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Revision Qs > Obstetrics 2 > Flashcards

Obstetrics 2 Flashcards

1
Q

What blood test can be done to investigate preterm labour?

A

Fetal fibronectin

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2
Q

What imaging may be useful in assessing preterm labour?

A

TVUS of cervical length

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3
Q

From what time period will steroids definitely need to be given in preterm labour?

A

24-34 weeks

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4
Q

What are tocolytics mainly used for?

A

Delaying labour for 24 hours to either give time for steroids to work or transfer to special care facility

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5
Q

What is the main thing to keep an eye out for in preterm labour or PPROM?

A

Chorioamnionitis

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6
Q

What type of presentation is more common in preterm labour?

A

Breech

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7
Q

What is the definition of PPROM?

A

Rupture of membranes before 37 weeks

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8
Q

What proportion of prelabour deliveries are preceded by PPROM?

A

1/3

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9
Q

When has delivery usual followed PPROM by?

A

48 hours time

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10
Q

What is funisitis?

A

Infection of the umbilical cord

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11
Q

What is the speculum sign of PROM?

A

Clear fluid pool in posterior fornix

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12
Q

Symptoms of chorioamnionitis?

A

Fever, tachycardia
Abdo pain
Uterine tenderness
Coloured/offensive liquor

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13
Q

What constitutes an infection screen for chorioamnionitis?

A

High vaginal swab
FBC
CRP
+/- amniocentesis, ctg

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14
Q

When should IoL follow PPROM?

A

After 36 weeks

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15
Q

What needs to be done if there are any signs of chorioamnionitis?

A

Deliver!

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16
Q

What maternal antibiotic carries a risk of necrotising enterocolitis?

A

Co-amoxiclav

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17
Q

What does SGA mean?

A

Weight under specific centile (10, 5, 2) for gestational age

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18
Q

What is IUGR?

A

Failure to reach full growth potential - a fetus may be IUGR but still ‘normal’ size for gestation

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19
Q

What may ‘falling off’ a growth curve suggest?

A

Fetal compromise leading to IUGR

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20
Q

What is fetal distress?

A

An acute situation seen most often in labour - e.g. Hypoxia

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21
Q

What is Fetal compromise?

A

A chronic situation whereby there are suboptimal conditions for Fetal growth and neuro development

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22
Q

What does Fetal compromise often result in?

A

IUGR

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23
Q

What suture technique may be employed to prevent preterm labour?

A

Cervical cerclage

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24
Q

6 causes of IUGR?

A 
Pre-eclampsia or pregnancy induced HTN
DM
Maternal smoking
Maternal alcohol
Congenital abnormalities
Maternal thyrotoxicosis
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25
Q

What may happen with head circumference and abdominal circumference in IUGR?

A

Abdo circumference plateaus giving asymmetrical picture as head circumference carries on as normal

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26
Q

What Doppler methods are available in to investigate IUGR?

A

Doppler umbilical artery

Doppler Fetal circulation - MCA, Ductus venosus

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27
Q

What indicates placental dysfunction in Doppler umbilical artery waveforms?

A

A high resistance circulation

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28
Q

What is the biophysical profile?

A 
5 features each worth 0-2 points
Limb movement
Breathing movements
Tone
Liquor volume (AFI)
CTG
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29
Q

What medical condition may accompany IUGR/SGA?

A

Pre-eclampsia

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30
Q

How does SGA become IUGR after investigation?

A

SGA + unusual UAD/MCA

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31
Q

What is appropriate investigation for preterm IUGR?

A

Regular UAD, daily CTG

Steroids if

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32
Q

Before when is IoL inappropriate unless otherwise indicated?

A

41 weeks

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33
Q

What assessment and management is done from 41 weeks onwards when thinking about IoL?

A

Vaginal exam and bishops score of cervical suitability
If no IoL, do sweep and daily CTG monitoring
If CTG abnormal, IoL straight away or CS

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34
Q

What 4 things are associated with multiple pregnancy?

A

Genetics
Age
Increasing parity
Assisted conception

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35
Q

What are the most common kinds of twins?

A

Non identical - dizygotic

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36
Q

What are identical twins otherwise known as?

A

Monozygotic

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37
Q

What are the most common type of monozygotic twins?

A

Monochorionic Diamniotic

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38
Q

In order of increasing time of cell division, what are the different types of multiple pregnancy?

A

DCDA
MCDA
MCMA
Conjoined

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39
Q

What are some early indicators of multiple pregnancy?

A

Hyperemesis

SFH palpable at umbilicus before 12 weeks

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40
Q

What does being able to palpate 3 Fetal poles suggest?

A

Multiple pregnancy

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41
Q

3 maternal complications of multiple pregnancy?

A

GDM
Pre-eclampsia
Anaemia

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42
Q

Fetal complications of all multiple pregnancies?

A

Increased morbidity and mortality
Preterm labour
IUGR

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43
Q

Fetal complications of MCDAs?

A

Twin twin transfusion syndrome
Congenital abnormalities
IUGR
Co-twin death

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44
Q

In what type of twins can TTTS occur?

A

MCDA

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45
Q

What happens to the donor baby in TTTS?

A

Gets anaemic, Oligohydramnios and IUGR

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46
Q

What happens to the recipient baby in TTTS?

A

It gets polycythaemia, volume overload (cardiac failure) and polyhydramnios

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47
Q

3 intrapartum complications of multiple pregnancy?

A

Malpresentation
Fetal distress
PPH

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48
Q

What USS sign indicates DCDA twins?

A

Lambda sign

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49
Q

What USS sign indicates MCDA pregnancy?

A

T sign

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50
Q

What causes decreased glucose tolerance in pregnancy?

A

Human placental lactogen, progesterone and cortisol

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51
Q

What happens to glucose tolerance in pregnancy?

A

It decreases

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52
Q

What urinary abnormality can occur physiologically in pregnancy?

A

Glycosuria

53
Q

Unofficial diagnostic criteria of gestational DM?

A

Fasting glucose >7mmol/L

2 hr post prandial glucose >7.8mmol/L

54
Q

What will happen to insulin requirements in pregnancy?

A

They will increase

55
Q

Where does delivery need to take place in a diabetic mother?

A

In a unit with a neonatal ICCU

56
Q

What prenatal management needs to take place in a pre-existing diabetic?

A

Insulin dependent women need retinal, renal and BP screen
Glucose control needs to be optimised
Lower BP if necessary with labetalol or methyldopa

57
Q

What is an ideal hba1c for diabetes in pregnancy?

A

Less than 6.5% (47)

58
Q

When checking BM at home, what should diabetic women aim to keep it below?

A

6mmol/L

59
Q

What prophylactic measure should be given to diabetic women from 12 weeks?

A

Aspirin 75mg to prevent pre-eclampsia

60
Q

When does delivery need to happen by for diabetic women? Why?

A

39 weeks

Risk of stillbirth and macrosomia

61
Q

What is a common neonatal complication of DM babies?

A

Neonatal hypoglycaemia due to high insulin production and suddenly lowered blood glucose

62
Q

Fetal complications of maternal DM in pregnancy?

A 
Macrosomia
Polyhydramnios 
IUGR
Birth trauma and shoulder dystocia
Fetal compromise, death
Preterm labour
Congenital defects - NTD, cardiac
63
Q

What congenital defects are more common in DM babies and what does the risk of these depend on?

A

Cardiac and NTDs

Risk depends on periconceptual glucose control

64
Q

Maternal complications of DM in pregnancy?

A

Insulin requirements
Intervention e.g. LSCS
Pre-eclampsia
Acceleration of complications
Ketoacidosis and undetected hypoglycaemia
Infection - UTI, endometritis, wound infection

65
Q

RFs for GDM?

A 
Previous GDM, macrosomic baby (>4.5kg) or unexplained stillbirth
FH of DM
BMI >30
Race
Polyhydramnios 
Persistent Glycosuria
PCOS
66
Q

When should screening for GDM take place if woman has had previous GDM?

A

18 weeks

67
Q

What is the screening method for GDM?

A

GTT

68
Q

When does ‘regular screening’ for GDM take place?

A

28 weeks

69
Q

What oral hypoglycaemics are safe in pregnancy?

A

Metformin

70
Q

What normally happens to BP and protein excretion in pregnancy?

A

BP drops by 30/15 in second trimester

Proteinuria but not >0.3g in 24 hours

71
Q

What is pregnancy induced hypertension?

A

BP >140/90 after 20 weeks in a normally normotensive woman

72
Q

What are the two subtypes of pregnancy induced hypertension?

A

Gestational hypertension - BP but no proteinuria

Pre-eclampsia - BP with proteinuria

73
Q

What is the basic pathophysiology behind pre-eclampsia?

A

Incomplete trophoblastic invasion -> reduced flow in spiral arteries
Endothelin release and exaggerated maternal immune response

74
Q

3 underlying factors of pre-eclampsia that lead to symptoms?

A

Increased vascular permeability
Vasoconstriction
Clotting abnormalities

75
Q

RFs for pre-eclampsia?

A 
Previous pre-eclampsia or nulliparity
Pre-existing hypertension
GDM or DM
Obesity, metabolic syndrome
Increasing maternal age
Multiple pregnancy 
HIV
76
Q

What infection is a risk factor for pre-eclampsia?

A

HIV

77
Q

When does pre-eclampsia typically present?

A

3rd trimester - 24-26 weeks

78
Q

What is the first sign of pre-eclampsia?

A

Hypertension

79
Q

What does increased vascular permeability in pre-eclampsia lead to?

A

Oedema

Proteinuria

80
Q

What does the vasoconstriction in pre-eclampsia lead to?

A

Hypertension
Headaches, visual disturbance -> eclampsia
Liver damage (nausea, vomiting, epigastric pain)

81
Q

What rise in BP suggests pre-eclampsia in someone with pre-existing hypertension?

A

> 30/15

82
Q

Appropriate investigation of proteinuria in pre-eclampsia?

A

Urine dip at least +
PCR - can do spot test (>0.3) or >30mg/nmol
24 hour protein collection >0.3g/24hr

83
Q

Hypertension criteria in a normotensive person for pre-eclampsia?

A

> 140/90

84
Q

Prophylaxis against pre-eclampsia?

A

Aspirin 75mg/day from 12 weeks

85
Q

When should delivery be aimed for in mild pre-eclampsia?

A

37 weeks

86
Q

When should delivery be aimed for in moderate-severe pre-eclampsia? What extra care should be taken?

A

34-36 weeks

Give steroids, use regular ctg and fluid monitoring

87
Q

If any pre-eclampsic woman deteriorates or shows signs of complications what should be done?

A

Deliver!

88
Q

Initial management of mild-moderate pre-eclampsia?

A

Give anti-hypertensives if BP >150/100

Labetalol or nifedipine first line

89
Q

What is MgSO4 used for in pre-eclampsia management?

A

Treatment and prevention of eclampsia

90
Q

What 2 things should be monitored if giving MgSO4 for eclampsia?

A

Patellar reflexes

Renal function

91
Q

During delivery in pre-eclampsia what needs to be monitored?

A

Fluid balance via catheter, Central venous pressure

92
Q

When can BP peak post-natally?

A

Around 5 days

93
Q

Why don’t you give ergometrine in 3rd stage of labour for pre-eclampsic women?

A

Can cause BP to rise

94
Q

What is a major respiratory cause of death in pre-eclampsia?

A

Pulmonary oedema

95
Q

What does HELLP stand for?

A

Haemolysis - dark pee, raised LDH
Elevated Liver enzymes - pain, liver failure
Low Platelets - bleeding

96
Q

How might a stroke arise in pre-eclampsia?

A

Haemorrhage - esp during pushing in 2nd stage of labour with massive HTN

97
Q

4 Fetal complications of pre-eclampsia?

A

IUGR
Preterm birth
Placental abruption
Fetal hypoxia and morbidity/mortality

98
Q

Any contraindications to VBAC?

A

Vertical Caesarean scar

99
Q

What is there a greater risk of in VBAC than normal labour?

A

Need for emergency section

100
Q

Methods of induction of labour?

A

Prostaglandins (E2)
Amniotomy and oxytocin
Or both

101
Q

Fetal indications for IoL?

A

Prolonged pregnancy (>41 weeks)
Prelabour term ROM
IUGR

102
Q

Maternal indications for IoL?

A

Pre-eclampsia
DM
Social factors

103
Q

Absolute contraindications to IoL?

A

Fetal distress
Placenta praevia
Where ELSCS is indicated

104
Q

Relative contraindications to IoL?

A

Previous LSCS

105
Q

Potential complications of IoL?

A

Need for LSCS or other interventions in labour
Long labour
Hyperstimulation and precipitate labour
PPH

106
Q

What is prelabour term rupture of membranes?

A

Rupture of the membranes after 37 weeks

107
Q

Common indications for ventouse/forceps delivery?

A

Prolonged active second stage or Fetal distress during this

Maternal exhaustion

108
Q

Prerequisites for instrumental delivery?

A

Head can’t be palpable abdominally I.e. Deeply engaged
Head must be at or below level of ischial spines
Cervix must be fully dilated (I.e. In second stage)
Known head position
Adequate analgesia
Empty bladder/catheterisation

109
Q

In what type of woman (nulliparous or multiparous) is instrumental delivery more common?

A

Nulliparous

110
Q

Indications for emergency CS?

A

Prolonged first stage of labour (not fully dilated within 12 hours)
Inefficient uterine action such that criteria for instrumental delivery is not reached
Fetal distress if CS is quickest route

111
Q

Common reasons for ELSCS?

A

Placenta praevia
Severe antenatal fetal compromise
Uncorrectable abnormal lie
Previous CS

112
Q

Relative indications for ESC?

A

Breech
Severe IUGR
Multiple pregnancy
DM

113
Q

Complications of LSCS?

A 
Fetal respiratory morbidity
Haemorrhage
Uterine or wound sepsis
VTE
Anaesthetic related
Need for CS in subsequent pregnancies
114
Q

Maternal complications of instrumental delivery?

A

Trauma
Haemorrhage
Third degree tears

115
Q

What is shoulder dystocia?

A

Failure of the shoulders to be delivered after normal downward traction

116
Q

Major RF for shoulder dystocia?

A

Macrosomia

117
Q

What is the major complication of shoulder dystocia and how is it avoided?

A

Erb’s (waiters tip) palsy

Avoid by not pulling too hard

118
Q

What is cord prolapse?

A

After membranes have ruptured, cord descends below presenting part potentially becoming compressed/spasming

119
Q

RFs for cord prolapse?

A 
Preterm labour
Breech
Polyhydramnios
Abnormal lie
Twin pregnancy 
Artificial amniotomy
120
Q

What is amniotic fluid embolism?

A

Liquor enters maternal circulation causing essentially a VTE

121
Q

Sequelae of amniotic fluid embolism?

A

Pulmonary oedema
ARDS
DIC

122
Q

RFs for amniotic fluid embolism?

A

ROM

Polyhydramnios

123
Q

What might lower abdo pain, Fetal heart rate abnormalities and PV bleed/stopped contractions/maternal collapse indicate in the context of a VBAC?

A

Uterine rupture

124
Q

What is the definition of the puerperium?

A

The 6 week period postpartum where the body returns to pre-pregnancy state

125
Q

What 2 hormones does lactation depend on?

A

Prolactin

Oxytocin

126
Q

The drop in which 2 hormones causes lactation after birth?

A

Oestrogen

Progesterone

127
Q

What is colostrum?

A

Yellow fatty milk, IgA protein and minerals passed for first few days of lactation

128
Q

5 advantages of breastfeeding?

A 
Protection of neonatal infection
Bonding
Protection against maternal Cancer
Can't give too much
Cost saving
129
Q

What vitamin should be given after birth and why?

A

K - avoid haemorrhagic disease of newborn

Revision Qs (28 decks)

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