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Year 4 - ObGyn > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Obstetric history

A

Obstetric history

  1. LMP
    - regular
    - no hormonal contraception
    - 1st day +9 months 7 days
  2. Booking scan (11-14wks)
    - EDD (40 weeks/266 days)
    - CRL on USS
    - Combined screening test (nuchal translucency 3.5mm)
  3. Ante natal booking blood
    - FBC + Group
    - Urine dip
    - Viral risk screening (BBIs -+syph)
    - Haemoglobinopathy
    - PAPP- A
  4. 20wk scan
    - congenital abnormalities
    - head to toe
    - placental site (check 32,36)
  5. SGA risk
    - scans 28,32,36
    - smoking, HTN, DM
  6. GDM risk
    - GTT test (24-28 weeks)
  7. PTL risk
    - previous preterm
    - cervical surgery
    - cervical length scan (25mm) (18-22wk)
  8. Gravidity, parity, and mode
    Eg. P1+2 -> G4 (now pregnant)
    - VD, CS (natural/assisted/forceps/ventose/induction/emergency/complication)
    - Weights
  9. Gynae history
  10. Social
    - Domestic violence
    - Finance
    - MH
    - Drugs
  11. Medical, drug, surgical, family
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2
Q

Pregnancy
- Naegele’s rule

A

LMP
- regular
- no hormonal contraception
- 1st day +9 months 7 days

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3
Q

Term
- Post
- Pre

A

Term (37-40)
- Post (40+)
- Pre (-37)

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4
Q

Abnormal booking screening
- Further Ix

A

Abnormal booking screening
- Further Ix

  1. CVS
    - Chorionic villus sampling
    - 1/100 risk
  2. Amniocentesis
    - 1/200 risk
  3. NIPTT
    - non invasive perinatal testing
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5
Q

Miscarriage Vs still birth

A

Miscarriage Vs still birth

  1. 22 weeks UK
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6
Q

Ectopic pregnancy
- Mx

A

Ectopic pregnancy
- Mx

  1. Medical
  2. Surgical
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7
Q

Obstetric examination
- Structure

A

Obstetric examination
- Structure

  1. Introduction and consent
    - pain
  2. Fundal height
    - Xiphisternum
    - Heighest point to public symphisis
    - cm = weeks
  3. Fundal grip
    - head Vs bottom
  4. Umbilical grip
    - back
    - limbs
  5. First … grip
  6. Second … grip
  7. Auscultation
  8. Summary
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8
Q

Gestational diabetes

A

Gestational diabetes

  1. FBG 5.6
  2. Post prandial 7.8
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9
Q

GDM
- Pathophysiology

A

GDM
- Pathophysiology

  1. Oestrogen and progesterone
  2. Increased insulin resistance
  3. Early pregnancy hypoglycaemia
    - Kidneys
    - Blood
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10
Q

GDM
- Risk factors

A

GDM
- Risk factors

  1. BMI
  2. FH
  3. Baby 4.5kg
  4. Ethnicities
  5. Polyhydramnios
  6. Antipsychotics
  7. Previous GDM
    - 12-16wk GTT
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11
Q

Pregnancy
- Physiology

A

Pregnancy
- Physiology

  1. Increased blood volume (7.5l)
    - Dilutional anaemia
  2. Increased GFR
    - 120ml/min +
    - Glucosuria
  3. Hyperemesis
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12
Q

GDM
- Fetal complications

A

GDM
- Effects

  1. Increased fetal insulin
    - anabolism
  2. macrosomia
    - shoulder and belly
  3. dystocia
  4. Fetal polyuria
    - polyhydramnios
    - stretched uterus
  5. preterm labour
  6. Neonatal hypoglycaemia
  7. Delayed lung maturity
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13
Q

GDM
- Maternal complications

A

GDM
- Maternal complications

  1. DKA
  2. Hyperglycaemia
  3. Infection
  4. TII DM risk
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14
Q

GDM
- Mx

A

GDM
- Mx

  1. Diet control
  2. Aerobic exercise
  3. Metformin (500-2000mg)
    +Insulin
    - Rarely
    - Long acting initially
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15
Q

GDM
- Delivery

A

GDM
- Delivery

  1. Diet control
    41 weeks
  2. Metformin control
    40 weeks
  3. Metformin and insulin
    38 weeks
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16
Q

Antepartum haemorrhage
- Causes

A

Antepartum haemorrhage
- Causes

  1. Trauma
  2. Iatrogenic
  3. Local/ca
  4. Obstetric
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17
Q

APH
- Definition

A

APH
- Definition

Bleeding after 20 weeks

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18
Q

Placental abruption
- Types

A

Placental abruption
- Types

  1. Concealed
    - very painful
  2. Revealed
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19
Q

Placental abruption
- Fetal consequences
- Maternal consequences

A

Placental abruption

  • Fetal consequences
    1. No impact (<50% separation)
    2. Distress
  • Maternal consequences
    1. Thromboplastin coagulation factor
  • Renal ischaemia/AKI
  • DIC
    2. Couvelaire uterus
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20
Q

Placental abruption
- Mx

A

Placental abruption
- Mx

  1. Assess
  2. Anti D
  3. Steroids
  4. Observe
    - if normal
  5. Deliver
    - if any disturbance
    - if term
21
Q

Placental previa
- Definition

A

Placental previa
- Definition

  1. Covering cervical Os
  2. Within 2cm of Os
22
Q

Lower uterine segment
- Origin

A

Lower uterine segment
- Origin

  1. Uterine Isthmus
  2. Develops after 20 weeks
  3. Not very muscular
23
Q

Placenta previa
- Grading

A

Placenta previa
- Grading

Minor
1. Within 2cm of Os
2. Touching os

Major
3. Partially covered
4. Completely covered

Abnormal invasive
- Scar invasion
- Uterine wall
- Bladder

24
Q

Placenta previa
- Scanning

A

Placenta previa
- Scanning

  1. Repeat at 32,36,36,38 weeks
  2. Can move away from Os
25
Q

Placenta previa
- RFs

A

Placenta previa
- RFs

  1. Recurrent caesarian section
  2. Previous previa
26
Q

Placenta previa
- Presentation

A

Placenta previa
- Presentation

  1. Asymptomatic
  2. Painless bleeding
  3. Trans vaginally US
  4. Trans abdominal US
    - Full bladder
27
Q

Placenta previa
- Mx

A

Placenta previa
- Mx

  1. Observe 24hrs if pre term
  2. Elective c section 36-37 weeks
  3. Major obstetric haemorrhage
    - if bleeding heavily
    - haematologist, obstetrician, senior midwife
28
Q

Abnormal uterine invasion
- Types

A

Abnormal uterine invasion
- Types

  1. Acreta
  2. Increta
  3. Percreta
29
Q

Vasa previa
- Definition

A

Vasa previa
- Definition

  1. Umbilical cord travels through the membranes before inserting
    - Velamentous insertion
  2. If membranes rupture
    - Vessels burst
30
Q

Vasa previa
- Mx

A

Vasa previa
- Mx

  1. Admit at 32 weeks
31
Q

APH
- Obstetric causes

A

APH
- Obstetric causes

  1. Abruption
  2. Placenta previa
  3. Vasa previa
  4. Uterine rupture
32
Q

Uterine rupture
- Presentation

A

Uterine rupture
- Presentation

  1. Painful bleeding
  2. Not primip
33
Q

PPH
- Definition

A

PPH
- Definition

  1. 500 ml vaginal
    (1000 caesarian…)
  2. Affects mother’s well-being
    /25% pre-delivery haemocrit
  3. 1.5l - Major
34
Q

PPH
- Classifications

A

PPH
- Classifications

1° 24hrs

2° 24hr-2 weeks

35
Q

PPH
- 4Ts

A

PPH
- 5Ts

  1. Tissue
    - not delivered in 1 hr
  2. aTony
    - most common
    - long labor
    - macrosomia
    - drugs
  3. Trauma
    - uterine tear/rupture
    - cervical/perineal/vaginal
  4. Thromboplastin
36
Q

PPH
- Complications

A

PPH
- Complications

  1. Metabolic acidosis
    - 40% blood loss
37
Q

PPH
- aTony Mx

A

PPH
- aTony Mx

  1. Manual simulation
  2. Oxytocin
    - give IV in hypovolemia
    - causes dilutional hyponatremia
  3. Ergometrine
    - not in pre-eclampsia
    - not in cardiac
  4. Tranexamic acid
  5. Misoprostol
    - Rectal
  6. Haemabate
    - Carbaprost
  7. Bimanual compression
  8. Bakri balloon
  9. Laparotomy
    - Brace stitch (BLynch)
    - Hysterectomy
38
Q

Labour
- Definition

A

Labour
- Definition

  1. Progressive effacement and dilatation
  2. Regular contractions
39
Q

Effacement
- Lengths

A

Effacement
- Lengths

  1. Not effaced
    - 4cm
  2. Fully effaced
    - 0cm
40
Q

Retained placenta
- Primip Vs multip

A

Retained placenta
- Primip Vs multip

1hr Vs 30 mins

41
Q

Factors affecting labor
- 3ps

A

Factors affecting labor
- 3ps

  1. Passage
  2. Powers
  3. Passenger
42
Q

Pelvic planes

A

Pelvic planes

  1. Inlet 11cm
  2. Mid cavity
  3. Outlet 10cm
43
Q

fetal station
- measurement

A

Fetal station
- measurement

  1. Lowest part with ischial spine -2 - +3
  2. bi-parietal diameter with pelvic inlet -2 - +3
44
Q

Cephalic presentation
- Sub categories

A

Cephalic presentation
- Sub categories

  1. Vertex
  2. Face
  3. Brow
45
Q

Mechanism of labor
- Stages

A

Mechanism of labor
- Stages

  1. Engagement
  2. Flexion
  3. Descent
  4. Internal rotation
  5. Extension
  6. External rotation
46
Q

Caput succedenium Vs cephalhematoma

A

Caput succedenium Vs cephalhematoma

  • cephalhematoma
    1. Doesn’t cross suture line
    2. Sub periosteum
    3. Blood not oedema
47
Q

Regular contractions

A

Regular contractions
- 3 per 10 minutes

48
Q

Ovarian cancer
- Origin

A

Ovarian cancer
- Origin

  1. 80% epithelium
  2. 20% germ cell
49
Q

Cervical cancer
- Origin

A

Cervical cancer
- Origin

  1. Endocervix
    - SCC
  2. Columnar
    - Adenocarcinoma

Year 4 - ObGyn (9 decks)

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