Obstetrics Flashcards
When does blastocyst implantation occur?
Cycle day 20-24
What makes progestins?
Corpus luteum
What makes oestrogens?
Ovary initially, both foetal and mother later in pregnancy
What does prolactin do?
Milk production
What does oxytocin do?
Milk ejection reflux
Define normal labour
Term pregnancy = between 37-42 weeks
Without: Induction of labour, spinal/epidural anaglesia, general anaesthesia, forceps, c-section
Stages of labour/birth
First stage - divided into early/latent and active labour
Second stage
Third stage
Define the 3P’s before birth
Power - need contractions strong enough
Passage - i.e. pelvis
Passenger - baby needs to be in correct position
Define the early/latent phase
Irregular/painful contractions
Cervix is effacing + thinning
Dilates to 4cm
Define active phase
Further dilatation from 4cms at 0.5cm/hour
What is used as pain relief?
Entonox - gas and air
Opiates - morphine/pethidine
Epidural
Define 2nd stage
Descent Flexion Internal rotation Crowning - head pokes out Extension Restitution Internal restitution of shoulders Lateral flexion
Define 3rd stage
Pushing out placenta
Active management - oxytocin
What does oxytocin do during labour?
Stimulates uterine contractions
Requires ROM before syntocinon infusion
What does relaxin do during labour?
Softens the ligaments and cartilages of the pelvis that it can expand
What do prostaglandins do during labour?
Ripens the cervix
What is the most common malpresentation?
Breech:
Diagnosed by ultrasound scan
Causes: Idiopathic, prematurity, placenta praevia
Categories of the Bishop’s score?
Cervical dilation Length of cervix Station of head Cervical consistency Position of cervix
Describe the induction procedure
Membrane sweep
Prostaglandin gel or pessary high in vagina (misoprostol)
Amniotomy (ROM)
Oxytocin/ Syntocinon infusion
What do the scorings of Bishop score mean?
Score <5 = unlikely to start without induction
Score >9 = likely to start spontaneously
What is normal for a Cardiotocography?
HR - 110-160
Variability >5bpm
No decelerations
Accelerations present
Where is epidural analgesia carried out?
L3/4
Define hyperemesis Gravidarum
Vomiting in early pregnancy, associated with weight loss
Causes of hyperemesis Gravidarum
Multiple pregnancies - twins
Molar pregnancies
H.Pylori infection
Symptoms of hyperemesis Gravidarum
Persistent vomiting - inability to keep food/vomit down
>5% body weight loss
Dehydration - tachycardia, hypotension, reduced skin turgor
Triad of hyperemesis Gravidarum
> 5% weight loss
Electrolyte imbalance
Dehydration
Investigations for hyperemesis Gravidarum
TFTs, UTI
FBC, LFT’s
Elevated haematocrit
US
Management for hyperemesis Gravidarum
Mild - moderate: Small carbohydrate meals, avoid large volume drinks
Severe: Admission
IV fluids, Anti-emetic: Metoclopramide, prochloperazine, ondansetron, thiamine
Define Puerperal pyrexia
A temperature of >38 degrees in the first 14 days following delivery
Causes of puerperal pyrexia
Endometritis UTI Wound infection Mastitis VTE
Management of puerperal pyrexia
Endometritis = clindamycin and gentamicin
Risk factors for VTE (venous thromboembolism)
Age >35 BMI >30 Parity >3 Immobility Smoker Family history Pre-eclampsia Multiple pregnancy
Symptoms of DVT
Leg swelling
Pain
Redness
Symptoms of PE
SOB
Chest pain
Haemoptysis
Investigations of VTE
FBC, U&E’s LFTs, clotting screen
Treatment of VTE
LMWH
Define ectopic pregnancy
A pregnancy that occurs anywhere outside the uterus
Where does an ectopic pregnancy most commonly occur?
Ampulla of fallopian tube
also isthmus
Risk factors for ectopic pregnancy
IVF PID Age Previous ectopic Smoking Previous tubal surgery IUCD use
Symptoms of ectopic pregnancy
Abdominal/pelvic pregnancy Amenorrhoea or missed period Vaginal bleeding Pelvic/abdominal tenderness Shoulder tip pain
Investigations for ectopic pregnancy
Pregnancy test
TVUSS
Cervical excitation on pelvic examination
Treatment for ectopic pregnancy
Methotrexate - contraception as methotrexate is teratogenic
Salpingectomy
Salpingotomy - preserve ovaries
Define molar pregnancy
Non-viable fertilised egg = implants into uterus -> will not come to term
Causes of molar pregnancy
Sperm plus empty egg
Risk factors of molar pregnancy
Age <16 or >45
Multiple pregnancies
Previous molar pregnancy
COCP
Symptoms of molar pregnancy
Vaginal bleeding in first half of pregnancy
Uterine evacuation at about 10 weeks of gestation
Pre-eclampsia
Investigations for molar pregnancy
Urine and blood levels of bhCG (very high)
Histology
USS - snowstorm appearance
Treatment for molar pregnancy
Urgent referral to specialist centre
Suction curettage
Chemotherapy - cisplatin
Evacuation of retained products of conception
Define miscarriage
Loss of pregnancy before 24 weeks gestation
Define complete miscarriage
No fetal heartbeat
Cervical os closed
Define threatened miscarriage
Mild symptoms of bleeding with little or no pain
Cervical os closed
Define inevitable miscarriage
Heavy bleeding with clots and pain
Cervical os is open
The pregnancy will not continue, will proceed to incomplete or complete miscarriage
Define incomplete miscarriage
Occurs when the products of conception are partially expelled
Cervical os is open
Pain + vaginal bleeding
Define missed miscarriage
Foetus is dead but retained, uterus is small for dates
Closed cervical os
Dirty brown discharge
Causes of miscarriage
Abnormal foetal development Previous miscarriage BV infection Uterine abnormality Placental failure PCOS Luteal phase deficiency
Risk factors for miscarriage
Age >30 Smoking >14 per day Excess alcohol Illicit drug use Uncontrolled DM
Symptoms of miscarriage
Vaginal bleeding with or without abdominal pain
Cervical os open
Uterine size small for dates
Investigations for miscarriage
TVUSS
Serum hCG
Treatment for miscarriage
Mifepristone (anti-progesterone) - to prime cervix
+ Misoprostol
Anti-D rhesus prophylaxis
Recurrent miscarriages causes
3 or more consecutive abortions Antiphospholipid syndrome Poorly controlled DM PCOS Smoking
Define termination of pregnancy
Medically directed miscarriage prior to independent viability using pharmacological or surgical means
Epidemiology of TOP
92% carried out under 13 weeks of gestation
Must be done before 24 weeks gestation
Treatment for TOP
Surgical - misoprostol
Medical - Mifepristone - to prime cervix, then Misoprostol (prostaglandin)
Define pre-eclampsia
Pregnancy induced hypertension + proteinuria with or without oedema
>160 or >110
Risk factors for pre-eclampsia
Previous pre-eclampsia CKD Antiphospholipid syndrome DM First pregnancy BMI >25 Family history Multiple pregnancy
Symptoms of pre-eclampsia
Severe headache Visual disturbance RUQ pain Epigastric pain and/or vomiting HELLP syndrome
Investigations of pre-eclampsia
Urinalysis - for proteinuria - no proteinuria = gestational hypertension
FBC, LFTs, renal function
USS of foetus
Treatment for pre-eclampsia
Antihypertensive - Labetalol
Nifedipine, hydralazine
Magnesium sulphate to reduce risk of eclampsia
What is used as prophylaxis for pre-eclampsia
Aspirin
Complications of pre-eclampsia
Seizures - magnesium sulphate Cerebrovascular haemorrhage HELLP syndrome Renal failure Eclampsia Placental abruption DIC Pulmonary oedema
What is HELLP syndrome
Haemolysis
Elevated liver enzymes
Low platelets
Foetal complications of pre-eclampsia
IUGR
Placental abruption
Preterm birth
Causes of eclampsia
Primigravida
