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Obstetrics And Gynaecology > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What serum HCG level is used to indicate pregnancy?

A

> 1500

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2
Q

Describe a threatened miscarriage

A

Pain +/- bleeding up to 24 weeks

US shows foetal heart beat

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3
Q

Describe an inevitable miscarriage

A 
Cervix open (internal os)
Productions of conception not yet passed
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4
Q

Describe incomplete miscarriage

A

Some products of conception have been passed
Some tissue/blood clot remains in the uterus
Cervix stays open

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5
Q

What is the treatment for septic miscarriage?

A

IV Antibiotics for 24 hours

Surgical removal

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6
Q

Describe complete miscarriage

A

All products of conception passed naturally

Bleeding and pain reduces naturally

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7
Q

What are the risk factors for T1 miscarriage?

A 
Increased age
Previous miscarriage
Smoking/alcohol
Folate deficiency 
Consanguinity 
NSAIDS/aspirin
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8
Q

What are the advantages of medical management of miscarriage?

A

Avoid surgery
Higher patient satisfaction
Can be done as outpatient

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9
Q

What are the advantages of expectant management of miscarriage?

A

Avoids any medications or surgery

Can be at home

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10
Q

What are the disadvantages of expectant management of miscarriage?

A

Unpredictable pain and bleeding
Patient worries
Takes longer
Can be unsuccessful

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11
Q

What are the disadvantages of medical management of miscarriage?

A

Can be more pain/bleeding than expectant
May experience side effects from drug
Day stay in hospital

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12
Q

What medication is used for medical management of miscarriage?

A

Misoprostol

Prostaglandin

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13
Q

Define recurrent miscarriage

A

3+ consecutive miscarriages with the same partner

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14
Q

Give some causes of recurrent miscarriage

A

Translocations
Antiphospholipid syndrome
Uterine anomalies
Unexplained

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15
Q

Lower HCG levels than expected may indicate:

A

Incomplete miscarriage
Early intrauterine pregnancy
Ectopic
Molar pregnancy

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16
Q

What is the most common location of ectopic?

A

Isthmus of Fallopian tube

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17
Q

What are the symptoms of an ectopic pregnancy?

A 
Unilateral pain, PV bleeding/spotting
Fainting/dizzy/collapse
Shoulder tip pain
Nausea and vomiting 
Diarrhoea
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18
Q

When would expectant management of ectopic be suitable?

A

If patient is asymptomatic
<3cm size
HCG <1500 and falling

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19
Q

What is the medical management of ectopic?

A

Methotrexate

Do not get pregnant for 3-6 months

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20
Q

When might medical management of ectopic be indicated?

A

<3.5cm size
HCG <5000
No symptoms or free fluid

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21
Q

What is gestational trophoblastic disease?

A

A spectrum of disorders of trophoblastic developing arising from abnormal fertilisation

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22
Q

Which GTD is potentially pre-malignant?

A

Hydratidiform mole/molar pregnancy

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23
Q

Which GTDs are malignant?

A

Invasive mole

Choriocarcinoma

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24
Q

What is the presentation of GTD?

A 
Asymptomatic - US 
Bleeding
N+V
Uterus large for dates 
Severe pre-eclampsia sx
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25
Q

What is the management of GTD?

A

Offer surgical evacuation
Confirm on histology
Refer to specialist centre for follow up

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26
Q

What is hyperemesis gravidum?

A

Excessive nausea and vomiting in the first trimester significant enough to affect the mother’s functioning

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27
Q

What are the complications of hyperemesis?

A

Dehydration
Ketosis
Weight loss
Nutritional deficiency

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28
Q

What causes the excessive vomiting in hyperemesis?

A

Reaction to HCG levels

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29
Q

How does thyrotoxicosis occur in pregnancy?

A

The alpha subunit of hcg is the same as a subunit of TSH therefore can stimulate thyroxine production

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30
Q

What investigations would you do for someone presenting with suspected hyperemesis?

A

Urine HCG and dipstick (ketones)
FBC, U+Es, LFT, amylase, TFT
US - exclude multiple pregnancy/GTD and if LFTs abnormal

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31
Q

What is the management of hyperemesis?

A

Rehydration - IV fluids (not glucose)
Thiamine and folic acid replacement if needed
Anti-emetics
Ranitidine

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32
Q

Why don’t we give glucose fluids in hyperemesis?

A

Can cause wernicke’s encephalopathy

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33
Q

Describe the pathophysiology pre-eclampsia

A

Abnormal trophoblastic invasion and adaptation of spiral arteries
Causing placental ischaemia due to microclots in the vasculature
Therefore resistance is increased causing maternal hypertension and the placenta doesn’t function as well

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34
Q

What values define hypertension in pregnancy?

A

Greater than 140/90 on two occasions more than four hours apart
Or a single diastolic reading of greater than 110

35
Q

When is proteinuria in pregnancy significant?

A

2+ or more

36
Q

What is the first line investigation for pre-eclampsia?

A

Protein:creatinine ratio

>30 diagnosis - then do 24 hr urine collection (>300 abnormal)

37
Q

Define pre-eclampsia

A

New onset hypertension and proteinuria in the second half of pregnancy that resolves after delivery

38
Q

What percentage of women with pre-eclampsia develop eclampsia?

A

2%

39
Q

What are the complications of pre-eclampsia?

A 
Eclampsia
Hepatic rupture
HELLP syndrome
Pulmonary oedema
Acute fatty liver of pregnancy
Cerebral oedema
AKI
40
Q

What are the risks to baby from pre-eclampsia?

A

Stillbirth
Growth restriction
Haemorrhage
Pneumothorax

41
Q

Define eclampsia

A

Cerebral vasospasm causing fits that can occur up to 3 weeks after birth

42
Q

What is the management of eclampsia?

A

Magnesium sulphate

43
Q

What are the clinical features of pre-eclampsia?

A 
Headache
Visual disturbance
Epigastric or right upper quadrant pain
Oedema
Vomiting
44
Q

What are the elements of HELLP syndrome?

A

Haemolysis
Elevated liver enzymes
Low platelets

45
Q

What investigations would you do for suspected pre-eclampsia?

A 
Blood pressure and urine dip
FBC, U+E, LFT, clotting
Fetal movements/CTG
Umbilical Doppler
Ultrasound for fetal size and liquor volume
46
Q

When do pre-eclampsia patients need admitting?

A

BP >170/110
BP >140/90 and proteinuria
Borderline with significant symptoms

47
Q

What preventative methods are used for pre-eclampsia?

A

Low dose aspirin 75mg from 12 weeks
Rest, exercise, weight loss
Calcium supplementation
Labetalol/nifedipine if hypertensive

48
Q

Which BP medications cannot be used in pregnancy?

A

Diuretics

Ace inhibitors

49
Q

Why do we always give modified release BP drugs to pregnant women?

A

Do not want a sudden decrease in BP as this could disturb placental flow

50
Q

What are the early effects of diabetes in pregnancy?

A

Increased risk of miscarriage
Increased risk of foetal abnormalities
N+V -> DKA
Increased risk of infection, hypertension and poor renal function

51
Q

What are the late effects of diabetes in pregnancy?

A 
Increased risk pre-eclampsia and SGA
Increased stillbirth risk 
Progression of nephropathy and retinopathy 
Decreased awareness of hypos
Increased insulin resistance
52
Q

What are the effects on labour of diabetes in pregnancy?

A

Increased risk of pre-term
Higher Csection rate
Increased induction rate
Macrosomia

53
Q

What is included in the pre-pregnancy planning for women with pre-existing diabetes?

A 
Smoking cessation
BMI <27 
5mg folic acid from 3 months pre-conception
HbA1c <48 
BMs 5-7
54
Q

If uncomplicated pre-existing Diabetes, when would we induce?

A

37-38+6 weeks

55
Q

If complicated pre-existing diabetes, when would we C section?

A

38 - 38+6 weeks

56
Q

What are the risk factors for gestational Diabetes?

A

Increased age
Obesity
Previous hx
First degree relative with diabetes

57
Q

When do we do the OGTT for pregnant ladies?

A

26-28 weeks

58
Q

What are the diagnostic values on the OGTT for gestational Diabetes?

A

Fasting >5.6 mmol/l

2 hours >7.8 mmol/l

59
Q

If the patient is diet controlled gestation diabetes, when do we deliver by?

A

40 +6

60
Q

If the patient is medication controlled gestational diabetes, when do we induce?

A

39 weeks

61
Q

Macrosomia is a birth weight of more than…

A

4.5 kg

62
Q

What are the foetal effects of iron deficiency anaemia in the mother?

A

Pre term
Low birth weight
Impaired psychomotor development

63
Q

When do we test for anaemia in pregnancy?

A

Booking

28 weeks

64
Q

What advice needs to be given when prescribing iron supplements?

A

Take on an empty stomach
1 hour before food
Take with a vitamin C source to aid absorption (orange juice)
Do not take with milk

65
Q

What factors contribute to increased VTE risk in pregnancy?

A

Hypercoaguable state
Venous stasis
Pressure of uterus

66
Q

How soon can gender of foetus be determined?

A

16 weeks by US

9 weeks through maternal blood

67
Q

When do we test the red cell antibodies?

A

Booking

28 weeks

68
Q

If rhesus negative mother, when do we give anti-D?

A

28 weeks

69
Q

How does clomiphene citrate work?

A

Binds to oestrogen receptors in pituitary to increase FSH and LH levels to encourage growth and rupture of follicles

70
Q

What are the complications of clomiphene?

A

Multiparity
Ovarian hyperstimulation syndrome
Enlarged ovarian cysts
Inhibit lactation

71
Q

What is the Naegele Rule?

A

To work out EDD

(1st day of LMP + 1 year) - 3 months + 7 days

72
Q

Describe the process of Down syndrome screening

A

10-14 weeks - US nuchal translucency and maternal blood test
14-20 weeks - quadruple blood test
Amniocentesis from week 15
CV 11-14 weeks

73
Q

What are the maternal CVS changes in pregnancy?

A 
Increased blood volume
Increased cardiac output
Increased stroke volume 
Increased heart rate 
Decreased blood pressure 
Decreased systemic vascular resistance
74
Q

What is the role of syntocin in labour?

A

Increases strength and frequency of contractions

75
Q

How often can you increase the dose of syntocin in labour?

A

Every 30 mins

76
Q

What are the side effects of syntocin?

A

Arrhythmia
Headaches
N+V
Uterine hyperstimulation

77
Q

What is the management of APS?

A

Aspirin and heparin

78
Q

What are the diagnostic criteria for APS?

A

3 + T1 losses or 1 + T2 loss
Unexplained thrombo-embolic event
Autoimmune thrombocytopenia
Confirmatory lab test

79
Q

What are the diagnostic lab tests for APS?

A

Lupus anticoagulant

Anti-cardiolipin antibody

80
Q

What is characteristic of obstetric cholestasis?

A

Pruritus in the absence of a skin rash - esp affecting palm and soles and worse at night
Abnormal LFTs

81
Q

What are the risks of obstetric cholestasis?

A 
Spontaneous/iatrogenic preterm birth
Foetal death
Meconium passage
PPH
increased likelihood of C section
82
Q

What is the management of obstetric cholestasis?

A

Discussion induction >37 weeks
Topical emollient or cholestyramine for pruritus
Ursodeoxycholic acid

83
Q

What are the risk factors for placenta praevia?

A 
Previous C section 
High parity
Maternal age >40
Multiple pregnancy 
Previous praevia
84
Q

What is included in the TORCH screen?

A 
Toxoplasmosis 
Other: parvovirus 
Rubella
Cytomegalovirus 
Hepatitis

Obstetrics And Gynaecology (6 decks)

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