Obstetrics Flashcards
1
Q
What is tested for weeks 0-10?
A
Hb, blood group, Rh, SCA, thalassaemia, syphilis, hep B, HIV, rubella
2
Q
What is a flaw of the nuchal translucency scan at 11-13 weeks?
A
Inaccurate in morbidly obese patients
3
Q
What’s the risk of miscarriage with a CVS and amniocentesis?
A
1% and 0.5%-1%
4
Q
What term is giving to itchy papule and plaques that develop on abdominal striae in the 3rd trimester?
A
Polymorphic eruption of pregnancy
5
Q
What colour are the excoriated papule in prurigo?
A
Red/brown
6
Q
What autoantibody causes blisters in the 2nd trimester?
A
IgG autoantibodies, in pemphigoid gestations
7
Q
Itching on the hands and feet is a sign of
A
Pregnancy cholestasis
8
Q
What epileptic drugs increase the risk of foetal abnormalities/cognitive impairments?
A
Sodium valproate, phenytoin, primidone, carbamazepine
9
Q
What are the complications associated with measles?
A
Miscarriage and stillbirth
10
Q
What are the complications associated with parvovirus B19?
A
Hydrops foetalis and miscarriage
11
Q
What can congenital rubella syndrome cause?
A
Deafness
12
Q
What is smoking commonly associated with?
A
SIDS
13
Q
When are AntiD IgG injections administered in Rhesus incompatibility?
A
At 28 weeks and 72 hours after birth
14
Q
What are complications of pre-eclampsia?
A
HELLP syndrome, eclampsia, stroke, organ failure, foetal death
15
Q
RF for gestational diabetes
A
BMI > 30, older maternal age, PCOS, smoking, T2DM
16
Q
What should be avoided after birth in patients with pregnancy cholestasis?
A
Oestrogen contraceptive pills
17
Q
What is a cause of partial HMs?
A
Dispermic fertilisation
18
Q
What are complete HM associated with?
A
Choriocarcinoma
19
Q
What are 2 signs of a threatened miscarriage?
A
Bleeding and closed cervix
20
Q
What are 2 signs of an inevitable miscarriage?
A
Bleeding and opened cervix
21
Q
What is the main sign of an incomplete miscarriage?
A
Ongoing bleeding
22
Q
What is the final sign of a complete miscarriage?
A
Bleeding ceased and empty uterus
23
Q
Vacuum aspiration abortions are performed until
A
9 weeks gestation
24
Q
What gestation is dilation and evacuation performed at?
A
14-15 weeks
25
What is the progesterone antagonist used in abortions?
Mifepristone
26
What is the prostaglandin analogue used in abortions?
Misoprostol
27
What is a RF for ectopic pregnancy?
PID/undiagnosed STI
28
When is a salpingectomy performed?
Foetal pole > 35 mm
29
What are RF for placenta praevia?
Uterine scarring (short inter-pregnancy interval, caesarean), advanced maternal age, smoking/drugs
30
A pH of what in a foetal scalp sample requires delivery?
< 7.20
31
Variable decelerations is a sign of what
Reduced amniotic fluid and umbilical cord compression
32
Sinusoidal rhythms suggest
Hypoxia, anaemia, haemorrhage, foetal mortality
33
What does APGAR stand for?
```
Activity (muscle tone)
Pulse
Grimace (reflex irritability)
Appearance
Respiration
Excellent 7-10, moderately depressed 4-6, severely depressed 0-3
```
34
What are the causes of postpartum haemorrhage?
Uterine atony, trauma, retained tissue, coagulopathies
35
RF for dystocia
Small pelvis, young mother, FGM, large babies
36
Puerperal sepsis can take place from rupture of membranes to when?
42 days postpartum
37
Common causes of puerperal sepsis?
GAS, Strep. pyogenes, E. coli
38
The blood spot tests for what diseases?
SCA, CF, congenital hypothyroidism, PKU, MCADD, MSUD, IVA, GA1, HCU
39
Newborn physical examination will investigate
Eyes, heart, hips, testicles
40
What age is the hearing loss test?
4-5 weeks
41
What are the chances of natural conception within 1, 2 and 3 years?
84%, 92%, 93%
42
What OTC drug is dangerous during pregnancy?
Ibuprofen
43
Toxoplasmosis is transmitted in what
Cat faeces
44
4 criteria to admit a pregnant woman with morning sickness
1. Unable to tolerate liquids
2. Ketonuria
3. 5% weight loss
4. Comorbidity/infection - i.e. UTI
45
Which 2 types of patients must take extra folic acid during pregnancy?
HIV+ patients (co-trimoxazole) and epileptic patients
46
What must babies born to epileptic mothers receive at birth?
Vitamin K injection to reduce risk of neonatal haemorrhage (from exposure to epileptic drugs)
47
2 main signs of postpartum psychosis
1. Extreme mood swings - mania and depression
| 2. Delusion
48
3 effects of foetal alcohol syndrome
1. Poor growth
2. Distinct facial features (thin upper lip, small eye openings)
3. Behavioural/learning difficulties
49
3 effects of smoking during pregnancy
1. Low birth weight/restricted growth
2. Pregnancy complications
3. Future lung conditions
50
Opioid use in pregnancy causes
Neonatal abstinence syndrome - Withdrawal: Irritable, vomiting, diarrhoea, poor weight gain, convulsions
51
Where must babies be placed in the cot?
On their back, with their feet touching the end of the cot with no excess bedding/obstructions
52
Diazepam increases the risk of what congenital defect?
Cleft palate
53
3 types of spina bifida
1. SB occulta - hidden
2. SB meningocele - Meninge herniation
3. SB myelomeningocele
54
What chromosome abnormality is seen in DS?
Trisomy 21
55
What chromosome abnormality is seen in Edward's Syndrome?
Trisomy 18 - Small head/face, heart defects
56
What chromosome abnormality is seen in Patau Syndrome?
Trisomy 13
57
Stage 1 of labour involves
Regular contractions with cervix dilation
58
What is the latent phase in stage 1 labour?
Amniotic fluid ruptures - mild/irregular contractions
59
What is the active phase in stage 1 labour?
Cervix dilates 3-4 cm - contractions are painful and regular
60
What is stage 2 of labour?
Full dilation of cervix with regular strong contractions leading to birth of baby
61
What is stage 3 of labour?
Placenta expulsion
62
What does foetal scalp sampling measure?
pH and lactate
63
A FBS pH > 7.25 is
Normal
64
A FBS pH of 7.21-7.24 is
Borderline - needs repeating 30 minutes later
65
A FBS pH of < 7.20 is
Abnormal - deliver baby
66
What is the baseline rate of a foetal HR?
110-160 bpm
67
5 reasons for reduced baseline variability
1. Sleeping baby
2. Foetal acidosis/hypoxia
3. Foetal tachycardia
4. Drugs - Opiates, magnesium sulphate
5. Prematurity
68
Variable decelerations can suggest
Reduced amniotic fluid or umbilical cord compression
69
Late decelerations can suggest
Insufficient blood flow to uterus and placenta
70
Sinusoidal patterns of decelerations are associated with
Foetal hypoxia, haemorrhage, mortality
71
AGPAR measures
```
Activity
Pulse
Grimace/reflex irritability
Appearance/skin colour
Respiration
```
72
Contraception is required how many days post birth?
21 days unless mother is exclusively breast feeding
73
How many weeks post birth before a IUD/IUS can be inserted?
4 weeks
74
When can COCP or cap/diaphragm be re-started in a postpartum female?
6 weeks
75
What's the risk of starting a COCP soon after giving birth?
Venous thromboembolism
76
What immunoglobulin passes from the mother to foetus in rhesus incompatibility?
IgG - attaches to foetal RBC and causes extravascular haemolysis in the foetal spleen by macrophages.
77
What happens to the foetus when foetal RBCs are destroyed in rhesus incompatibility?
Anaemia, hepatosplenomegaly, portal hypertension, stillbirth, hydrops fetalis
78
What 2 blood groups make it more common to be RhD-?
O+ and A+
79
When is an AntiD IgG given to the foetus?
28 weeks and 72 hours post birth
80
5 RF for pre-eclampsia
1. 20 weeks gestation
2. Obesity/gestational diabetes
3. Multiple pregnancy
4. Pre-existing cardiovascular or renal disease
5. Family history/previous history
81
Reduced foetal movement, foetal growth restriction and upper abdominal pain could be a sign of?
Pre-eclampsia
82
What antihypertensive is given to a mother with pre-eclampsia?
IV labetalol
83
HELLP syndrome stands for
Haemolysis
Elevated liver proteins
Low platelet count
84
Complications of eclampsia
```
Convulsions/eclampsia
HELLP syndrome
Stroke
Pulmonary oedema
Kidney/liver failure
Visual disturbances
```
85
5 risk factors for gestational diabetes
1. Obesity BMI > 30 - triples risk
2. Older maternal age (decreased b-cell reserve)
3. PCOS
4. Smoking
5. Physical inactivity
86
Foetal macrosomia and vaginal candidiasis are signs of
Gestational diabetes
87
Epigastric discomfort that worsens at night is a sign of
Cholestasis in pregnancy
88
A snow-storm pattern seen on a pelvic USS is a sign of what?
Complete hydatidiform mole
89
5 risk factors for ectopic pregnancy
1. IUD
2. Previous ectopic pregnancy (increases risk by 1/4)
3. PID/STI
4. Progesterone only pill
5. Previous surgery/damage to female reproductive system
90
Vomiting and diarrhoea, alongside shoulder pain in a fertile woman can suggest
Ectopic pregnancy
91
Management for an ectopic pregnancy
Salpingectomy
92
Small for gestational age is defined as
Foetus < 10th centile for their gestational age
93
2 types of SGA
1. Constitutionally small: Normal development but small family
2. Foetal growth restriction
94
Foetal growth restriction can be subdivided into
1. Placenta-mediated growth restriction
| 2. Non-placenta mediated growth restriction
95
3 signs of foetal growth restriction
1. Reduced foetal movement
2. Reduced amniotic fluid volume
3. Abnormal CTGs
96
3 causes of macrosomia (>90th gentile or > 4.5 kg)
1. Gestational diabetes
2. Maternal obesity
3. Male
97
3 macrosomia related risks to mother or baby
1. Shoulder dystocia
2. Obesity in childhood for the child
3. Instrumental delivery/c-section
98
2 investigations for a large for gestational age baby
1. US - exclude excess amniotic fluid, estimate foetal weight
2. Oral glucose tolerance test for gestational diabetes
99
3 dietary items that must be avoided in pregnancy
1. Vitamin A (teratogenic - pate/liver)
2. Unpasteurised dairy/blue cheese (listeriosis)
3. Undercooked/raw poultry (salmonella)
100
Monochorionic twins share the same...
Placenta
101
Monozygotic twins are from a
Single zygote
102
Risks of multiple births to the mother
1. Anaemia
2. Preterm delivery
3. C-section
4. Hypertension
103
What happens to the twin that receives the majority of blood supply in twin-twin transfusion syndrome?
Fluid overload resulting in heart failure. Increased amniotic fluid.
104
What happens to the twin that does not receive the majority of blood supply in twin-twin transfusion syndrome?
Growth restriction and anaemia. Reduced amniotic fluid.
105
Main complication of an UTI in a pregnant woman
Pre-term delivery
106
2 common bacteria causing UTIs in a pregnant woman
E.coli and Klebisiella pneumoniae
107
When should nitrofurantoin be avoided?
3rd trimester - risk of neonatal haemolysis.
108
When must trimethoprim be avoided?
1st trimester - Folate antagonist - increases risk of neural tube defects
109
VTE prophylaxis criteria in a pregnant woman
1. Start at 28 weeks if there are 3 RF
| 2. Start in 1st trimester if there are 4+ RF
110
Can you use the Wells Score in a pregnant woman?
No as pregnancy naturally raises D-dimer
111
5 RF for VTE in a pregnant woman
1. Parity > 3
2. Older maternal age
3. Obesity
4. Pre-eclampsia
5. Multiple pregnancy
112
Pre-eclampsia triad
Hypertension, proteinuria, oedema
113
What is pregnancy-induced hypertension?
HTN after 20 weeks gestation with no proteinuria
114
Pre-eclampsia can be diagnosed when the systolic BP > 140, diastolic BP > 90 and what 3?
1. Proteinuria 1+
2. Organ dysfunction (i.e. raised LFT)
3. Placental dysfunction (foetal growth restriction)
115
What can be tested for if a woman has suspected pre-eclampsia?
PIGF - levels are low 20-35 weeks in pre-eclampsia
116
What can be given to women at risk of pre-eclampsia?
Aspirin
117
Pruritus on palms/soles of the feet with abnormal liver function is a sign of
Cholestasis in pregnancy
118
A complete hydatidiform mole has what chromosomes?
Paternal
119
A partial hydatidiform mole has what chromosome?
Paternal and maternal
120
A complete hydatidiform increases the risk of
Choriocarcinoma
121
Medical management and advice for ectopic pregnancy
Methotrexate IM to cause termination and avoid getting pregnant for 3 months
122
4 criteria for ectopic pregnancy surgical management
1. Foetal pole > 35 mm
2. Heartbeat
3. HCG > 5000
4. Pain
123
Recommended surgery for a woman with poor fertility + ectopic pregnancy?
Salpingostomy
124
Define threatened miscarriage
PV bleeding < 24 weeks with closed cervix
125
Define inevitable miscarriage
PV bleeding with open cervix
126
Severe morning sickness and abnormally high HCG are signs of
Molar pregnancies
