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Obstetrics Flashcards

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1
Q

What serum HCG level is used to indicate pregnancy?

A

> 1500

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2
Q

Describe a threatened miscarriage

A

Pain +/- bleeding up to 24 weeks

US shows foetal heart beat

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3
Q

Describe an inevitable miscarriage

A 
Cervix open (internal os)
Productions of conception not yet passed
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4
Q

Describe incomplete miscarriage

A

Some products of conception have been passed
Some tissue/blood clot remains in the uterus
Cervix stays open

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5
Q

What is the treatment for septic miscarriage?

A

IV Antibiotics for 24 hours

Surgical removal

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6
Q

Describe complete miscarriage

A

All products of conception passed naturally

Bleeding and pain reduces naturally

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7
Q

What are the risk factors for T1 miscarriage?

A 
Increased age
Previous miscarriage
Smoking/alcohol
Folate deficiency 
Consanguinity 
NSAIDS/aspirin
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8
Q

What are the advantages of medical management of miscarriage?

A

Avoid surgery
Higher patient satisfaction
Can be done as outpatient

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9
Q

What are the advantages of expectant management of miscarriage?

A

Avoids any medications or surgery

Can be at home

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10
Q

What are the disadvantages of expectant management of miscarriage?

A

Unpredictable pain and bleeding
Patient worries
Takes longer
Can be unsuccessful

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11
Q

What are the disadvantages of medical management of miscarriage?

A

Can be more pain/bleeding than expectant
May experience side effects from drug
Day stay in hospital

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12
Q

What medication is used for medical management of miscarriage?

A

Misoprostol

Prostaglandin

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13
Q

Define recurrent miscarriage

A

3+ consecutive miscarriages with the same partner

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14
Q

Give some causes of recurrent miscarriage

A

Translocations
Antiphospholipid syndrome
Uterine anomalies
Unexplained

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15
Q

Lower HCG levels than expected may indicate:

A

Incomplete miscarriage
Early intrauterine pregnancy
Ectopic
Molar pregnancy

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16
Q

What is the most common location of ectopic?

A

Isthmus of Fallopian tube

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17
Q

What are the symptoms of an ectopic pregnancy?

A 
Unilateral pain, PV bleeding/spotting
Fainting/dizzy/collapse
Shoulder tip pain
Nausea and vomiting 
Diarrhoea
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18
Q

When would expectant management of ectopic be suitable?

A

If patient is asymptomatic
<3cm size
HCG <1500 and falling

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19
Q

What is the medical management of ectopic?

A

Methotrexate

Do not get pregnant for 3-6 months

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20
Q

When might medical management of ectopic be indicated?

A

<3.5cm size
HCG <5000
No symptoms or free fluid

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21
Q

What is gestational trophoblastic disease?

A

A spectrum of disorders of trophoblastic developing arising from abnormal fertilisation

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22
Q

Which GTD is potentially pre-malignant?

A

Hydratidiform mole/molar pregnancy

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23
Q

Which GTDs are malignant?

A

Invasive mole

Choriocarcinoma

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24
Q

What is the presentation of GTD?

A 
Asymptomatic - US 
Bleeding
N+V
Uterus large for dates 
Severe pre-eclampsia sx
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25
What is the management of GTD?
Offer surgical evacuation Confirm on histology Refer to specialist centre for follow up
26
What is hyperemesis gravidum?
Excessive nausea and vomiting in the first trimester significant enough to affect the mother’s functioning
27
What are the complications of hyperemesis?
Dehydration Ketosis Weight loss Nutritional deficiency
28
What causes the excessive vomiting in hyperemesis?
Reaction to HCG levels
29
How does thyrotoxicosis occur in pregnancy?
The alpha subunit of hcg is the same as a subunit of TSH therefore can stimulate thyroxine production
30
What investigations would you do for someone presenting with suspected hyperemesis?
Urine HCG and dipstick (ketones) FBC, U+Es, LFT, amylase, TFT US - exclude multiple pregnancy/GTD and if LFTs abnormal
31
What is the management of hyperemesis?
Rehydration - IV fluids (not glucose) Thiamine and folic acid replacement if needed Anti-emetics Ranitidine
32
Why don’t we give glucose fluids in hyperemesis?
Can cause wernicke’s encephalopathy
33
Describe the pathophysiology pre-eclampsia
Abnormal trophoblastic invasion and adaptation of spiral arteries Causing placental ischaemia due to microclots in the vasculature Therefore resistance is increased causing maternal hypertension and the placenta doesn’t function as well
34
What values define hypertension in pregnancy?
Greater than 140/90 on two occasions more than four hours apart Or a single diastolic reading of greater than 110
35
When is proteinuria in pregnancy significant?
2+ or more
36
What is the first line investigation for pre-eclampsia?
Protein:creatinine ratio | >30 diagnosis - then do 24 hr urine collection (>300 abnormal)
37
Define pre-eclampsia
New onset hypertension and proteinuria in the second half of pregnancy that resolves after delivery
38
What percentage of women with pre-eclampsia develop eclampsia?
2%
39
What are the complications of pre-eclampsia?
``` Eclampsia Hepatic rupture HELLP syndrome Pulmonary oedema Acute fatty liver of pregnancy Cerebral oedema AKI ```
40
What are the risks to baby from pre-eclampsia?
Stillbirth Growth restriction Haemorrhage Pneumothorax
41
Define eclampsia
Cerebral vasospasm causing fits that can occur up to 3 weeks after birth
42
What is the management of eclampsia?
Magnesium sulphate
43
What are the clinical features of pre-eclampsia?
``` Headache Visual disturbance Epigastric or right upper quadrant pain Oedema Vomiting ```
44
What are the elements of HELLP syndrome?
Haemolysis Elevated liver enzymes Low platelets
45
What investigations would you do for suspected pre-eclampsia?
``` Blood pressure and urine dip FBC, U+E, LFT, clotting Fetal movements/CTG Umbilical Doppler Ultrasound for fetal size and liquor volume ```
46
When do pre-eclampsia patients need admitting?
BP >170/110 BP >140/90 and proteinuria Borderline with significant symptoms
47
What preventative methods are used for pre-eclampsia?
Low dose aspirin 75mg from 12 weeks Rest, exercise, weight loss Calcium supplementation Labetalol/nifedipine if hypertensive
48
Which BP medications cannot be used in pregnancy?
Diuretics | Ace inhibitors
49
Why do we always give modified release BP drugs to pregnant women?
Do not want a sudden decrease in BP as this could disturb placental flow
50
What are the early effects of diabetes in pregnancy?
Increased risk of miscarriage Increased risk of foetal abnormalities N+V -> DKA Increased risk of infection, hypertension and poor renal function
51
What are the late effects of diabetes in pregnancy?
``` Increased risk pre-eclampsia and SGA Increased stillbirth risk Progression of nephropathy and retinopathy Decreased awareness of hypos Increased insulin resistance ```
52
What are the effects on labour of diabetes in pregnancy?
Increased risk of pre-term Higher Csection rate Increased induction rate Macrosomia
53
What is included in the pre-pregnancy planning for women with pre-existing diabetes?
``` Smoking cessation BMI <27 5mg folic acid from 3 months pre-conception HbA1c <48 BMs 5-7 ```
54
If uncomplicated pre-existing Diabetes, when would we induce?
37-38+6 weeks
55
If complicated pre-existing diabetes, when would we C section?
38 - 38+6 weeks
56
What are the risk factors for gestational Diabetes?
Increased age Obesity Previous hx First degree relative with diabetes
57
When do we do the OGTT for pregnant ladies?
26-28 weeks
58
What are the diagnostic values on the OGTT for gestational Diabetes?
Fasting >5.6 mmol/l | 2 hours >7.8 mmol/l
59
If the patient is diet controlled gestation diabetes, when do we deliver by?
40 +6
60
If the patient is medication controlled gestational diabetes, when do we induce?
39 weeks
61
Macrosomia is a birth weight of more than...
4.5 kg
62
What are the foetal effects of iron deficiency anaemia in the mother?
Pre term Low birth weight Impaired psychomotor development
63
When do we test for anaemia in pregnancy?
Booking | 28 weeks
64
What advice needs to be given when prescribing iron supplements?
Take on an empty stomach 1 hour before food Take with a vitamin C source to aid absorption (orange juice) Do not take with milk
65
What factors contribute to increased VTE risk in pregnancy?
Hypercoaguable state Venous stasis Pressure of uterus
66
How soon can gender of foetus be determined?
16 weeks by US | 9 weeks through maternal blood
67
When do we test the red cell antibodies?
Booking | 28 weeks
68
If rhesus negative mother, when do we give anti-D?
28 weeks
69
How does clomiphene citrate work?
Binds to oestrogen receptors in pituitary to increase FSH and LH levels to encourage growth and rupture of follicles
70
What are the complications of clomiphene?
Multiparity Ovarian hyperstimulation syndrome Enlarged ovarian cysts Inhibit lactation
71
What is the Naegele Rule?
To work out EDD | (1st day of LMP + 1 year) - 3 months + 7 days
72
Describe the process of Down syndrome screening
10-14 weeks - US nuchal translucency and maternal blood test 14-20 weeks - quadruple blood test Amniocentesis from week 15 CV 11-14 weeks
73
What are the maternal CVS changes in pregnancy?
``` Increased blood volume Increased cardiac output Increased stroke volume Increased heart rate Decreased blood pressure Decreased systemic vascular resistance ```
74
What is the role of syntocin in labour?
Increases strength and frequency of contractions
75
How often can you increase the dose of syntocin in labour?
Every 30 mins
76
What are the side effects of syntocin?
Arrhythmia Headaches N+V Uterine hyperstimulation
77
What is the management of APS?
Aspirin and heparin
78
What are the diagnostic criteria for APS?
3 + T1 losses or 1 + T2 loss Unexplained thrombo-embolic event Autoimmune thrombocytopenia Confirmatory lab test
79
What are the diagnostic lab tests for APS?
Lupus anticoagulant | Anti-cardiolipin antibody
80
What is characteristic of obstetric cholestasis?
Pruritus in the absence of a skin rash - esp affecting palm and soles and worse at night Abnormal LFTs
81
What are the risks of obstetric cholestasis?
``` Spontaneous/iatrogenic preterm birth Foetal death Meconium passage PPH increased likelihood of C section ```
82
What is the management of obstetric cholestasis?
Discussion induction >37 weeks Topical emollient or cholestyramine for pruritus Ursodeoxycholic acid
83
What are the risk factors for placenta praevia?
``` Previous C section High parity Maternal age >40 Multiple pregnancy Previous praevia ```
84
What is included in the TORCH screen?
``` Toxoplasmosis Other: parvovirus Rubella Cytomegalovirus Hepatitis ```

Obstetrics And Gynaecology (6 decks)

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