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Medicine Finals 2020 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Maternal Reasons for Induction of Labour? (7)

A 
Gestational Diabetes, Hypertension & Obstetric Cholestasis.
Maternal Request.
Prolonged pregnancy (>41-42w)
Symphysis Pubis Dysfunction
Recurrent Antenatal Haemorrhage.
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2
Q

Fetal Reasons for Induction of Labour? (5)

A 
IUGR
Reduced fetal movements.
Previous Stillbirth or Current Intrauterine Death
Prolonged Pregnancy
Isoimmunisation
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3
Q

Contraindications to induction of labour? (5)

A 
Previous uterine surgery or lower segment C-section.
Active genital herpes & HIV
Placenta praevia & Vasa Praevia
Umbilical cord prolapse
Abnormal lie
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4
Q

What are the risks of induction of labour? (7)

A

Failure leading to need for C-Section or operative vaginal delivery.
Uterine hyperstimulation
Uterine rupture
Cord prolapse
Fetal Compromise
Intrauterine infection (chorioamnionitis)
Post-partum haemorrhage

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5
Q

What is the step-by-step interventions used for induction of labour? Before-during

A

Before: Membrane Sweep w finger.

Start: Prostaglandin
Oral/Gel - one dose/6hrs then another (max 2)
Pessary - one dose/24 hours

If frequent/long contractions: Amniotomy

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6
Q

What is the risk of prostaglandin for induction of labour?

A

Risk of uterine hyperstimulation

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7
Q

What do you monitor during induction?

A

CTG for fetal wellbeing

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8
Q

What if the mum cant take prostaglandins due to risk of uterine hyperstimulation?

A

Amniotomy with or without oxytocin.

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9
Q

What happens if hyperstimulation occurs during induction of labour?

A

tocolysis

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10
Q

What happens if uterine rupture happens during induction of labour?

A

emergency c-section

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11
Q

Maternal (1) and foetal (3) complications of preterm-prelabour rupture of membrane?

A

M: Chorioamnionitis
F: Infection, respiratory hypoplasia, prematurity

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12
Q

Management of PPROM

A

Admit for observation and also start antibiotics.
Erythromycin (PO) for 10 days and corticosteroids (respiratory)
Consider delivery if past 34 weeks.

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13
Q

Risk factors for Gestational Diabetes

A
  • Previous Gestational Diabetes
  • First degree relative with Diabetes

*Previous baby > 4.5kg (macrosomia)
Previous unexplained stillbirth

*BMI > 30
Age > 40
*Racial origin

Smoking

Polyhydramnios
Persistent glycosuria
Polycystic ovarian syndrome

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14
Q

Maternal Complications of Gestational Diabetes

A

Worsens pre-existing Ischaemic Heart Disease, hypertension and pre-eclampsia

UTIs and endometrial infection
Can develop T2DM
Ketoacidosis and hypoglycaemia
Diabetic retinopathy and nephropathy

Caesarean & instrumental delivery

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15
Q

Foetal complications of gestational diabetes

A

Fetal compromise, fetal distress in labour,
Sudden fetal death

Macrosomia, shoulder dystocia
Hyperinsulinaemia/Hypoglycaemia

Polyhydramnios
Preterm labour
Reduced lung maturity
Neural tube & cardiac defect

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16
Q

What diabetes medication can u continue and not ?

A

Continue metformin +- insulin

Stop all other oral glucose lowering drugs.

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17
Q

In terms of heart related drugs what should be discontinue pre-conception and during pregnancy?

A

ACE-I & Angiotensin 2 receptor blockers

Statins

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18
Q

True or False?

Use fasting plasma glucose, random blood glucose, HbA1c, glucose challenge test or urinalysis for glucose to assess risk of developing gestational diabetes.

A

False. Do not use fasting plasma glucose, random blood glucose, HbA1c, glucose challenge test or urinalysis for glucose to assess risk of developing gestational diabetes.

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19
Q

What investigations can mums get if they are at risk of Gestational Diabetes?

A

2hr 75g oral glucose tolerance test.

If previous gestational, offer asap after booking and then 24-28 weeks if normal initially.
If not just 24-28 weeks.

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20
Q

What is a diagnostic result for Gestational Diabetes?

A

Either:

Fasting equal to or more than 5.6 mmol/L
2hours plasma glucose of more than or equal to 7.8 mmol/L

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21
Q

Management for GD?

A

Advice regarding diet and exercise.
Referral to a dietician.
Metformin (if exercise aint cutting it after 1-2 weeks)
If still not met, add insulin.

If fasting above 7 mmol/L from the start, just go straight to insulin with or without metformin.
If there are complications, then can start insulin from 6.

22
Q

Pruritus affecting palms and soles.

Investigations show: elevated bile salts and liver enzymes during 3rd trimester?

A

Obstetric Cholestasis

23
Q

Risk factors for Obstetric Cholestasis?

A

Multiple pregnancy (Twins)
Calculi - gallstones
Hepatitis C

24
Q

What investigations would you order in a pregnant woman presenting with itch (palms and soles) but no rash.

A

Bedside: urinalysis (proteinuria) and blood pressure

Blood:
Liver function test & Bile Acids
Hepatitis ABC, EBV, CMV
Liver auto-immune antibodies - PBC (anti-SMA, anti-mitochondrial antibodies)

Imaging: Liver ultrasound

25
Q

What is the definitive management for Obs Chole?

A

Delivery (IoL at week 37)

Ursodeoxycholic acid and sedating anti-histamines (chlorphenamine)

26
Q

What is the triad for Hyperemesis Gravidarum?

A

Dehydration, more than 5% pre-pregnancy weight loss and electrolyte disturbances

27
Q

What is the PUQE score?

A

Management stratification for HGE.

28
Q

What are the risk factors for HGE?

A

Multiple pregnancy & Obesity
Nulliparity
Trophoblastic disease
Hyperthyroidism

29
Q

What is first line treatment for HGE?

A

antihistamines (promethazine or cyclizine) –> odansetron or metoclopramide (max 5 days)

30
Q

Complications of HGE?

A 
Mallory Weiss Tear
Central Pontine Demyelination
Acute Tubular Necrosis
Wernicke's Encephalopathy
Foetal: SGA, pre-term birth
31
Q

Causes of polyhydramnios?

Hint - increased fluid production & impaired swallow

A

Increased fluid production: Maternal diabetes & hydrops fetalis due to: rhesus haemolysis, infection (CMV, parvovirus), trisomies and anaemia.

Impaired swallow: duodenal/oesophageal atresia, neuromuscular disease (myotonic atrophy), idiopathic

32
Q

Complications of polyhydramnios [2]

A

Prematurity & malpresentation

33
Q

What is pre-eclampsia?

What is gestational hypertension?

A

New onset hypertension (>140mmHg systolic or >90mmHg diastolic) after 20 weeks of pregnancy with proteinuria or major organ dysfunction (renal, liver, neurological, haematological, urteroplacental)

G.Htn: New onset hypertension (>140 or >90) without proteinuria

34
Q

What are the risk factors (High and moderate) for pre-eclampsia?

A

High:

  • Hx of previous hypertension disease in previous pregnancies
  • Chronic Hypertension
  • Chronic Kidney Disease
  • T1/2DM
  • Autoimmune disease (SLE, anti-phospholipid)

Moderate:

  • Nulliparous
  • Multiple pregnancy
  • BMI > 35
  • Pregnancy interval more than 10 years
  • More than 40 years old
  • Family history of pre-eclampsia
35
Q

What 3 investigations would you order to investigate pre-eclampsia?

A

Urine dipstick = 0/+1/+2

24 hour urine collection = > 0.3g/24hr
Protein:creatinine ratio = >30mg/nmol
Urine dip for protein = 0/+1/+2

36
Q

What is HEELP syndrome?

A

A severe form of pre-eclampsia associated with:

37
Q

Risk factors for ectopic? [6]

A 
Previous ectopic
IVF
Surgery or salpingitis
Endometriosis
IUCD
Progesterone only pill
38
Q

What beta-hCG levels would you expect in ectopic pregnancy?

A

more than 1500

39
Q

Investigations for ectopic pregnancy?

A

Pregnancy test kit first (positive) then trans-vaginal ultrasound.

40
Q

Mum is fitting what do you give? she also has severe hypertension

A

Magnesium Sulfate bolus then infusion over 24 hours

41
Q

Mum has high blood pressure what do you give?

A

labetalol if not then nifedipine

42
Q

Features of Placenta Praevia?

Bleeding, pain, uterine tenderness, fetus lie, shock?, Ultrasound findings?

A 
Red & profuse.
No pain.
No uterine tenderness.
Abnormal lie - breech? Normal heart rate
Shock consistent with blood loss
Placenta is low.
43
Q

Features of Placenta Abruption?

Bleeding, pain, uterine tenderness, fetus lie, shock?, Ultrasound findings?

A 
Dark, sometimes absent.
Pain is common & severe & constant
Uterus - woody tenderness
Lie is normal, distressed heart rate
Inconsistent with blood loss.
Ultrasound normal
44
Q

Risk Factors for placenta praevia?

A 
Smoking.
Previous praevia
Previous myomectomy or C-section
High age
High parity or large number of closely spaced pregnancy.
45
Q

Risk Factors for Placenta Abruption?

A

PMH: pre-eclampsia or hypertension or abruption
smoking, increased age
IUGR

46
Q

Complications of praevia:

A

Placenta Accreta (prevents separation) or precreta (penetrate through uterine wall)
IUGR
Premature delivery or death
Post-partum haemorrhage

47
Q

Complications of abruption?

A

Placental insufficiency - fetal hypoxia and death

MUM: DIC, kidney failure, post-partum haemorrhage

48
Q

Who gets anti-d, how much units, and when?

A

rhesus negative mums get 1500 units at 28 weeks and after any bleeding episodes and also after delivery if baby is rhesus positve

49
Q

Complications of rhesus isoimmunisation?

A

Haemolysis leading to jaundice
hydrops fetalis and fetal death if severe.
jaundice and anaemia if mild

50
Q

Risk factors for LGA

A

Previous LGA
Family Hx of LGA

High BMI mum
PMH: diabetes
Male infants

Medicine Finals 2020 (17 decks)

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