713 Flashcards
HbA1c >= X at booking for diagnosis of T2DM
50
HbA1c X-Y to get referred for 24-28 week OGTT
41-49
OGTT fasting and 2 hour BSL measurement for GDM diagnosis
Fasting >= 5.5
2 hour post >= 9
Polycose BSL measurement for diagnosis of GDM
11.1
Polycose range for OGTT
7.8-11.0
GDM BSL targets
Fasting
1 hour post
2 hour post
5
7.4
6.7
Neonatal hypoglycaemia
<= 2.6
How often should you express milk?
within 6 hours of delivery, then 8 times within 24 hours
what percentage of stillbirths >34/40 are SGA?
40%
BMI > X needs growth scans and not SFH in pregnancy
35
EFW < Xth, and AC <Yth diagnose SGA
10th, 5th
SGA diagnosed on USS - should have what doppler?
Umbilical artery doppler
When do you start to measure SFH?
26-28 weeks
When measuring SFH, what are the indications for a growth scan?
<10th or >30% change
Delivery time for SGA with abnormal dopplers
38 weeks
Delivery time for SGA with normal dopplers
39 weeks
First BSL measurement on SGA baby in first X-Y hours of life
1-2
When can you stop BSL measurements on SGA baby?
Once 3 consecutive normal range
What is the BSL monitoring schedule for SGA baby?
1-2 hours of life
Then prefeed
Placenta praevia delivery
36-37 weeks
Timing of delivery for accreta
35-36+6
Normal amount of fetal movements per 2 hours
10
when do MCDA twins split
Day 4-8
when do MCMA twins split
day 8-12
DCMA twins
Do not split, >12, conjoined
How much does aspirin reduce the risk of PET?
15-20%
If your risk of PET is >X%, then you should take aspirin
10%
Severity of bile salts > X for severe obstetric cholestasis
Bile salts > 40 = severe
bile salts > 100 = very severe
Four T’s of PPH
Tone
Tears
Tissue
Thrombin
Antidote to Mg toxicity
10ml 10% Ca gluconate or 10ml 10% Ca chloride
BP aim in emergency management of HTN in pregnancy
<160/100
MgSO4 dose
4g loading dose, then infusion at 1g/hr
How long do you continue MgSO4 post delivery?
24 hours
IOL time for PPROM
37/40
Management of term PROM
expectant management for 24H versus IOL - if GBS, then recommend IOL
can offer ECV from X/40
36/40
Delivery for DCDA
37-38
growth scan timing for DCDA twins
4 weeks from 24/40 if normal growth
definition of labour
regular, painful uterine contractions with progressive cervical effacement and dilatation
Risk of uterine rupture with VBAC
1 in 200
chance of successful VBAC
70%
First stage of labour
onset of contractions to full dilatation
delay in first stage
<2cm in 4 hours
How long should second stage take in first time mom
3 hours
how long should second stage take in multip
2 hours
is passive decent included in the total time
yes
3x P’s of second stage
passenger
passage
power
neonatal sats screening, need sats >
95 %
target coooling temp for neonate
33.5 degrees
guthrie card is done at X hours of life
48
if guthrie is abnormal, first line is to…
repeat guthrie
in general, milk comes in day X after birth
3
risk of hepatitis transmission if baby isnt given prophylaxis
90%
when can baby be given hepatitis B vaccine
6 weeks
How long do you treat a baby with oral thrush for
7/7
likelihood of CS for the second twin
5%
4x Ts of reversible cardiac arrest
Thrombosis
Tamponade
Tension PTX
Toxin
4x Hs of reversible cardiac arrest
hypo/hyperthermia
Hypo/hyperkalaemia
hypoxia
hypovolaemia
additional causes of cardiac arrest in maternal cardiac arrest
eclampsia
ICH
angle of L lateral tilt
15-30 degrees
numbers of weeks gestation that displacement of the uterus should be used from in maternal arrest
20/40
if no response to maternal collapse within X mins, then should proceed for PCMS
4 mins
ideally within how many mins of collapse should PMCS be undertaken
5 mins
how long should you wait to give clexane after spinal or removal of epidural catheter
4 hours
at what gestation do you measure the cervical length in women who have had a previous PTB
16-24 weeks
what is the cervical length to consider cerclage or PV progesterone
25mm
when should you start PV progesterone
16 to 24 weeks
how long should you cont PV progesterone until
until 34 weeks
do not offer emergency clerclage to:
PV bleeding
infection
contractions
gestations to consider emergency cerclage
16-27+6 with dilated cervix and intact membranes
what percentage of women experience postnatal depression in the first year after childbirth
15%
greatest risk factor for postnatal depression
anxiety or depression in the antenatal perdio
what percentage of women are affected by baby blues
70-80%
what day does baby blues peak and when should it resolve by
peaks day 3-5, resolves day 10-14
Incidence of puerperal psychosis
2 per 1000 births
score >= X on EPDS suggests possible depression
10
antidepressants compatible with breastfeeding
paroxetine
citalopram
fluoxetine
what is the triad of hyperemesis
weight loss
dehydration
electrolyte disturbance
what % of PPH are from tone
70%
what percentage of PPH are from tear
20%
what percantage of PPH are due to tissue
10%
what percentage of PPH are due to thrombin
1%
what percentage of people have a caesrean birth
25-30%
wound infections, UTI and endometritis occur in X% of CS births
8%
risk of uterine rupture with 1x prev CS
8 in 1000
risk of uterine rupture with 2x prev CS
16 in 1000
risk of uterine rupture with 2x prev CS
16 in 1000
rate of major congenital malformation in baseline community
2-3%
rate of major congenital malformation in women taking antiepileptic drugs
4-7%
antiepileptic drug with the greatest risk of congential malformation
sodium valproate
best antiepileptic for women of child bearing age
levetiracetam
lamotrigine
what percentage of women with epilepsy experience an increase in seizure frequency
33%
40F with twins, what is teh risk of T21 at term
1 in 50
what is often the first sign of uterine rupture
abnormal CTG
PDA murmur
pansystolic over precordium and posteriorly over L scapula
what % of cases of shoulder dystocia will have erbs palsy
5%
what % of cardiac output enters the pulmonary circulation in term infants
<10%
neonatal resus chest:breaths
3:1
pre-existing hypothyroidism, increase thyroxine dose X% ?
30%
TSH range trimester 1
0.1-2.5
TSH range trimester 2
0.2-3
TSH range trimester 3
0.3-3
what % of breastfeeding women will get mastitis
18%
what is the most common organism with mastitis
S aureus
how many times should a baby feed in a day
8-12
what percentage of women with breech vaginal birth need CS
40%
at what gestations presenting with APH should women be given steroids
24-34+6
optimal gestation for cyst surgery
14-16 weeks
BSL management for hypo <2.6-1.2
buccal dex gel 40% 0.5mg/kg and breastfeed, recheck 30 mins
BSL management for <1.2
NICU
most common organisms in early onset neonatal sepsis
GBS
E coli
Listeria
first line investigations for baby with >10% weight loss
BSL
Bilirubin
treatment for early onset neonatal sepsis
amox and gent
ductus closure normally occurs day X - Y of life
3-5
pH < X on gas would be an indication for therapeutic cooling
7
what hormone drives lactation during pregnancy
progesterone
suckling reflex causes the release of
oxytocin
what do you treat a baby with oral thrush with, and for how long?
Nylstat 7/7 OD
anticoagulants that are safe in breastfeeding
Heparins
Warfarin
HIE has to be identified < X hours of life to initiate therapeutic cooling
6 hours
Once there is X L lost in PPH, the recommendation is replacement with blood products
1.5L
IV Synto infusion prescription and rate
40IU In 1000mL NaCl at 250ml/hr
most sensitive time for radiation exposure to the fetus
10-17 weeks
what is the difference between TTTS and twin anaemia polycythaemia sequence?
both are from vascular anastamoses in the placenta, but TTTS results in discrepancy in amniotic fluid volume, and TAPS results in differences in fetal Hb with normal amniotic fluid
what percentage of women experience depression in pregnancy
18%
what percentage of women with a psychiatric illness experience deterioriation in pregnnacy
50%
nitrofurantoin should be avoided from
36 weeks onwards
trimethoprim should be avoided
in the first trimester
what percentage of successful ECV will return to breech
1 in 35
what is the risk of major complication in ecv (cord prolapse, fetal distress, placenta abruption)
1 in 200
what is the rate of minor complications for ecv (minor APH, CTG change for <3 mins, ROM)
4%
what percentage of ECV attempts are successful?
50% (40% in nullip, 60% in multip)
if an ECV is successful, what is the likelihood of vaginal birth
70%
for a diagnosis of postpartum depression, symptoms must be present for
2 weeks
what is the most common cause of hemolytic disease of the fetus and newborn?
ABO incompatibility
why do only 1% of neonates develop clinically significant ABO incompatibility hemolysis, despite 15-25% being incompatible with their mother?
due to IgM not crossing the placenta
conjugated hyperbili =
> 20%
maternal mortality is X times greater in twin pregnancy
2.5
fetal mortality is X times greater in twin pregnancty
4.5
growth scan timing in MCDA or MCMA twins
fornightly from 16 weeksq
MCMA twin delivery
32 weeks due to concern re cord entanglement
MCDA twin delivery
36-37
DCDA twin delivery
37-38
recommended mode of delivery for MCMA twins
CS due to risk of cord entanglement
recommended mode of delivery for MCDA twins
deepends on the presentation. if teh leading twin is cephalic, recommend attempting vaginal birth
recommended mode of delivery for DCDA twins
depends on the presentation, if the leading twin is cephalic, recommend trying for vaginal birth
timing for aspirin use in pregnancy
16 weeks until 36 weeks
what % of MC twins will develop TTTS?
10-15%
when does TTTS most commonly occur?
16-26 weeks
EFW discordance in monochorionic pregnancies for risk of sGR
20%
TTTS presenting before X weeks should be treated by fetoscopic laser ablation rather than amnioreduction or septostomy
26
delivery of monochorionic twins treated with laser ablation should be delivered X - Y
34 to 36+6
IOL timing for obstetric cholestasis with bile salts >40
38 weeks
IOL timing with obstetric cholestasis < 40
40 weeks
