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3 Women's Health EJR > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

how is SGA determined

A

<10% on customised growth chart

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2
Q

what does a customised growth chart take into account

A 
mothers BMI
parity
ethnicity
previous birth weights
single/multiple pregnancy
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3
Q

what are some constitutional causes of SGA

A

asian ethnicity, low maternal BMI, nulliparity and female fetal gender

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4
Q

what are some maternal causes of IUGR

A

existing disease like CVS, renal, hypertension, celiacs, diabetes

or smoking/drug use

malnutrition, low BMI

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5
Q

what are some uteroplacental causes of IUGR

A

pre-eclampsia, multiple pregnancy, uterine malformations, placental insufficiency

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6
Q

what are some fetal causes of SGA

A

female fetuses, chromosomal abnormalities, vertically transmitted infections

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7
Q

some complications of SGA and IUGR

A

stillbirth, c-section, long term handicaps, fetal distress

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8
Q

only reduced fetal movements mean that the baby is IUGR - true or false

A

false, only a very poorly baby will stop moving,

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9
Q

how is IUGR diagnosed?

A

ultrasound scan

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10
Q

management of SGA at preterm and at >37 weeks

A

preterm - growth rechecked in 2-3 weeks interval

> 37 weeks, induced or if umblical dopplers are normal and above 3rd centile, wait for due date

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11
Q

management of IUGR <34 weeks

A

repeat dopplers twice a week, if abnormal and <32 weeks, C section, if <32 weeks, CTG monitoring and deliver with fetal in distress.

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12
Q

what should the mother be given if she delivers before 34 weeks

A

magnesium sulphate

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13
Q

management of IUGR between 34-37 weeks

A

if normal doppler, wait till 37 weeks.

if abnormal, then induce or c-section if CTG is abnormal

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14
Q

management if IUGR after 37 weeks

A

induce if normal CTG, csection if abnormal

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15
Q

which ages are most common for endometrial cancer

A

50-60s, most are postmenopausal

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16
Q

the screening program for endometrial cancer is effective - T or F

A

False, there is no such thing

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17
Q

what is type 1 and type 2 endometrial cancers

A

type 1 is estrogen sensitive, obesity related, low grade endometroid cells and slow growing

type 2 are estrogen insensitive, not obesity related, faster growing an usually high grade endometroid, clear cell, serous or carcinosarcomas

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18
Q

what is the main risk factor for endometrial cancer

A

endogenous and exogenous estrogen exposure

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19
Q

examples of endogenous estrogen exposure that can increase risk of endometrium cancer

A 
PCOS
high BMI
nulliparity
early menarche/late menopause
older age
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20
Q

examples of exogenous estrogen exposure that can increase risk of endometrium cancer

A

unopposed estrogen therapy HRT without progesterone

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21
Q

typical endometrial hyperplasias should be treated immediately - T or F

A

false, most regress and don’t progress to cancer

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22
Q

presentations of someone with endometrial cancer

A 
postmenopausal bleeding
post coital bleeding
vaginal discharge
pelvic pain
(intermenstrual bleeding)
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23
Q

who to refer in suspected endometrial cancer

A

PMB w/o continuous HRT, on sequential HRT for more than 2 years

repeated bleeding

PCB more than 4 weeks

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24
Q

how to investigate endometrial cancer

A

TV US

> 5mm then pipelle biopsy

can escalate to hysteroscopy and biopsy

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25
Q

how is endometrial cancer diagnosis made

A

histologically from biopsy

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26
Q

most common endometrial cancer pathology

A

endometroid adenocarcinoma

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27
Q

how to stage endometrial cancer

A

1 - within uterus
2 - to cervix
3 - to pelvis
4 - distant sites

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28
Q

surgical treatment for endometrial cancer

A

total lap hyst + bilateral salpingoophrectomy

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29
Q

what is peritoneal washing done for in endometrial cancer treament

A

peritoneal cavity is flushed with saline and then analysed for malignant cells to stage spread

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30
Q

common causes of antepartum haemorrhage (APH)

A

placenta praevia
placenta abruption
undertermined origin

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31
Q

what is a bloody show

A

mucus plug of cervix mixed with blood, excreted just before labour

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32
Q

what is a vasa praevia

A

when fetal vein is attached to membrane of placenta, rupture of which can lead to fetal death

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33
Q

what is placenta praevia

A

when a placenta is in the lower segment of the uterus

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34
Q

what is the grading of placental praevias

A

marginal praevias have placentas not covering the cervical os. major praevias partially or completely cover the os

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35
Q

risk factors for placenta praevia

A

twins
high parity women
older women
previous c-section

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36
Q

complications of placenta praevia

A

obstructs natural lie and delivery
might require c-section
PPH
placenta accreta or placenta percreta

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37
Q

what is placenta accretea and percreta

A

accreta is when the placenta has embeded itself deeper than it usually would

percrete is when it has gone through the uterus and into the surrounding organs (e.g. intestines)

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38
Q

clinical features in history of placenta praevia

A

intermittent painless PV bleeding with increasing frequency and intensity

can be asymptomatic

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39
Q

what would an examination of someone with placenta praevia find?

A

breech and transverse lies are common

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40
Q

how to investigate and diagnose placenta praevia

A

ultrasound - repeat at 32 weeks

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41
Q

what to assess in someone with placenta praevia

A

maternal and fetal wellbeing

CTG, FBC, clotting and cross matching

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42
Q

when to admit someone with placenta praevia

A

bleeding

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43
Q

what to do when someone with placenta praevia is admitted

A

cross match
anti-D for Rh-ve
IV access
steroids if <34 weeks

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44
Q

how to deliver someone with placenta praevia

A

c-section

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45
Q

what is placenta abruption

A

separation of part or all of the placenta before delivery

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46
Q

where can blood go during a placenta abruption

A

into the amniotic sac or out through the vagina

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47
Q

bleeding always happens in placenta abruption, T or F

A

false, it can bleed into the amniotic sac

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48
Q

complications of placenta abruption

A

fetal death

haemorrhage - shock

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49
Q

risk factors of placenta abruption

A

IUGR
pre-eclampsia
autoimmune disease

hx of placental abruption
multiple pregnancy
high maternal parity

trauma

smoking
cocaine use

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50
Q

clinical features of placenta abruption

A

sudden localised painful bleeding

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51
Q

more bleeding = more severe placenta abruption, T or F

A

False, blood can bleed into the amniotic sac

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52
Q

findings on examination of someone with placental abruption

A

shock and blood loss
tender uterus
contractile uterus

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53
Q

when to admit with suspected placenta abruption

A

when there is pain and uterine tenderness, even without blood

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54
Q

delivery management for someone with placenta abruption

A

fetal distress => emergency CS

no fetal distress by term => induction + ARM

no fetal distress and preterm => give steroids and monitor

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55
Q

if a 31 week pregnant lady is admitted with abdominal pain with some bleeding but no fetal distress is found on CTG; symptoms which then subsqeuntly subside after 2 days. what should be done next?

A

if fetus is confirmed to be viable and healthy, then discharge but class as high risk pregnancy and arrange for serial fetal growth scans

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56
Q

what is a cervical ectropian

A

when endocervical columnar cells evert into the ectocervix causing redness and some vaginal discharge and/or PCB

57
Q

how to treat a cervical ectropian?

A

exclude carcinoma, then cryotherapy

58
Q

what are 3 benign conditions of the cervix

A

cervical ectropian
cervical polyps
acute/chronic cervicitis

59
Q

what can cause cervicitis

A

STIs, prolapses, pessaries

60
Q

what ligaments support the uterus

A

uterosacral

transverse ligament

61
Q

what is the junction called where cervical columnar cells meet squamous cells

A

squamocolumnar junction

62
Q

what is CIN

A

cervical intraepithelial neoplasia - dyskariotic cell changes on the cervix

63
Q

what does CIN I - III mean

A

CIN I is when atypical cells are limited to lower thirds of the epithelium

CIN II is when cells are found in lower 2/3rds of epithelium

CIN III is when the atypical cells are found in the full thickness of the epithelium

64
Q

what is CIN III also called

A

carcinoma in situ aka pre-invasive

65
Q

why is CIN III dangerous

A

it has the potential to invade through the basement membrane and become malignant

66
Q

what strains of HPV are associated with ca cervix

A

16 18 31 33

67
Q

what are the risk factors for ca cervix

A

hpv
smoking
long term steroid use

68
Q

what is the cervical screening schedule

A

> 25 years old every 3 years till 49 then every 5 years till 65.

69
Q

what happens if a smear comes back abnormal

A

they are invited back for another smear/colposcopy/hysteroscopy with biopsy.

70
Q

what is colposcopy

A

using speculum to visualise the cervix, acetic acid or iodine is added to stain any dyskariotic cells which are then looked thru a microscope. biopsy can be taken during this

71
Q

what is the treatment for CIN I II and III

A

CIN I is only monitored

CIN II and III are usually excised using LLETZ

72
Q

what is LLETZ

A

large loop excision of transformation zone

73
Q

who tend to be diagnosed with cervical cancer

A

women who dont go for their smears

74
Q

peaks of incidence for cervical cancer

A

30s and 80s

75
Q

what cell types are most cervical cancers

A

90% squamous, 10% adenocarcinomas

76
Q

which cell type cancer has a worse prognosis

A

adenocarcinoma

77
Q

history clinical features of cervical cancer

A

PCB
offensive vaginal smell
PMB
pain, urinary symptoms if advanced stage

78
Q

how to confirm the diagnosis of cervical cancer

A

biopsy

79
Q

what causes chronic pelvic inflammatory disease

A

infections that lead to adhesions, obstructed tubes and hydrosalpinx

80
Q

what can chronic pelvic inflammatory disease lead to

A

adhesions, obstructed tubes and hydrosalpinx

81
Q

common symptoms of chronic pelvic inflammatory dsiease

A 
lower abdominal pain
dysmenorrhea/menstrual irregularity
deep dyspareunia
chronic vaginal discharge
subfertility
82
Q

what is usually found on examination in someone with chronic pelvic inflammatory disease

A

uterine tenderness, adnexal tenderness, abdominal pain, fix retroverted uterus

83
Q

how to investigate and diagnose chronic pelvic inflammatory disease

A

laparoscopy

84
Q

what can cause chronic pelvic pain

A 
PID, chronic PID
endometriosis
adenomyosis
fibroids
abscess
ovarian cysts
IBS
adhesions
85
Q

what is one non-gynaecological differential for chronic pelvic pain

A

IBS

86
Q

how to investigate chronic pelvic pain

A

history, examination, bloods, TVUS, MRI, laparoscopy

87
Q

what is hyperemesis gravidarum defined as

A

severe nausea and vomitting during pregnancy

88
Q

what are some differentials for hyperemesis gravidarum

A 
infections (gastroenteritis)
GI disorders (HPB)
metabolic disorders (addison's diabetic ketoacidosis, thyrotoxicosis)
89
Q

management of hyperemesis gravidarum

A

IV rehydration
antiemetic (metoclopromide)
nutritional supplements

90
Q

What is the UK law on terminations of pregnancies?

A

It is allowed under 1 of 5 different clauses which account for maternal risk, fetal risk, existing children risk, including mental health risks and fetal wellbeing after birth

91
Q

How many physicians are required to sign off on a TOP in england?>

A

2

92
Q

What is the risk of unsafe abortions

A

Infection, haemorrhage, PID, death, injury to organs, sepsis, infertility

93
Q

What is done during an abortion consultation

A

Pelvic US to determine gestation, viability, single/multiple, intrauterine

Advise on contraception

Counselling alternatives

History

Blood tests (anti-D)

Swabs and STI screening

Consent

94
Q

What is the medical management for abortions

A

Mifepristone (anti progesterone)

Misoprostol (prostaglandin)

95
Q

What is the surgical management for abortion

A

Suction and curretage, dilation and evacuation

96
Q

Complications of termination of pregnancies

A

Haemorrhage, infection, damage to organs, failure, retention of products, psychological impact

97
Q

What is the definition of a breech presentation

A

Buttocks presenting first

98
Q

Describe the types of breech presentations

A

Frank is when feet are high but buttocks are low

Complete breech is when legs are cross with arms around face

Footling breech is when one foot is engaged while the other isn’t

99
Q

What are risk factors for breech

A 
Past hx
Twins
Placenta praevia
Tumours/fibroids
Oligohydramnios
Prematurity of fetus
100
Q

Complications in breech deliveries

A 
Cord prolapse
Cord compression
Brain compression
Spinal cord trauma
Prematurity
101
Q

When should an ECV be done if at all

A

After 37 weeks or if mother is labouring

102
Q

Risk factors in failure of ECVs

A 
Obesity
White caucasians
Nulliparous
Engaged breech
Reduced liquor volume
103
Q

What should be done immediately after performing ECV?

A

CTG and anti-D

104
Q

What are the contraindications for an ECV

A 
Twins
Placental praevia
Ruptured membranes
Fetal compromise
APH
105
Q

Indications for caeseran in breech

A 
Elective
Fetal distress
Failure to progress
Footling presentation
SGA or LGA babies
106
Q

Post natal complications in breech baby

A

Organ damage
Hypoxia
Autism and other conditions

107
Q

fetal risks in preterm labour

A

perinatal mortality
cerebral palsy
chronic lung disease
blindness

108
Q

risk factors for preterm labour

A 
hx of preterm labour
lower SEC
uterine abnormalities/fibroids
extremes of maternal age
maternal disease
pregnancy complications
109
Q

how does a preterm labour present?

A

before 37 weeks
painful contractions
vaginal bleeding
PPROM

110
Q

how to prevent preterm labour?

A

treat any medical disease
cervical cerclage
fetal reduction
progesterone supplementation

111
Q

what should be given acutely to a mother in preterm labour

A

steroids
antibiotics
tocolytic (oxytocin receptor antagonist, nifedipine)
magnesium sulphate

112
Q

name 5 methods of monitoring fetal wellbeing

A

ultrasound assessment of fetal size
doppler umbilical artery
doppler fetal arteries (MCA and ductus venosus)
ultrasound assessment of amniotic fluid and biophysical profile
CTG

113
Q

a one-off normal CTG is a good prognostic indicator of fetal wellbeing - T or F?

A

F - CTG only shows acute status, needs to be serially done to assessment wellbeing.

114
Q

what are 2 maternal maneuvers that can be done in shoulder dystocia

A

Mcrobert’s maneuver (legs and knees hyperflexed and brought to chest)
mother on all four limbs

115
Q

what is the first thing that should be done in shoulder dystocia

A

call for senior support

116
Q

in shoulder dystocia when should internal vaginal access be considered

A

after trying McRobert’s maneuver and mother-on-4-limbs,

117
Q

In Mcrobert’s maneuver, where should pressure be applied?

A

externally on suprapubic area

118
Q

difference between primary and secondary postpartum haemorrhage?

A

primary is within 24 hours of birth

119
Q

what are the 6 types of miscarriages

A

threatened - bleeding, but still viable 25% chance death
inevitable
incomplete
complete
septic
missed - miscarriage before pregnancy known

120
Q

in miscarriage, what are 3 patterns of HCG trends

A

viable pregnancy: 66% rise over 48 hours

miscarry: 50% decrease over 48 hours
ectopic: >66% rise or >50% decrease over 48 hours

121
Q

3 forms of gestational trophoblastic disease?

A

hydatidiform mole
invasive mole
chorioncarcinoma

122
Q

difference between invasive mole and chorioncarcinoma?

A

no mets in invasive mole

123
Q

subcategories of hydatidiform mole?

A

complete - 1 sperm fertilise 1 empty oocyte

incomplete - 2 or more sperms fertilise 1 oocyte

124
Q

what is a ‘snowstorm’ appearance on US scan suggestive of?

A

gestational trophoblastic disease

125
Q

what is the diagnostic test for GTD?

A

histological

126
Q

percentage of causes of subfertility

A

30% unexplained
30% ovulation d/o
25% tubal damage
25% male factor

127
Q

definition of oligospermia

A

<15 million/ml semen

128
Q

which of these drugs have a higher chance of multiple pregnancies - clomifene, gonadotrophins, metformin

A

clomifene and gonadotrophins

129
Q

which if these can cause OHSS clomifene, gonadotrophins, metformin

A

gonadotrophins

130
Q

possible complications of fertility treatment

A

multiple pregnancy

OHSS

131
Q

most common endometrial cancer pathology?

A

endometroid adenocarcinoma

132
Q

what is involved in the triple screening?

A

US for nuchal translucency
PAPP-A (low = higher risk)
beta-HCG (high = higher risk)

133
Q

when should the quadruple test be offered instead of the triple test?

A

when it is >15+0 weeks and before 20+0 weeks

134
Q

what is involved in the quadruple test? what levels are associated with downs syndrome?

A

beta hcg - high
papp-a - low
inhibin A - high
estriol - low

135
Q

what does an open os in early pregnancy indicate

A

inevitable miscarriage

136
Q

what is the diagnosis if someone is suspected to have a miscrriage, the Os is closed, and there is no fetus found in the uterus?

A

ectopic

137
Q

symptoms of a molar pregnancy

A

hyperemesis, nausea
bump on palpation
+/- bleeding
US -> snow storm appearance

138
Q

which of these is not a risk factor for hyperemesis gravidarum

Primip
Multiple pregnancy 
PMH
grand multiparity
Molar pregnancy
Young
A

grand multiparity

139
Q

difference between normal morning sickness and hyperemesis gravidarum

A

normal MS comes and goes in waves, symptoms don’t stay for the whole day, can usually eat/drink a little in between attacks.

HG stays for the entire day without relenting, food/drink is near impossible without vomiting everything out. signs of dehydration/malnutrition is possible

3 Women's Health EJR (6 decks)

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