Obstetrics Flashcards
When should you give the first dose of Anti-D prophylaxis to rhesus negative women?
28 weeks
What is the treatment of choice for pregnancy-induced hypertension?
Labetalol
Clinical features of placental abruption?
- Shock out of keeping with visible losses
- Pain constant
- Tender, tense uterus
- Normal lie and presentation
- Fetal heart: Absent/distressed
- Coagulation problems
- Beware of pre-eclampsia, DIC, Anuria
When does the anomaly scan take place?
18-20+6 weeks
Indications for a woman to receive 5mg of folic acid?
- Either partner has a NTD, they have had in a previous pregnancy affected by NTD, FH of NTD
- Woman is taking anti-epileptic drugs or has coeliac disease, diabetes or thalassaemia trait
- Woman is obese
What are the causes of Oligohydramnios?
- PPROM
- Potter sequence (bilateral renal agenesis + pulmonary hypoplasia)
- Intrauterine growth restriction
- Post-term gestation
- Pre-eclampsia
What is the preferred method of smoking cessation in pregnant women?
Nicotine replacement therapy
What is placenta accreta?
Chorionic Villi attach to the myometrium, rather than being restricted within the decidua basalis
What is placenta increta?
Chorionic Villi invade into the myometrium
What is placenta percreta?
Chorionic villi invade through the perimetrium
What is the first-line anti-hypertensive for pre-eclampsia in women with severe asthma?
Nifedipine
What are the antidepressants of choice for breastfeeding women?
Paroxetine or Sertraline
What is the first-line investigation for confirming PPROM?
Sterile speculum examination
To look for pooling of amniotic fluid in the posterior vaginal vault
What is the treatment for magnesium sulphate induced respiratory depression?
Calcium gluconate
What should be monitored during treatment with MgSO4?
Urine output, reflexes, respiratory rate and oxygen saturations
What is the first line investigation for reduced fetal movements?
handheld doppler should be used to confirm fetal heartbeat
When should fetal movements be established by?
24 weeks gestation
What is the antibiotic of choice for GBS prophylaxis?
Benzylpenicillin
What are the high risk factors for developing pre-eclampsia?
- Hypertensive disease in a previous pregnancy
- Chronic Kidney disease
- Autoimmune disease such as SLE or APS
- T1 or T2 diabetes
- Chronic hypertension
What are the moderate risk factors for developing pre-eclampsia?
- First pregnancy
- Ages 40 or older
- Pregnancy interval of more than 10 years
- BMI of 35kg/m2 or more at first visit
- FH of pre-eclampsia
- Multiple pregnancy
Who should receive aspirin in pregnancy and at what dose?
> 1 high risk factor
2 moderate risk factor
Should take 75-150mg daily from 12 weeks gestation until the birth
What is Gravida?
The total number of pregnancies a woman had
What is Para?
The number of times a woman has given birth after 24 weeks of gestation regardless of whether the fetus was alive or still born
When is the first trimester of pregnancy?
Start of pregnancy until 12 weeks gestation
When is the second trimester of pregnancy?
13 weeks until 26 weeks of gestation
When is the third trimester of pregnancy?
27 weeks until birth
What vaccines are offered to all pregnant women?
Whooping cough (pertussis) from 16 weeks pregnancy
Influenza when available in autumn or winter
What does smoking in pregnancy increase the risk of?
- Fetal growth restriction
- Miscarriage
- Stillbirth
- Preterm labour and delivery
- Placental abruption
- Pre-eclampsia
- Cleft lip or palate
- SIDS
What is the combined test?
Used as first line to screen for Down’s Syndrome.
It is performed between 11-14 weeks and is combined results from ultrasound and maternal blood tests.
What tests are involved in the combined test?
- Ultrasound which measures nuchal translucency, which is the thickness of the back of the nexk of the fetus
- Maternal blood tests
- Beta-HCG- a higher result indicates Down’s syndrome
- Pregnancy associated plasma-protein A - a lower result indicates a greater risk
What anti-epileptic drugs can be used in pregnancy?
Levetiracetam
Lamotrigine
Carbamazepine
When are babies termed as being large for gestational age?
When the weight of the newborn is more than 4.5kg at birth.
During pregnancy, an estimated fetal weight above the 90th centile is considered large for gestational age.
What are the best outcome for a twin pregnancy?
Diamniotic, Dichorionic twin pregnancies as each fetus has their own nutrient supply
When does a twin-twin transfusion occur?
When two fetuses share a placenta
Why does pre-eclampsia occur?
Occurs after 20 weeks gestation when the spiral arteries of the placenta form abnormally leading to a high vascular resistance in the vessels
What is pre-eclampsia a triad of?
- Hypertension
- Oedema
- Proteinuria
What happens in HELLP syndrome?
Haemolysis
Elevated Liver Enzymes
Low Platelets
Glucose cut offs for Gestational diabetes?
Fasting 5.6
After 2 hours 7.8
What is acute fatty liver of pregnancy?
Results from impaired processing of fatty acids in the placenta. This is the result of a genetic condition in the fetus that impairs acid metabolism
What is a low-lying placenta?
When the placenta is within 20mm of the internal cervical os
What are some risk factors for Placenta Praevia?
- Multiple C-sections
- Previous placenta praevia
- Older maternal age
- Maternal smoking
- Structural uterine abnormalities
- Assisted reproduction
What is Vasa Praevia?
Condition where the fetal vessels are within the fetal membranes and travel across the internal cervical os.
The fetal membranes surround the amniotic cavity and developing fetus
Risk factors for placenta accreta?
- Previous placenta accreta
- Previous endometrial curettage procedures
- Previous caesarean c sections
- Multigravida
- Increased maternal age
- Low-lying or placenta praevia
What are the three major causes of cardiac arrest in pregnancy?
- Obstetric haemorrhage
- PE
- Sepsis
When should you consider C-Section in pregnant cardiac arrest?
- If there is no response after 4 minutes to CPR performed correctly
- CPR continues for more than 4 minutes in a woman of more than 20 weeks gestation
What is the first stage of labour?
From the onset of labour (true contractions) until 10cm cervical dilatation.
What is the second stage of labour?
From 10 cm of cervical dilatation until the delivery of the baby
What is the third stage of labour?
From delivery of the baby until delivery of the placenta
What are the signs of labour?
- Show (mucus plug from the cervix)
- Rupture of membranes
- Regular, painful contractions
- Dilating cervix on examination
What is a prolonged rupture of membranes?
The amniotic sac ruptures more than 18 hours before delivery
How is secondary amenorrhoea defined?
Secondary amenorrhoea is the absence of menstruation for 6 months or longer in a woman with previously present menstrual cycles
What is the management of amniotic fluid embolism?
- The patient should be managed in ITU
- If PE has occured before delivery then continuous fetal monitoring is necessary
- Treatment is large supportive
What investigations should you do for Vasa praevia?
Bedside investigations - RR, BP, Oxygen sats, Pulse, Temp
Lab investigations - FBC, U&E and LFT, Clotting, Kleihauer test, G&S, Crossmatch
USS
CTG
What would you see in HELLP syndrome?
- Haemolysis
- Elevated liver enzymes
- Low platelets
You would get raised lactate dehydrogenase (due to haemolysis)
What are the four Ts related to primary PPH?
Tone: an atonic uterus accounts for up to 80% of cases
Trauma: Perineal tears, lacerations and/or episiotomy
Tissue: Retained products of conception
Thrombin: Underlying disorders of clotting
What is the management of PPH caused by Atony?
- Pharmacological: Uterotonic drugs (Oxytocin, syntometrine, carboprost, misoprotstol)
- Mechanical: Rub the uterine fundus to stimulate contractions and/or bimanual compression
-Surgical: Intra-uterine balloon tamponade and haemostatic sutures. Hysterectomy in life-threatening conditions
When should you deliver in Vasa praevia?
Elective C-Section at 34-36 weeks
Who should get an OGTT to screen for gestational diabetes?
- BMI >30kg/m2
- Previous macrosomic baby (>4.5kg)
- First degree relative with diabetes
- Previous gestational diabetes
- Ethnicity with a higher prevalence of diabetes
What is the gold-standard management of Twin-to-twin transfusion syndrome?
Fetoscopic laser ablation
What is the first line treatment for pregnant women with varicose veins?
Reassure and offer compression stockings
What is Hydrops fetalis?
The abnormal accumulation of fluid in the fetus’s body cavities (pleura, pericardium peritoneum) and soft tissues.
Why does Hydrops Fetalis occur?
Either immune or non-immune in origin
Immune-related results from alloimmune haemolytic disease or Rh isoimmunization
Nonimmune-related results from primary myocardial failure, high-output cardiac failure, decreased colloid oncotic plasma pressure, increased capillary permeability or obstruction of venous or lymphatic flow.
Fetal cardiac abnormalities are the most common cause followed by chromosomal abnormalities
What are the signs of labour?
- Regular and painful uterine contractions
- A show (shedding of mucous plug)
- Rupture of the membranes
- Shortening and dilation of the cervix
What lie needs intervention?
Transverse lie
What is the management for Preterm premature rupture of membranes?
Antibiotics (Erythromycin) Should be given for 10 days or until the woman is in established labour.
Also recommend steroids are given until 33 weeks’6days’ gestation
What is symphysis pubis dysfunction?
Ligament laxity increases in response to hormonal changes of pregnancy
What causes an increased AFP?
- Neural tube defects
- Abdominal wall defects
- Multiple pregnancy
What causes a decreased AFP?
Trisomy 21
Trisomy 18
Maternal Diabetes mellitus
What is Chorioamnionitis?
A potentially life threatening condition to both mother and foetus. Ascending bacterial infection of the amniotic fluid/membranes/placenta
What is human chorionic gonadotropin produced by?
Produced by the embryo and later the placental trophoblast.
Its main role is to prevent the disintegration of the corpus luteum
What is the management of Intrahepatic cholestasis of pregnancy?
- Induction of labour at 37-38 weeks
- Ursodeoxycholic acid
What is Lochia?
Lochia may be defined as the vaginal discharge containing blood mucous and uterine tissue which may continue for 6 weeks after childbirth.
What are the causes of Oligohydramnios?
- premature rupture of membranes
- Potter sequence
bilateral renal agenesis + pulmonary hypoplasia - intrauterine growth restriction
- post-term gestation
- pre-eclampsia
What is a first degree tear?
- Superficial damage with no muscle involvement
What is a second degree tear?
- Injury to the perineal muscle but not involving the anal sphincter
What is a third degree tear?
Injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
What is a fourth degree tear?
- Injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa
What are some causes of puerperal pyrexia?
- Endometritis: most common cause
- UTI
- Wound infection
- Mastitis
- VTE
What is the management of Shoulder dystocia?
McRoberts’ manoeuvre
then can used episiotomy
After what time post partum do women require contraception?
21 days
How long do you expect lochia to continue?
6 weeks after childbirth
When does gestational diabetes screening take place?
24-28 weeks gestaition
If a woman had gestational diabetes in a previous pregnancy, when should
screening for gestational diabetes take place?
As soon as possible after booking AND at 24-28 weeks
What test must all pregnant women with established T2DM undergo during
pregnancy to monitor for diabetes complications?
Retinopathy screening
When can you diagnose gestational hypertension?
New HT after 20 weeks gestation
Systolic >140 Diastolic >90
No or little proteinuria
What is the medical option for women that refuse insulin or do not tolerate metformin in GDM?
Glibenclamide
What is the definition of Antepartum haemorrhage?
Bleeding from anywhere in the genital tract after the 24th week of pregnancy
When does Haemolytic disease of the newborn occur?
When Rhesus positive babies are born to Rhesus negative mothers
What is the mechanism for Ovarian hyperstimulation syndrome?
An increase in vascular endothelial growth factor (VEGF) released by the granulosa cells of the follicles. VEGF increases vascular permeability, causing fluid to leak from capillaries. Fluid moves from the intravascular space to the extravascular space. This results in oedema, ascites and hypovolaemia.
