Pregnancy Flashcards
(259 cards)
1
Q
What are the trimesters by weeks?
A
1st trimester- 0-13wks
2nd trimester- 13-28wks
3rd trimester- 28-40wks
2
Q
What might a low serum progesterone indicate?
A
Ectopic pregnancy
Miscarriage
3
Q
The fundus of a pregnant uterus is normally palpable for a singleton pregnancy at how many weeks gestation?
A
12wks
4
Q
The trophoblast accomplishes implantation and develops ——–
A
Into fetal portions of the placenta
5
Q
What do the timbre do?
A
Sweep ovum into oviduct, carried along by smooth muscle contraction and cilia
6
Q
What day after fertilisation does the blastocyst attach to the lining of the uterus?
A
Day 5-8
7
Q
When the free floating blastocyst adheres to the endometrial lining what penetrates the endometrium?
A
Cords of trophoblastic tissue
8
Q
By what day is the blastocyst completely buried in the endometrium?
A
Day 12
9
Q
What is the placenta derived of?
A
Trophoblastic and decimal tissue
10
Q
From what week of pregnancy is the placenta functional?
A
Functional by the 5th week
Sole source of nutrients from week 6
11
Q
What is the function of the placenta?
A
Hormone production Gas exchange Fetal homeostasis Nutrient transport to fetus Waste product transport to fetus Acid base balance Transport of IgG
12
Q
What is the outermost fetal membrane around the embryo called?
A
Chorion
13
Q
What allows trophoblastic nutrition for the first 4-12 weeks of pregnancy until placental diffusion happens?
A
The syncytiotrophoblasts invading decide and breaking down capillaries to form cavities filled with maternal blood
14
Q
What does each placental villi contain?
A
Foetal capillaries
15
Q
Progesterone stimulates decimal cells to concentrate —— ——-
A
Glycogen proteins and lipids
16
Q
HCG signals the corpus lute to continue secreting ——
A
progesterone
17
Q
Umbilical blood is O2 rich before the exchangeTRUE/FALSE
A
FALSE - maternal blood is o2 rich
18
Q
In what vessel does the fetal O2 saturated blood return to the fetus?
A
Umbilical vein
19
Q
The supply of the fetus with O2 is facilitated by which 3 factors?
A
Fetal Hb
Higher Hb
Bohr effect
20
Q
In which trimester is high glucose needed?
A
3rd trimester
21
Q
What are the two effects of HCG?
A
Prevents involution of corpus luteum
Effect on the testes of a male fetus- development of sex organs
22
Q
From what week in pregnancy is human chorionic somatomammotropin produced?
A
From week 5 of pregnancy
23
Q
What are the three effects of human chorionic sommatomammotropin?
A
Growth hormone like effects
Decreased insulin sensitivity in mother
Involved in breast development
24
Q
What are the 3 effects of progesterone in pregnancy?
A
Development of decidual cells
Decreases uterus contractability
Preparation for lactation
25
What does the estriol level indicate?
Viability of fetus
26
3 effects of estradiol in pregnancy
Enlargement of uterus
Breast development
Relaxation of ligaments
27
What are the maternal cardiovascular adaptations to pregnancy?
CO--> Increases 6-24wks, decreased
HR--> Increased
BP--> Decreased, steady increase from 22wks
28
What hormone causes the respiratory maternal changes?
Progesterone
29
What are two problems that underweight women face when trying to get pregnant?
Reduced fertility
Hormone imbalance that affect ovulation
(Underweight women are more than 2x likely to take more than a year to get pregnant)
30
What are the risks for the baby if the mother is overweight?
```
Stillborn
Metabolic abnormalities
Defects
High birth weight
Diabetes
Cardio-metabolic abnormalities
```
31
Why is reduced fetal growth associated with a number fo chronic conditions later in life?
This increased susceptibility is due to adaptations made by the foetus in an environment limited by its supply of nutrients
32
What is the dose of vitamin b (e.g. folic acid) given during pregnancy?
400ug (5mg if obese, diabetic or history of NTD)
33
What can vitamin D deficiency cause in the mother?
