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نسائية > Obstetric > Flashcards

Obstetric Flashcards

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1
Q

Indications for continuous EFM

A

Significant meconium staining of the amniotic fluid.

Abnormal FHR detected by intermittent auscultation.

Maternal pyrexia (temperature ≥38.0°C or ≥37.5°C on two occasions). Fresh vaginal bleeding.

Augmentation of contractions with an oxytocin infusion.

Maternal request.

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2
Q

Active management of the third stage

A

Intramuscular injection of 10 IU oxytocin, given as the anterior shoulder of the baby is delivered, or immediately after delivery of the baby.

Early clamping and cutting of the umbilical cord.

Controlled cord traction

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3
Q

Signs of placental separation

A

Apparent lengthening of the cord.

A small gush of blood from the placental bed.

Rising of the uterine fundus to above the umbilicus

Uterine contraction resulting in firm globular feel on palpation.

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4
Q

Findings suggestive of CPD

A

Fetal head is not engaged.

Progress is slow or arrests despite efficient uterine

contractions. Vaginal examination shows severe moulding and caput formation.

Head is poorly applied to the cervix.

Haematuria.

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5
Q

Risk factors for fetal compromise in labour

A

Placental insufficiency – FGR and pre-eclampsia. Prematurity.

Postmaturity.

Multiple pregnancy.

Prolonged labour.

Augmentation with oxytocin/hyperstimulation.

Precipitate labour.

Intrapartum abruption.

Cord prolapse.

Uterine rupture/dehiscence. Maternal diabetes.

Cholestasis of pregnancy. Maternal pyrexia/chorioamnionitis. Oligohydramnios.

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6
Q

Side-effects of opioid analgesia

A

Nausea and vomiting (they should always been given with an antiemetic).

Maternal drowsiness and sedation.

Delayed gastric emptying (increasing the risks of general anaesthesia).

Short-term respiratory depression of the baby.

Possible interference with breastfeeding.

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7
Q

Indications of epidural analgesia

A

Prolonged labour/oxytocin augmentation.

Maternal hypertensive disorders.

Multiple pregnancy.

Selected maternal medical conditions.

A high risk of operative intervention.

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8
Q

contraindications for epidural analgesia

A

Coagulation disorders (e.g. low platelet count).

Local or systemic sepsis.

Hypovolaemia.

Logistical: insufficient numbers of trained staff (anaesthetic and midwifery).

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9
Q

Signs of uterine rupture

A

Sever lower abdominal pain

vaginal bleeding

haematuria

cessation of contractions

maternal tachycardia

Fetal compromise (often a bradycardia

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10
Q

Relative contraindications to VBAC

A

Two or more previous caesarean section scars.

Need for induction of labour (IOL).

Previous labour outcome suggestive of CPD.

Previous classical caesarean section is an absolute contraindication.

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11
Q

Indications for induction of labour

A

Prolonged pregnancy (usually offered after 41 completed weeks). PROM.

Pre-eclampsia and other maternal hypertensive disorders.

FGR.

Diabetes mellitus.

Fetal macrosomia.

Deteriorating maternal illness.

Unexplained antepartum haemorrhage.

Twin pregnancy continuing beyond 38 weeks.

Intrahepatic cholestasis of pregnancy.

Maternal isoimmunization against red cell antigens.

‘Social’ reasons.

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12
Q

Breech allowed to deliver virginally when

A

No other complication
Estimated Fetal size between 2.5 - 3.5 kg
A dequate pelvis

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13
Q

Complications of breech delivery

A

ROM
cord prolapse
Asphyxia
Infection
Marked molding
Maternal distress
Obstructed labour
Prolong and complicated labour

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14
Q

Indication of C.S in breech presentation

A

Large fetus
Fetal hypoxia
Unfavorable shape of pelvis
Uterind dysfunction
Previous history of perinatal death of children

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15
Q

Risks of external version

A

fetal bone

Preciptation of labour
PROM
placenta abruption
Fetomaternal hemorrhage
Cord entanglement

