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2020 phase 3a newer > obs > Flashcards

obs Flashcards

1
Q

how dilated is established labour?

A

4cm

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2
Q

how much would primip progress in an hour?

A

0.5cm/hr

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3
Q

how much would multip progress in an hour?

A

1-2cm/hr

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4
Q

what is the first stage of labour?

A

dilatation to 10cm

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5
Q

what is the second stage of labour?

A

10cm to birth of baby

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6
Q

what is the third stage of labour?

A

birth of placenta

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7
Q

what is used in active management of third stage of labour?

A

IM syntometrine if no HTN

IM syntocinon if HTN

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8
Q

what would you use for hypertensive woman who opts for active management?

A

IM syntocinon

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9
Q

how many arteries/veins in umbilical cord?

A

2 arteries and 1 vein

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10
Q

how often is low risk fetal heart rate assessed?

A

15 mins in first stage of labour

5 mins in second stage

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11
Q

baby pH of 7.2. what to do?

A

immediate delivery

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12
Q

baby pH of 7.25 what do?

A

normal

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13
Q

side effects of pethidine?

A

tingly

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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

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15
Q

when is epidural leg weakness a concern?

A

if weakness worse after removal - haematoma - medical emergency

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16
Q

when to induce labour for fetus

A 
IUGR
PPROM
chorioamnionitis
uteroplacental insufficiency
prolonged pregnancy
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17
Q

when to induce labour for mum/

A 
chorioamnionitis
maternal diabetes
pre-eclampsia
obstetric cholestasis
poor obstetric history (eg prev stillbirth)
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18
Q

when would you not induce labour?

A 
placenta praevia
acute fetal compromise
unstable lie
pelvic obstruction
previous classical c-section
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19
Q

what does bishops score >7 mean?

A

favorable candidate

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20
Q

how would you try to induce labour?

A

stretch and sweep
pge2
propess
prostin

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21
Q

when would prostaglandins be contraindicated?

A

previous uterine surgery

previous c-section

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22
Q

what are the next steps of induction/

A

artifical rupture of membranes

syntocinon IV

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23
Q

what would you monitor for someone given IV syntocinon to induce labour?

A

continuous CTG

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24
Q

how many contractions is hyperstimulation?

A

more than 5 in 10 mins

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25
Q

what are the effects of uterine hyperstimulation

A

fetal distress

placental abruption

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26
Q

what are the complications of treatment with IV syntocinon?

A

fetal distress
maternal exhaustion
unsuccessful

uterine rupture
cord prolapse
increased risk of instrumental delivery

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27
Q

how to reverse hyperstimulation?

A

stop syntocinon

give tocolytics if necessary

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28
Q

when to do ECV?

A

36 in nullip

37 in multip

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29
Q

what must be given in ECV?

A

anti D if mum is rh-

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30
Q

which instrumental method is worse for the baby?

A

ventouse is worse for baby

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31
Q

which instrumental baby is worse for the mum?

A

forceps worse for mum

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32
Q

`when would instrumental delivery be indicated?

A

exhaustion

malposition

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33
Q

what are the complications of instrumental

A

bleeding
perineal trauma
bruising

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34
Q

what are the four categories of c-section?

A

cat 1 - immediate - life-threatening
cat 2 - within 1 hour
cat 3 - within 24 hours
cat 4 - elective

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35
Q

when is c-section indicated?

A 
placenta praevia
fetal distress, cord prolapse
cervical cancer?
baby not coming out?
vbac not allowed
pre-eclampsia
heart condition in mum
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36
Q

in twin deliveries, if 1st twin is breech, how do you deliver?

A

c-section

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37
Q

when to deliver in twin pregs?

A

37 weeks

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38
Q

do you have to use CTG for twins?

A

yes, esp in second twin

CTG on 1 twin, scalp electrode on other

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39
Q

what is PROM?

A

prelabour rupture of membranes (1hr before) at term

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40
Q

what is PPROM?

A

preterm prelabour rupture of membranes

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41
Q

what are the risks associated with PROM?

A

chorioamnionitis

neonatal infection

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42
Q

what needs assessing in PROM?

A 
infection risk
fever
foul smell
reduced fetal movements
monitor fetal heart
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43
Q

what must be avoided in PROM?

A

PV exam

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44
Q

if there are signs of infection in prom, what?

A

immediate induction of labour

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45
Q

if fetal distress in prom, what?

A

immediate c-section

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46
Q

how long must you observe mum and baby following delivery in prom?

A

12 hours

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47
Q

what is fetal fibronectin in pprom?

A

if positive, then preterm labour!

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48
Q

how is pprom managed?

A

steroids - stimulate t2 pneumocytes
magsulf - cerebral palsy
erythromycin - prevent chorioamnionitis

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49
Q

what is threatened preterm labour?

A

contractions without effacement

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50
Q

what are the symptoms of preterm labour?

A

PPROM

regular contractions decreasing in interval

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51
Q

how is preterm labour prevented?

A

cerclage

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52
Q

when can you do cerclage?

A

if cervix <2.5 cm

history of preterm labour or miscarriage

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53
Q

how is preterm labour investigated if membranes intact?

A

speculum to look for cervical dilation
if >30 weeks, TVUS - offer cerclage and progesterone pessary

fibronectin - if positive - then will go into labour

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54
Q

what to do in PPROM?

A

no PV exam
speculum to look for amniotic fluid
check for infection

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55
Q

how is GBS checked for?

A

high vaginal and rectal swabs

56
Q

what to monitor if established preterm labour?

A

monitor fetus

57
Q

how is preterm labour managed?

A

im betamethasone 2x, 24 hrs apart
iv mgso4
erythromycin
iv benpen intrapartum if gbs

58
Q

when can combined screening for down’s be done?

A

11-13+6 weeks

59
Q

what is included in the combined screening for downs that is done at 11-13+6?

A

nuchal translucency
bHCG
PappA

60
Q

what results in combined screening would suggest downs?

A
  • increased nuchal translucency
  • increased bHCG
  • decreased pappa
61
Q

what screening for down’s 15-20 weeks?

A

quadruple test

62
Q

what is included in the quadruple test?

A

alpha-fetoprotein
inhibin A
HCG
unconjugated oestriol

63
Q

what causes decreased AFP?

A

down’s
trisomy 18
maternal diabetes

64
Q

what causes increased AFP?

A

neural tube defects
abdominal wall defects
multiple pregnancy

65
Q

if woman >20 weeks pregnant exposed to chickenpox, not vaccinated, what?

A

give VZIG 7-14 days post-exposure

not immediately

66
Q

when would vzig be given immediately

A

less than 20 weeks

67
Q

when is antiD given?

A

28 and 34 weeks

68
Q

which oral hypoglycaemic is safe when breastfeeding>?

A

metformin

69
Q

what are some causes of polyhydramnios?

A

maternal diabetes
twins
oesophageal atresia
anencephaly

70
Q

what is a common cause of oligohydramnios?

A 
pre-eclampsia - hypoperfusion of placenta
prom
renal agenesis
IUGR
post-term
71
Q

when would higher dose of folate be needed?

A 
previous child with NTD
diabetes
hiv on co-trimoxazole
bmi high
antiepileptic!!!
sickle cells
72
Q

what to do if late decelerations on ctg?

A

fetal blood sampling

73
Q

what to do if fetal pH <7.2?

A

immediate delivery

74
Q

what placental abnormality associated with IVF

A

placenta praevia

75
Q

how would you manage fetal bradycardia CTG?

A

immediate c section

76
Q

how do you manage late decelerations CTG?

A

immediate c section

77
Q

mother is in shock with placental abruption. how manage?

A

immediate c section

78
Q

how would vasa previa present?

A

rupture of membranes followed by immediate PV bleeding

79
Q

what is the triad of symptoms associated with vasa praevia?

A

rupture of membranes
painless pv bleeding
fetal bradycardia/death

80
Q

how is vasa praevia diagnosed?

A

can be diagnosed antenatally with ultrasound

81
Q

how is vasa praevia managed>?

A

elective at 35-36 weeks prior to rupture of membranes

82
Q

how is vasa praevia managed if woman ruptures membranes?

A

emergency c section

83
Q

if chorioamnionitis suspected, what do?

A

IV Abx and immediate delivery

84
Q

what hormones responsible for breast maturation in preg?

A

human placental lactogen

progesterone

85
Q

what is the effect of progesterone on lactation?

A

inhibits. when placenta delivered, drop in progesterone, allows lactation to occur

86
Q

what position to put mum in in obstetric emergency?

A

left lateral position

do not put on back; risk of aortocaval compression

87
Q

when is APH?

A

> 24 weeks

before, miscarriage

88
Q

how is placenta praevia managed?

A

elective c-section at term

if in labour - c-section

89
Q

how is placental abruption managed if maternal/foetal compromise

A

immediate c-section

90
Q

how is placental abruption managed if no compromise and <36?

A

steroids and monitor

91
Q

how is placental abruption managed if no compromise and >36

A

induce

if fetal distress - c section

92
Q

how is placental abruption managed if fetus dead?

A

deliver vag

if maternal distress - c-section

93
Q

how to reverse resp depression from mag sulf?

A

gluconate

94
Q

how is HELLP syndrome managed?

A

steroids and deliver baby

95
Q

what investigation for PE in preg

A

ecg
cxr

v/q or ctpa

96
Q

what is ctpa associated with in preg?

A

breast cancer increased risk

97
Q

what is vq scan associated with?

A

childhood cancer

more than ctpa

98
Q

how is shoulder dystocia managed?

A

mcroberts
episiotomy
- screw - reverse
- rubin’s

try again once woman is on all 4s
then c-section

99
Q

how does uterine rupture present?

A 
pain that persists between contractions
pv bleeding
shock
cessation of previous contractions
abnormal ctg
100
Q

how is uterine rupture managed?

A

abcde

c-section

101
Q

how is pph managed?

A 
abcde
lie flat
bimanual compression
pharmacological
ballooon tamponade
102
Q

how is pph pharma managed?

A

IV syntocinon

IM carboprost

103
Q

why no nitrofurantoin in third trimester?

A

neonatal jaundice and kernicterus

104
Q

why no trimethoprim in first trimester?

A

neural tube defects (antifolate)

105
Q

what causes a complete molar pregnancy?

A

1 sperm fertilises empty egg

106
Q

what causes a partial molar pregnancy?

A

2 sperm fertilise 1 egg

107
Q

what is a choriocarcinoma?

A

trophoblastic tumour
secretes hcg
metastasised to liver lung brain

108
Q

what are the signs of a molar preg?

A

hyperemesis
large for dates uterus
thyrotoxicosis
pre-eclampsia

109
Q

how is molar preg managed?

A

surgical evacuation and histological evaluation

110
Q

what needs to be monitored after removal of molar preg?

A

serial bHCG to ensure completely removed

also monitor bHCG after every pregnancy

111
Q

if woman rh-, does anti D need to be given in molar preg?

A

yes

112
Q

how long must woman use contraceptive for molar preg?

A

12 months

113
Q

when should baby be treated if mum is hep b+

A 
hep B immunoglobulin
vaccine: 
birth
21 weeks
1 year
114
Q

when is haemoglobin checked in pregh/

A

10 and 28 weeks

115
Q

when is booking appt?

A

10 weeks

116
Q

what happens at 12 weeks?

A

dating uss and screening

117
Q

what happens at 16 weeks?

A

BP and urinalysis

118
Q

what happens at 20 weeks?

A

anomaly scan

119
Q

list some sensitising events?

A 
birth
miscarriage
surgical termination
abdo trauma in first trimester?
PV bleeding >12 weeks
120
Q

which conditions screened for in 11-13+6?

A

down’s
edwards - 18
patau - 13

121
Q

what further ““diagnostic”” testing available if high probability of down’s?

A

if 11-15 weeks - chorionic villous sampling
if more than weeks - amniocentesis

blood test from 9 weeks (but expensive)

122
Q

what does the anomaly scan test for?

A 
11 conditions 
spina bifida
cleft lip
gastroschisis
can also find out sex of baby at this time
123
Q

what increases gord in pregnancy?

A

progesterone and relaxation of sphincter

124
Q

how is gord treated in preg?

A

gaviscon
ranitidine
emeprazole
avoid lansoprazole

125
Q

how is pelvic girdle pain treated in preg?

A

analgesia
physio
pillow

126
Q

when to admit in hyperemesis?

A

ketonuria
5% weight loss
antiemetics not working

127
Q

how is hyperemesis treated?

A

fluid replacement
kcl
cyclizine/promethazine

128
Q

what is a sga baby?

A

abdominal circumference <10th centile

129
Q

what causes asymmetrically small baby?

A

head bigger than abdo
placental insufficiency

SHIT
Smoking
Hypertension
IUGR
Twins
130
Q

how is placental insufficiency small baby investigated?

A

serial growth scans (2 weekly USS)

doppler ultrasound
if abnormal doppler after 36 weeks - deliver

131
Q

if less than 37 weeks and absent/reversed end diastolic flow, what to do?

A

c-section

132
Q

what are the complications of a large for dates uterusd?

A

neonatal hypoglycaemia

neonatal respiratory distress

133
Q

what type of twin pregnancy carries most risk?

A

monoamniotic monozygotic

134
Q

what are the risks associated with monoamniotic monozygotic?

A 
Twin to twin transfusion syndrome
IUGR
prematurity
miscarriage
polyhydramnios
135
Q

what happens in twin to twin transfusion syndrome?

A

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
Q

how is ttts treated?

A

laser of the anastamosing vessels

2020 phase 3a newer (11 decks)

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