Obs Flashcards
(162 cards)
1
Q
What is normal labour?
When diagnosed?
A
Process where foetus and placenta are expelled from uterus
Painful uterine contractions + dilation/effacement of cervix
2
Q
Mechanical factors in labour?
A
power
passage
passenger
3
Q
Braxton-Hicks contractions?
A
painless uterine contractions from 30/40
can be palpated
4
Q
who has poor uterine activity?
A
nulip
induced labour
5
Q
where is the ‘pacemaker’ of the uterus?
A
junction of fallopian tube and uterus
6
Q
physiological changes due to contractions?
A
permanent shortening of muscle fibres –> distension
7
Q
what causes pain in contractions?
A
ischaemia in myometrial fibres
8
Q
RFs for abnormal lie?
A
polyhydramnios
multip
fetal/uterine abnormalities
preterm
9
Q
what position in extended breech?
A
buttocks present; legs extended by head
10
Q
what is presentation?
A
part of fetus occupying the lower segment of uterus
11
Q
how common is abnormal lie?
A
1/200
12
Q
3 main parts of passage?
A
bony pelvis -inlet, mid cavity, outlet
ishial spine - used to assess descent
soft tissues - cervical dilation, vagina and perineum
13
Q
what does station 0 mean?
A
head level with ischial spines
+ve = below
-ve = above
14
Q
which presentation is best?
A
Vertex (narrowest diameter)
occipito-anterior normal deliver
15
Q
3 stages of labour
A
1 - initiation to full cervical dilatation
- -> Latent - slow dilation up to 3cm
- -> Active - about 1cm/hr
2 - full cervical dilation to delivery of fetus
- -> passive - til head reaches pelvic floor (desire to push)
- -> active - mother pushing
3 - delivery of foetus to delivery of placenta
- -> normall 15 mins
- -> expectant or active management
16
Q
how to epidurals affect labour?
A
remove desire to push
so labour is longer
17
Q
expectant management of 3rd stage?
active?
A
light massage of uterus through abdo
IM - syntocinon
18
Q
normal blood loss in delivery?
VD?
CS?
A
VD = 500ml CS = 1000ml
19
Q
Identifying abnormal labour?
A
partogram
20
Q
most common cause of slow progress in primip?
A
inefficient uterine action
21
Q
what is the worry in multip with slow progress in labour?
A
malposition –> uterine rupture is more likely
22
Q
when do you use tocolysis?
A
iatrogenic uterine hyperactivity eg prostaglandin
23
Q
why is eating discourage in labour?
whats this called?
A
aspiration of stomach contents
under anaesthetic = Mendelson’s syndrome
24
Q
general care points in labour?
A
physical - obs, mobility, delivery positions
mental - environment, control, partner
25
what to do in persistent inefficient uterine action?
augmentation (ARM)
26
Hyperactive uterine action can lead to...?
placental abruption
27
mx of hyperactive uterine action?
if no evidence of abruption --> tocolytic eg salbutamol
usually LSCS
28
what is augmentation? egs?
artificial strengthening of contractions in established labour
ARM, amniotomy, artificial oxytocin
29
nulip with slow 1st stage?
poor descent in passive 2nd stage?
longer than 1h in active second stage?
augementation --> if no full dilation by 16h --> LSCS
P2nd - oxytocin infusion
A2nd -> episiotomy, ventouse
30
how frequent do you auscultate fetal heart?
1st stage - /15mins
| 2nd - /5mins
31
intrapartum fetal problems?
meconium aspiration
fetal blood loss
trauma
infection (GBS)
32
what is fetal destress?
| signs?
hypoxia that could lead to fetal damage / death
colour of meconium, auscultate fetal heart, CTG, fetal blood sampling (scalp)
33
CTG mnemoic
```
DR C BRAVADO (normal values)
Define risk
Contractions / 10mins (<5)
Base rate (110-160)
Variability (>5)
Accelerations (with movement/contractions)
Deceleration
Overall assessment
```
34
What might fetal tachycardia indicate?
Fetal bradycardia?
fever, infection, hypoxia
sustained deterioration --> distress due to hypoxia
35
what do early, variable and late deceleration suggest?
early - synchronous with contraction = normal
variable - cord compression causing hypoxia
late - persist after contraction = hypoxia
36
what to do with sustained fetal brady?
deliver urgently!
37
pain relief in labour?
non-pharma --> warm towel / massage
pharma --> entonox, opiates (+antiemetic), epidural
38
perineal trauma degrees?
| mx?
1 - skin only
2 - perianal muscles but not sphincter
3 - involving anal sphincter
4 - anal sphincter + epithelium
1/2 - suture under LA
3/4 - epidural + physio
39
how frequently do you USS in multiple pregnancy?
monthly from 20/40
40
gestration for an elective CS?
37/40
41
comps of multiple pregnancy?
prem
42
twin-twin transfusion?
| when is it concerning?
arterial blood flow from donor through placenta to vein of recipient
if >30% discordance
43
comps of twin-twin transfusion?
donor - IUGR, oligohydramnios, hypovolaemia, hypotension, anaemia
recipient - poyhydramnios, hypertension, polycythaemia, oedema, kernicterus, CHF
44
mx of twin-twin transfusion?
doppler analysis
therapeutic amniocentesis to decrease polyhydramnios of recipient
+/- intra-uterine blood transfusion
45
RFs for shoulder dystocia?
high birth weight, maternal DM, induced labour, prev shoulder dystocia, oxytocin, abnormal lie
46
what is shoulder dystocia?
failure of the shoulder to deliver
47
comps of shoulder dystocia?
cord compression
asphyxiation
Erb's palsy
48
mx of shoulder dystocia
```
HELPERR
"Help!"
Episiotomy
Legs (McRoberts)
Pressure (suprapubic)
Enter (rotational manouevers)
Remove posterior arm
Roll patient onto hands + knees
```
49
last resort in shoulder dystocia?
deliberate clavicular fracture
Zavanelli's (push head back in + CS)
abdo surgery with hysterectomy
50
RFs for cord prolapse?
```
preterm
breech
abnorm lie
multiples
**AMNIOTOMY**
```
51
mx of cord prolapse
elevate presenting part to prevent cord comp
tocolytics (nifedipine, terbutaline)
CS
52
Pres of amniotic fluid embolus?
sudden dyspnoea, hypoxia, hypotension
can occur at any time in pregnancy
--> ARDS
53
mech of amniotic fluid embolus?
liquor enters maternal circulation --> anaphylaxis +/- seizures and cardiac arrest
54
mx of amniotic fluid embolus?
O2, fluids
bloods
blood transfusion + FFP
ICU
55
RFs for uterine rupture?
labour with scared uterus
CS / prev
obstructed labour
56
sx of uterine rupture
```
fetal heart rate abnomalities
constant abdo pain
VB
cessation of contractions
maternal collapse
```
57
comps of uterine rupture
fetal hypoxia
massive internal haemorrhage
high recurrence rate
58
mx of uterine rupture
maternal resus
| urgent laparotomy for delivery
59
uterine inversion?
| pres?
```
fundus inverts into uterine cavity
PPH
lower abdo pain
vaginal mass
CV collapse
```
60
mx of uterine inversion
```
GA
fluid replacement
1 - manually push back
2 - fill with warm saline
3 - laparotomy
```
61
mx of epileptiform seizures?
clear airway, O2
diazepam if epilepsy
MgSO4 if eclampsia
62
induction vs augmentation?
```
induction = artificial initiation of labour
augmentation = promotes contractions when spont contractions are inadequate
```
63
what is a ripe cervix? how can you ripen it?
soft, short, think, anterior cervix with open os
prostaglandin
64
CIs for induction of labour?
fetal distress
cord presentation
pelvic tumour
praevia
65
comps of induced labour
```
failure
infection
bleeding
cord prolapse
instrumental / CS
```
66
Bishops score?
pre-labour scoring
| ? IoL is required
67
how to induce labour?
if bishops<6 --> cervical ripening with PG
Induction:
amniotomy, monitor fetal HR, oxytocin IV
68
when do you use misoprostol?
after intra uterine death --> to deliver
69
mx for BV in pregnancy?
oral metronidazole (if not in 1st trimester)
70
RF for preterm labour?
```
prev
BV
short cervix
bacteiruria
prev abdo surgery
polyhydramnios
fetal hydrops
```
71
maternal causes of preterm labour?
infection
HTN, DM, chronic illness
prev surgery
smoking, alcohol, drugs
72
what is fetal fibroniectin?
glycoprotein in amniotic fluids
73
what is fetal hydrops?
abnormal fluid in >=2 areas = underlying disease
74
mx of preterm labour?
hydration
tocolytics (nifedipine, terbutaline)
dexamethasone
75
CI for tocolytics?
absolute - fetal death, chorioamnionitis, poor maternal condition
relative - pre-eclampsia, placenta praevia, cervix > 4cm, pulm oedema
76
periventricular malacia?
white matter surround ventricles is deprived of blood --> cerebral palsy
77
when is cervical cerclage performed? removed?
| indications?
sutures placed at internal os at the end of 1st trimester
removed in 3rd trimester
cervical incompetence, silent cervical dilation
78
Define PROM?
rupture of membranes prior to labour at any gestational age
79
Define prolonged ROM?
>24h between rom and onset of labour
80
Define preterm ROM?
ROM < 37/40
81
Define PPROM?
ROM < 37/40 AND prior to onset of labour
82
what is cervical effacement?
change in shape from bulb to flat
83
normal rate of cervical dilation?
1-3cm/h
84
Define APH?
Bleeding >24/40
85
Causes of APH?
placenta previa, placental abruption, vasa previa
86
What is placenta praevia?
major?
minor?
low lying placenta (common <20/40 but moves 'upwards' as pregnancy continues)
minor - in lower segment, does not cover os
major - covers internal os
87
features of placenta praevia?
intermittent PAINLESS bleeding - red/profuse
88
ix in placenta praevia?
USS (often incidental finding)
NEVER do vaginal examination
FBC + cross match if bleeding
89
Mx of placenta previa?
delivery
| if major --> elective c-section at 39/40
90
what is placental abruption?
part/all of placenta separates from the lining of the uterus before delivery of fetus
91
complications of placental abruption?
fetal death
DIC
maternal death
92
causes of placental abruption?
IUGR
pre eclampsia
smoking, cocaine
multiples
93
pres of placental abruption?
| signs?
PAINFUL bleeding - dark
can be concealed bleeding
o/e --> tachycardia, hypotension, tender uterus
WOODY, HARD ABDOMEN
94
ix in placental abruption
CTG
95
mx of placental abruption?
admission
IV fluids +/- blood transfusion
urgent CS
96
what is vasa praevia?
fetal blood vessels running in front of presenting part. When membranes rupture, fetal blood vessels rupture --> massive fetal bleeding --> copious bleeding and fetal death
97
pres of vasa previa?
membrane rupture --> painless VB + fetal bradycardia
98
mx of vasa praevia?
immediate CS
| often too slow to save fetus
99
define primary PPH?
>500mls of blood loss in first 24h after delvery
100
causes of primary PPH?
```
4T's
Uterine aTony
Tissue (retained placenta)
Trauma (uterine rupture)
Thrombin (clotting disorder)
```
101
mx of primary PPH?
oxytocin
bimanual compression
blood transfusion
102
what is uterine atony?
| RFs?
reduced tone --> doesnt compress vessels
prev atony
uterine abnorm
large placenta
placenta previa/abruption
103
Define secondary PPH?
Excess blood loss after 24h
104
Causes of secondary PPH?
retained placental tissue
| clot
105
Ix in secondary PPH?
USS - identify retained products
106
mx of secondary PPH?
ampicillin + metronidazole (prevent 2dary infection)
| curette of uterus
107
comps of prematurity
developmental delay
CLD
cerebral palsy
visual/hearing impairment
108
egs of teratogenic drugs?
```
warfarin
ACEi
carbimazole
propylthiouracil
angiotensin II antagonists
anitepileptics (bar lamotrigine)
MTX
isotretinoin
alocohol
cocaine
```
109
When are the 3 trimesters?
1 - LMP-12/40
2 - 13/40-27/40
3 - 28/40-40/40
110
Pre-existing HTN defined as?
| mx?
>140/90 before 20/40
labetalol or nifedipine
DO NOT USE ACEi --> teratogenic
111
Diagnosis of pre-eclampsia?
Sx?
BP > 140/90 + proteinuria > 0.3g/24h [20/40]
| Headache, visual disturbance, N+V, epigastric pain, oedema
112
Comps of pre-eclampsia?
```
Eclampsia -> MGSO4
CVA
Renal failure
DIC
ARDS
HELLP
IUGR
```
113
What is HELLP?
Haemolysis elevated liver enzymes low platelet count
114
pres of HELLP?
mostly 27-37/40
| non-specific: malaise, fatigue, RUQ/epigastric pain
115
Ix in HELLP?
raised bilirubin
raised LDH
raised AST / ALT
Platelets < 100
116
mx of HELLP
if after 34/40 -> deliver
if <34/40 -> corticosteroids
blood transfusion / FFP
BP control
+/- liver transplant
117
Mx of pre-eclampsia?
admit
labetalol if >150/100
regular monitoring
+/- delivery
118
Diagnosis of DM?
glucose >7mmol/l fasting
| HbA1c > 48mmol/L
119
mx of gestational DM?
lifestyle
monitor BMs
metformin --> insulin if severe
120
rhesus isoimmunisation?
Rh -ve mother mounts an immune response against Rh +ve baby via anti-D antibodies
121
sensitising events in rhesus isoimmunisation?
delivery, ToP, ectopic, intrauterine death, invasive uterine procedure
122
prevention of Rhesus disease?
Anti-D to Rh -ve women at 28/40 + after sensitising events
123
how does anti-D work?
mops up fetal RBCs without initiation of immune response
124
mx of epilepsy in pregnancy?
carbamazepine / lamotrigine
125
mx of VTE in pregnancy?
LMWH
126
mx of depression in pregnancy?
TCA / SSRI
127
mx of bipolar in pregnancy?
haloperidol / olanzipine
[Lithium causes Epstein's anomaly]
128
mx of hyperemesis gravidarum?
metoclopramide/cyclizine/ondansetron + thiamine
129
which infections can be teratogenic in pregnancy?
| how do you treat them?
CHRiST
CMV: hearing/visual/mental impairmnet -> gancyclovir
HZV: rare -> Ig + aciclovir
RUBELLA: hearing/visual/mental impairment -> TOP if <16/40
SYPHILLIS: miscarriage, congenital disease or still birth -> Benzypenicillin
TOXOPLASMOSIS: retardation, convulsions, visual impairment -> Spiramycin
130
infection causing maternal death?
Group A strep -> sepsis
131
mx of Group B strep in pregnancy?
penicillin - prevents transmission to baby
132
types of miscarriage?
threatened - fetus alive, os closed
inevitable - os open
incomplete - some fetal parts passed + os open
complete - fetal tissue passed, bleeing stopped, uterus no longer enlarged, os closed
septic - contents infected
missed - no fetus, os closed
133
drugs given post miscarriage?
IM ergometrine -> uterine contraction
| Anti-D
134
how many miscarriages = recurrent?
common cause?
mx?
3
| anti-phospholipid syndrome --> low dose aspirin
135
ectopic pregnancy?
egg implants outside uterine cavity (95% in fallopian tubes)
136
RFs for ectopic?
```
PID
prev ectopic
endometriosis
smoking
pelvic surgery
assisted conception
```
137
pres of ectopic?
abdo pain, PV bleeding, adnexal tenderness
138
ix in ectopic?
any female of childbearing age that present with collapse needs a pregnancy test
USS
139
Mx of ectopic?
Medical; MTX
| surgical: salpingectomy / sapingotomy
140
when is booking visit?
<10/40 - screen for complications
141
when is combined test?
11-13/40
142
when is anomaly scan?
18-21/40
143
what is involved in combined test?
PAPP-A
B-hCG
Nuchal translucency
PAPP-A is low in downs
144
what happens in anomaly scan?
what is measured?
look for obvious abnormalities
measure - HC, AC, FL
145
screening for pre-eclampsia?
regular GP, urinalysis
146
prevention of pre-eclampsia?
75mg aspirin <16/40 in high risk women
147
which maternal antibodies can cross placenta?
IgG
148
scalp pH indicating fetal hypoxia?
<7.2
149
dx of hyperemesis gravidarum?
severe vomiting with dehydration and electrolyte imbalances
| + wt loss + ketosis
150
mx of hyperemesis gravidarum?
IV fluids
anti-emetics
thiamine
151
cause of gestational DM?
increased insulin resistance
| physiological increase allows the fetus to absorb more glucose from the placenta
152
Dx of gestational DM?
GTT at 24-28/40
153
Mx of gestational DM?
1 - metformin
| 2 - insulin
154
mx of cholestasis of pregnancy?
induce at 37/40
ursodeoxycholic acid
Vit K if prolonged clotting
155
surgical mx of PPH?
1. rusch ballon
2. brace suture
3. hysterectomy
156
CI to entonox?
pneumothorax
157
RF for hyperemesis?
young
primip
hyperthyroid
multiples
158
placenta accreta?
chorionic villi penetrate decidua basalis to attach to the myometrium
159
placenta increta?
chorionic villi penetrate deeply into the myometrium
160
placenta percreta?
chorionic villi breech myometrium into the peritoneum
161
mx of placenta accretas?
CS +/- hysterectomy
162
mx of miscarriage?
mifepristone (progesterone inhibitor)
| misoprostol (prostaglandin)
