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4th Year Revision > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

Define Gravity and Partity.

A 
Gravity = Number of pregnancies 
Parity = Number of pregnancies made it past 28w
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2
Q

Antibiotics given in pregnancy for UTI?

A

1st and 2nd Trimester - give Nitrofurantoin 100mg BD for 7 days
3rd trimester - Trimethoprim 200mg bd

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3
Q

Can you breastfeed whilst on psychiatric medications?

What is the safest SSRI in pregnancy?

A

No

Safest - Fluoxetine

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4
Q

Best management for Hyperthyroidism in pregnancy

A

Avoid Carbamazepine - give Propylthiouracil

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5
Q

When should methotrexate be stopped in regards to pregnancy?

A

Ideally 3 months prior to trying to conceive

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6
Q

What trimester should NSAIDS be avoided? Why?

A

Should be avoided in 3rd trimester

Can cause premature closing of the ductus arteriosis

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7
Q

What should the management be switched to for pregnant women with Anti-phospholipid syndrome?

A

Normal management for antiphospholipid syndrome is Warfarin

Need to be switched to Low molecular;ar weight heparin (eg enoxaparin) + aspirin from 6w to 34 w

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8
Q

What is pre-eclampsia?

A

Triad of

  • Hypertension
  • Proteinuria
  • Oedema (peripheral)

Can occur from 20w
Should resolve within 10 days

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9
Q

RF for Pre-eclampsia

A 
FH/Previous Hx of pre-eclampsia 
Pre-existing HTN/renal disease 
Multiple pregnancy 
First birth (primipartity) 
Obesity
Migraine Hx
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10
Q

How does pre-eclampsia present?

A

Headaches, visual disturbance, sudden oedema/weight gain, N&V

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11
Q

Investigations for pre-eclampsia?

A

FBC, U&Es, LFTs, Coag
BP
Urinalysis
USS

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12
Q

Management of Preeclampsia?

A

IF BP rises more than 30/20 since booking, or SYS is more than 160 then admit
1st line Mx - labetalol
2nd line - Nifedipine

Aiming for target of below 135/85

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13
Q

If mum is at high risk of pre-eclampsia, any prophylatic treatment?

A

Aspirin from 12w until birth

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14
Q

What is placental abruption? How does it present?

A

Placental abruption is when there is a separation of placenta away from the uterus

Presents as: painful bleeding, tender uterus and backspin, bloody cervix

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15
Q

Diagnosis and management of placental abruption?

A

Diagnosis - clinical

Mx - Deliver baby

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16
Q

What is placenta praevia?

RF?

A

placenta is attached to lower portion of the uterus usually near or even over the cervical os

notable cause of Antepartum haemorrhage

RF: Multiple pregnancy, Prior c-sections, Hx of fibroids, smoking, older mum, IVF

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17
Q

Describe minor and major placenta praevia.

A

Minor - not covering the cervical os but near it

Major - Partially/completely covering cervical os

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18
Q

How does placenta praevia present?

A

Painless bleeding
Non-tender uterus
High presenting part

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19
Q

Management of placenta praevia?

A

If <2cm from os - C section
if > 2cm from os - Normal SVD

Do not physically examine vagina

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20
Q

What is Obstetric Cholestasis?

A

It is a common condition in pregnancy where there is reduced outflow of bile acids from the liver causing a build up and resulting in the classic itching symptom.

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21
Q

Presentation of Obstetric Cholestasis?

A

Presents later in pregnancy - usually third trimester
Itching is main symptom (hands & feet)
Also sees: fatigue, dark urine, pale/greasy stools and sometimes jaundice

22
Q

Investigations for Obstetric Cholestasis?

A

LFTs and bile acid levels
Rise in ALT, AST and GGT
Raised bile acids

23
Q

Why is a LFT result of only raised ALP not diagnostic for Obstetric Cholestasis?

A

Because the placenta produced ALP so an isolated high ALP with normal rest of LFTs may be physiological

24
Q

Management of Obstetric Cholestasis?

A

1st line - Ursodeoxycholic acid
Can add in calamine lotion for itch
or
Antihistamines to help sleep (chlorphenamine)

IF clotting factors deranged - give Vit K

25
Q

When does Eclampsia occur?

Management?

A

It occurs if pre-eclampsia is not managed properly. It is characterised by the presence of seizures on the background of pre-eclampsia Dx and symptoms.

Mx - IV Mg sulfate

26
Q

What is HELLP syndrome?
What does it stand for?

Presents as…

A

HELLP is a complication of pre-eclampsia and eclampsia when there is:

  • Haemolysis
  • Elevated liver enzymes (High ALT, AST & GGT)
  • Low platelets

Presents as: Jaundice, malaise, vomiting, headache

27
Q

What do Stage 1, 2 & 3 refer to in Labour?

A

Stage 1 - From regular contractions til complete cervical dilation
Stage 2 - From completed cervical dilation til delivery of baby
Stage 3 - Delivery of the placenta & membranes

28
Q

Why is the cord clamping delayed after delivery? How long is it delayed for?

A

Delayed for 60s to improve fetal perfusion and O2 delivery to baby

29
Q

What is the Bishops score?

A

Its a scoring system to work out the cervical ripeness and thus the likelihood of spontaneous labour

30
Q

What are the key scores for the Bishop score and what do they indicate?

A

Score of 8 or above indicates likely spontaneous labour

Score of 5 or less means spontaneous labour is unlikely - needs induction

31
Q

What is the stepwise approach to induction?

A

If under 40-41 weeks gestation - Vaginal prostaglandin (PGE)
If over 40-41 weeks
- Membrane sweep

Amniotomy
Syntocinon

32
Q

Stepwise Pain relief in labour

A 
Supportive massage/relaxation 
Entonox 
Water immersion 
TENS 
Pudendal block (S2,3) 
IM diamorphine 
IV remifentanyl 
Epidural Block (T11-S5)
33
Q

If a mother of 26 weeks gets chicken pox and has never been previously exposed, management is…

A

As mum is over 20 weeks - oral acyclovir

Under 20 weeks - IV immunglobulins

34
Q

PPH

  • Major vs Minor: over _____ml?
  • What is the first line Mx?
  • What is second line Mx?
  • What is third line?
A
  • Minor: over 500ml
  • Major: Over 1000ml
  • Uterine massage and oxytocin infusion
  • 2nd line - Ergometrine (contraindicated in high BP)
  • 3rd line - Carboprost (used if above don’t work)
35
Q

Sheehan syndrome…

A

When your pituitary swells due to loos of blood (typically post birth) - presents with headache and visual disturbance

36
Q

Sudden onset abdominal pain, hard uterus, dark red vaginal bleeding, indicative of?

A

Placental abruption

37
Q

Anterior vs Posterior tongue tie…

A

Anterior tongue tie - short frenulum that is visible

Posterior tongue tie - cannot visualise frenulum, heart shaped when lifting tongue

38
Q

WHO advise for breastfeeding

A

Exclusively breastfeed up to 6 months, then combo of breastfeeding and foods up to 2 years and beyond

39
Q

What is premature rupture of membranes?

A

Where the amniotic sac ruptures releasing amniotic fluid before onset of labour

40
Q

Diagnosis of premature rupture of membranes?

Management of premature rupture of membranes?

A

Diagnosis - speculum examination - visualise it

Mx - Prophylatic antibodies (Erythromycin) 4 times daily until labour is establish or 10 days (whatever comes first)

41
Q

When is CVS and Amniocentesis done for prenatal testing?

A

CVS can be done at 11 weeks

Amniocentesis done from 15 weeks

42
Q

Pregnant Diabetic mothers should give birth no later than…

A

40+6 weeks

43
Q

What is the most appropriate management in a mum who at 12 weeks has a fetal pole of 9 weeks and no fetal heartbeat detected?

A

This hx suggests missed miscarriage

Offer Vaginal misoprostol for these patients

44
Q

Difference between revealed placental abruption and concealed placental abruption?

A

Concealed - asymptomatic or mother might remember pain but without bleeding

Revealed - painful bleeding, hard uterus, sudden onset etctec

45
Q

Guidance on gestational diabetes…cut offs for treatment?

A

If women with gestational diabetes have a fasting glucose <7 mmol/l - lifestyle advice and 2 week follow up

Women with >7mmol - immediately started on insulin with lifestyle advice

46
Q

HIV in Pregnancy

If patient is known HIV and viral load <50copies/ml - Mx?

If patient is known HIV and viral load >50copies/ml - Mx?

If new presentation in pregnancy?

A

All women HIV +, even if they did not need meds before pregnancy, should be started on combined antiretroviral therapy in 2nd trimester by 24th week

This should be continued lifelong

47
Q

What volume is consistent with diagnosis of polyhydramnios?

A

> 2-3l of amniotic fluid

48
Q

If baby is breech and in early labour but sac is intact…mangement options?

A

External cephalic

49
Q

When do you stop methotrexate in planning pregnancy?

A

Both partners have to be off methotrexate for 6 months.

50
Q

Expected results from triple assessment in Downs…

A

Thickened nuchal translucency, increased bHCG and decreased PAPP-A

4th Year Revision (14 decks)

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