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Med School Finals > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

Gravidity vs parity?

A

G = number of pregnancies
P = number of births after 24+0 weeks

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2
Q

Trimesters of pregnancy?

A

First trimester = weeks 0-13
Second trimester = weeks 14-26
Third trimester = weeks 27-40

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3
Q

Types of foetal lie?

A

Longitudinal (~99.7%)
Transverse
Oblique

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4
Q

Management of transverse lie or Breech presentation?

A

< 36 weeks = advise should self-resolve
> 36 weeks = external cephalic version (ECV) or elective C-section

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5
Q

Causes of antenatal haemorrhage?

A

Placenta praevia
Placental abruption
Vasa praevia
Miscarriage
Ectopic pregnancy
Molar pregnancy

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6
Q

Placenta praevia vs placenta accreta?

A

Praevia = low-lying placenta
Accreta = placenta attached to myometrium

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7
Q

Features, investigation and management of placenta praevia?

A

Painless vaginal bleeding
Non-tender uterus
Foetal trace normal
Investigation = usually identified at anomaly scan, TVUS
Management = elective or emergency C-section (acute bleed)

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8
Q

When should women with a low-lying placenta be re-scanned?

A

32 weeks

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9
Q

Features and management of vasa praevia?

A

Painless vaginal bleeding
Rupture of membranes
Non-tender uterus
Foetal bradycardia or death
Management = emergency C-section

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10
Q

Features and management of placental abruption?

A

Painful vaginal bleeding
Tender, tense uterus
Foetal distress
PMH trauma or injury
Management = emergency C-section (foetal distress), observe or induced vaginal birth (no foetal distress)

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11
Q

Features, investigation and management of an ectopic pregnancy?

A

Painful vaginal bleeding
Recent amenorrhoea
Dizziness, syncope, shock
Investigation = TVUS
Management = expectant management (< 35mm, asymptomatic) or methotrexate (< 35mm, symptomatic), salpingectomy/salpingotomy (> 35mm, foetal heartbeat, bHCG > 5000)

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12
Q

Features, investigation and management of a molar pregnancy?

A

Painless vaginal bleeding
Large and bulky uterus
Abnormally high hCG
Hyperemesis gravidarum
Investigation = TVUS (“snowstorm sign”)
Management = suction or surgical curettage

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13
Q

Types of miscarriage and features?

A

Threatened = painless bleeding, os closed
Delayed = painless bleeding, dead foetus in sac, os closed
Inevitable = painful and heavy bleeding, os open
Incomplete = remnants left behind, os open

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14
Q

Management of miscarriage?

A

1st line = wait 7-14 days
2nd line = vaginal misoprostol
3rd line = vacuum aspiration or surgical management

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15
Q

Maximum gestation eligible for TOP?

A

24 weeks

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16
Q

Medical vs surgical management of TOP?

A

Medical = mifepristone (anti-progestogen) + misoprostol (prostaglandin) 48 hours later
Surgical = vacuum evacuation or D&E

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17
Q

Gestation of booking visit, early scan, Down’s screening, anomaly scan, anti-D injections for Rh -ve women?

A

Booking = 8-12 weeks
Early scan and Down’s screening = 10-13+6 weeks
Anomaly = 18-20+6 weeks
Anti-D = 28 weeks (first dose), 34 weeks (second dose)

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18
Q

Diseases screened for at the booking appointment?

A

HIV
Syphillis
Hepatitis B

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19
Q

Monozygotic vs dizygotic twins?

A

Monozygotic (“identical”) = one fertilised ova split into two
Dizygotic (“non-identical”) = two separate ova fertilised at same time

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20
Q

Lifestyle guidance for pregnancy?

A
  • Folic acid from before conception to 12 weeks
  • Aspirin from 12 weeks if at risk of pre-eclampsia
  • Vitamin D during pregnancy and breastfeeding
  • Low vitamin A intake e.g. liver
  • Should not drink or smoke
  • Avoid air travel after 37 weeks (singleton) or after 32 weeks (multiple)
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21
Q

NICE criteria for requiring iron supplementation in pregnancy?

A

First trimester = < 110g/L
Second and third trimester = < 105g/L
Postpartum = < 100g/L

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22
Q

Measuring the SFH?

A
  • From pubic bone to fundus
  • After 20 weeks should be within 2cm of gestational age e.g. 24 weeks = 22-26cm
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23
Q

Down’s syndrome screening investigations and features?

A

All 3 of:
→ nuchal translucency measurement
→ serum bHCG
→ pregnancy-associated plasma protein A (PAPP-A)

↑ bHCG, ↓ PAPP-A, thickened nuchal translucency

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24
Q

Management of women with a “high” risk of a foetus with Down’s syndrome?

A

Offer second screening test:
→ NIPT e.g. cffDNA
→ amniocentesis or CVS

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25
Oligohydramnios vs polyhydramnios?
Oligo = reduced amniotic fluid Poly = increased amniotic fluid
26
Features and management of pre-eclampsia?
Triad of: → new hypertension > 20 weeks gestation → proteinuria → other organ involvement e.g. liver disease, headaches, visual disturbances, epigastric pain Management = labetalol (1st line), nifedipine or hydralazine (2nd line)
27
Management of hypertension in pregnancy?
1st line = labetalol 2nd line = nifedipine or hydralazine
28
Feature and management of eclampsia?
Seizures Management = magnesium sulphate
29
How long should magnesium sulphate be given in eclampsia?
Until 24 hours post-seizure or post-delivery
30
Management of magnesium sulphate induced respiratory depression?
Calcium gluconate
31
Safest anti-epileptics during pregnancy?
Lamotrigine Levetiracetam
32
Features and management of HELLP syndrome?
Haemolysis Elevated liver enzymes Low platelet count Management = urgent delivery
33
Features and management of hyperemesis gravidarum?
Frequent N&V Ketonuria Dehydration Weight loss High beta-hCG Management = cyclizine or promethazine (long term), admission + IV saline with K+ (acute)
34
Complications of prematurity?
Increased risk of mortality Respiratory distress Chronic lung disease Intraventricular haemorrhage Necrotising entercolitis Retinopathy of prematurity Hypothermia, jaundice, infection
35
C-section categories?
Cat 1 = immediate threat to life of mother and/or baby, delivery within 30 mins Cat 2 = maternal or foetal distress which is not immediately life-threatening, delivery within 75 mins Cat 3 = mother and baby stable but delivery required Cat 4 = elective C-section
36
Vaginal birth after C-section success rate and contraindication?
70-75% women have a successful vaginal birth Contraindicated if PMH uterine rupture or classic C-section (longitudinal)
37
5 key features when assessing CTG?
Contractions Baseline rate (foetal HR) Variability (foetal HR) Accelerations/decelerations (foetal HR)
38
When do foetal movements first occur?
Prim = 18-20 weeks Multi = 16-18 weeks
39
Investigations for RFM?
Doppler scan Abdominal USS
40
Investigation and criteria for gestational diabetes?
OGTT → fasting ≥ 5.6 → 2-hour OGTT ≥ 7.8
41
Management of gestational diabetes (no PMH diabetes)?
Glucose < 7 = lifestyle modifications (1st line), short-acting insulin (2nd line) Glucose ≥ 7 or foetal complications = short-acting insulin Offer C-section at term e.g. 39 weeks
42
Management of gestational diabetes (PMH diabetes)?
Stop oral medication apart from metformin Commence short-acting insulin
43
Management of VZV exposure in pregnancy?
Check VZV antibodies ≤ 20 weeks and not immune = VZIG > 20 weeks and not immune = VZIG or aciclovir 7-14 days post-exposure
44
Management of group B strep infection in pregnancy?
Prophylactic benzylpenicillin if: → previous pregnancy with GBS → positive swab → preterm labour → pyrexia during labour
45
Investigations for baby born to a Rh -ve mother?
Cord blood taken at delivery → FBC, Coombs and ABO group
46
Investigations of preterm rupture of membranes?
1st line = speculum exam 2nd line = fluid PAMG-1 or insulin-like growth factor binding protein-1
47
Management of preterm rupture of membranes?
Admission Oral erythromycin (chorioamnionitis prophylaxis) Antenatal corticosteroids (NRDS prophylaxis)
48
Stages of labour?
Stage 1 = onset of true labour to fully dilated cervix → latent = 0-3cm → active = 3-10cm Stage 2 = from full dilation to foetal delivery Stage 3 = from foetal to placental delivery
49
Score used to assess if IOL needed and interpretation?
Bishop score < 5 = labour unlikely to start without induction ≥ 8 = ripe cervix with low need for induction
50
Options for IOL?
Membrane sweep before: → Bishop ≤ 6 = vaginal prostaglandin or oral misoprostol → Bishop > 6 = amniotomy + IV oxytocin
51
Types of perineal tear and management?
1st degree = skin torn (no repair) 2nd degree = perineal muscle torn (suturing on ward) 3rd degree = anal sphincter torn (theatre repair) 4th degree = rectum torn (theatre repair)
52
Management of shoulder dystocia?
Urgent senior help McRobert's manoeuvre
53
Main risk factor for umbilical cord prolapse?
Artificial rupture of membranes
54
Management of umbilical cord prolapse?
Push foetus back into uterus Keep cord warm and moist Fill bladder with 500ml Get mum on all 4s Tocolytics to stop contractions Definitive management = C-section
55
Tocolytic examples?
Indomethacin Nifedipine Magnesium sulphate Terbutaline
56
Most common cause of puerperal pyrexia and management?
Endometritis Management = admission + IV antibiotics
57
Causes of primary vs secondary PPH?
Primary (< 24 hours): → tone (atony = most common PPH cause) → trauma → tissue → thrombin Secondary (24 hours-6 weeks): → tissue → endometritis
58
Management of PPH?
ABCDE Rub the uterus Drugs = oxytocin/syntocinon (1st line), ergometrine, carboprost Surgery = balloon tamponate, ligation, hysterectomy
59
Anticoagulant of choice in pregnancy?
Low molecular weight heparin
60
Duration of maternal LMWH thromboprophylaxis?
Until 6 weeks post-partum

Med School Finals (18 decks)

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