Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

1. Senior Block- O&G > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is Naegele’s Rule?

A

First day of LMP + 1 year - 3 months + 7 days= Due date

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is fertilisation?

A

Fusion of the sperm nucleus with the ovum nucleus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the acrosome reaction?

A

The zona pellucida cell surface glycoproteins interact with the capacitated sperm cell. Calcium enters the sperm to increase intracellular cAMP. The sperm head swells and causes enzymes to be released around the sperm head. The enzymes allow the sperm to penetrate the zona pellucida.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give 4 risk factors for placenta praevia

A 
Previous C section 
High parity 
Previous placenta praevia 
Endometrial curettage after TOP/miscarriage 
Maternal age >40 years 
Multiple pregnancy 
Hx of uterine infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the pathophysiology of placenta praevia?

A

Placenta is attached to the lower uterine segment
Minor= low placenta but does not cover cervical os
Major= placenta lies over cervical os
The low lying placenta is more susceptible to haemorrhage and may be damaged when the fetus tries to prepare for labour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe how placenta praevia presents?

A

Painless vaginal bleeding which may increase in severity and intensity over several weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is placenta praevia diagnosed?

A

Diagnosed via US scan at 20 weeks

A low lying placenta in early pregnancy does not always become placenta praevia as when the uterus grows it can bring the placenta up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

If a patient is actively bleeding with placenta praevia what investigations should be done?

A 
FBC
Clotting 
Group and Save 
Crossmatch 
U+Es
LFTs
CTG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

If minor placenta praevia is found on the 20 week USS what is the management?

A

Repeat scan at 36 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If major placenta praevia is found on the 20 week USS, what is the management?

A

Repeat scan at 32 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If a patient is actively bleeding with placenta praevia, how should they be managed?

A

A-E approach
Admit
Anti-D given to Rh neg patients
Steroids if >34 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is a woman with confirmed placenta praevia managed?

A

Elective C-section at 39 weeks

High risk of intraoperative or postpartum haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is placenta accreta?

A

Placenta attaches too deeply into the uterine wall but does not extend into the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is placenta increta?

A

Placenta attached deep into the uterine wall and stretches into the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is placenta percreta?

A

Placenta penetrates through the entire wall and attaches to another organ eg. bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Give 2 risk factors for placenta accreta

A

Placenta praevia

Previous C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Give 3 clinical features of placenta accreta

A

Bleeding in T3
Premature delivery
Placenta doesn’t detach fully after birth leading to PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is placenta accreta managed?

A

Elective C-section +/- hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Give 5 predisposing factors for placental abruption

A 
Placental abruption in previous pregnancy 
Pre-eclampsia 
Transverse lie of fetus 
Polyhydramnios
Abdominal trauma 
Smoking 
Bleeding in T1
Thrombophilias 
Multiple pregnancy 
IUGR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the pathophysiology of a placental abruption?

A

Part or all of the placenta separates from the uterine wall prematurely. The vessels in the basal layer of the endometrium rupture. Blood accumulates and splits the placental attachment from the basal layer. The detached placenta can no longer function.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the difference between a revealed and a concealed placental abruption?

A

Revealed= bleeding tracks downwards and drains via cervix so presents with bleeding

Concealed= bleeding remains in uterus and forms a clot. No PV bleed but symptoms of shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Give 5 clinical features of placental abruption

A 
Painful PV bleed 
Constant pain 
Dark blood 
Tender, hard uterus 
Signs of shock: tachycardia, hypotension 
Abnormal/absent fetal heart sounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What investigations can be done for a patient with placental abruption?

A 
CTG 
FBC
Clotting 
G+S
Cross match 
U+Es
LFTs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is an unstable placental abruption managed?

A 
A-E assessment
Admit
Steroids if <34 weeks
Analgesia (opiates) 
Anti-D to Rhesus neg 
Fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

How is a stable placental abruption managed?

A

Steroids if <34 weeks
US to monitor growth

Plan delivery:

  • Fetal distress= urgent C-section
  • No fetal distress= IOL via amniotomy at 37 weeks
  • Stillborn= Give blood, induce labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Give 4 risk factors for vasa praevia

A 
Placenta praevia 
Multiple pregnancy 
Abnormal placenta shape 
IVF pregnancy 
Hx of uterine surgery 
Previous C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is vasa praevia?

A

Umbilical cord attached to membranes of placenta rather than directly into it. This weakens the cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Give 2 symptoms of vasa praevia

A

Painless vaginal bleeding in T2/3

Severe fetal distress- can result in organ failure and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How is vasa praevia diagnosed?

A

Can be seen on 20 week Doppler Ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

How is vasa praevia managed?

A

Elective C-section at 39 weeks

Increased monitoring throughout pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What weeks are covered by Trimester 1?

A

0-13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What weeks are covered by Trimester 2?

A

13-27

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What weeks are covered by Trimester 3?

A

27-42

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

At what age is the age of gestational viability?

A

24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Give 4 symptoms of early pregnancy

A 
Missed period
Nausea and vomiting 
Fatigue 
Sore breasts
Polyuria 
Altered taste and smell
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What symptoms can be felt in early T2?

A 
Thin white vaginal discharge
Backache 
5-7kg weight gain 
Small bump visible 
Breast enlargement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When should fetal movements be felt?

A

18-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What symptoms may be felt in late T2?

A

Swollen hands, face and feet
Backache
Urinary stress incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What symptoms may be experienced in T3 of pregnancy?

A 
Weight gain 
Large bump
Heartburn 
Swollen ankles 
Short of breath 
Braxton-Hicks contractions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What supplements can be started pre-conceptually to aid pregnancy?

A 
Folic acid- 0.4mg/day 
Vitamin D- 10 micrograms per day 
Iron 
Vitamin C
Calcium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What screening are diabetic mothers offered preconceptually?

A

Diabetic retinopathy screening

42
Q

When does the booking visit occur?

A

10 weeks

43
Q

Give 10 things discussed/done at the 10 week booking visit

A

Sickle cell and thalassaemia screen
Height and weight- for BMI and personalised fetal growth chart
Urine sample- check for infection/protein
Blood pressure
Bloods- FBC, U+Es
Screening for HIV, syphilis and Hepatitis B
Screening for rubella
Blood group and rhesus status
Diabetes screen
Lifestyle advice- stop smoking, good diet, gentle exercise, folate, vit D, no alcohol, antenatal classes, ask about domestic violence, leaflet about pregnancy

44
Q

Give 5 factors which make a woman more likely to develop diabetes in pregnancy

A 
High BMI (>30)
Previous gestational diabetes 
Previous baby >4.5kg
Close family history of diabetes 
Asian, Black or Middle Eastern
45
Q

What measurement is used to date a pregnancy?

A

Crown-rump length

46
Q

At how many weeks is the dating scan done?

A

12 weeks

47
Q

When can a multiple pregnancy first be picked up?

A

12 week scan

48
Q

What is the nuchal transleucency and what does it suggest?

A

Nuchal transleucency is the sonographic appearance of fluid under the skin behind the fetal neck.

The NT thickness will be increased in fetal anomalies

49
Q

What are the 3 components of the Combined Test and what does it test for?

A

Nuchal translucency
PAPP-A
free beta-hCG

Calculates the risk of the baby having Down’s syndrome (T21), Edward’s (T18) or Patau’s (T13)

50
Q

What does a low risk combined test score mean?

A

< 1 in 150 chance that the baby will have having Down’s syndrome (T21), Edward’s (T18) or Patau’s (T13)

51
Q

What does a high risk combined test score mean?

A

> 1 in 150 chance that the fetus will have Down’s syndrome (T21), Edward’s (T18) or Patau’s (T13)

52
Q

When is a quadruple test done instead of the combined test?

A

> 14 weeks into pregnancy

NT too hard to visualise on ultrasound

53
Q

What 4 elements are part of the quadruple test?

A

AFP
hCG
Estriol
Inhibin-A

54
Q

What does the quadruple test look for?

A

Down’s syndrome (T21)

55
Q

If a high risk score is given on the combined or quadruple test, what further investigations can be done to confirm the diagnosis?

A

Chorionic villus sampling- small sample of cells taken from the placenta using a transabdominal needle or transcervical forceps. 1% chance of miscarriage

Amniocentesis- sample of cells from amniotic fluid taken via transabdominal US guided needle. 1% risk of miscarriage.

56
Q

When is the fetal anomaly scan carried out?

A

20 weeks

57
Q

Give 5 examples of things that are looked for on the fetal anomaly scan

A 
Anencephaly 
Open spina bifida
Cleft lip 
Serious cardiac issues 
Lethal skeletal dysplasia 
Patau's (T13) 
Edward's (T18) 
Diaphragmatic hernia 
Gastroschisis 
Exomphalos 
Bilateral renal agenesis
Physical abnormalities- bones, heart, brain, spinal cord, face, kidneys, abdomen
58
Q

What routine tests are done at every antenatal appointment?

A

BP and urine dip
Symphysis-fundal height done at 24 weeks
After 36 weeks assess fetal presentation + US if unsure

59
Q

Give 6 risk factors for preeclampsia

A 
Nulliparity 
Maternal age >40 
Maternal BMI >35
Pregnancy interval >10 years 
FHx of preeclampsia
Multiple pregnancy 
Chronic hypertension 
Preeclampsia or HTN in previous pregnancy 
Chronic kidney disease
Diabetes mellitus 
Autoimmune diseases eg. SLE
60
Q

What is the suggested pathophysiology of preeclampsia?

A

Poor placental perfusion

Remodelling of the spiral arteries is incomplete so the uteroplacental circulation is high resistance and low flow. This causes an increase in BP and oxidative stress which results in a systemic inflammatory response and endothelial cell dysfunction in the kidney resulting in proteinuria.

61
Q

What are the 3 diagnostic criteria for preeclampsia?

A

Hypertension >140/90
>20 weeks gestation
++ proteinuria

62
Q

Give 4 symptoms of preeclampsia

A 
Headache 
Visual disturbance 
Vomiting 
Epigastric pain/tenderness
Hyperreflexia 
Ankle oedema
63
Q

What is the BP range in mild preeclampsia?

A

140/90 to 149/99

64
Q

What is the BP range for moderate preeclampsia?

A

150/100 to 159/109

65
Q

What is the BP range for severe preeclampsia?

A

160/110 or higher

Or BP >140/90 + symptoms

66
Q

Give 5 potential complications from preeclampsia

A 
Cerebrovascular event
IUGR
Prematurity 
Placental abruption 
Fetal death 
Eclampsia
Adult Respiratory Distress Syndrome 
Pulmonary oedema
Renal failure (AKI) 
Increased risk of DIC
Maternal death 
HELLP syndrome
67
Q

What is HELLP syndrome?

A

Syndrome seen in patients with preeclampsia

Haemolysis
Elevated Liver enzymes
Low platelets

68
Q

How is HELLP syndrome treated?

A

Blood transfusion for anaemia
Continuous fetal monitoring
Reduce BP
Magnesium sulphate to reduce seizures

69
Q

Apart from BP and urine dip what other investigations can be done in preeclampsia?

A

FBC- anaemia
U+Es- AKI
LFTs- increased ALT and AST

70
Q

How is mild preeclampsia monitored?

A

BP and urine dip every week

US every 2-4 weeks

71
Q

When should a patient be admitted with preeclampsia?

A 
Symptoms present 
BP >160/110 
Proteinuria >0.3g/24hr on 24hr collection 
IUGR
Abnormal CTG
72
Q

How is preeclampsia managed?

A

Anti-hypertensives:

  • Labetalol
  • Nifedipine
  • Methyldopa

VTE prophylaxis- LMWH

Plan delivery- deliver by 36 weeks, will need maternal steroid course. Continuous CTG monitoring in vaginal birth. C-section if IUGR or abnormal CTG

Managed 3rd stage of labour- Oxytocin

73
Q

Give 3 side effects of Labetalol and when it might be contraindicated?

A

S/E= leg oedema, SOB, bradycardia, chest pain, N+V, fatigue

CI= asthma, cardiac failure, heart block

74
Q

Give 3 side effects of Nifedipine and when it might be contraindicated?

A

S/E= dizziness, GI disturbance, oedema, headache

CI= angina, Hx of MI, aortic stenosis, diabets

75
Q

Give 3 side effects of Methyldopa and when it might be contraindicated?

A

S/E= fatigue, drowsiness, weakness, N+V

CI= heart failure, angina, kidney disease

Need to stop within 2 days of giving birth

76
Q

What is Rhesus D red cell isoimmunisation?

A

Rh+ Fetal RBCs enter the mother’s circulation via a ‘sensitising event’ or during delivery and if the mother is Rh-, maternal antibodies are formed against the fetal erythrocytes.

In subsequent pregnancies the maternal anti-D antibodies can cross the placenta and attack the fetal RBCs which results in fetal haemolytic anaemia.

77
Q

How is red cell isoimmunisation prevented in pregnancy?

A

Women have maternal blood group typing and antibody screen performed at booking (10 weeks)

Repeated at 28 weeks

If mother is Rh-, fetus genotype can be assessed via father’s blood or free fetal DNA in mother’s blood.

If a mother is Rh- and a sensitising event occurs, she is offered Anti-D immunoglobulin. This binds to any RhD+ cells in the maternal circulation so no immune response is stimulated.

78
Q

Give examples of 5 potential sensitising events

A 
Invasive obstructive testing 
Antepartum haemorrhage 
Ectopic pregnancy 
Fall/abdo trauma
Intrauterine death 
Miscarriage 
TOP
Delivery- any kind
79
Q

What is the Kleihauer/FMH test?

A

Assesses how much fetal blood has entered the maternal circulation after a sensitising event. This can be done to work out the dose of anti-D needed.

Only done at >20 weeks

80
Q

At <12 weeks what is the required dose of anti-D after a sensitising event?

A

250 IU within 72 hours

81
Q

At 12-20 weeks what is the required dose of anti-D after a sensitising event?

A

250 IU within 72 hours

82
Q

At >20 weeks what is the required dose of anti-D after a sensitising event?

A

500 IU within 72 hours and increase higher if the Kleihauer test suggests.

83
Q

If a woman is Rh negative, when will she be given anti-D?

A

Any sensitising event in the pregnancy
28 weeks (500 IU)
34 weeks (500 IU)
Post-nataly (if baby confirmed as Rh+) (500 IU)

84
Q

How is fetal haemolytic anaemia investigated prenatally?

A

Doppler US of the peak velocity of the fetal middle cerebral artery

Fetal blood sampling under US guidance

Severe anaemia= fetal hydrops, excessive fetal fluid

85
Q

How is fetal haemolytic anaemia treated prenatally?

A

Intrauterine blood transfusion to fetus

86
Q

What is the most common virus transmitted to the fetus in pregnancy?

A

Cytomegalovirus (CMV)

87
Q

Give 4 effects of Cytomegalovirus (CMV) on the fetus?

A 
IUGR
Hepatosplenomegaly 
Thrombocytopenic purpura
Jaundice 
Microcephaly 
Pneumonia 
Sensorineural hearing loss
Visual impairment 
Risk of DIC
88
Q

How is Cytomegalovirus (CMV) diagnosed in pregnancy?

A

Mother: Viral serology for CMV specific IgM and IgG

Fetus: US scan at 20 weeks, amniocentesis >21 weeks to confirm

89
Q

How is Cytomegalovirus (CMV) in pregnancy managed?

A

Offer TOP

Serial US scanning to look for abnormalities

90
Q

How does rubella in pregnancy present in the mother, neonate and older child?

A

Mother= asymptomatic, fine maculopapular rash, coryza, malaise, lymphadenopathy, headache

Neonate= sensorineural deafness, PDA, pulmonary stenosis, VSD, retinopathy, cataracts, microcephaly

Infant= diabetes, GH abnormalities, thyroiditis, behavioural disorders, learning difficulties

91
Q

How is a rubella infection in pregnancy managed?

A

Gestational age at exposure to rubella infection:
<12 weeks= TOP
12-20 weeks= amniocentesis diagnosis, TOP or US surveillance
>20 weeks= no action required

92
Q

What are the maternal symptoms of Varicella Zoster infection in pregnancy?

A

Pruritic maculopapular rash
Fever
Malaise

93
Q

What are the symptoms of Varicella Zoster infection in a fetus <20 weeks old?

A

Dermatomal skin scarring
Eye defects= optic atrophy, cataracts
Hypoplasia of limbs
Neurological abnormalities= microcephaly, seizures, Horner’s, spinal cord atrophy

94
Q

How is a Varicella Zoster infection in pregnancy managed?

A

Varicella zoster immunoglobulin within 10 days of potential infection if not already immune

If suffering from chickenpox= Aciclovir

95
Q

What are the effects to the fetus in maternal Parvovirus B19 in pregnancy?

A

Fetal hydrops= virus replicates in liver and bone marrow causing severe anaemia which results in cardiac failure and portal hypertension and hypoprolactinaemia

96
Q

How is Parvovirus in pregnancy treated?

A

Serial US and dopplers every 1-2 weeks until 30 weeks. In a tertiary center an intrauterine erythrocyte transfusion can be done

97
Q

Give 4 risk factors for Group B strep infection in neonates

A 
Prematurity <37 weeks 
GBS in previous baby 
Rupture of membranes >24hrs before delivery 
Pyrexia during labour 
Positive GBS in mother
98
Q

What 3 infections does Group B Streptococcus cause in the mother?

A

UTI
Chorioamnionitis
Endometritis

99
Q

How does a Group B Streptococcus infection present in a neonate?

A

Sepsis

Pyrexial, cyanosis, floppy, poor breathing, poor feeding

100
Q

How is Group B Streptococcus diagnosed in pregnancy?

A

High vaginal swab
Anal awab
Urine testing if UTI symptoms

Not routinely screened for in the UK

101
Q

How is Group B Streptococcus colonisation managed in pregnancy?

A

If any risk factors are present, maternal high dose penicillins given throughout vaginal labour.

1. Senior Block- O&G (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions