Obstetrics & gynae Flashcards
1
Q
Threatened miscarriage
A
foetus is intrauterine, mild symptoms. Cervical Os is closed.
2
Q
Complete miscarriage
A
all uterine contents expelled. Cervical Os is closed.
3
Q
Missed miscarriage
A
dead foetus in the uterus. Cervical os is closed
4
Q
Inevitable miscarriage
A
Fetus is dead, bleeding. Cervical os is opened
5
Q
What anti-epileptic drugs are safe for pregnancy?
A
Lamotrigine
Carbamazepine
levacit.
6
Q
Pre-eclampsia and Mx
A
High blood pressure during gestation
Assoc, with proteinuria, oedema, headaches
Anti-hypertensives e.g. labetalol.
Prevent eclampsia - magnesium sulphate
7
Q
Symptoms of pre-eclampsia but abnormal creatinine
A
Acute Tubular Necrosis
8
Q
Symptoms of pre-eclampsia but no proteinuria
A
gestational hypertension
9
Q
Twin-Twin Transfusion Syndrome
Mx
A
Happens in monochorionic twins. Donor baby begins transferring blood to recipient baby through new vessels.
Both babies are abnormal
Donor baby: more likely to survive
Recipient baby: high cardiac output -> heart failure. increased fluid -> fetal hydrops.
Transect the vessels with lasers
10
Q
what is the difference between partial and complete molar pregnancy
A
complete mole = 2 sperm, 1 egg with no genetics material
partial mole = 2 sperm, 1 egg with genetic material. makes an unviable fetus
11
Q
danger of invasive mole
A
metastasise into choriocarcinoma
12
Q
Dx and Mx of molar pregnancy
A
grape like/cloudy on ultrasound
removal of fetus, follow up with beta hCG testing, don’t get pregnant until 6 months after beta-hCG is normal
13
Q
Px of placental abruption
A
firm woody uterus
no visible bleeding
painful
14
Q
Px of placenta previa
A
soft uterus
visible bleeding
no pain
15
Q
Px of vasa previa
A
rupture of membranes
painless bleeding
fetal bradycardia
16
Q
Px of HELLP syndrome
A
haemolytic, elevated liver enzymes, low platelets
HTN, DIC, epigastric/RUQ pain, headaches
17
Q
Px of haemolytic disease of the newborn
A
jaundice, kernicterus
hydrops fetalis
18
Q
what is cervical ectropion, common cause of ??
A
benign. glandular cells grow outside of the cervix, causing increased levels of oestrogen
common cause of post-coital bleeding
19
Q
uterus that feels tense/large for dates. hard to palpate fetal parts
Mx
A
polyhydramnios
too much amniotic fluid
indomethacin
20
Q
sudden gush of fluid and non-reassuring fatal trace
A
cord prolapse
21
Q
fever, abdo pain, offensive fluid from vagina, preterm rupture of membranes
A
chorioamnionitis
22
Q
turtle neck sign, failure to progress labour
A
shoulder dystocia
23
Q
position to relieve shoulder dystocia
A
mcroberts maneuvre
24
Q
Mx of ectopic pregnancy
A
methotrexate and salphingectomy
25
common cause of recurrent miscarriage and the Mx
anti-phospholipid syndrome
aspirin and LMWH
26
trimethoprim avoided in the...
and why
1st trimester
it is a folate antagonist. contraindicated in 1st ttrimester when the neural tube is developing
27
nitrofurantoin avoided in the ... and why
3rd trimester
risk of haemolytic anemia
28
medical termination of pregnancy
oral mifepristone + vaginal misopristol
29
Px of ovarian torsion
sudden 10/10 peri-umbilical pain radiating to the lower back
internal bleeding (from the ovary)
nausea
30
Mx of confirmed ovarian cancer
total abdominal hysterectomy and bilateral salpingo-oophorectomy
31
difference between salpingotomy and salpingectomy
salpingotomy just removes the ectopic pregnancy
salpingectomy removes the ectopic pregancy AND the fallopian tube
32
first line Ix and gold standard diagnosis for endometriosis
first line: transvaginal ultrasound
gs: diagnostic laprascopy
33
Sheehan syndrome what is it and Px
Necrosis of anterior pituitary after post partumhaemorrhage
Low prolactin , so difficulty feeding
34
Mittelschmerz
Ovulation pain
35
Prolactinoma Px, Mx
Prolactinoma is a benign pituitary tumour
Px: galactorrhea, + gonadal dysfunction (amenorrhea, erectile dysfunction,) + neuro (headaches, visual impairment)
Mx: dopamine agonists (cabergoline/bromocriptine) or surgery
36
cabergoline used for...
managing prolactinoma
37
what are the 4 blood results for DIC
prolonged PT and APTT
raised D Dimer
thrombocytopenia
low fibrinogen
38
1st and 2nd line for managing epilepsy in pregnancy
1. lamotrigine
2. levetiracetam
39
suspected varicella in pregnancy, don't know if immune
test varicella antibodies
40
how to assess tubal patency (2 methods)
hysterosalpingography (no comorbid conditions)
laparoscopy and dye (with comorbid conditions)
41
commonly used test to test for ovulation
day 21 progesterone
42
where is ectopic pregnancy most likely to be
ampulla
43
where in fallopian tube is most likely to rupture in ectopic preg
isthmus
44
IgG and IgM. What results show immunity from vaccination
IgG positive, IgM negative
45
IgG and IgM. What results show immunity from recent infection
IgG -ve
IgM +ve
46
what is the combined test and when does it take place
PAPP-A, B-HCG, nuchal translucency
10-14 weeks
47
combined test results indicative of down syndrome
low PAPP-A
high B-HCG and nuchal translucency
48
how does sheehans syndrome affect cortisol and aldosterone
low cortisol
normal aldosterone
49
when to do surgical evacuation or vaginal misoprostol for miscarriage management
surgical evacuation if the patient is unstable or bleeding
50
when is methotrexate used in ectopic pregnancy
can return for follow up
no pain
no ruptured ectopic pregnancy
serum HCG level 1500 IU/L
51
when is a pregnancy considered viable
when fetal heartbeat can be heard
52
what value of crown rump length is fetal heartbeat heard
7mm
53
5 requirements for all pregnancies
all women have maternal blood grouping and Rhesus D typing
folic acid 5mg
vitamin D
Smoking cessation
exclude alcohol
54
5 features of prolonged pregnancy
- macrosomia
- oligohydramnios
- reduced fetal movements
- presence of meconium (meconium staining on nails)
- dry flaky skin with reduced vernix (waxy substance on baby’s skin)
55
when does membrane sweep take place in nulliparous and parous women
what is done
what is a requirement
after 40 weeks in nulliparous + 41 weeks in parous
insert gloved finger through cervix, separate the chorionic membrane from the decidua
can be done at any bishop score, before IOL
56
when does induction of labour take place in a normal prolonged preganncy
41-42 weeks
57
3 indications for IOL
premature rupture of membranes
maternal health problems (pre eclampsia)
fetal growth restriction
58
2 methods of IOL
vaginal prostaglandin
amniotomy and syntocinon infusion
59
define fetal growth restriction
when the fetus is below the 10th percentile in growth
60
when should IOL be done for a baby in fetal growth restriction
37 weeks
61
pathophysiology of neonatal hypoglycaemia
maternal hyperglycaemia -> fetal hyperglycemia and insulinemia -> B cell hyperplasia in fetal pancreas (more insulin)
when the maternal glucose supply is removed at birth -> the hyperinsulinaemic foetus becomes hypoglycaemic
62
management of neonatal hypoglycaemia
feeding within 30-60 minutes of birth
feed at least 3 times hourly
skin to skin
maintain temp 36-37.5
63
4 points for antenatal care of diabetic pregnant women
booking appointment: 2hr OGTT
measure CBG 4 times / day
from 28 weeks go a growth scan every four weeks
joint diabetes and antenatal clinic every 2 weeks
64
first line contraception for breastfeeding women
anything with progesterone (better to be an implant rather than pill)
65
bishop score of <6
vaginal prostaglandin
or
mechanical method (is woman is at risk of uterine hyper stimulation)
66
induction of labour method when bishop score >6
amniotomy and syntocinon
67
termination of pregnancy : two options and how to choose
oral mifepristone + vaginal misoprostol
surgical evacuation
do surgical evacuation if >14 weeks
68
Mx of pre-existing hypothyroidism in pregnancy
increase dose of levothyroxine
69
Mx of PID
Im ceftriazone
oral doxy and metronidazole
70
physiology behind breathlessness in pregnancy
high levels of progesterone leads to high levels of acidic CO2 so high levels of respiratory drive
minute ventilation and tidal volume increase which cause feelings of breathlessness
71
what can be measured at the start of menopause to verify that it has started
FSH
72
how to diagnose Trichomonas
wet slide mount from high vaginal swab
73
how many antenatal scans
2
74
what and when is the first antenatal scan
dating scan
10-14 weeks
75
what and when is the second antenatal scan
anomaly scan
17-21 weeks
76
vaginal bleeding. LMP was 9 weeks ago. high bHCG. ultrasound shows intrauterine gestational sac with cardiac activity. cervical os is closed
threatened miscarriage
77
Incomplete fusion of paramesonephric ducts?
Leads to bicornuate or septate uteri
2nd trimester miscarriage
78
Failure of migration of gonadotropin-releasing hormone (GnRH)-secreting neurones from the olfactory placode
Kallmann syndrome, hypogonadotrophic hypogonadism
Primary amenorrhoea
79
Paternal Robertsonian translocation
chromosomal abnormality = 1st trimester miscarriage
80
Maternal 45,XO chromosome complement
Turner syndrome
Primary amenorhhoea
81
Low maternal serum progesterone, what type of miscarriage
1st trimester
82
what is cyclical HRT
daily oestradiol
progesterone added on last 14 days
3 month cycles
83
2 causes of post menopausal vaginal bleeding
cervical and endometrial cancer
84
histology of the endometrium
simple columnar
85
histology of cervix
stratified squamous
86
histology of ovary
cuboidal
87
histology of vagina
glycogen containing stratified sqamous
88
histology of fallopian tubes
ciliated columnar
89
what analgesics should breast feeding women avoid
aspirin
codeine
90
what should be used in pregnant females with severe allergic rhinitis
oral. loratidine
91
where is the lesion in sheehans syndrome
what hormone is deficient
anterior pituitary
prolactin
92
how many litres of amniotic fluid is considered polyhydramnios
>2-3
93
what is adenomyosis
when the endometrial tissue starts to grow into the muscle wall
94
what is a risk factor for hyperemesis and why
trophoblastic disease (molar pregnancy) due to very high bHCG
95
fluid of choice for hyperemesis gravidarum
normal saline with potassium (hypokalemia is common)
96
what is in an antenatal infection screen
Hep B
HIV
syphilis
97
when is contraception required post partum?
what r 3 three methods?
Women need contraception after day 21 postpartum
LAM (lactational amennorhea method) :
Until 6 months post partum, if she if breastfeeding over 85% she can be covered for contraception under LAM
0-6 weeks: can use POP only, COCP contraindicated
6weeks + : can use COCP
98
what is normal dose of folic acid for all oregnant women
0.4mg daily
99
what is the dose of high dose folic acid
what are the indications
5mg
sickle cell,
on anti epileptic meds,
obese, diabetes,
history of neural tube defect,
thalassemia trait
celiac disease
100
if fetal movements have not been felt by x weeks then refer to fetal med unit
24
101
Contraindications to labetalol and what is used instead?
Asthma is a contraindication
Nifedipine
102
common cause of persistent vaginal bleeding and fever after C section
endometritis
103
which SSRIs are safe for breastfeeding
sertraline
paroxetine
104
birth plan for obstetric cholestasis
induction of labour at 37-38 weeks
105
what med (not HRT) can be used for vasomotor symptoms of menopause
fluoxetine
106
when is salpingectomy used for ectopic pregnancy management
>35mm in size
>5000 bHCG
107
threshold to treat pregnancy induced hypertension and what is the first line drug
140/90
labetalol
108
what antibiotic is used for group b strep prophylaxis during labour
benzylpenicillin
109
diagnosis of gestational diabetes
fasting glucose is >= 5.6 mmol/L,
or
2-hour glucose level of >= 7.8 mmol/L
'5678'
110
how long should you have folic acid for
12 weeks gestation (end of first trimester)
111
3 types of perineal tears and Mx
1st degree: tear of perineum. spontaneous healing.
2nd degree: tear of muscles. sutured by professional on ward
3rd degree: tear of anal sphincter. repair in theatre
112
Mx of umbilical cord prolapse
push the presenting part back into the uterus
pt get on all fours
retrofit the bladder
113
previous gestational diabetes. when to do OGTT test
at booking
24-28 weeks
114
diagnostic threshold for gest diabeets
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
115
suspected varicella in pregnancy, not immune. Mx?
give oral aciclovir from day 7-14 post exposure
116
endometrial cancer Mx
total abdominal hysterectomy with bilateral salpingoopherectomy
117
endometrial cancer Mx in frail old lady
provera
118
3 medical ways to manage PPH (and what are the two contraindications)
1. oxytocin
2. ergometrine (unless hypertension)
3. carboprost (unless asthmatic)
119
bladder training for...
urge incontinence
120
pelvic floor muscle training for ...
stress incontinence
121
from day xxx post party women need contraception
day 21
