Obstetrics Flashcards
How often to bHCG levels double?
48 hours
At what bHCG value is gestational sac seen and at what week?
5 weeks
1000-1500
What are the nutritional supplements recommended for pregnant women?
Folic acid: 0.4 or 4 if woman has hx of NTD
Iron 30 mg
Calcium
Complete vegetarians: vitamin D, vitamin B12
Which disease should be detected at first visit?
rubella HbSAg Syphillis HIV Pap smear Hep B Hep C
At what week does FTCS happen?
What is in the FTCS
9-14 weeks
PAPP-A, NT, free bHCG
When is second trimester combined screening happen?
What is in it?
15-22 weeks Alpha feto protein AFP Estrodiol bHCG inhibin A
When does U/S happen for anatomic screening?
18-20 weeks
When does the glucose challenge happen?
24-23 weeks
What is elevated alpha AFP associated with?
Open neural tube defects (anencephaly, spina bifida)
Abdominal wall defects
Multiple gestation
Incorrect gestational dating
What is associated with low alpha AFP?
Trisomy 18
Trisomy 21
Fetal demise
Incorrect gestational dating
What is high/low in the quad screen for trisomy 21?
AFP low
Estriol low
Inhibin high
bHCG high
When can CVS be done?
10-12 weeks
When can Amniocentesis be done?
15-20 weeks
What are the risks of CVS?
Risk of fetal loss high
What are the risks of amniocentesis?
PROM
Chorioamnionitis
Fetal maternal hemorrhage
When can free cell DNA be done?
10 weeks
What is the management of termination of pregnancy in the first trimester?
up to 49 days: mifepristone + oral misoprostol OR IM methotrexate + oral/vaginal miso
surgical up to 13 weeks
What is the management of termination of pregnancy in the second trimester?
D&E
How long is First stage of labour?
6-18
2-10
How long is the second stage of labour?
0.5-3 hours
How long is the 3rd stage of labour?
0-0.5
Late deceleration causes
Uteroplacental insufficiency
Fetal hypoxemia
Early deceleration causes?
Head compression from uterine contraction
Causes of variable deceleration?
Umbilical cord compression
Treatment of hyperemesis gravidum?
Vitamin B6
Doxylamine PO
Promethazine or dimenhydrinate PO or rectal administration
If severe: metoclopramide, ondansetron
If dehydrated: IV fluids, IV nutritional supplementation…
What are the complications of pregestational diabetes for mom?
PE Macrosomia leading to need for C-section Preterm labour Infection Polyhydramnios PPH Maternal mortality
What are the complications of pregestational diabetes for bb?
Macrosomia or IUGR Cardiac and renal defects NTD Hypocalcemia Polycythemia Hyperbilirubinaemia Hyperglycaemia RBS Birth injury
What is contraindicated for treatment of gestational or chronic HTN?
ACE
Diuretic
What is the classic triad of Pre-eclampsia?
HTN (140/90)
Proteinuria
Edema
occurring at > 20 weeks gestation
What is HELLP syndrome?
Hemolysis
Elevated LFT
Low Platelet
What are the symptoms of severe PE?
Headache Blurred vision Hyperactive reflexes Clonus RUQ pain
What are the symptoms of Magnesium toxicity?
Respiratory paralysis
Coma
Loss of deep tendon reflex
How to control BP of severe PE?
Labetalol
Hydralazine
Continuous Mag sulfate
Delivery
What is the treatment of asymptomatic bacteriuria in pregnancy?
3-7 days nitrofurantoin
What is the treatment of asymptomatic bacteriuria in pregnancy?
IV fluids
Hospital admonition
IV 3rd generation cephalosporin
Is placental Abruption painful or painless?
Painful
In what kind of APH do you never perform a VE?
Placental previa
Definition of IUGR?
EFW less 10th percentile for gestational age
Causes of polyhydramnios?
Maternal DM Multiple gestation Isoimmunization Pulmonary abnormality Fetal anomaly
What is the definition of polyhydramnios?
AFI > 25
What is the definition of oligohydramnions
AFI < 5
Causes of oligohydramnios?
Fetal urinary tract abnormality
Uteroplacental insufficiency
Rupture of membranes
What is the titre that suggest monitoring for mom for Rh -ve status?
1:16
How to prevent RH isoimmmunisation?
28 weeks give RhoGAM
What is the karyotype of a complete mole?
46 XX
What is the karyotype of an incomplete mole?
69 XXY
Definition complete mole
Sperm enters an egg that has no ovum
Definition incompletely mole
Normal ovum touched by 2 sperm
What is the presentation of molar pregnancy?
Uterine bleeding
Hyperemesis
PE < 4 weeks
Large uterine size
What is diagnosis of molar pregnancy?
Very high betaHCG > 100000
D&C shows cluster of grapes
Snowstorm appearance on U/S
Treatment molar pregnancy
Evacuate
Monitor bHCG
What are the complications of multiple pregnancy?
Placenta praaevia
….
What are the complications of twin pregnancy for bb?
TTT
IUGR
Preterm labour
Congenital malforamtion
What are the risk factors of shoulder dystocia?
Macrosomia
Obese mom
Diabetes
Hx previous shoulder dystocia
Treatment of shoulder dystocia?
Help reposition Episiotomy Leg elevation Pressure suprapubic Enter the vagina and help rotate Reach fetal arm
What are the hours for failure to progress in first stage?
Latent
- Prima > 20
- Multi > 14
Active
- Prima > 2
- Multi > 2 after reaching 3-4 cm
What are the hours for failure to progress in second stage?
Primary > 2, > 3 with epidural
Multi > 1, > 2 with epidural
What is premature ROM?
> 1 hour before onset of labour
What is preterm premature ROM?
ROM < 37 weeks gestation
What is prolonged ROM?
> 18s prior to delivery
How is ROM diagnosed?
Nitrazine paper test turns blue
Fern test +ve
Treatment of preterm premature ROM?
Abx CSC is < 32 w Term: check GBS and observe labour 34-36 w: Induce labour < 32 w: bed and pelvic rest
Treatment of preterm labour?
Steroids
Tocolysis : Beta-mimetic, MgSO4, CCB, PGI
Abx : penicillin or ampicillin for GBS prophylaxis
Transfer and admit
Intrapartum Care
Neuroprotection if < 30 w
Definition of preterm labour?
Onset of labour between 20-37 w
How do you diagnose preterm labour?
Regular uterine contractions
Concurrent cervical changes
Complications of preterm labour
PDA
NEC
RDS…
Definition PPH
Loss of blood > 500 mL
Causes of PPH
Tone (commonest )
Tissue
Trauma
Thrombin
6 W’s of postpartum delivery
Womb (endometritis) Wind Water (UTI Walk (DVT) Wound (incision infection ) Weaning (mastitis)
What is Sheehan’s syndrome?
Pituitary ischemia secondary to obstetric hemorrhageand shock
What is the presentation of Sheehan’s Syndrome?
Failure to lactate
What does colostrum contain?
Protein
Fat
Secretory IgA
Minerals
What is the treatment of mastitis?
dicloxacillin cephalexin amoxycillin azythromycin clyndamycin