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O&G - C.U > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Booking bloods for pregnancy

A

Hb and platlets
HIV, syphilis, Hep B
Blood group and antibody status
Sickle cell and thalassaemia

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2
Q

When is the routine date scan usually done?

A

8+0 to 13+6 weeks

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3
Q

Blood tests for Down’s syndrome

A

A PAPPA-A

HCG

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4
Q

The quad test comprises of -

A

AFP
Inhibin A
Oestriol
Beta - Hcg

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5
Q

When is the quad test done ?

A

14-20 weeks

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6
Q

Diagnostic tests for Downs syndrome

A

Chorionic villous sampling

Amniocentesis

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7
Q

Private test for Downs syndrome

A

Cell free fetal DNA test

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8
Q

At what time is the anomaly scan done?

A

18+0 - 20+6

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9
Q

Risk factors for gestational diabetes

A 
BMI >30 
Some ethnic origins 
FH 
PCOS 
Previous baby >4.5kg 
Previous gestational diabetes
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10
Q

Potential sensitising events for Anti D

A 
Spontaneous miscarriage 
Termination of a pregnancy 
Invasive procedures 
Traumatic events 
Placental abruption 
Fetomaternal haemorrhage 
Blood transfusions
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11
Q

When should prophylatic anti D be given?

A

28 weeks

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12
Q

Ages at risk if pregnant

A

<18

40+

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13
Q

What events in past pregnancies are significant ?

A 
Premature labour 
Fetal growth restriction 
APH 
Gestational diabetes
HTN 
Thrombocytopenia 
Types of delivery 
3rd / 4th degree tear 
PPH 
Previous stillbirth, late miscarriage or neonatal death
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14
Q

Which family Hx is it important to elicit in this context?

A

Diabetes

HTN / pre eclampsia

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15
Q

Fetal growth restriction =

A

baby who does not reach it’s growth potential

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16
Q

risk factors for FGR -

A 
Previous small baby 
pre-eclampsia / HTN 
reduced fetal movements 
maternal disease
smoking
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17
Q

3 measurements used on US to estimate fetal weight -

A

abdo circumfrence
head circumfrence
femur length

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18
Q

How can a placental problem be identified?

A

Fetal vessel resistance

Reduced liquor volume

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19
Q

Management of FGR

A

Exclude underlying causes
Monitor
Timely delivery - fetal HR and blood flow
C-section?

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20
Q

Pregnancy induced hypertension =

A

HTN after 20 weeks

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21
Q

Pre-eclampsia -

A

HTN after 20 weeks with proteinuria

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22
Q

Risk factors for PET

A 
First pregnancy 
Previous pre eclampsia 
>40 y/0 
BMI 35 
Multiple preg 
Pre-exisiting conditions
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23
Q

Maternal blood test when diagnosed with PET

A

u&e
LFTs
Urate
FBC

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24
Q

Fetal monitoring in a mum with PET

A

USS - fetal growth restriction

Markers of placental function

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25
Q

what infusion for eclampsia

A

magnesium sulfate

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26
Q

What happens in HELLP ?

A

Haemolysis, raised LFTs and low platelets (severe form of pre eclampsia)

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27
Q

What are obese women at risk of when pregnant?

A 
Miscarriage 
Congenital malformations 
PET 
GDM 
Macrosomia 
VTE
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28
Q

What is the aim for BMI before falling pregnant?

A

<30

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29
Q

How is diabetes impacted by pregnancy

A

Increased insulin during preg
Worsening neuropathy and retinopathy
Increase in hypoglycaemic attacks

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30
Q

Maternal impacts of diabetes

A 
Increase miscarriage risk 
Increase risk of PET 
Worsening renal disease 
Infections 
Higher induction rate 
LSCS rate higher 
Shoulder dystocia risk
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31
Q

Fetal impacts of diabetes

A

congenital malformations

unexplained still birth

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32
Q

Maternal hyperglycaemia leads to….

A

fetal hyperglycaemia which means there is increased production of insulin from the fetal pancreas. Therefore macrosomia can occur.

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33
Q

Before getting pregnant women with diabetes should….

A 
lose weight 
quit smoking and alcohol 
take folic acid for 3m 
Switch to metformin / insulin 
HbA1c <48 
Screened for retinopathy and nephropathy
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34
Q

How often should pregnant women be checking their BM?

A

Fasting
pre meal (omit if oral / diet controlled)
1hr post meal
bedtime

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35
Q

BM targets during pregnancy

A

Fasting <5.3
l hr post meal <7.8
maintaining above 4

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36
Q

USS app for women with diabetes in preg

A

Normal dating at 8-13 wks
Routine anomaly at 18-20
Serial growth scans every month from 28/40

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37
Q

What should be offered in terms of delivery for women with diabetes in preg

A

Elective delivery - IOL/ LSCS at 37-38+6

If complications can offer before 37 weeks

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38
Q

When should only LCSC be offered in women with diabetes in preg

A

EFW of >4.5kg

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39
Q

Which women are at risk of gestational diabetes?

A 
BMI >30 
Previous baby >4.5kg 
Previous GDM
FH
Ethnic origin
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40
Q

How is GDM diagnose?

A

28 weeks glucose tolerance test

fasting glucose >5.6
2 hr plasma glucose >7.8

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41
Q

Previous GDM what additional test should be done?

A

12-16/40 additional glucose tolerance test

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42
Q

When is FBC measured in preg?

A

Booking

28 weeks

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43
Q

Threshold for anaemia treatment in preg

A

<11g/dL @ booking

<10.5g/dL @ 28 weeks

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44
Q

What is the first line treatment for anaemia in preg?

A

Diet and ferrous sulfate.

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45
Q

Risk factors for VTE in pregnancy

A 
Thrombophilia 
Age >35 
BMI <30 
Parity of >3 
Smoker 
Immobility
Gross varicose veins 
Multiple preg 
Medical co-morbidities 
Systemic infection
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46
Q

Up to when post delivery are women at risk of VTE?

A

6 weeks

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47
Q

Which group of women are particularly at risk of VTE post delivery and how are they treated?

A

C-section

given 7 days of LMWH

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48
Q

Initial imaging investigation for PE in pregnancy =

And what can be done next depending on the results?

A

CXR
normal / V/Q scan
Abnormal - CTPA

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49
Q

treatment of choice for VTE in pregnancy

A

LMWH

NOT WARFARIN

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50
Q

Management of HTN in preg

A

12weeks +

Aspirin 75mg OD

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51
Q

Treatment for eclampsa

A

MgSO4 - as decision to deliver is made
Monitor the urine output, reflexes, RR and SpO2
Fluid restriction - prevent overload

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52
Q

Advice on folic acid and pregnancy

A

400mg should be taken from roughly 3m before conception up to 12 weeks

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53
Q

Risks of not giving Anti-D in a preg.

A

Baby may become anaemic, fetal hydrops (accumulation of fluid) and risk of still birth

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54
Q

When is anti D given

A

28 weeks
or divided dose at 28 and 34 weeks
postnatally if sensitizing event

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55
Q

Obstetric causes of abdo pain in 2nd and 3rd trimester

A 
Labour 
Placenta abruption 
Symphysis pubis dysfunction 
Ligamental pain 
Pre-eclampsia / HELLP
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56
Q

Gynae causes of abdo pain in 2nd and 3rd trimester

A

Ovarian torsion
Cyst rupture / haemorrhage
Uterine fibroid de-generation

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57
Q

GI causes of abdo pain 2nd and 3rd trimester

A 
Constipation 
Pyelonephritis 
Gall stones / cholestasis 
Pancreatitis 
Peptic ulcer 
Cystitis 
Renal stones
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58
Q

from what number of weeks can a CTG be used?

A

26

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59
Q

How does labour present?

A

Uterine tightening
Fetus engaged
Cervical changes on vaginal exam

60
Q

How does placental abruption present?

A

Mild - severe pain and vaginal bleeding
Uterus tender and tense
May be signs / symptoms of pre-eclampsia

61
Q

Symphysis pubis dysfunction presentation

A

Pain low and central
Tender SP
Symptoms worse on movement

62
Q

Ligament pain presentation

A

Sharp
Bilateral
Associated with movement

63
Q

Pre eclampsia presentation

A 
Epigastic / RUQ pain 
N&amp;V 
Headache 
Visual disturbance 
HTN and proteinuria
64
Q

Acute fatty liver of pregnancy presentation

A

Epigastric pain / RUQ
N&V
Anorexia
Malaise

65
Q

Ovarian cyst presentation

A

Unilateral intermittent pain

May be associated with vomiting

66
Q

Uterine fibroid presentation

A

localised constant pain

fibroid may be palpated - tender

67
Q

Appendicitis presentation

A

Pain associated with N&V
Guarding and rebound tenderness
May localise to RIF

68
Q

Gall stones / cholecystitis presentation

A

RUQ / epigastic pain
May radiate to the back / shoulder tip
Tenderness in R Hypochondria
Pyrexia

69
Q

Pancreatitis presentation

A

epigastric pain radiating to the back
N&V
More common in 3rd trimester

70
Q

Renal stones / renal colic / pyelonephritis presentation

A

Loin to groin pain
Associated vomiting and rigors
Pyrexia with pyelonephritis

71
Q

50% of antepartum vaginal bleeding caused by?

A

Placenta praevia and placental abruption

72
Q

Kleihauer test =

A

examine maternal blood film for the presence of fetal blood cells - suggests feto-maternal haemorrhage

73
Q

Uterine causes of antepartum haemorrhage

A

Placenta praevia
Placental abruption
Vasa praevia
Circumvallate placenta

74
Q

Lower genital tract causes of antepartum haemorrhage

A 
Cervical ectropion
Cervical polyp 
Cervical carcinoma 
Cervicitis 
Vaginitis 
Vulval varicosities
75
Q

Risk factors for placenta praevia

A 
previous c section 
previous pp
advanced maternal age 
multiparity 
multiple preg 
smoking 
succenturiate placental lobe
76
Q

Placenta praevia on examination

A

Uterus soft and non tender
non engaged / malpresentation
minor bleeding

77
Q

What to avoid if suspect placenta praevia?

A

Digital exam

78
Q

When is a follow up scan performed for placenta praevia?

A

36 weeks

79
Q

When should a c - section be performed in placenta praevia?

A

if placenta encroaching within 2cm of the cervical os

80
Q

if going to deliver a baby early what should you consider?

A

steroids for fetal lung maturity

81
Q

Complications of placenta praevia?

A

Risk of PPH

82
Q

What is placental abruption ?

A

Placental attachment to the uterus is disrupted by haemorrhage as blood dissects under the placenta.

83
Q

Risk factors for placental abruption?

A 
Previous abruption 
Advanced maternal age 
Multiparity 
PTE
Abdo trauma 
Smoking 
Cocaine use 
External cephalic version
84
Q

What condition is strongly linked with placental abruption?

A

PTE

85
Q

Complications for placental abruption

A

Blood loss - DIC and renal failure

PPH -> Sheehans syndrome

86
Q

At what point do you induce labour post term?

A

Term + 10 days IF NO PROBLEMS

87
Q

Maternal indications for the induction of labour?

A

severe pre eclampsia
recurrent APH
Pre-existing disease

88
Q

Fetal indications for the induction of labour?

A

prolonged pregnancy
IUGR
Rhesus disease

89
Q

Active management of the 3rd stage of labour involves

A

Clamping and cutting the cord
Controlled cord contraction
oxytocin

90
Q 
D
R
C
B
R
A
V
A
D
O
A 
define 
risk 
contractions 
baseline 
rate
accelerations 
variability 
and 
decelerations 
over all assessment
91
Q

normal range of fetal HR

A

110 - 160 bpm

92
Q

Complications of a breech birth

A

increase in perinatal mortality/ morbidity
difficult to deliver the head - can be entrapment
rapid compression and decompression of the fetal head

93
Q

3 management options in breech presentation

A

External cephalic version
Elective c-section
Planned vaginal breech

94
Q

Contraindications to ECV

A 
Pelvic mass 
Antepartum haemorrhage 
Placenta praevia 
previous c-section / hysteroscopy 
multiple preg 
ruptured membranes
95
Q

How is an ECV performed

A

On the labour ward
Monitoring
Tocolytics
US control

96
Q

How often is ECV successful?

A

1/2 the time

97
Q

What should be given in conjunction with ECV ?

A

anti - D

98
Q

What is the weight cut off for breech vaginal delivery?

A

> 4kg

99
Q

Risks for shoulder dystocia

A 
Previous 
Diabetes 
BMI >30 
Induced labour 
Long labour
Assisted vaginal birth
100
Q

When is delayed labour diagnosed in a nulilparous women?

A

2 hrs after active second stage of labour started

101
Q

When is delayed labour diagnosed in a multiparous women?

A

1 hour after active second stage of labour started

102
Q

When should you suspect delayed delivery in nulilparous?

A

progress is inadequate after 1hr

103
Q

When should you suspect delayed delivery in multiparous?

A

progress inadequate after 30mins

104
Q

Conservative measures to be used when a suspicious CTG

A 
Mobalise the mother
Adopt another position 
Offer IV fluids if hypotensive 
Stop oxytocin 
Offer tocolytic drug like terbutaline
105
Q

Management with a pathological CTG

A 
urgent review by an obstetrician and a senior midwife 
\+ measures used in conservative 
Offer digital fetal scalp stimulation
Consider fetal blood sampling 
Consider expediating the birth
106
Q

When is urgent intervention needed based on the CTG

A

Acute bradycardia / single prolonged deceleration >3 mins

107
Q

From when can ventouse delivery methods be used?

A

34 weeks

108
Q

Maternal indication for ventouse delivery

A

Delay in the 2nd stage of labour due to maternal exhaustion

109
Q

Fetal indications for ventous delivery

A

Abdnormal CTG / slow progress in the 2nd stage of labour due to fetal malposition

110
Q

What is needed in terms of maternal condition for ventouse delivery?

A

Adequate maternal effort and regular contractions

111
Q

Two types of forceps

A

Non rotational / traction

Rotational

112
Q

What is not required in terms of maternal condition for forceps delivery ?

A

maternal effort / adequate contractions

113
Q

2 maternal indications for forceps

A

Medical conditions complicating labour

Unconscious mother

114
Q

fetal indications for forceps

A 
Gestation less than 34 weeks
face presentation 
known / suspected fetal bleeding disorder 
for the after coming head in a breech 
c -section
115
Q

Maternal complication of instrumental delivery

A

Genital tract trauma with risk of haemorrhage / infection

116
Q

Fetal complication of instrumental delivery

A

Ventouse - scalp oedema / subperiosteal bleeding

Forceps - bruising / facial nerve palsy / depression skull fracture

117
Q

Maternal indications for c-section

A 
Two previous LSCS 
Placenta praevia 
Maternal disease 
Maternal request 
Active genital HSV 
HIV - viral load depending
118
Q

Fetal indications for c-section

A

Breech presentation
Twin pregnancy - if first twin not cephalic
Abnormal CTG/ abnormal fetal blood sample in 1st stage of labour
Cord prolapse
Delay in 1st stage of labour due to malpresentation / malposition

119
Q

Complications of LSCS

A

Haemorrhage - should have cross match w/ group and save
Gastric aspiration - use routine antacids
Visceral injury
Fetal laceration
Infection - can use routine prophylatic AB
VTE
Increase risk of complications in future pregnancies

120
Q

VBAC

A

if LSCS due to unrepeatable cause then can trial vaginal delivery

121
Q

APGAR score stands for?

A 
Appearance
Pulse 
Grimmace
Activity 
Respiration
122
Q

When is the APGAR score done?

A

1 min

5 mins

123
Q

APGAR normal score

A

7+

124
Q

APGAR score that indicates neurological damage

A

<3

125
Q

4 causes of postpartum haemorrhage (4 Ts)

A

Tone
Trauma
Tissue
Thrombin

126
Q

90% of PPH due to?

A

Uterine atony

127
Q

Risk factors for uterine atony?

A 
Multiple pregnancy
Grand multiparity 
Fetal macrosomia 
Polyhydramnios 
Fibroid uterus
Prolonged labour
Previous PPH 
Antepartum haemorrhage
128
Q

Cause other than uterine atony of PPH?

A 
genital tract trauma
retained placenta 
placenta accreta 
coagulation disorders
uterine inversion
uterine rupture
129
Q

Preventative measures for PPH

A

Treat anaemia before labour
avoid long traumatic labours
active management of the 3rd stage of labour

130
Q

Options if placenta in situ and PPH

A

Deliver by controlled cord contraction

If retained - manual removal under anaesthesia

131
Q

What to assess the uterus for if PPH but placenta delivered?

A

uterine contraction

132
Q

management for uterine atony

A

ABC
Large bore IV access
Send FBC, Xmatch, clotting, U&E
Rub up uterine contractions by massaging the uterine fundus
Give oxytocin
Prostaglandin can be given
Consider surgical options / uterine artery embolism

133
Q

Management of PPH

A 
ABC
Lie flat 
high flow O2
Large bore access 
Take bloods and give fluids 
Rhesus status - give anti D if indicated 
Rub up contraction 
Bimanual compression 
Catheterise 
Give progesterone
Consider tranexamic acid

If the above don’t work - take to theatre and examine under GA
Surgical techniques apply
Last resort - hysterectomy

134
Q

1st line screening for Downs syndrome

A

the combined test is now standard: nuchal translucency measurement + serum B-HCG + pregnancy associated plasma protein A

these tests should be done between 11 - 13+6 weeks

135
Q

Increased nuchal translucency indicates

A

Down’s syndrome
congenital heart defects
abdominal wall defects

136
Q

External cephalic version is contraindicated in individuals with a …

A

a recent antepartum haemorrhage,

ruptured membranes

uterine abnormalities

or previous Caesarean section.

137
Q

When does morning sickness commonly take place

A

4-7week to second trimester

138
Q

N&V in pregnancy with volume depletion treatment

A

Hartmanns rehydration - replace the calculated deficit, and maintenance

adjunct - ondansetron 4-8g every 12hrs as required (IV)

consider giving a PPI

139
Q

Conditions to ask about at pregnancy booking

A 
VTE
Thrombophilia 
Heart disease
Sickle cell 
SLE 
Obesity 
Anaemia 
DM 
HTN
140
Q

How much vit D should be taken during pregnancy

A

10 micrograms through to breast feeding

141
Q

conditions which can be identified on us scan

A 
anencephaly 
spina bifida 
cleft lip 
diaphragmatic hernia
gastroschisis 
exomphalos
serious cardiac abnormalities
142
Q

At what BP do you consider labetalol in pre eclampsia

A

> 160 systolic

>110 diastolic

143
Q

Presentation of pre eclampsia

A 
NandV
HTN 
Proteinuria 
Brisk tendon reflexes 
RUQ / epigastric pain 
Headache 
facial oedema
144
Q

Acute treatment for suspected HELLP

A

Magensium sulfate IV
IV dex

Consider BP therapy

145
Q

What is Lochia

A

Lochia may be defined as the vaginal discharge containing blood mucous and uterine tissue which may continue for 6 weeks after childbirth.

146
Q

Score for severity of hyperemesis gravidarum

A

The Pregnancy-Unique Quantification of Emesis (PUQE) score can be used to classify the severity of nausea and vomiting in pregnancy

O&G - C.U (5 decks)

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