HD EOYS3 Flashcards
Explain the significance and causes of acceleration and early deceleration in Cardiotocography [2]
Acceleration:
- Sympathetic activation in response to fetal movement or scalp stimulation. Baby is moving around in the uterus / cervix. Normal
Early deceleration:
- Parasympathetic response to head compression
- Fetal HR decreases BEFORE contractions: normal
Strategies that may help with during episodes of non-reassuring fetal statusinclude [5]
- Changing the mother’s position
- Increasing maternal hydration
- Maintaining oxygenation for the mother
- Amnioinfusion, where fluid is inserted into the amniotic cavity to relieve pressure on the umbilical cord
- Tocolysis, a temporary stoppage of contractions that can delay preterm labour
- Intravenous hypertonic dextrose – gives mother more energy
Explain manoeuvre used to fix shoulder dystopia? [1]
Whats are two other options? [2]
- McRoberts manoeuvrers tries to dislodge shoulder from being stuck on the pubis by pelvic symphysis orientated more horizontally to facilitate shoulder delivery
- Changing the mother’s position
- An episiotomy: surgical widening of the vagina, may be needed to make room for the shoulders
Possible complications of shoulder dystopia? [4]
- Fetal brachial plexus injury: Erb-Duchenne palsy - Single nerve stretching eg radial nerve
- Fetalfracture: Humerus or collar-bone break, which usually heal without problems
- Hypoxic-ischemic brain injury, or a low oxygen supply to the brain: Cerebral palsy
- Maternal complications include uterine, vaginal, cervical or rectal tearing and heavy bleeding after delivery
Explain 3rd stage of labour [1]
What does active managment of 3rd stage of labour decrease the risk of ? [1]
Which drug do you use for ^? [1]
Expulsion of placenta and membranes
Active management decreases risk of PPH - use oxytocin to stimulate placental delivery
How do you manage failure to progress:
- Initially? [1]
- If continued? [4]
- If still continued? [2]
How do you manage failure to progress:
- Initially: relax and wait
- If continued: givelabour-inducing medications: Oxytocin; misoprostal; mifepristone; oestrogen pessary
- If still not delivered: membrane sweep or c section
Underlying causes and conditionsthat cause fetal distress include? [5]
Insufficient oxygen levels
Maternal anemia
Pregnancy-inducedhypertensionin the mother
Intrauterine growth retardation (IUGR)
Meconium-stained (baby poo) amniotic fluid: baby drinks own amniotic fluid
Explain the significance and causes of variable decelerations and late deceleration in Cardiotocography [2]
Late deceleration:
* placenta is compressed and o2 to baby is compromised: causes vagal stimulation or myocardial depression
* Late and bradycardia: emergency C-section
variable decelerations:
- Abrupt decrease with rapid recovery from cord compression
- Looking at length of recovery of HR (as long as recovery is rapid, its fine)
- When contraction lessens is when HR should return to normal
Name the drugs used for Tocolysis (a temporary stoppage of contractions that can delay preterm labour) [5]
- nifedipine (calcium antagonist)
- atosiban: oxytocin receptor antagonists
- indomethacine NSAID: inhibitors of prostaglandin synthesis
- nitroglycerine: NO donors, Betamimetics (sympathetic beta agonsists)
- magnesium sulphate
CTG deceleration:
Abrupt decrease in baseline heart rate of >[] bpm for >[] seconds
Abrupt decrease in baseline heart rate of >15 bpm for >15 seconds
Explain potential complications of secondary perinatal apnea [3]
Not getting o2 in lungs and distributing surfactant.
Can lead to hypoxaemia: brain damage, heart damage and cause resp. acidosis.
Score system used to investigate perinatal asphyxia? [1]
Describe the clinical significance of APGAR scores
APGAR score
A low Apgar score of 0 to 1 at 1 minute is not predictive of adverse clinical outcomes or long-term health issues since most infants, even those with very low 1-minute scores will have normal scores by 5 minutes.
Low Apgar scores at 5 minutes correlate with mortality and may confer an increased risk of cerebral palsy in population studies but not necessarily with an individual neurologic disability
Scores less than five at 5 and 10 minutes correlate with an increased relative risk of cerebral palsy.
What are the three types breech pregnancies?
Frank: Has most favourable outcomes for vaginal deliveries
Complete
Footing
What are the 4 types of placenta previa? [4]
Minor praevia, or grade I – the placenta is in the lower uterus but not reaching the internal cervical os
Marginal praevia, or grade II – the placenta is reaching, but not covering, the internal cervical os
Partial praevia, or grade III – the placenta is partially covering the internal cervical os
Complete praevia, or grade IV – the placenta is completely covering the internal cervical os
What type of delivery occurs if placenta previa occurs? [1]
What can plecenta previa increase risk of? [1]
Treatment of placenta previa? [1]
Placenta previa:
- C section only
- Increases the liklihood of placenta accreta (when placenta becomes inseperable from uterus
- Treat with blood transfuison
Define precipitous labour [1]
Describe the two types of precipitous labour
Precipitous labor is defined as expulsion of the fetus within less than 3 hours of commencement of regular contractions.
1st is when it starts in the 1st stage of labour: lot of super intense contractions
2nd starts in the 2nd stage of labour: 2nd stage is “pushing stage”
What is difference between primary and secondary PPH? [2]
What are primary [4] and secondary [2] PPH associated with?
Primary PPH: bleeding within 24 hours of birth:
- Polyhydamnios
- Macrocosmic fetus
- Uterus overstretched
- Multifetal preg.
Secondary PPH: from 24 hours to 12 weeks after birth:
- Infection
- Retained products of conception
Explain MoA of Tranexamic acid for PPH
Analogue of lysine
Binds to plasminogen and stops conversion of plasmin: causes bigger clots to form
What is a positive Homon’s sign for investigating thromboembolic disease? [1]
Positive Homon’s sign: Pain with forced dorsiflexion of the foot
Which screening scale is used for post natal depression? [1]
What score requires further evaluation? [1]
Edinburgh Postnatal Depression Scale (EPDS):
* 0 item, self-rated questionnaire used extensively for detection of postpartum depression
* Score of 10 or more on EPDS or an affirmative answer on question 10 requires further evaluation
* Presentation is clinically indistinguishable from major depression
Which drugs are used to treat PPH? [5]
Oxytocin (slow injection followed by continuous infusion)
Ergometrine (intravenous or intramuscular) stimulates smooth muscle contraction (contraindicated in hypertension)
Carboprost (intramuscular) is a prostaglandin analogue and stimulates uterine contraction (caution in asthma)
Misoprostol (sublingual) is also a prostaglandin analogue and stimulates uterine contraction
Tranexamic acid (intravenous) is an antifibrinolytic that reduces bleeding
Which drugs are used as pharmalogical therapy for post natal depression? [4]
SSRIs: Selective serotonin reuptake inhibitors:
* Citalopram (SSRI)
* Sertraline (SSRI)
(SNRI) serotonin-noradrenaline reuptake inhibitor:
* Duloxetine (SNRI)
TCA: Tricyclic antidepressants
* Nortriptyline
What is the name of the progesterone metabolite important in PPD and which receptor does it work on? [2]
Progesterone metabolite allopregnanolone (ALLO) is a involved with GABA receptor and is a neurosteroidal transmitter
How do oestrogen levels change after birth? [1]
Why reduced levels of oestrogen affect which NT in PPD? / Why is giving it good? [1]
The change of what family of enzymes alter oestroen levels after delivery? [1]
What do have to be careful with oestrogen therapy? [1]
Oestrogen levels acutely fall
Oestrogen gives rise to increased serotonin
Monoamine oxidases (family of enzymes) rise after birth till day 4-6: causes oestrogen levels to be depressed (and therefore depressive symptoms)
Oestrogen therapy has a bell curve effect (bad at extreme high / lows)
What is the name for this sign / test? [1]
What would a positive sign indicate? [1]
Homon sign
Positive sign indicates DVT / thromboemolic disease
Label A-E & Green Arrow [6]
A: Sigmoid colon
B: (Ampulla of) rectum
Green Arrow: (Ampulla of) vas deferens
C: External anal sphincter muscle
D: Internal anal sphincter muscle
E: Bulb of penis
Label A-E
A: Testis
B: Epididymis
C: Left and right crus penis
D: bulb of penis
E: Bulbo-urethral or Cowper’s gland
Label A-E
A: Rectovesical pouch
B: Rectum
C: Deep inguinal ring
D: Inferior epigastric arteries
E: Femoral Nerve
Label A-G
A: Prostatic utricle (embryological remnant)
B: Ejac. ducts
C: Prostatic urethra
D: Membranous urethra
E: Spongy urethra
F: Sphincter urethrae muscle
G: Prostate
Label A-D
A: Pampiniform venous plexus
(anterior veins)
B: Ductus deferens
C: Testicular artery
D: Artery of ductus deferens
Label A-C [3]
A: Start of Vas deferens
B: Levator ani
C: Obturator internus muscle
