Obstetrics Flashcards

Question

Forceps Indications Prerequisites

Answer 1

Indications /why - Prolonged labour - Foetal distress but cannot CS - reduce maternal exhaustion ``` Prerequisites Fully dilated OA Ruptured membranes Cephalic Empty bladder Pain relief S - pelvic ```

Answer 2

``` Aetiology - Baby not ready Malpresentation Polyhydramnios Premature Multiple pregnancy ARM Uterine abnormalities Vasa previa Placenta previa ``` Presentation - Foetal distress of CTG - V/E - can see or palpate cord Investigations - V/E/CTG Management - Trendelenberg - Tocolytics - Push back up and wait to immediately deliver - CS - If past interoitus --> keep warm + moist don't push back in Complications - Foetal - hypoxia/ CP/ death

Answer 3

Normal - non reassuring - abnormal Baseline - 110-160 // 110-100 or 160-180 // >180 or <100 Variability - >5/ <5 for 40-90 mins - <5 for >90 mins Accelerations - should be present Decels - early/ variable/late 1 non reassuring LLP Fluids O2 and monitor 2 non reassuring or 1 abnormal FBS 2 abnormal or brady <100 for >3 mins - C1CS

Answer 4

Definition - foetal hypoxia ``` Aetiology Not enough direct blood supply: - APH - Cord prolapse Excessive uterine contractions eg in oxytocin prolonged labour ``` Diagnosis - CTG - Meconium stained liqour - premature labour Management LLP, O2, fluids Terbutaline / stop oxytocin Vaginal exam - exclude prolapse - FBS >7.2 - reassess or if maternal deterioration - another sample - if no improvement - CS FBS >7.2 - C1CS

Answer 5

RF - VBAC - main - Multiple pregnancy - Previous surgery Presentation - Cessation of uterine contractions - PPH - Abdo pain - Foetal distress - Shock etc Rx - Immediate delivery - Surgical repair +/- hysterectomy

Answer 6

Definitions Blood loss of >500ml or 1000ml in CS Primary <24 hrs Secondary 24hrs - 2 weeks Presentation - Blood innit ``` Aetiology - the Ts TONE - Uterine atony - most common cause - commonly seen in: Multiparous Multiple pregnancy / polyH ``` TISSUE - retained placenta (common cause of secondary - and common in accreta etc) TRAUMA - Forceps - CPD - Shoulder dystocia - Macrosomia THROMBIN - coag disorders Prevention - Offer all mothers syntocinon for 3rd stage ``` Management ABC IV access IV syntocinon +/- ergotramine (CI HTN) Look at uterus under anaesthesia IM carboprost (CI asthma) Surgical - Uterine artery embolisation - B lynch suture - Iliac artery embolisation - Hysterectomy ``` remember in secondary give Abx as endometritis is a main cause (along with retained placenta) + do ERPC if needed

Answer 7

Aetiology/RF - Macrosomia - Maternal obesity/ diabetes - CPD - Maternal exhaustion/ prolonged labour ``` Rx - HELPERRR Help - call for help Evaluate need for episiotomy Legs in McRoberts Pressure - suprapubic Enter pelvis Rotate - wood screw maneouver Release posterior arm Restitution - head back inside and --> CS - zavanelli ``` Complications Maternal -PPH, shock, psychological, tears Foetal Erbs, clavicle frac, hypoxia, death

Answer 8

Frank - buttocks Footling - feet first Causes - Preterm labour - Multiparous - Polyhdramnios - Uterine abnormalities Management - <36w - normal - >36w - ECV - remember this is a sensitising event - give Anti D if needed Plan CS at 38/9w - but can deliver vaginally if mother wishes to Complications - Cord prolapse - Clavicle # - brachial plexus palsy - DDH Maternal - PPH - Prolonged labour

Answer 9

Contraindications Classical scar >2 previous CS Prev uterine rupture Complications - Uterine rupture - Need for emergency CS Factors with successful outcome - <2 years between pregnancies - Spontaenous labour - Low age - Low BMI

Answer 10

Classical scar >2 previous Prev uterine rupture

Answer 11

Causes >10cm pools of liqour Presentation Taut uterus Foetus difficult to palpate Large for dates Multiple pregnancy Feotal cardiac/renal abnormality Rx - amnioreduction ``` Complications Cord prolapse Malpresentation Premature PPH as --> uterine atony ```

Answer 12

Causes <500 at 32-36w ``` causes PROM post date Pre-eclampsia Foetal renal problem IUGR ```

Answer 13

Causes >10cm pools of liqour ``` Presentation Taut uterus Foetus difficult to palpate Large for dates Maternal dyspnoea/SOB ``` Multiple pregnancy Feotal cardiac/renal abnormality Rx - amnioreduction Complications Cord prolapse Malpresentation Premature

Answer 14

Causes <500 at 32-36w ``` causes PROM post date Pre-eclampsia Foetal renal problem IUGR ```

Answer 15

Obs diabetes: 5. 8 - fasting 7. 8 - random Rx - Diet etc for 2 weeks --> - Stop all except metformin or insulin - Folic acid ``` Complications Abnormalities - NTD, heart defects - labour Macrosomia + friends (shoulder dystocia, PPH,) IUGR Preterm labour Polyhydramnios Transient hypoglyaemia fo newborn ``` For mother - pre-eclampsia - PPH - Polyhydramnios

Answer 16

Baby blues peaks at 5 days, usually over by 10 PPD 1m - 3m Paroxetine Edinburg depression score Post partum psychosis 2-3 weeks Abrupt change in mental state

Answer 17

Rh-ve mother Rh +ve baby - worrying in the second pregnancy Give anti D at 28 weeks or a sensitising event ``` TOP Miscarriage >12w Ectopic ECV Still birth Amnio/CVS APH FBS ``` ``` Haemolytic disease of the newborn Oedema Jaundice hepatosplenomegaly Kernicterus HF Anaemia ```

Answer 18

Infection of placenta RF - PPROM ROM and FOUL SMELLING can cause preterm Give Abx + deliver foetus

Answer 19

Offer IV abx IF - Previous GBS - Pyrexia - Premature Offer abx for GBS in all preterm labour Foetal complications Meningitis Sepsis Stillbirth Ben pen

Answer 20

If suspect give LMWH USS/doppler CTPA/VQ scan

Answer 21

booking 28w Cut offs 1st tri <110 2nd+3rd tri: <105 Post partum <100 Rx - oral ferrous sulphate

Answer 22

cause Induction of labour ^ maternal age SOB Chest pain cyanosis Rx - supportive can do pulmonary artery catheterisation if really unstable

Answer 23

``` CHRIST CMV - hearing, visual, growth,skin Herpes - herpes infantum Rubella - heart, cataract, hearing Syphilis - stillbirth Toxoplasmosis - cerebral calcification ```

Answer 24

``` Indications Maternal - APH - vasa prev, previa, accreta, abruption - Pre-eclampsia Foetal - IUGR - Foetal distress - Uncorrectable malpresentation - Twins - Cord prolapse ``` ``` Risks Maternal - Haemorrhage - Infection - VTE - Anaesthetic risk - Injury eg bladder ``` Late maternal - Accreta - Uterine rupture in VBAC - Need for another CS Foetal - RDS - Injury

Answer 25

Galactocoele Pres - lump, no systemic features, no erythema, painless - usually after they have stopped feeding Management - N/A Mastitis Pres - erythema, painful lactation (before feed) Management - KEEP FEEDING + NSAIDS or abx - fluclox if nipple fissure, milk test +ve, not gone after 12-24hrs Abscess Pres - systemic features, lump, pain Management - abx Engorgement usually bilateral - pain + discomfort before the feed Express milk to releive discomfort

Answer 26

Fasting 5.6 | Random 7.8

Answer 27

Macrosomia >4.5 or >4 for preterm Foetus larger than 90th percentile

Answer 28

Folic acid – pre-conception to 12 weeks (5mg) Stop all oral except metformin Continue insulin if needed

Answer 29

shoulder dystocia

Answer 30

Do fasting plasma glucose within 13 weeks of delivery and annual HbA1c

Answer 31

``` ABC LLP Magnesium IV labetalol/ hydralazine Deliver the baby ```

Answer 32

Presentation/ Types Threatened - cervical os closed, small painless PV bleed, foetal pole intact Inevitable Cervical os open PV bleed - may be larger, may be passing clots Incomplete - Cervical os open, large PV bleed - uterus is still large Missed/delayed empty gestational sac Cervical os closed Complete Cervical os closed, clots have passed, no foetal parts Small uterus

Answer 33

Miscarriage = painless Ectopic = painful and dark brown

Answer 34

1) Would endanger woman's life 2) Carrying on is > risk than risk of termination 3) Risk to health of children 4) Mental or physical health would suffer if she carried on 5) The child born would be severely disabled/mentally handicapped

Answer 35

Triad PV bleed Foetal bradycardia ROM

Answer 36

ROM --> deliver C1CS | No ROM --> Induce at 36w

Answer 37

``` Aetiology/ RF High risk CKD Autoimmune HTN in previous pregnancy Diabetes Chronic HTN ``` ``` Intermediate risk FHx First pregnancy Multiple pregnancy BMI >35 Age >40 Interval between pregnancies >10 years ```

Answer 38

- Eclampsia - HELLP - DIC - liver failure/ renal failure - Pulmonary oedema - Death Foetal - IUGR - Prem delivery - Placental abruption risk

Answer 39

Definition Stage 1 active = <2cm/4hrs Stage 2 active: Consider in 1, diagnose in 2hrs in nullip Consider in 30, diagnose in 1hr in multips

Answer 40

Terbutaline

Answer 41

Cessation of contractions Abdo pain Foetal bradycardia PPH

Answer 42

NTD, heart defects

Answer 43

Rh-ve mother and +ve baby in 2nd pregnancy/ after sensitising event

Answer 44

28w | Or sensitising event

Answer 45

Hydrops foetalis ``` Haemolytic anaemia Jaundice - kernicterus Hepatosplenomedaly Oedema HF Anaemia ```

Answer 46

Previous GBS Premature Pyrexia (in labour)

Answer 47

painful long labour Oxytocin use --> foetal distress PPH Cord prolapse Amniotic fluid emboli