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Finals > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

When do the following take place:

  1. Dating scan
  2. Screening results
  3. Anomaly scan
A
  1. 10-14 weeks
  2. 16 weeks
  3. 18-20 weeks
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2
Q

What is included in the following:

  1. Combined test - what results increase risk of DS?
  2. Quadruple test
  3. Blood screening test? (9)
A
  1. PAPP-A (low), hCG (high) and USS (thick nuchal)
  2. aFP, unconjugated oestriol, hCG and inhibin-A
  3. HIV, hepatitis B and C, syphillis, sickle cell, thalassaemia, blood group, Rh status, platelets
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3
Q

When can the following be performed?

  1. Amniocentesis
  2. CVS
A
  1. 15 weeks

2. 11-14 weeks

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4
Q

What factors constitute a high risk pregnancy? (5)

A 
Age - >40, <20
Past medical history
Past obstetric history (any previous problems in pregnancy)
Previous gynae surgery 
IVF treatment
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5
Q

When is a prophylactic dose of anti-D given to Rheus negative mothers?

A

28 weeks

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6
Q

What are the definitions for iron deficiency in pregnancy?

  1. 1st trimester
  2. 2nd and 3rd trimester
  3. Postpartum
A
  1. <110
  2. <105
  3. <100
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7
Q

What are signs of impending eclampsia? (4)

A

Facial oedema, confusion, hyperreflexia or clonus

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8
Q

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?

A

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

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9
Q

What are the complications of pre-eclampsia?

  1. Mother (6)
  2. Foetus (2)
A
  1. Eclampsia, HELLP syndrome, DIC, AKI, pulmonary oedema, cerebral haemorrhage
  2. Foetal growth restriction, placental abruption
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10
Q

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?

A

> 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

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11
Q

What are the complications of IUGR?

  1. Short term
  2. Long term
A
  1. Prematurity, Stillbirth, Hypoglycaemia, Hypothermia, Low Apgar’s
  2. Failure to thrive, short stature, cerebral palsy, learning difficulties
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12
Q

What investigations should you conduct if someone presents with reduce foetal movements? (4)

When should the woman be re-scanned? (2)

A

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

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13
Q

What are the risks to the baby if diabetes is uncontrolled before becoming pregnant?

A

Stillbirth, miscarriage, congenital malformation, neonatal death
Large for gestational age - birth trauma, induction of labour or C section
Neonatal hypoglycaemia

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14
Q

What should be checked in those with diabetes before becoming pregnancy?

A

Eyes and kidneys

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15
Q

Which groups of patients should have 5 mg folic acid? (8)

A

Diabetics, thalassaemia, coeliac
Taking AEDs
Either partner has a NTD, previous pregnancy affected, family history of NTD
BMI >30

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16
Q

Which women should have an OGTT? (6)

A 
BMI >30
Ethnicity 
Family history of diabetes
Previous large baby
Previous gestational diabetes
Dipstick revealed glycosuria +2 or +1 on two occasions
17
Q

What are the complications of gestational diabetes? (6)

A 
Large for gestational age
Pre-eclampsia
Prematurity
Polyhydraminos
Jaundice after birth 
Stillbirth
18
Q

What are the causes of bleeding in early pregnancy? (5)

A 
Miscarriage
Ectopic
Molar pregnancy 
Lower gynae pathology (rare)
Implantation bleed
19
Q

What are the possible causes for pregnancy of unknown location?

How would you investigate PUL?

A

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

20
Q

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)

A

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

21
Q

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?

A

Misoprostol
Nausea, diarrhoea, flu-like symptoms, painful cramping
Antiemetics and pain relief

22
Q

When would surgical management of miscarriage be appropriate? (4)

A

Excessive bleeding, molar pregnancy, haemodynamic instability, preference
Can be done under LA or GA

23
Q

When are expectant and medical management of ectopic pregnancy not suitable?

A 
Unable to return for follow up
Significant pain
Foetal heartbeat
Adnexal mass >35mm
hCG >5000
24
Q

Which blood tests are required before going ahead with medical management of ectopic pregnancy?

A

LFTs and U&Es

25
Q

Which antiemetic is used first line in hyperemesis gravidarum?

A

Cyclizine

26
Q

What exam should NOT be done if bleeding in the 3rd trimester?

A

Digital vaginal exam - need to exclude placenta praevia first

27
Q

What is the management for bleeding in 3rd trimester? (4)

A

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

28
Q

What are the causes of postpartum haemorrhage?

A

Tone - uterine atony
Trauma e.g. instrumental delivery
Tissue - retained placenta, abnormal placenta site
Thrombin - coagulation disorders

29
Q

What is the general management for PPH?

  1. Mechanical
  2. Medical
A
  1. Palpate uterus, catheterise

2. Oxytocin, ergometrine, carboprost, misoprostol, tranexamic acid

30
Q

When can secondary post partum haemorrhage occur?

What is the management? (2)

A

Between 24h and 6 weeks after birth

Antibiotics, examination under anaesthesia

31
Q

What increases risk of PPH? (5)

A

Induction of labour, prolonged 1st, 2nd or 3rd stage of labour, forceps delivery, C-section

32
Q

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)

A

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

33
Q

What is the normal progression in the second stage of labour?

Why might someone not progress? (3)

A

within 2h if primip, within 1h if multip

Power - inefficiency uterine activitiy
Passenger - malposition, malpresentation
Passage - non gynaecoid pelvis

34
Q

What is active management in the third stage of labour?

What constitutes delay in the third stage of labour?

A

Active - oxytocin and controlled cord traction

More than 30 minutes for active, more than 60 minutes for physiological

35
Q

Which medication is used in the pharmacological induction of labour?

A

Vaginal prostaglandin

36
Q

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)

A

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

37
Q

What are the indications for an elective C-section? (6)

A 
Placenta or vasa praevia
Previous C-section 
Breech presentation
HIV or herpes simplex
Multiple pregnancy
Cervical cancer
38
Q

What are the 4 outcomes after interpreting a CTG?

A

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

Finals (23 decks)

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