Obstetrics and Gynaecology - Passtest Flashcards
What would you do if a mother was exposed to a child with slapped cheek syndrome/parvovirus 19 infection?
Urgent referral to foetal medicine unit (to be seen within 4 weeks) and do serial USS as well as doppler to investigate for foetal anaemia, heart failure, and hydrops. USS can occur within 4 weeks after the onset of symptoms or estimated time of seroconversion.
When is risk of transmission of parvovirus 19 highest?
Less than 20 weeks
How can you confirm if the foetus has been exposed to parvovirus 19?
By sampling amniotic fluid and looking for parvovirus DNA
If parvovirus 19 is detected in the foetus what would you do?
Foetal blood sampling to look for anaemia and offer intrauterine transfusions in specialist centres if anaemia is detected.
How would you perform an episiotomy?
After injecting LA, you would make a cut posterior to vagina, by holding the presenting part of the baby away. Initially, you would start the incision medially at 6 o’clock position, then mediolaterally into soft tissues of perineum and perineal skin towards the ischial tuberosity.
Describe chance of live birth after 1,2 and 3 miscarriages
1 miscarriage - 85%
2 miscarriages - 75%
3 miscarriages - 60%
What is a threatened miscarriage?
Vaginal bleeding and an ongoing pregnancy - closed os
What is an inevitable miscarriage?
Cervix begins to dilate, alongside bleeding
What is a missed miscarriage?
The foetus dies in utero but it is not expelled and often found incidentally on USS at a later date. USS shows a foetus that is smaller compared to the appearance a foetus of this gestation would have.
What is a complete miscarriage?
All products of conception are expelled from the uterus
What is an incomplete miscarriage?
Passage of some, but not all products of conception
What is Mittelschmerz?
Mittelschmerz is one-sided, lower abdominal pain associated with ovulation. German for “middle pain,” Mittelschmerz occurs midway through a menstrual cycle — about 14 days before the next menstrual period. The membrane around ovary stretches to release the egg, sometimes releasing some pressure and pain. NOTE: Fluid in pouch of Douglas is indicative or recent ovulation.
Describe the levels of FSH, LH and Testosterone in PCOS
FSH normal, LH high (ratio of FSH:LH inverted, LH>FSH in PCOS), Testosterone normal or high.
What is the most common type of urinary incontinence in women?
Stress incontinence
What does the WHO recommend regarding feeding of LBW infants?
The WHO recommends that all babies <2500g should be exclusively breastfed for the first 6 months of life as soon as they are born, seen by paediatrician and deemed clinically stable to start feeding. If mother’s breastmilk not available, try use donor human milk or formula feeding.
What volume of amniotic fluid is consistent with a diagnosis of polyhydramnios?
> 2-3L of amniotic fluid, amniotic fluid index >95 centile
In which part of the Fallopian tube do most ectopic pregnancies occur?
Ampulla
In which part of the Fallopian tube are ectopic pregnancies more likely to rupture and why?
Isthmus, as it is a narrower and more rigid part of the Fallopian tube, so ectopic pregnancies rupture here earlier than in other parts e.g. ampulla.
What is unprovoked vulvodynia?
Chronic vulvovaginal pain lasting for at least 3 months, with no underlying identifiable cause. The pain can be localised or generalised and cannot be provoked by light touch on examination. It is associated with a varying degree of dyspareunia.
When are women that have received treatment in colposcopy seen again?
Repeat smear 6 months after treatment to assess for any residual disease. If this is negative for HR HPV, she will be recalled for a smear in 3 years irrespective of age group. If it remains negative at 3 years she can have a smear at the timeframe indicated for her age group. On the contrary, if positive for HR HPV, irrespective of cytological change, she is re-referred back to colposcopy. Similarly, if there is evidence of moderate/severe dyskaryosis the woman is re-referred to colposcopy, without the need for HPV reflex testing.
At what gestation does the uterus distend up to the umbilicus?
20 weeks
When do pregnant women with diabetes receive retinal screening?
They receive retinal screening at booking, unless they have had a normal exam within 3 months. If initial screening is normal, they receive a second screening at 28 weeks. If initial screening is abnormal, receive second retinal screening test between 16-20 weeks gestation.
What are the likely histological features found in the ovary when there is metastasis from the GI tract?
About 5% of all malignant ovarian tumours are secondary, most commonly from the GI tract. Gastric tumours that metastasise to the ovary are known as Krukenberg tumours, and these contain signet ring cells.
What type of anaemia occurs in pregnancy?
Dilutional anaemia due to increase in plasma volume.
What are the ovarian cysts called that are found in a patient with endometriosis?
Chocolate cysts
If a woman is experiencing very severe hyperemesis gravidarum before the first scan is performed would you perform a scan if presenting at the EPAU?
Yes, do a scan earlier
Describe the rates of cervical dilatation in cm in a nulliparous and multiparous woman
1cm/hr in nulliparous
1.5-2cm/hr in multiparous
Which autoimmune condition is a recognised cause of premature ovarian failure?
Addison’s - autoantibodies cross react with theca interna/graulosa layers of the ovarian follicles
Following a large PPH, a woman develops severe headache and visual field defect. What is this complication called?
Sheehan’s syndrome
What does a routine antenatal examination involve?
If after 24 weeks: symphysis-fundal height, alongside urine dipstick and blood pressure. Abdominal palpation for foetal presentation should be done after 36 weeks as before that it is not reliable. Foetal heart rate monitoring with doppler is not indicated and done for reassurance.
In which phase of the menstrual cycle does premenstrual syndrome (PMS) occur?
In the luteal phase
What is stress incontinence?
Characterised by a small volume loss of urine occurring with increases in intra-abdominal pressure e.g. during coughing/laughing/sneezing. Caused by bladder outflow tract and pelvic floor weakness. Usually requires surgical correction.
