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fourth year > reproductive > Flashcards

reproductive Flashcards

1
Q

describe the HP-GA axis

A

hypothalamus releases GnRH which stimulates anterior pituitary to secrete LH and FSH.

LH and FSH stimulate the follicle and in return oestrogen is secreted that inhibits the axis.

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2
Q

Theca granulosa cells around the follicle secrete

A

oestrogen

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3
Q

physiological role of oestrogen is for

A

development of female sex organs, uterine blood vessels and endometrial development

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4
Q

physiological role of progesterone

A

thickens both the cervical mucous and maintains endometrium and increases body temp.

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5
Q

age of puberty in females

A

8-14

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6
Q

age of puberty in males

A

9-15

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7
Q

average length of puberty

A

4 years

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8
Q

why may girls with low weight have a delayed puberty

A

lack of aromatase due to reduced adipose deposits

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9
Q

female puberty starts with development of

A

breast buds, then pubic hair and then menarche

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10
Q

scale for measuring puberty development is

A

tanner scale

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11
Q

during puberty FSH levels plateau how long before menarche?

A

a year

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12
Q

a follicle develops receptors for FSH in which stage?

A

secondary follicle stage

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13
Q

ovulation occurs what day of the cycle?

A

day 14

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14
Q

what hormone maintains the corpeus luteum and where does this originate?

A

HCG from the syncytiotrophoblast

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15
Q

during menstruation what does the stromal cells release

A

prostaglandins

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16
Q

primary oocyte is contained within

A

pregranulosa cells surrounded by outer basal lamina layer

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17
Q

three layers of the primary follicle

A

primary oocyte, zona pellucida and the granulosa cells

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18
Q

as the follicle grows id develops a further surrounding layer called the

A

theca folliculi

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19
Q

the inner theca folliculi name and function

A

theca interna secretes androgen hormones

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20
Q

theca externa consists of

A

connective tissue, smooth muscle and collagen

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21
Q

development of the secondary follicle involves

A

growth of the antrum within the granulosa. the granulosa cells surrounding the follicle as referred to as the corona radiata.

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22
Q

role of LH in ovulation

A

surge of LH triggers the theca externa to squeeze releasing the ovum.

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23
Q

primary oocyte meiosis creates

A

a polar body and a haploid cell called the secondary oocyte.

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24
Q

development of the fertilised cell as it migrated along the fallopian tube

A

zygote->morula->blastocyst which contains the embryoblast and surrounding this is the trophoblast.

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25
Q

the cells of the trophoblast undergo adhesion with the

A

stroma of the endometrium

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26
Q

endometrial stroma cells in contact with the trophoblast convert into the

A

decidua

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27
Q

a week after fertilisation the embryoblast forms into

A

yolk sac and the amniotic cavity

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28
Q

the choroin surrounds the embryonic complex and has two sides called

A

cytotrophoblast (inner) and the syncytiotrophoblast (outer)

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29
Q

the outer ectoderm layer forms

A

skin, hair, nails, teeth, CNS

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30
Q

the middle mesoderm layer forms

A

heart, muscle, bone, connective tissue, blood and kidneys

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31
Q

inner endoderm layers forms

A

GI tract, lungs, liver, pancreas, thyroid and reproductive system

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32
Q

at how many weeks does the heart form and start to beat?

A

6 weeks

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33
Q

the myometrium sends of arteries into the endometrium called

A

spiral arteries

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34
Q

the placenta originates from the

A

chorion frondosum

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35
Q

spiral arteries degenerate int

A

lacunae (lakes of blood)

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36
Q

lacunae form around what week?

A

week 20

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37
Q

if spiral arteries maintain vascular resistance this runs the risk of

A

pre-eclampsia

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38
Q

functions of the placenta are

A

respiration, nutrition, excretion, endocrine and immunity

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39
Q

HCG plateus around what week of gestation?

A

ten weeks

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40
Q

placental oestrogen role

A

softens tissue and increases flexibility to expand pelvis and soften cervix.

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41
Q

which has a higher affinity for oxygen foetal or adult haemoglobin

A

foetal

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42
Q

placental progesterone role

A

maintain pregnancy through muscle relaxation

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43
Q

hormonal changes during pregnancy include

A

raised ACTH, prolactin, progesterone, oestrogen, HCG, T3 and t4 and melanocyte stimulating hormone

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44
Q

consequences of increased ACTH during pregnancy are

A

rise in cortisol and aldosterone (steroids) improving autoimmune conditions but increased risk of diabetes.

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45
Q

consequences of increased melanocyte stimulating hormone are

A

linea nigra and melasma

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46
Q

role of prostaglandins prior to delivery

A

breakdown collagen in cervix enabling dilation

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47
Q

CV changes during pregnancy

A

increase: blood volume, cardiac output and decreased peripheral vascular resistance and blood pressure in early pregnancy

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48
Q

respiratory changes during pregnancy

A

increased tidal volume and respiratory rate

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49
Q

renal changes during pregnancy

A

increased blood flow, GFR, aldosterone, protein excretion and hydronephrosis

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50
Q

haematological and biochem changes during pregnancy

A

raised ESR, d-dimer, Alk P, WBC and platelets but reduced albumin.

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51
Q

stage one of labour is

A

onset of contractions until 10cm cervical dilation

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52
Q

stage two of labour is

A

delivery of baby

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53
Q

third stage of labour is

A

placental delivery

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54
Q

braxton hicks contractions are

A

irregular contractions of the uterus during second and third trimester

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55
Q

three phases of the first stage of labour

A 
latent phase (o.5 cm per hour, irregular contractions)
active phase (1cm per hour)
Transition phase (strong regular contractions)
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56
Q

stage 2 depends upon the three P’s

A

Power - uterine contractions
Passenger (size, attitude (position), Lie, presentation
Passage

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57
Q

different presentations of the passenger include

A

cephalic, shoulder, breech

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58
Q

three different types of breech include

A

complete (hips and knees flexed)
frank (hips flexed but knees extended)
footling (foot hanging through cervix)

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59
Q

cardinal movements of labour are

A 
Engagement
Descent
Flexion
Internal Rotation
Extension
Restitution and external rotation
Expulsion
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60
Q

active management of the third stage of labour may involve

A

an intramuscular injection of oxytocin.

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61
Q

what fraction of couples struggle to conceive naturally?

A

1/7

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62
Q

investigation for infertility should occur after

A

12 months, or six months if >35yrs

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63
Q

commonest causes for infertility

A 
mixed (40%)
sperm problems (30%)
tubal problems (15%)
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64
Q

general advice for infertility

A

The woman should be taking 400mcg folic acid daily
Aim for a healthy BMI
Avoid smoking and drinking excessive alcohol
Reduce stress as this may negatively affect libido and the relationship
Aim for intercourse every 2 – 3 days
Avoid timing intercourse

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65
Q

initial investigations for infertility

A 
Body mass index (BMI) (low could indicate anovulation, high could indicate PCOS)
Chlamydia screening
Semen analysis
Female hormonal testing (see below)
Rubella immunity in the mother
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66
Q

female hormone testing for infertility involves

A

Serum LH and FSH on day 2 to 5 of the cycle
Serum progesterone on day 21 of the cycle (or 7 days before the end of the cycle if not a 28-day cycle).
Anti-Mullerian hormone
Thyroid function tests when symptoms are suggestive
Prolactin (hyperprolactinaemia is a cause of anovulation) when symptoms of galactorrhea or amenorrhoea

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67
Q

high FSH in infertility indicates

A

poor ovarian reserve

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68
Q

high LH in infertility indicates

A

PCOS

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69
Q

high Anti-mullerian hormone in infertility indicates

A

high ovarian reserve

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70
Q

further investigations for infertility include

A

US, hysterosalpingogram, laparoscopy, and dye test.

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71
Q

management of anovulation in infertility includes

A

clomifene, ovarian drilling, metfromin, weight loss and gonadotrophins

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72
Q

clomifene is a

A

selective oestrogen receptor modulator (anti oestrogen)

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73
Q

management of tubal factors for infertility include

A

Tubal cannulation during a hysterosalpingogram
Laparoscopy to remove adhesions or endometriosis
In vitro fertilisation (IVF)

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74
Q

management of sperm problems for infertility include

A

surgical sperm retrieval, surgical correction, intra-uterine insemination, intracytoplasmic sperm injection and donor insemination

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75
Q

sperm sample analysis looks at

A

volume, semen pH, concentration, total number, motility, vitality, and percentage

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76
Q

pre-testicular causes of infertility include

A

Pathology of the pituitary gland or hypothalamus
Suppression due to stress, chronic conditions or hyperprolactinaemia
Kallman syndrome

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77
Q

testicular causes of infertility

A 
Mumps
Undescended testes
Trauma
Radiotherapy
Chemotherapy
Cancer
genetic
congenital
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78
Q

investigations into infertility for men include

A

LH, FSH, testosterone, geentic testing, MRI, US, vasography and testicular biopsy

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79
Q

post testicular causes of infertility

A

Damage to the testicle or vas deferens from trauma, surgery or cancer
Ejaculatory duct obstruction
Retrograde ejaculation
Scarring from epididymitis, for example, caused by chlamydia
Absence of the vas deferens (may be associated with cystic fibrosis)

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80
Q

Young’ syndrome is

A

(obstructive azoospermia, bronchiectasis and rhinosinusitis)

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81
Q

success rate of IVF

A

25-30%

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82
Q

IVF process

A 
Suppressing the natural menstrual cycle
Ovarian stimulation
Oocyte collection
Insemination / intracytoplasmic sperm injection (ICSI)
Embryo culture
Embryo transfe
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83
Q

methods for suppression of natural menstruation cycle

A

GnRH agonists or GnRH antagonists

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84
Q

ovarian stimulation is through

A

injections of FSH, once follicles have developed then injection of HCG 36 hours before collection

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85
Q

fertilised eggs in IVF are observed until the

A

blastocyst stage (day 5)

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86
Q

complication of IVF treatment is

A

ovarian hyperstimulation syndrome

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87
Q

pathology of ovarian hyperstimulation syndrome

A

increase in VEGF (vascular endothelial growth factor), fluid leaks to the extravascular space causing oedema, ascites and hypovolaemia

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88
Q

OHSS is specifically triggered by

A

HCG injection 36 hours prior to oocyte collection

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89
Q

monitoring for OHSS risk is through

A

serum oestrogen and US

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90
Q

risk reduction for OHSS is through

A

lower doses of hCG and GnRH antagonist

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91
Q

symptoms of OHSS

A 
Abdominal pain and bloating
Nausea and vomiting
Diarrhoea
Hypotension
Hypovolaemia
Ascites
Pleural effusions
Renal failure
Peritonitis from rupturing follicles releasing blood
Prothrombotic state (risk of DVT and PE)
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92
Q

management of OHSS is through

A

Oral fluids
Monitoring of urine output
Low molecular weight heparin (to prevent thromboembolism)
Ascitic fluid removal (paracentesis) if required
IV colloids (e.g. human albumin solution

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93
Q

haematocrit may be monitored to assess

A

volume of fluid in the intravascular space

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94
Q

folic acid 400mcg should be started in pregnancy from

A

12 weeks

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95
Q

why is folic acid taken in pregnancy?

A

reduces risk of neural tube defects

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96
Q

why should unpasturised dairy or blue cheese be avoided in pregnancy?

A

listeriosis

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97
Q

typically what weeks does ectopic pregnancies present?

A

6-8 weeks

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98
Q

presentation of an ectopic

A

Female patient with delayed menstruation and a history of sexual intercourse
Lower abdominal pain – constant and in the iliac fossa
Vaginal bleeding
Lower abdominal tenderness
Cervical excitation

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99
Q

criteria for methotrexate in an ectopic pregnancy

A 
Unruptured
Adnexal mass < 35mm
No visible heart beat
No significant pain
hCG level <1500 IU / l
Confirmed absence of intrauterine pregnancy on ultrasound
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100
Q

criteria for surgery in ectopic pregnancy

A

anything that doesn’t meet methotrexate criteria

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101
Q

miscarriage occurs in what fraction of pregnancies

A

1/5

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102
Q

missed miscarriage definition

A

foetus has died <20 weeks but inside uterus

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103
Q

threatened miscarriage definition

A

vaginal bleeding with closed cervix but foetus alive

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104
Q

incomplete miscarriage definition

A

retained products of conception

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105
Q

inevitable miscarriage

A

bleeding with open cervix

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106
Q

complete miscarriage

A

full miscarriage with no products of conception left

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107
Q

anembryonic pregnancy refers too

A

gestational sac present but n embryo

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108
Q

treatment for incomplete miscarriage

A

misoprostol vaginal pessary or evacuation of retained products of conception via surgery

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109
Q

recurrent miscarriage is referred to as

A

> 3 miscarriages in a row

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110
Q

causes of recurrent miscarriage

A

idiopathic, antiphospholipid syndrome, uterine abnormalities, genetic factors or chronic histiocytic intervillositis

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111
Q

investigations for recurrent miscarriage

A

antiphospholipid antibodies, pelvic US or genetic testing

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112
Q

diagnosis of chronic histiocytic intervillositis is made by

A

histology showing mononuclear infiltrate in the intervillous spaces of the placenta

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113
Q

medical abortion procedure

A

mifepristone followed 1-2 days by misoprostol

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114
Q

mifepristone is what type of drug?

A

anti-progestogen

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115
Q

misoprostol is what kind of drug

A

prostaglandin

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116
Q

two types of surgical abortion

A

cervical dilatation and suction of contents (15 weeks) or evacuation (15-24 weeks)

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117
Q

nausea vomiting in pregnancy peaks around

A

8-12 weeks gestation

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118
Q

correlation between high bHCG levels and

A

morning sickness due to molar pregnancies and multiple pregnancies

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119
Q

criteria for diagnosis of hyperemesis gravidarum

A

> 5% weight loss, dehydration and electrolyte imbalance

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120
Q

measuring severity of morning sickness is out of

A

pregnancy unique quantification of emesis score (PUQE) (15)

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121
Q

antiemetics for hyperemesis gravidarum

A

prochlorperazine or cyclizine

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122
Q

admission for hypermesis gravidarum should be considered for

A

unable to tolerate fluid.
Ketones on dipstix.
electrolyte imbalances and other medical conditions.

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123
Q

severe hypermesis gravidarum Tx

A

IV fluids, IV antiemetics, thiamine supplements and thromboprophylaxis.

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124
Q

complete mole pregnancy is caused by

A

two sperm fertilising an ovum with no genetic material

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125
Q

partial mole pregnancy occurs when

A

two sperm fertilise a normal ovum

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126
Q

presentation of molar pregnancy

A 
More severe morning sickness.
Vaginal bleeding
Increased enlargement of the uterus
Abnormally high bHCG
Thyrotoxicosis
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127
Q

US appearance of molar pregnancy

A

snowstorm appearance

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128
Q

diagnosis confirmation of molar pregnancy is by

A

histology

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129
Q

risk of what malignancy with molar pregnancy

A

gestational trophoblastic disease

130
Q

pregnancy anaemia checks around

A

8-12 weeks and 28 weeks

131
Q

anaemic pregnant women should be started on

A

ferrous sulphate 200mg three times daily

132
Q

women with low B12 should be tested for

A

pernicious anaemia

133
Q

pre-eclampsia triad

A

hypertension, proteinuria and oedema

134
Q

eclampsia refers to

A

seizures as a result of pre-eclampsia

135
Q

high risk factors for pre- eclampsia

A 
Pre-existing hypertension
Previous pre-eclampsia
Existing autoimmune conditions (e.g. SLE, antiphospholipid syndrome)
Diabetes
Chronic Kidney Disease
136
Q

moderate risk factor for pre-eclampsia

A 
Older than 40
Obese (BMI >35)
More than 10 years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history of pre-eclampsia
137
Q

pre-eclampsia has symptoms of

A 
Headache
Visual disturbance / blurriness
Upper abdominal / epigastric pain 
Reduced urine output
Brisk reflexes
Nausea and vomiting
Oedema
138
Q

pre-eclampsia epigastric pain is due to

A

liver swelling

139
Q

prophylaxis for pre-eclampsia involves

A

75mg aspirin from 12 weeks to birth if high risk or several moderate risk factors

140
Q

first line anti-hypertensive in pre-eclampsia is

A

labetolol

141
Q

when is magnesium sulphate given in pre-eclampsia

A

during labour and 24 hours post or IV bolus in eclampsia

142
Q

monitoring in pre-eclampsia involves

A

blood pressure, symptoms, urine dipstick, platelets, liver enzymes, U+E, foetal movement, amniotic fluid volume, growth scans and doppler.

143
Q

HELLP syndrome refers too

A

haemolysis, elevated liver enzymes and low platelets.

144
Q

what treatment does a rhesus positive mother during pregnancy require?

A

none

145
Q

what is the consequence of sensitization between a rhesus negative mother and rhesus positive son

A

haemolytic disease of the newborn

146
Q

prevention of rhesus sensitisation is through

A

anti-D medication given routinely at 28 weeks and again at birth or during any events

147
Q

the test to assess blood transfer during a sensitisation event is called

A

Kleihauer test

148
Q

if you have the risk factors for gestational diabetes when should you be tested?

A

oral glucose tolerance test at booking and 26 weeks gestation

149
Q

risk factors for gestational diabetes are

A

Raised BMI (>30)
Previous gestational diabetes
Asian, black Caribbean, Middle Eastern
Previous macrocosmic baby (or large for dates baby on scans)
Family history of diabetes (first degree relative)

150
Q

after an OGTT blood sugars are baseline and 2 hours should be

A

<5.6 at baseline and at 2 hours <7.8

151
Q

management for those >7 blood sugars during pregnancy

A

insulin, less is exercise and diet.

152
Q

safe diabetic agents for pregnancy?

A

insulin or metformin only.

153
Q

diabetic screening during pregnancy should occur for

A

retinopathy

154
Q

small foetus is defined as

A

below the 10th centile for their gestational age

155
Q

causes of foetal growth restriction

A 
Idiopathic
Pre-eclampsia
Maternal smoking
Maternal alcohol
Anaemia
Malnutrition
Infection
156
Q

growth restricted babies have a tendency towards

A

hypertension and type 2 diabetes

157
Q

large for gestational age is defined as

A

born at a weight of more than 4kg

158
Q

complications of chicken pox during pregnancy

A

varicella pneumonitis in the mother, or foetal varicella syndrome resulting in developmental abnormalities

159
Q

for mothers prophylaxis against chickenpox then treatment with

A

IV varicella immunoglobulins

160
Q

congenital rubella syndrome refers too

A

congenital disease, sensorineural deafness and cataracts

161
Q

the rubella vaccine is what type of vaccine?

A

live

162
Q

should pregnancy women receive live vaccines?

A

no

163
Q

chickenpox rash in pregnancy should be treated within 24 hours with

A

aciclovir

164
Q

chorioamnioitis presents with

A

Fever
Abdominal pain
Sepsis (tachycardia, tachypnoea, hypotension)
Evidence of fetal compromise on CTG

165
Q

with monoamniotic twins should aim to deliver around

A

32-34 weeks

166
Q

with diamniotic twins should aim to deliver around

A

37-38 weeks

167
Q

twin twin transfusion syndrome cause

A

one donor to become starved and the other fluid overloaded

168
Q

first choice test for down’s syndrome is

A

combined test

US for nuchal translucency and maternal blood tests of high BHCG and low PAPPA

169
Q

nuchal thickness of what mm sign of down’s syndrome

A

> 6mm

170
Q

triple test for down’s syndrome involves

A

BHCG (high), AFP (Low) and serum oestriol (low)

171
Q

antenatal testing is offered if risk is greater than

A

1/150

172
Q

antenatal testing comes in the forms of

A

chorionic villus sampling or amniocentesis samples for karyotyping.

173
Q

placenta praevia refers too

A

placenta covering lower portion of the uterus below the foetus

174
Q

presentation of placenta praevia

A

painless bleeding around 36 weeks

175
Q

management of placenta praevia

A

US scans, elective caesarean AVOID VAGINAL EXAMS

176
Q

placental abruption refers too

A

large maternal haemorrhage

177
Q

presentation of placental abruption is

A

“woody” abdomen, CTG abnormalities, shock (hypotension, tachycardia), vaginal bleeding and continuous severe pain.

178
Q

placental abruption resus of mother Tx

A

2 x grey cannula
Bloods including crossmatch and coagulation studies
Fluid and blood resuscitation as required
May need a fresh frozen plasma infusion

179
Q

further treatment for placental abruption is through

A

delivery of baby, Anti-D and monitoring for post partum haemorrhage

180
Q

presentation of obstetric cholestasis

A

Later in pregnancy (third trimester)
Itchiness, particularly to the palms of the hands and soles of the feet
No rash
Abnormal LFTs and Bile acids

181
Q

managment of obstetric cholestasis is

A

Ursodeoxycholic acid, emollients, antihistamines, vit K and birth of baby.

182
Q

a rare cause of acute hepatitis in third trimester of pregnancy is

A

acute fatty liver of pregnancy

183
Q

presentation of acute fatty liver of pregnancy is

A

General malaise
Nausea and vomiting
Jaundice
Abdominal pain

184
Q

biochemistry for acute fatty liver of pregnancy

A

Liver function tests will show elevated liver enzymes, particularly ALT.

185
Q

risk factors for a DVT or PE in pregnancy

A 
Smoking
Parity >3
Age >35
BMI >30
Reduced mobility
Multiple pregnancy
Personal history of VTE
Family history of VTE
Low risk thrombophilia
186
Q

situations to initiate labour early?

A

macrosomia, reduced foetal movements, pre-eclampsia and premature rupture of membranes

187
Q

Bishop score is for

A

to determine whether to induce labour

188
Q

A bishop score of what is sufficient for successful induction of labour

A

8

189
Q

criteria of Bishop’s score

A 
feotal station
cervical position
cervical dilatation
cervical effacement
cervical consistency
190
Q

two main methods of induction are

A

membrane sweep or vaginal pessaries

191
Q

membrane sweep induction involves

A

finger stimulation of cervix

192
Q

vaginal pessaries induction involves

A

prostaglandin E2

193
Q

indications for continuous CTG

A 
Sepsis
Oxytocin
Meconium
Pre-eclampsia (with blood pressure >160 / 110)
Antepartum haemorrhage
194
Q

key features of CTG are

A 
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
195
Q

what drugs are used for stimulating uterine contraction

A

syntocinon (oxytocin), ergometrine and syntometrine.

196
Q

active management of third stage of labour involves

A

empty bladder, IM syntocin, cord clamping, palpation of abdomen and controlled cord traction to deliver placenta in one piece.

197
Q

optimum uterine contraction ratio is

A

4 contractions every 10 minutes.

