Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NV - Phase 3A > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What are the main pregnancy hormones?

A 
hCG
progestins 
oestrogens
human placental lactogen 
prolactin 
oxytocin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the role of hCG and where is it produced?

A

secreted by trophoblastic cells of the blastocyst

role - to signal the presence of the blastocyst to the mother
prevents corpus luteum degenerating so it can persist until the placenta has formed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the role of progestins and where are they rpoduced?

A

initally come from the corpus lutem and then from the placenta

prepars endometrium and uterus for implantation by causing proliferation, vascularisation and differentiation of the endo metrial stroma

fascilitates myometrial quiescence (stops myometrium contracting too early)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the role of oestrogens and where are they produced?

A

comes from the ovary initially and then from the foetus too later in pregnancy

role - promotes changes in CVS and alters carbuhydrate metabolism
indicates foetal wellbeing (E3 - declines with foetal distress)
E2 - facilitates progesterone production by increasing endometrial progesterone receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the role of human placental lactogen?

A

mobilises glucose from fat reserves
diabetogenic (raises blood glucose levels) - to help increase nutrient supply to the blastocyst
converts mammary glands into milk secreting tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the role of prolactin and where is it produced?

A

increased levels of prolactin allow milk production
but ONLY when oestrogen and progesterone have declined postpartum
produced in anterior pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the role of oxytocin and where is it produced?

A

facilitates uterine contraction during labour
milk ejection reflex postpartum
produced in the hypothalamus, secreted by posterior pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Between which days of the menstrual cycle is the window of implantation?

A

between day 20-24

will not implant outside this timeframe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the layers of interface between the placenta and the myometrium?

A

placenta
decidua
myometrium
abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the varying degrees of morbid adherence of the placenta?

A

normal placenta - invades into decidua

placenta accreta - invades into superficial mometrium

placenta increta - invades into deeper myometrium

placenta percreta - invades through myometrium into nearby organs such as bladder and bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What risks are associated with morbid placental adherence?

A

poor placental separation - difficult to deliver

retained products –> increased risk of infection

significant post-partum haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which type of immunity remains unchanged during pregnancy and which type is dampened?

A

humoral - remains unchanged, Th2 cell based

cell mediated - reduced as progesterone down regulates the production of Th1 cells

this leads to increased Th2 production –> Th2 bias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which conditions in pregnancy do not have a Th2 humoral immunity bias?

A

pre-eclampsia
IUGR
miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which type of immunoglobulin is screted in breast milk?

A

IgA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which is the only antibody to cross the placenta?

A

IgG

if mum has low levels, baby can get primary immune deficiency hypogammaglobulinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Who is at risk of rhesus disease?

A

if the mother is Rh -ve
and the father is Rh +ve

this is because 50-100% of their offspring will also be Rh +ve

not a problem if dad is also Rh -ve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why does Rhesus disease not occur in the first pregnancy?

A

sensitisation in first pregnancy

maternal immune reaction to the Rh +ve antigen of foetal RBC produces IgM which does not cross the placenta to affect this pregnancy

However it does produce memory cells so IgG can be produced ina s subsequen pregnancy and can cross the placenta and affect the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What does Rhesus disease do to the foetus?

A

causes RBC haemolysis leading to severe foetal anaemia and possible death if not intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How to prevent Rhesus disease?

A

Anti-D prophylaxis

it destroys the anti-Rh +ve antibodies

given at 28 and 34 weeks after birth
given earlier if any sensitisation events occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How can DM during pregnancy affect the foetus?

A

macrosomic infant (>4kg birthweight)
increased risk of traumatic delivery and shoulder dystocia
still birth
cleft palate
neonatal hypoglycaemia due to hyperinsulinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the increased risks to the mother of DM durign pregnancy?

A

ketoacidosis
pre-eclmapsia
coronary heart disease
nephropathy etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which drugs are used to rpomote myometrial quiescence i.e. stop uterine contractions?

A

tocolytic drugs
B2 agonsits - salbutamol and ritodrine
CCB - nifedipine

stop smotth muscle contractions
cause myocytes to become hyperpolarised = cannot depolarise = cannot contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What serum marker can be measured to predict early labour?

A

foetal fibronectin

if raised, give IM steroids and monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How is labour induced?

A

membrane sweep + Bishop score –> PV prostaglandins like Dinoprostone inserted into posterior vaginal fornix –> mechanical balloon catheter/laminaria tents –> surgical amniotomy +/- oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Which scoring system can be used to assess whether induction of laour may be needed?

A

Bishop score

<5 = induction will be needed

> 9 = labour will likely be spontaneous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which drugs are given to prevent/stop postpartum bleeding?

A

Oxytocin
Ergometrine (CI in hypertensive women)
combined form - syntometrine

helps deliver placenta
makes uterus contract

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the 3 stages of labour?

A
  1. cervical dilatation (remodelling)
  2. myometrial contraction (pushing stage)
  3. placental delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which drug stops the effect of oxytocin by blocking its receptor?

A

Atosiban - used in preterm labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is defined as adequate progress in labour?

A

2 cm dilation per 4 hours of active labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Give a bried description of the stages of labour.

A

First stage - preparation

  • latent pahse - pianful, irregular contraction, cervical effacement ad dilation up to 4 cm
  • active phase - dilated >4cm, regular contractions, majority of dilatation happens in this phase

Second stage - pushing

  • passive stage - complete dilatation but no pushing
  • active - maternal pushing until delivery

Third stage - delivery of placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the 3 main causes of failure to progress in labour?

A
  1. power
  2. passenger
  3. passage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Name some problems with “power” which affect failure to progress in labour.

A

poor uterine contractions
most common cause of failure to progress
common in primigravidas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Name some problems with the “passenger” which can cause failure to progress in labour.

A

Malpresentation

malposition of a large baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Name some problems with the “passage” that can cause failure to progress in labour.

A

inadequate pelvis

cephalopelvic disproportion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are some risk factors for failure to progress in labour?

A 
large baby 
beach baby
first time mother
previous delayed labour 
premature rupture of membranes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How to assess someone in failure to progress?

A

palpate abdomen for lie, head and contractions
CTG
colour of amniotic fluid
vaginal examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How to manage delay in the first stage of labour?

A 
offer amniotomy 
if membranes already ruptured - oxytocin infusion
CTG
FBS if concerns on CTG
cosider LSCS if none of this helps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

How to manage a delay in the 2nd stage of labour?

A

allow to psuh - 2 hours if primip, 1 hour if multip

if still no imminent delivery - obstetric review for instrumental delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the foetal and maternal parameters recorded on the partogram?

A 
FHR - monitors the wellbeing of the foetus
Cervical dilatation
contractions per 10 minutes
drugs and IV fluids given
pulse and BP of the mother
urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What are some causes of breech presentation?

A
  • idiopathic
  • uterine abnormalities - bicornate uterus, fibroids
  • prematurity
  • placenta praevia
  • oligohydramnios
  • foetal abnormalities e.g. hydrocephalus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How is breech presentation managed?

A

External cephalic version at 37 weeks

LSCS if ECV unsuccessful or contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What are some contraindications for ECV?

A 
placenta praevia 
multiple pregnancies 
APH in last 7 days 
ruptured membranes
growth restricted babies
abnormal CTG
mothers wih uterine abnormalities or scars
foetal abnormlity 
pre-eclampsia or HTN (increased risk of abruption)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the correct positioning of a baby’s head when presenting?

A

occipito-anterior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What causes meconium stained liquor?

A

foetal distress
foetal maturity

risk of aspiration pneumonia in baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What pain relief medications can be used in labour?

A

paracetamol and codeine in early stages
entonox - gas and air
opiates - pethidine, morphine, diamorphine
epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

At what spinal level is an epidural administered?

A

L3-L4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What medications can be given epidurally?

A

local anaesthetics - bupivacaine

opioids - fentanyl, diamorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are some complications from an epidural?

