Obstetrics and Gynae Flashcards
(233 cards)
1
Q
ddx for preeclampsia features
A
acute fatty liver of pregnancy HUS TTP exacerbation of SLE cholecystitis
2
Q
predisposing factors which could make preeclampsia present
A
hydatidiform mole multiple pregnancy fetral triploidy severe renal disease antiphospholipid antibody syndrome
3
Q
what does HELLP syndrome stand for
A
Haemolysis
Elevated Liver enzymes, and a
Low Platelet count
4
Q
CNS complications of preeclampsia
A
cerebral haemorrhage cerebral oedema cortical and sinus vein thrombosis retinal detachment central serous retinopathy
5
Q
2 retinal complications of preeclampsia
A
retinal detachment
central serous retinopathy
6
Q
what are the first line drugs for the treatment of hypertension in preeclampsia?
A
methyldopa
labetalol
oxprenolol
7
Q
what are the second line drugs for the treatment of hypertension in preeclampsia?
A
hydralazine
nifedipine
prazosin
8
Q
what are the drugs used in severe hypertension >170/110 in preeclampsia?
A
labetalol
nifedipine
hydralazine
diazoxide
9
Q
what medications are contraindicated in the treatment of hypertension during pregnancy
A
ACEi
ARBs
10
Q
what are the risks of intravenous fluid administration in preeclampsia and why does this occur?
A
pulmonary oedema
peripheral oedema
because of increased vascular permiability and hypoalbuminaemia
11
Q
treatment for ecclampsia
A
- Resuscitation
- Magnesium sulphate (IV loading dose then infusion until 24hrs after last fit)
- Monitoring (BP, RR, urine, SaO2, deep tendon reflexes).
12
Q
why monitor urine output during magnesium sulphate infusion?
A
excreted renally and shouldnt be used in oliguria or renal impairment because serum magnesium concentration can rise.
13
Q
contraindications for use of tocolytics
A
gestation
14
Q
preferred agent for tocolysis
A
nifedipine 20mg oral stat
2nd dose after 30mins if contractions persist
15
Q
what do you call the foetal lie where the head is the presenting part?
A
cephalic
16
Q
what agent is used for prophylaxis of GBS during active preterm labour?
A
benzylpenicillin IV
17
Q
what is used to improve pulmonary outcomes in infants who are delivered prematurely?
A
IM Betamethasone to mum (2 doses 24hrs apart)
18
Q
If a woman goes into preterm labour at 28 weeks, in addition to nifedipine and betamethasone and abx, what should she receive?
A
magnesium sulphate –> neuroprotection (for preterm labour
19
Q
what is fFN?
A
Fetal fibronectin
glycoprotein promoting adhesion between the fetal chorion and maternal decidua
20
Q
criteria of chorioamnionitis
A
maternal fever + 2 or more of the following:
- Increased WCC
- Maternal tachycardia
- Fetal tachycardia (>160bpm)
- Uterine tenderness
- Offensive smelling vaginal discharge
- C-reactive protein >40
21
Q
tx for chorioamnionitis
A
ampicillin
gentamicin
metronidazole
22
Q
name 4 tocolytics
A
magnesium sulphate
Ca channel blockers - nifedipine
betamimetics - salbutamol
atosiban
23
Q
if 30-34 weeks gestation, which tocolytic should you use if someone goes into PTL?
A
nifedipine
24
Q
what is the complication associated with betamimetics which makes them less safe than other tocolytics?
A
can cause pulmonary oedema –> maternal death
do not use in fluid overload!!
25
what are the most potent inhibitors of uterine contractility available?
indomethacin (inhibits prostaglandin synthesis)
26
what is the side effect that means indomethacin should only be used in cases of PTL
- constriction of fetal ductus arteriosus (risk increases with increasing gestation)
- alteration of fetal cerebral blood flow
- reduced fetal renal function --> oligohydramnios
27
when do you administer corticosteroids to mothers in PTL?
if 23 --> 34+6 weeks gestation
28
when do you administer corticosteroids to mothers in PTL?
if 23 --> 34+6 weeks gestation
29
what tocolytic is known to have neuroprotective properties and decrease the risk of cerebral palsy?
mag sulphate
30
what is a fetal factor which affects intrauterine fetal growth?
fetal pancreatic B cell function (insulin is one of the main regulators of fetal growth).
31
what are four consequences of growth restriction in a fetus?
hypoglycaemia
acidosis/hypoxia (--> CP)
erythroblastosis
IUFD
32
what is the biggest maternal factor which can lead to fetal growth restriction?
maternal hypertension
33
How do you identify pregnancies of high risk for intrauterine growth restriction?
symphysiofundal height measurements and plotting on an appropriate chart which has been adjusted for the maternal demographics.
or U/S
34
what are 3 features on USS you look at to determine risk of IUGR?
fetus size
amniotic fluid volume
doppler umbilical blood flow velocity
35
what are 4 hx/exam/inv you can do in OPD to monitor pregnancies at risk of IUGR?
fetal movement (fetal kick) count
cardiotocography
serial USS exams
doppler flow velocity wave forms
(high negative predictive value)
36
when do you give Anti-D injections if rhesus negative?
28 and 34 weeks
and if symptoms or procedures are likely to cause fetal blood to mix with maternal blood (threatened miscarriage, ectopic pregnancy, D&C, termination)
37
what is the purpose of giving anti-D IM injections to pregnant women with Rhesus negative blood type?
prevent sensitisation of maternal immune system --> stops the formation of antibodies which could affect subsequent pregnancies.
38
what is the complication caused by RhD positive antibodies in the mother during the next pregnancy?
haemolytic disease of the newborn.
| HDN
39
what test can you do to see if the dose of anti-D was sufficient for the mixing of blood?
Kleihauer test
40
how do you treat a patient with mild iron deficiency on antenatal testing?
encourage to eat more iron from leafy green vegetables, beans, wholegrains etc.
41
when do you do oGTT in prenatal testing?
26-28weeks
42
what are the cut-offs for GDM on OGTT?
Fasting >5.1
1-hr >10
2hr >8.5
43
what are risks for GDM? / when would you do an earlier oGTT at 12weeks?
- previous GDM
- maternal age >40
- BMI >35
- Prev baby >4.5kg /90th percentile
- PCOS
44
how do you test for GBS?
low vaginal swab
45
what is the treatment for a GBS positive result and why do we treat?
- IV penicillin during labour
- clindamycin if allergic.
to prevent early-onset neonatal sepsis (1 in 200 neonates from GBS +ve)
46
what percentage of women are asymptomatically GBS +ve
15-25%
47
what does HCG stand for and what cells release it?
human chorionic gonadotropin
released by syncytiotrophoblasts
48
when can you do a nuchal translucency scan for fetal aneuploidy/trisomy 21
11 - 13+6 weeks
49
gram negative intracellular diplococci on urethral swab of male with discharge what's the bug?
gonorrhoea
50
what does gonorrhoea look like on gram stain?
gram negative intracellular diplococci
51
tx for sarcoptes scabiei
permethrin cream 5% from neck down and washed off 24hrs later
tx of household and sexual contacts
wash sheets hot cycle
antihistamines for persisting itch
52
STI that causes intense scratching groin, eyebrows, pubic hair, eyelashes
phthirus pubis
53
treatment for phthirus pubis
permethrin cream 5% rinse topically from chest to knees,
| washed off 10 minutes and repeat next week
54
typical clinical appearance of phthirus pubis
grains of sand
55
bumps at end of penis from masturbating lots
sclerosing lymphangitis
56
what types of HPV cause genital warts
6, 11
57
what types of HPV are assoc with cervical cancer
16, 18
58
treatment for genital warts
none
cryotherapy
podophyllin
59
treatment for chlamydia
azithromycin (plus doxy if complicated site)
60
treatment for gonorrhoea
ceftriaxone (resistant to penicillin)
61
normal vaginal pH premenopause
3.5-4.5
62
what is the most common organisms present in the vagina premenopause
lactobacilli
63
what is the most common fungus causing vulvovaginal candidiasis?
candida albicans
64
sx of vulvovaginal candidiasis
vulval itching and soreness
dyspareunia
thick curdy vaginal discharge
65
treatment of candidiasis
fluconazole PO or topical (a type of imidazole)
| or clotrimazole pessary
66
can a woman take fluconazole for candidiasis if pregnant?
