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My Reproduction > Pathology (mainly O) > Flashcards

Pathology (mainly O) Flashcards

1
Q

In what groups is maternal death more common?

A

older women, black women and women who live in deprived areas

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2
Q

What are the most common causes of maternal death?

A

cardiac disease, suicide, thrombosis, sepsis and neurological issues

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3
Q

What is the increased risk of VTE in pregnancy?

A

4-6x in pregnancy

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4
Q

What is used for VTE risk?

A

LMWH or warfarin (never in pregnancy but okay in breastfeeding)

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5
Q

What condition can cause recurrent pregnancy loss?

A
  • Antiphospholipid syndrome due to antibodies

- treated with aspirin and LMWH

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6
Q

What is done for seizure in labour?

A

benzodiazepines

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7
Q

What is the most teratogenic drug?

A

sodium valproate

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8
Q

What can obesity cause in pregnancy?

A
  • infertility
  • miscarriage
  • fetal anomalies (spina bifida and neural tube defects)
  • GDM
  • increase in operative delivery
  • haemorrhage
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9
Q

What is classed as large for dates?

A

symphyseal-fundal height >2cm for gestational age

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10
Q

What are the main causes of large for dates?

A
  • wrong dates
  • fetal macrosomia
  • polyhydramnios
  • diabetes
  • multiple pregnancy
  • obesity
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11
Q

What is fetal macrosomia?

A
  • big baby
  • US showing weight >90th centile or AC >97th centile
  • can cause labour or shoulder dystocia and increases risk of PPH
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12
Q

How is fetal macrosomia managed?

A
  • exclude diabetes

- if baby is seemed to be more than 5kg then C section

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13
Q

What are the possibilities for chorionicity and amnionicity in monozygotic twins?

A
  • MCMA (8-14w cleavage)
  • MCDA (4-7w cleavage)
  • DCDA (0-3 cleavage)
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14
Q

How can the number of placentas be seen on US?

A
  • lambda sign is two

- T sign is one

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15
Q

What are the complications of multiple pregnancies?

A
  • high fetal mortality
  • congenital anomalies
  • preterm birth
  • growth restriction
  • cerebral palsy
  • twin to twin transfusion
  • preeclampsia
  • hyperemesis gravidarum
  • anaemia
  • preterm labour
  • C section
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16
Q

What is management of multiple pregnancies?

A
  • low dose aspirin, Fe and folic acid

- USS more: 2 weekly for MC and 4 weekly for DC

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17
Q

How are multiple pregnancies delivered?

A
  • MCDA twins are delivered at 36w with steroids
  • MCMA C
  • triplets or more is C
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18
Q

Why is there a higher risk of DKA in pregnancy?

A

it increases insulin requirements so diabetes and N+V more likely to cause DKA

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19
Q

What are the complications of poorly controlled diabetes in pregnancy?

A
  • anomalies
  • miscarriage
  • IUD
  • hypod and hypers
  • DKA risk increased
  • worsening complications from DM
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20
Q

What is ideal for diabetes in pregnancy?

A
  • HbA1c should be 48
  • medication review before conception
  • high dose folic acid
  • education
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21
Q

What is a baby that is small for gestational age?

A

birth weight below 10th centile for gender

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22
Q

How is small for age measured in pregnancy?

A

abdominal circumference

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23
Q

What is a low birth weight?

A

below 2.5kg

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24
Q

What is fetal growth restriction?

A

failure to achieve genetic potential for growth so there is a pathological restriction

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25
Q

What are causes of small for gestational age?

A
  • placental (infarcts, abruption, secondary to hypertension so preeclampsia)
  • fetal (infection, congenital or chromosomal)
  • maternal (lifestyle, height/weight, age and maternal disease)
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26
Q

What are the risks for SGA and FGR?

A

increase risk of stillbirth, perinatal morbidity and mortality and iatrogenic preterm birth

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27
Q

What is done for the identification of SGA and FGR?

A
  • symphysis-fundal height chart
  • diagnose with US abdominal circumference
  • calculation of EFW
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28
Q

What can cause SGA?

A

resistance in the uterine artery which can be measured with a Doppler

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29
Q

What is the treatment for SGA?

A

treat those with RF for preeclampsia or uterine artery notching with 150mg aspirin

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30
Q

What is a normal finding on uterine artery dipper?

A

this measures placental resistance and there should always be forward flow to the fetus even in diastole

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31
Q

What are the ways to measure how much blood the foetus is getting?

A
  • uterine artery doppler
  • middle cerebral artery doppler
  • ductus venosus doppler
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32
Q

When do you deliver SGA babies?

A
  • <3rd centile deliver from 37w
  • 3rd-10th deliver at 39w even if normal trajectory
  • for early deliver give steroids (before 36w) and magnesium sulphate (before 32w)
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33
Q

Which drug doesn’t cross the placenta?

A

LMWH

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34
Q

When is the time of greatest teratogenic risk with drugs?

A

1st trimester especially 4th-11th week as this is the time of organogenesis

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35
Q

What is the effects of teratogenic drugs later in pregnancy?

A

intellectual and behavioural abnormalities

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36
Q

What is the treatment for epilepsy in pregnancy?

A

(seizures can get more frequent)

  • monotherapy
  • avoid valproate and phenytoin
  • give higher dose of folic acid
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37
Q

What is the treatment for diabetes in pregnancy?

A

insulin is safe but sulphonylureas aren’t

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38
Q

What is the treatment for hypertension in pregnancy?

A
  • give labetalol, methyldopa or nifedipine

- avoid ACEi and ARB

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39
Q

What is the treatment for N+V, pain and heartburn in pregnancy?

A
  • N and V use cyclizine
  • pain give paracetamol
  • heartburn give antacids
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40
Q

What is given for PE or DVT in pregnancy?

A

LMWH

warfarin is teratogenic in early pregnancy and causes bleeding in later pregnancy

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41
Q

What does phenytoin cause when given in pregnancy?

A

cleft lip and palate

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42
Q

What does tetracycline cause when given in pregnancy?

A

discolours teeth

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43
Q

What does stilbestrol cause when given in pregnancy?

A

vaginal adenocarcinoma in child

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44
Q

What does sodium valproate cause when given in pregnancy?

A

neural tube defects such as spina bifida and anencephaly

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45
Q

What are the types of malpresentation?

A

when the vertex isn’t presenting eg breech, shoulder, brow

46
Q

What is complete breech vs frank breech vs footling breech?

A
  • complete breech=legs folded down at baby’s bottom
  • footling breech=one or both feet down
  • frank breech=legs pointing up with feet at baby’s head so bottom first
47
Q

What is normal delivery position?

A

longitudinal with flexion to LOA to OA with extension

48
Q

What is given to women who can’t have regional anaesthesia?

A

IV Remifentanil is good for short sharp burst of pain

49
Q

What are the complications of epidural?

A
  • hypotension (due to vasodilation)
  • dural puncture
  • atonic bladder
  • high block (can cause breathing problems)
  • headache
50
Q

What are the risks with obstructed labour?

A 
sepsis
uterine rupture
obstructed AKI
postpartum haemorrhage
fetal asphyxia
neonatal sepsis
51
Q

What is delay for nulliparous women?

A

<2cm dilation in 4 hours is delay

52
Q

What are the possible reasons for failure to progress?

A
  • powers so inadequate contractions
  • passages so pelvis
  • passenger so big baby or malposition
53
Q

What is a partogram?

A

graphic presentation of the progress of labour including fetal HR, amniotic fluid, cervical dilation, descent, contractions, moulding/obstruction and maternal obs

54
Q

How is intrapartum fatal assessment done?

A
  • Doppler auscultation every 15 minutes during and after contraction and in stage 2 every 5 minutes for a whole minute
  • CTG
  • colour of amniotic fluid
55
Q

What are the RF for feral hypoxia?

A 
small fetus
preterm/post dates
pre-eclampsia
diabetes
antepartum haemorrhage
meconium
epidural analgesia (causing hypotension)
sepsis
56
Q

What are the causes of fatal hypoxia?

A
  • uterine hyperstimulation
  • abruption
  • cord prolapse
  • uterine rupture
  • feto-maternal haemorrhage
  • regional anaesthesia
  • chronic causes include placental insufficiency and fetal anaemia
57
Q

What is a normal HR for a foetus?

A

110-150bpm

58
Q

What are accelerations and decelerations on CTG?

A
  • Accelerations are a good sign as the fetus is moving
  • Decelerations- early are common as head moves through pelvis, late is when the HR decreases after peak of contraction with lowest point after which is associated with lack of oxygen
59
Q

How is fetal hypoxia seen on CTG?

A
  • loss of accelerations
  • persistent deeper and wider decelerations
  • loss of variability
  • rising fetal baseline HR
60
Q

What is the pneumonic DR C BRAVADO?

A

determine, risk, contractions, baseline, rate, variability, accelerations, decelerations, overall impression

61
Q

What is management of an abnormal CTG?

A
  • move mother
  • IV fluids
  • stop syntocinon
  • scalp stimulation
  • consider tocolysis
  • maternal assessment
62
Q

What are the main indications for CS?

A
  • previous CS
  • fetal distress
  • failure to progress in labour
  • breech
  • maternal request
63
Q

What is the first sign of maternal unwellness?

A

tachypnoea with BP changing last due to compensation

64
Q

What are the 2Cs added to the 4Hs and 4Ts?

A

eclampsia

intracerebral bleed

65
Q

What positions are essential in pregnancy ABCDE?

A
  • left lateral position if collapsed and breathing

- if not breathing, do supine left uterine displacement

66
Q

What are the reasons that its more difficult to resuscitate a pregnant woman?

A
  • aortocaval compression (gravid uterus compresses IVC and aorta)
  • pressure on diaphragm
  • fetal o2 consumption
  • aspiration
  • difficulties intubating
67
Q

When should a baby be delivered in maternal CPR?

A

5 minutes with CPR continuing throughout

68
Q

What drugs are given in maternal ALS?

A
  • Adrenaline 1mg after every 3rd shock then every over cycle (every 4 mins)
  • Amiodarone 300mg after 3rd shock
69
Q

What are the common reversal drugs?

A
  • Opiate overdose is reversed with naloxone
  • Magnesium toxicity is reversed with calcium gluconate
  • Local anaesthetic toxicity is reversed with intralipid
70
Q

What is amniotic fluid embolism?

A
  • amniotic fluid enters the maternal circulation
  • collapse with fetal distress
  • rare with a high mortality
71
Q

What are the features of cord prolapse?

A
  • obstetric emergency associated with malpresentation
  • preterm labour
  • 2nd twin
  • artificial membrane rupture
  • needs immediate delivery
72
Q

What are the red flags for mental health issues in mothers?

A
  • recent change in mental state or new symptoms
  • new thoughts of violent self harm
  • new expressions of incompetency as a mother
  • estrangement from baby
73
Q

When is admission to mother and baby unit required?

A
  • rapid changing mental state
  • suicidal ideation
  • estrangement from infant
  • pervasive guilt
  • belief of inadequacy as a mother
  • evidence of psychosis
74
Q

What happens if a women gets pregnant on a teratogenic drug?

A

if not stopped early enough maybe don’t need to be stopped as it’s too late and there are risks of stopping medication abruptly

75
Q

What is safe to give for depression in pregnancy?

A
  • SSRIs are first line
  • sertraline is least likely to pass into placenta
  • fluoxetine is safer as its older
  • tricyclics are safe
  • stay on treatment during and after pregnancy
  • paroxetine isn’t good
76
Q

What is safe to give for anti-psycotics in pregnancy?

A
  • safe but low risk of GDM and reduced fertility (due to raised prolactin)
  • with 2nd gen, olanzapine and quetiapine are the best
  • avoid clozapine (agranulocytosis)
77
Q

What mood stabiliser is the best in pregnancy?

A
  • none are completely safe
  • valproate (neural tube defects) is a nogo and carbamazepine too
  • lamotrigine is less bad
  • lithium is a probably not (cardiac abnormality) but can be reduced gradually preconception and then increased later on in pregnancy
78
Q

What is the aim for bipolar treatment in pregnancy?

A

switch to a safer antipsychotic eg quetiapine

79
Q

What is the treatment of anxiety in pregnancy?

A
  • benzodiazepines can cause floppy baby in 3rd trim so avoid

- SSRIs can be used

80
Q

What should never be taken while breastfeeding?

A

lithium

81
Q

What does alcohol in pregnancy carry a risk of?

A
  • miscarriage
  • foetal alcohol syndrome (facial deformity, lower IQ, epilepsy, hearing issues, heart and kidney defects)
  • withdrawal
  • risk of maternal Wernicke’s or Korsakoff
82
Q

What do illicit drugs in pregnancy cause?

A
  • teratogenic
  • cause abruption and preeclampsia
  • miscarriage
  • preterm labour
83
Q

Which mental health issue tends to get better in pregnancy?

A

eating disorders

84
Q

What are the features of rubella infection?

A
  • direct contact or respiratory droplets
  • presents with fever, maculopapular rash, lymph nodes and polyarthritis
  • screening (IgG antibody from vaccine), supportive treatment, rest, fluids
85
Q

What can rubella do in pregnancy?

A
  • miscarriage and still birth
  • birth defects
  • triad of cataract, cardiac abnormalities (PDA) and deafness in the fetus
  • risk is highest earlier in pregnancy
86
Q

What are the features of measles infection?

A
  • caused by paramyxovirus
  • causes fever, white spots on the inside of the mouth, runny nose, cough, red eyes and a rash
  • rash appears on the forehead to begin with and then spreads down
87
Q

What can measles do in pregnancy?

A
  • not teratogenic but a high fever can cause microcephaly, IUGR and stillbirth or preterm birth
  • bring down fever and watch for secondary complications
88
Q

What is the treatment of chicken pox in pregnancy?

A

supportive management with antihistamines and consider acyclovir after 20w

89
Q

What is congenital varicella syndrome?

A
  • chicken pox virus passes through placenta
  • refer to fetal medicine
  • can be hypoplasia of limbs, IUGR, retinal scarring, cataracts and microcephaly
90
Q

What can cytomegalovirus cause in pregnancy?

A
  • caused by herpes virus group

- causes miscarriage, permanent hearing impairment, microcephaly, visual impairment, IUGR, liver/lung/spleen issues

91
Q

What is different about CMV infections in pregnancy compared to other infections?

A

risk of abnormalities is higher the further into the pregnancy the infection is

92
Q

What is CMV in pregnancy treated with?

A

valacyclovir

93
Q

What can parvovirus in pregnancy cause?

A

aplastic anemia
congenital HF
hydrops
fetal death

94
Q

What vaccine can’t be given in pregnancy?

A

MMR as it is live

95
Q

What can Zika virus cause in pregnancy?

A
  • serious birth defects including microcephaly
  • brain defects
  • problems with hearing and vision
  • limited movements, muscle tone issues and seizures
96
Q

What should be done for HIV in pregnancy with high viral load?

A

C sections which decreases risk of transmission by 50% (give zidovudine infusion before)

97
Q

What is sepsis?

A

life-threatening organ dysfunction caused by the body’s response to infection

98
Q

What are the signs of sepsis?

A
  • tachycardia
  • high or low temp
  • raised RR
  • hypotension
  • low O2 sats
  • poor peripheral perfusion
  • skin clamminess
  • confusion
  • rash or mottled skin
99
Q

What can toxoplasmosis cause in pregnancy?

A

hydrocephalus, chorioretinitis, cerebral calcifications and mental retardation

100
Q

What can be given for toxoplasmosis in pregnancy?

A

PO spiramycin to reduce risk of transmission to fetus

101
Q

How is maternal listeriosis treated?

A

ampicillin and gentamicin (high risk of perinatal mortality)

102
Q

What is given during labour in GBS infection?

A

penicillin

103
Q

How long does it take the cervix to close after birth?

A

10d

104
Q

How long do maternal obs changes last?

A
  • CO and plasma volume in a week
  • BP goes down in 6w
  • oedema for up to 6w
105
Q

What are abnormal vaginal/labial tears?

A
  • 3rd degree involving the internal anal sphincter

- 4th degree involving anal or rectal mucosa

106
Q

What do you given for RF for VTE?

A
  • low give fluids and movement
  • mod give 10 days prophylactic LMWH
  • high give LMWH 6w
107
Q

When can ovulation occur after giving birth?

A

within 4w

108
Q

When can fistulas be formed in labour?

A

prolonged obstructed labor leading to necrosis

109
Q

What is treated by phyios in O+G?

A
  • bladder and bowel dysfunction
  • prolapse
  • vulvodynia
  • back pain
  • pelvic girdle pain
  • DRAM (linea alba stretching and doming)
  • carpal tunnel
110
Q

What is the treatment of pelvic floor dysfunction?

A
  • healthy BMI
  • smoking cessation
  • avoid constipation
  • avoid heavy lifting
  • reduce caffeine
  • pelvic floor exercises involving long and short holds

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