A 
potential damage to the spinal cord
hypotension and bradycardia
haematoma/abscess at injection site 
anaphylaxis
post dural puncture headache
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are some absolute contraindications for an epidural?

A

maternal refusal
local infection
allergy to local anaesthetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What conditions are screened for in the foetal anomaly screening programme?

A

trisomy 21 - down’s
trisomy 18 - edward’s
trisomy 13 - patau’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How are the trisomies screened for?

A

first trimester - triple test - nuchal translucency + serum beta hCG + Papp-A (combined test)
needs to be done before 13+6

second trimester - quadruple test if late booker or nuchal translucency not obtained

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which hormones are tested for in the triple test?

A

alpha fetoprotein

oestriol

beta-hCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Which hormones are tested for in the quadruple test?

A
  1. AFP
  2. oestriol
  3. beta-hCG
  4. inhibin A

done if after 15 weeks of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

When should the booking visit be?

A

8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When is the nuchal translucency scan?

A

11-13+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

When is the anomaly scan performed?

A

18 - 20+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What risk score is considered a screen positive result?

A

if the risk is 1 in 150 or worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What further tests can be given in these higher risk pregnancies?

A

diagnostic testing - same day

amniocentesis or chorionic villus sampling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the 3 infectious diseases pregnant women are screened for?

A

HIV
Syphilis
Hep B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What disease are newborns screeed for on the blood spot programme?

A 
sickle cell disease (and thalassaemia)
congenital hypothyroidism
cystic fibrosis 
6 inborn errors of metabolism:
isovolaric acidaemia 
maple syrup urine disease
phenyketonuria
Medium chain acyl-CoA dehydrogenase deficiency
homocysteinuria 
glutaric aciduria type 1
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the 4 baseline parameters on a CTG?

A
  1. baseline foetal heart rate
  2. FHR variability
  3. number of accelerations - rise in baseline HR
  4. number of decelerations - fall in baselines HR
62
Q

What is the difference between early and late deceleration on a CTG?

A

early - most likely due to uterine contractions

late - whilst the uterus is relaxing, sign of foetal distress

63
Q

What is the most common cause of early deceleration?

A

head compression due to uterine contraction

64
Q

What is the most common cause of late deceleration?

A

uterine placental insufficiency/foetal distress

65
Q

What causes variable deceleration?

A

cord compression

66
Q

What are normal features on a CTG?

A

baseline HR - 110-160 bpm
variability - >5bpm
accelerations present
no decelerations present

67
Q

For what time frame is a reduced level of variability acceptable and why?

A

40 mins

baby may be sleeping

68
Q

What is the gold standard investigation for foetal heart rate monitoring during labour?

A

scalp FHR monitoring

69
Q

Define antepartum haemorrhage.

A

blood loss of >50mL after 24 weeks of gestation.

70
Q

What are some causes of APH?

A 
placenta praevia
vasa praevia
placental abruption
placenta accreta
uterine rupture

less dangerous causes:

  • cervical polyps
  • cervicitis
  • carcinoma
  • vaginitis
  • vulval varicosities
71
Q

Define placental abruption.

A

When part of the placenta becomes detached from te uterus.

72
Q

What are the risk factors for placental abruption?

A 
previous abruption
hypertension
multiple pregnancy 
trauma
cocaine and crack 
infection 
uterine abnomrality 
pre-eclampsia
smoking
73
Q

How does placental abruption present?

A

painful + hard, woody uterus + foetal distress

maternal shock inconsistent with small amount of bleeding

could be concealed with no bleeding
posterior abruption could cause back ache

74
Q

What are some complications of placental abruption?

A 
foetal death 
post partum haemorrhage 
uterine yper-contractility 
DIC
renal failure 
Sheehan's syndrome
75
Q

How do you manage placental abruption?

A 
admit to hospital - ABC
IV fluids
oxygen
ABO Rh compatible blood or O neg
if safe and term - deliver baby
76
Q

Define placenta praevia.

A

low lying placenta - any part of the placenta has implanted into the lower segment of the uterus

major - fully covering the ceervical os

minor - encroaching the lower segment but not fully covering the os

77
Q

What should be avoided in a lady with a low lying placenta?

A

Digital PV exams
penetrative intercourse

speculum exam is safe

78
Q

How does a low-lying placenta present?

A

diagnosed antenatally on 20-week anomaly scan

can be re-checked closer to delivery

79
Q

What kind of bleed will be caused by placenta praevia?

A

painless

large amount of blood

80
Q

What are the risk factor for placenta praevia?

A 
previous CS
previous TOP - uterine evacuation 
multiparity 
mother >40 
assisstd conception 
manual removl of previous placenta 
fibroids
endometriosis
81
Q

How is placenta praevia managed?

A

if minor - aim for normal delivery unless placenta is within 2 cm of os

major - elective CS at 38-39 weeks

82
Q

Define vasa praevia.

A

the major foetal vessels are presenting before the foetus

83
Q

How does vasa praevia present?

A

painless bleeding
after rupture of membranes
severe foetal distress

84
Q

How to manage vasa praevia?

A

ABC management of bleeding

delivery by CS

85
Q

How do you manage a morbidly adherent placenta?

A

MRI scan if degree of adherence uncertain

elective LSCS at 36-37 weeks

discuss possible interventions - hysterectomy, leaving the placenta in place

86
Q

Define primary PPH.

A

loss of >500mL in the first 24 hours after delivery

87
Q

What are the causes of primary PPH?

A

4 Ts:

tone - uterine atony (most common)
trauma - big tear in the genital tract
tisue - retained products i.e. palcenta
thrombin - clotting disorder

88
Q

How do you diagnose uterine atony on abdo exam following delivery?

A

un-palpable uterus

89
Q

How do you manage PPH caused by uterine atony?

A

emptying bladder can help
rub the abdomen to help the uterus contract
bimanual compression of the uterus

IV syntocinon (combination of ergometrine and oxytocin to help uterus contract)
IM carboprost (or dinoprostone - prostaglandins)
surgical options - B-lynch sutures, internal iliac artery/ uterine artery ligation

others - uterine artery embolisation, hysterectomy

90
Q

Define secondary PPH.

A

excessive blood loss from the genital tract after 24 hours - 12 weeks from delivery

91
Q

What is the most common cause of secondary PPH?

A

retained placental tissue

92
Q

What are the most common causes for vaginal bleeding in the first trimester?

A

miscarriage

ectopic pregnancy

93
Q

What is the commonest cause of direct maternal death?

A

pulmonary embolism

high risk in post-partum period

thromboprophylaxis - LMWH injection i.e. dalteparin and TED compression stockings

94
Q

What is the gold standard investigation for VTE?

A

DVT - ultrasound doppler
PE - CTPA

if suspicious - Well’s score and D-dimer

95
Q

What is cord prolapse?

A

When the umbilical cord prolapses though the cervix when the membranes rupture.

96
Q

Why is cord prolapse dangerous?

A

exposure of the cord leads to vasospasm

can cause foetal hypoxia

97
Q

What are the risk factors for cord prolapse?

A 
PROM
polyhydramnios
long umbilical cord
malpresentation
multiparity 
multiple pregnancy
98
Q

How to manage cord prolapse?

A

call 999/pull emergency buzzer
alleviate pressure on cord - put their feet up in the air - Trendelenberg position
transfer to theatre and prep for delivery

99
Q

What’s the definition of shoulder dystocia?

A

failure of the anterior shoulder to pass under the symphysis pubis after delivery of the foetal head

100
Q

What are the risk factors for shoulder dystocia?

A 
macrosomia (baby >4 kg)
maternal diabetes
cephalopelvic disproportion 
post-maturity that required IoL
prolonged labour 
instrumental delivery
101
Q

What are the complications of shoulder dystocia to the baby?

A 
hypoxia 
fits
Cerebral Palsy
brachial plexus injury/Erb's palsy 
fractured clavicle or humerus
102
Q

What is the only licensed anticoagulant in pregnancy?

A

Dalteparin (LMW heparin)

103
Q

How does obstetric cholestaiss present and how is it treated?

A

presents with itchy hands and feet

tx - ursodeoxycholic acid
piriton helps with itching

104
Q

What is a common symptoms of hyperthyroidism during pregnancy?

A

excessive vomiting

105
Q

What are the side effects of anti-thyroid drugs during pregnancy?

A

propylthiouracil - maternal liver failure

carbimazole - foetal abnormalities

106
Q

What pre-conceptual advice should you give someone who has diabetes?

A 
aim for HbA1c < 48 mmol/L
take 5 mg folical acid 
stop ACEi and statins
retinal screening 
renal function screening 
establish good diabetic control before pregnancy (stay on contraception until then)
107
Q

Which diabetic drug is contraindicated in pregnancy?

A

Gliclazide

108
Q

Which anti-epileptic drugs are contraindicated in pregnancy?

A

most of them are teratogenic

valproate is the worst - neural tube defects, spina bifida

109
Q

Define gestational hypertension.

A

new htn after 20 weeks’ gestation
systolic >140
diastolic >90

110
Q

Define pre-eclampsia.

A

gestational HTN + proteinuria

111
Q

Define eclampsia.

A

gestational HTN + proteinuria + generlaied tonic-clonic seizures

112
Q

What are the risk factors for pre-eclampsia?

A 
smoker
young female
first pregnancy 
black ethnicity 
multiple pregnancy 
hypertension
diabetes
FHx
113
Q

What is the pathophysiology behind the seizures in eclampsia?

A

proteinuria –> hypoalbuminaemia –> oedema –> fludi loss into 3rd space = hypovolaemia –> lack of perfusion to vital organs –> cerebral hypo-perfusion –> seizures

114
Q

What is HELLP syndrome?

A

haemolysis
elevated liver enzymes (AST and ALT)
Low platelets

115
Q

What are the symptoms of pre-eclampsia?

A 
oliguria 
visual changes, headaches
oedema 
RUQ pain (liver capsule stretches)
rapid weight gain
116
Q

What are the signs of pre-eclampsia?

A 
hypertension
proteinuria
papilloedema
RUQ tenderness
ankle clonus (brisk reflexes are normal in pregnancy but ankle clonus is not)
117
Q

What test result is diagnositc for pre-eclampsia?

A

protein:creatinine ration > 30

118
Q

How do you treat pre-eclampsia?

A

admit to hospital
only cure is to deliver baby
if not at term, give labetalol to lower BP
give magnesium sulphate to prevent seixures
IoL is safe

119
Q

What prophylactic tx should you give a pregnant woman with a history of pre-eclampsia?

A

aspirin 75 mg

from 10-36 weeks’ gestation

120
Q

What high risk ladies should be given aspirin during pregnancy?

A

High BMI
renal disease
known HTN
hx of pre-eclampsia

121
Q

Define premature infant.

A

infant born before 37 weeks’ gestation

122
Q

Define small for dates.

A

below 10th centile for their gestational age

123
Q

Define large for dates.

A

above 90th centile for their gestational age

124
Q

Define low birth weight.

A

baby born with a weight < 2.5 kg

125
Q

Define macrosomia.

A

baby born weighing > 4 kg

126
Q

Define IUGR.

A

a baby which has not maintained its growth potential.

127
Q

What are the major complications of premature delivery to the baby?

A 
developmental delay 
cerebral palsy 
chronic lung disease
retinopathy of prematurity 
necrotising enterocolitis
128
Q

What are the diagnositc crtieria for preerm labour?

A

persistent uterine activity
+
change in cervical dilatation and/or effacement

129
Q

How can preterm labour be predicted?

A

measure cervical length with transvaginal USS

foetal fibronectin levels

130
Q

How to reduce the risk of pre-term birth in those at increased risk?

A

cervical stitch if length < 3 cm

IM or pessary progesterone

131
Q

What are the signs of SIRS - systemic inflammatory response syndrome?

A

3 Ts white with sugar

temperature (>38 or <36)
tachycardia (>90)
tachypnoea (>20)
white blood cell count (<4 or >12)
sugar - blood glucose (>7.7 mmol in the absence of DM)
132
Q

How should SGA babies be managed during pregnancy?

A
  • growth scans every 2-3 weeks
  • umbilical artery doppler to see if baby is getting enough blood
  • offer corticosteroids for foetal lung maturity up to 35+6 weeks
133
Q

What are 2 parental risk factors associated with miscarriage?

A

maternal age > 35

paternal age > 40

134
Q

What are some causes of miscarriage?

A

foetal chromosomal abnormalities
maternal illness - infections, pyrexia
trauma

135
Q

What is the definition of recurrent miscarriage?

A

loss of >= 3 consecutive pregnancies

before 24 weeks’ gestation

136
Q

What are some causes of recurrent miscarriage?

A

chronic materal disease - DM, SLE
Anti-phospholipid syndrome
uterine abnormality
infection - bacterial vaginosis
parental chromosomal abnormality - balanced Robertsonian translocation
thrombophilia - factor V Leiden deficiency, protein S and C deficiency

137
Q

What serum markers would you look for if you suspected anti-phospholipid syndrome?

A

lupus anticoagulant antibodies
anti-cardiolipin antibodies
phospholipid antibodies

138
Q

What is a threatened miscarriage?

A

mild symptoms

cervical os is closed

139
Q

What is inevitable miscarriage?

A

severe symptoms

cervical os is open and you can pass one finger through it

140
Q

What is incomplete miscarriage?

A

msot of the products have already been passed but there are some retaine dproducts of conception

141
Q

What is a missed miscarriage?

A

foetus dies in utero without any symptoms

picked up on USS

142
Q

How does a miscarriage present?

A

PV bleeding

143
Q

How do you investigate a miscarriage?

A

speculum exam - allows you to see the cervical os
digital vaginal exam
USS

144
Q

How is a miscarriage managed?

A

expectant mgmt
ergometrine - to stop profuse bleeding
medical mgmt - mifepristone followed by misoprostol

surgical mgmt - if unacceptable bleeding, pain or significant retained products seen on USS

145
Q

How should recurrent miscarriage be investigated?

A

refer to specialist recurrent miscarriage clinic
test for anti-phospholipid antibodies
thrombophilia screening
pelvic USS to look at structure of uterus
karyotype foetal products after 3rd foetal loss

146
Q

What is the most common site for an ectopic pregnancy?

A

ampulla of the fallopian tube

147
Q

What are the risk factors for an ectopic pregnancy?

A 
hx of it
PID
damage to the tubes
endometriosis 
copper coil 
POP 
smoking 
tubal ligation
148
Q

How does ectopic pregnancy present?

A

always consider ectopic in a sexually active woman with abdo pain, bleeding, fainting, diarrhoea or vomiting

uncertain LMP or 6-8 weeks amenorrhoea
unilateral abdo pain 
PV bleed
D&amp;V
dizziness and fainting 
shoulder pain due to haematoperitoneum - irritates the diaphragm
149
Q

How to investigate ectopic pregnancy?

A 
pregnancy test - urinary beta hCG
vaginal and speculum exam - cervical motion tenderness/cervical excitation 
USS
FBC
group and save
150
Q

How to manage ectopic pregnancy?

A

expectant mgmt if hCG is falling, mild symptoms, no foetal heart activity on USS, woman is haemodynamically stable

medical mgmt - methotrexate - contraception for 3m after as teratogenic

surgical mgmt - laparoscopy - salpingectomy if other tube healthy
other tube unhealthy = salpingectomy

151
Q

What are the SEs of methotrexate?

A

conjunctivitis
stomatitis
diarrhoea
abdo pain

152
Q

What signs/symptoms do you get with a molar pregnancy?

A

aka hyatidiform mole
uterus bigger than expected for gestation
hyperthyroidism
painless PV bleed
excessive mornign sickness
high serum hCG –> hyperememsis gravidarum and thyrotoxicosis

NV - Phase 3A (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions