Obstetrics Revision 2 Flashcards

Question

Which part of the large bowel does ovarian cancer commonly met. to? [1]

Answer 1

Colorectal

Answer 2

**Placental abruption** refers to when the **placenta** **separates** from the **wall of the uterus during pregnancy**. - The site of attachment can **bleed** **extensively** after the placenta separates. - Unknown cause Types: - Placental abruption can be either **concealed** (bleeding remains within the uterus and is not visible) or **revealed** (visible vaginal bleeding).

Answer 3

**Alcohol ingestion**: - it accumulates on the fetus and amniotic fluid after crossing the placenta. It causes vasospasm in the placenta and umbilical cord, which might lead to abruption of the placenta. **Advanced maternal age** **Cigarette smoking** **Pre-eclampsia** **Cocaine usage during pregnancy** - the high blood pressure and increased levels of catecholamines released by cocaine are considered to be responsible for the vasoconstriction in the uterine blood vessels that causes placental separation and abruption. **Abdominal trauma:** - injuries cause separation of the placental attachment from decidua.

Answer 4

The typical presentation of **placental abruption** is **sudden constant pain** with or without **dark red vaginal** **bleeding** (>24 weeks gestation). The pain is **continuous** **Shock** (hypotension and tachycardia) Characteristic “**woody**” **abdomen** on **palpation**, suggesting a large haemorrhage. Uterus is **extremely hard and tender**, and it **does not relax.** **Back pain** Associated with **fetal distress** ## Footnote **NB**: In 20% of cases it is possible for the blood to become trapped inside the uterus (concealed), so even with a severe placental abruption, there might be no visible bleeding.

Answer 5

**Ultrasound Imaging** - should have an ultrasound scan performed to **confirm or exclude placenta praevia** if the placental site is not already known. **Cardiotocograph (CTG)**: - should be performed in women above 26 weeks gestation to assess fetal wellbeing. - Abruption can result in **fetal** **hypoxia** and **abnormalities** of the fetal heart rate pattern **Blood Tests**

Answer 6

**Abnormal vaginal bleeding** during the **second half of pregnancy** is usually due to either **placental abruption or placenta praevia**. It is important to differentiate these two conditions. - With **placental abruption**, the **placenta** **partially** or **completely** **detaches** itself from the **uterine wall before delivery** - With **placenta praevia**, the placenta is **located** **over** or **near** the **cervix**, in the **lower part of the uterus**.

Answer 7

**placental abruption**: - **onset** of symptoms is **acute** and **severe** - **Haemorrhage** may be **visible** or **concealed** - **abdominal pain** are **intense** and **acute** - **Fetal hearts sounds** are **absent** or may show **distress** **placental praevia**: - **quiet** and **insidious** - **Haemorrhage** may be **external** and **visible** - **Fetal hearts sounds** are **normal**

Answer 8

**Initial resuscitation** **Delivery of baby:** **1.** **If < 36 weeks** and **no foetal distress:** - **admit** and give mother **steroids** **2**. **If < 36 weeks** and **foetal distress:** - **C-section** **3**. **If > 36 weeks** and **no foetal distress:** - **deliver vaginally** **4.** **If > 36 weeks** and **foetal distress:** - **C**-**section** **Post natal**: it is highly recommended to provide **active** **management** of the third stage of labour in these patients for the **prevention of postpartum haemorrhage.**

Answer 9

Corticosteroids: the risk of preterm births is increased in placental abruption and therefore RCOG suggests a single dose of **corticosteroid** may offer between 24th and 34th weeks of gestation.

Answer 10

**Placental abruption** is diagnosed **clinically**. An **USS** is **performed** to **rule** OUT **placenta praevia**

Answer 11

**1st trimester**: 0-12 weeks **2nd trimester**: 13-26 weeks **3rd trimester:** 27-50

Answer 12

**Booking visit** * general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes * BP * urine dipstick * check BMI **Booking bloods/urine** * FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies * hepatitis B, syphilis * HIV test is offered to all women * urine culture to detect asymptomatic bacteriuria * Screening for thalassaemia (all women) and sickle cell disease (women at higher risk)

Answer 13

**PMH**: - Diabetes - Hypertension **Previous obstetric history:** - previous still birth **Demographic characteristics:** - High BMI - Black ethnicity **Test results:** - Rh-ve

Answer 14

Book screening by **OGTT** between **24-28 weeks** if have risk factors - **women who've previously had gestational diabetes**: OGTT should be performed **as soon as possible** after **booking** and **at 24-28 weeks** if the **first test is normal**. NICE also recommend that early self-monitoring of blood glucose is an alternative to the OGTTs

Answer 15

**Blood group & Rh D status:** - Rhesus D mothers will be offered a blood sample to establish fetal genotype from DNA. - If fetus predicted to be Rhesus +, **Anti-D will be administered in the 3rd trimester and if any significant bleeding** **Full blood count**: - Screening for anaemia **Screening for hemoglobinopathies (Hb electrophoresis)**: - Screening for **thalassemia** (allwomen) - Screening for **sickle cell** (onlyhigh-riskwomen) - If women are carrier, also partners are tested .If both partners are carriers, prenatal diagnosis can be offered **Sexual health and ID:** - HIV, Hep B and Syphilus

Answer 16

11-14 weeks

Answer 17

The **combined test** is the **first line** and the **most accurate screening test**. It is performed between **11 and 14 weeks gestation** and involves combining **results from ultrasound and maternal blood tests**: **Ultrasound** measures **nuchal** **translucency**, which is the **thickness of the back of the neck of the fetus**. - **Down’s syndrome** is one cause of a **nuchal thickness greater than 6mm.** **Blood tests** * **Beta‑human chorionic gonadotrophin (beta-HCG)** – a **higher** result indicates a **greater** risk * **Pregnancy‑associated plasma protein‑A (PAPPA)** – a **lower** result indicates a **greater** risk

Answer 18

**11-14 weeks: Combined test** - **Nuchal translucency** (US): > 6mm - **Maternal blood tests** (bHCG - high; PAPPA - low) **14-20 weeks: Triple test:** - **bHCG** - **higher** indicates greater risk - **AFP** - **lower** result indicates greater risk - **Serum** **oestriol** - **lower** result indicates greater risk **14-20 weeks: Quadruple test** - **bHCG** - **higher** indicates greater risk - **AFP** - **lower** result indicates greater risk - **Serum** **oestriol** - **lower** result indicates greater risk - **Inhibin-A:** - **higher** indicates greater risk

Answer 19

**Chorionic villus sampling (CVS)** - involves an **ultrasound-guided biopsy of the placental tissue**. This is used when testing is done earlier in pregnancy (before 15 weeks). **Amniocentesis** - involves **ultrasound-guided aspiration of amniotic fluid** using a needle and syringe. - This is used later in pregnancy once there is enough amniotic fluid to make it safer to take a sample.

Answer 20

It involves a **simple blood test from the mother**. The blood will contain f**ragments of DNA**, some of which will come from the **placental tissue and represent the fetal DNA** - These fragments can be analysed to detect conditions such as **Down**’s - **NIPT is not a definitive test**, but it does give a very good indication of whether the fetus is **affected**. *NIPT is gradually being rolled out in the NHS as an alternative to invasive testing (CVS and amniocentesis) for women that have a higher than 1 in 150 risk of Down’s syndrome.*

Answer 21

**18-22weeks** - detailed assessment of the fetus by ultrasound and evaluation of placental location ## Footnote NB: 16 weeks = information on the anomaly and the blood results.

Answer 22

* **BMI** of **> 30 kg/m²** * **previous** **macrosomic** baby weighing **4.5 kg or above** * **previous gestational diabetes** * **first-degree relative with diabetes** * **family origin with a high prevalence of diabetes** (South Asian, black Caribbean and Middle Eastern)

Answer 23

**28 weeks:** * If **Hb < 10.5 g/dl** consider **iron** * **First dose of anti-D** **prophylaxis to rhesus negative women**

Answer 24

First dose: **28 weeks** Second dose: **34 weeks**

Answer 25

Screen via **symphysis-fundal- height (SFH)** at **28 weeks**

Answer 26

this is carried out by serial ultrasound scans in the third trimester (**28, 32, 36 weeks gestation**)

Answer 27

**Abdominal palpitation & confirm with USS @ 36 weeks** Delivery options are: - external cephalic version - breech vaginal delivery - c-section

Answer 28

**Dating scan (11-14 weeks)** - **The crown-rump length (CRL)** - **The nuchal translucency (NT)** - if parent consents **Anomaly scan (18-22 weeks)**: * To exclude congenital defects in the fetus * To assess fetal size * To assess amniotic fluid volume * To assess placental location

Answer 29

date the pregnancy **measuring the crown-rump length**

Answer 30

**Appropriate growth is usually estimated to be the number of weeks gestation in centimetres** (e.g.: 24 weeks = 24 cm +/- 2 cm) * **Difference 3cm or more is significant**

Answer 31

**Use Naegele’s rule** (LMP + 1 year + 7 days) – 3 months