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Women's Health > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What percentage of all pregnancies are ectopic?

A

0.5%

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2
Q

Risk factors for ectopic pregnancy:

A
  • damage to tubes (salpingitis, surgery)
  • previous ectopic
  • IVF (3%)
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3
Q

Typical history of female with ectopic pregnancy:

A
  • 6-9 weeks amenorrhoea
  • lower abdominal pain
  • peritoneal bleeding can cause shoulder tip pain and pain on defecation/urination
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4
Q

What suggests a threatened miscarriage?

A
  • painless bleeding before 24 weeks (typically 6-9 weeks)
  • cervical os closed
  • complicates up to 25% pregnancies
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5
Q

What suggests a missed (delayed) miscarriage?

A
  • gestational sac which contains dead foetus before 20 weeks without symptoms of expulsion
  • light bleeding an discharge
  • may have blighted ovum or anembryonic pregnancy
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6
Q

What is a blighted ovum/anembryonic pregnancy?

A
  • gestational sac >25mm

- no embryonic/foetal part seen

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7
Q

What suggests an inevitable miscarriage?

A
  • cervical os open

- heavy bleeding with clots and pain

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8
Q

What suggests an incomplete miscarriage?

A

not all products of conception have been expelled

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9
Q

What is placental abruption?

A
  • separation of normally sited placenta from uterine wall
  • maternal haemorrhage into intervening space
  • 1 in 200 pregnancies
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10
Q

Features of placental abruption:

A
  • shock out of keeping with visible loss
  • pain constant
  • tender, tense uterus
  • normal lie and presentation
  • foetal heart: absent/distressed
  • coagulation problems
  • beware pre-eclampsia, DIC< anuria
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11
Q

What is symphysis pubis dysfunction?

A
  • ligament laxity increases in response to hormonal changes of pregnancy
  • pain over pubic symphysis with radiation to groin and medial aspect of thighs
  • waddling gait may be seen
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12
Q

What is uterine rupture?

A
  • typically during labour but can occur during third trimester
  • risk factor: previous caesarean section
  • presents with maternal shock, abdominal pain and bleeding
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13
Q

What is the pain of pre-eclampsia/HELLP syndrome typically like?

A

epigastric or RUQ

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14
Q

What is the most common non-obstetric surgical emergency in pregnancy?

A

appendicitis

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15
Q

What is the risk of UTI in pregnancy?

A
  • 1 in 25 women develop

- associated with increased risk pre term delivery and IUGR

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16
Q

What is increased AFP a sign of in pregnancy?

A
  • neural tube defects (meningocele, myelomeningocele and anencephaly)
  • abdominal wall defects (omphalocele and gastroschisis)
  • multiple pregnancy
17
Q

What is decreased AFP a sign of in pregnancy?

A
  • Down’s
  • Trisomy 18
  • maternal diabetes mellitus
18
Q

What is an amniotic fluid embolism?

A
  • foetal cells/amniotic fluid enters the mother’s bloodstream and stimulates ra reaction
  • majority in labour
  • chills, shivering, sweating, anxiety and coughing
  • cyanosis, hypotension, bronchospasm, tachycardia, arrhythmias, MI
19
Q

What nutritional supplements are advised in pregnancy?

A
  • folic acid 400mcg from before conception until 12 weeks

- vitamin D 10 micrograms per day

20
Q

Which vitamin supplement can be teratogenic?

A
  • vitamin A

- above 700 micrograms

21
Q

Air travel during pregnancy:

A
  • women >37 weeks with singleton pregnancy and no risk factors should avoid
  • uncomplicated, multiple pregnancies avoid once >32 weeks
  • increased risk VTE
22
Q

Visits at 8-12 weeks gestation:

A
  • booking visit: general info, BP, urine dipstick, BMI
  • booking bloods/urine: FBC, blood group, rhesus, red cell all-antibodies, haemoglobinopathies, hepatitis B, syphilis, HIV, urine culture to detect asymptomatic bacteriuria
23
Q

Visit at 10-13+6 weeks:

A
  • early scan to confirm dates

- exclude multiple pregnancy

24
Q

Visit at 11-13+6 weeks:

A

Down’s syndrome screening including nuchal scan

25
Q

Visit at 16 weeks:

A

information on anomaly and blood results - if Hb <11g/dl consider iron (routine care: BP and urine dip)

26
Q

Visit at 18-20+6 weeks:

A

anomaly scan

27
Q

Visit at 25 weeks:

A
  • only if primip

- routine care: BP, urine dipstick, symphysis fundal height

28
Q

Visit at 28 weeks:

A
  • routine care: BP, urine dip, SFH
  • second screen for anaemia and atypical red cell alloantibodies
  • if Hb <10.5g/dL consider iron
  • first dose of antiD prophylaxis to rhesus negative women
29
Q

Visit at 31 weeks:

A

routine care

30
Q

Visit at 34 weeks:

A
  • routine care
  • check presentation - offer external cephalic version if indicated
  • information breast feeding, vit K etc.
31
Q

Visit at 38 weeks:

A

routine care

32
Q

Visit at 40 weeks:

A
  • only if primip
  • routine care
  • options for prolonged pregnancy
33
Q

Visit at 41 weeks:

A
  • routine care

- discuss labour plans and possibility of induction

34
Q

Conditions which all pregnant women should be offered screening:

A
  • anaemia
  • bacteriuria
  • blood group, rhesus status and anti-red cell antibodies
  • Down’s
  • foetal anomalies
  • hep B
  • HIV
  • neural tube
  • risk factors for pre-eclampsia
  • syphilis
35
Q

Which conditions should pregnant women be offered screening depending on history?

A
  • placenta previa
  • psychiatric illness
  • sickle cell
  • Tay Sachs
  • Thalassaemia
36
Q

What is antepartum haemorrhage?

A

bleeding from genital tract after 24 weeks pregnancy prior to delivery of foetus

37
Q

How is placenta praevia different from placental abruption?

A

-shock in proportion to visible loss
-no pain
-uterus not tender
-lie and presentation may be abnormal
-foetal heart normal
-coagulation problems rare
-small bleeds before large
(placental abruption all opposite)

38
Q

What is the Bishop score used for?

A

assess whether induction of labour is required

39
Q

What factors are involved in the Bishop score?

A

-cervical position
-cervical consistency
-cervical effacement
-cervical dilation
-foetal station
<5 labour unlikely to start without induction
>9 labour most likely to commence spontaneously

Women's Health (5 decks)

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