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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
What is abnormal cardiotocography ?
- A baseline heart rate not between 110 and 160 and - A baseline that varies by more or less than 5-25 bpm - Decelerations
26
High bishops score
- Score of over 8 indicates that spontaneous labour will be successful - An induction is likely to be successful
27
Moderate bishops score
- Between 6-7 means it is unlikely labour will start soon - An induction may or may not be successful
28
Low bishops score
- Score of < 5 Labour is less likely to start - Induction is unlikely to be successful
29
Features of an APGAR score
- Breathing effort - Heart rate - Muscle tone - Relex irritability - Skin colour
30
Good Apgar score
- Above 7
31
What are the stages of labour ?
- First stage – from the onset of labour until 10cm cervical dilation - Second stage from 10cm dilatation to delivery of baby
32
Things to check prior to induction
- Lie and position of foetus - Volume of amniotic fluid - Tone of uterus - Ripeness of cervix (bishops score)
33
Contraindications for induction of labour
- Severe degree of placenta previa - Transverse fetal lie or severe cephalopelvic disproportion - Cervix < 4 bishops score
34
Reasons for induction of labour
- Prolonged pregnancy (70% induced after 41 weeks) - Premature rupture of membranes – where labour does not then start - Diabetic mother > 38 weeks - Rhesus incompatibility
35
What is required for diagnosis for onset of labour
- Show (mucus plug of the cervix) - Rupture of membranes - Regular painful contractions - Dilating cervix on examination
36
What is the second stage of labour ?
- 10cm dilation to the delivery of the baby - Success depends on the 3Ps – power, passenger and passage
37
What is power in the 2nd stage of labour ?
- Strength of uterine contractions
38
What is passenger in the 2nd stage of labour ?
- The baby = - Size – of head - Attitude – posture of the fetus - Lie – position of the fetus - Presentation – e.g. cephalic
39
What is passage in the 2nd stage of labour ?
- The size and shape of the passageway mainly the pelvis
40
What is cephalic presentation ?
- Head first
41
What is breech presentation ?
- Legs are first
42
What is a complete breech ?
- Hips and knees flexed
43
Frank breech ?
- Hips flexed and knees extended, bottom first
44
What is a footling breach ?
- Foot hanging through the cervix
45
What are the 7 cardinal movements of labour
46
When does the 1st stage of labour start and end ?
- 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
What happens during the 3rd stage of labour
- 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
How is labour induced ?
- Membrane sweep - Prostaglandin gel or (misoprostol) pessary high in vagina - Amniotomy - Oxytocin
49
Non-pharmacological methods of labour pain relief
- Education e.g. breathing exercises and relaxation techniques - Acupuncture, homeopathy and hypnosis - Transcutaneous electrical nerve stimulation - Water birth
50
Pharmacological methods of pain relief during labour
- 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
Epidural analgesia
- Pain fibers carried by T10-S5 - Can be regularly topped up by catheter left in space - Can help lower BP in PE
52
What are the different roles of the placenta
- Respiration - Nutrition - Excretion - Endocrine - Immunity
53
How does the placenta do respiration ?
- Oxygen in - C02, hydrogen ions, bicarbonate and lactic acid out
54
How does the placenta do Nutrition ?
- Glucose, vitamins and minerals to the fetus - Can also transfer harmful substances such as medications, alcohol, caffeine or cigarette smoke
55
How does the placenta do excretion ?
- Urea and creatinine
56
How does the placenta do endocrine ?
- 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
How does the placenta do immunity ?
- The mothers ABs can transfer across the placenta to the fetus during pregnancy

3ayeeeee (12 decks)

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