obstetrics: ANC, LW and PP Flashcards
1
Q
threshold for using HC for EDD
A
CRL >84mm
2
Q
Nuchal translucency threshold
A
>6mm
3
Q
obesity increases risks of which maternal complications
A
PPHx2 GDM x3.6 VTE x9 Hypertensive disorders SB x2 Fetal macrosomia C/S Death (MBRRACE2015 - 30% of women who died were obese)
4
Q
Class I obesity
A
BMI 30-34.9
5
Q
Class II obesity
A
BMI 35-39.9
6
Q
Class III obesity
A
BMI >40 (increases M/M by 60%)
7
Q
how long to wait after bariatric surgery prior to conception
A
12-18 months
8
Q
% pregnancies affected by PIH
A
4-7%
9
Q
% of pregnancies affected by PET
A
2-8%
10
Q
incidence eclampsia
A
27/10 000 (approx 1/370)
11
Q
mortality eclampsia
A
1/50
12
Q
stillbirth eclampsia
A
22/1000 (approx 1/45)
13
Q
high risk factors for aspirin
A
- prev PET/PIH - CKD - Autoimmune conditions - DM - Chronic HTN
14
Q
Moderate risk factors for aspirin (2+)
A
- primip - age >40 - pregnancy interval ?10 - BMI >35 - FHx - multiple pregnancy
15
Q
indications for delivery <37/40 in PET
A
- uncontrolled BP x3 medications - Sat <90% - Deteriorating bloods - Neuro features - Abruption - abnormal doppler or CTG
16
Q
antidote to MgSO4
A
10ml 10% calcium gluconate
17
Q
HELLP incidence
A
15-20% of PET cases
18
Q
HELLP associated with DIC in ___%
A
21% up to 50% will require blood products
19
Q
HELLP diagnostic criteria
A
MAH LDH >600 Haptoglobin <25 PLT <100 AST >70
20
Q
SGA: UA Doppler Normal - When to repeat USS?
A
Fortnightly: AC & LV; EFW UA Doppler (MCA after 32 weeks)
21
Q
SGA: UA Doppler Normal - When to offer delivery?
A
at 37/40 with involvement of senior clinician
22
Q
SGA: UA Doppler Normal - When to recommend delivery?
A
by 37/40 if MCA Doppler PI <5th centile
23
Q
SGA: UA Doppler normal - when to consider delivery?
A
>34/40 if static growth over 3 weeks
24
Q
SGA: PI or RI >2SDs, EDV present - when to repeat USS?
A
Weekly AC & LV; EFW Twice weekly UA Doppler
25
SGA: PI or RI \>2SDs, EDV present - when to recommend delivery?
by 37/40
26
SGA: PI or RI \>2SDs, EDV present - when to consider delivery?
\>34/40 if static growth over 3 weeks
27
SGA: AREDV - when to repeat USS?
weekly AC & LV; EFW Daily UA Doppler, DV Doppler +/- cCTG if DV doppler unavailable
28
SGA: AREDV - when to recommend delivery?
\<32/40 after steroids if abnormal DV doppler and/or cCTG STV \<3ms
29
SGA: AREDV - fetal prerequisites for early delivery
\>24/40 and EFW \>500g
30
SGA: AREDV - when to consider delivery?
30-32/40 even when DV doppler is normal
31
definition of abnormal uterine artery doppler
PI \>95th centile and/or notching
32
if severe SGA identified at 18-20 week scan :
offer referral for a detailed fetal anatomical survey and uterine artery doppler by a fetal maternal specialist;
33
SGA: karyotyping should be offered for
severely SGA foetuses (\<3 centile) with structural abnormalities; and those detected \<23/40 \*triploidy most common\*
34
timing of birth for DCDA twins
37+0 to 37+6
35
timing of birth for MCDA twins
36+0 to 36+6
36
timing of birth for MCMA twins (uncomplicated)
32+0 to 33+6
37
timing of birth for triplets (uncomplicated)
35 to 35+6
38
multiple pregnancy: if decline birth at recommended timing:
- ANC wkly with obstetrician - AFI + doppler weekly - Growth USS 2 wkly
39
MC twins - TTTS - timing of birth
34-36+6 if no other indications
40
MC twins - type 1 SGR - timing of birth
34-36/40
41
MC twins - Type 2-3 SGR - timing of birth
By 32/40 unless growth velocity significantly abnormal or worsening dopplers
42
MC Twins - after twin 1 demise - incidence of 2nd IUFD
15%
43
MC Twins - after twin 1 demise - incidence of neurological abnormality in 2nd twin
26%
44
GBS: if benpen mild allergy, what alternative?
cefuroxime 1.5g then 750mg q8h
45
GBS: if benpen severe allergy, what alternative?
vancomycin 1g q12h
46
what % of women with GBS+ on swab 35-57/40 will be negative at delivery?
17-25%
47
what % of women with GBS- swab at 35-37/40 will be positive at delivery?
5-7%
48
GBS PROM at term - risk of serious infection
1%
49
fetal circulating blood volume
80-100ml/kg
50
incidence APH
3-5% of pregnancies
51
blood loss 1000 -1500 associated with what changes in obs
tachycardia, tachypnea, slight recordable fall in SBP
52
blood loss \>1500ml associated with what changes in obs
SBP \<80 worsening tachycardia & tachypnea altered mental state
53
timing of delivery for uncomplicated placenta previa
36-37/40
54
timing of delivery for placenta previa with history of PVB
34-36+6/40
55
timing of delivery for placenta accreta
35-36+6/40 (recommend elective admission from 34/40)
56
timing of delivery for vasa previa if confirmed prior to labour
34-36/40
57
inducing labour for VBAC associated with \_\_\_\_x risk of C/S
1.5x
58
inducing labour for VBAC associated with \_\_\_\_x risk of uterine rupture
2-3x
59
breech complicates \_\_\_% term deliveries
3-4%
60
spontaneous version of breech in nulliparous women after 36/40
8%
61
unsuccessful ECV: what proportion will spontaneously turn to ceph
3-7%
62
successful ECV: what proportion will turn back to breech
3%
63
recurrence of breech next pregnancy
9.9%
64
proportion of babies in breech position at 28/40
20%
65
vulval and vulvovaginal hematomas arise from damage to \_\_\_\_
branches of pudendal artery
66
paravaginal hematomas arise from damage to \_\_\_\_\_
uterine artery
67
supralevator/supravaginal hematomas arise from damage to \_\_\_\_\_
uterine artery in broad ligament
68
OASIS incidence overall
2.9%
69
OASIS incidence primip
6.1%
70
OASIS incidence multip
1.7%
71
OASIS incidence forceps with epis
6%
72
OASIS incidence in shoulder dystocia
3.8%
73
OASIS incidence forceps without epis
22%
74
OASIS repair anorectal mucosa
continuous or interrupted 3-0 polyglactin (modern braided)
75
OASIS repair IAS
interrupted to mattress 3-0 PDS or 2-0 polyglactin
76
OASIS repair EAS
overlapping or end-to-end 3-0 PDS or 2-0 polyglactin
77
OASIS risk of recurrence
5-7%
78
OASIS worsening of symptoms after 2nd NVD
17%
79
shoulder dystocia recurrence
1-25% (10x increase)
80
shoulder dystocia in DM
2-4x increased risk
81
shoulder dystocia risk of BPI
2.3-16%
82
shoulder dystocia humeral fractures with delivery of posterior arm
2-12%
83
minimal fetal fraction for cffDNA
4%
84
failed cell-free DNA tests
1-5% higher failure rates in pregnancies with Edwards and Pataus. on repeat sampling, 60% obtain results
85
main determinants of low fetal fraction cffDNA
maternal obesity small placental mass
86
Cervical length \<25mm - risk of PTL
25% under 28 weeks
87
Cervical length \<20mm - risk of PTL
42% under 32 weeks 62% under 34 weeks
88
most likely surgical complication in repeat sections
blood transfusion
89
PROM: risk of infection
1% compared to 0.5% for women with intact membranes
90
PROM: what % women go into labour within 24h
60%
91
PROM: until IOL started or if expectant management beyond 24h
- record temp every 4h during day - do not do CRP or LVS - avoid sex - assess fetal movement and heart rate at initial contact and every 24h
92
PROM: if labour not started 24h later
IOL should stay in hospital for at least 12h after birth
93
average duration of first stage
primip: 8-18h multip: 5-12h
94
delay in second stage: primip
suspect after 1h active Diagnose after 2h should have birth within 3h of active
95
delay in second stage: multip
suspect after 30 minutes active diagnose after 1h active should have birth within 2h of active
96
able for episiotomy
45-60 degrees right mediolateral
97
delay in second stage: how often should obstetric review occur
every 15-30 minutes after initial assessment
98
prolonged 3rd stage
30 minutes active, or 60 minutes physiological
99
active management of 3rd stage "care package"
uterotonic drug deferred clamping CCT
100
third stage: N/V in active vs. physiological
100/1000 vs 50/1000
101
third stage: PPH\>1L in active vs physiological
13/1000 vs 29/1000
102
third stage: need for blood transfusion active vs. physiological
14/1000 vs 40/1000
103
active management choice of drug for low risk care
syntocinon 10u IM
104
active management for c/s
syntocinon 5u IV
105
active management for NVD - absence of hypertension but increased risk of minor PPH
syntometrine
106
mec obs
1h, 2h then 2h until 12h
107
PROM neonatal obs
1h, 2h, 6h, 12h
