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Obs & Gynae > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Screening for Gestational Diabetes

A

GTT in high risk @ 10-18 weeks. 75g glucose, >7 at fasting or >7.8 at 2h = Gestational diabetes
Controlled in 60% with metformin and diet

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2
Q

Risk factors of gestational diabetes

A 
Previous or family history of any type of diabetes
>100kg
Previous macrosomic baby
PCOS
Persistent glycosuria
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3
Q

GDM complications

A

Maternal: pre-eclampsia and HD, diabetes risks, operative delivery
Fetal: premature, lung immaturity, dystocia, CV and NT defects

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4
Q

GDM management

A

Anomaly and cardiac scan
Fetal surveillance and glucose control
Long acting + short preprandial insulin (increaseing doses)
75mg aspirin from 12 wks to prevent PEclampsia
LSCS/Induce @39 wk unless well controlled
Postnatal GTT at 3m, 50% diabetes in next 10y

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5
Q

Incidence and types of VTE in pregnancy

A

6 fold increase in pregnancy (clotting factor increase, fibrinolytic decrease and blood flow altered)
Pulmonary embolus - VQ/CT dx, 0.3% pregnancies 1% mortality
DVT: D-dimer raised in pregnancy anyway, 1% of pregnant women

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6
Q

Management of VTE in pregnancy

A

Antenatal prophylaxis - not common, only v.high risk ie previous thrombosis
Event: use LMWH, stop if possible before birth and restart after birth
Postpartum prophylaxis: 50% of mortality - commonly used LMWH or warfarin for 6 weeks

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7
Q

What infections are screened for in pregnancy?

A

Hep B, rubella, CMV, syphilis, (chlamydia, BV and Strep B)

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8
Q

Which infections are teratogenic?

A

CMV, toxoplasmosis, syphilis, Zoster, Rubella

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9
Q

CMV in pregnancy

A

Vertical transmission common, amniocentesis for dx at 20weeks. Not done as amnio more dangerous than CMV (10% severely affected at birth)

Deafness, pneumonia, thrombocytopenia, IUGR
Termination offered on fetal blood sampling if high risk of severe defect

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10
Q

Rubella in pregnancy

A

Rare due to immunity

16wk: v low risk

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11
Q

Toxoplasmosis in pregnancy

A

Neural problems: fits, spasticity, mental ret
Rare and treated with spiromycin for mum, combo therapy for baby
Dx on maternal IgM or amnio for fetal

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12
Q

Syphilis in pregnancy

A

Rare now due to screening and simple benzylpenicillin tx

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13
Q

HSV in pregnancy

A

Can cause severe neonatal infection if inf within 6wk of delivery or vesicles at delivery so section. Aciclovir for mum and baby

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14
Q

Group A strep in pregnancy

A

50% maternal death in puerperal sepsis - High dose Abx and ITU, often fetal death

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15
Q

Group B strep in pregnancy

A

Maternal carrier = penicillin treatment for high risk or 3rd trimester +ve
Major cause of severe neonatal illness 6% term, 18% preterm

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16
Q

Herpes Zoster in pregnancy

A

Severe maternal infection, can cause baby infection if no Ig given, aciclovir if infected, teratogenic occasionally

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17
Q

Hep B in pregnancy

A

Carriage in high risk women, can cause chronic infection in neonate - universal screening for Ig requirement of neonate

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18
Q

Chlamydia and BV

A

Preterm labour - treat as per

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19
Q

Parvovirus B19 in pregnancy

A

Infection

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20
Q

HIV in pregancy

A

Maternal preeclampsia and GDM risk increased
Fetal stillbirth, IUGR and prematurity
Don’t breast feed, neonates with HIV 40% AIDs by 5 yr

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21
Q

Definition and causes of APH

A

Bleeding after 24wks from the genital tract

Placenta Praevia, abruption
Uterine rupture, vasa praevia

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22
Q

Placenta praevia definition

A

Low lying placenta in lower segment, 1 in 10 if early pregnancy become placenta praevia later (>2cm from os = marginal, over os = major)

23
Q

Complications of Placenta Praevia

A

Haemorrhage
Prevents engagement - transverse lie
Accreta
Preterm deliery

24
Q

Presentation and Ix of Pl.Praevia

A

Hx: Painless bleeding
Ex: don’t do vaginal examination!, abnormal lie is common
Ix: USS dx, low lying found at 2nd trimester, USS at 32weeks, prepare for accreta/praevia if

25
Q

Definition of abruption

A

Separation of placenta from uterus (partial or complete) before delivery

26
Q

Causes of abruption

A 
Idiopathic
IUGR
Pre-eclampsia
Autoimmune
Smoking
Previous abruption
27
Q

Complications of abruption

A

Fetal death
Haemorrhage
Renal failure
Maternal shock and death

28
Q

Hx and Ex of abruption

A

PAINFUL bleeding - may be concealed

Ex: Signs of shock, woody or tender uterus, FHR absent or abnormal

29
Q

Management of P.Praevia

A

Admit if bleeding + PP on USS or from 37wks if asyx

Blood stopped 37weeks = LSCS, blood transfusion, PPH preparation

30
Q

Abruption management

A

CTG abnormal: delivery via emergency section
Dead fetus: Induce and give bloods
Normal CTG 37: Induce unless small painless bleed, amniotomy, section

31
Q

Polyhydramnios definition

A

> 10cm considered abnormal - variable between women, 1% of pregnancies

32
Q

Polyhydramnios aetiology

A

Maternal disease (renal/GDM)
Twins
Molar pregnancy
Idiopathic

33
Q

Clinical features and complications of polyhydramnios

A

Maternal discomfort, lie hard to feel

Preterm delivery, abnormal lie

34
Q

Management of polyhydramnios

A

Dx on USS

Reduce liquor if

35
Q

Oligohydramnios definition

A
36
Q

Causes of oligohydramnios

A

Fetal urinary tract abnormal
Uteroplacetnal insufficiency
Dehydration
ACE inhibitors

37
Q

Oligohydramnios features, complications and mgmt

A

Small for dates, easy to feel fetus
Cord compression, MSK abnormalities, IUGR
Maternal hydration, amnioinfusions to prevent cord compression in labour

38
Q

Management of small for dates fetus

A

Monitor growth - no intervention if normal umbilical doppler
IUGR: deliver at term
34-37wks: regular umb doppler, CTG, consider delivery

39
Q

Management of large for dates

A

Reduce liquor volume if polyhyd

steroids

40
Q

Causes of fetal perinatal mortality

A

Prematurity
IUGR
Pre-eclampsia
INfection/malformation/hypoxia

41
Q

Gestational diabetes definition

A

Increased maternal insulin resistance and antagonistic lactogen, progesterone and cortisol = glucose tolerance impaired in pregnancy
Resolves post delivery. Raised fetal glucose = macrosomia

42
Q

Definition of subfertility

A

Failure to conceive after one year of regular unprotected sex
(declines with age due to reduced genetic quality of oocytes rather than ovulatory problems)

43
Q

Causes of anovulation

A 
PCOS
Hypothal hypogonad
Hyperprolactinaemia
Thyroid dysfunction
Ovarian failure
44
Q

Causes of male factor infertility

A 
Drug exposure (alcohol, smoking, anabolic steroids)
Genetic
Antisperm antibodies
Varicocele
Idiopathic
45
Q

Tubal causes of infertility

A

Surgery (adhesions)
infection
EMosis

46
Q

Investigations for anovulation

A

Regular cycle = ovulation
High mid luteal progesterone = ovulation
USS for drop in follicular size = ovulation
Urine LH for surge

47
Q

Ix for the causes of anovulation

A

Prolactin, TSH
Basal FSH: high in ov. failure, normal in PCOS, low in hypohypo
LH: raised in PCOS
Testosterone: raised in PCOS

48
Q

Male factor infertility investigations

A 
Semen analysis: 
Volume >2ml
count >20million/ml
progressive motility >50%
Repeat if abnormal
49
Q

Tubal factor infertility Ix

A

Laparoscopy and dye 1st line

Hysterosalpingogram 2nd line

50
Q

Treatment for subfertility

A

Anovulation: treat cause ie PCOS
Male factor: usually impossible and IVF needed
Tubal: ie EMosis removal, IVF if surgery fails
Unexplained: IVF

51
Q

PCOS definition

A

> 12 small follicles on ovaries with ovaries generally enlarged
2 of 3: PCO on scan, irregular periods, hirsutism and or XS body hair/acne

52
Q

Treatment of PCOS

A

If asyx: nothing but advise weight loss
Anovulation: clomifene 1st line (oest antag = inc FSH and LH then cycle take over
Metformin, FSH and LH replacement, IVF, ovarian diathermy
If menstrual problems: COCP
Acne: COCP +- cyproterone/spironolactone/eflornithine

53
Q

Tx of hyperprolactinaemia

A

Dopamine –> inhibits prolactin release

Obs & Gynae (3 decks)

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