Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a > Obs & Gynae 2 > Flashcards

Obs & Gynae 2 Flashcards

1
Q

What % of pregnancies results in miscarriage?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a threatened miscarriage?

A

A pregnancy with vaginal bleeding with or without abdominal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you best identify a delayed (missed) miscarriage?

A

USS - an empty sac is seen or foetal pole with no heart beat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When can you expectantly manage an incomplete miscarriage?

A

Gestational age less that 8 weeks and not heavily bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define gestation diabetes.

A

reduced response to insulin causing hyperglycaemia with first onset during pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A foetus presents with macrosomia. What further tests do you want to perform?

A
  • Blood glucose/HbA1C
  • USS
  • Umbilical artery doppler
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How do you treat gestational diabetes?

A
  • advise on diet and lifestyle
  • consider metformin
  • consider C-section to avoid shoulder dystocia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the causes of prolonged labour (failure to progress)?

A 
3 Ps
Passenger:
-size of baby - macrosomia 
-presentation - brow and face first = greater diameter. cephalic 
-lying transverse, not rotating head 
-head no flexing

Passages:

  • pelvic abnormalities
  • soft tissue - cervical dilation dependent on uterine contracts + pressure on foetal head
  • vagina + perineum must be over come - may require episiotomy

Power:
-poor uterine contractions common in nulliparous women
-uterine atony:
~induction or augmentation with oxytocin
~polyhydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are risk factors for failing to progress in labour?

A

maternal:

  • primi parity
  • high BMI/weight gain

Foetal:

  • macrosomia
  • large head circumference
  • malpresentation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What role do prostaglandins play in labour?

A
  • reduce cervical resistance and increase release of oxytocin from the posterior pituitary
  • Used as a first component of labour induction to soft and thin the cervix. Activation of collagenase - remodelling of extracellular matric and generation of uterine contractions.

MISOPROSTOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What role does oxytocin have during pregnancy?

A
  • stimulate uterine contractions
  • contractions promote dilation
  • give low dose and gradually increase to augment labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the side effects of giving misoprostol?

A

-prostaglandin receptors present throughout the body so may have an effect on other systems - meconium stained liquour, diarrhoea, abdo pain.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the possible side effects of giving syntocinon?

A
  • uterine tachystole

- abnormal foetal HRs due to reduction in blood flow during contractions = hypoxaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is recorded on a partogram? why is it important to do?

A

Maternal:

  • HR
  • BP
  • temperature
  • urine output
  • abdo exam - descent of head

Foetal:
-heart rate (CTG)

Contractions:

  • frequency
  • duration
  • strength
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are maternal consequences of failure to progress in pregnancy?

A
  • infection

- post-partum urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the foetal consequences on failure to progress in labour?

A
  • hypoxia
  • cerebral palsy
  • mortality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A woman is failing to progress due to inefficient uterine contractions. How do you manage this lady? How common is this?

A
  • most common cause of failure to progress - common in nulliparous women
  • artificial rupture of membrane (amniotomy)
  • augmentation with oxytocin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

A woman is failing to progress in labour because of uterine contractions that are too strong. What is this called? How do you treat it?

A
  • hyperactive uterine action
  • can cause foetal distress - reduced placental perfusion - ischaemia
  • treat with C section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When would you C section a nulliparous woman who has failed to progress?

A

not achieved full dilation by 12-16 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What indications are there for induction of pregnancy?

A

Foteal:

  • over due - risk of IU foetal death
  • IUGR

Maternal:

  • still birth
  • social reasons
  • APH
  • Preterm ROM

Both:

  • preeclampsia
  • diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some contraindication for induction of labour?

A
  • acute foetal compromise
  • abnormal lie
  • placenta praevia
  • pelvic obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What colours of liquor would be concerning?

A
  • green = meconium stained = foetal distress

- red = blood ~ not good

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A baby is in breech position, what could you attempt to turn it round?

A

-external cephalic version (ECV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What would you management of a foetus in breech position be?

A
  • CTG moitoring
  • examine every 4 hours
  • foetal blood sampling ig pH <7.21 emergency C section ASAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What’s the difference between primary and secondary post partum haemorrhage?

A
  • primary = occurs within 24 hours of birth

- secondary = occurs >24 hours - 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are risk factors for PPH?

A
  • previous PPH
  • prolonged labour
  • pre-eclampsia
  • increased maternal age
  • polyhydramnios
  • emergency C section
  • placenta praevia or accrete
  • macrosomia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What 3 ways may you induce labour?

A
  • amniotomy
  • prostaglandin pessary (misoprostol)
  • sweep

-IV oxytocin for more contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is bishops score used for and what parameters does it measure?

A 
-assesses likelihood of having a vaginal delivery (when thinking about induction)
Vaginal examination measuring:
-cervical position 
-cervical consistency 
-cervical effacement 
-cervical dilation
-foetal station

-greater than 8 points = likely good delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What acronym is used for reading CTG? (explain said acronym)

A

DR. C BRaVADO

  • Define Risk - what risk factors does the person have for a complicated pregnancy
  • Contractions - frequency, intensity, consistency, duration and resting tone
  • Baseline Rate - normal baseline rate is between 110-160bpm
  • Variability - can fluctuate between 10-15bpm which is considered a good thing. decreased variability longer than 40 mins is suspicious and probably result in C section. less than 40 mins is probs sleep.
  • Acceleration - these are normal a good sign
  • Decelerations = are periodic or episodic (start of contraction back to normal by the end)
  • late decelerations are bad and may suggest foetal distress due to decreased placental blood flow
  • Overall impression - normal, suspicious or pathological?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What would make a CTG suspicious?

A
  • decreased variability
  • progressing tachycardia
  • decrease in baseline rate
  • late decelerations with reduced variability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What would make a CTG pathological?

A
  • persistent late decelerations with reduced variability
  • variable decelerations if prolonged or associated with other signs
  • little or no variability for greater than 40 mins
  • severe bradycardia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

If a woman has diabetes preconception, what must you advise + do?

A
  • advise HbA1c control of <48mmol
  • start follic acid 5mg
  • CONTRAINDICATED ACEi and statins
  • retinal screening
  • do renal function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are maternal risks of diabetes in pregnancy?

A
  • DKA
  • hypos
  • progression of retinopathy
  • pre-eclampsia
  • premature labour
34
Q

What are the feotal risks of diabetes in pregnancy?

A
  • miscarriage
  • macrosomia+ shoulder dystocia
  • fetal abnormalities
  • late still birth
  • neonatal hypoglycemia
  • respiratory distress
  • hyocalcaemia
35
Q

How do you treat diabetes in pregnancy?

A
  • Insulin bolus regime
  • metformin
  • Glibenclamide
  • all other hypoglycaemics are contraindicated
36
Q

If a woman has a preexisting medical condition pre pregnancy what can be done to ensure baby and mother are safe?

A
  • planned delivery & postpartum care
  • “safest” mode of delivery
  • neonatal support
  • anaesthetic expertise
  • HDU/ITU facilities
  • Ongoing care postpartum
37
Q

What are 2 common caused of anaemia in pregnancy?

A
  • Iron deficiency
  • folate deficiency
  • both due to increased requirements in pregnancy
38
Q

What complications is iron deficient anaemia during pregnancy associated with?

A
  • low birth weight

- preterm delivery

39
Q

What would be the expected FBC result of someone with iron deficiency anaemia?

A
  • low haematocrit
  • low MCV (microcytic)
  • low MCH (hypochromic)
  • normal or low reticulocyte count
40
Q

What What would be the expected FBC result of someone with folate deficiency anaemia?

A
  • high MCV (macrocytic)

- high homocysteine

41
Q

When is the risk of asthma exacerbation highest?

A

3rd trimester

42
Q

What effects does maternal asthma have on the foetus?

A
  • IUGR due to inadequate placental perfusion

- premature delivery due to deterioration in maternal condition

43
Q

What’s the leading cause of maternal death in UK?

A

Cardiac disease

44
Q

What are low risk and high risk cardiac lesions during pregnancy?

A

Low:

  • mitral incompetence
  • aortic incompetence
  • ASD and VSD

High:

  • aortic stenosis
  • coarctation of aorta
  • prosthetic valves
  • cyanosed pts
45
Q

Tell me about obstetric cholestasis.

A
  • commonest liver disease in prgnancy
  • presents with itching + NO rash
  • abnormal LFTs
  • resolves after delivery
  • recurrence risk is 80%
46
Q

What are the complications of obstetric cholestasis?

A

-stillbirth due to level of bile acid

47
Q

what is the treatment for obstetric cholestasis?

A
  • ursodeoxcolic acid has some benefit to biochemistry abnormalities
  • Delivery is the best
48
Q

What is the maternal and foetal risks of hyperthryoidism?

A

maternal - thyroid crisis with cardiac failure

foetal - thyrotoxicosis due to transfer for thryoid stimulating antibodies

49
Q

How do you manage hyperthyroidism in pregnancy?

A
  • Propylthiouracil
  • carbimazole
  • if mother has stimulating antibodies monitor fetal growth with USS
50
Q

What are the risks of untreated hypothyroidism in pregnancy?

A

early foetal loss

impaired neurodevelopment

51
Q

What is the management for hypothyroidism in pregnancy?

A

-adequate replacement of thyroxine especially in first trimester

52
Q

What complications can chronic renal disease in pregnancy cause? WHY?

A

WHY - eGFR increases by 50% in pregnancy

  • severe HTN
  • deterioration of renal function
  • pre-eclampsia
  • IUGR
  • stillbirth
  • premature delivery
  • abnormalities due to drug therapy
53
Q

How do you manage someone with chronic renal disease in pregnancy ?

A
  • MDT
  • Close renal function monitoring
  • close BP management
  • regular foetal growth and well being assessments
54
Q

What are the 3 feotal changes associated with sodium valporate use during pregnancy?

A
  • congenital malformations (spina bifida, cleft palate, hypospadias, polydactyly)
  • Reduced IQ (dose related)
  • ASD risk
55
Q

What would increase the risk of a woman to have a VTE in pregnancy?

A
  • obesity
  • maternal age
  • operative delivery
  • general increase for everyone due to hypercoagulable state of pregnancy
56
Q

What is the VTE treatment in pregnancy?

A

-LMWH - doesn’t cross placenta and cause bleeding (deltiparin)

57
Q

What is the cause of endometrial cancer?

A

PROLONGED UNOPPOSED OESTROGEN

  • HRT
  • PCOS
  • nulliparity
  • Late menopause
  • ovarian tumours
  • Pelvic irradaition
  • Tamoxifen
  • Diabetes
  • Obesity
58
Q

In what order would you perform investifagations for post menopausal bleeding suspecting endo Ca?

A
  • TVUS
  • Biopsy
  • Hysteroscopy
59
Q

How do you treat Endometrial Cancer?

A
  • Hysterectomy +/- pelvic lymph node removal
  • Radiotherapy
  • progesterone therapy
60
Q

What causes cervical cancer?

A
  • High risk HPV
  • early age intercourse
  • multiple sexual partners
  • STDs
  • Cigarette smoking - HPV more persistent
  • previous CIN
  • Multiparity
  • OCPusage
  • Other genital tract neoplasm
61
Q

What are the 2 main onco genes of HPV?

A

HPV 16 & 18

62
Q

What is persistent HPV associated with?

A

-increased risk of high grade CIN

63
Q

What is Gardasil? When is it given?

A
  • HPV vaccine against strains 6, 11, 16, 18
  • 1st dose given to 12/13 year olds in year 8
  • 2nd dose either in year 8 or 9
64
Q

What are the 2 most common types of cervical cancer?

A
  • Squamous (90%)

- Adenocarcinoma

65
Q

how would you treat a stage one cervical Ca?

A

LLETZ

-Large loop excision of the transformation zone

66
Q

How would you treat stage 2 and above cervical Ca?

A
  • Radiotherapy
  • chemotherapy
  • Palliative care
67
Q

What are the 2 common aetiolgies of vulval cancer?

A

-VIN (HPV)
-Lichen sclerosis
(90% squamous)

68
Q

What are some symptoms associated with vulval cancer?

A
  • vulval itching
  • vulval soreness
  • persistent lump
  • bleeding
  • pain on PU
  • past hx of VIN or lichen sclerosis
69
Q

What are genetic causes of ovarian cancer?

A
  • BRAC 1/2

- HNPCC

70
Q

What non-genetic causes of ovarian cancer?

A

OVULATION

  • early menarche
  • late menopause
  • nuliparity
  • breast feeding
  • OCP
  • hysterectomy
  • ovulation induction
71
Q

How do you investigate suspected ovarian Ca?

A
  • CA125
  • TVUS

RMI (risk of malignancy index) = CA125 x USS score (1 or 3 for more than one abnormal feature of cyst on scan) x pre or post menopausal (1 or 3)

72
Q

Define placenta accreta. increta & percreata.

A

Accreta - placenta attaches too deeply in the uterine wall
Increta - placenta attaches to the myometrium
Percreta - placenta goes all the way through the uterine wall and sometimes attaches to other nearby viscera i.e. bladder

73
Q

How do you treat PPROM?

A
  • 10 day ABx prophalyaxsis - erythromycin
  • steroids for lung maturation before 34 weeks
  • magnesium sulphate infusion for cerebral palsy protection
  • deliver between 34-36 weeks
74
Q

Define PPROM.

A

Premature rupture of membranes before week 37 of pregnancy

75
Q

Define PROM.

A

premature rupture of membranes - membranes rupture before labour begins.

76
Q

Why is group b strep a bad thing?

A
  • can cause sever infection in the neonate e.g. sepsis, pneumonia, meningitis
  • 5% mortality rate
77
Q

What are risk factors for a neonate getting a GBS infection?

A
  • previous GBS infection of another sibling
  • prematurity <37 weeks
  • ROM >24hrs before delivery
  • oyrexia during labour
  • +ve GBS test in mother
  • mother diagnosed with a GBS UTI during pregnancy
78
Q

How is GBS detected?

A
  • swab of vagina and rectum
  • done in high risk women:
  • UTI or Chorioamnionitis
  • STI sx pre-pregnancy
  • Previous GBS infected bab
79
Q

How does one prevent a neonate from getting a GBS infection?

A

-High dose pen-ben throughout labour in high risk women

80
Q

When is IV Ben-Pen given to women during labour to prevent neonatal GBS?

A
  • GBS positive swabs
  • A UTI caused by GBS during this pregnancy
  • Previous baby with GBS infection.
  • Pyrexia during labour
  • Labour onset <37 weeks
  • Rupture of membranes >18 hours
81
Q

What are some possible sensitising events?

A
  • Ectopic pregnancy
  • Evacuation of retained products of conception and molar pregnancy
  • Vaginal bleeding < 12 weeks, only if painful, heavy or persistent
  • Vaginal bleeding > 12 weeks
  • Chorionic villus sampling and amniocentesis
  • Antepartum haemorrhage
  • Abdominal trauma
  • External cephalic version
  • Intra-uterine death
  • Post-delivery (if baby is RhD-positive)
82
Q

When is Anti-D given to previously non-sensitised women who have not had a sensitising event?

A

-all non-sensitised RhD -ve women @ 28 and 34 weeks

Phase 3a (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions