Sept 2015 recall Flashcards
When is it contraindicated to perform forceps?
When the head is 2/5 palpable PA
Higher than spines
Not DOA
What is a mid cavity forceps?
Anything higher than +2
What is a risk for failed forceps (so indication to take to theatre)?
Big mother, BMI>30
Big baby, >4kg
Mid cavity or when 1/5 palpable PA
OP
Which antibiotics for GBS?
(also give for PTL as they are at inc risk of GBS, 2.3/1000 and becoming unwell with GBS mortality 20-30% if they are infected, compared with 2-3% if term)
Benzylpenicillin
If not severe allergy- cephalosporin
If severe allergy- vancomycin
What gestation is an emergency cerclage considered up to?
27+6,
Can delay delivery by ~34 days an a 2 fold reduction of births <34/40
When are you less likely to perform an emergency cerclage?
Dilation >4cm,
>24/40 all have an increased risk of ROM
If you suspect a delay in progress when the presentation is breech what should you do next?
Caesarean section
What can reduce the risk of an assisted vaginal birth?
Continuous support in labour
If no epidural- upright/ lateral position
If epidural- lateral position
How do you manage a woman with parvovirus?
When confirming- check for rubella at the same time
Once confirmed:
refer to FMU 4 weeks after infection
Serial scans
If suspected hydrops- amniocentesis can confirm
What is the risk of vertical transmission of parvovirus?
30%
What is TSH similar to, in terms of molecular structure?
HCG, FSH, LH
What is the mechanism of contraception for COCP?
Suppress ovulation
What is classed as a high risk triple/ quadruple test?
Up to 1 in 150- these women should be offered a NIPT
HIV +ve, viral load >30,000, what should the plan for delivery be?
IV zidovudine and c/s between 38 and 39 weeks
What is PEP for neonates birthed by mothers who are HIV+ve?
If mother has been on cART for 10 weeks, VL<50 at 36/40 and <50 on 2 separate occasions 4 weeks apart- only 2 weeks of monotherapy with zidovudine.
If all the above isnt met, but their 36/40 VL was <50 (or preterm and most recent VL <50) then 4 weeks of monotherapy will be ok
In any other situation, combined PEP should be used and should be commenced within 4hr of birth and for 4 weeks
What is the diagnostic test for syphilis?
Treponema
TPHA
How common is syphilis
1 in 700 pregnant women in the UK have a positive result
What is the treatment for syphilis?
1st and 2nd trimester: IM 2.4 benzylpenicillin (if early)
3rd trimester: IM benpen on d1 and d8
Least likely organism in post partum sepsis?
clostridum perfringes
Post delivery, neonate with cranial swelling with ill defined margins, extending down to the eye, significant anaemia
sub galeal
Risk of placental abruption if one previously?
And if two previously?
4.4%
25%
Which antihypertensives can cause neonatal hypoglycaemia?
labetalol
How much AntiD per 1ml of FMH
125units per 1 ml
Is there an association between migraine and pre-eclampsia?
Migraines gives you a two fold inc in the risk of pre-eclampsia
(also have a 4 fold risk of MI and 17 fold risk of stroke)
From TOG
What are the clauses/ reasons allowed for a TOP?
Clue- A-E
A- risk of life to pregnany woman
B- risk of grave permanent injury to physical/ mental health of pregnant woman
C- Not over 24 weeks and risk to mental/ physical health of woman
D- Not over 24 weeks and risk to mental/ physical health to existing children
E- Child is likely to be born with life limiting condition/ significantly handicapped
(F and G are in emergencies, F is to save womans life, G is to prevent injury to woman)
Chance of recurrence of shoulder dystocia?
10%
Diameter of a brow presentation?
Mento-vertical
13.5cm
Diameter of deflexed OP?
Occipitofrontal
11.5
Diameter of flexed vertex?
suboccipito-bregmatic
9.5
Diameter of a face presentation?
submentobregmatic
9.5
Chances of getting a post dural headache after an epidural?
puncture of the dura: 0.5-2.5%
If this happens it is 70-80% likely that you will get a headache
How long does a post dural headache last?
Typically 7-10 days
Blood patch can provide cure for 60-90%
