Obstetrics Flashcards by Bethany Norman

3 most important investigations at the booking visit?

Blood pressure, dipstick, BMI

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When is the booking visit?

8-10w

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3 infectious diseases screened at the booking visit

Hep B, HIV, Syphilis

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When is the dating scane

10 - 13+6 weeks

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When is the anomaly scan

18-20+6w

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When are the first and second doses of anti-d given

28w and 34w

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When does hcg start to be secreted and what is it secreted by

day 8 by the syncytiotrophoblast

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6 people who need high dose folic acid
what is the dose

5mg
previous child with NTD
DM
BMI above 30
Antiepileptic medication
HIV +ve
Sickle cell

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Quadruple tests for downs
is PAPPA raised or reduced

DOWNS
Reduced AFP
Reduced Oestriol
Increased hcg
Increased inhibin A
Reduced PAPPA

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Quadruple test for edwards

EDWARDS
Reduced AFO
Reduced Oestriol
Reduced hcg
Stable Inhibin A

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First line investigation for gestational diabetes

OGGT at 28w

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When do you get your first OGGT if you have a pmhx of gestational diabetes

soon after booking

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Cut of levels for FASTING glucose and 2-HOUR glucose

Fasting 5.6
2-Hour 7.8

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When would you immediately start insulin

If the fasting glucose is above 7

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First line investigation if chicken pox exposure in pregnancy

Check antibodies

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Treatment if negative antibodies and chicken pox exposure

1 dose of VZ Ig
Over 20w and present in 48hrs - oral aciclovir

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What happens to urea, creatinine and hb in normal pregnancy

ALL REDUCED

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Increased AFP can indicate what

Abdominal wall defects

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2 normal changes to urine in pregnancy

Increased urinary protein loss and glucose

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painless PV bleed at 6-9w

threatened miscarriage

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light PV bleed and pregnancy sx disappear

missed (delayed) miscarriage

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heavy bleed and crampy abdominal pain in early pregnancy

Incomplete inevitable miscarriage

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light bleeding in early pregnancy

Complete inevitable miscarriage

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shoulder tip pain and cervical excitation

Ectopic Pregnancy

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Sequale of ectopics

Abdo pain then PV bleed

why is T4 raised in a molar pregnancy

hCG mimics TSH

constant lower abdo pain with a WOODY abdomen on examination, disproportionate shock and distressed foetal heart rate

placental abruption

increasing age, increasing parity, trauma, cocaine and polyhydramnios are all risk factors for what

placental abruption

what condition can progress to DIC

placental abruption

painless PV bleeding and shock in proportion to blood loss

placenta praevia

gold standard investigation for placenta praevia

transvaginal ultrasound

when would you refer for lack of foetal movements

24w

management of a low lying placenta found on the anomaly scan

rescan at 32w

Sequale of vasa praevia

ROM followed immediately by PV bleeding and foetal bradycardia

explain the difference between placenta accreta, increta and percreta

Accreta: chorionic villi attach to myometrium Increta: chorionic villi into the myometrium Percreta: chorionic villi into perimetrium

when can gestational hypertension be diagnosed

after 20 weeks

management of a lady with bp of 160/110

admit regardless of proteinuria

Define pre-eclampsia

new onset blood pressure above 140/90 AND proteinuria OR organ dysfunction

age above 40, renal disease, multiples, BMI above 40 and HTN increase the risk of what

pre eclampsia

management of women with SLE/antiphospholipid

75mg aspirin daily to prevent pre-eclampsia

management of eclampsia

MAGNESIUM SULPHAE until 24 hours post delivery/last seizure

increased liver and enzymes and jaundice

acute fatty liver

uterine tenderness and foul smelling discharge

choramnionitis

intense pruitis with RUQ pain, jaundice, steatorrhoea and increased bile acids

Intrahepatic cholestasis of pregnancy

Management of intrahepatic cholestasis of pregnancy

URSODEOXYCHOLIC ACID induction at 37-28w as increased stillbirth risk

what is the main complication of induction

uterine hyperstimulation

sudden collapse after artificial rupture of membranes

amniotic fluid embolism

sudden collapse after artificial rupture of membranes

amniotic fluid embolism

main cause of cord prolapse

artificial rupture of membranes

management of cord prolapse

retrofill bladder with saline minimal handling keep cord warm and moist to reduce vasospasm

first line investigation for pprom

speculum exam for pooling of amniotic fluid in posterior vaginal vault

abx after pprom

10 day erythromycin

pyrexia above 38 during labour

risk of GBS benzylpenicillin

observation of baby if +ve GBS?

24 hours

Explain the 4 categories of c-sections

1: Immediate threat to life, deliver in 30 min 2: Compromise, deliver in 75 min 3: Delivery needed but mum and baby stable 4: Elective

Contraindication to VBAC

classical s-section scar

define pph

blood loss of over 500ml

most common cause of pph

uterine atony

management of shoulder dystocia (5 steps)

1. mcroberts: hyperflex legs on abdo & suprapubic pressure 2: woods screw: hand in vagina and turn 3: rubin: press on posterior shoulder 4: try on all 4's 5: push head in and c-section

4 classifications of perineal tears

1st degree: tear in vaginal mucosa (no repair) 2nd degree: tear into perineal muscle (midwife suture on ward) 3rd degree: a. 50% external sphincter b. 100% external sphincter c. internal sphincter (dr repair in theatre) 4th degree: through sphincter to rectal mucosa (dr repair in theatre)

can you have a vaginal delivery if you have HIV

Yes - if the viral load is less than 50 copies/ml at 36w

can you breastfeed with HIV

How much weight does a baby have to lose for referral to the midwife led breast feeding clinic

10% in first week

can you breastfeed with Hep B

YES

how would ROP present

absent red reflex

management of baby when mum is hep b positive

Ig within 12 hours Vaccine after birth, 1m and 6m

investigation for lochia beyong 6w

Ultrasound

management of magnesium sulphate induced respiratory depression

calcium gluconate

DOAC in pregnancy?

Contraindicated - switch to LMWH

epidemiology of baby blues, postnatal depression and puerperal psychosis

baby blues 60-70% postnatal depression 10% puerperal psychosis 0.2%

women presents 3-7 days pp and is anxious, tearful and irritable

baby blues - reassure

women presents 1-3m pp with depressive sx

postnatal depression

management of postnatal depression

CBT Sertraline or Paroxetine (safe in breastfeeding)

women presents 2-3w pp with severe mood swings and disordered perception

puerperal psychosis

management of postpartum thyrotoxicosis

propanolol

medication to supress lactation

carbegoline

medication that causes folic acid deficiency

phenytoin

define station

head in relation to the ischial spine 0 is directly on it -2 2cm above and +2 is 2cm below

what do you monitor in DVT

factor xa

Indications for continuous CTG monitoring

Drugs that are safe and unsafe in breastfeeding