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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
Q

Define hyperemesis gravidarum

A

Vomiting in pregnancy causing weight loss (>5% body mass) and ketosis

26
Q

Give 4 Tx options in the management of hyperemesis gravidarum

A
  • Oral intake/dietary advice
  • IV fluids
  • Antiemetics
  • Thromboprophylaxis
27
Q

Give 3 risks of having a multiple pregnancy

A

IVF
Maternal age
West African

28
Q

What does a lambda sign on USS show?

A

Dichorionic, diamniotic twins

29
Q

What does a T sign on USS show?

A

Monochorionic, diamniotic twins

30
Q

Give 3 maternal risks of a multiple pregnancy

A

Hyperemesis
Pre-eclampsia
Gestational diabetes

31
Q

Give 2 risks of a multiple pregnancy to the fetus

A

Miscarriage

Congential anomoly

32
Q

How often are DC twins monitored?

A

4 weekly USS from 24 weeks

33
Q

How often are MC twins monitored?

A

2 weekly from 16 weeks

34
Q

Define acute transfusion in MC twins

A

Death of twin 1 in utero = risk of hypoxic-ischaemic injury to survivor because of acute transfusion from healthy to dying twin

35
Q

Define twin to twin transfusion syndrome in MC twins

A

Chronic net shunting from 1 twin to the other =

  • 1 growth restricted donor
  • 1 polyuric recipient
36
Q

Give 2 treatment options for twin to twin transfusion syndrome

A

Fetoscopic laser ablation of anastomoses

Cord occlusion

37
Q

Define twin reversed arterial perfusion syndrome (TRAPS)

A

2 cords linked by big arterio-arterial anastomosis causing retrograde perfusion

Pump twin and acardiac twin

38
Q

How is TRAPS managed?

A

Ablation of anastomoses

39
Q

What are the steps of DR C BRAVADO in reading a CTG?

A

Dr: define risk

C: contractions

Bra: Baseline rate 
V: variability
A: accelerations
D: decelerations
O: overall risk
40
Q

Which two hormones increased during pregnancy, after fertilisation?

A

Oestrogen and Progesterone

41
Q

At which point in pregnancy does HCG generally peak?

A

12 weeks

42
Q

How does the RAAS system affect urine output in pregnancy?

A

Increased RAAS activity causes increased plasma volume, increasing GFR and UO

43
Q

Which female hormone stimulates angiotensin production in the liver?

A

Oestrogen

44
Q

What happens to platelet levels overall in pregnancy?

A

Decrease

45
Q

What is physiological anaemia of pregnancy?

A

Dilutional anaemia due to increased plasma volume

46
Q

What effect do oestrogen and progesterone have on blood vessels?

A

Vasodilation

47
Q

What causes a split 1st heart sound in pregnancy?

A

Normally M and T close at the same time causing S1 but a bigger LV muscle causes Mitral to close before Tricuspid

48
Q

What is an early S3 heart sound in pregnancy caused by?

A

Early ventricular filling due to more blood volume

49
Q

Which metabolic abnormality can be seen during pregnancy?

A

Respiratory alkalosis due to increased arterial O2 and decreaed CO2

50
Q

Give 3 things which calcium is important for in pregnancy

A
  • Placenta
  • Endometrial stabilisation
  • Milk production
51
Q

Give 2 GI effects of progesterone relaxing smooth muscle in pregnancy

A

Less peristalsis = constipation

Oesophageal sphincter relaxation = heartburn

Obstetrics and Gynaecology (10 decks)

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