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part 2 > obstetrics: ANC, LW and PP > Flashcards

obstetrics: ANC, LW and PP Flashcards

1
Q

threshold for using HC for EDD

A

CRL >84mm

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2
Q

Nuchal translucency threshold

A

>6mm

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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)

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4
Q

Class I obesity

A

BMI 30-34.9

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5
Q

Class II obesity

A

BMI 35-39.9

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6
Q

Class III obesity

A

BMI >40 (increases M/M by 60%)

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7
Q

how long to wait after bariatric surgery prior to conception

A

12-18 months

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8
Q

% pregnancies affected by PIH

A

4-7%

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9
Q

% of pregnancies affected by PET

A

2-8%

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10
Q

incidence eclampsia

A

27/10 000 (approx 1/370)

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11
Q

mortality eclampsia

A

1/50

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12
Q

stillbirth eclampsia

A

22/1000 (approx 1/45)

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13
Q

high risk factors for aspirin

A
  • prev PET/PIH - CKD - Autoimmune conditions - DM - Chronic HTN
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14
Q

Moderate risk factors for aspirin (2+)

A
  • primip - age >40 - pregnancy interval ?10 - BMI >35 - FHx - multiple pregnancy
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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
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16
Q

antidote to MgSO4

A

10ml 10% calcium gluconate

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17
Q

HELLP incidence

A

15-20% of PET cases

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18
Q

HELLP associated with DIC in ___%

A

21% up to 50% will require blood products

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19
Q

HELLP diagnostic criteria

A

MAH LDH >600 Haptoglobin <25 PLT <100 AST >70

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20
Q

SGA: UA Doppler Normal - When to repeat USS?

A

Fortnightly: AC & LV; EFW UA Doppler (MCA after 32 weeks)

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21
Q

SGA: UA Doppler Normal - When to offer delivery?

A

at 37/40 with involvement of senior clinician

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22
Q

SGA: UA Doppler Normal - When to recommend delivery?

A

by 37/40 if MCA Doppler PI <5th centile

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23
Q

SGA: UA Doppler normal - when to consider delivery?

A

>34/40 if static growth over 3 weeks

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24
Q

SGA: PI or RI >2SDs, EDV present - when to repeat USS?

A

Weekly AC & LV; EFW Twice weekly UA Doppler

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25
Q

SGA: PI or RI >2SDs, EDV present - when to recommend delivery?

A

by 37/40

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26
Q

SGA: PI or RI >2SDs, EDV present - when to consider delivery?

A

>34/40 if static growth over 3 weeks

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27
Q

SGA: AREDV - when to repeat USS?

A

weekly AC & LV; EFW Daily UA Doppler, DV Doppler +/- cCTG if DV doppler unavailable

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28
Q

SGA: AREDV - when to recommend delivery?

A

<32/40 after steroids if abnormal DV doppler and/or cCTG STV <3ms

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29
Q

SGA: AREDV - fetal prerequisites for early delivery

A

>24/40 and EFW >500g

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30
Q

SGA: AREDV - when to consider delivery?

A

30-32/40 even when DV doppler is normal

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31
Q

definition of abnormal uterine artery doppler

A

PI >95th centile and/or notching

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32
Q

if severe SGA identified at 18-20 week scan :

A

offer referral for a detailed fetal anatomical survey and uterine artery doppler by a fetal maternal specialist;

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33
Q

SGA: karyotyping should be offered for

A

severely SGA foetuses (<3 centile) with structural abnormalities; and those detected <23/40 *triploidy most common*

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34
Q

timing of birth for DCDA twins

A

37+0 to 37+6

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35
Q

timing of birth for MCDA twins

A

36+0 to 36+6

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36
Q

timing of birth for MCMA twins (uncomplicated)

A

32+0 to 33+6

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37
Q

timing of birth for triplets (uncomplicated)

A

35 to 35+6

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38
Q

multiple pregnancy: if decline birth at recommended timing:

A
  • ANC wkly with obstetrician - AFI + doppler weekly - Growth USS 2 wkly
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39
Q

MC twins - TTTS - timing of birth

A

34-36+6 if no other indications

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40
Q

MC twins - type 1 SGR - timing of birth

A

34-36/40

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41
Q

MC twins - Type 2-3 SGR - timing of birth

A

By 32/40 unless growth velocity significantly abnormal or worsening dopplers

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42
Q

MC Twins - after twin 1 demise - incidence of 2nd IUFD

A

15%

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43
Q

MC Twins - after twin 1 demise - incidence of neurological abnormality in 2nd twin

A

26%

44
Q

GBS: if benpen mild allergy, what alternative?

A

cefuroxime 1.5g then 750mg q8h

45
Q

GBS: if benpen severe allergy, what alternative?

A

vancomycin 1g q12h

46
Q

what % of women with GBS+ on swab 35-57/40 will be negative at delivery?

A

17-25%

47
Q

what % of women with GBS- swab at 35-37/40 will be positive at delivery?

A

5-7%

48
Q

GBS PROM at term - risk of serious infection

A

1%

49
Q

fetal circulating blood volume

A

80-100ml/kg

50
Q

incidence APH

A

3-5% of pregnancies

51
Q

blood loss 1000 -1500 associated with what changes in obs

A

tachycardia, tachypnea, slight recordable fall in SBP

52
Q

blood loss >1500ml associated with what changes in obs

A

SBP <80 worsening tachycardia & tachypnea altered mental state

53
Q

timing of delivery for uncomplicated placenta previa

A

36-37/40

54
Q

timing of delivery for placenta previa with history of PVB

A

34-36+6/40

55
Q

timing of delivery for placenta accreta

A

35-36+6/40 (recommend elective admission from 34/40)

56
Q

timing of delivery for vasa previa if confirmed prior to labour

A

34-36/40

57
Q

inducing labour for VBAC associated with ____x risk of C/S

A

1.5x

58
Q

inducing labour for VBAC associated with ____x risk of uterine rupture

A

2-3x

59
Q

breech complicates ___% term deliveries

A

3-4%

60
Q

spontaneous version of breech in nulliparous women after 36/40

A

8%

61
Q

unsuccessful ECV: what proportion will spontaneously turn to ceph

A

3-7%

62
Q

successful ECV: what proportion will turn back to breech

A

3%

63
Q

recurrence of breech next pregnancy

A

9.9%

64
Q

proportion of babies in breech position at 28/40

A

20%

65
Q

vulval and vulvovaginal hematomas arise from damage to ____

A

branches of pudendal artery

66
Q

paravaginal hematomas arise from damage to _____

A

uterine artery

67
Q

supralevator/supravaginal hematomas arise from damage to _____

A

uterine artery in broad ligament

68
Q

OASIS incidence overall

A

2.9%

69
Q

OASIS incidence primip

A

6.1%

70
Q

OASIS incidence multip

A

1.7%

71
Q

OASIS incidence forceps with epis

A

6%

72
Q

OASIS incidence in shoulder dystocia

A

3.8%

73
Q

OASIS incidence forceps without epis

A

22%

74
Q

OASIS repair anorectal mucosa

A

continuous or interrupted 3-0 polyglactin (modern braided)

75
Q

OASIS repair IAS

A

interrupted to mattress 3-0 PDS or 2-0 polyglactin

76
Q

OASIS repair EAS

A

overlapping or end-to-end 3-0 PDS or 2-0 polyglactin

77
Q

OASIS risk of recurrence

A

5-7%

78
Q

OASIS worsening of symptoms after 2nd NVD

A

17%

79
Q

shoulder dystocia recurrence

A

1-25% (10x increase)

80
Q

shoulder dystocia in DM

A

2-4x increased risk

81
Q

shoulder dystocia risk of BPI

A

2.3-16%

82
Q

shoulder dystocia humeral fractures with delivery of posterior arm

A

2-12%

83
Q

minimal fetal fraction for cffDNA

A

4%

84
Q

failed cell-free DNA tests

A

1-5% higher failure rates in pregnancies with Edwards and Pataus. on repeat sampling, 60% obtain results

85
Q

main determinants of low fetal fraction cffDNA

A

maternal obesity small placental mass

86
Q

Cervical length <25mm - risk of PTL

A

25% under 28 weeks

87
Q

Cervical length <20mm - risk of PTL

A

42% under 32 weeks 62% under 34 weeks

88
Q

most likely surgical complication in repeat sections

A

blood transfusion

89
Q

PROM: risk of infection

A

1% compared to 0.5% for women with intact membranes

90
Q

PROM: what % women go into labour within 24h

A

60%

91
Q

PROM: until IOL started or if expectant management beyond 24h

A
  • 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
Q

PROM: if labour not started 24h later

A

IOL should stay in hospital for at least 12h after birth

93
Q

average duration of first stage

A

primip: 8-18h multip: 5-12h

94
Q

delay in second stage: primip

A

suspect after 1h active Diagnose after 2h should have birth within 3h of active

95
Q

delay in second stage: multip

A

suspect after 30 minutes active diagnose after 1h active should have birth within 2h of active

96
Q

able for episiotomy

A

45-60 degrees right mediolateral

97
Q

delay in second stage: how often should obstetric review occur

A

every 15-30 minutes after initial assessment

98
Q

prolonged 3rd stage

A

30 minutes active, or 60 minutes physiological

99
Q

active management of 3rd stage “care package”

A

uterotonic drug deferred clamping CCT

100
Q

third stage: N/V in active vs. physiological

A

100/1000 vs 50/1000

101
Q

third stage: PPH>1L in active vs physiological

A

13/1000 vs 29/1000

102
Q

third stage: need for blood transfusion active vs. physiological

A

14/1000 vs 40/1000

103
Q

active management choice of drug for low risk care

A

syntocinon 10u IM

104
Q

active management for c/s

A

syntocinon 5u IV

105
Q

active management for NVD - absence of hypertension but increased risk of minor PPH

A

syntometrine

106
Q

mec obs

A

1h, 2h then 2h until 12h

107
Q

PROM neonatal obs

A

1h, 2h, 6h, 12h

part 2 (21 decks)

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