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Pregnancy Flashcards

1
Q

In multiple pregnancies - what does zygosity tell you?

A

The number of eggs fertilised

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2
Q

In multiple pregnancies - what does chorionicity tell you?

A

the membrane pattern of the babies

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3
Q

How should twins be delivered?

A

If one is cephalic presentation - vaginal delivery

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4
Q

How should triplets be delivered?

A

C section

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5
Q

What is the survival rate for babies born at 24 weeks?

A

20-30%

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6
Q

Name 4 risk factors for pre term birth?

A 
Previous pre term labour
Multiple pregnancy
Uterine anomalies
Young age
Parity 0 or >5
Smoking
Drugs - cocaine
Low BMI
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7
Q

What is the definition of pre term birth?

A

Baby born between 24 and 36+6 weeks

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8
Q

What are the 2 types of IUGR?

A

Symmetrical - small head, small body

Asymmetrical - normal head, small body

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9
Q

What maternal infection may cause IUGR?

A

Rubella

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10
Q

Why might there be reduced liquor in IUGR?

A

Baby has small kidneys - so small volume or urine produced

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11
Q

What effect does gestational diabetes have on the foetus?

A

Causes fetal hyperinsulinaemia and macrosomia

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12
Q

At what gestation is gestational diabetes screened for?

A

28 weeks

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13
Q

What test is used for diagnosing gestational diabetes?

A

Glucose tolerance test
Fasting >5.1
2hours >8.5

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14
Q

At what gestation should induction be offered to those with gestational diabetes?

A

38 weeks

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15
Q

Name 2 causes of polyhydramnios?

A

Monochorionic twin pregnancy
Maternal diabetes
Fetal anomaly
Hydrops fetalis

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16
Q

How can polyhydramnios be managed?

A

Amnio reduction
NSAIDS
Steroids if

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17
Q

Zygosity, Chorionicity and amniocity of non identical twins?

A

Dizygotic
Dichorionic
Diamniotic

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18
Q

What do monochorionic diamniotic twins share?

A

Share a placenta

Separate amniotic fluids

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19
Q

How can fetal growth be measured?

A 
Biparietal diameter
Femur length (long bone length)
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20
Q

Accelerations in fetal heart rate on CTG. Good or Bad?

A

Good if after contractions - indicates good reflex of fetal circulation

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21
Q

What might cause loss of baseline variability in CTG?

A

Sedatives or analgesics

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22
Q

Late decelerations on CTG are associated with?

A

Asphyxia - consider delivery

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23
Q

What does reversed flow in umbilical artery doppler mean?

A

Very high resistance in placenta

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24
Q

Which doppler is the last to become abnormal?

A

Ductus venous doppler - requires delivery

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25
Q

What is the definition of the first stage of labour?

A

From initiation of contractions to 10cm dilation

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26
Q

What are the two phases of first stage of labour and their definitions?

A

Latent stage - up to 3-4cm

Active stage - 4-10cm

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27
Q

What is the definition of the second stage of labour?

A

Full dilation to delivery of baby

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28
Q

What is a prolonged 2nd stage in a nulliparous woman?

A

More than 3hours with anaesthesia

More than 2 hours without anaesthesia

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29
Q

What is a prolonged 2nd stage in a multiparous woman?

A

More than 2hours with anaesthesia

More than 1hour without

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30
Q

What is the definition of the 3rd stage of labour?

A

Delivery of baby to expulsion of placenta

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31
Q

What is the definition of Primary post partum haemorrhage?

A

More than 500ml blood loss in 24 hours

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32
Q

What are the 4 causes of post part haemorrhage?

A

Tone - atonic uterus
Trauma
Tissue - retained placenta
Thrombin

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33
Q

Initial management of post partum haemorrhage?

A

Uterine massage

Syntocinon

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34
Q

What is the definition of antepartum haemorrhage?

A

Bleeding from the genital tract after 24 weeks gestation

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35
Q

What is placenta praevia?

A

Abnormally cited placenta - lying in front of the presenting part

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36
Q

Name 3 features of placenta previa?

A 
Blood loss
Recurrent bleeding
Soft uterus
High presenting part
Head not engaged
Malpresentation
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37
Q

Name 2 features of placental abruption?

A

Blood loss
Pain
Uterine activity
Tense tender uterus

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38
Q

Pain - praevia or abruption?

A

Abruption

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39
Q

Contractions - praevia or abruption?

A

Abruption

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40
Q

Fetal distress - praevia or abruption?

A

Abruption

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41
Q

Soft uterus - praevia or abruption?

A

Praevia

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42
Q

What is HELLP syndrome?

A

H - haemolysis
EL - elevated liver enzymes
LP - Low platlets

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43
Q

In what condition does HELLP syndrome occur?

A

Pre eclampsia

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44
Q

What are women with HELLP syndrome more at risk of?

A

Abruption and DIC

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45
Q

What is a normal blood loss during labour?

