Obstetrics Flashcards
When do the following take place:
- Dating scan
- Screening results
- Anomaly scan
- 10-14 weeks
- 16 weeks
- 18-20 weeks
What is included in the following:
- Combined test - what results increase risk of DS?
- Quadruple test
- Blood screening test? (9)
- PAPP-A (low), hCG (high) and USS (thick nuchal)
- aFP, unconjugated oestriol, hCG and inhibin-A
- HIV, hepatitis B and C, syphillis, sickle cell, thalassaemia, blood group, Rh status, platelets
When can the following be performed?
- Amniocentesis
- CVS
- 15 weeks
2. 11-14 weeks
What factors constitute a high risk pregnancy? (5)
Age - >40, <20 Past medical history Past obstetric history (any previous problems in pregnancy) Previous gynae surgery IVF treatment
When is a prophylactic dose of anti-D given to Rheus negative mothers?
28 weeks
What are the definitions for iron deficiency in pregnancy?
- 1st trimester
- 2nd and 3rd trimester
- Postpartum
- <110
- <105
- <100
What are signs of impending eclampsia? (4)
Facial oedema, confusion, hyperreflexia or clonus
What are the high risk features for developing pre-eclampsia? (5)
What are the moderate risk features for developing pre-eclampsia? (6)
What is the management for these women?
Previous pregnancy affected, pre-existing hypertension, CKD, diabetes, autoimmune e.g. SLE, APS
> 40, BMI >35, more than 10 years since last pregnancy or first pregnancy, family history, twins or more
75-150mg aspirin OD from 12 weeks
What are the complications of pre-eclampsia?
- Mother (6)
- Foetus (2)
- Eclampsia, HELLP syndrome, DIC, AKI, pulmonary oedema, cerebral haemorrhage
- Foetal growth restriction, placental abruption
What are some major risk factors for IUGR?
What should you do if someone has 1 or more major risk factors?
What should you do if someone has more than 3 minor risk factors?
> 40, smoking >10 per day, renal impairment, chronic hypertension, APS, diabetes with vascular disease, previous stillbirth
Serial scans and umbilical artery Doppler at 26-28 weeks
Umbilical artery Doppler at same time as anomaly scan; if abnormal, serial scans from 28 weeks
What are the complications of IUGR?
- Short term
- Long term
- Prematurity, Stillbirth, Hypoglycaemia, Hypothermia, Low Apgar’s
- Failure to thrive, short stature, cerebral palsy, learning difficulties
What investigations should you conduct if someone presents with reduce foetal movements? (4)
When should the woman be re-scanned? (2)
Foetal heartbeat using Doppler
CTG
USS - liquor volume, umbilical artery, foetal growth
Plot height and weight on customised GROW chart
Height and weight after 2 weeks
Umbilical artery and liquor after 1 week
What are the risks to the baby if diabetes is uncontrolled before becoming pregnant?
Stillbirth, miscarriage, congenital malformation, neonatal death
Large for gestational age - birth trauma, induction of labour or C section
Neonatal hypoglycaemia
What should be checked in those with diabetes before becoming pregnancy?
Eyes and kidneys
Which groups of patients should have 5 mg folic acid? (8)
Diabetics, thalassaemia, coeliac
Taking AEDs
Either partner has a NTD, previous pregnancy affected, family history of NTD
BMI >30
Which women should have an OGTT? (6)
BMI >30 Ethnicity Family history of diabetes Previous large baby Previous gestational diabetes Dipstick revealed glycosuria +2 or +1 on two occasions
What are the complications of gestational diabetes? (6)
Large for gestational age Pre-eclampsia Prematurity Polyhydraminos Jaundice after birth Stillbirth
What are the causes of bleeding in early pregnancy? (5)
Miscarriage Ectopic Molar pregnancy Lower gynae pathology (rare) Implantation bleed
What are the possible causes for pregnancy of unknown location?
How would you investigate PUL?
Early gestation, ectopic, complete miscarriage
Serum hCG, repeat in 48h; should rise by >66%; if so, repeat USS in 1 week
If doesn’t rise, suggests miscarriage
How long does expectant management of a miscarriage take?
What should they do at the end of this period?
What advice should you give? (2)
When is expectant management not appropriate? (3)
Up to 3 weeks of bleeding, also takes this long for hCG to disappear from blood
Take a home pregnancy test or have another scan
Wear pads; if experience heavy bleeding e.g. 3 pads per hour, clots as big as hand, must come back in
Take OTC painkillers for cramping
Increased risk of haemorrhage, previous traumatic experience, infection
What medication is used in the medical management of miscarriage?
What are the side effects of this medication?
What should you prescribe alongside this medication?
Misoprostol
Nausea, diarrhoea, flu-like symptoms, painful cramping
Antiemetics and pain relief
When would surgical management of miscarriage be appropriate? (4)
Excessive bleeding, molar pregnancy, haemodynamic instability, preference
Can be done under LA or GA
When are expectant and medical management of ectopic pregnancy not suitable?
Unable to return for follow up Significant pain Foetal heartbeat Adnexal mass >35mm hCG >5000
Which blood tests are required before going ahead with medical management of ectopic pregnancy?
LFTs and U&Es
Which antiemetic is used first line in hyperemesis gravidarum?
Cyclizine
What exam should NOT be done if bleeding in the 3rd trimester?
Digital vaginal exam - need to exclude placenta praevia first
What is the management for bleeding in 3rd trimester? (4)
Admit until term if placenta praevia
If mild, take bloods and give IV fluids
Measure obs regularly
Anti-D if required
NB, if severe bleeding manage as per major hamorrhage
What are the causes of postpartum haemorrhage?
Tone - uterine atony
Trauma e.g. instrumental delivery
Tissue - retained placenta, abnormal placenta site
Thrombin - coagulation disorders
What is the general management for PPH?
- Mechanical
- Medical
- Palpate uterus, catheterise
2. Oxytocin, ergometrine, carboprost, misoprostol, tranexamic acid
When can secondary post partum haemorrhage occur?
What is the management? (2)
Between 24h and 6 weeks after birth
Antibiotics, examination under anaesthesia
What increases risk of PPH? (5)
Induction of labour, prolonged 1st, 2nd or 3rd stage of labour, forceps delivery, C-section
What is the normal time to dilate during the first stage of labour?
What counts as failure to progress? (2)
What is the management? (2)
0.5cm per hour for primip, 1cm per hour for multip
<2cm dilatation in 4 hours
Slowing of progression
Transfer to obstetric led unit
Amniotomy +/- oxytocin
What is the normal progression in the second stage of labour?
Why might someone not progress? (3)
within 2h if primip, within 1h if multip
Power - inefficiency uterine activitiy
Passenger - malposition, malpresentation
Passage - non gynaecoid pelvis
What is active management in the third stage of labour?
What constitutes delay in the third stage of labour?
Active - oxytocin and controlled cord traction
More than 30 minutes for active, more than 60 minutes for physiological
Which medication is used in the pharmacological induction of labour?
Vaginal prostaglandin
What are the indications for instrumental delivery? (4)
What criteria must be met for instrumental delivery?
What are the risks to baby with instrumental delivery?
What are the risks to mother with instrumental delivery? (4)
Foetal compromise, failure to progress, maternal exhaustion, physically cannot push e.g. paraplegic
Fully dilated cervix, OA position, Ruptured membranes, Cephalic presentation, Engaged, Pain relief, Sphincter (catheterised)
Forceps - facial nerve injury
Ventouse - cephalohaematoma
Nerve injury, incontinence of bladder and bowel, PPH, perineal tears
What are the indications for an elective C-section? (6)
Placenta or vasa praevia Previous C-section Breech presentation HIV or herpes simplex Multiple pregnancy Cervical cancer
What are the 4 outcomes after interpreting a CTG?
Normal
Suspicious: a single non-reassuring feature
Pathological: two non-reassuring features or a single abnormal feature
Need for urgent intervention: acute bradycardia or prolonged deceleration of more than 3 minutes
