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My Phase 3a cards > Obstetrics Peer Teaching > Flashcards

Obstetrics Peer Teaching Flashcards

1
Q

What tests are done at a pregnant woman’s first visit?

A

urine sample, haemaglobin, blood group
syphilis and rubella serology
HIV screening

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2
Q

What is the 11-13 weeks scan for?

A

How many fetuses, nuchal translucency, dating scan

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3
Q

What is the 20 week scan for?

A

fetal anomaly

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4
Q

What is checked at 36 and 37 weeks?

A

Lie and presentation of the baby

Head engaged at 37 weeks

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5
Q

What are the “latent” and “established” phases of the 1st stage of labour

A

Latent: dilated <4cm
Established: dilated >4cm and contractions

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6
Q

What are the “active” and “passive” phases of 2nd stage of labour?

A 
Passive = fully dilated, not pushing
Active = pushing
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7
Q

How long does the first stage of labor take?

A

Nulliparous: 8-12
Multiparous: 5-12

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8
Q

How long does the 2nd stage take?

A

Nulliparous: 3 hours
Multiparous: 2 hours

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9
Q

What is pre-eclampsia?

A

Hypertension and proteinuria in pregnancy

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10
Q

What are the symptoms of pre-eclampsia?

A

Shakinf, flu-like symptoms, visual changes and hyperreflexia

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11
Q

What is the cure for pre-eclampsia?

A

Delivery

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12
Q

How to prevent pre-eclampsia from becoming eclampsia?

A

Magnesium sulfate, MgSO4

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13
Q

Wha tis the pathophysiology of pre-eclampsia?

A

Failure of spiral arteries to embed properly into the trophoblast, causing an ncrease ion blood pressure to compensate

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14
Q

When should someone with pre-eclampsia be admitted?

A

BP 160/100

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15
Q

When should someone with pre-eclampsia be admitted if there is proteinurea or IUGR?

A

140/90 BP

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16
Q

If a pregnant woman is in shock but there appears to be little blood loss what is the diagnosis?

A

Concealed placental abruption

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17
Q

When would you feel a “woody” uterus?

A

Placental abruption

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18
Q

What is placenta praevia?

A

Placenta lies on the lower segment of the uterus

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19
Q

What are the symptoms of placentsa praevia?

A

Abnormal lie of fetus, painless bleeding

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20
Q

What should you not do if you suspect placenta praevia? Why?

A

A vaginal examination, because of the risk of beeding

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21
Q

What effects would maternal rubella infection have on the developing fetus?

A
  1. Deafness
  2. Cataracts
  3. Cardiac abnormalities
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22
Q

What effects would maternal cytomegalovirus infection have on the developing fetus?

A

cognitive impairment

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23
Q

How should a pregnant woman avoid listeria infection

A

Avoid soft cheese`

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24
Q

How should you initially manage a 28 week premature delivery?

A

Wrap in plastic and put under heat lamp, don’t dry

Delay cord cutting for 3 minutes.

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25
Q

What constitutes as a delay in 2st stage of labour?

A

<2cm/hr dilation in 4 hours

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26
Q

What treatment should you use in delayed labor?

A

Oxytocin

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27
Q

What is delayed 2nd labour?

A

When delivery isn’t imminent after 2 hours of pushing in a nulliparous woman and 1 hour for a parous woman

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28
Q

What should you do if there is a delay in 2nd stage?

A

a. Amniotomy
b. forceps
c. c-section

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29
Q

How should a diabetic woman trying for a baby be managed?

A

5mg folic acid preconception

Control diabetes

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30
Q

When should you deliver a baby in a maternal diabetic?

A

38 Weeks

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31
Q

What is the medical treatment for pre-eclampsia where the BP is >150/100

A

oral labetalol

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32
Q

What does blood pressure do in normal pregnancy?

A

Falls initially until 20-24 weeks then returns to pre pregnancy levels by term

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33
Q

What counts as hypertension in pregnancy?

