Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 3a > Obs notes > Flashcards

Obs notes Flashcards

1
Q

What do primordial follicles contain?

A

The primary oocyte

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are oocytes?

A

Germ cells that undergo meiosis to become the mature ovuum ready for fertilisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What produces b-hCG?

A

synciotrophoblast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Around what day does implantation occur?

A

8-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What week does the fetal heart form and begin to beat?

A

Around 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What week have all major organs began to develop?

A

8 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What later of the fertilised egg implants into the uterus (and which part?)

A

The synciotrophoblast implants into the endometrium via finger like projections (chorionic villi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 5 functions of the placenta?

A

Respiration, nutrition, excretion, endocrine, immunity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the placenta’s role in respiration?

A

Source of oxygen for the fetus. Fetal haemoglobin has a high affinity for O2, so draws O2 away from the mother across the placental membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do hCG levels plateau?

A

Around 10 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the job of hCG?

A

Maintains the corpus luteum until the placenta can take over the production of oestrogen and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What hormones does the placenta produce?

A

Oestrogen and progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the function of the oestrogen being produced by the placenta?

A
  • softens tissues and makes them more flexible
  • allows the muscles and ligaments of the uterus and pelvis to expand
  • helps cervix become soft and ready for birth
  • enlarges and prepares breasts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the primary role of progesterone in pregnancy?

A

To maintain the pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

By what week does the placenta take over progesterone production

A

Around 5 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does progesterone maintain the pregnancy?

A
  • relaxation of the uterine muscles (prevents contractions and labour)
  • maintains endometrium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What effects does the rise in progesterone have on other parts of the body than the uterus?

A
  • relaxes the lower oesophageal sphincter and causes heartburn
  • relaxes the bowel (constipation)
  • blood vessels (hypotension, headaches, skin flushing)
  • raises body temp by ~1 degree celsius
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does gas exchange occur in terms of the umbilical vessels?

A

x2 umbilical arteries leave the fetus (deoxygenated), and x1 umbilical vein comes back in (oxygenated). Exchange occurs across the placenta, specifically lacunae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What cardiovascular changes occur in pregnancy?

A
  • increased blood volume
  • increased plasma volume
  • increased cardiac output (increased stroke volume + heart rate)
  • decreased peripheral vascular resistance
  • decreased blood pressure in early/middle pregnancy
  • varicose veins
  • peripheral vasodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does cardiac output, HR and stroke volume change in pregnancy?

A

Increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why might there be ankle oedema and varicose veins in pregnancy?

A

Enlarged uterus may interfere with venous return

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do tidal volume and respiratory rate change in pregnancy?

A

Increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What hormone causes increased tidal volume?

A

Progesterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Why might their be some dyspnoea in pregnancy?

A

Pulmonary ventilation increased by 40%, but oxygen requirements only rise by 20%. Therefore, over breathing can lead to a fall in pCO2 and give a sense of dyspnoea. Can be worsened by elevated diaphragm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What changes occur to the blood in pregnancy?

A

Increase in coagulant activity, RBC volume increases (plasma more than RBC, so Hb falls), WCC and ESR rise, platelets fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What occurs to Hb in pregnancy?

A

Falls, due to plasma increasing more than RBC. Leads to anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why are pregnant women more at risk of DVT + PE?

A

Clotting factors such as fibrinogen and factor VII, VIII and X increase in pregnancy, making women hyper-coagulable.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How does ALP change in pregnant women?

A

Increase a lot due to secretion by the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How does GFR change in pregnancy?

A

Increases 30-60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Why is there sometimes trace glycosuria in pregnancy?

A

Due to increased GFR and reduction in tubular reabsorption of filtered glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Is there proteinuria in pregnancy?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How does changes in hormones affect salt and water retention in pregnancy?

A

More steroid hormones such as aldosterone, leads to more salt and water retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does calcium levels change in pregnancy?

A

Requirements increase, but so does gut absorption, so levels remain stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Does hepatic blood flow change?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What happens to albumin levels in pregnancy?

A

Fall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

How does the uterus change in size in pregnancy?

A

Gains a 1kg. Hyperplasia occurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are Braxton Hicks? When do they occur?

A

Non painful ‘practice contractions’, from around 30 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Why might linear nigra occur in pregnancy?

A

There may be increased skin pigmentation due to increased melanocyte stimulating hormone (alongside ACTH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What skin changes might be seen in pregnancy?

A
  • striae gravidarum (stretch marks of abdomen)
  • general itchiness
  • spider naevi
  • palmar erythema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What hormones change in pregnancy?

A

More ACTH, more prolactin, more melanocyte stimulate hormone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What does ACTH rise in pregnancy cause?

A

Increased cortisol and aldosterone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Why does prolactin rise in pregnancy?

A

To suppress FSH and LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What occurs to TSH, T3 and T4 levels in pregnancy?

A

TSH remains normal, T3 and T4 rise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

How might vaginal discharge change in pregnancy?

A

Increased oestrogen may cause cervical ectropion and increased cervical discharge. Oestrogen also causes hypertrophy of the vaginal muscles and increased vaginal discharge. The changes in the vagina prepare it for delivery, however they make bacterial and candidal infection (thrush) more common.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What do prostaglandins do to the cervix?

A

Cause breakdown of collagen, allowing dilating and effacing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How many stages of labour are there?

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the first stage of labour?

A

True contractions until 10cm cervical dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What is the 2nd stage of labour?

A

10cm cervical dilatation to delivery of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the 3rd stage of labour?

A

Delivery of the baby to delivery of the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are signs of labour?

A

Regular and painful uterine contractions, a show (shedding of mucous plug), rupture of membranes, shortening and dilation of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How often is FHR monitored?

A

Every 15 mins, or constantly via CTG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How often are contractions assessed in labour?

A

Every 30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How often is maternal BP and temp checked in labour?

A

Every 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How often should a vaginal examination be done in labour?

A

4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How often should maternal urine be checked for ketones and proteins in labour?

A

Every 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How often should maternal pulse rate be assessed in labour?

A

Every 60 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What can be used to induce labour?

A

Prostaglandin E2 (pessaries can be used)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When does cervical dilation and effacement occur?

A

In the first stage of labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is ‘the show’ and what is its funciton?

A

Mucus plug in the cervix, prevents bacteria from entering the uterus in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How long does stage 1 labour last typically in a primigravida?

A

10-16 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the two stages of the first stage of labour?

A

Latent and active phase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the latent phase of labour, and how long should it last?

A

0-3cm dilation, around 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the active phase of labour, and how long should it last?

A

3-10cm, normally 1cm/hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What position should the head enter the pelvis?

A

Occipito-lateral position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the 3 P’s of the second stage of labour?

A

Power, passenger and passage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How long should the 2nd stage of labour last?

A

around an hour: if longer consider ventouse/forceps/c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What can happen to the baby’s heartrate in the second stage of labour?

A

Can have transient fetal bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What does power refer to in the second stage of labour?

A

Strength of uterine contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What does passage refer to in the second stage of labour?

A

Size and shape of the passageway, mainly the pelvis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the 4 qualities of the fetus that can affect the second stage of labour?

A

Size (particularly head!), attitude, lie, presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What are the possible presentations of the fetus?

A

Cephalic, shoulder, breech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the 7 cardinal movements of labour?

A

Engagement, descent, flexion, internal rotation, extension, restitution and external rotation, expulsion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

How is descent measured in labour?

A

Obstetricians describe the position of the baby’s head in relation to the mother’s ischial spines during the descent phase. Descent is measured in centimetres, from -5 to +5. 0= at level of ischial spines (‘engaged’)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is physiological management of the third stage of labour?

A

When the placenta is delivered by maternal effort without medications or cord traction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What requires active management of the third stage of labour?

A

Haemorrhage, or more than 60 minute delay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is active management of the third stage of labour?

A

IM oxytocin to help uterus contract and expel the placenta. Careful traction is applied to the umbilical cord.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is the definition of gravida vs para?

A
  • gravida: total number of pregnancies
  • para: number of times the woman has given birth after 24 weeks (alive or dead)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

When does pregnancy technically begin?

A

From the day of the last menstrual period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

When is first trimester?

A

start of pregnancy to 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

When is second trimester?

A

From 13 weeks to 26 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

When is second trimester?

A

27 weeks until birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

When do fetal movements start?

A

Around 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

When should a booking clinic happen in pregnancy?

A

Before 10 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

When does the dating scan happen?

A

Between 10 and 13+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What happens at the dating scan?

A

Accurate gestational age calculated (crown rump length), and multiple pregnancies identified

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

When should their be antenatal appointments?

A

16, 25, 28, 31, 36, 38, 40, 41, 42

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

When does the anomaly scan occur?

A

Between 18 and 20 + 6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

When is the oral glucose tolerance test for women at risk of gestational diabetes done?

A

Between 24 and 28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

When are anti-D injections given to rhesus negative women?

A

Between 28 and 34 wrrks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Who is offered serial growth scans?

A

Women at risk of fetal growth restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

When is fetal presentation assessment done?

A

From 36 weeks onwards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What vaccines are offered to all pregnant women?

A

Whooping cough and influenza

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What vitamins/supplements are recommended and what vitamin should be avoided?

A

Take folic acid (400mcg) up to 12 weeks, take vitamin D supplements. Avoid vitamin A supplements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Why should vitamin A be avoided in pregnancy?

A

Teratogenic at high doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What amounts of alcohol are safe in pregnancy?

A

No amount is safe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What are the risks of alcohol in early pregnancy?

A

Miscarriage, small for dates, preterm delivery, fetal alcohol syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What are the features of fetal alcohol syndrome?

A

Microcephaly, smooth flat philtrum, short palpebral fissure (short distance from one eye to the other), learning disability, behavioural issues, hearing and vision problems, cerebral palsy, thin upper lip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is the risk of smoking in pregnancy?

A

Miscarriage, increased risk of preterm labour, increased risk of stillbirth, IUGR, increased risk of sudden unexpected death in infancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What bloods are booked at the booking clinic (the first midwife appointment)?

A

Blood group, antibodies, Rhesus D status, FBC for anaemia, screening for thalassaemia + SCD (women at risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

How many antenatal visits are recommended in the first pregnancy vs subsequent if uncomplicated?

A

10 and 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

When should iron be started in pregnancy?

A

Hb <11g/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What natural remedies are offered for nausea and vomiting in pregnancy?

A

Ginger and acupuncture on the p6 point (by the wrist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What does the combined test for Down’s syndrome test?

A

Ultrasound and maternal blood tests. Looks at nuchal translucency, and in bloods b-HCG and PAPPA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What levels of b-HCG can indicate downs syndrome?

A

High result = greater risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

How do levels of PAPPA indicate downs syndrome?

A

Low result= greater risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

When is the combined test offered?

A

between 11 and 14 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is involved in the triple test?

A

bHCG, AFP, serum oestriol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What levels of AFP and serum oestriol indicate a higher risk of downs?

A

Lower levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

When is the triple test done?

A

between 14 and 20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is assessed in the quadruple test?

A

bHCG, AFP, serum oestriol, inhibin A

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What levels of inhibin A can indicate risk of downs?

A

Increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

When is antenatal testing for Down’s offered?

A

If risk greater than 1 in 150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What antentatal testing for Down’s is done earlier in pregnancy?

A

CVS (up to 15 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is CVS?

A

Ultrasound guided biopsy of the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What is amniocentesis?

A

Ultrasound guided aspiration of amniotic fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What other disorders are checked for alongside downs?

A

Edwards (18) and Pataus (13)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is NIPT?

A

Non invasive prenatal screening test, which is a blood test from the mother which checks fetal DNA. High sensitivity and specificity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What should be done to dose of levothyroxine in pregnancy?

A

Increase the dose, as it can cross the placenta and provide thyroid hormone to the developing fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

How can hypothyroidism affect the fetus?

A

Miscarriage, anaemia, SGA, pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What HTN medications should be stopped in pregnancy?

A

ACE-I, ARBs, thiazide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

How much folic acid should women with epilepsy take?

A

5mg (compared to 400mcg in everyone else)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What can sodium valproate cause in pregnancy?

A

Neural tube defects, developmental delay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What can phenytoin cause in pregancy?

A

Cleft lip and palate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Are NSAIDs allowed in pregnancy?

A

Generally avoided, especially in 3rd trimester, as they can cause premature closure of ductus ateriosus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Why are NSAIDs avoided in pregnancy?

A

Work by blocking prostaglandins, which maintain the ductus arteriosus, soften the cervix and stimulate uterine contractions at the time of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Even though beta blockers are used in pregnancy, what can they cause?

A

Fetal growth restriction, hypoglycaemia, bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Why should ACE-I and ARBs be avoided in pregnancy?

A

They cross the placenta, and can affect the fetus’ kidneys, and reduce production of urine (oligohydramnios). Can also cause incomplete formation of skull bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is neonatal abstinence syndrome?

A

When babys are going through drug withdrawal after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

When does neonatal abstinence syndrome occur?

A

3-72 hours after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What are the symptoms of neonatal abstinence syndrome?

A

Irritability, tachypnoea, high temperature and poor feeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Can warfarin be used in pregnancy?

A

No: can cause fetal loss, congenital malformation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

What abnormality is Lithium associated with in pregnancy?

A

Ebstein’s anomaly: the tricuspid valve is set lower on the right side of the heart, causing a bigger right atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What acne medication is highly teratogenic?

A

Isotretinoin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What are the first trimester risks of SSRIs?

A

Congenital heart defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What SSRI particularly has risks in the first trimester?

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What can SSRIs in the third trimester be associated with?

A

Persistent pulmonary hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What are features of congenital rubella syndrome?

A

Deafness, bilateral cataracts, congenital heart disease, growth issues, purpuric skin lesions, small head, cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

If someone is diagnosed with rubella in pregnancy, what (holistic/legal) management is required?

A

Discuss with local health protection unit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Can MMR vaccines be administered to women known to be pregnant?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What increased risks are there to the mother if she encounters chicken pox in pregnancy?

A

Higher risk of pneumonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What is congenital varicella syndrome?

A

Features: FGR, microcephaly, hydrocephalus, scars and skin changes in specific dermatomes, underdeveloped limbs, cataracts and inflammation in the eye

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Can the varicella vaccine be given in pregnancy?

A

Yes: can check IgG levels to confirm if this is needed (or if planning to go to Tokyo…)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

What is the treatment for women who are not immune against chickenpox and exposure?

A

Give IV varicella immunoglobulins, and if the rash starts give oral aciclovir (if >20 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

When can oral aciclovir be given to women who have chickenpox in pregnancy?

A

> 20 weeks, and if she presents within 24 hours of rash onset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What causes Listeria, and thus what should be avoided in pregnancy?

A

Listeria is typically transmitted by unpasteurised dairy products, processed meats and contaminated foods. Pregnant women are advised to avoid high-risk foods (e.g. blue cheese) and practice good food hygiene.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Why is listeria dangerous in pregnancy?

A

Listeriosis in pregnant women has a high rate of miscarriage or fetal death. It can also cause severe neonatal infection.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What are the features of congenital CMV?

A

Growth retardation, pinpoint petechial blueberry muffin skin lesions, microcephaly, deafness, seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What is the triad of congenital toxoplasmosis?

A

Intracranial calcification, hydrocephalus, chorioretinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What are complications of parvob19 in pregnancy?

A

Miscarriage, fetal death, severe anaemia, hydrops fetalis, maternal pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Why does parvovirus B19 infection cause fetal anaemia?

A

Infection of the erythroid progenitor cells occurs in the fetal bone marrow and liver. This causes less erythropoiesis. This can lead to hydrops fetalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What is maternal pre-eclampsia like syndrome?

A

Rare complication of severe fetal heart failure (hydrops fetalis). Triad of hydrops fetalis, placental oedema, and oedema in the mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What causes rhesus disease?

A

When a woman is rhesus D negative, there is a chance her baby is Rhesus D positive. The babys blood will enter the mothers bloodstream at some point, and be recognised as foreign. Antibodies will be produced. This is sensitisaton. When the next exposure occurs (eg, next pregnancy), the antibodies can cross the placenta into the fetus, and attack the fetus’ RBCs (causing haemolysis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

When should anti D immunoglobulin be given?

A
  • delivery of Rh+ve infant
  • any termination of pregnancy
  • miscarriage if gestation >12 weeks
  • ectopic pregnancy that is managed surgically
  • antepartum haemorrhage
  • amniocentesis, CVS, fetal blood sampling
  • abdominal trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

How does anti-D medication work?

A

The anti-D medication works by attaching itself to the rhesus-D antigens on the fetal red blood cells in the mothers circulation, causing them to be destroyed. This prevents the mother’s immune system recognising the antigen and creating it’s own antibodies to the antigen.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

If a rhesus D sensitisation event occurs in 2nd/3rd trimester, what must be done?

A

Dose of anti-D and perform Kleihauer test (determines proportion of fetal RBC present in mother’s blood)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What are the symptoms of rhesus disease if it affects the baby?

A
  • oedematous (hydrops fetalis, as liver devoted to RBC production so albumin production falls)
  • jaundice
  • anaemia
  • hepatosplenomegaly
  • heart failure
  • kernicterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

How is fetal size assessed on ultrasound?

A

Estimated fetal weight and fetal abdominal circumference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

What is the definition of severe small for gestation age?

A

<3rd centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What is low birth weight definition?

A

<2500g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What are the two categories of SGA?

A

Constitutionally small (matches mother + family, growing appropriately on growth chart) and fetal growth restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What is fetal growth restriction?

A

When there is a small fetus due to a pathology reducing the amount of nutrients and oxygen being delivered to the fetus through the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What are the two categories of fetal growth restriction?

A

Placental mediated growth restriction and non-placenta mediated growth resitrction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What are causes of placenta mediated growth resitrction?

A

Idiopathic, pre-eclampsia, maternal smoking, maternal alcohol, anaemia, malnutrition, infection, malnutrition, infection, maternal health conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What are non placenta mediated growth restriction?

A

Genetic abnormalities, structural abnormalities, fetal infection, errors of metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What are signs other than SGA that there is fetal growth restriction?

A

Abnormal doppler studies, reduced fetal movements, abnormal CTGs, reduced amniotic fluid volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What are short term complications of fetal growth restriction?

A

Fetal death or stillbirth, birth asphyxia, neonatal hypothermia, neonatal hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

What are the long term complications of fetal growth restriction?

A

Cardiovascular disease (particularly HTN), T2DM, obesity, mood and behavioural problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

What are risk factors for SGA?

A

Previous SGA baby, obesity, smoking, diabetes, existing HTN, pre-eclampsia, older mother (other 35), multiple pregnancy, antepartum haemorrhage, antiphospholipid syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

When are women assessed for risk factors for SGA?

A

Booking clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

What growth monitoring is done for women at low risk of SGA/IUGR?

A

Symphisis fundal height at every antenatal appointment from 24 weeks. If this <10th centile, they are booked for serial growth scans with umbilical artery doppler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

When are women booked for serial growth scans with umbilical artery doppler?

A

3 or more minor risk factors (RCOG green-top guidelines), 1 or more major risk factor, issue with measuring the symphysis fundal height

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

When might there be issues with measuring the symphisis fundal height?

A

Large fibroids or BMI >35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

What is measured for women at risk of SGA via serial US/doppler?

A
  • estimated fetal weight and abdominal circumference to determine growth velocity
  • umbilical artery pulsality index
  • amniotic fluid volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

What investigations are done if a fetus is identified as SGA?

A
  • blood pressure and urine dipstick for pre-eclampsia
  • uterine artery doppler scanning
  • detailed fetal anomaly scan by fetal medicine
  • karyotyping
  • test for infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

What definitive management may be done if growth is static on birth charts?

A

Early delivery to reduce risk of stillbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What is the definition of macrosomia?

A

> 4.5kg at birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What centile is defined as large for gestational age?

A

> 90th centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What are causes of macrosomia?

A

Constitutional, maternal diabetes, previous macrosomia, maternal obesity or rapid weight gain, overdue, male baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

What are risks to the mother of a macrosomic baby?

A

Shoulder dystocia, failure to progress, perineal tears, instrumental delivery or caesarean, post partum haemorrhage, uterine rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What are risks to the baby of being macrosomic?

A

Birth injury (Erbs palsy, clavicular fracture, fetal distress, hypoxia), neonatal hypoglycaemia, obesity in childhood and later life, T2DM in adulthood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What are investigations for a large for gestational age baby?

A

Ultrasound to exclude polyhydramnios and estimate fetal weight, and oral glucose tolerance test for gestational diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What is monochorionic vs dichorionic twins?

A

One placenta vs two placentas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

What sort of multiple pregnancies have the best outcomes?

A

Diamniotic, dichorionic twin pregnancies (each fetus has their own nutrient supply)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
184
Q

When is multiple pregnancy identified?

A

Booking ultrasound scan. Can also determine the number of placentas and amniotic sacs at this stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
185
Q

How are dichorionic diamniotic twins identified on ultrasound scan?

A

Membrane between the twins with a lambda sign (or twin peak sign)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
186
Q

How are monochorionic diamniotic twins identified on ultrasound?

A

Have a membrane between the twins with a T sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
187
Q

What are the risks to the mother in a multiple pregnancy?

A

Anaemia, polyhydramnios, HTN, malpresentation, spontaenous preterm birth, instrumental delivery/c-section, PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
188
Q

What are the risks to the fetuses and neonates in multiple pregnancies?

A

Miscarriage, stillbirth, fetal growth restriction, prematurity, twin-twin transfusion syndrome, congenital abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
189
Q

What is twin-twin transfusion syndrome?

A

When fetuses share a placenta, so there is a connection between the blood supplies of the two fetuses. One fetus recieves more blood, and can become overloaded with heart failure and polyhydramnios. The other has growth restriction, anaemia and oligohydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
190
Q

What is the management of twin-twin transfusion syndrome?

A

Referral to tertiary specialist fetal medicine centre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
191
Q

What additional blood test is required in twin pregnancy, and why/when?

