Obstetrics and Gynaecology Flashcards
(120 cards)
1
Q
Investigation of Choice
Suspected Ectopic Pregnancy
A
Transvaginal USS
2
Q
Sensitising Events Rhesus Disease (3)
A
Miscarriage >12 weeks
Abdominal Trauma
Invasive Antenatal Testing
3
Q
Delivery of Anti-D in Rh -VE
Exception
A
- At 28 weeks
- At birth on confirmation that baby is Rh +VE
Cannot give to sensitised women
4
Q
Vaccines and Anti-D Injection
A
Cannot give live vaccines e.g. MMR within 3 months of anti-D injection
5
Q
Surfactant Production and Delivery
A
Catecholamines and cortisol released by the foetus at delivery stop the production of surfactant
6
Q
Umbilical Arteries Carry
A
Dexoygenated blood
From foetus to the placenta
7
Q
Umbilical Vein Carries
A
Oxygenated blood
From placenta to the foetus
8
Q
Result of Reduced Oxygen Delivery to Foetus (2)
A
Reduced growth
Reduced movements
9
Q
Medical TOP
Early VS Late
A
Early = up to 9+6 Late = from 10+0
10
Q
Medical TOP Regimen
A
Oral anti-progesterone
+
Oral or Vaginal Prostaglandin 24-48 hours later
e.g. 200mg mifepristone + misoprostol
11
Q
Surgical TOP Methods (2)
A
Vacuum Aspiration = 6-12 weeks
Dilation and Evacuation = 13-24 weeks
12
Q
Post-Procedure TOP Care
A
Pregnancy Test should be given at 2-3 weeks
Contraception should be given
Not progesterone contraception - could reverse TOP
13
Q
Transfer to CTG
Indications (5)
A
Decelerations after a contraction
Oxytocin augmentation
Pyrexia 37.5 >2 occassions
FHR <110 or >160
14
Q
Heart Rate Parameters
A
Normal = 110-160 Non-Reassuring = 161-180 Abnormal = <110 or >180
15
Q
Decelerations (pathophysiology, relation to contractions)
- Early
- Late
A
Early = associated with head compression: sync with contraction Late = mediated by chemoreceptors, recovery lasts beyond the contraction
16
Q
Hyperstimulation =
A
> 5 contractions in 10 minutes
17
Q
CTG Signs of Foetal Compromise (3)
A
Absent accelerations
Decreased baseline variability
Shallow decelerations
18
Q
Maternal Cardiac Changes (2)
A
Increased cardiac output - peaks week 24-28
SBP - slight drop in 2nd trimester
19
Q
Maternal Respiratory Changes (3)
A
Reduced functional capacity ( < elevation of diaphragm)
Increased tidal volume
Mildly compensated respiratory alkalosis
20
Q
Maternal Endocrine Changes (4)
A
Insulin resistant
Reduced bone density
Increased thyroid hormone requirements
Vitamin D deficiency
21
Q
Maternal Haematological Changes (4)
A
Iron deficiency anaemia
Hypercoagulable
+ WBC
Gestational thrombocytopaenia
22
Q
Definition of Gestational HTN
A
= hypertension + no proteinuria: usually after 20 weeks and resolves within 6 weeks
23
Q
Investigation of Pre-Eclampsia/HELLP
A
Bloods = FBC, LFTs, U&Es, coagulation, blood film
Urinary protein: creatinine ratio
24
Q
Management of Eclamptic Seizures
A
IV MgSO4
25
Blood Sugar Parameters in Diabetes
FBG = <5.3
| 1 hour Post Prandial = <7.8
26
Definition of Peripartum Cardiomyopathy
= heart failure 2y to LVSD towards the end of pregnancy
EF usually <45%
Often present in pulmonary oedema/symptoms of cardiac failure
27
Acute Fatty Liver of Pregnancy
- Presentation (4)
- Findings (5)
- Management
Pres: vomiting, abdominal pain, encephalopathy, polydipsia
```
Findings:
Elevated bilirubin
Hypoglycaemia
Elevated AST/ALT
Renal impairment
Disordered coagulation
```
Management: supportive, delivery of baby, N-acetylcysteine
28
Examples of Prostaglandins used in Labour (3)
Propress
Prostin
Misoprost - medical miscarriage, where intrauterine death has occured
29
Oxytocin
- Method of Action
- Foetal Distress
Action = stimulates uterine contractility, cervical ripening
= increases contraction frequency and resting tone
FD = bradycardia, transient acidosis
30
Syntometrine
- Action
- When to Use
= results in sustained tonic uterine contraction
| - Only post-natally, if accidentally given antenatal need to deliver immediately
31
Use of Tocolysis
Used to halt or slow pre-term labour
| e.g. atosiban, ritodrine, terbutaline
32
Pethidine
- Delivery
- Foetal Effects
= IM injection
| Can cause decreased FHR variability: directly acts on the foetal myocardial conducting system
33
Testing for Chlamydia or Gonorrhoea
- Male
- Female
```
Male = first void urine NAAT
Female = self-taken vulvo-vaginal swab
```
34
Describing a foetus as engaged
More than 2/5ths of the foetus are in the pelvis
35
Maternal Screening in Pregnancy
Sickle Cell and Thalassaemia: should be done by 10 weeks
Infection: should be done by 12 weeks, if refuse re-offer at 20 weeks
HIV, Hepatitis B, Syphilis
Needs to be done every pregnancy
36
If maternal Hepatitis B infection
Give foetus vaccine at 0,4,8,12,16 and 52 weeks
37
Combined Trisomy 13, 18 and 21 Testing
11-14 weeks
| = maternal age + crown-rump length + nuchal translucency + BhCG + PAPP-A
38
Quadruple Testing
14-20 weeks
| = maternal age + AFP + BhCG + unconjugated oestradiol + inhibin A
39
When is anomaly scan offered?
18-20+6 weeks
40
Blood Spot Test Post-Natal
Usually between days 5-9
| = sickle cell disease, cystic fibrosis, congenital hypothyroidism, IMDs
41
USS for assessment of hip dysplasia
Abnormal Exam = USS within 2 weeks
| Risk Factors = USS within 6 weeks
42
1st line assessment of Newborn Hearing
Automated otoacoustic emission
43
Management of pre-eclampsia and eclamptic seizures
| - 2nd Choice
Magnesium sulphate
Initial management of seizures = 4g MgSO4 IV over 5 minutes
Can use IV diazepam for prolonged seizures
44
Acceleration Definitions
= increase in FHR of at least 15 BPM for more than 15 seconds
45
Deceleration Definitions
= decrease in FHR of at least 15 BPM for more than 10 seconds
46
2nd Stage Decelerations
= normal
| The variability and baseline should be preserved
47
Limit age for foetal movements
24 weeks
48
Lithium in Pregnancy
Potentially teratogenic
| Try and use other mood stabilisers
49
Epilepsy Medications Safe in Pregnancy (2)
Lamotrigine
| Levetiracetam
50
Testing for haemoglobinopathies
| - Factor
Depends on prevalence
High = lab test
Low = questionnaire
51
Testing for Gestational Diabetes
- Risk Factors
- Previous Gestation Diabetes
RF = OGTT between 24-28 weeks
Previous Gestational = OGTT at/as close as to booking
- Repeat at 24-28 weeks if normal
52
Diagnosis of Gestational Diabetes
Fasting glucose >5.6
| 2 hour glucose >7.8
53
Insulin threshold for Gestational Diabetes
Treat with insulin if fasting glucose >7
54
Breech at 36 weeks
Offer External Cephalic Version at 37 weeks
55
Giving Anti-D in Rhesus Negative
500 units at 28 and 34 weeks
56
Management of DVT/PE
LMWH
| Titrated to booking weight - dose also depends on whether prophylaxis or treatment dose
57
Heparin and Delivery (2)
```
Therapeutic = stop 24 hours before delivery
Prophylaxis = stop 12 hours before delivery
```
58
Difference between threatened and inevitable miscarriage
Cervical os closed and open respectively
59
Partial Molar Pregnancy =
= 2 sperm with 1 egg, contains 69 chromosomes, foetal parts may be present
60
Complete Molar Pregnancy =
= egg without DNA: no foetus
61
Which cord blood gas best reflects the condition of the foetus?
Arterial blood gas
62
Difference between arterial and venous cord blood gas
- Small
- Big
```
Small = suggests chronic problem, compensated
Big = acute event e.g. cord compression
```
63
Reducing frequency and intensity of contractions (2)
- Slowing/reducing oxytocin infusions
| - Giving an IV fluid bolus
64
When does the autonomic nervous system mature? Order? What does this mean?
