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Repro Revision Flashcards

1
Q

How does cystic fibrosis affect fertility

A

Mutations and congenital bilateral absence of vas deferens

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2
Q

What does computed semen analysis assess

A 
Volume 
Concentration 
Number 
Motility 
Normal morphologically
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3
Q

Treatment for a women to help ovulation

A

Clomifine = anti-oestrogen, increases FSH and LH and follicle growth

Gonadotrophins - multifollicular response

GnRH - unifollicular response

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4
Q

How does metabolism change in pregnancy

A

Increased insulin resistance – gestational diabetes

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5
Q

Why are pregnant women more prone to GORD

A

Progesterone and prostaglandins slacken all smooth muscle hence LOS, slowed gastric emptying, constipation

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6
Q

Why do pregnant women get goitre

A

Feotus uses lots of iodine so thyroid needs to increase uptake and increases the size for efficiency

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7
Q

Why do crohn’s and rhuematoid arthritis improve during pregnancy

A

HCG decreases the immune response

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8
Q

How much does the mother’s cardiac output increase during pregnancy

A

40%

Due to decreased vascular resistance, increased circulating volume and heart rate

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9
Q

How does pregnancy affect peripheral resistance

A

Decreases

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10
Q

How does pregnancy affect the urinary tract

A

Dramatic dilatation particularly on R due to relaxant effect of progesterone
In later pregnancy there may be ureteric obstruction due to uterine enlargement
May be glycosuria as proximal tubular ability to absorb is less
Increased urinary frequency due to increased renal blood flow and pressure of pregnant uterus on bladder

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11
Q

Why are pregnant women at more risk for PE and DVT

A

They are hypercoagulable

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12
Q

How do folate and iron needs change in pregnancy

A

Increased need

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13
Q

What factor worsens morning sickness

A

When HCG is higher - multiple pregnancy and molar pregnancy

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14
Q

Hyperemesis gravidarum

A

Persistent severe vomiting leading to weight loss and dehydration

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15
Q

Why does the BP drop in the second trimester

A

Expansion of the uteroplacental circulation
A fall in sytemic vascular resistance
Decrease in blood viscosity
Decreased sensitivity to angiotensin

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16
Q

Why is urine output increased during pregnancy

A

Bladder decreases capacity
Renal blood flow increases
GFR increases

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17
Q

Effect of pregnancy on serum urea and creatinine

A

Decrease both due to increased GFR and dilutional effect of plasma volume

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18
Q

Factors affecting egg supply; causing problems with infertility

A

Androgen xs - hirsutism (clinical) or xs testosterone (biochemical)
Infrequent periods - anovulation
Polycystic ovaries

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19
Q

Name the 3 stages of labour

A
  1. Cervical dilation
  2. Expulsion of baby
  3. After birth - placenta delivery
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20
Q

How to ovarian hormones change in the leadup to labour

A

Progesterone lowers so that oestrogen > progesterone and the uterus is more sensitive to other hormones like oxytocin

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21
Q

Signs of labour

A
  1. The drop - baby goes lower into pelvis
    (2. Braxton-hicks contraction increase)
  2. Loss of mucous plug so canal not sealed - bloody show
  3. Spontaneous rupture of membranes
  4. Effacement and dilatation of the cervix
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22
Q

Which is the longest stage of labour

A

Stage 1 - for cervix to dilate to 10cm

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23
Q

How long does stage 1 of labour take

A

6-12 hours

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24
Q

How long should the second stage of labour take

A

30-120 mins

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25
Q

How long should stage 3 of labour take

A

10-30 mins

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26
Q

When would you consider induction of labour

A

Haven’t laboured spontaneously before 41-42 weeks

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27
Q

What is an amniotomy

A

Artificial rupture of foetal membranes using an amniohook

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28
Q

Complications associated with induction of labour

A

Longer, less efficient labour, needing more pain relief, more foetal distress and more likely to need operative or C-section

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29
Q

Length of labour in a primiparous woman

A

12-24 hour

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30
Q

Length of labour in a multiparous woman

A

6-12 hours

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31
Q

What would you do if the fetal heart rate is abnormal

A

Fetal scalp blood pH

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32
Q

How do you monitor the foetus during labour

A

Amniotic fluid appearance

Foetal heart rate monitoring - intermittent or continuous

Foetal scalp blood pH if abnormal fetal heart rate

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33
Q

How to assess uterine activity during labour

A

3-5 good tone contractions per 10 mins each lasting 40-60 seconds

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34
Q

What do you do if the placenta is not passed by 30mins

A

Manual removal under spinal or general anaesthesia

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35
Q

What are the criteria of the bishop score and why is it used

A

Cervical dilatation

Length of cervix

Station of presenting part In relation to ischial spines

Consistency of cervix (firm, medium, soft)

Position with regards to fornix of the vagina (posterior central anterior)

— To assess the cervix when considering induction of labour

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36
Q

Forms of induction of labour

A

Prostaglandins to “ripen the cervix” (bishop 7) followed by oxytocin infusion

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37
Q

What is the name for when the head is too big for the pelvis during labour

A

Cephalopelvic disproportion

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38
Q

What determines progress of labour

A

Determined by combo of abdominal and vaginal examinations:

Cervical effacement - needs to be very thin

Cervical dilatation

Descent of fetal head through maternal pelvis

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39
Q

Effect of cephalopelvic disproportion when baby is born

A

Caput - cone shaped head due to scalp oedema

and moulding - skull bones overlap

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40
Q

Forms of malpresentation

A

Face

Brow

Breech

Shoulder

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41
Q

How could the strength and duration of contractions be improved

A

Giving artificial oxytocin (syntocinon) as an IV infusion

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42
Q

Indications for induction

A

Hypertension
Pre-eclampsia
Prolonged pregnancy
Rhesus disease

Diabetes, previous still birth, abruption, fetal death in utero and placental insufficiency

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43
Q

What would be the effect of stimulating an obstructed labour

A

Could result in a ruptured uterus which can result in severe maternal and fetal morbidity and even mortality

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44
Q

How to assess fetal well being during pregnancy

A

Intermittent auscultation of the fetal heart

Cardiotocography

Fetal blood sampling

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45
Q

Potential complications of C-section

A

Increased risk of infection, visceral injury and VTE compared to vaginal birth

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46
Q

Define miscarriage

A

Termination/loss of pregnancy

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47
Q

Threatened miscarriage is when

A

Pregnancy is viable

Vaginal bleeding +/- pain

Cervix is closed

48
Q

Inevitable miscarriage is when

A

The pregnancy is viable

The cervix is open and bleeding (heavily)

49
Q

Missed miscarriage is when

A

Gestational sac is seen but no clear fetus or a fetul pole with no fetal heart

Also known as early fetal demise

50
Q

Incomplete miscarriage is when

A

Most of the pregnancyis expelled out with some products remaining in the uterus

Cervix is open and there may be vaginal bleeding

This can lead to a septic miscarriage

51
Q

Where is the most common site for an ectopic pregnancy

A

The fallopian tube

The ampulla in particular

52
Q

Name the the parts of the uterine tube

A

Fimbriae
Infundibulum
Ampulla
Isthmus

(Then onto uterus)

53
Q

Presentation of ectopic pregnancy

A

Period of amenorrhoea and positive pregnancy test

PV bleeding +/- abdo pain

Tenderness on vaginal exam and cervical excitation (pain when move cervix)

May have hypovolaemic shock in acute presentation

54
Q

Conservative management of ectopic

A

If stable wait and see if shrinks and serially measure bHCG

55
Q

Medical management of ectopic

A

Methotrexate and serially measure bHCG

56
Q

Surgical management of ectopic

A

Laparoscopic or open salpingectomy (tube and ectopic) or salpingotomy (remove ectopic)

57
Q

Antepartum haemorrhage

A

Bleeding >24 weeks but before birth of the baby

58
Q

Causes of antepartum haemorrhage

A

Vasa praevia (abnormal umbilical vessels)

Local lesion of genital tract

Unknown origin (50%)

Placenta praevia

59
Q

What is placenta praevia

A

When all or part of the placenta implants on the lower uterine segment

60
Q

What factors increase risk of placenta praevia

A

Multiparous

Old age

Multiple pregnancy

Previous C section

Scarring in uterus

61
Q

Features of placenta praevia

A

Painless PV bleeding

Malpresentation of fetus on scan

Soft, non-tender uterus

62
Q

Why must you not perform a vaginal exam in antepartum haemorrhage

A

If placenta praevia could disturb cervix and give bigger bleed

63
Q

Management of placenta praevia

A

Depending on gestation and severity may want to deliver by C-section

Cross match blood because there usually lots of bleeding

Give steroids to help foetal lungs develop

64
Q

Placenta abruption

A

Haemorrhage resulting from premature separation of placenta before baby birth

65
Q

Presentation of placental abruption

A

Pain - constant and contractions

Vaginal bleeding

Increased uterine activity - hard, pain, tender and sometimes enlarged

66
Q

What factors increase risk of placental abruption

A

Previous abruption

Pre-eclampsia/HT

Multiple pregnancy

Smoking and increased age

Cocaine use

67
Q

Why are pregnant women more at risk for venous thromboembolism

A

They are in a hypercoagulable state - more clotting factors

68
Q

Symptoms of VTE in pregnancy

A

Tender/pain in calf

SOB

Cough

increased HR

69
Q

Management of VTE in pregnancy

A

Antiocoagulation if VT is confirmed using LMWH

Dalteparin if lots of risk factors (sickle cell, increased BMI, older mothers, less mobility)

Encourage movement and advise stockings

70
Q

Preterm labour is classed as

A

Onset of labour

71
Q

Predisposing factors for preterm labour

A

Multiple pregnancy

Antepartum haemorrhage

Infection

Pre-eclampsia

72
Q

How do fetal fibronectin levels change during labour

A

They go up when women go into labour

Is the biological glue that bind the fetal sack to the uterine lining

73
Q

Management of an extreme premature

A

Consider tocolysis (delay) to allow steroids for fetal lung maturity and transfer to a specialist unit

Aim for a vaginal delviery

74
Q

Neonatal morbidity from prematurity

A

Visual impairment
Hearing loss

More infections

Jaundice

Nutrition

Cerebral palsy

Respiratory distress syndrome

75
Q

Management of those with chronic HT who are pregnant

A

Monitor for superimposed pre-eclampsia

Aim to keep BP low

Decrease sodium in diet

Consider changing drugs (ACEi and ramipril cause birth defects and B-blockers impair growth)

76
Q

How would you know if a lady has pregnancy induced hypertension

A

Begins >20 weeks

77
Q

Pre-eclampsia

A

New HT >20 weeks in association with significant proteinuria (24h urinary protein collection >300mg/day)

78
Q

Risk factors for pre-eclampsia

A

1st pregnancy

Maternal age extremes

Pregnancy interval > 10 yrs

BMI >35

Family history

Chronic HT, renal disease, diabetes, autoimmune conditions

79
Q

Symptoms of pre-eclampsia

A

Vision blurring, headache, epigastric pain, vomiting and sudden swelling

Potentially convulsions

80
Q

Signs of pre-eclampsia

A

High BP

Urine output decrease

Papiloedema

Clonus/brisk reflexes

Epigastric tenderness

81
Q

Biochemical investigations for pre-eclampsia

A

Increased liver enzymes and bilirubin

Increased urea and creatinine

82
Q

Haematological investigations for pre-eclampsia

A

Low platelets

Low Hg

Signs of haemolysis

83
Q

Complications of pre-eclampsia for the baby

A

Impaired placental perfusion

IUGR, prematurity

84
Q

What does HELLP stand for

A

Haemolysis
Elevated liver enzymes
Low platelets

85
Q

Maternal complications of pre-eclampsia

A 
Seizures
Stroke 
DIC
Renal failure 
Pulmonary oedema and heart failure 
HELLP
86
Q

Management of pre-eclampsia

A

BP and urine check frequently

Only cure is delivery - consider induction

Anti HT - labetolol

Steroids for fetal lung maturity

MONITOR POST DELIVERY

87
Q

Effect of pre-existing diabetes on the fetus

A

Cause fetal hyper-insulinaemia - maternal glucose crosses placenta and induces increased insulin production

Greater risk of foetal hypoglycaemia

Babies often hypoglycaemic and chubby

MACROSOMIA

88
Q

Effect of pre-existing diabetes in pregnancy for mother with regards to insulin requirments

A

Increased insulin requirements for mother

This is because human placental antigen, progesterone, HCG and cortisol from the placenta have anti-insulin actions

89
Q

How can gestation complicate existing diabetes

A

Maternal nephropathy
Retinopathy
Hypoglycaemia

90
Q

Physiology of gestational diabetes

A

HPL, cortisol, GH and progesterone all increase blood glucose and increase insulin resistance so there is more glucose available for baby

91
Q

Screening for gestational diabetes

A

Oral glucose tolerance test

92
Q

Treatment of gestational diabetes

A

Diet

Insulin

Keep an eye on HbA1c as prone to diabetes after pregnancy

93
Q

How does management of existing diabetes change in pregnancy

A

More aware of hypoglcaemic risk, ketonuria and infection

Consider changing to injecting insulin from oral to optimise control

94
Q

Aetiology of preterm labour

A 
Idiopathic 
Preterm rupture of membranes 
Polyhydramnios (++amniotic fluid)
Multiple pregnancy
Cervical incompetence 
Uterine abnormality
Antepartum haemorrhage 
Maternal pyrexia
95
Q

Aim of tocolysis

A

To suppress uterine contractions long enough to administer steroids and transfer somewhere with a neonatal unit

96
Q

Complications of premature rupture of membranes

A

Ascending infection

97
Q

Which anti-hypertensive agents are contra-indicated during pregnancy

A

Diuretics and ACE inhibitors

98
Q

What is HELLP syndrome

A

Haemolysis
Elevated Liver enzymes (particularly transaminases)
Low platelets

Is a variant of pre-eclampsia

99
Q

Categories of small infants

A

Born too small - normal size for gestation

Low birth weight -

100
Q

Purpose of an epiostomy

A

Indicated when signs of tearing or excessive blanching of the perineum during labour

  • avoids uncontrolled tearing in a downward direction which migh effect future bowel control
101
Q

The 4 Ts of post partum haemorrhage

A

Tissue: delayed spontaneous expulsion of placenta; incomplete delivery
Thrombus: placental abruption and pre-eclampsia impair maternal coagulation
Tone: multiple pregnancy, polyhydarmnios, macrosomy, general anaesthetic, prolonged or rapid labour
Trauma: birth canal or uterine trauma

102
Q

How do we test for trisomy 21

A

Maternal risk factors, b-HCG and pregnancy associated plasma protein and fetal nuchal translucency

103
Q

Fetal heart rate parameters

A

110-160

104
Q

Indications for operative delivery

A

Presence of fetal distress or “delay” or failed progress despite good contractions and maternal effort

105
Q

Uterine inversion is usually caused by

A

Pulling on the cord before separation

106
Q

Why are pregnant women prone to carpal tunnel syndrome

A

Swelling of soft tissues

107
Q

What is given to a newborn slow to establish respiration thought to be due to narcotic analgesics being given

A

Naloxone - narcotic antagonist

108
Q

Prematurity related problems

A 
Respiratory distress syndrome 
Periventricular haemorrhage 
Cortical damage 
Hydrocephalus 
Necrotising enterocolitis 
Sepsis 
Retinopathy/hearing problems
109
Q

Where is surfactant produced

A

Type 2 pneumocytes of the alveoli

110
Q

Effect of meconium aspiration syndrome

A

Meconium is irritant to the neonatal lungs and may lead to a pneumonitis

111
Q

Causes of seizures

A 
Neonatal encephalopathy
Focal cerebral infarction 
Cerebral malformation
Meningitis 
Hypoglycaemia 
Hypercalcaemia
Maternal drug abuse 
Inborn errors of metabolism
112
Q

Investigation for recurrent miscarriage

A

Karyotype from both parents
Maternal blood for lupus anticoagulant and anticardiolipin antibodies
Possible hysterosalpingogram and/or pelvic ultrasound to look for uterine abnormality

113
Q

Causes of recurrent spontaneous miscarriage

A 
Anti-phospholipid syndrome 
Chromosomal abnormality 
Cervical incompetence - suture may help
Thrombophilic defects
Anatomical uterine abnormalities
114
Q

Options for termination of pregnancy

A

Suction evacuation

Medical termination - mifepristone

115
Q

Follow up of termination

A

After termination anti-D should be given to those who are rhesus negative

Give patient pregnancy test to use

Arrange appointment to check termination is complete

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