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MED 5 > Lecture week 4-RNH > Flashcards

Lecture week 4-RNH Flashcards

1
Q

What is the 1st thing you should do when reading the OSCE stem and KFP

A

KNOW YOUR ROLE

e.g I am an RMO….part of the ….. team, can I have a chat to you until my consultant is coming….

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2
Q

When asking about CST, what other questions should be asked

A

Were there any abnormal reports/reading that came back from those tests?

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3
Q

Naegele rule for EDD

A

Add seven days to the first day of your LMP and then subtract three months.

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4
Q

MDT for GDM women

A

You must state MDT

  • Diabetic educator
  • Dietician
  • Physiotherapist
  • GP

You must take care of mother’s microvascular and macrovascular complications–> ophthalmology review is a must–> retinal haemorrhages

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5
Q

Why is GDM mother more likely to get an infection

A

Immunosuppressed

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6
Q

GDM

  • definition
  • risk factors
  • effects on the mother, fetus and pregnancy
  • screening guidelines–> what are the values
  • monitoring
  • labour
A

Look at the guidelines

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7
Q

Advice for GDM postpartum-3 points

A

6 weeks review of OGTT
Breastfeeding should be encouraged as it will help with managing the blood sugars
Interpregnancy interval

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8
Q

Pathophysiology of HTN in pregnancy

A

The placenta fails to invade properly to the level of the spiral arterioles leading to a high resistance placenta

This causes the release of vasculoendothelial substances from the placenta that causes multi-organ problems for the mother

The hormonal consequences result in generalised vasoconstriction. At the same time, endothelial cell damage causes interstitial leakage through which blood constituents, including platelets and fibrinogen, are deposited subendothelially

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9
Q

What are the 3 features of Mg toxicity

what should be done then?

A

Monitor urine output, tendon reflex and respiratory rate for R depression

o Urine output < 80 mL in 4 hours
o Deep tendon reflexes are absent or
o Respiratory rate < 12 breaths/minute

Serum magnesium level can be checked
Stop the infusion and start them on calcium gluconate

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10
Q

MgSO4 doses

-apparently we need to know doses?

A

Loading dose Magnesium Sulfate
• 4 g IV over 20 minutes via controlled
infusion device

Maintenance dose Magnesium Sulfate
• 1 g per hour IV via controlled infusion
device for 24 hours after birth

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11
Q

MgSO4 is also used in the fetus for what and before when

A

Neuroprotection before 30 weeks, prematurity

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12
Q 
One sentence for each: stages of labour
1st stage
2nd stage
3rd stage
4th stage
A

1- 0-4cm and then 4cm to fully dilated
2- 10 cm to delivery
3- Delivery of the placenta, 30-60, 60 min max
4-2-4 hours after delivery, need to monitor(even in a healthy mother with no complications during pregnancy)

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13
Q

Mechanisms of labour

A 
Floating 
Descent and flexion 
internal rotation
complete internal rotation
The complete extension(head is popping out)
restitution(external rotation)
Delivery of anterior shoulder
Delivery of posterior shoulder
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14
Q

Maternal collapse-4H and 4Ts

A 
4H
Hypovolemia
Hypoxia
Hypo/hyperkalaemia 
Hypothermia

MDT
Major transfusion protocol if needed

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15
Q

Maternal collapse-4Ts

A

Thromboembolism
Toxicity
Tension pneumothorax
Tamponade

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16
Q

What are some risk factors for cord prolapse

A

1) Multiparity/Multiple pregnancies
2) Prematurity/PPROM
3) Malpresntations
4) Polyhydramnios

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17
Q

What are the 2 types of cord prolapse

A

Concealed and revealed

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18
Q

Management of cord prolapse

A

DO NOT ATTEMPT TO REPLACE THE CORD
Displace the presenting part with the hand
If IDC in, full quickly with 500 ml of saline
CAT1 summoned
Can tocoylse if OT delayed

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19
Q

Cord prolapse vs cord presentation

A

Rupture of the membrane is the difference

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20
Q

Risk factors for shoulder dystocia

A 
Previous history 
Obesity(BMI>30)
DM
Macrosomia>4.5kg
IOL
Prolonged 1st or 2nd stage of labour 
Assisted vaginal delivery
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21
Q

Risk factors for shoulder dystocia

and what is the HELPERR

A 
Previous history 
Obesity(BMI>30)
DM
Macrosomia>4.5kg
IOL
Prolonged 1st or 2nd stage of labour 
Assisted vaginal delivery
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22
Q

3 complications for each shoulder dystocia

A

Look at slides- lecture week 4

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23
Q

Cord prolapse or presentation, what shouldn’t you do

A

PUT IT BACK

induce vasospasm, cut off blood to the fetus–> death

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24
Q

IX at your first antenatal visit

A

1) Blood group and antibody screen
2) FBC
3) Rubella
4) Syphilis
4) STI screen- chlamydia, HIV and Hep B and C
5) Urea, creatinine, uric acid
6) MSU
7) CST
8) Random blood glucose
9) USS dating scan

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25
Q

AT 26 week visit

A 
FBC
Antibody screen 
Syphilis
Hep C 
OGTT
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26
Q

At 34 weeks visit

A

FBC

Antibody screen

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27
Q

During an Obs OSCE state some of the things you will ask the mother

A

GA
Foetal movements
Uterine bleeding/leakage/cramping

BP, Weight, Fundal height, foetal lie, FHR

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28
Q

When can nuchal translucency be done

A

Nuchal Translucency

11 ———–13 +6

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29
Q

When can CVS be done

A

CVS—> 11-13wk

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30
Q

When can Aminocentesis be done

A

16-18wk

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31
Q

Which vital sign is really important in these antenatal visits

A

BP

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32
Q

What should be recommended for women with high BP in early antenatal visit

A

Low dose aspirin

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33
Q

The woman is 25 years old, should Down syndrome screening be discussed with her

A

Yes, it should be. Maternal age is irrelevant for having a baby with Down syndrome. Maternal age is a risk factor just like any other condition

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34
Q

CFTS- how much? private? public?

How good

A

Medicare-funded if high risk, if not it’s private

90%

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35
Q

NIPT

A 
99.5-99.9 sensitive
400$
Harmony test 
private 
SCREENING

The test is done after 10 weeks and is more than 99% accurate for Down syndrome

Trisomies 21, 18, 13; sex chromosome conditions*( sex conditions its upto the patient)

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36
Q

What is the risk of miscarriage with these screening a diagnostic test

A

The screening test is non-invasive hence no risk of miscarriage

However CVS(1 IN 100) and amino(1 in 200)

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37
Q

Frequency of Down syndrome

A

1 in 1000 births worldwide

38
Q

Why are we doing antenatal screening

A 
Down syndrome-trisomy 21
Edwards syndrome (trisomy 18) 
Patau syndrome (trisomy 13)
Neural tube defects(spinal cord defects)
39
Q

What will these screening tests tell the patient

vs diagnostic test

A

Screening tests: These do not give you a definitive answer, but let you know if your baby is at increased risk of Down syndrome. Screening tests do not harm the mother or baby.

Diagnostics test: These are very accurate, giving you a definitive answer. Diagnostic tests are usually offered to women whose babies are at increased risk, based on the result of the screening tests. A diagnostic test can increase your risk of having a miscarriage, so they aren’t routinely offered to all women.

40
Q

Second-trimester screening involves

A

The second trimester ‘quadruple test’ involves a different formula based on demographic information and the maternal serum levels of four markers; alpha-feto protein, human chorionic gonadotrophin, unconjugated estriol and inhibin

41
Q

Doctor, I know my screening test are high risk can I not have the diagnostic test

A

You don’t have to undergo any tests if you don’t want to. If you have a screening test that shows your baby is at increased risk of Down syndrome, you don’t have to proceed to the diagnostic test.

42
Q

There are 3 types of screening test for Down syndrome:

A

1) the combined first-trimester screening
2) the non-invasive prenatal testing (NIPT)
3) and second-trimester maternal serum screening.

43
Q

What are prenatal screening tests? what are they looking for

A 
chromosomal conditions (Down syndrome, and Patau syndrome)
neural tube defects (spina bifida or anencephaly)
birth defects (congenital heart or kidney conditions)
44
Q

If it a down syndrome station, what questions must you ask the mother

A

Any known genetic conditions among close family members (refer to ‘Family history’).

History of intellectual disability (ID), multiple pregnancy loss, stillbirth, children with congenital abnormalities.

MUST ASK ABOUT INCEST–>
Consanguinity (‘Is there any chance that a relative of yours might be related to someone in your partner’s family?’).

Pre-pregnancy and pregnancy folic acid intake.

Information about carrier screening (ideally pre-conception or early in first trimester).

45
Q

CFTS includes

A

Nuchal translucency
pregnancy-associated plasma protein-A (PAPP-A)
ß-subunit of human chorionic gonadotrophin (ß-hCG)

Trisomies 21, 18, 13; structural anomalies

46
Q

Second-trimester screening includes

A

Estriol
beta-HCG
alphafetoprotein
inhibin A

Trisomies 21 and 18; neural tube defects

47
Q

CFTS- when is the blood test and when is the USS for neck thickness to be done doc

A

• Screening blood–Free BhCG, Papp A
(after 10wk , 3-5 days before nuchal scan)
• Nuchal Translucency (11-13 +6)

48
Q

INVASIVE DIAGNOSTIC TESTING is done should be given

A

** Anti-D for ALL RhD-ve women

49
Q

Non-viable pregnancy diagnostic criteria (based on transvaginal USS)

A
  1. MSD ≥25mm but NO foetus present

2. Foetus with CRL ≥7mm but NO foetal heart movements (≥30 seconds)

50
Q

5 MUST ask symptoms of ectopic

A

1) Amenorrhea
2) PV bleeding
3) Shoulder tip pain
4) Symptoms of pregnancy
5) Signs of shock–> syncope, dizziness and fatigue

51
Q

Most common risk factors for ectopic

A

PID

52
Q

What USS sign is seen with ectopics

A

Ring of fire/Tubal ring sign

53
Q

What is the cut off for ectopics should you remember

A

> 2000 IU/L

54
Q

Indications for anti-D before 1wk-12+6 GA

A

For women w/

1) Miscarriage
2) Termination of Pregnancy
3) Ectopic
4) Chorionic Villous Sampling
5) Molar Pregnancy

55
Q

What are the indications for anti-D after 13 weeks

A
  • CVS, Amniocentesis
  • Abdo trauma,
  • APH- revealed or concealed
  • ECV,
  • Miscarriage or Termination of pregnancy
56
Q

Tenderness or acute abdomen, ‘woody’ feel of uterus -

A

Placental abruption

57
Q

Which APH is concerning? why?

A

Placental abruption

58
Q

DDX for placental abruption-4

A 
PTL
Placenta Praevia
Chorioamnionitis
Acute Appendicits
Acute Pyelo
UTI
59
Q

The biggest maternal complication with Placental abruption

A

DIC

Maternal- DIC or renal failure, PPH,
Foetal – prematurity, foetal distress, low birth weight or stillbirth

60
Q

Ruptured uterus, what is the clinical presentation

A

Tachycardia, signs of shock, sudden SOB,
- Constant abdo pain, shoulder tip pain, uterine/suprapubic tenderness

haematuria

  • Frank haematuria, abnormal vaginal bleeding,
61
Q

Indication for fetal fibronectin test

fFN number to be positive

A

Indication:
symptomatic women – 22+0 – 36+0 AND
intact membranes AND
≤3cm dilation of cervix

Contraindicated: dilated >3cm, +ve ROM, cervical cerclage +ve

fFN >50ng/ml +ve

62
Q

4 management steps of PTL

A

1) Tocolysis
2) Antibiotics if indicated
3) Corticosteroids
4) MgSO4

63
Q

Tell me the principles of corticosteroid use and PTL

  • whats the dose
  • when to use it
A

Indication: viable IUP in woman w/increased risk of PTB before 35+0 (bw 24-3%+0)

1st dose – betamethasone 11.4mg IM
2nd dose: betamethasone 11.4mg (24 hours after 1st dose or 12 hours if not enough time)

64
Q

Tell me the principles of MgS04 use and PTL

  • when to use it
  • why?
A

MgSO4 – neuroprotection: Give shortly before birth (4-6 hours before delivery)
- 24+0 – 30+0 GA

65
Q

PROM and PPROM, what would you like to know in the history about the discharge from the mother-5

A

Vaginal Loss

  • amount
  • colour
  • consistency
  • odour
  • bleeding
  • meconium
66
Q

PROM management is based on

A

1) GA
2) Signs of Labour
3) Signs of Infection
4) Foetal lie/presentation
5) foetal wellbeing
6) GBS status

67
Q

Outline the management for PROM

A

1) Routine Abs: Oral Erythromycin – 250mg QID for 10 days

2) Prematurity
- corticosteroids b/f 35+0
- MgS04 b/f 30+0
- Intrapartum Abx prophylaxis

3) 4 hourly: temp, foetal activity, uterine activity, vaginal discharge
4) Supportive cares – contact specialist, psychosocial support–> MDT, MDT, MDT

5) Advise patient re:
Risk of chord prolapse
Risk of infection – regular pad changes, shower not baths

** Tocolysis is patient-specific e.g. patient PPROM + contracting in the rural setting

68
Q

What advice do you need to tell the patient been discharged after evaluation from PROM

A

Advise patient re:
Risk of chord prolapse
Risk of infection – regular pad changes, shower not bath

MDT involvement

Personal hygiene—change sanitary pad four hourly (or more frequently), wiping front to
back after toileting, showering in preference to baths
o Self-monitoring temperature daily and vaginal loss with each pad change
o Avoiding tampon use, vaginal creams/medications, vaginal intercourse, swimming/baths
o Attending all review appointments

69
Q

How long do we need to give ABx for PPROM

A

Erythromycin 250 mg oral 6 hourly for 10 days

70
Q

What is the difference between primary and secondary PPH

A

Primary PPH: within 24 hours of delivery

Secondary PPH: 24 hours to 6 weeks post-partum

71
Q

PET what is it

A

Formerly called toxemia, preeclampsia

pre-eclamptic toxaemia

72
Q

What drug is contraindicated in uterine atony in PPH

A

Ergometrine:

  • Contraindicated for retained placenta
  • PET
  • severe/persistent sepsis
  • renal, hepatic or cardiac disease

what can be given is: - IV oxytocin
- Can also give oxytocin/0.9% saline infusion

73
Q

What are the complications of PPH-7

A
  • Hypovolaemic Shock
  • Renal Failure
  • Hepatic failure
  • DIC
  • ARDS
  • Sheehan Syndrome: post-partum hypopituitarism due to blood loss and shock-related necrosis
  • Death
74
Q

Tell me the difference between three main causes of vagintis/discharge

A

Trichomoniasis
Candidiasis
BV

75
Q

Why BV screening so important

A

Increase risk of PTL and PROM

BV is not a STI so ask this in your PTL patient and also ask about GBS and stuff

76
Q

A post-menopausal woman comes with an endometrial thickness of >5cm. What is the treatment algorithms

A

Pipelle—> D/C (blind biopsy)—> Hysteroscopy guided D/C(Definitive biopsy– cause it viewed)

Basically do for ongoing AUB or inadequate sample.
This is the step-up

77
Q

What is the change of PCOS Rotterdam criteria in 2019

A

USG: >20 subscapular follicular cysts in each ovary

and/ or 10m3 in ovarian volume

This criterion is NOT RECOMMENDED in adolescents

78
Q

6 MUST know contraindications for OCP

A

1) Gross obesity
2) Cerebrovascular disease
3) Any ischemic heart disease
4) Any liver disease
5) previous DVT–> thrombophilias
6) breast or gynaecological cancer

79
Q

CST algorithm

A

CST–> HPV 16/18 detected–> colp

–> HPV 16/18 not detected but other strain detected–> Reflex cytology–> then if indicated colp

80
Q

Colposcopy does either of the 2 treatment options

A

Ablation/excision

Biopsy–> follow up

81
Q

Maternal short term risk of GDM

A 
Preeclampsia Recurrent GDM
Induced labour Increased risk of T2 diabetes
Operative birth Cardiovascular disease
Hydramnios
Post-partum haemorrhage
Infection
82
Q

Maternal long term risk of GDM

A

Recurrent GDM
Increased risk of T2 diabetes
Cardiovascular disease

83
Q

Neonates short term risk of GDM

A 
Respiratory distress 
Jaundice
Hypoglycaemia
Premature birth
Hypocalcaemia
Polycythaemia
Increased newborn weight
and adiposity
Macrosomia/associated risks
84
Q

Neonatal long term risk of GDM

A

Impaired glucose tolerance
Type 2 diabetes
Obesity

85
Q

GDM mothers should be registered under

A

NDSS

-diabetic educator

86
Q

What are the indications for insulin therapy in GDM

A
  • Hyperglycaemia above BGL targets
  • Suboptimal BGLs with Metformin
  • Maternal preference
  • Metformin not tolerated
  • Fetal macrosomia
87
Q

Causes of pathological jaundice(Within the 1st 24 hours)- 3 causes

A 
• Haemolysis–bruising, haemorrhage,
isoimmunisation
• Decreased conjugation of bilirubin–
congenital hypothyroidism
• Decreased excretion of bilirubin–biliary
atresia, cystic fibrosis
88
Q

Exchange transfusion why for jaundice baby

-what are the indications

A

Medical emergency–perform in NICU

Indications
• TSB continues to rise despite phototherapy
• Baby shows signs of acute bilirubin encephalopathy

89
Q

4 risk factors for jaundice- what the neonatalologist said

A

1) sepsis
2) haemolysis
3) acidosis
4) asphyxia

90
Q

The most common cause of glomerulonephritis in children

A

PSGN

due to GAS infection

MED 5 (23 decks)

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