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Obs/Gyn > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What are the top causes of arrest in pregnant women?

A

Haemorrhage
Amniotic fluid embolism
Sepsis
Cardiac failure
Trauma
Anaesthetic complications

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2
Q

What is a normal foetal heart rate?

A

120-160bpm

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3
Q

When is the IVC compressed in pregnancy? How is this managed?

A

After 18-20 weeks gestation
Managed by lying the patient on their left side or manual displacement

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4
Q

When is CTG indicated in pregnant trauma?

A

When pregnancy >20 weeks, thought to be more sensitive than ultrasound for foetal distress/abruption
Should be applied for at least 4hrs

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5
Q

What is the utility of ultrasound in pregnant trauma?

A

No change to FAST sensitivity
Can assess for foetal HR and movement
Insensitive for excluding placental abruption or uterine rupture

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6
Q

What are some key positions for the uterine fundus?

A

24 weeks = at umbilicus
32 weeks = 1/2 way from umbilicus to xiphisternum
36 weeks at costal margin

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7
Q

When is the foetus most vulnerable to radiation?

A

The first 2 weeks of life it is most vulnerable to death from radiation
The first 8 weeks for organogenesis

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8
Q

What is the dose of oxytocin and when is it given during delivery?

A

10 units IM
Given post delivery of the shoulders in a vaginal birth

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9
Q

What are the risk factors for ectopic pregnancy?

A
  • Previous ectopic
  • Previous gynae/pelvic surgery
  • Known reproductive tract anatomical abnormality (ie congenital or acquired)
  • PID
  • Presence of an IUD
  • Undergoing IVF
  • Endometriosis
  • Age >35
  • Smoking
  • Previous placenta previa
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10
Q

What are the ultrasound findings in ruptured ectopic pregnancy?

A

Classic triad!
- Empty uterus (10-20% have pseudogestational sac, very rarely hetertopic pregnancy)
- Complex adnexal mass
- Free fluid in abdomen

Also tubal ring sign

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11
Q

What define a miscarriage vs a foetal death in utero?

A

In Australia/NZ a miscarriage is when the foetus prior to 20 weeks gestation
Foetal death in utero >20weeks (registered as a birth)

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12
Q

What is a threatened miscarriage?

A

Abdo pain and/or bleeding <20 weeks
- 85% chance to continue
- cervix closed, appropriate fundal height, uterus itself soft and non-tender

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13
Q

What is an inevitable mmiscarriage?

A

Abdo pain and/or bleeding <20 weeks
- Bleeding continues, products of conception still in uterus
- Cervix open +/- ROM
- Often have uterine contractions
- Not viable

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14
Q

What is a completed miscarriage?

A

Abdo pain and or bleeding <20 weeks
- BHCG falling
- U/S shows empty uterus
- Uterus contracts and OS closes

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15
Q

What is an incomplete miscarriage?

A

Partial expulsion of products of conception (RPOC), mostly occurs between 6 and 14 weeks
- cervical os remains open
- Often severe pain and worse bleeding
- If products lodge in the os will get cervical shock
- At high risk of endometritis

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16
Q

What is an Antepartum haemorrhage (APH)?

A

PV bleeding >20weeks gestation but before labor
- Occurs in 2-5% of all pregnancies
- Associated with perinatal morbidity and mortality
- Can be incidental, accidental or inevitable

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17
Q

What are the causes of incidental antepartum haemorrhage (APH)?

A
  • Ruptured uterus
  • Dehiscence of uterine scar
  • Ruptured vasa previa
  • Non-pregnant horn of uterus menstrual bleeding
  • in lesion in or around the genital tract (ie haemorrhoids)
  • Genitourinary infeciton
18
Q

What are the causes of accidental APH?

A
  • Placental abruption (20% all cases)
  • Trauma
  • Chorioamnionitis
  • Labour (bloody show)
  • Pre-eclampsia/HELLP associated
  • Stimulant use/hypertensive bleed
  • Polyhydramnios with multiple births

Can be concealed (under placenta, retroplacental haemorrhage) or revealed (blood leaks into uterus/vagina)

19
Q

What are the causes of inevitable APH?

A

Another name for Placenta Previa with haemorrhage
- 1% of all pregnancies but 30% of all cases of APH

  • When the placenta is partially or wholly in the lower segment in the 3rd trimester
  • RF’s include previous PP, previous LUSCS increasing with more LUSCS, high parity, large placenta, any uterine scarring, IVF, older age, abnormal uterine anatomy and smoking
20
Q

What are the 3 stages of labour?

A

1st stage
- Beginning of contractions until cervix fully dilated
- may take hours to days

2nd stage
- From full cervical dilatation to exulsion of the foetus
- usually 30mins-2hrs

3rd stage
- From expulsion of the foetus to expulsion of the placenta and membranes
- Usually 15mins

21
Q

How is the 3rd stage actively managed?

A
  • Syntocinon 10units IM post foetal expulsion
  • Clamp/cut the cord
  • placenta separates when cord lengthens and small gush of blood
  • Guard the uterus and provide slow gentle cord traction
  • Massage fundus as soon as placenta out
22
Q

What is the Puerperium?

A

AKA the 4th stage of labour
- Post birth when the body returns back to normal
- immediate (24hrs), early (7 days), remote (6 weeks)

23
Q

What is the definition of pre-term labour?

A
  • Labour between 20-37 weeks
  • At least 3 contractions in 30mins and then progresses
24
Q

What are the risk factors for pre-term labour?

A
  • PROM
  • PHx of pre-term delivery
  • Maternal distress/domestive abuse
  • Trauma
  • Infections
  • Multiple pregnancy
  • Smoking/drug abuse
  • <20 or >35
  • Low SES
25
Q

What are the contraindications to tocolysis?

A
  • FDIU
  • Maternal haemorrhage
  • Pre/eclampsia
  • Chorioamnionitis
  • Severe IUGR
  • Non-viable pregnancy/lethal foetal malformation
26
Q

What are the medications given for preterm labour?

A
  • Betamethasone 11.4mgs 2x doses 12hrs apart
  • Salbutamol OR Nifedipine, cannot be given together
  • Salbutamol 7.5mg IV
  • Nifedipine 20mg IR q30mins max 120mg in 24hrs
  • Consider MgS04 infusion 1-2gm/hr for foetal neuroprotection
27
Q

When are nifedipine and salbutamol contraindicated for tocolysis?

A

Salbutamol
- hypertension/pre/eclampsia
- Maternal/foetal tachycardia
- Valvular heart disease (ie MS)
- hyperthyroidism
- Maternal bleeding

Nifedipine
- Hypotension
- Concurrent MgS04 use
- Pre-eclampsia
- cardiac disease

28
Q

Early pregnancy bleeding differentials?

A

Ectopic
Completed/threatened abortion
Cervical ectropion
Bleeding diathesis
Vanishing twin
Physiologic/implantation bleeding (10-14 days, light)
Heterotopic pregnancy
Molar pregnancy

29
Q

Discharge advice to women with early pregnancy bleeding but viable pregnancy on ultrasound?

A

Use pads not tampons
No vaginal sex/heavy lifting while bleeding
Refer to mental health/EPAS if patient wishes to
GP/Obs review in a few days
Repeat BHCG in 48-72 hrs
Return if symptoms worsening

30
Q

What is the definition of Pre-eclampsia?

A
  • > 20 weeks gestation
  • New onset (or worsened chronic) hypertension (SBP/DBP >140/90)
  • New onset end organ dysfunction

End organ dysfunction
- Proteinuria >2+ dipstick or >0.3gm 24hrs
- platelets <100
- AKI
- Pulmonary oedema
- Transaminase rise
- New onset persistent headache
- Visual changes

31
Q

What is the typical immediate management of pre-eclampsia (not eclampsia)?

A

Magnesium
- seizure prophylaxis, contraindicated in myaesthenia gravis
- 4gm IV loading dose then 1-2gm/hr infusion aiming 2.0-3.5mmol/L

Methyldopa 250-500mg PO QID
Labetalol 20mg IV
Hydralazine 5mg IV
Nifedipine 10mg PO

32
Q

What is the definition of severe pre-eclampsia? What are the hallmarks?

A

BP >160/110
+
Signs of end organ dysfunction

Often have a rising Urate level (hallmark)
Pre-eclampsia post partum typically occurs in the 1st 7 days
Affects 5-7% of pregnancies

33
Q

What are the risk factors for Pre-eclampsia?

A

Primigravida
Multiple Gestations
Diabetes
Extremes of age
Molar pregnancy
Previous pre-eclampsia
Pre-existing HTN
Renal disease
High BMI

Smoking actually reduces the risk of pre-eclampsia/HTN

34
Q

Why are women prone to constipation in pregnancy?

A
  • More water absorbed from the GIT than normal
  • GI motility slows down
  • Uterus distorts colon
35
Q

How does the renal system change in pregnancy?

A
  • Mild glucosuria and mild proteinuria are normal (100-200mg/day)
  • GFR increase by 50%
  • Bladder moves into abdomen
  • Renal pelvices and urters dilate
36
Q

Why is bimanual pelvic exam avoided in the 2nd half of pregnancy?

A

Due to the risk of massive haemorrhage from irritating placenta praevia, less of an issue if this has been ruled out

37
Q

What are the potential intrapartum and post-partum complications of birth?

A

Intrapartum
- Nuchal cord
- Breech position
- Shoulder dystocia
- Uterine rupture (VBAC)

Post Partum
- PPH
- Retained placenta
- Endometritis
- Vaginal/anal lacerations/tears
- Foetal compromise/death

38
Q

What medications should be given in premature labour to help the foetus?

A

Corticosteroids
- 11.4mg Betamethasone IM
- 12mg Dexemathasone IM
- Causes foetal lung maturation decreasing the risk of RDS
- It also decreases the risk of Necrotizing enterocolitis and intraventricular haemorrhages
- Given between 23-34 weeks

Magnesium
- IV 4gm followed by 1gm/hr infusion
- Decreases the risk of cerebral palsy
- Used in pregnancies <30weeks

39
Q

What are the risk factors for foetal death in utero?

A
  • Previous still birth
  • Foetal growth restriction/IUGR
  • Diabetes/Obesity/poorly controlled medical conditions
  • Hypertension/Pre-eclampsia
  • low or high parity (0 or >3)
  • Trauma (DV, blunt, penetrating), Sepsis, severe maternal illness
  • Smoking, ETOH, illicit drugs
  • Indigenous, low SES, lack of antenatal care
  • Post dates gestation >41 weeks
  • PROM (P or T)
  • Connective tissue/autoimmune disorders
  • Advanced maternal age >35
40
Q

What are the reassuring findings on CTG?

A
  • Normal baseline HR (120-160)
  • Normal HR vairability (5-15)
  • Presence of accelerations (15bpm for 15sec)
  • No decelerations
  • Foetal movement detected

Broadly CTGs are interpreted as being “reassuring” or “non-reassuring”

41
Q

What are the extremes of maternal age?

A
  • <20 or >35
  • Generally higher risk pregnancies outside of this age range

Obs/Gyn (4 decks)

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