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MBBS Y5 > Obstetrics and Gynaecology 2 > Flashcards

Obstetrics and Gynaecology 2 Flashcards

1
Q

What is the bacteria that causes Chlamydia?

A

Chlamydia trachomatis

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2
Q

What type of bacteria is Chlamydia trachomatis?

A

Gram negative

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3
Q

How is Chlamydia transmitted?

A

Unprotected vaginal / anal / oral sex

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4
Q

What are the different serotypes of C trachomatis? (3 things)

A
  1. Serotypes A-C = ocular infection2. Serotypes D-K = classic genitourinary infection3. Serotypes L1-L3 = new infection in laway6a
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5
Q

What are the RF for Chlamydia? (5 things)

A
  1. Age under 252. Partner positive for chlamydia3. Recent change in sexual parner4. Co-infection w another STI5. Not using barrier contraception
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6
Q

What are the CF of Chlamydia? (7 things)

A
  1. Asymptomatic (50% men / 70% women)2. Lower abd / pelvic pain + tenderness3. Dyspareunia (pain @ intercourse)4. Cervical excitation5. Bleeding (intermenstrual / postcoital)6. Abn vaginal discharge7. Dysuria
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7
Q

What are some differential Dx that present similar to Chlamydia?

A

Other STIs especially gonnorhoea

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8
Q

What is the best investigation for Chlamydia Dx? (3 things)

A

NAAT test on specimen from:1. Vulvo-vaginal swab (best)2. Endocervical swab3. First catch urine sample

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9
Q

Why is NAAT preferred over microscopy for Chlamydia Dx?

A

Chlamydia too small to be seen in microscopy

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10
Q

What is the Tx for Chlamydia?

A

Abx course

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11
Q

What are the 2 different FIRST line Abx courses recommended for Chlamydia Tx?

A
  1. Doxycycline 100mg BD for 7 days2. Azithromycin 1g single dose(one or the other)
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12
Q

What are the alternative Abx courses for Chlamydia Tx when Doxycycline / Azithromycin are CI? (2 things)

A
  1. Erythromycin 500mg BD for 10-14 days2. Ofloxacin 200mg BD / 400mg OD for 7 days
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13
Q

What are pts advised while on Chlamydia Tx?

A

Avoid intercourse + oral sex until completed tx (or 7 days after azithromycin single dose)

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14
Q

Are Chlamydia pt tested to see if they’ve been cured?

A

No, not unless der pregnant / poor compliance / symptoms persist

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15
Q

What are the Complications of Chlamydia? (7 things)

A
  1. PID2. Chronic pelvic pain3. Infertility4. Ectopic preg5. Conjunctivitis6. Reactive arthritis7. Lymphagranuloma venereum (esp in laway6a)
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16
Q

What are some pregnancy related complications of Chlamydia? (5 things)

A
  1. Preterm delivery2. Premature rupture of membranes3. Low birth weight4. Postpartum endometritis5. Neonatal infection (conjunctivitis / pneumonia)
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17
Q

What is the bacteria responsible for Gonorrhoea?

A

Neisseria gonorrhoeae

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18
Q

What type of bacteria is Neisseria gonorrhoea?

A

Gram negative

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19
Q

How does Gonorrhoea spread?

A

Unprotected vaginal / oral / anal intercourse

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20
Q

Who does Gonorrhoea most commonly affect?

A

MSM under 25

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21
Q

What are the RF for Gonorrhoea? (5 things)

A
  1. Age under 252. MSM3. Urban areas4. Hx of STIs5. Multiple partners
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22
Q

What are the CF of Gonorrhoea? (5 things)

A
  1. Asymptomatic (90% men / 50% women)2. Lower abd / pelvic pain + tenderness3. Dyspareunia4. Discharge (purulent: green / yellow) (odourless)5. Dysuria
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23
Q

What are some Differential Dx that present similarly to Gonorrhoea?

A

Chlamydia

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24
Q

What is important to do when investigating someone w sus Gonorrhoea?

A

Full STI screen (bc STIs can co-exist)

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25
Q

What investigations should you do for sus Gonorrhoea? (2 things)

A
  1. Endocervical / vaginal swab –> NAAT2. Endocervical / urethral swab –> Microscopy + culture
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26
Q

What is NAAT? (3 points)

A
  1. Nucleic Acid Amplification Testing2. Gold standard investigation for Chlamydia3. Often has dual testing for both chlamydia + gonorrhoea
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27
Q

While waiting for lab results of gonorrhoea investigations to come back, what should you do for the pt?

A

Treat w empirical abx(if signs + symptoms are very sus)

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28
Q

What is the Tx for Gonorrhoea?

A

Single dose Ceftriaxone 1g

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29
Q

What advice should you give a pt receiving Tx for Gonorrhoea? (2 things)

A
  1. Abstain from sex for 7 days2. Use protection
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30
Q

What are the complications of Gonorrhoea? (6 things)

A
  1. PID2. Chronic pain3. Infertility4. Conjunctivitis5. Disseminated Gonococcal inf6. Septic arthritis
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31
Q

What is Disseminated Gonococcal Inf?

A

Gonorrhoea complication

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32
Q

Where does the bacteria spread in Disseminated Gonococcal infection? (2 things)

A
  1. Skin2. Joints
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33
Q

What does Disseminated Gonococcal Infection cause? (4 things)

A
  1. Skin lesions2. Polyarthralgia (joint pain)3. Migratory polyarthritis (arthritis dat moves between joints)4. Systemic symptoms (fever / fatigue)
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34
Q

How many people in the world have HIV?

A

37 million ppl

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35
Q

How does HIV replicate in the human immune system?

A

Using host CD4 T helper cells

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36
Q

What are the stages of HIV infection? (3 steps)

A
  1. Seroconversion: Flu-like illness (within 2-6 weeks of inf)2. Latent phase (Asymptomatic)3. Immunodeficiency –> AIDS (after 10 years)
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37
Q

How is HIV spread? (3 things)

A
  1. Unprotected anal / vaginal / oral intercourse2. Vertical transmission: Mother to child @ pregnancy / birth / breastfeeding3. Sharing needles / blood splashed in eye
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38
Q

What are the RF groups for HIV? (4 things)

A
  1. MSM2. IV drug users3. Being in high prevalence area4. Africa :(
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39
Q

What groups can the CF of HIV be divided into? (2 things)

A
  1. Seroconversion stage CF2. Symptomatic stage CF (after latent phase)
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40
Q

What are the Seroconversion stage CF of HIV? (6 things)

A
  1. Fever2. Malaise3. Pharyngitis4. Lymphadenopathy5. Muscle aches6. Maculopapular rash
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41
Q

What are the CF of the Symptomatic stage (after latent stage) of HIV? (4 things)

A
  1. Fever2. Weight loss3. Diarrhoea4. Frequent minor infections (e.g herpes zoster / candidiasis)
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42
Q

What the FIRST line investigation for HIV?

A

Fourth generation tests

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43
Q

What are the Fourth generation tests that are done for HIV?

A

ELISAs testing for serum / salivary HIV antibodies + p24 antigen

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44
Q

How long after exposure do Fourth generation tests give reliable results?

A

4-6 weeks after exposure

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45
Q

What is the Mx option for HIV?

A

Highly Active Antiretroviral Therapy (HAART)

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46
Q

What is important to note about HAART for HIV? (2 things)

A
  1. It doesn’t cure it2. It reduces viral load to UNDETECTABLE LEVELS in serum
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47
Q

What is good about having Undetectable levels of HIV in serum? (2 things)

A
  1. Excellent prognosis2. Reduced risk of transmission
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48
Q

What tests are included in the monitoring of HIV? (6 things)

A
  1. CD4 count2. HIV viral load3. FBC4. UnE5. Urinalysis6. LFTs
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49
Q

What precautions can be taken to reduce risk of Vertical transmission during / after pregnancy? (3 things)

A
  1. Antenatal antiretroviral therapy @ pregnancy + delivery2. X Breastfeeding3. Neonatal post-exposure prophylaxis
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50
Q

What is Urinary Incontinence?

A

Involuntary leakage of urine

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51
Q

What are the 2 types of Urinary Incontinence?

A
  1. Urge2. Stress
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52
Q

What is Mixed Incontinence?

A

Pt with features of both types of incontinence (most common)

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53
Q

What is the definition of Stress Incontinence?

A

Involuntary urine leakage @ increased intra-abd pressure

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54
Q

When is Stress Incontinence typically seen?

A

After childbirth (aka most common causative factor)

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55
Q

What is Stress Incontinence due to?

A

Weakness of pelvic floor + sphincter muscles

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56
Q

What occasions does urine leak out with Stress Incontinence? (4 things)

A
  1. Laughing2. Coughing3. Sneezing4. Surprised
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57
Q

What is Urge incontinence caused by?

A

Overactivity of detrusor muscle

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58
Q

What is another name for Urge incontinence?

A

Overactive bladder

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59
Q

What are the RF for Urinary Incontinence? (8 things)

A
  1. Age2. BMI3. Postmenopausal4. Vaginal delivery5. Pelvic organ prolapse6. Pelvic floor surgery7. Neurological conditions (e.g MS)8. Cogn impairment / Dementia
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60
Q

What are the CF of Stress Incontinence? (3 things)

A
  1. Leakage @ exertion (ask pt to cough)2. SMALL volume leakage3. Prolapse of urethra + ant vaginal wall (@ exam)
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61
Q

What are the CF of Urge Incontinence? (4 things)

A
  1. Urgency2. Frequency3. Nocturia4. LARGE volume leakage
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62
Q

What are some triggers for urgency in Urge Incontinence? (2 things)

A
  1. Hearing running water2. Cold weather
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63
Q

What is the aim of the primary investigation for sus Incontinence?

A

Excluding UTI

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64
Q

What are the 2 main investigations for Incontinence?

A
  1. Frequency / volume charts2. Urodynamic studies
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65
Q

How do you distinguish between Stress vs Urge with Frequency / volume charts?

A
  • Stress = Normal frequency* Urge = Increased frequency
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66
Q

What is the point of doing Urodynamic Studies? (2 points)

A
  1. Done for Stress incontinence when considering surgery2. Used to confirm Dx + rule out detrusor over-activity
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67
Q

What is important a pt does before Urodynamic Studies are done?

A

Stop taking anticholinergic meds 5 days before

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68
Q

What are some important Modifiable lifestyle factors you should ask about in the Hx of sus Incontinence? (3 things)

A
  1. Caffeine / Alcohol consumption2. Meds3. BMI
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69
Q

What are you checking for @ examination of sus Incontinence? (5 things)

A
  1. Pelvic tone2. Pelvic organ prolapse3. Atrophic vaginitis4. Urethral diverticulum5. Pelvic mass
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70
Q

What are the CONSERVATIVE Mx options for Stress Incontinence? (4 things)

A
  1. X caffeine / alcohol / overfilling bladder2. Weight Loss3. TUC (e.g chronic cough)4. Pelvic floor exercises (supervised)
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71
Q

How long should Pelvic floor exercises be done for before considering Surgery?

A

3 months

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72
Q

What are the SURGICAL Mx options for Stress Incontinence? (2 things)

A
  1. Tension Free Vaginal Tape (TVT) (most common)2. Laparoscopic colposuspension
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73
Q

What does Tension Free Vaginal Tape (TVT) involve?

A

Tape placed under mid-urethra via small vaginal incision

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74
Q

When should someone have MEDICAL Mx for Stress Incontinence?

A

Woman doesn’t want / not suitable for surgery

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75
Q

What is the Medical Mx of Stress Incontinence?

A

Duloxetine (SNRI antidepressant)

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76
Q

What are the CONSERVATIVE Mx options for Urge Incontinence? (2 things)

A
  1. X caffeine / alcohol / overfilling bladder2. Bladder retraining
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77
Q

What are the MEDICAL Mx options for Urge Incontinence? (2 things)

A
  1. Anticholinergics (e.g oxybutynin)2. Mirabegron (alternative to anticholinergics)
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78
Q

What are the Side fx of using Anticholinergics for Urge Incontinence? (5 things)

A
  1. Confusion2. Dry eyes / mouth3. Blurred vision4. Arrhythmias5. Constipation
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79
Q

What are the CI for taking Anticholinergics for Urge Incontinence? (3 things)

A
  1. Acute angle glaucoma2. Myasthenia gravis3. GI obst
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80
Q

What are the CI for taking Mirabegron for Urge Incontinence?

A

Uncontrolled HTN

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81
Q

Who is SURGICAL Mx of Urge Incontinence reserved for?

A

Only those with debilitating symptoms

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82
Q

What is the SURGICAL Mx option for Urge Incontinence?

A

Detrusor myomectomy + Augmentation Cystoplasty(using bowel tissue to enlarge bladder)

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83
Q

Which Incontinence type is SURGICAL BEFORE MEDICAL Mx?

A

Stress Incontinence(doc gets STRESSED n instantly does da Surgery)

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84
Q

What does Gravida refer to?

A

Total number of pregnancies a woman has had

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85
Q

What does Para refer to?

A

Total number of times a woman has given birth (after 24 wks gestation)(Regardless of fetus was alive / stillborn)

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86
Q

When does the timeline of a pregnancy start from?

A

Last Menstrual Period (LMP)

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87
Q

What is the timeline of a pregnancy measured in?

A

Gestational Age (GA)

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88
Q

What is the Gravida / Para of a woman who is currently Pregnant and had 3 previous deliveries?

A

G4 P3

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89
Q

What is the Gravida / Para of a woman who is currently NOT Pregnant and had a previous birth of twins?

A

G1 P1

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90
Q

What is the Gravida / Para of a woman who is currently NOT Pregnant and had a previous miscarriage?

A

G1 P0 + 1

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91
Q

What is the Gravida / Para of a woman who is currently NOT Pregnant and had a previous stillbirth (after 24 wks gestation)?

A

G1 P1

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92
Q

What is the timeframe for the FIRST trimester?

A

0-12 weeks gestation

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93
Q

What is the timeframe for the SECOND trimester?

A

13-26 weeks gestation

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94
Q

What is the timeframe for the THIRD trimester?

A

27 weeks gestation -> birth

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95
Q

What week are fetal movements meant to start from?

A

20 weeks gestation

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96
Q

What is a key milestone in pregnancy that should happen before 10 weeks?

A

Booking clinic

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97
Q

What is the point of a Booking Clinic in pregnancy?

A

Baseline assessment + Plan the pregnancy

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98
Q

What is a key milestone in pregnancy that should happen between 10 – 13+6 weeks?

A

Dating scan

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99
Q

What is the point of a Dating scan? (2 things)

A
  1. Calculate accurate Gestational Age (GA)2. Identify multiple pregnancies
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100
Q

How is the Gestational Age (GA) accurately measured in the Dating Scan?

A

From Crown Rump Length (CRL)

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101
Q

What is a key milestone in pregnancy that should happen at 16 weeks?

A

Antenatal appointment

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102
Q

What is the point of the Antenatal appointment? (2 things)

A
  1. Discuss results2. Plan future appointments
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103
Q

What is a key milestone in pregnancy that should happen between 18 – 20+6 weeks?

A

Anomaly scan

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104
Q

What is the point of the Anomaly scan?

A

US to identify any anomalies (e.g heart conditions)

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105
Q

What weeks should the Antenatal appointments that happen late in pregnancy occur at? (9 things)

A

25, 28, 31, 34, 36, 38, 40, 41, 42

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106
Q

What is the point of the Antenatal appointments starting from 25 weeks? (2 things)

A
  1. Monitor pregnancy2. Discuss future plans
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107
Q

What are some Additional appointments that some women may need? (4 things)

A
  1. Oral glucose tolerance test2. Anti-D injections3. US @ 32 weeks4. Serial growth scans
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108
Q

Which women require Oral glucose tolerance tests during pregnancy?

A

Women @ risk of gestational diabetes

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109
Q

When do Oral glucose tolerance tests occur during pregnancy?

A

Between 24-28 weeks

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110
Q

Which women require Anti-D injections during pregnancy?

A

Women who are Rhesus negative

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111
Q

When are Anti-D injections given during pregnancy? (2 times)

A
  1. 28 weeks2. 34 weeks
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112
Q

Which women require US scan @ 32 weeks during pregnancy?

A

Women w Placenta Praevia on anomaly scan

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113
Q

Which women require Serial growth scans during pregnancy?

A

Women @ risk of fetal growth restriction

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114
Q

What things are discussed at the Antenatal Appointments? (2 things)

A
  1. Plans for rest of pregnancy2. Delivery plans
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115
Q

What investigations are done at the Antenatal Appointments? (5 things)

A
  1. Symphysis-fundal height measurement2. Fetal presentation assessment3. Urine dipstick4. Blood pressure5. Urine
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116
Q

When is the Symphysis-fundal height measured?

A

24 weeks onwards

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117
Q

When is the Fetal presentation assessed?

A

36 weeks onwards

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118
Q

What are you checking for in the Urine dipstick @ Antenatal appointment, and what does it mean?

A

Protein = Pre-eclampsia

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119
Q

Why do you check Blood Pressure @ Antenatal appointment?

A

Check for Pre-eclampsia

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120
Q

Why do you take a urine sample @ Antenatal appointment? (2 points)

A
  1. For microscopy + culture2. To check for Asymptomatic Bacteriuria
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121
Q

What Vaccines are offered to all pregnant women? (2 things)

A
  1. Whooping cough (pertussis)2. Influenza (flu vax)
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122
Q

When is the Whooping cough vaccine given to pregnant ladies?

A

16 weeks gestation

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123
Q

When is the Influenza (flu vax) given to pregnant ladies?

A

Whenever it’s available in Autumn / Winter

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124
Q

What vaccines are avoided in during pregnancy?

A

Lives vaccines (e.g MMR)

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125
Q

What classes a Foetus as Small for Gestational Age?

A

Foetus below 10th centile for their gestational age

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126
Q

What measurements on the US are used to assess foetal size? (2 things)

A
  1. Estimated foetal weight (EFW)2. Abdominal circumference (AC)
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127
Q

What measurements are used to see if a foetus is Symmetrically / Assymetrically small? (2 things)

A
  1. Head circumference2. Abdominal circumference (AC)
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128
Q

What cause of SGA is Symmetrically small foetus likely to be?

A

Constitutionally small

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129
Q

What cause of SGA is Asymmetrically small foetus likely to be?

A

Placental insuffiency

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130
Q

What features of the mother are used to make Customised Growth Charts for the foetus? (4 things)

A
  1. Ethnic group2. Weight3. Height4. Parity
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131
Q

What is SEVERE SGA?

A

Foetus below 3rd centile for their gestational age

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132
Q

What is Low Birth Weight?

A

Birth weight less than 2500g

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133
Q

What are the causes of SGA? (3 things)

A
  1. Constitutionally Small2. Placenta mediated Growth Restriction3. Non-placenta mediated Growth Restriction
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134
Q

What does Constitutionally small mean? (2 points)

A
  1. Foetus matches mother + others in family2. Growing appropriately on growth chart
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135
Q

What does Placenta mediated Growth restriction refer to?

A

Conditions affecting transfer of nutrients across placenta

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136
Q

What are the causes of Placenta Mediated Growth restriction? (7 things)

A
  1. Idiopathic2. Pre-eclampsia3. Maternal smoking / alcohol4. Anaemia5. Malnutrition6. Inf7. Maternal health conditions
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137
Q

What does Non-Placenta Mediated Growth restriction refer to?

A

Pathology of foetus itself

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138
Q

What are the causes of Non-Placenta Mediated Growth restriction? (4 things)

A
  1. Genetic abn2. Structural abn3. Foetal inf4. Metabolism errors
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139
Q

Other than being SGA, what other signs could indicate Foetal Growth Restriction? (4 things)

A
  1. Reduced amniotic fluid volume2. Abn Doppler studies3. Reduced foetal movements4. Abnormal CTGs
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140
Q

How is Reduced Amniotic fluid volume caused? (3 things)

A
  1. Placental insufficiency2. Impaired foetal kidney function3. Reduced amniotic fluid volume
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141
Q

When should pregnant women be assessed for RF of SGA? (2 times)

A
  1. At booking2. At 20 wks
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142
Q

What are the RF for SGA? (10 things)

A
  1. Previous SGA baby2. Obesity3. Smoking4. DM5. HTN6. Pre-eclampsia7. Age 35+8. Multiple pregnancy9. Antepartum haemorrhage10. Antiphospholipid syndrome
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143
Q

What is the main obv investigation done for SGA?

A

US

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144
Q

What other investigations can be done for SGA? (4 things)

A
  1. Detailed foetal anatomical survey2. Uterine Artery Doppler (UAD)3. Karyotyping4. Inf screening
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145
Q

What are some Modifiable RF that should be advised about for SGA? (2 things)

A
  1. Smoking cessation2. Managing maternal conditions well (e.g DM / HTN)
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146
Q

What are women who are at high risk of Pre-eclampsia started on? What’s the time frame?

A
  • 75mg aspirin* From 16 weeks till delivery
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147
Q

What is the primary surveillance tool for SGA?

A

Uterine Artery Doppler (UAD)

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148
Q

How long should you repeat Uterine Artery Doppler (UAD) for SGA? (2 points)

A
  1. Every 14 days if normal2. More often if abn
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149
Q

When should early delivery of a SGA foetus be considered? (2 things)

A
  1. Growth is static2. Other problems (e.g abn Doppler)
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150
Q

What is the point of an early delivery of a SGA foetus?

A

Reduces risk of stillbirth

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151
Q

What should be given if delivery of a SGA foetus between 24-35+6 weeks is being considered?

A

Single course of antenatal steroids

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152
Q

What are the SHORT term complications of SGA? (5 things)

A
  1. Death / stillbirth2. Birth asphyxia (brain doesn’t get enough oxygen at birth)3. Neonatal hypothermia4. Neonatal hypoglycaemia5. Polycythaemia
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153
Q

What are the LONG term complications of SGA? (4 things)

A
  1. CVS disease (esp HTN)2. T2DM3. Obesity4. Mood / behavioural problems
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154
Q

What is Large for Gestational Age aka?

A

Macrosomia

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155
Q

What weight of a baby is considered Large for GA?

A

4.5+ kg @ birth

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156
Q

What is considered Large for GA during pregnancy?

A

Above 90th percentile for GA

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157
Q

What are the causes of Large for GA? (6 things)

A
  1. Constitutional (aka normal jus big like der fam)2. Maternal DM3. Previous Large for GA4. Maternal obesity5. Overdue (obv)6. Male baby (obv lol)
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158
Q

What are the Risks to MOTHER from Large for GA? (6 things)

A
  1. Shoulder dystocia (main one)2. Failure to progress3. Perineal tears4. Instrumental delivery / C section5. PPH6. Uterine rupture (rare)
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159
Q

What are the Risks to BABY from Large for GA? (4 things)

A
  1. Birth injury (e.g Erbs palsy / Clavic # / Foetal distress / Hypoxia)2. Neonatal hypoglycaemia3. Obesity @ childhood / later life4. T2DM @ adulthood
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160
Q

What investigations should you for a Large for GA baby? (2 things)

A
  1. US2. Oral glucose tolerance test (for Gestational Diabetes)
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161
Q

What is the point of US in Large for GA investigation? (2 things)

A
  1. Exclude Polyhydramnios2. Estimate Foetal weight
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162
Q

Will most women with Large for GA have a normal vaginal delivery?

A

Yes

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163
Q

How can the risks of Large for GA be reduced? (4 things)

A
  1. Deliver on a Consultant Lead Unit2. Delivery by XP midwife / obstetrician3. Early decision for C section if req4. Paediatrician attending birth
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164
Q

What are the 2 classifications of C sections?

A
  1. Elective2. Emergency
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165
Q

What is Emergency C sections further classified into?

A

Categories 1-3

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166
Q

What does RCOG recommend when C Section Emergency Category 1 is called?

A

Baby should be born within 30 mins(Bc immediate threat to life of mum / foetus)

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167
Q

What is usually recommended when C Section Emergency Category 2 is called?

A

Baby should be born within 60-75 mins(Mum / foetus but not immediately life threatening)

168
Q

What is usually recommended when C Section Emergency Category 3 is called?

A

Early delivery(But no maternal / foetal compromise)

169
Q

What are the indications for Elective C Sections? (11 things)

A
  1. Breech presentation2. Other malpresentation (e.g unstable / transverse / oblique lie)3. Twins (when Twin 1 not cephalic pres)4. Maternal conditions –> labour dangerous for mother5. Foetal compromise (e.g IUGR) –> labour dangerous for baby6. Transmissible disease (e.g HIV / herpes)7. Placenta praevia8. Maternal DM (w macrosomia)9. Previous Shoulder dystocia10. Previous Perineal tear11. Maternal request
170
Q

When should Twins be considered to be delivered as a C section?

A

When Twin 1 not cephalic presentation

171
Q

What is Placenta Praevia?

A

Low lying placenta

172
Q

When should Placenta Praevia be considered to be delivered as a C section?

A

When placenta covers / reaches internal os of Cervix

173
Q

When are C sections usually planned for?

A

After 39 weeks

174
Q

Why are C sections usually planned for after 39 weeks?

A

To reduce Neonatal resp distress

175
Q

What is Neonatal resp distress aka?

A

Transient Tachypnoea of Newborn (TTN)

176
Q

When C sections should be planned for before 39 weeks, what should you give the mother?

A

Corticosteroids

177
Q

What is the point of giving Corticosteroids when C sections are planned for before 39 weeks?

A

Stimulates dev of surfactant in Foetal lungs

178
Q

What routine tests should be done before a C section? (3 things)

A
  1. FBC2. G&S3. VTE risk score
179
Q

Why should FBC and G&S be taken before a C section?

A

Bc avg blood loss in C section is 500ml to 1L

180
Q

What are women lying flat for C section at risk of? (2 points)

A
  1. Mendelson’s syndrome (aspiration of gastric contents)2. This leads to Chemical Pneumonitis
181
Q

What should be prescribed before C section?

A
  1. H2 receptor antagonist (e.g Ranitidine)2. +/- Metoclopramide (anti-emetic)
182
Q

What is the point of H2 receptor antagonist +/- Metoclopramide b4 C section?

A

To protect against Mendelson’s syndrome

183
Q

What should be prescribed before C section if VTE risk score is high? (2 things)

A
  1. Stockings2. LMWH
184
Q

What anaesthesia are C sections usually done under?

A

Regional anaesthetic (epidural / spinal)

185
Q

When is using General Anaesthesia indicated for C sections? (3 things)

A
  1. Category 1 Emergency C section (bc foetal wellbeing concerns)2. Maternal CI to regional3. Regional failing to achieve req block
186
Q

What position is the C section woman placed in?

A

Left Lateral tilt of 15°

187
Q

Why is the woman put into a Left Lateral tilt of 15° in C section?

A

To reduce risk of supine hypotension due to Aortocaval compression

188
Q

What catheter is inserted before C section?

A

Indwelling Foley’s catheter

189
Q

What is the point of inserting an Indwelling Foley’s catheter before C section? (2 things)

A
  1. To drain bladder2. To reduce risk of bladder injury @ procedure
190
Q

What should be administered just prior C section incision?

A

Abx

191
Q

What is the C section incision?

A

Transverse lower abd skin incision

192
Q

What layers have to be cut to get down to baby? (8 things) (IN ORDER)

A
  1. Skin2. Camper’s fascia3. Scarpa’s fascia4. Rectus sheath5. Rectus muscle6. Abd peritoneum (parietal)7. Visceral Peritoneum (covers lower uterus)8. Uterus
193
Q

What is the Camper’s fascia?

A

Superficial fatty layer of subcut tissue

194
Q

What is the Scarpa’s fascia?

A

Deep membranous layer of subcut tissue

195
Q

What does cutting the Abdominal peritoneum reveal?

A

Gravid uterus

196
Q

What do you do once you reach Visceral Peritoneum (covering lower uterus)? (2 steps)

A
  1. Cut it and push down to reflect bladder2. Bladder then retracted by Doyen retractor
197
Q

How is the placenta delivered in C section?

A

Controlled cord traction by surgeon

198
Q

What should the anaesthetist give to aid with the placenta delivery?

A

Oxytocin 5 units

199
Q

What complications of Vaginal delivery do C sections protect against? (6 things)

A
  1. Perineal trauma2. Pain3. Urinary / faecal incontinence4. Uterovaginal prolapse5. Late stillbirth6. Early neonatal infections
200
Q

What are the complications of C sections classified into? (3 things)

A
  1. Immediate2. Intermediate3. Late
201
Q

What are the Immediate complications of C sections? (6 things)

A
  1. PPH2. Wound haematoma3. Intra-abd haemorrhage4. Bladder / bowel trauma5. Transient Tachypnoea of Newborn (TTN)6. Foetal lacerations
202
Q

What are the Intermediate complications of C sections? (4 things)

A
  1. UTI2. Endometritis3. Resp infection (higher risk if GA used)4. VTE
203
Q

What are the Late complications of C sections? (6 things)

A
  1. Urinary tract trauma (fistula)2. Infertility3. Regret4. Rupture / dehiscence of scar @ next labour5. Placenta praevia6. Caesarean scar ectopic preg
204
Q

What is Gestational Diabetes?

A

Diabetes triggered by pregnancy

205
Q

What percentage of Pregnant women will have GD?

A

20%

206
Q

What is GD caused by?

A

Progressively reduced insulin sensitivity @ pregnancy

207
Q

Does GD resolve @ birth?

