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Obstetrics > General Obs 3 > Flashcards

General Obs 3 Flashcards

1
Q

What counts as prolonged pregaz? (post dates)

A

> 42 wks

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2
Q

What kinds of woman get prolonged pregnancies?

A

nulliparous, old, fat, with FHx

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3
Q

Why does the rate of stillbirth rise exponentially after 37wks?

A

increased placental insufficiency

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4
Q

What could be an explanation for post dates?

A

inaccurate dating!

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5
Q

Why might a post-dates newborn have dry flaky skin?

A

lost their vernix caseosa

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6
Q

What is vernix caseosa?

A

white flaky cheese

not there in preterms or postdates

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7
Q

When should mum have a dating scan?

A

12 wks

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8
Q

Mum still hasn’t given birth beyond 42 wks. What investigations will you check? dont worry if not right :)

A

ultrasound (check growth)
liquor vol
Dopplers

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9
Q

What are the most common features of a prolonged pregnancy?

A

static growth / macrosomia
oligohydramnios
reduced foetal movements

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10
Q

When does NICE recommend delivery by to reduce risk of stillbirth.?

A

42 wks

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11
Q

When would you do a membrane sweep to avoid prolonged preg?

A

40-41-ish wks

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12
Q

What is a membrane sweep for?

A

try to kickstart labour to prevent prolonged preg (>42wks)

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13
Q

When would you offer other methods of induction of labour (not including membrane sweep) to prevent prolonged preg?

A

41-42-ish wks

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14
Q

You’ve got a lady who is at risk of prolonged preg, but she declines membrane sweep and induction. What do you do?

A

surveillance

(CTG, US)… if foetal distress - C section

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15
Q

Mum wants induction. Not necessarily safer for baby to be delivered rather than staying in utero. What does NICE say?

A

In the UK, NICE guidelines (2008) state that induction of labour should NOT be offered on maternal request alone.

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16
Q

Women with uncomplicated pregnancies are offered some kind of induction from when?

A

40wks

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17
Q

What is management of prolonged preg?

A

induction

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18
Q

You offer induction for uncomplicated pregs from 40wks. What other main scenario would you offer induction?

A

IUGR
(deliver before foetal compromise)

(and PROM)

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19
Q

What are the three main methods of induction?

A

membrane sweep (adjunct rlly)
ARM
vaginal prostaglandins

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20
Q

What are the mainstay of induction?

A

vaginal prostaglandins

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21
Q

What two things do vaginal prostaglandins do to induce labour?

A

ripen cervix

contract uterus Smooth muscle

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22
Q

Vaginal prostaglandins come as a tablet, gel, or pessary. Yes?

A

yes

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23
Q

What’s another word for ARM (artificial rupture of membranes)?

A

amniotomy

done with an AMNIOHOOOOOOK

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24
Q

How do you do artificial rupture of membranes?

A

amniohook poke

+ syntocinon to help the contractions along

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25
Q

What does NICE recommend as the primary method of induction of labour?

A

VAGINAL PROSTAGLANDINS

only use ARM + syntocinon when these are contraindicated.

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26
Q

What does the Bishop score assess?

A

cervical ripeness

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27
Q

Vaginal prostaglandin pessary is given in 1 cycle….

A

1 dose over 24hrs

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28
Q

Vaginal prostaglandin tablet /gel is given in 1 cycle

A

1st dose, then 2nd dose if labour hasn’t started 6hrs later

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29
Q

Score of 7 or above on Bishop’s suggests…….

A

cervix is ripe

… induction is poss

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30
Q

Score of 4 or below on Bishop’s suggests…..

A

not ripe, will need vaginal prostaglandins and maybe caesarean

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31
Q

What is a risk of labour induction when the womb goes crazy contracting?

A

uterine hyperstimulation syndrome

32
Q 
Cervical position
Cervical consistency
Cervical effacement
Cervical dilation
Foetal station

…are all involved in what?

A

Bishop’s score

PCEDS

33
Q

‘Third day blues’ or baby blues are common. How many mothers do they affect and how long last?

A

50%
7 days

(emotional lability)

34
Q

3 risk factors for postnatal depression

A

social isolation
pregnancy complications
Hx depression

35
Q

10% of women get postnatal depression but likely under-reported. Why?

A

stigma
denial by partner
fear of children being removed

36
Q

3 red flags for postnatal depression.

A
  1. significant change in mental state
  2. new thoughts / acts of self-harm
  3. estrangement from infant / expressions of incompetency as mother
37
Q

What must you rule out as a cause of postnatal depression?

A

postpartum thyroiditis

38
Q

What scale used to assess postnatal depression?

A

Edinburgh Postnatal Depression Scale

39
Q

New mother has had three months of tiredness, feeling of guilt and worthlessness which are affecting her bonding with her baby. What three forms of treatment might she benefit from.

A

social support
psychotherapy
ant-depressants if severe

40
Q

If a woman is breastfeeding and needs anti-depressants, have to weigh up risks and benefits. Which two anti-depressants are likely to be most suitable?

A

paroxetine and sertraline (SSRIs)

41
Q

Treatment for postnatal depression?

A

social support
psychotherapy
anti-depressants if severe

42
Q

Sudden onset of psychotic symptoms around FOURTH day. (0.2% of women). What’s this?

A

puerperal psychosis

fourth day

43
Q

Two risk factors for puerperal psychosis

A

prima gravida
Family Hx
previous puerperal psychosis (high recurrence)

44
Q

Prima gravida who gave birth a week ago presents to GP with psychotic symptoms. Needs?

A

urgent assessment by specialist mental health services

45
Q

You have to weight up risks and benefits of staying on psychiatric treatment in pregnancy. What is the risk of lithium in pregnancy?

A

congenital heart defects

Ebstein’s anomaly

46
Q

new >140/90 at 20wks without proteinuria??

A

gestational hypertension

47
Q

new >140/90 at 20wks WITH protineuria?

A

pre-eclampsia

48
Q

hypertension before 20wks, then at 20wks new proteinuria. What’s this?

A

pre-eclampsia superimposed on chronic hypertension

49
Q

features of pre-eclampsia + epileptform seizures = ?

A

eclampsia

50
Q

define gestational hypertension.

A

new >140/90 at 20wks without proteinuria.

51
Q

define pre-eclampsia

A

new >140/90 at 20wks with proteinuria.

52
Q

define eclampsia.

A

features of pre-eclampsia + epileptiform seizures

53
Q

define pre-eclampsia superimposed on chronic HTN

A

hypertension before 20wks, then at 20wks new onset proteinuria.

54
Q

what is the pathophys of pre-eclampsia?

A

incomplete trophoblast invasion – endovascular remodelling – spiral artery flow REDUCTION – infl response - endothelial damage

  1. dodgy CLOTTING
  2. increased vascular PERMEABILITY
  3. VASOCONSTRICTION
55
Q

in pre-eclampsia, incomplete trophoblast invasion – endovascular remodelling – spiral artery flow REDUCTION – infl response – ENDOTHELIAL DAMAGE, which leads to 3 things….

A
  1. dodgy CLOTTING
  2. increased vascular PERMEABILITY
  3. VASOCONSTRICTION
56
Q
  1. dodgy CLOTTING
  2. increased vascular PERMEABILITY
  3. VASOCONSTRICTION

are three features of what?

A

pre-eclampsia

57
Q

give me some RFs for pre-eclampsia

A 
nulliparity
Afro-Caribbean
obesity
diabetes
renal disease
58
Q

pre-eclampsia is usually asymptomatic! but it can present with… (x4)

A

headache
visual disturbance
epigastric pain
oedema

59
Q

why do they get epigastric pain in pre-eclampsia

A

liver damage

60
Q

right. in pre-eclampsia there’s three things about the urine. give me them :)

A

dipstick [>2 protein]
protein 24hr collection [0.3g/24hr]
protein:creatinine ratio [>30mg/mmol]

61
Q

A lady who is 26 wks pregnant presents with headaches, epigastric pain, visual disturbance and oedema. You test her urine dipstick and the protein is >2. What other urine tests would you do and what results would you expect?

A

protein 24hr collection [0.3g/24hr]

protein:creatinine ratio [>30mg/mmol]

62
Q

protein: creatinine ratio in pre-eclampsia is >30. what units??

A

> 30mg/mmol

63
Q

protein 24hr collection in pre-eclampsia is >0.3. what unirs?

A

0.3g/24hr

64
Q

in pre-eclampsia you test the urine dipstick protein, protein 24hr collection, and protein:creatinine ratio. What other investigations would you want to monitor?

A

BP, urine output!
FBC, U+Es, LFTs

foetal surveillance.

65
Q

2 differentials for pre-eclampsia

A

haemolytic uraemic syndrome

acute fatty liver of pregnancy

66
Q

what are the three broad elements of pre-eclampsia management?

A

treat HTN
prevent eclampsia
delivery

67
Q

talk me through the treatment of pre-eclampsia

A

oral nifedipine or IV labetalol
Mg sulfate
induce @37wks

68
Q

give IM dexamethasone to promote surfactant production before when?

A

34wks

69
Q

why would fluid restrict in pre-eclampsia?

A

prevent pulm oedema

70
Q

what is HELLP?

A

haemolysis
elevated liver enzymes
low platelets

71
Q

5 MATERNAL complications of pre-eclampsia?

A 
eclampsia
HELLLP
DIC!
pulm oedema 
liver failure, renal failure
72
Q

why have you to be careful with Mg sulfate in renal impairment?

A

toxicity

73
Q

pulm oedema, liver failure, renal failure and DIC are all complications of …

A

pre-eclampsia

also eclampsia and HELLP

74
Q

3 FOETAL complications of pre-eclampsia?

A

IUGR
preterm birth
placental abruption

75
Q

IUGR, preterm birth and placental abruption are all foetal complications of………

A

pre-eclampsia

Obstetrics (6 decks)

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