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Medicine > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

B-hCG rule of 10s

A

10 IU at time of missed menses

100, 000 IU at 10 weeks GA (peak)

10, 000 IU at term

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2
Q

Trimesters

A

T1 1-14 weeks
T2 14-28 weeks
T3 28-42 weeks

Normal pregnancy term 37-42 weeks

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3
Q

What is Goodell’s sign?

A

Cervical softening (4-6wks)

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4
Q

What is Chadwick’s sign?

A

Bluish discolouration of the cervix and vagina due to pelvic vascular engorgement (6 wks GA)

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5
Q

What is Hegar’s sign?

A

Softening of the cervical isthmus (6-8 wks GA)

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6
Q

Lower b-hCG levels than expected causes? (4)

A
  1. Ectopic
  2. Abortion
  3. Inaccurate dates
  4. Some normal pregnancies
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7
Q

Higher b-hCG levels than expected causes? (5)

A
  1. Multiple gestations
  2. Molar pregnancy
  3. Trisomy 21
  4. Inaccurate dates
  5. Some normal pregnancies
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8
Q

TVUSS signs of pregnancy at 5wks, 6wks, 6-8wks.

A

5 wks: gestational sac visible
6 wks: fetal pole visible
6-8wks: foetal heart activity visible

trans-abdominal US: pregnancy visible from 6-8wks

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9
Q

How to calculate due date?

A

Naegele’s rule: 1st LMP + 1year and 7 days - 3 mo.

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10
Q

N+V in pregnancy treatment

A

Normally in T1

Tx:
1. Pyridoxine monotherapy or doxylamine-B6 (Diclectin) PO

  1. Cyclizine (H1 receptor antagonist)
  2. Consider metoclopramide or ondansetron if sever
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11
Q

Hyperemesis gravidarum

A

Management:
1. doxylamine-pyridoxine
2. dimenhydrinate adjunct
3. consider metclop/ ondansetron
4. if severe, admit to hospital

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12
Q

Ultrasound screening dates

A

Dating USS: 8-12 wks

Nuchal translucency scan: 11-14 wks

Growth and anatomy USS: 18-20 wks

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13
Q

What does nuchal translucency screen for?

A

Measures amount of fluid behind baby’s neck.

Early screening for Downs Sydrome

May also detect cardiac anomalies and other aneuploidies

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14
Q

NIPT

A

At >10 wks onwards

Measures for Downs (21), Edward’s (18) and Patau’s (13)

As well as Turner’s, Di George, Cri du chat, etc.)

Only suggestive, does not confirm diagnosis.

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15
Q

CVS

A

10-12 wks GA

Offered for high risk pregnancies to test for genetic abnormalities

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16
Q

When do you test for rhesus status?

A

28 wks GA

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17
Q

When do you test for GBS?

A

35-37 wks GA

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18
Q

Amniocentesis

A

As early as 15 wks

Identify genetic abnormalities

+: screens for ONTD, more accurate than CVS

-: risk of pregnancy loss

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19
Q

Differentials for decreased foetal movement (4)

A
  1. Death of foetus
  2. Amniotic fluid decrease
  3. Sleep cycle of foetus
  4. Hunger/ thirst
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20
Q

Folic acid in pregnancy

A

0.4-1mg OD starting 2-3mo pre conception

4mg if high risk NTD

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21
Q

Antepartum haemorrhage definition?

A

Bleeding from 20 weeks to term

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22
Q

Placenta previa

A

Placenta implanted in the lower part of the abdomen

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23
Q

Risks of placenta previa (6)

A

1.Antepartum haemorrhage
2. Emergency caesarean section
3. Emergency hysterectomy
4, Maternal anaemia and transfusions
5. Preterm birth and low birth weight
6. Stillbirth

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24
Q

RF’s placenta previa (6)

A
  1. Previous caesarean sections
  2. Previous placenta praevia
  3. Older maternal age
  4. Maternal smoking
  5. Structural uterine abnormalities (e.g. fibroids)
  6. Assisted reproduction (e.g. IVF)
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25
Q

Investigation and management of placenta previa?

A

Transvaginal USS

Mx: stabilisation, keep pregnancy in uterine if possible, delivery via CS

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26
Q

Symptoms of placenta previa

A

Painless uterine bleeding

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27
Q

What is the role of corticosteroids in utero?

A

Mature the foetal lung’s (if risk of pre term delivery)

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28
Q

Placental Abruption

A

Detachment of the placenta prematurely

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29
Q

Features of placental abruption

A

Severe abdominal pain
Bleeding (unless concealed)
“woody” abdomen on palpation

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30
Q

Diagnosis and management of placental abruption

A

Clinical diagnosis

Mx:
Resuscitation
Stabilisation or delivery

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31
Q

What is the kleihauer-betke test?

A

Tests the amount of foetal cells in maternal circulation - used to calculate how much anti-D is needed

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32
Q

Vasa previa

A

Unprotected foetal vessels pass over the cervical os

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33
Q

Features of vasa previa

A

PAINLESS vaginal bleeding
Foetal distress

34
Q

Investigation and management of vasa previa

A

Ix: Apt test -> NaOH mixed with blood to determine if source of bleeding is foetal

Wright’s stain

Management: CS

35
Q

Preterm labour

A

Labour between 20 to 37 wks

36
Q

Causes of preterm labour?

A

Spontaneous

Maternal infection/ co-morbidity

Foetal: genetics abnormality, multiple gestation, foetal hydrops

Uterine malformations

37
Q

Prevention of PTL

A
  1. Cervical cerclage
  2. Progesterone
  3. Lifestyle
38
Q

Test to predict PTL?

A

Foetal fibronectin: positive if >50ng/mL

39
Q

Drug to help to suppress pre term labour?

A

Tocolytics

E.g. nifedipine, indomethacin.

40
Q

Why do you give MgSO4 in at risk pregnancy?

A

Neuroprotection

41
Q

PROM Investigation and Management

A

Speculum exam

Admit for expectant management

42
Q

Post-term pregnancy

A

> 42 wks GA

induction recommended at 41 + 3 wks

43
Q

Intrauterine foetal death *

A

Foetal death in utero after 20 wks GA

Causes:
1. Idiopathic
2. HTN, DM, erythroblastosis foetalis, congenital abnormalities, umbilical or placental complications, intrauterine infection, Antiphospholipid syndrome

Clinical features:
1. decreased foetal movement
2. absent heart tones
3. USS –> no FHR
4. High MSAFP

Management:
Investigate for secondary cause
Induction of labout

44
Q

IUGR

A

Estimated foetal weight <10% for GA

Causes: maternal malnutrition/smoking, alcohol, co-morbidity, any disease of placental insufficiency, TORCH infections, multiple gestation, genetic abnormality

45
Q

TORCH

A

T: Toxoplasmosis
Others: syphilis
R: Rubella
C: CMV
H: HSV

46
Q

Investigation and management of IUGR?

A

Ix:
symphysis fundal height
USS
Doppler umbilical cord blood flow

Mx:
modify lifestyle factors
determine cause
delivery when safe via CS

47
Q

Macrosomia

A

Infant weight >90th percentile for GA

RFs:
maternal obesity
T2DM
prolonged gestation
multiparity

48
Q

Oligohydramnios

A

Too little amniotic fluid

Consider therapeutic amniocentesis if severe

49
Q

Polyhydramnios

A

Too much amniotic fluid

50
Q

Dichorionic versus diamniotic

A

Dichorionic: two placentas

Diamniotic: two amniotic sacs

51
Q

Twin-Twin Transfusion Syndrome

A

Placental blood flow from donor twin to recipient twin

Donor: IUGR, hypovolaemia, hypotension, anaemia, oligohydramnios

Recipient: hypervolemia, HTN, polycythaemia, polyhydramnios, kernicterus

Ix: USS

Mx: fetoscopic laser ablation of anastomosis

Intrauterine blood transfusion to donor twin

52
Q

Breech presentation

A

Management:
ECV >36wks
Vaginal breech delivery or CS

53
Q

Hypertension in Pregnancy

A

140/90 after 20 wks GA without proteinuria in a patient who was previously normotensive

Tx: labetalol, nifedipine, hydralazine if severe

54
Q

Pre-eclampsia

A

HTN >140/90
Proteinuria
or end organ dysfunction
or placental dysfunction

Mx: expectant management +/- delivery, antenatal steroids, MgSO4 for seizure prevention

55
Q

Eclampsia

A

> 1 generalized convulsions in the setting of preeclampsia

Mx:
1. Roll patient into left lateral decubitus position
2. O2
3. Aggressive anti-HTNs
MgSO4
definitive treatment is DELIVERY

56
Q

HELLP

A

Haemolysis
Elevated liver enzymes
Low platelets

57
Q

Diabetes in pregnancy management: pre-pregnancy, pregnancy, and labour

A

Pre-pregnancy
- folic acid 1mg OD 3/12
- optimize glycaemia control (discontinue ACE-i, ARB, statins)

Pregnancy
- T2DM: insulin therapy
- increase foetal surveillance

Labour
- induce at 38-40wks

58
Q

Diabetic targets in pregnancy

A

FPG: <5.3mmol/L
1 hr after food: <7.8
2 hr after food <6.7

59
Q

Gestational DM screening

A

Screening btw 24-28wks GA

Step 1: RBG
<7.8 normal
>11.1 DM
7.8 - 11.1 proceed to Step 2

Step 2: FBG
>5.1
after 1 hr >10.0
after 2 hr > 8.5

60
Q

Management GDM

A
  1. Lifestyle and exercise
  2. Insulin therapy if glucose targets not achieved in 2/52
  3. Stop insulin and diabetic diet post-partum
  4. OGTT at 6/52-12 PP
  5. From 36 wks GA - weekly ax of pregnancy
  6. offer IOL at 38-40wks
61
Q

When is GBS infection screened in pregnancy?

A

35-37 wks GA with vaginal and anorectal swabs

62
Q

Treatment of GBS?

A

Give prophylaxis 4 hour before delivery

63
Q

UTI in pregnancy

A

Treat asymptomatic bacteriuria

Tx: amoxicillin first line

64
Q

Treatment to expectant mother if exposed to chicken pox?

A

Varicella zoster Ig

65
Q

Management of VTE in pregnancy?

A

UFH

66
Q

Foetal Monitoring - Vaginal Exam

A

Amniotic fluid - clear, bloody, meconium

Cervical effacement

Bony pelvis size and shape

67
Q

Foetal monitoring

A

Auscultation with Doppler very 15-30mins

Every 5 mins once pushing has begun

68
Q

Normal FHR

A

110-160bpm

69
Q

CTG

A
  1. Contractions
  2. Baseline rate
  3. Variability - reassuring 5-25bpm
  4. Accelerations - good sign
  5. Decelerations - concerning, indicate response to hypoxia
70
Q

Management of abnormal FHR

A

POIFSON - ER
Position - LLDP
O2
IVF
Foetal scalp stimulation/ electrode/pH
Stop oxytocin
Notify physician
Examine vagina ?cord prolapse
Rule out fever, dehydration, drug effects and prematurity

71
Q

Scoring to predict labour?

A

Bishops score

72
Q

Induction of Labour - methods

A
  1. Cervical ripening
    - PGE2 gel
    - foley catheter for manual dilatation
  2. Amniotomy
  3. Oxytocin - Pitocin

Amniotomy and oxytocin can also be used to strengthen contractions

73
Q

Shoulder dystocia complications

A

Erb’s palsy: C5-C7 “ waiter’s tip” internal rotation of forearm

Klumpke’s: C8-T1 -MCP extension and IP flexion

clavicle, humerus or C-spine

74
Q

Management of shoulder dystocia

A

McRobert’s manoeuvre
Anterior shoulder disimpaction
Episiotomy

Zavanelli - replace foetus in uterus and CS

75
Q

Umbilical cord prolapse

A

Descent of cord adjacent or below presenting part

Presents with FHR changes and visible or palpable cord

Emergency CS, manually elevate the presenting part until caesarean

76
Q

Uterine Rupture

A

Uterus tears
Tx: immediate stabilisation of mother and delivery

77
Q

Amniotic fluid embolus

A

Amniotic fluid in maternal circulation causes anaphylactoid response

Features: sudden onset respiratory distress, cardiovascular collapse, seizures

Mx: ITU supportive measures

78
Q

Chorioamnionitis

A

S/S: fever, maternal or foetal tachycardia, uterine tenderness, foul discharge

Tx: antibiotics

79
Q

Perineal lacerations

A

1st: skin and vaginal mucosa
2nd: fascia and muscles of perineum
3rd: involving the anal sphincter
4th: extends into the rectal mucosa

Give single dose IV antibx for 3rd and 4th degree tears

80
Q

Postpartum haemorrhage 4Ts

A

Tone (atony) - give oxytocin
Tissue
Trauma
Thrombin -DIC, ITP, TTP, VWD, haemophilia

81
Q

Uterine inversion

A

Presents with profound vasovagal and shock

Mx: tocolytics, surgery

82
Q

APGAR Score

A

Appearance
Pulse
Grimace
Activity (tone)
Respiration

> 7 good score

Medicine (16 decks)

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