Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Reproduction > Revision - Obstetrics > Flashcards

Revision - Obstetrics Flashcards

1
Q

Booking investigations

A

FBC - haemagloin and platelets
Blood group and abs
Rubella status
Hep B/C, HIV, Syph. If no chicken pox do varicella
Dip urine - pregnant women dont always have symptoms of a UTI

Risk factors for diabetes - HbA1C, OGTT

Haemoglobinopathy screen for not in UK

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is CUBS

A

Combined ultrasound and biochemical screening - 11-13 weeks

Screen for trisomy 21

–> if high risk are referred for counselling

Free fetal DNA is more accurate but expensive

Invasive tests have 1 in 6 miscarriage risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is primparous

Length

A

In labour for first time

12-24 hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the average time for labour in a patient with previous labour

A

6-12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Latent phase

A

Pre-labour phase where might experience contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stages of labour

A

Stage 1 - onset to full dilatation

Stage 2 - full dilatation to delivery of baby

Stage 3 - delivery of baby to placenta delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most favourable presentation

A

Vertex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is breech presentation

A

Bottom first - advise cessaerian as foot first causes complicated delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Can Brow presentation and shoulder presentation deliver vaginally?

A

Cant be delivered vaginally

Advise cessarean

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Station

A

Dilatation in relation to ischial spine

Only safe to assist if head is below the ischial spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Desired position of baby

A

Direct occiput posterior - face pointing down to anus as opposed to pubes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Analgesia in labour

A

Breathing/TENS/Bath/Co-codamol

Entonox (nitrous oxide/oxygen)

Morphine (can cause neonatal resp. Depression

Epidural L3/L4 - by anaesthetist

Remifentanil - short acting opiate - PCA - drowsy, need oxygen but can be reversed quickly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

SVD

A

Spontaneous vertex delivery - unassted delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Assisted delivery

A

Forceps/ventouse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Malpresentation

A

Breech, face, brow, compound

Cord prolapse - cord comes out with fluid –> medical emergency

Shoulder dystocia - head delivered but shoulder stuck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

The puerperium

A

6 weeks post natal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is lochia

A

Light brown discharge

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

PPH

A

Post partum haemorrhage

Primary
Secondary during purperium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hormones that stimulate breast proliferation

A

Oestrogena dn progesteroen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Prolacitn

A

Stimulated milk productioj and descent into alvelpoli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Oxytocin

A

Stimulates milk ejection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Colostrum

A

First thick yellow fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why not breast feed?

A

HIV positive with high viral load

…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Complications of breast feeding

A
  • cracked nipples
  • mastitis
  • milk stasis
  • poor supply - domperidone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Narrowest part of head
Vertex
26
Preterm labour
Onset of labour before 37 weeks Presense of uterine contractions of sufficient frequency and intensity to cause dilatation of the cervix prior to term gestation
27
Risk factors for preterm labour
Social - young mother, low maternal weight Overdistension of uterus - multiple pregnancy, polyhydramnios (xs amniotic fluid) Fetal anomaly Uterine anomaly - congenital; cervical incontinence Infection - anything causing bacteraemia Trauma - injury or surgery during pregnancy
28
Delivery before 24 weeks is termed
Miscarriage
29
Treatment for preterm labour
Delays delivery for a few days using tocolysis for 48 hours Allows time to be given corticosteroids to be given to accelerate fetal lung maturity
30
Tocolysis
Drug treatment for preterm labour CCB - nifedipine Inhibits uterine muscle contraction 20 mg fiven followed by 10-20mg given 3-4 times daily depending on uterine activity Need to make sure not hypotensive (Atosiban - oxytocin receptor antagonist)
31
Post partum haemorrhage
>500mls blood loss PV
32
Management of primary PPH
Emergency A - talk B - facial O2 C - IV access (2 large venflons)
33
Causes of primary PPH
TONE - atonic uterus (soft and floppy) - give oxytocic drugs and bimanual compression TISSUE - placenta/membranes left inside - need to remove manually TRAUMA - genital tract trauma - repair THROMBIN - coagulopathy; watch for signs of DIC
34
Antepartum haemorrage
Bleeding from genital tract after 24 weeks gestation
35
Placenta praevia
Placenta develops in lower uterine segment Grades 1-4 Major = when placenta completely covers vagina
36
Presentation of placenta praevia
20 wks UUS (97% will migrate) - transvaginal best to confirm if the patient isnt bleeding - wouldnt examine if person was bleeding Painless unprovoked vaginal bleeding Post coital bleeding Malpresentation Massive haemorrhage may follow warning bleed
37
Management of placenta praevia
If symptomatic - admit | Deliver at 37-38 weeks by caesarian section
38
Placental abruption
Bleeding following sepatation of normally sited placenta Hypotension and tachycardia following blood loss (PV Abdo pain and tension Shock/collapse Fetal distress Classified as revealed or concealed where revealed has pv bleeding
39
Risk of placental abruption
``` Age Multiparous Smoking Recreational drug use Abdominal trauma ```
40
Misscariage
15% of all confirmed pregnancies
41
Threatened miscarriage
PV bleeding +/- pain Cervix is closed USS confirms a viable pregnancy May lead on to miscarriage
42
Inevitable miscarriage
Heavy PV bleeding and pain Open cervix Products in canal
43
Complete miscarriage
Products are passed and uterus empty
44
Incomplete miscarriage
Not all products of conception passed but no fetal heart on USS and PV bleeding
45
Missed miscariage
Pregnancy loss with no sx Can be picked up at booking scan Symptoms of pregnancy usually gone away
46
Management of incomplete miscariage
Expectant - give time Surgical - evacuation - under general anaesthetic Manual vacuum aspiration - under local anaesthetic Medical - mifepristone and misoprostol
47
Recurrent miscarriages
3 or more Chormosomal abnormality - mum or dad has balance translocation Congenital uterine abnormalities Cervical incompetence (miscarriage late - uncommon) Infection - chronic PCOS Thrombophilia - can be treated with heparin or aspirin
48
Molar pregnancy
High HCG, large uterus | PV bleeding
49
Partial mole
Where part of placenta overgrows When 2 sperm enter one egg and instead of forming twins forms an abnormal foetus - triploid
50
Complete mole
Abnormal placenta and grows rapidly - no developing fetus one sperm enters the egg but only haploid - half of one set of chromosomes are present
51
Treatment for molar pregnancy
Surgical evacuation Track HCG until 0 No new pregnancy for 1 yr but need to avoid combined oral contraception
52
Complications of molar pregnancy
Persistent gestational trophoblastic disease - part of mole remains Choriocarcinoma - placenta become malignant and spreads to liver, lungs and brain
53
Chorionicity Amnionicity
Number of chorions Number of amniotic sacks ``` Dizygotic = DCDA Monozygotic = DCDA, MCDA (MCMA - could be conjoined) ```
54
FETAL Antenatal complications for multiple pregnancy
Increased preterm delivery and sequalae Increase risk of anomalies Increased risk IUGR/IUD
55
Maternal antenatal complications of multiple birth
Severe hyperemesis Increased risk miscarriage Increased risk of anaemia, pre-eclampsia, pelvic pain, placenta praevia, gestational diabetes and PPH Also cord accidents
56
Twin to twin transfusion
Monochorionic twin Uneven distribution Donor twin - anaemic, IUGR, oligohydramnios Recipient twin - Polycythaemia, polyhydraminios, ascites and pleural effusions Treatment is recommended as soon as diagnosis made - laser ablation of anastomosis vessels and early delivery
57
Small for dates
Picked up measuring fundal height Constitutionally small - symmetrically small, normal liquor volume and normal umbilical artery dopplets IUGR - assymetrical growth, low volumes/abnormal dopplers, sometimes fetal distress
58
Placental insufficiency
Diabetes Pre-eclampsia Thrombophilia Connective tissue disease Placental infarction/blockade Drugs - smoking, alcohol, recreational drugs, beta blockers
59
Pre-eclampsia
Increased BP and proteinuria +/- oedema >30mmHg systolic or >15mmHg diastolic above booking BP Systolic >150mmHg Only 20% with increased BP have pre-eclampsia majority have pregnancy induced hypertension
60
Aetiology of pre-eclampsia
Immunological disturbance decreased invasion of spiral arteries into placenta Endothelial cell damage fibrin fragments break away and deposit in kidney Kidney --> renal failure, proteinuria CNS convulsions
61
Risk factors for pre-eclampsia
Primigracida 35 Family/personal history of Multiple pregnancy Obesity Non smokers Pre-existing hypertension or renal disease
62
Risks of pre-eclampsia to mother
``` Renal/hepatic failure HELLP Stroke DIC Pulmonary oedema Convulsions Death ```
63
Risks of pre-eclampsia to baby
``` IUGR (growth restriction) Placental abruption Prematurity Hypoxic damage Death ```
64
Treat pre-eclampsia
Deliver baby! Antihypertensives (labetolol) Potentially betamethasone if
65
Previous pre-eclampsia prophylaxis for future
Low dose aspirin Careful BP monitoring Growth scans
66
Diabetes in pregnancy
Pregnancy is a state of insulin resistance Placenta produces anti insulin hormones
67
Gestational diabetes
Onset with pregnancy Assess clinical risk and consider HbA1c at booking and OGTT at 28 weeks Can progress to type 2 postnatally
68
Management of gestational diabetes
Diet control Metformin Insulin
69
How does pregnancy effect diabetes
Insulin requirements rise Decrease in renal function (proteinuria) Increased episode of hypoglycaemia Worsening retinopathy
70
Risk to foetus in diabetes during pregnancy
``` Congenital abnormalites IUD/neonatal death Increased risk of pre-eclampsia Polyhyrdamnios Macrosomia/IUGR Prematurity Post natal hypoglycaemia and jaundice ```
71
When do those with gestational diabetes get reviewed
6 month Glucose tolerance test
72
Heavy menstrual bleeding
>80mls blood loss/month Affecting QoL or causing anaemia
73
Causes of heavy menstrual bleeding
``` PALM COEIN Polyp Adenomyosis Leiomyoma Malignancy (>45) ``` ``` Coagulopathy (won willebrand) Ovulatory dysfunction - PCOS Endometrial Iatrogenic (warfarin ...) Not yet classified ```
74
Investigations of menorrhagia
Pelvic USS FBC, clotting, TFT In older women (>40) Pipelle biopsy Hysteroscopy +/- biopsy
75
Fibroids
Benign tumours of myometrium 20% incidence in women >40yrs old --> cause pressure/pain or bleeding
76
Medical Management of heavy menstrual bleeding
``` Mefenamic acid (NSAID) Tranexamid acid (antifibrinolytic) ``` Progesterones - norethisterone, provera, progesterone only pill (Cerazette) Mirena coil COC, Depopovera, GnRH Esmya - progesterone inhibitor (for large fibroids)
77
Radiological management of menorrhagia
Fibroids - uterine artery embolisation
78
Surgical management of menorrhagia
(Microwave) endometrial ablation - reduces bleeding, carry out biopsy before, family should be complete Myomectomy - remove fibroids Hysterectomy
79
Endometriosis
Pain associated with menstrual cycle or infertility Ectopic endometrial tissue: pouch of douglas, ovarian fossae, bladder... Rarely lungs, brain, muscle
80
Treatment of endometriosus
COCP Progesterones GnRH Surgical
81
Prolapse
Downward displacement of pelvic floor (weakening of support) Uterovaginal - uterus Cystocele - bladder Rectocele - large bowel Endocele - small bowel
82
Symptoms of prolapse
``` "Something coming down" Discomfort Urinary sx Recurrent UTI Constipation/difficulty emptying bowel ```
83
Treatment of prolapse
Mild - oestrogen cream, pelvic floor exercise Mod/severe - conservative (pessary) vs surgical (pelvic floor repair/vaginal hysterectomy/mesh)
84
Urge incontince
Overactive bladder Inability to delay following sensation to void Detrusor instability, neurogenic bladder, infecton
85
Stress incontinence
Loss of urine when increase abdominal pressure
86
Treatment of urge incontinence
Encourage to lose weight and moderate caffeine intake Anti-cholinergic medications - solifenacin Botox (rare)
87
Treatment of stress incontinence
Physio (pelvic floor exercise, electrical stimulation of muscles) Urethral bulking Sub-urethral sling Colposuspension NB prolapse can make urinary symptoms worse...
88
Endometrial cancer
Adenocarcinoma most common Mean age 60 yrs
89
Risk of endometrial cancer
Nulliparous Obesity E2 only HRT Late menopause HIGH OESTROGEN
90
Symptoms of endometrial cancer
Post menopausal bleeding Heavy irregular bleeding None
91
Diagnosis of endometrial cancer
TV USS 12mm premenopause; 4mm post menopause Pipelle biopsy Hysteroscopy, D&C
92
Spread of endometrial cancer
Myometrial Involvement of cervix Pelvic spread Bladder/rectum/distant (lung)
93
Treatment of endometrial cancer
Hysterectomy Pelvic clearance omentectomy/appendicectomy Chemo/hormone therapy if advanced
94
Ovarian cancer
``` Most deadly! Peak age 68-85 yrs 90% sporadic 10% genetic Epithelial tumours 85% Increased risk: nulliparous, ovulation induction ``` COC decreases risk
95
Symptoms of ovarian cancer
Abdo Distension/mass Abdo pain Weight loss/loss of appetite
96
Diagnosis of ovarian cancer
Ascitic tap Imaging - TV USS, CT, MRI, CXR Laparotomy
97
Cervical cancer
Peak age 45-55 Risks - defaulting smears, multiple partners, HPV 16 and 18, COC use, smoking
98
Cervical screening
Every 3 years from age 20-65 Liquid based cytology Abnormal results referred to colposcopy for cold coagulopathy
99
CIN
Cervical intraepithelial neoplasia Dyskaryosis May presist for years - can revert to normal
100
Symptoms of cervical cancer
Post coital bleeding Abnormal discharge/bleeding Weight loss Pain
101
Diagnosis cervical cancer
EUA, cytoscopy, proctoscopy Cone biopsy LLETZ
102
Vulval cancer
Peak age 65-70 Squamous carcinoma 92% Risks - HSV, HPV, smoking, immunosupression VIN - pre-cancer
103
Symptoms of vulval cancer
Pruirus vulva Vulval pain/discharge Lump or ulcer Diagnosed by vulval biopsy
104
Polycystic ovarian syndrome
Varying degrees Unknown aetiology Clinical signs - oligomenorrhoea, obesity, hirsutism
105
Endocrine PCOS measurements
Increased LH/low FSH (Lots of follicles?) Increased testosterone Decreased SHBG Insulin resistance and impaired glucose tolerance Moderate hyperprolactinaemia occasionally
106
Treatment of PCOS
``` Weight loss Metformin Laser Rx for hirsutism COC, mirena, depo povera Fertility Rx with clomid ```
107
Ectopic pregnancy
Implantation outside uterus Tubal - 97% Cervix, ovary, peritoneum, abdo, in cessarean scar
108
Risk factors of ectopic
``` STI/PID IUD/mirena Previous ectopy Sterilisation/tubal surgery Assisted reproduction ```
109
Presentation of ectopic pregnancy
``` Amennorhoea Positive pregnancy test Typically 6-8 weeks gestation Pain (shoulder tip) - 90% PV spotting Faint, collapse, haemodynamic compromise ```
110
Diagnosis extopic
Clinical (peritonism, adnexal mass, unstable) Serum HCG tracing TV USS (no IU pregnancy, adnexal mass, free fluid) Laparoscopy
111
Medical management of ectopic
IV access, FBC, G&S, X-match Resuscitation if required Anti-D if rhesus negative
112
Surgical management of ectopic pregnancy
Laparoscopic salpingectomy if any signs of rupture
113
Medical management of ectopics
Methotrexate Check U&E and LFT HCG tracking No pregnancy for 3 months Avoid alcohol and sunlight
114
Management of ectopic conservatively
More risky Must be assymptomatic and stable Falling HCG - need to track to zero
115
Follow up for ectopics
6 week follow up appointment Good contraception Single ectopic - 60-70% will have IU pregnancy Subsequent pregnancy - 10-15% will be ectopic
116
Which hormone is responsible for a positive pregnancy test
Human chorionic gonadatrophin

Reproduction (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions