Obstetrics Flashcards
1
Q
What does HELLP syndrome stand for? What is it associated with?
A
Haemolysis Elevated liver enzymes (pts can go into liver failure) Low platelets (thrombocytopaenia)
Pre-eclampsia
2
Q
What supplements do HELLP patients often go home on?
A
Iron (they often suffer significant haemorrhage)
3
Q
CTG <100bpm =
A
bradycardia in baby - emergency
4
Q
What are fibroids which have been treated with multiple surgeries before a risk of?
A
Uterine rupture
5
Q
Mx of symptomatic ectopic pregnancy + lots of pain?
A
Surgical
- Salpingectomy
- Salpingotomy if increased risk of infertility or known tubal damage
6
Q
The foetal heartbeat is visible as early as
A
6 weeks
7
Q
What is a miscarriage?
A
Pregnancy that spontaneously ends before 24wks gestation
8
Q
What gastro issues are pregnant women at higher risk of?
A
Cholelithiasis and cholecystitis
Acute fatty liver of pregnancy (AFL) (usually presents after 30wks)
9
Q
How should LMWH be given/monitored in pregnancy?
A
Pharmacokinetics change in preg. so give 1mg/kg dose BD (usually its 1.5mg/kg OD).
If labour suspected or begins then stop immediately.
If C-section planned then stop 24hr before.
Give any spinal anaesthesia or epidural at least 24hr AFTER last injection of LMWH.
10
Q
What are the risk factors for obstetric cholestasis?
A
- Previous pregnancy with OC
- Asian origin
- Genetic traits
- Pruritis on COCP
- Multiple pregnancy
11
Q
What are the complications of obstetric cholestasis?
A
- Severe liver impairment
- Fetal distress
- Premature delivery
- Intrauterine death
- Post-partum haemorrhage
12
Q
Why might altered liver function or GI function increase the risk of post-partum haemorrhage?
A
Decreased absorption of Vit K, leading to altered coagulation
13
Q
A 33-year-old lady presents to delivery suite at 34 weeks gestation in her fifth pregnancy with a history of painless vaginal bleeding. The patient also reported a small amount of spotting following sexual intercourse. The doctor performs an examination which shows the fetus to be lying transversely with a normal fetal heart rate. On speculum examination, there was a small amount of blood in the vagina and the cervix was normal. What is the most likely diagnosis?
A
Placenta praevia
14
Q
What are the risk factors for placenta praevia?
A
Multiparity Smoking Previous Hx of placenta praevia Previous uterine surgery Older mothers
15
Q
What are the three methods to measure fetal wellbeing during labour?
A
CTG (Cardiotocograph)
Intermittent auscultation
Fetal blood sampling
16
Q
What is the Normal baseline heart rate during labour?
A
110-160
17
Q
When do early decelerations occur on a fetal CTG and why do they happen?
A
Occur WITH the peak of contraction and happen due to head compression
18
Q
Late decelerations are associated with?
A
Fetal hypoxia
19
Q
Variable decelerations on CTG suggest?
A
Cord compression
20
Q
In the fetus a normal PH is
A
> 7.25. Borderline is 7.2-7.25.
21
Q
What is one of the first features of scar rupture in VBAC?
A
An abnormal CTG
22
Q
What is an absolute contraindication to trial of VBAC due to the greater risk of uterine rupture?
A
Classical incision
23
Q
What are some of the complications of VBAC?
A
72-75% chance of successful delivery - the rest involve emergency C section
If labour is induced it can result in increased risk of UTERINE RUPTURE
If baby is in cephalic position its a favourable factor for VBAC
24
Q
What two things should be prepared/monitored in VBAC during delivery?
A
1) IV access in case immediate resuscitation is needed
2) Continuous CTG (abnormality indicates uterine scar rupture)
25
What is secondary arrest of labour?
Failure for labour to progress when there was adequate or expected progress to begin with
26
What is primary dysfunction of labour often caused by?
Deflexion of fetal head and ineffective uterine action.
27
Risk factors for obstetric anal sphincter injuries
Forceps/instrumental delivery
Prolonged labour
During active second stage
Big babies
28
What should general anaesthesia for unplanned C section include?
Preoxygenation, cricoid pressure and rapid sequence induction to reduce the risk of aspiration
29
What are examples of infection that can occur in 8% of women after C section?
Endometritis
Wound infections
Urinary tract infections
30
What is the difference between SGA and IUGR?
SGA = below 10th centile for weight since beginning of pregnancy
IUGR= growing normally then drops by a few centiles
31
What is the difference between antepartum haemorrhage and threatened miscarriage?
Threatened miscarriage < 24 weeks
| Antepartum haemorrhage > 24 weeks
32
What are some causes of antepartum haemorrhage?
```
Placental abruption
Placenta praevia
Placenta accreta
Vasa praevia
Cervical ectropion
Trauma
Bloody show
```
33
What are some risk factors for placental abruption?
```
Previous placental abruption
Smoking
C-sections
Cocaine use
Pre-eclampsia
```
34
Why might there not be any PV bleeding in placental abruption?
It may be a concealed bleed
35
What is the difference between placenta praevia and placenta accreta?
Placenta praevia – the placenta grows over the internal os of the cervix (three types: complete, partial and marginal)
Placenta accreta – the placenta grows deep into the uterus. Tends to occur over C-section scars and is associated with severe post-partum haemorrhage
NOTE: a low-lying placenta just means that it is lying low in the uterus but does not touch the cervix
36
How can preterm premature rupture of membranes be prevented in high-risk women?
Prophylactic vaginal progesterone
| Cervical cerclage
37
If pooling of amniotic fluid is not observed on examination of a woman with suspected PPROM, which other test could be conducted?
IGF binding protein-1 test or placental alpha-microglobulin-1 test
38
Which organisms are typically implicated in chorioamnionitis?
GBS
| E. coli
39
How would a patient with PPROM but no signs of infection be managed?
Monitor for signs of infection
- Offer oral erythromycin 250 mg QDS for a maximum of 10 days or until the patient is in established labour
- Offer maternal corticosteroids
- Do NOT use tocolysis (increases risk of infection)
Decision to deliver depends on balance of risk of prematurity and risk of maternal/foetal infection if delivery is delayed
40
Risks of smoking during pregnancy
```
Miscarriage
Stillbirth
IUGR
Low birthweight
Neonatal death
Cot death
```
41
Risks of diabetes mellitus during pregnancy
```
Macrosomia
FGR
Congenital abnormalities
Pre-eclampsia
Stillbirth
Neonatal hypoglycaemia
```
42
What vaccines should be given during pregnancy and when?
27-26wks
- Influenza vaccine
- DTaP vaccine (protect neonate from bordatella)
43
What are the indications for anti-D prophylaxis administration <12wks GA? If these are not indicated but mum is Rhesus D positive, when should anti-D prophylaxis be given?
Give 250IU
- Molar pregnancy
- Ectopic pregnancy
- Therapeutic TOP
- Uterine bleeding
Give large does 1500U at 28wks
OR
two doses: 28wks and 34wks
44
What glucose levels are required for a diagnosis of gestational DM?
- Fasting plasma glucose
- 2-hr 75g OGTT
Fasting: >5.6mmol/L
OGTT: >7.8mmol/L
45
How should sickle cell anaemia be managed during pregnancy?
```
Stop hydroxyurea at least 3mths before conception
Manage with:
- low dose aspirin from 12wks
- serial scans every 4wks from 24wks
- IOL at 38wks
```
LMWH during hospital and 7days after, 6wks if C section
If contraceptive needed - progesterone
46
If a baby is born to an active HBV mother, what should be given to the child?
HBV IVIG: within 12hrs
| Hep B vaccine: 12hrs, 1mth, 6mths
47
What does the combined test screen for and what is involved in it?
Patau's, Edward's, Down's
- Nuchal translucency
- b-hCG
- PAPP-A
48
What does the quadruple test involve and what does it screen for? How does it differ to the triple test? What happens if a positive result is achieved?
Down's only
- NT
- b-hCG
- Oestriol
- Inhibin A
NB: the triple test does NOT include inhibin A
If positive result:
- Chorionic villous sampling (11-14wks)
- Amniocentesis (15-20wks)
49
What should be given to women at risk of pre-eclampsia?
75mg OD from 12wks to delivery (if high risk)
50
At what GA are the following scans done?
Booking scan:
Anomaly scan:
Booking scan: 10-14wks
| Anomaly scan: 18-21wks
51
Sensitising events for RhD negative mum
- Delivery of RhD+ infant
- Any TOP
- Miscarriage if > 12 weeks
- Ectopic pregnancy (if managed surgically)
- External cephalic version - Antepartum haemorrhage
- Amniocentesis, CVS, foetal blood sampling - Abdominal trauma
52
What conditions in women require a higher dose of daily folic acid than the normal 400mcg OD? What is the higher dose?
5mg OD
- Previous NTD in foetus/baby
- SCD
- Thalassemia
- Epilepsy
- HIV+ on co-trimoxazole
- Diabetes mellitus
- Obesity
- IBD
53
What is the normal progress of the active phase of first stage of labour?
Slow progress/no progress?
0.5cm/hr or 2cm/hr
Slow or no progress = <2cm in 4hrs
54
When is the most likely time for conception?
6 days prior to ovulation, so around day 8-14
55
Risk of alcohol consumption during pregnancy
```
Neurological damage
Abnormal facies
Fetal growth restriction
Low birth weight
Spontaneous miscarriage
```
56
What vitamin in the liver is associated with congenital abnormalities, thus means liver should not be eaten during pregnancy?
Vitamin A
57
Risks of the following drugs during pregnancy:
Beta blockers
Warfarin
Diuretics
Diclofenac
Beta blockers: growth restriction
Warfarin: teratogenic
Diuretics: teratogenic
Diclofenac: miscarriages in first trimester
58
Oligohydramnios typically detected between how many wks?
18-24wks
59
Things looked for on anomaly scan
```
NT
Gross abnormalities/cranial eg anencephaly
Abdo wall defect
Cystic hygroma
Bladder outflow obstruction
```
60
Risk factors for pre-eclampsia
```
Chronic HTN
Diabetes
Obesity
Nulliparity
Multiple pregnancy
Renal disease
Molar pregnancy
```
61
What serum markers rise in pre-eclampsia? A decrease in what other serum marker is worrying and why?
Urea
Creatinine
AST
ALT
Worried if low Plts as could indicate HELLP syndrome
62
Indications for CTG monitoring
Abnormal foetal HR on intermittent auscultation
Meconium in liquor
Maternal pyrexia (>38 or 2x >37.5 separated by 2hrs)
Fresh onset bleeding
Oxytocin for augmentation
63
Turtle sign/retraction of head during labour suggests? How should this be managed?
Shoulder dystocia
Mum needs to STOP pushing
1. Call for seniors
2. External manoeuvres (=/- episiotomy)
= MacRoberts manoeuvre + suprapubic pressure (works in 90%)
3. Internal manoeuvres
- Wood's screw or Rubin II
4. All fours position
5. Symphysiotomy, cleidotomy, zavanelli
64
Which fetal diamete is the most appropriate to engage in the pelvic inlet under normal circumstances?
Sub-occipito-bregmatic
65
What is the progress of labour determined by?
Power
Passage
Passenger
66
Two indications for emergency C-Section?
Placental abruption
| Transverse position
67
What are the factors that might mean a lower chance of achieving a VBAC?
Maternal obesity
Fetal macrosomia
Increased maternal age
Previous C section performed for recurring indication
Previous C section performed following failed instrumental delivery
68
Risks of C-section
- Maternal
- Foetal
Maternal:
- Visceral damage
- Haemorrhage
- VTE
- Future risk of uterine rupture and placenta praevia
- Infection
Foetal:
- Resp distress
- Traumatic injury
69
Options for IOL and indications
If delay in labour eg <2cm over 4hrs or other reasons eg pre-eclampsia and at term etc
1st line: Vaginal prostaglandins E2
- Gel or tablet: max 2 doses, 6 hours apart
- Pessary: 1 dose over 24hr
2nd line:
Membranes intact: ARM
Membranes ruptured but no labour after 2hr: IV syntocinon until 3-4 contractions every 10mins then review in 4hrs
70
What nerves does shoulder dystocia damage?
Brachial plexus
| C5-C8, T1
71
Turtle sign/retraction of head during labour suggests? How should this be managed?
Shoulder dystocia
Mum needs to STOP pushing
1. Call for seniors
2. External manoeuvres (=/- episiotomy)
3. Internal manoeuvres
4. All four position
5. Symphysiotomy, cleidotomy, zavanelli
72
What maternal cardiovascular changes occur during pregnancy? (Name 3)
Drop in venous return
Reduction in CO
Reduction in uterine blood flow
73
What is the position of the baby during labour?
Relationship of foetal occiput to the sacrum of the mother once the foetal head is in the pelvic inlet
74
What are the 5 components of a bishop score?
1. Dilation of cervix
2. Consistency of cervix
3. Length of cervical canal
4. Position of cervix
5. Foetal position
75
What is the risk of ARM?
umbilical cord prolapse
76
What are the risks of IV syntocinon?
Uterine hyperstimulation
| Uterine rupture risk (esp if VBAC or previous uterine myomectomy)
77
Options for IOL and indications
If delay in labour eg <2cm over 4hrs or other reasons eg pre-eclampsia and at term etc
1st line: Vaginal prostaglandins E2
- Gel or tablet: max 2 doses, 6 hours apart
- Pessary: 1 dose over 24hr
2nd line:
Membranes intact: ARM
Membranes ruptured but no labour after 2hr: IV syntocinon until 3-4 contractions every 10mins
78
What are the types of delay in the first stage of labour?
Primary dysfunctional labour
Secondary arrest
Prolonged latent phase
Cervical dystocia
79
What is puerperal pyrexia and what are some causes? How is it managed?
```
38degrees in mum within first 14days of delivery
Caused by
- endometritis
- wound infection
- VTE
- UTI
- mastitis
```
IV clindamycin + gentamicin
80
Definition of delay in second stage of labour
Nulliparous: >2hr if no epidural, >3hr if epidural
Parous: >1hr if no epidural, >2hr if epidural
81
What is crowning?
When the head no longer recedes between contractions
82
When should vitamin K be administered to a baby?
1st dose: just after they're born
2nd dose: by midwife after 7days
3rd dose: by GP/health visitor when baby is 6wks old
83
What abnormalities of the birth canal can result in abnormal labour?
```
Fibroids or any obstruction in canal
Cervical dystocia (usually because of previous surgery)
```
84
What medication should NOT be offered to hypertensive women in third stage of labour?
Ergometrine
Offer oxytocin only
85
If IOL is offered to a pregnant women at 41wks and she declines, what should be done?
Twice weekly USS and CTG
86
Risk factors for breech baby
```
Uterine malformations
Fibroids
Placenta praevia
Poly/oligohydramnios
Foetal anomaly (CNS malformation, chromosomal disorders)
Prematurity
Macrosomia
Multiple pregnancy
```
87
What is puerperal pyrexia and what are some causes? How is it managed?
```
38degrees in mum within first 14days of delivery
Caused by
- endometritis
- wound infection
- VTE
- UTI
- mastitis
```
88
When is engagement said to have occured?
When the widest part of the presenting part passes through the pelvic inlet
89
What is meconium passed in utero linked to?
Marked hypoxia +/- metabolic acidosis
90
What are some causes of abnormal labour?
Poor progress +/- signs of foetal compromise
- Foetal malpresentation
- Multiple pregnancy
- Uterine scar
- Induced labour
91
What are the absolute contraindications for a VBAC?
Previous uterine rupture
Classical (vertical) C-section scar
Other non-C-section contraindications eg major placenta praevia
92
In what circumstances is fetal blood sampling contra-indicated?
Maternal HIV
Hepatitis
Fetal coagulopathy / bleeding disorders
93
Counselling for vaginal delivery of breech baby
40% risk of needing emergency C-section
Footling breech is absolute contra-indication
Better chance if: normal sized foetus, multiparous, positive mental attitude of mother
94
Risks of breech baby
ECV - 50% success rate
Placental abruption
Foetal distress
Possible emergency C-section required
95
What are the cardiopulmonary symptoms of amniotic fluid embolism?
- Acute pulmonary HTN
- Hypoxia
- RVF then LVF and death
96
What is the risk of uterine rupture in VBAC (normal vs with syntocinon)?
1 in 200
| 1 in 100 if oxytocin
97
Complications of uterine rupture
Foetus
Death / cerebral palsy from hypoxic brain injury
Maternal
PPH
Coagulopathy
Hysterectomy
98
Counselling for ERCS
Reduced risk of uterine scar rupture and need for emergency C-section
Increased future risk of:
- Pelvic adhesions complicating surgery
- Placenta praevia or accreta in future pregnancies
If VBAC then increases likelihood of success of future vaginal births
99
In what circumstances is fetal blood sampling contra-indicated?
Maternal HIV
Hepatitis
Fetal coagulopathy
100
Risk factors for cord prolapse
```
Malpresentation or unstable presentation
Multiple pregnancy
Polyhydramnios
Preterm delivery
Placenta praevia
Macrosomia
```
101
Causes of suddenly abnormal CTG with variable decelerations
Cord compression
| Cord prolapse
102
How should detection of fetal bradycardia/deceleration be managed in labour?
1. If deceleration has not recovered at 3min then CALL FOR SENIOR HELP
2. If deceleration has not recovered at 6min then transfer to theatre and prepare for immediate delivery
3. If deceleration has not recovered at 9min then delivery IMMEDIATELY by category one 'crash' caesarean section (if immediate instrumental vaginal delivery not possible) usually involves GA as spinal anaesthetic hard to achieve by this time
103
What is the risk of uterine rupture in VBAC (normal vs with oxytocin)?
1 in 200
| 1 in 100 if oxytocin
104
What are the relative contraindications of VBAC?
2+ previous C section
IOL
Previous labour outcome suggestive of CPD
105
Counselling for ERCS
Reduced risk of uterine scar rupture and need for emergency C-section
Increased future risk of:
- Pelvic adhesions complicating surgery
- Placenta praevia or accreta in future pregnancies
106
Mechanism/method of vaginally delivering breech baby
Do NOT DO IOL, Continous CTG needed
Maternal position on all fours
Ideally take hands off approach
1) Delivery of buttocks
2) Delivery of legs +/- Pinards manoeuvre
3) If shoulders get stuck - winging of scapula - Loveset's manoeuvre (for 1/both arms)
4) If head gets stuck - Mauriceau-Smellie-Veit manoeuvre (if doesn't work use forceps)
107
Risk factors for P-PROM
Smokers
STI
Previous P-PROM
Multiple pregnancy
108
Absolute contra-indications for IOL
Placenta praevia
| Severe fetal compromise
109
What are some reasons for induction of labour?
- Prolonged pregnancy (>41wks)
- Multiple pregnancy
- Twin pregnancy beyond 38wks
- PROM
- Diabetes
- Pre-eclampsia/HTN type illness
- FGR
- Maternal declining health
- Unexplained antepartum haemorrhage
- Intrahepatic cholestasis of pregnancy
- Maternal isoimmunisation against red cell antigens
- Social reasons
110
What are common complications of pre-eclampsia?
```
Pulmonary oedema
DIC
Cerebral haemorrhage
Eclampsia
Placental abruption
```
111
Presentation of placental abruption
Dark red blood
Painful abdomen (severe)
Woody uterus
112
Painless vaginal bleeding and high fetal head suggest what diagnosis?
Placenta praevia
113
Risk factors for placental abruption
HTN
Pre-eclampsia
Diabetes
Tobacco
114
What does the venous glucose need to be for diagnosis of gestational diabetes?
2hr venous glucose >11
115
Complications of gestation diabetes
```
Polyhydramnios
Miscarriage
Shoulder dystocia
Infection
Cord prolapse
```
116
Complications of cholestasis in pregnancy
Foetal distress
Pre-term delivery
Intrauterine death
Intracranial fetal haemorrhage
117
Risk factors for multiple pregnancy
FH
Older age
Assisted conception
Obesity
118
Maternal complications of multiple pregnancy
Miscarriage
Gestational diabetes
Placental praevia
Anaemia
119
Fetal complications of multiple pregnancy
Pre-term labour
Intrauterine growth retardation
Malpresentation
Jaundice
120
Risk factors for pre-term labour
```
Smoking and Illicit drugs
Pre-eclampsia
Previous pre-term
Multiple pregnancy
Chorioamnionitis
Infection
Gynae surgery eg cervical incompetence
Polyamnionitis
Young maternal age
```
121
Risk factors for shoulder dystocia
```
Fetal weight >4.5kg
Previous big baby >4kg
Previous shoulder dystocia
Slow progress in 1st/2nd stage of labour
Post dates delivery
```
122
What should be given to women who might need an emergency C-section to reduce the need for gastric aspiration if they need a GA?
ranitidine and metoclopromide
123
What haematological tests should be checked in placental abruption? What results might indicate a DIC?
Check for DIC
- Raised INR
- Lowered platelets
- Positive D-dimer
124
Sensitising events include...
```
Placental abruption
Blood transfusion
CVS
Amniocentesis
Terminations
Miscarriage
ECV
Antepartum haemorrhage
Abdominal trauma
Surgical ectopic pregnancy removal
```
125
When should you NOT offer a digital examination?
Placenta praevia
| PROM/PPROM
126
What is the investigation for PROM or PPROM and what will you see?
Speculum examination: pooling of amniotic fluid
127
What cervical lengths might indicate PPROM/PROM if >30wks GA?
<15mm likely
| >15mm unlikely
128
When should fetal fibronectin not be used as a marker of PROM?
24-34wks (its dried so not detectable)
129
Risk factors for PPROM/PROM
```
Previous PROM/PPROM/PTL
UTI
Polyhydramnios
Multiple pregnancy
Smoking
Cervical incompetence
APH
Uterine abnormalities
Trauma
```
130
If maternal corticosteroids are given eg in pre-term labour etc then what else should be given if the mother is diabetic and why?
DKA can ensue so give with Insulin
131
What is the most common cause of preterm labour?
Infection (so always do Urine dip and MC&S)
132
What are the 3 types of preterm labour? (eg timing wise)
PTL: 32-37wks
Very PTL: 38-32wks
Extremely PTL: <28wks
133
What fetal conditions is indomethacin associated with?
PPH due to premature closure of DA
NEC
Neonatal renal dysfunction
134
What is a biomarker of PTL?
Foetal fibronectin - check cervicovaginal fluid
| Negative has high predictive value: if negative then unlikely to be in labour
135
What are the indications for IAP (intrapartum prophylaxis)?
Previous GBS infection in neonate
Preterm labour
Pyrexia during labour (>38degrees)
136
What contraceptive is absolutely contraindicated if breast feeding <6wks post-partum?
COCP
137
Causes of raised AFP during pregnancy?
NTD
Abdo wall defects eg omphalocele or gastroschistis
Multiple pregnancy
138
Causes of lowered AFP during pregnancy?
Downs syndrome
Edwards syndrome
Maternal DM
139
In which location is ectopic pregnancy most associated with rupture?
Isthmus
140
What advice should be given to women receiving medical management of ectopic pregnancy?
IM methotrexate
F/U with serial hCG: day 4 and 7, then once a week until -ve
- Avoid sex during treatment and conceiving for at least 3mths
- Avoid sunlight and alcohol
141
What are the different time points for splitting of the zygote and what type of twins do they produce?
Days 1-3 Dichorionic/diamniotic
Days 8-12 Monochorionic monoamniotic
After day 13 Conjoined twins
142
When is delivery indicated for monochorionic monoamniotic twins?
32-34wks
143
What does Lamba sign on a 12wk USS indicate?
Dichorionic pregnancy
144
Which anastomoses are more protective against the development of TTTS?
Arterioarterial
145
What staging is used for TTTS?
Quintero
146
T sign on fetal USS indicates
Monochorionic pregnancy
147
What are the degrees of perianal tear?
1 Mucosa no muscle
2 Perineal muscle
3 Anal sphincter (a <50% EAS, b >50% EAS, c IAS torn)
4 EAS + rectal mucosa
3+4 = OASIS
148
Management of eclampsia
1. A-E
2. IV MgSO4 (loading dose 4g over 5-15mins, then infusion of 1g/hr for 24hr after last seizure or until delivery)
3. If recurrent then repeat loading dose and get anaesthetists involved
4. Anti-HTNs: oral/IV labetalol, nifedipine, IV hydralazine
5. Expedite delivery
NB: Ca Gluconate = antidote to MgSO4
149
How does pregnancy increase the risk of VTE?
Hyperoestrogenic state
Altered blood viscosity
Obstruction to venous blood flow
150
What are the symptoms of post-thrombotic syndrome?
Chronic leg pain
Swelling
Ulceration
151
What factors are increased in pregnancy to produce the pro-coagulant state?
```
F7
F8
vWF
PAI-1
PAI-2
```
Also decreased protein S
152
What anti-coagulant protein is decreased in pregnancy?
Protein S
153
What is a blighted ovum?
Gestational sac is present but empty because foetus has not developed
154
What measurements are used to determine gestational age and at what time points?
CRL: up to 13wks 6days
HC: 14-20wks
155
Gestational age can no longer be accurately calculated by ultrasound after what time point?
20 weeks
156
What are some anomalies looked for at the anomaly scan and when does it take place?
18-20+6 wks
- Spina bifida
- Anencephaly
- Abdominal wall malformations eg omphalocele, gastroschisis
- Hydrocephalus
- Skeletal abnormalities eg achondroplasia
- Cleft lip/palate
- Congenital cardiac abnormalities
157
Which USS is best at detecting lower edge of placenta? Which condition may it be helpful in identifying?
TVUSS
| Placenta praevia
158
What is the normal passage of amniotic fluid in the foetus?
Foetus swallows amniotic fluid
Absorbs it in GI tract
Excretes urine into amniotic sac
159
What are the two indicators of amniotic fluid via USS?
1. Amniotic fluid index
| 2. Maximum vertical pool
160
What serial measurement should be taken from 16wks in women with a history of preterm birth or midtrimester loss?
Cervical length
161
What can cause foetal tachycardia?
Fetal or maternal infection
Acute fetal hypoxia
Fetal anaemia
Drugs (certain)
162
What factors affect baseline variability on CTG?
Foetal sleep states and activity
Hypoxia
Foetal infection
Drugs eg opioids
163
The velocity of blood flow in the middle cerebral artery is an indicator of...
Foetal anaemia - if anaemic then velocity increases
164
Indications for induction of labour
```
APH
IUGR
Maternal HTN
Post-maturity
Diabetes mellitus
```
165
Risk factors for shoulder dystocia
Excess maternal weight
Prolonged first or second stage of labour
Macrosomia
Post-maturity
166
Sudden infant death syndrome risk factors
```
Sleeping in the same bed as baby
Smoking
Prone sleeping
Hyperthermia and head covering
Prematurity
```
167
Investigations and management of Hirschsprungs
Full thickness rectal biopsy
| Anorectal pull through
168
What function tests may you check in molar pregnancy and what would be the results?
TFTs
- Low TSH
- High T4
as beta-hcg is so high and mimics TSH
169
Risk factors for ovarian torsion
Pregnancy
Ovarian mass
Ovarian hyperstimulation syndrome
Of reproductive age
170
Who should take folic acid 5mg OD?
Woman with child with previous NTD or partner has NTD or FHx
Diabetics
Women on anti-epileptic
Obese (Body mass >30)
HIV+ taking co-trimoxazole
Sickle cell anaemia or thalassemia trait
Coeliac disease
171
High risk groups for pre-eclampsia
Hypertensive disease during previous pregnancy
Chronic kidney disease
Autoimmune disease eg SLE/Anti-phospholipid syndrome
Diabetes (T1 or T2)
172
Associated factors for placental abruption
```
Previous abruption
Proteinuric HTN
Advancing maternal age
Cocaine use
Multiparity
Maternal trauma
```
173
Risk factors for shoulder dystocia
Macrosomia
High maternal BMI
Diabetes mellitus
Prolonged labour
174
Complications of placental abruption
```
Maternal:
Shock
DIC
Renal failure
PPH
```
Fetal:
IUGR
Hypoxia
Death
175
Features of congenital rubella syndrome
```
Chorioretinitis
Sensorineural deafness
Congenital cataracts
Congenital heart disease eg PDA
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Cerebral palsy
Microphthalmia
```
176
Risk factors for premature ovarian failure
FH
Chemotherapy/radiation
Autoimmune disease
