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نسائية > Obstetric > Flashcards

Obstetric Flashcards

1
Q

Indications for continuous EFM

A

Significant meconium staining of the amniotic fluid.

Abnormal FHR detected by intermittent auscultation.

Maternal pyrexia (temperature ≥38.0°C or ≥37.5°C on two occasions). Fresh vaginal bleeding.

Augmentation of contractions with an oxytocin infusion.

Maternal request.

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2
Q

Active management of the third stage

A

Intramuscular injection of 10 IU oxytocin, given as the anterior shoulder of the baby is delivered, or immediately after delivery of the baby.

Early clamping and cutting of the umbilical cord.

Controlled cord traction

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3
Q

Signs of placental separation

A

Apparent lengthening of the cord.

A small gush of blood from the placental bed.

Rising of the uterine fundus to above the umbilicus

Uterine contraction resulting in firm globular feel on palpation.

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4
Q

Findings suggestive of CPD

A

Fetal head is not engaged.

Progress is slow or arrests despite efficient uterine

contractions. Vaginal examination shows severe moulding and caput formation.

Head is poorly applied to the cervix.

Haematuria.

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5
Q

Risk factors for fetal compromise in labour

A

Placental insufficiency – FGR and pre-eclampsia. Prematurity.

Postmaturity.

Multiple pregnancy.

Prolonged labour.

Augmentation with oxytocin/hyperstimulation.

Precipitate labour.

Intrapartum abruption.

Cord prolapse.

Uterine rupture/dehiscence. Maternal diabetes.

Cholestasis of pregnancy. Maternal pyrexia/chorioamnionitis. Oligohydramnios.

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6
Q

Side-effects of opioid analgesia

A

Nausea and vomiting (they should always been given with an antiemetic).

Maternal drowsiness and sedation.

Delayed gastric emptying (increasing the risks of general anaesthesia).

Short-term respiratory depression of the baby.

Possible interference with breastfeeding.

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7
Q

Indications of epidural analgesia

A

Prolonged labour/oxytocin augmentation.

Maternal hypertensive disorders.

Multiple pregnancy.

Selected maternal medical conditions.

A high risk of operative intervention.

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8
Q

contraindications for epidural analgesia

A

Coagulation disorders (e.g. low platelet count).

Local or systemic sepsis.

Hypovolaemia.

Logistical: insufficient numbers of trained staff (anaesthetic and midwifery).

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9
Q

Signs of uterine rupture

A

Sever lower abdominal pain

vaginal bleeding

haematuria

cessation of contractions

maternal tachycardia

Fetal compromise (often a bradycardia

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10
Q

Relative contraindications to VBAC

A

Two or more previous caesarean section scars.

Need for induction of labour (IOL).

Previous labour outcome suggestive of CPD.

Previous classical caesarean section is an absolute contraindication.

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11
Q

Indications for induction of labour

A

Prolonged pregnancy (usually offered after 41 completed weeks). PROM.

Pre-eclampsia and other maternal hypertensive disorders.

FGR.

Diabetes mellitus.

Fetal macrosomia.

Deteriorating maternal illness.

Unexplained antepartum haemorrhage.

Twin pregnancy continuing beyond 38 weeks.

Intrahepatic cholestasis of pregnancy.

Maternal isoimmunization against red cell antigens.

‘Social’ reasons.

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12
Q

Breech allowed to deliver virginally when

A

No other complication
Estimated Fetal size between 2.5 - 3.5 kg
A dequate pelvis

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13
Q

Complications of breech delivery

A

ROM
cord prolapse
Asphyxia
Infection
Marked molding
Maternal distress
Obstructed labour
Prolong and complicated labour

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14
Q

Indication of C.S in breech presentation

A

Large fetus
Fetal hypoxia
Unfavorable shape of pelvis
Uterind dysfunction
Previous history of perinatal death of children

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15
Q

Risks of external version

A

fetal bone

Preciptation of labour
PROM
placenta abruption
Fetomaternal hemorrhage
Cord entanglement

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16
Q

Factors cause cord prolapse

A

Abnormal lie or presentation (transverse lie, breech) • .Multiple pregnancy • .
Polyhydramnios • .
Prematurity • .
High head •
Unusually long umbilical cord •

Maternal causes Pelvic tumours(e.g. fibroids in the lower segment) Narrow pelvis

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17
Q

Etiology of Placenta Previa

A

Advancing maternal age ◼ Multiparity ◼ Multifetal gestations ◼ Prior cesarean delivery ◼ Smoking ◼ Prior placenta previa

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18
Q

Risk Factors: of Vasa previa

A

◼ Bilobed and succenturiate placentas
◼ Velamentous insertion of the
cord
◼ Low-lying placenta
◼ Multiple gestation
◼ Pregnancies resulting from in
vitro fertilization
◼ Palpable vessel on vaginal exam

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19
Q

Risk factor of retained placenta

A

Previous retained placenta
Prior CS/curettage
Uterine infection
Multiparity
Prior placenta previa

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20
Q

Causes of uterine inversion

A

Excessive traction on cord
Uterine atony
Fundal pressure

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21
Q

Risk factors of uterine rupture

A

Prior CS
Parity >4
Hyperstimulation of uterus with oxytocin
Instrumented delivery
Trauma
Prior uterine surgery
Epidural anaesthesia
Placenta abruptio
Breech version

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22
Q

Signs of Uterine Rupture before delivery

A

Vaginal bleeding.

● Abdominal tenderness.

● Maternal tachycardia.

● Abnormal fetal heart rate tracing.

● Cessation of uterine contractions

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23
Q

Signs of Uterine Rupture after delivery

A

Hypotension more than expected with apparent blood loss.

● Increased abdominal girth.

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24
Q

مواصفات suture مال birth trauma

A

Initial suture above the apex of laceration to control retracted arteries

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25
Q

The advantages of the midline episiotomy are:

A

• less blood loss.

• it is easier to repair.

• the wound heals quicker.

• there is less pain in the postpartum period.

• the incidence of dyspareunia is reduced.

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26
Q

First degree perineal injury

A

Laceration involves the vaginal epithelium or perineal skin only.

27
Q

Second degree perineal injury

A

includes most episiotomies Laceration involves perineal muscle.

28
Q

Third degree perineal injury

A

secondary tear with partial or complete disruption of the anal sphincter.

29
Q

Fourth degree perineal injury

A

third degree tear with anal epithelium or rectal mucosa

30
Q

Prerequisites for Operative Vaginal Delivery

A

A
Ask for help

Anesthesia is needed

Anticipation of complications (e.g., shoulder dystocia, postpartum ).

Adequate Pelvis

B Bladder empty.

C complete Asepsis.

D Dilated cervix.

E Episiotomy

F Favorable presentation (vertex or aftercoming head)

G Gentle traction in the proper axis.
Good uterine contraction.

H Head is engaged.
I Informed consent.
M Membranes are Ruptured
N Neonatal resuscitation trained

31
Q

Advantages Of Vacuum over forceps

A

1) Can be used with local anesthesia or with no anesthesia.

• 2) Can be used before full cx dilatation.

• 3) Can be used for rotation and extraction by single application.

• 4)Less traumatic to mother.

5.less traumatic to fetal head.

• 6) less Compression and traction force

• 7) Does not require additional space between tight fitting head and pelvis.

• 8)No special skill is needed.

32
Q

Advantages Of Forceps over vacuum

A

After coming head of breech

Dead fetus.

Face presentation

33
Q

Time of contraction stress test

A

34 week

34
Q

Contraindication of stress test

A

Premature birth
Placenta previa
Cervical incompetence
Multiple gestation
Previous classic CS

35
Q

Lochia?

A

Vaginal discharge, lasts about 5 weeks

Lochia rubra
Red Duration is variable

Lochia serosa
Brownish red, more watery consistency Continues to decrease in amount

Lochia alba
Yellow

36
Q

معلومة

A

Lactation can occur by 16 weeks’ gestation

37
Q

Sexual Intercourse post partum?

A

May resume when…

■ Red bleeding ceases

■ Vagina and vulva are healed

■ Physically comfortable

■ Emotionally ready

38
Q

معلومة

A

اكثر سبب لل postpartum endometritis is CS after extended period of labour

39
Q

Causes of preterm labour

A

Cervical weakness
Infection
Multiple pregnancies
Uterine mullerian anomalies
Hemorrhage
Stress

40
Q

Types of circulage

A

McDonald transvaginal cerclage:Transvaginal purse-string suture inserted at the cervicovaginal junction without bladder mobilization

Shirodkar (hightransvaginal) cerclage

Transvaginal purse-string suture inserted following bladder mobilization, to allow insertion above the level of cardinal Ligaments

Transabdominal cerclage

Suture inserted at the cervicoisthmic junction via laparotomy or laparoscopy. Transabdominal cerclages can either be inserted preconceptionally or in the first trimester of pregnancy

41
Q

Wrong dating causes

A

• Uncertainty of LMP (10–30% of women).

• Irregular periods.

• Recent use of COCP.

• Conception during lactational amenorrhea.

42
Q

Risk of multiple gestation on mother

A

Hyperemesis gravidurum
Anemia
Preeclampsia
GDM
Polyhydroamnios
Placenta previa
PPH
Operative delivery

43
Q

Risk of multiple gestation on fetus

A

Miscarriage(MC)
Preterm labour
FGR
Intrauterine death
Perinatal death
Chromosomal abnormalities
Congenital abnormalities (MC)
Vanishing twin syndrome (1 trimester)
Disability

44
Q

Dx of multiple pregnancy

A

• Hyperemesis gravidarum.

• Uterus is larger than expected for dates.

• Three or more fetal poles may be palpable at >24wks.

• Two fetal hearts may be heard on auscultation.

45
Q

Timing of division in monozygotic twins

A

• < 3 days DCDA 30%.

• 4 –7 days monochorionic, diamniotic (MCDA) 70%.

• 8 –12 days monochorionic, monoamniotic (MCMA) <1%.

• > 12 days conjoined twins (very rare).

46
Q

Intrapartum risks associated with multiple pregnancy

A

Malpresentation
Operative delivery
Cord prolapse
Fetal hypoxia of second twin
Premature seperation of placenta
PPH

47
Q

Placental diameter

A

15-20 cm

48
Q

Placental weight

A

500-600g

49
Q

Cord length

A

50-60 cm

50
Q

Cord diameter

A

2-4 cm

51
Q

Causes of jaundice in pregnancy

Causes not specific to pregnancy

A

Haemolysis

• Gilbert’s syndrome

• Viral hepatitis (hepatitis A, B, C, E, EBV, CMV)

• Autoimmune hepatitis (primary biliary cirrhosis, chronic active hepatitis, sclerosing cholangitis)

• Gallstones

• Cirrhosis

• Drug-induced hepatotoxicity

• Malignancy.

52
Q

Causes of jaundice specific to pregnancy (

A

Hyperemesis gravidarum

• Pre-eclampsia/HELLP syndrome

• AFLP

• Obstetric cholestasis

53
Q

Risk factors of Asymptomatic bacteruria

A

Dm, sickle cell disease
Low socioeconomic
Primigravida
Age

54
Q

Chicken pox effect before 20w

A

Abortion
Limb hypoplasia
Skin scarring
IUGR
HYDROPS fetalis
Neurological abnormalities

55
Q

Congenital syphlis sx

A

Macular papular rash
Jaundice
Hepatosplenomegaly
Lymphadeno
Sabir shin
Huchinson teeth
Saddle nose

56
Q

Congenital rubella

A

Cataract
Cardiac abnormalities
Microcephaly
Deafness
Mental retardation

57
Q

Rx of rubella

A

No RX
JUST VACCINE

58
Q

Toxoplasmosis sx

A

Hydrocephaly
Seizure
Fever
Chorioretinitis
Intracranial calcification
Jaundice

59
Q

Rx of toxoplasmosis

A

Sipramycin
Sulphomamide

60
Q

CMV

A

Mental retardation
Hearing loss
Cerebral calcification
Chorioretinitis
Jaundice
Interstitial pneumonitis
Hepatosplenomegaly

61
Q

Infections cause hearing loss

A

CMV
SYPHILIS
RUBEELA

62
Q

Infections cause hydrops fetalis

A

Chicken pox
Parovirus

63
Q

Infection that cause cataract

A

Rubella

64
Q

Syphlis Rx

A

Penicillin

نسائية (2 decks)

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