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Obstetrics 1 Flashcards

1
Q

What USS measurement is most useful for fetal gestation estimation earlier on in pregnancy (9-14 weeks, so for booking scan)?

A

Crown rump length

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2
Q

What fetal measurements are used later on in pregnancy, so from 14 weeks onwards?

A

Head circumference, fetal abdominal circumference

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3
Q

What is parity?

A

Number of potentially viable births >24 weeks

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4
Q

Parity score?

A 
Para = x + y
x = number of births over 24 weeks, stillbirth or normal etc.
y = miscarriages, ToPs
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5
Q

What is gravidity?

A

Number of times been pregnant including current pregnancy

E.g. G6 P3+2

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6
Q

FLIPPERBUS?

A 
Fundus (SFH)
LIe and liquor - feel all round
Presenting Part
Engagement 
Rate and auscultation 
BP
Urine
Swelling
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7
Q

When is the uterus first palpable during pregnancy? When might this be earlier?

A

12-14 weeks

Earlier in multiple pregnancy

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8
Q

At what gestation is fundus of uterus roughly umbilical level? What implications does this have for SFH?

A

20 weeks

From that point, SFH roughly correlates to gestation +/- 2cm

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9
Q

Discuss engagement of fetal head?

A

5/5 palpable = fully above pelvic brim, not engaged

3/5 = generally engaged

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10
Q

How many routine antenatal visits would a nulliparous woman have?

A

10

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11
Q

How many routine antenatal visits would a multiparous woman have?

A

7

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12
Q

Normal folic acid supplementation?

A

400micrograms per day til > 12 weeks

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13
Q

Specific examples of food poisoning that can affect pregnant woman badly?

A

Listeriosis - milk

Salmonella - chicken, eggs

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14
Q

When should booking visit be done?

A

10-12 weeks

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15
Q

What is the combined test for Down’s syndrome screening?

A

Nuchal translucency
PAPPA
BhCG

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16
Q

What infections need to be screened for at booking visit?

A 
BBVs e.g. Hep B, HIV
Syphillis 
Rubella
STIs - chlamydia, BV, gonorrhoea
Asymptomatic bacteruria
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17
Q

What non-infectious conditions need to be enquired about at booking visit?

A

Haemaglobinopathies and anaemia
Clotting dysfunctions
Pre existing disease, e.g. Cardiac
Rhesus status

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18
Q

When is the anomaly scan done? What are you looking for?

A

18-20 weeks

NTDs +/- fetal echocardiography

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19
Q

When is rhesus anti-D routinely given prophylactically during pregnancy?

A

28 weeks and then 32 weeks

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20
Q

What is assessed at 36 week visit?

A

USS for fetal presentation - offer ECV if breech

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21
Q

When does early morning sickness often resolve in normal pregnancy?

A

By end of first trimester, 16-20 weeks

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22
Q

What is Naegele’s rule?

A

EDD = LMP + 9 months + 7 days

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23
Q

What yeast infection are pregnant women more susceptible to?

A

Candidiasis (thrush)

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24
Q

5 blood tests associated with Down’s syndrome screening?

A 
BhHCG
PAPP
Oestriol
Inhibin A
Alpha FetoProtein
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25
Q

What USS marker is used in Down’s syndrome screening?

A

Nuchal translucency

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26
Q

What is amniocentesis and when is the earliest it should be done?

A

US guided removal of amniotic fluid

Earliest 15 weeks

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27
Q

What 3 types of disease can amniocentesis be used to investigate?

A

Chromosomal abnormality
Infection
Inherited disease

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28
Q

Which has a higher miscarriage rate, amniocentesis or CVS?

A

CVS

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29
Q

What is chorionic villous sampling? Earliest it can be done?

A

Trophoblast (placental) biopsy

Earliest 11 weeks

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30
Q

What is CVS especially good at detecting?

A

Chromosomal abnormalities

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31
Q

2 major RFs for Down’s syndrome?

A

High maternal age

Previously affected baby

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32
Q

What signs of Down’s syndrome may be visible on USS?

A

Nuchal translucency
Cardiac abnormality (tricuspid regurge)
Short nasal bone

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33
Q

What are the 4 constituents which constitute the combined test for Down’s syndrome?

A

Maternal age
Nuchal translucency
BhCG
PAPP

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34
Q

What blood markers are raised in Down’s syndrome screening?

A

BhCG

Inhibin A

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35
Q

What blood markers are reduced in Down’s syndrome screening?

A

PAPP
Oestriol
Alpha FetoProtein

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36
Q

What is Edwards syndrome?

A

Trisomy 18

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37
Q

What is trisomy 18?

A

Edwards syndrome

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38
Q

What is trisomy 13?