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16
Q

Factors cause cord prolapse

A

Abnormal lie or presentation (transverse lie, breech) • .Multiple pregnancy • .
Polyhydramnios • .
Prematurity • .
High head •
Unusually long umbilical cord •

Maternal causes Pelvic tumours(e.g. fibroids in the lower segment) Narrow pelvis

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17
Q

Etiology of Placenta Previa

A

Advancing maternal age ◼ Multiparity ◼ Multifetal gestations ◼ Prior cesarean delivery ◼ Smoking ◼ Prior placenta previa

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18
Q

Risk Factors: of Vasa previa

A

◼ Bilobed and succenturiate placentas
◼ Velamentous insertion of the
cord
◼ Low-lying placenta
◼ Multiple gestation
◼ Pregnancies resulting from in
vitro fertilization
◼ Palpable vessel on vaginal exam

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19
Q

Risk factor of retained placenta

A

Previous retained placenta
Prior CS/curettage
Uterine infection
Multiparity
Prior placenta previa

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20
Q

Causes of uterine inversion

A

Excessive traction on cord
Uterine atony
Fundal pressure

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21
Q

Risk factors of uterine rupture

A

Prior CS
Parity >4
Hyperstimulation of uterus with oxytocin
Instrumented delivery
Trauma
Prior uterine surgery
Epidural anaesthesia
Placenta abruptio
Breech version

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22
Q

Signs of Uterine Rupture before delivery

A

Vaginal bleeding.

● Abdominal tenderness.

● Maternal tachycardia.

● Abnormal fetal heart rate tracing.

● Cessation of uterine contractions

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23
Q

Signs of Uterine Rupture after delivery

A

Hypotension more than expected with apparent blood loss.

● Increased abdominal girth.

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24
Q

مواصفات suture مال birth trauma

A

Initial suture above the apex of laceration to control retracted arteries

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25
The advantages of the midline episiotomy are:
• less blood loss. • it is easier to repair. • the wound heals quicker. • there is less pain in the postpartum period. • the incidence of dyspareunia is reduced.
26
First degree perineal injury
Laceration involves the vaginal epithelium or perineal skin only.
27
Second degree perineal injury
includes most episiotomies Laceration involves perineal muscle.
28
Third degree perineal injury
secondary tear with partial or complete disruption of the anal sphincter.
29
Fourth degree perineal injury
third degree tear with anal epithelium or rectal mucosa
30
Prerequisites for Operative Vaginal Delivery
A Ask for help Anesthesia is needed Anticipation of complications (e.g., shoulder dystocia, postpartum ). Adequate Pelvis B Bladder empty. C complete Asepsis. D Dilated cervix. E Episiotomy F Favorable presentation (vertex or aftercoming head) G Gentle traction in the proper axis. Good uterine contraction. H Head is engaged. I Informed consent. M Membranes are Ruptured N Neonatal resuscitation trained
31
Advantages Of Vacuum over forceps
1) Can be used with local anesthesia or with no anesthesia. • 2) Can be used before full cx dilatation. • 3) Can be used for rotation and extraction by single application. • 4)Less traumatic to mother. 5.less traumatic to fetal head. • 6) less Compression and traction force • 7) Does not require additional space between tight fitting head and pelvis. • 8)No special skill is needed.
32
Advantages Of Forceps over vacuum
After coming head of breech Dead fetus. Face presentation
33
Time of contraction stress test
34 week
34
Contraindication of stress test
Premature birth Placenta previa Cervical incompetence Multiple gestation Previous classic CS
35
Lochia?
Vaginal discharge, lasts about 5 weeks Lochia rubra Red Duration is variable Lochia serosa Brownish red, more watery consistency Continues to decrease in amount Lochia alba Yellow
36
معلومة
Lactation can occur by 16 weeks’ gestation
37
Sexual Intercourse post partum?
May resume when… ■ Red bleeding ceases ■ Vagina and vulva are healed ■ Physically comfortable ■ Emotionally ready
38
معلومة
اكثر سبب لل postpartum endometritis is CS after extended period of labour
39
Causes of preterm labour
Cervical weakness Infection Multiple pregnancies Uterine mullerian anomalies Hemorrhage Stress
40
Types of circulage
McDonald transvaginal cerclage:Transvaginal purse-string suture inserted at the cervicovaginal junction without bladder mobilization Shirodkar (hightransvaginal) cerclage Transvaginal purse-string suture inserted following bladder mobilization, to allow insertion above the level of cardinal Ligaments Transabdominal cerclage Suture inserted at the cervicoisthmic junction via laparotomy or laparoscopy. Transabdominal cerclages can either be inserted preconceptionally or in the first trimester of pregnancy
41
Wrong dating causes
• Uncertainty of LMP (10–30% of women). • Irregular periods. • Recent use of COCP. • Conception during lactational amenorrhea.
42
Risk of multiple gestation on mother
Hyperemesis gravidurum Anemia Preeclampsia GDM Polyhydroamnios Placenta previa PPH Operative delivery
43
Risk of multiple gestation on fetus
Miscarriage(MC) Preterm labour FGR Intrauterine death Perinatal death Chromosomal abnormalities Congenital abnormalities (MC) Vanishing twin syndrome (1 trimester) Disability
44
Dx of multiple pregnancy
• Hyperemesis gravidarum. • Uterus is larger than expected for dates. • Three or more fetal poles may be palpable at >24wks. • Two fetal hearts may be heard on auscultation.
45
Timing of division in monozygotic twins
• < 3 days DCDA 30%. • 4 –7 days monochorionic, diamniotic (MCDA) 70%. • 8 –12 days monochorionic, monoamniotic (MCMA) <1%. • > 12 days conjoined twins (very rare).
46
Intrapartum risks associated with multiple pregnancy
Malpresentation Operative delivery Cord prolapse Fetal hypoxia of second twin Premature seperation of placenta PPH
47
Placental diameter
15-20 cm
48
Placental weight
500-600g
49
Cord length
50-60 cm
50
Cord diameter
2-4 cm
51
Causes of jaundice in pregnancy Causes not specific to pregnancy
Haemolysis • Gilbert’s syndrome • Viral hepatitis (hepatitis A, B, C, E, EBV, CMV) • Autoimmune hepatitis (primary biliary cirrhosis, chronic active hepatitis, sclerosing cholangitis) • Gallstones • Cirrhosis • Drug-induced hepatotoxicity • Malignancy.
52
Causes of jaundice specific to pregnancy (
Hyperemesis gravidarum • Pre-eclampsia/HELLP syndrome • AFLP • Obstetric cholestasis
53
Risk factors of Asymptomatic bacteruria
Dm, sickle cell disease Low socioeconomic Primigravida Age
54
Chicken pox effect before 20w
Abortion Limb hypoplasia Skin scarring IUGR HYDROPS fetalis Neurological abnormalities
55
Congenital syphlis sx
Macular papular rash Jaundice Hepatosplenomegaly Lymphadeno Sabir shin Huchinson teeth Saddle nose
56
Congenital rubella
Cataract Cardiac abnormalities Microcephaly Deafness Mental retardation
57
Rx of rubella
No RX JUST VACCINE
58
Toxoplasmosis sx
Hydrocephaly Seizure Fever Chorioretinitis Intracranial calcification Jaundice
59
Rx of toxoplasmosis
Sipramycin Sulphomamide
60
CMV
Mental retardation Hearing loss Cerebral calcification Chorioretinitis Jaundice Interstitial pneumonitis Hepatosplenomegaly
61
Infections cause hearing loss
CMV SYPHILIS RUBEELA
62
Infections cause hydrops fetalis
Chicken pox Parovirus
63
Infection that cause cataract
Rubella
64
Syphlis Rx
Penicillin

نسائية (2 decks)

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