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Obstetrics > Core conditions. > Flashcards

Core conditions. Flashcards

1
Q

Types of breech presentation.

A

Frank (extended).
Complete (flexed).
Footling.

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2
Q

How to manage a breech presentation.

A

USS –at 36 weeks to confirm presentation.
ECV – at 37 weeks, if no CI.
Vaginal or caesarean delivery – in hospital.

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3
Q

CI for ECV.

A

Absolute – placenta praevia, major uterine abnormality, APH in 7/7 days.
Relative – SFGA, foetal abnormalities, significant HTN.

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4
Q

Causes of breech presentation.

A

Oligo/anhydramnios, placenta praevia, multiple pregnancies, prematurity, foetal abnormalities.

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5
Q

Indications for elective C-section.

A

Tokophobia.
“Too posh to push”.
Placenta praevia.
High HIV viral load.

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6
Q

Grades of C-section.

A

1 – emergency: deliver within 30 minutes.
2 – deliver within 50-75 minutes.
3 – deliver at appropriate time for mother and baby.
4 – elective.

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7
Q

Indications for grade 1 C-section.

A

Placental abruption.

Obstetric emergencies – eclamptic fit, cord prolapse, failed instrumental delivery.

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8
Q

Indications for grade 2 C-section

A

Failure to progress.

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9
Q

Presentation of gestational diabetes

A

Asymptomatic.

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10
Q

Test for GD, and values.

A

Oral Glucose Tolerance Test (OGTT).

Fasting glucose >5.6 or post-fasting glucose >7.8 (5, 6, 7, 8) = GD.

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11
Q

CI for GD and alternative.

A

Any bariatric surgery (causes ‘sugar dumpling syndrome’).

2 weeks HBGM from 16 weeks, medium risk pregnancy.

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12
Q

Method of OGTT.

A

Fasting overnight –> check blood glucose –> give 75 g glucose –> 2 hours later –> check blood glucose.

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13
Q

Prenatal management of GD.

A

Education and HBGM.
Targets: <5mmol/L premeal; <6.5 mmol/L postmeal.
Metformin/insulin if uncontrolled.
Monthly growth scans (28, 32 and 36) then fortnightly.

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14
Q

Labour management of GD.

A 
Plan for induction at 37 weeks.
Vaginal/C-section.
Early morning induction.
VRII if BG >8 mmol/L.
Hourly capillary glucose until in recovery.
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15
Q

Postnatal management of GD.

A

Early feed and encourage breast feeding (risk of hypo).
Wait until mother has meal then stop VRII and all other medications.
Keep mother and baby in hosp. for 24 h, measuring baby BG and temp. control.
6 week postnatal appointment, check maternal BG.

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16
Q

Preconception advice for existing diabetes.

A

Risks, hypo awareness, complications and Mx.
Aim for HbA1c <48 mmol/L; strongly advise against conception if >86 mmol/L.
Target glucose: 5-7 morning, 4-7 premeals.

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17
Q

Risks of uncontrolled diabetes in pregnancy.

A

Foetal – congenital malformations, still birth, heart defects, macrosomia.
Maternal –preeclampsia, miscarriage, retinopathy/nephropathy, birth trauma.

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18
Q

Antenatal schedule for PED.

A

8 week viability scan.
16 week neural tube defects.
16 and 28 weeks – maternal retinopathy and nephropathy.
20 week anomaly scan + four chamber heart.
26, 30, 34 week growth scans.
Weekly CTG; monthly HbA1c.
37-38 week induction.

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19
Q

Delivery management PED.

A

Taking insulin – NBM, switch to VRII.

Not taking – 2 hourly BG, switch to VRII if >12 mmol/L.

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20
Q

Neonatal care post delivery in diabetic patients.

A

Early feed (<1 h), encourage breast feeding.
BG pre-2º fed.
Monitor temperature control.

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21
Q

Indication for induction of labour.

A

Maternal – diabetes, prolonged pregnancy preeclampsia, IVF/ maternal age >40.
Foetal – SGA, IUGR, reduced foetal movements.
Uteroplacental insufficiency.

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22
Q

Mx of induction of labour.

A

Membrane sweep.
Prostaglandin pessaries – 6 h apart.
ARoM in between.

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23
Q

Complications of induction of labour.

A

Failure to progress.

Increased incidence of instrumental delivery and C-section.

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24
Q

Score for assessing cervix and relevance to ARoM.

A

BISHOP score.

Higher = greater chance of success.

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25
Q

Hormones in pregnancy.

A

Prostin – dilates the cervix.

Oxytocin – released in response to cervix movement, supports labour.

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26
Q

Risks of epilepsy in pregnancy.

