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Obs Flashcards

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1
Q

Ovarian Hyperstim Synd Patho

A 
Ovarian Stim (FSH/LH) => Maturation of mutiple follicles, 
hCG given (Trigger final maturation) => 
Excess VEGF => Oedema, Ascites, HypoVol, Act of RAAS
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2
Q

Ovarian Hyperstim Mx

A

PO/IV Fluids (Colloids),
Monitor UO,
Paracentesis,
LMWHep (Prevent VTE)

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3
Q

Ectopic Location + Sx

A

(Fallopian tubes, Ovaries, Cervix, Abdo):

Constant lower Abdo Pain (+/- Vag bleeding)

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4
Q

Ectopic Ix

A

(Abdo Pain/Vag bleeding and (+) Preg test => EPAU)

TV-USS,
hCG (Should double every 48hrs):
Increases but < 63%: Ectopic
Decreases > 50%: Miscarriage

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5
Q

Ectopic Mx

A

Expectant (Nat termination w/ reg f/ups)

Med (IM Methotrexate – cannot get pregnant again for 3 months)

Surg:
Salpingectomy: Removal of Fallopian tubes,
Salpingotomy: Removal of just Ectopics

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6
Q 
Miscarriage Def + Types
Early
Late
Missed
Inevitable
Threatened
A

Spontaneous TOP < 24wks

Types:
Early: < 12wks, Late: 12-24wks
Missed: No Sx
Inevitable: Vag bleed w/ Open Cervix
Threatened: Vag bleed w/ Closed Cervix
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7
Q

Miscarriage Ix

A

TV-USS to confirm

hCG: Decrease > 50% in 48hrs

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8
Q

Miscarriage Mx:
< 6wks
> 6wks

A

< 6wks:
Expectant (Wait, Repeat Preg test)

> 6wks:
Expectant (Wait, Repeat Preg test),
Med (Misoprostol: PG Analogue => Softens cervix + Stim Uterine contractions),
Surg (Manual/Electric Vacuum Asp)

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9
Q

TOP Legal Req

A

< 24wks:​
If continuing involves an Increased risk to Physical/Mental health of mother or existing children​

At any time:​
If continuing risks the life of the mother​
Prevent “grave permanent injury”​
Substantial risk child would be handicapped​

​
(Requires 2 Med practitioners​)

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10
Q

Med method for TOP

A

Mifepristone (Anti-Prog): Halts Pregnancy​

Misoprostol (PG Analogue): Softens cervix + Stim Uterus ​

(> 10wks: additional Misoprostol doses every 3hrs until expulsion)​

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11
Q

Surg method for TOP

A

Cervical priming (Misoprostol, Mifepristone, Dilators)​:
< 14wks: Suction​
> 14wks: Evacuation w/ forceps​

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12
Q

Anti-D Rules

A

Must be given to all mothers w/ Ectopics, Miscarriages, TOPs

Given at 28, 34 wks

Given w/in 72hrs of any Sensitisation event

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13
Q

Hyperemesis Gravidarum Patho + Admission Criteria

A

Rise in b-hCG => N+V

Criteria:
Dehydrated/Electro Imbalance
Unable to keep down Fluids/Meds
Lost > 5% Body weight (from Pre-Preg)
Ketones on Dipstick
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14
Q

Hyperemesis Gravidarum Mx

A 
IV Antiemetics (Cyclizine, Prochlorperazine) 
IV Fluids (+ KCl) w/ Daily U+E monitoring 
Thiamine Supp (Prevent Def) 
Thromboprophylaxis (Ted Stockings, LMWHep)
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15
Q

Molar Preg Sx + Patho

A

Abnormally High b-hCG =>
More Severe N+V
Thyrotoxicosis (Mimics TSH)
Rapid Uterus Enlargement, Vag Bleeding + HT

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16
Q

Molar Preg Ix

A

Pelvic USS (Snowstorm)
b-hCG
TSH, T3/4

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17
Q

Molar Preg Mx

A

Uterine Evacuation (+/- Metastases: ChemoTx)

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18
Q

Preg Lifestyle Advice: Supplements, Avoid, Exercise, Sex, Travel

A

Take folic acid 400mcg from before pregnancy to 12 weeks (reduces neural tube defects)
Take vitamin D supplement (10 mcg or 400 IU daily)
Avoid vitamin A supplements and eating liver or pate (vitamin A is teratogenic at high doses)
Don’t drink alcohol when pregnant (risk of fetal alcohol syndrome)
Don’t smoke
Avoid unpasteurised dairy or blue cheese (risk of listeriosis)
Avoid undercooked or raw poultry (risk of salmonella)
Continue moderate exercise but avoid contact sports
Sex is safe
Flying increases the risk of venous thromboembolism (VTE)
Place car seatbelts above and below the bump (not across it)

