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OBGYN > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Risk factors for ectopic pregnancy

A

Previous ectopic pregnancy
Previous PID
Previous fallopian tube surgery
IUD
Older age
Smoking

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2
Q

Features of ectopic pregnancy

A

Missed period
Constant lower abdominal pain
Vaginal bleeding
Pelvic tenderness
Cervical motion tenderness
Dizziness
Syncope
Shoulder tip pain

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3
Q

Transvaginal ultrasound findings in ectopic pregnancy

A

Gestational sac outside of uterus
Bagel sign
Empty uterus
Fluid in uterus

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4
Q

hCG changes in 48hr and indications

A

Rise of >63% = intrauterine pregnancy
Rise of <63% = ectopic pregnancy
Fall of >50% = miscarriage

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5
Q

Management options for ectopic pregnancy

A

Expectant management
Medical management - Methotrexate
Surgical management - Salpingectomy/salpingotomy

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6
Q

Criteria for expectant management of ectopic pregnancy

A

Follow up possible
Ectopic is unruptured
Adnexal mass <35mm
No visible heartbeat
No significant pain
HCG <1500

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7
Q

Criteria for medical management of ectopic pregnancy

A

Unruptured ectopic
Adnexal mass <35mm
No visible heartbeat
No significant pain
HCG <5000
Confirmed absence of intrauterine pregnancy on US

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8
Q

Side effects of methotrexate

A

Vaginal bleeding
Nausea & vomiting
Abdominal pain
Stomatitis

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9
Q

Criteria for surgical management of ectopic pregnancy

A

Pain
Adnexal mass >35mm
Visible heart beat
HCG >5000

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10
Q

1st line surgical management of ectopic pregnancy

A

Laparoscopic salpingectomy

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11
Q

When would an ectopic pregnancy be managed with laparoscopic salpingotomy

A

To preserve fertility

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12
Q

Features of threatened miscarriage

A

Vaginal bleeding with closed cervical os, viable pregnancy on US

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13
Q

Features of inevitable miscarriage

A

Vaginal bleeding with open cervical os

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14
Q

Features of incomplete miscarriage

A

Retained products of conception in the uterus after the miscarriage

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15
Q

US features to determine pregnancy viability

A

Mean gestation sac diameter
Fetal pole & crown-rump length
Fetal heartbeat

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16
Q

At what crown-rump length would a fetal heartbeat be expected

A

7mm

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17
Q

At what mean gestational sac diameter would a fetal pole be expected

A

25mm

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18
Q

Management of miscarriage at less than 6 weeks gestation

A

Expectant management
Urine pregnancy test after 7-10 days

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19
Q

Medical management of miscarriage

A

Misoprostol - expedites process

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20
Q

Side effects of misoprostol

A

Heavier bleeding
Pain
Vomiting
Diarrhoea

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21
Q

Surgical management of miscarriage

A

Manual vacuum aspiration - LA
Electric vacuum aspiration - GA

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22
Q

Which medications are used for medical abortion

A

Mifepristone - halts pregnancy
Misoprostol - pregnancy expulsion

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23
Q

Two options for surgical abortion

A

Cervical dilatation & suction of the contents of the uterus (up to 14 weeks)
Cervical dilatation & evacuation using forceps (14-24 weeks)

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24
Q

Complications of abortion

A

Bleeding
Pain
Infection
Failure of abortion
Damage to cervix, uterus or other structures

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25
Q

When does nausea & vomiting occur during pregnancy

A

Weeks 4-20

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26
Q

Criteria for diagnosing Hyperemesis Gravidarum

A

> 5% weight loss during pregnancy
Dehydration
Electrolyte imbalance

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27
Q

Management of hyperemesis gravidarum

A

Prochlorperazine
Cyclizine
Ondansetron
Metoclopramide
Ranitidine
Omeprazole

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28
Q

When should a hyperemesis gravidarum patient be admitted

A

Unable to tolerate oral anti-emetics
Unable to keep down fluids
Ketones in urine

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29
Q

What is a complete molar pregnancy

A

Two sperm cells fertilise an ovum with no genetic material, making a tumour of combined sperm genetic material

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30
Q

What is a partial molar pregnancy

A

Two sperm cells fertilise a normal ovum creating 3 sets of chromosomes. Some fetal tissue may form

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31
Q

Features of molar pregnancy

A

Severe morning sickness
Vaginal bleeding
Enlargement of the uterus
Abnormally high hCG
Thyrotoxicosis
Snowstorm appearance on US

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32
Q

Management of molar pregnancy

A

Evacuation of uterus
Referral to gestational trophoblastic disease centre

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33
Q

Features of fetal alcohol syndrome

A

Microcephaly
Thin upper lip
Smooth flat philtrum
Short palpebral fissure
Learning disability
Behavioural difficulties
Hearing & vision problems
Cerebral palsy

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34
Q

Smoking during pregnancy increases risk of:

A

Fetal growth restriction
Miscarriage
Stillbirth
Preterm labour & delivery
Placental abruption
Pre-eclampsia
Cleft lip/palate
Sudden infant death syndrome

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35
Q

Ideally, when does booking clinic occur

A

Before 10 weeks gestation

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36
Q

What is tested for in booking bloods

A

Blood group
Antibodies
Rhesus D status
FBC
Thalassaemia
Sickle cell
Offered screening for HIV, Hep B & Syphilis

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37
Q

Tests available for antenatal Down’s syndrome screening

A

Combined test (1st line @ 11-14 weeks)
Triple test (14-20 weeks)
Quadruple test (14-20 weeks)

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38
Q

What is involved in the Combined Test for Down’s syndrome

A

US for nuchal translucency (>6mm in Down’s)
beta-HCG
PAPPA

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39
Q

What is involved in the Triple Test for Down’s syndrome

A

beta HCG
AFP
Serum oestriol

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40
Q

What is involved in the Quadruple Test for Down’s syndrome

A

beta HCG
AFP
Serum oestriol
Inhibin-A

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41
Q

What changes to Levothyroxine during pregnancy

A

Increase dose

42
Q

Which hypertension medications must be stopped during pregnancy

A

ACEi
ARBs
Thiazides/thiazide-like diuretics

43
Q

Side effects of NSAID usage during pregnancy

A

Premature closure of ductus arteriosus
Delay of labour

44
Q

Side effects of beta blockers used during pregnancy

A

Fetal growth restriction
Hypoglycaemia in the neonate
Bradycardia in the neonate

45
Q

Side effects of ACEi/ARB usage during pregnancy

A

Oligohydramnios
Miscarriage/fetal death
Hypocalvaria
Renal failure in the neonate
Hypotension in the neonate

46
Q

Side effects of Warfarin usage during pregnancy

A

Fetal loss
Congenital malformations
Craniofacial problems
Bleeding during pregnancy
Postpartum haemorrhage
Fetal haemorrhage

47
Q

When are anti-D injections given

A

28 weeks gestation
Birth if baby is rhesus positive
Antepartum haemorrhage
Amniocentesis procedures
Abdominal trauma

48
Q

What are babies at risk of i there is rhesus incompatibility

A

Haemolytic disease of the newborn

49
Q

What measurements are used to assess fetal size

A

Estimated fetal weight
Fetal abdominal circumference

50
Q

Causes of small for gestational age

A

Constitutionally small
Fetal growth restriction

51
Q

Causes of placenta mediated fetal growth restriction

A

Idiopathic
Pre-eclampsia
Maternal smoking
Maternal alcohol
Anaemia
Malnutrition
Infection
Maternal health conditions

52
Q

Non placenta mediated causes of fetal growth restriction

A

Genetic abnormalities
Structural abnormalities
Fetal infection
Errors of metabolism

53
Q

Signs of fetal growth restriction

A

Small for gestational age
Reduced amniotic fluid volume
Abnormal Doppler studies
Reduced fetal movements
Abnormal CTG

54
Q

Short term complications of fetal growth restriction

A

Fetal death / stillbirth
Birth asphyxia
Neonatal hypothermia
Neonatal hypoglycaemia

55
Q

Long term risks for growth restricted babies

A

Hypertension
Type 2 diabetes
Obesity
Mood & behavioural problems

56
Q

Risk factors for SGA baby

A

Previous SGA baby
Obesity
Smoking
Diabetes
Existing hypertension
Pre-eclampsia
Older mother
Multiple pregnancy
Low PAPPA
Antepartum haemorrhage
Antiphospholipid syndrome

57
Q

Monitoring of those at risk of SGA

A

Serial US scans measuring:
- estimated fetal weight & abdominal circumference
- Umbilical arterial pulsatility index
- Amniotic fluid volume

58
Q

Causes of large for gestational age

A

Constitutional
Maternal diabetes
Previous LGA
Maternal obesity
Overdue
Male baby

59
Q

Risks of large for gestational age babies

A

Shoulder dystocia
Failure to progress
Perineal tears
Instrumental delivery
Caesarean
Postpartum haemorrhage
Uterine rupture
Erbs palsy
Neonatal hypoglycaemia
Obesity in childhood
Type 2 diabetes in adulthood

60
Q

Management of LGA baby

A

Delivery by experienced midwife or obstetrician
Access to theatre
Active management of 3rd stage
Early decision for caesarean section
Paediatrician to attend birth

61
Q

Types of multiple pregnancy

A

Monozygotic - identical twins, single zygote
Dizygotic - non identical, different zygote
Monoamniotic - Single amniotic sac
Diamniotic - Two separate amniotic sacs
Monochorionic - single shared placenta
Dichorionic - two separate placentas

62
Q

Risks to the mother associated with multiple pregnancy

A

Anaemia
Polyhydramnios
Hypertension
Malpresentation
Spontaneous pre-term birth
Instrumental delivery
Postpartum haemorrhage

63
Q

Risks to fetuses/neonates associated with multiple pregnancy

A

Miscarriage
Stillbirth
Fetal growth restriction
Prematurity
Twin-twin transfusion syndrome
Twin anaemia polycythaemia sequence
Congenital abnormalities

64
Q

What is twin-twin transfusion syndrome

A

Fetuses share a placenta, one twin receives the majority of the blood. The twin with more blood becomes fluid overloaded with heart failure & polyhydramnios. The donor has growth restriction, anaemia & oligohydramnios

65
Q

When do you aim to deliver monoamniotic twins

A

32 + 6 weeks, elective c section

66
Q

When do you aim to deliver diamniotic twins

A

37 + 6 weeks

67
Q

Pre-eclampsia triad

A

Hypetension
Proteinuria
Oedema

68
Q

High risk factors for pre-eclampsia

A

Pre-existing hypertension
Previous hypertension in pregnancy
Autoimmunity
Diabetes
CKD

69
Q

Moderate risk factors for pre-eclampsia

A

> 40yrs
BMI >35
More than 10 years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history

70
Q

When are women offered aspirin in pregnancy

A

From 12 weeks gestation if 1 high risk factor for pre-eclampsia or 2 moderate risk factors

71
Q

Symptoms of pre-eclampsia

A

Headache
Visual disturbance
Nausea & vomiting
Upper abdominal pain
Oedema
Reduced urine output
Brisk reflexes

72
Q

Management of pre-eclampsia

A

Aspirin from 12 weeks gestation
Routine screening & monitoring
1st - Labetalol
2nd - Nifedipine
IV magnesium sulphate during labour & following 24hrs

73
Q

What is HELLP syndrome

A

Haemolysis
Elevated liver enzymes
Low platelets

74
Q

Risk factors for gestational diabetes

A

Previous gestational diabetes
Previous macrosomic baby
BMI >30
Black Caribbean, Middle Eastern or South Asian ethnities
Family history of diabetes

75
Q

Management of gestational diabetes

A

Diet & exercise
Metformin
Insulin

76
Q

Risks to baby associated with maternal diabetes

A

Neonatal hypoglycaemia
Polycythaemia
Jaundice
Congenital heart disease
Cardiomyopathy

77
Q

When does obstetric cholestasis typically occur

A

After 28 weeks

78
Q

Symptoms of obstetric cholestasis

A

Itching - particularly palms & soles
Fatigue
Dark urine
Pale, greasy stool
Jaundice

79
Q

Investigation results in obstetric cholestasis

A

Abnormal ALT, AST & GGT
Raised bile acids

80
Q

Management of obstetric cholestasis

A

Ursodeoxycholic acid
Emollients
Water-soluble vitamin K

81
Q

Risks associated with placenta praevia

A

Antepartum haemorrhage
Emergency C section
Emergency hysterectomy
Maternal anaemia
Preterm birth
Low birth weight
Stillbirth

82
Q

Grades of placenta praevia

A

I - Placenta in lower uterus, does not reach cervical os
II - Placenta reaches, but does not cover cervical os
III - Placenta partially covers cervical os
IV - Placenta completely covers cervical os

83
Q

Risk factors for placenta praevia

A

Previous C section
Previous placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities
Assisted reproduction

84
Q

When is placenta praevia usually noticed

A

20 week abnormality scan

85
Q

Management of placenta praevia

A

Corticosteroids given between weeks 34 - 35+6
Planned delivery between 36 & 37 weeks

86
Q

What is vasa praevia

A

The fetal vessels cover the internal cervical os

87
Q

Risk factors for vasa praevia

A

Low lying placenta
IVF pregnancy
Multiple pregnancy

88
Q

Management of vasa praevia

A

Corticosteroids from 32 weeks
Elective C section 34-36 weeks

89
Q

Risk factors for placental abruption

A

Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine/amphetamine use

90
Q

Presentation of placental abruption

A

Sudden onset severe abdominal pain
Vaginal bleeding
Shock
Fetal distress on CTG
Woody abdomen on palpation

91
Q

Management of placental abruption

A

Urgent involvement of senior obstetrician, senior midwife & anaesthetist
CTG fetus monitoring
Crossmatch 4 units
Fluid & blood rescucitation
Prepare for potential emergency c-section

92
Q

Types of placenta accreta

A

Superficial - placenta implants in the surface of the myometrium
Placenta increta - Placenta attaches deeply into the myometrium
Placenta percreta - Placenta invades past the myometrium & perimetrum

93
Q

Risk factors for placenta accreta

A

Previous placenta accreta
Previous endometrial curettage procedures
Previous c section
Multigravida
Increased maternal age
Low-lying placenta

94
Q

Management of placenta accreta

A

Planned c section between 35 to 36.6 weeks

95
Q

Types of breech presentation

A

Complete breech - legs fully flexed at hip & knee
Incomplete breech - one leg flexed at hip & extended at knee
Extended breech - both legs flexed at the hip & extended at the knee
Footling breech - Foot presents through cervix with leg extended

96
Q

Management of breech presentation

A

External cephalic version at 37 weeks
Discuss c section vs vaginal delivery

97
Q

What pharmacological agent is used for tocolysis

A

SC terbutaline

98
Q

Causes of stillbirth

A

Unexplained in around 50%
Pre-eclampsia
Placental abruption
Vasa praevia
Cord prolapse or wrapped around fetal neck
Obstetric cholestasis
Diabetes
Thyroid disease
Infections (rubella, parvovirus, listeria)
Congenital malformation

99
Q

Risk factors for stillbirth

A

Fetal growth restriction
Smoking
Alcohol
Increased maternal age
Maternal obesity
Twins
Sleeping on the back

100
Q

Red flag symptoms during pregnancy

A

Reduced fetal movements
Abdominal pain
Vaginal bleeding

OBGYN (5 decks)

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