General Obs Flashcards

Question

Discuss fluid balance in severe PET or hypertension

Answer 1

In women with severe pre-eclampsia, limit maintenance fluids to 80 ml/hour unless there are other ongoing fluid losses (for example, haemorrhage)

Answer 2

-maternal BMI greater than 30 -short maternal stature -estimated fetal weight of greater than 4 kg or a clinically big baby -head circumference above the 95th percentile -occipito–posterior position -midpelvic birth or when one-fifth of the head is palpable per abdomen

Answer 3

Scar rupture in VBAC Stillbirth Placental abruption Polymorphic eruption of pregnancy ECV requiring emergency C/S

Answer 4

Abruption in previous pregnancy (most predictive) - 4.4% risk of recurrence Pre-eclampsia Fetal growth restriction Non-vertex presentations Polyhydramnios Advanced maternal age Multiparity Low BMI Pregnancy following assisted reproductive techniques Intrauterine infection PROM Abdominal trauma Smoking Drug misuse (cocaine and amphetamines) during pregnancy Weak association with some thrombophilias

Answer 5

10-17 weeks The accepted background cumulative dose of ionising radiation during pregnancy is 5 rad (50 mGy) (5 Msv) The average background dose of naturally occurring radiation in the UK is 2.2 mSv. Natural background radiation during an entire pregnancy is approximately 0.5 - 1.6 mGy The commonest teratogenic effects of exposure to high dose radiation are central nervous system changes. These risks may result in microcephaly and severe mental retardation. This risk is greatest at 10-17 weeks. There is no proven risk before 10 weeks or after 27 weeks The greatest risk of fetal growth restriction due to radiation is 3-10 weeks A dose of 250 mGy may be associated with a 0.1% risk of fetal malformation

Answer 6

HIGH RISK: Antithrombin Antiphospholipid (associated with VTE) Recurrent VTE - need 50%,75% or full dose of normal anticoagulant Protein C or S deficiency Homozygous Factor V Leiden- consider antenatal prophylaxis + 6 weeks post natal clean LOW RISK: Heterozygous Factor V Leiden Antiphospholipid antibodies

Answer 7

Only increased in severe ICP (BA >100) 3.44% vs 0.29%

Answer 8

Bile acids of 19 or more Mild 19-39 - deliver 40 weeks Moderate 40-99 - deliver 38-39 weeks Severe 100 or more - deliver 35-36 weeks

Answer 9

The fetal mortality rate in this situation is at least 60% despite urgent caesarean delivery. However, improved survival rates of over 95% have been reported where the diagnosis has been made antenatally by ultrasound followed by planned caesarean section. Vasa praevia prevalence: 1 in 1200 and 1 in 5000 pregnancies

Answer 10

1.5% Mostly due to PET Any creatinine >90 diagnostic of AKI A serum urea > 17 mmol/l despite medical management is a pregnancy-specific indicator for renal replacement therapy (urea is teratogenic)

Answer 11

Rates of fetal loss Simple appendicitis is 1.5% Appendicitis with peritonitis 6% Perforated appendix 36%

Answer 12

22-27 weeks 14.6% 28-31 weeks 6.2% 32-36 weeks 0.7% term 0.1% Who should be given IV magnesium sulphate? Women between 24+0 and 29+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours Consider in women between 30+0 and 33+6 weeks of pregnancy who are in established preterm labour or having a planned preterm birth within 24 hours

Answer 13

About 10%, 90% fully recover Brachial plexus injury (BPI) is one of the most important fetal complications of shoulder dystocia, complicating 2.3% - 16% In the UK and Ireland, the incidence of BPI was 0.43 per 1000 live births.

Answer 14

Caesarean section (compared with vaginal delivery) NNT to prevent one case fecal incontinence 167 NNT in Breech birth to prevent one case adverse outcome 29 NNT in Breech birth to prevent one case perinatal death 175-400

Answer 15

1 / (EER-CER) Experimental - control rate

Answer 16

Intrapartum antibiotic prophylaxis to prevent early onset GBS (compared with expectant management) NNT in intrapartum fever (>38ºC) 208 Preterm labour <35 weeks 307 Preterm labour <37 weeks 500 PROM (>18 hours) 595 NNT to prevent one case neonatal death from GBS >5000

Answer 17

Risk of transient respiratory morbidity in neonates born via planned VBAC is approximately 2-3% Risk of transient respiratory morbidity in neonates born via ERCS is approximately 4-5% (higher if born prior to 39 weeks) Risk of delivery related perinatal death in VBAC is approximately 0.04% Risk of delivery related perinatal death in ERCS is approximately 0.01% Risk of maternal death with planned VBAC is approximately 4 per 100000 Risk of maternal death with ERCS is approximately 13 per 100000

Answer 18

2 X 5 UNIT POOL Then go off bloods Fibrinogen >2

Answer 19

Singleton pregnancies and three or more previous PTB Singleton pregnancy and history of spontaneous second trimester loss + evidence of shortening on scan (<25mm) at less than 24 weeks Incidental shortening on scan - not to be offered suture

Answer 20

Average of 34 days (5 weeks) Two fold reduction in birth before 34 weeks

Answer 21

HIGH RISK - to be seen at 12 weeks and then 2-4 weekly -those with a previous preterm birth or second trimester loss (16–34 weeks’ gestation) -previous preterm pre-labour rupture of membranes (PPROM) less than 34 weeks -previous use of cerclage -known uterine variant -intrauterine adhesions -history of trachelectomy. INTERMEDIATE RISK - see between 18-22 weeks for one off scan -Women with C/S at fully dilated -Women with LLETZ >1cm or repeat procedures

Answer 22

Primary = 41% Recurrence = up to 3%

Answer 23

Primary = 41% Recurrence = up to 3%

Answer 24

MMBRACE October 2023 11.7 per 100,000, 10 per 100,000 if covid excluded Heart disease still leading cause of indirect deaths VTE leading cause of direct deaths

Answer 25

1-2 in 1000 (x4-6 fold than outside of pregnancy) PE = 1.3 in 100,000 If DVT remains untreated, 15–24% of these patients will develop PE. PE during pregnancy may be fatal in almost 15% of patients, and in 66% of these, death will occur within 30 minutes of the embolic event

Answer 26

An AFI above 25cm confirms polyhydramnios. This may be sub classified based on the AFI result as: Mild 25cm-29.9cm Moderate 30cm-34.9cm Severe 35cm and above Or DVP >8cm

Answer 27

Although evidence of occult placental abruption might also be identified, the sensitivity can be as low as 15%. Even large abruptions can be missed.

Answer 28

45% 50% of IUD - no cause found

Answer 29

DAT FBC Bilirubin

Answer 30

Cervical length at 20-24 weeks <25mm 25% risk of delivery before 28 weeks gestation <20mm 42.4% risk of delivery before 32 weeks gestation <20mm 62% risk of delivery before 34 weeks gestation

Answer 31

Post partum haemorrhage 11% 3rd & 4th degree perineal tears 3.8% Brachial plexus injury 2.3 to 16%

Answer 32

Insulin-like growth factor-binding protein 1 (IGFBP-1) or placental alpha microglobulin-1 (PAMG-1) test

Answer 33

3-4% Affects 30-40% pre term births

Answer 34

Rises in 24 hours and should return to baseline by 3 days

Answer 35

All health professionals must be aware of the Female Genital Mutilation Act 2003 in England, Wales and Northern Ireland and the Prohibition of Female Genital Mutilation (Scotland) Act 2005 in Scotland. Both Acts provide that: 1. FGM is illegal unless it is a surgical operation on a girl or woman irrespective of her age: (a) which is necessary for her physical or mental health; or (b) she is in any stage of labour, or has just given birth, for purposes connected with the labour or birth. 2. It is illegal to arrange, or assist in arranging, for a UK national or UK resident to be taken overseas for the purpose of FGM. 3. It is an offence for those with parental responsibility to fail to protect a girl from the risk of FGM. 4. If FGM is confirmed in a girl under 18 years of age (either on examination or because the patient or parent says it has been done), reporting to the police is mandatory and this must be within 1 month of confirmation. The Serious Crime Act 2015 reinforced existing FGM legislation and introduced mandatory reporting of FGM in girls under 18 years by healthcare workers, teachers and social workers to the police Female cosmetic genital surgery is prohibited unless necessary for mental or physical health. Re-infibulation is forbidden.

Answer 36

CLC Discuss de-infibulation if indicated on examination Risk assess and refer if high risk Add Hep C to booking bloods DOCUMENT: Including age at FGM, country where FGM was performed, date of entry to UK (if applicable) and past history of de-infibulation and/or re-infibulation.

Answer 37

Increased risk of haemorrhage Perineal trauma and caesarean section May have difficultly with examinations

Answer 38

Higher risk of fetal loss - mostly second trimester Associated neurodevelopment morbidity Twin to twin transfusion - 15% TAPS Selective growth restriction

Answer 39

2 weekly from 16 weeks Documented DVP, UA PI, fetal bladders and EFW discordance EFW more than 20% suggestive of selective growth restriction

Answer 40

Quintero grading system Management through laser ablation - Solomon technique Then need weekly monitoring, can be downgraded to 2 weekly if growth normal at 2 weeks Need assessment for fetal hearts Delivery between 34 and 36+6

Answer 41

Monitor at least 2 weekly In type I sGR, 34–36 weeks of gestation In type II and III sGR, delivery should be planned by 32 weeks of gestation

Answer 42

Death 15% Neurological abnormality 26% Fetal MRI of the brain may be performed 4 weeks after co-twin demise to detect neurological morbidity if this information would be of value in planning management. Monitor for fetal anaemia by MCA If death of a fetus occurs at <24 weeks' gestation the co-twin is more likely to also die but if it survives, neurologic damage may be less; if death occurs >24 weeks the co-twin is more likely to survive but also more likely to suffer brain damage.

Answer 43

Previous uterine rupture Classical C/S Any other contraindication to vaginal birth Non cephalic presentation

Answer 44

2-3x risk of uterine rupture 1.5 x risk of emergency C/S Lower with CRB, ARM than with prostaglandin

Answer 45

The rate of instrumental delivery is also increased up to 39%.

Answer 46

First - 110 Second and third - 105 Third - 100

Answer 47

If normocytic or microcytic anaemia - trial Ferrous Sulfate for 2 weeks then check for improvement and compliance Screen everyone at booking and 28 weeks Multiple pregnancy - additional screen at 20 weeks

Answer 48

If no other comorbidities and no antibodies then GTG says weekly

Answer 49

Minimum dose 1500IU Then take blood sample 30-40 mins after to check for fetomaternal haemmorhgage and need for further anti-D

Answer 50

If anticipated blood loss 20% of blood volume or to cause maternal anaemia

Answer 51

FFP at 12-15ml per kg every 6 units of blood Aim to keep PT and APTT <1.5x normal Cryo 2 x 5 unit pools Aim to keep Fibrinogen >1.5 Platelets >50

Answer 52

Ideally seen pre-pregnancy to establish plan Unless clearly linked to major surgery/provoking factor - for antenatal LMWH and 6 weeks postnatal If linked to antithrombin, should have higher dose LMWH (either 50,75,100% of treatment dose) Management with haematologist May need antiXa levels - use a test that does not use exogenous antithrombin and 4-hour peak levels of 0.5–1.0 iu/ml aimed for. May need antithrombin replacement pre delivery or C/S If linked to antiphosphospholipid or arterial VTE then manage with haem/rheum expert

Answer 53

Repeat USS day 3 and 7

Answer 54

Everyone should have ECG and CXR If signs of DVT and PE - perform USS Doppler, if this is positive then no need for investigation of PE Investigations for PE can be either V/Q or CTPA If abnormal CXR then CTPA over V/Q

Answer 55

Women with suspected PE should be advised that, compared with CTPA, V/Q scanning may carry a slightly increased risk of childhood cancer but is associated with a lower risk of maternal breast cancer; in both situations, the absolute risk is very small

Answer 56

None unless extremes of body weight or other co-morbidties (renal impairment) If on UFH then obstetric patients who are postoperative and receiving unfractionated heparin should have platelet count monitoring performed every 2–3 days from days 4 to 14 or until heparin is stopped.

Answer 57

IV unfractionated Heparin

Answer 58

Rest of pregnancy and at least 6 weeks postnatally - at least 3 months Liaise with Haematologist Consider filter if iliac DVT

Answer 59

Wound drain Interrupted suture to drain haematoma

Answer 60

Primips = 10 Multipls = 7

Answer 61

compared with white women (8/100,000), the risk of maternal death during pregnancy and up to 6 weeks after birth is: 4 times higher in black women (34/100,000) 3 times higher in women with mixed ethnic background (25/100,000) 2 times higher in Asian women (15/100,000; does not include Chinese women) compared with white babies (34/10,000), the stillbirth rate is more than twice as high in black babies (74/10,000) around 50% higher in Asian babies (53/10,000) women living in the most deprived areas (15/100,000) are more than 2.5 times more likely to die compared with women living in the least deprived areas (6/100,000) the stillbirth rate increases according to the level of deprivation in the area the mother lives in, with almost twice as many stillbirths for women living in the most deprived areas (47/10,000) compared with the least deprived areas (26/10,000).

Answer 62

Depression: During the past month, have you often been bothered by feeling down, depressed or hopeless? During the past month, have you often been bothered by having little interest or pleasure in doing things? Anxiety (GAD-2): Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge? Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying? None = 0 Several days = 1 More than 50% - 2 Every day = 3 If 3 - refer If less than 3 but concerned ask Do you find yourself avoiding places or activities and does this cause you problems?

Answer 63

Promethazine

Answer 64

Lithium Carbamazepine Clozapine

Answer 65

After collection, swabs should be placed in a non-nutrient transport medium, such as Amies or Stuart. Specimens should be transported and processed as soon as possible. If processing is delayed, specimens should be refrigerated. Enriched culture medium tests are recommended. The clinician should indicate that the swab is being taken for GBS.

Answer 66

50% Offer choice of antibiotics or retesting in this pregnancy in 3rd trimester - should be 3-5 weeks before anticipated delivery

Answer 67

Hourly until 2 hours of life then 2 hourly until 12 hours If term baby, and antibiotics 4 hours prior to delivery, then no need for extra monitoring

Answer 68

Penicillin and Gentamicin

Answer 69

Between 17% and 25% of women who have a positive swab at 35–37 weeks of gestation will be GBS negative at delivery. Between 5% and 7% of women who are GBS negative at 35–37 weeks of gestation will be GBS positive at delivery.

Answer 70

Non-severe allergy Cefuroxime 1.5 g loading dose followed by 750 mg every 8 hours). Severe allergy Vancomycin 1 g every 12 hours

Answer 71

Mast cell tryptase

Answer 72

By 4 minutes of CPR

Answer 73

Supportive care Recombinant factor VII should only be used if coagulopathy cannot be corrected by massive blood component replacement as it causes poorer outcome

Answer 74

10 ml 10% calcium gluconate or 10 ml 10% calciumchloride given by slow intravenous injection

Answer 75

Lipid rescue - intralipid 20%

Answer 76

1:1000 500 micrograms 0.5ml adrenaline IM

Answer 77

Gestational age (weeks) Proportion of spontaneous labours that started at this gestational age 31 weeks and under 2.4% 32+0 to 36+6 weeks 5.3% 37+0 to 37+6 weeks 5.1% 38+0 to 38+6 weeks 12.1% 39+0 to 39+6 weeks 25.4% 40+0 to 40+6 weeks 32.5% 41+0 to 41+6 weeks 16.2% 42+0 weeks and over 0.9% Cumulative proportion of spontaneous labours that started by this gestational age 31 weeks and under 2.4% 32+0 to 36+6 weeks 7.7% 37+0 to 37+6 weeks 12.8% 38+0 to 38+6 weeks 24.9% 39+0 to 39+6 weeks 50.3% 40+0 to 40+6 weeks 82.8% 41+0 to 41+6 weeks 99.0% 42+0 weeks and over 100%

Answer 78

Risks associated with a pregnancy continuing beyond 41+0 weeks may increase over time and these include: increased likelihood of caesarean birth increased likelihood of the baby needing admission to a neonatal intensive care unit increased likelihood of stillbirth and neonatal death

Answer 79

Fetal monitoring might consist of twice-weekly cardiotocography and ultrasound estimation of maximum amniotic pool depth.

Answer 80

Before 34 weeks - expectant management until 37/40 Between 34-37 - discuss IoL now vs expectant management taking maternal/fetal risk factors into account If GBS positive - consider IoL from 34/40

Answer 81

With induction of labour the risk of shoulder dystocia reduced compared with expectant management With induction of labour the risk of third- or fourth-degree perineal tears is increased compared with expectant management Risk of perinatal death, brachial plexus injuries in the baby, or the need for emergency caesarean birth is the same between the 2 options

Answer 82

Primip MLU - reduced risk intervention Homebirth - increased risk of poor neonatal outcome Multip - MLU or home birth reduced risk intervention, comparable outcomes Labour in a freestanding MLU reduces intervention with comparable neonatal outcomes

Answer 83

Breathing exercises, having a shower or bath, and massage may reduce pain during the latent first stage of labour. Do not offer or advise aromatherapy, yoga or acupressure for pain relief during the latent first stage of labour. TENS - no harm, no evidence of benefit Sterile water injections - allowed on NHS Sterile water injections can provide relief of back pain from 10 minutes after the injection for up to 3 hours, but there can be an initial stinging sensation. Giveat 4 different injection points around the Rhombus of Michaelis, using doses of 0.1 ml intracutaneously or 0.5 ml subcutaneously at each injection point. Remifentanil PCA - risk of needing oxygen, benefit is length of half life unaffected by time of use Epidural

Answer 84

during establishment of regional analgesia or after further boluses (10 ml or more of low-dose solutions), measure blood pressure every 5 minutes for 15 minutes assess the level of the sensory block hourly if the woman is not mobilising, assess the level of motor block hourly by asking the woman to do a straight leg raise. If she is unable to do this, ask the anaesthetist to review.

Answer 85

LA - Bupivocaine 0.0625% to 0.1% Opioid - Fentanyl 2 microgram/ml

Answer 86

60% by 24 hours

Answer 87

Offer IoL Advise to to give birth where there is access to neonatal services (this may be in an obstetric unit or an alongside midwifery unit) and to stay in hospital for at least 12 hours after the birth

Answer 88

First labours last on average 8 hours and are unlikely to last over 18 hours Second and subsequent labours last on average 5 hours and are unlikely to last over 12 hours.

Answer 89

Increases risk of PPH if taken in month before birth Also baby needs additional monitoring for ***72 hours*** due to small increased risk of persistent pulmonary hypertension of the newborn or neonatal withdrawal symptoms

Answer 90

Upto 12 hours

Answer 91

Bladder function - by 6 hours epidural - SLR by 4 hours

Answer 92

After spinal, prophylactic intravenous infusion of phenylephrine, started immediately after the spinal injection. Adjust the rate of infusion to keep maternal blood pressure at 90% or more of baseline value and avoid decreases to less than 80% of baseline. When using phenylephrine infusion, give intravenous ephedrine boluses to manage hypotension during caesarean birth, for example if the heart rate is low and blood pressure is less than 90% of baseline. Also IV crystalloid

Answer 93

When a woman has regained airway control, is haemodynamically stable, and is able to communicate after caesarean birth under a general anaesthetic: continue observations (oxygen saturations, respiratory rate, heart rate, blood pressure, temperature, pain and sedation) every half hour for 2 hours after 2 hours, if these observations are stable, carry out routine observations in accordance with local protocols if these observations are not stable, or the woman has other risk factors or complications (for example, severe hypertension, or signs of infection or sepsis), carry out a medical review and increase the duration and frequency of observations.

Answer 94

Those with diamorphine + risk factors for respiratory depression: carry out hourly monitoring of oxygen saturations, respiratory rate and sedation for at least 12 hours after birth, and then routine PN care Diamorphine 12 hours Morphine 24 hours

Answer 95

Some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin so hypoxaemia may not be detected.

Answer 96

Offer intrathecal diamorphine (up to 300 micrograms) to reduce the need for supplemental analgesia after a caesarean birth. Use epidural diamorphine (up to 3 mg) as an alternative if intrathecal diamorphine has not been given. If diamorphine is unavailable, offer intrathecal preservative-free morphine (up to 100 micrograms) plus intrathecal fentanyl (up to 15 micrograms). Use epidural preservative-free morphine (up to 3 mg) as an alternative if intrathecal morphine has not been used.

