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Medicine Year 4 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What should you do if a baby loses >10% of its birthweight in the first week of life

A

Refer to midwife-led breastfeeding clinic

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2
Q

What are the two phases in the 1st stage of labour

A

Latent phase: 0-3cm

Active phase: 3-10cm

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3
Q

Would you experience pain with a threatened miscarriage

A

No

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4
Q

How would you immediately manage an umbilical cord prolapse

A

Retrofill the bladder with 500-700ml of saline and push the presenting part back into the uterus

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5
Q

When should insulin be commenced in gestational diabetes

A

If fasting glucose level of >=7 mmol/l at the time of diagnosis

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6
Q

Define ‘station’

A

The term used to describe the head in relation to the ischial spine

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7
Q

3 parameters which indicate an antenatal diagnosis of Down’s Syndrome

A

Increased HCG
Decreased PAPP-A
Thickened nuchal translucency

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8
Q

How long should you continue magnesium treatment for after the last seizure

A

24 hours

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9
Q

Give one risk factor for pre-eclampsia

A

Pre-existing renal disease

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10
Q

What is the only contraindication for epidural anaesthesia in labour

A

Coagulopathy

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11
Q

When should you attempt to move a breech baby

A

36 weeks

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12
Q

Are DOACs safe to use in pregnancy?

A

NO

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13
Q

is it safe to breastfeed a baby with maternal hepatitis B

A

yes

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14
Q

Define renal agenesis and how would it present

A

Absence of one or both kidneys

Reduced amniotic fluid

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15
Q

What should you do if there are late decelerations on CTG

A

Fetal blood sampling

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16
Q

When should methotrexate be stopped before conception?

A

6 months

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17
Q

How would you manage a women who had a previous baby with group B strep

A

IV antibiotic prophylaxis

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18
Q

When would you give the first dose of anti-D

A

28 weeks

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19
Q

What dose of folic acid should you give women?

A

400 micrograms for the general population

5mg for women with a BMI over 30 or on anti-epileptics or diabetics

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20
Q

What should you do if a woman is exposed to chicken pox during pregnancy?

A

If they are not immune then give:
Below 20 weeks: varicella zoster immunoglobulin
Above 20 weeks: varicella zoster immunoglobulin or antivirals given at day 7-14 post-exposure (not immediately)

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21
Q

Antihypertensive for pre-eclampsia

A

Labetalol

If pt has asthma then Nifedipine

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22
Q

What 5 scenarios would warrant continuous CTG monitoring

A
  • suspected chorioamnionitis or sepsis, or a temperature of 38°C or above
  • severe hypertension 160/110 mmHg or above
  • oxytocin use
  • the presence of significant meconium
  • fresh vaginal bleeding that develops in labour - this was a new point added to the guidelines in 2014
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23
Q

Define postpartum haemorrhage

A

Blood loss of 500mls or more within 24 hours of the birth of a baby

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24
Q

2 SSRIs of choice in breastfeeding women

A

Sertraline

Paroxetine

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25
Q

What medication is absolutely contraindicated in breastfeeding

A

Aspirin

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26
Q

At what gestation do pregnancy associated blood pressure changes begin?

A

Past 20 weeks, anything before this is pre-existing hypertension

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27
Q

What is postpartum thyroiditis and how is it treated?

A

Autoimmune condition which usually lasts for 3-4 months postpartum and is treated with beta blockers

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28
Q

ABx of choice for GBS prophylaxis

A

IV benzylpenicillin

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29
Q

Bright red vaginal bleeding with a non-tender uterus and normal CTG at 28 weeks

A

Placenta praevia

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30
Q

Constant pain with bleeding and ‘woody’ abdomen with uterine contractions and foetal distress on CTG

A

Placental abruption

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31
Q

Painless vaginal bleeding before 24 weeks

A

Threatened miscarriage

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32
Q

Maternal shock, abdominal pain and fetal compromise

A

Uterine rupture

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33
Q

Rupture of membranes and dark red vaginal bleeding with foetal bradycardia

A

Vasa praevia

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34
Q

Pregnant women with a previous VTE history

A

LMWH throughout pregnancy until 6 weeks postpartum

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35
Q

Pre-existing diabetic treatment throughout pregnancy

A

Metformin and insulin are the only drugs

Other drugs such as glicazide and liraglutide are contraindicated

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36
Q

First step for chickenpox exposure in pregnancy

A

Check varicella antibodies

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37
Q

What is syndometrine

A

Works the same as oxytocin to contract the uterus during the third stage of labour

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38
Q

When should you investigate a lack of foetal movements?

A

24 weeks

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39
Q

Woman presents with reduced foetal movements after 28 weeks

A

Handheld doppler

If no heartbeat found then immediate ultrasound

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40
Q

What should you do if you suspect maternal rubella infection

A

Discuss immediately with the local health protection unit

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41
Q

Management of pregnant women above 20 weeks who develop chickenpox and present within 24 hours

A

Oral aciclovir

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42
Q

Management of intrahepatic cholestasis of pregnancy

A

Induce at 37-38 weeks due to increased risk of stillbirth

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43
Q

Management of PPROM

A

10 days erythromycin

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44
Q

first-line medical treatment for intrahepatic cholestasis of pregnancy

A

ursodeoxycholic acid

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45
Q

6 levels of management for PPH

A

bimanual uterine compression to manually stimulate contraction
intravenous oxytocin and/or ergometrine
intramuscular carboprost
intramyometrial carboprost
rectal misoprostol
surgical intervention such as balloon tamponade

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46
Q

Which presentation has the greatest mortality

A

Footling

Increased risk of cord prolapse

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47
Q

Features of HELLP syndrome

A

Haemolysis (H), elevated liver enzymes (EL), and low platelets (LP)

Severe form of pre-eclampsia with malaise, nausea, vomiting, headache, epigastric pain

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48
Q

% risk of developing postpartum psychosis a second time

A

25-50%

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49
Q

At what gestation is the second screen for anaemia and atypical red cell alloantibodies performed?

A

28 weeks

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50
Q

At what gestation is the nuchal scan performed

A

11-13+6 weeks

51
Q

At what gestation is the urine culture to detect asymptomatic bacteria performed (and the booking visit(

A

8-12 weeks

52
Q

What are the reference ranges to diagnose gestational diabetes?

A

Gestational diabetes can be diagnosed by either a:
fasting glucose is >= 5.6 mmol/L, or
2-hour glucose level of >= 7.8 mmol/L
‘5678’

53
Q

Who would you give routine antenatal anti-D prophylaxis at 28 weeks to?

A

Rhesus negative mothers who are not sensitised

54
Q

Which medications should be avoided whilst breastfeeding?

A 
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
diabetic drugs apart from metformin
55
Q

Which infectious diseases are routinely screened for in pregnancy?

A

Hepatitis B, HIV, rubella, syphilis

56
Q

First line treatment for mastitis

A

Continue breastfeeding, simple analgesia and warm compress

57
Q

Factors which would indicate ABx are appropriate in mastitis?

A

Infected nipple fissure, symptoms not improving after 12-24 hours or positive milk culture

58
Q

Risk factor for shoulder dystocia

A

Diabetes

59
Q

What is a galactocele

A

Well-circumscribed lesion with a white fluid on aspirate that appears after breastfeeding (no need for investigation)

60
Q

Management of cord prolapse

A

The presenting part of the fetus can be pushed back into the uterus

61
Q

Folic acid and vitamin D throughout pregnancy

A

Vitamin D throughout

Folic acid for the first 12 weeks

62
Q

Biggest risk factor for cord prolapse

A

Artificial amniotomy

63
Q

Sudden Hx of collapse with hypotension after artificial rupture of membranes

A

Amniotic fluid embolism

64
Q

What can you do to aid the McRobert’s manoeuvre

A

Suprapubic pressure

65
Q

Most common cause of severe infection in newborn babies

A

Group B septicaemia

66
Q

What assessment should you perform prior to induction of labour

A

Bishop score

67
Q

How does TTTS present

A

Sudden increase in size of abdomen and breathlessness

68
Q

What score do you calculate for Anti-D

A

Kleihauer test

69
Q

Layers of the abdomen cut through in a c-section

A

Anterior rectus sheath - rectus abdominis muscle - transversalis fascia - extraperitoneal connective tissue - peritoneum - uterus

70
Q

Is lamotrigine safe in pregnancy (epileptic drug)

A

Yes

71
Q

Pregnant women with a previous history of gestational diabetes, when are they offered OGTT

A

OGTT immediately after booking and again at 24-28 weeks

72
Q

first-line investigation for preterm prelabour rupture of the membranes

A

Careful speculum examination to look for pooling of amniotic fluid in the posterior vaginal vault

73
Q

Define pre-eclampsia

A

new-onset BP ≥ 140/90 mmHg after 20 weeks AND ≥ 1 of proteinuria, organ dysfunction

74
Q

How would you manage a woman with ONLY + protein on urinalysis

A

Routine

75
Q

What would a Bishop score mean?

A

A Bishop score less than 5 generally means induction will likely be necessary. A score above 9 indicates labour will likely occur spontaneously.

76
Q

Management of a suspected PE in pregnant women with a confirmed DVT

A

Treat with LMWH first then investigate

77
Q 
What is the cut off for iron supplementation in:
non-pregnant women
early pregnancy 
late pregnancy
postpartum women
A

non-pregnant women: 115 g/L
early pregnancy: 110 g/L
late pregnancy: 105 g/L
postpartum women: 100 g/L

78
Q

What are normal lab findings in pregnancy for urea, creatinine and urinary protein loss

A

Reduced urea, reduced creatinine, increased urinary protein loss

79
Q

4 normal physiological changes in a pregnant woman’s cardiac exam

A

Third heart sound
Peripheral oedema
Ejection systolic murmur
Forceful apex beat

80
Q

3 common causes of placental abruption

A

Cocaine abuse
Pre-eclampsia
HELLP syndrome

81
Q

Placental abruption, dilated pupils and hyperreflexia

A

Cocaine abuse

82
Q

What happens to blood pressure normally during pregnancy

A

Falls in first half of pregnancy before rising to pre-pregnancy levels before term

83
Q

How would you monitor treatment response for DVT in pregnant women?

A

Anti-Xa activity

84
Q

Molar pregnancy blood test findings

A

High beta HCG, low TSH, high thryoxine (HCG acts as TSH and stimulates the thyroid)

85
Q

preterm-PROM with a triad of maternal pyrexia, maternal tachycardia, and fetal tachycardia

A

chorioamnionitis

86
Q

High risk of pre-eclampsia - factors and management

A

First pregnancy, BMI above 35, FHx

Aspirin 75-150mg daily from 12 weeks to birth

87
Q

Medication of choice for depression in breastfeedign women

A

Sertraline or Paroxetine

88
Q

What is the most important risk factor for placenta accreta

A

Previous caesarean sections

89
Q

Is transverse myelitis associated with pre-eclampsia

A

No

90
Q

5 things that are associated with pre-eclampsia

A 
Intracerebral haemorrhage
Pulmonary oedema
Fetal prematurity
Fetal IUGR
oligohydramnios
91
Q

Which procedure carries the greatest risk of haemorrhage in the newborn

A

Prolonged ventouse delivery

92
Q

Which antiepileptic is safe in pregnancy

A

Lamotrigine

most are safe in breastfeeding

93
Q

What is the most common explaination for short episodes (less than 40 mins) of decreased variability on the CTG

A

The foetus is asleep

94
Q

Chicken pox exposure in pregnancy, if less than 20 weeks and woman is not immune then give…

A

…. Varicella zoster immunoglobulin

95
Q

Maximum time from cord prolapse to delivery

A

30 mins

96
Q

Perineal tear classification

A

First degree: superficial damage
Second degree: perineal muscle but not the anal sphincter
Third degree: includes anal sphincter
Fourth degree: anal sphincter and rectal mucosa

97
Q

ABx for mastitis

A

Fluclox

98
Q

Induction

A

Prostaglandin

99
Q

First line management of uterine atony

A

Syntocinon

100
Q

Initial step in women over terrm

A

Membrane sweep

101
Q

1st line in suspected pre-eclampsia

A

Urgently refer to obstetrics then they will start the labetalol

102
Q

Raised alpha fero protein

A

Omphalocele - abdominal wall defect

103
Q

When it TTTS detected

A

16-24 weeks

104
Q

Treatment for magnesium sulphate induced respiratory depression

A

Calcium gluconate

105
Q

Investigation for placenta praevia

A

Transvaginal ultrasound

106
Q

Women with known placenta praevia goes into labour

A

Emergency C-Section whether there is bleeding or not

107
Q

What is HCG secreted by

A

Syncytiotrophoblasts

108
Q

Target bp in pre-eclampsia

A

135/85

109
Q

What is puerperal pyrexia and how is it managed

A

temperature over 38 in first 14 days after delivery commonly caused by endometritis
admit to hospital for IV climdamycin and gent

110
Q

Drug during umbilical cord prolapse

A

Terbutaline

111
Q

Increased nuchal translucency other than downs

A

Congenital heart defects

112
Q

RF for placental abruption

A

A for Abruption previously;
B for Blood pressure (i.e. hypertension or pre-eclampsia);
R for Ruptured membranes, either premature or prolonged;
U for Uterine injury (i.e. trauma to the abdomen);
P for Polyhydramnios;
T for Twins or multiple gestation;
I for Infection in the uterus, especially chorioamnionitis;
O for Older age (i.e. aged over 35 years old);
N for Narcotic use (i.e. cocaine and amphetamines, as well as smoking)

113
Q

Look at CTG abnormalities

A
114
Q

When is an ultrasound needed for lochia

A

6 weeks

115
Q

Medication that causes folic acid deficiency

A

Phenytoin

116
Q

Which insulin is used in GD

A

Short acting only

117
Q

Mother with group b strep and no prophylaxis

A

Observe baby for 24 hours

118
Q

Position for mcroberts

A

Supine with both hips fully flexed and abducted

119
Q

Describe the woods screw manoeuvre

A

Put your hand in the vagina and attempt to rotate the foetus 180 degrees

120
Q

Pregnant women with blood pressure ≥ 160/110 mmHg are likely to be admitted and observed

A
121
Q

Cooked liver in pregnancy?

A

No

122
Q

Cottage cheese in pregnancy?

A

Yes

123
Q

adduction and internal rotation of the right arm in a foetus

A

Erbs

124
Q

Planned vaginal birth after caesarean (VBAC) is contraindicated in patients with previous vertical (classical) caesarean scars, previous episodes of uterine rupture and patients with other contraindications to vaginal birth (e.g. placenta praevia)

A

Medicine Year 4 (13 decks)

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