Obstetrics Flashcards
1
Q
what is perinatal?
A
pregnancy + 1 year post partum
2
Q
what is the difference between baby blues, PND and psychosis in terms of time frame?
A
- baby blues: <2 weeks
- PND: 2-4 weeks
- Psychosis: recover within 6-12 weeks
3
Q
what extra features need to be in the antenatal care in patients with cardiac disease in pregnancy?
A
- echo at booking and at 28 weeks
- anticoagulant if patient has: CHD, pulmonary HTN, artificial valves
- prophylactic Abx for women with structural heart defects
4
Q
what extra scans should happen in pregnant women with diabetes?
A
28, 32, 36 (4 weekly serial growth scans)
cardiac outflow scan
retinal and renal scanning
5
Q
what other appointments should pregnant women have?
A
every 2 weeks = joint antenatal-diabetes clinics
6
Q
when should pregnant women with diabetes deliver?
A
37+0 to 38+6 weeks = induction or ELCS
7
Q
what signs can be seen on USS in ectopic pregnancy?
A
- Tubal: bagel/blob sign
- Cervical: barrel cervix
8
Q
what extra medication should be recommended for pregnant women with epilepsy?
A
- Vit K in last month of pregnancy
- increased folate dose
- epidural for delivery
9
Q
what can you recommend to pregnant women with Epilsepy?
A
UK Epilepsy and Pregnancy register
10
Q
appearance of complete and incomplete mole on USS
A
- complete mole: snowstorm/”cluster of grapes”
- incomplete mole: foetal parts
11
Q
what is the management of a molar pregnancy?
A
URGENT referral to specialist centre
1. surgical: ERPC
2. monitor bHCG - methotrexate if rising/stagnant
AVOID pregnancy until 6 months of normal levels
12
Q
what is the main issue with GTD malignancy?
A
rapid metastasis
13
Q
3 main types of GTD malignancy
A
- invasive mole
- choriocarcinoma
- placental site trophoblastic tumour
14
Q
what is an invasive mole?
A
- hydatiform mole
- invasion of myometrium
- necrosis
- haemorrhage
15
Q
what is a choriocarcinoma?
A
cytotrophoblast and syncytiotrophoblast without formed chorionic villi invade myometrium
16
Q
what is placental site trophoblastic tumour?
A
intermediate trophoblasts infiltrate myometrium without causing destruction
17
Q
what PUQE-24 score indicated admission?
A
13+
18
Q
when else might you admit in HG?
A
- if can’t keep fluids down
- ketonuria
- weight loss >5%
- co-morbidities
19
Q
what medication do you give HG?
A
- VTE
- KCl
- Thiamine
20
Q
what is classified as HTN in pregnancy? what target do you try and achieve?
A
> 140/90
target: <135/85
21
Q
what do you give for high risk pre-eclampsia?
A
aspirin 75mg from 12 weeks to birth
22
Q
what are the high risk factors for pre-eclampsia? how many do you need to give aspirin?
A
1+ = aspirin
- previous pre-eclampsia
- CKD
- AI disease
- T1 or T2DM
- Chronic HTN
23
Q
what are the low risk factors for pre-eclampsia? how many do you need to give aspirin?
A
2+ = aspirin
- Primigravid
- age 40+
- pregnancy interval >10 years
- BMI >35
- FHx pre-eclampsia
- multiple pregnancy
24
Q
what is the definition of moderate HTN?
A
140/90 to 159/109
25
what checks do you need to do for moderate HTN?
- BP: measure 1-2/week
- Dipstick: 1-2/week
- FBC, LFTs, U&Es: ONCE at presentation
- USS for foetal growth
26
what is the definition of severe gestational HTN?
>160/110
27
what checks do you need to do in severe gestational HTN?
- BP: measure every 15-30 mins until <160/110
- Dipstick: daily whilst admitted
- FBC, LFTs, U&Es: ONCE at presentation
- USS for foetal growth
28
after discharge, what do you then do for moderate and severe gestational HTN?
- measure FBC, LFTs, U&Es ONCE a week
| - every 2-4 weeks: USS for foetal growth, umbilical artery doppler, amniotic fluid assessment, dipstick, BP measurement
29
if the patient has chronic HTN, when do you do assessments?
assess at 28, 32, 36 weeks only
30
what checks do you do in moderate pre-eclampsia (140/90)?
- BP: inpt = x4/day, outpt = every 48 hours
- blood: x2/week
- Admission: CTG, USS, umbilical artery doppler, amniotic fluid assessment
31
what checks do you do in severe pre-eclampsia?
- BP: every 15-30 minutes until <160/110, then x4/day as inpt
- Bloods: x3/week
- Admission tests: same as moderate
32
following discharge or going forward what checks need to be done in moderate and severe pre-eclampsia?
- every 2 weeks: USS, umbilical artery doppler, dipstick, BP measure
- moderate: bloods x2/week
- severe: bloods x3/week
- >37 weeks = initiate birth 24-48hrs
33
what is the pre-eclampsia postnatal discharge criteria?
- no symptoms
- BP < 150/100
- blood tests stable or improving
34
what is the inpt and outpt postnatal BP monitoring?
- inpt: x4/day
| - outpt: every other day until targets achieved, then once weekly
35
what is the pre-eclampsia aetiology?
impaired trophoblastic invasion of spiral arteries
1. impaired invasion = high resistance flow
2. low flow = poor perfusion of placenta
3. placenta releases factors into circulation
4. promotes further systemic effects
36
what are the symptoms of toxoplasmosis in the mother?
asymptomatic
| fever, malaise, arthralgia
37
treatment of mother with toxoplasmosis
Spiramycin
38
symptoms of congenital toxoplasmosis
- chorioretinitis = cataracts
- hydrocephalus
- convulsions
- intracranial calcifications
39
investigations for toxoplasmosis
Sabin Feldmen Dye Test
40
management of congenital toxoplasmosis?
pyrimethamine, sulfadiazine
41
what are the symptoms of congenital syphillis?
- rash (soles and palms)
- bloody rhinitis
- nose deformity
- saber shin's (anterior bowing of shins)
- Hutchinson's teeth (small widely spaces, notched)
- Clutton's joints (symmetrical knee swelling)
42
investigations of congenital syphillis
- micro
| - serology (non-treponemal or treponemal)
43
management of syphillis
Ben-Pen
| + prednisolone in mum
44
what are all the different names for parvovirus infection?
- erythema infectiosum
- fifth disease
- slapped cheek
45
when is transmission highest in parvovirus infection?
higher transmission <20 weeks
46
what investigations do you do in parvovirus and when are they indicated?
only if contracted if <20 weeks
| Foetal anomaly scan USS after 4 weeks, serial scans then every 2 weeks until 30/40
47
management of in utero parvovirus
in utero transfusions
48
what are the potential complications of maternal VZV infections?
risk of encephalitis, pneumonia and sepsis
49
management of a mother exposed/ infected with VZV?
- exposed <20/40 = VZIG (if no symptoms)
- symptomatic and >20/40 = aciclovir
- referral to foetal medicine specialist at 16-20 weeks or 5 weeks after infection
50
what are the symptoms of congenital varicella syndrome?
- eyes (chorioretinitis)
- CNS (microcephaly)
- MSK (cutaneous scarring, limb hypoplasia)
- IUGR
51
what are the symptoms of neonatal varicella infection?
- mild disease
- disseminated skin lesions
- pneumonia
- visceral infections (e.g. hepatitis)
52
management of neonatal varicella infection
aciclovir
| arrange neonatal opthalmic exam
53
what are the indications for neonatal VZIG?
- birth <7 days of mum rash
| - mum chickenpox <7 days since delivery
54
how do you test neonates for HIV?
- neonates test +ve for HIV Abs due to passive transfer
| - instead do direct viral amplification through PCR at birth, discharge, 6w, 12w, 18w
55
what maternal HIV monitoring should be carried out?
- 2x CD4 counts (baseline and delivery)
| - x8 viral load (every 2-4 weeks, 36 weeks and after delivery)
56
symptoms of rubella
- coryzal symptoms, arthralgia, rash
- maculopapular rash
- soft palate lesions
- lympadenopathy
57
management of rubella in pregnancy
supportive
offer TOP <16 weeks
refer to foetal medicine unit and HPT
58
when is the biggest risk of congenital rubella syndrome?
<12 weeks of GA
59
what are the symptoms of congenital rubella syndrome?
- chorioretinitis
- PDA
- SNHL
- microcephaly
60
what is the most common congenital infection?
CMV
61
symptoms of CMV in the mum
asymptomatic
62
what is CMV likely to be vertically transmitted?
30-40% vertical transmission at ANY STAGE
63
how many pt are asymptomatic for congenital CMV at birth?
90%
64
what are the symptoms of congenital CMV?
- SNHL
- chorioretinitis
- periventricular calcifications
- blueberry muffin rash
- jaundice
65
management of congenital CMV
- ganciclovir and valganciclovir
| - audiology and ophthalmology F/U
66
what are the symptoms of HSV in neonate?
- SEM disease (blistering vesicular rash, chorioretinitis)
- CNS +/- SEM (seizures, irritability, lethargy, bulging fontanelle)
- disseminates (encephalitis, CNS, hepatitis, pneumonitis
67
management of HSV in neonate
aciclovir
68
when do you treat HSV in mother?
only treat if primary infection
69
what delivery method if recommended in a mother with primary HSV?
- 1st episode >6 weeks prior to EDD = SVD
| - 1st episode <6 weeks prior to EDD = CS
70
what special precautions should be made in SVD in mothers with HSV?
- avoid invasive procedures
| - aciclovir intrapartum
71
how should mothers with recurrent HSV infection deliver?
- SVD
| - aciclovir TDS from 36 weeks
72
what is the GBS bacteria ?
streptococcus agalactiae
73
indications for intrapartum GBS prophylaxis?
- intrapartum fever, confirmed chorioaminitis
- prolonged ROM
- <37 weeks (preterm)
- previous infant with GBS
- maternal GBS bacteriuria, colonisation
74
when should you monitor neonatal vital signs ?
if Abx were given <4 hours before delivery
75
when is sepsis monitoring needed in newborns?
- 1 RF: hospital Obs 24 hours
| - >2 RFs or 1 red flag: sepsis Abx and septic screen
76
what are the sepsis red flags?
- intrapartum Abx for sepsis (not GBS prophylaxis)
- respiratory distress >4 hours postpartum
- seizures
- mechanical ventilation needed in term baby
- signs of shock
77
what is classed as engagement?
2/5th palpable or below
78
what is the 1st stage of labour?
Painful uterine contractions --> 10cm dilation
- Latent = painful contractions to 4cm
- Established = regular contractions, >4cm
79
what is the second stage of labour?
urge to push to delivery of the foetus
- passive (not pushing)
- active (pushing)
80
what is the 3rd stage if labour?
delivery of placenta and foetal membrane
81
where is the pelvic inlet/outlet widest?
- pelvic inlet widest = TRANSVERSE
| - pelvic outlet widest = AP
82
what controls the progression of labour?
power
passage
passenger
83
what is restitution?
bringing head in line with shoulders
84
what are the steps to labour?
1. head floating, before engagement
2. engagement, flexion, descent
3. further descent, internal rotation
4. complete rotation, beginning extension
5. complete extension
6. restitution (external rotation)
7. delivery of anterior shoulder
8. delivery of posterior shoulder
85
what are the signs and symptoms of shoulder dystocia?
- difficult face/chin delivery
- "turtling"
- failure of restitution
- failure of shoulder descent
86
shoulder dystocia manoeuvres?
1. Rubin's: push anterior shoulder towards baby's chest
2. Wood Screw's: Rubin + push posterior shoulder towards baby back
3. deliver posterior arm
87
what is included Bishop's score?
- cervical position
- cervical consistency
- cervical effacement
- cervical dilation
- fetal station
88
what is crowning?
- when head no longer recedes between contractions
| - midwife flexes foetal head and guards the perineum
89
method of induction
1. propess (24 hours)
2. prostin (if propess was insufficient, max 2x, 6 hourly)
3. ARM
4. Syntocinon
5. C-section`
90
what is puerperal pyrexia?
>38 degrees in first 14 days
91
treatment of puerperal pyrexia?
IV clindamycin and IV gentamicin
92
how do you manage LGA if detected at 18-21 weeks?
repeat scan
93
how do you manage LGA if detected at 24-36 weeks?
