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Obstetrics > For Clinical Exam > Flashcards

For Clinical Exam Flashcards

1
Q

Maternal indications for induction of labour

A
  • pre-eclampsia/ eclampsia
  • prolonged rupture of membranes
  • chorioamnionitis
  • previous unexplained SB
  • medical conditions (diabetes)
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2
Q

Fetal indications for induction of labour

A
  • IUD
  • growth restriction
  • prolonged pregnancy
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3
Q

Components of the Bishop’s score

A
  • dilatation
  • effacement
  • consistency
  • station
  • position
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4
Q

Prostaglandins used for induction

A
  • misoprostol (E1)
  • prandin gel (E2)
  • Dinoprostone
  • F2 alpha (vasoconstrictor, CI in asthmatic/HPT)
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5
Q

Dose of oxytocin for IOL/ augmentation

A
  • 12 U in 200mls (2mls/hour increaseing by 2mls/hour every 30 mins)
  • 5 units in 1000mls (24mls incraseing by 24mls/hour every 30 mins) max 96mls/hour
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6
Q

CI of oxytocin use

A
  • grandmultiparity
  • previous C-section
  • CPD
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7
Q

Surgical methods for induction

A
  • amniohook
  • kocher’s forceps
  • Drew-smythe catheter
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8
Q

Risks of amniotomy

A
  • trauma to cervix/fetal head
  • infection
  • cord prolapse
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9
Q

Process of an assisted delivery

A 
A - address patient (adequate analgesia)
B - empty bladder
C - fully dilated cervix
D - descent
E - engagement
F - apply to flexion point
G - gentle traction with contractions
H - hold traction
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10
Q

Possible causes of preterm labour

A
  • maternal infection
  • maternal pyrexia
  • growth restriction
  • APH/ abruptio
  • fetal anomaly
  • multiple pregnancy
  • uterine abnormality or incompetent cervix
  • polyhydramnios
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11
Q

Contraindications for tocolysis

A
  • intra-uterine infection
  • fetal distress
  • IUD
  • lethal congenital anomaly
  • APH
  • pre-eclampsia
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12
Q

Appropriate investigations in preterm labour

A
  • urine MC+S
  • CTG
  • US
  • high vaginal swab
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13
Q

Dose of indomethacin for tocolysis

A

100mg rectally every 12 hours for 48 hours

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14
Q

Dose of Nifedipine for tocolysis

A

30mg stat then 20mg after 90 mins, then 20mg every 6 hours

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15
Q

How to confirm ROM

A
  • turns red litmus blur
  • ferning
  • 1% nile blue sulphate (after 30 weeks)
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16
Q

Potential problems in twin pregnancy

A
  • preterm labour common
  • IUGR more common
  • congenital abnormalities more common
  • placenta praevia and abruptio more common
  • malposition and malpresentation
  • polyhydramnios, early ROM and cord prolapse
  • pre-eclampsia and anaemia more common
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17
Q

Indications for twin C-section

A
  • when presentation of leading twin is anything but occiput
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18
Q

Management of twin labour

A
  • NPO with IV line
  • epidural
  • both babies monitored in first stage
  • something to confirm lie of second twin after first delivery
  • paediatricion present
  • emergency blood
  • access to anaesthetist and operating theatre
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19
Q

Oxytocin regimen for twin delivery

A
  • 5 units IM with delivery of 2nd twin

- 20 units IV to run over 2 hours

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20
Q

Discourage breech NVD in:

A
  • EFW >3.5kg
  • EFW between 1-1.5
  • extended fetal head
  • foolting breech
  • kneeling breech
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21
Q

Signs and symptoms of uterine rupture

A
  • abnormal pain
  • vaginal bleeding
  • fetal distress
  • diminished uterine activity
  • change in fetal position
  • haematuria
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22
Q

Success rates of VBAC

A
  • 50-70%
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23
Q

Features indicating successful VBAC

A
  • previous successful VBAC
  • birth interval >2 years
  • spontaneous labour
  • EFW <4kg
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24
Q

Rates of uterine rupture in VBAC

A
  • 0.5-0.75 in one lower segment
  • 2-9% after classical
  • 2% after 2 c-sections
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25
Q

Therapeutic range of magnesium sulphate

A
  • 1.25-3.25 mmol/l
26
Q

Antidote to mag sulph toxicity

A

10% calcium gluconate: 10ml IVI over 10 mins

27
Q

Drug for terminating seizures

A
  • 1mg clonazepam IVI PRN
28
Q

Dose of dihydralazine for high BP

A
  • IVI 25mg in 200ml normal saline at 5,10,20 drops/ min titrated to DBP
29
Q

Definition of imminent eclampsia

A
  • headache
  • visual disturbance
  • epigastric pain
  • non-dependent oedema and clonus
30
Q

Treatment of HELLP syndrome

A
  • supportive therapy (fluids, anticonvulsatns, antihypertensives)
  • half hourly obs
  • serial biochemistry/ plt counts
  • renal support
  • delivery
  • monitor plt count (rise on 3rd day postpartum)
31
Q

Causes of pulmonary oedema in pre-eclampsia

A
  • fluid overload
  • LV dysfunction
  • high systemic vascular resistance
  • increased capillary permeability and low serum colloid osmotic pressure
  • occult valvular heart disease
32
Q

How to manage oliguria in pre-eclampsia

A
  • fluid challenge: 200ml IV over 30 mins

- low dose dopamine 1ug/kg/min increasing hourly to 5ug/kg/min

33
Q

Indications for c-section delivery in GD and IGT

A
  • EFW >4kg

- AC >97%

34
Q

Intrapartum management of IGT and DM not on treatment

A
  • Dextrose 5% infusion
  • HGT every 4 horus
  • if remains above 7, use subcut insulin pump
35
Q

Intrapartum management of IGT and DM on drugs

A
  • oral drugs stopped
  • continuous subcut insulin
  • 5% dextrose drip at 69ml/hour
36
Q

Indications for delivery in placenta praevia

A
  • electively at 37 weeks
  • bleeding
  • labour and ROM
  • fetal compromise
  • other conditions (IUGR)
37
Q

Fetal complications of shoulder dystocia

A
  • bruising
  • lacerations
  • fractures
  • brachial plexus injury
  • hypoxia
  • cerebral palsy
38
Q

Maternal complications of shoulder dystocia

A
  • perineal trauma
  • cervical trauma
  • 3rd/4th degree tears
  • significant blood loss
  • postpartum infections
  • lateral femoral nerve palsies
39
Q

Definition of PPH

A
  • > 500mls following NVD

- >1000 mls following C-section

40
Q

Major causes of PPH

A
  • atonic uterus
  • retained placenta
  • trauma
  • bleeding
  • uterine inversion
41
Q

Preventative measures for PPH

A
  • routine iron supplementation
  • people at risk (APH, grand multipara, previous PPH, multiple pregnancy, prolonged pregnancy) to deliver in hospital
  • prevent prolonged labour
  • active management of 3rd stage of labour
42
Q

Steps in PPH management

A
  • resus
  • oxytocin infusion
  • examine for retained placenta
  • soft uterus
  • ergometrine 0.5mg IMI
  • misoprostol 600ugm Pr or sublingual
  • F2a 5mg in 10ml saline, 1ml into myometrium
  • balloon tamponade
  • EU
  • laparotomy uterine artery ligation, B-lynch suture
43
Q

Maternal indications for C-section

A
  • CPD
  • previous C-section x2
  • previous classical C-section
  • failed IOL
  • failure to progress in active labour
  • previous surgery for incontinence or prolapse
  • cervical cancer in pregnancy
44
Q

Fetal indications for C-section

A
  • fetal distress
  • cord presentation or prolapse
  • abruptio placenta with live baby
  • breech presentation
  • transverse lie
  • conjoined/ monoamniotic twins
  • vasa previa
45
Q

Indications for classical C-section

A
  • very premature babies (<1000g)
  • abnormal fetal lie
  • shoulder impaction
  • placenta praevia
  • uterine segment not accessible
46
Q

Disadvantages of classical C-section

A
  • higher postop morbidity
  • higher risk of adhesions
  • higher risk of rupture
  • needs repeat C-section`
47
Q

When to test GTT

A
  • previous history of GDM
  • previous birthweight >4kg
  • BMI >35
  • AMA >40
  • glycosuria on 2 or more occasions
  • first degree relative with Hx
  • polyhydramnios (>25)
  • unexplained SB
48
Q

Normal fasting glucose

A

<5.5

49
Q

IGT fasting glucose

A

5.5-7

50
Q

GDM fasting glucose

A

> 7

51
Q

Normal 2 hour glucose

A

<7.8

52
Q

IGT 2 hour glucose

A

7.8-11

53
Q

GDM 2 hour glucose

A

> 11

54
Q

When to do a GTT

A

16 weeks, if normal, repeat at 28 weeks

55
Q

What to do if suspect prolonged pregnancy and accurate gestational age not known

A
  • U/S for EFW and AFI
  • if AFI <3, admit for IOL
  • If AFI 4-6, book IOL in 1 week
  • If AFI normal, then weekly AFI until <6
  • weekly CTG
  • fetal kick chart
56
Q

Causes of fundal height larger than dates

A
  • incorrect dates
  • multiple pregnancy
  • polyhydamnios
  • uterine pathology
57
Q

Causes of fundal height smaller than dates

A
  • incorrect dates
  • small baby
  • growth restriction
  • fetal demise
58
Q

Causes of anaemia in pregnancy

A
  • Iron def
  • folate def
  • vit B12 def
  • haemoglobinopathis
  • haemolytic anaemia
  • bone marrow aplasia
59
Q

Prerequisites for forceps delivery

A
  • vertex or aftercoming head
  • engaged head
  • no evidence of CPD
  • cervix must be fully dilated
  • membranes ruptured
  • empty bladder
  • adequate contractions
  • episiotomy
  • saggital suture in AP
  • adequate analgesia
  • experienced physician
60
Q

Complications of a C-section

A

Anaesthetic

  • high spinal
  • failed intubation
  • aspiration
  • atelectasis

Surgical

  • haemorrhage
  • trauma to bladder/ bowel
  • sepsis
  • thromboembolism
61
Q

Contraindications to VBAC

A
  • previous classical
  • two or more CS
  • patient refusal
  • very large baby
  • malpresentation
  • multiple pregnancy
  • placenta praevia

Obstetrics (1 decks)

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