A

FBC for anaemia. At booking clinic, 20 weeks, 28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
192
Q

What additional scans are done in twin pregnancies?

A
  • 2 weekly scans from 16 weeks for monochorionic twins
  • 4 weekly scans from 20 weeks for dichorionic twins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
193
Q

When is term for triplets?

A

Before 35+6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
194
Q

When is term for uncomplicated di di twins?

A

Between 37 and 37+6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
195
Q

When is term for uncomplicated monochorionic diamniotic twins?

A

Between 36 and 36+6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
196
Q

When is term for mono mono twins?

A

Between 32 and 33+6 weeks, c-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
197
Q

When can there be vaginal delivery in twins?

A

If diamniotic and the first twin is in a cephalic position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
198
Q

What is a major risk factor of UTI in pregnancy?

A

Preterm delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
199
Q

When are women tested for asymptomatic bacteria in UTI?

A

Booking clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
200
Q

What is seen on urine dipstick of UTI?

A
  • nitrites (produced by E.coli)
  • leukocytes (less accurate than leukocytes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
201
Q

What is the most common causes of UTI?

A

E.coli, Klebsiella pneuomoniae, enterococcus, pseudomonas aeruginosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
202
Q

What is the management of UTI in pregnancy?

A

Nitrofurantoin (until 3rd trimester), amoxicillin, cefalexin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
203
Q

When does nitrofurantoin need to be avoided in pregnancy?

A

3rd trimester: risk of neonatal haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
204
Q

Why is trimethoprim avoided in the first trimester of pregnancy?

A

Folate antagonist: can lead to congenital malformations, neural tube defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
205
Q

When are women routinely screened for anaemia in pregnancy?

A

Booking clinic and 28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
206
Q

What is the presentation of anaemia in pregnancy?

A

Shortness of breath, fatigue, dizziness, pallor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
207
Q

What are risk factors for VTE in pregnancy?

A

Smoking, parity >3, age >35, BMI >30, reduced mobility, multiple pregnancy, preeclampsia, gross varicose veins, immobility, family Hx of VTE, thrombophilia, IVF pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
208
Q

When should VTE prophylaxis be started?

A
  • 28 weeks if 3 or more risk factors
  • first trimester if four or more risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
209
Q

What is prophylaxis of VTE in pregnancy?

A

LMWH (dalteparin, enoxaparin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
210
Q

When is VTE prophylaxis stopped in pregnancy?

A

6 weeks post natally, though temporarily stopped when the woman goes into labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
211
Q

What can be considered in women with C/I to LMWH?

A

Intermittent pneumatic compression, anti embolic compression stockings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
212
Q

How do DVTs present?

A

Calf or leg swelling, dilated superficial veins, tenderness to the calf (particularly over deep veins), oedema, colour changes to the leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
213
Q

Where should leg swelling be examined in queried DVT, and what result is significant?

A

10cm below the tibial tuberosity. More than 3cm difference is significant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
214
Q

What score is used to calculate risk of DVT?

A

Wells. 2 points or more =DVT likely, 1 or less = unlikely

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
215
Q

What is the management of likely DVT?

A
  • doppler leg ultrasound within 4 hours
  • d-dimer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
216
Q

What is the first line management of DVT?

A

Apixaban or rivaroxaban (DOAC), even in patients with cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
217
Q

How long should all patients with a DVT recieve anticoagulation?

A

At least 3 months. If unprovoked, 6 months total

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
218
Q

What are the features of PE?

A

Chest pain (pleuritic), dyspnoea, haemoptysis, tachycardia, tachypnoea. Chest clear on examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
219
Q

If a woman is pregnant and has potential DVT but a negative doppler, what is the management?

A

Repeat on days 3 and 7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
220
Q

What should be done for women with queried PE?

A

Immediate ECG and CXR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
221
Q

What can be done to diagnosed PE in pregnancy?

A

CTPA or ventilation perfusion scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
222
Q

Can you use the wells score in pregnant women?

A

No: not validated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
223
Q

Do you check d-dimer in pregnant women?

A

No: will always be raised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
224
Q

Do pregnant women with a confirmed DVT on ultrasound and queried PE, need to be investigated for the PE?

A

No: treatment is the same

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
225
Q

What is the management of DVT/PE in pregnancy?

A

LMWH (dalteparin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
226
Q

When should LMWH be started in suspected DVT/PE?

A

IMMEDIATELY: can be stopped when excluded

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
227
Q

If a woman has confirmed VTE event in pregnancy, how long should they have LMWH for?

A

LMWH is continued for the remained of pregnancy, plus six weeks postnatally, or three months in total (whichever is longer). There is an option to switch to oral anticoagulation (e.g. warfarin or a DOAC) after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
228
Q

Can DOACs be taken in pregnancy?

A

No: switch to LMWH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
229
Q

What triad is observed in pre eclampsia?

A

New onset HTN, proteinuria, oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
230
Q

What is the definition of pre-eclampsia?

A

New onset blood pressure > 140/90 after 20 weeks of pregnancy, and 1 or more of proteinuria or other organ involvement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
231
Q

What causes pre-eclampsia?

A

Spiral arteries of the placenta and the lacunae form abnormally, leading to high vascular resistance.There is also poor perfusion in the placenta, leading to oxidative stress. This releases inflammatory chemicals into the systemic circulation leading to systemic inflammation and impaired endothelial function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
232
Q

If a woman has hypertension before she is pregnant, and then when pregnant technically fits the BP range for pre eclampsia, does this count?

A

No: this is chronic hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
233
Q

What is the name for hypertension in pregnancy that occurs after 20 weeks with no proteinuria?

A

Pregnancy induced hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
234
Q

What is eclampsia?

A

When seizures occur as a result of pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
235
Q

What are high risk factors for pre-eclampsia?

A

Pre existing HTN, previous HTN in pregnancy, existing autoimmune conditions, diabetes, chronic kidney disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
236
Q

What are moderate risk factors for pre-eclampsia?

A

Older than 40, high BMI, more than 10 years since previous pregnancy, multiple pregnancy, first pregnancy, FHx of pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
237
Q

What is the prophylaxis for pre-eclampsia and when is it offered?

A

Aspiring: offered from 12 weeks if one high risk factor or more than one moderate risk factor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
238
Q

What are the symptoms of pre-eclampsia?

A

Headache, visual disturbance or blurriness, N+V, upper abdo/epigastric pain (due to liver swelling), oedema, reduced urine output, brisk reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
239
Q

How can proteinuria be quantified in pre-eclampsia?

A

High urine protein:creatinine ratio, or high urine albumin:creatinine ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
240
Q

What blood test can be done to investigate pre-eclampsia?

A

Placental growth factor: it is low in pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
241
Q

How are all women routinely monitored at antenatal appointments for pre-eclampsia?

A

Blood pressure, symptoms, urine dipstick

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
242
Q

What blood pressure should indicate admission in pregnancy?

A

Above 160/110 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
243
Q

What is the blood pressure goal in gestational hypertension in pregnancy?

A

Below 135/85mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
244
Q

What scoring systems can be used to decide whether to admit a woman with pre-eclampsia?

A

fullPIERS or PREP-S

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
245
Q

How often should fetal ultrasound be done in women with pre-eclampsia?

A

Every 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
246
Q

What is first line management of pre-eclampsia?

A

Labetalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
247
Q

What is second line management of pre-eclampsia?

A

Nifedipine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
248
Q

What is third line management of pre-eclampsia?

A

Methyldopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
249
Q

What is used in the management of severe pre-eclampsia or eclampsia?

A

IV hydralazine (vasodilator)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
250
Q

What is given during labour and the 24 hours after if a woman has diagnosed pre-eclampsia?

A

IV magnesium sulphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
251
Q

What should be given to any woman having a premature birth?

A

Corticosteroids, to help mature fetal lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
252
Q

What is the definitive treatment of pre-eclampsia?

A

Giving birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
253
Q

What is first line management for pre-eclampsia after giving birth?

A

Enalapril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
254
Q

What is HELLP syndrome?

A

Combination of features that occur as a complication of pre-eclampsia and eclampsia. It is Haemolysis, Elevated Liver enzymes, Low Platelets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
255
Q

What are the presenting symptoms of HELLP syndrome?

A

N+V, right upper quadrant pain, lethargy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
256
Q

What is a s/e of magneisum sulfate that should always be managed?

A

Respiratory depression: calcium gluconate is first line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
257
Q

What must be monitored after given IV magnesium sulfate in pregnancy?

A

Urine output, reflexes, RR and oxygen sats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
258
Q

What is the most common medical disorder complicating pregnancy?

A

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
259
Q

When is oral glucose tolerance test done during pregnancy, and who for?

A

Anyone with risk factors, done at 24-28 weeks, or anyone with previous gestational diabetes (do asap)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
260
Q

What are risk factors for gestational diabetes?

A

BMI >30 kg/m2, previous macrosomic baby (>4.5kg), previous gestational diabetes, first degree relative with diabetes, family origin with high prevalence of diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
261
Q

What are the diagnostic thresholds for gestational diabetes?

A

Fasting glucose >= 5.6 mmol/L, and 2-hour glucose is >=7.8 mmol/L (5678)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
262
Q

How is a OGTT performed?

A

Perform in the morning after a fast. Patient drinks 75g glucose drink. Blood sugar is taken before drinking the sugar drink and at 2 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
263
Q

Who should women with gestational diabetes be under the care of?

A

Join diabetes and antenatal clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
264
Q

What is the fasting plasma glucose level that is a cutoff for insulin treatment of gestational diabetes?

A

<7 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
265
Q

What is the management for women with gestational diabetes with fasting glucose <7mmol/l

A

Trial diet and exercise. If targets not met in 1-2 weeks start metformin, and if still not met add short acting insulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
266
Q

What is the management of gestational diabetes with fasting glucose >7 mmol/l

A

Insulin started

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
267
Q

What is the management of pre-existing diabetes in pregnancy?

A

Weight loss if >27 BMI, folic acid 5mg/day, stop oral hypoglycaemia agents except metformin and start insulin, detailed anomaly scan at 20 weeks, treat retinopathy promptly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
268
Q

What are the most significant immediate complications of gestational diabetes?

A

Large for date fetus and macrosomia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
269
Q

What additional screening should be done for women with diabetes during pregnancy?

A

Retinopathy: referral to an ophthalmologist to check

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
270
Q

When should women with pre-existing diabetes give birth?

A

Between 37-38+6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
271
Q

What insulin regime is considered during labour for women with type 1 diabetes?

A

Sliding scale insulin regime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
272
Q

What is a risk for women with existing diabetes after birth?

A

Hypoglycaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
273
Q

What are risks for babies of mothers with diabetes?

A

Neonatal hypoglycaemia, polycythaemia, jaundice, congenital heart disease, cardiomyopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
274
Q

What is the figure that defines neonatal hypoglycaemia?

A

<2.6mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
275
Q

What levels can you expect of glucose after birth in a baby?

A

Transient hypoglycaemia in first few hours is common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
276
Q

What can cause persistent/severe hypoglycaemia in the neonate?

A

Preterm birth, maternal diabetes, IUGR, hypothermia, neonatal sepsis, inborn errors of metabolism

277
Q

What are features of neonate hypoglycaemia?

