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Gynaecology, Obstetrics and Sexual Health > Pregnancy and pregnancy issues > Flashcards

Pregnancy and pregnancy issues Flashcards

1
Q

Where does fertilisation most commonly take place?

A

In the ampulla of the fallopian tube

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2
Q

When does implantation of the fertilised egg take place?

A

Day 23 after last menstrual period (9 days post-ovulation)

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3
Q

Which pregnancy hormone is used to to detect pregnancy?

A

Beta-hCG.

Levels rise rapidly up to 10 weeks. Can be detected in the blood and urine 4 weeks from LMP

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4
Q

What is the main pregnancy hormone that modifies maternal physiology to adapt to pregnancy?

A

Progesterone.

Produced by the corpus luteum for first 12 weeks then placenta takes over.

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5
Q

What are the physiological changes to pregnancy driven by progesterone?

A

Increased circulating blood volume (increase HR and SV), reduced BP (PVR drops to facilitate more blood to placenta), increased RR, reduced FVC, lack of uterine contractions, immune system weakens (to not reject the baby)

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6
Q

When can fetal heart activity be detected on USS?

A

6-7 weeks

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7
Q

When can limb buds and fetal movements be detected on USS?

A

8 weeks

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8
Q

At what point does the fetus stop doubling in size every week?

A

By 12 weeks

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9
Q

What measurements are taken during an abdominal Ultrasound when assessing fetal growth?

A

Biparietal diameter
Head circumference
Abdominal circumference
Femur length

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10
Q

What does reduced/absent flow to the fetus during maternal diastole indicate?

A

Placental insufficiency

There should be flow to the fetus during systole and diastole

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11
Q

What needs to happen if placental function doppler shows reversed diastolic flow (baby losing blood to mother)?

A

Baby needs to be delivered

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12
Q

What is the success rate of Vaginal Birth After Cesarean?

A

75%

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13
Q

What is the risk of uterine rupture during Vaginal Birth After Cesarean?

A

0.3%

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14
Q

What is the commonest cause of pre-labour rupture of membranes?

A

Infection - chorioamnionitis

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15
Q

What steps can be taken to intervene if a CTG is worrying?

A

Move mother into left lateral position to pull uterus off IVC and restore maternal circulation
Give fluids (to increase cardiac output)
Fetal scalp stimulation/fetal blood sample - determine fetal pH
Delivery

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16
Q

From how many weeks gestation is bleeding from the genital tract called antepartum haemorrhage?

A

24 weeks

Before this, it is termed a threatened miscarriage

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17
Q

What is the definition of Primary Post-Partum Haemorrhage?

A

Bleeding of more than 500mls from the genital tract within the first 24 hours after delivery

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18
Q

What is the definition of Seconndary Post-Partum Haemorrhage?

A

Excessive bleeding from the genital tract between 24 hours and 6 weeks post-partum

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19
Q

What are some causes of antepartum haemorrhage?

A

Placenta praevia, placental abruption, local causes in the genital tract (e.g. cervical polyps, cervical erosion, trauma)

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20
Q

What are some causes of postpartum haemorrhage?

A 
4 Ts
Tone - atonic uterus 
Trauma - genital tract trauma	
Tissue - retained products of conception
Thrombin - Abnormal clotting
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21
Q

What is malposition?

A

Abnormal position of the vertex of the fetal head in relation to maternal pelvis.
Fetal lie can be vertical (good), transverse or oblique

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22
Q

What is malpresentation?

A

Presentation that is not cephalic. I.e. face presentation, brow presentation, shoulder presentation, or breech presentation

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23
Q

What types of breech presentation are there?

A

Extended (65%) - vaginal birth possible
Flexed (10%) - vaginal birth possible
Footling (25%) - requires C-section delivery

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24
Q

How is breech presentation managed?

A

External cephalic version.
After 37 weeks, use tocolytics (i.e. nifedipine)
If fetus remains breech, C-section indicated

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25
Q

What risks does malposition carry?

A

Risk of cord prolapse or prolapse of foot/hand/shoulder once in labour.
Malposition may correct itself or, if not, need C-section

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26
Q

What is the management of shoulder dystocia?

A

As soon as shoulder dystocia is recognised, call for help. Perform McRobert’s manoeuvre by flexing and abducting woman’s hips with bent knees. Apply suprapubic pressure to aid effectiveness of McRobert’s manoeuvre.
If shoulder still not delivered, consider episiotomy.
Then, Internal rotation manoeuvres.
If still no progress, consider cleidotomy (breaking fetal clavicle) or symphysiotomy (cutting pubic symphysis to expand outlet).

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27
Q

What is the risk of uterine rupture during a vaginal birth after casearean (VBAC)?

A

0.3%

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28
Q

What is a first degree tear?

A

Damage to skin only

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29
Q

What is a second degree tear?

A

Tear involves perineal muscles but not anal sphincter

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30
Q

What is a third degree tear?

A

Tear involves anal sphincter.

3a: <50% of external sphincter torn
3b: >50% of external sphincter torn
3c: Internal sphincter also involved

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31
Q

What is a fourth degree tear?

A

Tear involves anal sphincter and anal epithelium

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32
Q

What percentage of patient have long-term incontinence troubles following a 3rd or 4th degree tear?

A

Up to 30%

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33
Q

What factors increase the risk of pre-term labour?

A

Multiple pregnancy, genital tract infection, PPROM, antepartum haemorrhage, cervical incomptence, congenital uterine abnormalities, antiphospholipid syndrome, diabetes mellitus, low SES, previous pre-term labour. Also metranidazole increases risk of pre-term labour.

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34
Q

How is pre-term labour managed?

A

Tocolytic drugs: e.g. Nifedipine for 24 hours. For those in very pre-term labour who haven’t yet completed a course of steroids. Don’t use in PPROM.
Corticosteroids: e.g. dexamethasone, betamethasone. Give if between 24 and 36 weeks gestation.
MgSO4: Give for up to 24 hours to reduce risk of cerebral palsy
Emergency cervical cerclage: Consider if between 16 and 34 weeks gestation and have a dilated cervix and unruptured fetal membranes. Avoid if bleeding/infection/contractions present
Delivery.

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35
Q

After how many weeks gestation can a woman develop gestational hypertension?

A

20 weeks

Before this point, it is attributed to pre-existing HTN

36
Q

What prophylactic medication should women at high risk of pre-eclampsia be offered?

A

Aspirin 75mg daily from 12 weeks gestation

37
Q

What are the first and second line anti-hypertensives for pregnant women?

A

1st: Labetalol
2nd: Nifedipine

38
Q

What is the target BP during pregnancy for women with pre-existing hypertension?

A

Aim for <150/100

39
Q

How often should BP be measured and urine checked for proteinuria in women with mild (140-149/90-99) or moderate (150-159/100-109) gestational hypertension?

A

Twice a week

40
Q

When should labetalol be offered for gestational hypertension?

A

Moderate hypertension i.e. >150/100

41
Q

How is severe gestational hypertension (>160/110) managed?

A

Admit to hospital. Start labetalol. Measure BP >= 4x a day. Do bloods (FBC, U+Es, LFTs) weekly.

42
Q

What is needed to diagnose pre-eclampisa?

A

SBP > 140 or DBP > 90 in second half of pregnancy with proteinuria (> 0.3g in 24 hours/>= 1+ on dipstick)

43
Q

How may pre-eclampsia present?

A

Severe headache (usually frontal), swelling of hands/feet, liver tenderness, visual disturbance, epigastric pain and/or vomiting, clonus, papilloedema, fetal distress, SGA infant, features of HELLP syndrome.

44
Q

What is HELLP syndrome?

A

A complication of pre-eclampsia
H - Haemolysis
EL - Elevated Liver enzymes
LP - Low Platelets

45
Q

How is pre-eclampsia managed?

A

Delivery of the placenta is the only cure. But patients can be managed conservatively (anti-hypertensives) until at least 34 weeks if haemodynamically stable with intact clotting and no HELLP syndrome.

46
Q

What is the colostrum?

A

A yellow fluid containing fat-laden cells, protein and IgA which is passed to the baby from the breast for the first few days before the ‘actual’ breast milk starts

47
Q

For how long does fully breastfeeding provide natural ‘lactational amenorrhoea’?

A

Suppresses ovulation for 4-6 weeks.

48
Q

Which form of contraception should be avoided if breastfeeding?

A

Combined contraceptive - suppresses lactation so contraindicated.

49
Q

On what day post-partum do up to 50% of women experience the ‘blues’?

A

3rd day

50
Q

On what day do psychotic symptoms tend to occur in the 0.2% of women who develop puerperal psychosis?

A

Abrupt onset around day 4

51
Q

When should a pregnant woman be able to feel fetal movements from and when does the frequency of movements begin to plateau?

A

~ 20 weeks gestation

Plateaus from 32 weeks

52
Q

What is classed as prolonged pregnancy?

A

Delivery on or after 41+3 weeks gestation (10+ days after EDD)

53
Q

What features in the neonate indicate he might be post-term?

A

Less subcut fat and soft tissue mass, loose/flaky/dry skin, meconium yellow stained fingernails and toenails

54
Q

How is IUGR managed from 36 weeks, between 34-36 weeks and before 34 weeks, respectively?

A

From 36 weeks: Deliver
34-36 weeks: Regular umbilical artery doppler, daily CTG, consider delivery
< 34 weeks: Give steroids, other management as for 34-36 weeks

55
Q

How do dizygotic twins come about?

A

Two different eggs fertilised by two different sperm

56
Q

How do monozygotic twins come about?

A

One egg fertilised by one sperm. Egg then splits within days post fertilisation resulting in 2 individuals with same chromosomes (identical twins)

57
Q

What does dichorionic diamniotic (DCDA) mean?

A

Each fetus has its own placenta and own amniotic sac

58
Q

What does monochorionic diamniotic (MCDA) mean?

A

The fetuses share a placenta but have their own amniotic sac

59
Q

What does monochorionic monoamniotic (MCMA) mean?

A

The fetuses share a placenta and an amniotic sac.

The umbilical cords can tangle

60
Q

In multiple pregnancies, what is the main factor determining pregnancy outcome?

A

Chorionicity

One shared placenta = higher risk of problems

61
Q

Do ladies with multiple pregnancy receive any extra scans?

A

Yes, after the dating and anomaly scan at 20 weeks, they get regular scans every 2 weeks

62
Q

Which type of twins are more likely to get Twin-to-Twin Transfusion Syndrome (TTTS)?

A

Monochorionic twins - sharing a placenta

63
Q

When should DCDA, MCDA, and MCMA twins be delivered, respectively?

A

DCDA: 37-38 weeks - vaginal delivery recommended if 1st twin is cephalic
MCDA: 36 weeks
MCMA: 34 weeks - LSCS

64
Q

When should a baby with a mother with gestational diabetes be delivered?

A

Deliver by 39 weeks

If estimated fetal weight is above 4kg, elective C-section

65
Q

What is a neonate of a mother with gestational diabetes particularly at risk of?

A

Hypoglycaemia commonly develops.

Respiratory distress syndrome may also occur.

66
Q

How is gestational diabetes managed?

A

Diet and exercise advice. If levels still too high after 2 weeks, give metformin. If levels still too high after 2 further weeks, give insulin.

67
Q

When are pregnant women screened for gestational diabetes?

A

28 weeks - 75g glucose tolerance test. If previous GDM, perform test at 18 weeks.

68
Q

What percentage of women who gestational diabetes will go on to develop diabetes mellitus in the next 10 years?

A

50%

69
Q

What is the success rate of VBAC following 1 C-section?

A

75%

70
Q

Up to how many weeks is a loss of a pregnancy deemed a miscarriage?

A

24 weeks, after this point, it is a stillbirth

71
Q

What is classed as recurrent miscarriages?

A

The loss of 3+ consecutive pregnancies with the same partner

72
Q

What is a threatened miscarriage?

A

Sx of pv bleeding and pain but O/E the cervical os remains closed and uterine size is correct for dates. 50% proceed to miscarriage. If any products of conception are passed, abortion is inevitable.

73
Q

What is an inevitable miscarriage?

A

Spontaneous abortion that cannot be arrested. Products of conception may be found in vagina or protruding from cervical canal

74
Q

What is an incomplete abortion?

A

Retained products of conception in uterus, which, if infected, turns into septic abortion

75
Q

What is a complete abortion?

A

All products of conception are passed without intervention

76
Q

What drug should be offered to all pregnant women if they’re miscarriage occured after 12 weeks gestation?

A

Anti-D

77
Q

What is given to medically manage an incomplete miscarriage?

A

Misopristol

78
Q

Where do most ectopic pregnancies occur?

A

Ampulla (80%)

79
Q

What is the medical management of ectopic pregnancy?

A

Single IM injection of methotrexate if no significant pain, unruptured ectopic with adnexal mass < 35mm and no visible heartbeat, no intrauterine pregnancy on USS and serum hCG < 1500 IU/L. If serum hCG levels have not dropped by ~15% after 2 days, give another methotrexate dose. Avoid sex during treatment and use contraception for 3 months

80
Q

When is the only time expectant management of ectopic pregnancy is recommended?

A

If serum BhCG levels are very low and falling, or if asymptomatic or symptoms are very mild

81
Q

What is the surgical management of ectopic pregnancy?

A

Laparoscopic salpingectomy recommended for 1st tubal pregnancy. Give Anti-D.
Surgery recommended if significant pain, adnexal mass > 35mm, fetal heartbeat on USS, serum hCG > 5000 IU/L

82
Q

What is a hydatidiform mole?

A

Growing mass of tissue inside the uterus that will not develop into a baby

83
Q

What is a complete hydatidiform mole?

A

1 sperm fertilises an empty egg that doesn’t contain 23 chromosomes. Normally empty egg dies and doesn’t implant but, rarely, implantation does occur.

84
Q

What is a partial hydatidiform mole?

A

2 sperm fertilise 1 egg therefore 69 chromosomes present

85
Q

What is the classical description of a hydatidiform mole pregnancy on US?

A

‘Bunch of grapes’

86
Q

What is the management of hydatidiform mole?

A

Suction evacuation. Anti-D if rhesus negative. F/U test to monitor hCG levels for >1 year (risk of choriocarcinoma). Avoid pregnancy for 6 months.

Gynaecology, Obstetrics and Sexual Health (6 decks)

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