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19
Q

Antenatal Screening/Appt’s

A

< 10wks: Booking Appt
8-12wks: Booking Scan, Downs Screen (Combined test)
18-20wks: Anomaly Scan, Downs Screen (Triple, Quadruple test)
24-28wks: Gest DM Screen (OGTT)
28wks: Anti-D given
34wks: Anti-D given
36wks: Assess Fetal Lie + Presentation

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20
Q

Downs Screening at 8-12wks:

A

Combined Test:
Nuchal Translucency (> 6mm: +)
b-hCG (High: +)
PAPA (Low: +)

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21
Q

Downs Screening at 18-20wks

A

Triple Test:
b-hCG (High: +)
aFP (Low: +)
Serum Oestradiol (Low: +)

Quadruple Test:
b-hCG (High: +)
aFP (Low: +)
Serum Oestradiol (Low: +)
Inhibin A (High: +)

Anomaly Scan

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22
Q

HypoTh in Preg

A

Increase Levothyroxine by 25-50 micrograms (30-50%)

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23
Q

HT in Preg

A

Labetalol (Avoid in Asthma),
Nifedipine,
(Avoid ACEi/ARBs, Thiazides)

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24
Q

Epilepsy in Preg

A

Single AED before becoming Preg (Levitiracetam, Lamotrigine, Carbamazepine)

5mg Folic Acid daily (Pre-conceptually – 12wks Gest)

Avoid Na+Valproate, Phenytoin

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25
Med Contra in Preg - 8
``` NSAIDs ACEi/ARBs Warfarin Lithium AED's (Na+Valproate) Methotrexate Opiates Retinoids ```
26
Pre-eclampsia Def
New onset high blood pressure (S140/D90) after 20 weeks of pregnancy w/:​ ``` Proteinuria (> 300mg/day)​ Organ dysfunction (AKI, Liver, Neuro, Haem)​ Uteroplacental dysfunction​ ``` ​
27
Pre-eclampsia Sx + Signs
Hypertension, Proteinuria​ Oedema (Peripheral, Facial)​, Ascites Severe (Frontal)​ headache, Vision problems​ Epigastric/Chest pain​, Vomiting​ Cloudy urine​, Reduced urine output​ Hyperreflexia, Clonus​
28
Pre-eclampsia Mx: Prevention Conservative
Prevention: ​ Adcal-D3 (Ca2+ Supplements)​ Aspirin 75-150mg (Started from 12wks - Birth in women w/ Risk F)​ Conservative:​ Weight/Diet Mx​ Birth-timing (some births may need to be induced early)​
29
Pre-eclampsia Tx
``` Ongoing: ​ Labetalol (beta-blocker), Nifedipine (CCB), Methyldopa (Anti-sympathetic)​ (Avoid ACEi and other Diuretics​) ``` Emergency:​ (If < 34wks: IM Betamethasone)​ AED: IV Mg-sulphate (Prevent seizures)​ Cure: Delivery​
30
Gest DM Risk F
Previous Gest DM/Macrosomia/Shoulder Dystocia BMI > 30 FHx of DM/BAME Glu on Urin Dip
31
Gest DM Screening: Fasting 2hrs
Any Risk F => OGTT 24-28wks: 75mg Glu drink Fasting: > 5.6mmol 2hrs: > 7.8mmol
32
Gest DM Mx: Fasting < 7mmol Fasting > 7mmol/Macrosomia Monitoring
If fasting Glu < 7mmol: Diet + Exercise If fasting Glu > 7mmol/Macrosomia: Metformin, +/- Insulin, (Glibenclamide: Sulfonylurea) (Reg Blood Glu + USS monitoring every 4wks): Fasting: < 5.3mmol 2hrs: < 6.4mmol
33
Pre-existing DM Mx
Metformin, Insulin Safe 5mg Folic Acid Planned Delivery at 37-39wks w/ VRII during Labour Aim for fasting Glu: 5.3mmol (Retinopathy screening at booking clinic + 28wks)
34
Obstet Cholestasis Sx
Jaundice, (Dark Urine, Pale Stools), | Pruritus (Palms + Soles)
35
Obstet Cholestasis Ix
LFTs (Deranged – Placenta => Raised ALP), | Raised Bile Salts
36
Obstet Cholestasis Mx
Ursodeoxycholic Acid (dissolves stones) (Anti-histamines, Emollients: Reduce Pruritus) (If PT raised: Vit K) Planned Delivery at 37wks
37
Acute Fatty LD of Preg Patho + Sx
Fetus unable to breakdown fatty acids => Accumulation in mothers Liver Jaundice, Abdo Pain, Ascites, N+V
38
Acute Fatty LD of Preg Ix
LFTs (Raised ALT/AST, BiliR) Deranged Clotting w/ Low Plt’s Raised WBCs
39
Acute Fatty LD of Preg Mx
Delivery + Tx of Acute Hepatitis
40
Breech Presentation Mx: < 36wks > 36wks Nulli/> 37wks Multi
< 36wks: Watch+wait (Left to turn Spontaneously) > 36wks Nulliparous/> 37wks Multiparous: (ECV): SC Terbutaline (beta-Agonist) => Tocolysis + Press on Abdo to turn Fetus (If ECV Fails: Vag-delivery +/- C-Section)
41
Stillbirth Def, Ix + Mx
(Intrauterine Fetal death after 24wks) Ix: USS (Diagnose fetal death) ``` Mx: Rh(-) require Anti-D (+ Kleihauer test) Vag delivery: Expectant (Await natural delivery) IOL: PO Mifepristone (Anti-Prog) + Vag/PO Misoprostol (PG) ``` Dopamine Agonist (Cabergoline): Suppress Lactation
42
Preterm Prophylaxis: Cerv Length < 25mm Previous Premature birth/Cerv Trauma w/ Cerv Length < 25mm Cerv Dil w/out ROM
If Cerv length < 25mm (at 16-24wks): Vag Prog ``` If previous Premature birth/Cerv trauma w/ Cerv length < 25mm (at 16-24wks): Cerv cerclage (Stitches) ``` If Cerv dilation w/out ROM (at 16-28wks): Rescue Cerv cerclage
43
Preterm Premature ROM Ex + Ix
Pooling of Amniotic Fluid w/in Vag (Speculum Ex) Raised IGF-BP1/Placental alpha-Microglobulin-1 (present in Amniotic Fl)
44
Preterm Premature ROM Mx
Abx (Prevent Chorioamnioitis): Erythromycin 250mg QDS 10 days IOL at 34wks
45
IOL Scoring
``` CTG, Bishop Score ( >8: Favourable): Position (Ant, Mid, Post) Consistency (Soft, Firm) Effacement (80% - 30%) Dilation (> 5cm – Closed) Station (+2 - -3) ```
46
IOL Options
Memb sweep (If > EDD) Vag Prog (Dinoprostone) Cerv ripening balloon Artificial Rupt of Memb (w/ IV Oxytocin) (PO Mifepristone + Misoprostol: IUFD – TOP, Ectopics, Miscarriage, Stillbirth)
47
Preterm Labour w/ Intact Memb Features
Reg, Painful contractions w/ Cerv dilation Cerv length < 15mm on TV-USS (+) Fetal Fibronectin: > 50ng/L
48
Preterm Labour Mx
Fetal monitoring (CTG) If btw 24-34wks: Tocolysis (Nifedipine) => 48hr Delay 2x IM Betamethasone IV Mg Sulphate (given w/in 24hrs of Del when < 34wks): (Monitor for maternal Mg2+ Toxicity: Hypoventilation, HypoT, Absent reflexes) Delayed cord clamping/cord milking (Increase Fetal blood Vol + Hb)
49
Uterine Hyperstimulation Cause + Sx
Caused by Vag Prog Contractions are prolonged (> 2min) + frequent (> 5 in 10mins) => Fetal distress
50
Uterine Hyperstimulation Mx
Remove Vag Prog, Stop IV Oxytocin Infusion, (Tocolysis w/ Terbutaline)
51
CTG Worrying Signs
(DR: Define Risk): C: Prolonged + Frequent Contractions BR: BradyC (< 100), TachC (> 160) V: Reduced variability (<5bpm in > 50mins), Increased Variability (>25bpm in > 25mins), Sinusoidal (A: Always reassuring) D: Late decelerations (Fall at peak of contractions), Prolonged decelerations (> 3mins)
52
Prolonged Fetal BradyC Mx
3mins: Call for Help 6mins: Move to Theatre 9mins: Prepare for delivery 12mins: Deliver (by C-Section + w/in 15mins)
53
Fail to Progress (S1) Def + Mx
Delay in 1st Stage: (< 2cm dilation w/in 4hrs, Slowed progress in Multiparous): Record Cerv dilation on Partogram (If crosses alert-line: Amniotomy)
54
Fail to Progress (S2) Def + Mx
Delay in 2nd Stage: (Act pushing > 2hrs in Nulliparous/> 1hr in Multiparous): IV Oxytocin => Stim Uterine contractions
55
Fail to Progress (S3) Def + Mx
Delay in 3rd Stage: (> 60mins w/ Physiological Mx/> 30mins w/ Act Mx/PPH): IV Oxytocin 10 IU => Stim Uterine contractions w/ Controlled cord traction
56
Cord Prolapse Mx
Emergency C-section (+/- Tocolysis w/ Terbutaline) Change position (On all 4’s: prevent compression)
57
Shoulder Dystocia Mx:
Episiotomy McRoberts Manoeuvre (Knees to Chest w/ Post Pelvic tilt) Press to Ant shoulder (via Suprapubic Abdo) Rubin’s Manoeuvre (Push from w/in Vag) Woods Screw Manoeuvre (Rotate Post shoulder back while pushing Ant shoulder from w/in Vag) Zavanelli Manoeuvre (Push Fetus -> Vag, Emergency C-Section)
58
Perineal tears Mx:
1: Watch+wait ``` 2/3/4: Sutures Broad-spec Abx Laxatives (Prevent constipation), PT (Prevent Incontinence) ```
59
Perineal Tears Class
1: Epithelium 2: Perineal M 3: Anal Sphincter 4: Rectum
60
``` C-section Risks: Gen Surg Postpartum Maternal Fetal ```
Gen Surg risks: Inf, Bleeding, Pain, VTE, Damage to Abdo organs (+/- => Adhesions, Hernias, Ileus) ``` Post-partum complications (PPH, Wound Inf/Dehiscence)​ Maternal risks (Increased risk of future of Uterine rupture/Placenta praevia/C-sections​) Fetus risks (Lacerations, Tachypnoea​) ```
61
Placental Abruption Sx
``` Sudden-onset, Severe (continuous) Abdo pain​ Tender, hard Uterus/Abdo​ Vag bleeding/APH (Can be delayed until labour: Clots)​ Shock (HypoT, TachyC)​ Abnormal CTG (Fetal distress)​ ```
62
Placental Abruption Mx
ABCDE 4 Units Xmatch/O(-) Blood Steroids (=> Lung development) at 32wks​ Planned C-section 34-36wks (w/ active Mx of PPH)​
63
Primary PPH Def + Causes
Def:​ Bleeding w/in 24hrs of Birth​ ``` Causes:​ Tone (Uterine Atony: fail to contract)​ Trauma (Perineal tear, Uterine tear)​ Tissue (Retained Placenta)​ Thrombin (Bleeding D)​ ```
64
PPH Mx: Mech Med Surg
Mech:​ Uterine rub (=> contractions)​ Catheterisation (w/ bladder distension)​ Med:​ Oxytocin Infusion (40 Units in 500ml)​ IV Tranexamic acid​ Surg:​ Intra-uterine balloon tamponade​ B-lynch Suture​ Uterine A ligation (+/- Hysterectomy)​ ​
65
Secondary PPH Def + Causes
Def:​ Bleeding 24hrs – 12wks after birth​ Causes:​ Retained Prod of Conception​ Inf (Endometritis)​
66
Secondary PPH Ix + Mx
Invest:​ USS​ High-Vag/Endocervical Swabs​ Mx:​ Surg (Remove RPOC)​ Abx ​
67
Uterine Rupture Def + Mx
(Separation of Myometrium +/-Serosa from Peritoneum) ``` Mx: (Obstetric Emergency): Resus w/ blood transfusion Stop bleeding Emergency C-section Repair Uterus (+/- Hysterectomy) ```
68
Chickenpox in Preg Mx
Check VZV Antibodies: (If AB’s: No further Tx) If no AB’s: If no Sx but Exp w/in 10 days: VZV Immunoglobulins If > 20wks Gest + w/in 24hrs onset of vesicular rash: PO Aciclovir

Medicine (13 decks)

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