A

Autonomic (jitteriness, irritable, tachypnoea, pallor), neuroglycopenic (poor feeding/suckling, weak cry, drowsy, hypotonia), apnoea, hypothermia

278
Q

What is the management of asymptomatic neonatal hypoglycaemia?

A

Encourage normal feeding, monitor blood glucose

279
Q

What is the management of symptomatic or very low blood glucose in the neonate?

A

Admit to the neonatal unit, and IV infusion of 10% dextrose

280
Q

What is baby blues?

A

Seen in the majority of women in the first week of birth

281
Q

What is the peak incidence of post natal depression?

A

3 months after birth

282
Q

What are symptoms of baby blues?

A

Mood swings, low mood, anxiety, irritability, tearfulness

283
Q

What is the management of baby blues?

A

Nothing, usually resolve

284
Q

What is the presentation of postnatal depression?

A

The same as outside of pregnancy: low mood, anhedonia, low energy

285
Q

What scale is used to assess postnatal depression?

A

Edinburgh postnatal depression scale

286
Q

What is the treatment for post natal depression

A

Sertraline and paroxetine

287
Q

What management is needed in puerperal psychosis?

A

Admission to the mother and baby unit

288
Q

What is a potential complication of puerperal psychosis?

A

Recurrence: 25%

289
Q

How long is the puerperium?

A

6 weeks

290
Q

What is the pathophysiology of obstetric cholestasis?

A

Reduced outflow of bile acids from the liver

291
Q

When does obstetric cholestasis typically develop?

A

Later in pregnancy, after 28 weeks

292
Q

What is thought to cause obstetric cholestatis?

A

Increased oestrogen and progesterone levels

293
Q

What are bile acids a product of?

A

Break down of cholesterol

294
Q

What causes pruritis in obstetric cholestasis?

A

Build up of bile acids in the blood

295
Q

What complication is obstetric cholestasis associated with?

A

Stillbirth

296
Q

What are the features of obstetric cholestasis?

A

Pruritis (particularly palms of the hands and soles of the feet), fatigue, dark urine, pale greasy stools, jaundice, NO RASH

297
Q

What investigations should be done for women with queried obstetric cholestasis?

A

LFTs and bile acids checked

298
Q

What is found on investigation of obstetric cholestasis?

A

Abnormal liver function tests (mainly ALT, AST and GGT), and raised bile acids

299
Q

Why is a rise in ALP alone not enough to diagnose obstetric cholestasis?

A

Increases in pregnancy anyway, as it is produced by the placenta

300
Q

What is first line treatment of obstetric cholestasis?

A

Ursodeoxycholic acid. Sometimes may plan delivery at 37 weeks

301
Q

When does acute fatty liver of pregnancy tend to occur?

A

In the third trimester

302
Q

What is the pathophysiology of acute fatty liver of pregnancy?

A

Results from impaired processing of fatty acids in the placenta, due to a recessive genetic condition in the fetus. Fatty acids enter the maternal circulation and accumulate in the liver. This can lead to inflammation and liver failure in the mother

303
Q

What deficiency can cause acute fatty liver of pregnancy?

A

Long chain 3-hydroxyacyl CoA dehydrogenase (LCHAD) deficiency in the fetus, which is recessive, so the mother will also have a copy

304
Q

What is the presentation of acute fatty liver of pregnancy?

A

General malaise and fatigue, N+V, jaundice, abdominal pain, anorexia, ascites, headache, hypoglycaemia

305
Q

What is seen on investigation of acute fatty liver of pregnancy?

A

Deranged liver enzymes, raised bilirubin, raised WBC count, deranged clotting, low platelets

306
Q

What is the management of acute fatty liver of pregnancy?

A

Obstetric emergency, and requires delivery of the baby

307
Q

What is placenta praevia?

A

Where the placenta is attached in the lower portion of the uterus, lower than the presenting part of the fetus. It is over the internal cervical os

308
Q

What is the definition of a low lying placenta?

A

When the placenta is within 20mm of the internal cervical os (but not over it)

309
Q

What risks are associated with placenta praevia?

A

Antepartum haemorrhage, emergency c-section, emergency hysterectomy, maternal anaemia and transfusions, preterm birth and low birth weight, stillbirth

310
Q

What is grade 1 placenta praevia?

A

placenta reaches the lower segment but not the internal os

311
Q

What is grade 2 placenta praevia?

A

placenta reaches the internal os but doesn’t cover it

312
Q

What is grade 3 placenta praevia?

A

Placenta covers the internal os before dilation but not when dilated

313
Q

What is grade 4 placenta praevia?

A

Placenta completely covers the internal os

314
Q

What are risk factors for placenta praevia?

A

Previous c-section, previous placenta praevia, older maternal age, maternal smoking, structural uterine abnormalities (fibroids), assisted reproducton, multiple pregnancy

315
Q

When is placenta praevia diagnosed and how?

A

20 week ultrasound anomaly scan. Can do transvaginal

316
Q

What is the clinical features of placenta praevia?

A

Painless bleeding, uterus not tender, fetal heart usually normal

317
Q

What must not be done in placenta praevia?

A

Digital vaginal examination: may provoke severe haemorrhage

318
Q

What is the next step in women diagnosed with placenta praevia at the 20 week scan?

A

Repeat transvaginal scan at 32 weeks, and then 36 weeks to determine method of delivery

319
Q

What is the delivery management of placenta praevia/low lying placenta?

A

Planned c-section at 36-37 weeks. This reduces the risk of spontanous labour and bleeding

320
Q

What is the management for a woman with known placenta praevia who goes into premature labour?

A

Emergency c-section due to the risk of PPH

321
Q

What is the management of placenta praevia that is bleeding?

A

ADMIT + ABC. If unable to stabilise or in labour: emergency c-section

322
Q

What is placenta accreta?

A

When the placenta implants deeper, past the endometrium, which makes it difficult to deliver

323
Q

What are the three layers of the uterine wall?

A

Endometrium, myometrium, perimetrium

324
Q

What are risk factors for placenta accreta?

A

Previous placenta accreta, previous endometrial curettage, previous c-section, multigravida, increased maternal age, low lying placenta or praevia

325
Q

What is possible complication of placenta accreta?

A

Post partum haemorrhage due to the deep implantation making it hard for the placenta to separate in delivery

326
Q

What is placenta increta?

A

When the placenta attaches deeply into the myometrium

327
Q

What is placenta percreta?

A

Where the placenta invades past the myometrium and perimetrium, potentially reaching other organs such as the bladder

328
Q

What is the presentation of placenta accreta?

A

Typically doesn’t present. May have bleeding in the third trimester

329
Q

When might placenta accreta be diagnosed?

A

Antenatal ultrasound, or at birth when difficult to delivery placenta

330
Q

What imaging can be used to assess the depth and width of the invasion of placenta accreta?

A

MRI scans

331
Q

What management may be required in placenta accreta during the third stage of labour?

A

Complex uterine surgery, blood transfusions, intensive care for mother

332
Q

When is delivery planned in placenta accreta?

A

Between 35 and 37 weeks

333
Q

What options are recommended in c-section for the management of placenta accreta?

A

Hysterectomy with the placenta remaining in the uterus, uterus preserving surgery, or expectant management

334
Q

What is expectant management in placenta accreta?

A

Leaving the placenta in place to be reabsorbed over time: risks relating to bleeding and infection

335
Q

What is the recommendation for if placenta accreta is found when there is an elective c-section?

A

Abdomen closed and delivery delayed whilst specialist services put in place.

336
Q

What is vasa praevia?

A

Where the fetal vessels are within the fetal membranes and travel occur the internal cervical os. They aren’t within the umbilical cord the whole way

337
Q

What do the fetal vessels consist of?

A

Two umbilical arteries and a single umbilical vein

338
Q

What is a velamentous umbilical cord?

A

A type of vasa praevia: the umbilical cord inserts into the chorioamniotic membranes and the fetal vessels travel unprotected through the membanes being joining the placenta

339
Q

What is a succenturiate lobe?

A

An accessory lobe of the placenta

340
Q

What is the risk of unprotected fetal vessels in vasa praevia?

A

Fetal vessels are exposed, and can lead to dramatic fetal blood loss and death

341
Q

What are the two types of vasa praevia?

A

Type 1: the fetal vessels are exposed as a velamentous umbilical cord. Type 2: the fetal vessels are exposed as they travel to an accessory placental lobe

342
Q

What are risk factors for vasa praevia?

A

Low lying placenta, IVF pregnancy, multiple pregnancy

343
Q

When is vasa praevia diagnosed?

A

Ideally in ultrasound, though not always. May be diagnosed after a antepartum haemorrhage. May be diagnosed after vaginal examination during labour when pulsating fetal vessels are seen in the membranes. Or,it may be detected during labour when fetal distress and dark-red bleeding occur following rupture of the membranes

344
Q

How will vasa praevia present if it is not diagnosed before rupture of membranes?

A

Fetal distress and dark red bleeding

345
Q

What is the management of asymptomatic women with vasa praevia?

A

Give corticosteroids from 32 weeks, and elective c-section planning

346
Q

What is there a high risk of in vasa praevia?

A

Stillbirth or unexplained fetal death

347
Q

What is placental abruption?

A

Where the placenta separates from the wall of the uterus during pregnancy, which can cause significant bleeding

348
Q

What are risk factors for placental abruption?

A

Previous placental abruption, pre-eclampsia, bleeding in early pregnancy, trauma (especially domestic violence), multiple pregnancy, fetal uterine growth restriction, smoking, increased maternal age, cocaine use

349
Q

What is the typical presentation of placental abruption?

A

Sudden onset severe abdominal pain that is continous, vaginal bleeding, shock (hypotension + tachycardia) out of proportion to visible loss, abnormalities on CTG, woody abdomen

350
Q

What is the definition of antepartum haemorrhage?

A

Bleeding from the genital tract after 24 weeks (anything before =miscarriage)

351
Q

What can cause bleeding in the first trimester?

A

Molar pregnancy, ectopic pregnancy, spontaneous abortion

352
Q

What can cause bleeding in the 2nd trimester?

A

Spontaenous abortion, hydatidiform mole, placental abruption

353
Q

What can cause bleeding in the 3rd trimester?

A

Bloody show, placental abruption, placenta praevia, vasa praevia

354
Q

What are the definitions for severity of antepartum haemorrhage?

A

Minor: less than 50ml, major: 50-1000ml, major: >1000ml

355
Q

What is concealed abruption?

A

Concealed abruption is where the cervical os remains closed, and any bleeding that occurs remains within the uterine cavity. The severity of bleeding can be significantly underestimated with concealed haemorrhage.

356
Q

How is placental abruption diagnosed?

A

Clinically: no reliable tests, ultrasound is not very good

357
Q

What are the initial steps for management of large antepartum haemorrhage?

A
  • urgent involvement of senior obstetrician, midwife, anaesthetist
  • 2x grey cannula
  • crossmatch 4 units of blood
  • fluid and blood resus as required
  • ctg monitoring fetus
358
Q

What is breech presentation?