Gestational diabetes
Pre-eclampsia
Bacterial Vaginosis
34
What is the dose of vitamin d supplementation given?
10ug
35
How can the risk of iron deficiency be reduced?
iron supplementation -300mg
At risk if young age of first pregnancy
Have increased intervals between your births
36
TRUE/FALSE A high dose of vitamin A is teratogenic
TRUE
37
When breastfeeding how many extra calories do you need to have per day?
640
38
What is the anabolic and catabolic phase of pregnancy?
Anabolic- wk1-20
| Catabolic- wk21-40
39
What is the average wt gain in pregnancy
24lbs (can be 75lbs)
40
What is the fat gain per day in the last 4 weeks of pregnancy?
7g per day
41
What are the vitamin supplements given as part of the healthy start scheme?
70mg VitC
10ug Vit D
400ug folic acid
42
What is the incidence of baby blues?
50% of women
43
How long does baby blues last?
3-10 days
| self-limiting
44
What is the onset of postnatal depression?
2-6wks postnatally
45
What is the lifetime risk of depression in those with postnatal depression?
70%
46
How does postnatal depression present?
```
Lack of enjoyment
Wt loss
tearfullness
Irritability
Anxiety
Poor sleep
```
47
When does puerperal psychosis present?
<2 weeks after delivery
48
How does early puerperal psychosis present?
Sleep disturbances, confusion and irrational ideas
49
How does puerperal psychosis present later?
Mania, delusions, hallucinations
50
What is the lowest risk SSRI?
Sertraline
51
Why should benzodiazepines be avoided?
1st trimester- fetal malformations
2nd trimester- floppy baby syndrome
3rd trimester- lethargy, wt loss and accumulation of drug
52
Why should clozapine be avoided in pregnancy?
Risk of agranulocytosis
53
What can lithium toxicity mimic?
PET
54
Lithium should be avoided in breastfeeding TRUE/FALSE
TRUE
55
All antipsychotics are excreted in breastmilk TRUE/FALSE
TRUE- monitor for signs of sedation/lethargy
56
What day does the neural tube close?
Day 28
57
Sodium valproate is dangerous in breastfeeding TRUE/FALSE
NA TIS GRAND
58
What is there a risk of if breastfeeding and on Lamotrigine?
Steven-Johnson syndrome
59
What are the 5 risks of alcoholism in pregnancy?
```
Miscarraige
Fetal Alcohol Syndrome
Withdrawl
Wernicke's encephalopathy
Korsakoff Syndrome
```
60
Heparin does not cross the placenta
TRUE
61
Why are ACEi/ARB teratogenic?
Renal hypoplasia
62
how is lithium teratogenic?
Cardiovascular defects
63
In pregnancy there is increased plasma volume and fat stores. IS THIS A LIE?
THIS IS TRUE
| Therefore there is decreased protein binding and increased free drug
64
What is the period of greatest teratogenic risk?
4th-11th weeks
65
the risk of medication passing on in breast milk is usually similar to in utero TRUE/FALSE
FALSE
| Milk exposure usually less than in utero
66
What is the safest drug for nausea and vomiting in pregnancy?
Cyclizine
67
What is the safest drugs for pregnancy women with UTI
Nitrofurantoin
| In 3rd trimester Trimethoprim
68
If pain in pregnancy what is the best drug to use?
Paracetamol
69
If heartburn in pregnancy what is the best drug to use?
Antacids
70
What is fore milk rich in?
Protein rich
71
What is hing milk rich in?
Higher fat content
72
At what week is chorionic villus testing done?
12wks gestation
73
What is the miscarriage risk from chorionic villus testing?
1-2%
74
At what week gestation is amniocentesis testing done and where are the cells taken from?
15wks gestation
| Skin/Urine cells
75
What is the miscarriage risk with amniocentesis testing?
0.5-1%
76
What is the difference between a mutation and a polymorphism?
Mutation- De-novo, bigger, affects known gene and previously reported in same phenotype
Polymorphism- Normal parent has it, smaller, "empty" genetic region and previously reported as a polymorphism
77
What is aCGH for?
Chromosome deletions/duplications
78
What is a robertsonian translocation?
Two acrocentric chromosomes stuck end to end
79
If there is a condition that is X-linked such as duchesses can do non-invasive fetal sexing at how many weeks?
8wks
| if boy then invasive testing, if a girl then stop worrying
80
TRUE/FALSE
| There is a slight risk of preterm labour if there is previous TOP
TRUE
81
What does the Fraser guidelines rate to?
The contraceptive and sexual health in under 16 year old
82
In order to meet gillick competence what 5 points must be met?
1-Understand info given to them
2-Must be acting in their best interest
3-Advise that they are best to tell parent/guardian but do not have to do so
4-If without care their physical/mental health would suffer
5-If they will continue to be at risk then you should provide care
83
With TOP the later the gestation the more painful and longer it takes TRUE/FALSE
TRUE
84
What sample is taken to screen for chlamydia and gonorrhoea?
Urine
85
What sample is taken to screen for Hepatitis, HIV and Syphillis?
Blood
86
What sample is taken to test for herpes?
Swab of the genital
87
What drugs should be given pre TOP?
```
Antibiotic prophylaxis - Metronidazole and Azithromycin
Anti D (if rhesus -)
```
88
What is counted as early, late and mid trimester for medical TOP?
Early- <9 weeks
Late- 9-12 weeks
Mid-trimester 12-24wks
89
What are the two drugs used in medical TOP?
1-oral MIFEPRISTONE
| 2- 24-48h later Prostaglandin e.g. MISOPRISTOL
90
What types of surgical TOP can be carried out and when?
Manual vacuum aspiration (MVA) 6-12wks
| Dilation and evacuation 13-24wks
91
What is used for cervical priming in surgical TOP?
Vaginal prostaglandins
92
2-3 weeks after TOP give a regular pregnancy test TRUE/FALSE
FALSE
| give a low-sensitivity pregnancy test
93
When should anti-D be given?
Within 72h of any event that could cause fetal -maternal bleeding
94
What are the 3 indications for treatment?
1-Confirm or refute diagnosis
2-Determine extent of disease
3-Assess response to treatment
95
Why should a brief abdominal exam be conducted before transabdominal exam?
Ensure no hydronephrosis
Detect early ascites
Ensure pelvic abnormality is not secondary to upper abdominal pathology
96
How is the transvaginal transducer different than the one used in abdominal scanning?
Higher frequency ultrasound, has a shorter wavelength and better spatial resolution
97
For all US examinations need to have an empty bladder TRUE/FALSE
FALSE
TA- full bladder, "acoustic window"
TV-Empty bladder as if full it will be uncomfortable
98
What is the normal appearance of the endometrium on an US scan?
Trilaminar appearance (bright visible line in the centre of the uterus)
99
Name 3 things that imaging is great at in relation to repro?
1-Post-surgical complications
2-Staging of gynaecology malignancy
3-Assessing response to treatment
100
What is a radiological way of diagnosing endometriosis?
Diagnostic laparoscopy
101
What colour does fat look on T1 weighted scans?
White
102
What are ovarian teratomas otherwise known as?
DERMOID CYSTS
103
Where is the tissue that makes up dermoid cysts derived from?
Ectoderm, mesoderm and endoderm
104
What does hysterosalpingography test?
Tubal patency in patients with infertility
105
How are HSG preformed?
Cervix is cannulated and a radiopaque contrast instilled to fill the uterine cavity
106
How does ovarian cancer spread?
Disseminated peritoneal spread
107
TRUE/FALSE Malignant pleural effusions can occur as a result of ovarian cancer spread
YUP TOTALLY TRUE (Via pleural-peritoneal communications)
108
What radiology is used for initial diagnosis and then what radiology is used for staging of ovarian cancer?
Initial diagnosis- US
| Staging- CT
109
How are the mets from cervical cancer radiologically assessed?
MRI for local disease
| CT for distant mets
110
What scanning is best for establishing abnormally thickened endometrium/
TVUS
111
What radiology is used to determine the degree of myometrial invasion?
MRI scanning
112
What scanning is used in endometrial cancer to look for distant nodal mets and pulmonary mets?
CT
113
What is used to establish gestation accurately?
CRL until 13 weeks
| HC after this
114
What is the equation used for sensitivity?
True positive / (positive + false negative)
115
What is the equation used for specificity?
True negative/ (negative + false positive)
116
What does naegele's rule predict?
An estimated due date based on the onset of the woman last menstural period (add 280 days)
117
What percentage of people deliver 37-40wks
97%
118
TRUE/FALSE
| In most women as the womb grows upwards the placenta moves with it so that it is in a normal position before birth
TRUE
119
What is placenta praevia?
Placenta attached very low on uterine wall, can cause severe bleeding
120
What percentage of babies born with Down syndrome had a normal anomaly scan?
50%
121
What test is done in the first trimester for Down syndrome?
US to measure nuchal thickness
122
What is a normal nuchal thickness?
<3.5mm normal when CRL between 45-84mm
123
The Down syndrome screening test is more accurate the older the mother is TRUE/FALSE
TRUE
124
What is maternal serum AFP raised in/
```
Multiple pregnancies (physiological)
Gastroscesis and spina bifida (due to amniotic fluid mixing)
```
125
At 15-20wks a blood sample can be taken to test for Down syndrome by measuring which two things?
HCG
| AFP
126
Risk of Down syndrome is higher if serum levels are ------ and maternal age is -----
Serum low
| maternal high
127
What is non-invasive pre-natal testing?
Test that identifies pregnant women who are at higher risk of having a baby with certain genetic and chromosomal conditions
128
What is trisomy 18 also known as?
Edwards syndrome
129
What is Pataus syndrome also known as?
Trisomy 13
130
Maternal anaemia is due to ---------- deficiency
B12/IRON/FOLATE
131
When does vitamin D have to be given?
If there is a rhesus negative mother with a rhesus positive baby
132
Briefly describe the mechanism of Rh
At birth Rh+ baby bloods enters mothers causing production of antibodies
Antibodies initially IgM (so no problem as too big to cross the placenta)
In later pregnancies Rh antibodies attack the baby's blood cells causing Rh disease
133
At what level is gestational diabetes diagnosed?
>5.6mmol/l OR 2-hour 75g OGTT >7.8mmol/l
134
What are the RF for gestational diabetes?
1. BMI >30kg/m2
2. Previous macroscopic baby/gestational diabetes
3. FHx diabetes
4. Minority ethnic family origin with a high prevalence of diabetes
135
If there is a single SFH plot below the 10th centile OR serial measurement of slow/static growth then what is the next step?
US measurement of fetal size
136
What is hypertension defined as?
>= 140/90 mmHg on 2 occasions OR >160/110mmHg once
137
Hypertension affects what percentage of pregnancies?
10-15%
138
If BP is still not normal 3 months post delivery what is the diagnosis
Retrospective diagnosis of pre-existing hypertension
139
Which part of pregnancy do PET and PIH affect?
The second half
140
Why are B-Blockers avoided in pregnancy?
May inhibit fetal growth
141
If needed to treat pre-exisiting hypertension what drug could be used?
Labetalol
| Methydopa
142
Pregnancy induced hypertension has better outcomes than preeclampsia. What is the but?
15% progress to PET
143
What is the most common cause of iatrogenic prematurity?
Pre eclampsia
144
What is pre eclampsia defined as?
Pregnancy induced hypertension and proteinuria
145
Proposed pathophysiology of pre eclampsia?
Anti androgenic state associated with widespread endothelial dysfunction
146
PET is a widespread manifestation with multi system disorder. Name them alll
```
Renal blood flow and CFR decrease
Headache, visual disturbance and N&V
Epigastric/RUQ pain
Brisk reflexes/clonus, confusion, fits
Placental abruption, IUGR and stillbirth
```
147
Woman at high risk of pre-eclampsia should take 75mg of what daily from 12wks to birth
Aspirin
148
Who is at high risk of preeclampsia?
Hypotensive, CKD, Autoimmune conditions, diabetes
149
What are moderate risk factors for preeclampsia?
1st pregnancy, 40 years+, BMI >35, FHx of pre-eclampsia, multiple pregnancy, pregnancy interval 10y+
150
What will the urine protein- creatinine ratio (PCR) be if they have PET?
(PCR) >30mg/mmol
151
If patient has PET what will there be on US?
Notching
152
What is eclampsia?
Emergency
| Tonic clonic seizure + pre-eclampsia
153
How do you treat eclampsia?
Vasodilatory e.g. IV Labetalol, hydralazine & C-Section
Magnesium Sulphate
If repeated seizures then diazepam
154
What do you use if there is magnesium sulphate toxicity?
Calcium gluconate
155
What is HELLP?
```
H-Haemolysis
E-Elevated
L-Liver enzymes
L-Low
P-Platlets
```
156
What is the cure for HELLP?
Delivery of the fetus
157
What is the leading cause of maternal deaths in the UK?
Cardiac disease
158
TRUE/FALSE If patient has pulmonary hypertension advise against pregnancy
TRUE
159
if cyanotic and uncorrected congenital heart disease then increased risk of....
IUGR
160
What percentage of people with Marfans have cardiac involvement?
80%
161
If the pregnant patient has mitral stenosis then what should they watch for?
Dyspnoea
Orthopnoea
PND
162
How do you treat SVT?
Vagal manœuvres and/or adenosine
163
TRUE/FALSE Poorly controlled asthma poses a greater risk to pregnancy than the drugs used to treat it
TRUE
164
What is the commonest chronic medical disorder to complicate pregnancy?
Asthma
165
Why are asthma attacks rare in pregnancy?
Due to endogenous steroids
166
What are the treatment steps for asthma?
1. SABA
2. + inhaled steroid
3. + LABA
4. ^ Steroid dose if LABA not working or ineffective
167
Why should you beware new onset asthma in pregnant women?
Pulmonary oedema can cause wheezing too
168
What is the increase in risk of VTE in pregnancy?
4-6x increased risk
169
85-90% of DVTs occurring during pregnancy arise in which leg?
Left leg
170
What are the 3 things included in Virchow's triad?
Hypercoaguability
Venous stasis
Vascular damage
171
What is the presentation of DVT?
Swelling, Oedema, leg pain/discomfort, tenderness, increased leg temp, lower abdominal pain, elevated WCC
172
How do you test for DVT?
Compression Duplex US
| MRI and Venography (if iliac vein thrombosis suspected)
173
What is the presentation of VTE?
Dyspnoea, Chest pain, faintness, collapse, haemoptysis, ^ JVP, focal signs in the chest and symptoms/signs ass with DVT
174
The mother is at significant risk of VTE if she has 2+ RF. Name all da RF
```
Obesity
Age >35y
Smoking
Para >3
Previous DVT/VTE
C-section
```
175
If the mother is determined to be at significant risk of VTE then she is treated with...
Thromboprophylaxis with LMWH
176
Why is warfarin avoided?
Early pregnancy- teratogenic
| Late pregnancy- Risk of haemorrhage
177
TRUE/FALSE
| RA is made much worse during pregnancy
False
| Usually alleviated
178
Methotrexate is CI in RA TRUE/FALSE
TRUE (Use sulfasalazine instead)
179
Why are NSAIDs not used in the 3rd trimester of pregnancy?
Can cause premature closure of ductus arteriosus
| Associated with renal impairment in the newborn
180
What is APS?
Anti-phospholipid syndrome
| Acquired thrombophilia with variable severity and presentation
181
How does APS present?
Anterior/venous thrombosis
Recurrent early pregnancy loss usually preceded by FGR
Placental abruption
Severe early-onset pre-eclampsia
Severe early onset fetal growth restriction
182
How is APS diagnosed?
aPL on two tests taken >8wks apart +- past arterial/venous thrombosis or recurrent pregnancy loss
183
How is APS treated?
aspirin 75mg daily from conception
heparin from when fetal heart identified
postpartum use heparin or warfarin
184
TRUE/FALSE
| With epilepsy seizure frequency drastically increases during pregnancy?
FLASE
| IT DOES NOT AT ALL (increase in seizures in 10%)
185
If do get seizures in pregnancy these should be terminated as soon as possible using what?
Benzodiazepines
186
How much folic acid should those with epilepsy get?
5mg daily
187
Aside from epilepsy what are some causes of seizures in pregnancy?
```
Eclampsia
Stroke
Infection
Cerebral vein thrombosis
Intracranial mass
Hypoglycaemia
Drugs and withdrawl
Postural puncture
Pseudoseizure
```
188
How common is bleeding in early pregnancy?
20%
189
What are causes of bleeding in early pregnancy?
Implantation bleeding
Chorionic haematoma
Cervical causes (infection, malignancy, polyp)
Vaginal causes (infection, malignany-rare)
Unrelated ( haematuria, PR bleeding)
190
If bleeding is profuse then what should be administered?
Ergometrine 0.5mg IM
191
What is miscarriage?
The loss of a pregnancy before 24wks gestation
192
Pregnancy test may remain positive for several days after a pregnancy loss TRUE/FALSE
TRUE
193
What are the symptoms of miscarriage?
Bleeding 1st symptom
Positive UPT
Varied gestation
Period cramping
194
Severe emotional upset can cause a miscarriage TRUE/FALSE
TRUE
195
What is the pathophysiology of miscarriage?
Bleeding form placental bed or chorion causing hypoxia and villous/placental dysfunction. This causes embryonic demise.
196
What percentage of threatened miscarriages will settle?
75%
197
What is the management of early fetal demise?
Mifepristone or Misoprostol
198
How long might a lady bleed for after medical management for miscarriage?
3 weeks
199
What is recurrent miscarriages defined as?
The loss of 3+ consecutive pregnancies before 24wks gestation with the same biological father
200
Diabetes increases miscarriage risk TRUE/FALSE
FALSE
| Not if it is well controlled (The same goes for thyroid problems and PCOS)
201
Treatment for antiphospholid syndrome?
Aspirin from the day of positive pregnancy
| LMWH from when the fetal heartbeat is seen until delivery
202
Diagnostic criteria for antiphospholid syndrome
Presence of antibodies on 2 occasions plus one of the following....
.....3+ consecutive miscarriages <10wks
.... 1 fetal loss 10wks+
....1+ births to normal foetus >34/40wks with severe pre-eclapmsia/growth restriction
203
In those with inherited thrombophilia what it used to reduce the risk of miscarriage?
Heparin
204
Pregnancy after tubal ligation is more likely to be ectopic TRUE/FALSE
TRUE 9x more likely
205
Where are 97% of ectopic pregnancies?
Tubal
206
Signs and symptoms of ectopic pregnancy
Amenorrhoea, vaginal bleeding
Pain: Non specific unilateral lower abdominal + shoulder tip pain
Diarrhoea, loose stools and/or vomiting, dizziness, collapse
Cervical excitation w or wo adnexal tenderness
207
What would be your spot diagnosis?
| Young sexually active woman with abdominal pain, bleeding, fainting and D&V
Ectopic pregnancy
208
Hormone levels can distinguish where the pregnancy is TRUE/FALSE
WISE UP
| no but TVS can
209
If there is hypovolaemic shock in an ectopic pregnancy what is the preferred management?
Surgical
210
When should medical management for ectopic pregnancy be followed?
If woman is stable, asymptomatic/mild symptoms, low levels of bhCG (<3000IU) and ectopic is small (<3cm)
211
What would medical management of ectopic pregnancy look like?
Methotrexate IM as a single dose
(do hCG levels on days 4 and 7)
As tetrogenic need to use reliable contraception for 3months afterwards
212
What is hydatidiform mole?
Where the foetus doesn't develop properly in the womb and a lump of abnormal cells grows instead of a healthy foetus
213
A molar pregnancy is very vascular although it is not premalignant. TRUE/FALSE
FALSE
very vascular
pre-malugnant
214
What is a complete mole?
Mass of abnormal cells in womb, no foetus develops. Egg without DNA, 1 or 2 sperm fertilise
215
What does a complete mole look like on US?
Snowstorm appearance
216
What does a complete mole look like?
A bunch of grapes filling the endometrial cavity
| due to the overgrowth of placental tissue with chorionic villi swollen
217
What is a partial mole?
An abnormal foetus starts to form but it can't survive or develop into a baby
218
Molar pregnancies make lots of hCG giving rise to exaggerated pregnancy symptoms and a strongly positive pregnancy test. From which tissue is it derived?
Chorion
219
What makes molar pregnancies more common?
Asian
Extremes of reproductive age
Previous molar pregnancy
220
Why might you get hypothyroidism with a molar pregnancy?
hCG resembles TSH
221
After a molar pregnancy when should the hCG return to normal?
within 6 months
222
What is implantation bleeding?
Bleeding when a fertilised egg implants into the uterine wall, 10 days post-ovulation
223
How can an implantation bleed be differentiated from a period bleed?
Implantation-10 days post ovulation, Light/brownism, limited, soon signs of pregnancy
Period- 2wks post ovulation, heavier, bright red
224
What is chorionic haematoma?
Pooling of blood between endometrium and the embryo due to separation
225
What is the risk with a large haematoma?
Source of infection
226
What is the most common cause of bleeding in the last months of pregnancy?
Cervical ectropian
227
What is trichomoniasis known affectionately as?
Strawberry vagina
228
What is antepartum haemorrhage (APH)?
Bleeding from the genital tract >= 24wks and before the end of the second stage of labour
229
What is Keilhauer test?
Blood test that measures the amount of fetal haemoglobin transferred from fetus' to mothers' bloodstream
230
Name 4 causes of APH?
Placental abruption
Placenta praevia
Uterine rupture
Vasa praevia
231
What is placental abruption?
Separation of a normally implanted placenta- totally/portially before the birth of the foetus
CLINICAL DIAGNOSIS
232
What is couvelaire uterus?
Life-threatening
loosing of the placenta causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity
233
What are the symptoms of placental abruption?
Severe abdo pain-continuous
Bleeding
Preterm labour
May present with collapse or backache
234
If you have a previous abruption what is the chance of recurrance?
10%
235
What is placenta praevia?
Placenta lies directly over the internal os
236
What is the cause of 40% of APH?
Placental abruption
237
What is the cause of 20% of APH?
Placenta praevia
238
Presentation of placenta praevia
Painless bleeding >24wks
| Usually recurrent
239
What is placenta praevia confirmed by?
TV US
240
If you suspect placenta praevia preform a vaginal exam immediately true/false
FALSE
c'mon what ya playing
DO NOT PERFORM A VAGINAL EXAM until placenta praevia is excluded
241
TRUE/FALSE
| C-section is associated with increased risk of placenta praevia in subsequent pregnancies
TRUE
242
What scan should be done if placenta accrete is suspected?
MRI
243
Management fo placenta praevia?
Antenatal corticosteroids
Tocolysis
MgSO4
244
When can you do a vaginal delivery with placenta praevia?
If placenta >2cm from os and no malpresentation
245
What is uterine rupture?
Full thickness opening of the uterus
246
What are the signs of uterine rupture?
```
Loss of contractions
Acute abdomen
PP rises
Peritonism
Fetal distress/IUD
```
247
What is used to confirm vasa praevia?
TV US
248
What is type 1 vasa praevia?
Where the vessel is connected to a velamentous umbilical cord
249
What is type 2 vasa praevia?
When it connects the placenta with a succenturiate or accessory lobe
250
What is vasa praevia?
Where fetal blood vessels run near/across the opening of the internal os
251
What is the presentation of vasa praevia?
Painless vaginal bleeding
Rupture of membranes
Fetal bradycardia
252
What is PPH defined as?
Blood loss equal or exceeding 500mls after the birth of a baby
253
Do most women respond to the utero-tonic agents used with PPH?
Yes, yes they do
254
What is the number that is the border between a minor and a major PPH?
1000ml
255
What are the four T causes of PPH?
Tone- 70%
Trauma-20%
Tissue-10%
Thrombin- <1%
256
How can PPH in most cases be avoided?
Active management of the 3rd stage
| Syntocinon/Syntometrine
257
What drug can be used in PPH to try and stop the bleeding?
Ergometrine IV
258
When does placenta accrete occur?
When the placenta goes too deeply into the uterine wall
259
What are the two major RF for placenta accrete?
Placenta praevia
| Prior caesarean delivery
