Obstetrics Flashcards
1
Q
Average blood loss per menstrual cycle
A
30-40 mls
2
Q
Treatment for heavy menstrual bleeding
A
First line is antiprostaglandins - NSAIDs and TXA
COCP is second line
3
Q
What is primary amenorrhoea?
A
Pt never had period
4
Q
When should you investigate for primary amenorrhoea ?
A
14yo girl with no breasts
15 yp girl with breasts
5
Q
Causes of secondary amenorrhoea
A
HPA axis unbalanced - stress, hyperthyroidism, disease
6
Q
What is placenta accreta
A
Placenta is unusually adherent to uterine lining
7
Q
Sx placenta accrete
A
Painless vaginal bleeding, foetus is often in abnormal lie
8
Q
sx placental abruption
A
woody uterus
single instance of large blood loss
contractions
9
Q
Management placenta praaevia
A
If >24 weeks should go to ED
O2 and blood match
10
Q
Treatment of bacterial vaginosis
A
Metronidazole and clindamycin
11
Q
What is Ca125 a marker for ?
A
ovarian cancer
12
Q
Which palsy is associated with shoulder dystocia?
A
Erb’s - c5-7
13
Q
Most common place for ectopic
A
Ampulla
14
Q
Gold standard to diagnose ectopic pregnancy
A
laparascopuy
15
Q
Most common form of endometrial cancer
A
Adenocarcinoma of columnar cells
16
Q
Sx endometrial cancer
A
Post-menopausal bleeding
17
Q
Tx endometrial cancer
A
Hysterectomy with bilateral salpingo-oophorectomy
18
Q
Cause of endometritis
A
Pregnancy
GBS
19
Q
Management endometritis
A
Clindamycin and gentamicin
20
Q
What is adenomyosis
A
endometrial tissue grows inside myometrium
21
Q
sx adenomyosis
A
boggy uterus
dysmenorrhoea
22
Q
Most common type of cervical cancer
A
sqmaous cell
23
Q
Sx cervical cancer
A
abnormal vaginal bleeding/discharge
24
Q
screening programme cervical cancer
A
every 3 years from 25-49 and every 5 from 50-64
25
treatment for 1A cervical cancer
LLETZ
26
treatment for 1B-2A cervical cancer
hysterectomy
27
treatment for 2B-4A cervial cancer
chemo and radiotherapy
28
vulval cancer
- Squamous cell tumours
- R/F = HIV
- Sx = lumps + itching + pain
29
endometrial cancer
- Adenocarcinoma
- Exposure to oestrogen
- Post-menopausal bleeding
30
Missing POP
take pill ASAP and use protection for 48h - emergency contraception needed if had sex since missing pill
31
symptoms of PCOS
- Oligo-ovulation/anovulation
- Hyperandrogenism (hirsutism, acne, alopecia)
- Polycystic ovaries
32
hormone levels PCOS
- Increased LH and testosterone
- FSH normal
- High oestrogen
33
management PCOS
- Lifestyle changes and weight loss
- COCP to protect against endometrial cancer
34
What is premature ovarian insufficiency
menopause <40 years
35
medical management of miscarriage
mifepristone pessary
36
medical abortion <7 weeks
mifepristone (progesterone antagonist) + mifepristone
37
Pre-eclampsia
Spiral arteries have increased resistance = reduced blood flow to placenta = inflammation
38
Sx pre-eclampsia
headaches, visual changes and oedema
39
Ix pre-eclampsia
BP and urinalysis
40
Mx pre-eclampsia
labetolol and c-section
41
what is eclampsia
seizures due to pre-eclampsia , increased BP, proteinuria
42
mx eclampsia
magnesium sulphate
43
HELLP syndrome
inflammatory complications due to pre-eclampsia
44
mx HELLP
IV labetolol
45
why do you give magnesium sulphate in eclampsia?
prevent seizures
46
treatment pregnancy induced hypertension
magnesium sulphate
47
pathophysiology of Rh -ve pregnancies
When a Rh -ve mum has a Rh +ve baby, fetal RBCs can leak across to the placenta. Mum then makes anti-D IgG antibodies which can attack baby
48
Sx in baby if mum -Rhve and baby +ve
hydrops fetalis (oedema), jaundice (kernicterus), heart failure and anaemia. Can be treated with transfusion and phototherapy
49
anti-D needs to be given <72h when...
- TOP
- Baby +ve (live/stillborn)
- Miscarriage >12w
- Ectopic pregnancy managed surgically
- External cephalic version
- Antepartum haemorrhage
- Invasive testing (amniocentesis, CVS, fetal blood test)
- Abdo trauma
50
Coombs test
tests for antibodies in RBCs of baby
51
Kleihauer test
add acid to maternal blood - fetal cells resistant
52
What is alpha feta-protein?
Secreted from GIT and yolk sac in developing foetus - test for in 16-18w testing
53
Reasons for high AFP
Neural tube defect (meningocele, myelomeningocele, anencephaly)
Abdominal wall defect (omphalocele, gastroschisis)
Multiple babies
54
Reasons for decreased AFP
Aneuploidy
Maternal DM
55
Spina bifida occulta
Spinal laminae of L5 +/- S1 fail to unite, produces no symptoms - has small dimple and tuft of hair at base of spine
56
Meningocele
Protrusion of meninges and CSF
57
Myelomeningocele
Protrusion of meninges, CSF and spinal cord
58
Anencephaly
Absence of skull and cerebral hemispheres
59
Gastroschisis
Herniation of abdo contents without peritoneal covering lateral to umbilicus
60
Omphalocele
Herniation of abdo contents with umbilical covering through umbilicus
61
frank breech
hips flexed, knees extended
62
footling breech
one or both knees extended, hips extended
63
why is breech dangerous?
risk of cord prolapse
64
ECV should be attempted when?
36w
65
when should you NOT attempt ECV
c-section required, abnormal CTG, membranes already ruptured, multiple pregnancy
66
Define PPH
Blood loss >500ml after birth
67
causes of PPH
- Tone (uterine atony is most common cause)
- Trauma (perineal tear)
- Thrombin (clotting disorder)
- Tissue (retained tissue)
68
RF PPH
- Previous PPH
- Long labour
- Hypertension
- Increased maternal age
- Placenta accreta/praevia
69
Define primary PPH
<24h of delivery
70
Mx primary PPH
- Mx: oxytocin, ergometrine and carboprost to stimulate uterine contractions
- Intrauterine balloon tamponade is surgical first line when atony is cause
71
Define secondary PPH
24h-6w after delivery
72
Management secondary PPH
ampicillin and metronidazole, uterotonics (oxytocin, ergometrine, carboprost)
73
What is pre-eclampsia?
BP >140/90 after week 20 of pregnancy (this can cause placental abruption/haemorrhagic stroke)
74
Triad of pre-eclampsia symptoms
hypertension, proteinuria and oedema
75
baby complications pre-eclampsia
IUGR and prematurity
76
What is severe pre-eclampsia
BP >160/110
77
sx severe pre-eclampsia
Increased proteinuria, vision problems, headaches, abnormal liver enzymes
78
agreement severe pre-eclampsia
admit for observation
79
what is eclampsia
tonic-clonic seizures
80
what is HELLP?
Haemolysis, elevated liver enzymes and low platelets → can be associated with placental abruption and DIC
81
Sx HELLP
Bleeding/bruising, headache, fatigue, microcytic anaemia. RUQ pain, blurry vision, hypertension
82
Blood results HELLP
Schistocytes and increased UCB (haemolysis)
Elevated ALT and AST
Low platelets and high bleeding time
Anaemia
83
management HELLP
dexamethasone
84
managing pre-eclampsia/eclampsia/HELLP
- Definitive treatment is to deliver baby if after 34 weeks - if before this time then give corticosteroids (surfactant)
- Management includes antihypertensive therapy (labetolol), aspirin from 12w gestation, and magnesium sulfate to minimise seizures
85
when do you give anti-D
28 and 34 weeks
86
Define antepartum haemorrhage
>24 weeks
87
Baby blues features
irritability, tearfulness, anxiety -> normally 3-7d post-birth, common in primps
88
treatment baby blues
SR
89
features of post partum depression
Start within 1m of birth, peaks at 3m. mothers are aggressive, stressed and detached
90
tx post partum depression
normally SR but can give sertraline/paroxetine/CBT
91
puerperal psychosis features
severe mood swings and altered perception, normally starts within 2-3 weeks of birth
92
treatment puerperal psychosis
ADMIT
93
how to assess post partum depression
Edinburgh Postnatal Depression Scale - a score >13 indicates some level of depression
94
When do you screen for anaemia?
booking (8-10 weeks) and 28 weeks
95
Management pregnancy anaemia
ferrous fumarate/sulfate, continue 3m after anaemia resolved
96
Cut off in pregnancy for treatment for anaemia
Tri1 = <110
Tri2/3 = <105
Postpartum = <100
97
sx intrahepatic cholestasis pregnancy
pruritus wo rash, high bilirubin (dark urine and light poo)
98
mx intrahepatic cholestasis pregnancy
ursodeoxycholic acid, induce at 37w
99
sx acute fatty liver of pregnancy
- Abdominal pain
- N and V
- Headache
- Jaundice
- Hypoglycaemia
- Raised ALT
100
mx acute fatty liver of pregnancy
delivery
101
obesity definition
BMI >30 at first visit
102
what is puerperal pyrexia
temp >38c in first 2 weeks following delivery
103
causes puerperal pyrexia
endometritis, UTI, wound infection
104
mx puerperal pyrexia
IV ABx (clindamycin and gentamicin)
105
Which women should have HIV screening?
All
106
Which women should be offered ARVT?
all
107
when can pregnant women with HIV breast feed?
Never
108
Options for delivery depending on viral load
If <50, vaginally
If >50, give zidovudine infusion for 4h then c-section
109
neonatal ARVT depending on viral load
<50 give zidovudine
>50 needs triple ARVT for 4-6w
110
how to deal with hep b in pregnancy?
babies born to +ve mothers or those infected in pregnancy should receive full vaccination and immunoglobulin
111
most common cause of neonatal infections
GBC
112
When do you screen a woman for GBS
Not routine - only if labour pre-term or mother pyrexic
113
How do you treat a nmother if she had previous GBS infection?
- Chance of another infection is 50%
- Give benzylpenicillin
- Swab at 35-37 weeks
114
first line treatment for vomiting in pregnancy
anti-histamines e..g prochlorperazine
115
sx foetal varicella syndrome
skin scarring, eye defects, microcephaly, learning difficulties
116
how to treat mothers infected with varicella zoster
- ≤ 20w seek advice
- ≥ 20w oral aciclovir
117
prophylactic care for mothers who come into contact with varicella zoster
- Check mother’s blood for IG
- ≤20w: VZIG ASAP (up to 10d post-exposure)
- ≥ 20w: VZIG or aciclovir (7-14d post-exposure)
118
complete hydatiform mole
empty egg + normal sperm
119
partial mole
normal egg + 2x sperm
120
why do you need surgical management of hydatiform moles
ensure complete evacuation and stop choriocarcinoma development
121
sx molar pregnancy
large uterus for dates, morning sickness, high HCG
122
sx congenital rubella syndrome
- Sensorineural deafness
- Cataracts
- Heart disease
- ‘salt and pepper’ chorioretinitis
- Stunted growth
- Cerebral palsy
123
tx rubella in pregnancy
discuss with PHE, isolation
124
epilepsy drugs in pregnancy
Sodium valproate shouldn’t be prescribed (neural tube defects)
Phenytoin = risk of cleft palate
Carbemazepine and lamotrigine are okay, dose of lamotrigine may need to be increased
125
when do you give aspirin in pregnancy? (remember cant give BF)
high risk groups (CKD, autoimmune disorder, DM)
126
What normally happens to BP in pregnancy
Normally, BP falls in first trimester (especially diastolic) and then rises to normal levels by birth
127
Define hypertension in pregnancy
- Systolic >140, or >30 from booking reading
- Diastolic >90, or >15 from booking reading
128
Pros and cons breastfeeding
Pros: bonding, protection against breast and ovarian CA, unreliable contraceptive effect
Cons: transmission of drugs/disease, vit D/K deficiency, breast milk jaundice
129
Drugs CI whilst breastfeeding
- Amiodarone
- Metronidazole
- Sulfonylureas
- Aspirin
- Lithium/benzos
- ABx: ciprofloxacin, tetracycline, chloramphenicol
130
Best SSRI if breast feeding
sertraline
131
Blocked breast duct sx and mx
sx: pain when breast feeding
mx: continue feeding
132
candidiasis sx and mx
sx: painful, sore/cracked/itchy nipples
mx: miconazole for mum, nystatin for baby
133
mastitis sx and mx
sx: tender, hot, breasts with decreased milk supply and systemic upset
mx: flucloxacillin 14d
134
engorgement sx and mx
sx: occurs within first few days of birth, bilateral and worse before feeding
mx: hand-expressing milk
135
Raynaud's sx and mx
sx: intermittent pain during/just after BF, nipple may blanch -> cyanotic -> erythematous (pain resolves)
mx:nifedipine if persistent, if not then minimise RF (extreme temp exposure)
136
galactocele sx and mx
sx: recently stopped BF - is due to occlusion of lactiferous duct. Milk build up creates cystic lesion and is usually painless with no infection
mx: conservative
137
When should you expect to feel foetal movements by ?
20 weeks
138
Define RFM
<10 movements within 2h
139
Causes of RFM
Poor posture, foetal sleeping periods, distractions, IUGR, hypothyroidism
140
mx no foetal movements by 24 weeks
refer to foetal medicine unit
141
mx RFM <24 weeks and movements previously felt
handheld doppler should be used to confirm foetal heartbeat
142
mx RFM 24-28w
use handheld doppler
143
RFM after 28 weeks
handheld doppler should be used to confirm foetal heartbeat - if this is negative, immediate USS, if this is positive, CTG for 20 mins. If concerned despite normal CTG, urgent USS
144
mx more than 1 episode of RFM within 3 months
doctor review
145
RF gestational diabetes
- High BMI
- Previous macrosomic baby >4.5kg
- Previous GD
- First-degree relative with diabetes
- Family origin from somewhere with high diabetes prevalence (South Asian, Caribbean, middle eastern)
146
Screening for gestational diabetes
- If previous GD: OGTT at booking and at 24-28 weeks
- If risk factors: OGTT at 24-28 weeks
147
Diagnosis gestational diabetes
- Fasting glucose >5.6
- 2-hr glucose >7.8
148
Management of new onset GD
- Lifestyle changes for 1/2 weeks → add metformin → add insulin
- If fasting glucose >7 → insulin straight away
149
management of pre-existing diabetes
stop everything apart from metformin and start insulin