A

When the presenting part of the fetus is the legs and bottom

359
Q

What are the 4 types of breech?

A
  • complete breech: legs fulled flexed at hips and knees
  • incomplete breech: one leg flexed at hip and extended at knee
  • extended breech: both legs flexed at hip and extended at knee
  • footling breech: one foot presenting through the cervix with leg extended
360
Q

What is the most common breech presentation?

A

Frank breech (extended breech)

361
Q

What are risk factors for breech presentation?

A
  • uterine malformations such as fibroids
  • placenta praevia
  • polyhydramnios or olgiohydramnios
  • fetal abnormality
  • prematurity
362
Q

Up to what point do many babys in breech position turn spontaenouslt?

A

36 weeks

363
Q

What is first line management for breech presentation?

A

External cephalic version at 37 weeks to attempt to turn the fetus

364
Q

What is the management for breech if external cephalic version fails?

A

Mother can chose between vaginal delivery and elective c-section. If vaginal, need to be in consultant led care with access to emergency theatre

365
Q

What are women given for external cephalic version?

A

Tocolysis: this relaxes the uterus. Subcutaneous terbutaline is given, which is a beta agonist and reduces the contractility of the myometrium

366
Q

What test is required if external cephalic version is done?

A

Kleihauer test, and give anti-D prophylaxis if needed

367
Q

What is a potential complication of breech presentation?

A

Cord prolapse

368
Q

What are absolute C/I to external cephalic version?

A
  • where c-section is required
  • antepartum haemorrhage in the last 7 days
  • abnormal cardiotocography
  • major uterine anomaly
  • ruptured membranes
  • multiple pregnancy
369
Q

What is the management of placental abruption if <36 weeks?

A
  • fetal distress: c-section
  • no fetal distress: observe closely, no tocolysis, steroids
370
Q

What is symphysis fundal height?

A

The symphysis-fundal height (SFH) is measured from the top of the pubic bone to the top of the uterus in centimetres. After 20 weeks should match the gestational age in weeks to within 2cm

371
Q

What is oligohydramnios?

A

Reduced amniotic fluid. Definition ~ <500ml at 32-36 weeks

372
Q

What can cause oligohydramnios?

A

Premature rupture of membranes, potter sequence (renal agenesis), intrauterine growth restriction, post term gestation, pre-eclampsia

373
Q

What can cause polyhydramnios?

A
  • excess production due to increased foetal urination: maternal DM, foetal renal disorders, foetal anaemia
  • insufficient removal due to reduced fetal swallowing: oesophageal or duodenal atresia, diaphragmatic hernia, chromosomal disorders
374
Q

What are potential maternal complications of polyhydramnios?

A

Increased respiratory compromise, increased UTIs, increased risk of amniotic fluid embolism

375
Q

What are potential foetal complications of polyhydramnios?

A

Pre term labour and delivery, premature rupture of membranes, placental abruption, malpresentation, umbilical cord prolapse

376
Q

What are possible causes of stillbirth?

A

Unexplained, pre-eclampsia, placental abruption, vasa praevia, cord prolapse or wrapped around fetal neck, obstetric cholestasis, diabetes, thyroid disease, infections, genetic abnormalities

377
Q

What are factors that increase the risk of stillbirth?

A

Fetal growth restriction, smoking, alcohol, increased maternal age, maternal obesity, twins, sleeping on the back

378
Q

What can be done to prevent stillbirths?

A
  • aspirin for pre-eclampsia risk reduction
  • lifestyle modification
  • serial growth scans for those with/at risk of small for gestational age
379
Q

What three symptoms are red flag in pregnancy?

A

Reduced fetal movement, abdominal pain, vaginal bleeding

380
Q

How is intrauterine fetal death diagnosed?

A

Ultrasound scan

381
Q

What is first line for most women after intra uterine fetal death?

A

Vaginal birth; can be induced or expectant management

382
Q

What can be given to induce labour?

A
  • mifepristine (anti progestogen)
  • misoprostol (stimulate uterine contractions)
383
Q

What can be given to suppress lactation after stillbirth?

A

Dopamine agonists such as cabergoline

384
Q

What are the causes of cardiac arrest (in all general adults)?

A

4Ts and 4Hs
Thrombosis, tension pneumothorax, toxins, tamponade
Hypoxia, hypothermia, hypovolaemia, hyperkalaemia/hypoglycaemia

385
Q

What are the three major causes of cardiac arrest in pregnancy?

A

Obstetric haemorrhage, PE, sepsis leading to metabolic acidosis and septic shock

386
Q

What is aortocaval compression in pregnancy?

A

When the mass of the uterus compresses the inferior vena cava and aorta. Compressing the IVC can lead to reduced cardiac output + hypotension

387
Q

What is the management of acute aortocaval compression?

A

Place the woman in left lateral position

388
Q

What position should CPR be done in pregnant women?

A

15 degree tilt to the left side

389
Q

When should immediate c-section be done in a pregnant woman in cardiac arrest?

A

No response after 4 minutes of CPR. Aim to deliver baby and placenta within 5 minutes of CPR commencing

390
Q

What is the reason for immediate delivery in cardiac arrest in a pregnant woman?

A

To improve the survival of the mother: it improves cardiac output and reduces oxygen consumption

391
Q

How is latent first stage of labour differentiated from established first stage of labour?

A
  • Latent: painful contractions, changes to the cervix, effacement and dilation up to 4cm
  • Established: regular painful contractions, dilation of more than 4cm
392
Q

What is the latent phase at labour, and what rate should it progress?

A

0-3cm, at around 0.5cm/hr

393
Q

What is the active phase of labour, and what rate should it progress?

A

3-7cm, at around 1cm/hr

394
Q

What is the transition phase of labour, and what rate should it progress?

A

7-10cm, around 1cm/hour

395
Q

What is premature labour?

A

Before 37 weeks gestation

396
Q

How can preterm labour be prevented?

A

Vaginal progesterone, cervical cerclage

397
Q

When is vaginal progesterone given in regards to preterm labour?

A

In women with cervical length of less than 25mm on vaginal ultrasound between 16 and 24 weeks

398
Q

When is cervical cerclage done?

A

For prevention of premature labour in women with previous premature labour, or cervical trauma (eg, colposcopy/cone biopsy). If cervical length <25mm on TVUS between 16 and 24 weeks gestation

399
Q

When is rescue cervical cerclage done?

A

Between 16 and 28 weeks if there is cervical dilatation without rupture of membranes

400
Q

How is premature prelabour rupture of membranes diagnosed?

A

Speculum examination reveals pooling of amniotic fluid in vagina

401
Q

What tests can be done if there is doubt about preterm prelabour rupture of membranes?

A

Insulin like growth factor binding protein 1: this is a protein present in high concentrations in amniotic fluid, so can test fluid for this

402
Q

What management should be offered in P-PROM?

A

Prophylactic abx; erythromycin four times daily for 10 days, of until labour established. Given corticosteroids for RDS. Labour may be induced from 34 weeks

403
Q

How is potential pre term labour with intact membranes diagnosed?

A
  • <30 weeks: clinically
  • > 30 weeks: TVUS to assess ultrasound. Diagnose if cervical length <15mm
404
Q

What test can be done for diagnosis of preterm labour with intact membranes?

A

Fetal fibronectin: if >50ng/ml likely

405
Q

What is fetal fibronectin?

A

It is the glue between the chorion and uterus

406
Q

What are management options for preterm labour?

A
  • fetal monitoring
  • tocolysis with nifedipine
  • maternal cortorticosteroids
  • IV magnesium sulphate
  • delayed cord clamping
407
Q

What is tocolysis?

A

Stopping uterine contractions

408
Q

What is used for tocolysis in premature labour?

A

Nifedipine (CCB)

409
Q

When is tocolysis offered in pregnancy?

A

Between 24 and 34 weeks

410
Q

Why is IV magneisum sulfate given in premature labour?

A

Helps protect the fetal brain during premature delivery, can reduce cerebraly palsy

411
Q

What must be monitored if magneisum sulfate has been given due to prematurity?

A

Magnesium toxicity: reduced resp rate, reduced blood pressure, absent reflexes

412
Q

What is risk factors of prematurity?

A
  • RDS
  • intraventricular haemorrhage
  • necrotising enterocolitis
  • chronic lung disease, hypothermia, feeding problems
  • retinopathy of prematurity
  • hearing problems
413
Q

What is retinopathy of prematurity?

A

Visual impairment in babys born before 32 weeks gestation

414
Q

What is cardiotocography used for?

A

Used to measure the fetal heart rate and contractions of the uterus

415
Q

How is cardiotocography performed?

A

Two transducers are placed on the abdomen to get the CTG readout: one above the fetal heart for fetal heartbeat, one near the fundus for contractions

416
Q

How do the two transducers work in CTG?

A
  • fetal heart: doppler ultrasound
  • fundus: uses ultrasound to measure tension in the uterine wall, indicating uterine contraction
417
Q

What are the indications for continous CTG monitoring?

A

Sepsis, maternal tachycardia (>120 BPM), significant meconium, pre-eclampsia, fresh antepartum haemorrhage, delay in labour, use of oxytocin, disproportionate maternal pain

418
Q

What 5 things should be looked for on a CTG?

A

Contractions, baseline rate, variability, accelerations, decelerations

419
Q

When should accelerations be seen in CTG?

A

Alongside contractions of the uterus

420
Q

What are worrying signs when considering the contractions on CTG?

A

Too many: uterine hyperstimulation
- too few: not progressing

421
Q

What is reassuring baseline rate and variability?

A

Baseline: 110-160
Variability: 5-25

422
Q

What is abnormal baseline rate and variability?

A

Baseline: <100 or >180
Variability: <5 for 50 mins, or >25 for 25 mins

423
Q

Why are decelerations a concerning find on CTG?

A

The fetal heart rate is slowing to conserve oxygen for vital organs

424
Q

What are the 4 types of decelerations?

A

Early, late, variable, prolonged

425
Q

What are early decelerations?

A

Gradual dips and recoveries in HR in time with contractions. Normal and not pathological. Caused by compression of vagus nerve in head of fetus, slowing HR

426
Q

What are late decelrations?

A

Late decelerations are gradual falls in heart rate that starts after the uterine contraction has already begun. There is a delay between the uterine contraction and the deceleration. The lowest point of the declaration occurs after the peak of the contraction.

427
Q

What can cause late decelerations?

A

Hypoxia in the fetus: excessive uterine contractions, maternal hypotension, maternal hypoxia

428
Q

What are variable decelerations?

A

Abrupt decelerations that may be unrelated to contractions, and a fall of more than 15 bpm from baseline. Last less than 2 minutes, lowest point in 30seconds

429
Q

What are reassuring signs with variable decelerations?

A

‘Shoulders’: accelerations either side of the decelerations

430
Q

What are the features of prolonged decelerations?

A

2-10 minutes, drop more than 15bpm

431
Q

What causes prolonged decelerations?

A

Compression of the umbilical cord and fetal hypoxia. Very abnormal and concerning

432
Q

What is the most concerning form of decelerations?

A

prolonged

433
Q

What are the four categories of CTG?

A

Normal, suspicious, pathological, need for urgent intervention

434
Q

What means a CTG requires urgent intervention?

A

Acute bradycardia, or prolonged decelerations of more than 3 mins

435
Q

When is fetal scalp stimulation done?

A

If decelerations, can do this as an acceleration in response is reassuring

436
Q

What is the rule of 3’s for fetal bradycardia?

A

3 mins: call for help, 6 mins: move to theatre, 9 mins: prepare for delivery, 12 mins: deliver the baby, 15 mins: done

437
Q

What is sinusoidal CTG?

A

Pattern of CTG that can indicate severe fetal compromise. Can be associated with severe fetal anaemia, eg after a haemorrhage

438
Q

What can cause baseline bradycardia (CTG)?

A

Increased fetal vagal tone, maternal beta-blocker use

439
Q

What can cause baseline tachycardia (CTG)?

A

Maternal pyrexia, chorioamnionitis, hypoxia, prematurity

440
Q

Why are infusions of oxytocin used in labour?

A

Induce labour, progress labour, improve frequency and strength of contractions, prevent or treat PPH

441
Q

What are the roles of oxytocin in labour?

A

Stimulates ripening of the cervix and contractions of the uterus

442
Q

When might ergometrine be used in labour?

A

In the third stage of labour, and post partum to prevent and treat PPH. Only used AFTER delivery

443
Q

How does ergometrine work in pregnancy?

A

Stimulates smooth muscle contraction both in uterus and blood vessels

444
Q

What is syntometrine and when is it used?

A

Combination drug of both oxytocin and ergometrine, can be used for PPH

445
Q

Why are prostaglandins given in pregnancy?

A

To induce labour (dinoprostone, prostaglandin E2), due to cervical ripening

446
Q

Why are NSAIDs avoided in pregnancy?

A

Prostaglandins act as vasodilators, and lower blood pressure. NSAIDs such as ibuprofen and naproxen inhibit the action of prostaglandins. As a result, NSAIDs can increase blood pressure. NSAIDs are generally avoided in pregnancy, and also after delivery in women with raised blood pressure

447
Q

What is misoprostol?

A

Prostaglandin analogue; activates prostaglandin receptors. Ripens cervix + contractions

448
Q

How does mifepristone work?

A

Anti-progesterone; halts pregnancy, ripens cervix, stimulates contraction

449
Q

Why is nifedipine used in pregnancy?

A

Reduces smooth muscle contraction in blood vessels and the uterus. Reduces blood pressure + tocolysis

450
Q

When is terbutaline used?

A

Reduces contractions in uterine hyperstimulation

451
Q

How does carboprost work?

A

Carboprost is a synthetic prostaglandin analogue, meaning it binds to prostaglandin receptors. It stimulates uterine contraction

452
Q

When is carboprost C/I?

A

Patients with severe asthma, can cause life threatening exacerbation

453
Q

When is carboprost given?

A

In PPH when ergometrine and oxytocin have been inadequate

454
Q

How does TXA work?

A

Anti-fibrinolytic. Stops fibrin dissolving in clots, so reduces bleeding.

455
Q

What is failure to progress?

A

When labour is not developing at a good rate

456
Q

When is there delayed first stage of labour?

A

Less than 2cm cervical dilatation in 4 hours

457
Q

How are uterine contractions measured?

A

Per 10 minutes

458
Q

What is a partogram?

A

Way of measuring/monitoring progress in the 1st stage of labour

459
Q

What is measured on a partogram?

A

Cervical dilatation, descent of fetal head, maternal pulse + blood pressure + temp + urine output, frequency of contractions, fetal heart rate, membrane status, frequency of contractions, drugs and fluids

460
Q

What are the two lines on a partogram? What do they show?

A

Alert and action: shows if cervical dilation taking too long

461
Q

What occurs if the alert line is crossed on a partogram?

A

Indicates amniotomy

462
Q

What is indicated if the action line is crossed on a partogram?

A

Escalate to obstetric led care

463
Q

What indicates failure to progress in 2nd stage of labour?

A
  • nulliparous: 2 hours
  • multiparous: 1 hour
464
Q

What is the active management of 3rd labour?

A

IM oxytocin and controlled cord traction

465
Q

What is first line to stimulate contractions in labour?

A

Oxytocin

466
Q

How many contractions should be aimed for in 10 mins?

A

4-5 per 10 mins

467
Q

When is induction of labour offered (gestatational dates)?

A

Between 41 and 42 weeks gestation

468
Q

What are indications for induction of labour?

A

Prelabour rupture of membranes, fetal growth restriction, pre-eclampsia, obstetric cholestasis, existing diabetes, intrauterine fetal death

469
Q

What is the bishop score?

A

Used to determine whether to induce labour

470
Q

What is measured in the bishop score?

A

Fetal station, cervical position, cervical dilatation, cervical effacement, cervical consistency

471
Q

What Bishop score predicts a successful induction of labour?

A

8

472
Q

What Bishop score indicates that labour is unlikely to start without induction?

A

<5

473
Q

What is first line for induction of labour?

A

Membrane sweep done in antenatal clinic. Separate the chorionic membrane from decidua

474
Q

What is done after membrane sweep for induction of labour?

A

Vaginal prostaglandin E2

475
Q

What is done if vaginal prostaglandins fail or are contraindicated in induction of labour?

A

Cervical ripening balloon

476
Q

What is final line Induction of labour?

A

Artifical rupture of membranes with oxytocin infusion

477
Q

What is done to induce labour where intrauterine fetal death has occured?

A

Oral mifepristone plus misoprostol

478
Q

What is the management option if labour is unable to be induced?

A

Elective c-section

479
Q

What is a possible complication of induction of labour with vaginal prostaglandins?

A

Uterine hyperstimulation

480
Q

What are the common criteria for uterine hyperstimulation?

A

Contractions lasting longer than 2 minutes, and mroe than 5 contractions in 10 minutes

481
Q

What is the treatment for uterine hyperstimulation?

A

Tocolysis with terbutaline, and removal vaginal prostaglandins

482
Q

What are potential complications of uterine hyperstimulation?

A

Fetal compromise with hypoxia and acidosis, emergency c-section, uterine rupture

483
Q

What is lochia?

A

Vaginal discharge containing blood, mucous, and uterine tissue that may continue 6 weeks after childbirth

484
Q

Why might fetal scalp sampling be done in labour?

A

Measure capillary blood pH to determine if the baby is hypoxic

485
Q

What does a low pH fetal scalp blood indicate?

A

Indicates that the baby is hypoxic (if pH is <7.2)

486
Q

What simple analgesia is used in labour?

A

Paracetamol, and sometimes add codeine

487
Q

What simple analgesia is avoided in childbirth?

A

NSAIDs

488
Q

What is used for short term pain relief in labour?

A

Gas and air (50% NO, 50% oxygen)

489
Q

What opioids may be given in childbirth?

A

IM pethidine and diamorphine

490
Q

What patient controlled pain relief may be offered?

A

IV remifentanil, which is a short acting opiate medication

491
Q

What medications are kept readily available if patient controlled analgesia is being used?

A

Naloxone for respiratory depression, atropine for bradycardia

492
Q

Where is an epidural inserted?

A

Into the epidural space, which is outside the dura mater

493
Q

What anaesthetic options are used for epidural?

A

Levobupivacaine or bupivacaine, usually mixed with fentanyl

494
Q

What are possible AEs of epidural?

A

Headache after insertion, hypotension, motor weakness in legs, nerve damage, prolonged second stage, increased probability of instrumental delivery

495
Q

If a woman has an epidural and has significant motor weakness, what may have occurred?

A

Catheter may be incorrectly sited in the SAH space

496
Q

What is umbilical cord prolapse?

A

Where the umbilical cord descends below the presenting part of the fetus, after the membranes have rupture

497
Q

What are risk factors for cord prolapse?

A

Prematurity, multiparity, polyhydramnios, twin pregnancy, cephalopelvic disproportion, abnormal presentation

498
Q

What is the most significant risk factor for umbilical cord prolapse?

A

Abnormal lie

499
Q

What is the most significant complication of umbilical cord prolapse?

A

Presenting part may compress the cord, leading to fetal hypoxia

500
Q

How is umbilical cord prolapse diagnosed?

A

If there is fetal distress on CTG. Can be diagnosed by vaginal examination

501
Q

What can be done immediately after umbilical cord prolapse for acute temporary management?

A

Push the presenting part of the fetus back into the uterus to avoid compression

502
Q

What is the definitive management of cord prolapse?

A

C-section

503
Q

What should be done to the cord whilst waiting for further management in cord prolapse?

A

Kept warm, wet, and have minimal handling

504
Q

What management should be done in cord prolapse whilst waiting for c-section?

A
  • woman lie in left lateral position or knee-chest position
  • tocolytic medication such as terbutaline can minimise contractions
  • retrofilling the bladder
505
Q

What is shoulder dystocia?

A

When the anterior shoulder of the baby becomes stuck behind the pubis symphysis of the pelvis after delivery of the head

506
Q

What are risk factors for shoulder dystocia?

A

Fetal macrosomia, high maternal body mass index, diabetes mellitus, prolonged labour

507
Q

What is the turtle neck sign in labour?

A

Seen in shoulder dystocia: the head is delivered and then retracts into vagina

508
Q

What is failure of restitution in labour?

A

Where the face remains downwards and doesn’t turn sideways as expected

509
Q

What manouever should be performed in shoulder dystocia?

A

McRoberts: bringing knees towards the abdomen. Also Rubins (hand into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder) and Wood’s screw (trys to rotate the baby)

510
Q

Where can pressure be applied that may help shoulder dystocia?

A

On the anterior shoulder (suprapubic region of abdomen)

511
Q

What intervention may be done in shoulder dystocia?

A
  • episiotomy (enlarge vaginal opening)
512
Q

What is the zavanelli manoeuvre?

A

Zavanelli manoeuver involves pushing the baby’s head back into the vagina so that the baby can be delivered by emergency caesarean section.

513
Q

What are the potential complications of shoulder dystocia?

A

Maternal: PPH, perineal tears. Baby: death, brachial plexus injury (Erb’s palsy), cerebral palsy

514
Q

What is an instrumental delivery?

A

Vagina delivery assisted by either a ventouse suction cup or forceps

515
Q

What medication is given after instrumental delivery to reduce risk of infection?

A

Co-amoxiclav

516
Q

What are indications of instrumental delivery?

A

Failure to progress, fetal distress, maternal exhausation

517
Q

What factor increases the risk for instrumental delivery?

A

Epidural

518
Q

What are the risks of instrumental delivery?

A

Post partum haemorrhage, episiotomy, perineal tears, injury to anal sphincter, incontinence of bladder or bowel, nerve injury

519
Q

What is there a risk (to the baby) of with ventouse delivery?

A

Cephalohaematoma

520
Q

What is there a risk of (to the baby) with forcep delivery?

A

Facial nerve palsy

521
Q

What is a cephalohaematoma?

A

Swelling on a newborns head, typically in the parietal region, and doesn’t cross suture lines

522
Q

What nerves may be injured in a instrumental delivery (in the mother)?

A

Femoral nerve, obturator nerve

523
Q

What is seen if the femoral nerve in the mother is damaged in instrumental delivery?

A

Weakness of knee extension, loss of patella reflex, numbness of anterior thigh and medial lower leg

524
Q

What is seen if the obturator nerve in the mother is damaged in instrumental delivery?

A

Weakness of hip adduction and rotation, numbness of medial thigh

525
Q

What are risk factors for perineal tears?

A

First baby, large baby, shoulder dystocia, asian ethnicity, instrumental deliverys

526
Q

What is a first degree perineal tear + what is the management?

A

Superficial damage with no muscle involvement. Doesn’t require any repair

527
Q

What is a first degree perineal tear + what is the management?

A

Injury to the perineal muscle, but not the anal sphincter. Sutured on the ward

528
Q

What is a third degree tear + what is the management?

A

Including the anal sphincter, but not the rectal mucosa. Requires repair in theatre

529
Q

What is the classification of third degree perineal tears?

A

3a: less than 50% external anal sphincter torn
3b: more than 50% external anal sphincter torn
3a: internal anal sphincter torn

530
Q

What is a fourth degree perineal tear + how is it repaired?

A

Tear that includes the rectal mucosa. Repaired in theatre

531
Q

What is offered for future pregnancies in women with third or fourth degree perineal tears?

A

Elective C-section

532
Q

What are potential complications of perineal tears?

A

Pain, infection, bleeding, wound dehiscence, urinary incontinence, anal incontinence, fistula between the vagina and bowel, dyspareunia

533
Q

What is an episiotomy and when is it done?

A

When a cut is made in the perineum before the baby is delivered, under anticipation of needing more room. It is done downwards and laterally.

534
Q

What can reduced the risk of perineal tear?

A

Perineal massage, done from 34 weeks onwards

535
Q

What is delayed cord clamping?

A

When there is a delay of a few minutes between the delivery of the baby and the clamping of the cord to allow blood flow to the baby

536
Q

How is controlled cord traction in the third stage of labour?

A

Pulling the cord while applying counter pressure to help deliver the placenta

537
Q

What is done after the placenta is delivered?

A

It is examined to ensure it is complete and no tissue remains in the uterus

538
Q

What blood volume must be lost to be classified as a post partum haemorrhage?

A

500ml after vaginal delivery and 1000ml after a C-section

539
Q

What is a major and minor PPH?

A
  • Major: >1000ml
  • Minor: <1000ml
540
Q

What is a severe PPH?

A

> 2000ml

541
Q

What is a primary PPH?

A

Bleeding within 24 hours of birth

542
Q

What is a secondary PPH?

A

24 hours- 12 weeks

543
Q

What are the four T’s of PPH?

A

Tone, trauma, tissue, thrombin

544
Q

What is the most common cause of PPH?

A

Tone (uterine atony)

545
Q

What are risk factors for PPH?

A

Previous PPH, multiple pregnancy, obesity, large baby, failure to progress in the second stage of labour, prolonged third stage, pre-eclampsia, placenta accreta, retained placenta, instrumental delivery, general anaesthesia, episiotomy or perineal tear

546
Q

What generally causes secondary PPH?

A

Retained placenta or endometritis

547
Q

What are preventative measures for PPH?

A

Treating anaemia during antenatal period, giving birth with empty bladder, active management of third stage, IV TXA in C-section in third stage

548
Q

What is the ABC approach to PPH?

A

Lie the woman flat, keep her warm and communicate with her and her partner. Insert two large bore cannulas. Bloods for FBC, U+E, clotting. Group and match 4 units, warmed IV fluid and blood resus as required. Given oxygen regardless of saturations, and fresh frozen plasma can be used where there are clotting abnormalities

549
Q

What are the mechanical treatments for PPH?

A

Rubbing the uterus to stimulate contraction, catheterisation (bladder distension reduces contractions)

550
Q

What is the medical treatment of PPH?

A

IV oxytocin (slow injection then infusion, 40 units in 500mls), ergometrine (IV or IM), carboprost (IM), misoprostol (sublinguinal), TXA

551
Q

When is ergometrine C/I?

A

In patients with HTN

552
Q

When is carboprost C/I?

A

In patients with asthma

553
Q

What are the surgical options for managing PPH?

A
  • intrauterine balloon tamponade
  • B-lynch suture (suture around uterus)
  • uterine artery ligation
  • hysterectomy
554
Q

What are investigations for secondary PPH?

A

Ultrasound for retained productions of conception, and endocervical and high vaginal swabs for infection

555
Q

What anaesthetic is elective caesarean done under?

A

Generally a spinal anaesthetic

556
Q

What are indications for elective c-section?

A

Previous c-section, symptomatic after a previous significant perineal tear, placenta praevia, vasa praevia, breech presentation, multiple pregnancy, uncontrolled HIV infection, cervical cancer

557
Q

What is a category 1 c-section?

A

Immediate threat to the life of the mother or baby. Decision to delivery time is 30 minutes

558
Q

What is a category 2 c-section?

A

Not an imminent threat to life, but c-section is urgently required. Decision to delivery times is 75 minutes

559
Q

What is a category 3 c-section?

A

Delivery required but mother and baby stable

560
Q

What is a category 4 c-section?

A

Elective c-section

561
Q

What is the most common c-section type?

A

Transverse lower uterine segment incisions

562
Q

What is a vertical incision c-section and why would it be done?

A

Vertical incision down the middle of the abdomen. May be done if very premature or anterior placenta praevia

563
Q

What method is used dissect in c-section and why?

A

Blunt dissection. Results in less bleeding, shorter operating times, and less risk of injury to the baby

564
Q

What are the layers of the abdomen that have to be dissected in a c-section?

A

Skin, subcutaneous tissue, fascia/rectus sheath, rectus abdominis muscles, peritoneum, vesicouterine peritoneum, uterus, amniotic sac

565
Q

What is the benefit of spinal anaesthesia in c-seciton?

A

Safe, few complications, fast recovery

566
Q

What measures are taken during c-section to reduce risks of complications?

A
  • H2 receptor antagonists or PPI before the procedure
  • prophylactic antibiotics
  • oxytocin to reduce PPH
  • VTE prophylaxis with LMWH
567
Q

Why might H2 receptor antagonists or PPIs be given before c-section?

A

There is a risk of aspiration pneumonitis during caesarean section, caused by acid reflux and aspiration during the prolonged period lying flat.

568
Q

What are potential complications in the postpartum period that might be caused by c-section?

A

PPH, wound infection, wound dehiscence, endometritis

569
Q

What are potential complications to the local structures/abdominal organs that might be caused by c-section?

A

Ureter/bladder/bowel/blood vessel damage. Can also have ileus, adhesions, hernias

570
Q

What are increased risks on future pregnancies after a c-section?

A

Increased risk of repeat c-section, uterine rupture, placenta praevia, stillbirth

571
Q

What are the risks on the newborn with a c-section?

A

Risk of lacerations, and increased incidence of transient tachypnoea of the newborn

572
Q

When is a v-bac an appropriate method of delivery?

A

For pregnant women at >37 weeks gestation with a single previous c-section

573
Q

What are contraindications to V-bac?

A

Previous uterine rupture, classical caesarean scar (vertical)

574
Q

What are two key causes of sepsis in pregnancy?

A

Chorioamnionitis, UTIs

575
Q

What is septic shock?

A

When arterial blood pressure drops and results in organ hypo-perfusion

576
Q

What is chorioamnionitis?

A

Infection of the chorioamniotic membranes and amniotic fluid

577
Q

What causes chorioamnionitis?

A

Caused by a large variety of bacteria, including gram positive, negative and anaerobes

578
Q

What is a major risk factor for chorioamnionitis?

A

P-PROM

579
Q

What is the mainstay of treatment in chorioamnionitis?

A

Prompt delivery of the foetus, administration of IV abx

580
Q

What chart is used to identify sepsis in pregnant women?

A

MEOWS: maternal earlyobstetric warning system

581
Q

What are the non-specific signs of sepsis?

A

Fever, tachycardia, raised resp rate, reduced oxygen saturations, low blood pressure, altered consciousness, reduced urine output, raised WBC on FBC, fetal compromise on CTG

582
Q

What are signs and symptoms related to chorioamnionitis?

A

Abdominal pain, uterine tenderness, vaginal discharge, signs of sepsis

583
Q

What investigations should be done in suspected sepsis?

A

FBC, U+Es (assess kidney function and AKI), LFTs, CRP, clotting (DIC), blood cultures, blood gas (lactate, pH, glucose)

584
Q

What anaesthesia is used for women with maternal sepsis in c-section?

A

General anaesthesia: spinal is avoided

585
Q

What are examples of sepsis antibiotic management?

A

Piperacillin + tazobacatam + gentamicin, or amoxicillin + clindamycin + gentamycin

586
Q

What is sepsis six?

A

Blood lactate, blood cultures, urine output, oxygen, empirical broad spectrum abx, IV fluids

587
Q

What is amniotic fluid embolism?

A

Where fetal cells/amniotic fluid enters the mothers bloodstream and triggers an immune reaction from the mother

588
Q

What are risk factors for amniotic fluid embolus?

A

Increased maternal age, induction of labour, c-section, multiple pregnancy

589
Q

What is the presentation of amniotic fluid embolism?

A

Usually presents around the time of labour + delivery, can be post partum. Shortness of breath, hypoxia, hypotension, coagulopathy, haemorrhage, tachycardia, confusion, seizures, cardiac arrest

590
Q

What is the management of amniotic fluid embolus?

A

Largely supportive. Requires input of MDT: medical emergency. ABCDE. May need CPR and immediate c-section if cardiac arrest occurs

591
Q

What is uterine rupture?

A

Where the muscle layer of the uterus (myometrium) ruptures

592
Q

What is the difference between incomplete and complete uterine rupture?

A

Incomplete: uterine serosa (perimetrium) surrounding the uterus remains intact
Complete: serosa ruptures with the myometrium, contents of the uterus released into the peritoneal cavity

593
Q

What is the main risk factor for uterine rupture and why?

A

The main risk factor for uterine rupture is a previous caesarean section. The scar on the uterus becomes a point of weakness, and may rupture with excessive pressure (e.g. excessive stimulation by oxytocin)

594
Q

What are possible risk factors for uterine rupture?

A

VBAC, previous uterine surgery, increased BMI, high parity, increased age, induction of labour, use of oxytocin to stimulate contractions

595
Q

What is the presentation of uterine rupture?

A

Acutely unwell mother and abnormal CTG. Abdominal pain, vaginal bleeding, ceasing of uterine contractions, hypotension, tachycardia, collapse

596
Q

What is the management of uterine rupture?

A

Resuscitation and tranfusions, and emergency c-section

597
Q

What is uterine inversion?

A

Where the fundus of the uterus drops down through the uterine cavity and cervix, turning the uterus inside out

598
Q

What can cause uterine inversion?

A

Pulling too hard on the umbilical cord during active management of the third stage of labour

599
Q

How does uterine inversion typically present?

A

If complete, will be seen. If incomplete, may be felt with manual examination. Typically presents with large PPH, and maternal shock or collapse

600
Q

What manouevre can be used to treat uterine inversion, and how does this work?

A

Johnson manoeuvre: using a hand to push the fundus back up into the abdomen and to the correct position. Hold for several minutes, can give a drug such as oxytocin to trigger uterine contraction

601
Q

What is second line management of uterine inversion after Johnson manoeuvre?

A

Hydrostatic methods: fill the vagina with fluid to inflate the uterus back into the normal position

602
Q

What is done 6 weeks after the birth of a baby?

A

6 week postnatal appointment, and 6 week newbould check

603
Q

How long will bleeding (lochia) take to settle after childbirth?

A

Around 6 weeks

604
Q

What should be avoided whilst lochia is being produced?

A

Tampons: risk of infection

605
Q

Why might there be more bleeding during breastfeeding?

A

Breastfeeding releases oxytocin, which can cause uterine contraction and lead to more bleeding

606
Q

What is lactational amenorrhoea?

A

When a woman who is breastfeeding doesn’t have periods whilst breastfeeding. There is a reduction in GnRH and LH/FSH

607
Q

When is contraception required after childbirth?

A

21 days after

608
Q

How long is lactational amenorrhoea effective contraception and what is required?

A

98% effective up to 6 months, but women must be fully breast feeding and amenorrhoeic

609
Q

What contraception is considered safe in breast feeding?

A

Progestogen only pill and implant

610
Q

When can COCP be started after childbirth in women who are breast feeding?

A

6 weeks

611
Q

When can the IUD or IUS be inserted after childbirth?

A

Within 48 hours or after 4 weeks

612
Q

What is endometritis?

A

Inflammation of the endometrium, typically caused by infection

613
Q

What is a major risk factor for endometritis, and what can be done to prevent it?

A

C-section, and prophylactic abx are given after c-section to reduce risk of infection

614
Q

How does endometritis typically present?

A

Foul discharge or lochia, bleeding getting heavier/not improving, lower abdominal or pelvic pain, fever, sepsis

615
Q

What investigations should be done for endometritis?

A

Vaginal swabs (including chlamydia and gonorrhoea if RF), urine culture, sensitivities, ultrasound (rule out retained products of conception)

616
Q

How is mild endometritis treated (with no signs of sepsis)

A

Broad spectrum: co-amoxiclav

617
Q

What is a RF for retained products of conception?

A

Placenta accreta

618
Q

What is the presentation of retained products of conception?

A

Vaginal bleeding not improving, abnormal vaginal discharge, lower abdominal or pelvic pain, fever

619
Q

How is retained products of conception diagnosed?

A

Ultrasound

620
Q

What is the management of retained products of conception?

A

Surgical removal: D+C

621
Q

What are two possible complications of retained products of conception management?

A

D+C can lead to endometritis and Asherman’s syndrome

622
Q

Why can asherman’s occur after D+C for retained products of conception?

A

Endometrial curettage can damage the basal layer of the endometrium. Can heal in a way that there is scar tissue and adhesions

623
Q

When is a FBC indicated the day after delivery?

A

If there has been a PPH >500ml, c-section, antenatal anaemia, symptoms of anaemia

624
Q

What hb should be aimed for post natally?

A

> 100

625
Q

What is the management of Hb <100g/l post natally?

A

Oral iron

626
Q

What is the management of Hb <90 g/l postnatally?

A

Iron infusion

627
Q

What is the management of Hb <70g/l postnatally?

A

Blood transfusion in addition to oral iron

628
Q

What is a contraindication to iron infusion?

A

Active infection (pathogens can feed off iron: this is why anaemia can be a sign of inflammation)

629
Q

When does candida of the nipple occur? what can it cause?

A

After a course of abx, can lead to recurrent mastitis

630
Q

How can candida of the nipple present?

A

Sore nipples bilaterally (particularly after feeding), nipple tenderness and itching, cracked/flaky or shiney areola, symptoms in the baby (oral or candidal nappy rash)

631
Q

What is treatment for candida of the nipple?

A

Both mother and baby: mother is topical miconazole 2% after each breastfeed, for the baby miconazole gel or nystatin

632
Q

What are the three stages of postpartum thyroiditis?

A

Thyrotoxicosis, hypothyroidism, normal thyroid function

633
Q

What is post partum thyroiditis?

A

Changes in thyroid function within 12 months of delivery

634
Q

What is the pathophysiology of PP thyroiditis?

A
  • pregnancy has an immunosuppressant effect on the body
  • exaggerated rebound effect, with increased immune system activity and expression of antibodies
  • includes thyroid peroxidase antibodies
635
Q

When are thyroid function tests done after delivery?

A

6-8 weeks

636
Q

What is typical treatment of thyrotoxicosis in PP thyroiditis?

A

Symptomatic control (propanolol)

637
Q

What is the typical treatment of hypothyroidism in PP thyroiditis?

A

Levothyroxine

638
Q

What is sheehan’s syndrome?

A

Complication of PPH, where low blood volume leads to avascular necrosis of the pituitary gland. Ischaemia and cell death occurs

639
Q

What part of the pituitary is affected by Sheehans?

A

Anterior

640
Q

Why is only the anterior pituitary affected by Sheehans?

A

anterior pituitary gets its blood supply from a low-pressure system ( hypothalamo-hypophyseal portal system). This is susceptible to rapid drops in blood pressure. The posterior pituitary gets a good blood supply from various arteries, and is not susceptible to ischaemia when there is a drop in BP

641
Q

What hormones does Sheehans release?

A

TSH, ACTH, FSH, LH, GH, prolactin

642
Q

How does Sheehans present?

A

Due to lack of hormones. Can include amenorrhoea (low FSH and LH), reduced lactation (low prolactin), adrenal insufficiency and crisis (low ACTH), hypothyroidism with low thyroid hormones (lack of TSH)

643
Q

What is the management of Sheehans?

A

Hormone replacement by a specialist: eg, oestrogen, progesterone, hydrocortisone, levothyroxine, growth hormone

644
Q

What can cause abdominal pain in early pregnancy?

A

Ectopic pregnancy, miscarriage

645
Q

What are causes of abdominal pain in late pregnancy?

A

Labour, placental abruption, symphysis pubis dysfunction, pre-eclampsia/HELLP syndrome, uterine rupture

646
Q

What is symphysis pubis dysfunction?

A

Ligament laxity increases in hormonal change in pregnancy

647
Q

What is the presentation of symphysis pubis dysfunction?

A

Pain over pubic symphysis with radiation to groins + medial thighs. Waddling gait

648
Q

What should be done if a baby loses >10% of birthweight in the first week of life?

A

Expert review: eg, midwife breastfeeding clinic

649
Q

What are major contraindications to breastfeeding?

A

Viral infections (mostly HIV) and galactosaemia

650
Q

Is sodium valproate safe in breast feeding?

A

Yes

651
Q

Are antipsychotics safe in breast feeding?

A

Yes; except clozapine

652
Q

What antibiotics should be avoided when breast feeding?

A

Ciprofloxacin, tetracycline, sulphonamides

653
Q

What antibiotics are safe in breast feeding?

A

Penicillins, cephalosporins, trimethoprim

654
Q

What is the medication used for suppressing lactation if required?

A

Cabergoline

655
Q

What antiepileptics should be avoided in pregnancy?

A

Phenytoin (cleft lip), sodium valproate (neural tube defects)

656
Q

What can cause folic acid deficiency?

A

Methotrexate, phenytoin, pregnancy, alcohol excess

657
Q

Who should take 5mg of folic acid rather than just 400mcg?

A

FHx of neural tube defects, antiepileptic drugs, hx of coeliac or diabetes, obesity (>30 BMI)

658
Q

How can a galactocele be differentiated from an abscess?

A

Galactocele is painless, no signs of infection

659
Q

What is the most common cause of early onset infection in the neonatal period? (and thus sepsis)

A

GBS

660
Q

What are risk factors for GBS infection?

A

Prematurity, prolonged rupture of membranes, previous sibling with GBS infection, maternal pyrexia

661
Q

Should all women be screened for GBS?

A

No

662
Q

If a woman has had GBS in a previous pregnancy, what is her risk in her next one?

A

50%

663
Q

What is the management for women who have had GBS in a previous pregnancy?

A

Offer intrapartum abx prophylaxis or testing in late pregnancy + abx if positive then

664
Q

If women are being swabbed for GBS, when should this be done?

A

35-37 weeks, or 3-5 weeks before delivery date

665
Q

What is the prophylaxis of choice for GBS?

A

BenPen

666
Q

Which women should always be offered GBS prophylaxis?

A
  • pyrexia in labour
  • preterm labour (regardless of status)
  • a baby with previous early or late onset GBS disease
667
Q

What are the 3 types of foetal lie?

A

Longitudinal, transverse, oblique

668
Q

What are risk factors for transverse lie?

A

Multiparous, fibroids, pregnant with twins or triplets, prematurity, polyhydramnios, foetal abnormalities

669
Q

What is the possible complications of transverse lie?

A

PROM, cord prolapse

670
Q

What is the management of transverse lie?

A

The same as breech (ECV at 37 weeks, etc).

671
Q

What is puerperal pyrexia defined as?

A

Temperature of more than 38 degrees in the first 14 days following delivery

672
Q

What are possible causes of puerperal pyrexia?

A

Endometritis, UTI, wound infections, mastitis, VTE

673
Q

When should fetal movements be established by?

A

24 weeks

674
Q

At what point does fetal movements tend to plateau?

A

32 weeks

675
Q

What is the first line investigation for a mother reporting reduced fetal movements?

A

Handheld doppler for fetal heartbeat. If heartbeat felt, then CTG used for 20 mins

676
Q

What is the next management for a woman with reduced fetal movements reported, and no heartbeat on doppler?

A

Immediate ultrasound

677
Q

What are maternal risks of obesity during pregnancy?

A

Miscarriage, VTE, gestational diabetes, pre-eclampsia, dysfunction labour + induction, PPH, wound infections, C-section

678
Q

What is the fetal risks of obese mother?

A

Congenital anomaly, prematurity, macrosomia, stillbirth, neonatal death

679
Q

What is the BMI cut off for giving birth in a consultant led unit?

A

> 35 BMI

680
Q

Can hep B be transmitted by breast feeding?

A

No (in contrast to HIV)

681
Q

What is the management for a baby born to a mother who is hepB positive?

A

Complete course of vaccination and hep B immunoglobulin

682
Q

When is vaginal delivery recommended in HIV?

A

If the viral load is less than 50 copies/ml at 36 weeks

683
Q

What HIV prophylaxis should be used in birth for HIV mothers?

A

IV zidovudine, also give to neonate

684
Q

What investigation should be done for all women with queried PE?

A

DVT + PE

685
Q

What increased risk does CTPA hold for a mother if done during pregnancy?

A

Risk of maternal breast cancer because pregnancy makes breast tissue sensitive to radiation effects

686
Q

What is cephalopelvic disproportion?

A

When the head is too large for the baby

687
Q

What are causes of cephalopelvic disproportion?

A

Large baby, abnormal position of baby, small pelvis, abnormal shape to pelvis, abnormality of the genital tract

688
Q

What can cephalopelvic disproportion lead to?

A

Obstructed labour

Phase 3a (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions