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102 Cards in this Set

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What is the cut off week for viability in pregnancy?

24 week


Before is Miscarriage


After is still born

What are stages of labour

Stage 1- latent 0-3cm and active phase 3-10cm dilation


Stage 2- propulsive (full dilation to presenting part engaging), Expulsive (from reaching the pelvic floor to delivery of the baby).


Stage 3- from delivery to expulsion of the placenta

What is Macrosomia and what is it associated with?

Macrosomia- significantly larger than normal fetus. Commonly due to gestational diabetes.

What phase do primary oocytes arrest in?

Prophase 1 of meiosis 1

What phase do secondary oocytes arrest in?

metaphase 2 of meiosis 2 until fertilisation

What does progesterone do?

It switches the endometrium to it's secretory phase ready for implantation and also prevents uterine smooth muscle contraction.

What are the 3 signs of pregnancy?

The show- release of the mucus plug


Rupture of membranes- waters breaking


Painful contractions- begin to get progressively closer together.

What immunoglobulin is transferred in breast milk?

IgA, IgG is transferred across the placenta.

Eisenmenger's syndrome

Where a long standing left to right shunt causes pulmonary hypotension and eventual reversal of the shunt

At what level does the parasympathetic supply to the penis originate?

The pelvic splanchnic nerves- S2-S4

From which artery does the vessels that supply the erectile vessels branch from ?

The internal pudendal artery- this is initiated by the relaxing of the SM by the parasympathetic innervation.

Where do the sympathetic fibres that supply the genitals originate from?

The preganglionic fibres that leave the spinal cord at the levels T10- L2.

Signs and Symptoms of BPH?

Slowstream


Hesitancy


Intermittentflow


Terminaldribbling


Emptyingis incomplete

What is the significance of meconium in the fetal liquor?

Intrauterine fetal stool contains meconium from desquamated bowel cells and is usually released from the fetus during hypoxia. Hypoxia also causes gasping which can cause the fetus to aspirate this meconium which can prevent normal respiration at birth.

What is the APGAR score and what does it assess?

It is a test used to quickly assess an infant at 1 and 5 minutes of age. It assesses:


Apperance- cyanotic or not


Pulse- heart rate


Grimace- facial response to irritable stimuli


Activity- level of active movement (tone)


Respiration- crying, breathing?

What is hypoxia?

It is a lack of oxygen supplied to the tissues not lack of oxygen.

What is a normal fetal heart rate?

120-150 BPM

What is a neonate?

Neonate- a child which is less than 4 weeks old.

Give the three non-enveloped DNA viruses

P- Parvovirus


A- Adenovirus


P- Papillomavirus

Give the 3 types of subfertility

Type 1-Hypopituiatary failure- no LH/ FSH release


Type 2- Hypopituitary dysfunction- low or lack of response to LH/ FSH


Type 3- ovarian failure

What do you give in pregnancy for seizures?

Magnesium

What is Hypermesis Gravidum?

More sever morning sickness characterised by nausea and vomiting such that weight loss and dehydration occur- give ondasteron (5-HT3 receptor antagonist).

What can be given to induce placental delivery?

Oxytocin

What are fibroids?

They are oestrogen dependent soft tissue tumours which can grow and compress the uterus

Why do ectopic pregnancies cause bleeding?

Because they stretch the anastomoses of the vaginal and uterine artery which join along the course of the fallopian tubes.

What is the most common cause of post partum haemorrhage?

Uterine atony

What are the 4 causes of primary post partum haemorrhage?

4 T's


Tone


Trauma


Tissue


Thrombin



Define primary and secondary post partum haemorrhage.

Primary- Birth to 24 hours after, >500ml lost


Secondary- excessive blood loss, 24hrs to 6 weeks after

What is Scimitar syndrome?

Where oxygenated blood from the right lung returns to the venous system.

Give 3 bacteria that cause meningitis.

Streptococcus pneumoniae


Neisseria meningitidis


Haemophilus influenza B

What must be given to help fetal lungs in cesarian section?

Glucocorticoids to help induce production of fetal surfactant.

What is the definition of small for gestational age?

Being less than the 10th centile.

Definition of Faltering growth

Where the fetus does not achieve that same rate of growth predicted by earlier measurements- does not achieve full growing capacity.

Common complications of premature babies

Poor temperature control- hypothermia


Hypoglycemia


Polycythemia

Why does gestational diabetes cause macrosomia?

Due to the baby trying to compensate for the mother by producing more insulin which includes insulin like growth factor which causes the fetus to grow large. This may require induced birth or delivery as placental insufficiency may be an issue.

What is a preterm baby?

Less than 37 weeks gestation.


<37/40

What spinal levels provide parasympathetic innervation to the genitals?

T10-L2

What is Viagre?

It is a PD5 inhibitor

What is:


Antepartum haemorrhage?


Intrapartum haerorrhage?


Post partum haemorrhage (primary and secondary)?

Antepartum- 24 weeks to birth


Intrapartum- 1st and 2nd stages of birth


Post partum (primary)- more than 500 ml from delivery to 24hrs later.


Secondary- beyond 24 hrs later to 6 weeks.

Signs of fetal distress?

Tachy or bradycardia


Type 2 decelerations


Meconiumpresent in the amniotic fluid


Reduced baseline variablity

What is the definition of infertility?


Primary and Secondary

The inability to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.


Primary- never had successful pregnancy


Secondary- had previous successful pregnancies

What are the 3 types of classification of subfertility?

Type 1- hypopituitary failure- no LH/ FSH release


Type 2- Hypopituitary dysfunction- low or no response to LH/ FSH


Type 3- Ovarian failure

How many follicles per ovary is diagnostic of polycystic ovarian syndrome?

More than 10 follicles per ovary

What is endometriosis and what can it cause?

It is where there is the prescence of endometrium outside the uterine cavity causing pain, menorrhagia.


Can also be a cause of infertility.

What are fibroids?

They are uterine non-cancerous growths in and around the myometrium of the uterus and cause regular, heavy periods.


Trans acid can lighten the bleeding.


Common in Afrocaribeans



After what time periods should IVF be offered?

After 2 years of unprotected sexual intercourse.


Particularly if they are >36YO or have predisposing factors


Offer to women <40YO who have not concieved after 2 years of unprotected sexual intercourse or after 12 cycles of intrauterine sperm injection.


Offer 3 cycles.

What is Clomifene used for?

Clomifene- stimulates release of an egg.

Give 4 different interventions that can be used for subfertility.

Intrauterine insemination- sperm injected into the vagina.


In-vitro Fertilisation- eggs fertilised outside the body and then transferred back into the uterus.


Intracytoplasmic sperm injection- single sperm is injected directly into an egg, for severe deficits in semen quality.

What 3 measurements are taken during a sperm count?

Motility


Morphology


Volume

How many cycles should be offered to women under 40 and over 40 and what are the criteria?

Criteria- no success after 2 years of unprotected sexual intercourse and 12 cycles of IUI and no previous IVF.


Women <40YO- offer 3 cycles


Women 40YO-42YO- offer 1 cycle


1.9% success rate in women >45YO

Name the 3 non-enveloped RNA and DNA viruses

DNA- PAP


Papillomavirus, Adenovirus, Parvovirus.




RNA- REH


Rotavirus, Enteroviruses, Hepatitis A.

Why do women get gestational diabetes?

In pregnancy the placenta secretes cortisol and other anti-insulin hormones which cause a state of insulin resistance.

What is a common complication of gestational diabetes?

Macrosomia- the extra sugar goes to the baby and this can exacerbate the ability of the placenta to supply nutrients- birth asphyxia and traumatic birth occur.

Why may a HbA1c test give a false negative result in pregnancy?

Anaemia may result in pregnancy therefore the Hb will be naturally low.

What is the leading cause of neonatal infections?

Group B strep. from the normal vaginal bacteria (flora).

Which hepatitis is spread via sexual intercourse, is DNA and is tetragenic?

Hepatitis B

What are the different types of miscarriage?

Threatened- light bleeding with cervical Os closed


Inevitable- heavy bleeding with Os open


Incomplete- heavy bleeding, Os open, Some parts passed.


Complete- All parts passed, bleeding has diminished or stopped and Os closed.


Missed- Os closed but no fetal heart trace.


Septic- The contents of the uterus are infected.

What do you give Methotrexate for in ectopic pregnancy?

Give methotrexate as it is a chemotherapy drug which will cause removal of the ectopic contents.

What is placental abruption?

It is where antepartum (beyond 24 weeks but before delivery) hemorrhage occurs due to separation of the placenta from the uterine walls.

What is the difference between placenta praevia major and minor.

Major- the placenta grows over the Os completely.


Minor- the placenta touches the Os.


There is no SM in the lower uterus so at delivery there is lack of SM to contract to stop postpartum bleeding.

What is placenta accreta?

It is where the placenta inserts onto a scar from an old C-section meaning the placenta doesn't separate well. This must be treated with a hysterectomy (removal of the uterus).

Give 3 signs of fetal distress.

Meconium- stained liquor with fetal faeces which can be inhaled causing GI problems.


Baseline tachy or bradycardia <100 or >160 bpm.


Reduced baseline variability <5bpm


Decelerations

What is uterine atony?

It is where the uterus fails to contract after delivery causing excessive postpartum haemorrhage >500ml.

List problems with the passages in labour.

Contracted pelvis- android not gynecoid shape


Placenta praevia


Fibroids

Problems with the powers

Uterine inertia


Inco-ordinate contractions


Hypertonic contractions


Uterine rupture

Problems with the passengers

Number


Position


Size

Under what age is sexual intercourse considered rape?

13 Years Old

What is the Puerperium?

It is the time from delivery to 6 weeks after delivery- usually the amount of time for the uterus is involute and for the physiological changes to return to normal.

What is thromboembloic disease in pregnancy?

It is the increased risk of suffering from an embolism or thrombus formation during and post pregnancy due to increased coaguability.

Causes of postpartum complications?

•PostpartumHaemorrhage (PPH)•Thromboembolicdisease (TED)


•Psychiatricdisorders


•Pre-eclampsia


•Sepsis-women with infections who deliver at home and fail to seek help.

Direct vs Indirect maternal death

Direct- occurs as a direct result of the pregnancy.


Indirect- Occurs due to a pre-existing condition.

By what day does the neural tube close?

Day 28

What is birth asphyxia and what does it commonly result in?

It is the state or process of being deprived of oxygen which can result in unconsciousness or death.


Hypoxic-Ischemic encephalopathy,

Is Gastroschisis or Omanocephele covered in peritoneum?

Omanocephele is covered in peritoenum. Gastroschisis isn't as it look like shite.

What are the different definitions of:


Still born


Miscarriage


Neonatal death


Infant death

Still born- death after 24 weeks


Miscarriage- death before 24 weeks


Neonatal death- baby born alive but dies within first 28 days.


Infant death- death within the first year of life

What is a neonate?

It is a child that is less than 28 days (4 weeks) old.

Why does gestational diabetes lead to macrosomia?

The mother produces extra insulin to counteract the high blood glucose, this includes IGF-1 which acts similarly to growth factors causing an enlarged baby.

What is Waterhouse- Friderichsen syndrome?


Water= adrenal glands


Frid= Fred West= Infant death.

It is adrenal insufficiency in neonates leading to SUDS due to haemorrhag into the adrenal glands due to severe bacterial infection (meningococcus Neisseria meningitidis).


This causes- low BP, Shock, Disseminated intravascular coagulation, coma.

Sudden infant death syndrome?


Give 2 risk factors.

Is the death of an infant (birth- 1 year) where after full investigation of the death scene, review of clinical history and complete autopsy, a cause can still not be identified.


Risk factors- co-sleeping, low social classes, low birth weight, maternal smoking.

Give 2 reasons that SIDS numbers have reduced in recent years.

Better awareness- back-to-sleep


Less co-sleeping


Better autopsy process

What is the treatment ladder for Pneumonia?

Amoxicillin


Clithramycin


Co-amoxiclav

What is the difference between Crohn's disease and Ulcerative Colitis interms of spread along the colon.

Crohn's- from mouth to anus, but not continous- has skip lesions.




Ulcerative Colitis- continous with no skip lesions but only in the colon/ rectum.

What is Scimitar syndrome?

It is a cardiovascular abnormality where the oxygenated blood from the right lung drains back into the vena cava on the right side instead of the left atrium.


This presents with a shadow over the right lung- Scimitar sign.

Is an expiratory wheeze intra or extrathroacic?

Expiratory= intrathoracic


On expiration the alveoli constrict and narrow to help expel the air. On inspiration the opposite occurs and large airways constrict causing an inspiratory wheeze (asthma).

Are Cocci Gram +ve or Gram -ve?

Cocci are Gram +ve

What is long Q-T syndrome and why does it make an infant vunerable?

Long Q-T syndrome is a prolonged gap between the Q and T waves which is indicative of an abnormality of the serotoninergic network (including the arcuate nucleus). This causes slower responses to autonomic changes (increase in HR or RR).

What is a Wilm's tumour?

It is a tumour of the kidneys (nephroblastoma)

What is considered a premature birth?

Birth before 37 weeks gestation.

Small for gestational age?

Birth weight below the 10th centile.

What is respiratory distress syndrome?

Lack of surfactant- mainly in premature babies, causing collapse of the alveoli.

What is the main complication of CMV infection?

Causes Deafness.

What is the definition of fetal growth restriction?

Failure to achieve a normal rate of fetal growth.

What is the difference between Symmetrical and Asymmetrical IUGR?

Symmetrical- both head and abdomen are small


Asymmetrical- Head is spared and is normal size and abdomen is small.


For asymmetrical to occur the restriction must occur early in gestation.

Give two ways that IUGR can be assessed.

Fetal movements


Ultrasonography


Amniotic fluid volume

What does the heel prick test for?

Sickle cell anaemia


Cystic fibrosis


Hypothyroidism


phenylketouria


Downs syndrome

Causes of intrauterine growth restriction?

Cord Stricture


Thrombi in chorionic vessels


Hypercoiled umbilical cord

Causes of prematurity

Intrauterine infection


Premature rupture of membranes


Uterine fibroids


Cervical incompetence


Placental praevia


Placenta abruption


Induction of labour due to maternal or fetal distress

What are the 3 categories of muscoloskeletal disorders?

Back pain


Myalgia- muscle aches


Arthralgia- joint aches

Most common cause of post partum haemorrhage (>500ml birth to 24 hours after)?

Uterine atony

Where in the prostate are cancers and BPH usually found?

Prostate cancer- peripheral zone- harder to detect


BPH- peripheral zone- causes many S+S

What weights define:


Low birth weight


Very low birth weight


Extremely low birth weight



LBW- <2500g


VLBW- <1500g


ELBW- <1000g

Gestational diabetes

Intolerance to carbohydrate of variable severity with first presentation during pregnancy. Control with metformin or insulin and perform a glucose tolerance test 6 weeks after delivery.