Brainscape's Knowledge GenomeTM

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


See full index

Medicine > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

hyperemesis gravidum clinical features

A

raised bHCG, 8-12/40 (may persist up to 20/40), 5% pre-pregnancy weight loss, dehydration, electrolyte imbalance

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

hyperemesis gravidum associations

A

multiple pregnancies, trophoblastic DZ, hyperthyroidism, nulliparity, obesity

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

mamagement of hyperemesis gravidum

A
  1. antihistamines (promethazine), cyclizine, 2. ondansetron, metoclopramide admission may be required for IV fluids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

complications of hyperemesis gravidum

A

Wernike’s encephalopathy, Mallory-Weiss tear, central pontine myelinolysis, ATN, SGA, preterm birth

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

raised bHCG, 8-12/40 (may persist up to 20/40), 5% pre-pregnancy weight loss, dehydration, electrolyte imbalance

A

hyperemesis gravidum

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

multiple pregnancies, trophoblastic DZ, hyperthyroidism, nulliparity, obesity are associations with

A

hyperemesis gravidum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  1. antihistamines (promethazine), cyclizine, 2. ondansetron, metoclopramide admission may be required for IV fluids management of
A

hyperemesis gravidum

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

Wernike’s encephalopathy, Mallory-Weiss tear, central pontine myelinolysis, ATN, SGA, preterm birth complications of

A

hyperemesis gravidum

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

antenatal assessment aims

A

detect + manage pre-existing maternal conditions that may affect pregnancy outcome, prevent/detect maternal complications, prevent/detect foetal complications, detect congenital foetal abnormalities, plan delivery, educate/advise RE lifestyle

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

time of booking visit

A

10-12/40

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

booking visit Hx

A

age, obstetrics Hx (preterm, SGA, stillbirth, ante/post-partum haemorrhage, congenital abnormalities, Rh DZ, preeclampsia, GDM), LMP, gynae Hx (fertility, Sx), smear Hx, PMH (HTN, DM, AI DZ, Hbopathy, thromboembolic DZ, CVS/renal DZ, depression), DH, FH (DM, HTN, thromboembolic DZ, AI DZ, preeclampsia), SH (smoking, EtOH, drug abuse, domestic violence)

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

booking visit O/E

A

health, nutritional status, BMI, BP, abdo exam, foetal HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

booking visit investigations

A

TAUS (crown-rump l to date, multiple pregnancies, nuchal translucency), FBC, anti-D, OGTT (at risk females), syphillis, rubella immunity, HIV, hep B, Hb electrophoresis, urine culture

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

which trimesteris it best to generally avoid medications

A

first

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

1st trimester

A

1-12/40

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

2nd trimester

A

13-27/40

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

3rd trimester

A

28/40-birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

folic acid

A

0.4mg/d until >12/40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

0.4mg/d until >12/40

A

folic acid supplementation

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

vitamin D

A

10ug/d if BMI >30 or sunlight deprived areas

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

10ug/d if BMI >30

A

vitamin D supplementation

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

EtOH in pregnancy

A

avoid, esp in first 12/40, limit to 1U/d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

foods to avoid during pregnancy

A

unpasturised milk, soft/blue cheese, pate, uncooked/partially cooked ready prepared meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

pregnant women should sleep

A

in the L lateral position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

anomaly scan

A

18-21/40, detects structural foetal abnormalities, sex determination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

number/frequency of midwife visits

A

10 for nulliparous, 7 for multiparous women at increasing f as the pregnancy progresses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

10 for nulliparous, 7 for multiparous women at increasing f as the pregnancy progresses

A

number/f of midwive visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

25/40 midwife visit

A

exclude early onset preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

28/40 midwife visit

A

FH measurement, FBC, anti-D, OGTT if indicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

SGA definition

A

weight of foetus < 10/100th for its gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

SGA DD

A

wrong dates, small foetus (consistently small, still progressing along its own projectile), placental insufficiency (HTN, proteinuria, extremes of age), IUGR (smoking/drug abuse), maternal DM, prolonged pregnancy, multiple pregnancy, ch abnormalities/inborn errors of metabolism, ethnic groups, small parents, infection (CMV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

SGA vs IUGR

A

SGA is when the foetus’ weight falls below the 10/100th, IUGR is when the trajectory of the foetal growth has slowed suggesting foetal compromise + is more worrying (stillbirth risk) than SGA alone if growth continuing at a constant rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

stages of labour

A

1st stage: initiation to full dilatation (10cm), latent (slow dilatation to 3cm, several hours) + active phase (1-2cm/h progression)
2nd stage: 10cm to delivery of the foetus, passive (until head reaches pelvic floor, desire to push) + active stages (active pushing 20-40 mins)
3rd stage: foetus to delivery of the placenta (15 mins)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

three “ “‘s of labour

A

“P”’s: power, passenger, passage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

power

A

uterune contractions, painful, regular, leading to effacement (then dilatation) of the cervix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

passage

A

pelvis: inlet transverse d = 13cm, outlet AP d = 13cm
station: position of the head in relation to the ischial spines + is below the level of the spines and - is above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

passenger

A

unfused scull bones, vertex (sagital suture) = -/- the ant (bregma) + post (occipus) fontanelle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

presentation

A

the part of the foetus that occupies the lower segment/pelvis e.g. cepalic/breech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

presenting part

A

lowest part of the foetus palpable on VE e.g. vertex, brow, face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

position of the head

A

describes the rotation e.g. OT, OP, OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

attitude of the head

A

describes the degree of flexion e.g. vertex, brow, face

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

the part of the foetus that occupies the lower segment/pelvis e.g. cepalic/breech

A

presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

lowest part of the foetus palpable on VE e.g. vertex, brow, face

A

presenting part

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

describes the rotation e.g. OT, OP, OA

A

position of the head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

describes the degree of flexion e.g. vertex, brow, face

A

attitude of the head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Braxton-Hicks contractions

A

felt throughout the 3rd trimester, involuntary uterine smooth m contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

felt throughout the 3rd trimester, involuntary uterine smooth m contractions

A

Braxton-Hicks contractions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

show

A

pink/white mucus plug, usually happend once the cervix is effaced + followed by the rupture of the menbranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

pink/white mucus plug, usually happend once the cervix is effaced + followed by the rupture of the menbranes

A

show

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

observations during labour

A

temp, HR, BP, foetal HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

pyrexia in labour

A

> 37.5’c, increased risk of neonatal illness, vaginal swabs, blood, urine cultures, consider IV ABx + antipyretics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

partogram

A

used to assess progression of cervical dilatation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

used to assess progression of cervical dilatation

A

partogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

ARM

A

used when there is failure of cervical dilatation progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

1st line when there is failure of cervical dilatation progression

A

ARM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

2nd line when there is failure of cervical dilatation progression

A

IV oxytocin, required foetal montoring

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

IV oxytocin

A

when ARM has failed to progress cervical dilatation after 1-2hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

3rd line when there is failure of cervical dilatation progression

A

consider c/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

foetal HR monitoring during labour

A

every 15 min, after a contraction, auscultate for 60 sec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

VE every

A

2-4hrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

medical initiation of the 3rd stage of labour

A

IM oxytocin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

most common position of head at delivery

A

OA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

common abnormality of rotation leading to position of heat at delivery

A

OP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

IoL

A
  1. sweep 2. prostglandins pessary 3. oxytocin 4. amniotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

maternal collapse DD

A

ectopic pregnancy, major placental abruption, scar rupture in pregnancy post-c/s, amniotic fluid embolism, eclampsia, severe preeclampsia, uterine rupture, epilepsy, hypoxia, PPH, APH (haemorrhage is most common cause), cardiac DZ, spinal/LA toxicity, PE, placenta praevia, atonic uterus, retained placenta, laceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

management of maternal collapse

A

call for help (SOAP - semior midwife, obstetrician, anaethetist, paediatrician/porter), ABCDE apporach, supportive, rescusitation, fluid therapy, O2, FBC, clotting, x-match, U+Es, LFTs, transfusion, FFP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

uterine rupture risk factors

A

deep myomectomy (fibroid remouval), c/s, congenitally abnormal uterus, abnormal lie/presentation, hyperstimulation of the uterus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

retained placenta definition

A

3rd stage of labout >30 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

retained placenta risk factors

A

congenital uterine malformations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

APH definition

A

bleeding from genital tract after 24/40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

causes of APH

A

idiopathic, placental abruption, placenta praevia, ruptured vasa praevia, uterine rupture, bleeding of gynae origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

ruptured vasa praevia

A

foetal blood vessels run in membranes infront of presenting part (rare), rupture leads to APH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

ruptured vasa praevia presentation

A

painless, moderate vaginal bleeding at amniotomy/spontaneous membrane rupture, severe foetal distress (c/s often not quick enough to save foetus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

PPH management

A

call for help (SOAP senior midwife, obstetrician, anaethetist, porter), ABCED approach, massive haemorrhage call, give blood, FFP, compress uterus bimanually, FBC, U+E, clotting, x-match

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

PPH causes

A

uterine atony, retained placental parts, perineal/vaginal trauma/tears, cervical laceration (rare, associated with instrumental deliveries), uterine rupture, coagulopathy, episiotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

1’ PPH definition

A

loss of >500mL of blood <24h post-delivery, or >1000mL post-c/s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

the problem with retained placental parts

A

means that the uterus can’t contract properly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

uterine atony is more common in

A

prolonged labout, grand multips, overdistension of the uterus (polyhydramnios, multiple foetus’), fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

PPH risk factors

A

previous PPH, previous c/s, coagulation defect, anticoagulation therapy, instrumental delivery, c/s, retained placenta, APH, polyhydramnios, multiple pregnancies, grand multips, uterine malformation, fibroids, prolonged/induced labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

PPH prevention

A

oxytocin in the 3rd stage of labour, as effective as ergometrin which causes V + CI in HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

2’ PPH definition

A

excessive blood loss, 24h-6/52 post-delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

2’ PPH cause

A

endometritis with/w/o retained placenta tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

2’ PPH management

A

ABCDE approach, FBC, swabs, US, ERPC, ABx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

itching in pregnancy investigations

A

check sclera for jaundice, LFT, bile acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

itching in pregnancy DD

A

vaginitis, intrahepatic cholestsis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

intrahepatic cholestasis

A

itch w/o rash, abnormal LFTs, raised bile acids, FH, recurrent, increased risk of sudden stillbirth + preterm delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

intrahepatic cholestasis management

A

give vitamin K from 36/40 becuase of increased tendancy to haemorrhage, ursodeoxycholic acid relieves itching, IoL at 38/40, follow up at 6/52 to ensure LFTs have returned to N

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

preeclampsia HPC questions

A

headache, visual disturbances, flashing lights, drowsiness, EG pain, N+V, facial/hands/pretibial swelling, seizures, HTN, DM, FH of preeclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

general obstetrics history questions

A

weight change, appetite, fevers, rigors, seizures, results of scans/checks so far in pregnancy, previous pregnancies, smear, FM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

is paracetamol safe in pregnancy

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

is ibuprofen safe in pregnancy

A

no, NSAIDs not recommended in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

GDM glucose values

A

> 11.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

GDM ‘impaired glucose tolerance’ values

A

between 7.9-11.1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

GDM management

A

lifestyle changes: diet + exercise, medication, regular BM checking (3x/d pre + postprandial), >f antenatal checks, DM specialist team, IoL at 38-39/40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

risks of uncontrolled blood glucose during pregnancy

A

macrosomia, sholder dystocia, foetal hypoglycaemia (paediatricians to check BM regularly + present at birth), jaundice, breathing difficulties

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

GDM Hx questions

A

polyuria, polydipsia, previous miscarriages, FH (DM + GDM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

APH questions

A

colour, V, pain, previous bleeding in this/previous pregnancy, duration, outcome, precipitating factors (intercourse, straining, Sx), placental position on scans, blood group, Rh status, pregnancy-related problems to date, previous pregnancies, previous APH/PPH, FH (bleeding disorder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

post-partum low mood DD

A

baby blues, postnatal depression, postpartum thyroiditis, BPAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

postpartum thyroiditis prevalence

A

5-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

postpartum thyroiditis risk factors

A

antithyroid Abs, T1DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

postpartum thyroiditis course

A

3/12 postpartum transient + subclinical hyperthyroidism, followed by 4/12 of hypothyroidism (permanent in 20%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

baby blues

A

third d post partum, 10% prevalence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

tool for scoring PND

A

EPDS Edinburgh postnatal depression scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

risk factors for PND

A

social/emotional isolation, previous Hx, pregnancy complicaitons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

management of PND

A

social support, psychotherapy, antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

PND recurrence in subsequent pregnancies

A

70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

puerperal aka

A

postpartum period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

postpartum period aka

A

puerperal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

post partum period duration

A

immediately after birth to 6/52 later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

physiological change that happens during the puerperium

A

mothers body returns to its prepregnant state

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

mothers body returns to its prepregnant state during

A

the puerperium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

lochia

A

discharge from uterus post partum, may be blood stained for 4/52, then yellow/white

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

discharge from uterus post partum

A

lochia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

postpartum pyrexia

A

genital tract sepsis, chest infection, mastitis, perineal infection, would infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

endometritis causes in pregnancy

A

retained tissue, septic miscarriage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

common causes of polyhydramnios

A

DM, GDM, foetal abnormality (upper GI obstructions, inability to swallow, chest abnormalities, MD), idiopathic, maternal renal failure, twins,

117
Q

clinical features of polyhydramnios

A

maternal distress, large for dates, taut uterus, foetal parts difficult to palpate

118
Q

complications of polyhydramnios

A

preterm labour, maternal discomfort, abnormal lie, malpresentation

119
Q

management of polyhydramnios

A

amnioreducion, foetal surveillance, NSAIDs

120
Q

increased nuchal translucency indicated

A

Down S, congenital heart defects, abdo wall defects

121
Q

causes of hyperechogenic bowel

A

cf, Down S, CMV infection

122
Q

pulmonary hypoplasia + congenital diaphragmatic hernia

A

occur alongside each other rather than as a sequence of events

123
Q

causes of pulmonary hypoplasia

A

oligohydramnios (decreases size of intrathoracic cavity, preventing foetal L growth), congenital diaphragmatic hernia

124
Q

pulmonary hypoplasia is

A

underdeveloped L in newborn infants

125
Q

placenta praevia association

A

twins, high pariety, age, scarred uterus

126
Q

placental praevia is when

A

the placenta is implanted in the lower segment of the uterus

127
Q

low lying placentas at

A

20/40, most appear to move up as the pregnancy progresses, due to formaion of the lower segment of the uterus in the 3rd trimester

128
Q

classification of placenta praevia

A 
marginal = placent in lower segment, not over os
major = placenta completely/partially covering os
129
Q

complications of placenta praevia

A

obstructs head engagement, causes transverse lie, haemorrhage (A/PPH), placenta accreta, placenta percreta

130
Q

placenta accreta

A

when the placenta invades the myometrium, v high risk of PPH necessitating hysterectomy

131
Q

placenta percreta

A

when the placenta penetrates through the uterine myometrium into surrounding structures e.g. bladder (often at the site of a previous c/s scar), may necessitate hysterectomy

132
Q

placenta praevia presentation

A

intermittant painless bleeds, increasing f + intensity, incidental on US (some women experience no bleeding)

133
Q

placenta praevia O/E

A

breech presentation, transverse lie, high unengaged head

134
Q

examination never to perform in a pregnant wonam who’s bleeding

A

VE, unless placenta praevia is excluded

135
Q

placenta praevia investigations

A

TV/TAUS, 3D power US (if suspect placenta accreta), CTG, FBC, clotting, x-match

136
Q

if low lying placenta detected at 20/40 scan

A

repeat at 32/40

137
Q

placenta praevia management

A

admit (all women with bleeding), praevia on US amy warrent hositalisation until delivery, steroids if <34/40, elective c/s at 39/40 (earlier is bleeding is severe)

138
Q

why intraoperative/PPH so common with placenta praevia

A

because the lower segmentdoesn’t contract well after delivery

139
Q

twins, high pariety, age, scarred uterus increase the risk of

A

placenta praevia

140
Q

the placenta is implanted in the lower segment of the uterus

A

placenta praevia

141
Q

obstructs head engagement, causes transverse lie, haemorrhage (A/PPH), placenta accreta, placenta percreta are complications of

A

placenta praevia

142
Q

when the placenta invades the myometrium, v high risk of PPH necessitating hysterectomy

A

placenta accreta

143
Q

when the placenta penetrates through the uterine myometrium into surrounding structures e.g. bladder (often at the site of a previous c/s scar), may necessitate hysterectomy

A

placenta percreta

144
Q

intermittant painless bleeds, increasing f + intensity, incidental on US (some women experience no bleeding) describes the presentation of

A

placenta praevia

145
Q

breech presentation, transverse lie, high unengaged head O/E may suggest

A

placenta praevia

146
Q

never do a VE on a pregnant woman when

A

she’s bleeding

147
Q

placenta praevia vs placental abruption

A

PP: shock consistent with external loss, painless, red, ?profuse bleeding, abnormal lie, high head, foetal HR N, low placenta
PA: shock inconsistent with external loss, severe pain, absent/dark blood, tenderness, hard uterus, N lie/engagement, foetal HR ?dead/distressed, US N

148
Q

placental abruption is when

A

part/all pf the placenta separates from the uterine wall before the delivery of the foetus

149
Q

complications of placental abruption

A

foetal death, haemorrhage, DIC, renal failure

150
Q

risk factors for placental abruption

A

IUGR, preeclampsia, preexisting HTN, AI DZ, smoking, cocaine, previous placental abruption, multiple pregnancies, high pariety, trauma, rupture of membranes in polyhydramnios