- offer OGTT
- if it is following same path = reassure, arrange routine scan
- if it is an acceleration of growth = USS for foetal biometry
94
how do you manage LGA if detected at 36-40 weeks?
if SFH > 90th centile = USS for foetal biometry
- OGTT
- care in labour and postnatally as per GDM
95
what is the definition of SGA?
AC or EFW < 10th centile
96
what is the Mx for SGA before 20 weeks?
- if 1+ major RF or 3+ minor RFs, reassess at 20 weeks
97
what is the Mx of SGA if still at risk at 20 weeks?
- minor RFs (3+): uterine artery doppler (20-24 weeks) = if abnormal, serial USS from 26-28 weeks
- major RF (1+): foetal size and umbilical artery doppler (serial USS from 26-28 weeks)
98
if the baby is SGA or IUGR, what investigations need to be done throughout pregnancy?
- umbilical artery doppler serial measurements
| - ultrasound biometry every 2 weeks
99
what is the management for SGA?
low dose aspirin
| delivery by 37 weeks
100
what monitoring needs to be done in obstetric cholestasis?
weekly LFTs
x2/ week doppler
CTG
101
what are the complications of OC?
- PPH (vit K deficienct)
- foetal distress
- meconium delivery
- preterm birth
- intracranial haemorrhage
102
what are the RFs for OC?
- FHx
- Hx of liver disease
- multiple pregnancy
- pruritus on COCP
103
what would investigations show in acute fatty liver of pregnancy?
- high ALT
- low glucose
- high uric acid
NO PRURITUS (vs OC)
104
what are the 3 types of breech?
- frank
- footling
- complete
105
how many breech SVD need an emergency C-section?
40%
106
what maneuvers should be used in a breech vaginal delivery?
- Hands off
- Pinard manoeuvre
- Loveset manoeuvre (rotatoe baby to transverse, pull down anterior arm)
- Mauriceau-Smellie-Viet (rest baby on your forearm)
107
what will you see if the baby head gets stuck in breech delivery?
winging of scapulae
108
what is important to remember about breech vaginal delivery
try and avoid induction
109
what are the 4 types of unstable lie?
- transverse lie
- brow
- face
- compound (fetal arm along head)
110
how is a transverse lie managed?
CS
111
how is a brow lie managed?
if persistent or 2nd stage of labour = CS
112
how is a face presentation managed?
```
mentoposterior = CS
mentoanterior = SVD
```
113
how is compound unstable lie managed?
manage expectantly
114
how many pregnancies end in miscarriages?
20%
115
what are the causes of recurrent miscarriages?
- structural abnormalities
- cervical incompetence
- medical conditions (renal, diabetes, SLE)
- clotting abnormalities
116
how do you date pregnancies on an USS <14w and >14w?
```
<14w = CRL
>14w = AC, HC, FL
```
117
what needs to be seen on an USS to confirm a viable intrauterine pregnancy?
yolk sac
| gestational sac
118
how can you confirm a miscarriage on TVUSS?
- no FH and CRL >7mm
| - GS > 25m + no foetus
119
how does a pregnancy of unknown viability appear on TVUSS? what should you do?
TVUSS in 7 days
- no FH + CRL < 7mm
- GS <25mm + no foetus
120
when is anti-D given in miscarriage?
- if Rhesus -ve and >12GA (any management)
| - therapeutic termination, anti-D regardless
121
how do you assess if twins are monochorionic or dichorionic on USS?
- DC: lamda sign
| - MC: T sign
122
what extra tests need to be carried out in multiple pregnancy?
- FBC at 20-24 weeks, then repeat at 28 weeks
- BP and OGTT
- TTTS monitoring: starting at 16w (every 2w) for shared placenta, 20w (every 4w) no shared placenta
123
when are serial US scans carried out in shared placenta pregnancies?
12w, 16w and then every 2w
124
when are serial US scans carried out if a multiple pregnancy doesn't share a placenta?
12w, 20w and every 4 weeks
125
when are elective births planned in uncomplicated monochorionic twins?
36 weeks (after steroids)
126
when are elective births planned in uncomplicated dichorionic twins?
from 37w
127
when are elective births planned in uncomplicated triplets?
35 weeks after steroids
128
what might be needed in a twin vaginal birth if the 2nd baby is breech?
internal pedalic version
129
what are the signs of TTTS?
- sudden increase in size of abdomen
- SOB
- >25% difference in EFW
130
what is the pathophysiology of TTTS?
direct arterial to venous flow in placenta
131
what are the RFs for oligohydramnios?
- reduced fluid input: placental insufficiency, pre-eclampsia
- reduced fluid output: structural patholoy, Meds (ACEi, NSAIDs)
- lost fluid (ROM, IUGR, TTTS)
- chromosomal abnormalities
132
what are the RFs for polyhydramnios?
- failure of foetal swallow
- congenital infections
- foetal polyuria (maternal diabetes, TTTS)
133
what is the management of polyhydramnios?
- amnioreduction
| - COX inhibitors (decrease foetal urine output)
134
what happens if there is a grade 3/4 PP seen on the 32 week rescan ?
- admit at 34 weeks
| - C-section at 37 weeks
135
what happens if there is a APH from PP?
admit for 48 hours observation (or until bleeding stops)
136
what is vasa praevia?
ruptured foetal vessels when baby descends
137
what is the haemorrhage called when one of these vessels rupture?
Benckaiser's haemorrhage
138
what are the RFs for vasa praevia?
- foetal anomaly (bilobed placenta or succenturiate lobes): fetal vessels run through membranes joining lobes together
- Hx of low lying placenta in 2nd trimester
- multiple pregnancies
- IVF
139
what is type 1 vasa praevia?
velamentous cord insertion in single/bilobed placenta
140
what is type 2 vasa praevia?
foetal vessels running between lobes of placenta with 1+ accessory lobes
141
what is the time frame for secondary PPH?
24 hours to 12 weeks
142
what are the causes of secondary PPH?
endometritis
retained products
abnormal involution of placental site
trophoblastic disease
143
what are the different problems you can have with tone?
1. overdistended uterus (polyhydramnious, multiple gestation, macrosomia)
2. uterine muscle exhaustion (prolonged labour, GA, multiparity)
3. uterine anatomy abnormal
4. intra-amniotic infection
144
what are the steps to management of PPH?
1. bimanual compression
2. IM/IV syntocinon
3. IM ergometrine
4. IM carboprost
5. balloon tamponade
6. B-lynch suture
7. Hysterectomy
145
in what conditions should you not offer a vaginal exam?
Placenta praevia
| PPROM/SROM
146
what investigations should you do in PPROM/PROM?
1. Speculum (pooling), look at the Os
2. IGFBP1 or PAMG-1
3. FFN
147
what should you do if there are convincing signs/symptoms of PPROM?
admit to labour ward
| do not perform diagnostic tests
148
what is the management of PPROM?
- admission and expectant management until 37 weeks
- DO NOT offer tocolysis
- erythromycin (<37 weeks for 10 days or until in established labour)
- steroids (<34 weeks for 24 hours)
- MgSO4 (<30 weeks and labour/planned birth <24hrs)
149
what is the management of PROM (pre-labour, at term)?
clear liquor:
0-24 hrs = expectant
>24 hrs = IOL
meconium: induce ASAP
150
management of pre-term labour if the membranes have ruptured?
PPROM guidance
151
medical management of pre-term labour if the membranes have not ruptured?
- Tocolysis: <34 weeks, nifedipine
- Corticosteroids
- MgSO4
152
surgical management of pre-term labour if the membranes have not ruptured?
- emergency rescue cerclage
| - indication: 16-28 weeks, dilated cervix, unruptured membranes
153
when is a prophylactic cervical cerclage/vaginal progesterone offered?
if cervical length <25mm and other RF
154
what should you do if a mother is found to be RhD -ve and has Abs at booking?
monitor titres
| if peak above, monitor baby using MCA dopplers weekly
155
what are the different skin diseases of pregnancy?
- pemphigoid gestationis
- polymorphic eruption of pregnancy (PUPPP)
- prurigo or pregnancy
- pruritus folliculitis
- atopic eczema
156
what is pemphigoid gestationis and how does it present?
- pruritic AI bullous disorder
- 2nd/3rd trimester
- most lesions on abdomen = widespread cluster burns, sparing face
157
what is the management of pemphigoid gestationis?
topical steroids/oral prednisolone
158
what is polymorphic eruption of pregnancy and when does it present?
3rd trimester/immediately post-partum
begins on lower abdo - extends to thighs, bum, legs, arms
spares umbilicus
159
what is the management of polymorphic eruption of pregnancy?
symptomatic, recurs in most subsequent pregnancies
160
what is prurigo of pregnancy? how does it appear?
- common (20%)
- 3rd trimester, resolves after delivery
- excoriated papules on extensor limbs, abdo, shoulders
161
what is the management of prurigo of pregnancy?
symptomatic
topical steroids/emollients
do LFTs to exclude OC
162
what is pre-natal cannabis use linked to?
- negative effect of growth of baby's brain
- decreased attention and executive function
- decreased academic achievement
- behavioural problems
163
why is pregnancy a pro-coagulant state?
increase F7, F8, vWF, PAI-1, PAI-2, fibrinogen
| decrease protein S
164
what is the treatment of PE?
LMWH until 6 weeks post partum or 3 months total treatment (whichever greater)
165
when does LMWH need to be stopped for delivery or epidural?
- 24 hours before delivery
| - epidural >24 hours after last dose
166
what prevention of VTE is used in high risk patients?
LMWH + stockings
167
for how long is prophylaxis needed?
- 12w until 10 days to 6 weeks pp (>4 RFs, VTE event)
- 28w to 10 days pp (3 RFs)
- conservative (<3 RFs)
168
what are the RFs for VTE?
- age > 35 yrs
- BMI >30
- smoker
- pre-eclampsia
- immobility
- multiple pregnancy
- FHx
- VTE
- low risk thrombophilia
- parity > 3
169
how can you improve the success rate of ECV?
offer it with tocolysis and beta agonists (e.g. Terbutaline)
170
what can cause a HR < 110bpm on CTG?
increased foetal vagal tone
| maternal beta blocker use
171
what can cause a HR > 160bpm on CTG?
maternal pyrexia
chorioamionitis
hypoxia
172
what causes variability < 5bpm?
hypoxia
| prematurity
173
what causes early decelerations?
head compression (not of concern)
174
what causes a late deceleration?
reduced uteroplacental flow
175
what causes variable decelerations (independent of contractions)?
cord compression
176
what are the CTG indications for an emergency C-section?
- terminal bradycardia (FHR <100bpm for more than 10 mins)
| - terminal deceleration (FHR drops, does not recover for more than 3 mins)
177
what are the features of a non-reassuring CTG?
- 100-109, 161-180 bpm
- BV: <5 (for 30-50mins), >25 (for 15 mins)
- variable decels with: no other concerning characteristics for >90 mins, <50% contractions >30 mins, >50% contractions for <30 mins
- late decels in >50% contractions <30 mins
178
what are the features of a pathological CTG?
- sinusoidal = CAT1 EMCS
- <100bpm, >180bpm
- late decels >30mins
- BV < 5 (>50 mins), >25 (>25 mins)
- variable decels with any concerning characteristics in >50% contractions for >30 mins
- acute bradycardia or terminal bradycardia
179
what are the causes of a sinusoidal trace?
- severe foetal anaemia/ hypoxia
| - foetal/maternal haemorrhage
180
what are the causes of late decels for >30 mins?
maternal hypotension
pre-eclampsia
uterine hyperstimulation
181
what is the management of a non-reassuring CTG?
1. left lateral
2. stop oxytocin/consider tocolysis
3. exclude acute event, correct underlying cause, give fluids
4. digital foetal scalp stimulation (causes inc HR)
182
what is the management of a pathological CTG?
- foetal blood sampling
| - EMCS
183
requirements for instrumental delivery (FORCEPS)
```
- episiotomy often done first
Fully dilated cervix
OA position
Ruptured membranes
Cephalic membranes
Engaged presenting part
Pain relief
Sphincter (bladder) empty
```
184
what are the maternal complications of instrumental delivery? with which instrument are they more common?
forceps more common
- perineal tears
- cervical/vaginal lacerations
- PPH
185
what are the foetal complications of instrumental delivery? with which instrument are they more common?
more common with ventouse
- Ventouse: cephalohaemotoma, intracerebral haemorrhage, retinal haemorrhage, jaundice
- Forceps: facial nerve palsy
186
what is the success rate of VBAC?
75%
| + fewer complications compared to ERCS
187
what is important to remember in VBAC?
don't augment with prostaglandins as increased risk of uterine rupture
188
what are the 2 methods of sterilisation?
- hysteroscopic sterilisation
| - laparoscopic tubal occlusion
189
how does hysteroscopic sterilisation work? how long to use contraception after?
expanding springs inserted into tubal ostia --> induced fibrosis
use contraception for next 3 months
190
how does laparoscopic tubal occlusion work? how long to use contraception after?
occlude fallopian tubes with Filshie clips
| use contraception until next period
191
what is the medical management of TOP?
MIFEPRISTONE
24-48 hrs later
MISOPROSTOL (prostaglandin)
192
where should medical TOP be carried out?
- 0-9 weeks: at home (bleeding for 2 weeks)
- 9-24 weeks: in clinic, repeat miso 3-hourly until expulsion
- >22 weeks: use FETICIDE
193
when is surgical TOP better?
is there is more pregnancy tissue
194
what surgical management should be used <14 weeks?
misoprostol to dilate
ERPC (vacuum aspiration)
LA and can go home same day
195
what surgical management is used for >14 weeks?
misoprostol to dilate
then D+C
LA or GA
196
what important thing should you council TOP mums about?
call 24 hour helpline if:
- smelly discharge
- fever
- Symptoms of pregnancy
197
when do you give the whooping cough and influenza vaccines in pregnancy?
27-36 weeks
198
what are the down syndrome antenatal findings?
- Low AFP
- low oestriol
- low PAPP-A
- high b-HCG
- thickened NT
199
what causes an increased AFP antenatally?
- neural tube defects
- abdo wall defects
- multiple pregnancy
200
what causes a decreased AFP antenatally?
- Down's syndrome
- Trisomy 18
- maternal DM
201
what do anomaly scan checks for?
- spina bifida
- diaphragmatic hernia
- major congenital anomalies (e.g. heart defects)
- 1st degree relative with diabetes
202
what is done at the booking visit?
- general infomation: diet, alcohol. folic acid, Vit D, antenatal classes
- BP, urine, check BMI
- booking bloods (FBC, blood group, rhesus status, haemoglobinopathies, Hep B, Syphillis, HIV)
- urine culture
203
when is the early scan to confirm pregnancy and exclude multiple pregnancy?
10-13+6 weeks
204
when is the down syndrome screening, nuchal scan?
11-13+6 weeks
205
what happens on 16 weeks?
info on anomaly and blood results
| routine care = BP + urine + dipstick
206
when is the anomaly scan?
18-20+6 weeks
207
what happens at 28 weeks?
- Routine BP, urine dip, SFH
- second screen for anaemia and atypical red cell alloantibodies
- 1st dose of anti-D
208
what happens at 34 weeks?
- Routine: BP, urine dip, SFH
- 2nd dose of anti-D
- info on labour and birth plan
209
what happens at 36 weeks?
- routine: BP, urine dip, SFH
- check presentation (offer ECV)
- info on breast feeding, Vit K, baby blues
210
what happens at 38 weeks?
routine: BP, urine dip, SFH
211
what happens at 41 weeks?
- routine: BP, urine dup, SFH
| - discuss labour plans and possibility of induction
212
when do G1 mothers have extra visits?
25, 31 and 40 (routine care)
213
what are the components of a partogram?
- maternal HR (every 30 mins)
- contractions (every 30 mins)
- colour of liquor (every 30 mins)
- cervicograph
- cervical dilatation (every 4 hours)
- BP and temp (every 4 hours)
214
what is Neagle's rule?
add 9 months and 7 days
| if cycle >28 days, add number of days above to EDD
215
what are the physiological energy changes of pregnancy?
- increased energy demands (insulin sensitivity decreases)
216
what are the respiratory changes in pregnancy?
inc tidal volume by 30-50%
dec FRC
RR doesn't change
217
what are the cardiac changes in pregnancy?
- inc CO by 50%
- inc SV by 35%
- dec peripheral resistance (due to progesterone)
- inc HR by 15-25%
218
what are the physiological kidney changes in pregnancy?
- more aldosterone = fluid retention
| - GFR increases in 1st trimester
219
what are the physiological hematological changes that occur in pregnancy?
- macrocytosis
- neutrophilia
- thrombocytopaenia
- dilutional anaemia
