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3A Flashcards > Obs+Gynae > Flashcards

Obs+Gynae Flashcards

1
Q

Physiological cardiac changes in pregnancy

A

increased cardiac output and volume
Decreased albumin
Increased coagulation
Compressions of Inferior vena cava

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2
Q

Physiological GI changes in pregnancy

A

Nausea and vomiting
Reflux
Delayed gastric emptying
Prolonged small bowel transit time

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3
Q

Describe a ‘normal’ pregnancy. What are the parameters for 1st, 2nd and 3rd trimesters?

A

A normal pregnancy lasts for 40 weeks following LMP.

1st: LMP - 12 weeks gestation
2nd: 13 weeks - 27 weeks gestation
3rd: 28 weeks to partuition

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4
Q

What is ‘Gravidity’?

A

The number of pregnancies a woman has had, to any stage.

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5
Q

What is ‘Parity’?

A

The number of offspring that a woman has delivered beyond week 28.

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6
Q

What are the reasons for urinary frequency in pregnancy?

A

Enlarged uterus puts pressure on bladder
- Increased GFR

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7
Q

What are the reasons for constipation in pregnancy?

A

Decreased gastric motility
- Pressure on the GIT from a growing uterus

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8
Q

Describe the changes in blood pressure seen with pregnancy.

A

BP may fall during the 2nd trimester
- BP recovers to ‘normal’ levels by the 3rd trimester.

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9
Q

What changes in the legs might be seen in a pregnant woman?

A

Varicose veins

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10
Q

What changes in the skin might be seen in a pregnant woman?

A

Abdominal stretch marks - these may become highly pigmented.

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11
Q

What changes to the breast occur in pregnancy

A

Breast and nipple enlargement

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12
Q

what changes occur in the Liver and Kidneys

A

changes in oxidative enzymes (cytochrome p45 - drug metabolism)
increased blood flow/GFR

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13
Q

Describe the physiological changes during pregnancy.

A

Blood volume increases: RBC, WBC & platelets increase; Albumin, Urea & Creatinine decrease
Increased Cardiac Output
Increased tidal volume
Increased skin pigmentation
Breast & nipple enlargement
Increased GFR
Water retention
Increased temperature
Decreased gut motility

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14
Q

Give a definition of ‘normal labour’.

A

Spontaneous in onset, with absence of risk-associated features throughout.
The infant is born in the vertex position between 37 - 42 weeks gestation.
After birth, the mother and baby are in good condition,.

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15
Q

When might labour be considered to be ‘not normal’?

A

Labour is not normal if:

Induced
Forceps, Ventouse, or C-section is used
Spinal, epidural or GA is required
Episiotomy is required

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16
Q

What are the stages of labour?

A

Stage 1: Lasts 8 - 24 hours
(includes Latent phase; then Established phase)

Stage 2:
(includes passive stage; then active stage)

Stage 3: Delivery of the placenta. Should take place within one hour of delivery.

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17
Q

Describe ‘Stage 1’ of ‘Normal’ Labour

A

Lasts 8 - 24 hours (usually quicker in multiparous women)
i) Latent phase
Irregular contractions
Cervical thinning and effacing
Show of mucoid plug
ii) Established phase
- Contractions become regular
- Cervix is dilated more than 4cm (and should continue to dilate at 0.5cm/hour)

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18
Q

Describe ‘Stage 2’ of ‘Normal’ Labour

A

i) Passive stage
Cervix is completely dilated (10cm) but the mother has no active desire to push.

ii) Active stage
- Baby’s head can be seen
- Expulsive contractions with maternal effort

The 2nd stage ends following delivery of the baby, which should be within 3 hours for primiparous women or 2 hours for multiparous women.

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19
Q

Describe ‘Stage 3’ of ‘Normal’ Labour.

A

Delivery of the placenta.

This should take place within one hour of delivery.

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20
Q

What features indicted a woman is in Labour

A

regular uterine contractions increasing in frequency and intensity accompanied by cervical dilation

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21
Q

What does normal Labour require (3P’s)

A

Power - sufficient uterine activity
Passenger - correct foetal sixe and position (head flexion)
Passage - correct pelvis shape to facilitate rotation

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22
Q

Cardinal Movements in normal labour 1 - Engagement and descent

A

presenting part travels downwards, engagement is the passage of the widest head diameter through pelvic inlet

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23
Q

Cardinal Movements in normal labour 2 - flexion and internal rotation

A

foetal head pressed into chest and foetus rotates from lateral to anterior-posterior position

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24
Q

Cardinal Movements in normal labour 3 - extension and external rotation

A

foetal head is delivered due to upwards curve of birth canal, head rotates to normal position in relation to torso

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25
Q

Cardinal movement in normal labour 4 - expulsion

A

rest of foetus is delivered

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26
Q

Induction definition

A

interventions designed to initiate labor before spontaneous onset with a view to achieving vaginal delivery.

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27
Q

Augmentation definition

A

Enhancement of uterine contraction after the onset of labour eg. oxytosin

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28
Q

Absolute indication for induction

A

Maternal indications
Pre-eclampsia/eclampsia
Diabetes mellitus
Chronic renal disease
Chronic pulmonary disease

Fetal indications
Chorioamnionitis (infection of amniotic fluid)
Abnormal antepartum testing
Intrauterine growth restriction
Post-term pregnancy (>42 weeks)

Uteroplacental indications
Placental abruption

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29
Q

Relative indication for induction

A

Maternal indications
Chronic hypertension
Gestational hypertension
Gestational diabetes

Fetal indications
Premature rupture of membranes
Fetal demise
Previous stillbirth
Fetus with a major congenital anomaly

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30
Q

Augmentation indication

A

indicated for failure to progress in
labor in the presence of inadequate contractions

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31
Q

Methods of augmentation

A

amniotomy and/or oxytocin. unclear whether interventions improve outcome or speed it up

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32
Q

What does the Bishops score assess

A

cervical readiness and the likelihood of a vaginal birth following induction

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33
Q

How to interpret Bishop score

A

over 8 for multiparous
over 10 for nulliparous
means ready for induction

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34
Q

What factors affect bishop score

A

Dilation - 5-6 cm ideal
effacement - level of cervical thinning
station - Level baby has descended
Consistency - firm vs soft (soft good)
Position - Posterior vs anterior (anterior good)

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35
Q

How are follicles developed and released

A

Females are born with primary diploid (46xx) oocytes suspended in prophase 1. Following activation (after puberty) by FSH around 20 secondary haploid (23x) oocytes are formed from meiosis. A dominant oocyte is selected and LH causes it to be released into the abdominal cavity

36
Q

Zygote definition

A

cell formed when two gametes fuse during fertilization (diploid 46xx or 46xy)

37
Q

Zygote development and time/location of implantation

A

mitosis divisions cause development into blastomeres, which develops a fluid filled cavity and becomes a blastocyst (3-4 days)
Implantation occurs to posterior wall (commonly) (after 10 -11 days post conception)

38
Q

What is apposition

A

Before implantation, the collection of cells surrounding the blastocyst disappears and the blastocyst
adheres to the endometrium.

39
Q

development at 24-26 days

A

bilaminar embryonic disc (ectoderm and endoderm

40
Q

development at 31-32 days

A

cellular proliferation has caused midline thickening and a trilaminar embryonic disk (Ectoderm, mesoderm, and endoderm)

41
Q

Ectoderm gives rise to

A

nervous system
epidermis (derivatives = hair and eye lens)

42
Q

Mesoderm gives rise to

A

skeleton
muscles
dermis
vascular system
urogenital system

43
Q

endoderm gives rise to

A

GI tract (derivatives = Pancreas, liver, thyroid)

44
Q

when does the embryonic period end

A

10 weeks gestation, 8 weeks post conception

45
Q

Name 3 pregnancy hormones & their role during pregnancy

A

Progesterone: prepares the endometrium (vascularisation etc), stops contractions.
increases maternal ventilation
promotes glucose deposition in fat stores.
inhibition of progesterone with Mifepristone will terminate pregnancy.

Oestrogen: E3 (Oestradiol) = main oestrogen in pregnancy. Derived from the ovary initially, then foetus -> it is a measure of fetal wellbeing.
- promotes changes in the cardiovascular system.
-readies uterus for labour

hCG: produced by the trophoblast, hCG prevents decline of corpus luteum, ensuring sufficient progesterone production until the placenta forms (8-10 weeks).

46
Q

what hormone is measured in pregnancy tests

A

Human chorionic Gonadotropin (HCG) - 8-9 days post conception

47
Q

where are progesterone and oestrogen produced during pregnancy

A

Placenta

48
Q

what does progesterone do in pregnancy

A

Progesterone: prepares the endometrium (vascularisation etc), stops contractions.
increases maternal ventilation
promotes glucose deposition in fat stores.
inhibition of progesterone with Mifepristone will terminate pregnancy.

49
Q

what does oestrogen do during pregnancy

A

Oestrogen: E3 (Oestradiol) = main oestrogen in pregnancy. Derived from the ovary initially, then foetus -> it is a measure of fetal wellbeing.
- promotes changes in the cardiovascular system.
-readies uterus for labour

50
Q

What does Human Chorionic Gonadotropin (HCG) do during pregnancy

A

hCG: produced by the trophoblast, hCG prevents decline of corpus luteum, ensuring sufficient progesterone production until the placenta forms (8-10 weeks).

51
Q

Screening definition

A

Screening is the process of identifying apparently healthy people who may have an increased chance of a disease or condition.

52
Q

what is the name of the criteria for screening programs

A

Wilson Jungner screening criteria

53
Q

what factors are considered in the Wilson Jungner criteria

A

The condition - should be an important health problem (severity/frequency)which is well understood

The test – simple, safe, precise screening test which is acceptable to the target population

The intervention – effective intervention with evidence of better outcomes

The screening programme – is clinically ethically acceptable and reduces morbidity and mortality

54
Q

What conditions of the fetus is antenatal screening is run for?

