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Year 2- Obstetric Emergencies > MCQ > Flashcards

MCQ Flashcards

1
Q

What are the most important individual factors that have an impact on human performance? (2)

A

Stress
Fatigue

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2
Q

Which of the following conditions could increase the risk of a woman developing sepsis? (3)
A- Woman had miscarriage in last 12 weeks
B- Women taking immunosuppressants for autoimmune disease
C- Women who have premature rupture of membranes
D- Women who are pregnant

A

B
C
D

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3
Q

Which blood test taken in the context of sepsis, should be interpreted with caution if woman has recently given birth?

A

Lactate

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4
Q

Which of the following are not causes of maternal collapse? (2)
A- Hirsutism
B- AFE
C- Sepsis
D- Skin rash

A

A
D

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5
Q

Which of the following actions are recommended in the A-E assessment of deteriorating woman?
A- Head tilt/chin lift, IV access, insert catheter with urometer
B- Left lateral, fluid bolus, give oxygen
C- Elevate legs, consider oral or IV glucose, assess medical needs
D- All of above

A

D- All of above

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6
Q

Placenta praevia is classified in… categories

A

4

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7
Q

Which one of the following actions should NOT be performed if a woman presents at 37/40 with a 40mls APH to MAU, unless placental site has been confirmed?
A- Speculum examination
B- VE
C- Presentation scan
D- All of above

A

B- VE

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8
Q

Which of the following are true about AFE? (2)
A- Fatality rate is 90%
B- Most women who die do so within 2 hrs of presentation
C- An ABG is the only test that can detect an amniotic fluid embolism
D- It rarely happens in 1st trimester

A

B- Most die within 2 hrs
D- Rarely happens in 1st trimester

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9
Q

Which of following about uterine inversion are FALSE?
A- Replacing uterus may always be done in theatre
B- Tocolysis might exacerbate atonic postpartum haemorrhage
C- Placenta should be removed whilst uterus is inverted outside of the vulva to aid visualisation
D- There is no need to X-match blood products

A

A- replacing uterus may always be done in theatre
C- placenta removed whilst uterus inverted
D- no need to X-match

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10
Q

What signs and symptoms would make you suspicious of uterine rupture when caring for a woman in labour having a VBAC?

A

Severe continuous abdominal pain
Slowing down of previously effective and regular contractions
Maternal tachycardia

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11
Q

Definition of placenta percreta

A

Penetrate through the myometrium, up to the serosa. Can potentially involve other organs

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12
Q

Which of the following are risk factors for a retained placenta? (2)
A- Cervical constriction ring, previous retained placenta
B- Premature birth or stillbirth
C- Maternal cardiac conditions
D- Maternal eczema

A

A- Cervical constriction ring, prev retained placenta
B- Premature birth or stillbirth

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13
Q

Which of the following are risk factors for uterine rupture?
A- Gestational diabetes
B- Use of prostaglandin in women having VBAC
C- Trauma to abdomen
D- None

A

B- Prostaglandin in VBAC
C- Trauma to abdomen

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14
Q

Which one of the following about retained placenta is FALSE?
A- Oxytocic agents should be injected in umbilical vein
B- Offer VE to assess need for manual removal
C- Assessing blood loss is always important
D- Always check placenta, membranes and cord following manual removal

A

A

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15
Q

During NLS, if after first round of inflation breaths the chest has not risen and heart rate is still slow, what should you consider next?

A

Inserting a Guedel airway

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16
Q

What is the approach to newborn resuscitation in order?

A

Dry and cover baby, assess situation, airway, breathing, chest compressions, (drugs)

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17
Q

How can a midwife facilitate breech birth? (2)
A- Clean away maternal faeces
B- Discourage epidural use
C- Encourage all-fours position
D- Apply FSE

A

B- Discourage epidural
C- All-fours position

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18
Q

During a breech birth when do you need to be more alert and potentially prepare to intervene?
A- Barrel-shaped stomach
B- Emerging body is white/blue mottled with long repurfusion time
C- No bulging of perineum after arms born
D- All of above

A

D

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19
Q

Incidence of congenital heart disease

A

Averages 8 per 1,000
(6-12 per 1,000 live births)

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20
Q

Of the 8/1000 with CHD, what percentage accounts for Critical congenital heart disease?

A

15-25%

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21
Q

Critical CHD

A

potentially life-threatening duct dependent conditions and those conditions that require procedures within first 28 days of life

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22
Q

Major serious CHD

A

those defects not classified as critical but requiring invasive intervention in the 1st year

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23
Q

Clinical risk factors for CHD

A
  • 1st degree family hx
  • Fetal trisomy 21
  • Cardiac abnormality detected at anomaly scan
  • Maternal exposure to viruses eg. rubella in early pregnancy
  • Maternal T1 diabetes, epilepsy, SLE
  • Antiepileptic and psychotrophic drug use in pregnancy
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24
Q

What leads to the first gasp of newborn?

A

Light
Sound
Touch
Gravity
Cooler temp
Cord clamping- increased co2 stimulates respiratory centre

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25
Q

Process of examination in NIPE:

A

History
Appearance of baby
Breathing
Pulses
Peripheral circulation- capillary refill
Auscultation of heart

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26
Q

Areas of Auscultation

A
  1. Aortic area
  2. Pulmonic area
  3. Tricuspid area
  4. Mitral area
  5. Coarctation area- midscapulae
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27
Q

Screen positives for critical major CHD

A
  • tachypnoea at rest
  • episodes of apnoea > 20 secs
  • chest recession, nasal flaring
  • central cyanosis
  • visible heaves, thrills
  • absent/weak femoral pulses
  • cardiac murmur or extra heart sounds
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28
Q

Who is at risk of developing sepsis?

A
  • impaired immune system
  • gestational diabetes
  • C section, forceps, removal of retained products of conception
  • PROM
  • close contact with group A strep eg. Scarlet fever
  • continued vaginal bleeding
  • Premature labour
  • Invasive intrauterine procedure
  • cervical suture
    -breast abscess
  • wound haematoma
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29
Q

In how many cases is culture-positive sepsis observed?

A

30-40%

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30
Q

Signs and symptoms of Sepsis

A
  • Widespread rash, sandpaper/ goose skin texture
  • Fever
  • D+V
  • Abdo pain
  • Wound infection
  • Offensive vaginal discharge
  • Tachypnoea RR>24
  • Hypotension SBP<90
  • Tachycardia
  • Pyrexia >38
  • Low sats
  • Poor peripheral perfusion
  • Pallor/grey
  • Clamminess
  • Low urine output
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31
Q

Often, what is the first sign that a patient is deteriorating?

A

Tachypnoea

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32
Q

Why does sepsis cause hypotension?

A

Vasodilation leads to absolute hypovolemia

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33
Q

If sepsis causes hypotension, what does the body do to compensate?

A

Compensatory tachycardia

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34
Q

Definition of maternal collapse

A

Severe respiratory or cardiocirculatory distress that may lead to a sudden change in level of consciousness or cardiac arrest if untreated

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35
Q

What 6 H’s are the cause of maternal collapse?

A

Head
Heart
Hypoxia
Haemorrhage
wHole body and Hazards

36
Q

What signs trigger an emergency response for ABCN?

A

A- obstructed and noisy
B- resp rate <5 or >35
C- pulse <40 or >140, systolic BP <80 or >180
N- sudden decrease in level of consciousness, unresponsive or responsive to painful stimuli only, seizures

37
Q

What is Amniotic Fluid Embolism?

A

Caused by amniotic fluid entering maternal circulation and triggers a serious reaction that includes cardiorespiratory collapse and/or coagulopathy

38
Q

Initial onset of AFE is…

A

severe pulmonary hypertension

39
Q

Risk factors for AFE

A
  • IOL with prostaglandin
  • Increased maternal age
  • C section
  • Vaginal instrumental
  • placenta praevia
  • multiple pregnancy
  • atopy, or latex, medication or food allergy
40
Q

What triad could suggest diagnosis of AFE?

A

Hypotension
Coagulopathy
Hypoxia

41
Q

What is AFE always associated with a form of?

A

Disseminated intravascular coagulopathy (DIC)

42
Q

…. as a presenting feature is recorded in 60-80% of registered cases of AFE

A

Cardiac arrest

43
Q

When most commonly do women present with AFE?

A

in labour

44
Q

What helpful investigations help diagnose AFE?

A
  • X-ray showing diffuse opacity in lung fields
  • Arterial blood gases
  • Echocardiograms
  • ECG
45
Q

Define APH

A

bleeding from or in to the genital tract, occurring from 24 weeks and prior to birth

46
Q

What is responsible for around 31% of APH?

A

Placenta praevia

47
Q

Risk factors for placenta praevia

A
  • previous CS
  • prev TOP
  • multiparity
  • maternal age >40
  • multiple pregnancy
  • assisted conception
  • smoking
  • fibroids, uterine scar, endometriosis, prev MROP
48
Q

What is classed as a low-lying placenta?

A

< 20 mm from the internal os

49
Q

What gestation is the follow up USS for placenta praevia?

A

32 weeks

50
Q

Signs and symptoms of placenta praevia

A
  • out of blue- sometimes post coital
  • bright red blood loss
  • high presenting part or transverse lie
  • recurrent spotting
  • bleeding more common from 28-30 weeks due to formation of lower uterine segment
51
Q

What are the 4 categories of placenta praevia?

A
  1. minor
  2. marginal
  3. partial
  4. complete
52
Q

What is placental abruption?

A

premature separation of a normally positioned placenta occurring > 24/40

53
Q

What is the cause of APH in 22% of women?

A

placental abruption

54
Q

Risk factors for placental abruption

A
  • PET/hypertension
  • IUGR
  • non-vertex presentations
  • polyhydramnios
  • low BMI
  • abdo trauma
  • following ECV
  • PPROM
  • intrauterine infection
  • cocaine and amphetamines
55
Q

Signs and symptoms of placental abruption

A
  • loss dark red
  • uterus enlarged and irritable
  • abdomen hard, ‘woody’
  • difficult to auscultate FH or determine fetal lie
  • pathological CTG- fetal compromise
  • maternal skin grey/pale, moist
  • backache
56
Q

What is Vasa praevia

A

fetal vessels run through the membranes across the internal os and in front of presenting part.
Associated with velamentous cord insertion or succenturiate lobes.

57
Q

If APH settles and normally situated placenta…

A
  • daily CTG
  • stay in hospital until no APH for 24-48hrs
58
Q

3 degrees of placental invasion:

A
  1. Accreta
  2. Increta
  3. Percreta
59
Q

Placental accreta

A

placental villi adhere to the myometrium

60
Q

placental increta

A

invade into >50% of myometrium

61
Q

placental percreta

A

penetrate through the myometrium, up to the serosa. Can potentially invade organs eg. bladder

62
Q

Risk factors for placental accreta spectrum

A
  • uterine surgery
  • repeated surgical TOPs
  • age
  • multiparity and assisted conception
63
Q

At what gestation should elective delivery be for placenta accreta?

A

between 35-36 weeks with a course of steroids

64
Q

What is classed as prolonged third stage with active management?

A

> 30 mins

65
Q

What is classed as prolonged third stage with physiological management?

A

> 60 mins

66
Q

What can a midwife do to help placenta separation?

A
  • empty bladder
  • skin to skin and BF to release oxytocin
  • massage fundus
67
Q

If woman is bleeding after MROP, what oxytocic agent is given?

A

30-40 IU oxytocin infusion

68
Q

What are the 4 grades of uterine inversion?

A
  1. fundus inverts down to the cervical canal
  2. fundus inverts into the vagina
  3. fundus is visible at the introitus
  4. fundus below the level of the introitus
69
Q

Risk factors for uterine inversion

A
  • excessive traction on cord
  • inappropriate fundal pressure
  • short cord
  • abnormally adherent placenta
  • VBAC
  • unicornuate uterus
  • fetal macrosomia
  • precipitate labour
70
Q

Most common first sign of uterine inversion

A

sudden maternal shock or collapse

71
Q

uterine inversion associated with vasovagal shock which is characterised by…

A

bradychardia
hypotension

72
Q

What is the main complication with uterine inversion?

A

atonic postpartum haemorrhage

73
Q

What is not a sign of sepsis?

A

Bradycardia

74
Q

As a minimum, which physiological obs should be recorded at the initial assessment and as part of routine monitoring in critically ill and deteriorating patients?

A

Maternal pulse, respirations, systolic BP, level of consciousness, oxygen saturations, temperature

75
Q

What is the cut off that would make you consider the lactate level abnormal?

A

> 2 mmol/L

76
Q

What can be associated with an increased occurrence of placenta praevia?

A

Previous CS, multiple pregnancy, smoking, prev termination

77
Q

Usual signs and symptoms of placenta abruption?

A

Constant and severe pain
Acute onset

78
Q

What are potential complications of uterine inversion?

A

PPH
Neurogenic shock

79
Q

What is neurogenic shock characterised by?

A

Bradycardia and hypotension

80
Q

What 2 things are differential diagnoses for s&s of shock in labour?

A

Uterine rupture
AFE

81
Q

What step should be done immediately before chest compressions in NLS?

A

30 seconds of ventilation breaths

82
Q

During NLS ventilation breaths should be given at a rate of… per minute

A

30 bpm

83
Q

Definition of primary PPH

A

The loss of 500mls or more of blood from the genital tract within the first 24 hrs of birth

84
Q

A woman has lost over 1000mls of blood during PPH and he vital signs are still unstable. You’ve already given her 1.5L of Hartmann’s. What will you give her next?

A

1 unit of Red blood cells and 1 unit of Fresh Frozen Plasma

85
Q

In the case of magnesium sulphate toxicity, what is the antidote?

A

Calcium Gluconate 1g IV

86
Q

What does a lactate level > 4 mmol/l indicate?

A

tissue hypo perfusion
end-organ damage

Year 2- Obstetric Emergencies (7 decks)

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