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Medicine Finals: HARD STUFF ONLY > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

Management of acute placenta praevia?

A 
<34w = corticosteroids
>34w = C section
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2
Q

Management of placental abruption

A 
Urgent involvement of seniors
2 x grey cannula - bloods
Crossmatch 4 units
Fluid + blood resus if needed
CTG monitoring

If fetal distress - immediate CS
If no fetal distress + <36w = Steroids + observe
If no fetal distress +>36w = Delivery vaginally

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3
Q

Drugs to avoid in pregnancy

A

x

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4
Q

Drugs to avoid in breastfeeding

A
  • aspirin
  • lithium
  • ciprofloxacin
  • methotrexate
  • amiodarone
  • carbimazole
  • benzodiazepines
  • tetracyclines
  • sulphonamides
  • sulphonylureas
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5
Q

What is hydrops fetalis?

A

Abnormal fluid accumulation in two or more fetal compartments
Due to severe fetal anaemia

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6
Q

Causes of polyhydramnios

A

Impaired swallowing - oesophageal atresia/duodenal atresia, diaphragmatic hernia

Increased production - foetal anaemia, maternal DM, twin to twin, foetal renal disorders

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7
Q

Causes of oligohydramnios

A

Reduced production - renal agenesis, polycystic kidney disease
IUGR
PPROM

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8
Q

Management of pre-eclampsia

A

1) Labetalol (or nifedipine/methyldopa)

2) IV mag sulphate if becomes eclampsia

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9
Q

Who needs aspirin and from when?

A

If 1 high risk factor or 2 moderate risk factors

Aspirin daily from 12 WEEKS

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10
Q

What are high risk and moderate risk factors for pre-eclampsia?

A

High risk = previous pre-eclampsia, multifetal gestation, chronic HTN, diabetes, renal disease, autoimmune disease

Moderate risk = mother/sister with pre-eclampsia, nulliparity, obesity, age 40 years or older, multiple pregnancy

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11
Q

Who needs LMWH and from when

A

If 3 risk factors - LMWH from 28 weeks pregnancy to 6 weeks postpartum

If 4 risk factors - LWMH from first trimester to 6 weeks postpartum

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12
Q

What are risk factors for VTE in pregnancy?

A 
Smoking
Parity >3
Age >35
BMI >30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Varicose veins
Family history
Thrombophilia
IVF pregnancy

Note: D-dimer is not useful in pregnancy

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13
Q

How long do you take folic acid for?

A

From before conception until 12th week of pregnancy (end of first trimester)

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14
Q

What is chorionic blood sampling and when is it used?

A

used for diagnosis of Down syndrome
prior to 15 weeks gestation
2% risk of miscarriage

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15
Q

Amniocentesis

A

used for diagnosis of Down syndrome
after 15w gestation
1% risk of miscarriage

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16
Q

Management of cord prolapse

A

Need emergency CS

Whilst awaiting theatre:

  • Push in presenting part to avoid decompression
  • Ask patient to go on all fours
  • Retrofilling the bladder with saline can help to gently elevate the presenting part
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17
Q

Management of shoulder dystocia

A

McRobert’s manoeuvre

Apply suprapubic pressure

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18
Q

Management of perineal tears

A

First degree - superficial. No management needed.

Second degree - perineal msuclebut not anal sphincter. suturing on the ward.

third degree - affects anal sphincter. needs suturing in theatre.

fourth degree - affects rectal mucosa. needs suturing in theatre.

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19
Q

What are the 4 T’s of postpartum haemorrhage? How is postpartum haemorrhage managed?

A

Tone - uterine atony
Trauma - perineal tear
Thrombin - coagulation disorder
Tissue - retained products of conception

Insert 2x wide bore cannula
Crossmatch + group and save

  1. Bimanual uterine compression
  2. IV Oxytocin/Syntocinon/Ergometrine
  3. IM Carboprost
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20
Q

What is an amniotic fluid embolism?

How does it present?

How is it managed?

A

When amniotic fluid enters mothers bloodstream
Usually occurs during labour

Chills, shivering, sweating, anxiety
Cyanosis, hypotension, tachycardia
Can cause collapse

Management is supportive

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21
Q

What is the stepwise management for induction of labour?

A
  1. Membrane sweep
  2. Vaginal prostaglandins
  3. Cervical ripening balloon
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22
Q

Congenital rubella

A

Sensorineural deafness
Congenital cataracts
Congenital heart disease
Glaucoma

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23
Q

Congenital toxoplasmosis

Study These Flashcards
A

Cerebral calcification
Chorioretinitis
Hydrocephalus

24
Q

Congenital varicella syndrome

Study These Flashcards
A

Skin scarring
Limb hypoplasia
Microcephaly

25
Which conditions do pregnant women get screened for?
``` 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 Syphilis ```
26
What are examples of sensitisation events?
x
27
Gestational diabetes thresholds
Fasting >5.6 2 hour >7.8 Fasting >7 = straight to insulin (Short acting only - gestational diabetes is not managed with long acting insulin) Targets: Fasting = 5.3 2 hour = 6.4
28
What is a complication of induction? How is it managed?
Uterine hyperstimulation prolonged and frequent uterine contractions - sometimes called tachysystole Management= removing the vaginal prostaglandins if possible and stopping the oxytocin infusion if one has been started Tocolytics
29
Which rash in pregnancy spares the umbilicus and how is it managed?
Polymorphic eruption of pregnancy | Emollients/topical steroids
30
Which rash in pregnancy causes fluid filled blisters around the umbilicus?
Pemphigoid gestationitis
31
When to deliver someone with 1) obstetric cholestasis 2) gestational diabetes
1) 37-38 weeks | 2) 37-38 weeks
32
What is vasa praevia and how is it managed? (if it is diagnosed on ultrasound and if it presents as bleeding)
Foetal vessels exposed outside of the umbilical cord/placenta Vessels pass through internal cervical os Exposed vessels = prone to bleeding Presentation= 1) Painless bleeding 2) Ruptured membranes 3) Fetal bradycardia If diagnosed on ultrasound - planned CS at 35-36w If patient goes into labour - immediate CS needed.
33
How to interpret Bishop score?
Bishop score of less than 5 = induction will likely be necessary Bishop score of above 9 = labour will likely occur spontaneously
34
Who gets screened for gestational diabetes?
BMI of > 30 kg/m² previous macrosomic baby weighing 4.5 kg or above previous gestational diabetes first-degree relative with diabetes family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)
35
Anaemia iron supplementation requirement cut offs – pregnancy
First trimester = 110 Second/third trimester = 105 Postpartum = 100
36
When do you need to do a Kleihauer test?
Any sensitisation event after 20 weeks
37
How does obstetric cholestasis present and how is it managed?
intense pruritus, jaundice, raised biluribin Management: Ursodeoxycholic acid Induction at 37-38w
38
Obstetric cholestasis vs. acute fatty liver of pregnancy
Obstetric cholestasis - intense pruritus, jaundice, raised biluribin Acute fatty liver - rare. Abdominal pain, N+V, headache, hypoglycaemia, elevated ALT. Delivery is definitive management.
39
When can an IUD/IUS be inserted post-partum?
Either in first 48 hours or otherwise then wait 4 weeks.
40
What are risk factors for cord prolapse?
``` Artificial rupture of membranes Prematurity Multiparity Polyhydramnios Twin pregnancy Abnormal presentation - breech, transverse ```
41
What should the symphysis-fundal height be?
After 20 weeks - should match gestational age within 2cm | E.g. at 24 weeks should be 22-26cm
42
What tool is used to screen for postnatal depression?
Edinburgh Scale
43
Which antidepressant in breastfeeding women?
Sertraline or Paroxetine
44
What are the three methods of testing for Down syndrome in pregnancy?
Combined testing = bHCG+PAPP-A + nuchal thickness Triple testing = bHCG + AFP + uE3 (Unconjugated oestriol) Quadruple testing = bHCG + AFP + uE3 + Inhibin-A
45
What is the window for combined testing?
Between 11 and 13 weeks After 13 weeks -> Triple test (bHCG/AFP/uE3) or quadruple test (bHCG, AFP, uE3, Inhibin-A)
46
What gestation to do chorionic villous sampling vs. Amniocentesis?
After 15 weeks - Amniocentesis.
47
What are indications for foetal blood sampling?
Suspicious CTG to confirm presence of hypoxia
48
How can you interpret foetal blood sampling? How do you manage this?
pH <7.2 = abnormal Lactate >4.9 = abnormal If abnormal foetal blood sampling = immediate CS
49
When does postpartum depression usually present?
Around 3 months after birth
50
What are the 2 main causes of maternal sepsis?
Chorioamnionitis and UTI If maternal sepsis - do urine dip + high vaginal swab
51
How is chorioamnionitis managed?
IV abx + prompt delivery
52
When should you do active management of third stag of labour?
if placenta has not passed after 1 hour
53
How to management PPROM?
Admission for 10 day course of erythromycin + ACS
54
Congenital cytomegalovirus infection
LBW Purpuric skin lesions Sensorineural deafness Microcephaly
55
Fetal alcohol syndrome
Flat philtrum Short palpebral fissure Microcephaly Learning disability

Medicine Finals: HARD STUFF ONLY (23 decks)

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