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OBS&GYNAE Flashcards

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1
Q

At what gestation would a referral to the maternal foetal medicine unit for no foetal movements be done?

A

24 weeks

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2
Q

Whats the most common adverse effect of the progesterone-only pill?

A

Irregular vaginal bleeding

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3
Q

If Bishop score <=6, what should be done to induce labour?

A

vaginal prostaglandins or oral misoprostol

mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean

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4
Q

If bishop score >6 what should be done to induce labour?

A

Amniotomy and IV oxytocin infusion

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5
Q

After pregnancy, when can the contraceptive implant be safely inserted?

A

Any time!

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6
Q

What is the most common risk following a surgical termination of pregnancy?

A

Infection

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7
Q

How does cholestasis of pregnancy present differently yo acute fatty liver of pregnancy?

A

AFL of pregnancy - malaise, fever, n&v, abdo pain, jaundice, ALT very elevated (very non-specific)
Cholestasis - severe pruritus often in palms and soles and raised bilirubin

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8
Q

How should you manage a woman in labour when there is foetal bradycardia <80bpm?

A

Rule of 3 mins for foetal bradycardia:
3 minutes - call for help
6 minutes - move to theatre
9 minutes - prepare for delivery
12 minutes - deliver the baby as cat 1 c-section

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9
Q

What should always be done at any sensitising event after 20/40 in a woman who is rhesus D negative?

A

A kleihauer test after giving anti-D to determine if additional anti-D is required

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10
Q

Management of gestational diabetes if fasting glucose level is >=7.0mmol/l?

A

Immediate insulin

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11
Q

When do baby blues start and when does PND start?

A

Baby blues are typically seen 3-7 days following birth
PND usually starts within 1 month and peaks at 3 months

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12
Q

Risk factors for placenta praevia

A

multiparity
multiple pregnancy
previous caesarean section - Embryos implant in scar

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13
Q

How does placenta praevia present?

A

Shock in proportion to visible loss
Lie and presentation may be abnormal

(No pain or tender uterus and foeta;l heart good)

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14
Q

What is grade 1 placenta praevia?

A

I - placenta reaches lower segment but not the internal os

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15
Q

What is grade 2 placenta praevia?

A

II - placenta reaches internal os but doesn’t cover it

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16
Q

What is grade 3 placenta praevia?

A

placenta covers the internal os before dilation but not when dilated

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17
Q

What is grade 4 placenta praevia?

A

IV (‘major’) - placenta completely covers the internal os

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18
Q

First line investigations for PMB?

A

TVUS

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19
Q

What UKMEC category is having positive antiphospholipid antibodies e.g. SLE/

A

4 - i.e. There is an unacceptably high clinical risk and she cannot use the pill anymore

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20
Q

What is the risk of chickenpox in pregnancy for the mother?

A

5 times greater risk of pneumonitis

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21
Q

What are features of foetal varicella syndrome?

A

Skin scarring
Eye defects e.g. microphthalmia
Limb hypoplasia
Microcephaly
Learning disabilities

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22
Q

Management if 2 COCP pills are missed in week 1 and they had unprotected sex during this week or the pill-free interval?

A

Consider emergency contraception

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23
Q

Risk factors for ectopic pregnancy?

A

Any damage to tubes e.g. PID, surgery
Previous ectopic
Endometriosis
IUCD
POP
IVF

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24
Q

What % of IVF pregnancies are ectopic?

A

3%

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25
What drug class is leuprolide?
GnRH agonist
26
What can be used to screen for depression in the peurperal period?
The Edinburgh Postnatal Depression Scale
27
When does puerperal psychosis typically start?
2-3 weeks following birth
28
What is the most effective form of contraception?
Implantable contraceptive
29
Moa of mifepristone in termination of pregnancy?
acts as an anti-progestogen that primes the uterus to enhance its responsiveness to misoprostol
30
Moa of misoprostol in termination of pregnancy?
A prostaglandin analogue Misoprostol binds to smooth muscle cells in the uterine lining to increase the strength and frequency of contractions as well as reduce cervical tone
31
What is placenta accreta?
the attachment of the placenta chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis
32
What is the complication of placenta accreta?
Postpartum haemorrhage
33
How does placental abruption present?
Shock out of keeping with visible loss Pain with a tender and tense uterus Foetal heart absent or distressed Coagulation problems
34
Indications for referring a woman to hospital with hyperemesis gravidarum?
Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection)
35
What is yhe criteria for lactational amenorrhoea?
Amenhorrhoic A bay <6 months Breastfeeding exclusively
36
When are OGTT done?
As soon as possible after booking At 24-28 weeks if first test is normal or if any risk factors
37
What condition causes a raised AFP?
Neural tube defects Abdominal wall defects Multiple pregnancies
38
What condition causes a low AFP?
Down’s syndrome Trisomy 18 Maternal DM
39
Indications for induction of labour?
prolonged pregnancy prelabour premature rupture of the membranes maternal medical problems e.g. DM >38 weeks, pre-eclampsia, obstetric cholestasis intrauterine fetal death
40
Interpretation of bishop score?
a score of < 5 indicates that labour is unlikely to start without induction a score of ≥ 8 indicates that the cervix is ripe, or 'favourable' - there is a high chance of spontaneous labour, or response to interventions made to induce labour
41
How long should metoclopramide be used for for hyperemesis gravidarum and why?
No more than 5 days due to risk of extrapyramidal side efefcts
42
Risk factors for endometrial cancer?
Excess oestrogen Metabolic syndrome Tamoxifen HNPCC
43
A 31-year-old woman complains of intermittent pain in the left iliac fossa for the past 3 months. The pain is often worse during intercourse. She also reports urinary frequency and feeling bloated. There is no dysuria or change in her menstrual bleeding
Ovarian cyst - can cause abdominal swelling na pressure effects on bladder
44
After giving birth when do women require contraception?
After day 21
45
What is a threatened miscarriage?
Painless vaginal bleeding occurring before 24/40 Bleeding is often less than menstruation and cervical os is closed
46
What is a missed miscarriage?
Aka a delayed miscarriage a gestational sac which contains a dead fetus before 20/40 without the symptoms of expulsion mother may have painless, light vaginal bleeding / discharge and the symptoms of pregnancy disappear cervical os is closed
47
What is an anembryonic pregnancy?
When the gestational sac is >25mm and no embryonic/foetal parts can be seen
48
What is an inevitable miscarriage?
heavy bleeding with clots and pain cervical os is open
49
What is an incomplete miscarriage?
not all products of conception have been expelled pain and vaginal bleeding cervical os is open
50
Outline the scanning for placenta praevia after its first recognised at the 20 week scan?
Rescan at 32/40. If present and grade 1/2 then rescan every 2 weeks Final USS at 36-37/40 to determine method of delivery (if grade 1 vaginal, any higher than elective c-section)
51
Moa of ursodeoxycholic acid?
This inhibits the absorption of cholesterol in the intestine and secretion of cholesterol into bile = decreasing biliary cholesterol saturation and promoting bile acid secretion
52
What % of pregnant women get obstetric cholestasis? Which ethnicities is it more common in?
1% of pregnant women Women of Indian-Asian or Pakistani-Asian origin
53
When does obstetric cholestasis usually develop and why?
Usually after 28/40/third trimester due to the increased oestrogen and progesterone levels
54
Outline the pathophysiology of obstetric cholestasis?
Outflow of bile acid flow is reduced causing them to build up in the blood and this causes pruritis
55
What is the risk of obstetric cholestasis?
Increased risk of premature birth May increase the chance of stillbirth if severe
56
What is a partial hydatidiform mole?
When 1 ovum with 23 chromosomes is fertilised by 2 sperm, each with 23 chromosomes = triploid cell A foetus will be present but abnormal
57
What is a complete hydatidiform mole?
When 1 empty ovum without any chromosomes is fertilised by 1 sperm which duplicates, (or less commonly by 2 sperm) leading to 46 chromosomes of paternal origin alone = no foetus!
58
Are complete and partial molar pregnancies benign?
Yes but they can become malignant Complete molar pregnancies have a 15% chance of developing to gestational trophoblastic neoplasia
59
What are the 3 types of invasive gestational trophoblastic disease?
Choriocarcinoma Placental site trophoblastic tumour Epitheloid trophoblastic tumour
60
What is a choriocarcinoma?
A type of gestational trophoblastic disease - a maliganncy of the trophoblastic cells of the placenta Commonly co-exists with molar pregnancies Characteristically metastases to the lungs
61
USS findings for a complete hydatidiform mole?
A snow stop appearance of mixed echogenicity
62
When can you start the COCP after levonorgestrel emergency contraception?
Immediately
63
When should folic acid be taken as antenatal care?
Folic acid 400mcg OD 3 months before conception up to 12 weeks gestation
64
What is the Hb cut off for anaemia in the first trimester of pregnancy?
<110g/L
65
What is the Hb cut off for anaemia in the second and third trimester of pregnancy?
<105g/L
66
What is the Hb cut off for anaemia in the postpartum?
<100g/L
67
What are the requirements for an instrumental delivery? (Remember using FORCEPS mnemonic)
Fully dilated cervix OA position Ruptured membranes Cephalic Engaged presenting part Pain relief Sphincter bladder empty
68
What should be the next important investigation if you find a baby has a SFH of 25cm at 30/40?
US to confirm foetal size
69
When should magnesium sulphate be given in eclampsia?
Give once a decision to deliver has been made and continue for 24 hours after last seizure of delivery
70
What should be monitored during giving magnesium sulphate for eclampsia?
Urine output Reflexes RR (respiratory depression can occur) O2 sats
71
Which women should take aspiring 75-150mg daily from 12 weeks gestation until birth?
Those with >=1 high risk factor for pre-eclampsia OR >=2 moderate risk factors
72
What are high risk factors for pre-eclampsia?
hypertensive disease in a previous pregnancy chronic hypertension CKS autoimmune disease, such as SLE or APS T1 or T2DM
73
What are moderate risk factors for pre-eclampsia?
First pregnancy Aged 40 or older Pregnancy interval of >10 years BMI of 35 or more FHx of pre-eclampsia Multiple pregnancy
74
What is the first line investigation for PROM? Second line?
Sterile speculum to look for pooling of amniotic fluid in posterior vaginal vault Vaginal fluid tests for PAMG-1 or insulin-like growth factor binding protein-1 if no amniotic fluid is demonstrated on speculum,
75
What is the risk of expulsion of the IUD and IUS?
1 in 20 Most likely to occur in the first 3 months

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