28 weeks
Sympathetic before parasympathetic
Means that pre-term babies have a higher baseline and reduced variability
65
Association with variable decelerations
Cord compression
66
When to avoid methyldopa (2)
Liver dysfunction
| Post-partum period
67
Immunosupressants (3)
Tacrolimus
Azathioprine
MMF - teratogenic, can't use in pregnancy
68
Drug Levels and Pregnancy
As pregnancy goes on haemodiluted and increased renal clearance and metabolism = reduced drug levels
69
Painkiller to avoid in Pregnancy
= NSAIDs
70
Strawberry Cervix
= trichomonas vaginalis
71
Window Periods
- Chlamydia
- Gonorrhoea
- HIV
- Syphilis
- Hepatitis B
2 weeks = chlamydia and gonorrhoea
45 days = HIV
90 days = syphilis and hepatitis B
72
Emergency Contraception Time Periods
UPA = can be used up to 120 hours
Levonorgestrel = can be used up to 72 hours
Copper Coil = can be used up to 120 hours
73
Investigation to confirm ovulation
Midluteal progesterone level
| e.g. day 21 in 28 day cycle
74
Normal semen analysis
>15 million sperm count
75
Management of Chlamydia
100mg doxycycline for 7 days
76
Management of PID
14 days
Doxycycline 100mg bd
Metronidazole 400mg bd
Ceftriaxone 1g IM
77
Management of Syphilis
Penicillin G IM
78
Contact Tracing
- Chlamydia
- Gonorrhoea
```
Chlamydia = last 6 months
Gonorrhoea = last 3 months
```
79
Production of hCG
Produced by placental cells to maintain corpus luteum to produce progesterone
Peaks at 9 weeks, from 12 weeks placenta produces progesterone
80
Management of Ectopic Pregnanacy
```
Medical = methotrexate
Surgical = laparoscopic, preference is removal or tube
```
81
Use of Foetal Scalp Electrode
- When used (3)
- Contraindications (3)
```
Used = ruptured membranes, cervix >2cm, presenting part well presented
Contraindications = HIV, herpes, hepatitis
```
82
Diagnosis of IUGR (2)
Head and abdominal circumferences
| USS doppler of umbilical artery
83
Signs of Uterine Rupture (4)
Foetal bradycardia
Upward displacement of presenting part
Loss of contractions
Maternal hypotension
84
Management of Premature Ovarian Failure (2)
Combined Pill
| HRT
85
Types of Breech Presentation (3)
Frank
Complete
Footling
86
4 Ts of PPH
Tone
Tissue
Trauma
Thrombin
87
Management of Shoulder Dystocia (5)
```
McRobert's
Suprapubic Pressure
Episiotomy
Internal Manoeuvres
All Fours
```
88
Triad for Hyperemesis
Dehydration (e.g. ketones in urine)
Weight loss >5%
Electrolyte disturbance
89
Risk associated with ondansetron
Cleft palate
90
Delay in return of fertility - contraceptive method
Depo-Provera
91
Screening for Abnormalities
1. Screening tests
2. Non Invasive Pre-Natal Testing
3. Amniocentesis or CVS
92
Hormonal Options in Chronic Pelvic Pain (2)
OCP
| GnRH analogue
93
Management of HTN in PET (2)
1. Labetalol
| 2. Hydralazine
94
Maternal Sepsis ABx (Tayside)
IV Co-Amoxiclav and Gentamicin
95
Sheehan's Syndrome =
| - Cause
= necrosis of the pituitary gland
| Occurs due to hypovolaemia due to PPH
96
Improving Uterine Tone
1. 40 IU oxytocin in 500mls of saline
| 2. Consider PR Misoprostol or IM carboprost + bimanual compression
97
Copper Coil Time Period Contra-Indications
Between 48 hours and 28 days postpartum
98
Stopping the C-OCP before surgery
Need to stop 28 days before
99
Management of asymptomatic bacteriuria (pregnancy)
Antibiotics
100
Medication used in Stress Incontinence
Tolteradine
101
Foetal pole measurement where would expect to see heartbeat
>7mm
102
Time taken for contraceptive to work
POP - 2 days
| Everything else - 7 days
103
Whirpool Sign =
= ovarian torsion
104
Management of
- Bacterial Vaginosis
- Trichomonas
```
BV = metronidazole
Trichomonas = metronidazole
```
105
Painkiller contra-indicated in pregnancy
Aspirin
| Can cause Reye's Syndrome (brain disease, bad)
106
AFP in pregnancy: associations
- High
- Low
```
High = neural tube defects
Low = Down's Syndrome
```
107
Management of Premature Rupture of the Membranes
Oral erythromycin
108
Boggy, tender uterus =
= adenomyosis
109
Infection associated with foetal death and hydrops
Parvovirus
110
Switch from rivaroxaban to what in pregnancy
LMWH heparin
| All NOACs are contra-indicated in pregnancy
111
Contraindication for using ergometrine for active 3rd stage
Hypertension
112
Thrush + Pregnant
Topical clotrimazole
| Oral medications are contra-indicated
113
Mx of fibroids + causing difficulty conceiving
Myomectomy
114
Investigation of mild oligozoospermia
Repeat sperm analysis after 3 months
115
Risk factor for cord prolapse
Artificial rupture of the membranes
116
Which part of the fallopian tube is the most dangerous for ectopic pregnancies?
Isthmus
| part nearest the uterus
117
<6 weeks pregnant + bleeding
= manage expectantly
118
Group B streptococcus =
Streptococcus agalacticae
119
<20 weeks pregnant exposed to chicken pox
Single dose of immunoglobulin
120
>20 weeks pregnant exposed to chicken pox
Oral aciclovir
| Need to present within 24 hours of symptoms
