Brainscape's Knowledge GenomeTM

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


See full index

O&G > Obstetric Procedures > Flashcards

Obstetric Procedures Flashcards

1
Q

What is Evacuation of Retained Products of Conception (ERPC)?

A

Surgical procedure to remove ‘retained products of conception’ after delivery, miscarriage or TOP

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

What are the indications for ERCP?

A
  • Miscarriage (maternal preference or necessity)
  • Persistent bleeding, haemodynamic instability
  • Gestational trophoblastic disease (suspected)
  • Infected products of conception after ABx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the complications of ERCP?

A

Generic: bleeding, infection, procedural failure, necessity to repeat

Specific: intrauterine adhesions, perforation of uterus (0.5%)

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

What is External Cephalic Version (ECV)?

A

External manipulation of foetus through maternal abdomen to achieve a cephalic presentation

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

What are the indications for ECV?

A

Breech presentation (persistent at 36 or 37 weeks)

  • Nulliparous - offered at 36 weeks
  • Multiparous - offered at 37 weeks + Tocolytics

Success rate = 50-60%

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

What are contraindications for ECV?

A

Absolute contraindications:

  • Any requirement for C-section regardless
  • Abnormal CTG
  • APH <7 days
  • Major uterine abnormality
  • Ruptured membranes
  • Multiple pregnancy

Relative contraindications: (ECV may be complicated)

  • SGA
  • Pre-eclampsia
  • Oligohydramnios
  • Major foetal abnormalities
  • Scarred uterus
  • Unstable lie
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the complications of ECV?

A

There is a very low complication rate

  • Generic: procedural failure, necessity to repeat
  • Placental abruption
  • Uterine rupture
  • Foeto-maternal haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is CTG?

A

Cardiotocography – continuous monitoring of the foetal heart and uterine activity > used in labour

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

What are growth scans?

A

Booking scan at 12 (8-14) weeks, anomaly scan at 20 (18-21) weeks > monitor pregnancy

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

What is a foetal doppler?

A

Used to monitor FHR and should be placed over the anterior shoulder of foetus > monitor pregnancy

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

What is foetal blood sampling?

A

Blood withdrawn from umbilical vein to determine if severe anaemia caused by Rh sensitisation

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

What are the complications of foetal blood sampling?

A
  • Bleeding from site
  • Changes in FH
  • Infection
  • Leaking of amniotic fluid
  • Death of foetus (1%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the indications for an emergency CS?

A
  • Terminal Bradycardia: FHR < 100 bpm for more than 10 mins
  • Terminal Deceleration: FHR drops and does not recover for more than 3 mins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the indications for an IUS?

A
  • Desire for long-term contraception
  • Menorrhagia
  • Endometriosis
  • HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications of IUD / IUS insertion?

A
  • Generic: bleeding, infection, procedural failure, necessity to repeat
  • SE – heavier bleeding in first 2 weeks after insertion, pain, headache, nausea/vomiting, depression
  • Perforation, infection, bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is a ventouse?

A

Vacuum extractor cup placed directly over flexion point (better for mum but may upset baby)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are forceps?

A

Smooth metal instruments fit around baby’s head (doesn’t upset baby)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the birth options after a previous CS?

A

VBAC – Vaginal Birth After CS

  • <34w GA > forceps

ERCS – Elective Repeat CS

  • > 34w GA > forceps OR ventouse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the indications for instrumental delivery?

A
  • Maternal exhaustion
  • Prolonged second stage of labour
  • Foetal distress
  • Maternal illness where bearing down is risky (cardiac conditions, HTN, aneurysm, glaucoma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the indications for a CS?

A
  • Malpresentation
  • Foetal distress
  • Multiple pregnancy
  • Failure to progress
  • Placenta praevia
  • Severe IUGR
  • Placental abruption
  • Infections (HIV, HSV)
  • Cord prolapse
  • Previous CS
  • APH
  • Previous anal sphincter injury
21
Q

What are the requirements for instrumental delivery?

A

(FORCEPS) – an episiotomy will often be done first:

  • F Fully dilated cervix
  • O OA position (OP delivery is possibly with Keilland forceps and ventouse)
  • R Ruptured membranes
  • C Cephalic presentation
  • E Engaged presenting part (NOT palpable abdominally)
  • P Pain relief
  • S Sphincter (bladder) empty (usually requires catheterisation)
22
Q

What are the CS categories?

A
  • (Cat 1) Immediate threat to life of woman or foetus
  • (Cat 2) No immediate threat to life of woman or foetus
  • (Cat 3) Requires early delivery
  • (Cat 4) Elective CS
23
Q

What are the CS incisions?

A
  • Pfannenstiel
  • Joel-Cohen
  • Midline vertical/classical
  • Maylard
24
Q

What are the complications of instrumental delivery?

A

Maternal: (more common forceps)

  • Perineal tears (3rd degree)
  • Cervical and vaginal lacerations
  • PPH
  • 80% achieve SVD in subsequent pregnancy

Foetal: (more common ventouse)
Ventouse

  • Cephalohematoma
  • Intracerebral haemorrhage
  • Retinal haemorrhage
  • Jaundice
  • Prolonged ventouse delivery = greatest risk of haemorrhage in the newborn

Forceps

  • Facial nerve palsies
25
Q

What are the complications of CS?

A
  • Generic: bleeding, infection, damage to local structures, procedural failure
  • Visceral damage – bladder (1 in 10,000), ureter, bowel
  • VTE
  • Foetal laceration
  • Hysterectomy – rare
26
Q

What are absolute contraindications for VBAC?

A
  • Previous uterine rupture
  • Classical (vertical) C-section scar
  • Normal non-C-section contraindications (e.g. major placenta praevia)
27
Q

What are relative contraindications for VBAC?

A
  • 2 or more previous CS
  • The need for IOL
  • Previous labour suggestive of cephalopelvic disproportion
28
Q

What are the risks of VBAC?

A
  • Emergency C-section (EMCS) - 25%
  • Planned VBAC has a 1 in 200 risk of uterine rupture (1 in 100 if syntocinon is used)
  • Increased risk of instrumental delivery (39%)
  • Infant: transient respiratory morbidity, still birth (very small)
29
Q

What are the indications for safe VBAC?

A

Singleton, cephalic, >37 weeks, 1 previous C-section

30
Q

What are the risks of ERCS?

A
  • Placenta praevia/accreta
  • Pelvic adhesions
  • Neonatal respiratory morbidity (can be reduced with antenatal corticosteroids)
  • Longer recovery
  • Risk of bladder/bowel injury (rare)
  • Likely to need future LSCS (Lower Segment CS)
31
Q

What are the benefits of ERCS?

A
  • No risk of rupture
  • Able to plan recovery
32
Q

How should ERCS be planned?

A
  • ERCS should be conducted after 39 weeks (preterm VBAC has a lower risk of uterine rupture)
  • Antibiotics should be given before C-section
  • All women should receive thromboprophylaxis
33
Q

How should a CS scar be cared for?

A
  • Keep it dry and get sutures taken out after 5 days
  • No heavy lifting for 6 weeks
  • No getting pregnant for 12-18 months
34
Q

What is CVS?

A
  • Performed 10-13 wks (i.e. week 12)
  • 1% miscarriage rate
  • USS-guided needle aspirate of placental tissue
  • Foetal viability confirmed and anti- RHD given to Rh- women (sensitising event)
35
Q

What is amniocentesis?

A
  • Performed ≥15/40
  • 1% miscarriage rate
  • USS guided needle, avoid entry of placenta, small aspirate of amniotic fluid
  • Foetal viability confirmed and anti-RhD given to Rh-neg women (sensitising event)
36
Q

What are the indications for CVS / amniocentesis?

A
  • Demonstrated risk at antenatal screening
  • Suspected foetal anomaly on USS
  • FHX of inherited disorder
  • Known carrier status for inherited disorder
  • Previous pregnancy with chromosomal disorder
  • Increased maternal age
37
Q

What are the complications of CVS / amniocentesis?

A
  • Generic: bleeding, infection, damage to local structures, procedural failure
  • Abdominal pain
  • Miscarriage (both CVS and amniocentesis at 1%)
  • Chorioamnionitis
  • Limb abnormalities if CVS performed before 10/40
38
Q

What is sterilisation?

A

Surgical ligation or obstruction of both fallopian tubes as method of contraception:

  • Hysteroscopic sterilisation – expanding springs inserted into tubal ostia via hysteroscope  induce fibrosis
  • Tubal occlusion (laparoscopic procedure) – occlude fallopian tubes with Filshie clips
39
Q

What advice should be given to women considering sterilisation?

A
  • Method is irreversible (reversal requires high skilled and is difficult)
  • Vasectomy is safer, quicker and associated with less morbidity
  • High proportion of women regret sterilisation
  • Does not protect against STIs
40
Q

What is required prior to sterilisation?

A
  • Abstain from UPSI for 3 weeks and have a pregnancy test before the procedure
  • If the patient has had UPSI, the procedure should be deferred
  • Protected sex is ok
41
Q

Is contraception still required after sterilisation?

A
  • Laparoscopic procedure: the next menstrual period
  • Hysteroscopic procedure: 3 months
42
Q

Can you get pregnant after sterilisation?

A
  • Pregnancy following female sterilisation is rare but has an increased risk of ectopic pregnancy:
  • If missed period > immediate pregnancy test
  • If +ve > immediate USS to check location
43
Q

What are the indications for sterilisation?

A
  • Desire for permanent contraception (>99% effective)
  • Requires thorough counselling about nature of the procedure, risks, SE, irreversibility, alternative contraception
44
Q

What are the complications of sterilisation?

A
  • Generic: bleeding, infection, damage to local structures, procedural failure (1 per 200, 1% peripartum)
  • Increased risk of future ectopic pregnancy
  • Anaesthetic complications
  • VTE damage to other organs (bladder, bowel, vessels)
  • Risk of conversion to open procedure
45
Q

Normal parameters for CTG?

A

Br = 110-160
A = 15bpm above baseline for 15s
Va = 5-25bpm
D = 15bpm below baseline for 15s

46
Q

What is a pathological CTG?

A

1 abnormal feature, or
2 non-reassuring features

47
Q

What are abnormal features on a CTG?

A
  • Br <100 or >180
  • Va <5 for 50 mins or >25 for 25 mins
  • Single prolonged deceleration >3 mins
  • Late decelerations for 30mins (less if RFs)
  • Variable decelerations with any concerning characteristics in >50% for 30 mins (less if RFs)
48
Q

What are non-reassuring features of a CTG?

A
  • Br 100-109 or 161-180
  • Va >25 for 15-25 mins
  • Va <5 for 30-50 mins

O&G (17 decks)

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