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Dan's Copy > Obs & Gynae Peer Teaching > Flashcards

Obs & Gynae Peer Teaching Flashcards

1
Q

Describe the cardiovascular system changes seen in pregnancy

A
  • Increased plasma volume, cardiac output, stroke volume, heart rate
  • Decreased serum albumin concentration + serum colloid osmotic pressure
  • Increased coagulation factors and fibrinogen
  • Compression of the Inferior Vena Cava by the uterus
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2
Q

Describe the changes seen in the kidneys during pregnancy.

A
  • Increases in renal blood flow + glomerular filtration rate
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3
Q

Describe the changes seen in the liver during pregnancy.

A

Changes in Oxidative liver enzymes, such as cytochrome P450

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4
Q

Describe the changes seen in the lungs in pregnancy.

A
  • Increase in tidal volume and minute ventilation
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5
Q

Describe the changes seen in the stomach and intestines during pregnancy.

A
  • Nausea and vomiting
  • Delayed gastric emptying
  • Prolonged small bowel transit time
  • Gastrointestinal reflux
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6
Q

List some causes of an Antepartum Haemorrhage.

A
  • Placental Abruption
  • Placenta Praaevia

Rare:

  • vasa praevia
  • uterine rupture
  • 50% = unknown
  • Consider domestic violence
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7
Q

Describe the presentation of a woman with placental abruption.

A
  • Painful bleeding
  • PV loss doesn’t correlate with severity (can be concealed)
  • Patients may be in shock with a tender, firm uterus (‘woody hard’)
  • Labour may ensue
  • Foetal distress
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8
Q

Describe the presentation of a woman with placenta praevia.

A
  • Painless bleeds (increasing severity and frequency)
  • Foetus is often breech/transverse
  • NEVER do a Vaginal Examination
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9
Q

What investigations should you order for a ?Placental abruption / ?Placenta praevia?

A
  • FBC, U+E, Clotting, Group + Save
  • USS
  • CTG
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10
Q

Describe the Management of a patient with ?Placental abruption / ?placenta praevia.

A
  • Admit (until delivery if praevia)
  • Resuscitation
  • Steroids
  • Anti-D (if Rhesus negative_
  • C-section
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11
Q

Define ‘placenta accreta’.

A

Placental villi are attached to the myometrium.

Normal = attached to decidua basalis

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12
Q

Define ‘placenta increta’.

A

Placental villi invaded into >50% of the myometrium.

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13
Q

Define ‘placenta percreta’.

A

Placental villi pass through the whole myometrium up to the serosa, potentially involving other viscera (bladder or bowel).

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14
Q

List some risk factors for placenta accreta.

A
  • Uterine surgery (eg. C-section or Myomectomy)

- Repeated surgical termination of pregnancy

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15
Q

What is ‘Vasa praevia’?

A

Occurs when fetal vessels run in membranes below the presenting fetal part, unsupported by placental tissue or umbilical cord.

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16
Q

How might vasa praevia present?

A
  • PV bleeding after rupture of fetal membranes follow by rapid fetal distress (from exsanguination).
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17
Q

List some risk factors for Vasa Praevia.

A
  • Low-lying placenta
  • Multiple pregnancy
  • IVF pregnancy
  • Bilobed placenta
18
Q

List some gynaecological causes of an Antepartum Haemorrhage.

A
  • Cervical polyps

- Cervical cancer

19
Q

Describe a ‘threatened’ miscarriage.

A
  • Painless bleeding before 24 weeks
  • Cervical os = Closed
  • Sonography
  • Consider Anti-D for RhD -ve women after 12 weeks.
  • Affects 1 in 4 pregnancies.
20
Q

Describe a ‘missed’ or ‘delayed’ miscarriage.

A
  • Dead foetus / empty uterus before 20 weeks
  • Cervical os is closed
  • Can be bleeding, but usually without symptoms.
21
Q

What is the treatment for a ‘missed’ / ‘delayed’ miscarriage?

