Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Specialties > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What happens to blood pressure during pregncancy

A

It falls in early pregnancy due to fall in vascular resistance but then begins to rise after 24 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What blood pressure reading is a medical emergency in pregnancy and how should an acute severe episode like this be treated

A

160/105 or greater
Give parenteral labetalol (avoid in CHF and asthma) and methyldopa
Sodium Nitroprusside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is hypertension different to pre-eclampsia

A

Pre-eclampsia has proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is chronic hypertension in pregnancy

A

Hypertension present before pregnancy/before 20 weeks gestation and is there throughout pregnancy and post partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What hypertension drugs shouldn’t be used in pregnancy and what should they be changed to

A

ACEi, A2A2 agonists and thiazide - they can cause congenital abnormality
Change to labetalol or methyldopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is gestational hypertension and what is there a high risk of these women developing

A

Hypertension that develops after 20 weeks gestation in absence of proteinuria
high risk of developing pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is given to manage gestational HTN

A

Monitor BP and urine weekly

Labetalol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the definition of pre-eclampsia

A

Newly diagnosed hypertension and proteinuria at 20 weeks gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the definition of eclampsia

A

features of pre-eclampsia + generalised tonic/clonic seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What occurs in pre-eclampsia

A

Not very well understand but caused by development of abnormal placenta and poorly developed spiral arterioles leading to:
poorly perfused placenta
inflammatory like-responses - ?vasospasm
vasospasm - leading to ischaemia of maternal organs
activation of coagulation system - HELLP syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are risk factors for pre-eclampsia

A 
Previous pregnancy pre-eclampsia
Chronic or Gestational HTN
T2DM
Multiple pregnancies 
Obesity BMI >30
FHx 
Renal Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What organs can pre-eclampsia affect

A 
Liver - raised LFTs 
Kidneys - proteinuria 
Eyes - blurred vision 
Brain - cerebral haemorrhage, seizures
Coagulation system - mini thromboli and haemolysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the complications of pre-eclampsia

A 
IUGR
Renal failure 
Placental abruption 
Eclampsia 
HELLP syndrome 
Cerebral Haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How does pre-eclampsia effect the liver

A

hepatic swelling and inflammation causing elevated LFTs and RUQ pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does pre-eclampsia affect the retina

A

Scotoma, blurred vision and flashing lights

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does pre-eclampsia affect the renal system

A

Causes proteinuria - lowering plasma volume and causing oedema (limbs and face)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does pre-eclampsia affect the brain

A

Headaches, confusion, cerebral haemorrhage and seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does pre-eclampsia effect the coagulation system

A

HELLP syndrome - haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does pre-eclampsia effect the fetus

A

Intrauterine growth restriction
Placenta abruption
Still birth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the symptoms of pre-eclampsia

A 
Absent in mild
Visual Disturbances
RUQ pain 
Headaches 
Oedema
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the signs of pre-eclampsia

A 
HTN
proteinuria 
retinal oedema 
RUQ tenderness
brisk reflexes 
ankle clonus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the diagnosis of pre-eclampsia

A 
Gestational HTN: >140/90
Proteinuria: 0.3g of protein or more in 24hrs and +2 or more on urine dipstick 
abnormal LFTs
raised creatine 
anaemia from haemolysis
prolonged PT and APTT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Management of all new pre-eclampsia

A

All new pre-eclampsia should involve admission to hospital to monitor mother and fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the management of mild pre-eclampsia before 37 weeks

A

Keep in hospital for monitoring - if persistent HTN, proteinuria, abnormal Ix, Abnormal growth and unreliable patient
Send home with home BP kit and 2wk maternal and fetal evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the management of mild pre-eclampsia 37 weeks and onwards

A

Favourable cervix, patient symptomatic or fetal jeopardy - magnesium sulphate delivery
Stable condition and unfavourable cervix deliver at 40 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the criteria of severe pre-eclampsia

A

BP >160/110
Proteinuria >5mg in 24 hrs or over 3+ urine dipstick
Impaired Liver function tests
Severe Signs and Symptoms of pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the treatment of severe pre-eclampsia

A

Before 34 weeks:
1st line: Labetalol to lower BP
Don’t offer delivery unless severe HTN doesn’t resolve once treated or there if fetal/maternal comprimise
34 weeks onwards:
Delivery should be offered following a course of corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Delivery of severe pre-eclampsia

A

Stabilise BP- using Labetalol, Methyldopa or nifidepine
Bloods including platelets, renal and liver function
Monitor urine output
Fetal wellbeing - CTGs, US
Vaginal delivery preferable
Give prophylactic magnesium Sulphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why should you give prophylactic magnesium sulphate in women with pre-eclampsia

A

It prevents recurrent seizures in women with eclampsia
or prevent seizures in women with pre-eclampsia
Parenteral magnesium sulphate reduces eclampsia and maternal death!!!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is HELLP syndrome

A

Haemolysis, Elevated LFTs and Low Platelets

Treatment: deliver fetus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Treatment of Eclampsia

A

Treat HTN IV Labetalol, Methyldopa, Nifidepine, Hydralazine
Give Magnesium Sulphate to manage seizures
Recurrent seizures give further dose
Stabilise mum
Deliver the baby (LCSC may be quickest route)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the definition of prematurity

A

Born before 37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the risk factors for prematurity

A 
Unknown
Cervical weakness or surgery
Intra-amniotic infection/chorioamnonitis 
Bacterial Vaginosis 
STIs e.g gonorrhoea or chlamydia 
Uterine abnormalities 
Pre-eclampsia 
Previous premature birth 
Multiple pregnancies 
APH 
Diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How to manage PROM

A

Admit to hospital
Rule out evidence of chorioamnionitis
Using sterile speculum take temperature, MSU, high vaginal swab
Give corticosteroids for fetal lung maturity and erythromycin to reduce fetal mortality
In 80% PROMS intiates labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

If there is no advance to labour within 48hrs of PROM what needs to be considered

A 
It needs to be weighed up whether to keep baby in utero despite risk of infection or deliver baby
If baby stays in utero 
- monitor weekly 
- avoid swimming, intercourse 
- aim to deliver 34 weeks if cephalic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the risks of PROMS

A

prematurity
infection
limb contractures
pulmonary hypoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What should you give before delivery of premature labour

A

Corticosteroids and ABx e.g erythromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Why do you give Betamethasone in premature labour

A

To increase surfactant production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are tocolytics

A

They arrest uterine contractions during episode of preterm labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is a first line tocolytic in preterm labour to delay delivery

A

Nifidepine - reduces risk of newborn respiratory distress syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the treatment principles for premature labour

A

Find cause and treat if possible
Assess fetal maturity
Consider tocolytics and give steroids
Decide best route of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How can you try to screen for preterm labour in high risk women

A

TVS

Fetal fibronectin Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is antepartum haemorrhage and what are the most common causes

A

Genital tract bleeding from 24 weeks
Minor <50
Major 50-1000
Massive >100

Causes:
Cervical ectropion, Vaginal infection, bleeding from placenta edge, placenta praevia, Abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is placenta abruption

A

When part of the placenta becomes detached from the uterus wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the risks associated with placenta abruption

A 
Pre-eclampsia
Smoking 
Increasing maternal age
Infection
PROMS
Cocaine
Multiple pregnancy 
thrombophillia 
IUGR 
Abdominal trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Why do women often present with shock but no clear blood loss in placenta abruption

A

Bleeding is often delayed or concealed (trapped between wall of uterus and placenta)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What are the symptoms of placenta abruption

A

Abdominal pain
Back ache if posterior abruption
Vaginal bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the consequences of placental abruption

A

Placental insufficiency causing IUGR, fetal death
DIC
Haemorrhage leading to shock

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What is placental preavia

A

Placenta lies in lower uterine segment

leading to high risk of haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the significant difference in bleeding between abruption and preavia

A

Bleeding is always revealed in praevia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is high risk in placenta abruption after birth of fetus

A

post partum haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the risk associated with placenta praevia

A 
C-section 
dilation and curettage TOP
Multiparity 
Multiple pregnancy 
increased maternal age
Assisted contraception 
Fibroids and Endometriosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How is placenta abruption diagnosed

A

TVS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How is placenta abruption treated

A

Under 34 weeks:
abruption mild, no fetal distress - monitoring in hospital
if severe/fetal distress delivery will be necessary
Over 34 weeks:
mild abruption closely monitered vaginal delivery
severe abruption emergency: C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How is placenta praevia diagnosed

A

TVS - may show abnormal fetal lie

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is major placenta praevia and how is it managed

A

Placenta covers internal os

Requires C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is minor placenta praevia

A

Placenta doesn’t cover internal os

Aim for normal delivery unless encroaches within 2cm of os

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are the complications of praevia

A

Bleeding
Poor lower uterine contractility
PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Is pain present in:
placenta praevia?
placenta abruption?

A

No

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Is there fetal distress in:
placenta praevia?
placenta abruption?

A

No

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Does blood loss match symptoms of shock in:
placenta praevia?
placenta abruption?

A

Yes

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Is the uterus tender in:
Placenta praevia?
Placenta Abruption?

A

No

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Is there normal lie and presentation in:
Placenta praevia?
Placenta abruption?

A

No

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Is there coagulation problems in:
Placenta praevia?
Placenta Abruption?

A

No

Yes (DIC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How does placenta praevia present

A 
Bleeding matching symptoms of shock
No pain
No uterine tenderness
Abnormal lie and presentation
Coagulation normal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How does placenta abruption present

A 
Bleeding doesnt match symptoms of shock
Pain
Uterine tenderness/ Woody Hard Uterus 
Abnormal lie and presentation 
Abnormal coagulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How to manage APH

A 
ABCDE
Raise legs, take bloods and put on IVI
Give O2
Send blood for clotting screeing
Catheterise bladder and moitor fluids 
Bleeding severe - emergency C-section
Not as severe - establish cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What can anaemia increase the risk of

A

infection
PPH
Low birth weight
premature labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What is anaemia in pregnancy associated with

A 
anaemia before pregnancy
Malaria
haemoglobulinopathies 
poor diet 
multiple pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What are the most common types of anaemia in pregnancy

A

Iron deficency anaemia (low MCV) iron low

Folate deficiency anaemia (high MCV) folate low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How is anaemia treated in pregnancy

A

Iron and folate supplements

Oral iron e.g ferrous sulphate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the risks associated with asthma and pregnancy

A

increased risk of exacerbation in 3rd trimester
IUGR - due to inadequate placenta perfusion
Premature labour - due to deterioration of mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What asthma medications can be used in pregnancy

A

Short acting and long acting Beta agonists
Inhaled steroids
Theophyllines
Steroid tablets in severe asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What cardiac disease lesions are low risk in pregnancy

A

Mitral incompetence
Atrial incompetence
ASD
VSD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What cardiac disease lesions are high risk in pregnancy

A

aortic stenosis
coarctation of the aorta
prosthetic valves
cyanosed patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is the management of patients with cardiac disease

A 
Joint care with cardiologist 
pre-pregnancy assessment of risk of complications/death 
pregnancy and post partum care:
prevention and prediction of heart failire: ECHO/ECG
anticoagulation for heart valves
drug therapy-change medication 
Monitor fetal growth 
Plan timing and delivery of fetus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What does obstetric cholestasis present with

A

Prutritus
Abnormal LFTs
Raised bile acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the risks of obstetric cholestasis on the fetus and what is the main cause

A

Still birth and premature labour

caused by increased bile acids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What can improve bile acids and LFTs but not reduce fetal complications

A

Ursodeoxycolic Acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the risks of hyperthyroidism on the mother and baby

A

Often improves after 1st trimester of pregnancy
Maternal - Thyroid crisis causing cardiac failure
Fetus - Thyrotoxicosis due to transfer of thyroid stimulating antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How do you manage hyperthyroidism in pregnancy

A

Anti-Thyroid Medication:
Propylthiouracil (preferred drug less likely to cause congenital abnormality)
Carbimazole (risk of congenital abnormality)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What are the risks of hypothyroidism in pregnancy

A

Miscarriage

Impaired neurodevelopment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How should hypothyroidism be treated in pregnancy

A

Adequate thyroxine replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What are the 3 types of diabetes in pregnancy

A

Type 1 - autoimmune destruction of beta cells in islets of langerhans in pancreas
Type 2 - increased resistance to insulin
Gestational - carbohydrate intolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What is there a risk of developing after having gestational diabetes

A

Type 2 diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What should be done preconception for diabetic patients

A 
HbA1C should be under 48 
Retinal screening
Give folic acid 5mg
Stop ACEi, A2A and statins
renal function and microalbuminuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What are the complications associated with pregnancy and diabetes

A 
Hypoglycaemia
Increased risk of pre-eclampsia
Fetal abnormality 
Miscarriage 
Still birth
Macrosomia - shoulder dyscosia 
Prematurity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What is the key management of diabetes in pregnancy

A 
Good glycemic control:
Insulin
Metformin 
Glibenclamide 
ALL other hypoglycaemics are contrindicated
ALL ACEi and statins are contraindicated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

the ureters dilate during pregnancy what does this predispose women to

A

UTIs and pyelonephritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What are the risks associated with chronic renal disease

A 
Severe hypertension
Pre-eclampsia
Renal failure
IUGR
Prematurity
Still birth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What should be monitored in pregnant women with renal disease

A

BP
Creatine levels and proteinuria
Renal function
Regular Growth scans and fetal check ups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What are the risks associated with epilepsy and pregnancy

A

high risk of sudden unexpected death in epilepsy due to women being reluctant to take anticonvulsants during pregnancy and breastfeeding
high risk of fetal abnormality - due to anticonvulsants - SODIUM VALPORATE
High risk of fetal hypoxia during maternal seizures
inheritance of epilepsy
Neural tube defect - spinal bifida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

How should epilepsy be managed in pregnancy

A

Preconception: Give high dose of folic dose to reduce risk of NTD and discuss medication options e.g stopping
Offer regular scans for fetal abnormality
Control seizures
Discuss timing and mode of delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are the risk factors for VTE

A 
increased BMI
Increased maternal age
Operative delivery 
Family Hx
Thrombophilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

How should a DVT be investigated

A

Doppler US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How should a PE be investigated

A

V/Q (ventilation/perfusion) scan

CTPA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

How should VTE be managed

A

LMWH
6 weeks in high risk
10 days in intermediate risk
(low risk early mobilisation and hydration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Why should warfarin not be used

A

Crossing placenta can cause fetal abnormality and intracranial bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is the biggest cause of maternal death in the UK

A

Cardiac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

When is highest risk of VTE

A

Postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is placenta accreta

A

abnormal adherance of part/all of placenta into uterine wall (grows to deeply into uterus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is placenta increta

A

if myometrium is infiltrated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is placenta percreta

A

if penetration reaches serosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What are the risks of placenta acreta

A

PPH
C-section
Hysterectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What increases risk of acreta

A

Previous C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

How should acreta be managed

A

Watch for placenta praevia (can co-exist)
20 wk US scan will show loss of definition between wall of uterus and abnormal vasculature
MRI scan
Elective C-section 36-37 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What is vasa praevia

A

When fetal vessels cross the internal os - unprotected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What can vasa praevia cause

A

No risk to mother
But can cause fetal haemorrhage!!!
May be CTG abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What is the management of vasa praevia

A

if vasa praevia found on scan - elective C section

if presents as fetal haemorrhage - emergency C-section

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What is cord prolapse

A

the descent of the cord through the cervix below the presenting part so it is ahead of the baby after rupture of membranes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What makes cord prolapse an emergency

A

It leads to cord compression
exposure of the cord can cause vasospasm
These both can lead to asphyxia/hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What are the risk factors for cord prolapse

A 
Multiple pregnancy 
Multiple parity 
PROMS/prematurity 
malpresentation of fetus 
long umbilical cord 
polyhydramnios
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What is the management of cord prolapse

A 
Get senior help
Fetal monitoring - CTG
Infuse fluid into bladder via catheter 
Trendelenburg position with hip and knees up
Push presenting part back up off cord 
Transfer to theatre ready to deliver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What is shoulder dystocia

A

Failure for the anterior shoulder to pass under symphysis pubis after delivery of the head it requires specific manouvers to deliver the baby

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Associations of shoulder dystocia

A 
Macrosomia 
Maternal diabetes 
Disproportion between mother and fetus
Postmaturity or induced labour 
Maternal obesity 
Prolonged 1st and 2nd stage of labour
Instrumental delivery 
Previous shoulder dyscosia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is the management for shoulder dystocia

A 
H - call for help
E - Evaluate for Episiostomy 
L - Legs in McRoberts
P - Suprapubic Pressure
E - Enter the Pelvis 
R - Rotational Manouvers 
R - Remove posterior arm
R - Replace head and deliver by LCSC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What are the complications of shoulder dystocia

A 
Maternal:
PPH 
Extensive 3rd or 4th degree tear
Neonatal:
Hypoxia
Fits
Cerebral Palsy
Damage to brachial plexus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

If mother is comprimised in pregancy

A

Always stabilise mother before attempting to deliver a baby - as maternal comprimise will always lead to fetal comprimise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

If fetus is comprimised e.g prolonged bradycardia or fetal acidosis on scalp sample what should be done

A

DELIVER

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What are the risk factors for uterine rupture

A 
Dehiscence of CS scars 
obstructed labour 
previous cervical or uterine surgery
high forceps delivery 
breech extraction
induced labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is the risk of having a vaginal delivery after C-section

A

Uterine rupture

122
Q

What are the signs and symptoms of uterine rupture

A 
Pain - variable
Bleeding - variable
Cessation of uterine contractions
Maternal shock e.g tachycardia
Disappearance of presenting part
123
Q

When does uterine rupture usually occur

A

Labour

124
Q

What is the management of uterine rupture

A

Emergency C-section
Give o2, crossmatch blood - may need blood transfusion for shock
Senior obstetric decision - small rupture may be repairable, large rupture may need hysterectomy

125
Q

What is primary PPH

A

The loss of more than 500 mls of blood in thr first 24hrs after delivery

126
Q

What is secondary PPH

A

Blood loss after 24 hrs of delivery and up to 12 weeks after delivery
Minor: 500-1000 mls lost
Major: >1000 mls lost

127
Q

What are the causes of PPH

A 
4 Ts
Tissue: retained products of conception 
Tone: uterine atony 
Trauma: genital tract trauma 
Thrombin: clotting disorders
128
Q

How do you manage PPH and the 4 Ts

A

ABCDE, O2, Cannulate (bloods, crossmatch, clotting)
Start IV fluids and catheterise
Tissue: make sure all of placenta has been passed
Tone: ensure uterus is contracted
Trauma: Look for tears and repair
Thrombin: Check clotting

129
Q

What are the risk factors for PPH

A 
Macrosomia 
Nulliparity or grand multiparity 
Multiple pregnancy 
Shoulder dyskocia 
Operative delivery 
Precipitate or Prolonged labour 
Previous PPH
Placenta abnormalities
130
Q

What drugs are used to contract the uterus in PPH

A 
Syntometrine 
Oxytocin
Ergometrine
Misopristol 
Haemobate
131
Q

What could cause secondary PPH

A

Endometritis
Retained products of conception
Pseudoaneurysms
Arteriovenous malformations

132
Q

What cause is most common post natal infection

A

Group A beta-haemolytic Streptococcus

E.Coli

133
Q

What is sepsis

A

Infection but systemic manifestations of infection

134
Q

What is severe sepsis

A

Sepsis plus sepsis induced organ dysfunction or tissue hypoperfusion

135
Q

What is septic shock

A

The persistance of tissue hypoperfusion despite adequate fluid replacement

136
Q

What are the risk factors for Sepsis

A 
Obesity
Diabetes
Immunodeficiency 
Anaemia 
Vaginal trauma/ C-section 
Hx of Group B Strep 
Prolonged rupture of membranes
137
Q

What are the likely causes of SEPSIS

A 
Endometritis
Skin and soft tissue infection
Mastitis 
UTI
Pneumonia
Gastroenteritis/appendicitis/pancreatitis
Infection from epidural/spinal
138
Q

Signs and Symptoms of Sepsis

A 
2 signs/symptoms:
3 T's white with sugar
Temperature: <36 or >38
Tachycardia: HR >90
Tachypnoea: >20 
WCC >12
Hyperglycaemia >7.7 
Hypotension <90mmHg systolic
(Impaired mental state, offensive discharge, D&amp;V, Dysuria, Breast pain, wound infection, lactate)
139
Q

What is the management of SEPSIS

A

B lood cultures, FBC, U&Es, clotting, glucose
U rine output
F luid resusitation (bolus of hartmans/saline)
A ntibiotics IV within the hr, broad spectrum
L actate >2 and organ failure contact ITU
O xygen high flow

140
Q

What are the two phases of the 1st stage of labour

A

Latent

Active

141
Q

What is the latent phase of 1st stage labour

A 
Irregular contracts 
'show' mucoid plug
can last from 6hr to 2-3 days 
Cervix is effacing and thinning
Encouraged to stay at home 
Paracetamol, position, water and snacks
142
Q

What is effacement

A

When the cervix (dilates) soften, thins and open out
Starts in the fundus
Retraction and shortening of muscle fibres
Build in amplitude as labour progresses
Fetus is forced down

143
Q

What is full effacement/dilation of cervix

A

10cm

144
Q

What needs to be assessed in labour

A

Presentation - anatomical presenting part
Lie - relationship of long axis of fetus and uterus
Attitude - presenting flexed or deflexed
Engagement - widest part of presenting part has passed into pelvis
Station - relationship between lowest point of presenting part and ischial spines

145
Q

What is active labour in the 1st stage

A

regular, frequent contractions from 4cm dilation
Progressive
Role of oxytocin

146
Q

Transition from 1st to 2nd stage labour

A 
near 10cm - contactions longest and strongest
SROM - clear liquor 
irritable, anxious, distressed 
start feeling pressure 
need support and reassurance
147
Q

What are the two phases of 2nd stage labour

A

Latent

Active

148
Q

What is the latent phase of 2nd stage of labour

A

Complete cervical dilation to 10cm

No pushing

149
Q

Wha is the active phase of 2nd stage labour

A

Maternal pushing and visible external signs - head visible

150
Q

How long to expect delivery in active 2nd stage labour in nulliparous women

A

3hrs of commencement of pushing

151
Q

How long to expect delivery in active 2nd stage labour in multiparous women

A

2hrs of commencement of pushing

152
Q

What is the best position of fetus for delivery

A

Cephalic Occipital Anterior

153
Q

How do you determine position of fetus on delivery

A

skull sutures

154
Q

What is the 3rd stage of labour

A

Delivery of the placenta
Rush of blood
Active management - oxytocin, cut and clamp cord

155
Q

Why do you inject oxytocin in 3rd stage

A

Shorten length of 3rd stage and delivery of placenta

Reduce incidence of PPH

156
Q

Why do you use delayed cord clamping

A

Reduces prevalence of neonatal anaemia
1min term
3min preterm

157
Q

What nerves cause labour pain in the 1st stage of labour

A

T10 - L1

S2 - S4

158
Q

What nerves cause labour pain in the 2nd stage of labour

A

S2 - S4

L5 - S1

159
Q

What are non-pharmological therapies to manage labour pain

A 
Trained support
Education 
presence of birth partner
Accupuncture, Hypnosis, Homeopathy 
Massage 
Birth environment - e.g water birth
TENS - Transcutaneous electrical nerve stimulation
160
Q

Systemic Analgesia

A

Nitrous Oxide (entonox)
Simple - paracetamol, codine
Single shot opiods - Diamorphine, Morphine

161
Q

What is the benefits and drawbacks of nitrous oxide

A 
Rapid onset 
Minimal SE
Self limiting 
May cause N&amp;V
Green house gas
162
Q

What are two examples of simple analgesia for childbirth

A

Paracetamol

Codine

163
Q

What are three examples of single shot opiod analgesia

A

Morphine
Diamorphine
Pethidine (can cause seizures avoid in epileptics)

164
Q

What are the SE of single shot opiods

A 
Sedation 
Respiratory Depression 
N&amp;V
Pruritus 
Cross placenta causing respiratory depression and drowsiness of baby
165
Q

What are three types of regional techniques for childbirth

A

Epidural - high concentration LA + opioid
Spinal - heavy bupivacaine plus opioid
Combined spinal-epidural

166
Q

What level should epidurals be performed at

A

L3/4

167
Q

What local anaesthetic is used in epidural

A

Bupivacaine

168
Q

What are the indications for an epidural

A

maternal request
cardiac, HTN, other disease
multiple births
operative/instrumental delivery likely

169
Q

What are adverse effects of regional analgesia

A 
Cardiac - hypotension &amp; bradycardia
Respiratory - block intercostal muscle nerves
Drug related - anaphylaxis, allergy
Loss of bladder control and mobility
Headache!!!
Fever 
Prolonged labour 
Increase in instrumental rate and malposition
170
Q

What can Combined spinal-epidural do

A

Quicker pain relief

171
Q

Whats the most effective form of pain relief

A

Epidural

172
Q

What are the fetal SE of epidural

A

tachycardia due to rise in maternal temp

173
Q

What types of Anaesthesia are used in C-section

A

General Anaesthesia
Regional Anaesthesia
e.g. Spinal, Epidural, Combined

174
Q

What are the indications for General Anaesthesia

A

Imminent threat to mother or fetus
Contraindication to regional
Maternal preference
Failed regional

175
Q

What are the risks of general anaesthesia

A

Increased risks associated with altered physiology
Aspiration
Failed incubation

176
Q

What are the advantages of regional

A

Safer
Can see baby immediately
Partner can be present
Improved post op analgesia

177
Q

What are the disadvantages of regional

A

Hypotension
Headache
Discomfort
Failure

178
Q

What are indications for operative vaginal delivery using forceps or ventouse

A

prolonged 2nd stage of labour
maternal exhaustion
pushing not possible
suspected fetal distress

179
Q

What are the complications of using operative vaginal delivery tools

A

Trauma to genital tract

Injury to fetus especially ventouse e.g cephalohaematoma

180
Q

What are indications for C-section

A 
Repeat C-section
Severe pre-eclampsia
Placenta Praevia
Malpresentation of fetus
Failure to progress or faile induction 
Fetal/Maternal comprimise
181
Q

What are the complications of C-section

A 
Blood loss
Hysterectomy 
Bladder or bowel injury
Wound infection
Endometritis 
VTE!!!
Increased risk of accreta, uterine rupture
182
Q

What are the indications of induction of labour

A 
Post-maturity/prolonged pregnancy 
Diabetes 
Pre-eclampsia 
HTN
Rhesus Disease
183
Q

What assessment tool is used to assess state of cervix for induction and what does it mean

A

Bishops score
Score less than <5 indicates labour is unlikely to happen without induction
>8 indicates labour is likely to occur spontaneously without induction

184
Q

How is labour induced

A

Prostaglandin e.g Misoprostol

185
Q

After artificial rupture of membranes if contractions haven’t started what should you use

A

IV oxytocin

186
Q

What are the predisposing factors for twins

A

Previous twins
FH twins
Increasing maternal age
IVF

187
Q

What are complications of twins

A 
Polyhydramnios
Pre-eclampsia
Uterine Abruption and Praevia - APH
Anaemia 
Gestational DM
Operative Delivery 
IUGR
Prematurity/ Stillbirth 
Malformation 
Cord Prolapse
188
Q

What are the three types of breech

A

Top two the buttocks sit in the
Extended breech - flexed at hips, extended at knees
Flexed Breech - flexed at hips and knees
Footlings Breech - on or both feet point down as presenting part

189
Q

What increases risk of breech

A 
Idiopathic
Prematurity
Uterine abnormalities 
Placenta Praevia 
Oligohydramnios 
Fetal abnormalities
190
Q

What is the manouver you can perform to try and turn a breech and when should it be offered

A

External Cephalic Version

If baby is still in breech at 36 weeks

191
Q

What are the risks of vaginal delivery of a breech

A

Hypoxia

Birth Trauma

192
Q

What is the best mode of delivery of a breech baby

A

C-section

193
Q

What are some common symptoms of pregnancy

A 
N&amp;V
Headaches 
Breathlessness
Urinary Frequency 
GORD 
Carpal Tunnel Syndrome
Itchy rashes
194
Q

What should you rule out for increased breathlessness in pregnancy

A

VTE/PE

195
Q

What should you rule out for increased frequency of urine

A

UTI

196
Q

What should you use 1st line to treat a UTI in preganancy

A

Nitrofuritonin

197
Q

Why shouldn’t you use Trimethoprim in pregnancy

A

It lowers folic acid

198
Q

What is the diagnosis of persistant vomiting during pregnancy causing weight loss

A

Hyperemesis Gravidum
(Thought to be related to high hCG levels e.g multiple pregnancy)
Can be fatal!!!

199
Q

What does Hyperemesis Gravidum present as

A 
Inability to keep food/drink down
Weight loss/ Malnutrition
Hypokalaemia, Hyponatraemia 
Dehydration 
Shock
Mallory - Weiss tears
200
Q

What is the management of hyperemesis Gravidum

A

Admit to hospital if unable to keep anything down
Fluid replace correct metabolic imbalance
Give Anti-emetics e.g Promethazine
Try steroids e.g Prednisolone
May need to perform TOP

201
Q

What are the baby blues

A

Transient 3-5 days of feeling low, tearful and anxious

202
Q

How should you manage baby blues

A

Reassurance from midwife
Family support
Symptoms don’t resolve - psychiatric review

203
Q

What are three key things to note for diagnosing mental disorders of the puepurium

A
  1. A recent significant change in mental state/ new symptoms
  2. Recent thought of violence or self - harm
  3. New/Persistant thoughts of incompetency as a mother or estrangement from baby
204
Q

What is postnatal depression

A

risk of major depression after pregnancy

205
Q

What are two major risk factors for postnatal depression

A

Hx of postnatal depression

Hx of unipolar/bipolar depression

206
Q

What are the signs and symptoms of postnatal depression

A 
Depressed
Irritable 
Tired 
Crying at night/ sleepness
Anxiety 
Sense of Foreboding
207
Q

Management of postpartum depression

A 
Don't put off treatment 
Screen for depression 
Counselling (CBT)
Short term Antidepressents (possible SE to baby from breastmilk) 
ECT - severe cases
208
Q

What tool is used to screen for depression in post partum women

A

Edinburgh postnatal depression scale

209
Q

What is postpartum psychosis

A

Depression
Mania
Psychosis

210
Q

What are the signs and symptoms of psychosis

A

Rapid mood changes from depressed to elated
Confused or disorientated
Restless
Insomnia
Unable to concentrate
Psychotic Symptoms e.g delusions, hallucinations

211
Q

What are the risk factors for post partum psychosis

A

Previous postpartum psychosis
FHx of mental health problems
Bipolar disorder or other mental health problems

212
Q

How can you prevent postpartum psychosis

A

identify high risk patients

antenatal, perinatal and postpartum individualised care plan

213
Q

How can you manage postpartum psychosis

A

early detection
hospitilisation if necessary
Combination of medication:
Affective symptoms: mood stabiliser, antidepressants, ECT
Psychotic symptoms: 2nd generation antipsychotic
Therapy, reassurance

214
Q

Why is early detection essential in postpartum psychosis

A

Due to risk of self and baby e.g infantiside

215
Q

What is oligohydramnios

A

deficiency of amniotic fluid

216
Q

What is polyhydramnios

A

excess of amniotic fluid

217
Q

What can cause oligohydramnios

A

smaller babies, fetal malpresentation, chromosomal abnormalities, infection

218
Q

What complications can oligohydramnios cause

A

cords compression
IUGR
pulmonary hypotension

219
Q

How can you manage olighydramnios

A

maternal hydration

severe - amniofusion

220
Q

What causes polyhydramnios

A 
birth defects/chromosomal abnormalities 
multiple pregnancy 
maternal DM
TORCH infections
fetal anaemia
221
Q

What are complications of polyhdramnios

A

prematurity
placental abruption
Cord prolapse
Still birth

222
Q

How is polyhydramnios treated

A

Can cause SOB, swelling and discomfort
Ensure plenty of rest and birth plan
Amnioreduction if severe

223
Q

What infection can be asymptomatic in mothers and can sometimes be passed to babies during childbirth causing serious infection

A

Group B Streptococcus

224
Q

What babies are at risk of developing Group B Strep

A

Prematurity
Previous baby has developed GBS
Maternal fever
Prolonged labour

225
Q

How is Group B strep usually diagnosed

A

routine high vaginal swabs carried out 34-36 weeks

226
Q

What does early onset GBS present as

A

Pneumonia
Meningitis
Septicaemia

227
Q

What signs and symptoms may be present in an infected neonate with GBS

A

floppy/unresponsive
fevers/rigors
tachy/bradypnoea
tachy/bradycardia

228
Q

If a mother with GBS is at risk of passing GBS to newborn what management should be carried out

