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Year 3 Top Tips > Obs and Gynae > Flashcards

Obs and Gynae Flashcards

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1
Q

What is ante-partum haemorrhage?

A

Bleeding from the genital tract from 24 weeks gestation before the onset of labour

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2
Q

WHat are the causes of ante-partum haemorrhage?

A

Placenta praevia

Placenta Abruption

Vasa Praevia

Uterine rupture

Varicosities

Polyps

Tumours

Trauma

Ectropian

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3
Q

How do class placenta praevia?

A

Major

Minor

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4
Q

What is placenta praevia

A

When the placenta is blocking the opening of the cervix so the baby cannot be delivered vaginally

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5
Q

Symtpms of placenta praevia

A

Painless

Vaginal bleeding

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6
Q

What are the signs of placenta praevia?

A

High presenting part

Malpresentation

soft uterus

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7
Q

What do you look for in foetal assessment

A

Foetal movements

FH Auscultation

CTG

USS

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8
Q

Is a transvaginal USS safe to do if the lady had placenta praevia?

A

Yes

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9
Q

With any bleed in a pregnant lady, what should you always check?

A

rhesus status

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10
Q

What happens if the pregnant lady is rhesus negative?

A

She will require anti-D prophylaxis to prevent haemolytic disease of the newborn

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11
Q

What is placenta abruption?

A

Placental abruption occurs when the placenta separates from the inner wall of the uterus before birth. Placental abruption can deprive the baby of oxygen and nutrients and cause heavy bleeding in the mother. In some cases, early delivery is needed

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12
Q

Classification of placenta abruption?

A

Concealed

Revealed

Both

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13
Q

Symptoms of placenta abruption?

A

Abdominal pain

Vaginal Bleeding

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14
Q

Signs of placenta abruption?

A

Woody hard uterus

Vaginal bleeding

Foetal distress, maternal shock

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15
Q

Post partum harmorrhage is a obesteric emergency

TRUE OR FALSE

A

TRUE

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16
Q

What is postpartum haemorrhage

A

Postpartum haemorrhage (PPH) is heavy bleeding after birth. PPH can be primary or secondary: • Primary PPH is when you lose 500 ml (a pint) or more of blood within the. first 24 hours after the birth of your baby.

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17
Q

What is primary postpartum haemorrhage?

A

When 500mls or more of blood is lost from the genital tract occuring within 24 hours of delivery

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18
Q

Causes of primary PPH?

A

Tone- refers to a failure of the uterus to contract

Trauma- can be caused by episiotomy, tear, haematoma, uterine inversion or a ruptured uterus.

Tissue - refers to tretained placenta membrane

Thrombin- any coagulation problem.

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19
Q

What is the most common cause of primary PPH?

A

uterine atony

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20
Q

Tx for pph?

A

Tone - uterine massage, bimanual compression. Medical and surgical management (iv oxytoxin, uterine sutture,)

Trauma- repair

Tissue- manual removal

Thrombim-Harmatology

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21
Q

What is secondary PPH

A

an excessive abnormal bleeding from the gential tract from 24 hours to 6 weeks post partum

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22
Q

Causes of secondary PPH

A

Endometritis

Retained placenta and membranes

Trauma

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23
Q

What are the indication for assisted delivery?

A

Fetal: distress

Maternal: Exhaustion/ comorbidity i.e neuro/cardiac conditions

Delay in 2nd stage of labour

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24
Q

What instruments can be used for assisted delivery?

A

Simpsons Forceps

Hand hels suction cup or ventouse

Suction cup

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25
What are some important points you need to know about forceps?
- Need adequate analgesia ie pudendal block/epidural - Less reliant on maternal effort - Need to do episiotomy with all forceps to minimize OASI risk - Always check for vaginal trauma afterwards - Instrument of choice for preterm infants - Can rotate infants with forces (in theatre)
26
What are some important points about ventouse?
- Can be used with pudendal block or local infiltration (if necessary) - More reliant on maternal effort - Ensure all equipment correctly assembled and working beforehand - Positioning of cup important - Consider episiotomy (in mulliparous women) - Can't use on babies \<34/40, careful use \<36/40 (bleeding risk) - Warn parents of swelling on babies head- will settle down
27
Can caesarean section is only elective surgery TRUE OR FALSE
FALSE elective and emergency
28
How 'to do' emergencies weel?
- **Identify** high risk patients and **anticipate** any potential emergencies - take steps before hand to **reduce the risk** if possible - have appropriatley **trained staff** caring for woman - **inform** patient of increased risks and possibilities - **document** well- importance of a scribe - **debrief** with patient/relatives/colleagues afterwards - always ask for **help**, early
29
If the babys head is delivered but finding it hard to deliver the shoulders of the baby, what is the likely diagnoses?
Shoulder dystocia
30
What is shoulder dystocia?
Failure of head to deliver despite maternal effort and normal traction of head - the anterior shoulder impacts behind the pubic symphysis - disimpaction will lead to delivery - can cause compression of cord - risk of brachial plexus injury
31
In an obsteric emergency (shoulder dystocia) what is a good acronym to remember?
HELPERR **H**elp- emergency buzzer **E**pisiotomy- evaluate for this to make more room for maneuvers **L**egs- Mc Roberts position **P**ressure- constant then rocking suprpubic behind anterior shoulder **E**nter- finger behinf anterior shoulder, behind post shoulder, Wood screw amneuver **R**emove- posterior arm grabbed **R**oll- onto all fours and repeat
32
What can be the complications with shoulder dystocia?
brachial plexus injury erbs palsy specifically
33
What is cord prolapse?
- Immediate delivery via C/S- unless fully dilated and delivery imminent, could consider del in room with instrument - minimal handling of loops of cord - manually elevate the presenting part off cord or fill urinary bladder - mum in knee- chest position - consider tocolysis - if delivery is delayed
34
What is eclampsia?
Eclampsia is the new onset of seizures or coma in a pregnant woman with preeclampsia. These seizures are not related to an existing brain condition
35
Mx for eclampsia?
- call for help - ABCDE - Loading dose MgSO2 (50% strength) 1g/hour infusoin for 24 hours since last seizure - Monitor closely- HDU setting - 10min observation/ hourly urine output/reflexes - Magnesium Toxicity (poor UO \<25ml/hour, absent reflexes, RR\<14, Sats\<90%) - Consider Calciu Gluconate 10ml 10% IV - Treat high BP- IV infusion vs oral medication (labetalol 1st line) Amin \<150/100 - Fluid restrict (80ml/hour)- Renal failure and pulmonary oedema - Repeat bloods also - HELLP syndrome - Experdite delivery
36
What is abnormal uterine bleeding? AUB
Bleeding from the uterine corpus that is abnormal in duration, volume, frequency, and/or regularity
37
What is the classification used for abnormla uterine bleeding?
FIGO CLassifciation
38
What is always classed is abnormal uterine bleeding?
Intermenstrual bleeding (cyclical or random) Unschedules bleeding on hormone medication
39
WHat are the causes fo AUB
* *P**olyps * *A**denolyosis * *L**eimoyoma * *M**alignancy * *C**oagulopathy * *O**vulatory * *E**ndometrial * *I**atrogenic * *N**ot yet classified
40
What are the medical and surgical managements for heavy menstral bleeding
41
What does the infectious diseases screening programme screen for?
Hepatitis B HIV Syphillis
42
When should screening be performed for antenatals
screenign should ideally be performed as early as possible in pregancy but can be performed up to and including labour
43
What do you test in antenatal screening for infectious disease?
Materanl serum sample
44
What is urinary incontinence?
Involuntary leakage of urine
45
What is the difference between stress, urge and mixed urinary incontinence?
Stress UI; Incontinence on effort or physical exertion or on sneezing or coughing Urge UI: incontinence associated with urgency Mixed UI: UI associated with urgency and also with effort or physical exertion or on sneezing ot coughing
46
What trigger could cause urinary incontinence?
Cough Exercise Intercourse Urge to PU Nocturia coffee tea alcohol fizzy drinks
47
WHat is intialy treatment for UI
conservative lifestyle modification including weightloss to keep BMI\<30 and fluid adjustment and avoiding caffeine. behaviour modication with bladder training for at least 6 weeks Supervised pelvic floor exercises for at least 3 months
48
Drugs used for Urge (UI)
Anticholinergics If not tolerant can try mirabegron
49
WHat are the side effects of anticholinergics?
be wary of giving oxybutynin to elderly women due to risk of dementia
50
Investigations for urge incontinence?
Urodynamics: may help to determine flow pattern and confirm stress or detrusor overactibity, If confirmed DO non responsive to medication
51
WHat is the next step if detrusor overactivity is confirmed?
Cystoscopic injection of Botulim Toxin A (Botox) to the bladder wall. Start with 100IU Sacral Nerve stimulation If all fails: Augmentation cystoplasy Urinary Diversion
52
Treatment options for stress incontinence?
Colposuspension: Open or laproscopic Autologous fascial sling (Mid urethral mesh sling) Inramural bulking agent follow up in 6 months
53
What is pop-q classification?
The Pelvic Organ Prolapse Quantifications System (POP-Q) is a system for assessing the degree of prolapse of pelvic organs to help standardize diagnosing, comparing, documenting, and sharing of clinical findings.
54
Treatment for pelvic floor prolapse?
Based on patients desire stage 1 and stage 2: 16 weeks supervised PFE -Vaginal oestrogen for atrophic tissue Vaginal pessaries surgery based on compartment involved
55
When should nausea and vomiting be diagnosed in pregnancy?
when onsent is in the first trimester and toher causes of nausea and vomitting have been excluded if it is after 10 weeks of gestation then other csauses need to be considered
56
What is hyoeremesis gravidarum?
Some pregnant women experience very bad nausea and vomiting. They might be sick many times a day and be unable to keep food or drink down, which can impact on their daily life. This excessive nausea and vomiting is known as hyperemesis gravidarum (HG), and often needs hospital treatment.
57
How is hyperemesis gravidarum diagnosed in pregnancy?
When there is protracted nauseas and vomiting with the traid of more than 5% of pre-preganncy weight loss, dehydration and electrolyte imbalance.
58
How can the severity of nausea and vomitting be classified?
PUQE score pregnancy-unique quantification of emesis and nausea
59
Ix for nausea and vomitting?
History - exclude H. pylori Exam PUQE score Urinary dipstick Electrolytes FBC Blood glucose USS LFTs TFTs
60
What are the differential diagnosis when we see apatient with nausea and vomiting in patients?
peptic ulcers cholecystitis gastroenterisits, hepatitis pancreatits genitourinary condition : UTI, pyelonephritis metabolic conditions Neurological drug induced
61
Gastrodudenoscopy considered safe in pregnancy?
Yes
62
What is the inital management for people with nausea and vomitting?
oral anti-emetics Not tolerated then parenteral fluid, parenteral vitmains, multi and b complex vitamins Subcutaneous metoclopramide therapy
63
Theraputic options for nausea and vomittting in pregnancy?
Anti histamines Phenothiazines H2 receptor antagonists
64

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