OB Flashcards
Congenital Rubella Triad
Congenital Heart Disease
Cataract
Deafness
Extent of Damage In Rubella
First Trimester - Severe Damage
11 - 20 Weeks - Deafness Risk Only
20+ Weeks - Minimal Damage Risk
Slapped Cheek / Fifth Disease Caused By
Parvovirus B19
Most Common Congenital Infection
Cytomegalovirus
Fetal Varicella Syndrome (4)
Dermatomal Skin Scarring
Eye Defects
Limb Hypoplasia
Neurologic Abnormalities
Congenital Toxoplasmosis Triad
Intracranial Calcification
Hydrocephalus
Choroidoretinitis
Ophthalmia Neonatorum Management
Resolves Spontaneously
Saline / Water Only
Gonococcal Neonatal Conjunctivitis Presentation
Within 5 Days
Purulent Discharge
Chlamydial Neonatal Conjunctivitis Presentation
6 - 14 Days After
Mucopurulent
Gonococcal Neonatal Conjunctivitis Diagnosis & Treatment
Microscopy + Culture
Cefotaxime
Chlamydial Neonatal Conjunctivitis Diagnosis & Treatment
NAAT
Erythromycin / tetracycline
Umbilical Granuloma Management
Silver Nitrate
Sepsis
Infection + Systemic Manifestations of Infection
Severe Sepsis
Sepsis + Organ Dysfunction / Tissue Hypoperfusion
Septic Shock
Hypoperfusion despite adequate Fluid Replacement
Butterfly Pigmentation of Face
Chloasma Gravidarum
Urinary Changes In Pregnancy (2)
Dilation of Ureters (Estrogen Effect)
Increase in Micturition Frequency
(Due to pressure of uterus on Bladder)
GIT Changes in Pregnancy
Emesis Ptyalism (Increased Salivation) Heart Burn (Relaxation of Sphincter) Reduced Gut Motility / Constipation Gall Bladder Relaxation (Stone Formation)
Hematological Changes In Pregnancy
Increase in Clotting Factors 5/8/10 / Fibrinogen
Protein C Resistance
Reduced Protein S
Venous Stasis
Gestational Hypertension
Hypertension Only Occurring < 20 Weeks
Preeclampsia
Hypertension + Proteinuria >20 Weeks
Eclampsia
Preeclampsia + Seizures
Chronic Hypertension
HT Diagnosed Before Pregnancy or <20 Weeks
Superimposed PE
Preeclampsia + Chronic HTN
Hypertension in Pregnancy Values
> 140 / 90 (HTN)
> 160 / 110 (Severe)
HTN Prevention in High Risk Women
Aspirin 75-150
PE Proteinuria
> 0.3g in 24 Hours
1+ UA
0.3 Protein / Creatinine
What is given in Eclampsia to stop fit?
Magnesium Sulphate
Fetus Management in Eclampsia
Deliver once Mother Stabilized
Thunderclap headache is Associated with
Sub Arachnoid Hemorrhage
Reversible Cerebral Vasoconstriction Syndrome
Reversible Cerebral Vasoconstriction Syndrome
Multifocal Arterial Constriction + Dilation Post Partum
RCVS Symptoms
Nausea Photophobia Confusion Blurred Vision Thunderclap
RCVS Treatment
Calcium Channel Blockers
Corticosteroids
Magnesium Sulfate
Infants of HBsAg+ Mothers Precautions
HBIG + First Dose of Vaccine 0/1/6 Months within 12 Hours of Birth
Which Hepatitis B Marker Indicates Infection
HBsAg
(Surface Antigen)
(Acute or Chronic Infection)
What is given to Pregnant Mothers with HBsAg
Tenofovir
(28th Week - Birth)
(To Prevent Mother-Child Transmission)
First Trimester HG Cutoff
110
Second / Third Trimester HG Cutoff
105
Postpartum HG Cutoff
100
Aspirin Preeclampsia Prophylaxis
75mg 12 Weeks till Delivery
Preeclampsia First Line
Labetalol
PE First Line (Asthmatic)
Nifedepine
When is external cephalic version Offered To Breech Position Babies ?
36 Weeks
Intrahepatic Cholestasis of Pregnancy Management
Ursodeoxycholic Acid For Symptoms
Induction of Labor at 37/38 Weeks (Due to increased risk of stillbirth)
Greatest RF of Prolapsed Cord
Artificial Rupture Of Membranes
Why is first baby unaffected if RH+
First Baby IgM Produced
Second Baby IgG Produced which cross Placenta
Congenital Hemolytic Anemia
Hemolysis that results in Fetal Anemia Two Weeks After Birth
Also Called Erythroblastosis Fetalis
Icterus Gravis Neonatorum
Baby is anemic but not jaundiced
Hepatosplenomegaly
Kernicterus develops if Bilirubin exceeds 20
Hydrops Fetalis
Intrauterine Fetal Death
Severe Hemolytic Anemia that leads to HF
Function of Direct Coombs Test
Detects Antibodies absorbed to RBC
Glycoprotein Produced by Yolk Sac + Fetal Liver
AFP
Increased AFP Indicates
NTDs
Turner
Decreased AFP Indicates
T21
Increase in HCG Indicates (Disease)
Trisomy 21
PAPP-A Level in Downs Syndrome
Decreased
Estriol Level in Downs Syndrome
Decreased
What is the Double Marker Test
hCG + PAPP-A
When is the Combined Test Performed?
11-13 Weeks
Downs Syndrome Markers
Increased Nuchal Translucency
Reduced PAPP-A
Increased hCG
What is considered Increased Nuchal Translucency
Greater than 3.0mm
Combined Test vs Triple Marker Test
Combined (NT / PAPP-A / hCG) Triple Marker (AFP / hCG / UE3)
When are Anomaly Scans done?
1st (11-13 Weeks)
2nd (18-22 Weeks))
When can CVS be Done?
11 Weeks
When can Amniocentesis be done?
14-16 Weeks
When can Cordocentesis be perfomed?
20 Weeks
Folic Acid Recommendation for Epileptic Mothers
5 mg Daily (Preconception - 12 Weeks)
Vitamin K Recommendations Epileptic Mothers
20mg Orally (36 Weeks - Delivery) 1mg (IM at Birth)
Effect of Antiepileptic Medication on POP?
Reduces efficacy
Double Dose
Effect of AEDs on Depo-Provera
Reduce interval from 12 to 10 Weeks
Management of Preterm Delivery in Woman Who takes AEDs
Double Steroid Dose (25 - 48mg)
Commence Vitamin K (20mg)
How are fits in Labor Managed?
IV Diazepam 10-20mg
Side Effect of Carbamazepine
Interferes with Folate Metabolism
Take 5mg Folic Acid
Which Coagulation Factors Increase in Pregnancy
VII / VIII / IX / X
7 / 8 / 9 / 10
Which Imaging Tool is used to evaluate DVT in pregnant women
Compression Venous US
Management according to VTE Scoring
Admitted Pregnant - LMWH
2 - LMWH 10 Days Post Partum at least
3 - LMWH 28 Weeks till 6 Weeks Post Natal
4+ - LMWH Antenatal Period + 6 Weeks Post
Definitive Diagnosis of Pulmonary Embolism
VQ Scan
Or
Pulmonary Angiography
Diagnosis of Antiphospholipid Syndrome
Thrombosis
Unexplained Death 10 Weeks
1+ Preterm Births <34 Weeks
ACA antibody
B2 GP Antibody
C Lupus Anticoagulant
Antepartum Management APS
24 Urine Collection
Maternal Echo (Rule Out Endocarditis)
LFT (Biliary Cirrhosis / Budd Chiari / HELLP)
Anticoagulation Therapy
Low Dose Aspirin
LMWH (Switch to Unfractionated at 36 Weeks)
Asymptomatic Bacteriuria of Pregnancy Management
Ampicillin (10 Days Course)
Most Common MO in Pyelonephritis in Pregnancy
E Coli
Pyelonephritis Management
Ampicillin
Cystitis Management
Nitrofurantoin 100mg Nightly
Or
Cephalexin 250-500mg Nightly
Dichorionic / Diamniotic Split
2 Days
monochorionic/diamniotic
placentation
3-8 Days
monochorionic/monoamniotic
placentation
9-12 Days
Conjoined Twins
12 Days
Twin-to-twin transfusion syndrome Treatment
IU Laser Ablation
When to Offer Birth
d-d
m-d
m-m
D-D 37 Weeks
M-D 36 Weeks
M-M 32-34 Weeks
M-M Delivery
C Section Only
Mode of Delivery in DD & MD
C Section Unless
(First Twin Cephalic
No Significant Size Difference
No Contraindications)
Mode of Delivery MM
C Section Only
How is Amniotic Fluid Volume Assessed
Single Deepest Pocket
4 Quadrant Method
Single Pocket Measurement
Below 2 Oligohydramnios
Over 8 Polyhydramnios
Amniotic Fluid Index
Less than 5 Oligohydramnios
More than 25 Polyhydramnios
Polyhydramnios
AFI Greater than 25
Pocket Greater than 8
Fetal Factors in Oligohydramnios
Malformations / Anatomic Anomalies Fetal Anemia Multiple Pregnancies Infections Idiopathic
Treatment options Oligohydramnios
Majority - No Intervention Required
Amnioreduction (Therapeutic Amniocentesis)
Pharmacological Treatment (Indomethacin)
Pharmacologic Treatment of Polyhydramnios
Indomethacin (After 32 Weeks)
Oligohydramnios
Vertical Fluid Pocket - Less than 2
AFI Less than 5cm
Oligohydramnios Treatment
Maternal Hydration
Amnioinfusion
Define Preterm Birth
Birth before 37 Weeks
When does a fetus become viable
24 Weeks
Placenta Accreta
Placenta Attaches too firmly to Uterus
Placenta Increta
Placenta Attaches deeply into Muscle Wall of Uterus
Placenta Percreta
Placenta attaches and grows through uterus
Can be to near organs
Vasa Previa management
Planned Cesarian Delivery 34-36 Weeks
CS for Lung Maturity 32 Weeks
Placenta Delivery
12-30 Cotyledons
2 membranes
2 Arteries + 1 Vein
Cord Insertion
When is ECV offered ?
36 Weeks
Early detection of Ectopic Pregnancy
5 - 8 Weeks
When can a gestational sac be detected
4/5 Weeks
When can Yolk Sac be seen
5 Weeks
When can Fetal Pole be seen
6/7 Weeks
When could cardiac activity be detected
6/7 Weeks
Oxytocin Challenge Test
Monitor Fetal HR Changes on CTG in response to Oxytocin
Rarely used nowadays
OCT Interpretation
Positive - Decelerations after Uterine Contractions
Negative - No FHR Changes
Drugs to induce ovulation
Clomiphene Citrate
Tamoxifen
Letrozole
Clomiphene Citrate method of action
Similar to estrogen
Increases GnRH - Increasing FSH - Increasing Estrogen - Increasing LH - Leading to ovulation
Pituitary Gonadotrophins for induction of ovulation
HMG (75 FSH + 75 LH)
Ovarian Hyperstimulation
Clomiphene Citrate - Grade 1/2
Pituitary Gonadotrophins - Grade 3/4
hCG for ovulation induction method of action
Strong LH action - Surge - Ovulation
2 Ampoules 5000IU IM
Adjuvant drugs to assist ovulation induction
Bromocryptine - Hyperprolactinemia
Metformin - Insulin Resistance
Eltroxin - Hypothyroidism
CS - Addisons / PCOS
When is ovarian drilling done?
Cases requiring large HMG doses
Cases that respond with severe OHSS
Define secondary infertility
6/12 Months - Ectopic / Abortion
1/2 Years - Term Birth
Abnormal semen analysis management
Confirm after three months
Severe abnormality
Repeat as soon as possible
Erectile Dysfunction 1st Line
PDE5 Inhibitors
or
Vacuum Devices
Erectile dysfunction 2nd line
Intracavernous injections
Intraurethral alprostadil
Erectile Dysfunction 3rd Line
Penile Prosthesis implantation
Primary Syphilis
Genital / Mouth Ulcer
Secondary Syphilis
Rash / Constitutional Symptoms / Lymphadenopathy
How to screen for syphilis
Specific / Treponemal Test
Syphilis Treatment
Penicillin / Doxycyline
Syphilis Transmission
Mucosal Lesions
Oral / Vaginal / Anal
Even with condoms
Describe Syphilis Rash
Macular or Papular
Not Itchy
Tertiary Syphilis
Neuro
Cardio
Gummata - Necrotic Skin / Bone
Syphilis Direct Test
Treponema Pallidum PCR
Syphilis Screening Test and Confirmatory Test
Screening Test - EIA Enzyme Immunosorbent Assay
Confirmatory Test - TPPA - Particle Agglutination Assay
What are the treponemal tests
TPPA
EIA
Non treponemal tests
RPR / VDRL
Syphilis Stages
Primary - Highly Infectious Chancre
Secondary - MP Rash
Latent - +ve Test / No Signs
Tertiary - Neuro / Cardio / Gummas
Definitive Syphilis Diagnostic Test
Dark Field Microscopy - Spirochetes
Syphilis Serology
EIA - 14/21 Days
TPPA - 21/28 Days
RPR - 28 Days
Treponema Pallidum PCR
Highly Sensitive / Specific
Positive Test = Early Syphilis