HD EOYS2 Flashcards
Strategies that may help with during episodes of non-reassuring fetal statusinclude [5]
- Changing the mother’s position
- Increasing maternal hydration
- Maintaining oxygenation for the mother
- Amnioinfusion, where fluid is inserted into the amniotic cavity to relieve pressure on the umbilical cord
- Tocolysis, a temporary stoppage of contractions that can delay preterm labour
- Intravenous hypertonic dextrose – gives mother more energy
Explain manoeuvre used to fix shoulder dystopia? [1]
Whats are two other options? [2]
- McRoberts manoeuvrers tries to dislodge shoulder from being stuck on the pubis by pelvic symphysis orientated more horizontally to facilitate shoulder delivery
- Changing the mother’s position
- An episiotomy: surgical widening of the vagina, may be needed to make room for the shoulders
How do you manage failure to progress:
- Initially? [1]
- If continued? [4]
- If still continued? [2]
How do you manage failure to progress:
- Initially: relax and wait
- If continued: givelabour-inducing medications: Oxytocin; misoprostal; mifepristone; oestrogen pessary
- If still not delivered: membrane sweep or c section
Underlying causes and conditionsthat cause fetal distress include? [5]
Insufficient oxygen levels
Maternal anemia
Pregnancy-inducedhypertensionin the mother
Intrauterine growth retardation (IUGR)
Meconium-stained (baby poo) amniotic fluid: baby drinks own amniotic fluid
Explain the significance and causes of variable decelerations and late deceleration in Cardiotocography [2]
Late deceleration:
* placenta is compressed and o2 to baby is compromised: causes vagal stimulation or myocardial depression
* Late and bradycardia: emergency C-section
variable decelerations:
- Abrupt decrease with rapid recovery from cord compression
- Looking at length of recovery of HR (as long as recovery is rapid, its fine)
- When contraction lessens is when HR should return to normal
Name the drugs used for Tocolysis (a temporary stoppage of contractions that can delay preterm labour) [5]
- nifedipine (calcium antagonist)
- atosiban: oxytocin receptor antagonists
- indomethacine NSAID: inhibitors of prostaglandin synthesis
- nitroglycerine: NO donors, Betamimetics (sympathetic beta agonsists)
- magnesium sulphate
Score system used to investigate perinatal asphyxia? [1]
Describe the clinical significance of APGAR scores
APGAR score
A low Apgar score of 0 to 1 at 1 minute is not predictive of adverse clinical outcomes or long-term health issues since most infants, even those with very low 1-minute scores will have normal scores by 5 minutes.
Low Apgar scores at 5 minutes correlate with mortality and may confer an increased risk of cerebral palsy in population studies but not necessarily with an individual neurologic disability
Scores less than five at 5 and 10 minutes correlate with an increased relative risk of cerebral palsy.
What are the three types breech pregnancies?
Frank: Has most favourable outcomes for vaginal deliveries
Complete
Footing
What type of delivery occurs if placenta previa occurs? [1]
What can plecenta previa increase risk of? [1]
Treatment of placenta previa? [1]
Placenta previa:
- C section only
- Increases the liklihood of placenta accreta (when placenta becomes inseperable from uterus
- Treat with blood transfuison
What is difference between primary and secondary PPH? [2]
What are primary [4] and secondary [2] PPH associated with?
Primary PPH: bleeding within 24 hours of birth:
- Polyhydamnios
- Macrocosmic fetus
- Uterus overstretched
- Multifetal preg.
Secondary PPH: from 24 hours to 12 weeks after birth:
- Infection
- Retained products of conception
Explain MoA of Tranexamic acid for PPH
Analogue of lysine
Binds to plasminogen and stops conversion of plasmin: causes bigger clots to form
Which drugs are used to treat PPH? [5]
Oxytocin (slow injection followed by continuous infusion)
Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding
What tests would you do to exclude a medical cause for mood distubance? [2]
Thyroid dysfunction
Anaemia
What is brexanolone aka? [1]
What is MoA? [1]
allopregnanlone (a progesterone metabolite)
- Modulates synaptic GABA-receptors and extrasynaptic GABA-A receptors: (GABA is an inhibitory receptor)
- Allows GABA that binds to receptor to have a bigger effect on the GABA receptor Makes patients feel open and feeling of relaxtion
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of growth retardation in chiild?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of omphalocele and heart septal defects for fetus / neonate??
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
Which of the following has a possible risk of tachycardia and urinary retention in neonate and fetus?
fluoxetine
sertraline
citalopram
nortriptyline
duloxetine
How do you treat postnatal psychosis? [3]
Mood stabilizer: (lithium, valproic acid and carbamazepine)
In combination with antipsychotic medications and benzodiazepines
electroconvulsive therapy is well tolerated and rapidly effective
Which drugs prescribed should women avoid breastfeeding [2] (and why) [1]
valproic acid and carbamazepine should avoid breastfeeding
Linked to hepatotoxicity in the infant
What food substance / nutrient can you give to prevent PPD in pregnancy? [1]
Omega-3 (fish oil etc)
Label A-E
A: Testis
B: Epididymis
C: Left and right crus penis
D: bulb of penis
E: Bulbo-urethral or Cowper’s gland
Label A-E
A: Rectovesical pouch
B: Rectum
C: Deep inguinal ring
D: Inferior epigastric arteries
E: Femoral Nerve