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Obs > Other Important Topics > Flashcards

Other Important Topics Flashcards

1
Q

What is a bradycardia?

A

Deceleration (drop in the baseline >15 for >15 seconds) that goes on longer than 3 minutes

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2
Q

Causes of fetal bradycardia

A

drop in blood pressure, change in position

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3
Q

Management of fetal bradycardia

A

Change position (usually try left lateral)
Examine
If does not recover, immediate delivery by quickest / safest route

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4
Q

Is a CTG invasive?

A

No, it is a non-invasive method of monitoring foetal heart rate and uterine contractions during pregnancy and labour.

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5
Q

Mnemonic for interpretation of a CTG

A

DR C BRAVADO
Define Risk
Contractions
Baseline Rate
Variability
Accelerations
Decelerations
Overall Impression

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6
Q

When defining risk on a CTG, what pre-existing features suggest a high risk?

A

Gestational diabetes
Hypertension
Asthma
Multiple gestation
Post-term pregnancy
Previous C-section
IUGR
PPROM
Congenital malformations
Pre-eclampsia

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7
Q

When assessing contractions on a CTG, what should you do?

A

Record number of contractions over a 10 minute period
1 big square = 1 minute
Assess duration and intensity of contractions

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8
Q

When assessing contractions on a CTG, how long should you do it for?

A

10 mins

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9
Q

What does 1 big square on a CTG equal?

A

1 minute

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10
Q

When assessing baseline rate on a CTG, what is the normal range?

A

Normal Range: 110-160 bpm

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11
Q

What is a bradycardia on CTG?

A

<100 beats per min

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12
Q

What is a tachycardia on CTG?

A

> 160 beats per min

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13
Q

Causes of fetal tachycardia

A

Foetal hypoxia
Hyperthyroidism
Anaemia
Infection

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14
Q

Causes of foetal bradycardia

A

Cord prolapse
Cord compression
Anaesthesia
Maternal seizures

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15
Q

What is the normal baseline variability on a CTG?

A

5-25BPM

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16
Q

Causes of abnormal baseline variability

A

Foetal sleep

Hypoxia
Infection
Drugs (e.g. opioids, magnesium)
Prematurity
Congenital heart defects

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17
Q

What are accelerations defined as?

A

Definition: Increase in baseline heart rate of > 15 bpm for > 15 seconds

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18
Q

What do the presence of accelerations on a CTG suggest?

A

The presence of accelerations during contractions is reassuring and suggestive of a healthy foetus

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19
Q

What are decelerations defined as?

A

Definition: Decrease in baseline heart rate of > 15 bpm for > 15 seconds

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20
Q

Types of deceleration

A

Early
Late
Variable
Prolonged
Sinusoidal

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21
Q

What are early decelerations?

A

Begins with the onset of a contraction and recovers once the contractions ends
This is physiological and caused by increased vagal tone and intracranial pressure during a contraction

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22
Q

What are early decelerations caused by?

A

physiological and caused by increased vagal tone and intracranial pressure during a contraction

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23
Q

What are late decelerations?

A

Begins at the peak of a contraction and recovers after the contraction ends
Caused by reduced uteroplacental blood flow which results in foetal hypoxia and acidosis
Causes include maternal hypotension, pre-eclampsia and uterine hyperstimulation

24
Q

What are late decelerations caused by?

A

Caused by reduced uteroplacental blood flow which results in foetal hypoxia and acidosis
Causes include maternal hypotension, pre-eclampsia and uterine hyperstimulation

25
Q

What are variable deeclerations?

A

There appears to be no relationship between the decelerations and uterine contractions
Caused by compression of the umbilical cord

26
Q

What are variable deceleraitons caused by?

A

Caused by compression of the umbilical cord

27
Q

What are prolonged decelerations?

A

If lasting 2-3 minutes it is considered non-reassuring, and if it is > 3 mins it is considered abnormal

28
Q

When are decelerations classed as non-reassuring?

A

If lasting 2-3 minutes it is considered non-reassuring,

29
Q

When are decelerations classed as abnormal?

A

> 3 mins it is considered abnormal

30
Q

What is a sinusoidal pattern of decelerations?

A

Extremely concerning sign that is associated with severe foetal anaemia or hypoxia

31
Q

What are a sinusoidal pattern of decelerations associated with?

A

severe foetal anaemia or hypoxia

32
Q

How can an overall CTG be described?

A

as reassuring, non-reassuring or abnormal

33
Q

What post-partum mental health conditions are there?

A

Baby Blues

Postnatal Depression: persistent low mood, low energy and/or lack of enjoyment of usual activities that begins around the time of birth and lasts for longer than 2 weeks

Puerperal Psychosis: development of delusions and hallucinations in the peripartum period

34
Q

What is postnatal depression?

A

persistent low mood, low energy and/or lack of enjoyment of usual activities that begins around the time of birth and lasts for longer than 2 weeks

35
Q

What is puerperal psychosis?

A

development of delusions and hallucinations in the peripartum period

36
Q

Presentation of the baby blues

A

Features: Low mood, irritability and emotional lability

37
Q

Management of the baby blues

A

Management: Resolves spontaneously relatively soon after childbirth

38
Q

Features of postnatal depression

A

Features: Persistent low mood, low energy and/or lack of enjoyment of usual activities. Patients may complain of feelings of worthlessness, inadequacy and difficulties bonding with the baby.

39
Q

PACES: What is important to screen patients with postnatal depression for?

A

thoughts about harming themselves or harming their baby

40
Q

PACES: What screening tools can be used for postnatal depression?

A

Edinburgh Postnatal Depression Scale
Whooley Questions

41
Q

Management of postnatal depression?

A

Important to avoid separating mother and baby where possible
CBT
SSRIs
Sertraline and paroxetine are generally considered safe options in pregnancy and breastfeeding

42
Q

Which SSRIs are safe to use in pregnancy and breastfeeding?

A

Sertraline and paroxetine are generally considered safe options in pregnancy and breastfeeding

43
Q

Features of puerperal psychosis

A

Features: Delusions and hallucinations usually relating to the baby. May also demonstrate unusual behaviour, disinhibition and irritability. Usually presents within the first 6 weeks of childbirth.

44
Q

Management of puerperal psychosis

A

If the patient is thought to pose a risk to themselves or their baby, they need to be admitted to a mother and baby unit
They are likely to be started on antipsychotic medications
Electroconvulsive therapy may be considered
Talking therapies

45
Q

If the mother is thought to pose a risk to themselves or their baby, where should they be admitted?

A

mother & baby unit

46
Q

What medication are patients with puerperal psychosis likely to be started on?

A

Antipsychotic medications

47
Q

What is post partum thyroiditis?

A

Abnormal thyroid function arising in the first year after childbirth.

48
Q

Stages of post partum thyroiditis

A

Hyperthyroid (usually for the first 3 months)
Hypothyroid (occurs once the stores of thyroid hormone are depleted and the follicular cells are too damaged to generate more thyroid hormone)
Euthyroid (usually occurs within 1 year)

49
Q

How does post partum thyroiditis present?

A

Features of hyperthyroidism or hypothyroidism

50
Q

Investigations for post partum thyroiditis

A

Bloods
TFTs
Anti-TPO Antibodies
Anti-Thyroglobulin Antibodies

Imaging & Other
Thyroid Uptake Scan

51
Q

Management of post partum thyroiditis

A

Hyperthyroid Phase
Symptomatic management usually with propranolol
Carbimazole may be considered in some cases

Hypothyroid Phase
Thyroxine replacement

52
Q

Risks associated with smoking in pregnancy

A

Miscarriage
Preterm Birth
Stillbirth
Intrauterine Growth Restriction
Sudden Infant Death Syndrome

53
Q

Risks associated with alcohol in pregnancy

A

Foetal Alcohol Syndrome

54
Q

Presentation of foetal alcohol syndrome

A

Smooth or absent philtrum
Learning difficulties
Microcephaly
Growth retardation
Cardiac malformation

55
Q
A

Obs (5 decks)

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