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
2
Q
What fetal measurements are used later on in pregnancy, so from 14 weeks onwards?
A
Head circumference, fetal abdominal circumference
3
Q
What is parity?
A
Number of potentially viable births >24 weeks
4
Q
Parity score?
A
Para = x + y x = number of births over 24 weeks, stillbirth or normal etc. y = miscarriages, ToPs
5
Q
What is gravidity?
A
Number of times been pregnant including current pregnancy
E.g. G6 P3+2
6
Q
FLIPPERBUS?
A
Fundus (SFH) LIe and liquor - feel all round Presenting Part Engagement Rate and auscultation BP Urine Swelling
7
Q
When is the uterus first palpable during pregnancy? When might this be earlier?
A
12-14 weeks
Earlier in multiple pregnancy
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
9
Q
Discuss engagement of fetal head?
A
5/5 palpable = fully above pelvic brim, not engaged
3/5 = generally engaged
10
Q
How many routine antenatal visits would a nulliparous woman have?
A
10
11
Q
How many routine antenatal visits would a multiparous woman have?
A
7
12
Q
Normal folic acid supplementation?
A
400micrograms per day til > 12 weeks
13
Q
Specific examples of food poisoning that can affect pregnant woman badly?
A
Listeriosis - milk
Salmonella - chicken, eggs
14
Q
When should booking visit be done?
A
10-12 weeks
15
Q
What is the combined test for Down’s syndrome screening?
A
Nuchal translucency
PAPPA
BhCG
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
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
18
Q
When is the anomaly scan done? What are you looking for?
A
18-20 weeks
NTDs +/- fetal echocardiography
19
Q
When is rhesus anti-D routinely given prophylactically during pregnancy?
A
28 weeks and then 32 weeks
20
Q
What is assessed at 36 week visit?
A
USS for fetal presentation - offer ECV if breech
21
Q
When does early morning sickness often resolve in normal pregnancy?
A
By end of first trimester, 16-20 weeks
22
Q
What is Naegele’s rule?
A
EDD = LMP + 9 months + 7 days
23
Q
What yeast infection are pregnant women more susceptible to?
A
Candidiasis (thrush)
24
Q
5 blood tests associated with Down’s syndrome screening?
A
BhHCG PAPP Oestriol Inhibin A Alpha FetoProtein
25
What USS marker is used in Down's syndrome screening?
Nuchal translucency
26
What is amniocentesis and when is the earliest it should be done?
US guided removal of amniotic fluid
| Earliest 15 weeks
27
What 3 types of disease can amniocentesis be used to investigate?
Chromosomal abnormality
Infection
Inherited disease
28
Which has a higher miscarriage rate, amniocentesis or CVS?
CVS
29
What is chorionic villous sampling? Earliest it can be done?
Trophoblast (placental) biopsy
| Earliest 11 weeks
30
What is CVS especially good at detecting?
Chromosomal abnormalities
31
2 major RFs for Down's syndrome?
High maternal age
| Previously affected baby
32
What signs of Down's syndrome may be visible on USS?
Nuchal translucency
Cardiac abnormality (tricuspid regurge)
Short nasal bone
33
What are the 4 constituents which constitute the combined test for Down's syndrome?
Maternal age
Nuchal translucency
BhCG
PAPP
34
What blood markers are raised in Down's syndrome screening?
BhCG
| Inhibin A
35
What blood markers are reduced in Down's syndrome screening?
PAPP
Oestriol
Alpha FetoProtein
36
What is Edwards syndrome?
Trisomy 18
37
What is trisomy 18?
Edwards syndrome
38
What is trisomy 13?
Patau's syndrome
39
What is patau's syndrome?
Trisomy 13
40
What is Klinefelters syndrome?
47 XXY - infertile males
41
What chromosomal abnormality commonly causes infertility in males?
Klinefelters 47XXY
42
What is turners syndrome?
45XO - infertile females
43
What chromosomal abnormality commonly causes infertility in females?
Turners 45XO
44
What blood marker is raised in NTDs?
Alpha FetoProtein
45
What congenital abdominal wall defect often occurs in the absence of any other abnormalities?
Gastroschisis
46
How do congenital GI defects often present antenatally?
Polyhydramnios - impaired swallow
47
What GI defect is common with Down's syndrome?
Duodenal atresia
48
What is fetal hydrops?
Fluid accumulation in 2 or more fetal compartments e.g. Skin oedema and pleural effusion
49
What are the 2 classifications of causes of fetal hydrops?
Immune or non-immune
50
Major immune cause of fetal hydrops?
Ab immunisation incl Rhesus
51
5 main non-immune causes of fetal hydrops?
```
Chromosomal e.g. Down's
Structural - pleural effusions
Cardiac including arrhythmias
Anaemia - PV B19 infection, a thalassaemia
Twin-twin transfusion syndrome
```
52
Maternal causes of polyhydramnios?
DM
| Renal failure
53
Fetal causes of polyhydramnios?
Upper GI obstruction
Chest abnormalities
Myotonic dystrophy
54
What might be the cause of polyhydramnios in multiple pregnancy?
TTTS
55
Potential problems caused by polyhydramnios?
Preterm labour
| Abnormal lie and presentation
56
What medication can reduce fetal fluid output and therefore ease polyhydramnios?
NSAIDs
57
What are the major long term complications of maternal CMV infection?
Severe neurological sequelae e.g. Hearing, visual, mental impairment
58
What can early pregnancy rubella infection cause?
Fetal deafness
Congenital cataracts
Cardiac disease
Mental retardation
59
Can women have the rubella vaccine in pregnancy?
No - it's a live vaccine
60
What 2 implications can maternal BV have on pregnancy?
Preterm labour
| Late miscarriage
61
What can maternal chlamydia cause in pregnancy?
Neonatal conjunctivitis
62
Implications of GBS infection in pregnancy?
Often asymptomatic bacteruria
| However can cause PPROM, neonatal sepsis (meningitis or pneumonia)
63
Implications of HBV infection in pregnancy?
Vertical transmission is possible and 90% of infected neonates become chronic carriers
64
5 major antenatal risks of maternal HIV infection?
```
Pre-eclampsia
GDM
Stillbirth
IUGR
Premature labour
```
65
What should be avoided postnatally in HIV infected mothers?
Breastfeeding
66
What bacteria is traditionally responsible for puerperal sepsis?
GAS (strep pyogenes)
67
What can GAS infection cause in mothers?
Puerperal sepsis
68
4 early pregnancy events which may be 'sensitising' in terms of Rhesus factor?
ToP
Ectopic
ERPC
PV bleed
69
Procedure related to breech which may be a sensitising event?
ECV
70
When is rhesus screening acted upon in pregnancy?
To any rhesus negative woman:
Within 72 hours of any potentially sensitising event including delivery if neonate positive
At 28 weeks
71
Other important rhesus antibodies besides D?
C, E and Kell
72
6 differentials for antepartum haemorrhage?
```
Placenta praevia
Placental abruption
Bloody show
Genital tract pathology
Vasa praevia rupture
Uterine rupture
```
73
What is an antepartum haemorrhage?
Bleeding from the genital tract > 24 weeks
74
4 RFs for placenta praevia?
Multiple pregnancy
Multiparity
Scarred uterus
Age
75
Presentation of placenta praevia?
Intermittent painless bleeds which may become constant and heavy over several weeks
76
What is placenta accreta? What normally causes it?
Non-separation of the placenta from uterine wall at birth
| Often due to scarred uterus - prev CS
77
If a placenta is found to be low lying at 20 weeks, when should it be rescanned to exclude placenta praevia?
32 weeks
78
5 RFs for placental abruption?
```
Pre-eclampsia or maternal HTN
IUGR
Previous abruption
Maternal smoking
Multiple pregnancy and multiparity
```
79
How does placental abruption present?
Painful bleeding PV, degree of which doesn't necessarily reflect extent of bleed
80
What is the difference between a concealed and revealed placental abruption?
```
Concealed = pain no blood
Revealed = pain and blood
```
81
What may be found on obstetric exam in placenta praevia vs abruption?
Praevia - abnormal lie, breech, high fetal head
| Abruption - tender, woody hard uterus
82
3 genital tract pathologies that may cause antepartum haemorrhage?
Ectropion
Polyps
Cancer
83
What is the typical presentation of vasa praevia rupture?
Painless, moderate PV bleed around time of amniotomy or spontaneous ROM
84
What might a painless bleed just after amniotomy or ROM indicate?
Vasa praevia rupture
85
What is the normal lie in pregnancy?
Longitudinal
86
What 2 presentations can result from a longitudinal lie?
Cephalic
| Breech
87
In what group of babies is abnormal lie the biggest problem?
Preterm babies
88
What are the 3 groups of reasons for an abnormal lie or breech?
Too much room to move
No room to move
Factors preventing engagement
89
'Too much room to move' causes of abnormal presentation?
```
Polyhydramnios
High parity (lax uterus)
```
90
What does having too much room to move in the uterus often result in?
An unstable lie
91
'No turning' causes of an abnormal lie of breech?
Oligohydramnios
Multiple pregnancy
Uterine abnormality e.g. Fibroids
92
Factors preventing engagement resulting in an abnormal lie or breech?
Placenta praevia
Fibroids
Pelvic tumours
Uterine deformity
93
What 2 things can an unstable lie suggest?
```
Polyhydramnios
Lax uterus (multiparity)
```
94
Complications of abnormal lie or breech?
Failure to progress in labour
Uterine rupture
Umbilical cord prolapse
95
What 2 things need to be excluded first when investigating abnormal lie at term?
Polyhydramnios
| Placenta praevia
96
3 types of breech?
Extended
Flexed
Footing
97
What type of breech is most common?
Extended
98
2 RFs for breech presentation?
Previous breech
| IUGR
99
What symptom is relatively common in breech?
Epigastric discomfort
100
What technique is used to turn round a breech baby?
ECV
101
When can ECV be done after?
37 weeks
102
What 2 things need to be done straight after ECV?
Give anti D
| Do a CTG
103
What 2 things are used to aid ECV?
US guidance
| Give a uterine relaxant (tocolytic)
104
What is the purpose of doing an ECV?
To reduce the need for CS or vaginal breech delivery
105
In what 4 conditions is ECV less likely to work?
Nulliparous woman
Engaged breech
Obese women
Oligohydramnios
106
5 major contraindications to ECV?
```
APH
Fetal compromise
Multiple pregnancy
ROM
If subsequent vaginal delivery contraindicated e.g. Placenta praevia
```
107
Is a previous CS a contraindication to ECV?
Nope
108
Is a CS or vaginal breech delivery safer?
CS
109
Between what gestations is defined as preterm delivery?
24-37 weeks
110
Before what gestation do the majority of problems occur in preterm delivery?
34 weeks
111
2 major metabolic complications of prematurity?
Hypothermia
| Hypoglycaemia
112
5 conditions that are more common as a result of prematurity?
```
Cerebral palsy
Necrotising enterocolitis
NRDS/BPD
Intracranial haemorrhage
PDA
```
113
Major maternal complication of preterm labour?
Infection - endometritis
114
In the castle analogy, what are the 6 mechanisms of preterm labour?
```
Too many defenders
Defenders jump out
Poor castle design
Castle walls are weak
Attackers get through walls
Attackers get in from elsewhere
```
115
Castle analogy: too many defenders?
Multiple pregnancy
| Polyhydramnios
116
Castle analogy: defenders jump out?
```
Fetal survival response - fetal distress
Chorioamnionitis
Pre eclampsia
IUGR
Abruption
APH
```
117
Castle analogy: poor castle design?
Fibroids
Uterine malformation
Maternal age
PMH of premature labour
118
Castle analogy: weak walls?
Cervical incompetence e.g. Following LLETZ
119
Castle analogy: enemy breaks down walls
Infection which may be us clinical
BV, GBC, Trichomonas, chlamydia
Chorioamnionitis - offensive liquor
120
Castle analogy: enemy gets in from elsewhere?
UTI
| Poor dentition
