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Medicine Year 5 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

3 most important investigations at the booking visit?

A

Blood pressure, dipstick, BMI

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2
Q

When is the booking visit?

A

8-10w

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3
Q

3 infectious diseases screened at the booking visit

A

Hep B, HIV, Syphilis

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4
Q

When is the dating scane

A

10 - 13+6 weeks

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5
Q

When is the anomaly scan

A

18-20+6w

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6
Q

When are the first and second doses of anti-d given

A

28w and 34w

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7
Q

When does hcg start to be secreted and what is it secreted by

A

day 8 by the syncytiotrophoblast

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8
Q

6 people who need high dose folic acid
what is the dose

A

5mg
previous child with NTD
DM
BMI above 30
Antiepileptic medication
HIV +ve
Sickle cell

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9
Q

Quadruple tests for downs
is PAPPA raised or reduced

A

DOWNS
Reduced AFP
Reduced Oestriol
Increased hcg
Increased inhibin A
Reduced PAPPA

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10
Q

Quadruple test for edwards

A

EDWARDS
Reduced AFO
Reduced Oestriol
Reduced hcg
Stable Inhibin A

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11
Q

First line investigation for gestational diabetes

A

OGGT at 28w

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12
Q

When do you get your first OGGT if you have a pmhx of gestational diabetes

A

soon after booking

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13
Q

Cut of levels for FASTING glucose and 2-HOUR glucose

A

Fasting 5.6
2-Hour 7.8

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14
Q

When would you immediately start insulin

A

If the fasting glucose is above 7

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15
Q

First line investigation if chicken pox exposure in pregnancy

A

Check antibodies

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16
Q

Treatment if negative antibodies and chicken pox exposure

A

1 dose of VZ Ig
Over 20w and present in 48hrs - oral aciclovir

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17
Q

What happens to urea, creatinine and hb in normal pregnancy

A

ALL REDUCED

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18
Q

Increased AFP can indicate what

A

Abdominal wall defects

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19
Q

2 normal changes to urine in pregnancy

A

Increased urinary protein loss and glucose

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20
Q

painless PV bleed at 6-9w

A

threatened miscarriage

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21
Q

light PV bleed and pregnancy sx disappear

A

missed (delayed) miscarriage

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22
Q

heavy bleed and crampy abdominal pain in early pregnancy

A

Incomplete inevitable miscarriage

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23
Q

light bleeding in early pregnancy

A

Complete inevitable miscarriage

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24
Q

shoulder tip pain and cervical excitation

A

Ectopic Pregnancy

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25
Q

Sequale of ectopics

A

Abdo pain then PV bleed

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26
Q

why is T4 raised in a molar pregnancy

A

hCG mimics TSH

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27
Q

constant lower abdo pain with a WOODY abdomen on examination, disproportionate shock and distressed foetal heart rate

A

placental abruption

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28
Q

increasing age, increasing parity, trauma, cocaine and polyhydramnios are all risk factors for what

A

placental abruption

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29
Q

what condition can progress to DIC

A

placental abruption

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30
Q

painless PV bleeding and shock in proportion to blood loss

A

placenta praevia

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31
Q

gold standard investigation for placenta praevia

A

transvaginal ultrasound

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32
Q

when would you refer for lack of foetal movements

A

24w

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33
Q

management of a low lying placenta found on the anomaly scan

A

rescan at 32w

34
Q

Sequale of vasa praevia

A

ROM followed immediately by PV bleeding and foetal bradycardia

35
Q

explain the difference between placenta accreta, increta and percreta

A

Accreta: chorionic villi attach to myometrium
Increta: chorionic villi into the myometrium
Percreta: chorionic villi into perimetrium

36
Q

when can gestational hypertension be diagnosed

A

after 20 weeks

37
Q

management of a lady with bp of 160/110

A

admit regardless of proteinuria

38
Q

Define pre-eclampsia

A

new onset blood pressure above 140/90 AND proteinuria OR organ dysfunction

39
Q

age above 40, renal disease, multiples, BMI above 40 and HTN increase the risk of what

A

pre eclampsia

40
Q

management of women with SLE/antiphospholipid

A

75mg aspirin daily to prevent pre-eclampsia

41
Q

management of eclampsia

A

MAGNESIUM SULPHAE until 24 hours post delivery/last seizure

42
Q

increased liver and enzymes and jaundice

A

acute fatty liver

43
Q

uterine tenderness and foul smelling discharge

A

choramnionitis

44
Q

intense pruitis with RUQ pain, jaundice, steatorrhoea and increased bile acids

A

Intrahepatic cholestasis of pregnancy

45
Q

Management of intrahepatic cholestasis of pregnancy

A

URSODEOXYCHOLIC ACID
induction at 37-28w as increased stillbirth risk

46
Q

what is the main complication of induction

A

uterine hyperstimulation

47
Q

sudden collapse after artificial rupture of membranes

A

amniotic fluid embolism

48
Q

sudden collapse after artificial rupture of membranes

A

amniotic fluid embolism

49
Q

main cause of cord prolapse

A

artificial rupture of membranes

50
Q

management of cord prolapse

A

retrofill bladder with saline
minimal handling
keep cord warm and moist to reduce vasospasm

51
Q

first line investigation for pprom

A

speculum exam for pooling of amniotic fluid in posterior vaginal vault

52
Q

abx after pprom

A

10 day erythromycin

53
Q

pyrexia above 38 during labour

A

risk of GBS
benzylpenicillin

54
Q

observation of baby if +ve GBS?

A

24 hours

55
Q

Explain the 4 categories of c-sections

A

1: Immediate threat to life, deliver in 30 min
2: Compromise, deliver in 75 min
3: Delivery needed but mum and baby stable
4: Elective

56
Q

Contraindication to VBAC

A

classical s-section scar

57
Q

define pph

A

blood loss of over 500ml

58
Q

most common cause of pph

A

uterine atony

59
Q

management of shoulder dystocia (5 steps)

A
  1. mcroberts: hyperflex legs on abdo & suprapubic pressure
    2: woods screw: hand in vagina and turn
    3: rubin: press on posterior shoulder
    4: try on all 4’s
    5: push head in and c-section
60
Q

4 classifications of perineal tears

A

1st degree: tear in vaginal mucosa (no repair)
2nd degree: tear into perineal muscle (midwife suture on ward)
3rd degree: a. 50% external sphincter b. 100% external sphincter c. internal sphincter (dr repair in theatre)
4th degree: through sphincter to rectal mucosa (dr repair in theatre)

61
Q

can you have a vaginal delivery if you have HIV

A

Yes - if the viral load is less than 50 copies/ml at 36w

62
Q

can you breastfeed with HIV

A

NO

63
Q

How much weight does a baby have to lose for referral to the midwife led breast feeding clinic

A

10% in first week

64
Q

can you breastfeed with Hep B

A

YES

65
Q

how would ROP present

A

absent red reflex

66
Q

management of baby when mum is hep b positive

A

Ig within 12 hours
Vaccine after birth, 1m and 6m

67
Q

investigation for lochia beyong 6w

A

Ultrasound

68
Q

management of magnesium sulphate induced respiratory depression

A

calcium gluconate

69
Q

DOAC in pregnancy?

A

Contraindicated - switch to LMWH

70
Q

epidemiology of baby blues, postnatal depression and puerperal psychosis

A

baby blues 60-70%
postnatal depression 10%
puerperal psychosis 0.2%

71
Q

women presents 3-7 days pp and is anxious, tearful and irritable

A

baby blues - reassure

72
Q

women presents 1-3m pp with depressive sx

A

postnatal depression

73
Q

management of postnatal depression

A

CBT
Sertraline or Paroxetine (safe in breastfeeding)

74
Q

women presents 2-3w pp with severe mood swings and disordered perception

A

puerperal psychosis

75
Q

management of postpartum thyrotoxicosis

A

propanolol

76
Q

medication to supress lactation

A

carbegoline

77
Q

medication that causes folic acid deficiency

A

phenytoin

78
Q

define station

A

head in relation to the ischial spine
0 is directly on it
-2 2cm above and +2 is 2cm below

79
Q

what do you monitor in DVT

A

factor xa

80
Q

Indications for continuous CTG monitoring

A

-

81
Q

Drugs that are safe and unsafe in breastfeeding

A

Medicine Year 5 (27 decks)

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