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GOSH > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

how and when will a low-lying placenta usually present?

A

Painless bleeding at 26-28 weeks.

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2
Q

what is placenta previa?

A

Placenta previa is an obstetric complication that classically presents as painless vaginal bleeding in the third trimester secondary to an abnormal placentation near or covering the internal cervical os.

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3
Q

at how many weeks is it uncommon to feel fetal movements?

A

Before 20 weeks

*must ask about fetal movements from 26 weeks,, impossible to do anything before this time.

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4
Q

in pregnancy, when does the risk of VTE end?

A

Risk starts from the beginning of pregnancy until 6 weeks after delivery.

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5
Q

why are UTIs more common in pregnancy?

A

Due to the effects of progesterone

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6
Q

if a woman has had Large Loop Excision of the Transformation Zone what is she at risk of in pregnancy?

A

Preterm birth

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7
Q

what is the usual recommended pre-conceptual folate dose?

A

400mcg

*5mg if antiepileptics, Diabetes etc.

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8
Q

when are drugs the most teratogenic?

A

1st trimester (<12 weeks)

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9
Q

when is the early pregnancy scan performed?

A

12 weeks

11w +2 –> 14w +1

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10
Q

when is the fetal anomaly scan performed?

A

20 weeks

18w - 20w + 6

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11
Q

when is combined screening performed?

A

At the early pregnancy/dating scan: 12 weeks

11w +2 –> 14w +1

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12
Q

what does combined screening detect for?

A

Down’s syndrome
Edwards syndrome
Pataus syndrome

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13
Q

what 3 tests make up the combined screening?

A

Nuchal translucency scan
hCG
PAPPA

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14
Q

what happens to the hCG in Down’s syndrome?

A

It is increased

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15
Q

what happens to the PAPPA in Down’s syndrome?

A

It is decreased

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16
Q

when does the nuchal translucency scan lose accuracy?

A

14weeks + 1

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17
Q

what is offered to women with a high-risk result for Down’s after combined screening?

A

Chorionic villous sampling (CVS) from 11 weeks or

Amniocentesis from 15 weeks

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18
Q

when can the quaruple test be performed?

A

14+2 –> 20 weeks (2nd trimester)

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19
Q

what is the detection rate for Down’s using the combined screening?

A

85%

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20
Q

what is the detection rate for Down’s using the quadruple test?

A

80%

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21
Q

does the quaruple test detect Edwards and Patau’s syndrome?

A

No

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22
Q

what is the detection rate of the non-invasive pre-natal screening (NIPT)?

A

> 99%

*placental DNA extracted from maternal blood sample

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23
Q

what infectious diseases are tested for at the booking bloods?

A

HIV, Hep B, Syphilis

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24
Q

why can the rubella vaccine not be given in pregnancy?

A

Live vaccine

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25
Q

what is done to reduce the risk of HBV transmission to the newborn baby from Hep Be antibody +/Be antigen + mothers?

A

Newborn requires a dose of immunoglobulin at birth

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26
Q

is a pregnant woman tests positive for syphilis what is required to prevent transmission to the newborn?

A

Antibiotic treatment 4 weeks to prior to delivery.
*treatment too early incrases risk of miscarriage
Treatment to late - baby will require IV antibiotics

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27
Q

When is the rhesus group of the mother taken?

A

at booking bloods + at 28 weeks.

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28
Q

at what point are rhesus negative mothers offered anti-D immunoglobulins?

A

at 28-30 weeks

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29
Q

in what circumstances is the mother given anti-D immunoglobulins after delivery?

A

If the baby is rhesus positive

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30
Q

when are haemaglobinpathies tested for?

A

At booking bloods

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31
Q

is the mother is positive for a haemoglobinopathy trait- what is the next step?

A

Test the partner for the trait

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32
Q

is both the mother and father are positive for traits of haemoglobinpathies - what is offered?

A

Prenatal diagnosis via invasive testing

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33
Q

at what point is a blood spot performed on the newborn and what is test for?

A

5 days post delivery

Sickle cell, thalassaemia, hypothyroidism, phenylketonuria, MCADD, maple syrup urine disease

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34
Q

are haemoglobinopathies tested for in all mothers?

A

Universal screening in high prevalence areas

In low prevalence areas - identify higher risk ethnic groups

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35
Q

is chlamydia routinely screened for?

A

No - encourage under 25s to participate in opportunistic screening

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36
Q

in whom is hep C screened for as part of the antenatal screening process?

A

IVDU, obstetric cholestasis

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37
Q

Is group B strep part of the antenatal screening programme?

A

No (unless swab/urine tested)

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38
Q

how long does the latent phase of labour last?

A

<1 hour to a few days

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39
Q

what are the characteristics of the latent phase of labour?

A

painful contractions. Non-continuous period of time

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40
Q

what are the criteria for established labour?

A

Regular painful contractions (2-4 every 10 mins)

Progressive cervical dilatation from 4cm

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41
Q

in the 1st stage of labour how is he descent of the baby’s head assessed?

A

Vaginal examination: head position in relation to ischial spines of the pelvis
Abdominal palpation: how many 1/5 of the baby’s head is felt above the pelvis

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42
Q

what is defined as a term birth?

A

37weeks +

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43
Q

what are the 3 stages of labour?

A

1) dilatation of 4-10cm
2) full dilatation to birth
3) birth of baby to expulsion of placenta

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44
Q

what are the 2 key things that happen in the 1st stage of labour?

A

Opening of the cervix (4-10cm)

Descent of the baby’s head

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45
Q

is the descent of the baby’s head is negative what does that mean?

A

That the baby is still high up = above the ischial spine

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46
Q

what is characteristic of active 2nd stage labour?

A

Expulsive contractions or active maternal effort with full dilatation of the cervix

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47
Q

what are the signs of the 2nd stage of labour (full dilatation at birth)?`

A

bulging of the perineum
anal diltation
Red congestion mark

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48
Q

why is the time the head birth noted?

A

So if shoulder dystocia occurs the time at which this happened can be determined.

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49
Q

what is shoulder dystocia?

A

Baby’s shoulders can catch on the bony pelvis of the mother leading to a medical emergency because the imbilical cord becomes compressed in the birth canal.

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50
Q

do most women have active management or physiolocal management of the 3rd stage of labour?

A

Active management is recommended

51
Q

what drugs are used in active management of the 3rd stage of labour?

A

Uterotonic drugs - syntometrine

52
Q

why and when is deferred clamping of the cord performed?

A

benefit to the baby - prevents anaemia.

atleast > 1minute

53
Q

what are the side effects of syntometrine?

A

nausea and vomiting

54
Q

what is controlled cord traction?

A

Where counter-pressure is applied just above the pubic bone to guard the uterus and gentle downwards traction is placed on the cord. Reduces bleeding risk.

55
Q

why is active management recommended in the 3rd stage of labour?

A

Reduces the risk of post-partum haemorrhage and shortens the length of the 3rd stage
Quicker than physiological (10 mins compared iwth 30mins-1hour)

56
Q

in physiological management of expulsion of the placenta when is the cord clamped?

A

No clamping of the cord until pulsation has ceased

57
Q

what is the definition of induction of labour?

A

Artificial induction of a baby of gestational age

58
Q

what is the difference between induction and augmentation of labour?

A

Induction - Artificial induction of a baby of gestational age
Augmentation - enhanvement of uterine contractility

59
Q

what are the dangers of prolonged pregnancy?

A

Increased risk of stillbirth

60
Q

what are the absolute contra-indications to induction of labour?

A

Acute fetal compromise
Unstable lie
Placenta previa
Pelvic obstruction

61
Q

what are the relative contra-indications to induction of labour?

A

Previous C-section
Breech
Prematurity
High parity

62
Q

what is unstable lie?

A

From 37 weeks onwards, unstable lie is the term given to a baby that continues to change its position inside the womb

63
Q

what are the maternal indications for induction of labour?

A

Pre-eclampsia
Chronic renal disease
Diabetes
Malignancy

64
Q

what are the fetal indications for induction of labour?

A

Prolonged pregnancy (>42 weeks)
Placental insufficiency + IUGR
Rhesus isoimmunisation
Chorioamnionitis

65
Q

in a woman with pre-labour rupture of membrances how long do you wait before inducing labour?

A

Allow 24 hours to see if the woman goes into labour if not - induce
*risk of infection

66
Q

what maneouvres can be performed to reposition a breeched baby?

A

External cephalic version (ECV)

67
Q

what 4 things are assessed before induction of labour?

A

1) Favourability of the cervix - Bishop’s score
2) Obstetric examinatio - confirm life, cephalic presentation + engagement
3) MEWS score - maternal early warning score
4) CTG

68
Q

what does the modified bishops score assess?

A

Favourability of the cervix

69
Q

what 5 parameters are included in the modified bishops score?

A 
Position of the cervix
Dilatation of the cervix
Length of the cervix
Consistency of the cervix
Station of the presentation part
70
Q

in a non-pregnant woman how long is the cervix?

A

4-5cm

71
Q

What is the 1st thing tried to induce labour?

A

Membrane sweeping - finger into cervical os and separate the membrane from the cervix manually

72
Q

how does membrane sweeping work?

A

Causes a release of prostaglandins which induce labour

73
Q

when is membrane sweeping performed in a nulliparous woman?

A

40-41 weeks

74
Q

when is membrane sweeping performed in a parous woman?

A

41 weeks

75
Q

what do vaginal prostaglandins do to the cervix and uterus induce labour?

A

Cervix - promote ripening

Uterus - smooth muscle contraction

76
Q

What are the commonly used vaginal prostaglandins?

A 
Dinoprostone gel (predidil)
Misoprostol (PGE1)
77
Q

what must be performed before an oxytocin infusion is given to induce labour?

A

Membranes must be ruptured:

either spontaneously or artifically

78
Q

why is continuous CTG monitoring required if a oxytocin infusion is given?

A

As it can cause uterine tachysystole and fetal distress

79
Q

what is the name of the oxytocin infusion given?

A

syntocinon

80
Q

how does oxytocin induce labour?

A

Smooth muscle contraction of the uterus

81
Q

what should be used in a very low bishops score - prostaglandins or oxytocin?

A

prostaglandins - work on the cervix and the uterus

oxytocin - work only on the uterus

82
Q

what are the complications of induction of labour?

A 
fetal distress
precipitate delivery (can be too fast)
uterine hypotonia + possible rupture
amniotic fluid embolism
systemic effects
instrumental/operative delivery
83
Q

when is the booking appointment ?

A

at 10 weeks

84
Q

what is a normal nuchal translucency?

A

<3.5mm

85
Q

what has a higher risk of miscarriage - CVS or amniocentesis?

A

CVS (chorionic villous sampling)
CVS = 1%
Amniocentesis = 0.8%

86
Q

in CVS from where is the sample taken?

A

from the placenta

87
Q

what is the risk of transmission of HIV via breastfeeding?

A

3%

88
Q

what is the risk of transmission of HCV via breastfeeding?

A

none

89
Q

The nutrition recommendations given in pregnancy are to prevent against which infections?

A

Listeriosis

Salmonellosis

90
Q

Why are pregnant women advised to avoid excess oily fish?

A

Avoid mercury poisoning

91
Q

Why are pregnant women advised to avoid liver and liver products m?

A

Avoid high levels of vitamin A

92
Q

Why are women advised to avoid soft cheeses in pregnancy?

A

Listeriosis

93
Q

When do you expect morning sickness to subside?

A

16-18 weeks (2nd trimester)

94
Q

What is responsible for constipation during pregnancy?

A

Progesterone slows colonic motility and there is increased uterine pressure on the rectum

95
Q

What is the definition of hyperemesis gravidarum?

A

Severe vomiting associated with weight loss >5% of pre pregnancy weight, dehydration, electrolyte imbalance and need for admission to hospital

96
Q

Is bleeding in placental abruption painful or painless?

A

Painful

*unlike placenta previa = painless

97
Q

Is placenta previa possible if there is a normal 20 week scan without a low lying placenta?

A

No

98
Q

When is an oral glucose tolerance test warranted antenatally at 26 weeks?

A

Age >35
Ethnicity
BMI >30
Previous unexplained stillbirth

99
Q

If a woman has a BMI >30 what is she at increased risk of?

A

GDM
Pre-eclampsia
Macrosomia
Intrauterine growth restriction (placental insufficiency)

100
Q

What are the risk factors for antepartum haemorrhage?

A

Hypertension
Previous antepartum haemorrhage
Abdominal trauma
Cocaine/amphetamine use

101
Q

What is the preferred head presentation at birth?

A

Occipito-anterior

102
Q

what is cocaine a risk factor for in pregnancy?

A

antepartum haemorrhage

103
Q

in relation to postpartum haemorrhage what do the 4 T’s stand for?

A

Tone – atonic uterus
Trauma – genital tract trauma
Tissue – retained products of conception
Thrombin – abnormal clotting

104
Q

what is primary PPH?

A

> 500ml loss within 24 hours of delivery.

105
Q

what is secondary PPH?

A

> 500ml from the genital tract between 24 hours and 6 weeks post-partum.

106
Q

why is oxytocin used in PPH?

A

Induce uterine contraction and treat uterine atony

*also use ergometrine, misoprostol

107
Q

what is HELLP syndrome?

A

haemolysis, elevated liver enzymes, low platelets

*complication of pre-eclampsia/eclampsia

108
Q

what is the T sign?

A

Monochorionic twins - refers to the lack of chorion between the layers of the inter twin membrane

109
Q

what is the lambda sign?

A

Dichorionic twins - triangular appearance of the chorion between the layers of the inter twin membrane

110
Q

are the majority of twins dizygous or monozygous?

A

Dizygous 80% - derived from 2 separate embryos

Monozygous 20% - derived from division of a single zygote

111
Q

which antibiotic is used in the management of PPROM?

A

Erythromycin 250mg QDS for 10 days

112
Q

what are tocolytics?

A

Medications given to suppress preterm labour

113
Q

before 24 weeks what is bleeding referred to?

A

Threatened miscarriage

after 24 weeks: antepartum haemorrhage

114
Q

which steroid is used to promote lung maturity antenatally?

A

Betamethasone (24mg IM in 2 doses over 12 hours apart)

115
Q

what is defined as a preterm delivery?

A

24 weeks - 36 weeks + 6 days

116
Q

what is hydramnios?

A

Condition where excess amniotic fluid develops during pregnancy

117
Q

what are the major causes of death in the pre-term infant?

A

Infection
RDS
Necrotising enterocolitis
Periventricular haemorrhage

118
Q

at how many weeks would you inhibit uterine activity pharmacologically so cortosteroids can be given tot he mother if pre-term labour has occurred?

A

<34 weeks

119
Q

how do B-adrenergic agonists work in preterm labour?

A

Inhibit myometrial cell contraction

120
Q

what is indomethacin?

A

Prostaglandin synthase inhibitor (NSAID) used in preterm labour

121
Q

in which leg is DVT more likely to occur in pregnancy?

A

Left leg

122
Q

incorrect management of which stage is a risk factor for uterine inversion?

A

incorrect management of the 3rd stage.

123
Q

what is the risk of uterine rupture in spontaneous labour after c-section? (VBAC)

A

0.3%

124
Q

what is the risk of uterine rupture in induction of labour after c-section? (VBAC)

A

3%

GOSH (3 decks)

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