Obstetrics Flashcards
Gestational diabetes and macrosomia increases the risk of what obstetric emergency?
Shoulder dystocia
What is Seehan’s syndrome?
Seehan’s syndrome is a condition caused by severe blood loss or extremely low BP after or during childbirth.
Lack of blood flow to the pituitary gland, can cause damage to the gland and lead the pituitary dysfunction.
What is the most common organism that can cause of mastitis and what is the tx given?
Staphylococcus aureus
Flucloxacillin (erythromycin if patient is allergic)
What pre-conception advice is given to women who have diabetes and and are thinking of concieving?
Take High dose of Folic Acid supplements (5mg/day)
What medication is given in a medically managed miscarriage?
Vaginal Misoprostol or Oral Misoprostol
(But accoring to NICE, oral misoprostol can only be given up to 49 days gestation)
What is the medical management of an ectopic pregnancy?
IM Methotrexate
What drugs can be given to prevent premature labour?
1st line- Nifedipine (CCB)
Atosiban (Oxytocin receptor antagonist)
Indomethacin (NSAID)
Terbutaline (B2 Agonist)
Magnesium sulphate (may be administered for its foetal nueroprotective effects)
Inhibits contractions (tocolytic) and thus prevents labour
What drug can be given to promote contractions in labour?
Oxytocin analogues
What drug/drug class can be used to ripen cervix and promote labour?
Prostaglandin analogues
What is the first intervention that should be used to try and overcome shoulder dystocia once it has been identified?
McRoberts Manoeuvre
If McRoberts manoeuvre fails, what should be done next?
1) Apply suprapubic pressure
2) Cosider Episiotomy
3) Deliver anterior arm/Internal rotational manoeuvres
4) All fours and repeat
5) Consider Cleidotomy, Zavaneli or symphysiotomy
Asmmetrical small for gestational age is associated with what condition?
Placental Insufficiency
What drugs are contraindicated for use in breastfeeding women?
Abx- tetracyclines, sulphanomides, ciprofloxacin, chloramphenicol
Antipsychotics- lithium, benzos
Amiadarone
Methotrexate
Sulfonylureas
Aspirin
Carbimazole
What is the treatment for the prophylaxis of GBS in pregnant women
Intrapartum IV benzylpeniclillin
What is the cervical dilation during the different stages of labour;
-Latent
-Active
Latent- 0-4cm
Active- 4-10cm
How long should methotrexate usage be ceased before conception?
6 months
What is the 1st line tretement for reversing:
A) Respirtaory depression in Magnesium sulphate
B) Benzodiazepines overdose
C) Opioid overdose
A) Calcium Gluconate
B) Flumazenil
C) Naloxone
What are the signs of an amniotic fluid embolism?
Respiratory distress, hypoxia, and hypotension (usually occurs within 30 minutes of labour)
What is the medical management of an ectopic pregnancy?
Methotrexate
What are the basic initail Ixs undertaken when having fertility issues?
semen analysis-repeat 3months later if required
Serum progesteron- should be measure 7 days prior to the start of next period
What tool is the most appropriate in diagnosing postnatal depression?
Edinburgh scale
What fluids should be prescribed to a woman with hyperemesis gravidarum
IV normal saline with potassium chlroide
What pharmacological management is given to patients with urge incontinence?
anticholinergic Oxybutinin (solinfenacin, tolteradine)
or
b3 agonist- Mirabegron
When is the first anti d injection given to rhesus -ve women?
28 weeks
Which women should be prescribed 5mg of folic acid instead of the normal 0.4mg?
Either partner has NTD, previous pregnancy of NTD, FHx of NTD (neural tube defects)
Woman is taking anti-epileptic drugs, or has coeliacs, diabetes, or thalassaemia
Woman is obese
White, thick discharge that is sometimes described as ‘cottage-cheese’-like with a pH <4.5 is suggestive of what STI?
Candidiasis (Thrush)
What is the 1st line tretment of thrush in pregnant women?
Clotrimazole pessary- Since this patient is pregnant, oral antifungals are contraindicated as they may be associated with congenital abnormalities.
What management should be undrtaken for a preganant woman who presents with PROM?
Admit to hospital
Regular observations
Oral antibiotics
Antenatal corticosterods
Delivery should be considered at 34 weeks
What is the 1st line surgical intervention for managment of PPH after other medical measures have failed?
Intrauterine Bakri catheter- a baloon catheter that acts to tamponade the bleeding
What medical management can be undertaken to manage a PPH?
Iv Oxytocin
IV/IM ergometrine
IM Craboprost (CI in asthmatics)
Sublingual misoprostol
What are the indictaions for surgical management of an ectopic pregnancy and what does it include?
size >35mm
Significant pain
visible heartbeat
hCG>5000
Surgical management involes sapingectomy (1st line for no other rf for infertility) or salpingotomy
What are the indictaions for expectant management of an ectopic pregnancy and what does it include?
size <35mm
No pain
No foetal heatbeat
hCG <1500
What are the indictaions for expectant management of an ectopic pregnancy and what does it include?
size <35mm
Asymptomatic
No foetal heartbeat
hCG <1000
Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed.
What is asherman’s syndrome?
Asherman syndrome is the formation of scar tissue in the uterine cavity. The problem most often develops after uterine surgery.
What is Seehan’s syndrome?
Sheehan’s syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery.
Name 5 causes of secondary amenorrhoea?
Asherman’s Syndrome
Seehan’s Syndrome
PCOS
Prolactinoma
Pregnancy
Thyrotoxicosis
Turner’s syndrome
Premature ovarian failure
Congenital adrenal hyperplasia
At what gestation would a referral to the maternal fetal medicine unit for a pregnant woman who is yet to feel foetal movements?
24 weeks
Generally women can feel their babies move around 18-20 weeks, but this can be earlier especially in multiparous women
When is the OGTT offered to women at risk of GDM?
24-28 weeks
When should scrrening for Down’s syndrome take place, what tests are conducted and what are the results of a +ve screening?
a) test is conducted in 1st trimester at 11-13+6 weeks
b) combined test- bhCG, Nuchal translucency and PAPP-A
c)Raised serum bhCG, Thickened nuchal translucency, and low PAPP-A
What is the result of a quadruple test in people who tets +ve for Down’s syndrome?
Low Alpha fetoprotein
Low unconjugated oestriol
High hCG
High Inhibin A
For ach of the following components of routine antenatal care state the gestation when it should occur:
A) Anaomaly Scan
B) Down’s syndrome screening
C) Booking visit
A) 18-20+6 weeks
B) 11-13+6 weeks
C) 8-12 weeks
What tests are conducted at the Booking visit?
BP
Urine dipstick
BMI
FBC, Blood group, Rhesus status, Red cell alloantibodies, Haemoglobinopathies
Hepatitis B and syphilis
HIV test
What are the 2 most important RFs for placenta accreta?
Previous c-section
Placenta praevia
How long after a termination of pregnancy can a urine pregnancy test remain positive?
Urine pregnancy test often remains positive for up to 4 weeks following termination.
A positive test beyond 4 weeks indicates incomplete abortion or persistent trophoblast
What additonal investigation/test should be conducted in women who present with recurrent vaginal candidiasis?
HBA1c- to exclude diabetes
What is the mana gem t of intra hepatic cholestasis of pregnancy?
Plan induction of labour at 37-38 weeks
Ursodeoxycholic acid for symptomatic relief
What analgesic is absolutely contraindicated in breastfeeding individuals/
Aspirin- due to association with Reye’s syndrome
What is the diagnostic criteria for a diagnosis of GDM?
Fasting blood glucose >5.6 mmol
2 hour glucose >7.8 mmol
What is the management of GDM and how does BG dictate this?
If fasting glucose <7mmol — trial diet and exercise should be offered. If targets not met within 1-2 weeks add metformin
If fasting glucose >7mmol— insulin should be started
What is the management involved in women with pre-existing diabetes during pregnancy?
Encourage weight loss in women with BMI >27 kg/m2
Stop oral hypoglycaemics except metformin and start insulin
Folic acid 5mg/day from pre-conception to 12 weeks
Detailed Anamoly scan at 20 weeks
List 5 RF for GDM?
Obese (BMI >30)
Previous macroscopic baby (>4.5 kg)
Previous GDM
First degree relative with DM
South Asian/black Caribbean
What is eclampsia and it’s treatment?
Development of seizures in association with pre-eclampsia
Tx- magnesium sulphate IV
Continue for 24 hrs since birth/last seizure
Monitor reflexes and RR
Calcium gluconate tx if resp depression
What is pre-eclampsia?
new onset bp >140/90 after 20 weeks GA AND 1 more of the following
-Proteinuria
-Other organ involvement
Give 3 indications for induction of labour?
Prolonged pregnancy 1-2 weeks past due date
PPROM and labour hasn’t started
Diabetic mother >38
Pre eclampsia
Obstetric cholestasis
Give 5 methods of induction of Labour
Membrane sweep
Vaginal prostaglandin E2
Oral prostaglandin (misoprostol)
Maternal oxytocin infusion
Amniotomy
Cervical ripening balloon
What are the results for the quadruple test in someone who has edwards syndrome?
Beta HCG low
AFP low
Serum oestriol low
Inhibit a <->
When is the first and second dose of anti d given in rhesus -ve mothers?
1st- 28 weeks
2nd- 34 weeks
What medication is prescribed to women who are at a moderate-high risk of pre-eclampsia?
Aspirin 75mg-150mg from 12 weeks gestation to birth
List causes of low AFP levels in pregnancy?
Downs
Edwards
Maternal diabetes
Maternal obesity
List causes of elevated levels of AFP during pregnancy?
Multiple pregnancy
Neural tube defects
Omphalocele
When administering MGSO4 in eclampsia what are the two parameters that should be observed after its administration?
Monitor reflexes and resp rate
What is the most common cause of painless vaginal bleeding during pregnancy?
Placenta Praevia
What is HELLP syndrome and List the features?
HELLP syndrome us a severe form of pre eclampsia
Haemolysis
Elevated liver enzymes
Low platelets
List 5 causes of oligohydramnios?
Low amniotic fluid
PROM
IUGR
Pre-eclampsia
Potters syndrome (renal agenesis + pulmonary hypoplasia)
abnormalities of foetal urinary system e.g. renal agenisis
List 5 causes of polyhydramnios?
High levels of amniotic fluid
Maternal diabetes
Foetal anaemia
Twin to win transfusion syndrome
Oesophageal or duodenal atresia
Diaphragmatic hernia
What is a molar pregnancy/hydatiform mole and list it’s key features?
Pre cancerous form of gestational trophoblastoc disease caused by an imbalance of chromosomes
Painless vaginal bleeding
Uterus- large for date
Very high amounts of beta HCG therefore can cause symptoms of hyperemesis gravidarum and thyrotoxicosis
What is the investigation of choice for a molar pregnancy, and what does it show?
TV USS- mole appears as a solid collection of echoes w/ numerous small anechoic spaces —> snowstorm appearance
What are the cut off values for Anaemia in pregnancy?
1st trimester- <110
2nd and 3rd trimester- <105
What are baby blues and thus what’s it’s relevant mx?
Baby blues are essentially form of depression that occurs 3 days after birth and Usually resolves in 2 weeks
Mx- reassurance and support
What are the anti emetics of choice in hyperemesis gravidarum (give answer in order)?
Prochloroperazine
Cyclazine
Ondansetron
Metoclopramide
List the characteristics of hyperemesis gravidarum?
Persistent vomiting
Volume depletion
Ketosis
Electrolyte imbalance
Weight loss (>5% pre pregnancy)
What is the definition of a miscarriage?
A spontaneous termination of pregnancy before 24 weeks gestation
Give 5 causes of miscarriage?
Idiopathic
Antiphospholipid syndrome
PCOS
Uterine abnormalities
Cervical incompetence
Poorly controlled diabetes
What should you do if a pregnant woman has been in contact with someone with chickenpox?
Check Abs against varicella zoster
If not immune administer VZV immunoglobulins
MX OF Pregnant woman with hx of VTE ?
Low molecular weight heparin starting immediately until 6 weeks postnatal
In patients with suspected PPROM where there is no evidence of fluid in posterior vaginal vault, what is the next best step?
Test the fluid for PAMG-1 or IGF Binding protein 1
List 5 RF for placental abruption?
A- abruption previously
B- BP
R- ruptured membranes
U- Uterine injury
P- Polyhydramnios
T- Twins/multiple gestation
I- Infection in uterus
O- Older age >35
N- Narcotic use
List 5 rf for PPH
Polyhydramnios
previous PPH
Prolonged labour
High maternal age
Emergency c section
placenta praevia/accreta
macrosomia
List the 4 causes of PPH
Tone
Tissue
Trauma
Thrombin
What is secondary PPH
Bleeding (>500ml) that occurs 24 hours - 6 weeks- typically due to retained placental tissue
Painless vaginal bleeding=
Placenta praevia
What blood tests can be indicative of molar pregnancy
High BHCG
Low TSH
High thyroxine
What is the rx of choice in supporting in suppressing lactation in breastfeeding women
Cabergoline
List the causes and consequences of folic deficiency
causes:
Phenytoin
methotrexate
pregnancy
alcohol excess
consequences-
NT defects
Macrocytic megaloblastic anaemia
List the mx of placental abruption
Fetus alive and < 36 weeks
- fetal distress: immediate caesarean
- no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation
Fetus alive and > 36 weeks
- fetal distress: immediate caesarean
- no fetal distress: deliver vaginally
What is the definition of miscarriage?
Spontaneous terminantion of preganancy before 24 weeks of gestation
What is a threatened miscarriage?
Painless/little vaginal bleeding + cervical os is closed
What is a missed misscarriage?
The uterus still contains foetal tissue, but the foetus is no longer alive. The miscaariag is often msised as woman is asymptomatic. The cervical os is closed
What is an inevitable miscarriage?
heavy bleeding with clots and pain
cervical os is open
What is an incomplete miscarrigae?
not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open
List 4 causes of miscarriage?
Anti-phospholipid syndrome
PCOS
Uterine abnormality
Cervical incompetance
poorly controlled diabetes/thyroid disease
idiopathic
placental failure
What are the 2 legal requirements for an abortion
1) two registered medicla practitioners must sign to agree abortion is indicated
2) It must be carried out by a registered medical practitioner in an NHS hopsital or approved premise
What is involved in a medical abortion?
Mifepristone (relaexes the cervix- anti progesterone) follwoed 48h later by misoprostol (stimulates contraction)
What care is available post abortion?
women may experience vaginal bleeding and abdo cramps intermittently for up to 2 weeks after procedure
urine pregnancy tets must be undertaken 3 weeks after abortion
contraception should be discussed
What is the mx of molar pregnancies?
urgent referral to specialist centre
suction curettage or hysterectomy (if fertility does not ahve to be preserved)
surviellience
- two weekly bhcg until levels normal
What HB levels in the following would be indicative of oral iron therapy
1) First trimester
2) Seocnd/Third trimester
3) Postpartum
1) <110 g/L
2) <105 g/L
3) <100 g/L`
List 2 high RF that would determine the prescription of aspirin in a pre-eclampsia patient?
- Hypertensive disease in previous pregnancy
- CKD
- Autoimmune disease e.g. SLE or ntiphospholipid
- T1 or T2 diabetes
- Chronic HTN
List 3 moderate RF that would determine the prescription of aspirin in a pre-eclampsia patient?
need 2 of these
- First pregnancy
- Age 40 or older
Pregnancy interval of more than 10 years
- BMI>35
- FHx of pre-eclampsia
- Multiple preganncy
What are the key investigations for a diagnosis of pre-eclampsia
Blood pressure measurement: To confirm hypertension.
Urinalysis: To confirm proteinuria.
Blood tests: To assess kidney function, liver function, and clotting status.
NICE also recommneds teh use of PIGF (low)
List 2 maternal and foetal complicatiosn of pre-eclamsisa
maternal- eclampsia, organ failures, DIC, HELLP
foetal- neonatal hypoxia, placental abruption, IUGR, pre-term delivery
List the triad for thrombosis
hypercoaguable state
stasis of vlood flow
Damage to endothelium
What is the 1st line ix of VTE in pregnancy?
VTE- Doppler USS
PE- CXR and Echo
Why is D-dimer not the appropriate 1st lien Ix for VTE in pregnancy
Pregnancy causes a high d-dimer thus not helpful
What si the tx of choice for VTE in pregnancy?
LMWH e.g. enoxaparin, dlateparin
should be continued for rmeianed of preganncy + 6 weeks postnatal
What is Kleihaeur test and when is it indicated?
checks how much foetal blood has passed into mothers blood during sensitisation event. This tets is used after any sensitising event past 20 weeks gestation to assess further doses of anti-D required
List 5 rf for shoulder dystocia
Macrosomia
Maternal gestational diabetes
Birthweight >4kg
Advanced maternal age
Maternal short stature/small pelvis
Maternal obesity
When screening for Downs syndrome, when is CVS and amniocentesis preferred?
CVS- done between 11-13 weeks
Amniocentesis- after 15 weeks
What is the management of chorioamnionitis?
Admit to hsopital
Give IV antibiotics
Prompt delivery
List 3 complictaions of shoulder dystocia?
Humeral shaft fracture
Erbs palsy *
Klumpkes palsy
Shoulder dislocation
List 3 RF of PPH
Polyhydramnios
Previous PPH
Emergency c section
Macrosomia
Prolonged labour
Placenta pravia
Placenta accreta
After what time period should lochia be ix after giving birth?
6 weeks
what is the mx of a woman who is in labour with known placenta praevia
Emergency c-section
What causes folic acid deficiency?
Phenytoin
Methotrextae
Pregnancy
Alcohol excess
List the High rf in pre eclamsia?
HTN in prev pregnancies
CKD
Diabetes (T1/2)
CHornic HTN
Autoimmune diseases
List the moderate risk factors for pre eclampsia?
1st pregnancy
40+ years
interval of more than 10 years
BMI>35
FHx of pre eclampsia
Multiple preganncy
What is a first degree perineal tear and list its mx?
only superficial damage
No repair required
What is a second degree perineal tear and list its mx?
perineal muscle but NO anal sphincter
On ward sutured by midwife/clinician
What is a third degree perineal tear and list its mx?
Involves anal sphincter
theatre-trained clinican
What is a fourth degree perineal tear and list its mx?
perinum + anal sphncter + muscosa
theatre-trained clinican
What is used to monitor progress in the 1st satge of labour?
A partogram
if the paratogram crosses the following, what actions need to be taken
A) crosses alert line
B) crosses action line
a) indication for amniotomy and repeat exam in 2 hours
b) obstetrician led care
What measures are recorded on a partogram
cervical dilation
descent of foetal head
maternal bp/hr/temp/urine output
foetal HR
Frequency of contractions
Status of memebranes
Drugs and fluids given
Where is oxytocin produced?
Hypothalamus- in supraventricular nuclei
Where is oxytocin released from?
Posterior pituitary
What the difference between latent and active 1st stage of labour?
latent- 0-4cm. irregular contractions
active- 4-10cm, regular contractions
WHat is the 2nd stage of labour?
10cm cervix –> Delivery of baby
The success of the 2nd stage is dependent on what factors?
- power- force of contractions
- passenger- size, altitude, lie and presentation of baby
- passage- size and shape of pelvis
If strength of contrcations in the 2nd stage of labour is weak, what product can be given?
Oxytocin
What is the diference between physiological 3rd stage mx and active 3rd stage mx?
Physioogical 3rd stage mx- placenta deliverd by maternal effort w/o cord traction and medication
Active 3rd stage mx- midwife/dr assited. IM oxytocin and careful cord traction
in what 2 ways can Induction of labour be measured?
1) CTG
2) Bishop score
What is the complication of vaginal prsoatglandin e2 in IOL?
Uterine hyperstuimulation- can cause foetal compromise therefore mx by giving tocolytics
Give 3 signs taht are associated with obstructed labour?
Foetal malposition
Cephalopelvic disproportion
Failure to descend
Visible head retraction (Turtle-neck sign)
Failure of restitution
list 5 complcation of c sections
Haemorrhage
Bladder injury
Ureteric injury
Emergency hysterectomy
increased risk in subsequent pregnancies of placenta praevia and placenta accreta
Infection
Give 3 causes of delay in the 1st stage of labour
Maternal dehydration and exhaustion
Multiple gestation
Cephalopelvic disproportion
Inadequate uterine contractions
Malposition of foetus
Primagravida
What is the triad of sx/signs in vasa pravia?
- Ruptured membranes
- Painless vaginal bleeding
- Foetal bradycardia
What antibodies are seen in antiphospholipid syndrome?
anti cardioplin
anti lupus
anti beta2-glycoprotein 1
What transaminases will be raised in Intrahepatic cholestasis?
GGT and ALP
What are the torch infections
Toxoplasma gondii
Other (Syphyllis, VZV, Parvovirusb19, listeria)
Rubella
CMV
HSV2
What are the foetal sx of toxoplasma gondii infection?
Hydrocephalus
Chorioretinitis
Rash
Intracranial calcifications
What are the foetal sx in rubella infection?
Deafness
Cataracts
Rash
Heart defects
What are the foetal sx in CMV infection?
Microcephaly
Chorioretinitis
deafness
seizures
What are the foetal sx in HSV2 infection?
Blisters
Meningioencephalitis
What are the complications of TORCH infections?
IUGR
Miscarriages
Stillbirths
preterm delivery
What are the foetal sx in VZV infection?
Low birth weight
Limb hypoplasia
skin scarring
How often shoul patients with severe pre-eclampsia have their bloods taken?
3 x a week
incl FBC, U&E, Transaminases, Billirubin
What is the casuative organism for toxoplasmosis infection?
Protozoan parasiote- Toxoplasma Gondii
Describe the steps of the 2nd stage of labour?
Foetal head flexion, descent and engagement
Internal rotaion to face maternal back
Head Extension
External rotation
Deliver anterior shoulder and then rst of the body
What is Foetal blood sampling?
used duriong labour to assess presence or absence of foetal hypoxia
Give 2 indications of FBS?
Suspicious CTG
Lack of progress in labour
Abnormal pH or lactate in prev sample
What is the normal, boderline and abnormal range of pH in FBS?
normal- >7.25
boderline- 7.21-7.24
abnormal <7.20
What is the normal, boderline and abnormal range of lactate in FBS?
normal <4.1mmol/l
boderline- 4.2-4.8 mmol/l
Abnormal >4.9 mmol/l
What foetal signs may be seen on a CTG to indicate an umbilical cord prolapse?
Foetal bradycardia
Late decellerations
What is the normal HR for a foetus?
100-160bpm
Give 2 causes of foetal tachycardia on CTG?
Foetal hypoxia
Chorioamnionitis
Foetal/maternal aneamia
Give 2 causes of foetal bradycardia on CTG?
Prolonged cord compression
cord prolapse
epidural/spinal anaesthesia
Maternal seizures
Rapid foetus descent
Give 3 RF for reduced foetal movements?
Placental position (anterior)
Medications (Benzos, opiates, alcohol)
Obeisty
Amniotic fluid volume
List the causes of macrosomia?
Maternal diabetes
previous macrosomic baby
maternal obesity
overdue
List the types of breech and give breif description?
Complete breech- legs fully flexed at hips and knees
Footling breech- where foot is presenting through cervix with leg extended
Extended/Frank breech- both legs flexed at hip and extended at knee
What are the different foetal lies?
Longitudinal
oblique
transverse
List 2 indications for instrumental delivery?
Failure to progress
Foeatal distress
Maternal exhaustion
List the 2 nerves that may be injured during instrumental delivery?
Maternal injury to :
1. Femoral nerve (compressed against inguinal canal during forceps)
2. obturator nerve
List 2 maternal and 2 foetal complications of Instrumental delivery?
Maternal- PPH, Pernieal tears, bladder injury, injury to femoral or obturator nerve
Foetal- caphalohaematoma (V), facial nerve palsy (F)
What is uterine rupture?
A medical emergency where muscle layer of the uterus ruptures
List 3 rf for uterine rupture?
Previous c-section
Increase BMI
Increased age
IOL
Use of oxytocin to stimulate contractions
High parity
Previous uterine surgeyr
Mx for cord prolapse?
Emergency csection
adopt knees to chest position
fill bladder with 500ml of slaine to prevent further prolapse
give tocolytics e.g. terbutaline to stop contractions
What conditions are screened for in the 20 week analomy scan?
Edwards
Pataus
Anacephaly
Gastroschisis
Cleft lip
Bilateral renal agenesis
WHta is the difference between complete and incomplete molar pregnancy ?
Complete- absence of foetal tissue (XX)
Incomplete- presence of foetal tissue (XXX, XYY)
What is the normal Amniotic fluid Index (AFI)
2-25 cm
>25cm- polyhydramnios
<5cm- oligohydramnios
What moderate and severe PPH?
Moderate PPH- 1000-2000ml
severe PPH- >2000ml
List the physiological changes in pregnancy in regards to blood tests?
High WCC, ESR, D-Dimer, ALP
Low Insulin, Platelets
What vaccines are offered to all preg women?
pertussis, influenza
Definition of IUGR?
Failure of foetus to reach potential geniticlaly determiend size
What is occult and overt cord prolapse?
Occult- Incomplete: cord descends alongside presenting aprt but not beyond
Overt- complete: cord descends past presenting part and is lower than presenting part
Why is dextrose not given whne managing hyperemesis gravidarum?
can cause wernickes encephalopathy
List 3 differentials and complications of hyperemesis gravidarum?
differentials- Appendicitis, Bowel obstruction, UTI, Gastroenteritis
complciations- VTE, Mallory weiss tear, Wernickes encephalopathy, maternal dehydration and malnutrition
Give 3 examples of sensitisation events?
Amniocentesis and CVS
ECV
Placental abruption/ Placenta praveia
Ectopic pregnancy
TOP
What should the glucose targets for self monitoring of pregnant women be in the following:
a) Fasting
b) 1 hour after meal
c) 2 hours after meal
a) 5.3 mmol/l
b) 7.8 mmol/l
c) 6.4 mmol/l
List the MOA of these following anti-emetics?
a) Promethazine
B) ondansetron
c) Cyclizine
d) Metoclopramide
a) H1 receptor antagonist
b) 5HT3 receptor antgaonist
c) H1 receptor antagonist
d) D2 receptor antaginist
What should happen if a pregnant woman has come in contact with someone with chickenpox?
Immediately check VZIG
if not present then:
a) >20 weeks - either VZIG or oral aciclovir 7-14 dyas after exposure
b) <20 weeks - Give VZIG immediately
Moa of mifeprostone?
anti progesterone thus prevents advancement of pregnancy and relaxes the cervix
MOA of misoprostol?
Prostaglandin E1 analogue-induces strong uterine contractions leading to expulsion of prodcut of conceltion from uterus
What are the 2 prophylaxis options for women at high risk of pre-term labour
1) Vaginal progesterone (if cerrvical length <25mm or hx of spontaneous preterm birth)
2) Cervical cerclage
(if cerrvical length <25mm andhistory of PPROM or cervical trauma)
List 3 differentials for rashes in pregnancy?
1) Intrahepatic cholestatsis
2) Phemphigoid gestationis- itch around umbilicus and progress to form blisters
3) Polymorphic eruption of pregnancy- papules and plaques on stomach and thighs. typically spares umbilicus