A

140/90 OR 30 increase in systolic and 15 increase in diastolic

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34
Q

Give 3 high-risk factors for pre-eclampsia

A

CKD
SLE
Diabetes
previous pre-eclampsia

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35
Q

What is pre-eclampsia?

A

Hypertension + proteinuria >0.3g/day

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36
Q

What is HELLP syndrome?

A

Haemolysis, elevated liver enzymes, low platelets

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37
Q

Give 3 things that can be caused by pre-eclampsia?

A

IUGR, prematurity
kidney failure
placental abruption

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38
Q

What are features of severe pre-eclampsia?

A

170/110
headache/visual disturbance
papilloedema

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39
Q

When would you deliver in pre-eclampsia?

A

if mild, 37 weeks
If moderate/severe: 34-36 weeks
If there is maternal complications always deliver

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40
Q

What is eclampsia?

A

Pre-eclampsia + seizures

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41
Q

What is the treatment for eclampsia?

A

Magnesium sulfate

42
Q

How should MgSO4 be administered?

A

4g IV bolus over 5/10 minutes followed by an infusion of 1g/hr

43
Q

How long should MgSO4 treatment last?

A

24 hours after last seizure or delivery, whichever is last

44
Q

What is the most common pathogen in the mother causing neonatal sepsis/

A

Group B strep

45
Q

What are risk factors for developing neonatal sepsis?

A

Prolonged rpture of membranes
sibling with group B strep infection
maternal pyrexia

46
Q

What prophylaxis is given for group B strep?

A

Benzylpenicillin

47
Q

Name 4 causes of antepartum haemorrhage

A

placenta praevia
placental abruption
uterine abruption
vasa praevia

48
Q

What is the classis symptom of placenta praevia?

A

Painless vaginal bleeding

49
Q

What is a major placenta praevie?

A

where the placenta covers the os - type 3 and 4

50
Q

What is the managements of placenta praevia?

A

anti-D if rhesus -ve, c section at 39 weeks, steroids if <34 weeks gestation

51
Q

Should you be worried if the placenta is low lying at 20 weeks?

A

No - At 20 weeks placenta is low-lying in most pregnancies but appears to move upwards with time as the formation of the lower segment of the uterus occurs in the third trimester

52
Q

What are some risk factors for placental abruption?

A 
Previous abruption
Smoking
IUGR
pre eclampsia
pre-existing hypertension
53
Q

A patient presents with painful bleeding, a woody hard uterus, and appears to be shocked - what is the diagnosis?

A

Placental abruption

54
Q

What maternal investigations need to be performed in suspected placental abruption?

A

FBC, Coag screem cross-match, U&E, urine output

55
Q

What is the management for placental abruption?

A

anti-D, steroids if <34 weeks, C/S if fetal distress, induce labout >37 weeks
Blood transfusion if necessary

56
Q

What are the cardinal movements of labour?

A 
Engagement.
Descent.
Flexion.
Internal rotation.
Extension.
External rotation/restitution.
Expulsion.
57
Q
  1. Describe engagement
A

Head enters pelvis in occipito-transverse position.
OR
Widest part of the presenting part becomes level with the pelvic inlet

58
Q
  1. Describe descent
A

Passage of the widest presenting part through the pelvis

59
Q
  1. Describe flexion
A

Fetal head flexes as it is pushed downwards

60
Q
  1. Describe internal rotation
A

Head rotates 45 degrees

61
Q
  1. Describe extension
A

Fetal head faces the sacrum, occiput in contact with the symphisis pubis

62
Q
  1. Describe restitution/external rotation
A

Fetal head turns to be in line with its torse so shoulders can be delivered

63
Q
  1. Describe expulsion
A

Delivery of the fetal body

64
Q

What are the 3 Ps?

A

Mechanical factors determining the progress of labour: passenger, passage and power i.e. width of head, pelvis and strength of contractions

65
Q

What is the management of failre to progreess in labour in the first stage of a nulliparous woman?

A

amniotomy then oxytocin then c-section

66
Q

Management for failure to progress in passive 2nd stage?

A

2 hour wait before pushing, give oxytocin

67
Q

Management for failure to progress in active 2nd stage?

A

episiotimy if head is against the perineum, ventouse if not

68
Q

What can obstruct the passage of the fetus during delivery?

A

cephalo-pelvic disproportion
pelvic mass e.g. fibroid
abnormal pelvic architecture e.g. poorly healed pelvic fracture

69
Q

What is the OP position? What are the features?

A

Occiputo-posterior “back to back”

  • back ache
  • more painful and longer labour
  • early desire to push
70
Q

What is the OT position?

A

Occipito-transverse
Incomplete internal rotation
Ventouse needed

71
Q

What is the brow position?

A

Fetal head extended, large presenting diameter - nose and anterior fontanelle may be palpable

72
Q

What is the management of brow position?

A

C-section

73
Q

What are the factors that determine the bishop score?

A

Cervical dilation, effacement, and consistency

Position of the fetus and station of the fetal head

74
Q

What does a bishop score of <6 mean?

A

Unlikely to go into spontaneous labour, not suitable for induction

75
Q

What does a bishop score of >8 mean?

A

Likely to go into spontaneous labour, suitable for inductinop

76
Q

What is the first line induction of labour?

A

Membrane sweep - separate the membranes away from the cervix manually

77
Q

What is the 2nd line induction of labour?

A

Prostaglandin gel vaginally 2mg, 2 doses maximum

78
Q

What is the 3rd line induction of labour?

A

Amniotomy + oxytocin 2 hours later if still not progressing

79
Q

Give some fetal indications for induction of labout?

A

post term pregnancy, IUGR

80
Q

Gice some materno-fetal indication for induction of labour?

A

Diabetes, pre-eclampsia

81
Q

What are the maternal complications of shoulder dystocia?

A

perineal tears, PPH, urethral and bladder injuries

82
Q

What are the fetal complications of shoulder dystocia?

A

Erb’s palsy - brachial plexus injury

Hypoxic ischaemic encephalopathy

83
Q

What are risk factors for shoulder dystocia?

A

Diabetes, high maternal BMI, macrosomia

84
Q

What manouvre should be used in shoulder dystocia? Describe it.

A

McRoberts manouvre - flex thighs towards abdomen

Apply suprapubic pressure

85
Q

What is the management for cord prolapse?

A

Delivery

86
Q

When is the cord more likely to prolapse?

A

When the fetal head is not engaged in the pelvis

87
Q

What are risk factors for cord prolapse?

A

Polyhydramnios
Multiple pregnancy
Low lying placenta
Abnormal lie

88
Q

What is a risk factor for uterine rupture?

A

Previous c-section (or traumatic injury)

89
Q

Shock, severe abdominal pain which persists between contractions, vaginal bleeding and CTG abnormalities during labour indicate what?

A

Uterine rupture

90
Q

What might you see on CTG in uterine rupture?

A

Fetal Bradycardia

91
Q

How does amniotic fluid embolism present?

A

like a PE, with collapse

92
Q

How is fetal distressed measured?

A

fetal blood gas, CTG, fetal ECG

93
Q

What is fetal distress?

A

Hypoxia which may cause damage or death to the fetus if left unresolved.

94
Q

How do you interpret a CTG?

A

Dr C Brvado
DR - Define Risk
Contractions - how many in 10 minutes? More than 5 is hyperstimulation
Baseline Rate - 110-160
Accelerations in fetal heart rate with movement or contractions are reassuring
Decelerations
Overall assessment

95
Q

What do early, variable and late decelerations indicate?

A

Early - benign
Variable - cord compression
Late - persist after contractions, suggesting fetal hypoxia

96
Q

What is the first line management of primary PPH?

A

IV syntocinon followed by 0.5mg ergometrine

97
Q

What are the risk factors for PPH?

A

polyhydramnios, pre eclmapsia, prolonged labour, macrosomia, previous PPH

98
Q

What is the most common cause of PPH?

A

Uterine atony

99
Q

What are the causes of secondary PPH?

A

endometritis, retained placental tissue

100
Q

What is the scoring system for post natal depression?

A

Edinburgh scale

My Phase 3a cards (11 decks)

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