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Phase 3a Medicine🩺 > Obstetrics🤰 > Flashcards

Obstetrics🤰 Flashcards

1
Q

Stages of labour

A

Latent phase (cervix begins to efface and dilate)
First stage - Dilation up till 10cm
Second stage - from full dilation to birth
Third stage - from birth of fetus to expulsion of placenta

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2
Q

Steps of fetal journey to birth

A

Descent –> Flexion –> Internal rotation –> Extension –>Restitution –>External rotation –>Delivery of body

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3
Q

What is aortocaval compression syndrome?

A

If a woman is in the supine position at birth she will have
- Decreased venous return
- Decreased cardiac output
- Decreased arterial pressure
It reduces uteroplacental perfusion leading to fetal distress
Left lateral is a good position for women.

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4
Q

What is gestational hypertension?

A
  • New HT after 20 weeks gestation
  • Systolic >140 Diastolic >90
  • No or little proteinuria
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5
Q

Causes of APH?

A

Placenta praevia, placenta accreta, vasa praevia, minor/major abruption or infection

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6
Q

Causes of PPH?

A

qFOUR Ts
TISSUE - Ensure the placenta is complete
TONE - Ensure uterus is fully contracted
TRAUMA - look for tears
THROMBIN - Check clotting

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7
Q

Red flag symptoms in postnatal depression?

A

Ideation of suicide
Feeling incompetent as a parent
Estrangement from child
Hallucinations

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8
Q

Red flag symptoms in postnatal depression?

A

Ideation of suicide
Feeling incompetent as a parent
Estrangement from child
Hallucinations

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9
Q

What is the management of placenta praevia?

A
  • If diagnosed in 20 week scan the RCOG recommends TVS at 32 and 36 weeks gestation to guide decisions about delivery.
  • Corticosteroids are given between 34 weeks and 35+6 weeks gestation to mature the fetal lungs, given risk of preterm labour.
  • Planned delivery may be considered between 36/37 weeks to decrease risk fo spontaneous labour and bleeding. Planned C-Section is required.
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10
Q

What is the Bishop Score used for?

A

It is used to help assess whether induction of labour will be required.

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11
Q

What happens are 8-12 weeks?(ANTENATAL CARE)

A

Booking visit and booking bloods. Urine sample.

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12
Q

What happens at 10-13+6 weeks?

A

Early scan to confirm dates and exclude multiple pregnancy

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13
Q

What happens at 16 weeks?

A

Information on the anomaly scan and blood results. If Hb is less that 11g/dl then you can consider oral iron supplements.

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14
Q

When are doses of anti-D prophylaxis given?

A

28 weeks and 34 weeks.

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15
Q

What is Mirror syndrome?

A

Mirror syndrome, also called Ballantyne syndrome, is a rare condition in pregnancy, defined by the presence of the clinical triad of fetal hydrops, placentomegaly and maternal oedema. Any aetiology of fetal hydrops, including rhesus iso-immunization, congenital infection, twin-to-twin transfusion, structural anomalies and fetal malignancies, can lead to the syndrome.

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16
Q

What medication can be used to suppress lactation?

A

Cabergoline (dopamine receptor agonist which inhibits prolactin production causing suppression of lactation)

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17
Q

When should iron supplementation be taken in the first trimester

A

110g/L in the first trimester

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18
Q

What is the definition of postpartum haemorrhage?

A

Postpartum haemorrhage is defined as blood loss of 500 ml after a vaginal delivery

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19
Q

What foods should be avoided in pregnancy?

A

listeriosis: avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses), pate or undercooked meat
salmonella: avoid raw or partially cooked eggs and meat, especially poultry

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20
Q

HIV in pregnancy

A

HIV in pregnancy: vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks

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21
Q

What is a normal birth?

A

Spontaneous in onset, low risk at the start of labour and remaining so throughout labour and delivery. Infant is born spontaneously in vertex position between 37+42 weeks of pregnancy. Afterbirth mother and infant are in good condition.

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22
Q

What are indications for foetal blood sampling?

A

FBS is indicated when there is a suspicious cardiotocograph. It is used during labour during labour to confirm whether there is foetal hypoxia.

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23
Q

Contraindications for foetal blood sampling

A
  • Prolonged decelerations on Cardiotocography
  • Maternal infection e.g. HIV, Herpes simplex
  • Prematurity (<34 weeks)
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23
Q

Contraindications for foetal blood sampling

A
  • Prolonged decelerations on Cardiotocography
  • Maternal infection e.g. HIV, Herpes simplex
  • Prematurity (<34 weeks)
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24
Q

What are absolute contraindications for VBAC?

A

Classical (vertical) caesarean scar
Previous history of uterine rupture
The usual contraindications to vaginal delivery

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25
Q

What colour is vaginal bleeding in placental abruption?

A

May be absent but often dark

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26
Q

What are some risk factors for GBS infection in a newborn?

A
  • Maternal pyrexia
  • Prematurity
  • Previous sibling GBS infection
  • Prolonged rupture of membranes
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27
Q

When can you diagnose polyhydramnios?

A

Usually diagnosed at an AFI of >24cm (or 2000ml+)

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28
Q

When can you diagnose oligohydramnios?

A

Usually diagnosed with an AFI of <5cm (or under 200ml)

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29
Q

What is the most common cause of polyhydramnios?

A

Idiopathic

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30
Q

What is McRoberts manouvre?

A
  • Hyperflexion and abduction of the mother’s legs tightly to the abdomen
  • This may be accompanied with applied SUPRAPUBIC pressure
  • Routine traction in an axial direction should be applied to assess whether the shoulders have been released.
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31
Q

What is a Woods’ screw manoeuvre?

A

In shoulder dystocia - anterior shoulder is pushed towards the foetal chest and the posterior shoulder is pushed towards the foetal back.

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32
Q

What is the Zavanelli manoeuvre?

A

In shoulder dystocia - it is the replacement of the head into the canal and then subsequent delivery by caesarean section

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32
Q

What is the Zavanelli manoeuvre?

A

In shoulder dystocia - it is the replacement of the head into the canal and then subsequent delivery by caesarean section

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33
Q

What should you do when a woman with diagnosed hypothyroidism becomes pregnant but is it a euthyroid state?

A

Increase levothyroxine by 25mcg as soon as pregnancy is confirmed.

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34
Q

What vaccine should you avoid in pregnancy?

A

Live attenuated vaccines such as MMR

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35
Q

Who do you give anti- D to?

A

Rhesus negative women

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36
Q

What are normal laboratory findings in pregnancy compared to normal?

A

Reduced urea, reduced creatinine, increased urinary protein loss

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37
Q

Which anti-emetic used for hyperemesis gravidarum causes EPSEs?

A

Metoclopramide

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38
Q

How does pre-eclampsia cause oligohydramnios?

A

This is due to hypoperfusion of the placenta

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39
Q

After what period of time would continued lochia warrant further investigation?

A

6 weeks

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40
Q

How long should magnesium sulphate treatment last?

A

it should be continued for 24 hours after delivery or after last seizure whichever is later

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41
Q

What is the first line treatment for magnesium sulphate induced respiratory depression?

A

Calcium gluconate

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42
Q

What are the signs of pre-eclampsia and why?

A

Hyperreflexia - PET leads to increased intracranial pressure, which causes a loss of inhibitory fibres and therefore increased tendon reflexes
Epigastric pain - oedema in the liver capsule
Papilloedema and visual disturbance are caused the pressure of oedema on the optic nerve

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43
Q

When are women screened for anaemia?

A

Booking visit and 28 week appointment

44
Q

What is the Kleinhauer test used for?

A

It is used to detect the amount of fetal haemoglobin in the mothers bloodstream. It is usually needed in Rh negative mothers to determine the correct amount of Anti-D has been given following a potentially sensitising event

45
Q

What should the baseline rate of fetus be on CTG?

A

Should be 110-160bpm

46
Q

What should the normal baseline variability be on CTG?

A

Should vary between 5 to 25 beats per minute

47
Q

What are accelerations on CTG?

A

Accelerations are a rise in fetal heart rate of at least 15 beats lasting for 15 seconds or more. There should be 2 separate accelerations every 15 minutes. Accelerations typically occur with contractions.

48
Q

What are decelerations on CTG?

A

Reduction in the fetal heart rate by 15 beats or more for at least 15 seconds.

49
Q

What is fetal hydrops (hydrops fetalis)?

A

The abnormal accumulation of serous fluid in 2+ fetal compartments - pleural/pericardial effusions, ascites, skin oedema, polyhydramnios or placental oedema
Causes are either immune (blood group incompatibility between mother and fetus) or non immune.

50
Q

What are some non immune causes of hydrops fetalis?

A
  • Severe anaemia - Congenital parvovirus B19 infection, alpha thalassaemia major, massive materno-feto haemorrhage
  • Cardiac abnormalities
  • Chromosomal abnormalities - Trisomy 13,18,21 or turners
  • Infection - toxoplasmosis, rubella, CMV, varicella
  • Twin-twin transfusion syndrome (in the recipient twin)
  • Chorioangioma
51
Q

What is the most common cause of anaemia in pregnancy?

A

Iron deficiency

52
Q

What is the preferred method of induction?

A

Vaginal PGE2

53
Q

What causes increased AFP?

A
  • Neural tube defects (meningocele, myelomeningocele and anencephaly)
  • Abdominal wall defects (omphalocele and gastroschisis)
  • Multiple pregnancy
54
Q

What causes decreased AFP?

A
  • Down’s Syndrome
  • Trisomy 18
  • Maternal diabetes mellitus
55
Q

What are the symptoms and signs of amniotic fluid embolism?

A

Symptoms: chills, shivering, sweating, anxiety and coughing
Signs: cyanosis, hypotension, bronchospasms, tachycardia, arrhythmia and myocardial infarction

56
Q

What bloods are checked in the booking bloods/urine?

A

FBC, blood group, rhesus status, red cell alloantibodies, haemoglobinopathies
- Hepatitis B, Syphilis
- HIV test is offered to all women
- Urine culture to detect asymptomatic bacteriuria

57
Q

What should a woman at moderate or high risk of pre-eclampsia to reduce risk?

A

Aspirin 75mg-150mg daily from 12 weeks gestation until the birth

58
Q

When is induction of labour offered in intrahepatic cholestasis of pregnancy?

A

37-38 weeks gestation as beyond this increases the risk of stillbirth

59
Q

What is the treatment for a first degree perineal tear?

A

They do not require suturing as they heal on their own

60
Q

What is the treatment for a second degree tear?

A

Require suturing on the ward by a suitably experiences midwife or clinician

61
Q

What are the treatments recommended by NICE for nausea and vomiting in pregnancy?

A

natural remedies - ginger and acupuncture on the ‘p6’ point (by the wrist) are recommended by NICE
antihistamines should be used first-line (BNF suggests promethazine as first-line)

62
Q

When is the Nuchal scan?

A

11 - 13+6

63
Q

What investigations do you do for Preterm prelabour rupture of the membranes?

A
  • A sterile speculum examination should be performed (looking for pooling of amniotic fluid in the posterior vaginal vault)
  • DIGITAL EXAMINATION SHOULD BE AVOIDED DUE TO RISK OF INFECTION
  • Ultrasound may also be useful to show oligohydramnios
64
Q

What is the management for PPROM?

A
  • admission
  • regular observations to ensure chorioamnionitis is not developing
  • oral erythromycin should be given for 10 days
  • antenatal corticosteroids should be administered to reduce the risk of respiratory distress syndrome
  • delivery should be considered at 34 weeks of gestation - there is a trade-off between increased risk of maternal chorioamnionitis with a decreased risk of respiratory distress syndrome as the pregnancy progresses
65
Q

What foods shouldn’t be eaten to avoid listeriosis?

A

Avoid unpasteurised milk, ripened soft cheeses (Camembert, Brie, blue-veined cheeses) pate or undercooked meat.

66
Q

What foods shouldn’t be eaten to avoid salmonella?

A

Avoid raw or partially cooked eggs and meat, especially poultry

67
Q

When should you refer to an obstetrician for lack of fetal movements?

A

24 weeks

68
Q

What is a velamentous cord insertion?

A

It is an umbilical cord attachment to the membranes surrounding the placenta instead of the central mass

69
Q

If an abdominal trauma occurs in a rhesus negative woman between 12 and 20 weeks, what should you do?

A

For potentially sensitising event between 12 and 20 weeks gestation, a minimum dose of 250 IU of anti-D Ig prophylaxis should be administered within 72 hours of the event

70
Q

What is involved in active management of the third stage of labour?

A
  1. Injection of a uterotonic drug such as oxytocin
  2. Clamping of the cord between 1 and 5 minutes after delivery of the infant
  3. Delivery of the placenta by controlled cord traction
71
Q

What is the first-line antibiotic for asymptomatic bacteriuria at booking?

A

Oral nitrofurantoin 100mg modified-release tablets twice a day for seven days

72
Q

What is a common first-line regimen for HIV diagnosed in pregnancy?

A

All pregnant women who have been diagnosed with HIV should start antiretroviral therapy (ART) during pregnancy and be advised to continue lifelong treatment. Tenofovir disoproxil/emtricitabine is a common first-line regime.

73
Q

What is given to an infant born to a low-risk HIV positive mother?

i.e. low viral load <50HIV RNA copies/ml

A

Zidovudine monotherapy is used for post-exposure prophylaxis in an infant born to a low-risk mother (i.e. low viral load, <50 HIV RNA copies/mL). Zidovudine is also used for the management of untreated women presenting in labour at term, and is given intravenously throughout labour.

74
Q

What happens with anti-epileptic drugs during labour?

A

women should continue taking their regular anti-epileptic drugs orally during labour where tolerated

75
Q

What is the most common cause of secondary postpartum haemorrhage?

A

Endometritis typically presents between 2 and 10 days postpartum

76
Q

As well as antiemetics what do you give in hyperemesis gravidarum?

A
  • Fluids
  • Potassium chloride
  • Thiamine and folic acid to prevent development of Wernicke’s encephalopathy
  • Antacids to relieve gastric pain
77
Q

What is the aetiology of polyhydramnios?

A

Either due to excess production due to increased fetal urination:
- Maternal diabetes mellitus
- Foetal renal disorders
- Foetal anaemia
- Twin-to-twin transfusion syndrome

Or insufficient removal can be due to reduced foetal swallowing:
- Oesophageal or duodenal atresia
- Diaphragmatic hernia
- Anencephaly
- Chromosomal disorders

78
Q

What is frank breech presentation?

A

Where the legs are fully extended up to the shoulders and the presenting part is the buttocks

79
Q

What is complete breech presentation?

A

Complete breech is where the hips and knees are both flexed and the presenting part is the buttocks

80
Q

What is footling breech presentation?

A

Footling breech is where one or both legs are fully extended towards the pelvic inlet with the foot or feet being the presenting part

81
Q

What is the best predictor for a successful VBAC?

A

A previous vaginal birth

82
Q

What existing mental health condition puts you at highest risk of puerperal psychosis?

A

Bipolar affective disorder

83
Q

What is the risk of faecal or flatal incontinence after Grade 3C tear?

A

40%

84
Q

Who should be offered cervical cerclage?

A
  • Women with singleton pregnancy and three or more previous preterm births should be offered
85
Q

After what gestation should amniocentesis be performed?

A

15+0 weeks

86
Q

After what gestation should Chorionic villus sampling be performed?

A

10+0 weeks and where possible, to reduce the risk of technical challenges, CVS should be performed from 11+0 weeks gestation onwards

87
Q

If suprapubic pain persists despite epidural what could this indicate?

A

Uterine rupture

88
Q

When do levels of bHCG typically peak and at what gestational ages?

A

In a singleton pregnancy, levels peak at around 10 weeks’ gestation at a concentration of approximately 100,000 mIU/mL.

89
Q

What organism is chorioamnionitis caused by?

A

Usually a polymicrobial infection involving multiple organisms ascending from the vagina into the uterine cavity

90
Q

What should a baby born to a mother with chronic hepatitis B receive?

A

HBIG and Hep B vaccination

91
Q

When are congenital syndromes related to viral infections most likely to occur?

A

First trimester

92
Q

Compared with non-pregnant women, where in the abdomen is the appendix located in the third trimester of pregnancy?

A

It is higher in the abdomen. In the third trimester, the appendix is located in the right mid to upper quadrant of the abdominal cavity

93
Q

At what gestational age is the amniotic fluid at its maximum?

A

Amniotic fluid volume is maximal at around 30–32 weeks’ gestation (800–1,000 mL). Thereafter, amniotic fluid volume decreases slowly to term (400–500 mL) and then more rapidly after 40 weeks.

94
Q

When do you get Monochorionic/monoamniotic placentation?

A

If the blastocyst divides between days 9 and 12 post-conception

95
Q

When do you get dichorionic/diamniotic placentation?

A

If the embryo divides before day 3 post-conception

96
Q

When do you get monochorionic/diamniotic placentation?

A

If the embryo divides between days 4 and 8 post-conception.

97
Q

What happens if embryo division occurs after 12 days post-conception?

A

The embryo never completely separates and a conjoined twin pregnancy results

98
Q

What is the single greatest cause of intrauterine growth restriction (IUGR) worldwide?

A

Malaria
the malarial parasites clog up the maternal lacunae preventing adequate exchange of oxygen and nutrients

99
Q

What are the layers for C-Section?

A

During a lower segment Caesarian section, the following lies in between the skin and the fetus:
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus

100
Q

What is the location of injury for Erb’s palsy?

A

C5-C6

101
Q

What should you use in suspected preterm labour before 24 weeks with a TVUS cervical length of <25mm

A

Vaginal progesterone - This decreases the activity of the myometrium and prevents cervix remodelling

102
Q

What is the defect you are most likely to see if Sodium Valproate has been used in pregnancy?

A

Hypospadias (0.7%)
Spina Bifida (0.6%)
Atrial septal defect (0.5%)
Cleft Palate (0.3%)
Polydactyly (0.2%)

103
Q

What antibiotics are given for PPROM

A

PO Erythromycin

104
Q

What is the combined test for Down Syndrome

A

Nuchal Translucency, Beta hCG, PAPP-A

105
Q

What is the Triple test for Down Syndrome?

A

AFP, unconjugated oestriol, hCG

106
Q

What is the Quadruple test for Down Syndrome?

A

AFP, unconjugated oestriol, hCG and Inhibin A

107
Q

When do you give Varicella-Zoster immunoglobulin ASAP without checking Antibodies?

A

Before 20 weeks of gestation

108
Q

What are the absolute contraindications to breast feeding?

A
  • Infants of mothers with TB infection
  • Infants of mothers with uncontrolled/unmonitored HIV
  • Infants of mothers who are taking medications which may be harmful e.g. amiodarone

Phase 3a Medicine🩺 (12 decks)

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