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Obstetrics 1 Flashcards

1
Q

Causes of increased AFP (3)

A

Neural tube defects
Abdominal wall defects
Multiple pregnancy

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2
Q

Causes of decreased AFP (3)

A

Down’s
Trisomy 18
Maternal DM

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3
Q

All pregnant and breastfeeding women should take which vitamins?

A

10mcg vitamin D

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4
Q

First line treatment for nausea and vomiting in pregnancy

A

Anti-histamines - promethazine

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5
Q

What natural remedies are NICE recommended for nausea and vomiting in pregnancy?

A

Ginger and acupuncture on the p6 point by the wrist

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6
Q

NICE recommendations for number of antenatal visits in the first pregnancy and subsequent pregnancies if uncomplicated

A

10, then 7

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7
Q

Antenatal care timetable
What is the purpose of the 8-12 week appt?

A

Booking appt
Booking bloods - FBC, G&S, Rh, red cell alloantibodies, haemoglobinopathies, hep B, syphillis, HIV, urine culture

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8
Q

What is the purpose of the 10-13+6 week appt?

A

Confirm dates
Exclude multiple pregnancy

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9
Q

What is the purpose of the 11-13+6 week appt?

A

Down’s screening
Nuchal scan

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10
Q

What is the purpose of the 16 weeks appt?

A

If Hb<11 consider iron
Routine
Info on anomaly scan and bloods

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11
Q

What is the purpose of the 18-20+6 appt?

A

Anomaly scan

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12
Q

What is the purpose of the K25 appt?

A

Routine if primip

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13
Q

What happens at K28?

A

Routine
Second screen for anaemia and atypical red cell alloantibodies
First dose of anti-D to Rh-ve women
If Hb<10.5 consider iron

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14
Q

What happens at 31K

A

Routine care if primip

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15
Q

What happens at K34?

A

Second dose of anti-D to Rh-ve women
Information on labour and birth plan

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16
Q

What happens at K36? (3)

A

Check presentation
Offer external cephalic version
Breastfeeding, vitamin K and baby blues info

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17
Q

What happens at K38, K40 and K41?

A

Routine care
Discussion about options for prolonged pregnancy
Discuss labour plans and induction

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18
Q

Name seven conditions that should not be offered for screening

A

BV
Chlamydia
Hep C
Toxoplasmosis
Fragile X
Cytomegalovirus
Group B Strep

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19
Q

How is antepartum haemorrhage defined?

A

> K24

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20
Q

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

A

Hydatiform mole

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21
Q

Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen

A

Vasa praevia

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22
Q

Breastfeeding protects agains which two cancers?

A

Breast and ovarian

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23
Q

Which antibodies are passed from mother to child through breastfeeding?

A

IgA

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24
Q

Name five disadvantages of breastfeeding

A

Vitamin K deficiency
Vitamin D deficiency
Breast milk jaundice
Transfer of infections
Transfer of drugs

25
What is the treatment for nipple candidiasis? (2)
Topical miconazole for mum Nystatin suspension for the baby
26
Mx of blocked duct (milk bled) Should breastfeeding continue?
Breastfeeding should continue Breast massage and advice on position of baby
27
When to treat mastitis? (4)
Systemically unwell Nipple fissure present Sx not improving after 12-24 hours of effective milk removal Culture indicates infection
28
How to treat mastitis? Should breastfeeding continue?
Fluclox 10-14 days Yes
29
Mx of breast abscess (1)
Incision and drainage
30
Intermittent nipple pain during and immediately after breastfeeding =
Raynaud's disease of the nipple
31
Cut off threshold for weight loss for babies in the first week of life =
10%
32
Name two breastfeeding CI
Viral infections Galactosaemia
33
Most common breech position?
Frank breech - hips flexed, knees extended
34
Mx of breech Percentage success rate
K36 offer ECV if primip Otherwise offer at K37 60% success rate
35
Chickenpox is caused by which virus?
Varicella zoster virus
36
Increased risk of which condition for mothers with chickenpox exposure?
Pneumonitis
37
Name x5 features of fetal varicella syndrome
Skin scarring Limb hypoplasia Microcephaly LD Microphthalmia
38
Risk of FVC (in gestation)
K28 nil
39
What is severe neonatal varicella and what is the risk to the child?
Mother develops a rash between 5 days prior and 2 days post birth 20% fatal
40
Mx chickenpox exposure Step 1 If K<20 If K>20 Effective up to how many days post exposure?
Any doubt about previous chickenpox in mother = check maternal blood for antibodies If K<20 and not immune = give VZIG Effective up to 10 days post exposure If >K20 and not immune then either VZIG or antivirals (aciclovir or valaciclovir) to be given 7-14 days post exposure
41
Mx chickenpox in pregnancy If >K20 If
Specialist advice PO aciclovir if K>20 and if she present 24 hours from the onset of the rash If K<20 aciclovir with caution
42
What is the combined test when screening for Down's? (3) What would you expect in Down's babies?
Nuchal translucency (thickened) Serum BHCG (raised) PAPP-A (low)
43
What is the quadruple test in screening? When would it be offered? (gestation)
Offered if booked later - between 15-20K AFP Unconjugated oestriol HCG Inhibin A
44
Quadruple test interpretation Down's
AFP low Unconjugated oestriol low HCG high Inhibin A high
45
Quadruple test interpretation Edward's
AFP low Unconjugated oestriol low HCG low Inhibin A normal
46
Quadruple test interpretation neural tube defects
AFP high Unconjugated oestriol normal HCG normal Inhibin A normal
47
If 12 week scan comes back as high risk what is offered next? (3)
NIPT CVS Amniocentesis
48
Which is the least teratogenic anti-epileptic?
Carbamezapine
49
Which anti-epileptic is.. Associated with neural tube defects Associated with cleft palate Needs to be increased in pregnancy
Sod valp Phenytoin Lamotrogine
50
Women taking phenytoin should be given what in the last month of pregnancy?
Vitamin K
51
Folic acid guidelines in pregnancy
All women should take 400mcg until 12th week of pregnancy If at high risk of NTD then 5mg from before conception to 12th week
52
Who is high risk of NTD? (5)
Anti-epileptics Coeliacs DM Thalassaemia Obese
53
Viable age of pregnancy Twins GP
K24 G1P2
54
SFH measurement Used from what gestation? Leeway in cm
Top of uterus to top of pubic bone K20 2cm either side
55
Name three causes of hyperechogenic bowel
CF Down's Cytomegalovirus
56
Name three causes of increased nuchal translucency
Down's Congenital heart defects Abdominal wall defects
57
Anti-D given at which two weeks?
K28 and K34
58
Anaemia screen at which weeks?
K16 <11 consider iron and K28 <10.5 consider iron

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