Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
463 Cards in this Set
- Front
- Back
|
stage 1 of lactogenesis is usually complete by...
|
3rd trimester
|
|
|
when does stage 2 of lactogenesis occur
|
at time of delivery (removal of placenta)
|
|
|
What is a marker of onset of 2nd stage of lactogenesis
|
milk citrate
|
|
|
what is basic unit of mammary gland
|
acinus cell connected to ductule
|
|
|
where is prolactin producted
|
anterior pituitary
|
|
|
where does prolactin act?
|
binds to PRL receptors on epithelial cells in mammary glands
|
|
|
what substance inhibits secretion of prolactin? where is it produced?
|
dopamine
hypothalamus |
|
|
what stimulates production of oxytocin?
|
stimulation of touch receptors on nipple/areolar
|
|
|
where is oxytocin produced?
|
paraventricular nuclei of hypothalamus (secreted by posterior pituitary)
|
|
|
how much milk is produced/day (average)?
|
800ml
|
|
|
at what time is nausea most common during pregnancy?
|
6-12wks
|
|
|
when does baby movement usually start?
|
18-20wks
|
|
|
when does corpus luteum maintains pregnancy?
|
up until 8-10wks
|
|
|
what is Nagels rule?
|
LMP + 7 days - 3 months
|
|
|
when is transition between pre-term and term?
|
37wks
|
|
|
List gynaecological causes of acute pelvic pain
|
ectopic pregnancy
miscarriage PID ovarian cysts |
|
|
List GIT causes of acute pelvic pain
|
appendicitis
constipation diverticular disease IBS |
|
|
define chronic pelvic pain
|
intermittent or contstant pain in lower abdomen/pelvis for >6mnths
|
|
|
define dyschezia
|
pain or difficulty defecating
|
|
|
list causes of dyspareunia
|
endometriosis
PID fibroids adenomyosis anatomical: virginity, abnormality e.g. imperforate hymen |
|
|
why is there a low threshold for empirical treatment of PID
|
- lack of definitive Dx criteria
- consequences of not treating are serious |
|
|
follicular phase is also called
|
proliferative phase
|
|
|
luteal phase is also called
|
secretory phase
|
|
|
the phase prior to ovulation is called
|
follicular/proliferative phase
|
|
|
the phase after ovulation, before menstruation is called
|
luteal/secretory phase
|
|
|
what cell type produces GnRH?
|
unmyelinated nerve fibres in hypothalamus
|
|
|
what hormones are secreted in response to GnRH?
|
FSH or LH
|
|
|
what provides negative feedback to hypothalamus for GnRH secretion
|
estrogen, progesterone, testosterone
|
|
|
what is the function of FSH
|
stimulates follicle maturation and aromatisation of androgens
|
|
|
what is function of LH
|
stimulates theca cells to produce androgens, promotes ovum maturation & resumption of meiotic division. Stimualtes OVULATION and corpus luteum formation
|
|
|
what is origin of primordial follicles
|
originate in the endoderm of the yolk sac, allantois, hindgut of the embryo
|
|
|
how long does corpus luteum persist (if no pregnancy)
|
14 days
|
|
|
which cells form corpus luteum?
|
granulosa cells of dominant follicle
|
|
|
what color is copus luteum? why?
|
red, highly rapidly vascularised
|
|
|
what is average blood loss during menstruation
|
25-60ml
|
|
|
what are 3 zones of endometrium?
|
basal
intermediate/spongy compact |
|
|
which zones are shed during menstruation?
|
intermediate/spongy
compact |
|
|
which phase is characterised by tubular, straight, narrow endometrial glands?
|
proliferative
|
|
|
during which phase do spiral arterioles develop?
|
secretory
|
|
|
describe endometrium during secretory phase
|
stromal edema, tortuous glands, highly secretory, spiral arterioles, WBC infiltrates
|
|
|
what initiates menstruation?
|
progesterone withdrawal
|
|
|
why is heavy bleeding often result in clot formation?
|
demand for fibrinolytic enzymes greater than supply; have been exhausted.
|
|
|
what can be given IV to stop menstrual bleeding?
|
estrogen
|
|
|
what organisms cause PID?
|
polymicrobial
chlamydia, gonorrhoea, vaginal flora |
|
|
List 3 findings of pelvic exam associated with PID (at least 1 must be found for Dx)
|
uterine tenderness
cervical motion tenderness adnexal tenderness |
|
|
what are classic signs of PID on transvaginal US
|
tubal wall thickness >5mm, incomplete septae within the tube, fluid in cul-de-sac, cog-wheel appearance on x-section of tubes
|
|
|
list tumor markers for pelvic mass?
|
CEA, CA125, BHCG, aFP, CA19.9
|
|
|
what is seen on wet mount of vaginal secretions in PID
|
PMNs
|
|
|
List DDx for ovarian mass
|
ovarian Ca
endometriosis/chocolate cyst abscess cyst dermoid/teratoma metastasis |
|
|
what is a dermoid cyst
|
cyclic teratoma containing developmentally mature skim. Usually benign.
|
|
|
List clinical signs of severe disease in PID
|
pyrexia >28
evidence of abscess signs of peritonitis |
|
|
what is the incidence of Down Syndrome in Australia?
|
1.2 per 1000 live births
340 born per yr |
|
|
What % of Down Syndrome children have severe mental handicap?
|
20%
|
|
|
When is the nuchal translucency screen performed?
|
11-13wks
|
|
|
Why is 1st trimester assessment usefule?
|
accurate dating
exclusion of early pregnancy failure, twins, morphological abnormalities |
|
|
What is the incidence of early pregnancy failure (1st trimester)
|
3%
|
|
|
what is the cut off of high risk for NT-plus
|
>1:300
|
|
|
in 2011, what % of pregnant patients underwent NT-plus
|
55%
|
|
|
what is the baseline risk that a foetus will have trisomy 21?
|
dependent on age
|
|
|
what is the eponymous name of trisomy 18?
|
Edward's syndrome
|
|
|
What are the biochemical markers measured for NT-plus?
|
PAPP-A
beta-HCG |
|
|
Are biochemical markers affected by NT thickness?
|
no, markers are independent
|
|
|
What is specificity and FPR of NT-plus
|
Specificity 90%
FPR 5% |
|
|
What is 2nd most common autosomal trisomy after Down's syndrome?
|
Edwards Trisomy 18
|
|
|
List some features of Edwards Sydnrome
|
oligohydraminios (due to renal defects)
growth retardation heart defects (>90%) omphalocele, malrotation |
|
|
What % of Down's babies have abnormal ductus venosus?
|
65% (3% normal babies)
|
|
|
What % of Down's babies have Tricuspid Regurgitation?
|
55% (1% normal babies)
|
|
|
What % of Down's babies have an absent nasal bone?
|
60% (1% normal babies)
|
|
|
when is chorionic villus sampling performed?
|
11-14wks
|
|
|
What is risk of miscarriage for CVS?
|
<1%
|
|
|
What risk is associated with CVS done <10wks?
|
limb defects
|
|
|
When is amniocentesis performed?
|
>15wks
|
|
|
How much fluid is generally aspirated with amniocentesis?
|
20ml
|
|
|
When is fetal blood sampling performed?
|
>18wks
|
|
|
What is the miscarriage risk of amnciocentesis?
|
<0.5%
|
|
|
What is the miscarriage risk with fetal blood sampling?
|
2% in well foetus
20% in hydropic fetus |
|
|
Can amniocentesis be done vaginally?
|
NO, very high miscarriage rate
|
|
|
Can CVS be done vaginally?
|
yes, dependent on position of fetus and placenta (most are done abdominally)
|
|
|
why do results from CVS and amniocentesis take ~2wks to return?
|
cells must be cultured
|
|
|
why has rate of fetal blood sampling decrease?
|
better genetic testing available with CVS and amniocentesis; better imaging/technology (investigating blood flow etc), risks now deemed unacceptable.
|
|
|
Rapid, preliminary results for CVS and amniocentesis can be given by what genetic testing?
|
FISH
PCR |
|
|
What is FISH
|
Fluorescent In Situ Hybridisation
|
|
|
In what proportion of miscarriages, is aneuploidy implicated?
|
>50%
|
|
|
when is large BP cuff size needed?
|
>33cm
|
|
|
list some rule for taking blood pressure
|
mercury sphygomomanometer
same arm each time (R by convention) correct cuff size |
|
|
what is the incidence of preeclampsia?
|
4.2%
|
|
|
what is incidence of overall HTN disorders in pregnancy?
|
9.8%
|
|
|
when should gestational HTN resolve?
|
within 3mnths of delivery
|
|
|
Gestational HTN diagnosed <30wks have what chance of developing pre-eclampsia?
|
40%
|
|
|
Gestational HTN Dx >30wks have what chance of developing pre-eclapsia?
|
<10%
|
|
|
LIst risk factors for pre-eclampsia
|
primiparity, PHx, FHx, BMI>30, maternal age>35, multiple pregnancy, gestational HTN, DM, renal diseasese, chronic HTN, autoimmune disease
|
|
|
What are symptoms of pre-eclampsia
|
headache
upper abdominal pain reduced fetal movement/growth restriction oedema visual distubances |
|
|
what is definition of pre-eclampsia?
|
Occurs after 20wks; BP >140 systolic or >90 diastolic
on at least 2 measurements taken >4hrs apart + systemic involvement |
|
|
What systemic features contribute to Dx of pre-eclampsia?
|
proteinuria, renal insufficiency, liver disease (LFT derangement), neurological problems (e.g. clonus), haematological disturbances (thrombocytopenia, DIC), fetal growth restriction
|
|
|
Is preeclampsia Dx after 20 or 30 wks?
|
20 wks.
|
|
|
Are ACEi or ARBs useful in pre-eclampsia?
|
NO, category D!
|
|
|
what is the most common systemic sign of pre-eclampsia?
|
proteinuria
|
|
|
what is HELLP syndrome associated with pre-eclampsia?
|
haemolysis, elevated liver enzymes, low platelets
|
|
|
what are 3 main causes of maternal death?
|
haemorrhage
sepsis eclampsia |
|
|
what are CNS symptoms associated with pre-eclampsia?
|
hyperreflexia with clonus
severe persistent headaches visual disturbance altered consciousness |
|
|
What are haematological consequences of pre-eclampsia?
|
platelet count <100,00
prolonged APTT and PT DIC |
|
|
what are fetal consequences of pre-eclampsia?
|
IUGR
fetal hypoxia pre-maturity placental abruption intrauterine death |
|
|
what is definition of ACUTE elevation of BP?
|
>170 systolic and or >110 diastolic
|
|
|
What is 1st line therapy for pre-eclapsia?
|
monotherapy with labetolol, oxprenolol or methyldopa
|
|
|
why should BP be corrected slowly? (only 20-30mmHg systolic and 10-15 diastolic)
|
to prevent decreased blood flow to placenta.
|
|
|
what class of anti-hypertensives is most used in pregnancy?
|
alpha/beta adrenergic antagonist
|
|
|
how are eclampsia seizures treated?
|
diazepam if seizures prolonged
magnesium suphate |
|
|
Are calcium channel blockers used in pregnancy?
|
nifedipine is indicated for pre-eclampsia
|
|
|
why is magnesium sulfate used in seizures?
|
CNS depressant
|
|
|
Hydralazine may be given in pregnancy. What are its indications?
|
smooth muscle relaxant used to treat HTN (vasodilator)
|
|
|
Are vitamins and calcium supplementation recommended for prophylaxis of pre-eclampsia?
|
no, limited evidence available
|
|
|
list complications of pre-eclampsia?
|
IUGR
eclampsia pulmonary edema CVA placental abruption renal failure |
|
|
what is definition of stress incontinence?
|
involuntary leakage of urine on exertion, sneezing or coughing
|
|
|
what is definition of urge incontinence?
|
involuntary leakage of urine during increased abdominal pressure in the ABSENCE of detrusor contraction
|
|
|
what causes detrusor overactivity/instability?
|
involuntary urinary leakage when detrusor pressure is greater than urethral pressure
|
|
|
what are RF for incontinence associated with pregnancy?
|
>4kg baby
3rd degree tea forceps (not ventouse) long 2nd stage duration |
|
|
list RF for incontinence in women
|
increasing age
obesity dementia constipation pelvic organ prolapse previous gynecological surgery neurological disease pregnancy |
|
|
what medications may contribute to incontinence?
|
alpha-adrenergic e.g. prazocin
smooth muscle relaxant e.g. CCB Glaucoma eye drops |
|
|
what is the mean 24hr urine volume (normal value)
|
1.5L
|
|
|
what is average volume voided per micturition (normal value)?
|
250ml
|
|
|
does the mean and frequency of micturition increase with age?
|
no, not normally. Nocturia may increase.
|
|
|
what are the indications for urodynamics?
|
failed conservative management
failed surgery where neuropathy suspected complex medical Hx |
|
|
urodynamic studies are key for Dx....
|
voiding dysfunction and overactivity
|
|
|
what conditions are associated with reversible stress incontinence?
|
UTI
atrophic vaginitis/urethritis pregnancy stool impaction medications (e.g. diuretics) DM delirium |
|
|
what is the main surgical option for stress incontinence?
|
mid-urethral polypropylene slings
|
|
|
what are complications of mid-urethral sling surgery?
|
infection, potential erosions, voiding issues, unstable bladder, wound complicaitons
|
|
|
Is sling surgery useful in urge incompetence?
|
NO
|
|
|
what medications may be effective in urge incontinence? mechanisms?
|
anticholinergics; blocks ACh binding to M3 and causing detrusor contraction
|
|
|
what are adverse effects of anticholinergics?
|
dry mouth
ataxia tachycardia dizziness urinary retention |
|
|
in a mixed incontinence picture, which component should be treated first?
|
urge (i.e. retraining)
|
|
|
Is estrogen an effective treatment for stress incontinence?
|
unclear, was once recommended. vaginal more than oral
|
|
|
list some triggers for urge incontinence?
|
running water, visual associations, cold, latch key
|
|
|
what are modes of transmission of perinatal infections?
|
transplacental
ascending retrograde from peritoneum iatrogenic (CVS, amnioc) |
|
|
what is the mode of transmission of rubella?
|
respiratory droplets
|
|
|
what proportion of rubella infections are symptomati?
|
50-75%
|
|
|
what are symptoms of rubella?
|
generalised rash, fever, cough, conjunctivitis, arthralgia, lymphadenopathy
|
|
|
when during pregnancy is risk of congenital rubella highest?
|
<8wks (91-100%)
|
|
|
List features of congenital rubella
|
eye lesions(cataracts, retinopathy), cardiac lesions( PDA, PS), deafness, mental retardation, cerebral palsy
|
|
|
Is rubella vacination given during pregnancy?
|
No, because live virus, THEORETICAL risk of congenital rubella. No known cases
|
|
|
Is screening for varicella serology recommended?
|
yes, where there is no clear Hx of vaccination or previous infection
|
|
|
what treatment is available for varicella infection during pregnancy?
|
ZIG (zoster immune globulin)
|
|
|
what is a life-threatening complication of varicella infeciton?
|
varicella pneumonia
|
|
|
What is the fetal infection rate where maternal infection occurs within 5 days around delivery?
|
50%
|
|
|
When should ZIG be given to baby?
|
if mother develops chickenpox up to 7 days before delivery or up to 28 days after
|
|
|
should mother cease to breastfeed if the child becomes infected with VZV?
|
no
|
|
|
can aciclovir be given during pregnancy?
|
yes, is recommended for any women who develops complcated varicella
|
|
|
what are symptoms of congenital CMV?
|
microcephaly
deafness ascites hydrops fetalis oligo or polyhydramnios hydrocephalus intracranial calcification |
|
|
Why is IgM alone not sufficient for Dx of active CMV infection?
|
IgM serology may remain elevated for up to 12mnths after exposure. Demonstrate rising IgG titre for active infection
|
|
|
what is the risk of fetal transmission if mother has primary CMV infection?
|
50%
|
|
|
what is the risk of fetal transmission if mother has non-primary CMV?
|
<1%
|
|
|
what causes 'slapped cheek disease'?
|
parvovirus B19
|
|
|
what is the risk of acquiring parvovirus during pregnancy
|
1:400
|
|
|
what is the most common fetal consequence of maternal parvovirus infection?
|
foetal anaemia
|
|
|
how is foetal anaemia assessed?
|
US doppler of Middle cerebral artery
|
|
|
When is neonatal HSV acquired?
|
during vaginal delivery
|
|
|
What is the recommendation if mother develops primary infection within 6 wks of delivery?
|
caesarean section
(not recommended if primary infection occurs in 1st/2nd trimester unless active lesions) |
|
|
what is the MTC transmission rate of HIV if receiving antiviral therapy?
|
0.8%
(1.2% overall in UK) |
|
|
how can HIV be transmitted to neonate?
|
antenatally in utero
intrapartum breastfeeding |
|
|
If no intervention given and woman breastfeeds, what is MTC transmission rate?
|
20-45%
|
|
|
Does HAART reduce MTC transmission of HIV?
|
yes
|
|
|
What is the MTC transmission rate of Hep C
|
5% if RNA postive
very very rare if RNA negative |
|
|
What are symptoms of toxoplasmosis?
|
usually asumptomatic or non-specific fatigue, myalgia, lymphadenopathy
|
|
|
what infection may be acquired through eating raw meat, contact with soil contaminated with cat faeces?
|
toxoplasmosis
|
|
|
what are features of congenital infection?
|
ventriculomegaly
intracranial calcifications hydrocephalus microcephaly |
|
|
what may cause false positive results for VDRL screening for syphillis?
|
lupus, autoimmune disease
|
|
|
what is treatment of syphillis?
|
benzyl-penicillin
|
|
|
what are features of congenital syphillis
|
rhinitis, diffuse rash, hepatosplenomegaly
Hutchinson's teeth deafness |
|
|
what is hallmark of listeria infection
|
green stained liquor in pre-term labour
|
|
|
what is recommended if a women receives positive GBS screen at 36wks?
|
prophylaxis antibiotics during labour
|
|
|
why is an MSU performed?
|
to detect asymptomatic bacteriuria which may develop pyelonephritis if untreated.
|
|
|
what % of women receive positive screening for GBS at 36wks?
|
~20%
|
|
|
how is listeria transmitted?
|
via uncooked vegetables, milk, fish, poultry
|
|
|
what is the commonest cause of neonatal sepsis?
|
group B strep
|
|
|
define 'neonatal' period
|
birth until 28days postpartum
|
|
|
jaundice is defined as serum bilirubin....
|
>30mmol/L
|
|
|
neonatal jaundice appearing <24hrs after birth is usually physiological. True or False.
|
false. usually haematological
|
|
|
list causes of neonatal jaundice with onset in 1st 24 hours
|
Rhesus haemolytic disease
ABO incompatibility G6PD deficiency Spherocytosis congenital infection |
|
|
When does physiological neonatal jaundice occur?
|
between 24hrs - 2wks.
|
|
|
what is the mechanism of physiological neonatal jaundice?
|
immaturity of hepatic bilirubin conjugation
|
|
|
what is meant by 'breast milk jaundice'?
|
physiological jaundice that is exacerbated by breast milk
|
|
|
what clinical signs suggest elevated conjugated jaundice?
|
dark urine
pale stools |
|
|
Is conjugated or unconjugated bilirubin accumulated in physiological jaundice
|
unconjugated
|
|
|
what is an important cause of conjugated jaundice in neonate?
|
biliary atresia
|
|
|
kernicterus involves what organ?
|
brain (also called bilirubin encephalopathy)
|
|
|
how does kernicterus present?
|
lethargy, poor feeding, irritability, increased tone
|
|
|
why is regular feeding encouraged in neonatal jaundice?
|
dehydration exacerbates jaundice
|
|
|
what is the mechanism of phototherapy in jaundice?
|
light waves convert unconjugated bilirubin into water soluble pigment
|
|
|
what factors make physiological jaundice worse?
|
prematurity, bruising, polycythemia, cephalohaematoma, delayed passage of meconium, breast feeding
|
|
|
how does neonatal physiological jaundice progress (anatomically)?
|
cephalocaudally
(head to toe) |
|
|
What is Kramer's Rule
|
divides infant into 5 zones where zones involved used to estimate serum bilirubin (e.g. hands and feet >250mmol)
|
|
|
In addition to visual assessment, how is screening for jaundice performed?
|
Transcutaneous bilirubin measurement (TcB)
|
|
|
Is TcB reliable if phototherapy has commenced?
|
no
|
|
|
what is the gold standard investigation for assessing neonatal jaundice?
|
total serum bilirubin
|
|
|
list indications for performing total serum bilirubin
|
jaundice of <24hr onset
if estimated bilirubin >250 if preterm + estimated >200 any unwell baby with jaundice to ensure phototherapy is effective |
|
|
list causes of prolonged jaundice
|
thyroid agenesis/dysplasia
hypopituitarism UTI/infection hepatitis biliary atresia |
|
|
what is the first line treatment of neonatal jaundice?
|
phototherapy
|
|
|
what factors determine whether phototherapy is given?
|
gestational age
total serum bilirubin clinical state (well?) presence of risk factors |
|
|
list risk factors which lower threshold for phototherapy
|
haemolysis
G6PD deficiency asphyxia proven sepsis lethargic, temperature instability, respiratory distress, acidosis |
|
|
what treatment is recommended for severe neonatal jaundice?
|
exchange transfusion
|
|
|
are ovarian cysts more common in pre- or post-menopausal women?
|
pre-menopausal
|
|
|
list risk factors for ovarian cysts?
|
pre-menopausal
early menarche MHx infertility, PCOS, endometriosis tamoxifen therapy 1st trimester of pregnancy |
|
|
what are presenting symptoms of an ovarian cyst
|
pelvic pain, bloating, early satiety, palpable mass
|
|
|
list types of physiological cysts.
|
follicular, endometriotic, corpus luetum, theca lutein
|
|
|
what are common pulmonary causes of respiratory distress in neonate?
|
TTN
RDS/HMD Sepsis/pneumonia Pneumothorax Aspiration Pulmonary haemorrhage |
|
|
List structural causes of respiratory distress
|
choanal atresia
Pierre-Robin syndrome trachea-oesophageal fistula diaphragmatic hernia pulmonary hypoplasia |
|
|
what are neurological causes of neonatal respiratory distress?
|
perinatal asphyxia
neurological malformation/injury |
|
|
List some extra-pulmonary causes of neonatal respiratory distress.
|
severe anaemia, polycythemia
pulmonary hypertension (PPHN) congenital heart disease Potter's syndrome/oligohydraminios |
|
|
What is pathogenesis of transient tachypnoea of newborn (TTN)?
|
retained fetal lung fluid
|
|
|
What are risk factors for transient tachypnoea of newborn (TTN)?
|
caesarean section
absence of labour mild prematurity (34-36wks) |
|
|
what is incidence of transient tachypnoea of newborn (TTN)?
|
1-2% of newborns
|
|
|
what are CXR features of transient tachypnoea of newborn (TTN)
|
pulmonary congestion
fluid in pleural fissues "wet lungs" |
|
|
what is long term outcome of transient tachypnoea of newborn (TTN)
|
usually resolves spontaneously
no long term effects |
|
|
What is incidence of hyaline membrane disease?
|
1% of all newborns
(80% at 30wks; 20% at 34wks) |
|
|
what is underlying pathology of hyaline membrane disease?
|
lack of surfactant
atelectasis of some alveoli, overexpansion of other alveoli |
|
|
List risk factors for hyaline membrane disease?
|
prematurity
inadequate antenatal steroids hypoxia, acidosis male sex poorly controlled maternal DM |
|
|
What are CXR features of hyaline membrane disease?
|
diffuse granular "ground glass" pattern with bronchograms
Poorly inflated lungs |
|
|
List complications of hyaline membrane disease
|
pneumothorax, intraventricular haemorrhage, chronic lung disease
|
|
|
what are clinical features of hyaline membrane disease
|
respiratory distress <6hrs after birth
Expiratory "grunt" Fluid retention Resolution over 72-96hrs |
|
|
An expiratory "grunt" in a newborn is suggestive of what condition?
|
hyaline membrane disease
|
|
|
hyaline membrane disease is usually most severe at what time after birth?
|
48-72hrs
|
|
|
How is surfactant therapy administered to a neonate?
|
via endotracheal tube
|
|
|
"ground glass" diffuse granular pattern on CXR of neonate suggests....
|
hyaline membrane disease
|
|
|
what DDx should be considered in any unwell child
|
SEPSIS
|
|
|
what are risk factors for neonatal sepsis?
|
maternal fever
ruptured membranes chorioamnionitis GBS colonisation pathogenic gram -ve organisms e.g. E.coli |
|
|
what are clinical signs of neonatal sepsis?
|
lethargy, apnoea, bradycardia, temperature instability, feed intolerance
|
|
|
What WCC is indicative of neonatal sepsis?
|
>20,000 with neutrophil dominance
|
|
|
what screen is performed at 35-6wks gestation?
|
group B strep vaginal swab
|
|
|
Focal lung consolidation on CXR in neonate suggests....
|
pneumonia (e.g. group B strep, klebsiella, pseudomonas)
|
|
|
CXR can easily differentiate between hyaline membrane disease and neonatal pneumonia. True or False
|
No, particularly if pneumonia is DIFFUSE
|
|
|
Is a decreasing neutrophil and WCC count in a severely ill baby a sign of improvement?
|
NO, if no sign of clinical improvement it is suggestive of bone marrow depletion
|
|
|
Unexplained respiratory distress in a baby who is other wise well is suggestive of....
|
pneumothorax
|
|
|
What % of post-term babies have meconium stained liquor
|
50%
|
|
|
Meconium stained liquor is risk factor for....
|
meconium aspiration syndrome
|
|
|
Is meconium aspiration syndrome is more common in pre- or post-term babies?
|
post-term
|
|
|
patchy changes or "plugging" throughout the lung fields in CXR is suggestive of....
|
meconium aspiration syndrome
|
|
|
what are signs of respiratory distress in neonate
|
RR >60/min
expiratory grunt chest retraction/recessions nasal flaring cyanosis in air apnoea |
|
|
is a respiratory rate of 63 in a neonate concerning?
|
yes, tachypnoea defined as RR>60/min
|
|
|
what is choanal atresia?
|
congenital disorder where back of nasal passage obstructed by bone or soft tissue
|
|
|
what investigations should be performed in neonatal respiratory distress?
|
FBC CRP blood culture/sepsis screen
Blood gas CXR temperature monitoring |
|
|
oxygen saturation in the neonate should be maintained within what range?
|
85-95%
|
|
|
how is hyaline membrane disease treated?
|
CPAP/ventilation
surfactant via ET tube |
|
|
a long, thin child with relatively large head and absence of subcutaneous fat suggest...
|
growth restriction
|
|
|
Mild skin peeling is normal but maybe more common in...
|
post-term and IUFR infants
|
|
|
what is vernix caseosa?
|
translates "cheesey varnish"
waxy, greasy covering common between 35-58wks |
|
|
what is livedo reticularis
|
reticular vascular pattern on lower extremities due to immature vasculatures
|
|
|
a waxy, greasy skin covering in neonate born at 37wks is called...
|
vernix caseosa
|
|
|
fine, facial and body hair in babies which persists for the first month of life is called...
|
lanugo
|
|
|
is livedo reticularis a sign of pathology
|
not usually; but may be related to underlying disease e.g. haematology or autoimmune diseases
|
|
|
what are naevus flammeus
|
stork marks
|
|
|
what is the most common vascular birthmarks?
|
naevus flammus
found in up to 50% of newborns |
|
|
how can you differentiate mongolian blue spot from bruising?
|
it will not alter in colour over time or resolve
|
|
|
yellow or white soft papules over the nose are called...
|
milia
|
|
|
what causes milia?
|
epidermal cysts caused by blocked sebaceous glands; resolve spontaneously
|
|
|
An irregular pink blanching macule composed of dilated, distended capilliaries which is more prominent with crying is characteristic of....
|
naevus flammeus
(stork mark) very common |
|
|
what is erythema toxicum
|
white/yellow papules with an erythematouse base; cause unknown, peak incidence is 24-48hr. May disappear then reappear
|
|
|
what is an important DDx for erythema toxicum?
|
staph infection
|
|
|
a bright-red, raised, lobulated lesion is characteristic of...
|
strawberry haemangioma
|
|
|
what causes strawberry haemangiomas?
|
dilated capillaries (associated with endothelial proliferation)
|
|
|
What is the normal progression of a strawberry haemangioma?
|
increases in size for 9-12mnths, then regresses.
|
|
|
Are most strawberry haemangiomas present at birth?
|
Only 20-30% present from birth, most appear within first few weeks.
|
|
|
oedematous thickening of scalp where the baby's head presented during labour is called...
|
capit succedaneum
|
|
|
what causes milaria?
|
obstruction of sweat and rupture of exocrine sweat duct; common seen in thermal stress e.g. overwrapping
|
|
|
heat stress (e.g. overwrapping) may cause...
|
milaria
|
|
|
what is an important DDx for miliaria (vesicular rash)?
|
herpes
|
|
|
Bleeding between periosteum and cranium causes...
|
cephalohaematoma
|
|
|
is a cephalohaematoma usually present at birth?
|
no, usually appears on 2nd day of life
|
|
|
An fluctuant swelling confined to cranial bone (i.e. with bony margins) appearing on day 2 of life is most likely a...
|
cephalohaematoma
|
|
|
Babies presenting with cephalohaematoma should be assessed for...
|
an underlying cranial fracture
|
|
|
A 'tongue tie' commonly causes feeding and speech difficulty later in life. True of False.
|
False. Usually normal development
|
|
|
White cheesy patches on tongue and buccal mucosa is suggestive of...
|
oral candidiasis
|
|
|
preauricular skin tag is associated with what defect?
|
renal anomaly
|
|
|
Are umbilical hernias more common in pre or post term babies?
|
pre-term
|
|
|
When does a umbilical hernia usually develop?
|
in the first month of life
|
|
|
Describe the progression of umbilical hernias
|
develops in 1st month
resolves by 6-18mnths |
|
|
Which is more concerning: a dimple over the sacral/coccyx or lumbar region?
|
lumbar region: spinal defect
sacral/coccyx is usually benign |
|
|
what is the most common form of polydactyly?
|
an extra little finger
|
|
|
blisters on hand of neonate is usually caused by...
|
sucking
|
|
|
a translucent swelling surrounding testis at birth is called a...
|
congenital hydrocele
|
|
|
what treatment should be offered for congenital hydrocoele?
|
monitoring. no active treatment. Usually spontaneously dissapear by 1 year
|
|
|
What is DDx for congenital hydrocele?
|
testicular torsion
orchiditis testicular hernia |
|
|
what is the fetal death rate in indigenous mothers (2001-4)?
|
12 per 1000
(compared to 3 per 1000 overall) |
|
|
what is the neonatal death rate in indigenous mothers
|
6 per 1000
(compared to 3 per 1000 overall) |
|
|
Babies born to indigenous mothers are more likely to be....
|
pre-term
low birth weight shorter length of stay |
|
|
what is the rate of pre-term birth in NSW
|
~7.5%
|
|
|
what are risk factors for pre-term birth?
|
multiple pregnancy
spontaneous preterm labour pre-term rupture of membranes cervical incompetency IUGR pre-eclampsia antepartum haemorrhage |
|
|
list risk factors for cervical incompetency
|
Hx cervical biopsy, mechanical dilation
Connective tissue diseases Hx pervious pre-term labour structural abnormalities |
|
|
what are the 2 steroids given antenatally?
|
betamethasone
dexamethasone |
|
|
what is the name of the ongoing trial comparing betamethasone and dexamethasone antenatally?
|
ASTEROID
|
|
|
Can antenatal steroids be given orally?
|
NO, given IM 2 doses 24 hrs apart
|
|
|
which women should receive antenatal steroids?
|
all women with delivery 26-34wks+6days
|
|
|
Antenatal corticosteroids reduces risk of... (6 things, this is in exam)
|
Neonatal death
RDS Cerebroventricular haemorrhage NecrotEC systemic infections in 1st 48hrs NICU admissions |
|
|
Are corticosteroids appropriate for use in multiple pregnancies?
|
yes, they are recommended however evidence is sparse
|
|
|
To what extent does corticosteroids reduce RDS?
|
by 1/3
|
|
|
What are the benefits of antenatal steroids given more than 1 wk prior to delivery?
|
no benefit has been demonstrated
|
|
|
Antenatal corticosteroids decreases risk of necrotising enterocolitis by more than half. True or false?
|
True
|
|
|
To what extent do antenatal corticosteroids decrease risk of cerebrovascular haemorrhage?
|
by nearly half
|
|
|
Generally, are repeated doses of antenatal steroids recommended?
|
no. however, there are exceptions where a 'rescue dose' may be given
|
|
|
What agent is used to delay labour?
|
calcium channel blocker (nifedipine, Adalat)
|
|
|
What is PPROM?
|
preterm premature rupture of membrane. Membranes ruptures <37 wks where woman is not in labour.
|
|
|
Why are tocolytic agents used?
|
to delay labour so that steroids can be administered and/or to enable transfer to health service
|
|
|
Tocolysis is associated with increased risk of ...
|
depressed 5' apgar (<7)
increased need for ventilation increased chorioamnionitis |
|
|
when does the maximum benefit of corticosteroids occur?
|
24hrs after 2nd dose
|
|
|
Why are antibiotics not routinely recommended during labour (in absence of risk factors)?
|
no evidence of overall benefit on neonatal outcomes
some evidence for increase in neonatal mortality (e.g. cerebral palsy) |
|
|
what antibiotics are recommended in pre-term ruptured membranes?
|
erythromycin 250mg qid orally
|
|
|
what antibiotics are recommended in pre-term threatened labour (without ruptured membranes)?
|
Antibiotics NOT recommended
|
|
|
which antibiotics should NOT be used in pre-term ruptured membranes?
|
augmentin (amoxicillin/clavulanic acid)
Increased NEC |
|
|
Why are antibiotics given in pre-term ruptured membranes?
|
reduces chorioamnionitis
reduces neonatal infection, or need for surfactant/oxygen therapy |
|
|
Is there a difference in long-term outcomes if antibiotics are given in PPROM?
|
no (at 7yrs follow up)
but improved short term outcome |
|
|
what has been shown to provide neuroprotection in preterm birth?
|
magnesium sulphate
|
|
|
what is the impact of magnesium sulfate given in pre-term birth?
|
reduced risk of cerebral palsy and gross motor dysfunction
|
|
|
How is magnesium sulphate administered ?
|
Loading dose 4g STAT IM or IV +
1-1.5 g/hr (with at least 4 hours prior to birth) |
|
|
HRT for menopausal symptoms in a woman with a uterus should always include...
|
progestin (in addition to estrogen)
|
|
|
why is combined HRT recommended in menopausal women who have not undergone hysterectomies?
|
protect against endometrial hyperplasia
|
|
|
List non-hormonal medications that are indicated for treatment of vasomotor menopausal symptoms?
|
SSRI, SNRIs, gabapentin, clonidine
|
|
|
What HRT is indicated for a woman presenting with vaginal dryness and dyspareunia associated with menopause?
|
vaginal estrogen cream
|
|
|
define menopause?
|
cessation of menstruation diagnosed following 12 months of amenorrhoea
|
|
|
Are FSH levels increase or decrease as menopausal transition progresses?
|
increases
|
|
|
Are women more likely to have a longer or shorter menstrual cycle leading up to the menopause?
|
shorter; due to shrinking follicle cohort and increased FSH
|
|
|
Do ovarian follicles become less sensitive to FSH as they age?
|
yes
|
|
|
What is the dominant estrogen in postmenopausal women?
|
estrone (compared to estradiol in pre)
|
|
|
do testosterone levels increase following menopause?
|
No
|
|
|
What are symptoms of menopause?
|
hot flushes
vaginal dryness, dyspareunia sleep/mood disorders weight gain/bloating |
|
|
How does atrophic cystitis present?
|
urinary frequency, urgency incontinence (mimics UTI)
|
|
|
Define primary PPH
|
>500ml blood loss wthin 24hr birth. Severe >2000ml
|
|
|
Define secondary PPH
|
abnormal bleeding from 24hrs-12wks post delivery
|
|
|
List 4Ts causing PPH
|
tone- uterine atony
tissue- placental retention trauma thrombophilia |
|
|
Uterine atony increases a woman's risk of...
|
PPH
|
|
|
Why does uterine atony inrease a woman's risk of PPH?
|
decreased uterine contractions, decreased compression of intramyometrial blood vessels
|
|
|
define placental retention
|
where all/part of placenta remians in uterus >30mins post delivery
|
|
|
What is a common cause of placental retention?
|
placent acreta
|
|
|
list prevention strategies for PPH
|
assess risk factors, active management of 3rd stage labour, early cord clamping and cutting
|
|
|
When is syntocinon given in labour?
|
after delivery of anterior shoulder during 3rd stage of labour
|
|
|
what are the risk factors for PPH
|
pre-eclampsia, nulliparity, multiple gestation, previous c-section, placenta praevia, previous PPH, obestiy BMI>35, asian women, anaemia
|
|
|
What factors increase risk of traumatic intrapartum haemorrhage?
|
prolonged 3rd stage, episiotomy, arrest of descent, lacerations, assisted delivery
|
|
|
how is PPH managed in the absence of shock (generally <1000ml loss)?
|
monitor closely, fluid replacement
|
|
|
what is the most common cause of secondary PPH?
|
endometritis
|
|
|
Define shoulder dystocia?
|
bony impaction of anterior shoulder behind the pubic symphysis (less commonly) the posteroir shoulder behind sacral promontory
|
|
|
List risk factors for shoulder dystocia?
|
DM, macrosomia, high BMI >30, induced labour, PHx shoulder dystocia, polonged, difficult labour
|
|
|
what is the 'turtle neck' sign?
|
Head remains attached to vulva. Sign of shoulder dystocia.
|
|
|
How is shoulder dystocia managed?
|
HELPERR in order: help, episiotomy, legs up, pressure, enter vagina, remove posterior arm, roll over on all fours
|
|
|
Active pushing by mother usually resolves should dystocia. True or False
|
False. Further pushing should be stopped!!
|
|
|
What are foetal complications of shoulder dystocia?
|
hypoxia
brachial plexus injury fracture to clavicle |
|
|
what are the maternal complications of shoulder dystocia?
|
uterine rupture
perineal tears PPH |
|
|
Define ectopic pregnancy?
|
implantation of pregnancy in site other that the endometrial cavity
|
|
|
what is the leading cause of maternal death in the 1st trimester?
|
ectopic pregnancy
|
|
|
what is the most common site of ectopic pregnancy?
|
tubal 95%
Ampullary>isthmic>fimbrial>interstital |
|
|
Unilateral shoulder tip pain is a classic presentation of...
|
ectopic pregnancy
|
|
|
Is vaginal bleeding common in ectopic pregnancy?
|
Yes, occur in 75% of cases
|
|
|
Why is serial beta-HCG performed every 48hrs where ectopic pregnancy is suspected?
|
in normal pregnancy, it should double every 48hrs
|
|
|
At what beta-HCG level is a pregnancy usually visible via abdominal US?
|
>1500 Ui
|
|
|
Why is measuring progesterone useful for suspected ectopics?
|
<20 failing pregnancy
>60 ongoing pregnancy |
|
|
What is the primary medical Mx for ectopics>
|
methotrexate
|
|
|
what are the surgical options for Mx of ectopics?
|
larparoscopic salpingectomy
laparoscopic salpingotomy |
|
|
Is methotrexate appropriate for an ectopic pregnancy >3mm?
|
no
|
|
|
What is disadvantage of laparoscopic salpingotomy?
|
risk of recurrence
|
|
|
what is the most important modifiable risk factor associated with adverse pregnancy outcome?
|
smoking
|
|
|
what % of women smoke during pregnancy?
|
10-20%
|
|
|
Moderate alcohol intake during pregnancy has been associated with what foetal effects?
|
growth restriction
neurobehavioural effects |
|
|
what is the criteria for foetal alcohol syndrome?
|
prenatal alcohol exposure, growth restriction pre- and post-natally
facial malformation neurodevelopmental disorders |
|
|
what are the facial malformations associated with foetal alcohol syndrome?
|
short palpebral fissues
thin upper lip abnormal phitrum hypoplastic mid-face |
|
|
what is the recommended dose of folate?
|
0.5mg daily for low risk
5mg daily for high risk commence>1mnth before conception continue for 1st tri |
|
|
what are recommendations for caffeine consumption during pregnancy?
|
<2 cups/day or <250mg/day
|
|
|
For which women is 5mg daily folate supplementation recommended?
|
high risk for NTDs: previous HTD, FHx NTD, anticonvulsants, DM
|
|
|
Define antipartum haemorrhage (APH)?
|
bleeding after 20 wks until delivery
|
|
|
what is incidence of APH?
|
4-5%
|
|
|
What is the most common cause of APH?
|
placental abruption
|
|
|
List the causes of APH
|
placental abruption 30%
placenta praevia 20% more rarely uterine rupture, vasa praeva, cervical incompetence |
|
|
define placental abruption
|
premature separation of the placenta caused by rupture of maternal vessels in the dicidua basalis, splutting the decidua and separating its placental attachment from the uterus
|
|
|
What is the incidence of placental abruption?
|
0.4-1.3%
|
|
|
Placental abruption causes stillbirths in 1:800briths. True or False?
|
True
|
|
|
What is the most common cause of placental abruption
|
trauma (e.g. MVA, falls)
|
|
|
List the risk factors for placental abruption
|
previous abruption, mechanical factors, HTN, smoking, high parity, maternal age, cocaine, PPROM, inherited thrombophilia, multiple pregnancies, polyhyadraminos, placental abnormalities
|
|
|
Placental implantation over uterine septum or fibroid increases risk of...
|
placental abruption
|
|
|
Is a woman with well controlled HTN still at increased risk for placental abruption?
|
yes, risk derives from vascular damage, therefore if HTN was previously uncontrolled irreversible vascular damage may have occurred.
|
|
|
placental abruption is usually Dx using US. True or false.
|
False. only 2% abruptions detected on US. Dx is usually clinical
|
|
|
What are signs/symptoms of placental abruption?
|
bloody vaginal discharge >80%
Pelvic pain >50% Uterine contractions >35% Uterine tenderness 70% Non-reassuring CTG coagulopathy |
|
|
Should US be performed where placental abruption is suspected?
|
Yes, to exclude praevia and monitor foetal well-being. However, rarely provides positive Dx of abruption
|
|
|
Define placenta praevia.
|
the presence of placental tissue overlying the internal cervical os
|
|
|
90% of low-lying placentas detected during the 1st trimester will have resolved by the 3rd trimester. True or false
|
True
|
|
|
What is the incidence of placental praevia in the 3rd trimester?
|
4 in 1000 (0.4%)
|
|
|
What is the recurrence rate of placental praevia?
|
4-8%
|
|
|
What are the main risk factors for placental praevia?
|
1. endometrial scarring
2. increased placental surface area |
|
|
What may cause endometrial scarring?
|
increased parity
PHx caesareans increased maternal age PHx PID |
|
|
What may cause an increased placental surface area?
|
smoking, multiple gestations
|
|
|
Is pain more likely to be a dominant symptom in placental abruption or praevia?
|
Abruption. 70-80% of praevia resulting in APH is painless
|
|
|
What are the symptoms of placental praevia?
|
painless APH (70-80%)
Uterine contractions (10-30%) Asymptomatic 10% |
|
|
A woman 35+3GD presents with profuse red vaginal bleeding but no uterine pain or contraction. What is the most likely Dx?
|
APH due to placental praevia
|
|
|
A woman 35+3GD presents with abdominal pain and a small amount of vaginal bleeding following an MVA. What is most likely Dx?
|
placental abruption
|
|
|
Progesterone only pills must be taken at the same time every day. What is the 'window period'?
|
within 3 hrs
|
|
|
Which has high failure rate, OCP or POP?
|
POP
lowest efficacy is in young women |
|
|
What are side-effects of progesterone only pill (POP)?
|
mood changes
weight gain breast tenderness irregular bleeding |
|
|
what is a common problem with the POP?
|
break through bleeding (40%)
|
|
|
What is depoprovera?
|
depot of 150mg DMPA given IM every 12 weeks
|
|
|
A woman 28+3GD presents with abdominal pain, elevated LFTs, HTN and low platelets. This is characteristic of what syndrome?
|
HELLP in pre-eclampsia
|
|
|
What is the most common reason for removal of implanon?
|
irregular bleeding
|
|
|
How does the morning-after pill work?
|
thought to delay ovulation
(should be taken within 72hrs) |
|
|
What is the incidence of perinatal anxiety and/or depression?
|
1 in 5 mothers
1 in 10 fathers |
|
|
Define perinatal mood disorder?
|
a significant change in mood that lasts >2 wks and significantly affects function surrounding childbirth
|
|
|
A new mother is experiencing repetitive and intrusive thoughts related to her delivery. What is Dx?
|
post-traumatic stress disorder
|
|
|
A new mother is experiencing feelings of grief and loss of her previous lifestyle. This may suggest...
|
adjustment disorders
|
|
|
DDx of bleeding during early pregnancy?
|
implantation bleeding
miscarriage ectopic pregnancy other: vaginal trauma, cervical erosion, cervical polyp, neoplasia |
|
|
What are advantages of transvaginal US?
|
no full bladder, reproducible technique, earlier detection of both intra & extra uterine pregnancy
|
|
|
what is incidence of miscarriages?
|
15%
|
|
|
List the main causes of miscarriage
|
chromosomal abnormalities
congenital abnormalities iatrogenic infection uterine abnormalities |
|
|
What is a threatened miscarriage?
|
bleeding in early pregnancy with on going viable pregnancy
|
|
|
A cresent-shaped echo-free area between the chorionic membrane and myometrium is most likely a?
|
sub-choronic haematoma
|
|
|
what is the term used to describe where the baby's head is too large to fit through pelvis?
|
cephalopelvic disproporiton (CPD)
|
|
|
What are common indications for C-section?
|
previous caesarian
breech presentation cephalopelvic disproportion fetal distress dystocia |
|
|
What factors affect maternal transport to the placenta?
|
maternal hypotension/hypertension
uterine activity |
|
|
what factors affect diffusion across the placenta?
|
reduced placental SA
reduced oxygen availability altered fetal O2 affinity uterine activity/contraction |
|
|
what controls foetal HR?
|
SA node
ANS catecholamine chemoreceptors/baroreceptors cardio regulator centres |
|
|
Is the SA node innervated via sympathetic or parasympathetic?
|
both
|
|
|
Sympathetic innervation to the foetal heart develops before parasympathetic. True or false?
|
True. PS isn't fully developed until 28wks.
|
|
|
List actions of chatecholamines
(adrenaline/noradrenaline) |
increase HR, CO, BP, vasoconstriction
redirect blood flow to vital organs |
|
|
What are the 2 main mechanisms a foetus will respond to hypoxia
|
redistribution of CO
decrease oxygen consumption |
|
|
what is a 'kick chart'?
|
measure of foetal welfare from 28/9wks GD. Should be >10
|
|
|
1st stage labour is condsidered prolonged if it exceeds....
|
12hrs
|
|
|
2nd stage labour is condsidered prolonged if it exceeds....
|
1hr
|
|
|
what is the normal baseline foetal heart rate on CTG?
|
110-160
resting HR, assessed in absence of foetal movement or uterine activity. |
|
|
Should the HR vary by more than 5bpm on CTG?
|
YES. Should between 5-25bpm
|
|
|
A normal reactive CTG shows how many accelerations?
|
At least 2 accelerations of >15 beats above the baseline lasting >15s in a 20min period
|
|
|
On standard CTG graph paper 1cm on x axis is equal to what interval?
|
1min
|
|
|
Baseline variability on a CTG represents....
|
continuous interaction between sympathetic and parasympathetic; indicates adequate oxygenation
|
|
|
A CTG acceleration is an indicator of....
|
fetal response to stimulation
(release of catecholamine) |
|
|
List causes of reduced variability and reactivity on CTG
|
deep fetal sleep, drugs (narcotics), hypoxia, congenital anomalies, prematurity
|
|
|
List causes of foetal tachycardia?
|
maternal tachycardia, maternal fever, drugs: salbutamol, atropine
dehydration, hypoxia, fetal tachyarrhythmia, infection, premature |
|
|
List causes of foetal bradycardia?
|
low inherent rate, drugs (local anaesthetics, maternal hypotension, fetal heart conduction defets, prolonged umbilical cord compression, hypoxia, maternal hypothermia
|
|
|
What is a common cause of benign early decelerations?
|
compression of foetal head during contraction; caused by vagal stimulation
|
|
|
What is entonox?
|
50% NO
50% oxygen |
|
|
At what level does the ureter cross the pelvic brim?
|
birfurcation of the common iliac arter
|
|
|
Is the ureter is free from the peritoneum throughout it's entire course?
|
No, attached to the posterior lateral pelvic peritoneum (behind ovarian vessels)
|
|
|
In the broad ligament, does the ureter run above or below the uterine artery?
|
uterine runs POSTERIOR to uterine artery
|
|
|
At which locations is the ureter particularly prone to surgical injury (in female)?
|
pelvic brim
beneath uterine artery (broad lig) near UVJ |
|
|
At what spinal level is an epidural performed?
|
L3/4 at Iliac crests
(below level of spinal cord) |
|
|
What layers does the needle pass through in an epidural?
|
skin, subcut fat, supraspinous ligament, interspinous ligament
|
|
|
should an epidural pass through the dura mater?
|
No
|
|
|
What are common complications of epidurals?
|
accidental dural puncture
hypotension nausea, vomiting, shivering failure (missed segment, no block) |
|
|
what are rare (but serious) complications of epidurals?
|
neurological injury
abscess haematoma accidental IV administration |
|
|
Which requires higher volume of anesthethia- a spinal or epidural?
|
epidural ~20ml
spinal ~3mL |
|
|
Puncture of the dura sac during an epidural may cause...
|
CSF leak
headache |
|
|
If epidurals entering the subarachnoid space cause headaches, why is this not usually observed during spinals?
|
much smaller needle
no cannua negligible CSF leak |
|
|
What are specific concerns of general anaesthesia for c-section?
|
hypotension, difficult intubation, aspiration, rapid desaturation, awareness, neonatal respiratry depression, uterine atony
|
|
|
why is there a greater risk of hypotension when doing GA for C-section?
|
aortic caval compression after 20/40
|
|
|
TORCHS
|
Toxoplasmosis, rubella, CMV, herpes, syphillis
|
|
|
Transplacental infections
|
TORCHS, varicella, Hep B, Hep C, HIV
|
|
|
Ascending intrauterine infection
|
e.coli, klebsiella, pseudomonas, beta-haemolytic strept, listeria monocytogenes
|
|
|
what % of pregnant women in australia are colonised by group B strept
|
15-30%
|
|
|
what % of babies born to GB-strep positive mothers are colonised/ develop infection
|
10%/ 0.5 per 1000
|
|
|
A group B strep infection contracted at birth is fatal in what %
|
20% fatal
|
|
|
List indications for Abx during labour
|
Group B haemolytic strep +
PHx infant with invasive GBS disease GBS bacteriuria Intrapartum fever >37.5 preterm labour <37 prolong ROM >18hrs |
|
|
Listeria monocytogenes
|
gram positive bacilli
faculative anaerobe foodborne; listeriosis raw food, seafood |
|
|
Intrapartum infection risk factors
|
GBS colonization
Preterm labour Prolonged ROM >18hrs Frequent vaginal examinations Maternal fever Clinical chorioamionitis- uterine tenderness, offensive liquor Asphyxia |
|
|
early onset neonatal sepsis
|
<72hrs
|
|
|
Group B strept treatment
|
Penicillin/Ampicillin
100mg/kg |
|
|
Neonatal Gram negative infection
|
Gentamicin
(ototoxic, nephrotoxic) |
|
|
which has higher mortality
early or late-onset neonatal sepsis |
Early 10-30%
Late <10% |
|
|
what % of women who have untreated bacterinuria develop pyelonephritis during pregnancy
|
30%
|
|
|
what are the complications of pyelonephritis during pregnancy
|
PROM
perinatal death |
|
|
what hormone has subunit which is structurally similar to LH, FSH, TRH
|
HCG
|
|
|
What hormone is chemically similar to growth hormone and prolactin?
|
Human placental lactogen
|
|
|
What is function of human placental lactogen
|
antagonises cellular action of insulin, decreases insulin utilisation
|
|
|
what cells produce estrogen in non-pregnant pre-menopausal women
|
follicular granulosa cells
|
|
|
chadwick sign
|
bluish discolouration of vagina and cervix due to increased vascularity
|
