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Cross reference - year 5 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

what is perinatal?

A

pregnancy + 1 year post partum

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2
Q

what is the difference between baby blues, PND and psychosis in terms of time frame?

A
  • baby blues: <2 weeks
  • PND: 2-4 weeks
  • Psychosis: recover within 6-12 weeks
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3
Q

what extra features need to be in the antenatal care in patients with cardiac disease in pregnancy?

A
  • echo at booking and at 28 weeks
  • anticoagulant if patient has: CHD, pulmonary HTN, artificial valves
  • prophylactic Abx for women with structural heart defects
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4
Q

what extra scans should happen in pregnant women with diabetes?

A

28, 32, 36 (4 weekly serial growth scans)
cardiac outflow scan
retinal and renal scanning

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5
Q

what other appointments should pregnant women have?

A

every 2 weeks = joint antenatal-diabetes clinics

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6
Q

when should pregnant women with diabetes deliver?

A

37+0 to 38+6 weeks = induction or ELCS

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7
Q

what signs can be seen on USS in ectopic pregnancy?

A
  • Tubal: bagel/blob sign

- Cervical: barrel cervix

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8
Q

what extra medication should be recommended for pregnant women with epilepsy?

A
  • Vit K in last month of pregnancy
  • increased folate dose
  • epidural for delivery
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9
Q

what can you recommend to pregnant women with Epilsepy?

A

UK Epilepsy and Pregnancy register

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10
Q

appearance of complete and incomplete mole on USS

A
  • complete mole: snowstorm/”cluster of grapes”

- incomplete mole: foetal parts

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11
Q

what is the management of a molar pregnancy?

A

URGENT referral to specialist centre
1. surgical: ERPC
2. monitor bHCG - methotrexate if rising/stagnant
AVOID pregnancy until 6 months of normal levels

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12
Q

what is the main issue with GTD malignancy?

A

rapid metastasis

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13
Q

3 main types of GTD malignancy

A
  1. invasive mole
  2. choriocarcinoma
  3. placental site trophoblastic tumour
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14
Q

what is an invasive mole?

A
  • hydatiform mole
  • invasion of myometrium
  • necrosis
  • haemorrhage
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15
Q

what is a choriocarcinoma?

A

cytotrophoblast and syncytiotrophoblast without formed chorionic villi invade myometrium

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16
Q

what is placental site trophoblastic tumour?

A

intermediate trophoblasts infiltrate myometrium without causing destruction

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17
Q

what PUQE-24 score indicated admission?

A

13+

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18
Q

when else might you admit in HG?

A
  • if can’t keep fluids down
  • ketonuria
  • weight loss >5%
  • co-morbidities
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19
Q

what medication do you give HG?

A
  • VTE
  • KCl
  • Thiamine
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20
Q

what is classified as HTN in pregnancy? what target do you try and achieve?

A

> 140/90

target: <135/85

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21
Q

what do you give for high risk pre-eclampsia?

A

aspirin 75mg from 12 weeks to birth

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22
Q

what are the high risk factors for pre-eclampsia? how many do you need to give aspirin?

A

1+ = aspirin

  • previous pre-eclampsia
  • CKD
  • AI disease
  • T1 or T2DM
  • Chronic HTN
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23
Q

what are the low risk factors for pre-eclampsia? how many do you need to give aspirin?

A

2+ = aspirin

  • Primigravid
  • age 40+
  • pregnancy interval >10 years
  • BMI >35
  • FHx pre-eclampsia
  • multiple pregnancy
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24
Q

what is the definition of moderate HTN?

A

140/90 to 159/109

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25
Q

what checks do you need to do for moderate HTN?

A
  • BP: measure 1-2/week
  • Dipstick: 1-2/week
  • FBC, LFTs, U&Es: ONCE at presentation
  • USS for foetal growth
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26
Q

what is the definition of severe gestational HTN?

A

> 160/110

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27
Q

what checks do you need to do in severe gestational HTN?

A
  • BP: measure every 15-30 mins until <160/110
  • Dipstick: daily whilst admitted
  • FBC, LFTs, U&Es: ONCE at presentation
  • USS for foetal growth
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28
Q

after discharge, what do you then do for moderate and severe gestational HTN?

A
  • measure FBC, LFTs, U&Es ONCE a week

- every 2-4 weeks: USS for foetal growth, umbilical artery doppler, amniotic fluid assessment, dipstick, BP measurement

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29
Q

if the patient has chronic HTN, when do you do assessments?

A

assess at 28, 32, 36 weeks only

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30
Q

what checks do you do in moderate pre-eclampsia (140/90)?

A
  • BP: inpt = x4/day, outpt = every 48 hours
  • blood: x2/week
  • Admission: CTG, USS, umbilical artery doppler, amniotic fluid assessment
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31
Q

what checks do you do in severe pre-eclampsia?

A
  • BP: every 15-30 minutes until <160/110, then x4/day as inpt
  • Bloods: x3/week
  • Admission tests: same as moderate
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32
Q

following discharge or going forward what checks need to be done in moderate and severe pre-eclampsia?

A
  • every 2 weeks: USS, umbilical artery doppler, dipstick, BP measure
  • moderate: bloods x2/week
  • severe: bloods x3/week
  • > 37 weeks = initiate birth 24-48hrs
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33
Q

what is the pre-eclampsia postnatal discharge criteria?

A
  • no symptoms
  • BP < 150/100
  • blood tests stable or improving
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34
Q

what is the inpt and outpt postnatal BP monitoring?

A
  • inpt: x4/day

- outpt: every other day until targets achieved, then once weekly

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35
Q

what is the pre-eclampsia aetiology?

A

impaired trophoblastic invasion of spiral arteries

  1. impaired invasion = high resistance flow
  2. low flow = poor perfusion of placenta
  3. placenta releases factors into circulation
  4. promotes further systemic effects
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36
Q

what are the symptoms of toxoplasmosis in the mother?

A

asymptomatic

fever, malaise, arthralgia

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37
Q

treatment of mother with toxoplasmosis

A

Spiramycin

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38
Q

symptoms of congenital toxoplasmosis

A
  • chorioretinitis = cataracts
  • hydrocephalus
  • convulsions
  • intracranial calcifications
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39
Q

investigations for toxoplasmosis

A

Sabin Feldmen Dye Test

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40
Q

management of congenital toxoplasmosis?

A

pyrimethamine, sulfadiazine

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41
Q

what are the symptoms of congenital syphillis?

A
  • rash (soles and palms)
  • bloody rhinitis
  • nose deformity
  • saber shin’s (anterior bowing of shins)
  • Hutchinson’s teeth (small widely spaces, notched)
  • Clutton’s joints (symmetrical knee swelling)
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42
Q

investigations of congenital syphillis

A
  • micro

- serology (non-treponemal or treponemal)

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43
Q

management of syphillis

A

Ben-Pen

+ prednisolone in mum

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44
Q

what are all the different names for parvovirus infection?

A
  • erythema infectiosum
  • fifth disease
  • slapped cheek
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45
Q

when is transmission highest in parvovirus infection?

A

higher transmission <20 weeks

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46
Q

what investigations do you do in parvovirus and when are they indicated?

A

only if contracted if <20 weeks

Foetal anomaly scan USS after 4 weeks, serial scans then every 2 weeks until 30/40

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47
Q

management of in utero parvovirus

A

in utero transfusions

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48
Q

what are the potential complications of maternal VZV infections?

A

risk of encephalitis, pneumonia and sepsis

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49
Q

management of a mother exposed/ infected with VZV?

A
  • exposed <20/40 = VZIG (if no symptoms)
  • symptomatic and >20/40 = aciclovir
  • referral to foetal medicine specialist at 16-20 weeks or 5 weeks after infection
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50
Q

what are the symptoms of congenital varicella syndrome?

A
  • eyes (chorioretinitis)
  • CNS (microcephaly)
  • MSK (cutaneous scarring, limb hypoplasia)
  • IUGR
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51
Q

what are the symptoms of neonatal varicella infection?

A
  • mild disease
  • disseminated skin lesions
  • pneumonia
  • visceral infections (e.g. hepatitis)
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52
Q

management of neonatal varicella infection

A

aciclovir

arrange neonatal opthalmic exam

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53
Q

what are the indications for neonatal VZIG?

A
  • birth <7 days of mum rash

- mum chickenpox <7 days since delivery

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54
Q

how do you test neonates for HIV?

A
  • neonates test +ve for HIV Abs due to passive transfer

- instead do direct viral amplification through PCR at birth, discharge, 6w, 12w, 18w

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55
Q

what maternal HIV monitoring should be carried out?

A
  • 2x CD4 counts (baseline and delivery)

- x8 viral load (every 2-4 weeks, 36 weeks and after delivery)

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56
Q

symptoms of rubella

A
  • coryzal symptoms, arthralgia, rash
  • maculopapular rash
  • soft palate lesions
  • lympadenopathy
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57
Q

management of rubella in pregnancy

A

supportive
offer TOP <16 weeks
refer to foetal medicine unit and HPT

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58
Q

when is the biggest risk of congenital rubella syndrome?

A

<12 weeks of GA

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59
Q

what are the symptoms of congenital rubella syndrome?

A
  • chorioretinitis
  • PDA
  • SNHL
  • microcephaly
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60
Q

what is the most common congenital infection?

A

CMV

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61
Q

symptoms of CMV in the mum

A

asymptomatic

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62
Q

what is CMV likely to be vertically transmitted?

A

30-40% vertical transmission at ANY STAGE

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63
Q

how many pt are asymptomatic for congenital CMV at birth?

A

90%

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64
Q

what are the symptoms of congenital CMV?

A
  • SNHL
  • chorioretinitis
  • periventricular calcifications
  • blueberry muffin rash
  • jaundice
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65
Q

management of congenital CMV

A
  • ganciclovir and valganciclovir

- audiology and ophthalmology F/U

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66
Q

what are the symptoms of HSV in neonate?

A
  • SEM disease (blistering vesicular rash, chorioretinitis)
  • CNS +/- SEM (seizures, irritability, lethargy, bulging fontanelle)
  • disseminates (encephalitis, CNS, hepatitis, pneumonitis
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67
Q

management of HSV in neonate

A

aciclovir

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68
Q

when do you treat HSV in mother?

A

only treat if primary infection

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69
Q

what delivery method if recommended in a mother with primary HSV?

A
  • 1st episode >6 weeks prior to EDD = SVD

- 1st episode <6 weeks prior to EDD = CS

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70
Q

what special precautions should be made in SVD in mothers with HSV?

A
  • avoid invasive procedures

- aciclovir intrapartum

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71
Q

how should mothers with recurrent HSV infection deliver?

A
  • SVD

- aciclovir TDS from 36 weeks

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72
Q

what is the GBS bacteria ?

A

streptococcus agalactiae

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73
Q

indications for intrapartum GBS prophylaxis?

A
  • intrapartum fever, confirmed chorioaminitis
  • prolonged ROM
  • <37 weeks (preterm)
  • previous infant with GBS
  • maternal GBS bacteriuria, colonisation
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74
Q

when should you monitor neonatal vital signs ?

A

if Abx were given <4 hours before delivery

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75
Q

when is sepsis monitoring needed in newborns?

A
  • 1 RF: hospital Obs 24 hours

- >2 RFs or 1 red flag: sepsis Abx and septic screen

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76
Q

what are the sepsis red flags?

A
  • intrapartum Abx for sepsis (not GBS prophylaxis)
  • respiratory distress >4 hours postpartum
  • seizures
  • mechanical ventilation needed in term baby
  • signs of shock
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77
Q

what is classed as engagement?

A

2/5th palpable or below

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78
Q

what is the 1st stage of labour?

A

Painful uterine contractions –> 10cm dilation

  • Latent = painful contractions to 4cm
  • Established = regular contractions, >4cm
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79
Q

what is the second stage of labour?

A

urge to push to delivery of the foetus

  • passive (not pushing)
  • active (pushing)
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80
Q

what is the 3rd stage if labour?

A

delivery of placenta and foetal membrane

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81
Q

where is the pelvic inlet/outlet widest?

A
  • pelvic inlet widest = TRANSVERSE

- pelvic outlet widest = AP

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82
Q

what controls the progression of labour?

A

power
passage
passenger

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83
Q

what is restitution?

A

bringing head in line with shoulders

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84
Q

what are the steps to labour?

A
  1. head floating, before engagement
  2. engagement, flexion, descent
  3. further descent, internal rotation
  4. complete rotation, beginning extension
  5. complete extension
  6. restitution (external rotation)
  7. delivery of anterior shoulder
  8. delivery of posterior shoulder
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85
Q

what are the signs and symptoms of shoulder dystocia?

A
  • difficult face/chin delivery
  • “turtling”
  • failure of restitution
  • failure of shoulder descent
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86
Q

shoulder dystocia manoeuvres?

A
  1. Rubin’s: push anterior shoulder towards baby’s chest
  2. Wood Screw’s: Rubin + push posterior shoulder towards baby back
  3. deliver posterior arm
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87
Q

what is included Bishop’s score?

A
  • cervical position
  • cervical consistency
  • cervical effacement
  • cervical dilation
  • fetal station
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88
Q

what is crowning?

A
  • when head no longer recedes between contractions

- midwife flexes foetal head and guards the perineum

89
Q

method of induction

A
  1. propess (24 hours)
  2. prostin (if propess was insufficient, max 2x, 6 hourly)
  3. ARM
  4. Syntocinon
  5. C-section`
90
Q

what is puerperal pyrexia?

A

> 38 degrees in first 14 days

91
Q

treatment of puerperal pyrexia?

A

IV clindamycin and IV gentamicin

92
Q

how do you manage LGA if detected at 18-21 weeks?

A

repeat scan

93
Q

how do you manage LGA if detected at 24-36 weeks?

A
  • offer OGTT
  • if it is following same path = reassure, arrange routine scan
  • if it is an acceleration of growth = USS for foetal biometry
94
Q

how do you manage LGA if detected at 36-40 weeks?

A

if SFH > 90th centile = USS for foetal biometry

  • OGTT
  • care in labour and postnatally as per GDM
95
Q

what is the definition of SGA?

A

AC or EFW < 10th centile

96
Q

what is the Mx for SGA before 20 weeks?

A
  • if 1+ major RF or 3+ minor RFs, reassess at 20 weeks
97
Q

what is the Mx of SGA if still at risk at 20 weeks?

A
  • minor RFs (3+): uterine artery doppler (20-24 weeks) = if abnormal, serial USS from 26-28 weeks
  • major RF (1+): foetal size and umbilical artery doppler (serial USS from 26-28 weeks)
98
Q

if the baby is SGA or IUGR, what investigations need to be done throughout pregnancy?

A
  • umbilical artery doppler serial measurements

- ultrasound biometry every 2 weeks

99
Q

what is the management for SGA?

A

low dose aspirin

delivery by 37 weeks

100
Q

what monitoring needs to be done in obstetric cholestasis?

A

weekly LFTs
x2/ week doppler
CTG

101
Q

what are the complications of OC?

A
  • PPH (vit K deficienct)
  • foetal distress
  • meconium delivery
  • preterm birth
  • intracranial haemorrhage
102
Q

what are the RFs for OC?

A
  • FHx
  • Hx of liver disease
  • multiple pregnancy
  • pruritus on COCP
103
Q

what would investigations show in acute fatty liver of pregnancy?

A
  • high ALT
  • low glucose
  • high uric acid
    NO PRURITUS (vs OC)
104
Q

what are the 3 types of breech?

A
  • frank
  • footling
  • complete
105
Q

how many breech SVD need an emergency C-section?

A

40%

106
Q

what maneuvers should be used in a breech vaginal delivery?

A
  • Hands off
  • Pinard manoeuvre
  • Loveset manoeuvre (rotatoe baby to transverse, pull down anterior arm)
  • Mauriceau-Smellie-Viet (rest baby on your forearm)
107
Q

what will you see if the baby head gets stuck in breech delivery?

A

winging of scapulae

108
Q

what is important to remember about breech vaginal delivery

A

try and avoid induction

109
Q

what are the 4 types of unstable lie?

A
  • transverse lie
  • brow
  • face
  • compound (fetal arm along head)
110
Q

how is a transverse lie managed?

