Tutorials Flashcards
(163 cards)
1
Q
Gravidity?
A
no. of pregnancies (includes miscarriages, stillbirths)
2
Q
Parity?
A
no. of pregnancies longer than 24 weeks
3
Q
Menorrhagia
A
Heavy/long periods of bleeding
4
Q
Dysmenorrhoea?
A
Painful periods
5
Q
Amenorrhoea
A
Absence of period
6
Q
Oligomenorrhoea
A
infrequent periods or >35days between
7
Q
FIGO staging
A
0- in situ
1- confined to organ
2- surrounding tissue
3- distant nodes
4- mets
8
Q
Placental praevia
A
the placenta is inserted partially or wholly in the lower uterine segment
9
Q
Placental abruption
A
the placental lining separates from the uterus of the mother prior to delivery
10
Q
Average rate of cervix dilation during labour
A
1cm per hour
11
Q
Rheus disease
A
Mother and fetus (even if miscarriage or stillbirth) blood mix if mom Rh-ive and fetus +. Mother produces abs which could destroy current or future fetal Hbs.
12
Q
Emergency contaceptives
A
Intrauterine copper coil up to 5 days
Tablets:
1- levonelle (progestonegen) up to 3 days
2- ellaOne (progesteron modulatior inhibitor) up to 5 days
13
Q
CIs for the COCP pill?
A
Migrain with aura increases risk of ischaemic stroke so dont want the additional risk!
14
Q
Types of miscarriage
A
Threatened
Incomplete
Complete
Missed/silent
15
Q
Sx of miscarriage
A
ranges from pain and bleeding to asymptomatic (silent)
16
Q
Silent miscarriage diagnosis and management
A
USS (crown rump length and mean sac diameter):
- CRL<7mm with no FH or MSD< 25 mm with no fetal pole -> repeat USS in 1-2 weeks
- CRL >7mm with no fetal heart or MSD >25 mm with no fetal pole -> second opinion or repeat in 1 week
17
Q
Medical management of miscarriage
A
Misoprostol 800mcg
PRN: up to 4 doses of Misoprostol 400mcg every 3 hours
Repeat urine pregnancy test (UPT) in 3 weeks
18
Q
Risk factors for ectopic pregnancy
A
PID
Previous ectopic
IUD/IUS
IVF
Progesterone only pill
19
Q
Commonest site for ectopic pregnancy
A
majority in ampulla of fallopian tube
20
Q
Pregnancy of unknown location investigation
A
up to 3 serial serum hCG every 48 hrs
In intra uterine pregnancy -> increases by 63% + levels > 1500
In a failing pregnancy -> decreases by 50%
If static -> ectopic
21
Q
Medical management of ectopic pregnancy
A
methrotrexate
22
Q
When can medically manage a patient with ectopic pregnancy
A
no significant pain / no ruptured ectopic
HCG<1500
<35 mm
23
Q
Why shouldnt patients concieve after recieving methotrexate for ectopic pregnancy
A
depletes folate sources
should avoid for 3 months
24
Q
2 types of molar pregnancy
A
pre malignant (complete or partial mole)
Malignant
25
Complete mole genetic constituition
Diploid, 46 paternal chromosomes
26
Partial mole genetic constituition
Triploid (1 set of paternal + 2 sets of maternal)
27
Management of molar pregnancy
Surgical evacuation
Methotrexate
follow up future pregnancies (could recurr)
28
Prevention of preterm labour
Cervical suture could be at:
- pre-pregnancy (if high risk)
- 2nd trimester
- following USS evidence
29
Diagnosing preterm labour
1. Hx of regular painful contractions + cervical change
2. USS
3. If no cervical change, vaginal swabs
30
Vaginal swabs for Dx of preterm labour
- Actim partus (from cervical os)
- Quantitative Fetal Fibronectin (from high vaginal swab)
31
Preparing for preterm birth
Corticosteroids if \<35 weeks
Magnesium sulphate if \<30 weeks
32
Corticosteroid effects on preterm birth
lowers:
neonatal respiratory distress syndrome
neonatal intraventricular haemorrhage
death
33
Meds to try to stop preterm labour
Tocolysis with:
Nifedipine (Ca antagonist) or
Atosiban (oxytocin antagonist)
34
Tocolysis
stopping labour
35
when tocolysis contraindicated
when infection suspected eg SROM or bleeding
36
When are fetal movements first expected
18-20 weeks
Reliably reported by women at 24th week
37
How to identify reduced fetal movements
women over 24 weeks lie on their left side for 2hours should feel more than 10 discrete fetal movements
38
Assessment of fetal heart
\< 28 weeks Doppler auscultation
\> 28 weeks CTG
39
TORCH infections
Vertical transmission
Toxoplasmosis / Toxoplasma gondii
Others
Rubella
Cytomegalovirus
Herpes simplex virus-2 or neonatal herpes simplex
Others:
- Coxsackievirus
- Chickenpox (VZV)
- Chlamydia
- HIV
- Human T-lymphotropic virus
- Syphilis
- Zika fever
40
Small for gestational age (SGA) def?
Infant born less than 10th centile
41
Symmetrical causes of intraurterine growth restriction (IUGR)
Chromosmal
TORCH infections
Maternal smoking/alcohol/drugs
Maternal nutritional deficiency
42
Asymmetrical causes of intraurterine growth restriction (IUGR)
Utero-placental deficiency
Pre-eclampsia
Multiple gestation
Renal/cardiac disease
43
Pregnancy-associated plasma protein A (PAPP-A) significance?
Low level in first trimester ass with delivery of a SGA neonate
44
What counts as an early/late menupause?
40 early
52 late
45
Methods for Induction of labour
1. Stretch and Sweep
2. Prostoglandins (ripens cervix for amniotomy)
3. Amniotomy
4. Syntocinon infusion
5. Mechanical cervical dilators
46
Risks ass with induction of labour
Increased instumental delivery
Hyperstimulation leading to uterine rupture
47
Prostoglandins used for induction
Propess (slow release over 24hrs)
Prostin PO/gel (over 6 hours)
48
Mechanical cervical dilator
cook cervical ripenning balloon
49
Bishop score
assesses start of labour
\>9 spontaneous labour likely
\<5 induction likely
50
Increased fetal HR on CTG
Sepsis
51
Reduced fetal HR on CTG
fetal distress
cord compression
52
Risk ass with amniotomy
cord prolapse
53
Whats a normal variabilty in fetal HR and what is indicative of
\< 5bpm
normal CNS function
54
What are accelerations and deccelerations on CTG
a rise or fall of \>15bpm over 15 secs
55
Accelerations a sign of
normal ANS function (and the fact that Tom isnt driving)
56
Decceleration a sign of
cord compression
57
Normal rate of contraction in labour
3-5 contractions per 10 mins
58
Length of fully dilated cervix
10 cm
59
Fetal blood sampling values
pH \< 7.2 deliver
7.25 \> pH \> 7.2 borderline
pH \> 7.25 healthy
60
pre eclampsia def
new HTN after 20 weeks with proteinuria
61
gestational HTN def
new HTN after 20 weeks without proteinuria
62
Pre-eclampsia RFs?
Changing of partner
FHs
Antiphospholipid syndrome
DM
High BMI
\> 4yrs gaps between pregnancy
63
Anti hypertensives used for pre-eclampsia
Methyldopa
Nifedipine
Labetolol
64
Main SE of labetolol
intrauterine growth restriction
65
VTE prophylaxis used in pregnancy
LMW heparin
eg enoxaparin or dalteparin
66
Difficulty with LMW heparins in pregnancy
eGFR higher in pregnancy
Kidneys excrete them
higher doses required
67
Primary post partum haemorrhage def
blood loss from genital tract in 24 hours post birth
68
Secondary post partum haemorrhage def
blood loss from 24hrs post birth to 12 weeks post birth
69
Causes of post partum haemorrhage
4Ts:
Tone- uterus not contracting
Trauma- tear
Thrombin- DIC
Tissue- placenta missing
70
Manual methods of promoting uterine contraction for 3rd stage of labour
Uterine massage
Bimanual compression
71
Pharmacological methods of promoting uterine contraction for 3rd stage of labour
Syntometrine (2 IM injections)
Oxytocin (syntocinon infusion)
Misoprostol
Hemabate(PGF2α)
72
Management of continous post partum haemorrhage after manual and pharmacological management?
B lynch suture
Bakri balloon
73
Female genital mutilation types
III removal of clit, minor + suturing major
74
Different pelvic shapes
Gynecoid: Ideal shape,
Android: triangular inlet, and prominent ischial spines
Anthropoid: transverse diameter \< anteroposterior diameter.
Platypelloid: Flat inlet + shortened anteroposterior diameter (Predispose to OT presentation)
75
Different types of presentation? which cant deliver?
OT
76
Vaginal tears
1 vaginal muscles torn
2 perineal muscles torn
3 anal sphincter torn
4 rectum torn
77
Pelvic nerves
Sciatic (L4 to S3)
Pudendal (S2 to S4)
78
Latent phase of labour
Cervix effacing and thinning
\<4cm dilated
Painful irregular tightenings
79
First stage of labour
cervix effaced 4cm, fully dilated
Regular painful contractions
80
Second stage of labour
fully dilated cervix
Delicery of baby
81
Third stage of labour
delivery of placenta and membranes
82
Vasa praevia
cord vessels pass across the internal os
Could lead to blood loss from fetus
83
Different types of twins
Dichorionic diamniotic (DCDA)
Monochorionic: diamniotic (MCDA) or monoamniotic (MCMA)
84
Risk with MCMA twins?
cord entanglement
85
Twin to twin transfusion syndrome
Abnormal blood vessels
one becomes donor, one reciever
Donor is malnourished, reciever gets excess blood risk of heart failure
Could result in death of one or both
86
Twin to twin transfusion management
laser ablation of connecting vessels in utero
87
Types of malpresentation
Frank (extended)
Complete (flexed)
Footling
Kneeling
88
Options for management of breech presentation
- Eternal cephalic version ECV to manually change the lie
- Elective C section
- vaginal delivery with breech presentation
89
At which stage of pregnancy does nausea and vomiting occur most commonly
1st trimester
90
The severity of nausea and vomiting throughout pregnancy
starts at 4-7/40
peaks at 9/40
usually resolves by 20/40
91
Hyperemesis gravidarum def
N/V + triad of:
- 5% pre-pregnancy wt loss
- dehydration
- electrolyte imbalance
92
Rfs for hyperemesis gravidarum
Nulliparous
\< 20 yo
High BMI
Multiple pregnancy
Molar pregnancy
Iron meds
93
Pathology of hyperemesis gravidarum
Higher levels of bHCG could be causing thyrotoxicosis similar sx
94
Gestational thyrotoxicosis path
bHCG similar structure to TSH
Stimulates T3/4 release
Suppresses natural TSH production
95
Sx and mx of gestional thyrotoxicosis
Clinically euthyroid
Normalises over course of pregnancy no mx
96
1st line antiemetics for pregnancy
Antihistamines : Cyclizine, Promethazine
Prochlorperazine
97
2nd line antiemetics for n/v during pregnancy
Metoclopromide
Ondasteron
98
SEs and CIs with metoclopromide during pregnancy
Maternal extrapyrimidal SEs: eg dyskinesia
Avoid in \<18yo
99
SE of ondansteron in pregnancy
Slight association with cleft lip in 1st trimester
100
Maintenance fluid and electrolyte requirements in pregnancy
Same as normal
25-30 water mls/kg/day
1 mmols/kg/day K/Na/Cl
101
Analgesia during pregnancy
Paracetamol
Pethadine
Avoid NSAIDS
102
Abx to avoid in pregnancy
Trimethoprim (1st trimester)
Nitrofurantoin (3rd trimester, causes fetal haemolytic anaemia)
103
Meds in PEPSE
Raltagrivir and truvada
104
Obstetric cholestasis sx
itching of hands/feet
105
Risk associated with obstetric cholestasis
Preterm delivery
Meconium aspiration syndrome
Stillbirth
106
Management of obstetric cholestasis
ursodeoxycholic acid
antihistamin
aqeous cream + menthol
107
When does obstetric cholestasis present
3rd trimester
108
Dx of obstetric cholestasis
Itching + negative liver screening
109
Ix within liver screening
Hep A,B,C
EBV
CMV
autoimmune
USS
110
Placenta accreta
Placenta attatched to myometrium
111
Placenta percreta
placenta through uterus into other organs
112
How long after potential exposure should test for syphillis
up to 3 months
113
COCP side effect
blood clots
114
How long after potential exposure should test for gonnorrhoea/chlamydia
2 weeks
115
How long does sperm last in vagina
5 days
116
How to work out the ovulation day in cycle
14 days before the first day of bleeding
117
When is the optimum time for pregnancy
day 9 to 14
118
Progesterone side effect
reduced BMD
119
Risk of malignancy index (RMI) calculation
120
What RMI score is considered high?
\>200
121
How does management change with RMI\>200
high risk score
CT abdo/pelvis
Refer to senior gyno-oncologist
122
Classification of ovarian germ cell tumour
123
CA125 tumour marker§
Peritoneal inflammation: ovarian/ pancreatic etc
124
bHCG tumour marker
choriocarcinoma
125
AFP tumour marker
yolk sac tumour/immature teratoma
126
Contraception post partum if breastfeeding
1. Natural: if meets all 3 criteria:
day and night breastfeeding & \<6mo post partum & amenorrhoeic
2. Progesterone only: anytime post partum
127
Which contraception not when breastfeeding
combined pills: start at 6 mo
(if not breastfeeding, start at 3rd week)
128
Puerperium
6 weeks after delivery
129
Maternal structural changes during puerperium
uterus from 1 kg to 100g (involution)
internal os closes by 3 days, external by 3 weeks
130
Lochia
endometrial slough, red and white cells passed through vagina
Day 1 -3 red (lochia ruba)
10- week 6 white (lochia alba)
131
Indications to episiotomy?
distressed baby
instrumental/breech delivery
protect premature head
prevent 3rd (not 4th) degree head
132
Pain relief in labour
1. Breathing exercises
2. Pethidine IM (not \<2hrs of birth as depresses fetal resp)
3. NO
4. Pudendal block
5. Spinal/epidural
133
Resus blood tests
Test mothers blood;
if negative, do Fetal DNA analysis (using mothers blood)
if both negative, dont do anything
If incompatible, give anti-D
134
Indications for an epidural during labour
OP position
instrumental/breech
pre-eclampsia
135
Problems with epidural in labour
postural hypotension
urinary retention
paralysis
136
Treatment of seizure (eclampsia)
4g magnesium sulfate
137
Diagnosis of gestational diabetes
OGTT
fasting above 5.6
2hrs above 7.8
138
Small for gestational age maternal causes
multiple pregnancy
malformation
infection
pre-eclampsia
139
What conditons are babies small for gestational age susceptible to in adult life
hypertension
coronary artery disease
autoimmune thyroid disease
non-insulin dependent DM
140
What complications are SGA babies susceptible post delivery
hypoxia
hypoglycaemia
temperature regulation problems
jaundice (hypoxic in utero, so Hb up)
141
Maternal history to ask in newborn infant physical examination (NIPE)
Pregnancy complications/delivery/USS
Babies position/lie at delivery
RFs for neonatal infection
FHx
142
Newborn history to ask in newborn infant physical examination (NIPE)
feeding pattern
urination
passing of meconium
143
What is shown
lichen simplex chronicus
hyperpigmented plaques
144
lichen simplex sx
itching/soreness of skin
145
Mx of lichen simplex
Steroid cream (betamethasone or clobetasol)
Coal tar cream/ointment for maintenance (anti-inflammatory)
146
vulvar lichen planus sx
very painful, burning sensation
white lacy pattern
147
What is shown
lichen sclerosis
hypopigmentation
148
what is lichen sclerosis
autoimmune condition, affecting vulva skin, of women of any age
149
Sx of lichen sclerosis
itchiing
150
Mx of lichen sclerosis
strong steroids
151
What is polyhydramnios
excess amniotic fluid
152
Maternal causes of polyhydramnios
gestational diabetes
TORCH
153
Fetal causes of polyhydramnios
problems with swalllowing : atresia/fistula
or
urinating
154
What is shown
- Caput succedaneum
- subcutaneous fluid collection due to trauma during delivery
155
Difference between caput succedaneum and cephalohaematoma
succ: oedama collection between skull and skin over the presenting part (crosses the suture line)
cephalohaematoma: blood collection between skull and its periosteum ( does not cross the suture line)
156
Why use misoprostol vs methotrexate for miscarriage?
Methotrexate destroys dividing cells so kills foetus
Miscarriage - foetus already dead but just want to ensure all tissue is removed
Misoprostol stimulates uterine contraction
157
COCP increases risk of which cancer
Cervical and breast
158
COCP protective against which cancers
endometrial
ovarian
159
HRT types
Cyclical
Continous
160
Cyclical HRT use
Only if peri-menupausal (LMP less than 1 year ago)
161
Continous HRT use
Post menupausal
or 1 year of cyclical HRT
162
PCOS dx criteria
2 out of 3:
Oligomenorrhoea or Anovulation
Biochemical changes
Polycystic ovaries or increased ovarian volume
163
Biochemical changes in PCOS
Sx: eg Hirsutism
Elevated levels of androgens (eg total or free testosterone)
High LH
Low FSH
