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Obstetrics Flashcards

1
Q

What % of couples have a problem with conceiving?

A

85% will conceive within a year of regular unprotected sex. 1 in 7 couples will struggle to conceive naturally.

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2
Q

When are investigations done for infertility?

A

Investigation and referral for infertility should be initiated after the couple has been trying to conceive without success for 12 months. This can be reduced to 6 months if the woman is older than 35, as her ovarian stores are likely to be already reduced and time is more precious.

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3
Q

List causes of infertility

A

Sperm problems (30%)
Ovulation problems (25%)
Tubal problems (15%)
Uterine problems (10%)
Unexplained (20%)
40% of infertile couples have a mix of male and female causes.

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4
Q

Suggest investigations for infertility.

A

Initial investigations, often performed in primary care:

Body mass index (BMI) (low could indicate anovulation, high could indicate PCOS)
Chlamydia screening
Semen analysis
Female hormonal testing (see below)
Rubella immunity in the mother

Female hormone testing involves:

Serum LH and FSH on day 2 to 5 of the cycle
Serum progesterone on day 21 of the cycle (or 7 days before the end of the cycle if not a 28-day cycle).
Anti-Mullerian hormone
Thyroid function tests when symptoms are suggestive
Prolactin (hyperprolactinaemia is a cause of anovulation) when symptoms of galactorrhea or amenorrhoea

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5
Q

Suggest treatments for anovulation.

A

Weight loss for overweight patients with PCOS can restore ovulation
Clomifene may be used to stimulate ovulation
Letrozole may be used instead of clomifene to stimulate ovulation (aromatase inhibitor with anti-oestrogen effects)
Gonadotropins may be used to stimulate ovulation in women resistant to clomifene
Ovarian drilling may be used in polycystic ovarian syndrome
Metformin may be used when there is insulin insensitivity and obesity (usually associated with PCOS)

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6
Q

Outline how sperm problems are managed

A

Surgical sperm retrieval

Surgical correction of an obstruction in the vas deferens may restore male fertility.

Intra-uterine inseminsation

Intracytoplasmic sperm injection (ICSI)

Donor insemination with sperm from a donor is another option for male factor infertility.

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7
Q

How is a sperm sample taken?

A

Abstain from ejaculation for at least 3 days and at most 7 days
Avoid hot baths, sauna and tight underwear during the lead up to providing a sample
Attempt to catch the full sample
Deliver the sample to the lab within 1 hour of ejaculation
Keep the sample warm (e.g. in underwear) before delivery

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8
Q

What is measured in a sperm sample?

A

Semen volume (more than 1.5ml)
Semen pH (greater than 7.2)
Concentration of sperm (more than 15 million per ml)
Total number of sperm (more than 39 million per sample)
Motility of sperm (more than 40% of sperm are mobile)
Vitality of sperm (more than 58% of sperm are active)
Percentage of normal sperm (more than 4%)

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9
Q

What terms are used for sperm cell numbers?

A

Normospermia (or normozoospermia) refers to normal characteristics of the sperm in the semen sample.

Oligospermia (or oligozoospermia) is a reduced number of sperm in the semen sample. It is classified as:

Mild oligospermia (10 to 15 million / ml)
Moderate oligospermia (5 to 10 million / ml)
Severe oligospermia (less than 5 million / ml)
Cryptozoospermia refers to very few sperm in the semen sample (less than 1 million / ml).

Azoospermia is the absence of sperm in the semen.

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10
Q

What are the features of OHSS?

A

Early OHSS presents within 7 days of the hCG injection. Late OHSS presents from 10 days onwards.

Features of the condition include:

Abdominal pain and bloating
Nausea and vomiting
Diarrhoea
Hypotension
Hypovolaemia
Ascites
Pleural effusions
Renal failure
Peritonitis from rupturing follicles releasing blood
Prothrombotic state (risk of DVT and PE)

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11
Q

How is OHSS managed?

A

Oral fluids
Monitoring of urine output
Low molecular weight heparin (to prevent thromboembolism)
Ascitic fluid removal (paracentesis) if required
IV colloids (e.g. human albumin solution)

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12
Q

What is the bagel sign?

A

Ectopic pregnancy

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13
Q

What hcg represents an ectopic pregnancy?

A

A rise of less than 63% after 48 hours may indicate an ectopic pregnancy. When this happens the patient needs close monitoring and review.

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14
Q

How are ectopic pregnancies managed?

A

There are three options for terminating an ectopic pregnancy:

Expectant management (awaiting natural termination)
Medical management (methotrexate)
Surgical management (salpingectomy or salpingotomy)

Criteria for expectant management:

Follow up needs to be possible to ensure successful termination
The ectopic needs to be unruptured
Adnexal mass < 35mm
No visible heartbeat
No significant pain
HCG level < 1500 IU / l

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15
Q

Define gravida

A

Gravida (G) is the total number of pregnancies a woman has had

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16
Q

Define para

A

refers to the number of times the woman has given birth after 24 weeks gestation, regardless of whether the fetus was alive or stillborn

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17
Q

What is nulliparous, primiparous and multiparous?

A

Nulliparous (“nullip”) refers to a patient that has never given birth after 24 weeks gestation
Primiparous technically refers to a patient that has given birth after 24 weeks gestation once before (see below)
Multiparous (“multip”) refers to a patient that has given birth after 24 weeks gestation two or more times

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18
Q

What are the trimesters?

A

The first trimester is from the start of pregnancy until 12 weeks gestation.

The second trimester is from 13 weeks until 26 weeks gestation.

The third trimester is from 27 weeks gestation until birth.

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19
Q

What vaccines are given in pregnancy?

A

Whooping cough (pertussis) from 16 weeks gestation
Influenza (flu) when available in autumn or winter

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20
Q

What vaccines are avoided in pregnancy?

A

MMR and live vaccines

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21
Q

What are some milestones for pregnancy?

A

Between 10 and 13 + 6 -Dating scan

16 week antenatal appointment

Between 18 and 20 + 6 - anomaly scan

Oral glucose tolerance test in women at risk of gestational diabetes (between 24 – 28 weeks)

Anti-D injections in rhesus negative women (at 28 and 34 weeks)

Ultrasound scan at 32 weeks for women with placenta praevia on the anomaly scan

Serial growth scans are offered to women at increased risk of fetal growth restriction

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22
Q

What tests are done during antenatal testing?

A

Discuss plans for the remainder of the pregnancy and delivery
Symphysis–fundal height measurement from 24 weeks onwards
Fetal presentation assessment from 36 weeks onwards
Urine dipstick for protein for pre-eclampsia
Blood pressure for pre-eclampsia
Urine for microscopy and culture for asymptomatic bacteriuria

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23
Q

Discuss advice given to pregnant women.

A

Take folic acid 400mcg from before pregnancy to 12 weeks (reduces neural tube defects)
Take vitamin D supplement (10 mcg or 400 IU daily)
Avoid vitamin A supplements and eating liver or pate (vitamin A is teratogenic at high doses)
Don’t drink alcohol when pregnant (risk of fetal alcohol syndrome)
Don’t smoke (smoking has a long list of complications, see below)
Avoid unpasteurised dairy or blue cheese (risk of listeriosis)
Avoid undercooked or raw poultry (risk of salmonella)
Continue moderate exercise but avoid contact sports
Sex is safe
Flying increases the risk of venous thromboembolism (VTE)
Place car seatbelts above and below the bump (not across it)

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24
Q

When must pregnant women stop flying?

A

The RCOG advises flying is generally ok in uncomplicated healthy pregnancies up to:

37 weeks in a single pregnancy
32 weeks in a twin pregnancy

After 28 weeks gestation, most airlines need a note from a midwife, GP or obstetrician to state the pregnancy is going well and there are no additional risks.

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25
What are some booking bloods?
A set of booking bloods are taken for: Blood group, antibodies and rhesus D status Full blood count for anaemia Screening for thalassaemia (all women) and sickle cell disease (women at higher risk) Patients are also offered screening for infectious diseases, by testing antibodies for: HIV Hepatitis B Syphilis Screening for Down’s syndrome may be initiated depending on the gestational age. Bloods required for the combined test are taken from 11 weeks onwards.
26
What is combined testing?
Ultrasound measures nuchal translucency, which is the thickness of the back of the neck of the fetus. Down’s syndrome is one cause of a nuchal thickness greater than 6mm. Maternal blood tests: Beta‑human chorionic gonadotrophin (beta-HCG) – a higher result indicates a greater risk Pregnancy‑associated plasma protein‑A (PAPPA) – a lower result indicates a greater risk
27
What are the tests for Downs syndrome?
Triple testing = BAO = Bhcg, AFP, Oestrogen Quadruple testing NIPT Amniocentesis and CVS
28
How are chronic diseases managed in pregnancy?
Hypothyroidism - increase levothyroxine RA - hydroxchloroquine, sulfazalazine and steroids to be used Hypertension - change medications Epilepsy - change medications
29
Why are ACE inhibitors contraindicated in pregnancy?
Oligohydramnios (reduced amniotic fluid) Miscarriage or fetal death Hypocalvaria (incomplete formation of the skull bones) Renal failure in the neonate Hypotension in the neonate
30
What is the effect of opiates on the foetus?
The use of opiates during pregnancy can cause withdrawal symptoms in the neonate after birth. This is called neonatal abstinence syndrome (NAS). NAS presents between 3 – 72 hours after birth with irritability, tachypnoea (fast breathing), high temperatures and poor feeding.
31
What is the effect of warfarin on the foetus?
Fetal loss Congenital malformations, particularly craniofacial problems Bleeding during pregnancy, postpartum haemorrhage, fetal haemorrhage and intracranial bleeding
32
What is the effect of SSRIs on the foetus?
First-trimester use has a link with congenital heart defects First-trimester use of paroxetine has a stronger link with congenital malformations Third-trimester use has a link with persistent pulmonary hypertension in the neonate
33
What is the effect of valproate on pregnancy?
The use of sodium valproate in pregnancy causes neural tube defects and developmental delay.
34
What is the effect of beta blockers on the foetus?
Fetal growth restriction Hypoglycaemia in the neonate Bradycardia in the neonate Still used like labetolol
35
What is the triad of toxoplasmosis?
There is a classic triad of features in congenital toxoplasmosis: Intracranial calcification (IT) Chorioretinitis (inflammation of the choroid and retina in the eye) (C) Hydrocephalus (H)
36
What is the effect of congenital CMV on the foetus?
Fetal growth restriction Microcephaly Hearing loss Vision loss Learning disability Seizures (everything gets smaller except seizures)
37
What is the effect of rubella on the foetus?
Congenital deafness Congenital cataracts Congenital heart disease (PDA and pulmonary stenosis) Learning disability
38
What is the effect of chickenpox on the foetus?
Fetal growth restriction Microcephaly, hydrocephalus and learning disability Scars and significant skin changes located in specific dermatomes Limb hypoplasia (underdeveloped limbs) Cataracts and inflammation in the eye (chorioretinitis)
39
What is the effect of listeria in the foetus?
Listeriosis in pregnant women has a high rate of miscarriage or fetal death. It can also cause severe neonatal infection.
40
What is the effect of parvovirus in the foetus?
Hydrops fetalis
41
How long should pregnant women be treated for UTI?
7 DAYS
42
What are the thresholds for anaemia?
Booking bloods > 110 g/l 28 weeks gestation > 105 g/l Post partum > 100 g/l
43
What is the Lamda sign or twin peak?
The lambda sign, or twin peak sign, refers to a triangular appearance where the membrane between the twins meets the chorion, as the chorion blends partially into the membrane. This indicates a dichorionic twin pregnancy (separate placentas).
44
What is the T sign?
Represents a monochorionic and moniamniotic pregnancy
45
What are the types of twin pregnancy?
Dichorionic diamniotic twins have a membrane between the twins, with a lambda sign or twin peak sign Monochorionic diamniotic twins have a membrane between the twins, with a T sign Monochorionic monoamniotic twins have no membrane separating the twins
46
What are the risks to the mother for twin pregnancies?
Anaemia Polyhydramnios Hypertension Malpresentation Spontaneous preterm birth Instrumental delivery or caesarean Postpartum haemorrhage
47
What are the risks to the feotuses in twin pregnancy?
Miscarriage Stillbirth Fetal growth restriction Prematurity Twin-twin transfusion syndrome Twin anaemia polycythaemia sequence Congenital abnormalities
48
What is the definition of pre-eclampsia?
Pre-eclampsia refers to new high blood pressure (hypertension) in pregnancy with end-organ dysfunction, notably with proteinuria (protein in the urine). It occurs after 20 weeks gestation, when the spiral arteries of the placenta form abnormally, leading to a high vascular resistance in these vessels.
49
What is the triad for pre-eclampsia?
Pre-eclampsia features a triad of: Hypertension Proteinuria Oedema
50
What are the symptoms of pre-eclampsia?
Headache Visual disturbance or blurriness Nausea and vomiting Upper abdominal or epigastric pain (this is due to liver swelling) Oedema Reduced urine output Brisk reflexes
51
What are complications of pre-eclampsia?
HEC RIP
52
What scoring system is used in pre-eclampsia?
Scoring systems are used to determine whether to admit the woman (fullPIERS or PREP‑S) Blood pressure is monitored closely (at least every 48 hours) Urine dipstick testing is not routinely necessary (the diagnosis is already made) Ultrasound monitoring of the fetus, amniotic fluid and dopplers is performed two weekly
53
What does PIER stand for?
Preeclampsia integrated estimate of risk
54
How is pre-eclampsia managed?
Labetolol is first-line as an antihypertensive Nifedipine (modified-release) is commonly used second-line Methyldopa is used third-line (needs to be stopped within two days of birth) Intravenous hydralazine may be used as an antihypertensive in critical care in severe pre-eclampsia or eclampsia IV magnesium sulphate is given during labour and in the 24 hours afterwards to prevent seizures Fluid restriction is used during labour in severe pre-eclampsia or eclampsia, to avoid fluid overload Steroids and delivery
55
What is used to determine pre-eclampsia?
FullsPier Hypertension Proteinuria Oedema Multi organ failure
56
What is SGA?
<10th centile Establish if causes can be constitutional or growth restriction IUGR or non-placental.
57
What is LGA?
>90th centile Constitutional or disease related Risk of tears and shoulder dystocia
58
What are the risk factors for gestational diabetes?
Previous gestational diabetes Previous macrosomic baby (≥ 4.5kg) BMI > 30 Ethnic origin (black Caribbean, Middle Eastern and South Asian) Family history of diabetes (first-degree relative)
59
What would an OGTT show for gestational diabetes?
An OGTT should be performed in the morning after a fast (they can drink plain water). The patient drinks a 75g glucose drink at the start of the test. The blood sugar level is measured before the sugar drink (fasting) and then at 2 hours. Normal results are: Fasting: < 5.6 mmol/l At 2 hours: < 7.8 mmol/l
60
How is gestational diabetes managed?
Fasting glucose less than 7 mmol/l: trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin Fasting glucose above 7 mmol/l: start insulin ± metformin Fasting glucose above 6 mmol/l plus macrosomia (or other complications): start insulin ± metformin
61
What can be used if insulin or metformin is not tolerated?
Glibenclamide (a sulfonylurea) is suggested as an option for women who decline insulin or cannot tolerate metformin.
62
How is hypoglycaemia of the newborn managed?
Babies need close monitoring for neonatal hypoglycaemia, with regular blood glucose checks and frequent feeds. The aim is to maintain their blood sugar above 2 mmol/l, and if it falls below this, they may need IV dextrose of nasogastric feeding.
63
Why does neonatal hypoglycaemia occur?
Babies become accustomed to a large supply of glucose during the pregnancy, and after birth they struggle to maintain the supply they are used to with oral feeding alone.
64
How does intrahepatic cholestasis present?
Obstetric cholestasis typically present later in pregnancy, particularly in the third trimester. Itching (pruritis) is the main symptom, particularly affecting the palms of the hands and soles of the feet. Other symptoms are related to cholestasis and outflow obstruction in the bile ducts: Fatigue Dark urine Pale, greasy stools Jaundice NO RASH! this is in atopic eruption
65
How is intrahepatic cholestasis managed?
Ursodeoxycholic acid is the primary treatment for obstetric cholestasis. It improves LFTs, bile acids and symptoms. Symptoms of itching can be managed with: Emollients (i.e. calamine lotion) to soothe the skin Antihistamines (e.g. chlorphenamine) can help sleeping (but does not improve itching) Vitamin K
66
What causes acute fatty liver in pregnancy?
The most common cause is long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency in the fetus, which is an autosomal recessive condition. Very RARE so consider HELLP first
67
What are the symptoms of acute fatty liver disease?
General malaise and fatigue Nausea and vomiting Jaundice Abdominal pain Anorexia (lack of appetite) Ascites Raised ALT: AST
68
How is acute liver failure treated?
Deliver the baby Transplant
69
How does intrahepatic cholestasis, HELLP and acute fatty liver differ?
Cholestasis: Abnormal liver function tests (LFTs), mainly ALT, AST and GGT Raised bile acids HELLP > acute fatty liver - AST and ALT raised
70
What is antepartum haemorrhage?
Spotting: spots of blood noticed on underwear Minor haemorrhage: less than 50ml blood loss Major haemorrhage: 50 – 1000ml blood loss Massive haemorrhage: more than 1000 ml blood loss, or signs of shock
71
What are the symptoms and signs of abruption?
Sudden onset severe abdominal pain that is continuous Vaginal bleeding (antepartum haemorrhage) Shock (hypotension and tachycardia) Abnormalities on the CTG indicating fetal distress Characteristic “woody” abdomen on palpation, suggesting a large haemorrhage
72
How is placental abruption managed?
- Senior involvement i.e. senior obstetrician, midwife and anaesthetist (Sasha) - Grey cannula x 2 (Grey) - Bloods include FBC, UE, LFT and coagulation studies (Brings) - Crossmatch 4 units of blood (Clever) - Fluid and blood resuscitation as required CTG monitoring of the fetus Close monitoring of the mother
73
When is ECV done?
After 36 weeks for nulliparous women (women that have not previously given birth) After 37 weeks in women that have given birth previously
74
What is stillbirth?
Stillbirth is defined as the birth of a dead fetus after 24 weeks gestation. Stillbirth is the result of intrauterine fetal death (IUFD). It occurs in approximately 1 in 200 pregnancies.
75
How are pregnant women managed with CPR?
Immediate caesarean section is performed in a pregnant woman when: There is no response after 4 minutes to CPR performed correctly CPR continues for more than 4 minutes in a woman more than 20 weeks gestation
76
How is vasa previa managed?
Corticosteroids, given from 32 weeks gestation to mature the fetal lungs Elective caesarean section, planned for 34 – 36 weeks gestation
77
What are the stages of labour?
First stage – from the onset of labour (true contractions) until 10cm cervical dilatation Second stage – from 10cm cervical dilatation until delivery of the baby Third stage – from delivery of the baby until delivery of the placenta
78
What is involved in the first stage?
Latent phase – from 0 to 3cm dilation of the cervix. This progresses at around 0.5cm per hour. There are irregular contractions. Active phase – from 3cm to 7cm dilation of the cervix. This progresses at around 1cm per hour, and there are regular contractions. Transition phase – from 7cm to 10cm dilation of the cervix. This progresses at around 1cm per hour, and there are strong and regular contractions.
78
How can someone tell labour has started?
Show (mucus plug from the cervix) Rupture of membranes Regular, painful contractions Dilating cervix on examination
79
How is labour induced?
Sweep at 40 weeks Cervical ripening Balloon Dinoprostone Oxytocin
80
What are the components of the Bishop score?
Fetal station (scored 0 – 3) Cervical position (scored 0 – 2) Cervical dilatation (scored 0 – 3) Cervical effacement (scored 0 – 3) Cervical consistency (scored 0 – 2)
81
What are the bradycardia rules?
There is a “rule of 3’s” for fetal bradycardia when they are prolonged: 3 minutes – call for help 6 minutes – move to theatre 9 minutes – prepare for delivery 12 minutes – deliver the baby (by 15 minutes)
82
What is normal baseline rate?
110 – 160
83
What is variability?
5-25
84
What do deccelerations mean?
85
How is CTG interpretated?
DR – Define Risk (define the risk based on the individual woman and pregnancy before assessing the CTG) C – Contractions BRa – Baseline Rate V – Variability A – Accelerations D – Decelerations O – Overall impression (given an overall impression of the CTG and clinical picture)
86
What drugs are used to induce uterine tone?
Oxytocin Ergometrine Carboprost
87
Side effects of ergometrine?
it can cause several side effects, including hypertension, diarrhoea, vomiting and angina. It needs to be avoided in eclampsia, and used only with significant caution in patients with hypertension.
88
What is considered with failure to progress in labour?
4 P's Power (uterine contractions) Passenger (size, presentation and position of the baby) Passage (the shape and size of the pelvis and soft tissues) Psyche can be added as a fourth P, referring to the support and antenatal preparation for labour and delivery.
89
How is a cord prolapse managed?
Emergency caesarean section is indicated where cord prolapse occurs. A normal vaginal delivery has a high risk of cord compression and significant hypoxia to the baby. Pushing the cord back in is not recommended. The cord should be kept warm and wet and have minimal handling whilst waiting for delivery (handling causes vasospasm). When the baby is compressing a prolapsed cord, the presenting part can be pushed upwards to prevent it compressing the cord. The woman can lie in the left lateral position (with a pillow under the hip) or the knee-chest position (on all fours), using gravity to draw the fetus away from the pelvis and reduce compression on the cord. Tocolytic medication (e.g. terbutaline) can be used to minimise contractions whilst waiting for delivery by caesarean section.
90
Name some procedures used in prevening shoulder dystocia.
Episiotomy can be used to enlarge the vaginal opening and reduce the risk of perineal tears. It is not always necessary. McRoberts manoeuvre involves hyperflexion of the mother at the hip (bringing her knees to her abdomen). This provides a posterior pelvic tilt, lifting the pubic symphysis up and out of the way. Rubins manoeuvre involves reaching into the vagina to put pressure on the posterior aspect of the baby’s anterior shoulder to help it move under the pubic symphysis. Wood’s screw manoeuvre is performed during a Rubins manoeuvre. The other hand is used to reach in the vagina and put pressure on the anterior aspect of the posterior shoulder. The top shoulder is pushed forwards, and the bottom shoulder is pushed backwards, rotating the baby and helping delivery. If this does not work, the reverse motion can be tried, pushing the top shoulder backwards and the bottom shoulder forwards. Zavanelli manoeuver involves pushing the baby’s head back into the vagina so that the baby can be delivered by emergency caesarean section.
91
What are the main risks of instrumental based delivery?
Cephalohaematoma with ventouse Facial nerve palsy with forceps Epidural increases instrumental delivery need
92
What is PPH?
It can be classified as: Minor PPH – under 1000ml blood loss Major PPH – over 1000ml blood loss Major PPH can be further sub-classified as: Moderate PPH – 1000 – 2000ml blood loss Severe PPH – over 2000ml blood loss It can also be categorised as: Primary PPH: bleeding within 24 hours of birth Secondary PPH: from 24 hours to 12 weeks after birth
93
What are the causes of PPH?
T – Tone (uterine atony – the most common cause) T – Trauma (e.g. perineal tear) T – Tissue (retained placenta) T – Thrombin (bleeding disorder)
94
Part 1 Resuscitation with an ABCDE approach Lie the woman flat, keep her warm and communicate with her and the partner Insert two large-bore cannulas Bloods for FBC, U&E and clotting screen Group and cross match 4 units Warmed IV fluid and blood resuscitation as required Oxygen (regardless of saturations) Fresh frozen plasma is used where there are clotting abnormalities or after 4 units of blood transfusion Part 2 Rubbing the uterus through the abdomen to stimulates a uterine contraction (referred to as “rubbing up the fundus”) Catheterisation (bladder distention prevents uterus contractions) Part 3 Oxytocin (slow injection followed by continuous infusion) Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension) Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma) Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding Part 4 Intrauterine balloon tamponade – inserting an inflatable balloon into the uterus to press against the bleeding B-Lynch suture – putting a suture around the uterus to compress it Uterine artery ligation – ligation of one or more of the arteries supplying the uterus to reduce the blood flow Hysterectomy is the “last resort” but will stop the bleeding and may save the woman’s life
95
How is uterine inversion managed?
Johnson manoeuvre Hydrostatic methods Surgery
96
How should women with GBS be managed if no antibiotics given?
Maternal colonisation with group B streptococcus is a minor risk factor for early onset sepsis in the newborn. Newborns with only one minor risk factor for early onset sepsis should remain in hospital for at least 24 hours with regular observations
97
When is aspirin given for pre-eclampsia risk?
A woman at moderate or high risk of pre-eclampsia should take aspirin 75-150mg daily from 12 weeks gestation until the birth
98
What are some symptoms of retained products of conception?
Vaginal bleeding that gets heavier or does not improve with time Abnormal vaginal discharge Lower abdominal or pelvic pain Fever (if infection occurs)
99
What are the treatments for retained products of conception?
Evacuation of retained products of conception (ERPC) is a surgical procedure involving a general anaesthetic. The cervix is gradually widened using dilators, and the retained products are manually removed through the cervix using vacuum aspiration and curettage (scraping). The procedure may be referred to as “dilatation and curettage”
100
What are the complications of retained products of conception?
Endometritis Asherman’s syndrome
101
What are the symptoms of endometritis?
Foul-smelling discharge or lochia Bleeding that gets heavier or does not improve with time Lower abdominal or pelvic pain Fever Sepsis
102
What are the treatments for post-partum anaemia?
Hb under 100 g/l – start oral iron (e.g. ferrous sulphate 200mg three times daily for three months) Hb under 90 g/l – consider an iron infusion in addition to oral iron (e.g. Monofer, CosmoFer or Ferinject) Hb under 70 g/l – blood transfusion in addition to oral iron
103
How is candida of the nipple treated?
Topical miconazole 2% after each breastfeed Treatment for the baby (e.g. miconazole gel or nystatin)
104
What are the features of post-partum thyroiditis?
Thyrotoxicosis (usually in the first three months) Hypothyroid (usually from 3 – 6 months) Thyroid function gradually returns to normal (usually within one year)
105
When should a woman prevent getting pregnant if on methotrexate?
3 MONTHS
106
Why does ectopic pregnancy cause shoulder tip pain?
Affects C5
107
How are missed miscarriages managed?
108
When is anti -d given after desensitising event?
10-12 weeks
109
Why is anti-D given?
Prevent haemolytic disease of newborn
110
What are the causes of recurrent miscarriage?
111
What are the types of molar pregnancy?
112
Causes of pre-eclamspia?
113
Prophylaxis for pre-eclampsia
Aspirin 75 MG FROM WEEK 12
114
Do women with pre-eclampsia need to be admitted to hospital?
115
How is HELLP managed?
116
What are some conditions linked to pre-eclampsia?
HEC RIP
117
How long till pre-eclampsia develops after pregnancy?
118
What is deemed the correct values for minor and major PPH?
119
How is PPH managed?
Call for help - Critical A-E - Anaethetists Two wide bore - Take Blood - blood Warm IV - when Activate major haemorrhage - admitting Oxygen high flow - old Massage - munchkins Transfusion 4 units of blood - to 4 units of FFP - the Catheterise - closest Theatre - toilet
120
121
What is done to reduce risk of PPH?
IM oxytocin to reduce risk of PPH
122
What is the surgical management of PPH?
123
How are fibroids managed?
I HAEM GUNS
124
What questions should be asked for endometriosis?
125
What are given with GnRH analogues?
GnRH and tibolone
126
What findings may be found on diagnostic laproscopy?
127
What strains are offered in HPV vaccine?
9 strains
128
How does HPV affect the cervix?
129
Why might there be meconium aspiration?
Stress and infection
130
How is PET managed?
Labetolol, nifedipine or methyldopa Delivery of baby
131
What are the types of caesarean section?
Caesarean sections may be categorised by the urgency Category 1 an immediate threat to the life of the mother or baby examples indications include: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia delivery of the baby should occur within 30 minutes of making the decision Category 2 maternal or fetal compromise which is not immediately life-threatening delivery of the baby should occur within 75 minutes of making the decision Category 3 delivery is required, but mother and baby are stable Category 4 elective caesarean
132
When is a urine dip done to assess for assymptomatic bacteria?
Week 8 - 12
133
How are women treated with malaria falciparum vs vivax? What is given to mother's living in endemic areas?
1st line for falciparum is arteminsin and clindamycin For vivax it is chloroquinine Sulfadoxine and pyrimethamine
134
How is pyelonephritis treated in pregnancy?
Cefuroxime
135
What are causes of AKI in pregnancy?
HELLP Pre-eclampsia Sepsis Hypovolemia NSAIDs
136
What should be done in all pregnant women with AKI?
Catheterisation
137
What asthma medication should not be started in pregnancy?
Monteleukast
138
What medications are safest in pregnancy for autoimmune conditions?
Hydroxychloroquine Sulfazalazine Azathioprine
139
What is fetal monitoring for?
Detect signs of fetal compromise and is either done by intermittent auscultation (IA) or continous CTG If a baby decompensates during labour then maybe will not be able to withstand the stress of contractions
140
How often should fetal monitoring be done?
Every 15 minutes in the first stage of labour Every 5 minutes in the 2nd stage If abnormality noted start CTG
141
What are 5 indications for foetal monitoring?
Induction of labour Epidural Meconium stained liqour Pyrexia Prematurity
142
What is a cause of reduced variability?
Only for 30 minutes when baby takes a nap Fetal hypoxia Malformation Magnesium Prematurity
143
What is an acceleration?
An increase of 15bpm for more than 15 second
144
What are the criteria for diagnosing PET?
BP >140/90 AND proteinuria +2 Thrombocytopenia Impaired liver function tests Pleural oedema Serum creatinine raise Cerebral oedema
145
How is PET treated?
Nifedipine Magnesium sulphate 4mg Catheterise
146
What are the complications of pre-eclampsia?
HELLP Eclampsia Cerebral oedema Renal failure IUGR Placental insufficiency
147
How is PROMs managed?
GIVE ME THE FRENCH FRIES Glucorticoids Magnesium sulphate Tocolytics Fetal fibronectin Forty eight hours in hospital
148
How much does eGFR increase by in pregnancy?
55%
149
What is stillbirth?
Babies born dead after 24 weeks. It may help the mother to have a lock of hair or a handprint or photo of their baby. A certificate of stillbirth is issued
150
What charity can be recommended for stillbirths?
151
T or F, give all babies with trauma vitamin K when born?
T
152
What are some risks to baby during labour?
Moulding. This refers to the bones overlapping Cephalohaematoma = does not cross suture lines, can take weeks to dissapear Capput sacadeum = crosses sutures and can take days to dissapear Erb's palsy Intracranial injuries Fetal laceration
153
What is the most common position to find baby in?
The right occiput posterior (ROP) position is two to five times more common than left occiput posterior (LOP)
154
What is OASI?
Obstetric anal sphincter injuries OASI
155
How are OASI treated?
Back to theatre for stitching. Give lactulose and cefuroxime and metronidazole.
156
What are complications to mum during pregnancy?
Pudendal nerve neuropathy Pain Perineal tears Vesicovaginal fistula
157
Discuss VTE in pregnancy?
158
What criteria needs to be considered for managing VTE in pregnancy?
159
How is pre-eclampsia managed?
Come - call for help --> HELLP + cerebral haemorrhage --> SOMA Meet - magnesium sulphate 4g over 15 minutes IV --> 1g/hr 24 hours Gemma - glucoronate if resp depression <12 and loss of reflexes Clifford - catheterise and fluid restriction Don't - diazepam Come - CTG Late - LCSC
160
How is raised BP managed in pre-eclampsia?
Labetelol 20mg for 10 minutes then double 20, 40, 80 until 200mg Alternative is hydralazine
161
How is APH managed?
Remember - resuscitate and call for help Today - Two wide bore cannulas Is - IVI Gemma - Group and save Clifford - Crossmatch Birthday - bladder catheterise Party - provide oxygen Officially - oxygen
162
How is shoulder dystocia managed?
HERMES Help Episiotomy Roll McRoberts Enter the pelvis Suprapubic pressure
163
What is Mendelson syndrome?
Treated with aminophylline and steroids.
164
What is primary PPH?
Loss of more than 500ml in the first 24 hours after delivery. 4Ts Get - Get help --> SOMA The - Two wide bore cannulas One - Oxygen Gemma - Group and save Clifford - Cross match A -- Alert theatre Birthday - Bimanual compression Present - Prescribe : Synto--> oxytocin --> ergometrine --> misoprostol --> carboprost For - fresh frozen plasma Her - Hb replacement Crazy - catheter Birthday - Bakri catheter/ surgery Soiree - surgery
165
What is the management of uterine inversion?
Call for help Push the fundus through the cervix FBCs, U and Es, clotting Insert 2 large bore cannula IV fluid Transfer to theatre Tocolytics Laparoscopic procedure
166
What is SROM?
>37 weeks Spontaneous May take a woman time to establish.
167
What is a test for PPROM?
IGFBP
168
What is the new guidelines for PPH?
E-motive Early warning Massage Oxytocin Traxamic acid Iv fluids Explore

Finals (24 decks)

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