A

CS

111
Q

how is a brow lie managed?

A

if persistent or 2nd stage of labour = CS

112
Q

how is a face presentation managed?

A 
mentoposterior = CS
mentoanterior = SVD
113
Q

how is compound unstable lie managed?

A

manage expectantly

114
Q

how many pregnancies end in miscarriages?

A

20%

115
Q

what are the causes of recurrent miscarriages?

A
  • structural abnormalities
  • cervical incompetence
  • medical conditions (renal, diabetes, SLE)
  • clotting abnormalities
116
Q

how do you date pregnancies on an USS <14w and >14w?

A 
<14w = CRL
>14w = AC, HC, FL
117
Q

what needs to be seen on an USS to confirm a viable intrauterine pregnancy?

A

yolk sac

gestational sac

118
Q

how can you confirm a miscarriage on TVUSS?

A
  • no FH and CRL >7mm

- GS > 25m + no foetus

119
Q

how does a pregnancy of unknown viability appear on TVUSS? what should you do?

A

TVUSS in 7 days

  • no FH + CRL < 7mm
  • GS <25mm + no foetus
120
Q

when is anti-D given in miscarriage?

A
  • if Rhesus -ve and >12GA (any management)

- therapeutic termination, anti-D regardless

121
Q

how do you assess if twins are monochorionic or dichorionic on USS?

A
  • DC: lamda sign

- MC: T sign

122
Q

what extra tests need to be carried out in multiple pregnancy?

A
  • FBC at 20-24 weeks, then repeat at 28 weeks
  • BP and OGTT
  • TTTS monitoring: starting at 16w (every 2w) for shared placenta, 20w (every 4w) no shared placenta
123
Q

when are serial US scans carried out in shared placenta pregnancies?

A

12w, 16w and then every 2w

124
Q

when are serial US scans carried out if a multiple pregnancy doesn’t share a placenta?

A

12w, 20w and every 4 weeks

125
Q

when are elective births planned in uncomplicated monochorionic twins?

A

36 weeks (after steroids)

126
Q

when are elective births planned in uncomplicated dichorionic twins?

A

from 37w

127
Q

when are elective births planned in uncomplicated triplets?

A

35 weeks after steroids

128
Q

what might be needed in a twin vaginal birth if the 2nd baby is breech?

A

internal pedalic version

129
Q

what are the signs of TTTS?

A
  • sudden increase in size of abdomen
  • SOB
  • > 25% difference in EFW
130
Q

what is the pathophysiology of TTTS?

A

direct arterial to venous flow in placenta

131
Q

what are the RFs for oligohydramnios?

A
  • reduced fluid input: placental insufficiency, pre-eclampsia
  • reduced fluid output: structural patholoy, Meds (ACEi, NSAIDs)
  • lost fluid (ROM, IUGR, TTTS)
  • chromosomal abnormalities
132
Q

what are the RFs for polyhydramnios?

A
  • failure of foetal swallow
  • congenital infections
  • foetal polyuria (maternal diabetes, TTTS)
133
Q

what is the management of polyhydramnios?

A
  • amnioreduction

- COX inhibitors (decrease foetal urine output)

134
Q

what happens if there is a grade 3/4 PP seen on the 32 week rescan ?

A
  • admit at 34 weeks

- C-section at 37 weeks

135
Q

what happens if there is a APH from PP?

A

admit for 48 hours observation (or until bleeding stops)

136
Q

what is vasa praevia?

A

ruptured foetal vessels when baby descends

137
Q

what is the haemorrhage called when one of these vessels rupture?

A

Benckaiser’s haemorrhage

138
Q

what are the RFs for vasa praevia?

A
  • foetal anomaly (bilobed placenta or succenturiate lobes): fetal vessels run through membranes joining lobes together
  • Hx of low lying placenta in 2nd trimester
  • multiple pregnancies
  • IVF
139
Q

what is type 1 vasa praevia?

A

velamentous cord insertion in single/bilobed placenta

140
Q

what is type 2 vasa praevia?

A

foetal vessels running between lobes of placenta with 1+ accessory lobes

141
Q

what is the time frame for secondary PPH?

A

24 hours to 12 weeks

142
Q

what are the causes of secondary PPH?

A

endometritis
retained products
abnormal involution of placental site
trophoblastic disease

143
Q

what are the different problems you can have with tone?

A
  1. overdistended uterus (polyhydramnious, multiple gestation, macrosomia)
  2. uterine muscle exhaustion (prolonged labour, GA, multiparity)
  3. uterine anatomy abnormal
  4. intra-amniotic infection
144
Q

what are the steps to management of PPH?

A
  1. bimanual compression
  2. IM/IV syntocinon
  3. IM ergometrine
  4. IM carboprost
  5. balloon tamponade
  6. B-lynch suture
  7. Hysterectomy
145
Q

in what conditions should you not offer a vaginal exam?

A

Placenta praevia

PPROM/SROM

146
Q

what investigations should you do in PPROM/PROM?

A
  1. Speculum (pooling), look at the Os
  2. IGFBP1 or PAMG-1
  3. FFN
147
Q

what should you do if there are convincing signs/symptoms of PPROM?

A

admit to labour ward

do not perform diagnostic tests

148
Q

what is the management of PPROM?

A
  • admission and expectant management until 37 weeks
  • DO NOT offer tocolysis
  • erythromycin (<37 weeks for 10 days or until in established labour)
  • steroids (<34 weeks for 24 hours)
  • MgSO4 (<30 weeks and labour/planned birth <24hrs)
149
Q

what is the management of PROM (pre-labour, at term)?

A

clear liquor:
0-24 hrs = expectant
>24 hrs = IOL
meconium: induce ASAP

150
Q

management of pre-term labour if the membranes have ruptured?

A

PPROM guidance

151
Q

medical management of pre-term labour if the membranes have not ruptured?

A
  • Tocolysis: <34 weeks, nifedipine
  • Corticosteroids
  • MgSO4
152
Q

surgical management of pre-term labour if the membranes have not ruptured?

A
  • emergency rescue cerclage

- indication: 16-28 weeks, dilated cervix, unruptured membranes

153
Q

when is a prophylactic cervical cerclage/vaginal progesterone offered?

A

if cervical length <25mm and other RF

154
Q

what should you do if a mother is found to be RhD -ve and has Abs at booking?

A

monitor titres

if peak above, monitor baby using MCA dopplers weekly

155
Q

what are the different skin diseases of pregnancy?

A
  • pemphigoid gestationis
  • polymorphic eruption of pregnancy (PUPPP)
  • prurigo or pregnancy
  • pruritus folliculitis
  • atopic eczema
156
Q

what is pemphigoid gestationis and how does it present?

A
  • pruritic AI bullous disorder
  • 2nd/3rd trimester
  • most lesions on abdomen = widespread cluster burns, sparing face
157
Q

what is the management of pemphigoid gestationis?

A

topical steroids/oral prednisolone

158
Q

what is polymorphic eruption of pregnancy and when does it present?

A

3rd trimester/immediately post-partum
begins on lower abdo - extends to thighs, bum, legs, arms
spares umbilicus

159
Q

what is the management of polymorphic eruption of pregnancy?

A

symptomatic, recurs in most subsequent pregnancies

160
Q

what is prurigo of pregnancy? how does it appear?

A
  • common (20%)
  • 3rd trimester, resolves after delivery
  • excoriated papules on extensor limbs, abdo, shoulders
161
Q

what is the management of prurigo of pregnancy?

A

symptomatic
topical steroids/emollients
do LFTs to exclude OC

162
Q

what is pre-natal cannabis use linked to?

A
  • negative effect of growth of baby’s brain
  • decreased attention and executive function
  • decreased academic achievement
  • behavioural problems
163
Q

why is pregnancy a pro-coagulant state?

A

increase F7, F8, vWF, PAI-1, PAI-2, fibrinogen

decrease protein S

164
Q

what is the treatment of PE?

A

LMWH until 6 weeks post partum or 3 months total treatment (whichever greater)

165
Q

when does LMWH need to be stopped for delivery or epidural?

A
  • 24 hours before delivery

- epidural >24 hours after last dose

166
Q

what prevention of VTE is used in high risk patients?

A

LMWH + stockings

167
Q

for how long is prophylaxis needed?

A
  • 12w until 10 days to 6 weeks pp (>4 RFs, VTE event)
  • 28w to 10 days pp (3 RFs)
  • conservative (<3 RFs)
168
Q

what are the RFs for VTE?

A
  • age > 35 yrs
  • BMI >30
  • smoker
  • pre-eclampsia
  • immobility
  • multiple pregnancy
  • FHx
  • VTE
  • low risk thrombophilia
  • parity > 3
169
Q

how can you improve the success rate of ECV?

A

offer it with tocolysis and beta agonists (e.g. Terbutaline)

170
Q

what can cause a HR < 110bpm on CTG?

A

increased foetal vagal tone

maternal beta blocker use

171
Q

what can cause a HR > 160bpm on CTG?

A

maternal pyrexia
chorioamionitis
hypoxia

172
Q

what causes variability < 5bpm?

A

hypoxia

prematurity

173
Q

what causes early decelerations?

A

head compression (not of concern)

174
Q

what causes a late deceleration?

A

reduced uteroplacental flow

175
Q

what causes variable decelerations (independent of contractions)?

A

cord compression

176
Q

what are the CTG indications for an emergency C-section?

A
  • terminal bradycardia (FHR <100bpm for more than 10 mins)

- terminal deceleration (FHR drops, does not recover for more than 3 mins)

177
Q

what are the features of a non-reassuring CTG?

A
  • 100-109, 161-180 bpm
  • BV: <5 (for 30-50mins), >25 (for 15 mins)
  • variable decels with: no other concerning characteristics for >90 mins, <50% contractions >30 mins, >50% contractions for <30 mins
  • late decels in >50% contractions <30 mins
178
Q

what are the features of a pathological CTG?

A
  • sinusoidal = CAT1 EMCS
  • <100bpm, >180bpm
  • late decels >30mins
  • BV < 5 (>50 mins), >25 (>25 mins)
  • variable decels with any concerning characteristics in >50% contractions for >30 mins
  • acute bradycardia or terminal bradycardia
179
Q

what are the causes of a sinusoidal trace?

A
  • severe foetal anaemia/ hypoxia

- foetal/maternal haemorrhage

180
Q

what are the causes of late decels for >30 mins?

A

maternal hypotension
pre-eclampsia
uterine hyperstimulation

181
Q

what is the management of a non-reassuring CTG?

A
  1. left lateral
  2. stop oxytocin/consider tocolysis
  3. exclude acute event, correct underlying cause, give fluids
  4. digital foetal scalp stimulation (causes inc HR)
182
Q

what is the management of a pathological CTG?

A
  • foetal blood sampling

- EMCS

183
Q

requirements for instrumental delivery (FORCEPS)

A 
- episiotomy often done first
Fully dilated cervix
OA position
Ruptured membranes
Cephalic membranes
Engaged presenting part
Pain relief
Sphincter (bladder) empty
184
Q

what are the maternal complications of instrumental delivery? with which instrument are they more common?

A

forceps more common

  • perineal tears
  • cervical/vaginal lacerations
  • PPH
185
Q

what are the foetal complications of instrumental delivery? with which instrument are they more common?

A

more common with ventouse

  • Ventouse: cephalohaemotoma, intracerebral haemorrhage, retinal haemorrhage, jaundice
  • Forceps: facial nerve palsy
186
Q

what is the success rate of VBAC?

A

75%

+ fewer complications compared to ERCS

187
Q

what is important to remember in VBAC?

A

don’t augment with prostaglandins as increased risk of uterine rupture

188
Q

what are the 2 methods of sterilisation?

A
  • hysteroscopic sterilisation

- laparoscopic tubal occlusion

189
Q

how does hysteroscopic sterilisation work? how long to use contraception after?

A

expanding springs inserted into tubal ostia –> induced fibrosis
use contraception for next 3 months

190
Q

how does laparoscopic tubal occlusion work? how long to use contraception after?

A

occlude fallopian tubes with Filshie clips

use contraception until next period

191
Q

what is the medical management of TOP?

A

MIFEPRISTONE
24-48 hrs later
MISOPROSTOL (prostaglandin)

192
Q

where should medical TOP be carried out?

A
  • 0-9 weeks: at home (bleeding for 2 weeks)
  • 9-24 weeks: in clinic, repeat miso 3-hourly until expulsion
  • > 22 weeks: use FETICIDE
193
Q

when is surgical TOP better?

A

is there is more pregnancy tissue

194
Q

what surgical management should be used <14 weeks?

A

misoprostol to dilate
ERPC (vacuum aspiration)
LA and can go home same day

195
Q

what surgical management is used for >14 weeks?

A

misoprostol to dilate
then D+C
LA or GA

196
Q

what important thing should you council TOP mums about?

A

call 24 hour helpline if:

  • smelly discharge
  • fever
  • Symptoms of pregnancy
197
Q

when do you give the whooping cough and influenza vaccines in pregnancy?

A

27-36 weeks

198
Q

what are the down syndrome antenatal findings?

A
  • Low AFP
  • low oestriol
  • low PAPP-A
  • high b-HCG
  • thickened NT
199
Q

what causes an increased AFP antenatally?

A
  • neural tube defects
  • abdo wall defects
  • multiple pregnancy
200
Q

what causes a decreased AFP antenatally?

A
  • Down’s syndrome
  • Trisomy 18
  • maternal DM
201
Q

what do anomaly scan checks for?

A
  • spina bifida
  • diaphragmatic hernia
  • major congenital anomalies (e.g. heart defects)
  • 1st degree relative with diabetes
202
Q

what is done at the booking visit?

A
  • general infomation: diet, alcohol. folic acid, Vit D, antenatal classes
  • BP, urine, check BMI
  • booking bloods (FBC, blood group, rhesus status, haemoglobinopathies, Hep B, Syphillis, HIV)
  • urine culture
203
Q

when is the early scan to confirm pregnancy and exclude multiple pregnancy?

A

10-13+6 weeks

204
Q

when is the down syndrome screening, nuchal scan?

A

11-13+6 weeks

205
Q

what happens on 16 weeks?

A

info on anomaly and blood results

routine care = BP + urine + dipstick

206
Q

when is the anomaly scan?

A

18-20+6 weeks

207
Q

what happens at 28 weeks?

A
  • Routine BP, urine dip, SFH
  • second screen for anaemia and atypical red cell alloantibodies
  • 1st dose of anti-D
208
Q

what happens at 34 weeks?

A
  • Routine: BP, urine dip, SFH
  • 2nd dose of anti-D
  • info on labour and birth plan
209
Q

what happens at 36 weeks?

A
  • routine: BP, urine dip, SFH
  • check presentation (offer ECV)
  • info on breast feeding, Vit K, baby blues
210
Q

what happens at 38 weeks?

A

routine: BP, urine dip, SFH

211
Q

what happens at 41 weeks?

A
  • routine: BP, urine dup, SFH

- discuss labour plans and possibility of induction

212
Q

when do G1 mothers have extra visits?

A

25, 31 and 40 (routine care)

213
Q

what are the components of a partogram?

A
  • maternal HR (every 30 mins)
  • contractions (every 30 mins)
  • colour of liquor (every 30 mins)
  • cervicograph
  • cervical dilatation (every 4 hours)
  • BP and temp (every 4 hours)
214
Q

what is Neagle’s rule?

A

add 9 months and 7 days

if cycle >28 days, add number of days above to EDD

215
Q

what are the physiological energy changes of pregnancy?

A
  • increased energy demands (insulin sensitivity decreases)
216
Q

what are the respiratory changes in pregnancy?

A

inc tidal volume by 30-50%
dec FRC
RR doesn’t change

217
Q

what are the cardiac changes in pregnancy?

A
  • inc CO by 50%
  • inc SV by 35%
  • dec peripheral resistance (due to progesterone)
  • inc HR by 15-25%
218
Q

what are the physiological kidney changes in pregnancy?

A
  • more aldosterone = fluid retention

- GFR increases in 1st trimester

219
Q

what are the physiological hematological changes that occur in pregnancy?

A
  • macrocytosis
  • neutrophilia
  • thrombocytopaenia
  • dilutional anaemia

Cross reference - year 5 (22 decks)

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