A

Give high dose IV benzylpenicillin throughout labour

229
Q

How would you manage a newborn with chlamydia

A

Eye cleansing + erythromycin for baby

Give parents Doxycycline or Azithromycin

230
Q

How would you manage a newborn with Gonorrhoea conjuctivitis

A

Cefotaxime and chloramphenicol eye drops

231
Q

What is the only antibody which can cross the placenta during pregnancy

A

IgG

232
Q

How is Rhesus Disease caused

A

RhD -ve mothers deliver Rh +ve baby causing a leak of fetal cells into the mothers circulation this stimulates her to produce anti-D IgG antibodies

233
Q

What happens in subsequent pregnancies once the mother has produced anti-D IgG antibodies

A

Anti-D IgG antibodies cross the placenta into the fetus causing rhesus haemolytic disease

234
Q

Does rhesus haemolytic disease worsen with each pregnancy

A

yes

235
Q

How can 1st pregnancies be effected by rhesus disease

A 
threatened miscarriage
APH
mild trauma
amniocentesis 
Chorionic Villous sampling
236
Q

What is the subsequent consequence of fetal blood cells being destroyed in rhesus disease

A

Fetal Anaemia

237
Q

What does fetal anaemia in rhesus disease cause

A

anaemia associated congestive heart failure

Hypoalbuminaemia - liver too busy making RBC to make proteins

238
Q

What can severe rhesus disease lead to

A

hydrops fetalis

239
Q

What is hydrops fetalis

A

An oedamatous fetus with stiff oedamtous lungs

240
Q

What are the signs of a neonate born from rhesus disease

A

Jaundice and kernicterus from hyperbilirubinaemia
Yellow vernix
CCF (oedema)
Hepatosplenomegaly (due to high RBC demand)
Proggressive anaemia
Bleeding
CNS signs

241
Q

What is kernicterus

A

acute bilirubin encephalopathy - can cause athetoid movements, deafness and low IQ

242
Q

What investigations should be done for suspected rhesus disease in pregnancy

A

Screen all Rh-ve mothers for anti D antibodies at 28 and 34 wks gestation
If baby is at risk:
Perform doppler US to assess fetal blood flow (thinner means anaemia)
US to check for hepatosplenomegaly
Amniocentesis - to sample fetal blood

243
Q

What is a risk from amniocentesis

A

Misscarriage

244
Q

What management can be performed in pregnancy in severe cases of rhesus disease

A

Intrauterine transfusion

245
Q

How is rhesus disease diagnosed in the new born

A

Coombs test

246
Q

How is rhesus disease managed in the new born

A

Phototherapy
Blood transfusion
(IV IG may be used in some cases alongside phototherapy)

247
Q

What can be used to prevent rhesus diseaase

A

injection of anti-D immunoglobulin to prevent sensitisation in 3rd trimester or if there is a risk that the antigens may have entered mothers blood e.g haemorrhage

248
Q

What are the symptoms of a post dural headache

A

headaches thats worse sitting or standing
neck stiffness
dislike of bright lights

249
Q

What is the treatment of a post dural headache

A

Epidural blood patch
Lying flat
Simple analgesia

250
Q

What is low birth weight

A

birth weight under <2500g regardless of gestational age
Very low - < 1500g
Extremely low - < 1000g

251
Q

What is small for gestational age

A

Birth weight below 10th percentile for gestastional age

252
Q

What is IUGR

A

failure of growth in utero which may or may not result in baby being small for SGA

253
Q

What is symmetric SGA

A

all growth parameters are symemetrically small suggesting fetus was affected early pregnancy e.g chromosomal abnormalities or constitutionally small

254
Q

What is asymmetric SGA

A

the weight centile is < length and head circumference due to IUGR or insult later in pregnancy e.g pre-eclampsia

255
Q

What increases risk for SGA

A 
Smokers
Older mothers
Poverty 
Previous SGA
Diabetes
HTN
Renal problems
256
Q

How should SGA be managed

A

Umbilcal artery dopplers
Growth scans
Concerning? - consider LSCS (give corticosteroids)

257
Q

What methods are used for continuous fetal heart rate monitoring

A

Cardiotocography (CTG)

258
Q

What can CTG monitor

A

uses doppler US to measure:
FHR
Uterine contractions

259
Q

What is a disadvantage of CTG

A

No improvement in perinatal outcome

Doesnt reduce prevelance of still birth

260
Q

What are two methods of performing fetal electrocardiogram

A

Scalp ECG - Gold standard however invasive (monitoring only in labour)
Abdominal ECG - Non invasive its a research tool

261
Q

What is Wilson and Jungers criteria for screening

A

Knowledge of the disease:
The condition should be important
There should be a latent or early symptomatic stage
The natural course of the condition should be understood
Knowledge of test:
Suitable test or examination
Test acceptable to the population
Case-finding should be a continuous process
Treatment for disease:
Accepted treatment for patients with recognised disease
Facilities for diagnosis and treatment available
Agreed policy concerning whom to treat as patients
Cost considerations:
The cost of case-finding (including diagnosis and subsequent treatment) should be balanced by the expenditure on care as a whole

262
Q

What is screening

A

a process of identifying apparently healthy individuals who may be at an increased risk of a disease or condition

263
Q

What is detection rate

A

proportion of affected individuals who will be identified by screening test

264
Q

What is false positive rate

A

proportion of unaffected individuals with a higher risk/screen positive result

265
Q

What is false negative rate

A

proportion of affected individuals with a low risk/screen negative result

266
Q

What are the antenatal screening programmes

A

Fetal anomaly screening program
Infectious Disease screening programme
Sickle cell and thalassaemia screening programme

267
Q

What are the new born screening programmes

A

New Born blood spot screening programme
New Born hearing programme
New born and 6-8 week infant physical exam screening programme

268
Q

What does the fetal anomaly screening programme screen for

A

Downs Syndome - Trisomy 21
Edwards Syndrome - Trisomy 18
Pateaus Syndrome - Trisomy 13

269
Q

What is Downs Syndrome and how does it present

A

Extra copy of chromosome 21
Prevelance increases with maternal age

learning/ intellectual disability
Low Average height 
Hearing loss, recurrent otitis media 
Hypothyroidism 
Gastrointestinal Malformation (duodenal atresia) 
Hypogonadism, Low Fertility  
congenital heart conditions (AVSD)  
early onset alzheimers
Obesity 
Delayed motor onset/ Hypotonia 
Single Transverse Palmer Crease 
Sandal Gap
270
Q

What is Edwards Syndrome and how does it present

A

Extra copy of 18
Increases maternal age
Most die soon after birth and survival after a year is rare

Prominent Occiput
Rocker - Bottom Feet 
Intellectual Disability 
Non Disjunction 
Clenched fists 
Ears (Low set)
271
Q

What is Pateaus Syndrome and how does it present

A

Extra copy of 13
Increases with maternal age
Most will die before birth, stillborn or die shortly after birth

Symptoms:
Microcephaly, Cleft lip palate, polydactyl and congenital heart defects

272
Q

What test is used to screen for Trisomies in the 1st Trimester and when it can be carried out

A

The combined test - Nuclear translucency measurement and serum testing

11 -13 weeks

273
Q

A woman presents late as pregnant put she is past 13 weeks what test can she have instead to pick up trisomnies

A

the quadruple test - uses serum markers only

Can be done in the 2nd trimester: 15 - 20 weeks

274
Q

If a baby is screened with a positive test for anomaly testing what two further tests can she undergo

A 
Invasive:
Chorionic Villus Biopsy (10-13 weeks)
Amniocentesis  (15 weeks onwards)
Non Invasive:
Only available private
275
Q

What do invasive anomaly tests increase the frequency of

A

miscarriage

276
Q

What two scans should be offered to women during pregnancy

A

12 week scan - 8 -14 weeks + combined test

20 week scan - 18 - 21 weeks

277
Q

What is the first early scan used to check

A

Confirm viability
Assess GA
Multiple pregnancy
(May reveal fetal abnormality)

278
Q

What is the second scan used to check

A

Identify structural abnormalities

279
Q

What three infectious diseases are screened for during pregnancy

A

HIV
Syphillius
Hep B

280
Q

What two haemoglabobinopathies are screened antenatally

A

Alpha and Beta thalassaemias

Sickle cell disease

281
Q

What does sickle cell disease cause

A

Painful crises where RBC sickle blocking capillaries and depriving tissues of oxygen

282
Q

What thalassaemia is imcompatible with extrauterine life

A

Alpha Thalassaemia major

283
Q

What does beta thalassaemia major present as

A

life threatening anaemia - patient will need regular blood transfusions and iron chelation therapy

284
Q

What is the purpose of sickle cell and thalssaemia screening

A

Identify women who are carriers
Test partners of screen positive women
Identify at risk patients

285
Q

Screen Positive results in haemoglobinopathies

A

Discussion, termination is offered

286
Q

What does the new - born blood spot test involve

A

Screens 9 conditions to enable early detection and treatment before irreversible damage

287
Q

Where and when is new born blood spot test made

A

Heal prick blood 5-8 days of age

288
Q

What diseases are screened for in the new born heal test

A

Cystic Fibrosis
Congenital Hypothyroidism
Sickle Cell disease
6 x Inherited metabolic diseases - these can be life threatening

289
Q

When is hearing screening performed

A

Prior to discharge home or within 4 weeks of brith

290
Q

What is screened for in new born infant physical examination

A 
General Examination plus:
Eye problems 
Congenital Heart defects 
Developmental Dysplasia oh hips
Undescended Testes
291
Q

What two points is NIPE performed

A

72 hrs of birth

6-8 weeks

292
Q

Name two inherited metabolic disorders

A

Maple Syrup Disease
MCADD
Phenylketonuria

293
Q

What is present in the milk at birth

A

Colostrum

294
Q

What does the colostrum provide

A

Growth factors - to stimulate development of fetal gut

Antibodies - to provide passive immunity

295
Q

What is lactogenesis 2

A

onset of production of copious milk after expulsion of placenta and withdrawal from pregnancy hormones e.g progesterone - usually by 72 hrs

296
Q

What are the two hormones used in breatfeeding

A

Prolactin - anterior pituitary gland

Oxytocin - posterior pituitary gland

297
Q

What does oxytocin do

A

Causes expulsion of milk from contraction of myo-epithelial cells

298
Q

What does prolactin do

A

Stimulates lactocytes to produce milk

299
Q

What is a normal CTG

A

Accelerations present
Variability >5bpm
No decelerations (except when there on contractions - decelerations are normal)
HR 110-160

300
Q

What is the management of APH

A 
ABCDE
IV Access
Bloods, G&amp;S
IV Fluids 
Blood Transfusion 
Delivery of Baby

Specialties (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions