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Week 4 - Core clinical Problems Flashcards

1
Q

What is Fergusons reflex

A

Pressure applied to internal cervix - causes the release of oxytocin - causes uterine contractions

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2
Q

What chemical initiates the softening of the cervix before birth?

A

Hyaluronic acid

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3
Q

What is Bishop’s score

A

A score to see if it is safe to induce labour

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4
Q

What is the normal progress of a dilating cervix

A

1cm per hour

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5
Q

In a multiparous women, what time is considered prolonged during delivery of a baby?

A 
2 hrs (WITH regional anaesthetic) 
1 hr (WITHOUT regional anaesthetic)
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6
Q

What chemical causes true labour contractions

A

Oxytocin

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7
Q

When the babies head is said to be ‘engaged’ - what does this mean?

A

3/5ths of fetal head has entered mother’s pelvis.

2/5ths can still be felt abdominally

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8
Q

When should the cord be clamped immediately?

A

If baby needs resuscitation (if baby loses its pulse)

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9
Q

How long after baby delivery should the placenta be expelled?

A

5-10mins

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10
Q

What should you do if there is any blood loss prior to baby delivery?

A

Refer to consultancy unit. This is serious.

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11
Q

Lactation is stimulated by 2 things - what are they?

A

Expulsion of placenta

Decrease in oestrogen & progesterone

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12
Q

Common medical problems in each trimester

A

1st - miscarriage (esp in diabetic mothers)
2nd congenital malformations (esp in diabetic mothers)
3rd - growth restrictions & pre-eclampsia

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13
Q

Pregnant women comes in complaining of chest pain, what investigations do you preform?

A

ECG

+/- CT

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14
Q

Warfarin is safe in pregnancy: T/F?

A

F. V unsafe. Switch to LMWH

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15
Q

LMWH is safe in pregnancy: T/F

A

T

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16
Q

What cardiovascular changes does a women go through during 1st trimester of pregnancy?

A

Increase in cardiac output, stroke volume, plasma volume

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17
Q

What common cardiovascular conditions are commonly seen in pregnancy?

A

Palpitations
Sinus tachycardia
SVT

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18
Q

When is breathlessness most commonly seen in pregnancy?

A

3rd trimester

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19
Q

How to help manage breathlessness in pregnancy?

A

It can IMPORVE with exertion

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20
Q

Pregnant women comes in with breathlessness - what are your thoughts?

A

Usually physiological so don’t do unnecessary tests but do have to be aware that it could be an underlying PE

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21
Q

What happens to PaO2 and PaCo2 during pregnancy?

A

PaO2 increases

PaCO2 decreases

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22
Q

How to manage asthma during pregnancy & during birth?

A

Inhalers are safe to take
IV hydrocortisone to be given to mother during labour as a substitute for any oral steroids she may be taking for her asthma

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23
Q

Pathogenesis behind VTE in pregnancy

A

Decreased blood flow in legs (esp towards the end of pregnancy)

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24
Q

What can increase risk of VTE in terms of baby delivery?

A

If baby is delivered by forceps or C-section

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25
Why is LMWH safe compared to warfarin?
Heparins: a) Do NOT cross the placenta b) Are NOT secreted in breast milk
26
Why are DVTs and VTEs commonly missed in pregnancy?
They symptoms they cause are similar to those of a 'normal' pregnancy
27
What Ix do you preform (and what test do you NOT preform) on a pregnant woman with a suspected DVT?
DO a compression duplex ultrasound | DON'T do D-dimers test - they will be raised in pregnancy regardless of whether or not they have a DVT
28
Symptoms of DVT?
Swelling, oedema, Leg pain, Increased leg temp, lower abdo pain, elevated WCC
29
Pregnant women comes in with whole leg swollen + back pain. What investigation do you want to preform?
MRI venography (you suspect an iliac vein thrombosis)
30
Symptoms of PE in pregnancy?
Dyspnoea, Chest pain, Faintness, Collapse, Haemoptysis, Raised JVP
31
What Ix do you preform on a pregnant women with a suspected PE?
ECG | CXR
32
Difference in pros and cons with a CTPA vs V/Q scan?
CTPA - more sensitive & specific but can cause breast cancer V/Q - Less sensitive & specific but lower radiation dose in comparison to CTPA
33
If a baby is born with a flat face, short arms, legs and fingers & scoliosis. What do you suspect?
Mother had taken warfarin during pregnancy
34
Warfarin can be taken during breastfeeding period: T/F?
T. It can be taken (do 5 days postnatally just to be safe from PPH)
35
Pregnant mother with Connective Tissue Disease, what drugs do you need to stay away from?
NSAIDS, Cyclophosphamide, MTX, Gold, Penicillamine
36
Azathioprine is safe in pregnancy: T/F?
T
37
What condition is Antiphospholipid Syndrome commonly associated with?
SLE (systemic Lupus Erythematous)
38
Clinical features of Antiphospholipid Syndrome
Arterial/Venous thrombosis Recurrent pregnancy loss Severe pre-eclampsia
39
How to diagnose APS?
Diagnosis can be clinical (if pregnant women has thrombosis or miscarriages) Diagnosis can be via laboratory - IgM/IgG
40
Obstetric complications in mothers
Miscarriage, Pre term birth, Hypertension, post partum haemorrhage
41
Foetal risks with epileptic mothers
Maternal abdominal trauma Pre term premature rupture of membrane Congenital malformations
42
Anti-epileptic drugs increase teratogenicity risk?- T/F
T
43
What anti-epileptic drug MUST be avoided?
Sodium Valporate
44
If the mother has a tonic-clonic seizure, what is the baby at risk of?
Hypoxia
45
A pregnant woman presents with a seizure for the first time. Is this epilepsy?
No, you assume this is pre-eclampsia
46
Mx of epileptic seizure during birth? (emergency!!)
Left lateral tilt IV lorazepam/diazepam IV Phenytoin
47
What is the sequence of BP changes during pregnancy?
``` BP falls in early pregnancy There is a steady rise until term BP falls after delivery Rises & peaks at day 3 postnatally By day 10 post natal - BP should be normal ```
48
Limits for BP hypertension (how to diagnose) ?
140/90 twice | 160/110 once
49
How can you discriminate between pregnancy induced hypertension & pre-eclampsia?
Pregnancy induced: - Occurs in 2nd half of pregnancy - Resolves around 6 weeks of delivery - No proteinuria or other features of pre-eclampsia
50
Pre-eclampsia triad
Hypertension Proteinuria Oedema
51
symptoms of pre-eclampsia
``` headaches visual disturbance epigastric pain N&V Rapidly progressing oedema ```
52
Ix for PET
``` U&Es Serum urate LFTs FBC Coagulation screen CTG scan ```
53
Mx of PET
75mg aspirin Look for secondary cause of hypertension & treat (e.g. any endocrine disorder) Treat the hypertension itself Keep a careful surveillance on mother & baby The only cure of PET is giving birth
54
Are you more at risk of PET if its your first pregnancy or a multiparous birth?
First pregnancy
55
What kind of imaging can be used for PET and what characteristics will it show?
MUAD | Notching indicates PET
56
Treatment of hypertension in pregnancy?
1st - Labetolol | 2nd - Hydralazine
57
What hypertension medication should be avoided during pregnancy?
Diuretics | ACEI
58
What foetal surveillance is needed in a hypertensive mother or a mother with PET?
CTG
59
If you have a PET mother who needs to give birth, what should you give the baby (medication) to help? And why??
IV hydrocortisone - given to premature babies to promote foetal lung maturity Then x2 dexamethasone
60
Mx for severe eclampsia?
Control BP - IV labetolol & hydralazine Stop seizures - Magnesium sulphate Fluid balance - be careful not to fluid overload do 80ml/hour Delivery of baby - aim of vaginal, give epidural anaesthesia (helps BP too)
61
Symptoms of puerperal psychosis?
Sleep disturbance, Confusion, Irrational ideas, mania, suicidal thoughts
62
When is the usual onset of puerperal psychosis?
2 weeks post delivery
63
Symptoms of post-natal depression
Tearful, irritable, anxiety, lack of enjoyment, poor sleep, weight loss
64
When is the onset of post natal depression?
2-6 weeks post natal. Can last weeks-months
65
Can anti-psychotics be used in pregnancy?
Generally yes
66
What psych drugs should be avoided during pregnancy?
Sodium valproate Benzodiazepines Carbamazepine - neural tube defect Lamotrigene - oral cleft
67
What vitamin can become deficient when a pregnant mother drinks alcohol? What is the condition associated with this called?
Vit B1 | Wernicke's encephalopathy
68
Effects of substance misuse in a pregnant woman?
IUGR, Pre term, miscarriage, sepsis, domestic abuse, STIs
69
What is placental abruption?
When the placenta separates from the uterine wall (partially or totally before birth of baby)
70
What could placental abruption cause in the baby?
Hypoxia - death
71
Mx of placental abruption?
Resuscitate mother - FBC, clotting, LFTs, U&Es, cross match, fluids, catheterise Do a CTG on baby. If no heart beat, do a USS Deliver baby
72
What are the 4 different types of urinary incontinence?
Stress incontinence - leakage on exertion Urinary or 'Urge' incontinence- leakage with or immediately preceding the feeling of urge Mixed incontinence - Leakage associated with both stress & urge Overactive bladder - Same as urge but can be WITHOUT incontinence
73
If you had blood in your urine - what 2 diagnosis are you worried about?
Bladder cancer | Renal stones
74
Ix for incontinence
Urinalysis Urodynamics Cystoscopy Imaging
75
Mx for incontinence
``` Lifestyle advice (least invasive) Bladder drill Pelvic floor physiotherapy Drugs (antimuscarinic) Botulinum toxin - woman must be able to self catheterise Reconstructive surgery (most invasive) ```
76
What antimuscarinic drug can you use for incontinence? | Why is it now used compared to the old drugs?
MIRABEGRON | Less likely to cause confusion
77
Mechanism of action of Mirabegron?
Selective B3 adrenoreceptor agonist Works in parasympathetic control to inhibit involuntary contractions Works in sympathetic control to relax the bladder
78
If pt is getting nocturia, what is a good drug to add into their treatment?
Desmopressin
79
Symptoms of prolapses
Sensation of pressure & dragging Incontinence issues Incomplete emptying (bladder & bowel) Sexual dysfunction
80
Mx of prolapses
Conservative Pessaries Surgery - Pelvic floor repair

Reproduction (15 decks)

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