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ORAL EXAM > General Pregnancy > Flashcards

General Pregnancy Flashcards

1
Q

Risk factors with AMA

A 
chromosomal abnormalities
miscarriage
PTL
PET
IUGR
GTN HTN
GDM
Praevia 
PPH
SB
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2
Q

Risk factors with multiple pregnancy

A 
miscarriage
chromosomal abnormalities
PTL
IUGR
HTN/PET/HELLP
SB
Anaemia
PPH
TTS/TAPS/TRAP
PND
Feeding difficulties
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3
Q

lambda sign

A

DIDI

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4
Q

T sign

A

MCDA

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5
Q

Additional management with twins

A

Early USS
additional anaemia screening at 24 weeks
8 antenatal appointments

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6
Q

MDT input for twin pregnancy

A 
Obsetrics
Tertiary scanning/experience sonographers
Perinatal mental health professional
PT
Lactation consultant
Dietician
MFM if any complications
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7
Q

MCDA twin monitoring

A

2 weekly scans from 16 weeks
Increase to weekly if differences in AFI (DVP >4cm or more)
MCA PSV to monitor for TAPS - weekly for those at risk (TTTS treated w laser, sFGR)

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8
Q

Complications of MCDA pregnancies

A

TTTS
TAPS
sFGR
TRAP (pump twin)

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9
Q

Twin intrapartum considerations

A 
Centre of care/NICU capabilities
Timing of birth
Mode of birth
analgesia during labour
continuous fetal monitoring
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10
Q

Timing of birth twin pregnancies

A

DCDA - 37
MCDA 36
MCMA 32-34
Triplets 35

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11
Q

Ok to try for vag birth for twins

A

> 32 weeks gestation and uncomplicated
cephalic lead twin
no significant size discordance between twins
no obstetric contraindications to labour

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12
Q

Women with cervical risk factors but no previous hx loss managment

A

HVS & MSU - treat any infection
cervical length at 16/40 - if >3cm no further scans
25mm-30mm - commence two weekly scans
<25mm prog +/- cerclage if ongoing shortening

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13
Q

women with previous 2nd trimester loss or delivery before 34 weeks

A

HVS & MSU - treat any infection
consider progesterone
cervical length at 14/40 - two weekly scanning
<25mm prog +/- cerclage if ongoing shortening

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14
Q

3 or more preterm births <34 weeks

A

HVS & MSU - treat any infection
history indicated cerclage at 12-14 weeks
two weekly scans until 24 weeks

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15
Q

cervical os fully effaced & more than 1cm dilated

A

consider emergency cervical cerclage
consider steroids depending on gestational age
if contracting - manage as TPTL

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16
Q

Instrumental delivery ABCs

A 
Anaesthesia/Assistance (prep for SD)
Bladder empty
Cervix fully-dilated
Determine position
Explain to patient/exit plan if fails
Fontanelle - to recheck position
Gentle traction
Hand elevated for forceps
Halt if vacuum and no descent or 3x pop offs
Incision/Episiotomy
Jaws visible remove forceps
17
Q

Causes of maternal collapse

A 
Eclampsia
Abruption
Uterine rupture
AFE
Anaesthesia related complications
PE 
sepsis
Epilepsy
MI
Hypoglycaemia
18
Q

Maternal collapse resus

A

call for help
lie supine with left lateral tilt
open airway and look/listen/feel for breathing-if none
CPR
Attach defibrillator
Secure airway and oxygenate.
Secure 2x large bore IV access.
Send blood for FBC, U&Es, LFTs, calcium, magnesium, coag screen and crossmatch.
Diagnose and correct reversible causes (4Hs and 4Ts)
Give adrenaline every 3 mins.
Consider amiodarone, atropine, magnesium.
Peri-mortem c/s if 4mins and no return of circulation

19
Q

4 H’s

A

hypoxia
hypovolameia
hypo/hyperkaleamia
hypothermia

20
Q

4 T’s (and obs ones)

A 
Tone
Trauma
Thrombosis
Toxins
Tension Pneumothorax
Tamponade
AND Eclampsia (use mneumonic THE)
21
Q

Management if cardiac output restored

A

Transfer to OT for suturing of caesarean section incision
Anticipate PPH/DIC
Investigate causes of collapse (bloods, ABG, ECG, CXR etc).
Consider transfer to ITU.

22
Q

Swansea diagnostic criteria for AFLP

A 
Symptoms: vomiting, abdo pain, hepatic encephalopathy, polydypsia, polyuria
Biochem: 
Increased bili
hypoglycaemia
Increased uric acid
leukocytosis
increased transaminases
increased ammonia
increased cr
coagulopathy
23
Q

AFLP management

A

Deliver by C/S - likely GA if coagulopathy
MDT (including members of the obstetrics, infectious disease, gastroenterology, anesthesiology, intensive care, neonatology, and blood transfusion departments/units)
Consider steroids depending on gestation
ICU cares post op

24
Q

Recurrent UTIs in pregnancy management

A

Ensure cultures
Monthly MSUs
Hygiene (wipe front to back, empty bladder after sex)
increase fluid intake
Prophylaxis for rest of pregnancy and 6/52 PP

25
Q

Debrief unexpected NICU admission

A 
Review notes
Review notes with other smo/CD
arrange MDT meeting with patient and paeds
Involvement of quality services
empathize with patient
explain indication for ventouse
explain ph findings
Ensure calm non-judgemental communication
quality services will review case
26
Q

Stillbirth investigations

A 
CBC, U/Es, LFTs
Kleihauer
TORCH screen + parvo
bile salts
TFTs
HbA1c
Coags 
APLS (lupus anticoagulant, anti-cardiolipin antibodies, beta 2glycoprotein 1)
vaginal swabs
swab placenta (maternal/fetal side)
Post mortem - full, partial
27
Q

ECV absolute contraindications

A 
recent APH
uterine abnormality
abnormal CTG
ruptured membranes
multiple pregnancy
28
Q

ECV relative contraindications

A 
IUGR
previous C/S/scarred uterus
major fetal abnormalities
oligohydramnios
PET
hyperextended neck
nuchal cord
unstable lie
29
Q

Obstetric cholestasis explanation

A

Obstetric cholestasis is a disorder that affects your liver during pregnancy. This causes a build-up of bile
acids in your body. The main symptom is itching of the skin but there is no skin rash. The symptoms get
better when your baby has been born.

30
Q

Eclampsia management

A

Help, DRs ABCDE - maintain open airway, O2
ensure bed rails up and in left lateral position
Commence MgSo4 4g loading dose then 1g per hour - continue until 24 hours PP; monitor reflexes
Consider other anti-hypertensives
auscultate lungs - aspiration risk
Q5min observations
IDC - strict input/output monitoring
fluid restrict to 80mls an hour total
bloods - perform Q6H until patient stable/effective diuresis
involve MDT approach - consider head imaging for ?stroke

ORAL EXAM (20 decks)

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