General obstetrics Flashcards
(107 cards)
1
Q
GnRH is released from ? and acts on ?
A
Hypothalmus and acts on anterior pituitary
2
Q
GnRH stimulates the release of?
A
LH and FSH
3
Q
What cells secrete oestrogen
A
Theca granulosa cells
4
Q
Staging for puberty ?
A
Tanner
5
Q
What provides negative feedback for LH and FSH
A
Oestrogen
6
Q
What can affect age of puberty
A
Fat (aromatase in adipose tissue)
7
Q
Skin changes in pregnancy and cause
A
Increased melanocyte stimulating hormone
Melasma, linea nigra
8
Q
What produces hCG
A
synctiotiotrophoblast
9
Q
Causes of raised hCG
A
Twins and molar pregnancy
10
Q
hCG main function
A
Maintain corpus luteum (which produces progesterone)
11
Q
Where is progesterone produced after 5 weeks?
A
Placenta (instead of corpus luteum)
12
Q
Oestrogen function: (4)
A
Breast tissue development
Growth and development of female sex organs
Blood vessels in uterus
Development of endometrium
13
Q
Progesterone function: (3)
A
Thicken and maintain endometrium
Thicken cervical mucus
Increase body temperature
14
Q
oligohydramnios meaning
A
Low amniotic fluid levels
15
Q
Meigs syndrome
A
Triad of ascites, benign ovarian tumour (fibroma) and pleural effusion
16
Q
Drugs ending in -relin and function
A
GnRH agonist
17
Q
Drugs ending in -relix
A
GnRH antagonist
18
Q
Goserelin class
A
GnRH agonist
19
Q
Mnemonic for CTG reading
A
DR C Bravado
20
Q
Degarelix class
A
GnRH antagonist
21
Q
G? P? Patient is pregnant and had one previous baby
A
G2 P1
22
Q
G? P? Patient is currently pregnant and had two previous deliveries
A
G3 P2
23
Q
Gravity and parity
A
Gravity = number of times pregnant Parity = number of times pregnant past 24 week
24
Q
What is Mendelson’s syndrome
A
Aspiration of gastric juices into maternal lungs during analgesia in child birth
25
Methods for labour induction (3)
Vaginal prostoglandins
Amniotomy
Membrane sweep
26
How do prostaglandins induce labour
Ripen cervix and help smooth muscle of uterus contract
27
Drug to increase strength and frequency of contractions
Syntocinon (artificial oxytocin)
28
When is membrane sweep offered to most women
40 and 41 weeks to nulliparous
| 41 weeks to multiparous
29
Score to access cervical ripeness
Bishops
30
Bishops score cut offs (2)
7 or above: cervix is ripe
| Less than 4: labour is unlikely to progress naturally
31
Common complications of IOL
failure (15% - give further cycle), uterine hyper stimulation (5% - give tocolytic agent like terbutaline), pain, infection, further intervention, rupture
32
OVD meaning
Operative vaginal delivery. Use of instrument to aid delivery
33
Terbutaline
Treats uterine hypersensitivity. Tocolytic.
34
Two types of OVD
Ventouse and forceps
35
Complications of forceps use
Higher rate of 3/4 degree tear
36
When would you expect delivery after pushing begins (time to use OVD)
2 hours in NP
| 1 hour in MP
37
Pre-requisites for instrument delivery
Fully dilated, ruptured membranes, cephalic presentation, metal head at ischial spine, empty bladder
38
P-PROM vs PROM
P-PROM is before 37 weeks
| PROM is after 37 weeks (takes longer than 1 hour to then enter labour)
39
Stage 1 of labour
Onset of true contractions till 10cm dilation
40
Latent phase of labour
0 to 3cm dilation - progressing at 0.5cm an hour
41
Active phase of labour
3-7cm dilation - progressing at 1cm an hour
42
What are Braxton-hicks contractions
Occasional irregular that do not indicate labour
43
What is the "show" in labour
Plug of mucus leaves cervix
44
Ergometrine
Contracts uterus to treat post partum haemorrhage. Commonly given with Oxytocin
45
Folate dose in low/ high risk
400 mcg. 5 mg
46
Mx of women with previous GBS delivery
Offer intrapartum antibiotic prophylaxis. Benzyl penicillin
47
Loss of CTG variability?
Prematurity or hypoxia
48
When does Anti-D injections need to be given?
Mum Rhesus -ve and at any sensitising event: birth, miscarriage <12 weeks, abdominal trauma, PV bleeding
49
3 risk factors for placental abruption
Increasing maternal age
Multiparity
Maternal trauma
50
Drug of choice to reduce fetal resp problems in PPROM
Dexamethasone
51
Main risks of mother having uncontrolled GDM (3)
Shoulder dystocia, macrosomia, neonatal hypoglycaemia
52
RF for GDM
```
BMI <30
Previous hx
Previous macroscopic baby
Ethnic (black, Middle Eastern, south Asian)
Family hx
```
53
GDM results range
Fasting <5.6
OGTT <7.8 (at two hours)
(5678)
54
GDM management in patients with fasting BM <7
Diet and exercise
55
GDM management in patients with fasting BM>7
Insulin (+/- metformin)
56
Which vaccines offered in pregnancy and which should be avoided?
Whooping cough (from 16 weeks) and flu
Live vaccines
57
Medical name for stretch mark
striae gravidarium (silvery fine ones -> albicans)
58
Screening tool for post natal depression
Edinburgh Scale
(PHQ-9) can also be used
59
Two drugs that cause folic acid deficiency (non ABX)
Phenytoin and methotrexate
60
Chorioamnionitis triad
Fetal tachycardia, maternal tachycardia, maternal pyrexia
61
Chorioamnionitis main risk factor
PPROM
62
Dates for miscarriage (early vs late)
0-24 weeks
Early: 0-13 and much more common
63
Hormone that induces cervix remodelling
Prostoglandins
64
Hormone that regulates blood flow through endometrium
XXX Cortisol
65
Tripple test contains:
HCG, AFP, estriol
66
Vessel that shunts blood from away from liver
Ductus venosus
67
What can be performed first: amniocentesis or CVS
CVS
68
PAPP-A in trisomy 18 and 21 levels
Very low
69
Treatment of hyperthyroidism in post delivery women
Betablockers not anti thyroid medication
70
Downs syndrome in combined test
bHCG high, PAPP-A low (not very low), tick nuchal
71
What position must a breech baby be in for delivery?
Back/ sacrum must remain anterior
71
What position must a breech baby be in for delivery?
Back/ sacrum must remain anterior
72
At what bHCG level are you likely to see pregnancy on USS
1500-2000
73
Ectopic diagnosis by bHCG levels
Less than 66% rise every 48 hours (should double)
74
Miscarried lady with retained products in cervix presents with hypotension and tachycardia
Products in cervical Os can cause vasovagal response
| speculum and remove
75
Blood pressure changes in second trimester
Hypotension
76
+++ in pregnant urine -> what else with urine
PCR urine - greater than 30 is bad
| Could do 24hour urine sample
77
SFH in pre-eclapsia
Low
78
40% of eclampsia happens where?
Postpartum
79
PAAP-A is low -> what drug
Asprin to prevent pre eclampsia
80
Should you ask about smears in Obstetrics bleeding/ pain
YES!! 1 in 6000 cervix ca
81
What does oestrogen do to uterus
Endometrial proliferation (multiply and spread)
82
PMB investigations
TV USS then hysteroscopy and biopsy
83
Endometritis pattern of bleeding
heavy light then heavy
| ?? check??
84
How does endometritis feel on exam and how to treat
Boggy and tender
| Co-amox
85
Should you do a bi manual in SROM
NO as infection risk
86
fFN test is for
87
Augumentation
Start of oxytocin
88
Consequence of mum becoming sensitised to rh in future pregnancies
How to test
Haemolytic disease of newborn
Direct Coombs test
89
SPD symptoms
Pain/ discomfort around pubic symphysis, lower back pain, side-side gate
90
Test to see how much fetal blood is in mothers blood during a possible sensitisation event?
Kleihauer test
91
Drug to prevent preterm labour
Vaginal progesterone
92
When is cervical cerclage used
?pre term labour to keep cervix shut
93
Three phases of labour
Latent: 0-3
Active: 3-7
Transition 7-10
94
What type of contractions in latent phase and how quick is progression
Irregular and 0.5cm per hour
95
Do Braxton Hicks contractions indicate the start of labour
NO
96
CTG baseline rate
110-160
97
Where is a 'low lying placenta'
Within 20mm of Os
98
3 main causes of APH
Placenta previa
Placenta abruption
Vasa previa
99
First line treatment for PCOS pts who cannot conceive
Letrozole
100
Rare complication of ovarian induction
Ovarian hyperstimulation syndrome
101
Ovarian hyperstimulation syndrome signs (3)
Hypovolemic shock, acute renal failure, VTE
102
Ovarian hyperstimulation syndrome symptoms
Abdo pain, DandV, weight gain, decreased urine output, DVT
103
Ergometrine and carboprost contraindications
Ergometrine - HTN
| Carboprost - asthma
104
Minimum time between pregnancies
12 months - preterm birth, low birth weight
105
Likely organism in pregnancy to cause baby to have: seizure, hydrocephalus, hearing and visual issues
Toxoplasma Gondii
106
Medical management of a miscarriage
Misiprostol alone!
| Not mifepristone
