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FLASH FINALS > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

Pain during pregnancy in epigastric/RUQ region w/ deranged LFTs

A

HELLP syndrome

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2
Q

Causes of increased AFP:

A

NTDs (anencephaly, meningocele)
Abdominal wall defects (omphalocele etc.)
Multiple pregnancy

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3
Q

Decreased AFP:

A

Down’s syndrome
Trisomy 18 (Edward’s)
Maternal diabetes mellitus

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4
Q

First-line tx. for nausea and vomiting in pregnancy

A

Ginger and wrist acupuncture may be effective

Antihistamines first line medical - PROMETHAZINE

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5
Q

Rupture of membranes followed by immediate vaginal bleeding -> foetal bradycardia classically seen ->

A

Vasa Praevia

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6
Q

Drug to be avoided in breast feeding:

Antibiotics:

A

Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides

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7
Q

Drug to be avoided in breast feeding:

Psych drugs:

A

Lithium and Benzodiazepines

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8
Q

Drug to be avoided in breast feeding:

Others:

A 
Aspirin
Carbimazole
Methotrexate
Sulfonylureas
Cytotoxics
Amiodarone
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9
Q

Cord prolapse is more common in which foetal-lie presentation:

A

Breech

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10
Q

Foetal varicella syndrome: features:

A 
Skin scarring
Eye defects (microphthalmia)
Limb hypoplasia
Microcephaly
Learning disabilities
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11
Q

if < 20 weeks pregnant and is NOT immune to varicella:

A

VZIg given

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12
Q

How many days after exposure is VZIg effective for?

A

up to 10 days

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13
Q

if > 20 weeks pregnant and is NOT immune to varicella:

A

VZIG OR oral ACICLOVIR

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14
Q

if < 20 weeks pregnant and is NOT immune to varicella - when should tx. be given

A

7-14 days after exposure

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15
Q

Down’s syndrome triple test:

A

AFP
Unconjugated oestriol
HcG

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16
Q

Down’s quadruple test:

A

AFP, unconjugated oestriol, HCG, INHIBIN A

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17
Q

Combined test: down’s

A

Increased HCG,
Increased Nuchal thickness
Decreased PAPP-A

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18
Q

When in pregnancy will triple/quadruple test be offered:

A

15-20 weeks

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19
Q

Tx. for magnesium sulphate induced respiratory depression:

A

Calcium gluconate

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20
Q

How long should magnesium sulphate treatment continue for after last seizure/delivery

A

24 hours

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21
Q

Causes of folate acid deficiency (4)

A

Phenytoin
Methotrexate
Pregnancy
Alcohol excess

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22
Q

Indications for forceps delivery:

A

Fetal distress in second stage of labour
maternal distress in second stage of labour
failure to progress in second stage of labour
Control of head in breech delivery

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23
Q

Which substance release in pregnancy may mimic TSH and cause hypertension and hyperthyroidism

A

HCG

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24
Q

When should swabs for GBS be taken if they are to be taken:

A

35-37 weeks or 3-5 weeks prior to anticipated delivery date

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25
GBS prophylaxis:
IAP - benzylpenicillin
26
Mx. for HELLP syndrome
Delivery
27
Babies born to mothers w/ hepatitis B should receive:
Complete course of vaccination AND Hep B immunoglobulin
28
Mode of delivery in HIV +ve mothers: | What should be started during delivery:
Vaginal delivery recommended if viral load is less than 50 at 36 weeks. otherwise C-section is recommended ZIDOVUDINE infusion
29
Can you breastfeed w/ HIV
Not recommended
30
Uterine hyperstimulation is the main complication from which act:
Artificial Induction of labour
31
Uterine hyperstimulation tx:
Remove vaginal prostaglandins Stop oxytocin infusion if started Tocolysis w/ terbutaline
32
Signs of labour:
Regular and painful uterine contractions A show - shedding of mucous plug Rupture of membranes Shortening and dilation of the cervix
33
How often should foetal heart beat be monitored
every 15 minutes | or continuous w/ CTG
34
How often are contractions checked:
every 30 minutes
35
Labour STAGE 1 define latent phase: How long does it take?
0-3 cm dilation normally takes 6 hours
36
Labour STAGE 1 | define active phase:
3-10 cm dilation, normally 1 cm/hour
37
Labour stage 2 - typical length:
1 hour
38
if stage 2 longer than an hour consider:
Venthouse or forceps | C-section
39
Causes of oligohydramnios:
``` Premature rupture of membranes Post-term gestation Pre-eclampsia Foetal renal problems Intrauterine growth restriction ```
40
Second degree perineal tear: | Where/who repairs
Injury to perineal muscle, NOT INVOLVING THE ANAL SPHINCTER Can be sutured on ward by mid-wife
41
Fourth degree tears extend into:
RECTAL MUCOSA
42
Placenta praevia classes:
I - placenta reaches lower segment but not os II - placenta reaches internal os but doesn't cover it III - placenta covers os BEFORE dilation but not after IV - placenta completely covering os
43
When would placenta praevia be picked up?
18-20+6 week scan
44
Placenta praevia Mx.
if still present at 34 weeks: scan every 2 weeks
45
If scan shows placenta praevia class III/IV between 37-38 weeks:
ELECTIVE C-section
46
If scan shows placenta praevia class I:
Vaginal delivery may be offered
47
Placental abruption mx.
Foetus alive and < 36 weeks and not distressed: OBSERVE, STEROIDS, no tocolysis threshold to deliver depends on gestation Foetus > 36 weeks - no distress: deliver vaginally distress = c-section If dead -> deliver vaginally
48
Post natal depression tx.
CBT if SSRI required, offer SERTRALINE OR PAROXETINE (Sad Post-pregnancy)
49
Tx. post-partum thyroiditis:
Propranolol = symptomatic mx.
50
PPH initial mx.
Uterine massage IV syntocinon - 10 units or IV ergometrine IM carboprost
51
PPH if initial mx. doesn't work:
Intrauterine baloon tamponade B-lynch suture, ligation of uterine arteries, internal iliac arteries.
52
Secondary PPH When does it present: Causes:
24 hours - 12 weeks Retained placenta Endometritis
53
Women w/ BP > __ should be admitted and observed
> 160/110 mmHg
54
What should be offered for anaemia in pregnancy:
ORAL ferrous sulfate or fumerate
55
When is anaemia screened for:
Booking | 28 weeks
56
Women w/ suspected DVT in pregnancy Ix.
Compression DUPLEX US
57
Women w/ suspected PE in pregnancy Ix.
ECG CXR for all pts.
58
If symptoms and signs of DVT plus positive US findings, is there need for further investigation:
NO
59
CTPA increases chance of
Maternal breast cancer
60
V/Q scanning increases chance of
Childhood cancer
61
Acute fatty liver of pregnancy - occurs when?
3rd TM
62
Acute fatty liver Ix. LFT:
Increased ALT (500u/l)
63
Obese women should have OGTT at which gestation:
24-28 weeks gestation
64
What may cause ankle swelling, varicose veins and supine hypotension in pregnant women?
Enlarged uterus interfering w/ venous return
65
CO2 increased or decreased in pregnancy?
Decreased - due to slightly increased oxygen requirements -> may feel dyspnoeic
66
Hb in pregnancy:
Falls due to increase in plasma of 50% -> DILUTION
67
GFR in pregnancy:
Increases
68
Visual impairment in premature babies:
retinopathy of prematurity - neovascularisation from over-oxygenation
69
Complications of prematurity:
``` RDS Interventricular haemorrhage Necrotizing enterocolitis Chronic lung disease Jaundice ```
70
Premature prelabour rupture of membranes mx.:
Sterile speculum exam (pooling of fluid in post. vaginal vault) US may show oligohydramnios Admission Erythromycin (10 days) Antenatal corticosteroids should be administered to reduce risk of RDS Delivery considered at 34 weeks gestation.
71
Most common cause of puerperal pyrexia:
Endometritis
72
Endometritis mx.
Admit for IV antibiotics | Clindamycin and gentamicin till afebrile
73
Reduced foetal heart beat steps:
Handheld doppler -> Ultrasound -> CTG for at least 20 minutes
74
Rhesus baby px.: | tx.
Oedematous Jaundice Heart failure Kernicterus Transfusions, UV phototherapy
75
Methotrexate in pregnancy:
Contraindicated and should be stopped at least 6 months before conception
76
DMARDs safe in pregnancy
Sulfasalazine and hydroxychloroquine
77
When should NSAIDs be stopped in pregnancy and why?
32 weeks | Risks premature closure of ductus arteriosus
78
If rubella suspected in pregnancy
Discuss immediately w/ local health protection unit
79
Can you give MMR in pregnancy
NO but non-immune mothers should be given in in the post-natal period
80
Shoulder dystocia tx w/
McRobert's manouevre
81
Can ECV be performed in labour:
Yes as long as the membranes have not ruptured
82
Monoamniotic monozygotic twins are associated w/:
Increased spontaneous miscarriage Increased malformations: IUGR, prematurity Twin to twin tranfusion syndrome - recipient is larger w/ polyhydramnios
83
Management of twin pregnancy:
US for diagnosis + monthly checks Weekly checks from > 30 weeks precautions at labour - 2 obstetricians present Most are induced by 38-40 weeks
84
Causes of increased nuchal translucency:
Down's syndrome Congenital heart defects Abdominal wall defects
85
Causes of hyperechogenic bowel:
CF Down's syndrome CMV
86
Risk factors for cord prolapse:
``` Prematurity Multi-parity Polyhydramnios Twin pregnancy Abnormal presentations ```
87
Mx. Cord prolapse:
Foetus pushed BACK into uterus Pt. to go on all fours untill c-section can be performed TOCOLYTICS to reduce contractions Retrofilling bladder may help as it gently elevates the presenting part.
88
Four or more risk factors for VTE in pregnancy, women are tx. w/
LMWH
89
When should LMWH be initiated if indicated: | When is it continued till:
From 28 weeks Six weeks post-partum
90
Are DOACs and warfarin allowed in pregnancy:
NO

FLASH FINALS (34 decks)

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