Obstetrics Flashcards
What should you do if a baby loses >10% of its birthweight in the first week of life
Refer to midwife-led breastfeeding clinic
What are the two phases in the 1st stage of labour
Latent phase: 0-3cm
Active phase: 3-10cm
Would you experience pain with a threatened miscarriage
No
How would you immediately manage an umbilical cord prolapse
Retrofill the bladder with 500-700ml of saline and push the presenting part back into the uterus
When should insulin be commenced in gestational diabetes
If fasting glucose level of >=7 mmol/l at the time of diagnosis
Define ‘station’
The term used to describe the head in relation to the ischial spine
3 parameters which indicate an antenatal diagnosis of Down’s Syndrome
Increased HCG
Decreased PAPP-A
Thickened nuchal translucency
How long should you continue magnesium treatment for after the last seizure
24 hours
Give one risk factor for pre-eclampsia
Pre-existing renal disease
What is the only contraindication for epidural anaesthesia in labour
Coagulopathy
When should you attempt to move a breech baby
36 weeks
Are DOACs safe to use in pregnancy?
NO
is it safe to breastfeed a baby with maternal hepatitis B
yes
Define renal agenesis and how would it present
Absence of one or both kidneys
Reduced amniotic fluid
What should you do if there are late decelerations on CTG
Fetal blood sampling
When should methotrexate be stopped before conception?
6 months
How would you manage a women who had a previous baby with group B strep
IV antibiotic prophylaxis
When would you give the first dose of anti-D
28 weeks
What dose of folic acid should you give women?
400 micrograms for the general population
5mg for women with a BMI over 30 or on anti-epileptics or diabetics
What should you do if a woman is exposed to chicken pox during pregnancy?
If they are not immune then give:
Below 20 weeks: varicella zoster immunoglobulin
Above 20 weeks: varicella zoster immunoglobulin or antivirals given at day 7-14 post-exposure (not immediately)
Antihypertensive for pre-eclampsia
Labetalol
If pt has asthma then Nifedipine
What 5 scenarios would warrant continuous CTG monitoring
- suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
- severe hypertension 160/110 mmHg or above
- oxytocin use
- the presence of significant meconium
- fresh vaginal bleeding that develops in labour - this was a new point added to the guidelines in 2014
Define postpartum haemorrhage
Blood loss of 500mls or more within 24 hours of the birth of a baby
2 SSRIs of choice in breastfeeding women
Sertraline
Paroxetine
What medication is absolutely contraindicated in breastfeeding
Aspirin
At what gestation do pregnancy associated blood pressure changes begin?
Past 20 weeks, anything before this is pre-existing hypertension
What is postpartum thyroiditis and how is it treated?
Autoimmune condition which usually lasts for 3-4 months postpartum and is treated with beta blockers
ABx of choice for GBS prophylaxis
IV benzylpenicillin
Bright red vaginal bleeding with a non-tender uterus and normal CTG at 28 weeks
Placenta praevia
Constant pain with bleeding and ‘woody’ abdomen with uterine contractions and foetal distress on CTG
Placental abruption
Painless vaginal bleeding before 24 weeks
Threatened miscarriage
Maternal shock, abdominal pain and fetal compromise
Uterine rupture
Rupture of membranes and dark red vaginal bleeding with foetal bradycardia
Vasa praevia
Pregnant women with a previous VTE history
LMWH throughout pregnancy until 6 weeks postpartum
Pre-existing diabetic treatment throughout pregnancy
Metformin and insulin are the only drugs
Other drugs such as glicazide and liraglutide are contraindicated
First step for chickenpox exposure in pregnancy
Check varicella antibodies
What is syndometrine
Works the same as oxytocin to contract the uterus during the third stage of labour
When should you investigate a lack of foetal movements?
