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Fifth year revision > Obstetrics and Gynae > Flashcards

Obstetrics and Gynae Flashcards

1
Q

ddx for preeclampsia features

A 
acute fatty liver of pregnancy 
HUS
TTP 
exacerbation of SLE 
cholecystitis
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2
Q

predisposing factors which could make preeclampsia present

A 
hydatidiform mole 
multiple pregnancy 
fetral triploidy 
severe renal disease 
antiphospholipid antibody syndrome
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3
Q

what does HELLP syndrome stand for

A

Haemolysis
Elevated Liver enzymes, and a
Low Platelet count

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4
Q

CNS complications of preeclampsia

A 
cerebral haemorrhage 
cerebral oedema 
cortical and sinus vein thrombosis 
retinal detachment 
central serous retinopathy
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5
Q

2 retinal complications of preeclampsia

A

retinal detachment

central serous retinopathy

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6
Q

what are the first line drugs for the treatment of hypertension in preeclampsia?

A

methyldopa
labetalol
oxprenolol

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7
Q

what are the second line drugs for the treatment of hypertension in preeclampsia?

A

hydralazine
nifedipine
prazosin

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8
Q

what are the drugs used in severe hypertension >170/110 in preeclampsia?

A

labetalol
nifedipine
hydralazine
diazoxide

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9
Q

what medications are contraindicated in the treatment of hypertension during pregnancy

A

ACEi

ARBs

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10
Q

what are the risks of intravenous fluid administration in preeclampsia and why does this occur?

A

pulmonary oedema
peripheral oedema

because of increased vascular permiability and hypoalbuminaemia

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11
Q

treatment for ecclampsia

A
  • Resuscitation
  • Magnesium sulphate (IV loading dose then infusion until 24hrs after last fit)
  • Monitoring (BP, RR, urine, SaO2, deep tendon reflexes).
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12
Q

why monitor urine output during magnesium sulphate infusion?

A

excreted renally and shouldnt be used in oliguria or renal impairment because serum magnesium concentration can rise.

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13
Q

contraindications for use of tocolytics

A

gestation

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14
Q

preferred agent for tocolysis

A

nifedipine 20mg oral stat

2nd dose after 30mins if contractions persist

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15
Q

what do you call the foetal lie where the head is the presenting part?

A

cephalic

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16
Q

what agent is used for prophylaxis of GBS during active preterm labour?

A

benzylpenicillin IV

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17
Q

what is used to improve pulmonary outcomes in infants who are delivered prematurely?

A

IM Betamethasone to mum (2 doses 24hrs apart)

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18
Q

If a woman goes into preterm labour at 28 weeks, in addition to nifedipine and betamethasone and abx, what should she receive?

A

magnesium sulphate –> neuroprotection (for preterm labour

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19
Q

what is fFN?

A

Fetal fibronectin

glycoprotein promoting adhesion between the fetal chorion and maternal decidua

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20
Q

criteria of chorioamnionitis

A

maternal fever + 2 or more of the following:

  • Increased WCC
  • Maternal tachycardia
  • Fetal tachycardia (>160bpm)
  • Uterine tenderness
  • Offensive smelling vaginal discharge
  • C-reactive protein >40
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21
Q

tx for chorioamnionitis

A

ampicillin
gentamicin
metronidazole

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22
Q

name 4 tocolytics

A

magnesium sulphate
Ca channel blockers - nifedipine
betamimetics - salbutamol
atosiban

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23
Q

if 30-34 weeks gestation, which tocolytic should you use if someone goes into PTL?

A

nifedipine

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24
Q

what is the complication associated with betamimetics which makes them less safe than other tocolytics?

A

can cause pulmonary oedema –> maternal death

do not use in fluid overload!!

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25
Q

what are the most potent inhibitors of uterine contractility available?

A

indomethacin (inhibits prostaglandin synthesis)

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26
Q

what is the side effect that means indomethacin should only be used in cases of PTL

A
  • constriction of fetal ductus arteriosus (risk increases with increasing gestation)
  • alteration of fetal cerebral blood flow
  • reduced fetal renal function –> oligohydramnios
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27
Q

when do you administer corticosteroids to mothers in PTL?

A

if 23 –> 34+6 weeks gestation

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28
Q

when do you administer corticosteroids to mothers in PTL?

A

if 23 –> 34+6 weeks gestation

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29
Q

what tocolytic is known to have neuroprotective properties and decrease the risk of cerebral palsy?

A

mag sulphate

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30
Q

what is a fetal factor which affects intrauterine fetal growth?

A

fetal pancreatic B cell function (insulin is one of the main regulators of fetal growth).

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31
Q

what are four consequences of growth restriction in a fetus?

A

hypoglycaemia
acidosis/hypoxia (–> CP)
erythroblastosis
IUFD

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32
Q

what is the biggest maternal factor which can lead to fetal growth restriction?

A

maternal hypertension

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33
Q

How do you identify pregnancies of high risk for intrauterine growth restriction?

A

symphysiofundal height measurements and plotting on an appropriate chart which has been adjusted for the maternal demographics.
or U/S

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34
Q

what are 3 features on USS you look at to determine risk of IUGR?

A

fetus size
amniotic fluid volume
doppler umbilical blood flow velocity

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35
Q

what are 4 hx/exam/inv you can do in OPD to monitor pregnancies at risk of IUGR?

A

fetal movement (fetal kick) count
cardiotocography
serial USS exams
doppler flow velocity wave forms

(high negative predictive value)

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36
Q

when do you give Anti-D injections if rhesus negative?

A

28 and 34 weeks

and if symptoms or procedures are likely to cause fetal blood to mix with maternal blood (threatened miscarriage, ectopic pregnancy, D&C, termination)

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37
Q

what is the purpose of giving anti-D IM injections to pregnant women with Rhesus negative blood type?

A

prevent sensitisation of maternal immune system –> stops the formation of antibodies which could affect subsequent pregnancies.

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38
Q

what is the complication caused by RhD positive antibodies in the mother during the next pregnancy?

A

haemolytic disease of the newborn.

HDN

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39
Q

what test can you do to see if the dose of anti-D was sufficient for the mixing of blood?

A

Kleihauer test

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40
Q

how do you treat a patient with mild iron deficiency on antenatal testing?

A

encourage to eat more iron from leafy green vegetables, beans, wholegrains etc.

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41
Q

when do you do oGTT in prenatal testing?

A

26-28weeks

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42
Q

what are the cut-offs for GDM on OGTT?

A

Fasting >5.1
1-hr >10
2hr >8.5

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43
Q

what are risks for GDM? / when would you do an earlier oGTT at 12weeks?

A
  • previous GDM
  • maternal age >40
  • BMI >35
  • Prev baby >4.5kg /90th percentile
  • PCOS
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44
Q

how do you test for GBS?

A

low vaginal swab

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45
Q

what is the treatment for a GBS positive result and why do we treat?

A
  • IV penicillin during labour
  • clindamycin if allergic.

to prevent early-onset neonatal sepsis (1 in 200 neonates from GBS +ve)

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46
Q

what percentage of women are asymptomatically GBS +ve

A

15-25%

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47
Q

what does HCG stand for and what cells release it?

A

human chorionic gonadotropin

released by syncytiotrophoblasts

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48
Q

when can you do a nuchal translucency scan for fetal aneuploidy/trisomy 21

A

11 - 13+6 weeks

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49
Q

gram negative intracellular diplococci on urethral swab of male with discharge what’s the bug?

A

gonorrhoea

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50
Q

what does gonorrhoea look like on gram stain?