A

Less than 500mls

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46
Q

What is a “show” and what causes it?

A

Mucus discharge - caused by effacement of he cervix

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47
Q

What is a normal presentation?

A

Cephalic

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48
Q

What is a normal lie?

A

Longitudonal

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49
Q

What is the normal presenting part?

A

Vertex

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50
Q

What is the normal position?

A

Occiput anterior

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51
Q

What after how long in 3rd stage should placenta be removed surgically?

A

1 hour

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52
Q

How often should a vaginal exam be performed during labour?

A

2-4 hours

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53
Q

How often should maternal obs be performed during labour?

A

1-2 hours

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54
Q

How often should fetal heart rate be measured during labour?

A

Every 15 minutes

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55
Q

What is the best management of the 3rd stage?

A

Active - oxytocin, cord traction

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56
Q

What chemical change causes cervical softening?

A

Increase in hyaluronic acid - spaces collagen and decreases firmness of cervix

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57
Q

What are 3 signs of placental separation?

A

Uterus contracts, hardens and rises
Cord lengthens
Gush of blood

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58
Q

What is lochia and when is it seen?

A

Discharge containing blood and mucus - in puerperium

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59
Q

How long after birth does endometrium take to regenerate?

A

1 week

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60
Q

How long does fundal height take to return to umbilicus?

A

2 weeks

61
Q

What part of breast milk is rich in immunoglobulins?

A

Colostrum

62
Q

What type of antibody crosses the placenta in haemolytic disease?

A

IgG

63
Q

When can CVS be performed?

A

From 12 weeks

64
Q

When can amniocentesis be performed?

A

From 15 weeks

65
Q

When can fetal blood sampling be performed?

A

From 18 weeks

66
Q

What is the miscarriage rate with CVS?

A

1-2%

67
Q

What is the miscarriage rate with amniocentesis?

A

0.5-1%

68
Q

Why might you get a false result in CVS?

A

There may be a confined placental mosaicism

69
Q

What is trisomy 13?

A

Patau syndrome

70
Q

When is the booking scan performed?

A

12 weeks

71
Q

When is anti-D given if the woman is rhesus negative?

A

28 and 34 weeks

72
Q

At what gestation is the fundal height first palpable?

A

12 weeks

73
Q

At what gestation is the fundal height the level of the umbilicus?

A

20 weeks

74
Q

In the second half of pregnancy how fast does the fundal height grow?

A

1cm per week

75
Q

Why is UTI risky in pregnancy?

A

Can cause pre term labour

76
Q

Should you immunise against rubella in pregnancy?

A

No - advise avoidance

77
Q

At what gestation is nuchal thickness measured?

A

11 - 13+6

78
Q

What blood sampled are taken to assess for down syndrome risk?

A

1st trimester - HCG - raised and PAPP-A

2nd trimester - HCG and AFP - lower

79
Q

What risk of down syndrome requires further investigation?

A

Greater than 1:250 risk

80
Q

How is down syndrome diagnosed antenatally?

A

Amniocentesis

81
Q

Why is CVS no done before 12 weeks?

A

Risk of absent limbs

82
Q

What is entonox?

A

O2 and Nitrous Oxide

83
Q

What nerves does TENS target?

A

T10-L1, S1-S4

84
Q

What % of women experience complete pain relief with an epidural?

A

95%

85
Q

What is the disadvantage of an epidural?

A

May inhibit stage 2 progression

86
Q

Name 3 complications of epidural?

A

Hypotension
Dural Puncture
Headache + photophobia - treat with blood into epidural site

87
Q

What is the definition of failure to progress?

A

Less than 2cm dilatation in 4 hours + slowing or progress in multiparous women

88
Q

How many 5ths of the head are palpable when the head is engaged?

A

2/5ths

89
Q

What are the 3 causes of failure to progress?

A

Power - inadequate contractions
Passsage - short stature
Passenger - big baby, malposition

90
Q

How often should contractions be?

A

4 every 10 minutes - lasting 1 minute

91
Q

What can be given to improve the strength of contractions?

A

Synthetic oxytocin

92
Q

Compare transfers and AP diameters in the 3 regions of the pelvis?

A

Inlet - Transverse bigger than AP
Mid Cavity - Transverse = AP
Outlet - Transverse is smaller than AP

93
Q

How often should doppler auscultation of fetal heart be performed?

A

Stage 1 - every 15 mins

Stage 2 - every 5-10 mins

94
Q

What do the two traces on a CTG represent?

A

Top line - Fetal HR

Bottom line - Contractions (frequency)

95
Q

Are early declarations physiological or pathological?

A

Physiological

96
Q

What do late decelerations indicate?

A

Hypoxia

97
Q

What does DR C BRAVADO stand for in CTG interpretation?

A

D - determine
R - risk

C - contractions

BRA - Baseline rate
V - variability
A - accelerations
D - decelerations
O - overal impressions
98
Q

What is a normal baseline rate?

A

100-150

99
Q

What is an abnormal baseline rate?

A

Greater than 180

Less than 100

100
Q

What is a normal variability?

A

More than 5BPM

101
Q

What is an abnormal variability?

A

Less than 5BPM for more than 90 mins

102
Q

What is a normal fetal pH?

A

More than 7.25

103
Q

What is an abnormal fetal pH and what action should be taken?

A

Less than 7.2

Deliver

104
Q

What is the first line drug for hypertension in pregnancy?

A

Labetalol (also methyldopa and nifedipine)

105
Q

What is the definition of pre eclampsia?

A

Hypertension + proteinuria + Oedema

106
Q

When should delivery occur in pre eclampsia?

A

By 37 weeks

107
Q

When test should be performed in all cases of polyhydramnios?

A

Glucose tolerance test

108
Q

Why is pregnancy a pro thrombotic state?

A

Increased clothing factors and fibrinogen

109
Q

If high risk of VTE what can be given?

A

Prophylactic heparin

110
Q

What test should be done in suspected DVT in pregnancy?

A

Duplex ultrasound of lower limb

111
Q

When may warfarin be used?

A

Not in pregnancy

OK in breastfeeding

112
Q

How should treatment be changed in women with hypothyroidism?

A

Increase levothyroxine dose

113
Q

What risk does hypothyroidism pose to the baby?

A

May have lower IQ at 5 years

114
Q

What risk does hyperthyroidism pose to the baby?

A

May cause IUGR

115
Q

What should be done for asthma during pregnancy?

A

All medicines OK

Keep under control

116
Q

Why is epilepsy risky to the baby?

A

Epilepsy may cause malformations

Anti- convulsants may cause malformations

117
Q

What treatment should be given to women with epilepsy?

A

Higher dose folic acid
More regular scans
Keep epilepsy under control - use least number of drugs

118
Q

In what % of pregnancies does hypertension occur?

A

10-15%

119
Q

What is the risk of eclampsia?

A

1/2000

120
Q

At what gestation during pregnancy is BP lowest?

A

22-24 weeks

121
Q

What is the criteria for hypertension?

A

140/90 on two occasions

122
Q

If hypertension persists more than 3 months after delivery what is the likely cause?

A

Pre existing hypertension

123
Q

What is the risk of hypertension in pregnancy processing to pre eclampsia?

A

15%

124
Q

What test is done to measure for protein in suspected pre eclampsia?

A

24 hour urine sample

125
Q

What is the pathogenesis of pre eclampsia?

A

Abnormal placental and trophoblastic invasions - arteries fail to adapt

126
Q

Name 4 risk factors for pre eclampsia?

A 
Age over 40
BMI over 30
Family history
1st pregnancy
Multiple pregnancies
Previous pre eclampsia
Molar pregnancy
127
Q

What scan can be done to predict pre eclampsia?

A

Uterine artery doppler

128
Q

What should be done if there is absent end diastolic flow?

A

Delivery in 4 days

129
Q

What should be done if there is reversed end diastolic flow?

A

Deliver immediately if over 28weeks

130
Q

At what BP should you admit a woman?

A

More than 170/110

or more than 140/90 with ++ protein

131
Q

What BP should you aim for in pregnancy?

A

140/90-110

132
Q

Name 3 anti hypertensives that you should avoid in pregnancy?

A

Diuretics
ACE-i’s
ARB’s

133
Q

In which condition should you avoid labetalol?

A

Asthma

134
Q

In which condition should you avoid methyldopa?

A

Depression

135
Q

What type of drug is nifedipine?

A

Ca channel blocker

136
Q

Why are steroids given in pregnancy?

A

To promote fetal lung surfactant production

137
Q

Up to what gestation should steroids be given?

A

36 weeks

138
Q

What steroid should be used in pre term delivery?

A

Bethametasone (better than dexamethasone)

139
Q

How are pre delivery steroids given?

A

2 IM injections 24 hours apart

140
Q

What characterises eclampsia?

A

Grand mal seizures

141
Q

What should be used for treatment of seizures in pregnancy?

A

Magnesium sulphate

Diazepam if persistent

142
Q

What is the main cause of death in eclampsia?

A

Pulmonary oedema

143
Q

Which drug used for PPH prophylaxis should you avoid in hypertension?

A

Ergometrine

144
Q

What is the most common cause of IUGR?

A

Smoking

145
Q

What might cause new onset hypertension before 20 weeks and very high HCG?

A

Molar pregnancy

146
Q

Where is a common metastases site for molar pregnancy?

A

Lungs

147
Q

What are the 5 areas assessed in bishops score?

A 
Consistency
Position
Dilation
Length 
Station
148
Q

What form of induction should be done is bishops score is less than 6?

A

Ripening with prostaglandins - PGE2

Reproduction (7 decks)

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