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Phase 3a Medicine - Women's Health > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

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

A

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

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2
Q

What is the first scan in pregnancy for?

A

Dating and viability (can also find out gender.)

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3
Q

What antenatal screening programmes are offered?

A
  1. Foetal anomaly scan.
  2. Infectious diseases screening.
  3. Sickle cell and thalassaemia screening.
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4
Q

What does the foetal anomaly scan test for?

A

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

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5
Q

What does the infectious diseases screening test for?

A

HIV, Hep B, Syphilis

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6
Q

List the newborn screening programmes.

A
  1. Newborn blood spot screening.
  2. Newborn hearing programme.
  3. Newborn and 6-8 week infant physical examination (NIPE.)
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7
Q

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

A
  • 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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8
Q

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

A

ToRCHp

  • Toxoplasmosis.
  • Rubella.
  • Cytomegalovirus.
  • Hepatitis/HIV.
  • Parovirus.
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9
Q

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

A
  • Chromosomal abnormalities (Down’s, Edward’s, Patau’s.)
  • Infection.
  • Constitutionally small.
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10
Q

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

A
  • Smaller abruptions over time.
  • Placental insufficiency leading to preeclampsia.
  • Multiple pregnancies relying on placenta.
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11
Q

Define small for gestation age/small for dates.

A

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

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12
Q

Define low, very low and extremely low birth weight.

A

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

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13
Q

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

A

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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14
Q

Define intrauterine growth restriction.

A

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

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15
Q

Define foetal macrosomia.

A

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

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16
Q

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

A
  • Symmetrical: each part of baby is small.

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

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17
Q

What foetal measurements are taken on USS?

A

-Abdominal circumference.
- Head circumference.
Femur length.

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18
Q

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

A

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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19
Q

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

A

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

20
Q

How to interpret ECG?

A 
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.
21
Q

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

A

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

22
Q

Define hydrops fetalis.

A

Foetal oedema.

23
Q

Define polyhydramnios

A

Abnormally large volume of liqour.

24
Q

List causes of a large baby

A
  • Constitutional.
  • Hydrops foetalis (oedema) due to: heart failure, chromosomal abnormalities, maternal hypertension.
  • Foetal anaemia due to: rhesus isoimmunisation or parovirus.
  • Maternal obesity.
    Gestational diabetes.
25
Q

Why does gestational diabetes cause large baby?

A

Excess insulin, and insulin acts as a growth hormone.

26
Q

What is OGTT, when and how is it performed?

A
  • 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.
27
Q

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

A
  • If >5kg and not diabetic, or >4,5kg with gestational diabetes.
  • To prevent shoulder dystocia.
28
Q

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

A

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

29
Q

Summary of early conception.

A
  • 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.
30
Q

List the 3 common early pregnancy complications.

A
  • Bleeding.
  • Hyperemesis gravidarum.
  • Gestational trophoblastic disease.
31
Q

Define gestational trophoblastic disease.

A

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

32
Q

Define hydatidiform mole.

A

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

33
Q

Define partial and total hydatidiform mole.

A

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.

34
Q

Define invasive mole.

A

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

35
Q

Define choriocarcinoma.

A

When gestational trophoblastic disease starts to metastasise.

36
Q

Define spontaneous miscarriage. When do the majority occur?

A

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

37
Q

Define threatened miscarriage.

A

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

38
Q

Define inevitable miscarriage.

A

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

39
Q

Define incomplete miscarriage.

A

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

40
Q

Define complete miscarriage.

A

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

41
Q

Define septic miscarriage.

A

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

42
Q

Define missed miscarriage.

A

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

43
Q

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

A

Normally a 66% increase in 48 hours.

44
Q

Describe the typical pain felt during miscarriage.

A

Midline, suprapubic.

45
Q

Where is the commonest site for ectopic pregnancy?

A

Fallopian tubes.

46
Q

Define antepartum haemorrhage.

A

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

Phase 3a Medicine - Women's Health (2 decks)

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