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Big Reece's Little Specialties > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Cord prolapse risks

A 
prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. Breech, transverse lie
placenta praevia
long umbilical cord
high fetal station
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2
Q

Cord prolapse management

A

Manually move cord back up - with hand or by filling bladder UNLESS it is below the level of the intritous, then just keep it warm and wet
Usually deliver by C-section
Put patient on all fours
Can use tocyolytics e.g terbertaline can be used while preparing for C section

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3
Q

When does cord prolapse tend to happen

A

With ARM

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4
Q

Signs of cord prolapse

A

Variable decelerations on CTG

Palpable/visibile cord

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5
Q

Oligohydramnios Causes

A 
premature rupture of membranes
fetal renal problems e.g. renal agenesis
intrauterine growth restriction
post-term gestation
pre-eclampsia

It’s associated w/ chromosomal abnormalities, medication (ACEi, indomethacin) and multiple pregnancies

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6
Q

Oligohydramnios Rx

A

Term - deliver if not contrindicated

Preterm - Monitor w/ serial USS for growth, liquor volume, dopplers + regular CTG –> deliver if necessary

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7
Q

total contraindications for COCP

A

more than 35 years old and smoking more than 15 cigarettes/day
migraine with aura
history of thromboembolic disease or thrombogenic mutation
history of stroke or ischaemic heart disease
breast feeding < 6 weeks post-partum
uncontrolled hypertension
current breast cancer
major surgery with prolonged immobilisation

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8
Q

When should lochia stop post partum

A

6w

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9
Q

Obstetric Cholestasis - signs

A

Generally in 2nd half of pregnancy (3rd trimester)
No other cause
Pruritis in the absence of rash (worse at night and over palms and soles) –> excoriations
Raised LFTS, bilirubin, raised bile acids can have decreased clotting factors (due to decreased vit K absorption)

Rarely get dark urine and steatorrhoea

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10
Q

Obsetric Cholestasis - Management

A

Weekly LFTs and clotting
Serial USS and intermittent CTG for monitoring
[Chlorpheniramine to control pruritus]
Ursodeoxycholic acid (to reduce bile acids and pruritus) –> dexamethasone if no response
Vit K
Induce at 37w due to increased risk of foetal death
Ensure resolution of LFTs and 10d post partum

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11
Q

Acute Fatty Liver in pregnancy

A

Rare, in 3rd trimester
On spectrum w/ Pre-eclampsia
Malaise, vomiting, jaundice, vague epigastric pain and thirst are early features
Acute hepatorenal failure, DIC and hypoglycaemia come later
Treatment is supportive - dextrose, blood products, careful fluid balance, occasionally dialysis

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12
Q

Safest anti-epileptics in pregnancy

A

Carbamazapine and Lamotragine

Give folic acid with them

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13
Q

what epilepsy drug should ideally not be used

A

Sodium valproate

Congential abnormalities (orofacial, neural tube and heart defects) and Low IQ

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14
Q

What anomaly can Lithium cause

A

Ebstein’s anomaly

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15
Q

what occurs regarding pre-existing epilepsy in pregnancy

A

Change in seizure frequency due to increased renal and hepatic drug clearance, increased volume of distribution, decreased absorption, and compliance issues

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16
Q

What epilepsy drugs need to be monitored in pregnancy

A

Levetriacem and Lamotregine

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17
Q

What do you need to give if a woman if on an enzyme inducing anti-epileptic and why

A

Vitamin K - prevent haemorrhage disease of the newborn

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18
Q

Contraindications for VBAC

A

Previous uterine rupture
Classic Section scar
Contraindication to vaginal birth - e.g major placenta praevia

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19
Q

When do pre-eclampsia and gestational HTN begin to occur

A

20 weeks

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20
Q

Definition of PPH

A

> 500mls blood loss

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21
Q

1st line Treatment for PPH

A

IM Syntocin

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22
Q

Treatment for Polyhydramnios

A

Indomethican

Reducitve amniocentesis

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23
Q

most common cause of PPH

A

uterine atony

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24
Q

Causes of 2º PPH & rx

A

endometritis and retained products of conception

Abx, evacuate retained products only if unavoidable as increased risk of uterine perforation

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25
Q

treatments for PPH

A

Atony - Bimanual compression, IM Syntocin (oxytocin + ergometrine), IM carboprost, PR msioprosol
Intrauterine ballon insertion, uterine artery embolisation, laparotomy and insertion of brace suture
hysterectomy is severe

If trauma - suture
If retained products - manually evacuate in theatre §

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26
Q

Early deceleration on CTG

A

Head compression

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27
Q

Late deceleration on CTG

A

foetal distress - asphyxia or placental insufficency

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28
Q

variable decelerations on CTG

A

head compression

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29
Q

what is normal variability on CTG. what causes reduced variability

A

> 5

Loss = prematurity, hypoxia, foetus is asleep (if short period)

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30
Q

what is foetal tachycardia on CTG

what can cause this

A

> 160bpm

maternal pyrexia, chorioamnioniitis, hypoxia, prematurity

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31
Q

what is foetal bradycardia on CTG

A

<100

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32
Q

what do you give if a woman is at risk of GBS

A

Intrapartum antibiotics

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33
Q

When do you give the neonate antibiotics with regards to GBS

A

If there are signs of sepsis

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34
Q

what is placenta acreta and what is the risk of this

A

attachment of the placenta to the myometrium (Muscle layer

risk = PPH –> often requiring hysterectomy

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35
Q

what are risk factors for placenta acreta

A

placenta praevia,

previous C section

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36
Q

how do you treat seizures in eclampsia and how is it given

A

Magnesium sulphate, IV, 4g bolus then 1g per hour
should continue until 24hrs after last seizure or delivery
urine output, reflexes, respiratory rate and oxygen saturations should be monitored during treatment

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37
Q

A woman has a blood pressure of 150/95 at 13 weeks. what does she have

A

PRe-existing HTn

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38
Q

A woman has a blood pressure of 150/95 at 25 weeks, with no proteinuria, what does she have

A

Gestational HTN

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39
Q

A woman has a blood pressure of 150/95 at 25 weeks with >0.3g proteinuria in 24hours , what does she have?

A

Pre-eclampsia

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40
Q

what symptoms would you expect with pre-eclampsia

A 
CAN BE ASYMPTOMATIC 
Headache
oedema (especially face) 
Visual disturbances
RUQ pain due to liver capsule swelling
Hyperreflexia
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41
Q

Rx for mild-moderate pre-eclampsia

A

Regular BP monitoring and urinalysis
Regular blood testing
Serial USS for foetal growth
Regular CTGs
Aspirin - [if nuliparious, age >40, BMI >35, Fhx of pre-eclampsia, multiple pregnancy, HTN in previous pregnancy, CKD, Autoimmune disease, diabetes or chronic HTN]
Antihypertensives - labetelol (methydopa, nifedipine)
Delivery at 36/37weeks

42
Q

Rx for severe pre-eclampsia/foetal compromise

A 
Admit and monitor 
Delivery (Steroids if necessary) 
Antihypertensives
Seizure prophylaxis (Iv Mag Sulph)
Fluid restriction
Strict fluid balance
43
Q

what is the BP for severe pre-eclampsia and what do you do

A

160/110

ADMIT

44
Q

Increased AFP causes

A

Neural tube defects
Abdominal tube defects e.g omphaocele
Multiple pregnancy

45
Q

Decreased AFP causes

A

Down’s
Edwards (t18)
DM

46
Q

Diagnostic criteria for hyperemesis gravidarum

A

5% pre-pregnancy weight loss, electrolyte imbalance, dehydration, ketosis

47
Q

Associations with hyperemesis gravidarum?

A 
multiple pregnancies
hyperthyroidism
obesity 
nulliparity
trophoblastic disease
48
Q

What decreases risk of hyperemesis gravidarum

A

smoking

49
Q

Rx for hyperemesis gravidarum

A

Anti-histamine anti emetics are first line - cyclizine, promethazine
metoclopromide and ondansetron can also be used
IV fluids if dehydrated

50
Q

when is hyperemesis gravidarum most common, and when can it persist beyond

A

8-12 weeks

can persist up to 20 weeks and rarely beyond

51
Q

placenta praviea signs

A 
PAINLESS bleeding
Shock in accordance with visible loss 
non tender uterus 
can have abnormal lie/presentation
small bleeds before large 
foetal heart usually normal
should be diagnosed on 20 week ultrasound
52
Q

Associations with placenta praevia

A

nuliparity
previous pregnancy
previous caesarian - can implant in scar

53
Q

Aortic dissection in preganancy associations

A

3rd trimerster
Ehlers-Danlos
Bicuspid valve
(can get ST elevation if right coronary involved - causing MI)

54
Q

Most common valve issue in immigrant pregnant woemn

A

Mitral Stenosis
Becoming less common in UK so suspect in immigrants
assoc with rheumatic heart disease
hear mid diastolic murmur

55
Q

what do you use to treat ~VTE in pregnancy and for how long

A

LMWH throughout pregnancy and until 4-6 weeks after

- warfarin is contraidnidcated

56
Q

Ix for placenta praevia

A

Scan at 16-20 weeks should pick it up
Rescan at 34 weeks
If still high at 34 weeks, scan every 2 weeks]
if still there and grade 3/4 at 37 weeks - C section
If high presenting part or abnormal lie at 37 weeks - also C section

57
Q

Management for placenta praevia

A

Consider delivery options e.g C section at 37 weeks if present
Don’t have to avoid sex/acitvity unless bleeding

If bleeding:
Admit
Cross match blood
Treat shock

58
Q

1º surgical management for PPH

A

Uterine balloon tamponade

59
Q

Inevitable miscariage

A

heavy bleeding with clots and pain

cervical os is open

60
Q

incomplete miscarriage

A

not all products of conception have been expelled
pain and vaginal bleeding
cervical os is open

61
Q

Missed/delayed miscarriage

A

a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
cervical os is closed
when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’

62
Q

Threatened miscarriage

A

painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
the bleeding is often less than menstruation
cervical os is closed
complicates up to 25% of all pregnancies

63
Q

what advice regarding breast feeding do you give for peupleural mastitis

what do you do regarding abx?

A

Continue!
or express/pump if too painful

Antibiotics are only recommended if the lady has an infected nipple fissure, symptoms do not improve or are worsening after 12-24 hours despite effective milk removal, or bacterial culture is positive.
The first line antibiotic is flucloxacillin 500 mg qds for 14 days (erythromycin 250 mg to 500 mg qds for 14 days if penicillin allergic)

64
Q

Score for assessing hyperemesis gravidarum

A

Pregnancy-Unique Quantification of Emesis (PUQE) score

65
Q

when to offer ECV

A

The RCOG recommend ECV should be offered from 36 weeks in nulliparous women and from 37 weeks in multiparous women

Not after rupture of membranes

66
Q

what is the questionnaire for postnatal depression

A

Edinburgh Postnatal Depression Scale

67
Q

Symptoms of Placental Abruption

A

severely PAINFUL bleeding, which is constant with exacerbations
Tender, hard, “woody” uterus
Bleeding can be absent or dark
Shock is inconsistent with blood loss - maternal collapse
Lie is often normal and baby engaged
Baby can be dead or distressed
Most common cause of DIC
Can cause poor urine output or renal failure

68
Q

Risk factors for placental abruption

A

IUGR
Pre-eclampsia/Pre-exisiting HTN
Maternal smokinf
Previous abruption

69
Q

Rx for placental abruption

A

Resusitate
Give steroids if <34 weeks
Give anti-D to Rh- women
If foetus distressed - C section
If no foetal distress but >37 weeks - induce with an ARM, monitor, C section if distress
If no foetal distress, appears to be a minor bleed and pregnancy is preterm - closely monitor on wards
If baby is dead - coagulopathy is likely so give blood products and induce labour

70
Q

Symptoms of vasa praevia
what is it’s cause
what do you do?

A

ONCE MEMBRANES RUPTURE:
Massive foetal blood loss = foetal distress –> bradycardia, late decelerations, loss of variability
Painless moderate PV bleeding for mother

Cause by rupture of foetal blood vessels running in front of the presenting part –> usually occur when umbilical cord is attached to the membrane, not placenta

C-section, before if you know the vessels run there, in emergency if there’s bleeding

71
Q

SGA

A

Smaller than the 10th gentile for gestation

72
Q

IUGR

A

Small compared to genetic determination, and compromised

Often maternal illness e/g renal, pre-eclampsia, multiple pregnancy, chromosomal abnormalities, infections, smoking

73
Q

When and what’s in the Booking visit

A 
before 10w GA
Full Hx and Ex inc previous pregnancies, obstetric history, baseline blood pressure etc 
FBC
Serum antibodies e/g anti-D
Test for syphillis, HIV, Hep B
Rubella immunity is checked
Urine MC&amp;S
USS happens at 11-13+6 = dating scan --> using crown rump length --> can also screen for multiple pregnancies and nuchal translucency
74
Q

When is the dating scan & what does it measure

A

between 11 and 13+6 weeks , crown rump length

75
Q

When is the anomaly scan

A

20 weeks

76
Q

From when can you preform chorionic villus sampling

A

from 11 weeks

77
Q

when can you perform amniocentesis & what can you diagnose

A

from 15 weeks

Chromosome abnormalities, Sickle cell, CF, Toxoplasmosis, CMV

78
Q

What is in the combined test, when does it occur, what is it for

A

11-13+6 (dating scan time)
Measure Nuchal translucence on USS, β-HCG (high) and PAPP-A (low)
Chromosomal abnormalities e/g down’s

79
Q

What is in the quadruple test and when is it used

A

14-22 weeks

AFP (low) , total HCG, inhibin (high) and oestriol (low)

80
Q

When do you measure the AGPAR score

A

1, 5, and 10 mins

81
Q

Rx of PPROM

A

admission
regular observations to ensure chorioamnionitis is not developing
oral erythromycin should be given for 10 days
antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
delivery should be considered at 34 weeks of gestation - there is a trade-off between increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progresses

82
Q

What types of twins do you need to have twin to twin trransfusion syndrome

A

Monochorionic, diamniotic –> one gets Oligohydramnios, one gets Polyhydramnios

83
Q

What is the criteria for continuous CTG monitoring in labour

A

suspected chorioamnionitis or sepsis, or a temperature of 38°C or above

severe hypertension 160/110 mmHg or above

oxytocin use

the presence of significant meconium

fresh vaginal bleeding that develops in labour

84
Q

Medical RX of ectopic

A

methotrexate is most commonly given as a singleintramuscular dose of 50 mg/m2(see Appendix II).86Serumb-hCG levels are measured on days 4 and 7post methotrexate

85
Q

Complications of olgiohydramnios

A

Labour - CTG abnormalities, meconium liquor, emergency CS

Neonate - pulmonary hypoplasia, limb deformities

86
Q

Complications of polyhydramnios

A 
Preterm labour
Placental abruption
Cord prolapse
PPH 
Increased risk of caesarian
87
Q

when is the biggest risk of congenital toxoplasmosis and what does it present with

A

First trimester

Encephalitis
thrombocyopenia
Intracranial tram track calcifications
Retinochoroditis 
IUGR
hepatosplenomegaly 
#rash

(+preterm labour, miscarriage, foetal death(

88
Q

when is the greatest risk for congenital rubella and what does it present with

A

First trimester

Deafness
VSD
PDA
Cataracts
CNS defects
IUGR
Hepatosplenomegaly
thrombocytopenia
Rash
89
Q

When is parvovirus B19 infection a risk in preganacy and what does it cause

A

between 4 and 20 weeks

Fetal hydrops

90
Q

was does congenital CMV cause

A 
miscarriage/still birth
IUGR
Microcephaly
Intracerebral calcification
Sensori-neural deafness
hepatosplenomegaly
skin rash
pneumonitis 
mental retardation
91
Q

infection before when will cause foetal varicella syndrome

What does it cause

A

before 28w

Skin scarring
eye defects
limb deformities
Neurological abnormalities

92
Q

what viral load allows for a vaginal birth in pregnancy

what do they need during labour

A

<50 if they’re on HAART
they need IV zidovudine
Always C section if theyre on zidovudine monotherapt

93
Q

How long does the neonate need antriretrovirals for after birth in HIV
When is PCR testing

A

4-6 weeks

94
Q

what viral load do you need for zidovudine monotherapy in preganacy

A

<10000

95
Q

when do you test the baby for HIV post partum

A

at birth, within 48hrs, on discharge, 6 weeks, 12 weeks, 18m

96
Q

should the woman breastfeed if she’s HIV+

A

No, she’s recommended not to

97
Q

what are the cut off values for a diagnosis of GDM

A

FPG >5.6

2hr OGTT >7.8

98
Q

what are the target plasma glucoses for a woman with GDM or pre-existing diabetes

A

FPG <5.3
1hr post meal <7.8
2hr post meal <6.4

(maintain >4 if on insulin)

99
Q

What is the Rx for GDM

A

Diet, exercise if FPG <7
Can add metformin if blood glucose not below target in 1-2w
Insulin therapy if >7

Consider immediate treatment with insulin, with or without metformin[2], as well as changes in diet and exercise, for women with gestational diabetes who have a fasting plasma glucose level of between 6.0 and 6.9 mmol/litre if there are complications such as macrosomia or hydramnios

100
Q

what bishops score suggests induction of labour

A

<6

101
Q

what bishops score suggests that labour will continue spontaneously

A

> 8

Big Reece's Little Specialties (4 decks)

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