Obstetrics Flashcards by Aureliah K | Brainscape

Q

Define an APH

A

Bleeding in pregnancy after 24 weeks

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Q

Name 4 differentials for an APH

A

Placental abruption/praevia
Vasa Previa
Maternal genital infection
Trauma
Ectropion
GTD

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Q

Define placental abruption

A

Separation of placenta from uterine wall

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Q

Name 4 risk factors for placental abruption

A

Pre-eclampsia
Polyhydramnios
Older mother
Multiparity
Cocaine
Smoking
Trauma

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Q

Name 4 sx of placentla abruption

A

PV bleeding
Pain
shock
contranctions

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Q

Name 4 signs associated with placetnal abruption

A

Woody hard uterus
Tachycardia
Hypotension
Tenderness on palaption

CTG - Foetal distress and decreased fetal movements

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Q

What investigations are required in placental abruption

A

USS - R/O placenta praevia
Speculum examination - identify the source of the bleed
Maternal blood
- FBC / Group and save / Clotting / Crossmatch

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Q

Placental abruption management

A

ABCDE
Anti-D prophylaxis
IM steroids if <36

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Q

Define placenta praevia

A

Pacenta overlying cervical os

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Q

Name 4 RF for placenta praevia

A

Uterine structural abnormality - fibroids
Hx C sections
Mulltiparity
Smoking
Older age

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Q

Symptoms of placenta praevia

A

Painless bright red PV bleed

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Q

What are the examination findings in placenta praevia

A

Abnormal lie and presentation of foetus

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Q

What are the examination findings in placenta praevia

A

Abnormal lie and presentation of foetus

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Q

What are the examination findings in placenta praevia

A

Abnormal lie and presentation of foetus

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Q

What are the examination findings in placenta praevia

A

Abnormal lie and presentation of foetus

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Q

What are the examination findings in placenta praevia

A

Abnormal lie and presentation of foetus

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Q

How is placenta praevia picked up

A

Anomaly scan - 20 weeks
TVUS

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Q

What is contraindicated in APH

A

DVE - Especially in Placenta praevia due to risk of provoking a severe haemorrhage

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Q

What is vasa praevia

A

foetal vessels run near to or across the internal cervical os

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Q

What are the clinical features of vasa praevia

A

painless PV bleed
Rupture of membranes
foetal bradycardia

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Q

Name 3 risk factors of vasa praevia

A

multiple pregnancy
placenta praevia
IVF

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Q

What is the management of vasa praevia

A

elective c-section prior to ROM

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Q

Describe the differences between placenta: Acreeta, Increta and Percreta

A

Acreeta - attachment of palcenta onto myometrium without penetration

Increta - Chorionic villi invade into but not through myometrium

Percreta - chorionic villi invade through full thickness of myometrium

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Q

Name 4 risk factors for placental invasion

A

Previous TOP
Dilatation and curettage
previous c section
advanced maternal age
uterine structural defects

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Q

Outline pre-existing HTN of pregnancy

A

High BP prior to 20 weeks gestation

No proteinuria

No oedema

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Q

Outline pregnancy induced hypertension

A

Hypertension occuring following 20 weeks gestation

No proteinuria

No oedema

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Q

Outline pre-eclampsia

A

new-onset blood pressure ≥ 140/90 mmHg after 20 weeks of pregnancy, AND 1 or more of the following:

proteinuria

other organ involvement (see list below for examples): e.g. renal insufficiency (creatinine ≥ 90 umol/L), liver, neurological, haematological, uteroplacental dysfunction

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Q

Who should take aspirin

A

1 high risk RF
2 Moderate risk RF

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Q

Name 3 high risk RF for pre-eclampsia

A

prev HTN disease in pregnancy
CKD
DM
Chronic HTN
AI - SLE / Antiphospholipid

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Q

Name 3 moderate risk RF for Pre-eclampsia

A

FHx
Multiple pregnancy
BMI>35
1st pregnancy
>40 years old

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Q

Name 4 sx of pre-eclampsia

A

Headache
visual disturbance
RUQ pain
Vomiting

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Q

Name 4 signs of pre-eclapmsia

A

Altered emntal status
Hyper-reflexia
Peripherla oedema
Proteinuria
N+V

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Q

What blood tests would you order and what would be seen in a patient with pre-eclampsia

A

FBC - Raised HB and low platelets

U+E - Raised Ur / creatinine / urate

PLGF - low

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Q

Why does eclamsia occur in a patient with pre-eclampsia

A

cerebrovascular vasospasm

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Q

Name 4 complications of pre-eclampsia for the foetus

A

IUGR
PRre-term delivery
Placental abruption
Neonatal hypoxia

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Q

What are the consequences / clinical features of HELLP

A

H - Dark urine / Raised LDH / Anameia

EL - RUQ pain / liver failure / Abnormal clotting

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Q

Name 4 risk factors for GDM

A

BMI > 30
Previosu macrosomic baby
previous GDM
1st degree relative with diabetes

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Q

When should the OGTT be done

A

Previous GDM - Booking + 28 weeks

All other - 28 weeks

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Q

Name 2 complications of GDM

A

Macrosomia
Shoulder dystocia
Pre term delivery
Neonatal hypoglycaemia
congenitla heart defects
Polycythaemia

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Q

Outline the classification and the causes of SGA

A

SGA - Foetal weight <10th centile

constitutionally small - based on sex/ parents height/ethnicity

placental mediated - growth slown in utero
Placental insufficiency

Foetal factors - infection / chromosomes

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Q

Name 3 causes of polyhydramnios

A

increased foetal urination
- foetal renal disorders
- twin to twin trasfusion
- maternal DM

Reduced foetal swallowing
- oesophageal or duodenal atresia
- chromosomal disorder
- diaphragmatic hernia

Q

How does polyhydramnios present

A

Uterus feels tense
large for dates
difficult to palapte foetal parts

Q

What investigations are required for polyhydramnios

A

USS and examination
TORCH screen
Maternal OGTT

Q

Name 4 causes of oligohydramnios

A

Maternal
- PROM
- Placental insufficiency

Foetal
- PCKD
- Renal agenesis
- Urethral obstruction
- Chromosomal abnormalities

Q

Name 3 complications of oligohydramnios

A

clubbed feet
congenital hip dysplasia
pulmonary hypopasia

Q

What is potter sequence

A

Bilateral renal agenesis + pulmonary hypoplasia

Q

what is obstetric choelstasis

A

condition occurring after 24 weeks gestations due to build up of bile acids

Associated with high risk stillbirth

Q

What are the clinical features of obstetric cholestasis

A

itching - worse on hands and feet
fatigue
Nausea
mild jaundice - dark urine and pale stools
RUQ pain

Q

What investigations are required for obstetric cholestasis

A

LFTs - Abnormal
Bilirubin - raised

Q

What is the management of obstetric cholestasis

A

Induction of labour: 37-38 weeks

Ursodeoxyxholic acid - reduce serum bile acids

Chlorphenamine - improves sleep

Vit K - reduce risk of haemorrhage

Q

Name 4 risk factors for VTE in pregnancy

A

Smoker
>35
multiplt pregnancy
BMI>30
IVF pregnancy
Pre-eclampsia

Q

How is VTE in pregnancy managed

A

Treatment determined at booking clinic appointment

> 4 RF –> LMWH antenatal and 6 weeks post partum

3 Risk factors start at 28 weeks

Q

How do you estimate due date

A

Add 1 year and 7d to LMP

Subtract 3 months

Q

What is the bishop score and what does it indicate

A

Indicates if IOL will be successful
Score > 8 - indicates success

Score < 8 - indicates cervical ripening required first

Q

What are the methods for induction of labour

A

Membranse sweep

Vaginal prostaglandins

cervical ripening balloon

AROM + IV oxytocin

Q

What is monitored during IOL

A

CTG - Foetal HR / Contractions

Bishop score - assess progress

Q

What is uterine hyperstimulation syndrome

A

Due to vaginal prostaglandins causing prolonged and frequent contractions causing foetal compromise

Q

What is uterine hyperstimulation syndrome

A

Due to vaginal prostaglandins causing prolonged and frequent contractions causing foetal compromise

Risk of uterine rupture

Q

How is uterine hyperstimulation syndrome managed

A

stopping prostaglandins

starting tocolytics - terbutaline

Q

How do you manage Braxton Hicks

A

Hydration and relaxation

Q

What is the 2st stage of labour

A

onset of labour to 10cm dilated

cervical dilatation and effacement

Q

How do you recognise the onset of labour

A

ROM
Cervical show
Regular painful contractions
Dilatation of cervix

Q

Describe the management of the 3rd stage of labour - active and physiological

A

Physiologiclal - placenta delivered via maternal effort. No cord traction or medication

Active -
IM Oxytocin following delivery of the baby
delayed cord clamping
cord traction to deliver placenta

Q

What are the options for pain management in labour

A

Gas and Air - short term
IM Diamorphine
PCA - IV Remifentanil
Epidural - Bupivocane + Fentanyl

Q

Name 4 adverse effects of an epidural

A

headache after insertion
hypotension
motor weakness in the legs
nerve damage
prolonged 2nd stage
urinary retention
increased risk of instrumental delivery

Q

What are the parameters for failure to progress in each stage of labour

A

1st stage
- >2cm every 4 hours

2nd stage
- primiparous > 2 hours
- multiparous > 1 hour

3rd stage
- active > 30 mins
- passive > 60 mins

Q

What factors affect progression in 2nd stage of labour

A

3 Ps
Power
Passage - cephalopelvic disproportion
Passenger
- Lie
- Attitude
- Presentation
- Size

Q

Describe the cardinal movements of labour

A

Every darn fool in Egypt eats raw eggs

Engagement
Descends
Flexion
Internal rotation
Crowning
Extension
External rotation
Restitution
Expulsion

Q

What is required following instrumental delivery

A

Co-amoxiclav

Q

What are the indications for instrumental delivery

A

Failure to progress - 2nd stage
foetal distress
maternal exhaustion
Breech

Q

What are the foetal risks to delivery via forceps and ventouse

A

ventouse - cephalohaematoma

forceps - facial nerve palsy

Q

Name 4 causes of malpresentation

A

Multiple pregnancy
Uterine abnormalities
Polyhydramnios
Placenta praevia
Preterm labour

Q

What is involved in prophylaxis of preterm labour

A

Done between 16-24 weeks for women with cervical length <2.5cm

Vaginal progesterone - decreases activity of myometrium and prevents cervical remodelling

Cervical cerclage

Q

How is ROM diagnosed

A

Speculum - amniotic fluid pooling in vagina

Insulin like growth factor binding protein - present in high concentration in amniotic fluid

Q

Give 2 optiosn for tocolysis

A

Nifedipine
Atosiban - oxytoxcin receptor antagonist

Q

Layers for C section

A

Skin
Subcutaneous tissue
Fascia / rectus sheath
Rectus abdominis muscles
Peritoneum

Uterus (perimetrium, myometrium and endometrium)
Amniotic sac

Q

Why shoudl you not handle the cord during a cord prolapse

A

causes vasospasm

Q

How is cord prolapse managed

A

Push presenting part upwards
Woman on all 4’s
Tocolytics
C- section

Q

What is shoulder dystocia

A

Anterior shoulder of foetus gets stuck behind pubic symphisis

Q

How is shoulder dystocia managed

A

Episiotomy
Mc Robertson manoevere

Q

Name 3 complications of shoulder dystocia

A

Foetal hypoxia
Brachial plexus injury
Erbs palsy
Perneal tears
PPH

Q

Name 3 signs and sx of chorioamnionits

A

Fever
Tachy
High resp rate
Abdominal pain
Uterine tenderness
Vaginal discharge

Q

Describe the classifications of a PPH

A

> 500mls - vaginal
1000ml - C section

Q

Describe the primary and secondary classifications of a PPH

A

Primary - within 24hrs of birth
Secondary - from 24 hours to 12 weeks

Q

Name 3 preventative measures to a PPH

A

Treating anaemia during antental period
give birth with empty bladder
Active 3rd stage management

Q

Give 3 causes of PPH - Tone

A

Polyhydramnios
Multiple pregnancy
Macrosomia
Fatigue - prolonged labour
Medications - Tocolytics

Q

Why does Retained products in Tissue lead to PPH

A

Retained placenta prevents contractions –> Atony

Q

Give 3 causes of PPH - Trauma

A

Perineal tear
Episeotomy
Rupture

Q

Outline the management of a PPH

A

ABCDE
2 wide bore cannulas
Bloods - FBC / U+E / Clotting
Group and save + cross match

Uterine massage + catheterisation
IV Oxytocin
Ergormetrine - CI in HTN
Carboprost - Caution in Asthma

Uterine balloon tampoande
Hysterectomy

Q

Name 2 causes of secondary PPH

A

Endometritis - Uterine infection
Lower abdominal pain / Fever / Foul smelling lochia

Retained tissue -Uterue palpable highly

Q

What are the investigations for secondary PPH

A

USS - Retained products
Swabs - Endocervical and HVS

Q

Name 4 features of congenital rubella

A

Congenital deafness
Congenital cataracts
CHD - PDA and pulmonary stenosis
LD

Q

Give 4 features of congenitla varicella syndrome

A

Occurs within 28 weeks gestation
FGR
Microcepahly
LD
Skin scarring
Limb hypoplasia
Cataracts

Q

Name 4 features of Congenital CMV

A

FGR
Microcephaly
Hearing loss
Vision loss
LD
Seizures

Q

Give 4 features of toxoplasmosis

A

Intracranial calcification
Hydrocephalus
Chorioretinitis

Q

Give 4 general lifestyle measures for infertility

A

400mcg folic acid
healthy BMI
Avoid smoking and drinking
Intercourse 2-3 days

Q

Name 4 hormones tested for in infertility - female

A

Serum LH and FSH - On day 2-5 of the cycle
D21 progesterone
TFT
Prolactin

Q

What does high FSH indicate

A

Low ovarian reserve

Q

What does high LH indicate

A

PCOS

Q

What does high LH indicate

A

PCOS

Q

What does AMH indicate

A

Measured at any point in the cycle - marker of ovarian reserve
released by granulosa cells

Q

What is the MOA of clomifine

A

Anti-oestrogen - selective oestrogen receptor modulator
given on day 2 - 6 of cycle
Stops the -ve feedback of oestrogen on hypothalamus