Obstetrics Flashcards
(139 cards)
1
Q
how is SGA determined
A
<10% on customised growth chart
2
Q
what does a customised growth chart take into account
A
mothers BMI parity ethnicity previous birth weights single/multiple pregnancy
3
Q
what are some constitutional causes of SGA
A
asian ethnicity, low maternal BMI, nulliparity and female fetal gender
4
Q
what are some maternal causes of IUGR
A
existing disease like CVS, renal, hypertension, celiacs, diabetes
or smoking/drug use
malnutrition, low BMI
5
Q
what are some uteroplacental causes of IUGR
A
pre-eclampsia, multiple pregnancy, uterine malformations, placental insufficiency
6
Q
what are some fetal causes of SGA
A
female fetuses, chromosomal abnormalities, vertically transmitted infections
7
Q
some complications of SGA and IUGR
A
stillbirth, c-section, long term handicaps, fetal distress
8
Q
only reduced fetal movements mean that the baby is IUGR - true or false
A
false, only a very poorly baby will stop moving,
9
Q
how is IUGR diagnosed?
A
ultrasound scan
10
Q
management of SGA at preterm and at >37 weeks
A
preterm - growth rechecked in 2-3 weeks interval
> 37 weeks, induced or if umblical dopplers are normal and above 3rd centile, wait for due date
11
Q
management of IUGR <34 weeks
A
repeat dopplers twice a week, if abnormal and <32 weeks, C section, if <32 weeks, CTG monitoring and deliver with fetal in distress.
12
Q
what should the mother be given if she delivers before 34 weeks
A
magnesium sulphate
13
Q
management of IUGR between 34-37 weeks
A
if normal doppler, wait till 37 weeks.
if abnormal, then induce or c-section if CTG is abnormal
14
Q
management if IUGR after 37 weeks
A
induce if normal CTG, csection if abnormal
15
Q
which ages are most common for endometrial cancer
A
50-60s, most are postmenopausal
16
Q
the screening program for endometrial cancer is effective - T or F
A
False, there is no such thing
17
Q
what is type 1 and type 2 endometrial cancers
A
type 1 is estrogen sensitive, obesity related, low grade endometroid cells and slow growing
type 2 are estrogen insensitive, not obesity related, faster growing an usually high grade endometroid, clear cell, serous or carcinosarcomas
18
Q
what is the main risk factor for endometrial cancer
A
endogenous and exogenous estrogen exposure
19
Q
examples of endogenous estrogen exposure that can increase risk of endometrium cancer
A
PCOS high BMI nulliparity early menarche/late menopause older age
20
Q
examples of exogenous estrogen exposure that can increase risk of endometrium cancer
A
unopposed estrogen therapy HRT without progesterone
21
Q
typical endometrial hyperplasias should be treated immediately - T or F
A
false, most regress and don’t progress to cancer
22
Q
presentations of someone with endometrial cancer
A
postmenopausal bleeding post coital bleeding vaginal discharge pelvic pain (intermenstrual bleeding)
23
Q
who to refer in suspected endometrial cancer
A
PMB w/o continuous HRT, on sequential HRT for more than 2 years
repeated bleeding
PCB more than 4 weeks
24
Q
how to investigate endometrial cancer
A
TV US
> 5mm then pipelle biopsy
can escalate to hysteroscopy and biopsy
25
how is endometrial cancer diagnosis made
histologically from biopsy
26
most common endometrial cancer pathology
endometroid adenocarcinoma
27
how to stage endometrial cancer
1 - within uterus
2 - to cervix
3 - to pelvis
4 - distant sites
28
surgical treatment for endometrial cancer
total lap hyst + bilateral salpingoophrectomy
29
what is peritoneal washing done for in endometrial cancer treament
peritoneal cavity is flushed with saline and then analysed for malignant cells to stage spread
30
common causes of antepartum haemorrhage (APH)
placenta praevia
placenta abruption
undertermined origin
31
what is a bloody show
mucus plug of cervix mixed with blood, excreted just before labour
32
what is a vasa praevia
when fetal vein is attached to membrane of placenta, rupture of which can lead to fetal death
33
what is placenta praevia
when a placenta is in the lower segment of the uterus
34
what is the grading of placental praevias
marginal praevias have placentas not covering the cervical os. major praevias partially or completely cover the os
35
risk factors for placenta praevia
twins
high parity women
older women
previous c-section
36
complications of placenta praevia
obstructs natural lie and delivery
might require c-section
PPH
placenta accreta or placenta percreta
37
what is placenta accretea and percreta
accreta is when the placenta has embeded itself deeper than it usually would
percrete is when it has gone through the uterus and into the surrounding organs (e.g. intestines)
38
clinical features in history of placenta praevia
intermittent painless PV bleeding with increasing frequency and intensity
can be asymptomatic
39
what would an examination of someone with placenta praevia find?
breech and transverse lies are common
40
how to investigate and diagnose placenta praevia
ultrasound - repeat at 32 weeks
41
what to assess in someone with placenta praevia
maternal and fetal wellbeing
CTG, FBC, clotting and cross matching
42
when to admit someone with placenta praevia
bleeding
43
what to do when someone with placenta praevia is admitted
cross match
anti-D for Rh-ve
IV access
steroids if <34 weeks
44
how to deliver someone with placenta praevia
c-section
45
what is placenta abruption
separation of part or all of the placenta before delivery
46
where can blood go during a placenta abruption
into the amniotic sac or out through the vagina
47
bleeding always happens in placenta abruption, T or F
false, it can bleed into the amniotic sac
48
complications of placenta abruption
fetal death
| haemorrhage - shock
49
risk factors of placenta abruption
IUGR
pre-eclampsia
autoimmune disease
hx of placental abruption
multiple pregnancy
high maternal parity
trauma
smoking
cocaine use
50
clinical features of placenta abruption
sudden localised painful bleeding
51
more bleeding = more severe placenta abruption, T or F
False, blood can bleed into the amniotic sac
52
findings on examination of someone with placental abruption
shock and blood loss
tender uterus
contractile uterus
53
when to admit with suspected placenta abruption
when there is pain and uterine tenderness, even without blood
54
delivery management for someone with placenta abruption
fetal distress => emergency CS
no fetal distress by term => induction + ARM
no fetal distress and preterm => give steroids and monitor
55
if a 31 week pregnant lady is admitted with abdominal pain with some bleeding but no fetal distress is found on CTG; symptoms which then subsqeuntly subside after 2 days. what should be done next?
if fetus is confirmed to be viable and healthy, then discharge but class as high risk pregnancy and arrange for serial fetal growth scans
56
what is a cervical ectropian
when endocervical columnar cells evert into the ectocervix causing redness and some vaginal discharge and/or PCB
57
how to treat a cervical ectropian?
exclude carcinoma, then cryotherapy
58
what are 3 benign conditions of the cervix
cervical ectropian
cervical polyps
acute/chronic cervicitis
59
what can cause cervicitis
STIs, prolapses, pessaries
60
what ligaments support the uterus
uterosacral
| transverse ligament
61
what is the junction called where cervical columnar cells meet squamous cells
squamocolumnar junction
62
what is CIN
cervical intraepithelial neoplasia - dyskariotic cell changes on the cervix
63
what does CIN I - III mean
CIN I is when atypical cells are limited to lower thirds of the epithelium
CIN II is when cells are found in lower 2/3rds of epithelium
CIN III is when the atypical cells are found in the full thickness of the epithelium
64
what is CIN III also called
carcinoma in situ aka pre-invasive
65
why is CIN III dangerous
it has the potential to invade through the basement membrane and become malignant
66
what strains of HPV are associated with ca cervix
16 18 31 33
67
what are the risk factors for ca cervix
hpv
smoking
long term steroid use
68
what is the cervical screening schedule
>25 years old every 3 years till 49 then every 5 years till 65.
69
what happens if a smear comes back abnormal
they are invited back for another smear/colposcopy/hysteroscopy with biopsy.
70
what is colposcopy
using speculum to visualise the cervix, acetic acid or iodine is added to stain any dyskariotic cells which are then looked thru a microscope. biopsy can be taken during this
71
what is the treatment for CIN I II and III
CIN I is only monitored
| CIN II and III are usually excised using LLETZ
72
what is LLETZ
large loop excision of transformation zone
73
who tend to be diagnosed with cervical cancer
women who dont go for their smears
74
peaks of incidence for cervical cancer
30s and 80s
75
what cell types are most cervical cancers
90% squamous, 10% adenocarcinomas
76
which cell type cancer has a worse prognosis
adenocarcinoma
77
history clinical features of cervical cancer
PCB
offensive vaginal smell
PMB
pain, urinary symptoms if advanced stage
78
how to confirm the diagnosis of cervical cancer
biopsy
79
what causes chronic pelvic inflammatory disease
infections that lead to adhesions, obstructed tubes and hydrosalpinx
80
what can chronic pelvic inflammatory disease lead to
adhesions, obstructed tubes and hydrosalpinx
81
common symptoms of chronic pelvic inflammatory dsiease
```
lower abdominal pain
dysmenorrhea/menstrual irregularity
deep dyspareunia
chronic vaginal discharge
subfertility
```
82
what is usually found on examination in someone with chronic pelvic inflammatory disease
uterine tenderness, adnexal tenderness, abdominal pain, fix retroverted uterus
83
how to investigate and diagnose chronic pelvic inflammatory disease
laparoscopy
84
what can cause chronic pelvic pain
```
PID, chronic PID
endometriosis
adenomyosis
fibroids
abscess
ovarian cysts
IBS
adhesions
```
85
what is one non-gynaecological differential for chronic pelvic pain
IBS
86
how to investigate chronic pelvic pain
history, examination, bloods, TVUS, MRI, laparoscopy
87
what is hyperemesis gravidarum defined as
severe nausea and vomitting during pregnancy
88
what are some differentials for hyperemesis gravidarum
```
infections (gastroenteritis)
GI disorders (HPB)
metabolic disorders (addison's diabetic ketoacidosis, thyrotoxicosis)
```
89
management of hyperemesis gravidarum
IV rehydration
antiemetic (metoclopromide)
nutritional supplements
90
What is the UK law on terminations of pregnancies?
It is allowed under 1 of 5 different clauses which account for maternal risk, fetal risk, existing children risk, including mental health risks and fetal wellbeing after birth
91
How many physicians are required to sign off on a TOP in england?>
2
92
What is the risk of unsafe abortions
Infection, haemorrhage, PID, death, injury to organs, sepsis, infertility
93
What is done during an abortion consultation
Pelvic US to determine gestation, viability, single/multiple, intrauterine
Advise on contraception
Counselling alternatives
History
Blood tests (anti-D)
Swabs and STI screening
Consent
94
What is the medical management for abortions
Mifepristone (anti progesterone)
Misoprostol (prostaglandin)
95
What is the surgical management for abortion
Suction and curretage, dilation and evacuation
96
Complications of termination of pregnancies
Haemorrhage, infection, damage to organs, failure, retention of products, psychological impact
97
What is the definition of a breech presentation
Buttocks presenting first
98
Describe the types of breech presentations
Frank is when feet are high but buttocks are low
Complete breech is when legs are cross with arms around face
Footling breech is when one foot is engaged while the other isn’t
99
What are risk factors for breech
```
Past hx
Twins
Placenta praevia
Tumours/fibroids
Oligohydramnios
Prematurity of fetus
```
100
Complications in breech deliveries
```
Cord prolapse
Cord compression
Brain compression
Spinal cord trauma
Prematurity
```
101
When should an ECV be done if at all
After 37 weeks or if mother is labouring
102
Risk factors in failure of ECVs
```
Obesity
White caucasians
Nulliparous
Engaged breech
Reduced liquor volume
```
103
What should be done immediately after performing ECV?
CTG and anti-D
104
What are the contraindications for an ECV
```
Twins
Placental praevia
Ruptured membranes
Fetal compromise
APH
```
105
Indications for caeseran in breech
```
Elective
Fetal distress
Failure to progress
Footling presentation
SGA or LGA babies
```
106
Post natal complications in breech baby
Organ damage
Hypoxia
Autism and other conditions
107
fetal risks in preterm labour
perinatal mortality
cerebral palsy
chronic lung disease
blindness
108
risk factors for preterm labour
```
hx of preterm labour
lower SEC
uterine abnormalities/fibroids
extremes of maternal age
maternal disease
pregnancy complications
```
109
how does a preterm labour present?
before 37 weeks
painful contractions
vaginal bleeding
PPROM
110
how to prevent preterm labour?
treat any medical disease
cervical cerclage
fetal reduction
progesterone supplementation
111
what should be given acutely to a mother in preterm labour
steroids
antibiotics
tocolytic (oxytocin receptor antagonist, nifedipine)
magnesium sulphate
112
name 5 methods of monitoring fetal wellbeing
ultrasound assessment of fetal size
doppler umbilical artery
doppler fetal arteries (MCA and ductus venosus)
ultrasound assessment of amniotic fluid and biophysical profile
CTG
113
a one-off normal CTG is a good prognostic indicator of fetal wellbeing - T or F?
F - CTG only shows acute status, needs to be serially done to assessment wellbeing.
114
what are 2 maternal maneuvers that can be done in shoulder dystocia
Mcrobert's maneuver (legs and knees hyperflexed and brought to chest)
mother on all four limbs
115
what is the first thing that should be done in shoulder dystocia
call for senior support
116
in shoulder dystocia when should internal vaginal access be considered
after trying McRobert's maneuver and mother-on-4-limbs,
117
In Mcrobert's maneuver, where should pressure be applied?
externally on suprapubic area
118
difference between primary and secondary postpartum haemorrhage?
primary is within 24 hours of birth
119
what are the 6 types of miscarriages
threatened - bleeding, but still viable 25% chance death
inevitable
incomplete
complete
septic
missed - miscarriage before pregnancy known
120
in miscarriage, what are 3 patterns of HCG trends
viable pregnancy: 66% rise over 48 hours
miscarry: 50% decrease over 48 hours
ectopic: >66% rise or >50% decrease over 48 hours
121
3 forms of gestational trophoblastic disease?
hydatidiform mole
invasive mole
chorioncarcinoma
122
difference between invasive mole and chorioncarcinoma?
no mets in invasive mole
123
subcategories of hydatidiform mole?
complete - 1 sperm fertilise 1 empty oocyte
| incomplete - 2 or more sperms fertilise 1 oocyte
124
what is a 'snowstorm' appearance on US scan suggestive of?
gestational trophoblastic disease
125
what is the diagnostic test for GTD?
histological
126
percentage of causes of subfertility
30% unexplained
30% ovulation d/o
25% tubal damage
25% male factor
127
definition of oligospermia
<15 million/ml semen
128
which of these drugs have a higher chance of multiple pregnancies - clomifene, gonadotrophins, metformin
clomifene and gonadotrophins
129
which if these can cause OHSS clomifene, gonadotrophins, metformin
gonadotrophins
130
possible complications of fertility treatment
multiple pregnancy
| OHSS
131
most common endometrial cancer pathology?
endometroid adenocarcinoma
132
what is involved in the triple screening?
US for nuchal translucency
PAPP-A (low = higher risk)
beta-HCG (high = higher risk)
133
when should the quadruple test be offered instead of the triple test?
when it is >15+0 weeks and before 20+0 weeks
134
what is involved in the quadruple test? what levels are associated with downs syndrome?
beta hcg - high
papp-a - low
inhibin A - high
estriol - low
135
what does an open os in early pregnancy indicate
inevitable miscarriage
136
what is the diagnosis if someone is suspected to have a miscrriage, the Os is closed, and there is no fetus found in the uterus?
ectopic
137
symptoms of a molar pregnancy
hyperemesis, nausea
bump on palpation
+/- bleeding
US -> snow storm appearance
138
which of these is not a risk factor for hyperemesis gravidarum
```
Primip
Multiple pregnancy
PMH
grand multiparity
Molar pregnancy
Young
```
grand multiparity
139
difference between normal morning sickness and hyperemesis gravidarum
normal MS comes and goes in waves, symptoms don't stay for the whole day, can usually eat/drink a little in between attacks.
HG stays for the entire day without relenting, food/drink is near impossible without vomiting everything out. signs of dehydration/malnutrition is possible
