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OBS and GYN > RCSI LECTURES > Flashcards

RCSI LECTURES Flashcards

1
Q

Complications of molar pregnancy

A
  • severe hyperemesis
  • thyrotoxicosis
  • early onset preeclampsia
  • hemorrhage
  • persistant trophoblasict disease
  • choriocarcinoma
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2
Q

Labour diagnosis

A

Progressive effacement and dilatation of the cervix in the presence of uterine contractions

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3
Q

First stage of labour

A

From establishment of labour until full dilatation

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4
Q

Second stage of labour

A

Full dilatation to delivery of the fetus

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5
Q

Third stage of labour

A

Delivery of the placenta

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6
Q

What are the standard procedures in labour assessment?

A
  • general examination
  • assessment of uterine contractions and fetabl wellbeing
  • FBC, blood type and Rh status
  • Partogram
  • Minimal vaginal examinations following initial assessment
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7
Q

What are the fetal assessments in labour?

A
  • Amniotic fluid (volume and colour)

- Maternal assessment - BP, HR and temp charting - uterine contractions

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8
Q

Average rate of cervical dilatation in a primigravida?

A

1cm per hour

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9
Q

When is the fetal head considered engaged?

A

When 2/5ths or less are palpable

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10
Q

When does the second stage of labour begin?

A

-with full dilatation

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11
Q

What are the two phase of the second stage of labour?

A

Passive phase: from full dilatation until the head reaches the pelvic floor
Active phase: when the fetal head reaches pelvic floor - usually associated with strong desire to push

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12
Q

First degree tear?

A

Injury to the vaginal epithelium and vulval skin only

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13
Q

Second degree tear?

A

Injury to the perineal muscles but not the anal sphinctor

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14
Q

Third degree tear?

A

Injury to the perineum involving the anal sphinctor

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15
Q

Fourth degree tear?

A

Injury involving the anal sphincter and rectal mucosa

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16
Q

Signs of placental separation

A
  • lengethening of the umbilical cord
  • gush of blood
  • Rising up of the fundus
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17
Q

what is the latent phase of labour?

A

up to 3cm dilation

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18
Q

how long may the latent phase of labour take?

A

up to 6 hours

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19
Q

what is the active phase of labour?

A

3cm to 10cm dilation

20
Q

at what rate should dilation occur?

A

1cm per hour in primi, 1-2cm per hour in multi

21
Q

what are EFFICIENT uterine contractions?

A

Regular contractions, lasting 60-80 seconds with a frequency of up to 7 in 15 min

22
Q

Most common cause of failure to progress in primigravid women?

A

Inefficient uterine action

23
Q

Management of inefficient uterine action?

A

Oxytocin via IV infusion - start low and increase
Aim to acheive 7 contractions in 15 min
Must monitor fetal heart while using oxytocin

24
Q

A multigravid woman is likely to have inefficient uterine action T OR F

A

FALSE - unlikely - caution when using oxytocin, failure to progress could be from malpresentation

25
Q

Diagnosis of prolonged labour?

A
  • certainty about onste of labour?
  • review history
  • assess contractions
  • review the CTG
  • perform abdominal and vaginal exams before making any decisions
26
Q

Management of prolonged labour?

A

IF maternal and fetal wellbeing are satisfactory - alllow labour to continue

IF suspected fetal compromise, arrest in cervical dilation despite adequate contractions, or cephalic disproportion -> C-section

27
Q

What is malpresentation?

A

When any non-vertex part presents - arm/face/feet/brow etc

28
Q

Risk factors for oblique/transverse lie?

A
  • preterm labour
  • placenta previa
  • abnormal uterus
  • polyhydramnios
29
Q

why does transverse lie occur in women with high parity?

A

laxity of the abdominal wall

30
Q

Management of a non-reassuring CTG ?

A

Fetal blood sampling OR delivery via C section/instrumental delivery

31
Q

normal pH on fetal blood sampling?

A

7.25 and up

32
Q

Borderline ph and procedure for borderline ph?

A

7.2-7.25 = repeat in 30 min or deliver if rapid fall since last sample

33
Q

What is an abnormal pH on fetal blood sampling?

A

<7.20 -> delivery (based on cervical dilation)

34
Q

Indicators of down syndrome on a first trimester screening?

A
  • nuchal translucency

- decreased PAPP-A and elevated b-hcg

35
Q

What are the definitive tests for down syndrome in uteruo?

A

Chorionic villus sampling - performed at 11-14 weeks gestation
Amniocentesis - greater than 15 weeks gestation

36
Q

what is the risk of chorionic villus sampling?

A

1% risk of miscarriage

37
Q

Risk of amniocentesis?

A

<0.1% chance of miscarriage

38
Q

trisomy 18 =

A

edwards syndrome

39
Q

ultrasound features of a fetus with edwards syndrome?

A

IUGR, strawberry shaped head, choroid plexus cysts, hydrocephalus, micrognathia, nuchal edema, heart defects, neural tube defects

40
Q

trsimoy 13 =

A

patau syndrome

41
Q

ultrasound features of a fetus with patau syndrome?

A

IUGR, holoprosencephaly, facial abnormalities, microcephaly, heart defects

42
Q

when should the neural tube close?

A

26-28 days

43
Q

when should a woman commence folic acid?

A

3 months prior to conception - 0.4mg OR 5mg if high risk

44
Q

what is the role of the first trimester scan?

A
  • to confirm viability of the pregnancy
  • to confirm that its an intrauterine pregnancy
  • to confirm or exclude multiple gestation
  • if multiple gestation - confirm chorionicity
  • confirm dates by measuring crown rump length
45
Q

What is the role of the second trimester scan?

A

18-22 weeks - fetal anomoly scan

  • confirm pregnancy dating with biophysical measurements
  • placental location (especially in women with bleeding)

OBS and GYN (42 decks)

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