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Finals > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What are the complications of gestational diabetes?

A

Large for date fetus
Macrosomia
Shoulder dystocia

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2
Q

What are the risk factors for gestational diabetes?

A 
Previous gestational diabetes
Previous macrosomic baby >4.5kg
BMI>30
Ethnic origin: Black/Arab/Indian
Family history of diabetes
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3
Q

What test is done for women with risk factors of gestational diabetes?

A

OGTT at 24-28 weeks

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4
Q

What is the diagnosis of gestational diabetes?

A

Normal results of OGTT:
Fasting <5.6mmol/l
At 2 hours: <7.8mmol/l

5-6-7-8

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5
Q

What is the management for gestational diabetes?

A

Fasting glucose <7: diet and exercise for 1-2 weeks followed by metformin then insulin

Fasting glucose >7: start insulin ± metformin

Fasting glucose >6 plus macrosomia: start insulin ± metformin

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6
Q

What should women with pre-existing diabetes do prior to getting pregnant?

A

Take 5mg folic acid from preconception until 12 weeks gestation

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7
Q

What happens to retinopathy screening for diabetic pregnant women?

A

Screening should be performed shortly after booking and at 28 weeks gestation

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8
Q

What happens at term for diabetic pregnant women?

A

Planned delivery between 37 and 38+6 weeks

women with gestational diabetes can give birth up to 40+6 weeks

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9
Q

What happens during labour for diabetic pregnant women

A

Sliding scale insulin regime is considered during labour for women with T1DM.

Also considered for women with poorly controlled T2DM

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10
Q

What is the postnatal care for diabetic pregnant women?

A

Gestational diabetic women can stop medication immediately and follow up with fasting glucose after 6 weeks.

Existing diabetic women should be vary of hypoglycaemia and lower insulin dose.

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11
Q

What is an amniotic fluid embolism?

A

When the amniotic fluid passes into the mother’s blood. Causes an immune reaction from the mother leading to systemic illness.

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12
Q

What are the risk factors for amniotic fluid embolism?

A

Increasing maternal age
Induction of labour
C-section
Multiple pregnancies

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13
Q

How does amniotic fluid embolism present?

A

Like sepsis, PE or anaphylaxis:

SOB
Hypoxia
Hypotension
Coagulopathy
Haemorrhage
Tachycardia
Confusion
Seizures
Cardiac arrest
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14
Q

What is management of amniotic fluid embolism?

A

Overall supportive but needs ABCDE

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15
Q

Definitions of different miscarriages

A

Missed: no longer alive, no symptoms have occurred

Threatened: vaginal bleeding with closed cervix and fetus alive

Inevitable: vaginal bleeding with open cervix

Incomplete miscarriage: retained products of conception

Complete miscarriage: full miscarriage and no products left

Anembryonic pregnancy: gestational sac is present but no embryo

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16
Q

What is the management for miscarriage at less than 6 weeks gestation?

A

Managed expectantly

Repeat urine pregnancy test after 7-10 days

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17
Q

What is the management for miscarriage after 6 weeks?

A

USS to confirm location and viability

Expectant management
Medical management (misoprostol)
Surgical management

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18
Q

What is the diagnosis of molar pregnancy?

A 
More severe morning sickness
Vaginal bleeding
Increased enlargement of the uterus
Abnormally high hCG
Thyrotoxicosis

US shows snowstorm appearance

Confirmed with histology of mole

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19
Q

How is hypothyroidism managed in pregnancy?

A

Levothyroxine dose needs to be increased by at least 25-50mcg

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20
Q

Which hypertension medications are harmful in pregnancy?

A

ACE inhibitors (ramipril)
ARB (losartan)
Thiazide and thiazide like diuretics (indapamide)

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21
Q

Which hypertension medications can be used in pregnancy?

A 
Labetalol 
Calcium channel blockers (e.g. nifedipine)
Alpha clockers (doxazosin)
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22
Q

How is epilepsy managed in pregnancy?

A

5mg folic acid daily before conception

Levetricetam, lamotrigine and carbamazepine safe in pregnancy

NO SODIUM VALPROATE

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23
Q

How is rheumatoid arthritis managed in pregnancy?

A

Hydroxycholoroquine is considered safe and first line

Sulfasalazine is safe

Corticosteroids may be used during flare-ups

NO METHOTREXATE

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24
Q

What is placenta praevia?

