Obstetrics Flashcards
What is involved in first trimester Down’s Syndrome screening?
Nuchal translucency + B-HCG + pregnancy associated plasma protein A
What is involved in second trimester Down’s syndrome screening?
α-fetoprotein, unconjugated oestriol, β-hCG and inhibin-A
When in pregnancy should Folic Acid be taken?
From 12 weeks before conception to 12 weeks after ideally
What are the first-line anti-hypertensives in pregnancy?
- Labetalol
- Nifedipine
- Methyldopa
Fever, uterine tenderness and foul-smelling discharge in pregnancy suggests…
Chorioamnionitis
What is Chorioamnionitis?
Ascending infection of the amniotic sac - potentially life-threatening
Which emergency contraception can be given during breast feeding?
Copper IUD or Levonestrogel
When is the first dose of Anti-D given to rhesus negative women in pregnancy?
24 weeks
What is the preferred method for induction of labour?
Vaginal Prostaglandin E2
What are the first-line anti-emetics in pregnancy?
anti-histamines that also have anti-emetic effects such as cyclizine, prochlorperazine or promethazine
How are 1st degree perineal tears usually managed?
Usually no suturing required
How are 2nd degree perineal tears managed?
Sutured on the ward by a trained doctor/midwife
How are 3rd and 4th degree perineal tears managed?
Sutured in theatre by a trained clinician
What are the SSRIs of choice in breastfeeding women?
Sertraline or Paroxetine
When should the first USS scan be done in pregnancy?
10 - 13 + 6 weeks
How long after declaring a Cat 1 C-section should it be performed?
Within 30 minutes
What is the anti-depressant of choice in breast-feeding women?
Sertraline
Which antibiotic should be used for UTI if breastfeeding?
Trimethoprim
Which diabetic medications are safe in pregnancy?
Metformin & Insulin
What are the main risk factors for gestational diabetes?
Previous GDM
First-degree relative with diabetes
BMI > 30
Age > 35
What is the screening test for gestational diabetes?
OGTT at 24-28 weeks
Which glucose values are diagnostic of GDM?
Fasting glucose > 5.6
OGTT > 7.8
What follow-up should women with gestational diabetes receive?
Fasting glucose 6-13 weeks after birth
HbA1C every year
Which women should be started on LDA?
One of Hypertension, CKD, Autoimmune disease, T1/2DM, Hypertension OR
Two of prim, age > 40, BMI > 35, FH of PET, multi-foetal pregnancy or pregnancy interval > 10 years
What are the diagnostic criteria for pre-eclampsia?
New HTN and one of: Proteinuria Renal failure Liver involvement Haematological Placental dysfunction
How should eclamptic seizures be managed?
Mag sulphate
Which AEDs are most safe in pregnancy?
Carbamazepine, Lamotrigine, Levetiracetam
What must you remember before examining a woman with APH?
Need to exclude placenta praevia with TV USS before DVE
Give risk factors for placental abruption.
previous PA, trauma, PET, smoking & drug use
What is vasa praevia?
Umbillical cord/vessels pass near to the cervix
What is the biggest risk factor for vasa praevia?
Artifical rupture of membranes
Which maneovres may be used in vasa praevia?
Can support the presenting part or get Mum on all fours
What is the investigation for suspected placenta praevia?
TV USS
How long after a Cat 2 C-section is declared should it be performed?
Within 75 mins
What should you look for on examination in suspected pre-labour ROM?
Speculum examination - pooling of amniotic fluid in posterior fornix
By what week of pregnancy should foetal movements be felt?
24 weeks
Under what circumstances can lactational amenorrhoea be used as a contraceptive method?
amenorrhoeic, baby <6 months, and breastfeeding exclusively
Which vaccines are offered in pregnancy?
Influenza and pertussis
What is the normal baseline CTG rate?
110-160
What is the normal variability on a CTG?
5 - 25
Which type of decelerations are abnormal?
Late or prolonged (> 3 mins)
When is the ‘combined test’ offered?
~12 weeks
When is the ‘quadruple test’ offered?
15 - 20 weeks
If a higher risk of aneuploidy is identified in combined or quadruple screening, which test(s) should be offered?
NIPT first then diagnostic testing (CVS or amniocentesis) if high/Mum wants definitive testing
What is the miscarriage rate in CVS/amniocentesis?
around 1%
When is CVS usually performed?
Between 11 and 13+6 weeks
When is amniocentesis usually performed?
From 15 weeks
Which women with gestational diabetes should be commenced on insulin at the time of diagnosis?
Those with glucose > 7
How long after birth can women start the COCP?
3 weeks if not breastfeeding, 6 weeks if breastfeeding
Which type of insulin is used in pregnancy?
Short-acting only
What is the cut-off for iron supplementation in the first trimester?
< 110 Hb
What is the cut-off for iron supplementation in the second and third trimester?
< 105 Hb
