Short SAQ questions Flashcards
What is the carrier frequency of cystic fibrosis?
1 in 35 in Australia
1 in 25 in New Zealand
What is the carrier frequency of spinal muscular dystrophy?
1 in 50
What is the carrier frequency of fragile X syndrome?
1 in 332
What are the risk factors for placenta accreta spectrum?
- Previous accreta *
- Previous CS *
- Placenta praevia
- Placenta praevia and previous CS *
- Previous uterine surgery *
- ART
- Short inter-pregnancy interval
- CUA
- Increasing maternal age
- Major risks
What are the risk factors for vasa praevia?
- low-lying placenta/ placenta praevia
- bilobed/succenturiate lobe
- velamentous cord insertion
- ART
- Multiple pregnancy (not independent risk factor)
What are the risk factors for placenta praevia?
- Prev CS (increasing risk with increasing # of CSs)
- ART
- Smoking
- Prev praevia
- AMA
- Prev uterine surgery
- Multiple pregnancy
How is BMI calculated?
kg/m2
weigh in kilograms divided by the square of height in metres
What are the risk factors for ovarian torsion?
- Ovarian mass
- Prev torsion
- Ovulation induction
- Pregnancy, particularly 1st trimester
- Long ovarian suspensory ligament
What are possible complications of Dermoid cysts?
- Torsion
- Rupture
- Hyperthyroidism if presence of active thyroid tissue
- Infection
- Malignancy
- Chemical peritonitis
What features increase the risk of a failed operative delivery?
- Suspected fetal macrosomia (>4kg)
- Maternal obesity (BMI >30)
- 1/5th head palpable abdominally
- Malposition >45degrees from occipito-anterior position
- Midcavity, station 0 to +2
- Inadequate analgesia in delivery room
- No descent of vertex with pushing
- Poor maternal effort/pushing
What are the risk factors for shoulder dystocia?
Pre-labour:
- Prev shoulder dystocia
- Fetal macrosomia
- Maternal diabetes mellitus
- Maternal obesity
Intra-partum:
- labour dystocia
- prolonged 2nd stage
- assisted vaginal delivery
- epidural
What are the 5 principles of managing a PPH?
- Recognition
- Communication
- Resuscitation
- Monitoring and investigations
- Management of PPH
What is the definition of sepsis?
Life threatening organ dysfunction caused by a dysregulated host response to infection
What is the rate of reduction of early onset neonatal GBS with use of prophylaxis?
80%
What are the benefits of antenatal corticosteroids in women at risk of preterm birth?
Reduced risk of:
- perinatal death
- neonatal death
- respiratory distress syndrome
- probably reduces the risk of intraventricular haemorrhage
What are the causes of post-menopausal bleeding in order from most common to least common?
- Atrophy
- Exogenous estrogen
- Endometrial/cervical polyp
- Endometrial hyperplasia
- Endometrial cancer
- Cervical cancer
What are the risk factors for endometrial cancer?
- Hyperplasia
- Obesity
- T2DM
- Unopposed oestrogen therapy
- PCOS
- Early menarche/later menopause
- Nulliparity
- Age
- Oestrogen secreting tumour (eg. Granulosa cell tumour)
- Tamxifen therapy
- Genetic syndromes eg. Lynch, Cowden
What prognostic factors for endometrial hyperplasia/cancer are associated with a poor outcome?
- Increasing age (over 65)
- Stage (>1b)
- Increasing myoinvasion
- Vascular invasion
- Tumour extending beyond the fundus
- Grade 3
- Histological subtypes - clear cell, serous, adenosquamous
- Tumour >2cm
Hyperplasia without atypia.
- What is the risk of co-existent invasive endometrial carcinoma?
- What is the risk of progression to invasive carcinoma?
- What is the risk of co-existent invasive endometrial carcinoma? <1%
- What is the risk of progression to invasive carcinoma? <5% over 20 years
Atypical hyperplasia
- What is the risk of co-existent invasive endometrial carcinoma?
- What is the risk of progression to invasive carcinoma?
- What is the risk of co-existent invasive endometrial carcinoma? 25-59%
- What is the risk of progression to invasive carcinoma? RR 14-45
What is endometrial hyperplasia?
Irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium
What is the lifetime risk of uterine cancer?
1 in 45
What is the genetic bases of cystic fibrosis?
Autosomal recessive inheritance of a mutation in the cystic fibrosis transmembrane conductance regulator gene.
Over 1000 mutations have been identified. Phenotype depends of what combination of mutations they have inherited.
What is the anatomical pathology which defines placenta accreta?
Chorionic villi attach to the myometrium. Invasion through nitabuch layer (80% of placenta accreta spectrum)
Nitabuch layer is a fibrous junction of the decidua and cytotrophoblast, prevents excessive penetration of the decidua.
What is the anatomical pathology which defines placenta increta?
Chorionic villi invade the myometrium (15% of placenta accreta spectrum)
What is the anatomical pathology which defines placenta percreta?
Chorionic villi invade the myometrium and serosa, may invade adjacent organs (eg. bladder) (<5% of placenta accreta spectrum)
What USS features are suggestive of placenta accreta spectrum?
- Loss of defined interface between decidual layer of placenta and myometrium
- Presence of numerous placental lacunae
- Myometrial thinning
- Placental bulge
- Hypervascularity
What are the USS features of vasa praevia?
- Visualising aberrant linear or tubular echolucent structures with 2D imaging.
- Aberrant vessels locations over or within 2cm of the internal os attached to the inner perimeter of the fetal membranes.
- Demonstrating blood flow in these structures using colour or power Doppler.
- Demonstrating umbilical artery/venous Doppler waveforms using pulse wave Doppler.
What are the prognostic features for whether a placenta will remain low lying following anatomy scan?
- Posterior placenta less likely to migrate
- Less likely to migrate if anterior placenta and previous CS
- Less likely to migrate if placenta is covering the internal os by >2.5cm
90% of low-lying placentas resolve by term.
What is the Rotterdam criteria to diagnose PCOS?
2 out of 3 of:
- Oligomenorrhoea or anovulation
- Clinical and/or biochemical signs of hyperandrogenism
- Polycystic ovaries on USS (either 20 or more peripheral antral follicles or increased ovarian
volume)
What is the criteria to diagnose metabolic syndrome?
3 or more of:
- High blood sugar
- Reduced HDL
- High triglycerides
- High BP
- Abdominal obesity
What are the different pathological causes of anaemia that may occur in pregnant women?
- Haemolytic anaemia eg. HELLP syndrome
- Haemorrhage eg. Placenta praevia
- Consumptive eg. DIC
- Hereditary eg. Thalasaemia
- Anaemia of chronic disease eg. Chronic kidney disease
- Nutritional deficiency eg. Iron
What are the potential adverse outcomes related to prolonged pregnancy for the mother?
Risks due to macrosomia:
- PPH
- Labour dystocia
- Obstructed labour
- Operative vaginal delivery
- Perineal injury
Hypertension or PET risk increases as pregnancy progresses
Caesarean section
What are the potential adverse outcomes related to prolonged pregnancy for the fetus?
- Stillbirth and neonatal death
- Caesarean birth
- Admission to NICU
- Meconium aspiration
- Oligohydramnios causing intrapartum cord compression and fetal distress
Macrosomia increasing the risk of:
- Shoulder dystocia and related peripheral nerve damage and fracture
- Hypogylcaemia
What are the evidence based strategies that reduce pregnancy duration beyond 42 weeks?
- Membrane sweeping after 39/40
- Induction of labour from 41/40
- Accurate dating of pregnancy
Outline the FIGO PALM-COIEN classification system for AUB
Structural abnormalities that can be imaged o P – endometrial polyps o A – adenomyosis o L – Leiomyomata o M – Malignancy Non-structural abnormalities o C – coagulopathy o O – Ovulatory o I – Iatrogenic o E – Endometrial o N – Not otherwise specified
What are the short term risks of endometrial ablation?
- Equipment failure 9%
- Haemorrhage 1.2%
- Uterine perforation 0.3%
- Infection 1-2%
- Uterine cramping 38%
- Thermal injury to adjacent tissues 1:10,000
What are the long term complications of second generation endometrial ablation?
- Treatment failure and need for hysterectomy (Balloon ablation 9% at 5 years, 21% at 7-10 years. Bipolar ablation <5% at 5 years).
- If pregnancy occurs there is high morbidity, with case reports of uterine rupture and disordered placentation such as placenta accrete.
- Intrauterine adhesions causing haematometra 1%.
- Post ablation tubal sterilisation syndrome 6-8%.
What are the effects of overt hypothyroidism on maternal obstetric outcome?
Increased risk of:
- Pre-eclampsia
- Placental abruption
- Post-partum haemorrhage
- Anaemia
- Postnatal depression
- Miscarriage
What are the effects of overt hypothyroidism on fetal development?
- Risk of prematurity
- Perinatal mortality
- FGR
- Developmental delay/ Cretinism
How do you optimise the quality of a semen sample for analysis for infertility?
- 2-3 days of abstinence prior to sample
- Taken by masturbation
- Avoid lubricant or saliva.
- Deposited directly into a sterile container
- If taken at home, keep it at body temperature during transport and take to lab within 1 hour
What are the major components of a semen analysis and the normal parameters?
- Volume (≥1.5mL)
- Sperm count (≥39 million)
- Sperm concentration (≥15 million/mL)
- Total motility (≥40%)
- Progressive motility (≥32%)
- Morphology (≥4% normal forms)
- pH (≥7.2)
What are the modifiable risk factors that can impact male infertility?
- Alcohol
- Smoking
- Obesity
- Scrotal temperature
- Certain drugs eg. cannabis
- Occupational exposure eg. heat
How long do you wait to repeat a semen analysis?
3 months, which is how long spermatogenesis takes
What is the definition of premature ovarian insufficiency?
Loss of normal ovarian function before the age of 40
What are the causes of premature ovarian insufficiency?
- Idiopathic (no cause found)
- Genetic (eg. Complete gonadal dysgenesis XY, Turner’s Syndrome XO, Fragile X syndrome)
- Autoimmune oophoritis (eg. Addison’s disease)
- Environmental or toxic (Eg. chemotherapy, radiation, infection)
- Surgery (eg. oophorectomy)
How do you diagnoses premature ovarian insufficiency?
- Oligo/amenorrhoea for at least 4 months
- Elevated FSH level in association with low oestradiol level, repeat measurements after at least 4 weeks to confirm diagnosis
- Age less than 40
- Rule out other causes
What are the risk factors for AFE?
No risk factors, rare and unpredictable
What are the potential causes of peripartum collapse?
Obstetric:
- Haemorrhage
- Eclampsia
- Uterine rupture
- Peripartum cardiomyopathy
- Uterine inversion
- AFE
Non-obstetric:
- Thromboembolism (PE)
- Sepsis/septic shock
- Anaphylaxis
What is the pathophysiology of AFE?
- has been compared to anaphylaxis or severe sepsis.
- may be due to complement activation.
- activation of the extrinsic coagulation cascade resulting in consumption of platelets and thrombocytopenia/DIC
- Coagulopathy causing haemorrhage
What are the immunological and physiological changes that occur in pregnancy making pregnant women more likely to become unwell with respiratory infections?
- Shift away from cell mediated immunity to humoral immunity
- Reduced lung capacity
- Increased oxygen consumption
- Less buffering capacity
What are the differential diagnoses of vulval ulcers?
Infectious causes of vulval ulcers: - Sexually transmitted infections: o Genital herpes (HSV) o Primary syphilis - Non-sexually transmitted infections: o Epstein barr virus (EBV) o Cytomegalovirus (CMV) o Chickenpox or herpes zoster (shingles) caused by varicella zoster virus (VZV) o Group A streptococcal o Vulvovaginal candidiasis
Non-infectious causes of vulval ulcers:
- Vulval aphthosis
- Autoimmune and autoinflammatory diseases eg. Lichen sclerosus
- Malignancy
List 4 physiological factors that interact to regulate fetal heart rate variability
- Change in blood pressure measured by baroreceptors.
- Reduction in oxygenation measured by chemoreceptors.
- Catecholamines and the sympathetic nervous system.
- Acetylcholine and the parasympathetic nervous system.
What are 4 situations that account for absent variability on CTG?
Decreased variability = 4 S’s • Sleep (20-40mins) • Sedation (drugs such as opiates, MgSO4, Anti-hypertensives) • Small (premature) • Sick (hypoxic)
What is the cause of a complete molar pregnancy?
Tumour of placental tissue arising due to fertilisation of an empty ovum (egg) by either 2 sperm or 1 sperm that duplicates.
Diploid.
What are the characteristic histopathological features of a complete molar pregnancy?
- P57 negative
- Absence of fetal tissue.
- Extensive hydropic change to villi.
- Excess trophoblastic proliferation.
What is the long term risk associated with molar pregnancy?
Persistent gestational trophoblastic disease requiring chemotherapy