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NMF: Obs & Gynae > PREGNANCY > Flashcards

PREGNANCY Flashcards

1
Q

What is placenta praevia?

A

low-lying placenta: overlying cervix os

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2
Q

How does placenta praevia present?

A

painless bleeding during late pregnancy or picked up on ultrasound

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3
Q

How do you manage placenta praevia?

A

most will resolve so rescan at 32 and 36 weeks

if not and complete –> c section

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4
Q

2 causes of haemolytic disease of the newborn

A
  • rhesus

- kell

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5
Q

What is sensitivity?

A

ability to identify those with disease

- true positive

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6
Q

What is specificity?

A

abiltiy to identify those without the disease

- true negative

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7
Q

When is the booking visit?

A

around 12 weeks

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8
Q

What investigations are part of the booking visit?

A

check haemoglobin
confirm bood type and rhesus group
screen for STI and BBV - HIV/AIDs, syphilis, hepatitis B and C.
Urinalysis for UTI and diabetes
Culture and sensitivity of mid-stream urine
US

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9
Q

What does an ultrasound at 12 weeks look at?

A
  • confirm viable pregnancy
  • single or multiple pregnancy
  • estimate gestational age
  • detect major structural abnormality

OFFER: down syndrome screening

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10
Q

When is the second ultrasound normally carried out in pregnancy?

A

18-21 weeks

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11
Q

What does FASP screen look for?

A

anencephaly, open spina bifida, cleft lip, gastroschisis, edward’s and patau’s

–> not down’s

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12
Q

What Down’s screening is offered in the first trimester (11-14 weeks)?

A

CUBS (combined ultrasound and biochemical screening)

  • looks at NT, HCG and PAAP-a
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13
Q

What Down’s screening is offered in the second trimester?

A

serum screening

- maternal age and biochemical markers

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14
Q

When can chromosomal diagnostic tests be carried out?

A

amniocentesis after 15 weeks

CVS after 12 weeks

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15
Q

What conditions cause a raised AFP?

A

multiple pregnancy, gastroschisis, spina bifida

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16
Q

When is the initial anti-D given?

A

28 weeks

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17
Q

What does the placenta develop from?

A

trophoblast and decidual tissue

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18
Q

When is the placenta functional?

A

week 5 onwards

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19
Q

What is the role of HCG in pregnancy?

A

prevents corpus luteum from degeneration so progesterone continues to be secreted

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20
Q

What is the role of progesterone in pregnancy?

A

development of decidual cells
decreases uterus contractility
preparation for lactation

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21
Q

What is the role of oestrogen in pregnancy?

A

enlarges uterus
breast development
relaxation of ligaments

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22
Q

What is the estriol level?

A

urinary oestrogen that is an indicator of fetal vitality and wellness
? chromosomal conditions

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23
Q

Which cardiac factors increase in pregnancy?

A

CO
heart rate
blood volume
stroke volume

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24
Q

Which cardiac factors decrease in pregnancy?

A

peripheral resistance

BP in 2nd trimester

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25
Q

Which respiratory factors increase in pregnancy?

A

oxygen demand and consumption
respiratory rate
tidal and minute volume

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26
Q

Which respiratory factors decrease in pregnancy?

A

PCO2

Functional residual capacity (due to diaphragmatic elevation)

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27
Q

Which acid/base disturbance is physiological in pregnancy?

A

respiratory alkalosis

inc ventilation > inc O2 consumption = hyperventilation

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28
Q

What are the 2 stages of metabolism during pregnancy?

A

week 1-20: anabolic, small demand

week 21-40: high demand, starvation

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29
Q

During which part of pregnancy is there insulin resistance?

A

week 21-40 due to HCS, cortisol and growth hormone

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30
Q

Which hormone is HCS and what is its role in pregnancy?

A

human chorionic somatomammotropin

  • growth hormone-like (protein formation)
  • dec insulin sensitivity
  • breast development
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31
Q

During which part of pregnancy can there be increased insulin sensitivity?

A

week 1-20

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32
Q

What is the difference between insulin sensitivity and insulin resistance?

A

insulin sensitivity = interaction of insulin with its receptor, increased sensitivity means they need less insulin to lower blood glucose

insulin resistance = seen in type 2 diabetes where body doesn’t respond to insulin so high blood glucose

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33
Q

What type of hormone is insulin?

A

peptide

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34
Q

How is gestational diabetes diagnosed?

A

2 hour OGTT at 24-28 weeks

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35
Q

What are the diagnosis criteria for gestational diabetes?

A

Fasting glucose ≥ 5.1mmol/l

2 hour level ≥ 8.5mmol/l

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36
Q

What are the diagnosis criteria for normal diabetes?

A

Fasting glucose ≥ 7mmol/l
2 hour level ≥ 11.1mmol/l
HbA1c ≥ 48
Random glucose ≥ 11.1mmol/l

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37
Q

Which hormones increase contractility in labour?

A

oestrogen
oxytocin
mechanical stretch of myometrium and cervix

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38
Q

What controls onset of labour?

A

foetal hromones (oxytocin, adrenal hormones and prostaglandins)

39
Q

What are the 3 stages of labour?

A
  1. cervical dilation (8-24 hours)
  2. passage through birth canal (few to 120 min)
  3. expulsion of placenta
40
Q

Which hormones inhibit milk production?

A

oestrogen and progesterone

41
Q

Which hormone causes enlargement of the mammary glands and stimulates milk production?

A

prolactin

42
Q

Which hormone stimulattes milk ejection?

A

oxytocin

43
Q

In which cardiac conditions should a woman not get pregnant?

A 
pulmonary hypertension
heart failure 3 and 4
cyanosis
TIA/ arrythmia
left heart obstruction
aortic root >45mm
Ejection fraction <40%
44
Q

What additional drug needs to be provided for asthmatic patients who have been on steroids for more than 2 weeks?

A

IV hydrocortisone as their body can’t produce its own

45
Q

If a pregnant woman has had a previous VTE how should she be managed?

A

prophylaxis with LMWH

46
Q

Give risk factors for VTE in pregnancy

A

obesity, age>35, parity>3, smoker, varicose veins, current pre-eclampsia, immobility, first degree relative, low-risk thrombophilia, multiple pregnancy, IVF

47
Q

When is prophylactic LMWH given if a woman has

a) 4 or more risk factors?
b) 3 risk factors?

A

a) first trimester

b) 28 weeks

48
Q

What is Virchow’s triad?

A

hypercoagulability
venous stasis
vascular damage

49
Q

What is anti phospholipid syndrome?

A

Elevated antiphospholipid antibodies cause thromboses and pregnancy-related morbidity

50
Q

Which antibodies are associated with APS?

A

lupus anticoagulant, anticardiolipin antibody, and/or anti-beta2-glycoprotein

51
Q

When should we suspect APS?

A

any young patient with arterial thrombosis.

unexplained venous/arterial events,
foetal death after 10weeks, premature birth due to severe preeclampsia,
unexplained thrombocytopaenia

52
Q

How is APS diagnosed?

A

clinically (any vascular thrombosis or pregnancy morbidity:
≥ 3 miscarriages <10 weeks
≥ 1 fetal loss >10 weeks (morphologically normal fetus)
≥1 preterm birth (<34 weeks) due to PET or utero-placental insufficiency

lab (confirm twice, 6 weeks apart)
IgM/ IgG aCL
LA

53
Q

How is APS treated?

A

with life-long warfarin (LMWH in pregnancy)

also give low dose aspirin in pregnancy

54
Q

When is the placenta the sole source of fetal nutrition?

A

6 weeks - birth

55
Q

What is the cut-off between early and late bleeding in pregnancy?

A

24 weeks

56
Q 
How much blood is lost in 
a) minor
b) major
c) massive 
haemorrhage ?
A

a) <50ml
b) 50-1000ml
c) >1000ml +/- shock

57
Q

What is a couvelaire uterus?

A

a life-threatening condition where the uterus forces into the peritoneal cavity following placental abruption with bleeding into the myometrium

58
Q

What is the normal position of the foetal head in labour?

A

OA

59
Q

How do you manage normal labour with reassuring CTG but meconium stained liquor?

A

reassure and reexamine in 2 hours

60
Q

What supplements should all pregnant women take?

A

folic acid 400mcg and Vitamin D 10mcg daily during pregnancy.
- 5mg folic acid if diabetic, epileptic…

61
Q

What happens to blood pressure in pregnancy?

A

The blood pressure decreases in the second trimester due to the expansions of uteroplacental circulation and decreased peripheral resistance.
it returns to normal by the third trimester

62
Q

What happens to erythropoiesis and haemoglobin in pregnancy?

A

erythropoietin increases by 25%

haemoglobin reduced by dilution

63
Q

What happens to the vital capacity of the lungs in pregnancy?

A

stays the same

64
Q

What is placenta accreta?

A

placenta is abnormally attached to uterine wall. As the placenta does not properly separate during labour there is a risk of post-partum haemorrhage.

65
Q

How do you investigate placenta accreta?

A

MRI

66
Q

What is placental abruption?

A

when the placenta partly or completely separates from the uterine wall before birth

67
Q

How does placental abruption present?

A

continuous, severe abdo pain
bleeding
large, tense uterus

68
Q

How does uterine rupture present?

A 
severe abdominal pain
shoulder tip pain
maternal collapse
PV bleeding 
acute abdomen 
foetal distress
69
Q

Causes of IUGR

A

smoking
IVF
PMH
low maternal BMI

70
Q

When is the fundus normally palpable?

A

12 weeks

71
Q

What is the landmark to administer a pudendal nerve block?

A

ischial spine

72
Q

management for minimal bleeding from suspected mild placental abruption , not in labour, and a normal fetal well being at 32 weeks

A

admit
give steroids
monitor closely

73
Q

risk factors for pre-eclampsia

A 
maternal age >40
multiple pregnancy
family history
first pregnancy
long birth interval
Bilateral abnormalities of Maternal Uterine Artery Doppler waveform at 20 weeks gestation
74
Q

Does pelvic girdle pain in one pregnancy put you at risk of it for subsequent pregnancies?

A

no

75
Q

In Down syndrome what would the expected values be for

a) HCG?
b) PAAP-a?
c) nuchal thickness?
d) estriol?

A

a) high
b) low
c) above 3.5
d) low

76
Q

Treat UTI in pregnancy

A

trimester 1-2: nitrofurantoin

trimester 3: trimethoprim

77
Q

Presentation of mastitis

A

unilateral pain

breast engorgement + erythema in wedge-shaped distribution

78
Q

Sudden collapse after AROM

A

amniotic fluid embolism

79
Q

If urine dip shows ++ proteins, what blood tests are needed to diagnose pre-eclampsia?

A

Full blood count, urea & electrolytes and liver function tests

80
Q

Which condition presents with preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia

A

chorioamnionitis

81
Q

Which oral hypoglycaemic agent can be continued in pregnancy?

A

metformin

82
Q

Investigate placenta praevia

A

transvaginal ultrasound

83
Q

is lithium contraindicated in breast-feeding?

A

yes

84
Q

What is the normal birth weight for a

a) baby born at 28 weeks?
b) term baby?

A

a) 1150g

b) 3550g

85
Q

Which foetal abnormalities are T1DM more at risk of?

A

neural tube defect eg spina bifida

cardiac abnormality

86
Q

What is the normal fundal height?

A

gestation +/-3cm

87
Q

Which antihypertensives can be used in pregnancy?

A

methyldopa, labetalol

nimodipine second line

88
Q

Why are ACE-inhibitors contraindicated in pregnancy?

A

damage to foetal kidneys

89
Q

How can we classify the causes of PPH?

A 
4Ts
tone 
trauma
tissue
thrombin
90
Q

What is Asherman’s syndrome?

A

scar tissue in the uterus

91
Q

What is sheehan’s syndrome?

A

pituitary necrosis due to blood loss

92
Q

How long is labour on average for

a) prim?
b) multi?

A

a) 8

b) 5

93
Q

What weeks are

a) trimester 1?
b) trimester 2?
c) trimester 3?

A

a) 0-12
b) 13-26
c) 27-birth

94
Q

What congenital defect is most linked with t1dm?

A

Neural tube eg spina bifida

NMF: Obs & Gynae (12 decks)

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