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O&G > Normal pregnancy, labour and delivery > Flashcards

Normal pregnancy, labour and delivery Flashcards

1
Q

How can mean sac diameter be used to assess failure of intrauterine gestation?

A

MSD > 25mm with no foetal pole

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2
Q

How can CRL be used to diagnose failure of intrauterine gestation?

A

Crown-rump length > 7mm with no heartbeat

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3
Q

How is the mean sac diameter calculated?

A

(length + height + width)/3

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4
Q

How is crown rump length calculated?

A

Length of the embryo or foetus from the top of its head to bottom of torso

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5
Q

What measurement provides the most accurate estimation of gestational age in early pregnancy and why?

A

Crown-rump length

There is little biological variability which affects this measurement in early pregnancy

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6
Q

What is a foetal pole?

A

First direct imaging manifestation of the foetus

Thickening of the yolk sac

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7
Q

When can the foetal pole first be visualised on US?

A

Transabdominal: 6.5 weeks

Transvaginal: 6 weeks

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8
Q

What normally happens to hCG levels in early pregnancy?

A

Doubles every 48-72 hours, peaking between weeks 8 and 11

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9
Q

What is the discriminatory zone?

A

The BhCG level above which an imaging scan should reliably visualize a gestational sac within the uterus in a normal intrauterine pregnancy

1500-1800 mIU/mL

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10
Q

Why is B-hCG as opposed to hCG measured in pregnancy?

A

hCG has a beta and alpha subunit

The beta subunit is unique to trophoblastic tissue

The alpha subunit is identical to that found in LH, FSH and TSH

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11
Q

At what bHCG should a foetus be visualised on TVUS?

A

1500

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12
Q

What is a normal birth weight?

A

2.4-4.6kg

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13
Q

What are the stages of labour?

A
  1. Contractions and cervical dilation
  2. Delivery of the foetus
  3. Delivery of the placenta
    * Normally 24 hours*
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14
Q

What are each of these foetal positions?

A
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15
Q

What is effacement?

A

Cervical length

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16
Q

What is a station?

A

The relationship of the denominator of the presenting part to the ischial spines

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17
Q

What is this?

A

Caput

Reflects scalp oedema which can be present in normal and prolonged labour

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25
Q

What are 2 drugs that inhibit uterine contractions?

A
  1. Nifedipine
  2. Salbutamol
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26
Q

What is the most common type of twin?

Mono/dichorionic - mono/diamnioitc?

A

Monochorionic-diamniotic (70%)

Twins share a placenta and have individual amniotic sacs

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27
Q

Dizygotic twins always share the placenta and amniotic sac in which way?

A

Dichorionic-diamniotic

Each has an individual amniotic sac and placenta

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28
Q

How is due date calculated from last menstrual period?

A

40 weeks (280 days) from LMP

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29
Q

How does nifepipine work to delay labour?

A

Blocks Ca chennels → decreased intracellular Ca → myometrial relaxation

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30
Q

What is the effect of indomethacin on labour?

A

Delays labour by decreasing prostaglandin synthesis

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31
Q

How do prostaglandin analogues induce labour?

A

Loosen and ripen the cervix

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32
Q

What are the 3 p’s of labour that can cause issues?

A

Pelvis - size and shape

Passenger - size and position of baby

Power - strength and frequency of contractions

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33
Q

How is a due date calculated with Naegele’s rule?

A
  1. First day of LMP
  2. Add a year
  3. Subtract 3 months
  4. Add 7 days
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34
Q

What is a Bishop Score?

A

Method of assessing the readiness for induction of labour

Measures dilation, effacement, station, consistency and position

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35
Q

What is quickening?

A

Foetal movement

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36
Q

What causes a linea nigra?

A

Placenta produces melanocyte stimulating hormone

Occurs around 22 weeks

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37
Q

What is the most accurate means of determining the due date of a foetus?

A

First trimester ultrasound

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38
Q

Typically, how long is the 3rd stage of labour?

A

Delivery of the placenta - within 30 minutes of delivery of the child

If this does not occur within 30 minutes it is called “retained placenta” and the woman is at a higher risk of PPH and infection

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39
Q

What are the active and latent phases of the first stage of labour?

A

Latent: irregular contractions, dilatation < 4-6cm

Active: regular contractions, dilatation of at least 4-6cm

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40
Q

What are the active and passive stages of the second stage of labour?

A

Passive: full cervical dilatation without the urge to push

Active: full cervical dilatation of baby visible with involuntary expulsive contractions

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41
Q

What are 3 ways by which the cervix can be ripened to induce labour

A
  1. Stretch and sweep
  2. Prostaglandins
  3. Balloon catheter
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42
Q

How is a stretch and sweep performed?

A

Move your index finger into the cervix and use a circular motion to try separate the membranes of the amniotic sac from the cervix

Releases prostaglandins which promote cervical ripening

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43
Q

Which drug is used to induce contractions?

A

Syntocinon

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44
Q

What are the signs of placental separation in the 3rd stage of labour?

A
  1. Gush of blood
  2. Lengthening of the umbilical cord
  3. Upwards movement of the uterine fundus
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45
Q

What are Alvarez waves?

A

Low intensity, high frequency physiological contractions in the second half of pregnancy

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46
Q

What are false labour contractions?

A

Uncoordinated uterine contractions 3-4 weeks before birth

Contractions do not increase in frequency, intensity or duration

Helps to position the foetus

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47
Q

What are prelabour contractions?

A

Irregular, high-intensity contractions which occur ever 5-10 minutes

Position the foetal head in the pelvis

Do not cause cervical dilation

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48
Q

What is cervical funnelling?

A

Dilation of the internal cervical os and reduction of the cervical length

Significant funnelling is associated with preterm delivery

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49
Q

Why is nitrous oxide (N2O) given during labour?

A

Mild anaesthetic and anxiolytic

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50
Q

What information is obtained from the second trimester ultrasound?

A
  1. Structural abnormalities
  2. Gender
51
Q

What is the value of a third trimester ultrasound?

A

Not necessary

Used for assessing complicated pregnancies e.g. foetal size, twins, abnormal positions

52
Q

What is being visualised here?

A

Foetal pole and yolk sac

53
Q

Why is intubating pregnancy women more difficult?

A

Progesterone: dilates smooth muscle

BUT

Oestrogen: tissue oedema and hyperplasia of mucus glands

54
Q

Why does ESR increase in pregnancy?

A

ESR rises with increased proteins

Pregnancy → increased gammaglobulins

Immunity becomes increasingly humoral rather than cell-mediated

55
Q

Why does blood pH increase in pregnancy?

A

Increased respiration → respiratory alkalosis

  • Low CO2 increases the foetal/maternal gradient* → easier for foetal CO2 to enter maternal circulation and be expired
  • Bicarbonate excretion increases*
56
Q

Why do pregnant women become constipated?

A

Increased progesterone → smooth muscle relaxation → poor colonic motility

57
Q

What is puerperium?

A

The period of adjustment after childbirth during which the mother’s reproductive system returns to its normal prepregnant state. It generally lasts six to eight weeks and ends with the first ovulation and the return of normal menstruation.

58
Q

What is meconium?

A

Thick, black-green material formed from bile salts, gastric secretions, mucous, vernix, lanugo, blood, pancreatic enzymes, free fatty acids and squamous cells

59
Q

What is the significance of meconium-stained liquor?

A

May suggest foetal hypoxia (more likely to be significant in a preterm foetus)

20% of newborns have MSAF at term

60
Q

What are 5 obstetric risks of maternal smoking?

A
  1. Spontaneous miscarriage
  2. Preterm birth
  3. Placenta previa
  4. Placenta abruption
  5. Stillbirth
  6. Ectopic pregnancy
  7. PPROM
61
Q

What are 5 risks of maternal smoking to the grown child and adult?

A
  1. SIDS
  2. T2DM
  3. Obesity
  4. HTN
  5. Nicotine dependence
  6. Respiratory disease (asthma, LRTI)
  7. Decreased cognitive performance
  8. Behavioural (conduct disorder, ADHD, antisocial behaviour)
  9. Increased risk of mental illness
62
Q

What haemoglobin concentration to do you aim to maintain in pregnancy?

A

0-20 weeks: 110 mg/dL

>20 weeks: 105 mg/dL

Minimum

63
Q

What serum iron level do we want pregnancy women to have?

A

> 15

> 30 if not pregnant

64
Q

When is pre-conceptional 5mg of folic acid daily recommended? (as opposed to 0.5mg)

A

Anticonvulsant use

Pre-existing DM

Family history of NTD or a child with NTD

65
Q

What are the indications for an early GTT?

18 weeks

Normal: 26-28

A

Previous GDM

Maternal age > 40

Asian, Indian, ATSI, African ethnicity

BMI > 30

Previous macrosomia

PCOS

Corticosteroid or antipsychotic medication

First degree relative with diabetes

66
Q

What is the normal frequency of antenatal clinic appointments?

A

0-28/40: every 4 weeks

28-36/40: every 2 weeks

36/40-delivery: weekly

67
Q

When might bleeding from implantation occur?

A

10-14 days from fertilisation (at time of missed period)

68
Q

In order of when they appear, what are the first features that can be visualised on US in a pregnancy?

A

Gestational sac → yolk sac → embryo

69
Q

When is cardiac activity first visualised on US?

A

7 weeks

70
Q

How long following implantation do hCG levels become detectable?

A

6-12 days

71
Q

What is this dermatological condition?

A

Melasma

Common in pregnancy

72
Q

What are the three factors (3 P’s) that determine the progress through labour?

A

Passages Passenger Power

73
Q

What about the contractions during labour do we monitor?

A

Strength

Frequency

Duration

74
Q

What are the side effects of an epidural when used to control pain in labour?

A

Transient hypotension

Risk of dural tap

Increased length of second stage because of reduced pelvic floor tone and loss of bearing down reflex

75
Q

What is a physiological 3rd stage of labour?

A

They do not receive any oxytocic drugs, the attendant waits for the umbilical cord to stop pulsating before cutting it and delivery of the placenta occurs passively.

76
Q

How can we treat cervical incompetence or insufficiency?

A

Cervical cerclage can be performed. This is the insertion of a suture into the cervix to reduce the prolapsed membrane.

77
Q

How should preterm babies be delivered? Vaginal or caesarean?

A

There is no evidence to suggest that caesarian section is any safer than vaginal birth in preterm babies.

78
Q

What is the principal issue with preterm prelabour rupture of the membrane?

A

Sepsis of both the mother and the fetus.

79
Q

How long after preterm prelabour rupture of membrane will a women normally go into labour?

A

Within 72 hours

80
Q

What are the potential side effects of NSAIDs such as indomethacin when used as tocolytics?

A

Mother: Heartburn, nausea

Fetus: premature closure of ductus arteriosus, reduced renal function causing oligohydramnios

81
Q

How often should women with gestational diabetes be checking their blood sugars?

A

Daily fasting (best in the morning) 2 hours after every meal

82
Q

What should the target blood glucose levels be in GDM?

A

Fasting: less than 5.6mmol/L

1 hour after meals: less than 7.8mmol/L

2 hours after meals: less than 6.4mmol/L

83
Q

Are the following low or high in trisomy 21?

Alpha fetoprotein

Oestriol

hCG

PAPP-A

A

Alpha fetoprotein - low

Oestriol - low

hCG - high

PAPP-A - low

84
Q

Which LFT may be physiologically elevated in pregnancy?

A

ALP

Released by the placenta

85
Q

What do you need to know to calculate a Bishop score?

A
  1. Dilation
  2. Effacement
  3. Station
  4. Consistency
  5. Position of the cervix
86
Q

What is the definition of a postdates delivery?

A

42+0

87
Q

What is the false positive rate of the first-trimester combined screening test?

A

5%

88
Q

What is the sensitivity and specificity of the NIPT test?

A

Close to 99% for both

Slightly lower for Edwards and Patau

Should not be used for final diagnosis as it is not 100% accurate

89
Q

When is the gestatial sac first visible on TVUS?

A

5 weeks

Foetal pole at 6 weeks

90
Q

Why are pregnancy women advised to avoid soft cheeses, deli meats and pates?

A

They may be sources of Listeria monocytogenes

Pregnant women are particularly susceptible

May cause foetal death, premature birth or newborn infections

91
Q

What corticosteroids readily cross the placenta?

A

Betamethasone

Dexamethasone

92
Q

What is involved in active management of the 3rd stage of labour?

A

Oxytocin 10U IM/IV with delivery of the anterior shoulder

93
Q

What are the most common adverse effects of syntocinon?

A

Nausea and vomiting

94
Q

On what day is the blastocyst formed?

A

Day 5

95
Q

From when in pregnancy can be NIPT be used?

A

10 weeks

96
Q

What is being visualised and how far along is this pregnancy?

A

Gestational sac

4 weeks

97
Q

What is being visualised and how far along is this pregnancy?

A

Yolk sac

5 weeks

98
Q

What is the function of the yolk sac?

A

Provides nutrition to the foetus until the placenta takes over

99
Q

What is being visualised and how far along is this pregnancy?

A

Foetal pole

6 weeks

100
Q

What is being visualised and how far along is this pregnancy?

A

Foetal limb buds

8 weeks

101
Q

What is involved in active management of the third stage of labour?

A
  1. Oxytocin 10U IM/IV
  2. Controlled cord traction once the uterus is well contracted and the placenta separated
102
Q

What are the risks and benefits of delayed cord clamping?

A

Preterm

  • Reduced risk of transfusion, infection, NEC and IVH

Term

  • Reduced iron deficiency (may be beneficial if low maternal iron)
  • Risk of PCV and jaundice
103
Q

What is the difference between ergometrine and syntocinon?

A

Syntocinon - wave contractions

Ergometrine - one big contraction

104
Q

Grand multiparity is an indepedent risk factor for which obstetric complications?

A

Placental previa

Placental abruption

105
Q

What is the definition of grand multiparity?

A

5 or more births (> 20 weeks)

106
Q

What are Category A drugs in pregnancy?

A

Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the fetus having been observed

107
Q

What are Category B1/2/3 drugs in pregnancy?

A

Drugs have only been taken my a limited number of pregnancy women

No evidence of malformation of harmful effects in the foetus

B1 - no evidence of damage in animal studies

B2 - limited studies in animals, but no evidence of damage

B3 - evidence of damage in animal studies with uncertain significance in humans

108
Q

What are Category C drugs in pregnancy?

A

Have caused or are suspected of causing harmful effects without malformation

Effects may be reversible

109
Q

What are Category D drugs in pregnancy?

A

Drugs have cause or are suspected to have caused foetal malformations or irreversible damage

May also have adverse pharmacological effects

110
Q

Which conditions are associated with an increased nuchal translucency?

A

Down syndrome

Congenital heart defects

Abdominal wall defects

111
Q

Which conditions are associated with hyperechogenic bowel?

A

Cystic fibrosis

Down syndrome

CMV infection

112
Q

What is the definition of increased nuchal translucency? (mm)

A

> 3.5 mm

113
Q

A PAPP-A below what level is a poor prognostic sign?

A

< 0.4 MoM

Suggests poor placentation - SGA, IUGR, foetal demise, preterm birth, pre-eclampsia

O&G (13 decks)

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