Obstetrics 2 Flashcards
1
Q
What blood test can be done to investigate preterm labour?
A
Fetal fibronectin
2
Q
What imaging may be useful in assessing preterm labour?
A
TVUS of cervical length
3
Q
From what time period will steroids definitely need to be given in preterm labour?
A
24-34 weeks
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
5
Q
What is the main thing to keep an eye out for in preterm labour or PPROM?
A
Chorioamnionitis
6
Q
What type of presentation is more common in preterm labour?
A
Breech
7
Q
What is the definition of PPROM?
A
Rupture of membranes before 37 weeks
8
Q
What proportion of prelabour deliveries are preceded by PPROM?
A
1/3
9
Q
When has delivery usual followed PPROM by?
A
48 hours time
10
Q
What is funisitis?
A
Infection of the umbilical cord
11
Q
What is the speculum sign of PROM?
A
Clear fluid pool in posterior fornix
12
Q
Symptoms of chorioamnionitis?
A
Fever, tachycardia
Abdo pain
Uterine tenderness
Coloured/offensive liquor
13
Q
What constitutes an infection screen for chorioamnionitis?
A
High vaginal swab
FBC
CRP
+/- amniocentesis, ctg
14
Q
When should IoL follow PPROM?
A
After 36 weeks
15
Q
What needs to be done if there are any signs of chorioamnionitis?
A
Deliver!
16
Q
What maternal antibiotic carries a risk of necrotising enterocolitis?
A
Co-amoxiclav
17
Q
What does SGA mean?
A
Weight under specific centile (10, 5, 2) for gestational age
18
Q
What is IUGR?
A
Failure to reach full growth potential - a fetus may be IUGR but still ‘normal’ size for gestation
19
Q
What may ‘falling off’ a growth curve suggest?
A
Fetal compromise leading to IUGR
20
Q
What is fetal distress?
A
An acute situation seen most often in labour - e.g. Hypoxia
21
Q
What is Fetal compromise?
A
A chronic situation whereby there are suboptimal conditions for Fetal growth and neuro development
22
Q
What does Fetal compromise often result in?
A
IUGR
23
Q
What suture technique may be employed to prevent preterm labour?
A
Cervical cerclage
24
Q
6 causes of IUGR?
A
Pre-eclampsia or pregnancy induced HTN DM Maternal smoking Maternal alcohol Congenital abnormalities Maternal thyrotoxicosis
25
What may happen with head circumference and abdominal circumference in IUGR?
Abdo circumference plateaus giving asymmetrical picture as head circumference carries on as normal
26
What Doppler methods are available in to investigate IUGR?
Doppler umbilical artery
| Doppler Fetal circulation - MCA, Ductus venosus
27
What indicates placental dysfunction in Doppler umbilical artery waveforms?
A high resistance circulation
28
What is the biophysical profile?
```
5 features each worth 0-2 points
Limb movement
Breathing movements
Tone
Liquor volume (AFI)
CTG
```
29
What medical condition may accompany IUGR/SGA?
Pre-eclampsia
30
How does SGA become IUGR after investigation?
SGA + unusual UAD/MCA
31
What is appropriate investigation for preterm IUGR?
Regular UAD, daily CTG
| Steroids if
32
Before when is IoL inappropriate unless otherwise indicated?
41 weeks
33
What assessment and management is done from 41 weeks onwards when thinking about IoL?
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
34
What 4 things are associated with multiple pregnancy?
Genetics
Age
Increasing parity
Assisted conception
35
What are the most common kinds of twins?
Non identical - dizygotic
36
What are identical twins otherwise known as?
Monozygotic
37
What are the most common type of monozygotic twins?
Monochorionic Diamniotic
38
In order of increasing time of cell division, what are the different types of multiple pregnancy?
DCDA
MCDA
MCMA
Conjoined
39
What are some early indicators of multiple pregnancy?
Hyperemesis
| SFH palpable at umbilicus before 12 weeks
40
What does being able to palpate 3 Fetal poles suggest?
Multiple pregnancy
41
3 maternal complications of multiple pregnancy?
GDM
Pre-eclampsia
Anaemia
42
Fetal complications of all multiple pregnancies?
Increased morbidity and mortality
Preterm labour
IUGR
43
Fetal complications of MCDAs?
Twin twin transfusion syndrome
Congenital abnormalities
IUGR
Co-twin death
44
In what type of twins can TTTS occur?
MCDA
45
What happens to the donor baby in TTTS?
Gets anaemic, Oligohydramnios and IUGR
46
What happens to the recipient baby in TTTS?
It gets polycythaemia, volume overload (cardiac failure) and polyhydramnios
47
3 intrapartum complications of multiple pregnancy?
Malpresentation
Fetal distress
PPH
48
What USS sign indicates DCDA twins?
Lambda sign
49
What USS sign indicates MCDA pregnancy?
T sign
50
What causes decreased glucose tolerance in pregnancy?
Human placental lactogen, progesterone and cortisol
51
What happens to glucose tolerance in pregnancy?
It decreases
52
What urinary abnormality can occur physiologically in pregnancy?
Glycosuria
53
Unofficial diagnostic criteria of gestational DM?
Fasting glucose >7mmol/L
| 2 hr post prandial glucose >7.8mmol/L
54
What will happen to insulin requirements in pregnancy?
They will increase
55
Where does delivery need to take place in a diabetic mother?
In a unit with a neonatal ICCU
56
What prenatal management needs to take place in a pre-existing diabetic?
Insulin dependent women need retinal, renal and BP screen
Glucose control needs to be optimised
Lower BP if necessary with labetalol or methyldopa
57
What is an ideal hba1c for diabetes in pregnancy?
Less than 6.5% (47)
58
When checking BM at home, what should diabetic women aim to keep it below?
6mmol/L
59
What prophylactic measure should be given to diabetic women from 12 weeks?
Aspirin 75mg to prevent pre-eclampsia
60
When does delivery need to happen by for diabetic women? Why?
39 weeks
| Risk of stillbirth and macrosomia
61
What is a common neonatal complication of DM babies?
Neonatal hypoglycaemia due to high insulin production and suddenly lowered blood glucose
62
Fetal complications of maternal DM in pregnancy?
```
Macrosomia
Polyhydramnios
IUGR
Birth trauma and shoulder dystocia
Fetal compromise, death
Preterm labour
Congenital defects - NTD, cardiac
```
63
What congenital defects are more common in DM babies and what does the risk of these depend on?
Cardiac and NTDs
| Risk depends on periconceptual glucose control
64
Maternal complications of DM in pregnancy?
Insulin requirements
Intervention e.g. LSCS
Pre-eclampsia
Acceleration of complications
Ketoacidosis and undetected hypoglycaemia
Infection - UTI, endometritis, wound infection
65
RFs for GDM?
```
Previous GDM, macrosomic baby (>4.5kg) or unexplained stillbirth
FH of DM
BMI >30
Race
Polyhydramnios
Persistent Glycosuria
PCOS
```
66
When should screening for GDM take place if woman has had previous GDM?
18 weeks
67
What is the screening method for GDM?
GTT
68
When does 'regular screening' for GDM take place?
28 weeks
69
What oral hypoglycaemics are safe in pregnancy?
Metformin
70
What normally happens to BP and protein excretion in pregnancy?
BP drops by 30/15 in second trimester
| Proteinuria but not >0.3g in 24 hours
71
What is pregnancy induced hypertension?
BP >140/90 after 20 weeks in a normally normotensive woman
72
What are the two subtypes of pregnancy induced hypertension?
Gestational hypertension - BP but no proteinuria
| Pre-eclampsia - BP with proteinuria
73
What is the basic pathophysiology behind pre-eclampsia?
Incomplete trophoblastic invasion -> reduced flow in spiral arteries
Endothelin release and exaggerated maternal immune response
74
3 underlying factors of pre-eclampsia that lead to symptoms?
Increased vascular permeability
Vasoconstriction
Clotting abnormalities
75
RFs for pre-eclampsia?
```
Previous pre-eclampsia or nulliparity
Pre-existing hypertension
GDM or DM
Obesity, metabolic syndrome
Increasing maternal age
Multiple pregnancy
HIV
```
76
What infection is a risk factor for pre-eclampsia?
HIV
77
When does pre-eclampsia typically present?
3rd trimester - 24-26 weeks
78
What is the first sign of pre-eclampsia?
Hypertension
79
What does increased vascular permeability in pre-eclampsia lead to?
Oedema
| Proteinuria
80
What does the vasoconstriction in pre-eclampsia lead to?
Hypertension
Headaches, visual disturbance -> eclampsia
Liver damage (nausea, vomiting, epigastric pain)
81
What rise in BP suggests pre-eclampsia in someone with pre-existing hypertension?
>30/15
82
Appropriate investigation of proteinuria in pre-eclampsia?
Urine dip at least +
PCR - can do spot test (>0.3) or >30mg/nmol
24 hour protein collection >0.3g/24hr
83
Hypertension criteria in a normotensive person for pre-eclampsia?
>140/90
84
Prophylaxis against pre-eclampsia?
Aspirin 75mg/day from 12 weeks
85
When should delivery be aimed for in mild pre-eclampsia?
37 weeks
86
When should delivery be aimed for in moderate-severe pre-eclampsia? What extra care should be taken?
34-36 weeks
| Give steroids, use regular ctg and fluid monitoring
87
If any pre-eclampsic woman deteriorates or shows signs of complications what should be done?
Deliver!
88
Initial management of mild-moderate pre-eclampsia?
Give anti-hypertensives if BP >150/100
| Labetalol or nifedipine first line
89
What is MgSO4 used for in pre-eclampsia management?
Treatment and prevention of eclampsia
90
What 2 things should be monitored if giving MgSO4 for eclampsia?
Patellar reflexes
| Renal function
91
During delivery in pre-eclampsia what needs to be monitored?
Fluid balance via catheter, Central venous pressure
92
When can BP peak post-natally?
Around 5 days
93
Why don't you give ergometrine in 3rd stage of labour for pre-eclampsic women?
Can cause BP to rise
94
What is a major respiratory cause of death in pre-eclampsia?
Pulmonary oedema
95
What does HELLP stand for?
Haemolysis - dark pee, raised LDH
Elevated Liver enzymes - pain, liver failure
Low Platelets - bleeding
96
How might a stroke arise in pre-eclampsia?
Haemorrhage - esp during pushing in 2nd stage of labour with massive HTN
97
4 Fetal complications of pre-eclampsia?
IUGR
Preterm birth
Placental abruption
Fetal hypoxia and morbidity/mortality
98
Any contraindications to VBAC?
Vertical Caesarean scar
99
What is there a greater risk of in VBAC than normal labour?
Need for emergency section
100
Methods of induction of labour?
Prostaglandins (E2)
Amniotomy and oxytocin
Or both
101
Fetal indications for IoL?
Prolonged pregnancy (>41 weeks)
Prelabour term ROM
IUGR
102
Maternal indications for IoL?
Pre-eclampsia
DM
Social factors
103
Absolute contraindications to IoL?
Fetal distress
Placenta praevia
Where ELSCS is indicated
104
Relative contraindications to IoL?
Previous LSCS
105
Potential complications of IoL?
Need for LSCS or other interventions in labour
Long labour
Hyperstimulation and precipitate labour
PPH
106
What is prelabour term rupture of membranes?
Rupture of the membranes after 37 weeks
107
Common indications for ventouse/forceps delivery?
Prolonged active second stage or Fetal distress during this
| Maternal exhaustion
108
Prerequisites for instrumental delivery?
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
In what type of woman (nulliparous or multiparous) is instrumental delivery more common?
Nulliparous
110
Indications for emergency CS?
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
Common reasons for ELSCS?
Placenta praevia
Severe antenatal fetal compromise
Uncorrectable abnormal lie
Previous CS
112
Relative indications for ESC?
Breech
Severe IUGR
Multiple pregnancy
DM
113
Complications of LSCS?
```
Fetal respiratory morbidity
Haemorrhage
Uterine or wound sepsis
VTE
Anaesthetic related
Need for CS in subsequent pregnancies
```
114
Maternal complications of instrumental delivery?
Trauma
Haemorrhage
Third degree tears
115
What is shoulder dystocia?
Failure of the shoulders to be delivered after normal downward traction
116
Major RF for shoulder dystocia?
Macrosomia
117
What is the major complication of shoulder dystocia and how is it avoided?
Erb's (waiters tip) palsy
| Avoid by not pulling too hard
118
What is cord prolapse?
After membranes have ruptured, cord descends below presenting part potentially becoming compressed/spasming
119
RFs for cord prolapse?
```
Preterm labour
Breech
Polyhydramnios
Abnormal lie
Twin pregnancy
Artificial amniotomy
```
120
What is amniotic fluid embolism?
Liquor enters maternal circulation causing essentially a VTE
121
Sequelae of amniotic fluid embolism?
Pulmonary oedema
ARDS
DIC
122
RFs for amniotic fluid embolism?
ROM
| Polyhydramnios
123
What might lower abdo pain, Fetal heart rate abnormalities and PV bleed/stopped contractions/maternal collapse indicate in the context of a VBAC?
Uterine rupture
124
What is the definition of the puerperium?
The 6 week period postpartum where the body returns to pre-pregnancy state
125
What 2 hormones does lactation depend on?
Prolactin
| Oxytocin
126
The drop in which 2 hormones causes lactation after birth?
Oestrogen
| Progesterone
127
What is colostrum?
Yellow fatty milk, IgA protein and minerals passed for first few days of lactation
128
5 advantages of breastfeeding?
```
Protection of neonatal infection
Bonding
Protection against maternal Cancer
Can't give too much
Cost saving
```
129
What vitamin should be given after birth and why?
K - avoid haemorrhagic disease of newborn
