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Obstetrics Flashcards

1
Q

what is the ideal position for a baby to be in for vaginal delivery?

A

vertex presentation

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2
Q

which fontanelle looks like a diamond?

A

anterior

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3
Q

causes of polyhydramnios

A 
DITCH
diabetes
idiopathic
twins
congenital abnormalities
heart failure (mother)
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4
Q

when should you induce post dates?

A

41 weeks

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5
Q

what does the Rotterdam SHOP consist of

A

string of pearls on USS
hyperandrogenism
oligomenorrhoea
PROLACTIN NORMAL

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6
Q

what are the risks of gestational diabetes?

A 
SMASH
shoulder dystocia
macrosomnia
amniotic-polyhydramnios
stillbirth
hypertension and hypoglycaemia in baby
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7
Q

whats the difference between the circles and crosses on a growth chart?

A

circles-estimated foetal growth

crosses-fundal height

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8
Q

causes of IUGR

A

placental insufficiency: smoking

multiple pregnancy, uterine malformation, infection, labetolol, alcohol

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9
Q

what is the normal birth weight?

A

2.5-4kg

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10
Q

what is small for dates defined as?

A

under 10th

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11
Q

complications of large for dates

A 
birth injury
immature suckling
hypoglycaemia
jaundice
left colon syndrome
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12
Q

how is gestational diabetes managed?

A

diet and exercise control for 2 weeks, if this doesn’t work then insulin/metformin and glibenclamide can be used

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13
Q

how many weeks does a baby have to be before it is counted in parity?

A

24weeks

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14
Q

when should the first trimester scan be?

A

11-13 weeks

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15
Q

when can you do amniocentesis?

A

15-20 weeks

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16
Q

when is the second trimester?

A

13-27 weeks

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17
Q

risks of breech

A

difficulty delivering head
cord prolapse
fetal hypoxia

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18
Q

what are the stages of labour and delivery

A 
Every-Engagement
Decent-Descent
Female-Flexion
I-Internal rotation (occ transverse to OA)
Crown-extension during delivery
Rules-Restitution
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19
Q

what are the indications for induction?

A 
4 Ps
post dates
PROM
pre eclampsia
plus diabetes
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20
Q

define PROM

A

=SROM rupture of membranes before labour (PROM means pre labour) and over 37 weeks

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21
Q

what drug is opposite to oxybutanin

A

terbutaline-a beta agonist so used in hyperstimulation

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22
Q

what is the onset of gestational hypertension?

A

24/40 so if it’s detected before this then it must be underlying diabetes

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23
Q

when should the combined test be done?

A

10-14 weeks

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24
Q

do you need to be concerned about micro and macrovascular complications in gestational diabetes?

