Esr Obs And Gynae

Front 1

Pre Eclampsia BP severity

Back 1

Mild = 140-150 / 90-100

Moderate = 150-160 / 100-110

Severe = 160+ / 110 +

Front 2

Pre Eclampsia drug treatment

Back 2

Lobetalol, Nifedipine, Methyldopa for control

Hyrdralazine, Magnesium Sulphate and Diazepam when eclamptic

Front 3

Liver changes during normal pregnancy

Back 3

Increased metabolism, ALK PHOS and Fibrinogen

Decreased transaminases and protein concentration

Normal Bilirubin

Front 4

HELLP Syndrome

Back 4

Haemolysis, Elevated Liver enzymes, Low Platelets

Liver enzymes are transaminases, LDH and unconjugated bilirubin.

Give steroids post partum due to worsening.

Front 5

Triple Test (Down's)

Back 5

15-20 weeks
Beta hCG, Oestriol, Alpha Feto Protein,
(BOA)

Front 6

Combined Test (Down's)

Back 6

Nuchal translucency, nasal bone presence on USS

hCG and PAPP-A (pregnancy associated plasma protein A)

Front 7

Obstetric Cholestasis

Back 7

Generalised severe pruritis
NO RASH
Bile acids and ALT raised
Dark urine, pale stools

Front 8

Acute Fatty Liver

Back 8

Very rare, potentially lethal
N+V, Malaise, abdo pain, hypertension, proteinuria
Jaundice, FULMINANT LIVER FAILURE
HEPATIC ENCEPHALOPATHY
DIC
Decreased glucose, increased uric acid

Front 9

Booking Bloods

Back 9

FBC, LFT, U + E
Glucose if risk
Blood group and RHESUS
Blood disorders if risk (ethnicity)
INFECTIONS:
UTI, chlamydia, syphilis, HIV, Hep B, rubella

Front 10

Management of Obstetric Cholestasis

Back 10

Counsel about risks (IUD 2%)
Weekly monitoring
Piriton, UDCA, Vit. K
Elective delivery after 37 weeks

Front 11

Pre-eclampsia, protein above..

Back 11

0.3g in 24h

Front 12

Risk factors for pre-eclampsia

Back 12

Primiparity
Previous/Family history
Older age
Chronic hypertension
Diabetes/Autoimmune disease
Twins
Obesity
Renal disease

(SMOKING IS PROTECTIVE)

Front 13

Maternal complications of pre-eclampsia

Back 13

HELLP
DIC
Liver failure
Renale failure
Eclamptic fits
Pulmonary oedema
CVA

(all can lead to death)

Front 14

Fetal complications of pre-eclampsia

Back 14

IUGR
Preterm labour
Placental ABRUPTION
Hypoxia

Front 15

Antepartum Haemorrhage definition

Back 15

Bleeding from the vagina after 24 weeks gestation, but before labour

Front 16

Causes of Antepartum Haemorrhage

Back 16

Uterine: Placenta praevia, placental abruption, vasa praevia, circumvallate placenta

Cervical: Ectropion, polyp, cancer, cervicitis

Vaginal: Vaginitis

Front 17

Differential diagnosis of Antepartum Haemorrhage

Back 17

Vulval varices
Rectal bleeding
Haematuria
Bleeding diatheses

Front 18

Complications of Antepartum Haemorrhage

Back 18

Maternal:
Anaemia
Infection
Shock
Renal tubular necrosis
Consumptive coagulopathy
PPH

Foetal:
Hypoxia
IUGR
Preterm
IUD

Front 19

Clinical assessment of Antepartum Haemorrhage

Back 19

(ABC)
Pulse, BP
Abdo palpation - tense woody uterus --> significant abruption
Contractions

Speculum exam: cervical dilatation, other causes

Bimanual: NEVER if placenta praevia is suspected

Front 20

Management of Antepartum Haemorrhage

Back 20

Mother is priority
FBC, Group and Save, Coag screen
U+E, LFT
RhD management (Kleihauer test to gauge the dose of anti-D Ig required)

USS to exclude placentra praevia

Fetal CTG

Front 21

Tocolysis

Back 21

Anti-contraction medication
Indicated in: preterm situations to buy time for steroid administration
Contraindicated in placenta praeviae or abruption.

Front 22

Preterm Prelabour Rupture of Membranes epidemoiology

Back 22

Occurs between 24-37 weeks gestation in 2% of pregnancies. 40% of preterm deliveries.

Front 23

Complications of PPROM

Back 23

Prematurity (and Pulmonary Hypoplasia)
Sepsis (4x mortality than non-septic)
Maternal risks with choriamnionitis (infection of fetal membranes)

Front 24

Diagnosis of PPROM

Back 24

History of waters breaking <37 weeks
Sterile speculum examination to visualise pool of fluid in posterior fornix
Test pH of fluid (neutral --> PPROM)
Avoid bimanual
USS

Observe for infections: VItal signs, temperature, offensive discharge, foetal vitals.

Front 25

Management of PPROM

Back 25

Erythromycin prophylaxis for 10 days.
This also delays delivery, allowing time for steroids.

Do not use tocolytics.
Delivery considered at 34 weeks.
Insufficient evidence for use of fibrin glue.

Front 26

Gynaecology presenting complaint empiricals

Back 26

LMP
Cycle (k=a/b)
Sexually active?
Dysmenorrhoea/menorrhagia
Dyspareunia (deep/superficial)
Discharge
Urinary + Bowel symptoms

Front 27

Gynaecology Past History empiricals

Back 27

Menarche
Smears
Contraception use
STIs
Pregnancies - outcomes and weights
Previous gynae problems/surgeries

Front 28

Parity definition

Back 28

Pregnancies after 24 weeks

Front 29

Obstetric history empiricals

Back 29

LMP
Gestation from LMP
Gestation from scan
Gravidity and Parity
Pregnancy problems
Test and Scan results
Foetal movements (>20 weeks)
Contractions/abdo pain
Fluid/blood
Urinary/Bowel

Front 30

Types of speculum

Back 30

Simms (for prolapse)
Cusco (cervix visualisation)

Front 31

Presentations of uterus on bimanual

Back 31

Anteverted (tipped forwards) - normal
Anteflexed (anterior or uterus is concave)

Retroverted (tipped backwards) - less common, some dyspareunia/dysmenorrhoea.
Retroflexed (anterior of uterus is convex)

Front 32

Group B Strep

Back 32

Most common cause of severe neonate infection
Offer Intrapartum Antibiotic Prophylaxis during identified pregnancy
Pyrexial in labour --> give broad specs.
Previous baby with GBS disease --> offer broad specs in new pregnancy

Benzylpenicillin is best, then clindamycin

Front 33

Stages of foetal descent

Back 33

Engagement
Descent
Flexion
Internal rotation
Extension
External rotation
Expulsion

Front 34

Naegele's rule

Back 34

+ 1 year
- 3 months
+ 1 week

Front 35

Stages of labour

Back 35

1. Dilation of cervix to 10cm
2.baby
3. Placenta

Front 36

Managed third stage of labour

Back 36

If over 1 hour unmanaged, treat for retained placenta.
If over 30 minutes after syntometrine or oxytocin, treat for retained.
Can also breastfeed or stimulate nipples to encourage contractions.

Retained placental product can be removed by hand under anaesthetic in operating theatre

Front 37

Causes of retained placenta

Back 37

1. Uterine atony
2. Adherent placenta
3. Trapped placenta, behind closing cervix

Front 38

Primary post partum haemorrhage

Back 38

Before 24 hours after delivery

Front 39

Secondary post partum haemorrhage

Back 39

Between 24 hours and 6
May need ultrasound to rule out retained product

Front 40

Rhesus status

Back 40

Kleihauer test shows dose of anti D needed.
If maternal mixing of blood with foetal, give anti D

Front 41

Tocolytic agents

Back 41

Nifedipine and atosiban

Also betamimetics such as terbutaline and salbutamol

Contraindicated in placenta praeviae and abruption

Front 42

Prostaglandins

Back 42

Used to ripen the cervix and induce abortion, or for preparation for surgical abortion

Misoprostol or gemeprost