Obs - general Flashcards
difference between gestational age and fetal age?
based on the first day of your last menstrual period. It technically includes approximately two weeks where the woman was not pregnant.
glomerular endotheliosis is pathognomic of ____?
pre-eclampsia
what is the term for very severe states of pre-eclampsia?
hellp syndrome
delivery is curative for pre-eclampsia but what must you monitor in days after delivery and why?
must STILL watch AND treat BP very closely, can still fluctuate days after delivery and cause issues
(BP peaks at day 3-6 postpartum)
what is the relevance of systolic and diastoliic BP in preeclampsia?
systolic - when very high: strokes
diastolic: associated with birth weight:
when high - macrosomia
when very high/low: low birth weight
what are considerations when giving fluids in preeclampsia ?
dont overload them! -> pulmonary oedema
in labour, the first rotation of the occiput of the fetus is in which direction?
Anterior roatation Anti-clockwise - internal rotation
in labour, the 2nd rotation of the shoulder of the fetus is in which direction?
clockwise - external rotation
list the mechanisms of labour?
Descent flexion internal rotation - Anti-clockwise extension external rotation - clockwise
thee relationship between pressing part of fetus and chial spines is called?
fetal station
the onset of labour is characterised by?
painful uterine contractions
cervical dilation
vaginal show
what is a partograph and when does one begin to use it?
what are the key features?
it is a continuous record of a womans active progress in labour
start in active phase of labour (stage 1) when cevical dilation >3/4 cm
key: cervical dilation, descent of head, hours in labour
which diameteers of the fetal head are smallest and largest?
smallest :
Sub-Occipito Bregmatic (9.5cm) - elearning
but Biparieta (9.5cm)
largest:
from occipital area to anterior fontanelle
Mento Vertical (13.5cm)
what is the normal presentation of a foetus?
- Longitudnal lie
- Ceephalic presentation, Occipito-anterior position
- HR 110-160bpm
- CTG - normal baseline, reactive, accelerative
- no meconium in liquor
what are the normal timeframes of labour?
stage 1: 12 Hours
stage 2: 12 hours
stage 3: 5-10 minutes
which fetal position is most appropriate to engage in pelvic inlet normally?
sub occipito bregamtic - 9.5cm
what are the parameters indicating normal labour?
Gestation: after 37 weeks
- after 42 weeks; abnormal/post-mature
Spontaneous labour
Progress in normal timeframe
- if its too fast; worrying as well
Fetal factors eg lie
Maternal factors; well
Mode of delivery: spontaneoud vaginal
when may labour need to be induced?
42 wks+
htn
insulin dependent diabetes
epidural anaesthesia is placed where?
when is it initiated?
notes for epidural?
in the epidural space
initiated in 1st stage of labour
note: woman should be placed in lateral position due to risk of Low BP/CO + its effect on fetus
name some regional obstetric anaesthesia types
pudendal block
epidural
-> 5-10 minutes onset. hip to toes numb.
spinal
-> immediate onset. pelvic area numb.
Whats the differeence in anaestheesia and analgesia?
analgesia - reduces or rids of pain
anaesthesia - loss of sensation / consciousness
a woman comes in at 35 weeks pregnant. cervical dilation is 3cm. what does this mean.
not much. dilation >4cm will bee classed as preterm labour:
or cervical changes seen eg effacement
or if + contractions + ruptured membrane
what is the limit of viability?
23-24 weeks
so 6 months
what is gold standard analgesia/pain relief in labour?
Epidurals or combiend standard epidurals
why do some women need 5mg folic acid?
obesity
anti-epileptics
name some drugs that are teratogenic in pregnancy?
methotrexate - should stop for 6 months before conception
sodium valproate
ace inhibitors
retinoid - derived form vitamin A
what is Naegele rule?
used to calculate EDD - estimateed delivery date based on LMP
LMP + 1year - 3months + 7days
(in otherwords + 9 months and 7 days)
What is the most common cause of early onset (before 7 days) infection of newborms?
Group B strep
what are the components of the apgar socre?
Heart rate
Breathing
Reflex irritability
Muscle tone
Appearance/colour
what is the purpose of the apgar score and what do different results mean?
Indicates need for resuscitation (oxygenation, help with breathing) and resposne to resuscitation. determines risk of asphyxia.
done at 1 minute and 5 minutes after birth.
5 minute scores:
7+ normal/good
4-6 moderately abnormal
0-3 concerning
low 1 minute scores may spontaenously resolve by 5
an apgar score should be used to predict individual adverse neurologic outcome. TRUE/FALSE
FALSE
score of 0–3 correlates with neonatal mortality in large populations , but does not predict individual future neurologic dysfunction
A 1-minute Apgar score of 0–3 predicts any individual infant’s outcome. TRUE/FALSE
false
it does NOT predict this
a low score cannot predict morbidity or mortality for any individual infant
When a newborn has an Apgar score of 5 or less at 5 minutes. what should be the next step?
umbilical artery blood gas from a clamped section of the umbilical cord should be obtained
0-3:
more intervention and support with bresthing required
may need NICU admission
an Apgar score alone can be used to diagnose asphyxia. TRUE/FALSE
False
list some causes of a low apgar score?
Fetal distress due to hypoxia before delivery.
Maternal anaesthesia or recent analgesia.
Preterm infant.
Difficult or traumatic delivery.
A woman is 37 week pregnant and has a SROM. How would you manage?
Assess cervix for length and opening (VE and speculum)
If long, not effaced. Pooling in fornix with speculum.
So then admit then
Erythromycin
No steroids as above 36 week
A woman has had a LLETZ proceedure and is now pregnant? What are the implications for her antenatal care and delivery?
Antenatal: obstetrician led care because of risk of preterm labour. Ned to monitor cervical length in pregnancy
Delivery: risk of preterm labour
What are some warning signs of preterm labour?
Regular or frequent sensations of abdominal tightening (contractions)
Constant low, dull backache
A sensation of pelvic or lower abdominal pressure
Mild abdominal cramps
Vaginal spotting or bleeding
Preterm rupture of the membranes — in a gush or a continuous trickle of fluid after the membrane around the baby breaks or tears
A change in type of vaginal discharge — watery, mucuslike or bloody
What is the meaning of a positive FFN?
If you have a positive result between weeks 22 and 34, you’re at increased RISK of premature birth within 5-seven days.
What is the meaning of a negative FFN?
A negative result means that fetal fibronectin isn’t present in your cervical fluid. This indicates that you aren’t likely to deliver in the next two weeks.
Excellent negative predictive value! More reliable than positive predictive value. The power to rule out is greater power to predict.
What things can make an FFN result unreliable?
To avoid a false-positive result, the test will be done before any pelvic exam or transvaginal ultrasound. These tests can cause a release of fetal fibronectin and lead to a false-positive result. Intercourse and vaginal bleeding can affect the test results, too. If you experience vaginal bleeding or have had sex within the last 24 hours, the test probably won’t be done
Do not use lube on the speculum.
what is thee definition of a normal, suspicious and pathological trace on CTG?
normal - all 4 features are reassuring
suspicious - 1 feature is non-reassuring and remaining are reassuring
pathological - 2 or moree featurees are non-reassuring
Which of the Following is not associated with squamous cell carcinoma?
Lichen sclerosis, simplex, planus
Lichen simplex
