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CFPC exam KM > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Definition of inevitable abortion

A

Cervix dilated, no products expelled

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2
Q

Definition of septic abortion

A

spontaneous abortion complicated by uterine infection

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3
Q

Definition of incomplete abortion

A

some but not all products expelled, retained products

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4
Q

Definition of complete abortion

A

all products expelled

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5
Q

Definition of missed abortion

A

fetal demise but no uterine activity

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6
Q

Definition of recurrent abortion

A

> / consecutive pregnancy losses

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7
Q

Risk factors for spontaneous abortion

A

Advanced maternal age
Thrombophilia, autoimmune disease
Infection
Previous SA
Uterine abnormalities

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8
Q

Investigations for spontenous abortion

A

Beta HCG
CBC
Group and screen ?Rho
G and C
US

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9
Q

When to give Anti-D and what dose in spontaneous abortion

A

If Rh Neg administer Anti D (<12 week give 120 IM, >12 week give 300 IM)

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10
Q

Management options of spontaenous abortion

A
  • Expectant management
  • Misoprostol 800 mcg vaginally and then in 24-72h if no bleeding
  • RhoGAM if Rh negative
  • Vacuum aspiration if hemodynamically unstable or septic
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11
Q

Preabortion care

A

Discuss options such as term bityh, abortion adoption
Discuss methods
Discuss risks
Support and confirmation that decision is voluntary
Emotional neds, values, coping abilites
Discuss future contraception

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12
Q

What is included and discussed in consent for medical abortion

A
  1. MA involves using drugs to end pregnancy
  2. Mifeprostine 200mg oral and misoprostol 800mcg vaginally are as effective as SA before 49d after LMP, and highly effective up to 70d after LMP
  3. MA is irreversible but does not eliminate the need for SA. If ongoing pregnancy then SA if recommended.
  4. Must have access to medical care for 7-14d after medication taken
  5. Risks include: bleeding, cramping/pelvic pain, GI upset, headaches, fevers/chills, pelvic/lower gential infection, mortality is 0.3 per 100 000 usually from infection or undiagnosed ectopic.
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13
Q

Medical evaluation prior to abortion

A

bHCG, CBC, Rh ABO, STI screen
Determine gestational age and pregnancy location with medical history/LMP, gyne exam and US

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14
Q

Absolute and relative contraindications to MA

A

Absolute:
Ectopic
Chronic adrenal failure
Inherited porphyria
Uncontolled asthma

Relative:
Unconfirmed GA
IUD
Concurrent systemic corticosteroids
Hemorrhagic disorder
Concurrent antioag

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15
Q

Regimen for MA

A

If Rh neg and 49d give Rh immunoglobulin 24h prior to MA
Day 1: Mifepristone, Day 2-3 Misoprostol
Day 14: FU: US, decrease in bHCG more than 80% and contraception

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16
Q

When to swab to GBS

A

35-37w

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17
Q

Management for GBS

A

IV penicillin during labour or Cefazolin if penicillin allergy

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18
Q

When to give prophylactic abx for GBS and immediate delivery

A

PROM/in labour >37w and any of the following:
- GBS swab +
- Previous infant with GBS
- GBS bacteremia in currenty preg

> / 37 weeks unknown GBS and ROM >18h

Give 48h of IV abx if ROM/inlabour <37 and unknown or positive GBS

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19
Q

Reasons for induction of labour

A
  • Spontaneous ROM
  • IUGR
  • Decreased fetal movement
  • Post dates
  • Pre-eclampsia
  • Maternal conditions: T2DM, renal dz, pulmonary dz, PIH
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20
Q

Risks of induction of labour

A
  • Increased risk of operative delivery
  • Abnormal FHR
  • Uterine rupture
  • Cord prolapse
  • Wrong dates/ pre-term infant
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21
Q

Contraindications of induction of labour

A
  • Previous uterine rupture
  • Fetal transverse lie
  • Placenta previa/vasa previa
  • Invasive cervical cancer
  • Active gential herpes
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22
Q

Bishop score

A

Points: 0 -1 - 2 -3
Dilation: 0 - 1 to 2 - 3 to 4 - 5 to 6
Effacement: 0 to 30 - 40 to 50 - 60 to 70 - 80
Station: -3 - -3 - -1/0 - +1+2
Consistency: firm - med - soft - X
Position: posterior - mid - anterior - X

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23
Q

Options for cervical ripening

A
  • Intracervical/Intravaginal PGE Prepidil 0.5mg q6-12h up to 3 doses - do not use in VBAC
  • Foley catheter (increased need for oxytocin, can use in VBAC, slower than PGE)
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24
Q

Definition of labour dystocia

A
  • During active first stage of labour >4 hours or <0.5cm/hr dilation or 0 cm/2hr
  • During second stage >1hr with no descent during active pushing nullparious >3hr with regional anesthetic or 2h without; parous >2hr with regional anaesthetic or 1hr without
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25
Q

Etiology of labour dystocia

A

Power - leading cause, inadequate maternal effort, poor contractions
Passenger - fetal position, size, anomalies
Passage - pelvic structure, maternal soft tissue factors
Psyche - psyche, anxiety, pain

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26
Q

Approach to non-reassuring fetal heart rate

A

Fetal tracing
Call fo help
LLD position
100% O2
Stop oxytocin
Correct low BP
Fetal scalp monitor
R/o cord prolapase
Look for causes ?infection ?drugs

27
Q

What to rule out with variable decelerations

A

60s (severe): <60bpm, <60bpm from baseline, >60 with slow return to baseline

28
Q

What is placental abruption

A

Premature separation of placenta after 20w

29
Q

Risk factors for placental abruption

A

Previous hx, HTN, vascular dx, smoking, ETPH, multiparity, increased age, PPROM, uterine abnormalities, trauma

