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Semester 6 > Perinatal > Flashcards

Perinatal Flashcards

0
Q

A woman should book for antenatal care when…

A

She has missed her 2nd period

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1
Q

Extra uterine pregnancy suggested by…

A

Lower abdo pain and vaginal bleeding

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2
Q

What C/S patient can have a vaginal labour?

A

Transverse lower segment incision with a non-recurring problem

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3
Q

The LMP can be used to calculate duration of preg if

A

Patient has regular cycle and not on contraception.

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4
Q

Abdo exam is useful for duration of pregnancy from

A

13-17 weeks

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5
Q

Uss accurate for dates until

A

24 weeks

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6
Q

Active syphilis

A

+ RPR

+ TPHA

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7
Q

Positive RPR if titre is more than

A

1:16

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8
Q

Syphilis treated in preg with

A

Benzathene penicillin

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9
Q

How often must a low risk preg mum visit clinic between 28 and 34 weeks

A

No visit is required

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10
Q

Visit at week 34 is NB because

A

The lie and presentation become NB and have to be determined

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11
Q

Oesophageal candidiasis = what HIV stage

A

4

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12
Q

ARV prophylaxis provided with what drugs

A

AZT and nevirapine

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13
Q

Which clinical technique is best to measure uterine growth between 18 and 36 weeks

A

Sf height

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14
Q

Which sf height = intrauterine growth restriction

A

Slowing of sf height til 1 is below 10th centile

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15
Q

Severe intrauterine growth restriction = ? Weeks difference between gest age and sf height

A

4 weeks or more

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16
Q

Growth restriction at 32 weeks

, what must be done?

A

Refer to level 2 hospital for Doppler umbilical artery flow

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17
Q

Antenatal fetal condition determined by

A

Number of fetal movements

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18
Q

Essential to determine fetal condition from ? Weeks

A

28 weeks

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19
Q

Who needs a fetal movement chart

A

All mums where there is a reason to be worried about fetal condition

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20
Q

When to worry about decrease fetal movement

A

Less than half previously counted movements

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21
Q

Patients reports few fetal movements in hour. What to do?

A

Ask them to lie on side and count movement for further hour

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22
Q

Management for reduced fetal movement when there is no ctg.

A

Exclude death by listening for fetal heart

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23
Q

Who should get antenatal fetal hr monitoring?

A

High risk pt where fetal movements not reliable eg. Insulin dependent diabetics, pure labour ROM, conservatively managed preeclampsia

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24
Q

Non reactive fetal hr pattern?

A

Assess beat to beat variability to determine fetal well being

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25
Q

Why repeat fetal hr pattern test 45 mins later if beat to beat variability is poor?

A

Sleeping fetus can produce non reactive fetal hr pattern and poor beat to beat variability

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26
Q

Abnormal stress test equals

A

Uterine contractions with late decelerations

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27
Q

Late deceleration defined as…

A

Biggest decrease in hr occurs 30 or more after peak of contraction.

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28
Q

What to do if abnormal stress test?

A

Rule out false positives. Eg
Postural hypotension
Spontaneous overstimulation of uterus

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29
Q

Correct method of intrauterine resus

A

Suppress uterine contractions

Decrease uterine tone

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30
Q

Hypertension in preg?

A

> 90 diastolic

>140 systolic

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31
Q

Significant proteinuria?

A

1+ or more

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32
Q

Defn preeclampsia

A

Hypertension + proteinuria after 20 weeks preg

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33
Q

Defn chronic hypertension

A

Hypertension without proteinuria in first half of preg

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34
Q

How common preeclampsia

A

5-6% preg woman

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35
Q

Preeclampsia associated with

A

Abruptioplacenta
Intrauterine growth restriction
Fetal distress

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36
Q

Preeclampsia results in fetal distress because

A

Decrease placental blood flow

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37
Q

Sign of imminent eclampsia

A

Increased tendon reflexes

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38
Q

early warning sign of preeclampsia

A

Generalized oedema esp on face

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39
Q

Management of preeclampsia

A

Hospitalisation

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40
Q

Method of deliver usually chosen in preeclampsia

A

Surgical induction at 36 weeks, if reached

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41
Q

NB complications of preeclampsia

A

Eclampsia

Intracerebral haemorrhage

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42
Q

Management of severe preeclampsia

A

Stabilize patient and send to level 2 hospital

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43
Q

Drug used for diastolic >110

A

Nifedipine (adalat)

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44
Q

Sign of magnesium sulphate overdose

A

Depressed tendon reflexes

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45
Q

Drug used to prevent and manage eclampsia

A

Magnesium sulphate

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46
Q

Borderline preeclampsia at 36 weeks

A

Weekly check ups and additional visits if needed

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47
Q

Defn of antepartum hemorrhage

A

Any vaginal bleeding between 24 weeks and DELIVERY

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48
Q

Antepartum hemorrhage NB because

A

Mother and fetus may die

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49
Q

NB sign of shock due to blood loss

A

Fast pulse rate

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50
Q

Why speculum exam wi antepartum hemorrhage?

A

Exclude local cause of bleeding from vagina/cervix

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51
Q

Antenatal hemorrhage + no fetal heart sounds usually

A

Abruptioplacenta

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52
Q

Massive hemorrhage most likely

A

Placenta previa

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53
Q

Factor causing highest risk of abruptioplacenta

A

Previous episode

54
Q

What suggests abruptioplacenta

A 
Signs of shock
Severe abdo pain
Uterus tonically contracted = hard and tender
Uterus bigger than dates
No fetal hr
Hub is low
Fetal parts hard to palpate
55
Q

Management of abruptioplacenta plus intrauterine death

A

Vaginal exam + ROM + vaginal delivery

56
Q

Risk factors for placenta previa

A

Multiple fetus
Previous c section
G5 or more
Threatened abortion in 3rd trimester

57
Q

Findings on exam with placenta previa

A 
Shocked
Soft non tender abdo
Fetus easily palpated
Head not engaged
Abnormal presentation
58
Q

Management of small placenta previa bleed at 34 weeks

A

Hospitalize, manage conservatively til 36 weeks or until active bleeding

59
Q

What can exclude placenta previa.

A

Vaginal exam in theatre

60
Q

Management of antepartum hemorrhage of unknown cause

A

Admit to hospital and monitor fetal movements

61
Q

Antepartum hemorrhage of unknown cause NB because

A

Can be abruptioplacenta

62
Q

Typical feature of a ‘show’

A

Slight bleed of blood mixed with mucus

63
Q

Management of 30 week patient with blood stained vaginal discharge caused by vaginitis

A

Metronidazole (flagyl)

64
Q

What is a partogram

A

Chart for progress of labour, maternal and fetal condition

65
Q

A partogram must be used on all patients in 1st stage of labour. True or dale

A

True

66
Q

What indicates patient is fine in first stage of labour?

A

Relaxed between contractions and not pale. (Nothing to do with BP, urine, pulse, temp)

67
Q

Young anxious primigravida with painful contractions must recieve

A

Comfort, analgesia and a friend/family member if possible

68
Q

What is normal maternal temp during labour

A

37-38

69
Q

Why is pyrexia an NB complication in first stage?

A

May cause convulsions

70
Q

Normal pulse in labour

A

80-100

71
Q

What causes rapid pulse in labour?

A

Pyrexia

72
Q

How often mus BP be measured in low risk patient in latent phase?

A

2 hourly

73
Q

Hypotension patient on back must be…

A

Turned on her side and BP measured soon after

74
Q

Oliguria = urine less than

A

20 ml per hour

75
Q

Oliguria NB sign of ..

A

Dehydration

76
Q

UTI may cause how much proteinuria

A

1+

77
Q

Is ketonuria abnormal

A

It may be seen in normal patients

78
Q

Signs of maternal exhaustion

A 
Tachycardia
Pyrexia
Dry mouth
Oliguria
Ketonuria
79
Q

What causes exhaustion

A

Long labour with low fluid and energy intake

80
Q

How to treat maternal exhaustion

A

2 liters ringers lactate with 5% dextrose IV and adequate analgesia

81
Q

Commonest cause of reduced blood supply to fetus

A

Contraction

82
Q

How does fetus respond to lack of oxygen

A

Decrease HR

83
Q

What is preferred to measure fetal HR in labour

A

Doptone

84
Q

When should fetal HR be monitored

A

Before during and after contraction

85
Q

How often to measure fetal HR in low risk pt

A

2 hourly in latent phase

Half hourly in active phase

86
Q

Baseline fetal HR in labour

A

100-160 bpm

87
Q

Early decelerations usually cause bu

A

Compression of fetal head

88
Q

Defn late decelerations

A

Return to baseline 30 s or more after contraction has ended

89
Q

What do late decelerations always indicate

A

Fetal distress

90
Q

What can cause a baseline tachy

A 
Maternal pyrexia
Exhaustion
Salbutamol
Chorioamnionitis
Fetal hemorrhage
91
Q

Baseline Brady indicates..

A

Fetal distress caused by hypoxia

Fetus is at high risk of dying

92
Q

Which HR pattern indicate increased risk of fetal distress

A

Early decelerations

93
Q

How common is MSL

A

10-20% of pregs

94
Q

What form of meconium in the liquor most likely indicates distress

A

Any form of meconium .

95
Q

What cause fetus to pass meconium

A

Hypoxia

96
Q

Correct management when there is MSL

A

Monitor fetal HR carefully

97
Q

What is latent phase of first stage of labour

A

Onset of labour to 3cm dilation

98
Q

What is first oblique line on partogram called

A

Alert line

99
Q

What rate should cervix dilate in active phase

A

1cm or more / hour

100
Q

Second oblique line of partogram

A

Action line

101
Q

If alert line crosses action line?

A

Very slow progress of labour. Doctor must be in charge of patient.

102
Q

What defines the second stage of labour

A

Cervix full dilated to complete delivery of baby

103
Q

What suggests patient is full dilated

A

Contractions increase in freq and time
Restlessness, vomiting, nausea
Uncontrollable urge to push
Perineum bulges

104
Q

Fetal head engaged when..

A

2/5 or less of head palpable above brim

Largest transverse diameter of head passes pelvic inlet/brim

105
Q

Why anxiety make pain worse

A

Lowers pain threshold

106
Q

Defn third stage of labour

A

Period between delivery of baby and delivery of placenta/membranes

107
Q

Do not give oxytocin (syntometrine) if

A

Hypertensive disorder of preg

Valve disease

108
Q

What sign will confirm placenta has separated

A

Pushing on uterus does not shorten cord

109
Q

What advantage does active method in third stage have

A

Less blood loss

110
Q

When should umbilical cord be allowed to bleed before delivering placenta

A

Rhesus negative mother with single baby

111
Q

Management of prolonged third state of labour

A

IV oxytocin and traction on cord

112
Q

When should post partum hemorrhage be diagnosed

A

When there is any hemorrhage after delivery that is seen to be excessive

113
Q

Management of retained placenta.?

A

Give IV oxytocin , if still retained refer to hospital for manual removal under anesthesia

114
Q

Severe hemorrhage before placenta? Management

A

IV oxytocin in 1000ml basol/saline. Attempt to remove placenta

115
Q

If hemorrhage after placenta delivered, what must be done

A

Rub up the uterus

116
Q

What sign suggests bleeding is caused by an atomic uterus?

A

Intermittent vaginal bleeding and presence of dark red clots

117
Q

Most likely cause of post partum hemorrhage due to atomic uterus.

A

Uterus full of blood clots

118
Q

If a cotyledon is found to be missing what sound be done

A

Evacuate uterus

119
Q

Clinical finding that indicates a tear

A

Continuous stream of bright red blood

120
Q

The puerperium starts when…

A

The placenta is delivered

121
Q

Soon after normal delivery, a mother’s pulse should be?

A

Below 100

122
Q

Hb becomes stable by

A

Day 4

123
Q

The cervical os should be closed by..

A

Day 7

124
Q

Normal lochia smells like?

A

Non offensive

125
Q

How does a normally involuting uterus feel?

A

Firm and nontender

126
Q

How long is puerperium

A

42 days

127
Q

How often must primipara visit clinic after birth

A

Day 1,3,5,7

128
Q

Cystitis is treated with

A

Single oral dose amoxicillin or co-trimoxazole

129
Q

Why NB to treat asymptomatic bacteruria?

A

One third develop acute pyelonephritis

130
Q

How asymptomatic bacteruria diagnosed

A

Culture MSU sample

131
Q

Defn anemia in preg

A

Hb less than 11

132
Q

Commonest cause if anemia

A

Fe deficiency

133
Q

Management of anemia depends on

A

Whether there is SOB or thachycardia

Semester 6 (9 decks)

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