcards

1
Q

What initially produces BHCG? What does this do?

A

Trophoblast -> maintains corpus luteum -> keeps secreting progesterone

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2
Q

What takes over progesterone secretion from corpus luteum? When?

A

Placenta - day 7-8

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3
Q

Most common cause of a miscarriage?

A

Chromosomal abnormality - sporadic not recurring

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4
Q

Management of a miscarriage

A

Medical
-Prostaglandin (mifepristone) good for incomplete miscarriage

Surgical
-Evacuation of retained produces of conception (ERPC) under anaesthetic via vacuum

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5
Q

Causes of recurrent miss carriage?

A

Antiphospholipid antibodies (will have anticardiolipin antibodies)

Chromosomal defects

Anatomical
-Uterine abnormalities -> more commonly with late miscarriages

Infection

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6
Q

Usual Hx / What might be found OE of ectopic

A

Lower abdo pain -> scanty, dark vaginal bleeding
-starts cockily -> constant

Cervical excitation
Tachycardia

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7
Q

How is a mole removed? Mx after?

A

Suction curettage

  • > serial blood and HCG levels monitored
  • > chemo if persistent trophoblastic disease
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8
Q

Complications of auxiliary surgery for breast Ca?

A

Lymphoedema

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9
Q

Which hormonal therapy for breast Ca can only be used in post menopausal women?

A

Aromatase inhibitors - Eg arimidex

[work in similar way to taxmoxifen]

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10
Q

4 types of breast surgery? When would you use each?

A

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
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11
Q

When would you offer chemo fro breast?

A

Those with poor prognosis

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12
Q

When would you offer radiotherapy for breast ca?

A

Always after lumpectomy

  • can be used to shrink ca
  • can be used after mastectomy
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13
Q

3 types of benign breast lump

A

Noduality
-lumpy breasts

Fibroadenoma
-common in young
Small and motile
1/3 better, 1/3 same / 1/3 grow

Cyst

  • 40-60 usually
  • Aspirate
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14
Q

What pre conceptual care and cousilling can be offered

A 
Cervical smear 
Rubella status - immunise 
Diabetes - control glucose 
Medication changes for pregnancy 
Folic acid 
Lifestyle
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15
Q

Fetal / maternal complications of gestational diabetes?

A 
Fetal 
Macrosomia 
Pre term labour 
Birth trauma 
Congenital abnormalities - neural tube / CHD

Maternal
Hypertension / pre eclampsia
UTI
Worsening of. Pre existing IHD, retinopathy, neuropathy

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16
Q

Pregnancy CO and vascular resistance? What does the increased flow do?

A

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

17
Q

Low risk cardiac lesions? High risk? Mx?

A

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

18
Q

What happens to asthma in pregnancy ?

A

Often get exacerbation in 3rd trimester

19
Q

Hypo/hyperthyroidism in pregnancy?

A

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

20
Q

Maternal / fetal risks of epilepsy ?

A

Maternal - increased seizures
SUDEP - due to not taking meds

Fetal - Abnormalities from taking meds

  • inheritance of epilepsy
  • Hypoxia during maternal seizure
21
Q

Preconception changes in epilepsy

A

Planned pregnancy
As few drugs as possible at lowest dose possible and avoid valproate
High dose folic acid
MDT management

22
Q

Autoantibodies in antiphospholipid? Features? Mx?

A

Anticardiolipin
Thrombosis -> miscarriage
-IUGR
-pre-eclampsia

Aspirin and LMW heparin

23
Q

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?

A

Maternal age
BMI
Operative delivery
Prothrombin conditions Eg antiphospholipid syndrome

Good hydration and mobilisation
[can use LMW heparin in high risk]

24
Q

If the mother has developed rhesus isomminization, how do you detect fetal anaemia and manage?

A

Doppler assessment

Blood transfusion via umbilical vein

25
Q

When is a baby low birth weight? Very low?

A

<2500g
<1500
Extremely <1000

26
Q

Eg of 1/2/tertiary prevention of prematurity ?

A

1 population risk - STI, smoking

2 Assess cervical length at 20weeks via TVUS -> cervical clergage
Treat BV / polyhydroaminos

3 - Tocolysis, corticosteroids

27
Q

When is a fetus small for dates ?

A

<10th centile for gestation

28
Q

Physiological / maternal / placental / fetal causes for small for dates ?

A

Low maternal height / weight
Nulliparity

Disease eg renal
Maternal infection - TORCH
Smoking

Pre-eclampsia
Multiple pregnancy
Placenta previa / abruption

Chromosomal abnormalities
Infection - TORCH

29
Q

Decrease in fetal movements indicates?

A

Late sign that the fetus is distressed

30
Q

3 methods of fetal surveillance

A

Kick chart

US assessment of growth
-Head circumference, abdo circumference, liquor volume

Umbilical artery Doppler waveforms

31
Q

Mx of small for dates fetus with absent end-diastolic flow

A

steroids (if <34wks) and Csecion if distress

32
Q

Usual gestation for whether identical twins share a placenta or not

A

<3days - separate placentas and aminons

4-8 - Same placenta different amnions

33
Q

Monitoring labour use?

A

Partogram

Fetal HR, colour of liquor, decent, maternal obs

34
Q

When would you not give oxytocin in augmentation of slow labour?

A

Previous c section

35
Q

Maternal / fetal consequences of prolonged labour?

A

Maternal

  • uterine rupture, PPH, infections, perineal trauma
  • dehydration / hypoglycaemia

Fetal (Hypos)
Hypoglycaemia, hypothermia, hypoxia

36
Q

How many epidurals work

A

85-92%

37
Q

Only method of analgesia that allows women to be pain free? Disadvantages? Major complications?

A

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

38
Q

CIs to epidural

A

Sepsis
Coagulopathy
Fetal distress
Antepartum haemorrhage

39
Q

Level of injection for epidural / spinal

A

Between L4/5

Sheff 3a (30 decks)

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