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AKT > obstetrics > Flashcards

obstetrics Flashcards

1
Q

pre-eclampsia is usually a triad of which 3 things

A
  1. new onset HTN
  2. proteinuria
  3. oedema
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2
Q

pre-eclampsia is defined by what criteria

A

New onset BP >140/90 after 20 weeks and 1 or more of:
1. proteinuria
2. other organ involvement e.g. renal Cr >90, liver, neuro, haem, uteroplacental dysfunction

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3
Q

Women who are at risk of developing pre-eclampsia or the risks, what should they take?

A

Aspirin 75-150mg daily from 12 weeks gestation until birth

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4
Q

Women with how many high/moderate risk factors should be taking aspirin 75-150mg daily (from 12 weeks gestation until birth)?

A

If >1 high risk factor or >2 moderate risk factors

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5
Q

women where pre-eclampsia is suspected are usually admitted + observed to secondary care when their blood pressure is over…

A

160/110

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6
Q

what is the first line for eclampsia

A
  1. oral labetalol
  2. nifedipine if asthmatic and hydralazine can be used
  3. deliver baby !
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7
Q

When are D antibodies tested for in all Rh -ve mothers

A

At booking scan

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8
Q

When is anti-D immunoglobulin given to non-sensitised R -ve negative mothers?

A

28 and 34 weeks

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9
Q

If there is an event in 2nd or 3rd trimester, what should be done in terms of rhesus negative mothers?

A

Give large dose of anti-D immunogloublin
Perform Kleihauer test - to check % of foetal RBCs are present

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10
Q

Anti-D immunoglobulin should be given as soon as possible (but always within 72 hours) in which 8 situations

A
  1. Delivery of Rh +ve infant
  2. TOP
  3. Miscarriage >12 weeks
  4. Ectopic (surgical)
  5. ECV
  6. Antepartum haemorrhage
  7. Amniocentesis, CV sampling, foetal blood sampling
  8. Abdominal trauma
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11
Q

Does a medical management of ectopic pregnancy (with methotrexate) require anti-D immunoglobulin?

A

NO
only surgical

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12
Q

All babies born to Rhesus negative mums should have cord blood taken at delivery to look for..

A

FBC
Blood group
Direct Coombs test - direct antiglobulin, shows any antibodies on RBCs of baby

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13
Q

What anti-hypertensive medications are TERATOGENIC in pregnancy

A

ACE inhibitors
Angiotensin receptor blockers

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14
Q

Babies born to mothers who are chronically infected with hep B or to mothers who had acute hepatitis B during pregnancy should receive …

A

Complete course of vaccination and hepatitis B immunoglobulin

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15
Q

Can Hep B be transmitted via breastfeeding

A

No

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16
Q

HBeAg is a marker of…

A

hep B infectivity!

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17
Q

Pregnant women who have risk factor of gestational diabetes (but never had it themselves) should have what investigation and when

A

OGTT at 24-28 weeks

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18
Q

Five risk factors for gestational diabetes

A
  • BMI >30
  • Previous macrosomic baby >4.5kg
  • Previous gestational diabetes
  • 1st degree relative with diabetes
  • Ethnicity - black, south asian, middle eastern
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19
Q

What is the test of choice for gestational diabetes

A

Oral glucose tolerance test

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20
Q

For women who have previously had gestational diabetes should have what investigation and when

A

OGTT at booking, and at 24-28 weeks if the first test is normal

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21
Q

Diagnostic thresholds for gestational diabetes:
(a) fasting glucose
(b) 2-hour glucose

A

(a) fasting glucose >5.6
(b) 2-hour glucose >7.8

5678!!

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22
Q

Gestational diabetes, if fasting glucose <7, what is the management

A
  1. trial diet (low glycaemic index) + exercise
  2. then metformin
  3. add insulin
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23
Q

what type of insulin is used for gestational diabetes

A

short-acting NOT long-acting

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24
Q

Gestational diabetes, if fasting glucose >7, what is the management

A

Insulin (short-acting)

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25
Q

What medication should be offered for gestational diabetes if women cannot tolerate metformin or decline insulin

A

Glibenclamide

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26
Q

If fasting plasma glucose is between 6-6.9 and there is evidence of complications such as macrosomnia or hydramnios, what medication should be offered

A

insulin (short acting)

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27
Q

Management of pregnant women with pre-existing diabetes

A
  1. Weight loss
  2. Stop oral hypoglycaemics, continue metformin
  3. Start insulin
  4. Folic acid 5mg /day from preconception to 12 weeks GA
  5. Detailed anomaly scan at 20 weeks including 4 chamber view of heart
  6. Treat retinopathy
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28
Q

Targets for self-monitoring of pregnant women (pre-existing and gestational diabetes):
(a) fasting
(b) 1 hour after meals
(c) 2 hours after meals

A

(a) fasting - 5.3
(b) 1 hour after meals - 7.8
(c) 2 hours after meals - 6.4

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29
Q

Risks of using SSRIs in pregnancy

A

Use in 1st trimester increases risk of congenital malformations especially cardiovascular malformations

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30
Q

Hydatidiform mole typically presents with painless or painful PV bleeding?

A

PAINLESS!

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31
Q

Management of complete hydatidiform mole

A
  1. Urgent referral to specialist centre - evacuation of uterus
  2. Contraception to avoid pregnancy in next 12 months
31
Q

Around 2-3% of complete molar pregnancies (hydatidiform moles) go on to develop into

A

choriocarcinoma

32
Q

High levels of hCG in molar pregnancies can mimic what other hormone

A

TSH = causing symptoms of thyrotoxicosis

33
Q

Can methotrexate be used while breastfeeding

A

No - contraindicated

it is a folic acid antagonist and can suppress bone marrow cause hepatotoxicity

34
Q

What is the antibiotic of choice for GBS prophylaxis

A

Benzylpenicillin

35
Q

4 risk factors for GBS

A
  • Previous GBS in pregnancy
  • Sibling with neonatal GBS infection
  • maternal pyrexia at labour
36
Q

Chickenpox exposure in pregnancy - first step is to…

A

check antibodies

36
Q

Foetal varicella syndrome is highest if mum gets chickenpox before what time during pregnancy

A

BEFORE 20 weeks gestation

or between 2-5 days before birth

PC: skin scars, eye defects (microphthalmia), microcephaly, LD

37
Q

If pregnant woman <20 weeks gestation not immune to varicella, what should be done

A

Give VZIG asap

38
Q

How long is varicella VZIG effective up to post-exposure to chickenpox for pregnant women

A

10 days post exposure

39
Q

If pregnant woman <20 weeks gestation not immune to varicella, what should be done

A

VZIG or antivirals days 7-14 days after exposure

40
Q

What is management for gestational hypertension

A

Oral labetalol
Oral nifdepine (if asthmatic) + hydralazine

41
Q

Risk factors of neural tube defect in child

A
  1. Family history of NTD
  2. Taking antiepileptics
  3. Coeliac disease
  4. Diabetes
  5. Thalassemia trait
  6. Obese - BMI >30
42
Q

What 4 things (2 drugs) can cause folic acid deficiency

A
  1. phenytoin
  2. methotrexate
  3. pregnancy
  4. methotrexate
43
Q

Prevention of neural tube defects during pregnancy (not high risk women)

A

400mcg folic acid daily until 12th week of pregnancy

44
Q

Prevention of neural tube defects during pregnancy (in high risk women - i.e. family history of NTD, antiepileptics, coeliac, DM, thal trait, obese)?