Answer 97

Risk of childhood cancer VQ 1/280,000 CTPA 1/100,000 Increased risk of fatal childhood cancer to the age of 15 following in utero radiation exposure = 0.006% per mGy (1 in 17000 per mGy) Fetal radiation V/Q 0.5mGy CTPA 0.1mGy Maternal breast tissue CTPA 10mGy - increases Breast Ca risk 13.6% above background risk

Answer 98

fasting: 5.3 mM and 1 hour after meals: 7.8 mM or 2 hours after meals: 6.4 mM.

Answer 99

4 weeks Risk of death 15% and neurological abnormality 25% in surviving twin Damage to the surviving twin is believed to be caused by acute haemodynamic changes around the time of death, with the survivor losing part of its circulating volume into the circulation of the dying twin. This may cause transient or persistent hypotension and low perfusion, leading ischaemic organ damage especially to the watershed areas of the brain

Answer 100

Multips - no real difference regardless of location of birth 3/1000 Primips 9/1000 if homebirth 5/1000 if obstetric unit or alongside MLU

Answer 101

Urine dipstix at 6 weeks If still positive recheck at 3 months - then consider referral to renal team ?CKD

Answer 102

Antithrombin III protein C Protein S deficiencies Lupus anticoagulants Acquired activated protein C resistance (APCR) are NOT associated with pre-eclampsia. Hyperhomocysteinaemia Anticardiolipin Prothrombin Methylenetetrahydrofolae reductase gene mutation homozygous ARE all associated with PET.

Answer 103

PLGF used as predictor for developing PET Binds to vascular endothelial growth factor receptor Soluble form regulates activity by binding and inhibiting activity

Answer 104

Early marker of compromise Calculated for ratio of pulse to systolic BP

Answer 105

PCR 30mg/mmol ACR 8mg/mmol.

Answer 106

Herpes Simplex

Answer 107

Always IAP if previous baby had EOGBS No role for swabs

Answer 108

Mild hydronephrosis is normal in pregnancy Up to 5 mm on the left and 15 mm on the right Dilatation of the ureters up to 2 cm in the third trimester are all acceptable

Answer 109

Lower vagina and rectum

Answer 110

2)1)Avulsion (tearing from the spine), 2)Rupture (torn but not at spinal attachment) 3)Neuroma (torn but healed and scarring prevents signal conduction) 4)Neuropraxia (stretching) - the most common, most infants recover by 3-4 months, physio/occasionally surgery is required

Answer 111

General population 1:3000 Obstetrics 1:300

Answer 112

1/4 have early onset fetal growth restriction

Answer 113

>10mm - mild 1-3% chromosomal abnormality >15mm - severe 50% neurodevelopment delay Manage through FMU Serial USS - want ventricles to stay same size despite fetal growth

Answer 114

About 40cm

Answer 115

Fetal hydrops results in PET in the mother

Answer 116

Combined (first trimester) - 85% T21 80% T13/18 False positive 2% Quad (second trimester) 80% T21 only False positive 3%

Answer 117

Brachial plexus injury (BPI) is one of the most important fetal complications of shoulder dystocia, complicating 2.3% to 16% of such deliveries <10% have permanent neurological dysfunction 0.43 per 1000 live births in the UK

Answer 118

Equally important, 48% of births complicated by shoulder dystocia occur with infants who weigh less than 4000g (according to GTG)

Answer 119

The McRoberts’manoeuvre is hyperflexion and abduction of the maternal hips,positioning the maternal thighs on her abdomen. It straightens the lumbosacral angle, rotates the maternal pelvis towards the mother’s head and increases the relative anterior-posterior diameter of the pelvis. The McRoberts’manoeuvre is an effective intervention,with reported success rates as high as 90%.

Answer 120

Same principles as adult cardiac arrest Need uterine displacement to be performed whilst doing CPR (push uterus up and left) Normal 30:2 ratio Defibrilliation safe If PEA - immediate Adrenaline 1g IV then every 3-5 minutes if VF/VT - after 3rd shock and Amiodarone 300mg Peri-mortem C/S immediately if over 20 weeks and prolonged pre-hospital arrest or by 5 minutes for maternal factors Obstetric specific causes: Eclampsia Cardiac myopathy Haemmorhage (can be concealed) Amniotic Fluid Embolism Uterine rupture Massive PE

Answer 121

Right side normally affected - drains directly into IVC, more valves + more likely to be compressed by gravid uterus

Answer 122

Between 1-2000 and 1 in 5800 deliveries Rare presentation, but higher association with caesarean section/twin C/S POVT characterised by abdominal pain + fever that does not improve with infection Typically present by day 10 Palpable abdominal mass in up to 50% USS poor at detecting CT first line in most units - 78% sensitivity Require anticoagulation for 3-6 months High risk for sepsis No indication for haemophilia testing LMWH in future pregnancies (similar recurrence as VTE)

Answer 123

1 in 10,000 in Caucasians/East Asians Not present in Africa Autosomal recessive metabolic disorder - one of the most common Caused by deficiency of phenylketonuria hydroxylase (PAH) which converts phenylketonuria to tyrosine

Answer 124

Those affected should follow dietary restrictions during the first 5–6 years of life, when brain growth is most rapid - low PKU diet to prevent build up In pregnancy: Need to resume Phe-restricted diet, with supplementation of amino acids Poor tasting - not liked by patients Need optimal control (tested by blood spots twice weekly) PRIOR to conception Need four readings of <50 μmol/l before trying to conceive Untreated or suboptimally treated women with PKU have elevated Phe levels that are teratogenic to the unborn fetus. Phe is actively transported across the placenta, reaching fetal concentrations that are 1.25–2.5 times greater than maternal concentrations Uncontrolled PKU in pregnancy causes similar presentation to fetal alcohol syndrome - irreversible brain damage Clinical signs in fetus: IUGR, microcephaly, congenital heart disease and facial dysmorphism Need regular scanning in pregnancy to assess for signs listed above Risk of congenital heart defects 7-10% In older children: Fair skinned ++ as Tyrosine required for melanin production Musty-smell Intellectual disability Behavioural problems Breastfeeding safe

Answer 125

The severe impairment category includes any of: severe cognitive impairment with an IQ lower than 55 (< -3 standard deviation); this will usually result in the need for special educational support and require supervision in daily activities severe cerebral palsy – classified as Gross Motor Function Classification System (GMFCS) grade 3 or greater (Appendix 1) blindness or profound hearing impairment.

Answer 126

FETAL: Gender - female lower risk FGR Singleton pregnancy - lower risk MANAGEMENT: Full course of steroids MgSO4 Delivery in tertiary unit

Answer 127

Survival 22 weeks - 7/10 die 23 weeks -6/10 die 24 weeks - 4/10 die 25 - 3/10 die 26 - 2/10 die Disability (SEVERE form, up to 1/4 will have milder) 22 weeks - 1/3 have severe disability 23 - 1/4 are disabled 24 - 1/7 are disabled 25 -1/7 are disabled 26 - 1/10 are disabled

Answer 128

Early (within 24 hours) - always pathological -Haemolytic disease -Infection (TORCH screen) -Haematoma (traumatic birth) -Maternal autoimmune haemolytic anaemia (SLE) -Crigler-Najar -Gilbert' syndrome Physiological - normally presents day 2/3 and resolves by day 10. More likely in breastfed infants. Prolonged - continuing following Day 14 (term) or day 21 (preterm) -Infection -Hypothyroid -Galactosemia -GI: biliary atresia, Conjugated hyperbilirubinaemia (does not cause kernicterus as cannot cross blood brain barrier) Infection. Cystic fibrosis. Metabolic: alpha-1-antitrypsin deficiency, galactosaemia, aminoacidurias, organoacidaemias. GI: biliary atresia , choledochal cyst, neonatal hepatitis. Endocrine: hypothyroidism, hypopituitarism. Prolonged TPN Measure bilirubin - treat with phototherapy/exchange transfusion

Answer 129

Inadequate labour pain relief: 1/8 women Inadequate analgesia for caesarean section necessitating general anaesthetic: 1/20 Significant drop in blood pressure: 1/50 Severe headache (dural puncture): 1/100 women (epidural); 1/ 500 women (spinal) Nerve damage (numb patch on a leg or foot, or having a weak leg): Temporary – 1/1,000 Permanent - 1/13,000 Epidural abscess: 1/50,000 Epidural haematoma: 1/170,000

Answer 130

Essential to detect duct dependent cardiac disease Combining pulse oximetry (Pre-ductal – RIGHT HAND and Post-ductal – ANY FOOT SPO2) screening with existing screening methods, antenatal screening and routine examination, will improve detection of critical CHD cases to over 90%. A sustained, good signal both readings of ≥ 95% and difference less than or equal to 2% is accepted as normal

Answer 131

<2.5 in a baby with abnormal clinical signs <2 in a well baby with risk factors (persistent over 2 readings) <1 at any time

Answer 132

Rise in PaO2 Prostaglandin F, low calcium, low glucose and high pulmonary pressure keep ductus arteriosus open in utero. Hypoxia can cause ductus to become patent.

Answer 133

Caused by decreased right atrial pressure and increased left atrial pressure. Held shut by haemodynamic forces only for the first few weeks. Remains potentially patent in 25-30% of normal adults.

Answer 134

Cephalohaematoma - do not cross suture line, occur beneath the periosteum, associated with jaundice, may not appear until second day of life and may take several weeks to finally disappear Subgleal - crosses the midline, beneath aponeurosis, cause fetal anaemia and shock, associated with ventouse delivery

Answer 135

The delivery room temperature should be at least 26°C for the most immature infants.

Answer 136

The adjusted stillbirth rate in the UK is 4/1000 (excludes late mid-trimester losses and terminations)

Answer 137

Placenta accreta occurs in 11–14% of women with placenta praevia and one prior caesarean delivery and in 23–40% of women with placenta praevia and two prior caesarean deliveries. In women with placenta praevia and five or more prior caesarean deliveries, the incidence of placenta accreta is up to 67%.

Answer 138

Idiopathic

Answer 139

Turner's 45XO

Answer 140

Middle cerebral artery Doppler * In preterm SGA, MCA Doppler has limited accuracy to predict acidaemia and adverse outcome and should not be used to time delivery. * In SGA detected after 32 weeks where umbilical artery Doppler indices are typically normal, an abnormal middle cerebral artery Doppler (PI < 5thcentile) has moderate predictive value for acidosis at birth and should be used to time delivery

Answer 141

Absence of nasal bone Increased resistance to flow in the ductus venosus and tricuspid regurgitation

Answer 142

They are anucleate

Answer 143

Karyotype results available within 48-72h from fetal blood and chorionic villi but in 2-3 weeks from amniotic fluid NIPT 9 -14 days

Answer 144

X-linked dominant Fragile site at Xq27 Associated with learning disability Enlarged testes * A degree of learning disability is present in 20-30% of carrier females * Refer for genetic counselling

Answer 145

No translocation - age related risk + 0.34% at term (0.42% mid-trimester) Mother carrier of t(14;21) - 15% recurrence risk Father carrier of t(14;21) - 1% recurrence risk Mother or father t(21;21) - 100% recurrence risk

Answer 146

High risk 1:2 Low risk 1:10,000

Answer 147

Rare 3 main conditions: Rett's Vitamin D resistent Rickets Fragile X

Answer 148

10 ug or 400 IU

Answer 149

50% transmission, about half of which will have clinical neonatal varicella syndrome

Answer 150

pH drops in.. Acute 0.01/min Sub-acute 0.01/2-3min

Answer 151

1. Evidence of hypoxic stress (decelerations) 2. Loss of accelerations and lack of cycling 3. Exaggerated response to hypoxic stress (decelerations become wider and deeper) 4. Attempted redistribution to perfuse vital organs facilitated by catecholamines (first sign noted is a rise in baseline) 5. Further redistribution with vasoconstriction affecting the brain (reduced baseline variability) 6. Terminal heart failure (unstable/ progressive decline in the baseline - “step ladder pattern to death”)

Answer 152

Electrosurgery generates the smallest particles with a mean diameter of 0.07 μm Laser-generated particles are typically larger, at up to 0.31 μm Ultrasonic scalpel by-products are the largest, with particle diameters ranging from 0.35 to 6.5 μm Particle size Those below 10 μm are classified as inhalable Particles of 5 μm or less will be deposited on the walls of the nose, pharynx and trachea, irritating the respiratory tract and requiring clearance by mucociliary action Smaller matter of less than 2.5 μm, including bacteria and viruses, will penetrate deeper into the alveolar region of the lungs, where clearance by macrophage phagocytosis will induce an inflammatory response. Masks only effective at stopping inhalation of 5um and larger

Answer 153

6 months LMWH

General Obs Flashcards

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