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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
Q

Symptoms of hyperemesis Gravidarum

A

Persistent vomiting - inability to keep food/vomit down
>5% body weight loss
Dehydration - tachycardia, hypotension, reduced skin turgor

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26
Q

Triad of hyperemesis Gravidarum

A

> 5% weight loss
Electrolyte imbalance
Dehydration

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27
Q

Investigations for hyperemesis Gravidarum

A

TFTs, UTI
FBC, LFT’s
Elevated haematocrit
US

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28
Q

Management for hyperemesis Gravidarum

A

Mild - moderate: Small carbohydrate meals, avoid large volume drinks
Severe: Admission
IV fluids, Anti-emetic: Metoclopramide, prochloperazine, ondansetron, thiamine

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29
Q

Define Puerperal pyrexia

A

A temperature of >38 degrees in the first 14 days following delivery

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30
Q

Causes of puerperal pyrexia

A 
Endometritis
UTI
Wound infection
Mastitis
VTE
31
Q

Management of puerperal pyrexia

A

Endometritis = clindamycin and gentamicin

32
Q

Risk factors for VTE (venous thromboembolism)

A 
Age >35
BMI >30
Parity >3
Immobility
Smoker
Family history
Pre-eclampsia
Multiple pregnancy
33
Q

Symptoms of DVT

A

Leg swelling
Pain
Redness

34
Q

Symptoms of PE

A

SOB
Chest pain
Haemoptysis

35
Q

Investigations of VTE

A

FBC, U&E’s LFTs, clotting screen

36
Q

Treatment of VTE

A

LMWH

37
Q

Define ectopic pregnancy

A

A pregnancy that occurs anywhere outside the uterus

38
Q

Where does an ectopic pregnancy most commonly occur?

A

Ampulla of fallopian tube

also isthmus

39
Q

Risk factors for ectopic pregnancy

A 
IVF
PID
Age
Previous ectopic
Smoking
Previous tubal surgery
IUCD use
40
Q

Symptoms of ectopic pregnancy

A 
Abdominal/pelvic pregnancy
Amenorrhoea or missed period
Vaginal bleeding
Pelvic/abdominal tenderness
Shoulder tip pain
41
Q

Investigations for ectopic pregnancy

A

Pregnancy test
TVUSS
Cervical excitation on pelvic examination

42
Q

Treatment for ectopic pregnancy

A

Methotrexate - contraception as methotrexate is teratogenic
Salpingectomy
Salpingotomy - preserve ovaries

43
Q

Define molar pregnancy

A

Non-viable fertilised egg = implants into uterus -> will not come to term

44
Q

Causes of molar pregnancy

A

Sperm plus empty egg

45
Q

Risk factors of molar pregnancy

A

Age <16 or >45
Multiple pregnancies
Previous molar pregnancy
COCP

46
Q

Symptoms of molar pregnancy

A

Vaginal bleeding in first half of pregnancy
Uterine evacuation at about 10 weeks of gestation
Pre-eclampsia

47
Q

Investigations for molar pregnancy

A

Urine and blood levels of bhCG (very high)
Histology
USS - snowstorm appearance

48
Q

Treatment for molar pregnancy

A

Urgent referral to specialist centre
Suction curettage
Chemotherapy - cisplatin
Evacuation of retained products of conception

49
Q

Define miscarriage

A

Loss of pregnancy before 24 weeks gestation

50
Q

Define complete miscarriage

A

No fetal heartbeat

Cervical os closed

51
Q

Define threatened miscarriage

A

Mild symptoms of bleeding with little or no pain

Cervical os closed

52
Q

Define inevitable miscarriage

A

Heavy bleeding with clots and pain
Cervical os is open
The pregnancy will not continue, will proceed to incomplete or complete miscarriage

53
Q

Define incomplete miscarriage

A

Occurs when the products of conception are partially expelled
Cervical os is open
Pain + vaginal bleeding

54
Q

Define missed miscarriage

A

Foetus is dead but retained, uterus is small for dates
Closed cervical os
Dirty brown discharge

55
Q

Causes of miscarriage

A 
Abnormal foetal development
Previous miscarriage
BV infection
Uterine abnormality
Placental failure
PCOS
Luteal phase deficiency
56
Q

Risk factors for miscarriage

A 
Age >30
Smoking >14 per day
Excess alcohol
Illicit drug use
Uncontrolled DM
57
Q

Symptoms of miscarriage

A

Vaginal bleeding with or without abdominal pain
Cervical os open
Uterine size small for dates

58
Q

Investigations for miscarriage

A

TVUSS

Serum hCG

59
Q

Treatment for miscarriage

A

Mifepristone (anti-progesterone) - to prime cervix
+ Misoprostol
Anti-D rhesus prophylaxis

60
Q

Recurrent miscarriages causes

A 
3 or more consecutive abortions
Antiphospholipid syndrome
Poorly controlled DM
PCOS
Smoking
61
Q

Define termination of pregnancy

A

Medically directed miscarriage prior to independent viability using pharmacological or surgical means

62
Q

Epidemiology of TOP

A

92% carried out under 13 weeks of gestation

Must be done before 24 weeks gestation

63
Q

Treatment for TOP

A

Surgical - misoprostol

Medical - Mifepristone - to prime cervix, then Misoprostol (prostaglandin)

64
Q

Define pre-eclampsia

A

Pregnancy induced hypertension + proteinuria with or without oedema
>160 or >110

65
Q

Risk factors for pre-eclampsia

A 
Previous pre-eclampsia
CKD
Antiphospholipid syndrome
DM
First pregnancy
BMI >25
Family history
Multiple pregnancy
66
Q

Symptoms of pre-eclampsia

A 
Severe headache
Visual disturbance
RUQ pain
Epigastric pain and/or vomiting
HELLP syndrome
67
Q

Investigations of pre-eclampsia

A

Urinalysis - for proteinuria - no proteinuria = gestational hypertension
FBC, LFTs, renal function
USS of foetus

68
Q

Treatment for pre-eclampsia

A

Antihypertensive - Labetalol
Nifedipine, hydralazine
Magnesium sulphate to reduce risk of eclampsia

69
Q

What is used as prophylaxis for pre-eclampsia

A

Aspirin

70
Q

Complications of pre-eclampsia

A 
Seizures - magnesium sulphate
Cerebrovascular haemorrhage
HELLP syndrome
Renal failure
Eclampsia
Placental abruption
DIC
Pulmonary oedema
71
Q

What is HELLP syndrome

A

Haemolysis
Elevated liver enzymes
Low platelets

72
Q

Foetal complications of pre-eclampsia

A

IUGR
Placental abruption
Preterm birth

73
Q

Causes of eclampsia

A

Primigravida

Phase 3A (10 decks)

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