A

Sickle cell and Thalassemia
Infectious diseases screening
chromosome abnormality screening (trisomy 21, trisomy 13 and trisomy 18)
Fetal anomaly scan

55
Q

what tests are ran at a 12 week antenatal appointment on the mother

A

Blood pressure (HTN/Kidneys)
Hight/Weight
Urine (Kidneys)

FBC - anaemia, platelets
Blood group + rhesus antibodies
HIV, Syphalis, Hepatitis B

56
Q

what newborn screening programs are run

A

Newborn infant physical examination
Newborn hearing screen
Newborn blood spot

57
Q

Syphilis in pregnancy

A

Can be transmitted transplacentally at any stage in pregnancy and may result in miscarriage, pre-term labour, stillbirth and congenital syphilis.

58
Q

Combined test for chromosomal abnormality (when and what is measured)

A

Performed wetween 11 and 14 weeks
consideres:
Maternal age
neural translucency
PAPP-A
HCG

59
Q

what is considered high risk in chromosomal abnormality testing

A

1/150

60
Q

What happens following high risk chromosomal abnormality detection

A

Offered non invasive prenatal testing (NIPT)
provides a more accurate screening result

if also positive - amniocentesis (diagnostic - 0.5% risk of miscarriage)

61
Q

what is the purpose of the early pregnancy scan and when is it performed

A

Confirm viability
singleton or multiple pregnancy
Estimate gestational age
Detect major structural anomalies

10-14 weeks

62
Q

Quadruple test for chromosomal abnormalities measures what?

A

Alpha Feto Protein, total Beta HCG, Oestriol & Inhibin A

63
Q

at what pregnancy stage is the combined test vs quadruple test (chromosomal abnormality) used

A

combined test - 1st trimester - more accurate

Quadruple test - 2nd trimester

64
Q

When are Ultrasound to screen for structural anomalies performed

A

between 18 weeks 20 weeks gestation

65
Q

what does the newborn infant physical exam check for

A

eyes, heart, hips and testes

66
Q

when is the newborn physical exam performed

A

first within 72 hours of birth and then at 6-8 weeks

67
Q

Group B streptococcus in pregnancy Symptoms

A

Asymptomatic or UTI symptoms

68
Q

Group B streptococcus in pregnancy effect on neonate

A

Early onset - (80%) transmitted in labour

Signs of serious infection (respiratory
distress, septic shock) The mortality rate is 25%

2 Late-onset - community-acquired.

Presents as meningitis. Lower mortality rate

69
Q

Group B Streptococcus in pregnancy treatment

A

Treatment. Intrapartum penicillin (vancomycin if allergic)

70
Q

Urinary incontinence definition

A

involuntary leakage of urine sufficient in frequency to cause physical/emotional distress

71
Q

stress incontinence causes

A

weak pelvic floor eg. childbirth/pregnancy/menopause

damage to nerve structures

72
Q

Mechanism of stress incontinence

A

during increased abdominal pressure, bladder pressure increases to exceed the urethral sphincter closure pressure and urine is expelled

73
Q

stress incontinence investigation

A

urodynamic studies/ urine stress test

74
Q

stress incontinence treatment (lifestyle, conservative and surgical)

A

Lifestyle: decrease caffeine/alcohol, assess medication and reduce BMI

conservative: Kegel exercises/pessaries
surgeries: tension free transvaginal tape/sub-urethral sling

75
Q

urge incontinence mechanism

A

detrusor muscle overactivity

76
Q

urge incontinence investigation

A

urodynamic studies

77
Q

Conservative management of urge incontinence

A

bladder retraining - increase time between voiding over 6 weeks

78
Q

medicinal management of urge incontinence (+side effects)

A

anticholinergic medication - oxybutynin/tolterodine

dry eyes/mouth/constipation

79
Q

surgical management of urge incontinence

A

botox injections into bladder wall
sacral nerve stimulation

80
Q

what components make up the APGAR score

A

Appearance
Pulse
Grimace
Activity (tone)
Respiration

81
Q

What is a bad vs good appearance (APGAR)

A

Blue and cyanotic 0
blue peripheries 1
Pink 2

82
Q

What is a bad vs good pulse (APGAR)

A

absent = 0
100 = 1
120+ = 2

83
Q

What is a bad vs good Grimace (APGAR)

A

No response = 0
Weak cry =1
strong cry + pull away = 2

84
Q

What is a bad vs good activity (Tone) (APGAR)

A

floppy and no tone =0
flexed arms/legs =1
active movement=2

85
Q

What is a bad vs good respiration (APGAR)

A

absent =0
slow and irregular =1
cry+regular breaths =2

86
Q

what is APGAR used for

A

to standardise assessment of new-born wellbeing

87
Q

at which times after birth is APGAR performed

A

1 minute
5 minutes
10 minutes

3A Flashcards (9 decks)

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