Obstetrics Flashcards
What is McRoberts manoeuvre?
Supine with hips fully flexed and abducted -> shoulder dystocia
What are the SSRI drugs of choice for breastfeeding women?
Sertraline or Paroxetine
How to manage reduced foetal movements?
- Handheld doppler
- US scan
Respiratory distress, hypoxia, and hypotension within 30 mins of delivery suggests what?
Amniotic fluid embolism
What is the management of PPH secondary to uterine atony?
Syntocin then ergometrine
Management of low lying placenta at 20 weeks?
Re-scan at 32 weeks
How to investigate suspected placenta praveia?
Transvaginal US
When is CVS done?
11 weeks to end of 13
When is amniocentesis done?
Week 15 onwards
How should suspected cases of rubella be managed?
Discussion with local health protection unit
What is involved in combined screening?
- Nuchal translucency
- bHCG
- PAPPA
What is the most common cause of PPH?
Placentra increta
What are risk factors for placental abruption?
increasing maternal age, multiparity and maternal trauma
An ultrasound is indicated after how many weeks of lochia?
6 weeks
When should aspirin be taken for pre-eclampsia?
12 weeks until delivery
What is wood screws manoeuvre?
Put the hand in the vagina and attempt to the foetus by 180 degrees
What should you monitor when you give magnesium sulfare for eclampsia?
- Reflexes and respiratory rate
What is a C/I to ECV for a transverse lie baby?
If the amniotic sac has ruptured
What is the medical management of miscarriage?
Vaginal misoprostol
Management of cord prolapse when it is past the level of the introitus?
Avoid handling and keep warm/moist to avoid vasospasm
Management of reduced foetal movements
- Handheld doppler
- If heartbeat, CTG
- If no heartbeat, US scan
First line investigation for preterm prelabour rupture of membranes?
Speculum exam to look for pooling of fluid in the posterior vaginal vault
Management of PE in pregnant women?
Treat with LMWH first then investigate
Management of woman with BP > 160/110
Admit for observation
When is the latest that women can travel via plane?
37 weeks for single pregnancy
32 weeks for twins
General malaise, anorexia, vomiting, jaundice in third trimester?
Acute fatty liver of pregnancy
What are the blood results for acute fatty liver of pregnancy?
- elevated liver enzymes
- prolonged PT
- raised bilirubin
What is the management of AFLP?
- Delivery of foetus
- Ongoing monitoring of LFTs
- Stabilise mother
A blighted ovum suggests what?
Ovum with no embryonic tissue -> missed miscarriage
What infection can occur following delivery of foetus?
Endometritis
Women with grade III/IV placenta praevia should be offered what?
Elective C-section at 37-38 weeks
APH definition
Bleeding from the genital tract after 24 weeks’ gestation.
Signs of placental abruption/shock but minimal bleeding?
Blood is retroplacental -> not escaping from the uterus
What would you expect to see on clotting studies after a major
abruption?
Afibrinogenemia as you get DIC which uses up clotting factors and fibrinogen
Which medication is used to suppress lactation when breastfeeding?
Cabergoline
BP >160/110
Admission to maternal unit for observation
Dizziness, electric shock sensations and anxiety
SSRI discontinuation syndrome
Bladder still palpable after urination
Urinary overflow incontinence
Management of pregnant woman with VTE history?
LMWH throughout pregnancy + 6 weeks after
What is an amniotic fluid embolism?
Where the amniotic fluid enters the maternal circulation causing PE like symptoms
What is the management of amniotic fluid embolism?
- ICU
- Oxygen and fluid resus
- CTG for foetal monitoring if before delivery
When does puerpueral psychosis often present?
Within 3-5 days of delivery
What is the probable cause of baby blues?
Change in hormone levels
How to check for mag sulph toxicity when given for eclampsia?
Reflexes
What are the components of bishop score?
Station
Consistency of cervix
Os position
Cervical dilatation
Effacement
Why is DVT more common in left leg than right in pregnancy women?
Gravid uterus puts greater pressure on the left iliac vein at the point it crosses the left iliac artery, slowing venous return to the heart.
What are the risks of obstetric cholestasis?
Premature delivery
Stillbirth
Sleep deprivation of mother
What are risk factors for cord prolapse?
- Polyhydramnios
- Prematurity
- Abnormal lie
- AROM
- Breech presentation
What can be helpful in cord prolapse?
Insert a urinary catheter and fill the bladder with saline
What are associated defects with anti-epileptics in pregnancy?
Orofacial
Neural tube
Congenital heart disease
Haemorrhagic disease of newborn
Primary herpes in third trimester?
Oral aciclovir 400mg tds until delivery
Suspected PE in someone with confirmed DVT?
Treat with LMWH first then scan
What should be prescribed for breastfeeding mothers who are omitting dairy from diet in suspected CMPI?
Calcium + Vit D
Management of asthma attack in pregnancy?
Admission - even if symptoms improve
Management of hypothyroidism in pregnancy?
Increase thyroxine by 25 and repeat TFT in 4 weeks
What is the biggest risk factor for cord prolapse?
Artificial ROM
Other include prematurity, multiparty, twin pregnancy
How should cord prolapse be managed?
- Push presenting part of foetus back into uterus to avoid compression
- If past level of Introits, do not handle and keep warm/moist to avoid vasospasm
What should be done in pregnant women treated for UTI?
Urine culture
serum bHCG levels >1,500 points
Think ectopic
Pre eclampsia symptoms?
- Headache
- Oedema
- Vision changes
- Epigastric/RUQ pain
- HTN
What is associated with pre eclampsia?
HELLP - Haemolysis, elevated LFTs, low platelets
What anatomical landmark is used to determine the station of the foetal head?
Ischial spines
Combined screening features?
- Done between 11 and end of 13 weeks
- Nuchal translucency, serum BHCG and PAPP-A
Quadruple test features?
- AFP, unconjugated oestriol, HCG, inhibin A
Management of abnormal results of combined/quadruple screening?
- Non-invasive prenatal testing
- Amniocentesis
- Chorionic villus sampling
What are are indications for expectant management of ectopic?
- Size <35mm
- Unruptured
- No symptoms
- No heartbeat
- HCG < 1000
- Closely monitor patients over 48 hours and recheck hCG
What are indications of surgical management of ectopic?
- Size >35mm
- Ruptured
- Pain
- Visible heartbeat
- HCG >5000
Management of chickenpox exposure in pregnant?
- Check VZV antibodies
- If not present, give oral Aciclovir from day 7-14 of exposure
Management of chickenpox in pregnancy?
- Specialist advice
- Give oral aciclovir if >20 weeks pregnant and presents within 24 hours of onset of rash
UTI in third trimester?
Treat with amoxicillin or cefalexin
Management of woman in early stages of labour with transverse lie?
Can do ECV if membranes have not ruptured
Placenta accreta vs increta vs percreta
Accreta - where the placenta adheres to the myometrium
Increta - where the placenta invades into the myometrium but not through
Percreta - where the placenta invades through the full thickness of the myometrium
Foetal anomalies which can result in death?
Termination of pregnancy can be at any point in pregnancy
Membrane sweep vs prostaglandin?
Membrane sweep is a labour adjunct not a method of induction
PPH management
- ABCDE
- Palpate fundus to stimulate contractions + catheterise
- IV Oxytocin
- IV/IM Ergometrine (C/I in HTN)
- Carboprost (C/I in asthma)
- Surgical: intrauterine balloon tamponade
Risk factors for cord prolapse?
- Breech/transverse lie
- Multiple pregnancy
- Polyhydramnios
- Multiparity
What is the process of rhesus disease?
- Rhesus negative mother has a rhesus positive foetus and produced anti-RH antibodies
- During next pregnancy, these cross the placenta and cause haemolysis of foetal RBC causing rhesus haemolytic disease of newborn
When does uterus normally return to pre pregnancy size?
4 weeks
What BMI should take higher dose of folic acid?
> 30
What drug can be given to improve the success of ECV?
Terbutaline
What swab can be done to confirm pre labour rupture of membranes?
Actim-PROM vaginal swab
Instrumental deliveries can increase the risk of what?
PPH
What is given prophylactically before a C-section?
Omeprazole
Perineal tears classification
First - limited to superficial skin
Second - Into perineal muscles but not affecting sphincters
3a - <50% of sphincter, 3b - >50% of sphincter
Fourth - Skin, muscle sphincters and anal mucousa torn
Bloods for pre eclampsia monitoring?
U+E,FBC,LFTs and bilirubin
Twice a week for mild, Thrice a week for severe
What is Sheehan’s syndrome?
Post partum pituitary necrosis due to blood loss and hypovolaemia shock immediately after delivery
Which nerve is blocked during instrumental delivery?
Pudendal
What are the components of the quadruple test?
- Serum oestriol
- hCG
- AFP
- inhibin-A
Most specific test for intrahepatic cholestasis of pregnancy?
Bile acids
lambda sign of US is a sign of what?
Dichorionic diamniotic twin pregnancy
Stages of labour
1 - Latent: 0-3cm dilation
1 - Active: 3cm-10cm dilation
2 - Full dilation to delivery of foetus
3 - Delivery of foetus to delivery of placenta
