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CP2 OBS > Passmedicine Knowledge > Flashcards

Passmedicine Knowledge Flashcards

1
Q

Presentation of placental abruption

A

Severe abdominal pain in third trimester
Cold mother
Bleeding in 80% cases (not always)

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2
Q

Tx of PPROM?

A

10 days erythromycin

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3
Q

Contraindications of VBAC?

A

Classical Caesarean scar

other contraindications = praevia

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4
Q

MCC of PPH?

A

Atony

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5
Q

Other causes of PPH?

A

Tone
Tissue
Trauma
Thrombin

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6
Q

Risk factors for primary PPH?

A 
Previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency C-section
placenta praevia, placenta accreta
macrosomia
ritodrine
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7
Q

Mx of Primary pph?

A

ABC
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
surgical:
b-lynch suture, ligation of uterine arteries or internal iliac arteries

hysterectomy

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8
Q

Tx for babies born to mother with acute hepatitis B during pregnancy

A

complete course of vaccination and hepatitis B immunoglobulin

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9
Q

Causes of bleeding in 1st trimester

A

spontaneous abortion
ectopic pregnancy
hydatidiform mole

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10
Q

Causes of bleeding in 2nd trimester

A

Spontaneous abortion
hydatidiform mole
placental abruption

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11
Q

Causes of bleeding in 3rd trimester

A

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

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12
Q

Presentation of ectopic pregnancy

A

6-8 weeks amenorrhoea
lower abdominal pain
may be shoulder tip pain and cervical excitation

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13
Q

Presentation of hydatidiform mole

A

Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy: hyperemesis

LFD uterus
serum hcg may be very high

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14
Q

presentation of placental abruption?

A

constant lower abdominal pain
women may be more shocked than is expected by visible blood loss

tender, tense uterus with normal lie and presentation

fetal heart distressed

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15
Q

presentation of placental praevia?

A

vaginal bleeding, no pain

non tender uterus but presentation may be abnormal

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16
Q

presentation of vasa praevia?

A

rupture of membranes followed immediately by vaginal bleeding

fetal bradycardia is classically seen

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17
Q

Cord prolapse position

A

all fours

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18
Q

risk factors for cord prolapse

A 
prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic distortion
abnormal presentations 
placenta praevia
long umbilical cord
high fetal station
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19
Q

Classification of tears:

A

1st: superficial damage with no muscle involvement t
2nd: injury to perineal muscle but not involving the anal sphincter
3rd: injury to perineum, involving anal sphincter complex
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn

4th: injury to perineum involving anal sphincter complex

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20
Q

McRobert’s manœuvre position

A

This manoeuvre entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen

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21
Q

Tx of varicella exposure in pregnancy?

A

Varicella zoster immunoglobulin

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22
Q

Presentation of chorioamnionitis?

A

uterine tenderness and foul-smelling discharge

Preterm PPROMM + pyrexia, maternal/foetal tachycardia

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23
Q

Placenta accreta

A

attachment of the placenta to the myometrium due to a defective decidua basalts

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24
Q

Risk factors for placenta accreta?

A

previous Caesarean section

placenta praevia

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25
Q

Elements of the combined test

A

Nuchal translucency

beta-hCG and PAPPA + CRL

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26
Q

Combined test results for Downs syndrome

A

low PAPPA and high beta hCG

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27
Q

quadruple test components

A

AFP
unconjugated oestriol
beta-hCG
inhibin A

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28
Q

Placenta praevia associated factors?

A

Multiparity

multiple pregnancy

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29
Q

Mx of shoulder dystocia in labour

A

Help

Do not use fundal pressure

McRobert’s manœuvre = first line intervention

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30
Q

Tx of suspected PE in pregnancy?

A

ECG and chest X ray

compression duplex USS

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31
Q

Antenatal care:

8-12 weeks

A

booking visit: general info
BP, using dipstick, check BMI

Booking bloods/urine:
FBC, blood group, rhesus, red cell alloantibodies, haemoglobinopathies
hepatitis, syphilis, rubella
HIV
urine culture - asymptomatic bacteriuria
32
Q

antenatal care 10-13+6 weeks

A

early scan to confirm dates, exclude multiple pregnancy

33
Q

antenatal care 11-13+6 weeks

A

Down’s syndrome screening including nuchal scan

34
Q

antenatal care: 16 weeks

A

information on anomaly and blood results. If Hb <11g/dl consider iron

Routine care: BP and urine dipstick

35
Q

antenatal care: 18-20+6 weeks

A

anomaly scan

36
Q

antenatal care 28 weeks:

A

Urine dip, BP, SFH

Second screen for anaemia and atypical red blood cells
anti-D prophylaxis if needed

37
Q

antenatal care 34 weeks

A

routine care

second dose of anti-D

38
Q

antenatal care 36 weeks

A

routine care

check presentation - offer external cephalic version if indicated
information on breast feeding, vitamin K, baby blues

39
Q

40-41

A

routine care

labour plans, prolonged pregnancy plans

40
Q

What does low/high AFP indicate?

A

Increased: NTD, fetal abdominal wall defects, multiple pregnancy

Decreased: Down’s syndrome, trisomy 18, maternal diabetes mellitus

41
Q

Abnormal features on CTG

A

Single prolonged deceleration lasting 3 minutes or more

Variable decelerations occurring with over 50% of contractions

In labour: variability <5bpm

42
Q

Intrahepatic obstetric cholestasis presentation

A

pruritus
no rash
raised bilirubin
High ALP and GGT, lesser rise in ALT

43
Q

Features of acute fatty liver of pregnancy

A 
abdominal pain
nausea and vomiting 
headache
jaundice
hypoglycaemia
44
Q

Pre-eclampsia high risk factors

A 
hypertensive disease in a previous pregnancy
chronic kidney disease
autoimmune disease
t1/t2DM
chronic hypertension
45
Q

Pre-eclampsia moderate risk factors

A 
first pregnancy
40 years or older
pregnancy interval of more than 10 years
35+ BMI
FH of pre-eclampsia
multiple pregnancy
46
Q

Causes of oligohydramnios

A 
premature rupture of membranes
fetal renal problems e.g. renal agenesis 
intrauterine growth restriction
post-term gestation 
pre-eclampsia
47
Q

management of cord prolapse

A
  1. tocolytics to reduce cord compression
  2. presenting part of foetus may be pushed back into uterus
  3. patient advised to go on all fours
  4. emergency c section
  5. If delivering - hand into vagina to elevate presenting part
48
Q

GBS management in labour

A

IV Abx for mum

49
Q

HELLP syndrome presentation

A

haemolysis, elevated liver enzymes, low platelets

50
Q

Drugs contraindicated in breastfeeding

A

abx: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

Psychiatric: lithium, BDZ

Aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
51
Q

What is the name of the depression scale for Post natal depression?

A

Edinburgh scale

52
Q

Placenta praevia investigations

A

transvaginal USS

53
Q

Drug to reverse respiratory depression caused by magnesium sulphate?

A

Calcium gluconate

54
Q

Obstetric cholestasis treatment?

A

Induction of labour at 37 weeks

Ursodeoxycholic acid

Vitamin K supplementation

55
Q

Secondary prevention of women with pre-eclampsia?

A

Low dose aspirin to reduce risk of babies being born SGA

56
Q

When can gestational hypertension be recognised?

A

after 20 weeks

57
Q

Which markers indicate downs syndrome?

A 
low AFP
low oestriol
High HCG 
Low PAPPA 
thickened nuchal translucency
58
Q

What is a molar pregnancy?

A

significantly high levels of beta hCG for gestational age - marker of gestational trophoblastic disease. beta hCG has a similar structure to LH, FSH and TSH, so can produce higher levels of thyroxine (symptoms of thyrotoxicosis)

59
Q

What is the treatment for women with high VTE risk?

A

4 risk factors: LMWH until 6 weeks postpartum (DOAC and warfarin avoided)

3 risk factors: heparin from 28 weeks until 6 weeks postnatal

60
Q

What are the causes of puerperal pyrexia?

A

Endometritis - needs treating with IV clindamycin and gentamicin)
UTI
wound infections (perineal tears and Caesarean section)
mastitis
venous thromboembolism

61
Q

What are the features of HELLP syndrome?

A

haemolysis
elevated liver enzymes
low platelets

62
Q

Which layers of the abdominal wall are cut through in C-section?

A 
Skin
Superficial fascia
Deep fascia
Anterior rectus sheath 
Rectus abdominis muscle
Transversalis fascia
exztraperitoneal connective tissue
Peritoneum
Uterus
63
Q

What are the indications of C-section?

A 
absolute cephalopelvic disproportion 
placenta praevia grades 3/4 
pre-eclampsia
post-maturity
IUGR
fetal distress in labour/prolapsed cord
failure of labour to progress
malpresentations: brow
placental abruption: only if fetal distress 
vaginal infection e.g. active herpes
cervical cancer (disseminates cancer cells)
64
Q

What is the wood screw manoeuvre?

A

Action of putting a hand in the vagina and rotating the foetus 180 degrees

65
Q

What is McRobert’s position?

A

hyperflex the mother’s legs onto her abdomen and apply suprapubic pressure

66
Q

What is the Rubin manoeuvre?

A

press on the posterior shoulder to allow the anterior shoulder extra room

67
Q

What is the management of puerperal mastitis?

A
  1. Continue breast feeding - improves milk removal
  2. Antibiotics if lady has infected nipple fissure, symptoms do not improve / are worsening after 12-24 hours despite effective milk removal or bacterial culture positive.
    flucloxacillin 500 mg qds for 14 days
68
Q

What test is used to monitor DVT treatment with LMWH in obese women?

A

anti Xa activity

69
Q

Steps of PPH treatment

A
  1. bimanual uterine compression
  2. IV oxytocin/ergometrin
  3. IM carboprost
  4. Intramyometrial carboprost
  5. rectal misoprostol
  6. surgical intervention
70
Q

What is vasa praevia?

What is the presentation?

A

Vasa praevia describes a complication in which fetal blood vessels cross or run near the internal orifice of the uterus. The vessels can be easily compromised when supporting membranes rupture, leading to frank bleeding.

The classic triad of vasa praevia is rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.

71
Q

What is the presentation of placenta accreta?

A

Delayed third stage of labour

underlying RF: previous section + previous PID

Definitive treatment = hysterectomy

72
Q

What is placenta accreta?

A

Attachment of the placenta to the myometrium due to a defective decidua basalis

73
Q

Under what circumstances can you perform ECV in a transverse lie?

A

At 36 weeks if the amniotic membrane has not ruptured

74
Q

What is Sheehan’s syndrome?

A

Complication of PPH in which the pituitary gland undergoes necrosis which can manifest as hypopituitarism

Lack of postpartum milk production and amenorrhoea following delivery

75
Q

What is the indication of positive fetal fibronectin?

A

Having a high level has been shown to be related with early labour

Give 2 doses steroids and monitor BMs

76
Q

What is the most common cause of umbilical cord prolapse?

A

ARM

CP2 OBS (20 decks)

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