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Finals > Obstetrics Medicine 🤱🏼 > Flashcards

Obstetrics Medicine 🤱🏼 Flashcards

1
Q

What is the gestational age

A

Weeks since last menstrual period (2 weeks longer than embryonic age)

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2
Q

Embryonic age vs gestational age

A

Embryonic age is gestational age - 2wks

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3
Q

HCG pattern in the first 8-10 weeks

A

Doubles every 48 hours and peaks to 100,000

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4
Q

HCG around 20 wks

A

12,000

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5
Q

To diagnose pregnancy?

A

HCG… then if positive do transvaginal ultrasound

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6
Q

Best way to date pregnancy

A

CRL (done earlier, is more accurate)

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7
Q

5 ways to estimate fetal weight

A

BPD, head circ, abd circ, femur length, and fundal height on physical exam

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8
Q

Do fetal movements occur sooner or later in multigravida women?

A

Earlier

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9
Q

Roughly normal weight gain in pregnancy

A

~25 lbs

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10
Q

CI for a pregnant woman to do exercise

A

Cervical insufficiency, placenta prévia, amniotic fluid leak, HTN, multiple gestations

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11
Q

Potential side effects of NSAIDs in preg

A

Oligohydramnios (after 20 weeks), can close PDA. Recall time when we can give low dose?

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12
Q

Prenatal care 1st trimester list

A

FBC, Rh test/Ab test, urinalysis, Vx (Tdap, influenza), HCG and PAPP-A, US (nuchal translucency),

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13
Q

What next? If mum Rh positive

A

Don’t worry about haemolytic disease of the newborn

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14
Q

What next? If mum Rh negative

A

Check if mum has anti Rh antibody

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15
Q

What next? If mum Rh positive , and she doesn’t have anti Rh antibody

A

Risk for future pregnancy, not this one. Give RhoGAM at 28 weeks and after birth (or after amniocentesis, trauma, etc.). Prevent sensitisation

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16
Q

What next? If mum Rh positive (negative?) and she has antibodies against Rh

A

Baby is at risk for haemolytic disease of the newborn. So now check fetus Rh (can usually deduce from dads status)

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17
Q

What next? If mum Rh positive and had antibodies against Rh, and baby is Rh+…

A

Fetal MCA Doppler, umbilical Htc, serial Ab titres in mum. May need to transfuse if severe and delivery at 35 weeks

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18
Q

If pregnancy women has asymptomatic bacteruria. How to Mx

A

Abx, and repeat culture (30% don’t clear 1st time)

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19
Q

Three microbes that must screen for in pregnancy

A

Syphilis, HBV, HIV

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20
Q

If women at risk of gestational diabetes, or has a positive challenge test, what do we do

A

Offer referral for an oral glucose tolerance test at 24-28 weeks

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21
Q

What is the oral glucose tolerance test

A

100g of glucose given, and measure glucose at baseline, 1 hour, 2 hour and 3 hour.
(Challenge test is just 50g and check after 1 hr)

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22
Q

When should pregnant women get the Tdap?

A

All! At 27-36 weeks. If they haven’t had any dose (Give 3 dose series)

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23
Q

Two Vxs that all women pregnant should be given

A

Influenza and Tdap (for the rest, only give if haven’t received)

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24
Q

When to do our GBS check

A

3rd trimester (do culture). Give Abx if +

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25
Q

When does our 1st trim screening for aneuploidy occur

A

12-13 weeks

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26
Q

PAPPA and HCG high in X and low in Y & Z

A

X - downs
Y - edwards
Z - patau

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27
Q

2nd trimester screen

A

AFP, BHCG, Estriol, Inhibin

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28
Q

Recall 2nd trimester screening results

A
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29
Q

What is the cell free DNA and when is done

A

Test of maternal blood for fetal DNA. Done after 10 weeks as a screening method (not Dx’ic)

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30
Q

Easier/more common access for CVS.

A

Transabdominal

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31
Q

If the CVS doesn’t show anything abnormal, why do we sometimes do another scan in 2 weeks?

A

Confined placental mosaisism can occur which means DNA from placenta isn’t babies…

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32
Q

When is CVS done?

A

Weeks 11-14, if there’s indication (higher chance of aneuploidy)

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33
Q

When is amniocentesis done

A

15-20 weeks

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34
Q

When doing CVS or amniocentesis, do we consider Rh risks

A

Yes, give RhoGAM

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35
Q

All HIV positive preg mums should receive what?

A

ART

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36
Q

If HIV viral load in mum is >1000… do we need any delivery changes

A

Yes. C sec and give IV zidovudine

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37
Q

If fetal HIV count above 50… give what?

A

ART

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38
Q

If fetal HIV count below 50… give what?

A

Zidovudine for 4-6 weeks

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39
Q

We all know babies get Hep B Vx given at birth… but what is mum is Hep B +

A

Vx and HBIg

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40
Q

Do we test for chlamydia and gonorrhea? In preg

A

Yes, at 1st visit, do a swab

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41
Q

If preg woman positive for gonorrhea? Mx?

A

Ceftriaxone and Azithromycin (test if cured 2 weeks after)

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42
Q

Tx for pregnancy women with toxo

A

Pyr-sulf for mum and fetus

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43
Q

If trep and non trep test are positive in first trimester… do what?

A

Penicillin G (1 dose of 1°/2° or three if 3°)

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44
Q

Parvovirus in >20 weeks women?

A

Weekly US (MCA Doppler). IU transfusion may be needed

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45
Q

FDA drug pregnancy class
A
B
C
D
X

A

A no risk and human studies done
B no risk but animal studies done
C no studies done
D evidence of risk
X risk

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46
Q

What is the non stress test?

A

At 32 weeks, check fetal movements and HR

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47
Q

Reactive non stress test?

A

2 accelerations in HR in 20 mins. Good sign

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48
Q

Non-Reactive non stress test?

A

No accelerations in 40 mins… potentially a bad sign. Try again in 30 mins

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49
Q

Uterine artery Doppler. What does REDV and AEDV mean?

A

Reverse end diastolic flow - normal

Absent end diastolic flow - needs urgent delivery

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50
Q

What is the biophysical profile in pregnancy. When is it done and what 4 parameters does it measure

A

US and non stress test, done after 28 weeks. Tests fetal moment, tone, breathing, amniotic fluid vol, HR

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51
Q

Biophysical test if 6/10

A

Repeat in 24 hours

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52
Q

Biophysical test of 0-4/10

A

C sec

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53
Q

Amniotic fluid index normal values

A

10-15 cm. less than 5 = oligo. more than 24 = poly

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54
Q

More fetuses… longer or shorter preg?

A

Shorter

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55
Q

Difference between di/monochorionic and di/monoamniotic

A
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56
Q

How to diagnose twin twin transfusion syndrome

A

US

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57
Q

How to diagnose twin twin transfusion syndrome

A

US

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58
Q

How to Mx twin twin transfusion syndrome

A

Expectant if mild. Laser coag to close anatomosis and amnioreduction to relieve polyhydramnios

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59
Q

(Twin A closer to cervix) both twins cephalic. How to deliver?

A

Vaginal delivery

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60
Q

(Twin A closer to cervix) A cephalic, B breach . How to deliver?

A

Try a vaginal delivery

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61
Q

(Twin A closer to cervix) A if breach. How to deliver?

A

C sec

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62
Q

When do we do leopald maneuvres to assess presentation?

A

After 36 weeks

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63
Q

If suspect breech presentation on exam, do what?

A

US to confirm

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64
Q

If after 36 weeks, fetus is breech, what options do we have

A

External cephalic conversion or elective C sec

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65
Q

After 28 weeks, how should a pregnant woman sleep

A

Not on back!

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66
Q

Patient has unexplained vaginal bleeding after 13 weeks…. Mx? Consider Rh, preterm

A

Give RhoGAM. Assess whether to admit (risk of abruption, preterm, amount of blood). Give CSs if risk of preterm birth

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67
Q

When do we invx vaginal discharge in pregnant women?

A

If itch, sore, smells or painful

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68
Q

Ectopic pregnancy signs occur how long after last menstrual period

A

4-6 weeks

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69
Q

Less than x% increase in HCG within 48 hours points toward ectopic pregnancy

A

35%

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70
Q

First line Invx for ectopic pregnancy

A

Transvag US

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71
Q

Best and diagnostic Invx for ectopic pregnancy

A

Exploratory laparoscopy

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72
Q

If TVUS non diagnostic for ectopic pregnancy…. Check what?

A

HCG every 48 hours. If increasing, likely ectopic (repeat US), if decreasing then likely abortion

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73
Q

Patient has ectopic pregnancy, and is stable, asymptomatic, HCG<5000. How to Mx

A

MTX and leucovorin. Monitor HCG

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74
Q

If patient has ectopic pregnancy and is symptomatic, HCG > 5000. How to Tx

A

Salpingostomy (preserved tubal function)

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75
Q

If patient has ruptured ectopic pregnancy. How to Tx

A

Salpingectomy (doesn’t preserve tubal function)

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76
Q

Threatened abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -

A

Vaginal bleeding - yes
Fetal activity - yes
Conception products IU
Os - closed
Px - reversible

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77
Q

Inevitable abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -

A

Vaginal bleeding - yes
Fetal activity - maybe ok
Conception products - visible
Os - dilated
Px - irreversible

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78
Q

Missed abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -

A

Vaginal bleeding - no
Fetal activity - no
Conception products - no expulsion
Os - closed
Px - irreversible

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79
Q

Incomplete abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -

A

Vaginal bleeding - yes
Fetal activity - no
Conception products - in cervical canal or IU
Os - Dilated
Px - irreversible

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80
Q

Complete abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -

A

Vaginal bleeding - yes
Fetal activity - no
Conception products - outside uterus
Os - closed
Px - irreversible

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81
Q

Absent fetal cardiac activity and suspect spontaneous abortion… Invx?

A

Transvag US. And downtrending HCG

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82
Q

Threatened abortion Mx

A

Expectant (watch and wait)

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83
Q

Complete abortion Mx

A

Abx and ergot

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84
Q

Mx of inevitable incomplete or missed abortion

A

Expectant for 4 weeks. If nothing, then intervene.
Medically: misoprostol (+- mifepristone)
Sx: dilation and curettage (if heavy bleed or septic)

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85
Q

Concealed placental abruption presentation

A

Presents like preterm labour. Abd pain, rigid uterus but no bleeding

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86
Q

When to do vaginal exam placental abruption?

A

Don’t! Can worsen bleeding

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87
Q

Signs of placental abruption

A

Dark red vaginal bleeding
Abd pain, uterine tenderness
Rigid uterus
Fetal distress (decelerations and low fetal movement)

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88
Q

Is the Transabdominal US good for placental abruption

A

Yes…. But not ideal/reliable

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89
Q

Couvelaire uterus

A

In abruption, the blood extends into the myometrium then out into the peritoneum

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90
Q

Approach to abruption in stable mum and normal fetus findings. <34th week

A

Observe. CSs and tocolysis. Aim for normal delivery

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91
Q

Approach to abruption in stable mum and normal fetus findings. 34-36 weeks. Active uterine contractions.

A

Deliver

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92
Q

Approach to abruption in stable mum and normal fetus findings. 34-36 weeks. No uterine contractions.

A

Observe

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93
Q

Approach to abruption in stable mum and normal fetus findings. >36 weeks

A

Deliver

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94
Q

Approach to abruption in unstable mum and alive fetus

A

Emergency C sec

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95
Q

Approach to abruption in unstable mum and dead fetus

A

Induce vaginal delivery using meds, or c sec if risk to mum

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96
Q

Different between gestational HTN and preeclampsia

A

Gestational HTN is HTN after 20 weeks gestation. Preeclampsia is the same, but with Proteinuria and end organ dysfunction

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97
Q

HTN before 20 weeks gestation

A

Chronic HTN

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98
Q

Chronic HTN Mx

A

Labetelol, CCB, Methyldopa (Tx if > 160/110)

99
Q

Hypertensive crisis in pregnancy (how to manage)

A

IV labetolol

100
Q

Chronic HTN patient… if BP above 160/110… how to Mx?

A

Hospitalise until delivery (~34 weeks. Onward). If less than 160/110, can deliver at term

101
Q

Workup to Invx gestational HTN

A

2 or more recordings of HTN >4 hours apart. Urinalysis (check for preeclampsia). FBC, LFTs, KFTs, coag and smear

102
Q

Preeclampsia with vs without severe features

A

With: HTN >160/110, proteinuria, oliguria, headache, blurred vision, RUQ pain, edema, AMS

without: mild headache, edema, RUQ pain, proteinuria

103
Q

When to hospitalise and deliver in preeclampsia without severe features

A

> =37 weeks (deliver) all.
Abruption suspicion
=34 weeks and PROM, low amniotic fluid, small fetus, abnormal CTG

104
Q

In a preeclampsia patient without severe features, whom is not indicated for delivery, how to Mx

A

Usual anti HTN meds, regular monitoring, and US. Educate patient to safety net

105
Q

When to hospitalise and deliver in preeclampsia with severe features

A

> =34 weeks (all)
Or deliver (after stabilised) if instability present (DIC, pulmonary edema, abruption, seizure etc.)

106
Q

Prior to delivery for a severe feature preeclampsia patient… we need to stabilise. What do we need to do

A

IV MgSO4, anti HTN, CSs

107
Q

When do we do expectant managing for severe feature preeclampsia. What do we do

A

If <34 weeks and somewhat stable. But monitor in the ICU nonetheless
MgSO4, anti HTN, CSs, diuretics

108
Q

HELLP sy Mx

A

Stabilise (fluids, transfuse, anti HTN, MgSO4). Deliver >= 34 weeks, or if status deteriorates

109
Q

Eclampsia Mx

A

Stabilise (left fetal position, airway, O2), MgSO4 IV (lorazepam IV if nonresponsive). Deliver once stable and seizure stopped

110
Q

Prevention of preeclampsia

A

Low dose ASA PO (daily until deliver). For women at high risk

111
Q

Eclampsia patient gets low DTRs, resp issue and arrhythmia… likely issue?

A

Mg toxicity from MgSO4 Tx

112
Q

Initial screening for gestational diabetes

A

oral glucose challenge (50g load, and measure glucose after 1 hour)

113
Q

Confirmatory test for gestational diabetes

A

Glucose tolerance test

114
Q

First line mx for gestational diabetes

A

Diet control and excersize

115
Q

First line Tx for gestational diabetes

A

Insulin

116
Q

2nd line Tx for gestational diabetes

A

Metformin and glyburide

117
Q

If glycemic control poor in gestational diabetes… we can consider what 39 weeks

A

Delivery

118
Q

Normally the placenta is >Xcm from the cervical Os

A

> 2 cm

119
Q

Placenta previa vs low lying placenta

A

Previa covers Os, low lying doesn’t (but is <2cm from it)

120
Q

Is there a soft/firm uterus in previa? Is there any fetal distress

A

Soft uterus and no distress (vs abruption)

121
Q

Suspect previa… do transvag US or bimanual?

A

Transvag US (bimanual is CI)

122
Q

Previa patient, identified early at ~20 weeks. How to approach

A
123
Q

How to manage previa identified ~<37 weeks? Both with no bleeding and active bleeding

A

Bleeding? C sec
No bleeding? Expectant

124
Q

How to manage a previa case >37 weeks

A

Deliver immediately

125
Q

Advice of 3 things to avoid in previa woman

A

Avoid sex, activity, prolonged standing

126
Q

If very severe previa… what can we do

A

Emergency caesarean hysterectomy

127
Q

What can we do in a patient with very severe previa symptoms (bleeding)

A

Emergency cesarean hysterectomy

128
Q

What could you see on speculum exam in PROM?

A

Amniotic fluid flowing out of cervix and pooling in fornix

129
Q

What could be see on US in PROM?

A

oligohydramnios

130
Q

Important invx in patient with PROM

A

Fetal heart rate monitoring

131
Q

3 factors that determine management in premature rupture of the membranes

A

Gestational age, intramniotic infection, poor fetal status

132
Q

If an unstable patient with PROM presents. How do we manage

A

Deliver if signs of Abruption, prolapse, infection. And give empiric Abx (while collecting cervical cultures)

133
Q

If a stable patient with PROM presents. They are >= 37 weeks. How do we manage

A

Induce labour

134
Q

If a stable patient with PROM presents. They are 34-36 weeks. How do we manage

A

Can induce labour or expectant

135
Q

If a stable patient with PROM presents. They are 24-33 weeks. How do we manage

A

Expectant Mx

136
Q

Expectant management in PROM includes

A

Bed rest
ABx (ampi and azithro then amoxi and azithro)
CSs
Tocoylsis
MgSO4

137
Q

Shoulder dystonia usually associated with abnormality in 3 Ps of labour

A

Pelvis
Passenger (macrosomia or odd orientation)
Power (strength of contraction)

138
Q

Diagnosis shoulder dystonia

A

Clinical!
Signs of arrested labour, turtle sign etc

139
Q

First line Mx for shoulder dystonia

A

Stop bearing down
McRoberts manuever

140
Q

Mx of amniotic fluid embolism (consider hypoxia, hypotension, anemia, coagulation)

A

O2 (ventilation maybe needed), vasopressors, transfuse (RBCs FFP), cesarean

141
Q

Main invx tool to diagnose uterine rupture

A

US

142
Q

Recall signs of uterine rupture

A
143
Q

Recall signs of uterine rupture

A
144
Q

Recall signs of uterine rupture

A
145
Q

Mx of imminent uterine rupture

A

IV tocolysis and emergency C sec

146
Q

Mx of uterine rupture

A

Laparotomy and emergency c sec. If bleeding continues, do hysterectomy

147
Q

Confirmatory invx for the diagnosis of placenta accreta/increta

A

Doppler US

148
Q

In acreta patients, what advice to we give before delivery

A

Avoid pelvic exams, sex, etc (prevent pre delivery)

149
Q

Mx of acreta in labour

A

During third stage of labour, Give oxytocin, and uterine massage. Whilst doing a controlled traction of the cord

150
Q

Sx options for acreta

A

D&C, vacuum removal, or C sec hysterectomy (main Tx)

151
Q

Main Tx (most commonly used) for acreta

A

Cesarean hysterectomy. After delivery, remove uterus with placenta still attached

152
Q

CTG changes in overt umbilical cord prolapse

A

Abrupt change From normal to bradycardia and severe decelerations

153
Q

Diagnostic finding for overt umbilical cord prolapse

A

Pulsating cord palpable on vaginal exam

154
Q

Initial management for overt umbilical cord prolapse

A

Reposition mother and fetus. Mum lies on left or right, or do trendelenburg position. Manually push baby back into uterus. Fill bladder with saline

155
Q

If repositioning didn’t work for overt umbilical cord prolapse, what next!

A

Amnioinfusion (if PROM), tocoylsis (if high uterine activity), C sec

156
Q

Vasa previa definition

A

Umbilical vessels <2cm near os

157
Q

How to screen and diagnose vasa previa

A

US

158
Q

Mx of vasa previa if IDd before labour

A

CSs, admit and surveillance, C sec

159
Q

Mx of vasa previa in labour and bleeding

A

Emergency c sec

160
Q

What is a threatened abortion

A

Bleeding in early pregnancy, Os is closed and preg still viable

161
Q

Tx for septic abortion

A

Boris spec ABx, and suction cutterage

162
Q

Spontaneous abortion vs stillbirth/IU fetal demise

A

Stillbirth is pregnancy loss >20 weeks

163
Q

Main way to Dx stillbirth

A

US (absent movements, uterus small, absent heart sounds)

164
Q

Mx for stillbirth <24 weeks

A

Dilation and evacuation of fetus

165
Q

Mx for stillbirth >24 weeks

A

Induce labour

166
Q

What is the Kleinhauer Betke acid elution and when is it used

A

Used after spontaneous abortion or still birth. Detects if any HbF in material blood

167
Q

Cervicle insufficiency Sx

A

Cerclage

168
Q

Cervical insufficiency vs spontaneous abortion signs

A

Cervical insufficiency: recurrent 2nd trim pregnancy loss, with not bleeding or pain

169
Q

Can we do a nuclear medicine thyroids scan in hyperthyroid pregnant women?

A

No!

170
Q

2 tests to evaluate for risk of preterm delivery

A

Cervical length with US, fetal fibronectin (if elevated = increased risk)

171
Q

When to give CSs (IM beta or Dexa) in preterm

A

If 24-33 weeks and risk of delivery in 7 days. Admin again every 14 days until birth. Can give 34-36 weeks, if didn’t have any before

172
Q

First line tocolysis drugs? For 24-32 and 32-34 weeks

A

Indomethacin then Nifedipine (in ni)

173
Q

Role of MgSO4 in preterm

A

Fetal Neuro protection. Give. <32 weeks.

174
Q

2 indications for a woman to take vaginal progesterone to prevent preterm

A

Short cervicle length, or prior preterm pregnancy

175
Q

Invasive Mole Tx?

A

MTX and actinomycin D (hysterectomy is good, if women doesn’t want kids)

176
Q

Hydatidiform Mole Tx

A

Uterine suction cutterage (not often hysterectomy), and chemo is not indicated here

177
Q

Choriocarcinoma Mx

A

MTX and actinomycin

178
Q

Following treatment for mole pregnancy, and HCG doesn’t fully go down (plateaues instead)…. Could be what?

A

Invasive mole or choriocarcinoma

179
Q

Should Patients after molar pregnancy be cautious about pregnancy again

A

Avoid pregnancy for 1 year

180
Q

Cu IUD can cause what main side effects

A

Heavy menses

181
Q

Patient has liver adenoma… which is the only contraceptive safe to use

A

Cu IUD

182
Q

IUD inserted… and patient gets amenorrhea/irreg periods. Which contraceptive was used

A

prog IUD

183
Q

Name 5 CId for IUDs generally

A

Anatomical uterine issue, AUB unexplained, PID, endometrial/cervical CA, (Prog IUD cannot be used in active liver disease or PR+ breast cancer)

184
Q

CI for smoker for COCP

A

Smoker above 35, Hx if clot/thrombus, breast cancer HR+, liver adenoma, migraine with aura, HTN

185
Q

COCP for post partum?

A

Not for first month (can cause thromboembolism/decrease breast milk

186
Q

When is Cu IUD CId in post partum?

A

If anemic/or high post partum bleeding

187
Q

Most effective emergency contraceptive

A

Cu IUD

188
Q

Benefit of Progesterone IUD over Cu

A

Less bleeding

189
Q

Copper and prog IUD, and ulipristal should be taken within X days (in emergency)

A

5 days

190
Q

Oral progestin or COCP should be given within x days (for emergency contraceptive)

A

3

191
Q

When give oral prog instead of COCP

A

If CI for COCP

192
Q

Talk to me about the management of threatened abortion

A

Expectant management. Do weekly ultrasound, cereal HCG and RhoGAM

193
Q

For inevitable, missed and incomplete abortion… How do we manage? Consider what you would do first, maybe try second, and then the last resort

A

Can do expectant (allow natural passage of POC). Medications (mifepristone and misoprostol). Dilation and cutterage lastly

194
Q

Patient has inevitable, missed, incomplete abortion, and has severe bleeding or septic abortion. How do you manage

A

Must do dilation and cutterage

195
Q

Stillbirth management before 24 weeks

A

Dilation and evacuation

196
Q

Stillbirth management after 24 weeks

A

Induce labour

197
Q

Is vaginal exam contraindicated in abruptio placentae

A

Yes

198
Q

Dx? Patient presents with seven weeks of aminuria, and now has lower abdominal pain, and mild vaginal bleeding.

A

Ectopia Pregnancy

199
Q

Patient presents with abdomen pain, at 37 weeks gestation. Visible vaginal bleeding. Tender and tense uterus. CTG findings unstable. Pain is constant. What is the diagnosis

A

Likely placental abruption

200
Q

Main to abdomen pain causes in early pregnancy

A

Ectopic pregnancy. Or miscarriage

201
Q

List as many signs and symptoms of amniotic fluid embolus

A

Chills, shivering, sweating, anxiety, cyanosis, hypertension, bronchospasm, tachycardia, Features of DIC, consciousness altered

202
Q

Folick acid recommendations for women

A

400 mg every day until 12 weeks. If on antiepileptics higher doses are recommended

203
Q

Smoking and alcohol advice for pregnant women

A

Do not drink or smoke is the recommendation. But note vareniciline or bupropion are CI’d

204
Q

Air travel advice for pregnant women

A

Women above 37 weeks with a Singelton pregnancy should avoid her travel, because of the increased risk of DVT. If many pregnancies they should avoid air travel after 32 weeks

205
Q

First line therapy for nausea and vomiting in pregnancy

A

Promethazine as suggested. Also considered ginger and acupuncture

206
Q

10 conditions which or pregnant women should be screened for

A

Anaemia, bacteria, Rh, downs, fetal anomalies, Hep B, HIV, NTD, pre-eclampsia risk factors, syphilis

207
Q

Two main differentials for anti-partum haemorrhage

A

Placental abruption and placenta previa

208
Q

Three causes of first trimester bleeding

A

Spontaneous abortion, ectopic pregnancy, mole. Note that the mole anti-abortion can also be second trimester to

209
Q

Third trimester bleeding differential

A

Visa previa, placenta previa, placental abruption

210
Q

Patient has a rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia seen. What is the most likely diagnosis 

A

Vasa previa

211
Q

Woman at 36 weeks or above, has breech presentation how do you manage her

A

External Catholic version is good. Unless patient has Caesarean. If the CV does not work and perform Caesarean.

212
Q

CTG; variable decelerations indicate what

A

Likely cord compression

213
Q

CTG; early deceleration indicate what

A

Often head compression

214
Q

CTG; late deceleration often indicates what

A

Fetal distress, for example asphyxia or placental insufficiency

215
Q

Extra; chorioamnionitis management

A

Deliver fetus, Caesarean if necessary, an admin IV antibiotics

216
Q

If patient has a “high chance” Of having down syndrome patient baby, what are the two options we can be doing

A

Non-invasive screening tests (cell free fetal DNA)  or invasive tests (CVS or amniocentesis)

217
Q

Magnesium toxicity in magnesium sulphate patience. What is the antidote

A

Calcium gluconate

218
Q

Newly diagnosed gestational diabetes patient. Glucose still less than seven (126 mg/dl). First line and second line

A

Lifestyle its first line. If the glucose target not met within one to 2 weeks start Metformin

219
Q

In what circumstances do we use insulin for gestational diabetes

A

If glucose is ever above seven (126 mg/dl). If complications have already presented (polyhydram/macrosomia). Or if Metformin and diet don’t help

220
Q

When are women swabbed for GBS in pregnancy

A

At 35 to 37 weeks. Or 3 to 5 weeks prior to anticipated delivery date.

221
Q

When should we give intrapartum antibiotic prophylaxis for GBS. What do we give

A

Previous pregnancy with GBS, pyrexia during labour, Preterm. Give benzylpenicillin 

222
Q

Does Caesarean lower the transmission rate for hepatitis B in pregnancy

A

No evidence

223
Q

When can we do vaginal delivery in HIV women

A

If viral load is less than 50

224
Q

Before doing Caesarean section in HIV patient. What should be given four hours before

A

Zidovudine infusion

225
Q

If when the fetus is born the HIV viral load is less than 50 how do you manage? If more than 50 how do we manage?

A

Less than 50 give zidovudine. More than 50 give ART

226
Q

First line for gestational hypertension

A

Labetalol. Nifedipine if asthmatic

227
Q

Abruption; fetus alive but it is less than 36 weeks how do I manage if the fetus is in distress or if the fetus is not in distress

A

If in distress do immediate Caesarean. If not in distress observe closely, do tocolysis, give steroids, prevent pregnancy

228
Q

Abruption; if fetus alive and pregnancy is above 36 weeks, how do we manage if the foetuses in distress and if the fetus is not in distress

A

If in distress do immediate Caesarean. If no distress do vaginal delivery

229
Q

Vaginal delivery only ok if HIV less than ?

A

50

230
Q

HIV less than 50 in fetus = give what
HIV more than 50 in fetus = give what

A

zidovudine
ART

231
Q

If HIV load more than 50, what do we do

A

c sec and IV zidovudine 4 hours before

232
Q

Deepest pocket of amniotic fluid should be how big?

A

2 or more cm. Amniotwoic

233
Q

decelerations recap

A

Accel and decel are normal…. but not all decel are!

234
Q

placenta previa vs abruption; transabd or transvag

A

transvag for previa, transabd for abruptio

235
Q

CIs for tocolysis

A

chorioam, abruptio, dodgy CTG, risk of cord prolapse, advanced labour

236
Q

what is mcRoberts
what is Rubin, Woods, posterior arm
what is Gaskin
what is fracture of clavicle
what is zavanelli
what is symphysiotomy

A
237
Q

Mx for imminent uterine rupture?

A

tocolysis and c sec

238
Q

NICE guidelines reccomendations for preterm labour, in terms of best tocolysis

A

Nifedipine or atosiban

239
Q

only contraceptive which doesn’t return fertility straight away

A

IM prog

240
Q

contraceptives that can give up to 5 days after

A

ANY IUD, or uliprsital. OCP are 3 days only

241
Q

post partum contraceptive Mx?

A

Not COCP for 1st month. Not Cu if had high post partum hem.

242
Q

1st line for N/V in preg

A

promethazine (antiH)

243
Q

patient who has Hx of previous GD…. what should be done to check glucose…

A

straight to an OGTT at 24-28 weeks

244
Q

how much proteinuria needed for preeclampsia Dx

A

300mg

Finals (11 decks)

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