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122 Cards in this Set
- Front
- Back
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What is the name of the newborn screening test?
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Guthrie test
|
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What does the newborn screening test, test for?
|
CF
PKU Galactosemia Congenital hypothryoidism Amino acid disorder Fatty acid metabolism disorders |
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What are two factors which can invalidate the results of the newborn screening test?
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Antibiotics
Lack of enteral feeding |
|
List the benefits of the OCP?
|
1. Decreases menorrhagia and dysmenorrhea
2. Acne 3. Ovarian and endometrial CA 4. PID 5. Regulation of menstral cycle 6. Benign cystic breast disease 7. Endometriosis 8. Contraception |
|
List the side effects of the OCP?
|
1. DVT
2. PE/Stroke 3. Hypertension 4. Weight gain 5. Nausea 6. Decreases libido |
|
What are some types of emergency contraception?
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1. Combo pill (100ug estrogen+0.75mg levonorgestrel) 2 doses 12 hrs apart
2. Progestin only (levonorgestrel 2 doses 12 hrs apart) 3. Mifepristone (abortifacent) 4. IUD |
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What are the major fetal complications of multiple gestations?
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1. increased mortality (5-10x higher)
2. prematurity 3. Twin-twin transfusion 4. Cord accidents (twisting) 5. Conjoined twins 6. IUGR 7. Low birth weight 8. Operative delivery 9. Placenta previa/abruption more common |
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What is the name of the drug which is given to stimulate ovulation in infertility (esp in PCOS)
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Clomiphene
|
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What are the major maternal complications of multiple gestations?
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1. HTN
2. PPH 3. Pre-eclampsia |
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What are the most common infectious agents in mastitis?
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1. Staph aureus
2. Streptococcus species |
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What is the treatment for mastitis?
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1. Continue breast feeding or pumping
2. Warm, moist heat 3. NSAIDs 4. Dicloxacillin 5. Surgical drainage in the case of breast abscess |
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What are the benefits of breast feeding?
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1. Maternal-fetal bonding
2. IgA 3. Decreases PPH (uterus contraction) 4. Economical 5. Ideal solute load for kidneys 6. ?prevent diabetes? 7. Contraception 8. Decreases risk of breast cancer and ovarian cancer 9. Decreased AOM in baby 10. Decreased SIDS 11. Get to know baby quicker 12. Decreases infections (esp GI) 13. lower antigenicity than cows milk (cow's milk protein allergy or eczema) |
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What are the risk/complications of breast feeding?
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1. Infection transfer (HIV)
2. Difficult to quantify amount of each feed 3. NO Vit D or Fe 4. Longer feeding times 5. Sore cracked nipples 6. Oral candidiasis |
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In a glucose challenge test what is considered abnormal at 1 hour?
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50g glucose load
>7.7mmol/L If >11mmol/L then diagnose with GDM |
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In a glucose tolerance test what is the diagnostic criteria?
0hrs? 1hr? 2hrs? 3hrs? |
0hrs >5.5 mmol/L
1hr >10.0 mmol/L 2hrs >8.0mmol/L |
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What are the fetal effects of GDM?
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1. Macrosomnia
2. Increased risk of shoulder distocia 3. Neural tube defects 4. Atrial/Ventricular septal defects 5. Transposition of vessels 6. Hypoglycemia after birth 7. Renal anomalies 8. Stillbirth |
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What are the maternal risks/effects of GDM?
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1. predisposition to DM in later life (50%)
2. Increases C/S rate 3. infection 4. PPH 5. HTN/pre-eclampsia |
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What are the beneficial effects of HRT?
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1. Hot flushes control
2. Osteoporosis 3. Urogenital symptoms 4. Vaginal dryness 5. Sleep improvements 6. Colorectal cancer |
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What are the risks of HRT?
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1. DVT/PE/Stroke
2. Breast cancer 3. Endometrial/Ovarian cancer (estrogen only HRT) |
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What is a non-hormonal drug given to treat menorrhagia?
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Tranexamic acid
|
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What is the Bishop score and what are the components?
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Measure of favourability for induction of labour
1. Consistency of cervix 2. Position of cervix 3. Dilitation of cervix 4. Effacement 5. Station |
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What screening questions should be asked to screen for pre-eclampsia?
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Swelling of face or hands?
Headache? Blurry vision? |
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Definition of antepartum hemorrhage?
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Bleeding after 20 weeks gestation to before delivery
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Major causes of antepartum hemorrhage?
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1. Placental abruption (30%)
2. Placenta previa (20%) 3. Uterine rupture (rare) 4. Vasa previa (rare) 5. Coagulopathy 6. Cervical incompetence 7. Threatened premature labour |
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Risk factors for antepartum hemorrhage?
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Previous abruption
Trauma HTN Cigarette smoking Parity (increased) Maternal age Cocaine PROM Coagulopathies Multiple pregnancies |
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Types of placenta previa?
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1. complete
2. partial 3. marginal 4 low lying (withing 2cm of os) |
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Risk factors for placental previa?
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Endometrial scarring (increased parity, LSCS, maternal age, prior curette)
Increased demand for placental surface area ie increased oxygen demand(maternal smoking, multiple gestation, higher altitudes) Early gestational age |
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Initial management of mod to severe abruption
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1. 2 large canulas
2. maternal vitals and hemodynamic status 3. Continuous CTG 4. IV fluid resus 5. Bloods: FBC, G&H cross match, QFMH, DIC screen, Coags |
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Management of PPH? (non-initial)
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1. All initial managment stuff (vitals, bloods etc)
2. Oxytocin infusion 3. Direct uterine massage 4. Correction of DIC 5. Prostaglandins 6. B-lynch suture 7. Uterine embolization 8. Hysterectomy |
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What are some commonly used medications for overactive bladder?
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Ditropan (Oxybutynin)
Detrusitol (Tolterodine) Tofranil (Imipramine) |
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What are the risks associated with maternal smoking?
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Lower birth weight
Perinatal mobidity and mortality (PROM, abruption, preterm delivery, stillbirth and SIDS) |
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What is the criteria for Fetal Alcohol Syndrome?
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1. Prenatal alcohol exposure
2. Growth restriction pre and postnatally 3. Facial malformation (short palpebral fissures, thin upper lip, abnormal philtrum and hypoplastic midface 4. Neurdevelopmental disorders (language, motor, learning) |
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S&S of Endometriosis?
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Recurrent dysmenorrhea
Dyspareunia Low back pain Infertility Adnexal mass Bowel/bladder symptoms |
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What are some risk factors for Endometriosis?
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Early menarche
Late menopause Shorter menstral cycle length Longer duration of menstral flow Not on OCP (is protective) |
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What are some medical treatments for endometriosis?
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1. NSAIDs
2. OCP 3. IUD 4. Danazol (ovarian suppression) 5. GnRH analogue |
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What are some causes of post-menopausal bleeding?
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1. HRT
2. Atrophic changes (endometritis, cervicitis, vaginitis) 3. Cancer (endometrial, cervical, vaginal, vulvar) 4. Polyps 5. Endometrial hyperplasia 6. Trauma 7. Bleeding disorder |
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What are the risk factors for endometrial cancer?
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Medications - estrogen, tamoxifen
Family hx Low parity, infertile Endometrial hyperplasia PCOS HNPCC Obesity |
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What endometrial thickness is considered abnormal in a post-menopausal women?
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>4mm (if not on HRT)
|
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What investigations would you perform in a women with PMB?
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Pap smear
Endometrial biopsy Transvaginal U/S (uterus, endometrial thickness, pelvic masses and free peritoneal fluid) Hysteroscopy D&C |
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What pts would you book for colposcopy ?
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1. 2 LGSIL smears in 12 months
2. Any HGSIL 3. Any glandular abnormality on smear 4. Persistent post-coital bleeding 5. Abnormal appearing cervix |
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What strains of HPV are implicated in Low grade cervical dysplasia?
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HPV 6 and 11
|
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What strains of HPV are implicated in High grade cervical dysplasia?
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HPV 16 and 18
|
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What % of LGSIL regress?
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60-70%
|
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What % of LGSIL progress to HGSIL?
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4%
<0.1% progress to cancer |
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What % of CIN 2 regress?
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43%
|
|
What % of CIN 2 progress?
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22%
|
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What % of CIN 3 progress?
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14%
|
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What % of CIN 3 regress?
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32%
|
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What are the risk factors for cervical cancer?
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Preinvasive disease
smoking HPV infection Multiple sexual parters Early age of first intercourse Immunosuppression |
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What is the treatment for bacterial vaginosis (gardnerella vaginalis)?
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Metronidazole 400mg bd x7days
|
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What is the treatment for Chlamydia?
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Azithromycin 1g stat dose OR
Doxycycline 100mg bd x 10days No sex for 10days Treat partners from last 6/12 |
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What is the timeframe of post-partum blues?
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First 10days
(peak 5 days) |
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What is the timeframe of post-partum depression?
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First 6 months
(first 90 days greatest risk) |
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Define lie
|
Long axis of the fetus to the long axis of the uterus.
(Transverse or longitudinal) |
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Define presentation
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Part of fetus felt on vaginal examination
|
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Define position
|
The rotational relationship defined by the presenting part as the denominator ie normally cephalic = occiput
(OA, OP, L or R OT |
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Define Engagement
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The station at which the maximum diameter of the presenting part is through the pelvic inlet. If vertex 1/5 palpable above symphsis pubis
|
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Describe the mechanisms of labour (stages)
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1. Descent
2. Flexion 3. Internal rotation 4. Crowning 5. Restitution 6. External rotation 7. Lateral flexion |
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What are some common signs of the begining of the second stage of labour?
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Feeling of wanting to push or have bowels open
Perineal flattening Vaginal gaping Large mucoid show Anal pouting No cervix felt on examination |
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What are the common causes of bleeding in early pregnancy?
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1. Misscariage
2. Ectopic 3. Normal bleeding 4. Non pregnancy related (cancer, trauma, urethra/UTI) |
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What are the treatment options for an ectopic pregnancy?
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Surgical: Laparoscopy or Laparotomy
Methotrexate IM (if small and stable) |
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What is the normal rate of misscariage?
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1:5
|
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What is the mechanism of action of the progesterone only pill?
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Viscous, hostile cervical mucous
Atrophic endometrium |
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How does depo-provera work?
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Inhibits ovulation (progestogen containing)
|
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How long does depo-provera last for ?
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12 weeks
|
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What are the side effects/disadvantages of depo-provera?
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Change in periods (irregular bleeding, amenorrhea)
Cannot be removed (side effects for 3 months Delay in return of fertility Weight gain Depression Mood swings Headaches Acne Breast tenderness |
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How long does Implanon last for?
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3 years
|
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How does Implanon work?
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Inhibits ovulation
Thickens cervical mucous Thinning of endometrium (atrophic) |
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How does the copper IUD work?
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Impede sperm transport (copper kills sperm)
Blocks fertilization Blocks implantation |
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How does the Mirena work?
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Suppresses endometrium
Thickens cervical mucous (inhibs ovulation in 50%) |
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At what gestational age is a fetal morphology scan done?
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18-20 weeks
|
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What is the overall incidence of trisomy 21?
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1:660
|
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What is the risk of trisomy 21 with a maternal age of 40years
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Approx 1:100
|
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What is the detection rate of trisomy 21 using free bHCG, PAPPA, NT and age?
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90%
|
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Which anesthetic is commonly used in epidurals?
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Low conc long acting (bupivacaine aka Marcane)
|
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What are the potential complications of epidurals?
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Dural puncture with post dural puncture headache
Hypotension N/V Shivering Failure Neurological injury Epidural abcess Epidural hematoma |
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What is the definition of heavy menstral bleeding?
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>80ml lost per cycle
|
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How many pads or tampons used over a single mentral period is normal?
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<21 pads/tampons
|
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What are some causes of heavy menstral bleeding?
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Uterine causes
- Fibroids, polyps, adenomyosis, dysfunctional uterine bleeding - thyroid, coagulation abnormal. - IUD - Cancer |
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What are the treatments available in menorrhagia where sinister abnormality is suspected?
|
IUD
Transexamic acid NSAIDs OCP Depot provera |
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What are some common causes of intermenstral bleeding?
|
Polyps
Cancer Fibroids Clotting disorders HPA dysfunction HRT |
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What conditions should be ruled out before a diagnosis of PCOS is made?
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- Congenital adrenal hyperplasia
- Cushing syndrome - Androgen producing tumors - Hyperprolactemia - Acromegaly |
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What is the diagnostic criteria for PCOS?
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2 of the following 3:
1. S&S of androgen excess (hirsuitism, acne, alopecia) 2. Oligo/amenorrhea 3. Polycystic ovaries |
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What are some contradindications to medical termination of pregnancy?
|
1. >9 weeks gestation
2. Known or suspected ectopic 3. Allergy to mifepristone/misoprostol 4. Adrenal failure 5. Hemorrhagic disorder or anticoagulant therapy 6. IUD in place |
|
After medical TOP, how should a pt be counciled regarding side effects and symptoms?
|
N/V
Diarrhea Fever/chills Cramping pain Bleeding for 9-12 days If soaking more than 2 pads/hr for more than 2 hours this is a warning sign |
|
What are some common causes of respiratory distress in newborns?
|
1. RDS
2. TTN 3. Sepsis 4. Mec aspiration 5. Asphyxia (acidosis) |
|
What combination of tumor markers produces higher sensitivity/specificity for ovarian cancer?
|
CA -125
HE4 |
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Name some infections which impact mainly on the fetus
|
TORCH
B19 GBS LIsteria Yersinia |
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Name some infections which impact mainly on the Mother
|
Mastitis
Endometritis Wound infection Perineum Pneumonia |
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Name some infections which impact both on the fetus and mother
|
VZV
HBV HCV HIV Chorioamnionitis UTI |
|
What are some causes of neonatal hypoglycemia?
|
Maternal GDM
Sepsis Hypothyroidism In-borne errors of metabolism IUGR Chorioamnionitis Prematurity |
|
What are some common causes of female infertility?
|
Ovulation abnormalities
Endometriosis Pelvic adhesions Cervical pathology Uterine pathology |
|
What are some complications associated with placenta previa?
|
1. Hemorrhage
2. Preterm delivery 3. Congenital malformations 4. Malpresentation 5. Placental abruption 6. Endometritis |
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What is the most common cause of IUGR?
|
Chronic hypertension
|
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What is the diagnostic criteria for pre-eclampsia?
|
Pregnancy induced HTN that develops after 20weeks AND
>300mg of proteinuria in 24 hrs |
|
What are some of the findings in pre-eclampsia?
|
Edema
Proteinuria Rapid weight gain Headache Epigastric abdominal pain Visual disturbances Hyperreflexia Increased Cr Pulmonary edema Elevated LFTs |
|
What are the types of cephalic presentations and what are their diameters?
|
1. Vertex (9.5cm)
2. Deflexed vertex (11.5cm) 3. Brow (13.5cm) 4. Face (9.5cm) |
|
What are some medications which can be used in HTN disease of pregnancy?
|
Hydralazine
Methyldopa Labetalol Nifedipine |
|
What is HELLP syndrome
|
H- hemolysis
EL - elevated liver enzymes LP - low platelets |
|
What is the reccomended daily intake of folate in a women (with no risk factors) trying to fall pregnant?
|
0.5mg folate daily (at least 3 month prior and 3 months post falling pregnant)
|
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What is the reccomended daily intake of folate in a women with a high risk of neural tube defects, trying to fall pregnant?
|
5mg daily (at least 3 months prior and 3 months post falling pregnant)
|
|
What are some S&S of neonatal withdrawal?
|
High pitched cry
Restlessness Hypertonia Jitterness Tremors Myoclonic jerks Frequent yawning Increased resp rate (>60/min) |
|
What is the name of the scale for assessing neonatal withdrawal?
|
Finnegan scale
|
|
What is the difference in Complete breech and Frank breech?
|
Complete - Hips and knees flexed
Frank - Hips flexed, knees EXTENDED |
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What dates correspond to the 1st trimester?
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0-12weeks
|
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What dates correspond to the 2nd trimester?
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13 - 28 weeks
|
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What dates correspond to the 3rd trimester?
|
29weeks-birth (~40)
|
|
What is the average weight range of a neonate born at 40weeks?
|
2.5 kg to 4.0 kg
|
|
What are 3 signs of PROM?
|
1. Pooling of vaginal fluid in the posterior fornix
2. +ve Nitrazine test paper pH>6.0-6.5 (normal vag pH is 4.5-6) 3. Ferning on a slide prepared from a thin layer of fluid obtained from vaginal wall. |
|
What is the cause of symmetric IUGR?
|
Usually secondary to an early gestational insult
|
|
What is the normal range of the menstral cycle?
|
21 to 35 days
|
|
What is the prevalence of the post-partum blues?
|
70%
|
|
What is the prevalence of the post-partum depression?
|
10-15%
|
|
What is the prevalence of the peurperal psychosis?
|
0.1%
|
|
What is the maternal death rate in Australia?
|
10:10,000
|
|
What physiological changes occur during pregnancy?
1. Cardiac output 2. Blood pressure (initially) 3. Stroke volume |
1. CO - Increases 40%
2. BP - Decrease slightly 3. SV - Increases (10-30%) |
|
In neonatal resus. what should the rate of chest compression be per minute?
|
Ratio of 3 compressions to 1 breath
90 compressions/ minute 30 breaths/minute |
|
What are the stages in the progression of lochia?
|
1. Lochia rubra
2. Lochia serosa 3. Lochia alba |
|
What physiological changes occur during pregnancy?
Respiratory 1. RV 2. ERV 3. FRC 4. TV |
1. RV - decreases
2. ERV - decreases 3. FRC - decreases 4. TV - Increases |
|
What physiological changes occur during pregnancy?
Renal 1. Renal plasma flow 2. BUN 3. Cr 4. GFR |
1. RPF - increase
2. BUN - decrease 3. Cr - decrease 4. GFR - increases by 40% |
|
In a sperm count what is considered normal:
1. Number/ml 2. Motility % 3. Volume 4. Morphology % 5. pH 6. WBC |
1. Number/ml
>20million/ml 2. Motility % >50% adequate motion 3. Volume 2-5ml 4. Morphology % 30% normal forms 5. pH 7.2 - 7.8 6. WBC <10^6 WBC/ml |
|
Why is pregnancy a hypercoagulable state?
|
1. Protein S decreases
2. Plasminogen activator inhibitor (PAI) increases 3. Fibrinogen increases |
