Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

3a womens health > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is ectopic pregnancy

A

a pregnancy is implanted outside the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common site of ectopic pregnancy

A

fallopian tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Where can an ectopic pregnancy implant

A

fallopian tube (cornual region), ovary, cervix or abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are risk factors for ectopic pregnancy

A

Previous ectopic pregnancy
Previous pelvic inflammatory disease
Previous surgery to the fallopian tubes
Intrauterine devices (coils)
Older age
Smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are classical features of ectopic pregnancy

A
  • Missed period
  • Constant lower abdominal pain in the right or left iliac fossa
  • Vaginal bleeding
  • Cervical motion tenderness (pain when moving the cervix during a bimanual examination)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

When does ectopic pregnancy typically present

A

6-8 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the investigation of choice for ectopic pregnany

A

A transvaginal ultrasound scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does ectopic pregnancy appear on ultrasound examination

A

gestational sac containing a yolk sac or fetal pole may be seen in a fallopian tub

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is “blob sign”, “bagel sign” or “tubal ring sign” on transvaginal ultrasound

A

a non-specific mass containing an empty gestational sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is ectopic pregnancy differentiated from corpus luteum

A

A mass representing a tubal ectopic pregnancy moves separately to the ovary

a corpus luteum will move with the ovary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What features on ultrasound beside a mass with or without gestational sac may also indicated ectopic pregnancy

A

An empty uterus
Fluid in the uterus, which may be mistaken as a gestational sac (“pseudogestational sac”)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is a pregnancy of unknown location (PUL)

A

woman has a positive pregnancy test and there is no evidence of pregnancy on the ultrasound scan

ectopic pregnancy cannot be excluded follow up needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What hormone can be tracked to help monitor pregnancy of unknown location

A

Serum human chorionic gonadotropin (hCG)
measured again after 48 hours to measure change from baseline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How much should hCG change every 48 hours in an intrauterine pregnancy

A

double

This will not be the case in a miscarriage or ectopic pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What produces hCG

A

developing syncytiotrophoblast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

hCG rises more than 63% in 48 hours what does this indicate

A

intrauterine pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

hCG rises less than 63% in 48 hours what does this indicate

A

ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

hCG falls more than 50% in 48 hours what does this indicate

A

miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

At what hCG should pregnancy be visible on ultrasound

A

above 1500 IU / l.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what test should be performed on all women with abdominal or pelvic pain that might be cuased by ectopic pregnancy

A

pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Where should women with pelvic pain or tenderness and a positive pregnancy test be referred to

A

early pregnancy assessment unit (EPAU) or gynaecology service

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How are ectopic pregnancies managed

A

All ectopic pregnancies need to be terminated. An ectopic pregnancy is not a viable pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the three options for terminating an ectopic pregnancy

A
  • Expectant management (awaiting natural termination)
  • Medical management (methotrexate)
  • Surgical management (salpingectomy or salpingotomy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What criteria need to be met for expectant management in ectopic pregnancy

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What criteria need to be met for methotrexate management in ectopic pregnancy

A

the same as expectant management, except:
No heartbeat
HCG level must be < 5000 IU / l / hCG <1,500IU/L
Confirmed absence of intrauterine pregnancy on ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How is ectopic pregnancy management with methotrexate provided

A

an intramuscular injection into a buttock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is ectopic pregnancy methotrexate management

A

highly teratogenic

halts the progress of the pregnancy and results in spontaneous termination.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What advise is given to women who have methotrexate management for ectopic pregnancy

A

advised not to get pregnant for 3 months following treatment.

This is because the harmful effects of methotrexate on pregnancy can last this long.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are side effects of methotrexate for mother

A

Vaginal bleeding
Nausea and vomiting
Abdominal pain
Stomatitis (inflammation of the mouth)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is the criteria surgical ectopic pregnancy management

A

Pain
Adnexal mass > 35mm
Visible heartbeat
HCG levels > 5000 IU / l

Most patients with an ectopic pregnancy will require surgical management.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the two surgical options for ectopic pregnancy

A

Laparoscopic salpingectomy
Laparoscopic salpingotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is Laparoscopic salpingectomy

A

removal of the affected fallopian tube, along with the ectopic pregnancy inside the tube.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the 1st line treatment for ectopic pregnancy

A

Laparoscopic salpingectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is Laparoscopic salpingotomy

A

A cut is made in the fallopian tube, the ectopic pregnancy is removed, and the tube is closed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which surgical option has an increased risk of failure to remove the ectopic pregnancy

A

salpingotomy

1 in 5 women having salpingotomy may need further treatment with methotrexate or salpingectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What prophylaxis is given to women having surgical management of ectopic pregnancy.

A

Anti-rhesus D prophylaxis is given to rhesus negative women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are risk factors for ectopic pregnancy

A

Previous ectopic pregnancy
Pelvic inflammatory disease
Endometriosis
IUD
tubal ligation
pelvic surgery
embryo transfer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

does an IUD increase the risk of ectopic pregnancy

A

The use of contraception actually reduces the rate of pregnancy. However, if there is failure of the contraception types below, the pregnancy is more likely to be ectopic.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What is a complication of untreated ectopic pregnancy

A

fallopian tube rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a miscarriage

A

spontaneous termination of a pregnanc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

When is early miscarriage

A

before 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

When is late miscarriage

A

between 12 and 24 weeks gestation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is missed miscarriage

A

the fetus is no longer alive, but no symptoms have occurred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is a threatened miscarriage

A

vaginal bleeding with a closed cervix and a fetus that is alive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is a inevitable miscarriage

A

vaginal bleeding with an open cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

what is an incomplete miscarriage

A

retained products of conception remain in the uterus after the miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

what is a complete miscarriage

A

a full miscarriage has occurred, and there are no products of conception left in the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

what an anembryonic pregnancy

A

a gestational sac is present but contains no embryo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is the investigation of choice for diagnosing a miscarriage

A

transvaginal ultrasound scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What are the three key features on ultrasound for diagnosing miscarriage

A

Mean gestational sac diameter
Fetal pole and crown-rump length
Fetal heartbeat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

When is a pregnancy considered viable

A

When a fetal heartbeat is visible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

When is fetal heartbeat expected

A

once the crown-rump length is 7mm or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is procedure when crown-rump length is less than 7mm, without a fetal heartbeat

A

can is repeated after at least one week to ensure a heartbeat develops

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is procedure when crown-rump length of 7mm or more, without a fetal heartbeat

A

scan is repeated after one week before confirming a non-viable pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When is a fetal pole expected

A

once the mean gestational sac diameter is 25mm or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

what is procedure when there is a a mean gestational sac diameter of 25mm or more, without a fetal pole

A

the scan is repeated after one week before confirming an anembryonic pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is management for less than 6 week gestation miscarriage

A

managed expectantly

awaiting the miscarriage without investigations or treatment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

When can a miscarriage be confirmed

A

after a repeat urine pregnancy test after 7 – 10 days, and if negative, a miscarriage can be confirmed.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is management for miscarriage more than 6 weeks gestation

A

referral to an early pregnancy assessment service (EPAU)
Ultrasound to confirm location and viability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What symptoms indicate miscarriage

A

positive pregnancy test + bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are three options of managing a miscarriage

A

Expectant management (do nothing and await a spontaneous miscarriage)
Medical management (Oral mifepristone followed by vaginal misoprostol)
Surgical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

When is expectant management offered first line for miscarriage

A

women without risk factors for heavy bleeding or infection

1 – 2 weeks are given to allow the miscarriage to occur spontaneously

repeat urine pregnancy test after 3 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is medical management for miscarriage

A

Oral mifepristone followed by vaginal misoprostol 48hrs later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

how does mifepristone work

A

weakening of attachment to the endometrial wall + cervical softening and dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

what is mifepristone

A

progesterone receptor antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is Misoprostol and how does it work in miscarriage

A

prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them

Prostaglandins soften the cervix and stimulate uterine contractions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How is misoprostol given

A

as vaginal suppository or an oral dose.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

what are key side effects of misoprostol

A

Heavier bleeding
Pain
Vomiting
Diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the two options of surgical management of miscarriage

A

Manual vacuum aspiration under local anaesthetic as an outpatient
Electric vacuum aspiration under general anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

what is manual vacuum aspiration

A

tube attached to syringe inserted through cervix into uterus and contents are aspirated

women must be under 10 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

what is Medical management of an incomplete miscarriage

A

vaginal misoprostol alone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

what is electric vacuum aspiration

A

traditional, under GA

cervix is widened using dilators and the products of conception are removed through the cervix using an electric-powered vacuum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

what is classed as recurrent miscarriage

A

three or more consecutive miscarriages.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

when are investigations for recurrent micarriage started

A

Three or more first-trimester miscarriages
One or more second-trimester miscarriages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the causes of recurrent miscarriages

A

Idiopathic (particularly in older women)
** Antiphospholipid syndrome **
Hereditary thrombophilias
Uterine abnormalities
Genetic factors in parents (e.g. balanced translocations in parental chromosomes)
Chronic histiocytic intervillositis
Other chronic diseases such as diabetes, untreated thyroid disease and systemic lupus erythematosus (SLE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

When should Antiphospholipid syndrome be considered in a patient presenting with recurrent miscarriages

A

past history of deep vein thrombosis

test for antiphospholipid antibodies, and treatment is with aspirin and LMWH.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What investigations should be arranged for recurrent miscarriages

A

Antiphospholipid antibodies
Testing for hereditary thrombophilias
Pelvic ultrasound
Genetic testing of the products of conception from the third or future miscarriages
Genetic testing on parents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What legal acts outline framework for abortion

A

1967 Abortion Act.
1990 Human Fertilisation and Embryology Act

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What is the criteria for an abortion

A

before 24 weeks if continuing the pregnancy involves greater risk to the physical or mental health of woman and exisiting children

anytime time during pregnancy if continuing the pregnancy presents risk to life of woman, prevents permanent injury to woman, the child is incompatible w life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are legal requirements for an abortion

A
  • Two registered medical practitioners must sign to agree abortion is indicated
  • It must be carried out by a registered medical practitioner in an NHS hospital or approved premise
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How can abortion services be accessed

A

self-referral or by GP, GUM or family planning clinic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What does a medical abortion involve

A

involves two treatments:

  • Mifepristone (anti-progestogen)
  • Misoprostol (prostaglandin analogue) 1 – 2 day later
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How does Mifepristone end pregnancy

A

anti-progestogen medication that blocks the action of progesterone

weakening of attachment to the endometrial wall + cervical softening and dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How does Misoprostol end pregnancy

A

prostaglandin analogue, meaning it binds to prostaglandin receptors and activates them. Prostaglandins soften the cervix and stimulate uterine contractions. From 10 weeks gestation, additional misoprostol doses (e.g. every 3 hours) are required until expulsion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Who should receive prophylaxis in abortion treatment

A

Rhesus negative women given anti-D prophylaxis

medical and surgical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

what are the two options for surgical abortion

A
  • Cervical dilatation and suction of the contents of the uterus (usually up to 14 weeks)
  • Cervical dilatation and evacuation using forceps (between 14 and 24 weeks)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

before a surgical abortion what medications are given and why

A

misoprostol, mifepristone or osmotic dilators

for cervical priming - softening and dilating the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

How long after abortion is a pregnancy test taken

A

3 weeks after the abortion to confirm it is complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are complications of abortion

A

Bleeding
Pain
Infection
Failure of the abortion (pregnancy continues)
Damage to the cervix, uterus or other structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

what is placenta praevia

A

placenta laying in the lower proportion of the uterus lower than the presenting part of the fetus

“going before”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

what does low lying placenta refer to

A

when the placenta is within 20mm of the internal cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

when is the term placenta praevia only used

A

used only when the placenta is over the internal cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

what are the three causes of antepartum haemorrhage.

A

placenta praevia
placental abruption
vasa praevia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

what are causes of spotting or minor bleeding in pregnancy

A

cervical ectropion
infection
vaginal abrasions from intercourse or procedures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What are risk/complications associated with having placenta praevia

A

Antepartum haemorrhage
Emergency caesarean section
Emergency hysterectomy
Maternal anaemia and transfusions
Preterm birth and low birth weight
Stillbirth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is grade 1 placenta praevia

A

Minor praevia, or grade I

  • the placenta is in the lower uterus but not reaching the internal cervical os
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is grade 2 placenta praevia

A

Marginal praevia, or grade II

– the placenta is reaching, but not covering, the internal cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What is grade 3 placenta praevia

A

Partial praevia, or grade III

– the placenta is partially covering the internal cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is grade 4 placenta praevia

A

Complete praevia, or grade IV

– the placenta is completely covering the internal cervical os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What are the risk factors for developing placenta praevia

A

Previous caesarean sections
Previous placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities (e.g. fibroids)
Assisted reproduction (e.g. IVF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

How is placenta praevia diagnoses

A

the 20-week anomaly scan is used to assess the position of the placenta and diagnose placenta praevia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

how does placenta praevia present

A
  • mostly asymptomatic
  • may present with painless vaginal bleeding in pregnancy (antepartum haemorrhage).
  • Bleeding usually occurs later in pregnancy (around or after 36 weeks).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

How is placenta praevia managed

A

recommends a repeat transvaginal ultrasound scan at:

  • 32 weeks gestation
  • 36 weeks gestation (if present on the 32-week scan, to guide decisions about delivery)
  • Corticosteroids given at 34 and 35 + 6 weeks gestation to mature the fetal lungs, given the risk of preterm delivery.
  • planned early delivery at 36 and 37 weeks gestation
  • c section safest delivery option
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is the major complication of placenta praevia

A

haemorrhage before, during and after delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is the management for haemorrhage before, during and after delivery.

A

ABC
Blood transfusions
warmed crystalloid infusion
Emergency caesarean section
rubbing up the fundus
IV oxytocin

Intrauterine balloon tamponade - 1st line
Uterine artery occlusion
Emergency hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is vasa praevia

A

fetal vessels are exposed, outside the protection of the umbilical cord or the placenta.

the fetal vessels travel through the chorioamniotic membranes, and pass across the internal cervical os (the inner opening of the cervix). These exposed vessels are prone to bleeding,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

where are the fetal membranes

A

surround the amniotic cavity and developing fetus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

what comprises the fetal vessels

A

two umbilical arteries and single umbilical vein.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the normal anatomy of fetal vessels

A

umbilical cord containing the fetal vessels (umbilical arteries and vein) inserts directly into the placenta

always protected, either by the umbilical cord or by the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is Whartons Jelly

A

comprises umbilical cord

layer of soft connective tissue that surrounds the blood vessels in the umbilical cord, offering protection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are two types of vasa praevia

A

Type 1 vasa praevia -Velamentous umbilical cord - fetal vessels travel unprotected through membranes before joining placenta

Type II vasa praevia - An accessory lobe of the placenta - bilobed placenta and vessels exposed as they travel between lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What are the complications of vasa praevia

A

prone to bleeding, particularly when the membranes are ruptured during labour and at birth.

this can lead to dramatic fetal blood loss and death.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What are the risk factors for vasa praevia

A

Low lying placenta
IVF pregnancy
Multiple pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

How does vasa praevia present

A

usually presents with painless, sudden vaginal bleeding after the rupture of membranes and rapid foetal deterioration.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

how is vasa praevia diagnosed

A
  • ultrasound
  • vaginal examination during labour, pulsating fetal vessels are seen in the membranes through the dilated cervix
  • fetal distress and dark-red bleeding occur following rupture of the membranes.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

how does vasa praevia present

A

antepartum haemorrhage, with bleeding during the second or third trimester of pregnancy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What is outcome for vasa pravia when haemorrhage occurs

A

very high fetal mortality, even with emergency caesarean section.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

How is vasa praevia managed

A

Corticosteroids, given from 28 weeks gestation to mature the fetal lungs
Elective caesarean section, planned for 34 – 36 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What is placenta abruption

A

when the placenta separates from the wall of the uterus during pregnancy

site of attachment can bleed extensively after the placenta separates.

significant cause of antepartum haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are risk factors for placenta abruption

A
  • A for Abruption previously;
  • B for Blood pressure (i.e. hypertension or pre-eclampsia);
  • R for Ruptured membranes, either premature or prolonged;
  • U for Uterine injury (i.e. trauma to the abdomen);
  • P for Polyhydramnios;
  • T for Twins or multiple gestation;
  • I for Infection in the uterus, especially chorioamnionitis;
  • O for Older age (i.e. aged over 35 years old);
  • N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

How does placenta abruption present

A
  • Sudden onset severe abdominal pain that is continuous
  • Vaginal bleeding (antepartum haemorrhage)
  • Shock (hypotension and tachycardia)
  • Abnormalities on the CTG indicating fetal distress
  • tender and tense uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

how is the severity of antepartum haemorrhage classified

A
  • Spotting: spots of blood noticed on underwear
  • Minor PPH – under 1000ml blood loss
  • Major PPH – over 1000ml blood losss
  • Major: Moderate PPH – 1000 – 2000ml blood loss
  • Major: Severe PPH – over 2000ml blood loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is a concealed abruption

A

where the cervical os remains closed, and any bleeding that occurs remains within the uterine cavity.

The severity of bleeding can be significantly underestimated with concealed haemorrhage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is a revealed abruption

A

blood loss is observed via the vagina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

how is placenta abruption diagnosed

A
  • clinical diagnosis based on presentation
    obstetric emergency
  • Ultrasound can be useful in excluding placenta praevia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

What does the urgency of placenta abruption depend on

A
  • depends on the amount of placental separation
  • extent of bleeding
  • haemodynamic stability of the mother and condition of the fetus.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

how is placenta abruption managed if Fetus alive and < 36 weeks

A

fetal distress: immediate caesarean
no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

how is placenta abruption managed if Fetus alive and > 36 weeks

A

fetal distress: immediate caesarean
no fetal distress: deliver vaginally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What are complications of placental abruption to the mother

A

shock
DIC
renal failure
PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

What are complications of placental abruption to the baby

A

IUGR
hypoxia
death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

what is the prognosis of placenta abruption

A

associated with high perinatal mortality rate
responsible for 15% of perinatal deaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

what is a kleihauer test

A

quantify how much fetal blood is mixed with the maternal blood, to determine the dose of anti-D that is required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

what is placenta accreta

A

when the placenta implants deeper, through and past the endometrium eg myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

what does placenta accreta result in

A

Results in delayed separation and/or placental retention as well as postpartum hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

Where does the placenta usually attach to

A

endometrium

allows the placenta to separate cleanly during the third stage of labour, after delivery of the baby.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What are risk factors for developing placenta accreta

A

Previous placenta accreta
Previous endometrial curettage procedures (e.g. for miscarriage or abortion)
Previous caesarean section
Multigravida
Increased maternal age
Low-lying placenta or placenta praevia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

How does placenta accreta present

A

typically asymptomatic

can present with bleeding (antepartum haemorrhage) in the third trimester.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

How is placenta accreta diagnosed/investigated

A

antenatal ultrasound scans
MRI to assess depth and width of invasion

may be diagnosed at birth, when it becomes difficult to deliver the placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What additional management should be given to women with placenta accreta before birth

A

Complex uterine surgery
Blood transfusions
Intensive care for the mother
Neonatal intensive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What are management options for placenta accreta during caesarean

A
  • Hysterectomy with the placenta remaining in the uterus (recommended)
  • Uterus preserving surgery, with resection of part of the myometrium along with the placenta
  • Expectant management, leaving the placenta in place to be reabsorbed over tim
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

When is a hysterectomy recommended for placenta accreta

A

If placenta accreta is discovered after delivery of the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What is superficial placenta accreta

A

where the placenta implants in the surface of the myometrium, but not beyond

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

what is placenta increta

A

the placenta attaches deeply into the myometrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

what is placenta percreta

A

the placenta invades past the myometrium and perimetrium, potentially reaching other organs such as the bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

what is cord prolapse

A

when the umbilical cord descends below the presenting part of the fetus and through the cervix into the vagina, after rupture of the fetal membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is the danger associated with cord prolapse

A

significant danger of the presenting part compressing the cord, resulting in fetal hypoxia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

What is the most significant risk factor for developing cord prolapse

A

fetus in abnormal lie after 37 weeks gestation (i.e. unstable, transverse or oblique).

Being in an abnormal lie provides space for the cord to prolapse below the presenting part.

In a cephalic lie, the head typically descends into the pelvis, without room for the cord to descend.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

How is cord prolapse investigated

A

suspected where there are signs of fetal distress on the CTG.

diagnosed by vaginal examination.

Speculum examination can be used to confirm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

how is cord prolapse managed

A

Emergency caesarean section

  • can push the baby back into uterus
  • cord should be kept warm and wet and have minimal handling whilst waiting for delivery to prevent vasospams
  • tocolytics to prevent contrations
  • fill the bladder
  • mother on all fours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

what medication can be used to minimise contractions whilst waiting for c section

A

Tocolytic medication (e.g. terbutaline)\

β2-adrenergic agonist - smooth muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

How is cord prolapse managed when the baby is compressing the cord

A

the presenting part of fetus 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 on all fours, using gravity to draw the fetus away from the pelvis and reduce compression on the cord.

+ Tocolytic medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What is Postpartum haemorrhage

A

bleeding after delivery of the baby and placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What amount of blood loss is required to have Postpartum haemorrhage

A

500ml after a vaginal delivery
1000ml after a caesarean section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What is minor PPH

A

under 1000ml blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

what is major PPH

A

over 1000ml blood loss

Major PPH can be further sub-classified as:
moderate
severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What is moderate PPH

A

1000 – 2000ml blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

what is severe PPH

A

over 2000ml blood loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

What is primary PPH

A

bleeding within 24 hours of birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

what is secondary PPH

A

from 24 hours to 12 weeks after birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What are the causes of PPH

A

T – Tone (uterine atony – the most common cause)
T – Trauma (e.g. perineal tear)
T – Tissue (retained placenta)
T – Thrombin (bleeding disorder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What are risk factors for PPH

A

Previous PPH
Multiple pregnancy
Obesity
Large baby
Failure to progress in the second stage of labour
Prolonged third stage
Pre-eclampsia
Placenta accreta
Retained placenta
Instrumental delivery
General anaesthesia
Episiotomy or perineal tear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What preventative measures can be taken to reduce risk and consequence of PPH

A
  • Treating anaemia during the antenatal period
  • Giving birth with an empty bladder
  • Active management of the third stage (IM oxytocin)
  • Intravenous tranexamic acid can be used during caesarean section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What team of specialists would be involved in a PPH

A

senior midwives, obstetricians, anaesthetics, haematologists, blood bank staff and porters.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

How would a PPH patient be stablized

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

How much blood is given in a major haemorrhage protocol.

A

4 units of crossmatched or O negative blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What is the mechanical treatment for to stop bleeding in PPH

A
  • Rubbing the uterus through the abdomen to stimulates a uterine contraction
  • Catheterisation
167
Q

What are the medical options to stop bleeding in PPH

A
  • Oxytocin (IV)
  • Ergometrine (IV or IM)
  • Carboprost (IM)
  • Misoprostol (sublingual)
  • Tranexamic acid (IV) i
168
Q

what does oxytocin do

A

induce labor, strengthen uterine contractions during labor, contract uterine muscle after delivery of the placenta, and control postpartum hemorrhage.

169
Q

what is Ergometrine

A

stimulates smooth muscle contraction

CI in hypertension

170
Q

what is Carboprost

A

prostaglandin analogue and stimulates uterine contraction

(caution in asthma)

171
Q

what is Misoprostol

A

prostaglandin analogue and stimulates uterine contraction

172
Q

what is Tranexamic acid

A

antifibrinolytic that reduces bleeding

173
Q

how much oxytocin is given in PPH

A

40 units in 500 mls.

174
Q

what are surgical treatment options for PPH

A
  • 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
175
Q

What are causes of secondary PPH

A

retained products of conception (RPOC) or infection (i.e. endometritis).

176
Q

how is secondary PPH investigated

A

Ultrasound for retained products of conception
Endocervical and high vaginal swabs for infection

177
Q

how is secondary PPH managed

A

Surgical evaluation of retained products of conception
Antibiotics for infection

178
Q

What is instrumental delivery

A

vaginal delivery assisted by either a ventouse suction cup or forceps

~ 10% of births in UK

179
Q

what medication is given after instrumental delivery

A

A single dose of co-amoxiclav

180
Q

What are indications of instrumental delivery

A
  • Failure to progress
  • Fetal distress
  • Maternal exhaustion
  • Control of the head in various fetal positions
  • epidural is in place for analgesia.
181
Q

What does having instrumental delivery increase the risk to the MOTHER of

A

Postpartum haemorrhage
Episiotomy
Perineal tears
Injury to the anal sphincter
Incontinence of the bladder or bowel
Nerve injury (obturator or femoral nerve)

182
Q

What does having instrumental delivery increase the risk to the BABY of

A

Cephalohaematoma with ventouse
Facial nerve palsy with forceps

183
Q

what is cephalohaematoma

A

collection of blood between the skull and the periosteum.

does NOT cross suture lines resolves in couple months

184
Q

what nerves of the mother are at most risk in instrumental delivery

A

Femoral nerve
Obturator nerve

185
Q

What are femoral nerve injury symptoms

A

weakness of knee extension, loss of the patella reflex and numbness of the anterior thigh and medial lower leg.

186
Q

What are obturator nerve injury symptoms

A

weakness of hip adduction and rotation, and numbness of the medial thigh.

187
Q

level of what haemoglobin is defined as first, second trimester and postpartum anaemia

A

1st - less than 110 g/l
2nd - less than 105 g/l
Postpartum - less than 100 g/l.

188
Q

what is anaemia

A

deficiency of haemoglobin (Hb) in the blood

189
Q

When are women screened for anaemia in pregnancy

A

Booking clinic
28 weeks gestation

190
Q

what happens to plasma volume in pregnancy

A

plasma volume increases. This results in a reduction in the haemoglobin concentration. The blood is diluted due to the higher plasma volume.

191
Q

why is it important to treat anaemia during pregnancy

A

so that the woman has reasonable reserves, in case there is significant blood loss during delivery.

192
Q

what are symptoms of anaemia

A

Shortness of breath
Fatigue
Dizziness
Pallor

193
Q

What may low MCV anaemia indicate

A
  • iron deficiency
  • Thalassaemia
  • Sideroblastic anaemia
194
Q

What may normal MCV anaemia indicate

A
  • physiological anaemia due to the increased plasma volume of pregnancy
  • Anaemia of chronic disease
  • Marrow infiltration
  • Haemolytic anaemia
  • Chronic kidney disease
195
Q

What may raised MCV with anaemia indicate

A

B12 or folate deficiency

  • Alcohol consumption
  • Recticulocytosis
  • Hypothyroidism
196
Q

What screening tests are pregnant women offered at booking clinic

A

haemoglobinopathy screening

thalassaemia (all women)
sickle cell disease (women at higher risk).

197
Q

What additional investigation may be performed to establish cause of anaemia

A

Ferritin
B12
Folate

198
Q

What investigations can be ordered for women suspected with anaemia

A

FBC - haemoglobin level and MCV

199
Q

how is iron anaemia managed

A

iron replacement (e.g. ferrous sulphate 200mg three times daily)

200
Q

how is b12 anaemia managed

A
  • tested for pernicious anaemia –> checking for intrinsic factor antibodies
  • Intramuscular hydroxocobalamin injections
  • Oral cyanocobalamin tablets
201
Q

how is folate anaemia managed

A

All women should already be taking folic acid 400mcg per day.

Women with folate deficiency are started on folic acid 5mg daily.

202
Q

what is pre eclampsia

A

new high blood pressure (hypertension) in pregnancy with end-organ dysfunction,

203
Q

what causes preeclampsia

A

abnormal formation of spiral arteries, leading to a high vascular resistance in these vessels and poor perfusion of the placenta

204
Q

When does pre eclampsia occur

A

new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy

205
Q

What is preeclampsia triad

A

Hypertension
Proteinuria
Oedema

206
Q

Without treatment what are outcomes of preeclampsia

A

maternal organ damage
fetal growth restriction
eclampsia -> seizures
early labour
maternal and fetal mortality

207
Q

What is chronic hypertension

A

high blood pressure that exists before 20 weeks gestation and is longstanding.

This is not caused by dysfunction in the placenta and is not classed as pre-eclampsia.

208
Q

What is pregnancy induced hypertension or gestational hypertension

A

hypertension occurring after 20 weeks gestation, WITHOUT proteinuria.

209
Q

what is eclampsia

A

when seizures occur as a result of pre-eclampsia.

210
Q

what should be monitored in eclampsia management

A

urine output, reflexes, respiratory rate and oxygen saturations

211
Q

what are high risk factors for pre eclampsia

A

Pre-existing hypertension
Previous hypertension in pregnancy
Existing autoimmune conditions (e.g. systemic lupus erythematosus)
Diabetes
Chronic kidney disease

212
Q

what are moderate risk factors for pre eclampsia

A

Older than 40
BMI > 35
More than 10 years since previous pregnancy
Multiple pregnancy
First pregnancy
Family history of pre-eclampsia

213
Q

When are women offered aspirin as prophylaxis against pre eclampsia

A

from 12 weeks gestation until birth if they have

  • one high-risk factor
  • or more than one moderate-risk factors.
214
Q

What are symptoms of pre eclampsia

A

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

215
Q

How is pre eclampsia diagnosed

A

Systolic blood pressure above 140 mmHg
Diastolic blood pressure above 90 mmHg

PLUS
proteinuria
organ dysfunction
placental dysfunction

216
Q

What are investigational signs of organ dysfunction

A
  • raised creatinine
  • elevated liver enzymes
  • seizures
  • thrombocytopenia
  • haemolytic anaemia
217
Q

what are signs of placental dysfunction

A

fetal growth restriction or abnormal Doppler studies

218
Q

How can proteinuria be quantified

A
  • Urine protein:creatinine ratio (above 30mg/mmol is significant)
  • Urine albumin:creatinine ratio (above 8mg/mmol is significant)
219
Q

What is placental growth factor

A

protein released by the placenta that functions to stimulate the development of new blood vessels.

Low in pre eclampsia

used btwn 20 and 35 week

220
Q

how is pre eclampsia monitored

A

Blood pressure
Symptoms
Urine dipstick for proteinuria

assessed at every antenatal appointment

221
Q

What is the general management of pre eclampsia / gestational hypertension

A
  • Treating to aim for a blood pressure below 135/85 mmHg
  • BP monitored at least every 48hrs
  • Admission for women with a blood pressure above 160/110 mmHg
  • ultrasound monitoring of fetus, amniotic fluid every 2 weeks
  • Monitoring of blood tests weekly (full blood count, liver enzymes and renal profile)
  • Monitoring fetal growth by serial growth scans
  • PlGF testing on one occasion
222
Q

what scoring system is used to determine to admit women with pre eclampsia

A

fullPIERS or PREP‑S

223
Q

what is the 1st line medical management of pre eclampsia

A

Labetolol - anti hypertensive
Beta blocker

224
Q

what is the 2nd line medical management of pre eclampsia

A

Nifedipine
CCB if have asthma

225
Q

what is the 3rd line medical management of pre eclampsia

A

Methyldopa
alpha agonist

226
Q

What common anti hypertenive is CI in pregnancy

A

ACE-inhibitors are contra-indicated in pregnancy due to their association with congenital abnormalities.

227
Q

What the medical management during labour for pre eclampsia

A
  • 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
228
Q

what is the medical management in critical care in severe pr eclampsia and eclampsia

A

IV hydralazine

229
Q

What is medical management for pre eclampsia after delivery (1st, 2nd and 3rd line)

A
  • Enalapril (first-line)
  • Nifedipine or amlodipine (first-line in black African or Caribbean patients)
  • Labetolol or atenolol (third-line)
230
Q

What are the features of the complication that occur as a result of pre eclampsia and eclampsia

A

Haemolysis
Elevated Liver enzymes
Low Platelets

231
Q

What is rhesus

A

various types of rhesus antigens on the surface of red blood cells

232
Q

What rhesus antigen does rhesus-negative refer to

A

Rhesus D antigen

233
Q

What rhesus antigen requires treatment

A

When a woman that is rhesus-D negative becomes pregnant

234
Q

What is Rhesus Incompatibility in Pregnancy

A
  • rhesus-D negative woman with rhesus-D positive baby
  • blood from the baby will find a way into the mother’s bloodstream.
  • baby’s red blood cells display the rhesus-D antigen
  • the mother’s immune system will recognise this rhesus-D antigen as foreign, and produce antibodies to the rhesus-D antigen.
  • The mother has then become sensitised to rhesus-D antigens.
  • During subsequent pregnancies, the mother’s anti-rhesus-D antibodies can cross the placenta into the fetus.
  • If that fetus is rhesus-D positive, these antibodies attach themselves to the red blood cells of the fetus and causes the immune system of the fetus to attack them, causing the destruction of the red blood cells (haemolysis)
235
Q

what is haemolytic disease of the newborn.

A

red blood cell destruction caused by antibodies from the mother

236
Q

how is Rhesus Incompatibility in Pregnancy managed

A

Prevention of sensitisation - IM anti-D injection to pregnant woman

237
Q

how do anti-D injection work

A

attaching itself to the rhesus-D antigens on the fetal red blood cells in the mothers circulation, causing them to be destroyed.

prevents the mother’s immune system recognising the antigen and creating it’s own antibodies to the antigen

238
Q

When are anti D injections given routinely

A

28 & 34 weeks gestation
Birth (if the baby’s blood group is found to be rhesus-positive)

239
Q

At what points where sensitisation could occur should anti D injections be given

A

Antepartum haemorrhage
Amniocentesis procedures
Abdominal trauma

240
Q

how does a kleihauer test work

A
  • Adding acid to a sample of the mother’s blood.
  • Fetal haemoglobin is naturally more resistant to acid, so that they are protected against the acidosis that occurs around childbirth.
  • Therefore, fetal haemoglobin persists in response to the added acid, while the mothers haemoglobin is destroyed.
  • The number of cells still containing haemoglobin (the remaining fetal cells) can then be calculated.
241
Q

what is Small for gestational age

A

a fetus that measures below the 10th centile for their gestational age.

242
Q

what two measurements on ultrasound are used to assess fetal size

A

Estimated fetal weight (EFW)
Fetal abdominal circumference (AC)

243
Q

what factors into customised growth charts for a fetus

A

mothers:
Ethnic group
Weight
Height
Parity

244
Q

what is severe SGA

A

when the fetus is below the 3rd centile for their gestational age

245
Q

what is low birth weight

A

defined as a birth weight of less than 2500g.

246
Q

what are two categories of causes for SGA

A

Constitutionally small, matching the mother and others in the family, and growing appropriately on the growth chart
Fetal growth restriction (FGR), also known as intrauterine growth restriction (IUGR)

247
Q

what are causes of fetal growth restriction

A
  • Placenta mediated growth restriction
  • Non-placenta mediated growth restriction, where the baby is small due to a genetic or structural abnormality
248
Q

what are causes of placenta mediated growth restriction

A

Idiopathic
Pre-eclampsia
Maternal smoking
Maternal alcohol
Anaemia
Malnutrition
Infection
Maternal health conditions

249
Q

what are causes of Non-placenta medicated growth restriction

A

Genetic abnormalities
Structural abnormalities
Fetal infection
Errors of metabolism

250
Q

what are signs of fetal growth restriction

A

Reduced amniotic fluid volume
Abnormal Doppler studies
Reduced fetal movements
Abnormal CTGs

251
Q

What are short term complications of fetal growth restriction

A

Fetal death or stillbirth
Birth asphyxia
Neonatal hypothermia
Neonatal hypoglycaemia

252
Q

What are long term complications of fetal growth restriction

A

Cardiovascular disease, particularly hypertension
Type 2 diabetes
Obesity
Mood and behavioural problems

253
Q

What are risk factors of small for gestational age babies

A

Previous SGA baby
Obesity
Smoking
Diabetes
Existing hypertension
Pre-eclampsia
Older mother (over 35 years)
Multiple pregnancy
Low pregnancy‑associated plasma protein‑A (PAPPA)
Antepartum haemorrhage
Antiphospholipid syndrome

254
Q

How are low risk women monitored for small for gestational age

A
  • monitoring of the symphysis fundal height (SFH) at every antenatal appointment from 24 weeks onwards to identify potential SGA
  • If the symphysis fundal height is less than the 10th centile, women are booked for serial growth scans with umbilical artery doppler.
255
Q

when are women booked for serial growth scans with umbilical artery doppler

A
  • Three or more minor risk factors
  • One or more major risk factors
  • Issues with measuring the symphysis fundal height (e.g. large fibroids or BMI > 35)
256
Q

what is measured in women at risk or with SGA serial ultrasound scans

A
  • Estimated fetal weight (EFW) and abdominal circumference (AC) to determine the growth velocity
  • Umbilical arterial pulsatility index (UA-PI) to measure flow through the umbilical artery
  • Amniotic fluid volume
257
Q

what are the critical management steps of SGA

A
  • Identifying those at risk of SGA
  • Aspirin is given to those at risk of pre-eclampsia
  • Treating modifiable risk factors (e.g. stop smoking)
  • Serial growth scans to monitor growth
  • Early delivery where growth is static, or there are other concerns
258
Q

what investigations can be ordered to identify the underlying cause of SGA

A
  • Blood pressure and urine dipstick for pre-eclampsia
  • Uterine artery doppler scanning
  • Detailed fetal anatomy scan by fetal medicine
  • Karyotyping for chromosomal abnormalities
  • Testing for infections (e.g. toxoplasmosis, cytomegalovirus, syphilis and malaria)
259
Q

what is large for gestational age

A

weight of the newborn is more than 4.5kg at birth.

During pregnancy, an estimated fetal weight above the 90th centile is considered large for gestational age.

260
Q

what are causes of macrosomia

A

Constitutional
Gestational diabetes
Previous macrosomia
Maternal obesity or rapid weight gain
Overdue
Male baby

261
Q

what are risks to the mother of LGA

A

Shoulder dystocia
Failure to progress
Perineal tears
Instrumental delivery or caesarean
Postpartum haemorrhage
Uterine rupture (rare)

262
Q

what are risks to the baby of LGA

A
  • Birth injury (Erbs palsy, clavicular fracture, fetal distress and hypoxia)
  • Neonatal hypoglycaemia
  • Obesity in childhood and later life
  • Type 2 diabetes in adulthood
263
Q

What are investigation used for LGA

A
  • Ultrasound to exclude polyhydramnios and estimate the fetal weight
  • Oral glucose tolerance test for gestational diabetes
264
Q

How can risks associated with LGA delivery be mitigated

A
  • Delivery on a consultant lead unit
  • Delivery by an experienced midwife or obstetrician
  • Access to an obstetrician and theatre if required
  • Active management of the third stage (delivery of the placenta)
  • Early decision for caesarean section if required
  • Paediatrician attending the birth
265
Q

what is chorionicity

A

Number of placentas

266
Q

what is amnionicity

A

number of amniotic sacs

267
Q

what ultrasound sign is shown in Dichorionic diamniotic

A

lambda sign or twin peak sign

268
Q

what ultrasound sign is shown in Monochorionic diamniotic

A

twins have a membrane between the twins, with a T sign

269
Q

what type of multiple pregnancy has best outcomes

A

diamniotic, dichorionic twin pregnancies, as each fetus has their own nutrient supply.

270
Q

What are risks to mother in multiple pregnancy

A

Anaemia
Polyhydramnios
Hypertension
Malpresentation
Spontaneous preterm birth
Instrumental delivery or caesarean
Postpartum haemorrhage

271
Q

What are risks to baby in multiple pregnancy

A

Miscarriage
Stillbirth
Fetal growth restriction
Prematurity
Twin-twin transfusion syndrome
Twin anaemia polycythaemia sequence
Congenital abnormalities

272
Q

what is Twin-Twin Transfusion Syndrome

A

occurs when the fetuses share a placenta

one fetus (the recipient) may receive the majority of the blood from the placenta, while the other fetus (the donor) is starved of blood.

273
Q

What is the risk to the recipient in Twin-Twin Transfusion Syndrome

A

fluid overloaded, with heart failure and polyhydramnios.

274
Q

What is the risk to the donor in Twin-Twin Transfusion Syndrome

A

growth restriction, anaemia and oligohydramnios

275
Q

What is the management in severe Twin-Twin Transfusion Syndrome

A

laser treatment may be used to destroy the connection between the two blood supplies.

276
Q

What is Twin Anaemia Polycythaemia Sequence

A

similar to twin-twin transfusion syndrome, but less acute.

One twin becomes anaemic
The other develops polycythaemia (raised haemoglobin).

277
Q

Women with multiple pregnancies require additional monitoring for what

A

anaemia, with a full blood count
Additional ultrasound scans

278
Q

What are ultrasounds used to monitor in twin pregnancies

A

fetal growth restriction, unequal growth and twin-twin transfusion syndrome:

279
Q

how often are twin pregnancies scanned

A

2 weekly scans from 16 weeks for monochorionic twins
4 weekly scans from 20 weeks for dichorionic twins

280
Q

When are women with twin pregnancies tested for anaemia

A

Booking clinic
20 weeks gestation
28 weeks gestation

281
Q

when is planned birth offered for uncomplicated monochorionic monoamniotic twins

A

32 and 33 + 6 weeks

282
Q

when is planned birth offered for uncomplicated monochorionic diamniotic twins

A

36 and 36 + 6 weeks

283
Q

when is planned birth offered for uncomplicated dichorionic diamniotic twins

A

37 and 37 + 6 weeks

284
Q

when is planned birth offered for triplets

A

Before 35 + 6 weeks

285
Q

What type of twins requires elective caesarean section

A

Monoamniotic twins

286
Q

how are Diamniotic twins delivered

A
  • Vaginal delivery is possible when the first baby has a cephalic presentation (head first)
  • Caesarean section may be required for the second baby after successful birth of the first baby
  • Elective caesarean is advised when the presenting twin is not cephalic presentation
287
Q

What is Oligohydramnios

A

low level of amniotic fluid during pregnancy

amniotic fluid index that is below the 5th centile or less than 500ml at 32-36

288
Q

What can cause oligohydramnios

A
  • Preterm prelabour rupture of membranes
  • Placental insufficiency
  • Renal agenesis (known as Potter’s syndrome)
  • Non-functioning fetal kidneys, e.g. bilateral multicystic dysplastic kidneys
  • Obstructive uropathy
  • Genetic/chromosomal anomalies
  • Viral infections (although may also cause polyhydramnios)
289
Q

how does Placental insufficiency cause oligohydramnios

A

resulting in the blood flow being redistributed to the fetal brain rather than the abdomen and kidneys. This causes poor urine output.

290
Q

how is oligohydramnios diagnosed

A

ultrasound examination
amniotic fluid index (AFI) *MC
or maximum pool depth (MPD).

291
Q

how is amniotic fluid index calculated

A

by measuring maximum cord-free vertical pocket of fluid in four quadrants of the uterus and adding them together.

292
Q

what proteins in amniotic fluid suggest membrane rupture

A

IGFBP-1 (insulin-like growth factor binding protein-1) or PAMG-1 (placental alpha-microglobulin-1)

293
Q

how is Ruptured Membranes cause of oligohydramnios managed

A
  • admission
  • regular observations to ensure chorioamnionitis is not developing
  • oral erythromycin should be given for 10 days
  • antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
  • delivery should be considered at 34 weeks of gestation
294
Q

what factors when timing delivery in placental insufficiency oligohydramnios

A
  • Rate of fetal growth
  • Umbilical artery and middle cerebral artery Doppler scans
  • Cardiotocography (baby HR - assess distress)
295
Q

what is Polyhydramnios

A

abnormally large level of amniotic fluid during pregnancy.

amniotic fluid index that is above the 95th centile for gestational age.

296
Q

what comprised amniotic fluid

A

fetal urine output, with small contributions from the placenta and some fetal secretions

297
Q

How much does amniotic fluid change over pregnancy

A

increases until 33 weeks then
plateaus from 33-38 then
declines
approx 500mls at delivery

298
Q

What causes Polyhydramnios

A
  • MC - idiopathic
  • condition that prevents the fetus from swallowing
  • Duodenal atresia
  • Anaemia
  • Twin-to-twin transfusion syndrome
  • Maternal diabetes
299
Q

how is Polyhydramnios diagnosed

A

US Scan
- Amniotic fluid index
- Maximum pool depth

300
Q

how is Polyhydramnios managed

A

No medical intervention is required in the majority of women
- aminoreduction - risky due to infection and placental abruption risk
- Indomethacin (enhance water retention)

301
Q

What is gestational diabetes

A

any degree of glucose intolerance with onset or first recognition during pregnancy

1 in 5 pregnancies

fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L

302
Q

What are risk factors for gestational diabetes

A
  • BMI >30
  • Asian ethnicity
  • Previous gestational diabetes
  • 1st degree relative with diabetes
  • Polycystic ovarian syndrome
  • Previous macrosomic baby (>4.5kg)
303
Q

what is the pathophysiology of gestational diabetes

A
  • body unable to respond to the increased insulin requirements, resulting in transient hyperglycaemia
304
Q

what happens to insulin function in pregnancy

A

progressive insulin resistance
a higher volume of insulin is needed in response to a normal level of blood glucose.

On average, insulin requirements rise by 30% during pregnancy.

305
Q

what are the symptoms of gestational diabetes

A

if present, polyuria, polydipsia and fatigue.

306
Q

what are the fetal complications of gestational diabetes

A
  • Macrosomia
  • Organomegaly (<3)
  • neonatal hypoglycaemia
  • polycythaemia (high # RBC)
  • Polyhydramnios
  • pre term delivery
307
Q

What is the main investigation for gestational diabetes

A

oral glucose tolerance test (OGTT)

308
Q

When is OGTT offered in pregnancy

A

booking
24-28 weeks if present RF
any point of glycosuria

309
Q

What level of fasting glucose and 2hr post glucose is required for GD diagnoses

A

Fasting glucose > 5.6mmol/L
2hrs postprandial glucose > 7.8mmol/L

(5 – 6 – 7 – 8)

310
Q

What is the medical management of GD if Fasting glucose less than 7 mmol/l

A

trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin if metformin not sufficient

311
Q

What is the medical management of GD if Fasting glucose above 7 mmol/l

A

start insulin

312
Q

What is the medical management of GD if Fasting glucose between 6-6.9 mmol/l, and there is evidence of complication

A

insulin

313
Q

What is the medical management of GD for women who decline insulin or cannot tolerate metformin.

A

Glibenclamide (a sulfonylurea)

314
Q

when should additional growth scans be done for GD

A

28, 32 and 36 weeks

315
Q

what is postnatal care for GD for mother

A
  • All anti-diabetic medication should be stopped immediately after delivery
  • blood glucose should be measured before discharge
  • fasting glucose test @ 6-13 weeks postpartum
316
Q

what percent of mothers with GD will go on to develop diabetes

A

50%

317
Q

What screening during pregnancy for women with existing diabetes.

A

retinopathy screening

318
Q

What is the post natal care for babies born to mothers with GD

A

close monitoring for neonatal hypoglycaemia, with regular blood glucose checks and frequent feeds

319
Q

how are hypoglycaemic newborns managed

A

asymptomatic

  • encourage normal feeding (breast or bottle)
  • monitor blood glucose

symptomatic or very low blood glucose

  • admit to the neonatal unit
  • intravenous infusion of 10% dextrose
320
Q

What is uterine rupture

A

rupture of myometrium in labor

321
Q

What is the difference between incomplete and complete uterine rupture

A

incomplete = uterine serosa (perimetrium) surrounding the uterus remains intact.

complete = serosa ruptures along with the myometrium, and the contents of the uterus are released into the peritoneal cavity.

322
Q

what are risk factors of uterine rupture

A

** previous caesarean section **

Previous uterine surgery
Increased BMI
High parity
Increased age
Induction of labour
Use of oxytocin to stimulate contractions

323
Q

How does uterine rupture present

A

acutely unwell mother and abnormal CTG

  • Ceasing of uterine contractions
  • Abdominal pain
  • Vaginal bleeding
  • Hypotension
  • Tachycardia
  • Collapse
324
Q

how is uterine rupture managed

A

obstetric emergency.
Resuscitation and transfusion may be required.
Emergency caesarean section
stop any bleeding and repair or remove the uterus (hysterectomy).

325
Q

How common is baby blues and when is its incidence

A

seen in the majority of women in the first week or so after birth

326
Q

How common is postnatal depression and when is its incidence

A

low mood in the postnatal period.

seen in about one in ten women, with a peak around three months after birth

327
Q

How common is puerpal psychosis and when is its incidence

A

seen in about one in a thousand women, starting a few weeks after birth

328
Q

What are symptoms of baby blues

A

Mood swings
Low mood
Anxiety
Irritability
Tearfulness

329
Q

what are causes of baby blues

A

Significant hormonal changes
Recovery from birth
Fatigue and sleep deprivation
The responsibility of caring for the neonate
Establishing feeding
All the other changes and events around this time

330
Q

What is triad of postnatal depression presentation

A

Low mood
Anhedonia (lack of pleasure in activities)
Low energy

331
Q

how long should symptoms last to be diagnosed with post natal depression

A

2 weeks

332
Q

What is a screening tool for post natal depression

A

Edinburgh Postnatal Depression Scale

score >10/30 –> postnatal depression

333
Q

How does puerperal psychosis present

A

Delusions
Hallucinations
Depression
Mania
Confusion
Thought disorder

334
Q

how is puerperal psychosis treated

A

Admission to the mother and baby unit
Cognitive behavioural therapy
Medications (antidepressants, antipsychotics or mood stabilisers)
Electroconvulsive therapy (ECT)

335
Q

what is a complication of a mother taking SSRI during pregnancy

A

3rd trimester = persistent pulmonary hypertension
1st trimester= small increased chance of congenital heart defects

336
Q

what is SSRI of choice in breastfeeding women

A

Sertraline or paroxetine

337
Q

where are women with existing mental health concerns before or during pregnancy are referred to

A

perinatal mental health services for advice and specialist input

338
Q

what are types of fetal lie

A

Longitudinal, transverse or oblique

long axis relative

339
Q

what are types of fetal presentations

A

fetal part that first enters the maternal pelvis.

cephalic vertex
breech
shoulder
brow

340
Q

what are types of fetal head positions

A

position of the fetal head as it exits the birth canal.

occipito-anterior
occipito-posterior
occipito-transverse

341
Q

what are RF for abnormal fetal lie, malpresentation and malposition

A
  • Prematurity
  • Multiple pregnancy
  • Uterine abnormalities (e.g fibroids, partial septate uterus)
  • Fetal abnormalities
  • Placenta praevia
  • Primiparity
342
Q

how is abnormal fetal lie managed

A

external cephalic version (ECV) - manipulation of the fetus to a cephalic presentation

50-60% success rate

343
Q

what is chickenpox caused by

A

varicella zoster virus (VZV).

344
Q

what can varicella zoster in pregnancy lead to

A
  • More severe cases in the mother, such as varicella pneumonitis, hepatitis or encephalitis
  • Fetal varicella syndrome
  • Severe neonatal varicella infection (if infected around delivery)
345
Q

How are mothers tested for immunity to chickenpox

A

IgG levels for VZV can be teste

positive = immunity

346
Q

How are not immune women exposed to chickenpox managed

A

IV varicella immunoglobulins prophylaxis

within 10 days

347
Q

what are features of Congenital varicella syndrome

A

in 1% of cases

  • 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)
348
Q

chickenpox infection in first XX weeks of pregnancy can lead to Congenital varicella syndrome

A

in the first 28 weeks of gestationn

349
Q

What is lower urinary tract infection

A

infection in the bladder, causing cystitis (inflammation of the bladder)

350
Q

what is Upper urinary tract infection

A

infection up to the kidneys, called pyelonephritis.

351
Q

what are complications of UTI in pregnancy

A

preterm delivery
low birthweight
preeclampsia

352
Q

What is Asymptomatic bacteriuria

A

bacteria present in the urine, without symptoms of infection.

higher risk of UTI

353
Q

How does Lower urinary tract infections present

A

Dysuria (pain, stinging or burning when passing urine)
Suprapubic pain or discomfort
Increased frequency of urination
Urgency
Incontinence
Haematuria

354
Q

how does Pyelonephritis present

A

Fever (more prominent than in lower urinary tract infections)
Loin, suprapubic or back pain (this may be bilateral or unilateral)
Haematuria
Renal angle tenderness on examination

355
Q

What 2 substance is indicative of UTI on dipstick

A

nitrites
leukocytes

356
Q

What are infective causes of UTI

A

Escherichia coli (E. coli).
Klebsiella pneumoniae
Enterococcus
Pseudomonas aeruginosa

357
Q

How are UTIs in pregnancy managed

A

7 days of Abx

Nitrofurantoin (avoid in the third trimester)
Amoxicillin (only after sensitivities are known)
Cefalexin

358
Q

What Abx should be AVOIDED in 1st trimester

A

Trimethoprim - folate antagonist

359
Q

What Abx should be AVOIDED in 3rd trimester

A

Nitrofurantoin - neonatal haemolysis

360
Q

what is Venous thromboembolism

A

blood clots (thrombosis) developing in the circulation

361
Q

what causes thrombosis

A
  • stagnation of blood
  • epithelial injury
  • hyper-coagulable states, such as pregnancy.
362
Q

what is a pulmonary embolism

A

thrombosis can mobilise (embolisation) from the deep veins and travel to the lungs, where it becomes lodged in the pulmonary arteries.

363
Q

what is DVT

A

When a thrombosis develops in the venous circulation

364
Q

What are pre-existing RF for VTE in pregnancy

A
  • Age >35 years
  • BMI >30 kg/m2
  • Parity >3
  • Smoking
  • Paraplegia
365
Q

What are obstetric RF for VTE in pregnancy

A
  • Multiple pregnancy
  • Pre-eclampsia
  • caesarean section
  • Prolonged labour
  • PPH
366
Q

What are transient RF for VTE in pregnancy

A
  • Dehydration
  • Ovarian hyperstimulation syndrome
  • Admission or immobility
  • Systemic infection
  • Long distance travel
367
Q

When is it advised to start prophylaxis for VTE in pregnancy

A

28 weeks if there are three risk factors
First trimester if there are four or more of these risk factors

or

  • Hospital admission
  • Surgical procedures
  • Previous VTE
  • Medical conditions such as cancer or arthritis
  • High-risk thrombophilias
  • Ovarian hyperstimulation syndrome
368
Q

What is prophylaxis for VTE in pregnancy

A

low molecular weight heparin (LMWH) eg enoxaparin, dalteparin and tinzaparin.

369
Q

when is prophylaxis for VTE in pregnancy be stopped

A

when the woman goes into labour

370
Q

what are the Mechanical prophylaxis options for VTE in pregnancy

A
  • Intermittent pneumatic compression with equipment that inflates and deflates to massage the legs
  • Anti-embolic compression stockings
371
Q

How does DVT present

A

unilateral

  • Calf or leg swelling
  • Dilated superficial veins
  • Tenderness to the calf (particularly over the deep veins)
  • Oedema
  • Colour changes to the leg

> 3cm change in calves is significant

372
Q

How does PE present

A
  • sudden onset shortness of breath
  • Cough with or without blood (haemoptysis)
  • Pleuritic chest pain
  • Hypoxia
  • Tachycardia
  • Tachypnoea
  • Low-grade fever
  • Haemodynamic instability causing hypotension
373
Q

What is investigation of choice for suspected DVT

A

Doppler ultrasound

374
Q

What bloods can be preformed for suspected DVT or PE

A

FBC, U&Es, LFTs and a coagulation screen

375
Q

What is investigation of choice for suspected PE

A

Chest xray
ECG

376
Q

What is the investigation of choice for a definitive diagnosis for DVT/PE

A
  • CT pulmonary angiogram (CTPA)
  • or ventilation-perfusion (VQ) scan.
377
Q

When is CTPA the preferred choice investigation for VTE in pregnancy

A

CTPA is the test for choice for patients with an abnormal chest xray

378
Q

What does CTPA have a higher risk of

A

higher risk of breast cancer for the mother (minimal absolute risk)

379
Q

What does VQ scan have a higher risk of

A

higher risk of childhood cancer for the fetus (minimal absolute risk)

380
Q

Why is wells score not validated in pregnancy

A

D-dimers are not helpful in pregnant patients, as pregnancy is a cause of a raised D-dimer.

381
Q

how is VTE in pregnancy managed

A

low molecular weight heparin (LMWH).

started immediately before confirming diagnosis

382
Q

Give an example of a LMWH

A

enoxaparin, dalteparin and tinzaparin.

383
Q

What is LMWH does based on

A

weight at booking clinic

384
Q

how long should LMWH be continued when used for VTE prophylaxis in pregnancy

A

LMWH is continued for the remained of pregnancy, plus six weeks postnatally, or three months in total (whichever is longer).

385
Q

what are treatment options for women with a massive PE and haemodynamic compromise in pregnancy

A
  • Unfractionated heparin
  • Thrombolysis
  • Surgical embolectomy
386
Q

How many maternal deaths if VTE responsible for

A

in UK approximately 1/3 of maternal deaths

387
Q

What is an alternative to LMWH in pregnancy

A

rivaroxaban

388
Q

why should Warfarin not be used in pregnancy

A

teratogenic
and can lead to foetal loss through haemorrhage.

389
Q

what is Group B streptococcus

A

gram positive cocci, which typically grow in chains.

390
Q

What can Group B streptococcus infection cause in neonate

A

sepsis, pneumonia, or meningitis

5% mortality rate

391
Q

what are the RF for colonisation with GBS in neonate

A
  • GBS infection in a previous baby
  • Prematurity <37 weeks
  • Rupture of membranes >24 hours before delivery
  • Pyrexia during labour
  • Positive test for GBS in the mother
  • Mother diagnosed with a UTI found to be GBS during pregnancy
392
Q

What are clinical feature of maternal GBS that leads to infection

A

UTI - frequency urgency dysuria
Chorioamnioitis - fever lower abdo pain, foul discharge
Endometritis - fever lower abdo pain, foul discharge

393
Q

How is GBS investigated

A

swabs, cultured, PCR

394
Q

what are neonatal symptoms of GBS infection

A

pyrexia, cyanosis, difficulty breathing and feeding, and floppiness.

395
Q

How is GBS infection prevented

A
  • High dose IV penicillins (benzylpenicillin)
  • cefuroxime or clindamycin in penicillin-allergic patients

throughout labour

396
Q

when is Abx indicated in GBS

A

GBS positive swabs
A UTI caused by GBS during this pregnancy
Previous baby with GBS infection.
Pyrexia during labour
Labour onset <37 weeks
Rupture of membranes >18 hours

397
Q

what is management of a woman who has rupture of membranes in a woman of >37 weeks gestation known to be GBS positive

A

induced immediately

398
Q

what is the 1st stage of labour

A

Dilation stage -> involves cervical effacement and dilatation facilitated by uterine contractions.

399
Q

what is the 2nd stage of labour

A

Theexpulsion stagecommences when cervix is fully dilated until delivery of the baby

400
Q

what is the 3rd stage of labour

A

placental stageconcludes with placental expulsion.

401
Q

what is bishops score

A

used to help assess whether induction of labour will be required

402
Q

what does a bishops score of <5 indicate

A

labour is unlikely to start without induction

403
Q

what does a bishops score of ≥8 indicate

A

cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour

404
Q

how is labor induced if bishops score is ≤6

A
  • vaginal prostaglandins or oral misoprostol
  • mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
405
Q

how is labor induced if bishops score is >6

A
  • amniotomy and an intravenous oxytocin infusion
406
Q

what is inadequate progress in the active phase of 1st stage of labour

A

cervical dilatation less than 2 cm over 4 hours, or no change in cervical dilatation over 4 hours despite adequate uterine contractions.

407
Q

what is inadequate progress in the latent phase of 1st stage of labour

A

exceeds 20 hours in nulliparous women or 14 hours in multiparous women.

408
Q

What RF indicate 5mg of folic acid

A
  • Previous child with NTD
  • Diabetes mellitus
  • Women on antiepileptic
  • Obese (body mass index >30kg/m²)
  • HIV +ve taking co-trimoxazole
  • Sickle cell
409
Q

What are categories of C section and their time frame

A

1 = within 30 mins
2 = within 75 mins
3 = needed but stable
4 = elective

410
Q

What medication are CI in breastfeeding

A

L - Lithium
A - Aspirin
M - Methotrexate
B - Benzodiazepines
A - Amiodarone
S - Sulphonylureas
T - Tetracycline
4’Cs - Carbimazole, Ciprofloxacin, Chloramphenicol, Cytotoxics

LAMBAST + 4C’s

411
Q

When should women with hyperemesis gravidarum be admitted

A
  • Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics
  • unable to keep down liquids or oral antiemetics
412
Q

What is the management of hyperemesis gravidarum

A

first-line medications

  • antihistamines: oral cyclizine or promethazine

second-line medications

  • oral ondansetron
  • oral metoclopramide -> no more than 5 days
413
Q

who is at increased risk of hyperemesis gravidarum

A
  • multiple pregnancies
  • trophoblastic disease
  • nulliparity
  • obesity
  • family or personal history of NVP

3a womens health (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions