Obstetrics Flashcards by Qaiys Abu Qaoud

How many scans during a routine pregnancy and at what point?

2 scans. First at 10-14 weeks, second at 18+0 and 20+6.

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What is the first scan in pregnancy for?

Dating and viability (can also find out gender.)

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What antenatal screening programmes are offered?

Foetal anomaly scan.
Infectious diseases screening.
Sickle cell and thalassaemia screening.

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What does the foetal anomaly scan test for?

Downs, Edwards, Patau’s and any structural abnormalities.

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What does the infectious diseases screening test for?

HIV, Hep B, Syphilis

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List the newborn screening programmes.

Newborn blood spot screening.
Newborn hearing programme.
Newborn and 6-8 week infant physical examination (NIPE.)

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List the maternal causes of a small baby and the reasons for this.

Obesity (poor diet.)
Smoking/drugs (blood vessel constriction.)
Constitutionally small (small mother.)
HTN in pregnancy (HTN effects placental vessels.)
Diabetes (if long term and uncontrolled, leads to decreased placental vascularisation.)
Maternal anorexia nervosas.
Infection.

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What are the common infections screened for if baby is SGA?

ToRCHp

Toxoplasmosis.
Rubella.
Cytomegalovirus.
Hepatitis/HIV.
Parovirus.

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List the foetal causes of a small baby and the reasons for this.

Chromosomal abnormalities (Down’s, Edward’s, Patau’s.)
Infection.
Constitutionally small.

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List the placental causes of a small baby and the reasons for this.

Smaller abruptions over time.
Placental insufficiency leading to preeclampsia.
Multiple pregnancies relying on placenta.

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Define small for gestation age/small for dates.

Weight of the foetus is more than 90th centile for gestational age.

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Define low, very low and extremely low birth weight.

Low - <2500g.
Very low - <1500g.
Extremely low - <1000g.

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Why can SGA be diagnosed with one scan, whereas IUGR can’t?

Because SGA uses gestational age as a marker, so does not need multiple scans for comparison of foetal growth, whereas IUGR does.

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Define intrauterine growth restriction.

Foetus fails to reach its own growth potential, based on what it should genetically be able to reach.

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Define foetal macrosomia.

Newborn with weight > 4000g, regardless of gestational age.

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What are the different types of IUGR and what do they mean?

Symmetrical: each part of baby is small.

- Asymmetrical: one part maintains normal growth, and other doesn’t.

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What foetal measurements are taken on USS?

-Abdominal circumference.
- Head circumference.
Femur length.

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How does the process of booking appointment and midwife vs consultant lead care work?

Patient is assessed at booking, and identified risk from a long list mean they are referred from midwife-led to consultant-led care. Midwife-led care uses only foetal movements and symphisiofundal height with the 2 normal scans, whereas consultant-led care has regular scans every 2/3 weeks.

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What type of growth chart is used to plot foetal measurements?

Personalised to mother, based on her age, height, weight, ethnicity, previous pregnancies etc.

How to interpret ECG?

Dr. C BrAVDO
Dr - defined risk.
C - contractions.
Br - baseline rate (110-160.)
A - acceleration (inc in 15 bmp for 15 mins.)
V - variability (good.)
D - deceleration (bad unless with contractions in active labour.)
O - Overall assessment.

What is liqour, what is it made up of and what does this show?

Amniotic fluid, made up of foetal urine, if too little, is dehydrated.

Define hydrops fetalis.

Foetal oedema.

Define polyhydramnios

Abnormally large volume of liqour.

List causes of a large baby

Constitutional.
Hydrops foetalis (oedema) due to: heart failure, chromosomal abnormalities, maternal hypertension.
Foetal anaemia due to: rhesus isoimmunisation or parovirus.
Maternal obesity.
Gestational diabetes.

Why does gestational diabetes cause large baby?

Excess insulin, and insulin acts as a growth hormone.

What is OGTT, when and how is it performed?

- Oral glucose tolerance test to test for gestational diabetes. - Screened at around 24-28 weeks. 2 blood tests, one fasting and one 2 hours after taking 75g glucose.

When is early delivery or c-section indicated with a big baby and why?

- If >5kg and not diabetic, or >4,5kg with gestational diabetes. - To prevent shoulder dystocia.

When are the first, second and third trimesters of pregnancy?

1st: 1-12 weeks. 2nd: 13-26 weeks. 3rd: 27-end of pregnancy.

Summary of early conception.

- Day 1: fertilisation at ampulla of fallopian tube. - Day 4: zygote enters uterus as morula. - Morula becomes blastocyst (outer trophoblast = placenta, inner embryoblast = embryo, fluid filled sac = blastocoele.) - Day 6-12 trophoblast invades endometrium and partially myometrium. - Trophoblastic proliferation into chorionic villi.

List the 3 common early pregnancy complications.

- Bleeding. - Hyperemesis gravidarum. - Gestational trophoblastic disease.

Define gestational trophoblastic disease.

Trophoblastic tissue (the part of the blastocyst that normally form placenta) proliferates more aggressively.

Define hydatidiform mole.

Local and non-invasive trophoblastic gestational disease. Is benign.

Define partial and total hydatidiform mole.

Complete - one sperm fertilises one oocyte (no DNA.) Completely paternal, no embryo can form. Partial - 2 sperm fertilise one oocyte creating a triploid after mitosis. Therefore can be some evidence of abnormal embryo development, but will be abnormal and can't survive.

Define invasive mole.

When gestational trophoblastic disease starts to invade nearby tissue. Is malignant.

Define choriocarcinoma.

When gestational trophoblastic disease starts to metastasise.

Define spontaneous miscarriage. When do the majority occur?

The foetus dying or delivering dead before 24 weeks of pregnancy. Majority occur before 12 weeks.

Define threatened miscarriage.

When there is bleeding +/- abdominal pain, but everything else remains normal and the foetus is still alive.

Define inevitable miscarriage.

Heavier bleeding +/- abdominal pain. The cervical os is open enough to admit a finger, so a miscarriage will definitely occur.

Define incomplete miscarriage.

Some foetal parts have been passed, but some remain in the uterus. The os remains open.

Define complete miscarriage.

All foetal tissue has passed, bleeding has slowed or stopped and the os is closed again.

Define septic miscarriage.

Contents of the uterus are infected and lead to inflammation of the endometrium.

Define missed miscarriage.

Foetus has died in utero, but this is not picked up immediately - either after bleeding occurs or on doing an USS.

Describe the pattern of HCG levels in a viable intrauterine pregnancy.

Normally a 66% increase in 48 hours.

Describe the typical pain felt during miscarriage.

Midline, suprapubic.

Where is the commonest site for ectopic pregnancy?

Fallopian tubes.

Define antepartum haemorrhage.

Bleeding from or in to the genital tract from 24 weeks of pregnancy, prior to birth of the baby.