obsterics Flashcards
(93 cards)
1
Q
combined test for down syndrome done when
and quadruple test done
A
10-14 weeks
14-20 weeks
2
Q
combined test
triple test
quadruple test
A
hCG+PAPP-A(high #hCG, low pappa)
hCG+APF+uncong oestriol
hCG+APF+uncong oestriol+ inhibin A(uncong low, low AFP, high hCG, high inhibin A )
thickened nuchal translucency
3
Q
maternal group B strep(GBS) is a risk factor for neonatal sepsis
A
observe the baby for 24hrs if more than two risk factors empirical antibiotic treatment
4
Q
antibiotic of choice for GBS prophylaxis
A
benzylpenicillin
5
Q
antidiabetic safe for breastfeeding
A
metformin
6
Q
testing for gestational diabetes
A
if had before OGTT at booking repeat at 24-28 weeks
normally at 24-28 weeks
7
Q
antidepressant of choice in postnatal depression
A
sertraline or paroxetine since low milk plasma ratio
8
Q
antihypertensive of choice for pre-eclampsia
A
oral labetalol or nifedipine/hydralazine
9
Q
when and how much aspirin is given to women with a risk of preeclampsia
A
moderate risk at 12 weeks start 75mg OD until birth
10
Q
the most common cause of mastitis
A
staph aureus
11
Q
a first-line antibiotic for mastitis
A
oral flucloxacillin for 10-14 days if penicillin-allergic give erythromycin
12
Q
the standard dose of folic acid
A
0.4mg(400mcg) preconception until 13 weeks pf pregancy
13
Q
women with a higher risk of neural tube defect(NTD)
A
take 5mg of folic acid risk factors include- previous NTD DM on antiepileptic obese HIV +ve sickle cell/thalasemia
14
Q
layers cut through for lower segment c section
A
ant. rectus sheath- rectus abdominis muscles- tranversalis fascia- extraperitoneal connective tissue- peritonium- uterus
15
Q
indication for forceps delivery
A
fetal distress
maternal distress
failure to progress
16
Q
the requirement for forceps delivery
A
FORCEPS nmumonic F-ully dialted cervix O-A position R-uptured membranes C-ephalic presenation E-ngaded presenting parts P-ain relief S-hincter(bladder empty )
17
Q
puerperal pyrexia definition
A
temp >38c in first 14 days following delivery
cause by endometritis
tx iv clindamycin and gentamycin
18
Q
McRoberts maneuver with suprapubic pressure
A
flexion and abduction of maternal hips increases AP angle of pelvis indicated in shoulder dystocia
19
Q
station
A
head in relation to ischial spine
20
Q
bishops score used for
A
assessment to see if induction of labor is required
21
Q
painless vaginal bleed after 20 weeks
OE non tender uterus, high presenting part and abnormal fetal lie
A
placenta previa
routine US scan at 20 weeks
22
Q
chorioamnionitis
A
potentially a life-threatening emergency
result of bacterial infection of amniotic fluid/membranes/placenta
risk factor preterm premature rupture of membranes
tx prompt deliver and iv antibiotics
23
Q
risk for VTE in pregnancy
A
give LWMH antenatally and postnatally
24
Q
postnatal depression assessment tool
A
Edinburgh scale or PHQ9
25
hCG
secreted by syncytiotrophoblasts maintains productions of progesterone by corpus luteum and itsmaintainance and detected on day 8 in maternal blood
26
Spontaneous abortion
Threatened miscarriage - painless vaginal bleeding typically around 6-9 weeks
Missed (delayed) miscarriage - light vaginal bleeding and symptoms of pregnancy disappear
Inevitable miscarriage - complete or incomplete depending or whether all fetal and placental tissue has been expelled.
Incomplete miscarriage - heavy bleeding and crampy, lower abdo pain.
Complete miscarriage - little bleeding
27
Ectopic pregnancy
Typically history of 6-8 weeks amenorrhoea with lower abdominal pain (usually unilateral) initially and vaginal bleeding later. Shoulder tip pain and cervical excitation may be present
28
Hydatidiform mole or molar pregnancy
Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high
on US it resembles a solid collection of echos with small anechoic spaces
29
Placental abruption
Constant lower sudden abdominal pain in 3rd trimester and, woman may be more shocked than is expected by visible blood loss/blood loss not necessary. Tender, tense uterus* with normal lie and presentation. Fetal heart may be distressed
30
Placenta praevia
Vaginal bleeding, no pain. Non-tender uterus* but lie and presentation may be abnormal
31
Vasa praevia
Triad- Rupture of membranes followed immediately by painless vaginal bleeding. Fetal bradycardia is classically seen
fetal blood vessel cross or run near internal orifice of the uterus
32
diagnosis for hyperemesis gravidarum
5% pre-pregnancy weight loss and dehydration and electrolyte imbalance
33
first line treatment for hyperemesis
antihistamines
| cyclizine
34
substance abuse in pregnancy
```
Smoking
Increased risk of miscarriage
Increased risk of pre-term labour
Increased risk of stillbirth
IUGR
Increased risk of sudden unexpected death in infancy
```
```
Alcohol
Fetal alcohol syndrome (FAS)
learning difficulties
characteristic facies: smooth philtrum, thin vermilion, small palpebral fissures
IUGR & postnatal restricted growth
microcephaly
```
Binge drinking is a major risk factor for FAS
Cannabis
Similar to smoking risks due to tobacco content
Cocaine
Maternal risks
hypertension in pregnancy including pre-eclampsia
placental abruption
```
Fetal risk
prematurity
neonatal abstinence syndrome
Heroin
Risk of neonatal abstinence syndrome
```
35
pregnancy safe antiepileptic
lamotrigine at low doses
36
UTI drug safe in pregnancy
nitrofurantoin
37
cause of PPH
atony of uterus
38
when should EVC be offered
at 36 weeks for nulliparous
| at 37 weeks for multiparous
39
initial management of primary PPH
give oxytocin 10 units or syntometrine or egomertine 500 microgms
IM carboprost
40
placental abruption
```
seperation fo normal sited placenta from the uterine wall
clinical feautures
shock
pain
woody uterus/firm
tender and tensed uterus
blood seen is dark red
```
41
lochia
Lochia may be defined as the vaginal discharge containing blood mucous and uterine tissue which may continue for 6 weeks after childbirth
42
degree of perineal tear
first degree: superficial damage with no muscle involvement
second degree: injury to the perineal muscle, but not involving the anal sphincter
third degree: injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS):
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn
fourth degree: injury to perineum involving the anal sphincter complex (EAS and
IAS) and rectal mucosa
43
the main cause of chord prolapse
artificial rupture of membranes
44
anti D is given to whom?
Rh -ve mothers who are not sensitized at 28 and 34 weeks
45
vaicella zoster exposure in pregnant women
give single dose varicella-zoster immunoglobulin up to 10 days after contact
aciclovir is only given 24hrs after the onset of rash in pregnant women with chickenpox
46
management of preterm prelabour rupture of membranes
```
admission
observation
oral erythromycin to prevent infection
antenatal corticosteroids dexamethasone to reduce respiratory distress syndrome
consider delivery at 34 weeks
```
47
antenatal care timetable
8 - 12 weeks (ideally < 10 weeks)
Booking visit
general information e.g. diet, alcohol, smoking, folic acid, vitamin D, antenatal classes
BP, urine dipstick, check BMI
Booking bloods/urine
FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
hepatitis B, syphilis
HIV test is offered to all women
urine culture to detect asymptomatic bacteriuria
10 - 13+6 weeks
Early scan to confirm dates, exclude multiple pregnancies
11 - 13+6 weeks
Down's syndrome screening including nuchal scan
16 weeks
Information on the anomaly and the blood results. If Hb < 11 g/dl consider iron
Routine care: BP and urine dipstick
18 - 20+6 weeks
Anomaly scan
```
25 weeks (only if primip)
Routine care: BP, urine dipstick, symphysis-fundal height (SFH)
```
28 weeks
Routine care: BP, urine dipstick, SFH
Second screen for anemia and atypical red cell alloantibodies. If Hb < 10.5 g/dl consider iron
First dose of anti-D prophylaxis to rhesus negative women
```
31 weeks (only if primip)
Routine care as above
```
34 weeks
Routine care as above
Second dose of anti-D prophylaxis to rhesus negative women*
Information on labour and birth plan
36 weeks
Routine care as above
Check presentation - offer external cephalic version if indicated
Information on breast feeding, vitamin K, 'baby-blues'
38 weeks
Routine care as above
```
40 weeks (only if primip)
Routine care as above
Discussion about options for prolonged pregnancy
```
41 weeks
Routine care as above
Discuss labour plans and possibility of induction
48
hep b in pregnancy
all women should be screened
safe for breastfeeding
babies born to hep b mothers should be given complete course of vaccination and immunoglobulin
49
absolute contraindication of induction of labour and vaginal birth
previous classical c-section
50
methods of induction of labour
membrane sweep
intravaginal prostaglandins
breaking of water
oxytocin
51
what reduces the risk of hyperemesis
smoking
52
woodscrew maneuver can be best described as
putting a hand in the vagina and rotating the fetus 180o to dislodge anterior shoulder from symphysis pubis
53
most common cause of fever in newborn infant
group B strep
54
lisinopril should be avoided in preeclampsia
because it is feto toxic
55
management of chord prolapse
push back presenting part of fetus
tocolytics
instrumental vaginal delivery possible
c-section
56
clinical features of cholestasis in pregnancy
```
itching
jaundice
obstructive LFT
normal WBCs
no evidence of coagulopathy
```
57
women with abdominal trauma during pregnancy
should get ABO and Rhesus because Rh -ve women should be given anti D
58
The following drugs can be given to mothers who are breastfeeding:
antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin
59
The following drugs should be avoided:
```
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
```
60
avoid liver in antenatal diet
cause it contains vitamin A which is a teratogen
61
Conditions which all pregnant women should be offered screening
```
Anaemia
Bacteriuria
Blood group, Rhesus status and anti-red cell antibodies
Down's syndrome
Fetal anomalies
Hepatitis B
HIV
Neural tube defects
Risk factors for pre-eclampsia
Rubella immunity
Syphilis
```
The following should be offered depending on the history:
```
Placenta praevia
Psychiatric illness
Sickle cell disease
Tay-Sachs disease
Thalassaemia
```
62
Conditions for which screening should not be offered
```
Bacterial vaginosis
Chlamydia
Cytomegalovirus
Fragile X
Hepatitis C
Group B Streptococcus
Toxoplasmosis
```
63
do not perform ECV if
have ruptured during active labour and membrane
64
medication used to suppress lactation
cabergoline
65
NICE recommendation for CTG monitering when
```
suspected chorioamnionitis or sepsis
severe hypertension 160/110
oxytocin use
meconium
fresh vaginal bleeding develops in labour- a sign of placental rupture or previa
```
66
metoclopramide is prescribed with caution
because it can have extrapyramidal side effects in young women
67
erbs palsy (waiters tip)
due to upper brachial plexus damage caused by shoulder dystocia
characteristic adduction and internal rotation of arm and pronation of forearm
68
klumpke palsy
is due to damage to the lower brachial plexus leading to claw hand appearance
69
the highest risk of neonatal hemorrhage
prolonged ventouse delivery
70
Risk of prematurity
```
increased mortality depends on gestation
respiratory distress syndrome
intraventricular haemorrhage
necrotizing enterocolitis
chronic lung disease, hypothermia, feeding problems, infection, jaundice
retinopathy of newborn, hearing problems
```
71
AFP levels indiacte
raised in Neural Tube defects, abdominal wall defects and multiple pregnancies
decreased in Down syndrome, trisomy 18 maternal diabetes, edwards syndrome
72
Distinguishing placental abruption from praevia
```
Placental abruption
shock out of keeping with visible loss
pain constant
tender, tense uterus*
normal lie and presentation
fetal heart: absent/distressed
coagulation problems
beware pre-eclampsia, DIC, anuria
```
```
Placenta praevia
shock in proportion to visible loss
no pain
uterus not tender*
lie and presentation may be abnormal
fetal heart usually normal
coagulation problems rare
small bleeds before large
```
73
rubella not routinely screened in booking visit
so contact health protection unit in all rubella related cases
74
abdominal pain in early pregnacy
Ectopic pregnancy
This is the single most important cause of abdominal pain to exclude in early pregnancy
0.5% of all pregnancies are ectopic
Risk factors (anything slowing the ovum's passage to the uterus)
damage to tubes (salpingitis, surgery)
previous ectopic
IVF (3% of pregnancies are ectopic)
A typical history is a female with a history of 6-8 weeks amenorrhoea who presents with lower abdominal pain and later develops vaginal bleeding
lower abdominal pain: typically the first symptom. Pain is usually constant and may be unilateral. Due to tubal spasm
vaginal bleeding: usually less than a normal period, may be dark brown in colour
history of recent amenorrhoea: typically 6-8 weeks from start of last period; if longer (e.g. 10 wks) this suggest another causes e.g. inevitable abortion
peritoneal bleeding can cause shoulder tip pain and pain on defecation / urination
```
Miscarriage
Threatened miscarriage
painless vaginal bleeding occurring before 24 weeks, but typically occurs at 6 - 9 weeks
cervical os is closed
complicates up to 25% of all pregnancies
```
Missed (delayed) miscarriage
a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear
when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a 'blighted ovum' or 'anembryonic pregnancy'
Inevitable miscarriage
cervical os is open
heavy bleeding with clots and pain
Incomplete miscarriage
not all products of conception have been expelled
75
abdominal pain in late pregnancy
Labour Regular tightening of the abdomen which may be painful in the later stages
Placental abruption Placental abruption describes the separation of a normally sited placenta from the uterine wall, resulting in maternal hemorrhage into the intervening space
Occurs in approximately 1/200 pregnancies
Clinical features
shock out of keeping with visible loss
pain constant
tender, tense uterus
normal lie and presentation
fetal heart: absent/distressed
coagulation problems
beware pre-eclampsia, DIC, anuria
Symphysis pubis dysfunction Ligament laxity increases in response to hormonal changes of pregnancy
Pain over the pubic symphysis with radiation to the groins and the medial aspects of the thighs. A waddling gait may be seen
Pre-eclampsia/HELLP syndrome Associated with hypertension, proteinuria. Patients with HELLP also have haemolysis, elevated liver enzymes and a low platelet count.
The pain is typically epigastric or in the RUQ
Uterine rupture Ruptures usually occur during labour but occur in third trimester
Risk factors: previous caesarean section
Presents with maternal shock, abdominal pain and vaginal bleeding to varying degree
76
abdominal pain at any point in the pregnancy
Appendicitis
most common non-obstetric surgical emergency
Higher morbidity and mortality in pregnancy
Location of pain changes depending on gestation, moving up from the RLQ in the first trimester to the umbilicus in the second and the RUQ in the third
Urinary tract infection (UTI) 1 in 25 women develop in UTI in pregnancy
Associated with an increased risk of pre-term delivery and IUGR
77
blood sugar testing for type I diabetic pregnancy women
daily fasting, premeal, 1 hr post-meal and bedtime measurement
78
intrahepatic cholestasis of pregnancy
ictching with jaundice
79
increased nuchal translucency seen in
down syndrome,
congenital heart defects
abdominal wall defects
80
Sheehan syndrome
a complication of severe PPH causing ischemic necrosis of pituitary gland leading to
lack of postpartum milk production and amenorrhea
81
calcium gluconate used to treat
Magnesium sulfate induced respiratory depression
82
ergometrine
avoided in hypertension
83
amniotic fluid embolism
this is when fetal cells/amniotic fluid enters mothers bloodstream occurs 30mins after labour
SS- respiratory distress, hypoxia, hypotension, cyanosis, bronchospasm, tachycardia
84
vaginal prostaglandin gel used
to help make the cervix more favorable
85
epidural analgesia is contraindicated in
coagulopathy
86
oligohydramnios
condition where there is a deficiency of amniotic fluid(less than 500ml at 32-36weeks) caused by renal agenesis
87
streptococcus agalacticae causes
GBS
| gram +ve anerobic cocci
88
carboprost is contraindicated in
asthama
89
contraindicated in breastfeeding
lithium
90
macrocytic anemia with hypersegmented neutrophils
folate deficiency
91
MMR vaccine
should not be administered to womwn know to be pregnant or attempting to become pregnant for 28 days
92
causes of placental abruption
cocain abuse (hyperreflexia and dialted pupils )
pre eclampsia
HELLP
93
methotrexate is used to treat rheumatoid arthritis
both men and women should stop it before
