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o&g rotation 1 2018 > O&G Basics > Flashcards

O&G Basics Flashcards

1
Q

Salpingitis

A

infection of fallopian tubes

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2
Q

Accelerations

A

Episodes of heart rate above baseline for at least 15 bpm and lasting at least 15sec

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3
Q

Decelerations

A

Episodic changes in fetal heart rate below baseline
Early: mirror image of contractions (caused by head compression, benign)
Variable: abrupt jagged dips below baseline (most common, caused by cord compression, observe)
Late: offset, following uterine contractions (suggest fetal hypoxia, if recurrent (i.e. >50% contractions), then can indicate fetal acidemia)
Late + decreased variability –> strongly suggestive of fetal acidemia

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4
Q

Multiparous

A

More than one pregnancy

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5
Q

Normal labour

A

Defined by cervix dilation rate, not contraction patter

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6
Q

Active phase of labour

A

Part of labour where dilation occurs more rapidly. Usually cervix dilated >4cm.
Dilation rate during this phase: >1.2cm/hr or >1.5cm/hr for 1+ previous deliveries

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7
Q

Labour

A

Cervical change accompanied by regular uterine contractions

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8
Q

Latent phase of labour

A

Initial part - Cervix mainly effaces (thins) rather than dilates (usually <4cm dilation)

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9
Q

Protraction of the active phase

A

Cervical dilation less than expected (i.e. <1.2 or 1.5cm/hr)

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10
Q

Arrest of the active phase

A

No progress in active phase for 2hrs

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11
Q

Stages of labour

A
  1. Onset to complete dilation (latent and active phases)
  2. Complete cervical dilation to delivery of infant
  3. Delivery of infant to delivery of placenta
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12
Q

Fetal heart rate

A

Normal: 110-160 bpm

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13
Q

Normal labour parameters (nulliparous)

A

Latent (cervix <4cm): <18-20hrs
Active (cervix >4cm): >1.2cm/hr
2nd stage (end dilation to delivery of infant): <2hrs (or <3hrs if epidural given)
3rd stage (infant –> placenta): <30mins

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14
Q

Normal labour parameters (>1 births)

A

Latent (cervix <4cm): <14hrs
Active (cervix >4cm): >1.5cm/hr
2nd stage (end dilation to delivery of infant): <1hr (or <2hrs if epidural given)
3rd stage (infant –> placenta): <30mins

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15
Q

3Ps

A

Power
Passenger
Pelvis

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16
Q

Prolongation of the latent phase of labour

A

Latent phase exceeds 18-20hrs (or 14hrs for 1+ previous pregnancy)

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17
Q

Cephalopelvic disproportion

A

Pelvis too small for the fetus (either abnormal pelvis or excessively large baby)

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18
Q

Adequate uterine contractions

A

Contractions every 2-3minutes, firm on palpation, lasting for at least 40-60seconds
>200 Montevideo units (200 mmHg total above baseline when contractions added in a 10min window)

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19
Q

Arrest of descent

A

Baby head does not engage the pelvis correctly

Located above the pelvic inlet, i.e. at plant of ischial spines

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20
Q

Bloody show

A

Dark vaginal blood mixed with mucous
Represents loss of the cervical mucous plug
Sign of impending labour
Sticky mucous differentiates from antepartum bleeding

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21
Q

Anthropoid pelvis

A

Pelvis with AP diameter > transverse diameter
Prominent ischial spines
Narrow anterior segment

Predisposes to fetal occiput posterior position

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22
Q

Placenta previa

A

Placenta lying close to or over the cervical opening

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23
Q

Placental abruption

A

Placenta detaches from the wall of the uterus early

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24
Q

Decidualisation

A

Preparation of the endometrium
Stromal cells undergo decidual cellr eaction: accumulation of glycogen and lipid in cytoplasm and cells become larger and more round

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25
Q

Stages of implantation

A

Hatching: shedding of zona pellucida
Apposition: first cell-cell contact, close apposition of trophoblast and luminal epithelium
Attachment/adhesion: cell contacts much closer, interdigitation between apical microvilli or uterine epithelium and apical memrbane of trophoblast
Invasion: trophoblast erodes the uterine surface epithelium

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26
Q

Syncytiotrophoblast

A

Outer layer of placental villi

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27
Q

Cytotrophoblast

A

Inner layer to syncytiotrophoblast. External to blastocyst. Trophoblastic stem cell.
“Layer of langerhans”

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28
Q

Where and when does implantation occur?

A

Ampulla of fallopian tube

Day 7 post-fertilisation

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29
Q

What is a morula and when does it form?

A

Cleaved zygote, becomes blastocyst on day 5

Day 3 post-fertiliation

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30
Q

When and where is hCG produced?

What is hCG function?

A

From approx day 7 post-conception
Syncytiotrophoblast
Prevents luteolysis/evolution of corpus luteum to corpus albicans

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31
Q

What does corpus luteum secrete? When does the placenta take over that compound’s production?

A

Progesterone

Placenta starts at 6wks, takes over at 8wks

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32
Q

What causes hCG to increase?

A

Pregnancy
Ectopic
Hydatiform mole

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33
Q

What are the functions of progesterone in pregnancy?

A

Maternal recognition of pregnancy, implanation and decidualisation
Maintains uterine and placental integrity and synthetic capacity
Inhibits uterine activity
Increases appetite, fat deposition, mammary development, modifies immune response

Normal levels: 10-35ng/mL

If levels are too low (<5-10ng/mL) –> 80-100% abortion rate

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34
Q

What is the bioavailability of estrogens?

A

Oestadiol: 100%
Oestriol: 10%
Oestrone: 1%

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35
Q

Parturition

A

Onset of birth

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36
Q

Tocolytic

A

drugs that relax smooth muscles and interfere with uterine contractions

Examples: Calcium channel blockers, Oxytocin R antagonists, COX inhibitors, PGF2 antagonists, B-adrenoceptor agonists

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37
Q

Preterm birth

A

<37 weeks
5-10% births
30% associated with infection
50% idiopathic

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38
Q

Where does ACTH act in adrenals? and what does it produce?

A

Zona fasciculata –> glucocorticoids

(Glomerulosa –> mineralocorticoids
Reticularis –> sex steroids)

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39
Q

Why does cortisol increase in pregnancy?

A

Placenta produces CRH in cytotrophoblast and syncytiotrophoblast which stimulates cortisol synthesis

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40
Q

What is the Ferguson (neuroendocrine) reflex?

A

Self-sustaining cycle of uterine contractions

Positive feedback pathway: pressure on cervical/vaginal walls –> oxytocin release –> stimulates strong waves of contraction through myometrium –> baby head puts further pressure on cervix –> further oxytocin release and contractions

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41
Q

What are the Stages of parturition and associated hormones? (hint: not phases of labour)

A

Quiescence (P)
Activation (E decr, P, CRH, PGE, uterine stretch)
Stimulation (oxytocin and PGF)
Expulsion (oxytocin)

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42
Q

When is the placenta thickness fully developed?

A

4 months
No new villi or lobules after 10-12weeks
Do get circumferential growth after this time.
Area:Volume increases from 28w to term.

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43
Q

What are the functions of the placenta?

A

Diffusion: O2, CO2, steroids, H2O
Active transport: glucose, AA
Transcytosis: materal Abs
Endocrine: progesterone production from ~6wks, estrogen, hCG, lactogen

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44
Q

Placenta Accreta

A

placenta extends into the myometrium

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45
Q

When do hcg levels return to normal after delivery?

A

4-6 weeks

46
Q

When do you do a coagulation profile postpartum?

A

Massive haemorrhage

47
Q

Where are FSH and LH produced? And what action?

A

Anterior pituitary

Oogenesis, regulating menstrual cycle

48
Q

When do you use the following tumour markers?
CA125
AFP
HCG

A

Ca125 - ovarian cancer, monitoring, also raised in endometriosis
AFP - hepatocellular ca, nonseminiferous germ cell cancers, also raised in pregnancy
HCG - male choriocarcinoma

49
Q

What is the minimum time for a woman to bleed out from PPH?

A

5mins

50
Q

What are consequences of massive PPH?

A

Sheehan syndrome, death, acute tubular necrosis, ARDS….

51
Q

What is the classic triad of ectopic pregnancy?

A

PV bleeding
Amenorrhea
Pelvic pain

52
Q

Placenta Increta

A

placenta extends further into the myometrium than placenta accreta

53
Q

Placenta percreta

A

placenta extends through the perimetrium

54
Q

Placental underinvasion characterised by…

A

reduced invasion and transformation of spiral arteries (dilation of lumen, trophobblast invasion, replacement of muscle/elastic with fibrinoid material), reduced perfusion
Causes intrauterine growth restriction

55
Q

What is Preeclampsia?

A

Hypertensive multisystem disorder
Characterised by HTN, proteinuria, end organ damage
Reversal upon termination of pregnancy

56
Q

What causes preeclampsia?

A

Likely due to placenta:
Aberrant invasion of the trophoblast and failure of complete spiral artery formation causing placental ischemia and release of factors causing endothelial dysfunction (e.g. VEGF, FLT1, sFLT-1)

57
Q

What does VEGF do?

A

Induce angiogenesis

58
Q

What is PAPP-A?

A

pregnancy associated plasma protein A
Placental marker of chromosomal abnormality and fetal growth (low in trisomy 21)
High in macrosomia
Can be a marker for early onset severe preeclampsia

59
Q

What is the leading cause of pregnancy related mortality in the 1st trimester?

A

Ectopic pregnancy

60
Q

How do you treat an ectopic pregnancy?

A

Methotrexate
Surgery
Watch and wait

61
Q

What are risk factors for ectopic pregnancy?

A 
Fallopian tube injury
PID
Endometriosis
Previous ectopic
Young maternal age
Smoking
ART
Pregnancy with an IUD
62
Q

What is the most common cause of spontaneous abortion?

A

Chromosomal abnormalities

63
Q

Which organs are essential for intrauterine life?

A

Placenta, yolk sac, liver, CVS

64
Q

What is the incidence of infertility in Australian couples?

A

6%
Composed of 33% Female and at least 20% Male factors
Unknown factors in 7% of cases

65
Q

What are causes of male infertility?

A

Klinefelters, endocrine, infections, psychological, lifestyle factors, age (older make take longer to conceive), tumours, hernias, varicocele, etc

66
Q

What are female causes of infertility?

A

Obesity, underweight, smoking, EtOH, caffeine, occupation, PCOS, endometriosis, fibroids, uterine structural abnormalities (septate, bicornuate, didelphys)

67
Q

What are the possible mechanisms of spread of endometriosis?

A

Metastatic spread
Lymphatic spread
Retrograde menstruation

68
Q

What are combined causes of infertility?

A

Not enough sex
Not having sex during fertility window
Using compounds affecting sperm mobility
Combined genetics

69
Q

What treatments are available for infertility?

A

Intrauterine insemination
In vivo fertilisation
Intracytoplasmic sperm infection (for non-motile sperm)
Embryonic stem cell gametes (use nucleus from skin cell from infertile woman and donated egg oocyte)

70
Q

What are the PCOS diagnostic criteria?

A

2 of:
Hyperandrogenism
Multiple cysts on ovaries
Failure to ovulate

71
Q

What treatments are available for PCOS?

A

Metformin
Possibly insulin
Weight loss

72
Q

Where can fibroids form?

A

Intramural
Submucosal
Subserosal
Pedunculated

73
Q

What is the average age of menopause?

A

51

74
Q

What happens to hormones during menopause?

A

Low estrogen –> increased FSH

75
Q

What are the symptoms and Rx of menopause?

A

Hot flushes
Vaginal atrophy
Osteoporosis

Rx: hormone replacement therapy (Premarin)

76
Q

What does LUSCS stand for?

A

Lower Uterine Segment Caesarean Section

77
Q

What constitutes a pre-viable gestation?

A

0-22+6 weeks
Embryonic period to 12 weeks
Fetal period >12weeks

78
Q

What constitutes a peri-viable gestation?

A

23-25+6 weeks

79
Q

What constitutes a viable gestation?

A

26 weeks onwards

80
Q

What are signs of a transverse lie?

A

uterus extending out to hips

81
Q

What are causes of a larger uterus than expected?

A

Polyhydramnios
Macrosomia
>1 Fetus
Mistaken dates

82
Q

What is the incidence and risk factors for Hyperemesis gravidarum?

A

0.3-1.5%

RF: multiples or molar pregnancy

83
Q

What are the complications of hyperemesis gravidarum?

A 
Electrolyte disturbance
Ketosis
Anaemia
Hyponatremia
Vitamin deficiency
Thyroid dysfunction (pseudo thyrotoxicosis)
Renal/he.patic dysfxn
Ulcerative oesophagitis
Mallory-weiss tears
84
Q

Which anti-emetics are used in pregnancy?

A

Doxylamine (H1 antagonist) + Pyridoxine (VitB6)

Prochlorperazine (Stemetil; D2 receptor antagonist)

Metoclopromide (Maxolon; D2 receptor antagonist)

Ondansetron (Zofran; 5HT3 receptor antagonist)

85
Q

What is a threatened miscarriage?

A

Any vaginal bleeding <20weeks (fetus viable)

86
Q

What is a complete miscarriage?

A

Intrauterine pregnancy that has been completely expelled from the uterus

87
Q

What is an incomplete miscarriage?

A

Parts of products of conception have been expelled. Failed Intrauterine pregnancy that has not been completely expelled from the uterus.
Open OS.

88
Q

What is a missed miscarriage?

A

Intrauterine pregnancy failed, but not detected as no pain or bleeding obvious.

89
Q

What is an inevitable miscarriage?

A

Intrauterine pregnancy destined to fail as there is an Open OS.

90
Q

What is an anembryonic pregnancy?

A

gestational sac >25mm with no fetal pole

can go on to become complete or incomplete miscarriages

91
Q

What is recurrent miscarriage?

A

3 consecutive miscarriages

92
Q

What are the USS diagnostic criteria of miscarriage?

A

Crown-Rump length >7mm and no FHR
or
Mean sac diameter >25mm and no fetal pole

93
Q

What are the three life threatening emergencies associated with miscarriage?

A

Septic miscarriage
Cervical shock
Incomplete miscarriage with severe haemorrhage

94
Q

Name a uterotonic drug?

A

Ergotamine (500mcg IM)

95
Q

What are the diagnostic criteria for an ectopic pregnancy?

A

BhCG >1500 and uterus empty on transvaginal USS
(beware Dx of complete miscarriage - which would have a previously non-empty uterus scan)

Adnexal mass and empty uterus (strongly suggestive)

96
Q

When would you use Methotrexate to treat an ectopic pregnancy?

A 
Clinical stable woman with minimal pain
BhCG <3000
Minimal free abdo fluid
Mass <3.5cm
No fetal heart beat
Patient reliable for follow up
Patient does NOT have renal or hepatic disease
Woman agrees not to try to fall pregnant for 3 months after Rx (teratogenic)
97
Q

What do you use to treat hyperthyroidism in pregnancy?

A

PTU in first trimester, then change to carbimazole

98
Q

What is the definition of a breech baby?

A

Fetus in longitudinal position with buttocks or feet closest to the cervix (3-4% of all deliveries)

99
Q

What types of breech babies are there?

A

Frank breech (50-70%): hips flexed, knees extended (pike position)

Complete breech (5-10%): hips flexed, knees flexed (cannonball position)

Footling or incomplete (10-30%): one or both hips extended, foot presenting

100
Q

Risk factors for breech?

A

prematurity, uterine malformations, fibroids, polyhydramnios, placenta previa, fetal abnormalties, multiple gestations

101
Q

What are appriopriate modes of delivery for breech babies?

A

Spontaneous: no traction or manipulation of the infant is used. Predominantly preterm, often previable, deliveries

Assisted: most common. Infant allowed to spontaneously deliver up to the umbilicus and then manoeuvres are initiated to assist with the delivery of the body, arms and head.

Total breech extraction: fetal feet grasped and the entire fetus is extracted. Should only be used for a noncephalic 2nd twin.

102
Q

For total breech extraction, what are the contraindications and risks to fetus?

A

Not for singeton fetus as the cervix may not be adequately dilated to allow passage of the fetal head.

Can cause head entrapment or nuchal arms (as long as FHR stable and no evidence of prolapsed cord, can await dilation of cervix), brachial plexus injuries, cervical spine injury, cord prolapse.

103
Q

When should you conduct C section for breech baby?

A

> 37wk

>4kg

104
Q

What C section incisions are suitable for breech babies?

A

Low vertical uterine incision for preterm to avoid head entrapment

Low transverse incision: must move quickly to avoid head entrapment

105
Q

What is external cephalic version (ECV)?

A

transabdominal manual rotation of the fetus into a cephalic presentation

106
Q

What are the risks of ECV?

A

fractures, precipitation of labour, premature rupture of membranes, abruptio placentae, fetomaternal haemorrhage and cord entanglement, transient slowing of FHR (common)

107
Q

What is the mechanism of labour (i.e. seven cardinal movements)?

A

Mechanism of labour

  1. Engagement
  2. Descent
  3. Flexion
  4. Internal rotation
  5. Extension
  6. Restitution and external rotation
  7. Expulsion
108
Q

How to tell a missed miscarriage on USS?

A

No fetal heart rate with crown rump length >7mm

109
Q

How to tell an anembryonic pregnancy on USS?

A

No fetal pole (crown rump length) when gestational sac >25mm

110
Q

What are treatment options for anembryonic miscarriage?

A

Suction curette - bets for heavy bleeding, infection, unstable. risk of infection similar to conservative mgmt. risk of perforation.

Misoprostil - 400mcg PV rpt 24hrs later if no POC passed. 80% success. 2% need surgical intervention.

Do not use: Expectant - more successful if early, incomplete, ltd tissue, not missed MC or blighted ovum

111
Q

What are contraindications to ergometrine?

A

Cardiovascular disease

o&g rotation 1 2018 (2 decks)

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