Obstetrics Flashcards
1
Q
what are the congenital TORCH infections?
A
Toxoplasmosis Rubella CMV HSV Syphilis
2
Q
what is pre-eclampsia?
A
hypertension during pregnancy discovered after 20 weeks >140/90 + proteinura (>0.3g/24h) +/- oedema
3
Q
risk factors for pre-eclampsia?
A
nulliparity diabetes previous pre-eclampsia FHx increased maternal age renal disease obesity
4
Q
what is given to prevent pre-eclampsia?
A
aspirin 75mg
5
Q
what are the symptoms of pre-eclampsia?
A
headaches due to cerebral oedema (risk of stroke from cerebral haemorrhage)
visual disturbance e.g. flashing lights
nausea and vomiting
oedema
RUQ pain- late stage (due to haemorrhage of liver)
6
Q
what are the signs of pre-eclampsia?
A
HTN >140/90
proteinuria >0.3g
facial oedema
hyper-reflexia + ankle clonus (sign of cerebral irritability)
uterine tenderness or vaginal bleeding from placental abruption
foetal growth restriction
7
Q
investigations of pre-eclampsia?
A
urine dipstick 24 hr urine creatinine ratio FBC- to check for HELLP clotting- PT increased, APTT increased USS- IUGR uterine artery doppler- reduced placental blood flow
8
Q
management of mild pre-eclampsia?
A
admit if >2+ protein, >0.3 proteinuria manage at home - intensive monitoring: 4 hourly BP 24hr collection for protein daily urinalysis regular USS for growth and blood tests deliver at 37 weeks
9
Q
management of severe pre-eclampsia?
A
PO nifedipine (given twice, 30 mins apart)
if BP remains high -start IV labetalol infusion
once BP lowered and stable, start maintenance therapy - PO labetalol or methyldopa if asthmatic
magnesium sulphate can be used is severe
deliver at 34 weeks
10
Q
complications of pre-eclampsia?
A
eclampsia- grand mal seizures cerebrovacular haemorrhage HELLP syndrome renal failure pulmonary oedema
11
Q
what is eclampsia?
A
transition of pre-eclampsia to generalised tonic clonic seizures
12
Q
management of eclampsia?(Acute)
A
IV magnesium sulphate bolus dose first, then maintenance infusion for 24 hours
treat HTN- labetolol, nifedipine
delivery of baby immediately after stabilising mother
13
Q
what does HELLP syndrome stand for?
A
Haemolysis
Elevated Liver enzymes
Low Platelets
14
Q
symptoms of HELLP?
A
RUQ pain
malaise
nausea and vomtiing
DIC
15
Q
management of HELLP?
A
admit to monitor + prompt delivery within 34 weeks
Mg sulfate + anti-hypertensives
16
Q
complications of HELLP?
A
placental abruption acute renal failure DIC liver haematoma retinal detachment pulmonary oedema
17
Q
screening for gestational diabetes?
A
OGTT >7.8mmol/l
fasting glucose >5.6mmol/l
18
Q
RF for gestational diabetes?
A
FHx previous Hx race, ethnicity PCOS previous large baby/unexplained stillbirth obesity
19
Q
management of gestational diabetes?
A
diet
metformin
if inadequate control, introduce insulin
home monitoring of blood sugars every 4 hours
delivery by 40 weeks
20
Q
investigations of gestational diabetes?
A
opthalmological examination every trimester
24hr urine and protein clearance
HbA1c
21
Q
which diabetes medications are contraindicated in pregnancy?
A
gliclazide
GLP-1 receptor agonist
22
Q
what are some maternal complications of pre-gestational diabetes?
A
pre-eclampsia, eclampsia, HELLP DKA in 1 trimester polyhydramnios prem labour post-partum haemorrhage
23
Q
definition of pre-term delivery?
A
delivery between 24-37 weeks
24
Q
management of pre-term delivery?
A
steroid administration (betamethasone - 2 doses 12-24hrs apart) to mature the lungs Tocolysis (nifedipine- oxytocin receptor antagonist) to delay delivery
25
what are the causes of antepartum haemorrhage?
```
placenta praevia
placental abruption
vasa praevia
uterine rupture
infection
trauma
```
26
what is the likely diagnosis in a pregnant woman with painless intermitted bleeding of increasing frequency and intensity over a few weeks?
placenta praevia
27
what is placental praevia?
placenta partially or wholly implanted in the lower uterine segment
28
What are the four types of placenta praevia?
1. Minor: placenta in lower segment, not covering the internal os
2. Marginal: placenta reaches the internal os, but doesn’t cover it
3. Major: placenta partially covers cervix/ internal os
4. Placenta completely covers cervix/ internal os
29
what features of the foetus may indicate placenta praevia?
low lying at 20 weeks
moves upwards as pregnancy continues
high presenting part
30
RF for placenta praevia?
smoking
advanced maternal age
uterine surgery
31
investigation for diagnosis of placenta praevia?
USS
32
management of placent praevia?
anti-D
steroids
c-section
33
likely diagnosis in pregnant woman with woody hard uterus and bleeding?
placental abruption
34
what is placental abruption?
bleeding following premature seperation of a normally sited placenta before delivery
35
RF for placental abruption?
```
Px
IUGR
pre-eclampsia
maternal smoking
abnormal placentation
thrombophilia
cocaine use
truama
```
36
management of placental abruption?
```
A-E assessment, Anti-D
Fetal condition: CTG
Maternal condition: fluid balance, renal function, FBC & clotting
Immediate delivery (almost always a CS)
Transfusions for haemorrhage
```
37
what is vasa praveia?
Fetal blood vessel runs in the membranes in front of the presenting part. When the membranes rupture, the vessel may rupture too, with massive fetal bleeding
38
presentation of vasa praevia?
painless, moderate vaginal bleeding at SROM
| severe foetal distress
39
management of vasa praevia?
emergency CS
40
what is IUGR?
IUGR: small compared to genetic determination, and compromised
41
complications of IUGR?
```
Intrapartum fetal distress and asphyxia
Meconium aspiration
Emergency CS.
Necrotizing enterocolitis.
Hypoglycaemia
Hypothermia
Hyperbilirubinemia
Hypocalcaemia
```
42
what are the maternal causes of IUGR?
```
chronic maternal disease- HTN, cardiac, CKD, anaemia, atniphospholipid
substance abuse
infection- malaria
poor nutrition
low socio-economic status
pre-eclampsia
placenta accreta
maternal height + weight
```
43
what are some foetal causes of IUGR?
genetic abnormality- trisomy 21, 13, 18
congenital abnormalities- cardiac (ToF)
Infection- TORCH
multiple pregnancy
44
clinical features of IUGR?
low symphsis-fundal height
| features of pre-eclampsia (as they often co-exist)
45
investigations of IUGR?
```
USS
umbilical artery doppler
CTG
measure fundal height
BP
urine dip
GBS
karyotyping
screening for TORCH or downs
```
46
management of IUGR?
manage cause if identified
Deliver from 36wks.
34-36: regular Doppler, daily CTG, consider delivery.
<34wks: give steroids, same as above/ undertake delivery
47
what is the definition of macrosomia?
pathologically large for dates > 90th centile
48
RF for macrosomia?
```
maternal DM
maternal obesity
genetic
ethnicity
maternal age
overdue pregnancy
```
49
what are two abnormal presentations/lies of baby?
transverse
| breech
50
causes of transverse lie?
preterm
polyhydramnios
multiparity
placenta praevia
51
complications of breech presentation?
should dystocia
| perinatal mortality
52
management of breech presentation?
extra-cephalic version from 37 weeks
| elective c-section
53
what are the different types of twins?
Dizygotic (DZ): different oocytes fertilized by different sperm
Monozygotic (MZ): division of zygote after fertilization
Dichorionic: Two placentas (DZ or MZ)
Monochorionic (MC): Shared placenta (always MZ)
54
complications of twin birth?
Maternal: pre-eclampsia, anaemia, gestational diabetes, operative delivery
All twins: Increased morbidity and mortality due to most ob complications particularly: miscarriage, preterm labour, placental insufficiency/ intrauterine growth restriction (IUGR), antepartum and postpartum haemorrhage and malpresentations
MC twins: Congenital abnormalities, twin-twin transfusion (TTTS), IUGR
55
causes of polyhydramnios?
```
twin-twin transfusion
maternal cardiac, kidney + DM-> hyperglycaemia-> polyuria
oesophageal/duodenal atresia
downs/edwards syndrome
skeletal dysplasia
```
56
causes of oligohydramnios?
foetal chromosomal abnormalities
untra-uterine infections
renal agenesis
IUGR
57
definition of PROM?
ROM < 37 weeks
58
complications of PROM?
chorioamionitis
RDS
sepsis
pulmonary hypoplasia
59
management of PROM?
corticosteroids
antibiotics
nifedipine - tocolytic to delay labour
foetal surveillance
60
what are the stages of labour?
stage 1 - start to full dilation (10cm)
stage 2- full dilation to delivery of foetus
stage 3- delivery of placenta
61
what are the phases of stage 1 of labour?
early/latent phase- 8-12hrs, irregular contractions every 5-30mins lasting up to 30 seconds, cervix dilates 0-3cm, efface-> 30%
active phase- 3-5hrs, contractions every 3-5mins lasting up to 1 min, cervix dilates 3->7cm, effacement - 80%
transition phase- 30mins - 2hrs, contractions every 0.52 mins lasting 60-90seconds, cervix dilates to 10cm, efface-100%
62
what are the cardinal movements of labour during stage 2?
Descent: downward movement of fetus to pelvic outlet (fetal stations: -5, 0 at ischial spine = engagement, & 5)
Flexion: chin against chest, resistance from pelvic floor
Internal rotation: foetus shoulders internally rotate 45
At +4 station = symphysis pubis; extension (head flexion extended) +5 and emerges
After head delivery: Restitution: head externally rotates to allow shoulder passing through pelvic outlet and under symphsis pubis.
Expulsion: anterior shoulder then posterior shoulder then body
63
non-reassuring signs on CTG?
variable decelerations > 30 mins
late decelerations > 30mins
acute bradycardia
single prolonged episode of deceleration lasting 3 mins or more
64
what is used to induce labour?
prostalgandins (misoprostol) -> encourage expulsion through uterine contraction, inserted into vagina
amniotomy- artifical rupture of membranes using amnihook
natural induction - cervical sweep
oxytocin- used alone if SROM or following amniotomy
65
what does the bishops score involve?
Consistency, degree of dilation, degree of effacement, station (the position of the head in the pelvis), position of cervix (anterior is more favourable)
<5 = unlikely to occur therefore induction
>9 = labour likely to occur spontaneously
66
what are the RF for shoulder dystocia?
large baby > 4kg
previous dystocia
increased maternal BMI
DM
67
management of shoulder dystocia?
mcRoberts manouvere
woodscrew manouvere
last resort- symphisiotomy + zavanelli
68
complication of shoulder dystocia?
erbs palsy- excessive traction on neck damage brachial plexus
69
risk of cord prolapse?
preterm, breech, Polyhydramnios, abnormal lie & twin. Artificial amniotomy
70
management of cord prolapse?
patient to go on all fours
cord pushed back up with finger
immediate C-section
71
definition of post-partum haemorrhage and types?
Primary: Loss of >500ml of blood <24hr of delivery
Secondary: excessive blood loss occurring between 24hr and up to 6 weeks after delivery
72
causes of primary post-partum haemorrhage?
```
4 T’s:
TISSUE: retained placenta
TONE: uterus fails to contract properly
TRAUMA: cervical/ vaginal tears or epiotomy
THROMBIN: coagulopathy, DIC
```
73
management of primary post-partum haemorrhage?
Mx. NICE
- A-E assessment
- Johnsons manoeuvre (uterine repositioning)
- IV Syntocin (oxytocin) + IV/IM Ergometrine, carbetocin
- IM Carbopost (prostaglandin F2a) into myometrium
- B-lynch suture, Rusch Balloon, hysterectomy
74
causes of secondary post-partum haemorrhage?
endometriosis with or without retained placental tissue
75
investigatoins of secondary post-partum haemorrhage?
vaginal swabs
FBC
cross-match
76
management of post partum haemorrhage?
antibiotics
| evacuation of retained products of conception
77
management of BV?
oral metronidazole
