Obstetrics Medicine 🤱🏼 Flashcards
1
Q
What is the gestational age
A
Weeks since last menstrual period (2 weeks longer than embryonic age)
2
Q
Embryonic age vs gestational age
A
Embryonic age is gestational age - 2wks
3
Q
HCG pattern in the first 8-10 weeks
A
Doubles every 48 hours and peaks to 100,000
4
Q
HCG around 20 wks
A
12,000
5
Q
To diagnose pregnancy?
A
HCG… then if positive do transvaginal ultrasound
6
Q
Best way to date pregnancy
A
CRL (done earlier, is more accurate)
7
Q
5 ways to estimate fetal weight
A
BPD, head circ, abd circ, femur length, and fundal height on physical exam
8
Q
Do fetal movements occur sooner or later in multigravida women?
A
Earlier
9
Q
Roughly normal weight gain in pregnancy
A
~25 lbs
10
Q
CI for a pregnant woman to do exercise
A
Cervical insufficiency, placenta prévia, amniotic fluid leak, HTN, multiple gestations
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?
12
Q
Prenatal care 1st trimester list
A
FBC, Rh test/Ab test, urinalysis, Vx (Tdap, influenza), HCG and PAPP-A, US (nuchal translucency),
13
Q
What next? If mum Rh positive
A
Don’t worry about haemolytic disease of the newborn
14
Q
What next? If mum Rh negative
A
Check if mum has anti Rh antibody
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
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)
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
18
Q
If pregnancy women has asymptomatic bacteruria. How to Mx
A
Abx, and repeat culture (30% don’t clear 1st time)
19
Q
Three microbes that must screen for in pregnancy
A
Syphilis, HBV, HIV
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
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)
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)
23
Q
Two Vxs that all women pregnant should be given
A
Influenza and Tdap (for the rest, only give if haven’t received)
24
Q
When to do our GBS check
A
3rd trimester (do culture). Give Abx if +
25
When does our 1st trim screening for aneuploidy occur
12-13 weeks
26
PAPPA and HCG high in X and low in Y & Z
X - downs
Y - edwards
Z - patau
27
2nd trimester screen
AFP, BHCG, Estriol, Inhibin
28
Recall 2nd trimester screening results
29
What is the cell free DNA and when is done
Test of maternal blood for fetal DNA. Done after 10 weeks as a screening method (not Dx’ic)
30
Easier/more common access for CVS.
Transabdominal
31
If the CVS doesn’t show anything abnormal, why do we sometimes do another scan in 2 weeks?
Confined placental mosaisism can occur which means DNA from placenta isn’t babies…
32
When is CVS done?
Weeks 11-14, if there’s indication (higher chance of aneuploidy)
33
When is amniocentesis done
15-20 weeks
34
When doing CVS or amniocentesis, do we consider Rh risks
Yes, give RhoGAM
35
All HIV positive preg mums should receive what?
ART
36
If HIV viral load in mum is >1000… do we need any delivery changes
Yes. C sec and give IV zidovudine
37
If fetal HIV count above 50… give what?
ART
38
If fetal HIV count below 50… give what?
Zidovudine for 4-6 weeks
39
We all know babies get Hep B Vx given at birth… but what is mum is Hep B +
Vx and HBIg
40
Do we test for chlamydia and gonorrhea? In preg
Yes, at 1st visit, do a swab
41
If preg woman positive for gonorrhea? Mx?
Ceftriaxone and Azithromycin (test if cured 2 weeks after)
42
Tx for pregnancy women with toxo
Pyr-sulf for mum and fetus
43
If trep and non trep test are positive in first trimester… do what?
Penicillin G (1 dose of 1°/2° or three if 3°)
44
Parvovirus in >20 weeks women?
Weekly US (MCA Doppler). IU transfusion may be needed
45
FDA drug pregnancy class
A
B
C
D
X
A no risk and human studies done
B no risk but animal studies done
C no studies done
D evidence of risk
X risk
46
What is the non stress test?
At 32 weeks, check fetal movements and HR
47
Reactive non stress test?
2 accelerations in HR in 20 mins. Good sign
48
Non-Reactive non stress test?
