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Phase 3A > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

When does blastocyst implantation occur?

A

Cycle day 20-24

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2
Q

What makes progestins?

A

Corpus luteum

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3
Q

What makes oestrogens?

A

Ovary initially, both foetal and mother later in pregnancy

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4
Q

What does prolactin do?

A

Milk production

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5
Q

What does oxytocin do?

A

Milk ejection reflux

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6
Q

Define normal labour

A

Term pregnancy = between 37-42 weeks

Without: Induction of labour, spinal/epidural anaglesia, general anaesthesia, forceps, c-section

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7
Q

Stages of labour/birth

A

First stage - divided into early/latent and active labour
Second stage
Third stage

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8
Q

Define the 3P’s before birth

A

Power - need contractions strong enough
Passage - i.e. pelvis
Passenger - baby needs to be in correct position

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9
Q

Define the early/latent phase

A

Irregular/painful contractions
Cervix is effacing + thinning
Dilates to 4cm

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10
Q

Define active phase

A

Further dilatation from 4cms at 0.5cm/hour

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11
Q

What is used as pain relief?

A

Entonox - gas and air
Opiates - morphine/pethidine
Epidural

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12
Q

Define 2nd stage

A 
Descent
Flexion
Internal rotation
Crowning - head pokes out
Extension
Restitution
Internal restitution of shoulders
Lateral flexion
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13
Q

Define 3rd stage

A

Pushing out placenta

Active management - oxytocin

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14
Q

What does oxytocin do during labour?

A

Stimulates uterine contractions

Requires ROM before syntocinon infusion

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15
Q

What does relaxin do during labour?

A

Softens the ligaments and cartilages of the pelvis that it can expand

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16
Q

What do prostaglandins do during labour?

A

Ripens the cervix

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17
Q

What is the most common malpresentation?

A

Breech:
Diagnosed by ultrasound scan
Causes: Idiopathic, prematurity, placenta praevia

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18
Q

Categories of the Bishop’s score?

A 
Cervical dilation
Length of cervix
Station of head
Cervical consistency
Position of cervix
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19
Q

Describe the induction procedure

A

Membrane sweep
Prostaglandin gel or pessary high in vagina (misoprostol)
Amniotomy (ROM)
Oxytocin/ Syntocinon infusion

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20
Q

What do the scorings of Bishop score mean?

A

Score <5 = unlikely to start without induction

Score >9 = likely to start spontaneously

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21
Q

What is normal for a Cardiotocography?

A

HR - 110-160
Variability >5bpm
No decelerations
Accelerations present

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22
Q

Where is epidural analgesia carried out?

A

L3/4

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23
Q

Define hyperemesis Gravidarum

A

Vomiting in early pregnancy, associated with weight loss

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24
Q

Causes of hyperemesis Gravidarum

A

Multiple pregnancies - twins
Molar pregnancies
H.Pylori infection

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25
Symptoms of hyperemesis Gravidarum
Persistent vomiting - inability to keep food/vomit down >5% body weight loss Dehydration - tachycardia, hypotension, reduced skin turgor
26
Triad of hyperemesis Gravidarum
>5% weight loss Electrolyte imbalance Dehydration
27
Investigations for hyperemesis Gravidarum
TFTs, UTI FBC, LFT's Elevated haematocrit US
28
Management for hyperemesis Gravidarum
Mild - moderate: Small carbohydrate meals, avoid large volume drinks Severe: Admission IV fluids, Anti-emetic: Metoclopramide, prochloperazine, ondansetron, thiamine
29
Define Puerperal pyrexia
A temperature of >38 degrees in the first 14 days following delivery
30
Causes of puerperal pyrexia
``` Endometritis UTI Wound infection Mastitis VTE ```
31
Management of puerperal pyrexia
Endometritis = clindamycin and gentamicin
32
Risk factors for VTE (venous thromboembolism)
``` Age >35 BMI >30 Parity >3 Immobility Smoker Family history Pre-eclampsia Multiple pregnancy ```
33
Symptoms of DVT
Leg swelling Pain Redness
34
Symptoms of PE
SOB Chest pain Haemoptysis
35
Investigations of VTE
FBC, U&E's LFTs, clotting screen
36
Treatment of VTE
LMWH
37
Define ectopic pregnancy
A pregnancy that occurs anywhere outside the uterus
38
Where does an ectopic pregnancy most commonly occur?
Ampulla of fallopian tube | also isthmus
39
Risk factors for ectopic pregnancy
``` IVF PID Age Previous ectopic Smoking Previous tubal surgery IUCD use ```
40
Symptoms of ectopic pregnancy
``` Abdominal/pelvic pregnancy Amenorrhoea or missed period Vaginal bleeding Pelvic/abdominal tenderness Shoulder tip pain ```
41
Investigations for ectopic pregnancy
Pregnancy test TVUSS Cervical excitation on pelvic examination
42
Treatment for ectopic pregnancy
Methotrexate - contraception as methotrexate is teratogenic Salpingectomy Salpingotomy - preserve ovaries
43
Define molar pregnancy
Non-viable fertilised egg = implants into uterus -> will not come to term
44
Causes of molar pregnancy
Sperm plus empty egg
45
Risk factors of molar pregnancy
Age <16 or >45 Multiple pregnancies Previous molar pregnancy COCP
46
Symptoms of molar pregnancy
Vaginal bleeding in first half of pregnancy Uterine evacuation at about 10 weeks of gestation Pre-eclampsia
47
Investigations for molar pregnancy
Urine and blood levels of bhCG (very high) Histology USS - snowstorm appearance
48
Treatment for molar pregnancy
Urgent referral to specialist centre Suction curettage Chemotherapy - cisplatin Evacuation of retained products of conception
49
Define miscarriage
Loss of pregnancy before 24 weeks gestation
50
Define complete miscarriage
No fetal heartbeat | Cervical os closed
51
Define threatened miscarriage
Mild symptoms of bleeding with little or no pain | Cervical os closed
52
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
53
Define incomplete miscarriage
Occurs when the products of conception are partially expelled Cervical os is open Pain + vaginal bleeding
54
Define missed miscarriage
Foetus is dead but retained, uterus is small for dates Closed cervical os Dirty brown discharge
55
Causes of miscarriage
``` Abnormal foetal development Previous miscarriage BV infection Uterine abnormality Placental failure PCOS Luteal phase deficiency ```
56
Risk factors for miscarriage
``` Age >30 Smoking >14 per day Excess alcohol Illicit drug use Uncontrolled DM ```
57
Symptoms of miscarriage
Vaginal bleeding with or without abdominal pain Cervical os open Uterine size small for dates
58
Investigations for miscarriage
TVUSS | Serum hCG
59
Treatment for miscarriage
Mifepristone (anti-progesterone) - to prime cervix + Misoprostol Anti-D rhesus prophylaxis
60
Recurrent miscarriages causes
``` 3 or more consecutive abortions Antiphospholipid syndrome Poorly controlled DM PCOS Smoking ```
61
Define termination of pregnancy
Medically directed miscarriage prior to independent viability using pharmacological or surgical means
62
Epidemiology of TOP
92% carried out under 13 weeks of gestation | Must be done before 24 weeks gestation
63
Treatment for TOP
Surgical - misoprostol | Medical - Mifepristone - to prime cervix, then Misoprostol (prostaglandin)
64
Define pre-eclampsia
Pregnancy induced hypertension + proteinuria with or without oedema >160 or >110
65
Risk factors for pre-eclampsia
``` Previous pre-eclampsia CKD Antiphospholipid syndrome DM First pregnancy BMI >25 Family history Multiple pregnancy ```
66
Symptoms of pre-eclampsia
``` Severe headache Visual disturbance RUQ pain Epigastric pain and/or vomiting HELLP syndrome ```
67
Investigations of pre-eclampsia
Urinalysis - for proteinuria - no proteinuria = gestational hypertension FBC, LFTs, renal function USS of foetus
68
Treatment for pre-eclampsia
Antihypertensive - Labetalol Nifedipine, hydralazine Magnesium sulphate to reduce risk of eclampsia
69
What is used as prophylaxis for pre-eclampsia
Aspirin
70
Complications of pre-eclampsia
``` Seizures - magnesium sulphate Cerebrovascular haemorrhage HELLP syndrome Renal failure Eclampsia Placental abruption DIC Pulmonary oedema ```
71
What is HELLP syndrome
Haemolysis Elevated liver enzymes Low platelets
72
Foetal complications of pre-eclampsia
IUGR Placental abruption Preterm birth
73
Causes of eclampsia
Primigravida

Phase 3A (10 decks)

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