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Medicine > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Management of diabetic mother: preconception

A

Maintain blood glucose/ prenatal HbA1c
Good diet, weight, exercise
Retinal examination before preg
Stop statins and ACEi/ARB

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2
Q

Management of diabetic mother: during pregnancy

A

Maintain blood glucose, monitor urine for ketones
Good diet, weight, exercise
Stop oral hypoglycaemics (except metformin) - consider insulin
High dose folate in first trimester
Retinal screening each trimester
Early viability scan + detailed anomaly scan

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3
Q

Management of diabetic mother: after pregnancy

A

Delivery in consultant-led unit
Early breastfeeding to avoid neonatal hypoglycaemia
Follow-up

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4
Q

Medical mx morning sickness

A

Antihistamines eg promethazine, cyclizine

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5
Q

Red flags morning sickness

A

Dehydration
Ketonuria
?UTI, ?hydatiform mole

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6
Q

Medical mx heartburn

A

Antacids

Omeprazole (others not licensed)

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7
Q

Second/ third tri causes abdo pain: obstetric causes

A 
Labour
Placental abruption
Symphysis pubis disruption
Ligament pain
Pre-eclampsia/ HELLP syndrome
Acute fatty liver of pregnancy
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8
Q

Second/ third tri causes abdo pain: non-obstetric causes

A

Gynae acute
acute abdo
urinary, eg UTI

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9
Q

define APH

A

after 24 weeks

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10
Q

which APH usually has pain

A

placental abruption

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11
Q

when is digital contraindicated

A

placenta praevia

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12
Q

bloods for APH

A
  • Should be cross-matched if bleeding significant/ ongoing
  • Hb
  • Coagulation profile
  • Rhesus status
  • Kleihauer test (examines maternal blood film for presence of fetal blood cells, suggesting feto-maternal haemorrhage)
  • U&Es: important if urine is poor secondary to hypovolaemia
  • LFTs

(ALSO URINALYSIS AND CTG)

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13
Q

When can CTG be done?

A

after 26 weeks

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14
Q

how is placenta praevia categorised

A

minor and major (overlies os at least partially)

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15
Q

how is placenta praevia diagnosed?

A

usually detected at 20-week scan and if a low-lying placenta is noted, then a follow-up scan in third trimester is performed to make the diagnosis
• High suspicion of placenta accreta can be confirmed on MRI

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16
Q

why is placenta praevia associated with PPH?

A

the lower uterine segment where the placenta is sited is less efficient at retraction following delivery of the placenta, compared with the upper segment – thus occlusion of the venous sinuses is less efficient

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17
Q

when may uterus feel woody?

A

placental abruption

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18
Q

in what % APH is cause unidentified

A

50%

still associated with increased fetal probs so should continue to have regular monitoring

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19
Q

causes of malpresentation: fetal + maternal

A 
Maternal:
-	Contraction of the pelvis
-	Pelvic tumour, eg fibroid
-	Placenta praevia
-	Mullerian abnormality
-	Multiparity
Fetal:
-	Prematurity
-	Placenta praevia
-	Polyhydramnios
-	Multiple pregnancy
-	Fetal abnormality: hydrocephalus – extension of the fetal head by neck tumours – anencephaly – decreased fetal tone
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20
Q

contraindications to ECV

A

pelvic mass – antepartum haemorrhage – placenta praevia – previous csection or hysterotomy – multiple pregnancy – ruptured membranes

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21
Q

What could be needed for ECV

A

Anti-D

needs to be on labour ward for monitoring

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22
Q

recommendations if going ahead with vaginal breech

A
  • Synctocin often discouraged so to allow slower descent – likewise second stage allowed to happen slowly
  • Epidural recommended as likely to need instrumentation
  • Routine episiotomy recommended for extra room

obstrerician and paediatrician present

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23
Q

3 Ps of failure to progress in labour

A

passages
passenger
power

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24
Q

threatened miscarriage

A

os is closed

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25
Q

inevitable miscarriage

A

os is open

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26
Q

delayed/ silent miscarriage

A

uterus empty, os closed - NOT AWARE

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27
Q

Complete miscarriage

A

uterus empty, os closed - AWARE

28
Q

If ectopic ruptures, what happens to pain

A

all over abdo (not localised to iliac fossa)

shoulder-tip pain

29
Q

what should happen to B-hcg OVER 48H

A

Double

30
Q

COMPLETE MOLE

A

a pregnancy within the uterus consisting of a multivesicular mass of trophoblastic tissue with hydropic change (looks like grapes on US) – no evidence of a fetus – formed by mono- or dispermic fertilisation of an oocyte which has deleted all maternal genetic material, ie it’s all paternal – 1 in 1000 births

31
Q

PARTIAL MOLE

A

a pregnancy within the uterus consisting of some trophoblastic proliferation and some hydropic change, where a fetus (usually non-viable) may also be seen – formed by dispermic fertilisation of oocyte resulting in triploidy (ie maternal and paternal genetic material) – more common

32
Q

CHORIOCARCINOMA

A

tumour of trophoblastic calls which secrete hCG – occurring when molar pregnancies do not regress after surgical evacuation, or more rarely after a non-molar pregnancy

33
Q

clues trophoblastic disease

A
  • Likely to be bleeding in early pregnancy
  • Exaggerated symptoms of pregnancy due to increase hCG
  • Uterus may appear large for dates
  • Grape appearance on USS
  • Or may not be detected until histopathologist has examined products of conception following miscarriage
34
Q

3 types of HTN in pregnancy

A

pre-existing
pregancy-induced (after 20 weeks, no proteinuria)
Proteinuric hypertension (ie pre-eclampsia) (PET): presents after 20 weeks with significant proteinuria

35
Q

sx PET tto ask about

A
  • Headache
  • Visual disturbance (typically in the form of flashing lights)
  • RUQ or epigastric pain (due to oedema of the liver capsule)
  • Vomiting
  • Swelling of face, hands or feet
36
Q

neuro tests if htn in preg

A

• Neurological: brisk reflexes and clonus seen in pre-eclampsia -do fundoscopy (papilloedema can be seen in pre-eclampsia, and retinopathy may be seen in severe pre-existing hypertension)

37
Q

Bloods in PET will be different to other causes of HTN

FBC
U&Es
LFTs
urate
clotting
A

FBC: Low platelets
High haematocrit

U&Es: high creatinine

LFTs: high ALT/ AST

urate: high
clotting: can be deranged

38
Q

why is lactate dehydrogenase taken?

A

if suspicion of haemolysis in HELLP

39
Q

HELLP stands for

A

haemolysis elevated liver enzymes low plts

40
Q

how fetus affected by PET

A

IUGR, oligohydromnios and abnormal Dopplers due to placental insufficiency

41
Q

BP in preg

A

150/100 – if evidence of end-organ damage (renal or retinal) tighter control may be needed (eg 140/90)

42
Q

how to reduce PET

A

• Low-dose aspirin (75 mg daily) from 12 weeks’ gestation

43
Q

anti-hypertensives used in preg

A

labetalol
nifedipine
Methyldopa

44
Q

risk factors for PET

A 
High risk:
-	Previous PET
-	CKD
-	DM I & II
-	SLE, antiphospholipid syndrome
Moderate risk:
-	Primips
-	Age >40 years
-	BMI >35
-	Family hx PET
-	Twins
45
Q

Use of Mg in PET

A

IV as prophylaxis when v risky

also treatMent

46
Q

rate of cervical dilatation

A

0.5-1 cm/h in nulliparous women – 1-2 cm/ h in multiparous woman

47
Q

SGA vs IUGR

A

just little

probs with growth

48
Q

polyhydramnios is found in the absence of DM, what should be checked

A

antibodies to rubella and CMV

49
Q

Fetal causes of polyhydramnios

A

inability to swallow, eg oesophageal atresia

50
Q

Fetal causes of oligohydramnios

A

inability to produce urine, eg renal agenesis

51
Q

causes of increased liquor

A

DM – fetal abnormality – multiple pregnancy – fetal infection

52
Q

causes of decreased liquor

A

ruptured membranes – fetal abnormality – aneuploidy – IUGR – fetal infection – maternal drugs (eg atenolol)

53
Q

maternal collapse definition

A

Acute event involving the cardiorespiratory systems and/or brain, resulting in reduced or absent consciousness level (and potentially death) at any stage in pregnancy or up to 6 weeks after birth

54
Q

Most common cause of collapse in obstetric pts

A

haemorrhage

55
Q

causes of collapse in obstetric pts

A 
haemorrhage
large PE
Amniotic Fluid Embolism
MI
others
56
Q

mx obstetric cholestasis

A
  • All other causes of deranged LFTs should be excluded
  • LFTs should be repeated every 1-2 weeks
  • Treatment is usually: chlorphenamine (Piriton), aqueous creams and UCDA (unlicensed in pregnancy but no bad reports – alters bile acid pool by reducing number of hydrophobic bile acids which are thought to be hepatotoxic)
57
Q

indications for csection

fetal vs maternal

A

Maternal:
Two previous LSCS
Placenta praevia
Maternal disease, eg fulminating pre-eclampsia
Active primary genital herpes simplex virus
HIV (depending on viral load)
Maternal request

Fetal:
Breech presentation
Twin pregnancy if presentation of first twin not cephalic
Abnormal CTG or abnormal FBS in first stage
Cord prolapse
Delay in first stage of labour, eg due to malpresentation or malposition

58
Q

PPH definition

1 vs 2

A

Bleeding from the genital tract of more than 500 mL after delivery. in practice, 1 litre + is clinically relevant

  • PRIMARY PPH: within 24h
  • SECONDARY PPH: between 24h and 6 weeks
59
Q

risk factors uterine atony

A

• Risk factors may include:

  • Multiple pregnancy
  • Grand multiparity
  • Fetal macrosomia
  • Polyhydramnios
  • Fibroid uterus
  • Prolonged labour
  • Previous PPH
  • Antepartum haemorrhage
60
Q

mx uterine atony

A
  • ABC
  • Large-bore IV access x2
  • Send FBC/ XM/ clotting/ U&E
  • Massaging uterine fundus
  • IV oxytocin
  • Oxytocin infusion
  • Give PGs (IV/ IM/ intramyometrial) – Hemabate™ (carboprost)
  • Consider surgical options of uterine artery ablation – B-Lynch compression can avoid need for hysterectomy and restore fertility in many cases
61
Q

most common cause of postnatal infection

A

Strep A

62
Q

how to prescribe CS for surfactant production

A

Up to 34 wks, attempts should be made to stop labour to administer corticosteroids to mother – betamethasone or dexamethasone are given to the mother as two IM injections 12-24h apart

63
Q

risk factors preterm labour

A
  • Previous preterm labour (most significant)
  • Smoking
  • Low socio-economic group
  • BMI <19
  • Lack of social support
  • African-Caribbean
  • Extremes of reproductive age (<20 or >35)
  • Domestic violence
  • Bacterial vaginosis
  • Chronic medical conditions
64
Q

drug to suppress lactation

A

cabergoline

65
Q

when is anti-D given?

A
  • In one dose at 28 weeks, or in divided doses at 28 and 34 weeks
  • Postnatally
  • If a potentially sensitising event has occurred
66
Q

what is Day 21 Progesterone Level for?

A

shows ovulation happened (in 28 day cycle)

Medicine (30 decks)

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