No accelerations in 40 mins… potentially a bad sign. Try again in 30 mins
49
Uterine artery Doppler. What does REDV and AEDV mean?
Reverse end diastolic flow - normal
Absent end diastolic flow - needs urgent delivery
50
What is the biophysical profile in pregnancy. When is it done and what 4 parameters does it measure
US and non stress test, done after 28 weeks. Tests fetal moment, tone, breathing, amniotic fluid vol, HR
51
Biophysical test if 6/10
Repeat in 24 hours
52
Biophysical test of 0-4/10
C sec
53
Amniotic fluid index normal values
10-15 cm. less than 5 = oligo. more than 24 = poly
54
More fetuses… longer or shorter preg?
Shorter
55
Difference between di/monochorionic and di/monoamniotic
56
How to diagnose twin twin transfusion syndrome
US
57
How to diagnose twin twin transfusion syndrome
US
58
How to Mx twin twin transfusion syndrome
Expectant if mild. Laser coag to close anatomosis and amnioreduction to relieve polyhydramnios
59
(Twin A closer to cervix) both twins cephalic. How to deliver?
Vaginal delivery
60
(Twin A closer to cervix) A cephalic, B breach . How to deliver?
Try a vaginal delivery
61
(Twin A closer to cervix) A if breach. How to deliver?
C sec
62
When do we do leopald maneuvres to assess presentation?
After 36 weeks
63
If suspect breech presentation on exam, do what?
US to confirm
64
If after 36 weeks, fetus is breech, what options do we have
External cephalic conversion or elective C sec
65
After 28 weeks, how should a pregnant woman sleep
Not on back!
66
Patient has unexplained vaginal bleeding after 13 weeks…. Mx? Consider Rh, preterm
Give RhoGAM. Assess whether to admit (risk of abruption, preterm, amount of blood). Give CSs if risk of preterm birth
67
When do we invx vaginal discharge in pregnant women?
If itch, sore, smells or painful
68
Ectopic pregnancy signs occur how long after last menstrual period
4-6 weeks
69
Less than x% increase in HCG within 48 hours points toward ectopic pregnancy
35%
70
First line Invx for ectopic pregnancy
Transvag US
71
Best and diagnostic Invx for ectopic pregnancy
Exploratory laparoscopy
72
If TVUS non diagnostic for ectopic pregnancy…. Check what?
HCG every 48 hours. If increasing, likely ectopic (repeat US), if decreasing then likely abortion
73
Patient has ectopic pregnancy, and is stable, asymptomatic, HCG<5000. How to Mx
MTX and leucovorin. Monitor HCG
74
If patient has ectopic pregnancy and is symptomatic, HCG > 5000. How to Tx
Salpingostomy (preserved tubal function)
75
If patient has ruptured ectopic pregnancy. How to Tx
Salpingectomy (doesn’t preserve tubal function)
76
Threatened abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -
Vaginal bleeding - yes
Fetal activity - yes
Conception products IU
Os - closed
Px - reversible
77
Inevitable abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -
Vaginal bleeding - yes
Fetal activity - maybe ok
Conception products - visible
Os - dilated
Px - irreversible
78
Missed abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -
Vaginal bleeding - no
Fetal activity - no
Conception products - no expulsion
Os - closed
Px - irreversible
79
Incomplete abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -
Vaginal bleeding - yes
Fetal activity - no
Conception products - in cervical canal or IU
Os - Dilated
Px - irreversible
80
Complete abortion
Vaginal bleeding -
Fetal activity -
Conception products -
Os -
Px -
Vaginal bleeding - yes
Fetal activity - no
Conception products - outside uterus
Os - closed
Px - irreversible
81
Absent fetal cardiac activity and suspect spontaneous abortion… Invx?
Transvag US. And downtrending HCG
82
Threatened abortion Mx
Expectant (watch and wait)
83
Complete abortion Mx
Abx and ergot
84
Mx of inevitable incomplete or missed abortion
Expectant for 4 weeks. If nothing, then intervene.
Medically: misoprostol (+- mifepristone)
Sx: dilation and curettage (if heavy bleed or septic)
85
Concealed placental abruption presentation
Presents like preterm labour. Abd pain, rigid uterus but no bleeding
86
When to do vaginal exam placental abruption?