30
Q

Symptoms and signs of placental abruption

A

Painful vaginal bleeding, sudden onset, constant, localised to lower back and uterus, +/- fetal distress

31
Q

Complications of placental abruption

A

Neonatal: fatality, prematurity, hypoxia
Maternal: mortality, DIC, ARF, anemia, shock, pituitary necrosis, amniotic fluid embolism

32
Q

Ix and management of placental abruption

A

US on 15% sensitive. CBC, fibrinogen, type and cross

Stabilize, monitors, blood products, may need c/s

33
Q

Management of PROM

A

GBS status - if + or unknown then start abx
Consider Celestone if preterm
If term and GBS - can wait 24h prior to induction

34
Q

Investigations of preterm labour

A

Fetal fibronectin, US for cervical length

35
Q

Management of preterm labour

A

Consider Celestone 12mg IM q24h x 2
Bed rest.
Tocolytics: nifedipine or indomethacin

36
Q

What to do if imminent preterm birth and </ 33 + 6

A

D/C tocolytic and consider antenatal magnesium sulfate 4g IV loading dose over 30 min +/- 1g/hr (max 12h) for fetal neuroprotection.

37
Q

Definition of shoulder dystocia

A

Impact of anterior shoulder on symphysis pubis after delivery of the head

38
Q

Risk factors for shoulder dystocia

A

Obesity, DM, multiparity, macrosomia, increased gestation, prolonged second stage, advanced maternal age, induction

39
Q

Management of shoulder dystocia

A

ALARMER
A: Apply suprapubic pressure / Ask for help
L: Legs in full flexion
A: Anterior shoulder disimpaction
R: Release posterior shoulder
M: Manual corkscrew
E: Episiotomy
R: Roll over hand and knees

40
Q

Risks for uterine rupture

A

Previous uterine scar - classical higher risk.
Oxytocin, grand multip, previous uterine manipulation.

41
Q

Complications for uterine rupture

A

Maternal mortality, hemorrhage, shock, abnormal FHR

42
Q

Management of uterine rupture

A

R/O abruption, immediate delivery

43
Q

Definition of first stage of labour

A

Regular contractions causing cervical dilation
Dystocia >4 h of <0.5cm / hr dilation or 0cm / 2 hr

44
Q

Definition of latent first stage of labour

A

Complete when nulliparous >/4cm, parous 4-5cm
Cervical length generally <1cm

45
Q

Definition of active first stage of labour

A

Starts when nulliparous >/4cm, parous >4-5cm

46
Q

Definition of second stage of labour

A

Full dilation to delivery of baby
Dystocia >1hr of active pushing without descent of the presenting part

47
Q

Definition of third stage of labour

A

Immediately after delivery of baby to delivery of placenta

48
Q

Definition of forth stage of labour

A

Immediately after delivery of placenta to 1h postpartum

49
Q

When to use continuous EFM in labour

A

Decelerations or abnormal intermittent auscultation, single umbilical artery, velamentous cord insertion, >/3 nuchal loops of cord, combined spinal-epidural anesthetic, labour dystocia, FHR arrhythmia, pre pregnancy BMI >35

50
Q

Etiology of postpartum hemorrhage

A

Tone: uterine atony, prevent by giving oxytocin with delivery of ant shoulder
Tissue: retained placenta or clot
Trauma: laceration, hematoma, rupture
Thrombin: coagulopathy, DIC

51
Q

Management of postpartum hemorrhage

A

Oxytocin 20U/L NS IV continuous infusion
Ergotamine 0.25mg IM q5min up to 1.25mg - causes smooth muscle contraction
Hemabate 0.25mg IN q15min tp to 2mg - prostaglandin

May require D and Cm laparotomy with ligation of urine arteries, hysterectomy +/- angio embolization

52
Q

Management of retained placenta

A
  • Explore uterus and assess blood loss
  • 2 large bore IVs
  • Type and screen
  • Firm traction on umbilical cord with suprapubic pressure and oxytocin 10 IU in 20ml NS
  • Manual removal - D and C
53
Q

Definition of postpartum fever

A

Fever >38 on any 2 of the first 10 days postpartum, not including first day

54
Q

Etiology of postpartum fever

A

Wind - pneumonia, atelectasis
Wound - episiotomy site, incisions
Water - UTI
Walking - DVT
Womb - endometritis
Breast - mastitis

55
Q

Empiric treatment for wound infections in postpartum

A

Clindamycin and Gentamicin

56
Q

When to give rhogam post partum

A

Give 300ug IM within 72 hours of delivery if infant is RH positive

57
Q

Contraception counselling postpartum

A

Non lactating - OCP 3 weeks post partum
Lactating - Micronor 6 weeks PP and change to OCP when supplemental feeding or OCP at 3 months if breastfeeding exclussively
IUD - 6 weeks PP

58
Q

Post partum blues onset and length

A

Onset 3-10 days, doesn’t last longer than 2 weeks

59
Q

Numbers for gestational diabetes

A

50g OGCT <7.8
If 7.8 - 11.1 order 2h 75g OGTT

60
Q

Target HbA1c and BG for gestational diabetes

A

<6
2h post pranial <6.7
1h post pranial <7.8

61
Q

Monitoring in gestational diabetes

A

Monitor growth q3-4 weeks starting at 24weeks
offer induction 38-40 weeks
Monitor newborn for hypoglycemia

62
Q

Number for severe hypertension in pregnancy

A

Higher than 160/110

63
Q

How long? to avoid pregnancy following live vaccines

A

Four weeks

64
Q

When to give tdap during pregnancy

A

between 21 and 32 weeks

CFPC exam KM (16 decks)

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