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Obstetrics Flashcards

1
Q

What is gestational diabetes?

A

Any degree of glucose intolerance with onset or first recognition during pregnancy.

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2
Q

Name 5 risk factors for GD.

A

BMI > 30
Asian ethnicity
Previous GD
1st degree relative with diabetes
PCOS
Previous macrosomic baby

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3
Q

What investigation is used for gestational diabetes?

A

Oral glucose tolerance test

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4
Q

When do you test for GD in the pregnancy?

A

Between 24 and 28 weeks of pregnancy

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5
Q

If you had diabetes in a previous pregnancy, when should you be tested for GD in your next?

A

At the booking appointment

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6
Q

What is the first line treatment for GD in pregnancy?

A

Metformin

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7
Q

What is the second line treatment for GD?

A

Glibenclamide

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8
Q

What is the treatment for GD if not controlled with metformin and glibenclamide?

A

Insulin basal bolus routine

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9
Q

What are the foetal complications associated with GD?

A

Macrosomia
Shoulder dystocia
Still birth at term
Hyperinsulinemia

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10
Q

What causes macrosomia in GD?

A

Glucose is able to pass across the placenta but insulin cannot.
Therefore the baby gets too much glucose leading to macrosomia

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11
Q

Name 4 maternal complications of GD.

A

Miscarriage
DKA
Hypoglycaemia
Progression of retinopathy
Premature labour
Pre-eclampsia

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12
Q

What is the pathophysiology of pre-eclampsia?

A

Abnormal invasion of the trophoblast into maternal spiral arterioles. Causing high vascular resistance and poor perfusion of the placenta.

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13
Q

Name the 5 key symptoms of pre eclampsia.

A

Headache
Visual disturbance
Nausea and vomiting
Upper abdo pain
Oedema

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14
Q

What are the signs of pre-eclampsia?

A

Brisk reflexes
Reduced urine output

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15
Q

Name 3 risk factors for pre-eclampsia.

A

Family history of pre-eclampsia
Pre-existing hypertension
Diabetes
First pregnancy
Obesity

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16
Q

Name 3 maternal complications of pre-eclampsia.

A

Pulmonary oedema
Renal failure
Stroke
Eclampsia
HELLP syndrome

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17
Q

What does HELLP stand for?

A

Haemolysis, Elevated liver enzymes, low platelets.

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18
Q

Foetal complications of pre-eclampsia?

A

Intrauterine growth restriction
Placental abruption
Still birth

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19
Q

What is the medical management of pre-eclampsia?

A

Aspirin from 12 weeks in high risk patients
Labetalol
Nifedipine
Methyldopa

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20
Q

Symptoms of HELLP syndrome?

A

Bleeding
Fatigue
Malaise
RUQ pain (liver going wrong)
N&V
Swelling
Blurred vision

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21
Q

How does a concealed abruption present?

A

Woody uterus

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22
Q

What is placenta praevia?

A

A low lying placenta close to or lying over the internal OS.

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23
Q

Name 5 risk factors for placenta praevia.

A

Previous C-section
High parity
Over 40
Multiple pregnancies
Previous placenta praevia

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24
Q

What is placenta accreta?

A

The placenta attaches beyond the endometrium of the uterus and into the myometrium.

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25
Name 2 causes of placenta accreta.
Previous c-section Curettage procedure
26
What is the management of placenta accreta?
C-section with hysterectomy Uterus preserving surgery Expectant management, letting the placenta be absorbed over time
27
What is placental abruption?
When all or part of the placenta is separated from the wall of the uterus leading to bleeding.
28
What are the 2 types of placental abruption?
Revealed where there is bleeding through the cervix. Concealed where the bleeding remains within the uterus
29
Name 3 risk factors for placental abruption.
Pre-eclampsia Polyhydramnios Abdo trauma Transverse lie Smoking or drug use Previous abruption
30
What is obstetric cholestasis?
Reduced outflow of bile acids from the liver.
31
When in pregnancy does obstetric cholestasis typically present?
After 28weeks
32
What are the key symptoms of obstetric cholestasis?
Itching Fatigue Dark urine Pale greasy stool Jaundice
33
Which medication can be given in secondary care for obstetric cholestasis?
Ursodeoxycholic acid
34
What does cervical effacement mean?
Thinning of the cervix
35
What is the definition of stage 1 of labour?
From the onset of labour until the cervix is 10cm dilated
36
What is stage 2 of labour?
From 10cm dilated unto the delivery of the baby
37
What is stage 3 of labour?
From the delivery of the baby until the delivery of the placenta
38
Which position should the baby be in for delivery?
Longitudinal cephalic
39
What is involved in the active management of stage 3 of labour?
IM oxytocin Careful traction applied to umbilical cord to guide it out of the uterus and vagina
40
What is the name of the ideal shape of a mothers pelvis?
Gynaecoid
41
What are 2 signs of shoulder dystocia?
Difficulty delivering the head Turtle neck sign Failure of restitution
42
How should the babies shoulders be delivered?
Head is delivered Foetus restitutes, external rotation Slight downwards traction on the anterior shoulder Then upwards traction on the posterior shoulder Shoulders are delivered
43
What is the mneumonic for the management of shoulder dystocia?
HELPERR
44
What does the mneumonic HELPERR stand for?
H - Call for help E - Evaluate for episiotomy L - Lift legs (McRoberts manoeuvre) P - Suprapubic pressure E - Enter rotational manoeuvres R - Remove posterior arm R - Roll the patient onto hands and knees then try again
45
Name 3 risk factors for umbilical cord prolapse.
Breech position Abnormal fetal lie Artificial rupture of membranes Polyhydramnious Prematurity
46
What happens in umbilical cord prolapse?
Umbilical cord descends below the presenting part of the foetus, through the cervix and into the vagina.
47
What is an occult cord prolapse?
Incomplete, descends alongside the presenting part but not beyond
48
What is an overt cord prolapse?
A complete cord prolapse, where the umbilical cord descends past the presenting part
49
What fetal signs show on CTG in cord prolapse?
Decelerations and bradycardia
50
What are the 2 main reasons why fetal hypoxia occurs in cord prolapse?
Occlusion of blood flow to the foetus Arterial vasospasm due tp cord being compressed
51
How do you manage a cord prolapse in the community?
Do not handle the cord to avoid vasospasm Manually elevate the presenting part to reduce compression on the cord Knee to chest position to relieve pressure off the presenting part
52
What is the definition of a primary PPH?
Greater than 500ml of blood lost PV within 24 hours of delivery
53
What is a major PPH?
Greater than 1L blood loss
54
What is a minor PPH?
Between 500-1000ml of blood lost
55
What are the 4 categories of type of PPH?
4T's Tissue, Tone, Thrombin, Trauma
56
What are the reasons for tone causing a PPH?
Uterus fails to contract adequately following delivery.
57
What are the risk factors for tone causing PPH problems?
Over 40, BMI >35, Asian ethnicity, Multiple pregnancies, Placental abnormalities
58
How do you manage PPH if the issue is tone?
Bimanual compression to stimulate uterine contractions Intrauterine balloon tamponade
59
What percentage of people are affected by perinatal depression?
12%
60
What score is used to assess post natal depression?
Edinburgh post natal depression score
61
What are the risks of taking SSRI's in pregnancy?
Slight risk of fetal heart defects
62
Which is the preferred SSRI when breast feeding?
Sertraline
63
What is the difference between baby blues and post partum depression?
Baby blues occur around 3-5 days after giving birth due to a drop in hormone levels and tend to last 2 weeks. Post partum depression lasts much longer
64
What symptoms might you experience that are different to depression in PPD?
Difficulty bonding with your baby
65
How frequently does puerperal psychosis occur?
1 in 1000 after childbirth
66
What is the onset of post partum psychosis like?
Very sudden, patients tend to deteriorate within a few days
67
What is the strongest risk factor for developing post partum psychosis?
Previous post partum psychosis
68
What is polyhydramnios in pregnancy?
Too much amniotic fluid around the baby
69
What does monozygotic mean?
Identical twins from a single zygote
70
What does diamniotic mean?
2 separate amniotic sacs
71
What does monochorionic mean?
They share a single placenta
72
What is twin to twin transfusion syndrome?
Where twins share a placenta and one gets more blood flow than the other leading to a discrepancy in size
73
What is the monitoring schedule for monochorionic twins?
2 weekly scans from 16 weeks
74
What is the monitoring schedule for dichorionic twins?
4 weekly scans from 20 weeks
75
When should monoamniotic twins be delivered?
Elective c-section between 32 and 33+6 weeks
76
What is an amniotic fluid embolisim?
Where amniotic fluid enters the blood stream of the mother
77
How long after delivery does an amniotic fluid embolism occur?
Within 30 mins
78
What are the signs and symptoms of an amniotic fluid embolism?
Hypoxia, hypotension, cyanosis, tachycardia
79
What is the APGAR score?
Assess how well the baby has tolerated the birthing process and how wll they are doing outside the mothers womb
80
At what times should the APGAR score be assessed?
1 and 5mins after birth
81
What does APGAR stand for?
Appearance Pulse Grimace Activity (muscle tone) Respiratory effort
82
Name 4 causes of oligohydramnios.
Remember, amniotic fluid is made of fetal urine, so therefore: Foetal renal problems such as renal agenesis PROM Intrauterine growth restriction Post term gestation Pre-eclampsia
83
What is a Kleihauer test?
A test used to measure the amount of fetal haemoglobin in the mothers circulation and therefore how much Anti D is needed
84
When is a Kleinhauer test needed in mothers?
Required after any sensitising event after 20 weeks gestation
85
When is a Kleinhauer test needed in mothers?
Required after any sensitising event after 20 weeks gestation
86
When do patients typically present with an ectopic pregnancy?
Between 6-8 weeks
87
What are the signs and symptoms of an ectopic?
Shoulder tip pain Cervical excitation Abdo pain Bleeding
88
Name 4 risk factors for ectopics.
Damage to tubes (PID) Previous ectopic Endometriosis IUCD POP IVF
89
How do you diagnose PROM?
History plus sterile speculum showing fluid in the posterior vaginal vault USS showing oligohydramnios if no signs on speculum
90
Which is the most common congenital cardiac abnormality in diabetic mothers?
Transposition of the great arteries
91
What is the management of a cord prolapse?
Presenting part of fetus can be pushed back in to avoid compression Do not touch the cord Patient go on all fours Tocolytics to reduce uterine contractions C-section usually best method of delivery

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