obs Flashcards
1
Q
how dilated is established labour?
A
4cm
2
Q
how much would primip progress in an hour?
A
0.5cm/hr
3
Q
how much would multip progress in an hour?
A
1-2cm/hr
4
Q
what is the first stage of labour?
A
dilatation to 10cm
5
Q
what is the second stage of labour?
A
10cm to birth of baby
6
Q
what is the third stage of labour?
A
birth of placenta
7
Q
what is used in active management of third stage of labour?
A
IM syntometrine if no HTN
IM syntocinon if HTN
8
Q
what would you use for hypertensive woman who opts for active management?
A
IM syntocinon
9
Q
how many arteries/veins in umbilical cord?
A
2 arteries and 1 vein
10
Q
how often is low risk fetal heart rate assessed?
A
15 mins in first stage of labour
5 mins in second stage
11
Q
baby pH of 7.2. what to do?
A
immediate delivery
12
Q
baby pH of 7.25 what do?
A
normal
13
Q
side effects of pethidine?
A
tingly
14
Q
what analgesia available in birth?
A
pudendal nerve blocks
epidural - long birth, instrumental, good for HTN
spinal if c-section
GA if emergency
15
Q
when is epidural leg weakness a concern?
A
if weakness worse after removal - haematoma - medical emergency
16
Q
when to induce labour for fetus
A
IUGR PPROM chorioamnionitis uteroplacental insufficiency prolonged pregnancy
17
Q
when to induce labour for mum/
A
chorioamnionitis maternal diabetes pre-eclampsia obstetric cholestasis poor obstetric history (eg prev stillbirth)
18
Q
when would you not induce labour?
A
placenta praevia acute fetal compromise unstable lie pelvic obstruction previous classical c-section
19
Q
what does bishops score >7 mean?
A
favorable candidate
20
Q
how would you try to induce labour?
A
stretch and sweep
pge2
propess
prostin
21
Q
when would prostaglandins be contraindicated?
A
previous uterine surgery
previous c-section
22
Q
what are the next steps of induction/
A
artifical rupture of membranes
syntocinon IV
23
Q
what would you monitor for someone given IV syntocinon to induce labour?
A
continuous CTG
24
Q
how many contractions is hyperstimulation?
A
more than 5 in 10 mins
25
what are the effects of uterine hyperstimulation
fetal distress
| placental abruption
26
what are the complications of treatment with IV syntocinon?
fetal distress
maternal exhaustion
unsuccessful
uterine rupture
cord prolapse
increased risk of instrumental delivery
27
how to reverse hyperstimulation?
stop syntocinon
| give tocolytics if necessary
28
when to do ECV?
36 in nullip
| 37 in multip
29
what must be given in ECV?
anti D if mum is rh-
30
which instrumental method is worse for the baby?
ventouse is worse for baby
31
which instrumental baby is worse for the mum?
forceps worse for mum
32
`when would instrumental delivery be indicated?
exhaustion
| malposition
33
what are the complications of instrumental
bleeding
perineal trauma
bruising
34
what are the four categories of c-section?
cat 1 - immediate - life-threatening
cat 2 - within 1 hour
cat 3 - within 24 hours
cat 4 - elective
35
when is c-section indicated?
```
placenta praevia
fetal distress, cord prolapse
cervical cancer?
baby not coming out?
vbac not allowed
pre-eclampsia
heart condition in mum
```
36
in twin deliveries, if 1st twin is breech, how do you deliver?
c-section
37
when to deliver in twin pregs?
37 weeks
38
do you have to use CTG for twins?
yes, esp in second twin
| CTG on 1 twin, scalp electrode on other
39
what is PROM?
prelabour rupture of membranes (1hr before) at term
40
what is PPROM?
preterm prelabour rupture of membranes
41
what are the risks associated with PROM?
chorioamnionitis
| neonatal infection
42
what needs assessing in PROM?
```
infection risk
fever
foul smell
reduced fetal movements
monitor fetal heart
```
43
what must be avoided in PROM?
PV exam
44
if there are signs of infection in prom, what?
immediate induction of labour
45
if fetal distress in prom, what?
immediate c-section
46
how long must you observe mum and baby following delivery in prom?
12 hours
47
what is fetal fibronectin in pprom?
if positive, then preterm labour!
48
how is pprom managed?
steroids - stimulate t2 pneumocytes
magsulf - cerebral palsy
erythromycin - prevent chorioamnionitis
49
what is threatened preterm labour?
contractions without effacement
50
what are the symptoms of preterm labour?
PPROM
| regular contractions decreasing in interval
51
how is preterm labour prevented?
cerclage
52
when can you do cerclage?
if cervix <2.5 cm
| history of preterm labour or miscarriage
53
how is preterm labour investigated if membranes intact?
speculum to look for cervical dilation
if >30 weeks, TVUS - offer cerclage and progesterone pessary
fibronectin - if positive - then will go into labour
54
what to do in PPROM?
no PV exam
speculum to look for amniotic fluid
check for infection
55
how is GBS checked for?
high vaginal and rectal swabs
56
what to monitor if established preterm labour?
monitor fetus
57
how is preterm labour managed?
im betamethasone 2x, 24 hrs apart
iv mgso4
erythromycin
iv benpen intrapartum if gbs
58
when can combined screening for down's be done?
11-13+6 weeks
59
what is included in the combined screening for downs that is done at 11-13+6?
nuchal translucency
bHCG
PappA
60
what results in combined screening would suggest downs?
- increased nuchal translucency
- increased bHCG
- decreased pappa
61
what screening for down's 15-20 weeks?
quadruple test
62
what is included in the quadruple test?
alpha-fetoprotein
inhibin A
HCG
unconjugated oestriol
63
what causes decreased AFP?
down's
trisomy 18
maternal diabetes
64
what causes increased AFP?
neural tube defects
abdominal wall defects
multiple pregnancy
65
if woman >20 weeks pregnant exposed to chickenpox, not vaccinated, what?
give VZIG 7-14 days post-exposure
| not immediately
66
when would vzig be given immediately
less than 20 weeks
67
when is antiD given?
28 and 34 weeks
68
which oral hypoglycaemic is safe when breastfeeding>?
metformin
69
what are some causes of polyhydramnios?
maternal diabetes
twins
oesophageal atresia
anencephaly
70
what is a common cause of oligohydramnios?
```
pre-eclampsia - hypoperfusion of placenta
prom
renal agenesis
IUGR
post-term
```
71
when would higher dose of folate be needed?
```
previous child with NTD
diabetes
hiv on co-trimoxazole
bmi high
antiepileptic!!!
sickle cells
```
72
what to do if late decelerations on ctg?
fetal blood sampling
73
what to do if fetal pH <7.2?
immediate delivery
74
what placental abnormality associated with IVF
placenta praevia
75
how would you manage fetal bradycardia CTG?
immediate c section
76
how do you manage late decelerations CTG?
immediate c section
77
mother is in shock with placental abruption. how manage?
immediate c section
78
how would vasa previa present?
rupture of membranes followed by immediate PV bleeding
79
what is the triad of symptoms associated with vasa praevia?
rupture of membranes
painless pv bleeding
fetal bradycardia/death
80
how is vasa praevia diagnosed?
can be diagnosed antenatally with ultrasound
81
how is vasa praevia managed>?
elective at 35-36 weeks prior to rupture of membranes
82
how is vasa praevia managed if woman ruptures membranes?
emergency c section
83
if chorioamnionitis suspected, what do?
IV Abx and immediate delivery
84
what hormones responsible for breast maturation in preg?
human placental lactogen
progesterone
85
what is the effect of progesterone on lactation?
inhibits. when placenta delivered, drop in progesterone, allows lactation to occur
86
what position to put mum in in obstetric emergency?
left lateral position
| do not put on back; risk of aortocaval compression
87
when is APH?
>24 weeks
before, miscarriage
88
how is placenta praevia managed?
elective c-section at term
if in labour - c-section
89
how is placental abruption managed if maternal/foetal compromise
immediate c-section
90
how is placental abruption managed if no compromise and <36?
steroids and monitor
91
how is placental abruption managed if no compromise and >36
induce
if fetal distress - c section
92
how is placental abruption managed if fetus dead?
deliver vag
| if maternal distress - c-section
93
how to reverse resp depression from mag sulf?
gluconate
94
how is HELLP syndrome managed?
steroids and deliver baby
95
what investigation for PE in preg
ecg
cxr
v/q or ctpa
96
what is ctpa associated with in preg?
breast cancer increased risk
97
what is vq scan associated with?
childhood cancer
more than ctpa
98
how is shoulder dystocia managed?
mcroberts
episiotomy
- screw - reverse
- rubin's
try again once woman is on all 4s
then c-section
99
how does uterine rupture present?
```
pain that persists between contractions
pv bleeding
shock
cessation of previous contractions
abnormal ctg
```
100
how is uterine rupture managed?
abcde
| c-section
101
how is pph managed?
```
abcde
lie flat
bimanual compression
pharmacological
ballooon tamponade
```
102
how is pph pharma managed?
IV syntocinon
| IM carboprost
103
why no nitrofurantoin in third trimester?
neonatal jaundice and kernicterus
104
why no trimethoprim in first trimester?
neural tube defects (antifolate)
105
what causes a complete molar pregnancy?
1 sperm fertilises empty egg
106
what causes a partial molar pregnancy?
2 sperm fertilise 1 egg
107
what is a choriocarcinoma?
trophoblastic tumour
secretes hcg
metastasised to liver lung brain
108
what are the signs of a molar preg?
hyperemesis
large for dates uterus
thyrotoxicosis
pre-eclampsia
109
how is molar preg managed?
surgical evacuation and histological evaluation
110
what needs to be monitored after removal of molar preg?
serial bHCG to ensure completely removed
also monitor bHCG after every pregnancy
111
if woman rh-, does anti D need to be given in molar preg?
yes
112
how long must woman use contraceptive for molar preg?
12 months
113
when should baby be treated if mum is hep b+
```
hep B immunoglobulin
vaccine:
birth
21 weeks
1 year
```
114
when is haemoglobin checked in pregh/
10 and 28 weeks
115
when is booking appt?
10 weeks
116
what happens at 12 weeks?
dating uss and screening
117
what happens at 16 weeks?
BP and urinalysis
118
what happens at 20 weeks?
anomaly scan
119
list some sensitising events?
```
birth
miscarriage
surgical termination
abdo trauma in first trimester?
PV bleeding >12 weeks
```
120
which conditions screened for in 11-13+6?
down's
edwards - 18
patau - 13
121
what further ""diagnostic"" testing available if high probability of down's?
if 11-15 weeks - chorionic villous sampling
if more than weeks - amniocentesis
blood test from 9 weeks (but expensive)
122
what does the anomaly scan test for?
```
11 conditions
spina bifida
cleft lip
gastroschisis
can also find out sex of baby at this time
```
123
what increases gord in pregnancy?
progesterone and relaxation of sphincter
124
how is gord treated in preg?
gaviscon
ranitidine
emeprazole
avoid lansoprazole
125
how is pelvic girdle pain treated in preg?
analgesia
physio
pillow
126
when to admit in hyperemesis?
ketonuria
5% weight loss
antiemetics not working
127
how is hyperemesis treated?
fluid replacement
kcl
cyclizine/promethazine
128
what is a sga baby?
abdominal circumference <10th centile
129
what causes asymmetrically small baby?
head bigger than abdo
placental insufficiency
```
SHIT
Smoking
Hypertension
IUGR
Twins
```
130
how is placental insufficiency small baby investigated?
serial growth scans (2 weekly USS)
doppler ultrasound
if abnormal doppler after 36 weeks - deliver
131
if less than 37 weeks and absent/reversed end diastolic flow, what to do?
c-section
132
what are the complications of a large for dates uterusd?
neonatal hypoglycaemia
| neonatal respiratory distress
133
what type of twin pregnancy carries most risk?
monoamniotic monozygotic
134
what are the risks associated with monoamniotic monozygotic?
```
Twin to twin transfusion syndrome
IUGR
prematurity
miscarriage
polyhydramnios
```
135
what happens in twin to twin transfusion syndrome?
umbilical artery of donor feeds vein of recipient
donor is small and malnourished and anaemic. better outcome
recipient is macrosomic and polycythaemia and heart failure!! worse outcome
136
how is ttts treated?
laser of the anastamosing vessels
