obstetrics cont'd Flashcards by evelyn zielinski

what fetal anomaly highest in obesity

spina bifida;

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

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fetal movements - when first perceived

18-20/40

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if on methyldopa, when to stop PP

two days

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measuring BP - indicator for DBP

korotkoff sound 5 (disappearance)

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significant proteinuria criteria

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

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chronic HTN - when to do scans

28/32/36 weeks

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chronic HTN - how often for ANC

q2-4 weeks, see weekly if BP not controlled

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eclampsia diagnostic criteria

convulsions
2 of organ dysfunction:
HTN
proteinuria
decreased PLT
increased LFT

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FGR - if three or more minor risk factors

uterine artery doppler at 20-24 weeks

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FGR - if one or more major risk factor

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

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FGR - minor risk factors, if normal uterine artery doppler

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

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FGR - maternal risk factors, top three highest OR

previous SB, 6.4
APLS, 6.2
diabetes with vascular disease, 6.0

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FGR - maternal risk factors, lowest OR

Pregnancy interval, BMI <30, previous PET

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FGR - current pregnancy complications, highest OR

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

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best time to determine chorionicity

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

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FBC in twins

booking, 20-24 weeks, 28 weeks

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broad spectrum abx choice if temp in labour

1) IV amoxicillin 2g QDS, or

2) IV cefuroxime 1.5g QDS if mild allergy

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incidence of APH

3-5% of pregnancies

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incidence of placental abruption

3-6/1000

accounts for 30% of APH??

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% of abruption occurring in low risk women

70%

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most common signs of abruptions

bleeding, 70%
tenderness, 70%
fetal distress, 65%

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incidence of placenta previa at term

1/200 (-1/400)

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

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incidence of placenta accreta at term

1/300-1/2000

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

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incidence of vasa previa

1/1200-1/5000

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

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vasa previa USS diagnosis - when most accurate?

18-24/40 ## Footnote *RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018*

vasa previa USS diagnosis - when to confirm?

30-32/40 | resolves in 20% ## Footnote *RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018*

placenta previa, what proportion resolves?

90% by 32 weeks, another 50% by 36/40 ## Footnote *RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018*

placenta acreta, most specific USS sign

uterus bladder interface ## Footnote *RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018*

placenta acreta, most sensitive USS sign

abnormal vasculature on doppler ## Footnote *RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018*

placenta acreta, most common USS sign

"moth eaten" placenta, or abnormal lacunae ## Footnote *RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018*

placenta acreta management

elective admission from 34/40, | C/S 35-36+6, level 3 bed required ## Footnote *RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018*

ECV max attempt

4 attempts, or max 10 minutes

ECV risk or emcs within 24h

0.5%

ECV most common complication

pain, 75%

ECV - use of tocolysis, success rate increased

OR18

labour following ECV, increased risks of?

C/S, OR 2.2 | and OVB, OR 1.4

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

5-7 days, same for perineal repair

antenatal corticosteroids, reduce the risk of

- ICH, by 46% - Resp distress, 44% - NND, by 31%

perinatal mortality when cord prolapse occurs in community

increased 10x

when to offer S+S for primip

40+41 weeks

when to offer S+S for multip

41 weeks

SROM - expectant management, what proprotion will labour

60%

level 1 NNU accepts

>32 weeks

level 2 NNU accepts

>28 weeks

level 3 NNU accepts

<27 weeks

PTL confirmed on USS if

cx <15mm

PTL unlikely if

cx>15mm

PTL, if USS unavailable:

use fetal fibronectin, diagnose if >50

tocolysis for PTL can prolong pregnancy by

up to 7 days

prophylaxis for PTL, cerclage or progesterone can be offered if

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

prophylaxis for PTL, cerclage can be considered if

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

prophylaxis for PTL, PV progesterone can be considered if

Cx length <25mm with no history

after NVD, bladder voiding within ___h

temperature of water for pool

37.5, should be monitored hourly

neonatal risk for home delivery for low risk primips

4/1000, most common is encephalopathy 40% | #2 = mec aspiration, 34%

STAN monitoring decreases

OVB and FBS

gestational age cut off for ventouse delivery

32/40, caution 32-36

OVB - episiotomy angle

60degrees

how long to keep catheter if OVB with regional anaesthesia

6-12 hours

incidence of pelvic floor morbidity in OVB vs CS

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

failure rate with ventouse

17-36%

most common breech presentation in labour/at term

frank/extended, 65%

VBB: risk of fetal head entrapment

14%

VBB: how long to give passive 2nd stage

2h: if not visible, do c/s

VBB: delay between buttocks and head

5 minutes

VBB: delay between umbilicus and head

3 minutes

VBB: if head entrapment, where to incise cx

2, 6, 10 o'clock positions

twins - risk of head interlocking if breech/ceph

1/800

C/s at full dilatation: benefits

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

c/s at full dilatation vs. OVB

``` more SCBU (11% vs 6%), increased PPH (10% vs 3%) ```

syntocinon RR of PPH vs none

decreased 68%

dural puncture, chance of headache?

70-80%

epidural blood patch, % cure rate

60-90% | untreated, lasts 7-10 days but up to 6 weeks

treatment for ovarian vein thrombosis

1) IV abx x7/7 (tazocin + clindamycin) | 2) anticoagulation 3-6/12