Brainscape's Knowledge GenomeTM

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


See full index

FPE > Obs > Flashcards

Obs Flashcards

1
Q

At what point is the uterus palpable in a pregnant patient? At what point does it cross the umbilicus?

A

12/40

20/40

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

How can pregnancy be dated with scanning? Specifics!

A

USS - 14wks bipariatal diameter

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

What rule allows the dating of pregnancy without a scan? What is it?

A

Naegele’s rule

1st day of LMP + 7 days + 9 months

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

Limitation of naegele’s rule

A

Assumes regular cycles

Assumes can remember 1st day of LMP

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

Why is dating important in pregnancy

A

Know when baby is overdue
Know when baby is viable (for resus if over, can abort if under - crude!)
Can monitor for normal development

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

When would USS first see something in pregnancy?

When would a heart be first detectable?

A 
5 weeks (foetal sac)
6 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What routine USS are done in pregnancy?

When?

A

Dating 11-14/40

Abnormality 18-20/40

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

Why should overdue babies be induced? When is it offered?

A

Placental function decreases
Offer at 40+7
Always at 40+14

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

What increase should be seen in betaHCG in a normal pregnancy? What do variations in this suggest?

A

Double every two days
Less than this suggests ectopic
Dropping suggests failing pregnancy

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

Problems with alcohol in pregnancy

A

Foetal alcohol syndrome

Increased miscarriage

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

Problems with smoking in pregnancy

A

Miscarriage
Preterm labour
Small for date
Placenta pravia and abruption

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

When should folic acid supplementation commence and end in pregnancy

A

1 month pre conception until 14 weeks

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

What should trigger high dose folic acid in pregnancy

A 
Previous neural tube defect
Antiepileptics 
Obese 
Diabetic 
HIV +ve on co-trimoxazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When would a pregnancy test be positive?

A

Day 9 to 20 weeks

5 days post foetal death or miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What should be considered when examining a patient with placenta pravia? Concomitant lifestyle advice?

A

Don’t examine PV

Avoid penetrative sex

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

Risk factors for placenta previa

A 
>40
Previous c-section 
Fibroids 
Multiple pregnancy 
Multiparity 
Assisted conception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of placenta praevia

A

Major (covering OS) - needs c-section

Minor - aim for PV but may need c-section

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

Presentation of placenta praevia

A

Antepartum haemorrhage

Failure of head to engage

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

What placental problem can accompany placenta praevia? What is it? Problem?

A

Placenta accreta
Invasion of the placenta into the myometrium
Heavy bleeding

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

When should LMWH be considered in pregnancy? Duration?

A

Two or more risk factors - post labour for 7 days
Three or more risk factors - from as early as possible to 6 weeks post partum
OR
BMI >40 or caesarian - post delivery for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dietary advice in pregnancy

A 
Pasturised milk only
No ripened or mouldy cheese
No pate
Undercooked food
Raw eggs
Raw meat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When will morning sickness generally pass by?n

A

16-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Non pharmacological and pharmacological methods to reduce morning sickness?

A

Ginger
Wrist accupresure
Antihistamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Treatment for varicose veins in pregnancy

A

Compression stockings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What should raise suspicion of candidiasis in vaginal discharge during pregnancy? Treatment?

A

Itch
Sore
Offensive smell
Dysuria

Topical imidazole. No oral antifungals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Routine bloods on booking

A

FBC
Group and save
Haemoglobinopathy screen in at risk groups
Hep B, syphalis and HIV screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the screening tests for downs syndrome?

A 
1st trimester (11-13 weeks) perform combined test measuring nuchal translucency with HCG and PrAP-A combined with patient age to stratify risk 
2nd trimester (15-20 weeks) perform quadruple test measuring AFP, estriol, HCG, inhibin A and combine with patients age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Above what risk will invasive testing for downs be performed?

A

1:150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Symptoms of pregnancy

A

Lethargy
Morning sickness
Amenorrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What should you advise a patient wanting to take nsaids in pregnancy? Why?

A

Try to avoid and definitely not in 3rd trimester

In utero closure of ductus arteriosus and fetal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is hyperemesis gravidarum? Risk factors?

A

Persistant vomiting in pregnancy with weight loss and ketosis
- young, non-smoker, primip, diabetes, psychiatric illness, family history, multiple pregnancy and molar pregnacy (high HCG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What complications are patients with hyperemesis gravidarum at risk of?

A 
Dehydration and shock
Postural hypotension and collapse
Electrolyte disturbance (hypokalaemia and hyponatraemia) 
Malnutrition 
Liver and renal failure 
Hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Tests in hyperemeisis?

A

FBC, U+E, LFTs, TFTs
TVUSS (twins? Molar?)
Postural BP
Urine dip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Conservative Treatment of hyperemesis gravidarum

A

Ginger
Bland food
Rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Medical treatment of hyperemesis gravidarum in order of use

A 
Thromboprophylaxis 
Thiamine supplementation
IV fluids and urine output
Cyclizine 
Hydrocortisone and prednisolone 
Parenteral nutrition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Definition of preeclampsia with diagnostic values

A

Hypertension (>140/90 x3) with proteinuria (dipstick >1+ or 1+ with raised PCR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Risk factors for pre eclampsia

A 
Maternal age
PMH (sle, dm, htn, ckd)
FHx
Obesity 
Multiple pregnancy 
Primip
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Management of someone with risk factors of preeclampsia presenting early in pregnancy.

A

Aspirin if one major (pmh) or 2 minor risk factors from week 12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Presentation of pre-eclampsia?

A 
Asymptomatic 
Headache, visual disturbance (increased icp) 
SOB, frothy sputum (pulmonary oedema) 
PE/DVT (hypercoagubility) 
RUQ pain (liver capsule stretch) 
Peripheral oedema 
Decreased fetal movements (fetal growth restriction)
Hyperreflexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Complications of preeclampsia

A

Subarachnoid haemorrhage (sudden severe headache)
Placental abruption (severe abdo pain +/- pv bleed)
HELLP
Seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Why are preeclamptic patients susceptible to clotting?

A

Endothelial damage causing renal failure and loss of antithrombin 3, also resulting in DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Investigations in suspected preeclampsia

A 
FBC (Hb and platelets)
U+E (creatinine and K+) 
Clotting
LFTs (albumin, bilirubin, ALT) 
Urine dip and MSC
CTG / USS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Why do Hb, K and bilirubin in preeclampsia?

A

Risk of HELLP thus haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is HELLP

A

Haemolysis, elevated liver enzymes, low platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is severe preeclampsia

A

BP >160/110 or >140/90 with symptoms / severe signs (HELLP, papilloedema, clonus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Management of severe pre eclampsia

A

Prophylactic magnesium sulphate
Catheterise and fluid restrict
Decrease BP
Deliver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Drugs to lower BP in pregnancy and contraindication

A

Nifedipine
Methyldopa - mental health
Labetalol - asthmatics (also decreases hypo awareness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What medication can be used IV to rapidly lower BP?

A

Hydralazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Complications of preeclampsia on delivery?

A

BP too high - tube causes reflex HTN - stroke
Low platelets - spinal bleeds
DIC - severe PPH snd DVT/PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is a complication of magnesium therapy in preeclampsia? Reversal?

A

Arrhythmia and resp depression
Patients become hyporeflexic
Reverse with calcium gluconate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Definition of primary and secondary PPH

A

Blood loss of >500ml
1o within 24 hrs of delivery
2o after 24 hrs of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Definition of massive haemorrhage?

A

> 1.5L not controlled

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What four factors contribute to PPH?

A

Thrombus (lack of!)
Tone (atony!)
Trauma
Tissues (retained!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Causes of uterine atony resulting in PPH

A

Exhaustion - prolonged labour, uterine infection

Overstretch - induction, multiple pregnancy, macrosomia, polyhydraminos, fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Traumatic causes of PPH

A

Episiotomy or tear
Macrosomy
Instrumentation
Previous c-section

56
Q

Medical treatment of PPH

A 
External massage
Bimanual compression
IM syntocinon
IV syntocinon infusion
IM ergometrine
IM carboprost 
PR misoprostal
57
Q

Surgical treatments of PPH

A

Balloon compression
Uterine artery ligation
Brace sutures
Hysterectomy

58
Q

Major side effect of ergometrine

A

Significant BP increase

59
Q

Main cause of secondary PPH

A

Infection or retained products

60
Q

Big risk post resolved PPH , why, tx

A

DVT/PE
Massive transfusion, hard to balance clotting,
Give LMWH after 24 hrs

61
Q

Management of placenta accreta

A

Conservative - leave and will reabsorb
Surgical - hysterectomy
Medical - all on ABX as will need lots of examinations

62
Q

Effect of maternal diabetes on the fetus and mechanism

A
  • High maternal BM
  • High fetal BM - polyuria - POLYHYDRAMINOS
  • High fetal insulin - fetal growth - MACROSOMIA
  • Macrosomia + maternal small vessel disease placental insufficiency FETAL HYPOXIA, GROWTH RESTRICTION
  • Fetal hypoxia - MISCARRIAGE, STILL BIRTH, POLYCYTHEMIA
63
Q

Specific fetal abnormalities associated with maternal diabetes

A

Sacral agenesis

Cardiac abnormalities

64
Q

Risks and problems to mother of diabetes during pregnancy?

A

Must switch to insulin (+/- metformin)

High risk of DKA in T3

65
Q

Complications for mother and fetus in maternal diabetes for stage 1/2 labour

A

Hypo/hyperglycaemia
Abnormal lie 2o polyhydraminos
Shoulder dystocia due to macrosomia

66
Q

In maternal diabetes risks to mother in 3rd stage labour. Important info to know in managing this?

A

Sudden decreased insulin requirements thus hypoglycaemia

Must know what tx on before pregnancy - go back to that!

67
Q

In maternal diabetes, risks to baby once born. Management?

A

Large pancreas thus hypoglycaemia and hypercalcaemia - feed quickly and lots!
Polycythemia - haemolysis - jaundice

68
Q

What problems does pregnancy pose to screening for diabetes?

A

Glycosiuria and ketonuria are normal during pregnancy

69
Q

Who should be screened for gestational diabetes?

A

FHx
Previous GD
Previous miscarriage or stillborn

70
Q

How can a baby in breech be delivered?

A

Deliver PV breech
C-section
External cephalic version and PV delivery

71
Q

Risk of complications delivering breech PV?

A

1:20

72
Q

When would external cephalic version be carried out? Where? Risks?

A

36-37 weeks
Delivery suite
Fetal distress mandating delivery

73
Q

What meds would you give prior to external cephalic version?

A

Ranitidine incase of csection need

Anti d if rh neg

74
Q

Success rate of external cephalic version

A

50-60% can be turned

5% then turn back

75
Q

Can external cephalic version be repeated? Anything different?

A

Yes! Can be done under epidural

76
Q

Complications of multiple pregnancy?

A 
Increased risk of pre eclampsia 
Increased risk of anaemia 
Premature labour
Increased risk of non cephalic presentation 
Increased risk of PPH 
Increased risk of small baby 
Twin to twin transfusion
77
Q

What medications will patients with multiple pregnancies tend to recieve?

A

Iron supplementation

78
Q

How will multiple pregnancies tend to be delivered?

A

Twins - PV but second often needs instrumentation or csection
Triplets or more - csection

79
Q

Presentation of obstetric cholestasis? When in pregnancy?

A

Generalised itching, worse on palms and soles, worse at night, mild jaundice or dark urine may occur
Usually post 28 weeks

80
Q

Diagnosis of obstetric cholestasis

A

LFTs and bile acids

USS to rule out gallstones

81
Q

Effect of obstetric cholestasis on fetus?

A

Increased chance of merconium in waters, premature birth and stillbirth (very slight if at all)

82
Q

Conservative treatment of obstetric cholestasis

A

Skin creams, keep nails short, cool baths, loose fitting clothes

83
Q

Medical treatment of obstetric cholestasis

A 
Vit K due to liver disfunction 
Skin creams
Antihistamines to aid sleep
Ursideoxycholic acid 
Induce at 37 weeks roughly
84
Q

Follow up advice for obstetric cholestasis post delivery

A

GP in 2 months to check lfts
45-90% chance of repeat next pregnancy
Can be best to avoid COCP

85
Q

Contraindications to fetal blood sampling

A

BBV
Fetal blood disorder
Malpresentation

86
Q

When would fetal blood sampling be performed? When would it not be performed (not a contraindication)

A

Signs of fetal distress

Dont do in fetal bradycardia - needs delivery whatever the result

87
Q

Complications of fetal blood sampling

A

Infection, trauma to somewhere not intended (mother or fetus), bleeding

88
Q

Interpretation of pH in fetal blood sample with action

A

> 7.24 - normal

7.2-7.24 - repeat in 30 minutes once

89
Q

What is the medical term for breaking the waters? Indications?

A

Amniotomy

Induction of labour, prolonged stage 1 labour, suspicion of merconium

90
Q

Why does an amniotomy result in induction of labour?

A

Releases prostoglandins

91
Q

Complications of amniotomy

A

Injury to cervix

Cord prolapse

92
Q

Disadvantages of pinnard use?

A

User variability
Not real time for everyone in room
Hard with multiple pregnancies

93
Q

Contraindications to fetal scalp electrode use

A

BBV, bleeding disorder, malpresentation

94
Q

Complications of fetal scalp electrode use

A

Infection, injury to mother, injury to baby

95
Q

Indications for instrumental delivery

A 
>2 hrs stage two labour 
Fetal compromise at full dilatation 
Unable to push (eg paralysis) 
Risk of pushing (eg pre-eclampsia, high ICP) 
Aiding delivery of breech
96
Q

What should be done prior to an instrumental delivery?

A

Empty the bladder

97
Q

Contraindications to an instrumental delivery

A

Cervix not fully dilated

Cephalopelvic disproprotion

98
Q

Complications of instrumental delivery

A

Injuries to baby or cervix

Uterine rupture

100
Q

Risk factors for preterm labour

A 
Previous Hx
Multiple pregnancy (low space) 
Polyhydraminos (low space) 
Uterine abnormality (low space)
UTI
PPROM (usually 2o subclinical chorioamnoitis) 
Extremes of age
101
Q

Definition of labour

A

Progressive and strengthening contractions with cervical dilatation

102
Q

How can PPROM be tested for?

A

Test pH of vaginal fluid

103
Q

What test can be done with a high negative predicative value for labour if a patient presents with preterm pains?

A

Fetal fibronectin swab

104
Q

Broad managment of preterm labour prior to 34 weeks

A

Steroids
Tocolysis
Move to centre with neonatal itu
ABX if PPROM

105
Q

What drugs can be used for tocolysis

A

Atociban (oxytocin receptor antagonist)
Nifedipine
Indomethacin

106
Q

Contraindications to tocolysis

A

Suspected infection
Fetus dead
Maternal condition requiring delivery
APH

107
Q

Can tocolysis be repeated? Why

.

A

No

Commonly preterm labour is due to infection so repeating leaves child in infectious environment

108
Q

How should PPROM be managed in the absence of labour?

A

ABX

Expectant management, if signs of infection (on bloods ie. Increasd crp - do not wait for symptoms) then deliver

109
Q

Problem with use of indomethacin as tocolytic

A

Prematurely closes ductus arteriosus

110
Q

Complications of fetal hypoxia at delivery?

A

Death

Cerebral palsy

111
Q

Investigation to run in a small for date baby to check for hypoxia?

A

Doppler ultrasound

  • MCA - high flow suggests hypoxia
  • umbilical artery - should have positive end diastolic flow, absent or negative suggests incased flow resistance
112
Q

Ways of monitoring a fetus antinatally

A

Movements - any reported change in pattern
Pinnard
CTG
USS

113
Q

How often should a low risk pregnancy be monitored during delivery ?

A

1st stage pinnard every 15 minutes and after each contraction
2nd stage pinnard every 5 minutes and after each contraction

114
Q

What is the benfit and problems with ctg monitoring in high risk labour

A

Decreases neonatal seizure but no change to long term outcomes and increases rate of instrumentation and csection

115
Q

Interpretation of a ctg

A

DR - determine risk
C - contractions - frequency, intensity, regularity
BR - baseline rate 110-160
A - accelerations
VA - variability >5bpm
D - decelerations - early, late or variable
O - overall assessment

116
Q

Causes of fetal tachycardia

A 
Fever
Hypoxia
Arrhythmia 
Anxiety 
Dehydration
117
Q

Causes of fetal bradycardia

A

Medications
Heart block
Cord compression

118
Q

Differentiate early and late decelerations

A

Early occur peak to peak with contractions, - normal

Late occur 15s after - pathological

119
Q

What is a deceleration

A

Decrease of 15bpm or more for 15 seconds or more

120
Q

Management of an worrying ctg, conservative to surgical?

A

Position left lateral to increase pacental blood flow (clear ivc)
Stop syntocinon
Fetal blood sample
Deliver

121
Q

Signs of uterine rupture during delivery.

A 
CTG abnormalities
Severe pain between contrations
Shoulder tip pain
Shock
Vaginal bleeding
Scar tenderness
Loss of effective contractions 
Breakthrough pain through epidural
Loss of station
122
Q

What percentage of children can be delivered PV. How does this change post section?

A

80% falling to 75%

123
Q

Advantages of VBAC

A 
Avoids surgery  (bladder damage, blood loss, hysterectomy, infection, cut nto baby. )
Faster recovery (thrombosis, no driving for 6 weeks)
124
Q

Disadvantages of VBAC

A

Weakening to rupture in 1:200
Higher risk to baby
25% will need emergency c-section which is higher risk of blood transfusion

125
Q

Contraindications to VBAC

A

Upper segment csection

>2 csections

126
Q

What must happen in a VBAC birth that is not always necessary in normal vaginal?

A

In hospital with IV access and CTG

127
Q

What would increase the risk of scar rupture in VBAC?

A

Induction of labour

128
Q

What options are there for downs screening?

A

1st trimester - combined test
2nd trimester - triple test
Detailed scan (50%)

129
Q

How can the results of a amniocentesis or cvs be sped up?

A

FISH test paid for privately

130
Q

Risk in cvs sampling

A

1% risk of miscarriage
1% risk of placental mosaicism
Infection

131
Q

When can cvs be performed for downs

A

Weeks 11-14

132
Q

When can amniocentesis be performed?

A

Weeks 15-20

133
Q

Other than age what increases the risk of downs syndrome in pregnancy?

A

Previous downs pregnancy

135
Q

What patients should recieve treatment for group b strep?

A

All those that test positive in this pregnancy or any previously positive babies

136
Q

What is treatment for group b strep?

A

IV antibiotics for mother for at least 4 hours prior to delivery
If not possible antibiotics for baby and admission

137
Q

Background prevalence of GBS
Infection rate of GBS for babies
Mortality of GBS infection in babies

A

20%
1:2000
10%

138
Q

What are the torch infections? What is the relevance?

A 
Toxoplasmosis 
Other (syphallis, cocksackie, lymes, malaria, HIV)
Rubella
CMV
Herpes

Common infections acquired by the mother than can be passed to the child vertically transplacentally or at delivery. Results in sepsis or malformation in the infant.

FPE (11 decks)

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