Brainscape's Knowledge GenomeTM

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


See full index

year 3 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is the role of the amniotic sac

A

Stores amniotic fluid: Prevents shock and infections to the baby

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

Why does someone’s ‘water’ break

A

Indicator of uterine contractions

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

What is the premature rupture of membranes

A

This is membrane rupture in the absence of uterine contractions

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

When is premature rupture of membranes diagnosed

A

If it happens after 37 weeks

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

What is preterm premature rupture of membranes(pPROM)

A

This is when membrane ruptures before 37 weeks.

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

What is prolonged rupture of membranes

A

When membrane rupture happens greater than 18 hours before delivery.

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

Risk factors for PROM or pPROM

A
  1. Previous PROM
  2. Genital or UTIs
  3. Smoking
  4. Polyhydramnios (too much amniotic fluid)
  5. Abdo trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Diagnosis of PROM

A
  1. Speculum Exam

AVOID DIGITAL EXAMINATION (increases risk of infection and precipitate labour in women with pPROM)

  1. Nitrazine and Fern test
  2. Check fetal status
  3. Screen for STIs (can be caused by rupture)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does a speculum exam show in PROM

A
  1. Shows fluid pooling in posterior vaginal fornix
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Is there a cause for concern if blood or meconium is found in the posterior vaginal fornix

A

No

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

What is the Nitrazine and Fern test

A

To check for amniotic fluid (make sure it is).

Nitrazine: fluid placed on pH sensitive paper (pos = dark blue)

Fern test: Fluid placed on slide and examined under microscope - positive if ferning pattern is seen (like a plant)

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

What do we do if no fluid is seen in posterior vaginal fornix when checking for PROM

A
  1. Individual asked to cough and press on uterine fundus.

May enhance amniotic fluid flow through cervical opening

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

If nothing is seen on the speculum exam for PROM after amniotic fluid press, what should be done and what is seen

A
  1. USS: should see low amniotic fluid volume (oligohydramnos)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is oligohydramnios

A

When Amniotic fluid index <5cm

This confirms premature reupture of membrane

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

What do we do if AFI turns out low-normal when checking for PROM

A

6-7cm:
PAMG-1 test

IGFBP-1 test

Combined test

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

What is PAMG-1

A

Placental alpha-microglobulin-1

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

What does IGFBP-1 look for

A

Placental protein 12

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

What does the combined test look for

A
  1. Placental protein 12

2. Alpha fetoprotein

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

How is fetal status determined

A
  1. USS: to check for fetal position and gestational age

2. Non-stress test: fetal wellbeing

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

What is a non-stress test

A
  1. 20 minute recording of fetal heart rate using Cardiotocograph
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a cardiotocograph

A

Electronic fetal monitor

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

What is a normal heart rate on cardiotocography

A
  1. 110-160BPM

2. at least 2 accelerations (changes in 15BPM up or down

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

What kind of accelerations do we see in preganncies above 32 weeks

A

changes in 15BPM lasting for 12 secs

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

What kind of accelerations do we see in pregnancies below 32 weeks

A

changes in 10BPM lasting at least 10 secs.

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

What readings show fetal distress on an NST

A
  1. Decreased heart rate
  2. Fewer/shorter accelerations

This is calleed non-reactive result

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

Infectious causes for STIs as a cause of membrane rupture

A
  1. UTI (urinalysis)

2. Chalmydia/gonorrhoea (cervical swabs)

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

What are infectious consequences of PROM, pPROM and prolongued PROM

A
  1. Inauterine infections as environment is no longer sterile

This can cause an ascending infection of endometritis/chorioamnnionitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What bacteria make up normal vaginal flora

A
  1. Gram negative lactobacilli (anaerobic)

2. Group B strep (vaginal and rectal swabs for culture)

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

What is endometritis

A
  1. Where to endometrium is infected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Symptoms of ascending infections from vaginal flora in PROM

A
  1. Fever
  2. Tachycardia
  3. tender uterus
  4. Septic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How is PROM managed

A
  1. After 37 weeks:

Labour is induced with oxytocin or c section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

If the cervix is unfavourable, what should be given

A

25mcg misoprostal intravaginally every 3-6 hours

Perorally every 2 hours.

5 times total

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

If someone with PROM is GBS positive, what should be given

A

Ampicillin during delivery

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

How should pPROM be managed

A

Intrauterine infection is major concern

Azithromycin single dose

IV ampicillin (2g) every 6 hours for 48 hours.

Oral Amoxicillin for 5 more days

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

When should delivery be induced in PROM

A
  1. > 34 weeks as fetal lungs have matured

Waiting would cause infection

GBS posiitive: Ampicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

24-34 weeks gestation (PROM and pPROM), what should be management plan

A
  1. Antenatal corticosteroids
  2. tocolytic meds for 48 hours (Nifedipin, NSAID and terbutaline
  3. Mg Sulfate to protect CNS and cerebral palsy

Delivery should be within 1 week.

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

management of pProm before 24 weeks

A

Fetus is non-viable = abortion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When does vaginal bleeding most commonly occur

A

1st Trimester

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

Management of vaginal bleeding

A
  1. Assess haemodynamic stability (hypovolaemia/ Vital Sign Status).
  2. Compensate blood loss (ABC)

B- breathing (non-rebreathable mask)
C - circulation (measuring hypovolaemia/ IV catheter for fluid resus)

  1. Exams: Pelvic, TVUSS, Lab tests
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Findings of hypovolaemia:

Stage 1, Stage 2, Stage 3, Stage 4

A

Stage 1:

Hypo: 500-1000 mL

Vital Sign Status:

BP Normal
Tachycardia
Palpitations
Dizziness

Stage 2:

Hypo: 1000-1500 mL

Vital Sign Status:

  • SBP: 80-100 mmHg
  • Tachycardia
  • Weakness
  • Sweating

Stage 3:

Hypo: 1500-2000 mL

Vital Sign Status:

  • SBP: 70-80 mmHg
  • Restelessness
  • Palor
  • Decreased Urine

Stage 4:

Hypo: >2000 mL

Vital Sign Status:

  • SBP: 70-80 mmHg
  • Cardio/Resp Collapse
  • Loss of Consciousness
  • Anuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Management of those in stage 3 hypovolaemia or higher

A

Blood transfusion

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

Causes of antepartum haemorrhages in first trimester

A
  1. Implantation bleeding
  2. Ectopic
  3. Miscarriage
  4. Genital tract pathology

Always assume ectopic

Vaginal Pathology:

Vaginitis: Discharge + wet mount needed
Vaginal Tumours:
Warts: Remove and histopathology

Cervical Pathology:
Cervical Ectropion/polyps
Fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Causes of antepartum haemorrhage in second trimester

A
  1. Miscarriage

2. Genital tract pathology

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

Why does implantation bleeding occur

A
  1. Developing embryo burrows into uterine lining 10-14 days after fertilisation (light bleeding lasting 2 days max)

Mistaken for menstrual period

Diagnosed by exclusion

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

What is an ectopic pregnancy

A

Where embryo implants elsewhere instead of the uterine cavity (the ampulla of fallopian tube usually )

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

RF for ectopic pregnancy

A
  1. Previous ectopic
  2. Previous tubal surgery
  3. IUD
  4. Bilateral tubal ligation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Symptoms of ectopic pregnancy

A
  1. Pain

2. Vaginal bleeding

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

Diagnosis of ectopic pregnancy

A
  1. Serum HCG

> 2000 mIU/ mL

Pregnancy can be seen on TVUSS

<2000 mIU/mL

Measurements every 48-72 hours

TVUSS

Methotrexate or surgery to terminate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Symptoms of cervical ectopic pregnancy

A
  1. Painless and profuse bleeding - leads to haemodynamic instability

Must be terminated

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

Termination of pregnancy in haemodynamically stable vs unstable pregnancies

A
  1. Stable:

Methotrexate

  1. Unstable

Dilation
Curettage

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

What is a curettage

A
  1. Scoop that removes tissue by scrapping the lining of the uterus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Two types of miscarriage

A
  1. Threatened (may be eliminated)

2. Inevitable (definitely - elimination 2-4 weeks after diagnosis )

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

Findings of a threatened miscarriage

A
  1. Closed cervix
  2. Detectable fetal cardiac activity

Either resolves or progresses to inevitable

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

Advice to someone with threatened miscarriage

A
  1. Avoid exercise
  2. Avoid heavy lifting
  3. Avoid sexual intercourse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Management of threatened miscarriage

A
  1. Expectant management

2. Intravaginal progestins

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

Role of intravaginal progestins

A
  1. Helps uterine viability, stops lining from giving in during pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Examination findings of an inevitable miscarriage

A
  1. Cramps or contractions
  2. Cervix dilated
  3. Increased vaginal bleeding

Sometimes gestational tissue is seen in opening

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

Management of inevitable miscarriage

A
  1. Haemodynamically stable:
    - Expectant management
    - Reevaluation at 4 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Complete vs incomplete miscarriage

A
  1. After an inevitable miscarriage: placental tissue may be left behind (incomplete) or complete evacuation (complete)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Management of incomplete miscarriage

A
  1. Medical or surgical evacuation

In first trimester:

Mifepristone (200 mg orally) - THEN Misoprostol (800 microgram intravaginally) after 24 hrs. Or repeat dose of misoprostol

2nd trimester:

Dilation and curettage/aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How does mifepristone work

A
  1. Progesterone antagonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How does misoprostol work

A
  1. Prostaglandin E1 Analogue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Role of prostaglandin E1

A

Vasodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is cervical ectropion

A
  1. Glandular epithelium of endocervix is present in vagina because of endocervical eversion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Examination finding for cervical ectropion

A
  1. Bright red vagina, columnar epithelium prone to light bleeding when touched (after intercourse or speculum examination)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

management of cervical ectropion

A
  1. PAP smear to screen for cervical neoplasia

Ectropion is usually harmless and needs no treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Diagnosis of uterine polyps and fibroids

A
  1. TVUSS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Polyps vs fibroids

A
  1. Polyps emerge from endometrium

2. Fibroids emerge from uterine smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Consequences of fibroids

A
  1. Fetal growth restriction
  2. Miscarriage
  3. Preterm birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

In what trimester is cervical insufficiency seen in

A

Second trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is cervical insufficiency

A

When cervical dilation and effacement (thinning) too early in pregnancy

  1. Vaginal fullness
  2. Pelvic pressure
  3. Lower back pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Clinical signs of cervical insufficiency

A
  1. Dilation
  2. Effacement
  3. Fetal membrane visible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Diagnosis of CI in obstetric history

A
  1. Two + consecutive pregnancy loses in second trimester or preterm brith (less than 28 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

When is TV USS in CI appropriate

A
  1. When cervix is less than 25 mm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Treatment of cervical insufficiency

A
  1. Cervical Cerclage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is cervical cerclage

A

Strong sutures sewn into or around the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

When is cervical cerclage done

A
  1. History based: 12-14 weeks

2. Exam-based : <24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Painless causes of bleeding in third trimester

A
  1. Placenta Praaevia (placenta is covering cervical opening)

2. Vasa Parvaeia (Blood supply of fetus covers cervical opening)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Painful causes of bleeding in third trimester

A
  1. Placental abruption (Placenta prematurely detaches from uterine wall)
  2. Uterine Rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Important changes to examination approach in third trimester

A
  1. Avoid digital examination.

Can cause immediate haemorrhage in placenta praevia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Diagnosis of placenta and vasa praaevia

A
  1. TVUSS to grade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Grading of placenta praaevia

A
  1. Grade 1: Low lying placenta (in lower segment but lower edge is still 0.5-5cm away from cervical opening)
    Grade 2: Marginal Placenta
    Grade 3: Partial Praaevia
    Grade 4: Complete Praaevia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Management of placenta praaevia

A

Based on three factors:

  • Haemodynamic stability
  • Fetal Heart Rate
  • gestational Age
  1. However, C-Section ALWAYS occurs

If all three are fine:

  • Expectant management
  • Antenatal corticosteroids
  • C section

Emergency C section if any of these are compromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How is vasa pavia categorised

A

Type 1: Velamentous umbilical cord (cord inserts into chorioamniotic membranes rather than centre of placenta)

Type 2: Bilobed placenta (two equal sized lobes split by chorionic tissue)

If uneven: Succenturiate lobe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

How is vasa praaevia diagnosed

A
  1. Colour doppler to look at fetal vessels crossing cervical opening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Management of vasa praaevia

A

Between 28-32 weeks:
Weekly NST and antenatal corticosteroids

Between 30-34 weeks:
Hospital admission for NST 2-3 times a day

Emergency c-section if labour starts, PROM, haemodynamic instability, NST abnormalities, blood coming out of vagina is pure fetal blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

How is pure fetal blood tested

A
  1. Apt Test or Kleihauer-Betke test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

RF for placental abruption

A
  1. Prior
  2. trauma
  3. Smoking
  4. HTN
  5. Cocaine
  6. PROM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Why can blood loss be underestimated in placental abruption

A
  1. Pools behind the placenta

In this case bleeding may be light or non-existent depending on clinical symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Categories of placental abruption and associated symptoms

A
  1. Light:
  2. Mild
    - Light bleeding
    - tenderness
    - No haemodynamic change
    - No distress
  3. Moderate
    - Greater tenderness
    - Contractions
    - Signs of haemodynamic instability and fetal distress
  4. Severe:
    - Severe bleeding
    - tetanic uterus (board like on palpitation)
    - Maternal shock or fetal death

PAIN IS SUDDEN, AND CONSTANT

Fetal heart is absent

Severe needs immediate delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Consequences of severe placental abruption

A
  1. Progress to DIC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What is DIC

A
  1. Excessive clotting factor use up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Blood test findings in DIC

A
  1. Decreased fibrinogen
  2. Increased INR
  3. Prolongues PT and PTT
  4. Reduced platelets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Rf for uterine rupture

A
  1. Previosu c section as caused by abdominal trauma.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Consequences of uterine rupture

A
  1. Blood spills into peritoneum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Symptoms of Uterine rupture

A
  1. Sudden abdo pain
  2. Haemodynamic instability
  3. Fetal HR abnormalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Treatment of uterine rupture

A
  1. Suture/ sometimes Hysterectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What causes bleeding disorders in: primary/secondary haemostasis

A
  1. Formation of platelet plug

2. Strong fibrin clot through activation of intrinsic and extrinsic pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

How is haemophilia A and B passed on

A
  1. X-linked affects males and females carriers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Two types of haemophilia

A

A: reduction in factor 8

B: reduction in factor 9

C: autosomal recessive (male and females) factor 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is von willebrand disease

A
  1. Mutations of vWF making hard for platelets to adhere to collagen

Causes impaired platelet function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is cervical incompetence

A
  1. Inability of the cervix to retain pregnancy during second trumester

Usually as a result of premature cervical os opening = fetal expulsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Complications of cervical incompetence

A
  1. Chorioamnionitis
  2. PROM
  3. Cervical lacerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

When does GDM occur in pregnancy

A

BEGINS second trimester, peaks in third

insulin resistance is normal in the second trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Screening for GDM

A

DO NOT use OGTT in women already at risk (only offer testing for those with previous GDM):

  1. 75g 2-hour OGTT

Urine Ketone bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

When is oral glucose tolerance test contraindicated

A

Diagnosis of GDM but glucose levels return to normal after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Management plans for pregnant women with T1DM

A
  1. Ketone blood testing strips

2. HbA1c levels monthly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Prevention of GDM

A
  1. Vitamin D supplementation

2. Diet and physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Advice to give to diabetic women planning a pregnancy

A
  1. Lose weight (if above 27kg/m^2)

2. Take 5mg folic acid a day until 12th wekk of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

RF for GDM

A
  1. BMI over 30
  2. Previous macrosomic baby
  3. Previous GDM
  4. Family History
  5. Ethnciity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

OGTT results that indicate GDM

A
  1. Fasting plasma glucose level over 5.6 mmol/litre

2. 2-hour plasma glucose level over 7.8 mmol/litre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Consequences of GDM

A
  1. Macrosomia
  2. Neonatal hypoglycaemia
  3. Increased c section risk
  4. Resp distress
  5. Polycythaemia
  6. Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Signs of GDM in infant

A
  1. Low APGAR score
  2. Large for gestational age (>4kg)
  3. Plethora
  4. Hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Neonatal diagnostics for GDM

A
  1. Fetal ultrasound for fetal seize and weight estimation

2. Pulse oximetry to see decreased saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Postnatal management of GDM

A
  1. Serial capillary glucose test and continue glucose management til normal
  2. Neonatal: supplemental oxygen, oral/IV glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Advice to give a woman with GDM

A
  1. Healthy diet and low gylcaemic index food
  2. Excercise regularly (walk for 30 mins after a meal)
  3. Offer retinal testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

When does Gestational HTN occur

A

20 weeks of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

When does gestational HTN resolve

A

Postpartum week 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

RF for gestational HTN

A
  1. Primigravidas

2. Genetic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Complications of gestational HTN

A
  1. Preeclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q
  1. Diagnosis of Gestational HTN
A
  1. Urine dipstick (normal protein)
  2. Normal platelet
  3. Creatinine, hepatic transaminases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

When does hyperemesis Gravidum occur

A
  1. Week 4-8 of gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

How long does hyperemesis Gravidarum last

A

16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Symptoms of hyperemesis Gravidarum

A
  1. Prolongues nausea/vomiting
  2. Dehydration
  3. Weight Loss
  4. Low PB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

RF for Hyperemesis Gravidarum

A
  1. Previous
  2. Raised hCG
  3. Biologically-female fetus
  4. Hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Complications of hyperemesis Gravidarum

A
  1. Electrolyte imbalance
  2. Mallory-weiss tear
  3. Metabolic alkalosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Treatment of HG

A
  1. Antiemetics
  2. Vit B6 tor educe nausea
  3. Bland food (avoid spicy food)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is Inauterine Growth Restriction

A
  1. Full fetal growth not accomplished during gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Types of IGR

A
  1. Symmetric

2. Asymmetric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What causes symmetric IGR

A
  1. Early in gestation

Caused by infection or chromosomal abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

What is symmetric IGR

A
  1. All organs and body parts have restricted sizes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What is asymmetric IGR

A
  1. Head circumferences usually affected on its own
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

When does asymmetric IGR manifest

A

Late second/third trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What causes asymmteirc IGR

A
  1. Reduced delivery of nutrients to fetus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Causes of IGR

A

Fetal:
Genetic (aneuploidy)
Infection (CMV, rubella)
Multiple gestation

Placental:
Preeclampsia
Single umbilical artery

Maternal:
Chronic disease
Substance use

Environmental:
SMOKING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Complications of IGR

A
  1. Inauterine asphyxia
  2. Impaired thermoregulation
  3. Hypoglycaemia
  4. Polycythaemia
  5. Hypocalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Signs and symptoms of IGR

A
  1. Thin, loose skin

2. Growth restriction (head could be normal but large relative to rest of body in asymmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Diagnosis of IGR

A
  1. Ultrasound Biometry to measure head, abdo and AFI
  2. Doppler velocimetry
    to measure vascular resistance and cardiac function
  3. Ponderal index (body weight: length ratio) and Ballard score (gestational age assessment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Treatment of IGR

A
  1. Glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What is mastitis

A
  1. Localised infection from one/more mammary ducts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Causes of mastitis

A
  1. Microorganisam introduction from breatfeeding baby’s mouth
  2. Milk stasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

RF of mastitis

A
  1. Cracked/damaged nipples
  2. Poor Hygeiene
  3. Impaired Immunity
  4. Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Signs and Symptoms of Mastitis

A
  1. Localised firmness
  2. Palpable lump
  3. Breast pain
  4. Tender axillary nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Diagnostics of Mastitis

A
  1. USS to exclude abscess

2. Breast milk culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Treatment of mastitis

A
  1. Analgesics NOT antibiotics

2. Continue breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is cervical incompetence

A
  1. Inability of the cervix to retain pregnancy during second trumester

Usually as a result of premature cervical os opening = fetal expulsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Complications of cervical incompetence

A
  1. Chorioamnionitis
  2. PROM
  3. Cervical lacerations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

When does GDM occur in pregnancy

A

BEGINS second trimester, peaks in third

insulin resistance is normal in the second trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Screening for GDM

A

DO NOT use OGTT in women already at risk (only offer testing for those with previous GDM):

  1. 75g 2-hour OGTT

Urine Ketone bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

When is oral glucose tolerance test contraindicated

A

Diagnosis of GDM but glucose levels return to normal after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Management plans for pregnant women with T1DM

A
  1. Ketone blood testing strips

2. HbA1c levels monthly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Prevention of GDM

A
  1. Vitamin D supplementation

2. Diet and physical activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Advice to give to diabetic women planning a pregnancy

A
  1. Lose weight (if above 27kg/m^2)

2. Take 5mg folic acid a day until 12th wekk of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

RF for GDM

A
  1. BMI over 30
  2. Previous macrosomic baby
  3. Previous GDM
  4. Family History
  5. Ethnciity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

OGTT results that indicate GDM

A
  1. Fasting plasma glucose level over 5.6 mmol/litre

2. 2-hour plasma glucose level over 7.8 mmol/litre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Consequences of GDM

A
  1. Macrosomia
  2. Neonatal hypoglycaemia
  3. Increased c section risk
  4. Resp distress
  5. Polycythaemia
  6. Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Signs of GDM in infant

A
  1. Low APGAR score
  2. Large for gestational age (>4kg)
  3. Plethora
  4. Hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Neonatal diagnostics for GDM

A
  1. Fetal ultrasound for fetal seize and weight estimation

2. Pulse oximetry to see decreased saturation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Postnatal management of GDM

A
  1. Serial capillary glucose test and continue glucose management til normal
  2. Neonatal: supplemental oxygen, oral/IV glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Advice to give a woman with GDM

A
  1. Healthy diet and low gylcaemic index food
  2. Excercise regularly (walk for 30 mins after a meal)
  3. Offer retinal testing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

When does Gestational HTN occur

A

20 weeks of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

When does gestational HTN resolve

A

Postpartum week 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

RF for gestational HTN

A
  1. Primigravidas

2. Genetic factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Complications of gestational HTN

A
  1. Preeclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q
  1. Diagnosis of Gestational HTN
A
  1. Urine dipstick (normal protein)
  2. Normal platelet
  3. Creatinine, hepatic transaminases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

When does hyperemesis Gravidum occur

A
  1. Week 4-8 of gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

How long does hyperemesis Gravidarum last

A

16 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Symptoms of hyperemesis Gravidarum

A
  1. Prolongues nausea/vomiting
  2. Dehydration
  3. Weight Loss
  4. Low PB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

RF for Hyperemesis Gravidarum

A
  1. Previous
  2. Raised hCG
  3. Biologically-female fetus
  4. Hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Complications of hyperemesis Gravidarum

A
  1. Electrolyte imbalance
  2. Mallory-weiss tear
  3. Metabolic alkalosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

Treatment of HG

A
  1. Antiemetics
  2. Vit B6 tor educe nausea
  3. Bland food (avoid spicy food)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What is Inauterine Growth Restriction

A
  1. Full fetal growth not accomplished during gestation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Types of IGR

A
  1. Symmetric

2. Asymmetric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

What causes symmetric IGR

A
  1. Early in gestation

Caused by infection or chromosomal abnormality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What is symmetric IGR

A
  1. All organs and body parts have restricted sizes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What is asymmetric IGR

A
  1. Head circumferences usually affected on its own
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

When does asymmetric IGR manifest

A

Late second/third trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What causes asymmteirc IGR

A
  1. Reduced delivery of nutrients to fetus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Causes of IGR

A

Fetal:
Genetic (aneuploidy)
Infection (CMV, rubella)
Multiple gestation

Placental:
Preeclampsia
Single umbilical artery

Maternal:
Chronic disease
Substance use

Environmental:
SMOKING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

Complications of IGR

A
  1. Inauterine asphyxia
  2. Impaired thermoregulation
  3. Hypoglycaemia
  4. Polycythaemia
  5. Hypocalcaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

Signs and symptoms of IGR

A
  1. Thin, loose skin

2. Growth restriction (head could be normal but large relative to rest of body in asymmetrical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

Diagnosis of IGR

A
  1. Ultrasound Biometry to measure head, abdo and AFI
  2. Doppler velocimetry
    to measure vascular resistance and cardiac function
  3. Ponderal index (body weight: length ratio) and Ballard score (gestational age assessment)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

Treatment of IGR

A
  1. Glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

What is mastitis

A
  1. Localised infection from one/more mammary ducts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

Causes of mastitis

A
  1. Microorganisam introduction from breatfeeding baby’s mouth
  2. Milk stasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

RF of mastitis

A
  1. Cracked/damaged nipples
  2. Poor Hygeiene
  3. Impaired Immunity
  4. Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

Signs and Symptoms of Mastitis

A
  1. Localised firmness
  2. Palpable lump
  3. Breast pain
  4. Tender axillary nodes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

Diagnostics of Mastitis

A
  1. USS to exclude abscess

2. Breast milk culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

Treatment of mastitis

A
  1. Analgesics NOT antibiotics

2. Continue breast feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

When does preeclampsia typically develop

A

After 20 weeks gestation and 6 weeks after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What is preeclampsia

A

New onset hypertension and proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

Why is preeclampsia important to detect

A
  1. Marker of Kidney Damage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

What is Eclampsia

A

Combination of preeclampsia and seizures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

RF for preeclampsia

A
  1. First pregnancy
  2. Multiple gestations
  3. Mothers > 35 years
  4. HTN
  5. Diabetes
  6. Obesity
  7. Family History
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

What causes preeclampsia

A

Development of an abnormal placenta.

Spiral arteries expand to 10 times normal size, to deliver large quantities of blood to feats, these become fibrous in preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

Consequences of preeclampsia to baby

A
  1. Intrauterine growth restriction and death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

Consequences of preeclampsia to mother

A
  1. Intrauterine growth restriction causes the release of pro-inflammatory proteins into mother’s circulation
  2. These proteins cause endothelial cells to become dysfunctional:
  3. Vasoconstriction
  4. Salt retention by kidneys

HTN!

Can cause haemorrhage stroke or placental abruption

Also causes local vasospasming, restricting blood flow to other organs (e.g. kidneys, leading to glomurlar damage = oliguria).

Retina (scotoma)

Liver (LFT abnormal) = RUQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

Diagnosis of preeclampsia

A

140/90 or more

severe: 160/110 (just be aware)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

What is placental abruption

A

Premature detachment of placenta from uterine wall.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

Symptoms of preeclampsia

A
  1. Stroke symptoms
  2. Oliguria
  3. HTN
  4. Blurred vision/flashing lights/scotoma
  5. RUQ pain (liver)
  6. HELLP syndrome
  7. Increases vascular permeability from endothelial damage = Generalised oedema, pulmonary oedema, cerebral oedema (headaches, confusion and SEIZURES)

Haemoolysis
Elevated Liver enzymes
Low
Platelets

HELLP is common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

What does HELLP syndrome stand for

A

Haemoolysis
Elevated Liver enzymes
Low
Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

What causes seizures in eclampsia

A
  1. Endothelial damage, increases vascular permeability, causing fluid to enter local sites, including the brain
  2. Causes cerebral oedema

Headaches, nausea and seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

Treatment of preeclampsia

A
  1. After delivery, treat symptoms:
    Supplemental oxygen for organ damage
    Medications for seizures etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

What is placenta accrete

A

When all or part of the placenta attaches to the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

What are the grades to the placenta accrete spectrum

A

Graded depending on what layer of the myometrium, the placenta has invaded:

  1. Accreta: Chorionic villi attach to the myomteirum
  2. Increta: Villi invade into the myometrium
  3. Perceta: Invade through to the perimetric (serosal layer)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

RF for placenta accreta spectrum

A
  1. Placenta previa in the presence of a uterine scar.

2. Anything causing scar tissue formation: termination, postpartum haemorrhage, miscarriage etc, c section.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

Most common placenta accrete spectrum type

A

Accrete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

Diagnosis of placenta accreta spectrum

A

USS doppler

  1. Vascular lacunae (Swiss cheese appearance)
  2. Blood vessels crossing the myometrium or serosla layer.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

Complications of PAS

A
  1. Damage to local organs
  2. Thromboembolism and infection.
  3. Increased preterm bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

Treatment of PAS

A
  1. Hysterectomy to control bleeding

2. Cesearaen hysterectomy (foetus delivery by uterus and placental removal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

What is gestational trophoblastic disease

A

Bengin:
The development of hydatidiform moles

Malignant:
Invasive moles from hydatidiform or choriocarcinomas

Moles result from errors in normal fertilisation, lead to abnormal proliferation of trophoblast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

How do moles in GTD form

A

Two ways:

Complete/Classic: Chromosomally empty egg fuses with normal sperm. The normal sperm duplicates to form 46 chromosomes, to make up for lacking egg. No maternal chromosomes so cells continue to divide into a mass.

Incomplete/Partial:
When a normal egg is fertilised by two sperms. Forms an organism with 69 chromosomes (23+ 23+ 23). Becomes non-viable fatal parts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

What does a complete mole secrete/ symptoms?

A
  1. Extremely high hCG

So,

  1. Signs of missed pregnancy (missed periods)
  2. Vaginal bleeding/ parts of the mole may be eliminated (cherry like clusters)
  3. Early preeclampsia
  4. Hyperemesis Gravidarum (dehydration)
  5. Hyperthyroidism
  6. Theca lutein cysts/ pelvic pain or pressure
  7. Since mole grows faster than normal pregnancy so ultrasound/examination shows uterus too big for gestational age.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

Signs on examination for complete mole

A
  1. Hydropic villi (oedematous)
  2. Circumferential proliferation of syncytiotrophoblasts (multiple nuclei, dark cytoplasm) and cut-trophoblast (pale cytoplasm, central nuclei)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

Screening for complete mole

A
  1. Stain for p57 protein. only expressed on maternal cells so should be negative.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

Diagnosis for complete mole

A
  1. p57 staining

2. TVUSS, NO FETAL PARTS, just SNOWSTORM PATTERN (cluster of grapes from abnormal blood clots and placental villi).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

What does a complete mole secrete/ symptoms?

A

hCG but not as much as complete.

  1. Missed periods/vaginal bleeding
  2. Uterus is NOT larger than expected for gestational age
  3. No symptoms of hCG hyper stimulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

Complete vs incomplete on examination

A
  1. Thyroid symptoms vs none
  2. Lots of hydronic villi vs little
  3. p57 is neg vs pos
  4. TVUSS no fetal parts vs fetal parts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

treatment for moles

A
  1. Suction Curetage
  2. Methotrexate

Monitor hCG levels til back to normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

Why is methotrexate used for moles

A
  1. Toxic to rapidly dividing cells of embryo
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

What does hCG not returning back to normal levels indicate

A
  1. Invasive mole

2. Choriocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

What causes invasive moles

A
  1. Villi invade into myomteirum.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

When in pregnancy can choriocarcinomas develop

A
  1. During or after a non-molar pregnancy

Usually small but if large can cause lower abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

Where can choriocarcinomas metastasise

A
  1. To lungs
DISTINCTIVE:
CANNONBALL METASTASES (well circumsised metastasises)

Haemptysis
SOB
And can go to brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

Choriocarcinoma vs molar pregnancy caused malignant moles

A
  1. Cytotophoblasts and synctioblasts BUT NO VILLI vs VILLI.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

What is morbidly adherent placenta

A
  1. Abnormal attachment of placenta to uterine wall
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

What part of the uterine wall does the placenta bind to

A
  1. Decidua basalis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

What usually causes binding of placenta to myometrium

A

If decidua is too thin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

What are the four causes of post parts haemorrhage

A

4Ts:

Uterine Antony (loss of TONE)

Trauma (lacerations, incisions, uterine rupture)

Thrombin (coagulopathies)

Tissues (PAS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

Consequences of postpartum haemorrhage

A

Hypovolaemic shock and Sheehan’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

Treatment of PAS

A
  1. Uterine massage
  2. Oxytocin for tone
  3. Bilateral ligation of internal iliac artery
  4. Hysterectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

What is Sheehan’s syndrome

A
  1. postpartum hypopituitarism caused by pituitary gland necrosis. Caused by severe Hypotension from postpartum haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

What causes polyhydramnios

A
  1. Fetus cannot swallow amniotic fluid, causing I to build.

Attributed to oesophageal or duodenal atresia

Anencephaly (parts of brain responsible are absent)

Increased urine production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

What causes oligohydramnios

A
  1. Bilateral renal agenesis: failure of kidneys develop
  2. Posterior urethral valves blocking excretion (thus usually affecting boys)
  3. Placental insufficiency
  4. Amniotic rupture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

Consequence of oligohydramnios

A

POTTER SEQUENCE:

Pressing of the baby against the membrane of the amniotic sac = developmental abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

Signs of potter sequence

A
  1. FLATTENED face
  2. Widely separated eyes
  3. Low-set ears
  4. Clubbed feet.

Pulmonary hypoplasia

P- Pulmonary hypoplasia
O- Oligohydramnios
T - twisted skin 
T - twisted face
E - extreme deformities
R - renal agenesis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

Role of amniotic fluid

A
  1. Development of metal lungs (stretched the airways)

2. Contributes to the production of proline (helps form connective tissue and collagen in the lungs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

Diagnosis of potter sequence

A

USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

What is cervical show

A

Bloody discharge from the uterus. mixed in with mucuous. that blocks cervical Canal during normal labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

What causes cervical show

A

Caused by slow cervical dilation that characterises early labour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

When is a foetus full term

A

Between 37 and 42 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

Two ways a woman might show signs of going into labour

A
  1. Cervical Show
  2. Amniotic sac rupture

Cause true labour contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

What are Braxton hicks contractions

A

Sporadic contractions and relaxations of the uterus

Can be caused by sex, full bladder or exercise.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

Braxton hicks contractions vs full labour contractions

A
  1. Irregular in duration and intensity
  2. Non-rhythmic
  3. Uncomfortable vs painful
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

How do true labour contractions change over the course of labour

A
  1. Increase in frequency, duration and intensity. Then decrease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

What are the point of contractions

A
  1. To thin the cervix and dilate it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

How long does a first time preganncy take vs multiple gestations

A
  1. 12-18 hours

2. 6-9 hours.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

What phases make up the first stage of pregnancy

A
  1. LATENT/ Early: dilation of cervix to 6 cm

2. ACTIVE Phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

How long does the latent phase last

A

20 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

What characterises the latent phase of pregnancy

A
  1. Irregular contractions
  2. Every 5-30 mins
  3. Last 30 seconds.

THEN these become regular

Every 3-5 mins
Last 1 min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

What is the active phase of labour

A
  1. Cervix dilates to 6-10 cm
  2. Intense contractions (60-90 seconds each).
  3. Every 0.5-2 mins

These contractions can overlap

Water defo breaks by this point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

What is the second stage of labour

A

The pushing stage:

Baby’s head must navigate through the maternal pelvis.

PPP:
Power
Passenger
Passage: Bony pelvis. In fact baby’s have unfused skulls to allow them to pass through the pelvis.

Cardinal Movements of Labour

  • Foetal Enaggement
  • Foetal Flexion
  • Foetal internal rotation
  • Foetal Extension
  • Restitution
  • Expulsion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

What factors dictate how easy the passage of the baby is in the second stage of labour

A
  1. Featl size (head)
  2. Fetal attitude (how flexed the foetus is)
  3. Fetal Lie (ideally should be longitudinal)
  4. Fetal presentation (ideally vertex cephalic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

What is a normally fully flexed foetus

A
  1. Chin on chest
  2. Rounded back
  3. Flexed arms and legs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

What is the suboccipitobregmatic diameter

A

Smallest diameter of the foetus - presents at the pelvis inlet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

Types of foetal presentation

A
  1. Cephalic (ideally cephalic vertex - flexion of the head)
  2. Breech (Bottom first)
    3, shoulder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q

What is the foetal station

A
  1. The degree to the descent of the foetus in the second stage

Measured by how relative the descent is to the ischial spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

What is foetal engagement

A

Where the head moves from the pelvic inlet (station -5) to the ischial spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

What is foetal flexion

A

Chin goes against chest as it receives resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
260
Q

What is foetal internal rotation

A

Shoulders internally rotate at 45 degrees until the widest part of the shoulders is lined with the widest part of the pelvic inlet .

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
261
Q

When does foetal extension occur

A
  1. When the baby reaches the symphysis pubis (-4), extension of the head and emerge out the vagina
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
262
Q

What is foetal restitution

A

Where head externally rotates so the shoulders can pass through the pelvic outlet and under the symphysis pubis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
263
Q

What is expulsion

A
  1. Anterior shoulder slips under symphysis pubis, followed by posterior shoulder and rest of the body.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
264
Q

What is the third stage of labour

A

Delivery of the placenta:

Uterus contracts firmly and carefully removed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
265
Q

What is the fourth stage of labour

A
  1. Major physiological chagnges: Adaption to blood loss and uterine involution
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
266
Q

What causes VTE in pregnancy

A
  1. Hypercoagulability and decreased venous blood flow
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
267
Q

What factors conctibute to VTE

A
  1. 7, 8, 10 and vWF

Less protein S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
268
Q

What are the two stages of haemostats

A
  1. Primary: Formation of a platelet plug
  2. Secondary: Coagulation
  • Clotting Factors
  • Proteolytically activated
  • Activation of Fibrin (Factor 1a)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
269
Q

What activates the extrinsic pathway

A
  1. Tissue Factor found outside the blood

Instrinsic: Factors found in the blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
270
Q

What is the extrinsic pathway

A
  1. Factor VIIa in blood binds to tissue factor and calcium ions = VIIaTF complex on smooth muscle walls
  2. Cleaved factor X -> Xa
  3. Xa: V -> Va
  4. Xa + Va (prothrombinase complex) = II -> IIa (Thrombin)
  5. IIa = V -> Va
    VIII -> VIIIa
    IX -> IXa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
271
Q

What is the role of thrombin

A
  1. Thrombin binds to platelets to activate them = adhesion
  2. Thrombin cleaves fibrinogen to fibrin
  3. Cleaves XIII -> XIIIa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
272
Q

Why does fibrinogen need to be cleaved into fibrin

A

Can move out of plasma to form chains

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
273
Q

Role of XIIIa

A

Reinforces fibrin mesh (tentacles)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
274
Q

Intrinsic Pathway

A

XII: Detects endothelial collagen exposed by trauma or activated platelets

XII -> XIIa
XIIa = XI -> XIa
XIa = IX -> IXa
IXa + VIIIa = X -> Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
275
Q

Why is VWF needed

A

Keeps VIII soluble.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
276
Q

What produces VWF

A

Released by endothelial cells in primary haemostats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
277
Q

Role of Prothrombin Time

A

Checks if extrinsic pathway is working

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
278
Q

aPTT role

A

Checks if intrinsic pathway (TT = table tennis indoors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
279
Q

Role of Protein S and C

A
  1. excess thrombin bind to thrombomodulin, Protein C and S join the complex

Activates protein C to destroy factor V, needed for thrombin production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
280
Q

What is Factor V Leiden

A
  1. Forms in the femoral veins

Cannot be cleaved by Factor C because their shape mutates: causes multiple clots

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
281
Q

Blood types

A

A (antibodies to B)
B (antibodies to A)
AB (universally none): Can receive any bloody
O (A and B antibodies): Receive only O blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
282
Q

What’s the problem giving RH+ to Rh= individuals

A

Haemolytic Transfusion Reaction

Rh+: can receive either

Rh-: No Rh+ unless emergency, can only use once and then they’ll develop antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
283
Q

What’s the usual cause for anaemia in pregnancy

A

Iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
284
Q

What is a complicated UTI

A
  1. Structural or functional condition of GU tract

Underlying disease = severe infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
285
Q

RF for complicated UTI

A
  1. Male
  2. Pregnancy Female
  3. Indwelling Urinary Catheter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
286
Q

What pathogens cause uncomplicated cystitis

A

KEEPS

Klebsiella pnuemoniae
Escherichia Coli
Proteus Mirabilis
Staphylococcus saprophyticus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
287
Q

RF for cystitis

A
  1. Sex/Spermicides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
288
Q

Interventions for UTI

A
  1. Dipstick:
    +Leucocyte esterase (Pyuria) and nitrites (enterobacteriases)
  2. Microscopy (>10 leucocytes/microletre)
    Rcs/microleter
  3. Midstream sample (bacteriuria)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
289
Q

How is cystitis treated

A
  1. 100mg Nitrofurantoin daily for 5 days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
290
Q

Symptoms of pyelonephritis

A
  1. Fever, costovertebral angle tenderness, nausea, vomtiing, cystitis
291
Q

Interventions for pyelonephritis

A
  1. CBC: Leucocytosis e/ Neutrophilia
  2. BUN + Creatinine Levels : renal functinos
  3. Dipstick and microscopy
  4. Urine culture
292
Q

Treatment of pyelonephritis

A
  1. IV or oral Ceftriaxone until afebrile

2. Then switched to oral cefepime for 10 days.

293
Q

How is urinary obstruction treated

A

IV Imipenem

294
Q

What bacteria commonly infects pregnant women and newborns

A
  1. Gram-Positive Strep Agalactiae:
295
Q

Properties of gram positive strep agalactiae

A
  1. Non motile
  2. Doesn’t form spores
  3. Facultative Anaerobe
  4. Catalase negative
296
Q

How does strep agalactiae infect women

A
  1. Ascencds from vagina through cervix into the foetal membranes = chorioamnioninitis, miscarriage as they rupture prematurely .

infect the baby = intrauterine death

Cystitis

Pass to newborn = pneumonia by destroying lung cells = neonatal sepsis

PENECILLIN G/ AMPICILLIN

297
Q

RF for cephalopelvic disproportion

A
  1. Large fetus: Gestational diabetes, poster pregnancy and multiparty
298
Q

Treatment of cephalopelvic disproportion

A
  1. Induced labour

2. During active labour, this results in a c-section

299
Q

When does preterm labour occur

A
  1. Between 20 and 37 weeks

Before 20 weeks = abortion

300
Q

RF for preterm labour

A
  1. Prior preterm, multiple or short cervical length

Urinary infections
Preeclampsia
HELLP Syndrome
Placenta Praevia

301
Q

Prophylaxis of preterm labour

A

Intravaginal Progesterone

302
Q

How is preterm labour managed

A
  1. Screening of preterm labour:

Cervical Changes:

If cervix is longer than 30mm = low risk

Check 4-6 hours -> discharged and reevaluated 2 weeks later

If less than 20 mm = high risk

Foetal Well-Being:

Sample of cervicovaginal discharge sample for fibronectin: if present, risk is high.

Obstetrical Complications

303
Q

If preterm labour seems imminent (cervical size <20 mm, fibronectin positive), what measures are taken

A
  1. Antenatal corticosteroids to mature fetal lungs
  2. Tocolytic medications (Nifedipine, NSAIDs) - to suppress contracts, gives time for steroids to give effect
  3. Antibiotics (Ampicillin and Gentamicin) for group B strep
  4. Magnesium Sulfate to reduce cerebral palsy
304
Q

What is post-term pregnancy

A

No birth after 42 weeks

305
Q

RF post term pregnancy

A

Prior post term

306
Q

Management of post term pregnancy

A

Fetal monitoring (high likelihood for macrosomia or inauterine foetal death)

307
Q

How does foetal monitoring in post term pregnancy occur

A
  1. Foetal size
  2. Amniotic fluid
  3. NST
  4. BPP
308
Q

What is an NST

A
  1. Cardiotocograph (20 mins):

Normal: Varies between 110-160 BPM + 2 accelerations (changes between 15bpm for 15 seconds above 32 weeks or 10bpm for 10 seconds below 32 weeks).

309
Q

What is a BPP

A 
5 Criteria:
NST results (is it non reactive)
Breathing movements
Torso and limb movements
Muscle tone
Amount of amniotic fluid

Score of 10 (higher = better)

Should be 6/10 or higher.

310
Q

When is induced labour indicated from the get-go

A
  1. Post Term delivery
  2. Oligohydramnios
  3. Distress on NST or BPP

Basically, when there’s no labour and the foetus is well

311
Q

Four methods of induced labour

A
  1. Amniotomy (when foetal head is pressed against the cervix, foetal membrane is cut through the cervix ) or Membrane Sweep
  2. Cervical Ripening agent
  3. IV Oxytocin (60 mU/mL at 1mL/hr)

IN this preference

312
Q

Name two cervical ripening agents

A

Prostaglandin (PGE2 and PGF2a)

Balloon Catheter

313
Q

How does a balloon catheter induce labour

A
  1. Inflates in the womb and puts pressure on the cervix to encourage dilation
314
Q

How do prostaglandins work in induced labour

A
  1. Acts on cervical collagen to encourage cervix softening
315
Q

What is the role of Oxytocin

A

Causes contractions

316
Q

Side effects of oxytocin use

A
  1. Non-reactive NST
317
Q

What is a membrane sweep

A
  1. Lubrictaed fingers put into vagina into opening of the cervix, in a circular movement separate the membranes of the amniotic sac
318
Q

RF for prolongs latent phase

A
  1. Early Analgesia (epidural)

2. Abnormal foetal position

319
Q

Management of prolongs latent phase

A
  1. Rest (stops false labour)
  2. Morphine (5-10mg IM + IV)

May tire out the mother from the beginning

Also distinguishes between false and true labours

  1. Oxytocin
  2. Amniotomy

NO C-SECTION

320
Q

How long does the active phase of labour last

A

4-6 hours (dilates 1.2 cm/hr)

321
Q

When is labour induced in the active phase of stage 1 labour

A
  1. If cervix dilates less than 1cm/2hr , Oxytocin is given + amniotomy is membrane hasn’t ruptured
322
Q

How are uterine contractions measures

A

Pressure catheter (MVU)

323
Q

Formula of MVU

A

(Peak Pressure per Contraction - Resting Tone of the Uterus) x number of contractions in 10 mins

200 is adequate for labour progression

324
Q

When is a C-Section indicated

A
  1. If after 4 hours of adequate contractions, or 6 hours of no adequate contractions = C-Section
325
Q

Methods of C-Section

A
  1. Transverse: Done 2-3 cm above the symphysis pubis

Better for planned c-sections (cosmetic) + less hernia risk

  1. Vertical: Done on midline and extends to belly button

Emergency only

326
Q

How long does stage 2 labour last

A

Less than 3hours

327
Q

When is labour induced if stage 2 prolongs

A
  1. Contractions less than 3 minutes apart
  2. Lower than 200 MVU

OXYTOCIN

If foetal head not engaged = c-section

If foetal head engaged = operative vaginal delivery

328
Q

Two methods of operative vaginal delivery

A
  1. Vacuum

2. Forceps

329
Q

When is a vacuum delivery indicated

A
  1. When an easy extraction is indicted

A plastic cup is put on baby head and sucked out

CAN CAUSE MINOR SWELLING

330
Q

What is a forceps delivery

A
  1. When there is a sign of foetal distress and more urgent delivery needed
  2. Locked into position on baby’s head.

CAN CAUSE BRUISING

331
Q

When do we go from operative vaginal delivery to emergency c-section

A

After 15-20 mins or 3 PULLS

332
Q

How long does stage 3 pregnancy take

A
  1. Less than 30 Mins

More is retained placenta

333
Q

Management of retained placenta

A
  1. Increase Oxytocin
  2. Controlled cord traction
  3. Manual extraction
  4. Hysterectomy
334
Q

What is a controlled cord traction

A
  1. One hand is placed on the abdomen to secure uterine funds, the other GENTLY tugs at the umbilical cord.
335
Q

What is uterine inversion

A
  1. When the uterus comes out of the vagina if you pull too hard in cord traction.
336
Q

What is Manual Extraction

A
  1. One hand secures the funds of the uterus
  2. The other hand goes all the way into the uterus with side to side motion of the uterus to break placenta

STOP is abnormally adherent (placenta accreta, can cause postpartum haemorrhage and requires hysterectomy)

337
Q

What is Bishop Scoring

A
  1. Assesses ripeness of the cervix:
    - Dilation:

Closed, 1-2, 3-4, 5+

  • Efficacement

0-30%, 40-50, 60-70, 80%+

  • Station (where the baby’s head is I relation to pelvis)
  • 3, -2, -1/0, +1,+2
  • Consistency

Firm, Medium, Soft

  • Position
    Posterior, Middle, Anterior.

Score, 1-3

338
Q

Bishop score that indicates labour ready

A

8 or more, labour will more likely commence

Less than 6 is an unripe cervix, induction is not likely to be successful.

339
Q

What is Apgar scoring

A

A- Appearance (skin colour)

0 - Blue/Pale all over
1 - Blue at extremities
2- No cyanosis

P - Pulse
0- Absent
1 - <100 BPM
2- >100 BPM

G - Grimace (Reflex irritability grimace)

0 - No response
2- Grimace on suction or agressive stimulation
3 - Cry on stimulation

A - Activity (muscle tone)

0 - None
1 - Some flexion
2- Flexed arms and legs resisting extension

R - Respiration (resp effort

0- Absent
1- Weak, irregular gasping
2- Strong, robust cry

340
Q

When is the Apgar Score done

A
  1. At one and five minutes after birth
341
Q

What is an abnormal score for APGAR

A

Below 7

342
Q

Complications of a low Apgar Score

A

Remains low three times in a row, indicates long term near damage like seizures or ischaemic encephalopathy

343
Q

What’s a partogram

A
  1. Measurements of cervical dilation, fetal heart rate, labour duration and vital signs during a time-stamped labour
344
Q

4 components of a partogram

A 
1. Time
Fetal heart rate
State of membranes
Dilation 
Head descent
Uterine contractions
BP
Pulse rate
Oxytocin 
Urine analysis
Temp 
Drugs an dfluids
345
Q

How is a cardiotocography conducted

A
  1. Two transducers placed on mother’s abdomen: One above the fetal heart to monitor heart rate, the other at the funds of the uterus to measure contraction frequency.

Dopper US provides information .

  1. Internal: Transucers placed on baby’s scalp, can only be used if cervix is open.
346
Q

Type sof cardiotocography

A

External, Internal

347
Q

4 Elements of a cardiotocograph

A

DR C BRA VADO

1, Contractions

  1. Define Risk
  2. Baseline fetal heart rate
  3. Accelerations
  4. Periodic or episodic decelerations
348
Q

How is foetal blood sampling done

A
  1. A shallow cut is made transvaginally, a blood lancet is inserted and a thin pipe is inserted into the capillary site of the scalp.
349
Q

Name three types of oestrogen

A
  1. Oestradiol
  2. Oestrone
  3. Oestriol
350
Q

What form of oestrogen is produced by the ovaries

A

Oestridiol (most active)

351
Q

Role of Oestradiol (2)

A
  1. Monthly Ovulation and Menstruation

2. Secondary Sex Characteristics

352
Q

Name four organs which produce oestrogen

A
  1. Fat cells
  2. Adrenal Cortex
  3. Ovaries
  4. Placenta
353
Q

Describe the role of GnRH

A
  1. Produced by the anterior pituitary gland

2. Produces LH and FSH

354
Q

What is the role of LH and FSH

A
  1. Development of the ovarian follicles
355
Q

What is an ovarian follicle

A
  1. A sack containing a primary oocyte, surrounded by follicular cells
356
Q

What do the follicular cells differentiate into after stimulation

A
  1. theca Cells

2. Granulosa cells

357
Q

What cell produces progesterone (follicles)

A

Theca cells

358
Q

What foccilular cell produces oestrogen

A

Granulosa cells

359
Q

How long does the menstrual cycle last

A
  1. 28 Days
360
Q

What happens on day 14 of the menstrual cycle

A
  1. Surge of FSH and LH (OVULATION)
361
Q

Two phases of the menstural cycle

A
  1. Follicular phase (mostly oestrogen is produced) 1-14

2. Luteal Phase (mostly progesterone is produced) 14-28

362
Q

What happens in the follicular phase

A
  1. Oestrogen causes the endometrium to thicken and produce progesterone receptors.
  2. Oestrogen acts on pituitary glands to stop FSH production
  3. As oestrogen levels rise, pituitary becomes more sensitive, causing MORE LH AND FSH to be produced.

Causes ovulation

363
Q

What happens in the luteal phase

A
  1. Progesterone binds to receptors in the endometrium, causes endometrial glands to secrete and prepare for pregnancy
  2. Inhibits LH, causing menstruation as progesterone levels decrease.
364
Q

Describe the cascade that causes th production of Oestrdiaol

A
  1. Cholesterol -> Pregnenolone -> 17-Hydroxypregnenolone -> Dehydroepiandrosterone (DHEA) -> Androstenedione

Broken down by granulose cells

-> Testosterone -> 17b-estradiol

365
Q

What enzyme is used to break testosterone down to 17b-oestradiol

A

Aromatase.

366
Q

4 Roles of Oestrogen and Progesterone

A
  1. Maturation of Fallopian tubes, uterus, cervix and vagina
  2. Development of secondary sex characteristics

Fat distribution, hips widening, breast growth

  1. Keeps blood vessels flexible

Bone density protection

Lowers LDL cholesterol

Progesterone: Bone strength and skin elasticity

367
Q

What happens to progesterone and oestrogen during pregnancy

A

Placenta takes over their secretions.

BUT THERE’S a TWIST: Estriol is produced instead of 17 beta-estradiol

Both Prepare breast for lactation too

368
Q

What happens between 1-10 days of cycle

A

Production of LH, binds to theca cells -> androstenedione which is converted into 17 beta estradiol by aromatase.

369
Q

What cell produces aromatase

A

Granulose cells

370
Q

What happens day 10-14

A

Increased oestrogen levels act as a negative feedback mechanism, reducing GnRH production.

Causes some of the follicles to die off and stop growing. However the follicle with the most FSH receptors will continue to grow and become the most dominant follicle. continues to secrete oestrogen which increases pituitary sensitivity = more gNRH

NOW POSITIVE FEEDBACK

Happens a day or two before ovulation

Excess LH and FSH causes rupture of the ovarian follicle and release of oocyte. OBVULATION

371
Q

How long does the menstrual phase lasts

A

5 days

372
Q

What phase follows the menstrual phase

A

Proliferative phase

373
Q

Three stages of the proliferative phase

A
  1. Endometrium thickening
  2. Growth of the Endometrium Glands
  3. Emergence of Spiral Arteries
  4. Changes cervical mucous

Optimise chance of fertilisation

374
Q

When is fertility highest

A

Day 11-15 of the cycle

375
Q

What happens following ovulation to the follicles

A
  1. Remannt of follicle becomes the corpus luteum
  2. Luteinised theca cells continue producing androstenedione, and Grnaulosa cells continue to convert it to 17 beta-estradiol
376
Q

Cells found in the corps lute

A

LUTEINISED

  1. Theca cells
  2. Granulose cells
377
Q

Role of luteinised Granulose cells in the luteal phase

A
  1. Produce P450scc enzyme to convert cholesterol -> pregnenolone
  2. Produce Inhibin to enhance negative feedback effect of progesterone on the pituitary
378
Q

What is the secretory phase

A
  1. Spiral arteries grow longer and uterine glands secrete mucous (however, after day 15 it can be too thick and reduce fertility window).
379
Q

What happens to the corpus lute after day 15

A

Turns into the corpus albicans: does not produce any hormones, so progesterone and oestrogen levels decrease

When progesterone reaches lowest levels, spiral arteries collapse and sloughs off.

380
Q

Role of the spiral arteries

A
  1. Supplies nutrients to the placenta and fundus
381
Q

Phases of the uterus in the cycle

A

1-14: Menstural and Proliferative phase

15-28: Secretory Phase.

382
Q

What are the three ligaments that suspend the ovaries

A
  1. Ovarian
  2. Suspensory
  3. Broad
383
Q

What is the role of the suspensory ligament

A
  1. Ovarian artery vein and nerve endings are found there
384
Q

Layers of the ovaries

A
  1. Cortex (contains follicles)

2. Medulla (nerves and blood vessels)

385
Q

What are the primordial follicles

A

The number of follicles one is born with

386
Q

What is contained within the follicle

A
  1. Primary oocyte with 46 chromosomes.
387
Q

Describe the stages of gamete development

A
  1. Primary Oocyte gets through Prophase of Meiosis I

Primordial cell s-> primary follicle (grnaulosa and theca)

2a. A few LUCKY primary follicles. The primary oocyte remains in prophase step, but has more grnaulosa and theca cells
2b. Formation of Grafian Follicle: A central cavity call ed the antrum forms, granulose cells secrete nourishing fluids for the primary oocyte (75-80 days)

388
Q

Where does fertilisation typically take place

A

Ampula

389
Q

What is the entrance to the fallopian tube called

A

Fimbriae

390
Q

Three causes of hymens to break

A
  1. Sex
  2. Excercise
  3. Tampons
391
Q

Describe the process off pregnancy

A
  1. Day 1 - Fertilisation

Day 4 - Blastocyst Forms and floats around the uterus

Day 5 - Implantation, oestrogen: progesterone ratio drops, to allow for implantation

Day 6 - Blastocyst has two layers, foetal tissue and trophoblasts. Trophoblasts bury into endometrium to cause implantation and start developing the placenta

Day 8 - Trophoblasts Produces HcG:

  • Allows corpus luteum to continue oestrogen and progesterone production to suppress other follicles from maturing
  • Pregnancy

Day 10 - Mensturation if nothing happens

392
Q

When does HCG production peak

A

Week 9, then falls off causing the corpus letup to shrivel up and placenta takes over progesterone and oestrogen production

393
Q

What do the placenta’s syncytiotrophoblasts produce

A

Produce progesterone and estriol

394
Q

What is the role of human placental lactogen

A

Counters the effect of maternal insulin

395
Q

Landmarks for gestation growth

A
  1. Grows up to the umbilicus by week 20

2. Grows towards the xiphoid process by 36 weeks

396
Q

How is fundal height measured

A

Symphysis pubis to top of the uterus

397
Q

Physiological impacts of pregnancyy to CV

A

Blood volume increases by 30-50% (7.5 L of blood by third trimester)

Increase in plasma volume but RBC is unchanged: causes haematocrit to go down

Heart Rate increases by 20BPM

Mild Hypertrophy of the heart

Blood pressure decreases as progesterone dilates it

Uterus pushes up on the diaphragm, nudging the heart upwards and to the left

Presses on the pelvic veins causing varicose veins and swelling in lower legs and ankles.

Uterus presses on inferior vena cava -> less blood to right atrium = hypotension

Increased CO: higher GFR and urinary output = urinary frequency

Increase in size in response, by expanding calyces and renal pelvis = hydronephrosis

Increased size of ureters = hydrometer

Progesterone causes hyper motility of the ureters = increased UTi infection

Pressing on diaphragm causes SOB.

Decreased peristalsis = constipation and bloating

Relaxation of oesophageal sphincter = heartburn and gastric reflux and morning sickness

Changes in taste

Irritability, Anger, depression, anxiety

Mental fogginess and reduced concentration

Sleep Deprivation

398
Q

Heart sounds heard in a pregnant woman

A
  1. Split S1 sound (from mitral and tricuspid valves shutting)
  2. S2

and a physiological S3 sound

399
Q

Advice to hypotensive pregnant woman

A

Put pillow under hips or lay sideways

400
Q

How does progesterone and oestrogen act on preventing SOB in pregnancy

A
  1. Relaxes ligaments in the thorax, increasing transverse diameter of the ribcage and anterior posterior diameter of the ribcage

This increases the tidal volume and minute volume

Causes respiratory alkalosis but improves gas exchange with the placenta

Oestrogen causes increased vascularisation and capillary engorgement in the thorax = sinus congestion and nasal stuffiness.

Thyroid glands increase in activity

Promotes blood clotting and platelet aggregation: decreases activity of antithrombin III, leading you in a hypercoaguable state.

VTE

401
Q

Role of progesterone and relaxin in the pelvis

A

Loosen the sacroiliac joints and symphysis pubis = waddling gait and joint pain in ribs and coccyx

402
Q

Role of progesterone and oestrogen in breast

A
  1. Breast development, causes tingling fullness and tenderness.
  2. Production for prolactin
  3. Stimulates production of melanocytes, darkening the areola
403
Q

How does progesterone inhibit prolactin

A

Not in its production, but inhibits its release until the baby is born

404
Q

Four causes for weight gain in women

A
  1. Increase in blood volume
  2. Fetus volume
  3. Fat stores
  4. Uterus and placental weight
405
Q

Consequences of weight gain during pregnancy

A
  1. Lordosis
  2. Diastasis Recti (where the uterus puts direct pressure on the rectus abdominus, separating them and causing pain at night).
406
Q

If the umbilical cord is palpitated at the vaginal Introitus, what does this indicate

A

Cord Prolapse (where age umbilical cord is comprised between the foetus and the cervix

407
Q

What is the management in a patient with a cord prolapse

A

Push back the presenting part of the foetus to avoid compression

If cord is passed the Introits, then Ask mother to go on all fours

408
Q

RF for a cord prolapse

A

Artificial rupture of membranes

409
Q

When is a nuchal scan performed

A

11-13 weeks

410
Q

What can cause increased nuchal translucency

A
  1. Down’s Syndrome
  2. Congenital Heart Defects
  3. Abdominal wall defects

Basically, when dilated lymphatic channels

411
Q

What is nuchal translucency

A

Normal fluid-filled subcutaneous space at the back of the fetal neck

412
Q

What three conditions can cause an echogenic fetal bowel (fetal bowel appears brighter than usual)

A
  1. Cystic Fibrosis
  2. Down’s Syndrome
  3. CMV
413
Q

What defines proteinuria

A

> 0.3g over 24 hours

414
Q

What corticosteroid is used to mature the baby’s lungs in pPROM

A
  1. Dexamethasone
415
Q

What should babies with Hep B positive mothers be given

A
  1. Hep B vaccine + 0.5mg of HB-IG within 12 hours of birth

and another vaccine at 1-2 months

and another at 6

416
Q

What anticoagulants are contraindicated for use in pregnancy and why

A
  1. DOACs (rivaroxaban) - Because they cause placental haemorrhage
  2. Warfarin - because it can lead to warfarin embryopathy
417
Q

Signs of warfarin embryopathy

A
  1. Mid face flattening

2. Dwarfism

418
Q

What anticoagulant should all women be switched to during pregnancy if absolutely needed

A

Low molecular weight heparin

419
Q

RF for VTE

A
  1. Age> 35
  2. BMI > 30
  3. Parity > 3
    SMoker
    Gross Varciose veins
    Pre eclampsia
    FH
    Immobility
    IVF
    Multiple Pregnancy
420
Q

How should pregnant women with hyperthyroidism be treated

A

Propranolol only, NO ANTIHYPERTHROID MEDICATIONS as it will resolve on its own, becoming hypothyroid which does need levothyroxine treatment

421
Q

What are the three stages if postpartum thyroiditis

A
  1. Thyrotoxicosis
  2. Hypothyroidism
  3. Normal thyroid Function
422
Q

What antibodies are found in post-partum thyroiditis

A

Thyroid Peroxidase antibodies

423
Q

4 Causes of hypothyroidism

A
  1. Amiodarone (can also cause hyper)
  2. Lithium
  3. Iodine deficiency
  4. Hashimoto’s
424
Q

Why is the uterus in placental abruption hard and birdlike

A

Because retroplacental blood tracks into the myometrium

425
Q

A woman complains of itching during her pregnancy and a still birth 31 weeks into gestation, what is the diagnosis and effective treatment

A
  1. Intrahepatic cholestasis
  2. Ursodeoxycholic acid

Labour induction

Vit K

426
Q

Consequences of intahepatic colhestasis

A

Stillbirths and premature births

427
Q

Signs and symptoms of intrahepatic cholestaiss

A
  1. Intense pruritus and raised arum bile acid

2. Bilirubin and LFTs may be normal

428
Q

How many antenatal care visits are needed in an uncomplicated pregnancy

A
  1. 10 in first, 7 in subsequent
429
Q

Name three checks done in 8-12 week visit

A
  1. Hep B
  2. Syphillis
  3. HIV
  4. BP and urine culture
  5. Anaemia
430
Q

In what visits are early scans conducted to confirm dates and exclude multiple pregnancies

A

10- 13+6 weeks

431
Q

In what visits is Down syndrome screening and nuchal scan done

A

11 (13+6 weeks)

432
Q

What is done in the 16th week of gestation visit-wise

A
  1. BP and urine dipstick
433
Q

When during gestation, is an anomaly scan conducted

A

18 (20+6 weeks)

434
Q

On the 25th week visit, what is done

A
  1. BP
  2. Urine dipstick
  3. Symphysis-fundal height
435
Q

In what visit, is the first anti-D prophylaxis to rhesus negative women given

A

28 weeks

436
Q

When is the second dose of anti-d prophylaxis to rhesus negative women given

A

34 weeks

437
Q

When is external cephalic version given

A

36th week gestation

438
Q

What is the most common cause of primary postpartum haemorrhage

A

Uterine Antony

439
Q

What defines postpartum haemorrhage

A

Loss of >500 pls of blood

440
Q

How is postpartum haemorrhage managed

A
  1. IV syntocinon (oxytocin)

2. IM Carboprost

441
Q

First line surgical intervention for post parts bleeds

A
  1. Inauterine balloon tamponade
  2. Ligation of the internal iliac arteries
  3. Hysterectomy
442
Q

What causes secondary post aprtum haemorrhage

A
  1. Retained placental tissue or endometritis (24-12 weeks after delivery)
443
Q

When do baby blues dissipate by

A

Day 3 of giving birth

444
Q

What scale should be used to assess post parts depression

A

Edinburgh Depression Scale (>10 = possible depression)

445
Q

Postnatal blues vs depression vs puerperal psychoses

A
  1. subsides within 10 days vs months vs first two weeks
446
Q

Symptoms of puerperal psychoses

A

Manic depression or schizophrenia

447
Q

If no foetal movement has been felt by 24 weeks, what should be done

A

Urgent referral to maternal foetal medicine unit

448
Q

What should be done if baby movements reduced between 24 and 28 weeks an below

A

Doppler USS

449
Q

What is the first onset of recognised foetal movement known as

A

Quickening, occurs between 18-20 weeks of gestation until 32 before plating

450
Q

RF for reduced foetal movements

A
  1. Posture
  2. Distraction
  3. Medication
  4. Position
451
Q

What virus causes chicken pox

A

Varicella-zoster virus

452
Q

What is shingles

A

Reactivation of dormant virus in dorsal root ganglion

453
Q

What if foetal varicella syndrome

A
  1. Exposure to the virus causes pneumonitis in the mother, skin scorning, eye defects and limb hypoplasia, microcephaly and LD in babies
454
Q

How is chicken pox exposure managed

A
  1. Check of VZIG then either given them IG or acyclovir if no antibodies are present
  2. If infected, given oral acyclovir within 24 hours of rash onset
455
Q

At what glucose level should insulin be given in GDM

A
  1. 7 mol/l or higher

Lower than this, we should stick to lifestyle changes, if lower than 7 mol/l and no changes in glucose levels within 1-2 weeks, then metformin is given

456
Q

Targets for GDM

A
  1. Fasting: 5.3

2 hour: 6.4

457
Q

What do late decelerations on a CTG imply

A
  1. Foetal hypoxia and acidosis

We should do a foetal blood sample asap to check pH

458
Q

What is the preferred method of labour induction above all else

A

Vaginal prostaglandin E2

459
Q

Main complication of labour induction

A

Uterine hyperstimulation

460
Q

What ia a risk factor for shoulder dystocia

A

DM, due to foetal macrosomia,

461
Q

What is the McRobert’s Manouevre

A

1, Flexion and abduction of maternal hips, bringing thighs towards abdomen, relieves shoulder dystocia in DM

462
Q

What causes shoulder dystocia

A
  1. impaction of anterior foetal shoulder on maternal pubic symphysis
463
Q

How should LMWH be monitored

A

Anti-Xa activity (look at how heparin/aspirin etc work)

464
Q

What us puerperal pyrexia

A

Temperature over 38 degrees in first 14 days

465
Q

What can cause puerperal pyrexia

A
  1. Endometritis
  2. UTI
  3. Wound Infection
  4. Mastitis
  5. VTE
466
Q

What is the wood’s screw manoeurvre

A
  1. Putting the hand in the vagina and rotating the foetus 180 degrees to dislodge anterior shoulder from symphysis pubis - tried after the mcroberts
467
Q

A woman just had an artificial rupture of membranes for progressing labour, but collapses from low BP and raised HR. what is the likely diagnosis

A

Amniotic fluid embolism (when foetal cells enter mothers bloodstream and causes a reaction

468
Q

What can be given to reduce the risk of eclampsia

A

MG SO4

469
Q

What is sensitisation

A

Where RHD-positive foetal red blood cells enter RhD-negative maternal circulation

This means subsequent pregnancies, sensitisation means greater immune response = death

470
Q

Treatment of rhesus positive blood being introduced to foetus

A

UV phototherapy

471
Q

What tests should be done to a baby to check for rhesus blood

A
  1. COOMBS test: antibodies on RBCs

Kleihauer test: maternal blood, foetal cells are resistant

472
Q

How long is LMWH given to women during pregnancy

A

6 weeks postnatal

473
Q

Why is warfarin not given during pregnancy

A

Teratogenic

474
Q

In surgical management of an ectopic pregnancy, what immunoglobulin should be given

A

Anti-D

475
Q

People at risk of eclampsia should be started on what prophylaxis

A

Aspirini daily from 12 weeks gestation onwards.

476
Q

Screening for Down syndrome in pregnancy

A
  1. Nuchal Translusceny at week 11

2. Beta-hCG and PAPP-A (pregnancy associated plasma protein a)

477
Q

Results of Down syndrome screening in pregnancy

A
  1. PAPP-A is low

2. beta-hCG is raised

478
Q

When is the combined test for gestation done

A

14-20 weeks gestation

479
Q

If the combined test was missed, what test is offered for screening for down syndrome

A

AFP, estriol, beta-hCG and inhibit A

AFP and oetsrioil low

beta-HCG and inhibit raised

480
Q

What seizure medication should be given to pregnant women who suffer from seizures

A

Lamotrigine

481
Q

In asthmatic women with gestational HTN, what medication should be given

A

AVOID LABETOLOL, give oral nifedipine

482
Q

What is an episiotomy

A
  1. an incision between the vaginal opening and the anus done in the second stage of birth to facilitate birth
483
Q

Foetal physiological changes in stage 2 birth

A

Foetal bradycardia

484
Q

When is an episiotomy necessary

A

Following crowning

485
Q

What is crowning

A

Seeing the top of the baby’s head through the vaginal opening

486
Q

What is lochia

A

Fresh bleeding from c-section or vaginal birth which then turns brown once stopping

487
Q

How long does lochia last

A

6 weeks after childbirth

488
Q

When does acute fatty liver of pregnancy occur

A

Third trimester

489
Q

Fatures of acute fatty liver of pregnancy

A
  1. Abdo pain
  2. Nausea and Vomiting
  3. Headache
  4. Jaundice
  5. Hypoglycaemia
490
Q

Investigations for fatty liver

A

ALT levelled

491
Q

The requirement criteria for instrumental delivery

A
  1. FULLY DILATED CERVIX
  2. RUPTURE MEMBRANE
  3. OA position
  4. Cephalic
  5. Pain Relief
  6. Sphincter
492
Q

Indications for forceps delivery

A
  1. Foetal distress
  2. Maternal distress
  3. Failure to progress
  4. Control of head in breech delivery
493
Q

What is gestational thrombocytopenia

A
  1. Decreased production and increased destruction of platelets ONLY affecting pregnant women
494
Q

What is Immune Thrombocytopenia (ITP)

A
  1. Autoimmune condition associated with acute purports episodes in children and women
495
Q

What is ventouse delivery

A

Vacuum

496
Q

What procedure in delivery carries the greatest risk of haemorrhage in newborns

A

Prologued ventouse delivery

497
Q

Chorioamnionitis vs uterine fibroids

A

Chorioamnionitis has uterine tenderness and foul-smelling discharge with foetal tachycardia showing infection.

Fibroids only affects the mother and happens earlier on, in first or second trimester,

498
Q

What does bradycardia on CTG indicate

A

Beta blocker use by mum

499
Q

What does tachycardia on CTG indicate

A

Chorioamnionitis, hypoxia, maternal pyrexia

500
Q

What does loss of baseline variability indicate

A

Hypoxia

501
Q

What do early decelerations indicate

A

Head compression

502
Q

What do late decelerations indicate

A

Foetal distress

503
Q

What do variable decelerations indicate

A

Cord Compression

504
Q

What is breast engorgement

A

Affects BOTH breasts, and is discomfort just before a feed.

Infant may find it difficult to attach.

505
Q

Treatment of breast engorgement

A

Hand expression

506
Q

What is Raynaud’s disease of the nipple

A

Intermittent pain, during and after feeding

It’s where the nippled blanches, coyness or srthemas.

507
Q

treatment of rayndaud’s disease of the nipple

A

Nifedipine or heat packs.

508
Q

What drug should be avoided when breast feeding

A 
Amiodarone 
Aspirin
Psychiatric drugs
Antibiotics
Mtehotrexate
Sulfonylureas
Carbimazole
509
Q

Contraindications to breast feeding (diseases)

A
  1. Galactosaemia

2. Viral infections (HIV)

510
Q

Why should cooked liver be avoided in pregnancy

A

Vit A is a teratogen

511
Q

What procedure can reduce the incidence of shoulder dystocia in women with GDM

A

Induction of labour

512
Q

What measures can improve the effectiveness of the McRobert’s manoeuvre

A

Suprapubic Pressure

513
Q

What is given as GBS prophylaxis

A

Benzyl penecillin

514
Q

Sources of folic acid

A

Green leafy vegetiables

515
Q

What is the consequence of folic acid deficiency

A

Macroycytic, megaloblastic anaemia

2. Neural tube defects

516
Q

What is an indicator of megaloblastic anaemia

A

Hypersegemnted neutrophils

517
Q

What is the choice of SSRIs in breastfeeding women

A

Sertraline

518
Q

Why is fluoxetine not fabvourable in women

A

Has a high half life and present in breast milk.

519
Q

How are atonic uterine primary haemorrhages treated

A
  1. Syntometrine or oxytocin to contract the uterus

2. Cord traction and massage the uterus.

520
Q

How should pregnant women with abdomen trauma be managed

A

Rhesus testing, so they can be given atni-D to prevent rhesus isoimmunisation

521
Q

Symptoms of exotic pregnancy

A

6-8 weeks amenorrhoea, with lower, unilateral abdomen pain. Vaginal bleeding later, sometimes with tender cervix.

522
Q

Symptoms of placental abruption

A

CONSTANT lower abdomen pain, woman may be in more shock than visible blood loss seen.

523
Q

If after 28/40 weeks, woman reports reduced foetal movements and no heart is detected by a handheld doppler, what should be done

A

USS.

524
Q

What is active management of the third stage of labour

A
  1. Uterotonic drugs (oxytocin)
  2. Deferred clamping and cutting of the cord (1-5 mins after delivery)
  3. Controlled cord traction
525
Q

When is erogemetrine or syntometrine contraindicated

A
  1. Gestational HTN, eclampsia or preeclampsia
526
Q

How often should FHR be monitored

A

15 mins

527
Q

How often should contractions be monitored

A

Every 30 mins

528
Q

When do galactoceles develop

A

Typically after women stop breastfeeding, builds up

529
Q

In what conditions is AFP low

A

DOwn’s syndrome

GDM

530
Q

In what conditions is AFP high

A

Neural tube defects

531
Q

What infectious diseases are routinely screened for in pregnancy

A

HIV
Rubella
Syphillis
Hep B

532
Q

Where is fibronectin produced

A

Gestational sac

533
Q

When is foetal fibronectin raised

A

Early labour

534
Q

When should folic acid be given in pregnancy

A

400mcg until the 12th week of pregnancy

535
Q

When is folic acid stepped up to 500mcf

A
  1. NTD
  2. Antiepileptic drugs or has chronic disease
  3. Obese
536
Q

RF for breech presentation

A

Fibroids

  1. Placenta praevia
  2. Polyhydramnios or oligohydramnios
  3. Prematurity
537
Q

When is external cephalic version offered

A

36 weeks

538
Q

Placental abruption vs placental preavia

A

Painless and bright red vs painful and dark brown.

539
Q

Vasa praevia vs placental praaevia

A

Both have vaginal bleeding that’s painless HOWEVER:

Vasa has foetal bradycardia and memraben rupture.

540
Q

Then grade for perineal tears

A
  1. First: Superficial damage to skin
  2. Second: Injury to perineal muscle but no anal sphincter
  3. Injury involving anal sphincter
541
Q

RF for perineal tears

A
  1. Shoulder dystocia
  2. Forceps Delivery
  3. Large babies
  4. Primigravidas
542
Q

Consequence of cord prolapse

A

Cord compression

543
Q

How is cord compression managed

A

Place hand into vagina to elevate the cord.

544
Q

Treatment of all women with pPROM

A

10 days erythromycin

545
Q

What should be given to women with a previous baby suffering from early or late onset GBS disease

A

IV maternal antibiotics during labour

546
Q

What is the appropriate management of placenta praaevia during labour

A

Emergency C-Section

547
Q

Management for babies at risk of strep B infection

A
  1. Regular observations for 24 hours
548
Q

Management of strep B infection in pregnant women

A
  1. Intrapartum antibiotics

2. 24-hours before or after birth

549
Q

Treatment of Eclampsia in women

A

Magnesium for 24 hours after last seizure or delivery

550
Q

RF for placental abruption

A 
A - Abruption previously 
B - BP
R - Ruptured Membranes (PROM)
U - Uterine Injury 
P - Polyhydramnios
T - Twins
I - Infections in the uterus (chorioamnionitis)
O - Older Age 
N - Narcotic.
551
Q

Consequence of shoulder dystocia

A

Erb’s Palsy

552
Q

What is Erb’s Palsy

A
  1. Damage of the upper brachial plexus

Signs:

Adduction
Internal Rotation of the arm
Pronation of the Forearm.

553
Q

What is an absolute contraindications for a vaginal delivery

A

Vertical caesarean scar

554
Q

What cell produces hCG

A

Syncytiotrophoblasts

555
Q

When can HcG be detected in maternal blood

A

Day 8 after conception

556
Q

Most common agent causing mastittis

A

Staph aureus

557
Q

If symptoms of mastitis do not improve after conservative management, what treatment is given

A

Oral Flucloxacillin or erythromycin if allergic

558
Q

When, during gestation, is same day delivery an option

A

After 34 weeks

559
Q

What will reduce the BP in induced labour of someone with eclampsia

A

Epidural anaesthesia

560
Q

When does a miscarriage become a stillbirth

A

After 24 weeks of gestation

561
Q

Contraindication of epidural anaesthesia

A

Coagulopathy

562
Q

What parts of the cardinal movements of labour, form crowning

A
  1. Extension
  2. Restituition
  3. Delivery of anterior and posterior shoulders.
563
Q

In what position does the feats head enter the pelvic inlet

A

Either L or R OT (45 degree angle, not direct OP)

564
Q

What is syncretism

A

Saggital suture lies halfway between pubic symphysis and sacral pronometry

565
Q

Differences in foetal descent between nulliparas and multiparae women

A
  1. Nulli: Occurs during 2nd stage

2. Descent begins alongside engagement.

566
Q

What is the name of the diameter given to the change in shape as the baby feels resistance during flexion

A

Occiptofrontal diameter (12cm) -> subocciptobregmatic diameter.

567
Q

What position does the baby move into during internal rotation

A

OA position

568
Q

Two forces that act on the baby during extension

A
  1. Forces from the uterus acting posteriorly

2. Force from pelvic floor and pubic symphysis

569
Q

What structure does the baby face during external rotation

A

Ischial tuberosity

570
Q

What causes macrosomia

A

An abundance of glucose

571
Q

How does DM affect the glucose levels of a newborn

A

The newborn will be born hyperglycaemic and quickly turn to hypoglycaemia

572
Q

What is station 0

A

Ischial spine

573
Q

What do positive numbers in the stations indicate

A

The feoutus has entered the birth canal

574
Q

What is foetal engagement

A

Head enters pelvis, causing effacement and dilation of the cervix as it presses its head against it

575
Q

What is foetal lie

A

Relationship of the foetal spinal column to the mother’s

576
Q

What is complete breech presentation

A

Buttocks and flexed feet present first

577
Q

What is frank presentation

A
  1. Hips are flexed but legs are extended resting on chest
578
Q

What presentation is a result of a transverse lie

A

Shoulder

579
Q

What causes the foetus head to extend

A

Upward resistance from the pelvic floor

580
Q

What keeps the placenta from separating prematurely during labour

A

Pressure from the foetus

581
Q

What is the name given to the following placentas:

  1. Feotal side

Mother’s side

A
  1. Foetal: Schultze’s (shiny)

2. Mother: Duncan (raw)

582
Q

What is Leopold’s manoeuvre

A
  1. Palpating the funds to identify the occupying foetal part
583
Q

Three situations where finternal cardiotocography is used

A
  1. Foetal descent
  2. 2cm dilation
  3. Active phase of labour
584
Q

What FHR is associated with low APGAR scores

A
  1. Late decelerations (hypoxia)
585
Q

What causes FHR accelerations

A

Foetal movement

586
Q

What drug is used to halt uterine contractions in preterm labour

A

Magnesium Sulfate or tocolytics

587
Q

What opioids are given during labour

A
  1. Fentanyl or Morphine
588
Q

How is an epidural delivered

A
  1. L4 level.
589
Q

What is toxic shock syndrome

A

Fever, rash. Low BP caused by strep progenies or Staph aureus.

590
Q

Where is oxytocin naturally produced

A

Posterior pituitary gland

591
Q

What nerve is commonly injured during prolonged labour

A

Pudendal nerve (runs along the back of the ischial spine):

can cause faecal, urinary and sexual dysfunction

592
Q

What muscle is strengthened in keels and pelvic floor excercises

A

Levator ani

593
Q

Indications for episiotomy

A
  1. Foetal distress

2. Macrosomia

594
Q

Two types of episiotomy

A
  1. Median: From posterior vaginal wall vertically into perineal body (as the healing tissue is similar to the perineal body)
  2. Mediolateral: From posterior vaginal wall diagonally to the outer part of the anus. Lowers risk of anal muscle tears
595
Q

What nerve roots are affected in an epidural block (does not pierce the dura or subarachnoid space)

A

s2-s4 nerve roots

596
Q

When does an epidural need to be delivered before it becomes contraindicated

A

In ADVANCE OF DELIVERY (1st stage of labour)

597
Q

What is the ponderal index

A

Assess if a newborn is malnourished, healthy or overweight.

598
Q

CV changes during pregnancy

A

Increased HR
Increased SV
Increased CO

BP drops from peripheral vasodilation and then increases back to normal.

599
Q

Resp changes during pregnancy

A

Progesterone: Bronchial dilation

Increased subcostal angle
Increased pulmonary blood flow
Increased tidal volume but decreased vital capacity.

600
Q

Foetal blood vs normal blood

A

Has two gamma chains instead of two beta chains.

601
Q

GI change sin pregnancy

A

Delayed Gastric Emptying (HEARBURN) - likely to get aspiration pneumonitis

602
Q

What is contained in entonox

A

O2 and NO

603
Q

What causes labour pains in stage 2 of pregnancy

A

Stretching of the vagina and perineum

604
Q

Types of PCA opioids

A

Fentalu, Alfentanil, Remifentanil

605
Q

What is the criteria for early referral to infertility clinics

A
  1. Over 35
  2. Menstrual disorder
  3. Previous ado surgery
  4. Previous PID/STD
606
Q

Name two hormone profiles used when checking inferiority

A

D2 FSH and D21 Progesterone

607
Q

What are indications for tubal latency testing (HSG)

A

STI, PID, Pain and previous surgery

608
Q

Treatment of male infertility

A

Usually IVF

Intracytoplasmic cperm injection

Azoospermia: Surgical sperm recovery or donor insemination

609
Q

What occupations drive male infertility

A

Overheating: Lorry drivers

610
Q

Diet and supplements that can improve male infertility

A

Folic acid and Zinc

Lose Weight

611
Q

When is IVF indicated

A

After 2 years of infertility.

612
Q

What does the combined test offered to pregnant womenn consist of

A

T21, T18 (Edwards) and T13 (pate) screening.

613
Q

What is the optimum crown-rump length in the first trimester

A

45-84 mm

614
Q

In a pregnant woman with pre-existing hypothyroidism, what should be done to her levothyroxine medication

A

It should be increased

615
Q

What is a marker for end organ damage in pre-eclampsia

A

Thrombocytopenia (can be a sign off eclampsia without proteinuria)

Can cause VTEs, HTN and ischaemic heart disease later in life.

616
Q

What is the purpose of giving anti-D immune globulin

A

It is to prevent the mother from developing Rh+ antigens against Rh-D positive blood in an infant.

It is not needed in people who are already negative as long as both parents are rhesus negative.

617
Q

What pre-existing condition can result in APL

A

SLE

618
Q

What are the indications for taking 5mg folic acid instead of 400mcg

A
  1. If either partner has an NTD, a previous child with an NTD or FH with NTD
  2. Antiepleptic Drugs
  3. Coeliac’s, Diabetes, Thalassaemia
  4. Obese (over 30BMI)
619
Q

What are the indications for Aspiring prophylaxis from the 12th week gestation until birth

A 
HTN in a previous disease
CKD
Autoimmune diseases (SLE, APL)
DM 1 or 2
Chronic HTN 
2 of:
BMI over 35
FH of pre-eclampsia
Multiple Pregnancy
Age 40 or older
620
Q

When should women with pre-eclampsia bet admitted and observed

A

160/110 mmHg

621
Q

When would administration of Anti-D not work

A
  1. Ectopic
  2. Evacuation of retained products of molar pregnancy or abortions
  3. Vaginal Bleeding under 12 weeks if heavy or persistent
  4. Vaginal Bleeding over 12 weeks
  5. Chorionic Villus Sampling and Amniocentesis
  6. PPH
  7. External Cephalic Version
  8. Intrauterine death or post-delivery
622
Q

In what foetal occipital-position, are women more likely to experience an earlier urge to push: OA or OP

A

OP

623
Q

Why is labour longer in OP

A

Because a greater rotation is required during the physiological stages of birth

624
Q

Management of a face presentation

A

Emergency C-Section

625
Q

What is the risk with a footling presentation at delivery

A

Can cause cord prolapse, obstructing foetal blood flow

626
Q

What is a face presentation

A

When the head extends prematurely instead of flexing after engagement

627
Q

What is Reverse End-Diastolic Flow in Pregnancy and how is this treated

A

This is where blood flows back into the foetus instead of exiting

You must give them another course of steroids (this only lasts 1-4 weeks)

MgSO4

628
Q

Signs of Chronic Lung Disease of Prematurity on X-Ray

A

Hyperinflation but no alveoli

629
Q

Treatment of Apnoea of Prematurity

A

NCPAP, tactile stimulation and CAFFEINE (phosphodiesterase inhibitor)

630
Q

Treatment of Grade I Placenta Praevia

A

Vaginal Delivery can be offered. The others usually require a C-Section

631
Q

What is the only oral therapy that is allowed in DM mothers when they’re breast feeding

A

Metformin

632
Q

Difference in presentation between Placenta Accrete and Placenta Praevia

A

Placenta Accreta only presents as PPH, and is asymptomatic until labour

633
Q

First Line Treatment for PROM according to NICE Guidelines

A

10 Days ERYTHROMYCIN

634
Q

What should be given as intrapartum antibiotics if a pregnant woman is allergic to penecillin

A

Vancomycin

635
Q

Galactocele vs a Breast Abscess

A

Galactoceles are painless and non-tender, with no systemic signs of infection (e.g., tachycardia or fevers)

636
Q

How does Methotrexate work

A

It Inhibits Dihydrofolate Reductase - can cause Macrocytic Megaloblastic Anaemia

637
Q

What is the triple test for Down’ Syndrome and when is it conducted

A

15-20 weeks:

AFP (Low), Unconjugated Oestradiol (Low) and Beta-HCG (High)

638
Q

At what point after birth does a midwife handover to a health visitor after birth

A

10-14 days

639
Q

Features of aspirin overdose

A

Respiratory alkalosis due to hyperventilation -> metabolic acidosis

Tinnitus, vomiting and severe dehydration

640
Q

What is the complication that can occur if a pregnant woman takes sodium valproate

A

Hypospadias and ASDs

641
Q

Main pregnancy complication from GDM

A

Polyhydramnios

642
Q

What makes up baby weight size monitoring

A
  1. Femoral height
  2. Abdominal circumference
  3. Palpation of the head
643
Q

What antibiotic is safe for use throughout pregnancy

A

Cephalosporins

644
Q

What is the first line management of PID

A

Metronidazole
ceftriaxone
Doxycyclines

645
Q

How is Mifepristone and Misoprostol given

A

ORAL mifepristone

VAGINAL Misoprostol

646
Q

What is the first line intervention for a failure to progress in the first stage

A

Membrane sweep (amniotomy)

Then wait and re-assess, then give oxytocin

647
Q

What is the first line tocolytic that is given in Obstetrics

A

Oral Nifedipine

648
Q

According to NICE, what should be the first line management of a possible preterm birth/miscarriage

A

As long as th ecervix is less than 25mm, Vaginal Progesterone should be given

No point giving Steroids at this time as foetal lungs haven’t even developed yet. We need to keep the baby in for as long as possible

649
Q

What is multiple pregnancies a risk factor for

A 
Vasa Praevia (NOT PLACENTA)
Placental Abruption
650
Q

What is Ovarian Hyperthecosis

A

Presence of lots of lutenised theca cells in the ovarian storm -> jhyperandrogenism

Most common cause of hirstusim in postmenopausal women

651
Q

When is the combined test for Down syndrome done

A

11-13 weeks

652
Q

After 13 weeks gestation, what test is offered instead of the combined test

A

Triple or Quadruple

653
Q

Prior to C-Sections, what medication should be given to pregnant women

A

Omeprazole

Rhesus- D if they’re negative
If positive, leave it

654
Q

Sub types of type 3 perineal tears

A

3a. Less than 50% of the thickness of the external anal sphincter is torn
3b. More than 50% of the thickness of the external sphincter is torn
3c. External and internal sphincter is torn but mucosa is intact

655
Q

What is a type 4 perineal tear

A

Both internal and external sphincters and anal mucosa is torn

656
Q

Management of a first degree tear

A

Nothing, leave alne

657
Q

Management of a second degree tear

A

Suturing by midwives

658
Q

Management of a third degree tear

A

3rd degree tear + requires surgical repair

659
Q

First step in managing a post-term pregnancy

A

Cervical membrane sweep and then induction of labour

660
Q

Management of APL

A

Aspirin and LMWH

661
Q

What is polymorphic eruption of pregnancy

A

Itchy papular rash the starts on the abdomen

Compared to Cholestasis of Pregnancy which is itching of palms and soles without a rash

662
Q

How long does it take for a uterus to go back to its original size

A

4 Weeks

663
Q

What is a Dichorionic and diamniotic sac

A

Two Different sacs

664
Q

What is a monochorionic and diamniotic sac

A

Same outer sac, two inner sacs

665
Q

When is lactational breast feeding indicated

A
  1. FULLY breast feeding
  2. Amenorrhoea
  3. Less than 6 months post partum
666
Q

What is an early sign that can be seen in a urine dipstick during Hyperemesis Gravidarum

A

Ketones

667
Q

When is tocolysis contraindicated

A

Over 34 weeks gestation

668
Q

After what cervix size is tocolysis contraindicated

A

2cm

669
Q

What pain relief should be avoided d in pregnancy

A

NSAIDs - they can cause premature closure of the ductus arteriosus

670
Q

What examination finding is consistent with oligohydramnios

A

The baby foetal parts will be abnormally prominent

671
Q

What is normal variability in a baby

A

Between 5 and 25 BPM

672
Q

First line treatment for pain relief

A

Paracetamol

If not tolerated, codeine phosphate

673
Q

What is a major indication for thromboprophylaxis post partum?

A

A twin pregnancy

674
Q

What is the role of the Kleihauer test

A

t gauge the dose of anti-D required

675
Q

What should be done to patients on ramipril who no have gestational hypertension

A

Switch ACEi to Labetolol, discontinue ramipril

676
Q

What defines PPH

A

Loss of 1000ml over 24 hours

677
Q

How successful is an ECV

A

50%

678
Q

How long is rump-crown length the main way of measuring a baby

A

13 weeks

679
Q

After 13 weeks, what is the main way we measure a baby

A

Femoral length

Head circumference

680
Q

When is a surgical management of a miscarriage indicated

A

Bleeding for over 2 weeks

681
Q

How many contractions are normal within 10 minutes during labour to show healthy progression

A

3-5 in 10 mins - first stage

682
Q

First line treatment for hyperemesis Gravidaru

A

Promethazine

683
Q

What is a category 1 cesarean section

A

When there is acute foetal compromise

684
Q

What is the main consequence of polyhydramnios that mother’s can get during delivery

A

Umbilical cord prolapse

685
Q

Inevitable miscarriage vs complete miscarriage

A

Inevitable: Cervical os is open and there is active bleeding

Complete: Cervical os is closed, previous bleeding and cramping which has now stopped. Can only be confirmed on USS

686
Q

When should women with gestational diabetes give birth by

A

40 + 6 weeks of gestation

687
Q

When is an epidural anaesthesia given

A

During the active phase of labour, this is contraindicated in the latent phase

688
Q

What pain relief can be given in the latent phase of pregnancy

A

Diamorphine IM

689
Q

How long does epidural anaesthesia last for

A

2 Hours

690
Q

When is arterial rupture of membranes done

A

Ripened cervix

Head is well-engaged

691
Q

First line management of placental abruption in <36 weeks who are asymptomatic/ not systemically unwell

A

Admit and administer steroids

692
Q

Most common cause of polyhydramnios

A

Idiopathic

693
Q

Indications for C-Section

A
  1. Woman is in established labour
  2. Foetal Compromise
  3. Ruptured Membranes or vaginal bleeding
  4. Severe Hypertension
694
Q

If the baby in a Herpes +ve mother appears unwell, what is the first line management plan

A

Lumbar puncture HSV PCR

695
Q

If a miscarriage is suspected and the crown-rump length on TVUSS is <7mm, what should be done

A

Another TVUSS in 7 days as the foetus may still be developing - it’s too early to tell

696
Q

Pseudosac vs a true sac

A

In PUL:

A cyst would be seen in the endometrium that is centrally located.

In a confirmed Intrauterine Pregnancy, this cyst would be slightly off centre.

So a centrally located cyst in the endometrium would still be a PUL.

697
Q

What is a major complication of polyhydramnios

A

Pre-Term Labour

698
Q

How should unstable Bipolarism be treated during pregnancy

A

Switch gradually to an atypical antipsychotic (mood stabiliser)

699
Q

How does age affect pre-eclampsia

A

Over 40 increases risk

700
Q

AT what pregnancy interval, do we get an increased risk of pre-eclampsia

A

If a previous pregnancy was greater than 10 years before the new one

701
Q

What is a complication of Chorionic Villus Sampling

A

Total limb abnormalities if performed before 11 weeks gestation

702
Q

If a woman has a diagnosed Gestational Diabetes in a previous pregnancy, when should the OGTT be offered

A

As soon as possible following a booking visit

Should not be routinely offered

Usually, do fasting glucose at 13 weeks gestation

703
Q

How does parity affect the chances of a PPH

A

Multiparity increases its risk

704
Q

Name a brain complication found in congenital rubella syndrome

A

Hydrocephalus

705
Q

What is more accurate, Chorionic Villus Sampling or Amniocentesis

A

Amniocentesis

706
Q

When is benzylpenecillin given to pregnant women

A

During delivery and after

707
Q

What is the target fasting glucose level for pregnant women

A

5.3 mmol/mol

708
Q

First line management of suspected endometritis

A

Admission to hospital for IV antibiotics

709
Q

Does pre-eclampsia cause oligohydramnios or polyhydramnios

A

Oligohydramnios

710
Q

What is the first line management of a woman with moderate/high gestational hypertension or pre-eclampsia after 37 weeks

A

Plan immediate delivery

711
Q

From what gestation age should mothers with placenta praaevia and vasa praaevia be admitted

A

34 weeks

712
Q

At what age doe physiological jaundice present

A

2-3 days of being born

713
Q

When is prophylactic vaginal progesterone indicated in a pregnancy

A

A history of spontaneous pre-term births AND a cervix length less than 25mm between 16 and 24 weeks

714
Q

When can intravaginal progesterone use be stopped

A

After 34 weeks

715
Q

When is cervical cerclage indicated for pregnant women

A

Cervical length < 25mm AND:
Previous pPROM
History of cervical trauma

716
Q

When can rescue cervical cerclage be used (rescue, being during the course of the pregnancy itself)

A

Between 16 and 27 weeks with a dilated cervix.

717
Q

When is the earliest we can do a foetal fibronectin testing done for a preterm pregnancy

A

30 weeks

718
Q

When should someone with Peuperal pyrexia be taken to the hospital instead of conservative management

A
  1. > 38 degrees
  2. Tachycardia
  3. Breathlessness
  4. Abdominal Pain
  5. Diarrhoea

If the woman is in distress

719
Q

What is an absolute contraindication to ECV

A

Bleeding in the past 7 days

720
Q

Why is promethazine the first line for hyperemesis gravidarum

A

BNF suggest promethazine (anti-histamines) as the first line

Metoclopramide is second line

721
Q

How do we calculate a due date

A

Last Menstrual period + 9 months + 7 days

722
Q

Umbilical cord prolapse vs uterine rupture

A

Both cause foetal tachycardia etc

But Umbilical cord prolapse is painless vs uterine rupture which is painful

723
Q

When should steroids be given during placental abruption

A

As long as the foetus and mother have stable obs and there is no sign of foetal distress.

year 3 (25 decks)

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