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O+G > Obs > Flashcards

Obs Flashcards

1
Q

anaemia cut off in pregnancy?

A

Hb <110

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2
Q

if Hb <110 in pregnancy, next step?

A

check ferritin
if <30 start iron and repeat FBC + ferritin in 6 weeks
if >30 check folate and B12

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3
Q

check FBC within 48 hours in postnatal women, if >____ then no treatment required

A

100

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4
Q

can you have a planned vaginal delivery with HIV?

A

yes depending on viral load
only offered if <40

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5
Q

recommended course of action in HIV +ve women if viral load >400 at 36 weeks?

A

pre-labour c-section
(between 39 and 40 weeks)

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6
Q

T/F: all HIV +ve women are given IV zidovudine during labour

A

false
depends on viral load and the ART given during pregnancy
if <20 (undetectable) at 36 weeks and adherent to ART, not required

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7
Q

when is IV zidovudine given to HIV+ women in labour?

A

viral load > 1000 (consider if between 40-1000)
untreated women with unknown viral load

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8
Q

T/F: babies born to HIV +ve mothers required PEP

A

true- duration and dose depends on risk

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9
Q

T/F: HIV +ve mothers can breastfeed regardless of viral load

A

false - safest way to feed infants in formula milk as there is ongoing risk

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10
Q

diagnostic criteria for hyperemesis gravidarum?

A

protracted N+V in pregnancy with the triad of >5% pre-pregnancy weight loss, dehydration and electrolyte imbalance

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10
Q

criteria for admission in HG?

A

Na <120
haematemesis
>10% pre-pregnancy weight loss
persistent vomiting/ ketosis after rehydration in day care
3 previous day case for rehydration admissions
haematemesis
severe abdo pain

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11
Q

avoid giving what type of fluids in HG?

A

dextrose containing fluids - high carb contents may precipitate Wernicke’s encephalopathy

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12
Q

T/F: IV pabrinex should be given to all women admitted to hospital with severe prolonged vomiting

A

True (once weekly, over 60 mins)

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13
Q

oculogyric crisis can occur with which antiemetics? treatment?

A

prochlorperazine or metoclopramide
Procyclidine 5mg IM or IV

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14
Q

pre-eclampsia defintion?

A

new hypertension after 20 weeks associated with significant proteinuria

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15
Q

all pts with PET should be admitted to hospital

A

true
also severe hypertension (SBP >160)

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16
Q

systolic blood pressure of what level requires treatment

A

> 150

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17
Q

T/F: early delivery should be considered in women with PET

A

true
if non-severe, consider from 37 weeks
if mod-severe, consider from 34-37 weeks
offer delivery within 48 hours if PET develops >37weeks

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18
Q

1st and 2nd line hypertensive therapy?

A

1) oral labetolol
2) oral nifedipine

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19
Q

why is vit K given to all babies after birth

A

vit K is needed for production of clotting factors
babies are relatively deficient in this and require vit K to reduce risk of serious bleeding including ICH

(1mg IM then 2mg oral within 6 hrs of birth, 2nd and 3rd doses at day 7 and 28 respectively)

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20
Q

who should be tested for gestational diabetes?

A

BMI >35
previous macrosomic baby
FH of diabetes in first degree relative

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21
Q

testing for gestational diabetes?

A

fasting BG and a OGTT of 75g between 24-28weeks

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22
Q

diagnosis of gestational diabetes
1) fasting glucose >___
2) 2 hours after OGTT >___

A

diagnosis of gestational diabetes
1) fasting glucose >5.1
2) 2 hours after OGTT >8.5

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23
Q

if a woman with gestational diabetes has a fasting BG <___ then they should first be offered a trial of lifestyle and diet modifications

A

7

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24
Q

treatment of mild hypoglycaemia in pregnancy (BG <4, mild symptoms)

A

15g of quick acting CHO e.g. 4 glucotabs, 60mls of glucojuice, 150ml fizzy juice
recheck in 15 mins
if >4 give 20g starchy carbohydrate snack e.g. sandwich/ banana

25
Q

treatment of moderate hypoglycaemia in pregnancy (BG <4, drowsy)

A

squirt glucoboost into sides of mouth
follow by 20g complex carb snack once swallowing ok e.g. 2 biscuits, slice of toast

26
Q

treatment of severe hypoglycaemia in pregnancy (BG <4, unconscious)

A

1mg IM glucagon
or
100ml IV 20% dextrose

reduce all insulin doses by 10%

27
Q

management of women with gestational diabetes requiring elective c-section

A

give use insulin dose the evening before
fast from midnight
put first on the list
rarely require sliding scale
if BM >8, delay

28
Q

monitoring and management of patients with gestational diabetes who have gone into spontaneous labour?

A

monitor BG hourly
if >8 commence sliding scale (specific maternal one)

29
Q

when is 3rd stage of labour considered prolonged

A

no placental delivery after 30 minutes of active management after birth or 60 mins is physiological management

30
Q

T/F: physiological management of 3rd stage of labour is first line

A

false active management first line, but can have physiological at the mothers request if low PPH risk

31
Q

what does active management of the 3rd stage of labour involve?

