Obstetrics document Flashcards by Shubham Agwan

What day does the blastocyst form

Day 5

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What is the blastocyst

Term used to describe when the embryo has divided into two separate cell masses

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What are the two cell masses in a blastocyst made up of

Inner cell mass: develops in the embryo.
Outer cell mass: the trophoblast, which is responsible for initial production of progesterone and is involved in the process of implantation

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What does the blastocyst go on to develop into

the placenta

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When is the placenta fully developed and functional

By Week 5 of pregnancy

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What are the 3 main functions of the placenta

Hormone secretion
Gas exchange
Nutrient and waste exchange

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Which two hormones does the placenta secrete

HCG

Progesterone

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What are the only two electrolytes that can only travel from mother to baby

Calcium

Iron

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When do HCG levels peak during pregnancy

Week 10

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What is the function of HCG secreted by the placenta

Simulation of corpus luteum to produce testosterone, which will prevent endometrial shedding

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What is the function of progesterone during pregnancy

Prepare and maintain endometrium.

Decreases uterine contractions

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Where does oestrogen come from during pregnancy

Placenta

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What is the function of oestrogen during pregnancy

Enlargement of the uterus.
Development of the breasts.
Relaxation of the pelvic ligaments

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What do Prolactin and Oxytocin do in terms of breast milk

Prolactin - stimulates production of milk

Oxytocin - stimulates contraction and thus expulsion of milk

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What is the Ferguson reflex, with regards to pregnancy

Involves stretching of the cervix, which stimulates release of oxytocin, with this causing further stretch of the cervix and activation of the reflex

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How does Progesterone act during the onset of labour

This keeps the uterus settled.
It prevents the formation of gap junctions
Hinders the contractibility of myocytes

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How does Oestrogen act during the onset of labour

This makes the uterus contract

Promotes prostaglandin production

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How does Oxytocin act during the onset of labour

Oxytocin initiates and sustains contractions

Oxytocin acts on decidual tissue to promote prostaglandin release

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What are Braxton-Hick’s contractions

False contractions not associated with labour and can be experienced throughout pregnancy. Can be differentiated from true labour contractions as they are less painful, do not increase in frequency or intensity and can resolve by lying down or changing position

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Which three parameters are used to measure contractions

Frequency
Duration
Intensity

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What is the normal frequency of contractions

At peak, the normal number of contractions is 3 – 4 / 10 minutes

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What is the normal duration of contractions

Initial length = 10 – 15 seconds.

Maximal length = 60 seconds

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What is the main determinant of the passage of the baby

Shape of the maternal pelvis

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Name 2 maternal indications for induction of labour

Prolonged pregnancy (>41 weeks) 
Premature rupture of membranes

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Name 2 fetal indications for induction of labour

IUGR | Macrosomia

Name 3 contra-indications for induction of labour

Placenta Praevia Cord prolaps Fetal Distress

What must have occurred before IV syntocinon can be administered

Membranes must have ruptured

What is the maximum acceptable time for stage 2 of labour for a nulliparous woman with anaesthesia

3 hours

What is the maximum acceptable time for stage 2 of labour for a nulliparous woman WITHOUT anaesthesia

2 hours

What is the maximum acceptable time for stage 2 of labour for a multiparous woman WITHOUT anaesthesia

1 hour

What is the maximum acceptable time for stage 2 of labour for a multiparous woman with anaesthesia

2 hours

Why is active management preferred for stage 3 of labour

Reduces risk of PPH

What are the Bishop score cut offs which indicate pregnancy likely to occur and pregnancy likely to require induction

<5 likely requires induction | >9 probably will happen spontaneously

What is the most effective form of analgesia in pregnancy

Epidural

What are some maternal side effects of an epidural

Headache Urinary retention Hypotension

Which analgesic is the main choice for C-section

Spinal

What is the difference between spinal and epidural anaesthetic

Spinal

What is the difference between spinal and epidural anaesthetic

Spinal is into the subarachnoid space, whereas epidural is in the epidural space

When is the risk of VTE highest

Puerperium

What does a category 1 C-section mean

Immediate threat to life of woman or baby

What is the normal fetal scalp pH

>7.25

Why might the McRobert's position be adopted

Managing shoulder dystocia

Which palsies can be a complication of shoulder dystocia

Erb's | Klumpke's

When is Uterine Rupture most commonly seen

Vaginal birth after a previous C-section

What is the difference between a 2nd degree and 3rd degree tear

3rd Degree has involvement of anal sphincters

What is an episiotomy

An episiotomy is a surgical postero-lateral incision through the skin and perineal muscles that is made from the vagina to the ischio-anal fossa

What is the purpose of an episiotomy

Widen the birth canal. | Reduce the risk of 3rd and 4th degree tears by directing any further tears away from the anal sphincters

Which antibiotic should you give for cover in the case of preterm rupture of membranes

Erythromycin

Which two drugs must be given when preparing for the delivery of a premature baby

Dexamethasone | Magnesium Sulphate

Define placental retention

Failure to completely pass the placenta within: 30 minutes of active management of 3rd stage 60 minutes of passive management of 3rd stage

What is the Johnson manoeuvre

Pushing the uterus back into place after inversion

What is the management of PPH

uterine massage bladder emptied Ergometrine IV

Define PPH

Blood loss >500mls following delivery

What is the difference between primary and secondary PPH

Primary - within 24hrs of delivery | Secondary - 24hrs - 6 weeks after delivery

What management options should you consider if medical management of PPH fails

Balloon tamponade Interventional radiology Hysterectomy

When are Anti-D injections given

28 and 34 weeks

When should Nuchal thickness be measured

11- 13+6 weeks

What is the quadruple test and what is is used to test for

bHCG, AFP, Inhibin A, unconjugated estriol | 15-20 weeks for Down's Syndrome

What is trisomy 18 also called

Edward Syndrome

What is trisomy 13 called

Patau Syndrome

When can chorionic villus sampling be carried out

> 12 weeks

When can amniocentesis sampling be carried out

> 15 weeks

How can the whole genome be analysed

Array CGH

How are targeted genes analysed

FISH

Define large for dates

Symphyseal - fundal height >2cm than expected for dates

Define small for gestational age (SGA)

Corrected birth weight <10 centile

What is a normal baby birth weight

2.5 - 4.0 kg

Define the terms Zygosity, Chorionicity and Amnionicity

Zygosity: number of eggs. Chorionicity: number of placenta. Amniocity: number of amniotic sacs

All dizygotic twins will have how many placentae and amniotic sacs

2 placentae and 2 amniotic sacs | DCDA

What is a normal volume of amniotic fluid

500-1500mls

What is the normal amniotic sac measurement on ultrasound

>2cm but <8cm

Define Polyhydramnios

Excessive amount of amniotic fluid (>1500ml, >8cm)

What is hydrops fetalis

An accumulation of fluid, or oedema, in at least two fetal compartments

What is Potter's Syndrome

Potters syndrome is a group of characteristic changes seen as a result of oligohydramnios: - Club feet. - Pulmonary hypoplasia. - Potters sequence -> flat nose, recessed chin, low set ears, skeletal abnormalities

What is the primary problem in Potter's syndrome

Kidney failure

What is the Kleihauer–Betke test

A blood test used to measure the amount of fetal hemoglobin transferred from a fetus to a mother's bloodstream

What does an indirect coomb's test tell you in rhesus pathology

Tells you whether mum is sensitized or not. Positive: sensitized. Negative: not sensitized

What are the three possible scenarios when Anti-D can be given

Mother negative. Baby positive. Mother is coombs negative

When should folic acid be started with regards to pregnancy

3 months pre conception to end of 1st trimester

What do Ace inhibitors or ARB's cause in babies

Renal hypoplasia

What do Valproate and Phenytoin cause in babies

Valproate - Spina bifida | Phenytoin - Cleft lip

Which cardiac abnormality can lithium cause

Ebstein's abnormality

What can tetracyclines cause in babies

Hypoplasia of teeth enamel and yellowing

What treatments are safe for UTI during pregnancy

Trimester 1 - nitrofurantoin/cephalexin Trimester 2 & 3 - Trimethoprim/Cephalexin

What is given for VTE prophylaxis in hyperemesis gravidarum

Heparin

How can you replace Thiamine in Hyperemesis Gravidarum

Pabrinex

Which anti-emetic is best in pregnancy

Cyclizine

Describe the trend of blood pressure over pregnancy

Falls due to expansion of utero-placental circulation - lowest at week 24 Will steadily rise after this

Name 3 fetal associations with hypertension in pregnancy

IUGR Still Birth Placental Abruption

When should low dose aspirin be started for those at risk of pre-eclampsia

Start 75mg at 12 weeks

What is the diagnostic triad of pre-eclampsia

Hypertension Proteinuria Oedema

What is the main cause of death in pre-eclampsia

Pulmonary Oedema

What are the 2 diagnostic criteria for gestational diabetes

Fasting glucose > 5.1 mmol | 2 hour OGTT > 8.5 mmol

When is OGTT offered during pregnancy

24 – 28 weeks

When is pyelonephritis most common in pregnancy and how is it treated

Most common around 20 weeks | Co-Amoxiclav

Which is the only SSRI reccomended for use in breastfeeding

Sertraline

What do atypical anti-psychotics have a risk of causing during pregnancy

Gestational diabetes | IUGR

Define antepartum haemorrhage

Vaginal bleeding after 24 weeks gestation but before birth

In the case of Antepartum haemorrhage, what should you always do before carrying out a PV exam

Rule out placenta praevia with ultrasound

What is Vasa Praevia

Vasa Previa is when the fetal blood vessels develop within the membranes When the membranes rupture, the fetal vessels will too, resulting in a catastrophic bleed

When can fetal blood sampling be carried out

18 weeks onwards

When can the Combined oral contraceptive pill be started postpartum if a woman is breastfeeding

6 weeks onwards

Define Lactational Amenorrhoea

Exclusively breastfeeding Amenorrhoea <6 months postpartum

How effective is Lactational Amenorrhoea as contraception

98%