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Passmed > O&G > Flashcards

O&G Flashcards

1
Q

First line drug for pre-eclampsia? Other options and when would you use them?

A

Lobetolol

Nifedipine (if patient has Hx of asthma)
Hydralazine - more commonly used acutely

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2
Q

Eclampsia with fits - emergency drug management

A

Magnesium sulphate

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3
Q

Definition of pre-eclampsia

A

Gestation >20 weeks

Hypertension and proteinuria (>0.3g/24 hours)

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4
Q

Indomethacin MoA and use in obstetrics?

A

NSAID used as a tocolytic

Salbutamol is also a tocolytic

Can also be used to inhibit prostglandin production and close patent ductus arteriosus

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5
Q

Drug given to facilitate placental delivery

A

Oxytocin/ergometrin - encourages SM contraction

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6
Q

Primary PPH due to uterine atony management

A

ABC including two peripheral cannulae, 14 gauge
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
if medical options failure to control the bleeding then surgical options will need to be urgently considered
the RCOG state that the intrauterine balloon tamponade is an appropriate first-line ‘surgical’ intervention for most women where uterine atony is the only or main cause of haemorrhage
other options include: B-Lynch suture, ligation of the uterine arteries or internal iliac arteries
if severe, uncontrolled haemorrhage then a hysterectomy is sometimes performed as a life-saving procedure

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7
Q

Signs of acute fatty liver of pregnancy

A

jaundice, mild pyrexia, hepatitic LFTs, raised WBC, coagulopathy and steatosis on imaging. Clinically, acute fatty liver of pregnancy has predominantly non-specific symptoms (e.g. malaise, fatigue, nausea)

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8
Q

Secondary PPH defined as what?

A

Bleed (>500ml) in 24hr - 12 weeks postpartum

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9
Q

When should delivery be offered to pre-eclamptic patients?

A

After 34 weeks once a course of steriods has been completed

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10
Q

HTN in preganancy definition

A

Systolic > 140, Diastolic > 90

BP usually dips up to 20-24wks, and should return to pre-pregnancy levels after this (this is why pre-eclampsia is defined as HTN & proteinuria post 20 weeks gestation

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11
Q

What is the rule used to calculate expected date of delivery?

A

Naegele rule

First day of LMP + one year - 3 months + 7 days

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12
Q

Who needs extra folic acid treatment and what is the dose?

A

On anti-epileptics/obese/diabetics/family history of neural tube defects/ceoliac disease/thalasseamia trait

5mg OD (ideally 3 months before pregnancy) until 12 weeks

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13
Q

What is the normal dose of folic acid and how long/when do you need to take it?

A

400mcg OD 3 months before to 12 weeks

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14
Q

Drugs to stop in pregnancy

A 
Warfarin
NSAIDs
ACEi 
Anti-epileptics: phenytoin, sodium valproate 
Methotrexate
ABx such as trimethoprim (anti-folate) 
Sulphonylureas 
Lithium
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15
Q

What teratogenic effect is phenytoin associated with?

A

Cleft palate

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16
Q

Two anti-epileptic drugs considered safe in pregnancy?

A

Lamotrigine and carbemazepine

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17
Q

Drugs to avoid when breastfeeding

A 
Barbiturates 
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
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18
Q

Pre-eclamptic patient who is fitting - drug of choice and dose

A

MgSO4 IV

4g bolus over 5-10 mins
1g per hour infusion over next 24hrs

monitor for signs of OD - reduced reflexes/resp rate

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19
Q

What type of antiemetic is used for non severe pregnancy related N&V

A

Antihistamine antiemetics - e.g. promethazine or cyclizine)

20
Q

Active management of the third stage of labour involves what 3 things?

A

1) Admistering of syntometrine (or oxytocin in CI)
2) Deffered cord clamping (after 1 minute but less than 5 minutes)
3) Controlled cord traction

21
Q

What secretes HCG, what is the purpose of HCG and when do levels peak?

A

HCG is secreted by the syncitiotrophoblasts 8 days post fertilization to maintain the corpus letuem and its progesterone production. Levels peak at 8-10 weeks

Human chorionic gonadotropin (hCG) is a hormone first produced by the embryo and later by the placental trophoblast. Its main role is to prevent the disintegration of the corpus luteum

hCG levels double approximately every 48 hours in the first few weeks of pregnancy. Levels peak at around 8-10 weeks gestation.

22
Q

VTE history in a pregnant women - management?

A

VTE thrombophrophylaxis with LMWH throughout pregnancy and 6 weeks postnatally

23
Q

What would warrant VTE prophylaxis in a pregnant women without VTE history?

A 
Four of the following:
Age > 35
Body mass index > 30
Parity > 3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
Family history of unprovoked VTE
Low risk thrombophilia
Multiple pregnancy
IVF pregnancy

If three risk factors start LMWH from 28 weeks until 6 weeks postnatal

If diagnosis of DVT is made shortly before delivery, continue anticoagulation treatment for at least 3 month, as in other patients with provoked DVTs.

24
Q

When would you give anti-D in a termination of pregnancy?

A

Surgical management - anti D given

Medical management or pregnancy of unknown location - no need for anti D

25
Q

What percentage of mothers are Rh-ve?

A

15%

26
Q

What kind of hypersensitivity reaction is rhesus disease of the newborn and what antibodies mediate this type of hypersensitivity reaction?

A

Type II

IgM and IgG

27
Q

At what gestation do you give anti D to Rh -ve mothers?

A

28 and 34 weeks (double dose regimen, or just 28 weeks - depends on local policy)

28
Q

Name some situations in which anti-D would need to be adminsitered (within 72 hrs) to a Rh-ve mother

A

delivery of a Rh +ve infant, whether live or stillborn
any termination of pregnancy
miscarriage if gestation is > 12 weeks
ectopic pregnancy (if managed surgically, if managed medically with methotrexate anti-D is not required)
external cephalic version
antepartum haemorrhage
amniocentesis, chorionic villus sampling, fetal blood sampling
abdominal trauma

29
Q

Name the layers needed to cut through for a C section

A

Skin - superficial fascia - deep fascia - anterior rectus sheath - rectus abdominus muscle - transversalis fascia - extraperitoneal connective tissue layer - peritoneum - uterus (lower segement to minimise bladder damage?) with feather strokes to minimse danger of laceration of feotus

30
Q

Baby blues are seen in what percentage of women?

A

60-70%

3-7 days post delivery
More common in primimps

31
Q

Name a questionarrie to screen for postnatal depression

A

The Edinburgh Postnatal Depression Scale

32
Q

Postnatal depression affects what percentage of women

A

10%

Most cases start within a month and typically peaks at 3 months

33
Q

Postnatal depression management

A

CBT mainly
SSRIs can be used (secreted in breastmilk but not known to be harmful) but usually sertraline/paroxetine - not fluoxetine as this has a long half life (parotextine recommended due to low milk/plasma ratio)

34
Q

How common is vasa peavia?

A

Rare - 1 in 3000 (0.03)

35
Q

Contraindications to performing a vaginal examination in pregancy

A

suspicion of placenta praevia or infection

36
Q

Definition of uterine hyperstimulation

A

> 7 contractions/15 mins

37
Q

Gravidity definition

A

Number of times a woman has or is currently pregnant

38
Q

Parity definition

A

the number of times a woman has carried a pregnancy to viable gestational age (>24 weeks) even if baby is stillborn, twin pregnancy is jus counted as 1.

39
Q

How does a Kleihauer test work

A

e standard method of quantitating fetal–maternal hemorrhage (FMH). It takes advantage of the differential resistance of fetal hemoglobin to acid. A standard blood smear is prepared from the mother’s blood and exposed to an acid bath. This removes adult hemoglobin, but not fetal hemoglobin, from the red blood cells. Subsequent staining, using Shepard’s method,[3] makes fetal cells (containing fetal hemoglobin) appear rose-pink in color, while adult red blood cells are only seen as “ghosts”. 2,000 cells are counted under the microscope and a percentage of fetal to maternal cells is calculate

40
Q

From what gestation can you hear a fetal heart with a Pinard steth? Where should you listen over?

A

24 weeks

Feotus’ anterior shoulder

41
Q

At what gestation can a CTG be used and when would it be considered reliable?

A

28 weeks

42
Q

At what gestational age is the fundus palpable above pubis? at umblicus? xiphisternum?

A

12-14wks
20-22wks
36wks (then drops down >37wks as head engages)

43
Q

What are non rotational forceps called

A

Neville Barnes forceps (have a curved edge - this would damage soft tissues if used for rotation)

44
Q

What are the rotational forceps called and when would they be used

A

Kielland’s forceps
If baby wasn’t in occiptoanterior postion and second stage of labour was prolonged (>2 hrs in primimp or >1hr in multipimp)

45
Q

What is the maximum number of tractions used with instrumental delivery

A

3 tractions that are co-ordinated with maternal contractions

46
Q

Prerequistites for intstrumental delivery

A

Empty bladder (minimise risk of bladder injury), head below the level of the ischial spines/not palpable abdominally (i.e. positive station) analgesia

47
Q

At what level does the bHCG need to be for a feotus to be visible on TV and TA US? What is the peak HCG level and at what time? What does it go down to at term?

A

TV US bHCG needs to be >1500 to be visulised
TA US bHCG >6500

Peaks at 10 weeks (100,000) and drops to 10,000 at term

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