obstetrics Flashcards
(98 cards)
1
Q
what are the risk factors for cord prolapse
A
breech presentation prolonged labour polyhydramnios twins prematurity multiparity artificial membrane rupture
2
Q
what is the management of cord prolapse
A
place mother on hand and knee position (all fours)
elevate presenting part of baby
avoid handling cord, keep warm and moist to prevent vasospasm
tocolytics (terbutaline)
fill bladder
c-section most of time, unless fully dilated and head is low
3
Q
what are the complications of cord prolapse
A
fetal distress, hypoxia, HIE/CP
fetal mortality
4
Q
when would you suspect cord prolapse
A
signs of fetal distress on CTG
5
Q
what are the RFs for folate deficiency
A
- anti-epileptics
- obesity (BMI 30+)
- relative with NTD
- coeliac, diabetes, thalassaemia
6
Q
what blood cells would you see in folate deficiency
A
macrocytic megaloblastic anaemia
hypersegmented neutrophils
7
Q
what investigation for gestational diabetes and how to interpret results
A
ogtt
fasting >5.2 = diabetes
2hr >7 = diabetes
8
Q
how is gestational diabetes treated
A
if low fasting glucose <7 trial wk exercise diet metformin short acting insulin glibenclamide if declines insulin
9
Q
how should pre-existing diabetes be managed in pregnancy
A
stop hypoglycaemics aside from metformin insulin tight glycaemic control anomaly scan at 20 weeks folic acid 5mg pre-conception until 12 weeks treat retinopathy as can worsen in preg
10
Q
what RFs for gest diabetes
A
obesity prev gest diabetes prev macrosomia family history diabetes BAME
11
Q
when to screen for gest diabetes
A
at booking if previous gest diabetes
24-28 weeks if RFs
12
Q
what is an ectopic pregnancy and where is the most common place
A
fertilised egg implants outside uterus - commonly in ampulla or isthmus of fallopians
13
Q
what symptoms of ectopic
A
constant lower abdo pain (usually unilateral) then PV bleeding after 6-8 weeks amenorrhea
shouldertip pain if peritoneal bleeding
pain on defecation/micturition
14
Q
what signs on examination in ectopic
A
cervical motion tenderness (excitation) adnexal mass (do not palpate as may rupture)
15
Q
what risk factors for ectopic
A
PID previous ectopic copper coil previous fallopian surgery older age smoking progesterone only pill
16
Q
what investigation in ectopic
A
TVUSS - gestational sac, fetal pole/yolk sac, pseudogestational sac
bHCG levels
17
Q
what management in ectopic
A
expectant - await ectopic to resolve (monitor bHCG levels to ensure they are dropping)
medical - IM methotrexate - check bHCG to ensure dropping
surgical - salpingectomy, salpingotomy if abnormal contralateral fallopian (chance of retained trophoblast, check bHCG after to confirm complete removal)
18
Q
when is surgical mgmt indicated in ectopic
A
pain adnexal mass >35mm rupture visible heartbeat HCG >5000
19
Q
what must be given to women undergoing surgical management of ectopic
A
anti-D if Rh neg
20
Q
what is placenta praevia
A
low-lying placenta, covers the cervical os
21
Q
what are the symptoms of placenta praevia
A
painless PV bleeding
shock in keeping with visible blood loss
fetal distress, hypoxia
22
Q
how is placenta praevia diagnosed
A
usually picked up in 20 week anomaly scan
TVUSS
23
Q
what RFs for placenta praevia
A
smoking previous c-section multiparity multiple pregnancy fibroids IVF
24
Q
how is placenta praevia managed
A
repeat TVUSS at 34 and 37 weeks planned c-section at 36-37 weeks steroids to mature foetal lungs if active bleeding, stabilise mum if unable to stabilise - emergency c-section if in labour - emergency c-section
25
what is placental abruption
separation of placenta from uterine wall
26
how does placental abruption present
```
painful PV bleeding
shock not in keeping with visible blood loss
woody uterus
fetal distress
DIC
anuria
coagulation problems
```
27
what are the RFs for placental abruption
```
previous placental abruption
trauma (consider domestic abuse)
cocaine
increasing maternal age
smoking
IUGR
multiple pregnancy
```
28
how is major placental abruption managed in the immediate sense
- Call for help - involve consultant, midwives, and anaesthetist
- A-E assessment - 2 large bore cannulae
- bloods - FBC, X-match group and save 6 units, coagulation studies, U+E, LFTs
- fluid and blood resus as required
- KLEIHAUER TEST
- monitor fetus via CTG
- close monitoring of mother
29
if no shock/fetal distress at <36 weeks, how is placental abruption managed
admit and administer steroids to mature lungs.
| no tocolytics
30
if fetus >36 weeks and abruption
immediate c-section
31
what are the maternal complications of placental abruption
```
PPH
shock
death
DIC
renal failure
```
32
what are the fetal complications of placental abruption
IUGR
hypoxia
death
33
there is an increased risk of PPH in placental abruption. how is this risk managed
active third stage - IV syntocinon
34
what are the four causes of PPH
```
4Ts
tone
tissue
trauma
thrombin
```
35
what are the main causes of uterine atony
large uterus
- macrosomia
- polyhydramnios
- multiple pregnancy
maternal age
prolonged labour
placental problems
36
what causes of trauma (PPH)
c-section
episiotomy
instrumental delivery
37
what causes of thrombin (PPH)
```
coagulation problems
DIC/HELLP (acquired)
placental abruption
pre-eclampsia
HTN
vWF
haemophilia
```
38
what mgmt of PPH
A-E assessment
2 large bore cannulae (14 gauge), cross match, FBC, UE LFT, coagulation
```
bimanual uterine massage
IV syntocinon
intrauterine balloon tamponade
b-lynch suture
uterine artery ligation
hysterectomy
```
39
how can PPH be prevented
active management - IM syntocinon in third stage of labour
40
what is the triad of features of pre-eclampsia
new HTN after 20 weeks
proteinuria
oedema
41
what are the complications of pre-eclampsia
```
eclampsia
IUGR
HELLP
haemorrhage
cardiac failure
```
42
what are the features of sheehan's syndrome
PPH - avasc nec of anterior pituitary
- amenorrhea (no LH/FSH)
- no lactation (no prolactin)
- addisonian crisis (no ACTH)
- hypothyroidism (lack of TSH)
43
what symptoms/signs of severe pre-eclampsia
```
BP >160/110
headache
visual disturbances
papilloedema
proteinuria
RUQ/epigastric pain
hyperreflexia
HELLP
```
44
what are some major RFs for pre-eclampsia
major:
- previous pre-eclampsia
- CKD
- auto-immune disease (SLE/anti-PLD)
- diabetes
- chronic hypertension
moderate:
- age >40
- first pregnancy
- preg interval >10 years
- BMI high
- family history of pre-eclampsia
- multiple pregnancy
45
what prevention of pre-eclampsia
75-150mg aspirin OD from 12 weeks until birth
46
how is pre-eclampsia managed
```
labetalol
nifedipine
methyldopa
hydralazine
fluid restrict to prevent fluid overload
```
steroids to mature fetal lungs if prem labour
47
how is pre-eclampsia managed during labour and following 24 hours
mag sulf
48
what is eclampsia and how is it managed
seizures associated with pre-eclampsia
| IV mag sulf to protect CNS
49
what side effect of mag sulf and how can this be treated
mag sulf can cause respiratory depression
| treat with calcium gluconate
50
what complications of pre-eclampsia
maternal:
- eclampsia
- HELLP
- heart failure
- haemorrhage
- blindness
- stroke
- headaches
fetal:
IUGR
prematurity
51
list some sensitising events in a rh-ve mother
- delivery of Rh +ve infant (live/stillborn)
- termination of pregnancy
- haemorrage
- external cephalic version
- miscarriage >12 weeks
- surgical management of ectopic
- abdominal trauma
- amniocentesis/chorionic villous sampling/fetal blood sampling
52
what is a small for dates baby and which measurements are used to determine this
<10th centile
EFW
AC
plotted on customised growth charts
53
what causes for small for dates
constitutionally small
| iugr
54
what causes for iugr
placental insufficiency or genetic/structural abnormality
55
what causes for placental insufficiency
```
pre-eclampsia
smoking
alcohol
anaemia
malnutrition
infection
autoimmune
idiopathic
```
56
what other signs aside from low EFW/AC can indicate Iugr
oligohydramnios
abnormal doppler studies
reduced fetal movements
abnormal CTGs
57
what are the complications of IUGR
```
neonatal hypoglycaemia
neonatal polycythaemia and jaundice
birth asphyxia
death
neonatal hypothermia
```
58
what monitoring if to assess baby growth if risk for iugr
SFH plotted on customised growth chart
| if <10th centile women are booked for serial growth scans and umbilical artery doppler
59
if <10th centile SFH, what investigations
serial growth scans and umbilical artery doppler
60
what umbilical artery doppler finding indicates placental insufficiency
absent end-diastolic flow
61
what management of IUGR/small for dates?
stop smoking
aspirin 75mg from 12 weeks until birth
serial growth scans to monitor growth
early deliver if no growth/concerns
62
when fetus is identified as SGA what investigations for underlying cause
```
BP and urine dip for pre-eclampsia
uterine artery doppler
detailed fetal anomaly scan
karyotyping
testing for TORCH infections
```
63
what are the RFs for IUGR
```
obesity
smoking
diabetes
existing hypertension
low PAPPA
antepartum haemorrhage
antiphospholipid syndrome
pre-eclampsia
infections
genetic abnormalities
maternal illness
anaemia
CKD
```
64
what medical management for top
mifepristone and misoprostol (more required if >10wks gestation)
if rh-ve and >10 weeks gestation, anti-D
65
what is mifepristone
anti-progesterone. halts pregnancy and relaxes cervix
66
what is misoprostol and how is it used in top
prostaglandin analogue - stimulates uterine contractions and softens cervix
67
what surgical management of top
mifepristone and misoprostol
osmotic cervical dilation
up to 14 weeks, dilation and suction
14-24 weeks, dilation and forceps removal
68
what is vasa praevia
vessels cover the internal cervical os, before foetus
69
what are the RFs for vasa praevia
placenta praevia
IVF
multiple pregnancy
70
what management for vasa praevia detected antenatally
steroids from 32 weeks to mature lungs
| c-section 34-36 weeks
71
how does vasa praevia present
dark red bleeding following membrane rupture
| fetal distress
72
how is vasa praevia managed in labour
immediate c-section
73
how is placenta accreta managed
c-section 35-36+6 weeks with steroids to mature fetal lungs
hysterectomy
uterus preserving surgery
expectant management
74
what are the risks of expectant management in placenta accreta
bleeding
| infection
75
what management for preterm prelabour rupture of membranes
prophylactic antibiotics to prevent chorioamnionitis
- erythromycin for 10 days
offer induction of labour after 34 weeks
76
what investigation for preterm labour with intact membranes
fetal fibronectin test
77
what mgmt of preterm labour with intact membranes
- CTG monitoring
- tocolysis with nifedipine/atosiban
- steroids to mature fetal lungs
- IV magnesium sulf for fetal neuroprotection
- delayed cord clamping/cord milking
78
what are the symptoms of mag toxicity after magsulf treatment in women
absent reflexes
respiratory depression
hypotension
treat with calcium gluconate
79
what prophylaxis for preterm labour
vaginal progesterone
| cervical cerclage
80
what are the symptoms of chorioamnionitis
PPROM
fever
maternal/fetal tachycardia
uterine tenderness
81
how is chorioamnionitis managed
prompt delivery of fetus
| antibiotics
82
what prophylaxis for chorioamnionitis
erythromycin qds for 10 days
83
what prophylaxis for vte in preg
lmwh until 6 weeks postnatal
84
if DVT in preg how to manage
LMWH for 3 months (considered provoked)
85
what are the RFs for VTE in preg
```
pre-eclampsia
maternal age
previous DVT
thrombophilia
gross varicose veine
obesity
parity >3
smoking
immobility
FH
IVF
```
86
what monitoring for pts on LMWH in preg
monitor factor Xa
87
what investigations for vte in preg
doppler artery ultrasound scan
if positive, no need for CTPA V/Q scan (unnecessary radiation)
CTPA - inc risk of breast cancer
V/Q - inc risk of childhood cancer
88
what mgmt of vte in preg
lmwh immediately until investigations rule out vte
until 6 weeks post partum
3months if provoked
89
what are the features of antiphospholipid syndrome
thrombosis
| recurrent miscarriages
90
what antibodies are found in antiphospholipid syndrome
anticardiolipin
lupus anticoagulant
antiphospholipid antibodies
anti-beta-2-glycoprotein-1
91
how is antiphospholipid syndrome managed
long term warfarin
| if preg, LMWH and aspirin to prevent pre-eclampsia
92
what conditions associated with antiphospholipid syndrome
livedo reticularis
liebmann sacks endocarditis
thrombocytopaenia
93
what is the relationship between APTT and antiphospholipid syndrome
APTT paradoxical rise in antiphospholipid syndrome
94
what is acute fatty liver of pregnancy
rapid accumulation of lipid in hepatocytes - acute hepatitis
95
what symptoms of acute fatty liver of pregnancy
```
ascites
anorexia
nausea vomiting
jaundice
hypoglycaemia
malaise fatigue
```
96
what might severe acute fatty liver of pregnancy lead to
pre-eclampsia
97
what investigations for acute fatty liver of pregnancy
LFTs - raised AST, ALT, bilirubin
raised WCC, low platelets
deranged clotting - INR and PTT raised
98
how is acute fatty liver of pregnancy managed
admission and delivery of baby
| consider liver transplant