A

gram negative intracellular diplococci

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51
Q

tx for sarcoptes scabiei

A

permethrin cream 5% from neck down and washed off 24hrs later
tx of household and sexual contacts
wash sheets hot cycle
antihistamines for persisting itch

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52
Q

STI that causes intense scratching groin, eyebrows, pubic hair, eyelashes

A

phthirus pubis

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53
Q

treatment for phthirus pubis

A

permethrin cream 5% rinse topically from chest to knees,

washed off 10 minutes and repeat next week

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54
Q

typical clinical appearance of phthirus pubis

A

grains of sand

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55
Q

bumps at end of penis from masturbating lots

A

sclerosing lymphangitis

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56
Q

what types of HPV cause genital warts

A

6, 11

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57
Q

what types of HPV are assoc with cervical cancer

A

16, 18

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58
Q

treatment for genital warts

A

none
cryotherapy
podophyllin

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59
Q

treatment for chlamydia

A

azithromycin (plus doxy if complicated site)

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60
Q

treatment for gonorrhoea

A

ceftriaxone (resistant to penicillin)

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61
Q

normal vaginal pH premenopause

A

3.5-4.5

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62
Q

what is the most common organisms present in the vagina premenopause

A

lactobacilli

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63
Q

what is the most common fungus causing vulvovaginal candidiasis?

A

candida albicans

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64
Q

sx of vulvovaginal candidiasis

A

vulval itching and soreness
dyspareunia
thick curdy vaginal discharge

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65
Q

treatment of candidiasis

A

fluconazole PO or topical (a type of imidazole)

or clotrimazole pessary

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66
Q

can a woman take fluconazole for candidiasis if pregnant?

A

topical is safe, oral is contraindicated

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67
Q

RFx for candidiasis

A 
pregnancy 
high dose OCP or HRT
immunosuppression/HIV
broad spectrum abx use 
diabetes
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68
Q

should you treat the partner of someone with vulvovaginal candidiasis?

A

no evidence if asymptomatic partner

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69
Q

strawberry cervix + fouls smelling vaginal discharge
vulval soreness and itching.

what’s the likely diagnosis

A

trichomonas vaginalis

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70
Q

should you treat the partner of someone with trichomonas vaginalis?

A

yes, high rate of recurrence if partner not treated

also screen for other STIs

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71
Q

treatment for trichomonas vaginalis

A

metronidazole single dose 2g

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72
Q

foul smelling “fishy” vaginal discharge with no pain/itching/inflammation.
most likely dx?

A

bacterial vaginosis

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73
Q

What is the Amsel criteria for bacterial vaginosis?

A

1 presence of clue cells on microscopy (epithelial cells covered in bacteria

  1. Creamy greyish white discharge seen during speculum exam
  2. Vaginal pH of more than 4.5
  3. Release of characteristic fishy odour on addition of alkali: 10% potassium hydroxide.

(3 out of 4 criteria for dx)

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74
Q

Treatment for bacterial vaginosis

A

metronidazole orally or as a gel.
single dose 2g or 5 days BD 400mg

or clindamycin but more expensive

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75
Q

complications of bacterial vaginosis

A

if infected in 1st trimester can –> late 2nd trimester miscarriage and preterm labour

swab in first trimester if past hx of 2nd trimester fetal loss –> if present then treat with metronidazole early 2nd trimester. metro is safe in pregnancy

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76
Q

complications of chlamydia infection

A

PID –> ectopic pregnancy, Fitz-Hugh-Curtis syndrome (perihepatic adhesions like violin strings), infertility, intraperitoneal abscesses and adhesions

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77
Q

tx of PID during infection

A

ceftriaxone IM
+ oral doxycycline
+ oral metronidazole

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78
Q

what is the optimum weight gain in pregnancy for persons of BMI 18.5-25?

A

11.5-16 kg

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79
Q

what is the optimum weight gain in pregnancy for persons of BMI >30

A

5-9kg

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80
Q

what is the name for when a newborn has fluid in its lungs and has resp distress?

A

TTN - transient tachypnoea of the newborn

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81
Q

what is the common cause for RDS? respiratory distress syndrome?

A

surfactant deficiency

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82
Q

2 components to the maternal serum antenatal first trimester screening for trisomy?

A

free bHCG

PAPP-A (pregnancy associated plasma protein-A)

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83
Q

what are the components used to estimate risk for trisomy in the first trimester screening?

A

Maternal age
Maternal serum (bHCG, PAPP-A)
NT on US (11-13+6 weeks)

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84
Q

what are the components of the second trimester screening for fetal aneuploidy and neural tube defects?

A

triple test serum:

  • alpha-feto protein
  • hCG
  • unconjugated estriol
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85
Q

what does levels of alpha feto protein tell us in second trimester screening?

A

measured as multiple of median
high = spina bifida
normal = unaffected
low = down syndrome

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86
Q

if second trimester screening for NTD (neural tube defect) comes back high risk, what would you recommend?

A

detailed morphology USS focussing on the brain, ventricles and spine.

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87
Q

when can you perform NIPT testing?

A

anytime from 10 weeks gestation

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88
Q

when can you perform an amniocentesis?

A

from 14 weeks (if BMI>40 do after 15 weeks)

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89
Q

what is the risk of amniocentesis?

A

miscarriage (0.5%)

amniotic fluid leak/infection

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90
Q

what is the definition of an SGA fetus?

A
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91
Q

what are some causes of the SGA fetus/IUGR?

A 
low maternal weight 
poor nutrition in pregnancy 
birth defects/aneuploidy
use of drugs/etoh/smoking 
gestational hypertension 
gestational diabetes
multiple pregnancy 
placental abnormalities 
oligohydramnios
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92
Q

what is the AC as measured on US an indicator of?

A

metabolic function because it is mostly the liver being measured and thus glycogen stores.

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93
Q

what is potter syndrome?

A

characteristic physical appearance of a fetus with oligohydramnios (mostly d/t renal failure or lack of kidneys developing) which results in pressure during utero.
downwards nose, flat ears, flat face, micrognathia.

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94
Q

what is the incidence of preeclampsia?

A

3% of all pregnancies

95
Q

what does a negative fetal fibronectin result indicate?

A

very high negative predictive value.

very unlikely that the woman will deliver in the next 7-14 days.

96
Q

what is the normal thyroid response to pregnancy and bHCG?

A

bHCG –> acts like TSH and can stimulate thyroid –> lower TSH, higher T4. Often affected in early pregnancy

97
Q

when should you treat high TSH in pregnancy?

A

if TSH > reference range + low T4
or
TSH >10 regardless of T4

(no evidence if subclinical)

98
Q

what is the guideline for folic acid for the normal population?

A

0.4mg daily for one month preconception and first 12weeks of pregnancy

99
Q

what is the folic acid dose for pregnant women at increased risk of NTD?

A

5mg per day

100
Q

what extra supplement should pregnant or breastfeeding vegans take?

A

vit B12

101
Q

what is the treatment cut-off for vit D levels in a pregnant woman

A

50 still take 400IU per day as part of a pregnancy multivitamin

102
Q

What are the biological functions of bhCG?

A

Maintains corpus luteum

Regulates growth factors and cytokines involved in cell proliferation, growth and differentiation

103
Q

What are the clinical uses of bHCG testing?

A

Pregnancy test and idea of dates
Pregnancy surveillance (including trisomy 21)
Tumour marker

104
Q

What produces HCG?

A

Syncytiotrophoblasts

105
Q

When is the peak level of HCG?

A

9-12 weeks

106
Q

What does doubling mean in HCG?

A

That HCG level should at least double in 48hrs.

107
Q

How can we determine the approximate gestation by early USS?

A

Crown-rump length and the ration between the size of the embryo and the yolk sac. The yolk sac decreases is size and disappears by about 12-13weeks.

108
Q

What is the incidence of miscarriage in clinically recognised pregnancies?

A

12-20%

109
Q

What is inevitable miscarriage

A

Open cervical os, plus pain and bleeding

110
Q

What is an Incomplete miscarriage

A

Some of the products of conception have been lost. But not all

111
Q

What is a missed miscarriage

A

Pregnancy which has failed but has not expelled the products of conception

112
Q

What is a septic miscarriage

A

Rare now. Used to be attempted terminations which went wrong before legal abortion,

113
Q

What are two possible history presentations of a woman with miscarriage?

A

Missed/delayed menses followed by pain and bleeding.

Or
Bleeding in early pregnancy

114
Q

What is the best way to diagnose miscarriage?

A

Products of conception in clots analysed by lab (sometimes chorion villi macroscopic too

115
Q

What are the management options of incomplete or missed miscarriage

A

Expectant
Surgical evacuation-most popular
Medical: Misoprostol + mifepristone

116
Q

What is the definition of recurrent miscarriage

A

Three or more consecutive miscarriages

117
Q

What is a procedure you can offer for cervical insufficiency resulting in recurrent miscarriage?

A

Cervical cerclage

118
Q

What is the most common site for an ectopic pregnancy

A

85% in ampulla of Fallopian tube

119
Q

What is a heterotopic pregnancy?

A

Ectopic pregnancy plus intrauterine pregnancy concurrently

120
Q

When would you suspect a heterotopic pregnancy?

A

IVF -1:100 incidence

121
Q

Risk factors for ectopic pregnancy

A 
Previous ectopic 
PID 
Tubal surgery 
IVF pregnancy
if pregnant on IUD - 50% ectopic

Minor: smoking, increased age and multiple sex partners

122
Q

What is a convincing symptom of ectopic pregnancy?

A

Shoulder-tip pain

123
Q

What are the 3 pillars of ectopic pregnancy?

A

Clinical: amenorrhea +/- pv spotting and/or pain
BHCG positive
USS: embryo or gestational sac outside uterus or a non-cystic mass in adnexa, can just have free fluid if ruptured but non-specific

124
Q

What is the gold standard treatment for ectopic pregnancy?

A

Laparoscopic salpingectomy or salpingotomy

125
Q

What is a medical treatment for ectopic pregnancy?

A

IM methotrexate

126
Q

What is the tumour marker for a molar pregnancy/hydatidiform mole/trophoblast tumour?

A

HCG

127
Q

Where is hydatidiform mole of high incidence?

A

Vietnam/Asian

128
Q

What is the management for hydatidiform mole?

A

Do chest X-ray looking for metastasis

Then treat with chemotherapy

129
Q

What factors favour success of VBAC?

A

Previous NVD
Previous successful VBAC
Spontaneous onset of labour
Uncomplicated pregnancy

130
Q

What factors reduce likelihood of successful VBAC?

A 
High BMI 
Previous LSCS for shoulder dystocia 
IOL
Macrosomia 
Advancing maternal age 
>1 previous LSCS
131
Q

What are signs or symptoms of caesarean scar rupture when attempting VBAC.

A 
Abnormal CTG (55-87% of cases)
Severe abdo pain 
Pain between contractions 
Chest pain/SOB/shoulder tip pain 
Scar tenderness 
Abnormal vaginal bleeding 
Maternal shock
Loss of uterine activity 
Loss of station of the presenting part
132
Q

What are the legal requirements for TOP in SA.

A

2 registered practitioners

133
Q

What are the methods of TOP

A

Surgical: e.g. VSTOP (vacuum suction TOP)
Medical: e.g. Prostaglandins (often used after 2nd trimester aneuploidy)
Or anti-progesterones e.g. Mifepristone

134
Q

What is hyperemesis gravidarum?

A

Extreme morning sickness,

3rd commonest cause of hospitalisation in pregnancy

135
Q

What are complications of hyperemesis gravidarum

A 
Electrolyte disturbances
Vit deficiency syndromes 
Oesophageal tears
Pneumomediastinum 
Tooth decay
136
Q

What antiemetics are safe in pregnancy?

A

Metoclopramide
Ginger

Sometimes may use ondansetron, not extensively tested.

137
Q

What is ptyalism?

A

Excessive spitting (due to saliva build up) in pregnancy

138
Q

What is a complication of ptyalism

A

Electrolyte disturbance, especially low potassium

139
Q

Risk factors for ovarian hyperstimulation

A

Age 4000
Multiple follicles
Previous hyperstimulation

140
Q

Complications of ovarian hyperstimulation

A

Ascites
Reduced intravascular volume
Pulmonary effusions (pericardial rare)
Thrombosis in cerebral and upper limb vessels

141
Q

Sx of ovarian hyperstimulation

A

Abdominal discomfort
N & v
Abdominal distension
Dyspnoea

3-7 days after HCG
Or 12-17days if conception

142
Q

What is one way to prevent ovarian hyperstimulation often used for women with PCOS?

A

In vitro maturation (immature eggs collected and matured in lab and then ICSI: intracytoplasmic sperm injection directly into egg)

143
Q

How does size of ovaries correspond with severity of ovarian hyperstimulation

A

Mild 12cm

144
Q

What are the biological functions of bhCG?

A

Maintains corpus luteum

Regulates growth factors and cytokines involved in cell proliferation, growth and differentiation

145
Q

What are the clinical uses of bHCG testing?

A

Pregnancy test and idea of dates
Pregnancy surveillance (including trisomy 21)
Tumour marker

146
Q

What produces HCG?

A

Syncytiotrophoblasts

147
Q

When is the peak level of HCG?

A

9-12 weeks

148
Q

What does doubling mean in HCG?

A

That HCG level should at least double in 48hrs.

149
Q

How can we determine the approximate gestation by early USS?

A

Crown-rump length and the ration between the size of the embryo and the yolk sac. The yolk sac decreases is size and disappears by about 12-13weeks.

150
Q

What is the incidence of miscarriage in clinically recognised pregnancies?

A

12-20%

151
Q

What is inevitable miscarriage

A

Open cervical os, plus pain and bleeding

152
Q

What is an Incomplete miscarriage

A

Some of the products of conception have been lost. But not all

153
Q

What is a missed miscarriage

A

Pregnancy which has failed but has not expelled the products of conception

154
Q

What is a septic miscarriage

A

Rare now. Used to be attempted terminations which went wrong before legal abortion,

155
Q

What are two possible history presentations of a woman with miscarriage?

A

Missed/delayed menses followed by pain and bleeding.

Or
Bleeding in early pregnancy

156
Q

What is the best way to diagnose miscarriage?

A

Products of conception in clots analysed by lab (sometimes chorion villi macroscopic too

157
Q

What are the management options of incomplete or missed miscarriage

A

Expectant
Surgical evacuation-most popular
Medical: Misoprostol + mifepristone

158
Q

What is the definition of recurrent miscarriage

A

Three or more consecutive miscarriages

159
Q

What is a procedure you can offer for cervical insufficiency resulting in recurrent miscarriage?

A

Cervical cerclage

160
Q

What is the most common site for an ectopic pregnancy

A

85% in ampulla of Fallopian tube

161
Q

What is a heterotopic pregnancy?

A

Ectopic pregnancy plus intrauterine pregnancy concurrently

162
Q

When would you suspect a heterotopic pregnancy?

A

IVF -1:100 incidence

163
Q

Risk factors for ectopic pregnancy

A 
Previous ectopic 
PID 
Tubal surgery 
IVF pregnancy
if pregnant on IUD - 50% ectopic

Minor: smoking, increased age and multiple sex partners

164
Q

What is a convincing symptom of ectopic pregnancy?

A

Shoulder-tip pain

165
Q

What are the 3 pillars of ectopic pregnancy?

A

Clinical: amenorrhea +/- pv spotting and/or pain
BHCG positive
USS: embryo or gestational sac outside uterus or a non-cystic mass in adnexa, can just have free fluid if ruptured but non-specific

166
Q

What is the gold standard treatment for ectopic pregnancy?

A

Laparoscopic salpingectomy or salpingotomy

167
Q

What is a medical treatment for ectopic pregnancy?

A

IM methotrexate

168
Q

What is the tumour marker for a molar pregnancy/hydatidiform mole/trophoblast tumour?

A

HCG

169
Q

Where is hydatidiform mole of high incidence?

A

Vietnam/Asian

170
Q

What is the management for hydatidiform mole?

A

Do chest X-ray looking for metastasis

Then treat with chemotherapy

171
Q

What factors favour success of VBAC?

A

Previous NVD
Previous successful VBAC
Spontaneous onset of labour
Uncomplicated pregnancy

172
Q

What factors reduce likelihood of successful VBAC?

A 
High BMI 
Previous LSCS for shoulder dystocia 
IOL
Macrosomia 
Advancing maternal age 
>1 previous LSCS
173
Q

What are signs or symptoms of caesarean scar rupture when attempting VBAC.

A 
Abnormal CTG (55-87% of cases)
Severe abdo pain 
Pain between contractions 
Chest pain/SOB/shoulder tip pain 
Scar tenderness 
Abnormal vaginal bleeding 
Maternal shock
Loss of uterine activity 
Loss of station of the presenting part
174
Q

What is a maternal serum marker of possible IUGR?

A

Low PAPP-A <0.4

175
Q

At what level must bHCG be for uterine pregnancy to be seen (gestational sac) on transvaginal uss?

A

1500-2000

176
Q

How much should beta HCG rise during the first 10 weeks of pregnancy?

A

At least double every 48hrs

177
Q

What is the incidence of placenta Previa in the first trimester?

A

5%

178
Q

What is the incidence of placenta Previa in the first trimester?

A

0.5%

179
Q

What is the incidence of placental abruption?

A

1-2%

180
Q

What are the risk factors for placental abruption?

A

Substance abuse (cocaine)
HTN, vascular abnormalities
Blunt trauma (MVA)
Smoking

181
Q

What are the 4 main causes of PPH

A

4 Ts:

  • Tone: uterine agony
  • Tear: cervical, vaginal, perineal
  • Tissue: retained placenta/membranes
  • Thrombin: coagulopathy (including DIC)
182
Q

what is the condition which you prevent by administering Vit K to newborns?

A

bleeding diathesis (haemorrhagic disease of the newborn)

183
Q

when inspecting the placenta, what would blood vessels running to the edge of the membranes indicate?

A

succenturiate lobe

184
Q

what are the lumps on the maternal side of the placenta called?

A

cotyledons

185
Q

what is placenta accreta?

A

the trophoblast/placenta has invaded the decidua and myometrium to varying degrees

186
Q

what is placenta percreta

A

placenta has penetrated to the serosa of the uterus

187
Q

what are some of the complications of poorly controlled blood glucose during pregnancy?

A 
congenital malformations
pre-eclampsia 
polyhydramnios 
preterm birth 
macrosomia 
growth restriction 
IUFD
shoulder dystocia 
newborn hypoglycaemia/jaundice or resp distress
188
Q

what anti-diabetic drug is contraindicated in pregnancy?

A

glitazones

189
Q

what is the definition of preeclampsia?

A

hypertension >140/90 after 20 weeks
+ proteinuria (>300mg in 24hrs or protein-creatinine index >3)

or other new onset organ involvement:

  • liver disease
  • neurological problems
  • haematological changes
  • pulmonary oedema
  • IUGR
190
Q

what is a severe complication of HELLP syndrome?

A

DIC

191
Q

what is a long term fetal complication which can be a result of IUGR?

A

Metabolic syndrome

“thrifty gene”

192
Q

what are risk factors for preeclampsia?

A 
multiple pregnancy 
age 35 
ethnicity: indian 
obesity 
working during pregnancy 
high booking BP
low fruit intake 
primipaternity or sex
193
Q

grade 1 placenta previa

A

low uterine segment edge >5cm

194
Q

Grade 2 placenta previa

A

marginal, toucches edge

195
Q

Grade 3 placenta previa

A

partly covers os

196
Q

Grade 4 placenta previa

A

covers os completely

197
Q

What are the 4 main causes of PPH

A

4 Ts:

  • Tone: uterine agony
  • Tear: cervical, vaginal, perineal
  • Tissue: retained placenta/membranes
  • Thrombin: coagulopathy
198
Q

what is the genetic link to TOF?

A

chromosome 22 deletions
or
DiGeorge sydrome

199
Q

what is the most common cyanotic congenital heart defect?

A

TOF

200
Q

what percentage of cyanotic congenital heart defects does TOF make up?

A

50-70%

201
Q

how does squatting down help relieve the cyanosis of a tet spell?

A

squatting –> increased peripheral vascular resistance –> increased left heart pressure –> reversal of shunt –> blood goes to lungs –> oxygenated

202
Q

how do you diagnose TOF?

A

echocardiogram (sometimes even pre-natally)

203
Q

how do you treat TOF?

A

surgery in first year of life:

  • close septal defect
  • enlarge RV outflow tract
204
Q

what is a ddx for lower extremity cyanosis in a neonate?

A

coarctation of the aorta
coarctation occurs after the subclavian vessels but before the patent ductus arteriosis –> deoxygenated blood enters aorta to go to the lower extremities.

205
Q

what genetic anomaly is coarctation of the aorta associated with?

A

Turner’s syndrome

206
Q

what does the ductus arteriosus turn into?

A

the ligamentum arteriosum

207
Q

what’s a sign on xray of ribs that you might see with coarctation of the aorta?

A

rib notching

d/t wear away at bone from pulsating intercostals due to differences in pressure

208
Q

what conditions are assoc with ventricular septal defects?

A

Down Syndrome

Fetal alcohol syndrome

209
Q

what murmur is assoc with VSD?

A

holosystolic murmur heard at the left sternal border

210
Q

What is eisenmenger syndrome?

A

when pulmonary hypertension develops from a VSD and the shunt changes to R –> L

211
Q

baby seems fine but has a VSD, then baby turns blue, what is the diagnosis

A

Eisenmenger Syndrome, shunt reversal from pulmonary HTN

212
Q

what is a complication of an ASD?

A

paradoxical embolism –> thromboembolism from vein –> into RA –> crosses ASD –> LA –> LV -> brain

213
Q

what are the two parts that form the atrial septum?

A

ostium primum

ostium secundum

214
Q

what is the active management of PPH?

A

administer oxytocin IM or IV immediately after anterior shoulder delivered.
deliver placenta with controlled cord traction and guarding uterus.

215
Q

what stimulates FSH release?

A

Low-frequency pulses of LHRH

216
Q

What stimulates LH release?

A

high-frequency pulses of LHRH

217
Q

which phase of the menstrual cycle is of fixed length?

A

luteal phase

218
Q

what is the main test used to see if a woman is ovulating?

A

day 21 progesterone (mid-luteal phase = highest level of progesterone)

219
Q

what is Mendelson’s syndrome?

A

chemical pneumonitis or aspiration pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.

220
Q

what is Sheehan syndrome?

A

post-partum hypopituitarism caused by large PPH

221
Q

what are 3 drugs which lower the efficacy of the COCP

A

Carbamazepine
Rifampicin,
Phenytoin.

222
Q

what type of ovarian cancer can cause symptoms of hyperthyroidism?

A

struma ovarii

223
Q

what is Tibolone?

A

a synthetic steroid hormone with estrogenic and progestrogenic and weak androgen actions. Can prevent hot flushes, bone loss and vaginal dryness when used in perimenopausal women

224
Q

severe preecclampsia in first pregnancy. now 10 weeks pregnant, what do you give her to prevent preeclapsia happening this pregnancy

A

aspirin and calcium

225
Q

how does ethanol work as a tocolytic

A

suppresses oxytocin release by the pituitary

226
Q

most common side effect of nifedipine

A

headache

227
Q

3 x side effect of steroids used in PTL

A

maternal leukocytosis
increased maternal blood glucose levels
decreased fetal movements

228
Q

5 causes of PPH

A 
uterine atony 
retained placenta/products 
vaginal/perineal lacerations 
cervical laceration 
haemostatic disorder
229
Q

Mx of PPH

A

send for help
ABC
bimanual uterine massage
10 unit bolus of syntocinon
40 units syntocinon in 1L hartmann’s over 4 hrs
ergometrine 500mcg half IV and IM
insert indwelling catheter
misoprostol tablets mcg per vagina/rectum
Units of blood (4)
theatre if still not stop
- prostaglandin F2alpha injected via abdo into 4 quadrants uterus.
- uterine artery ligation/internal iliac artery
- hysterectomy

230
Q

AE of syntoconon

A

hypotension

hyponatraemia

231
Q

AE of ergometrine

A

nausea and vomiting

hypertension

232
Q

misoprostol AE

A

bronchoconstriction (beware in asthma)

233
Q

consequences of PPH

A

Death
hypovolaemic shock
DIC
Sheehan’s syndrome (avascular necrosis of pituitary)

Fifth year revision (2 decks)

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