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YR 3 MED > OBS & GYNAE WK 4 > Flashcards

OBS & GYNAE WK 4 Flashcards

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1
Q

Placenta-oxygen transport

A

passive diffusion

oxygen and nutrients pass thru placenta from mum -> foetus
CO2 and waste - foetus to mum

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2
Q

the supply of the foetus with oxygen is facilitated by what 3 factors??

A

fetal Hb - increase in carrying capacity of O2
higher Hb concentration in foetal blood
Bohr effect - foetal Hb can carry more O2 in PCO2

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3
Q

human placental lactose - when is it produced and what is it involved in ??

A

from wk 5
decreases insulin sensitivity in mothers

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4
Q

Importance of HCG

A

useful to monitor changes in levels eg. ectopic pregnancy (static), failing pregnancy (falling)

side effect = nausea and vomiting

levels fall from 12-14 wks

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5
Q

cardiovascular changes in pregnancy

A

increase in CO
increase in HR
BP DROPS DURING 2ND TRIMESTER (rises in 3rd trimester)

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6
Q

The _________ acts as a physiological
arteriovenous shunt

A

placenta

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7
Q

CRH pathway

A

CRH-> ACTH -> aldosterone / cortisol

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8
Q

ECG changes in pregnancy

A

sinus tachycardia
INVERTED T WAVES
Q wave

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9
Q

haematological changes in pregnancy

A

PV increases
RBC INCREASES
Hb is decreased by dilution
NEED MORE IRON

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10
Q

WHO definition of anaemia in pregnancy

A

1st tri = <110g/L
2nd and 3rd = <105g/L
postnatal = <100g/L

normally outside of pregnancy, normal level = 120-160g/L

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11
Q

Mx of major haemorrhage - trauma vs obstetrics (postpartum haemorrhage)

A

trauma = tranexamic acid
transfusion 1:1 RBC:FFP

obstetrics = tranexamic acid
transfusion 4 X RBC

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12
Q

resp changes in pregnancy

A

lung function changes occur due to progesterone increases and enlarging uterus interfering w lung function

O2 consumption increases

resp rate increases

TV increases

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13
Q

urinary system in pregnancy

A

increased urinary frequency, increased risk of urine infection, urinary incontinence, retention

postural changes affect renal function

supine position and lateral position - increase in renal perfusion??

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14
Q

_______ _____ contractions increase toward the end of pregnancy

cervical stretching causes ________ release

A

Braxton hicks - false labour

cervical stretching -> oxytocin release

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15
Q

3 stages of labour

A

1 - cervical dilatation (8-24hrs)

2 - passing of fetus thru birth canal (few mins - 120mins)

3 - placenta expulsion

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16
Q

what 2 hormones inhibit milk production

what stimulates milk production, and what is responsible for the release of milk??

A

estrogen and progesterone

prolactin - milk production

oxytocin

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17
Q

how to estimate gestational age - what’s most reliable

A

crown to rump length - head to butt
12 + 6 wks
head shouldn’t be tucked into chin

can also do head width circumference but this is less effective after 13 wks

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18
Q

FASP

A

foetal anomaly screening programme - around 20 wks??

can’t pick up all of them

eg. anencephaly, cleft lip, open spina bifida

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19
Q

placenta praevia

A

placenta is low lying in uterus and covers all or part of cervix

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20
Q

nuchal thickness - Trisomy Risk Assessment
First trimester

A

measure of skin thickness behind foetal neck using ultrasound

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21
Q

NIPT
aka
Cell free fetal DNA (cffDNA)

A

non-invasive prenatal testing

  • detecting fatal DNA fragment in sample of blood taken from mum
  • more specific and accurate
  • expensive

The improved accuracy is important as cffDNA itself does not carry any risk of miscarriage, won’t harm the baby

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22
Q

diagnostic tests

A

amniocentesis
performed after 15 wks

chorionic villus sampling
after 12 wks

sticking needle into abdomen

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23
Q

why is red cell antibodies important ??

A

may cause fatal anaemia

anti-d injections given- at 28 wks

for blood transfusions

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24
Q

fetal growth - serial measurement of ____ is recommended at each antenatal appointment from 24 wks of pregnancy, as this improves prediction of a SGA neonate

A

SFH - SYMPHYSIS FUNDAL HEIGHT

small for gestational age

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25
pre-eclampsia what med is taken 12 - 36 wks ? CLASSIC TRIAD??
hypertension in pregnancy, can affect every system take aspirin 12 weeks until 36 weeks HYPERTENSION, PROTEINURIA, OEDEMA
26
definition of hypertension
140/90 mmHg on 2 occasions, 4 hrs apart OR 160/110mmHg once
27
what meds to give for hypertension for women during pregnancy ?? what meds would you stop ??
labetalol (contraindicated in asthma) Methyldopa (contraindicated in depression) nifedipine STOP ACEi/ARB and thiazides
28
gestational hypertension
2nd half of pregnancy no systemic features or proteinuria compared to pre-eclampsia continue antihypertensive - review after 2 wks
29
who are at high risk of PRE-ECLAMPSIA
Women at high risk are those with any of the following: -hypertensive disease during a previous pregnancy -chronic kidney disease -autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome -type 1 or type 2 diabetes -chronic hypertension.
30
EARLY VS LATE PRE-ECLAMPSIA
LATE IS MORE COMMON EARLY - extensive villous, vascular lesions of placenta, higher risk of maternal and fetal complications LATE - maternal factors eclampic seizure
31
what causes pre-eclampsia?? 2 stages
genetic/environment not too sure but may be due to abnormal implantation and dysfunctional trophoblast invasion of the spiral arterioles -> endothelial damage and thrombosis Stage 1 - abnormal placental perfusion placental ischaemia Stage 2 - maternal syndrome an anti-angiogenic state associated with endothelial dysfunction
32
normal placentation vs pre-eclampsia
spiral artery from uterine artery - sending low volume of blood to placenta in pre-eclampsia, trophoblast does not invade, endothelial damage, cytokines release, thrombosis
33
symptoms of pre-eclampsia
Headache Visual disturbance Epigastric / RUQ pain Nausea / vomiting Rapidly progressive oedema Hyperreflexia
34
ix of pre-eclampsia
U&Es serum urate Blood tests: To assess kidney function, liver function, and clotting status.
35
mx of pre-eclampsia definitive tx??
Antenatal screening - BP, urine, symptoms, Uterine Artery Doppler Treat hypertension Aspirin is used for prophylaxis against the development of pre-eclampsia. It is given from 12 weeks gestation until birth to women with one high risk factor or two (or more) moderate risk factors. The only definitive curative treatment is the delivery of the placenta. It is also crucial to monitor the mother and foetus closely for complications.
36
in doppler - what is a sign of high resistance blood flow?? uterine artery doppler ultrasound
high resistance / poor flow, increased risk of pre-eclampsia diastolic notch
37
Complications of pre-eclampsia
HELLP syndrome - rare liver and blood clotting disorder "H" is for haemolysis – this is where the red blood cells in the blood break down "EL" is for elevated liver enzymes (proteins) – a high number of enzymes in the liver is a sign of liver damage "LP" is for low platelet count – platelets are substances in the blood that help it clot eclampsia Tonic-clonic (grand mal) seizure
38
MX OF ECLAMPSIA
MG SULPHATE
39
calories nutrition in pregnancy, 1st 2nd and 3rd trimester
1st and 2nd = normal, no need to increase calories 3rd last 12 weeks = increase 200
40
what supplements are needed for pre-pregnancy and during
400 mg folic acid 10mg vit d
41
deficiency in folic acid causes what
spina bifida heart / limb defects
42
Listeriosis monocytogenes infection, and sources of infection
infection can cause in-utero infection miscarriages, stillbirths and pre-term labour unpasteurised milk, dairy products, soft cheeses, chilled ready to eat meals
43
mx of obesity in pregnancy
low dose aspirin VTE score oral glucose tolerance test (OGTT)
44
bariatric surgery mx
advise not to get pregnant until after 2 yrs supplements and monitoring - vit d, iron, folic acid, calcium nutritional screening - ferritin, folate any foetal abnromalities ??
45
FASD
foetal alcohol spectrum disorder
46
most common cause of maternal death ??
cardiac disease diabetes hypertension VTE epilepsy pregnancy-associated w 3-4 x risk of MI
47
link between asthma and pregnancy
poorly controlled asthma might affect foetal development -> premature delivery, low birth weight babies
48
APS - what is it and clinical features??
Antiphospholipid syndrome acquired thrombophilia, increased risk of blood clots pregnancy loss, placental abruption, arterial/venous thrombosis
49
mx of APS
LDA LMWH
50
what defects are associated w AEDs - anti epilepsy drugs??
neural tube defects heart disorder skeletal abnormalities cleft palate
51
Describe the main causes of a small for gestational baby - maternal, placental, fetal
pre-term delivery and SGA due to FGR (fetal growth restriction) maternal placental fetal
52
ix for small babies check
growth scan Symphysial fundal height - cheap, easy uterine artery doppler umbilical artery doppler MCA doppler
53
mx for small babies
-frequent scans for fatal growth, DVP and dopplers -ensure regular BP + urine check -advice on pre-eclampsia -advice about increased risk of stillbirth and report reduced movements -induction of labour
54
liquor pool
DVP - most accurate
55
prevention of SGA
56
HIGH RISK OF FGR
growth scans every 4 wks from 28 weeks
57
most common reason for measuring large for dates??
obesity
58
what is large for dates ??
symphyseal fundal height > 2cm for gestational age
59
fetal macrosomia
"big baby" risks = labour dystocia, shoulder dystocia
60
mx of large for dates
conservative - doing nothing EXLUDE DIABETES IOL vs c/s delivery
61
gravidity vs parity
Gravidity is the total number of pregnancies, regardless of outcome. Parity is the total number of pregnancies carried over the threshold of viability (24+0 in the UK). eg. Patient is not pregnant, had one previous delivery = G1 P1 Patient is currently pregnant; had two previous deliveries = G3 P2
62
polyhydramnios and causes
excess amniotic fluid deepest pool > 8 cm AFI > 25cm maternal - diabetes, red cell antibodies baby getting a lot of sugar, pees more fetal - viral infection, foetal anomaly eg. GI atresia hydrops fetalis
63
clinical features of polyhydramnios
abdo discomfort pre-labour rupture of membranes pre-term labour cord prolapse = EMERGENCY CAN'T feel fetal parts
64
IX FOR POLYH
OGTT Antibody screen USS
65
MX FOR POLYH
serial USS IOL by 40 wks Labour
66
high order births - definition
presence of more than 1 fetes - twins, triplets
67
risks for multiple pregnancy
assisted contraception eg. IVF Japan and china - rarest, 1in 500 fam history tall women > short
68
zygosity and chorionicity
Zygosity: number of eggs fertilised to produce twins Chorionicity: membrane pattern of the twins monozygotic - splitting of a single fertilised egg dizygotic - fertilisation of 2 ova by 2 spermatozoa chronicity dizygous - ALWAYS DCDA monozygous - MCMA, MCDA, DCDA
69
cleavage - splitting the later the cleavage happens, what happens??
more risk, higher risk of conjoined twins morula days 1 -3 = DCDA (Each foetus has its own amniotic sac and its own placenta) blastocyst 4-8 = MCDA (The twins are in two separate sacs but the placentas are joined) implanted blastocyst 8-13 = MCMA (sharing 1 sac and placenta) formed embryonic disc 13-15 = CONJOINED TWINS (sharing organs)
70
Determining Chorionicity what sign do you look for in USS
US - shape of membrane and thickness fetal sex LAMBDA = DICHORIONIC T SIGN = MONOCHORIONIC
71
MP - MULTIPLE PREGNANCY SYMPTOMS
EXAGGERATED PREGNANCY SYMPTOMS - EXCESSIVE SICKNESS high AFP
72
TTTS
twin to twin transfusion - rare pregnancy condition affecting identical twins or other multiples. - sharing 1 placenta syndrome w artery-vein anastomoses before 26 wks = foetscopic laser ablation after 26 = amnioreduction / septostomy deliver 34-36 wks
73
why is pregnant woman sleeping on her back bad??
bc it is compressing on the IVC should sleep on left side, where aorta is. this can handle. arteries>veins

YR 3 MED (23 decks)

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