Obstetrics Flashcards by Belle Storey

Name 2 situations where placenta praevia is more commonly found

Twin pregnancies
Multiparity
Older pregnant women
Previous C section

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What is the definition of antepartum haemorrhage?

Bleeding from the genital tract after 24 weeks pregnancy prior to delivery

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Other than placenta praevia, name 2 other causes of antepartum haemorrhage in the 3rd trimester

Placental abruption
Vasa praevia

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Why is vaginal examination never performed in suspected placenta praevia?

Can provoke massive bleeding

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In antepartum haemorrhage, name 3 investigations you would perform/request?

Cross match
Rhesus status
CTG

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If a woman is rhesus NEGATIVE, what treatment would you administer in antepartum haemorrhage?

Anti-D immunoglobulins

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Except vaginal blood loss, what will a patient likely also be experiencing in placental abruption?

Constant lower abdo pain
Shock out of keeping with visible blood loss

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What is placental abruption

Separation of a normally sited placenta from the uterine wall resulting in maternal haemorrhage into the intervening space

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What do you expect the lie and presentation to be in placental abruption

Normal lie and presentation

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Name 2 major risk factors for placental abruption

Placental abruption in previous pregnancy (**)
Cocaine use
Proteinuric hypertension e.g. pre-eclampsia
Abdominal trauma
Multiparity

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Describe the management of placental abruption

a) Fetal distress
b) No fetal distress + <36 weeks
b) No fetal distress + >36 weeks

a) Immediate C-section
b) Observe closely, steroids, no tocolysis
c) Deliver vaginally

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What would you expect on clotting studies after a major abruption?

Afibrinogenaemia/DIC: placental damage causes clotting factors to be used up

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What is vasa praevia?

Rupture of membranes followed immediately by vaginal bleeding, fetal bradycardia classically seen

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What is the earliest (in weeks) a pregnant uterus can be palpated if there is a single foetus present?

12 weeks

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What is Naegeles rule

Subtract 3 months from LMP and add 1 year and 7 days to calculate estimated due date

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Name 4 blood tests routinely offered at the start of pregnancy

FBC
Rhesus status
Rubella
Syphilis serology
Blood glucose
HIV
Hep B

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Pregnant w/ multiple sexual partners over the last 6 months. What screening will you offer and why

Screening for sexual infection e.g. chlamydia due to risk of premature delivery and vertical transmission (neonatal conjunctivitis)

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At the 11 to 14 week scan, there is increased nuchal translucency thickness. Except downs syndrome, what can this be suggestive of?

Congenital heart conditions
Patau syndrome (Trisomy 13)
Edwards syndrome (Trisomy 18)

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Name 2 components of blood that are measured in the triple test and state whether they are normally increased or decreased in trisomy 21

Lo:
Alpha-fetO protein
UncOnjugated oestriol

Hi:
HCG
InHIbin A

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Name 3 risk factors for developing gestational diabetes

BMI > 30
Previous macrosomic baby (>4.5kg)
Previous gestational diabetes
First degree relative with diabetes
Family origin with a high prevalence of diabetes (South Asian, Afro-Caribbean and
Middle Eastern)

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Explain the mechanism behind the development of a macrosomic baby in a diabetic pregnant woman

Higher amount of blood glucose passing through the placenta into fetal circulation which is stored in adipocytes

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Name risks to the foetus in women who suffer diabetes (gestational or established) during pregnancy

What is the commonest complication in the neonate post-delivery?

Macrosomia / shoulder dystocia / Erb’s palsy
T2DM in adulthood

Neonatal hypoglycaemia

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What is the usual time frame from delivery to onset of peurperal psychosis?

Nearly always within the first 2 weeks
Usually 3-5 days

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Risk factors a/w postpartum psychosis

Previous postpartum psychosis
Family history of postpartum psychosis / psychosis / schizophrenia in a close relative
Bipolar disorder (type 1) / hx of affective mood disorder
Schizoaffective disorder / Schizophrenia
Discontinuation of psychiatric medications during pregnancy
Sleep deprivation
Traumatic birth
Negative pregnancy/birthing outcomes (fetal/infant death, preterm birth <32 weeks,
congenital malformations)

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Over what post-partum period does post-partum depression usually present?

First 3 months

Name 2 maternal risk factors for developing post-partum depression

Previous mental health disorder Previous post-partum depression Lack of social support Relationship problems

What alternative medical diagnosis should be considered in women presenting with depressive symptoms post-partum?

Post-partum thyroiditis

Definition of pre-eclampsia

New-onset blood pressure >140/90 after 20 weeks of pregnancy AND proteinuria OR other organ involvement (renal, liver, neuro etc)

name 6 risk factors for the development of pre-eclampsia

Hypertension in previous pregnancy CKD Autoimmune disease e.g. SLE T1DM or T2DM Chronic hypertension Aged 40 or older BMI >35 FH

Other than the classical triad, name 4 signs and symptoms of severe pre-eclampsia

Papilloedema Headache RUQ/epigastric pain Visual disturbance Hyperreflexia

Name 2 common anti-hypertensive drugs safely used in pregnancy for pre-eclampsia

Labetalol Nifedipine (if asthmatic)

What drug should be given in severe pre-eclampsia to prevent seizures and eclampsia? What 4 things should be monitored during treatment

Magensium sulphate Reflexes, urine output, respiratory rate, oxygen saturations

What is HELLP syndrome?

Haemolysis Elevated liver enzymes Low platelets

Complications of preterm prelabour rupture of the membranes (PPROM)

Fetal: prematurity, infection, pulmonary hypoplasia Maternal: chorioamnionitis

Name 2 specific drugs to administer for PPROM until induction at 37 weeks

Oral erythomycin for 10 days Dexamethasone (to reduce risk of RDS esp. <34 weeks) Consider IV magnesium sulphate if <30 weeks for fetal neuroprotection

Name one shared maternal and foetal sign of chorioamnionitis

Tachycardia

Name the five components of the Bishop score

Cervical position Cervical consistency Cervical effacement Cervical dilation Fetal station <5 unlikely without induction >8 high chance of spontaneous labour or good response to interventions

Which two methods of induction can be used if a) Bishop score <6 b) Bishop score >6

a) Vaginal prostaglandin E2 (PGE2) i.e. dinoprostone or oral misoprostol b) Amniotomy and IV oxytocin

After O2 administration, management of PE in pregnancy?

LMWH at therapeutic dose

What test will you order to diagnose the suspected PE in pregnancy

CTPA or V/Q

Why do you suspect this patient presenting with a PE is taking daily aspirin during her pregnancy?

Antiphospholipid syndrome

Name 3 pre-existing factors for VTE in pregnancy?

Previous DVT or PE Family history Obesity Thrombophilia

why is DVT commoner in the left leg than the right leg in pregnant women?

Gravid uterus puts greater pressure on the left iliac vein at the point it crosses the left iliac artery, slowing venous return to the heart

2 most useful blood tests for obstetric cholestasis

LFTs Bilirubin

What past obstetric history may indicate previous obstetric cholestasis

Previous stillbirth

What are the risks of obstetric cholestasis?

Premature delivery Stillbirth

Name pharmacological method is used to treat obstetric cholestasis?

Ursodeoxycholic acid

What is the usual definitive management of obstetric cholestasis?

Induction of labour at 37-38 weeks

4 key risk factors for shoulder dystocia

Macrosomia High maternal BMI DM Prolonged labour

1st line manoeuvre for shoulder dystocia

McRoberts manoeuvre: flexion and abduction of maternal hips

Name the 5 components of the APGAR score

Appearance (acyanosis) Pulse Grimace (reflex irritability) Activity (muscle tone) Respiratory effort

Name 4 risk factors for cord prolapse

Polyhydramnios Prematurity Abnormal presentations e.g. breech, transverse lie Multiparity Twin pregnancy Artificial rupture of the membranes (50%)

Explain 4 steps you would take to manage cord prolapse

1. a) Pushing the presenting part of the fetus back into the uterus to avoid compression b) If the cord is past the level of the introitus, minimal handling/keep warm and moist 2. 'All fours' until preparation for immediate C-section 3. Tocolytics to reduce uterine contractions 4. Retrofilling the bladder with saline

Definitive management step in cord prolapse

C-section *instrumental delivery is possible if the cervix is fully dilated and head is low*

Normal Hb throughout pregnancy

110 105 100

Ejection systolic murmur and anaemia in pregnancy

Physiological

How do women increase O2 uptake during pregnancy

foetal Hb

What are the 4 parameters of a cardiotocograph trace that represent a reassuring trace?

Rate (110-160) Variability >5 bpm Presence of accelerations Absence of decelerations

Name 2 contraindications to doing foetal blood sampling

Maternal infection Foetal bleeding disorder Prematurity Abnormal presentation

Immediate management of placental abruption with shock

ABCD Get senior help / 2222 / emergency bleep obstetrics A:Protect airway B: 15L of 100% oxygen through a non-rebreather mask C: Insert two large bore (14G) cannulas, Take bloods: group + save, FBC, clotting screen, U&E, LFT, cross match Activate major haemorrhage protocol Give warmed fluids D: Monitor patient’s GCS

Combined test

Thickened nuchal Reduced PAPPA Raised beta hCG

When will general screening for gestational diabetes take place

24-28 weeks

When will screening take place for woman with prev GDM

ASAP after booking and at 24-28 weeks

Glucose levels that indicate GDM a) fasting b) at 2 hours

>5.6 >7.8

Treatment for fasting glucose of >7 OR Fasting glucose >6 AND macrosomnic baby =

Immediate insulin +/- metformin (stop other hypoglycaemics)

Fasting glucose less than 7 mmol/l

Trial of diet and exercise for 1-2 weeks, followed by metformin, then insulin

Advice for diabetic woman planning for pregnancy

Folic acid 5mg/day until 12 weeks gestation. Monthly HbA1c levels monitoring - keeping them below 48mmol/L. Fasting plasma glucose of 5mmol/L to 7mmol/L and a BM of 4mmol/L to 7mmol/L during the day. Diabetic retinopathy screening.

Obstetrics Flashcards

(67 cards)