Pregnancy Drug s Flashcards
1
Q
Cleft lip / palate
A
Methotrexate ( folic acid antagonist )
Phenytoin
2
Q
Seizure in pregnancy
A
Magnesium sulphate
3
Q
Uterine inversion
- fundus of uterus drops down through the uterine cavity and cervix, turning inside out
Obstetric emergency
A
Johnson menoeruve - using hand - push the fundus back into the abdo
Hydrostatic - filling vagina with fluid to inflate it back up
Laparotomy
4
Q
TRIAD of AMNIOTIC FLuid embolism
After birth
A
Coagulopathy, hypoxia and hypotension
5
Q
Rupture of membrane followed by immediate bleeding
A
Vasa praveia
6
Q
What happens if they have vasa Praveva
A
EMERGNECY c section
7
Q
Cytomegalovrius infection
A
Hearing loss, visual impairment and learning disability
8
Q
If stage 1 is prolonged, what do you do
A
1st : aminotomy
2nd : oxytocin infusion
9
Q
Bright, red, fresh vaginal bleeding which is painless in nature
A
Placenta Praevia
10
Q
What does molar pregnancies present
A
14 weeks
11
Q
Treatment for hyperemesis gravidarum
A
1st line: anti emetic : Promethazine
2nd: electrolyte Imbalance
12
Q
What is hypermeresis gravidum
A
Vvvv bad vomiting before 20 weeks. Leading to weight loss, dehydration and electrolyte imbalance
13
Q
Drug to prime the cervix
A
Vaginal prostaglandin e2 pessay ( allows it to soften and become shorter for labour)
14
Q
Hard, woody uterus
Little bit of bleed
Lots of pain
A
Placental abruption
15
Q
What landmark do you use for a pudenal nerve block
A
Ischial spine
16
Q
Most common cause of a post partum haemorrhage
A
Uterine Antony
17
Q
Chorioamniontis
A
Pre rupture of the membrane - allows bacteria to enter
18
Q
Another word for externally rotates
A
Restitution
19
Q
Vaginal bleeding, rupture of foetal membrane and foetal deterioration
A
Vasa praevia
20
Q
Painless bright red vaginal bleeding only after 24 weeks
A
Placenta praevia
21
Q
What does corticosteroid steroid do ( given 24 and 34 week)
A
Aids foetal Lung maturation
22
Q
Should you treat asymtomatic bacteriaemia ( uti)
A
Yesssssssssss
23
Q
What week does antepartum haemorrhage cut off
A
24 weeks - birth
24
Q
Branchial cyst
A
Embrological remnant from the development of the brachial arches which forms parts of the head and neck
25
How long should you breast feed for
Exclusively only breast feeding for 6 MONTHS
Then eating and breast feeeding till up to 2h years
26
Is breast milk high in vit d?
NO !! LOW
27
What issue does this cause in pregnancy?
- ciprofloxacin
Joint problems
28
What issue does this cause in pregnancy?
Methotrexate
Cleft lip
29
What issue does this cause in pregnancy?
Nitrofuraontin
G6PD deficiency - activates intra vascular haemolysis
30
What issue does this cause in pregnancy?
- aspirin
Reye ( cant see, cant pee, cant climb a tree)
31
Should hiv mothers do vaginal births and breast feed
No - c section
Refrain from breast feeding
32
Dm of mastitis
Antibiotics
Continue to breast feed
33
Ix for breech baby
At 36 weeks - over external cephalic version ie turn baby arohnd
Multiparous women - 37 weeks
34
Success rate of ECv
50%
35
What spinal block is c section occur under
Spinal !!
36
Indications for elective c section
- previous c cession
- vasa praevia
- placental praevia
- uncontrolled hiv
- cervical cancer
- mutiple pregnancy
37
Infection of membranes in the uterus
Chorioamniontis
38
Biggest risk factor for chorioamniotiurs
Preterm rupture of membranes
39
Ix of Chorioamniontis
- delivery of baby
- iv antibitocs… sepsis 6
40
Triad of cmv infection
Visual impairment
Hearing loss
Learning disability
41
What group does cmv belong to
Herpes
42
Triad for rubella
Cardiac defects, deafness, cataracts
43
Toxoplasmosis… from protozoan parasite toxoplasma gondii is found where
Cat, faeces, infected meat or soil
44
If a woman gets varicella zoster virus ( chicken pox) during pregnancy .,… is this bad
YESSSS - causies teratogenic
Avoid people with it once pregnancy ]
Give immunoglobulin as prophylaxis
Of acyclovir within 24 hours of rash … then baby get iv acyclovir after delivery
45
Is the anterior or posterior wall of the vagina longer?
POSTERIOR
46
Artery supply to vagina.
Internal iliac artery ( uterine and vaginal arteries)
47
Venous drainage from vagina
Internal iliac vein
48
Cord prolapse
The umbilical cord exits before delivery of baby - causes acute compromise of the umbilical blood supply to the infant
49
Mx of cord prolapse
Delivery of baby through forceps or c section if the cervix isn’t dilated
Knees - chest position to prevent further prolapse
Filling bladder with 500ml warm saline to prevent
Tocolytics e.g.terbutaline to stop uterine contractions
50
What limit is macrosomina
Birthweight >4kg
51
How does macrosomia occur
Maternal blood glucose crossing placenta and inducing increased neonatal insulin production
It can increase chance of shoulder dystocia
52
What are the 3 main genetic mechanisms for Down syndrome
- gamete non disjunction
- robertsonian translocation
-mosaic
53
Pre- eclampsia
Proteinuria + hypertension at 20 weeks
54
Consequences of pre eclampsia
HELLP SYNDROME
DIC
Eclampsia ( seizures due to cerebrovascular vasospasm)
Organ failure
55
Treatment of preeclampsia
- antihypertensiopns ( labetalol )
56
When do you do surgical option in ectopic
1. Vvvv much in pain
2. It is >35mm
3. B - hcg are >5000
4. Ultrasound identifies a foetal heartbeat
57
Type 1 FGM
Partial or total removal of the clit and or prepuce
58
Type 2 FGM
Partial / total removal of clit and inner labia, with /without other labia
59
Type 3 FGB
Narrowing of the vaginal opening, wee hole at the end.
60
Type 4 FGM
Any other harmful stuff
- piercing
- incising
- scarping
- cauterising
61
First stage of labour
Latent : up to 3/4 cm
Active : 3/4 - 10 cm
62
What is prolonged first stage
<2 cm in 4 hours
It should be 1 every 2
63
Gravity
Number of gravid events - number of times person been pregnanct
Each one count as one, doesnt matter if twin, or miscarriage.
64
Nulligravida
Never been pregnant
65
Primigravida
Pregnanct once
66
Multigravida
Pregnant more than once
67
Parity
Number of porous events
- number of times a person has given birth to a pregnancy with a gestational age of at least 24 weeks!!! Whether it was born alive or stillborn
Again even if c section of mutiple = still 1
68
Most women have group b strep, what issues can this cause baby
Sepsis
Pneumonia
Meningitis
So give iv penicillin during labour
69
Rhesus negative mother = becomes sensisted to rheuses blood of baby
Haemolytic disease of newborn
70
HELLP syndrome
- haemolyiss
- elevated liver liver enzymes
- low platelet s
71
If mothers load ( Hiv) is <50
What is recommend
Normal vaginal delivery
If more - c section
72
Hyeremesis gravidarim
Severe vomiting before 20 weeks
73
Used to assess if patient is likely a good candidate for induction of labour
Bishops score
74
What are the components for bishops score
Pregnancy can enlarge dainty stomachs
- position
- consistency
- effecament
- dilation
- foetal station
75
Measure the volume of foetal hb present in mothers blood stream
Ie work out is there is a need for anti d - has there been a sensitaiton event
Kheihauer test
76
Cheese
Listeria
77
Can pregnancy people take lithium
NOOOOOOOO esp in 1st trimester
78
What should be offered at 41 weeks
Membrane sweep - insert a finger into cervical opening and sweeping to separate the amniotic membrane from cervix - causes prostaglindins release - stimulate sponetanous labour
If failure - induce of labour visa prostaglandins to stimulate contractions
79
Meconium
First faces passed by newborn .. usually after delivery and vvv green
If passed prior to birth - meconium stained liquor IE FOETAL DISTRESS
80
Meconium aspiration syndrome
When the baby aspirates into lungs
81
Mx of meconium aspiration syndrome
Gentle suctioning of the mouth and nose
82
Miscarriage
Loss prior 24 weeks gestion
83
Mild bleeding
Viable pregnancy
Os closed
Threatened
84
Heavy bleeding
viable pregnancy
Os open
Inevitable
85
Complete
Os may be open or closed
Uterus empty
86
Incomplete
Os dilutes
Retained
Foetus
87
Missed
Uterus has foetal tissue
Not viable
Cervical is closed
It’s missed cos woman is asymtomatic
88
Complete
1 sperm and an empty egg
The sperm doubles to get a normal number of chromosomes
89
Partial mole
2 sperm and a normal egg
Some evidnce of foetal parts
90
Calculate the expectted delivery date based on LMP
Naegele rule
Add 1 year and 7 days to first day of last period and substract 3 months
91
If you have herpes - what do you do
C section and iv acyclovir
Baby can get herpes on head if vaginal
92
What is entonox
Gas and air
93
Another name for obstetric cholestasis
Intra hepatic cholestasis
94
what is cholestasis
After 24 weeks, bulid up of bile acid
Vvv itchy
95
Lower than normal volume of amniotic fluid in uterus
Oligohydramnios
96
Common complication of infertility treatment
Ovarian hyper stimulation syndrome
Causees bloating and abdo discomfort
97
1st degree tear
Perineal skin or vaginal mucosa
98
Second degree tear
Perneal muscles and fascia
Not anal spinchers
99
What would espistomy be classed as as a tear
2nd degree
100
3a tear
Less than 50% of external anal sphincter is torn
101
3b tear
More than 50% of external anal sphincter but internal is fine
102
3c tear
Interal gone nut anal mucosa is fi e
103
4th tear
Anal mucosa gone
104
Placenta accreta
Adherence of placenta directly to superfical myometrium but does not penetrate the thickness of muscle
105
Placenta increta
Occurs where the villi innate but not through myometrium
106
Placenta per create
Full thickness myometrium to the serosa
107
Woody, heard I uterus
Bvvvvvv Pain
Little blood
Placental abruption
Abcde approach
108
Placenta overlaying the cervical os
Bright red vaginal bleeding
PAINLESSSSSSSSSSS
109
Ix and mX of placenta praevia
Reasses at 32 and 36
If at 35 and still there- plan a c section at 37 - 38
110
Too much amniotic fluid in uterus
Polyhydramnios
111
How long is contraceptive not needed for after pregnancy
3 weeks
112
When can ius/ iud be inserted
- immediately after delivery, up to 48 hours after delivery
- if nottt then 28 days after
113
When can pop be given after pregnancy
Anytime
114
Should you give combined oral if breast feeding
Nooooooo
115
When can you give oral combined pill after proegnacy
21 after child brith
116
Iffff exclusive breast feeding, am i protected
Yes for 6 months
117
Postpartum haemorrage
500ml blood within first 24 hours
118
Causes of pph
Tone - uterine Antony, most common cause. Failure of uterine to contract after delivery
Trauma
Tissue - retained tissue
Thrombin - coagulopathies
119
Mx of pph
Major haemorrage procotol
120
Secondary pph
24 hours - 12 weeks posr partum
121
Pre labour rupture of membranes e
Before 37 weeks … if labour doesn’t start within 24 hours - induce
122
Prolonged 2nd stage labour
Null: >3 with epidural, 2 without … multi >2 with epidural, 1 without
123
Shoulder dystocia
Delivery of head, shoulder get caught
124
Mx of shoulder dystocia
Mc Robert’s manoeuvre - hyper flexion and abduction of mothers leg, apply suprapubic pressure .. if not then all fours .. if not interal rotation manoeuvre
125
Mifepristone
Progesterone antagonist - blocks the progesterone - cant continue pregnancy there is a pppp in it
126
misoprostol
Prostagladin analogue = causes smooth muscle contractions - explusion
127
How long should 3rd stage last
30 mins naturally … 5- 10 with oxytocin
128
How do you know 3rd stage is coming
Lengthing of the cord, feeling heaviness in vagina, gush of blood, hard uterine
129
Terbutaline
Stop contractions, beta 2
130
Most common cephalic presentations
Vertex
131
Vasa praevia
Foetal vessels run near os
132
1st trimester
First day of last periods- 12 weeks
133
2nd trimester
13-28 weeks
134
3rd
29 - term
135
What issues does this cause in pregnancy
Bromocriptine
Suppress lactation
136
What issues does this cause in pregnancy
Benox
Drowsiness , poor feeding
137
What issues does this cause in pregnancy
Cytotoxic
Bone marrow suppression
138
What issues does this cause in pregnancy
Amiodarone
Hypothyroidism
139
What issues does this cause in pregnancy
Phenytoin
Cleft lip
140
What issues does this cause in pregnancy
Warfarin
Limb and fascia defects
141
What issues does this cause in pregnancy
Retinoids
Ear, cv and skeletal defects
142
What issues does this cause in pregnancy
Lithium
Cv defects
143
What issues does this cause in pregnancy
Androgens
Virislation of female foetus
144
What issues does this cause in pregnancy
Acei /arbs
Renal hypoplaia
145
Need to really have what to get a uterine rupture
A prior c section
146
Normally what dose to give of folic acid
400 micro gram
147
When do you give a higher dose of folic acid ( 5mg)
DIABETESSS
148
What Down syndrome test in 1st trimester
Combined test :
Free bhcg
Papp a ( pregnancy associated plasma protein )
149
What is nuchal translucency
Behind baby neck
150
What test is done in 2nd trimester
Quadruple test
- afp
Bhcg
InhibiN a
Unconjugated oestriol
151
If after combined and quadrade - what next?
NIPT ( NON INVIATE PRENATAL TESTING)
Placental cell free dna in maternal blood
152
If nipt is positive - what next?
Chorionic villus sampling : cvs : 11 - 14 weeks ( sample of placenta)
After 15 weeks - amniocentesis ( sample of amniotic fluid)
153
What do reduced variability on ctg show
Sleeping probs but no more than 40 mins
154
What’ does acceleration during contractions mean
Healthy foetus
155
what does absent acceleration in a normal ctg mean
Unknown sign
156
Early Deceleration ie when the uterine begins to contract and recover once it stops
Physiological - due to increase fetal increased icp
157
Variable deceleration - rapid fall for a variable amount of time
Umbukical cord compression
158
Late deceleration ie starts at peak of uterine contractions
Reduced uteroplacental blood flow
159
Prolonged deceleration : non reassuring
More than 2-3 minutes
160
Prolonged deceleration : abnormal
3 minute s
161
Sinousidal pattern of ctg
Fetal morbidity
162
What is normal baseline variability
5-25 bpm
163
Non reassuring baseline variability
Less than 5 for 30-50 mins
More than 25 for 15-25
164
Abnormal baseline variability
Less than 5 for 50 mins
More than 25 for 25 mins
Sinusoidal
165
What would you see in urine of hyperemesis gravidarum
Ketones
166
What does help syndrome msot likely happen
Once born
167
Most common lie of twins
Longitudinal with vertex presention
168
Is there foetal matter in complete mole
No only partial
169
What do you give for a magnesium sulfate overdose
Calcium gluconate
170
Treatment of benzo overdose
Flumenazil
171
Examples of tocyolti ( stops contractions
Nifedipine ( calcium channel blocker)
172
When should induction of labour happen
Between 41 - 42 weeks obvvvv after a membrance sweep ( once)
173
Can you do external cepoahtiv versioon during LABOUR
Nooo
174
What are diagnostic test of Down syndrome
CVS
Amniocentesis
175
What is nuchal testing done
11-14 weeks
176
When is double testing for Down syndrome done ( a - Papp) and free bcg
10-14
177
When is quadruple testing down
AFP, bhcg, serum oestroil and inhibin A
14 -20 WEEKS
178
How is bhcg and a Papp showed in down
Increased bhcg
Decreased a Papp
179
How is beta bcg, inhibin a, serum oestriol and afp represent in down
Increased bhcg
Increased inhibin
Decreased rest
180
CVS is done when
11-14
181
When is amnioncentiss down
15 weeks
182
If obese - is nuchal a good test?
Nooo
183
What do you do for a pph
Uterine massage
2nd line iv syntocinon
3rd line Iv ergometrine
