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Med School Finals > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Gravidity vs parity?

A

G = number of pregnancies
P = number of births after 24+0 weeks

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2
Q

Trimesters of pregnancy?

A

First trimester = weeks 0-13
Second trimester = weeks 14-26
Third trimester = weeks 27-40

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3
Q

Types of foetal lie?

A

Longitudinal (~99.7%)
Transverse
Oblique

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4
Q

Management of transverse lie or Breech presentation?

A

< 36 weeks = advise should self-resolve
> 36 weeks = external cephalic version (ECV) or elective C-section

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5
Q

Causes of antenatal haemorrhage?

A

Placenta praevia
Placental abruption
Vasa praevia
Miscarriage
Ectopic pregnancy
Molar pregnancy

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6
Q

Placenta praevia vs placenta accreta?

A

Praevia = low-lying placenta
Accreta = placenta attached to myometrium

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7
Q

Features, investigation and management of placenta praevia?

A

Painless vaginal bleeding
Non-tender uterus
Foetal trace normal
Investigation = usually identified at anomaly scan, TVUS
Management = elective or emergency C-section (acute bleed)

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8
Q

When should women with a low-lying placenta be re-scanned?

A

32 weeks

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9
Q

Features and management of vasa praevia?

A

Painless vaginal bleeding
Rupture of membranes
Non-tender uterus
Foetal bradycardia or death
Management = emergency C-section

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10
Q

Features and management of placental abruption?

A

Painful vaginal bleeding
Tender, tense uterus
Foetal distress
PMH trauma or injury
Management = emergency C-section (foetal distress), observe or induced vaginal birth (no foetal distress)

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11
Q

Features, investigation and management of an ectopic pregnancy?

A

Painful vaginal bleeding
Recent amenorrhoea
Dizziness, syncope, shock
Investigation = TVUS
Management = expectant management (< 35mm, asymptomatic) or methotrexate (< 35mm, symptomatic), salpingectomy/salpingotomy (> 35mm, foetal heartbeat, bHCG > 5000)

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12
Q

Features, investigation and management of a molar pregnancy?

A

Painless vaginal bleeding
Large and bulky uterus
Abnormally high hCG
Hyperemesis gravidarum
Investigation = TVUS (“snowstorm sign”)
Management = suction or surgical curettage

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13
Q

Types of miscarriage and features?

A

Threatened = painless bleeding, os closed
Delayed = painless bleeding, dead foetus in sac, os closed
Inevitable = painful and heavy bleeding, os open
Incomplete = remnants left behind, os open

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14
Q

Management of miscarriage?

A

1st line = wait 7-14 days
2nd line = vaginal misoprostol
3rd line = vacuum aspiration or surgical management

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15
Q

Maximum gestation eligible for TOP?

A

24 weeks

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16
Q

Medical vs surgical management of TOP?

A

Medical = mifepristone (anti-progestogen) + misoprostol (prostaglandin) 48 hours later
Surgical = vacuum evacuation or D&E

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17
Q

Gestation of booking visit, early scan, Down’s screening, anomaly scan, anti-D injections for Rh -ve women?

A

Booking = 8-12 weeks
Early scan and Down’s screening = 10-13+6 weeks
Anomaly = 18-20+6 weeks
Anti-D = 28 weeks (first dose), 34 weeks (second dose)

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18
Q

Diseases screened for at the booking appointment?

A

HIV
Syphillis
Hepatitis B

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19
Q

Monozygotic vs dizygotic twins?

A

Monozygotic (“identical”) = one fertilised ova split into two
Dizygotic (“non-identical”) = two separate ova fertilised at same time

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20
Q

Lifestyle guidance for pregnancy?

A
  • Folic acid from before conception to 12 weeks
  • Aspirin from 12 weeks if at risk of pre-eclampsia
  • Vitamin D during pregnancy and breastfeeding
  • Low vitamin A intake e.g. liver
  • Should not drink or smoke
  • Avoid air travel after 37 weeks (singleton) or after 32 weeks (multiple)
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21
Q

NICE criteria for requiring iron supplementation in pregnancy?

A

First trimester = < 110g/L
Second and third trimester = < 105g/L
Postpartum = < 100g/L

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22
Q

Measuring the SFH?

A
  • From pubic bone to fundus
  • After 20 weeks should be within 2cm of gestational age e.g. 24 weeks = 22-26cm
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23
Q

Down’s syndrome screening investigations and features?

A

All 3 of:
→ nuchal translucency measurement
→ serum bHCG
→ pregnancy-associated plasma protein A (PAPP-A)

↑ bHCG, ↓ PAPP-A, thickened nuchal translucency

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24
Q

Management of women with a “high” risk of a foetus with Down’s syndrome?

A

Offer second screening test:
→ NIPT e.g. cffDNA
→ amniocentesis or CVS

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25
Q

Oligohydramnios vs polyhydramnios?

A

Oligo = reduced amniotic fluid
Poly = increased amniotic fluid

26
Q

Features and management of pre-eclampsia?

A

Triad of:
→ new hypertension > 20 weeks gestation
→ proteinuria
→ other organ involvement e.g. liver disease, headaches, visual disturbances, epigastric pain
Management = labetalol (1st line), nifedipine or hydralazine (2nd line)

27
Q

Management of hypertension in pregnancy?

A

1st line = labetalol
2nd line = nifedipine or hydralazine

28
Q

Feature and management of eclampsia?

A

Seizures
Management = magnesium sulphate

29
Q

How long should magnesium sulphate be given in eclampsia?

A

Until 24 hours post-seizure or post-delivery

30
Q

Management of magnesium sulphate induced respiratory depression?

A

Calcium gluconate

31
Q

Safest anti-epileptics during pregnancy?

A

Lamotrigine
Levetiracetam

32
Q

Features and management of HELLP syndrome?

A

Haemolysis
Elevated liver enzymes
Low platelet count
Management = urgent delivery

33
Q

Features and management of hyperemesis gravidarum?

A

Frequent N&V
Ketonuria
Dehydration
Weight loss
High beta-hCG
Management = cyclizine or promethazine (long term), admission + IV saline with K+ (acute)

34
Q

Complications of prematurity?

A

Increased risk of mortality
Respiratory distress
Chronic lung disease
Intraventricular haemorrhage
Necrotising entercolitis
Retinopathy of prematurity
Hypothermia, jaundice, infection

35
Q

C-section categories?

A

Cat 1 = immediate threat to life of mother and/or baby, delivery within 30 mins
Cat 2 = maternal or foetal distress which is not immediately life-threatening, delivery within 75 mins
Cat 3 = mother and baby stable but delivery required
Cat 4 = elective C-section

36
Q

Vaginal birth after C-section success rate and contraindication?

A

70-75% women have a successful vaginal birth
Contraindicated if PMH uterine rupture or classic C-section (longitudinal)

37
Q

5 key features when assessing CTG?

A

Contractions
Baseline rate (foetal HR)
Variability (foetal HR)
Accelerations/decelerations (foetal HR)

38
Q

When do foetal movements first occur?

A

Prim = 18-20 weeks
Multi = 16-18 weeks

39
Q

Investigations for RFM?

A

Doppler scan
Abdominal USS

40
Q

Investigation and criteria for gestational diabetes?

A

OGTT
→ fasting ≥ 5.6
→ 2-hour OGTT ≥ 7.8

41
Q

Management of gestational diabetes (no PMH diabetes)?

A

Glucose < 7 = lifestyle modifications (1st line), short-acting insulin (2nd line)
Glucose ≥ 7 or foetal complications = short-acting insulin
Offer C-section at term e.g. 39 weeks

42
Q

Management of gestational diabetes (PMH diabetes)?

A

Stop oral medication apart from metformin
Commence short-acting insulin

43
Q

Management of VZV exposure in pregnancy?

A

Check VZV antibodies
≤ 20 weeks and not immune = VZIG
> 20 weeks and not immune = VZIG or aciclovir 7-14 days post-exposure

44
Q

Management of group B strep infection in pregnancy?

A

Prophylactic benzylpenicillin if:
→ previous pregnancy with GBS
→ positive swab
→ preterm labour
→ pyrexia during labour

45
Q

Investigations for baby born to a Rh -ve mother?

A

Cord blood taken at delivery
→ FBC, Coombs and ABO group

46
Q

Investigations of preterm rupture of membranes?

A

1st line = speculum exam
2nd line = fluid PAMG-1 or insulin-like growth factor binding protein-1

47
Q

Management of preterm rupture of membranes?

A

Admission
Oral erythromycin (chorioamnionitis prophylaxis)
Antenatal corticosteroids (NRDS prophylaxis)

48
Q

Stages of labour?

A

Stage 1 = onset of true labour to fully dilated cervix
→ latent = 0-3cm
→ active = 3-10cm
Stage 2 = from full dilation to foetal delivery
Stage 3 = from foetal to placental delivery

49
Q

Score used to assess if IOL needed and interpretation?

A

Bishop score
< 5 = labour unlikely to start without induction
≥ 8 = ripe cervix with low need for induction

50
Q

Options for IOL?

A

Membrane sweep before:
→ Bishop ≤ 6 = vaginal prostaglandin or oral misoprostol
→ Bishop > 6 = amniotomy + IV oxytocin

51
Q

Types of perineal tear and management?

A

1st degree = skin torn (no repair)
2nd degree = perineal muscle torn (suturing on ward)
3rd degree = anal sphincter torn (theatre repair)
4th degree = rectum torn (theatre repair)

52
Q

Management of shoulder dystocia?

A

Urgent senior help
McRobert’s manoeuvre

53
Q

Main risk factor for umbilical cord prolapse?

A

Artificial rupture of membranes

54
Q

Management of umbilical cord prolapse?

A

Push foetus back into uterus
Keep cord warm and moist
Fill bladder with 500ml
Get mum on all 4s
Tocolytics to stop contractions
Definitive management = C-section

55
Q

Tocolytic examples?

A

Indomethacin
Nifedipine
Magnesium sulphate
Terbutaline

56
Q

Most common cause of puerperal pyrexia and management?

A

Endometritis
Management = admission + IV antibiotics

57
Q

Causes of primary vs secondary PPH?

A

Primary (< 24 hours):
→ tone (atony = most common PPH cause)
→ trauma
→ tissue
→ thrombin
Secondary (24 hours-6 weeks):
→ tissue
→ endometritis

58
Q

Management of PPH?

A

ABCDE
Rub the uterus
Drugs = oxytocin/syntocinon (1st line), ergometrine, carboprost
Surgery = balloon tamponate, ligation, hysterectomy

59
Q

Anticoagulant of choice in pregnancy?

A

Low molecular weight heparin

60
Q

Duration of maternal LMWH thromboprophylaxis?

A

Until 6 weeks post-partum

Med School Finals (18 decks)

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