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4 MBCHB > REPRO 6 > Flashcards

REPRO 6 Flashcards

1
Q

when does blood pressure normally fall in pregnancy

A

second trimester

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2
Q

when is htn in pregnancy diagnosed (3)

A

> = 140/90 on two occasions
DBP >110 or SBP >160
rise of SBP by 30 or DBP by 15 or more from booking

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3
Q

complications of hypertension during pregnancy

A

PET, IUGR, abruption

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4
Q

when is pregnancy induced hypertension diagnosed and when does it resolve

A

second half of pregnancy and resolves 6 weeks PN

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5
Q

what percentage of patients with hypertension go on to develop PET and what is the recurrence rate

A

15%

high

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6
Q

treatment - in order of hypertension - and CI/SE

A

Labetalol PO/IV asthma, IUGR
Nifedipine PO
IV hydralazine
Methyldopa - can cause rebound hypertension

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7
Q

what is the triad of PET

A

oedema
hypertension
proteinuria >=3g/24h

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8
Q

when is maternal artery doppler done

what is it checking for

A

20-24weeks

placentation

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9
Q

what is abnormal placentation

A

failure of trophoblasts and placentation leading to low flow and high pressure

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10
Q

what is HELLP syndrome

A

haemolysis, elevated liver enzymes and low platelets

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11
Q

what is the normal amniotic fluid index and what is it in PET

A

6-22

<6

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12
Q

complication involving mean arterial pressure

A

MAP >=150 -> cerebral haemorrhage

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13
Q

what should the blood pressure aim be

A

140-150/90-100

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14
Q

what is eclampsia

A

PET and tonic clonic gen seizures

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15
Q

how many patients have seizures before the onset of hypertension/proteinuria

A

1/3

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16
Q

when do most patients have seizures

A

in labour or after

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17
Q

what is eclampsia associated with

A

ischaemia/cereberal vasospasm

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18
Q

treatment of eclampsia - htn

A

Labetalol, nifedipine, hydralazine

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19
Q

treatment for eclampsia - seizures
if further seizure
if even further seizure

A

4g IV magnesium sulphate loading dose over 5-10mins
then 1g/hour infusion for 24 hours

2g magnesium sulphate

Diazepam 10mg IV

20
Q

eclampsia fluid balance and why is this important

A

run patient dry at 80mls/hour

giving fluids can lead to pulmonary oedema

21
Q

what is given to induce labour in eclampsia and what should be avoided

A

syntocin

ergometrine - causes hypertension

22
Q

steroids in pregnancy - what and till when

A

12mg beclamethasone IM 2 doses 24h apart

up to 36 weeks

23
Q

mod risk factors of PET

A 
first pregnancy 
>=40
pregnancy interval >10y
FH
multuple preg
BMI >35
24
Q

high risk factors for PET

A 
prev PET/htn
CKD
AI disease like SLE antiphos
DM type 1 or 2
chronic hypertension
25
Q

when should aspirin be started

what dose and how often

A

2 mod or 1 high risk factor

75mg once daily

26
Q

stage 1 of labour

A

onset of labour to full dilatation

27
Q

stage 2 of labour

A

full dilatation to delivery of the baby

28
Q

stage 3 of labour

A

delivery of the baby to deliver of the placenta

29
Q

normal position of baby
lie
presentation

A

occipitoanterior
longitudinal
cephalic

30
Q

normal labour takes how long from active phase

A

<24 hours

31
Q

types of analgesia available (6)

A 
enterox
IV remifentanil PCA
spinal block
epidural
pudendal nerve block
32
Q

which works faster spinal block or epidural

A

spinal

33
Q

what is epidural - whats in it
does it impair uterine activity
what can it do
effects

A

levobupavicaine +/- opiate
no
can delay second stage
maternal hypotension, headache, back pain, atonic bladder

34
Q

risk of epidural

A

dural puncture

severe headache and photophobia due to CSF leak

35
Q

induction of labour (4)

A

membrane sweep
prostaglandins
amniotomy
IV syntocin

36
Q

failure to progress in stage 1 nulli v parous

A

nulli <2cm in 4h

multi <2cm in 4h or slowing in progress

37
Q

causes of delay in stage 1 of labour

A

passage, passanger, power

38
Q

delay in second stage of labour para and mult

A

para 0cm in >2h or 3h with epidural

multi 0cm in 1h or 2h plus epidural

39
Q

approach for delay in second stage

A

change position
amniotomy
syntocin
deliver

40
Q

fatal distress risk factors

A

small fetes, prem/post, APH, htn/pet, DM, epidural, PROM >24h, sepsis, IOL, vaginal birth after CS

41
Q

causes for fatal distress

A

abruption, vasa praevia, cord prolapse, cord prolapse, uterine rupture, haemorrhage, regional anaethesia, hypoxia

42
Q

what does CTG show in fatal dsitress

A

variable decel or late decel

43
Q

fatal blood sampling

A

> 7.25 normal
7.2 to 7.25 repeat in 30mins
<7.2 deliver

44
Q

treatment for fatal distress

A 
change maternal position 
IV fluids 
stop syntocin 
terbutaline 250mcg - stops contractions 
deliver
45
Q

Downs test in first trimester

A

nuchal thickness measurement 11-13(+6) combined with HCG and PAPPA

46
Q

downs quadrouple test

A

14-20w bloos test

bHCG, AFP, inhibin A, unconjugated bilirubin

47
Q

genetic tests for downs

A

amniocentesis 15w miscarriage risk 1%

CVS 12w misc risk 2%

4 MBCHB (80 decks)

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