Brainscape's Knowledge GenomeTM

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


See full index

ISCE prep > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Clinical features of an ectopic pregnancy

A 
Pain- pelvic or lower abdominal classically, can be referred to shoulder tip 
\+/- 
Vaginal bleeding
Vaginal discharge- brown 'prune juice'
History of amenorrhoea 
Haemodynamically unstable 
Signs of peritonitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Differentials of an ectopic pregnancy

A 
Miscarriage
Ovarian cyst accident- torsion, cyst haemorrhage or rupture 
Acute PID
UTI
Appendicitis 
Diverticulitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Investigations for ectopic pregnancy

HINT: When should a laparoscopy be offered?

A

Pregnancy test for urinary beta HCG
+ then transvaginal USS
MRI second line

If pregnancy of unknown origin (cannot be identified on USS) then 48 hours later beta HCG
Should double if early intrauterine
Half if miscarriage
>1500 then ectopic until proven otherwise- diagnostic laparoscopy

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

Management of an ectopic pregnancy

A

If haemodynamically unstable then (haemorrhage protocol), ABCDE

Expectant/ conservative- PUL, stable, minimal or no symptoms

Medical- IM methotrexate (offered first line), monitor beta HCG levels (<1500), unruptured ectopic with a small adnexal mass

Surgical- laparoscopic salpingectomy (if no contralateral tubal damage), significant pain, mass >35mm, fetal heartbeat on USS, serum HCG >5000
Anti-D immunoglobulin

Follow up to see serum HCG decreasing at acceptable rate

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

`Up to what age is an early medical abortion (EMA)? Where can this be done?

A

10/40
Home or clinic
After this until 12 weeks the medical abortion must be done in a clinic

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

Medical abortion management up to 12/40

A

Mifepristone- anti-progesterone orally

Vaginal misoprostol- prostaglandin analogue to cause uterine contraction to expel

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

What to expect from an EMA

A 
Dizziness
Flushing 
Diarrhoea 
Nausea
Period like cramping
Vaginal bleeding, may be heavy with clots up to 2/52
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Medical abortion management 12/40+

A

Inpatient stay
Mifepristone followed by 3 hourly misoprostol
Feticide recommended in late second trimester- digoxin or potassium chloride

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

Surgical abortion options

A

Vacuum aspiration up to 14/40

Dilation and evacuation 14/40+ (with forceps as well as the vacuum aspiration)

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

Differentials for continued bleeding after medical or surgical abortion

A

Retained products of conception- persistent pain and/or bleeding
Infection- endometritis
Contraception
Failure of procedure- uterine perforation

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

Signs of endometritis

A 
Pain
Bleeding
Deep dyspareunia 
Vaginal discharge
Fever
Cervical motion tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of endometritis

A

Sepsis 6 if systemically unwell
(H) ABCDE if haemodynamically unstable
Broad spectrum antibiotics
Empty uterus if indicated

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

Signs of tubal rupture and intra-abdominal bleeding

A 
Pallor
Tachycardia
Hypotension
Shock or collapse 
Shoulder tip pain (from diaphragmatic irritation due to intraperitoneal blood)
Vomiting and diarrhoea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What should ALWAYS be checking in a bleeding obstetric history?

A

Rhesus status

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

Vaginal bleeding and slight abdominal discomfort 30/40 pregnant differentials

A 
Placenta praevia 
Placental abruption
Endometritis 
Haemorrhage 
Trauma
Vasa praevia 
Early labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Vaginal bleeding and slight abdominal discomfort 30/40

Investigations

A

History
General examination for signs of haemodynamic compromise
Urine dip
FBC, LFTs, U&Es
Transabdominal ultrasound- looking for placenta
CTG- Fetal heart rate and situation
Speculum examination- trying to localise the cause of bleeding

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

Factors associated with recurrent miscarriages

A 
Antiphospholipid syndrome
DM and thyroid disease
PCOS 
Anatomical malformations- uterine or cervical, fibroids, Asherman's syndrome 
Infection 
Lifestyle
Advancing maternal age
Inherited thrombophilia- factor V leiden
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Investigating recurrent miscarriage

A

Blood tests- antiphospholipid antibodies (anticardiolipin, lupus anticoagulant and glycoprotein B2)
Karotyping
Imaging- pelvic USS

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

Clinical features of placental abruption

A

Painful vaginal bleeding (may not be visible if concealed)
Woody hard uterus and may be pain on palpation
May be haemodynamically unstable

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

Triad of vasa praevia

A

Vaginal bleeding
Rupture of membranes
Fetal compromise (rapid deterioration due to loss of fetal blood from the umbilical cord vessels)

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

Investigations for placental abruption

A

FBC, clotting profile
Kleihauer test- to determine amount of anti-D required
Group and save- if unknown
Cross match
U&Es, LFTs- HELLP
Ultrasound scan- poor negative predictive value though

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

Management of placental abruption

A

Conservative- marginal abruption no compromise
Induction of labour
Emergency delivery if mother or fetal compromise- C/section
ANTI-D within 72 if rhesus negative

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

Clinical features of placenta praevia

A

Classically painless vaginal bleeding

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

Useful questions to ask regarding antepartum haemorrhage

A 
How much bleeding and timescale (how many pads)
Details of the blood
Could the waters have broken
Provoked or not
Abdo pain
Fetal movements normal
Risk factors for abruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Differentials for antepartum haemorrhage

A

Placental abruption
Placenta praevia
Vasa previa
Uterine rupture
Local genital causes- polyps, carcinoma, ectropion
Traumatic
Infections- candida, bacterial vaginosis, chlamydia

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

Placenta praevia management

A

Minor or major USS scans at 36 and 32 weeks respectively
Planned C-section at 38 weeks
ABCDE if significant haemorrhage
Give anti-D within 72 hours of onset of bleeding if rhesus negative

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

High risk factors for pre-eclampsia

A

Chronic HTN
previous pregnancy HTN, pre or eclampsia
CKD
DM
Autoimmune diseases- SLE, antiphospholipid syndrome

28
Q

Prophylaxis for pre-eclampsia

A

75mg daily aspirin if 1 high risk factor or 2 moderate risk factors
From 12 weeks

29
Q

Clinical features of pre-eclampsia

Including criteria

A

HTN on two occasions
Significant proteinuria
In a women >20 weeks pregnant

Headaches, blurred vision, halos, photopsia, epigastric pain, sudden onset oedema, hyperreflexia

30
Q

Complications of pre-eclampsia

A 
HELLP syndrome
Eclampsia
DIC
AKI
ARDS
HTN post-partum
Cerebrovascular haemorrhage 
Death

Fetal- growth restriction, placental abruption, death

31
Q

Pregnancy induced hypertension

A

New onset after 20 weeks gestation

32
Q

Management of pre-eclampsia

A

Monitoring of maternal and fetal wellbeing- regular blood pressure check, urinalysis, blood tests, fetal growth scans and cardiotocography

Venous thromboembolism prevention- low molecular weight heparin
Antihypertensives- labetalol (1) or nifedipine (2) or methyldopa
Delivery- the definitive cure

Monitor mother until 24 hours post-partum

33
Q

To diagnose hyperemesis gravidarum

A

More than 5% pre-pregnancy weight loss
Dehydration
Electrolyte imbalances

34
Q

Management of hyperemesis gravidarum

A

Mild- community, oral antiemetics, oral hydration, dietary advice, reassurance

Moderate- ambulatory daycare- IV fluids, parenteral antiemetics and thiamine

Severe- inpatient care

35
Q

Fetal complications of gestational diabetes

A 
Macrosomia 
Organomegaly
Erythropoiesis 
Polyhydramnios 
Increased rates of pre-term delivery
36
Q

Gestational diabetes plasma glucose tests

A

Fasting >5.6mmol/L

2hr post-prandial >7.8mmol/L

37
Q

Management of gestational diabetes

A

Patient education and careful monitoring and control of BM
Consultant lead care
Metformin (1) Sulphonylurea (2)
Insulin if fasting glucose >7.0mmol/L at diagnosis

Aim to deliver 37-38 weeks

38
Q

What is the definition of a major PPH?

A

> 1000ml of blood loss within 24 hours of delivery

39
Q

Causes of primary post-partum haemorrhage

A

Tone- uterine atony- inadequate contraction
Tissue- retention, preventing uterine contraction
Trauma- vaginal or cervical tears- instrumental, episiotomy, C-section
Thrombin- vascular abnormalities (abruption, HTN, pre-eclampsia) or coagulopathies (von Willebrand’s disease, haemophilia, ITP, DIC, HELLP)

40
Q

Clinical features of PPH

A

PV bleeding
May be signs of hypovolaemia
May be signs of local trauma

41
Q

Management of PPH

HINT: TRIM

A

Teamwork

Resuscitation- ABCDE
Protect airway
15L of 100% via non-rebreathe
Cap refill, HR, BP and ECG monitoring, two large 14G cannulas, give cross matched blood, up to 2L of warmed crystalloid and 1-2L of warmed colloids until blood available
Monitor GCS
Expose to identify bleeding sources

Investigations and monitoring- every 15 mins, consider catheter and central line insertion

Measures to arrest bleeding

Atony- Bimanual compression, pharmacological management, surgical intrauterine balloon tamponade
Hysterectomy always last resort
Repair of any trauma
Administration of oxytocin to remove placenta, or manual removal
Correction of coagulation abnormalities with haematology team advice

42
Q

Obstetric history

A 
Previous obstetric history
- gestation period
- mode of delivery
- gender
- birth weight 
- complications (any assistance required)
- who was involved in the care
- miscarriages/ terminations/ gestation periods of these/ ectopics 
GRAVIDITY and PARITY 
Current pregnancy
Gestational age and EDD
Use of folate
Singleton or multiple
Any screening- any fetal anomalies
Placenta position 
Amniotic fluid index
43
Q

Gynaecological history

A

PC- type and site of symptoms, timing (cyclical, continuous/intermittent), exacerbating and relieving factors, previous episodes + treatment, other symptoms
PV bleeding- intermenstrual, post-coital, post-menopausal
SOCRATES
Vaginal discharge- colour, consistency, amount, smell
Menstrual history- frequency, duration, volume
Other symptoms- dyspareunia, vulval itching, skin changes, infertility- assisted conception, investigations

PMH- pregnancies, deliveries, complications
Cervical smear
Surgical history
Previous gynae problems or STIs

DH- allergies, contraception, HRT, recent abx, any other (recreational or OTC)

FH- Breast/ cervical/ ovarian/ endometrial cancer
DM, bleeding disorders

44
Q

Causes of post-coital bleeding

A

Cervical ectropion
Infection
Vaginitis
Malignancy

45
Q

Causes of intermenstrual bleeding

A 
Infection
Malignancy
Fibroids
Endometriosis
Pregnancy
Hormonal contraception
46
Q

Causes of post-menopausal bleeding

A

Malignancy
Vaginal atropy
HRT use

47
Q

Clinical features of uterine fibroids

A 
Majority asymptomatic 
Pressure symptoms +/- abdo distension- constipation, urinary retention 
Menorrhagia 
Subfertility 
Red degeneration- acute pelvic pain
48
Q

Investigations for uterine fibroids

A

Routine bloods if unclear what the diagnosis is

Pelvic ultrasound

49
Q

Management of uterine fibroids

A

Medical- tranexamic or mefenamic acid
Hormonal contraception to control menorrhagia- COCP, POP and Mirena IUS
GnRH analogues, progesterone receptor modulators

Surgical- hysteroscopy and transcervical resection of fibroid
Myomectomy- to preserve uterus
Uterine artery embolisation
Last resort hysterectomy

50
Q

Clinical features of endometriosis

A

Cyclical pelvic pain
Dysmenorrhoea, dyspareunia, dysuria, subfertility

O/E, general tenderness, may be nodularity

51
Q

Differentials of endometriosis

A

PID
Ectopic pregnancy
Fibroids
IBS

52
Q

Investigating endometriosis

A

Pelvic USS

Gold standard is laparoscopy- chocolate cysts, adhesions, peritoneal deposits

53
Q

Management of endometriosis

A

Pain- NSAIDs
Medical- Ovulation suppression for 6 months can cause atrophy of the lesions- COCP, progesterone agonist or Mirena coil
Surgical- excision, fulgaration (destruction with diathermy), laser ablation

54
Q

Risk factors for endometrial cancer

A 
Early menarche/ late menopause
Low parity
PCOS- due to oligomenorrhoea 
HRT with oestrogen alone
Tamoxifen use 
Increasing age
Obesity 
Hereditary factors that predispose to cancer- Lynch syndrome
55
Q

Clinical features of endometrial cancer

A

Post-menopausal bleeding - 75-90% present like this
Clear or white vaginal discharge
Abdo pain or weight loss if advanced

56
Q

Investigations for endometrial cancer

A

Transvaginal ultrasound
if >4mm then endometrial biopsy
If high risk case then hysteroscopy with biopsy
FIGO staging

57
Q

Management of endometrial cancer

A

MDT and supportive therapy
Stage dependent
Hysterectomy and bilateral salpingo-oophorectomy even at stage 1, any larger and radical with radiotherapy and chemotherapy

Hyperplasia or atypia may precede malignancy and should be treated and surveyed

58
Q

Causes of heavy menstrual bleeding

A 
Polyp
Adenomyosis
Leiomyoma (fibroids)
Malignancy and hyperplasia
Coagulopathy 
Ovulatory dysfunction 
Endometrial
Iatrogenic 
Not classified
59
Q

Investigating heavy menstrual bleeding

A

FBC, TFT, other hormones if suspicious (prolactin)
Coag screen and test for von Willebrand’s disease
USS pelvis- transvaginal
Smear up to date
High vaginal and endocervical swabs for infection
Pipelle endometrial biopsy
If pathology identified or inconclusive- hysteroscopy and endometrial biopsy

60
Q

Management of heavy menstrual bleeding

A

Mirena coil if contraception needed
Tranexamic acid or mefenamic acid if not
COCP or POP

Surgical- endometrial ablation or hysterectomy

61
Q

Two most common hormonal abnormalities in PCOS

A

Excess luteinising hormone- generating too many androgens

Insulin resistance

62
Q

Clinical features of PCOS

A 
Oligomenorrhoea or amenorrhoea 
Infertility
Hirsutism/ acne/ acanthosis nigricans/ male pattern baldness 
Obesity 
Chronic pelvic pain
Depression
63
Q

Differentials for PCOS

A

Hypothyroidism
Hyperprolactinaemia
Cushing’s disease

64
Q

Investigating PCOS

A

Blood tests- raised testosterone, raised LH, normal FSH, low progesterone, TFTs, serum prolactin, oral glucose tolerance test
Imaging- pelvic USS- transvaginal

65
Q

Managing PCOS

A

Weight management through lifestyle changes
Induction of bleeds through COCP use to protect the endometrium from hyperplasia
Infertility- clomifene +/- metformin
Anti-androgen medication- spironolactone can lower levels

ISCE prep (6 decks)

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