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3ayeeeee > Obs notes > Flashcards

Obs notes Flashcards

1
Q

At what week does the heart start to beat ?

A
  • Week 6
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2
Q

What are the 3 layers of the fetal pole ?

A
  • Ectoderm
  • Mesoderm
  • Endoderm
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3
Q

What parts of the body come from the endoderm

A
  • GI tract
  • Lungs
  • Liver
  • Pancreas
  • Thyroid
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4
Q

What parts of the body come from the mesoderm

A
  • Heart
  • Muscle
  • Bone
  • Connective tissue
  • Blood
  • Kidneys
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5
Q

What part of the body comes from the ectoderm

A
  • Skin
  • Hair
  • Nails
  • Teeth
  • CNS
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6
Q

What produces hCG

A
  • Syncytiotrophoblasts
  • This maintains the corpus luteum in the ovary allowing it to continue to continue to produce progesterone and oestrogen
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7
Q

Ovulation occurs following a surge of what hormone ?

A
  • LH surge from the pituitary causing the smooth muscle of the theca externa to squeeze the follicle to burst
  • Follicular cells also release digestive enzymes that puncture a hole in the wall of the ovary allowing the ovum to pass through
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8
Q

What is the function of the placenta ?

A
  • The only source of oxygen for the fetus
  • Fetal haemoglobin has a higher affinity for oxygen than adult and this oxygen transfers from one to the other across the placental membrane
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9
Q

What is the role of hCG

A
  • Helps maintain the corpus luteum until the placenta can take over the production of oestrogen and progesterone
  • hCG can cause symptoms of nausea and vomiting
  • Levels increase in early pregnancy and plateau around 10 weeks
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10
Q

What is the role of oestrogen in pregnancy ?

A
  • The placenta produces oestrogen which helps soften the tissues and make them more flexible
  • Allows the muscles and ligaments of the uterus and pelvis to expand and the cervix to become soft and ready for birth
  • (Also enlarges the breasts and prepares them for breastfeeding)
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11
Q

What is the role of progesterone in pregnancy ?

A
  • The placenta takes over production of progesterone by 5 weeks
  • The role of progesterone is to maintain pregnancy
  • It relaxes the uterine muscles (preventing contraction and labour) and maintains the endometrium
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12
Q

What are side effects of progesterone in pregnancy ?

A
  • Causes relaxing of other muscles too
  • Lower oesophageal sphincter (causing heartburn), the bowel (causing constipation) and the blood vessels (hypertension, headaches and flushing)
  • Also raises body temp between 0.5-1
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13
Q

What is gestational age ?

A
  • Refers to the duration of pregnancy starting from the date of the last menstrual period
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14
Q

Gravida

A
  • Number of pregnancies
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15
Q

Para

A
  • Number of times a patient has given birth after 24 weeks gestation, regardless of whether the fetus is alive or still born
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16
Q

G&P of A pregnant patient with three previous deliveries at term

A
  • G4 P3
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17
Q

G&P of A non-pregnant person with a previous birth of healthy twins

A
  • G1 P1
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18
Q

G&P of A non-pregnant person with a previous miscarriage

A
  • G1 P0+1
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19
Q

G&P of A non-pregnant person with a previous stillbirth (after 24 weeks gestation)

A
  • G1 P1
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20
Q

Conditions identified with parental screening ?

A
  • Trisomy 21 Down’s
  • Trisomy 18 Edward’s
  • Trisomy 13 Patua’s syndrome
  • 45XO Turner’s syndrome
  • 47XXY Klinefelter’s syndrome
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21
Q

What is the combined screening test ?

A
  • USS (Nuchal)
  • Blood test – PAPP-A and b-hCG
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22
Q

Quadruple tests – 15 weeks

A
  • AFP reduced
  • Oestriol reduced
  • hCG increased
  • Inhibin A increased
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23
Q

What is a CTG ?

A
  • Cardiotocography
  • Electrotonic monitoring of the fetal heart rate correlated with any uterine contractions
24
Q

What is normal cardiotocography ?

A
  • The baseline fetal heart rate is between 110 and 160 and varies from that baseline by 5-25bpm
  • The heart rate should speed up by at least 15bpm for at least 15s (accelerations) 2 accretions should be seen in 20 mins (reactive)
  • There should be no slowing of the fetal heart rate from the baseline (decelerations)
25
Q

What is abnormal cardiotocography ?

A
  • A baseline heart rate not between 110 and 160 and
  • A baseline that varies by more or less than 5-25 bpm
  • Decelerations
26
Q

High bishops score

A
  • Score of over 8 indicates that spontaneous labour will be successful
  • An induction is likely to be successful
27
Q

Moderate bishops score

A
  • Between 6-7 means it is unlikely labour will start soon
  • An induction may or may not be successful
28
Q

Low bishops score

A
  • Score of < 5 Labour is less likely to start
  • Induction is unlikely to be successful
29
Q

Features of an APGAR score

A
  • Breathing effort
  • Heart rate
  • Muscle tone
  • Relex irritability
  • Skin colour
30
Q

Good Apgar score

A
  • Above 7
31
Q

What are the stages of labour ?

A
  • First stage – from the onset of labour until 10cm cervical dilation
  • Second stage from 10cm dilatation to delivery of baby
32
Q

Things to check prior to induction

A
  • Lie and position of foetus
  • Volume of amniotic fluid
  • Tone of uterus
  • Ripeness of cervix (bishops score)
33
Q

Contraindications for induction of labour

A
  • Severe degree of placenta previa
  • Transverse fetal lie or severe cephalopelvic disproportion
  • Cervix < 4 bishops score
34
Q

Reasons for induction of labour

A
  • Prolonged pregnancy (70% induced after 41 weeks)
  • Premature rupture of membranes – where labour does not then start
  • Diabetic mother > 38 weeks
  • Rhesus incompatibility
35
Q

What is required for diagnosis for onset of labour

A
  • Show (mucus plug of the cervix)
  • Rupture of membranes
  • Regular painful contractions
  • Dilating cervix on examination
36
Q

What is the second stage of labour ?

A
  • 10cm dilation to the delivery of the baby
  • Success depends on the 3Ps – power, passenger and passage
37
Q

What is power in the 2nd stage of labour ?

A
  • Strength of uterine contractions
38
Q

What is passenger in the 2nd stage of labour ?

A
  • The baby =
  • Size – of head
  • Attitude – posture of the fetus
  • Lie – position of the fetus
  • Presentation – e.g. cephalic
39
Q

What is passage in the 2nd stage of labour ?

A
  • The size and shape of the passageway mainly the pelvis
40
Q

What is cephalic presentation ?

A
  • Head first
41
Q

What is breech presentation ?

A
  • Legs are first
42
Q

What is a complete breech ?

A
  • Hips and knees flexed
43
Q

Frank breech ?

A
  • Hips flexed and knees extended, bottom first
44
Q

What is a footling breach ?

A
  • Foot hanging through the cervix
45
Q

What are the 7 cardinal movements of labour

A
46
Q

When does the 1st stage of labour start and end ?

A
  • From onset of true contractions until cervix is fully dilated
  • Mucus plus will fall out
  • Latent phase – 0-3cm dilation irregular contractions
  • Active phase – 3-7 (1cm per hour) 3-4 contractions per 10 minutes regular and frequent
  • Transition phase 7-10, strong an regular contractions, full dilation, head visible
47
Q

What happens during the 3rd stage of labour

A
  • From complete birth of the baby to the delivery of the placenta
  • Physiological management = if the placenta is delivered naturally
  • Haemorrhage or more than 60 min delay should aid in delivery of the placenta
  • IM oxytocin helps uterus to contract
48
Q

How is labour induced ?

A
  • Membrane sweep
  • Prostaglandin gel or (misoprostol) pessary high in vagina
  • Amniotomy
  • Oxytocin
49
Q

Non-pharmacological methods of labour pain relief

A
  • Education e.g. breathing exercises and relaxation techniques
  • Acupuncture, homeopathy and hypnosis
  • Transcutaneous electrical nerve stimulation
  • Water birth
50
Q

Pharmacological methods of pain relief during labour

A
  • Nitrous oxide – gas and air
  • Entonox – SE = nausea, vomiting and fainting
  • Narcotic agents – Diamorphine/pethidine SE = drowsiness, nausea and vomiting
  • Pudendal nerve block – for instrumental delivery
  • Local anesthetic – lidocaine – before episiotomy and before suturing vaginal tears
51
Q

Epidural analgesia

A
  • Pain fibers carried by T10-S5
  • Can be regularly topped up by catheter left in space
  • Can help lower BP in PE
52
Q

What are the different roles of the placenta

A
  • Respiration
  • Nutrition
  • Excretion
  • Endocrine
  • Immunity
53
Q

How does the placenta do respiration ?

A
  • Oxygen in
  • C02, hydrogen ions, bicarbonate and lactic acid out
54
Q

How does the placenta do Nutrition ?

A
  • Glucose, vitamins and minerals to the fetus
  • Can also transfer harmful substances such as medications, alcohol, caffeine or cigarette smoke
55
Q

How does the placenta do excretion ?

A
  • Urea and creatinine
56
Q

How does the placenta do endocrine ?

A
  • In early pregnancy the Syncytiotrophoblasts produces hCG which maintains the corpus luteum until the placenta can take over the production of oestrogen and progesterone
57
Q

How does the placenta do immunity ?

A
  • The mothers ABs can transfer across the placenta to the fetus during pregnancy

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