Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

CCFP 3 > Pregnancy *** > Flashcards

Pregnancy *** Flashcards

1
Q

What to cover in Preconception Counselling

A

Review previous pregnancies
Mental health
Family + genetic hx
Optimise chronic medical conditions + meds
CI in pregnancy: ACEi, valproic acid, lithium, topiramate, methotrexate, warfarin
Better anticonvulsants: carbamazepine or lamotrigine
Immunizations
Screen for STIs
Lifestyle: smoking cessation, stop alcohol and substance use
Supplementation: folic acid, calcium, omega 3s, vit D, vit B12
Nutrition: Avoid undercooked or raw meat + fish, unpasteurized milk, fish high in mercury (tuna steak, swordfish, shellfish)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Recommended dose of folic acid

A

0.4 to 1mg daily
5mg for people with RF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sx associated with pre-eclampsia

A

RUQ Pain
Visual Changes (blurring/scotoma)
Headaches
Edema
Nausea
Vomiting
Somnolence
Irritability
Hyperreflexia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Indications for Rhogam

A

In negative women

Routinely at 28 weeks gestational age
Within 72 hours of birth of a Rh positive infant
Miscarriage
Antepartum Hemorrhage
Ectopic Pregnancy
Invasive Procedures During Pregnancy
Positive Kleinhauer-Betke Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tests performed in maternal serum screen

A

Alpha-Feto Protein
B-hCG
Estriol (unconjugated estrogen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

First visit content to cover

A

Is pregnancy desirable?
Assess risk factors (teens, substance use, DV victims, single moms, HIV, diabetes, epilepsy)
Establish dates
Advise pt about ongoing care (include SW as needed)
Bloods:
bHCG
Blood type + Rh status
CBC (Hb + MCV)
TSH
HIV, rubella, varicella, HBsAg, Syphilis, Hep C (if RFs)
Urine: midstream C+S
Swabs: GC + CT, pap if out of date

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What to cover at 10-14 weeks

A

Dating US
SIPS1
IPS (SIPS1 + NT) for women 35-39

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What to cover at 12 weeks

A

GDM screen if high risk
SFH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What to cover at 15-21 weeks

A

SIPS2 or Quad screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What to cover at 18-20 wks

A

Anatomy, gender + placenta US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What to cover at 24-26 wks

A

Repeat blood type + Rh status in Rh negative pts
GDM screening: 1 hour 50g OGTT screen, 75g 2 hour test for confirmation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What to cover at 28 wks

A

Rh Ig to Rh negative
Edinburgh PDS
Repeat CBC, consider iron
Tdap

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What to cover at 34 wks

A

Assess presentation, ECV if necessary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What to cover at 35-37

A

GBS screen
Suppression therapy for current HSV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Recommended vax + CI in pregnancy

A

Flu shot if during flu season
Tdap between 21-32w for every pregnancy
Hep A, B, meningococcal and pneumococcal if high risk
Contraindicated: live influenza, herpes, MMR, polio, rubella, varicalla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the 1st stage of labour?

A

regular contractions causing cervical dilatation and effacement
Latent: complete when nulliparous >4cm, parous 4-5cm
Active: starts at >4cm NP and 4-5cm MP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the 2nd stage of labour?

A

full dilatation to delivery of baby
Passive = no pushing
Active = pushing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the 3rd + 4th stage of labour?

A

immediately after delivery of baby to delivery of placenta

4th: immediately after delivery of placenta to 1hr postpartum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Indications for continuous FM

A

Decels, single umbilical artery, velamentous cord insertion, >3 nuchal loops of cord, spinal-epidural anesthesia, labour dystocia, FHR arrhythmia, BMI >35

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Pain relief options

A

Non-pharmacologic (self-hypnosis, acupuncture, water immersion
Systemic: nitrous oxide, opioids
Regional: pudendal nerve block (inferior to sacrospinal ligament + medial to ischial spine bilaterally), epidural

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3rd stage management

A

Prophylactic uterotonic (oxytocin)
Early cord clamping
Controlled cord traction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Bishops score characteristics

A

C-PEDS

Consistency
Position
Effacement
Dilatation
Station

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the definition of decreased cervical length + what is the Rx

A

<25mm @ 16-24w GA
Rx: vaginal progesterone from 16-36w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is normal and decreased fetal movements, and rx for decreased?

A

Normal = >26w = 6 movements / 2 hrs
<6 = NST, normal = daily movement counting, abnormal = biophysical

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When would HTN be considered gestational?
>20wks
26
RF for GHTN
<18 or >35, 1st pregnancy new partner, primip, >1 fetus
27
Maternal and fetal complications of GHTN
Maternal: sz, retinal detachment, stroke, TIA, HELLP Fetal: placental abruption, IUGR, oligohydramino
28
Screening for HTN
UA + BP each visit
29
Ix if UA + for protein
CBC, INR, PTT, fibrinogen, BUN, Cr, lytes, glucose, AST, ALT, LDH, bili, albumin (low) 24hr urine fetal movement count/ NST, US for growth, middle cerebral artery doppler
30
Prevention of GHTN
Calcium supplementation No EtOH Smoking cessation High risk women: LMWH if prev placental complications
31
When to deliver in GHTN/ pre-eclampsia
Severe = immediate Hemolysis + raised LFTs - deliver >35w Non severe = >37w
32
Rx for GHTN
Labetalol or methyldopa 1st line, clonidine 2nd line Nifedipine if severe MgSO4 4g IV to prevent eclampsia Corticosteroids for fetus if <34+6 HELLP management: consider blood or platelet transfusion
33
RF for GDM
prev GDM, fam hx, macrosomia, >25y/o, obese, PCOS, steroids, hispanic/ asian/ african
34
Complications of GDM
cephalo-pelvic disproportion, LGA, shoulder dystocia, VSD, NTD, neonatal hypoglycemia, Erb palsy, pyloric stenosis, premature
35
Ix + results for GDM
screen at 24-28w w/ 75g OGTT, GDM if FBG >5.1, >10 @ 1hr or >8.5 @ 2hrs
36
Rx of GDM
Nutritional counselling Monitor fetal growth q4w from 24w Weekly NST from 36w Induce at 38w Monitor newborn for hypoglycemia Repeat 75g OGTT between 6w-6mo PP
37
Rx for hyperemesis
pyridoxine 10mg QID or diclectin 10mg QID + gravol 50mg Q4H + metoclopramide 5-10mg Q8H PO/ IM/ IV + ondansetron 8mg Q12H IV
38
IUGR definition
<10th % on US d/t pathological process
39
Causes of IUGR
smoking, drugs, TORCH, genetic abnormalities
40
Screening for IUGR
in trisomy 21, uterine dopplers @ 19-23w
41
Rx for IUGR
Previable - monitor Viable (>500g + >24w) - EFW, AFV, umbilical doppler, weekly BPP in 3rd trimester If growth plateaus <34w = corticosteroids, consider hospitalisation, increased surveillance If >34w + abnormal (AFV <5cm or DVP <2cm) BPP + doppler, consider delivering
42
Polyhydraminos causes
GDM, fetal hydrops, genetics, GI problem
43
Oligohydraminos causes
renal problem, placenta hypoxia, PROM
44
TOLAC Success rate Rupture rate Who is at increased risk Who is likely to have reduced success
Success rate = 75% Rupture rate = 1% Increased risk: >2 CS, <18mo since CS, induction of labour Reduced success: increasing age, BMI, GA >40w, BW >4000g, hx dystocia
45
Rx for previa
Management: US at 32 + 26 No vaginal or anal sex, no insertion of FB into vagina
46
What dose of Rhogam to give?
If Rh neg, repeat at 28w Give RhoGAM: <12w = 120mcg >12w = 300mcg Amniocentesis = 300mcg ;
47
How do you test for parvovirus in pregnancy?
Parvovirus B19 IgG (positive indicates past infection and immunity) Parvovirus B19 IgM (positive indicates recent infection)
48
Rx for Group B strep
Rx w/ IV penicillin
49
Reasons + risks of inducing
Reasons: spontaneous ROM, IUGR, reduced fetal movement, postdates, pre-eclampsia, maternal conditions Risks: increased risk of operative delivery, abnormal FHR, uterine rupture, cord prolapse
50
Pre-requisites + CI to induction
CI: prev uterine rupture, fetal transverse lie, placenta previa, invasive cervical cancer, active genital herpes Pre-requisites: Bishop >6
51
How to ripen cervix
vaginal prostaglandin (Prepidil 0.5mg q12H x 3 doses), foley catheter
52
Oxytocin risks
fetal compromise, uterine rupture, hypotension
53
When can you perform ARM
active labour + head engaged
54
Definition of dystocia in 1st + 2nd stage
Active first stage >4hrs w/ <0.5cm/hr dilatation 2nd stage >1hr w/ no descent
55
Causes + rx of dystocia
Causes: Power Passenger Passage Psyche Management: Oxytocin augmentation
56
RF for placental abruption
previous abruption, HTN, vascular dz, smoking, alcohol use, multiparity, increasing maternal age, PPROM
57
Sx of placental abruption
painful vaginal bleeding, sudden onset, constant, lower back + uterus, fetal distress
58
Complications of placental abruption
prematurity, hypoxia, DIC, anemia, shock, amniotic fluid embolism
59
RF for uterine rupture
prev uterine scar, oxytocin, grand multip, previous uterine manipulation
60
Sx of uterine rupture
acute onset abdo pain, abnormal FHR, vaginal bleeding
61
Complications of uterine rupture
hemorrhage, shock, DIC, amniotic fluid embolism, fetal distress
62
Premature rupture of membranes management
sterile spec, r/o cord prolapse, looking for 1) pooling, 2) nitrazine blue 3) ferning. Determine GBS status.
63
Preterm labour Ix + Rx
Ix: fetal fibronectin, US for cervical length Management: - betamethasone 12mg IM q24 x2, - transfer to NICU place - nifedipine - magnesium sulphate 4g IV
64
RF for shoulder dystocia
obesity, DM, multiparity, macrosomia, longer gestation, long 2nd stage, advanced maternal age, male newborn, induction
65
Sx of shoulder dystocia
Turtle sign (head retracting after delivery)
66
Complications of shoulder dystocia
PPH, uterine rupture, newborn brachial plexus injury/ clavicle fracture, hypoxia
67
Rx for shoulder dystocia
ALARMER: apply suprapubic pressure, legs in full flexion, anterior shoulder disimpaction, release posterior shoulder, manual corkscrew, episiotomy, roll over onto hands and knees
68
Rx of Non-reassuring FHR
Management: ensure fetal tracing, call for help, LLD position, 100% O2, stop oxy, give fluids, r/o cord prolapse
69
Postpartum history
Brain: depression, psychosis, sleep, suicide, substances, support, sex Breasts: feeding, concerns BP Bladder/ bowels: incontinence, UTI Bleeding: colour, smell, clots Baby: bonding, feeding, concerns
70
Contraception options postpartum (lactating vs not)
Non lactating: OCP from 3wks Lactating: micronor 6wks PP + change to OCP at 3mo or sooner if formula fed IUD from 6w PP
71
What to counsel parents on after birth
Transition to parenthood Family violence + safety Nutrition + healthy living Contraception Pelvic floor exercises Community resources Future pregnancies Preconception planning C/S: discuss VBAC + pregnancy spacing
72
FU for pts w/ HTN, DM, preterm, IUGR, placental abruption after delivery
If HTN, DM, preterm, IUGR, placental abruption: 6mo: BMI, BP, lipids, glucose, UA 12mo: BMI + BP
73
FU for GDM after delivery
75g OGTT 6w PP + a1c q1yr
74
Definition of PPH
Blood loss >500ml for SVD or >1000ml for CS, up til 6wks
75
Causes of PPH
uterine atony, retained placenta, laceration of cervix/ vagina/ uterus, coagulopathy, DIC, ITP, TTP
76
Management of PPH
Cross match 4 units Oxytocin infusion Ergotamine 0.25mg IM q5 mins Hemabate 0.25mg IM Manual compression/ uterine massage D+C, lap w/ ligation of uterine arteries
77
Causes of postpartum fever
Wind (atelectasis, PNA), water (UTI), wound, walking (DVT), womb (endometritis)
78
Ix for postpartum fever
Ix: blood + genital cultures if suspecting endometritis
79
Definition + causes of retained placenta
Undelivered placenta >30 mins from delivery of baby Causes: accreta, incret, percreta
80
RF + Rx of retained placenta
RF: placenta previa, prior CS, curettage, uterine infection Management: explore uterus, firm traction, oxytocin into umbilical vein, manual removal, D+C
81
How to manage existing hypothyroidism
May need to decrease thyroxine dose in known hypothyroid pts
82
Rx for endometritis
Management: clindamycin + gentamicin
83
Blues vs depression
Blues: onset day 3-10, lasts <2wks Depression: within 4wks - 6mo from delivery
84
RF for depression
personal or fam hx, prenatal depression or anxiety, stressful life situation, poor support, unwanted pregnancy, sick infant
85
How to offer abortion
confirm gestational age, exclude ectopic, assess for CI (uncontrolled asthma, chronic adrenal failure, chronic steroid use, hematological dz, remove IUD), advise on how to take meds, expect pain, FU - mifepristone/ misoprostil
86
How to diagnose gestational HTN?
>140/90 x2 >20 wks
87
How to diagnose preterm labour?
Fetal fibronectin + serial vaginal exam
88
RF for PPH
prior hx, rapid delivery, shoulder dystocia, instrumentation
89
Causes of postpartum infection
endometritis, septic pelvic thrombophlebitis
90
What supplements reduce sz occurrence in pregnant pts?
Calcium, folic acid
91
Bipolar med advice in pregnancy
lowest effective dose, monotherapy, avoid valproate, psychosocial preferred over meds in 1st trimester
92
Recommended wt gain per week in pregnancy
Underweight = 0.5kg/wk Healthy = 0.4kg/wk Overweight = 0.3kg/wk Obese = 0.2kg/wk
93
Recommended wt gain in pregnancy for obese women
5-9kg
94
Bugs causing mastitis
staph aureus, beta hemolytic strep, e coli

CCFP 3 (67 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions