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3MB EXAM NOTES > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Which class of diabetes medication is contraindicated in pregnancy AND breastfeeding?

A

Sulphonylureas (Gibenclamide, Gliplizide
Tolbutamide, Gliclazide)
Glinides (Repaglinides, nateglinide.)

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2
Q

What effect does pregnancy have on the thyroid?

A

Increase in size
Increase TBG levels
IncreasesfT4, decreasesTSH

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3
Q

What effect does HCG have on thyoxine levels?

A

Increases it

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4
Q

What effect does pregnancy have on Grave’s Disease?

A

Grave’s disease is often SUPRESSED during pregnancy (as there is immunosuppression in this time.) BUT rebound postpartum

Thyroid receptor antibodies TRAB should be measured in 3rd trimester to predict thyrotoxicosis risk for baby.
May require small doses of Carbimazole.

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5
Q

Managing Grave’s in pregnancy?

A

‘Wait & See’
1st trimester - avoid carbimazole & use Propythyouracil
2nd trimester - give carbimazole

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6
Q

What effect does hypothyroidism have on pregnancy?

A

Cretinism - dwarfism plus limited mental functioning.

risks infertility, pre-eclampsia, post-partum haemorrhage & preterm labour.

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7
Q

How should levels of levothyroxine be altered for pregnant women with hypothyroidim?

A

Increased by 50%

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8
Q

What crisis can be precipitated by labour? (related to the thyroid)

A

Thyroid crisis & transient neonatal thyrotoxicosis

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9
Q

What are the complications of thyroid crisis in labour?

A

increases risk of miscarriage, stillbirth

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10
Q

Which hormones are secreted from the posterior pituitary?

A

Oxytocin & ADH

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11
Q

Where is prolactin released from?

A

Anterior pituitary

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12
Q

How does pregnancy affect the respiratory system?

A

Tidal volume increases

Minute ventilation increases (Tidal volume x RR)

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13
Q

What is dilutional anaemia?

A

This is when plasma volume rises in pregnancy & RBCs are diluted. Hb conc falls

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14
Q

What is first line contraception for women who are breastfeeding?

A

Progesterone only
Can be used first day postpartum
Implant is most effective
IUS & IUD SHOULD BE AVOIDED DUE TO RISK OF PERFORATION.

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15
Q

Which contraceptives are contraindicated postpartum & why?

A

COC due to increases risk of VTE

IUS & IUD SHOULD BE AVOIDED DUE TO RISK OF PERFORATION.

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16
Q

Ibuprofen & Paracetamol can safely be used for analgesia during breastfeeding T/F?

A

True

17
Q

Is aspiring contraindicated in breastfeeding?

A

Yes. (can lead to liver failure & thrombocytopenia in infant)

18
Q

Opiates are contraindicated in breastfeeding T/F?

A

F - use with caution & seek help signs of toxicity

19
Q

In CTG what does prolonged decceleration indicate?

A

Prolonged deccelaration >3min

Foetal bradycardia

20
Q

On CTG what is a normal baseline variability?

A

> 5bpm

21
Q

What is normal pH levels on foetal blood sampling?

A

> 7.25

22
Q

What is a normal foetal heart rate?

A

100-160bpm

adult 60-100

23
Q

What is Bishop’s score used for?

A

Check if its safe to induce labour

24
Q

Induction of labour if bishop’s score is?

A

<5 labour unlikely to start without induction

>9 means its likely to occur spontaneously

25
Q

How do you induce labour?

A
  1. Vaginal membrane sweeping

2. Vaginal PGE2 (but not misoprostol as this is for miscarriages)

26
Q

What are the foetal cardinal movements in labour?

A 
1…Engagement 
2…Decent
3…Flexion
4…Internal Rotation
5…Crowning and extension
6…Restitution and external rotation (head adopts optimal position for shoulder)
7…Expulsion, anterior shoulder first
27
Q

Describe foetal descent

A

Descent inocciput transverse position (widest pelvic diameter available for the widest part of the fetal head.)

28
Q

Describe engagement

A

largest diameter of the fetal head is engaged when the widest diameter of the brim of the pelvis.
occiput transverse position
3/5ths or less of the foetal head should be palpable in the abdomen - station -2.
Foetus is at station 0 (ischial spine)

29
Q

Why does flexion of the foetal head occur?

A

Fundal dominance of uterine contraction exerting pressure down the fetal spine forcing occiput to come into contact with the pelvic floor.
Flexion allows the circumference of the foetal head to reduce. This assists passage through the pelvis.

30
Q

Describe internal rotation

A

Maternal contractions slowly push the foetal head to completing a 90 degree turn.
Will only occur in established labour. Commonly completed by the beginning of the second stage of labour (full dilation to delivery.)
Occiput transverse -> Occiput anterior position

31
Q

Describe crowning

A

widest diameter of the fetal head successfully negotiates through the narrowest part of the maternal bony pelvis.
Head visible at the vulva and does not disappear between contractions.

32
Q

Describute restitution & external rotation

A

Return of the fetal head returns to the correct anatomic position relative to the fetal torso.
This is shoulders that have only reached pelvic floor.
May need to return to occipito-transverse position to get these out.

33
Q

What is the frequency of contractions during latent stage 1 labour?

A

varies from every 5-30 minute to every 3-5 minutes

or 2-3 every ten minutes

34
Q

What is the frequency of contractions during ACTIVE stage 1 labour?

A

every 60-90 seconds, can even overlap.

35
Q

What is the normal length (hrs) of the second stage of labour?

A 
Prims 3hrs (with analgesia), 2 hrs (without analgesia)
Multiparous 2hrs (with analgesia), 1hr (without analgesia)
36
Q

What does foetal station measure?

A 
The degree of descent
Measured as presenting part relative to ischial spines.
Pelvic inlet (station -5) 
Ischial spine (station 0)
Vagina (station +5)
37
Q

List the indications for continous CTG monitoring in labour:

A

suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
severe hypertension 160/110 mmHg or above
oxytocin use
the presence of significant meconium
fresh vaginal bleeding that develops in labour - this could respresent placental rupture (the most common cause of antepartum haemorrhage) or placental praevia (second most common cause of antepartum haemorrhage) and therefore monitoring of the baby is required.

3MB EXAM NOTES (11 decks)

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