Obstetrics Flashcards
0
Q
Semen in miscarriages
A
Not analyses
1
Q
Diagnosis of pregnancy
A
Pregnancy test urine dip
2
Q
Entropy on caused by
A
Pregnancy
Pill
Puberty
3
Q
Fixed, retro verged uterus and tender
A
Endometriosis
4
Q
Pcos hormones
A
Lh:fsh of 3
5
Q
How many cross units for pph?
A
6 units of blood
6
Q
Zoladex
A
Goserelin
Lhrh agonist
Endometriosis
7
Q
Non sexually active teen
A
Mefanamic acid
NSAID
8
Q
Post menopausal bleeding
A
Cervical cancer
Endometrial cancer
Endometrial polyp
Strophic vaginitis
9
Q
Dysmenoorhoe
A
Endometriosis IUCd Pid Pcos Ovarian cancer Sexual abuse
10
Q
Deep dyspareunia
A
Pid
Endometriosis
Ectopic
Ovarian cancer
11
Q
Post coital bleeding
A
Polyp Ectoprocta Cervical cancer Infection Torch
12
Q
Ovarian cancer marker
A
Ca125
13
Q
High hCG
A
Choriocarcinoma
Hyperemesis
Hydatidiform
14
Q
Give anti d at:
A
28 and 34 weeks
15
Q
Indications for anti d
A
Spontaneous miscarriage after 12 weeks
16
Q
Bloods raised in pregnancy
A
Alk phos Fibrinogen Factors 7, 8, 10 Red cell mass D dimer Urea White cell
17
Q
Syntometrin
A
Helps uterus contract
Nomal blood pressure
18
Q
Syntocynin
A
Helps uterus contract
High blood pressure
19
Q
Misoprostol
A
Helps efface the cervix
Used to induce labour or for abortion
(Oxytocin doesn’t help with cervix
Prostaglandin e analogue
20
Q
Mifepristal
A
Anti progesterone and anti glucocorticoid
Abortion agent
Helps with labour
21
Q
Hemabate
A
Prostaglandin
Used b
In atonic pph
22
Q
Tibalone
A
Endometriosis
Hrt
Oestrogen
23
Q
Danazol
A
Low oestrogen
High androgen
Endometriosis
24
Clomiphine
Used in amenorrhea
| Stimulates ovulation
25
Surfactant develops
34/35 weeks
26
Perinatal mortality
Pregnancy and a week
27
Neonatal mortality
Day 1-28
28
Neonatal jaundice
First 24 h
29
hCG doubles every:
24 hours
30
Should see a fetal pole with hCG IS
1500
31
Most effective contraceptive?
Implanon
32
Fluid restrict in pet
Less than 85ml per hour
33
Hyperemesis most in
First 12 weeks
34
Decapaptyl
Gnrh agonist
35
Ovulation when oestrogen reaches
800-1200 mmol
36
Ovulation when follicles size
18-25mm
37
How many days before next period does ovulation happen?
14 days
38
Follicular phase
9 to 21 days
39
Contraception for breast feeding
Pop
40
Contraception for breast cancer
Copper coil
41
Larc definition
Less than monthly
42
Parity includes
Any still births after 24 weeks
43
Primary ammenorhoe age
Over 16
44
Threshold for pregnancy test
25 or 50 mlU
45
Booking appointment at
8-12 weeks
46
Appointments during pregnancy
```
Booking
10
20
25
28
31
34
36
38
40
41
```
47
Cleft on anomaly scan
Can see cleft lip
| Cleft palat more difficult
48
Congenital rubella
```
eye problems, such as cataracts (cloudy patches on the lens of the eye)
deafness
heart abnormalities
brain damage
First 20 weeks
```
49
Gestational diabetes
After 20 weeks
| Blood test at 28 weeks
50
Gestational diabetes before
Get ogtt done earlier at 18 weeks
| Then again at 28
51
Pregnancy induced hypertension starts
After 32 weeks
52
How many women get hypertension in pregnancy?
10%
53
How many get pet in pregnancy
2-5%
54
How many get eclampsia?
1%
55
Control of glucose most important in the first
8-10 weeks
56
Vitamin a
Potent teratogen
57
Folic acid
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).
58
Avoid sauna
Fetal hyperthermia
59
Opiate addiction in pregnancy
intrauterine growth restriction and preterm delivery. This contributes to an increased rate of low birth weight and perinatal mortality.
60
Varicella in pregnancy
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.
62
Increased maternal age
```
Downs.
miscarriage,
twins,
fibroids,
hypertension,
gestational diabetes,
labour problems
perinatal mortality with increasing maternal age.
```
62
Hypertension in pregnancy
May be related to increased aldosterone
63
Hormones in pregnancy
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.
64
Hematology pregnancy
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.
66
Kidney and pregnancy
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.
67
Peurperium
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.
68
PPH definition
first 24 hours is primary
minor 500-1l
major is more than a litre
69
secondary PPH
Bleeding 24 hours-12 weeks. postnatal
70
4Ts of pph
Atony
Trauma
Tissue
Thrombin
71
To stimulate uterine contraction we can:
```
Uterine massage
Bimanual compression
Syntometrin
Oxytocin
Misoprosol
```
72
Misoprostol type of prostaglandin
PGE1
73
Hemabate type of prostaglandin
PGE2alpha
74
What type of suture for uterine compression?
B-Lynch
75
Other treatments for uterine compression
Rusch balloon
Bakn balloon
Internal iliac ligation
Artery embolization
76
How long do we let first baby push and what rate should they dilate?
Dilate at .5cm an hour
| Push for 2 hours
77
How long do we let them push if they've had a kid and rate of progression?
1cm an hour please
| push for 1 hour
78
Latent phase
3-4cm
79
Active phase
4cm-8cm
80
Transition phase
8cm-10cm
81
Second stage of labour
10cm to delivery to delivery of fetus
82
third stage of labour
delivery of fetus to delivery of placenta.
83
We want baby to come out
occiput anterior
84
brow presentation
possible
85
face presentation
impossible
86
Ventouse cups
Silastic
Metal
Omnicup
87
Where do we put ventouse?
1cm before lambda
88
Tachycardic fetus
baseline above 160
cocaine patients
induced by medication
infection
89
Early decels
good
| mimic contractions
90
late decels
```
BAD
not in sync with contraction
placenta praevia
insufficient praevia
decreased uterine blood flow
OXYGENATE MUM!
```
91
Turn to left to:
reduce pressure on heart and vena caves
| also keep bed low
92
Suction ventouse
omnicup
ventouse
pump to 0.7bar
93
Use metal ventouse when:
baby is higher up in birth canal
more difficult
baby's head is deflexed
94
Wrigleys
WLO
| lift out
95
Neville Barnes
mid/low cavity
96
Kielland
| kelly is spinning
baby is in posterior position
| rotation
97
Pudendal nerve block
Pudendal nerve runs parellel to ischial spines
98
Degrees of tears
1. skin
2. muscle
3. anal spincter
4. Rectum
99
Pregnancy induced hypertension
after 20 weeks.
100
Mild, moderate, severe hypertension
140-149/90-99
150-159/100-109
160+/110+
101
aspirin 75mg for
those at high risk of PET
Previous history/Diabetes/over 40/ CKD/multiple pregnancy
FROM 12 weeks
102
Chronic hypertension in pregnancy
NO ACE aloud.
| advice to stop 2 weeks before pregnancy too
103
chronic hypertension after pregnancy
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
treat gestational hypertension with:
labetolol oral to get under 150/100 from moderate to severe
(no treatment for mild.
105
Mild hypertension
don't really do anything different.
106
Women at high risk of pet
check their amniotic fluid and growth scan again at 28-30 weeks.
107
Magnesium sulphate
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
Barker hypothesis
IUGR and diseases later in life.
109
causes of iugr
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
consequences of iugr
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
maternal mortality
1 day gestation to 42 days after
112
uk mmr
11/ 100,000
113
rf for mmr
too old >35
| too young 3
114
puerperal sepsis
group a strep pyogenes
115
Breech position
may try to adjust but may need C-section
116
abnormal lie
ECV or C-section
117
Hormones in labour
Cortisol up
oestrogen up
PGL up
oxytocin up
progesterone down
118
Order to labour positions of baby
```
Engagement
Descent
Flexion of head
Internal rotation
Extension of head
RESTITUTION (45o rotation of head and 45o further external rotation)
Delivery of shoulders
```
119
risk factors for pet
```
1st baby (6x)
Multiple pregnancy (x3)
Family history (x3)
Previous history (x7)
Obesity
Age
```
120
Renal in PET
Oliguria
| ATN
121
Liver in PET
right upper quadrent pain
vomiting
hepatic rupture
abnormal liver enzymes
122
Lungs in PET
pulmonary oedema
123
Blood in PET
low platelets
| DIC
124
Eclamptic fit can happen
post-partum
125
when one twin dies we deliver the other at
34 weeks
126
TRAP sequence
direct anastamosis?
| pressure- reverse flow etc.
127
Treatment for TRAP
laser ablation, bipolar cord diathermy
128
TRAP levels
1. bladder visible.
2. bladder not visible.
3. abnormal dopplers
4. hydrops
5. dead
129
MC deliver from
36 weeks
130
DC deliver from
37 weeks
131
actim partus
IGF binding protein
| endocervical
132
Afosiban
inhibits oxytocin
| delays labour
133
foetal fibronectin
posterior fornix
134
quadruple down's test
```
AFP
Oestroil
bhCG
inhibin-A
Cut off 1/150
```
135
triple test
AFP
Oestriol
beta-hCG
136
types of pain relief in labour
Gas and air
Pethidine/Diamorphine (takes 20 mins- lasts 2-4h)
Epidural
137
Perinatal mortlaity
sillbirth and first 7 days
138
neonatal mortality
first 4 weeks
139
Prems have what type of lungs?
Saccular
140
SGA definition
<10th centile
141
PE on ECG
S1Q3T3 inversion
142
CTPA in pregnancy
increases breast cancer for mum
143
V/Q in pregnancy
increases childhood cancer risk.
144
Lactaction
During lactation, prolactin is the main factor maintaining tight junctions of the ductal epithelium and regulating milk production through osmotic balance
145
late miscarriage
after 12 weeks before 24 weeks
146
listeriosis
food poisoning
147
heart burn from
12 weeks
148
TTTS
in monotwins
149
hyperthyroidism
preterms
150
antiepileptics
NTDs
151
beta blockers
IUGR
152
Ideal HbA1c pre-conception
under 43mmol
153
ogtt for mum
>7 at 0 hours
| >7.8 at 2 hours
154
Fetal scalp blood monitoring
pH and lactacte
155
Tocolytic S/C
Terbutaline
156
Syntometrin contraindicated in:
high blood pressure and heart disease
| use oxytocin instead
157
First line treatment for diabetes
Insulin (if a drug is needed)
158
Test for IUGR
Urterine artery doppler
159
First fetal movements
1st timer: 18-20 weeks
| 2nd timer: 16-18 weeks
160
Engagement usually happens
36-38 weeks.
161
Chorionic villus sampling
diagnostic
| after 10 weeks
162
Amniocentesis
after 15 weeks
163
Triploidy
three of everything!
| Present with early PET
164
Frontal bossing
beta thalassaemia
| Achondroplasia
165
Warfarin in different trimesters
1st. bone and cartilage
2nd. fine
3rd. blood
breast feeding- is ok
166
Hydatidi
XS vomiting and large for dates
167
Cleft palate caused by drug
phenytoin
| phenytoin gives mums gingival hyperplasia
168
Hyperemesis and your Hb
Will appear as HIGH hb as you are dehydrated
169
Amniocentesis can pick up
neural tube defects (raised AFP levels in the amniotic fluid)
chromosomal disorders
inborn errors of metabolism
170
Hyperemesis complications
```
Hyperemesis and Wernickes encephalopathy!
Mallory-Weiss Tear
Central Pontine myelinolysis
ATN
Small baby, preterm
```
171
How much does bp go up for hypertension?
an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic
172
oligohydramnios
<500ml amniotic fluid=oligohydramnios
| Week 32-36
173
Maternal hyPERthyroidism
-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
Maternal hyPOthyroidism
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
Hyperechogenic bowel
cystic fibrosis
Down's syndrome
cytomegalovirus infection
176
Polyhydramnios
2-3 litres
