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RHCN > Obstetrics > Flashcards

Obstetrics Flashcards

0
Q

Semen in miscarriages

A

Not analyses

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1
Q

Diagnosis of pregnancy

A

Pregnancy test urine dip

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2
Q

Entropy on caused by

A

Pregnancy
Pill
Puberty

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3
Q

Fixed, retro verged uterus and tender

A

Endometriosis

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4
Q

Pcos hormones

A

Lh:fsh of 3

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5
Q

How many cross units for pph?

A

6 units of blood

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6
Q

Zoladex

A

Goserelin
Lhrh agonist
Endometriosis

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7
Q

Non sexually active teen

A

Mefanamic acid

NSAID

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8
Q

Post menopausal bleeding

A

Cervical cancer
Endometrial cancer
Endometrial polyp
Strophic vaginitis

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9
Q

Dysmenoorhoe

A 
Endometriosis
IUCd
Pid
Pcos
Ovarian cancer
Sexual abuse
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10
Q

Deep dyspareunia

A

Pid
Endometriosis
Ectopic
Ovarian cancer

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11
Q

Post coital bleeding

A 
Polyp
Ectoprocta
Cervical cancer
Infection
Torch
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12
Q

Ovarian cancer marker

A

Ca125

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13
Q

High hCG

A

Choriocarcinoma
Hyperemesis
Hydatidiform

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14
Q

Give anti d at:

A

28 and 34 weeks

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15
Q

Indications for anti d

A

Spontaneous miscarriage after 12 weeks

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16
Q

Bloods raised in pregnancy

A 
Alk phos
Fibrinogen
Factors 7, 8, 10
Red cell mass
D dimer
Urea
White cell
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17
Q

Syntometrin

A

Helps uterus contract

Nomal blood pressure

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18
Q

Syntocynin

A

Helps uterus contract

High blood pressure

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19
Q

Misoprostol

A

Helps efface the cervix
Used to induce labour or for abortion
(Oxytocin doesn’t help with cervix
Prostaglandin e analogue

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20
Q

Mifepristal

A

Anti progesterone and anti glucocorticoid
Abortion agent
Helps with labour

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21
Q

Hemabate

A

Prostaglandin
Used b
In atonic pph

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22
Q

Tibalone

A

Endometriosis
Hrt
Oestrogen

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23
Q

Danazol

A

Low oestrogen
High androgen
Endometriosis

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24
Q

Clomiphine

A

Used in amenorrhea

Stimulates ovulation

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25
Q

Surfactant develops

A

34/35 weeks

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26
Q

Perinatal mortality

A

Pregnancy and a week

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27
Q

Neonatal mortality

A

Day 1-28

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28
Q

Neonatal jaundice

A

First 24 h

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29
Q

hCG doubles every:

A

24 hours

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30
Q

Should see a fetal pole with hCG IS

A

1500

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31
Q

Most effective contraceptive?

A

Implanon

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32
Q

Fluid restrict in pet

A

Less than 85ml per hour

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33
Q

Hyperemesis most in

A

First 12 weeks

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34
Q

Decapaptyl

A

Gnrh agonist

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35
Q

Ovulation when oestrogen reaches

A

800-1200 mmol

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36
Q

Ovulation when follicles size

A

18-25mm

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37
Q

How many days before next period does ovulation happen?

A

14 days

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38
Q

Follicular phase

A

9 to 21 days

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39
Q

Contraception for breast feeding

A

Pop

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40
Q

Contraception for breast cancer

A

Copper coil

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41
Q

Larc definition

A

Less than monthly

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42
Q

Parity includes

A

Any still births after 24 weeks

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43
Q

Primary ammenorhoe age

A

Over 16

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44
Q

Threshold for pregnancy test

A

25 or 50 mlU

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45
Q

Booking appointment at

A

8-12 weeks

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46
Q

Appointments during pregnancy

A 
Booking
10
20
25
28
31
34
36
38
40
41
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47
Q

Cleft on anomaly scan

A

Can see cleft lip

Cleft palat more difficult

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48
Q

Congenital rubella

A 
eye problems, such as cataracts (cloudy patches on the lens of the eye)
deafness
heart abnormalities
brain damage
First 20 weeks
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49
Q

Gestational diabetes

A

After 20 weeks

Blood test at 28 weeks

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50
Q

Gestational diabetes before

A

Get ogtt done earlier at 18 weeks

Then again at 28

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51
Q

Pregnancy induced hypertension starts

A

After 32 weeks

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52
Q

How many women get hypertension in pregnancy?

A

10%

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53
Q

How many get pet in pregnancy

A

2-5%

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54
Q

How many get eclampsia?

A

1%

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55
Q

Control of glucose most important in the first

A

8-10 weeks

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56
Q

Vitamin a

A

Potent teratogen

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57
Q

Folic acid

A

All women should take at least 400 micrograms/day whilst trying to become pregnant and for at least the first three months of pregnancy to reduce the risk of neural tube defects (NTDs).

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58
Q

Avoid sauna

A

Fetal hyperthermia

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59
Q

Opiate addiction in pregnancy

A

intrauterine growth restriction and preterm delivery. This contributes to an increased rate of low birth weight and perinatal mortality.

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60
Q

Varicella in pregnancy

A

In the first 20 weeks of pregnancy, varicella in the mother may cause congenital fetal varicella syndrome. This may cause limb hypoplasia, microcephaly, cataracts, growth restriction and skin scarring.

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62
Q

Increased maternal age

A 
Downs.
 miscarriage, 
twins, 
fibroids, 
hypertension, 
gestational diabetes,
labour problems 
perinatal mortality with increasing maternal age.
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62
Q

Hypertension in pregnancy

A

May be related to increased aldosterone

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63
Q

Hormones in pregnancy

A

Prolactin levels increase due to maternal pituitary gland enlargement by 50%. This mediates a change in the structure of the mammary gland from ductal to lobular-alveolar.
Parathyroid hormone is increased which leads to increases of calcium uptake in the gut and reabsorption by the kidney. Adrenal hormones such as cortisol and aldosterone also increase.

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64
Q

Hematology pregnancy

A

During pregnancy the plasma volume increases by 50% and the red blood cell volume increases only by 20-30%.[13] Consequently, the hematocrit decreases on lab value; this is not a true decrease in hematocrit, however, but rather due to the dilution. The white blood cell count increases and may peak at over 20 mg/mL in stressful conditions. Conversely, there is a decrease in platelet concentration to a minimal normal values of 100-150 mil/mL.

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66
Q

Kidney and pregnancy

A

increase in kidney and ureter size. (GFR) commonly increases by 50%, returning to normal 20 weeks post
Plasma sodium does not change because this is offset by the increase in GFR.
decreased blood urea nitrogen (BUN) and creatinine and glucosuria (due to saturated tubular reabsorption) may be seen.
The renin-angiotensin system is upregulated, causing increased aldosterone levels.

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67
Q

Peurperium

A

The cardiovascular system reverts to normal during the first 2 weeks. The extra load on the heart from extra volume of blood disappears by the second week.
The vaginal wall is initially swollen, bluish and pouting but rapidly regains its tone, although remaining fragile for 1-2 weeks. Perineal oedema may persist for some days.
After delivery of the placenta, the uterus is at the size of 20-week pregnancy, but reduces in size on abdominal examination by 1 finger-breadth each day, such that on the 12th day it cannot be palpated. By end of puerperium it is only slightly larger than pre-pregnancy.

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68
Q

PPH definition

A

first 24 hours is primary
minor 500-1l
major is more than a litre

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69
Q

secondary PPH

A

Bleeding 24 hours-12 weeks. postnatal

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70
Q

4Ts of pph

A

Atony
Trauma
Tissue
Thrombin

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71
Q

To stimulate uterine contraction we can:

A 
Uterine massage
Bimanual compression
Syntometrin
Oxytocin
Misoprosol
72
Q

Misoprostol type of prostaglandin

73
Q

Hemabate type of prostaglandin

74
Q

What type of suture for uterine compression?

75
Q

Other treatments for uterine compression

A

Rusch balloon
Bakn balloon
Internal iliac ligation
Artery embolization

76
Q

How long do we let first baby push and what rate should they dilate?

A

Dilate at .5cm an hour

Push for 2 hours

77
Q

How long do we let them push if they’ve had a kid and rate of progression?

A

1cm an hour please

push for 1 hour

78
Q

Latent phase

79
Q

Active phase

80
Q

Transition phase

81
Q

Second stage of labour

A

10cm to delivery to delivery of fetus

82
Q

third stage of labour

A

delivery of fetus to delivery of placenta.

83
Q

We want baby to come out

A

occiput anterior

84
Q

brow presentation

85
Q

face presentation

A

impossible

86
Q

Ventouse cups

A

Silastic
Metal
Omnicup

87
Q

Where do we put ventouse?

