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Obstetrics > General Obstetrics > Flashcards

General Obstetrics Flashcards

1
Q

What does para 2+1 mean?

A

2 pregnancies past 28 weeks gestation and 1 ended before 28 weeks

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2
Q

Babies conceived how long after a live birth have lowest rate of perinatal problems?

A

18-23 months

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3
Q

What should be counselled before conception?

A

1) Weight loss if obese
2) Make sure mother is rubella immune
3) Get chronic diseases under control
4) Stop teratogenic medications

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4
Q

What is paroxetine used for?

Teratogenic effect?

A

SSRI - causes fetal heart defects with 1st trimester use

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5
Q

Effect of lithium in pregnancy

A

Increases rate of Ebsteins anomaly (heart defect) in 1st trimester use

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6
Q

When and why and how much should mums have folate?

A

> 1 month pre-conception till 13weeks should have folate rich foods and 0.4mg folic acid
To prevent neural tube defects and cleft lip

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7
Q

When should folic acid be increased (x6) and to how much?

A

To 5mg/day

If previous Neural tube defect, obese, diabetic, sickle cell, on anti-epileptics, HIV+ on co-trimoxazole

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8
Q

Which foods have lots of folic acid in? (>0.1mg) x5

A

Brussel sprouts, spinach, asparagus, black eyed beans, fortified cereals

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9
Q

What foods should be avoided in pregnancy? x3

A

Liver
Vitamin a (vit a embryopathy)
Caffeine

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10
Q

Effect of smoking on pregnancy? x5

A

Decreases ovulation, decreases sperm production + less penetrating capacity, increased risk of miscarriage (x2), preterm labour and small babies, placenta praevia and abruption

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11
Q

Effects of alcohol on pregnancy?

A

High levels of consumption are associated with fetal alcohol syndrome
Miscarriage rates are higher in drinkers
Binge drinking is especially dangerous

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12
Q

Risk of spontaneous miscarriage in women 20-40 years

A

8.9%

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13
Q

Risk of miscarriage in women >45years

A

74%

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14
Q

High risk maternal indicators for pregnancy x9

A 
Nullip younger than 20 or > 34
>40 years old
Obese bmi >35
Hx of infertility 
>5 previous pregnancies
Social deprivation 
HBsAg or HIV+ 
Multip smaller than 154cm 
Primip smaller than 158cm
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15
Q

Past delivery risk factors x12

A 
Preterm (before 37 weeks)
Small for dates (less than 2.5kg) and growth restricted
Stillbirth 
C-section 
APH and PPH 
Congenital anomalies 
Rhesus disease
Pre-eclampsia 
Malpresentations after 34 weeks 
Gestational diabetes 
Pelvic floor repair
Instrumental deliveries
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16
Q

Risk factors from this pregnancy x6

A 
Cardiac/thyroid disease
Renal/liver disease 
Epilepsy/asthma
Rhesus antibodies
Autoimmune 
Multiple pregnancies
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17
Q

Effect of progesterones in pregnancy x4

A

Decreases smooth muscle excitability - uterus, gut (constipation) and ureters
Raises body temperature
Increases ventilation 40% by increasing depth of breath
Growth of mammary glands

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18
Q

Effect of oestrogens in pregnancy - which oestrogen? x6

A 
Oestriol 90% 
Increase breast and nipple growth 
Water retention + CV adaptation to pregnancy 
Protein synthesis 
Growth of uterus and priming for labour
Cervical ripening
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19
Q

What happens to prolactin and thyroid in pregnancy?

A

Maternal thyroid enlarges - increased colloid production

Pituitary secretion of prolactin rises throughout pregnancy

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20
Q

What could happen to cervix?

A

Ectropion ‘erosions’

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21
Q

What causes increased vaginal discharge

A

Vaginal discharge increases due to cervical ectopy, cell desquamation and increased mucus production from a vasocongested vagina

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22
Q

Change in uterus weight

A

100g non-pregnant to 1100g by term

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23
Q

Increase in blood during pregnancy and final volume

Weight gain due to blood

A

50% >non-pregnant - ends in 3.8 litres

1.3 kg

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24
Q

Hb differences in pregnancy

A

Red blood cells increase (stimulated by erythropoietin) but volume increases more therefore “physiological anaemia” - haematocrit falls 40%-32%

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25
Q

Urea and creatinine changes

A

Fall

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26
Q

WCC, platelet and ESR

A

Increase

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27
Q

Gamma-globulin and albumin

A

Fall

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28
Q

Cardiac output changes

A

Increases from 5l to 6.5-7 in the first 10 weeks due to increased stroke volume and heart rate (5-8beats/min)

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29
Q

BP changes

Important feature of BP regulation in pregnancy

A

Falls, especially diastolic by second trimester by 10-20mmHg
Then rises to non-pregnancy levels by term

Renin-angiotension system - vasodilation and hypotension increase the release of them and stimulate the system

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30
Q

Venous system changes

A

Increased venous distensibility and raised venous pressure - therefore varicose veins might form

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31
Q

Hair changes

A

Hair shedding from the head is reduced in pregnancy but the extra hairs are lost in the puerperium

32
Q

When are pregnancy tests positive from and till? When are they positive after a miscarriage or fetal death?

A

9 days post-conception
Or from day 23 of a 28 day cycle
Until about 20 weeks
Remain positive 5 days after miscarriage or fetal death

33
Q

What do pregnancy tests detect?

A

B-subunit of the human chorionic gonadotrophin - in early morning urine

34
Q

What does maternal obesity increase the prevalence of? x10

A 
Miscarriage
GDM 
Pre-eclampsia
Thromboembolism 
Cardiac disease 
Induced labour and C-section 
Infection post op 
PPH 
Maternal mortality 
Feeding by bottle
35
Q

How should you manage an obese pregnant lady?

A

5mg folic acid
More prone to vitamin D deficiency therefore 10ug vit d whilst pregnant and breastfeeding
Screen for diabetes
Mobilise early
>2cm of sc fat and have c-section - suture fat as well to prevent infection and give IV antibiotics

If >30 heparin thromboprophylaxis 7 days postnatally if one more thrombotic risk factor and TED stockings if 2
If >40 always heparin postnatally and TED stockings

36
Q

Recommended weight gain for BMI below 19.8

A

12.5-18kg

37
Q

Recommended weight gain for BMI 19.8-26

A

11.5-16kg

38
Q

Booking visit bloods and tests x9

A 
FBC - anaemia
Rhesus antibodies - group
Syphilis and rubella serology 
HBsAg
HIV
Sickle if high risk - Hb electrophoresis 
MSU culture and Urinalysis 
Ultrasound scan
39
Q

What is 12 week USS looking for

A

Viabile
Multiple pregnancy
Dating scan
Aid with downs test (nuchal translucency - larger it is, higher the risk)

40
Q

Anomaly scan - when is it and what is nuchal thickening associated with?

A

Done at 18-21 weeks - USS

Trisomy 21 - downs

41
Q

Anomaly scan - what is echogenic bowel associated with?

A

Trisomy 21 and cystic fibrosis

42
Q

Anomaly scan - what is choroid plexus cyst associated with?

A

Trisomy 21 and 18 (Edwards syndrome)

43
Q

What do AFP levels indicate? What are they measuring? In which mothers is AFP lower?

A

AFP fetal levels fall after 13 weeks and maternal AFP rises until 30 weeks (measured at 17 weeks)
High AFP - 10% have fetal malformation (eg.neural tube defect), in 30% with no malformation there is adverse outcome
1 in 40 with lower AFP - chromosomal abnormality
AFP is lower in diabetic mothers

44
Q

Amniocentesis - fetal loss rate? When is it done? What does it measure?

A

1% at 16 weeks but 5% if done early 10-13 weeks - safest from 15 weeks - mostly done 16-20weeks
Amniotic fluid sample is taken transabdominally and AFP is measured and cells are cultured for karotyping (takes 3 weeks therefore terminated at late stage - some tests are available earlier)

45
Q

Chorionic villus biopsy - when is it done? How is it done? Fetal loss rate?

A

Done from 10+ weeks up to 20 weeks (usually between 11-14 weeks)
Placenta is sampled transcervically or transabdominally (more common)
Karyotyping takes 2 days and enzyme and gene probe 3 weeks (termination earlier)
4% (1-2%) fetal loss rate (slightly higher than amnio)
May cause fetal malformation, does not detect neural tube defects and not recommended in dichorionic multiple pregnancy

46
Q

Significance of nuchal translucency

A

> 3mm nuchal translucency at 10-13weeks concerning - greater the translucency = greater the risk of abnormality

Can see who would benefit from further amniocentesis or chorionic villus sampling - positive predictive value = 4% therefore 96% undergo unnecessary invasive test

47
Q

What is high-resolution good and not good at detecting at 11-14weeks?

