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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
Investigation and management of placenta previa?
Transvaginal USS Mx: stabilisation, keep pregnancy in uterine if possible, delivery via CS
26
Symptoms of placenta previa
Painless uterine bleeding
27
What is the role of corticosteroids in utero?
Mature the foetal lung's (if risk of pre term delivery)
28
Placental Abruption
Detachment of the placenta prematurely
29
Features of placental abruption
Severe abdominal pain Bleeding (unless concealed) "woody" abdomen on palpation
30
Diagnosis and management of placental abruption
Clinical diagnosis Mx: Resuscitation Stabilisation or delivery
31
What is the kleihauer-betke test?
Tests the amount of foetal cells in maternal circulation - used to calculate how much anti-D is needed
32
Vasa previa
Unprotected foetal vessels pass over the cervical os
33
Features of vasa previa
PAINLESS vaginal bleeding Foetal distress
34
Investigation and management of vasa previa
Ix: Apt test -> NaOH mixed with blood to determine if source of bleeding is foetal Wright's stain Management: CS
35
Preterm labour
Labour between 20 to 37 wks
36
Causes of preterm labour?
Spontaneous Maternal infection/ co-morbidity Foetal: genetics abnormality, multiple gestation, foetal hydrops Uterine malformations
37
Prevention of PTL
1. Cervical cerclage 2. Progesterone 3. Lifestyle
38
Test to predict PTL?
Foetal fibronectin: positive if >50ng/mL
39
Drug to help to suppress pre term labour?
Tocolytics E.g. nifedipine, indomethacin.
40
Why do you give MgSO4 in at risk pregnancy?
Neuroprotection
41
PROM Investigation and Management
Speculum exam Admit for expectant management
42
Post-term pregnancy
>42 wks GA induction recommended at 41 + 3 wks
43
Intrauterine foetal death *
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
IUGR
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
TORCH
T: Toxoplasmosis Others: syphilis R: Rubella C: CMV H: HSV
46
Investigation and management of IUGR?
Ix: symphysis fundal height USS Doppler umbilical cord blood flow Mx: modify lifestyle factors determine cause delivery when safe via CS
47
Macrosomia
Infant weight >90th percentile for GA RFs: maternal obesity T2DM prolonged gestation multiparity
48
Oligohydramnios
Too little amniotic fluid Consider therapeutic amniocentesis if severe
49
Polyhydramnios
Too much amniotic fluid
50
Dichorionic versus diamniotic
Dichorionic: two placentas Diamniotic: two amniotic sacs
51
Twin-Twin Transfusion Syndrome
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
Breech presentation
Management: ECV >36wks Vaginal breech delivery or CS
53
Hypertension in Pregnancy
140/90 after 20 wks GA without proteinuria in a patient who was previously normotensive Tx: labetalol, nifedipine, hydralazine if severe
54
Pre-eclampsia
HTN >140/90 Proteinuria or end organ dysfunction or placental dysfunction Mx: expectant management +/- delivery, antenatal steroids, MgSO4 for seizure prevention
55
Eclampsia
>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
HELLP
Haemolysis Elevated liver enzymes Low platelets
57
Diabetes in pregnancy management: pre-pregnancy, pregnancy, and labour
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
Diabetic targets in pregnancy
FPG: <5.3mmol/L 1 hr after food: <7.8 2 hr after food <6.7
59
Gestational DM screening
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
Management GDM
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
When is GBS infection screened in pregnancy?
35-37 wks GA with vaginal and anorectal swabs
62
Treatment of GBS?
Give prophylaxis 4 hour before delivery
63
UTI in pregnancy
Treat asymptomatic bacteriuria Tx: amoxicillin first line
64
Treatment to expectant mother if exposed to chicken pox?
Varicella zoster Ig
65
Management of VTE in pregnancy?
UFH
66
Foetal Monitoring - Vaginal Exam
Amniotic fluid - clear, bloody, meconium Cervical effacement Bony pelvis size and shape
67
Foetal monitoring
Auscultation with Doppler very 15-30mins Every 5 mins once pushing has begun
68
Normal FHR
110-160bpm
69
CTG
1. Contractions 2. Baseline rate 3. Variability - reassuring 5-25bpm 4. Accelerations - good sign 5. Decelerations - concerning, indicate response to hypoxia
70
Management of abnormal FHR
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
Scoring to predict labour?
Bishops score
72
Induction of Labour - methods
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
Shoulder dystocia complications
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
Management of shoulder dystocia
McRobert's manoeuvre Anterior shoulder disimpaction Episiotomy Zavanelli - replace foetus in uterus and CS
75
Umbilical cord prolapse
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
Uterine Rupture
Uterus tears Tx: immediate stabilisation of mother and delivery
77
Amniotic fluid embolus
Amniotic fluid in maternal circulation causes anaphylactoid response Features: sudden onset respiratory distress, cardiovascular collapse, seizures Mx: ITU supportive measures
78
Chorioamnionitis
S/S: fever, maternal or foetal tachycardia, uterine tenderness, foul discharge Tx: antibiotics
79
Perineal lacerations
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
Postpartum haemorrhage 4Ts
Tone (atony) - give oxytocin Tissue Trauma Thrombin -DIC, ITP, TTP, VWD, haemophilia
81
Uterine inversion
Presents with profound vasovagal and shock Mx: tocolytics, surgery
82
APGAR Score
Appearance Pulse Grimace Activity (tone) Respiration >7 good score

Medicine (16 decks)

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