Obstetrics Flashcards by Ang Qing Kang Dominic

3 most common trisomy syndromes

T13 Patau
T18 Edwards
T21 Downs

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Risk factors for placenta accreta spectrum disorders

Repeated C-sections
Repeated Dilatation and Curettage
Multiparity
Placenta Previa
Advanced maternal Age

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difference between placenta accreta, increta and percreta

Chorionic villi

Accreta: Attach to myometrium
INcreta: INvade into myometrium
PERcreta: PEnetrate through myometrium

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What describes the placenta accreta spectrum disorders

Morbidly adherent placenta

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Cx of placenta accreta

1.PPH when manually seperating placenta
2. Abnormal Uterine bleeding(AUB(

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Complications of manual separation of placenta

Uterine Perforation
Endometritis
PPH

-> Give uterotonics and antibiotics

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What is a septic abortion

Any abortion complicated by uterine infection such as endometritis

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Number of weeks more uterus becomes a pelvic organ after delivery

6 weeks

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Sizes of uterus relative to GA

12 weeks:Palpable suprapubically
20-22 weeks: Umblicus

GA correlates with SFH from umblicus above

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Layers that are dissected during a C section

(Superficial)
Skin
Subcutaneous fat
Anterior layer of rectus sheath
Rectus abdominis
Parietal peritoneum
Visceral Peritoneum
Uterine serosa and myometrium
(Deep)

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11) Most common fetal head position in delivery

Left occipital anterior (LOA)

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fetal anamoly pathognomic of poorly controlled prexisting DM?

Sacral agenesis

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Mx for missed or incomplete abortion

Medical: PO/PV Misoprostol 600mg
Surgical: Evacuation using vacuum aspiration

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Methods of IOL

Artificial rupture of membranes (ARM)
-Foley’s catheter
-Amiotomy hook
-laminaria tent
Pharmaco methods: PGE pessaries or IV oxytocin

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Cx of Induction of Labour

Uterine hyperstimulation syndrome
Fetal distress
Cord prolapse
Failed IOL->CS
Uterine rupture
Amniotic fluid embolism

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Mechanisms of Labour

Engagement flexion IR extension ER expulsion (just remember ED FIERE)

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Most common type of twins

dizygotic twins(DCDA)

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Most common type of monozygotic twins

Monochorionic Diamniotic(MCDA)

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What do the trophoblasts and inner cell mass form respectively

trophoblasts: Placenta
Inner cell mask: Embryo

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Why twin pregnancies are predisposed to GDM

Increased amount of placental hormones and placental-mediated insulin resistance
Higher caloric intake leading to excessive gestational weight gain
Twins seen in older mothers who are more likely to have impaired glucose tolerance at baseline

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Maternal complications of multiple pregnancies

IGDM
Hypertensive disorders(PE, PIH)
Venous thromboembolism
Anemia
Hyperemesis

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Fetal complications of twin pregnancies

Congenital heart disease
Placenta Previa
IUGR
Pre term birth(quite high chance)
MCDA: Twin-Twin transfusion syndrome(TTS)
MCMA: Cord entanglement

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Delivery method for twins

Will opt for NVD as long as presentation of leading twin is cephalic and the placenta is NOT previa

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3 steps to reduce risk of VTEs

Adequate hydration
Adequate mobilisation
TED(Thromboembolism deterrent) Stockings

Supplements for mothers(general)

Folate from pre conception to 2nd trimester Multivitamins from 2nd tri onward Aspirin if indicated from week 12 to 36

Legal gestational age limit for abortion

24 weeks, but must consider 48hr cool off period

Method of medical abortion

Mifepristone and misoprostol

Surgical methods of abortion

Vacuum aspiration(1st trimester) Dilation and evacuation(2nd tri)

6 Booking blood tests

FBC +- th a l GXM Hep B HIV Syphilis(VDRL) Rubella

Components of First Trimester Screening(FTS)

Nuchal Translucency Beta HCG PAPP-A

Groups of causes of Female infertility

Tubal Causes Ovarian causes Uterine causes Ovulatory(HPOA)

Cx of PPH

Death Shock Sheehans syndrome: agalactorrhea

Common causes of PPH due to DIC

Placental abruption Pre eclampsia/HELLP Sepsis Amniotic fluid embolism Dilutional coagulopathy Fetal death Top 3 are most common

What is sheehans syndrome

Postpartum necrosis of the pituitary gland, often due to PPH

Primary vs secondary PPH

Primary <24 hrs postpartum Secondary 24hrs-6weeks postpartum

Mx of RPOCs

Manual evacuation Ultrasound guided vacuum aspiration/DnC

Mx of uterine arony

Fundal/Uterine massage Uterotonics eg oxytocin,ergometrine,carboprost

Last resort treatment for undifferentiated PPH

Balloon tamponade eg using sengstaken blakemore tub Uterine artery ligation Iliac artery ligation Hysterectomy as last resort

Causes of fetal distress

1.Uterine hyperstimulation(Induction or augmentation of labour) 2. Maternal hypotension(esp epidural related) 3. Massive placental abruption 4. Cord prolapse 5. Uterine/scar rupture

Components of in utero resuscitation

1. Left lateral position to reduce aortocaval compression by uterus 2. O2 supplementation 3. IV fluids fast

Intervions for shoulder dystocia

1. Lie bed flat, FABER 2. Mcroberts Maneuver with suprapubic pressure 3. Rubin and Woodscrew manuevers 4. Last resort maneuvers: Symphysiotomy, Cleidotomy, Zavanelli

What to check for after shoulder dystocia case

1. PPH due to high risk of uterine atony 2. Brachial plexus injury to Neonate (Erbs palsy)

Risk factors for GDM

GDM in previous pregnancy Previous macrosomic baby Previous stillbirth Previous Miscarriages PCOS Obesity GDM or DM in first degree relative

Complications of GDM

Antenatal -Miscarriage -congenital abnormalities eg sacral agenesis Delivery -PPROM from polyhydramnios -Prolonged labor -PPH -? Post Natal -Future DM or metabolic syndrome -Neonatal hyoogly, electrolyte abnormalities, hypothermia etc

Mx of GDM

1. Reduce simple carbs 2. Increase complex carbs 3. Diabetic nurse 4. Metformin 5. Insulin 6. 6 week postnatal OGTT 7. Early IOL or CS

% of GDM mothers who develop DM

60%

OGTT values for GDM/DM dx

Fasting : >5.1 >10 >8.5 DM same as normal, 7 and 11.1

Mx of Placenta Previa

-Admit patient until delivery -pad charting to measure blood loss -Iron supp , tocolysis, anti-D immunoglobulin, IM dexamethasone -CS at 37 weeks

Invx for placenta previa

POCT: CTG Biochemical: FBC for Hb,DIVX screen, GXM and Rh isoimmunisation Pelvic US to look for placenta positioning

Mx of Menorrhagia

Pharm 1. TXA 2. Iron supplementation 3. Contraception(COCP,Depot, IUD) if not planning for pregnancy Surgical 1. Underlying cause

Numbers of weeks that uterus is not palpable after pregnancy

6 weeks

Number of weeks Pre eclampsia and GDM should resolve

6 weeks

Number of weeks postpartum after which can start normal contraception

6 weeks

Number of months post partum before return of menses

Lactational amenorrhea, 6 months

Antibodies tested for in anti phospholipid syndrome

Lupus anticoagulant, anti cardiolipin, anti beta 2 glycoprotein

Mx of RPOCs at cervical os

Removal with sponge forceps

Biochemical findings of PCOS

High LH/FSH ratio Hyperandrogenism Low progesterone

Mx of PCOS

Exercise and LOW OCP Cyclical progesterone for 3/12 Drosperienone for hirsutism

Cutoff to consider postpartum acute retention

6 hrs