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Obs & Gynae > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is the normal foetal position of engagement

A

occiput anterior position

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2
Q

Classification of delay in failure to progress in labour

A

Primigravida: 1 hour suspect delay
2hours dx delay within active phase

Multiparous: 30 minutes suspect delay
1 hour dx delay

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3
Q

List the risk factors for a difficult labour

A 
High BMI
HTN 
Previous C section 
Multifoetal pregnancies 
Small women large babies 
Gestational DM 
Foetal position
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4
Q

Types of malpresentation

A

Abnormal lie

  • longitudinal
  • transverse

Occiputposterior/transverse
Breech
Brow
Face presentation

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5
Q

Discuss the potential causes of meconium stained liquor, the potential adverse effect associated with it and the management?

A

Indicator of foetal distress

Cx: placental insufficiency 
HTN
Oligohydraminos 
Smoking 
Cocaine 
Increase in maternal age

Risks: Meconium aspiration syndrome

Rx: Continous foetal monitoring
Obstetrician led-care
Foetal blood sample pH > 7.2 emergency c-section

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6
Q

Progesterone challenge test

A

Give 5mg of methoxyprogesterone for five days if positive vaginal bleeding will follow

Negative result may indicate an absent womb

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7
Q

Gestational trophoblastic disease

A 
Bleeding in early pregnancy 
Severe hyperemesis
New onset HTN
Uterus that is large than expected 
Extremely elevated HCG
No foetal parts id on USS
USS looks like a snow storm
Strongly associated with thyroid dysfunction
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8
Q

Complications of polyhydraminos

A

Postpartum haemorrhage

Preterm labour

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9
Q

Role of progestins and oestrogens in the normal physiology of labour

A

Progestins

  • Proliferation, vascularisation and differentiation of endometrial stroma
  • Myometrium quiescence
  • Represses contractile proteins
  • Impairs Oxycontin and PGF2alpha synthesis

Oestrogens

  • Foetal wellbeing
  • Endometrial proliferation and differentiation
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10
Q

Discuss the physiology of pregnancy. Make reference to implantation, endovascular invasion, immunity and myometrial quiescence.

A

Hormones involved

  1. HCG
  2. Progestins
  3. Oestrogen
  4. Prolactin
  5. Oxytocin
Implantation
Dedidual reaction
Placenta develops floating and anchoring villi
Differentiation of cells under hypoxic conditions 
Cells 
1. CTB
2.ScTB (terminal differention)
3. Anchoring villi

Endovascular invasion by the spiral arteries
wide bore low resistance veins
Pre-eclampsia: poor endovascular remodelling
reduced foetal o2

Reduced immune response especially humeral related immunity

Myometrial quiescence based on cell signalling cascades and secondary messengers phosphorylation of intracellular proteins = inactivation of actin/myosin ATPase

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11
Q

Define screening and discuss the antenatal screening programmes carried out

A

Screening: a process of identifying apparently health individual who may be at increased risk of a disease or a condition

Detection rate: % of affected individuals identified by the test

Programmes

  • Foetal anomaly screening
  • Infectious diseases (Hep B, HIV and syphillis)
  • Sickle cell and thalasaemia
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12
Q

Foetal anomaly screening programme

A

First semester

  • crown-rump measurement
  • blood sample (measure levels of PAPP-A, HCG-B)
  • measure nuchal translucency

Second trimester

  • Serum markers
  • Nuchael translucency

+ve results
CVS (11-13)
Amniocentesis (post 15 weeks)

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13
Q

Apart from FA what other conditions are screened for in antenatal clinic

A 
Infectious disease (Hep B, HIV, Syphillis, Rubella)
Haemoglobinopathies (alpha and beta thalasaemias, sickle cell disease)
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14
Q

What conditions are tested for in the newborn screening programme

A 
Sickle cell disease 
Cystic fibrosis
Congenital hypothyroidism 
Phenylketonuria 
MCADD
Maple syrup disease 
Isovaleric acidaemia 
Glutamic acidaemia 
Homocystinuria
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15
Q

Define gestational diabetes and the diagnostic criteria

A

Carbohydrate intolerance which is diagnosed during pregnancy. May or may not resolve post pregnancy.
Fasting glucose > 5.6mmol/L
2 hour glucose tolerance test >7.8mol/L

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16
Q

List the risk factors for GDM

A 
BMI >30 
Previous macrocosmic baby weighting >4.5kg
Previous gestational diabetes 
Previous gestational diabetes 
1st degree relative with diabetes 
Ethnicity 
- South Asian
- Black Caribbean
- Middle eastern
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17
Q

Foetal risks associated with having GDM

A 
Congenital abnormalities 
Preterm labour
Increased birthweight 
Increased likelihood of polyhydraminos 
Increase risk of birth trauma/ dsytocia 
Increased risk of later developing DMII
Increased risk of jaundice
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18
Q

Maternal risks associated with GDM

A 
Ketoacidosis
Hypoglycaemia 
UTI
Endometrial infection
Increased likelihood of a C-section
Increased likelihood of an instrumental delivery
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19
Q

Treatment and screening of GDM

A

Treatment

  • Advise re diet and exercise
  • Treat with metformin. If not well controlled on metforim treat with insulin
  • Perform serial growth scans
  • During delivery patient requires a sliding scale of insulin and dextrose

Screening
- 28 weeks GTT as part of routine antenatal screening

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20
Q

Preconceptual care for women with pre-existing DM

A 
Optimising glycemic control
Education of the patient 
Pre-conceptual folic acid (5mg)
Screen for retinopathy/nephropathy
HbA1c > 85mmol/mol DO NOT get pregnant 
Stop all hypoglycaemic except metformin
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21
Q

Epilepsy in pregnancy

A

Epilepsy drugs can be tetrogenic
Seizure free monotherapy should be a the lowest possible dose
Patients require detailed USS to observe
- cardiac function
- neural tubal defects
- skeletal condition

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22
Q

Risk factors for pre-term labour

A 
Previous preterm labours 
Smoking 
Low socio-ecconomic group 
BMI <19
Lack social support 
Extremes of reproductive age 
Chronic medial conditions
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23
Q

List the potential causes of preterm labour

A 
Infections 
Uterine overextension 
Ureoplacental ischaemia 
Cervical incompetence 
Foetal abnormality 
Iatrogenic
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24
Q

Name the pathogens which are involved in pre-term labour

A

STD; Chylamydia, Trichomonas,Syphilli
Enteric orgnaism: E.coli and strep faecsali
Bacterial vaginosa: Gardnerella, Mycoplasma
Grp B strep

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25
Q

Management of a potential pre term

A

1)Tocolysis: drugs to reduce uterine contractions. Depends on cervical dilation, administer steroids and need for inter transfer.

Drugs
Oxytocin antagonists -Atosiban
Calcium channel blockers - Nifedipin
B blockers- Ritodrine, acts on the beta receptors in the myometrium to relax
NSAID’s- act on cox enzyme that catalyses the production of prostaglandins
Nitric oxide acts on the myometrium in vitro to cause reaction

2)Abs therapy
Erythromin given prophylactically in PROM _ protect the foetus from an ascending infection

3) Cervical cleavage

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26
Q

Premature rupture of membranes

A

Main risk = SEPSIS
Dx: Confirmed by a pool of liquid in the poster fornix

Expectant management: Erythromycin and steroids

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27
Q

Outline the role corticosteoirds play in preterm labour

A

x2 IM injections 12-24hrs apart
reduce neonatal distress
Pree 24+0 weeks and post 34+6 weeks

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28
Q

Define APH

A

Any bleeding from the genital tract that occurs after 24 weeks of gestation till before the birth of the infant

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29
Q

List the causes of APH

A 
Placenta previa
Placenta abruption
Uterine rupture
Infection
Post coital
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30
Q

Classify the types of APH

A

Minor < 50mL
Major < 50-100mL
Massive 1000mL

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31
Q

How does APH commonly present

A

Bleeding (painful/painless)
Uterine contractions
Foetal distress

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32
Q

Management of APH

A 
ABC 
15L O2
IV access wide bore cannula 
Group and save - order blood 
Cathertise (maintain urine output > 30mL)
Perform a USS 
Do NOT perform a VE
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33
Q

Define placenta previa and classify the grades

A

Placenta previa is the placenta wholly or partially attached to the lower uterine segment

1: % of the placenta does not sit in the lower segment
2: Placenta reaches the internal os, on dilation =bleeding
3: Placenta is covering the os asymmetrically
4: All of the placenta is in the lower segement

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34
Q

Risk factor for APH

A 
Previous c-section 
Advanced maternal age 
Multiparity
Multiple pregnancy 
Smoking
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35
Q

Discuss the key presenting feature of placenta previa and discuss the management of these patients

A

PAINLESS BLEEDING occurs unprovoked. Degree of maternal shock will correlate with the degree of blood loss
Internal Os should be 3cm away from the leading placental edge
Grade 1: May be able to deliver vaginally
Grade 2-4: Delivery via c-section. Avoid penetrative intercourse.
May require inpatient care @ 34 weeks
Cross match 4 units of blood

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36
Q

Define placenta abruption

A

Placenta attachement to the uterus is disrupted by haemorrhage as the blood dissects under the placenta

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37
Q

Risk factors for placenta abruption

A 
Previous abruption
Increase maternal age
Multiparity
HTN
Smoking 
Cocaine use 
ECV
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38
Q

Clinical presentation of placenta abruption

A

PAINFUL bleeding
Revealed haemorrhage vs concealed haemorrhage
Pain may be out of proportional with the perceived loss of blood
Hardy woody uterus and guarding of the abdomen

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39
Q

Management of placenta abruption

A 
ABC 
Oxygen 
Wide bore cannula IV access 
If foetus remain alive 
Give steroids and emergency c-section
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40
Q

Explain the pathophysiology of vasa previa

A

Foetal blood
Umbilical cord = x2 arteries x1 veins
Arteries carry C02 from the baby to the placenta
Veins carry O2 and nutrients from the placenta to the baby
Umbilical cord inserts into the membranes
SROM or AROM can tear the vessels
BABY EXSANGUINATE = cold white baby
Must c-section immediately

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41
Q

Define PPH

A

Bleeding from the genital tract of more than 500mL after delivery of the infant

Primary PPH: bleeding of more than 500mL within 24hours after delivery

Secondary PPH: bleeding of more than 500mL that starts 24hours after delivery

> 2000mL = massive obstetric haemorrhage

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42
Q

Haematological changes in the mother during pregnancy and immediately afterwards

A 
Pregnancy
Increase in VWF 
Increase in Factor 8
Increase in Factor 9 
Increase in in Factor 10 
Increase in Protein resistance C 
Decrease in Protein resistance S 
Decrease in fibrinolytic activity

++ve coagulation state

@pregnancy: Increase RCV and plasma volume

@post partum: increase in RCV, plasma volume returns to normal = VTE is common

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43
Q

List the causes of PPH

A

TONE

  • Atonic delivery
  • Multiparous
  • Gestational DM
  • Increased foetal size
  • Multifoetal birth
  • Polyhydraminos
  • Long labour

TISSUE
-Retained products of conception
commonest cause of 2nd PPH

TRAUMA

  • Laceration the the uterus, cervix and vagina
    1: injury to the perennial skin
    2: injury to the perinial skin + muscles
    3: Injury to the perineal skin + muscles+ anal sphincter
    4: Injury to the perineal skin+ muscles+ anal sphincter + anal muscles

THROMBIN
Disseminated intravascular coagulation
Consumptive coagulopathy = all the clotting factors and the platelets are consumed

2 PPH: very commonly due to retained products of placenta.
Very common in molar pregnancies
Patient presents with fever, increased RR, increased HB, decreased BP

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44
Q

Discuss the management of PPH

A

ABC APPROACH ALWAYS

Atony:

  • Bimanual compressions
  • Syntometrin
  • Misoprostolol
  • Ballon compression
  • Bilateral ligation of the arteries
  • Hysterectomy

Retained Products of Placenta

  • Controlled cord traction
  • Placenta examined ( cotyledons + membranes intact)
Uterine Inversion (RARE) 
Uterine rupture (RARE)
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45
Q

List the physiological adaptions that occur during pregnancy

A

RESP

  • CO2 levels decreased
  • Tidal volume increases
  • Compensated resp alkalois

CV

  • Increased cardiac output
  • Increase blood volume = physiological anaemia
  • systolic ejection murmur

URINARY

  • Kidneys increase in size
  • Increase in eGFR
  • Decrease in plasma urea and creatine
  • Increased frequency of urination

ENDO

  • All increase except
  • Decrease in FSH/LH/GH/Oxytocin
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46
Q

List the causes of prolonged labour

A

3 P’s
Power
- Poor uterine activity
- Ruptured uterus

Passenger

  • Malposition
  • Malpresentation
  • Size of infant

Passage
Cephalopelvic disproportion
Cervical dystocia

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47
Q

Dx criteria for polyhydraminos

A

Amniotic fluid index > 25cm

Deepest vertical pool > 8cm

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48
Q

Define early pregnancy

A

First trimester of pregnancy, up to and including the 12th week

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49
Q

List the complications of early pregnancy

A

Miscarriage: loss of pregnancy before 24 weeks of gestation

Ectopic pregnancy: pregnancy which is implanted outside of the uterus
Can occur in the ovary, cervix, corneal or most commonly in the fallopian tube.

Trophoblastic disease: partial or completel molar pregnancies. Can be followed by a choriocarcinoma

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50
Q

List the different types of miscarriage

A

Threatened: Bleeding, cervical os is closed

Inevitable: Heavy bleeding with clots and pain, cervical os is open

Missed/delayed/silent: Non viable foetus or empty intrauterine sac on scan. Cervical os is closed o/e

Complete: No products of conception in uterus on scan. Cervical os is closed

Incomplete: products of conception are only partially expelled. Cervical os is open

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51
Q

Causes of miscarriage

A 
Foetal abnormality 
Infection (TORCH)
Maternal age 
Abnormal uterine cavity
Maternal illness 
Intervention
52
Q

Management of miscarriage

A

Expectant management to expel the products of conception
Medical can give vaginal misoprostolol or oral misoprostolol
Evacuation of retained products of conception
Discuss endometritis: fever, feeling unwell, lower abdominal pain and change in vaginal bleeding
Rheusus negative: require anti-D is after

53
Q

Define recurrent miscarriage

A

Three or more consecutive first trimester miscarriages

54
Q

Possible causes of recurrent miscarriage

A 
Abnormal uterine cavity 
Antiphospholipid antibodies 
Cervical weakness 
Foetal abnormalities (Karotype both partners and the products of conception if possible)
Bacterial infection
55
Q

Define ectopic pregnancy

A

Pregnancy implanted outside of the uterine cavity

56
Q

Causes of ectopic pregnancy

A 
Damage to the uterine tubes or the ciliary lining 
PID 
Tubal surgery 
Pelvic surgery 
IUCD
IVF
Endometriosis
57
Q

Clinical features of an ectopic pregnancy

A 
Abdominal pain 
Pelvic pain 
Shoulder tip pain 
Missed period 
Empty uterus on scaning

Ruptured
Shock
Intense pain
Bleeding

In a viable pregnancy B-HCG will double every 48hrs . In ectopic the level will either plateau or rise but not double

58
Q

Treatment of an ectopic pregnancy

A

Medical

  • Methotrexate
  • not in significiant pain
  • unruptured ectopic pregnancy adrenax mass <35cm and no visible heart beat
  • Serum B-HCG <1500UI/L
  • use contraception for 3-6 months as tetraogenic

Surgical

  • Salpingectomy (complete or partial) tube fully or partially removed
  • Salpingotomy ( incision made into the tube and tube allowed to heal by secondary intention)
59
Q

Define gestational trophoblastic disease

A

Covers complete and partial molar pregnancies as well as the choriocarcinoma which can follow

Complete molar: Pregnancy consisting of a mass of trophoblastic tissue, no evidence of a foetus, all maternal genetic material has been deleted, all genes are paternal.

Partial molar: Pregnancy consisting of a mass of trophoblastic proliferation, foetus is visible (non-viable)

Chpriocarcinoma: trophoblastic cells which secrete hCG when molar pregnancies do not regress after surgical evacuation.

60
Q

Clinical evaluation of a molar pregnancy

A 
Bleeding early in the pregnancy 
Uss: bunch of grapes 
High levels of hCG 
Severe hyperemesis
Vaginal bleeding 
Uterus is large for dates
61
Q

Management of a molar pregnancy

A

Surgical evacuation
Fortnightly samples of hCG to confirm levels are falling and the tumour is regressing
Levels normal: monthly samples tested monthly for either 6 months (if normalised in 8 weeks or 2 years)
Avoid hormonal contraception or conceiving for a least 6 months post normal levels

62
Q

Causes of polyhydraminos

A 
Multiple pregnancy 
Infection (TORCH)
Gestational diabetes 
Oesophageal atresia 
Neural tubal defect 
Foetal anomaly 
Genetic disorders 
Maternal substance abuse
63
Q

Management of polyhydraminios

A

Treat the cause
Give steroid prenatally in case of preterm labour
Progesterone synthase inhibitors maybe given for up to max 48hrs
Induction of labour in case of foetal distress

64
Q

Risk factors associated with polyhydraminos

A 
Preterm delivery and labour 
Increased incidence of C-sections 
Low birth weight 
Low APAGAR Scores 
Malpresentation 
Cord prolapse 
PPH
65
Q

Complications of GDM

A

Foetal

  • Congenital abnormalties
  • Preterm labour
  • Increased risk of birth trauma (shoulder dystocia)
  • Increase birth weight

Maternal

  • Ketoacidosis (rare)
  • Hypoglycaemia
  • UTI
  • Endometrial infection
  • Increased likelihood of c-section
66
Q

Signs of hypothyroidism in pregnancy

A 
Lethargy 
Tiredness
Weight gain 
Dry skin 
Hair loss

Note for the first 12 weeks foetus relies on maternal thyroid hormone. If absent = miscarriage, reduced intelligence, near-developmental delay and brain damage

67
Q

Treatment of hypoparathyroidism in pregnancy

A

Thyroxine

Check TSH and T4 levels regularly

68
Q

Treatment of hyperparathyroidism in pregnancy

A

Anti thyroid meds: Proplythioruracil or carbimazole
B-Blockers to improve symptoms
Monitor TFT’s throughout

69
Q

Pathophysiology of VTE

A

Prothrombotic state
Increase in clotting factors
Increase in fibrionogen levels

70
Q

Risk factors for VTE in pregnancy

A 
Thrombophilia 
Age >35
BMI > 30
Parity > 3
Smoker 
Immobility
Gross varicose veins 
Multiple pregnancy 
Medical comorbities 
Systemic infection
71
Q

Management of high risk VTE patients

A

Antenatal risk assessment
General measures of mobilisation and maintenance or hydration
Compression stockings
LMW heparin
Postpartum prophylaxis ( high risk up to 6 weeks)

72
Q

Treatment of VTE

A

Therapeutic dose of LMW heparin

Warfarin is tetraogenic

73
Q

Anaemia in pregnancy

A

Common disorder
Physiological anaemia
<11g/dl at booking
<10.5g/dl at 28 weeks

Iron supplements to be given
Increase vitamin C consumption to aid with absorption
Will reduce the need for a transfusion following delivery

74
Q

Define the Bishops score

A

Cervix scoring system to assist in predicting of induction of labour will be required
Based on
- Cervical dilation in centimeters
- Cervical effacement as a percentage
- Cervical consistency by provider assessment/judgement
- Cervical position
- Foetal station, the position of the fetal head in relation to the pelvic bones

75
Q

Classify the types of HTN in pregnancy

A
  1. Pre-existing HTN: Bp >140 before pregnancy. Increased risk of pre-pre-eclampsia
  2. Pregnancy induced HTN : HTN presenting after 20 weeks of gestation. No proteinuria
  3. Pre-eclampsia: HTN presenting after 20 weeks of gestation
    - HTN
    - Proteinuria
    - Oedema
76
Q

Treatment of HTN in pregnancy

A

Pre-existing: Pregnancy appropriate medication. Low-dose aspirin (75mg) has been shown to be beneficial in reducing the risk of developing PET

Pregnancy induced: Start on laneetalol ( methlydopa/ nifedipine) regular urine dips to rule out proteinuria

77
Q

Define pre-eclampsia

A

New onset HTN after 20 weeks with significant proteinuria. Multi system disorder

  • HTN
  • Proteinuria
  • Oedema

Placental in origin

78
Q

Risk factors for developing pre-eclampsia

A 
Nulliparity 
Previous hx
Family hx
Increase age
Chronic HTN
Twin pregnancies
Autoimmune disease 
Renal disease 
Obesity
79
Q

Pathophysiology of pre-eclampsia

A

Stage one: DEVELOPMENT OF THE DISEASE

  • incomplete trophoblastic invasion
  • Spiral artery flow reduction
  • Uteroplacental blood flow reduction
  • Exaggerated inflammatory response
  • Endothelial cell damage

Stage two: MANIFESTATION OF THE DISEASE

  • Increased vascular permeability = Oedema, HTN and proteinuria
  • Vasoconstriction = HTN, eclampsia, liver damage
80
Q

Clinical features of pre-eclampsia

A 
Asymptomatic (often)
Headaches
Drowsiness
Visual disturbance 
Nausea/ Vomiting 
Epigastric pain
81
Q

Treatment of pre-eclampsia

A
  1. Labetalol: alpha and beta blocker
  2. Nifedipine: Calcium channel blocker
  3. Methyldopa: alpha agonist. prevents vasoconstriction
  4. Hydralazine: IV causes vasodilation

Severe risk of eclampsia: give MgSO4 IV

82
Q

Define eclampsia

A

Occurrences pf seizures in pregnancy following from pre-eclampsia

83
Q

Management of eclampsia

A

Airway: protect
Breathing: give high flow O2
Circulation: Obtain IV access and take bloods

Give MgSO4 4 gram bolus over 20 mins
MgSO4 1g/hr over 24 hours following last seizure
Treat HTN
Consider delivery

84
Q

Clinical features of sepsis

A 
Pyrexia
Tachycardia 
Hypotension 
Rigors 
Confusion 
Collapse
85
Q

Cord prolapse

A

Cord is the presenting part
Often leads to foetal death
Exposure of the cord = vasospasm
Foetus is starved of oxygen

86
Q

Risk factors for cord prolapse

A 
PROM
Polyhydraminos
Long umbilical cord 
Low lying placenta 
Low birth weight 
Malpresentation
87
Q

Define shoulder dystocia

A

Failure of the anterior shoulder to pass under the symphysis pubis after delivery of the foetal head that requires specific manoeuvres

88
Q

Risk factors for shoulder dystocia

A

Macrosomia
Maternal DM
Distortion between the mother and the foetus
Maternal obesity

89
Q

Discuss how a CTG should be interpreted

A

DR.C.Bravdo

Define risk: (PC, age, primi, multi,gravida, para, BMI )

Contractions: Number of contractions present in a 10 minute window

Baseline rate: Average foetal heart rate over a 10 minute window (110-160bpm)

Accelerations: abrupt increase in baseline heart rate. 2 acceleration every 15 minutes

Variability: variation of foetal HR from one beat to another

Overall impressions: reassuring, suspicious, pathological

90
Q

List the potential causes of oligohydramnios

A 
Ruptured membranes 
Foetal abnormality
Aneuploidy
IUGR
Foetal infection
Maternal drugs (atenolol)
91
Q

Describe the stages of labour

A

1st stage

  • Latent stage: cervix effaces and dilates <4cm
  • Active stage: contractions, dilation >4cm

2nd stage

  • Passive: complete dilation
  • Active: pushing

3rd Stage
- Passage of the placenta

92
Q

Define cervical ripening

A

Physical softening and distensibility of the cervix
Occurs prior to the onset of labour
Enzymatic dissolution of the collagen and increase in the water content

93
Q

Outline the timeframes for delay in labour

A

1st stage

  • Primi <1cm/ hour
  • Multi <1cm/30 minutes

2nd stage

  • Multi: delivery not imminent within 1hr of active pushing
  • Primi: Delivery not imminent within 2hrs of active pushing
94
Q

Explain the role of prostaglandins and oxytocin

A

PROSTAGLANDINS

  • Local application of prostaglandin E2 can help with the ripening of the cervix
  • Uterine contractions
  • Expulsion of the placenta
  • Feedback mechanism

OXYTOXIN

  • Uterine contractions
  • Syntocin
95
Q

List the factors recorded on a partogram and the role of an alert and action line

A

Foetal HR: monitor wellbeing of the infant
Cervix dilation: progression of labour
Contractions per minute: speed of labour

Indicates slow progression and measures that should be taken

96
Q

Maternal and foetal consequences of failure to progress

A

MATERNAL

  • Long labour
  • Increased risk of tears
  • Increased risk of bleeding

FOETAL

  • Foetal hypoxia
  • Increase risk of mortality or morbidity
97
Q

Outline the descent of the foetus in the birth canal

A 
Descent 
Flex 
Internal rotation 
Crown 
Extention
98
Q

Define small for gestational age

A

Weight of the foetus is less than the tenth centile for gestational age

99
Q

Define large for gestational age

A

Weight of the foetus is greater than the 95th centile

100
Q

Define intrauterine growth restriction

A

Foetus has failed to reach their growth potential, often due to placental dysfunction

101
Q

List the cause of intrauterine growth restriction

A

FOETAL

  • Chromosome abnormalities (trisomies)
  • Infections (TORCH)
  • Multiple pregnancy

PLACENTAL
- Abnormal trophoblastic infiltration ( pre-eclampsia/infraction/abruption)

MATERNAL

  • Chronic disease
  • Behavioural ( smoking/durgs/alcohol)
102
Q

List the risk factors for small for gestational age

A

MAJOR

  • Maternal age >40
  • Smoker
  • Cocaine use
  • Previous SGA baby
  • Previous stillbirth
  • Chronic hypertension
  • Diabetes
  • Renal impairment
  • Antiphospholipid
  • Low PappA

MINOR

  • Maternal age >35
  • Nulliparity
  • BMI >20
103
Q

Management of an abnormally sized baby

A

SMALL

  • Umbilical artery doppler ( if normal), serial growth scans every 2-3 weeks
  • If abnormal consider delivery via CS
  • Give glucocorticoids
  • Feed within 2hrs of birth due to the likelihood of hypoglycaemia

LARGE

  • Monitor with growth scans
  • Rule out potential causes ( GDM)
  • Consider CS
  • Prone to hypoglycaemia and hypocalcaemia
104
Q

Causes of breech

A 
Idiopathic 
Uterine abnormalities 
Fibroids 
Prematurity 
Placenta previa 
Oligohydraminos 
Foetal abnormalities
105
Q

Principle of ECV

A

Turn the baby through a forwards somersault

Contraindications

  • Placenta previa
  • Multiple pregnancy
  • APH
  • Ruptured membranes
  • IUGR
106
Q

Signs of uterine rupture

A

Pain ( variable, can just be tenderness over the uterus)
Variable vaginal bleeding
Continued bleeding with a well contracted uterus
Shock

107
Q

Management of uterine rupture

A

ABCD
C- section
May require a hysterectomy

108
Q

Define cord prolapse

A

Descent of the cord through the cervix below the presenting part after the rupture of the membranes
Cord compression and vasospasm results in foetal asphyxia

CF: Foetal braycardia (always do a VE)
Visible cord

109
Q

Define shoulder dystocia

A

A delivery requiring obstetric manoeuvres to release the shoulder after gentle downward traction has failed.

110
Q

Risk factors for shoulder dystocia

A 
Large foetus 
Maternal BMI >30
Induced or augmented labours 
Prolonged labours 
Previous shoulder dystocia 
Diabetes mellitus
111
Q

Management of shoulder dystocia

A

Legs in McRoberts position

Suprapubic pressure

112
Q

Group B streptococcus infection in pregnancy

A

No screened for
Found on routine swabs

Can lead to neonatal infections
Give all women IV antibiotics in labour 
- Previous GBS infected baby
- Gestation <37wks 
- PROM
113
Q

Components of the quadruple test

A 
@ 16 weeks 
Dating scan +
- AFP
- Unconjugated oestriol
- Free B-HCG
- Inhibin A

Takes into account the women age in the 2nd trimester

114
Q

Components of the combined test

A

Nuchael translucency ( <3.5cm)
hCG
PAPP-A

Womens age must also be taken into account

115
Q

Role of PAPP-A

A

Large glycoprotein
1st trimester
- poor placentation
- trisomies

2nd trimester

  • Pre-eclampsia
  • Growth restriction
  • Preterm delivery
  • Foetal demise
116
Q

Treatment of a UTI in pregnancy

A

Often asymptomatic
Cefalexin 500mg
Avoid trimethoprim in first semester antidotal action

117
Q

Features of multiple pregnancy

A

Uterus large for dates
Hyperemesis
Plyhydraminos

118
Q

Complications of multiple pregnancy

A

PREGNANCY

  • Polyhydraminos
  • Pre-eclampsia
  • Anaemoa
  • Increase risk of APH
  • Gestational DM

FOETAL

  • Prematurity
  • IUGR
  • Twin-twin transfusion
119
Q

Management of a multiple pregnancy

A

Aspirin >12 wks to prevent pre-eclampsia
Consultant led care
Elective birth @ 37 weeks
Give steroids @ 36wks

120
Q

What is the APGAR scoring system and what does it assess

A 
APGAR is a method of assessing infants rapidly at 1 minute of age to see if they require assistance. 
It assesses 
- Pulse 
- Respirations 
- Muscle tone 
- Colour 
- On suction

A score above 7 is reassuring

121
Q

Risk factors for maternal sepsis

A 
Obesity 
Impaired glucose tolerance 
Immunosuppression 
Anaemia
Vaginal discharge 
HX of Grp B streph
122
Q

Causes of maternal sepsis

A

Grp A betahaemolytic strep
E.coli
Bacteroides

123
Q

Treatment of maternal sepsis

A

IV broad spec: Tazocin (piperacillin-tazobactam) 4.5g/8hr
Crystalloid fluid bolus
Vasopressors to maintain the blood pressure

Puerperal period check wound sites and consider necrotising fasciitis

124
Q

Define cervical show

A

Mucus plug and blood

125
Q

Principle of chorionic villus sampling

A

Dx procedure for karyotyping during the first trimester
@ 11-13weeks
sample of chorionic villi from the foetal placenta
Potential sensitisation event give anti-D

126
Q

Principle of amniocentesis

A

Sample of amniotic fluid
Karotype foetal cells within the fluid
@ 15 weeks and above
Potential sensitisation event

Obs & Gynae (2 decks)

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