Pregnancy Flashcards
1
Q
In multiple pregnancies - what does zygosity tell you?
A
The number of eggs fertilised
2
Q
In multiple pregnancies - what does chorionicity tell you?
A
the membrane pattern of the babies
3
Q
How should twins be delivered?
A
If one is cephalic presentation - vaginal delivery
4
Q
How should triplets be delivered?
A
C section
5
Q
What is the survival rate for babies born at 24 weeks?
A
20-30%
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
7
Q
What is the definition of pre term birth?
A
Baby born between 24 and 36+6 weeks
8
Q
What are the 2 types of IUGR?
A
Symmetrical - small head, small body
Asymmetrical - normal head, small body
9
Q
What maternal infection may cause IUGR?
A
Rubella
10
Q
Why might there be reduced liquor in IUGR?
A
Baby has small kidneys - so small volume or urine produced
11
Q
What effect does gestational diabetes have on the foetus?
A
Causes fetal hyperinsulinaemia and macrosomia
12
Q
At what gestation is gestational diabetes screened for?
A
28 weeks
13
Q
What test is used for diagnosing gestational diabetes?
A
Glucose tolerance test
Fasting >5.1
2hours >8.5
14
Q
At what gestation should induction be offered to those with gestational diabetes?
A
38 weeks
15
Q
Name 2 causes of polyhydramnios?
A
Monochorionic twin pregnancy
Maternal diabetes
Fetal anomaly
Hydrops fetalis
16
Q
How can polyhydramnios be managed?
A
Amnio reduction
NSAIDS
Steroids if
17
Q
Zygosity, Chorionicity and amniocity of non identical twins?
A
Dizygotic
Dichorionic
Diamniotic
18
Q
What do monochorionic diamniotic twins share?
A
Share a placenta
Separate amniotic fluids
19
Q
How can fetal growth be measured?
A
Biparietal diameter Femur length (long bone length)
20
Q
Accelerations in fetal heart rate on CTG. Good or Bad?
A
Good if after contractions - indicates good reflex of fetal circulation
21
Q
What might cause loss of baseline variability in CTG?
A
Sedatives or analgesics
22
Q
Late decelerations on CTG are associated with?
A
Asphyxia - consider delivery
23
Q
What does reversed flow in umbilical artery doppler mean?
A
Very high resistance in placenta
24
Q
Which doppler is the last to become abnormal?
A
Ductus venous doppler - requires delivery
25
What is the definition of the first stage of labour?
From initiation of contractions to 10cm dilation
26
What are the two phases of first stage of labour and their definitions?
Latent stage - up to 3-4cm
| Active stage - 4-10cm
27
What is the definition of the second stage of labour?
Full dilation to delivery of baby
28
What is a prolonged 2nd stage in a nulliparous woman?
More than 3hours with anaesthesia
| More than 2 hours without anaesthesia
29
What is a prolonged 2nd stage in a multiparous woman?
More than 2hours with anaesthesia
| More than 1hour without
30
What is the definition of the 3rd stage of labour?
Delivery of baby to expulsion of placenta
31
What is the definition of Primary post partum haemorrhage?
More than 500ml blood loss in 24 hours
32
What are the 4 causes of post part haemorrhage?
Tone - atonic uterus
Trauma
Tissue - retained placenta
Thrombin
33
Initial management of post partum haemorrhage?
Uterine massage
| Syntocinon
34
What is the definition of antepartum haemorrhage?
Bleeding from the genital tract after 24 weeks gestation
35
What is placenta praevia?
Abnormally cited placenta - lying in front of the presenting part
36
Name 3 features of placenta previa?
```
Blood loss
Recurrent bleeding
Soft uterus
High presenting part
Head not engaged
Malpresentation
```
37
Name 2 features of placental abruption?
Blood loss
Pain
Uterine activity
Tense tender uterus
38
Pain - praevia or abruption?
Abruption
39
Contractions - praevia or abruption?
Abruption
40
Fetal distress - praevia or abruption?
Abruption
41
Soft uterus - praevia or abruption?
Praevia
42
What is HELLP syndrome?
H - haemolysis
EL - elevated liver enzymes
LP - Low platlets
43
In what condition does HELLP syndrome occur?
Pre eclampsia
44
What are women with HELLP syndrome more at risk of?
Abruption and DIC
45
What is a normal blood loss during labour?
Less than 500mls
46
What is a "show" and what causes it?
Mucus discharge - caused by effacement of he cervix
47
What is a normal presentation?
Cephalic
48
What is a normal lie?
Longitudonal
49
What is the normal presenting part?
Vertex
50
What is the normal position?
Occiput anterior
51
What after how long in 3rd stage should placenta be removed surgically?
1 hour
52
How often should a vaginal exam be performed during labour?
2-4 hours
53
How often should maternal obs be performed during labour?
1-2 hours
54
How often should fetal heart rate be measured during labour?
Every 15 minutes
55
What is the best management of the 3rd stage?
Active - oxytocin, cord traction
56
What chemical change causes cervical softening?
Increase in hyaluronic acid - spaces collagen and decreases firmness of cervix
57
What are 3 signs of placental separation?
Uterus contracts, hardens and rises
Cord lengthens
Gush of blood
58
What is lochia and when is it seen?
Discharge containing blood and mucus - in puerperium
59
How long after birth does endometrium take to regenerate?
1 week
60
How long does fundal height take to return to umbilicus?
2 weeks
61
What part of breast milk is rich in immunoglobulins?
Colostrum
62
What type of antibody crosses the placenta in haemolytic disease?
IgG
63
When can CVS be performed?
From 12 weeks
64
When can amniocentesis be performed?
From 15 weeks
65
When can fetal blood sampling be performed?
From 18 weeks
66
What is the miscarriage rate with CVS?
1-2%
67
What is the miscarriage rate with amniocentesis?
0.5-1%
68
Why might you get a false result in CVS?
There may be a confined placental mosaicism
69
What is trisomy 13?
Patau syndrome
70
When is the booking scan performed?
12 weeks
71
When is anti-D given if the woman is rhesus negative?
28 and 34 weeks
72
At what gestation is the fundal height first palpable?
12 weeks
73
At what gestation is the fundal height the level of the umbilicus?
20 weeks
74
In the second half of pregnancy how fast does the fundal height grow?
1cm per week
75
Why is UTI risky in pregnancy?
Can cause pre term labour
76
Should you immunise against rubella in pregnancy?
No - advise avoidance
77
At what gestation is nuchal thickness measured?
11 - 13+6
78
What blood sampled are taken to assess for down syndrome risk?
1st trimester - HCG - raised and PAPP-A
| 2nd trimester - HCG and AFP - lower
79
What risk of down syndrome requires further investigation?
Greater than 1:250 risk
80
How is down syndrome diagnosed antenatally?
Amniocentesis
81
Why is CVS no done before 12 weeks?
Risk of absent limbs
82
What is entonox?
O2 and Nitrous Oxide
83
What nerves does TENS target?
T10-L1, S1-S4
84
What % of women experience complete pain relief with an epidural?
95%
85
What is the disadvantage of an epidural?
May inhibit stage 2 progression
86
Name 3 complications of epidural?
Hypotension
Dural Puncture
Headache + photophobia - treat with blood into epidural site
87
What is the definition of failure to progress?
Less than 2cm dilatation in 4 hours + slowing or progress in multiparous women
88
How many 5ths of the head are palpable when the head is engaged?
2/5ths
89
What are the 3 causes of failure to progress?
Power - inadequate contractions
Passsage - short stature
Passenger - big baby, malposition
90
How often should contractions be?
4 every 10 minutes - lasting 1 minute
91
What can be given to improve the strength of contractions?
Synthetic oxytocin
92
Compare transfers and AP diameters in the 3 regions of the pelvis?
Inlet - Transverse bigger than AP
Mid Cavity - Transverse = AP
Outlet - Transverse is smaller than AP
93
How often should doppler auscultation of fetal heart be performed?
Stage 1 - every 15 mins
| Stage 2 - every 5-10 mins
94
What do the two traces on a CTG represent?
Top line - Fetal HR
| Bottom line - Contractions (frequency)
95
Are early declarations physiological or pathological?
Physiological
96
What do late decelerations indicate?
Hypoxia
97
What does DR C BRAVADO stand for in CTG interpretation?
D - determine
R - risk
C - contractions
```
BRA - Baseline rate
V - variability
A - accelerations
D - decelerations
O - overal impressions
```
98
What is a normal baseline rate?
100-150
99
What is an abnormal baseline rate?
Greater than 180
| Less than 100
100
What is a normal variability?
More than 5BPM
101
What is an abnormal variability?
Less than 5BPM for more than 90 mins
102
What is a normal fetal pH?
More than 7.25
103
What is an abnormal fetal pH and what action should be taken?
Less than 7.2
| Deliver
104
What is the first line drug for hypertension in pregnancy?
Labetalol (also methyldopa and nifedipine)
105
What is the definition of pre eclampsia?
Hypertension + proteinuria + Oedema
106
When should delivery occur in pre eclampsia?
By 37 weeks
107
When test should be performed in all cases of polyhydramnios?
Glucose tolerance test
108
Why is pregnancy a pro thrombotic state?
Increased clothing factors and fibrinogen
109
If high risk of VTE what can be given?
Prophylactic heparin
110
What test should be done in suspected DVT in pregnancy?
Duplex ultrasound of lower limb
111
When may warfarin be used?
Not in pregnancy
| OK in breastfeeding
112
How should treatment be changed in women with hypothyroidism?
Increase levothyroxine dose
113
What risk does hypothyroidism pose to the baby?
May have lower IQ at 5 years
114
What risk does hyperthyroidism pose to the baby?
May cause IUGR
115
What should be done for asthma during pregnancy?
All medicines OK
| Keep under control
116
Why is epilepsy risky to the baby?
Epilepsy may cause malformations
| Anti- convulsants may cause malformations
117
What treatment should be given to women with epilepsy?
Higher dose folic acid
More regular scans
Keep epilepsy under control - use least number of drugs
118
In what % of pregnancies does hypertension occur?
10-15%
119
What is the risk of eclampsia?
1/2000
120
At what gestation during pregnancy is BP lowest?
22-24 weeks
121
What is the criteria for hypertension?
140/90 on two occasions
122
If hypertension persists more than 3 months after delivery what is the likely cause?
Pre existing hypertension
123
What is the risk of hypertension in pregnancy processing to pre eclampsia?
15%
124
What test is done to measure for protein in suspected pre eclampsia?
24 hour urine sample
125
What is the pathogenesis of pre eclampsia?
Abnormal placental and trophoblastic invasions - arteries fail to adapt
126
Name 4 risk factors for pre eclampsia?
```
Age over 40
BMI over 30
Family history
1st pregnancy
Multiple pregnancies
Previous pre eclampsia
Molar pregnancy
```
127
What scan can be done to predict pre eclampsia?
Uterine artery doppler
128
What should be done if there is absent end diastolic flow?
Delivery in 4 days
129
What should be done if there is reversed end diastolic flow?
Deliver immediately if over 28weeks
130
At what BP should you admit a woman?
More than 170/110
| or more than 140/90 with ++ protein
131
What BP should you aim for in pregnancy?
140/90-110
132
Name 3 anti hypertensives that you should avoid in pregnancy?
Diuretics
ACE-i's
ARB's
133
In which condition should you avoid labetalol?
Asthma
134
In which condition should you avoid methyldopa?
Depression
135
What type of drug is nifedipine?
Ca channel blocker
136
Why are steroids given in pregnancy?
To promote fetal lung surfactant production
137
Up to what gestation should steroids be given?
36 weeks
138
What steroid should be used in pre term delivery?
Bethametasone (better than dexamethasone)
139
How are pre delivery steroids given?
2 IM injections 24 hours apart
140
What characterises eclampsia?
Grand mal seizures
141
What should be used for treatment of seizures in pregnancy?
Magnesium sulphate
| Diazepam if persistent
142
What is the main cause of death in eclampsia?
Pulmonary oedema
143
Which drug used for PPH prophylaxis should you avoid in hypertension?
Ergometrine
144
What is the most common cause of IUGR?
Smoking
145
What might cause new onset hypertension before 20 weeks and very high HCG?
Molar pregnancy
146
Where is a common metastases site for molar pregnancy?
Lungs
147
What are the 5 areas assessed in bishops score?
```
Consistency
Position
Dilation
Length
Station
```
148
What form of induction should be done is bishops score is less than 6?
Ripening with prostaglandins - PGE2
