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YR 3 MED > OBS & GYNAE WK 4 > Flashcards

OBS & GYNAE WK 4 Flashcards

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
Q

pre-eclampsia

what med is taken 12 - 36 wks ?

CLASSIC TRIAD??

A

hypertension in pregnancy, can affect every system

take aspirin 12weeks until 36 weeks

HYPERTENSION, PROTEINURIA, OEDEMA

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26
Q

definition of hypertension

A

140/90 mmHg on 2 occasions, 4 hrs apart
OR
160/110mmHg once

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27
Q

what meds to give for hypertension for women during pregnancy ??

what meds would you stop ??

A

labetalol (contraindicated in asthma)
Methyldopa (contraindicated in depression)
nifedipine

STOP ACEi/ARB and thiazides

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28
Q

gestational hypertension

A

2nd half of pregnancy

no systemic features or proteinuria compared to pre-eclampsia

continue antihypertensive - review after 2 wks

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29
Q

who are at high risk of PRE-ECLAMPSIA

A

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.

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30
Q

EARLY VS LATE PRE-ECLAMPSIA

A

LATE IS MORE COMMON

EARLY - extensive villous, vascular lesions of placenta, higher risk of maternal and fetal complications

LATE - maternal factors
eclampic seizure

31
Q

what causes pre-eclampsia??

2 stages

A

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
Q

normal placentation vs pre-eclampsia

A

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
Q

symptoms of pre-eclampsia

A

Headache
Visual disturbance
Epigastric / RUQ pain
Nausea / vomiting
Rapidly progressive oedema
Hyperreflexia

34
Q

ix of pre-eclampsia

A

U&Es

serum urate

Blood tests: To assess kidney function, liver function, and clotting status.

35
Q

mx of pre-eclampsia

definitive tx??

A

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
Q

in doppler - what is a sign of high resistance blood flow??

uterine artery doppler ultrasound

A

high resistance / poor flow, increased risk of pre-eclampsia

diastolic notch

37
Q

Complications of pre-eclampsia

A

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
Q

MX OF ECLAMPSIA

A

MG SULPHATE

39
Q

calories nutrition in pregnancy, 1st 2nd and 3rd trimester

A

1st and 2nd = normal, no need to increase calories
3rd last 12 weeks = increase 200

40
Q

what supplements are needed for pre-pregnancy and during

A

400 mg folic acid
10mg vit d

41
Q

deficiency in folic acid causes what

A

spina bifida
heart / limb defects

42
Q

Listeriosis monocytogenes infection, and sources of infection

A

infection can cause in-utero infection

miscarriages, stillbirths and pre-term labour

unpasteurised milk, dairy products, soft cheeses, chilled ready to eat meals

43
Q

mx of obesity in pregnancy

A

low dose aspirin
VTE score
oral glucose tolerance test (OGTT)

44
Q

bariatric surgery mx

A

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
Q

FASD

A

foetal alcohol spectrum disorder

46
Q

most common cause of maternal death ??

A

cardiac disease

diabetes
hypertension
VTE
epilepsy

pregnancy-associated w 3-4 x risk of MI

47
Q

link between asthma and pregnancy

A

poorly controlled asthma might affect foetal development
-> premature delivery, low birth weight babies

48
Q

APS - what is it and clinical features??

A

Antiphospholipid syndrome

acquired thrombophilia, increased risk of blood clots

pregnancy loss, placental abruption, arterial/venous thrombosis

49
Q

mx of APS

A

LDA
LMWH

50
Q

what defects are associated w AEDs - anti epilepsy drugs??

A

neural tube defects
heart disorder
skeletal abnormalities
cleft palate

51
Q

Describe the main causes of a small for gestational baby - maternal, placental, fetal

A

pre-term delivery and SGA due to FGR (fetal growth restriction)

maternal

placental

fetal

52
Q

ix for small babies check

A

growth scan
Symphysial fundal height - cheap, easy
uterine artery doppler
umbilical artery doppler
MCA doppler

53
Q

mx for small babies

A

-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
Q

liquor pool

A

DVP - most accurate

55
Q

prevention of SGA

A
56
Q

HIGH RISK OF FGR

A

growth scans every 4 wks from 28 weeks

57
Q

most common reason for measuring large for dates??

A

obesity

58
Q

what is large for dates ??

A

symphyseal fundal height > 2cm for gestational age

59
Q

fetal macrosomia

A

“big baby”

risks = labour dystocia, shoulder dystocia

60
Q

mx of large for dates

A

conservative - doing nothing
EXLUDE DIABETES
IOL vs c/s delivery

61
Q

gravidity vs parity

A

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
Q

polyhydramnios and causes

A

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
Q

clinical features of polyhydramnios

A

abdo discomfort
pre-labour rupture of membranes
pre-term labour
cord prolapse = EMERGENCY
CAN’T feel fetal parts

64
Q

IX FOR POLYH

A

OGTT
Antibody screen
USS

65
Q

MX FOR POLYH

A

serial USS
IOL by 40 wks
Labour

66
Q

high order births - definition

A

presence of more than 1 fetes - twins, triplets

67
Q

risks for multiple pregnancy

A

assisted contraception eg. IVF
Japan and china - rarest, 1in 500
fam history
tall women > short

68
Q

zygosity and chorionicity

A

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
Q

cleavage - splitting
the later the cleavage happens, what happens??

A

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
Q

Determining Chorionicity

what sign do you look for in USS

A

US - shape of membrane and thickness
fetal sex

LAMBDA = DICHORIONIC

T SIGN = MONOCHORIONIC

71
Q

MP - MULTIPLE PREGNANCY SYMPTOMS

A

EXAGGERATED PREGNANCY SYMPTOMS - EXCESSIVE SICKNESS

high AFP

72
Q

TTTS

A

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
Q

why is pregnant woman sleeping on her back bad??

A

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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