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O+G > Perinatal medicine > Flashcards

Perinatal medicine Flashcards

1
Q

Still birth

A

fetes with no signs of life >= 24/40

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2
Q

Perinatal mortality rate definition

A

still births and deaths within the FIRST WEEK per 1000 live births and still births

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3
Q

Neonatal mortality rate

A

deaths of live born infants within the first 4 WEEKS after birth per 1000 live births

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4
Q

Preterm

A
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5
Q

term

A

37-41 weeks

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6
Q

post term

A

> =42 weeks

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7
Q

12 advice for mother planning conception

A
  1. smoking - low birth weight, miscarriage, still birth
  2. pre-pregnancy folic acid - neural tube defects
  3. Mx diabetes/epilepsy/HIV etc
  4. avoid teratogens e.g. warfarin, valproate, retinoids
  5. alcohol/drugs
  6. congenital rubella - maternal immunisation before pregnancy
  7. toxoplasmosis - avoid undercooked meat and cat litter
  8. listeria - unpasturised dairy, soft cheese, pate
  9. avoid eating liver - high vitamin A (not good)
  10. obesity - gest diabetes/HTN
  11. risk of inherited disorders e.g. maternal age, FHx, consanguinity
  12. complication of delivery e.g. previous preterm, recurrent miscarriage - identify and tx/mx
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8
Q

12 advice for mother planning conception

A
  1. smoking - low birth weight, miscarriage, still birth
  2. pre-pregnancy folic acid - neural tube defects
  3. Mx diabetes/epilepsy/HIV etc
  4. avoid teratogens e.g. warfarin, valproate, retinoids
  5. alcohol/drugs
  6. congenital rubella - maternal immunisation before pregnancy
  7. toxoplasmosis - avoid undercooked meat and cat litter
  8. listeria - unpasturised dairy, soft cheese, pate
  9. avoid eating liver - high vitamin A (not good)
  10. obesity - gest diabetes/HTN
  11. risk of inherited disorders e.g. maternal age, FHx, consanguinity
  12. complication of delivery e.g. previous preterm, recurrent miscarriage - identify and tx/mx
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9
Q

Perinatal mortality rate definition

A

still births and deaths within the FIRST WEEK per 1000 live births and still births

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10
Q

Neonatal mortality rate

A

deaths of live born infants within the first 4 WEEKS after birth per 1000 live births

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11
Q

Cause of hydrous fetalis

A

Fetal anaemia due to:

  1. rhesus disease (immune)
Non-immune causes:
2. fetal IDA
3. maternal parvovirus B19 (fifth disease), syphilis, CMV, diabetes, hyperthyroidism
4. noonan, turners
etc
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12
Q

complications associated with poorly controlled maternal diabetes

A

macrosomia (fetal hyperglycaemia –> hyperinsulinism)
IUGR (2o to maternal microvascular disease)
congenital malformations
polyhydramnios
pre-eclampsia
early fetal loss
congenital malformtions
late unexplained intrauterine death (esp ketoacidosis)
neonatal hypoglycaemia, rds, hypertrophic cardiomyopathy, polycythemia

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13
Q

large for gestational age

A

birthweight > 90th centime for gestational age

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14
Q

12 advice for mother planning conception

A
  1. smoking - low birth weight, miscarriage, still birth
  2. pre-pregnancy folic acid - neural tube defects
  3. Mx diabetes/epilepsy/HIV etc
  4. avoid teratogens e.g. warfarin, valproate, retinoids
  5. alcohol/drugs
  6. congenital rubella - maternal immunisation before pregnancy
  7. toxoplasmosis - avoid undercooked meat and cat litter
  8. listeria - unpasturised dairy, soft cheese, pate
  9. avoid eating liver - high vitamin A (not good)
  10. obesity - gest diabetes/HTN
  11. risk of inherited disorders e.g. maternal age, FHx, consanguinity
  12. complication of delivery e.g. previous preterm, recurrent miscarriage - identify and tx/mx
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15
Q

when is amniocentesis performed?

A

> 15 weeks gestation

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16
Q

when is chorionic villous sampling performed?

A

> 10 weeks gestation

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17
Q

Potter syndrome

A

Oligohydramnios causing pulmonary hypoplasia and limb and facial deformities from pressure on the fetus

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18
Q

What features of mother and fetus are associated with polyhydrmnios

A

maternal diabetes

structural GI abnormalities eg atresia in fetus

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19
Q

Arnold Chiari malformation

A

‘lemon shaped’ skull identifiable on US
abnormal cerebellum
associated with spina bifida

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20
Q

treatment for fetal SVT

A

Give mother digoxin or flecainide

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21
Q

Cause of hydrous fetalis

A 
fetal anaemia due to:
1. rhesus disease (immune)
Non-immune causes:
2. fetal IDA
3. maternal parvovirus B19 (fifth disease), syphilis, CMV, diabetes, hyperthyroidism
4. noonan, turners
etc
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22
Q

Risks of multiple pregnancies

A

prenatal: IUGR, congenital abnormalities, low BW
delivery: preterm (~37 weeks), complicated ?c/s
postpartum: housework, finances, emotional and physical exhaustion
NB. local and national support groups for parents of multiple births.

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23
Q

complications associated with poorly controlled maternal diabetes

A 
macrosomia
IUGR
polyhydramnios
pre-eclampsia
early fetal loss
congenital malformations
late unexplained intrauterine death (esp ketoacidosis)
neonatal hypoglycaemia, rds, hypertrophic cardiomyopathy, polycythemia
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24
Q

affect of maternal graves disease

A

fetal hyperthyroidism:
fetal tachycardia on CTG
fetal goitre on USS
irritability, weihgt lose, tacky, heart failure,diarrhoea, exopthalmos in neonate

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25
Q

carbimazole

A

treatment for hyperthyroidism

thyroid peroxidase inhibitor

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26
Q

Affect of maternal SLE

A 
associated with antiphospholipid syndrome:
recurrent miscarriage
IUGR
preeclapsia
placental abruption
preterm delivery

neonatal lupus - self limiting rash, heart block

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27
Q

effects of anticonvulsants during pregnancy (carbamezapine, valproate, phenytoin)

A

midfacial hypoplasia
CNS, limb and cardiac malformations
developmental delay

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28
Q

effect of cytotoxic drugs in pregnancy

A

congenital malformations

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29
Q

effect of lithium during pregnancy

A

congenital heart disease

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30
Q

tetracycline during pregnancy

A

enamel hypoplasia of teeth

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31
Q

effect of thalidomide in pregnancy

A 
(= immunomodulatory drug)
limb shortening (phocomelia)
32
Q

effect of vitamin a or retinoids in pregnancy

A

increased spontaneous abortions, abnormal face

33
Q

effect of warfarin in pregnancy

A

interferes with cartilage formation
cerebral haemorrhages
microcephaly

34
Q

fetal alcohol syndrome

A 
growth restriction
developmental delay
cardiac defects
saddle shaped nose
maxillary hypoplasia
absent philtrum between nose and upper lip
35
Q

smoking in pregnancy

A

increased risk of miscarriage and still birth, low birth weight, IUGR

36
Q

complications of IUGR

A 
fetal distress
fetal asphyxia (lack of oxygen)
neonatal hypoglycaemia or hypocalcaemia
meconium aspiration
impaired neurodevelopment
intrauterine death
T2D and HTN in adult life
37
Q

Risk factors for IUGR

A 
high maternal age
smoking
high intensity exercise
cocaine
Chronic hypertension, diabetes and vascular disease, renal impairment, antiphospholipid syndrome
pre-eclampsia
severe maternal bleeding
low maternal weight

placental insufficiency = head sparing
fetal prob eg chromosomal abnormality = uniform IUGR

38
Q

apgar

A

score used to describe baby’s condition 1 min and 5 min after birth ( 5 min intervals thereafter if condition remains poor)

total = /10

score 0, 1 or 2 for the following:

appearance (pale/blue, blue extremities, pink)
pulse (absent, 100)
grimace/irritability (none, grimace, cry/cough)
activity (flaccid, some flexion, good flexion/active)
resp (absent, gasping/irregular, regular/crying)

39
Q

infants at higher risk of haemorrhagic disease of newborn

A

mothers taking anti-convulsants (impair synthesis of vitamin K dependant clotting factors)

40
Q

Guthrie test

A

day 5-9 of life

phenyketouria
hypothyroidism
sickle cell anaemia + thalassaemia
CF - serum immunoreactive trypsin (raised if pancreatic obstruction)
MCADD
41
Q

clinical signs of shock

A 
early (compensated):
tachycardia
tachypnoea
decreased skin turgor
sunken eyes and fontanelle
cap refill > 2 sec
mottled, pale, cold skin
core-peripheral temperature gap > 4oC
decreased urinary output
late (decompensated)
Kussmaul breathing
bradycardia
confusion/depressed cerebral state
blue peripheries
absent urine output
hypotension
42
Q

informed consent

A

Given voluntarily (with no coercion or decit)
Given by an individual who has been fully informed about the issue
Given by an individual who has capacity
Can be written, verbal or non-verbal/implied

43
Q

consent in children

A
  • at 16 years or older a young person can be treated as an adult and can be presumed to have capacity to decide
  • under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved
  • where a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests*

those under the age of 13 years are considered unable to legally consent to sexual activity

44
Q

Fraser guidelines

A
  • the young person understands the professional’s advice
  • the young person cannot be persuaded to inform their parents
  • the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
  • unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
  • the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
45
Q

Abortion Act

A

• Legal grounds for abortion –

o A) The pregnancy is less than 24 weeks and that the risks to the physical and mental health of the woman or any children in her family are greater if the pregnancy were continued (accounts for 97% of all UK abortions, 87% are carried out before 13 weeks in the UK. The inherent risks of pregnancy compare to the low risk of early abortion mean that pregnancy will almost always pose a greater physical risk than an abortion).

o B) At any stage of pregnancy:
• I. Necessary to prevent grave and permanent injury to the mother.
OR
• II. Continuing pregnancy would involve a greater risk to the life of the pregnant woman than termination.
OR
• III. Substantial risk of serious physical or mental handicap (Down’s syndrome accounts for 20% of abortions performed on the grounds of “serious handicap”)

46
Q

foetal rights

A

The fetus is a recognised entity in law but has no right to life. Once born it acquire full legal rights.
The fact that a woman is pregnant does not affect her legal right in anyway. She can engage in (lawful) behaviour that is harmful to the foetus. She can refuse medical treatment including caesarean section even if it risks the life of the baby

47
Q

• Stillbirth

A

death of foetus >24 weeks

48
Q

Neonatal death

A

death of a newborn within 28 days (early neonatal death = within 7 days, late neonatal death = lives over 7 days)

49
Q

Miscarriage

A

death of foetus

50
Q

Corrected perinatal mortality

A

excludes stillbirths and deaths secondary to congenital malformations

51
Q

• Most common cause of perinatal mortality

A

Antepartum stillbirth

52
Q

8 causes of perinatal mortality

A

Antepartum stillbirth

pre-eclampsia,
lethal congenital abnormalities,
antepartum haemorrhage
intrapartum hypoxia

infection,
birth trauma,
foetal/foetomaternal haemorrhage

53
Q

risk factors of perinatal mortality

A
  • Extremities of maternal age
  • Smokers/recreational drug users
  • Poor nutrition
  • Highly parous
  • Afrocribbean/Asian
  • Multiple pregnancies
54
Q

Gavidity

A

the number of times a woman has been pregnant

55
Q

Parity

A

the number of times a woman has delivered potentially viable babies (beyond 24 weeks)

56
Q

Expected date of delivery

A

add one year, subtracting 3 months, and adding 7 days to the first day of a woman’s last menstrual period.

57
Q

lie

A

The relationship between the foetus and the long axis of the uterus (longitudinal = head and buttocks palpable at each end etc.)

58
Q

presentation

A

The foetal part that occupies the lower segment or the pelvis (with a longitudinal lie, the head or buttocks will be presenting)

59
Q

engagement

A

Engagement describes the decent of the foetal head into the pelvis. It is described as fifths palpable. If only 2 fifths are palpable then more than half of the head has entered the pelvis and so the head must be engaged

60
Q

HTN in pregnancy definition

A
  • systolic > 140 mmHg or diastolic > 90 mmHg

* or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic

61
Q

HTN in pregnancy DD

A

pre existing HTN:
A history of hypertension before pregnancy or an elevated blood pressure > 140/90 mmHg before 20 weeks gestation
No proteinuria, no oedema
Occurs in 3-5% of pregnancies and is more common in older women

pregnancy induced HTN
Hypertension (as defined above) occurring in the second half of pregnancy (i.e. after 20 weeks)
No proteinuria, no oedema
Occurs in around 5-7% of pregnancies
Resolves following birth (typically after one month). Women with PIH are at increased risk of future pre-eclampsia or hypertension later in life

pre-eclampsia
Pregnancy-induced hypertension in association with proteinuria (> 0.3g / 24 hours)
Oedema may occur but is now less commonly used as a criteria
Occurs in around 5% of pregnancies

62
Q

Urinalysis

A

pH, protein, glucose, nitrites, ketones, leukocytes, erythrocytes/haemoglobin

63
Q

Genital swabs

A

Gynae triple swabs are usually taken to screen for infection in symptomatic women. Most infections should be diagnosed on history and examination with confirmation from the laboratory investigations.

  • Swab 1 “HVS” – High vaginal swab taken in the posterior fornix, testing for TV, BV (“heavy growth of anaerobes”), Candida (& group B Strep) on Stuart’s medium
  • Swab 2 “ECS” – Endocervical swab cultured on Stuart’s medium, looking for gonorrhoea
  • Swab 3 “Chlamydia” – Endocervical swab looking for Chlamydia (intracellular)

Stuart’s medium is an agar and charcoal culture medium – standard medium for most microbiological specimens

Chlamydia is an obligate intracellular parasite so can be identified by PCR (NAATS). The swab needs to be taken in a particular way, 5 rotations in the cervix in the same direction followed by 10 dunks in the appropriate preservative solution.

64
Q

Features of dyskaryosis on smear test

A 
abnormally high nuclear:cytoplasmic ratio, 
abnormal mitotic figures, 
clumping of chromatin, 
pleomorphism, 
abnormal outline of nuclear membrane, 
crowding of cells
65
Q

Menopause

A

the permanent cessation of menstruation resulting from loss of ovarian follicular activity. It occurs at a median age of 51 years. Natural menopause is recognised to have occurred after 12 consecutive months of amenorrhoea.

66
Q

Perimenopause

A

This includes the time beginning with the first features of the approaching menopause, such as vasomotor symptoms and menstrual irregularity, and ends 12 months after the last menstrual period.

67
Q

when does BhCG peak in normal pregnancy

A

12 weeks gestation (when placental growth is complete)

68
Q

HPV linked to what cancers

A
  • over 99.7% of cervical cancers
  • around 85% of anal cancers
  • around 50% of vulval and vaginal cancers
  • around 20-30% of mouth and throat cancers
69
Q

HPV vaccine

A

Girls aged 12-13 years are offered the vaccine in the UK.
Given as 2 doses - girls have the second dose between 6-24 months after the first, depending on local policy

Gardasil protects against HPV 6, 11, 16 & 18, used since 2012.

Introducted in 2008, the initial vaccine, Cervarix, only protected against HPV 16 and 18, leaving high risk of disease burden from genital warts.

Injection site reactions are particularly common with HPV vaccines.

70
Q

Number of deaths in UK prevented from cervical screening

A

1,000-4,000 deaths per year

NB cervical adenocarcinomas, which account for around 15% of cases, are frequently undetected by screening

71
Q

Who is screened and how often?

A
  • 25-49 years: 3-yearly screening
  • 50-64 years: 5-yearly screening

In Scotland women from the ages of 20-60 years are screened every 3 years.

72
Q

How many smears are abnormal?

A

about 5%

73
Q

when do most PEs and DVTs occur

A

2nd week post delivery

74
Q

amniotic fluid embolism PC

A 
dyspnoea
hypotension
hypoxia
seizures
heart failure
75
Q

primary vs secondary PPH

A

primary: >= 550ml blood loss from genital tract within 24 hours of birth.
minor = 500-1000ml, major = >1000ml, severe = >2000ml

secondary = abnormal or excessive bleeding between 24 hours and 12 weeks postnatally.

O+G (5 decks)

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