A

When the placenta is over the internal cervical OS

Notable cause of antepartum haemorrhage

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25
Q

What are the risk factors for placenta praevia?

A 
Previous C-section
Previous placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities (fibroids)
Assisted reproduction (IVF)
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26
Q

What is the presentation and diagnosis of placenta praevia?

A

20 week anomaly scan is used to assess the placenta position and diagnose

Many are asymptomatic

May present with PAINLESS VAGINAL BLEEDING later in pregnancy (around or after 36 weeks)

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27
Q

What is the management of placenta praevia?

A

Corticosteroids are given between 34 and 35+6 weeks for lung maturity

Planned delivery between 36 and 37 weeks gestation

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28
Q

What are the risk factors for placental abruption?

A 
Previous placental abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
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29
Q

What is the presentation of placental abruption?

A

Sudden onset severe CONTINIOUS abdominal pain

Vaginal bleeding

Shock (hypotension and tachycardia)

Abnormalities on CTG - fetal distress

WOODY abdomen on palpation

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30
Q

What are the guidelines regarding measurements for antepartum haemorrhages?

A

Minor: <50ml
Major: 50-1000ml
Massive: >1000ml or shock

31
Q

What is the management of placental abruption?

A 
2x grey cannula
Bloods
Crossmatch 4 units
Fluid and blood resus
CTG
Monitor mother

USS to exclude placenta praevia

Steroids between 24 and 34+6

Rhesus-D negative require anti-D prophylaxis

32
Q

What is the triad of preeclamsia?

A

Hypertension
Proteinuria
Oedema

After 20 weeks gestation

33
Q

What are the risk factors for pre-eclampsia?

A 
Pre-existing hypertension
Previous hypertension in pregnancy
Existing autoimmune conditions
Diabetes
CKD
34
Q

What are the symptoms of pre-eclampsia?

A 
Headache
Visual disturbance/blurriness
Nausea and vomiting
Upper abdo/epigastric pain
Oedema
Reduced urine output
Brisk reflexes
35
Q

What is the diagnosis of pre-eclampsia?

A

Systolic >140 and diastolic >90

Plus any of:
Proteinuria
Organ dysfunction
Placental dysfunction

36
Q

What is the management of pre-eclampsia during labour?

A

Prophylactic aspirin at 12 weeks gestation for women with a single high risk factor or two or more moderate risk factor

  1. Labetalol
  2. Nifedipine
  3. Methyldopa (stopped within 2 days of birth)
  4. IV hydralazine
  5. IV magnesium sulfate (stopped 24 hours after labour)
  6. Fluid restriction
37
Q

What is the management of pre-eclampsia after labour?

A

Switch to one or a combination of:

  1. enalapril
  2. nifedipine or amlodopine (first line in black peeps)
  3. labetalol or atenolol
38
Q

What is HELLP syndrome?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

39
Q

What is the criteria for an abortion to be performed at any time during pregnancy?

A

IF:

Continuing pregnancy is likely to risk the life of the woman

Terminating pregnancy will prevent “grave permanent injury” to the physical or mental health of woman

There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped

40
Q

What are the legal requirements for an abortion?

A

Two registered medical practitioners must sign to agree abortion is indicated

Must be carried out by a registered medical practitioner in an NHS hospital

41
Q

What are the medical abortion drugs

A

Mifepristone

Misoprostol 1-2 days later

42
Q

What is vasa praevia?

A

where the fetal vessels are within the fetal membranes and travel across the internal cervical OS

43
Q

What are the risk factors for vasa praevia?

A

Low lying placenta
IVF pregnancy
Multiple pregnancies

44
Q

What is the presentation of vasa praevia?

A

May be diagnosed by USS

Antepartum haemorrhage during 2nd or 3rd trimester

Vaginal examination during labour

Fetal distress and dark red bleeding during labour

45
Q

What is the management for vasa praevia?

A

For asymptomatic women: corticosteroids from 32 weeks and elective c-section for 34-36 weeks

46
Q

What are the risk factors for a VTE in pregnancy?

A 
Smoking 
Parity >3
Age >35
BMI >30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
FHx of VTE
Thrombophilia
IVF pregnancy
47
Q

What is guidance regarding prophylaxis for VTE in pregnancy?

A

28 weeks if there are three risk factors

First trimester if there are four or more risk factors

LMWH e.g. enoxaparin, dalteparin and tinzaparin

Stopped when they go into labour and started afterwards

48
Q

What is the diagnosis of DVT and PE in pregnancy?

A

DVT:
Doppler US

PE:
CXR and ECG first line
VQ scan diagnostic

49
Q

What is the management of DVT in pregnancy>

A

LMWH and continued for 3 months after pregnancy

50
Q

Which antibiotic should be given to children with group b strep sepsis?

A

Benzylpenicillin and gentamycin first line

OR

cefotaxime

51
Q

What is the combined test?

A

First line and most accurate screening test for down syndrome performed between 11 and 14 weeks.

USS shows nuchal thickness >6mm

Blood test:

  • high bHCG
  • low PAPPA
52
Q

What is the triple test?

A

Screening test for down syndrome performed between 14 and 20 weeks:

Bloods:
high bHCG
low AFP
low serum oestriol

53
Q

Which form of contraception is safe in epilepsy?

A

If on enzyme inducers e.g. carbemazepine, phenytoin or topiramate: COPPER COIL, LEVONOGESTRAL IUS AND DEPO

If on non-enzyme inducers e.g. levetriacetam, lamotrigin, sodium valproate: ANYTHING

BUT DON’T GIVE COCP AND LAMOTRIGINE

54
Q

What needs to be done in regards to COCP and surgery?

A

Stop 4 weeks before surgery and start 2 weeks after

55
Q

What is the interaction between progesterone only pills and antibiotics

A

nothing

56
Q

What is the treatment of bacterial conjunctivitis in pregnancy?

A

Topical fusidic acid eye drops

57
Q

What are the classifications for post partum haemorrhage?

A

Defined as 500ml loss after vaginal delivery or 1000ml loss after C-section

Minor <1000ml
Major >1000ml
Moderate 1000-2000ml
Severe >2000ml

Primary: within 24hrs
Secondary: 24hr - 12weeks after birth

58
Q

What are the causes of postpartum haemorrhage?

A

Four T’s

Tone
Trauma
Tissue
Thrombin

59
Q

What is the management to stop the bleeding in postpartum haemorrhage?

A

Mechanical:
Rubbing uterus
Catheterisation

Medical:
Oxytocin
Ergometrine
Caboprost
Misoprostol
TXA
Surgical:
Intrauterine balloon tamponade
B-lynch suture
Uterine artery lligation
Hysterectomy
60
Q

What is Sheehan’s syndrome?

A

Rare complication of post partum haemorrhage where there is avascular necrosis of the anterior pituitary gland which leads to cell death

61
Q

What are the features of sheehan’s syndrome?

A

Lack of lactation
Amenorrhea
Adrenal insufficiency and adrenal crisis
Hypothyroidism

Low cortisol and normal aldosterone

62
Q

What is the management of Sheehan’s syndrome?

A

Oestrogen and progesterone
Levothyroxine
Hydrocortisone
Growth hormone

63
Q

What is Meig’s syndrome?

A

Triad of:
Ovarian fibroma (benign ovarian tumour)
Pleural effusion
Ascites

64
Q

What is cord prolapse?

A

When the umbilical cord descends below the presenting part of the fetus and through the cervix into the vagina.

High risk of fetal hypoxia due to cord compression

65
Q

What is the diagnosis of cord prolapse?

A

Should be suspected where there are signs of fetal distress on CTG.

Speculum exam: DIAGNOSTIC

66
Q

What is the management of cord prolapse?

A

Emergency C-Section

Can push the presenting part of the baby back in

Woman lie in left lateral position or on all fours

Terabutaline can be used to minimise contractions

67
Q

What is the definition of proteinuria?

A

Persistent urinary protein >300mg/25hr

68
Q

What volume of amniotic fluid is consistent with polyhydraminos?

A

> 2-3L

69
Q

What are the signs of uterine hyperstimulation?

A

Either:
>6 contractions within 10 minutes
or
<60s in between each contraction

70
Q

Which babies are at risk of NRDS?

A

Diabetic mothers

71
Q

What is the WHO guidelines for breast feeding?

A

Exclusively for 6 months and then combined with food for upto 2 years and beyond

72
Q

What should be given to pregnant women who have a previous history of having a child with early/late onset group B strep?

A

IV antibiotic prophylaxis intrapartum

73
Q

What is the preferred method of induction of labour?

A

Vaginal prostaglandin (PGE2)

74
Q

What is the treatment for a RhD-ve women during pregnancy?

A

Anti-D
1st dose at 28 weeks
2nd dose at 34 weeks

Finals (20 decks)

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