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Phase 3a > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

what are the congenital TORCH infections?

A 
Toxoplasmosis
Rubella
CMV
HSV
Syphilis
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2
Q

what is pre-eclampsia?

A

hypertension during pregnancy discovered after 20 weeks >140/90 + proteinura (>0.3g/24h) +/- oedema

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3
Q

risk factors for pre-eclampsia?

A 
nulliparity 
diabetes
previous pre-eclampsia 
FHx
increased maternal age
renal disease
obesity
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4
Q

what is given to prevent pre-eclampsia?

A

aspirin 75mg

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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)

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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

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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
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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
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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

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10
Q

complications of pre-eclampsia?

A 
eclampsia- grand mal seizures 
cerebrovacular haemorrhage 
HELLP syndrome 
renal failure
pulmonary oedema
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11
Q

what is eclampsia?

A

transition of pre-eclampsia to generalised tonic clonic seizures

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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

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13
Q

what does HELLP syndrome stand for?

A

Haemolysis
Elevated Liver enzymes
Low Platelets

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14
Q

symptoms of HELLP?

A

RUQ pain
malaise
nausea and vomtiing
DIC

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15
Q

management of HELLP?

A

admit to monitor + prompt delivery within 34 weeks

Mg sulfate + anti-hypertensives

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16
Q

complications of HELLP?

A 
placental abruption 
acute renal failure 
DIC
liver haematoma 
retinal detachment 
pulmonary oedema
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17
Q

screening for gestational diabetes?

A

OGTT >7.8mmol/l

fasting glucose >5.6mmol/l

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18
Q

RF for gestational diabetes?

A 
FHx
previous Hx
race, ethnicity
PCOS
previous large baby/unexplained stillbirth 
obesity
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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

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20
Q

investigations of gestational diabetes?

A

opthalmological examination every trimester
24hr urine and protein clearance
HbA1c

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21
Q

which diabetes medications are contraindicated in pregnancy?

A

gliclazide

GLP-1 receptor agonist

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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
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23
Q

definition of pre-term delivery?

A

delivery between 24-37 weeks

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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
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25
Q

what are the causes of antepartum haemorrhage?

A 
placenta praevia
placental abruption 
vasa praevia
uterine rupture 
infection 
trauma
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26
Q

what is the likely diagnosis in a pregnant woman with painless intermitted bleeding of increasing frequency and intensity over a few weeks?

A

placenta praevia

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27
Q

what is placental praevia?

A

placenta partially or wholly implanted in the lower uterine segment

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28
Q

What are the four types of placenta praevia?

A
  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
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29
Q

what features of the foetus may indicate placenta praevia?

A

low lying at 20 weeks
moves upwards as pregnancy continues
high presenting part

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30
Q

RF for placenta praevia?

A

smoking
advanced maternal age
uterine surgery

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31
Q

investigation for diagnosis of placenta praevia?

A

USS

32
Q

management of placent praevia?

A

anti-D
steroids
c-section

33
Q

likely diagnosis in pregnant woman with woody hard uterus and bleeding?

A

placental abruption

34
Q

what is placental abruption?

A

bleeding following premature seperation of a normally sited placenta before delivery

35
Q

RF for placental abruption?

A 
Px
IUGR
pre-eclampsia 
maternal smoking
abnormal placentation 
thrombophilia
cocaine use 
truama
36
Q

management of placental abruption?

A 
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
Q

what is vasa praveia?

A

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
Q

presentation of vasa praevia?

A

painless, moderate vaginal bleeding at SROM

severe foetal distress

39
Q

management of vasa praevia?

A

emergency CS

40
Q

what is IUGR?

A

IUGR: small compared to genetic determination, and compromised

41
Q

complications of IUGR?

A 
	Intrapartum fetal distress and asphyxia
	Meconium aspiration
	Emergency CS. 
	Necrotizing enterocolitis.
	Hypoglycaemia
	Hypothermia
	Hyperbilirubinemia
	Hypocalcaemia
42
Q

what are the maternal causes of IUGR?

A 
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
Q

what are some foetal causes of IUGR?

A

genetic abnormality- trisomy 21, 13, 18
congenital abnormalities- cardiac (ToF)
Infection- TORCH
multiple pregnancy

44
Q

clinical features of IUGR?

A

low symphsis-fundal height

features of pre-eclampsia (as they often co-exist)

45
Q

investigations of IUGR?

A 
USS
umbilical artery doppler 
CTG
measure fundal height 
BP
urine dip 
GBS
karyotyping
screening for TORCH or downs
46
Q

management of IUGR?

A

manage cause if identified
Deliver from 36wks.

34-36: regular Doppler, daily CTG, consider delivery.

<34wks: give steroids, same as above/ undertake delivery

47
Q

what is the definition of macrosomia?

A

pathologically large for dates > 90th centile

48
Q

RF for macrosomia?

A 
maternal DM
maternal obesity
genetic
ethnicity
maternal age
overdue pregnancy
49
Q

what are two abnormal presentations/lies of baby?

A

transverse

breech

50
Q

causes of transverse lie?

A

preterm
polyhydramnios
multiparity
placenta praevia

51
Q

complications of breech presentation?

A

should dystocia

perinatal mortality

52
Q

management of breech presentation?

A

extra-cephalic version from 37 weeks

elective c-section

53
Q

what are the different types of twins?

A

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
Q

complications of twin birth?

A

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
Q

causes of polyhydramnios?

A 
twin-twin transfusion 
maternal cardiac, kidney + DM-> hyperglycaemia-> polyuria 
oesophageal/duodenal atresia 
downs/edwards syndrome 
skeletal dysplasia
56
Q

causes of oligohydramnios?

A

foetal chromosomal abnormalities
untra-uterine infections
renal agenesis
IUGR

57
Q

definition of PROM?

A

ROM < 37 weeks

58
Q

complications of PROM?

A

chorioamionitis
RDS
sepsis
pulmonary hypoplasia

59
Q

management of PROM?

A

corticosteroids
antibiotics
nifedipine - tocolytic to delay labour
foetal surveillance

60
Q

what are the stages of labour?

A

stage 1 - start to full dilation (10cm)
stage 2- full dilation to delivery of foetus
stage 3- delivery of placenta

61
Q

what are the phases of stage 1 of labour?

A

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
Q

what are the cardinal movements of labour during stage 2?

A

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
Q

non-reassuring signs on CTG?

A

variable decelerations > 30 mins
late decelerations > 30mins
acute bradycardia
single prolonged episode of deceleration lasting 3 mins or more

64
Q

what is used to induce labour?

A

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
Q

what does the bishops score involve?

A

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
Q

what are the RF for shoulder dystocia?

A

large baby > 4kg
previous dystocia
increased maternal BMI
DM

67
Q

management of shoulder dystocia?

A

mcRoberts manouvere
woodscrew manouvere
last resort- symphisiotomy + zavanelli

68
Q

complication of shoulder dystocia?

A

erbs palsy- excessive traction on neck damage brachial plexus

69
Q

risk of cord prolapse?

A

preterm, breech, Polyhydramnios, abnormal lie & twin. Artificial amniotomy

70
Q

management of cord prolapse?

A

patient to go on all fours
cord pushed back up with finger
immediate C-section

71
Q

definition of post-partum haemorrhage and types?

A

Primary: Loss of >500ml of blood <24hr of delivery
Secondary: excessive blood loss occurring between 24hr and up to 6 weeks after delivery

72
Q

causes of primary post-partum haemorrhage?

A 
4 T’s:
TISSUE: retained placenta
TONE: uterus fails to contract properly
TRAUMA: cervical/ vaginal tears or epiotomy
THROMBIN: coagulopathy, DIC
73
Q

management of primary post-partum haemorrhage?

A

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
Q

causes of secondary post-partum haemorrhage?

A

endometriosis with or without retained placental tissue

75
Q

investigatoins of secondary post-partum haemorrhage?

A

vaginal swabs
FBC
cross-match

76
Q

management of post partum haemorrhage?

A

antibiotics

evacuation of retained products of conception

77
Q

management of BV?

A

oral metronidazole

Phase 3a (4 decks)

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