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Specialities > Obstetrics Pregnancy > Flashcards

Obstetrics Pregnancy Flashcards

1
Q

What are the functions of the placenta?

A

Organ of respiration
Organ of nutrients transfer and excretion
Organ of hormone synthesis

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2
Q

How can the expectant date be worked out?

A

Establish regularity of menstrual cycle.
If normal:
+ 7 days. - 3 months (+following year)

or

Ultrasound dating

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3
Q

Where would you expect the uterine growth to be to at 20 weeks gestation?

A

Umbilicus

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4
Q

What are the trimesters?

A

1st trimester: <12 weeks

2nd trimester: 12-28 weeks

3rd trimester: > 28 weeks

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5
Q

What is the function of hCG? and where produces it?

A

Produced by the placenta specifically the trophoblast cells

To maintain Oestrogen and progesterone

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6
Q

What is the effect of progesterone in pregnancy?

A

Progesterone relaxes the uterus, allowing dilation.

It also relaxes the:

  • Lower esophageal sphincter
  • Peristalsis
  • accounting for gastric reflux and delay in stomach emptying
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7
Q

What are the physiological changes during pregnancy:

A

Enlargement of pituitary gland

  • 50% increase.
  • prolactin

Haematological:

  • increased clotting factors
  • Anaemia - increased use of Iron and increased plasma

Thyroid function

  • increased thyroid binding globulin
  • increased T4, T3 in response
  • free thyroid hormone still same, TSH still same

Uterus

  • relaxes
  • enlarges
  • increased smooth muscle

Cervix:

  • Softer
  • swollen

Vagina:

  • mucosal thickening
  • more dilation

Cardiovascular

  • increased cardiac output
  • drop in blood pressure early pregnancy

Respiratory

  • increases slightly
  • Increased tidal volumes
  • driven by progesterone

Renal:

  • renal pelvis and ureter relaxation - Hydronephrosis can occur
  • increased GFR - can lead to glucose in urine
  • urinary stasis - increased risk of UTIs

G.I:

  • Delayed gastric emptying
  • Reduced peristalsis (constipation)
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8
Q

What are the aims of the first antenatal clinic and when should be it be arranged by?

A

Booking appt made by 10 weeks and seen on 12th week.

  1. Full PMH
  2. Past obstetric history
  3. Screening blood tests (FBC, G&S, Syphilis, Rubella, HIV)
  4. Dating scan for EDD
  • identify risks (including domestic violence)
  • Screen for abnormalities
  • Develop Rapport
  • Provide health info
  • social work if needed
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9
Q

How is the Due date worked out?

A

Naegeles Rule:
- (Last menstrual period + 7 days) - 3 months
+ 1 year

So if the LMP was 15th July 2021:

15th + 7 days = 22nd July - 3 months = 22nd April + 1 year:
= 22nd April 2022

**note you need to be careful for womens who menstrual cycle is not the standard 28days. you may need to add less or more than 7 days

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10
Q

What screening can be done into Down’s syndrome?

A 
Triple test: 
Conducted at 11th-14th week: 
- Nuchal translucency 
\+
- PAPP-A (low) 
\+ 
- beta - hCG (high)

> 14 weeks: Quadruple test can be done.

  • beta - hCG
  • AFP
  • Inhibin A
  • Oestriol

These can be combined to give a score. If high 1/200 then

  • amniocentesis can be conducted 15 weeks
  • Chorionic villus sampling 11 weeks
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11
Q

What non-invasive Parental testing can be offered?

A

Cell Free fetal DNA

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12
Q

What key Care is given during the second trimester?

A

Fetal Anomaly Scan
- 18 - 22 weeks

Antenatal appointments

  • BP
  • Urinalysis
  • Fetal HR - 18 weeks

Assessment of common problems

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13
Q

What key aspects of care/ investigations/ questions are sought in third trimester?

A

BP/ Urinalysis/ Auscultation of fetal heart rate

Vaginal pain

Enquire about fetal movements

abdominal distention

  • inspection
  • palpation
  • auscultation
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14
Q

Describe the differences between Pregnant and non-pregnant uterus:

A

Non - pregnant:

  • Almost solid
  • Approximately 70g
  • <10ml

Pregnant:

  • Thin walled (1.5cm)
  • Approx 10g
  • Approx 5L
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15
Q

What are the signs of labour:

A

Regular painful contractions
Interval between contractions decreasing
Increased pain
Contraction during increasing

Increased cervical dilation

A show
- this mucus formation at the cervix which breaks off. This can occur a few days before. it demonstrates the cervix is softening in preparation for labour

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16
Q

When reading a CTG - how should you interrupt it?

A

DR C BRAVADO

Define Risk

Contractions

Baseline Rate 
Variability 
Accelerations 
Deaccelerations 
Overall impression
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17
Q

How is normal labour monitored?

A

Normally monitored on Partogram:

Vaginal Examination

  • 4 hourly
  • assess dilatation

Maternal Urine

  • 4 hourly
  • Ketones
  • Protein

Maternal Stats

  • temperature
  • BP
  • HR

Fetal HR

  • every 15 mins
  • especially after contractions

*if the pregnancy is more high risk then CTG monitoring may be required +/- fetal scalp or electrodes

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18
Q

What is called when a non-natural process is used for third stage of labour and why is there a delay in the cord clamping?

A

Active third stage management:

  • cord traction
  • use of syntometrine
  • delayed cord clamping

*this reduced PPH and anaemia in baby.

Delay clamping:

  • Improves haematocrit
  • Reduces need for fetal transfusion
  • is done at 1 minute
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19
Q

What drug is given routine to promote uterine contraction? and what does it consist off?

A

Syntrometrine

  • ergometrine (alpha, dopamine, 5HT2 agonist)
  • Oxytocin
20
Q

Name two measures that can be done to prevent preterm:

A

Pessary progesterone

  • prevents uterine contraction
  • prevents dilatation of the cervix

Cervical Cerclage
- a stitch put through the cervix to maintain its closure

21
Q

What are the drugs called that prevent labour progressing? and give an example:

A

Tocolytics

Nifedipine

22
Q

What is the management options for preterm labour with intact membranes?

A

Fetal monitoring - CTG

<4cm dilated:

  • Steroids
  • tocolysis (to allow steroids to take effect)
  • Contact neonate team

> 4cm dilated:

  • Steroids
  • IV magnesium if <30 weeks
  • IV steroids
  • plan for delivery (they’ve entered active stage there isn’t much stopping now)
23
Q

Give some indications for induction:

A

Induction is done when the risk of continuing pregnancy is greater than the risk of labour. Anything that falls into that will be an indication for induction. Some include:

> 12 days post term

Pre-eclampsia

Macrosomia

Premature rupture of membranes

Reduced fetal movements

24
Q

What are the options for inducing labour:

A

A membrane sweep is often conducted prior to the induction. Membrane sweep greatly increases the chances of labour without need for induction.

Induction:
Bishop score:
<8:
- Vaginal Pessary of prostaglandins

> 8:
- Artificial rupture of membranes + Oxytocin

Mifepristone + Misoprostol
- used if fetus death

25
Q

By what stage are people considered a late booker?

A

24 weeks

- at 24 weeks the EDD may be inaccurate

26
Q

What week is the fetal abnormality scan conducted?

A

20 week scan

27
Q

How many follow up appointments should pregnant women have?

A

10 for primigravida

7 for parous women

28
Q

Which week is Anti - D prophylaxis given to Rh Negative women?

A

IM injection at 28 weeks

29
Q

What are the top complaints of pregnant women during pregnancy?

A

G.I

  • N&V
  • Heartburn
  • Constipation
  • Haemorrhoids

Urinary

  • Frequency
  • UTIs

General

  • Fatigue
  • oedema

MSK

  • backpain
  • Symphysis pubis dysfunction

Breast tenderness

30
Q

What is the definition of labour?

A

Process by which the contents of the uterine cavity are expelled following 24 weeks of pregnancy.

  • regular contraction
  • painful contractions
  • Progressive cervical dilatation
31
Q

What are the top 5 analgesic methods used in pregnancy?

A

Non - pharmacological

  • bath
  • birthing pool

Entonox

Diamorphine IM

Epidural

Pudendal and Perineal infiltration

32
Q

What are the top reasons for elective Lower uterine segmental caesarean Section?

A
  1. Previous E LUSCS
  2. Breech presentation
  3. Multiple pregnancy with non cephalic presentation
  4. Placenta previa
  5. Previous traumatic delivery
33
Q

What are some of the reasons for an Emergancy lower uterine caesarean section?

A

Fetal Distress in labour

Malpresentation

Cord prolapse

Prolonged second stage

Maternal:

  • cardiac arrest
  • Bleeding
  • Cephalopelvic disproportion
34
Q

What are the screening tests for Down’s syndrome?

A 
Combined test at 10-14 weeks 
- Nuchal ultrasound scan 
\+ 
- Beta hCG (raised) 
- PAPP- A (lowered)

If the window at 10-14 weeks is missed then:

  • AFP
  • Unconjugated oestriol
  • inhibin A
  • Beta hCGH

If score >1/150 then chorionic villous samplying or amniocentesis can be conducted

35
Q

What is the most common type of skin condition induced by pregnancy?

A

Prurigo Eruption of pregnancy
- Eczematous type

  • Prurigo type

Involves trunk and arms.
Early pregnancy
20% history of eczema before

Treatment:

  • emollients
  • topical steroids
  • antihistamine
  • UVB
  • Oral steroids
36
Q

What is a condition that causes itchy skin rash on the stomach and what are some clinical features?

A

Polymorphic eruption of pregnancy

  • pruritic skin eruption of lower abdomen
  • Stria skin formation
  • Sparing of umbilicus
37
Q

What is a skin pathology that develops in pregnancy that leads to blister formation? and what are some clinical findings?

A

Pemphigoid gestationis

  • urticarial lesions
  • Wheals
  • bullae
  • Umbilical area
38
Q

Why is the pH of the mother and fetus important during labour?

A

Usually the fetus will be 1 unit below the mothers pH.

therefore if the mother has a high pH and the fetus pH is ‘normal’ it is in fact not normal and should be investigated.

39
Q

Stage 2 of labour is when the baby is passed, in order for this to occur successfully there are 3 important factors - what are they?

A

Pelvis
Power
Passenger

40
Q

List several ways the fetus can adapt to a chronic hypoxic and low nutrient environment:

A

Spend less:

  • reduced fetal movement
  • Reduced growth

Spend wisely:

  • Brain
  • Heart
  • Kidney prioritised

Gain more:

  • Polycythaemia
  • Increased extraction of oxygen
41
Q

At 32 weeks how much fetal movements should a mother be feeling when lying on her side?

A

> 5 kicks in an hour
or
10 in 2 hours

42
Q

What blood tests would you offer at first antenatal appointment?

A 
FBC 
ABO and Rh status 
HIV status 
Hep B screening 
Syphilis screening 
Rubella Antibody screening
43
Q

What dietary advice should be given to pregnant women?

A

400micrograms of Folic acid
- prior to pregnancy and first trimester

Avoid:

  • unpasteurised milk (listeria)
  • soft cheese (listeria)
  • raw meats/ undercooked meat (toxoplasmosis)
  • Alcohol
  • Vitamin A

Eat plenty of greens

44
Q

List several common minor complaints during pregnancy:

A

N&V

Backache

Constipation

Heartburn

Varicose veins

Carpal tunnel

Urinary frequency

45
Q

What are the risk associated with IUGR?

A

Hypoxia
Death
- both antenatally and during delivery

Hypoglycaemic (poor glycogen stores)
Hypothermia (poor fat stores)
Jaundice (polycythaemia)
Small weight (future life implications)

46
Q

What topics should be discussed with a mother in the third trimester:

A

How to recognise onset of labour

Where they want the baby/ and any risk associated with that

Pain management plan:

  • epidural?
  • local LA

Future contraception/ plans

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