24 weeks
Woman presents with reduced foetal movements after 28 weeks
Handheld doppler
If no heartbeat found then immediate ultrasound
What should you do if you suspect maternal rubella infection
Discuss immediately with the local health protection unit
Management of pregnant women above 20 weeks who develop chickenpox and present within 24 hours
Oral aciclovir
Management of intrahepatic cholestasis of pregnancy
Induce at 37-38 weeks due to increased risk of stillbirth
Management of PPROM
10 days erythromycin
first-line medical treatment for intrahepatic cholestasis of pregnancy
ursodeoxycholic acid
6 levels of management for PPH
bimanual uterine compression to manually stimulate contraction
intravenous oxytocin and/or ergometrine
intramuscular carboprost
intramyometrial carboprost
rectal misoprostol
surgical intervention such as balloon tamponade
Which presentation has the greatest mortality
Footling
Increased risk of cord prolapse
Features of HELLP syndrome
Haemolysis (H), elevated liver enzymes (EL), and low platelets (LP)
Severe form of pre-eclampsia with malaise, nausea, vomiting, headache, epigastric pain
% risk of developing postpartum psychosis a second time
25-50%
At what gestation is the second screen for anaemia and atypical red cell alloantibodies performed?
28 weeks
At what gestation is the nuchal scan performed
11-13+6 weeks
At what gestation is the urine culture to detect asymptomatic bacteria performed (and the booking visit(
8-12 weeks
What are the reference ranges to diagnose gestational diabetes?
Gestational diabetes can be diagnosed by either a:
fasting glucose is >= 5.6 mmol/L, or
2-hour glucose level of >= 7.8 mmol/L
‘5678’
Who would you give routine antenatal anti-D prophylaxis at 28 weeks to?
Rhesus negative mothers who are not sensitised
Which medications should be avoided whilst breastfeeding?
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides psychiatric drugs: lithium, benzodiazepines aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone diabetic drugs apart from metformin
Which infectious diseases are routinely screened for in pregnancy?
Hepatitis B, HIV, rubella, syphilis
First line treatment for mastitis
Continue breastfeeding, simple analgesia and warm compress
Factors which would indicate ABx are appropriate in mastitis?
Infected nipple fissure, symptoms not improving after 12-24 hours or positive milk culture
Risk factor for shoulder dystocia
Diabetes
What is a galactocele
Well-circumscribed lesion with a white fluid on aspirate that appears after breastfeeding (no need for investigation)
Management of cord prolapse
The presenting part of the fetus can be pushed back into the uterus
Folic acid and vitamin D throughout pregnancy
Vitamin D throughout
Folic acid for the first 12 weeks
Biggest risk factor for cord prolapse
Artificial amniotomy
Sudden Hx of collapse with hypotension after artificial rupture of membranes
Amniotic fluid embolism
What can you do to aid the McRobert’s manoeuvre
Suprapubic pressure
Most common cause of severe infection in newborn babies
Group B septicaemia
What assessment should you perform prior to induction of labour
Bishop score
How does TTTS present
Sudden increase in size of abdomen and breathlessness
What score do you calculate for Anti-D
Kleihauer test
Layers of the abdomen cut through in a c-section
Anterior rectus sheath - rectus abdominis muscle - transversalis fascia - extraperitoneal connective tissue - peritoneum - uterus
Is lamotrigine safe in pregnancy (epileptic drug)
Yes
Pregnant women with a previous history of gestational diabetes, when are they offered OGTT
OGTT immediately after booking and again at 24-28 weeks
first-line investigation for preterm prelabour rupture of the membranes
Careful speculum examination to look for pooling of amniotic fluid in the posterior vaginal vault
Define pre-eclampsia
new-onset BP ≥ 140/90 mmHg after 20 weeks AND ≥ 1 of proteinuria, organ dysfunction
How would you manage a woman with ONLY + protein on urinalysis
Routine
What would a Bishop score mean?
A Bishop score less than 5 generally means induction will likely be necessary. A score above 9 indicates labour will likely occur spontaneously.
Management of a suspected PE in pregnant women with a confirmed DVT
Treat with LMWH first then investigate
What is the cut off for iron supplementation in: non-pregnant women early pregnancy late pregnancy postpartum women
non-pregnant women: 115 g/L
early pregnancy: 110 g/L
late pregnancy: 105 g/L
postpartum women: 100 g/L
What are normal lab findings in pregnancy for urea, creatinine and urinary protein loss
Reduced urea, reduced creatinine, increased urinary protein loss
4 normal physiological changes in a pregnant woman’s cardiac exam
Third heart sound
Peripheral oedema
Ejection systolic murmur
Forceful apex beat
3 common causes of placental abruption
Cocaine abuse
Pre-eclampsia
HELLP syndrome
Placental abruption, dilated pupils and hyperreflexia
Cocaine abuse
What happens to blood pressure normally during pregnancy
Falls in first half of pregnancy before rising to pre-pregnancy levels before term
How would you monitor treatment response for DVT in pregnant women?
Anti-Xa activity
Molar pregnancy blood test findings
High beta HCG, low TSH, high thryoxine (HCG acts as TSH and stimulates the thyroid)
preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia
chorioamnionitis
High risk of pre-eclampsia - factors and management
First pregnancy, BMI above 35, FHx
Aspirin 75-150mg daily from 12 weeks to birth
Medication of choice for depression in breastfeedign women
Sertraline or Paroxetine
What is the most important risk factor for placenta accreta
Previous caesarean sections
Is transverse myelitis associated with pre-eclampsia
No
5 things that are associated with pre-eclampsia
Intracerebral haemorrhage Pulmonary oedema Fetal prematurity Fetal IUGR oligohydramnios
Which procedure carries the greatest risk of haemorrhage in the newborn
Prolonged ventouse delivery
Which antiepileptic is safe in pregnancy
Lamotrigine
most are safe in breastfeeding
What is the most common explaination for short episodes (less than 40 mins) of decreased variability on the CTG
The foetus is asleep
Chicken pox exposure in pregnancy, if less than 20 weeks and woman is not immune then give…
…. Varicella zoster immunoglobulin
Maximum time from cord prolapse to delivery
30 mins
Perineal tear classification
First degree: superficial damage
Second degree: perineal muscle but not the anal sphincter
Third degree: includes anal sphincter
Fourth degree: anal sphincter and rectal mucosa
ABx for mastitis
Fluclox
Induction
Prostaglandin
First line management of uterine atony
Syntocinon
Initial step in women over terrm
Membrane sweep
1st line in suspected pre-eclampsia
Urgently refer to obstetrics then they will start the labetalol
Raised alpha fero protein
Omphalocele - abdominal wall defect
When it TTTS detected
16-24 weeks
Treatment for magnesium sulphate induced respiratory depression
Calcium gluconate
Investigation for placenta praevia
Transvaginal ultrasound
Women with known placenta praevia goes into labour
Emergency C-Section whether there is bleeding or not
What is HCG secreted by
Syncytiotrophoblasts
Target bp in pre-eclampsia
135/85
What is puerperal pyrexia and how is it managed
temperature over 38 in first 14 days after delivery commonly caused by endometritis
admit to hospital for IV climdamycin and gent
Drug during umbilical cord prolapse
Terbutaline
Increased nuchal translucency other than downs
Congenital heart defects
RF for placental abruption
A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
Look at CTG abnormalities
When is an ultrasound needed for lochia
6 weeks
Medication that causes folic acid deficiency
Phenytoin
Which insulin is used in GD
Short acting only
Mother with group b strep and no prophylaxis
Observe baby for 24 hours
Position for mcroberts
Supine with both hips fully flexed and abducted
Describe the woods screw manoeuvre
Put your hand in the vagina and attempt to rotate the foetus 180 degrees
Pregnant women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed
Cooked liver in pregnancy?
No
Cottage cheese in pregnancy?
Yes
adduction and internal rotation of the right arm in a foetus
Erbs
Planned vaginal birth after caesarean (VBAC) is contraindicated in patients with previous vertical (classical) caesarean scars, previous episodes of uterine rupture and patients with other contraindications to vaginal birth (e.g. placenta praevia)
