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Passmed questions > Obs pass med > Flashcards

Obs pass med Flashcards

1
Q

what is puerperal pyrexia?

A

A temperature of > 38ºC in the first 14 days following delivery

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2
Q

What is the most common cause of puerperal pyrexia?

A

Endometritis
other causes include: UTI, wound infections, mastitis, venous thromboembolism

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3
Q

What is the management of puerperal pyrexia?

A

If endometritis is suspected the patient should be referred to hospital for IV (clindamycin and gentamicin until afebrile for greater than 24 hours)

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4
Q

what medications are suitable for breastfeeding women (antidepressant)?

A

sertraline and paroxetine are the SSRIs of choice

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5
Q

What are the two main risk factors for placenta acretta?

A

-Previous C section
-Placenta previa

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6
Q

What is oligohydraminous?

A

-Reduced amniotic fluid
-Less than 500ml between 32-36 weeks and an amniotic fluid index <5th percentile

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7
Q

What are the causes of oligohydraminous?

A

-Premature rupture of membranes
-Potter sequence (bilateral renal agenesis + pulmonary hypoplasia)
-IUGR
-Post-term gestation
-Pre-eclampsia

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8
Q

Why folic acid important to take in pregnancy?

A

protects against neural tube defects - which are caused by folic acid deficiency

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9
Q

How should “high risk” women take folic acid?

A

5mg of folic acid before conception until 12th week pregnancy

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9
Q

What is recommended with folic acid to all women in pregnancy?

A

400 mg of folic acid until 12 weeks

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10
Q

When are women considered “high risk” for having a baby with neural tube deftect?

A

-Fhx NTD
-Taking antiepileptic drugs
-Coeliac disease
-Diabetes
-Thalassemia triat
-Obese BMI>30kg

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11
Q

Why does shoulder dystocia occur?

A

Due to impaction of anterior fetal shoulder on maternal pubic symphysis - occurs after the head has been delivered

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12
Q

What are the risk factors of shoulder dystocia?

A

-Fetal macrosomia (hence association with MDM)
-High BMI
-Prolonged labour
-DM

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13
Q

How should shoulder dystocia be managed once idenifted?

A

-Senior help
-Episiotomy (allows better access for internal manoeuvres)
-McRoberts’ manoeuvre

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14
Q

What is McRoberts’ manoeuvre?

A

Flexion and abduction of maternal hips - it increases the relative anterior-posterior angle of the pelvis

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15
Q

What are the complications of shoulder dystocia?

A

-Maternal: PPH and perineal tears
-Fetal: Brachial plexus injury and neonatal death

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16
Q

What are symptoms of placental abruption?

A

Vaginal bleeding with pain and discomfort

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17
Q

What are risk factors for placental abruption?

A

-Chronic hypertension
-Smoking
-Cocaine use
-Abdominal trauma

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18
Q

What investigation should be done if placental abbruption?

A

NOTE: these are performed to investigate the extent and consequence of the arupbtion
-Blood test - FBC (Hb), group and save, Kleihauer in RhD - women, this is to gauge the dose of anti D
-Ultrasound can be used to diagnose placenta praevia but does not exclude abruption
-CTG to see if the there is fetal distress

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19
Q

What weeks are corticosteriods useful ?

A

24- 34+6 - if at risk of preterm birth

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20
Q

What are antenatal corticosteroids associated with?

A

Significant reduction in rates of neonatal death, RDS, intraventricular haemorrhage

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21
Q

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

A

Fetal distress: immediate C section
No fetal distress: Admit observe closely, administer corticosteroids, no tocolysis, threshold to deliver depneds on gestation

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22
Q

What is the management of placental abruption if fetus alive and >36 weeks?

A

Fetal distress: Immediate C section
No fetal distress: deliver vaginally

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23
Q

How to manage placental abruption if fetus dead?

A

Induce vaginal delivery

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24
Q

What are the maternal complication of placental abruption?

A

-Shock
-DIC
-Renal failure
-PPH

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25
Q

What are the fetal complication of placental abruption?

A

-IUGR
-Hypoxia
-Death

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26
Q

What is the prognosis of placental abruption?

A

-Associated with high perinatal mortality rate
-Responseible for 15% of perinatal deaths

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27
Q

What are the high risk factors for developing pre-eclmapsia?

A

-Hypertensive disease in pregnancy
-CKD
-Autoimmune diseases, such as lupus
-Chronic hypertension
-Type 1 or 2 diabetes

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28
Q

What are the moderate risk factors for developing pre-eclampsia?

A

-First pregnancy
-Age >40
-Pregnancy internal >10 years
-BMI >35 at first vist
-Multiple pregnancy

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29
Q

What should women with either > 2 moderate factors or >1 high factors take?

A

75-150mg aspirin

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30
Q

What is the classical triad of pre-eclampsia?

A

-New-onset hypertension
-Proteinuria
-Oedema

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31
Q

What is the definition of pre-eclampsia?

A

-Newonset blood pressure > 140/90 mmHg after 20 weeks AND 1 or more of :
-Proteinuria
-Other organ involvement (renal, liver, neurological, uteroplacental dysfunction)

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32
Q

What are features of severe pre-eclampsia?

A

-Hypertension: typically > 160/110 mmHg and Proteinuria
-Proteinuria: dipstick ++/+++
-Headache
-Visual disturbance
-Papilloedema
-RUQ/epigastric pain
-Hyperreflexia
-Platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome

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33
Q

What are the complications of pre-eclampsia?

A

-Eclampsia
-Fetal complications: Intrauterine growth retardation, prematurity
-Liver involvement (elevated transaminases)
-Haemorrhage (placental abruption)
-Cardiac failure

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34
Q

What is the initial management of pre-eclampsia?

A

-NICE recommend arranging emergency secondary care assessment for any woman in whom pre-eclampsia is suspected
-Women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed

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35
Q

What is the further management of pre-eclampsia?

A

-Oral labetalol 1st line, nifedipine if asthmatic
-Delivery of baby is most important and defintive management

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36
Q

What is the first line Abx for mastitis?

A

-Flucloxacillin 10-14 days - as the most common organism is staphylococcus aureus
-Erythromycin can also be used

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37
Q

If a women is breastfeeding and they have mastitis what should they do?

A

Continue breastfeeding

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38
Q

What is the first line conservative management of lactation mastitis?

A

-Analgesia and encouraging effective milk removal to prevent further milk stasis

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39
Q

What is the main cause of lactation mastitis?

A

Milk stasis, due to overproduction or insufficient removal

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40
Q

Air travel during pregnancy?

A

> 37 weeks with singleton pregnancy avoid air travel
32 weeks multiple pregnancy
-This is due to the increased risk of venous thromboembolism

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41
Q

What Erbs palsy?

A

Damage to the upper brachial plexus - resulting in a characteristic pattern of adduction and internal rotation of the arm - with protonation of the forearm
- commonly called the waiter’s tip

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42
Q

What is Klumpke’s palsy?

A

It occurs due toi damage of the lower brachial plexus and commonly affects nerves innervating muscles of the hand

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43
Q

What is placenta accreta?

A

Attachment of placenta to the myometrium, due to defective decidua basalis

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44
Q

What is the main risk of placenta accreta?

A

PPH - as the placenta does not separate properly during labour

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45
Q

What are the risk factors of placenta accreta?

A

-Previous C section
-Placenta previa

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46
Q

What are the three types of placenta accreta?

A

-Accreta: chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis
-Increta: Chorionic villi invade into the myometrium
-Percreta: Chorionic villi invade through the perimetrium

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47
Q

How often should pregnant patients with T1DM test their blood glucose levels?

A

-Multiple times
(Daily fasting, pre-meal, 1 hour post meal, bedtime)

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48
Q

What should be discussed with patient that have intrahepatic cholestasis of pregnancy?

A

Induction of labour 37-38 weeks as there is a risk of still birth

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49
Q

When is a nuchal scan performed?

A

11- 13 weeks

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50
Q

What are the causes of increased nuchal translucency on USS?

A

-Down syndrome
-Congentital heart defects
-Abdominal wall defects

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51
Q

What is the threshold of blood pressure where you woould admit a women?

A

> 160/110

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52
Q

What is the screening tool used for post natal depression?

A

-Edinburgh postnatal depression scale
-10 question max score 30
->13 indicates a depressive illness of varying severity
-Screens for self harm questions

53
Q

How to manage a visible umbilical cord during labour?

A
  • This is an umbilical cord prolapse
    -Manual elevation of the presenting part back into the uterus to avoid compression
    -If cord past level of introitus minimal handling, keep wet and warm to avoid vasospasm
    -Patient asked ot go on all fours (or left lateral position as an alternative) - C section prepared
    -Tocolytics can be used to reduce uterine contractions
    -Filling bladder may be helpful as it gentle elevates presenting part
54
Q

What is galactocele?

A

-When a build up of milk creates a cystic lesion in the breast
-Occurs in women who have recently stopped breastfeeding
-is due to occlusion of a lactiferous duct
-is usually painless, with no local or systemic signs (how to differentiate from an abscess)

55
Q

When is GDM diagnosed?

A

-Fasting glucose >5.6mmol/L
-2-hour gluocse >7.8mmmol/L
Remember (5678)

56
Q

In GDM if fasting glucose <7 what should be management?

A

-A 2 weeks trial of diet and exercise
-If not met within 1-2 weeks start metformin
-If still not met then short acting insulin is added

57
Q

If at time of diagnosis fasting glucose>7mmol/L then what is the management of GDM?

A

Short acting insulin should be added
(this is because at 6-6.9mmol/l complications such as macrosomia and hydramnios occur)

58
Q

What is the treatment for pregnant women that cannot tolerate metformin or fail to meet glucose targets with metformin and decline insulin?

A

Glibenclamide

59
Q

What are the risk factors for umbilical cord proplapse?

A

-Prematurity
-Multipartity
-Polyhydramnios
-Multiple pregnancy
-Cephalopelvic disproportion
-Abnormal presentation (breech , transverse lie)

60
Q

When do 50% of cord prolapses occur

A

at artificial rupture of membranes - cord visible beyond level of introitus

61
Q

When is vaginal delivery possible with a umbilical cord prolapse?

A

-An instrumental vaginal delivery is possible if the cervix is fully dilates and the head is low
-NOTE- C section is first line

62
Q

What is the main complication of umbilical cord prolapse?

A

-Compression of the cord or cord spasm which can lead to fetal hypoxia, irreversible damage or death

63
Q

How common in umbilical cord prolpase?

A

1/500 deliveries

64
Q

What is the main complication of induction of labour?

A

Uterine hyperstimulation

65
Q

What is the BISHOP score?

A

It is used to assess whether the induction of labour will be required
-Score <5 indicates labour is unlikely to start without induction
-Score >8 indicates cervix is ripe and high chance of spontaneous labour

66
Q

What are the 5 factors assessed with the BISHOP score?

A

-Cervical position
-Cervical consistency
-Cervical effacement
-Cervical dilation
-Fetal station

67
Q

Draw the bishop score table

A
68
Q

Smoking cessation in pregnancy?

A

-Discuss risk of smoking: low birth weight and premature
-NRT but discuss risks/benfits
-Do not give varenicline or bupropion to pregnant or breastfeeding women

69
Q

What is PPROM and how common is it?

A

Premature prelabour rupture of membranes - occurs in 2% pregnancy but is associated with around 40% of preterm deliveries

70
Q

How to confirm PPROM?

A

-A sterile speculum examination - look for pooling of amniotic fluid in posterior vaginal vault

71
Q

How to confirm PPROM if no pooling is observed with speculum examination?

A

Test fluid for PAMG-1 (placental alpha microglobulin 1) or IGFBP-1 (insulin-like growth factor binding protein 1)

72
Q

Why should a digital examination be avoided when investigated PPROM?

A

Risk of infection

73
Q

How does PPROM present?

A

-Feeling gush/leak of fluid from vagina

74
Q

WHat medications cause folic acid deficiency?

A

Phenytoin
Methotrexate

75
Q

Hwo results at combined sreening test at 12 weeks would suggest Down’s syndrome?

A

-Increased HCG, Decreased PAPP-A and a thickned nuchal translucency

76
Q

What is the management for a suspected PE in a pregnant women with a confirmed DVT?

A

Treat with LMWH and then investigate to rule out

77
Q

What is the complication of PE in pregnancy?

A

-Hypoxia to foetus and mother
-Potentila cardiac arrest

78
Q

What is the investigation of choice for women with a suspected DVT?

A

Compression duplex US

79
Q

Investigation for patients with suspected PE?

A

-ECG and CXR in all patients
-If signs and symptoms of DVT the compression duplex US
-If confirms presence of DVT, no further investigation is needed and treatment for VTE should continue
-The decision to perform a V/Q or CPTA should be taken at local level after discussionw ith patient and radiologist

80
Q

CPTA vs V/Q scanning in pregnancy?

A

-CPTA slightly increased lifetime risk of maternal breast cancer (1/200) as pregnancy makes breast tissue particularly sensitive to effects of radiation
-V/Q scanning increased risk of childhood cancer 1/50,000)

81
Q

Why is the use of D-dimer limited in the investigation of thromboembolism in pregnanyc?

A

it is often already raised in pregnancy

82
Q

What is the treatment for women who develop chickenpox >20 weeks and presnets within 24hours of onset of the rash ?

A

oral aciclovir

83
Q

When is zoster immunoglobulin given?

A

To a pregnancy women exposed to chicken pox in first 20 weeks of pregnancy

84
Q

What is the preferred method of induction of labour after membrane sweep when Bishops score <6?

A

Vagianal prostaglandins or oral misoprostol

85
Q

What type of pregnancy does twin-to-wtin transfusion syndrome occur?

A

In a monochorionic pregnancy where the two fetuses share a single placenta

86
Q

Why does twin-to twin transfusion syndrome occur?

A

-As two fetus share one placenta, blood can flow between the twins
-One is the donor and receives a lesser share of the placental blood flow than the recipient
-It occurs due to abnormalities in the network of placental blood vessels

87
Q

What may happen to the the recipient and donor in twin to twin transfusion syndrome?

A

Donor - may become anemic (oligohydramnios)
Recipient - Fluid overload (polyhydramnios)

88
Q

What maternal symptoms may the mother experience and should be specifically asked to report if pregnant with monochorionic twins?

A

-Any sudden increase in size of abdomen
-Breathlessness - this may be result of polyhydramnios affecting recipient twin

89
Q

How to manage a women taking an ACE inhibitor or ARB for pre-exisitng hypertension?

A

Stop immediately and started on labetalol

90
Q

What vitamin is recommended for all pregnant women?

A

Vitamin D 10mg

91
Q

What is an alternative name for group B streptococcus (GBS)?

A

Steptococcus agalactiae

92
Q

What is the most common cause of early onset severe infection in neonatal period?

A

-Group B streptococcus (GBS)
-Inafnts may be exposed to maternal GBS during labour and develop a serious infection (neonatal spesis)

93
Q

How many mothers are thought to be carrier of GBS?

A

20-40 %
-Found in bowel flora

94
Q

What are the risk factors for GBS infection?

A

-Prematurity
-Prolonged rupture of membranes
-PRevious sibling with GBS infection
-Maternal pyrexia e.g. sec ondary to chorioamnionitis

95
Q

If a woman has had a previous GBS detected in a previous pregnancy what is the management?

A

-Inform that the risk of carriage in this pregnancy is 50%
-Offer intrapartum antibiotic prophylaxis (IAP)
or
-Test later on in the pregnancy to see with GBS positive

96
Q

When should swabs for GBS testing be carried out?

A

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

97
Q

When should intrapartum antibiotic prophylaxis be offered?

A

-If previous baby had early or late onset GBS disease
-Women in pre-term labour (regardless of GBS status)
-Women with pyrexia (>38)

98
Q

What is the Abx of choice for GBS prophylaxis?

A

Benzylpenicillin

99
Q

What layers are cut through in C-section?

A

1.Superficial fascia
2.Deep fascia
3.Anterior rectus sheath
4.Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
4.Transversalis fascia
5.Extraperitoneal connective tissue
6.Peritoneum
7.Uterus

100
Q

What is the standard screening test for Down’s syndrome?

A

The combined test
-Trisomy 21 is suggested by: ↑ HCG, ↓ PAPP-A, thickened nuchal translucency
NOTE - trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower

101
Q

When is the combined test done?

A

11-13+6 weeks

102
Q

What is does the quadruple test look at?

A

-Alpha fetoprotein
-Unconjugated oestriol
-Human chorionic gonadotropin
-Inhibin A

103
Q

How do you interpret the results of the quadruple tests?

A
104
Q

What are the two screening tests for Down’s syndrome?

A

-Combined test and quadruple test

105
Q

What to the results of the combined or quadruple tests show?

A

-“lower chance” 1 in 150 or more
-“high chance” 1 in 150 or less

106
Q

If a woman has a ‘higher chance’ result then what will she be offered?

A

-A non-invasive prenatal screening test (NIPT) or
-Diagnostic test (amniocentesis or chorionic villus sampling)
NOTE: most women chose NIPT as it is non0invasive and has high sensitivity and specificity

107
Q

When is chorionic villous sampling carried out as a diagnostic tests?

A

11-13+6 weeks

108
Q

When is amniocentesis performed as a diagnostic test?

A

From 15 weeks

109
Q

What risk of miscarriage do CVS and amniocentesis carry?

A

CVS -1-2%
Amniocentesis - 0.5-1%

110
Q

What is the SSRI of choice in breastfeeding women?

A

-Sertraline
-Paroxetine

111
Q

What is the screening test for GDM?

A

Oral glucose tolerance test

112
Q

When should OGTT be performed if previous GDM?

A

-As soon as possible after booking
-24-28 weeks if first test is normal

113
Q

What do NICE advise as an alternative to OGTT?

A

Early self monitoring of blood glucose

114
Q

If a women has a risk factors for GDM when should OGTT be performed?

A

24-28 weeks

115
Q

What are the risk factors for GDM?

A

-BMI >30kg/m
-Previous macrosomic baby weighing 4.5kg or above
-Previous GDM
-First degree relative with diabetes
-Family origin with high prevalence of diabetes (south asian, black caribbean and middle eastern)

116
Q

What analgesic is absolutely contraindicated in breastfeeding?

A

-Aspirin
-It is associated with Reye’s syndrome which can cause liver and brain damage

117
Q

What can be used to help with nausea and vomiting during pregnancy?

A

-NICE reccomend ginger and acupuncture on the “p6” point (by wirst)
-Antihistamine sshould be used 1st line (BNF - promethazine)

118
Q

What are the baby blues?

A

-Seen in 60-70% of women
-Seen 3-7 days following birth and is more common in primips
-Symptoms:>

119
Q

What is the incubation period of rubella?

A

-14-21 days
-Individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash

120
Q

When is the foetus most at risk of rubella infection?

A

-8-10 weeks damage to fetes is as high as 90%
-Damage is rare after 16 weeks

121
Q

What are the features of congenital rubella syndrome?

A

-Sensorineural deafness
-Congenital cataracts
-Congenital heart disease (PDA)
-Growth retardation
-Hepatosplenomegaly
-Purpuric skin lesions
-Salt and pepper choriortinitis (type of posterior uveitis)
-Micophthalmia
-Cerebral palsy

122
Q

Diagnosing rubella?

A

-IgM antibodies are raised in women recently exposed to the virus

NOTE: it is very difficult to distinguish between parvovirus and B19 serology so must check provirus B19 serology and there is a 30% risk of transplacental infection and 5-10% risk of fatal loss

123
Q

When should non-immune mothers be offered the vaccine ?

A

Post natal period

124
Q

What is the difference between primary postpartum haemorrhage and secondary?

A

-Primary occurs within 24 hours after delivery
-Secondary occurs between 24hours - 6 weeks and is typically due to retained placental tissue or endometritis

125
Q

What are the causes of primary PPH (the 4Ts)

A

-Tone (uterine aony) - majority of cases
-Trauma (perineal tear)
-Tissue (retained placenta)
-Thrombin (clotting/bleeding disorder)

126
Q

What are the risk factors of PPH?

A

-Previous PPH
-Prolonged labour
-Pre-eclampsia
-Increased maternal age
-Polyhydraminos
-Emergency C-section
-Placenta praevia, placenta accreta
-Macrosomia

127
Q

What is the 1st step in management of PPH?

A

PPH is life threatening emergency - senior members of staff should be involved immediately

128
Q

What is required in the ABC approach of PPh?

A

-Two large boree cannula - 14 gauge
-Lie women flat
-Bloods with group and save
-Commence warm crysalloid infusion

129
Q

What is the mec h

A

Passmed questions (11 decks)

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