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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

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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

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3
Q

What is primparous

Length

A

In labour for first time

12-24 hrs

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4
Q

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

A

6-12 hours

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5
Q

Latent phase

A

Pre-labour phase where might experience contractions

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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

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7
Q

What is the most favourable presentation

A

Vertex

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8
Q

What is breech presentation

A

Bottom first - advise cessaerian as foot first causes complicated delivery

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9
Q

Can Brow presentation and shoulder presentation deliver vaginally?

A

Cant be delivered vaginally

Advise cessarean

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10
Q

Station

A

Dilatation in relation to ischial spine

Only safe to assist if head is below the ischial spine

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11
Q

Desired position of baby

A

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

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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

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13
Q

SVD

A

Spontaneous vertex delivery - unassted delivery

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14
Q

Assisted delivery

A

Forceps/ventouse

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15
Q

Malpresentation

A

Breech, face, brow, compound

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

Shoulder dystocia - head delivered but shoulder stuck

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16
Q

The puerperium

A

6 weeks post natal

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17
Q

What is lochia

A

Light brown discharge

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18
Q

PPH

A

Post partum haemorrhage

Primary
Secondary during purperium

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19
Q

Hormones that stimulate breast proliferation

A

Oestrogena dn progesteroen

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20
Q

Prolacitn

A

Stimulated milk productioj and descent into alvelpoli

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21
Q

Oxytocin

A

Stimulates milk ejection

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22
Q

Colostrum

A

First thick yellow fluid

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23
Q

Why not breast feed?

A

HIV positive with high viral load

…

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24
Q

Complications of breast feeding

A
  • cracked nipples
  • mastitis
  • milk stasis
  • poor supply - domperidone
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25
Q

Narrowest part of head

A

Vertex

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26
Q

Preterm labour

A

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

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27
Q

Risk factors for preterm labour

A

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

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28
Q

Delivery before 24 weeks is termed

A

Miscarriage

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29
Q

Treatment for preterm labour

A

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

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30
Q

Tocolysis

A

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)

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31
Q

Post partum haemorrhage

A

> 500mls blood loss PV

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32
Q

Management of primary PPH

A

Emergency
A - talk
B - facial O2
C - IV access (2 large venflons)

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33
Q

Causes of primary PPH

A

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

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34
Q

Antepartum haemorrage

A

Bleeding from genital tract after 24 weeks gestation

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35
Q

Placenta praevia

A

Placenta develops in lower uterine segment

Grades 1-4

Major = when placenta completely covers vagina

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36
Q

Presentation of placenta praevia

A

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

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37
Q

Management of placenta praevia

A

If symptomatic - admit

Deliver at 37-38 weeks by caesarian section

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38
Q

Placental abruption

A

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

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39
Q

Risk of placental abruption

A 
Age 
Multiparous
Smoking 
Recreational drug use 
Abdominal trauma
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40
Q

Misscariage

A

15% of all confirmed pregnancies

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41
Q

Threatened miscarriage

A

PV bleeding +/- pain

Cervix is closed

USS confirms a viable pregnancy

May lead on to miscarriage

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42
Q

Inevitable miscarriage

A

Heavy PV bleeding and pain

Open cervix

Products in canal

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43
Q

Complete miscarriage

A

Products are passed and uterus empty

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44
Q

Incomplete miscarriage

A

Not all products of conception passed but no fetal heart on USS and PV bleeding

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45
Q

Missed miscariage

A

Pregnancy loss with no sx

Can be picked up at booking scan

Symptoms of pregnancy usually gone away

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46
Q

Management of incomplete miscariage

A

Expectant - give time
Surgical - evacuation - under general anaesthetic
Manual vacuum aspiration - under local anaesthetic
Medical - mifepristone and misoprostol

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47
Q

Recurrent miscarriages

A

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
Q

Molar pregnancy

A

High HCG, large uterus

PV bleeding

49
Q

Partial mole

A

Where part of placenta overgrows

When 2 sperm enter one egg and instead of forming twins forms an abnormal foetus - triploid

50
Q

Complete mole

A

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
Q

Treatment for molar pregnancy

A

Surgical evacuation

Track HCG until 0

No new pregnancy for 1 yr but need to avoid combined oral contraception

52
Q

Complications of molar pregnancy

A

Persistent gestational trophoblastic disease - part of mole remains

Choriocarcinoma - placenta become malignant and spreads to liver, lungs and brain

53
Q

Chorionicity

Amnionicity

A

Number of chorions

Number of amniotic sacks

Dizygotic = DCDA
Monozygotic = DCDA, MCDA (MCMA - could be conjoined)
54
Q

FETAL Antenatal complications for multiple pregnancy

A

Increased preterm delivery and sequalae

Increase risk of anomalies

Increased risk IUGR/IUD

55
Q

Maternal antenatal complications of multiple birth

A

Severe hyperemesis

Increased risk miscarriage
Increased risk of anaemia, pre-eclampsia, pelvic pain, placenta praevia, gestational diabetes and PPH

Also cord accidents

56
Q

Twin to twin transfusion

A

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
Q

Small for dates

A

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
Q

Placental insufficiency

A

Diabetes

Pre-eclampsia

Thrombophilia

Connective tissue disease

Placental infarction/blockade

Drugs - smoking, alcohol, recreational drugs, beta blockers

59
Q

Pre-eclampsia

A

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
Q

Aetiology of pre-eclampsia

A

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
Q

Risk factors for pre-eclampsia

A

Primigracida

35

Family/personal history of

Multiple pregnancy

Obesity

Non smokers

Pre-existing hypertension or renal disease

62
Q

Risks of pre-eclampsia to mother

A 
Renal/hepatic failure 
HELLP
Stroke 
DIC
Pulmonary oedema 
Convulsions 
Death
63
Q

Risks of pre-eclampsia to baby

A 
IUGR (growth restriction)
Placental abruption 
Prematurity 
Hypoxic damage 
Death
64
Q

Treat pre-eclampsia

A

Deliver baby!

Antihypertensives (labetolol)

Potentially betamethasone if

65
Q

Previous pre-eclampsia prophylaxis for future

A

Low dose aspirin

Careful BP monitoring

Growth scans

66
Q

Diabetes in pregnancy

A

Pregnancy is a state of insulin resistance

Placenta produces anti insulin hormones

67
Q

Gestational diabetes

A

Onset with pregnancy
Assess clinical risk and consider HbA1c at booking and OGTT at 28 weeks

Can progress to type 2 postnatally

68
Q

Management of gestational diabetes

A

Diet control

Metformin

Insulin

69
Q

How does pregnancy effect diabetes

A

Insulin requirements rise
Decrease in renal function (proteinuria)
Increased episode of hypoglycaemia
Worsening retinopathy

70
Q

Risk to foetus in diabetes during pregnancy

A 
Congenital abnormalites 
IUD/neonatal death 
Increased risk of pre-eclampsia
Polyhyrdamnios 
Macrosomia/IUGR
Prematurity
Post natal hypoglycaemia and jaundice
71
Q

When do those with gestational diabetes get reviewed

A

6 month Glucose tolerance test

72
Q

Heavy menstrual bleeding

A

> 80mls blood loss/month

Affecting QoL or causing anaemia

73
Q

Causes of heavy menstrual bleeding

A 
PALM COEIN
Polyp
Adenomyosis 
Leiomyoma 
Malignancy (>45)
Coagulopathy (won willebrand)
Ovulatory dysfunction - PCOS
Endometrial 
Iatrogenic (warfarin ...)
Not yet classified
74
Q

Investigations of menorrhagia

A

Pelvic USS
FBC, clotting, TFT

In older women (>40)
Pipelle biopsy
Hysteroscopy +/- biopsy

75
Q

Fibroids

A

Benign tumours of myometrium
20% incidence in women >40yrs old
–> cause pressure/pain or bleeding

76
Q

Medical Management of heavy menstrual bleeding

A 
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
Q

Radiological management of menorrhagia

A

Fibroids - uterine artery embolisation

78
Q

Surgical management of menorrhagia

A

(Microwave) endometrial ablation - reduces bleeding, carry out biopsy before, family should be complete

Myomectomy - remove fibroids

Hysterectomy

79
Q

Endometriosis

A

Pain associated with menstrual cycle or infertility

Ectopic endometrial tissue: pouch of douglas, ovarian fossae, bladder…

Rarely lungs, brain, muscle

80
Q

Treatment of endometriosus

A

COCP
Progesterones
GnRH
Surgical

81
Q

Prolapse

A

Downward displacement of pelvic floor (weakening of support)

Uterovaginal - uterus
Cystocele - bladder
Rectocele - large bowel
Endocele - small bowel

82
Q

Symptoms of prolapse

A 
"Something coming down" 
Discomfort
Urinary sx 
Recurrent UTI
Constipation/difficulty emptying bowel
83
Q

Treatment of prolapse

A

Mild - oestrogen cream, pelvic floor exercise

Mod/severe - conservative (pessary) vs surgical (pelvic floor repair/vaginal hysterectomy/mesh)

84
Q

Urge incontince

A

Overactive bladder
Inability to delay following sensation to void

Detrusor instability, neurogenic bladder, infecton

85
Q

Stress incontinence

A

Loss of urine when increase abdominal pressure

86
Q

Treatment of urge incontinence

A

Encourage to lose weight and moderate caffeine intake

Anti-cholinergic medications - solifenacin

Botox (rare)

87
Q

Treatment of stress incontinence

A

Physio (pelvic floor exercise, electrical stimulation of muscles)
Urethral bulking
Sub-urethral sling
Colposuspension

NB prolapse can make urinary symptoms worse…

88
Q

Endometrial cancer

A

Adenocarcinoma most common

Mean age 60 yrs

89
Q

Risk of endometrial cancer

A

Nulliparous
Obesity
E2 only HRT
Late menopause

HIGH OESTROGEN

90
Q

Symptoms of endometrial cancer

A

Post menopausal bleeding
Heavy irregular bleeding
None

91
Q

Diagnosis of endometrial cancer

A

TV USS
12mm premenopause; 4mm post menopause
Pipelle biopsy
Hysteroscopy, D&C

92
Q

Spread of endometrial cancer

A

Myometrial

Involvement of cervix

Pelvic spread

Bladder/rectum/distant (lung)

93
Q

Treatment of endometrial cancer

A

Hysterectomy

Pelvic clearance omentectomy/appendicectomy

Chemo/hormone therapy if advanced

94
Q

Ovarian cancer

A 
Most deadly!
Peak age 68-85 yrs 
90% sporadic 10% genetic 
Epithelial tumours 85%
Increased risk: nulliparous, ovulation induction

COC decreases risk

95
Q

Symptoms of ovarian cancer

A

Abdo Distension/mass
Abdo pain
Weight loss/loss of appetite

96
Q

Diagnosis of ovarian cancer

A

Ascitic tap
Imaging - TV USS, CT, MRI, CXR
Laparotomy

97
Q

Cervical cancer

A

Peak age 45-55

Risks - defaulting smears, multiple partners, HPV 16 and 18, COC use, smoking

98
Q

Cervical screening

A

Every 3 years from age 20-65

Liquid based cytology

Abnormal results referred to colposcopy for cold coagulopathy

99
Q

CIN

A

Cervical intraepithelial neoplasia

Dyskaryosis

May presist for years - can revert to normal

100
Q

Symptoms of cervical cancer

A

Post coital bleeding
Abnormal discharge/bleeding
Weight loss
Pain

101
Q

Diagnosis cervical cancer

A

EUA, cytoscopy, proctoscopy

Cone biopsy

LLETZ

102
Q

Vulval cancer

A

Peak age 65-70

Squamous carcinoma 92%

Risks - HSV, HPV, smoking, immunosupression

VIN - pre-cancer

103
Q

Symptoms of vulval cancer

A

Pruirus vulva
Vulval pain/discharge
Lump or ulcer
Diagnosed by vulval biopsy

104
Q

Polycystic ovarian syndrome

A

Varying degrees
Unknown aetiology

Clinical signs - oligomenorrhoea, obesity, hirsutism

105
Q

Endocrine PCOS measurements

A

Increased LH/low FSH (Lots of follicles?)

Increased testosterone

Decreased SHBG

Insulin resistance and impaired glucose tolerance

Moderate hyperprolactinaemia occasionally

106
Q

Treatment of PCOS

A 
Weight loss
Metformin 
Laser Rx for hirsutism 
COC, mirena, depo povera 
Fertility Rx with clomid
107
Q

Ectopic pregnancy

A

Implantation outside uterus
Tubal - 97%
Cervix, ovary, peritoneum, abdo, in cessarean scar

108
Q

Risk factors of ectopic

A 
STI/PID
IUD/mirena 
Previous ectopy 
Sterilisation/tubal surgery 
Assisted reproduction
109
Q

Presentation of ectopic pregnancy

A 
Amennorhoea
Positive pregnancy test 
Typically 6-8 weeks gestation 
Pain (shoulder tip) - 90%
PV spotting 
Faint, collapse, haemodynamic compromise
110
Q

Diagnosis extopic

A

Clinical (peritonism, adnexal mass, unstable)
Serum HCG tracing
TV USS (no IU pregnancy, adnexal mass, free fluid)
Laparoscopy

111
Q

Medical management of ectopic

A

IV access, FBC, G&S, X-match

Resuscitation if required

Anti-D if rhesus negative

112
Q

Surgical management of ectopic pregnancy

A

Laparoscopic salpingectomy if any signs of rupture

113
Q

Medical management of ectopics

A

Methotrexate

Check U&E and LFT

HCG tracking

No pregnancy for 3 months

Avoid alcohol and sunlight

114
Q

Management of ectopic conservatively

A

More risky

Must be assymptomatic and stable

Falling HCG - need to track to zero

115
Q

Follow up for ectopics

A

6 week follow up appointment

Good contraception

Single ectopic - 60-70% will have IU pregnancy
Subsequent pregnancy - 10-15% will be ectopic

116
Q

Which hormone is responsible for a positive pregnancy test

A

Human chorionic gonadatrophin

Reproduction (6 decks)

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