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1 - MSRA > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Categories CI to breatfeeding

A
  • Drugs
  • Infection
  • Galactosaemia
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2
Q

Drugs containdicated in breastfeeding

A
  • Some antibiotics
  • Lithium
  • Benzodiazepines
  • Aspirin
  • Carbimazole
  • Methotrexate
  • Sulphonylureas
  • Cytotoxic drugs
  • Amiodarone
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3
Q

Antibiotics contraindicated in breastfeeding

A
  • Ciprofloxacin
  • Tetracycline
  • Chloramphenicol
  • Sulphonamines
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4
Q

Risk factors amniotic fluid embolism

A
  • Increasing maternal age
  • Induction
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5
Q

Symptoms amniotic fluid embolism

A

Chills, shivering, sweating
Anxiety
Coughing

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6
Q

Signs amniotic fluid embolism

A

Cyanosis
Hypotension
Bronchospasm
Tachycardia
Arrhythmia
MI

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7
Q

Diagnosis amniotic fluid embolism

A

Diagnosis of exclusion - no definitive test

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8
Q

Management amniotic fluid embolism

A

Supportive

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9
Q

Vitamin D supps pregnancy

A

10microgram/day

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10
Q

When is booking visit

A

8-12 weeks (ideally <10)

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11
Q

Investigations done at booking

A
  • FBC, blood group, rhesus, red cell alloantibodies, haemoglobinopathies
  • Hep B, syphilis
    HIV
    Urine culture - detect asymptomatic bacteriuria
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12
Q

Purpose of 11-13+6 weeks scan

A
  • Confirm dates
  • Exclude multiple pregnancy
  • Down syndrome screening
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13
Q

When to consider iron 16 week antental appt

A

Hb <11

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14
Q

When is anomaly scan

A

18 - 20+6

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15
Q

What is done at 28 week antenatal visit

A

Second screen for anaemia and atypical red cell alloantibodies

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16
Q

When to consider iron 28 weeks

A

Hb <10.5

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17
Q

When is presentation of baby checked antenatally

A

36 weeks - offer ECV if indicated

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18
Q

When is anti-D prophylaxis given to rhesus neg women

A

28 weeks and 34 weeks

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19
Q

Causes of first trimester bleeding

A

Spontaneous abortion
Ectopic pregnancy
Hydatidiform mole

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20
Q

Causes of second trimester bleeding

A

Spontaneous abortion
Hydatidiform mole
Placental abruption

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21
Q

Causes of third trimester bleeding

A

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

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22
Q

Features hydatidiform mole

A
  • Bleeding in first or early second trimester
  • Exaggerated symptoms of pregnancy, e.g. hyperem
  • Uterus large for dates
  • Serum hCG very high
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23
Q

Features placental abruption

A
  • Constant lower abdominal pain
  • Shock out of proportion with visible blood loss
  • Tender, tense uterus with normal lie and presentation
  • Fetal heart may be distressed
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24
Q

Features vasa praevia

A

Rupture of membranes followed immediately by vaginal bleeding
Fetal bradycardia classically seen

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25
Q

Treatment nipple candidiasis

A

Miconazole cream for mother
Nystatin suspension for baby

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26
Q

Indications for antibiotics mastitis

A
  • Systemically unwell
  • Nipple fissure present
  • Symptoms do not improve after 12-24 hours of effective milk removal
  • If culture indicates infection
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27
Q

First line antibiotic mastitis

A

Flucloxacillin

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28
Q

Complication mastitis

A

Breast abscess

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29
Q

Treatment breast abscess caused by mastitis

A

Usually needs I&D

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30
Q

Presentation breast engorgement

A
  • Bilateral
  • Worse just before a feed
  • Milk doesn’t flow well, infant find it difficult to latch and suckle
  • Fever - usually settles within 24 hours
  • Breasts may appear red
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31
Q

Complications engorgement

A

Blocked milk ducts
Mastitis
Difficulties with breastfeeding

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32
Q

Presentation Raynaud’s disease of niple

A
  • Pain often intermittent, present during and immediately after feeding
  • Blanching of nipple → cyanosis and/or erythema
  • Nipple pain resolves when nipples return to normal colour
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33
Q

Non-medical management of Raynaud’s disease of nipple

A
  • Minimising exposure to cold
  • Use of heat packs following breastfeed
  • Avoiding caffeine
  • Stopping smoking
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34
Q

Medical management Raynaud’s disease of nipple

A

Oral nifedipine

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35
Q

Suppression of lactation

A
  • Stop suckling/expressing
  • Supportive measures - well-supported bra, analgesia
  • Cabergoline
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36
Q

Risk factors breech presentation

A
  • Uterine malformations, fibroids
  • Placenta praevia
  • Polyhydraminos or oligohydraminos
  • Fetal abnormality, e.g. CNS malformation, chromosomal disorders
  • Prematurity
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37
Q

When should ECV be offered

A

36 weeks in nulliparous
37 weeks in multiparous

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38
Q

Absolute contraindications to ECV

A
  • C-section required
  • Antepartum haemorrhage in last 7 days
  • Abnormal CTG
  • Major uterine anomaly
  • Ruptured membranes
  • Multiple pregnancy
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39
Q

Why is C-section indicated in cervical cancer

A

Vaginal delivery can disseminate cancer cells

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40
Q

Timeframe emergency sections

A

Cat 1 - 30 mins
Cat 2 - 75 mins

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41
Q

Cause baseline bradycardia on CTG

A
  • Increased fetal vagal tone
  • Maternal beta blocker use
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42
Q

Cause baseline tachycardia on CTG

A
  • Maternal pyrexia
  • Chorioamnionitis
  • Hypoxia
  • Prematurity
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43
Q

Normal baseline variability CTG

A

> 5 beats/min

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44
Q

Cause loss of baseline variability on CTG

A

Prematurity
Hypoxia

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45
Q

What is early decel

A

Decel of HR which commences with onset of contraction and returns to normal on completion of contraction

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46
Q

Cause early decel on CTG

A

Usually normal, indicates head compression

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47
Q

What is late decel

A

Decel of HR which lags the onset of contraction, does not return to normal 30 seconds after end of contraction

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48
Q

Cause late decel

A

Fetal distress, e.g. asphyxia, placental insufficiency

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49
Q

What is variable decel

A

Decels independent of contractions

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50
Q

Cause variable decel on CTG

A

Cord compression

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51
Q

Risk to mother of chickenpox in pregnancy

A

5x increase risk of pneumonitis

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52
Q

Risk of fetal varicella syndrome based on gestation

A

1% risk if exposed before 20 weeks
Very small number of cases 20-28 weeks
No cases following 28 weeks

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53
Q

Features fetal varicella syndrome

A

Skin scarring
Eye defects - microphthalmia
Limb hypoplasia
Microcephaly
Learning disbilities

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54
Q

Risk of shingles in infancy based on gestation at exposure

A

1-2% risk if maternal exposure in 2nd or 3rd trimester

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55
Q

When is there a risk of severe neonatal varicella

A

If mother develops rash 5 days before - 2 days after birth

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56
Q

First step in management of chickenpox exposure in pregnancy

A

If any doubt about previous chickenpox, urgent varicella antibodies in maternal blood

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57
Q

Management chickenpox exposure in pregnancy if not immune

A

Oral aciclovir (or valaciclovir) given at days 7-14 after exposure (not immediately)

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58
Q

Management of chickenpox in pregnancy

A

Specialist advice
Oral aciclovir given if pregnant women ≥20 weeks, and presents within 24 hours of rash. If <20 weeks, aciclovir ‘considered with caution’

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59
Q

Components of combined test for Down’s syndrome

A
  • Nuchal translucency
  • Serum b-hCG
  • PAPP-A
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60
Q

Results of combined test suggesting DS

A

High HCG
Low PAPP-A
High nuchal translucency

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61
Q

What other conditions give similar results to DS on combined test

A

Edwards and Pataus (but hcg tends to be lower)

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62
Q

When is quadruple test for DS offered

A

15-20 weeks

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63
Q

Components of quadruple test for DS

A
  • Alpha fetoprotein
  • Unconjugated oestriol
  • hCG
  • Inhibin A
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64
Q

Results of quadruple test suggesting DS

A
  • Alpha fetoprotein low
  • Unconjugated oestriol low
  • hCG high
  • Inhibin A high
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65
Q

Quadruple test results DS vs Edwards

A

Inhibin A normal in Edwards

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66
Q

Cause of isolated raised alpha-fetoprotein on quad test

A

Neural tube defects

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67
Q

What to do if high risk on DS screening

A

Offer NIPT or diagnostic (amnio/CVS) - NIPT lower risk

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68
Q

Definition pre-eclampsia

A

New onset BP ≥140/90 after 20 weeks and one of;
- Proteinuria
- Other organ involvement, e.g. renal insufficiency, liver, neuro, haem, uteroplacental

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69
Q

Neurological complications of pre-E

A
  • Eclampsia
  • Altered mental status
  • Blindness
  • Stroke
  • Clonus
  • Severe headaches
  • Persistent visual scotomata
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70
Q

Fetal complications pre-E

A

IUGR
Prematurity

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71
Q

Other comlications pre-E

A

Liver involvement - elevated transaminases
Haemorrhage - placental abruption, intra-abdominal, intra-cerebral
Cardiac failure

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72
Q

Features of severe pre-E

A

HTN >160/110
Proteinuria ++/+++
Headache
Visual disturbance
Papilloedema
RUQ/epigastric pain
Hyperreflexia
Plts <100/abnormal liver enzymes/HELLP

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73
Q

High risk factors pre-E

A

HTN in prev preg
CKD
Autoimmune disease, e.g. SLE, antiphospholipid
T1 or T2DM
Chronic HTN

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74
Q

Moderate risk factors pre-E

A

First preg
Age 40+
Preg interval >10 years
BMI ≥35 at booking
Family Hx
Multiple preg

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75
Q

Risk reduction of pre-E

A

Aspirin 75-150mg OD from 12 weeks if;
≥1 high risk factor
≥2 moderate risk factors

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76
Q

First line anti-HTN pre-E

A

Oral labetalol

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77
Q

Other anti-HTN options in pre-E

A

Nifedipine
Hydralazine

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78
Q

Treatment eclampsia

A

Magnesium - prevents seizures in severe pre-E and treats seizures in eclampsia

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79
Q

Dose magnesium in eclampsia

A

IV bolus 4g over 5-10 mins followed by infusion 1g/hour

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80
Q

Treatment resp depression caused by magnesium sulphate

A

Calcium gluconate

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81
Q

How long to continue magnesium in eclampsia

A

24 hours after last seizure or delivery

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82
Q

Least teratogenic anti-epileptic

A

Carbamazepine

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83
Q

Sodium valproate in preg associated with

A

Neural tube defects

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84
Q

Phenytoin in preg associated with

A

Cleft palate
Coag disorders - give mother vit K in last month of preg

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85
Q

Lamotrigine in preg

A

Studies so far suggest rate of congenital malformations low. Dose may need increasing in preg

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86
Q

Breastfeeding and anti-epileptic

A

Safe (except maybe barbiturates)

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87
Q

Causes folic acid deficiency

A
  • Phenytoin
  • Methotrexate
  • Pregnancy
  • Alcohol excess
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88
Q

Consequence of folic acid deficiency

A
  • Macrocytic, megaloblastic anaemia
  • Neural tube defects
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89
Q

Indications for 5mg folic acid

A
  • Either partner had NTD, prev preg with NTD, or FHx NTD
  • Anti-epileptic drugs
  • Coeliac, diabetes, thalassaemia trait
  • BMI ≥30
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90
Q

Risk factors gestational diabetes

A

BMI >30
Previous macrosomic baby ≥4.5kg
Previous gestational diabetes
First-degree relative with diabetes
Family origin with high prevalence of diabetes - South Asian, black Caribbean, Middle Eastern

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91
Q

When do do OGTT

A
  • If previously had gestational diabetes, ASAP after booking at at 24-28 weeks if first test is normal
  • If risk factors, 24-28 weeks
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92
Q

Alternative to OGTT for gestational diabetes

A

Self-monitoring of BM

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93
Q

Diagnostic threshold for gestational diabetes

A

Fasting glucose ≥5.6
2-hour glucose ≥7.8

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94
Q

First line management gestational diabetes with fasting glucose <7

A

Trial of diet and exercise

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95
Q

Second line management gestational diabetes with fasting glucose <7

A

If targets not met within 1-2 weeks of alterating diet/exercise, add metformin

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96
Q

Third line management gestational diabetes with fasting glucose <7

A

Add insulin (short acting)

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97
Q

When to start insulin immediately in gestational diabetes

A
  • Fasting glucose ≥7
  • Fasting glucose 6-6.9 and evidence of complications e.g. macrosomia, polyhydramnios
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98
Q

Alternative to metformin/insulin in gestational diabetes

A

Glibenclamide

Used if can’t tolerate metformin, or don’t meet targets with metformin but decline insulin

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99
Q

Management pre-existing diabetes in pregnancy

A
  • Weight loss of BMI >27
  • Stop oral hypoglycaemic agents, apart from metformin, and start insulin
  • Folic acid 5mg/day
  • Tight glycaemic control
  • Treat retinopathy - can worsen in pregnancy
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100
Q

Glucose targets in gestational diabetes

A

Fasting 5.3
1 hour after meals 7.8
2 hours after meals 6.4

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101
Q

What is a complete hydatidiform mole

A

Benign tumour of trophoblastic material

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102
Q

Features complete hydatidiform mole

A
  • Bleeding in first or early second trimester
  • Exaggerated symptoms of pregnancy, e.g. hyperem
  • Uterus large for dates
  • Very high beta hCG
  • Hypertension and hyperthyroidism
103
Q

Management complete hydatidiform mole

A

Urgent referral to specialist centre for evacuation of the uterus
Effective contraception recommended to avoid pregnancy in next 12 months

104
Q

Complication complete hydatidiform mole

A

1-2% develop choriocarcinoma

105
Q

Management GBS in previous pregnancy

A

Offered intrapartum antibiotic prophylaxis or testing in late pregnancy → antibiotics if still positive

106
Q

When to test for GBS if indicated

A

35-37 weeks, or 3-5 weeks prior to anticipated delivery date

107
Q

When to offer intrapartum antibiotics (regardless of GBS status)

A
  • Preterm labour
  • Previous baby with early or late onset GBS disease
  • Pyrexia during labour (>38)
108
Q

Antibiotic GBS prophylaxis

A

Benzypenicillin

109
Q

Factors reducing vertical transmission of HIV

A
  • Maternal antiretroviral therapy
  • C-section delivery
  • Neonatal antiretroviral therapy
  • Bottle feeding
110
Q

Management of delivery in HIV

A
  • Vaginal delivery if viral load less than 50 at 36 weeks, otherwise C-section
  • Zidovudine infusion started 4 hours before beginning the C-section
111
Q

Antiretroviral therapy for babies born to HIV positive mothers

A

Zidovudine orally if maternal viral load <50
Triple ART if viral load >50

Continue for 4-6 weeks

112
Q

Breastfeeding and HIV

A

Advise not to breast feed

113
Q

Definition hypertension in pregnancy

A

Systolic >140 or diastolic >90, or
Increase in booking readings >30 systolic or >15 diastolic

114
Q

Management pre-existing hypertension in pregnancy

A

If taking ACEi or ARB, stop immediately and alternative anti-hypertensives started, whilst awaiting specialist review

115
Q

First line anti-hypertensive in pregnancy

116
Q

Alternative anti-hypertensives in pregnancy

A

Nifedipine
Hydralazine

117
Q

Interpretation of Bishops score for induction

A

Score <5 = labour unlikely
Score ≥8 = cervix ripe, high change of spontaneous labour/interventions to induce labour

118
Q

Methods of induction of labour

A
  • Membrane sweep (adjunct, not true method)
  • Vaginal prostaglandin (dinoprostone)
  • Oral prostaglandin (misoprostol)
  • Oxytocin infusion
  • Amniotomy
  • Cervical ripening balloon
119
Q

Induction of labour method if Bishop score ≤6

A

Vaginal prostaglandins or oral misoprostol

120
Q

When to consider mechanical methods (e.g. balloon catheter) for induction when Bishop ≤6

A

If woman higher risk of hyperstimulation or had previous C-section

121
Q

Induction of labour method if Bishop score >6

A

Amniotomy and IV oxytocin infusion

122
Q

Complications of induction of labour

A

Uterine hyperstimulation → fetal hypoxaemia and acidaemia, uterine rupture

123
Q

Management uterine hyperstimulation caused by induction of labour

A

Removing vaginal prostaglandins if possible, stopping oxytocin infusion id one has been started
Consider tocolysisFe

124
Q

Features intrahepatic cholestasis of pregnancy

A
  • Pruritis, typically worse palms, soles, and abdomen
  • Raised bilirubin - clinically detectable jaundice in 20%M
125
Q

Management intrahepatic cholestatis of pregnancy

A

IOL 37-38 weeks
Ursodeoxycholic acid
Vit K supp

126
Q

Complications intrahepatic cholestasis of pregnancy

A

Increased rate of stillbirth

127
Q

Monitoring in labour

A

FHR every 15 mins
Contractions every 30 mins
Maternal pulse every 60 mins
Maternal BP and temp every 4 hours
VE every 4 hours to check progression
Maternal urine for ketones and protein every 4 hours

128
Q

Stage 1 labour

A

From onset of true labour → cervical fully dilated

129
Q

Stage 2 labour

A

Full dilation → delivery of fetus

130
Q

Passive second stage labour

A

2nd stage but not pushing

131
Q

Active second stage

A

Active process of maternal pushing

132
Q

How long is too long second stage labour

A

1 hour - if longer, consider instrumental or section

133
Q

Criteria oligohydraminos

A

Less than 500ml at 32-36 weeks
AFI <5th percentile

134
Q

Causes oligohydraminos

A

PROM
Potter sequence (bilateral renal agenesis and pulmonary hypoplasia)
Intrauterine growth restriction
Post-term
Pre-eclampsia

135
Q

What is first degree perineal tear

A

Superficial damage with no muscle involvement

136
Q

Management first degree perineal tear

A

Do not require any repair

137
Q

What is second degree perineal tear

A

Injury to perineal muscle, but not involving anal sphincter

138
Q

Management second degree perineal tear

A

Suturing on ward by suitably experienced midwife or clinician

139
Q

What is third degree perineal tear

A

Injury to perineum involving anal sphincter complex (external +/- internal anal sphincter)

140
Q

What is 3a perineal tear

A

Less than 50% of external anal sphincter torn

141
Q

What is 3b perineal tear

A

More than 50% of external anal sphincter torn

142
Q

What is 3c perineal tear

A

Internal anal sphincter torn

143
Q

Management third degree perineal tear

A

Require repair in theatre

144
Q

What is fourth degree tear

A

Injury to perineum involving anal sphincter complex and rectal mucosa

145
Q

Management fourth degree tear

A

Repair in theatre

146
Q

Risk factors for perineal tears

A
  • Primigravida
  • Large babies
  • Precipitant labour
  • Shoulder dystocia
  • Forceps delivery
147
Q

What is placenta accreta

A

Attachment of the placenta to the myometrium, due to a defective decidua basalis

148
Q

Risk factors placenta accreta

A

Previous C-section
Placenta praevia

149
Q

Risk factors placenta praevia

A
  • Multiparity
  • Multiple pregnancy
  • Previous C-section
150
Q

Clinical features placenta praevia

A
  • Shock in proportion to visible loss
  • No pain
  • Uterus not tender
  • Lie and presentation may be abnormal
  • Fetal heart usually normal
  • Small bleeds before large
151
Q

Diagnosis of placenta praevia

A

Transvaginal ultrasound - improves accuracy of placental localisation and is considered safe

152
Q

What to avoid placenta praevia

A

Digital vaginal examination - may provoke severe haemorrhage

153
Q

Grade I placenta praevia

A

Placenta reaches lower segment but not internal os

154
Q

Grade II placenta praevia

A

Placenta reaches internal os but doesn’t cover it

155
Q

Grade III placenta praevia

A

Placenta covers internal os before dilation but not when dilated

156
Q

Grade IV placenta praevia

A

Placenta completely covers internal os

157
Q

Management low lying placenta at 20 week scan

A

Rescan at 32 weeks
No need to limit activity or intercourse unless bleed

158
Q

Management low lying placenta at 32 weeks

A

Scan every 2 weeks, with final scan 36-37 to determine method of delivery

159
Q

Management placenta praevia at 36-37 weeks

A

Elective section
If grade I, trial of vaginal delivery may be offered

160
Q

Management of known placenta praevia woman going into labour

A

Emergency C-section

161
Q

Management placenta praevia with bleeding

A

Admit
ABC approach to stabilise
If not able to stabilise, or if in labour/term reached → emergency C-section

162
Q

Risk factors placental abruption

A

Proteinuric hypertension
Cocaine use
Multiparity
Maternal trauma
Increasing maternal age

163
Q

Clinical features placental abruption

A

Shock out of keeping with visible loss
Pain constant
Tender, tense uterus
Normal lie and presentation
Fetal heart absent/distressed

164
Q

Coag probelms abruption vs praevia

A

Coag problems more common in abruption, rare in praevia

165
Q

Definition PPH

A

> 500ml blood loss after delivery

166
Q

What is primary PPH

A

Occurring within 24 hours

167
Q

Causes primary PPH

A
  • Tone (uterine atony) - vast majority
  • Trauma, e.g. perineal tear
  • Tissue (retained placenta)
  • Thrombin, e.g. clotting/bleeding disorder
168
Q

Fluids in PPH

A

Warmed crystalloid (until blood available)

169
Q

Mechanical management PPH

A
  • Palpate fundus and rub to stimulate contractions
  • Catheterise (prevent bladder distention, monitor UO)
170
Q

Medical management PPH

A
  • IV oxytocin - slow IV injection → IV infusion
  • Ergometrine - slow IV or IM
  • Carboprost IM
  • Misoprostol sublingual
171
Q

CI ergometrine for PPH

A

History of hypertension

172
Q

CI carboprost for PPH

A

History of asthma

173
Q

First line surgical management PPH

A

Intrauterine balloon tamponade

174
Q

Other surgical options PPH

A

B lynch suture
Ligation of uterine arteries or internal iliac arteries

175
Q

Management severe, uncontrolled PPH

A

Hysterectomy

176
Q

What is secondary PPH

A

Haemorrhage occurring 24 hours - 12 weeks

177
Q

Cause secondary PPH

A
  • Retained placental tissue
  • Endometritis
178
Q

Whats used to screen for postpartum depression

A

Edinburgh Postnatal Depression Scalente

179
Q

Interpretation Edinburgh Postnatal Depression Scale

A

Score >13 indicates a depressive illness of varying severity

180
Q

Features baby blues

A
  • Typically 3-7 days after birth
  • More common in primips
  • Mothers anxious, tearful, irritable
181
Q

Management baby blues

A

Reassurance and support

182
Q

Timeline postnatal depression

A

Most cases start within a month and typically peaks at 3 months

183
Q

Management postnatal depression

A

Reassurance and support
CBT
SSRIs if severe symptoms

184
Q

SSRIs used in postnatal depression

A

Sertraline
Paroxetine

185
Q

Timeline puerperal psychosis

A

Onset usually within the first 2-3 weeks following birth

186
Q

Features puerperal psychosis

A

Severe swings in mood - similar to bipolar disorder
Disordered perception, e.g. auditory hallucinations

187
Q

Management puerperal psychosis

A

Admission to hospital usually required, ideally mother and baby unit

188
Q

Risk of recurrence puerperal psychosis in future pregnancies

189
Q

When is anaemia screening done in pregnancy

A
  • Booking visit
  • 28 weeks
190
Q

Cut off iron treatment first trimester

191
Q

Cut off iron treatment second/third trimester

192
Q

Cut off iron treatment postpartum

193
Q

Management anaemia in pregnancy

A

Oral ferrous sulfate or ferrous fumurate

Treatment continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished

194
Q

Maternal complications diabetes

A
  • Polyhydraminos
  • Preterm labour
195
Q

Neonatal complications diabetes

A

Macrosomia
Hypoglycaemia
RDS
Polycythaemia → jaundice
Congenital malformations
Stillbirth
Hypomagnesaemia
Hypocalcaemia
Shoulder dystocia

196
Q

What congenital malformations at increased risk in diabetes

A
  • Sacral agenesis
  • CNS malformations
  • CVS malformations, hypertrophic cardiomyopathy
197
Q

Investigation suspected DVT in pregnancy

A

Compression duplex ultrasound

198
Q

Investigation suspected PE in pregnancy

A
  • ECG and CXR in all patients
  • In women who also have symptoms and signs of DVT, compression duplex ultrasound, and if positive no further investigation needed
  • If not, CT or V/Q scan
199
Q

Risk of CTPA in pregnancy

A

Slightly increased lifetime risk of maternal breast cancer (breast tissue more sensitive to effects of radiation)

200
Q

Risk V/Q scanning in pregnancy

A

Slightly increased risk of childhood cancer

201
Q

When does acute fatty liver of pregnancy occur

A

Abdominal pain
Nausea and vomiting
Headache
Jaundice
Hypoglycaemia

202
Q

LFTs in acute fatty liver of pregnancy

A

ALT elevated >500

203
Q

Management acute fatty liver of pregnancy

A

Supportive care
Once stabilised, delivery is definitive management

204
Q

What jaundice causing conditions may be exacerbated in pregnancy

A

Gilbert’s
Dubin-Johnson

205
Q

Maternal risks obesity in pregnancy

A
  • Miscarriage
  • VTE
  • Gestational diabetes
  • Pre-eclampsia
  • Dysfunctional labour, induced labour
  • Postpartum haemorrhage
  • Wound infections
206
Q

Fetal risks maternal obesity

A
  • Congenital anomaly
  • Prematurity
  • Macrosomia
  • Stillbirth
  • Increased risk of developing obesity and metabolic disorders in childhood
  • Neonatal death
207
Q

Management obesity in pregnancy

A
  • 5mg folic acid
  • Screen for GD

Should not loose weight in pregnancy

208
Q

Management BMI ≥35 in pregnancy

A

Should give birth consultant-led obstetric unit

209
Q

Management BMI ≥40 in pregnancy

A

Antenatal consultation with obstetric anaesthetist and plan made

210
Q

Risks of smoking in pregnancy

A
  • Miscarriage
  • Preterm labour
  • Stillbirth
  • IUGR
  • Sudden unexpected death in infancy
211
Q

Features fetal alcohol syndrome

A
  • Learning difficulties
  • Characteristic facies
  • IUGR and postnatal restricted growth
212
Q

Characteristic facies FAS

A
  • Smooth philtrum
  • Thin vermillion
  • Small palpebral fissures
  • Epicanthic folds
  • Microcephaly
213
Q

Maternal risks cocaine use during pregnancy

A

Hypertension in preg, inc pre-E
Placental abruption

214
Q

Fetal risks cocaine use during preg

A

NAS
Prematurity

215
Q

Fetal complications PROM

A

Prematurity
Infection
Pulmonary hypoplasia

216
Q

Maternal complications PROM

A

Chorioamnionitis

217
Q

How to confirm PROM

A

Sterile speculum to look for pooling of amniotic fluid in posterior vaginal vault.
If pooling of fluid not observed, test fluid for PAMG-1 or IGF-1

218
Q

Management PROM

A

Admission
Regular observations to ensure chorioamnionitis not developing
Oral antibiotics
Antenatal corticosteroids
Consider delivery at 34 weeks

219
Q

Antibiotic prophylaxis in PROM

A

Oral erythromycin for 10 days

220
Q

Definition puerperal pyrexia

A

Temp >38 in first 14 days following delivery

221
Q

Causes puerperal pyrexia

A
  • Endometritis
  • UTI
  • Wound infections (perineal tears, C-section)
  • Mastitis
  • VTE
222
Q

Management endometritis

A

Admission for IV antibiotics

223
Q

IV antibiotics in endometritis

A

Clindamycin and gentamicin until afebrile for >24 hours

224
Q

Investigations RFM if past 28 weeks

A

Handheld doppler initially
If no fetal heartbeat, immediate ultrasound
If fetal heartbeat, CTG for at least 20 minutes
If concern remains despite normal CTG, USS within 24 hours

225
Q

Investigation RFM 24-28 weeks

A

Doppler to confirm fetal heartbeat

226
Q

Investigation RFM under 24 weeks

A

If movements felt before, handheld doppler

227
Q

Investigation never felt fetal movements at 24 weeks

A

Referral to FMU

228
Q

Screening for women at risk of rhesus disease of newborn

A

Test for D antibodies in all rh -ve women at booking

229
Q

Limitation of anti-D

A

Prophylaxis only - once sensitisation has occurred it is irreversible

230
Q

Management sensitising event in rhesus -ve mother in 2nd/3rd trimester

A

Give large dose of anti-D
Perform Kleihauer test

231
Q

Events requiring anti-D in Rh -ve mother

A
  • Delivery of rh +ve infant, if live or stillborn
  • Any termination of pregnancy
  • Miscarriage if gestation >12 weeks
  • Ectopic pregnancy managed surgically
  • ECV
  • Antepartum haemorrhage
  • Amnio, CVS, fetal blood sampling
  • Abdo trauma
232
Q

Tests for all babies born to Rh -ve mother

A

Cord blood at delivery for FBC, blood group, and direct Coombs

233
Q

Features rhesus disease of fetus

A
  • Oedema (hydrops)
  • Jaundice
  • Anaemia
  • Hepatosplenomegaly
  • Kernicterus
  • Treatment - transfusions, UV phototherapy
234
Q

RA symptoms in pregnancy

A

Tend to improve, but only resolve in small minority
Patients tend to have flare in minority

235
Q

RA drugs not safe in pregnancy

A

Methotrexate - needs to stop at least 6 months before conception
Leflunomide

236
Q

RA drugs safe in pregnancy

A

Sulfasalazine
Hydroxychloroquine
Low-dose corticosteroids
NSAIDs until 32 weeks

237
Q

Specialist input required RA in pregnancy

A

Need referring to obstetric anaesthetist due to risk of atlanto-axial subluxation

238
Q

What gestation is rubella infection dangerous

A

Highest risk 8-10 weeks (90%)
Damage rare after 16 weeks

239
Q

Features congenital rubella syndrome

A
  • Sensorineural deafness
  • Congenital cataracts
  • Congenital heart disease
  • Growth retardation
  • Hepatosplenomegaly
  • Purpuric skin lesions
  • Salt and pepper chorioretinitis
  • Micropthalmia
  • CP
240
Q

Investigation suspected exposure to rubella in pregnancy

A

IgM antibodies

241
Q

Risk factors shoulder dystocia

A
  • Fetal macrosomia
  • High maternal BMI
  • Diabetes mellitus
  • Prolonged labour
242
Q

First line management shoulder dystocia

243
Q

Other management options shoulder dystocia

A

Symphysiotomy
Zavanelli manoeuvre

244
Q

Normal symphysis fundal height

A

Gestation +/- 2cm

245
Q

Complications mono mono twins

A
  • Increased spontaneous miscarriage and perinatal mortality
  • Increased malformations, IUGR, prematurity
  • Twin to twin transfusion
246
Q

Predisposing factors dizygotic twins

A

Previous twins
Family history
Increasing maternal age
Multigravida
Induced ovulation and IVF
Race

247
Q

Antenatal complications twins

A

Polyhydraminos
Pregnancy induced hypertension
Anaemia
Antepartum haemorrhage

248
Q

Fetal complications twins

A

Prematurity
Small for dates babies
Malformation

249
Q

Labour complication twins

A

PPH
Malpresentation
Cord prolapse/entanglement

250
Q

Risk factors cord prolapse

A
  • Prematurity
  • Multiparity
  • Polyhydraminos
  • Twin pregnancy
  • Cephalopelvic disproportion
  • Abnormal presentation

Around 50% occur at ARM

251
Q

Features cord prolapse

A

Fetal HR abnormal
Cord palpable vaginally/visible beyond level of introitus

252
Q

Immediate management cord prolapse

A

Presenting part may be pushed back into uterus
If cord past level of introitus, minimal handling and kept warm and moist to avoid vasospasm
‘All fours’ until prep for immediate C-section carried out

253
Q

Mode of delivery cord prolapse

A

C-section

Instrumental possible if cervix dilated and head low

1 - MSRA (23 decks)

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