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Obstetrics and Gynaecology > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

How many days after fertilisation of an egg does implantation in the uterine wall occur?

A

6 days

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2
Q

What is the typical peak level and time of Beta HCG during pregnancy?

A

120IU/ml at around 10 weeks

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3
Q

What is the difference between miscarriage and stillbirth?

A

Miscarriage before 24 weeks

Stillbirth after 24 weeks (fetus born dead)

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4
Q

Give 3 signs of a miscarriage on USS

A

o No fetal heart activity >7mm crown-rump length on TV scan
o Empty sac
o Empty uterus

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5
Q

Give 3 management options for miscarriage

A

Expectant

Medical with misoprostol

Surgical (Vacuum aspiration under GA or manual vacuum aspiration under local)

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6
Q

Give 3 situations when Anti-D should be given to a Rhesus negative mother

A
  • <12 weeks vaginal bleed and severe pain
  • <12 week medical/surgical management
  • Any potential sensitising event >12 weeks
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7
Q

Give 4 possible causes of miscarriage

A
  • Unexplained
  • Maternal age
  • Fetal chromosomal abnormality
  • Endocrine (PCOS, poorly controlled DM)
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8
Q

Define threatened miscarriage

A

Bleeding with continuing intrauterine pregnancy

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9
Q

Define inevitable miscarriage

A

Bleeding with non-continuing intrauterine pregnancy

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10
Q

Define incomplete miscarriage

A

Incomplete passage of pregnancy tissue

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11
Q

Define complete miscarriage

A

All pregnancy tissue expelled, uterus now empty

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12
Q

Define delayed/missed miscarriage

A

Fetus has died in-utero prior to 24 weeks gestation

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13
Q

Give 4 risks of an ectopic pregnancy

A
  • Previous ectopic
  • Pelvic infection
  • Pelvic surgery
  • Endometriosis
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14
Q

How may an ectopic pregnancy present (needs to have a + pregnancy test)

A 
o	Asymptomatic 
o	Vaginal bleeding 
o	Pelvic discomfort or pain 
o	Pain when opening bowels 
o	Maternal collapse/hypovolaemic shock
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15
Q

How may an ectopic pregnancy be examined?

A
  • Assess pain and bleeding
  • Bimanual exam
  • Vaginal swabs?
  • Examine POC
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16
Q

Give 3 ways a non-emergency ectopic pregnancy may be managed

A
  • Conservative
  • Medical (methotrexate)
  • Surgical (Salpingostomy/salpingectomy)
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17
Q

Give 3 criteria for the management of an ectopic with methotrexate

A
  • Pain free
  • HCG <5000
  • Unruptured <35mm
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18
Q

Define gestational trophoblastic disease

A

Abnormal proliferation of trophoblastic tissue with production of HCG

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19
Q

Define a partial hydatidiform mole

A

63 chromosome, 2 sperm, 1 egg

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20
Q

Define a complete hydatidiform mole

A

46 chromosome, all father, empty ovum

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21
Q

Give 2 risks of a molar pregnancy

A
  • Extremes of maternal age (<20, >40)

- Previous molar pregnancy

22
Q

Give 3 signs and symptoms of a molar pregnancy

A

PV bleeding
Enlarged uterus
Early onset pre-eclampsia

23
Q

What is the typical appearance of a molar pregnancy on USS?

A

Snowstorm appearance

24
Q

Where are molar pregnancies followed up?

A

Dundee specialist centre

25
Define hyperemesis gravidarum
Vomiting in pregnancy causing weight loss (>5% body mass) and ketosis
26
Give 4 Tx options in the management of hyperemesis gravidarum
- Oral intake/dietary advice - IV fluids - Antiemetics - Thromboprophylaxis
27
Give 3 risks of having a multiple pregnancy
IVF Maternal age West African
28
What does a lambda sign on USS show?
Dichorionic, diamniotic twins
29
What does a T sign on USS show?
Monochorionic, diamniotic twins
30
Give 3 maternal risks of a multiple pregnancy
Hyperemesis Pre-eclampsia Gestational diabetes
31
Give 2 risks of a multiple pregnancy to the fetus
Miscarriage | Congential anomoly
32
How often are DC twins monitored?
4 weekly USS from 24 weeks
33
How often are MC twins monitored?
2 weekly from 16 weeks
34
Define acute transfusion in MC twins
Death of twin 1 in utero = risk of hypoxic-ischaemic injury to survivor because of acute transfusion from healthy to dying twin
35
Define twin to twin transfusion syndrome in MC twins
Chronic net shunting from 1 twin to the other = - 1 growth restricted donor - 1 polyuric recipient
36
Give 2 treatment options for twin to twin transfusion syndrome
Fetoscopic laser ablation of anastomoses Cord occlusion
37
Define twin reversed arterial perfusion syndrome (TRAPS)
2 cords linked by big arterio-arterial anastomosis causing retrograde perfusion Pump twin and acardiac twin
38
How is TRAPS managed?
Ablation of anastomoses
39
What are the steps of DR C BRAVADO in reading a CTG?
Dr: define risk C: contractions ``` Bra: Baseline rate V: variability A: accelerations D: decelerations O: overall risk ```
40
Which two hormones increased during pregnancy, after fertilisation?
Oestrogen and Progesterone
41
At which point in pregnancy does HCG generally peak?
12 weeks
42
How does the RAAS system affect urine output in pregnancy?
Increased RAAS activity causes increased plasma volume, increasing GFR and UO
43
Which female hormone stimulates angiotensin production in the liver?
Oestrogen
44
What happens to platelet levels overall in pregnancy?
Decrease
45
What is physiological anaemia of pregnancy?
Dilutional anaemia due to increased plasma volume
46
What effect do oestrogen and progesterone have on blood vessels?
Vasodilation
47
What causes a split 1st heart sound in pregnancy?
Normally M and T close at the same time causing S1 but a bigger LV muscle causes Mitral to close before Tricuspid
48
What is an early S3 heart sound in pregnancy caused by?
Early ventricular filling due to more blood volume
49
Which metabolic abnormality can be seen during pregnancy?
Respiratory alkalosis due to increased arterial O2 and decreaed CO2
50
Give 3 things which calcium is important for in pregnancy
- Placenta - Endometrial stabilisation - Milk production
51
Give 2 GI effects of progesterone relaxing smooth muscle in pregnancy
Less peristalsis = constipation Oesophageal sphincter relaxation = heartburn

Obstetrics and Gynaecology (10 decks)

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