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Final > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What s normal Labour outcome?

A

Expulsion of fetes and placenta

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2
Q

Main symptom and sign of labour

A

Painful uterine contraction

Dilation and effacement of cervix

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3
Q

Mechanical factors in labour: 3Ps

A

Powers - degree of force/contraction expelling Passage - dimension of pelvis and resistance of soft tissues Passenger - diameter of fetal head

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4
Q

Who has poor powers (uterine contraction force)

A

Nuliparous

Induced labour

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5
Q

What are Montevideo Units measuring?

A

Measure of uterine activity

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6
Q

How to Measure uterine activity (Montevideo units)

A

Intensity of contraction x frequency of contraction (per 10 mins)

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7
Q

Equipment used to measure Uterine activity (also to calc Montevideo units)

A

cardiotocograph (CTG)

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8
Q

Factors assoc with neonatal complications

A

Polyhydramnios, High parity, Uterine/Fetal anomalies, Preterm birth

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9
Q

What Part presents during extended breach?

A

Buttocks

The legs are extended by head

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10
Q

Which uterine segment provides push for fetus?

A

Upper segment of uterus

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11
Q

What does stationeries 0 mean

A

Head is at level of ischial spines

+ve means head below, -ve means head above

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12
Q

Diameter of Pelvic outlet

A

12.5cm

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13
Q

What kind of presentation do you want?

Why?

A

Cepahlic - Vertex (Occiput: the back)

think chin to chest

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14
Q

What is it presented if head is extended from vertex position by:

  • 90 degree
  • 120 degree
A

Brow

Face

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15
Q

3 stages of labour

A

1) Split into Latent and Active.
From initiation to full cervical dilation

Latent: slow dilation up to 3cm
Active1cm/hr
dilation

2) Full dilation to delivery. Mother pushing (epidural may have effect) until head reaches pelvic floor
3) From delivery of foetus to delivery of placenta

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16
Q

How do epidurals affect labour

A

Slow the process of dilation

Longer labour

Remove pushing desire

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17
Q

Traditional Vs active 3rd stage management (placental delivery)

A

Trad:
Abdo massage of uterus to encourage contraction

Active:
IM Syntocinon (oxytocin analogue)
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18
Q

Normal blood loss in normal Vs C-section

A

500ml

1L

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19
Q

Most common cause of slow progress in labour in Primiparous woman

A

Inefficient Uterine Action (Poor Powers)

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20
Q

What is more common reason for slow progress in multiparous

A

Fetal Malpositioning

Uterine Rupture more likely

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21
Q

What to do if hyperactive uterine contractions, vaginal bleeding and fatal HR abnormalities

A

C-Section

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22
Q

Urinary issue during labour

A

Retention can cause detrusor damage

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23
Q

What can be done in someone with slow progress of labour

A

Augmentation:

Oxytocin - strengthens contraction

Artificial Rupture of Membranes

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24
Q

What is associated with hyperactive uterine contractions

A

Too much Oxytonin, Placental abruption.

Can cause fatal distress as blood flow diminishes

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25
Q

Tx of Uterine hyperactivity

A

Usually C-section

Tocolytic (e.g. Beta-mimetic - Salbutamol, Nifedipine - CCB)

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26
Q

Management Nuliparous slow 1st stage

A

Augmentation

C-section after 16hr

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27
Q

Management Nuliparous Poor descent in 2nd stage

A

Oxytocin infusion (uterus pushes down)

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28
Q

Management Nuliparous Over 1hr active second stage

A

Episiotomy, Ventouse, Forceps

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29
Q

How often to auscultate fatal HR in Labour

A

every 15m in 1st stage

Every 5m in 2nd stage

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30
Q

Intrapartum (during birth) Fetal problems

A

Meconium aspiration
Fetal blood loss
Trauma
Infection (GBS)

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31
Q

What causes fatal distress

A

Hypoxia.

Results in Death or disability if not reversed

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32
Q

Investigations for fetal distress

A

Fetal HR

Cardio-tocogram

Fetal ECG

Scalp blood sampling

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33
Q

How to read a CTG acronym

A

DR C BRaVADO

Define Risk
Contractions

Baseline Rate
Variability
Accelerations
Decelerations
Overall impression
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34
Q

Define risk (CTG)

A

Maternal illness?

Gestational DM
HTN
Asthma

Obstetric complications

Multiple gestation, post gestation, prev c-section, Fetal problem, pre-eclampsia

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35
Q

Contractions on CTG

A

Over 10 mins (less than 5)

e.g. 3 in 10

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36
Q

Normal Baseline Rate CTG

A

110-150bpm

Tachy: hypoxia, anaemia

Brady: cord prolaps/compressio, if cause cant be found - immediate delivery

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37
Q

Normal Variability CTG

A

5-25bpm

non-reassuring: less than 5 or more than 25

abnormal: if lasts for long time

physiological abnormal: sleeping

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38
Q

Accelerations, good or bad?

A

Presence is reassuring

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39
Q

Types of decelerations

A

Early: when uterine contract begins , stops when they do
(normal)

late: begin at peak of contraction, recover as contraction ends. show insufficient blood flow to uterus

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40
Q

What is sign of prolonged reduced variability in fetal HR

A

Hypoxia

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41
Q

Pain relief in labour

A

Non-med: Massage

Entonox

Systemic opiates (+ antiemetic)

Epidural

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42
Q

Degrees of perineal damage

A

1) skinonly
2) perineal muscles
3) anal sphincter
4) anal sphincter and epithelium

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43
Q

Which inc risk of twins

  • FH Monozygotis twins
  • FH dizygotic twins
A

FH Dizygotic twins

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44
Q

How often to USS multiple pregnancies

A

Monthly from 20 weeks

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45
Q

What gestation for an elective C-section

A

38wk+

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46
Q

Most complication of multiple preg

A

Prematurity

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47
Q

What is TTTS, when to get concerned?

A

Although each uses own portion of placenta, connecting blood vessels allow blood to pass from one twin to other

Blood can disproportionately distribute between ‘donor’ to ‘recipient’ causing in blood vol and strain on heart (HF), inc urine, Polyhydramnious

Concerned if 30% difference in size

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48
Q

TTTS Tx

A

Amniocentesis

Intrauterine blood transfusion to donor

Laparoscopic placental vessel occlusion

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49
Q

RF for shoulder dystocia

A

High birth weight (Maternal diabetes)

Induced labour

Prev dystocia

Abnormal lie

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50
Q

What is dystocia

A

Failure of the shoulder to deliver

Problem with Passenger or passage

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51
Q

What can dystocia cause

A

Clavicular / Humeral fracture

cord compression -> asphyxiation

Erb’s palsy (brachial plexus damage)

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52
Q

Shoulder dystocia Tx

A

Call for help

Legs in McRoberts (knees to chest)

Rotational manœuvres

Evaluate for episiotomy

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53
Q

Last resort for Dystocia

A

Clavicular fracture (deliberate)

Zavanelli (push back in and c-section)

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54
Q

Amniotic fluid embolus

  • Pres
  • When can it occur
  • Complications
A

Amniotic fluid enters maternal circulation

Sudden dyspnoea, hypoxia, hypotension

Any time in preg

DIC, Pulmonary oedema, ARDS

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55
Q

Amniotic fluid embolus Tx

A

Take bloods (clotting, FBC, electrolytes, cross-match)

Manage in ICU

Give: O2, Fluids, Blood, fresh frozen plasma

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56
Q

RF for uterine rupture

A

Prev C-section

Labour obstruction

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57
Q

Signs of uterine rupture

A

Fetal HR abnormalities

Abdo pain

Vaginal bleeding

Cessation of contractions

Maternal shock/collapse

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58
Q

Management Uterine rupture

A

Maternal resuscitation

Urgent laparotomy for delivery

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59
Q

Management of eclampsia (epileptiform seizure)

A

Clear airway and give O2

Diazepam if epilepsy

MgSO4

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60
Q

Induction Vs Augmentation

A

Induction initiates artificial labour

Augmentation promotes inadequatecontractions

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61
Q

How to ripen cervix

A

Prostaglandin gel

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62
Q

What is a ripe cervix

A

Soft
Short
Open OS

63
Q

CI for induction of labour

A

Placenta previa
Fetal distres
Cord presentation

64
Q

Induction of labour complications

A

Intrumental delivery (15%)
C-Scetion (22%)
Failed induction

65
Q

What is Bishops Score

A

Cervix score.

Assists in predicting need for induction of labour

66
Q

Bishops score sections (Re Cervix)

A 
Position (poster-Anter)
Consistency (Frim - Soft)
Effacement (thinning)
Dilation (0-5)
Fetal station
67
Q

Fetal station 0 = ?

A

Head at level of ischial spin (not to be confused with ASIS)

68
Q

What might need to be done before Induction of Labour?

A

Cervical ripening if Bishops score under 6 (PG via Foley Catheter)

69
Q

Methods of inducing labour:

A

Amniotomy (Rupture of membranes)

Oxytocin IV with 5% dextrose

70
Q

Misoprostol

  • What is
  • When used in Preg
A

Prostaglandin analogue. gives Uterine contractions.

Used after intrauterine death (to deliver)

71
Q

Risk of BV in Preg?

What is tx?

A

Preterm labour
Also: PROM, low birthweight

Oral Metranidazole

72
Q

RFs for Preterm labour

A

Previous Preterm labour

BV

Cervical length (short)

Fetal hydrops

73
Q

Maternal RF for Preterm labour

A

Infection (BV), HTN, DM, Chronic illness, Smoking, Alc, Stress

74
Q

What is Fetal Fibrotectin. What is high FF risk for?

A

Glycoprotein in amniotic fluid

Preterm birth

75
Q

What is Fetal Hydrops

A

Abnormal build up of fluid in 2+ body areas

sign of underlying disease

76
Q

What are tocolytics for?

E.G.

A

Suppression of labour

Nifedipine (CCB)
Indomethacin (PG inhib)
Terbutaline (Beta agonist)

77
Q

Management of preterm labour:

A

Fluids and bed rest

Avoid repeated pelvic exam (infection risk)

USS

Tocolytics

78
Q

What is another function of suppressing labour?

A

Gives time to administer corticosteroid:

Betamethasone/Dexamethasone

Help stimulate fetal surfactant production (1-2 days to work)

79
Q

Tocolytics Absolute CI

A

Fetal death, Pre-eclampsia

Pre-eclampsia

80
Q

What do corticosteroids do? (28-34wks)

A

Reduce severity of RDS

Also help to close PDA

81
Q

What is Periventricular malacia?
What can it cause?
RF?

A

When the white matter around ventricle deprived of blood

Cerebral Palsy

LBW, Uterine infections, PROM

82
Q

What is cervical cerclage used for?

When is it done?

Indication?

A

Suture in internal OS

Insert 1st trimester, out 3rd

Cervical incompetence (short)

83
Q

What is PROM

A

Premature rupture of membranes prior to labour (under 37wk)

84
Q

What is prolonged ROM?

A

Over 24 hours between rupture and labour

85
Q

PPROM

A

Pre-Term Prolonged Rupture of Membranes

86
Q

What is cervical effacement?

A

Change of shape from bulb to flat

87
Q

What is antepartum haemorrhage?

A

Bleeding after 24 weeks gestation

88
Q

3 causes of antepartum haemorrhage:

A

Placenta previa

Placental abruption

Vasa previa (fetal vessels near internal os)

89
Q

Minor Vs Major Placenta previa

A

Major: Low lying placenta over internal os

Minor: in lower segment (doesn’t cover os)

  • note: placenta moves up as uterus expands in preg
90
Q

What not to do if placenta previa

A

Vaginal exam - may precipitate large bleed

91
Q

Placenta previa Ix

A

USS

FBC and cross match

92
Q

Placenta previa management

A

Elective C-section at 39 weeks for major

2cm from os = vaginal delivery

93
Q

Placental abruption

  • Def
  • Causes
  • Complication
A

Part/All placenta separates from living of the uterus prior to delivery

IUGR, Pre-eclampsia, Smoking, Cocaine, History of it.

Fetal death, DIC, Renal failure, Maternal death

94
Q

Abruption

  • Features
  • Tx
A

Abdo pain/Uteral pain, bleeding (into myometrium), Tachycardia, hypotensive

IV fluids, blood transfusion, Opiate analgesia

If fetal distress urgent C section (after 37 weeks)

95
Q

What is risk of vasa previa?

A

These are fetal vessels prone to bleeding when membranes rupture.

Risk of massive bleed and stillbrith

96
Q

Vasa previa

  • Triad in diagnosis
  • Management
A

Membrane rupture
Painless vaginal bleeding
Fetal bradycardia

Emergency C-section

97
Q

What is primary postpartum haemorrhage?

A

Over 500mls of blood loss in 1st 24 hours after uterine atony

98
Q

Causes of Primary PPH

A

Uterine Atony (doesn’t compress vessels) clotting disorders, uterine rupture

99
Q

Treatment of Primary PPH

A

ABC
Syntocinon (Oxytocin - helps uterus to contract and stop bleed)

IM carboprost

Hysterectomy if severe

100
Q

What is secondary PPH

A

Blood loss after 24 hours

101
Q

Causes of secondary PPH

A

Retained placental tissue, Clot

102
Q

Secondary PPH Tx

A

USS to identify products
Give Ampicillin and Metronidazole (infection common)

Careful curette of uterus

103
Q

4 T’s of PPH

A

Tone (atony)
Trauma (delivery)
Tissue retention (placenta)
Thrombin (coag disorder)

104
Q

Primary secondary and tertiary prevention of premature birth

A

1) smoking, STD, weight loss
2) diagnosis and Tx of diseases (e.g. DM, pre-eclampsia)
3) Prompt diagnosis and tocolytics (Nifedipine, terbutaline) + corticosteroids

105
Q

What is Pleuperium?

Issues?

A

6 weeks post natal

Urinary incontinence,
Post-natal depression

sever: psychosis, mania

106
Q

Teratogenic drugs

A 
Warfarin
ACEi
Anti-thyroid (Carbimazole)
Antiepileptics (minus lamotrigine)
MTX
Abx (Trimethoprim, doxy)
Alc
107
Q

Ectopic Preg

  • When to suspect
  • RF
  • Pres
A

Abdo pain in some one of child bearing age

Damage to tubes (surgery, inflam:PID)
Prev ectopics
IVF

Lower abdo pain, Vaginal bleed, Amenorrhoea (6-8 weeks), Shoulder pain (peritoneal bleed)

108
Q

Types of miscrriage (Vaginal bleed)

3 types
2 categories

A

Threatened
- Cardiac activity

Missed
- No cardiac activity or empty sac

Inevitable
- Dilated os, prod. of conception may be seen/felt at os

Complete (all prods of conception out)
Incomplete (some prods remain)

109
Q

Causes of abdo pain in late preg

A

Labour
Placental abruption
Pre-Eclampsia/HELLP (RUQ pain)
Uterine rupture

110
Q

HELLP syndrome

A

Pre-Eclampsia (HTN + Proteinuria)
+
Haemolysis, elevated liver enzymes and low platelets

111
Q

Triple test

what for and what in it

A

Downs syndrome (trisomy 21)

AFP, hCG, Estriol

112
Q

Trisomy 18

Trisomy 13

A

18 = Edwards

13 = Pataus

113
Q

Causes:

  • High AFP
  • Low AFP
A

NTD
Abdo wall defect

Downs, trisomy 18

114
Q

What must be avoided in preg?

A 
Vit A (liver)
Alcohol 
Food infections (unpasteurised milk, soft cheese, pate, partially cooked food)
Prescribed med (use as little as poss esp if teratogen)
115
Q

1st scan

A

10-13 weeks to confirm dates and exclude multiple

116
Q

Downs screen + Nuchal thickening

A

11-13 weeks

117
Q

Anomaly scan

A

18-20 weeks

118
Q

When is Anti D given to Rh negative women

A

28 weeks first dose

34 weeks second

119
Q

What Preg women scanned for

A

Rhesus
Down’s/Fetal anomalies
NTD
Rubella

120
Q

1st line for mastitis + Risk for non treat

A

Fluclox

Abscess

121
Q

CI in breast feeding

A

ABx: cipro, tetracycline

Lithium, benzo

Aspirin
MTX
Sulfonyurea
Amiodarone

122
Q

C-section indications

A 
Placenta previa
Pre-Eclampsia
Post due date
IUGR
Fetal distress
Malpres
Active herpes
123
Q

Types of c-section

A

Lower segment C-section (99%)

Classic (longitudinal in upper segment)

124
Q

Testing for Downs

A

Nuchal translucency + serum b-HCG + plasma protein A

If later in preg triple test

125
Q

Eclampsia

  • def
  • tx
A

Seizures in assoc with pre-eclampsia

Magnesium sulphate (also given to prev) + Delivery

126
Q

Pre-eclampsia

A

condition seen after 20 weeks gestation

pregnancy-induced hypertension

proteinuria

127
Q

Risk assoc with Mole

Genetics

Features

A

Choriocarcinoma

Triploid (two sperms/duplication of paternal sperm)

Large uterus for dates, bleed, Very high hCG

128
Q

Common cause of neonatal sepsis?

Maternal Prophylaxis

A

GBS

IV Benzylpenicillin

129
Q

What is basis of preg test

A

hCG

130
Q

Hyperemisis

  • What gestation
  • Tx
A

Sever Morning sickness 8-12 weeks
(high hCG)

Promethazine (antihistamine), Ondansetron

Admission in sever for IV hydration

131
Q

BP in preg

A

Falls in 1st trimester up to 20-24 wks

After this it inc to normal (high in HTN of preg/pre-eclampsia)

132
Q

Methods of induction of labour

A

Membrane sweep
Intravaginal PGs
Break waters
Oxytocin

133
Q

Oligohydramnious

  • Def
  • Causes
A

Reduced amniotic fluid (under 500ml at 32-36 wks)

PROM, Fetal renal angenesis, IUGR, Post-termgestation, Pre-eclampsia

134
Q

Placenta Accreta

  • What is
  • complication
A

Placenta attach to myometrium

Risk postpartum haemorrhage

135
Q

Severity of post-natal mental probs

A

Baby blue 60-70% - days after (anxious tearful irritable)

Depression 1-3 month after

Psychosis 0.2% - severe mood swings, hallucinations, mania. 2-3 weeks

136
Q

RF PPH

A 
Prolonged labour
Pre-eclampsia
inc age
POolyhydramnios
Emergency c-section
Macrosomia
137
Q

Examination features of pre-eclampsia

A

HTN (over 170/110 + Proteinuria)

Headache
Visual disturbance
papilloedema
RUQ pain (HELLP)
hyperrreflexia
Low PT (HELLP)
138
Q

Treatment of pre-eclampsia

A

Labetalol
Magnesium sulphate

Delivery (timing depends on scenarios)

139
Q

Compication of maternal DM

A

Macrosomia

140
Q

RF for gestation diabetes

A

BMI over 30
Previous
1st degree relative with DM

141
Q

Tx gestation diabetes

A

Lifetstyle (diet + exercise

Metformin if poor control

142
Q

Suspected DVT..

A

Give duplex USS

ECG/CXR if PE suspected

143
Q

What factors increase in preg

A

Cardiac out put, blood volume, HR, pulmonary ventilation (volume), GFR

144
Q

Why inc risk clots

A

Fibrinolytic system decreased during preg (even though fall in Pt)

145
Q

Complications of prematurity

A

mortality
RDS
Intraventricular haemorrhage
NEC

146
Q

Tx of Preterm rupture of membrane

A

Oral erythromycin

Antenatal corticosteroids (RDS)

Delivery considered after 34 weeks

147
Q

When doe rhesus sensitisation occur

A

When Rh positive baby to Rh negative mother (sensitisation during birth when inc risk blood mix)

148
Q

Effects of congenital Rubella

A

Sensorineural deafness

Cataracts

Heart defect (e.g. patent ductus)

Growth retardation

Cerebral Palsy

(Give non-immune mothers MMR)

149
Q

Tx of VTE in preg

A

LMWH

150
Q

Causes of in nuchal translucency

A

Downs syndrome
Congenital heart defect
Abdo wall defects

151
Q

Causes of oligohydramnios

A

Fetal: renal anagenesis, GU obstruction

Uteroplacental insufficiency

Rupture of membranes

152
Q

Causes of polyhydramnios

A

Maternal DM

Multiple gestation

Pulmonary abnormalities

Fetal anomalies

TTTs

153
Q

Tx of Htn in pre-eclampsia

Tx of seizures in eclampsia

A

Nifedipine

Mag sulphate

Final (26 decks)

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