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Module 3 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is tested for weeks 0-10?

A

Hb, blood group, Rh, SCA, thalassaemia, syphilis, hep B, HIV, rubella

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2
Q

What is a flaw of the nuchal translucency scan at 11-13 weeks?

A

Inaccurate in morbidly obese patients

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3
Q

What’s the risk of miscarriage with a CVS and amniocentesis?

A

1% and 0.5%-1%

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4
Q

What term is giving to itchy papule and plaques that develop on abdominal striae in the 3rd trimester?

A

Polymorphic eruption of pregnancy

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5
Q

What colour are the excoriated papule in prurigo?

A

Red/brown

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6
Q

What autoantibody causes blisters in the 2nd trimester?

A

IgG autoantibodies, in pemphigoid gestations

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7
Q

Itching on the hands and feet is a sign of

A

Pregnancy cholestasis

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8
Q

What epileptic drugs increase the risk of foetal abnormalities/cognitive impairments?

A

Sodium valproate, phenytoin, primidone, carbamazepine

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9
Q

What are the complications associated with measles?

A

Miscarriage and stillbirth

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10
Q

What are the complications associated with parvovirus B19?

A

Hydrops foetalis and miscarriage

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11
Q

What can congenital rubella syndrome cause?

A

Deafness

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12
Q

What is smoking commonly associated with?

A

SIDS

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13
Q

When are AntiD IgG injections administered in Rhesus incompatibility?

A

At 28 weeks and 72 hours after birth

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14
Q

What are complications of pre-eclampsia?

A

HELLP syndrome, eclampsia, stroke, organ failure, foetal death

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15
Q

RF for gestational diabetes

A

BMI > 30, older maternal age, PCOS, smoking, T2DM

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16
Q

What should be avoided after birth in patients with pregnancy cholestasis?

A

Oestrogen contraceptive pills

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17
Q

What is a cause of partial HMs?

A

Dispermic fertilisation

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18
Q

What are complete HM associated with?

A

Choriocarcinoma

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19
Q

What are 2 signs of a threatened miscarriage?

A

Bleeding and closed cervix

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20
Q

What are 2 signs of an inevitable miscarriage?

A

Bleeding and opened cervix

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21
Q

What is the main sign of an incomplete miscarriage?

A

Ongoing bleeding

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22
Q

What is the final sign of a complete miscarriage?

A

Bleeding ceased and empty uterus

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23
Q

Vacuum aspiration abortions are performed until

A

9 weeks gestation

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24
Q

What gestation is dilation and evacuation performed at?

A

14-15 weeks

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25
Q

What is the progesterone antagonist used in abortions?

A

Mifepristone

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26
Q

What is the prostaglandin analogue used in abortions?

A

Misoprostol

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27
Q

What is a RF for ectopic pregnancy?

A

PID/undiagnosed STI

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28
Q

When is a salpingectomy performed?

A

Foetal pole > 35 mm

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29
Q

What are RF for placenta praevia?

A

Uterine scarring (short inter-pregnancy interval, caesarean), advanced maternal age, smoking/drugs

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30
Q

A pH of what in a foetal scalp sample requires delivery?

A

< 7.20

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31
Q

Variable decelerations is a sign of what

A

Reduced amniotic fluid and umbilical cord compression

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32
Q

Sinusoidal rhythms suggest

A

Hypoxia, anaemia, haemorrhage, foetal mortality

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33
Q

What does APGAR stand for?

A 
Activity (muscle tone)
Pulse
Grimace (reflex irritability)
Appearance
Respiration
Excellent 7-10, moderately depressed 4-6, severely depressed 0-3
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34
Q

What are the causes of postpartum haemorrhage?

A

Uterine atony, trauma, retained tissue, coagulopathies

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35
Q

RF for dystocia

A

Small pelvis, young mother, FGM, large babies

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36
Q

Puerperal sepsis can take place from rupture of membranes to when?

A

42 days postpartum

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37
Q

Common causes of puerperal sepsis?

A

GAS, Strep. pyogenes, E. coli

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38
Q

The blood spot tests for what diseases?

A

SCA, CF, congenital hypothyroidism, PKU, MCADD, MSUD, IVA, GA1, HCU

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39
Q

Newborn physical examination will investigate

A

Eyes, heart, hips, testicles

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40
Q

What age is the hearing loss test?

A

4-5 weeks

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41
Q

What are the chances of natural conception within 1, 2 and 3 years?

A

84%, 92%, 93%

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42
Q

What OTC drug is dangerous during pregnancy?

A

Ibuprofen

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43
Q

Toxoplasmosis is transmitted in what

A

Cat faeces

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44
Q

4 criteria to admit a pregnant woman with morning sickness

A
  1. Unable to tolerate liquids
  2. Ketonuria
  3. 5% weight loss
  4. Comorbidity/infection - i.e. UTI
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45
Q

Which 2 types of patients must take extra folic acid during pregnancy?

A

HIV+ patients (co-trimoxazole) and epileptic patients

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46
Q

What must babies born to epileptic mothers receive at birth?

A

Vitamin K injection to reduce risk of neonatal haemorrhage (from exposure to epileptic drugs)

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47
Q

2 main signs of postpartum psychosis

A
  1. Extreme mood swings - mania and depression

2. Delusion

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48
Q

3 effects of foetal alcohol syndrome

A
  1. Poor growth
  2. Distinct facial features (thin upper lip, small eye openings)
  3. Behavioural/learning difficulties
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49
Q

3 effects of smoking during pregnancy

A
  1. Low birth weight/restricted growth
  2. Pregnancy complications
  3. Future lung conditions
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50
Q

Opioid use in pregnancy causes

A

Neonatal abstinence syndrome - Withdrawal: Irritable, vomiting, diarrhoea, poor weight gain, convulsions

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51
Q

Where must babies be placed in the cot?

A

On their back, with their feet touching the end of the cot with no excess bedding/obstructions

52
Q

Diazepam increases the risk of what congenital defect?

A

Cleft palate

53
Q

3 types of spina bifida

A
  1. SB occulta - hidden
  2. SB meningocele - Meninge herniation
  3. SB myelomeningocele
54
Q

What chromosome abnormality is seen in DS?

A

Trisomy 21

55
Q

What chromosome abnormality is seen in Edward’s Syndrome?

A

Trisomy 18 - Small head/face, heart defects

56
Q

What chromosome abnormality is seen in Patau Syndrome?

A

Trisomy 13

57
Q

Stage 1 of labour involves

A

Regular contractions with cervix dilation

58
Q

What is the latent phase in stage 1 labour?

A

Amniotic fluid ruptures - mild/irregular contractions

59
Q

What is the active phase in stage 1 labour?

A

Cervix dilates 3-4 cm - contractions are painful and regular

60
Q

What is stage 2 of labour?

A

Full dilation of cervix with regular strong contractions leading to birth of baby

61
Q

What is stage 3 of labour?

A

Placenta expulsion

62
Q

What does foetal scalp sampling measure?

A

pH and lactate

63
Q

A FBS pH > 7.25 is

A

Normal

64
Q

A FBS pH of 7.21-7.24 is

A

Borderline - needs repeating 30 minutes later

65
Q

A FBS pH of < 7.20 is

A

Abnormal - deliver baby

66
Q

What is the baseline rate of a foetal HR?

A

110-160 bpm

67
Q

5 reasons for reduced baseline variability

A
  1. Sleeping baby
  2. Foetal acidosis/hypoxia
  3. Foetal tachycardia
  4. Drugs - Opiates, magnesium sulphate
  5. Prematurity
68
Q

Variable decelerations can suggest

A

Reduced amniotic fluid or umbilical cord compression

69
Q

Late decelerations can suggest

A

Insufficient blood flow to uterus and placenta

70
Q

Sinusoidal patterns of decelerations are associated with

A

Foetal hypoxia, haemorrhage, mortality

71
Q

AGPAR measures

A 
Activity
Pulse
Grimace/reflex irritability
Appearance/skin colour
Respiration
72
Q

Contraception is required how many days post birth?

A

21 days unless mother is exclusively breast feeding

73
Q

How many weeks post birth before a IUD/IUS can be inserted?

A

4 weeks

74
Q

When can COCP or cap/diaphragm be re-started in a postpartum female?

A

6 weeks

75
Q

What’s the risk of starting a COCP soon after giving birth?

A

Venous thromboembolism

76
Q

What immunoglobulin passes from the mother to foetus in rhesus incompatibility?

A

IgG - attaches to foetal RBC and causes extravascular haemolysis in the foetal spleen by macrophages.

77
Q

What happens to the foetus when foetal RBCs are destroyed in rhesus incompatibility?

A

Anaemia, hepatosplenomegaly, portal hypertension, stillbirth, hydrops fetalis

78
Q

What 2 blood groups make it more common to be RhD-?

A

O+ and A+

79
Q

When is an AntiD IgG given to the foetus?

A

28 weeks and 72 hours post birth

80
Q

5 RF for pre-eclampsia

A
  1. 20 weeks gestation
  2. Obesity/gestational diabetes
  3. Multiple pregnancy
  4. Pre-existing cardiovascular or renal disease
  5. Family history/previous history
81
Q

Reduced foetal movement, foetal growth restriction and upper abdominal pain could be a sign of?

A

Pre-eclampsia

82
Q

What antihypertensive is given to a mother with pre-eclampsia?

A

IV labetalol

83
Q

HELLP syndrome stands for

A

Haemolysis
Elevated liver proteins
Low platelet count

84
Q

Complications of eclampsia

A 
Convulsions/eclampsia 
HELLP syndrome
Stroke
Pulmonary oedema
Kidney/liver failure 
Visual disturbances
85
Q

5 risk factors for gestational diabetes

A
  1. Obesity BMI > 30 - triples risk
  2. Older maternal age (decreased b-cell reserve)
  3. PCOS
  4. Smoking
  5. Physical inactivity
86
Q

Foetal macrosomia and vaginal candidiasis are signs of

A

Gestational diabetes

87
Q

Epigastric discomfort that worsens at night is a sign of

A

Cholestasis in pregnancy

88
Q

A snow-storm pattern seen on a pelvic USS is a sign of what?

A

Complete hydatidiform mole

89
Q

5 risk factors for ectopic pregnancy

A
  1. IUD
  2. Previous ectopic pregnancy (increases risk by 1/4)
  3. PID/STI
  4. Progesterone only pill
  5. Previous surgery/damage to female reproductive system
90
Q

Vomiting and diarrhoea, alongside shoulder pain in a fertile woman can suggest

A

Ectopic pregnancy

91
Q

Management for an ectopic pregnancy

A

Salpingectomy

92
Q

Small for gestational age is defined as

A

Foetus < 10th centile for their gestational age

93
Q

2 types of SGA

A
  1. Constitutionally small: Normal development but small family
  2. Foetal growth restriction
94
Q

Foetal growth restriction can be subdivided into

A
  1. Placenta-mediated growth restriction

2. Non-placenta mediated growth restriction

95
Q

3 signs of foetal growth restriction

A
  1. Reduced foetal movement
  2. Reduced amniotic fluid volume
  3. Abnormal CTGs
96
Q

3 causes of macrosomia (>90th gentile or > 4.5 kg)

A
  1. Gestational diabetes
  2. Maternal obesity
  3. Male
97
Q

3 macrosomia related risks to mother or baby

A
  1. Shoulder dystocia
  2. Obesity in childhood for the child
  3. Instrumental delivery/c-section
98
Q

2 investigations for a large for gestational age baby

A
  1. US - exclude excess amniotic fluid, estimate foetal weight
  2. Oral glucose tolerance test for gestational diabetes
99
Q

3 dietary items that must be avoided in pregnancy

A
  1. Vitamin A (teratogenic - pate/liver)
  2. Unpasteurised dairy/blue cheese (listeriosis)
  3. Undercooked/raw poultry (salmonella)
100
Q

Monochorionic twins share the same…

A

Placenta

101
Q

Monozygotic twins are from a

A

Single zygote

102
Q

Risks of multiple births to the mother

A
  1. Anaemia
  2. Preterm delivery
  3. C-section
  4. Hypertension
103
Q

What happens to the twin that receives the majority of blood supply in twin-twin transfusion syndrome?

A

Fluid overload resulting in heart failure. Increased amniotic fluid.

104
Q

What happens to the twin that does not receive the majority of blood supply in twin-twin transfusion syndrome?

A

Growth restriction and anaemia. Reduced amniotic fluid.

105
Q

Main complication of an UTI in a pregnant woman

A

Pre-term delivery

106
Q

2 common bacteria causing UTIs in a pregnant woman

A

E.coli and Klebisiella pneumoniae

107
Q

When should nitrofurantoin be avoided?

A

3rd trimester - risk of neonatal haemolysis.

108
Q

When must trimethoprim be avoided?

A

1st trimester - Folate antagonist - increases risk of neural tube defects

109
Q

VTE prophylaxis criteria in a pregnant woman

A
  1. Start at 28 weeks if there are 3 RF

2. Start in 1st trimester if there are 4+ RF

110
Q

Can you use the Wells Score in a pregnant woman?

A

No as pregnancy naturally raises D-dimer

111
Q

5 RF for VTE in a pregnant woman

A
  1. Parity > 3
  2. Older maternal age
  3. Obesity
  4. Pre-eclampsia
  5. Multiple pregnancy
112
Q

Pre-eclampsia triad

A

Hypertension, proteinuria, oedema

113
Q

What is pregnancy-induced hypertension?

A

HTN after 20 weeks gestation with no proteinuria

114
Q

Pre-eclampsia can be diagnosed when the systolic BP > 140, diastolic BP > 90 and what 3?

A
  1. Proteinuria 1+
  2. Organ dysfunction (i.e. raised LFT)
  3. Placental dysfunction (foetal growth restriction)
115
Q

What can be tested for if a woman has suspected pre-eclampsia?

A

PIGF - levels are low 20-35 weeks in pre-eclampsia

116
Q

What can be given to women at risk of pre-eclampsia?

A

Aspirin

117
Q

Pruritus on palms/soles of the feet with abnormal liver function is a sign of

A

Cholestasis in pregnancy

118
Q

A complete hydatidiform mole has what chromosomes?

A

Paternal

119
Q

A partial hydatidiform mole has what chromosome?

A

Paternal and maternal

120
Q

A complete hydatidiform increases the risk of

A

Choriocarcinoma

121
Q

Medical management and advice for ectopic pregnancy

A

Methotrexate IM to cause termination and avoid getting pregnant for 3 months

122
Q

4 criteria for ectopic pregnancy surgical management

A
  1. Foetal pole > 35 mm
  2. Heartbeat
  3. HCG > 5000
  4. Pain
123
Q

Recommended surgery for a woman with poor fertility + ectopic pregnancy?

A

Salpingostomy

124
Q

Define threatened miscarriage

A

PV bleeding < 24 weeks with closed cervix

125
Q

Define inevitable miscarriage

A

PV bleeding with open cervix

126
Q

Severe morning sickness and abnormally high HCG are signs of

A

Molar pregnancies

Module 3 (6 decks)

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