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Aaska's specialities > OBSTETRICS > Flashcards

OBSTETRICS Flashcards

1
Q

RF for IUGR

A

smoking
alcohol

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2
Q

drugs contraindicated in breast feeding

A

sulphonamides, tetracyclines, ciprofloxacin, clindamycin
amiodarone
psychiatric: lithium, benzos
methotrexate
carbimazole
sulphonylureas
aspirin

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3
Q

APGAR score calculated when

A

min 1, 5, 10

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4
Q

pertussis vaccine in pregnancy when

A

16 weeks

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5
Q

at booking appt offer screening for

A

haemoglobinopthies
red cell alloantibodies
foetal anomalies
hep B
HIV
syphillis

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6
Q

at 16 weeks GA give iron supplements if Hb is under

A

11

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7
Q

at 28 weeks GA give iron supplements if Hb is under

A

10.5

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8
Q

membrane sweep/IOL is offered if a women hasnt given birth by

A

41 weeks

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9
Q

at every antenatal appt you check

A

BP
BMI
urine dip
SFH

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10
Q

first stage of labour duration in nullip/multip

A

nullip <18 hrs
mulltip <12 hrs

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11
Q

normal progress of labour in active stage

A

1cm dilation every 2 hrs

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12
Q

abnormal progress of labour in active stage

A

<2cm dilation in 4 hrs

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13
Q

2nd stage of labour normal duration

A

2hrs nullip
1hr multip

add an hour if they have an epidural

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14
Q

apgar score interpretation

A

0-3= very low
4-7= moderately low
7-10= good state

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15
Q

what cervical length indicates need for prevention of preterm labour

A

<25mm

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16
Q

contraindications for rescue cervical cerclage

A

infection
bleeding
presence of uterine contractions

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17
Q

indications for prevention of preterm labour

A

history of labour <34 weeks
mid trimester loss hx
cervix <25mm

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18
Q

what GA is midtrimester loss

A

> 16 weeks

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19
Q

1st line tocolytic

A

nifedipine

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20
Q

tocolytics contraix when

A

bleeding or infection

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21
Q

nifedipine moa

A

CCB

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22
Q

2nd line tocolytic

A

atosiban

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23
Q

preterm labour 2 medications given

A

corticosteroids
tocolytics
magnesium sulfate

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24
Q

preterm labour definition

A

labour before 37 weeks GA

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25
Q

abx for pre prom

A

erythromycin 250mg QDS

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26
Q

p prom admission

A

admit till 28 weeks
then 2-3 weekly monitoring

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27
Q

maternal corticosteroid route/dose for premature delivery

A

IM betamethasone 24mg in 2 doses 12 hrs apart

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28
Q

mag sulf route/dose for premature delivery

A

IV loading 4g over 5-15 mins
then 1g/hr infusion

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29
Q

group B strep positive >34 weeks PPROM

A

IOL

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30
Q

preterm labour vs PPROM

A

preterm rupture of membranes in both
in PPROM absence of contractions/labour

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31
Q

PPROM full form

A

preterm premature rupture of membranes

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32
Q

PPROM admit or no

A

YES

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33
Q

PROM admit or no

A

YES

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34
Q

IOL after PROM when

A

> 24 hrs and absence of contraction

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35
Q

meconium seen in PROM

A

immediate IOL

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36
Q

PROM mx

A

admit for speculum, 4 hrly temperature and foetal monitoring
give prophylactic abx

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37
Q

shoulder dystocia mx

A
  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
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38
Q

shoulder dystocia complications for baby

A

brachial plexus injury
fracture
pneumothorax
hypoxic brain injury

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39
Q

ECV contrindications

A

antenatal haemorrhage previous 7 days
multiple pregnancy
CTG abnormality
ruptured membranes

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40
Q

implications of c section for future pregnancy

A

VBAC
placenta praevia
uterine rupture

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41
Q

breech delivery counseling

A

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

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42
Q

vaginal delivery in breech is not possible if

A

footling breech

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43
Q

ECV offered when

A

36 weeks nullip
37 weeks multip

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44
Q

medication given before ECV

A

terbutaline

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45
Q

face presentation chin anterior delivery

A

vaginal possible

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46
Q

face presentation chin posterior delivery

A

c section

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47
Q

brow presentation delivery

A

c section

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48
Q

unstable lie delivery

A

consider ECV or elective c section

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49
Q

bishop score 5 or lower IOL method

A

vaginal prostaglandins

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50
Q

bishop score 6 or above IOL method

A

ARM then IV oxytocin

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51
Q

what must you exclude before doing a membrane sweep

A

placenta praevia

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52
Q

cervical ripening balloon vs vaginal prostaglandin in IOL

A

cervical balloon is preferred as reduced risk of overstimulation

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53
Q

ARM only used first line in IOL if

A

bishop score over 6

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54
Q

IV syntocinon used in IOL if

A

bishop score over 6
contractions haven’t started 2hrs after ARM

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55
Q

VBAC success rate

A

72-75%

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56
Q

best predictor of VBAC success

A

previous successful VBAC

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57
Q

IOL in VBAC implications

A

2-3 fold increased risk in uterine rupture

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58
Q

uterine rupture risk in VBAC

A

1 in 200

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59
Q

cord outside interoitus in cord prolapse mx

A

avoid handling, keep warm and moist, dont put it back inside

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60
Q

what uterotonic is contraindicated in women with hypertension

A

syntometrine

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61
Q

fluids given in PPH

A

IV warm crystalloid

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62
Q

what clotting must you request in PPH

A

fibrinogen

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63
Q

how many units of blood should be crossmatched in PPH

A

4

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64
Q

what uterotonic drug is contraindicated in asthmatics

A

IM carboprost

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65
Q

oxytocin dose for PPH prophylaxis VB vs CS

A

VB= 10 iu
CS= 5iu

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66
Q

major PPH blood vol

A

> 1000mL

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67
Q

PPH positioning

A

lie flat

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68
Q

pharmacological mx of uterine atony

A
  1. 5iu oxytocin slow IV infusion
  2. syntocinon (not if htn)
  3. IV infusion oxytocin
  4. IM carboprost (not if asthmatic)
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69
Q

1st/2nd/3rd line antihypertensive for existing htn in pregnancy

A
  1. labetalol
  2. nifedipine
  3. methyldopa
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70
Q

BP monitoring in pregnancy for exisiting htn

A

weekly if poorly controlled
2-4 weekly if well controlled

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71
Q

BP target in pregnancy for exisiting htn

A

<135/85

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72
Q

what extra scans do pregnant women with htn get in pregnancy

A

serial growth scans 4 weekly from 28-36 weeks

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73
Q

medications for preexisiting htn

A

antihypertensives
aspirin 12 weeks onwards

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74
Q

low dose aspirin in htn exact dose

A

75-150mg

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75
Q

IOL in exisiting hypertension

A

if BP <160/110 do not offer induction <37 weeks

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76
Q

postnatal BP monitoring for existing htn

A

daily for 2 days
on day 3 and day 5
2 week review at GP

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77
Q

diabetes mellitus in pregnancy monitoring

A

joint diabetes and antenatal clinic every 1-2 weeks

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78
Q

extra scans for diabetes mellitus in pregnancy

A

foetal heart scan 19-20 weeks
serial growth scans 4 weekly from 28-36 weeks

79
Q

diabetes mellitus in pregnancy screen for what

A

retinal and renal damage at booking and 28 weeks
if abnormal at booking also at 16-20 weeks

80
Q

diabetes mellitus in pregnancy when to increase insulin advice

A

after 20 weeks GA as resistance rises

81
Q

aditional insulin is needed for diabetes mellitus in pregnancy when what medication is given

A

steroids

82
Q

insulin during labour for diabetes mellitus

A

sliding scale

83
Q

BG aim suring labour for women with diabetes mellitus

A

4-7

84
Q

BG in diabetes mellitus measure how many times a day

A

7

85
Q

BG targets diabetes mellitus

A

<5.3 fasting
<7.8 1 hr post prandial
<6.4 post prandial

86
Q

diabetes mellitus check neonatal blood glucose within what time frame

A

4 hrs

87
Q

how often are thyroid levels checked in pregnancy

A

every 2-4 weeks

88
Q

thyroxine dose for hypothroidism in pregnancy

A

higher as demand increases
usually by 25 mg

89
Q

TFTs check postpatrum in those with thyroid disease when

A

6 weeks at GP

90
Q

thyroid medications for hyperthyroidism in pregnancy

A

propylthiouracil preferred for 1st trimester only (but women dont need to switch to it)
carbimazole in 2nd and 3rd trimester

91
Q

what medication for hyperthyroidism is contraindicated in pregnancy?

A

radioactive iodine

92
Q

what does carboprost due in women with asthmap

A

bronchospasm

93
Q

women with asthma what may be used for IOL/PPH

A

prostaglandin E1 or E2

94
Q

women with heart disease teratogenic drugs to stop

A

ACEi
ARB
thiazides
warfarin
statins

95
Q

echocardiogram for women with heart disease

A

at booking
again at 28 weeks GA

96
Q

extra scans for women with heart disease

A

foetal heart scan at 22 weeks GA

97
Q

women with heart disease prophylaxis antenatal

A

LMWH and ted stockings
for DVT/PE

98
Q

intrapartum care for women with heart disease

A

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
Q

AED dose should be reviewed after pregancy within how many days

A

10 days

100
Q

abx maternal uti

A

nitrofurantoin 50mg QDS 7 days

101
Q

dont give nitrofurantoin to pregnant women who are

A

at term

102
Q

what abx for uti is contraindicated in pregnancy and why

A

trimethoprim
folate antagonist

103
Q

syphillis in pregnancy mx

A

refer to gum clinic
IM benzylpenicillin stat

104
Q

1st line abx for toxoplasmosis in pregnancy

A

spiramycin

sulfadiazine and pyrimethamine if pregnancy continues

105
Q

VZV vaccine in pregnancy

A

contraindicated

106
Q

VZV exposure <20 weeks GA

A

VZIG immediately

107
Q

VZV exposure >20 weeks GA

A

VZIG or antivirals after 7-14 days of exposure

108
Q

pregnant women with VZV are infectious for

A

21 days if not treated
28 days if given VZIG

109
Q

VZIG is not helpful in pregnancy if

A

someone has contracted the infection

(only helpful after exposure to prevent contraction)

110
Q

> 20 weeks GA and present with VZV within 24 hrs onset of rash

A

oral aciclovir for 7-14 days after exposure

111
Q

<20 weeks GA and present with VZV within 24 hrs onset of rash

A

consider aciclovir

112
Q

VZV infection in last 4 weeks of pregnancy delivery plan

A

wait for 7 days after onset of rash for elective delivery

113
Q

mx for foetus if delivery before 7 days after VZV or maternal development of VZV 7 days after delivery

A

VZIG

114
Q

maternal parvovirus b19 risk of transmission to foetus

A

30%

115
Q

mx if foetal hydrops due to parovirus b19

A

foetal blood sampling and intrauterine red blood cell transfusion

116
Q

listeria abx

A

IV amoxicillin 2mg every 6 hrs for 14 days

117
Q

when does second trimester start

A

13 weeks

118
Q

when does third trimester start

A

28 weeks

119
Q

maternal HIV appointments

A

HIV clinician and obstetrician joint appt every 1-2 weeks

120
Q

maternal HIV monitoring

A

CD4 count
viral load every 2-4 weeks, at 36 weeks and delivery

121
Q

maternal HIV viral load for vaginal delivery vs c section

A

measured at 36 weeks GA
vaginal= <50 copies/mL
c section= >50 copies/mL

122
Q

neonatal HIV tested using

A

direct viral amplification by PCR

123
Q

postnatal care for maternal HIV

A

wash baby immediately
clamp cord immediately
avoid breastfeeding
low risk= zidovusine monotherapy 2-4 weeks
high risk= triple ART 2-4 weeks

124
Q

maternal hep B medication given to mother if high risk

A

tenofovir

125
Q

maternal hep B medication given to child

A

IVIG immediately after birth
vaccine at 0 weeks, 4 weeks and 12 months

126
Q

breastfeeding advice for hep B

A

encourage

127
Q

neonate test for hep B

A

viral serology

128
Q

pre eclampsia proteinuria +1 next test

A

quantify using protein:creatinine or albumin:creatinine

129
Q

protein:creatinine threshold pre eclampsia

A

> 30mg/mol

130
Q

albumin:creatinine threshold pre eclampsia

A

> 8mg/mol

131
Q

aspirin for pre eclampsia prophylaxis when how many major/minor rf

A

1 major
2 or more minor

132
Q

minor rf pre eclampsia

A

over 40
first pregnancy
pregnancy interval over 10 yrs
bmi over 35 at booking
FH pre eclampsia
multiple pregnancy

133
Q

adverse events for mother in preeclampsia prediction models

A

PIERS
PREP-S (only until 34 weeks GA)

134
Q

pre eclampsia monitoring

A

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
Q

foetal surveillance monitoring includes

A

growth
liquor
umbilical artery blood flow

136
Q

IV magnesium sulfate in pre eclampsia when

A

eclampsia occurs
severe disease and delivery in next 24 hrs
delivery <34 weeks

137
Q

delivery plan for pre eclampsia

A

arrange delivery for 37 weeks GA

138
Q

avoid use of what during IOL if women has pre eclampsia

A

ergometrine

139
Q

reduce antihypertensives in pre eclampsia after birth when bp is

A

<130/80

140
Q

pre eclampsia risk of recurrence

A

15%

141
Q

mag sulf dose/route etc in eclampsia

A

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
Q

mag sulf reversal

A

10ml 10% calcium gluconate over 10 mins

143
Q

delivery in eclampsia

A

expedite

144
Q

pregnant women on insulin CBG should be above

A

4

145
Q

postpartum medication rules for gestational diabetes

A

discontinue glucose lowering medications immediately

146
Q

checking for new diagnosis of diabetes after gestational diabetes and result

A

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
Q

what can be given if a patient doesnt want insulin in gestational diabetes

A

glibenclamide (sulphonylurea)

