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part 2 > obstetrics cont'd > Flashcards

obstetrics cont'd Flashcards

1
Q

what fetal anomaly highest in obesity

A

spina bifida;

Should take 5mg folic acid, at least 1 month prior to conception and till end of first trimester

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2
Q

fetal movements - when first perceived

A

18-20/40

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3
Q

if on methyldopa, when to stop PP

A

two days

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4
Q

measuring BP - indicator for DBP

A

korotkoff sound 5 (disappearance)

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5
Q

significant proteinuria criteria

A

PCR>30 of 24h >300, or ACR>8

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6
Q

chronic HTN - when to do scans

A

28/32/36 weeks

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7
Q

chronic HTN - how often for ANC

A

q2-4 weeks, see weekly if BP not controlled

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8
Q

eclampsia diagnostic criteria

A
  • convulsions
  • 2 of organ dysfunction:
  • HTN
  • proteinuria
  • decreased PLT
  • increased LFT
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9
Q

FGR - if three or more minor risk factors

A

uterine artery doppler at 20-24 weeks

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10
Q

FGR - if one or more major risk factor

A

serial growth scans from 26-28 weeks, and umbilical artery doppler

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11
Q

FGR - minor risk factors, if normal uterine artery doppler

A

repeat scan for growth and umbilical artery doppler in 3rd trimester

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12
Q

FGR - maternal risk factors, top three highest OR

A
  • previous SB, 6.4
  • APLS, 6.2
  • diabetes with vascular disease, 6.0
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13
Q

FGR - maternal risk factors, lowest OR

A

Pregnancy interval, BMI <30, previous PET

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14
Q

FGR - current pregnancy complications, highest OR

A
  • unexplained APH, 5.6
  • low maternal weight gain, 4.9
  • low PAPP-A, 2.6
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15
Q

best time to determine chorionicity

A

<14/40, best is 10-13 but earliest from 6-8 weeks

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16
Q

FBC in twins

A

booking, 20-24 weeks, 28 weeks

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17
Q

broad spectrum abx choice if temp in labour

A

1) IV amoxicillin 2g QDS, or

2) IV cefuroxime 1.5g QDS if mild allergy

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18
Q

incidence of APH

A

3-5% of pregnancies

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19
Q

incidence of placental abruption

A

3-6/1000

accounts for 30% of APH??

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20
Q

% of abruption occurring in low risk women

A

70%

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21
Q

most common signs of abruptions

A
  • bleeding, 70%
  • tenderness, 70%
  • fetal distress, 65%
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22
Q

incidence of placenta previa at term

A

1/200 (-1/400)

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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23
Q

incidence of placenta accreta at term

A

1/300-1/2000

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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24
Q

incidence of vasa previa

A

1/1200-1/5000

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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25
Q

vasa previa USS diagnosis - when most accurate?

A

18-24/40

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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26
Q

vasa previa USS diagnosis - when to confirm?

A

30-32/40

resolves in 20%

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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27
Q

placenta previa, what proportion resolves?

A

90% by 32 weeks, another 50% by 36/40

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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28
Q

placenta acreta, most specific USS sign

A

uterus bladder interface

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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29
Q

placenta acreta, most sensitive USS sign

A

abnormal vasculature on doppler

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

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30
Q

placenta acreta, most common USS sign

A

“moth eaten” placenta, or abnormal lacunae

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

31
Q

placenta acreta management

A

elective admission from 34/40,

C/S 35-36+6, level 3 bed required

RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018

32
Q

ECV max attempt

A

4 attempts, or max 10 minutes

33
Q

ECV risk or emcs within 24h

A

0.5%

34
Q

ECV most common complication

A

pain, 75%

35
Q

ECV - use of tocolysis, success rate increased

A

OR18

36
Q

labour following ECV, increased risks of?

A

C/S, OR 2.2

and OVB, OR 1.4

37
Q

is on biologics and having c/s, how long to wait before restarting

A

5-7 days, same for perineal repair

38
Q

antenatal corticosteroids, reduce the risk of

A
  • ICH, by 46%
  • Resp distress, 44%
  • NND, by 31%
39
Q

perinatal mortality when cord prolapse occurs in community

A

increased 10x

40
Q

when to offer S+S for primip

A

40+41 weeks

41
Q

when to offer S+S for multip

A

41 weeks

42
Q

SROM - expectant management, what proprotion will labour

A

60%

43
Q

level 1 NNU accepts

A

> 32 weeks

44
Q

level 2 NNU accepts

A

> 28 weeks

45
Q

level 3 NNU accepts

A

<27 weeks

46
Q

PTL confirmed on USS if

A

cx <15mm

47
Q

PTL unlikely if

A

cx>15mm

48
Q

PTL, if USS unavailable:

A

use fetal fibronectin, diagnose if >50

49
Q

tocolysis for PTL can prolong pregnancy by

A

up to 7 days

50
Q

prophylaxis for PTL, cerclage or progesterone can be offered if

A

1) history of previous PTL<34/40 , or midtrimester loss
and
2) Cx length <25mm at 16-24 weeks

51
Q

prophylaxis for PTL, cerclage can be considered if

A

1) PPROM previous, or hx of cervical trauma
and
2) Cx length <25mm at 16-24 weeks

52
Q

prophylaxis for PTL, PV progesterone can be considered if

A

Cx length <25mm with no history

53
Q

after NVD, bladder voiding within ___h

A

6h

54
Q

temperature of water for pool

A

37.5, should be monitored hourly

55
Q

neonatal risk for home delivery for low risk primips

A

4/1000, most common is encephalopathy 40%

#2 = mec aspiration, 34%

56
Q

STAN monitoring decreases

A

OVB and FBS

57
Q

gestational age cut off for ventouse delivery

A

32/40, caution 32-36

58
Q

OVB - episiotomy angle

A

60degrees

59
Q

how long to keep catheter if OVB with regional anaesthesia

A

6-12 hours

60
Q

incidence of pelvic floor morbidity in OVB vs CS

A

3x higher at 6 weeks in OVB compared to 2nd stage section, but attenuated at 1 and 3 years

61
Q

failure rate with ventouse

A

17-36%

62
Q

most common breech presentation in labour/at term

A

frank/extended, 65%

63
Q

VBB: risk of fetal head entrapment

A

14%

64
Q

VBB: how long to give passive 2nd stage

A

2h: if not visible, do c/s

65
Q

VBB: delay between buttocks and head

A

5 minutes

66
Q

VBB: delay between umbilicus and head

A

3 minutes

67
Q

VBB: if head entrapment, where to incise cx

A

2, 6, 10 o’clock positions

68
Q

twins - risk of head interlocking if breech/ceph

A

1/800

69
Q

C/s at full dilatation: benefits

A

less likely to experience incontinence, less likely to have neonatal trauma

70
Q

c/s at full dilatation vs. OVB

A 
more SCBU (11% vs 6%),
increased PPH (10% vs 3%)
71
Q

syntocinon RR of PPH vs none

A

decreased 68%

72
Q

dural puncture, chance of headache?

A

70-80%

73
Q

epidural blood patch, % cure rate

A

60-90%

untreated, lasts 7-10 days but up to 6 weeks

74
Q

treatment for ovarian vein thrombosis

A

1) IV abx x7/7 (tazocin + clindamycin)

2) anticoagulation 3-6/12

part 2 (21 decks)

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