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Y3- TO LEARN > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

1st trimester

A

0-13 weeks

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2
Q

2nd trimester

A

14-28 weeks

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3
Q

3rd trimester

A

29-40 weeks

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4
Q

What does a urinary pregnancy test detect?

A

beta HCG levels

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5
Q

Where does fertilisation occur?

A

Fallopian tubes

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6
Q

Where does the blastocyst implant?

A

Uterine wall

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7
Q

Causes of early pregnancy bleeding (<12 weeks)?

A 
Implantation bleeding
Miscarriage
Ectopic/Molar
Chorionic haematoma
Cervical (infection, cancer, polyp)
Vaginal (infection)
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8
Q

How common is early pregnancy bleeding?

A

20%

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9
Q

Symptoms of a miscarriage?

A

Bleeding, cramping

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10
Q

Investigation of miscarriage?

A

USS, speculum exam

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11
Q

What does a closed os mean in miscarriage?

A

Threatened miscarriage

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12
Q

What does an open os mean in miscarriage?

A

Inevitable miscarriage

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13
Q

What causes cervical shock?

A

Incomplete miscarriage, products still left in cervix

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14
Q

Symptoms of cervical shock?

A

Cramps, N+V, sweating, fainting

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15
Q

Causes of miscarriage?

A 
Embryonic abnormality e.g. chromosomal
APS
Infections- CMV, Rubella, Listeria
Iatrogenic (after CVS)
Emotional upset
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16
Q

What is early foetal demise?

A

Pregnancy in-situ but no heartbeat

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17
Q

What is anembryonic pregnancy?

A

No feotus (lack of development/reabsorbed)

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18
Q

Management of miscarriage?

A 
Conservative- allow natural expulsion
OR
Medical induce expulsion
OR
Surgical removal
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19
Q

Causes of recurrent miscarriage?

A 
APS
Thrombophilia
Balanced translocation
Uterine abnormality
Age of mother
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20
Q

Where is the most common location of ectopic pregnancy?

A

Ampulla

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21
Q

Symptoms and signs of ectopic pregnancy?

A

Pain + shoulder tip pain, bleeding, dizziness, collapse, SOB, N+V, pallor, peritonism, guarding

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22
Q

Investigations of ectopic?

A

FBC, group and save, bHCG, USS

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23
Q

What is pregnancy of unknown location (PUL)?

A

+ve pregnancy test but no sign of intrauterine or ectopic pregnancy

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24
Q

Management of ectopic or molar pregnancy?

A

Surgery if acutely unwell

Methotrexate

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25
Q

What is a molar pregnancy?

A

Non-viable fertilised egg- leads to an overgrowth of placental tissue

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26
Q

What is the appearance of molar pregnancy on ultrasound?

A

“snow storm”

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27
Q

What is a complete molar pregnancy?

A

Egg without DNA with 1/2 sperm

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28
Q

What is partial molar pregnancy?

A

Egg with 2 sperm

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29
Q

What kind of foetus results from complete molar pregnancy?

A

Diploid

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30
Q

What kind of foetus results from partial molar pregnancy?

A

Triploidy

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31
Q

Symptoms of molar pregnancy?

A

Hyperemesis (due to high bHCG), bleeding, SOB

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32
Q

When does implantation bleeding occur?

A

~10 days after ovulation

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33
Q

What is a chorionic haematoma?

A

Pooling of blood between endometrium and embryo

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34
Q

Uses of intra-uterine insemination?

A

Sexual problems, same-sex couples, BBV

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35
Q

Uses of IVF?

A

Pelvic disease, anovulatory infertility, unexplained

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36
Q

How long does an IVF cycle take?

A

6 weeks

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37
Q

Steps of IVF?

A
  1. Down regulation of ovulation (GnRH)
  2. Ovarian Stimulation (FSH + LH)
  3. Oocyte collection
  4. Fertilisation
  5. Embryo Transfer
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38
Q

What does ICSI stand for?

A

Intra-cytoplasmic Sperm Injection

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39
Q

Uses of ICSI?

A

Male infertility

Failed IVF

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40
Q

Complications of assisted conception?

A

Ovarian Hyperstimulation
Multiple Pregnancy
Ectopic Pregnancy
Miscarriage

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41
Q

Define hyperemesis gravidarum (HG)?

A

Excessive, protracted vomiting- decreasing quality of life (usually just 1st trimester)

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42
Q

Other complication of HG?

A

Dehydration, ketosis, electrolyte imbalance, weight loss, malnutrition, depression, altered LFTs

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43
Q

Management of HG?

A 
Rehydrate + electrolyte replacement
Parenteral anti-emetics (cyclizine)
Nutritional supplement
Thiamine supplement
Steroids if SEVERE
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44
Q

What does the placenta secrete to maintain corpus luteum (maintain progesterone levles)?

A

HCG

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45
Q

At how many weeks can the external genitalia be seen on USS?

A

16 weeks

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46
Q

Where does spermatogenesis occur?

A

Seminiferous tubules

mature on inside and burrow to outside

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47
Q

Where is sperm stored?

A

Epididymis

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48
Q

Which cells produce testosterone and which hormone controls this?

A

Leydig cells

LH

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49
Q

What does blood fill to produce an erection and which muscles contract?

A

Corpora cavernosa

Accessory sex glands and urtheral + erectile muscles

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50
Q

Causes of male infertility?

A

CF, vasectomy, undescended testes, chlamydia, chemo/radiotherapy, tumours, Klinefelters (XXY), tubal abnormalities, CAH, steroid abuse, pituitary tumours etc.

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51
Q

Investigations of male infertility?

A 
Sperm analysis (3 days abstinence)
Endocrine profile
Chromosome analysis
CF screening
STI screening
Scrotal scan
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52
Q

Treatment of male infertility?

A

Reversal of vasectomy
ICSI
Sperm aspiration
Donor sperm insemination

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53
Q

Abortion act- who needs to sign?

A

2 registered medical practitioners

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54
Q

In Tayside, you can get an abortion up to…?

A

18 weeks + 6 days

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55
Q

When is conscientious objection to abortion not valid?

A

Emergency situations

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56
Q

Until how many weeks can you have an abortion if there are foetal abnormalities?

A

Term

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57
Q

What is the most common approach to treatment of psychosexual dysfunction?

A

Psychodynamic psychotherapy

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58
Q

How long can sperm live in vagina for?

A

5 days

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59
Q

How long can the ovum live in the vagina?

A

up to 24 hours

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60
Q

Name for methods of “natural family planning”

A

Basal body temp (slight increase= ovulation)
Cervical mucus
Cervical position
“Standard days”

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61
Q

How can breastfeeding act as a form of contraception?

A

Lactational amenorrea:

Exclusive breastfeeding, <6 months postnatal and amenorrhea

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62
Q

2 medical steps for TOP?

A
  1. Mifepristone 200mg
    24-48 hours later
  2. Misoprostol
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63
Q

What kind of medication is mifepristone?

A

Anti-progesterone

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64
Q

What kind of medication is misoprostol?

A

Prostaglandin

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65
Q

What happens after misoprostol is taken?

A

4-6 hours later, womb lining breaks down and womb contracts

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66
Q

What are the surgical options for TOP?

A

Vacuum aspiration

Dilatation and evacuation

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67
Q

When can vacuum aspiration take place?

A

6-12 weeks

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68
Q

When can dilatation and evacuation take place?

A

13-24 weeks

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69
Q

Which contraceptives CANNOT be started straight away after TOP?

A

Depo injection

Vaginal ring

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70
Q

What does foetal malnutrition lead to?

A

Insulin resistant + impaired glucose tolerance- T2DM

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71
Q

Risks of overweight to mother?

A

Miscarriage
Gestational diabetes
Pre-eclampsia
Still birth

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72
Q

Risks of overweight to baby?

A

Macrosomia
Congenital anomalies
Increased weight

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73
Q

How many extra calories are needed during pregancy?

A

300 kcal

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74
Q

How many extra calories are needed for breastfeeding?

A

640 kcal

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75
Q

What supplements are given during pregnancy, and how much?

A

Folic acid- 400 micrograms (pre- 12 weeks) (5mg if high risk)
Vitamin D- 10mg (pregnancy + breastfeeding)
Iron- if high risk of anaemia

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76
Q

Foods to avoid in pregnancy?

A 
Soft cheese
Tuna
Raw/partial eggs
Pate
Liver
Undercooked meat, game, cured meat
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77
Q

Which pregnancy hormone causes mammary gland enlargement and prepares for lactation?

A

Prolactin

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78
Q

What is a molar pregnancy at risk of becoming, and which type has a bigger risk?

A

Choriocarcinoma

Complete molar

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79
Q

How do you work out due date?

A

Add 9 months + 7 days to first day of last period

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80
Q

Important parts of booking visit of antenatal care?

A 
BMI
BP
Urinalysis
USS
Mental health screen
Test for trisomy, sickle cell + thalassemias
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81
Q

How is gestation determined on USS?

A 
Crown-rump length
Head circumference (>14 weeks)
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82
Q

When is USS carried out to test for foetal anomalies?

A

20 weeks

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83
Q

What is looked for in a foetal anomalies screen?

A 
Trisomy
Cleft palate
Neural tube defects
Abdominal wall
Limb deformities
Placental health
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84
Q

How is Down’s Syndrome screened for and when?

A

Nuchal thickness/translucency (11-13 wks)
Bloods- HCG + AFP (15-20 wks)
Amniocentesis (15 wks) or CVS (12 wks)

(also NIPT)

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85
Q

When is anti-D given to Rhesus negative mothers, and how much?

A

500 units IM

at 28 weeks or after a sensitising event (surgical evacuation, miscarriage, CVS/amio, delivery)

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86
Q

When is the dating USS in pregnancy?

A

10-16 weeks

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87
Q

What is Non-Invasive Prenatal testing (NITP) used for and how does it work?

A

Testing for trisomy and sex determination (e.g. X linked conditions)

Tests for free foetal DNA in maternal blood (ratio normal or abnormal?)

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88
Q

When might NITP cause a false positive?

A

Maternal cancers

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89
Q

When does the placenta become functional?

A

Week 5

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90
Q

What does the placenta secrete to maintain progesterone secretion?

A

human chorionic gondotropin (hCG)

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91
Q

Oxygen diffuses from mother to foetus via..?

A

Umbilical blood

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92
Q

Foetal oxygenated blood returns to foetus via..?

A

Umbilical VEIN

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93
Q

Foetal de-oxygenated blood returns to placenta via..?

A

Umbilical ARTERY

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94
Q

Urinary adaptations in pregnancy? (2)

A

Increased GFR

Increased renal plasma flow

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95
Q

What does the placenta release that leads to hypertension, insulin resistance and gestational diabetes?

A

CRH- corticotropin-releasing hormone

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96
Q

Definition of small for dates (SGA) pregnancy?

A

Estimated fetal weight/fetal abdominal circumference is <10th centile

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97
Q

Haematological adaptations in pregnancy? (2)

A

Increased plasma volume
Increased RBCs (erythropoeisis)
Haemoglobin reduced by dilution

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98
Q

Respiratory adaptations in pregnancy? (3)

A

Increased RR
Increased tidal volume
Increased O2 consumption

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99
Q

Risk factors for SGA pregnancy?

A 
>40
BMI >35
Cocaine, smoking
Previous stillbirth
Hypertension
Diabetes
Renal impairment
APS
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100
Q

Causes of small for dates pregnancy?

A

Constitutionally small

IUGR- intra-uterine growth restriction

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101
Q

Causes of preterm delivery?

A 
Infection- UTI, appendicitis, pneumonia
Multiple pregnancy
Polyhydramnios
Placental abruption
Idiopathic
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102
Q

IUGR can be symmetrical or asymmetrical. What causes each?

A

Symmetrical- chromosomal

Asymmetrical- placental problems (normal head, small abdomen)

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103
Q

IUGR can be symmetrical or asymmetrical. What causes each?

A

Symmetrical- chromosomal

Asymmetrical- placental problems (normal head, small abdomen)

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104
Q

Causes of SGA pregnancy?

A

Maternal risk factors
Placental infarcts or abruption
Foetal infection- rubella, CMV
Chromosomal

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105
Q

What is IUGR- intra-uterine growth restriction?

A

Failure to achieve growth potential (crossing centiles of growth in uterus)

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106
Q

Causes of large for dates pregnancy?

A 
Wrong dates
Macrosomia
Polyhydramnios
Multiple Pregnancy
Diabetes in pregnancy
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107
Q

Features of IUGR?

A

Decreased fundal height, liquor and fetal movements

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108
Q

Investigations of IUGR?

A

USS
CTG
Umbilical artery doppler

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109
Q

Management of IUGR?

A

37 week delivery, consider C-section
Steroids during delivery
Magnesium sulphate- foetal neuroprotection

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110
Q

Definition of large for dates pregnancy?

A

Symphyseal-fundal height >2cm for gestational age

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111
Q

Definition of macrosomia?

A

Estimated foetal weight >90th centile

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112
Q

Risks of macrosomia?

A

Obstructed labour
Shoulder dystocia
PPH

113
Q

Management of macrosomia?

A

Exclude diabetes

Induction or C-section

114
Q

What is polyhydramnios and what causes it?

A

Excess amniotic fluid

Causes- diabetes, fetal anomaly, twins, viral infections, hydrops fetalis, idiopathic

115
Q

Symptoms of polyhydramnios?

A

Abdo discomfort, prelabour membrane rupture, preterm labour, cord prolapse

116
Q

What is monozygotic?

A

Splitting of one egg- identical twins

117
Q

What is dizygotic?

A

2 ova + 2 sperm

118
Q

Management of diabetes in pregnancy?

A

Low dose aspirin
Insulin injections
5mg folic acid
Deliver at 38 wks

119
Q

What is monozygous?

A

1 placenta

MCDA- 1 placenta, 2 sacs
MCMA- 1 placenta, 1 sac

120
Q

Foetal complications of multiple pregnancy?

A 
Increased mortality
Congenital anomaly
IUD
Preterm birth
Growth restriction
Cerebral palsy
Twin-to-twin transfusion
121
Q

Maternal complications of multiple pregnancy?

A 
HG
Anaemia
Pre-eclampsia
C section
Antepartum haemorrhage
122
Q

Complications of poorly controlled diabetes in pregnancy?

A 
Congenital anomaly
Miscarriage
IUD
Pre-eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia
Neonatal hypoglycaemia
123
Q

Pathogenesis of gestational diabetes?

A

Pregnancy causes relative insulin deficiency/insulin resistance
If predispose- can tip into diabetes

124
Q

How does the uterus become more excitable in labour?

A

Increased oestrogen makes uterus contract and express oxytocin receptors

125
Q

What does oxytocin do during labour?

A

Increase and sustain contractions

126
Q

What does mechanical stretch do to hormones during labour?

A

Increase oxytocin release

127
Q

Which hormones does the foetus produce during labour?

A

Oxytocin and prostaglandins
Cortisol
Surfactant into amniotic fluid

128
Q

After the membranes rupture in pregnancy, how long until the baby is delivered?

A

Within 48 hours, or induce labour

due to high risk of infection

129
Q

What happens to the cervix to prepare for labour?

A

Cervical softening (ripening)

130
Q

What is the Bishop score, and what are the 5 elements?

A

Used for assessing labour:

  1. Position
  2. Consistency
  3. Effacement
  4. Dilatation
  5. Station (-3 to +3… 0=ischial spine)
131
Q

What is the first stage of labour and how long does it last?

A

Cervical dilatation

8-24 hours

132
Q

Features of latent phase of first stage of labour?

A

3-4cm dilation

Mild irregular contractions

133
Q

Features of active phase of first stage of labour?

A

4cm +
usually 1-2cm/hour
Decent, strong, rhythmic contractions
MOBILITY AND ANALGESIA

134
Q

What is the second stage of labour and how long does it last?

A

Delivery of baby

Nulliparous- 2.5 hours
Multiparous- 60-90 mins

135
Q

What is gravidity?

A

number of times that a woman has been pregnant

136
Q

What is parity?

A

number of times that she has given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn

137
Q

What is the third stage of labour and how long does it last?

A

Expulsion of placenta and membranes
(cord lengthens and gush of blood)
~10 mins after baby

138
Q

What are Braxton-Hicks contractions?

A

Tightening of uterine muscles

Irregular, mild, resolve with movement

139
Q

How regular should true contractions be, and what duration?

A

Should have 3-4 in 10 mins

Should be ~45 secs

140
Q

When are contractions hyperstimulated?

A

> 5 in 10 mins

141
Q

What are contractions insufficient?

A

<3 in 10 mins

142
Q

What is the most suitable pelvic shape for giving birth?

A

Gynaecoid pelvis

143
Q

How can foetal position be determined during labour?

A

Feeling fontanelle position on vaginal exam

144
Q

What is a normal foetal position during labour?

A

Longitudinal lie, cephalic presentation, flexed head

OCCIPITO-ANTERIOR

145
Q

What is engagement in labour?

A

When widest part of head entered brim of pelvis (3/5 in pelvis, 2/5 in abdomen)

146
Q

What does the foetal head do in labour?

A

Flexion (chin to chest) then internal rotation, then extends

Finally, external rotation (restitution) to align with torso

147
Q

What is crowning in labour?

A

When widest part of head is at vaginal opening

148
Q

Which shoulder should be birthed first?

A

Anterior shoulder

149
Q

Analgesia used during labour? (6)

A
  1. Paracetamol/co-codamol
  2. TENS
  3. Entonox
  4. Diamorphine
  5. Epidural
  6. Spinal anaesthesia
150
Q

What does entonox cause?

A

Euphoria
Sickness
Inattention

151
Q

What is an epidural?

A

Injected L2-4

Numb below level (dermatomes and myotomes)

152
Q

Side effect of epidural?

A

Hypotension, bradycardia, fetal hypoperfusion

153
Q

What is a spinal anaesthesia?

A

Pudendal nerve block

154
Q

2 important steps after delivery and why?

A

Delayed cord clamping (1-2 mins/pulsation ceases)- allow transfer of RBCs
Skin-to-skin (1 hour)- promotes breastfeeding, calming bonding

155
Q

When should active management of third stage of labour occur, and what can be done?

A

After >1 hour post-birth

Syntometrine 1ml
Oxytocin 10 units

156
Q

What does syntometrine contain?

A

Oxytocin and ergometrine

157
Q

What is the puerperium?

A

6 weeks post birth

Repair and recovery period

158
Q

What is lochia?

A

Vaginal discharge with blood and mucus after birth (may be fresh blood, brown or yellow)

159
Q

What stimulate production and secretion of breast milk?

160
Q

What is the leading cause of maternal mortality?

A

VTE (4-6x risk)

161
Q

What do palpitations and systolic/extra-systolic murmurs mean in pregnancy?

A

Mostly benign (common)

162
Q

What does chest pain in pregnancy require?

A

ECG +/- CTG

163
Q

Which cardiac conditions are very dangerous in pregnancy and often contraindicate becoming pregnant?

A

Pulmonary hypertension
Cyanosis
TIA/arrhythmia
HF

164
Q

How many pregnancies can involve breathlessness?

165
Q

Sudden SOB in pregnancy?

166
Q

How does asthma change during pregnancy?

A

1/3 improve
1/3 the same
1/3 deteriorate

167
Q

Can inhalers for asthma be continued throughout pregnancy?

168
Q

What to do if an oral steroid has been used >2 weeks before labour?

A

Give IV hydrocortisone 100mg qid during labour

169
Q

Where do most VTEs occur in pregnancy (85-90%)?

A

Left leg

Mostly ileo-femoral

170
Q

What is used as VTE prophylaxis if high risk in pregnancy?

A

Dalteparin

171
Q

What is used as VTE prophylaxis if high risk post-natally?

A

Warfarin from day 5- 6 weeks

172
Q

Affects of APS on pregnancy?

A 
Early pregnancy loss (recurrent)
Thrombosis
Foetal growth restriction
Placental abruption
Severe pre-eclampsia
173
Q

Management of APS in pregnancy?

A

Low dose aspirin +/- LMWH

174
Q

Foetal risk of maternal epilepsy?

A

Injury from seizure
Congenital malformations
Developmental defects
Haemorrhagic disease of newborn

175
Q

High BP in pregnancy is defined as..?

A

2x 140/90
1x 160/110
or
30/15 increase compared to 1st trimester

176
Q

Define pregnancy induced hypertension?

A

New hypertension after 20 weeks with no proteinuria

Resolves 6 weeks postpartum

177
Q

What is pre-eclampsia and how many pregnancies are affected?

A

New hypertension after 20 weeks with significant proteinuria (>0.3g/L)
+ oedema

5% of UK pregnancies

178
Q

Risk factors for pre-eclampsia?

A 
Existing hypertension
Diabetes
Renal disease
Autoimmune disorder
FH
Obesity
Multiple pregnancy
First pregnancy
179
Q

What is ‘early’ pre-eclampsia?

A

<34 weeks

uncommon, high risk

180
Q

What is ‘late’ pre-eclampsia?

A

> 34 weeks

more common

181
Q

Pathogenesis of pre-eclampsia?

A
  1. Abnormal placental perfusion–> ischaemia and endothelial dysfunction
  2. Maternal syndrome
182
Q

CNS effects of pre-eclampsia?

A 
Eclampsia
Hypertensive encephalopathy
Intracranial haemorrhage
CN palsy
Cerebral oedema
Cortical BLINDNESS (temporary)
183
Q

Renal effects of pre-eclampsia?

A

Decreased GFR
Proteinuria
AKI
Increases serum uric acid

184
Q

Liver effects of pre-eclampsia?

A

Pain
Abnormal LFTs
HELLP
Hepatic rupture

185
Q

Haematological effects of pre-eclampsia?

A

Low PV
Haemolysis
Thrombocytopenia

186
Q

Cardiac/lung effects of pre-eclampsia?

A

Pulmonary oedema

PE

187
Q

Foetal effects of pre-eclampsia?

A

Growth restriction

Placental abruption

188
Q

Symptoms of pre-eclampsia?

A 
Headache
Visual disturbance
RUQ pain
N+V
Oedema
SOB
Confusion
189
Q

Investigations of pre-eclampsia?

A 
FBC, U+Es, LFTs, coag screen
Serum urate
Urine PCR
Fetal CTG
USS
190
Q

Treatment of pre-eclampsia?

A

DELIVERY

Anti-hypertensive

191
Q

How to manage pre-eclampsia birth?

A

Most within 2 weeks of diagnosis
Steroids
Use epidural (reduce BP)
Continuous CTG monitoring

192
Q

Which anti-hypertensives are used in pre-eclampsia and how do they work?

A

Labetalol- alpha and beta antagonist (NOT IN ASTHMA)
Nifedipine- Ca channel antagonist
Methyl-dopa

193
Q

What is eclampsia?

A

Tonic clonic seizure with extreme hypertension

194
Q

Treatment of eclampsia?

A

IV magnesium sulphate (4g) then IV infusion
IV diazepam if persistent
Strict fluid balance (catheterise)

195
Q

What is HELLP syndrome?

A

Haemolysis Elevated Liver enzymes, Low Platelets

196
Q

How to prevent pre-eclampsia in high risk patients?

A

75mg aspirin from 12 weeks

197
Q

Define an antepartum haemorrhage?

A

> 24 weeks and before second stage of labour

198
Q

Define a minor haemorrhage?

A

> 50 ml loss, now settled

199
Q

Define a major haemorrhage?

A

50-1000ml

No signs of shock

200
Q

Define a massive haemorrhage?

A

> 1000ml

and/or signs of shock

201
Q

What is placental abruption?

A

Premature separation of placenta before birth (partial or total)

202
Q

Pathogenesis of placental abruption?

A

Vasospasm leading to arteriole rupture
Blood into amniotic fluid
Tonic contraction- placenta hypoxia

203
Q

Risk factors for placental abruption?

A 
Pre-eclampsia/ high BP
Trauma
Drugs- smoking, cocaine
Thrombophilia
Renal disease
Diabetes
Multiple pregnancy
Polyhydramnios
Premature ROM
204
Q

Symptoms/signs of placental abruption?

A 
Severe CONTINUOUS abdo pain
Backache
Bleeding
Preterm labour
Collapse
Distressed
WOODY-HARD UTERUS
Large uterus
205
Q

How is placental abruption managed?

A

O2, fluids, ABC
C-section ASAP
Bloods + X match

206
Q

What is Kleihauer’s test?

A

For foetal haemoglobin

207
Q

What is placenta praevia?

A

Placenta partially or fully implanted in the lower uterine segment (covering the cervical os)
- AKA low-lying placenta

208
Q

Which part of the uterus doesn’t contract during labour?

A

Lower segment (passively dilates)

209
Q

Why is the lower segment important in C-sections?

A

Less bleeding, thinner, easier to heal

Allows future vaginal births

210
Q

Risk factors of placenta praevia?

A 
Previous C-section/placenta praevia
Asian
Smoking
Assisted conception
Multiparity
Multiple pregnancy
>40
211
Q

Symptoms of placenta praevia?

A

PAINLESS bleeding
(patients condition directly proportional to amount of bleeding)
Uterus soft, non-tender
Malpresentation

212
Q

Investigations of placenta praevia?

A

DO NOT DO VAGINAL EXAM
Speculum exam
USS

213
Q

Management of placenta praevia?

A

ABC resuscitation + X match
CTG
Steroids + magnesium sulphate
C section delivery

214
Q

What is placenta accreta?

A

A morbidity adherent placenta to uterine wall

Causes DOUGHY ABDOMEN

215
Q

Risk factors of placenta accreta?

A

Placenta praevia

Previous C section

216
Q

Difference between the two types of placenta accreta- placenta increta and placenta percreta?

A

placenta increta- placental infiltration of myometrium

placenta percreta- penetration reaches serosa, into bladder

217
Q

Management of placenta accreta?

A

Prophylactic internal iliac artery balloon
C section
May need hysterectomy
(expect >3L blood loss)

218
Q

What is uterine rupture?

A

Full thickness opening of uterus

219
Q

Risk factors for uterine rupture?

A

Previous C section
Previous uterine surgery
Multiparity
Obstructed labour

220
Q

Symptoms of uterine rupture?

A 
Severe abdo pain
SHOULDER TIP PAIN
Collapse
Peritonitis
IUD
221
Q

Management of uterine rupture?

A 
Urgent resuscitation (+ anti-D)
C section
222
Q

What is vasa praevia?

A

Unprotected fetal vessels traverse the fetal membranes over the internal os (block exit)

223
Q

Investigation of vasa praevia?

A

USS doppler

224
Q

Symptoms of vasa praevia?

A

Sudden bleeding + fetal bradycardia/IUD

225
Q

Risk factors of vasa praevia?

A

Placental anomalies
Placenta praevia
Multiple pregnancy
IVF

226
Q

Define PPH? What is primary and secondary?

A

> 500ml blood loss after birth of baby

Primary- in first 24 hours
Secondary= 24hours- 6 weeks

227
Q

What is major PPH?

A

> 1000ml lost + signs of shock or ongoing bleeding

228
Q

Causes of PPH? 4Ts?

A

Tone (uterine atony)
Trauma
Tissue (retained placenta)
Thrombin (clotting disorders etc.)

229
Q

Risk factors of PPH?

A 
Anaemia
Previous C section
Previous PPH
Previous retained placenta
Polyhydramnios
Macrosomia
Obesity
Multiple pregnancy
230
Q

General management of PPH?

A

X match 6 units
IV warmed crystalloid infusion
Tranexamic acid

231
Q

Management of PPH due to uterine atony?

A
  1. Uterine massage
  2. IV syntocinon
  3. Carboprost/Misoprostol
  4. Uterine balloon tamponade
  5. Hysterectomy if extreme
232
Q

Management of PPH due to retained tissue?

A

Remove tissue

Examination under anaesthesia

233
Q

Management of PPH due to thrombin?

A

Blood and platelet transfusion

234
Q

How to prevent PPH?

A

Active management of 3rd stage of labour

235
Q

Commonest cause of secondary PPH?

A 
Retained tissue (foul smelling, fever, discharge)
Infection common
236
Q

What shape is the anterior fontanelle?

237
Q

What shape is the posterior fontanelle?

238
Q

In breech, what are the risks?

A

Fetal distress, trauma, head entrapment

239
Q

What is ECV and when is it done?

A

External cephalic version at 36 weeks to turn baby

240
Q

What management is often needed in an occipito-posterior positioning?

241
Q

What is there an increased risk of in occipito-transverse positioning, and what is its management?

A

Cord prolapse

Emergency C-section (30 mins) if occurs

242
Q

What happens after 42 weeks gestation?

A

High rates of stillbirth

243
Q

Signs of obstruction in failure to progress?

A 
Moulding
Caput (head swelling)
Haematuria
Vulval oedema
Retention
Anuria
244
Q

When should failure to progress be expected in nulliparous women?

A

<2cm dilatation in 4 hours (2-3 hrs pushing)

245
Q

When should failure to progress be expected in multiparous women?

A

<2cm dilatation in 4 hours or slowing in progress (1-2 hrs pushing)

246
Q

Causes of failure to progress?

A

3Ps
Power- inadequate/uncoordinated contractions (<3 in 10 mins)
Passage- pelvis too small, short stature
Passenger- big baby, malpresentation/malposition

247
Q

How is progress of labour assessed?

248
Q

Causes of foetal distress?

A 
Abruption
Vasa praevia
Hyperstimulation
Placental insufficiency
Cord prolapse
Uterine rupture
Regional anaesthesia
Fetal anaemia
249
Q

Monitoring of foetal distress?

A

Doppler auscultation
Colour of amniotic fluid
Cardiotocograph (CTG)

250
Q

What might colour of amniotic fluid indicate?

A

Red- bleeding/clots

Green/brown- meconium passed- sign of distress

251
Q

Mneumonic for CTG interpretation?

A

Dr C Bravado

DR- define risk (high or low from Hx)
C- contractions (frequency + duration)

Bra- Baseline rate (fetal HR normal-110-160)
Variability (at least 10-15bpm- reassuring)
Accelerations (15bpm increase for 15 secs- reassuring)
Decelerations (early- normal, variable- cord compression, late- hypoxia)
Overall (reassuring, suspicious or abnormal)

252
Q

One a CTG, how long does 1 box represent?

253
Q

Management of foetal distress?

A 
IV fluids
Stop syntocinon
Scalp stimulation (normal- acceleration on CTG)
Tocolysis (terbutaline)- relax uterus
Fetal blood sampling- blood gases
Forceps/ventouse/C section
254
Q

What is shoulder dystocia and complications?

A

Shoulder stuck behind pubic symphysis- can lead to fetal asphyxia

May lead to PPH, 3rd degree tears, fetal hypoxic, fractures and palsies

255
Q

Management of shoulder dytocia?

A 
Mc Roberts (knees to chest)
Episiotomy
Remove posterior arm
Turn on to all fours
Internal manoeuvres
256
Q

How does uterine inversion occur?

A

Pulling on placenta before detachment

257
Q

How to manage aortocaval compression?

A

Turn onto left lateral position

258
Q

Indications for induction of labour?

A 
Pre-eclampsia
Post-dates
Suspected IUGR
Renal disease
Rhesus isoimmunisation
Placental insufficiency
Diabetes
Connective Tissue Disease
Premature ROM
259
Q

How to induce labour?

A

Prostaglandins (vaginal gel)
Membrane sweep
Amniotomy- artificial ROM
IV syntocinon

260
Q

Most drugs cross the placenta. Name a safe drug that DOES NOT?

A

Anything large molecular weight–> HEPARIN

261
Q

How is drug absorption affected in pregnancy?

A

Decreased in morning sickness

262
Q

How is drug distribution affected in pregnancy?

A

Increased plasma volume= Increased volume of distribution

Increased free drug

263
Q

How is drug metabolism affected in pregnancy?

A

Increased liver metabolism

264
Q

How is drug elimination affected in pregnancy?

A

Increased GFR, increased metabolism

265
Q

When is the period of greatest teratogenicity?

266
Q

Name some teratogenic drugs?

A 
ACEi/ARBs
Androgens
Anti-epileptics
Cytotoxics
Lithium
Methotrexate
Retinoids
Warfarin
267
Q

What do drugs affect in 2nd and 3rd trimester?

A

Growth of foetus + functional development (intelligence/behaviour)

268
Q

What can epilepsy cause in pregnancy if untreated?

A

Congenital malformations, reduced IQ etc.

269
Q

How many epileptic people experience more seizures in pregnancy?

270
Q

Anti-epileptics to avoid in pregnancy?

A

Sodium valproate
Phenytoin
Lamotrigine (in breastfeeding)

271
Q

Is insulin safe in pregnancy?

272
Q

Which diabetes medication should be avoided in pregnancy?

A

Sulphonylureas

273
Q

Which anti-emetic can be used in pregnancy?

A

Cyclizine (cycle away from vomiting)

274
Q

For treatment of UTI, which can’t be used in 3rd trimester?

A

Nitrofurantoin

275
Q

What is foremilk high in?

276
Q

What is hindmilk high in?

277
Q

How long after a molar pregnancy should you wait to get pregnant again?

A

wait until bHCG falls to normal (roughly 3 months)

278
Q

PPH followed by pituitary failure?

A

Sheehan’s syndrome

Y3- TO LEARN (13 decks)

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