Don’t! Can worsen bleeding
87
Signs of placental abruption
Dark red vaginal bleeding
Abd pain, uterine tenderness
Rigid uterus
Fetal distress (decelerations and low fetal movement)
88
Is the Transabdominal US good for placental abruption
Yes…. But not ideal/reliable
89
Couvelaire uterus
In abruption, the blood extends into the myometrium then out into the peritoneum
90
Approach to abruption in stable mum and normal fetus findings. <34th week
Observe. CSs and tocolysis. Aim for normal delivery
91
Approach to abruption in stable mum and normal fetus findings. 34-36 weeks. Active uterine contractions.
Deliver
92
Approach to abruption in stable mum and normal fetus findings. 34-36 weeks. No uterine contractions.
Observe
93
Approach to abruption in stable mum and normal fetus findings. >36 weeks
Deliver
94
Approach to abruption in unstable mum and alive fetus
Emergency C sec
95
Approach to abruption in unstable mum and dead fetus
Induce vaginal delivery using meds, or c sec if risk to mum
96
Different between gestational HTN and preeclampsia
Gestational HTN is HTN after 20 weeks gestation. Preeclampsia is the same, but with Proteinuria and end organ dysfunction
97
HTN before 20 weeks gestation
Chronic HTN
98
Chronic HTN Mx
Labetelol, CCB, Methyldopa (Tx if > 160/110)
99
Hypertensive crisis in pregnancy (how to manage)
IV labetolol
100
Chronic HTN patient… if BP above 160/110… how to Mx?
Hospitalise until delivery (~34 weeks. Onward). If less than 160/110, can deliver at term
101
Workup to Invx gestational HTN
2 or more recordings of HTN >4 hours apart. Urinalysis (check for preeclampsia). FBC, LFTs, KFTs, coag and smear
102
Preeclampsia with vs without severe features
With: HTN >160/110, proteinuria, oliguria, headache, blurred vision, RUQ pain, edema, AMS
without: mild headache, edema, RUQ pain, proteinuria
103
When to hospitalise and deliver in preeclampsia without severe features
>=37 weeks (deliver) all.
Abruption suspicion
>=34 weeks and PROM, low amniotic fluid, small fetus, abnormal CTG
104
In a preeclampsia patient without severe features, whom is not indicated for delivery, how to Mx
Usual anti HTN meds, regular monitoring, and US. Educate patient to safety net
105
When to hospitalise and deliver in preeclampsia with severe features
>=34 weeks (all)
Or deliver (after stabilised) if instability present (DIC, pulmonary edema, abruption, seizure etc.)
106
Prior to delivery for a severe feature preeclampsia patient… we need to stabilise. What do we need to do
IV MgSO4, anti HTN, CSs
107
When do we do expectant managing for severe feature preeclampsia. What do we do
If <34 weeks and somewhat stable. But monitor in the ICU nonetheless
MgSO4, anti HTN, CSs, diuretics
108
HELLP sy Mx
Stabilise (fluids, transfuse, anti HTN, MgSO4). Deliver >= 34 weeks, or if status deteriorates
109
Eclampsia Mx
Stabilise (left fetal position, airway, O2), MgSO4 IV (lorazepam IV if nonresponsive). Deliver once stable and seizure stopped
110
Prevention of preeclampsia
Low dose ASA PO (daily until deliver). For women at high risk
111
Eclampsia patient gets low DTRs, resp issue and arrhythmia… likely issue?
Mg toxicity from MgSO4 Tx
112
Initial screening for gestational diabetes
oral glucose challenge (50g load, and measure glucose after 1 hour)
113
Confirmatory test for gestational diabetes
Glucose tolerance test
114
First line mx for gestational diabetes
Diet control and excersize
115
First line Tx for gestational diabetes
Insulin
116
2nd line Tx for gestational diabetes
Metformin and glyburide
117
If glycemic control poor in gestational diabetes… we can consider what 39 weeks
Delivery
118
Normally the placenta is >Xcm from the cervical Os
> 2 cm
119
Placenta previa vs low lying placenta
Previa covers Os, low lying doesn’t (but is <2cm from it)
120
Is there a soft/firm uterus in previa? Is there any fetal distress
Soft uterus and no distress (vs abruption)
121
Suspect previa… do transvag US or bimanual?
Transvag US (bimanual is CI)
122
Previa patient, identified early at ~20 weeks. How to approach
123
How to manage previa identified ~<37 weeks? Both with no bleeding and active bleeding
Bleeding? C sec
No bleeding? Expectant
124
How to manage a previa case >37 weeks
Deliver immediately
125
Advice of 3 things to avoid in previa woman
Avoid sex, activity, prolonged standing
126
If very severe previa… what can we do
Emergency caesarean hysterectomy
127
What can we do in a patient with very severe previa symptoms (bleeding)
Emergency cesarean hysterectomy
128
What could you see on speculum exam in PROM?
Amniotic fluid flowing out of cervix and pooling in fornix
129
What could be see on US in PROM?
oligohydramnios
130
Important invx in patient with PROM
Fetal heart rate monitoring
131
3 factors that determine management in premature rupture of the membranes
Gestational age, intramniotic infection, poor fetal status
132
If an unstable patient with PROM presents. How do we manage
Deliver if signs of Abruption, prolapse, infection. And give empiric Abx (while collecting cervical cultures)
133
If a stable patient with PROM presents. They are >= 37 weeks. How do we manage
Induce labour
134
If a stable patient with PROM presents. They are 34-36 weeks. How do we manage
Can induce labour or expectant
135
If a stable patient with PROM presents. They are 24-33 weeks. How do we manage
Expectant Mx
136
Expectant management in PROM includes
Bed rest
ABx (ampi and azithro then amoxi and azithro)
CSs
Tocoylsis
MgSO4
137
Shoulder dystonia usually associated with abnormality in 3 Ps of labour
Pelvis
Passenger (macrosomia or odd orientation)
Power (strength of contraction)
138
Diagnosis shoulder dystonia
Clinical!
Signs of arrested labour, turtle sign etc
139
First line Mx for shoulder dystonia
Stop bearing down
McRoberts manuever
140
Mx of amniotic fluid embolism (consider hypoxia, hypotension, anemia, coagulation)
O2 (ventilation maybe needed), vasopressors, transfuse (RBCs FFP), cesarean
141
Main invx tool to diagnose uterine rupture
US
142
Recall signs of uterine rupture
143
Recall signs of uterine rupture
144
Recall signs of uterine rupture
145
Mx of imminent uterine rupture
IV tocolysis and emergency C sec
146
Mx of uterine rupture
Laparotomy and emergency c sec. If bleeding continues, do hysterectomy
147
Confirmatory invx for the diagnosis of placenta accreta/increta
Doppler US
148
In acreta patients, what advice to we give before delivery
Avoid pelvic exams, sex, etc (prevent pre delivery)
149
Mx of acreta in labour
During third stage of labour, Give oxytocin, and uterine massage. Whilst doing a controlled traction of the cord
150
Sx options for acreta
D&C, vacuum removal, or C sec hysterectomy (main Tx)
151
Main Tx (most commonly used) for acreta
Cesarean hysterectomy. After delivery, remove uterus with placenta still attached
152
CTG changes in overt umbilical cord prolapse
Abrupt change From normal to bradycardia and severe decelerations
153
Diagnostic finding for overt umbilical cord prolapse
Pulsating cord palpable on vaginal exam
154
Initial management for overt umbilical cord prolapse
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
If repositioning didn’t work for overt umbilical cord prolapse, what next!
Amnioinfusion (if PROM), tocoylsis (if high uterine activity), C sec
156
Vasa previa definition
Umbilical vessels <2cm near os
157
How to screen and diagnose vasa previa
US
158
Mx of vasa previa if IDd before labour
CSs, admit and surveillance, C sec
159
Mx of vasa previa in labour and bleeding
Emergency c sec
160
What is a threatened abortion
Bleeding in early pregnancy, Os is closed and preg still viable
161
Tx for septic abortion
Boris spec ABx, and suction cutterage
162
Spontaneous abortion vs stillbirth/IU fetal demise
Stillbirth is pregnancy loss >20 weeks
163
Main way to Dx stillbirth
US (absent movements, uterus small, absent heart sounds)
164
Mx for stillbirth <24 weeks
Dilation and evacuation of fetus
165
Mx for stillbirth >24 weeks
Induce labour
166
What is the Kleinhauer Betke acid elution and when is it used
Used after spontaneous abortion or still birth. Detects if any HbF in material blood
167
Cervicle insufficiency Sx
Cerclage
168
Cervical insufficiency vs spontaneous abortion signs
Cervical insufficiency: recurrent 2nd trim pregnancy loss, with not bleeding or pain
169
Can we do a nuclear medicine thyroids scan in hyperthyroid pregnant women?
No!
170
2 tests to evaluate for risk of preterm delivery
Cervical length with US, fetal fibronectin (if elevated = increased risk)
171
When to give CSs (IM beta or Dexa) in preterm
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
First line tocolysis drugs? For 24-32 and 32-34 weeks
Indomethacin then Nifedipine (in ni)
173
Role of MgSO4 in preterm
Fetal Neuro protection. Give. <32 weeks.
174
2 indications for a woman to take vaginal progesterone to prevent preterm
Short cervicle length, or prior preterm pregnancy
175
Invasive Mole Tx?
MTX and actinomycin D (hysterectomy is good, if women doesn’t want kids)
176
Hydatidiform Mole Tx
Uterine suction cutterage (not often hysterectomy), and chemo is not indicated here
177
Choriocarcinoma Mx
MTX and actinomycin
178
Following treatment for mole pregnancy, and HCG doesn’t fully go down (plateaues instead)…. Could be what?
Invasive mole or choriocarcinoma
179
Should Patients after molar pregnancy be cautious about pregnancy again
Avoid pregnancy for 1 year
180
Cu IUD can cause what main side effects
Heavy menses
181
Patient has liver adenoma… which is the only contraceptive safe to use
Cu IUD
182
IUD inserted… and patient gets amenorrhea/irreg periods. Which contraceptive was used
prog IUD
183
Name 5 CId for IUDs generally
Anatomical uterine issue, AUB unexplained, PID, endometrial/cervical CA, (Prog IUD cannot be used in active liver disease or PR+ breast cancer)
184
CI for smoker for COCP
Smoker above 35, Hx if clot/thrombus, breast cancer HR+, liver adenoma, migraine with aura, HTN
185
COCP for post partum?
Not for first month (can cause thromboembolism/decrease breast milk
186
When is Cu IUD CId in post partum?
If anemic/or high post partum bleeding
187
Most effective emergency contraceptive
Cu IUD
188
Benefit of Progesterone IUD over Cu
Less bleeding
189
Copper and prog IUD, and ulipristal should be taken within X days (in emergency)
5 days
190
Oral progestin or COCP should be given within x days (for emergency contraceptive)
3
191
When give oral prog instead of COCP
If CI for COCP
192
Talk to me about the management of threatened abortion
Expectant management. Do weekly ultrasound, cereal HCG and RhoGAM
193
For inevitable, missed and incomplete abortion… How do we manage? Consider what you would do first, maybe try second, and then the last resort
Can do expectant (allow natural passage of POC). Medications (mifepristone and misoprostol). Dilation and cutterage lastly
194
Patient has inevitable, missed, incomplete abortion, and has severe bleeding or septic abortion. How do you manage
Must do dilation and cutterage
195
Stillbirth management before 24 weeks
Dilation and evacuation
196
Stillbirth management after 24 weeks
Induce labour
197
Is vaginal exam contraindicated in abruptio placentae
Yes
198
Dx? Patient presents with seven weeks of aminuria, and now has lower abdominal pain, and mild vaginal bleeding.
Ectopia Pregnancy
199
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
Likely placental abruption
200
Main to abdomen pain causes in early pregnancy
Ectopic pregnancy. Or miscarriage
201
List as many signs and symptoms of amniotic fluid embolus
Chills, shivering, sweating, anxiety, cyanosis, hypertension, bronchospasm, tachycardia, Features of DIC, consciousness altered
202
Folick acid recommendations for women
400 mg every day until 12 weeks. If on antiepileptics higher doses are recommended
203
Smoking and alcohol advice for pregnant women
Do not drink or smoke is the recommendation. But note vareniciline or bupropion are CI’d
204
Air travel advice for pregnant women
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
First line therapy for nausea and vomiting in pregnancy
Promethazine as suggested. Also considered ginger and acupuncture
206
10 conditions which or pregnant women should be screened for
Anaemia, bacteria, Rh, downs, fetal anomalies, Hep B, HIV, NTD, pre-eclampsia risk factors, syphilis
207
Two main differentials for anti-partum haemorrhage
Placental abruption and placenta previa
208
Three causes of first trimester bleeding
Spontaneous abortion, ectopic pregnancy, mole. Note that the mole anti-abortion can also be second trimester to
209
Third trimester bleeding differential
Visa previa, placenta previa, placental abruption
210
Patient has a rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia seen. What is the most likely diagnosis 
Vasa previa
211
Woman at 36 weeks or above, has breech presentation how do you manage her
External Catholic version is good. Unless patient has Caesarean. If the CV does not work and perform Caesarean.
212
CTG; variable decelerations indicate what
Likely cord compression
213
CTG; early deceleration indicate what
Often head compression
214
CTG; late deceleration often indicates what
Fetal distress, for example asphyxia or placental insufficiency
215
Extra; chorioamnionitis management
Deliver fetus, Caesarean if necessary, an admin IV antibiotics
216
If patient has a “high chance” Of having down syndrome patient baby, what are the two options we can be doing
Non-invasive screening tests (cell free fetal DNA)  or invasive tests (CVS or amniocentesis)
217
Magnesium toxicity in magnesium sulphate patience. What is the antidote
Calcium gluconate
218
Newly diagnosed gestational diabetes patient. Glucose still less than seven (126 mg/dl). First line and second line
Lifestyle its first line. If the glucose target not met within one to 2 weeks start Metformin
219
In what circumstances do we use insulin for gestational diabetes
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
When are women swabbed for GBS in pregnancy
At 35 to 37 weeks. Or 3 to 5 weeks prior to anticipated delivery date.
221
When should we give intrapartum antibiotic prophylaxis for GBS. What do we give
Previous pregnancy with GBS, pyrexia during labour, Preterm. Give benzylpenicillin 
222
Does Caesarean lower the transmission rate for hepatitis B in pregnancy
No evidence
223
When can we do vaginal delivery in HIV women
If viral load is less than 50
224
Before doing Caesarean section in HIV patient. What should be given four hours before
Zidovudine infusion
225
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?
Less than 50 give zidovudine. More than 50 give ART
226
First line for gestational hypertension
Labetalol. Nifedipine if asthmatic
227
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
If in distress do immediate Caesarean. If not in distress observe closely, do tocolysis, give steroids, prevent pregnancy
228
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
If in distress do immediate Caesarean. If no distress do vaginal delivery
229
Vaginal delivery only ok if HIV less than ?
50
230
HIV less than 50 in fetus = give what
HIV more than 50 in fetus = give what
zidovudine
ART
231
If HIV load more than 50, what do we do
c sec and IV zidovudine 4 hours before
232
Deepest pocket of amniotic fluid should be how big?
2 or more cm. Amniotwoic
233
decelerations recap
Accel and decel are normal.... but not all decel are!
234
placenta previa vs abruption; transabd or transvag
transvag for previa, transabd for abruptio
235
CIs for tocolysis
chorioam, abruptio, dodgy CTG, risk of cord prolapse, advanced labour
236
what is mcRoberts
what is Rubin, Woods, posterior arm
what is Gaskin
what is fracture of clavicle
what is zavanelli
what is symphysiotomy
237
Mx for imminent uterine rupture?
tocolysis and c sec
238
NICE guidelines reccomendations for preterm labour, in terms of best tocolysis
Nifedipine or atosiban
239
only contraceptive which doesn't return fertility straight away
IM prog
240
contraceptives that can give up to 5 days after
ANY IUD, or uliprsital. OCP are 3 days only
241
post partum contraceptive Mx?
Not COCP for 1st month. Not Cu if had high post partum hem.
242
1st line for N/V in preg
promethazine (antiH)
243
patient who has Hx of previous GD.... what should be done to check glucose...
straight to an OGTT at 24-28 weeks
244
how much proteinuria needed for preeclampsia Dx
300mg
