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79 Cards in this Set
- Front
- Back
Postnatal Check for mother at 6 weeks:
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weight, BP
urine vaginal discharge, period wounds breasts contraception, sex +/- pap |
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isoimmunisation
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development of antibodies to antigen
(eg. Rh incompatibility) |
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Group & Hold
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Determines ABO group and screening for antibodies to common red cell antigens that can cause transfusion reactions
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Group & Crossmatch
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In additionto group & hold, crossmatching involves mixing samples from donor blood with the patient's blood
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1 unit of blood raises the Hb by
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1 g/dl (non-bleeding adult)
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When should you order a group & hold or crossmatch?
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If the patient needs blood, you should crossmatch the number of units they will need.
Group & Hold if the patient is unlikely to need a blood transfusion but it will reduce the time required for cross-matching later. |
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Infections that can be passed down to the neonate during pregnancy due to transplacental IgG :
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Toxoplasmosis
Other (varicella, parvovirus, listeria, TB, malaria, fungi) Rubella CMV HSV / HIV Syphilis |
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Explain the risks of having C-Section
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TO MOTHER:
General Surgical Risks - infection - bleeding (PPH) - clotting (DVT/PE) Anaesthetic Risks -anaphylactic reactions Injury to adjacent structures - bowel, bladder ↑ risk of complications in later pregnancies - uterine rupture Family Planning - size of family desired TO BABY: - TTN - RDS - surgical injury |
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LGA vs. macrosomia ?
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LGA:
≥ 90th percentile for GA Macrosomia: ≥ 4000g (or 4500g in USA) regardless of GA |
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clinical sx of ovulatory/anovulatory failure?
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regular cycles = ovulatory
irregular cycles = anovulatory |
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biochemical factors responsible for growth of the endometrial lining?
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ovaries (estrogen & progesterone) → PG, cytokines, MMPs → endothelium
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Breast Feeding OSCE explanation
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.
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Signs of Pregnancy
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Presumptive (skin & mucous membrane changes)
- Chadwick's sign, linea nigra, cholasma Probable (uterus changes) Positive (fetal movement & heart beat) |
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gestational sac visualised by US at
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week 5
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fetal heart beat visualised by US at
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6-8 weeks
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Pfannenstiel incision
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- horizontal (slightly curved) line just above the pubic symphysis
- commonly used for c-section or hernia repair |
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Role of Theca and Granulosa cells in the ovary
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Cycle Development from primodial follicle to corpus luteum
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Ovarian cycle
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Overview of Menstrual Cycle Diagram
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Steroidogenesis Pathway
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circulating estrogens & androgens are mostly bound to
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SHBG
serum albumin + small unbound fraction (biologically active) |
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Phases of menstrual cycle:
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Follicular vs. Luteal phase
Proliferative vs. Secretory phase |
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What causes the LH surge which leads to ovulation?
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a burst of estradiol synthesis at the end of the follicular phase causes +ve feedback on secretion of FSH & LH
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Hormonally, what happens if fertilisation occurs?
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placenta → HCG → recues corpus luteum from regression → estradiol & progesterone
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peak levels of HCG occur at
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week 9
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Hormonally, what happens in the 2nd & 3rd trimesters of pregnancy?
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placenta → progesterone
fetal adrenal gland → DHEA → placenta → estriol |
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Which hormones cause growth & development of breasts during pregnancy?
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estrogen
progesterone |
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Comment on prolactin levels during pregnancy
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estrogen → anterior pituitary → prolactin increases steadily during pregnancy
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Why doesnt lactation occur during pregnancy?
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estrogen & progesterone block the action of prolactin on the breast
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What causes lactation after parturition?
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sharp fall in estrogen & progesterone
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lactation is maintained by
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suckling → oxytocin & prolactin secretion
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Effects of prolactin in suppressing ovulation?
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inhibits GnRH secretion
antagonizes LH & FSH on the ovaries |
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Absence of adequate amniotic fluid during mid-pregnancy is associated with
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pulmonary hypoplasia at birth
(incompatible with life) |
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When does engagement of the fetal head occur?
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primip - 37 weeks
multip - up to the onset of labour |
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How is non-engagement of the fetal head investigated?
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US
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What are causes of non-engagement of the fetal head?
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placenta previa
fetal abnormality |
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Positions of the fetal head (pelvis diagram)
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When is a head considered to be engaged?
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2/5 palpable (not ballotable)
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what are the pelvic floor muscles?
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levator ani
coccygeus |
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Shapes of the female pelvis
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gynocoid (50%)
anthropoid android platypolloid |
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Can one assess pelvic adequacy for childbirth?
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Not unless there is a gross abnormality (from gait or hx)
- fetal head "moulds" & the joints of the pelvis can move slightly |
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Breech Presentations
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A - complete (thighs & knees flexed) 5-10%
B - frank (thighs flexed knees extended) 50-75% |
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Fetal Position - diagram of different presentations
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Positions of the fetal head
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5 bones of fetal skull
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2x parietal
2x frontal 1x occipital |
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4 sutures of fetal skull
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coronal
frontal sagittal lambdoid |
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fontanelle =
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where 2 or more sutures meet
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fontanelles of the fetal head
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anterior fontanelle = bregma (diamond)
posterior fontanelle = lambda (triangular) |
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Regions of the fetal head
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Outline the Stages of Labour
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Types of Twin Pregnancies
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caput succedaneum
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- occurs when the dilating cervix presses against the fetal scalp, preventing normal venous blood & lymphatic fluid flow → tissue swelling
- soft & boggy - disappears <24 hours after birth |
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Describe physiological "moulding" of the fetal head during labour
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- process of slipping/overlapping of the cranial bones
- disappears a few hours after birth |
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types of placenta circulations?
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uteroplacental (maternal side)
fetoplacental (fetal side) |
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interaction between maternal & fetal blood flow?
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side by side but in opposite directions (counterflow faciliates exchange)
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Functions of the placenta
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- anchor the fetus
- barrier against infection - gas & substance exchange - endocrine organ (HCG, estrogen, progesterone) |
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when is oxytocin released by the posterior pituitary?
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first stage of labour
suckling |
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effect of pregnancy on thyroid
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thyroid gland enlarges due to ↑ demand
↑ renal clearance of iodine = relative iodine deficiency → ↑iodide uptake → follicular enlargement slight ↑ in T3/4 & ↓TSH but in normal range |
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Haemodynamic changes in pregnancy
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↑ plasma volume
↑ red cell volume ↓ platelets ↑ WCC ↑ clotting factors |
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Cardiovascular changes in pregnancy
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↑ cardiac output
↓ peripheral vascular resistance = ↓BP nu mid pregnancy which returns to normal levels by term |
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Respiratory changes in pregnancy
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↑ tidal volume
↑ inspiratory capacity only slight change to RR, therefore breathe more deeply SOB (↓pCO2) |
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Uterus changes in pregnancy
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↑ weight x10
stretching hypertrophy of uterine & ovarian arteries → ↑ uterine blood flow ↑ vaginal discharge due to glandular hypertrophy |
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Urinary tract changes in pregnancy
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↑ renal blood flow (in line with ↑CO) → ↓plasma creatinine & urea
(creatinine in normal range indicates renal impairment in pregnancy) |
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GIT changes in pregnancy
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↓ esophageal spincter tone → reflux
↓ gastric emptying ↓ GI motility |
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conception occurs on day
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14
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When does implantation occur?
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6-7 days after fertilisation
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inner cell mass forms the
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embryo
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trophoblast forms the
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placenta
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cytotrophoblast produces
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hCG
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syncytiotrophoblast produces
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estrogen & progesterone
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Pregnancy can be diagnosed by
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b-hCG
US (FHR) fetal movements (17-22 weeks onwards) |
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embryo =
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from fertilisation until end of week 8 of gestation (10 weeks from LMP)
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fetus =
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from week 8 of gestation (10 weeks from LMP)
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miscarriage =
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delivery <20 weeks OR <400g
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previable =
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<24 weeks
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preterm =
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<37 weeks
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term =
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37-42 weeks
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post term =
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>42 weeks
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