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CP2 OBGYN > ANC p3 > Flashcards

ANC p3 Flashcards

1
Q

What is breech particularly associated with

A

prematurity

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2
Q

% babies breech at term

A

3%

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3
Q

% babies breech at 32w

A

15%

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4
Q

% babies breech at 28w

A

25%

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5
Q

What are the 3 types of breech position

A

Extended/frank breech
Flexed/complete breech
Footling breech

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6
Q

What is Extended/frank breech

A

Hips = flexed
Knees = extended
feet adjacent to fetal head

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7
Q

What is flexed/complete breech

A

Flexed @ hips + knees

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8
Q

What is footling breech

A

Flexed @ hips + knees /ffet present to maternal pelvis

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9
Q

Uterine causes of breech (4)

A

Mutliparity
Uterine malformation
Fibroids
Placenta praevia

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10
Q

Fetal causes of breech (5)

A 
Prematurity 
Macrosomia 
Polyhydramnios 
Twin pregnancy 
Abnormality
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11
Q

How is the diagnosis of breech made (4)

A

Head felt on examination
Fetal heart auscultated @ higher level
VE to confirm
If any doubt - USS

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12
Q

What % of breech is not diagnosed until labour

A

20%

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13
Q

How can breech PS in labour

A

Meconium stained liquor

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14
Q

3 main DDx breech

A

Oblique lie
Transverse lie
Unstable lie

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15
Q

3 main Mx options breech

A

ECV
CSC
Vaginal breech birth

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16
Q

What is ECV

A

Manipulation of fetus to cephalic presentation through maternal abdomen

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17
Q

ECV success rate primip

A

40%

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18
Q

ECV success rate multip

A

60%

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19
Q

Complications ECV (5)

A 
Transient fetal heart abnormalities 
Placental abruption 
PROM 
Cord prolapse 
Intracranial haemorrhage
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20
Q

C/I ECV (4)

A

Recent APH
Ruptured membranes
Uterine abnormalities
Previous CSC

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21
Q

When is Vaginal breech birth C/I

A

When baby is in footlong breech

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22
Q

Specific manouvres for vaginal breech birth (3)

A

Flexing fetal knees (for delivery legs)
Lovsett’s manouvre
Mauriceau-Smellie-Veit (deliver head by flexion)

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23
Q

Lovsett’s manouvre breech

A

Rotate body + deliver shoulders

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24
Q

Def preterm labour

A

Between 24-37w

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25
Q

What % of deliveries are pre-term

A

5-8%

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26
Q

Neonatal complications of pre-term (5)

A 
Mortality 
Cerebral palsy
Chronic lung disease 
Blindness 
Minor disabilities
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27
Q

Maternal complications of pre-term labour (3)

A

Infection
CSC used >
Illness/ death

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28
Q

RF pre-term (10)

A 
Prev Hx
Low SE class 
extremes maternal age
Short interpregnancy interval 
Renal failure/DM/thyroid disease 
Pregnancy complications 
STIs 
CV
prev cervical surgery 
Uterine abnormalities
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29
Q

Infections that can –> pre-term labour (4)

A

Chorioamninitis
Offensive liquor
Neonatal sepsis
Endometritis

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30
Q

Preventing pre-term labour

A 
Cervical cerclage 
Progesterone supplementation 
Infection 
Tx polyhydramnios 
Tx medical disease
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31
Q

Methods of cervical cerclage for preventing preterm labour (3)

A

1 - 12-14w (elective)
2 - cervix scanned reg + sutured if signif shortening
3 - Rescue suture

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32
Q

How to Tx polyhydramnios to prevent preterm labour (2)

A

Need aspiration = amnioreduction

NSAIDS - reduce fetal urine output

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33
Q

Hx suggesting pre-term labour (4)

A

Painful contractions
Cerivcal incompetence
APH
Fl - PPROM

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34
Q

Ix - preterm labour (6)

A 
Check lie + PS fetus 
VE to confirm dilated cervix
TVS cervical length
CTG/USS
Vaginal swabs 
CRP (check for chorioamnionitis)
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35
Q

Mx pre-term labour

A 
Steroids betw 23-34w
Delay delivery w/ tocolysis
Detect + prevent infection 
MgSO4 4g IV <12h prior to deliver 
Transfer to level 3 facility 
Deliver vaginally if can
Paediatrics on site 
DO NOT CLAMP CORD FOR 45s
ABx for delivery b/c incr risk GBS
36
Q

Why give steroids in pre-term laboru

A

Reduce perinatal morb/mortality

+ Incr pulmonary maturing

37
Q

E.g.s of tocolysis

A

Nifedipine

Oxytocin antagonists

38
Q

Why give MgSO4 in pre-term labour

A

Neuroprotective

39
Q

Def PPROM

A

Rupture of membranes <37w

40
Q

What % of pre-term deliveries have PPROM

41
Q

Complications of PPROM (4)

A

Pre-term delivery
Infection - chorioamnionitis or funiculitis
Cord prolapse
Pulmonary hypoplasia + postural deformities

42
Q

CF PPROM

A

Gush of clear fl + further leaking

Pool of fl in post fornix on speculum = diagnostic

43
Q

What NOT to do O/E PPROM + why

A

Don’t VE

Don’t want to intro infection

44
Q

Ix PPROM (6)

A 
'Point of care' test 
USS - reduced liquor 
HVS
FBC, CRP
Lactate (Id. sepsis) 
CTG
45
Q

Mx PPROM (4)

A

Admit + give steroids
Close surveillance
If gestation 34-6w –> delivery
Use prophylactic erythromycin

46
Q

Def premature ROM

A

Rupture of membranes >1h prior to onset of labour occuring 37w or > gestation

47
Q

What % pregnancies have premature ROM

48
Q

How is diagnosis of premature ROM made

A

sterile speculum + maternal Hx

49
Q

Mx premature ROM (4)

A

Monitor signs chorioamnionitis
ABx if GBS isolated
W+W 24hrs
IOL + delivery if >24hrs

50
Q

Def prolonged pregnancy

A

> 42w gestation

51
Q

Who is more likely to have a prolonged pregnancy? (2)

A

PMH

Nulliparous

52
Q

Risks of prolonged pregnancy (3)

A

Increased risk stillbirth
Neonatal illness + encephalopathy
Foetal distress

53
Q

Mx prolonged pregnancy - 41-42w (3)

A

IOL
If dont want IOL - daily CTG monitoring
Sweep cervix

54
Q

Mx prolonged pregnancy if CTG = abnorm

55
Q

What is ruptured vasa praevia?

A

Fetal BV run in membranes in front of presenting part
Due to velamentous insertion
Can rupture when membranes rupture –> massive PPH

56
Q

PS ruptured vasa praevia

A

Painless moderate vaginal bleed @ROM

Severe foetal distress

57
Q

Causes of bleeding - 1st trimester (3)

A

Spontaneous abortion
Ectopic pregnancy
Hydatidiform mole

58
Q

Causes of bleeding - 2nd trimester (3)

A

Spontaneous abortion
Hydatidiform mole
Placental abruption

59
Q

Causes of bleeding - 3rd trimester (4)

A

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

60
Q

Def anaemia 1st trim

A

Hb <110g/l

61
Q

Def anaemia 2nd/3rd trim

62
Q

Anti-anaemia changes in pregnancy (3)

A

Incr prod RBC
Incr FE absorption in gut
Decrtransferrin hence Incr TIBC

63
Q

‘Pro-anaemia’ chanes pregnancy (4)

A

Incr plasma vol –> haemodilution
Decr Se Fe
Decr Se ferritin
Incr renal clearance folate

64
Q

RF Anaemia in pregnancy (5)

A 
Haemoglobinopathies 
Incr maternal age
Low SE status 
Poor diet
Anaemia in prev preg
65
Q

CF anaemia in pregnancy (5)

A 
Dizzy
Fatgigue 
Dyspnoea
Asymp 
Pallor
66
Q

DDx - microcytic anaemia (<76 MCV) (3)

A

IDA
Thalassaemia
Sideroblastic anaemia

67
Q

DDx - normocytic anaemia (4)

A

Anaemia chronic disease
Marrow infiltration
Haemolytic anaemia
CKD

68
Q

DDx macrocytic anaemia (5)

A 
B12
Folate defic
Alcohol 
Reticulocytosis 
Hypothyroidism
69
Q

Ix anaemia of pregnancy

A

FBC

+ further Ix if suspecting haemoglobinopathies/Fe/B12 defic

70
Q

Screening for pregnant women for anaemia?

A

ALL women @ booking + 28w
Can also check at 34w
If multip: addiitional betw 20-28w

71
Q

Mx IDA in pregnancy

A

200mg ferrous sulphate tds

72
Q

Mx macrocytic anaemia b/c folate in preg

A

5mg folic acid o.d.

73
Q

Mx B-thalassaemia in preg

A

Folate + blood transfusions as req

74
Q

Mx Sickle cell in pregnancy

A

Folate + Fe

75
Q

Iron rich foods to eat in pregnacy

A

Meat
Kidney/liver
Eggs
Greens

76
Q

Folate rich food to eat in pregnancy

A

Raw greens

Fish

77
Q

What is fetal fibronectin and what does it mean

A

Protein released from gestational sac

High levels = related to early labour

78
Q

Sickle cell appearance of chains

A

2 alpha + 2 s chains

79
Q

Maternal complications sickle cell disease (3)

A

Painful crises
Pre-eclampsia
Thrombosis

80
Q

Foetal complications sickle cell disease (4)

A

Miscarriage
IUGR
Pre-term
death

81
Q

Mx Sickle cell in pregnancy (3)

A

5mg folic acid
Hydration
Rx - specialist haematologist

82
Q

4 alpha thalassaemia mutations - outcome

A

Death in utero (Barts hydrops)

83
Q

3 alpha thalassaemia mutation - outcome

A

Lifelong blood transfusions req

84
Q

PS beta thalassaemia in pregnancy

A

Chronic anaemia that worsens in pregnancy

85
Q

Mx beta thalassaemia in pregnancy

A

Folic acid

USS x 4 weekly

CP2 OBGYN (21 decks)

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