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Obstetrics and Gynaecology > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

what are the components of the first stage of labour

A

Latent phase and the active phase

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2
Q

Define the latent phase

A

cervical effacement and increasingly intense irregular contractions lasting 2-3 days.

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3
Q

Define cervical effacement

A

thinning, softening and shortening of the cervix

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4
Q

what is presentation

A

the presenting part of the baby engaged with the cervix e.g. cephalic, breech, brow, shoulder and face

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5
Q

define lie in examination of a pelvic examination

A

the position in which the baby is lying within the abdomen e.g. longitudinal, transverse and oblique

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6
Q

define engagement

A

the amount that the presenting part of the baby is engaged with the cervix - measured in fifths

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7
Q

describe the cardinal movements in the mechanism of delivery

A

1) descent
2) engagement
3) flexion of head
4) internal rotation
5) extension
6) external rotation (or restitution)
7) expulsion

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8
Q

Describe the second stage of labour

A

pushing baby out

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9
Q

Talk through the physiological changes of pregnancy and symptoms

A

Cardiac: increased output, increased heart rate and decreased BP in 24 weeks.

Haematology: increase in plasma volume = decrease in Hb concentration. Iron absorption increases but iron requirements also increase.

Respiratory: TLC decreases with growing baby, Tidal volume increases

GI: heartburn from baby pressing, N&V from HCG, constipation, haemorrhoids

Renal: increased urination

Vascular: Varicose veins

MSK: backache, symphysis pubis dysfunction

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10
Q

Risk factors for Obstetric issues

A
  • Smoking
  • Drug abuse
  • alcohol
  • weight
  • age
  • multiple pregnancies
  • family Hx of complications
  • chronic diseases e.g. diabetes, epilepsy and thyroid problems
  • previous abdominal surgery
  • STIs
  • food poisoning
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11
Q

Which food should pregnant women avoid and why?

A
  • Soft cheeses, unpasteurized milk/cheese, raw fish (sushi) = listeria
  • Unwashed salad, fruit, vegetables, raw meats = toxoplasmosis
  • shellfish and raw eggs = food poisoning e.g. salmonella
  • Caffeine (no more than 200mg a day (2 cups of coffee)) = increases maternal BP and heart rate, increase risk of low birth weight
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12
Q

What are the risks of smoking during pregnancy?

A

low birth weight and IUGR

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13
Q

What three chromosomal abnormalities are screened for in pregnancy?

A 
Down syndrome (trisomy 21)
Edward syndrome (trisomy 18)
Patau syndrome (trisomy 13)
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14
Q

What three screening tests can be run for chromosomal abnormalities in pregnancy?

A

Combined screening test
Triple/quadruple test
Non-invasive testing

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15
Q

What does the combined screening test involve

A 
First trimester
•	USS
•	Maternal blood tests
USS
•	Between 11- 14+0 weeks gestation 
•	Measures nuchal translucency – black space seen at the back of the baby’s neck. 
•	Increased NT can sometimes be seen in foetuses with down syndrome 
Maternal blood tests
•	β-human chorionic gonadotropin levels
•	pregnancy associated plasma protein A 
Risk score generated from the results of the blood tests and USS for down syndrome
•	1 in 150 deemed high risk 
•	May need more invasive tests
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16
Q

What does the triple/quadruple test involve

A 
For those who booked late or miss the cut off for the combined screen test. Carried out in the second trimester. Blood tests for placental hormones that a risk score is calculated from. 
Triple test:
•	α – feto- protein
•	oestriol
•	β-human chorionic gonadotropin levels
Quadruple test:
•	addition of inhibin – A
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17
Q

What does the non-invasive testing involve

A
  • Also known as cfDNA (cell free DNA)
  • Blood test that looks at foetal blood in maternal blood which can give risk factors for syndromes like down syndrome.
  • Can be done from the 10th week
  • Thought to be more accurate than the combined screening test
  • Not on NHS, privately for £400
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18
Q

In an uncomplicated pregnancy how many USS scans are performed and when

A

foetal aging, sexing and growth - 11-14 weeks

foetal abnormality USS at 18-20 weeks

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19
Q

In a complicated pregnancy what are the minimum amount of scans performed

A

foetal aging, sexing and growth - 11-14 weeks

foetal abnormality USS at 18-20 weeks

growth scans at 28, 32 and 36 weeks

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20
Q

How can you carry out prenatal diagnosis

A

USS
Chorionic villous sampling
amniocentesis
foetal blood sampling

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21
Q

What antiemetics can be prescribed to a pregnant lady

A
  • Cyclizine
  • Metoclopramide
  • Ondansetron
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22
Q

What is classified as an early pregnancy problem

A

any issue occurring in the first 12 weeks

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23
Q

What is the definition of miscarriage

A

loss of a pregnancy in the first 24 weeks

24
Q

What is the definition of a complete miscarriage

A

Miscarriage has occurred in a woman with previously confirmed pregnancy; experienced bleeding. Cervical os may be open or closed. No products of conception remain in the uterus

25
Q

What is the definition of an incomplete miscarriage

A

Nonviable pregnancy in a woman who has experience some bleeding that may or may not be ongoing. Cervical os may be open or closed. Retained products of conception

26
Q

What is the definition of a missed/silent/delayed miscarriage

A

Nonviable pregnancy in asymptomatic woman. Cervical os is closed. Nonviable pregnancy seen

27
Q

what is the definition of a threatened miscarriage

A

Currently ongoing pregnancy in woman presenting with bleeding or pain. Cervical os is closed. Viable intrauterine pregnancy

28
Q

What is the definition of a inevitable miscarriage

A

Ongoing pain and bleeding.
Cervical Os is open.
Products of conception low in the uterus or within cervix

29
Q

What is a pregnancy of unknown viability

A

Scan findings suggest pregnancy may not be progressing normally. Small sac without metal pole/fetus seen <6mm without cardiac activity.

30
Q

What is pregnancy of unknown location

A

Positive pregnancy test without scan confirmation of intrauterine or extrauterine pregnancy. No intrauterine or extrauterine pregnancy seen on scan.

31
Q

What are the main causes of miscarriage

A
  • genetic and structural foetal abnormalities
  • infective factors = toxoplasma
    -rubella virus
    -tuberculosis
    -listeria
    -malaria
    -salmonella
    -cytomegalovirus
    -bacterial vaginosis links with 2nd trimester miscarriage
    • Maternal illness
    -diabetes
    -thyroid disease
    -renal disease
    -thrombophilia
    • Cervical weakness
    -clinical diagnosis based on history of second trimester miscarriage preceded by spontaneous rupture of membranes or painless cervical dilatation
    • Uterine cavity abnormalities
    -higher in women with second trimester miscarriages
32
Q

Investigations for miscarriage

A
  • Pregnancy test
  • Serum β- human chorionic gonadotropin
  • FBC
  • Group and save blood
  • Confirmed with a transvaginal USS
  • Needs two clinicians to view the scan to confirm
33
Q

Treatment and management miscarriage

A

Conservative
• Allowing miscarriage to happen naturally offered up to 14 days
• Most appropriate for threatened miscarriage
• Pregnancy test 3 weeks later
• May take several weeks for uterus to expel POC if left
• Women should be counselled about the process and what to expect e.g. duration of bleeding, analgesia advice, when to come into hospital
WATCH AND WAIT
Medical
• Prostaglandin analogues
• Misoprostol – most commonly used vaginally/oral
• Analgesia
Surgical
• Evacuation of Retained Products of Conception (ERPC)
• Based on preference or if woman is undergoing persistent excessive bleeding, haemodynamic instability, evidence of infected retained tissue or suspected gestational trophoblastic disease
Follow-up
• POC sent to histology – ensure no presence of molar pregnancy
• Post ERPC must be given anti-D

34
Q

What are the risk factors for an ectopic pregnancy

A 
Previous ectopic pregnancy
IUCD
Pelvic/tubal surgery
Assisted reproduction
PID
pelvic inflammation
35
Q

What investigations are needed for an ectopic pregnancy

A
  • Pregnancy Test
  • FBC
  • Serial serum hCG (every 48h): rate of rise >66% sugguest IUP. EP = falling/rising slowly
  • Group and save blood group
  • Pelvic/TVUSS
  • laparoscopy
36
Q

How do you treat an ectopic pregnancy

A

•Expectant/conservative – watch and wait. Serial serum hCG until repeated fall in levels - if clinically stable, minimal pain, ectopic mass <3.5 cm, no foetal heart rate and falling HCG (less than 1,000 IU/L)

Medical - systemic methotrexate: no significant pain, unruptured ectopic pregnancy with an adnexal mass smaller than 35mm and no fetal heart beat, and serum hCG <1500IU/litre, and no intrauterine pregnancy
o Anti-folate – targets the embryonic cells due to high amounts DNA

• Surgical: laparoscopic salpingectomy or salpingotomy if significant pain/adnexal mass ≥35mm/ visible Fetal Heartbeat/ hCG>5000IU/mL
o Anti-D for women who are rhesus negative

37
Q

What is the difference between a complete molar pregnancy and an incomplete/partial molar pregnancy

A

Complete = one sperm + empty egg (diploid)

incomplete = 2 sperm + one egg

38
Q

What are the effects of diabetes on pregnancy (think SMASH)

A
  • Shoulder Dystocia (Erb’s Palsy)
  • Macrosomnia (classically AC&raquo_space; HC on USS)
  • Amniotic Fluid Excess (Polyhydramnios)
  • Still birth
  • HTN, Hypoglycaemia (neonate due to fetal hyperinsulinaemia)
39
Q

What are the effects of pregnancy on diabetes

A
  • ↑ risk of DKA/Hypoglycaemia

* ↑ risk of progression of Retinopathy/Nephropathy (can cause HTN/Pre-eclampsia)

40
Q

How is gestational diabetes diagnosed

A

Risk factors present = OGTT at booking

No risk factors = OGTT at 24-28 weeks

41
Q

What are the three or four main hormones in pregnancy

A

progesterone
oestrogen
B-HCG

can consider human placental lactogen but not one of the main three.

42
Q

Where is B-HCG secreted from

A

B-HCG secreted from placenta

43
Q

Where is Oestrogen and progesterone secreted from in pregnancy

A

initially the corpus luteum, then the placenta takes over

44
Q

What is the role of oestrogen in pregnancy

A

Oestrogen prepares the body for delivery. Increase of mucus production for the cervical mucus plug.
vaginal lactobacilli proliferation - increase in lactic acid leading to decrease in pH of vagina. Therefore creates an unfavourable environment for pathogens to protect uterus.
increase in adipose tissue in breast and increase in lactiferous duct system ready for breast feeding.

45
Q

What is the role of progesterone in pregnancy

A

Progesterone is a smooth muscle relaxant and maintains the uterine lining throughout pregnancy.
Enlargement of breast lobules.

46
Q

What are the changes to the respiratory system in pregnancy

A

Increase in diaphragmatic breathing - due to an increase in abdominal pressure from the uterus.
Increase in tidal volume.
Decrease in TLC.
increase in resp rate
arterial pO2 increases whilst pCO2 decreases
mild compensatory respiratory alkalosis is normal in pregnancy

47
Q

What are the changes to the cardiac system in pregnancy

A

increased cardiac output - more flow to placenta.
increase in stroke volume and heart rate.
In vascular system there is a decrease in systemic vascular resistance.
Usually there is a drop in BP.

48
Q

What are the haematological changes in pregnancy

A

40% increase in plasma volume - leads to an overall decrease in Hb concentration and peripheral oedema.
Increase in RBC volume by 25%.
Increase in clotting factors - hypercoagulable state.

49
Q

What are the MSK changes in pregnancy

A 
increase in body mass index.
Stretch marks
lower back pain
Lordosis
Increased risk of carpal tunnel syndrome, muscle cramps and sciatica.
50
Q

What are the endocrinological changes in pregnancy

A

Increase in anterior pituitary gland function therefore more anterior pituitary gland hormones.
Hypertrophy of the anterior pituitary gland.
Increase in thyroid hormone production - can lead to goitre production.

51
Q

what is the role of human placental lactogen

A

association with gestational diabetes

52
Q

What are the dermatological changes in pregnancy

A

Increase in Skin pigmentation.
Distension and proliferation in blood vessels. This can lead to spider angiomata and facial flushing.
Striae gravidarum.

53
Q

What are the female reproductive changes during pregnancy.

A

Due to increases in oestrogen and progesterone.
Breast enlargement
areolar pigmentation
Uterine hypertrophy and stretching (10x increase)
cervical gland hypertrophy - increase in mucus secretion.

54
Q

What are the urological changes seen in pregnancy

A

increase in renal blood flow - up to 40%.
Increase in GFR leading to increase in urinary frequency.
Increase in kidney size.
increase in ureter dilatation (smooth muscle relaxation).

55
Q

What are the GI changes in pregnancy

A 
oesophageal relaxation (smooth muscle relaxation) - leading to reflux
Increase in intraabdominal pressure also leads to reflux and haemorrhoids.
 reduced bowel motility = constipation (smooth muscle relaxation).

Obstetrics and Gynaecology (4 decks)

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