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Obs & Gynae > Random 2 > Flashcards

Random 2 Flashcards

1
Q

Outline the antenatal screening pathway

A

Pre conception counselling: 400microg folic acid

8-12 weeks: booking: smoking/weight/dietary advice, BP, urine, FBC, rhesus status, haemoglobinopathies, syphilis, rubella, hepatitis B

10-13+6 weeks: dating scan

11-13+6 weeks: down’s scan including NT

18 weeks: anomaly scan

28 weeks: first dose anti-D to Rh- women, anaemia screen

34 weeks: second dose anti-D to Rh- women

36 weeks: check foetal presentation, info on breast feeding, baby blues etc

38 weeks: vitals

41 weeks: vitals/discuss labour

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2
Q

What tests are used to diagnose Down’s and what are the results?

A

11 weeks: bHCG, plasma protein A, NT
15 weeks onwards: bHCG, oestriol, AFP

results: ‘HIgh’. bHCG and inhibin A are increased, the rest are decreased

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3
Q

What are the results of screening tests in Turner’s, Edward’s and Patau’s?

A 
Turner's = HIgh = bHCG and inhibin A are high 
Edward's = HE is low = bHCG and oestriol is low 
Patau's = only AFP increased
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4
Q

What is the triad of hyperemesis gravidarum?

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance

most common between 8-12 weeks

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5
Q

What score can be used to assess hyperemesis gravidarum?

A

PUQE

pregnancy unique quantification of emesis score

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6
Q

What is hyperemesis gravidarum associated with?

What are the investigations for hyperemesis gravidarum?

A

multiple pregnancies, trophoblastic disease, hyperthyroidism, obesity, nulliparity, smoking is a protective factor

renal function/electrolytes
ultrasound
LFTs
MSSU

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7
Q

What is the management of hyperemesis gravidarum?

A

small, frequent meals. high in carbs.
P6 (wrist) acupressure
promethazine or cyclizine
metoclopramide, prochlorperazine, ondansetron

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8
Q

What are the indications for secondary care referral in hyperemesis gravidarum?

A

continued nausea/vomiting associated with ketonuria or weight loss despite anti-emetics
inability to keep down oral anti-emetics
comorbidity

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9
Q

What are the risk factors of an ectopic pregnancy?

A

damage to tubes (salpingitis, surgery)
previous ectopic
IVF

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10
Q

what are the obstetric causes of abdominal pain in pregnancy?

A

pre-eclampsia/HELLP syndrome (epigastric/RUQ)
placental abruption
uterine rupture (constant pain, shock)
chorioamnionitis
acute fatty liver of pregnancy (second half, abdo pain, nausea, jaundice, malaise)

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11
Q

what are the gynae causes of abdominal pain in pregnancy?

A

ectopic pregnancy (5-9w)
ovarian torsion
fibroids
salpingitis

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12
Q

what are the surgical causes of abdominal pain in pregnancy?

A

appendicitis
cholecystitis
intestinal obstruction
meckel’s diverticulitis

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13
Q

what are the medical causes of abdominal pain in pregnancy?

A

constipation
DKA
sickle cell anaemia
IBS

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14
Q

Outline what threatened, missed, inevitable and incomplete miscarriages are

A

Threatened: painless vaginal bleeding <24w, cervical os still closed. typically 6-9w.

Missed: dead foetus. pregnancy symptoms have disappeared. <20w.

Inevitable: painful vaginal bleeding, cervical os open.

Incomplete: partial passage of blood, cervical os open, rest to come

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15
Q

What is post mature pregnancy?

A

Pregnancy which persists beyond 42 weeks

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16
Q

What are the foetal and neonatal risks in post mature pregnancy?

A 
Increased risk of death
Meconium aspiration
Macrosomia
Neonatal encephalopathy
Placental insufficiency
Neonatal acidaemia
17
Q

What are the maternal risks of postmature pregnancy?

A

C Section
Instrumental delivery
Perineal damage
PPH

18
Q

What is the pathway for induction of labour?

A

before induction: continuous CTG, bishop score

1) membrane sweeping: at 40/41 weeks for nulliparous women, at 41 weeks for multiparous women
2) PGE2: pessary for nullips, gel for multips
3) amniotomy (with or without oxytocin)
4) syntocinon (continous CTG)

if there is a risk of uterine hyperstimulation and fetal distress = intermittent CTG

19
Q

During induction of labour, if uterine hyperstimulation occurs, what is the management?

A

tocolysis

20
Q

What are the indications for CTG during labour?

A 
Maternal:
previous C section
pre-eclampsia
PROM
recurrent antepartum haemorrhage
diabetes

Foetal:
IUGR
abnormal presentation
reduced foetal movements

Intrapartum:
epidural analgesia
fresh bleeding during labour
augmentation of labour with oxytocin
prior to induction
21
Q

What is a ‘non-reassuring’ CTG?

What is the management?

A

CTG has one feature that is non-reassuring

decrease contraction frequency (discontinue oxytocin, start tocolytic agents e.g. terbutaline)
screen for infection if maternal tachycardia

22
Q

What is an ‘abnormal’ CTG?

What is the management?

A

two or more features which are non-reassuring

foetal blood sampling

23
Q

What is a normal foetal blood sampling result?

A

Lactate <4.1

pH >7.2

24
Q

What is an abnormal foetal blood sampling result?

A

Lactate >4.9

pH <7.2

25
Q

What are risk factors for P-PROM?

A

PROM occurs <37 weeks

Smoking
Lower genital tract infection
Previous preterm delivery
Vaginal bleeding

26
Q

What are the investigations and management of P-PROM?

A

Investigations: do not perform vaginal examination, ask women to lie down for 30mins and see if amniotic fluid pools. monitor for infection (fetal tachycardia, mild increase in maternal temperature)

Management: erythromycin 250mg 4x daily
If infection is suspected perform CTG, WCC, CRP
antenatal steroids if between 24-34 weeks

27
Q

How do you prevent P-PROM?

A

Women who have had a preterm birth <34w before or PROM before: offer cervical cerclage

Women with no Hx: offer intravaginal progesterone

28
Q

How does haemolytic disease of the newborn occur?

A

Women produce anti-D antibodies if they are Rh- and the fetus is Rh+. In later pregnancies, the antibodies will cause haemolytic disease of the newborn/

29
Q

When should you give a dose of anti-D within 72 hours?

A 
In a potentially sensitising event:
Rh+ infant delivered 
Any TOP
External cephalic version
Amiocentesis/FBS/CVS
Ectopic pregnancy
Antepartum haemorrhage
30
Q

In all babies born to a Rh- mother, what investigations should be performed?

A

cord blood taken
direct Coombs test
blood group

31
Q

How would a foetus present who has had haemolytic disease of the newborn?

A

oedamatous (hydrops fetalis)
jaundice/anaemia/hepatosplenomegaly
kernicterus

Obs & Gynae (10 decks)

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