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MURMURS > obs and gynae > Flashcards

obs and gynae Flashcards

1
Q

Risk of diabetes

A 
S- Shoulder dystocia
M- macrosomia 
A- amniotic fluid excess 
S- Still birth 
H- Hypertension and neonatal hypoglycaemia
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2
Q

What is gravida

A

the number of times a women has concieved

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3
Q

What is parity

A

no. of times women has delivered p >24 and up smaller is <24 doesnt include the current preganancy

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4
Q

currently 12/40 two miscariages 8/40 and 20/40 and son born at 38/40

A 
G= 4 - conceived 4 times 
P= 1+2
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5
Q

not pregnant has twins born 34/40

A

g= 1 p =2+0

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6
Q

currently 28/40 one previous ectopic two terminations of pregnancy both 6/40 one still birth at 25/40

A 
g= 5 
P= 1+3 - doesnt include the current pregnancy
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7
Q

primigravid meaning

A

G1P0

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8
Q

nulliparous

A

no live baby delivered - so name is given to those who have never given birth and to those who have had stillbirths

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9
Q

multiparous

A

one or more babies delivered

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10
Q

What is nagele rule

A

LMP subtract 3 months add 1 year 7 days

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11
Q

the two tests in the first trimester

A

booking (10 weeks), dating scan (11 weeks) and combined screening test (at 11-13 weeks)

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12
Q

What is tested in combined scrrening

A

NT and two serum markers PAPPA and hCG gives a early result and has a high detection rate

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13
Q

What to do if late for combined testing

A

Quadruple test

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14
Q

Quadruple test consists of

A

AFP HCG oestriadiol and inhibin A combined with maternal age gives a individualised risk

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15
Q

What happens with a positive quadruple or combo test

A

offered cvs or amniocenthesis - cvs is earlier andtherefore has a higher miscarriage rate

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16
Q

If you are rich what test can you do

A

non invasive prenatal testing in which detect free dna of fetus in maternal circulation

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17
Q

Are cephalic and breech types of lie

A

no

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18
Q

The risks of breech presentation

A

fetal hypoxia
increase fetal mortality and morbiditu
cord prolapse
Difficulty delivering head

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19
Q

How is ECV done

A

uterine relaxants are given to relax the uterus pripr to the prcoedure these are tetrabutaline or salbutamol fetal heart and ctg are monitoried benefits is it may prevent c section and all the risks that come with it

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20
Q

Causes of polyhydraminos

A

DITCH - Diabetes, idiopathic, twins, congenital abnormalities , heart failure

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21
Q

RRisks of polyhydraminos

A

6p’s - placental abruption, pretty unusual lie premature labour prolapse of cord post partum haemhorrhage oerinatal mortality

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22
Q

MOL - Every decent female is crowned rubies lovingly

A

enhgagement in transverse position
decent of head into pelvis
flexsion
internal rotation as head hits the floow
crowns- extends head in delivery
restitiution- external rotation
lateral flexsion of head to deliver shoulders

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23
Q

Inidications for induction

A

4p’s - post dates prelabour rupture of membranes preeclampsia plus diabetes

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24
Q

how does membrane swweep work

A

digital vaginal examination into the uterus to release hormones which may tirgger labour

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25
Q

Three stages of induction

A

cervical ripening and artificial rupture of mmebranes cervicall diataiton to fully dilates

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26
Q

when is propess and prostin used

A

propess in nulliparous its a pessary and gel prostin in multips

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27
Q

bishop score less than 5

A

more prostin needed

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28
Q

Bisphop score 5-8

A

consider more propess but artifical rupture of memebranes may be needed

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29
Q

BS greater 8

A

amniotomy further prostin not needed - but amniotomy has a risk of cord prolapse

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30
Q

how are contractions generated to create cervical dilatation

A

by iv oxytocin

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31
Q

What is the management in uterine hyperstimulation

A

terbutaline must be administered

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32
Q

WHat is pelivc girdle pain

A

symphysieal pubis dysfunction due to mechanical strain on the pelvic girl

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33
Q

what is symphyseal pubis pain

A

radiates to groin and medical tights worse on standing on one leg and going up stairs worse when abducting hip when getting out of bath or into the car tender of the pubis symphesis hip abduction reporduces symptoms

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34
Q

mangement of pelvic girdle and sympheseal pubis pain

A

keep active within limits of pain and sleep witha . pillow between legs pelvic floor excersizes get a physio to help iuse paracetamol and avoid NSAIDS

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35
Q

coMFORT ZONE OF A WOMEN

A

MEASURE THE COMFORT ZONE AND AVOID ABUCTION BEYOND THE COMFORT ZONE AND OFFER EPIDURAL IN LABOUR ESPECIALLY IN W OMEN WHO IS HAVE SYMPHYSEAL PELVIS OR PELVIC GIRLDLE PAIN

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36
Q

effect of pregnancy on pre exisiting diabetes

A

deterioration in renal funtion if pre exisitinf nephropathy can manifest as hypertension and hyperglycaemia

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37
Q

What timester does GDM start

A

second trimester - preganacy is in a diabretogenic state

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38
Q

When is the OGTT taken

A

24-28 weeks but after booking if had GDM in a previous prganancy - this is the only form of diagnosis monitoring thereafter will take place with HBA1C

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39
Q

gdm Values which are abnormal

A

fasting more than 5.6 with 5.6 or less being normal and more than 7.8 after 2 hours with 7.8 or less being normal

40
Q

Manouvres in shoulder dystocia - Remember (Dr Mcroberts)

A

Mc roberts - flex and externally rotate hips to stre symphysis and pelvic outlet Suprapubic pressure and epsiotomy

41
Q

The advanced manourvers in shouder dystocia

A

the woodscrew manouvre - rotate shoulder, deliver posterior arm break clavicle. then emergency c section in zanvelli manourvre

42
Q

Checklist in an antenatal exam

A

SALPINX - sixe and SFH, Amniotic fluid, lie, presenting part, inlet of pelvis- engagement, number of fetuses, marks the spot ober upper fetal aback for fopppler and pinard

43
Q

the weeks around which hypertension in preganancy revolves around

A

20 weeks - pregestiing is before pregnancygestation is less than 20 weeks gestation and preeclampsia is after 20 weeks

44
Q

difference between severe and hypeternsion values

A

140/90 is hypetension the more serious is 160/100

45
Q

First and second line management of hypertension

A

first line labetaolo but if asthma Second line nifedipine or labetalol

46
Q

How much is proteinuria

A

> 0.3g/24 hours

47
Q

How to prevent preeclampsia

A

give 75g of aspirin from 12 weeks gestation onwards

48
Q

who would recieve preeclampsia prevention

A

ECLAMP- existing hypention, CKD, SLE, antiphospholipid syn, maternal diabetes, prvious pregnancy with hypertension

49
Q

Maternal shame and complication with pre eclampsia

A

SHAME - stroke, hELLP which leads to DIC, abruption of placenta, multi organ failure , eclampsia

50
Q

would you admit all pregnancy women with HTN

A

YES

51
Q

which of the hypertensions would you treat

A

the mod and severe ones so anything above 150/100

52
Q

What are the four red flag symptoms of eclampsia

A

headache visual disturbance epigastric or RUQ pain - due hepatic distention and infarcts, breathlessness due to ARDS

53
Q

what are the three red flag signs of eclampsia

A

periorbital odema hyperreflexia and clonus

54
Q

how to moniotro eclampsia

A

sympt and BP monitor, fetal growth monitor and umbilical artery blood flow monitor pre eclampsia bloods

55
Q

What are the pre eclampsia bloods

A

FBC - for low platelets Low hb due to HELLP syn. u&e cause urea and creatine raised LFT raised bilrubin if haemolysis

56
Q

WHAT ARE the plans for delivery with eclampsia

A

keep baby survival till 34 weeks give mother sterios till then

57
Q

how do steroids help a premature baby

A

prevent necrotising entercollitis resp distress intravascular haemhorrhage

58
Q

what must you do if high BP imparied renal or hepatic function and fetal distress

A

delivery bby

59
Q

emergency management of eclampsia

A

control fits with magnesium sulphate and control hypertension with iv labetalol and hydrazalaine

60
Q

treatment of cervcal shortening

A

cervical stitch

61
Q

if membranes have ruptured and signs of infection what do you do

A

it is not appropriotw to use tocolytics to stop contractions so you deliver

62
Q

if membranes have not ruptured can tolytic med be used

A

yes if no sign of infection

63
Q

mangement of preterm rupture three steps

A
  1. consider antenatal corticosteroids
  2. consider tocolysis
  3. consider trnafer to nenonatal teritary unit
64
Q

preterm prom born 24-34 weeks what is the managment

A

daily review for infection and steroids for lungs and erythromycin to prevent necrotising neterocollitis

65
Q

zygosity meaning

A

this is what parents care about itis the identical or not deteminating factor

66
Q

dividision at day . 1)0-3 2)4-8 3)8-13

A

1) DCDA . 2)MCDA . 3)MCMA

67
Q

true or false Dizytoic twins are always dichorionic and chorinoic menaing

A

true and dichorionic meaning two placentas

68
Q

Which type highest risk of TTS

A

Monchorionic

69
Q

How can you tell how many placenta there are

A

look for lambda sign indicating two amniotic sacs indicating DCDA or the t sign indicating mCDA

70
Q

ANTENATAL MANAGMENT OF TWINS

A

aspirin and from 16-24 weeks uss for TTTS every 2 weeks and elective cs at 32-34 weeks due to cord entanglement risk not because of TTTS. bp and glucose will need monitoring as more likley to dev preeclampsia and diabetes and dvelivery will be befoer 40 weeks but additional scans will be needed to deliver babies before 40 weeks

71
Q

Fetal complications of twin pregnancy

A

miscarrigae vanishing twin syndrome, IUGR abdruptions and intrauterine death polyhydraminos malpresentation preterm delivery and cord prolapse

72
Q

what is ttts

A

umbilical arteries feeld the umlilcan vien of the recipient and the donor twin becoems naemic and growth risticted where as the reciepient twin become polycythaemic hypertensive and may have heart failure

73
Q

causes of small of gestational age and complication

A

SWAN - starved small IUGR Wrong small abnormal small and normal small STILLBIRTH is biggest complication

74
Q

what will graph of a wrong small or normal small look like

A

along the lower deciles following the pattern

75
Q

what will graph of starved small look like

A

will follow the average lines and level out tworards the date

76
Q

What will the graph of a abnormal small look like

A

outside the gestatioal deciles

77
Q

neonatal complciations of SGA

A

hypoglycaemia polycythaemia and complciations of prematurity e.g. intrventricular haemhorrhage resp distress and encrotising enterocollitis

78
Q

High risk prgannacies

A

SHIT - smoking HTN IUGR previously and twins - need continuous screenign and growht monitoring

79
Q

what concerns you on umbilical doppler

A

absent end disasytolic flow indicates placental resistance and increase MCA causing brain sparing

80
Q

Management of absent end diasystolic flow

A

1, surveillance- CTG liquor vol, umbilical a doopler

  1. consider early delivery
  2. prenatual steroids for prematurity - two doses beclamethasone/dexamethasone 12-24hrs apart max effect within 7 days of second dose reduces risk of intraven haemhorrhage, resp distress and enctosifing enterocolitis
81
Q

How would youmonitor high risk preganancoies

A

screen pre eclampsia
risk reduced and optimise medical conditions
Serial scans fetal growth liquor volume and umbilical artery

82
Q

antepartum and post partum separated by what value

A

antepartum is bleeding at more than 24 weeks and misscarriage is bleeding less than 24 weeks

83
Q

Symptoms of placental abruption

A

vaginal bleeding - although this can be concelaed

Blood is usually dark red and abdominal pain and uterine contractions

84
Q

Signs of placental abruption (4)

A
  1. woody hard uterus
  2. uterine tenderness
  3. fetal distress
  4. shock
85
Q

Placenta previa symptoms (4)

A
  1. painless bright red vaginal bleeding
  2. blood on toes - severe bleeding with shock
  3. fetus unaffected
86
Q

managment of placenta previa

A

remain in hospital till delivery major previas delivered by cs at 39 weeks or before a signficant bleed but avoid examination and sex until placental site has be determined

87
Q

WHAT MUST BE GIVEN TO WOMEN ROUTINELY WHO HAVE HAD PLACENTA PREVIA AND ABRUPTION

A

ANTI D in the second pregannacy

88
Q

examples of sensitising events

A 
Aminocenthesis/CVS
ECV 
APH 
Threatened or complete miscarrigaage after 12/40 
closed abdo injusry 
top
89
Q

classification of PPH

A 
within 24 hours and 6 weeks 
Blood loss of 
1. minor 500-1000
2. major >1000 
3. massive obs haemhorrahed >1500
90
Q

primary causes of PPH

A

TONE (UTERINE MUSCLE AND CONTENT) TISSUE TRAUMA THROMBIN

91
Q

RF FOR PPH

A

BIG BABY OR MILTIPLE PREGANNACY , PROLONGED PREGANANCY

92
Q

PROPHYLAXIS OF pph

A

oxytocin to deliver the ant shoulder if significant RF consider oxytocin with ergometrine and remeber most PPH dont have RF

93
Q

Mx of PPH

A
  1. Left lateral positon - avoid autocaval compression
  2. kleiheauher - look for fetal cells in maternal circulation) also fo FBC clotting group and save
  3. Replace fluid loss, blood loss and clotting factor loss
94
Q

stepwise surgical managment of PPH

A 
EVACUALTION OF RETAINED PLACENTA 
INTRAUTERINE BALLOON TAMPNOADE 
haemhostatic suture 
interal illiac ligation 
hysterectomy
95
Q

postpartum aim for pre-exisiting diabetes

A

4-9 and resume insulin

96
Q

post partum aim for GDM

A
  1. STOP their insulin
  2. Do OGTT at 6 weeks to calculate future risk ( revolves around > 7 being high risk and <6 being low risk)
    6-6.9 inc risk
    >7 have DM
    < 6 low probability - diet and excersize recommended
  3. If past 13 weeks and no OGTT done - a HBA1C can be done to calculate risk
    no risk < 39
    39-47 high risk
    > 48 have type 2

MURMURS (16 decks)

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