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YR 3 MED > OBS & GYNAE WK 5 > Flashcards

OBS & GYNAE WK 5 Flashcards

1
Q

NORMAL LABOUR - 3 STAGES

A
  1. Cervical effacement and dilatation
    latent/active stage (8-24hrs)
  2. FULL dilatation and delivery of the baby (0-30mins)
  3. BIRTH OF PLACENTA
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2
Q

3Ps - failure to progress or obstructed labour

management for each

A

power - insufficient uterine activity
passenger - baby too big
passage - mum has small pelvis

Artificial rupture of the amniotic membranes (ARM)
forceps/suction cup

malpresentation

mcroberts position - lifting legs up and in case of shoulder dystocia

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3
Q

Augmentation of labour
how to induce labour - pros and cons

A

breaking water, need to be dilated to rupture
propess

bring forward delivery to reduce risk to mum and baby eg. diabetes, reduced movements

more painful than the actual birth
need more exams and monitoring

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4
Q

breech position

A

instead of head first, its feet are
LUSCS - lower uterine segment caesarean section
ECV - External cephalic version

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5
Q

chorioamnionitis - and mx

A

intra-uterine infection, infection of placenta and the amniotic fluid - may be life threatening

abdo pain, offensive discharge, mum unwell

PPROM - preterm premature rupture of membranes

PROM

IV antibiotics, C-section DELIVERY

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6
Q

APH aka antepartum haemorrhage - before childbirth

CAUSES??

MX??

A

vaginal bleeding from 24 + 0 weeks until birth

don’t do digital exam until u can exclude PLACENTA PRAEVIA

caused by PLACENTAL ABRUPTION OR PRAEVIA

Kleihauer, anti-d, steroids for baby

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7
Q

cord prolapse - mx??

A

may obstruct blood supply to baby
RAPID DELIVERY via section

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8
Q

shoulder dystocia

risk factors ??

mx

A

baby anterior shoulder stuck against mother pelvis, pubic symphysis bone
causing delayed delivery and hypoxia

risk factors - diabetes, big head baby and narrow pelvis, BMI>30, short stature, slow labour, IOL, FORCEPS

HELPERR mx - call for help
evacuate for episiotomy
legs - mcroberts manoeuvre
external pressure - suprapubic

need to get baby out <4 mins or may risk permanent neurolgocial damage, Brachial plexus injury

may have to break baby’s clavicle to help narrow space

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9
Q

amniotic fluid embolism and maternal collapse

A

Rare complication of labour where amniotic fluid enters systemic circulation and causes acute respiratory and circulatory collapse with coagulopathy

Maternal collapse can arise from numerous pathologies including
Haemorrhage (Obstetric and non obstetric)
Pulmonary embolism
MI
AFE
Septic shock
Eclampsia/Epilepsy

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10
Q

uterine inversion

A

uterus turning inside out after delivery

neurogenic shock

push uterus back in

delivery of placenta and then theatre

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11
Q

vaginal / perineal tears and Obstetric Anal Sphincter Injury - degrees??

A

1st Degree
Vaginal mucosa / perineal skin only
2nd Degree - most common
Includes perineal skin + muscles but does not involve anal sphincter
3A tear
<50% of external anal sphincter torn
3B tear
>50% of EAS torn
3C tear
>50% EAS and IAS (internal) torn
4th degree tear
Tear involving anal/rectal mucosa

repair in theatre

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12
Q

maternal collapse

A

acute event involving the cardiorespiratory systems and/or CNS

maternal cardiac arrest may occur

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13
Q

most common cause of maternal collapse?? other specific condition causes

A

vasovagal

anaphylaxis
eclampsia
aortic dissection
hypoglycaemia
sepsis
PE
Drugs eg. MgSO4
amniotic fluid embolism

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14
Q

4Hs and 4Ts - causes of collapse in pregnancy

A

-hypovolaemia
-hypoxia
-hypokalaemia and hyponatraemia
-hypothermia

-toxicity
-thromboembolism
-tension pneumothroax
-tamponade

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15
Q

MEOWS score

A

modified early obstetric warning score

1 red / 2 amber = review

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16
Q

cpr in pregnant woman

SPECIAL MODIFICATIONS

A

During chest compressions, place your hands slightly higher than usual. This is because the pregnant woman’s diaphragm is elevated, and her heart is positioned higher in her chest.

manually displace the pregnant woman’s uterus to her left side, in a technique called “left lateral tilt.” = relieve pressure on IVC

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17
Q

perimortem caesarean

A

4 minutes post-arrest and completed at 5 minutes

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18
Q

PPH - what is major volume??

CAUSES, 4Ts

can be primary or secondary, up to 6 wks after birth

A

postpartum haemorrhage
>1000ml
but can be proportionate to body weight

tone - uterine atony
trauma - perineal tears, cervical tears
tissue - retained placenta
thrombin - coagulation problems

IV syntocinon
carboprost
misoprostol

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19
Q

calculating volume - body weight

A

50 kg -> 5000ml

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20
Q

PPH medical mx

A

ABCDE (may have to go to theatre)
UTERINE TONICS:
1. SYNTOCIN
2. ERGOMETRINE

tranexamic acid

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21
Q

PPH surgical mx

A

intrauterine balloon - saline inside
brace sutures

22
Q

mx of 3rd stage - up to how long do you do this

A

delivery of placenta
30 mins max

23
Q

morbidly adherent placenta

A

becoming more common if previous CS OR UTERINE SURGERY

placenta is abnormally stuck to womb, normally is at decidua
accreta (end of womb), increta, percreta

may have to have hysterectomy

24
Q

uterine inversion

A

usually pulled the placenta cord too hard
v rare

25
Q

postpartum sepsis

rx??

most common sources??

A

risk factors - anaemia, long labour, assisted delivery, raised BMI, diabetes, prolonged membrane rupture

most common - uterus (endometritis)
skin/wound infection
breasts

26
Q

the fetal circulation - 3 shunts

A

ductus venosus
foramen ovale
ductus arteriosus

small fraction of RV output goes via lungs

27
Q

umbilical cord has how many blood vessels?? what are they?

A

3 blood vessels – one vein which carries oxygenated blood to the baby, 2 arteries which carry deoxygenated blood back to the placenta

28
Q

Duct smooth muscle __________ in response to oxygen.

A

constricts

29
Q

thermoregulation - babies lose heat by what 4 methods

in utero/preparation vs after delivery

A

radiation
convection
conduction
evaporation

Mum responsible for thermoregulation
Lots of brown fat laid down between scapulae and around internal organs in 3rd trimester
Less in growth restricted or preterm infants

after delivery:
Heat produced by breakdown of stored brown adipose tissue in response to catecholamines

30
Q

glucose homeostasis

A

-Babies in utero have a constant supply of glucose from the placenta
-blood sugar drops when born which is normal

watch out for babies w diabetes, too much insulin

31
Q

breast feeding feedback loop

what is the earliest milk??

A

suckling - more feeding, more prolactin produced, more milk.
earliest milk is colostrum, v rich in immune and growth factors

32
Q

what % is normal weight loss at beginning

A

10%
babies have excess fluid, water

33
Q

PPHN

A

Persistent Pulmonary Hypertension of the Newborn

the pulmonary resistance does not drop for some reason, DUE TO
hypoxia, acidosis, cold stress, lung disease, sepsis

34
Q

DIAGNOSIS AND MX OF PPHN

A

Measuring pre and post ductal oxygen saturations with a sats probe on the right hand and one on a foot helps to make the diagnosis. Usually there will be a 10-20% difference in saturation between the two.

Ventilation
Oxygen
Nitric oxide
Sedation
Inotropes
ECLS

35
Q

transient tachypnoea

A

A more minor problem this time mainly with lung transition.

usually need more oxygen or CPAP

common reason for mums and babies to have to be separated in the first few hours of life and has an effect on feeding being established and on bonding

36
Q

where do most of the oxygenated blood from the placenta go to, via what? what about the rest??

A

crosses straight over from right atrium (via the ductus venosus, inferior vena cava) to left atrium, via the foramen ovale
-> left ventricle

The rest, mixed with SVC return passes into the right ventricle.

37
Q

what substance is produced in the placenta and metabolised quickly in lung

A

Prostaglandin

It maintains duct patency and may have a role in suppressing breathing in fetal life.

37
Q

causes of Failure of cardiorespiratory adaptation

A

hypoxia
premature
cold stress
congenital pneumonia
meconium aspiration

38
Q

placental abruption

A

vasospasm, blood gets into amniotic sac, blocks cervix

CTG - foetal heart, C-section

39
Q

placental praevia

A

placenta lies directly over internal os
severe abdo pain
risk factors include previous C-sections
painless vag bleeding usually in 3rd trimester

40
Q

vasa praevia

A

It occurs when the blood vessels from the placenta or umbilical cord block the birth canal.

triad of rupture of membrane, painless bleed and foetal bradycardia.

Assisted conception, such as IVF, a low-lying placenta and multiple pregnancies can increase the risk of vasa praevia.

US TA AND TV with doppler

41
Q

maternal sepsis - signs

A

offensive discharge
sore throat
rash (meningitis?)
abdo pain
dysuria
urinary frequency, dysuria
productive cough

temp >38
hr > 100 bpm
resp rate > 20
confusion mental state

42
Q

mx of sepsis

A

ABCDE
Sepsis 6 bundle

FBC, U+Es, LFTs, glucose, Lactate

HVS, throat swab (group A strep?), MSSU

IV co-amoxiclav within the GOLDEN HR

43
Q

GBS - GROUP B STREP

A

pretty common
give Benz-penicillin

44
Q

mastitis

A

inflammation of mammary gland, painful, unilateral
still need to breastfeed from that side

1.breastfeeding or expressing to empty breast, warm compresses
2. flucloxacillin if its staph
3.no response, referral

45
Q

epidural abscess

A

rare cause of sepsis
back pain and fever
high death rate

IV antibiotics

46
Q

what hormonal factors influence the onsset of labour ? - 3

A

progesterone - keeps uterus settled

oestrogen - uterus contracts

oxytocin - initiates and sustains contractions

47
Q

bishops score

A

to see if it is safe to induce labour

position
consistency
effacement
dilatation
station in pelvis

4 or less score indicates unfavourable cervix

48
Q

Braxton hicks contractions vs true labour contractions

A

false labour
giving false sense that woman is having real contractions

true = timing of contractions become evenly spaced and time between them gets shorter

49
Q

delayed cord clamping

A

immediate clamping can reduce the red blood cells that infant receives, may cause more problems

50
Q
A

YR 3 MED (23 decks)

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