Obstetrics brief Flashcards
1
Q
Describe the screening test for diabetes mellitus for the general population at the age of 40.
A
Fasting blood sugar (FBS) test.
2
Q
What is the recommended screening test for Gestational Diabetes Mellitus (GDM) between 24-28 weeks of pregnancy?
A
75g Oral Glucose Tolerance Test (OGTT).
3
Q
What are the indications for performing FBS in the first antenatal visit for a pregnant woman?
A
BMI >30 kg/m2, family history of diabetes, previous history of Gestational Diabetes Mellitus (GDM).
4
Q
How is Gestational Diabetes Mellitus (GDM) initially managed?
A
First line: diet and exercise. Second line: insulin.
5
Q
What is the recommended follow-up for a female with a history of Gestational Diabetes Mellitus (GDM) after delivery?
A
Fasting blood sugar (FBS) every 3 years.
6
Q
Define the most common fetal complication associated with GDM.
A
Cardiac defects.
7
Q
What is the most unique fetal complication of Gestational Diabetes Mellitus (GDM)?
A
Sacral agenesis.
8
Q
What is the drug of choice for treating Gestational Hypertension during pregnancy?
A
Methyldopa.
9
Q
Describe the diagnosis of severe pre-eclampsia.
A
Preeclampsia (hypertension, proteinuria) with any of the following: persistent headache, visual disturbances, epigastric or right upper quadrant pain, vaginal bleeding, hyperreflexia.
10
Q
How is severe pre-eclampsia managed?
A
First: control blood pressure. Second: magnesium sulfate. Third: delivery.
11
Q
What are the medications used to control blood pressure in severe pre-eclampsia?
A
Labetalol, hydralazine, nifedipine.
12
Q
What is the diagnosis when a pregnant woman presents with Preeclampsia and Hemolysis, Elevated Liver enzymes, Low Platelets (HELLP) syndrome?
A
HELLP syndrome.
13
Q
What is the treatment for HELLP syndrome?
A
Delivery.
14
Q
How is eclampsia managed?
A
ABC (Airway, Breathing, Circulation) management, diazepam, then similar to severe pre-eclampsia management.
15
Q
What is the first sign of magnesium sulfate toxicity?
A
Depressed deep tendon reflexes (DTR).
16
Q
How is magnesium sulfate toxicity treated?
A
Calcium gluconate.
17
Q
What is the only cure for severe pre-eclampsia?
A
Delivery.
18
Q
What is the initial or next step when a woman presents with amenorrhea for 2 weeks?
A
Pregnancy test.
19
Q
What is the next step if a woman with amenorrhea for 2 weeks also has abdominal pain and vaginal bleeding?
A
Pregnancy test.
20
Q
If a urine pregnancy test is negative but suspicion, what is the next step?
A
Blood Beta-Human Chorionic Gonadotropin (B-HCG) test.
If a urine pregnancy test is negative and pregnancy is still suspected due to missed periods or symptoms, the next step according to RACGP guidelines is to:
- Repeat the Test: If the test was done very early, repeat the urine pregnancy test in one week.
- Blood Test: Perform a quantitative serum beta-hCG test to check for pregnancy more accurately.
- Ultrasound: If the blood test is inconclusive and periods remain absent, consider a pelvic ultrasound to look for other causes.
- Clinical Evaluation: Assess for other potential causes of missed periods, such as hormonal imbalances, thyroid issues, or stress.
For more detailed information, refer to the RACGP guidelines.
21
Q
What is the management if Beta-HCG is negative?
A
No pregnancy.
22
Q
What is the next step if Beta-HCG is positive?
A
Transvaginal ultrasound to differentiate between normal and ectopic pregnancy.
23
Q
If no sac is seen on transvaginal ultrasound, what is the next step?
A
Check Beta-HCG levels for doubling.
24
Q
What does doubling of Beta-HCG levels indicate?
A
Normal pregnancy.
25
What does the absence of doubling of Beta-HCG levels indicate?
Ectopic pregnancy.
26
What is the most common cause of ectopic pregnancy?
Pelvic Inflammatory Disease (Chlamydia infection).
27
What is the most common risk factor for ectopic pregnancy?
Previous ectopic pregnancy.
Risk factors for ectopic pregnancy
According to a meta-analysis, previous ectopic pregnancy, previous tubal surgery, documented tubal pathology, and in utero diethylstilbestrol exposure were found to be associated strongly with the occurrence of ectopic pregnancy.
https://www.racgp.org.au › ...PDF
Ectopic pregnancy - RACGP
28
Where is the most common site of ectopic pregnancy?
Ampulla of the fallopian tube.
29
How is a stable, non-ruptured ectopic pregnancy managed?
Laparoscopy.
30
How is an unstable or ruptured ectopic pregnancy managed?
Methotrexate
Management options for tubal ectopic pregnancy include surgery (salpingectomy or salpingostomy), medical management with methotrexate, and possibly expectant management in a limited population of carefully selected cases, although no high-level evidence exists to recommend this approach.
https://www.racgp.org.au › ...PDF
Early pregnancy bleeding - RACGP
31
What is the initial step when a pregnant woman presents with vaginal bleeding and placental abnormalities?
Ultrasound, but always remember ABC (Airway, Breathing, Circulation) comes first in emergencies.
32
What is the most common risk factor for placental abruption?
Hypertension.
33
What is the most common risk factor for placenta previa?
Previous Cesarean section.
34
How does bleeding in placental abruption compare to bleeding in placenta previa?
Placental abruption is painful, while placenta previa is painless.
35
What is the most important sign associated with placental abruption?
Uterine tenderness.
36
What is the main investigation for placenta previa?
Ultrasound.
37
What is the main investigation for placental separation?
Ultrasound.
38
Which drug is known to cause placental infarction?
Cocaine.
39
What is the main complication associated with placental separation?
Disseminated Intravascular Coagulation (DIC).
40
What is the diagnosis when fetal vessels cross the internal os during labor?
Vasa previa.
41
Describe the management steps for umbilical cord prolapse in pregnancy.
1st step: assess cord pulsation; 2nd step: put the patient in knee-chest position; 3rd step: consider cesarean section.
42
What is the recommended treatment for asymptomatic bacteriuria in pregnant females?
Nitrofurantoin, amoxicillin-clavulanate, cephalexin. Nitrofurantoin is the drug of choice if all three options are available.
43
Define the key features of vesicular mole.
Vesicles with bloody vaginal discharge, snowstorm appearance.
44
How is pyelonephritis in pregnancy treated?
Hospitalization and intravenous antibiotics.
45
Describe the management of shoulder dystocia during delivery.
The first step is leg elevation (McRoberts maneuver).
46
What is the most important diagnostic marker for gestational trophoblastic disease?
Beta-hCG.
47
Do pregnant females with asymptomatic gallbladder stones require cholecystectomy? Why?
Yes, due to the increased risk of cholestasis of pregnancy.
48
Define the most common risk factor for vesicular mole.
Extremes of age.
Better Health Channel
https://www.betterhealth.vic.gov.au › healthyliving › m...
The cause of molar pregnancy is unknown, but risk factors include maternal age of less than 20 years or more than 40 years. If promptly treated, molar ..
49
How is asymptomatic bacteriuria managed in individuals other than pregnant women and those with vesicoureteral reflux?
No prophylactic treatment with antibiotics.
50
Describe the presentation that should raise suspicion for vesicular mole.
Rapidly enlarging uterus and severe vomiting.
51
What is the most common site for metastasis in gestational trophoblastic disease?
Lung.
52
Do patients with clavicle fractures resulting from shoulder dystocia require treatment?
No treatment is necessary for clavicle fractures.
The most imp bone 2 b fractured in shoulder dystocia>> clavicle… NO TTT of clav. Fracture.
53
Define the most important follow-up marker after evacuation of a mole.
Beta-hCG.
54
How should a patient with broad ligament hematoma post-labor be described?
Hypotension, contracted uterus, and deviated uterus.
55
Describe the first step in managing shoulder dystocia.
Leg elevation (McRoberts maneuver).
56
What is the most important drug in the management of premature rupture of membranes?
The first step is management.
57
Describe the role of dexamethasone in preterm labor management.
Dexamethasone is the most important drug used in the first step of managing preterm labor.
58
Define tocolytics and their absolute contraindication.
Tocolytics are drugs used to delay preterm labor. The absolute contraindication to tocolytics is chorioamnionitis.
59
What is the key characteristic of chorioamnionitis?
Maternal fever is the key characteristic of chorioamnionitis.
60
What is the next step after chorioamnionitis occurs?
The next steps are sampling and administering antibiotics.
61
Do you transfer a patient with PROM to a primary care hospital 50 km away or a tertiary care hospital 150 km away?
Transfer the patient to a tertiary care hospital, regardless of the distance.
62
When is external cephalic version typically performed?
External cephalic version is usually done around week 36 of pregnancy.
63
Describe the most common indication for a Cesarean section.
The most common indication for a Cesarean section is a previous Cesarean section.
64
What is the most common cause of primary Cesarean section?
Cephalopelvic disproportion is the most common cause of primary Cesarean section.
65
How do you manage a female in labor with sudden abdominal pain and fetal ascent?
The likely diagnosis is uterine rupture, with the most common risk factor being a previous Cesarean section. The next step is resuscitation and laparotomy.
66
Define uterine atony and its initial management.
Uterine atony is when the uterus is soft and enlarged (boggy) on palpation. The first step in management is uterine massage.
67
What is the first-line medication used during uterine massage for uterine atony?
Oxytocin is the first-line medication used during uterine massage for uterine atony.
68
Describe the presentation of endometritis and its most common risk factor.
Endometritis presents with postpartum fever, uterine tenderness, and foul-smelling lochia. The most common risk factor is Cesarean section.
69
How is endometritis treated?
Endometritis is treated with intravenous antibiotics targeting gram-positive and gram-negative organisms.
The treatment of endometritis typically involves the use of broad-spectrum antibiotics. First-line treatment includes a combination of clindamycin and gentamicin administered intravenously until the patient is afebrile for at least 48 hours. In some cases, other antibiotic combinations like ampicillin with gentamicin may be used. Supportive care, such as ensuring adequate hydration and managing pain with NSAIDs or acetaminophen, is also important.
For more detailed information, refer to the RACGP guidelines [here](https://www.racgp.org.au/clinical-resources/clinical-guidelines).
### Explanation of Antibiotic Choices for Endometritis in Simple Terms
1. **Clindamycin**:
- **Reason**: Clindamycin is effective against a wide range of bacteria, including those that commonly cause infections in the uterus after childbirth. It works well against anaerobic bacteria, which thrive in environments with little or no oxygen, like the uterus after childbirth.
2. **Gentamicin**:
- **Reason**: Gentamicin targets a different group of bacteria than clindamycin, particularly Gram-negative bacteria. Using it together with clindamycin provides broad coverage against most types of bacteria that could be causing the infection.
3. **Alternative Regimen (Ampicillin and Gentamicin)**:
- **Reason**: Ampicillin is effective against many Gram-positive bacteria and some Gram-negative bacteria. When combined with gentamicin, it ensures a wide range of bacterial coverage, making it a good alternative to the clindamycin and gentamicin combination.
These antibiotics are chosen to ensure that the treatment covers all potential bacteria that might be causing the infection, which is often polymicrobial (involving multiple types of bacteria).
For more detailed guidelines and information, refer to the RACGP resources and the [MSD Manual on Postpartum Endometritis](https://www.msdmanuals.com/professional/gynecology-and-obstetrics/postpartum-care/postpartum-endometritis) [oai_citation:1,Postpartum Endometritis - Postpartum Endometritis - MSD Manual Professional Edition](https://www.msdmanuals.com/en-au/professional/gynecology-and-obstetrics/postpartum-care-and-associated-disorders/postpartum-endometritis) [oai_citation:2,RACGP - Endometriosis action plan to help diagnose and manage patients](https://www1.racgp.org.au/newsgp/clinical/endometriosis-action-plan-to-help-gps-diagnose-and).
70
What is Sheehan's syndrome and how is it managed?
Sheehan's syndrome is postpartum pituitary necrosis. It is managed with cortisone followed by thyroxine to prevent adrenal crisis.
71
What is colostrum rich in?
Colostrum is rich in protein and secretory Ig (immunoglobulins).
72
Can HIV-positive mothers breastfeed?
HIV-positive mothers should not breastfeed.
73
Are breastfeeding allowed for mothers with HBV and HCV infections?
Mothers with HBV and HCV infections can breastfeed.
74
Is metronidazole safe to use during pregnancy?
Metronidazole is considered safe to use during pregnancy.
75
Is metronidazole contraindicated during lactation?
Metronidazole is contraindicated during lactation.
76
How is slow cervical dilation managed during labor?
Slow cervical dilation, often due to weak contractions, is managed with oxytocin.
77
What is the management for arrested active phase of labor?
If there is no cervical dilation for more than 3 hours in the active phase of labor, it may lead to arrested active phase and may require a Cesarean section.
78
Describe the management of arrested labor after engagement.
Arrested labor after engagement is managed with forceps.
79
What are the normal findings on a cardiotocography (CTG) during labor?
Normal CTG findings during labor include fetal heart rate between 110-160, accelerations, variability, and no decelerations.
80
What are the causes of fetal tachycardia and fetal bradycardia during labor?
Fetal tachycardia is often due to maternal fever, while fetal bradycardia can be caused by a sleeping baby.
81
What does early deceleration in fetal heart rate during labor indicate?
Early deceleration is usually caused by fetal head compression.
82
What does late deceleration in fetal heart rate at the end of a contraction indicate?
Late deceleration is often due to fetal hypoxia.
83
What does variable deceleration in fetal heart rate with no relation to contractions suggest?
Variable deceleration is typically caused by umbilical cord compression.
84
How is abnormal fetal movement initially assessed?
The first step in assessing abnormal fetal movement is detecting fetal heart rate using Doppler.
85
Describe the management of a missed abortion.
Management involves a dilation and curettage (D&C).
86
What is the most serious complication of a missed abortion?
Disseminated intravascular coagulation (DIC).
87
Define threatened abortion.
Uterine bleeding before 20 weeks, closed cervical os, and no products of conception expelled.
88
How is cervical incompetence diagnosed?
Diagnosed via ultrasound showing shortening of the cervix.
89
What is the treatment for cervical incompetence?
Cerclage, which is placed at 13-14 weeks and removed at 36-37 weeks.
90
Describe the management of hyperemesis gravidarum.
Treatment involves anti-emetics.
91
What is the antiemetic of choice in pregnancy?
Metoclopramide.
92
How is the severity of fetal affection assessed in Rh isoimmunization?
Through fetal blood sampling.
93
What is the best way to monitor intrauterine fetal growth in alcoholic pregnant women?
Ultrasound is the best method.
94
Do you induce labor if a pregnant woman continues to 42 weeks?
Yes, induction of labor is recommended as normal labor occurs between 37-41 weeks.
95
Define inevitable abortion.
Bleeding before 20 weeks, open cervical os, and no products of conception expelled.
96
What is the most common congenital abnormality associated with systemic lupus erythematosus (SLE)?
Heart block due to anti-RO/anti-LA antibodies.
97
How do you manage intrauterine fetal demise (IUFD)?
Delivery is the management approach, with cesarean section not being the first option.
98
Describe the management of cervical incompetence.
Treatment involves cerclage placement at 13-14 weeks and removal at 36-37 weeks.
99
What is the best way to monitor intrauterine fetal growth?
Ultrasound is the best method for monitoring.
100
Describe the recommended supplementation during pregnancy for iron, folic acid, calcium, and iodine.
Iron, folic acid, calcium, and iodine are essential supplements during pregnancy.
101
What are the vitamins needed in pregnancy?
Vitamin D and B12 are necessary during pregnancy.
102
Define the vitamins NOT needed in pregnancy.
Vitamins A, C, and E are not required during pregnancy.
103
What vaccinations are needed/safe during pregnancy?
Influenza and DTaP vaccinations are safe and recommended during pregnancy.
104
Do all live attenuated vaccines pose a risk during pregnancy?
Yes, all live attenuated vaccines (e.g., MMR, varicella) are not safe during pregnancy.
105
How should folic acid supplementation be increased for individuals with diabetes mellitus, history of neural tube defects, or those on anti-epileptic medications?
Folic acid supplementation should be increased for those with diabetes mellitus, history of neural tube defects, or individuals on anti-epileptic medications during pregnancy.
106
Describe the restrictions during pregnancy regarding alcohol, smoking, and illegal drugs.
Alcohol, smoking, and illegal drugs are strictly prohibited during pregnancy.
107
What are the screening methods for Down syndrome in the 1st trimester?
Screening methods for Down syndrome in the 1st trimester include ultrasound or beta-hCG, with ultrasound being preferred if both are available.
108
Define the confirmatory (diagnostic) test for Down syndrome in the 1st trimester.
Chorionic villous sampling is the confirmatory (diagnostic) test for Down syndrome in the 1st trimester.
109
What is the preventive measure for toxoplasmosis during pregnancy?
Avoiding contact with cats is a preventive measure for toxoplasmosis during pregnancy.
110
How should pregnant individuals prevent listeria infection?
Pregnant individuals should avoid consuming cheeses to prevent listeria infection.
111
Describe the initial step if a pregnant individual is exposed to a child with parvovirus infection.
The initial step is to check for IgG antibodies.
112
What is the next step if IgG antibodies are negative after exposure to parvovirus during pregnancy?
If IgG antibodies are negative, the next step is to check for IgM antibodies.
113
Do pregnant individuals exposed to rubella during pregnancy require vaccination?
Pregnant individuals exposed to rubella should be vaccinated.
114
How should a baby born to an HBV-infected woman be managed?
The baby should receive both vaccine and immunoglobulin.
115
What is the recommended mode of delivery and feeding for pregnant individuals with HBV and HCV infections?
Normal vaginal delivery and breastfeeding are allowed for pregnant individuals with HBV and HCV infections.
116
Describe the management for pregnant individuals with HIV and genital herpes.
Pregnant individuals with HIV and genital herpes should undergo cesarean section and avoid breastfeeding.
117
What therapy is recommended for pregnant individuals with HIV?
HAART therapy is recommended for pregnant individuals with HIV.
118
How should a child born to a woman with HIV be treated?
The child should receive zidovudine.
119
What is the next step if a pregnant individual tests positive for IgM antibodies to CMV during screening?
The next step is to test for IgG antibodies.
120
Describe the timing for routine Rh screening during pregnancy.
Routine Rh screening should be done between 24-28 weeks of pregnancy to prevent isoimmunization.
121
What should be administered to Rh-negative females exposed to Rh-positive blood to prevent isoimmunization?
RhoGAM should be given at 28 weeks and post-partum.
122
How should pregnant individuals with a positive group B strept early in pregnancy be managed during labor?
Intra-partum IV penicillin should be administered.
123
What is the management for pregnant individuals with a positive history of group B streptococcus in a previous pregnancy but now negative?
Intra-partum IV penicillin should still be administered.
124
If the Bishop score is less than 2, what is the recommended management?
Induction with prostaglandin should be initiated, and reassessment should occur after 6-12 hours.
125
How can the risk of transmitting Hepatitis C to the baby be reduced during delivery?
Avoiding the use of fetal scalp electrodes can reduce the risk of transmission.
126
What is the best test to determine the prevalence of HCV in a child born to an HCV-positive mother?
HCV antibody testing at 18 months is the best test for prevalence.
127
What test is used to diagnose premature rupture of membranes?
Fibronectin testing is used to diagnose premature rupture of membranes.
