Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Specialities > Obstetrics 2 > Flashcards

Obstetrics 2 Flashcards

1
Q

What blood tests do you want in pre-eclampsia?

A

FBC

  • low Hb
  • Low platelets
  • Haemolysis on film

U&Es
- increase urea and creatinine

LFTs
- raised AST, ALT

Coagulation studies
- prolonged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What would be the definitive treatment in pre-eclampsia to control blood pressure?

A

Delivery of fetus and placenta

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is are the complications of hyperthyroidism in pregnancy?

A

• Increased miscarriage
• Intrauterine growth restriction
• Increased preterm delivery
Increased perinatal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What aspects in the history would you want to establish for pre-eclampsia?

A

Headaches

Visual changes

Swelling of the body

Abdominal pain
- especially RUQ

Bruising
- bruising due to platelet consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the complications of pre-term prelabour rupture of the membranes:

A

Pre-term delivery

Chorioamnionitis

Cord prolapse

Oligohydramnios

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Outline the definitions of PROM:

A

• Pre-labour rupture of membranes / PROM

- >37 weeks 
- rupture of membranes prior to onset of labour

P-PROM
- <37 weeks
- rupture of membrane prior to onset of labour
Accounts for 40% of preterm babies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What investigations should be done into suspected PROM:

A

Sterile speculum examination

  • fluid build up in the posterior fornix of vagina
  • patient should of been lying down for 30mins
  • look for fluid
  • do high vaginal swab whilst there
  • check cervical dilation

Nitrazine paper test
- paper turns blue

Ultrasound testing
- oligohydramnios

High vaginal swab

  • for infections that may have caused it
  • Group B strep

Ferning test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of P-PROM?

A

<34 weeks:

  • Monitor for chorioamnionitis
  • prophylactic erythromycin for 10 days
  • steroids
  • if no labour after 48 hours discharge. Advise no tampons, no swimming, no sex.
  • IV antibiotics at time of delivery

34- 36 weeks

  • induction of labour
  • IV antibiotics to cover for delivery
  • steroids

> 36 weeks

  • induction of labour
  • IV antibiotics to cover for delivery

**IV antibiotics are Benzylpenicillin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some complications of P-PROM?

A

Chorioamnionitis

Oligohydramnios

Cord prolapse

Placental abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How can fetal wellbeing be assessed?

A

Measurement of fetal:

  • head circumference
  • Abdominal circumference
  • Femur length

Liquor volume measurement

Doppler ultrasound of umbilical artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

During labour - what fetal signs would suggest distress on the CTG?

A

Abnormal Baseline HR (<100 or >180)

Reduced variability in the HR (<5 and >25) and no more than >50mins of no variability

Decelerations

  • late deceleration
  • placental insufficiency
  • asphyxia
  • variable deaccelerations
  • early is fine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the short and long term consequences of intrauterine growth restriction?

A

Short:

  • ARDS
  • Hypothermia
  • hypoglycaemia
  • Low birth weight

Long:

  • coronary artery disease
  • T2DM
  • Cerebral palsy
  • Reduced intellect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Other than HR and Heart sounds, how else can a fetal wellbeing be monitored?

A

Liquor volume

umbilical artery doppler

MCA doppler

Estimated fetal weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In a woman of child baring age who presents with amenorrhoea and bleeding, what important aspects of the history do you want to establish?

A

If she has had a positive pregnancy test

Abdominal pain (ectopic pregnancy?)

  • type
  • onset

Change in bowel habit (appendicitis/ G.I related?)

Previous history of pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are your most important investigations when considering an ectopic pregnancy?

A

Urinary pregnancy test

FBC
Group and Save
hCG levels

TVS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the general management for a miscarriage?

A

Conservative management

Medical management: 
Misoprostol 
- prostaglandin agonist 
\+
Analgesia

Surgical management:
- Vacuum curette

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the risks associated with a premature baby?

A

Respiratory distress syndrome

Hypothermia

Hypoglycaemia

Sepsis

Jaundice

Unable to suckle - may require NG

Intraventricular bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are some of the risk factors for IUGR?

A 
Pre-eclampsia 
Smoking 
Alcohol 
Chromosomal abnormalities 
Poor maternal health 
Maternal infections - CMV, Rubella, Toxoplasmosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some differentials for fluid leakage in a pregnant female?

A 
Rupture of membranes (PROM/ PPROM) 
Vaginal secretions 
Cervical discharge 
Semen 
Perineal sweat
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What score is used for post-natal depression?

A

Edinburgh score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are some of the symptoms of post-natal depression?

A

Clouded thinking/ difficulty making decisions

Lack of concentration

Poor memory

Avoidance

Not feeling like a proper mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some of the signs of post-partum psychosis?

A 
Fear/ even terror 
Restlessness 
Insomnia
Purposeless activity  
Fear for baby
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the management of cord prolapse?

A

Recognise Condition:

  • deaccelerations
  • cord felt

**call for senior help

  • Wrap cord in warm gauze and do not push back in or handle.
  • place mother on all 4’s or modified sim’s position
    and/ or
  • use to fingers to push babies head of cord
  • deliver baby as fast as possible.
  • if cervix is fully dilated proceed with use of tocolytic agents
  • if cervix is closed C-section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the management of localised (stage I and II) endometrial cancer?

A

Open abdominal radical hysterectomy + Bilateral salpingo - oophorectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Out line the investigations wanted into amenorrhea:

A

Pregnancy test

Gonadotrophin levels - FSH/ LH

Prolactin

Androgen levels

Oestrogen

Thyroid levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How often should an HIV patient have their cervical screening done?

A

Every year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the quantitative definition of heavy menstrual bleeding?

A

> 80mls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which bacterial infection is most likely to produce malodorous smell with yellow/ green discharge? What other clinical finding may be seen with it?

A

Trichomonas vaginalis

Strawberry cervix

29
Q

What are some differentials for PID?

A

Appendicitis

UTI

Ectopic pregnancy

30
Q

List some differentials for gynaecological causes of pelvic pain:

A

Mittelschmerz syndrome

PID

Ectopic pregnancy

Endometriosis

Ovarian Abscess

Ovarian torsion

31
Q

What are some complications of ovarian cysts?

A

Torsion

Haemorrhage

Rupture

32
Q

What can be measured which is suggestive of early premature labour onset, and if positive what measures should be taken?

A

Fetal fibronectin - fFN
- released from fetal sac. Suggests early labour will come on

start:
- IM steroids
- Inform neonatal care

33
Q

A woman who has epilepsy and gets pregnant - what should the management be?

A

5mg of folic acid starting immediately (even before confirmation of pregnancy)

Detailed US at 18-22 weeks

Aim for monotherapy of medication - if possible remove sodium valproate

Vitamin K analogue
+
IM Vitamin K to new born

34
Q

How should IV magnesium be continued for following an eclampsia seizure?

A

24 hours

35
Q

What is the antibiotic of choice for group B strep?

A

Benzylpenicillin

36
Q

What are some key tests done during antenatal visits and on what weeks:

A

8-12 weeks - booking visit

  • FBC
  • Rhesus status
  • Hep B, syphilis, rubella screen
  • HIV
  • Urine culture

10-14 weeks - multi pregnancy scan

11-14 week - nuchal scanning - down’s syndrome

18-20 week - anomaly scan

28 week - FBC, Anti D given

37
Q

What are the indications to admit a patient with hyperemesis gravidum into hospital?

A
  • unable to keep fluids down despite antiemetics
  • ketonuria present
  • Weight loss >5%
  • Co - morbidities
  • unable to keep antibiotics down
38
Q

What is the criteria of hyperemesis gravidum?

A 
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
\+/- 
Ketones
39
Q

What are some complications of hyperemesis gravidum?

A 
Wernicke's encephalopathy 
Mallory Weiss tear 
central pontine myelinolysis 
AKI 
VTE*
40
Q

If a mother has a history of DVT what should be started on and for how long?

A

LMWH

Start immediately - 6 weeks postpartum

41
Q

What is the non-invasive test that can be done to test for chromosomal abnormalities?

A

Non - invasive prenatal screening test - NIPT

42
Q

What signs may be seen on the anomaly scan for neural tube defects?

A

Frog like appearance - anencephaly

Banana shaped cerebellum

Spinal cord abnormalities
- spina bifida

43
Q

Where anatomically are epidurals delivered? and what are spinals and epidurals used for?

A

Epidural:
- delivered into the potential space filled with fat and blood vessels between the ligamentum flavum and dura (first level of meninges)

Spinals into the intrathecal space (into CSF) causing complete nerve dysfunction - C-section.

Epidurals - epidural space causing predominantly nociceptive reduction - Labour

44
Q

What are the risks with epidurals?

A

Prolonged second stage

Hypotension - patient should be laid flat and in the left lateral position

45
Q

What are the two options for management during 3rd stage of labour and what are they?

A

Active

  • use of uterotonics - syntrometrine
  • cord traction
  • delayed cord clamping

Physiological:

  • no use of uterotonics
  • cord only clamped when pulsations have stopped
  • maternal effort of placenta

Inspection of the placenta to make sure it is complete.

46
Q

Outline how the progression of labour is monitored:

A

Maternal:

  • HR
  • BP
  • contractions
  • Urinalysis
  • 4hrly vagina examination (dilation, effacement)

Fetus:

  • 15 mins HR
  • position
  • engagement degree (>2/5ths)
  • Caput oedema (+,++,+++)
  • moulding of the head
47
Q

What is precipitate labour?

A

> 5 uterine contractions per 10mins

usually results in rapid labour of less than 2-3 hours.

*often implicated with oxytocin and prostaglandin use

48
Q

What will a diabetic mother need to be put on if there is premature labour?

A

Variable rate insulin infusion (VRII).

- because steroids will be administered to promote fetal lung maturity which will effect the mothers glycaemic control.

49
Q

What are some of the fetal complications of diabetes in pregnancy?

A

1st trimester congenital abnormalities

Macrosomia

Polyhdrymonias

Polycaethemia

50
Q

How is a diagnosis of small for gestational age made?

and what are some main causes?

A

Ultrasound using circumference of the abdomen
- if <10% then diagnostic

  • constitutionally small
  • intrauterine growth restriction
  • genetic abnormalities
  • multiple pregnancy
51
Q

How can IUGR vs conditionally small be differentiated?

A

Risk factors towards IGUR

Change in growth charts (IUGR may drop off whereas SGA usually remains on a constant low decile)

Umbilical artery doppler

52
Q

What is the biggest risk factor for cord prolapse?

A

Artificial rupture of membranes

53
Q

What is the first line drug used for PPH, following Bimanual uterine compression and how is it delivered?

A

Syntocinon - IV (synthetic oxytocin) 10 units
or
Ergometrine - IV

2nd line:
Carboprost - IM

54
Q

If a synthetic prostaglandin has to be used in PPH, how is it supplied and what is it called?

A

Carboprost

- IM

55
Q

If a pregnant woman has previously been seen to be group B strep positive, what action should be taken?

A

IV antibiotics at birth
or
Late pregnancy testing

If a mother has previously had a child that suffered from Group B sepsis they should be offered prophylactic antibiotics

Testing and antibiotics should be given 3-5 weeks prior to their due date.

56
Q

What is the most appropriate next line investigation if there is late accelerations or variable accelerations noted on the CTG?

A

Fetal blood sample

- looking for acidosis - if present then Emergancy section should be done

57
Q

What are the layers cut through during a C-section:

A

Skin
Subcut tissue

Camper’s fascia
Scarpers fascia

Anterior Rectus sheath
Rectus muscle
**this is usually cut at the linae alba and pushed to the side
Transverse fascia

Parietal peritoneum
Visceral peritoneum

Uterus muscle

58
Q

What is a Omphalocele?

A

Fetal abdominal wall defect

59
Q

What are the symptoms and management of chorioamnionitis?

A

Potentially fatal to both mother and fetus as infection enters a usually sterile environment.

  • signs of infection
  • malodours amniotic fluid secretions

Emergancy C - section
IV antibiotics

60
Q

What are the clinical features of a misciarage? and highlight investigations:

A

Vaginal bleeding
Passing of products of conception
Cramping abdominal pain
Haemodynamic instability

Investigations: 
Bloods: 
- FBC 
- Group and save/ cross match 
- Beta - hCG

Imaging:
- TVS

61
Q

What are some common minor aliments of pregnancy?

A

Nausea + vomiting

GORD

Constipation

Carpal tunnel syndrome

Oedema

Leg cramps

62
Q

List the factors that influence fetal growth, highlighting some that may lead to small for gestational age:

A

Fetal:

  • genetic
  • chromosomal abnormalities
  • fetal anomalies (can be caused by infections)

Maternal:

  • pre-pregnant disease
  • drugs/ smoking
  • pregnancy disease (pre-eclampsia)

Placental:

  • trophoblast invasion (pre-eclampsia if inaffective)
  • vascular flow
63
Q

How much can insulin doses need to increase by in pregnant women with diabetes?
and outline management of diabetes in pregnancy:

A

50 -100% as pregnancy continues.
- due to increased insulin resistance.

Antenatal care:

  • Fetal anomaly scan - 20 weeks
  • Education
  • Monitoring of glucose + increased in insulin
  • 32- 34 weeks fetal monitoring
Medication: 
- Diet and exercise 
2nd line: 
- Metaformin 
\+/- 
- Insulin

Delivery:

  • 37-39 week delivery
  • variable rate insulin infusion during delivery

Managed by:

  • diabetic team
  • anenatal team
64
Q

Define gravity and parity:

A

Gravity - number of times the mother has been pregnancy regardless of outcome

Parity - (X+Y)
X - Any live or still birth >24 weeks
Y - Any pregnancy <24 weeks

65
Q

List some indications for CTG antenatal monitoring:

A

Reduced fetal movement

Maternal disease

  • hypothyroidism
  • CRD
  • DM - insulin dependent

Polyhydramnious/ oligo

66
Q

what investigations should be conducted into reduced fetal movement and the varying weeks?

A

<26 weeks

  • History
  • Examination
  • Auscultating HR

> 26 weeks

  • History
  • Examination
  • CTG
  • USS
  • if near term plan for delivery
67
Q

Highlight the potential complications of a prolonged pregnancy:

A

Prolonged pregnancy >42 weeks

  • Placenta insufficiency
  • Meconium aspiration
  • Cord complication
  • Neonatal hypoglycaemia
  • C-section
  • Pelvic floor trauma
  • Instrumental delivery
68
Q

What are the types of invasive implantation?

A

Accreta: penetration into myometrium but not full thickness

Increta: penetrate through the entire myometrium

Percreta: penetrate through the entire uterus and into surrounding organs

Specialities (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions