Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Sheff 3a > Obs 2017 > Flashcards

Obs 2017 Flashcards

1
Q

When / what is done in the booking visit?
When is the combine test?
When is the anomaly scan?

A

Before 10 weeks - screen for complications
-urine culture, FBC, antibody screen, syphilis, rubella. HIV, hep b

11-13wks

18-21 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What does the combine test involve? Levels in downs ? Other disease it looks for? What is offered if there is a 1 in 150 risk of downs or more?

A

Blood sample

  • pregnancy associated plasma protein-A (PAPP-A)
  • Free B-hCG

Ultra sound scan
-Nuchal translucency

Downs - PAPPA=low, NT/BHCG=raised
Edwards

Another US and CVS or amniocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens in an anomaly scan (20 week scan)? What 3 things are measured ?

A 
US 
Shape of brain and head 
Check cleft lip 
Spine 
Abdo wall covers organs 
Heart 
Kidneys
Hands and feet 
Placenta

Will measure - head circumference, abdominal circumference, femur length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is amniocentesis?
When is it Safe?
What can it diagnose?
What is the risk?

A

Ultrasound guided removal of a sample of amniotic fluid
Safest from 15 week gestation
Can diagnose chromosomal abnormalities, infections (e.g. CMV), inherited disorders (e.g. sickle cell anaemia, cystic fibrosis)
Risk of miscarriage (1%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is cvs? When can it be done? What advantage over amniocentesis?

A

Biopsy of trophoblast
Done after 11 weeks
Earlier than amniocentesis so abortion could still be performed if abnormality identified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment of pulmonary oedema as a complication of pre eclampsia

A

Furosemide, oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Maternal complications of pre eclampsia?

A

Eclampsia: grand mal seizures, Tx magnesium sulphate
Cerebrovascular haemmorhage
‘HELLP’ syndrome: Haemolysis, Elevated Liver enzymes, Low Platelets
Other: DIC, liver failure, liver rupture
Renal Failure
Pulmonary oedema, Tx furosemide, oxygen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Fetal complications of pre eclampsia

A

IUGR
Placental abruption
Preterm birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3 aspects of screening / prevention of pre eclampsia

A

Regular BP and urinalysis checks, uterine artery doppler, 75mg aspirin starting before sixteen weeks in high risk women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Mx of pre eclampsia
When do you use antihypertensives?
Steroids?
Delivery time?

A

Antihypertensives if BP >150/100,

Steroids if moderate/severe at <34wks

Delivery: Mild by 37 wks, moderate/severe 34-36 wks, maternal complications deliver whatever the gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which type of maternal antibody crosses the placenta in RBC isoimmunization?

A

IgG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What scalp pH would indicate significant fetal hypoxia

A

<7.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

4 methods of induction

A

Prostaglandins:
Prostaglandin E2 gel
Inserted into the vagina posterior to the cervix
Starts labour or alters the ripeness of the cervix allowing amniotomy

Amniotomy:
Artificial rupture of the membranes using an amnihook

Natural Induction:
Cervical sweeping
Use of finger to strip between membranes and uterus

Oxytocin:
Used alone if there is spontaneous rupture of membranes or following amniotomy after around 2 hours if labour hasn’t started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ix and management of placenta previa

A

Investigations
FBC, U&E, Clotting, Group and save
USS
CTG

Management
Admit (until delivery if previa)
Resuscitation 
Steroids
Anti-D (if resus negative)
C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Absolute CI to VBAC ?

A

Placenta/vasa previa

Cephalopelvic disproportion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

4 ways f preventing vertical transmission of HIV?

A

Maternal ART
Elective C/S
Avoid breast feeding
Neonatal ART

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is in the quadruple test for downs?

A

B-hCG, AFP, Inhibin-A and free estriol 3 (after 14 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Vomiting in pregnancy in around 50% but what is hyperemesis gravidarum ? Mx?

A

Severe vomiting with dehydration and electrolyte abnormalities

IV rehydration, anti-emetics, thiamine and psychological support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Cause? Diagnosis and mx of gestational diabetes?

A

Increased insulin resistance

Glucose tolerance test at 24-28 weeks
Metformin 1st line
Insulin 2nd line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Intrahepatic cholestasis of pregnancy ix? Risk? Mx?

A

LFT
Bile acid levels

Risk of premature birth

Induce at 37 weeks
Ursodeoxycholic acid
Vit k if prolonged clotting

21
Q

Physiological changes in pregnancy

A

CV

  • Increase CO, HR
  • Decrease serum albumin
  • Increase in coagulation
  • Vena cava compression by uterus

Kidneys
-Increase GFR

Lungs
-Increase tidal volume and resp rate

GI

  • n+V
  • delayed gastric emptying
  • prolonged small bowel transit time
22
Q

Mx of PPH

A

ABC

Retained placenta  removal if not expelled in 60 mins

Atony  PGF2a into the myometrium

EUA

Rescue methods
Rusch balloon
Brace suture
Hysterectomy

23
Q

Usual cause of of perinatal sepsis and chorioamnionitis?

A

Group A strep

24
Q

Risks of HIV in pregnancy? Prevent transmission by?

A

IUGR, Still birth, pre-eclampsia, prematurity (gestational DM in mother)

Preventing vertical transmission 
Maternal ART
Elective C/S
Avoid breast feeding 
Neonatal ART
25
Q

Parovirus b19 causes?

A

Anaemia

26
Q

Tobacco in pregnancy?

Cocaine?

A

Tobacco
increase miscarriages, prematurity, PROM, abruption and praevia

Cocaine
= abruption in examland

27
Q

What is gravity and parity?

A

Gravidity: The number of pregnancies that a woman has had, to any stage.
Parity: The number offspring that a woman has delivered beyond week 28.

28
Q

Method of reducing pain in labour without drugs?

A

Waterbirth

29
Q

When is entonox (NO) CI?

A

Pneumothorax

30
Q

What narcotic injection can be given in labour? When should it not be given? How to reverse?

A

Pethidine IM 50-150mg

Not given if birth expected in 2 hours - due to neonatal respiratory depression

Naloxone to reverse

31
Q

When do you need to be careful with epidural?

A

In mothers receiving heparin

32
Q

What can be used for instrumental delivery for pain relief?

A

Pudendal block

-lidocaine injected into area containing sacral nerve routes

33
Q

2 types of small for GA?

A

Constitutionally small - Approriate size for maternal size and ethnicity

IUGR - growth is normal in early part and then slows by at least 2 measurements

34
Q

Maternal and fetal RF for IUGR

A 
Maternal 
Age
Maternal weight extremes 
Smoking 
Alcohol 
Hx 
Anaemia 
Hypertension 
Fetal 
Multiple gestation 
Chromosomal 
TORCH infection 
Placental dysfunction
35
Q

Mx of IUGR ?

Complications ?

A

Increased monitoring
Umbilical artery Doppler

Short term

  • Meconium aspiration
  • hypothermia
  • Feeding difficulties
  • jaunduce
  • NEC

Long term
-Learning difficulties, CP

36
Q

Define hyperemisis gravidarum

A

Persistent vomiting in pregnancy which causes weight loss and ketosis

37
Q

Rf for hyperemesis?

A

Young
Primi
Hyperthyroid
Multiple pregnancy

38
Q

Define chronic hypertension?

Gestational hypertension?

A

Chronic Hypertension: HTN pre-dating pregnancy or which develops before 20 weeks gestation.

Gestational Hypertension: HTN after 20 weeks gestation which is not complicated by proteinuria.

39
Q

Mx of chronic hypertension in pregnancy

A

STOP ACEi, ARB

Give labetalol aim for <150/90
Give aspirin from 12th week

40
Q

Reversal of magnesium toxicity if given?

A

Calcium glucornate

41
Q

Define placenta acretta? Next 2 severities?

Mx?

A

Placenta accreta: chorionic villi penetrate the decidua basalis to attach to the myometrium.
Placenta increta; the villi penetrate deeply into the myometrium.
Placenta percreta: the villi breech the myometrium into the peritoneum.

C section ± hysterectomy

42
Q

Ectopic Ix? Mx?

A

Investigation
TVUS
Repeat
Management
Medical: Oral methotrexate to cause fetal death (warn of pain and ensure f/u arranged)
Surgical
Salpingectomy – remove entire tube and fetua
Salpingotomy – remove affected section of tube only (allows fertility to be preserved)

43
Q

Rf for PPH.

A 
Bmi >35
Uterine malformations / fibroids 
Antepartum haemairrhage 
Prolonged labour 
Use of oxytocin
44
Q

Management of primary PPH

A

Give oxytocin 5u slowly (IV)
Give high flow oxygen

If signs of shock (ABCDE approach), give Gelofusine or Blood transfusion (ideally matched but O –ve in emergency)

Is the placenta delivered? If not – explore uterus.

Is there trauma? If so – correct.

45
Q

MX of retained placenta if uterus well contracted? If bulky?

A

If the uterus is well contracted, the placenta is probably separated but trapped by the cervix. Wait for the cervix to relax, and release the placenta.

If the uterus is bulky, the placenta may have failed to separate:
Rub up a contraction
Give 20u oxytocin into umbilical vein
If still no placental delivery after 30 min, consider need for manual removal.

46
Q

Manual removal of placenta how?

A

Epidural
Use a hand and separate placenta

Prophylactic Abx (Doxy and metronidazole) are required

47
Q

Classic sx of amniotic fluid embolism ?

Mx?

A

Sudden dyspnea and hypotension
±seizures, DIC, Pulm oedema

1- Prevent death from respiratory failure: Oxygen +/- ventilatory support
2- Obtain IV access in case DIC develops.
3- If hypotensive give fluids rapidly, but don’t over hydrate to avoid pulmonary oedema.
4- Transfer to ICU
5- If the mother dies, peri-mortem CS is indicated, and this may aid resuscitation of the mother.

48
Q

Indications for operative delivery

A

Delay or exhaustion in second stage
Reduced urge to push - eg epidural
Malposition of head
Fetal distress

Sheff 3a (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions