OBSTETRICS Flashcards
1
Q
RF for IUGR
A
smoking
alcohol
2
Q
drugs contraindicated in breast feeding
A
sulphonamides, tetracyclines, ciprofloxacin, clindamycin
amiodarone
psychiatric: lithium, benzos
methotrexate
carbimazole
sulphonylureas
aspirin
3
Q
APGAR score calculated when
A
min 1, 5, 10
4
Q
pertussis vaccine in pregnancy when
A
16 weeks
5
Q
at booking appt offer screening for
A
haemoglobinopthies
red cell alloantibodies
foetal anomalies
hep B
HIV
syphillis
6
Q
at 16 weeks GA give iron supplements if Hb is under
A
11
7
Q
at 28 weeks GA give iron supplements if Hb is under
A
10.5
8
Q
membrane sweep/IOL is offered if a women hasnt given birth by
A
41 weeks
9
Q
at every antenatal appt you check
A
BP
BMI
urine dip
SFH
10
Q
first stage of labour duration in nullip/multip
A
nullip <18 hrs
mulltip <12 hrs
11
Q
normal progress of labour in active stage
A
1cm dilation every 2 hrs
12
Q
abnormal progress of labour in active stage
A
<2cm dilation in 4 hrs
13
Q
2nd stage of labour normal duration
A
2hrs nullip
1hr multip
add an hour if they have an epidural
14
Q
apgar score interpretation
A
0-3= very low
4-7= moderately low
7-10= good state
15
Q
what cervical length indicates need for prevention of preterm labour
A
<25mm
16
Q
contraindications for rescue cervical cerclage
A
infection
bleeding
presence of uterine contractions
17
Q
indications for prevention of preterm labour
A
history of labour <34 weeks
mid trimester loss hx
cervix <25mm
18
Q
what GA is midtrimester loss
A
> 16 weeks
19
Q
1st line tocolytic
A
nifedipine
20
Q
tocolytics contraix when
A
bleeding or infection
21
Q
nifedipine moa
A
CCB
22
Q
2nd line tocolytic
A
atosiban
23
Q
preterm labour 2 medications given
A
corticosteroids
tocolytics
magnesium sulfate
24
Q
preterm labour definition
A
labour before 37 weeks GA
25
abx for pre prom
erythromycin 250mg QDS
26
p prom admission
admit till 28 weeks
then 2-3 weekly monitoring
27
maternal corticosteroid route/dose for premature delivery
IM betamethasone 24mg in 2 doses 12 hrs apart
28
mag sulf route/dose for premature delivery
IV loading 4g over 5-15 mins
then 1g/hr infusion
29
group B strep positive >34 weeks PPROM
IOL
30
preterm labour vs PPROM
preterm rupture of membranes in both
in PPROM absence of contractions/labour
31
PPROM full form
preterm premature rupture of membranes
32
PPROM admit or no
YES
33
PROM admit or no
YES
34
IOL after PROM when
>24 hrs and absence of contraction
35
meconium seen in PROM
immediate IOL
36
PROM mx
admit for speculum, 4 hrly temperature and foetal monitoring
give prophylactic abx
37
shoulder dystocia mx
1. lie woman flat and tell her to stop pushing
2. call for senior help
3. external manoeuvres: mc roberts with suprapubic pressure
4. consider episiotomy
5. internal manouevres
6. all fours
7. third line manouevres
38
shoulder dystocia complications for baby
brachial plexus injury
fracture
pneumothorax
hypoxic brain injury
39
ECV contrindications
antenatal haemorrhage previous 7 days
multiple pregnancy
CTG abnormality
ruptured membranes
40
implications of c section for future pregnancy
VBAC
placenta praevia
uterine rupture
41
breech delivery counseling
c section= small reduction in foetal mortality, slightly increased risks for mum, future pregnancies affected
vaginal birth= 40% risk of needing c section, increased risk of foetus immediately but long term no concerns, mum less complications
42
vaginal delivery in breech is not possible if
footling breech
43
ECV offered when
36 weeks nullip
37 weeks multip
44
medication given before ECV
terbutaline
45
face presentation chin anterior delivery
vaginal possible
46
face presentation chin posterior delivery
c section
47
brow presentation delivery
c section
48
unstable lie delivery
consider ECV or elective c section
49
bishop score 5 or lower IOL method
vaginal prostaglandins
50
bishop score 6 or above IOL method
ARM then IV oxytocin
51
what must you exclude before doing a membrane sweep
placenta praevia
52
cervical ripening balloon vs vaginal prostaglandin in IOL
cervical balloon is preferred as reduced risk of overstimulation
53
ARM only used first line in IOL if
bishop score over 6
54
IV syntocinon used in IOL if
bishop score over 6
contractions haven't started 2hrs after ARM
55
VBAC success rate
72-75%
56
best predictor of VBAC success
previous successful VBAC
57
IOL in VBAC implications
2-3 fold increased risk in uterine rupture
58
uterine rupture risk in VBAC
1 in 200
59
cord outside interoitus in cord prolapse mx
avoid handling, keep warm and moist, dont put it back inside
60
what uterotonic is contraindicated in women with hypertension
syntometrine
61
fluids given in PPH
IV warm crystalloid
62
what clotting must you request in PPH
fibrinogen
63
how many units of blood should be crossmatched in PPH
4
64
what uterotonic drug is contraindicated in asthmatics
IM carboprost
65
oxytocin dose for PPH prophylaxis VB vs CS
VB= 10 iu
CS= 5iu
66
major PPH blood vol
>1000mL
67
PPH positioning
lie flat
68
pharmacological mx of uterine atony
1. 5iu oxytocin slow IV infusion
2. syntocinon (not if htn)
3. IV infusion oxytocin
4. IM carboprost (not if asthmatic)
69
1st/2nd/3rd line antihypertensive for existing htn in pregnancy
1. labetalol
2. nifedipine
3. methyldopa
70
BP monitoring in pregnancy for exisiting htn
weekly if poorly controlled
2-4 weekly if well controlled
71
BP target in pregnancy for exisiting htn
<135/85
72
what extra scans do pregnant women with htn get in pregnancy
serial growth scans 4 weekly from 28-36 weeks
73
medications for preexisiting htn
antihypertensives
aspirin 12 weeks onwards
74
low dose aspirin in htn exact dose
75-150mg
75
IOL in exisiting hypertension
if BP <160/110 do not offer induction <37 weeks
76
postnatal BP monitoring for existing htn
daily for 2 days
on day 3 and day 5
2 week review at GP
77
diabetes mellitus in pregnancy monitoring
joint diabetes and antenatal clinic every 1-2 weeks
78
extra scans for diabetes mellitus in pregnancy
foetal heart scan 19-20 weeks
serial growth scans 4 weekly from 28-36 weeks
79
diabetes mellitus in pregnancy screen for what
retinal and renal damage at booking and 28 weeks
if abnormal at booking also at 16-20 weeks
80
diabetes mellitus in pregnancy when to increase insulin advice
after 20 weeks GA as resistance rises
81
aditional insulin is needed for diabetes mellitus in pregnancy when what medication is given
steroids
82
insulin during labour for diabetes mellitus
sliding scale
83
BG aim suring labour for women with diabetes mellitus
4-7
84
BG in diabetes mellitus measure how many times a day
7
85
BG targets diabetes mellitus
<5.3 fasting
<7.8 1 hr post prandial
<6.4 post prandial
86
diabetes mellitus check neonatal blood glucose within what time frame
4 hrs
87
how often are thyroid levels checked in pregnancy
every 2-4 weeks
88
thyroxine dose for hypothroidism in pregnancy
higher as demand increases
usually by 25 mg
89
TFTs check postpatrum in those with thyroid disease when
6 weeks at GP
90
thyroid medications for hyperthyroidism in pregnancy
propylthiouracil preferred for 1st trimester only (but women dont need to switch to it)
carbimazole in 2nd and 3rd trimester
91
what medication for hyperthyroidism is contraindicated in pregnancy?
radioactive iodine
92
what does carboprost due in women with asthmap
bronchospasm
93
women with asthma what may be used for IOL/PPH
prostaglandin E1 or E2
94
women with heart disease teratogenic drugs to stop
ACEi
ARB
thiazides
warfarin
statins
95
echocardiogram for women with heart disease
at booking
again at 28 weeks GA
96
extra scans for women with heart disease
foetal heart scan at 22 weeks GA
97
women with heart disease prophylaxis antenatal
LMWH and ted stockings
for DVT/PE
98
intrapartum care for women with heart disease
aim for spontaneous labour
give epidural analgesia
minimise 2nd stage of labour with instrumental delivery
3rd stage of labour avoid syntometrine, oxytocin only
consider planned c section
prophylactic abx if structural heart defect
99
AED dose should be reviewed after pregancy within how many days
10 days
100
abx maternal uti
nitrofurantoin 50mg QDS 7 days
101
dont give nitrofurantoin to pregnant women who are
at term
102
what abx for uti is contraindicated in pregnancy and why
trimethoprim
folate antagonist
103
syphillis in pregnancy mx
refer to gum clinic
IM benzylpenicillin stat
104
1st line abx for toxoplasmosis in pregnancy
spiramycin
sulfadiazine and pyrimethamine if pregnancy continues
105
VZV vaccine in pregnancy
contraindicated
106
VZV exposure <20 weeks GA
VZIG immediately
107
VZV exposure >20 weeks GA
VZIG or antivirals after 7-14 days of exposure
108
pregnant women with VZV are infectious for
21 days if not treated
28 days if given VZIG
109
VZIG is not helpful in pregnancy if
someone has contracted the infection
(only helpful after exposure to prevent contraction)
110
>20 weeks GA and present with VZV within 24 hrs onset of rash
oral aciclovir for 7-14 days after exposure
111
<20 weeks GA and present with VZV within 24 hrs onset of rash
consider aciclovir
112
VZV infection in last 4 weeks of pregnancy delivery plan
wait for 7 days after onset of rash for elective delivery
113
mx for foetus if delivery before 7 days after VZV or maternal development of VZV 7 days after delivery
VZIG
114
maternal parvovirus b19 risk of transmission to foetus
30%
115
mx if foetal hydrops due to parovirus b19
foetal blood sampling and intrauterine red blood cell transfusion
116
listeria abx
IV amoxicillin 2mg every 6 hrs for 14 days
117
when does second trimester start
13 weeks
118
when does third trimester start
28 weeks
119
maternal HIV appointments
HIV clinician and obstetrician joint appt every 1-2 weeks
120
maternal HIV monitoring
CD4 count
viral load every 2-4 weeks, at 36 weeks and delivery
121
maternal HIV viral load for vaginal delivery vs c section
measured at 36 weeks GA
vaginal= <50 copies/mL
c section= >50 copies/mL
122
neonatal HIV tested using
direct viral amplification by PCR
123
postnatal care for maternal HIV
wash baby immediately
clamp cord immediately
avoid breastfeeding
low risk= zidovusine monotherapy 2-4 weeks
high risk= triple ART 2-4 weeks
124
maternal hep B medication given to mother if high risk
tenofovir
125
maternal hep B medication given to child
IVIG immediately after birth
vaccine at 0 weeks, 4 weeks and 12 months
126
breastfeeding advice for hep B
encourage
127
neonate test for hep B
viral serology
128
pre eclampsia proteinuria +1 next test
quantify using protein:creatinine or albumin:creatinine
129
protein:creatinine threshold pre eclampsia
>30mg/mol
130
albumin:creatinine threshold pre eclampsia
>8mg/mol
131
aspirin for pre eclampsia prophylaxis when how many major/minor rf
1 major
2 or more minor
132
minor rf pre eclampsia
over 40
first pregnancy
pregnancy interval over 10 yrs
bmi over 35 at booking
FH pre eclampsia
multiple pregnancy
133
adverse events for mother in preeclampsia prediction models
PIERS
PREP-S (only until 34 weeks GA)
134
pre eclampsia monitoring
BP every 2 days
FBC/UEs/LFTs 2x weekly
foetal surveillance 2 weekly
24 hrs after birth in hospital, BP every 4 hrs
BP every 1-2 days for 2 weeks after discharge
135
foetal surveillance monitoring includes
growth
liquor
umbilical artery blood flow
136
IV magnesium sulfate in pre eclampsia when
eclampsia occurs
severe disease and delivery in next 24 hrs
delivery <34 weeks
137
delivery plan for pre eclampsia
arrange delivery for 37 weeks GA
138
avoid use of what during IOL if women has pre eclampsia
ergometrine
139
reduce antihypertensives in pre eclampsia after birth when bp is
<130/80
140
pre eclampsia risk of recurrence
15%
141
mag sulf dose/route etc in eclampsia
4g loading in 100ml 0.9% saline in 10-15 mins
then IV infusion of 1g/hour
recurrent seizure give another loading dose (and call anaesthetist)
142
mag sulf reversal
10ml 10% calcium gluconate over 10 mins
143
delivery in eclampsia
expedite
144
pregnant women on insulin CBG should be above
4
145
postpartum medication rules for gestational diabetes
discontinue glucose lowering medications immediately
146
checking for new diagnosis of diabetes after gestational diabetes and result
measure fasting glucose 6 weeks postpartum
<6= low likelihood, yearly monitoring
6-7= high likelihood, yearly monitoring
>7= likely have it, offer diagnostic test
147
what can be given if a patient doesnt want insulin in gestational diabetes
glibenclamide (sulphonylurea)
148
clinic appts in gestational diabetes
within 1 week of diagnosis
1-2 weekly thereafter
149
Hb levels through pregnancy for anaemia
1st trimester <110
2nd/3rd trimester <105
postpartum <100
150
antenatal iron supplement dose and take when
100-200mg oral iron
for 3 months after Hb normalises and till 6 weeks postpartum
151
check Hb when after starting iron supplements for anaemia
2-4 weeks
152
monitoring for obestetric cholestasis
weekly LFTs
women to monitor foetal movements closely
153
serum bile acid conc obstetric cholestatsis delivery by
>100= 35-36 weeks
40-99= 38-39 weeks
15-39= 40 weeks
154
conservative measures of obstetric cholestasis
loose fitting clothing
cold packs
ice
menthol cream
antihistamines
urseodeoxycholic acid
vit K if fat digestion impaired (steatorrhoea)
155
screen baby for what in even of acute fatty liver
LCHAD deficiency
156
correct what in acute fatty liver
hypoglycaemia
electrolytes
clotting abnormalities
157
relationship between SGA and IUGR
IUGR causes baby to be SGA
therefore
all IUGR babies are SGA
not all SGA babies have IUGR
158
magnesium sulfate given for foetal neuroprotection when
any delivery under 30 weeks GA
consider if under 34 weeks GA
159
monitoring for IUGR
serial growth scans 2 weekly
doppler US to look at umbilical artery blood flow 2 weekly
monitor foetal movements
160
delivery for IUGR when
usually by 37 weeks
161
what GA can you have placenta praevia or a low lying placenta
>16 weeks
162
what guides decisions about delivery when someone has an antenatal haemorrhage due to placenta praevia
haemodynamic stability of mother (if no, deliver)
foetal distress (if yes, deliver)
163
scanning for low lying placenta/placenta praevia
usually picked up at 20 week scan
rescan at 32 weeks
if still low rescan at 36 weeks
if still low recommend c section
164
what guides decisions about delivery in placental abruption
foetal distress
if no distress=
< 36 weeks can observe, give steroids NO tocolytics
>36 weeks vaginal delivery can be trialled
any evidence of distress= emergency c section
165
bloods to send in placental abruption
G+S x match
FBC
clotting profile
kleihauer test and rhesus status
166
discordant foetal growth in a twin pregnancy is
>25% difference
167
GA in twin pregnancy is measured by
the size of the larger twin
168
when is vaginal delivery in twin pregnancy possible
diamniotic
first twin cephalic presentation
169
which twin pregnancy requires the most appts
monochorionic monoamniotic
170
twin to twin transfusion syndrome is a more likely complication in what pregnancy
monochorionic monoamniotic
171
monitoring in twin pregnancy
scan for anaemia at 20 weeks
serial growth scans every 2-4 weeks
172
delivery plan in twin pregnancy
recommend an elective birth, timing depending on type of pregnancy
173
complications in twin pregnancy
miscarriage
IUGR
prematurity
twin to twin transfusion syndrome
PPH
174
normal rate of contractions in labour
4 every 10 mins
175
normal variability in CTG
5-25
176
define CTG acceleration
rise in HR of >15bpm for 15 seconds
177
normal accelerations
>2 every 20-30 mins
178
absent accelerations on CTG are indicative of
foetal hypoxia
179
3 types of decelerations and what they mean
early= occurs only during contraction, is normal
variable= varies when compared to contractions
late= occurs during contraction and persists after
180
each feature on a CTG can be describes as
reassuring
non reassuring
pathological
181
overall CTG impression
normal= no concerning features
suspicious= one non reassuring feature
pathological= one pathological feature or 2 non reassuring features
182
foetal bradycardia must last for how long for delivery to be expeditied
9 mins
183
what is conservative mx when interpreting a CTG
always involve a senior obstetrician or midwife first if suspicious/pathological overall impression
mobilise mother
adopt left lateral position
hold oxytocin
observe maternal observations
give fluids
184
if there is acute bradycardia or a prolonged deceleration >3 mins
urgently involve senior obstetrician
prepare for birth but initate conservative measures
expedite birth IF acute event eg rupture, cord prolapse or bradycardia for >9mins
185
DR C BRAVADO
determine risk- whats the indication
contractions
baseline rate
variability
accelerations
decelerations
overall impression
186
cord compression causes what CTG abnormality
variable decelerations
187
foetal hypoxia causes what CTG abnormality
tachycardia
absent accelerations
late decelerations
188
no of antenatal appts in a normal pregnancy
10 if nullip
7 if multip
189
dating scan
10-13+6 weeks
190
anomaly scan
18-20+6 weeks
191
booking visit
8-12 weeks
192
cervical excitation is found in
PID
ectopic pregnancy
193