148
Q

clinic appts in gestational diabetes

A

within 1 week of diagnosis
1-2 weekly thereafter

149
Q

Hb levels through pregnancy for anaemia

A

1st trimester <110
2nd/3rd trimester <105
postpartum <100

150
Q

antenatal iron supplement dose and take when

A

100-200mg oral iron
for 3 months after Hb normalises and till 6 weeks postpartum

151
Q

check Hb when after starting iron supplements for anaemia

A

2-4 weeks

152
Q

monitoring for obestetric cholestasis

A

weekly LFTs
women to monitor foetal movements closely

153
Q

serum bile acid conc obstetric cholestatsis delivery by

A

> 100= 35-36 weeks
40-99= 38-39 weeks
15-39= 40 weeks

154
Q

conservative measures of obstetric cholestasis

A

loose fitting clothing
cold packs
ice
menthol cream
antihistamines
urseodeoxycholic acid
vit K if fat digestion impaired (steatorrhoea)

155
Q

screen baby for what in even of acute fatty liver

A

LCHAD deficiency

156
Q

correct what in acute fatty liver

A

hypoglycaemia
electrolytes
clotting abnormalities

157
Q

relationship between SGA and IUGR

A

IUGR causes baby to be SGA

therefore
all IUGR babies are SGA
not all SGA babies have IUGR

158
Q

magnesium sulfate given for foetal neuroprotection when

A

any delivery under 30 weeks GA
consider if under 34 weeks GA

159
Q

monitoring for IUGR

A

serial growth scans 2 weekly
doppler US to look at umbilical artery blood flow 2 weekly
monitor foetal movements

160
Q

delivery for IUGR when

A

usually by 37 weeks

161
Q

what GA can you have placenta praevia or a low lying placenta

A

> 16 weeks

162
Q

what guides decisions about delivery when someone has an antenatal haemorrhage due to placenta praevia

A

haemodynamic stability of mother (if no, deliver)
foetal distress (if yes, deliver)

163
Q

scanning for low lying placenta/placenta praevia

A

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
Q

what guides decisions about delivery in placental abruption

A

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
Q

bloods to send in placental abruption

A

G+S x match
FBC
clotting profile
kleihauer test and rhesus status

166
Q

discordant foetal growth in a twin pregnancy is

A

> 25% difference

167
Q

GA in twin pregnancy is measured by

A

the size of the larger twin

168
Q

when is vaginal delivery in twin pregnancy possible

A

diamniotic
first twin cephalic presentation

169
Q

which twin pregnancy requires the most appts

A

monochorionic monoamniotic

170
Q

twin to twin transfusion syndrome is a more likely complication in what pregnancy

A

monochorionic monoamniotic

171
Q

monitoring in twin pregnancy

A

scan for anaemia at 20 weeks
serial growth scans every 2-4 weeks

172
Q

delivery plan in twin pregnancy

A

recommend an elective birth, timing depending on type of pregnancy

173
Q

complications in twin pregnancy

A

miscarriage
IUGR
prematurity
twin to twin transfusion syndrome
PPH

174
Q

normal rate of contractions in labour

A

4 every 10 mins

175
Q

normal variability in CTG

A

5-25

176
Q

define CTG acceleration

A

rise in HR of >15bpm for 15 seconds

177
Q

normal accelerations

A

> 2 every 20-30 mins

178
Q

absent accelerations on CTG are indicative of

A

foetal hypoxia

179
Q

3 types of decelerations and what they mean

A

early= occurs only during contraction, is normal
variable= varies when compared to contractions
late= occurs during contraction and persists after

180
Q

each feature on a CTG can be describes as

A

reassuring
non reassuring
pathological

181
Q

overall CTG impression

A

normal= no concerning features
suspicious= one non reassuring feature
pathological= one pathological feature or 2 non reassuring features

182
Q

foetal bradycardia must last for how long for delivery to be expeditied

A

9 mins

183
Q

what is conservative mx when interpreting a CTG

A

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
Q

if there is acute bradycardia or a prolonged deceleration >3 mins

A

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
Q

DR C BRAVADO

A

determine risk- whats the indication
contractions
baseline rate
variability
accelerations
decelerations
overall impression

186
Q

cord compression causes what CTG abnormality

A

variable decelerations

187
Q

foetal hypoxia causes what CTG abnormality

A

tachycardia
absent accelerations
late decelerations

188
Q

no of antenatal appts in a normal pregnancy

A

10 if nullip
7 if multip

189
Q

dating scan

A

10-13+6 weeks

190
Q

anomaly scan

A

18-20+6 weeks

191
Q

booking visit

A

8-12 weeks

192
Q

cervical excitation is found in

A

PID
ectopic pregnancy

193
Q
A

Aaska's specialities (7 decks)

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