topical is safe, oral is contraindicated
67
RFx for candidiasis
```
pregnancy
high dose OCP or HRT
immunosuppression/HIV
broad spectrum abx use
diabetes
```
68
should you treat the partner of someone with vulvovaginal candidiasis?
no evidence if asymptomatic partner
69
strawberry cervix + fouls smelling vaginal discharge
vulval soreness and itching.
what's the likely diagnosis
trichomonas vaginalis
70
should you treat the partner of someone with trichomonas vaginalis?
yes, high rate of recurrence if partner not treated
also screen for other STIs
71
treatment for trichomonas vaginalis
metronidazole single dose 2g
72
foul smelling "fishy" vaginal discharge with no pain/itching/inflammation.
most likely dx?
bacterial vaginosis
73
What is the Amsel criteria for bacterial vaginosis?
1 presence of clue cells on microscopy (epithelial cells covered in bacteria
2. Creamy greyish white discharge seen during speculum exam
3. Vaginal pH of more than 4.5
4. Release of characteristic fishy odour on addition of alkali: 10% potassium hydroxide.
(3 out of 4 criteria for dx)
74
Treatment for bacterial vaginosis
metronidazole orally or as a gel.
single dose 2g or 5 days BD 400mg
or clindamycin but more expensive
75
complications of bacterial vaginosis
if infected in 1st trimester can --> late 2nd trimester miscarriage and preterm labour
swab in first trimester if past hx of 2nd trimester fetal loss --> if present then treat with metronidazole early 2nd trimester. metro is safe in pregnancy
76
complications of chlamydia infection
PID --> ectopic pregnancy, Fitz-Hugh-Curtis syndrome (perihepatic adhesions like violin strings), infertility, intraperitoneal abscesses and adhesions
77
tx of PID during infection
ceftriaxone IM
+ oral doxycycline
+ oral metronidazole
78
what is the optimum weight gain in pregnancy for persons of BMI 18.5-25?
11.5-16 kg
79
what is the optimum weight gain in pregnancy for persons of BMI >30
5-9kg
80
what is the name for when a newborn has fluid in its lungs and has resp distress?
TTN - transient tachypnoea of the newborn
81
what is the common cause for RDS? respiratory distress syndrome?
surfactant deficiency
82
2 components to the maternal serum antenatal first trimester screening for trisomy?
free bHCG
| PAPP-A (pregnancy associated plasma protein-A)
83
what are the components used to estimate risk for trisomy in the first trimester screening?
Maternal age
Maternal serum (bHCG, PAPP-A)
NT on US (11-13+6 weeks)
84
what are the components of the second trimester screening for fetal aneuploidy and neural tube defects?
triple test serum:
- alpha-feto protein
- hCG
- unconjugated estriol
85
what does levels of alpha feto protein tell us in second trimester screening?
measured as multiple of median
high = spina bifida
normal = unaffected
low = down syndrome
86
if second trimester screening for NTD (neural tube defect) comes back high risk, what would you recommend?
detailed morphology USS focussing on the brain, ventricles and spine.
87
when can you perform NIPT testing?
anytime from 10 weeks gestation
88
when can you perform an amniocentesis?
from 14 weeks (if BMI>40 do after 15 weeks)
89
what is the risk of amniocentesis?
miscarriage (0.5%)
| amniotic fluid leak/infection
90
what is the definition of an SGA fetus?
91
what are some causes of the SGA fetus/IUGR?
```
low maternal weight
poor nutrition in pregnancy
birth defects/aneuploidy
use of drugs/etoh/smoking
gestational hypertension
gestational diabetes
multiple pregnancy
placental abnormalities
oligohydramnios
```
92
what is the AC as measured on US an indicator of?
metabolic function because it is mostly the liver being measured and thus glycogen stores.
93
what is potter syndrome?
characteristic physical appearance of a fetus with oligohydramnios (mostly d/t renal failure or lack of kidneys developing) which results in pressure during utero.
downwards nose, flat ears, flat face, micrognathia.
94
what is the incidence of preeclampsia?
3% of all pregnancies
95
what does a negative fetal fibronectin result indicate?
very high negative predictive value.
| very unlikely that the woman will deliver in the next 7-14 days.
96
what is the normal thyroid response to pregnancy and bHCG?
bHCG --> acts like TSH and can stimulate thyroid --> lower TSH, higher T4. Often affected in early pregnancy
97
when should you treat high TSH in pregnancy?
if TSH > reference range + low T4
or
TSH >10 regardless of T4
(no evidence if subclinical)
98
what is the guideline for folic acid for the normal population?
0.4mg daily for one month preconception and first 12weeks of pregnancy
99
what is the folic acid dose for pregnant women at increased risk of NTD?
5mg per day
100
what extra supplement should pregnant or breastfeeding vegans take?
vit B12
101
what is the treatment cut-off for vit D levels in a pregnant woman
50 still take 400IU per day as part of a pregnancy multivitamin
102
What are the biological functions of bhCG?
Maintains corpus luteum
| Regulates growth factors and cytokines involved in cell proliferation, growth and differentiation
103
What are the clinical uses of bHCG testing?
Pregnancy test and idea of dates
Pregnancy surveillance (including trisomy 21)
Tumour marker
104
What produces HCG?
Syncytiotrophoblasts
105
When is the peak level of HCG?
9-12 weeks
106
What does doubling mean in HCG?
That HCG level should at least double in 48hrs.
107
How can we determine the approximate gestation by early USS?
Crown-rump length and the ration between the size of the embryo and the yolk sac. The yolk sac decreases is size and disappears by about 12-13weeks.
108
What is the incidence of miscarriage in clinically recognised pregnancies?
12-20%
109
What is inevitable miscarriage
Open cervical os, plus pain and bleeding
110
What is an Incomplete miscarriage
Some of the products of conception have been lost. But not all
111
What is a missed miscarriage
Pregnancy which has failed but has not expelled the products of conception
112
What is a septic miscarriage
Rare now. Used to be attempted terminations which went wrong before legal abortion,
113
What are two possible history presentations of a woman with miscarriage?
Missed/delayed menses followed by pain and bleeding.
Or
Bleeding in early pregnancy
114
What is the best way to diagnose miscarriage?
Products of conception in clots analysed by lab (sometimes chorion villi macroscopic too
115
What are the management options of incomplete or missed miscarriage
Expectant
Surgical evacuation-most popular
Medical: Misoprostol + mifepristone
116
What is the definition of recurrent miscarriage
Three or more consecutive miscarriages
117
What is a procedure you can offer for cervical insufficiency resulting in recurrent miscarriage?
Cervical cerclage
118
What is the most common site for an ectopic pregnancy
85% in ampulla of Fallopian tube
119
What is a heterotopic pregnancy?
Ectopic pregnancy plus intrauterine pregnancy concurrently
120
When would you suspect a heterotopic pregnancy?
IVF -1:100 incidence
121
Risk factors for ectopic pregnancy
```
Previous ectopic
PID
Tubal surgery
IVF pregnancy
if pregnant on IUD - 50% ectopic
```
Minor: smoking, increased age and multiple sex partners
122
What is a convincing symptom of ectopic pregnancy?
Shoulder-tip pain
123
What are the 3 pillars of ectopic pregnancy?
Clinical: amenorrhea +/- pv spotting and/or pain
BHCG positive
USS: embryo or gestational sac outside uterus or a non-cystic mass in adnexa, can just have free fluid if ruptured but non-specific
124
What is the gold standard treatment for ectopic pregnancy?
Laparoscopic salpingectomy or salpingotomy
125
What is a medical treatment for ectopic pregnancy?
IM methotrexate
126
What is the tumour marker for a molar pregnancy/hydatidiform mole/trophoblast tumour?
HCG
127
Where is hydatidiform mole of high incidence?
Vietnam/Asian
128
What is the management for hydatidiform mole?
Do chest X-ray looking for metastasis
| Then treat with chemotherapy
129
What factors favour success of VBAC?
Previous NVD
Previous successful VBAC
Spontaneous onset of labour
Uncomplicated pregnancy
130
What factors reduce likelihood of successful VBAC?
```
High BMI
Previous LSCS for shoulder dystocia
IOL
Macrosomia
Advancing maternal age
>1 previous LSCS
```
131
What are signs or symptoms of caesarean scar rupture when attempting VBAC.
```
Abnormal CTG (55-87% of cases)
Severe abdo pain
Pain between contractions
Chest pain/SOB/shoulder tip pain
Scar tenderness
Abnormal vaginal bleeding
Maternal shock
Loss of uterine activity
Loss of station of the presenting part
```
132
What are the legal requirements for TOP in SA.
2 registered practitioners
133
What are the methods of TOP
Surgical: e.g. VSTOP (vacuum suction TOP)
Medical: e.g. Prostaglandins (often used after 2nd trimester aneuploidy)
Or anti-progesterones e.g. Mifepristone
134
What is hyperemesis gravidarum?
Extreme morning sickness,
| 3rd commonest cause of hospitalisation in pregnancy
135
What are complications of hyperemesis gravidarum
```
Electrolyte disturbances
Vit deficiency syndromes
Oesophageal tears
Pneumomediastinum
Tooth decay
```
136
What antiemetics are safe in pregnancy?
Metoclopramide
Ginger
Sometimes may use ondansetron, not extensively tested.
137
What is ptyalism?
Excessive spitting (due to saliva build up) in pregnancy
138
What is a complication of ptyalism
Electrolyte disturbance, especially low potassium
139
Risk factors for ovarian hyperstimulation
Age 4000
Multiple follicles
Previous hyperstimulation
140
Complications of ovarian hyperstimulation
Ascites
Reduced intravascular volume
Pulmonary effusions (pericardial rare)
Thrombosis in cerebral and upper limb vessels
141
Sx of ovarian hyperstimulation
Abdominal discomfort
N & v
Abdominal distension
Dyspnoea
3-7 days after HCG
Or 12-17days if conception
142
What is one way to prevent ovarian hyperstimulation often used for women with PCOS?
In vitro maturation (immature eggs collected and matured in lab and then ICSI: intracytoplasmic sperm injection directly into egg)
143
How does size of ovaries correspond with severity of ovarian hyperstimulation
Mild 12cm
144
What are the biological functions of bhCG?
Maintains corpus luteum
| Regulates growth factors and cytokines involved in cell proliferation, growth and differentiation
145
What are the clinical uses of bHCG testing?
Pregnancy test and idea of dates
Pregnancy surveillance (including trisomy 21)
Tumour marker
146
What produces HCG?
Syncytiotrophoblasts
147
When is the peak level of HCG?
9-12 weeks
148
What does doubling mean in HCG?
That HCG level should at least double in 48hrs.
149
How can we determine the approximate gestation by early USS?
Crown-rump length and the ration between the size of the embryo and the yolk sac. The yolk sac decreases is size and disappears by about 12-13weeks.
150
What is the incidence of miscarriage in clinically recognised pregnancies?
12-20%
151
What is inevitable miscarriage
Open cervical os, plus pain and bleeding
152
What is an Incomplete miscarriage
Some of the products of conception have been lost. But not all
153
What is a missed miscarriage
Pregnancy which has failed but has not expelled the products of conception
154
What is a septic miscarriage
Rare now. Used to be attempted terminations which went wrong before legal abortion,
155
What are two possible history presentations of a woman with miscarriage?
Missed/delayed menses followed by pain and bleeding.
Or
Bleeding in early pregnancy
156
What is the best way to diagnose miscarriage?
Products of conception in clots analysed by lab (sometimes chorion villi macroscopic too
157
What are the management options of incomplete or missed miscarriage
Expectant
Surgical evacuation-most popular
Medical: Misoprostol + mifepristone
158
What is the definition of recurrent miscarriage
Three or more consecutive miscarriages
159
What is a procedure you can offer for cervical insufficiency resulting in recurrent miscarriage?
Cervical cerclage
160
What is the most common site for an ectopic pregnancy
85% in ampulla of Fallopian tube
161
What is a heterotopic pregnancy?
Ectopic pregnancy plus intrauterine pregnancy concurrently
162
When would you suspect a heterotopic pregnancy?
IVF -1:100 incidence
163
Risk factors for ectopic pregnancy
```
Previous ectopic
PID
Tubal surgery
IVF pregnancy
if pregnant on IUD - 50% ectopic
```
Minor: smoking, increased age and multiple sex partners
164
What is a convincing symptom of ectopic pregnancy?
Shoulder-tip pain
165
What are the 3 pillars of ectopic pregnancy?
Clinical: amenorrhea +/- pv spotting and/or pain
BHCG positive
USS: embryo or gestational sac outside uterus or a non-cystic mass in adnexa, can just have free fluid if ruptured but non-specific
166
What is the gold standard treatment for ectopic pregnancy?
Laparoscopic salpingectomy or salpingotomy
167
What is a medical treatment for ectopic pregnancy?
IM methotrexate
168
What is the tumour marker for a molar pregnancy/hydatidiform mole/trophoblast tumour?
HCG
169
Where is hydatidiform mole of high incidence?
Vietnam/Asian
170
What is the management for hydatidiform mole?
Do chest X-ray looking for metastasis
| Then treat with chemotherapy
171
What factors favour success of VBAC?
Previous NVD
Previous successful VBAC
Spontaneous onset of labour
Uncomplicated pregnancy
172
What factors reduce likelihood of successful VBAC?
```
High BMI
Previous LSCS for shoulder dystocia
IOL
Macrosomia
Advancing maternal age
>1 previous LSCS
```
173
What are signs or symptoms of caesarean scar rupture when attempting VBAC.
```
Abnormal CTG (55-87% of cases)
Severe abdo pain
Pain between contractions
Chest pain/SOB/shoulder tip pain
Scar tenderness
Abnormal vaginal bleeding
Maternal shock
Loss of uterine activity
Loss of station of the presenting part
```
174
What is a maternal serum marker of possible IUGR?
Low PAPP-A <0.4
175
At what level must bHCG be for uterine pregnancy to be seen (gestational sac) on transvaginal uss?
1500-2000
176
How much should beta HCG rise during the first 10 weeks of pregnancy?
At least double every 48hrs
177
What is the incidence of placenta Previa in the first trimester?
5%
178
What is the incidence of placenta Previa in the first trimester?
0.5%
179
What is the incidence of placental abruption?
1-2%
180
What are the risk factors for placental abruption?
Substance abuse (cocaine)
HTN, vascular abnormalities
Blunt trauma (MVA)
Smoking
181
What are the 4 main causes of PPH
4 Ts:
- Tone: uterine agony
- Tear: cervical, vaginal, perineal
- Tissue: retained placenta/membranes
- Thrombin: coagulopathy (including DIC)
182
what is the condition which you prevent by administering Vit K to newborns?
bleeding diathesis (haemorrhagic disease of the newborn)
183
when inspecting the placenta, what would blood vessels running to the edge of the membranes indicate?
succenturiate lobe
184
what are the lumps on the maternal side of the placenta called?
cotyledons
185
what is placenta accreta?
the trophoblast/placenta has invaded the decidua and myometrium to varying degrees
186
what is placenta percreta
placenta has penetrated to the serosa of the uterus
187
what are some of the complications of poorly controlled blood glucose during pregnancy?
```
congenital malformations
pre-eclampsia
polyhydramnios
preterm birth
macrosomia
growth restriction
IUFD
shoulder dystocia
newborn hypoglycaemia/jaundice or resp distress
```
188
what anti-diabetic drug is contraindicated in pregnancy?
glitazones
189
what is the definition of preeclampsia?
hypertension >140/90 after 20 weeks
+ proteinuria (>300mg in 24hrs or protein-creatinine index >3)
or other new onset organ involvement:
- liver disease
- neurological problems
- haematological changes
- pulmonary oedema
- IUGR
190
what is a severe complication of HELLP syndrome?
DIC
191
what is a long term fetal complication which can be a result of IUGR?
Metabolic syndrome
| "thrifty gene"
192
what are risk factors for preeclampsia?
```
multiple pregnancy
age 35
ethnicity: indian
obesity
working during pregnancy
high booking BP
low fruit intake
primipaternity or sex
```
193
grade 1 placenta previa
low uterine segment edge >5cm
194
Grade 2 placenta previa
marginal, toucches edge
195
Grade 3 placenta previa
partly covers os
196
Grade 4 placenta previa
covers os completely
197
What are the 4 main causes of PPH
4 Ts:
- Tone: uterine agony
- Tear: cervical, vaginal, perineal
- Tissue: retained placenta/membranes
- Thrombin: coagulopathy
198
what is the genetic link to TOF?
chromosome 22 deletions
or
DiGeorge sydrome
199
what is the most common cyanotic congenital heart defect?
TOF
200
what percentage of cyanotic congenital heart defects does TOF make up?
50-70%
201
how does squatting down help relieve the cyanosis of a tet spell?
squatting --> increased peripheral vascular resistance --> increased left heart pressure --> reversal of shunt --> blood goes to lungs --> oxygenated
202
how do you diagnose TOF?
echocardiogram (sometimes even pre-natally)
203
how do you treat TOF?
surgery in first year of life:
- close septal defect
- enlarge RV outflow tract
204
what is a ddx for lower extremity cyanosis in a neonate?
coarctation of the aorta
coarctation occurs after the subclavian vessels but before the patent ductus arteriosis --> deoxygenated blood enters aorta to go to the lower extremities.
205
what genetic anomaly is coarctation of the aorta associated with?
Turner's syndrome
206
what does the ductus arteriosus turn into?
the ligamentum arteriosum
207
what's a sign on xray of ribs that you might see with coarctation of the aorta?
rib notching
| d/t wear away at bone from pulsating intercostals due to differences in pressure
208
what conditions are assoc with ventricular septal defects?
Down Syndrome
| Fetal alcohol syndrome
209
what murmur is assoc with VSD?
holosystolic murmur heard at the left sternal border
210
What is eisenmenger syndrome?
when pulmonary hypertension develops from a VSD and the shunt changes to R --> L
211
baby seems fine but has a VSD, then baby turns blue, what is the diagnosis
Eisenmenger Syndrome, shunt reversal from pulmonary HTN
212
what is a complication of an ASD?
paradoxical embolism --> thromboembolism from vein --> into RA --> crosses ASD --> LA --> LV -> brain
213
what are the two parts that form the atrial septum?
ostium primum
| ostium secundum
214
what is the active management of PPH?
administer oxytocin IM or IV immediately after anterior shoulder delivered.
deliver placenta with controlled cord traction and guarding uterus.
215
what stimulates FSH release?
Low-frequency pulses of LHRH
216
What stimulates LH release?
high-frequency pulses of LHRH
217
which phase of the menstrual cycle is of fixed length?
luteal phase
218
what is the main test used to see if a woman is ovulating?
day 21 progesterone (mid-luteal phase = highest level of progesterone)
219
what is Mendelson's syndrome?
chemical pneumonitis or aspiration pneumonitis caused by aspiration during anaesthesia, especially during pregnancy.
220
what is Sheehan syndrome?
post-partum hypopituitarism caused by large PPH
221
what are 3 drugs which lower the efficacy of the COCP
Carbamazepine
Rifampicin,
Phenytoin.
222
what type of ovarian cancer can cause symptoms of hyperthyroidism?
struma ovarii
223
what is Tibolone?
a synthetic steroid hormone with estrogenic and progestrogenic and weak androgen actions. Can prevent hot flushes, bone loss and vaginal dryness when used in perimenopausal women
224
severe preecclampsia in first pregnancy. now 10 weeks pregnant, what do you give her to prevent preeclapsia happening this pregnancy
aspirin and calcium
225
how does ethanol work as a tocolytic
suppresses oxytocin release by the pituitary
226
most common side effect of nifedipine
headache
227
3 x side effect of steroids used in PTL
maternal leukocytosis
increased maternal blood glucose levels
decreased fetal movements
228
5 causes of PPH
```
uterine atony
retained placenta/products
vaginal/perineal lacerations
cervical laceration
haemostatic disorder
```
229
Mx of PPH
send for help
ABC
bimanual uterine massage
10 unit bolus of syntocinon
40 units syntocinon in 1L hartmann's over 4 hrs
ergometrine 500mcg half IV and IM
insert indwelling catheter
misoprostol tablets mcg per vagina/rectum
Units of blood (4)
theatre if still not stop
- prostaglandin F2alpha injected via abdo into 4 quadrants uterus.
- uterine artery ligation/internal iliac artery
- hysterectomy
230
AE of syntoconon
hypotension
| hyponatraemia
231
AE of ergometrine
nausea and vomiting
| hypertension
232
misoprostol AE
bronchoconstriction (beware in asthma)
233
consequences of PPH
Death
hypovolaemic shock
DIC
Sheehan's syndrome (avascular necrosis of pituitary)
