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FINALS: PASSMED/QUESMED > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is McRoberts manoeuvre?

A

Supine with hips fully flexed and abducted -> shoulder dystocia

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2
Q

What are the SSRI drugs of choice for breastfeeding women?

A

Sertraline or Paroxetine

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3
Q

How to manage reduced foetal movements?

A
  • Handheld doppler
  • US scan
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4
Q

Respiratory distress, hypoxia, and hypotension within 30 mins of delivery suggests what?

A

Amniotic fluid embolism

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5
Q

What is the management of PPH secondary to uterine atony?

A

Syntocin then ergometrine

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6
Q

Management of low lying placenta at 20 weeks?

A

Re-scan at 32 weeks

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7
Q

How to investigate suspected placenta praveia?

A

Transvaginal US

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8
Q

When is CVS done?

A

11 weeks to end of 13

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9
Q

When is amniocentesis done?

A

Week 15 onwards

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10
Q

How should suspected cases of rubella be managed?

A

Discussion with local health protection unit

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11
Q

What is involved in combined screening?

A
  • Nuchal translucency
  • bHCG
  • PAPPA
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12
Q

What is the most common cause of PPH?

A

Placentra increta

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13
Q

What are risk factors for placental abruption?

A

increasing maternal age, multiparity and maternal trauma

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14
Q

An ultrasound is indicated after how many weeks of lochia?

A

6 weeks

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15
Q

When should aspirin be taken for pre-eclampsia?

A

12 weeks until delivery

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16
Q

What is wood screws manoeuvre?

A

Put the hand in the vagina and attempt to the foetus by 180 degrees

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17
Q

What should you monitor when you give magnesium sulfare for eclampsia?

A
  • Reflexes and respiratory rate
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18
Q

What is a C/I to ECV for a transverse lie baby?

A

If the amniotic sac has ruptured

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19
Q

What is the medical management of miscarriage?

A

Vaginal misoprostol

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20
Q

Management of cord prolapse when it is past the level of the introitus?

A

Avoid handling and keep warm/moist to avoid vasospasm

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21
Q

Management of reduced foetal movements

A
  1. Handheld doppler
  2. If heartbeat, CTG
  3. If no heartbeat, US scan
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22
Q

First line investigation for preterm prelabour rupture of membranes?

A

Speculum exam to look for pooling of fluid in the posterior vaginal vault

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23
Q

Management of PE in pregnant women?

A

Treat with LMWH first then investigate

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24
Q

Management of woman with BP > 160/110

A

Admit for observation

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25
Q

When is the latest that women can travel via plane?

A

37 weeks for single pregnancy
32 weeks for twins

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26
Q

General malaise, anorexia, vomiting, jaundice in third trimester?

A

Acute fatty liver of pregnancy

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27
Q

What are the blood results for acute fatty liver of pregnancy?

A
  • elevated liver enzymes
  • prolonged PT
  • raised bilirubin
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28
Q

What is the management of AFLP?

A
  • Delivery of foetus
  • Ongoing monitoring of LFTs
  • Stabilise mother
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29
Q

A blighted ovum suggests what?

A

Ovum with no embryonic tissue -> missed miscarriage

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30
Q

What infection can occur following delivery of foetus?

A

Endometritis

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31
Q

Women with grade III/IV placenta praevia should be offered what?

A

Elective C-section at 37-38 weeks

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32
Q

APH definition

A

Bleeding from the genital tract after 24 weeks’ gestation.

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33
Q

Signs of placental abruption/shock but minimal bleeding?

A

Blood is retroplacental -> not escaping from the uterus

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34
Q

What would you expect to see on clotting studies after a major
abruption?

A

Afibrinogenemia as you get DIC which uses up clotting factors and fibrinogen

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35
Q

Which medication is used to suppress lactation when breastfeeding?

A

Cabergoline

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36
Q

BP >160/110

A

Admission to maternal unit for observation

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37
Q

Dizziness, electric shock sensations and anxiety

A

SSRI discontinuation syndrome

38
Q

Bladder still palpable after urination

A

Urinary overflow incontinence

39
Q

Management of pregnant woman with VTE history?

A

LMWH throughout pregnancy + 6 weeks after

40
Q

What is an amniotic fluid embolism?

A

Where the amniotic fluid enters the maternal circulation causing PE like symptoms

41
Q

What is the management of amniotic fluid embolism?

A
  • ICU
  • Oxygen and fluid resus
  • CTG for foetal monitoring if before delivery
42
Q

When does puerpueral psychosis often present?

A

Within 3-5 days of delivery

43
Q

What is the probable cause of baby blues?

A

Change in hormone levels

44
Q

How to check for mag sulph toxicity when given for eclampsia?

A

Reflexes

45
Q

What are the components of bishop score?

A

Station
Consistency of cervix
Os position
Cervical dilatation
Effacement

46
Q

Why is DVT more common in left leg than right in pregnancy women?

A

Gravid uterus puts greater pressure on the left iliac vein at the point it crosses the left iliac artery, slowing venous return to the heart.

47
Q

What are the risks of obstetric cholestasis?

A

Premature delivery
Stillbirth
Sleep deprivation of mother

48
Q

What are risk factors for cord prolapse?

A
  • Polyhydramnios
  • Prematurity
  • Abnormal lie
  • AROM
  • Breech presentation
49
Q

What can be helpful in cord prolapse?

A

Insert a urinary catheter and fill the bladder with saline

50
Q

What are associated defects with anti-epileptics in pregnancy?

A

Orofacial
Neural tube
Congenital heart disease
Haemorrhagic disease of newborn

51
Q

Primary herpes in third trimester?

A

Oral aciclovir 400mg tds until delivery

52
Q

Suspected PE in someone with confirmed DVT?

A

Treat with LMWH first then scan

53
Q

What should be prescribed for breastfeeding mothers who are omitting dairy from diet in suspected CMPI?

A

Calcium + Vit D

54
Q

Management of asthma attack in pregnancy?

A

Admission - even if symptoms improve

55
Q

Management of hypothyroidism in pregnancy?

A

Increase thyroxine by 25 and repeat TFT in 4 weeks

56
Q

What is the biggest risk factor for cord prolapse?

A

Artificial ROM
Other include prematurity, multiparty, twin pregnancy

57
Q

How should cord prolapse be managed?

A
  • Push presenting part of foetus back into uterus to avoid compression
  • If past level of Introits, do not handle and keep warm/moist to avoid vasospasm
58
Q

What should be done in pregnant women treated for UTI?

A

Urine culture

59
Q

serum bHCG levels >1,500 points

A

Think ectopic

60
Q

Pre eclampsia symptoms?

A
  • Headache
  • Oedema
  • Vision changes
  • Epigastric/RUQ pain
  • HTN
61
Q

What is associated with pre eclampsia?

A

HELLP - Haemolysis, elevated LFTs, low platelets

62
Q

What anatomical landmark is used to determine the station of the foetal head?

A

Ischial spines

63
Q

Combined screening features?

A
  • Done between 11 and end of 13 weeks
  • Nuchal translucency, serum BHCG and PAPP-A
64
Q

Quadruple test features?

A
  • AFP, unconjugated oestriol, HCG, inhibin A
65
Q

Management of abnormal results of combined/quadruple screening?

A
  • Non-invasive prenatal testing
  • Amniocentesis
  • Chorionic villus sampling
66
Q

What are are indications for expectant management of ectopic?

A
  • Size <35mm
  • Unruptured
  • No symptoms
  • No heartbeat
  • HCG < 1000
  • Closely monitor patients over 48 hours and recheck hCG
67
Q

What are indications of surgical management of ectopic?

A
  • Size >35mm
  • Ruptured
  • Pain
  • Visible heartbeat
  • HCG >5000
68
Q

Management of chickenpox exposure in pregnant?

A
  1. Check VZV antibodies
  2. If not present, give oral Aciclovir from day 7-14 of exposure
69
Q

Management of chickenpox in pregnancy?

A
  1. Specialist advice
  2. Give oral aciclovir if >20 weeks pregnant and presents within 24 hours of onset of rash
70
Q

UTI in third trimester?

A

Treat with amoxicillin or cefalexin

71
Q

Management of woman in early stages of labour with transverse lie?

A

Can do ECV if membranes have not ruptured

72
Q

Placenta accreta vs increta vs percreta

A

Accreta - where the placenta adheres to the myometrium
Increta - where the placenta invades into the myometrium but not through
Percreta - where the placenta invades through the full thickness of the myometrium

73
Q

Foetal anomalies which can result in death?

A

Termination of pregnancy can be at any point in pregnancy

74
Q

Membrane sweep vs prostaglandin?

A

Membrane sweep is a labour adjunct not a method of induction

75
Q

PPH management

A
  • ABCDE
  • Palpate fundus to stimulate contractions + catheterise
  • IV Oxytocin
  • IV/IM Ergometrine (C/I in HTN)
  • Carboprost (C/I in asthma)
  • Surgical: intrauterine balloon tamponade
76
Q

Risk factors for cord prolapse?

A
  • Breech/transverse lie
  • Multiple pregnancy
  • Polyhydramnios
  • Multiparity
77
Q

What is the process of rhesus disease?

A
  • Rhesus negative mother has a rhesus positive foetus and produced anti-RH antibodies
  • During next pregnancy, these cross the placenta and cause haemolysis of foetal RBC causing rhesus haemolytic disease of newborn
78
Q

When does uterus normally return to pre pregnancy size?

A

4 weeks

79
Q

What BMI should take higher dose of folic acid?

A

> 30

80
Q

What drug can be given to improve the success of ECV?

A

Terbutaline

81
Q

What swab can be done to confirm pre labour rupture of membranes?

A

Actim-PROM vaginal swab

82
Q

Instrumental deliveries can increase the risk of what?

A

PPH

83
Q

What is given prophylactically before a C-section?

A

Omeprazole

84
Q

Perineal tears classification

A

First - limited to superficial skin
Second - Into perineal muscles but not affecting sphincters
3a - <50% of sphincter, 3b - >50% of sphincter
Fourth - Skin, muscle sphincters and anal mucousa torn

85
Q

Bloods for pre eclampsia monitoring?

A

U+E,FBC,LFTs and bilirubin
Twice a week for mild, Thrice a week for severe

86
Q

What is Sheehan’s syndrome?

A

Post partum pituitary necrosis due to blood loss and hypovolaemia shock immediately after delivery

87
Q

Which nerve is blocked during instrumental delivery?

A

Pudendal

88
Q

What are the components of the quadruple test?

A
  • Serum oestriol
  • hCG
  • AFP
  • inhibin-A
89
Q

Most specific test for intrahepatic cholestasis of pregnancy?

A

Bile acids

90
Q

lambda sign of US is a sign of what?

A

Dichorionic diamniotic twin pregnancy

91
Q

Stages of labour

A

1 - Latent: 0-3cm dilation
1 - Active: 3cm-10cm dilation
2 - Full dilation to delivery of foetus
3 - Delivery of foetus to delivery of placenta

FINALS: PASSMED/QUESMED (22 decks)

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