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Revision Qs > Obstetrics 3 > Flashcards

Obstetrics 3 Flashcards

1
Q

What is a PPH?

A

Primary postpartum haemorrhage, blood loss >500ml within 24 hours of delivery

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2
Q

What is the criteria for PPH in CS?

A

1L of blood loss

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3
Q

Common causes of PPH?

A

Retained placental fragments
Atonic uterus
Perineal trauma

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4
Q

Less common causes of PPH?

A

Uterine rupture

Cervical or high vaginal tear

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5
Q

In whom is atony more common?

A

Prolonged labour (fatigue)
Grand multiparity (lax uterus)
Overdistention of uterus (Polyhydramnios and multiple pregnancy)
Fibroids

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6
Q

Administration of what in the 3rd stage of labour reduces the risk of PPH?

A

Oxytocin (rather than ergometrine in hypertensive women)

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7
Q

What is a secondary PPH?

A

Excessive blood loss occurring between 24 hours of delivery and 6 weeks postpartum

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8
Q

What is the most common cause of secondary PPH?

A

Endometritis +/- retained placental tissue

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9
Q

If the uterus is enlarged and tender with open cervical os and there is postpartum bleeding, what does this suggest?

A

Endometritis

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10
Q

3 most important bacterial causes of puerperal sepsis?

A

Group A strep (pyogenes)
Staph
E. coli

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11
Q

Common sites and causes of postpartum pyrexia?

A

Genital tract sepsis - Endometritis, wound infection
Chest infection
Mastitis
UTI

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12
Q

What is lochia?

A

Uterine discharge which may be bloodstained for up to 4 weeks

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13
Q

Signs of genital tract sepsis?

A

Offensive lochia

Enlarged and tender uterus

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14
Q

What important causes of mortality throughout pregnancy are even more common in the puerperium?

A

VTE

Pre-eclampsia/Eclampsia

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15
Q

Endocrine cause of postnatal depression?

A

Postpartum thyroiditis

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16
Q

Urinary trouble postpartum?

A

Urinary retention common
UTI
Stress incontinence

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17
Q

Excruciating perineal pain presenting a few hours after delivery?

A

Paravaginal haematoma

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18
Q

Advice regarding postnatal contraception?

A

Lactation is important but not adequate on its own
Usually start 4-6 weeks after delivery; COCP not okay if breastfeeding but POP fine
IUD is also fine at 6 weeks

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19
Q

How is labour diagnosed?

A

Cervical dilatation and effacement

Uterine contraction

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20
Q

What constitutes the first stage of labour?

A

Onset of contractions -> full (10cm) cervical dilatation

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21
Q

What constitutes the second stage of labour?

A

Full cervical dilatation to delivery of fetus

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22
Q

What constitutes the third stage of labour?

A

From delivery of fetus to delivery of placenta

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23
Q

3 constituent parts of the labour process (things that can go wrong)?

A

Powers
Passage
Passenger

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24
Q

Rate and timing of contractions in established labour?

A

For 45-60s every 2-3 mins

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25
Q

In whom is poor uterine contractility a common cause of failure to progress in labour?

A

Nulliparous

IoL

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26
Q

What does station mean when describing fetal head position?

A

Position of occiput related to ischial spines

E.g. Station -2 is 2cm above ischial spines

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27
Q

What 3 factors does cervical dilatation depend on?

A

Fetal head pressure
Uterine contraction
Ability of cervix to soften and efface

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28
Q

What is the anterior fontanelle of the baby called?

A

Bregma

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29
Q

What is the attitude of the Fetal head?

A

The degree of flexion/extension

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30
Q

Disorders of attitude (presentation) in labour?

A 
Ideally vertex (full flexion)
Varying degrees of extension can cause brow or face presentation
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31
Q

What is localised swelling of the Fetal head due to pressure on fontanelles called?

A

Caput seccadeum

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32
Q

What is the term for rotation of fetus once head delivers to deliver the shoulders?

A

Restitution

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33
Q

What are Braxton Hix contractions?

A

Irregular involuntary uterine contractions typically occurring in 3rd trimester in absence of cervical dilatation and effacement

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34
Q

How long does the first stage of labour take in nulliparous vs multiparous women?

A

6 for multi, 10 (up to 12) for Nulli

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35
Q

What 2 subphases constitute the first stage of labour?

A

Latent phase - slow cervical dilatation to 3cm over several hours
Active phase - 3-10cm at rate of 1-2cm/hour depending on parity

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36
Q

Progression of second stage of labour?

A

Full dilatation -> passive stage -> desire to push -> active stage -> delivery

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37
Q

Over how long is abnormal for the second stage of labour?

A

Over 1 hour

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38
Q

What graphing system is used for monitoring in labour?

A

Partogram

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39
Q

What part of labour does augmentation aim to help?

A

The powers - inefficient uterine contraction

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40
Q

2 things which constitute augmentation?

A

Amniotomy if needed and oxytocin

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41
Q

Most common positional abnormality of fetus causing trouble in labour?

A

OP position (back to back)

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42
Q

3 things which may indicate OP position in labour?

A

Backache
Long labour
Early desire to push

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43
Q

Management of OT position in labour?

A

Rotation with ventouse

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44
Q

Is brow presentation deliverable vaginally?

A

Nope - CS

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45
Q

Commonest cause of fetal damage in labour?

A

Hypoxia

46
Q

What disease does meconium aspiration cause in the fetus?

A

Chemical pneumonitis

47
Q

What Fetal investigation in labour can be carried out to indicate hypoxia and suggest need for delivery?

A

Fetal scalp blood monitoring -

48
Q

DRCBRVADO of CTGs?

A 
Define Risk
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
Overall interpretation (reassuring?)
49
Q

In practise what 2 investigations are most commonly used to measure Fetal distress?

A

Ctg and Fetal blood scalp monitoring

50
Q

2 things that can help Fetal hypoxia?

A

Woman in left lateral position

Stop oxytocin

51
Q

Non-medical pain management in labour?

A

TENS, water submerging, massage

52
Q

Systemic opioid used in maternal labour pain management?

A

Pethidine

53
Q

What can Pethidine cause in the newborn? How to fix?

A

Transient respiratory depression - give naloxone

54
Q

Where does an epidural go?

A

Between L3 and L4

55
Q

3 complications of epidural anaesthesia?

A

Spinal tap (headache)
Complete spinal block (resp arrest)
Hypotension, convulsion, cardiac arrest

56
Q

What anaesthesia is suitable for instrumental delivery?

A

Pudendal nerve block

57
Q

What anaesthesia is used for CS/instrumental delivery if epidural not in situ?

A

Spinal anaesthesia

58
Q

What does active management of 3rd stage of labour aim to reduce?

A

PPH

59
Q

What constitutes active management of third stage of labour?

A

Retained placenta - >30mins third stage

Give oxytocin

60
Q

What type of perineal tear does episiotomy cause?

A

2nd degree but may extend to 3rd/4th

61
Q

What is a first degree perineal tear?

A

Skin only

62
Q

What is a second degree perineal tear?

A

Skin and perineal muscles but not anal sphincter

63
Q

3rd degree perineal tear?

A

Involves anal sphincter but not mucosa

64
Q

4th degree perineal tear?

A

Involves anal mucosa and sphincter

65
Q

Which types of perineal tear require surgical management?

A

3 and 4

66
Q

3 RFs for 3rd and 4th degree perineal tears?

A

Nulliparity
Macrosomia
Instrumentation

67
Q

Normal dose of folic acid? High dose? Til when?

A

400micrograms
5mg if high risk e.g. DM, epilepsy
Til 12 weeks gestation

68
Q

2 types of bloods to be taken at booking?

A

Infection screen

FBC and rbc related

69
Q

Infection screen bloods taken at booking?

A

Rubella
STDs - Syphillis, asymptomatic bacturia
BBVs - hep b, hep c and HIV

70
Q

FBC and rbc related screening at booking visit?

A

Anaemia
ABO and rhesus
SCD/thalassaemia if indicated by family questionnaire

71
Q

When is routine rhesus prophylaxis given for rhesus negative women?

A

28 and 34 weeks

72
Q

Presentation after what gestation defines gestational hypertension?

A

20 weeks

73
Q

When should BP have normalised in gestational hypertension following delivery?

A

Within 3 months

74
Q

Criteria for GDM diagnosis via OGTT at 26ish weeks?

A

Fasting >5.6

2 hour post prandial >7.8

75
Q

What needs to be done between 28-36 weeks for gestational diabetics?

A

4 weekly growth and AFI scans

76
Q

Pathophysiology behind obstetric cholestasis?

A

Oestrogen impairs bile acid sulfation

77
Q

Is obstetric cholestasis responsive to antihistamine?

A

Nope

78
Q

2 big RFs for obstetric cholestasis?

A

Previous obs chole (nearly always recurs)

Family history

79
Q

When does obstetric cholestasis present in terms of gestation?

A

Over 30 weeks

80
Q

What vitamin can become deficient in obstetric cholestasis?

A

K - give to prevent haem disease of newborn

81
Q

What vitamins can become deficient in hyperemesis?

A

B - can develop Wernicke-korskaoff

82
Q

When should delivery happen in obstetric cholestasis? With what assistance?

A

35-37 weeks, under steroid cover

As risk of stillbirth, preterm labour, clotting dysfunction, and also bile acids impair surfactant production

83
Q

What is increasingly likely postpartum due to obs chole?