A

5mg folic acid daily until 12th week of pregnancy

45
Q

3rd trimester 4 reasons for bleeding in pregnancy

A
  1. bloody show
  2. placental abruption - painful bleed
  3. placenta praevia - painless
    .4. vasa praevia
46
Q

2nd trimester - 3 reasons for bleeding

A
  1. spontaneous abortion
  2. hydatidiform mole - painless
  3. placental abruption - painful
47
Q

pregnant women are screened for anaemia at what times

A

Booking visit (8-10 weeks)
28 weeks

48
Q

What are NICE cut offs for when a woman should receive oral iron tablets
(a) first trimester
(b) second/third trimester
(c) postpartum

A

(a) first trimester - <11
(b) second/third trimester - <10.5
(c) postpartum - <10

49
Q

Management of iron def anaemia in pregnancy

A

Oral ferrous sulfate or fumarate

Continue for 3 months after IDA is corrected

50
Q

What are the SSRIs of choice in breastfeeding women

A

Sertraline
Paroxetine

51
Q

Which SSRI can accumulate in breast milk and so is avoided

A

FLUOXETINE

52
Q

Nausea and vomiting NICE recommendations

A
  • Natural remedies of ginger and acupuncture on p6 (by the wrist)
  • Antihistamines - promethazine and cyclizine are first line
53
Q

Vitamin D recommendations by NICE during pregnancy

A

10mcg per day

54
Q

Alcohol advice by NICE for pregnancy

A

Avoid throughout pregnancy

55
Q

after woman has given birth with gestational diabetes, how long should you wait before doing fasting glucose sample to check for diabetes post-partum?

A

6 weeks after birth

56
Q

what 3 things cause increased AFP during pregnancy

A
  1. pregnancy
  2. neural tube defects (memingocele, myelomeningocele, anecephaly)
  3. abdominal wall defects (omphalocele, gastroschisis)
57
Q

what 3 things in pregnancy cause decreased AFP

A
  1. Down’s syndrome
  2. Trisomy 18
  3. maternal diabetes
58
Q

sertraline risks during pregnancy

A

1st trimester = congenital malformations including CVS
2nd trimester = pulmonary HTN
3rd trimester = risk neonatal withdrawal

59
Q

is warfarin safe to use in breastfeeding

A

YES

60
Q

what pathogen is the most common cause of neonatal sepsis

A

Group B strep

61
Q

puerperal (post-partum) pyrexia (38oC) may be defined by fever in what timeframe

A

within first 14 days following delivery

62
Q

5 causes of puerperal pyrexia (fever >38oC) within 14 days of delivery

A
  1. endometritis
  2. UTI
  3. wound infections (tears, c-section)
  4. mastitis
  5. VTE
63
Q

If endometritis is suspected in primary care what is the next step

A

SEND TO HOSPITAL
for IV antibiotics

64
Q

suspected cases of rubella in pregnancy - what is appropriate management

A

should be discussed with the local Health Protection Unit

65
Q

Post-natal depression is seen in around what % of women

A

10%

65
Q

A nuchal scan is performed at 11-13 weeks. 3 causes of an increased nuchal translucency are

A

Down’s syndrome
congenital heart defects
abdominal wall defects

66
Q

3 causes of hyperechogenic bowel of a foetus on ultrasound

A

cystic fibrosis
Down’s syndrome
cytomegalovirus infection

67
Q

What is the current recommended combined screening (between 11 - 13+6 weeks) tests for Down’s syndrome?

A

Nuchal translucency
B-HCG
Pregnancy associated plasma protein A

68
Q

What tests are in quadruple test (between 15 - 20 weeks combined screening) for Down’s syndrome?

A

alpha-fetoprotein
unconjugated oestriol
hCG
inhibin A

69
Q

Galactocele occurs in those who recently stopped breastfeeding due to occlusion of a lactiferous duct. A build up of milk creates a cystic lesion. Do they need to be investigated?

A

NO!

70
Q

The main cause of itch without an associated rash in pregnancy is …

A

obstetric cholestasis

71
Q

The symphysis-fundal height (SFH) is measured from

A

top of the pubic bone to the top of the uterus in centimetres

72
Q

symphysis-fundal height (SFH) should match the gestational age in weeks to within 2 cm after how many weeks

A

after 20 weeks

e.g. if 24 weeks then the a normal SFH = 22 to 26 cm

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