A
  • Pain relief
  • Anti-emetics
  • Vaginal misoprostol
22
Q

Describe an ‘inevitable’ miscarriage.

A
  • Heavy bleeding with clots and pain

- Cervical os is open

23
Q

Describe an ‘incomplete’ miscarriage.

A
  • Not all products of conception have been expelled
  • Pain + vaginal bleeding
  • Cervical os is open
24
Q

Describe the 3 ways in which an incomplete miscarriage could be managed.

A
  • Expectant
  • Medical
  • Surgical
25
Q

Describe ‘Expectant’ management of an incomplete miscarriage.

A
  • Repeat pregnancy test in a week
26
Q

Describe ‘Medical’ management of an incomplete miscarriage.

A
  • Vaginal Misoprostol
  • Pain relief
  • Anti-emetics
27
Q

Describe ‘Surgical’ management of an incomplete miscarriage.

A
  • Vacuum aspiration
    (under general anaesthetic)
  • Anti-D
28
Q

Describe Stage 1 of Labour.

A
  • From onset until cervix is fully dilated
  • Latent phase: 0-3cm dilation
  • Active phase: 3-10cm, at 1cm/hour
29
Q

What interventions might be offered during Stage 1 of labour?

A
  • Membrane sweep (done in the community)
  • Prostaglandin pessary (done as an inpatient)
  • Amniotomy (not routine)
  • Oxytocin (offered for delayed 1st stage)
30
Q

Describe Stage 2 of Labour.

A
  • From full dilation to delivery of the foetus

- Lasts approx 1 hour.

31
Q

If Stage 2 of Labour is delayed, what interventions can be offered?

A
  • Ventouse
  • Forceps
  • C-section
32
Q

What are the options for presentation of the foetus?

A
  • Brow presentation
  • Face presentation
  • Compound / shoulder presentation
  • Transverse lie
  • OP / OT position
33
Q

Which conditions are absolute contraindications to VBAC (Vaginal Birth after Caesarean)?

A
  • Placenta praevia
  • Vasa praevia
  • Cephalopelvic disproportion
34
Q

What should you do if a patient has shoulder dystocia?

A
  • McRoberts -> spread legs + push
  • Internal manœuvres (Wood screw + Zavanelli)
  • Surgical rescue: Clavicular fracture, Symphysiotomy, hysterotomy
35
Q

What position should a patient be in if they have a cord prolapse?

A
  • On all fours
  • Push foetus up
  • C-section ASAP
36
Q

Describe Stage 3 of Labour.

A
  • From delivery of foetus to delivery of the placenta
37
Q

Describe Active management of stage 3 of labour.

A
  • Oxytocin
  • Cord clamping after 1 minute
  • Cord traction
38
Q

Describe Physiological management of Stage 3 of Labour.

A
  • Clamp cord after pulsation stops
39
Q

When is Stage 3 of Labour considered to be ‘prolonged’?

A
  • If it lasts over 30 minutes with active management
  • If it lasts over 60 minutes with physiological management
  • > VE with analgesia -> ?manual removal
40
Q

Define ‘Post Partum Haemorrhage’.

A

> 500ml blood loss (1000ml for C-section)

  • Primary: within the first 24 hours
  • Secondary: 24hrs - 6 wees post partum
41
Q

What the the causes of a Primary PPH?

A
  • Tissue
  • Tone (Oxytocin reduces incidence)
  • Trauma
  • Thrombin

Rare:

  • Cervical tear
  • High vaginal tear
  • Uterine rupture
42
Q

Describe the management of a Post partum haemorrhage.

A
  • ABCDE!
  • Removal of placenta if retained
  • If uterine atony -> PGF2a into the myometrium
  • Rescue methods:
    > Rusch balloon
    > Brace suture
    > Hysterectomy

Dan's Copy (19 decks)

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