A

PPH due to clotting dysfunction

84
Q

What must be checked postpartum if mum has had obs chole?

A

LFTs at 3 weeks

85
Q

What factors are upregulated in pregnancy to predispose to VTE?

A

8,9,10 and fibrinogen

86
Q

Besides the usual RFs, 4 other RFs for VTE in pregnancy?

A

Multiple pregnancy
CS
High parity
Pre-eclampsia

87
Q

Management of pregnant woman at high risk of VTE?

A

LMWH til 12 hours before labour
Stop during labour
Recommence 6-12 hours after delivery
Carry on until 6 weeks

88
Q

Management of TTTS?

A

Laser ablation of communicating placental vessels

89
Q

What 3 defects does tight glycaemic control before conception help prevent in diabetic women?

A

Cardiac, skeletal and NTD

90
Q

What should Hba1c be less than before getting pregnant in pre-existing diabetic? Absolute contraindication?

A

Should ideally be less than 47mmol/mol (6.5%)

Absolute contraindication is 86mmol/mol (>10%)

91
Q

3 times BM should be measured during the day in gestational/diabetic women? Desired targets?

A

Fasting pre-meal less than 5.3
Post prandial less than 7.8
Bedtime BM

92
Q

When should diabetic women deliver by? Why?

A

38 weeks

Risk of stillbirth primarily, also macrosomia, NRDS, neonatal hypoglycaemia

93
Q

What drugs are used during labour for diabetic woman?

A

Sliding scale GKI infusion (glucose potassium insulin)

94
Q

What should be done pre-conception for epileptic women?

A

Good seizure control - preferably 2 years without seizure
Try to taper down meds, be on maximum one (not valproate)
Need high dose folic acid til 12 weeks

95
Q

What scan should be offered for epileptic women who are pregnant in first trimester?

A

Early anomaly scan between booking/dating and anomaly

96
Q

What needs to be given postnatally for baby of epileptic woman?

A

Vit K - risk of haem disease of newborn

97
Q

What symptoms may be present in the couple of weeks preceding labour?

A

Constipation and urinary frequency, due to baby head in pelvis

98
Q

What constitutes Fetal monitoring in ‘normal’ first stage of labour?

A

Auscultation every 15 mins

99
Q

Fetal monitoring in ‘normal’ active second stage of labour?

A

Auscultation every 5 mins

100
Q

3 criteria for defining preterm labour?

A

Less than 37 weeks gestation
Contractions every 5-10 mins, lasting over 30 seconds, for over 60 min
Dilation of cervix to 2.5cm, 75% effacement

101
Q

Abx cover if PPROM?

A

Erythromycin 10 day course

102
Q

5 indications for forceps delivery?

A 
Maternal exhaustion
Mum has pre-existing obstetric condition
Prolonged 2nd stage (DTA of head, OP arrest, poor uterine contractions)
Fetal distress
Aiding breech delivery
103
Q

What should be done in 3rd stage of labour for women with severe pre-eclampsia?

A

Deliver 37 weeks with steroid and MgSO4 cover

Active 3rd stage management (oxytocin)

104
Q

What is Turtle sign and what does it indicate?

A

Head pops out of vagina and then back in, indicating shoulder dystocia

105
Q

What forms the pelvic inlet (brim)?

A

Sacral prominence and ala
Arcuate line of ileum and pectineal line of pubis
Upper margin of symphysis pubis (pubic crest)

106
Q

What forms the pelvic outlet?

A

Tip of coccyx
Sacrotuberous ligament
Ischial tuberosities
Inferior margin of pubic arch

107
Q

Features of female pelvic making it more suitable for childbirth?

A 
Wider and shallower
Round/oval brim (as opposed to heart shaped male one)
Large pelvic outlet
Pelvic arch is over 100 degrees
Wider sciatic notch
Curved sacrum
108
Q

5 things included on Partogram?

A

Maternal and Fetal obs - half hourly, look for trends
Contractions - each hour frequency, strength, regularity
Cervical dilatation - PV every 4 hours
Head descent - PV every 4 hours, look at station and engagement
Liquor - each hour. Intact? Otherwise colour - bloody, meconium

109
Q

5 things included in bishops score?

A 
Cervical dilatation
Cervical consistency
Cervical length
Cervical position
Station of presenting part
110
Q

What score indicates unsuitability for spontaneous labour?

A

5 or under

111
Q

What 5 things are included in an APGAR?

A 
Appearance
Pulse
Grimace
Activity (muscle tone)
Respiration
112
Q

When is APGAR done after birth? What score indicates need for escalation?

A

1 and 5 mins

Less than 7 indicates need for paeds support, O2

Revision Qs (28 decks)

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