Clinical- Week 4 Flashcards
1
Q
what on MUAD, indicates pre-eclampsia risk?
A
notching
2
Q
what is variability of fetal heart rate a sign of?
A
an intact sympathetic nervous system
3
Q
what facial deformity can benzodiazepines in pregnancy cause?
A
cleft lip
4
Q
what scan can you do to predict pre-eclampsia risk?
A
maternal uterine artery doppler at 20-24 weeks
5
Q
what is first line therapy for adults with urgency urinary incontinence or mixed urinary incntinene?
A
bladder training
6
Q
what score is the best and simplest method available to determine if it is safe to induce labour?
A
bishop score
uses the 5 cervical parameters
7
Q
what is a rectocele?
A
rectum (posterior compartment) has prolapsed out of vagina
8
Q
what is lochia?
A
vaginal discharge in the puerperium phase
9
Q
when does puerperal psychosis present?
A
within 2 weeks of delivery
10
Q
describe the different degrees of uterine descent in uterovaginal prolapse?
A
1st degree- uterus in vagina
2nd degree- at interiotus
3rd degree- outside vagina
procidentia- entirely outside vagina
11
Q
what types of collagen are present in cervical tissue?
A
1,2,3,4
12
Q
what 7 features does the partogram record?
A
- fetal heart
- amniotic fluid colour
- cervical dilatation
- descent
- contractions
- obtruction (moulding)
- maternal obs
13
Q
how long does the third stage of labour have to go on for in order to think about removal under GA?
A
1 hour
14
Q
what drug, used to accelerate the delivery of the placenta should you avoid in hypertension?
A
ergometrine
15
Q
what is tokophobia?
A
pathological fear of labour
16
Q
what does oestrogen do to the contractibility of the uterus?
A
increases it
17
Q
what is the normal fetal position?
A
longituinal lie with cephalic presentation with flexed head
occipito-anterior
18
Q
what is the active management of the third stage of labour?
A
oxytotic drugs
-syntometerine (ergometrine + oxytocin) or oxytocin
and
-cord clamping and cutting with controlled cord traction
19
Q
what are the 2 types of placenta previa?
A
major
minor
20
Q
what does stretch of the myometrium do to the myometrial fibres?
A
increases their excitability
21
Q
how do b3 adrenoreceptor agonists (eg mirabegron) work in the treatment of overactive bladder?
A
relaxes bladder smooth muscle
22
Q
what is antepartum haemorrhage?
A
bleeding in late pregnancy (24 weeks onwards)
23
Q
why is there commonly malpresentations with placental previa?
A
reduced space for babies head in lower segment of uterus
24
Q
what gases make up entonox?
A
50% oxygen
50% nitrous oxide
25
what is the normal baseline variability?
greater than 5 beats/min
26
what can meconium in amniotic fluid indicate?
fetal distress
| breech presentation
27
what is the post-micturation volume of urine in bladder?
shouldnt be above 100ml
| normal is age dependent: 10-80ml
28
what happens to the number of oxytocin receptors in myometrial and decidual tissues near the end of pregnancy?
numbers increase
29
if the fetus is in transverse lie, what is the presentation of the fetus?
shoulder
30
what may the uterus feel like in placental abruption?
wooden hard consistency
31
when can topical oestrogens be used for urinary incontinence?
only if there is atrophic vaginitis
32
what are the 5 main complications of epidural anaesthesia?
```
atonic bladder
hypotension
dural puncture
headache
back pain
```
33
in nulliparous women, how long does the second stage of labour have to continue for to be considered prolonged?
greater than 2 hours (no regional anaesthetic)
| greater then 3 hours (with regional anaesthetic)
34
how long should pelvic floor muscle exercises for stress or mixed urinary incontinence be performed for?
3 months mininum
35
for ladies who want to be pregnant with bipolar affective disorder who need to remain on an anticonvulsant, what folic acid dose should be given to them pre-conception?
5mg folic acid
36
how many weeks post-labour does it take for the fundal height to go from umbilicus to within the pelvis?
2 weeks
37
which is the longest stage of labour?
1st stage
38
after lifestyle changes, what is the next line therapy for over active bladder?
-antimuscarinic agents
39
when does placentation occur?
1st 20 weeks of pregnancy
40
what type of urinary incontinence are pelvic floor muscle exercise effective in?
stress
| mixed
41
what antimuscarinic is the first line drug used in urgency urinary incontinence?
oxybutynin (immediate release)
42
when do you usually diagnose placenta previa?
at 20 week anomaly scan (then 32/34 scan)
43
in vertex position, what is the presenting part of the babies head?
occiput
44
how long does the third stage of labour usually take?
around 10 minutes
45
up till what week are steroids administered for preterm babies?
36 weeks
46
how long does the puerperium phase take?
6 weeks
47
what is placental abruption?
separation of a normally implanted and sited placenta
48
why does cocaine use increase chance of pre-eclampsia and cause chronic small abruptions?
cocaine is a vasoconstrictor
49
the cervix is assessed by what 5 parameters?
```
effacement
dilatation
firmness (consistency)
position
level of presenting part
```
50
why does recurrent bleeding occur in placenta previa?
placenta doensn't grow as much as it should to fit with the growing uterus- some of it separates
51
what are the 2 reasons labour is painful?
transient myometrial hypoxia
| stretching of pelvis nerves
52
what causes cervical softening?
increased hyaluronic acid
53
what is the treatment for a dural puncture when administering an epidural?
hydrate mother and get a blood patch
54
describe the third stage of labour?
from delivery of baby to expulsion of placenta and membranes
55
how long after delivery can pregnancy-indued hypetension last?
6 weeks
56
what does green liquor indicate?
meconium
57
is placenta previa painful?
no
58
what are the 3 types of lochia?
```
lochia rubra (fresh red)
lochia serosa (brownish-red, watery)
lochia alba (yellow)
```
59
in labour, what equates to the power?
uterine contraction
60
what is the gold standard surgical treatment of stress urinary incontinence?
low tension vaginal tape (not done in scotland)
61
ca women on lithium breast feed?
no
62
what is the main risk factor for placenta accreta?
C section
63
why do mothers having a VBAC (vaginal birth after C section) have a risk of fetal distress and hypoxia?
contractions of uterus with scarring carries a risk of rupture
64
why can epidurals inhibit progress in stage 2 of labour?
relaxation of pelvic floor- baby's head doesnt flex and internally rotate as efficiently
65
can women on anti-convulsants breast feed?
yes
66
the release of what from the fetus into the amnitoic fluid stimulates prostaglandin synthesis in preparation for labour?
pulmonary surfactant
67
what is eclampsia?
tonic-clonic seizure occuring with features of pre-eclampsia
68
how can strength of uterine contractions be measured?
by abdominal palpation
69
what does primigravida mean?
first pregnancy
70
why do mothers with induction/augmentation of labour have a risk of fetal distress and hypoxia?
risk of hyperstimulation
71
what is considered normal blood loss during labour?
<500mls during delivery
| >500mls or blood before delivery is abnormal
72
how long does bladder retraining have to be done for?
6 weeks minimum
73
what is urgency?
the sudden compelling desire to pass urine
| -fear of incontinence during these episodes
74
what 3 key factor determine whether labour progesses?
Power
Passage
Passenger
75
if there has been no bleeding in pregnancy with placenta praevia, when should a C section be carried out?
38/39 weeks
76
what is mixed urinary incontinence?
involuntary leakage associated with urgency and also with increased abdominal pressure
77
what hormone initiats and sustains contractions of the uterus?
oxytocin
78
in labour, what equates to the passenger?
fetus
79
what classes as adequate uterine contraction during labour?
4 contractions in 10 minutes
80
what is the expectant management of the third stage of labour?
just wait for spontanoues delivery of the placenta
81
are anti-psychotics safe in pregnancy and breastfeeding?
yes (except clozapine)
82
how do you obtain fetal blood sampling?
use a fetoscope into vagina up to babies scalp and make a small incision
83
what is a cystocele?
bladder (anterior compartment) has prolapsed out of vagina
84
what hormone can we give to augment uterine contractions?
synthetic oxytocin
85
at how many weeks should you do a planned C section for placenta accreta?
37 weeks
86
at what getation does BP start to increase again?
22-24 weeks
87
how do you measure descend of the head with abdominal palpation?
abdominal fifths
88
what do you give to prevent respiratory depression in opiod overdose?
naloxone
89
what is the most common cause of iatrogenic prematurity?
pre-eclampsia
90
in what phase of labour does effacement of the cervix happen?
latent phase of labour
91
what is the prophylaxis/treatment of eclamptic seizures?
IV magnesium sulphate
| if persistent- consider diazepam
92
when are physiological early decelerations of baesline heart rate usually seen?
in 2nd stage of labour
93
what should you look out for when patients on SSRIs and TCAs are breastfeeding?
may cause sedation in babies
94
what are the 5 main pain relief options in labour?
- massage relaxation and aromatherapy etc
- TENS machine
- entonox
- opiods (diamorphine, pethidine, remifentanyl)
- epidural anaesthesia
95
what advice should you give to women in the active 1st stage of labour?
encourage walking as gravity and movement helps
96
what is puerperium?
the period of repair and recovery after childbirth
97
compare the definition of bleeding in early and late pregnancy?
early <24 weeks
| late 24 weeks or later
98
what is the inital management of postpartum haemorrhage?
```
uterine massage
IV syntocin (utero-tonic agent)
```
99
from what gestation can pregnancy-induced hypertension occur?
after 20 weeks
100
if the placenta previa is more than 2cm from the os what is the recommended delivery method?
consider vaginal delivery
101
what surgical treatment for uterine prolapse can be done in patients who are not sexually active with 100% success rate?
colpocleisis (close vagina completely)
102
from what dilation of the cervix is the active 1st phase of labour?
from 4cm
[latent phase up till 3cm]
103
what are the 3 main functions of antimuscarinics used for an overactive bladder?
- reduce pressure within bladder
- raise volume threshold for micturation
- reduce uninhibited contractions
104
what drug should you give for patients with a major risk factor (or 2 minor risk factors) for pre-eclampsia?
75mg aspirin daily from week 12
105
what are the biggest risk factors for uterine rupture?
prev C section
uterine surgery
obstructed labour
106
how do you interpret a CTG?
```
DR C BRAVADO
Determine
Risk
Contractions
Baseline
RAte
Variability
Accelerations
Decelerations
OVerall impression
```
107
what are the 4 pieces lifestyle advice used for an overactive bladder?
bladder retraining
sensible fluid intake
reduce caffeine
weight reduction if BMI over 30
108
what postion should the cervix be in to show advancement of labour?
anterior
109
at what gestational age can there meconium be produced?
from 32 weeks
110
what do braxton hicks contactions tend to resolve with?
ambulation or change in activity
111
why may you see a reduced AFI (amnitiofic fluid index) in pre-eclampsia?
underperfusion of babies kidneys due to relocation of blood to head
112
what is the normal fetal heart rate?
110-165 beats per minute
113
what are the 5 main symptoms of pre-eclampsia?
- headache
- visual disturbane
- epigastric/RUQ pain
- nausea/vomiting
- oedema
114
why is it important to hydrate patients during labour?
improves efficiency and co-ordination of contractions
115
how do you classify a placenta previa as major or minor?
anything covering cervix is major
116
from what week of pregnancy can braxton hicks contractions occur? when are they usually actually felt?
6 weeks into pregnancy
| 2/3rd trimesters
117
when are b3 adrenoreceptor agonists (eg mirabegron) used in the the treatment of an overactive bladder?
if antimuscarinics are clinically ineffective, have unacceptable side effects or are contraindicated
118
what is the most suitable female pelvic shape for child birth?
gynaecoid pelvis
119
what is the aim of bladder retraining?
increase bladder capacity and decrease frequency
120
if we can feel the anterior fontanelle, what is the likely position of the baby?
occipito-posterior
121
why are rates of placenta accreta increasing?
because of increasing C section rate
122
what is nocturai?
waking at night to void
123
how many days post-natally do baby blues occur?
day 3-day 10
124
what is the pathogenesis of an overactive bladder?
detrusor instability
125
why is there initially reduced BP in pregnancy?
pregnancy causes vasodilation
126
if on cystometry, the pressure of the bladder goes up between voiding phases, what is the diagnosis?
overactive bladder
127
for women who want to be pregnant with bipolar affective disorder who are on lithium, what drug should you change them to?
SSRIs (not TCAs as it can switch them to mania)
128
what is cystometry?
measures pressure/volume relationship of bladder during filling, provocation and voiding
129
what is placenta percreta?
when the placenta invades the serosa
130
why can epidurals increase chance of needing an operative birth?
can inhibit progress in stage 2 of labour
131
in labour, what equates to the passage?
maternal pelvis
132
what chart is used as a representation of the progress of labour?
partogram
133
what is cervical effacement?
shortening of the cervix
134
what is moulding?
overlapping of skull bones of baby's head
135
when should you suspect failure to progress in stage 1 of labour?
nulliparous: <2cm dilation in 4 hours
parous: <2cm dilation in 4 hours or slowing in progress
136
what is the recommended fluid intake per day?
24ml/kg/day
137
what is expelled from the uterus during labour?
fetus
membranes
umbilical cord
placenta
138
what is fergusons reflex?
a neuroendocrine reflex
| -positive feedback causing sustained cycle of uterine contractions in response to pressure on cervix or vaginal walls
139
what is uroflowmetry?
measures the volume of urine expelled from the bladder each second
140
what is major post-partum haemorrhage?
greater than 1500ml blood loss
141
what 3 signs indicate separation of the placenta?
- uterus contracts, hardens and rises
- umbilical cord lengthens
- gush of blood
142
which drug is most commonly used for treatment of hypertension in pregnancy?
labetalol
143
what are kegels exercise?
exercises to strengthen your pelvic floor muscles
| -reduced stress urinary incontinence
144
what are the 2 stages in the pathogenesis of pre-eclampsia?
1. abnormal placental perfusion
| 2. maternal syndrome
145
what hormones promote prostaglandin release from decidual tissues?
oestrogen
| oxcytocin
146
how is haemostasis achieved after separation of the placenta?
- tonic contraction of uterus strangulates the blood vessels
| - thrombosis of torn vessel ends (hypercoaguable state of pregnancy)
147
what initiates lactation?
placental expulsion (decrease in oestrogen and progesterone)
148
what diagnoses hypertension?
>_ 140/90 mmHg on 2 occasions
149
what is secondary post-partum haemorrhage?
greater than 500ml of blood loss within weeks of labour
150
what is the pathogenesis of stage 1 of pre-eclampsia?
spiral arteries fail to lose muscle layer during trophoblastic invasion- increased pressure causing endothelial damage and toxin release
151
how many mls are passed in an average void?
300ml
152
what is the prerequisite for a forceps delivery? (in terms of how many 5th of baby is palpable on abdomen)
1/5th of 0/5ths
153
is placental abruption painful?
yes, sudden onset pain
154
what are the 4 main side effects of antimuscarinics?
dry mouth
constipation
blurred vision
somnolence
155
if there has been bleeding in pregnancy with placenta praevia, when should a C section be carried out?
37/38 weeks
156
why is there damage to fetal life in vasa praevia?
the blood loss is fetal not maternal
157
what hormone inhibits contraction of the uterus?
progesterone
158
where is the pacemaker for uterine contractions?
in the tubal ostia
159
what are the 2 signs of obstruction during vaginal delivery?
- caput (soft tissue bulge at head)
| - moulding (overriding of the bones)
160
what is the treatment of puerperal psychosis?
admission to specialised mother-baby unit, antidepressants, antipsychotics, mood stabilisers, ECT
161
why are hysterectomies no longer done for uterine prolapses?
increases risk of prolapse of vaginal vault
162
what is a complete eversion prolapse?
all compartments have prolapsed out of vagina
163
post-labour, how long does it take for the endometrium (all areas except placental site) to regenerate?
1 week
164
what is the position of the fetus?
the babies position relative to the maternal pelvis
165
what are the 4 types of urinary incontinence?
stress
urge
mixed
overflow
166
compare uses of maternal uterine artery doppler to umbilical artery doppler?
MUAD- to predict risk of pre-eclampsia
| umbilical artery doppler- to look at blood flow once patient already has pre-eclampsia
167
if CTG is abnormal what should be your next step?
fetal blood sampling to check pH
168
how do you assess cervical effacement and dilatation?
vaginal exam
169
describe the second stage of labour?
from full dilatation to delivery of baby
170
what does pink/red liquor indicate?
bleeding
171
what is placenta accreta?
when the placenta invades the myometrium
172
if over 34 weeks with absent end diastolic flow on umbilical artery doppler, what is the treatment?
deliver
173
what is overactive bladder syndrome?
urgency with or without urge urinary incontinence
| Wet or dry
174
when might you become concerned about meconium in the liquor?
if it's a pre-term baby
| lots of meconium
175
what is the only treatment for pre-eclampsia?
delivery
176
why can a women have urinary incontinence with an epidural?
it weakens pelvic floor
177
compare the contractions in the latent and active stages of the first stage of labour?
latent: mild and irregular
active: progressively more rhythmic and stronger
178
what consistency should the cervix to show advancement of labour?
soft
179
the change in what hormone ratio promotes the initiation of labour?
oestrogen/progesterone ratio
180
what are late decelerations of baseline heart rate a sign of?
hypoxia and fetal distress
181
what is urge urinary incontinence?
involuntary urine leakage accompanied by or immediately preceded by urgency
182
what shoulder is expelled first?
anterior shoulder
183
if the placenta previa is less than 2cm from the os, what is the recommended delivery method?
C section
184
if we can feed the posterior fontanelle, what is the likely position of the baby?
occipito-anterior
185
what is crowning?
when fetal head is at introitus of vagina
186
postnatally, when does diuresis commence?
2/3 days
187
in the active phase of the 1st stage of labour, what happens to the baby?
presenting part slowly descends
188
when are membranes usually ruptured?
1st stage of labour
189
what can happen if there is placental residue left in the uterus?
infection
| haemorrhage
190
what is vasa praevia?
when blood vessels of run across the uterus opening
191
how can duloxetine (a combine serotonin and noradrenaline reuptake inhibitor) treat stress urinary incontinence?
increases intraurethral closure pressure
192
why is active management of the third stage of labour preferred?
lowers risk of post partum haemorrhage
193
what can indicate intra-partum uterine rupture?
loss of contractions
194
what is the main side effect of femsoft urethral devices?
UTIs
195
the increase of production of what fetal hormone stimulates an increase in maternal estriol in preparation for labour?
fetal cortisol
196
why may beta-3-agonists be more appropriate than anticholinergics in patients who suffer from post-voidal residuals?
anticholinergics cause relaxation in the voiding phase too (so residual urine volume will increase)
beta-3-agonists will not effect flow rate in voiding phase
197
what is the main cause of death in pre-eclampsia?
pulmonary oedema
198
what happens in the 1st stage of labour?
cervix dilation from 0-10cm
199
in multiparous women, how long does the second stage of labour have to continue for to be considered prolonged?
greater than 1 hour (no regional anesthetic)
| greater than 2 hours (with regional anaesthetic)
200
what is the gold standard surgical treatment of uterine prolapse?
sacrocolpopexy
201
why can cord prolapse cause fetal distress and hypoxia?
baby's head can compress the cord
202
what is remifentanil?
an IV opiod analgesia
203
when is the usual onset of postnatal depression?
2-6 weeks
204
what is primary post-partum haemorrhage?
greater than 500ml of blood loss within 24 hours of labour
205
what is the most common position of the fetus?
left occipital anterior
206
what is the reference point for measuring level of pelvic organ prolapse?
hymenal ring (- zero point of reference)
207
what is HELLP syndrome?
a variant of pre-eclampsia-
haemolysis
elevated liver enzymes
low platelets
208
what syndrome does administering steroids 24-48 hours before delivering a preterm baby reduce the risk of?
neonatal respiratory distress syndrome
209
which patient group is labetalol contraindicated in? what drug should be used instead?
asthmatics
| nifedipine or hydralazine
210
where in the uterus is the density of smooth muscle highest?
at fundus
211
why do we look for ketones in urine during labour?
to look for and prevent dehydration
212
what should be excluded before doing a speculum or vaginal exam on a pregnant lady?
placenta praevia
213
at what blood pressure in pregnancy should you treat for hypertension?
>_ 150/100mmHg
214
what is an atonic bladder?
bladder doesnt empty
215
compare the shapes of anterior and posterior fontanelles?
anterior- diamond shape (bigger)
| posterior - triangular (smaller)
216
what is 'show'?
when the mucous plus dislodges from teh cervix during labour
