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Sexual and Reproductive Health > Pregnancy > Flashcards

Pregnancy Flashcards

1
Q

Name causes of being large for dates

A 
Diabetes
Wrong dates
Polyhydramnios
Multiple pregnancies 
Constitutionally large
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2
Q

Define polyhydramnios

A

excessive amniotic fluid AFI >25cm, DVP >8cm

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3
Q

What are causes of polyhydramnios?

A 
Fetal anomaly
Monochorionic twin pregnancy
Rh iso immunisation
viral infection 
idiopathic
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4
Q

What are the symptoms/signs of polyhydramnios?

A 
feeling like bursting 
abdominal discomfort
cord prolapse 
preterm labour
SoB
unable to lie flat 
tense shiny abdomen 
inability to feel fatal parts
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5
Q

How is polyhydramnios diagnosed?

A

USS
AFI >25cm
DVP >8cm
is subjective

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6
Q

What investigations should be completed in a suspected polyhydramnios?

A

OGTT
serology: viruses (CMV, toxoplasmosis)
antibody screen
USS: fetal survey - lips/stomach - make sure there is a patent oesophagus

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7
Q

How is polyhydramnios managed?

A

regular USS and maternal observation
IOL by 40 weeks
prepare for labour (pre-term, cord prolapse, PPH)

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8
Q

Name risk factors for multiples

A

African descent
family hx
increased parity/maternal age
tall women > small women

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9
Q

How are twins categorised?

A

Monozygotic/dizygotic

by chorionicity and amniotic sacs

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10
Q

Name the different types of twin

A

Dizygotic - DCDA

Monozygotic
DCDA - 1/3
MCDA - 2/3
MCMA - ~1%

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11
Q

If an embryo splits after 15 days what type of twin will result?

A

conjoined

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12
Q

If an embryo splits after 1-3 days what type of twin will result?

A

DCDA

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13
Q

If an embryo splits after 4-8 days what type of twin will result?

A

MCDA

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14
Q

If an embryo splits after 8-13 days what type of twin will result?

A

MCMA

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15
Q

How is chorionicity determined?

A 
USS 
first fetal sex 
Shape and thickness of membrane 
- (lambda sign DCDA)
- T sign MCDA
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16
Q

How do women with multiple pregnancies present?

A

Normally
With exaggerated symptoms (sickness) - hyperemesis gravidarum

serum high AFP
large for dates uterus

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17
Q

If having twins/multiple births who monitors antenatal care/

A

Consultant led care

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18
Q

If having monochorionic twins how often are appointments?

A

every 2 weeks from 16/40

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19
Q

If having dichorionic twins how often are appointments?

A

every 4 weeks

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20
Q

How are MCMA twins delivered?

A

By c-section

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21
Q

How are DCDA twins delivered?

A

try vaginally at 37/38 weeks

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22
Q

How are triplets delivered?

A

c-section

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23
Q

How are MCDA twins delivered?

A

After 36+0 weeks with steroids

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24
Q

If you suspect a women has GDM what investigation should be carried out and when?

A

OGTT
24-28weeks
can be done in first trimester but if normal recheck 24-28 weeks

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25
Q

What is rhesus haemolytic disease?

A

Rh +’ve baby
Rh -‘ve mother
sensitisation then future pregnancies are attacked by maternal antibodies

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26
Q

In Rhesus haemolytic disease if antibodies cross the placenta what can happen to the baby?

A

Breakdown of RBC’s

  • anaemia
  • hyperbilirubinaemia
  • congestive cardiac failure
  • hepato-splenomegaly
  • fetal death
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27
Q

When is rhesus disease screened for?

A

12 weeks

@booking appointment

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28
Q

In a rhesus negative mother, when do we give anti-d (IgG)?

A

28 and 34 weeks

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29
Q

What investigation do we run to check enough anti-d has been given?

A

Kleihauer

is positive if maternal and fetal blood has mixed

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30
Q

What investigation tells you whether a mother is sensitised to rhesus?

A

indirect coombs

positive: sensitised
negative: not sensitised

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31
Q

What does anti-d do?

A

Prevents a mother making rhesus antibodies

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32
Q

How many units of anti-d do we use if the mother is less than 20 weeks gestation?

A

250 units

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33
Q

How many units of anti-d do we use if the mother is more than 20 weeks gestation?

A

500 units + Kleihauer test

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34
Q

When can anti-d not be used?

A 
If the mother has been sensitised (coombs positive)
so only give if:
mother negative 
baby +'ve
coombs negative
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35
Q

What is the definition of miscarriage?

A

spontaneous loss of pregnancy before 24 weeks

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36
Q

Define a threatened miscarriage

A

bleeding with maintenance of viability (closed cervix)

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37
Q

Define an inevitable miscarriage

A

fetus still alive but miscarriage has commenced as cervix has opened and POC are beginning to pass
death of fetes inevitable
cervix open

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38
Q

Define an incomplete miscarriage

A

miscarriage has commenced with fetus lost and the passage of POC not yet completed
cervix open

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39
Q

Define a complete miscarriage

A

passage of all POC

cervix closed

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40
Q

Define a missed miscarriage

A

Fetus has died but remains in uterus

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41
Q

Define a septic miscarriage

A

infection of a missed/incomplete miscarriage

42
Q

Define recurrent miscarriage

A

3 or more miscarriages <24 weeks gestation

43
Q

What are causes of recurrent miscarriage?

A 
PCOS
anti-phospholipid syndrome 
uterine abnormalities 
thrombophilia 
parental chromosome abnormalities
44
Q

What is the management for a septic miscarriage?

A

Dilatation and curettage

45
Q

What are causes of a septic miscarriage?

A

chlamydia

non-sterile abortion attempt

46
Q

What is an ectopic pregnancy?

A

implantation of a fertilised ovum outwith the uterine cavity

47
Q

What are common sites of implantation of an ectopic pregnancy?

A 
ampulla of fallopian tube
fallopian tube 
ovary
cervix
myometrium (interstitial)
48
Q

How does an ectopic pregnancy occur?

A 
anything that slows  travel of ovum 
endometriosis 
tubal damage (surgery/prev ectopic)
tubal inflammation (PID from STI, chlamydia/gonorrhoea)
IUCD - normally copper coil 
congenital abnormalities of the tubes
49
Q

What is the definition of a term baby?

A

37-42 weeks

50
Q

What is the definition of a moderate preterm baby?

A

32-36+6 weeks

51
Q

What is the definition of a very preterm baby?

A

28-36+1 weeks

52
Q

What is the definition of an extremely preterm baby?

A

<28 weeks

youngest surviving preterm infant was 23 weeks

53
Q

What does a large birthweight baby weigh?

A

> 4000g

54
Q

What does a normal birthweight baby weigh?

A

3500-4000g

55
Q

What does a low birthweight baby weigh?

A

<2500g

56
Q

What does a very low birthweight baby weigh?

A

<1500g

57
Q

What does an extremely low birthweight baby weigh?

A

<1000g

58
Q

In pregnancy a mother needs an extra ____ calories per day

A

250-300

85% due to fetal metabolism
15% stored as maternal fat

59
Q

What increases contractions and excitability?

A

oxytocin

60
Q

Where is oxytocin produced?

A

posterior pituitary

61
Q

What is the ferguson reflex?

A

where the cervix is stretched and oxytocin released which then causes further stretch of the cervix and activation of the reflex
Seen until delivery is achieved

62
Q

Describe the frequency of contractions

A

initially every 10-15 minutes
increase in frequency throughout labour
@ peak the number of contractions is 3/4 every 10 minutes

63
Q

How long does each contraction last?

A

initially 10-15 seconds

maximum length 60 seconds

64
Q

Oxytocin causes uterine contraction and what else?

A

placenta to make and release prostaglandins

65
Q

How is the diagnosis of labour made?

A

strong uterine contractions resulting in progressive changes in the cervix (dilation and effacement)

Is not diagnostic but usually happens at the same time: rupture of membranes (either spontaneous or via a sweep)

66
Q

Induction of labour is indicated when?

A

> 41 weeks
premature rupture of membranes
HTN, diabetes, cholestasis of pregnancy, APH, deteriorating illness
Social reasons

IUGR
Macrosomia

67
Q

What are the different methods of induction of labour?

A

membrane sweep
artificial rupture of membranes
topical prostaglandin to the cervix
IV syntocinin (membranes should be ruptured before use)

68
Q

The time from full dilation to delivery varies on parity and use of anaesthesia, what are the acceptable times in different situations?

A

nulli, w anaesthesia - 3 hours
nulli, w/o anaesthesia - 2 hours
multi, w anaesthesia - 2 hours
multi, w/o anaesthesia - 1 hour

(maximal acceptable time)

69
Q

There are 3 stages of labour, what are they?

A

Dilation/Effacement
Latent 0-4cm
Active 4-10cm

Delivery
Delivery of the placenta

70
Q

How long after the baby is born should the placenta be delivered?

A

expectant management: 60 mins
active management: > 30 mins
active mg includes: syntocinin, ergometrine, controlled cord traction

71
Q

What is the most common cause of PPH?

A

uterine atony

72
Q

Name some non-pharmacological methods of pain relief in labour?

A

massage
aromatherapy
waterbirth
TENS machine

73
Q

Name some pharmacological methods of pain relief in labour?

A

entonox (gas and air)
opiates - pethidine or diamorphine
epidural - LA/opioid mix

74
Q

What is the most effective form of pain relief in labour?

A

epidural

75
Q

How long after an epidural is given does it become effective?

A

20-30 minutes

can be topped up if needed

76
Q

What are the disadvantages of an epidural?

A

slows the 2nd stage of labour
increases the chance of malpresentation
increases risk of operational vaginal delivery
mother can’t lie flat: it will increase the aorta-caval compression

77
Q

What are the side effects of an epidural?

A 
maternal:
headache 
urinary retention 
high block 
hypotension (20%)
dural puncture (1%)

fetal:
increased risk of distress
if maternal hypotension persists give IV fluids and ephedrine

78
Q

Where is an epidural given?

A

L3/4 space

into the epidural space

79
Q

What is the difference between braxton-hicks contractions and true labour?

A

Braxton hicks
irregular
don’t increase in frequency or intensity
resolve with ambulation (walking) or change of position
relatively painless

80
Q

What are the different types of breech?

A

footling - one or both feet so legs emerge 1st
complete - legs folded with feet at bottom
frank- MOST COMMON
legs point up with feet by head so the bottom emerges 1st

81
Q

What are the complications associated with breech presentation?

A

cord prolapse

theres not the same plug at the cervix when the feet are there instead of the head

82
Q

Wha is the commonest cause of labour not progressing?

A

suboptimal flexion of the babies head

83
Q

What are the drugs used in an epidural?

A

Local Anaesthetic and opiate

levobubivacaine +/- opiate

84
Q

How do we assess progress in labour?

A

Partogram

should progress 2cm in 4 hours

85
Q

How to we asses fetal distress?

A

CTG assessment

86
Q

What are the 5 parts of the CTG that we assess?

A 
Baseline HR 
Variability 
Accelerations 
Decelerations 
Recording of contractions
87
Q

What is a normal variability in HR on a CTG?

A

5-25 BPM

88
Q

What is a reduced variability in HR on a CTG and what does it suggest?

A

<5BPM
if <40 mins - the baby is sleeping
that the baby isn’t getting oxygenated

89
Q

What is a saltatory pattern in variability on a CTG and what does it suggest?

A

> 25 BPM variability

sign that the baby is hypoxic

90
Q

What does complete loss of variability in HR on a CTG mean?

A

pathological

ominous sign

91
Q

What is an acceleration on a CTG?

A

15 beats above the baseline for at least 15 seconds

92
Q

What is a deceleration on a CTG?

A

abrupt decrease in the baseline fetal heart rate of greater than 15 bpm for greater than 15 seconds

93
Q

What is more pathological early decelerations or late?

A

Late

94
Q

What are early decelerations?

And why do they happen?

A

Early decelerations start when the uterine contraction begins and recover when uterine contraction stops.

This is due to increased fetal intracranial pressure causing increased vagal tone.
physiological and not pathological

95
Q

What are the 3 types of decelerations?

A

early, variable, late

96
Q

What are variable decelerations?

A

rapid fall in baseline fetal heart rate with a variable recovery phase
variable in their duration and may not have any relationship to uterine contractions

97
Q

Where are variable decelerations seen?

A

Variable decelerations are usually caused by umbilical cord compression:

The umbilical vein is often occluded first causing an acceleration in response.
Then the umbilical artery is occluded causing a subsequent rapid deceleration.
When pressure on the cord is reduced another acceleration occurs and then the baseline rate returns.

THEREFORE WE SEE SHOULDERING OF DECELERATIONS

98
Q

What are late decelerations and what does it indicate?

A

Late decelerations begin at the peak of the uterine contraction and recover after the contraction ends.

This type of deceleration indicates there is insufficient blood flow to the uterus and placenta.

As a result, blood flow to the fetus is significantly reduced causing fetal hypoxia and acidosis.

99
Q

What is the recommended drug regimen for women trying to conceive?

A

400mcg folic acid
10mcg vitamin D

until 12 weeks pregnant

100
Q

What is the recommended drug regimen for women with diabetes trying to conceive?

A

5mg folic acid
10mcg vitamin D

until 12 weeks pregnant

Sexual and Reproductive Health (9 decks)

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