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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
Cardinal movement in normal labour 4 - expulsion
rest of foetus is delivered
26
Induction definition
interventions designed to initiate labor before spontaneous onset with a view to achieving vaginal delivery.
27
Augmentation definition
Enhancement of uterine contraction after the onset of labour eg. oxytosin
28
Absolute indication for induction
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
29
Relative indication for induction
Maternal indications Chronic hypertension Gestational hypertension Gestational diabetes Fetal indications Premature rupture of membranes Fetal demise Previous stillbirth Fetus with a major congenital anomaly
30
Augmentation indication
indicated for failure to progress in labor in the presence of inadequate contractions
31
Methods of augmentation
amniotomy and/or oxytocin. unclear whether interventions improve outcome or speed it up
32
What does the Bishops score assess
cervical readiness and the likelihood of a vaginal birth following induction
33
How to interpret Bishop score
over 8 for multiparous over 10 for nulliparous means ready for induction
34
What factors affect bishop score
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)
35
How are follicles developed and released
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
Zygote definition
cell formed when two gametes fuse during fertilization (diploid 46xx or 46xy)
37
Zygote development and time/location of implantation
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
What is apposition
Before implantation, the collection of cells surrounding the blastocyst disappears and the blastocyst adheres to the endometrium.
39
development at 24-26 days
bilaminar embryonic disc (ectoderm and endoderm
40
development at 31-32 days
cellular proliferation has caused midline thickening and a trilaminar embryonic disk (Ectoderm, mesoderm, and endoderm)
41
Ectoderm gives rise to
nervous system epidermis (derivatives = hair and eye lens)
42
Mesoderm gives rise to
skeleton muscles dermis vascular system urogenital system
43
endoderm gives rise to
GI tract (derivatives = Pancreas, liver, thyroid)
44
when does the embryonic period end
10 weeks gestation, 8 weeks post conception
45
Name 3 pregnancy hormones & their role during pregnancy
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
what hormone is measured in pregnancy tests
Human chorionic Gonadotropin (HCG) - 8-9 days post conception
47
where are progesterone and oestrogen produced during pregnancy
Placenta
48
what does progesterone do in pregnancy
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
what does oestrogen do during 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
50
What does Human Chorionic Gonadotropin (HCG) do during pregnancy
hCG: produced by the trophoblast, hCG prevents decline of corpus luteum, ensuring sufficient progesterone production until the placenta forms (8-10 weeks).
51
Screening definition
Screening is the process of identifying apparently healthy people who may have an increased chance of a disease or condition.
52
what is the name of the criteria for screening programs
Wilson Jungner screening criteria
53
what factors are considered in the Wilson Jungner criteria
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
What conditions of the fetus is antenatal screening is run for?
Sickle cell and Thalassemia Infectious diseases screening chromosome abnormality screening (trisomy 21, trisomy 13 and trisomy 18) Fetal anomaly scan
55
what tests are ran at a 12 week antenatal appointment on the mother
Blood pressure (HTN/Kidneys) Hight/Weight Urine (Kidneys) FBC - anaemia, platelets Blood group + rhesus antibodies HIV, Syphalis, Hepatitis B
56
what newborn screening programs are run
Newborn infant physical examination Newborn hearing screen Newborn blood spot
57
Syphilis in pregnancy
Can be transmitted transplacentally at any stage in pregnancy and may result in miscarriage, pre-term labour, stillbirth and congenital syphilis.
58
Combined test for chromosomal abnormality (when and what is measured)
Performed wetween 11 and 14 weeks consideres: Maternal age neural translucency PAPP-A HCG
59
what is considered high risk in chromosomal abnormality testing
1/150
60
What happens following high risk chromosomal abnormality detection
Offered non invasive prenatal testing (NIPT) provides a more accurate screening result if also positive - amniocentesis (diagnostic - 0.5% risk of miscarriage)
61
what is the purpose of the early pregnancy scan and when is it performed
Confirm viability singleton or multiple pregnancy Estimate gestational age Detect major structural anomalies 10-14 weeks
62
Quadruple test for chromosomal abnormalities measures what?
Alpha Feto Protein, total Beta HCG, Oestriol & Inhibin A
63
at what pregnancy stage is the combined test vs quadruple test (chromosomal abnormality) used
combined test - 1st trimester - more accurate Quadruple test - 2nd trimester
64
When are Ultrasound to screen for structural anomalies performed
between 18 weeks 20 weeks gestation
65
what does the newborn infant physical exam check for
eyes, heart, hips and testes
66
when is the newborn physical exam performed
first within 72 hours of birth and then at 6-8 weeks
67
Group B streptococcus in pregnancy Symptoms
Asymptomatic or UTI symptoms
68
Group B streptococcus in pregnancy effect on neonate
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
Group B Streptococcus in pregnancy treatment
Treatment. Intrapartum penicillin (vancomycin if allergic)
70
Urinary incontinence definition
involuntary leakage of urine sufficient in frequency to cause physical/emotional distress
71
stress incontinence causes
weak pelvic floor eg. childbirth/pregnancy/menopause damage to nerve structures
72
Mechanism of stress incontinence
during increased abdominal pressure, bladder pressure increases to exceed the urethral sphincter closure pressure and urine is expelled
73
stress incontinence investigation
urodynamic studies/ urine stress test
74
stress incontinence treatment (lifestyle, conservative and surgical)
Lifestyle: decrease caffeine/alcohol, assess medication and reduce BMI conservative: Kegel exercises/pessaries surgeries: tension free transvaginal tape/sub-urethral sling
75
urge incontinence mechanism
detrusor muscle overactivity
76
urge incontinence investigation
urodynamic studies
77
Conservative management of urge incontinence
bladder retraining - increase time between voiding over 6 weeks
78
medicinal management of urge incontinence (+side effects)
anticholinergic medication - oxybutynin/tolterodine dry eyes/mouth/constipation
79
surgical management of urge incontinence
botox injections into bladder wall sacral nerve stimulation
80
what components make up the APGAR score
Appearance Pulse Grimace Activity (tone) Respiration
81
What is a bad vs good appearance (APGAR)
Blue and cyanotic 0 blue peripheries 1 Pink 2
82
What is a bad vs good pulse (APGAR)
absent = 0 100 = 1 120+ = 2
83
What is a bad vs good Grimace (APGAR)
No response = 0 Weak cry =1 strong cry + pull away = 2
84
What is a bad vs good activity (Tone) (APGAR)
floppy and no tone =0 flexed arms/legs =1 active movement=2
85
What is a bad vs good respiration (APGAR)
absent =0 slow and irregular =1 cry+regular breaths =2
86
what is APGAR used for
to standardise assessment of new-born wellbeing
87
at which times after birth is APGAR performed
1 minute 5 minutes 10 minutes

3A Flashcards (9 decks)

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