A

Patau’s syndrome

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39
Q

What is patau’s syndrome?

A

Trisomy 13

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40
Q

What is Klinefelters syndrome?

A

47 XXY - infertile males

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41
Q

What chromosomal abnormality commonly causes infertility in males?

A

Klinefelters 47XXY

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42
Q

What is turners syndrome?

A

45XO - infertile females

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43
Q

What chromosomal abnormality commonly causes infertility in females?

A

Turners 45XO

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44
Q

What blood marker is raised in NTDs?

A

Alpha FetoProtein

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45
Q

What congenital abdominal wall defect often occurs in the absence of any other abnormalities?

A

Gastroschisis

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46
Q

How do congenital GI defects often present antenatally?

A

Polyhydramnios - impaired swallow

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47
Q

What GI defect is common with Down’s syndrome?

A

Duodenal atresia

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48
Q

What is fetal hydrops?

A

Fluid accumulation in 2 or more fetal compartments e.g. Skin oedema and pleural effusion

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49
Q

What are the 2 classifications of causes of fetal hydrops?

A

Immune or non-immune

50
Q

Major immune cause of fetal hydrops?

A

Ab immunisation incl Rhesus

51
Q

5 main non-immune causes of fetal hydrops?

A 
Chromosomal e.g. Down's
Structural - pleural effusions
Cardiac including arrhythmias
Anaemia - PV B19 infection, a thalassaemia 
Twin-twin transfusion syndrome
52
Q

Maternal causes of polyhydramnios?

A

DM

Renal failure

53
Q

Fetal causes of polyhydramnios?

A

Upper GI obstruction
Chest abnormalities
Myotonic dystrophy

54
Q

What might be the cause of polyhydramnios in multiple pregnancy?

55
Q

Potential problems caused by polyhydramnios?

A

Preterm labour

Abnormal lie and presentation

56
Q

What medication can reduce fetal fluid output and therefore ease polyhydramnios?

57
Q

What are the major long term complications of maternal CMV infection?

A

Severe neurological sequelae e.g. Hearing, visual, mental impairment

58
Q

What can early pregnancy rubella infection cause?

A

Fetal deafness
Congenital cataracts
Cardiac disease
Mental retardation

59
Q

Can women have the rubella vaccine in pregnancy?

A

No - it’s a live vaccine

60
Q

What 2 implications can maternal BV have on pregnancy?

A

Preterm labour

Late miscarriage

61
Q

What can maternal chlamydia cause in pregnancy?

A

Neonatal conjunctivitis

62
Q

Implications of GBS infection in pregnancy?

A

Often asymptomatic bacteruria

However can cause PPROM, neonatal sepsis (meningitis or pneumonia)

63
Q

Implications of HBV infection in pregnancy?

A

Vertical transmission is possible and 90% of infected neonates become chronic carriers

64
Q

5 major antenatal risks of maternal HIV infection?

A 
Pre-eclampsia
GDM
Stillbirth
IUGR
Premature labour
65
Q

What should be avoided postnatally in HIV infected mothers?

A

Breastfeeding

66
Q

What bacteria is traditionally responsible for puerperal sepsis?

A

GAS (strep pyogenes)

67
Q

What can GAS infection cause in mothers?

A

Puerperal sepsis

68
Q

4 early pregnancy events which may be ‘sensitising’ in terms of Rhesus factor?

A

ToP
Ectopic
ERPC
PV bleed

69
Q

Procedure related to breech which may be a sensitising event?

70
Q

When is rhesus screening acted upon in pregnancy?

A

To any rhesus negative woman:
Within 72 hours of any potentially sensitising event including delivery if neonate positive
At 28 weeks

71
Q

Other important rhesus antibodies besides D?

A

C, E and Kell

72
Q

6 differentials for antepartum haemorrhage?

A 
Placenta praevia
Placental abruption
Bloody show
Genital tract pathology
Vasa praevia rupture
Uterine rupture
73
Q

What is an antepartum haemorrhage?

A

Bleeding from the genital tract > 24 weeks

74
Q

4 RFs for placenta praevia?

A

Multiple pregnancy
Multiparity
Scarred uterus
Age

75
Q

Presentation of placenta praevia?

A

Intermittent painless bleeds which may become constant and heavy over several weeks

76
Q

What is placenta accreta? What normally causes it?

A

Non-separation of the placenta from uterine wall at birth

Often due to scarred uterus - prev CS

77
Q

If a placenta is found to be low lying at 20 weeks, when should it be rescanned to exclude placenta praevia?

78
Q

5 RFs for placental abruption?

A 
Pre-eclampsia or maternal HTN
IUGR
Previous abruption
Maternal smoking
Multiple pregnancy and multiparity
79
Q

How does placental abruption present?

A

Painful bleeding PV, degree of which doesn’t necessarily reflect extent of bleed

80
Q

What is the difference between a concealed and revealed placental abruption?

A 
Concealed = pain no blood
Revealed = pain and blood
81
Q

What may be found on obstetric exam in placenta praevia vs abruption?

A

Praevia - abnormal lie, breech, high fetal head

Abruption - tender, woody hard uterus

82
Q

3 genital tract pathologies that may cause antepartum haemorrhage?

A

Ectropion
Polyps
Cancer

83
Q

What is the typical presentation of vasa praevia rupture?

A

Painless, moderate PV bleed around time of amniotomy or spontaneous ROM

84
Q

What might a painless bleed just after amniotomy or ROM indicate?

A

Vasa praevia rupture

85
Q

What is the normal lie in pregnancy?

A

Longitudinal

86
Q

What 2 presentations can result from a longitudinal lie?

A

Cephalic

Breech

87
Q

In what group of babies is abnormal lie the biggest problem?

A

Preterm babies

88
Q

What are the 3 groups of reasons for an abnormal lie or breech?

A

Too much room to move
No room to move
Factors preventing engagement

89
Q

‘Too much room to move’ causes of abnormal presentation?

A 
Polyhydramnios 
High parity (lax uterus)
90
Q

What does having too much room to move in the uterus often result in?

A

An unstable lie

91
Q

‘No turning’ causes of an abnormal lie of breech?

A

Oligohydramnios
Multiple pregnancy
Uterine abnormality e.g. Fibroids

92
Q

Factors preventing engagement resulting in an abnormal lie or breech?

A

Placenta praevia
Fibroids
Pelvic tumours
Uterine deformity

93
Q

What 2 things can an unstable lie suggest?

A 
Polyhydramnios
Lax uterus (multiparity)
94
Q

Complications of abnormal lie or breech?

A

Failure to progress in labour
Uterine rupture
Umbilical cord prolapse

95
Q

What 2 things need to be excluded first when investigating abnormal lie at term?

A

Polyhydramnios

Placenta praevia

96
Q

3 types of breech?

A

Extended
Flexed
Footing

97
Q

What type of breech is most common?

98
Q

2 RFs for breech presentation?

A

Previous breech

IUGR

99
Q

What symptom is relatively common in breech?

A

Epigastric discomfort

100
Q

What technique is used to turn round a breech baby?

101
Q

When can ECV be done after?

102
Q

What 2 things need to be done straight after ECV?

A

Give anti D

Do a CTG

103
Q

What 2 things are used to aid ECV?

A

US guidance

Give a uterine relaxant (tocolytic)

104
Q

What is the purpose of doing an ECV?

A

To reduce the need for CS or vaginal breech delivery

105
Q

In what 4 conditions is ECV less likely to work?

A

Nulliparous woman
Engaged breech
Obese women
Oligohydramnios

106
Q

5 major contraindications to ECV?

A 
APH
Fetal compromise
Multiple pregnancy
ROM
If subsequent vaginal delivery contraindicated e.g. Placenta praevia
107
Q

Is a previous CS a contraindication to ECV?

108
Q

Is a CS or vaginal breech delivery safer?

109
Q

Between what gestations is defined as preterm delivery?

A

24-37 weeks

110
Q

Before what gestation do the majority of problems occur in preterm delivery?

111
Q

2 major metabolic complications of prematurity?

A

Hypothermia

Hypoglycaemia

112
Q

5 conditions that are more common as a result of prematurity?

A 
Cerebral palsy
Necrotising enterocolitis
NRDS/BPD
Intracranial haemorrhage
PDA
113
Q

Major maternal complication of preterm labour?

A

Infection - endometritis

114
Q

In the castle analogy, what are the 6 mechanisms of preterm labour?

A 
Too many defenders
Defenders jump out
Poor castle design
Castle walls are weak
Attackers get through walls
Attackers get in from elsewhere
115
Q

Castle analogy: too many defenders?

A

Multiple pregnancy

Polyhydramnios

116
Q

Castle analogy: defenders jump out?

A 
Fetal survival response - fetal distress
Chorioamnionitis 
Pre eclampsia
IUGR
Abruption
APH
117
Q

Castle analogy: poor castle design?

A

Fibroids
Uterine malformation
Maternal age
PMH of premature labour

118
Q

Castle analogy: weak walls?

A

Cervical incompetence e.g. Following LLETZ

119
Q

Castle analogy: enemy breaks down walls

A

Infection which may be us clinical
BV, GBC, Trichomonas, chlamydia
Chorioamnionitis - offensive liquor

120
Q

Castle analogy: enemy gets in from elsewhere?

A

UTI

Poor dentition

Revision Qs (28 decks)

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