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CP2 OBGYN > ANC p2 > Flashcards

ANC p2 Flashcards

1
Q

What % pop are Rhesus -ve

A

15%

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2
Q

What is the sensitising event in Rhesus

A

When foetal cells enter the maternal circulation during 1st pregnancy

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3
Q

Causes of sensitising events (6)

A 
Ectopic 
TOP 
Foetal-maternal haemorrhage 
Maternal trauma 
Miscarriage 
Amniocentesis
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4
Q

How does antiD immunoglobulin work?

A

Binds to RhD+ cells in maternal circulation so no response is stimulated

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5
Q

Indications Anti-D Ig (8)

A 
Invasive obstetric testing 
APH 
Ectopic 
Fall/abdo trauma 
IU death 
Misscarriage 
Termination 
Delivery
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6
Q

How do you work out how much Anti-D Ig a patient needs?

A

Kleihauer test

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7
Q

When should AntiD Ig be given to Rhesus -ve mothers? (weeks)

A

28

36

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8
Q

How much AntiD Ig should be given to Rh -ve mothers after delivery

A

500IU AntiD

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9
Q

How can Dr’s now ID if a baby is Rh +ve or -ve

A

NIPT
at booking
Looking at cells in maternal blood from foetus

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10
Q

Def gestational diabetes

A

Any degree of glucose intolerance w/ onset/recognition during pregnancy

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11
Q

What % rise in insulin req occurs on average in pregnancy?

A

30%

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12
Q

RF poor pancreatic reserve (6)

A 
BMI >30 
Asian Ethnicity
Prev gestational DM 
1st degree relative DM 
PCOS 
Prev macrosomic baby
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13
Q

CF gestational DM (5P

A

Classic DM Sx
Plus infection risk incr- UTI
Worsening pre-existing Heart disease
Diabetic retinopathy worsens

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14
Q

Why does the foetus suffer from hyperinsulinaemia if mum has GDM?

A

Because glucose is transported through placenta
but insulin isnt
–> fetal hyperglycaemia
hence foetus prod lots of insulin –> hyperinsulinaemia

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15
Q

Effects on foetus of hyperinsulinaemia (5)

A 
Macrosomia 
Organomegaly 
Erythropoeisis 
Polyhydramnios 
Incr rates pre-term delivery
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16
Q

What happens after delivery to foetus if has hyperinsulinaemia

A

High I but now no glucose from mum
–> hypoglycaemia
High I –> Decr fetal surfactant prod –> TTN

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17
Q

Indications GGT to be done

A 
Prev pregnancy w/ GDM
1st degree relative w/ DM
FHx 
Prev macrosomic baby 
Prev unexplained stillbirth 
Prev baby w/ neonatal hypogylcaemia 
BMI >30 
PCOS
Glycosuria on 2 occ within 7 days 
Polyhydramnios 
Foetal growth >4.5kg
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18
Q

Ix GDM

A

OGTT = mainstay

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19
Q

When is OGTT offered?

A

Booking in prev GFM
24-8w if RF present
Any point if 2+ glycoosuria

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20
Q

Diagnosis of GDM is made if:

A

Fasting glucose >5.6

2h >7.8

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21
Q

Mx GDM

A 
Lifestyle advice 
BG measure q.d.s
Fortnightly visits <34w
Weekly visits >34w 
Med - insulin
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22
Q

What extra USS do GDM pt needs?

A

For foetal growth/liquour volume @32/6w

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23
Q

When should you aim to deliver GDM

A

37-9 w/ if on Tx
Or
elective CSC when >4kg

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24
Q

How to maintain glucose levels during labour

A

Insulin/dextrose infusion

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25
Q

Post natal care GDM

A

Check fetal levels glucose within 4hrs
Stop anti-DM Dx after delivery
6-13w - fasting gluc test

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26
Q

How many scans does a nulliparous low risk female have?

A

10

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27
Q

How many scans does a multiparous low risk female have

A

7

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28
Q

AN schedule - 10 weeks (2)

A

Booking visit

Blood test

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29
Q

AN schedule - 11-13+6 (2)

A

Dating scan/excl multip

Downs screening + NT

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30
Q

AN schedule - 16 w (2)

A

Results of screening tests

Bloods + USS

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31
Q

AN schedule - 18-21w

A

Anomaly scan

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32
Q

AN schedule - 25w (4)

A

For Nulliparous ONLY
Excl pre-eclampsia
Routine care - BP/Urinalysis/SFH
Perform GGT if indicated

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33
Q

AN schedule - 28w (4)

A

Routine SFH/BP/Urinlaysis
FBC,antibodies
GTT
NIPT + anti-D if Rhe -ve

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34
Q

AN schedule - 31w (3)

A

Nulliparous only
Routine - BP/SFH/Urinalysis
Review bloods/anaemia

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35
Q

AN schedule - 34w (3)

A

Routine SFH/BP/urinalysis
Repeat bloods - Hb/2nd AntiD
Inform about delivers

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36
Q

AN schedule - 36,38,40,41

A 
Routine - SFH/BP/Urinalysis
Check presentation (if not cephalic --> ECV) `
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37
Q

AN schedule - 42w (2)

A

Sweep membranes

Offer IOL

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38
Q

Minor conditions in pregnancy - itching Mx (3)

A

Monitor:
Jaundice
LFTs
Bile acids

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39
Q

Minor conditions in pregnancy - pelvic girdle pain Mx (4)

A

Physio
Analgesia
Crutches
Corsets

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40
Q

What % of pregnancy women experience heart burn?

A

70%

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41
Q

Mx heart burn in pregnancy (3)

A

More pillows
Antacids
Ranitidine

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42
Q

What serious condition can heartburn indicate in pregnancy?

A

Pre-eclampsia

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43
Q

What can ankle oedema signify in pregnancy?

A

Pre-eclampsia

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44
Q

What mustn’t you give to Mx ankle oedema in pregnancy?

A

Diuretics

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45
Q

Which 3 chromosomal abnormalities can an increased NT indicate?

A

Trisomy 21,13,18

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46
Q

What NT is significant?

A

> 3.5

47
Q

Which blood markers are used as a combined screening tool for trisomies?

A

E3
hCG
PAPPA
aFP

48
Q

When can amniocentesis be performed?

A

> 16w

49
Q

What can amniocentesis be used for diagnosing? (3)

A

Chromosomal abnormalties
Infections
Inherited disorders

50
Q

What week is the cut off for CVS?

A

14w

51
Q

When is CVS safest?

A

11w

52
Q

What is CVS diagnostic for? (3)

A

Chromosomal abnrom
AD disorder
AR disorders

53
Q

Risks of miscarriage for amniocentesis

A

2-3%

54
Q

Risk of miscarriage for CVS?

A

4%

55
Q

What is now used instead of CVS/amnio

A

NIPT (99.5% specificity)

56
Q

Which conditions are picked up at the 20w scan? (10)

A 
Clefts 
Anencephaly
Open spina bifida 
Gastroschisis 
Exomphalos 
Bilateral renal agenesis 
Lethal skeletal dysplasia 
Edwards/Pataus
X-linked conditions
57
Q

Downs - screening (3)

A

PAPPA - decreased
bHCG - increased
NT - increases

58
Q

47XXY

A

Kleinfelters

59
Q

Features of Kleinfelters (3)

A

Normal intellect
Small testes
Infertile

60
Q

Screening anencephaly/SB (2)

A

Increased AFP

USS at 20w

61
Q

Tx of fetal cardiac abnormalities (2)

A

Digoxin for arrhythmias

Valvuloplasty for critical aortic stenosis or hypoplastic L heart

62
Q

What is Exophalmos

A

Extrusion of bowel contents in the perineal sac

63
Q

What is gastrochisis

A

Free bowel loop in amniotic cavity

64
Q

Who is more at risk of abdominal wall defects?

A

Young mothers

65
Q

Def fetal hydrops

A

Accumulation of fluid in 2+ fetal compartments

66
Q

causes of fetal hydrops (6)

A 
Barts hydrops 
Chromosomal defects
Structural defects 
Cardiac defects 
Twin-twin transfusion syndrome 
Rhesus
67
Q

Ix fetal hydrops (4)

A

USS
ECG
Maternal blood
Amniocentesis

68
Q

Average increase in W in pregnancy

A

10-15kg

69
Q

CHanges to the genital tract during pregnancy (3)

A

Increase uterus W by up to1kg
Mm hypertrophy
Cervix softens

70
Q

What % increase in blood volume do you get during pregnancy

A

50%

71
Q

What components of FBC increase during pregnancy

A

RBC

WCC

72
Q

What component of FBC decreases during prepgnancy

A

Hb

73
Q

Cardiac output change pregnancy

A

40%

74
Q

Change to tidal volume during pregnancy

A

40% increase

75
Q

Change to U+E in pregnancy

A

40% increase GFR

Decr Cr + urea

76
Q

Prevalence twins

A

1/80

77
Q

prevalence triplets

A

1/1000

78
Q

What % of twins are dizygotic

A

2/3

79
Q

What are dizygotic twins

A

Different sperm fertilise different oocytes

Non identical

80
Q

What % of monozygotic twins are DCDA (dichorionic, dizygotic)

A

30%

81
Q

DCDA division day

A

Before day 3

82
Q

What ‘sign’ can be seen in DCDA

A

Lambda sign

83
Q

WHat 5 of monozygotic twins are MCDA (monochorionic, diamniotic)

A

70%

84
Q

MCDA division say

A

Day 4-8

85
Q

What ‘sign’ can be seen in MCDA

A

T sign

86
Q

MCMA - division day

A

9-13

87
Q

What is the risk w/ MCMA

A

Cord entanglement

Hence sudden death

88
Q

What are MC twins

A

Incomplete division –> conjoined twins

89
Q

Causes of twins (2)

A

Assisted conception

? Maternal age/parity

90
Q

Diagnosis of twins is made by: (5)

A 
Vomiting in early pregnancy
Incr uterus size for dates 
Palpation before 12 w 
3+ foetal poles felt 
USS
91
Q

Complications of twins - maternal (5)

A 
Exaggeration all obstetric risks 
Gestatioinal DM + PE > 
Incr risk pre-eclampsia 
Anaemia 
Haemorrhage
92
Q

Complications of twins - foetal (5)

A 
mortality/
LT handicap 
Miscarriage 
Pre-term labour 
IUGR
Abnormalities
93
Q

What incr mortality is there for twins

A

6x

94
Q

What is the main cause of mortality - twins

A

Pre-term labour

95
Q

Specific complications for monochorionic twins (6)

A 
TTTS
TAPS (Swin anaemia polycythaemia sequence) 
Twin reversal arterial perfusion
IUGR
Co-twin death
Cord entanglement
96
Q

What is TTTS

A

Twin-twin transfusion syndrome

Unequal blood distribution

97
Q

TTTS - donor twin

A

VOlume depleted
Anaemia
IUGR
Oligohydramnios

98
Q

TTTS - recipient twin

A

Volume overload
Polycythaemia
Heart failure

99
Q

Tx of TTTS

A

Laser ablation

100
Q

What is TAPS

A

Twin anaemia polycythaemia sequence

= differences in Hb

101
Q

What is twin reversal aa perfusion

A

One twin is pump and supplies blood to other due to cardiac defect

102
Q

What is co-twin death

A

Death of 1 twin –> hypovolaemia in the other –> death/neurodisability

103
Q

Why is there an increased chance of death for the 2nd twin after the 1st is delivered? (5)

A 
Hypoxia
Cord prolapse 
Placental abruption 
Tetanic uterine contraction 
Breech
104
Q

Antepartum Mx of twins (6)

A 
Consultant lead 
Fe, folic acid, aspirin (prevent pre-eclampsia) 
USS every 4w from w24 if DC
ID risk of pre-term delivery 
ID IGUR
Early delivery
105
Q

When is delivery advised for DC twins?

A

37w

106
Q

When is delivery advised for MC twins

A

36w

107
Q

How often is USS for DC twins

A

Ev 4 w from w24

108
Q

How often is USS or MC twins

A

ev 2 w from week 12

109
Q

Between what weeks is TTTS usually diagnosed

A

16-24w

110
Q

What cardiac abnormalitiy can be ID’d in TTTS

A

Triscuspid regurg

111
Q

Foetal termination due to abnormality - DC

A

Kcl intracardiac before 14w

Or TOP from 32w to allow other twin to survive

112
Q

Foetal termination due to abnormality - MC

A

Bi-polar diathermy

113
Q

What helps prevent PPH in twin pregnancies

A

Prophylactic oxytocin infusion post-delivery

CP2 OBGYN (21 decks)

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