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Misc. Notes Year 3 > Obstetrics document > Flashcards

Obstetrics document Flashcards

1
Q

What day does the blastocyst form

A

Day 5

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2
Q

What is the blastocyst

A

Term used to describe when the embryo has divided into two separate cell masses

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3
Q

What are the two cell masses in a blastocyst made up of

A

Inner cell mass: develops in the embryo.
Outer cell mass: the trophoblast, which is responsible for initial production of progesterone and is involved in the process of implantation

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4
Q

What does the blastocyst go on to develop into

A

the placenta

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5
Q

When is the placenta fully developed and functional

A

By Week 5 of pregnancy

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6
Q

What are the 3 main functions of the placenta

A

Hormone secretion
Gas exchange
Nutrient and waste exchange

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7
Q

Which two hormones does the placenta secrete

A

HCG

Progesterone

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8
Q

What are the only two electrolytes that can only travel from mother to baby

A

Calcium

Iron

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9
Q

When do HCG levels peak during pregnancy

A

Week 10

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10
Q

What is the function of HCG secreted by the placenta

A

Simulation of corpus luteum to produce testosterone, which will prevent endometrial shedding

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11
Q

What is the function of progesterone during pregnancy

A

Prepare and maintain endometrium.

Decreases uterine contractions

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12
Q

Where does oestrogen come from during pregnancy

A

Placenta

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13
Q

What is the function of oestrogen during pregnancy

A

Enlargement of the uterus.
Development of the breasts.
Relaxation of the pelvic ligaments

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14
Q

What do Prolactin and Oxytocin do in terms of breast milk

A

Prolactin - stimulates production of milk

Oxytocin - stimulates contraction and thus expulsion of milk

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15
Q

What is the Ferguson reflex, with regards to pregnancy

A

Involves stretching of the cervix, which stimulates release of oxytocin, with this causing further stretch of the cervix and activation of the reflex

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16
Q

How does Progesterone act during the onset of labour

A

This keeps the uterus settled.
It prevents the formation of gap junctions
Hinders the contractibility of myocytes

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17
Q

How does Oestrogen act during the onset of labour

A

This makes the uterus contract

Promotes prostaglandin production

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18
Q

How does Oxytocin act during the onset of labour

A

Oxytocin initiates and sustains contractions

Oxytocin acts on decidual tissue to promote prostaglandin release

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19
Q

What are Braxton-Hick’s contractions

A

False contractions not associated with labour and can be experienced throughout pregnancy. Can be differentiated from true labour contractions as they are less painful, do not increase in frequency or intensity and can resolve by lying down or changing position

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20
Q

Which three parameters are used to measure contractions

A

Frequency
Duration
Intensity

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21
Q

What is the normal frequency of contractions

A

At peak, the normal number of contractions is 3 – 4 / 10 minutes

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22
Q

What is the normal duration of contractions

A

Initial length = 10 – 15 seconds.

Maximal length = 60 seconds

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23
Q

What is the main determinant of the passage of the baby

A

Shape of the maternal pelvis

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24
Q

Name 2 maternal indications for induction of labour

A 
Prolonged pregnancy (>41 weeks) 
Premature rupture of membranes
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25
Q

Name 2 fetal indications for induction of labour

A

IUGR

Macrosomia

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26
Q

Name 3 contra-indications for induction of labour

A

Placenta Praevia
Cord prolaps
Fetal Distress

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27
Q

What must have occurred before IV syntocinon can be administered

A

Membranes must have ruptured

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28
Q

What is the maximum acceptable time for stage 2 of labour for a nulliparous woman with anaesthesia

A

3 hours

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29
Q

What is the maximum acceptable time for stage 2 of labour for a nulliparous woman WITHOUT anaesthesia

A

2 hours

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30
Q

What is the maximum acceptable time for stage 2 of labour for a multiparous woman WITHOUT anaesthesia

A

1 hour

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31
Q

What is the maximum acceptable time for stage 2 of labour for a multiparous woman with anaesthesia

A

2 hours

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32
Q

Why is active management preferred for stage 3 of labour

A

Reduces risk of PPH

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33
Q

What are the Bishop score cut offs which indicate pregnancy likely to occur and pregnancy likely to require induction

A

<5 likely requires induction

>9 probably will happen spontaneously

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34
Q

What is the most effective form of analgesia in pregnancy

A

Epidural

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35
Q

What are some maternal side effects of an epidural

A

Headache
Urinary retention
Hypotension

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36
Q

Which analgesic is the main choice for C-section

A

Spinal

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37
Q

What is the difference between spinal and epidural anaesthetic

A

Spinal

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38
Q

What is the difference between spinal and epidural anaesthetic

A

Spinal is into the subarachnoid space, whereas epidural is in the epidural space

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39
Q

When is the risk of VTE highest

A

Puerperium

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40
Q

What does a category 1 C-section mean

A

Immediate threat to life of woman or baby

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41
Q

What is the normal fetal scalp pH

A

> 7.25

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42
Q

Why might the McRobert’s position be adopted

A

Managing shoulder dystocia

43
Q

Which palsies can be a complication of shoulder dystocia

A

Erb’s

Klumpke’s

44
Q

When is Uterine Rupture most commonly seen

A

Vaginal birth after a previous C-section

45
Q

What is the difference between a 2nd degree and 3rd degree tear

A

3rd Degree has involvement of anal sphincters

46
Q

What is an episiotomy

A

An episiotomy is a surgical postero-lateral incision through the skin and perineal muscles that is made from the vagina to the ischio-anal fossa

47
Q

What is the purpose of an episiotomy

A

Widen the birth canal.

Reduce the risk of 3rd and 4th degree tears by directing any further tears away from the anal sphincters

48
Q

Which antibiotic should you give for cover in the case of preterm rupture of membranes

A

Erythromycin

49
Q

Which two drugs must be given when preparing for the delivery of a premature baby

A

Dexamethasone

Magnesium Sulphate

50
Q

Define placental retention

A

Failure to completely pass the placenta within:
30 minutes of active management of 3rd stage
60 minutes of passive management of 3rd stage

51
Q

What is the Johnson manoeuvre

A

Pushing the uterus back into place after inversion

52
Q

What is the management of PPH

A

uterine massage
bladder emptied
Ergometrine IV

53
Q

Define PPH

A

Blood loss >500mls following delivery

54
Q

What is the difference between primary and secondary PPH

A

Primary - within 24hrs of delivery

Secondary - 24hrs - 6 weeks after delivery

55
Q

What management options should you consider if medical management of PPH fails

A

Balloon tamponade
Interventional radiology
Hysterectomy

56
Q

When are Anti-D injections given

A

28 and 34 weeks

57
Q

When should Nuchal thickness be measured

A

11- 13+6 weeks

58
Q

What is the quadruple test and what is is used to test for

A

bHCG, AFP, Inhibin A, unconjugated estriol

15-20 weeks for Down’s Syndrome

59
Q

What is trisomy 18 also called

A

Edward Syndrome

60
Q

What is trisomy 13 called

A

Patau Syndrome

61
Q

When can chorionic villus sampling be carried out

A

> 12 weeks

62
Q

When can amniocentesis sampling be carried out

A

> 15 weeks

63
Q

How can the whole genome be analysed

A

Array CGH

64
Q

How are targeted genes analysed

A

FISH

65
Q

Define large for dates

A

Symphyseal - fundal height >2cm than expected for dates

66
Q

Define small for gestational age (SGA)

A

Corrected birth weight <10 centile

67
Q

What is a normal baby birth weight

A

2.5 - 4.0 kg

68
Q

Define the terms Zygosity, Chorionicity and Amnionicity

A

Zygosity: number of eggs.
Chorionicity: number of placenta.
Amniocity: number of amniotic sacs

69
Q

All dizygotic twins will have how many placentae and amniotic sacs

A

2 placentae and 2 amniotic sacs

DCDA

70
Q

What is a normal volume of amniotic fluid

A

500-1500mls

71
Q

What is the normal amniotic sac measurement on ultrasound

A

> 2cm but <8cm

72
Q

Define Polyhydramnios

A

Excessive amount of amniotic fluid (>1500ml, >8cm)

73
Q

What is hydrops fetalis

A

An accumulation of fluid, or oedema, in at least two fetal compartments

74
Q

What is Potter’s Syndrome

A

Potters syndrome is a group of characteristic changes seen as a result of oligohydramnios:

  • Club feet.
  • Pulmonary hypoplasia.
  • Potters sequence -> flat nose, recessed chin, low set ears, skeletal abnormalities
75
Q

What is the primary problem in Potter’s syndrome

A

Kidney failure

76
Q

What is the Kleihauer–Betke test

A

A blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother’s bloodstream

77
Q

What does an indirect coomb’s test tell you in rhesus pathology

A

Tells you whether mum is sensitized or not.
Positive: sensitized.
Negative: not sensitized

78
Q

What are the three possible scenarios when Anti-D can be given

A

Mother negative.
Baby positive.
Mother is coombs negative

79
Q

When should folic acid be started with regards to pregnancy

A

3 months pre conception to end of 1st trimester

80
Q

What do Ace inhibitors or ARB’s cause in babies

A

Renal hypoplasia

81
Q

What do Valproate and Phenytoin cause in babies

A

Valproate - Spina bifida

Phenytoin - Cleft lip

82
Q

Which cardiac abnormality can lithium cause

A

Ebstein’s abnormality

83
Q

What can tetracyclines cause in babies

A

Hypoplasia of teeth enamel and yellowing

84
Q

What treatments are safe for UTI during pregnancy

A

Trimester 1 - nitrofurantoin/cephalexin

Trimester 2 & 3 - Trimethoprim/Cephalexin

85
Q

What is given for VTE prophylaxis in hyperemesis gravidarum

A

Heparin

86
Q

How can you replace Thiamine in Hyperemesis Gravidarum

A

Pabrinex

87
Q

Which anti-emetic is best in pregnancy

A

Cyclizine

88
Q

Describe the trend of blood pressure over pregnancy

A

Falls due to expansion of utero-placental circulation - lowest at week 24
Will steadily rise after this

89
Q

Name 3 fetal associations with hypertension in pregnancy

A

IUGR
Still Birth
Placental Abruption

90
Q

When should low dose aspirin be started for those at risk of pre-eclampsia

A

Start 75mg at 12 weeks

91
Q

What is the diagnostic triad of pre-eclampsia

A

Hypertension
Proteinuria
Oedema

92
Q

What is the main cause of death in pre-eclampsia

A

Pulmonary Oedema

93
Q

What are the 2 diagnostic criteria for gestational diabetes

A

Fasting glucose > 5.1 mmol

2 hour OGTT > 8.5 mmol

94
Q

When is OGTT offered during pregnancy

A

24 – 28 weeks

95
Q

When is pyelonephritis most common in pregnancy and how is it treated

A

Most common around 20 weeks

Co-Amoxiclav

96
Q

Which is the only SSRI reccomended for use in breastfeeding

A

Sertraline

97
Q

What do atypical anti-psychotics have a risk of causing during pregnancy

A

Gestational diabetes

IUGR

98
Q

Define antepartum haemorrhage

A

Vaginal bleeding after 24 weeks gestation but before birth

99
Q

In the case of Antepartum haemorrhage, what should you always do before carrying out a PV exam

A

Rule out placenta praevia with ultrasound

100
Q

What is Vasa Praevia

A

Vasa Previa is when the fetal blood vessels develop within the membranes
When the membranes rupture, the fetal vessels will too, resulting in a catastrophic bleed

101
Q

When can fetal blood sampling be carried out

A

18 weeks onwards

102
Q

When can the Combined oral contraceptive pill be started postpartum if a woman is breastfeeding

A

6 weeks onwards

103
Q

Define Lactational Amenorrhoea

A

Exclusively breastfeeding
Amenorrhoea
<6 months postpartum

104
Q

How effective is Lactational Amenorrhoea as contraception

A

98%

Misc. Notes Year 3 (25 decks)

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