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Flashcards in Obstetrics 1 Deck (120):
1

What USS measurement is most useful for fetal gestation estimation earlier on in pregnancy (9-14 weeks, so for booking scan)?

Crown rump length

2

What fetal measurements are used later on in pregnancy, so from 14 weeks onwards?

Head circumference, fetal abdominal circumference

3

What is parity?

Number of potentially viable births >24 weeks

4

Parity score?

Para = x + y
x = number of births over 24 weeks, stillbirth or normal etc.
y = miscarriages, ToPs

5

What is gravidity?

Number of times been pregnant including current pregnancy
E.g. G6 P3+2

6

FLIPPERBUS?

Fundus (SFH)
LIe and liquor - feel all round
Presenting Part
Engagement
Rate and auscultation
BP
Urine
Swelling

7

When is the uterus first palpable during pregnancy? When might this be earlier?

12-14 weeks
Earlier in multiple pregnancy

8

At what gestation is fundus of uterus roughly umbilical level? What implications does this have for SFH?

20 weeks
From that point, SFH roughly correlates to gestation +/- 2cm

9

Discuss engagement of fetal head?

5/5 palpable = fully above pelvic brim, not engaged
3/5 = generally engaged

10

How many routine antenatal visits would a nulliparous woman have?

10

11

How many routine antenatal visits would a multiparous woman have?

7

12

Normal folic acid supplementation?

400micrograms per day til > 12 weeks

13

Specific examples of food poisoning that can affect pregnant woman badly?

Listeriosis - milk
Salmonella - chicken, eggs

14

When should booking visit be done?

10-12 weeks

15

What is the combined test for Down's syndrome screening?

Nuchal translucency
PAPPA
BhCG

16

What infections need to be screened for at booking visit?

BBVs e.g. Hep B, HIV
Syphillis
Rubella
STIs - chlamydia, BV, gonorrhoea
Asymptomatic bacteruria

17

What non-infectious conditions need to be enquired about at booking visit?

Haemaglobinopathies and anaemia
Clotting dysfunctions
Pre existing disease, e.g. Cardiac
Rhesus status

18

When is the anomaly scan done? What are you looking for?

18-20 weeks
NTDs +/- fetal echocardiography

19

When is rhesus anti-D routinely given prophylactically during pregnancy?

28 weeks and then 32 weeks

20

What is assessed at 36 week visit?

USS for fetal presentation - offer ECV if breech

21

When does early morning sickness often resolve in normal pregnancy?

By end of first trimester, 16-20 weeks

22

What is Naegele's rule?

EDD = LMP + 9 months + 7 days

23

What yeast infection are pregnant women more susceptible to?

Candidiasis (thrush)

24

5 blood tests associated with Down's syndrome screening?

BhHCG
PAPP
Oestriol
Inhibin A
Alpha FetoProtein

25

What USS marker is used in Down's syndrome screening?

Nuchal translucency

26

What is amniocentesis and when is the earliest it should be done?

US guided removal of amniotic fluid
Earliest 15 weeks

27

What 3 types of disease can amniocentesis be used to investigate?

Chromosomal abnormality
Infection
Inherited disease

28

Which has a higher miscarriage rate, amniocentesis or CVS?

CVS

29

What is chorionic villous sampling? Earliest it can be done?

Trophoblast (placental) biopsy
Earliest 11 weeks

30

What is CVS especially good at detecting?

Chromosomal abnormalities

31

2 major RFs for Down's syndrome?

High maternal age
Previously affected baby

32

What signs of Down's syndrome may be visible on USS?

Nuchal translucency
Cardiac abnormality (tricuspid regurge)
Short nasal bone

33

What are the 4 constituents which constitute the combined test for Down's syndrome?

Maternal age
Nuchal translucency
BhCG
PAPP

34

What blood markers are raised in Down's syndrome screening?

BhCG
Inhibin A

35

What blood markers are reduced in Down's syndrome screening?

PAPP
Oestriol
Alpha FetoProtein

36

What is Edwards syndrome?

Trisomy 18

37

What is trisomy 18?

Edwards syndrome

38

What is trisomy 13?

Patau's syndrome

39

What is patau's syndrome?

Trisomy 13

40

What is Klinefelters syndrome?

47 XXY - infertile males

41

What chromosomal abnormality commonly causes infertility in males?

Klinefelters 47XXY

42

What is turners syndrome?

45XO - infertile females

43

What chromosomal abnormality commonly causes infertility in females?

Turners 45XO

44

What blood marker is raised in NTDs?

Alpha FetoProtein

45

What congenital abdominal wall defect often occurs in the absence of any other abnormalities?

Gastroschisis

46

How do congenital GI defects often present antenatally?

Polyhydramnios - impaired swallow

47

What GI defect is common with Down's syndrome?

Duodenal atresia

48

What is fetal hydrops?

Fluid accumulation in 2 or more fetal compartments e.g. Skin oedema and pleural effusion

49

What are the 2 classifications of causes of fetal hydrops?

Immune or non-immune

50

Major immune cause of fetal hydrops?

Ab immunisation incl Rhesus

51

5 main non-immune causes of fetal hydrops?

Chromosomal e.g. Down's
Structural - pleural effusions
Cardiac including arrhythmias
Anaemia - PV B19 infection, a thalassaemia
Twin-twin transfusion syndrome

52

Maternal causes of polyhydramnios?

DM
Renal failure

53

Fetal causes of polyhydramnios?

Upper GI obstruction
Chest abnormalities
Myotonic dystrophy

54

What might be the cause of polyhydramnios in multiple pregnancy?

TTTS

55

Potential problems caused by polyhydramnios?

Preterm labour
Abnormal lie and presentation

56

What medication can reduce fetal fluid output and therefore ease polyhydramnios?

NSAIDs

57

What are the major long term complications of maternal CMV infection?

Severe neurological sequelae e.g. Hearing, visual, mental impairment

58

What can early pregnancy rubella infection cause?

Fetal deafness
Congenital cataracts
Cardiac disease
Mental retardation

59

Can women have the rubella vaccine in pregnancy?

No - it's a live vaccine

60

What 2 implications can maternal BV have on pregnancy?

Preterm labour
Late miscarriage

61

What can maternal chlamydia cause in pregnancy?

Neonatal conjunctivitis

62

Implications of GBS infection in pregnancy?

Often asymptomatic bacteruria
However can cause PPROM, neonatal sepsis (meningitis or pneumonia)

63

Implications of HBV infection in pregnancy?

Vertical transmission is possible and 90% of infected neonates become chronic carriers

64

5 major antenatal risks of maternal HIV infection?

Pre-eclampsia
GDM
Stillbirth
IUGR
Premature labour

65

What should be avoided postnatally in HIV infected mothers?

Breastfeeding

66

What bacteria is traditionally responsible for puerperal sepsis?

GAS (strep pyogenes)

67

What can GAS infection cause in mothers?

Puerperal sepsis

68

4 early pregnancy events which may be 'sensitising' in terms of Rhesus factor?

ToP
Ectopic
ERPC
PV bleed

69

Procedure related to breech which may be a sensitising event?

ECV

70

When is rhesus screening acted upon in pregnancy?

To any rhesus negative woman:
Within 72 hours of any potentially sensitising event including delivery if neonate positive
At 28 weeks

71

Other important rhesus antibodies besides D?

C, E and Kell

72

6 differentials for antepartum haemorrhage?

Placenta praevia
Placental abruption
Bloody show
Genital tract pathology
Vasa praevia rupture
Uterine rupture

73

What is an antepartum haemorrhage?

Bleeding from the genital tract > 24 weeks

74

4 RFs for placenta praevia?

Multiple pregnancy
Multiparity
Scarred uterus
Age

75

Presentation of placenta praevia?

Intermittent painless bleeds which may become constant and heavy over several weeks

76

What is placenta accreta? What normally causes it?

Non-separation of the placenta from uterine wall at birth
Often due to scarred uterus - prev CS

77

If a placenta is found to be low lying at 20 weeks, when should it be rescanned to exclude placenta praevia?

32 weeks

78

5 RFs for placental abruption?

Pre-eclampsia or maternal HTN
IUGR
Previous abruption
Maternal smoking
Multiple pregnancy and multiparity

79

How does placental abruption present?

Painful bleeding PV, degree of which doesn't necessarily reflect extent of bleed

80

What is the difference between a concealed and revealed placental abruption?

Concealed = pain no blood
Revealed = pain and blood

81

What may be found on obstetric exam in placenta praevia vs abruption?

Praevia - abnormal lie, breech, high fetal head
Abruption - tender, woody hard uterus

82

3 genital tract pathologies that may cause antepartum haemorrhage?

Ectropion
Polyps
Cancer

83

What is the typical presentation of vasa praevia rupture?

Painless, moderate PV bleed around time of amniotomy or spontaneous ROM

84

What might a painless bleed just after amniotomy or ROM indicate?

Vasa praevia rupture

85

What is the normal lie in pregnancy?

Longitudinal

86

What 2 presentations can result from a longitudinal lie?

Cephalic
Breech

87

In what group of babies is abnormal lie the biggest problem?

Preterm babies

88

What are the 3 groups of reasons for an abnormal lie or breech?

Too much room to move
No room to move
Factors preventing engagement

89

'Too much room to move' causes of abnormal presentation?

Polyhydramnios
High parity (lax uterus)

90

What does having too much room to move in the uterus often result in?

An unstable lie

91

'No turning' causes of an abnormal lie of breech?

Oligohydramnios
Multiple pregnancy
Uterine abnormality e.g. Fibroids

92

Factors preventing engagement resulting in an abnormal lie or breech?

Placenta praevia
Fibroids
Pelvic tumours
Uterine deformity

93

What 2 things can an unstable lie suggest?

Polyhydramnios
Lax uterus (multiparity)

94

Complications of abnormal lie or breech?

Failure to progress in labour
Uterine rupture
Umbilical cord prolapse

95

What 2 things need to be excluded first when investigating abnormal lie at term?

Polyhydramnios
Placenta praevia

96

3 types of breech?

Extended
Flexed
Footing

97

What type of breech is most common?

Extended

98

2 RFs for breech presentation?

Previous breech
IUGR

99

What symptom is relatively common in breech?

Epigastric discomfort

100

What technique is used to turn round a breech baby?

ECV

101

When can ECV be done after?

37 weeks

102

What 2 things need to be done straight after ECV?

Give anti D
Do a CTG

103

What 2 things are used to aid ECV?

US guidance
Give a uterine relaxant (tocolytic)

104

What is the purpose of doing an ECV?

To reduce the need for CS or vaginal breech delivery

105

In what 4 conditions is ECV less likely to work?

Nulliparous woman
Engaged breech
Obese women
Oligohydramnios

106

5 major contraindications to ECV?

APH
Fetal compromise
Multiple pregnancy
ROM
If subsequent vaginal delivery contraindicated e.g. Placenta praevia

107

Is a previous CS a contraindication to ECV?

Nope

108

Is a CS or vaginal breech delivery safer?

CS

109

Between what gestations is defined as preterm delivery?

24-37 weeks

110

Before what gestation do the majority of problems occur in preterm delivery?

34 weeks

111

2 major metabolic complications of prematurity?

Hypothermia
Hypoglycaemia

112

5 conditions that are more common as a result of prematurity?

Cerebral palsy
Necrotising enterocolitis
NRDS/BPD
Intracranial haemorrhage
PDA

113

Major maternal complication of preterm labour?

Infection - endometritis

114

In the castle analogy, what are the 6 mechanisms of preterm labour?

Too many defenders
Defenders jump out
Poor castle design
Castle walls are weak
Attackers get through walls
Attackers get in from elsewhere

115

Castle analogy: too many defenders?

Multiple pregnancy
Polyhydramnios

116

Castle analogy: defenders jump out?

Fetal survival response - fetal distress
Chorioamnionitis
Pre eclampsia
IUGR
Abruption
APH

117

Castle analogy: poor castle design?

Fibroids
Uterine malformation
Maternal age
PMH of premature labour

118

Castle analogy: weak walls?

Cervical incompetence e.g. Following LLETZ

119

Castle analogy: enemy breaks down walls

Infection which may be us clinical
BV, GBC, Trichomonas, chlamydia
Chorioamnionitis - offensive liquor

120

Castle analogy: enemy gets in from elsewhere?

UTI
Poor dentition