Obs + Gynae Flashcards
(155 cards)
1
Q
Name 4 characteristics of normal birth
A
-Spontaneous onset
-Between 37-42 wks
-Infant in vertex position
-Remains low-risk throughout labour
2
Q
What are the stages of labour?
A
Latent, 1st, 2nd, 3rd
3
Q
What happens in the latent phase of labour?
A
-Irregular contractions
-Mucoid plug ‘show’
Cervix effacing/thinning
-Dilatation 0-4cm
4
Q
How long is the latent phase?
A
6hr-2/3 days
5
Q
How do you manage the latent phase?
A
Paracetamol, position, water, snacks
6
Q
What is effacement?
A
Thinning of cervix aka ripening, up to 4cm in length - goes from closed tube to short/thin
7
Q
What happens in the 1st stage of labour?
A
Cervix effaces + dilates up to 10cm
Stronger contractions
8
Q
What happens in the 2nd stage of labour?
A
Full dilatation to birth of baby
9
Q
What happens in the 3rd stage of labour?
A
Birth of baby to expulsion of placenta
10
Q
What is a normal rate of dilatation?
A
0.5cm an hour in primip
11
Q
How can labour be sped up?
A
Oxytocin drip
Artificial breaking of waters
12
Q
What is a ‘passive hour’?
A
Transitional phase after a woman is fully dilated before contractions start
13
Q
What does a sweep do?
A
Finger through cervix, can cause oxytocin release + encourage labour
14
Q
What does oxytocin do?
A
Sustains labour, contracts uterus
But drip makes contractions more painful + can be more stressful for baby
15
Q
Average length of labour for primip?
A
12-24hrs
16
Q
Role of prolactin?
A
Starts process of milk production in mammary glands
17
Q
What do prostaglandins do?
A
Aid cervical ripening
18
Q
What is a the role of oestrogen in pregnancy?
A
Surges at start of labour-inhibits progesterone to prepare smooth muscle for labour
19
Q
Role of beta-endorphins in labour?
A
Natural pain relief
20
Q
What is antenatal colostrum harvesting?
A
Massaging breast to collect + store milk before baby is born-can be given to baby straight away + can encourage labour = not done too early as can stimulate labour
21
Q
What is colostrum?
A
Milk produced in first few days-v nutrient rich
22
Q
What is the role of adrenaline in labour?
A
Gives woman energy in birth-released when birth is imminent
23
Q
What is presentation + what are the types?
A
Lie of baby in abdomen:
Cephalic (head-first)
Breech (bottom/legs first)
Transverse (sideways)
24
Q
Where do contractions originate?
A
Fundus (pacemaker)
25
What are the 4 types of female pelvis?
-Gynecoid
-Platypelloid
-Android
-Anthropoid
26
Describe a gynaecoid pelvis
Most common type of pelvis in females:
Inlet = slightly transverse oval
Wide sacrum
Straight side walls, blunt ischial spines
Wide suprapubic arch
27
Which 3 bones make up the foetal skull?
Frontal, temporal, parietal
28
What are the 7 mechanisms of labour?
-Descent
-Flexion
-Internal rotation
-Extension
-Restitution
-External rotation
-Delivery
29
What happens in descent?
Foetus descends into pelvis-from 37wks, encouraged by contractions but may not start until established labour
30
What is flexion?
Occiput comes into contact with pelvic floor-causes baby's neck to flex + reduces head circumference
31
What is internal rotation?
Each contraction pushes head to pelvic floor + a rebound effect causes small amounts of rotation-complete = 90 degrees
32
What is extension?
Baby's occiput slips beneath suprapubic arch allowing head to extend-head is born, normally facing maternal back
33
What is restitution/external rotation?
Baby aligns head with shoulders-another 90 degree rotation, normally during 1 min break after delivery of head. No restitution may suggest shoulder dystocia
34
What happens in delivery of the body?
Gentle downward traction by midwife to help shoulder delivery below suprapubic arch, then may have upwards traction for other shoulder
35
What is SROM + ARM?
Spontaneous rupture of membranes
Artificial rupture of membranes
36
What is the role of amniotic fluid?
Fluid between baby + amniotic sac, cushion that protects. Baby can swallow it to produce urine + meconium
Rich in stem cells
500-800mls at term
AKA liquor
Should be clear + not smell
37
What does 'en caul' mean?
Baby born within amniotic sac
38
What are the benefits of delayed cord clamping?
-Time to transition to extra-uterine life
-Increase in RBC, iron + stem cells-up to 214g of blood
-Reduced need for inotropic support (heart assistance)
Normally allow at least 1 min - until cord goes white
39
What is the placenta?
Temporary organ during pregnancy, made up lobes that attach to uterine wall, connected to foetus via umbilical cord (2 arteries, 1 vein)
Passes O2 + nutrients to baby + removes waste e.g. CO2
Produces hormones that assist with growth + development
40
What are the membranes in the placenta?
Amnion-bag around baby
Chorion-membrane around placenta
41
Name 5 types of hollistic analgesia
-Water immersion-birthing pool
-Aromatherapy
Massage
-Hypnobirthing
-TENS machine (transcutaneous electrical nerve stimulation)
42
Name 3 types of non-invasive medical analgesia
Entonox (gas + air)-effect wears off quickly but can feel nauseous
Paracetamol
Codeine
43
What opioids can be used in labour?
-Diamorphine
-Pethidine
-Remifentanyl (can cause N+V and given by anaethetist)
44
What is an epidural?
Mix of bupivacaine + fentanyl given by catheter inserted into epidural space
45
Cons of epidurals?
Reduced mobility
Can take up to an hour to take effect
Needs urinary catheter
Can slow down labour
46
What is puerperium?
6 week period after delivery
47
What is lochia?
Blood loss normal after delivery
48
How many appointments will you have when pregnant?
About 8 (+3 if nullip)
49
What infectious disease are screened for in pregnancy?
HIV
Hep B
Syphilis
50
What blood screening tests are done?
Sickle cell + thalassaemia:
Blood test, family origin questionnaire, heel prick in newborn
51
What scans/blood tests are typically done over the course of a pregnancy?
-Booking scan (11+2 - 14+1)
-Combined test (risk of having a baby with Down's syndrome, Edwards' syndrome, or Patau's syndrome)
-Foetal anomaly scan (18+0 - 20+6)
-Quadruple test (Down's syndrome or neural tube defects)
52
How are risks identified?
Booking questionnaire
Booking appt w/ midwife
Booking appt w/ medical team
53
What are the risks with smoking mothers?
Small for gestational age (SGA)
Abruption of placenta
Miscarriage/stillbirth
54
How do you identify risk of pre-eclampsia/pregnancy induced hypertension (PIH)?
-Personal/family Hx
-1st pregnancy
-Age >35
55
How to reduce risk of pre-eclampsia/PIH?
Aspirin throughout pregnancy
Expedited delivery
56
What puts you at risk for/may suggest gestational diabetes?
Personal/family Hx
High BMI
LGA/SGA babies
57
What is done for patients with higher risk of gestational diabetes?
Screening
Regular growth scans + diabetes team involvement
58
What increases risk of PPH?
BMI
Previous PPH
59
What is done for patients with higher risk of PPH?
Active Mx for 3rd stage
Crossmatch
FBC
60
What is done for patients with social factor red flags?
Individual care plan to mitigate risk
Growth scans, delivery plans
?safeguarding referral
61
What is done at the 11-14wk scan?
Dating
Nuchal translucency (fluid at back of neck)
62
When is the anomaly scan + what does it do?
18-20wks
Screens for 11 structurally visible conditions
63
What additional scans can be done?
Early - for bleeding/hyperemesis
Cervical length - if Hx of pre-term delivery
Growth scans - if concerns
64
How is foetal growth + wellbeing monitored?
-Symphysis fundal height-from 24wks
-Foetal movement-particularly post 24wks
-Liquor volume + doppler
-Growth scans
65
What is maternal death?
Death of a patient whilst pregnant/within 42 days of a termination from any cause related to/aggravated by pregnancy or tis Mx
66
What is the most common cause of maternal death?
VTE
67
What happens to progesterone + oestrogen during pregnancy?
Gradually increase then drop at birth
68
What hormones increase in childbirth?
Prolactin, oxytocin - they continue to peak in puerperium
69
What happens to the uterus following delivery?
Immediately contracts fully to level of umbilicus then decreases about 1cm a day until 6wks when returns to normal
70
How does the muscle layer decrease in the puerperium?
Ischaemia
Autolysis
Phagocytosis
71
What is the decidua?
Specialized lining of the uterus, made of endometria + shed as lochia after birth
72
What are the sepsis red flags?
RR >25
Systolic BP<90
HR>130
Lactate >2
Need supplemental O2
Purpuric rash
73
What are the sepsis 6?
Fluids
O2
Abx
Cultures
Lactate
Hourly monitoring fluid balance
All within the hour + senior review
74
What is a PPH?
>500m; blood loss within 24hrs
minor = <1000ml, no shock
major = >1000ml/continuing to bleed/clinical shock
75
What is a life threatening amount of blood loss?
If patient is 70kg- losing 40%+ of total blood volume (2800ml) is life threatening
76
What is secondary PPH?
Abnormal/excessive bleeding from birth canal 24hrs-12wks postnatally
77
Name 4 causes of primary PPH (4 T's)
Tone-uterine atony (doesn't contract enough after birth)
Tissue-retained placental tissue
Trauma-damage to reproductive tract e.g. tears, episiotomy, C-section
Thrombin-coagulopathies
78
How do you treat primary PPH?
AtoE
IV access-2 wide bore cannulae
Tone-bimanual compression, oxytocin
Tissue-manually remove placenta
Trauma-repair
Thrombin-blood products
79
Name 4 causes of secondary PPH
Endometritis
Retained placental fragments
Abnormal involution of placental site
AV malformations
80
How do you assess VTE risk in pregnant women?
TRAF score (thromboprophylaxis risk assessment ...)
81
When is the highest risk of VTE in pregnancy?
First 3wks postpartum
82
What do you do with a woman with high VTE risk?
High TRAF=6wks dalteparin
Intermediate=10 days dalteparin
83
Define pre-eclampsia
Hypertension >140/90
Proteinuria >300mg in 24hrs
>20wks gestation
84
What is eclampsia?
Seizure that occurs if pre-eclampsia worsens / is not identified and managed
85
How do you Mx pre-eclampsia?
-Monitor BP
-Treat BP medically - labetalol
-Delivery
-MgSO4 if eclampsia develops
86
When does most eclampsia occur?
After delivery -25%>48hrs after delivery
87
What is baby blues?
Brief period of feeling emotional / tearful 3-10 days after giving birth
Very common
88
What is postnatal depression?
Depressive episode within the first 12 months postpartum
89
What is puerperal psychosis?
Severe form of mental illness which usually starts days to weeks following delivery; presentation variable
Rare - 1 in 1000
90
What is an ectopic pregnancy?
Pregnancy that occurs when the fertilised egg implants outside the uterus
91
Where is the most common location of an ectopic pregnancy?
Fallopian tube (90%)
92
Name 6 risk factors for ectopic pregnancy
-Previous ectopic
-Tubal damage e.g. STI, sterilisation, pelvic inflammatory disease
-IVF
-Smoker
-Age >35
-IUD/POP
93
What are 4 presentations for an ectopic?
PV bleeding
Abdo pain on one side
Dizziness
Shoulder tip pain
94
Name 4 investigations for an ectopic
UPT (urine pregnancy test)
BHCG (human chorionic gonadotropin)
USS
95
When would you conservatively Mx an ectopic?
If patient is clinically stable,
ectopic <35mm,
BHCG <1000,
patient can return for follow-up
96
What is the medical Mx for an ectopic + when would you do this?
Methotrexate-if no sig. pain + clinically well,
unruptured ectopic <35mm,
BHCG <1500
97
What is the surgical Mx for an ectopic + when would you do this?
Salpingectomy 1st line IF:
Sig pain
Adnexal mass >35mm
Live ectopic
HCG >5000
Signs of rupture
98
How many pregnancies end in miscarriage?
1 in 5
99
What is a miscarriage?
Spontaneous loss of foetus <24wks
100
Name the 5 types of miscarriage
Complete
Incomplete
Threatened
Missed
Inevitable
101
What is a complete miscarriage?
PV bleeding + passage of POC, USS shows empty uterus
102
What is a complete miscarriage?
Heavy bleeding including some passage of POC, USS shows some retained tissues, os is open
103
What is a threatened miscarriage?
Mild PV bleeding, abdo pain, intact membranes, closed os, USS shows viable intrauterine pregnancy
104
What is a missed miscarriage?
Asymptomatic nonviable pregnancy, retained products with no foetal HB or empty gestational sac, closed os
105
What is an inevitable miscarriage?
Progresses to an incomplete/complete, PV bleeding, abdo pain +/- intact membranes, os open
106
How do you manage miscarriages?
-Monitor bHCG, decrease >50% in 48hrs indicates early pregnancy loss
-Repeat UPT in 3wks to confirm
-Medical/surgical Mx for incomplete
-Consider Abx if signs of infection
107
What is a molar pregnancy?
Gestational trophoblastic disease where there is an abnormality in chromosomal number during fertilisation
108
What is a complete vs a partial molar pregnancy?
Partial = 2 sperm fertilising 1 egg that has its DNA
Complete = single sperm (90%) or two sperm (10%) fertilise an egg that has lost its DNA
109
How do you diagnose a molar pregnancy?
USS irregular echobright area containing multiple cysts (bunch of grapes sign)
110
What is Mx for a molar pregnancy + why?
Surgical-POC to histology urgently as can develop into rare choriocarcinoma
111
What is an ovarian torsion?
When ovary +/- fallopian tubes twist on its vascular and ligamentous supports, can block blood flow
112
What is the presentation of an ovarian torsion?
Severe abdo pain
N+V
Often non-specific
113
Mx for ovarian torsion?
Surgical emergency-detorsion + potential for oopherectomy
114
What could you see on USS with ovarian torsion?
Enlarged ovary
115
What is PID?
Infection within the female reproductive system
116
How might PID present?
Asymptomatic
Pelvic pain
Dysuria
Change in discharge
Dyspareunia (pain during sex)
117
What are the common causes of PID?
Bacterial infection, usually STI-chlamydia/gonorrhoea
118
How do you manage PID?
Swabs
14 days Abx - stat IM ceftriaxone + PO metronidazole + doxycycline
Avoid sex until Tx complete
Contact tracing
119
What is an antepartum haemorrhage?
Bleeding from anywhere within the genital tract after 24th week of pregnancy
120
Name 5 causes of antepartum haemorrhage
Placenta praevia
Vasa praevia
Abruprion
Infection
Unknown
121
What is placenta praevia?
When part of the placenta has implanted into the lower segment
122
What are the 2 types of placenta praevia?
Partial/minor=encroaching on lower segment
Major=covering/reaching os
123
How do you Dx placenta praevia?
20wk anomaly USS
124
How do you Mx placenta praevia?
Safety net bleeding/pain
Avoid SI
If recurrent bleeding admit until delivery
Elective lower segment C-section around 37wks
125
What is vasa praevia?
Where the fetal vessels are coursing through the membranes over the internal cervical os and below the fetal presenting part, unprotected by placental tissue or the umbilical cord-no risk to mother but risk to baby
126
What is the risk of vasa praevia?
If membrane ruptures then risk of major haemorrhage with mortality of 60%
127
How do you Mx vasa praevia?
Steroids
Lower segment C-section 34-37wks
128
What is a placental abruption?
Premature separation of the placenta from the uterine wall
129
Name the 2 types of placental abruption
Concealed/
Revealed haemorrhage-depends where separation is + if blood can escape through cervix
130
What is the presentation of placental abruption?
Woody hard
Tense uterus
Foetal distress
Maternal shock out of proportion with bleeding
130
How do you Mx placental abruption?
Conservative >37wks with no foetal distress
OR
Emergency C-section + steroids if distress
131
What is cord prolapse?
When the umbilical cord comes out before the baby during delivery
132
What is the risk with cord prolapse?
Exposure of cord -> vasospasm->higher risk of foetal morbidity/mortality from hypoxia
133
How many weeks is the 1st trimester?
0-12wks
134
How many weeks is the 2nd trimester?
12-28wks
135
How many weeks is the 3rd trimester?
28-40wks
136
What is the period of viability?
24wks+
137
How do you manage a cord prolapse?
Trendelenburg position (feet higher than head)
Foetal monitoring
Alleviate pressure on cord
C-section
138
What are the risk factors for cord prolapse?
Premature ROM
Polyhydramnios
Long umbilical cord
Foetal malpresentation
Multiparity
Multiples
139
What is pre-eclampsia?
Hypertension in pregnancy with proteinuria
140
How does pre-eclampsia present?
Severe headache
Visual disturbance
Papilloedema
Clonus
Liver tenderness
Abnormal LFTs
Platelet count down to <100
141
How do you manage pre-eclampsia? First line?
First line=Labetalol
Nifedipine
Methyldopa
142
What is eclampsia?
Onset of seizure in a woman with pre-eclampsia
143
How do you manage eclampsia?
IV MgSO4 4mgs over 5 mins
Infusion of MgSO4 of 1g/hr for 24hrs
Treat underlying causes e.g. HTN
Deliver baby
144
What is the leading cause of maternal death in the UK?
Sepsis
145
What is the sepsis 6?/BUFALO
Blood cultures
Urine output monitoring + catheter insertion
Fluid resus IV
Abx IV
Lactate (V/ABG)
Oxygen
146
What is shoulder dystocia?
Failure for anterior shoulder to pass under the symphysis pubis after delivery of the foetal head
147
What are the risk factors for shoulder dystocia?
Macrosomia
Maternal DM
Previous Hx
Disproportion between mother + baby
Post maturity
Instrumental delivery
148
HELPERRR for shoulder dystocia?
H-call for help
E-elevate for episiotomy
L-legs into McRoberts
P-suprapubic pressure
E-enter pelvis
R-rotational manoeuvres
R-remove posterior arm
R-replace head + deliver by LSCS PRN
149
What are the complications of shoulder dystocia?
Maternal:
PPH
3rd/4th degree tears
Distress
Foetal:
Hypoxia
Fits
Cerebral palsy
Injury to brachial plexus
150
What is PPH?
Blood loss >500mls after delivery
151
What are the 4 T causes of PPH?
Tone
Tissue
Trauma
Thrombin
152
Risk factors for PPH?
LGA
Nulliparity + grand multiparity
Multiples
Prolonged labour
Operational delivery
Shoulder dystocia
153
How do you manage PPH?
Syntocinon-stims contractions
Ergometrine-increases force + frequency of contractions
Haemobate-stims contractions
Tranexamic acid
Surgery
154
