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Medicine Finals: HARD STUFF ONLY > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Management of acute placenta praevia?

A 
<34w = corticosteroids
>34w = C section
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2
Q

Management of placental abruption

A 
Urgent involvement of seniors
2 x grey cannula - bloods
Crossmatch 4 units
Fluid + blood resus if needed
CTG monitoring

If fetal distress - immediate CS
If no fetal distress + <36w = Steroids + observe
If no fetal distress +>36w = Delivery vaginally

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3
Q

Drugs to avoid in pregnancy

A

x

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4
Q

Drugs to avoid in breastfeeding

A
  • aspirin
  • lithium
  • ciprofloxacin
  • methotrexate
  • amiodarone
  • carbimazole
  • benzodiazepines
  • tetracyclines
  • sulphonamides
  • sulphonylureas
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5
Q

What is hydrops fetalis?

A

Abnormal fluid accumulation in two or more fetal compartments
Due to severe fetal anaemia

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6
Q

Causes of polyhydramnios

A

Impaired swallowing - oesophageal atresia/duodenal atresia, diaphragmatic hernia

Increased production - foetal anaemia, maternal DM, twin to twin, foetal renal disorders

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7
Q

Causes of oligohydramnios

A

Reduced production - renal agenesis, polycystic kidney disease
IUGR
PPROM

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8
Q

Management of pre-eclampsia

A

1) Labetalol (or nifedipine/methyldopa)

2) IV mag sulphate if becomes eclampsia

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9
Q

Who needs aspirin and from when?

A

If 1 high risk factor or 2 moderate risk factors

Aspirin daily from 12 WEEKS

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10
Q

What are high risk and moderate risk factors for pre-eclampsia?

A

High risk = previous pre-eclampsia, multifetal gestation, chronic HTN, diabetes, renal disease, autoimmune disease

Moderate risk = mother/sister with pre-eclampsia, nulliparity, obesity, age 40 years or older, multiple pregnancy

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11
Q

Who needs LMWH and from when

A

If 3 risk factors - LMWH from 28 weeks pregnancy to 6 weeks postpartum

If 4 risk factors - LWMH from first trimester to 6 weeks postpartum

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12
Q

What are risk factors for VTE in pregnancy?

A 
Smoking
Parity >3
Age >35
BMI >30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Varicose veins
Family history
Thrombophilia
IVF pregnancy

Note: D-dimer is not useful in pregnancy

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13
Q

How long do you take folic acid for?

A

From before conception until 12th week of pregnancy (end of first trimester)

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14
Q

What is chorionic blood sampling and when is it used?

A

used for diagnosis of Down syndrome
prior to 15 weeks gestation
2% risk of miscarriage

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15
Q

Amniocentesis

A

used for diagnosis of Down syndrome
after 15w gestation
1% risk of miscarriage

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16
Q

Management of cord prolapse

A

Need emergency CS

Whilst awaiting theatre:

  • Push in presenting part to avoid decompression
  • Ask patient to go on all fours
  • Retrofilling the bladder with saline can help to gently elevate the presenting part
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17
Q

Management of shoulder dystocia

A

McRobert’s manoeuvre

Apply suprapubic pressure

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18
Q

Management of perineal tears

A

First degree - superficial. No management needed.

Second degree - perineal msuclebut not anal sphincter. suturing on the ward.

third degree - affects anal sphincter. needs suturing in theatre.

fourth degree - affects rectal mucosa. needs suturing in theatre.

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19
Q

What are the 4 T’s of postpartum haemorrhage? How is postpartum haemorrhage managed?

A

Tone - uterine atony
Trauma - perineal tear
Thrombin - coagulation disorder
Tissue - retained products of conception

Insert 2x wide bore cannula
Crossmatch + group and save

  1. Bimanual uterine compression
  2. IV Oxytocin/Syntocinon/Ergometrine
  3. IM Carboprost
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20
Q

What is an amniotic fluid embolism?

How does it present?

How is it managed?

A

When amniotic fluid enters mothers bloodstream
Usually occurs during labour

Chills, shivering, sweating, anxiety
Cyanosis, hypotension, tachycardia
Can cause collapse

Management is supportive

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21
Q

What is the stepwise management for induction of labour?

A
  1. Membrane sweep
  2. Vaginal prostaglandins
  3. Cervical ripening balloon
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22
Q

Congenital rubella

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease
Glaucoma

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23
Q

Congenital toxoplasmosis

A

Cerebral calcification
Chorioretinitis
Hydrocephalus

24
Q

Congenital varicella syndrome

A

Skin scarring
Limb hypoplasia
Microcephaly

25
Q

Which conditions do pregnant women get screened for?

A 
Anaemia
Bacteriuria
Blood group, Rhesus status and anti-red cell antibodies
Down's syndrome
Fetal anomalies
Hepatitis B
HIV
Neural tube defects
Risk factors for pre-eclampsia
Syphilis
26
Q

What are examples of sensitisation events?

A

x

27
Q

Gestational diabetes thresholds

A

Fasting >5.6
2 hour >7.8

Fasting >7 = straight to insulin (Short acting only - gestational diabetes is not managed with long acting insulin)

Targets:
Fasting = 5.3
2 hour = 6.4

28
Q

What is a complication of induction? How is it managed?

A

Uterine hyperstimulation

prolonged and frequent uterine contractions - sometimes called tachysystole

Management=
removing the vaginal prostaglandins if possible and stopping the oxytocin infusion if one has been started
Tocolytics

29
Q

Which rash in pregnancy spares the umbilicus and how is it managed?

A

Polymorphic eruption of pregnancy

Emollients/topical steroids

30
Q

Which rash in pregnancy causes fluid filled blisters around the umbilicus?

A

Pemphigoid gestationitis

31
Q

When to deliver someone with

1) obstetric cholestasis
2) gestational diabetes

A

1) 37-38 weeks

2) 37-38 weeks

32
Q

What is vasa praevia and how is it managed? (if it is diagnosed on ultrasound and if it presents as bleeding)

A

Foetal vessels exposed outside of the umbilical cord/placenta
Vessels pass through internal cervical os
Exposed vessels = prone to bleeding

Presentation=

1) Painless bleeding
2) Ruptured membranes
3) Fetal bradycardia

If diagnosed on ultrasound - planned CS at 35-36w
If patient goes into labour - immediate CS needed.

33
Q

How to interpret Bishop score?

A

Bishop score of less than 5 = induction will likely be necessary
Bishop score of above 9 = labour will likely occur spontaneously

34
Q

Who gets screened for gestational diabetes?

A

BMI of > 30 kg/m²
previous macrosomic baby weighing 4.5 kg or above
previous gestational diabetes
first-degree relative with diabetes
family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)

35
Q

Anaemia iron supplementation requirement cut offs – pregnancy

A

First trimester = 110
Second/third trimester = 105
Postpartum = 100

36
Q

When do you need to do a Kleihauer test?

A

Any sensitisation event after 20 weeks

37
Q

How does obstetric cholestasis present and how is it managed?

A

intense pruritus, jaundice, raised biluribin

Management:
Ursodeoxycholic acid
Induction at 37-38w

38
Q

Obstetric cholestasis vs. acute fatty liver of pregnancy

A

Obstetric cholestasis - intense pruritus, jaundice, raised biluribin
Acute fatty liver - rare. Abdominal pain, N+V, headache, hypoglycaemia, elevated ALT. Delivery is definitive management.

39
Q

When can an IUD/IUS be inserted post-partum?

A

Either in first 48 hours or otherwise then wait 4 weeks.

40
Q

What are risk factors for cord prolapse?

A 
Artificial rupture of membranes
Prematurity
Multiparity
Polyhydramnios
Twin pregnancy
Abnormal presentation - breech, transverse
41
Q

What should the symphysis-fundal height be?

A

After 20 weeks - should match gestational age within 2cm

E.g. at 24 weeks should be 22-26cm

42
Q

What tool is used to screen for postnatal depression?

A

Edinburgh Scale

43
Q

Which antidepressant in breastfeeding women?

A

Sertraline or Paroxetine

44
Q

What are the three methods of testing for Down syndrome in pregnancy?

A

Combined testing = bHCG+PAPP-A + nuchal thickness

Triple testing = bHCG + AFP + uE3 (Unconjugated oestriol)

Quadruple testing = bHCG + AFP + uE3 + Inhibin-A

45
Q

What is the window for combined testing?

A

Between 11 and 13 weeks

After 13 weeks -> Triple test (bHCG/AFP/uE3) or quadruple test (bHCG, AFP, uE3, Inhibin-A)

46
Q

What gestation to do chorionic villous sampling vs. Amniocentesis?

A

After 15 weeks - Amniocentesis.

47
Q

What are indications for foetal blood sampling?

A

Suspicious CTG to confirm presence of hypoxia

48
Q

How can you interpret foetal blood sampling? How do you manage this?

A

pH <7.2 = abnormal
Lactate >4.9 = abnormal

If abnormal foetal blood sampling = immediate CS

49
Q

When does postpartum depression usually present?

A

Around 3 months after birth

50
Q

What are the 2 main causes of maternal sepsis?

A

Chorioamnionitis and UTI

If maternal sepsis - do urine dip + high vaginal swab

51
Q

How is chorioamnionitis managed?

A

IV abx + prompt delivery

52
Q

When should you do active management of third stag of labour?

A

if placenta has not passed after 1 hour

53
Q

How to management PPROM?

A

Admission for 10 day course of erythromycin + ACS

54
Q

Congenital cytomegalovirus infection

A

LBW
Purpuric skin lesions
Sensorineural deafness
Microcephaly

55
Q

Fetal alcohol syndrome

A

Flat philtrum
Short palpebral fissure
Microcephaly
Learning disability

Medicine Finals: HARD STUFF ONLY (23 decks)

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