Reproduction 6

Front 1

What happens to BP during pregnancy ?

Back 1

1-2nd trimester = hypotension

3rd trimester = Pre-pregnancy BP

Front 2

What are the types of HTN in pregnancy ?

Characteristics

Back 2

-Pre-existing HTN (>140/90mmHg <20 weeks)

-Pregnancy-induced HTN ( > 20 weeks)

-Pre-eclampsia ( >140/90 mmHg + 0.3g/day proteinuria) ( >30/15 mmHg from booking appointment)

-Eclampsia ( >160mmHg + 0.3g/day proteinuria) (Pre-eclampsia + symptoms)

Front 3

What are the values for HTN in pregnancy ?

Back 3

- >140/90 mmHg

OR

-> 30/15 mmHg from BP @ booking appointment

(If 150/100mmHg -> Anti HTN Rx)

(If 160/110 mmHg->eclampsia)

(If 170/110mmHg --> IMMEDIATE Rx)

Front 4

If a patient has HTN during pregnancy , what additional Rx should they be given ?

Nutrition ect..

Back 4

Folic acid 5mg

ASA

betamethasone (b/w 24-34 weeks)

Front 5

When should a patient with HTN be admitted?

Back 5

>140/90mmHg + proteinuria (>0.3g/day)

Abnormal biochemistry

Fetal distress

S/S - headache, visual disturbance, abdo pain

Front 6

What are the risk factors for Pre-eclampsia ?

Back 6

Previous HTN , pre-eclampsia

>40 yrs - afrocarribean

FHx

Smoking

DM

Obesity

Chronic renal dx

Multiple pregnancy

1st partner

Nulliparous

Front 7

What S/S of Pre-eclampsia ?

Back 7

Headache

Visual disturbance

SOB (pulmonary oedema)

Epigastric/RUQ pain

Frothy urine

Peripheral oedema

Hyperreflexia , Clonus

Front 8

What are the complications of HTN in pregnancy ?

Back 8

Cerebral hemorrhage

Blindness

ARDS, pulmonary edema

Liver failure - HELLP, DIC

Renal failure

Placental abruption, IUGR

Front 9

What Ix are indicated for Pre-eclampsia

Back 9

FBC, LFT, U&E

Coagulation screen

USS

Uterine/umbilical artery doppler

(if delivery - partogram)

Front 10

What would an abnormal uterine artery doppler show ?

Back 10

Notching

Front 11

What Rx are indicated for pre-eclampsia

Back 11

ASA

Betamethasone INJ (2x 12 hrs apart )

Fluid restriction (80mL/Hr)

If >150/100mmHg --> Labetalol (or Hydralazine/nifedipine if asthmatic)

Front 12

What Anti-HTN can you use in Pregnancy ?

Back 12

-Labetalol

-Hydralazine

-Nifedipine

-Methyldopa

Front 13

What are the indications for inducing delivery in a pt with pre-eclampsia ?

Back 13

37 weeks gestation

S/S

Fetal distress

Unresponsive to Rx

Front 14

What is HELLP syndrome ?

Characterstics

Back 14

(DIC affecting liver)

Hemolytic + Elevated Liver + Low platelets

Characteristics: DIC , Schistocytes, Coca-cola urine , Liver failure , Clotting disorder

Front 15

How do you monitor a pt with HELLP syndrome ?

Rx?

Back 15

Monitoring: Partogram, CTG, Uterine artery doppler

Rx:

Fluid restriction (80mL/hr)

Betamethasone INJ (2x 12 hrs apart)

-IV Labetalol/nifedipine/hydralazine

-MgSulphate

-VAGINAL delivery

Front 16

Why is a vaginal delivery indicated for HELLP syndrome ?

Back 16

b/c of coagulation disorder!!!

Front 17

What is eclampsia ?

Back 17

>160/110mmHg + proteinuria

OR

Pre-eclampsia + S/S or seizure

Front 18

When does eclampsia commonly occur ?

Back 18

Post-partum

Front 19

How do you Rx eclampsia ?

Back 19

(Same as HELLP)

Monitoring: Partogram,CTG, Uterine artery doppler

Betamethasone (2x 12 hrs apart)

Fluid restriction (80mL/hr)

IV labetalol/Nifedipine/Hydralazine

MgSulphate

Delivery

Front 20

What is a Dx contraindication in pre-eclampsia ?

What can be used instead?

Back 20

Syntometrine/Ergometrin ( a vasoconstrictor)

Instead use Syntocinon

Front 21

If Antepartum hemorrhage occurs , what management needs to be done ?

Back 21

USS

ABO, rhesus status

Anti-D @ 28 & 34 weeks

Betamethasone INJ (2x 12 hrs apart)

Front 22

What is the DDx of antepartum hemorrhage ?

Characteristics

Back 22

Placenta previa (plainless bleed + Abnormal lie/high presenting part)

Vasa previa (painless bleeding + fetal distress)

Placental abruption (Painful hard woody uterus + fetal distress )

Uterine rupture (Periotnism + DIC + ↓ contractions + fetal distress)

Cervical dx (Painless light bleeding)

Show - NORMAL!:)

Front 23

When does antepartum hemorrhage occur ?

Back 23

>24 weeks gestation

Front 24

What Ix are indicated for antepartum hemorrhage ?

Back 24

FBC

ABO/Rhesus status

Kleinhauer betke

USS

Partogram/CTG

Front 25

What should be cautioned in antepartum hemorrhage ?

Back 25

Vaginal examination! (exclude placenta previa!)

Front 26

What is placenta previa ?

Risk factor

S/S

Ix

Back 26

Implantation of placenta in lower uterine segment

Risk factor: previous C-section, Multiple pregnancies , Multiparity

S/S: Painless bleed + Abnormal lie/high presenting part

Ix: USS

Front 27

What is the classification for placenta previa ?

Management ?

Back 27

Type I - @ lower uterine segment

Type II - touching the cervix

Type III - overlying the cervix

Type IV - covering the cervix + no dilatation allowed

Type III/IV --> C-section @ 38 weeks/Hemorrhage

Front 28

Picture of placenta previa

Back 28

Front 29

What is placenta acreeta ?

S/S

Complication

Back 29

Placental attachment to myometrium

S/S: Delayed stage 3 (i.e placenta doesn't detach!)

Complication: PPH

Front 30

What is vasa previa ?

Types?

Back 30

Abnormal attachment of fetal vessels to placenta (overlying cervical os & unprotected from Wharton's jelly)

@ labour -> damage to fetal vessels

Subtypes ; Velamentous (Cord insertion further away from placenta). Succenturiate lobe (Insertion to an abnormal extra lobe)

Front 31

For vasa previa , describe

S/S

Rx ?

Back 31

S/S: Painless bleed + fetal distress

Rx: C-section URGENT. (b/c occurs @ labour)

Front 32

What is placental abruption ?

Where is the blood loss from?

Back 32

Seperation of placenta from uterus

Blood loss from fetal circulation

Front 33

For placental abruption, describe

Risk factors

S/S

Rx

Back 33

Risk factors: HTN, Smoking, Trauma

S/S: Painful Hard woody uterus (bleeding variable) + Fetal distress

Rx: Delivery @ 38 weeks/hemorrhage

(if viable --> C section. If stillbirth -> Vaginal)

Front 34

What are the complications of placental abruption /

Back 34

DIC (commonest cause of DIC in pregnancy)

Couvelaire's uterus (Bleeding into myometrium -> peritoneal cavity)

Maternal/fetal death

Front 35

For uterine rupture ,describe

Risk factors

S/S

Rx

Back 35

Risk factor: previous C-section, Syntometrine/syntocinon

S/S: ↓ contractions , Peritonism , high head presentation , fetal distress

Rx: Laparotomy/C-section

Front 36

How much is PPH ?

Vaginal

C-section

Back 36

Vaginal <500mL

C-section <1L

Front 37

When can PPH occur up to ?

Back 37

stage 3 --> 6 weeks post-partum

(PPH >1 day - due to endometritis/retained products )

Front 38

What is PPH caused by ?

Complications ?

Back 38

4T's

Tone

Tissue

Trauma

Thrombin (i.e coagulation disorders)

Complications: DIC/Shock/Sheehan's

Front 39

What is the management of PPH ?

Back 39

ABCDE

(MSC)

Uterine massage + bimanual compression

IM/IV Syntometrine

Carboplast/misoprostol

Front 40

What are the different ways of fetal assessment ?

Back 40

Head/abdo circumference

CTG

USS - Biophysical assessment

Doppler USS

Front 41

What does CTG compare ?

Describe

Back 41

Fetal HR cf. Contractions

(Dr. C. BraVADO)

Define Risk

Contractions (1x 2-3mins)

Baseline Rate (110-160bpm)

Variability (5-25bpm)

Accelerations (1x10mins)

Decelerations (late = hypoxia)

Overall score = Suspicious/pathological?

Front 42

What are early decelerations caused by ?

Back 42

Compression of fetal head

O.K (occur & resolve w/ contractions)

Front 43

What are variable decelerations caused by ?

Back 43

Compression of cord

Associated w/ shouldering

Front 44

What are late decelerations caused by ?

Back 44

Fetal hypoxia

WORRYING!

Front 45

What does the biophysical profile of the fetus assess?

Back 45

(ABC TM)

Amniotic fluid

Breathing

Circulation- HR

Tone

Movement

(2pt if normal)

(Normal = 8-10)

Front 46

What does an umbilical artery doppler show ?

What is abnormal ?

Back 46

Shows placental resistance to blood flow

Abnormal = notching

Front 47

Why are pregnant women hypercoaguable?

Back 47

↑ Clotting factors

↓ natural anticoagulants (Protein C/S, Antithrombin)

Front 48

What is prophylactic Rx of DVT in pregnancy ?

Back 48

LMWH @ delivery + 7 days post-partum

Front 49

What nutritional supplements should pregnancy women receive ?

Back 49

400mcg Folic acid ( 5mg if HTN, epileptic, DM)

300mg Fe

10mcg Vitamin D

Front 50

What Dx are teratogenic ?

Back 50

ACEi

Betablockers (poor growth)

NSAIDS ( premature closure of ductus arteriosis)

Warfarin

AED (Carbamazepine, valproate)

Methotrexate

Carbimazole

Lithium (Ebsteins anomaly)

Tetracycline

Sulphonylureas (Gly-, Gli)

Thalidomide

Diethylstillbestrol

Front 51

What Dx should be avoided in breastfeeding ?

Back 51

Amiodarone (neonatal hypothyroidism)

BDZ

Cytotoxic dx

Bromocriptine (DA agonist)

Front 52

What effects does pregnancy have on pharmokinetics ?

Absorption

Distirbution

Metabolism

excretion

Back 52

Absorption - ↓ morning sickness

Distribution - ↑ Plasma volume & fat . ↓ protein binding (hemodilution)

↑ Metabolism and excretion (↑ hepatic metabolism & GFR)

Front 53

What are infections that can transmit through the placenta ?

Back 53

TORCHeS

Toxoplasmosis

Rubella

CMV

HIV

Herpes Simplex/Zoster

Syphillis

Parvovirus B19 (Hydrops fetalis)

Group B strep/ E.coli/Listeria

Front 54

What are the characteristic of neonatal toxoplasmosis

Back 54

Chorioretinitis

Cataracts

tram-like intracranial calcifications

Front 55

What are the characteristic of neonatal Rubella

Back 55

Cataracts + deafness

PDA/pulmonary artery stenosis

Purpura

Front 56

What are the characteristic of neonatal CMV

Back 56

Unilateral deafness

Periventricular leukomalacia

Chorioretinitis

Purpura

Front 57

What are the characteristic of neonatal HIV

Back 57

recurrent infection

Chronic diarrhoea

Front 58

What are the characteristic of neonatal Herpes Simplex

Back 58

Conjunctivitis

Temporal lobe encephalitis

Front 59

What are the characteristic of neonatal Herpes Zoster ?

Back 59

Microophtalmia

Microcephaly

Limb hypoplasia

Front 60

What are the characteristic of neonatal Syphillis

Back 60

Hydrops fetalis

snuffles

Rash on palms/soles

(late)

Hutchinson teeth

Saber's shins

Saddle node

Deafness

Front 61

How do you manage HIV in pregnancy ?

Back 61

Antiretroviral Rx @ 28-32 weeks gestation

Neonatal antiretroviral Rx

C-section

no breasfeeding

Front 62

How do you manage herpes zoster contact in pregnancy

Back 62

If immunized --> PO acyclovir if <24 hrs of symptoms

If non-immunized -> IV Varicella Ig

(can detect immunisation by serum varicella Ig)

Front 63

If a neonate is septic , what ABx would you give ?

Back 63

IV Cefotaxime

Front 64

What are the risk factors for neonatal infection ?

Back 64

maternal pyrexia near labour

PROM >24 hrs

Group B strep +ve in mother , Previous Group B Strep in baby

Pre-term

Meconium aspiration

Front 65

What is hemorrhagic disease of newborn ?

Rx?

Back 65

Coagulation dx in neonates due to Vit K deficiency

Rx: Prophylactic vit K IM (iN ALL NEONATES)

Front 66

What is transient tachopnea of newborn ?

Back 66

Poor resorption of fluid from lungs --> transient tachopnea

Self-limiting & resolves within 1 day

Front 67

What are the characteristics of fetal alcohol syndrome

Back 67

Mental retardation

flat face, smooth philtrum, thin upper lip, epicanthal folds, Upturned nose

Short

VSD

Front 68

What are the characteristics of down syndrome ?

Back 68

Variable learning disability

low set ears

Epicanthal folds

Brushfield spot

Single palmar crease

5th clinodactyly

1st wide spaced toe

Early onset dementia

ALL/AML

VSD/ASD

Front 69

What screening test are performed in neonates ?

Back 69

Automated hearing test

Guthrie test @5 days ( PKU, MACAD, CF, Sickle cell, Hypothyroidism)

Infection -TORCHeS, HCV/HBV vaccination

Front 70

When do the baby blues occur ?

Back 70

3-7 days post-partum

Front 71

When does post-natal depression occur ?

Rx?

Back 71

within 1 month ( peaks @3 months)

Rx: Sertraline

Front 72

What is puerpural psychosis ?

When does it occur

Rx?

Back 72

2-3 weeks post-partum

Depression + psychosis

Rx: Emergency admission + ECT

Front 73

What is the commonest metabolic disorder in neonates ?

Back 73

Hypothermia -> hypoglycemia -> hypoxia

Front 74

How do you calculate "corrected gestational age"

Back 74

Actual age (weeks) - (# weeks preterm)

(Term = 40 weeks)

Front 75

If a child is born @ <32 weeks , when will they reach their milestones ?

Back 75

2 yrs old

Front 76

If a child is born @ 32-36 weeks , when will they reach their milestones ?

Back 76

1 yr old

Front 77

What is classified as normal birth weight ?

Low ?

Very low?

Extremely low ?

Back 77

Normal =3.5kg

Low <2.5 kg

Very low <1.5 kg

extremely low <1.0kg

Front 78

If a pregnancy is at high risk of pre-term birth , what management Rx should be performed ?

Back 78

Anti-D INJ within 72 hrs (or @ 28 & 34 weeks)

Betamethasone INJ (2x 12 hrs apart)

Delay cord clamping for 1 min

Warmth (plastic bag + heater)

Front 79

What conditions commonly affect pre-term babies ?

Back 79

Hypothermia, hypoglycemia, hypoxia

Sepsis

Bronchopulmonary dysplasia , RDS

PDA

Retinopathy of prematurity

Interventricular hemorrhage

NEC

Front 80

How do you Rx sepsis in a neonate

If meningitis

if unknown origin ?

Back 80

If meningitis -> IV Benzylpenicillin + gentamycin

If unknown origin -> IV cefotaxime

Front 81

What are the S/S of neonatal RDS

Rx?

Back 81

Immediately after birth --> resp distress (grunting, nasal flaring, tachypneic, Indrawing)

Rx:

A) CPAP

B) Intubation + Artificial surfactant

Front 82

prophylaxis for neonatal RDS ?

Back 82

Betamethasone 2xINJ 12 hrs apart weekly

if high risk - Betamethasone 72 hrs prior to labour

(works best @ 24 hrs)

Front 83

Intraventricular hemorrhage is caused by what ?

Risk factor ?

Ix?

Prophylaxis ?

Back 83

Premature babies w/ germinal matrix present in ventricles --> labour -> hemorrhage of germinal matrix

Risk factors: Prematurity, RDS

Ix: USS of anterior fontanelle

Prophylaxis: antenatal betamethasone

Front 84

What is Necrotising enterocolitis ?

When does it occur ?

S/S

Ix

Rx

Back 84

Ischemic bowel & colon Within 1 week of birth

S/S: Poor feeding, blood stool, abdominal distention, vomitting

Ix: AXR URGENT - shows air in bowel

Rx: NBM

IV penicillin + met + gent

Front 85

How can NEC be prevented ?

Back 85

Breastfeeding

Front 86

Pudendal nerve contains which nerve roots ?

Does it supply parasympathetic or sympathetic supply ?

Back 86

S2-4

Parasympathetic

Front 87

Which uterine ligament is commonly ligated during sterilization ?

Back 87

Round ligament

Front 88

Which ligament attaches the uterus to the sacrum?

Back 88

Uterosacral ligament

Front 89

Which ligament attaches the cervix to the pelvic brim?

Is it located medial or lateral

Back 89

Cardinal ligament

Lateral

Front 90

Which ligament is the strongest uterine ligament ?

Back 90

Uterosacral ligament

Front 91

What does the round ligament attach to ?

Back 91

Uterine fundus --> into inguinal canal --> labia majora

Front 92

Which ligaments attach the uterus

Posteriorly

Anteriorly

Laterally ?

Back 92

Posterior = uterosacral

Anteriorly = Round ligament

Laterally = Cardinal ligament

Front 93

Which ligament attaches the ovaries to the uterus ?

Back 93

Broad ligament

Front 94

What are the stages of prolapse

Back 94

Stage I - within vagina

Stage II - @ Hymen

Stage III- Past Hymen

Stage IV - Procidentia

Front 95

What are the S/S of prolapse

Back 95

"feeling of something coming down"

Itch

Bleed

Urinary S/S- stress incontinence, Retention

Bowel S/S- Constipation, Dyschezie (painful)

Front 96

Management of prolapse

Back 96

Lifestyle - avoid heavy lifting, coughing, straining

TOP estrogen

Pessaries - reassess every 6 months

Surgery

Front 97

What surgical options are there for a uterocoele

Back 97

Sacrohysteropexy

Hysterectomy (If family complete)

Front 98

What surgical options are there for a vaginal vault prolapse ?

Back 98

Manchester repair (meshes + shortening cervix & uterosacral ligament)

Sacrocolpopexy

Colpocleisis ( closure, ONLY if not sexually active)

Front 99

What Surgical options is there for cystocele ?

Back 99

Anterior colporrhaphy

Front 100

What surgical options is there for rectocele ?

Back 100

Posterior colporrhaphy

Front 101

What is the Gold standard Ix for endometriosis ?

Back 101

Laparoscopy

Front 102

What cancers does the OCP protect against ?

Back 102

Endometrial

Ovarian

Colorecal

Front 103

Name e.g of GnRH analogues

Back 103

Buserelin

Goserelin