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MS4 - OnG > Tutorials > Flashcards

Tutorials Flashcards

1
Q

Gravidity?

A

no. of pregnancies (includes miscarriages, stillbirths)

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2
Q

Parity?

A

no. of pregnancies longer than 24 weeks

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3
Q

Menorrhagia

A

Heavy/long periods of bleeding

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4
Q

Dysmenorrhoea?

A

Painful periods

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5
Q

Amenorrhoea

A

Absence of period

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6
Q

Oligomenorrhoea

A

infrequent periods or >35days between

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7
Q

FIGO staging

A

0- in situ

1- confined to organ

2- surrounding tissue

3- distant nodes

4- mets

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8
Q

Placental praevia

A

the placenta is inserted partially or wholly in the lower uterine segment

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9
Q

Placental abruption

A

the placental lining separates from the uterus of the mother prior to delivery

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10
Q

Average rate of cervix dilation during labour

A

1cm per hour

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11
Q

Rheus disease

A

Mother and fetus (even if miscarriage or stillbirth) blood mix if mom Rh-ive and fetus +. Mother produces abs which could destroy current or future fetal Hbs.

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12
Q

Emergency contaceptives

A

Intrauterine copper coil up to 5 days

Tablets:

1- levonelle (progestonegen) up to 3 days

2- ellaOne (progesteron modulatior inhibitor) up to 5 days

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13
Q

CIs for the COCP pill?

A

Migrain with aura increases risk of ischaemic stroke so dont want the additional risk!

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14
Q

Types of miscarriage

A

Threatened

Incomplete

Complete

Missed/silent

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15
Q

Sx of miscarriage

A

ranges from pain and bleeding to asymptomatic (silent)

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16
Q

Silent miscarriage diagnosis and management

A

USS (crown rump length and mean sac diameter):

  • CRL<7mm with no FH or MSD< 25 mm with no fetal pole -> repeat USS in 1-2 weeks
  • CRL >7mm with no fetal heart or MSD >25 mm with no fetal pole -> second opinion or repeat in 1 week
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17
Q

Medical management of miscarriage

A

Misoprostol 800mcg

PRN: up to 4 doses of Misoprostol 400mcg every 3 hours

Repeat urine pregnancy test (UPT) in 3 weeks

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18
Q

Risk factors for ectopic pregnancy

A

PID

Previous ectopic

IUD/IUS

IVF

Progesterone only pill

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19
Q

Commonest site for ectopic pregnancy

A

majority in ampulla of fallopian tube

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20
Q

Pregnancy of unknown location investigation

A

up to 3 serial serum hCG every 48 hrs

In intra uterine pregnancy -> increases by 63% + levels > 1500

In a failing pregnancy -> decreases by 50%

If static -> ectopic

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21
Q

Medical management of ectopic pregnancy

A

methrotrexate

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22
Q

When can medically manage a patient with ectopic pregnancy

A

no significant pain / no ruptured ectopic

HCG<1500

<35 mm

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23
Q

Why shouldnt patients concieve after recieving methotrexate for ectopic pregnancy

A

depletes folate sources

should avoid for 3 months

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24
Q

2 types of molar pregnancy

A

pre malignant (complete or partial mole)

Malignant

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25
Q

Complete mole genetic constituition

A

Diploid, 46 paternal chromosomes

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26
Q

Partial mole genetic constituition

A

Triploid (1 set of paternal + 2 sets of maternal)

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27
Q

Management of molar pregnancy

A

Surgical evacuation

Methotrexate

follow up future pregnancies (could recurr)

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28
Q

Prevention of preterm labour

A

Cervical suture could be at:

  • pre-pregnancy (if high risk)
  • 2nd trimester
  • following USS evidence
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29
Q

Diagnosing preterm labour

A
  1. Hx of regular painful contractions + cervical change
  2. USS
  3. If no cervical change, vaginal swabs
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30
Q

Vaginal swabs for Dx of preterm labour

A
  • Actim partus (from cervical os)
  • Quantitative Fetal Fibronectin (from high vaginal swab)
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31
Q

Preparing for preterm birth

A

Corticosteroids if <35 weeks

Magnesium sulphate if <30 weeks

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32
Q

Corticosteroid effects on preterm birth

A

lowers:

neonatal respiratory distress syndrome

neonatal intraventricular haemorrhage

death

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33
Q

Meds to try to stop preterm labour

A

Tocolysis with:

Nifedipine (Ca antagonist) or

Atosiban (oxytocin antagonist)

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34
Q

Tocolysis

A

stopping labour

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35
Q

when tocolysis contraindicated

A

when infection suspected eg SROM or bleeding

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36
Q

When are fetal movements first expected

A

18-20 weeks

Reliably reported by women at 24th week

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37
Q

How to identify reduced fetal movements

A

women over 24 weeks lie on their left side for 2hours should feel more than 10 discrete fetal movements

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38
Q

Assessment of fetal heart

A

< 28 weeks Doppler auscultation

> 28 weeks CTG

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39
Q

TORCH infections

A

Vertical transmission

Toxoplasmosis / Toxoplasma gondii

Others

Rubella

Cytomegalovirus

Herpes simplex virus-2 or neonatal herpes simplex

Others:

  • Coxsackievirus
  • Chickenpox (VZV)
  • Chlamydia
  • HIV
  • Human T-lymphotropic virus
  • Syphilis
  • Zika fever
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40
Q

Small for gestational age (SGA) def?

A

Infant born less than 10th centile

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41
Q

Symmetrical causes of intraurterine growth restriction (IUGR)

A

Chromosmal

TORCH infections

Maternal smoking/alcohol/drugs

Maternal nutritional deficiency

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42
Q

Asymmetrical causes of intraurterine growth restriction (IUGR)

A

Utero-placental deficiency

Pre-eclampsia

Multiple gestation

Renal/cardiac disease

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43
Q

Pregnancy-associated plasma protein A (PAPP-A) significance?

A

Low level in first trimester ass with delivery of a SGA neonate

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44
Q

What counts as an early/late menupause?

A

40 early

52 late

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45
Q

Methods for Induction of labour

A
  1. Stretch and Sweep
  2. Prostoglandins (ripens cervix for amniotomy)
  3. Amniotomy
  4. Syntocinon infusion
  5. Mechanical cervical dilators
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46
Q

Risks ass with induction of labour

A

Increased instumental delivery

Hyperstimulation leading to uterine rupture

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47
Q

Prostoglandins used for induction

A

Propess (slow release over 24hrs)

Prostin PO/gel (over 6 hours)

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48
Q

Mechanical cervical dilator

A

cook cervical ripenning balloon

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49
Q

Bishop score

A

assesses start of labour

>9 spontaneous labour likely

<5 induction likely

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50
Q

Increased fetal HR on CTG

A

Sepsis

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51
Q

Reduced fetal HR on CTG

A

fetal distress

cord compression

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52
Q

Risk ass with amniotomy

A

cord prolapse

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53
Q

Whats a normal variabilty in fetal HR and what is indicative of

A

< 5bpm

normal CNS function

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54
Q

What are accelerations and deccelerations on CTG

A

a rise or fall of >15bpm over 15 secs

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55
Q

Accelerations a sign of

A

normal ANS function (and the fact that Tom isnt driving)

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56
Q

Decceleration a sign of

A

cord compression

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57
Q

Normal rate of contraction in labour

A

3-5 contractions per 10 mins

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58
Q

Length of fully dilated cervix

A

10 cm

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59
Q

Fetal blood sampling values

A

pH < 7.2 deliver

7.25 > pH > 7.2 borderline

pH > 7.25 healthy

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60
Q

pre eclampsia def

A

new HTN after 20 weeks with proteinuria

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61
Q

gestational HTN def

A

new HTN after 20 weeks without proteinuria

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62
Q

Pre-eclampsia RFs?

A

Changing of partner

FHs

Antiphospholipid syndrome

DM

High BMI

> 4yrs gaps between pregnancy

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63
Q

Anti hypertensives used for pre-eclampsia

A

Methyldopa

Nifedipine

Labetolol

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64
Q

Main SE of labetolol

A

intrauterine growth restriction

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65
Q

VTE prophylaxis used in pregnancy

A

LMW heparin

eg enoxaparin or dalteparin

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66
Q

Difficulty with LMW heparins in pregnancy

A

eGFR higher in pregnancy

Kidneys excrete them

higher doses required

67
Q

Primary post partum haemorrhage def

A

blood loss from genital tract in 24 hours post birth

68
Q

Secondary post partum haemorrhage def

A

blood loss from 24hrs post birth to 12 weeks post birth

69
Q

Causes of post partum haemorrhage

A

4Ts:

Tone- uterus not contracting

Trauma- tear

Thrombin- DIC

Tissue- placenta missing

70
Q

Manual methods of promoting uterine contraction for 3rd stage of labour

A

Uterine massage

Bimanual compression

71
Q

Pharmacological methods of promoting uterine contraction for 3rd stage of labour

A

Syntometrine (2 IM injections)

Oxytocin (syntocinon infusion)

Misoprostol

Hemabate(PGF2α)

72
Q

Management of continous post partum haemorrhage after manual and pharmacological management?

A

B lynch suture

Bakri balloon

73
Q

Female genital mutilation types

A

III removal of clit, minor + suturing major

74
Q

Different pelvic shapes

A

Gynecoid: Ideal shape,

Android: triangular inlet, and prominent ischial spines

Anthropoid: transverse diameter < anteroposterior diameter.

Platypelloid: Flat inlet + shortened anteroposterior diameter (Predispose to OT presentation)

75
Q

Different types of presentation? which cant deliver?

A

OT

76
Q

Vaginal tears

A

1 vaginal muscles torn

2 perineal muscles torn

3 anal sphincter torn

4 rectum torn

77
Q

Pelvic nerves

A

Sciatic (L4 to S3)

Pudendal (S2 to S4)

78
Q

Latent phase of labour

A

Cervix effacing and thinning

<4cm dilated

Painful irregular tightenings

79
Q

First stage of labour

A

cervix effaced 4cm, fully dilated

Regular painful contractions

80
Q

Second stage of labour

A

fully dilated cervix

Delicery of baby

81
Q

Third stage of labour

A

delivery of placenta and membranes

82
Q

Vasa praevia

A

cord vessels pass across the internal os

Could lead to blood loss from fetus

83
Q

Different types of twins

A

Dichorionic diamniotic (DCDA)

Monochorionic: diamniotic (MCDA) or monoamniotic (MCMA)

84
Q

Risk with MCMA twins?

A

cord entanglement

85
Q

Twin to twin transfusion syndrome

A

Abnormal blood vessels

one becomes donor, one reciever

Donor is malnourished, reciever gets excess blood risk of heart failure

Could result in death of one or both

86
Q

Twin to twin transfusion management

A

laser ablation of connecting vessels in utero

87
Q

Types of malpresentation

A

Frank (extended)

Complete (flexed)

Footling

Kneeling

88
Q

Options for management of breech presentation

A
  • Eternal cephalic version ECV to manually change the lie
  • Elective C section
  • vaginal delivery with breech presentation
89
Q

At which stage of pregnancy does nausea and vomiting occur most commonly

A

1st trimester

90
Q

The severity of nausea and vomiting throughout pregnancy

A

starts at 4-7/40

peaks at 9/40

usually resolves by 20/40

91
Q

Hyperemesis gravidarum def

A

N/V + triad of:

  • 5% pre-pregnancy wt loss
  • dehydration
  • electrolyte imbalance
92
Q

Rfs for hyperemesis gravidarum

A

Nulliparous

< 20 yo

High BMI

Multiple pregnancy

Molar pregnancy

Iron meds

93
Q

Pathology of hyperemesis gravidarum

A

Higher levels of bHCG could be causing thyrotoxicosis similar sx

94
Q

Gestational thyrotoxicosis path

A

bHCG similar structure to TSH

Stimulates T3/4 release

Suppresses natural TSH production

95
Q

Sx and mx of gestional thyrotoxicosis

A

Clinically euthyroid

Normalises over course of pregnancy no mx

96
Q

1st line antiemetics for pregnancy

A

Antihistamines : Cyclizine, Promethazine

Prochlorperazine

97
Q

2nd line antiemetics for n/v during pregnancy

A

Metoclopromide

Ondasteron

98
Q

SEs and CIs with metoclopromide during pregnancy

A

Maternal extrapyrimidal SEs: eg dyskinesia

Avoid in <18yo

99
Q

SE of ondansteron in pregnancy

A

Slight association with cleft lip in 1st trimester

100
Q

Maintenance fluid and electrolyte requirements in pregnancy

A

Same as normal

25-30 water mls/kg/day

1 mmols/kg/day K/Na/Cl

101
Q

Analgesia during pregnancy

A

Paracetamol

Pethadine

Avoid NSAIDS

102
Q

Abx to avoid in pregnancy

A

Trimethoprim (1st trimester)

Nitrofurantoin (3rd trimester, causes fetal haemolytic anaemia)

103
Q

Meds in PEPSE

A

Raltagrivir and truvada

104
Q

Obstetric cholestasis sx

A

itching of hands/feet

105
Q

Risk associated with obstetric cholestasis

A

Preterm delivery

Meconium aspiration syndrome

Stillbirth

106
Q

Management of obstetric cholestasis

A

ursodeoxycholic acid

antihistamin

aqeous cream + menthol

107
Q

When does obstetric cholestasis present

A

3rd trimester

108
Q

Dx of obstetric cholestasis

A

Itching + negative liver screening

109
Q

Ix within liver screening

A

Hep A,B,C

EBV

CMV

autoimmune

USS

110
Q

Placenta accreta

A

Placenta attatched to myometrium

111
Q

Placenta percreta

A

placenta through uterus into other organs

112
Q

How long after potential exposure should test for syphillis

A

up to 3 months

113
Q

COCP side effect

A

blood clots

114
Q

How long after potential exposure should test for gonnorrhoea/chlamydia

A

2 weeks

115
Q

How long does sperm last in vagina

A

5 days

116
Q

How to work out the ovulation day in cycle

A

14 days before the first day of bleeding

117
Q

When is the optimum time for pregnancy

A

day 9 to 14

118
Q

Progesterone side effect

A

reduced BMD

119
Q

Risk of malignancy index (RMI) calculation

A
120
Q

What RMI score is considered high?

A

>200

121
Q

How does management change with RMI>200

A

high risk score

CT abdo/pelvis

Refer to senior gyno-oncologist

122
Q

Classification of ovarian germ cell tumour

A
123
Q

CA125 tumour marker§

A

Peritoneal inflammation: ovarian/ pancreatic etc

124
Q

bHCG tumour marker

A

choriocarcinoma

125
Q

AFP tumour marker

A

yolk sac tumour/immature teratoma

126
Q

Contraception post partum if breastfeeding

A
  1. Natural: if meets all 3 criteria:

day and night breastfeeding & <6mo post partum & amenorrhoeic

  1. Progesterone only: anytime post partum
127
Q

Which contraception not when breastfeeding

A

combined pills: start at 6 mo

(if not breastfeeding, start at 3rd week)

128
Q

Puerperium

A

6 weeks after delivery

129
Q

Maternal structural changes during puerperium

A

uterus from 1 kg to 100g (involution)

internal os closes by 3 days, external by 3 weeks

130
Q

Lochia

A

endometrial slough, red and white cells passed through vagina

Day 1 -3 red (lochia ruba)

10- week 6 white (lochia alba)

131
Q

Indications to episiotomy?

A

distressed baby

instrumental/breech delivery

protect premature head

prevent 3rd (not 4th) degree head

132
Q

Pain relief in labour

A
  1. Breathing exercises
  2. Pethidine IM (not <2hrs of birth as depresses fetal resp)
  3. NO
  4. Pudendal block
  5. Spinal/epidural
133
Q

Resus blood tests

A

Test mothers blood;

if negative, do Fetal DNA analysis (using mothers blood)

if both negative, dont do anything

If incompatible, give anti-D

134
Q

Indications for an epidural during labour

A

OP position

instrumental/breech

pre-eclampsia

135
Q

Problems with epidural in labour

A

postural hypotension

urinary retention

paralysis

136
Q

Treatment of seizure (eclampsia)

A

4g magnesium sulfate

137
Q

Diagnosis of gestational diabetes

A

OGTT

fasting above 5.6

2hrs above 7.8

138
Q

Small for gestational age maternal causes

A

multiple pregnancy

malformation

infection

pre-eclampsia

139
Q

What conditons are babies small for gestational age susceptible to in adult life

A

hypertension

coronary artery disease

autoimmune thyroid disease

non-insulin dependent DM

140
Q

What complications are SGA babies susceptible post delivery

A

hypoxia

hypoglycaemia

temperature regulation problems

jaundice (hypoxic in utero, so Hb up)

141
Q

Maternal history to ask in newborn infant physical examination (NIPE)

A

Pregnancy complications/delivery/USS

Babies position/lie at delivery

RFs for neonatal infection

FHx

142
Q

Newborn history to ask in newborn infant physical examination (NIPE)

A

feeding pattern

urination

passing of meconium

143
Q

What is shown

A

lichen simplex chronicus

hyperpigmented plaques

144
Q

lichen simplex sx

A

itching/soreness of skin

145
Q

Mx of lichen simplex

A

Steroid cream (betamethasone or clobetasol)

Coal tar cream/ointment for maintenance (anti-inflammatory)

146
Q

vulvar lichen planus sx

A

very painful, burning sensation

white lacy pattern

147
Q

What is shown

A

lichen sclerosis

hypopigmentation

148
Q

what is lichen sclerosis

A

autoimmune condition, affecting vulva skin, of women of any age

149
Q

Sx of lichen sclerosis

A

itchiing

150
Q

Mx of lichen sclerosis

A

strong steroids

151
Q

What is polyhydramnios

A

excess amniotic fluid

152
Q

Maternal causes of polyhydramnios

A

gestational diabetes

TORCH

153
Q

Fetal causes of polyhydramnios

A

problems with swalllowing : atresia/fistula

or

urinating

154
Q

What is shown

A
  • Caput succedaneum
  • subcutaneous fluid collection due to trauma during delivery
155
Q

Difference between caput succedaneum and cephalohaematoma

A

succ: oedama collection between skull and skin over the presenting part (crosses the suture line)
cephalohaematoma: blood collection between skull and its periosteum ( does not cross the suture line)

156
Q

Why use misoprostol vs methotrexate for miscarriage?

A

Methotrexate destroys dividing cells so kills foetus

Miscarriage - foetus already dead but just want to ensure all tissue is removed

Misoprostol stimulates uterine contraction

157
Q

COCP increases risk of which cancer

A

Cervical and breast

158
Q

COCP protective against which cancers

A

endometrial

ovarian

159
Q

HRT types

A

Cyclical

Continous

160
Q

Cyclical HRT use

A

Only if peri-menupausal (LMP less than 1 year ago)

161
Q

Continous HRT use

A

Post menupausal

or 1 year of cyclical HRT

162
Q

PCOS dx criteria

A

2 out of 3:

Oligomenorrhoea or Anovulation

Biochemical changes

Polycystic ovaries or increased ovarian volume

163
Q

Biochemical changes in PCOS

A

Sx: eg Hirsutism

Elevated levels of androgens (eg total or free testosterone)

High LH

Low FSH

MS4 - OnG (5 decks)

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