A

Seizure injury, neural tube defects, miscarriage, IUGR, placental abruption.

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27
Q

What causes increased risk of seizure in pregnancy.

A

Vomiting.
Increased drug clearance.
Pain and lack of sleep.
Decreased compliance with medications.

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28
Q

How do you manage the increased risk of seizure from labour?

A

Early epidural to reduce pain and loss of sleep.

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29
Q

Important education post-delivery in epileptic patients.

A

Change baby on the floor, don’t bathe them alone.

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30
Q

Safe medications in pregnancy (chronic and acute).

A

Lamotrigine.

Phenobarbital (for seizures).

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31
Q

Management of obesity in pregnancy.

A

Preconception 5 mg folic acid + vitD –> 12 weeks.
OGTT 24-26 weeks.
Growth scans from 26 weeks.
No weight gain, dietary advice.
Consultant led if BMI >35; anaesthetist led >40.

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32
Q

Complications of obesity in pregnancy.

A

Shoulder dystopia, GD, preeclampsia, birth trauma, emergency C-section, preterm labour, miscarriage.

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33
Q

What is obstetric cholestasis?

A

Diagnosis of exclusions.
Itching of palms and soles a/w raised LFTs (AST, ALT) and increased serum bile acids.
No rash.

34
Q

Risks of OC.

A

Still birth, IUD, foetal distress, maternal morbidity.

35
Q

Differentials of OC.

A

Acute fatty acid of pregnancy.
HELLP syndrome.
Infection.
Jaundice of preeclampsia.

36
Q

Mx of OC.

A

UDCA.
Weekly LFTs, bile salts and foetal monitoring from Dx.
Chlorphenamine and vitamin K from 36 weeks.
Induction at 37 weeks.
Check LFTs 10d post delivery.

37
Q

Risks of OC post pregnancy.

A

90% chance of recurrence.

Cannot go on COCP as will recur.

38
Q

Vasa praevia.

A

Foetal blood vessels running through the placenta membrane.
Risks damage when membranes rupture.
Urgent C-section when identified.

39
Q

Placenta praevia.

A

Abnormal lie of placenta in the lower third of the uterus.

40
Q

Placenta membranacea.

A

Thin placenta surrounding baby. Risk of APH and may fail to separate in third trimester.

41
Q

Placenta accreta.

A

Abnormal attachment of the placenta to the uterus.
Predisposes to PPH.
Increased risk of C-section +/- hysterectomy.
Increased incidence with previous C-section.

42
Q

Grades of placenta praevia.

A

Marginal.
Partial.
Total.

43
Q

Management of PROM.

A

Prophylactic erythromycin.
Oral corticosteroids if 24–34 weeks/previous PROM.
Aim for IoL at 34 weeks.
Admit (usually).

44
Q

Causes of PROM.

A

Smoking.
Multiple pregnancies.
Polyhydramnios.
Amniocentesis.

45
Q

Complications of PROM.

A 
Neontal infection.
Sepsis.
Death.
Long-term disability.
Cord prolapse.
Placental abruption.
46
Q

Investigations following PROM.

A

Speculum + high vaginal swab.
Bloods – CRP, FBC.
Foetal feritonin.
Observations.

47
Q

Define preeclampsia.

A

Hypertension.
Oedema.
Significant proteinuria (>30 on PCR).

48
Q

What is gestational HTN.

A

HTN in the second half of pregnancy, without the proteinuria or other markers of preeclampsia.

49
Q

RF for preeclampsia (high and moderate).

A

High: previous Hx, diabetic, CKD, AI disease, chronic HTN.
Moderate: >40 yo, birth interval >10 years, multiple pregnancy, FH, BMI >35 at booking.

50
Q

What do you give to patients at risk of preeclampisa, and how do you decide.

A

75 mg Aspirin.

1x high RF or 2x medium.

51
Q

Hypertension medications CI in pregnancy (classes).

A

ACEi.

ARB.

52
Q

Mx gestational HTN.

A

Mild – weekly bp + urinalysis + USS.
Moderate – oral labetalol (target <150/100), as above.
Severe – admit, oral/IV labetalol, plan for delivery (not before 37 w).

53
Q

Mx preeclampsia.

A

Mild – admit, biweekly bloods, QDS bp, USS + serial growth scans, delivery 37 w.
Moderate – admit, triweekly bloods, PO labetalol (target 150/100), USS + serial growth scans, delivery 37 w.
Severe – urgent admission, ? delivery, IV labetalol, IV MgSO4, strict fluid Mx.

54
Q

Alternative medication to Labetalol to treat HTN in pregnancy.

A

Hydralazine – if asthmatic.

Methyldopa and nifedipine.

55
Q

Complications of preeclampsia.

A 
Eclampsia.
Renal failure.
IUD or IUGR.
Placental abruption.
HELLP syndrome.
DIC.
56
Q

Postnatal treatment for gestational HTN.

A

Varied with severity.
Stop antihypertensives or min. 72 hour admission.
Discharge when stable and review in high-risk clinic in 2 w.

57
Q

Primary PPH.

A

> 500 ml within 24 h delivery.

58
Q

Major PPH.

A

> 1000 ml within 24 h delivery.

59
Q

Secondary PPH.

A

Abnormal or excessive bleeding from the birth canal between 24 h and 12 w after delivery.

60
Q

Causes of PPH.

A

Tone – abnormalities of uterine contraction.
Tissue – retained placenta, placenta accreta.
Trauma – genital trauma.
Thrombin – DIC, pre-existing bleeding disorders.

61
Q

Mx minor PPH.

A

15 minutely obs.
IV access – FBC, group and save, coag screen.
Uterine massage.
Warm crystalloid fluid.
Ergometrine or combined ergometrine+oxytocin.

62
Q

Mx major PPH/clinical shock.

A

ABC + 15L O2.
Uterine massage + bimanual compression.
Catheterise.
2x 16G cannulas – bloods, cross match 4 units packed rbc.
Fluids – 2L Hartmann’s then 1.5L warmed crystalloid if transfusion not available.
Uterotonic drugs.
Theatre + transfusion.

63
Q

Medication given to cause uterine contractions.

A

Ergometrine.

Bolus or slow IV.

64
Q

When is a woman at greatest risk of psychosis.

A

Weeks following delivery.

65
Q

Mx puerperal psychosis.

A

Urgent assessment, referral and admission to specialist mother-baby unit.
Mood stabilisers and antipsychotics (lamotrigine and quetiapine).
Risk assessment – varying levels of supervision.

66
Q

Prognosis following puerperal psychosis.

A

Complete recovery likely.

1 in 2 chance of recurrence in future pregnancy.

67
Q

Risk of OC recurrence in future pregnancy.

A

90%.

68
Q

Define HELLP syndrome.

A

Haemolysis.
Elevated liver enzymes.
Low platelets.

69
Q

What is HELLP.

A

Rare and serious complication of pregnancy occurring in the final 3 months or post delivery.

70
Q

Mx HELLP.

A

Treat HTN – labetalol.
Treat coagulopathy – FFP +/- platelets.
Prompt delivery.

71
Q

Biochemistry in acute fatty liver of pregnancy.

A

Mild HTN.
Hypoglycaemia.
Low platelets.
Raised: bilirubin, wcc, AST/ALT, creatinine, uric acid, INR.

72
Q

Mx acute fatty liver of pregnancy.

A

Treat hypoglycaemia and coagulopathy.
Prompt delivery.
Supportive liver treatment +/- transplant.

73
Q

Causes of jaundice in pregnancy.

A 
HELLP.
Preeclampsia.
Acute fatty liver of pregnancy.
Cholelithiasis
Hepatitis.
74
Q

What is hyperemesis gravidarum?

A

Persistent and severe n+v.

75
Q

Signs of hyperemesis gravidarum (clinical and biochemical).

A

N+v, malaise.

Dehydration, raised bilirubin, ketonuria, AKI, weight loss >5% pre-pregnancy weight.

76
Q

Mx hyperemesis gravidarum.

A 
IV fluids – 1L stat.
Antiemetics –cyclizine.
Admit if persisting.
Vitamins, steroids, nutritional and psychological support.
USS.
77
Q

Different types of twins.

A

Dichorionic diamniotic.
Monochorionic diamniotic.
Monochorionic monoamniotic.

78
Q

Complications of multiple pregnancies.

A

Maternal – GDM, preeclampsia, hyperemesis gravidarum.

Feotal – miscarriage, vanishing twin syndrome, TTTS, IUD, cerebral palsy.

79
Q

What is TTTS?

A

Vascular anastomoses between monochorionic twins causing unequal blood distribution from shared placenta.

Donor – gives blood, risk of IUGR + oligohydramnios.
Recipient – gains blood, risk of polyhydramnios+polycythema+cardiac failure.

Death of one twin can cause transfusion of blood from the other leading to neurological injury/death.

80
Q

Mx of TTTS.

A

Serial amniocentesis.
Selective foeticide.
Laser ablation.

81
Q

Antenatal monitoring of multiple pregnancy.

A

Obstetrician led.
Early assessment of chorionocity and placenta.
Detailed anomaly scan.
Dichorionic: serial growth scans from 28 weeks.
Monochorionic: fortnightly scans from 12 weeks (for TTTS).

Obstetrics (3 decks)

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