A

no

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25
what additional risk factors does pre existing DM carry over GDM?
congenital abnormalities miscarriage NOT IN GDM
26
what does pregnancy cause in diabetics?
increased insulin requirements and so hypoglycaemia in early pregnancy speeds up retinopathy, nephropathy
27
what is the management for any chronic health condition in pregnancy?
pre-conception counselling!
28
what is the prognosis of GDM?
glucose metabolism returns to normal after metabolism but increased risk of T2DM in the 10 years following the pregnancy
29
when is GDM tested for?
24 to 28 weeks with OGTT | then 6 weeks postpartum do another to see if there was underlying DM
30
management of diabetes
folic acid serial growth scans metformin or glibenclamide induction at 38-40
31
what is the definition of preeclampsia?
140/90 and 300mg of protein in 24hrs
32
what increases risk of developing pre-eclampsia
``` young mother primigravida last baby over 10 years ago change in partner from last chronic hypertension renal disease ```
33
4 red flag symptoms of pre eclampsia
headache visual disturbance RUQ pain breathlessness (pulmonary oedema)
34
4 red flag signs of preeclampsia
clonus hyperreflexia fits periorbital oedema
35
how do you treat a pre eclampsic fit
get help IV magnesium sulfate IV labetolol or hydralazine
36
pre eclampsia buzz words
spiral arteriole persistence failure of placentation widespread endothelial dysfunction multi organ failure
37
what is worrying on Doppler?
after 20w absent end diastolic flow
38
what should pregnant women avoid eating?
``` pate high mercury fish (shark, swordfish) unpasteruised milk or juice liver uncooked egg must limit caffeine intake ```
39
what are your differentials for abdominal pain in pregnancy?
UTI stones cholecystitis appendicitis
40
what do you give a pregnant woman with a UTI at 21 weeks?
trimethoprim | nitro is only for 0-12
41
what are the effects of smoking on a fetus?
``` placental insufficiency so pre eclampsia miscarriage ectopic stillbirth SIDS asthma otitis media ```
42
guidelines for alcohol consumption in pregnancy
none in first trimester, after: 2U once or twice a week
43
wat are the effects of alcohol on a fetus?
IUGR prem stillbirth FAS
44
what are the features of FAS?
``` mental retardation: learning difficulties, ADHD smooth philtrum low set ears microcephalus microganthia flat nasal bridge ```
45
what is prematurity defined as?
under 37 weeks
46
what is the management of pre eclampsia?
hydralazine and nifedipine and labetolol, if hyperreflexic>MgSO4 induce at 37weeks
47
which medications will affect a pregnant asthmatic woman?
mainly induction agents: ergometrine prostaglandin labetolol
48
what is the only indication for warfarin in pregnancy
metal valves
49
why does obstetric cholestasis occur?
more female hormones that the liver has to deal with, it can cause stillbirth and affect fetal heart. Mx=ursodeoxycholic acid
50
how is placenta praevia defined?
placenta within 2.5 cm of the os
51
give some general complications of antepartum haemorrhage
transfusion DIC ARDS acute tubular necrosis
52
risk factors of shoulder dystocia
``` large foetus large mother induction prolonged labour GDM instrumental delivery ```
53
management of shoulder dystocia
``` HELPERRR help espisiotomy consider legs into McRobert's pressure enter the pelvis rotational manourvres remove posterior arm repeat (very last-break symphisis or zalvanellis) ```
54
complication of shoulder dystocia?
Erb's palsy-arm is extended, internally rotated and wrist is flexed and protonated PPH, 3+4 tears, PTSD
55
when is Guthrie's test done?
5-8 days old or when feeding is established
56
once labour is established, how often do contractions occur?
45-60s every 2 to 3min
57
what are the contraindications for induction and vaginal delivery?
bishops of under 4 transverse severe cephalopelvic disproportion placenta praevia
58
risk factors for prematurity
``` previous prem baby black multiple pregnancy smoking genital infection ```
59
what is the normal birthweight?
2.5-4.5kg
60
what does ergometrine do?
causes uterus to contract so used in PPH and induction
61
what is given after delivery to mother?
IM oxytocin for active managment of the third stage
62
why are NSAIDs contraindicated in the after 27 weeks?
they open the ductus arteriosus
63
what are the risks of not breastfeeding?
to mother-breast ca | baby: otitis media, T2DM, obesity, SIDS, leukaemia
64
what does APGARs stand for?
``` appearance pulse grimace activity respiratory effort ```
65
what do you do with a low APGARs?
0-3 full resus 4-6 some resus-o2 and rub repeat APGARs at 5 min
66
when is APGARs done?
1 min after delivery and 5 min if low
67
when is the baby check done?
first 72 hours | 6-8 week baby check
68
what medications are used to increase tone in PPH?
``` ergometrine misopristol carboprost oxytocin tranexamic acid ```
69
what are you trying to stimulate by sweeping membranes?
Ferguson reflex
70
what does the cytotrophoblst differentiate into?
more cytotrophoblast cells syncitiotrophoblast extra villus trophoblast
71
what is the role of hcg?
its from the trphoblast, it signals the prescence of an embryo and prevents luteal regression
72
which is the main hormone in pregnancy?
E3-oestriol | others being oestrodiol and oestrone
73
when does the blastocyst hatch?
6th day so this is when implantation happens
74
how many cells are a blastocyst?
32-64
75
how is blood supply established?
haemochorial placentation
76
what are the risk factors for GDM?
previous macrosomic baby previous GDM 1st degree relative with diabetes SE asian, carribean
77
what is the cutoff for gestational diabetes?
>5.6 fasting | >7.8 OGTT
78
what bloods would you do if you suspected pre eclampsia and what would you find?
FBC (low plts, low hb) U&Es (raised creatinine and urea) LFTs (raised AST)
79
what would you worry about in reversed end diastolic flow?
could be heart failure-need to get MRI asap | it's when the line goes beyond the x axis
80
why might a baby be small for dates?
SWAN starved (asymetrical-IUGR so placental insufficiency, maternal disease, pre eclampsia) wrong dates abnormal (chromosomal abnormality, abnormal uterus, infection) normal-constitutional
81
when should a woman be admitted to labour ward
when contractions are regular and at 5-10 intervals
82
how many contractions should there be in 10?
3, if anymore there's a risk of fetal distress
83
how long should each stage of labour last?
1st nulli-10h; multi-6h 2nd nulli-40min; multi-20min 3rd-15min so 7 or 11 hours
84
how quickly should someone progress in the active stage?
nulli 1cm in 1hr | multi 2cm in 2hr
85
what produces hcg?
syncitiotrophoblast
86
what is ritodrine?
beta 2 agonist used for tocolysis
87
what is the management of pre-eclampsia in pregnancy?
1) oral labetolol or hydralazine if not working 2) steroids at 34+ 3) delivery: mild-37w; severe-34-6; any complications-now
88
what prophylaxis should be used in woman with: prev pre htn in pregnancy, CKD, SLE, antiphospholipid syndrome and DM?
aspirin 75mg after 12 weeks to reduce pre eclampsia
89
how is antiphospholipid syndrome treated?
aspirin or LMWH
90
risk factors for pre eclampsia
``` previous pre eclampsia in another pregnancy smoking multiple pregnancy CKD autoimmune disease: SLE or antiphospholipid DM chronic htn age FHx first pregnancy first pregnancy in over 10 years ```
91
what are the risks of preeclampsia?
``` PPH IUGR HELLP eclampsia placental abruption liver failure pulmonary oedema ```
92
3 days post birth, SCBU baby develops sepsis, what is the likely pathogen?
after 48 hours-HAI more likely so staph epidermidis or staph aureus
93
what antibiotic is used for GBS prophylaxis?
benzylpenicillin
94
when can termination be offered in rubella infection?
before 16 weeks
95
how do you treat toxoplasmosis infection?
spiramycin
96
abruption risk factors
``` IUGR pre eclampsia HTN smoking previous abruption ```
97
management of OP presentation?
may need to induce or use instrumental delivery
98
what does a bishop score of over 9 mean?
labour is likely to commence spontaneously
99
what does a bishop score of under 5 mean?
induction is needed
100
when should the different forms of induction be used?
sweep vaginal prostaglandins in most, esp nulliparous-need to do CTG 1hr after amniotomy if prostaglandins aren't working oxytocin after SROM or 2 hr after amniotomy-need to cont CTG
101
what increases the risk of shoulder dystocia?
high maternal BMI DM macrosomnia prolonged labour
102
what increases the risk of cord prolapse
anything that prevents the head from engaging
103
what pH suggests fetal hypoxia
under 7.2
104
what should you consider if syntocinin isn't working?
ergometrine unless they're hypertensive, it will cause severe vomiting
105
investigations in recurrent miscarriage
antiphospholipid screen karyotyping USS empty uterus
106
what should you do in someone diagnosed with hyperemesis?
encourage hydration, exclude things that could dehydrate further like UTI or multiple pregnancy
107
what antibiotic should be given to prevent GBS?
IV benzylpenicillin or ampicillin
108
which STI is asso with opthalmia neonatorum?
gonorrhoea
109
what does CMV cause in infants?
sensorineural hearing loss, CP, mental retardation, jaundice, splenomegaly, IUGR, microcephaly treat baby with ganciclovir
110
what is measured on the combined test
PAPPA A BETA hcg nuchal translucency
111
what is measured on the quadruple test
unconjugated oestrodiol beta hcg inhibin A AFP
112
when can chemo be used in pregnancy?
2nd and 3rd trimester, radiotherapy cannot unless livesaving
113
what considerations are there in the management of an obese pregnant woman
``` need thrombopropylaxis post delivery 5mg folic acid 10mg vit D anaestetist rv active management of the third stage bc at greater risk of PPD ```
114
what are the values for GDM?
2hrs past then 7.8 mmol indicates intolerance | 7mmol random also suggests GDM
115
what serum tests are done on booking?
syphilis, HIV, hep B, rubella | not CMV or GBS
116
give 2 rfs for accreta
prev caesarean | Asherman's
117
when can you give steroids for lung maturity?
only over 24w
118
what investigation can be done in pregnancy for suspected PE
VQ scan, MRI not useful, CTPA too much radiation, D dimer isn't definitive at best of times and is raised in pregnancy anyway
119
what has to be avoided in all women with antepartum bleeding?
VE-only if preterm labour is dx
120
what is the conservative managment of someone with PPROM?
10d antibiotics, steroids from 24-34w then deliver 34-36w
121
what is the diameter in face presentation?
sugmentobregmatic
122
what is the diameter in brow presentation?
mentovertical
123
what antibiotic is best to use in UTI during pregnancy?
amoxicillin but co amoxiclav is teratogenic
124
causes of miscarriage
chromosomal infective (BV) uterine abnormalities thrombophilic abnormalities
125
RFs of miscarriage
prev miscarriage maternal age smoking
126
how does the definition of PPH change when it was CS?
it's over 1L rather than 500mL
127
how should oxytocin be given when ripening the cervix?
titrated up
128
what are the complications of antepartum haemorrhage?
``` PPH-consumptive coagulopathy anaemia IUFD fetal hypoxia blood transfusion ```
129
how do you determine how much anti D IMMUNOGLOBULIN to give?
Kleihauer test
130
what is a healthy birthweight
2.5-4.5kg
131
when should CTG be used continuously?
oxytocin infusion (intermittent with prostaglandin) epidural DM previous antepartum haemorrhage
132
what is the immediate management of fetal distress?
``` LLP o2, fluids, stop oxytocin use beta agonist VE exam to exclude cord prolapse and rapid progress fetal blood sampling ```
133
what are the indications for induction?
``` 41/40 SROM over 24 hours ago pre eclampsia DM IUGR CI: fetal distress-emergency CS! ```
134
what should be avoided in SROM?
vaginal exam, instead do a CTG
135
what is perinatal morality
24 weeks to 28 days

3a (11 decks)

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