obstetrics cont'd Flashcards
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
fetal movements - when first perceived
18-20/40
if on methyldopa, when to stop PP
two days
measuring BP - indicator for DBP
korotkoff sound 5 (disappearance)
significant proteinuria criteria
PCR>30 of 24h >300, or ACR>8
chronic HTN - when to do scans
28/32/36 weeks
chronic HTN - how often for ANC
q2-4 weeks, see weekly if BP not controlled
eclampsia diagnostic criteria
- convulsions
- 2 of organ dysfunction:
- HTN
- proteinuria
- decreased PLT
- increased LFT
FGR - if three or more minor risk factors
uterine artery doppler at 20-24 weeks
FGR - if one or more major risk factor
serial growth scans from 26-28 weeks, and umbilical artery doppler
FGR - minor risk factors, if normal uterine artery doppler
repeat scan for growth and umbilical artery doppler in 3rd trimester
FGR - maternal risk factors, top three highest OR
- previous SB, 6.4
- APLS, 6.2
- diabetes with vascular disease, 6.0
FGR - maternal risk factors, lowest OR
Pregnancy interval, BMI <30, previous PET
FGR - current pregnancy complications, highest OR
- unexplained APH, 5.6
- low maternal weight gain, 4.9
- low PAPP-A, 2.6
best time to determine chorionicity
<14/40, best is 10-13 but earliest from 6-8 weeks
FBC in twins
booking, 20-24 weeks, 28 weeks
broad spectrum abx choice if temp in labour
1) IV amoxicillin 2g QDS, or
2) IV cefuroxime 1.5g QDS if mild allergy
incidence of APH
3-5% of pregnancies
incidence of placental abruption
3-6/1000
accounts for 30% of APH??
% of abruption occurring in low risk women
70%
most common signs of abruptions
- bleeding, 70%
- tenderness, 70%
- fetal distress, 65%
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
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
incidence of vasa previa
1/1200-1/5000
RCOG. Placenta Praevia and Placenta Accreta: Diagnosis and Management. Green-top Guideline No. 27a. BJOG 2018
vasa previa USS diagnosis - when most accurate?
18-24/40
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%
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
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
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
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
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
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
6h
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
