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Phase 3A content > Obstetrics > Flashcards

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
Q

Name 2 causes of placenta accreta.

A

Previous c-section
Curettage procedure

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26
Q

What is the management of placenta accreta?

A

C-section with hysterectomy
Uterus preserving surgery
Expectant management, letting the placenta be absorbed over time

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27
Q

What is placental abruption?

A

When all or part of the placenta is separated from the wall of the uterus leading to bleeding.

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28
Q

What are the 2 types of placental abruption?

A

Revealed where there is bleeding through the cervix.
Concealed where the bleeding remains within the uterus

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29
Q

Name 3 risk factors for placental abruption.

A

Pre-eclampsia
Polyhydramnios
Abdo trauma
Transverse lie
Smoking or drug use
Previous abruption

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30
Q

What is obstetric cholestasis?

A

Reduced outflow of bile acids from the liver.

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31
Q

When in pregnancy does obstetric cholestasis typically present?

A

After 28weeks

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32
Q

What are the key symptoms of obstetric cholestasis?

A

Itching
Fatigue
Dark urine
Pale greasy stool
Jaundice

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33
Q

Which medication can be given in secondary care for obstetric cholestasis?

A

Ursodeoxycholic acid

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34
Q

What does cervical effacement mean?

A

Thinning of the cervix

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35
Q

What is the definition of stage 1 of labour?

A

From the onset of labour until the cervix is 10cm dilated

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36
Q

What is stage 2 of labour?

A

From 10cm dilated unto the delivery of the baby

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37
Q

What is stage 3 of labour?

A

From the delivery of the baby until the delivery of the placenta

38
Q

Which position should the baby be in for delivery?

A

Longitudinal cephalic

39
Q

What is involved in the active management of stage 3 of labour?

A

IM oxytocin
Careful traction applied to umbilical cord to guide it out of the uterus and vagina

40
Q

What is the name of the ideal shape of a mothers pelvis?

A

Gynaecoid

41
Q

What are 2 signs of shoulder dystocia?

A

Difficulty delivering the head
Turtle neck sign
Failure of restitution

42
Q

How should the babies shoulders be delivered?

A

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
Q

What is the mneumonic for the management of shoulder dystocia?

A

HELPERR

44
Q

What does the mneumonic HELPERR stand for?

A

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
Q

Name 3 risk factors for umbilical cord prolapse.

A

Breech position
Abnormal fetal lie
Artificial rupture of membranes
Polyhydramnious
Prematurity

46
Q

What happens in umbilical cord prolapse?

A

Umbilical cord descends below the presenting part of the foetus, through the cervix and into the vagina.

47
Q

What is an occult cord prolapse?

A

Incomplete, descends alongside the presenting part but not beyond

48
Q

What is an overt cord prolapse?

A

A complete cord prolapse, where the umbilical cord descends past the presenting part

49
Q

What fetal signs show on CTG in cord prolapse?

A

Decelerations and bradycardia

50
Q

What are the 2 main reasons why fetal hypoxia occurs in cord prolapse?

A

Occlusion of blood flow to the foetus
Arterial vasospasm due tp cord being compressed

51
Q

How do you manage a cord prolapse in the community?

A

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
Q

What is the definition of a primary PPH?

A

Greater than 500ml of blood lost PV within 24 hours of delivery

53
Q

What is a major PPH?

A

Greater than 1L blood loss

54
Q

What is a minor PPH?

A

Between 500-1000ml of blood lost

55
Q

What are the 4 categories of type of PPH?

A

4T’s
Tissue, Tone, Thrombin, Trauma

56
Q

What are the reasons for tone causing a PPH?

A

Uterus fails to contract adequately following delivery.

57
Q

What are the risk factors for tone causing PPH problems?

A

Over 40, BMI >35, Asian ethnicity, Multiple pregnancies, Placental abnormalities

58
Q

How do you manage PPH if the issue is tone?

A

Bimanual compression to stimulate uterine contractions
Intrauterine balloon tamponade

59
Q

What percentage of people are affected by perinatal depression?

A

12%

60
Q

What score is used to assess post natal depression?

A

Edinburgh post natal depression score

61
Q

What are the risks of taking SSRI’s in pregnancy?

A

Slight risk of fetal heart defects

62
Q

Which is the preferred SSRI when breast feeding?

A

Sertraline

63
Q

What is the difference between baby blues and post partum depression?

A

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
Q

What symptoms might you experience that are different to depression in PPD?

A

Difficulty bonding with your baby

65
Q

How frequently does puerperal psychosis occur?

A

1 in 1000 after childbirth

66
Q

What is the onset of post partum psychosis like?

A

Very sudden, patients tend to deteriorate within a few days

67
Q

What is the strongest risk factor for developing post partum psychosis?

A

Previous post partum psychosis

68
Q

What is polyhydramnios in pregnancy?

A

Too much amniotic fluid around the baby

69
Q

What does monozygotic mean?

A

Identical twins from a single zygote

70
Q

What does diamniotic mean?

A

2 separate amniotic sacs

71
Q

What does monochorionic mean?

A

They share a single placenta

72
Q

What is twin to twin transfusion syndrome?

A

Where twins share a placenta and one gets more blood flow than the other leading to a discrepancy in size

73
Q

What is the monitoring schedule for monochorionic twins?

A

2 weekly scans from 16 weeks

74
Q

What is the monitoring schedule for dichorionic twins?

A

4 weekly scans from 20 weeks

75
Q

When should monoamniotic twins be delivered?

A

Elective c-section between 32 and 33+6 weeks

76
Q

What is an amniotic fluid embolisim?

A

Where amniotic fluid enters the blood stream of the mother

77
Q

How long after delivery does an amniotic fluid embolism occur?

A

Within 30 mins

78
Q

What are the signs and symptoms of an amniotic fluid embolism?

A

Hypoxia, hypotension, cyanosis, tachycardia

79
Q

What is the APGAR score?

A

Assess how well the baby has tolerated the birthing process and how wll they are doing outside the mothers womb

80
Q

At what times should the APGAR score be assessed?

A

1 and 5mins after birth

81
Q

What does APGAR stand for?

A

Appearance
Pulse
Grimace
Activity (muscle tone)
Respiratory effort

82
Q

Name 4 causes of oligohydramnios.

A

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
Q

What is a Kleihauer test?

A

A test used to measure the amount of fetal haemoglobin in the mothers circulation and therefore how much Anti D is needed

84
Q

When is a Kleinhauer test needed in mothers?

A

Required after any sensitising event after 20 weeks gestation

85
Q

When is a Kleinhauer test needed in mothers?

A

Required after any sensitising event after 20 weeks gestation

86
Q

When do patients typically present with an ectopic pregnancy?

A

Between 6-8 weeks

87
Q

What are the signs and symptoms of an ectopic?

A

Shoulder tip pain
Cervical excitation
Abdo pain
Bleeding

88
Q

Name 4 risk factors for ectopics.

A

Damage to tubes (PID)
Previous ectopic
Endometriosis
IUCD
POP
IVF

89
Q

How do you diagnose PROM?

A

History plus sterile speculum showing fluid in the posterior vaginal vault
USS showing oligohydramnios if no signs on speculum

90
Q

Which is the most common congenital cardiac abnormality in diabetic mothers?

A

Transposition of the great arteries

91
Q

What is the management of a cord prolapse?

A

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

Phase 3A content (15 decks)

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