A

1cm before lambda

88
Q

Tachycardic fetus

A

baseline above 160
cocaine patients
induced by medication
infection

89
Q

Early decels

A

good

mimic contractions

90
Q

late decels

A 
BAD
not in sync with contraction
placenta praevia
insufficient praevia
decreased uterine blood flow
OXYGENATE MUM!
91
Q

Turn to left to:

A

reduce pressure on heart and vena caves

also keep bed low

92
Q

Suction ventouse

A

omnicup
ventouse
pump to 0.7bar

93
Q

Use metal ventouse when:

A

baby is higher up in birth canal
more difficult
baby’s head is deflexed

94
Q

Wrigleys

A

WLO

lift out

95
Q

Neville Barnes

A

mid/low cavity

96
Q

Kielland

kelly is spinning

A

baby is in posterior position

rotation

97
Q

Pudendal nerve block

A

Pudendal nerve runs parellel to ischial spines

98
Q

Degrees of tears

A
  1. skin
  2. muscle
  3. anal spincter
  4. Rectum
99
Q

Pregnancy induced hypertension

A

after 20 weeks.

100
Q

Mild, moderate, severe hypertension

A

140-149/90-99
150-159/100-109
160+/110+

101
Q

aspirin 75mg for

A

those at high risk of PET
Previous history/Diabetes/over 40/ CKD/multiple pregnancy
FROM 12 weeks

102
Q

Chronic hypertension in pregnancy

A

NO ACE aloud.

advice to stop 2 weeks before pregnancy too

103
Q

chronic hypertension after pregnancy

A

daily for the first 2 days after birth
at least once between day 3 and day 5 after birth
as clinically indicated if antihypertensive treatment is changed after birth.

104
Q

treat gestational hypertension with:

A

labetolol oral to get under 150/100 from moderate to severe

(no treatment for mild.

105
Q

Mild hypertension

A

don’t really do anything different.

106
Q

Women at high risk of pet

A

check their amniotic fluid and growth scan again at 28-30 weeks.

107
Q

Magnesium sulphate

A

loading dose of 4 g should be given intravenously over 5 minutes, followed by an infusion of 1 g/hour maintained for 24 hours
recurrent seizures should be treated with a further dose of 2–4 g given over 5 minutes.

108
Q

Barker hypothesis

A

IUGR and diseases later in life.

109
Q

causes of iugr

A

Advanced diabetes
High blood pressure or heart disease
Infections such as rubella, cytomegalovirus, toxoplasmosis, and syphilis
Kidney disease or lung disease
Malnutrition or anemia
Sickle cell anemia
Smoking, drinking alcohol, or abusing drugs

110
Q

consequences of iugr

A

Low birth weight
Difficulty handling the stresses of vaginal delivery
Decreased oxygen levels
Hypoglycemia (low blood sugar)
Low resistance to infection
Low Apgar scores (a test given immediately after birth to evaluate the newborn’s physical condition and determine need for special medical care)
Meconimum aspiration (inhalation of stools passed while in the uterus), which can lead to breathing problems
Trouble maintaining body temperature
Abnormally high red blood cell count

111
Q

maternal mortality

A

1 day gestation to 42 days after

112
Q

uk mmr

A

11/ 100,000

113
Q

rf for mmr

A

too old >35

too young 3

114
Q

puerperal sepsis

A

group a strep pyogenes

115
Q

Breech position

A

may try to adjust but may need C-section

116
Q

abnormal lie

A

ECV or C-section

117
Q

Hormones in labour

A

Cortisol up
oestrogen up
PGL up
oxytocin up

progesterone down

118
Q

Order to labour positions of baby

A 
Engagement
Descent
Flexion of head
Internal rotation 
Extension of head
RESTITUTION (45o rotation of head and 45o further external rotation)
Delivery of shoulders
119
Q

risk factors for pet

A 
1st baby (6x)
Multiple pregnancy (x3)
Family history (x3)
Previous history (x7)
Obesity
Age
120
Q

Renal in PET

A

Oliguria

ATN

121
Q

Liver in PET

A

right upper quadrent pain
vomiting
hepatic rupture
abnormal liver enzymes

122
Q

Lungs in PET

A

pulmonary oedema

123
Q

Blood in PET

A

low platelets

DIC

124
Q

Eclamptic fit can happen

A

post-partum

125
Q

when one twin dies we deliver the other at

126
Q

TRAP sequence

A

direct anastamosis?

pressure- reverse flow etc.

127
Q

Treatment for TRAP

A

laser ablation, bipolar cord diathermy

128
Q

TRAP levels

A
  1. bladder visible.
  2. bladder not visible.
  3. abnormal dopplers
  4. hydrops
  5. dead
129
Q

MC deliver from

130
Q

DC deliver from

131
Q

actim partus

A

IGF binding protein

endocervical

132
Q

Afosiban

A

inhibits oxytocin

delays labour

133
Q

foetal fibronectin

A

posterior fornix

134
Q

quadruple down’s test

A 
AFP
Oestroil
bhCG
inhibin-A
Cut off 1/150
135
Q

triple test

A

AFP
Oestriol
beta-hCG

136
Q

types of pain relief in labour

A

Gas and air
Pethidine/Diamorphine (takes 20 mins- lasts 2-4h)
Epidural

137
Q

Perinatal mortlaity

A

sillbirth and first 7 days

138
Q

neonatal mortality

A

first 4 weeks

139
Q

Prems have what type of lungs?

140
Q

SGA definition

A

<10th centile

141
Q

PE on ECG

A

S1Q3T3 inversion

142
Q

CTPA in pregnancy

A

increases breast cancer for mum

143
Q

V/Q in pregnancy

A

increases childhood cancer risk.

144
Q

Lactaction

A

During lactation, prolactin is the main factor maintaining tight junctions of the ductal epithelium and regulating milk production through osmotic balance

145
Q

late miscarriage

A

after 12 weeks before 24 weeks

146
Q

listeriosis

A

food poisoning

147
Q

heart burn from

148
Q

TTTS

A

in monotwins

149
Q

hyperthyroidism

150
Q

antiepileptics

151
Q

beta blockers

152
Q

Ideal HbA1c pre-conception

A

under 43mmol

153
Q

ogtt for mum

A

> 7 at 0 hours

>7.8 at 2 hours

154
Q

Fetal scalp blood monitoring

A

pH and lactacte

155
Q

Tocolytic S/C

A

Terbutaline

156
Q

Syntometrin contraindicated in:

A

high blood pressure and heart disease

use oxytocin instead

157
Q

First line treatment for diabetes

A

Insulin (if a drug is needed)

158
Q

Test for IUGR

A

Urterine artery doppler

159
Q

First fetal movements

A

1st timer: 18-20 weeks

2nd timer: 16-18 weeks

160
Q

Engagement usually happens

A

36-38 weeks.

161
Q

Chorionic villus sampling

A

diagnostic

after 10 weeks

162
Q

Amniocentesis

A

after 15 weeks

163
Q

Triploidy

A

three of everything!

Present with early PET

164
Q

Frontal bossing

A

beta thalassaemia

Achondroplasia

165
Q

Warfarin in different trimesters

A

1st. bone and cartilage
2nd. fine
3rd. blood
breast feeding- is ok

166
Q

Hydatidi

A

XS vomiting and large for dates

167
Q

Cleft palate caused by drug

A

phenytoin

phenytoin gives mums gingival hyperplasia

168
Q

Hyperemesis and your Hb

A

Will appear as HIGH hb as you are dehydrated

169
Q

Amniocentesis can pick up

A

neural tube defects (raised AFP levels in the amniotic fluid)
chromosomal disorders
inborn errors of metabolism

170
Q

Hyperemesis complications

A 
Hyperemesis and Wernickes encephalopathy!
Mallory-Weiss Tear
Central Pontine myelinolysis
ATN
Small baby, preterm
171
Q

How much does bp go up for hypertension?

A

an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

172
Q

oligohydramnios

A

<500ml amniotic fluid=oligohydramnios

Week 32-36

173
Q

Maternal hyPERthyroidism

A

-propylthiouracil has traditionally been the antithyroid drug of choice.
-maternal free thyroxine levels should be kept in the upper third of the normal reference range to avoid fetal hypothyroidism
thyrotrophin receptor stimulating antibodies should be checked at 30-36 weeks gestation - helps to determine risk of neonatal thyroid problems

174
Q

Maternal hyPOthyroidism

A

thyroxine is safe during pregnancy
serum thyroid stimulating hormone measured in each trimester and 6-8 weeks post-partum
some women require an increased dose of thyroxine during pregnancy
breast feeding is safe whilst on thyroxine

175
Q

Hyperechogenic bowel

A

cystic fibrosis
Down’s syndrome
cytomegalovirus infection

176
Q

Polyhydramnios

A

2-3 litres

RHCN (4 decks)

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