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AMK > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Average blood loss per menstrual cycle

A

30-40 mls

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2
Q

Treatment for heavy menstrual bleeding

A

First line is antiprostaglandins - NSAIDs and TXA
COCP is second line

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3
Q

What is primary amenorrhoea?

A

Pt never had period

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4
Q

When should you investigate for primary amenorrhoea ?

A

14yo girl with no breasts
15 yp girl with breasts

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5
Q

Causes of secondary amenorrhoea

A

HPA axis unbalanced - stress, hyperthyroidism, disease

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6
Q

What is placenta accreta

A

Placenta is unusually adherent to uterine lining

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7
Q

Sx placenta accrete

A

Painless vaginal bleeding, foetus is often in abnormal lie

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8
Q

sx placental abruption

A

woody uterus
single instance of large blood loss
contractions

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9
Q

Management placenta praaevia

A

If >24 weeks should go to ED
O2 and blood match

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10
Q

Treatment of bacterial vaginosis

A

Metronidazole and clindamycin

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11
Q

What is Ca125 a marker for ?

A

ovarian cancer

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12
Q

Which palsy is associated with shoulder dystocia?

A

Erb’s - c5-7

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13
Q

Most common place for ectopic

A

Ampulla

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14
Q

Gold standard to diagnose ectopic pregnancy

A

laparascopuy

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15
Q

Most common form of endometrial cancer

A

Adenocarcinoma of columnar cells

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16
Q

Sx endometrial cancer

A

Post-menopausal bleeding

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17
Q

Tx endometrial cancer

A

Hysterectomy with bilateral salpingo-oophorectomy

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18
Q

Cause of endometritis

A

Pregnancy
GBS

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19
Q

Management endometritis

A

Clindamycin and gentamicin

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20
Q

What is adenomyosis

A

endometrial tissue grows inside myometrium

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21
Q

sx adenomyosis

A

boggy uterus
dysmenorrhoea

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22
Q

Most common type of cervical cancer

A

sqmaous cell

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23
Q

Sx cervical cancer

A

abnormal vaginal bleeding/discharge

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24
Q

screening programme cervical cancer

A

every 3 years from 25-49 and every 5 from 50-64

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25
Q

treatment for 1A cervical cancer

A

LLETZ

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26
Q

treatment for 1B-2A cervical cancer

A

hysterectomy

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27
Q

treatment for 2B-4A cervial cancer

A

chemo and radiotherapy

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28
Q

vulval cancer

A
  • Squamous cell tumours
  • R/F = HIV
  • Sx = lumps + itching + pain
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29
Q

endometrial cancer

A
  • Adenocarcinoma
  • Exposure to oestrogen
  • Post-menopausal bleeding
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30
Q

Missing POP

A

take pill ASAP and use protection for 48h - emergency contraception needed if had sex since missing pill

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31
Q

symptoms of PCOS

A
  • Oligo-ovulation/anovulation
  • Hyperandrogenism (hirsutism, acne, alopecia)
  • Polycystic ovaries
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32
Q

hormone levels PCOS

A
  • Increased LH and testosterone
  • FSH normal
  • High oestrogen
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33
Q

management PCOS

A
  • Lifestyle changes and weight loss
  • COCP to protect against endometrial cancer
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34
Q

What is premature ovarian insufficiency

A

menopause <40 years

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35
Q

medical management of miscarriage

A

mifepristone pessary

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36
Q

medical abortion <7 weeks

A

mifepristone (progesterone antagonist) + mifepristone

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37
Q

Pre-eclampsia

A

Spiral arteries have increased resistance = reduced blood flow to placenta = inflammation

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38
Q

Sx pre-eclampsia

A

headaches, visual changes and oedema

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39
Q

Ix pre-eclampsia

A

BP and urinalysis

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40
Q

Mx pre-eclampsia

A

labetolol and c-section

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41
Q

what is eclampsia

A

seizures due to pre-eclampsia , increased BP, proteinuria

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42
Q

mx eclampsia

A

magnesium sulphate

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43
Q

HELLP syndrome

A

inflammatory complications due to pre-eclampsia

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44
Q

mx HELLP

A

IV labetolol

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45
Q

why do you give magnesium sulphate in eclampsia?

A

prevent seizures

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46
Q

treatment pregnancy induced hypertension

A

magnesium sulphate

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47
Q

pathophysiology of Rh -ve pregnancies

A

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

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48
Q

Sx in baby if mum -Rhve and baby +ve

A

hydrops fetalis (oedema), jaundice (kernicterus), heart failure and anaemia. Can be treated with transfusion and phototherapy

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49
Q

anti-D needs to be given <72h when…

A
  • 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
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50
Q

Coombs test

A

tests for antibodies in RBCs of baby

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51
Q

Kleihauer test

A

add acid to maternal blood - fetal cells resistant

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52
Q

What is alpha feta-protein?

A

Secreted from GIT and yolk sac in developing foetus - test for in 16-18w testing

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53
Q

Reasons for high AFP

A

Neural tube defect (meningocele, myelomeningocele, anencephaly)
Abdominal wall defect (omphalocele, gastroschisis)
Multiple babies

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54
Q

Reasons for decreased AFP

A

Aneuploidy
Maternal DM

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55
Q

Spina bifida occulta

A

Spinal laminae of L5 +/- S1 fail to unite, produces no symptoms - has small dimple and tuft of hair at base of spine

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56
Q

Meningocele

A

Protrusion of meninges and CSF

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57
Q

Myelomeningocele

A

Protrusion of meninges, CSF and spinal cord

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58
Q

Anencephaly

A

Absence of skull and cerebral hemispheres

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59
Q

Gastroschisis

A

Herniation of abdo contents without peritoneal covering lateral to umbilicus

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60
Q

Omphalocele

A

Herniation of abdo contents with umbilical covering through umbilicus

61
Q

frank breech

A

hips flexed, knees extended

62
Q

footling breech

A

one or both knees extended, hips extended

63
Q

why is breech dangerous?

A

risk of cord prolapse

64
Q

ECV should be attempted when?

65
Q

when should you NOT attempt ECV

A

c-section required, abnormal CTG, membranes already ruptured, multiple pregnancy

66
Q

Define PPH

A

Blood loss >500ml after birth

67
Q

causes of PPH

A
  • Tone (uterine atony is most common cause)
  • Trauma (perineal tear)
  • Thrombin (clotting disorder)
  • Tissue (retained tissue)
68
Q

RF PPH

A
  • Previous PPH
  • Long labour
  • Hypertension
  • Increased maternal age
  • Placenta accreta/praevia
69
Q

Define primary PPH

A

<24h of delivery

70
Q

Mx primary PPH

A
  • Mx: oxytocin, ergometrine and carboprost to stimulate uterine contractions
  • Intrauterine balloon tamponade is surgical first line when atony is cause
71
Q

Define secondary PPH

A

24h-6w after delivery

72
Q

Management secondary PPH

A

ampicillin and metronidazole, uterotonics (oxytocin, ergometrine, carboprost)

73
Q

What is pre-eclampsia?

A

BP >140/90 after week 20 of pregnancy (this can cause placental abruption/haemorrhagic stroke)

74
Q

Triad of pre-eclampsia symptoms

A

hypertension, proteinuria and oedema

75
Q

baby complications pre-eclampsia

A

IUGR and prematurity

76
Q

What is severe pre-eclampsia

A

BP >160/110

77
Q

sx severe pre-eclampsia

A

Increased proteinuria, vision problems, headaches, abnormal liver enzymes

78
Q

agreement severe pre-eclampsia

A

admit for observation

79
Q

what is eclampsia

A

tonic-clonic seizures

80
Q

what is HELLP?

A

Haemolysis, elevated liver enzymes and low platelets → can be associated with placental abruption and DIC

81
Q

Sx HELLP

A

Bleeding/bruising, headache, fatigue, microcytic anaemia. RUQ pain, blurry vision, hypertension

82
Q

Blood results HELLP

A

Schistocytes and increased UCB (haemolysis)
Elevated ALT and AST
Low platelets and high bleeding time
Anaemia

83
Q

management HELLP

A

dexamethasone

84
Q

managing pre-eclampsia/eclampsia/HELLP

A
  • 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
Q

when do you give anti-D

A

28 and 34 weeks

86
Q

Define antepartum haemorrhage

A

> 24 weeks

87
Q

Baby blues features

A

irritability, tearfulness, anxiety -> normally 3-7d post-birth, common in primps

88
Q

treatment baby blues

89
Q

features of post partum depression

A

Start within 1m of birth, peaks at 3m. mothers are aggressive, stressed and detached

90
Q

tx post partum depression

A

normally SR but can give sertraline/paroxetine/CBT

91
Q

puerperal psychosis features

A

severe mood swings and altered perception, normally starts within 2-3 weeks of birth

92
Q

treatment puerperal psychosis

93
Q

how to assess post partum depression

A

Edinburgh Postnatal Depression Scale - a score >13 indicates some level of depression

94
Q

When do you screen for anaemia?

A

booking (8-10 weeks) and 28 weeks

95
Q

Management pregnancy anaemia

A

ferrous fumarate/sulfate, continue 3m after anaemia resolved

96
Q

Cut off in pregnancy for treatment for anaemia

A

Tri1 = <110
Tri2/3 = <105
Postpartum = <100

97
Q

sx intrahepatic cholestasis pregnancy

A

pruritus wo rash, high bilirubin (dark urine and light poo)

98
Q

mx intrahepatic cholestasis pregnancy

A

ursodeoxycholic acid, induce at 37w

99
Q

sx acute fatty liver of pregnancy

A
  • Abdominal pain
  • N and V
  • Headache
  • Jaundice
  • Hypoglycaemia
  • Raised ALT
100
Q

mx acute fatty liver of pregnancy

101
Q

obesity definition

A

BMI >30 at first visit

102
Q

what is puerperal pyrexia

A

temp >38c in first 2 weeks following delivery

103
Q

causes puerperal pyrexia

A

endometritis, UTI, wound infection

104
Q

mx puerperal pyrexia

A

IV ABx (clindamycin and gentamicin)

105
Q

Which women should have HIV screening?

106
Q

Which women should be offered ARVT?

107
Q

when can pregnant women with HIV breast feed?

108
Q

Options for delivery depending on viral load

A

If <50, vaginally
If >50, give zidovudine infusion for 4h then c-section

109
Q

neonatal ARVT depending on viral load

A

<50 give zidovudine
>50 needs triple ARVT for 4-6w

110
Q

how to deal with hep b in pregnancy?

A

babies born to +ve mothers or those infected in pregnancy should receive full vaccination and immunoglobulin

111
Q

most common cause of neonatal infections

112
Q

When do you screen a woman for GBS

A

Not routine - only if labour pre-term or mother pyrexic

113
Q

How do you treat a nmother if she had previous GBS infection?

A
  • Chance of another infection is 50%
  • Give benzylpenicillin
  • Swab at 35-37 weeks
114
Q

first line treatment for vomiting in pregnancy

A

anti-histamines e..g prochlorperazine

115
Q

sx foetal varicella syndrome

A

skin scarring, eye defects, microcephaly, learning difficulties

116
Q

how to treat mothers infected with varicella zoster

A
  • ≤ 20w seek advice
  • ≥ 20w oral aciclovir
117
Q

prophylactic care for mothers who come into contact with varicella zoster

A
  • Check mother’s blood for IG
  • ≤20w: VZIG ASAP (up to 10d post-exposure)
  • ≥ 20w: VZIG or aciclovir (7-14d post-exposure)
118
Q

complete hydatiform mole

A

empty egg + normal sperm

119
Q

partial mole

A

normal egg + 2x sperm

120
Q

why do you need surgical management of hydatiform moles

A

ensure complete evacuation and stop choriocarcinoma development

121
Q

sx molar pregnancy

A

large uterus for dates, morning sickness, high HCG

122
Q

sx congenital rubella syndrome

A
  • Sensorineural deafness
  • Cataracts
  • Heart disease
  • ‘salt and pepper’ chorioretinitis
  • Stunted growth
  • Cerebral palsy
123
Q

tx rubella in pregnancy

A

discuss with PHE, isolation

124
Q

epilepsy drugs in pregnancy

A

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
Q

when do you give aspirin in pregnancy? (remember cant give BF)

A

high risk groups (CKD, autoimmune disorder, DM)

126
Q

What normally happens to BP in pregnancy

A

Normally, BP falls in first trimester (especially diastolic) and then rises to normal levels by birth

127
Q

Define hypertension in pregnancy

A
  • Systolic >140, or >30 from booking reading
  • Diastolic >90, or >15 from booking reading
128
Q

Pros and cons breastfeeding

A

Pros: bonding, protection against breast and ovarian CA, unreliable contraceptive effect
Cons: transmission of drugs/disease, vit D/K deficiency, breast milk jaundice

129
Q

Drugs CI whilst breastfeeding

A
  • Amiodarone
  • Metronidazole
  • Sulfonylureas
  • Aspirin
  • Lithium/benzos
  • ABx: ciprofloxacin, tetracycline, chloramphenicol
130
Q

Best SSRI if breast feeding

A

sertraline

131
Q

Blocked breast duct sx and mx

A

sx: pain when breast feeding
mx: continue feeding

132
Q

candidiasis sx and mx

A

sx: painful, sore/cracked/itchy nipples
mx: miconazole for mum, nystatin for baby

133
Q

mastitis sx and mx

A

sx: tender, hot, breasts with decreased milk supply and systemic upset
mx: flucloxacillin 14d

134
Q

engorgement sx and mx

A

sx: occurs within first few days of birth, bilateral and worse before feeding
mx: hand-expressing milk

135
Q

Raynaud’s sx and mx

A

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
Q

galactocele sx and mx

A

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
Q

When should you expect to feel foetal movements by ?

138
Q

Define RFM

A

<10 movements within 2h

139
Q

Causes of RFM

A

Poor posture, foetal sleeping periods, distractions, IUGR, hypothyroidism

140
Q

mx no foetal movements by 24 weeks

A

refer to foetal medicine unit

141
Q

mx RFM <24 weeks and movements previously felt

A

handheld doppler should be used to confirm foetal heartbeat

142
Q

mx RFM 24-28w

A

use handheld doppler

143
Q

RFM after 28 weeks

A

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
Q

mx more than 1 episode of RFM within 3 months

A

doctor review

145
Q

RF gestational diabetes

A
  • 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
Q

Screening for gestational diabetes

A
  • If previous GD: OGTT at booking and at 24-28 weeks
  • If risk factors: OGTT at 24-28 weeks
147
Q

Diagnosis gestational diabetes

A
  • Fasting glucose >5.6
  • 2-hr glucose >7.8
148
Q

Management of new onset GD

A
  • Lifestyle changes for 1/2 weeks → add metformin → add insulin
  • If fasting glucose >7 → insulin straight away
149
Q

management of pre-existing diabetes

A

stop everything apart from metformin and start insulin

AMK (33 decks)

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