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O&G Flashcards

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1
Q

Describe what happens to insulin in pregnancy

A

Release is increased
Resistance increases

Maternal insulin resistance

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2
Q

What Fetal compound antagonises maternal insulin

A

Fetal hPL

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3
Q

What is endovascular remodelling seen in the maternal uterus

A

spiral arteries Goes from low bore high resistance ->high bore low resistance

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4
Q

What can a mother do to optimise her foetus’s health?

A 
Not smoke.
Folic acid
Stop teratogenic meds
Don’t eat undercooked meats- listeria
Avoid oily fish - pollutants and mercury
Avoid liver - high vit A
Maternal rubella vaccination
Good control of preexisting med conditions
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5
Q

What medications are teratogenic

A 
Valporate 
Warfarin 
Retinoids
Trimethoprim 
ACEi
Methotrexate
Co amox
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6
Q

For what reasons might a woman need higher doses of folic acid?

A

Diabetes
Previous child/ relative with neural tube defects
On anticonvulsants

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7
Q

Up to what age is a neonate

A

Up to 28days

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8
Q

What is preterm

A

<37w

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9
Q

What is considered term

A

37-41w

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10
Q

What is considered low birthweight

A

<2500g

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11
Q

What weight is very low birthweight

A

<1500g

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12
Q

What weight is extremely low birth weight

A

<1000g

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13
Q

What is SGA?

A

Below 10th centile for gestation

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14
Q

What is large for gestational age?

A

> 90th centile for gestational age

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15
Q

What risks do maternal obesity carry

A

Miscarriage
Gestational diabetes
Pregnancy induced hypertension

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16
Q

Benefits of neonatal screening

A

Reassurance when it’s fine
Counselling
Early termination
Interventions in utero

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17
Q

What are the types of antenatal screening test?

A 
Standard= maternal serum screen, detailed USS
Advanced = chorionic villus sampling, fetal blood test, amniocentesis
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18
Q

Benefits of glucocorticoids before preterm delivery

A

Matures lungs - less RDS

Less risk of IVH

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19
Q

How many hours do steroids need to be given before birth

A

At least 24hours

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20
Q

When might a pregnant mother be given digoxin?

A

What the foetus is experiencing supraventricular tachyC

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21
Q

What is screened for in a maternal antenatal blood test ?

A 
Blood group
HIV
Syphilis
HepB
Rubella
Neural tube defects- raised alphafetoprotein
Congenital abnormalities
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22
Q

Complications of oligohydraminos

A

IUGR
Facial and limb deformities - potters syndrome
Pulmonary hypoplasia

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23
Q

What information can be obtained in antenatal USS

A

Gestation of foetus
Growth of foetus
Anatomical abnormalities
Oligo/polyhydraminos

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24
Q

What is the Arnold chari malformation ?

A

Lemon shaped skull associated with spina bifida

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25
Complications of preeclampsia to the foetus
Eclampsia- Placental insufficiency Growth restriction
26
Two causes of IUGR
Oligohydraminos | Placental insufficiency
27
Give the names of three drugs to treat OAB/urge incontinence
Oxybutanin Tolterodine Mirabegran
28
What investigations should you do for incontenence
Bladder diary PV exam Urine dip Urodynamics
29
What is the medical treatment for stress incontinence
Duloxitine
30
Symptoms of cervical Ca
Purulent discharge Post coital bleeding IMB
31
In what area is cervical Ca most likely to occur and what cells would you find here
In the transition zone | Endocervix and ectocervix meet
32
What is the classic symptom in ovarian CA
IBS symps
33
What is the red flag for endometrial Ca
PMB
34
What are the risk factors for endometrial Ca
Nulliparity HRT Tamoxifen Obesity
35
What is the most common gynae CA
Endometrial
36
What age spikes is cervical most common at
30s and 80s
37
HPV risk factors
Early SI Multiple partners OCP smoking
38
Risk factors for ovarian CA
``` FHX Brca1/2 Early menarche Late menopause Nulliparity ```
39
What type of CA is endometrial CA
Adenocarcinoma
40
What type of CA is ovarian CA
Epithelial
41
What type of ultrasound is suggested in investigating ovarian Ca
Pelvic USS
42
What are the investigations you would do in endometrial Ca
Histeroscopy TVuss Biopsy
43
What is the treatment for stage 1 cervical Ca
Cone biopsy
44
Which cells is the follicle does oestrogen come from
Granulosa cells
45
Which cells in the follicle does FSH act on
Granulosa
46
What 3 hormones does the corpus luteum secrete ?
Oe P Inhibit
47
The CL secretes inhibin what is the role of this
To suppress FSH as we don’t want another follicle growing yet
48
What is the role of FSH
To stimulate follicular growth
49
What is the role of LH
Ovulation. | Maintain CL
50
Where is beta-HCG produced from and where does it act
Produced from and acts on the Corpus luteum
51
What is the role of oestrogen in the menstrual cycle
Endometrial growth At low concs suppress LH and FSH At high concs cause LH surge
52
Which hormone is prominent in the first half of the menstrual cycle
Oestrogen
53
Which hormone is dominant in the second half of the menstrual cycle
Progesterone
54
What is the role of progesterone
To maintain endometrial lining and promote secretory changes
55
Where are LH and FSH secreted from
Ant pit
56
Where is the ovary would you find the follicles
In the cortex
57
How does the admin of exogenous progesterone act as contraception
It maintains the secondary endometrium
58
How does the administration of exogenous oestrogen act as contraception
Steady low levels of oestrogen prevent ovulation through suppression of LH and FSH
59
What is the relationship between oestrogen and FSH
As oestrogen increases (from the follicle) FSH decreases
60
How does the fertilised egg prevent menstruation
It produces bhcg which acts on itself to keep producing progesterone which maintains endometrium
61
What are the 3 WHO causes of anovulation
Hypogonadotrophic hypogonasim inc kallmanns and FHA 2. PCOS 3. primary ovarian insufficiency
62
What are the 3 causes of hyperprolactineamia resulting in anovulation
Hypothyroidism Androgen secreting Tumour Psychotropic drugs
63
What medication would you use for hyperprolactinaemia
Cabergoline (dopamine agonist)
64
What does prolactin inhibit the secretion of
GnRH
65
What inhibits the secretion of prolactin
Dopamine
66
Where might you get referee pain in ectopic pregnancy
Shoulder tip pain.
67
What finding might you see in TVUSS in ?ectopic
Excess fluid in peritoneal cavity
68
What are the presenting features of ectopic pregnancy
Abdo pain Amennorhoea +/- bleeding
69
Where is the most likely location for an ectopic
Ampulla
70
RFs for ectopics
``` Previous ectopic PID Gynae surgery IUD IVF Smoking ```
71
What is the management of someone presenting to hospital with ?ectopics
Check they are HD stable Is the bHCG doubling every two days Methotrexate Salpingectomy / salpingotomy
72
What investigations should you do in ?PCOS
TVUSS GTT Bloods - testosterone, LH, FSH, Oe, prolactin
73
What is the TVUSS result in PCOS
Enlarged ovary with 12+ follicles on it
74
At how many weeks does a person with an ectopic usually present to medical services
6-8w
75
Differentials for ectopic
Ovarian torsion Appendicitis Miscarriage
76
What might you differentials be for someone who is tender on bimanual examination
PID | Endometriosis
77
What might your differentials be for someone with cervical motion tenderness
Ectopic | PID
78
What is a large uterus on palpation suggestive of?
Fibroids
79
What investigations would you do in someone with chronic pelvic pain
``` MSU Swabs- HVS, ECS Laparoscopy - endometriosis TVUSS-fibroids MRI- adenomyosis Bloods- TFT, acute p reactants, LFT ```
80
Where are endometrial tissue deposits most commonly found
Uterosacral ligaments | Pouch of Douglas
81
What is the proper name for the pouch of Douglas
Rectouterine pouch
82
Treatment of endometriosis
``` NSAIDs Tranexamic acid COCP GnRH analogues Diathermy of lesions Hysterectomy ```
83
What are the two characteristic features of endometriosis
Sub fertility | Cyclical abdo pain
84
What is the typical age of a patient presenting with endometriosis
Young female As oestrogen dependent Presents when trying for a baby
85
What are the three theoretical causes of endometriosis
Retrograde mestruation - most common cause Metaplastic theory Blood/lymphatic dissemination theory
86
Explain how GnRH analogues work in tx endometriosis
GnRH sits in R causing release of LH &FSH When they are being released they cannot be synthesised The longer the R is occupied for there is down regulation Therefore initial worsening of symps before artificial menopause
87
What other treatment do you need to give with GnRH in endometriosis
HRT- add back therapy
88
Give 3 aims of treatment in endometriosis
To reduce pain Stop progression of implants Address sub fertility
89
What two radiological investigations would you do in adenomyosis
TVUSS | MRI
90
Palpation on a patient with adenomyosis would give you what finding
Tender uterus
91
What is adenomyosis
Endometrial deposits within the myometrium
92
What is the treatment for adenomyosis
Same as endometriosis but without ablation
93
What age group would you see adenomyosis in?
40ish (older premenopausal women)
94
Name two gynaecological pathologies that are oestrogen drive
Endometriosis | Fibroids
95
What are the main complications of a fibroid
Sub fertility Red degeneration Tortion Miscarriage
96
What is a fibroid
A benign tumour of myometrium
97
What are the main symps of fibroids
Depends on size and location Sub fertility Menorrhagia Pressing on structures
98
What is the first line treatment for symptom management with fibroids
LNG-IUS (marina )
99
What problems may arise with fibroids in pregnancy
``` Miscarriage Premature delivery Malpresentation/ lie Obstruct delivery PPH ```
100
What is an ovarian cyst
Fluid filled pouch
101
Complications of ovarian cysts
Rupture- commonly after intercourse Haemorrhage Tortion
102
What are the three types of functional ovarian cyst
- follicular - dominant follicle that fails to rupture - corpus luteal cyst- didn’t dissolve - theca lutein cysts - over stim of HCG in preg
103
What are the commonest ovarian tumours in young women
Ovarian teratomas
104
What are the two classes of ovarian cyst
Functional | neoplastic
105
What are the features of a neoplastic ovarian cyst
Over 10cm and irregular boarders
106
Management of ovarian cysts
W&w NSAIDs Oophrectomy
107
What is pelvic congestion syndrome
Incompetent pelvic veins post pregnancy
108
When is pelvic congestion syndrome worse ?
After intercourse | When have been standing up for a long time
109
investigations for pelvic congestion syndrome
Tvuss | MRI venogram
110
What is the treatment for pelvic congestion syndrome
Transcatheter vein embolism
111
``` Fever Dyspareunia Cervical motion tenderness Purulent discharge Points to what diagnosis ```
PID
112
What investigations would you do ?PID
``` Swabs - HV , EC NAAT Bloods - CRP USS 4 complications Laparoscopy as last resort ```
113
Treatment for PID
IM ceftriaxone 100mg doxycycline 400mg metronidazole
114
Complications of PID
- Hydrosalpinx from adhesions - Abscesses from pus- tubo- ovarian abscess is life threatening if ruptures - Ectopic pregtd - sub fertility - fitz Hugh Curtis syndrome
115
What is fitz Hugh Curtis syndrome
Inflammation from PID spreads to Glissons capsule around the liver = RUQ pain
116
What complication of pregnancy might China mans shuffle indicate?
Obstetric chloestasis
117
What type of anaemia In pregnancy would present as macrocytic megaloblastic?
Folate deficiency anaemia
118
What type of anaemia In pregnancy would present as microcytic
``` Fe deficient (TICS- Thalassaemia, chronic disease, sideroblastic) ```
119
What happens to tidal volume in pregnancy
Decreases
120
What happens to CO in pregnancy
Increases due to SV increasing
121
What are considered high risk cardiac lesions in pregnancy
Aortic stenosis Coarctation Prosthetic valves Cyanosis
122
What are the maternal complications of diabetes in pregnancy
DKA Hypoglycaemia- common Progression of retinopathy PreE
123
Complications of maternal diabetes on the foetus
``` Macrosomia Hyperinsulinaemia Neonatal hypoglycaemia Still birth Resp distress ```
124
What diabetic medications can’t you use in pregnancy
Sulphonyl ureas
125
What effect does pregnancy have on renal function
Increases GFR , 50% increase in renal blood flow
126
What effects could CKD have on the pregnancy
PreE Severe hypertension Growth restrictions Prem delivery/ still birth/ caesarean
127
What is the risk to the foetus with a maternal seizure ?
Hypoxia
128
How would you manage epilepsy in preg
High dose folic acid Make sure antiepileptics aren’t teratogenic Regular checkups Delivery Plan
129
What can you give for VTE in preg
LMWH | Not warfarin
130
What investigations would you do in a pregnant woman who is SOB and has chest pain
CTPA
131
How would you manage hydatidform mole (GTD)
ERPC+ serial bHCG
132
What interventions can you give during the first stage of labour
Membrane sweep Vaginal PG pessary Synt
133
What are the 6 stages of delivery
``` Decent Engagement Flexion IR Extension Restitution/ ER Expulsion ```
134
When does stage 2 of labour begin?
With full dilation and contractions every 2-5mins
135
What is the maximum cervical dilation reached in the latent phase
4cm
136
What fetal attitude do we want during labour
Suboccipital bregmatic
137
What diameter is the pelvic cavity
10.5cm
138
What is the diameter of the suboccipital bregmatic presentation
9.5cm
139
The pelvic outlet is widest in what plane
Anteroposteriorly
140
How much flexion do we want for a suboccipitalbregmatic presentation
Well flexed
141
And extended head will give what presentation
Brow or face
142
What is the biparietal diameter
9.5 cm
143
What intervention will be required in cephalopelvic disproportion
C section
144
What factors effect the passage (pelvic cavity)
``` Nutrition- vit D, Ca, rickets, osteomalacia Abnormal gait- pelvic distortion Trauma - fractures Soft tissue abnormalities Spinal abnormalities ```
145
Types of breech presentation + descriptions
Frank- buttocks presents with legs extended Complete- legs are flexed so feet present next to buttocks Footling- foot below buttocks
146
Which is the most common breech presentation ?
Footling
147
What are the causes of breech presentation
``` Idiopathic Placenta previa Polyhydraminos Prematurity Pelvic abnormalities Grand multiparty ```
148
Causes of foetal tachyC = >160
Hyperthyroidism Hypoxia Chorioamnitis Anaemia
149
Cause of foetal bradyC
Hypoxia
150
What range to you want variability to be in
5-25 from baseline HR
151
What is an acceptable baseline HR for a foetus
110-160
152
What are the foetal signs of hyperthyroidism
Goitre | TachyC
153
What are the neonatal signs of hyperthyroidism
``` Irritable Diarrhoea Wt loss TachyC Exophthalmos ```
154
How does the foetus get hyperthyroidism from the mum
TSHR abs cross the placenta
155
Treatment for neonatal hyperthyroidism
Carbimazole
156
What is the classic risk factor for someone to have placenta accreta
Placenta previa and c section
157
What should the birth plan for someone with placenta previa or placenta accreta look like
Consultant obstetrician and anaesthetist there UTI bed available Blood products on site Consent re potential interventions I.e. hysterectomy
158
What is considered a low birth weight?
<2.5kg
159
What is considered a very low birthweight
Less than 1.5kg
160
What is considered an extremely low birth weight
<1kg
161
What complications might a macrosomic infant have
Transient hypoG secondary to hyperinsulinaemia Birth trauma RDS Polycythemia
162
What is the treatment for polycythemia in macrosomia
Tx- partial exchange transfusion.
163
What is the most common congenital infection and what is the treatment ?
CMV | Gancyclovir
164
What are the potential complications of CMV infection in a baby
Sensorineural hearing loss Hepatosplenomegally Cerebral palsy Epilepsy
165
What are the potential complications of rubella as a congenital infection
Deafness Cataracts CHD
166
What are the potential complications of toxoplasmosis in the neonate
Retinopathy Cerebral calcifications Hydrocephalus
167
Name a congenital infection that can cause hydrops
B19
168
What two congenital infections should you not breast feed with
HepC | HIV
169
What are the mock common pathogens to cause neonatal sepsis
GBS. Listeria E. coli
170
What factors should indicate the need to treat for group B strep intrapartum
Prolonged rupture of membranes | Maternal fever
171
What is the intrapartum treatment for GBS
Penicillin
172
What does foetal distress mean?
Hypoxia (ph might be low)
173
What should you never do in a bleeding pregnant woman
PV exam until placenta previa has been excluded
174
What investigations would you want to do in placenta previa
FBC Cross match CTG USS/ MRI
175
Painless bleeding at ROM + severe foetal distress points to what diagnosis
Vasa previa
176
What is vasa previa
Foetal blood vessels run in the membranes of the uterus in front of the presenting part
177
Give 5 causes of prepartum/ antepartum haemorrhage
``` Uterine rupture Vasa previa Placenta previa Placental abruption Gynae cause ```
178
Continuously painful tender uterus +/- bleeding =?
Placental abruption
179
What are the complications of placental abruption
Shock Renal failure DIC PPH
180
How would you manage placental abruption?
Assess mum - FBC, U&E, crosshatch, monitor urine output hourly if foetus stable Resus with fluids as required Assess foetus w/ CTG- deliver if distressed >37w Transfuse
181
What is an antepartum haemorrhage
Bleeding after 24w (>50ml)
182
What should you do with a placental abruption with no foetal distress and <37w
Monitor
183
What should you do in a placental abruption >37w with no foetal distress
IOL via aminotomy
184
What should you do if there is placental abruption with foetal distress
Emergency Csection
185
What investigations should you do for placenta accreta
MRI
186
Complications after APH
``` PPH DIC Renal failure Transfusion Premature labour and delivery Fetal morbidity and mortality ```
187
When is C section indicated in herpes simplex
If primary attack is In 6w of delivery
188
What is the treatment for a neonate exposed to HSV
Acyclovir
189
What is the definition of primary PPH
Blood loss over >500ml w/in 24hours (1000ml if Csection)
190
What is the most common cause of PPH
Uterine tone- fails to contract properly
191
Why might the uterus fail to contract properly
It is atonic | There is retained placenta
192
What is a major PPH
Blood loss over 1000ml
193
When would you stop antenatal thromboprophylaxis
12 hours before delivery
194
What are two risk factors for uterine atony
Prolonged labour | Overstretched uterus I.e. multiparity/ polyH
195
What should be the management of PPH >1500ml
Activate MOH protocol Fresh frozen plasma Tranexamic acid +/-
196
If uterine atony persists after oxytocin what should the next step be
Inject PGF2a into myometrium | +/- tranexamic acid
197
Bleeding from placental bed with a well contracted uterus - what is the tx
Rusch balloon
198
What are the surgical options to tx PPH
Brace suture Uterine artery embolism Hysterectomy
199
What is the definition of secondary PPH
Excessive blood loss 24hrs-6w
200
What is the first line tx In an atonic uterus
Bimanual compression
201
How do you prevent /tx coagulopathy problems in PPH
Fresh frozen plasma | +/- cryoprecipitate
202
Common causes of secondary PPH
Retained placenta Infection Endometriosis
203
Management of secondary PPH
Swabs Pelvic USS for retained placenta - surgical evaction of retained placenta (SERP) Abx Uterotonics = misoprostel, syntocin
204
What is the normal weight range at delivery In kg
2.5-4.5kg
205
What is the normal weight range at delivery in lbs
5.5-10lb
206
How much does the average baby weigh
7.5lb = 3.5kg
207
What are the complications of shoulder dystocia
``` Brachial plexus damage Foetal hypoxia- fits/ cerebral palsy PPH Tears Psychological ```
208
Management of shoulder dystocia
HELPERR ``` Call for help Evaluate for episiotomy Legs in mc Roberts position Suprapubic pressure Enter pelvis Rotational manoeuvres Remove posterior arm ```
209
Risk factors for cord prolapse
``` Polyhydraminos Prematurity Long cord Malpresentation SROM ```
210
Causes of sudden deceleration in fetal HR in labour
Vasa previa | Cord prolapse
211
What is the management of cord prolapse
Fill bladder or push back inside / trendelenburgs position to elevate pressure until Csection
212
Definition of severe preE
``` 140/90+ proteinuria +1 of: “HELLP” Headache Elevated liver enzymes Liver tenderness Low platelets Papilodema / visual changes + clonus ```
213
What is the cure for severe preE
Spont Delivery | / IOL
214
Treatment of severe PreE
``` Manage bp- labetalol , nifedipine If hyperreflexia- MgSO4 Correct any coag issues Monitor urine output Monitor foetal wellbeing ```
215
How do you treat eclampsia in pre-E
MgSO4 4mg In 5mins+ IV 1g/hour | Restrict fluids and monitor urine output
216
What is a differential for post partum depression
Post partum thyroiditis
217
What is medication used for depressive illness in pregnancy
Fluoxetine (SSRI)
218
When does puerperal psychosis normally occur
4 days post delivery
219
What is the management of puerperal psychosis
Admission | Major tranquillisers
220
When would placental location be highlighted
20w scan
221
What should you start someone on with RFs for PreE
Aspirin 75mg day
222
What are the High risk indications for starting low does aspirin
``` PreE in a previous pregnancy Preexisting hypertension CKD Diabetic AI disease (SLE) ```
223
What is the criteria for PrE
Bp over 140/90 + proteinuria >0.3 Past 20w gestation
224
What is the cut off gestation for early vs late preE?
34w
225
What are the consequences for early Pre E
IUGR
226
What can you give as protection from eclampsia
MgSO4
227
Shay do you need to monitor for when giving MgSO4
Mg toxicity | 4hourly reflexes,RR, BP, pulse
228
What is the pathophysiology as to why PreE develops
Placental origin Fails to turn to a low resistance system Secrete proteins that cause vasoC Kidneys retain NaCl
229
What are the complications of PreE
``` Still birth IUGR Placental abruption Eclampsia DIC AKI Liver problems - HELLP syndrome Cerebral haemorrhage Pulmonary odema ```
230
When do you need to be cautious about giving MgSO4
In renal failure as is excreted by the kidneys
231
Management of mild preE
2x weekly FBC, U&E, LFT
232
Management of moderate PreE
Start on labetalol/ nifedipine | Monitor bloods 3x weekly
233
Management of Severe preE
Should be on labetalol 3x weekly bloods 5x daily bp
234
Management of eclampsia
1. ABCDE 2. Lie in L lateral position 3. MgSO4 stat 4. MgSO4 IV 5. Labetalol IV 6. :fluid restriction, monitor output 7. Deliver by Csection when mum is stable
235
What colour discharge do you get in gonorrhoea
Yellow green
236
What symptoms do you get In syphilis
Chancre Neuro syphilis Rash Thoracic AA
237
Treatment of chlymidia
Doxycycline 100mg 7d | Erythromycin in preg
238
Tx of gonorrhoea
Ceftriaxone once 1G
239
Tx of trichomonas vaginalis
Metranidazole
240
Female findings in trichamonas vaginalis
Strawberry cervix | PH>4.5
241
Investigations in chlamydia
First void urine In males Swan females NAAT
242
Investigations in gonorrhoea
Swabs NAAT
243
Investigations in syphilis
Bloods | Swab- motile spirochetes
244
What sort of discharge would you have in trichamos vaginalis
Frothy
245
Tx In syphilis
IM penicillin
246
How long are you covered for contraceptionally post delivery
21d if not b feeding | 6mnths if solely bfeeding
247
How long after delivery can you start CHC
6w if not b feeding | 6m if breastfeeding
248
When can you start the POP/ implant / injectable post delivery
Any time
249
When can you have a device/ system fitted post delivery
<48hours | >4w

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