A

oxytocin if low risk (syntometrine if moderate/ high risk and BP normal)

32
Q

in pregnant women who also have signs of a DVT, what is the first line test

A

bilateral lower limb doppler

33
Q

imaging in ?PE

A

bilateral lower limb doppler if have signs of DVT too
if not do CXR to r/o other causes
if normal CXR do CTPA

34
Q

T/F: the radiation dose to the foetus from a CXR during pregnancy is negligible

A

true

35
Q

women should be fully counselled before undergoing a CTPA in pregnancy - why?

A

higher radiation dose to maternal breasts therefore higher risk maternal breast cancer (lifetime risk increased by up to 13.6%)- especially important if there is a family history of breast cancer

36
Q

T/F: d dimer testing should not be done in pregnancy

A

true

37
Q

take which bloods prior to commencing anticoagulant treatment for VTE in pregnancy

A

FBC, coag, UEs, LFTs

38
Q

T/F: warfarin is contraindicated in breastfeeding

A

false (but should be avoided until at least 3 days postpartum)

39
Q

treatment of choice for pregnant patients presenting with massive PE

A

unfractioned IV heparin
(thrombolysis with alteplase if arrested/ massive PE confirmed on imaging)

40
Q

in PROM >37/40, when would induction of labour be considered

A

after 24 hours (60% of women will go into labour before this point)

IMMEDIATE induction of labour offered in certain risk factors: significant meconium/ blood stained liquor, known GBS +, diabetes, evidence of infection, reduced foetal movements)

41
Q

T/F: induction of labour reduces risk of neonatal infection

A

false - only maternal

42
Q

T/F: digital examination in the absence of contraction should be avoided in PROM

A

true - increases risk of infection

43
Q

women who have GBS in a previous pregnancy have a ___% chance of having it again in subsequent pregnancy

A

50%

they should be offered intrapartum antibiotic prophylaxis or testing in late pregnancy and antbiotics if still positive

44
Q

who should receive Intrapartum Antibiotic Prophylaxis (IAP)?

A
  • in pre-term labour or
  • have group B strep colonisation, bacteriuria or infection during the current pregnancy or a previous pregnancy (without a subsequent negative swab in this pregnancy)
  • previous baby with invasive group B strep infection or
  • clinical diagnosis of chorioamnionitis
45
Q

when should IAP be given in relation to the birth?

A

where possible, at least 2 hours prior to delivery

46
Q

how long post SRM shoulder IAP be commenced?

A

48hrs

47
Q

do NOT administer syntocinin within __ hours following a vaginal prostaglandin

A

6

48
Q

how long is a syntocinin infusion continued for after delivery

A

at least an hour - decrease the rate by half every 15 minutes as long as the fundus is firm and the lochia normal

49
Q

anti-D should be given following sensitising events in RhD- NEGATIVE/ POSITIVE women

A

negative

(there’s no issues with blood incompatibility if a women is resus positive)

50
Q

examples of sensitising events requiring anti-D in RhD-negative women?

A

invasive prenatal diagnosis after 12 weeks
APH after 12 weeks
ECV
Any abdominal trauma after 12 weeks
Foetal death
Surgical/ medical TOP
Miscarriage after 12 weeks
Inadvertent administration of RhD-positive blood products
Surgical management of ectopic or molar pregnancy

51
Q

when is post-partum anti-D Ig given?

A

to all rhesus D negative women within 72hrs of delivery of a rhesus D positive baby

52
Q

what’s a kleihauer test used for? when to do it?

A

to determine if there is fetal blood in maternal circulation

within 2 hours of delivery and also following a sensitising event after 20 weeks

53
Q

in PPROM, ensure steroids are given if <___ weeks

A

34

also 10 days oral erythromycin

54
Q

T/F: expectant management in PPROM <37 weeks has better outcomes

A

true

perform twice weekly follow up inc CTG and FH
weekly CRP, FBC, LVS
contact triage if symptoms e.g. liquor changes colour, abdo pain, bleeding, fever

55
Q

T/F: blood should be taken for an antibody screen at 28 weeks regardless of rhesus status

A

true

56
Q

when is prophylactic anti D given?

A

to all Rh D-negative women by 30 weeks (even if they’ve previously received a dose following a sensitising event)

57
Q

management of a pregnant women exposed to chicken pox?

A

test for VCIG if unvaccinated/ no history of chickenpox

otherwise safety net and contact GP if rash develops

58
Q

management of cord prolapse

A

push presenting part off the cord by VE, do not remove fingers from vagina

call for help

prep for emergency c-section (or can delivery immediately if fully dilated)

tocolysis with 250mcg s/c terbutaline if any delay in delivery

59
Q

T/F: VE should be done in all women presenting with antepartum haemorrhage

A

false - do speculum exam but never VE until placental site established

O+G (2 decks)

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