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MRCOG - Part 1 > Clinical Management > Flashcards

Clinical Management Flashcards

1
Q

How do you calculate RMI?

A

= ultrasound score x menopausal score = Ca125

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2
Q

What RMI score should warrant referral to the MDT?

A

> /= 250 (NICE), but a score >200 is recommended by RCOG to treat as highly suspicious of cancer

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3
Q

What is the current recommended HbA1c in pregnancy?

A

= 48

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4
Q

At what HbA1c should a woman be advised not to get pregnant?

A

> 86

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5
Q

What proportion of women have the classic ‘frothy’ discharge of TV?

A

Only 20%

Only 2% get cervicitis - i.e. strawberry cervix

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6
Q

What is the 1st line treatment of TV?

A

Metronidazole 400-500mg BD for 5-7 days. Also 1st line in pregnancy. BASHH recommend 500mg BD for 7 days in concurrent HIV infection

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7
Q

Which 3 disease should be screened for antenatally?

A

1) HIV; 2) Hep B; 3) Syphillis

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8
Q

What is the tubal infertility rate following 1 episode of PID?

A

12.5%

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9
Q

What is the tubal infertility rate following 3 episodes of PID?

A

50%

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10
Q

What are the 3 different utertonics?

A

1) Oxytocin; 2) Prostaglandins - misoprostal being the most commonly used; 3) Ergometrine

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11
Q

What is the 1st-line uterotonic?

A

Oxytocin

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12
Q

What is the half-life of oxytocin?

A

5 minutes

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13
Q

What is the half-life of ergometrine?

A

30-120 minutes

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14
Q

What is the half life of misoprostal?

A

40 minutes

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15
Q

What type of receptor does oxytocin bind to?

A

G-protein coupled receptor requiring Mg2+ and cholesterol

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16
Q

What is syntometrine?

A

Combination oxytocin and ergometrine

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17
Q

What are uterotonics?

A

Drugs that aid uterine contraction

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18
Q

What is the most important process necessary for cervical ripening??

A

Degradation of type 1 collagen by interstitial collagenase

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19
Q

What is the cervical screening frequency?

A

Age 25-49 = every 3 years

Age 50-64 = every 5 years

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20
Q

What is the new style (2019) cervical screening?

A

If HPV -ve = routine recall
If HPV +ve –> cytology triage. If cytology normal, re-screen in 12 months, if abnormal, colposcopy

Pt’s whom are HPV +ve with normal cytology may be re-screened every 12 months for 2 cycles. If at the 3rd test, i.e. 2 years from the 1st HPV +ve result and the pt is still HPV +ve but with normal cytology, they then need to go for colposcopy like abnormal cytology would do

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21
Q

What is the most common cancer of the vagina?

A

Squamous cell

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22
Q

What is the most common cancer of the cervix?

A

Squamous cell

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23
Q

What is the most common cancer of the vulva?

A

Squamous cell

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24
Q

What is the most common cancer of the ovary?

A

Epithelial (85%), of which 75% are serous

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25
Q

What is the most common cancer of the endometrium?

A

Endometroid carcinoma

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26
Q

What is the LFT monitoring regime in OC?

A

Every 1-2 weeks during pregnancy and at least 10 days postnatally.
If a pregnant patient is itching - this may occur before derranged LFTs - if LFTs normal int eh first instance, check again in 1-2 weeks.

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27
Q

What does OC increase the risk of?

A

1) Passage of meconium
2) Pre-term delivery
3) Fetal distress
4) C-section delivery
5) PPH

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28
Q

How long must a woman wait to become pregnant whom has received chemo for gestational trophoblastic disease?

A

1 year post-completion of treatment

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29
Q

What is the frequency of molar pregnancy?

A

1/1000 pregnancies

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30
Q

In what proportion of molar pregnancies is hCG high enough to trigger hyperthyroidism?

A

3%

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31
Q

What is choriocarcinoma?

A

= a malignant tumour of the trophoblast, 70% occur after a molar pregnancy (20% after TOP, 10% after a normal pregnancy)

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32
Q

How do ovarian cancers metastasise?

A

Transcoelomic route

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33
Q

How do choriocarcinomas metastasise?

A

Haematogenous route

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34
Q

When should platelets be administered?

A

When = 75 give x1 pool

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35
Q

When should fibrinogen be administered?

A

When =2 give x2 pools of cryoprecipitate

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36
Q

When should FFP be administered?

A

If ongoing haemorrhage, after 4 units of blood and no haemostatic tests yet available - give 4 units FFP

If prolonged APTT/PT and haemorrhage ongoing, give 12-15ml/kg of FFP

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37
Q

What is a WHO group I ovulation disorder?

A

Hypothalamic pituitary failure (Stress, anorexia, exercise induced)

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38
Q

What is a WHO group II ovulation disorder?

A

Hypothalamic-pituitary-ovarian dysfunction (PCOS)

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39
Q

What is a WHO group III ovulation disorder?

A

Ovarian failure

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40
Q

How do you manage a WHO group I ovulation disorder with regards to fertility?

A

Increase BMI >19, reduce high levels of exercise, pulsatile GnRH to induce ovulation

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41
Q

How do you manage a WHO group II ovulation disorder with regards to fertility?

A

Weight reduction if BMI <30; clomiphene (1st line); metformin (1st line) - may also be used together; 2nd line = laparoscopic drilling or gonadorophins

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42
Q

What is the risk of fetal laceration in CS?

A

2%

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43
Q

What is the average blood loss in a cycle?

A

35-40ml, max. normal blood loss = 80ml

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44
Q

What are the 2 types of endometrial hyperplasia?

A

1) Hyperplasia without atypia

2) Atypical hyperplasia

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45
Q

How should endometrial atypical hyperplasia be managed?

A

Hysterectomy

IUS or oral progesterone’s for those that decline surgery

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46
Q

How should endometrial hyperplasia w/out atypia be managed?

A

IUS first-line with 6 monthly endometrial surveillance

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47
Q

What is the progression rate to cancer of endometrial hyperplasia w/out atypia?

A

<5% over 20 years

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48
Q

What is used to inhibit Galactopoiesis and Lactogenesis?

A

Dopamine

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49
Q

After how long do you SUSPECT delay in multips/nullips?

A 
Multips = inadequate progress in active 2nd stage after 30 mins
Nullips = inadequate progress in active 2nd stage after 1 hour
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50
Q

What can you do if you SUSPECT delay in labour?

A

If membranes intact, may offer amniotomy

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51
Q

Is lamotrigine an enzyme inducer?

A

No

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52
Q

What contraceptives may be used with lamotrigine?

A

Progesterone only

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53
Q

Why can’t combined contraception be used when a pt is taking lamotrigine?

A

The oestrogen component has been shown to reduce lamotrigine levels and therefore increases the risk of seizure.

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54
Q

What is St Anthony’s fire?

A

= ergotism, i.e. posioning by ergot compounds. Ergometrine is an ergot alkaloid

Erogtism causes convulsions and gangrene, the gangrene being due to prolonged vasospasm

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55
Q

What is the only UKMEC 4 condition for POP?

A

Breast cancer within the last 5 years

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56
Q

What produces superior images during hysteroscopy - distension with saline or CO2?

A

Saline

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57
Q

What type of hysteroscopes should be used in outpatient setting?

A

Miniature hysteroscopes - 2.7mm

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58
Q

Which nerve roots does the brachial plexus consist of?

A

C5-T1

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59
Q

What nerve roots are damaged in Erb’s palsy?

A

C5-C6

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60
Q

What is the most common cause of Erb’s palsy?

A

Shoulder dystocia

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61
Q

What is the prevalence of endometriosis?

A

2-3%

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62
Q

How is stage I endometriosis defined?

A

Superficial lesions & filmy adhesions

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63
Q

How is stage II endometriosis defined?

A

Deep lesions at cul-de-sac (space between the uterus and the rectum)

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64
Q

How is stage III endometriosis defined?

A

As above + ovarian endometriomas

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65
Q

How is stage IV endometriosis defined?

A

As above + extensive adhesions

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66
Q

What are the risks in laparoscopy?

A

Risk of ‘serious’ complication = 2/1000
Risk of bowel injury = 0.4/1000
Risk of vascular injury = 0.2/1000
Risk of death = 5/100,000

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67
Q

What are your first-line treatments for hyperthyroidism in pregnancy?

A

Propylthiouracil - as crosses the placenta less readily than carbimazole
Then carbimazole
Radioiodine is contraindicated

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68
Q

What are the risk factors for acute fatty liver of pregnancy?

A

1) Male fetus; 2) Obesity; 3) Nulliparous; 4) Multiple pregnancy

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69
Q

What is the cause of acute fatty liver of pregnancy?

A

Fetal deficiency of long-chain 3-hydroxyl-CoA dehydrogenase (LCHAD) - causes accumulation of toxic products of impaired fatty acid metabolism which then accumulate in the maternal circulation

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70
Q

What is the risk of VIN progressing to SCC?

A

15%

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71
Q

What are the histological features of lichen sclerosis?

A

1) Epidermal atrophy
2) Hydropic degeneration of the basal layer (sub-epidermal hyalinisation)
3) Dermal inflammation

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72
Q

What are the histological features of lichen simplex?

A

1) Epithelial thickening

2) Increased mitosis in basal and prikle layers

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73
Q

What are the histological features of VIN?

A

1) Epithelial nuclear atypia
2) Loss of surface differentiation
3) Increased mitosis

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74
Q

What would be the cause of a tender nodule during PV exam?

A

Endometriosis of the uterosacral ligament (sign specific to this)

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75
Q

How far back do individuals need to contact trace when diagnosed with an STI?

A

Men - 4 weeks if was symptomatic, 6 months if were asymptomatic at diagnosis
Women - 6 months

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76
Q

Which women would you give 5mg folate to daily?

A

1) On AEDs
2) Coeliac’s
3) DM
4) Prev. neural tube defect
5) FHx neural tube defects
6) On methotrexate
7) Sickle Cell

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77
Q

What is the risk cut off at which CVS would be offered?

A

> 1/150

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78
Q

In whom should cell salvage be used?

A

In those whom >1500ml blood loss is anticipated

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79
Q

What intra-abdominal pressure is required to insert the primary trocar?

A

20-25mmHg

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80
Q

What intra-abdominal pressure should be maintained once the trochar is inserted?

A

12-15mmHg

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81
Q

What is significant proteinuria?

A

Significant proteinuria = urinary protein:creatinine ratio >30 mg/mmol
or 24-hour urine collection result shows greater than 300 mg protein

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82
Q

What is the Abx regime in medical abortion?

A

Dual (unless tested -ve for chlyamydia in which case metronidazole PR only) - either azithromycin + metronidazole PR, or doxycycline + metronidazole PR

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83
Q

When does the luteoplacental shift occur?

A

6-8 weeks

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84
Q

When should simple ovarian cysts have follow-up?

A

When they are 50-70mm in daimeter there should be annual USS F/U

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85
Q

What is the maternal and fetal mortality rate of acute fatty liver of pregnancy?

A

20%

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86
Q

What is the definition of placenta accreta?

A

Chorionic villi attached to myometrium rather than decidua basalis

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87
Q

What is the definition of placenta increta?

A

Chorionic villi invade into the myometrium

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88
Q

What is the definition of placenta percreta?

A

Chorionic villi invade through the myometrium and into serosa

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89
Q

What proportion of birthing brachial plexus injuries are permanent?

A

<10%

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90
Q

What is the most common form of fibroid degeneration?

A

Hyaline

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91
Q

What is the most common form of fibroid degeneration in pregnancy?

A

Red

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92
Q

What are the Rotterdam criteria for PCOS?

A

1) Polycystic ovaries (either 12 or more peripheral follicles or increased ovarian volume (greater than 10 cm3)
2) Oligo-ovulation or anovulation
3) Clinical and/or biochemical signs of hyperandrogenism

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93
Q

What is the histological feature indicative of serous ovarian cancer?

A

Psammoma bodies

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94
Q

What is the histological feature indicative of mucinous ovarian cancer?

A

Mucin vacuoles

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95
Q

What proportion of pregnancies are choriocarcinoma?

A

1/45,000

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96
Q

How long do afterpains go on for post-delivery?

A

2-3 days

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97
Q

How long does it take for the uterus to involute?

A

4-6/52

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98
Q

How long does it take for vaginal tone to return?

A

4-6/52

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99
Q

How long does lochia flow for?

A

3-6/52

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100
Q

What proportion of women are asymptotic of gonorrhoea?

A

50%

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101
Q

At what gestation does a fetus start to urinate?

A

Weeks 8-11

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102
Q

At what gestation does a fetus start to swallow?

A

Week 12

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103
Q

Which COCP is used in hirsutism?

A

Dianette (co-cypindriol). It should be discontinued 3-4/12 after resolution of hirsutism. If the hirsutism relapses after discontinuation of Dianette consider use of Yasmin

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104
Q

What is the risk of serious neonatal infection in PROM?

A

1/100

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105
Q

When is it reasonable to induce labour in PROM?

A

When >34/40 and >24 hours post-rupture

If <34/30, induction shouldn’t be performed unless obstetric indication e.g. infection

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106
Q

What proportion of women with PROM will go into labour within 24 hours?

A

60%

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107
Q

What are the changes in blood composition in pregnancy?

A

Platelet count reduced

Increased ESR, coagulation factors and fibrinogen

108
Q

Should routine episiotomy be performed after previous 3rd/4th degree tears?

A

No

109
Q

What are the contraindications to ARM?

A

1) High presenting part (risk of cord prolapse)
2) Preterm labour
3) Known HIV carrier
4) Caution is taken with polyhydramnios or any malposition or malpresentation
5) Placenta praevia
6) Vasa praevia

110
Q

What are the USS features of partial molar pregnancy?

A

1) Enlarged placenta
2) Fetus with severe structural abnormality
3) Oligohydramnios or deformed gestational sac

111
Q

What are the USS features of complete molar pregnancy?

A

1) Snowstorm
2) Bunch of grapes - represents swelling of trophoblastic villi
3) No identifiable fetal tissue or gestational sac

112
Q

How long may a tocolytic prolong a pregnancy by?

A

7 days

113
Q

What proportion of individuals whom are allergic to penicillin will also be allergic to cephalosporins?

A

0.5-6.5%

114
Q

What are the 1st line choices for OAB after bladder training/treatment of vaginal atrophy?

A
  1. Oxybutynin
  2. Tolterodine
  3. Darifenacin
115
Q

What are the 2nd line choices for OAB/adjuvant treatments?

A

2nd line = mirabegron

Adjuvants = desmopressin if struggling with nocturia; duloxetine if unsuitable for/declines surgery

116
Q

What ABx should given to women with suspected UTI (don’t wait for the culture results, start empirical treatment)?

A
  1. Nitrofurantoin 50 mg QDS (or 100 mg MR BD) for 7 days
  2. Trimethoprim 200 mg twice daily, for 7 days - give folic acid 5 mg OD if it is the 1st trimester
  3. Cefalexin 500 mg BD (or 250 mg 6qds) for 7 days
117
Q

At what gestation should CTG be performed for RFM?

A

28/40+

118
Q

What should not be used to diagnose BV?

A

Positive vaginal culture for Gardnerella vaginalis - since can be positive in 50 % of women w/out BV

119
Q

What Hb levels define anaemia in pregnancy?

A

1st trimester <110
2nd-3rd trimester <105
Postnatal <100

120
Q

At what gestation does amniotic fluid peak?

A

35/40

121
Q

What is the relative risk of VTE in pregnancy?

A

4-6x fold increase

122
Q

What is the absolute risk of VTE in pregnancy?

A

1-2/1000 pregnancies

123
Q

At what gestation may bleeding be defined as APH?

A

24/40

124
Q

Which clotting factors reduce during pregnancy?

A

Factors XI and XIII

125
Q

What are the risks of hysteroscopy?

A

Serious complications = 0.2%
Uterine perforations = 0.13%
Risk of death (under GA) = 8/100,000

126
Q

By what percentage can prophylactic oxytotics reduce the risk of PPH in the 3rd stage?

A

60%

127
Q

What proportion of women with gonorrhoea will develop PID?

A

15%

128
Q

What proportion of women are asymptomatic of TV?

A

50%

129
Q

In whom are polymorphic eruptions of pregnancy more common?

A

1) Multiple gestation pregnancies
2) Excessive maternal weight
3) Rh +ve blood type

130
Q

When should women whom have previously had GDM be tested in subsequent pregnancies?

A

As soon as possible after booking

Otherwise if risk factors alone = week 24-28 pregnancy

131
Q

What tumour markers should you measure in women <40 with a complex ovarian mass and why?

A

AFP, hCG, lactate

The reason being to exclude germ cell tumours

132
Q

What us Zavanelli manoeuvre?

A

Replacement of the baby’s head prior to emergency CS

133
Q

What percentage of parasited red blood cells in a pregnant woman can indicate severe malaria?

A

2%

134
Q

Which Abx is used to treat P vivax, P malariae and P ovale?

A

Chloroquine

135
Q

Which Abx is used to treat P falciparum?

A

Clindamycin and quinine (used in combination)

136
Q

How should severe infection with P falciparum be treated?

A

IV artesunate

137
Q

What is type 1 FGM?

A

Partial or total removal of the clitoris

138
Q

What is type 2 FGM?

A

Partial or total removal of clitoris and labia minora (with or w/out excision of the labia majora)

139
Q

What is type 3 FGM?

A

Narrowing of the vaginal orifice, with or w/out the excision of the clitoris

140
Q

What is type 4 FGM?

A

All other harmful procedures to the female genitalia including pricking, incising, scraping, piercing and cauterisation

141
Q

What is the correct position for the ventouse cup?

A

On the sagittal suture line, approximately 3 cm anterior (in front) of the posterior fontanelle

142
Q

What is the risk of uterine perforation in hysteroscopy?

A

1%

143
Q

Administration of oxytocin reduces the risk of PPH by what percentage?

A

60%

144
Q

What is the minimum number of sperm in a normal ejaculate?

A

39x10(6)

145
Q

What is the volume of the female bladder?

A

400-600ml

146
Q

What is the max. flow rate of urine?

A

18ml/sec

147
Q

What is the max. normal residual bladder volume?

A

10ml

148
Q

What are a) the early filling pressure of the bladder; b) micturition prompting pressures; c) max. urethral closing pressure

A

a) 10
b) 25-40
c) 60

149
Q

In pregnancy are hydroureter and hydronephrosis more common on the R or the L, and it is seen in what proportion of pregnancies?

A

More common on the R

Seen in 80% of pregnancies

150
Q

Which oestrogen is secreted predominantly post-menopausally?

A

Oestrone

151
Q

What happens to testosterone levels post-menopause?

A

Fall

152
Q

How can OHSS present to an ED/AMU?

A

Thromboembolic events - preference for upper limb sites and the arterial system

153
Q

In which trimester does obstetric cholestasis usually occur?

A

3rd trimester

154
Q

What proportion of pregnancies are affected by OC?

A

0.7%

155
Q

What are tocolytic agents?

A

Agents used to suppress contractions

156
Q

What are the different tocolytic agents available?

A

1) B2 agonists - e.g. ritodrine; terbutaline; fenoterol
2) Oxytocin antagonists - e.g. atosiban
3) Ca2+ channel blockers
4) NSAIDs
5) Nitric oxide donors
6) Magnesium sulphate

157
Q

What are the 1st and 2nd choice tocolytics?

A

1st - nifedipine

2nd - atosiban

158
Q

Which women are most likely to benefit from tocolytics?

A

1) Pre-term labour
2) Those that need transfer to hospitals with neonatal units
3) Those that have not yet completed steroids

159
Q

What is the most significant factor in slowing down drug metabolism in pregnancy?

A

Progesterone effect on gastric motility

160
Q

What is the lifetime prevalence of fibroids?

A

30%

161
Q

What type of drug is Levonelle?

A

Synthetic progesterone

162
Q

What type of drug is EllaOne?

A

Selective progesterone receptor modulator

163
Q

Can women using enzyme inducers - e.g. phenytoin - use hormonal EC?

A

Yes - double dose of ullipristal. Copper IUS preferred

164
Q

What is the incidence of obstetric anal sphincter injuries (OASIS)?

A

2.9%

165
Q

What is the incidence of OASIS in primips?

A

6.1%

166
Q

What is the incidence of OASIS in multips?

A

1.7%

167
Q

What percentage of women with OASIS will be asymptomatic at 12 months post-delivery?

A

60-80%

168
Q

What type of stitch is used in the anorectal mucosa?

A

Continuous interrupted suture

3-0 vicryl (braided)

169
Q

What type of stitch is used in the external anal sphincter?

A

End-to-End sutures

Either 3-0 PDS (monofilament) or 2-0 vicryl (braided)

170
Q

What type of stitch is used in the internal anal sphincter?

A

Interrupted mattress

Either 3-0 PDS (monofilament) or 2-0 vicryl (braided)

171
Q

What are the risks of abdominal hysterectomy?

A 
Overall serious complications = 4%
Haemorrhage requiring transfusion = 2.3%
Bladder/ureter injury = 0.7%
Return to theatre = 0.7%
VTE = 0.4%
Pelvic abscess/infection = 0.2%
Bowel injury = 0.04%
Risk of death w/in 6/52 = 0.03%
172
Q

What is the risk of serious complication in abdominal hysterectomy?

A

4%

173
Q

What is the risk of haemorrhage requiring transfusion in abdominal hysterectomy?

A

2.3%

174
Q

What is the risk of bladder/ureter injury in abdominal hysterectomy?

A

0.7%

175
Q

What is the risk of returning to theatre in abdominal hysterectomy?

A

0.7%

176
Q

What is the risk of VTE in abdominal hysterectomy?

A

0.4%

177
Q

What is the risk of pelvic abscess/infection in abdominal hysterectomy?

A

0.2%

178
Q

What is the risk of bowel injury in abdominal hysterectomy?

A

0.04%

179
Q

What is the risk of death w/in 6/52 in abdominal hysterectomy?

A

0.03%

180
Q

What are the constituents of breast milk?

A

Fat 4%; Protein 1%; Sugar 7%

181
Q

What is the risk of placenta accreta/increta/percreta?

A

1.7/10,000 deliveries

182
Q

What is the mode of action of tranexamic acid?

A

Inhibits plasminogen activation

Can reduce flow by 50%

183
Q

What is the mode of action of mefenamic acid?

A

Inhibits prostaglandin synthesis

Reduces menstrual loss by 25%

184
Q

What is the most common type 2 congenital thrombophillia?

A

Factor V Leiden

185
Q

What are examples of type I thrombophillia?

A

Protein C + S deficiencies

186
Q

What type of thrombophillia is antiphospholipid?

A

Acquired

187
Q

What is current?

A

Rate of flow (amps)

188
Q

What is voltage?

A

Force of flow (volts)

189
Q

At what frequency do electrosurgery generators operate at?

A

200kHz - 3.3 MHz

190
Q

At what temp does tissue death occur in electrosurgery?

A

45 degrees

191
Q

At what temp does coagulation occur in electrosurgery?

A

70 degrees

192
Q

At what temp does desiccation occur in electrosurgery?

A

90 degrees

193
Q

At what temp does vaporisation occur in electrosurgery?

A

100 degrees

194
Q

At what temp does carbonisation occur in electrosurgery?

A

200 degrees

195
Q

What is cut mode in electrosurgery?

A

Continuous wave form at low voltage

196
Q

What is coagulation mode in electrosurgery?

A

Current produced in spikes at higher voltage

197
Q

What should the surgical site infection rate be below?

A

<2%

198
Q

SSI causes an average increase in hospital stay of how many days?

A

6.5 days

199
Q

What are Littlewoods forceps usually used for?

A

Grasping rectus sheath

200
Q

What are Rampley forceps usually used for?

A

Swab on a stick

201
Q

What are Babcocks used for?

A

Delicate structures e.g. ovaries/fallopian tubes

202
Q

What are vullselum forceps used for?

A

Cervical lip grabbing

203
Q

What are the commonly used types of retractors?

A

Doyens and Langenbecks

204
Q

What are Green-Armytage’s used for?

A

Haemostatic forceps - usually 4, one on each side of uterine incision angle

205
Q

What are the different surgical positions?

A

1) Lithotomy
2) Trendelenberg - 45 degrees head down tilt
3) Lloyd Daavis - 30 degrees head down tilt, hips flexed at 15 degrees

206
Q

What is the risk of Trendelenberg position?

A

Can increase V/Q perfusion mismatch and increase ICP

207
Q

What size suture is used in uterine culture?

A

Size 1

208
Q

What is the symbol representing a cutting needle?

A

Downwards triangle

209
Q

What is the symbol representing a tapered point needle?

A

Circle with a dot in the middle

210
Q

What is the healing time of skin?

A

1-2 weeks

211
Q

What is the healing time of peritoneum?

A

4-10 days

212
Q

What is the healing time of uterus?

A

8 days

213
Q

What is the healing time of vagina and perinum?

A

8-10 days

214
Q

What is the healing time of bladder?

A

5 days

215
Q

What are the rates of instrumental delivery in the UK?

A

10-13%

216
Q

What is an OUTLET instrumental delivery?

A

Fetal scalp visible w/out parting the labia

217
Q

What is a LOW cavity instrumental delivery?

A

Leading point of skull is at station +2

218
Q

What is a MID cavity instrumental delivery?

A

Fetal head no more 1/5th palpable per abdomen, leading point of skull above station +2

219
Q

What are the indications for instrumental delivery?

A

1) Inadequate progress, inc. maternal fatigue

2) Maternal factors - e.g. to reduce effects of 2nd stage labour on medical conditions

220
Q

What is inadequate progress in nullips?

A

Lack of progress for 2 hours w/out regional anaesthesia (suspect after 1 hours)

221
Q

What is inadequate progress in multips?

A

Lack of progress for 1 hour w/out regional anaesthesia (suspect after 30 mins)

222
Q

What are the pre-requisites for instrumental delivery?

A

1) Head <1/5th palpable in the abdomen
2) Cervix fully-dilated
3) Membranes ruptured
4) Vertex presentation
5) Assessment of caput and moulding
6) Pelvis deemed inadequate
7) Consent
8) Asepsis
9) Analgesia
10) Maternal bladder emptied

223
Q

What conditions favour ventouse to forceps?

A

1) Urgent low lift out with no analgesia on-board
2) Rotational delivery
3) Operator/maternal preference when either instrument can be used

224
Q

What conditions favour forceps to ventouse?

A

1) Poor maternal effort
2) Operator/maternal preference when either instrument can be used
3) Large amount of caput
4) Gestation <34/40
5) Marked active bleeding from FBS site
6) Face presentation

225
Q

What are the neonatal risks of ventouse?

A

Cephalohaematoma

Retinal haemorrhage

226
Q

What are the indications for FBS?

A

1) Pathological CTG in labour (cervix >3cm)

2) Suspected acidosis in labour (cervix >3cm)

227
Q

What are the contraindications for FBS?

A

1) Maternal infection; 2) Fetal blood disorders; 3) Prematurity; 4) Acute fetal compromise (e.g. prolonged bradycardia)

228
Q

What does a fetal pH of >/= 7.25 mean?

A

Normal, repeat after an hour in CTG remains same

229
Q

What does fetal pH of 7.21-7.24 mean?

A

Borderline, repeat after 30 mins

230
Q

What does fetal pH of = 7.2 mean?

A

Abnormal, consider delivery

231
Q

What are the limitations of continuous electronic fetal monitoring?

A

1) Decreased mobility; 2) Increased intervention; 3) Variation in CTG interpretation; 4) Chorioamnionitis can make interpretation unreliable

232
Q

What is the recording rate of CTG?

A

1cm/min

233
Q

What is the rule of 3 for fetal bradycardia?

A

3 mins - call for help
6 mins - move to theatre
9 mins - prepare for assisted delivery
12 mins - aim to deliver the baby

234
Q

From what gestation can CTG replace handheld doppler to assess fetal movements?

A

24/40

235
Q

What is the earliest gestation that fetal heart can be detected on a transvaginal USS?

A

5-6 weeks

236
Q

What enzyme level may be raised in sarcoidosis?

A

ACE

237
Q

What is normal CTG variability?

A

5-25

238
Q

At what hCG level would a single intrauterine pregnancy be visible on scan?

A

1000-2400

239
Q

Which bacterial cell component is detected by gram staining?

A

Peptidoglycan

240
Q

What is a risk factor for ectopic pregnancy?

A

Smoking

241
Q

What is the medical treatment for ectopic pregnancy?

A

Methotrexate 75mg IM STAT

242
Q

What proportion of teratomas are bilateral?

A

10%

243
Q

What is the radiation dose of a CXR? Chest CT?

Abdo/pelvis CT/background?

A

CXR - 0.1 mSv
CT chest - 7 mSv
CT abdo/pelvis - 10 mSv
Background - 3mSv

244
Q

What is the causative agent of Kapsoi sarcoma?

A

Human herpes virus 8

245
Q

When in cutaneous wound healing do macrophages replace neutrophils?

A

48-92 hours

246
Q

What is stage 1 of labour?

A

Effacement and dilatation of the cervix up to 10cm

  • –> Latent phase = <4cm
  • –> Active phase =>4cm
247
Q

What is stage 2 of labour?

A

From full dilatation to delivery of the fetus

  • –> Propulsive phase
  • –> Expulsive phase
248
Q

What is the process of delivery?

A

Engagement —> descent and flexion —> Fetal head rotation to OA —> Extension and delivery of head —> Restitution —> Delivery of shoulders/body

249
Q

What are the different types of breech?

A

Extended (or frank)
Flexed (or complete)
Footling

250
Q

What are the fetal risks of vaginal breech delivery?

A
  1. Intracranial haemorrhage
  2. Brachial plexus injury
  3. Limb fractures
  4. Spinal cord injury
251
Q

Why is the presentation USUALLY cephalic?

A
  1. Piriform shaped uterus

2. Calcification of the fetal skull, and therefore increased density

252
Q

What is the incidence of shoulder dystocia?

A

0.6%

253
Q

Which shoulder is most commonly involved in shoulder dystocia?

A

Anterior shoulder

254
Q

What is hypoxaemia? And how does the fetus respond to it?

A

Decreased O2 content in arterial blood with normal cell and organ function

Reduced activity of fetus —> decreased fetal growth rate

255
Q

What is hypoxia? And how does the fetus respond to it?

A

O2 deficiency which affects peripheral tissues

Surge of stress hormones —> reduced peripheral blood flow —> redistribution of blood flow to central organs —> peripheral tissues enter anaerobic metabolism

256
Q

What is spalding sign?

A

Spalding sign on XR represents overlapping fetal skull bones in advanced maceration of fetal tissues

257
Q

What is the speed of CTG recording?

A

1cm/min

258
Q

What is the false +ve rate of CTG?

A

50%

259
Q

What are the causes of reduced variability?

A

Sleep cycle

Pre-terminal pattern

260
Q

When is a sinusoidal pattern seen on CTG?

A

Seen in fetal anaemia or feto-maternal haemorrhage
Frequency of 3-5 cycles/min
Seen as a smooth undulating sine wave pattern

261
Q

What are the 4 patterns of hypoxic change?

A

Acute - sudden drop in baseline rate

Subacute - HR below the baseline the majority of the time

Evolving - decelerations –> loss of accelerations –> tachycardia —> loss of variability

Chronic

262
Q

What are the causes of acute hypoxia?

A
  1. Unknown - approx. 50%
  2. Placental abruption
  3. Uterine rupture
  4. Cord prolapse
  5. Epidural top-up
263
Q

What are the stages of evolving hypoxia?

A
  1. Stress stage - decelerations
  2. Distress stage - max. tachycardia, marked reduction in variability
  3. Collapse stage
264
Q

What is evolving hypoxia also known as?

A

Hon’s stepladder pattern to death

265
Q

Which of the androgens in females is the most potent?

A

Dihydrotestosterone

266
Q

What is the distance between two z lines in a muscle fibre?

A

Sarcomeres

MRCOG - Part 1 (13 decks)

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