A

CNS, neck, GI or renal abnormalities

Not good at detecting spina bifida, limb abnormalities or heart defects

48
Q

What risk of downs syndrome is offered amnio or CVS?

A

> 1 in 250

49
Q

What 4 things does the combined test use to work out downs syndrome risk?

A

Nuchal translucency, free b-hcg, pregnancy associated plasma protein (PrAP-A or PAPP-A - low is increased risk) + women’s age

50
Q

When is combined downs syndrome test done?

A

Between 10+3 and 13+6 weeks

51
Q

What are the detection rates for aneuploides, trisomy-21 and trisomy 18 + 13 with the combined test?

A

100% for trisomy 13 and 18
95% for aneuploides
86% trisomy 21

52
Q

What 3 things does the integrated test use to measure downs risk? When is it done?

A

Done in 2nd trimester (16 weeks)

NT + PrAP-A (1st tri) + quadruple test in 2nd tri

53
Q

What 5 things does the quadruple test use to measure downs risk?

A

Maternal AFP + unconjugated estriol + free BHCG or total BHCG + inhibin-A + womans age in 2nd trimester

54
Q

When is quadruple test done?

A

Between 15+0 and 20+0 weeks - less effective than combined therefore only done is screening is being performed later than 14 weeks

55
Q

Weight gain for fetus

A

3.4 kg

56
Q

Weight gain for placenta + amniotic fluid + uterus

A

Placenta 0.7 kg
Amniotic fluid 0.8kg
Uterus 1kg

57
Q

Fat weight gain in pregnancy

A

3.5 kg

58
Q

Breast weight gain in pregnancy

A

0.4 kg

59
Q

Extracellular water weight gain

A

1.5-4.5kg

60
Q

Placental nutrient transfer and excretion - how is it done normally

A

Mainly by carrier mediated transport

61
Q

What are energy requirements for fetal growth

A

90% from glucose

10% from amino acids

62
Q

What is the biological functions of hCG?

A

Rescue and maintenance of function of corpus luteum - and survival of pregnancy is dependent on progesterone from CL until 7th week of pregnancy

Stimulation of maternal thyroid activity

63
Q

Metabolic actions of hPL?

A

Maternal lipolysis - increase in maternal plasma free fatty acids - source of energy for maternal metabolism and fetal nutrition
Anti-insulin activity - increase in maternal insulin favouring protein synthesis and provision of amino acids and glucose for transport to fetus

64
Q

Importance of Leptin

A

Stimulates placental aa/fa transport
Fetal leptin levels correlate with fetal birthweight
therefore role in fetal development and growth

65
Q

What stimulates lactation hormonally?

A

Prolactin secreted from 16 weeks but breast tissue unresponsive
Withdrawal of oestrogen and progesterone essential
Suckling stimulates production of vasoactive intestinal peptide which reduces dopamine release and ensures prolactin secretion

66
Q

When should booking visit be?

A

Before 10 weeks gestation

67
Q

What is done at the booking visit?

A

Risk of pregnancy assessed including appropriate pre-natal screening, general health check and health advice

68
Q

When can uterus be palpated via abdominal exam?

A

About 12 weeks

69
Q

When can fetal heart rate be auscultated

A

12 weeks

70
Q

When is first ultrasound scan done

A

Between 11-13+6 weeks

71
Q

What is first ultrasound scan looking for

A

Multiple pregnancy
Nuchal translucency measurement
B-HCG levels and PAPPA are done (for combined test)

72
Q

Who needs vitamin D supplementation

A

Women with BMI >30

South Asian or afro-carribean with low sunlight exposure

73
Q

How is listeriosis avoided in pregnancy

A

Only drinking pasteurized or UHT milk

Avoiding soft and blue cheese, pate, uncooked/partially cooked ready prepared food

74
Q

How should pregnant women sleep? (position)

A

Left lateral position

75
Q

After the anomaly scan - when are women seen

A

25 (n), 28, 31 (n), 34, 36, 38, 40 (n) and 41 weeks

76
Q

What are the minor conditions of pregnancy x10

A 
Itching
Pelvic girdle pain 
Abdominal pain (usually benign and unexplained, UTI and fibroids)
Heartburn 
Backache 
Constipation (exacerbated by oral iron) 
Ankle oedema 
Leg cramps 
Carpal Tunnel 
Vaginitis (clotrimazole pessaries)
Tiredness
77
Q

What is nuchal translucency?

A

Space between skin and soft tissue overlying c-spine

Obstetrics (5 decks)

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