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Reproduction > Week 4 - Core clinical Problems > Flashcards

Week 4 - Core clinical Problems Flashcards

1
Q

What is Fergusons reflex

A

Pressure applied to internal cervix - causes the release of oxytocin - causes uterine contractions

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2
Q

What chemical initiates the softening of the cervix before birth?

A

Hyaluronic acid

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3
Q

What is Bishop’s score

A

A score to see if it is safe to induce labour

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4
Q

What is the normal progress of a dilating cervix

A

1cm per hour

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5
Q

In a multiparous women, what time is considered prolonged during delivery of a baby?

A 
2 hrs (WITH regional anaesthetic) 
1 hr (WITHOUT regional anaesthetic)
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6
Q

What chemical causes true labour contractions

A

Oxytocin

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7
Q

When the babies head is said to be ‘engaged’ - what does this mean?

A

3/5ths of fetal head has entered mother’s pelvis.

2/5ths can still be felt abdominally

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8
Q

When should the cord be clamped immediately?

A

If baby needs resuscitation (if baby loses its pulse)

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9
Q

How long after baby delivery should the placenta be expelled?

A

5-10mins

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10
Q

What should you do if there is any blood loss prior to baby delivery?

A

Refer to consultancy unit. This is serious.

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11
Q

Lactation is stimulated by 2 things - what are they?

A

Expulsion of placenta

Decrease in oestrogen & progesterone

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12
Q

Common medical problems in each trimester

A

1st - miscarriage (esp in diabetic mothers)
2nd congenital malformations (esp in diabetic mothers)
3rd - growth restrictions & pre-eclampsia

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13
Q

Pregnant women comes in complaining of chest pain, what investigations do you preform?

A

ECG

+/- CT

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14
Q

Warfarin is safe in pregnancy: T/F?

A

F. V unsafe. Switch to LMWH

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15
Q

LMWH is safe in pregnancy: T/F

A

T

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16
Q

What cardiovascular changes does a women go through during 1st trimester of pregnancy?

A

Increase in cardiac output, stroke volume, plasma volume

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17
Q

What common cardiovascular conditions are commonly seen in pregnancy?

A

Palpitations
Sinus tachycardia
SVT

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18
Q

When is breathlessness most commonly seen in pregnancy?

A

3rd trimester

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19
Q

How to help manage breathlessness in pregnancy?

A

It can IMPORVE with exertion

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20
Q

Pregnant women comes in with breathlessness - what are your thoughts?

A

Usually physiological so don’t do unnecessary tests but do have to be aware that it could be an underlying PE

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21
Q

What happens to PaO2 and PaCo2 during pregnancy?

A

PaO2 increases

PaCO2 decreases

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22
Q

How to manage asthma during pregnancy & during birth?

A

Inhalers are safe to take
IV hydrocortisone to be given to mother during labour as a substitute for any oral steroids she may be taking for her asthma

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23
Q

Pathogenesis behind VTE in pregnancy

A

Decreased blood flow in legs (esp towards the end of pregnancy)

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24
Q

What can increase risk of VTE in terms of baby delivery?

A

If baby is delivered by forceps or C-section

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25
Q

Why is LMWH safe compared to warfarin?

A

Heparins:

a) Do NOT cross the placenta
b) Are NOT secreted in breast milk

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26
Q

Why are DVTs and VTEs commonly missed in pregnancy?

A

They symptoms they cause are similar to those of a ‘normal’ pregnancy

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27
Q

What Ix do you preform (and what test do you NOT preform) on a pregnant woman with a suspected DVT?

A

DO a compression duplex ultrasound

DON’T do D-dimers test - they will be raised in pregnancy regardless of whether or not they have a DVT

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28
Q

Symptoms of DVT?

A

Swelling, oedema, Leg pain, Increased leg temp, lower abdo pain, elevated WCC

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29
Q

Pregnant women comes in with whole leg swollen + back pain. What investigation do you want to preform?

A

MRI venography (you suspect an iliac vein thrombosis)

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30
Q

Symptoms of PE in pregnancy?

A

Dyspnoea, Chest pain, Faintness, Collapse, Haemoptysis, Raised JVP

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31
Q

What Ix do you preform on a pregnant women with a suspected PE?

A

ECG

CXR

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32
Q

Difference in pros and cons with a CTPA vs V/Q scan?

A

CTPA - more sensitive & specific but can cause breast cancer
V/Q - Less sensitive & specific but lower radiation dose in comparison to CTPA

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33
Q

If a baby is born with a flat face, short arms, legs and fingers & scoliosis. What do you suspect?

A

Mother had taken warfarin during pregnancy

34
Q

Warfarin can be taken during breastfeeding period: T/F?

A

T. It can be taken (do 5 days postnatally just to be safe from PPH)

35
Q

Pregnant mother with Connective Tissue Disease, what drugs do you need to stay away from?

A

NSAIDS, Cyclophosphamide, MTX, Gold, Penicillamine

36
Q

Azathioprine is safe in pregnancy: T/F?

A

T

37
Q

What condition is Antiphospholipid Syndrome commonly associated with?

A

SLE (systemic Lupus Erythematous)

38
Q

Clinical features of Antiphospholipid Syndrome

A

Arterial/Venous thrombosis
Recurrent pregnancy loss
Severe pre-eclampsia

39
Q

How to diagnose APS?

A

Diagnosis can be clinical (if pregnant women has thrombosis or miscarriages)
Diagnosis can be via laboratory - IgM/IgG

40
Q

Obstetric complications in mothers

A

Miscarriage, Pre term birth, Hypertension, post partum haemorrhage

41
Q

Foetal risks with epileptic mothers

A

Maternal abdominal trauma
Pre term premature rupture of membrane
Congenital malformations

42
Q

Anti-epileptic drugs increase teratogenicity risk?- T/F

A

T

43
Q

What anti-epileptic drug MUST be avoided?

A

Sodium Valporate

44
Q

If the mother has a tonic-clonic seizure, what is the baby at risk of?

A

Hypoxia

45
Q

A pregnant woman presents with a seizure for the first time. Is this epilepsy?

A

No, you assume this is pre-eclampsia

46
Q

Mx of epileptic seizure during birth? (emergency!!)

A

Left lateral tilt
IV lorazepam/diazepam
IV Phenytoin

47
Q

What is the sequence of BP changes during pregnancy?

A 
BP falls in early pregnancy 
There is a steady rise until term
BP falls after delivery 
Rises & peaks at day 3 postnatally 
By day 10 post natal - BP should be normal
48
Q

Limits for BP hypertension (how to diagnose) ?

A

140/90 twice

160/110 once

49
Q

How can you discriminate between pregnancy induced hypertension & pre-eclampsia?

A

Pregnancy induced:

  • Occurs in 2nd half of pregnancy
  • Resolves around 6 weeks of delivery
  • No proteinuria or other features of pre-eclampsia
50
Q

Pre-eclampsia triad

A

Hypertension
Proteinuria
Oedema

51
Q

symptoms of pre-eclampsia

A 
headaches
visual disturbance
epigastric pain 
N&V
Rapidly progressing oedema
52
Q

Ix for PET

A 
U&Es 
Serum urate 
LFTs 
FBC 
Coagulation screen
CTG scan
53
Q

Mx of PET

A

75mg aspirin
Look for secondary cause of hypertension & treat (e.g. any endocrine disorder)
Treat the hypertension itself
Keep a careful surveillance on mother & baby
The only cure of PET is giving birth

54
Q

Are you more at risk of PET if its your first pregnancy or a multiparous birth?

A

First pregnancy

55
Q

What kind of imaging can be used for PET and what characteristics will it show?

A

MUAD

Notching indicates PET

56
Q

Treatment of hypertension in pregnancy?

A

1st - Labetolol

2nd - Hydralazine

57
Q

What hypertension medication should be avoided during pregnancy?

A

Diuretics

ACEI

58
Q

What foetal surveillance is needed in a hypertensive mother or a mother with PET?

A

CTG

59
Q

If you have a PET mother who needs to give birth, what should you give the baby (medication) to help? And why??

A

IV hydrocortisone - given to premature babies to promote foetal lung maturity
Then x2 dexamethasone

60
Q

Mx for severe eclampsia?

A

Control BP - IV labetolol & hydralazine
Stop seizures - Magnesium sulphate
Fluid balance - be careful not to fluid overload do 80ml/hour
Delivery of baby - aim of vaginal, give epidural anaesthesia (helps BP too)

61
Q

Symptoms of puerperal psychosis?

A

Sleep disturbance, Confusion, Irrational ideas, mania, suicidal thoughts

62
Q

When is the usual onset of puerperal psychosis?

A

2 weeks post delivery

63
Q

Symptoms of post-natal depression

A

Tearful, irritable, anxiety, lack of enjoyment, poor sleep, weight loss

64
Q

When is the onset of post natal depression?

A

2-6 weeks post natal. Can last weeks-months

65
Q

Can anti-psychotics be used in pregnancy?

A

Generally yes

66
Q

What psych drugs should be avoided during pregnancy?

A

Sodium valproate
Benzodiazepines
Carbamazepine - neural tube defect
Lamotrigene - oral cleft

67
Q

What vitamin can become deficient when a pregnant mother drinks alcohol? What is the condition associated with this called?

A

Vit B1

Wernicke’s encephalopathy

68
Q

Effects of substance misuse in a pregnant woman?

A

IUGR, Pre term, miscarriage, sepsis, domestic abuse, STIs

69
Q

What is placental abruption?

A

When the placenta separates from the uterine wall (partially or totally before birth of baby)

70
Q

What could placental abruption cause in the baby?

A

Hypoxia - death

71
Q

Mx of placental abruption?

A

Resuscitate mother - FBC, clotting, LFTs, U&Es, cross match, fluids, catheterise

Do a CTG on baby. If no heart beat, do a USS

Deliver baby

72
Q

What are the 4 different types of urinary incontinence?

A

Stress incontinence - leakage on exertion

Urinary or ‘Urge’ incontinence- leakage with or immediately preceding the feeling of urge

Mixed incontinence - Leakage associated with both stress & urge

Overactive bladder - Same as urge but can be WITHOUT incontinence

73
Q

If you had blood in your urine - what 2 diagnosis are you worried about?

A

Bladder cancer

Renal stones

74
Q

Ix for incontinence

A

Urinalysis
Urodynamics
Cystoscopy
Imaging

75
Q

Mx for incontinence

A 
Lifestyle advice (least invasive) 
Bladder drill 
Pelvic floor physiotherapy 
Drugs (antimuscarinic) 
Botulinum toxin - woman must be able to self catheterise 
Reconstructive surgery (most invasive)
76
Q

What antimuscarinic drug can you use for incontinence?

Why is it now used compared to the old drugs?

A

MIRABEGRON

Less likely to cause confusion

77
Q

Mechanism of action of Mirabegron?

A

Selective B3 adrenoreceptor agonist
Works in parasympathetic control to inhibit involuntary contractions
Works in sympathetic control to relax the bladder

78
Q

If pt is getting nocturia, what is a good drug to add into their treatment?

A

Desmopressin

79
Q

Symptoms of prolapses

A

Sensation of pressure & dragging
Incontinence issues
Incomplete emptying (bladder & bowel)
Sexual dysfunction

80
Q

Mx of prolapses

A

Conservative
Pessaries
Surgery - Pelvic floor repair

Reproduction (15 decks)

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