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GOSH > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is the management for Hyperemesis Gravidarum?

A
  • IV fluid replacement
  • Metclopromide or cyclizine
  • Thromboprophylaxis with enoxaparin + stocking
  • Avoid dextrose but correct electrolytes
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2
Q

What type of laxatives should you avoid in pregnancy?

A
  • Stimulant
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3
Q

How do you define small for gestational age?

A

< 10th centil for age

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4
Q

What is the commonest cause of stillbirth?

A

Brain sparing effect of placental insufficiency

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5
Q

If there is evident IUGR, when should you deliver?

A

After 34 weeks ideally after 37

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6
Q

If a baby is larger for dates, at what weights should you consider an elective C-section?

A
  • Diabetic - >4500g

- Non-Diabetic >5000g

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7
Q

What are the risks of Large for gestational age for baby?

A
  • Neonatal death
  • Birth trauma
  • Hypoglycaemia
  • Jaundice
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8
Q

What are the ranges for normal amniotic fluid in utero?

A

2cm - 8cm (outside of these boundaries = poly/Oligohydramnios)

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9
Q

What is Foetal Hydrops?

A

Abnormal accumulation of fluid in two or more fetal compartments, including ascites, pleural effusion, pericardial effusion, and skin oedema

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10
Q

When are the first foetal movements felt?

A

18-20weeks

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11
Q

If a woman cannot feel movements what advice do you give?

A
  • Lie of left side
  • Focus for 2 hours
  • If they do not feel 10 movements in 2 hours, contact midwife/MAU
  • If first time, reassure that 70% pregnancies with 1 episode are uncomplicated
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12
Q

At which point should escalation be considered if no foetal movements are felt by?

A

24 weeks

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13
Q

What is the difference between PROM and PPROM?

A
  • PROM = labour not started within 1hr of rupture, >37weeks

- PPROM = Membranes break before 37 weeks

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14
Q

Give 4 signs of Chorioamnionitis

A
  • Maternal pyrexia/tachycardia
  • Uterine tenderness
  • Foetal tachycardia
  • Offensive, yellow vaginal discharge
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15
Q

What is the management for PPROM <34 weeks?

A
  • Betamethasone IM BD for one day
  • Erythromycin for 10 days
  • Admit 24hrs for close monitoring
  • MAC twice a week with regular CTG and infection monitoring
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16
Q

What is the management for PROM (>37 weeks)

A
  • Go home and come back in 24hours for induction
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17
Q

What advice is important when sending a mother home for PROM?

A
  • Call MAC in infection risk/red flag
  • Change pad every 4 hours
  • No tampons, no sex, no soap
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18
Q

What risk to the foetus of CMV infection is there?

A
  • Deafness
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19
Q

What is offered to women who get Rubella infection <16 weeks

A
  • Termination
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20
Q

How do you define hypertension in pregnancy?

A

> 140/90 on more than one occasion

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21
Q

What is your target blood pressure treatment in pre-eclampsia/gestational hypertension?

A

<150/80-100 as over treatment can cause IUGR

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22
Q

What is the first and second line treatment for gestational hypertension if diagnosed before 20weeks

A

Labetolol
Nifedipine
Hydralazine

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23
Q

What is should be given if the woman has HTN from 12 weeks?

A

aspirin

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24
Q

What are red flag signs of Pre-eclampsia?

A
  • Headache
  • Visual disturbance
  • Epigastric or RUQ pain
  • Breathlessness
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25
Q

What are signs of Eclampsia (asides from fitting)

A
  • Peri-orbital oedema
  • Hyper-reflexia
  • Clonus > 3 beats
  • Fits
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26
Q

What is HELLP Syndrome?

A

Haemolysis, elevated liver enzymes, low platelets - Self-limiting but permanent liver damage can occur

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27
Q

What HbA1C level should indicate avoiding pregnancy?

A

> 86

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28
Q

What is used for the diagnosis of diabetes in pregnancy?

A

OGTT

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29
Q

List 4 factors that makes a woman eligible for a OGTT

A
  • BMI >30
  • Previous DM in pregnancy
  • 1st degree relative with diabetes
  • Previous large baby >4.5kg
  • South Asian, Black Caribbean or Middle Eastern
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30
Q

What are the 4 steps of management for Gestational Diabetes?

A

1 - lifestyle
2 - Metformin with food and increase dose after 1 week
3 - Single injection of intermediate acting insulin - Isophane
4 - Add short acting insulin before meals - Novorapid

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31
Q

Give 3 comorbidities for VTE

A
  • Parity >3
  • Smoking
  • Gross varicose veins
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32
Q

Give 4 Medical comorbidities for VTE

A
  • Cancer
  • Active SLE
  • IBD
  • Type I Diabetes
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33
Q

What Blood disorders can increase risk of VTE in pregnancy?

A
  • Thrombophilia
  • Protein S deficiency
  • Protein C deficiency
  • Factor V Leiden
  • Antithrombin deficiency
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34
Q

Whats the treatment for VTE?

A
  • LMWH - Enoxaparin or Dalteparin
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35
Q

How long should therapeutic anticoagulation be continued for after VTE in ooregnancy

A

6 months

36
Q

How long should treatment continue for for VTE?

A

6 weeks

37
Q

Is Warfarin safe for breast feeding?

A

Yes but additional growth scans required

38
Q

Prevention - 4+ risk factors/previous VTE

A

Prophylactic LMWH throughout antenatal period

39
Q

Prevention - 3 risk factors for VTE

A

LMWH for 28 weeks and 6 weeks post-partum

40
Q

Prevention - 2 risk factors for VTE

A

LMWH 10 days post partum

41
Q

Prevention - Heritable thrombophilia

A

High dose LMWH antenatally and 6 weeks post partum

42
Q

When would a C-section be planned for Monochorionic Monoamniotic twins?

A

32-34 weeks

43
Q

When would a delivery be planned for Monochorionic Diamniotic twins?

A

36-37weeks

44
Q

How frequent do appointments need to be for expecting twins?

A

Every 2 weeks

45
Q

What would you use to treat hyperthyroidism in pregnancy?

A

Propylthiouracil as Carbimazole is toxic

46
Q

What blood test would indicate acute fatty liver disease?

A

Raised ALT

47
Q

How would you treat Cholestasis in pregnancy?

A

Vit K + supportive and close monitoring

48
Q

Which infections can increase the risk of miscarriage?

A
  • Listeria
  • Toxoplasmosis
  • Varicella zoster
  • Malaria
49
Q

What is the risk of expectant management of miscarriage?

A
  • Haemorrhage particularly if late 1st trimester

- Higher risk of emergency intervention and blood transfusion

50
Q

What is used for the medical management of miscarriage?

A
  • Vaginal Misoprostol
51
Q

What is Antiphospholipid syndrome?

A
  • Autoimmune, hypercoagulable state caused by antiphospholipid antibodies
  • Provokes thrombosis in arteries and veins
52
Q

How do you diagnose Antiphospholipid syndrome?

A
  • One clinical event - thrombosis or pregnancy complications
  • 2 antibody blood tests spaced at least 3 months apart confirming lupus anticoagulant or anti Beta-2 glycoprotein I
53
Q

What is the management of stillbirth?

A
  • Mother is induced from prostaglandins administered vaginally
54
Q

What is a complete hyatidiform mole?

A
  • Empty egg fertilised by single sperm

- 46XX

55
Q

What is a partial hyatidiform?

A
  • Normal haploid egg fertilised by 2 sperm or by one sperm with duplication of paternal chromosomes
  • 69 XXX
  • 69 XXY
56
Q

What advice is given following a hyatidiform mole?

A
  • Urgent referral for evacuation
  • Avoid pregnancy until hCG reaches 0/next 6-12 months - tested every 2 weeks
  • Future pregnancies need serial hCG monitoring
57
Q

What level of hCG might indicate conservative management of an ectopic pregnancy?

A

< 1000IU

58
Q

What effects can a Rhesus negative mother have on a foetus?

A
  • Hydrops foetalis
  • Jaundice
  • Anaemia
  • Hepatosplenomegaly
  • Heart failure
59
Q

To encourage the 3rd stage of labour, after deliver of the anterior shoulder, what drug can be given?

A

IM Syntometrine

60
Q

If no signs of placental separation during the 3rd stage of labour, what drug should be given?

A

Syntocinon

61
Q

What is the causative agent of Group B strep?

A

Streptococcus agalactiae

62
Q

Why can’t you use NSAIDs during labour?

A

Causes premature closure of the ductus arteriosus

63
Q

Which opioids can be used during labour?

A

Pethidine / Meptid

64
Q

Give 4 advantages of an epidural

A
  • Lowers BP in HTN
  • Abolish premature urge to push
  • Analgesia in place for emergency CS
  • Pain free
65
Q

Give 4 disadvantages of an epidural

A
  • Hypotension - IV fluids
  • Increased instrumental delivery rate
  • Urinary retention
  • Local anaesthetic toxicity
66
Q

Where is an epidural inserted?

A

Between L3 and L4

67
Q

What is an absolute contraindication of epidural/spinal anaesthetic during labour?

A

Anticoagulant bleeding disorders

68
Q

Give 4 absolute contraindications of induction

A
  • Abnormal lie
  • Placenta praevia
  • Pelvic obstruction - mass/deformity
  • Acute foetal compromise
69
Q

What factors may make you consider not allowing induction?

A
  • Previous LSCS
  • Prematurity
  • High parity
70
Q

What Bishops score would indicates ripening?

A

< 5

71
Q

What is involved in cervical ripening?

A

Prostaglandins
Membrane sweep
Oxytocin

72
Q

What is the management if labour does not start after ARM?

A
  • 2 hours for primip
  • 4hours for multip
  • Oxytocin/syntocinon infusions started
73
Q

What are potential complications of induction?

A
  • Instrumental delivery
  • Hyperstimulation of uterus causing rupture/foetal distress
  • PPH
  • PGE2 side effects - N+V, diarrhoea, bronchoconstriction
74
Q

After how many hours following prostaglandin must oxytocin not be given?

A

6hrs

75
Q

What position must the baby be in to indicate operational delivery?

A

Occipito-anterior

76
Q

What is the main contra-indication of using tocolytics?

A

Ruptured membranes

77
Q

What does FFN indicate?

A

Positive means that likely to go into labour

78
Q

How many days does it take for the Os to close after birth?

A

3 days

79
Q

How is lactation achieved?

A

Oxytocin + prolactin

80
Q

What is colostrum?

A

Thick yellow fatty fluid passed for 1st 3 days before milk comes in

81
Q

What differential diagnoses are there for an amniotic fluid embolus?

A
  • MI
  • PE
  • Anaphylaxis
  • Sepsis
  • Eclampsia
82
Q

What are 4 causes of abdominal pain during pregnancy?

A
  • HELLP
  • Placental abruption
  • Pre-eclampsia
  • Acute fatty liver of pregnancy
83
Q

How would you manage an atonic uterus causing PPH?

A

Oxytocin +/- ergometrine IV

PEG2a infected into myometrium

84
Q

When does puerperal psychosis commonly start?

A

3-5days post partum

85
Q

Which methods of contraception are recommended post-partum?

A

Condom, IUD, POP, NOT COC

86
Q

When is lactational amenorrhoea effective as a method of contraception?

A
  • Complete amenorrhoea
  • Woman is fully breast feeding - 4hrly feeds a day, 6hrly at night
  • Baby no more than 6months old
87
Q

When is it safe to insert a IUD after pregnancy?

A
  • Either 48hrs after or

- wait 4 weeks

GOSH (4 decks)

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