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MRCOG part 2 > Antepartum Care > Flashcards

Antepartum Care Flashcards

1
Q

Incidence of placenta praevia

A

1 in 200 pregnancies

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2
Q

Resolution rate of placenta praevia at 32 weeks

A

90%

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3
Q

Resolution rate of placenta praevia at 36 weeks

A

50%

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4
Q

Cervical length of less than ________ predicts antepartum haemorrhage and emergency c/s

A

31mm

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5
Q

Risk factors for placenta praevia

A

Smoking
ART
Caesarean birth

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6
Q

Timing of steroids for placenta praevia

A

34+0 to 35+6

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7
Q

Timing of delivery in placenta praevia

A

34+0 - 36+6 if vaginal bleeding/other risk factors

36+0 - 37+0 if uncomplicated

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8
Q

Risk of bleeding by gestation with placenta praevia

A

4.7% by 35 weeks
15% by 36 weeks
30% by 37 weeks
59% by 38 weeks

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9
Q

Risk of MOH requiring blood transfusion with placenta praevia c/s

A

12 x higher

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10
Q

Risk factors for PAS

A

C/S
Previous uterine surgery
Placenta praevia
IVF
Maternal age
Bicornuate uterus
Adenomyosis
Submucous fibroids
Myotonic dystrophy

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11
Q

Rate of PAS with praevia and 3 or more c/s

A

50-67%

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12
Q

Proportion of PAS undiagnosed

A

1/3 to 2/3rds

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13
Q

USS signs of PAS

A

Abnormal uterus-bladder interface
Abnormal vasculature on colour Doppler
Placental lacunae
Increased vascularity of the placental bed

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14
Q

MRI signs of PAS

A

Abnormal uterine bulging
Dark intraplacental bands
Heterogenous signal intensity in placenta
Disorganised vasculature of placenta
Disruption of uteroplacental zone

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15
Q

Gestation for delivery with PAS

A

35+0 to 36+0

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16
Q

Risk of urinary tract injury during PAS surgery

A

16% of uterus preserved
57% with standard hysterectomy

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17
Q

Risks of conservative management of PAS (placenta in situ)

A

Infection
Bleeding
Septic shock
Peritonitis
Uterine necrosis
Fistula
Pulmonary oedema
Acute renal failure
VTE
Injury to adjacent organs

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18
Q

Emergency cerclage can be considered up from ______ to _____ gestation

A

16+0 to 27+6

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19
Q

Risk of preterm birth with cervical length of <25mm and history of PTB

A

14%

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20
Q

Indications for serial cervical length scans

A

Previous PTB/2nd trimester loss 16-34 weeks
Previous PPROM <34 weeks
Previous cerclage
Intrauterine adhesions
Known uterine variant
History of trachelectomy

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21
Q

Indication for trans abdominal cerclage

A

Previous failed vaginal cerclage

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22
Q

Risks of cervical cerclage

A

Cervical laceration
Bladder injury
Membrane rupture
Fistula formation
Removal under anaesthetic required if performed with bladder mobilisation

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23
Q

Removal of cervical suture should be at

A

36+1 to 37+0 unless pt undergoing c/s

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24
Q

History indicated cerclage

A

Singleton, 3 or more preterm births
Singleton, history of second trimester loss

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25
Q

Gestation at which you MUST remove cervical cerclage after PPROM

A

Less than 23 weeks
More than 34 weeks

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26
Q

Incidence of PPROM

A

3%

27
Q

PPROM occurs in what percentage of PTB

A

30-40%

28
Q

Median latency after PPROM

A

7 days

29
Q

Management of PPROM

A

Delivery if septic
Erythromycin (penicillin if allergic) 10 days or established labour
Offer steroids between 24+0 to 33+6
Consider steroids 34+0 to 35+6

30
Q

Benefit of abx in PPROM

A

Reduce babies born within 48 hours and within 7 days
Reduce risk of chorio
Reduces risk of neonatal infection, surfactant use, oxygen therapy and abnormal cerebral USS

31
Q

Most helpful marker of chorioamnionitis

A

CRP (77% specificity)

32
Q

Tocolysis in PPROM is not recommended because

A

Associated with lower APGAR scores (<7) and increased need for ventilatory support
Increased risk of chorio below 34 weeks

33
Q

Timing of Delivery following PPROM

A

37+0

From 34+0 if GBS pos

34
Q

MgSO4 for PPROM

A

Offer when Planned or established labour 24+0 to 29+6
Consider between 30+0 and 33+6

35
Q

Average time to delivery after PPROM

A

8-10 days at 24+0 to 28+0
5 days at 31+0

May be sooner if there is oligo

36
Q

Factors leading to worse outcomes for PPROM

A

Oligo
Non-cephalic presentation
Occurring <26+0

Consider hospital care

37
Q

Benefits of antenatal steroids

A

Reduce NND
Reduce NEC
Reduce RDS
Reduce intraventricular haemorrhage
Reduce risk of infection in first 48 hours of life
Reduces risk of ITU admission/respiratory support
Reduce developmental delay

38
Q

Optimal Timing of steroids

A

Greatest benefit with delivery within 48 hours of first dose

Benefit seen within 24 hours of delivery
Benefit for up to 7 days of giving

39
Q

Dose and type of steroids

A

Dexamethasone phosphate 12mg 24 hours apart or 4 doses of 6mg given 12 hourly (better risk reduction for IVH)

Betamethasone phosphate/acetate mix - 12mg 24 hours apart

40
Q

Gestations to give steroids

A

Offer between 24+0 to 34+6

Consider 35+0 to 36+6

Consider between 22+0 to 23+6

41
Q

Harms of steroids

A

Affects maternal glycaemic control for 5 days
Neonatal hypoglycaemia
Reduced birth weight with repeat courses
Neurodevelopmental affects if baby born at term

42
Q

Stillbirth rate

A

32 in 10, 000 (white)
72 in 10, 000 (black)
51 in 10, 000 (Asian)

43
Q

Consider Prophylactic vaginal progesterone when

A

History of PTB up to 34+0/2nd trimester loss OR cervical length is <25mm on TV USS

44
Q

Offer either cerclage or vaginal progesterone when

A

History of PTB/2nd trimester loss AND cervical length <25mm

45
Q

Gestation to give vaginal progesterone

A

Start between 16+0 and 24+0
Continue until 34+0

46
Q

Offer prophylactic cerclage when

A

History of cervical trauma OR
History of PPROM

AND cervical length <25mm

47
Q

Contraindications for emergency cerclage

A

Uterine contractions
Active vaginal bleeding
Signs of infection

48
Q

Diagnosis of PTB at 30+0 or more

A

15mm cervical length on TV USS (preferred)
OR
Fetal fibronectin >50

Treat for PTB if above tests not available

49
Q

Tocolysis should be given at what gestation?

A

Consider between 24+0 and 26+0
Offer PTB between 26+0 and 33+6

50
Q

Tocolysis medication

A

Nifedipine
Oxytocin receptor antagonists if nifedipine is contraindicated (atosiban)

Do not use betamimetics

51
Q

Monitoring of FH in established PTB

A

Offer IA or CTG if no other risk factors

52
Q

Fetal scalp electrode monitoring should not be used below _____ gestation

A

34+0

53
Q

FBS should not be used below ______ gestation

A

34+0

54
Q

Cord clamping technique in preterm babies

A

60 seconds
Hold baby below the level of the placenta

55
Q

Incidence of PTB

A

7.3% of live births

56
Q

Gestation for amniocentesis

A

15+0

Higher risk of low DNA quantity prior to 16+0

57
Q

Risks of amniocentesis

A

Miscarriage 0.5%
Second sample required 6%
Blood stained sample 0.8%
Maternal cell contamination 1-2%
Rapid test failure 2%
Failed cell culture 0.5-1%
Severe infection
Fetal injury
Maternal visceral injury

58
Q

Risks of CVS

A

Miscarriage 0.5%
Second sample required 6%
Confined placental mosaicism 2%
Failed cell culture 0.5-1%
Severe infection
Fetal injury
Maternal visceral injury

59
Q

Gestation for CVS

A

10+0 minimum
Ideally after 11+0 to reduce technical difficulty

60
Q

Pregnancy loss risk for CVS/amniocentesis in multiple pregnancy

A

1%

61
Q

Risk of cross contamination in multiple pregnancy CVS

A

1%

62
Q

Risks of 3rd trimester amniocentesis

A

10% risk cell culture failure
PTB 3-4%
More than one needle insertion 5%
Blood stained sample 5-10%

63
Q

Amniocentesis/CVS considerations with blood borne viruses

A

Testing required prior to test
Ensure HIB viral load is undetectable
Ensure Hep B viral load is <6.99log10 copies/ml
No evidence for Hep C

64
Q

Maternal mortality rates

A

8 per 100, 000 (white)
34 per 100, 000 (black)
25 per 100, 000 (mixed)
15 per 100, 000 (Asian)

MRCOG part 2 (15 decks)

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