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Obs and Gynae > Obstetric issues > Flashcards

Obstetric issues Flashcards

1
Q

Factors associated with increased risk of miscarriage

A 
Increased maternal age
Smoking, alcohol, drugs
High caffeine intake
Obesity
infections and food poisioning
Health conditions e.g. uncontrolled DM, severe HTN
Medicines e.g. ibuprofen
Unusual shape or structure of womb
Cervical incompetence
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2
Q

Signs of labour

A

Regular and painful uterine contractions
Show- shedding of mucous plug
ROM
shortening and dilatation of cervix

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3
Q

Stages of labour

A

Stag1: onset of true labour to when cervix fully dilated
Stage 2: from full dilatation to delivery of foetus
Stage 3: from delivery of fetus to when the placenta and membranes have completely been delivered.

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4
Q

Monitoring in labour

A 
FHR every 15min or continuously by CTG
Contractions assessed every 30min
Pulse every 60min
BP and temp every 4h
VE offered every 4 hours to check progression
urine- ketones and protein every 4h
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5
Q

Anaemia in pregnancy

A

Checked at booking at 28w.
oral iron therapy if:
booking- <11g/dl
28- <10.5g/dl

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6
Q

Amniotic fluid embolism

A

When foetal cells/amniotic fluid enters mothers bloodstream and stimulates reaction which results in chills, sweating, hypotension, cyanosis, tachycardia, MI

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7
Q

Indications of IOL

A

Prolonged pregnancy- 40 +12
Prelabour premature ROM where labour doesn’t start
Diabetic mother >38w
Rhesus incompatibility

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8
Q

Raised AFP

A

NTDs
Abdominal wall defects
Multiple pregnancy

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9
Q

Decreased AFP

A

Down’s syndrome
Trisomy 18
Maternal DM

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10
Q

RF for VTE in pregnancy

A 
Age >35
BMI >30
Parity >3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
FHx of unprovoked VTE
Low risk thrombophilia
Multiple pregnancy
IVF
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11
Q

Treatment of VTE in pregnancy

A

4 or more RF- immediate treatment with LMWH continued to 6 weeks postnatal
3 RF- LMWH from 28w until 6w post natal

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12
Q

VTE prophylaxis to avoid in pregnancy

A

DOACs

Warfarin

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13
Q

RF for pre-eclampsia

A 
hypertensive disease in previous pregnancy
CKD
autoimmune disease
DM -T1/2
Chronic HTN
First pregnancy
>40y
pregnancy interval >10y
BMI >35
FHx of pre-eclampsia
Multiple pregnancy
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14
Q

Consequences of pre-eclampsia

A 
Fetal prematurity or IUGR
Eclampsia
Haemorrhage- abruption, intra-abdominal, intra-cerebral
Cardiac failure
Multi-organ failure
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15
Q

Definition of pre-eclampsia

A

HTN >20w + proteinuria (>0.3g/24h)

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16
Q

Features of severe pre-eclampsia

A 
HTN typically >170/100 mmHg + proteinuria
Protein on dipstick 2/3+
headache
visual disturbance
papilloedema
RUQ/epigastric pain
Hyperreflexia
Platelet count <100 x106/l, abnormal liver enzymes or HELLP syndrome
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17
Q

Management of pre-eclampsia

A

Oral labetalol
Nifedipine and hydralazine may also be used
Delivery of baby

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18
Q

PPH: definition

A

blood loss >500ml
primary- within 24h
Secondary- 24h-12w (retained tissue or endometritis)

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19
Q

RF for PPH

A 
Previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency C-section
placenta praevia, accreta
macrosomia
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20
Q

4 causes of PPH

A

Tone- uterine atony
Tissue- retained products of conception
Thrombin- coagulopathy
Trauma- genital tract trauma

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21
Q

Management of PPH

A

ABC + two peripheral 14 gauge cannula
IV syntocin 10u or IV ergometrine 500 micrograms
IM carboprost
if medical fail- surgical options
intrauterine balloon tamponade, ligation of uterine arteries
last resort- hysterectomy

22
Q

Requirements for instrumental delivery

A 
FORCEPS
Fully dilated cervix
OA position preferably OP
Ruptured membranes
Cephalic presentation
Engaged presenting part i.e. head at or below ischial spines
Pain relief
Sphincter (bladder) empty
23
Q

Indications for forceps use

A

Fetal distress in second stage of labour
Maternal distress in 2nd stage
Failure to progress in 2nd stage
control of head in breech delivery

24
Q

Indications for CTG monitoring

A 
Suspected chorioamnionitis/sepsis/ T> 38
Severe HTN >160/100
Oxytocin use
Presence of significant meconium
Fresh vaginal bleeding that develops in labour
25
Q

CTG interpretation

A 
DR
C
BRA
V
A
D
O
26
Q

Cause of bradycardia on CTG

A

<100 bpm
increased fetal vagal tone
maternal B-blocker use

27
Q

Cause of tachycardia on CTG

A 
>160 bpm
Maternal pyrexia
Chorioamnionitis
Hypoxia
Prematurity
28
Q

Cause of loss of baseline on CTG

A

<5bpm
Prematurity
Hypoxia

29
Q

Cause of early deceleration on CTG

A

Deceleration of HR which commences with onset of contraction and returns to normal on completion
Usually innocuous and indicated head compression

30
Q

Cause of late deceleration on CTG

A

deceleration of HR which lags onset of contraction and doesn’t return to normal until after 30s following end of contraction
Indicated fetal distress- asphyxia or placental insufficiency

31
Q

Cause of variable decelerations on CTG

A

independent of contractions

may indicate cord compression

32
Q

Eclampsia

A

development of seizures in association to pre-eclampsia.

33
Q

Management of eclampsia

A

MgSO4 1V bolus 4g over 5-10 min followed by infusion of 1g/hour
monitor urine output, reflexes, RR and oxygen sats
continue for 24h after last seizure or delivery

34
Q

Placenta praevia

A

Placenta lying wholly or partly in lower uterine segment
Associated factors- multiparity, multiple pregnancy, previous LSCS
clinical features- shock in proportion to visible loss, np pain, no tenderness
Usually picked up on routine 20w abdo USS

35
Q

Placenta accreta

A

Attachment of placenta to myometrium due to defective decidua basalis. Doesn’t properly separate during labour- risk of PPH
RF- placenta praevia, previous C-section

36
Q

Physiological changes in pregnancy

A

CV- raised HR, CO, SV. lower BP
Resp- O2 requirements increase
Blood- blood volume increases, increased risk of thromboembolism, platelets fall, calcium requirements increase
Urine- GFR increases, salt and water reabsorption increased
Uterus size increases

37
Q

Chorioamnionitis

A

Result of ascending bacterial infection of amniotic fluid/membranes/ placenta
Medical emergency- life threatening to mother and foetus
Prompt delivery of foetus and IV Abx considered mainstay of initial treatment

38
Q

Hyperemesis gravidarum

A

Most common 8-12, can be up to 20.

Linked to raised beta hCG levels

39
Q

Hyperemesis: diagnosis and associations

A 
Diagnosis: 5% pre-pregnancy weight loss, dehydration, electrolyte imbalance
Associations:
Multiple pregnancies
Trophoblastic disease
Hyperthyroidism
Nulliparity
Obesity
40
Q

Hyperemesis: management and complications

A

Management:
Antihistamines- cyclizine
Ondansetron and metoclopramide- 2nd line
admission may be needed for IV hydration

Complications- Wernicke’s encephalopathy, Mallory-Weiss tear, central pontine myelinolysis, acute tubular necrosis, fetal- SGA, preterm

41
Q

Possible sensitisation events

A 
Delivery of Rh +ve infant
TOP
Miscarriage if gestation >12w
Ectopic- surgical management
ECV
antepartum haemorrhage
amniocentesis/chorionic villus sampling/ foetal blood sampling
abdominal trauma
42
Q

Threatened miscarriage

A

Painless vaginal bleeding <24w

Cervical os closed

43
Q

Missed (delayed) miscarriage

A

Gestational sac which contains dead fetus <20w without symptoms of expulsion
Light vaginal bleeding/discharge, disappearance of pregnancy symptoms

44
Q

Inevitable miscarriage

A

Cervical os open

Heavy bleeding- clots and pain

45
Q

Incomplete miscarriage

A

Not all products of conception have been expelled

46
Q

Ectopic pregnancy: signs and symptoms

A

Lower abdominal pain- constant and unilateral
vaginal bleeding- lighter and darker than normal (brown)
recent amenorrhoea
ruptured- peritoneal bleeding causes shoulder tip pain and pain on defecation and urination

47
Q

Placental abruption

A

Shock out of keeping with visible loss
constant pain
tender, tense uterus
distressed foetus

48
Q

Symphysis pubis dysfunction

A

Pain of pubis symphysis with radiation to the groins and medial aspects of thigh
may have waddling gait
Due to increased ligament laxity in response to hormonal changes of pregnancy

49
Q

Uterine rupture: signs and symptoms

A

Maternal shock, abdominal pain, vaginal bleeding

50
Q

RF for perineal tears

A 
Primigravida
Large babies
Precipitant labour
Shoulder dystocia
Forceps
51
Q

RF for cord prolapse

A 
Prematurity
Multiparity
Polyhydraminos
Twin pregnancy
Cephalopelvic disproportion
Abnormal presentation e.g. Breech, transverse lie
Placenta praevia
Long umbilical cord
High fetal station

Obs and Gynae (7 decks)

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