A

Yes

208
Q

What are the RF for GD? (6 things)

A
  1. Previous GD2. Previous Macroscomic baby (4.5kg +)3. BMI 30+4. Caribbean / Middle Eastern / South Asian5. FHx of DM6. PCOS
209
Q

If a pregnant woman has RF for GD, what should happen?

A

Oral Glucose Tolerance Test (OGTT) @ 24-28 weeks

210
Q

If a pregnant woman has previously had GD, what should happen?

A

OGTT after Booking Clinic

211
Q

What CF could suggest GD? (3 things)

A
  1. Large for GA2. Polyhydramnios3. Glucose on Urine dipstick
212
Q

What are the CF of GD? (4 things)

A
  1. Asymptomatic (most woman w pancreatic reserve)2. Polyuria3. Polydipsia4. Fatigue
213
Q

What is the NICE recommendation for a GD woman with Fasting glucose less than 7? (3 things) (IN ORDER)

A
  1. Diet + Exercise Trial for 1-2 wks2. Metformin3. Insulin
214
Q

What is the NICE recommendation for a GD woman with Fasting glucose of 7+? (2 things) (IN ORDER)

A
  1. Insulin2. Metformin
215
Q

What is the NICE recommendation for a GD woman with Fasting glucose of 6+ + Macrosomia / Other complications? (2 things) (IN ORDER)

A
  1. Insulin2. Metformin
216
Q

What can you give women who decline Insulin / Can’t tolerate Metformin?

A

Glibenclamide (a Sulfonylurea)

217
Q

What monitoring scans do GD women need during pregnancy?

A

US scans every 4 weeks (from 28-36 weeks)

218
Q

What is monitored in the US scans every 4 weeks for a GD woman? (2 things)

A
  1. Foetal growth2. Amniotic fluid volume
219
Q

When should a woman aim to deliver if her GD is managed by Treatment?

A

37-38 weeks

220
Q

When should a woman aim to deliver if her GD is managed by Diet?

A

B4 40+6 weeks

221
Q

What type of delivery should a woman w GD managed by Diet be advised to have? (2 things)

A
  1. Induction of labour2. C section
222
Q

When can a GD woman stop her GD medication?

A

Immediately after birth

223
Q

What should be checked before a GD woman is discharged?

A

Blood glucose(to check it has returned to normal levels)

224
Q

What are GD women at risk of developing in future?

A

DM

225
Q

What percentage of GD women will develop T2DM in future?

A

50%

226
Q

What should you do to monitor risk of developing DM in GD women?

A

Fasting glucose test 6-13 weeks after giving birth

227
Q

If the Fasting glucose test 6-13 weeks after giving birth is normal, what should you do?

A

Offer yearly tests(bc still risk of developing DM in future)

228
Q

What are babies of GD woman at risk of? (6 things)

A
  1. Macrosomia2. Neonatal hypoglycaemia3. Polycythaemia4. Jaundice5. Congenital HD6. Cardiomyopathy
229
Q

How do you manage the risk of a baby of a GD woman developing Neonatal hypoglycaemia? (2 things)

A
  1. Regular blood glucose checks2. Frequent feeds
230
Q

What should you give if the baby’s Blood Glucose drops below 2?

A

IV dextrose (via NG tube)

231
Q

What is Polyhydramnios?

A

Too much amniotic fluid @ pregnancy

232
Q

What is the numerical definition of Polyhydramnios?

A

Amniotic fluid index above 95% centile for GA

233
Q

How does the volume of Amniotic fluid change throughout pregnancy? (3 points)

A
  • 0-33 weeks: Increases steadily* 33-38 weeks: Plateaus* 38+ weeks: Declines
234
Q

What is the volume of Amniotic fluid at term?

A

500ml

235
Q

What is Amniotic fluid made up of? (3 things)

A
  1. Foetal urine output (mostly)2. Placenta contributions3. Foetal secretions
236
Q

What is the pathophysiology of Polyhydramnios?

A

Problems w any of structures in Amniotic fluid pathway

237
Q

What is the Amniotic fluid pathway? (5 steps)

A
  1. Foetus breathes + Swallows Amniotic fluid2. AF processed3. AF fills blader4. AF voided5. Cycle repeats
238
Q

What are the causes of Polyhydramnios? (11 things)

A
  1. Idiopathic (60%)2. Swallowing abn (oesophageal atresia / CNS abn / muscular dystrophies)3. Duodenal atresia4. Anaemia5. Foetal hydrops6. Twin-to-Twin transfusion syndrome7. Increased lung secretions8. Chromosomal abn9. Maternal DM10. Maternal ingestion of lithium11. Macrosomia (bc big babies make more urine)
239
Q

What investigation is Polyhydramnios diagnosed with?

A

US

240
Q

What are the ways to measure AF using US to diagnose Polyhydramnios? (2 things)

A
  1. Amniotic Fluid Index (AFI) (more common)2. Maximum Pool Depth (MPD)
241
Q

Apart from the Dx, why are examinations / investigations done for Polyhydramnios?

A

To find out the cause

242
Q

What examination can you do for Polyhydramnios?

A

Palpate uterus to see if it feels tense

243
Q

What can you check for in the US for Polyhydramnios? (3 things)

A
  1. Assess foetal size2. Assess foetal anatomy (to check for structural causes)3. Doppler (to detect foetal anaemia)
244
Q

What other investigations can you do for Polyhydramnios?

A
  1. Maternal Glucose Tolerance Test (for maternal DM)2. Karyotyping (for chromosomal abn)
245
Q

Is any Medical intervention routinely required for women with Polyhydramnios?

A

No

246
Q

If Maternal symptoms of Polyhydramnios are severe (aka SOB), what can be considered?

A

Amnioreduction

247
Q

What are the complications of Amnioreduction? (2 things)

A
  1. Infection2. Placental abruption (bc sudden decrease in intrauterine pressure)
248
Q

What medication can be used enhance water retention in foetus in Polyhydramnios?

A

Indomethacin

249
Q

What is a con of Indomethacin?

A

Premature closure of Ductus Arteriosus

250
Q

How do you get around the con of Indomethacin?

A

Don’t use it beyond 32 weeks

251
Q

What is special about Idiopathic Polyhydramnios?

A

Baby has to be examined by Paediatrician before first feed

252
Q

How does the Paediatrician examine a baby with idiopathic polyhydramnios before their first feed?

A

Pass NG tube to ensure no Tracheoesophageal fistula / oesophageal atresia

253
Q

What is Severe + Persistent + Unexplained Polyhydramnios associated with?

A

Perinatal mortality

254
Q

Why does Severe + Persistent + Unexplained Polyhydramnios have a bad prognosis? (2 things)

A
  1. Likely presence of underlying abn / congenital malformation2. Increased incidence of preterm labour (bc of uterus over-distension)
255
Q

What needs to be looked out for with Polyhydramnios DURING pregnancy?

A
  1. Malpresentation (transverse lie / breech)2. Membrane rupture3. Cord prolapse
256
Q

Why are Malpresentations possible with Polyhydramnios?

A

Foetus has more room to move within cavity

257
Q

What needs to be looked out for with Polyhydramnios AFTER pregnancy? Why?

A
  • PPH* Bc uterus has to contract further to achieve haemostatis
258
Q

What is Oligohydramnios?

A

Low level of amniotic fluid in pregnancy

259
Q

What is the numerical definition of Oligohydramnios?

A

Amniotic fluid index below 5th centile for GA

260
Q

What percentage of pregnancies does Oligohydramnios affect?

A

4.50%

261
Q

What can cause Oligohydramnios pathophysiologically speaking? (3 things)

A
  1. Reduced production of urine2. Blocked output from foetus3. Membrane rupture (fluid leaks)
262
Q

What are the causes of Oligohydramnios? (7 things)

A
  1. Preterm prelabour membrane rupture2. Placental insufficiency3. Renal agenesis (aka Potters syndrome)4. Non-functioning foetal kidneys5. Obstructive uropathy6. Chromosomal abn7. Viral infections (can also cause Polyhydramnios)
263
Q

How does Placental insufficiency cause Oligohydramnios? (2 steps)

A
  1. Blood flow redistributed to foetal brain (instead of abdomen + kidneys)2. Poor urine output
264
Q

What investigation is Oligohydramnios diagnosed with?

A

US

265
Q

What are the ways to measure AF using US to diagnose Polyhydramnios? (2 things)

A
  1. Amniotic Fluid Index (AFI) (more common)2. Maximum Pool Depth (MPD)
266
Q

What might you also see in the US that might suggest Oligohydramnios?

A

Small foetus (bc placental insufficiency, which is a cause of Oligo)

267
Q

What CF in the Hx might suggest Oligohydramnios?

A

Leaking fluid + feeling damp all the time (described as new urinary incontinence)

268
Q

What CF @ examination might suggest Oligohydramnios?

A

Palpable foetal parts

269
Q

If Oligohydramnios is caused by Ruptured Membrane, what is gonna happen next?

A

Labour within 24-48 hours

270
Q

If Oligohydramnios is caused by PRETERM Ruptured Membrane (b4 37 wks), and labour doesn’t start automatically, what should you do?

A

Consider labour induction @ 34-36 weeks

271
Q

What should you also give in the case of Oligohydramnios caused by PRETERM Ruptured Membrane? (2 things)

A
  1. Steroids course (to aid foetal lung dev)2. Abx (reduce inf risk)
272
Q

If Oligohydramnios is caused by Placental Insuff, what does the delivery timing depend on? (3 things)

A
  1. Foetal growth rate2. Umbilical artery + Middle cerebral artery Doppler scans3. Cardiotocography
273
Q

When should babies with Placental insuff be delivered by?

A

Before 36/37 wks

274
Q

Which trimester does Oligohydramnios have a poor prognosis?

A

In 2nd trimester(bc usually due to premature ruptured membrane)

275
Q

What are the complications of Oligohydramnios? (2 things)

A
  1. Muscle contractures –> disability after birth2. Pulmonary hypoplasia (fatal)
276
Q

Why can foetus develop Muscle contractures bc Oligohydramnios? (2 points)

A
  1. Amniotic Fluid usually allows foetus to move limbs in utero (basically exercises)2. Without this –> muscle contractures
277
Q

Can muscle contractures bc Oligohydramnios be resolved with Physio?

A

Maybe

278
Q

What is a breech presentation?

A

Foetus presenting feet / bum first (instead of head first aka cephalic)

279
Q

What percentage of pregnancies present as breech by 28 weeks?

A

20%

280
Q

What percentage of pregnancies present as breech by 37 weeks?

A

3%

281
Q

What are the types of breech? (4 things)

A
  1. Complete breech2. Incomplete breech3. Extended breech (aka Frank breech)4. Footling breech
282
Q

What is Complete breech?

A

Legs fully flexed @ hips + knees

283
Q

What is Incomplete breech?

A

One leg flexed @ hip + Extended @ knee

284
Q

What is Extended breech (aka Frank breech)?

A

Both legs flexed @ hip + Extended @ knee

285
Q

What is Footling breech?

A

Foot presenting through cervix w leg extended

286
Q

What can the RF of Breech be divided into? (2 things)

A
  1. Uterine2. Foetal
287
Q

What are the Uterine RF for Breech? (4 things)

A
  1. Multiparity2. Uterine malformations (e.g septate uterus)3. Fibroids4. Placenta praevia
288
Q

What are the Foetal RF for Breech? (5 things)

A
  1. Prematurity2. Macrosomia3. Polyhydramnios4. Twins5. Abnormality (e.g anencephaly)
289
Q

What could suggest Breech even before you see on scan? (2 things)

A
  1. Palpating abdomen: foetal head felt in upper uterus2. Auscultating heart: Heart heard higher up maternal abd
290
Q

What are some differential Dx that are similar to breech? (3 things)

A
  1. Oblique lie (diagonal)2. Transverse lie (sideways)3. Unstable lie (presentation changes everyday)
291
Q

When is unstable lie common?

A

Polyhydramnios

292
Q

How do you confirm Breech Dx?

A

US

293
Q

What are the Mx options for Breech? (3 things)

A
  1. External cephalic version (ECV)2. C section3. Vaginal breech birth
294
Q

What is External cephalic version (ECV)?

A

Manipulating foetus to cephalic presentation thru mums abd

295
Q

What is the success rate of External cephalic version (ECV)?

A

50%

296
Q

What increases the success rate of External cephalic version (ECV)?

A

Multiparity

297
Q

What is a complication of External cephalic version (ECV)?

A

Transient foetal heart abn(transient, so they revert to normal)

298
Q

What is a CI for Vaginal breech birth?

A

Footling breech

299
Q

Why is Footling breech a CI for Vaginal breech birth?

A

Feet + legs can slip thru non-fully dilated cervix –> shoulders + head get trapped

300
Q

What are the complications of Breech? (4 things)

A
  1. Cord prolapse2. Premature rupture of membranes3. Birth asphyxia (no blood flow to brain)4. Intracranial haemorrhage
301
Q

Why do you get Intracranial haemorrhage with Breech?

A

Bc rapid compression of head @ delivery

302
Q

What is cord prolapse?

A

Umbilical cord drops below presenting part of baby n gets compressed

303
Q

What percentage of Breech get cord prolapse?

A

1%

304
Q

What is the classification of PPH in NORMAL delivery?

A

500ml +

305
Q

What is the classification of PPH in C Section?

A

1000ml +

306
Q

What are the different severity classifications of PPH? (3 things)

A
  1. Minor PPH: Under 1000ml1. Major PPH: 1000-2000ml1. Severe PPH: 2000ml +
307
Q

What is the different TIMING classifications of PPH? (2 things)

A
  1. Primary PPH: Within 24 hours of birth1. Secondary PPH: from 24 hours – 12 wks after birth
308
Q

What are the causes of PPH? (4 things)

A
  1. Tone (uterine atony aka no tone) (most common cause)1. Trauma1. Tissue (retained placenta)1. Thrombin(4 T’s)
309
Q

How does Uterine atony cause PPH?

A

Lack of tone in uterine muscle –> uterus can’t contract properly

310
Q

What are the types of Trauma that cause PPH?

A

Vaginal / Cervical / Perineal tears

311
Q

What are the RF for Trauma causing PPH? (3 things)

A
  1. Instrumental delivery1. Episiotomy1. C section
312
Q

How does a retained placenta cause PPH?

A

Stops uterus from contracting

313
Q

What does Thrombin refer to as a cause of PPH? (2 things)

A
  1. Vascular abn1. Coagulopathies
314
Q

What Vascular abn cause PPH? (3 things)

A
  1. Placental abruption1. HTN1. Pre-eclampsia
315
Q

What Coagulopathies cause PPH? (3 things)

A
  1. von Willebrand’s disease1. Haemophilia A/B1. DIC
316
Q

What are the RF for PPH? (12 things)

A
  1. PPH Hx1. GA1. Obesity1. Multiple pregnancy1. Large baby1. Failure to progress to 2nd stage of labour1. Prolonged 3rd stage1. Pre-eclampsia1. Placenta accreta (grows into uterus wall)1. Retained placenta1. Episiotomy / perineal tear1. Instrumental delivery
317
Q

Apart from the obv bleeding, what other CF can you get if substantial PPH? (4 things)

A
  1. Dizziness1. Palpitations1. SOB1. Haemodynamic instability
318
Q

What might you see @ Abd examination of PPH?

A

Signs of uterine rupture (aka fetal parts as it moves from uterus –> abd)

319
Q

What might you see @ Speculum examination of PPH?

A

Local trauma sites may be revealed

320
Q

What should you examine after PPH? Why?

A
  • Placenta* To ensure placenta is incomplete
321
Q

What causes of PPH might you see @ Placenta examination? (2 things)

A
  1. Missing cotyledon1. Ragged membranes
322
Q

What is the pneumonic for the Mx plan for PPH?

A

TRIM

323
Q

What does TRIM stand for as the Mx plan of PPH? (4 things)

A
  1. Teamwork (Immediate)1. Resus (ABCDE) (Immediate)1. Investigations + Monitoring (Immediate)1. Measures to arrest bleeding (Definitive)
324
Q

Who is involved in the Teamwork aspect of PPH Mx? (6 things)

A
  1. Obstetricians1. Anaesthetists1. Haematologist1. Midwife in charge + Midwives1. Blood bank1. Porters
325
Q

What Investigations should you for PPH? (5 things)

A
  1. FBC1. Cross match 4-6 units blood1. Coag profile1. UnEs1. LFT
326
Q

How should you Monitor a PPH? (5 things)

A
  1. RR1. O2 sats1. HR1. BP1. Temperature
327
Q

How often should you do the Monitoring things for PPH?

A

Every 15 mins

328
Q

What else should you consider for Monitoring PPH? (2 things)

A
  1. Catheterisation1. Central venous line insertion
329
Q

What are the Definitive Mx option titles for PPH? (3 things)

A
  1. Mechanical1. Medical1. Surgical
330
Q

What are the MECHANICAL Mx options for PPH?

A
  1. Rubbing uterus (thru abd)1. Catheterization
331
Q

How does Rubbing uterus work to manage PPH?

A

Stimulates uterine contraction

332
Q

How does Catheterization work to manage PPH?

A

Reduces bladder distention(which was preventing uterine contractions)

333
Q

What are the MEDICAL Mx options for PPH? (5 things)

A
  1. Oxytocin1. Ergometrine (IV / IM)1. Carboprost (IM)1. Misoprostol (subling)1. Tranexamic acid (IV)
334
Q

How should Oxytocin be administered in PPH Mx?

A

Slow injection then continuous infusion

335
Q

How does Ergometrine work in PPH Mx?

A

Stimulates SMC contractions

336
Q

When is Ergometrine CI for PPH Hx?

A

HTN

337
Q

What class of meds are Carboprost + Misoprostol?

A

Prostaglandin analogue

338
Q

How do Carboprost + Misoprostol work in PPH Mx?

A

Stimulate uterine contraction

339
Q

What class of meds is Tranexamic acid?

A

Antifibrinolytic

340
Q

How does Tranexamic acid work in PPH Mx?

A

Reduces bleeding

341
Q

What are the SURGICAL Mx options for PPH? (4 things)

A
  1. IU balloon tamponade1. B-Lynch suture1. Uterine artery ligation1. Hysterectomy (last resort)
342
Q

How does IU balloon tamponade work in PPH Mx?

A

Insert inflatable balloon into uterus to press against bleeding

343
Q

How does B-Lynch suture work in PPH Mx?

A

Putting suture around uterus to compress it

344
Q

How does Uterine artery ligation work in PPH Mx?

A

Ligate 1+ arteries supplying uterus to reduce blood flow

345
Q

How does Hysterectomy (last resort) work in PPH Mx?

A

Stops bleeding + saves woman’s life

346
Q

What are the causes of Secondary PPH (24 hrs – 12 wks)? (2 things)

A
  1. Retained products of conception (RPOC)1. Inf (e.g endometritis)
347
Q

What investigations should you do for Secondary PPH? (2 things)

A
  1. US (for RPOC)1. Endocervical + high vaginal swabs (for inf)
348
Q

What are the Mx options for Secondary PPH? (2 things)

A
  1. Surgery (for RPOC)1. Abx (for inf)
349
Q

How do you prevent PPH even happening in 1st place? (4 things)

A
  1. Treat anaemia during antenatal period1. Give birth on empty bladder1. Active Mx of 3rd stage (w IM oxytocin)1. IV Tranexamic acid in C section for high risk pt
350
Q

What is a prolonged pregnancy aka?

A

Post-term

351
Q

What is the definition of Prolonged Pregnancy?

A

Pregnancy persist up to and beyond 42 wks

352
Q

What are the RF for Prolonged Pregnancy? (4 things)

A
  1. Nulliparity1. Maternal age 40+1. Prolonged preg Hx / FHx1. Obesity
353
Q

What are the CF of Prolonged Pregnancy? (5 things)

A
  1. Static growth / Macrosomia1. Oligohydramnios1. Reduced foetal movements1. Meconium presence1. Dry / flaky skin w reduced Vernix
354
Q

What is Vernix?

A

Waxy white substance coating skin on newborn babies

355
Q

What is Vernix?

A

Waxy white substance coating skin on newborn babies

356
Q

What are the NICE / RCOG guidelines for prolonged pregnancy?

A

Deliver by 42 weeks, to reduce risk of stillbirth

357
Q

How can you achieve delivery by 42 weeks? (2 things)

A
  1. Membrane sweeps1. Induction of labour
358
Q

When can Membrane sweeps be offered from? (2 things)

A
  1. 40 weeks (if nulliparous)1. 41 weeks (if parous)
359
Q

When can Induction of labour be offered?

A

Between 41-42 weeks

360
Q

What should you do with women who decline Induction of labour? (2 things)

A
  1. Twice weekly CTG monitoring1. USS w amniotic fluid measurement(To identify foetal distress)
361
Q

What should you do @ Foetal distress / srs complication to mother / child?

A

Emergency C section

362
Q

What is Pre-eclampsia?

A

New HTN @ pregnancy w End-organ dysfunction

363
Q

What is the general Pathophysiology of Pre-eclampsia?

A

Poor placental perfusion, secondary to abn placentation

364
Q

How an you understand Pathophysiology of Pre-eclampsia?

A

Compare normal Placentation vs Pre-eclampsia placentation

365
Q

What are the steps for Normal placentation? (2 steps)

A
  1. Trophoblasts invades Endometrium + Spiral arteries –> Destroys tunica muscularis media1. Spiral arteries dilate –> High flow, low resistance circulation for pregnancy
366
Q

What are the steps for Normal placentation in Pre-eclampsia? (3 steps)

A
  1. Spiral arteries remodelling incomplete –> Low flow, High resistance circulation for pregnancy1. Increase in BP + Hypoxia + Oxidative stress (bc inadeq uteroplacental perfusion)1. Systemic inflamm response + Endothelial cell dysfunction –> leaky blood vessels
367
Q

What are the titles of RF for Pre-eclampsia? (2 things)

A
  1. High RF1. Moderate RF
368
Q

What are the HIGH RF for Pre-eclampsia? (5 things)

A
  1. HTN1. Pre-eclampsia Hx1. AI conditions (e.g SLE)1. DM1. CKD
369
Q

What are the MODERATE RF for Pre-eclampsia? (5 things)

A
  1. Age 40+1. BMI 35+1. 10+ yrs since previous preg1. 1st preg1. Pre-eclampsia FHx
370
Q

How does number of RF affect Mx of Pre-eclampsia?

A
  1. 1+ HIGH RF: Aspirin1. 2+ MODERATE RF: Asprin
371
Q

When should you offer women w RF Aspirin?

A

12 wks

372
Q

What is a simple way to remember CF of Pre-eclampsia? (3 things)

A
  1. Proteinuria1. Rise in BP1. Edema| (PRE – eclampsia)
373
Q

What are the CF Pre-eclampsia? (7 things)

A
  1. Headache1. Visual disturbance / blurriness1. N + V1. Brisk reflexes1. Upper abd / epigastric pain (bc liver swelling)1. Oedema1. Reduced urine output
374
Q

What are the NICE guidelines for Dx of Pre-eclampsia?

A

BP reading + one Extra CF

375
Q

What BP readings needed for for Dx of Pre-eclampsia? (2 things

A
  1. Systolic 140+1. Diastolic 90+
376
Q

What are the CF needed for Dx of Pre-eclampsia? (3 things)

A
  1. Proteinuria (1+ on dipstick)1. Organ dysf CF1. Placental dysf (e.g foetal growth restriction / abn Doppler)| (only need 1 for Dx)
377
Q

What CF suggest Organ dysfunction? (5 things)

A
  1. Raised creatinine 1. Raised liver enzymes1. Seizures1. Thrombocytopaenia1. Haemolytic anaemia
378
Q

What investigation does NICE recommend for women w sus Pre-eclampsia?

A

Placental Growth Factor Testing (PlGF) (low in Pre-eclampsia)

379
Q

What are the Mx options for Gestational HTN (w/o proteinuria, aka NOT Pre-eclampsia)? (5 things)

A
  1. Tx n aim for BP below 135/851. Admit if BP above 160/1101. Weekly bloods + urine dipstick1. Monitor foetal growth (serial growth scans)1. PlGF testing
380
Q

How do the Mx options change once Pre-eclampsia is Dx? (4 things)

A
  1. Same as Gestation HTN plus:1. BP monitor every 48 hrs at least1. Don’t need Dipstick anymore (bc Dx already made)1. US to monitor: Foetus / amniotic fluid / Dopplers (2 weekly)
381
Q

What are the MEDICAL Mx options for Pre-eclampsia? (6 things)

A
  1. Labetolol (anti-HTN) (FIRST LINE) 1. Nifedipine (SECOND LINE)1. Methyldopa (THIRD LINE)1. IV hydralazine (SEVERE pre-eclampsia / eclampsia)1. IV Mg sulphate (during labour + 24 hrs after –> to prevent seizures)1. Fluid restriction
382
Q

What is important to know about Methyldopa as Tx for Pre-eclampsia?

A

Need to stop it within 2 days of birth

383
Q

When should you give IV Mg Sulphate in Pre-eclampsia?

A
  1. During labour1. 24 hours afterwards
384
Q

What is the point of giving IV Mg Sulphate in Pre-eclampsia Mx?

A

Preventing seizures

385
Q

When should you do Fluid restriction in Pre-eclampsia?

A

During labour

386
Q

What is the point of doing Fluid restriction in Pre-eclampsia Mx?

A

Avoid fluid overload

387
Q

What should you do for Pre-eclampsia when BP can’t be controlled?

A

Premature birth

388
Q

What should you give Pre-eclampsia women having a Premature birth? Why?

A
  • Corticosteroids* Help mature foetal lungs
389
Q

What should you monitor after delivery?

A

BP

390
Q

When will the BP go back to normal after delivery?

A

Once placenta is removed

391
Q

What Tx does NICE recommend you switch to after delivery? (3 things)

A
  1. Enalapril (FIRST LINE)1. Nifedipine / amlodipine (SECOND LINE) (FIRST LINE IN NIGGAS)1. Labetolol / Atenolol (THIRD LINE)
392
Q

What is Eclampsia?

A

Refers to seizures assoc w Pre-eclampsia

393
Q

What are the Mx options for Seizures (aka Eclampsia) assoc w Pre-eclampsia?

A

IV Mg Sulphate

394
Q

What is a complication of Pre-eclampsia?

A

HELLP Syndrome

395
Q

What are the CF of HELLP Syndrome? (3 things)

A
  1. Haemolysis1. Elevated Liver enzymes1. Low Platelets| (stands for HELLP)
396
Q

What is the RCOG definition of a Low lying placenta?

A

Placenta within 20mm of Internal cervical os (but not covering it)

397
Q

What is the RCOG definition of Placenta Praevia?

A

Placenta covering Internal cervical os

398
Q

What is the percentage of the incidence of Placenta Praevia?

A

1% of pregnancies

399
Q

What is Placenta Praevia a notable cause of?

A

Antepartum haemorrhage

400
Q

What are the 3 main causes of Antepartum haemorrhage?

A
  1. Placenta praevia1. Placental abruption1. Vasa praevia
401
Q

What are the RF for Placenta praevia? (6 things)

A
  1. Previous C sections (main RF)1. Hx of Placenta praevia1. Age 40+1. Smoking1. Structural uterine abn (e.g fibroids)1. IVF
402
Q

What is the main CF of Placenta praevia? (2 things)

A
  1. Asymptomatic (most)1. Painless vaginal bleeding
403
Q

When does bleeding usually occur in Placenta praevia?

A

Late, aka 36+ weeks

404
Q

What are some DDx that present similarly to Placenta Praevia? (5 things)

A
  1. Placental abruption1. Vasa praevia1. Uterine rupture1. Benign / malignant lesions (e.g polyps / carcinoma)1. Infection (e.g candida / bac vaginosis / chlamydia)
405
Q

What should you do if sus MAJOR bleeding and you haven’t done any investigations?

A

Resus + do investigations at same time

406
Q

What investigations should you do for bleeding at Placenta praevia? (8 things)

A
  1. FBC (anaemia)1. UnE1. LFT1. Clotting profile1. G&S1. Crossmatch1. Kleihauer test (if woman Rh negative)1. CTG
407
Q

What do you do the Kleihauer test for? (2 steps)

A
  1. To determine amount of Feto-maternal haemorrhage1. Thus dose of Anti-D req
408
Q

What is the point of CTG in Placenta praevia investigation?

A

To assess foetal wellbeing

409
Q

What investigation gives you the definitive Dx of Placenta praevia?

A

US

410
Q

What does RCOG recommend for woman Dx w Placenta praevia at 20 wk anomaly scan? (2 things)

A

Repeat US @:1. 32 weeks1. 36 weeks (if still present @ 32 wks)

411
Q

What medication is useful to give in Placenta praevia?

A

Corticosteroids

412
Q

Why are Corticosteroids useful to give in Placenta Praevia?

A

To mature foetal lungs, given risk of preterm delivery

413
Q

When should you give Corticosteroids in Placenta praevia?

A

Between 34 – 36 weeks

414
Q

When should you plan delivery in Placenta praevia?

A

Between 36 – 37 weeks

415
Q

How should you deliver foetus w Placenta Praevia?

A

C section

416
Q

What is the main complication of Placenta Praevia?

A

Haemorrhage

417
Q

What are the Mx options for Haemorrhage in Placenta Praevia? (5 things)

A
  1. Emergency C section1. Blood transfusion1. Intrauterine balloon tamponade1. Uterine artery occlusion1. Emergency hysterectomy

MBBS Y5 (27 decks)

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