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PHASE 3A > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Gestational diabetes and macrosomia increases the risk of what obstetric emergency?

A

Shoulder dystocia

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2
Q

What is Seehan’s syndrome?

A

Seehan’s syndrome is a condition caused by severe blood loss or extremely low BP after or during childbirth.

Lack of blood flow to the pituitary gland, can cause damage to the gland and lead the pituitary dysfunction.

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3
Q

What is the most common organism that can cause of mastitis and what is the tx given?

A

Staphylococcus aureus

Flucloxacillin (erythromycin if patient is allergic)
Encourage them to continue breast-feeding

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4
Q

What pre-conception advice is given to women who have diabetes and and are thinking of concieving?

A

Take High dose of Folic Acid supplements (5mg/day)

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5
Q

What medication is given in a medically managed miscarriage?

A

Missed Miscarriage - Oral Mifepristone, then after 48 hours Misoprostol (vaginal, oral)

Incomplete miscarriage - Misoprostol (oral or vaginal)

(But accoring to NICE, oral misoprostol can only be given up to 49 days gestation)

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6
Q

What is the medical management of an ectopic pregnancy?

A

IM Methotrexate

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7
Q

What drugs can be given to prevent premature labour?

A

1st line- Nifedipine (CCB)
Atosiban (Oxytocin receptor antagonist)
Indomethacin (NSAID)
Terbutaline (B2 Agonist)
Magnesium sulphate (may be administered for its foetal nueroprotective effects)

Inhibits contractions (tocolytic) and thus prevents labour

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8
Q

What drug can be given to promote contractions in labour?

A

Oxytocin analogues

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9
Q

What drug/drug class can be used to ripen cervix and promote labour?

A

Prostaglandin analogues

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10
Q

What is the first intervention that should be used to try and overcome shoulder dystocia once it has been identified?

A

McRoberts Manoeuvre

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11
Q

If McRoberts manoeuvre fails, what should be done next?

A

1) Apply suprapubic pressure
2) Cosider Episiotomy
3) Rubin Manouvre- Deliver anterior arm/Internal rotational manoeuvres
4) All fours and repeat
5) Consider Cleidotomy, Zavaneli or symphysiotomy

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12
Q

Asymmetrical small for gestational age is associated with what condition?

A

Placental Insufficiency

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13
Q

What drugs are contraindicated for use in breastfeeding women?

A

Abx- tetracyclines, sulphanomides, ciprofloxacin, chloramphenicol
Antipsychotics- lithium, benzos
Amiadarone
Methotrexate
Sulfonylureas
Aspirin
Carbimazole

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14
Q

What is the treatment for the prophylaxis of Group B Strep in pregnant women

A

Intrapartum IV benzylpeniclillin

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15
Q

What is the cervical dilation during the different stages of labour;
-Latent
-Active

A

Latent- 0-4cm
Active- 4-10cm

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16
Q

How long should methotrexate usage be ceased before conception?

A

6 months

Both men and women

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17
Q

What is the 1st line tretement for reversing:
A) Respirtaory depression in Magnesium sulphate
B) Benzodiazepines overdose
C) Opioid overdose

A

A) Calcium Gluconate
B) Flumazenil
C) Naloxone

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18
Q

What are the signs of an amniotic fluid embolism?

A

Respiratory distress, hypoxia, and hypotension (usually occurs within 30 minutes of labour)

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19
Q

What is the medical management of an ectopic pregnancy?

A

Methotrexate

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20
Q

What are the basic initail Ixs undertaken when having fertility issues?

A

semen analysis-repeat 3months later if required
Serum progesteron- should be measure 7 days prior to the start of next period

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21
Q

What tool is the most appropriate in diagnosing postnatal depression?

A

Edinburgh scale

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22
Q

What fluids should be prescribed to a woman with hyperemesis gravidarum

A

IV normal saline with potassium chlroide

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23
Q

What pharmacological management is given to patients with urge incontinence?

A

anticholinergic Oxybutinin (solinfenacin, tolteradine)
or
b3 agonist- Mirabegron

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24
Q

When is the first anti d injection given to rhesus -ve women?

A

28 weeks

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25
Q

Which women should be prescribed 5mg of folic acid instead of the normal 0.4mg?

A

Either partner has NTD, previous pregnancy of NTD, FHx of NTD (neural tube defects)
Woman is taking anti-epileptic drugs, or has coeliacs, diabetes, or thalassaemia
Woman is obese

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26
Q

White, thick discharge that is sometimes described as ‘cottage-cheese’-like with a pH <4.5 is suggestive of what STI?

A

Candidiasis (Thrush)

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27
Q

What is the 1st line tretment of thrush in pregnant women?

A

Clotrimazole pessary- Since this patient is pregnant, oral antifungals are contraindicated as they may be associated with congenital abnormalities.

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28
Q

What management should be undrtaken for a preganant woman who presents with PROM?

A

Admit to hospital
Regular observations
Oral antibiotics
Antenatal corticosterods
Delivery should be considered at 34 weeks

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29
Q

What is the 1st line surgical intervention for managment of PPH after other medical measures have failed?

A

Intrauterine Bakri catheter- also know as Intrauterine balloon tamponade

baloon catheter that acts to tamponade the bleeding

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30
Q

What medical management can be undertaken to manage a PPH?

A

Iv Oxytocin
IV/IM ergometrine
IM Craboprost (CI in asthmatics)
Sublingual misoprostol

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31
Q

What are the indictaions for surgical management of an ectopic pregnancy and what does it include?

A

size >35mm
Significant pain
visible heartbeat
hCG>5000

Surgical management involes sapingectomy (1st line for no other rf for infertility) or salpingotomy if rf for infertility

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32
Q

What are the indictaions for expectant management of an ectopic pregnancy and what does it include?

A

size <35mm
No pain
No foetal heatbeat
hCG <1500

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33
Q

What are the indictaions for expectant management of an ectopic pregnancy and what does it include?

A

size <35mm
Asymptomatic
No foetal heartbeat
hCG <1000

Expectant management involves closely monitoring the patient over 48 hours and if B-hCG levels rise again or symptoms manifest intervention is performed.

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34
Q

What is asherman’s syndrome?

A

Asherman syndrome is the formation of scar tissue in the uterine cavity. The problem most often develops after uterine surgery.

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35
Q

What is Seehan’s syndrome?

A

Sheehan’s syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive hemorrhage during or after delivery.

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36
Q

Name 5 causes of secondary amenorrhoea?

A

Asherman’s Syndrome
Seehan’s Syndrome
PCOS
Prolactinoma
Pregnancy
Thyrotoxicosis
Turner’s syndrome
Premature ovarian failure
Congenital adrenal hyperplasia

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37
Q

At what gestation would a referral to the maternal fetal medicine unit for a pregnant woman who is yet to feel foetal movements?

A

24 weeks
Generally women can feel their babies move around 18-20 weeks, but this can be earlier especially in multiparous women

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38
Q

When is the OGTT offered to women at risk of GDM?

A

24-28 weeks

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39
Q

When should scrrening for Down’s syndrome take place, what tests are conducted and what are the results of a +ve screening?

A

a) test is conducted in 1st trimester at 11-13+6 weeks

b) combined test- bhCG, Nuchal translucency and PAPP-A

c)Raised serum bhCG, Thickened nuchal translucency, and low PAPP-A

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40
Q

What is the result of a quadruple test in people who tets +ve for Down’s syndrome?

A

Low Alpha fetoprotein
Low unconjugated oestriol
High hCG
High Inhibin A

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41
Q

For ach of the following components of routine antenatal care state the gestation when it should occur:
A) Anaomaly Scan
B) Down’s syndrome screening
C) Booking visit

A

A) 18-20+6 weeks
B) 11-13+6 weeks
C) 8-12 weeks

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42
Q

What tests are conducted at the Booking visit?

A

BP
Urine dipstick
BMI
FBC, Blood group, Rhesus status, Red cell alloantibodies, Haemoglobinopathies
Hepatitis B and syphilis
HIV test

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43
Q

What are the 2 most important RFs for placenta accreta?

A

Previous c-section
Placenta praevia

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44
Q

How long after a termination of pregnancy can a urine pregnancy test remain positive?

A

Urine pregnancy test often remains positive for up to 4 weeks following termination.

A positive test beyond 4 weeks indicates incomplete abortion or persistent trophoblast

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45
Q

What additonal investigation/test should be conducted in women who present with recurrent vaginal candidiasis?

A

HBA1c- to exclude diabetes

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46
Q

What is the management of intra hepatic cholestasis of pregnancy?

A

Plan induction of labour at 37-38 weeks
Ursodeoxycholic acid for symptomatic relief
Vitamin K supplementation

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47
Q

What analgesic is absolutely contraindicated in breastfeeding individuals/

A

Aspirin- due to association with Reye’s syndrome

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48
Q

What is the diagnostic criteria for a diagnosis of Gestational Diabetes Mellitus?

A

EITHER OF THESE: 5678

Fasting blood glucose >5.6 mmol

2 hour glucose >7.8 mmol

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49
Q

What is the management of GDM and how does BG dictate this?

A

If fasting glucose <7mmol trial diet and exercise should be offered. If targets not met within 1-2 weeks add metformin

If fasting glucose >7mmol insulin should be started

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50
Q

What is the management involved in women with pre-existing diabetes during pregnancy?

A

Encourage weight loss in women with BMI >27 kg/m2
Stop oral hypoglycaemics except metformin and start insulin
Folic acid 5mg/day from pre-conception to 12 weeks
Detailed Anamoly scan at 20 weeks

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51
Q

List 5 RF for GDM?

A

Obese (BMI >30)
Previous macroscopic baby (>4.5 kg)
Previous GDM
First degree relative with DM
South Asian/black Caribbean

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52
Q

What is eclampsia and it’s treatment?

A

Development of seizures in association with pre-eclampsia

Tx- magnesium sulphate IV

Continue for 24 hrs since birth/last seizure
Monitor reflexes and RR
Calcium gluconate tx if resp depression

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53
Q

What is pre-eclampsia?

A

new onset bp >140/90 after 20 weeks GA AND 1 more of the following
-Proteinuria
-Other organ involvement

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54
Q

Give 3 indications for induction of labour?

A

Prolonged pregnancy 1-2 weeks past due date
PPROM and labour hasn’t started
Diabetic mother >38
Pre eclampsia
Obstetric cholestasis

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55
Q

Give 5 methods of induction of Labour

A

Membrane sweep
Vaginal prostaglandin E2
Oral prostaglandin (misoprostol)
Maternal oxytocin infusion
Amniotomy
Cervical ripening balloon

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56
Q

What are the results for the quadruple test in someone who has edwards syndrome?

A

Beta HCG low
AFP low
Serum oestriol low
Inhibit a <->

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57
Q

When is the first and second dose of anti d given in rhesus -ve mothers?

A

1st- 28 weeks
2nd- 34 weeks

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58
Q

What medication is prescribed to women who are at a moderate-high risk of pre-eclampsia?

A

Aspirin - Prophylaxis

Labetalol- FIRST LINE
Others- Nifedipine, Methyldopa and Hydralazine

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59
Q

List causes of low AFP levels in pregnancy?

A

Downs
Edwards
Maternal diabetes
Maternal obesity

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60
Q

List causes of elevated levels of AFP during pregnancy?

A

Multiple pregnancy
Neural tube defects
Omphalocele

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61
Q

When administering MGSO4 in eclampsia what are the two parameters that should be observed after its administration?

A

Urine output
Reflexes
Respiratory rate
Oxygen Saturation

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62
Q

What is the most common cause of painless vaginal bleeding during pregnancy?

A

Placenta Praevia

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63
Q

What is HELLP syndrome and List the features?

A

HELLP syndrome us a severe form of pre eclampsia

Haemolysis
Elevated liver enzymes
Low platelets

Typically present with malaise, nausea, vomiting and headache

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64
Q

List 5 causes of oligohydramnios?

A

Low amniotic fluid

PROM
IUGR
Pre-eclampsia
Potters syndrome (renal agenesis + pulmonary hypoplasia)
abnormalities of foetal urinary system e.g. renal agenisis

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65
Q

List 5 causes of polyhydramnios?

A

High levels of amniotic fluid

Maternal diabetes
Foetal anaemia
Twin to win transfusion syndrome
Oesophageal or duodenal atresia
Diaphragmatic hernia

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66
Q

What is a molar pregnancy/hydatiform mole and list it’s key features?

A

Pre cancerous form of gestational trophoblastic disease caused by an imbalance of chromosomes

Painless vaginal bleeding
Enlarged uterus
Very high amounts of beta HCG therefore can cause symptoms of hyperemesis gravidarum and thyrotoxicosis

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67
Q

What is the investigation of choice for a molar pregnancy, and what does it show?

A

TV USS- mole appears as a solid collection of echoes w/ numerous small anechoic spaces —> snowstorm appearance

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68
Q

What are the cut off values for Anaemia in pregnancy?

A

1st trimester- <110
2nd and 3rd trimester- <105

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69
Q

What are baby blues and thus what’s it’s relevant mx?

A

Baby blues are essentially form of depression that occurs 3 days after birth and Usually resolves in 2 weeks

Mx- reassurance and support

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70
Q

What are the anti emetics of choice in hyperemesis gravidarum (give answer in order)?

A

Prochloroperazine
Cyclazine
Ondansetron
Metoclopramide

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71
Q

List the characteristics of hyperemesis gravidarum?

A

Persistent vomiting
Volume depletion
Ketosis
Electrolyte imbalance
Weight loss (>5% pre pregnancy)

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72
Q

What is the definition of a miscarriage?

A

A spontaneous termination of pregnancy before 24 weeks gestation

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73
Q

Give 5 causes of miscarriage?

A

Idiopathic
Antiphospholipid syndrome
PCOS
Uterine abnormalities
Cervical incompetence
Poorly controlled diabetes

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74
Q

What should you do if a pregnant woman has been in contact with someone with chickenpox?

A

Check Abs against varicella zoster
If not immune administer VZV immunoglobulins

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75
Q

MX OF Pregnant woman with hx of VTE ?

A

Low molecular weight heparin starting immediately until 6 weeks postnatal

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76
Q

In patients with suspected PPROM where there is no evidence of fluid in posterior vaginal vault, what is the next best step?

A

Test the fluid for PAMG-1 or IGF Binding protein 1

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77
Q

List 5 RF for placental abruption?

A

A- abruption previously
B- BP
R- ruptured membranes
U- Uterine injury
P- Polyhydramnios
T- Twins/multiple gestation
I- Infection in uterus
O- Older age >35
N- Narcotic use

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78
Q

List 5 rf for PPH

A

Polyhydramnios
previous PPH
Prolonged labour
High maternal age
Emergency c section
placenta praevia/accreta
macrosomia

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79
Q

List the 4 causes of PPH

A

Tone (uterine atony)
Tissue (retained placenta)
Trauma (perineal tear)
Thrombin

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80
Q

What is secondary PPH

A

Bleeding (>500ml) that occurs 24 hours - 6 weeks- typically due to retained placental tissue

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81
Q

Painless vaginal bleeding=

A

Placenta praevia

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82
Q

What blood tests can be indicative of molar pregnancy

A

High BHCG
Low TSH
High thyroxine

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83
Q

What is the rx of choice in supporting in suppressing lactation in breastfeeding women

A

Cabergoline

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84
Q

List the causes and consequences of folic deficiency

A

causes:
Phenytoin
methotrexate
pregnancy
alcohol excess

consequences-
NT defects
Macrocytic megaloblastic anaemia

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85
Q

List the mx of placental abruption

A

Fetus alive and < 36 weeks
- fetal distress: immediate caesarean
- no fetal distress: observe closely, steroids, no tocolysis, threshold to deliver depends on gestation

Fetus alive and > 36 weeks
- fetal distress: immediate caesarean
- no fetal distress: deliver vaginally

86
Q

What is the definition of miscarriage?

A

Spontaneous terminantion of preganancy before 24 weeks of gestation

87
Q

What is a threatened miscarriage?

A

Painless/little vaginal bleeding + cervical os is closed

88
Q

What is a missed misscarriage?

A

The uterus still contains foetal tissue, but the foetus is no longer alive. The miscaariag is often msised as woman is asymptomatic. The cervical os is closed

89
Q

What is an inevitable miscarriage?

A

heavy bleeding with clots and pain
cervical os is open

90
Q

What is an incomplete miscarrigae?

A

not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open

91
Q

List 4 causes of miscarriage?

A

Anti-phospholipid syndrome
PCOS
Uterine abnormality
Cervical incompetance
poorly controlled diabetes/thyroid disease
idiopathic
placental failure

92
Q

What are the 2 legal requirements for an abortion

A

1) two registered medicla practitioners must sign to agree abortion is indicated

2) It must be carried out by a registered medical practitioner in an NHS hopsital or approved premise

93
Q

What is involved in a medical abortion?

A

Mifepristone (relaexes the cervix- anti progesterone) follwoed 48h later by misoprostol (stimulates contraction)

94
Q

What care is available post abortion?

A

women may experience vaginal bleeding and abdo cramps intermittently for up to 2 weeks after procedure

urine pregnancy tets must be undertaken 3 weeks after abortion

contraception should be discussed

95
Q

What is the mx of molar pregnancies?

A

urgent referral to specialist centre
suction curettage or hysterectomy (if fertility does not ahve to be preserved)

surviellience
- two weekly bhcg until levels normal

96
Q

What HB levels in the following would be indicative of oral iron therapy
1) First trimester
2) Seocnd/Third trimester
3) Postpartum

A

1) <110 g/L
2) <105 g/L
3) <100 g/L`

97
Q

List 2 high RF that would determine the prescription of aspirin in a pre-eclampsia patient?

A

need 1 of these
- Hypertensive in previous pregnancy
- CKD
- Autoimmune disease e.g. SLE or Antiphospholipid syndrome
- Type 1 or 2 Diabetes
- Chronic hypertension

98
Q

List 3 moderate RF that would determine the prescription of aspirin in a pre-eclampsia patient?

A

need 2 of these
- First pregnancy
- Age 40 or older
Pregnancy interval of more than 10 years
- BMI>35
- FHx of pre-eclampsia
- Multiple preganncy

99
Q

What are the key investigations for a diagnosis of pre-eclampsia

A

Blood pressure measurement: To confirm hypertension.

Urinalysis: To confirm proteinuria.

Blood tests: To assess kidney function, liver function, and clotting status.

NICE also recommneds teh use of PIGF (low)

100
Q

List 2 maternal and foetal complicatiosn of pre-eclamsisa

A

maternal- eclampsia, organ failures, DIC, HELLP

foetal- neonatal hypoxia, placental abruption, IUGR, pre-term delivery

101
Q

List the triad for thrombosis

A

hypercoaguable state
stasis of vlood flow
Damage to endothelium

102
Q

What is the 1st line ix of VTE in pregnancy?

A

VTE- Doppler USS

PE- CXR and Echo

103
Q

Why is D-dimer not the appropriate 1st lien Ix for VTE in pregnancy

A

Pregnancy causes a high d-dimer thus not helpful

104
Q

What si the tx of choice for VTE in pregnancy?

A

LMWH e.g. enoxaparin, dlateparin

should be continued for rmeianed of preganncy + 6 weeks postnatal

105
Q

What is Kleihaeur test and when is it indicated?

A

checks how much foetal blood has passed into mothers blood during sensitisation event. This tets is used after any sensitising event past 20 weeks gestation to assess further doses of anti-D required

106
Q

List 5 rf for shoulder dystocia

A

Macrosomia
Maternal gestational diabetes
Birthweight >4kg
Advanced maternal age
Maternal short stature/small pelvis
Maternal obesity

107
Q

When screening for Downs syndrome, when is CVS and amniocentesis preferred?

A

CVS- done between 11-13 weeks
Amniocentesis- after 15 weeks

108
Q

What is the management of chorioamnionitis?

A

Admit to hsopital
Give IV antibiotics
Prompt delivery

109
Q

List 3 complictaions of shoulder dystocia?

A

Humeral shaft fracture
Erbs palsy *
Klumpkes palsy
Shoulder dislocation

110
Q

List 3 RF of PPH

A

Polyhydramnios
Previous PPH
Emergency c section
Macrosomia
Prolonged labour
Placenta pravia
Placenta accreta

111
Q

After what time period should lochia be ix after giving birth?

A

6 weeks

112
Q

what is the mx of a woman who is in labour with known placenta praevia

A

Emergency c-section

113
Q

What causes folic acid deficiency?

A

Phenytoin
Methotrextae
Pregnancy
Alcohol excess

114
Q

List the High rf in pre eclamsia?

A

HTN in prev pregnancies
CKD
Diabetes (T1/2)
CHornic HTN
Autoimmune diseases

115
Q

List the moderate risk factors for pre eclampsia?

A

1st pregnancy
40+ years
interval of more than 10 years
BMI>35
FHx of pre eclampsia
Multiple preganncy

116
Q

What is a first degree perineal tear and list its mx?

A

only superficial damage
No repair required

117
Q

What is a second degree perineal tear and list its mx?

A

perineal muscle but NO anal sphincter
On ward sutured by midwife/clinician

118
Q

What is a third degree perineal tear and list its mx?

A

Involves anal sphincter
theatre-trained clinican

119
Q

What is a fourth degree perineal tear and list its mx?

A

perinum + anal sphncter + muscosa
theatre-trained clinican

120
Q

What is used to monitor progress in the 1st satge of labour?

A

A partogram

121
Q

if the paratogram crosses the following, what actions need to be taken
A) crosses alert line
B) crosses action line

A

a) indication for amniotomy and repeat exam in 2 hours

b) obstetrician led care

122
Q

What measures are recorded on a partogram

A

cervical dilation
descent of foetal head
maternal bp/hr/temp/urine output
foetal HR
Frequency of contractions
Status of memebranes
Drugs and fluids given

123
Q

Where is oxytocin produced?

A

Hypothalamus- in supraventricular nuclei

124
Q

Where is oxytocin released from?

A

Posterior pituitary

125
Q

What the difference between latent and active 1st stage of labour?

A

latent- 0-4cm. irregular contractions

active- 4-10cm, regular contractions

126
Q

WHat is the 2nd stage of labour?

A

10cm cervix –> Delivery of baby

127
Q

The success of the 2nd stage is dependent on what factors?

A
  1. power- force of contractions
  2. passenger- size, altitude, lie and presentation of baby
  3. passage- size and shape of pelvis
128
Q

If strength of contrcations in the 2nd stage of labour is weak, what product can be given?

A

Oxytocin

129
Q

What is the diference between physiological 3rd stage mx and active 3rd stage mx?

A

Physioogical 3rd stage mx- placenta deliverd by maternal effort w/o cord traction and medication

Active 3rd stage mx- midwife/dr assited. IM oxytocin and careful cord traction

130
Q

in what 2 ways can Induction of labour be measured?

A

1) CTG
2) Bishop score

131
Q

What is the complication of vaginal prsoatglandin e2 in IOL?

A

Uterine hyperstuimulation- can cause foetal compromise therefore mx by giving tocolytics

132
Q

Give 3 signs taht are associated with obstructed labour?

A

Foetal malposition
Cephalopelvic disproportion
Failure to descend
Visible head retraction (Turtle-neck sign)
Failure of restitution

133
Q

list 5 complcation of c sections

A

Haemorrhage
Bladder injury
Ureteric injury
Emergency hysterectomy
increased risk in subsequent pregnancies of placenta praevia and placenta accreta
Infection

134
Q

Give 3 causes of delay in the 1st stage of labour

A

Maternal dehydration and exhaustion
Multiple gestation
Cephalopelvic disproportion
Inadequate uterine contractions
Malposition of foetus
Primagravida

135
Q

What is the triad of sx/signs in vasa pravia?

A
  1. Ruptured membranes
  2. Painless vaginal bleeding
  3. Foetal bradycardia
136
Q

What antibodies are seen in antiphospholipid syndrome?

A

anti cardioplin
anti lupus
anti beta2-glycoprotein 1

137
Q

What transaminases will be raised in Intrahepatic cholestasis?

A

GGT and ALP

138
Q

What are the torch infections

A

Toxoplasma gondii
Other (Syphyllis, VZV, Parvovirusb19, listeria)
Rubella
CMV
HSV2

139
Q

What are the foetal sx of toxoplasma gondii infection?

A

Hydrocephalus
Chorioretinitis
Rash
Intracranial calcifications

140
Q

What are the foetal sx in rubella infection?

A

Deafness
Cataracts
Rash
Heart defects

141
Q

What are the foetal sx in CMV infection?

A

Microcephaly
Chorioretinitis
deafness
seizures

142
Q

What are the foetal sx in HSV2 infection?

A

Blisters
Meningioencephalitis

143
Q

What are the complications of TORCH infections?

A

IUGR
Miscarriages
Stillbirths
preterm delivery

144
Q

What are the foetal sx in VZV infection?

A

Low birth weight
Limb hypoplasia
skin scarring

145
Q

How often shoul patients with severe pre-eclampsia have their bloods taken?

A

3 x a week
incl FBC, U&E, Transaminases, Billirubin

146
Q

What is the casuative organism for toxoplasmosis infection?

A

Protozoan parasiote- Toxoplasma Gondii

147
Q

Describe the steps of the 2nd stage of labour?

A

Foetal head flexion, descent and engagement
Internal rotaion to face maternal back
Head Extension
External rotation
Deliver anterior shoulder and then rst of the body

148
Q

What is Foetal blood sampling?

A

used duriong labour to assess presence or absence of foetal hypoxia

149
Q

Give 2 indications of FBS?

A

Suspicious CTG
Lack of progress in labour
Abnormal pH or lactate in prev sample

150
Q

What is the normal, boderline and abnormal range of pH in FBS?

A

normal- >7.25
boderline- 7.21-7.24
abnormal <7.20

151
Q

What is the normal, boderline and abnormal range of lactate in FBS?

A

normal <4.1mmol/l
boderline- 4.2-4.8 mmol/l
Abnormal >4.9 mmol/l

152
Q

What foetal signs may be seen on a CTG to indicate an umbilical cord prolapse?

A

Foetal bradycardia
Late decellerations

153
Q

What is the normal HR for a foetus?

A

100-160bpm

154
Q

Give 2 causes of foetal tachycardia on CTG?

A

Foetal hypoxia
Chorioamnionitis
Foetal/maternal aneamia

155
Q

Give 2 causes of foetal bradycardia on CTG?

A

Prolonged cord compression
cord prolapse
epidural/spinal anaesthesia
Maternal seizures
Rapid foetus descent

156
Q

Give 3 RF for reduced foetal movements?

A

Placental position (anterior)
Medications (Benzos, opiates, alcohol)
Obeisty
Amniotic fluid volume

157
Q

List the causes of macrosomia?

A

Maternal diabetes
previous macrosomic baby
maternal obesity
overdue

158
Q

List the types of breech and give breif description?

A

Complete breech- legs fully flexed at hips and knees

Footling breech- where foot is presenting through cervix with leg extended

Extended/Frank breech- both legs flexed at hip and extended at knee

159
Q

What are the different foetal lies?

A

Longitudinal
oblique
transverse

160
Q

List 2 indications for instrumental delivery?

A

Failure to progress
Foeatal distress
Maternal exhaustion

161
Q

List the 2 nerves that may be injured during instrumental delivery?

A

Maternal injury to :
1. Femoral nerve (compressed against inguinal canal during forceps)
2. obturator nerve

162
Q

List 2 maternal and 2 foetal complications of Instrumental delivery?

A

Maternal- PPH, Pernieal tears, bladder injury, injury to femoral or obturator nerve

Foetal- caphalohaematoma (V), facial nerve palsy (F)

163
Q

What is uterine rupture?

A

A medical emergency where muscle layer of the uterus ruptures

164
Q

List 3 rf for uterine rupture?

A

Previous c-section
Increase BMI
Increased age
IOL
Use of oxytocin to stimulate contractions
High parity
Previous uterine surgeyr

165
Q

Mx for cord prolapse?

A

Emergency csection
adopt knees to chest position
fill bladder with 500ml of slaine to prevent further prolapse
give tocolytics e.g. terbutaline to stop contractions

166
Q

What conditions are screened for in the 20 week analomy scan?

A

Edwards
Pataus
Anacephaly
Gastroschisis
Cleft lip
Bilateral renal agenesis

167
Q

WHta is the difference between complete and incomplete molar pregnancy ?

A

Complete- absence of foetal tissue (XX)

Incomplete- presence of foetal tissue (XXX, XYY)

168
Q

What is the normal Amniotic fluid Index (AFI)

A

2-25 cm
>25cm- polyhydramnios
<5cm- oligohydramnios

169
Q

What moderate and severe PPH?

A

Moderate PPH- 1000-2000ml

severe PPH- >2000ml

170
Q

List the physiological changes in pregnancy in regards to blood tests?

A

High WCC, ESR, D-Dimer, ALP

Low Insulin, Platelets

171
Q

What vaccines are offered to all preg women?

A

pertussis, influenza

172
Q

Definition of IUGR?

A

Failure of foetus to reach potential geniticlaly determiend size

173
Q

What is occult and overt cord prolapse?

A

Occult- Incomplete: cord descends alongside presenting aprt but not beyond

Overt- complete: cord descends past presenting part and is lower than presenting part

174
Q

Why is dextrose not given whne managing hyperemesis gravidarum?

A

can cause wernickes encephalopathy

175
Q

List 3 differentials and complications of hyperemesis gravidarum?

A

differentials- Appendicitis, Bowel obstruction, UTI, Gastroenteritis

complciations- VTE, Mallory weiss tear, Wernickes encephalopathy, maternal dehydration and malnutrition

176
Q

Give 3 examples of sensitisation events?

A

Amniocentesis and CVS
ECV
Placental abruption/ Placenta praveia
Ectopic pregnancy
TOP

177
Q

What should the glucose targets for self monitoring of pregnant women be in the following:
a) Fasting
b) 1 hour after meal
c) 2 hours after meal

A

a) 5.3 mmol/l
b) 7.8 mmol/l
c) 6.4 mmol/l

178
Q

List the MOA of these following anti-emetics?
a) Promethazine
B) ondansetron
c) Cyclizine
d) Metoclopramide

A

a) H1 receptor antagonist
b) 5HT3 receptor antgaonist
c) H1 receptor antagonist
d) D2 receptor antaginist

179
Q

What should happen if a pregnant woman has come in contact with someone with chickenpox?

A

Immediately check VZIG
if not present then:
a) >20 weeks - either VZIG or oral aciclovir 7-14 dyas after exposure
b) <20 weeks - Give VZIG immediately

180
Q

Moa of mifeprostone?

A

anti progesterone thus prevents advancement of pregnancy and relaxes the cervix

181
Q

MOA of misoprostol?

A

Prostaglandin E1 analogue-induces strong uterine contractions leading to expulsion of prodcut of conceltion from uterus

182
Q

What are the 2 prophylaxis options for women at high risk of pre-term labour

A

1) Vaginal progesterone (if cerrvical length <25mm or hx of spontaneous preterm birth)

2) Cervical cerclage
(if cerrvical length <25mm andhistory of PPROM or cervical trauma)

183
Q

List 3 differentials for rashes in pregnancy?

A

1) Intrahepatic cholestatsis

2) Phemphigoid gestationis- itch around umbilicus and progress to form blisters

3) Polymorphic eruption of pregnancy- papules and plaques on stomach and thighs. typically spares umbilicus

184
Q

In terms of antenatal care what supplementation should women take and when?

A

Folic acid 400mcg before conception until 12 weeks

185
Q

What is the medicative action for a pregnant woman with pre-existing hypertension?

A

Stop ACEi or ARB immediately and start alternative e.g. Labetalol while awaiting specialist review

186
Q

When should delivery of the baby occur within in a category 2 C-section?

A

Within 75 minutes

186
Q

When should delivery of the baby occur within in a category 1 C-section?

A

Within 30 minutes

187
Q

What does a bishop score of <5 indicate?

A

Labour unlikely to start without induction

188
Q

What does a bishop score of ≥ 8 indicate?

A

Cervix is ripe, or ‘favourable’ and thus high chance of spontaneous labour

189
Q

What is Puerperal pyrexia?

A

a temperature of >38C in first 14 days following delivery

190
Q

What are the causes of puerperal pyrexia?

A

Endometritis
UTI
Wound infections
Mastitis

191
Q

What is the most likely location of an ectopic pregnancy?

A

Ampulla of fallopian tube

192
Q

What is the thrombprophylaxis of choice in pregnancy?

A

LMWH

193
Q

What is the main complications of vasa praevia?

A

Foetal death

194
Q

What is the foetal complication for a mother infected with Parvovirus B19>

A

Hydrops fetalis

195
Q

What defines a first degree perineal tear?

A

Superficial damage with no muscle involvement
Doesn’t need repair

196
Q

What defines a second degree perineal tear?

A

Injury to the perineal muscle, no anal sphincter involvements
Require suturing on the ward by a suitably experienced midwife or clinician

197
Q

What defines a third degree perineal tear?

A

Injury to perineum involving anal sphincter complexes
3A - Less than 50% EAS Thickness torn
3B - More than 50% EAS Thickness torn
3C - IAS Torn

Require repair in theatre

198
Q

What defines a fourth degree perineal tear?

A

Injury to perineum involving anal sphincter complex and rectal mucosa
Require repair in theatre by a suitably trained clinician

199
Q

Define antepartum haemorrhage?

A

Bleeding from the genital tract after 24 weeks gestation

200
Q

At what gestation should Anti-D be administered?

A

28 and 34 weeks

201
Q

Define primary postpartum haemorrhage?

A

The loss of 500ml or more of blood from the genital tract within 24 hours of the birth of a baby

202
Q

What is given in PPROM to reduce the risk of respiratory distress syndrome?

A

Antenatal corticosteroids e.g. IM Dexamethasone

203
Q

What is

A
204
Q

Women who are at high risk of developing pre-eclampsia should take..

A

aspirin 75mg od from 12 weeks until the birth of the baby.

205
Q

What is Gastroschisis?

A

This describes a congenital defect in the anterior abdominal wall, lateral to the umbilical cord.

206
Q

What is the Mx of Gastroschisis?

A

Vaginal delivery can be attempted but newborn should go to theatre after birth

207
Q

What is Exompahlos?

A

Also known as Omphalocoele
Abdominal contents prodtrude through the anterior abdominal wall but are covered in a n amniotic sac

208
Q

What is the Mx of Exomphalos?

A

Planned elective C-section

209
Q

When and how is vitamin K given to a new born

A

IM Injection of VitK on first day of life

210
Q

What is the formula to calculate estimated delivery date?

A

Estimated delivery date is: first day of last menstrual period + 1 year − 3 months + 7 d.

PHASE 3A (11 decks)

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