Obstetrics Flashcards
1
Q
gravidity
A
total no of pregnancies reguardless of outcome
2
Q
parity
A
number of pregnacies carried over 24wks
3
Q
preconception advice folic acid
A
400 micrograms per day for first 12 wks
dose increased to 5miligrams if neural tube defects / FHx
4
Q
when do you give anti-D (all Rh-ve mothers)
A
28 and 34 wks
5
Q
hyperemesis gravidarum - prolomged and severe NVP with - more than 5% pre-preg wt loss, dehydartion, electrolyte imbalances. wtaht is management of mild hyperemesis gravidarum
A
oral antiemetics, oral hydration, dietray advice
6
Q
management of moderate hyperemesis gravidarum
A
IV fluids, parenteral antiemetics & thiamine
7
Q
severe hyperemesis gravidarum Mx
A
admit if - wt loss more than 5%, failure oral antiemetics, ketonuria
8
Q
antiemetics thearpy pregancy 1st line
A
cyclizine
prochloperazine
promethazine
9
Q
2nd line antiemetics pregancy
A
ondansetron / metoclopramide
10
Q
reflux in pregancy
A
antacids
ranitidine / omeprazole (NOT LANSOPRAZOLE)
11
Q
constipation in pregancy
A
bulk forming - ispaghula
if stools hard - softner - lactulose
stimulant - senna
12
Q
molar pregancy Mx
A
evacuation of uterus & products on conception for histology
hCG measurements to see if return to normal
occasuionally metastasie thereore chemo
EFFECTIVE CONTRACEPTION NEEDED FOR NEXT 12 MONTHS
13
Q
ectopic preg - Mx clinically stable / symptomatic / hCG ess than 1000 / unruptured / less than 35mm & no viable FHR
A
expectant - serial bHCGs
14
Q
medical Mx ectopic preg
A
IM methotrexate
15
Q
surgical Mx of ectopic - (indications sugical - severe pain / bHCG more than 1500, mass over 35mm, foetal heartbeat visable
A
laproscopic salpingectomy
16
Q
conservative Mx miscarrage
A
Products of conception to pass naturally
17
Q
medical managemnet miscarrage (if mother at increased risk haemorrage - she is in the late 1st trimester / coagualopathies or evidence infection) or expectant not working
A
vaginal misoprostal
18
Q
sugical management miscarrage -
A
manual aspiration with local anaethetic if more than 12 wks
19
Q
anaemia in preg - if anaemia is micro or normocytic
A
oral iron
20
Q
management SGA
A
smoking cessation
optimising maternal disease - HTN, DM, thyroid disease
(if CTG abnormal delivery considered - steroids & mag sulphate)
21
Q
LGA Mx
A
early induction of labour / c-section
shouder dytocia anicipated therefore senior obsteric team member should be informed
22
Q
RFM Mx
A
handheld doppler - if heartbeat not confimed urgent USS
if heartbeat confimed CTG
23
Q
pre-eclampsia Mx
A
monitor foetal & maternal welbeing - BP, urinalysis, blood tests, foetal growth scans etc
if at moderate or high risk take aspirin 75mg from 12wks gestation until birth
24
Q
HTN in pregnacy
A
labetalol
nifedipine 2nd line
25
Mx severe pre-eclampsia
IV magnesium sulphate & delivery
| A to E
26
HELLP Mx
A to E
CTG
delivery is indicated
27
prolonged pregancy - NICE guidelines delivery by 42 wks to reduce risk of stillbirth in prolonged preg - this can be achived by
```
membrane sweeps (40 wks)
inducton of labour (offered between 41 and 42 wks)
```
28
obstetric cholestasis
urodeoxycholic acid
emollients
antihistamines
weekly monitoring of LFTs and early delivery at 37wks
29
preterm labour Mx
```
admit
check foetal position USS
steroids 2 doses (12hrs apart)
mag sulphate
consider tocolytics
ABx if labour confirmed
```
30
PROM Mx more than 36wks
monitor signs chorioamniocentesis
clindamycin / penicillin during labour if group B step isolated from HVS
IOl & delivery recommened if greater than 24hrs
31
Mx 34-36 weeks PROM
prophylactic erythromycin
clindamycin / penicllin during labour if GBS isolated
cortciosteroids (surfacatnt foetal lung)
32
24-33 wks PROM Mx
prophylactic erythromycin
| corticosteroids
33
gestational diabetes
if fasting level less than 7 - trail diet & excercide
then mettformin
the insulin + metformin
34
if fasting glucose more than 7 (gestational diabetes)
start insulin
35
when should labour be induced for gestational diabetes
37-38 wks
36
polyhydraminos Mx
no medical intervention usually needed
but if maternal Sx severe e.g SOB - aminoreduction considered
(risk to foetus of unsteady lie / premature labour)
37
oligohydraminos Mx
dependent on underlying cause; 2 mian; ruptured membranes (managed see other flashcards), or placnetal insuffiency (early delivery)
38
placental abruption
2x grey cannula
crossmatch
fluid & blood resus
delivery the baby - if unstable or heavy bleeding - emergency C sect
if mother stable warch & wait - admit & steroids
39
placental preavia Mx
A to E
should have been diagnosed at 20wk USS - plan for delivery made
C-section safest mode of delivery
placenta preavia usally warrants Csect at 38wks
40
vase praevia
if diagnosed before labour - elective c sect before membranes ruptured
if diagnosed in labour - emergency c sect
41
risk factors for thrombolysis - VTE prophylaxis
LMWH e.g enoxaparin
continue after preg for 6wks
(once in labour LMWH should not be injected)
42
general Mx of high risk preg
```
councelling - mode of delivery / wt
scans e.g growth scans
specialist clinic e.g diabetic
anaethets r/v
close obs - e.g BP
```
43
Hypertensive disease in pregnancy Mx
lifestyle
discontinue ARBs / ACEi
consider labetalol (nifedipine in asthma)
monitoring - growth scans / BP
44
twin Mx
Twins are usually induced at 38 weeks, Foetal distress is more common in twins. Therefore, constant foetal monitoring with CTG is important throughout labour.
Oxytocin may be helpful if contractions diminish after delivery of the first twin
If foetal distress occurs in the second twin, delivery may be expedited with either forceps of ventouse
45
antenatal care twin
Advise aspirin 75mg od if additional risk factors for pre-eclampsia
Serial growth scans
Discuss mode, timing and place of delivery
Establish presentation of leading twin by 34 weeks
Offer delivery at 37-38 weeks: induction or C-section
46
vaginal birth after c sect
CTG is recommended during labour as foetal heart rate changes may be the earliest signs of scar rupture
delivery in hospital
Avoid induction and augmentation
Epidural analgesia is not contraindicated in a planned VBAC, although an increasing requirement for pain relief in labour should raise awareness of the possibility of an impending uterine rupture
After 39 weeks an elective repeat caesarean is recommended delivery method
47
thyroid disease in preg
Aim for optimum treatment e.g. levothyroxine
48
epilepsy in preg
folic acid 5mg
seizure control
if seizure - use benzodiazepines
neonatal vit K
49
HIV pre-pregancy Mx - HIV can be transmitted in utero, at delivery & through breastfeeding. Several measures that reduce the risk of transmission
antenatal antiretroviral therapy during pregnancy & delivery
avoidance breastfeeding
neonatal post-exposure prophylaxis
50
HSV Mx pregancy - existing genital herpes
her baby should be protected from acquiring the infection due to the antibodies she will pass to the foetus through the placenta
However, she may be required to still take Aciclovir
Vaginal delivery is offered to women with recurrent lesions at time of delivery although they may want to have a caesarean section
51
contracting herpes in last trimester
baby more likely to contract herpes by vaginal birth therefore c-section is recommmended
52
hep B Mx obstretrics
all women routinely screened for hep B in preg
| high risk women (e.g CSW, IV drug users) vaccinated before preg
53
management of chickenpox in pregnancy
If there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies (IgG)
If the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given varicella-zoster immunoglobulin (VZIG) as soon as possible
If the pregnant woman > 20 weeks gestation is not immune to varicella then either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure
54
confirmed case of chickenpox Mx
aciclovir
55
rubella. Assesment includes IgM antibody – present in acute infection the IgG antibody – present following infection or vaccination. Any pregnant woman with a positive rubella screen should be ...
referred to a foetal medicine specialist for counselling and can do a amniotic fluid sample to see if foetal rubella infection is there.
56
group B strep Mx
Intrapartum intravenous benzylpenicillin is required to reduce neonatal transmission. An alternative would be clindamycin
57
CMV Mx
viral cytology performed
| All women with confirmed cytomegalovirus infection during pregnancy should be referred to a foetal medicine specialist.
58
parvovirus B19
can often result in miscarrage
Women with a confirmed infection of parvovirus B19 should be referred to a foetal medicine specialist for further management
59
Where there is an increased risk of PPH (e.g. in multiple pregnancy) what should be done?
an oxytocin infusion should be given prophylactically for 3-4 hours
60
If bilateral weakness after removal of epidural – think what?
haematoma pressing on the spinal cord caused by trauma from the epidural needle. Needs an urgent MRI and referral to neurosurgery
61
hyperstimulation management
If using syntocinon, the rate should be reduced
Tocolytic such as terbutaline should be considered if reducing the rate of syntocinon proves ineffective
62
cord prolapse management
Place hand in vagina to elevate the presenting part of the cord (due to the risk of foetal hypoxia)
Keep cord warm and most and don’t push it back inside
Toxolytics to reduce cord compression
C-section
patient on all fours
63
management of breech before term
ECV
64
Forceps tend to have a lower risk of what compliactions
Forceps tend to have a lower risk of foetal complications
| Ventouse tend to have a lower risk of maternal complications
65
general rule for instumental delivery
After three contractions and pulls with any instrument - if there is no reasonable progress, the attempt should be abandoned.
66
Category 1: immediate threat to the life of the women or foetus
Category 2: maternal or foetal compromise which is not immediately life-threatening
Category 3: no maternal or foetal compromise but needs early delivery
Category 4: elective caesarean section – delivery timed to suit woman and staff
Q: what are he 2 indications for emergency c-sect
Failure to progress in labour
| Suspected/confirmed foetal compromise
67
management of twins in labour
Twins are usually induced at 38 weeks
constant foetal monitoring with CTG
Oxytocin may be helpful if contractions diminish after delivery of the first twin
If foetal distress occurs in the second twin, delivery may be expedited with either forceps of ventouse
68
shoulder dystocia Mx
call for help
tell woman to stop pushing
avoid downward traction of foetal head - increases risk brachial plexus injury
1st line maneuver - McRoberts manoveur & suprapubic pressure
2nd line - episiotomy, rubin manevour, corkscrew maneour
if fails on all fours and repear
last oprion - Last optiton : returning the foetal head to the pelvis for delivery of the baby via caesarean section.
69
uterine rupture Mx
A to E
| The foetus is delivered by Caesarean section, and the uterus is either repaired or removed (hysterectomy)
70
PPH Mx
A to E approach.
```
Management usually requires:
Lie flat
Bloods and fluids
Bimanual compression
IM syntometrine
Surgery if peri-arrest
```
71
uterine atony Mx
Bimanual compression
IV Syntocinon followed by ergometrine
(carboplast & misoprostal can also be used)
surgical measures - intrauterine balloon tamponade
72
repair of 1° / 2° tears
Suture as soon as possible to reduce bleeding and infection risk
A rectal examination is recommended before starting, to ensure there is no trauma to the anal sphincter complex
73
Repair of 3° / 4° tears:
repair carried about by experienced clinician
broad-spectrum antibiotics and stool softeners
physiotherapy input
74
amniotic embolism
A to E assessment, focusing on resuscitation.
Investigations may include:
Bloods: FBC, U&E, clotting studies, ABG
ECG – looking for ischaemic changes
Chest X-ray
If the baby is not yet delivered and the patient is relatively stable, continuous foetal monitoring should be instigated with a view to imminent delivery
If cardiac arrest or severe maternal compromise, perimortem section is indicated to facilitate CPR of the mother.
75
what happens if lochia persists beyond 6 wks
An ultrasound is indicated
Continue vaginal discharge beyond this time is an indication for ultrasound to investigate the possibility of retained products of conception.
76
post partum depression - offer CBt and which medication
sertraline
77
postpartum psychosis Mx
mother would be admitted to a specialist mother and baby unit, where the maternal–infant relationship can be protected.
Pharmacological treatment usually involves an antipsychotic and a mood-stabiliser.
