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Obstetrics Flashcards

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1
Q

RF for hyperemesis gravidarum

A

obesity
nulliparity
non-smoker
multiple pregnancy
Hydatidiform mole (molar pregnancy)

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2
Q

APGAR score components
max score and is this good or bad?
Range for a good score

A

Appearance - 0 cyanosis all over, 1 peripheral cyanosis, 2 pink
Pulse - 0 0, 1 <100, 2 100-140
Grimace - 0 no response on stimulation, 1 weak response 2 crying on stimulation
Activity (tone) - 0 floppy 1 some flexion 2 well flexed and resisting extension
Resp - 0 apnoeic 1 slow irregular 2 strong crying

10 GOOD!!
7-10 is good

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3
Q

rf for ectopic pregnancy

A

increasing age
prev ectopic
prev gynae surgery
prev PID
Coil
Smoking

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4
Q

4 types of miscarriage and the features

A

threatened - painless bleeding, os closed
inevitable - painful heavy bleeding, os open
missed - no symptoms but has occured
incomplete - incomplete expulsion of tissues

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5
Q

talk through down syndrome screening

A

see geeky medics flow chart for answer

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6
Q

signs and sx of amniotic fluid embolism
when does it occur

A

during labour
chills, sob, cyanosis, hypotension, coughing

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7
Q

how long should you take folate for and what dose
what if you are high risk for neural use defect

A

for 3 months pre pregnancy and first 12 weeks
400 micrograms
5mg if high risk

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8
Q

what constitutes as high risk for neural tube defects during pregnancy

A

Previous pregnancy with neural tube defect
you or the baby’s biological father have a neural tube defect
you or the baby’s biological father have a family history of neural tube defects
you have diabetes
you’re very overweight
you have sickle cell disease
you’re taking certain epilepsy medicines
you’re taking antiretroviral medicines for HIV

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9
Q

when are the 2 doses of anti D given

A

28 and 34

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10
Q

when is presentation checked and ECV offered if needed

A

36 weeks

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11
Q

when is a pregnancy considered term

A

37 weeks

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12
Q

2 top causes of antepartum haemorrhage. Compare their presentations

A

placenta abruption and praevia

abruption - painful bleeding, woody uterus, coat disturbances, shock > visible bleeding

Praevia - painless bleeding, may have abnormal lie or presentation

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13
Q

Rx of placental abruption if >36 weeks and no/fetal distress
Rx if <36weeks with no and fetal distress

A

> 36 distress - EmCS
36 no distress - vag delivery
<36 distress - EmCs
<36 no distress - observe, steroids

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14
Q

what bp would you admit a pregnant lady for observation regardless of whether she has symptoms

A

> 160/110

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15
Q

SSRIs of choice when breastfeeding

A

sertraline or paroxetine

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16
Q

methods of TOP and when is each done ie medical and surgical

A

medical usually before 9 weeks - mifepristone followed by misoprostol
surgical - 10+weeks - cervical dilation followed by either suction or evacuation (forceps)

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17
Q

is anti d needed for rhesus neg women in top

A

only if >10 weeks

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18
Q

who should take 5mg of folic acid instead of the usual 400 micrograms

A

fhx of NTD
mum or partner pmhx of NTD
taking anti epileptic meds
BMI>30

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19
Q

what should women on phenytoin be given in the last month of pregnancy and why

A

vit k to prevent clotting disorders in the newborn

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20
Q

breastfeeding and epileptics

A

generally safe with possible exception of barbiturates

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21
Q

RF for gestational diabetes

A

prev gestational diabetes
prev macrosomic baby
BMI >30
first degree relative that had it

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22
Q

screening for gestational diabets - who, how and when

A

those at high risk
OGTT is gold standard
done asap after booking. If normal then repeat at 24-28 weeks

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23
Q

diagnostic thresholds for GD

A

> 5.6 fasting
7.8 random

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24
Q

rx of GD

A

if >5.6 but <7 fasting - offer 2 weeks lifestyle, then 2 weeks metformin. If no satisfactory improvement, start on short acting insulin

if fasting >7 - start on insulin

+lifestyle advice for everyone

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25
maternal and fetal complications of GD (inc pathophys for fetal)
M - HTN, increased risk of infection F - macrosomia and polyhydramnios, neonatal hypoglycaemia macrosomia caused by increase glucose, increase, insulin, increase glucose uptake polyhdramnios - increase glucose, increase fetal osmotic diuresis
26
presentation of HELLP syndrome
n+v ruq pain lethargy prev diagnosis of pre eclampsia
27
rx of HELLP
deliver baby
28
pre eclampsia triad
htn proteinuria oedema
29
criteria for pre eclampsia
new onset BP >140/90 after 20 weeks PLUS at least 1 of - proteinuria - other organ involvement eg renal insufficiency, liver problems, neurological or haematological
30
maternal and fetal complications of non severe pre eclampsia
M - eclampsia (seizures, severe headaches, blindness, stroke) PPH, liver involvement, F - IUGR, prematurity
31
Features of severe pre-eclampsia
proteinuria +++ bp >160/110 visual disturbances papilloedema hyperreflexia HELLP - ruq pain. low platelets, deranged LFTS
32
risk factors of pre eclampsia
>40 prev pre eclampsia BMI >35 fhx multiple pregnancy first pregnancy high risk - diabets - prev pre eclampsia - APL, SLE, chronic htn - CKD
33
rx of pre eclampsia
if have risk factors aspirin 75mg daily from 12 weeks until birth labetolol or nifedipine (if Asthma)
34
rx of chicken pox in pregnancy
acyclovir
35
rx of chicken pox exposure in pregnancy
if not sure whether had it before - check blood for varicella antibodies if had before - give VZIG
36
drug used for preventing and for treating seizures in eclampsia
mag sulf
37
considerations during treatment with magnesium sulphate
monitor - urine output, rr, o2 sats and reflexes IV continue for at least 24hrs after last seizure or after delivery
38
rx of mag self induced respiratory depression
calcium gluconate
39
rx of mother who tests positive for GBS
Intrapartum Abx - benpen
40
Indications for intrapartum abx
GBS carrier or prev baby with GBS pyrexia during labour preterm rupture of membranes
41
what antihypertensives are CI in pregnancy
ACEi and ARBs - risk of fetal renal damage
42
features of obstetric cholestasis
itching jaundice
43
rx of obstetric cholestasis
ursodeoxycholic acid IOL at 37-38 weeks
44
rx of placental abruption if <36 weeks ± fetal distress >36 weeks ± fetal distress
<36 no fetal distress - steroids and observe <36 with fetal distress - EmCS >36 no fetal distress - vaginal delivery >36 fetal distress - EmCS
45
maternal and fetal complications of placental abruption
m - shock, dic, renal failure, pph f - IUGR, death, hypoxia
46
causes of placental abruption
trauma, cocaine, older age, multiple pregnancy, polyhydramnios
47
4 causes of pph
Tone - uterine atony Trauma - episiotomy Tissue - placenta retention Thrombin - clotting disorder
48
rf for pph
EmCS macrocosmic baby prolonged labour increased maternal age multiparty placenta praevia polyhydramnios
49
Rx of PPH
SENIORS! A-E - cannulas - bloods inc G&S and x match - lie woman flat - catheterise to prevent bladder distension and monitor urine output - rub up the fundus -give IV uterotonics eg oxytocin, ergometrine - tranexamic acid - surgical - intrauterine balloon tamponade
50
when does secondary PPH occur and what is most likely cause
24hrs - 6 weeks after caused by placenta retention or endometritis
51
baby blues, post natal depression and puerperal psychosis comparison inc rx
BB - 3-7 days after birth, rx - reassurance PND - 1 month to 6 months rx - reassurance, CBT, sertraline/paroxetine if severe PP - 2-3 weeks rx - mother and baby unit admission. high rate of recurrence in future pregnancies
52
postpartum thyroiditis - course
thyrotoxicosis then hypothyroidism then normal rx of hyperthyroid phase is beta blockers and hypothyroid is thyroxine
53
physiological changes in pregnancy
increased CO increased tidal volume increase in clotting factors - hence increased VTE risk increased eGFR - trace glycosuria is common
54
risks associated with smoking in pregnancy
preterm labour miscarriage stillbirth IUGR SIDS
55
Fetal alcohol syndrome
wide eyes flat philtrum microcephaly epicentral folds learning difficulty IUGR
56
ix of PPROM
speculum exam to observe any pooling if non observed - AMNIsure or USS for oligohydramnios
57
complications of PPROM
fetal: prematurity, infection, pulmonary hypoplasia maternal: chorioamnionitis
58
Rx of PPROM
admission regular observations to ensure chorioamnionitis is not developing oral erythromycin should be given for 10 days antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome delivery should be considered at 34 weeks of gestation
59
most common cause of pyrexia after delivery and rx
endometritis admit for IV clindamycin and gentamicin
60
when should fetal movements be well established
24 weeks
61
haemolytic disease of the newborn presentation
oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls) jaundice, anaemia, hepatosplenomegaly heart failure kernicterus
62
which twin type have more complications
mono amniotic, monozygotic complications inc - TTTS, spontaneous miscarriage, IUGR, perinatal mortality,
63
risk factors for cord proplapse
prematurity multiparity polyhydramnios twin pregnancy cephalopelvic disproportion abnormal presentations e.g. Breech, transverse lie
64
Rx of cord prolapse
mum on all fours, push presenting part of foetus back into uterus, minimal handling of cord and keep it warm and moist to prevent vasospasm , tocolytics eg indomethacin, nifedipine, terbutaline to reduce contractions
65
indications for induction of labour
prolonged pregnancy, e.g. 1-2 weeks after the estimated date of delivery prelabour premature rupture of the membranes, where labour does not start. maternal medical problems - diabetic mother > 38 weeks - pre-eclampsia - obstetric cholestasis intrauterine fetal death
66
what is the bishop score used for, what is measured and what do the points mean
likelihood of spontaneous labour measures - cervical effacement - cervical position - cervical consistency - cervical dilation - fetal station <5 unlikely to progress >8 likely to progress
67
IoL methods and when offered
if 40 weeks - membrane sweep offered as an adjunct if bishop <6 - vaginal prostaglandins or oral misoprostol if bishops >6 amniotomy and IV oxytocin infusion
68
complication of IOL and rx
uterine hyperstimulation - can cause fetal hypoxia or uterine rupture (rare) stop drugs, consider tocolytics
69
definition of decelerations on CTG
abrupt decrease in baseline HR of >15 for >15s
70
what do variable decelerations usually indicate
umbilical cord compression
71
CTG normal variability
5-25bpm
72
features of normal ctg - baseline bpm - baseline variability - decelerations - interpretation - management
- 110-160 - 5 - 25 - no repetetive decels - no fetal distress - no management
73
features of suspicious CTG - baseline bpm - baseline variability - decelerations - interpretation - management
lacking at least one feature of normality but no pathological features
74
features of pathological CTG - baseline bpm - baseline variability - decelerations - interpretation - management
- >180 or <100 - Less than 5 (reduced) >50 minutes OR More than 25 (saltatory) >30 minutes OR sinusoidal for >30 minutes - Repetitive, late or prolonged decelerations with any concerning characteristics >30 minute OR A single prolonged deceleration (below 100 bpm) lasting 3 minutes or more - high probability of hypoxia or acidosis - reverse causes. if not possible, deliver baby
75
when is it recommended to star measuring the symphis fungus height what is normal
24 weeks week of pregnancy ± 2cm
76
triad of vasa praevia
rupture of membranes painless vaginal bleeding plus fetal bradycardia
77
first line med for breast milk suppression
cabergoline bromocripitine can be used but has a worse side effect profile
78
normal number of contractions in 10 mins
4 or less
79
how much blood loss is deemed a pph
500ml
80

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