Brainscape's Knowledge GenomeTM

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


See full index

Specialities > Obstetrics 4 > Flashcards

Obstetrics 4 Flashcards

1
Q

When a placenta previa is picked up at 20 week scan when are they next scanned for the position?

A

32 weeks

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

What are the risk factors for preterm:

A

Too much inside:

  • multiple pregnancy
  • polyhydramnios

Placenta defects (fetus wants out)

  • IUGR
  • Chromosomal abnormalities

Poor integrity of the uterus:

  • short cervix (previous LETZ procedure)
  • lots of previous pregnancies (uterus
    stretched)

Maternal:

  • smoking
  • Low BMI
  • Alcohol
  • Maternal disease (Gestation diabetes)
  • maternal age

Infection

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

What investigations do you want into a woman who you think is about to go into preterm labour?

A 
Bloods: 
- FBC 
- U&Es 
- G&S 
(incase they go into labour)

+/- blood cultures - looking for causes of going into preterm

Orifices:

  • Urine dip
  • High vaginal swap

Preterm labour tests:

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

What are some differentials for contractions?

A

Braxton Hicks
- doesn’t lead to cervical changes

MSK

UTI
- very common

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

How long are tocolytics used during pre-term labour?

A

48 hours

they don’t stop labour they just give time for steroids to work

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

What are two non-pharmacological managements to help prevents PPH?

A

Uterine rub
- massaging the fundus to stimulate contraction

Early suckling
- increases oxytocin release causing contraction

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

What are the core reasons for failure of progression?

A

Insufficient uterine contractions
- maternal fatigue

Palpresentation

Malposition
- anterior occipital

Cephalo-pelvic disproportion

Cervicle dystocia

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

What are the components of the Bishop score?

A

Position of the cervix

Dilation

Effacement

Consistency (how firm does it feel)

Fetal station

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

What are the risks of oxytocin?

A

Uterine Hyperstimulation

  • normal is <4 contractions per 10mins
  • excessive contraction can cause fetal distress

Uterine rupture
- more common in multiparous women

Water intoxication
- oxytocin has ADH like properties

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

What are some complications of artificially ventilating a a preterms lungs?

A

Retinopathy of prematurity

Pneumothorax

Pulmonary interstial emphysema

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

If there is artificial rupture of the membranes and patient starts to bleed and there is fetal distress what is the likely underlying diagnosis?

A

Vasa praevia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some risk factors for placental abruption?

A 
Previous placental abruption 
C-section 
ECV 
Cocaine use 
pre-eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is Antepartum officially diagnosable and what is before it?

A

Antepartum is >24 weeks

<24 weeks is miscarriage type bleeding

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

In a woman with antepartum bleeding what questions, examinations and investigations do you want to do?

A

Questions:

  • Pain
  • Fetal movement?
  • When are they due?
  • Ask about risk factors?
  • Sex before bleeding?

Examination:

  • Abdominal
  • Speculum
  • do not do vaginal examination due to risk of placenta previa

Bloods:

  • FBC
  • U&Es
  • Coagulation
  • LFTs
  • CXM
  • Keilhauer test

Orifices:
- Urine analysis

X-rays:
- USS

Baby:
- CTG

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

List some current risk factors in a pregnancy that would warrant it to be high risk and thus consultant led on the red pathway.

A

Multiple pregnancy

PV bleeding in 1st sememster

> 2 UTIs

Hypertension

Proteinuria

Pre-eclampsia

Placenta abnormalities

Malpresentation at 36/40

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

When should Anti-D be given following a sensitising event and how is it administered?

A

Within 72 hours of the event

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

What screening can be done to assess the risk of a woman going into pre-term labour? and which women are offered this screening?

A

Cervical length screening

Offered:

  • Previous preterm birth
  • 2nd trimester loss
  • Previous LETZ operation
  • Cone biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What tests do you want in in someone you suspect has entered preterm?

A

Bloods:

  • FBC
  • G&S

Orifices:

  • High vaginal swab
  • MSUS

Baby:
- CTG

Special tests:

  • Fetal fibronectin
  • Actim Partus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the complications of epidurals?

A

Hypotension
Prolonged 2nd stage
Risk of instrumental delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In a normal delivery when is syntocinon given? and by which route?

A

IM following delivery of anterior shoulder

Or if there is failure to progress - oxytocin can be given to speed things up

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

When has established labour said to begun?

A

Regular painful contractions with >4cm dilation

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

What is it called when the fetus head enters into the pelvis and when may this occur?

A

Engagement

  • usually occurs some 2-3weeks prior to delivery
  • sits in flexed position
23
Q

Why does the baby enter into the pelvis cavity at a transverse position then move into a anterior-occipital position and what is the final movement of the head to allow allow delivery of the shoulders?

A

Engagement: occipital transverse position
- widest part of head fits through widest part of pelvic inlet

Entering into pelvis floor: Flexion of head

  • compressed against the floor the baby will flex its neck
  • creates smaller size

Passes further down: Occipital - anterior position
- this is seen as crowning

Passing under the arch: extension of head

External rotation of head to a occipital transverse position
- head is delivered

Restitution: shoulders rotate transversely to follow

24
Q

What are some contraindications to fetal blood sampling?

A

Maternal infection

  • HIV
  • herpes

<34 weeks

Haemoglobinopathies

Breech presentation

25
Q

List some indications for induction of labour:

A

Post term

Maternal compromise
- if mother has underlying health conditions it may be safer to carry out induction at 37 weeks

Diabetes

Fetal distress

PROM
- if >37 weeks and spontaneous labour hasn’t occurred then induction is usually done since the risk of infection outweighs preterm complications

Maternal age

26
Q

What are two of the main complications of oxytocin use?

A

Uterine hyperstimulation

Fluid retention and reduced urine output
- has ADH like properties

27
Q

What can be done prior to induction:

A

Membrane sweep

This is a help adjunct which can stimulate labour increasing the chances of labour within 48 hours.
typically used at 40-41 weeks.

28
Q

For a still birth what is the most appropriate management to induce labour?

A

Use of misoprostol and mifepristone

*misoprostol has increased risk of uterine hyperstimulation which is harmful to an alive baby but in this situation it is not warranted

29
Q

What are the values for gestation diabetes and does it resolve following pregnancy? what are some risk factors for it?

A

Fasting glucose: >5.6

OGTT: 7.8

Yes it resolves following pregnancy

Risk factors:

  • previous GDM
  • BMI >30
  • Previous macrosomia baby
  • South Asian
  • PCOS

*any of the above risk factors should initiate the fasting and OGTT

30
Q

What are the complications of GDM for the mother and fetus?

A

Maternal:

  • increased UTIs
  • increased risk of pre-eclampsia
  • increased risk of C-secretion or instrumental delivery
  • increased risk of PPH

Neonate:

  • hypoglycaemia
  • macromania - shoulder dystocia
  • Respiratory distress syndrome of new born due to poor production of surfactant
31
Q

How is gestational diabetes managed during pregnancy?

A

Multi-disciplinary care:

  • endocrine
  • obstetrics
  • dieticians

Aim for bloods between 4-7mmol.

1st line:
- diet exercise

If not met:
- metformin

> 7mmol
- Insulin

Delivery:

  • CTG monitoring
  • at a centre with NICU
  • remove insulin postpartum
  • aimed for 38-39weeks induction
32
Q

Does having gestational diabetes increase the likely hood of the mother developing diabetes in the future?

A

Yes.

*6 weeks postpartum women should be offered a fasting blood glucose test.

50% likely to in the next 10 years.

33
Q

Where does the rupture occur in placenta abruption? and list some risk factors:

A

Occurs in the decidua basalis

Risk factors:

  • previous placental abruption
  • C-section
  • Smoking
  • Pre-eclampsia
  • external cephalic rotation
34
Q

Is smoking a risk factor for pre-eclampsia?

A

no.

35
Q

In pre-eclampsia what is looked for on US and how often should they be done?

A

Every 2 weeks:

looking for:

  • Monitoring growth
  • liquor volume (this demonstrates fetal urine output which is proportional to placenta function)
  • Umbilical artery flow
36
Q

When are ant-hypertensives started in pre-eclampsia?

A

150/100mmHg
or
>30mmHg from baseline

37
Q

What can be given prophylactically at intra-partum for pre-eclamptic women and when should they followed up and what’s the prognosis?

A

Magnesium sulphate can be given prophylactically at birth for severe cases

Follow up 6 weeks in primary care

  • assess BP
  • urinalysis

Prognosis:

  • 25% likely to have pre-eclampsia in another pregnancy
  • increased likely hood of cardiovascular disease in the future
38
Q

What are some differentials for preterm labour?

A

Essentially differentiating if someone is in labour:

  • Braxton Hicks contractions
  • MSK pain
  • UTI

Placental differentials:

  • placenta abruption
  • uterine rupture
39
Q

Whats your management of preterm labour?

A

Identify causes:
- UTI, infection etc

Confirm:
- fibronectin

if <4cm:

  • corticosteroids
  • tocolytics (for 48 hours)
  • inform neonatal team

> 4cm:

  • corticosteroids
  • inform neonatal team
  • <30 weeks magnesium sulphate
  • IV antibiotics if group B strep
40
Q

What are some risk factors for preterm labour?

A 
previous pre-term 
smoking 
pre-eclampsia 
cervical incompetence
infection 
multiple pregnancy

**these are also the risk factors for PPROM

41
Q

What are the investigations that should be done into suspected chorioamnionitis and what is the gold standard investigation? and what are some risk factors?

A

Bloods:

  • FBC
  • CRP
  • U&Es
  • ABG

Orifices:

  • high vaginal swab
  • urine culture

Chest x-ray

CTG monitoring

gold standard:

  • amniotic fluid cultures
  • this is rarely done though as it usually adds little to the evidence of chorioamnionitis

Risk factors:

  • group B step colonisation
  • Pro-longed rupture of membranes
  • preterm
  • Young mother
  • UTI infection
42
Q

What measurements are used to assess the estimated fetal weight and list the general management of IUGR along with some risk factors:

A

Measurements:

  • head circumference
  • abdominal circumference
  • femur length

General management for suspected IUGR

  • umbilical artery doppler studies
  • Growth scans (to guide delivery management)
  • maternal assessment (BP, infection etc)

Delivery:

  • <36 weeks: steroids
  • <30 weeks: Magnesium sulphate

C-section at 37 weeks
C-section at 34 weeks if reverse diastolic flow

*C-section due to risk of fetus during delivery.

Risk factors:

  • Maternal age >40
  • maternal illness (diabetes)
  • Drugs and smoking
  • pre-eclampsia
  • maternal nutrition
43
Q

What is the management for Haemolytic disease of the fetus/ newborns and list some sensitising events and what is the major complication in-utero?

A

Sensitising events:

  • Abortion
  • Ectopic
  • External cephalic rotation
  • Amniocentesis
  • Antepartum bleeding
  • Trauma

Management:
- Delivery at 36 weeks.

Severe:

  • intrauterine blood transfusion
  • Delivery of fetus then blood transfuse

Newborns:
- Jaundice management - usually needs transfusion

Major complication in-utero:
- fetalis hydrops

44
Q

When is Anti-D given?

A

28 weeks

Following sensitising events

At birth
- following sampling of the umbilical cord to see status of child

45
Q

How is delivery of a still birth conducted and what important drugs should be considered for another side effect which may be distressing to the mother:

A

Mifepristone
+
Misoprostol

Dopamine agonists
- to supress lactation

46
Q

What is the ‘best’ treatment for pre-eclampsia?

A

Delivery of baby and placenta

47
Q

What advice can be given to parents following a miscarriage?

A

Next menstrual cycle will be different and heavier
- endometrium returning to normal

Avoid trying to conceive for another month

80% chance of successful future pregnancy

48
Q

What is Asherman’s syndrome?

A

Adhesions within the uterus due to surgical procedures

49
Q

Why might seizures become more frequent in pregnancy in patients who suffer from epilepsy?

A

Change in medication

Increased dilution of anti-epileptic medication due to increased blood volume

Increase in steroid binding hormone can lower anti-epileptic medication

Increased amounts of vomiting

50
Q

What is general management of epilepsy in pregnancy?

A

Consultant led with obstetricians and neurologists.

Folic acid 5mg in first trimester

Mono-therapy - carbamazepine is ideal

Life style advice

  • no swimming
  • adequate sleep

Labour:

  • careful hydration
  • avoidance of pethidine (lowers seizure threshold)
  • birth in special unit
  • continual CTG monitoring

Post-partum:

  • anti - epileptics are safe in breast feeding
  • if on COCP dose adjustment may be needed due to CYP450 enzyme activity
51
Q

What is the follow up of Gestational diabetes?

A

6 weeks follow up - assess blood glucose levels

50% chance of developing DM within 10 years

52
Q

What are some neonatal complications of diabetes in pregnancy?

A

Hypoglycaemia

Birthing injuries

Respiratory distress
- high glucose shuts off surfactant production

Jaundice

Still birth

53
Q

What are the risks associated with hypothyroidism in pregnancy?

A

Miscarriage/ still birth

PPH

Reduced IQ of child

IUGR

Deafness

54
Q

If a mother has hypothyroidism what should be done to the levels of medications following confirmation of pregnancy?

A

Increase dose by 25%

*returns to normal after pregnancy

Specialities (63 decks)

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