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FLASH FINALS > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Pain during pregnancy in epigastric/RUQ region w/ deranged LFTs

A

HELLP syndrome

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2
Q

Causes of increased AFP:

A

NTDs (anencephaly, meningocele)
Abdominal wall defects (omphalocele etc.)
Multiple pregnancy

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3
Q

Decreased AFP:

A

Down’s syndrome
Trisomy 18 (Edward’s)
Maternal diabetes mellitus

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4
Q

First-line tx. for nausea and vomiting in pregnancy

A

Ginger and wrist acupuncture may be effective

Antihistamines first line medical - PROMETHAZINE

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5
Q

Rupture of membranes followed by immediate vaginal bleeding -> foetal bradycardia classically seen ->

A

Vasa Praevia

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6
Q

Drug to be avoided in breast feeding:

Antibiotics:

A

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

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7
Q

Drug to be avoided in breast feeding:

Psych drugs:

A

Lithium and Benzodiazepines

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8
Q

Drug to be avoided in breast feeding:

Others:

A 
Aspirin
Carbimazole
Methotrexate
Sulfonylureas
Cytotoxics
Amiodarone
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9
Q

Cord prolapse is more common in which foetal-lie presentation:

A

Breech

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10
Q

Foetal varicella syndrome: features:

A 
Skin scarring
Eye defects (microphthalmia)
Limb hypoplasia
Microcephaly
Learning disabilities
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11
Q

if < 20 weeks pregnant and is NOT immune to varicella:

A

VZIg given

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12
Q

How many days after exposure is VZIg effective for?

A

up to 10 days

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13
Q

if > 20 weeks pregnant and is NOT immune to varicella:

A

VZIG OR oral ACICLOVIR

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14
Q

if < 20 weeks pregnant and is NOT immune to varicella - when should tx. be given

A

7-14 days after exposure

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15
Q

Down’s syndrome triple test:

A

AFP
Unconjugated oestriol
HcG

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16
Q

Down’s quadruple test:

A

AFP, unconjugated oestriol, HCG, INHIBIN A

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17
Q

Combined test: down’s

A

Increased HCG,
Increased Nuchal thickness
Decreased PAPP-A

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18
Q

When in pregnancy will triple/quadruple test be offered:

A

15-20 weeks

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19
Q

Tx. for magnesium sulphate induced respiratory depression:

A

Calcium gluconate

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20
Q

How long should magnesium sulphate treatment continue for after last seizure/delivery

A

24 hours

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21
Q

Causes of folate acid deficiency (4)

A

Phenytoin
Methotrexate
Pregnancy
Alcohol excess

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22
Q

Indications for forceps delivery:

A

Fetal distress in second stage of labour
maternal distress in second stage of labour
failure to progress in second stage of labour
Control of head in breech delivery

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23
Q

Which substance release in pregnancy may mimic TSH and cause hypertension and hyperthyroidism

A

HCG

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24
Q

When should swabs for GBS be taken if they are to be taken:

A

35-37 weeks or 3-5 weeks prior to anticipated delivery date

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25
Q

GBS prophylaxis:

A

IAP - benzylpenicillin

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26
Q

Mx. for HELLP syndrome

A

Delivery

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27
Q

Babies born to mothers w/ hepatitis B should receive:

A

Complete course of vaccination AND Hep B immunoglobulin

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28
Q

Mode of delivery in HIV +ve mothers:

What should be started during delivery:

A

Vaginal delivery recommended if viral load is less than 50 at 36 weeks.
otherwise C-section is recommended

ZIDOVUDINE infusion

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29
Q

Can you breastfeed w/ HIV

A

Not recommended

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30
Q

Uterine hyperstimulation is the main complication from which act:

A

Artificial Induction of labour

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31
Q

Uterine hyperstimulation tx:

A

Remove vaginal prostaglandins
Stop oxytocin infusion if started
Tocolysis w/ terbutaline

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32
Q

Signs of labour:

A

Regular and painful uterine contractions
A show - shedding of mucous plug
Rupture of membranes
Shortening and dilation of the cervix

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33
Q

How often should foetal heart beat be monitored

A

every 15 minutes

or continuous w/ CTG

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34
Q

How often are contractions checked:

A

every 30 minutes

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35
Q

Labour STAGE 1
define latent phase:
How long does it take?

A

0-3 cm dilation normally takes 6 hours

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36
Q

Labour STAGE 1

define active phase:

A

3-10 cm dilation, normally 1 cm/hour

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37
Q

Labour stage 2 - typical length:

A

1 hour

38
Q

if stage 2 longer than an hour consider:

A

Venthouse or forceps

C-section

39
Q

Causes of oligohydramnios:

A 
Premature rupture of membranes 
Post-term gestation
Pre-eclampsia
Foetal renal problems 
Intrauterine growth restriction
40
Q

Second degree perineal tear:

Where/who repairs

A

Injury to perineal muscle, NOT INVOLVING THE ANAL SPHINCTER

Can be sutured on ward by mid-wife

41
Q

Fourth degree tears extend into:

A

RECTAL MUCOSA

42
Q

Placenta praevia classes:

A

I - placenta reaches lower segment but not os
II - placenta reaches internal os but doesn’t cover it
III - placenta covers os BEFORE dilation but not after
IV - placenta completely covering os

43
Q

When would placenta praevia be picked up?

A

18-20+6 week scan

44
Q

Placenta praevia Mx.

A

if still present at 34 weeks: scan every 2 weeks

45
Q

If scan shows placenta praevia class III/IV between 37-38 weeks:

A

ELECTIVE C-section

46
Q

If scan shows placenta praevia class I:

A

Vaginal delivery may be offered

47
Q

Placental abruption mx.

A

Foetus alive and < 36 weeks and not distressed: OBSERVE, STEROIDS, no tocolysis
threshold to deliver depends on gestation

Foetus > 36 weeks - no distress: deliver vaginally
distress = c-section

If dead -> deliver vaginally

48
Q

Post natal depression tx.

A

CBT
if SSRI required, offer SERTRALINE OR PAROXETINE
(Sad Post-pregnancy)

49
Q

Tx. post-partum thyroiditis:

A

Propranolol = symptomatic mx.

50
Q

PPH initial mx.

A

Uterine massage

IV syntocinon - 10 units or IV ergometrine
IM carboprost

51
Q

PPH if initial mx. doesn’t work:

A

Intrauterine baloon tamponade

B-lynch suture, ligation of uterine arteries, internal iliac arteries.

52
Q

Secondary PPH
When does it present:
Causes:

A

24 hours - 12 weeks

Retained placenta
Endometritis

53
Q

Women w/ BP > __ should be admitted and observed

A

> 160/110 mmHg

54
Q

What should be offered for anaemia in pregnancy:

A

ORAL ferrous sulfate or fumerate

55
Q

When is anaemia screened for:

A

Booking

28 weeks

56
Q

Women w/ suspected DVT in pregnancy Ix.

A

Compression DUPLEX US

57
Q

Women w/ suspected PE in pregnancy Ix.

A

ECG CXR for all pts.

58
Q

If symptoms and signs of DVT plus positive US findings, is there need for further investigation:

A

NO

59
Q

CTPA increases chance of

A

Maternal breast cancer

60
Q

V/Q scanning increases chance of

A

Childhood cancer

61
Q

Acute fatty liver of pregnancy - occurs when?

A

3rd TM

62
Q

Acute fatty liver Ix. LFT:

A

Increased ALT (500u/l)

63
Q

Obese women should have OGTT at which gestation:

A

24-28 weeks gestation

64
Q

What may cause ankle swelling, varicose veins and supine hypotension in pregnant women?

A

Enlarged uterus interfering w/ venous return

65
Q

CO2 increased or decreased in pregnancy?

A

Decreased - due to slightly increased oxygen requirements -> may feel dyspnoeic

66
Q

Hb in pregnancy:

A

Falls due to increase in plasma of 50%

-> DILUTION

67
Q

GFR in pregnancy:

A

Increases

68
Q

Visual impairment in premature babies:

A

retinopathy of prematurity - neovascularisation from over-oxygenation

69
Q

Complications of prematurity:

A 
RDS
Interventricular haemorrhage 
Necrotizing enterocolitis
Chronic lung disease 
Jaundice
70
Q

Premature prelabour rupture of membranes mx.:

A

Sterile speculum exam (pooling of fluid in post. vaginal vault)
US may show oligohydramnios
Admission
Erythromycin (10 days)
Antenatal corticosteroids should be administered to reduce risk of RDS
Delivery considered at 34 weeks gestation.

71
Q

Most common cause of puerperal pyrexia:

A

Endometritis

72
Q

Endometritis mx.

A

Admit for IV antibiotics

Clindamycin and gentamicin till afebrile

73
Q

Reduced foetal heart beat steps:

A

Handheld doppler ->
Ultrasound ->
CTG for at least 20 minutes

74
Q

Rhesus baby px.:

tx.

A

Oedematous
Jaundice
Heart failure
Kernicterus

Transfusions, UV phototherapy

75
Q

Methotrexate in pregnancy:

A

Contraindicated and should be stopped at least 6 months before conception

76
Q

DMARDs safe in pregnancy

A

Sulfasalazine and hydroxychloroquine

77
Q

When should NSAIDs be stopped in pregnancy and why?

A

32 weeks

Risks premature closure of ductus arteriosus

78
Q

If rubella suspected in pregnancy

A

Discuss immediately w/ local health protection unit

79
Q

Can you give MMR in pregnancy

A

NO but non-immune mothers should be given in in the post-natal period

80
Q

Shoulder dystocia tx w/

A

McRobert’s manouevre

81
Q

Can ECV be performed in labour:

A

Yes as long as the membranes have not ruptured

82
Q

Monoamniotic monozygotic twins are associated w/:

A

Increased spontaneous miscarriage
Increased malformations: IUGR, prematurity
Twin to twin tranfusion syndrome - recipient is larger w/ polyhydramnios

83
Q

Management of twin pregnancy:

A

US for diagnosis + monthly checks
Weekly checks from > 30 weeks
precautions at labour - 2 obstetricians present
Most are induced by 38-40 weeks

84
Q

Causes of increased nuchal translucency:

A

Down’s syndrome
Congenital heart defects
Abdominal wall defects

85
Q

Causes of hyperechogenic bowel:

A

CF
Down’s syndrome
CMV

86
Q

Risk factors for cord prolapse:

A 
Prematurity 
Multi-parity 
Polyhydramnios
Twin pregnancy 
Abnormal presentations
87
Q

Mx. Cord prolapse:

A

Foetus pushed BACK into uterus
Pt. to go on all fours untill c-section can be performed
TOCOLYTICS to reduce contractions

Retrofilling bladder may help as it gently elevates the presenting part.

88
Q

Four or more risk factors for VTE in pregnancy, women are tx. w/

A

LMWH

89
Q

When should LMWH be initiated if indicated:

When is it continued till:

A

From 28 weeks

Six weeks post-partum

90
Q

Are DOACs and warfarin allowed in pregnancy:

A

NO

FLASH FINALS (34 decks)

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