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Medicine Year 1 > Week 115 Pregnancy > Flashcards

Week 115 Pregnancy Flashcards

1
Q

What should you ask in an obs/gynae history?

A 
Age
Parity
LMP
Contraception
Smear

Heavy periods and pain

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2
Q

What do you examine in an obs/gynae history

A
  • General
  • Breasts
  • Abdomen (masses/ascites)
  • Pelvic (speculums- cusco, sim’s)
  • Bimanual (uterus, sspmt)
size
shape 
position
mobility 
tender
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3
Q

Where anatomically is an ectopic pregnancy most likely to form?

A

Ampulla of uterine tube

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4
Q

What can cause severe hyperemesis?

A

Molar pregnancy

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5
Q

Which of the following Hb values is normal in the antenatal period?

A

110g/l

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6
Q

What proportion of pregnancies are affected by VTE?

A

1%

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7
Q

What clinical signs are frequently present in severe PET?

A

clonus

brisk reflexes

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8
Q

What are the symptoms are classically associated with more severe PET?

A

headache
visual disturbances
epigastric pain

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9
Q

What anti-hypertensives is first line for treatment of raised BP in pregnancy?

A

Labetolol

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10
Q

What are indications for a GTT?

A

Previous GDM

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11
Q

What medication would you offer to all women with DM from 12/40?

A

Aspirin

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12
Q

When would you aim to deliver a woman with pre existing DM?

A

37-38/40

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13
Q

In a pregnant patient with a history of hyperthyroidism, who is thyroid receptor antibody (TRAB) positive, what is the baby at risk of?

A

High risk of neonatal thyrotoxicosis

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14
Q

What is labour?

A

Process of birth: expulsion of foetus and placenta from uterus = 3 stages of unequal length

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15
Q

describe the first stage of labour

A

First Stage : onset of labour – Cx fully dilated

a) Latent – contractions - cervix fully effaced
b) Active – cervical dilatation

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16
Q

describe the second stage of labour

A

•Second Stage : full dilatation – delivery of baby 2 phases

a) Propulsive – full dilatation - head to pelvic floor
b) Expulsive – irresistible desire to bear down / push - delivery.

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17
Q

describe the third stage of labour

A
  • Third Stage delivery of the baby - expulsion of the placenta & membranes.
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18
Q

describe the mechanism of normal labour

A
  • Head at pelvic brim in Left Occipito Lateral (LOL) position
  • Neck flexes & presenting diameter is Suboccipito Bregmatic
  • Head hits pelvic floor- occiput rotates to Occipito – Anterior (OA)
  • Head delivers by extension * Head restitutes (comes in line with the shoulders)
  • Descent continues & shoulders rotate into the antero – posterior diameter of the pelvis
  • Anterior shoulder slips under pubis & with lateral flexion baby is born.
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19
Q

How is normal labour characterised?

A
  • regular, painful uterine contractions
  • Dilatation of cervix
  • Descent of head
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20
Q

What are associated symptoms of labour?

A
  • “Show” of blood stained mucous discharge

- Spontaneous rupture of membranes (SRM) in 1/3 women

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21
Q

What are the cardinal signs of labour?

A

Effacement (incorporation of cervical canal into lower uterine segment from internal os downwards)

Dilation of cervix (cervical os)

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22
Q

What is the shape of a nulliparous cervix?

A

Tubular

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23
Q

What is the shape of a multiparous cervix?

A

Patulous (tent shaped)

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24
Q

Describe features of a primigravid labour

A
  • unique psychological experience
  • inefficient uterine action- prolonged labour common if untreated
  • rupture of uterus virtually unknown
  • risk of cephalopelvic disproportion and foetal trauma
  • size of foetus related to mother’s size
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25
Q

Describe features of a multigravid labour

A
  • uterine action efficient- dystocia rare
  • risk of uterine rupture
  • disproportion and trauma rare if mother has a previous delivery
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26
Q

Caput

A

Oedema of scalp due to pressure of head against rim of cervix

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27
Q

Moulding

A

Overlapping of vault bones, shape of the skull alters so the engaging diameters become shorter

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28
Q

Engagement

A

Descent of biparietal diameter through pelvic brim

If head is at level of ischial spines, it must be engaged unless there is caput

When head is engaged not more than 2/5ths can be abdominally

engagement usually occurs after labour is established

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29
Q

Lie

A

Relation of long axis of foetus to mother

May be longitudinal, oblique or transverse. Only longitudinal lie is normal.

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30
Q

Presentation

A

Part of fetus in lower pole of uterus e.g. cephalic, vertex or breech.

31
Q

Attitude

A

Posture of fetus e.g. flexion, deflexion or extension. The normal attitude is full flexion when normal presentation is a vertex.

32
Q

Position

A

the relationship of the presenting part to mother’s pelvis. The denominator is used to describe the position of baby wrt mother’s pelvis e.g. LOL or LOA.

33
Q

Denominator

A

Denominator: arbitrary part of presentation. * Occiput in vertex presentation * Sacrum in breech presentation * Mentum in face presentation. It denotes position of presenting part with reference to pelvis.

34
Q

What is the notation of the relationship of head to ischial spines?

A

By notation the ischial spines are designated station zero.

When the head is above the spines, it is said to be at –1, -2, -3, or – 4 cm.

If the head is below the spines the notation is +1, +2, +3, or + 4cm. The station can only be determined by vaginal examination.

35
Q

Why is syntocinon administered?

A

synthetic oxytocin–an octapeptide that causes rhythmical uterine contractions. Acts in 2 mins when given IM.

36
Q

Why is ergometrine administered?

A

500 micro g injected IV acts within 40 seconds & persists for 30 mins.

Takes 6 mins to act when given IM. It causes tetanic contractions (prolonged spasm).

It is used for post-partum haemorrhage & the main side effects are nausea, vomiting & hypertension. It is contraindicated in hypertension & cardiac disease.

37
Q

Why is syntometrine administered?

A

10iu of syntocinon + 500 micro g of ergometrine. This is used for the active management of the third stage of labour. It is given as the anterior shoulder appears under the pubic symphysis.

38
Q

Describe the third stage of labour

A

Cord lengthens
Gush of blood
Fundus of uterus rises
Controlled cord traction (CCT)= Brandt-Andrews method

39
Q

What are complications in early pregnancy?

A

Miscarriage
Ectopic pregnancy
Molar pregnancy
Hyperemesis Gravidarum

40
Q

What are symptoms of ectopic pregnancy?

A

pain
bleeding
faint/collapse

41
Q

How many pregnancies are ectopic?

42
Q

What is the management of ectopic pregnancy?

A

Conservative
Medical (methotrexate)
Surgical (laparoscopy/laparotomy)

43
Q

How is molar pregnancy diagnosed?

A

Ultra sound scan appearance

44
Q

What is the treatment for molar pregnancy?

A
  • Suction evacuation indicated (risk perf)
  • Rarely hysterectomy •Persistent choriocarcinoma (<1%)
  • Methotrexate

Large For Dates, high HCG, biochemical hyperthyroid, hyperemesis

45
Q

How many pregnancies are molar?

46
Q

What is hyperemesis gravidarum?

A 
Excessive nausea and vomiting of pregnancy  Leads to:  
–Electrolyte imbalance 
–Weight loss 
–Reduced urine output 
–Raised creatinine
47
Q

How is hyperemesis gravidarum treated?

A

Exclude molar or multiple pregnancy
Admission for rehydration and anti-emetics
May need vitamin supplementation

48
Q

What are complications during late pregnancy?

A

Pre-existing Medical Disorders:
Psychiatric
Diabetes
Anaemia

Disorders arising in pregnancy:
Antepartum Haemorrhage Hypertensive Disorders Thromboemobilsm
Pre-term Labour
Obstetric Cholestasis

49
Q

What is gestational diabetes?

A

– intolerance to glucose in pregnancy

50
Q

What is management for GDM?

A 
•Management  –Multidisciplinary   –
Diet  –
Monitor blood glucose  –Exercise  –
Regular growth scans –Aspirin  –
Hypoglycaemic agents – metformin/insulin  –
Planned delivery at 38 weeks
51
Q

What are associated risks of GDM for the mother?

A 
Spontaneous miscarriage  Gestational hypertension  Preterm labour  
Premature rupture of membranes  
Polyhydramnios  
Infections  
Ketoacidosis
52
Q

What are foetal risks during GDM?

A

Congenital abnormalities Macrosomia
Intrauterine growth restriction Birth injury
Delayed lung maturity

Neonatal –
hypoglycaemia, hypocalcaemia, hyperbilirubinaemia, jaundice

Perinatal death

53
Q

What are indications for GTT? (glucose tolerance test)

A 
Previous GDM (16/40 and 28/40) ⁻
Previous baby >4.5kg ⁻
BMI >30 ⁻
Ethnicity ⁻
First degree relative with DM ⁻
PCOS

Manage with delivery at 40+6
and same as pre-existing DM

54
Q

What are the physiological changes in anaemia?

A

•Physiological changes
–50% increase in circulating blood volume
–Fall in haemoglobin, red cell count and haematocrit
–2-3 fold increase in iron requirement
–10 to 20 fold increase in folate requirement

Hb <105
Check iron and folate levels
Replacement therapy

55
Q

Describe features of pregnancy induced hypertension

A

BP > 140/90
Asymptomatic
No proteinuria

56
Q

Describe features of pre-eclampsia

A

•BP >140/90
Commonly symptomatic NOT always •
Proteinuria (>30mg/mmol) •May have abnormal liver function, renal function and low platelets (HELLP) •Eclampsia

57
Q

What are risk factors for hypertensive disorders?

A

•First pregnancy •Obesity •Family history •Extremes of maternal age (<19 or >40) •Multiple pregnancy •Chronic hypertension •Chronic renal disease •Diabetes

58
Q

How are hypertensive disorders managed?

A 
•Antihypertensives  
•Regular monitoring  
–Bloods  
–Urine  
–BP  
–Symptoms  
•May require admission and early delivery  
•For next pregnancy 
– consultant led care, aspirin, serial growth scans
59
Q

How does thrombo-embolism present?

A

•Presentation – leg pain, swelling, breathlessness, chest pain, haemoptysis, tachypnoea, tachycardic, hypoxic on ABG

60
Q

How is thromboembolism diagnosed?

A

•Diagnosis – –Doppler, –CXR, –ECG, –CTPA or V/Q Scan

61
Q

What is treatment for thromboembolism?

A

•Treatment - low molecular weight heparin until 6 weeks post delivery

62
Q

What is pre-term labour?

A

•Labour before 37 weeks gestation •
Clinical diagnosis – regular contractions, progressive cervical change
•5-10% pregnancies
•70% neonatal deaths in normally formed babies

63
Q

What are causes of pre-term labour?

A 
–Unknown  
–Infection  
–Multiple pregnancy, polyhydramnios  
–Cervical incompetence  
–Antepartum haemorrhage  
–Iatrogenic
64
Q

What is management for pre-term labour?

A
  • Tocolytics

–Steroids

65
Q

What is obstetric cholestasis?

A
  • 0.7% UK pregnancies – increased in Indian/Pakistani Asian population 1.2-1.5% •Multifactorial
  • Intense itching
  • No rash
  • Abnormal liver function tests •May be diagnosis of exclusion
66
Q

What are the risks of obstetric cholestasis?

A

•Fetal risks of prematurity (iatrogenic/spontaneous), ?stillbirth, meconium stained liquor

67
Q

How is obstetric cholestasis treated?

A
  • Treat with emollients, antihistamines, ursodeoxycholic acid, vitamin K
  • 50% risk recurrence
  • Advise avoid oestrogen containing COCP
68
Q

What are causes of “failure to progress” of baby during labour?

A
  • Inefficient uterine action
  • Occipito-posterior position
  • Cephalopelvic disproportion
69
Q

What drug is given during inefficient uterine action?

A

Syntocinon (but be careful during multiparous delivery as risk of uterine rupture)

70
Q

When is induced labour performed?

A
  • 10-15% induction of labour rate
  • Performed when benefit of delivering baby outweighs risk of continuing with pregnancy
  • Indications obstetric or medical
  • Obstetric – prolonged pregnancy (>T+12) non-reassuring CTG, severe PET, uteroplacental insufficiency, PROM.
  • Medical – Renal disease, uncontrolled DM malignancy
71
Q

What are the advantages of induced labour?

A

•Advantages of IOL

  1. Less risk of PNM (PNMR inc x 2 >42 wks)
  2. CS rate inc x 2 after 42 wks
  3. Mec. staining occurs 40% preg >42 wks
72
Q

Disadvantages of induced labour

A

•Disadvantages of IOL 1.Failed IOL - CS

2.Longer labour than if spontaneous labour

73
Q

If cervix is unfavourable during inducing labour, what is administered?

A

PGE2 (prostagladin)

  • softens and effaces cervix
  • may cause labour for patient

Medicine Year 1 (13 decks)

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