Obstetrics Flashcards

Question

If mother isn’t immuned for rubella & varcilla, should they have vaccines in pregnancy?

Answer 1

Never, Mx is: - Avoid exposure - Postpartum immunisation

Answer 2

- Vaccine in pregnancy is OK - HBUG & HBV after birth

Answer 3

- Vaccine in pregnancy is ok - HBIG & HBV after birth

Answer 4

-Screening (Performed 24 to 28 weeks): 50 gram, one-hour glucose challenge test(GCT) - Diagnostic test: • 100-gram, three-hour oral glucose tolerance test (GTT) • Fasting for 6 hours • Baseline, one-hour(180) , two-hour (155) , and three-hour (140) glucose testing

Answer 5

- Tetanus - Influenza

Answer 6

بابا ينحب على الفا وبيتا وسيستر الي انفصل عنها - PPAAP,A - Inhibin A - AFP - BHCG - Unconjugated Estriol

Answer 7

1- Down (21) ~> Nuchal T + Inhibin A + BHCG الBHCG طويل في الي يكوله يصير منغولي لإن ينعوج حلكه ويظل ينحب 2- Edward (18) ~> Nuchal T 3- Ptau (13) ~> Determined by U/S Note/ In 1st trimester only U/S but in 2nd maternal lab

Answer 8

High: - Multiple gestation - Abdominal wall defects - NTD - Incorrect Dating Low: - Trisomy 21, 18 - Fetal demise - Incorrect dating

Answer 9

- Chorion villous sampling (10-13wks) لإن الماي قليل متكدر تسوي الجوا - Amniocentesis (15-20wks)

Answer 10

Reactive - 2 accelerations in 20m Non reactive - Insufficient accelerations after 40m DDx ~> (Sleep & Hypoxia) for baby and hypoglycaemia for mom Mx ~> Repeat after 30m & Vibroacoustic stimulation & U/S & Biophysical profile

Answer 11

- NST - 4 U/S parameters: Movement & Tone & Breathing & Amniotic fluid volume حركة بشدة عالية تخليك تعرك وتتنفس اسرع 6~> Repeat in 24hrs 0-4 ~> Delivery

Answer 12

- NST - Contraction stress test - Biophysical profile - Umbilical artery doppler - AF index

Answer 13

Determines flow velocity and direction • Flow should not stop and always be forward • Absent or backward diastolic flow = abnormal • Absence of end-diastolic flow velocity (AEDV) • Reversal of end-diastolic flow velocity (REDV) -fetal demise imminent (indicates urgent delivery)

Answer 14

- Irregular - Not increase in frequency & duration & intensity over time - Relieved by analgesics - Not associated with cervical changes

Answer 15

• Frank breech (50-75%): rear first,flexed hips,extended knees • Footling breech (20%): one or both legs first • Complete breech (5-10%): rear first, flexed hips and knees

Answer 16

- Thining & Shortening & Softening "Bloody show" • Blood-tinged mucous released vaginally • Associated with onset of effacement

Answer 17

• Clinical tool for assessment of cervix in pregnant women according to: - Dilation - Effacement - Position - Consistency - Station of fetus • Maximum score = 13

Answer 18

EFDI ERE • Engagement • Flexion • Descent • Internal rotation • Extension • External rotation = restitution • Expulsion

Answer 19

- Latent ~> 8-10 - Active ~> 4-6 (1cm per hour) - 2nd ~> 2 - 3rd ~> 30m

Answer 20

- Post date or term - Oligohydramnios - IUGR - IUD - PROM - Intrahepatic cholestasis - Maternal alloimmunization - Gestational diabetes at term - Twin beyond 38 weeks

Answer 21

- Complete placenta praevia or Vasa praevia - Transverse lie - Cord prolapse - Previous classical caesarean section or myomectomy - Fetal distress

Answer 22

- Tachysystole (may cause rupture or fetal hypoxemia) - Hyponatremia (Same action of ADH) - Hypotension (relaxes vascular smooth muscles) - Fatigue & Sleepiness

Answer 23

• Protracted latent phase (dilation<6cm) • Protracted active phase (dilation>6cm) - Dilation progress less than1cm/hour • Arrested active phase - No cervical changes in 4hrs despite efficient uterine contractions

Answer 24

- CPD - Malposition (OP) - Hypotonic concentrations - Inefficient mother’s push Note/ Intervention by Instruments or Oxytocin or CS

Answer 25

- Speculum (pooling of fluid in posterior vaginal vault) - Oligohydramnios in U/S - Amniocure - Nitrazzine test - Fern test

Answer 26

- Macrosomia - Dysmaturity syndrome - Oligohydramnios - Mortality

Answer 27

- Asymptomatic bacteriuria - UTI - Chorioamniotitis - Postpartum endometritis - Neonatal sepsis

Answer 28

- Positive culture for GBS - GBS infection during pregnancy - Hx of neonatal GBS infection - Preterm labour - PPROM - Prolonged ROM - Fever Note/ ABx given 4 hours prior to delivery

Answer 29

- Ampicillin or penicillin If allergy with low anaphylaxis risk ~> Cefazolin If allergy with high anaphylaxis risk ~> Clindamycin & Vancomycin

Answer 30

• Fever • Maternal leukocytosis • Maternal tachycardia • Fetal tachycardia (>160/min) • Uterine tenderness • Purulent or malodorous amniotic fluid • Rarely bacteremia (usually with GBS or E.coli)

Answer 31

- Broad spectrum ABx • Intrapartum: ampicillin and gentamycin • Cesarean delivery: add clindamycin or metronidazole - Prompt IOL or CS

Answer 32

- Early ~> Head compression - Late ~> Placental insufficiency - Variable ~> Cord compression or Oligohydramnios

Answer 33

- Hx of preterm labour - Polyhdramnios - Multiple gestation - Cervical insufficiency - Infection - DM - Smokinh

Answer 34

If more than 36wks ~> Delivery If less: - Steroids - Azithromycin + Ampicillin If has contractions or any signs of maternal of fetal distress ~> Delivery

Answer 35

- Cervical length in 13,16 weeks - Fetal fibronectin in 22, 34 weeks - Cervical dilation

Answer 36

• Beyond 34 weeks: admit and deliver • Before 34 weeks: - Maternal betamethasone (Tocolytic drugs to give steroids time to work) - GBS prophylaxis (penicillin, ampicillin or clindamycin) - Magnesium sulfate: neuroprotective (reduce risk of cerebral palsy according to ACOG)

Answer 37

• Often identified by falling serial hCG levels or ultrasound findings • Presents clinically as vaginal bleeding and pelvic cramping

Answer 38

• Fetal chromosomal anomalies • Maternal anatomic anomalies • Uterine fibroids • Uterine polyps or septa • Abnormal implantation • Corpus luteum failure • TORCH infections • Trauma Risks: - Age > 35 - Maternal (DM, HTN, Thyroid) - Smoking & Alcohol

Answer 39

Documented pregnancy & Closed OS & No RPOC on U/S & Vaginal bleeding with cramping

Answer 40

اثنينهم بيهم الم ونزف والطفل عايش بس عنق الرحم اذا انفتح يعني سيتم اسقاط

Answer 41

• Implantation at time menses • Cervical trauma during intercourse • Subchorionic haemorrhage (due to developing placenta)

Answer 42

- Mifepristone: progesterone antagonist • Causes endometrial degeneration • Only dispensed to limited facilities that perform terminations - Misoprostol: prostaglandin E1 analog • Causes uterine contractions • Must be hemodynamically stable • Must have no evidence of hemorrhage or infection

Answer 43

تجيك الأم تكلك مدا احس الطفل يتحرك فمن تفحص لا تسمع نبض للطفل ولا تشوف حجم الرحم يناسب عمر الطفل ومن تسوي سونار صدك يطلع ماكو نبض

Answer 44

• Fetal autopsy • Placental examination • Drug screen • Fetal chromosome testing • Testing for antiphospholipid syndrome • Testing for fetomaternal hemorrhage

Answer 45

فقط في حالة الأم تعمدت تسوي اسقاط ودخلت شغلات غريبة بجسمها فتشوفها جايتك مصخنة وبيها ريحة افرازات تشك الخشم

Answer 46

• Test of red cells in maternal circulation • Detects hemoglobin F in fetal red cells • Reports percentage fetal red cells in circulation

Answer 47

- More than 3 consecutive pregnancies - Causes: — Genetic — Uterus ~> Cervical insufficiency & Polyp & Fibroid & Adhesions — Immunological ~> APS — Endocrine ~> Hypothyroidism & DM — Haematological ~> Hypercoaguable state

Answer 48

- Obstetric Hx ~> Pregnancy loss with no Sx - Examination ~> Dilated & Effaced in early pregnancy - U/S ~> Cervical length < 25 mm

Answer 49

- Fallopian Tubes ( Ampulla > Isthmus > Fimbrae) - Abdomen - Cervix - Scar

Answer 50

• It is a sign of an underlying pathology that may be preexisting or appears for the first-time during pregnancy that is why it is also called as TOXEMIA OF PREGNANCY

Answer 51

• 300 mg/24 hour. • 100 mg/dl concentration or more in 2 random specimens taken 6 hour apart • +1 on dip stick method.

Answer 52

• Mild: diastolic blood pressure 90–99 mmHg, systolic blood pressure 140–149 mmHg • Moderate: diastolic blood pressure 100–109 mmHg, systolic blood pressure 150–159 mmHg • Severe: diastolic blood pressure ≥110 mmHg, systolic blood pressure ≥160 mmHg

Answer 53

- 18 > Age > 45 - APS & SLE - Hx in previous pregnancy or Family Hx or being Primi - MP & Molar - BMI > 35 & DM - Chronic hypertension - Chronic renal disease - Smoking - Booking proteinuria

Answer 54

sustained rise of blood pressure to 140/90 mm of Hg or more on at least two occasions 4 or more hours apart beyond the 20th week of pregnancy or within the first 48 hours of delivery in the absence of other findings suggestive of preeclampsia in a previously normotensive women Note/ if BP returns to baseline by 12 weeks postpartum = Transient hypertension of pregnancy Note/ ثلثهم يصيرون بريكلامسيا

Answer 55

• Measure blood pressure as clinically indicated • Reduce antihypertensive treatment if their blood pressure falls below 130/80mmHg • If a woman on methyldopa, stop 2 days after birth and change to alternative treatment if necessary • women who did not take antihypertensive treatment and have given birth, treatment if their blood pressure is 150/100mmHg or higher. • Offer all women medical review with their GP or specialist 6–8 weeks after birth

Answer 56

It is a multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mm of Hg or more recorded on at least two separate occasions and at least 4 hours apart and in the presence of at least 300 mg protein in a 24-hour collection of urine, arising de novo after the 20th week of pregnancy in a previously normotensive, non-protein uric women and resolving completely by the sixth postpartum week

Answer 57

Eye symptoms- blurring, flashing lights, dimness of vision or at times complete blindness. regained within 4-6 weeks following delivery

Answer 58

• BP<160 systolic and <110 diastolic with significant proteinuria and no maternal complications 2+ protein OR >300 mg proteinuria/ 24h

Answer 59

• admission is advised: • protein: creatinine ratio, the normal value In general is >30 equates to >300 mg proteinuria/ 24h • 2-hourly BP • 24 h urine collection for protein • Daily fetal assessment with CTG • Regular blood test (every 2-3 days unless symptoms or signs worsen) • Regular US assessment

Answer 60

• blood pressure of 160/ 110mmHg or more in the presence of significant proteinuria (>1g/24hor >or=2+ on dipstick) or if maternal complications occur

Answer 61

• Offer pharmacological treatment to all women. Aim for BP of 135/85 mmHg or less • Blood pressure measurement: Every 15–30 minutes until BP is less than 160/110 mmHg, then at least 4 times daily while the woman is an inpatient, depending on clinical circumstances • Dipstick proteinuria testing: Only repeat if clinically indicated • Blood tests: Measure full blood count, liver function and renal function 3 times a week • Strict fluid balance chart, consider a catheter • Fetal assessment: ultrasound assessment of the fetus, evidence of IUGR, estimate weight if severely preterm, assess condition using fetal and umbilical artery doppler • CTG monitoring of the fetus

Answer 62

Aldomate (appears after 48 hours): - Reduce Sympathetic drive - Dose: 250-500 mg every 6-8 hours up to a maximum dose of 4gm/day. - Loading single dose of 2 gm may act within 1-2 hours Hydralazine: - It is a vasodilator, increases renal and uteroplacental blood flow - Dose: Initially 5 to 10 mg by slow intravenous injection Nifidepine: - Can be given sublingually (acts within 10 minutes) or orally (acts within 30 minutes) in a - Dose: 10-20 mg 2-3 times daily

Answer 63

• reversed end-diastolic flow in the umbilical artery Doppler velocimetry • non reassuring cardiotocography, or IUD

Answer 64

• Before 34 weeks: - Continue surveillance, intravenous magnesium sulfate and a course of antenatal corticosteroids • From 34 to 36+6 weeks: - Planned early birth - Course of antenatal corticosteroids • 37 weeks onwards; Initiate birth within 24–48 hours

Answer 65

- In women who did not take antihypertensive treatment: • measure blood pressure at least 4 times a day while the woman is an inpatient • start antihypertensive treatment if blood pressure is 150/ 100mmHg or higher • Ask women about severe headache and epigastric pain each time blood pressure is measured - In women with pre-eclampsia who took antihypertensive treatment and have given birth: - measure blood pressure at least 4 times a day while the woman is an inpatient - every 1–2 days for up to 2 weeks after transfer to community care until the woman is off treatment and has no hypertension • Reduce antihypertensive treatment if their blood pressure falls below 130/80 mmHg • If a woman has taken methyldopa to treat pre-eclampsia, stop within 2 days after the birth and change to an alternative treatment if necessary • Measure platelet count, transaminases and serum creatinine 48–72 hours after birth

Answer 66

• It complicate 1-2% of preeclamptic pregnancies • May be the initial presentation of PE and may occur before hypertension or proteinuria • Ante - Intra - Post (within 48h)

Answer 67

- CABC - IV access - CBC & RFT & LFT & LDH & GUE - MgSO4 (watch for toxicity every 1h) - Antihypertensive if 160/110 - Foley catheter - Strict monitoring for Vital signs & CTG - Deliver once mom is stable (hird stage, 5-10U oxytocin, no Ergometrine because of increase BP)

Answer 68

MgSo4 for control of fits and preventing further seizures. Loading 4g over 5-10min followed by an infusion 1g/h for 24h. Further 2g if further fits

Answer 69

• ongoing or recurring severe headaches • visual scotomata • nausea or vomiting • epigastric pain • oliguria and severe hypertension • progressive deterioration in laboratory blood tests

Answer 70

Labetolol: 10 – 20 mg IV, then 20 – 80 mg every 20 – 30 minutes to a maximum dose of 300 mg Constant infusion 1 – 2 mg/min IV Hydralazine: 5 mg IV or IM, then 5 – 10 mg IV every 20 – 40 min Constant infusion 0.5 – 10 mg/h Nifedipine: 10 - 20 mg orally, repeat in 30 minutes if needed, then 10 - 20 mg every 2 - 6 hours

Answer 71

- Confusion - Loss of reflexes - Respiratory depression - Hypotension

Answer 72

• Stop MgSO4 • IV 1 g 10% calcium gluconate slow • Administer Oxygen

Answer 73

- 5-20% of preeclamptic pregnancies - Liver enzymes increase, platelets decrease before hemolysis occurs

Answer 74

Symptoms: • Epigastric or RUQ pain • Nausea and vomiting • Urine is tea-colored due to hemolysis Signs: • Tenderness in RUQ • Increase BP and other features of PE (Hypertension may be mild or even absent) • Eclampsia may co-exist

Answer 75

• Treatment is supportive and as for eclampsia (MgSo4 is indicated) • Although platelet levels may be very low, infusions only required if bleeding, or for surgery and <40

Answer 76

Do not use dexamethasone or betamethasone for the treatment of HELLP syndrome

Answer 77

The presence of HTN of any cause antedating or before the 20th week & beyond the 12w after delivery

Answer 78

• Ultrasound for fetal growth, amniotic fluid volume assessment, and umbilical artery doppler velocimetry at 28 weeks, 32 weeks and 36 weeks

Answer 79

Note/ If BP normal or low: no treatment - Weight management & Exercise & Diet - Aspirin 75 mg once daily from 12 weeks until 4w before delivery - Consider labetalol to treat chronic hypertension in pregnant women. Nifedipine for women in whom labetalol is not suitable, or methyldopa if both labetalol and nifedipine are not suitable

Answer 80

Do not offer planned early birth before 37 weeks to women with chronic hypertension whose blood pressure is lower than 160/110 mmHg, with or without antihypertensive treatment, unless there are other medical indications

Answer 81

• Enalapril to treat hypertension in women during the postnatal period, with appropriate monitoring of maternal renal function and maternal serum potassium • Nifedipine or Amlodipine if the woman previously used this to successfully control her blood pressure • Atenolol or labetalol to the combination treatment

Answer 82

- Weight loss - Muscle wasting - ketonuria - Dehydration - Electrolyte disturbance - ptyalism (inability to swallow saliva)

Answer 83

Obstetrical causes: • Multiple gestation • GTN Non obstetrical causes: • Renal problem :UTI (which often coincides with hyperemesis) • Electrolyte disturbance: hypercalcaemia • Endocrine : Addison’s disease & thyrotoxicosis & DKA • GIT: Cholecystitis & Appendicitis • Neurological: Raised intracranial pressure

Answer 84

- Missed abortion - IUGR - Preterm labour - Maternal hyponatraemia leading to central pontine myelinolysis - Thiamine deficiency leading to Wernicke’s encephalopathy

Answer 85

– Abdominal pain – Urinary symptoms – Infection, fever – Drug history – FBM – Vaginal bleeding – Headache – Chrome H.Pylori infection – Thyroid, DM

Answer 86

- CBC - U/S - Dipstick for ketonuria - TFT & LFT & RFT - Urea & electrolyte - Serum Glucose

Answer 87

● Continued nausea and vomiting and inability to keep down oral antiemetics ● Continued nausea and vomiting associated with ketonuria and/or weight loss (greater than 5% of body weight), despite oral antiemetics ● Confirmed or suspected comorbidity (such as urinary tract infection and inability to tolerate oral antibiotics)

Answer 88

- Cyclizine 50mg every 8h - Promethazine - Prochlorperazine

Answer 89

- Metaclopramide - Ondasetron

Answer 90

Corticosteroids

Answer 91

• Pyridoxine is not recommended for NVP and HG • Diazepam is not recommended for the management • Dextrose infusions are not appropriate unless the serum sodium levels are normal and thiamine has been administered

Answer 92

● Frequent small meal ● Good hydration ● Avoiding iron-containing preparations ● Rest with psychological support ● Ginger (1000mg): may be used by women wishing avoid antiemetic therapies in mild-moderate NVP ● Acustimulations : acupuncture, acupressure

Answer 93

- Antroposterior ( true conjugate) : 11 cm - Transverse (widest) : 13.5cm

Answer 94

TD, APD: 12 cm

Answer 95

1- Assess the sacrum ( straight or curved) 2- palpation of the sacrospinous ligaments,which should be of a length that will accommodate three fingers-breadths 3- Palpate side walls( concave, straight, converging) 4- prominence of ischial spines, & interspinous diameter

Answer 96

- AP: 13.5 cm (Widest) is measured from the lower part of symphysis pubis to the lower end of the sacrum (not the coccyx because it is a movable bone) - TD: is measured between the inner surface of the ischial tuberosities : 11cm.

Answer 97

- The intertuberous diameter can be determined by external palpation using closed fist. Intertuberous diameter should accept 4 knuckles on pelvic exam (10 cm) - Wide Sub-pubic arch (Broad), Accept ˃2 fingers

Answer 98

- Sacral promontory can not be felt - Diagonal conjugate: ˃11.5 cm - Curved concave sacrum - Ischial spines are not prominent - Interspinous diameter: ˃ 9.5 cm - Intertuberous diameter accept 4 knuckles on pelvic exam ≥10 cm - Wide Subpubic arch. Accept ≥ 2 fingers

Answer 99

- It is the angle that any pelvic plane makes with the horizontal - The angle of the inlet is normally 60 to the horizontal in the erect position More angle = delay the head entering the pelvis during labour

Answer 100

Imaginary curved line which shows the part which the fetal head follows during its passage through the pelvis during childbirth

Answer 101

Pelvic brim TD >>>APD Æ kidney shape Sacral promontory pushed forwards

Answer 102

Pelvic brim APD > TD Long & narrow pelvic canal with long, concave sacrum Divergent pelvic sidewalls

Answer 103

Pelvic brim is heart shaped or triangular Pelvis funnels from above downwards (convergent sidewalls) Prominent ischial spine Straight sacrum → contracted pelvic outlet Narrow pubic arch

Answer 104

TD diameter ˃ APD (inlet) Rounded—slightly oval inlet Straight pelvic sidewalls with roomy pelvic cavity Good sacral curve Concave Ischial spines are not prominent Wide subpubic arch ˃ 90 ̊

Answer 105

The bones of the vault (not joined) are frontal , parietal & occipital, temporal

Answer 106

- Occiput boney prominence behind post fontanelle - Vertex diamond shaped area between ant & post fontanelles & parietal eminences - Sinciput The area in front of the anterior fontanelle

Answer 107

1. Sagittal suture: between 2 parietal bones 2. Frontal suture: between 2 frontal bones 3. Coronal suture: between parietal & frontal

Answer 108

1.the anterior fontanelle: (bregma) 2.the posterior fontanelle: (lambda)

Answer 109

Ociipitofrontal 11.5 cm

Answer 110

Mentovertical 13.5cm

Answer 111

Submento vertical (bregmatic) 9.5cm

Answer 112

Half life of 6- 24 hr Peak in pregnancy at 9-11wk gestation يحافظ على الجستيشنال ساك حتى تتكون المشيمة

Answer 113

Urine: - By rapid dipstick test (1-2 min) - Detection limit of around 50iu/L - Positive 14 days after ovulation Blood: - Detection limit around 0.1-0.3 iu/L - It can detct pregnancy 6-7 days after ovulation

Answer 114

- TVS the GS can be visualized(2-4mm) around 4.4-4.6 wk(32-34 days) following the onset of LMP - Abdominal US, GS can be seen during the 5th wk post menstruation

Answer 115

Secondary yolk sac, which indicate a true gestational sac thus excluding the possibility of a peudosac or an ectopic pregnancy

Answer 116

Steroids cause S&W retention

Answer 117

A level of Hb≥ 11g/dl is adequate in 1st trimester A level of ≥10.5g/dl is adequate in 2nd& 3rd trimester A level of ≥10g/dl is adequate postpartum

Answer 118

Diaphragm is elevated 4 cm

Answer 119

• 1st stage and 2nd stage. - ↑ H.R because of Pain, maternal effort. - ↑plasma volume. Uterine contractions which seqeezes 300- 500 ml into maternal circulation

Answer 120

- Pear shaped, 6.5cm, 70 gm, Pelvic organ In pregnancy, oval shape, 32cm long, 1000gm (Hypertrophy & hyperplasia of muscle cells) - It has two parts: corpus body & cervix 3rd trimester uterus --- upper and lower segment - Uterine blood flow 700ml/min

Answer 121

Increase vascularity = Bluish discolouration of cervix

Answer 122

• In 1st half of pregnancy FBS reduced • In 2nd half FBS ↑( increased insulin resistance)

Answer 123

• Incidence :20% at 28 wks • 3-4% at term

Answer 124

• Maternal :fibroids ,congenital uterine abnormalities and uterine surgery • Fetal :multiple gestation ,prematurity ,fetal abnormality (anencephaly or hydrocephaly), fetal neuromuscular conditions ,oligohydramnios and polyhydramnios • Placental: placenta praevia

Answer 125

Performed at or after completed 37 wks

Answer 126

- Experienced obstetrician - Nifedipine - Left lateral tilt - Empty bladder - U/S Guidance - Shouldn’t last more than 10m - anti D should be given if the women is RH negative

Answer 127

• Fetal abnormalities like hydrocephalus • Placenta praevia • Oligohydramnios or polyhydramnios • History of APH • Previous cesarean or myomectomy scar on the uterus • Multiple gestation • Preeclampsia or hypertension • Plan to deliver by caesarean section

Answer 128

• placental abruption • premature rupture of membrane • cord accident • Transplacental haemorrhage • Fetal bradycardia

Answer 129

• Delivery of buttocks with episiotomy can be cut when fetal anus seen at maternal fourchette • Delivery of the leg by pinard manoeuver • Delivery of the body • Delivery of shoulders by Lovesets manoeuver • The head is delivered by Mawriceau Smellie Veit manoeuver or by using forceps

Answer 130

- secreted by amnion but by 10th weeks via the skin and umbilical cord - At 16th weeks gestation the fluid will mainly formed of fetal urine ,and lung secretion

Answer 131

From term there is rapid fall in volume

Answer 132

- Protect the fetus from mechanical injury - Permit movement of fetus and prevent limb contractures - Permit fetal lung development - Prevent adhesions between fetus and amnion

Answer 133

DVP = 8cm AFI = 25 cm (above 95 centile)

Answer 134

- 2/3rd are idiopathic - Fetal causes that is associated with impaired swallowing like esophageal atresia,duodenal atresia - Anencephaly - Twin to twin transfusion syndrome - Parvovirus B19 infection - Maternal causes like multiple pregnancies ,maternal diabetes mellitus and Rh incompatibility - Lithium

Answer 135

- Tx of the cause if possible - Amniodrainage - Assessing the risk of preterm labour due to uterine overdistension - Pharmacological like NSAID (indomethacin ) and sulindac

Answer 136

Maternal: Respiratory compromise - abdominal discomfort - APH - PPH - Preterm labour Fetal: Congenital malformations - Preterm birth - Increased perinatal morbidity and stillbirth umbilical cord prolapse - abnormal fetal presentation

Answer 137

AFI of less than 5 cm or DVP of less than 2cm

Answer 138

- Idiopathic - Preterm premature rupture of membrane - Birth defect like renal agenesis ,renal dysplasia and posterior urethral valve - Post term pregnancy >40wks - Placental dysfunction like placental thrombosis infarction and placental abruption - Maternal diseases like GDM ,preeclampsia ,chronic hypertension and connective tissue diseases - Drugs like ACE inhibitor and NSAID - Fetal chromosomal abnormalities

Answer 139

- Patient may give history of leaking liquor - The patient may give history of reduced fetal movement - Fundal height is less than the expected for corresponding gestational age - Uterus appear full of fetus - Examination by speculum may reveal leaking liquor

Answer 140

- U/S examination to assess AFI, DVP and Doppler study - Biophysical profile

Answer 141

Maternal: - Operative delivery - Preterm labour - Miscarriage Fetal: - Cord compression - Pressure deformities like club foot - Lung hypoplasia - Meconium aspiration - IUFD

Answer 142

- Maternal age <18 or >35 - Chronic disease – hypertension, diabetes, cardiovascular or renal disease, thyroid disorder - Preeclampsia - Rh isoimmunization - History of stillbirth - FGR - Postterm pregnancy - Multiple gestation - History of preterm labor - Previous cervical incompetence

Answer 143

• Sleep • Sound • Smoking • Drugs • Blood glucose level

Answer 144

- Monitoring the fetal heart rate in response to fetal movement • Reactive: 2 or more FHR accelerations at least 15 bpm with duration of at least 15 seconds in 20m • Nonreactive NST: reactive criteria not met within 30 minutes

Answer 145

• Applied to maternal abdomen for 2-5 seconds up to 3 times • Stimulates fetal movement - acceleration of FHR

Answer 146

• Records FHR response to stress of uterine contractions (Compress arteries to placenta) • Uterine Contractions induced by nipple stimulation or Oxytocin (Caution: may cause pt to go into labor!)

Answer 147

– Negative: 3 good contractions lasting 40 seconds in 10 minute interval with no late decelerations – Positive: persistent late decelerations with more than 50% of the contractions

Answer 148

• Early identification of pregnancy & dating & gender • FHR and breathing movements • Anomalies • Amniotic fluid index • Location of placenta and grading • Fetal death • Determination of fetal position and presentation • Accompanying procedures (ex: Amniocentesis)

Answer 149

• Amniotic fluid assessment • Biophysical profile • Umbilical artery & MCA Doppler

Answer 150

1) Fetal breathing movement 2) Fetal movement of body or limbs 3) Fetal tone 4) Amniotic fluid volume 5) Reactive NST with activity • Scoring: – 2 is given for normal – 0 is given for an abnormal finding – Between 8-10 is good

Answer 151

Absent or reversed velocities abnormal Note/ We use ut for anaemia & echo & preeclampsia & fetal wellbeing

Answer 152

– Genetics – Fetal lung maturity

Answer 153

حركته تقل بعدها الماي يقل لإن ميبول بعدها تغيرات بالدوبلر ومن ثم يموت

Answer 154

• Cellular hyperplasia.(8- 20w) symetric • Hyperplasia and hypertrophy (20-28) mixed • Hypertrophy only. (28-40) asymetric

Answer 155

• Head circumference, length and weight are all proportionally reduced • Causes: 1- chromosomal or genetics abnormality or anomalies 2- congenital infection 3- maternal cause ( age, weight, hypertension, smoking, alcohol abuse, thrombophilia, nutrition)

Answer 156

• Fetal weight is reduced , but normal length and head circumference

Answer 157

BPD & FL & Abdominal circumference = Type Amniotic volume & Doppler ultrasound = Mx

Answer 158

• Gestational age • Underlying etiology • Fetal condition

Answer 159

Steroids reduce the incidence of RDS, IVH and death

Answer 160

• Confirmation of IUFD • Base line investigation (Blood group , Rh, fibrinogen, CBC) • Induction of labor • Caesarean section

Answer 161

• Psychological support • Suppression of lactation (dopamine agonists) • Evaluation of the new born baby (اوديه للأطفال يشوفون شنو سبب الموت حتى اتجنبه بالأحمال السابقة)

Answer 162

- The anterior shoulder becomes trapped behind the symphysis pubis - The posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory

Answer 163

• Fetal Macrosomia • Maternal Obesity • Instrumental delivery • Anencephaly • Fetal ascites or congenital abnormalities

Answer 164

Once the head delivered it looks like it is trying to return to vagina, which is caused by reverse traction

Answer 165

H = Call for help E = Episiotomy L = Leg (McRobbert) P = Suprapubic Pressure E = Entermaneuver (Rubin & Clockscrew) R = Arm (Wood) Cleidotomy Zavenelli Craniotomy if baby is dead Note/ All done for 30s

Answer 166

- The vessel in the fetal neck are occluded after delivery of the head and cerebral damage will occur if delivery is delayed more than 5 minutes - Erbs palsy if traction - PPH - CS in next pregnancy

Answer 167

All pregnant women advised to take folic acid (0.4 mg, once daily) pre-pregnancy and antenatally

Answer 168

• To optimize pregnancy outcomes for women and babies • To prevent, detect and manage those factors that adversely affect the mother and baby • To provide advice, reassurance, education and support for the woman and her family • To deal with the ‘minor ailments’ of pregnancy • To provide general health screening

Answer 169

- BMI - BP - Dietary & Exercise advice - Investigations (CBC & B GROUP & RH & SICKLE CELL & THALASSEMIA & GUE & OGTT) - Infections screening (HBV & HCV & STI & RUBELLA)

Answer 170

If normal BMI = 11-16 If overweight BMI = 7-11 If obese BMI = 5-9

Answer 171

MATERNAL ANTENATAL: • Difficult to assess growth and anatomy of the fetus • Increase risk of GDM (3 times >BMI<30) • HT disorders of pregnancy • Risk of VTE Maternal intrapartum : • Difficulty with anesthesia • Difficulty with monitoring in labour • Increase instrumental delivery ,c/s rate • Shoulder dystocia • Maternal postnatal : • VTE risk • Wand break down and infection • Postnatal depression

Answer 172

1. Increase congenital malformations :NTD 3 times (folic acid 5mg /day) 2. Macrosomia 3. FGR 4. Miscarrage & Stillbirth 5. Increase risk of childhood obesity and diabetis

Answer 173

- IUGR - PRETERM BIRTH - MISCARRIAGE

Answer 174

This enables early initiation of treatment including antihypertensive agents and low-dose aspirin

Answer 175

- Blindness - Deafness - Intracranial calcification - Handicap - Mental retard

Answer 176

The infant should receive hepatitis B vaccine and one dose of hepatitis B immune globulin within the first 12 hours of life ,1 and 6 months of age

Answer 177

- Antiretroviral therapy (ART) by 24 weeks’ gestation - Planned elective c/s for those with viral load ≥400 HIV RNA copies/ml at 36wk gestation - Exclusive formula feeding

Answer 178

Best performed between 11+3 and 13+6 weeks’ gestation when the crown–rump length (CRL) measures between 45 and 84 mm

Answer 179

Serial cervical length screening with or without fetal fibronectin to detect increased risk of preterm birth

Answer 180

5mg for those with: Previous h/o NTD ,DM,SCA,OBESITY, EBELIPSY

Answer 181

• Excessive weight gain should be avoided • Rest with elevation of the legs to flex the hips • Massaging the back muscles • Analgesics and rest

Answer 182

- Supplementary calcium therapy after the principal meals may be effective - Massaging the leg - Local heat and vitamin B1

Answer 183

تاكل بسكت وتوست واطعمة غنية بالبروتين بس تبتعد عن الدهون وتخلي وجباتها frequent & small

Answer 184

- Taking plenty of fluids & milk & vegetables - Stool softeners

Answer 185

- Elastic crepe bandage during movements - Elevation of the limbs during rest

Answer 186

- Avoid overeating before bed - Antacids

Answer 187

- Laxative to keep the bowel soft - Local application of hydrocortisone ointment - Replacement of piles

Answer 188

اهم شي تسويه بأول ترايمستر هو الBooking visit وشغلاته ال5 وتدور انفكشن وتسوي سونار وتدور تشوهات وتحدد خطورة الحمل

Answer 189

- Having DM before pregnancy - Hx of GDM in previous pregnancy - Hx of macrosomia & Polyhydramnios - Family Hx of DM - High BMI

Answer 190

• Women with history of GDM should have 75mg OGTT at 16–18 weeks’ gestation • The test should be repeated at 24–28 weeks of pregnancy

Answer 191

The high prevalence of multiple pregnancy is explained by increasing use of assisted fertility

Answer 192

- All physiological changes like N&V and Heartburn exaggerated - HTN & DM - APH & PPH - PRETERM LABOUR, Especially if Di,Di - THROMBO EMBOLITIC DISEASE - IUGR - Fetal mortality as result of extreme prematurity

Answer 193

Yes, one theory is that older women have high FSH

Answer 194

- Number of fertilized eggs: zygosity (dizygotic 70% or monozygotic 30%) - Number of placentae: chorionicity - Number of amniotic cavities: amnionicity

Answer 195

Impn the dichorionic type there is an extension of placental tissue into the base of the inter-twin membrane, forming the lambda sign

Answer 196

- Dichorionic, Diamniotic have the two cavities are separated by thick three-layer membrane fused amnion in the middle with chorion on either side - The vast majority of monochorionic twins have two amniotic cavities (diamniotic) but the dividing membrane is thin, as it consists of a single layer of amnion alone

Answer 197

Di - Di = Before day 4 (shortly after fertilisation) Monochorionic - Diamniotic = Between 4 to 8 Mono - Mono = After 8 to 12 Conjoid = After 13

Answer 198

Regular ultrasound assessment is used to date the pregnancy, perform first trimester screening and to monitor growth every 2 weeks

Answer 199

Full blood count should be checked at 20 and 28 weeks’ gestation and supplementation with iron, folic acid or vitamin B12 initiated

Answer 200

المشيمة الواحدة ٣٠ لكل الف المشيمتين ٣،٨ لكل الف اي ان معدل الوفيات هو عشر اضعاف

Answer 201

- Fetal death of one twin in monochorionic twins may result in immediate complications in the survivor (Death or handicup) وبهذول يكون اصلا معدل نقص النمو اكبر وحتلو مات واحد حاول متجيب قبل ال٢٨-٣٠ - If dichorionic, intrauterine death of one fetus may be associated with the onset of labour

Answer 202

Monochorionic twin (10% of monochorionic diamniotic pregnancies and 5% in monoamniotic)

Answer 203

Single placental mass Concordant gender Oligohydramnios with maximum vertical pool (MVP) less than 2 cm in one sac Polyhydramnios in the other sac (MVP >8 cm) Discordant bladder appearances Haemodynamic and cardiac compromise

Answer 204

- Stage I: oligo and poly sequence and bladder of donor twin visible Dopplers in both twins are normal - StageII: oligo and poly sequence, but bladder of donor not visualized, Dopplers in both twins normal - Stage III: oligo and poly sequence, non-visualized bladder and abnormal Dopplers. There is absent/reversed end-diastolic velocity in the umbilical artery, reversed flow in a-wave of the DV or pulsatile flow in the umbilical vein in either fetus - Stage IV: One or both fetuses show signs of hydrops - Stage V: One or both fetuses have died

Answer 205

- Between 16 and 26 weeks’ gestation Fetoscopic laser ablation: Under ultrasound guidance a 2–3 mm diameter fetoscope is introduced into the amniotic cavity of the recipient twin. Following the laser therapy, the fetoscope is removed and an amnioreduction is performed until the amniotic fluid volume appears normal by ultrasound - Above 26 weeks, delivery may be considered

Answer 206

- Hospitalized from 28 weeks’ gestation and fetal heart auscultation performed several times daily using cardiotocography in an effort to detect signs of cord compression - Delivery by caesarean section generally at 32–34 weeks’ gestation - Congenital anomalies including neural tube defects and abdominal wall and urinary tract malformations & Discordant birthweight affects 20% of surviving twin

Answer 207

- 9 if monochorionic - 8 if dichorionic

Answer 208

- Dating U/S to accurately estimate GA (CRL), To determine chorionicity (number of placental masses and assessing for the lambda or Tsign and membrane thickness), To screen for Down’s syndrome - DV at 11–13 weeks’ gestation may help identify monochorionic pregnancies at risk of severe TTTS as reversed a-wave is associated with an increased risk of developing severe TTTS - Both amniocentesis and chorion villous sampling (CVS) can be performed in twin pregnancies, but in dichorionic pregnancies, it is essential that both fetuses are sampled

Answer 209

- Monozygotic twins are two to three times more likely to have structural defects than dizygotic twins or singleton fetuses. These include anencephaly and holoprosencephaly - In general only 1 affected so, if dichorionic do selected feticide but if monochorionic do cord occlusion

Answer 210

Growth assessments Multiple pregnancies are at high risk of FGR. As a result, fetal weight should be calculated from 20 weeks’ gestation at a maximum of 4 week intervals. A growth discrepancy of 25% or greater should be considered clinically significant

Answer 211

- Dichorionic twin pregnancies delivery from 37 weeks - monochorionic twin pregnancies should be offered elective delivery from 36 weeks

Answer 212

- Monochorionic triamniotic and dichorionic triamniotic triplet pregnancies be offered at least 11 antenatal appointments with a health care professional from the core team - It is not recommended to prolong pregnancy beyond 36 weeks’ gestation

Answer 213

- Hemoglobin level of less than 11 g/dL, or hematocrit less than 33%, the first or third trimester - Hemoglobin less than 10.5 g/dL, or hematocrit less than 32% in the second trimester

Answer 214

• Mild: 10-11 gm/dl • Moderate: 7-10 gm/dl • Severe: 4-7 gm/dl • Very severe: <4 gm/dl

Answer 215

• Hb: 10gm% • PCV: 30% • RBC: 3.2 million/mm3 • Peripheral smear showing normal morphology of RBC with central pallor

Answer 216

- Higher incidence of (PET, placenta previa, abruption, preterm labor or PROM) - Predisposed to infections like – UTI, puerperal sepsis - Poor weight gain - Dysfunctional Labour - Increased risk to PPH - Sub involution of uterus - Lactation failure - Maternal mortality – due to CHF & Cerebral anoxia & postnatal sepsis

Answer 217

- Symptoms weakness, fatigue, dyspnoea, palpitation, Loss of appetite, Digestive upset - Signs pallor, facial puffiness, tachycardia, tachypnea, Pale Tongue, Glossitis, stomatitis, chelosis, &brittle hair

Answer 218

- Age - Parity - Diet - Chronic bleeding - Worm infestation - Piqua - S&S of anaemia

Answer 219

Hb & Haematocrit, at first visit, 28-30 weeks & 36

Answer 220

- Pallor - Glossitis - Splenomegaly & Jaundice in hemolytic anemia - Purpura – bleeding disorder - Evidence of chronic disease – Renal, TB - Anasarca & signs of cardiac failure in severe cases

Answer 221

- Diet - MP or Short intervals between pregnancies - Piqua - Absorption defects (worm infestation, amoebiasis, giardiasis) - Increases loss

Answer 222

4-6 mg daily & 1000mg in total: - 2.5 mg/day in early pregnancy - 5.5 mg/day from 20-32 weeks - 6-8 mg/day from 32 weeks onwards

Answer 223

↓ ↓ Serum ferritin – first abnormal laboratory test ↓ ↓ Transferrin saturation – second to be affected ↑ ↑ Serum transferrin receptor – best indicator TIBC

Answer 224

- Oral iron therapy with 200 mg elemental iron with 5mg Folic acid / day Will improve the Hb by 0.8 gm in week

Answer 225

- Parenteral Iron therapy should be considered (Sucrose & Sorbitol & Dextran) - Parenteral therapy will take 4-6 weeks to reach their optimal effect

Answer 226

- Blood transfusion. - PCV transfusion, if available is preferred than Whole Blood خصوصاً اذا عندها مشاكل بالقلب

Answer 227

Recomponent EPO

Answer 228

- Non pregnant women –-------- 50 -100 microgram - Pregnant woman –-------- 300- 400 microgram

Answer 229

- Increased MCV (> 100 fl) - Peripheral smear: - Macrocytosis, hypochromia - Hypersegmented neutrophils (> 5 lobes) - Neutropenia - Thrombocytopenia - Low Serum folate level

Answer 230

- Vitamin B12 level < 80 pico g/ml - Vit B12 1mg I/M weekly for 6 weeks

Answer 231

The simultaneous development of two pregnancies: one within and one outside the uterine cavity

Answer 232

- Tubal factors (Ligation & Infection & Surgery (even abdominal) & Endometriosis) - IVF & Ovulation induction (PRG effect) - Uterine causes (IUD & uterine synechiae & multiple fibroids) - Age - Smoking

Answer 233

Amenorrhea Abdominal pain Vaginal bleeding

Answer 234

Speculum or bimanual examination should not be performed

Answer 235

- Sensitivity 90% and specificity of 95% in the diagnosis of EP - The presence of moderate to significant free fluid is suggestive of a ruptured EP

Answer 236

- In patients with EP, the rise of hCG is often suboptimal - 1500-2000 HCG & empty uterus & adnexal mass = EP

Answer 237

- A PUL is a working diagnosis defined as an empty uterus with no evidence of an adnexal mass on TVUSS (in a patient with a positive pregnancy test) Investigation of a PUL • consecutive measurement of serum hCG concentrations • An endometrial biopsy can occasionally be helpful when hCG levels are static • laparoscopy or laparotomy to visually confirm an ectopic pregnancy or PUL and other organs, This takes place in an operating room with anesthesia

Answer 238

• patient is hemodynamically stable and asymptomatic (and remain so) • less than 100 ml fluid in the pouch of Douglas • hCG less than 1000 iu/l at initial presentation • Adnexal mass less than 3cm

Answer 239

• No hemodynamic instability • No tubal rupture • Fertility desired • Gestational sac < 4cm • Beta HCG level < 5000mIu/ml • No cardiac motion on USG (nonviable fetus) • Ability and willingness to comply with follow up

Answer 240

- 50 mg/m2 - measured on days 4, 7 and 11, then weekly thereafter until undetectable

Answer 241

(1) chronic liver, renal or hematological disorder (2) active infection (3) Immunodeficiency (4) breastfeeding

Answer 242

- Avoid intercourse during Tx and 3months after it avoid conceive - Avoid sunlight exposure & Alcohol

Answer 243

- CBC / Low mcv & mch but normal mchc - Smear / nucleated RBC - Electrophoresis / HbA2 Minor & Hb F major Mx: - Parenteral iron should be avoided because of iron overload - If no respond to oral folate ---I/M folic acid - Blood transfusion close to time of delivery

Answer 244

Under hypoxic conditions, HbS polymerizes, gels or crystallizes leading to hemolysis of cells & thrombosis of vessels in various organs (due to necrosis) In long standing cases, multiple organ damage frequently occurs in pregnancy, puerperium & in state of hypoxia like general anesthesia G/A and Haemorrhage

Answer 245

- Infertlility - Abortion and still birth - IUGR & premature birth - Preeclampsia - placental abruption - Painful crisis

Answer 246

- Visit every 2 wks up to 28 wks and then weekly until delivery - Regular monitoring of Bp and urinalysis for proteinuria for early diagnosis of pre-eclampsia - Folic acid 5mg

Answer 247

Never, due to risk of hypertension

Answer 248

- Continue iron (if deficient) & folate therapy for 3 months after delivery - Take progestin only contraceptives

Answer 249

Never, mini pills only

Answer 250

1. History of previous prolonged pregnancy 2. Inaccurate dating 3. Anencephaly, fetal adrenal hypoplasia 4. Nulliparous / white ethnicity 5. Male fetus 6. Obese

Answer 251

- Labour dystocia - Shoulder dystocia - Increase operative delivery - PPH - C/S rate - Emotional impact

Answer 252

• Genetic: Chromosomal abnormalities (50%) • Luteal Phase Defect (LPD), Deficient progesterone, Thyroid abnormalities, Diabetes mellitus • Haemoglobinopathies • Infections but Spirochetes hardly cause abortion before 20th week because of effective thickness of placental barrier • Drugs/chemicals. methotrexate, some antiepileptic drugs • Immunological: Antiphospholipid antibody syndrome (APAS), autoimmune

Answer 253

• Cervical incompetence • Infection, may occur with or without ruptured membranes • Thrombophilias • Uterine abnormalities: submucous fibroids, uterine congenital malformation, uterine septa • Chromosomal abnormalities: may not become apparent until the second trimester. • Environmental: Cigarette smoking, alcohol, X-ray exposure, Contraceptive agents—IUD • Blood group incompatibility • Unexplained (M/C)

Answer 254

Pregnancy not located on scan where there is/has been a positive pregnancy test which subsequently becomes negative

Answer 255

Gestational sac with absent or minimal structure

Answer 256

• LMP: regularity, use of contraception around time of conception, (for calculating GA) • Symptoms: pain and/or bleeding. • Past obstetric and gynecological history may provide evidence for sexually transmitted infection or pelvic inflammatory disease. It is important to ascertain the last smear date and any history of cervical abnormality/colposcopic treatment • Past medical history: poorly controlled diabetes mellitus is known to be associated with miscarriage • Medication: prescribed, non-prescribed and recreational

Answer 257

- General: Vital signs - Abdominal: SFH & Site of pain & Internal bleeding - Vaginal: Cervix opening & Local causes of bleeding & Any cervical abnormalities

Answer 258

- CBC & Blood group & RH - Virology screening - U/S - HCG - PRG

Answer 259

13% decrease in 48h are associated with a possible ectopic pregnancy; and a decrease of more than 13% is associated with a failing pregnancy

Answer 260

Progesterone level equal to or below 10ng/mL predicted a non-viable pregnancy in 96.8% of cases

Answer 261

• A repeat ultrasound scan is not required to confirm completion • Women may be advised to take a urinary pregnancy test after 3 weeks and attend if it is positive

Answer 262

• PG E1 (misoprostol) 800 mg vaginally in the posterior fornix is given and repeated after 24h • Pretreatment with the progesterone antagonist mifepristone (if over 9 weeks’ gestation) • Post treatment Pregnancy test recommended • Surgical intervention may be needed if bleeding is heavy or medical Mx failed

Answer 263

- Failed Medical Tx - Hemodynamically unstable patient - Heavy bleeding - Patient’s preference

Answer 264

• Active Treatment: Before 12 weeks: D&C • After 12 weeks: The uterine contraction is accelerated by oxytocin drip • If the placenta is not separated, digital separation under general anesthesia

Answer 265

- Medical management: Tablet misoprostol 200 µg is used vaginally every 4 hours - Evacuation of the retained products of conception (ERCP) is done Early abortion: Dilatation and evacuation under analgesia or general anaesthesia Late abortion: Uterus evacuated under GA and products removed by ovum forceps or blunt curette - The removed materials are subjected to a histological examination

Answer 266

• Cervical or high vaginal swab for culture& sensitivity • CBC and blood for culture • ABO and Rh grouping. • Urine analysis including culture • Ultrasonography (utero-fallopian sepsis) • Plain X-ray

Answer 267

• Haemorrhage & Injury due to abortion process and also due to injury inflicted during interference • Spread of infection leads to Generalized peritonitis • Acute renal failure • Lungs: atelectasis, ARDS • Thrombophlebitis (Dic) • maternal deaths Remote: chronic debility, chronic pelvic pain and backache, dyspareunia, ectopic pregnancy, secondary infertility due to tubal blockage and emotional depression

Answer 268

• Injury to the uterus or to bowel • Foreign body in abdomen seen by U/S or X- ray or felt through fornix on bimanual examination • Unresponsive peritonitis suggestive of collection of pus. • Septic shock or oliguria not responding to the conservative treatment. • Uterus too big to be safely evacuated per vagina

Answer 269

• Genetic factors (3–5%): Parental chromosomal abnormalities • Endocrine and metabolic: DM, Presence of thyroid autoantibodies, Luteal phase defect (LPD) & PCOS • Infection • Inherited thrombophilia • Autoimmune Disease (APS) • Unexplained

Answer 270

lupus anticoagulant anticardiolipin antibodies anti b glycoprotein-I

Answer 271

Genetic - Anatomic - Endocrine - Haematological - Immunological - Infection

Answer 272

• Blood-glucose (fasting and postprandial), thyroid function test • VDRL for STI • ABO and Rh grouping (husband and wife) • Toxoplasma antibodies IgG and IgM • Autoimmune screening—lupus anticoagulant and anticardiolipin antibodies (APHS) • Serum LH on D2 /D3 of the cycle • Ultrasonography—to detect congenital malformation of uterus, polycystic ovaries and uterine fibroid • HAG in the secretory phase to detect cervical incompetence, uterine synechiae and malformation • Karyotyping (husband and wife) • Endocervical swab to detect chlamydia, mycoplasma and bacterial vaginosis

Answer 273

low-dose aspirin (75 mg/day) & low molecular weight heparin (LMWH) up to 34 weeks

Answer 274

- Dose of 50 µg (250 IU) as soon as possible and within 72 hours of the surgery - Anti-D immunoglobulin should be given to all non-sensitized RhD-negative women who have a spontaneous miscarriage after 12 weeks of pregnancy but not required for threatened, incomplete or complete natural miscarriage (unless non sensitised) and PUL

Answer 275

HbA1c of < 42 mmol/mol (4-7) without inducing hypoglycaemia ملاحظة/ هاي النسبة لازم تكون نفسها حتى تكدر تجيب ويطلع الطفل معنده هبوط

Answer 276

- The level of HbA1c in early pregnancy also correlates with the risk of early fetal loss - An HbA1c of >85 mmol/mol is associated with a fetal loss during pregnancy of around 30%

Answer 277

- Sacral agenesis - PDA & VSD - Spina bifida - Polyhydramnios & preterm birth - Lung hypoplasia - IUFD or Stillbirth - Macrosomia & Shoulder dystocia - Neonatal hypoglycaemia

Answer 278

Low-dose aspirin from 12 weeks’ gestation

Answer 279

Retinal screening at booking, 16–20 weeks’ and 28 weeks’ gestation

Answer 280

- PET - Retinopathy - Nephropathy - Infection - DKA - Instrumental delivery

Answer 281

- 7 times a day (before and 1 hour after meals) - Targets of with targets of <5.3 mmol/l and 1-hour postprandial levels of <7.8 mmol/l

Answer 282

In 2nd trimester increase the dose

Answer 283

19-20 wks Note/ increase the dose if you want to give steroids

Answer 284

between 38 and 39 weeks

Answer 285

- Age > 35 - Pregnancy itself - Multiparty > 4 - Smoking - Obesity - PET - APS - Infection - Thrombophilia - Operative delivery

Answer 286

Only in case of IVC blockage Note/ Bilateral edema more commonly caused by PET & Pregnancy itself

Answer 287

• Compression Doppler US • Venography (not used in pregnancy) • MRI • D –dimer non specific during pregnancy

Answer 288

Prevention: - Early mobilisation - Good hydration - Stockings Tx/ LMWH = 1mg per kg per day ملاحظة/ دي في تي وهي حامل مثلا 3 اشهر اول 10 ايام مرتين باليوم بكد وزنها بعدين لحدما تجيب 1 باليوم بكد وزنها

Answer 289

• For the whole duration of pregnancy • Following delivery we can convert to warfarin which is safe in breast feeding • Elastic stocking should be worn for 2 years following DVT to prevent post phlebitis syndrome

Answer 290

Haematoma Thrombocytopenia

Answer 291

- Tachypnoea - Dyspnoea - Haemoptysis - Pleuritic chest pain - Tachycardia - Cyanosis - Pyrexia - Syncope or varying degree of shock

Answer 292

• Chest X- ray, ECG, Blood gases • Compression Doppler US to exclude DVT • Ventilation-perfusion isotope lung scan (V/Q) • Spiral CT • CT angiography

Answer 293

- C A B C - Heparin (LMWH) 1 mg /kg/day *2 ( for 2 weeks) then switched to prophylactic dose of enoxaparin for the whole period of pregnancy

Answer 294

اذا جرعة وقائية (مرة باليوم) قبل ١٢ ساعة اما اذا دوائية (مرتين) قبل ٢٤ ساعة وبعد ٦ ساعات من العملية تكدر تبلش وارفرين اذا هي تستعمل اسبرين لازم ينكطع قبل ٤ اسابيع

Answer 295

Maternal: Trauma - Infection - Cervical causes Fetal: Vasa praevia Placental: Abruption & PRV

Answer 296

• Gravidity and parity/ gestational age • Amount of bleeding (clots) • Triggering factors (e.g. postcoital bleed) • Presence of abdominal pain or contractions • Fetal movement • Signs of anaemia • History of the same condition in this pregnancy or the previous one • Mode of delivery / any uterine surgery • Last cervical smear • Past medical history (hypertension) • Over distended uterus (multiple pregnancy, polyhydramnious) • IVF • Trauma • Smoking

Answer 297

• General look for signs of anaemia • Vital signs • Abdomen: soft- hard, tender, contraction • Fetal heart auscultation/CTG • Speculum vaginal examination (PL PRV)

Answer 298

• Full blood count, • Coagulation profile • Blood group & Rh • Renal function test • Ultrasound (fetal size, amniotic fluid, placental position and morphology)

Answer 299

• Previous history of abruption • Hypertension (including preeclampsia) • Smoking , cocaine • Trauma • polyhydramnios • Multiple pregnancy • Fetal growth restriction (FGR) • Thrombophilia (APS)

Answer 300

Clinical Dx: - Vaginal bleeding - Abdominal pain - Absence or reduced fetal movements - Sweating - Shock - Hypotension - Tachycardia - Tense painful abdomen

Answer 301

The absence of a tense abdomen or ultrasound changes does not rule out a placental abruption

Answer 302

• Multiple gestation • Previous caesarean section/ uterine surgery (curettage) • Uterine structural anomaly • Assisted conception • Increase maternal age • Submucous Fibroid • Endometritis

Answer 303

- The bleeding may trigger preterm labour so often patients with bleeding from placenta praevia will have irregular abdominal pain associated with uterine contractions - High SFH - Malpresentation

Answer 304

Delivery should be considered between 36+0 and 37+0 weeks

Answer 305

If after 16 weeks the placenta thought to be low lying (less than 20 mm from internal os) or praevia (covering the os) at the routine fetal anomaly scan A follow-up U/S examination including a TVS is recommended at 32 weeks of gestation to diagnose persistent low-lying placenta and/or placenta praevia

Answer 306

Depending on the depth of villous tissue invasiveness - Creta: without interposing decidua - Percreta: villi penetrate deeply into myometrium down to serosa - Increta: villous tissue perforates through the entire uterine wall

Answer 307

Either velamentous insertion of the umbilical cord or may be joining an accessory (succenturiate) placental lobe

Answer 308

Combination of both transabdominal and transvaginal colour doppler imaging (CDI) ultrasonography

Answer 309

Elective CS should be carried out prior to onset of labour at 34-36 weeks

Answer 310

Anaemia Infection Maternal shock Renal tubular necrosis Consumptive coagulopathy (DIC) Postpartum haemorrhage Prolonged hospital stay Psychological sequelae Complications of blood transfusion Preterm labour

Answer 311

● C A B C ● Oxygen by mask at 10–15 litres/minute ● Intravenous access (14-gauge cannula x 2) ● Position left lateral tilt ● Keep the woman warm ● Foley’ catheter ● Until blood is available, infuse up to 3.5 litres of warmed crystalloid solution (2 litres) and/colloid (1–2 litres) as rapidly as required ● Blood transfusion

Answer 312

• The Hb concentration above 8 g/dL • The pulse rate below 100 bpm • The systolic blood pressure above 100 mmHg • The platelet count above 75 *10 9 • The prothrombin and activated prothrombin times <1.5 * mean control • Fibrinogen >1 g/L

Answer 313

Blood replacement should be based on the amount of blood lost, the vital signs and the likely ongoing clinical scenario, not the haemoglobin

Answer 314

urgency of delivery in an interval from decision to delivery of 20 min or less

Answer 315

Cervix changes in consistency prior to the onset of labour: collagen content and cross‐linking decline and water content increases. The cervix becomes softer, shortens, moves forward, effaces and starts to dilate

Answer 316

- Membrane sweeping - ARM (amniotomy) - Oxytocin infusion - Vaginal prostaglandins (PGs) - Mifepristone (antiprogesterone) & misoprostol - Mechanical methods

Answer 317

عملية جداً امنة وسهلة كأنك تدخل اصبعك بين البرتقالة وقشرها وعادي يصير نزيف والم تسويها اسبوعياً بعد الاسبوع الأربعين

Answer 318

Opened cervical os (ripened cervix )

Answer 319

ROM whether artificial or spontaneous

Answer 320

- One cycle of vaginal PGE2 tablets or gel: one dose, followed by a second dose after 6 hours if labour is not established (up to maximum two doses) - One cycle of vaginal PGE2 controlled-release pessary: 1 dose over 24 hours اذا اكو سيرفكس مرتب وانطيته فتوصل ولادة خلال 24 ساعة والخطر من النزيف يكون اقل مقارنة بالARM & Oxytocin

Answer 321

• Extra‐amniotic saline solution infusion • Laminaria hygroscopic dilator • Extra‐amniotic foley catheter placement (Best option) • Cervical ripening balloon

Answer 322

Cardiotocograph should be performed to confirm that the FHR is normal prior to prostaglandin insertion

Answer 323

The cardiotocographic assessement should be repeated when contractions begin, normally 2–6 hours after PG administration PV every 6 hours to determine if there has been any change in the cervix

Answer 324

Breech presentation Preterm gestation Previous CS

Answer 325

- An ARM is still impossible after the maximum number of doses of prostaglandin have been given - If the cervix remains uneffaced and less than 3cm dilated after an ARM has been performed and oxytocin has been running for 6-8hours with regular contractions.

Answer 326

• pain • Failure • Uterine hyperstimulation • Cord prolapse • Emergency caesarean birth • Intrauterine infection • Increased risk of PPH • Increased risk of fetal distress • Risk of scar rupture in previous CS

Answer 327

• IOL before 34 weeks in absence of any additional risks • IOL for fetal growth restriction with confirmed fetal compromise • IOL for history of precipitate labour • Amniotomy, alone or with oxytocin, as a primary method of IOL

Answer 328

Acute event results in reduced or absent consciousness at any stage in pregnancy and up to 6 weeks after delivery

Answer 329

An obstetric modified early warning score (MEWS) chart should be used for all women undergoing observation

Answer 330

- 4H = Hypovolemia & Hypoxia & Hypothermia & Hypo/Hyper kalemia - 4T = TED & Toxicity & Tension pneumothorax & Temponade - Eclampsia - ICH

Answer 331

- Presents as collapse during labour or birth, or within (usually) 30 minutes of birth, in the form of acute hypotension, respiratory distress and acute hypoxia, Seizures and cardiac arrest may occur - هي لو يصير عندها فشل بالقلب لو تعديها بس تدخل بدايس وببتش

Answer 332

- 5 minutes or as soon as possible - This is for the benefit of the woman to improve the effect of resuscitation

Answer 333

- Direct death ~> Related to pregnancy so, if she’s not pregnant this will not happen - DVT direct but Cardiac disease (ischaemia and sudden arrhythmic cardiac death) not direct

Answer 334

- Ischaemia - Sudden arrhythmic cardiac death - Dissection of the coronary artery - Acute left ventricular failure - Infective endocarditis - Pulmonary oedema

Answer 335

Bacteraemia, which can be present in the absence of pyrexia or a raised white cell count, can progress rapidly to severe sepsis and septic shock leading to collapse يعني بدون اعراض

Answer 336

- Streptococcal groups A, B and D - Pneumococcus - Escherichia coli

Answer 337

- PROM & PPROM - Immunocompromised patients - Obesity - DM minority - Anaemia - UTI - Previous pelvic infection - Group A & B streptococcal infection - Amniocentesis - Cervical cerclage

Answer 338

- Obtain blood cultures prior to antibiotic administration. - Administer broad-spectrum antibiotic within 1 hour of recognition of severe sepsis - Measure serum lactate if 4 or more give crystalloid - If no response, administer vasopressors for hypotension that not respond to initial fluid resuscitation - Aim to achieve: mean arterial pressure (MAP) ≥ 65 mmHg (risk for pulmonary edema) central venous pressure (CVP) of ≥8 mmHg venous oxygen saturation ≥70% or mixed venous oxygen saturation ≥65% كل ساعة تتأخرها يزيد خطر الوفاة ٨

Answer 339

- Temperature >38ºC - 100 beats per minute - Respiratory rate >20 respirations per minute - White cell count >17 or 10% immature band forms

Answer 340

- Co amoxylav provides gram-positive and anaerobe cover - Clindamycin for streptococci & staphylococci - Gentamicin provides gram-negative cover against coliforms and Pesuodomonas - Metronidazole for anaerobs

Answer 341

MgSo4 in presence of renal impairment or another anaesthetic agent

Answer 342

- Rapid labor & delivery - Operative delivery - Episiotomy - Shoulder dystocia - Cesarean delivery - Uterine rupture - Macrosomic fetus - Obesity

Answer 343

• 1st degree: includes part of vaginal wall & perineal skin • 2nd degree: as 1st degree & the perineal muscles (include episiotomy) • 3rd degree: as 2nd degree in addition to injury to anal sphincter • 4th degree tears involves injury to anal sphincter extending into rectal mucosa (fecal incontinence)

Answer 344

PPH shock anemia (cervical incompetence & preterm labour) in future

Answer 345

- cervical dystocia - During labour with unproved way of removing cervical cerclage

Answer 346

1. Scar dehiscence 2. Neglected obstructed labour 3. Abuse of oxytocin for Induction or augmentation 4. Forceps use, fetal version 5. Rupture of rudimentary horn of the uterine cavity 6. Placenta percreta 7. Macrosomic fetus

Answer 347

- Maternal tachycardia - Restless agitated mother - Bandl′s ring between upper & lower uterine segment, also a strong, tetanic uterine contractions - Abnormal tenderness on the previous scar - Sudden change in FHR tracing (deceleration)

Answer 348

• Mother feel something bursts in her abdomen • stopping of uterine contraction (constant dull pain) • Fresh bleeding per vagina • Signs of internal or external haemorrhage (signs of shock are out of proportion to visible blood loss) • Fetal parts are felt superficially under the abdominal skin, & on PV exam. no presenting part • Absent fetal heart sounds • Haematuria (due to pressure of fetal head on bladder or ruptured uterus into bladder)

Answer 349

- Immediate resuscitation of ABC - prepare the mother for Immediate laparotomy to deliver the baby and repair the uetrus - IF the mother is grand multipara & she complete her family → hysterectomy (total, subtotal) - IF she is young & the uterus is reparable & she doesn't complete her family → repair - IF she is young & complete her family & the uterus is reparable → repair the uterus with sterilization

Answer 350

- CS - Forceps - Neglected obstructed labour (appear 1wk after delivery) - Uterine rupture - During Hysterectomy

Answer 351

Traction on peritoneal structures → vasovagal vasodilatation + neurogenic shock

Answer 352

1. Lax atonic uterus 2. Fundal insertion of the placenta 3. Short umbilical cord 4. Morbidly adherent placenta 5. Precipitate labour

Answer 353

- 1st degree:- fundus is turned inside out the uterine cavity, but not protrude outside cervix - 2nd degree:- = & protrude from cervix & lies within vagina butnot seen outside introitus - 3rd degree :- whole uterus is seen hanging outside the introitus

Answer 354

1. Resuscitate the patient (ABC) 2. Two intravenous lines should be started 3. Not to remove the placenta if it is still attached (this will increase bleeding) 4. Immediately replace the uterus through the cervix 5. If this fails, hydrostatic pressure can be applied by pouring warmed normal saline 4-5 L into the vagina 6. Tocolysis (to relax the cervical ring) & manual replacement under GA. when the uterus is replaced, keep the hand inside uterine cavity, give oxytocin & then separate the placenta if still attached 7. Last resort, surgery to reposition the uterus from above (pull on the round ligament & the assistance pushes the uterus from below) 8. If this fails, we do longitudinal incision posteriorly

Answer 355

- Beneath the skin covering the external genitalia - Beneath the vaginal mucosa - In the broad ligament

Answer 356

• Infralevator hematomas (ischiorectal fossa) Include those of the vulva & perineal as well as paravaginal hematomas • Supralevator haematomas (retroperitoneal space) Spreads upwards & outwards beneath the broad ligament or bulge into the walls of the upper vagina

Answer 357

If > 5cm Give ABx & Analgesics

Answer 358

Severe pain Shock Anaemia Infection

Answer 359

- Broad ligament hematoma may be treated either conservatively (expectant) with blood transfusion, fluid resuscitation, and observation - If it is not possible to maintain a stable haemodynamic state prompt surgical exploration is recommended & evacuation or hysterectomy may be indicated

Answer 360

حسب حجمها اذا اقل 5 كونسرفتف واسويلها ماركر بالجلد واخليلها كمادات بارده وانطيها مسكن اذا اكبر من 5 اسويلها درنج يعني افرغها وانطيها مسكن وانتيبايتك

Answer 361

Fitting + HTN after 20 weeks gestation may be attributable to eclampsia, notably where there is no known history of epilepsy

Answer 362

- There is significant intravascular volume redistribution, which can lead to decreased cardiac output - Acute ventricular failure and myocardial ischaemia may occur - Upper airway occlusion secondary to angioedema, bronchospasm and mucous plugging of smaller airways all contribute to significant hypoxia

Answer 363

1. sudden onset and rapid progression of symptoms 2. life-threatening airway and/or breathing and/or circulation problems 3. skin and/or mucosal changes (flushing, urticaria, angioedema)

Answer 364

Mast cell tryptase levels

Answer 365

- Look for chest movements, listen for breath sounds and feel for air movement for a maximum of 10m  If breathing is present, give high-flow oxygen  If breathing is absent, start ventilation

Answer 366

Minimize aorto-caval compression Minimize risk of aspiration

Answer 367

Absence of circulation

Answer 368

AVPU score (Alert, responds to Voice, responds to Pain, Unresponsive) Glasgow coma score (GCS)

Answer 369

GCS 8 or less Absent breathing

Answer 370

4 minutes, because delivery will help in resuscitation

Answer 371

- Every 4wks until 30 - Every 2wks until 36 - Weekly until delivery

Answer 372

- 1 in first trimester - 1 in second trimester - 2 in third trimester - 1 after delivery

Answer 373

- N&V - Pain - Bleeding - UTI - Infection - Folic acid

Answer 374

- N&V - Pain - Bleeding - UTI & Infection - Folic acid & Iron - Anaemia & Blood transfusion - HTN & DM - Fetal movement - Vaccinations

Answer 375

- Pain - Bleeding - UTI & Infection - Anaemia & Blood transfusion - Fetal movement - Edema - DM & HTN

Answer 376

• At home or hospital? • Onset? (gradual or sudden) • Duration?>>>>primigravida>>24hr,,,,,multipara>>16hr • Time • Characters of the pain? • Spontaneous? Induced? • Difficult or easy? • Vaginal delivery, cesarean section, episiotomy, forceps used or not

Answer 377

• Live or dead • Male or female • Weight of baby • Crying after birth • Infant movement • Cyanosis –jaundice – anemia – blood exchange • Fetal distress • Admission to the neonatal intensive care unit • Feeding (breast or bottle or mixed) • Neonatal care • APGAR score (Appearance – pulse – grimace – activity - respiratory effort)

Answer 378

- Appearance – Pulse – Grimace (irritability) – Activity – Respiratory effort

Answer 379

PPH DVT puerperal sepsis

Answer 380

- Date of marriage and her age at that time - Date of her first pregnancy - Interval between each pregnancy - Type of delivery and Place - Ask about the baby - Pureperium: Fever, bleeding, depression, breast feeding, any complication

Answer 381

• Any chronic disease (HTN, DM, Thyroid, Epilepsy, TED) • Consanguineous marriage • History of twin pregnancy or congenital anomalies or cerebral palsy • History of Genetic problems • History of malignancy in family • History of T.B or allergies or Bleeding disorders or psychiatric disorders

Answer 382

- Anaemia - Itching & Soreness - Thyroid disease

Answer 383

- Frequency & Intensity & Duration - Associated symptoms (VB, FM, fever, nausea, vomiting, dysuria, frequency)

Answer 384

- Primary within 24 hours of birth - Secondary PPH: abnormal or excessive bleeding from the birth canal between 24 hours and 12 weeks

Answer 385

Blood loss ≥2,500 ml Requiring a blood transfusion ≥5 units red cells Treatment for coagulopathy (DIC)

Answer 386

Anaemia & Hx of previous PPH & Full bladder & APH

Answer 387

Visually Weight - Scale Direct measurement

Answer 388

Left lateral tilt & Catheter

Answer 389

- To administer FFP at a rate to keep the activated partial thromboplastin:control ratio <1.5; - To administer packed platelets to maintain a platelet count >75 × 109/L; 4 - To administer cryoprecipitate to keep the fibrinogen level >1 g/L.

Answer 390

Platelets should be given if levels fall below 50 × 109/L

Answer 391

- Renal failure - Liver failure - DIC - Sheehan syndrome - Hysterectomy - Shock - Anemia & complication of blood transfusion - ARDS - Death

Answer 392

• CBC • B-hCG titer • High and low vaginal swabs & blood cultures if pyrexia • Pelvic USS may help to exclude the presence of retained products of conception

Answer 393

- Optimize haemoglobin prior to delivery - Active management of third stage of labour (AMTSL)

Answer 394

1. In less than one minute, administer uterotonic drug 2. Early cord clamping 3. Apply controlled cord traction 4. After delivery of the placenta, immediately start massaging the uterus 5. Examine the placenta to make sure it is complete and none of it has been retained in the uterus 6. Examine the woman’s vagina, perineum and external genitalia for lacerations and active bleeding

Answer 395

• Multiple pregnancy • Breech presentation and transverse lie • Placenta praevia and Morbidly adherent placenta • Mother-to-child transmission of maternal infections (HIV & HSV) • CPD • Fetal macrosomia > 4500 gm • VV fistula repair • More than 2 CS

Answer 396

• Category 1 – when there is immediate threat to the life of the woman or fetus – Perform category 1 CS within 30 minutes • Category 2 – when there is maternal or fetal compromise which is not immediately life threatening – Perform within 75 minutes • Category 3 – no maternal or fetal compromise but needs early delivery • Category 4 – delivery timed to suit woman or staff (elective)

Answer 397

- Joel Cohen: straight, transverse incision - Pfannenstiel: low transverse, curved, suprapubic incision 2cm above symphysis pubis - Vertical: usually midline sub-umbilical incision - Maylard

Answer 398

- Transverse lie with SROM and back presenting - Fibroids or Structural abnormality that makes lower segment approach difficult - Fetal abnormality (conjoint twin, hydrocephalus) - Ant PP & abnormally vascular lower segment - Mother dead & rapid delivery is required - Very preterm delivery

Answer 399

- Low risk of rupture & Haemorrhage & Infection - Better healing بي ريهه

Answer 400

- Admission and open file - Take detailed history - Explain to the Pt & husband all complications and obtain consent - Obtain consent for hysterectomy if risky patient - Obtain consent for tubal ligation as patient desires - CBC & Blood group & RH & Crossmatching of blood - Virology screen for HBV & HCV & HIV - Mode of anaethesia - Catheterize the bladder - Thromboprophylaxis - Prophylactic antibiotics before skin incision incidence of infection - Cut off anticoagulants - Control DM & Hypertension - Sodium citrate 20 ml , metoclopramide 10 mg IV - Fasting for 6-8 hrs

Answer 401

- Vital signs & blood loss must be monitored. - Uterine fundus palpated - Hydration - Analgesics - Remove urinary catheter once woman is mobile after a regional anaesthetic and not sooner than 12 hours after the last epidural ‘top up’ dose - Early mobilization - Deep breathing & coughing encouraged - Wound care - Breast care & feeding - Prophylaxis for thromboembolism - Offer early discharge

Answer 402

- Remove urinary catheter once woman is mobile after a regional anaesthetic - Not sooner than 12 hours after the last epidural ‘top up’ dose

Answer 403

- Anaesthetic complications - Bladder or bowel injury - Intra abdominal bleeding - PPH - Wound hematoma - Fetal injury

Answer 404

- Paralytic ileus - Infection - DVT

Answer 405

- Subfertility - Uterine rupture - Placenta accreta or preavia - Fistula

Answer 406

Period approximately 6 weeks following delivery

Answer 407

• After delivery uterus below level of umbilicus in the midline • The uterus lies in the pelvis after 2 weeks of delivery • At 6 weeks post delivery the uterus return to its normal size

Answer 408

- Lochia - Abdominal pain - Constipation - Dilation of cervix - Lactation - Secondary PPH - Thromboembolism - Pyrexia - Chest complication (24 hours post delivery) - Sepsis

Answer 409

- عندها ابزيوتومي فتخاف تروح للحمام - قبل العملية هي اصلا لا ماكلة ولا شاربة - من الألم متكدر تاكل

Answer 410

• During pregnancy , estrogen and progesterone secreted by placenta prepare the breast for lactation. Estrogen inhibit milk production until the end of pregnancy • After delivery of placenta , the E2 level decrease and stimulation of anterior pituitary to produce prolactine which result in milk production • Suckling stimulate oxytocin release which cause milk ejection

Answer 411

• Temperature of 38 C or more on any two of the first 10 days postpartum

Answer 412

• Chest complication (pneumonia & atelectasis) • Genital tract infection (wound infection including episiotomy) • Urinary tract infection • DVT • Mastitis

Answer 413

اكلها تكح وتضرب ع ظهرها او تكلها احسبي من 1 لل10 واذا عندها بلغم اكلها طلعيه

Answer 414

• Malaise, headache, rigour • Fever & Tachycardia • Vomiting and diarrhoea • Abdominal discomfort (Uterus is boggy and tender) or Peritonism • Offensive lochia • Secondary PPH • Infected wound • Paralytic ileus • PV mass fulling in the adnexia - abscess

Answer 415

• Antenatal intrauterine infection • Caesarean section • Cervical circlage • Prolong rupture of membrane, prolong labour • Multiple vaginal examination • Instrumental delivery • Obesity, DM, HIV • Manual removal of placenta, retained POC

Answer 416

• CBC (leukocytosis) • Urea and electrolyte (sepsis may lead to RF) • HVS (swap) • US (abscess) • Clotting screen (DIC) • Arterial blood gas analysis

Answer 417

• Mild to moderate ~> oral broad spectrum antibiotics ( co- amoxiclav + metronidazole) • Severe infection (septicaemia, septic shock) need intensive care admission and MDT • Necrotizing fasciatis ~> need debridement of necrotic tissue under GA and skin graft later on

Answer 418

- Single intraoperative dose of (amoxiclav or cephalosporin + metronidazole) - Either 4h before delivery or after cord clamping

Answer 419

* Prevention of perineal lacerations by anatomical incision and repair of the episiotomy * = prolonged and overstretch of perineum which predisposes to prolapse and stress incontinence * Minimising compression and decompression of the head which causes intracranial haemorrhage

Answer 420

- Less blood loss - Easier to repair - Heals quickly - Less pain in postpartum period - Less dyspareunia

Answer 421

* Fetal distress * Short or inelastic perineum * Shoulder dystocia *Fetal malposition e.g. occiput post * An instrumental * Breech delivery * Previous pelvic floor surgery

Answer 422

Now the recommendation is to use mediolateral episiotomy but also must begin in midline and suture 1cm above the apex

Answer 423

- Hx of same condition - Infection - APH - DM - Polyhydramnios - Macrosomia - Cervical insufficiency - MP - Trauma - Smoking

Answer 424

• 1ry only • Maternal 1ry infection usually asymptomatic or appear as: - Lymphadenopathy & Fever & chills & sweats

Answer 425

• Hydrocephalus • Chorioretinitis (inflammation of choroid in eye) • Intracranial calcifications (often on prenatal US imaging)

Answer 426

• Pyrimethamine - sulfadiazine • leucovorin (used for the 2 above) • Spiramycin (2-3g /day until delivery)

Answer 427

• Sensorineural deafness • Congenital cataracts • Cardiac malformations (classically PDA) • Purpuric skin lesions (blueberry muffin baby) • Microcephaly • Intellectual disability • Autism

Answer 428

Dx: rubella IgM/IgG or viral culture Prevention: MMR prior to pregnancy (live vaccine)

Answer 429

Presence of 100,000 bacterial colonies per ml in freshly voided urine by mid stream clean catch sampling

Answer 430

Nitrofurantoin 100 mg, ampicillin or cephalexin 500 mg for 7- 14 days

Answer 431

- Hospitalization, intravenous hydration should be started to get UOP> 30 ml/h - Culture & Intravenous antibiotics as cephalosporines, gentamicin or ampicillin 1g /6h - Repeat culture after 1 wk from Tx - Opiate analgesia can also be given - The fetus should be followed up by CTG or US to detect IUGR& oligohydramnios

Answer 432

■ Nothing ■ Miscarriage – from fetal infection or maternal pyrexia ■ Congenital malformations ■ Intrauterine growth restriction ■ Preterm labour and delivery ■ Neonatal sepsis/infections

Answer 433

Streptococcus agalactiae

Answer 434

■ Intravenous penicillin 3g as soon as possible after the onset of labour and 1.5g 4-hourly until delivery ■ Clindamycin 900 mg intravenously 8-hourly to those allergic to penicillin

Answer 435

Bacterial vaginosis

Answer 436

■ ฀Thin, gray or white homogeneous vaginal discharge ■ ฀Increased vaginal discharge odor (fishy) after intercourse ■ ฀Alkaline pH (> 4.5); ■ Bacterial vaginosis does not cause vaginal itching or dysuria

Answer 437

Metronidazole(Flagyl) 500mg orally twice daily for 7 days

Answer 438

Bacterial vaginosis

Answer 439

■ Vaginal and vulvar irritation (erythematous and oedematous) ■฀Pruritic, white, curd cheesy vaginal discharge ฀ ■ Yeasty odor ■฀Dysuria ฀ ■ Dyspareunia ■ Wet mount microscopically examined: shows hyphae, pseudohyphae and budding yeast ■ ฀Usually pH more than 4.7

Answer 440

Antifungal drug intravaginally such as clotrimazole, miconazole or terconazole

Answer 441

■ ฀Vaginal discharge: may be profuse purulent and yellow green ■ ฀Itching or swelling of vulva ฀ ■ Dysuria ■ ฀Dyspareunia ■ ฀Joint and tendon pain ■ ฀Anal discharge, discomfort and pain with rectal infection

Answer 442

PCR High vaginal swap Endocervical culture

Answer 443

■ cefixime, 400 mg orally ■ one dose of Ceftriaxone, 125 mg intramuscularly

Answer 444

Gonococcal ophthalmia, which can cause blindness

Answer 445

Dx: NAAT Tx for pregnant woman: One gram of oral azithromycin (1 dose) Tx for baby: Oral Erythromycin

Answer 446

Diagnosis: ■฀Enzyme immunoassay ■ Western blot test ■ Immunofluroscence assay ■ Immunoglobulin PCR

Answer 447

■ ฀Breast feeding should be prevented ■ ฀Zidovudine syrup, 2mg/kg, given to the neonate 4 times daily for first 6 weeks of life

Answer 448

■ Zidovudine IV infusion starting at onset of labour or 4 hours before CS until cord clamping is done ■ Amniotomy and oxytocin augmentation for vaginal delivery should be avoided whenever possible ■ Elective caesarean delivery is recommended at 38 weeks of women receiving HAART

Answer 449

- Poor progress - Fetal malpresentation or makposition - Multiple gestation - Uterine scar - IOL

Answer 450

Failure to progress

Answer 451

Cervical dilatation of less than 2 cm in 4 hours

Answer 452

Dysfunctional uterine activity

Answer 453

- Hydration - Good pain relief - Emotional support - Repeat vaginal examination 2,rather than 4, hours after the last, If delay is confirmed = ARM - If there is still poor progress in a further 2 hours = oxytocin infusion to augment the contractions - If still poor progress after 4 to 6 hours = CS

Answer 454

Malposition of the fetal head

Answer 455

Multiparous woman where CPD is suspected

Answer 456

Yes, as long as CTG is reactive

Answer 457

Non-compliant cervix which effaces but fails to dilate

Answer 458

Delay is diagnosed if delivery is not imminent after 2 hours of pushing in a nulliparous labour (1 hour for a parous woman)

Answer 459

2ry uterine inertia

Answer 460

- Rehydration and intravenous oxytocin Full assessment of the patient: - General = vital sign ,assessment of the patient contraction ,sign of obstructed labour - Vaginal exam = presentation ,position ,engagement ,presence of caput ,moulding, vaginal dryness - If there is no contraindication deliver the patient by assisted vaginal delivery - If there any contraindication ,fetal distress ,sign of obstructed labour C/S is indicated

Answer 461

Poor progress in the active phase of labour (2 cm cervical dilatation/4 hours)

Answer 462

Progress in active phase of 1st stage initially good but then slows, or stops typically after 7cm dilatation

Answer 463

■ Malaise ■ Myalgia ■ Persistent fever ■ Cervical lymphadenopathy ■ Pneumonitis ■ Hepatitis

Answer 464

Parvovirus B-19 CMV

Answer 465

■ Low avidity indicates recent infection (within 18-20 weeks) ■ High avidity indicates past infection (12-16 weeks) ■ Avidity performed before 16-18th week identifies 100% of infected fetuses

Answer 466

■ PCR searching for DNA Note/ Amnocentesis can be used also

Answer 467

■ Ganciclovir ■ Cidoforvir

Answer 468

اذا تجي وحدة عندها HSV-2 واول مرة تنصاب حتكون كلش خطيرة اصابتهم ننطيهم acyclovir ابو ال200 على 4 مرات باليوم لمدة اسبوعين

Answer 469

اذا 4 ساعات وما طاك الممبرين جيبها قيصرية بس اذا طك اكثر من 4 ساعات خلص العدوى انتقلت فجيبها طبيعي

Answer 470

■ PCR ■ Fetal hydrops ■ Doppler US of MCA Tx: Transfusion

Answer 471

Before 20wks … 25% After 20wks … 1%

Answer 472

- Electron microscopy - Culture of fluid from vesicles - Viral PCR for quick results

Answer 473

V-Z (chickenpox)

Answer 474

■ Give VZ immunoglobulin - effective up to 10 days after contact (most effective within 3-4 days) ■ Manage as potentially infectious from 8-28 days after ■ Protection is only for 3 weeks maximum

Obstetrics Flashcards

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