Obs + Gynae Flashcards
Components of Triple test?
Beta-hCG, AFP, unconjucated oestradiol
Components of combined test?
Nuchal tranluscency
PAPP-A
AFP
Window for combined test?
10-13w.
Components of quadruple test?
AFP, unconjugated oestradiol (UE3), beta-hCG, Inhibin A
Difference in false results in quadruple test v combined test?
Quadruple test: 4.4% false positive
Combined test: 2.2% false positive
What should be offered to mothers BMI>30 at booking?
Preconception advice: 5mg folic acid
Vitamin D 10mg OD
Postnatal LMWH for 7d (+ antenatal LMWH if moderate risk)
Screening for diabetes (OGTT)
Active management of 3rd stage of labour
Aspirin after 12w if moderate risk of pre-eclampsia
Glucose tolerance test abnormal result
2h plasma glucose 7.8mmol/l or above = diagnosis of GDM
Booking bloods for infection?
Syphilis, HIV, Hep B, rubella.
What is placental adhesion to uterine wall without extension though full myometrium?
Placenta accreta
What is placental adhesion through full myometrium, but not beyond?
Placenta increased
What is placentation fully through myometrium and into surrounding structures?
Placenta percreta
Causes of postpartum haemorrhage
Tone
Trauma
Tissues (e.g. Placenta not fully out)
Thrombin
What is asherman’s syndrome?
Placentation into site of uterine scar
Worrying causes of PV bleeding in pregnancy (to rule out):
Placenta praevia
Vasa praevia
Abruption
how to distinguish placenta praevia v abruption v vasa praevia?
Placenta praevia: painless PV bleeding.
Abruption: tender, woody uterus
Vasa praevia: rare. Use apt test on PV blood.
Management of known placenta praevia + small PV bleed. 30w
Assess foetal condition: CTG, movements Assess maternal condition: BP, HR, etc. Small bleeds can precede big bleeds Do USS to assess placental location IV access, group + save (2-4 units). Steroids if bleed again.
Management of 37w with PV bleed
Assess foetal + maternal stability
If stable: ?double set up exam - is there placenta praevia
If so: C-section
If not: rule out local causes and then manage as abruption.
Causes of oligohydramnios?
Increased absorption/loss of fluid: premature rupture of membranes.
Decreased production:
-congenital renal anomalies/ACEi exposure
-uteroplacental insufficiency: abruption, pre-eclampsia, post-mature
-others: congenital infection, Neural tube defects, TTTS, NSAIDs
Causes of polyhydramnios?
Idiopathic (50-60%)
Maternal: isoimmunisation (immune hydrops), diabetes mellitus
Foetal 10-15%: non-immune hydrops; multifoetal gestation; structural anomalies (foetal DI, GI obstruct, defective swallowing)
Placental: placental chorioangioma (rare)
Outcome of oligohydramnios?
Increased perinatal morbidity and mortality at any gestation.
Complications: amniotic band syndrome; MSK deformities (club foot)
Outcomes of polyhydramnios?
Increased maternal morbidity, increased perinatal morbidity and mortality.
Complications: maternal SOB/refractory oedema in legs/vulva. Foetal malpresentation, dysfunctional labour, PPH.
How to measure amniotic fluid volume?
(Fundal height)
Maximal vertical pocket: single deepest pocket free of umbilical cord
Amniotic fluid index: sum of MVPs in 4 quadrants of uterus. Normal AFP >20w: 5-20cm
Roles of amniotic fluid
Shock absorption
Protect cord from compression
Allow unrestricted foetal movement (MSK development)
Lung development
Lubricate foetal skin
Prevent maternal chorioamnionitis + foetal infection
Help foetal temperature regulation
What produces amniotic fluid?
Transudation in <8w (across amnion and foetal skin)
Urination of foetus (near term ~1l)
Foetal lungs (but mostly swallowed)
What absorbs amniotic fluid?
Transudation <8w
Swallow >8w. 500-1000ml pd at term
Absorption through foetal membranes (smaller)
Some cross amnion -> maternal blood.
Complications of diabetes in pregnancy
SMASH Stillbirth Macrosomia Amniotic fluid overload Shoulder dystocia Hypertension
Effect of maternal hypothyroidism in pregnancy? Management?
Early diagnosis to avoid IUGR and cretinism. Levothyroxine 100-150microg OD. Monitor every 4w
Effect of maternal hyperthyroidism in pregnancy?
Preterm delivery, IUGR
If due to Graves’s disease: IgG TSH can cross placenta to foetus.
Regular foetal testing after 32w. E.g. Tachycardia
Management for hyperthyroidism in pregnancy?
Propylthiouracil (PTU). Blocks release of hormone from thryoid gland. (Takes 3-4w to effect)
Carbamizole is AVOIDED (block peripheral conversion) + risk of aplasia cutis congenita
Causes of menorrhagia
Pregnancy + dysfunctional uterine bleeding Fibroids Pelvic infection Polyps Endometriosis Hypothyroidism Blood dyscrasias e.g. VWD.
Treatment of menorrhagia?
- Mirena
- Antifibrinolytics/anti-PGs
- Progestagens/nor-esphisterone.
What is the triple assessment in breast disease?
History and examination
Diagnostic imagining by mammography +/- USS
Cytology or histology.
Likely differentials of a painless breast lump:
Carcinoma
Cyst
Fibroadenoma
Fibroadenosis
