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CP2 OBGYN > ANC p3 > Flashcards

ANC p3 Flashcards

1
Q

What is breech particularly associated with

A

prematurity

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2
Q

% babies breech at term

A

3%

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3
Q

% babies breech at 32w

A

15%

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4
Q

% babies breech at 28w

A

25%

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5
Q

What are the 3 types of breech position

A

Extended/frank breech
Flexed/complete breech
Footling breech

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6
Q

What is Extended/frank breech

A

Hips = flexed
Knees = extended
feet adjacent to fetal head

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7
Q

What is flexed/complete breech

A

Flexed @ hips + knees

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8
Q

What is footling breech

A

Flexed @ hips + knees /ffet present to maternal pelvis

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9
Q

Uterine causes of breech (4)

A

Mutliparity
Uterine malformation
Fibroids
Placenta praevia

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10
Q

Fetal causes of breech (5)

A 
Prematurity 
Macrosomia 
Polyhydramnios 
Twin pregnancy 
Abnormality
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11
Q

How is the diagnosis of breech made (4)

A

Head felt on examination
Fetal heart auscultated @ higher level
VE to confirm
If any doubt - USS

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12
Q

What % of breech is not diagnosed until labour

A

20%

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13
Q

How can breech PS in labour

A

Meconium stained liquor

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14
Q

3 main DDx breech

A

Oblique lie
Transverse lie
Unstable lie

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15
Q

3 main Mx options breech

A

ECV
CSC
Vaginal breech birth

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16
Q

What is ECV

A

Manipulation of fetus to cephalic presentation through maternal abdomen

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17
Q

ECV success rate primip

A

40%

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18
Q

ECV success rate multip

A

60%

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19
Q

Complications ECV (5)

A 
Transient fetal heart abnormalities 
Placental abruption 
PROM 
Cord prolapse 
Intracranial haemorrhage
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20
Q

C/I ECV (4)

A

Recent APH
Ruptured membranes
Uterine abnormalities
Previous CSC

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21
Q

When is Vaginal breech birth C/I

A

When baby is in footlong breech

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22
Q

Specific manouvres for vaginal breech birth (3)

A

Flexing fetal knees (for delivery legs)
Lovsett’s manouvre
Mauriceau-Smellie-Veit (deliver head by flexion)

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23
Q

Lovsett’s manouvre breech

A

Rotate body + deliver shoulders

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24
Q

Def preterm labour

A

Between 24-37w

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25
What % of deliveries are pre-term
5-8%
26
Neonatal complications of pre-term (5)
``` Mortality Cerebral palsy Chronic lung disease Blindness Minor disabilities ```
27
Maternal complications of pre-term labour (3)
Infection CSC used > Illness/ death
28
RF pre-term (10)
``` Prev Hx Low SE class extremes maternal age Short interpregnancy interval Renal failure/DM/thyroid disease Pregnancy complications STIs CV prev cervical surgery Uterine abnormalities ```
29
Infections that can --> pre-term labour (4)
Chorioamninitis Offensive liquor Neonatal sepsis Endometritis
30
Preventing pre-term labour
``` Cervical cerclage Progesterone supplementation Infection Tx polyhydramnios Tx medical disease ```
31
Methods of cervical cerclage for preventing preterm labour (3)
1 - 12-14w (elective) 2 - cervix scanned reg + sutured if signif shortening 3 - Rescue suture
32
How to Tx polyhydramnios to prevent preterm labour (2)
Need aspiration = amnioreduction | NSAIDS - reduce fetal urine output
33
Hx suggesting pre-term labour (4)
Painful contractions Cerivcal incompetence APH Fl - PPROM
34
Ix - preterm labour (6)
``` Check lie + PS fetus VE to confirm dilated cervix TVS cervical length CTG/USS Vaginal swabs CRP (check for chorioamnionitis) ```
35
Mx pre-term labour
``` Steroids betw 23-34w Delay delivery w/ tocolysis Detect + prevent infection MgSO4 4g IV <12h prior to deliver Transfer to level 3 facility Deliver vaginally if can Paediatrics on site DO NOT CLAMP CORD FOR 45s ABx for delivery b/c incr risk GBS ```
36
Why give steroids in pre-term laboru
Reduce perinatal morb/mortality | + Incr pulmonary maturing
37
E.g.s of tocolysis
Nifedipine | Oxytocin antagonists
38
Why give MgSO4 in pre-term labour
Neuroprotective
39
Def PPROM
Rupture of membranes <37w
40
What % of pre-term deliveries have PPROM
1/3
41
Complications of PPROM (4)
Pre-term delivery Infection - chorioamnionitis or funiculitis Cord prolapse Pulmonary hypoplasia + postural deformities
42
CF PPROM
Gush of clear fl + further leaking | Pool of fl in post fornix on speculum = diagnostic
43
What NOT to do O/E PPROM + why
Don't VE | Don't want to intro infection
44
Ix PPROM (6)
``` 'Point of care' test USS - reduced liquor HVS FBC, CRP Lactate (Id. sepsis) CTG ```
45
Mx PPROM (4)
Admit + give steroids Close surveillance If gestation 34-6w --> delivery Use prophylactic erythromycin
46
Def premature ROM
Rupture of membranes >1h prior to onset of labour occuring 37w or > gestation
47
What % pregnancies have premature ROM
10-15%
48
How is diagnosis of premature ROM made
sterile speculum + maternal Hx
49
Mx premature ROM (4)
Monitor signs chorioamnionitis ABx if GBS isolated W+W 24hrs IOL + delivery if >24hrs
50
Def prolonged pregnancy
>42w gestation
51
Who is more likely to have a prolonged pregnancy? (2)
PMH | Nulliparous
52
Risks of prolonged pregnancy (3)
Increased risk stillbirth Neonatal illness + encephalopathy Foetal distress
53
Mx prolonged pregnancy - 41-42w (3)
IOL If dont want IOL - daily CTG monitoring Sweep cervix
54
Mx prolonged pregnancy if CTG = abnorm
CSC
55
What is ruptured vasa praevia?
Fetal BV run in membranes in front of presenting part Due to velamentous insertion Can rupture when membranes rupture --> massive PPH
56
PS ruptured vasa praevia
Painless moderate vaginal bleed @ROM | Severe foetal distress
57
Causes of bleeding - 1st trimester (3)
Spontaneous abortion Ectopic pregnancy Hydatidiform mole
58
Causes of bleeding - 2nd trimester (3)
Spontaneous abortion Hydatidiform mole Placental abruption
59
Causes of bleeding - 3rd trimester (4)
Bloody show Placental abruption Placenta praevia Vasa praevia
60
Def anaemia 1st trim
Hb <110g/l
61
Def anaemia 2nd/3rd trim
Hb <105
62
Anti-anaemia changes in pregnancy (3)
Incr prod RBC Incr FE absorption in gut Decrtransferrin hence Incr TIBC
63
'Pro-anaemia' chanes pregnancy (4)
Incr plasma vol --> haemodilution Decr Se Fe Decr Se ferritin Incr renal clearance folate
64
RF Anaemia in pregnancy (5)
``` Haemoglobinopathies Incr maternal age Low SE status Poor diet Anaemia in prev preg ```
65
CF anaemia in pregnancy (5)
``` Dizzy Fatgigue Dyspnoea Asymp Pallor ```
66
DDx - microcytic anaemia (<76 MCV) (3)
IDA Thalassaemia Sideroblastic anaemia
67
DDx - normocytic anaemia (4)
Anaemia chronic disease Marrow infiltration Haemolytic anaemia CKD
68
DDx macrocytic anaemia (5)
``` B12 Folate defic Alcohol Reticulocytosis Hypothyroidism ```
69
Ix anaemia of pregnancy
FBC | + further Ix if suspecting haemoglobinopathies/Fe/B12 defic
70
Screening for pregnant women for anaemia?
ALL women @ booking + 28w Can also check at 34w If multip: addiitional betw 20-28w
71
Mx IDA in pregnancy
200mg ferrous sulphate tds
72
Mx macrocytic anaemia b/c folate in preg
5mg folic acid o.d.
73
Mx B-thalassaemia in preg
Folate + blood transfusions as req
74
Mx Sickle cell in pregnancy
Folate + Fe
75
Iron rich foods to eat in pregnacy
Meat Kidney/liver Eggs Greens
76
Folate rich food to eat in pregnancy
Raw greens | Fish
77
What is fetal fibronectin and what does it mean
Protein released from gestational sac | High levels = related to early labour
78
Sickle cell appearance of chains
2 alpha + 2 s chains
79
Maternal complications sickle cell disease (3)
Painful crises Pre-eclampsia Thrombosis
80
Foetal complications sickle cell disease (4)
Miscarriage IUGR Pre-term death
81
Mx Sickle cell in pregnancy (3)
5mg folic acid Hydration Rx - specialist haematologist
82
4 alpha thalassaemia mutations - outcome
Death in utero (Barts hydrops)
83
3 alpha thalassaemia mutation - outcome
Lifelong blood transfusions req
84
PS beta thalassaemia in pregnancy
Chronic anaemia that worsens in pregnancy
85
Mx beta thalassaemia in pregnancy
Folic acid | USS x 4 weekly

CP2 OBGYN (21 decks)

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