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System based flashcards > Obs&gynae > Flashcards

Obs&gynae Flashcards

1
Q

The four Ts of partum haemorrhage

A

Tone- uterine atony
Tissue- retained tissue or clots
Trauma- uterine, vaginal or cervical lacerations
Thrombin- preexisting or acquired coagulation disorders

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2
Q

Risk factors for PPH

A

APH, placenta previa, placental abruption, multipregnancy, multiparity (4+), preeclampsia, previous PPH, obesity, maternal age, caesarean, induction of labour

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3
Q

Management of uterine atony in PPH

A 
ABCDE
bimanual uterine massage
Catheterise
Oxytocin
Ergometrin
Carboprost
Misoprostol
Surgery:
Balloon tamponade
Hysterectomy
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4
Q

what blood pressure levels are deemed serious pre eclampsia?

A

diastolic 110+

systolic 160+

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5
Q

risk factors for pre eclampsia

A 
first pregnancy
maternal age 40+
BMI 35+
Family history
multipregnancy
DM1&2
Hypertension
CKD
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6
Q

symptoms of pre eclampsia

A

headache
ankle swelling
visual disturbances
epigastric pain/vomiting

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7
Q

signs of pre eclampsia

A 
high blood pressure
proteinuria
papilloedema
reduced foetal movements
foetus small for gestational age
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8
Q

investigations for pre eclampsia

A 
FBC- platelets hellp?
LFTs- hellp?
urine- protein, MC&S
renal function
ultrasound- Foetal size, amniotic fluid volume
doppler scan- umbilical arteries
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9
Q

management for pre eclampsia

A 
usually conservative
delivery of placenta is the only 'cure'
labetalol if 150/100 +
magnesium sulphate for seizure risk if severe
fluid restrictions
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10
Q

what does HELLP stand for?

A

Haemolysis, elevated liver enzymes, low platelets

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11
Q

risk factors for HELLP

A 
age 35+
nulliparous
multipregnancy
PMH HELLP or hypertension
APS- antiphospholipid syndrome
caucasian
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12
Q

symptoms of HELLP

A 
*nonspecific
headache
vomiting/nausea/epigastric pain
fatigue
symptoms worse at night
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13
Q

signs of HELLP

A

Oedema
proteinuria
hypertension
hepatomegaly

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14
Q

investigations for HELLP

A

Blood film- haemolysis, fragmented red cells
liver enzymes- AST/ALT raised
FBC- low platelets

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15
Q

treatment for HELLP

A

delivery (If 34w+)
magnesium sulphate
transfusions

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16
Q

what is eclampsia?

A

severe complication of pre eclampsia, in which high blood pressure leads to one or more seizures

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17
Q

management of eclampsia

A 
resus
magnesium sulfate
intubation if required
labetalol
fluid monitoring
delivery of baby once control of blood pressure, seizures and hypoxia is ascertained 
(caesarean likely)
18
Q

What is gestational diabetes?

A

Glucose intolerance with onset during pregnancy

19
Q

what level of fasting glucose would indicate gestational diabetes?

A

5.6mmol/L

20
Q

risk factors for gestational diabetes (GD)

A 
age
ethnicity
high BMI pre pregnancy
smoking
previous macrosomia
FH of DM2 or GDM
21
Q

what are the criteria for screening for gestational diabetes

A 
BMI>30
prev macrosomic baby
prev GDM
1st relative diabetic
family origin with increased risk associated
22
Q

risks of Gestational diabetes to foetus

A 
macrosomia
obesity risk increased
diabetes risk increased
intellectual impairment
shoulder dystocia
23
Q

causes of antepartum haemorrhage

A

*placenta previa
*placental abruption
local trauma, domestic violence, vasa previa, uterine rupture

24
Q

presentation of antepartum haemorrhage

A

bleed +/- pain

contractions, foetal distress, malpresentation, hypovolaemic shock

25
Q

management of antepartum haemorrhage

A 
estimate blood loss
bloods- FBC, group and save, crossmatch, clotting studies, U&Es, LFTs
foetal monitoring and ultrasound scan
antiD for resus negative
corticosteroids if preterm risk
avoid vaginal exam
26
Q

why should a vaginal examination be avoided in antepartum haemorrhage?

A

if previa then risk of torrential bleed

27
Q

what is placenta previa?

A

partial or full covering of the cervical os by the placenta

28
Q

risk factors for placenta previa

A 
previous placenta previa
previous caesarean
older maternal age
increased parity
smoking
cocaine use in pregnancy
previous spontaneous or induced abortion
endometritis
assisted conception
29
Q

presentation of placenta previa

A 
routine scan
painless bleed 28w+
post coital bleed
spontaneous preterm
abnormal lie- transverse/oblique
30
Q

diagnosis for placenta previa

A

ultrasound for leading edge of placenta

31
Q

management of minor placenta previa

A

vaginal delivery possible

if <2cm from os then caesarean

32
Q

management of major placenta previa

A

caesarean
no penetrative intercourse
hospitalisation from 34 weeks if bleed

33
Q

what are the risks of a placenta previa?

A

major haemorrhage- hypovolaemic shock
VTE- associated with hospitalisation
Foetal prematurity
asphyxia during birth

34
Q

what is the normal presentation of the head during vaginal delivery?

A

occipito-anterior position

35
Q

what are the different types of malpresentations?

A

breech (frank, complete, footling), transverse, oblique

36
Q

what are the different types of breech presentation?

A

frank (legs extended upwards), complete (legs fully bent), footling (one flexed one extended)

37
Q

what are the risk factors for breech presentation?

A 
high parity (lax uterus)
placenta previa
uterine abnormalities
multipregnancy
polyhydraminous
IUGR
preterm
previous breech presentation
smoking, diabetes
38
Q

what treatments are available for breech presentation?

A

ECV- external cephalic version after 37w
moxibustion- Chinese medicine
caesarean

39
Q

what are the risk factors for a malpresentation?

A 
prematurity
multipregnancy
uterine abnormalities
foetal abnormalities
placenta previa
40
Q

what are the complications associated with breech delivery?

A 
preterm
cord prolapse
foetal head entrapment
intracranial haemorrhage due to rapid head descent
hyperextension causing spinal injury

System based flashcards (4 decks)

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