151
Q

placental abruption presentation

A

painful bleeding, constant, dark blood

152
Q

concealed abruption

A

pain alone w/o PV bleeding

153
Q

placental abruption O/E

A

tachycardia, low BP, tender uterus, contracting, woody uterus (severe cases)

154
Q

placental abruption investigations

A

clincal diagnosis, CTG, tocograph, US (exclude praevia), regular FBC, regular clotting, x-match, catheterise + monitor UO, regular U+Es, central v P monitoring (severe cases)

155
Q

features of major placental abruption

A

maternal collapse, coagulopathy, foetal distress/demise, woody hard uterus, poor UO/renal failure

156
Q

placental abruption management

A

hospitalise, IV fluids, steroids (if gestation <34/40), analgesia, anti-D (if necessary), blood transfusion (if necessary)

157
Q

delivery in placental abruption

A

stabilise mother first
foetal distress: emergency c/s
no foetal distress >37/40: IoL with amniotomy
no foetal distress <37/40: steroids (<34/40), close monitoring
foetus is dead: coagulopathy likely, blood products, IoL

158
Q

part/all pf the placenta separates from the uterine wall before the delivery of the foetus

A

placental abruption

159
Q

foetal death, haemorrhage, DIC, renal failure are complications of

A

placental abruption

160
Q

IUGR, preeclampsia, preexisting HTN, AI DZ, smoking, cocaine, previous placental abruption, multiple pregnancies, high pariety, trauma, rupture of membranes in polyhydramnios are risk factors for

A

placental abruption

161
Q

painful bleeding, constant, dark blood

A

placental abruption

162
Q

tachycardia, low BP, tender uterus, contracting, woody uterus (severe cases)

A

placental abruption

163
Q

pain alone w/o PV bleeding

A

concealed placental abruption

164
Q

pregnancy induced HTN

A

BP >140/90 after 20/40

165
Q

causes of pregnancy induced HTN

A

preeclampsia, transient HTN

166
Q

preeclampsia is definied as

A

HTN + proteinuria (>0.3g/24h) +/- oedema

167
Q

eclampsia

A

occurrence of epileptiform/grand mal seizures in pregnancy

168
Q

pregnancy induced HTN aka

A

gestational HTN

169
Q

preexisting HTN in pregnancy

A

BP >140/90 <20/40 or already on antiHTN medication

170
Q

1’ vs 2’ preexisting HTN in pregnancy

A

2’ = as a result of renal/other DZ

171
Q

physiological consequences of preeclampsia

A

increased vascular R leads to HTN, increased vascular permeability leads to proteinuria, reduced placental blood flow leads to IUGR, reduced cerebral perfusion leads to eclampsia

172
Q

in early stage preeclampsia what sign can be absent

A

proteinuria (a relatively late sign)

173
Q

preeclampsia risk factors

A

nulliparity, previous preeclampsia, FH, long interpregnancy interval, obesity, old maternal age, chronic HTN, DM, twins, AI DZ, renal DZ, obesity

174
Q

HTN in pregnancy classification

A 
mild = >140/90
moderate = >150/100
severe = >160/110
175
Q

preeclampsia classification

A 
mild = proteinuria + HTN <160/110
moderate = proteinuria + HTN >160/110 w/o maternal complications
severe = proteinuria + any HTN + <34/40 or maternal complications
176
Q

preeclampsia investigations

A

urine dipstick (2+), protein creatinine ratio (30mg/nmol), 24h urine collection (>0.3g/24h), exclude infection, FBC, U+E, LFT, clotting, US

177
Q

HELLP S

A

haemolysis (dark urine, raised LDH, anaemia), elevated liver EZ (EG pain, liver failure, abnormal clotting), low platelets

178
Q

preeclampsia O/E

A

HTN, oedema (massive, not postural, sudden onset), EG tenderness (impending complications)

179
Q

complications of preeclampsia

A

eclampsia, cerebrovascular haemorrhage, HELLP, DIC, liver failure, renal failure, pulmonary oedema, IUGR, preterm birth, placental abruption, hypoxia

180
Q

any complication of preeclampsia warrents

A

delivery

181
Q

complications of eclampsia

A

hypoxia, death

182
Q

prophylaxis against eclampsia

A

Mg sulphate

183
Q

prophylaxis in at risk women for preeclampsia

A

aspirin 75mg before 16/40

184
Q

management of new onset mild/moderate HTN in pregnancy w/o proteinuria

A

OP management, BP + urinalysis twice weekly, US 2-4 weekly

185
Q

criteria for admission in preeclampsia/suspected preeclampsia

A

symptoms, proteinuria (2+ dipstick, 30mg/nmol PCR, 0.3g/24h), BP >160/110, suspected foetal compromise

186
Q

give antihypertensive at what BP

A

150/100, give urgently if >160/110, target BP <140/90

187
Q

antihypertensives in preeclampsia

A

labetalol, nifedipine

188
Q

effect of antihypertensives in preeclampsia

A

don’t change the course of the DZ but increase safety for the mother

189
Q

non antihypertensive medications in preeclampsia

A

Mg sulphate

190
Q

mechanism of action of Mg sulphate

A

increase cerebral perfusion to minimise seizure risk

191
Q

symptoms of Mg sulphate toxicity

A

loss of plantar reflexes, respiratory depression, hypotension

192
Q

gestational HTN delivery management, w/o foetal compromise

A

regular monitoring, IoL at 40/40 if required antihypertensive medication

193
Q

mild preeclampsia + delivery

A

IoL by 37/40

194
Q

moderate/severe preeclampsia + delivery

A

if gestation >34-36/40: IoL

if <34/40: inPT managment, steroids, deterioration will prompt c/s

195
Q

severe preeclampsia with complications/ foetal distress + delivery

A

deliver now

196
Q

postnatal care of preeclampsia

A

LFT, FBC, U+E, fluid balance, UO, BP

197
Q

a really accurate way to measue BP

A

CVP central venous P

198
Q

risk factors for preexisting HTN in pregnancy

A

obesity, increased maternal age, COCP induced HTN, FH

199
Q

women with pregnancy induced HTN are at greater risk of

A

developiong HTN in later life

200
Q

antihypertensives not to use in pregnancy

A

ACEi (teratogenic)

201
Q

BP >140/90 after 20/40

A

pregnancy induced HTN

202
Q

HTN + proteinuria (>0.3g/24h) +/- oedema defines

A

preeclampsia

203
Q

occurrence of epileptiform/grand mal seizures in pregnancy

A

eclampsia

204
Q

gestational HTN aka

A

pregnancy-induced HTN

205
Q

BP >140/90 <20/40 or already on antiHTN medication

A

preexisting HTN in pregnancy

206
Q

nulliparity, previous preeclampsia, FH, long interpregnancy interval, obesity, old maternal age, chronic HTN, DM, twins, AI DZ, renal DZ, obesity are riskfactors for

A

preeclampsia

207
Q

HTN, oedema (massive, not postural, sudden onset), EG tenderness (impending complications) O/E suggests

A

preeclampsia

208
Q

eclampsia, cerebrovascular haemorrhage, HELLP, DIC, liver failure, renal failure, pulmonary oedema, IUGR, preterm birth, placental abruption, hypoxia are complications of

A

preeclampsia

209
Q

Mg sulphate is used as

A

prophylaxis against eclampsia

210
Q

aspirin 75mg before 16/40 is used as

A

prophylaxis in women at risk of preeclampsia

211
Q

labetalol, nifedipine are

A

antihypertensives used in pregnancy

212
Q

medication that increase cerebral perfusion to minimise seizure risk

A

Mg sulphate

213
Q

loss of plantar reflexes, respiratory depression, hypotension are symptoms of

A

Mg sulphate toxicity

214
Q

obesity, increased maternal age, COCP induced HTN, FH are risk factors for

A

preexisting HTN in pregnancy

215
Q

can you use ACEi in pregnancy

A

no - teratogenic

216
Q

amniotic fluid embolism

A

when liquor enters the maternal circulation, extremely rare

217
Q

consequence of an amniotic fluid embolism

A

anaphylaxis, sudden SOB, hypoxia, hypotension, seizures, cardiac arrest, acute HF, DIC, pulmonary oedema, ARDS

218
Q

risk factors for amniotic fluid embolism

A

maternal age, IoL, strong contractions in the presence of polyhydramnios

219
Q

prevention of amniotic fluid embolism

A

impossible

220
Q

management of amniotic fluid embolism

A

rescuscitation, supportive treatment, O2, fluids, blood, FFP, transfer to ITU

221
Q

amniotic fluid embolism investigations

A

FBC, clotting, U+E, x-match

222
Q

when liquor enters the maternal circulation, extremely rare

A

amniotic fluid embolism

223
Q

anaphylaxis, sudden SOB, hypoxia, hypotension, seizures, cardiac arrest, acute HF, DIC, pulmonary oedema, ARDS are consequences of

A

amniotic fluid embolism

224
Q

maternal age, IoL, strong contractions in the presence of polyhydramnios are risk factors for

A

amniotic fluid embolism

225
Q

effect of epidural anaesthesia on BP

A

reduced

226
Q

clinical features of HELLP S

A

HTN, V, abdo pain

227
Q

HTN, V, abdo pain are clinical features of

A

HELLP S

228
Q

Mg sulphate dose in eclampsia

A

IV 4g bolus over 5-10mins, followed by 1g/h infusion

229
Q

preexisting DM in pregnancy management

A

women may require > insulin/similar to maintain their blood glucose levels

230
Q

GDM glucose levels

A

> 7 fasting

>7.8 2hrs post OGTT

231
Q

foetal complications of GDM/DM during pregnancy

A

congenital abnormalities (neural tube, cardiac), preterm, reduced foetal L maturity, increased birthweight, polyhydramnios, shoulder dystocia, birth trauma, foetal compromise, foetal distress, sudden foetal death

232
Q

maternal complications of GDM/DM during pregnancy

A

increased insulin requirements, hypoglycaemia, DKA, UTI, wound/endometrial infection post partum, HTM, preeclampsia, worsening of IHD, c/s/instrumental > likely, DM nephropathy, DM retinopathy

233
Q

investiagations in GDM/DM in pregnancy

A

foetal ECHO, US to monitor foetal growth + liquor V, U+E, fundoscopy

234
Q

management of GDM/DM in pregnancy

A

preconceptual diabetic control, aspirin 75mgfrom 12/40, diet, exercise, home monitoring, metformin, insulin, OGTT at 3/12 post delivery

235
Q

delivery + GDM/DM in pregnancy

A

should be by 39/40

236
Q

c/s is indicated in GDM/DM when

A

birth weight is predicted >4kg

237
Q

screening for GDM

A

screen at 28/40: previous large baby (>4.5kg), unexplained still birth, 1st degree relative with DM, BMI >30, South Asian, Black Carribean, Middle Eastern origin, PCOS
screen at 18/40: previous GDM

238
Q

risk factors for GDM

A

personal Hx of GDM, previous >4.5kg foetus, previous unexplained stillbirth, 1st degree relative with DM, BMI >30, racial origin, polyhydramnios, persistent glycosuria

239
Q

congenital abnormalities (neural tube, cardiac), preterm, reduced foetal L maturity, increased birthweight, polyhydramnios, shoulder dystocia, birth trauma, foetal compromise, foetal distress, sudden foetal death

A

foetal complications of GDM/DM in pregnancy

240
Q

increased insulin requirements, hypoglycaemia, DKA, UTI, wound/endometrial infection post partum, HTM, preeclampsia, worsening of IHD, c/s/instrumental > likely, DM nephropathy, DM retinopathy

A

maternal complications of GDM/DM in pregnancy

241
Q

personal Hx of GDM, previous >4.5kg foetus, previous unexplained stillbirth, 1st degree relative with DM, BMI >30, racial origin, polyhydramnios, persistent glycosuria are risk factors for

A

GDM

242
Q

molar pregnancy is a types of

A

trophoblastic DZ

243
Q

presentation of a molar pregnancy

A

vaginal bleeding, large for dates uterus, hyperemesis, hyperthyroidism

244
Q

shoulder dystocia is associated with

A

PPH, perineal tears, brachial plexus injury, neonatal death

245
Q

risk factors for shoulder dystocia

A

foetal macrosomia, high maternal BMI, DM, prolonged labour

246
Q

vaginal bleeding, large for dates uterus, hyperemesis, hyperthyroidism may suggest

A

molar pregnancy

247
Q

foetal macrosomia, high maternal BMI, DM, prolonged labour are risk factors for

A

shoulder dystocia

248
Q

intrahepatic cholestasis of pregnancy is characterised by

A

itch w/o rash, abnormal LFTs

249
Q

intrahepatic cholestasis is caused by

A

abnormal sensitivity to the cholestatic effects of oestrogens

250
Q

complications of intrahepatic cholestasis

A

stillbirth, preterm

251
Q

intrahepatic cholestasis management

A

vit K 10mg/d from 36/40, ursodeoxycholic acid (UDCA) relieves itch, IoL at 38/40, follow up 6/52 post partum

252
Q

itch w/o rash, abnormal LFTs indicated

A

intrahepatic cholestasis

253
Q

ectopic pregnancies

A

fertilised egg implants outside of the uterus, most commonly the fallopial tubes

254
Q

risk factors for ectopic pregnancy

A

PID, assisted conception, Sx, previous ectopic, smoking, IUD

255
Q

ectopic pregnancy presentaion

A

scanty dark vaginal bleeding, lower abdo pain, syncope, shoulder tip pain, amenorrhoea

256
Q

ectopic pregnancy O/E

A

abdo tenderness, rebound tenderness, cervical excitation, adenexal tenderness, tachycardia, hypotension

257
Q

ectopic pregnancy investigations

A

urine pregnancy test, TVUS, serum B-hCG (repeat in 48h)

258
Q

ectopic pregnancy management

A

NBM, FBC, x-match, TVUS, laproscopy (esp if HD unstable/heartbeat, salpingectomy), IV access, methotrexate (no cardiac activity), serial B-hCG

259
Q

PID, assisted conception, Sx, previous ectopic, smoking, IUD are all risk factors for

A

ectopic pregnancy

260
Q

scanty dark vaginal bleeding, lower abdo pain, syncope, shoulder tip pain, amenorrhoea

A

ectopic pregnancy

261
Q

abdo tenderness, rebound tenderness, cervical excitation, adenexal tenderness, tachycardia, hypotension O/E may indicate

A

ectopic pregnancy

262
Q

threatened miscarriage

A

there is bleeding by the foetus is still alive, the uterus is the correct size for dates, os is closed

263
Q

% with a threatened miscarriage that go on to miscarry

A

25%

264
Q

miscarriage definition

A

foetus dies/delivers <24/40

265
Q

ineviatable miscarriage

A

heavy bleeding, foetus alive, os open, miscarriage is about to occur

266
Q

incomplete miscarriage

A

some foetal parts have passed, os open

267
Q

complete miscarriage

A

all foetal tissue passed, bleeding reduced, uterus no longer enlarged, os closed

268
Q

septic miscarriage

A

contents of uterus are infected, causing endometritis, offensive vaginal loss, tender uterus

269
Q

missed miscarriage

A

foetus undeveloped/died in utero, not recognised until US/bleeding occurs, uterus is smaller than expected for dates, os closed

270
Q

myths that don’t really cause miscarriages

A

exercise, stress, emotional trauma

271
Q

miscarriage investigations

A

early pregnancy assessment unit, TVUS, B-hCG, FBC, anti-D

272
Q

recurrent miscarriage definition

A

3+ miscarriages in succession

273
Q

management of recurrent miscarriages

A

counselling, US monitoring, aspirin + low dose LMWH (in anti-PL S), karyotyping (ch)

274
Q

recurrent miscarriage risk factors

A

anti-PL S, ch abnormalities, uterine abnormalities, cervical incompetence, obesity, smoking, PCOS, excess caffeine, high maternal age, poorly controlled DM, thyroid DZ

275
Q

there is bleeding by the foetus is still alive, the uterus is the correct size for dates, os is closed

A

threatened miscarriage

276
Q

heavy bleeding, foetus alive, os open, miscarriage is about to occur

A

ineviatable miscarriage

277
Q

some foetal parts have passed, os open

A

incomplete miscarriage

278
Q

all foetal tissue passed, bleeding reduced, uterus no longer enlarged, os closed

A

complete miscarriage

279
Q

contents of uterus are infected, causing endometritis, offensive vaginal loss, tender uterus

A

septic miscarriage

280
Q

foetus undeveloped/died in utero, not recognised until US/bleeding occurs, uterus is smaller than expected for dates, os closed

A

missed miscarriage

281
Q

anti-PL S, ch abnormalities, uterine abnormalities, cervical incompetence, obesity, smoking, PCOS, excess caffeine, high maternal age are risk factors for

A

miscarriage

282
Q

risks of twin pregnancies

A

preterm labour, miscarriage, congenital abnormalities, IUGR, GDM, hyperemesis, preeclampsia, anaemia

283
Q

delivery of twins

A

most likely c/s due to mal presentaion, if 1st baby = cephalic can do vaginal, IoL at 38-39/40

284
Q

risks of vaginal delivery with twins

A

risk of cord prolapse/breech presentation with 2nd twin), PPH

285
Q

breech presentation

A

try ECV, elective c/s at 38/40

286
Q

ECV CI

A

fibroids, low placenta, APH, premature ROM

287
Q

`% success rate of ECV

A

50%

288
Q

breech presentation risks in vaginal delivery

A

cord prolapse

Medicine (30 decks)

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