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Year 5 O&G > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Infertility risk factors

A 
Age >35
Smoking
Coital frequency (er, infrequency)
EtOH
Weight (high or low)
Drugs (NSAIDs, chemo, cimetidine, sulfasalazine, androgen injections)
Occupational hazards
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2
Q

Clomiphene

A

Helps induce ovulation

If >3 follicles develop (i.e. response too high), don’t complete cycle or avoid sex or may have multiple pregnancy

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3
Q

Tx-PCOS as cause infertility

A
  1. Clomiphene
  2. Metformin
  3. Recombinant LH/FSH
  4. Ovarian diathermy
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4
Q

Complications ovarian hyperstimulation

A 
Hypovolemia
Electrolyte disturbances
Ascites
Thromboembolism
Pulmonary edema
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5
Q

Female sterilization

A 
1/200 failure
Clips preferred method
If failure occurs-most likely ectopic
Both doc and woman must be satisfied that there will be no regret--older, completed family, disease contraindicates pregnancy
Can do IVF in future. 
Reversal not on NHS
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6
Q

Male sterilization

A

1/2000 failure–must wait for 2 semen-free analyses (may take up to 6/12)
Clips preferred method
Complications: infection, chronic pain, “sperm granulomas” (lump at end of vas)
Not associated with prostate or testicular cancer
Reversal not on NHS

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7
Q

Steps to assisted repro

A
  1. S/C gonadotrophins OD for 2/52 and HnRH analog/antag to prevent endogenous LH surge
  2. Ovulation and egg collection; single injection hCG or LH for oocyte maturation
  3. Incubate egg with washed sperm
  4. Transcervical uterine transfer
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8
Q

Causes female subfertility

A 
Anovulation
   Hypothalamic gonadism
   Hyperprolactinemia
   Hyper or hypo-thyroidism
   Adrenal hyperpalsia
   Ovarian causes (PCOS, gonadal dysgenesis)
Tubal factor
   Infxn
   Endometriosis
   Previous sx
Cervical factor
   Abs to sperm
   Inadequate mucus
   Cone biopsy
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9
Q

Causes male infertility

A 
Idiopathic
Varicocele
Abs
Genetic
Drug/chemical exposure
CF
kartageners
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10
Q

Complete mole

A

Two sperm (90%) or haploid sperm that duplicates (10%) and fertilizes empty ovum. 46XX or 46XY
Cystic swelling chorionic villi
No fetal tissue
Grape-like clusters/snowstorm appearance on USS
2-3% risk choriocarc

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11
Q

Partial mole

A

2 sets paternal, one maternal. 69XXY or 69XXX
Fetal tissue present
Minimal risk choriocarc

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12
Q

Choriocarcinoma mets

A

To lungs, liver, brain

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13
Q

RF gestational trophoblastic disease

A

Asian

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14
Q

Sxs-GTD

A

Amenorrhea, HMB, irregular bleeding, uterine enlargement greater than expected for dates, hyperemesis
Red flags: Dyspnoea, neuro sxs, abdo pain weeks-months after last pregnancy

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15
Q

Tx-GTD

A

Suction curettage if small enough

Medical evacuation if large (not if risk embolization/disseminated trophoblastic tissue through venous system)

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16
Q

Down’s screening

A 
Nuchal scan 11-14w
Combined test (nuchal, b-hCG, papp-a): 11-13+6w
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17
Q

Screening for gestational diabetes

A

If previous GDM: 16 week OGTT
Other risk factors: 24-28 weeks
Not routine screening
Glucose should be

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18
Q

RFs for pre-eclampsia

A 
Nullip
BMI>30
>40yrs
FHx pre-eclamp
Previous hx pre-eclamp
Multiple preg
Pre-existing renal or vascular disease
Pregnancy interval >10yrs
Autoimmune disease, e.g. antiphospholipid, SLE
Afro-Caribbean, Asian

NB smoking decreases risk so go wild

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19
Q

Indications for immediate health care advice (in terms pre-eclampsia)

A 
Severe HA
Vision problems, blurring, flashing
Severe pain just below ribs
Vomiting
Sudden swelling face, hands, feet
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20
Q

Pre-eclampsia

A

Proteinuria >0.3g/24 hrs

HTN

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21
Q

Vasa previa

A

Fetal BVs cross/run near external orifice of uterus. At risk rupture when membranes rupture….can lead to fetal exsanguination/death
RF: multiple gestation, IVF
triad: membrane rupture, painless vaginal bleeding, fetal bradycardia
Tx: immediate emergency CS

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22
Q

Placenta previa

A

Leading cause APH (1/3 cases)
“Low lying palcenta”
Grades I-IV
Sxs: painless bright red vaginal bleeding, oft around 32/40. Suspect this dx if bleeding after 24/40
May also present with failure engagement
Dx: US. TVUS>TAUS
Tx: if grades I, II can do vaginal birth. Placenta must be >2cm from os…have consultant and anesthetist present
‘Roids 24-34/40 if bleeding in case pre-term
CS if high grade or fetal/maternal disress
No CS if DIC–may require hysterectomy

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23
Q

Point at which gestational sac seen on TVUSS

A

4-5 weeks

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24
Q

Point at which yolk sac seen on TVUSS

A

5 weeks

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25
Q

Point at which embryo seen on TVUSS

A

5-6 weeks

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26
Q

Point at which heart beat seen on TVUSS

A

6 weeks

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27
Q

Threatened miscarriage

A

Bleeding in early pregnancy

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28
Q

Inevitable miscarriage

A

Cervix open

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29
Q

Complete miscarriage

A

Successfully expelled all pregnancy tissue
Early weeks-like heavy period
Late first tri-may resemble sac

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30
Q

Incomplete miscarriage

A

Partially expelled.

Heavy bleeding and cramping

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31
Q

Missed miscarriage

A

Preg tissue dies but not expelled.
No fetal heart, devel
Empty gestational sac

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32
Q

CVS

A

Aka CVB (B=biopsy)
Biopsy trophoblast cells from developing placenta
From 11 weeks
2% risk MC

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33
Q

Amniocentesis

A

15-20mL amniotic fluid sampled (contains amniocytes and fibroblasts shed from fetus)
From 15 weeks
1% risk MC

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34
Q

Cordocentesis

A

From 20 weeks.
Can get fetal blood and full culture for karyotype
2-5% risk MC

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35
Q

Quad screen results for Downs

A

Decreased AFP and estriol
Increased b-HCG and inhibin A

(Also decreased PAPP-A)

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36
Q

Ectopic pregnancy:
RFs
H&E

A

Roughly 1%
95% in fallopian tubes
RFs: anything that causes tubal scarring–PID, previous ectopic, pelvic surgery (esp tubal), smoker
Hx: lower abdo pain, scanty dark vaginal bleeding.
Syncope and shoulder tip pain if intraperitoneal blood loss

May have abdo and rebound tenderness, cervical excitation (PID), tender adnexa, smaller uterus than expected, closed os
If positive for hCG and uterus empty, quantify hCG

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37
Q

Management ectopics

A

If small,unruptured, location unclear, hCG

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38
Q

Dizygotic twins: #amnions, chorions

A

Always dichorionic, diamniotic

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39
Q

Monozygotic twins: # amnions, chorions

A 
Depends on when egg splits:
Days 1-3: DCDA
4-8: MCDA
8-13: MCMA
13-15: conjoined
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40
Q

Which is more dangerous: monochorionic or dichorionic

A

Monochorionic

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41
Q

RF twins

A

IVF, older mother, high parity, Afro-Caribbean, maternal FHx

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42
Q

Twin-Twin transfusion

A

In monochorionic–placental vascular anastamoses
Donor: hypovolemia, oliguria, oligohydram
Recipient: hypervolemia, polyuria, polyhydram, myocardial damage, high output failure

Can drain large volumes amniotic fluid every 1-2w

43
Q

Post-partum hemorrhage: management

A

ABC, fluid resusc, oxytocin (40 units in 500mL saline over 4hrs)
Uterine massage, bimanual compression
VE for tears-compress
Ergometrine, PGF2alpha, misoprostol (uterine contrac)
Catheter
FFP, paltelets, cryoprecip
Sx: uterine tamponade, occlude uterine vessels, iliac artery ligtion, uterine compression sutures, hysterectomy

44
Q

Mechanism pre-eclampsia

A

BV endothelial damage–exaggerated inflamm response causing vasospasm, increased capillary permeability, clotting dysfunction

45
Q

Maternal complications pre-eclampsia

A 
Eclampsia
Cerebrovascular hemorrhage
HELLP syndrome
DIC, liver failure, liver rupture
Renal failure
Pulmonary edema -->ARDS
46
Q

Fetal complications of pre-eclampsia

A 
IUGR
Pre-term delivery
Stillbirth
Abruption
Hypoxia
47
Q

Indications for 75mg aspirin treatment from 16/40

A 
Hypertensive disease in previous preg
CKD
AI (antiphosph syndr, SLE)
DM
Chronic HTN
48
Q

Urgent delivery in pre-eclampsia

A 
Persistent BP >160/100 with signif proteinuria
HELLP
Eclampsia
Anuria
Significant fetal distress
49
Q

Delivery: mild pre-eclampsia

A

By 37/40

50
Q

Delivery moderate-severe pre-eclampsia

A

34-36/40

51
Q

Delivery severe pre-eclampsia with fetal distress

A

Deliver regardless of gestational date

52
Q

First line for HTN in pregnancy

A

Nifedipine PO

53
Q

First line severe HTN in pregnancy

A

Labetalol IV

54
Q

Why isn’t methyldopa first line for HTN in pregnancy

A

While has longest record of safety takes 24 hrs to work

55
Q

Prevention and treatment seizures (eclampsia)

A

MgSO4

56
Q

Tx-GDM

A
  1. Diet and exercise (most ok with only this)
  2. Insulin (doesn’t cross placenta)
  3. Metformin
  4. Other oral hypolycemics (glibencamide)
57
Q

Pre-existing DM

A

RETINAL SCAN booking and 28/40

Renal assessment and booking, refer if Cr>120 umol/

58
Q

Complications GDM

A 
Oligohydr causing pre-term delivery
Neonatal hypoglycemia
Big baby (shoulder dystocia)
Fetal RDS (insulin inhibits surfactant)
59
Q

Pulmonary hypertension before conception

A

Don’t conceive. If you do, get abortion.

Extremely high maternal mortality. Pregnancy contraindicated

60
Q

Metal valves in pregnancy

A

Only indication for warfarin despite teratogenicity

61
Q

Asthma in pregnancy

A

Meds safe

Same chance asthma will improve, stay same, or deteriorate

62
Q

Thyrotoxicosis in pregnancy

A

No radioactive iodine

Carbimazole or PTU in smallest dose possile

63
Q

Epilepsy in pregnancy

A

Continue meds. Add 5mg folic acid
Avoid valproate if possible.
Carbamazepine, lamotrigine safest
If no seizures in >2 years, can consider stopping
Seizure control can deteriorate in preg and labor..can cause maternal death

64
Q

MS in pregnancy

A

Can use a;; MS drugs except cyclophosphamide and MTX

65
Q

Migraine in pregnancy

A

Usually improve in pregnancy
Analgesics, anti-emetics, trigger avoidance
If severe–low dose aspirin, beta blockers

66
Q

Acute fatty liver in pregnancy

A

May be a part of pre-eclamp
High maternal and fetal mortality
Sxs: malaise, vomiting, jaundice, epigastric pain (early), thirst
tx: correct clotting defects, hypoglycemia. Supportive: dextrose, blood, fluid balance, maybe dialysis

67
Q

Intrahepatic cholestasis in pregnancy

A

Itching without rash, abn LFTs. FAmilial
50% recurrence
Risk sudden stillbirth, preterm delivery
Tx: monitor LFTs. Vit K 10mg/day
UCDA decreases itching and reduces obs risk
Advice induction at 38/40
Consultant care

68
Q

Antphospholipid syndrome

A

Lupus anticoagulant and/or anticardiolipin Abs (measured twice, 3/12 apart)
Associated with adverse preg outcomes, incl RMC
PLACENTAL THROMBOSIS

69
Q

SLE in preg

A

Steroids, azathioprine, sulfasalazine, hydroxychloroquine ok in preg. Avoid NSAIDs 3rd tri
Aspirin, LMWH antenatally and 6/52 post-natally
Manage preg as v high risk: serial USS, elective IOL by at least term

70
Q

Combined test for Downs

A

USS (NT)

Blood: PAPP-A, beta HCG

71
Q

Breast cancer in pregnancy

A

Tricky.
If earlier, may consider termination
Tamoxifen contraindicated
Radiotherapy contraindicated unless life saving
Chemo potentially teratogenic but may be used mid to third trimester….deliver minimum 2-3w after last treatment

72
Q

Placenta accreta

A

Firm adhesion placenta to uterine wall without extending through full myometrium

73
Q

Placenta increta

A

Extends through full myometrium

74
Q

Placenta percreta

A

Extends through myometrium and beyond

75
Q

RF -accreta,increta, percreta

A

Uterine scar tissue, e.g. Ashermans

76
Q

Routine infection tests in pregnancy

A

HIV
Syphilis
Rubella
HBV

77
Q

First line treatment for PPH

A

Fluid resuscitation, oxytocin, uterine massage

78
Q

First line treatment for PPH didn’t work. Now what?

A

IV ergometrine and bimanual uterine compression

79
Q

Tx-Bartholins

A

Marsupialization

80
Q

IVF risks

A

Increased risk ectopics, congenital abnormalities, multiple pregnancy, SGA babies, low birth weight babies
If donor eggs, increased risk PIH

81
Q

Initial subfertility tests

A

Day 1-3 LH and FSH
Mid-luteal progesterone
Semen analysis

82
Q

Normal semen analysis

A 
1.5-6mL
pH 7.2-8
>4% normal morphology
>15million sperm/mL
50% have normal motility
83
Q

Ovarian hyperstimulation syndrome

A

Due to ovarian stimulation in IVF
Abdo pain, swelling, vomiting

Hemoconcentration, hypoproteinemia, ascites
Enlarged ovaries
High risk VTE
Oliguria if severe

84
Q

Suspicious CTG

A

1 non-reassuring feature

85
Q

Pathological CTG

A

2 non-reassuring or 1 abn feature

86
Q

Non-reassuring CTG features

A

HR 160-180 or 100-109

Variability

87
Q

Abnormal CTG features

A

HR >180 or 90min
Single prolonged decel >3min
Atypical variable decels

88
Q

Management suspicious CTG

A

Fetal blood sampling.

Deliver if abnormal

89
Q

Management cord prolapse

A

Help help help
Deliver immediately in theatre
If cervix not fully dilated–CS
Elevate presenting part with midwive’s hand or fill up bladder (reduces compression on cord)

90
Q

Induction for stillbirth

A

Mifepristone (cervical ripening)

Misoprostol (contractions)

91
Q

Turtleneck sign

A

Head delivered but then appears to retract

Heralds shoulder dystocia

92
Q

Management shoulder dystocia

A

McRobert’s position
(Flexion everything)
In majority of cases, baby will spontaneously deliver this way

93
Q

Management uterine rupture during normal labor

A

Crash CS with subsequent repair uterus.

94
Q

Risks for third degree tears

A 
Forceps and ventouse 
2nd stage >1hr
Shoulder dystocia
Big baby (>4kg)
Primip
Induction
OP position
Midline episiotomy
95
Q

Management PPROM

A

10 days Abx to prevent chorioamnionitis
Roids
Expectant management until 34w

96
Q

Management PE in pregnancy

A

Enoxaparin (clexane)

97
Q

Vasa previa

A

At time rupture of membranes

Painless bleed and sudden fetal demise

98
Q

Management RhD negative woman if dad is also RhD negative

A

Still give anti-D because 1/10 “dads” aren’t the actual father…. :/

99
Q

HSV (genital) in pregnancy

A

No vaginal deliveries for six weeks. Do CS

if refuses, give IV acyclovir during labor and tell her she’s a bad person

100
Q

Obstructive cholestasis

A

Itching and deranged LFTs, esp bile acid (>20)
Main concern is stillbirth. Increase in pre-term labor and mec-stained liquor
UDCA decreases pruritis and bile acids but no evidence it reduces stillbirths
Continuous CTG

101
Q

Management eclamptic fit

A

Help help help
Lie woman flat and in left lateral position
Prepare MgSO4

102
Q

Travel to malaria-endemic region during pregnancy—prophylaxis

A

Chloroquine
Proguanil if take 5mg folate
Caution with mefloquine

Do not use malarone, doxy

103
Q

First line hyperemesis gravidarum

A

Promethazine (anti-histamine)

104
Q

Causes hyperechogeniec bowel

A

CF
Down’s
CMV infection

Year 5 O&G (2 decks)

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