198
Q

indications for caesarean are

A 
Previous caesarean
Placenta praevia
Breech presentation
Cephalopelvic Disproportion (large baby small pelvis)
Female choice (after full discussion about pros and cons)
IUGR
Post-maturity
Uncontrolled HIV infection
Cervical cancer
199
Q

target decision time for emergency threat to mother or baby for C section is

A

30 minutes

200
Q

post op emergency C section should be offered

A

thromboprophylaxis

201
Q

survival of 23 weekers are

A

10%

202
Q

term is birth after how many weeks?

A

> 37 weeks

203
Q

methods for prophylaxis of preterm labour are

A

vaginal progesterone and cervical cerclage (stitch in cervix)

204
Q

diagnosis of preterm prelabour rupture of membranes is through

A

speculum, insulin-like growth factor binding protein or placental alpha-microglobin-1

205
Q

management of preterm prelabour rupture of membrane should involve

A

prophylactic antibiotics

206
Q

preterm labour with intact membranes require

A

foetal monitoring, tocolysis (stop contractions with nifedipine), maternal corticosteroids and magnesium sulfate.

207
Q

corticosteroids should be given if a preterm labour is before how many weeks?

A

less than 36 weeks gestation

208
Q

how to monitor for magnesium toxicity?

A

reflex times

209
Q

IV magnesium sulfate in premature delivery protects from?

A

cerebral palsy

210
Q

risk factors for a amniotic fluid embolism are

A

Increasing maternal age

Induction of labour

211
Q

presentation of amniotic fluid embolism is

A 
Shortness of breath
Cough
Respiratory failure
Tachycardia
Hypotension
Fever
Haemorrhage
212
Q

uterine rupture requires

A

emergency laparotomy

213
Q

risk factors for uterine rupture are

A 
Vaginal birth after caesarean (VBAC)
Previous uterine surgery
Increased BMI
High parity
Induction of labour
214
Q

initial management of a shoulder dystocia may require

A

episiotomy or a McRoberts manoeuvre

215
Q

mcrobert’s manoeuvre of a shoulder dystocia requires

A

hyperflexing the mother at the hip (bringing her knees all the way to her abdomen) provides a posterior pelvic tilt, lifting the pubic symphysis up and out of the way.

216
Q

Rubin’s manoeuvre of a shoulder dystocia requires

A

reaching into the vaginal to put pressure on the posterior aspect of the babies anterior (stuck) shoulder to help it deliver under the pubic symphysisis.

217
Q

wood screw manoeuvre of shoulder dystocia requires

A

hilst doing Rubins Manoeuvre, the other hand is used to reach in the vaginal and put pressure on the anterior aspect of the posterior shoulder. This way you encourage the baby to twist sideways and be delivered. If this doesn’t work, the reverse motion can be tried (pushing the top shoulder backwards and the bottom shoulder forwards).

218
Q

Zavanelli Manoeuver of shoulder dystocia involves

A

The Zavanelli manoeuvre involves pushing the babies head back into the vagina so that the baby can be delivered by emergency caesarean.

219
Q

complications of shoulder dystocia are

A

Fetal hypoxia (and subsequent cerebral palsy)
Erb’s palsy (due to damage of the brachial plexus)
Perineal tears
Postpartum haemorrhage

220
Q

biggest risk factor for cord prolapse is

A

abnormal lie after 37 weeks

221
Q

diagnosis of cord prolapse is through

A

CTG, vaginal examination or speculum.

222
Q

management of cord prolapse is

A

emergency C section, presenting part pushed back in, not handling the cord (vasospasm), left lateral lie and toclytic medication (nifedipine)

223
Q

ventouse delivery involves

A

suction cup on babies head and cord traction

224
Q

ventouse delivery risk

A

cephalohaematoma

225
Q

forceps delivery risk is

A

facial nerve palsy and temporary fat necrosis

226
Q

episiotomy procedure

A

diagonal 45 degree cut downwards and laterally

227
Q

post partum haemorrhage is defined as

A

500ml after normal delivery or 1l after C section

228
Q

four causes T’s of post partum haemorrhage

A

Tone
Tissue
Trauma
Thrombin

229
Q

risk factors for post partum haemorrhage

A 
Previous PPH
Multiple pregnancy
Grand multipara (5 or more normal vaginal deliveries)
Large baby
Slow or failure to progress in second stage of labour
Pre-eclampsia
Retained placenta
Anaesthetic
230
Q

prevention of PPH is through

A

treatment of anaemia, empty bladder, oxytocin during third stage of labour and tranexamic acid

231
Q

managment of PPH is with

A

resus, large bore cannula, major haemorrhage protocol, group and cross match

232
Q

mechanical treatment of PPH

A

rubbing the uterus from the abdomen and catheter

233
Q

medical treatment of PPH

A

IV 10 units of syntocinon, carboprost and misoprostol prostaglandin analogues and tranexamic acid

234
Q

surgical treatment of PPH

A

B-lynch suture, balloon tamponade, uterine artery ligation or last resort hysterectomy

235
Q

uterine inversion is

A

when the uterus drops don into the cervix causing PPH

236
Q

Johnson’s manoeuvre is when

A

hand to push back an inverted uterus back into the abdomen

237
Q

postnatal check is usually performed around

A

6 weeks same time as the newborn baby check

238
Q

key areas for a post natal check are

A

bleeding, healing, breast feeding, blood fasting glucose if gestational diabetes, blood pressure and urine dipstick for pre-eclampsia

239
Q

post partum Hb<100g/l you should

A

start oral iron ferrous sulphate

240
Q

post partum Hb<70g/l you should

A

give a blood transfusion in addition to oral iron

241
Q

mastitis is

A

inflammation of the breast tissue due to accumulation of milk in the ducts

242
Q

presentation of mastitis is

A

Breast pain and tenderness (unilateral)
Erythema
Local warmth and inflammation
Fever

243
Q

infective mastitis may be caused by

A

Staph aureus

244
Q

initial managment of mastitis should be

A

expressing and analgesia

245
Q

second line active treatment of mastitis is through

A

flucloxacillin, with milk sent for culture and sensitivities

246
Q

post natal depression is seen by what fraction of women?

A

one in ten

247
Q

peak of postnatal depression is

A

3 months

248
Q

“baby blues” occur commonly around the

A

first week

249
Q

puerperal psychosis is seen by what fraction of women

A

1/1000 starting a few weeks after birth

250
Q

what is the screening tool for post natal depression?

A

Edinburgh postnatal depression scale

251
Q

significant score on the Edinburgh postnatal depression scale is

A

score 10/30 is significant

252
Q

common post partum endocrine issue is

A

postpartum thyroiditis

253
Q

hyperthyroidism is managed with

A

propranolol

254
Q

hypothyroidism is managed with

A

levothyroxine

255
Q

sheehan’s syndrome is a complication of

A

post partum haemorrhage

256
Q

sheehan’s syndrome refers to

A

necrosis of the pituitary gland

257
Q

pathology of sheehan’s syndrome

A

anterior pituitary gland blood supply is from the hypothalamo-hypophysial portal system which is susceptible to rapid drops in blood pressure

258
Q

presentation of sheehan’s syndrome

A

Reduced lactation (lack of prolactin)
Amenorrhea (lack of LH and FSH)
Adrenal Insufficiency (lack of ACTH)
Hypothyroidism (lack of TSH)

259
Q

what contraception would you want to avoid in breast cancer?

A

avoid any hormonal contraception and opt for copper coil

260
Q

cervical and endometrial cancer contraception advice?

A

avoid the intrauterine system - mirena

261
Q

what contraception advice would you give for someone with wilson’s disease?

A

avoid the copper coil.

262
Q

COCP specific risk factors

A

Uncontrolled hypertension (particularly ≥160 / ≥100)
Migraine with aura
History of VTE
Aged over 35 smoking more than 15 cigarettes per day
Major surgery with prolonged immobility
Vascular disease or stroke
Ischaemic heart disease, cardiomyopathy or atrial fibrillation
Liver cirrhosis and liver tumours
Systemic lupus erythematosus and antiphospholipid syndrome

263
Q

progesterone injection and COCP can be used up to

A

age fifty

264
Q

fertility post pregnancy isn’t considered until

A

21 days

265
Q

COCP after pregnancy should be started until

A

6 weeks to avoid concurrent use during breastfeeding

266
Q

diaphragms and cervical caps are utilised with

A

spermicide gel

267
Q

COCP mechanims is through

A

preventing ovulation, thickens cervical mucous and inhibits endometrial proliferation

268
Q

first lien COCP is

A

levonorgestrel

269
Q

cancer risk with COCP is what and returns to normal when?

A

breast and cervical but returns to normal ten years post

270
Q

COCP started day 0-5 of cycle provides

A

immediate protection

271
Q

COCP after day 5 of cycle requires

A

7 days of protection

272
Q

missing one COCP pill (<72 hours) requires

A

taking missed pill ASAP (even if double pilling)

273
Q

missing one COCP pill >72 hours require

A

additional contraception and potentially emergency contraception if day 1-7, and taking missing pill ASAP

274
Q

what else classifies as missing the pill for COCP?

A

vomiting and diarrhoea

275
Q

prior to a major op COCP should be stopped how many weeks prior

A

4 weeks

276
Q

CI for pop is

A

active breast cancer

277
Q

traditional POP or desogrestel only pill a missed dose is counted as

A

trad > 3hrs or desogrestel >12 hours

278
Q

POP day 1-5 of cycle confers

A

immediate protection

279
Q

POP >5 days req.

A

48 hours of protection

280
Q

primary adverse effect of POP is

A

unscheduled bleeding; third no bleed, third normal and third prolonged or heavy

281
Q

missed pill POP guidance

A

pill ASAP, extra contraception and if had intercourse then emergency contraception

282
Q

progestogen injection timetable

A

every 12-13 weeks

283
Q

depo-provera route of delivery

A

IM injection

284
Q

risk factors for injectable progestogen

A

weight gain, irregular bleeding and osteoporosis

285
Q

benefits for injectable progestogen are

A

improves endometriosis, dysmenorrhoea, risk of ovarian and endometrial cancer and severity of sickle cell crisis

286
Q

progestogen only implant lasts for

A

3 years

287
Q

implant contraception CI in

A

active breast cancer

288
Q

implant problematic bleeding treatment is

A

COCP

289
Q

CI for coils are

A 
Pelvic inflammatory disease or infection
Immunosuppression
Pregnancy
Unexplained bleeding
Pelvic cancer
Uterine cavity distortion (e.g. by fibroids)
290
Q

examination required prior to coil insertion is

A

bimanual

291
Q

check up after how many weeks post coil insertion?

A

3-6 weeks

292
Q

risks relating to coil insertion are

A

Bleeding
Pain on insertion
Vasovagal reactions
Uterine perforation (1 in 1000, higher in breastfeeding women)
Pelvic inflammatory disease (particularly in the first 20 days)
The expulsion rate is highest in the first three months

293
Q

vasovagal reaction refers too

A

(dizziness, bradycardia and arrhythmias)

294
Q

problematic bleeding with coil insertion is common for the first how many months?

A

6

295
Q

women with smear tests may reveal what organism if they have a coil?

A

actinomyces like organisms

296
Q

emergency contraception levonorgestrel should be taken within

A

72 hours s

297
Q

emergency contraception ulipristal should be taken within

A

120 hours

298
Q

copper coil should be inserted within as an emergency contraception

A

5 days

299
Q

most effective emergency contraception is

A

copper coil as not affected by BMI, enzyme inducing drugs or malabsorption

300
Q

risk of copper coil as emergency contraception

A

pelvic inflammatory disease if STI risk

301
Q

ilipristal should be avoided in patients with

A

severe asthma

302
Q

female sterilisation involves

A

tubal occlusion with filshie clips via laparoscopy

303
Q

failure rate of female sterilisation

A

1/200

304
Q

vasectomy failure rate is

A

1/2000

305
Q

sperm testing should take place how many post weeks for vasectomy?

A

12 weeks

306
Q

Gillick competence refers too

A

understanding and intelligence of a child to voluntarily consent to treatment on a case by case basis

307
Q

what are the frazer guidelines

A
  1. mature and intelligent enough to understand
  2. They can’t be persuaded to discuss it with their parents or let the health professional discuss it
  3. likely to have intercourse regardless of treatment
  4. physical or mental health likely to suffer
  5. in their best interest
308
Q

1st trimester screening consists of

A

Statistical analysis of maternal age, NT measurement & biochemical markers free beta HCG and PAPP-A

309
Q

1st trimester screening occurs during what gestation?

A

11+2 - 14+1 G

310
Q

parents can opt for screening for what conditions

A

Screening for Trisomies 21, 18 and 13.

311
Q

trisomy 13 refers to

A

Patau’s syndrome

312
Q

trisomy 18 refers too

A

edward’s syndrome

313
Q

2nd trimester occurs in what gestation?

A

14+2 - 20 weeks

314
Q

2nd trimester screening involves

A

Quadruple maternal serum screening (statistical analysis of maternal age & biochemical markers AFP, Beta HCG, Inhibin A, oestradiol).

315
Q

high risk for down syndrome (>1/150) involves what test next line?

A

Non-invasive prenatal testing (NIPT)

316
Q

NIPT or non invasive prenatal testing involves

A

detection of free fetal DNA in maternal symptom

317
Q

High risk on NIPT warrants use of

A

Chorionic villus sampling (CVS)
Amniocentesis
Cordocentesis (Fetal blood sampling FBS)

318
Q

risk of foetal loss with invasive testing is

A

approx 0.5 - 1% for CVS or Amniocentesis

319
Q

as what week in gestation does an anomaly scan take place

A

20 weeks

320
Q

20 week anomaly scan looks at

A

structural anomalies and also for “soft markers “ of chromosomal abnormality

321
Q

3rd trimester scan involves

A

Serial Scanning every 4 weeks from 28 weeks gestation is undertaken as a screening for Fetal Growth Restriction.

fourth year (12 decks)

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