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Obstetrics Flashcards

1
Q

3 most common trisomy syndromes

A

T13 Patau
T18 Edwards
T21 Downs

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2
Q

Risk factors for placenta accreta spectrum disorders

A

Repeated C-sections
Repeated Dilatation and Curettage
Multiparity
Placenta Previa
Advanced maternal Age

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3
Q

difference between placenta accreta, increta and percreta

A

Chorionic villi

Accreta: Attach to myometrium
INcreta: INvade into myometrium
PERcreta: PEnetrate through myometrium

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4
Q

What describes the placenta accreta spectrum disorders

A

Morbidly adherent placenta

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5
Q

Cx of placenta accreta

A

1.PPH when manually seperating placenta
2. Abnormal Uterine bleeding(AUB(

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6
Q

Complications of manual separation of placenta

A
  1. Uterine Perforation
  2. Endometritis
  3. PPH

-> Give uterotonics and antibiotics

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7
Q

What is a septic abortion

A

Any abortion complicated by uterine infection such as endometritis

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8
Q

Number of weeks more uterus becomes a pelvic organ after delivery

A

6 weeks

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9
Q

Sizes of uterus relative to GA

A

12 weeks:Palpable suprapubically
20-22 weeks: Umblicus

GA correlates with SFH from umblicus above

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10
Q

Layers that are dissected during a C section

A

(Superficial)
Skin
Subcutaneous fat
Anterior layer of rectus sheath
Rectus abdominis
Parietal peritoneum
Visceral Peritoneum
Uterine serosa and myometrium
(Deep)

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11
Q

11) Most common fetal head position in delivery

A

Left occipital anterior (LOA)

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12
Q

fetal anamoly pathognomic of poorly controlled prexisting DM?

A

Sacral agenesis

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13
Q

Mx for missed or incomplete abortion

A

Medical: PO/PV Misoprostol 600mg
Surgical: Evacuation using vacuum aspiration

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14
Q

Methods of IOL

A

Artificial rupture of membranes (ARM)
-Foley’s catheter
-Amiotomy hook
-laminaria tent
Pharmaco methods: PGE pessaries or IV oxytocin

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15
Q

Cx of Induction of Labour

A

Uterine hyperstimulation syndrome
Fetal distress
Cord prolapse
Failed IOL->CS
Uterine rupture
Amniotic fluid embolism

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16
Q

Mechanisms of Labour

A

Engagement flexion IR extension ER expulsion (just remember ED FIERE)

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17
Q

Most common type of twins

A

dizygotic twins(DCDA)

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18
Q

Most common type of monozygotic twins

A

Monochorionic Diamniotic(MCDA)

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19
Q

What do the trophoblasts and inner cell mass form respectively

A

trophoblasts: Placenta
Inner cell mask: Embryo

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20
Q

Why twin pregnancies are predisposed to GDM

A
  1. Increased amount of placental hormones and placental-mediated insulin resistance
  2. Higher caloric intake leading to excessive gestational weight gain
  3. Twins seen in older mothers who are more likely to have impaired glucose tolerance at baseline
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21
Q

Maternal complications of multiple pregnancies

A
  1. IGDM
  2. Hypertensive disorders(PE, PIH)
  3. Venous thromboembolism
  4. Anemia
  5. Hyperemesis
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22
Q

Fetal complications of twin pregnancies

A
  1. Congenital heart disease
  2. Placenta Previa
  3. IUGR
  4. Pre term birth(quite high chance)
  5. MCDA: Twin-Twin transfusion syndrome(TTS)
  6. MCMA: Cord entanglement
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23
Q

Delivery method for twins

A

Will opt for NVD as long as presentation of leading twin is cephalic and the placenta is NOT previa

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24
Q

3 steps to reduce risk of VTEs

A
  1. Adequate hydration
  2. Adequate mobilisation
  3. TED(Thromboembolism deterrent) Stockings
25
Q

Supplements for mothers(general)

A

Folate from pre conception to 2nd trimester
Multivitamins from 2nd tri onward
Aspirin if indicated from week 12 to 36

26
Q

Legal gestational age limit for abortion

A

24 weeks, but must consider 48hr cool off period

27
Q

Method of medical abortion

A

Mifepristone and misoprostol

28
Q

Surgical methods of abortion

A

Vacuum aspiration(1st trimester)
Dilation and evacuation(2nd tri)

29
Q

6 Booking blood tests

A

FBC +- th a l
GXM
Hep B
HIV
Syphilis(VDRL)
Rubella

30
Q

Components of First Trimester Screening(FTS)

A

Nuchal Translucency
Beta HCG
PAPP-A

31
Q

Groups of causes of Female infertility

A

Tubal Causes
Ovarian causes
Uterine causes
Ovulatory(HPOA)

32
Q

Cx of PPH

A

Death
Shock
Sheehans syndrome: agalactorrhea

33
Q

Common causes of PPH due to DIC

A

Placental abruption
Pre eclampsia/HELLP
Sepsis
Amniotic fluid embolism
Dilutional coagulopathy
Fetal death

Top 3 are most common

34
Q

What is sheehans syndrome

A

Postpartum necrosis of the pituitary gland, often due to PPH

35
Q

Primary vs secondary PPH

A

Primary <24 hrs postpartum
Secondary 24hrs-6weeks postpartum

36
Q

Mx of RPOCs

A

Manual evacuation
Ultrasound guided vacuum aspiration/DnC

37
Q

Mx of uterine arony

A

Fundal/Uterine massage

Uterotonics eg oxytocin,ergometrine,carboprost

38
Q

Last resort treatment for undifferentiated PPH

A

Balloon tamponade eg using sengstaken blakemore tub

Uterine artery ligation
Iliac artery ligation

Hysterectomy as last resort

39
Q

Causes of fetal distress

A

1.Uterine hyperstimulation(Induction or augmentation of labour)
2. Maternal hypotension(esp epidural related)
3. Massive placental abruption
4. Cord prolapse
5. Uterine/scar rupture

40
Q

Components of in utero resuscitation

A
  1. Left lateral position to reduce aortocaval compression by uterus
  2. O2 supplementation
  3. IV fluids fast
41
Q

Intervions for shoulder dystocia

A
  1. Lie bed flat, FABER
  2. Mcroberts Maneuver with suprapubic pressure
  3. Rubin and Woodscrew manuevers
  4. Last resort maneuvers: Symphysiotomy, Cleidotomy, Zavanelli
42
Q

What to check for after shoulder dystocia case

A
  1. PPH due to high risk of uterine atony
  2. Brachial plexus injury to Neonate (Erbs palsy)
43
Q

Risk factors for GDM

A

GDM in previous pregnancy
Previous macrosomic baby
Previous stillbirth
Previous Miscarriages
PCOS
Obesity
GDM or DM in first degree relative

44
Q

Complications of GDM

A

Antenatal
-Miscarriage
-congenital abnormalities eg sacral agenesis
Delivery
-PPROM from polyhydramnios
-Prolonged labor
-PPH
-?
Post Natal
-Future DM or metabolic syndrome
-Neonatal hyoogly, electrolyte abnormalities, hypothermia etc

45
Q

Mx of GDM

A
  1. Reduce simple carbs
  2. Increase complex carbs
  3. Diabetic nurse
  4. Metformin
  5. Insulin
  6. 6 week postnatal OGTT
  7. Early IOL or CS
46
Q

% of GDM mothers who develop DM

47
Q

OGTT values for GDM/DM dx

A

Fasting : >5.1
>10
>8.5

DM same as normal, 7 and 11.1

48
Q

Mx of Placenta Previa

A

-Admit patient until delivery
-pad charting to measure blood loss
-Iron supp , tocolysis, anti-D immunoglobulin, IM dexamethasone
-CS at 37 weeks

49
Q

Invx for placenta previa

A

POCT: CTG
Biochemical: FBC for Hb,DIVX screen, GXM and Rh isoimmunisation
Pelvic US to look for placenta positioning

50
Q

Mx of Menorrhagia

A

Pharm
1. TXA
2. Iron supplementation
3. Contraception(COCP,Depot, IUD) if not planning for pregnancy

Surgical
1. Underlying cause

51
Q

Numbers of weeks that uterus is not palpable after pregnancy

52
Q

Number of weeks Pre eclampsia and GDM should resolve

53
Q

Number of weeks postpartum after which can start normal contraception

54
Q

Number of months post partum before return of menses

A

Lactational amenorrhea, 6 months

55
Q

Antibodies tested for in anti phospholipid syndrome

A

Lupus anticoagulant, anti cardiolipin, anti beta 2 glycoprotein

56
Q

Mx of RPOCs at cervical os

A

Removal with sponge forceps

57
Q

Biochemical findings of PCOS

A

High LH/FSH ratio
Hyperandrogenism
Low progesterone

58
Q

Mx of PCOS

A

Exercise and LOW
OCP
Cyclical progesterone for 3/12
Drosperienone for hirsutism

59
Q

Cutoff to consider postpartum acute retention

M4 Stuff (11 decks)

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