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To Revise > Obstetrics > Flashcards

Obstetrics Flashcards

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
Q

maternal and fetal complications of GD (inc pathophys for fetal)

A

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

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26
Q

presentation of HELLP syndrome

A

n+v
ruq pain
lethargy

prev diagnosis of pre eclampsia

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27
Q

rx of HELLP

A

deliver baby

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28
Q

pre eclampsia triad

A

htn
proteinuria
oedema

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29
Q

criteria for pre eclampsia

A

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

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30
Q

maternal and fetal complications of non severe pre eclampsia

A

M - eclampsia (seizures, severe headaches, blindness, stroke) PPH, liver involvement,
F - IUGR, prematurity

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31
Q

Features of severe pre-eclampsia

A

proteinuria +++
bp >160/110
visual disturbances
papilloedema
hyperreflexia
HELLP - ruq pain. low platelets, deranged LFTS

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32
Q

risk factors of pre eclampsia

A

> 40
prev pre eclampsia
BMI >35
fhx
multiple pregnancy
first pregnancy

high risk
- diabets
- prev pre eclampsia
- APL, SLE, chronic htn
- CKD

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33
Q

rx of pre eclampsia

A

if have risk factors
aspirin 75mg daily from 12 weeks until birth

labetolol or nifedipine (if Asthma)

34
Q

rx of chicken pox in pregnancy

A

acyclovir

35
Q

rx of chicken pox exposure in pregnancy

A

if not sure whether had it before - check blood for varicella antibodies
if had before - give VZIG

36
Q

drug used for preventing and for treating seizures in eclampsia

A

mag sulf

37
Q

considerations during treatment with magnesium sulphate

A

monitor - urine output, rr, o2 sats and reflexes
IV
continue for at least 24hrs after last seizure or after delivery

38
Q

rx of mag self induced respiratory depression

A

calcium gluconate

39
Q

rx of mother who tests positive for GBS

A

Intrapartum Abx - benpen

40
Q

Indications for intrapartum abx

A

GBS carrier or prev baby with GBS
pyrexia during labour
preterm rupture of membranes

41
Q

what antihypertensives are CI in pregnancy

A

ACEi and ARBs - risk of fetal renal damage

42
Q

features of obstetric cholestasis

A

itching
jaundice

43
Q

rx of obstetric cholestasis

A

ursodeoxycholic acid
IOL at 37-38 weeks

44
Q

rx of placental abruption if
<36 weeks ± fetal distress
>36 weeks ± fetal distress

A

<36 no fetal distress - steroids and observe
<36 with fetal distress - EmCS

> 36 no fetal distress - vaginal delivery
36 fetal distress - EmCS

45
Q

maternal and fetal complications of placental abruption

A

m - shock, dic, renal failure, pph
f - IUGR, death, hypoxia

46
Q

causes of placental abruption

A

trauma, cocaine, older age, multiple pregnancy, polyhydramnios

47
Q

4 causes of pph

A

Tone - uterine atony
Trauma - episiotomy
Tissue - placenta retention
Thrombin - clotting disorder

48
Q

rf for pph

A

EmCS
macrocosmic baby
prolonged labour
increased maternal age
multiparty
placenta praevia
polyhydramnios

49
Q

Rx of PPH

A

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
Q

when does secondary PPH occur and what is most likely cause

A

24hrs - 6 weeks after
caused by placenta retention or endometritis

51
Q

baby blues, post natal depression and puerperal psychosis comparison inc rx

A

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
Q

postpartum thyroiditis - course

A

thyrotoxicosis then hypothyroidism then normal

rx of hyperthyroid phase is beta blockers and hypothyroid is thyroxine

53
Q

physiological changes in pregnancy

A

increased CO
increased tidal volume
increase in clotting factors - hence increased VTE risk
increased eGFR - trace glycosuria is common

54
Q

risks associated with smoking in pregnancy

A

preterm labour
miscarriage
stillbirth
IUGR
SIDS

55
Q

Fetal alcohol syndrome

A

wide eyes
flat philtrum
microcephaly
epicentral folds
learning difficulty
IUGR

56
Q

ix of PPROM

A

speculum exam to observe any pooling
if non observed - AMNIsure or USS for oligohydramnios

57
Q

complications of PPROM

A

fetal: prematurity, infection, pulmonary hypoplasia
maternal: chorioamnionitis

58
Q

Rx of PPROM

A

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
Q

most common cause of pyrexia after delivery and rx

A

endometritis
admit for IV clindamycin and gentamicin

60
Q

when should fetal movements be well established

A

24 weeks

61
Q

haemolytic disease of the newborn presentation

A

oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
jaundice, anaemia, hepatosplenomegaly
heart failure
kernicterus

62
Q

which twin type have more complications

A

mono amniotic, monozygotic

complications inc - TTTS, spontaneous miscarriage, IUGR, perinatal mortality,

63
Q

risk factors for cord proplapse

A

prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. Breech, transverse lie

64
Q

Rx of cord prolapse

A

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
Q

indications for induction of labour

A

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
Q

what is the bishop score used for, what is measured and what do the points mean

A

likelihood of spontaneous labour

measures
- cervical effacement
- cervical position
- cervical consistency
- cervical dilation
- fetal station

<5 unlikely to progress
>8 likely to progress

67
Q

IoL methods and when offered

A

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
Q

complication of IOL and rx

A

uterine hyperstimulation - can cause fetal hypoxia or uterine rupture (rare)

stop drugs, consider tocolytics

69
Q

definition of decelerations on CTG

A

abrupt decrease in baseline HR of >15 for >15s

70
Q

what do variable decelerations usually indicate

A

umbilical cord compression

71
Q

CTG normal variability

A

5-25bpm

72
Q

features of normal ctg
- baseline bpm
- baseline variability
- decelerations
- interpretation
- management

A
  • 110-160
  • 5 - 25
  • no repetetive decels
  • no fetal distress
  • no management
73
Q

features of suspicious CTG
- baseline bpm
- baseline variability
- decelerations
- interpretation
- management

A

lacking at least one feature of normality but no pathological features

74
Q

features of pathological CTG
- baseline bpm
- baseline variability
- decelerations
- interpretation
- management

A
  • > 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
Q

when is it recommended to star measuring the symphis fungus height
what is normal

A

24 weeks

week of pregnancy ± 2cm

76
Q

triad of vasa praevia

A

rupture of membranes
painless vaginal bleeding plus fetal bradycardia

77
Q

first line med for breast milk suppression

A

cabergoline
bromocripitine can be used but has a worse side effect profile

78
Q

normal number of contractions in 10 mins

A

4 or less

79
Q

how much blood loss is deemed a pph

A

500ml

80
Q
A

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