Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Obstetrics > General Obs 2 > Flashcards

General Obs 2 Flashcards

1
Q

Is it big or small ?
Is it growing normally or not?

These are two different questions. What measurements do you need?

A

for big / small - only one measurement

for growing normally - series of measurements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define ‘small for dates’

A

Weight is less than 10th centile for its gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define ‘IUGR’

A

failed to reach full growth POTENTIAL

e.g. meant to be 4kg at term but 3kg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which chart uses ‘criterion referencing’ (based on mum’s height, booking weight, BMI, ethnicity & parity)?

A

Customised foetal growth chart

Top line is 90th centile, middle 50th, bottom 10th centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

left axis of customised foetal growth chart?

A

symphyso-fundal height (cm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

right axis of customised foetal growth chart?

A

estimated foetal weight (g)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Bottom axis of customised foetal growth chart?

A

gestation (wks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

at 24 wks, what would symphyso-fundal height be?

A

21-27cm (3 either side)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

at 30 weeks, what would symphyso-fundal height be?

A

27-33cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is ‘estimated foetal weight (g)’ calculated?

A

BIOMETRY from ultrasound

or by formulas (varies hosp to hosp)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

For foetal biometry, what are the main measurements from the ultrasound?

A

HC - head circumference
AC - abdo circumference
FL - femur length

these come together to make estimated foetal weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s the commonest cause of IUGR ?

A

PLACENTAL INSUFFICIENCY

*foetal factors like chromosomal abnormality can also cause IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Placental insufficiency is the most common cause of IUGR. Give me some risk factors for placental insufficiency.

A
  • pre-eclampsia!
  • smoking!!
  • twins
  • maternal malnutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Instead of actual IUGR (pathological) , they might just be constitutionally small for dates. Name 3 risk factors for Small for Dates.

A
  • low parental height
  • female foetus
  • ethnicity (inc Asian)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

A symmetrically small fetus is more likely to be constitutionally small for dates,
… whilst an ASYMMETRICALLY small fetus is more likely to be caused by IUGR (placental insufficiency).

True or false?

A

True :)

in terms of circumferences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which circumference is the first bit to slow down if placental insufficiency?

A

abdominal circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does AFI stand for?

A

amniotic fluid index

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is the amniotic fluid index measured?

A

ultrasound

amount of fluid in each of the four quadrants.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a normal AFI?

A

8-18cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

AFI counts as oligohydramnios?

A

<5th centile for gestational age

usually <5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

AFI counts as polyhydramnios?

A

> 95th centile for gestational age

usually >24cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which investigation is used for the diagnosis of IUGR?

A

ultrasound, plotting biometry on customised foetal growth chart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When IUGR is confirmed from the customised foetal growth chart, what investigations is the woman offered ongoing?

A

ultrasound every fortnight

umbilical artery Doppler every fortnight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Give me 4 SHORT TERM complications associated with IUGR?

A

perinatal asphyxia
hypo/hyperglycaemia
polycythaemia
persistent pulm HTN of newborn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Give me 3 LONG TERM complications associated with IUGR?

A

learning difficulties
behavioural problems
more prone to obesity, HTN, metabolic syndrome (heart disease, stroke, T2DM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Babies with IUGR are more likely to develop chronic diseases earlier. True or false?

A

trrruuuuee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does placental insufficiency often do to amniotic fluid levels?

A

oligohydramnios

(less amniotic fluid made by baby’s kidneys bc of low renal perfusion- it’s diverting blood to brain bc of chronic hypoxia)

28
Q

What makes amniotic fluid?

A

baby’s wee

swallows it and wees it out again

29
Q

Name 3 causes of oligohyrdramnios

A 
PROM (leaks)
placental insufficiency (less renal perfusion)

foetal urinary tract malformations (renal agenesis)

also…
chromosomal abnormalities
post term gestation (we dont know why)

30
Q

Ultrasound shows oligohydramnios. If placental insufficiency is suspected, What extra test would you do?

A

umbilical artery Doppler

31
Q

Why can oligohydramnios lead to muscle contractures at birth?

A

they cant exercise by swimming around in the amniotic fluid

32
Q

The management of oligohydramnios depends on the underlying cause. What are the two commonest causes of oligohydramnios?

A

PROM

placental insufficiency

33
Q

The earlier the oligohydramnios occurs, the _______ the prognosis.

A

The earlier the oligohydramnios occurs, the worse the prognosis.

34
Q

In placental insufficiency, what would be the likely result of umbilical artery Doppler?

A

absent end diastolic flow.

a.k.a foetal vascular stress

35
Q

What is a NORMAL finding on Umbilical artery Doppler?

A

POSITIVE end-diastolic flow

36
Q

Midwife suspects large for dates. How would she have come to this?

A

serial symphyso-fundal heights crossed the 90th centile

37
Q

What investigations in large for dates?

A

oral GTT
ultrasound

(+BP obvs)

38
Q

Ultrasound shows that head circumference and femur length are on the 50th centile, whereas abdominal circumference is on the 95th centile. This is …..

A

asymmetrical macrosomia

39
Q

What is the difference between large for dates and macrosomia?

A

large for dates = birth weight greater than 90th percentile for gestational age
macrosomia = birth weight >4kg

40
Q

When can large for dates and macrosomia be diagnosed?

A

After birth

cant estimate weight properly in utero

41
Q

In macrosomia, baby is more at risk of birth complications such as …

A

shoulder dystocia

birth injuries e.g. fractures, palsies

42
Q

What is the absolute main cause of macrosomia

A

gestational DIABETES

can also be heavy parents but bit extreme like

43
Q

Over half of polyhdramnios is idiopathic. Yeah?

A

yeah

44
Q

Over half of polyhdramnios is idiopathic. But name 6 other causes of polydramnios. You can.

A

genetic/chromosomal abnormalities - trisomy 13,18,21
oes / duodenal atresia (stop foetus swallowing)
macrosomia! maternal diabetes
multiple preg! twin to twin transfusion syndrome
foetal anaemia
hydrops

45
Q

No medical intervention is required in the majority of women with polyhydramnios. True or false?

A

true

46
Q

If polydramnios picked up late, what symptom can the mum have?

A

breathlessness

47
Q

On routine antenatal examination it is difficult to palpate foetal parts, and chart shows large for dates. Differential diagnosis? (x3)

A

polyhdramnios (yep)
macrosomia
multiple preg!

48
Q

What is hydrops fetalis?

A

Abnormal accumulation of fluid in two or more foetal compartments.
Including:
ascites, pericardial effusion, pleural effusion, subcutaneous OEDEMA

49
Q

What is the key cause of hydrops fetalis?

A

ANAEMIA

e. g. Rhesus disease
e. g. Parvovirus B19, other infections
e. g. alpha thalassemia

50
Q

Treatment for severe hydrops?

A

foetal blood transfusion

51
Q

Treatment of polyhydramnios depends on underlying cause, mostly no intervention. What 2 interventions can be considered in severe polydramnios where maternal symptoms are severe?

A

INDOMETACIN - stop baby weeing
AMNIOREDUCTION - drain amniotic fluid - risky

when delivered, baby has to be check for oes. atresia by paediatrician passing NG tube

52
Q

Polyhydramnios increases the risk of what three complications??

A

preterm labour
malpresentation
PPH

53
Q

Which can the extra-fluid-compartments be in hydrops? (x4)

A

ascites,
pericardial effusion,
pleural effusion,
subcutaneous OEDEMA

54
Q

When do you use indomethacin

A

polyhydramnios - stop baby weeing

close PDA

55
Q

the two types of PROM?

A

PROM

preterm PROM

56
Q

define PROM

A

rupture of membranes at least 1 hr prior to the onset of labour

57
Q

4 risk factors for PROM

A 
genital infection
polyhydramnios
cervical insufficiency
smoking in preg
amniocentesis
58
Q

what test is done in all cases of PROM?

A

HIGH VAGINAL SWAB

59
Q

what test can be used to check its actually the waters and not just vaginal discharge

A

Actim-PROM

60
Q

two bits of the foetal membranes are

A

chorion , amnion

61
Q

suggest two infections that commonly cause PROM

A

GBS

BV

62
Q

2 complications of PROM?

A

oligohydramnios

chorioamnionitis

63
Q

management of PROM <34wks?

A

expectant..

prophylactic erythromycin + corticosteroids

64
Q

management of PROM >36wks?

A

induce + deliver if lasts >24hrs

IV penicillin during labour if GBS

65
Q

management of PROM between 34 - 36wks?

A

induce!!

IV penicillin during labour if GBS

Obstetrics (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions