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AKT > Obstetrics 2 > Flashcards

Obstetrics 2 Flashcards

1
Q

Rubella contraction in pregnancy
Infectious from what time period?

A

7 days before sx appear to 4 days after onset of rash

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2
Q

Congenital rubella syndrome is as high as 90% during what gestations?
Rare after what gestation

A

K8-10
K16

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3
Q

Sensorineural deafness
Congenital cataracts
Congenital heart disease
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Salt and pepper chorioretinitis
Microphthalmia
Cerebral palsy
=

A

Congenital rubella syndrome

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4
Q

Mx of suspected cases of rubella in pregnancy =

A

Discuss with Health Protection Unit

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5
Q

Define RFM

A

K28>
<10 movements in 2 hours

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6
Q

When should RFM be established?
When should they start? Primip multip

A

K24
K18-20, 16-18

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7
Q

RFM Mx
>K28

A

Handheld doppler
If no heartbeat then US immediately
If heartbeat then CTG for at least 20 mins
If any concerns with CTG then USS within 24 hours

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8
Q

RFM Mx
K<28

A

Doppler for HR

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9
Q

When to refer if no fetal movements have been felt?

A

K24

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10
Q

RF for placenta praevia (3)

A

Multiparity
Multiple pregnancy
Prev CS

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11
Q

Grading of placenta praevia

A

I - lower segment only not then os
II - reaches internal os
III - covers internal os before dilatation but not when dilated
IV - completely covers the os

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12
Q

RF for placental abruption (4)

A

Cocaine
Multip
Maternal trauma
Increasing maternal age

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13
Q

When should women have swabs for GBS?

A

Not routinely offered to everyone
Only if GBS in previous pregnancy
Should be offered at K35-K37 or can have it prophylactically intrapartum

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14
Q

HIV positive women when should a vaginal delivery be offered over a CS

A

If viral load is less than 50 copies/ml at K36

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15
Q

What should be given before a CS and when in HIV+ pts and when?

A

Zidovudine infusion - 4 hours prior to the CS

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16
Q

Neonatal antiretroviral therapy
What should be given and for how long?

A

Zidovudine PO otherwise ART for all neonates
4-6 weeks long treatment

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17
Q

Women who are at high risk of developing pre-eclampsia should be given what and for how long?

A

Aspirin 75mg OD from 12 weeks until birth of baby

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18
Q

High risk groups of for pre-eclampsia? (4)

A

HTN during prev preg
CKD
Autoimmune disorders
DM

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19
Q

What is HTN in pregnancy and when does it normally start to rise?

A

First trimester BP usually falls then rises K20
BP 140/90
OR
Increase in booking reading by 30 or 15 sys/dias

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19
Q

Pre-existing HTN definition

A

> 140/90 before K20

20
Q

PIH definition

A

> 140/90 >K20

21
Q

Pre-eclampsia definition

A

With proteinuria >0.3g/24 hours

22
Q

Mx of obstetric cholestasis (3)
Meds (2)
Induction at what K

A

Induction at K37- K38
Urso
Vitamin K

23
Q

4 causes of PPH

A

Trauma (tear)
Tone (uterine atony)
Tissue (retained placenta)
Thrombin (bleeding disorder)

24
Q

Poly or oligohydramnios is a RF for PPH

A

Polyhydramnios

25
Q

Mx PPH (6)

A

ABC
Palpate the uterine
IV oxytocin slow IV injection followed by infusion
Ergometrine slow IV or IM
Carboprost IM (unless asthma)
Misoprostol sublingual

26
Q

When is a secondary PPH?
Usually secondary to?

A

24 hours - 6 weeks
Retained placenta or endometritis

27
Q

Onset of symptoms for
1. Baby blues
2. Postnatal depression
3. Puerperal psychosis

A
  1. Within 3-7 days
  2. Within a month - peaks at 3 months
  3. Within 2-3 weeks post birth
28
Q

Which SSRIs can be offered for post natal depression? (2)

A

Sertraline
Paroxetine

29
Q

What are the three stages of postpartum thryroiditis?

A

Thyrotoxicosis
Hypothyroidism
Normal thyroid function

30
Q

Which antibodies are found in 90% of cases in postpartum thyroiditis?

A

Thyroid peroxidase antibodies

31
Q

Name the seven features of severe pre-eclampsia (8)

A

BP >160/100
Proteinuria
Headache
Visual disturbances
Papilloedema
RUQ/ epigastric pain
Hyper-reflexia
Platelet count <100

32
Q

What is HELLP?

A

Haemolysis
Elevated liver enzymes
Low platelets

33
Q

First line management pre-eclampsia
First line in asthmatics (2)

A
  1. Labetalol
  2. Nifedipine/ hydralazine if asthmatic
34
Q

Anaemia in pregnancy - Hb values
First trimester
Second/ Third
Postpartum

How long should treatment continue

A

<110
<105
<100

3 months post correction of deficiency

35
Q

Puerperal pyrexia is classified as?

A

T>38 in the first 14 days post delivery

36
Q

Endometritis Mx (2)

A

Clinda and gent

37
Q

Test of choice for GDM
When is it offered
Women with any RF
Women with prev GDM

A

OGTT
K24-28
Soon after booking and then if negative again at K24-K28

38
Q

Diagnostic threshold for GDM
Fasting
2 hour glucose

A

Fasting glucose >=5.6
2 hour glucose >=7.8

39
Q

Mx of GDM
Fasting glucose <7
Fasting glucose >=7

A

Diet and exercise for 1-2 weeks, if not meeting targets then to start metformin, if still not met, then insulin

Insulin

40
Q

When should insulin be offered for GDM (2)

A

If fasting glucose 6-6.9 and evidence of macrosomia or hydramnios
Or fasting glucose >=7

41
Q

When should glibenclamide be offered to women with GDM? (2)

A

Women who do not tolerate metformin or women who decline insulin

42
Q

Mx of women with pre-existing diabetes (3)

A

Weight loss if BMI >27
Stop PO hypoglycaemics except metformin and start insulin
Folic acid 5mg OD from pre conception to 12 weeks

43
Q

Target glucose for GDM/ DM
Fasting
1 hour
2 hour

A

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

44
Q

How long to avoid pregnancy post molar pregnancy

A

Avoid pregnancy for the next 12 months

45
Q

Can hep B be transmitted via breastfeeding?

A

No

46
Q

Which babies should receive a complete course of vaccination and hep B immunoglobulin?

A

Babies born to mothers who are chronically infected with hep B or acutely infected during pregnancy

47
Q

Obstetric cholestasis Mx
Symptomatic relief
How often are LFTs
Induced at K?

A

Urso
Weekly LFTs
Induced at K37

48
Q

BMI ?>= should give birth in a consultant led obstetric unit
BMI?>= should have an antenatal consultation with an obstetric anaesthetist and a plan made

A

35 and 40

AKT (52 decks)

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