Obstetric: Corrections Flashcards
Give some risk factors for miscarriages
1) Age
2) Previous miscarriage (2 or more consecutive)
3) Chronic conditions e.g. uncontrolled diabetes
4) Uterine or cervical problems e.g. large cervical cone biopsies
5) Smoking, alcohol and illicit drugs
6) Underweight/overweight
7) Invasive prenatal tests e.g. chorionic villus sampling and amniocentesis
Give the criteria for expectant management of an ectopic
1) An unruptured embryo
2) <35mm in size
3) Have no heartbeat
4) Be asymptomatic
5) Have a B-hCG level of <1,000IU/L and declining
Describe US appearance of a molar pregnancy
‘Snowstorm’ appearance - the mole appears as a solid collection of echoes with numerous small anechoic spaces which resembles a bunch of grapes.
What is an omphalocele?
Omphalocele is a fetal abdominal wall defect which is associated with a raised maternal serum AFP.
How does an omphalocele affect maternal AFP?
Raised
How does maternal obesity affect maternal AFP?
Low levels
How does maternal diabetes affect maternal AFP?
Low levels
What blood test can be used to monitor treatment with LMWH?
Anti-Xa activity
1st line drug for gestational HTN?
oral labetalol
2nd line drug for gestational HTN?
oral nifedipine (e.g. if asthmatic)
Contraindication of labetalol?
asthma
Give some causes of Dupuytren’s contracture
1) manual labour
2) trauma to hand
3) alcoholic liver disease
4) diabetes mellitus
5) phenytoin treatment
AFP levels in neural tube defects?
Raised
Name 2 infections that can cause erythema nodosum
1) TB
2) Streptococci
Why can ALP be raised in pregnancy?
As placenta produces ALP
What BMI indicates the need for higher dose folic acid during pregnancy?
Pregnant women with a BMI >= 30 kg/m² should receive 5 mg folic acid daily until the 13th week of pregnancy
What is Sheehan’s syndrome?
This is post-partum pituitary gland ischemic necrosis due to blood loss and resultant hypovolemic shock in the immediate post-partum period.
What are the features of Sheehan’s syndrome?
Features of hypopituitarism:
1) Hypothyroidism: fatigue, cold intolerance, constipation, weight gain, hair loss
2) Hypoadrenalism: fatigue, weight loss, hypoglycemia, hyponatremia, confusion
3) Hypogonadism: amenorrhea, hot flashes, loss of libido
4) GH deficiency: fatigue and reduced muscle mass
5) Failure of lactation
At what gestational age do pregnancy related blood pressure problems (such as pregnancy-induced hypertension or pre-eclampsia) occur?
After 20 weeks gestation
what is the drug of choice for treating the patent ductus arteriosus in a newborn?
Indomethacin - acts by inhibiting prostaglandin E2.
What is the Hb cut off to determine if iron supplementation should be taken in the 1st trimester?
110 g/L
What is the biggest risk factor for cord prolapse?
Artificial amniotomy (artificial rupture of membranes)
What infection should you consider with severe transaminitis (i.e. elevated ALT & AST) in pregnancy?
Hepatitis E infection
How is Hep E often contracted?
Undercooked pork
What is seen on FBC in hep E infection?
Thrombocytopenia
What is the Hb cut off to determine if iron supplementation should be taken in the:
a) 1st trimester
b) 2nd/3rd trimester
c) postpartum
a) <100 g/L
b) <105 g/L
c) <100 g/L
How long following a termination of pregnancy can a urine pregnancy remain positive for?
Up to 4 weeks
What does a positive pregnancy test beyond 4 weeks after a termination of pregnancy indicate?
Incomplete abortion or persistent trophoblast
What specific monitoring is recommended when considering starting hydroxychloroquine?
Visual acuity and fundoscopy - risk of severe and permanent retinopathy
What are the gonads in androgen insensitivity syndrome?
Gonads in these patients are testes rather than ovaries.
Up to 90% develop inguinal hernias containing the immature testes.
What is the target for fasting blood glucose in gestational diabetes?
<5.3 mmol/L
What is the target for blood glucose 2 hours after an oral glucose tolerance test in gestational diabetes?
<6.4 mmol/L
How long should magnesium sulphate be given for in eclampsia?
Magnesium treatment should continue for 24 hours after delivery or after last seizure
For patients with with a monochorionic multiple pregnancy, they are asked specifically to report any sudden increases in the size of their abdomen and/or any breathlessness.
Why?
Symptoms of twin-to-twin transfusion syndrome - these symptoms may be the result of polyhydramnios affecting the recipient twin.
Is metformin safe during breastfeeding?
Yes
What is fetal fibronectin (fFN)?
A protein that is released from the gestational sac.
What is a high level of fetal fibronectin (fFN) associated with?
Early labour.
Having a high level however does not mean that early labour is definite, some women will go to term even with a raised fFN.
What is the key feature seen in obstetric cholestasis?
Pruritus (typically affecting palms & soles) WITHOUT a rash.
What is required following a medical TOP?
A ‘multi-level pregnancy test’ is required 2 weeks following a medical TOP.
\ This test assesses for β-hCG levels and can confirm the successful termination of a pregnancy if these levels are low.
When is anti-D immunoglobulin offered to rhesus-negative women in TOP?
Offered to those who are having an abortion AFTER 10+0 weeks’ gestation.
Do NOT offer to women who are having a MEDICAL abortion up to and including 10+0 weeks’ gestation.
Consider for women who are rhesus D negative and are having a SURGICAL abortion up to and including 10+0 weeks’ gestation.
What is the 1st line management of syphilis?
IM benzathine penicillin G (safe in pregnancy)
What is the diagnostic triad for hyperemesis gravidarum?
1) 5% pre-pregnancy weight loss
2) dehydration
3) elecytolyte imbalance
Definitive management of obstetric cholestasis?
Induction of labour at 37 weeks
How long after receiving the MMR vaccination should women avoid becoming pregnant?
28 days
What is the commonest cause of respiratory distress in the newborn period?
Transient tachypnoea of the newborn (TTN)
What is transient tachypnoea of the newborn (TTN) caused by?
Caused by delayed resorption of fluid in the lungs.