Obstetrics Flashcards
What is most distressing immediate complication of perineal injury?
Perineal pain
SOGC 330
What are the reported rates of anal incontinencefollowing primary repair of OASIS range?
Between 15-61%. Mean 39%
SOGC 330
Which degree of OASIS does the patient have if her external sphincter is more than 50% torn?
3b
SOGC 330
Which of the following will have the highest risk of anal sphincter injury?
- Occiput posterior and vacuum delivery
- Forceps and mediolateral episiotomy
- Large gestational age and vacuum delivery
- Midline episiotomy and forceps
- Midline episiotomy and forceps
SOGC 330
By how much (%) does head control at the time of delivery decrease the risk of anal sphincter injury?
50-70%
SOGC 330
What is the NNT of a Cesarean section to prevent one patient with a previous OASIS?
2.3
To prevent 1 case of anal incontinence in a women with a previous OASIS, 2.3 elective CS need to be done.
SOGC 330
Is it the internal or external anal sphincter that is most responsible for maintaining anal sphincter tone at rest?
Internal anal sphincter
○ 70-80% of resting anal pressure
○ 40% of anal pressure in response to sudden distention
○ 65% of anal pressure in response to constant rectal distention
SOGC 330
Does pregnancy increase or decrease or not affect the levels of the following factors?
- Factor VIII
- von Willebrand Factor
- Factor IX
- Factor XI
- Increase, reaches its maximal peak at 29-35 weeks
- Increase, reaches its maximal peak at 29-35 weeks
- Unchanged
- Unchanged
Returns to normal about 7-10 days after delivery
SOGC 163
What is average yearly number of births to adolescent mothers worldwide?
14 million
10% of births worldwide
23% of maternal morbidity and mortality
SOGC 327
Name 9 risk factors for the development of GDM and Type 2 diabetes postpartum.
- Maternal age >35
- Obesity BMI >30
- Ethnicity (Aboriginal, African, Asian, Hispanic, south Asian)
- Family hx of diabetes
- PCOS
- Acanthosis nigricans
- Corticosteroid use
- Previous pregnancy complicated by GDM
- Previous macrosomic infant
SOGC 393
According to the SOGC, at how many weeks should screening for GDM be offered?
24 to 28 weeks
SOGC 393
What are the abnormal values of the OGTT at fasting for the 2-step approach? 1-hour? and 2-hour?
Fasting >=5.3
1-hour >=10.6
2-hour>=9.0
For alternative 1-step approach, values are a bit different:
Fasting >= 5.1
1-hour >= 10.0
2-hour >=8.5
SOGC 393
What are the targets for maternal glycemic control?
Fasting <5.3
1-hour 7.8 OR 2-hour 6.7
SOGC 393
In pregnant women who have not yet received screening or diagnostic testing for GDM, how many days after a betamethasone injection can we perform the test?
After 7 days
** Note that recommended to do a 1-step 75g OGTT
SOGC 393
Name the contraindications to VBAC. (5)
- Previous classical incision
- Previous inverted T incision or low vertical incision
- Previous full-thickness surgery (e.g. myomectomy)
- Previous uterine rupture
- Patient refusal to TOLAC
SOGC 382
What are some factors that increase the likelihood of VBAC?
Maternal ○ Age <=30 years old ○ BMI <30 ○ Caucasian Obstetric ○ Previous vaginal birth *** Best odds ratio ○ Previous CS indication not dystocia ○ Spontaneous labor ○ Bishop Score >=6 on admission Fetal ○ Birth weight <4000g
SOGC 382
What is the most important predictor for a successful VBAC?
Previous vaginal delivery
86.7% instead of 60.9% if they never delivered vaginally
* 63.3% after 0 VBAC * 87.6% after 1 VBACs * 90.9% after 2 VBACs * 90.6% after 3 VBACs * 91.6% after 4 or more VBACs
SOGC 382
What is the most common finding in women who experience a uterine rupture?
Fetal tracing abnormality
SOGC 382
What is the percentage of uterine rupture in a patient who has had
A) 1 previous LTCS?
B) a classical CS?
C) an inter delivery interval of less than 12 months?
A) 0.4%
B) 4-9%
C) 4.8%
SOGC 382
What is the percent of uterine rupture in a woman who has had 1 previous CS and undergoes
A) induction of labour with oxytocin for a favourable cervix?
B) IOL with PGE2?
C) IOL with misoprostol?
A) 1.1%
B) 2%
C) 6%
SOGC 382
What is the incidence of vasa previa in patients with villamentous cord insertions?
1 in 50
SOGC 231
Name 4 risk factors for vasa previa.
Risk factors for vasa previa
• IVF (1 in 202 instead of 1 in 2200 for non-IVF)
• Second trimester placenta previa
• Bilobed and succenturiate-lobed placentas
• Fetal anomalies (renal tract anomalies, spina bifida, single umbilical artery, exomphalos)
Must be a villamentous cord insertion!
One of these risk factors is present in 89% of vasa previa cases
SOGC 231
What is the recommended delivery management for a pregnancy known for placenta previa?
Planned elective CS at 35-36 weeks
Betamethasone at 28-32 weeks of gestation
Antenatal admission is debated
SOGC 231
What is the recommendation for exercise in pregnancy?
150 minutes of moderate intensity exercise per week if the patient has no contraindications
SOGC 367