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AKT > Obstetrics 1 > Flashcards

Obstetrics 1 Flashcards

1
Q

Causes of increased AFP (3)

A

Neural tube defects
Abdominal wall defects
Multiple pregnancy

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2
Q

Causes of decreased AFP (3)

A

Down’s
Trisomy 18
Maternal DM

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3
Q

All pregnant and breastfeeding women should take which vitamins?

A

10mcg vitamin D

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4
Q

First line treatment for nausea and vomiting in pregnancy

A

Anti-histamines - promethazine

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5
Q

What natural remedies are NICE recommended for nausea and vomiting in pregnancy?

A

Ginger and acupuncture on the p6 point by the wrist

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6
Q

NICE recommendations for number of antenatal visits in the first pregnancy and subsequent pregnancies if uncomplicated

A

10, then 7

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7
Q

Antenatal care timetable
What is the purpose of the 8-12 week appt?

A

Booking appt
Booking bloods - FBC, G&S, Rh, red cell alloantibodies, haemoglobinopathies, hep B, syphillis, HIV, urine culture

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8
Q

What is the purpose of the 10-13+6 week appt?

A

Confirm dates
Exclude multiple pregnancy

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9
Q

What is the purpose of the 11-13+6 week appt?

A

Down’s screening
Nuchal scan

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10
Q

What is the purpose of the 16 weeks appt?

A

If Hb<11 consider iron
Routine
Info on anomaly scan and bloods

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11
Q

What is the purpose of the 18-20+6 appt?

A

Anomaly scan

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12
Q

What is the purpose of the K25 appt?

A

Routine if primip

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13
Q

What happens at K28?

A

Routine
Second screen for anaemia and atypical red cell alloantibodies
First dose of anti-D to Rh-ve women
If Hb<10.5 consider iron

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14
Q

What happens at 31K

A

Routine care if primip

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15
Q

What happens at K34?

A

Second dose of anti-D to Rh-ve women
Information on labour and birth plan

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16
Q

What happens at K36? (3)

A

Check presentation
Offer external cephalic version
Breastfeeding, vitamin K and baby blues info

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17
Q

What happens at K38, K40 and K41?

A

Routine care
Discussion about options for prolonged pregnancy
Discuss labour plans and induction

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18
Q

Name seven conditions that should not be offered for screening

A

BV
Chlamydia
Hep C
Toxoplasmosis
Fragile X
Cytomegalovirus
Group B Strep

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19
Q

How is antepartum haemorrhage defined?

A

> K24

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20
Q

Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high

A

Hydatiform mole

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21
Q

Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen

A

Vasa praevia

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22
Q

Breastfeeding protects agains which two cancers?

A

Breast and ovarian

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23
Q

Which antibodies are passed from mother to child through breastfeeding?

A

IgA

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24
Q

Name five disadvantages of breastfeeding

A

Vitamin K deficiency
Vitamin D deficiency
Breast milk jaundice
Transfer of infections
Transfer of drugs

25
Q

What is the treatment for nipple candidiasis? (2)

A

Topical miconazole for mum
Nystatin suspension for the baby

26
Q

Mx of blocked duct (milk bled)
Should breastfeeding continue?

A

Breastfeeding should continue
Breast massage and advice on position of baby

27
Q

When to treat mastitis? (4)

A

Systemically unwell
Nipple fissure present
Sx not improving after 12-24 hours of effective milk removal
Culture indicates infection

28
Q

How to treat mastitis?
Should breastfeeding continue?

A

Fluclox 10-14 days
Yes

29
Q

Mx of breast abscess (1)

A

Incision and drainage

30
Q

Intermittent nipple pain during and immediately after breastfeeding =

A

Raynaud’s disease of the nipple

31
Q

Cut off threshold for weight loss for babies in the first week of life =

A

10%

32
Q

Name two breastfeeding CI

A

Viral infections
Galactosaemia

33
Q

Most common breech position?

A

Frank breech - hips flexed, knees extended

34
Q

Mx of breech
Percentage success rate

A

K36 offer ECV if primip
Otherwise offer at K37
60% success rate

35
Q

Chickenpox is caused by which virus?

A

Varicella zoster virus

36
Q

Increased risk of which condition for mothers with chickenpox exposure?

A

Pneumonitis

37
Q

Name x5 features of fetal varicella syndrome

A

Skin scarring
Limb hypoplasia
Microcephaly
LD
Microphthalmia

38
Q

Risk of FVC (in gestation)

A

<K20 = 1%
20-28 very few cases
>K28 nil

39
Q

What is severe neonatal varicella and what is the risk to the child?

A

Mother develops a rash between 5 days prior and 2 days post birth
20% fatal

40
Q

Mx chickenpox exposure
Step 1
If K<20
If K>20
Effective up to how many days post exposure?

A

Any doubt about previous chickenpox in mother = check maternal blood for antibodies

If K<20 and not immune = give VZIG
Effective up to 10 days post exposure

If >K20 and not immune then either VZIG or antivirals (aciclovir or valaciclovir) to be given 7-14 days post exposure

41
Q

Mx chickenpox in pregnancy
If >K20
If <K20

A

Specialist advice
PO aciclovir if K>20 and if she present 24 hours from the onset of the rash
If K<20 aciclovir with caution

42
Q

What is the combined test when screening for Down’s? (3)
What would you expect in Down’s babies?

A

Nuchal translucency (thickened)
Serum BHCG (raised)
PAPP-A (low)

43
Q

What is the quadruple test in screening?
When would it be offered? (gestation)

A

Offered if booked later - between 15-20K

AFP
Unconjugated oestriol
HCG
Inhibin A

44
Q

Quadruple test interpretation Down’s

A

AFP low
Unconjugated oestriol low
HCG high
Inhibin A high

45
Q

Quadruple test interpretation Edward’s

A

AFP low
Unconjugated oestriol low
HCG low
Inhibin A normal

46
Q

Quadruple test interpretation neural tube defects

A

AFP high
Unconjugated oestriol normal
HCG normal
Inhibin A normal

47
Q

If 12 week scan comes back as high risk what is offered next? (3)

A

NIPT
CVS
Amniocentesis

48
Q

Which is the least teratogenic anti-epileptic?

A

Carbamezapine

49
Q

Which anti-epileptic is..
Associated with neural tube defects
Associated with cleft palate
Needs to be increased in pregnancy

A

Sod valp
Phenytoin
Lamotrogine

50
Q

Women taking phenytoin should be given what in the last month of pregnancy?

A

Vitamin K

51
Q

Folic acid guidelines in pregnancy

A

All women should take 400mcg until 12th week of pregnancy
If at high risk of NTD then 5mg from before conception to 12th week

52
Q

Who is high risk of NTD? (5)

A

Anti-epileptics
Coeliacs
DM
Thalassaemia
Obese

53
Q

Viable age of pregnancy
Twins GP

A

K24
G1P2

54
Q

SFH measurement
Used from what gestation?
Leeway in cm

A

Top of uterus to top of pubic bone
K20
2cm either side

55
Q

Name three causes of hyperechogenic bowel

A

CF
Down’s
Cytomegalovirus

56
Q

Name three causes of increased nuchal translucency

A

Down’s
Congenital heart defects
Abdominal wall defects

57
Q

Anti-D given at which two weeks?

A

K28 and K34

58
Q

Anaemia screen at which weeks?

A

K16 <11 consider iron and K28 <10.5 consider iron

AKT (52 decks)

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