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Women's > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

List the 3 main aetiological categories of antepartum haemorrhage

A

Placenta praevia
Placental abruption
Unclassified

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2
Q

What is antepartum haemorrhage?

A

Bleeding from the genital tract after 20 weeks gestation up until the onset of labour

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3
Q

What percentage of pregnancies does antepartum haemorrhage affect?

A

2-5%

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4
Q

Besides placenta praevia and placental abruption, what are some unclassified causes of APH?

A 
Marginal placental bleeding
Show
Trauma
Infection
Cervical polyp
Cervical carcinoma
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5
Q

What is placenta praevia?

A

Placenta inserted into the lower uterine segment

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6
Q

How is placenta praevia classified?

A

Major: placenta covers the internal cervical os

Minor: placenta does not cover the os

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7
Q

What are the risk factors for placenta praevia?

A 
Increasing maternal age
Multiparity
Smoking
Previous placenta praevia
Previous CS
Prior termination of pregnancy
Multiple pregnancy
Assisted reproductive technique
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8
Q

How does placenta praevia present?

A

Unprovoked, painless vaginal bleeding, often between 32 and 34 weeks gestation

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9
Q

How is placenta praevia diagnosed?

A

TA or TV localisation of placenta

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10
Q

What is placenta accreta?

A

A placenta that invades the myometrium

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11
Q

What is placental abruption?

A

Separation of the placenta from the uterus in the antenatal or intrapartum period

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12
Q

What are the risk factors for placental abruption?

A 
Maternal hypertension
Blunt abdominal trauma
Previous placental abruption
Increased maternal age
Multiparity
Smoking
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13
Q

How does placental abruption usually present?

A

Sudden onset of abdominal pain, with or without back pain, and vaginal bleeding

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14
Q

What examination findings are expected in placental abruption?

A 
Maternal tachycardia
Uterine tenderness
Board-like abdomen
Difficult to palpate fetal parts 
Non-reassuring CTG
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15
Q

What are the maternal complications of placental abruption?

A 
Hypovolaemic shock
Acute renal failure
DIC
PPH
Death
Feto-maternal haemorrhage
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16
Q

What is vasa praevia?

A

Fetal vessels lying in the membranes in front of the presenting part

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17
Q

What is shoulder dystocia?

A

Difficulty delivering the fetal shoulders following delivery of the fetal head

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18
Q

How common is shoulder dystocia?

A

Subjective diagnosis - incidence varies from 0.2-3%

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19
Q

What are the antepartum risk factors for shoulder dystocia?

A 
Prior shoulder dystocia
Fetal macrosomia 
Maternal diabetes
Post-term pregnancy
Male fetal gender
Maternal obesity
20
Q

What are the intrapartum risk factors for shoulder dystocia?

A

Prolonged labour
Induction of labour
Augmented labour
Instrumental labour

21
Q

Name three movements to avoid when managing shoulder dystocia

A

Rotation of the fetal head
Excessive traction
Fundal pressure

22
Q

What are the HELPERR principles for management of shoulder dystocia?

A 
H - call for help
E - evaluate for episiotomy
L - legs in McRoberts position
P - pressure suprapubic
E - enter 
R - remove posterior arm (Barnum)
R - roll the patient to all fours (Gaskin)
23
Q

What are the fetal complications of shoulder dystocia?

A 
Bone fracture
Transient or permanent brachial plexus palsy
Asphyxia
Hypoxic ischaemic encephalopathy
Death
24
Q

What are the antepartum indications for CS?

A

Maternal: 2 prior CS, uterine surgery, pelvic anomaly, prior OASI, prior shoulder dystocia, medical conditions, obstetric conditions

Fetal: fetal anomalies, macrosomia, malpresentation, APH or abruption, severe IUGR, multiples, abnormal presentation

25
Q

What are the intrapartum indications for CS?

A

Maternal: Failure to progress and obstructed labour, unsuccessful instrumental delivery or unsuccessful induction

Fetal: fetal distress, cord prolapse, uterine rupture

26
Q

What are the pros and cons of spinal anaesthesia in CS?

A

Pros: dense block, predictable, rapid onset

Cons: can’t be topped up

27
Q

What are the pros and cons of epidural anaesthesia in CS?

A

Pros: can be topped up, can be used for post-op analgesia

Cons: slower onset, less predictable than spinal

28
Q

What are the complications of caesarean section?

A 
Anaesthetic complications
Haemorrhage and risks of transfusion of blood products
Hysterectomy
Infection
DVT and PE
Damage to adjacent organs
Wound breakdown
Abnormal placentation in future pregnancy
Scar rupture in future pregnancy
Death
29
Q

What are the 3 minimum requirements for a vaginal birth after ceasarean section?

A

Singleton cephalic fetus
Continuous monitoring
Immediate access to OT

30
Q

Define abortion.

A

The unexpected, unplanned, spontaneous loss of a pregnancy up to 20 weeks gestational age

31
Q

What is a threatened abortion?

A

Pregnancy complicated by vaginal bleeding prior to the 20th week

32
Q

Define inevitable abortion

A

Vaginal bleeding & pain, non viable pregnancy, open os

33
Q

Define missed abortion

A

Fetus has died, but it is retained in the uterus

34
Q

Define recurrent abortion

A

The occurrence of 3 successive abortions

35
Q

What are the transvaginal ultrasound criteria for diagnosing a miscarriage?

A

Gestational sac greater than 25mm with no fetal pole

Fetal pole greater than 7mm with no fetal heart

Absence of an embryo more than 2 weeks after a scan shower an empty gestational sac

Adnexae

36
Q

How can a miscarriage be medically managed?

A

Misoprostil 600-800mcg

37
Q

How successful is misoprostil in expelling POC in miscarriage?

A

80% success

38
Q

How can a miscarriage be managed surgically?

A

Dilation & curettage - sometimes with PV misoprostil

39
Q

What are the 3 most important fetal biometric measurements?

A

Femur length
Abdominal circumference
Head circumference

40
Q

What is a normal amniotic fluid measurement?

A

7 to 20

41
Q

What is a normal fetal HR on CTG?

A

110 to 160

42
Q

What is normal variability on fetal CTG?

A

2 to 25 bpm

43
Q

What is a reassuring number of accelerations on CTG?

A

Two or more accelerations lasting for 15 bpm

44
Q

What are early decelerations?

A

Slow onset, slow recovery decelerations caused by head compression during labour

45
Q

What are slow decelerations?

A

Slow onset, slow recovery decelerations that occur after the peak of contraction caused by fetal hypoxia

Women's (2 decks)

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