Obstetrics Flashcards by Emily Snow

What is the anatomical landmark against which foetal head position is assessed during labour?

Ischial spine

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What is the risk of uterine rupture during VBAC?

0.2 - 0.8%
= 25 per 10,000 or 2 in 1,000

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Incidence of anal sphincter injury in primips?

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Definition of anaemia in second / third trimester?

Hb <105

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Definition of anaemia in first trimester?

Hb <110

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What effect does active management of third stage of labour have on risk of PPH?

Reduce by 60%

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Which 3 infectious diseases are routinely screened for in antenatal care?

Syphillis, Hep B, HIV

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By what process is the cervix softened during labour?

Break down of type 1 collagen by interstitial collagenase

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What is the incidence of PPH in the UK?

24%

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Most common causative organism of peuperal sepsis?

Group A Strep

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What is the effect of pregnancy on platelet count?

Reduces platelets

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What is the earliest gestational age at which amniocentesis should be carried out?

15/40

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When should we test for gestational diabetes?

If previous history of GD:
As soon as possible after booking and again at 24-28/40

If no history but risk factors for GD:
24-28/40

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When should abx given in ELCS?

Prophylactic abx should be given in every case prior to incision

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Which antibiotic does NICE recommend for UTI in pregnancy?

Nitro
Trimethoprim (given with folic acid in 1st trimester)
Cefalexin

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First line pharmacological management of PPH in LSCS

Syntocinon
5 units by slow IVI

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What is the risk of foetal varicella syndrome in mothers who have chickenpox?

Week 1-12/40 = 0.4%

Week 12/20/40 = 2%

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What abnormalities are associated with foetal varicella syndrome?

Hypoplasia of one limb
CNS abnormalities
Eye abnormalities
Cicatricial lesions (band like hair loss) in dermatomal distribution

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Normal arterial pH range of cord blood

7.26 - 7.3

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Cord gas threshold for adverse neurological outcomes

<7.1

(Normal 7.26 - 7.3)

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Foetal mortality rate in listeria infection during pregnancy?

25%

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Which interleuken is raised during pregnancy?

IL10
Felt to have increased survival advantage

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Most common cause of maternal mortality in UK?

Cardiac disease

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Which is the only immunoglobulin to cross the placenta

IgG

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Management of group b strep in labour

No allergy: Ben pen Pen allergy: cephalosporin (eg cefalexin) Severe pen allergy: vancomycin

Cause of raised AFP in pregnancy

Spina bifida

How many days after fertilisation does implantation occur

8 days

Main hormone causing uterine involution after delivery

Oxytocin

Blood flow in ml/min through uterine artery at full term

750 ml / min (12% maternal cardiac output)

First immunoglobulin to be made by the neonate

IgM

Mortality rate of disseminated neonatal herpes (treated)

30% mortality rate 17% neurological sequelae in survivors

At what gestation does maternal IgG cross to the foetus

12/40

Which cytokine is reduced during pregnancy?

Th1

Definition of concerning variability on CTG

<5bpm for 30 - 50 minutes

Main cause of acute fatty liver of pregnancy

Foetal deficiency of long chain 3 hydroxyl CoA dehydrogenase (LCHAD)

Incidence of obstetric cholestasis

1.7%

Leading cause Down’s syndrome

Non disjunction maternal gamete

Leading cause Down’s syndrome

Non disjunction maternal gamete

At what gestation is amniotic fluid greatest volume

35/40

Risk of miscarriage in 35-39 year olds

25%

Risk of miscarriage in over 45s

>90%

Polyhydramnios radiological definition

Deepest pocket >8cm Amniotic fluid index >25cm

What is lowest gestational age at which CVS can be done

10/40

Risk of foetal laceration during c section

Chance of successful VBAC

75%

Incidence of placenta accreta in UK

1.7 per 10,000

What sutures should you use to repair anal mucosa

3.0 polyglactin Interrupted sutures

Which antibody is present in breast milk

IgA (A glass of milk pls)

Treating gonorrhoea in pregnancy

Azithromycin / ceftriaxone / spectinomycin

Oligohydramnios USS definition

<5cm or deepest amniotic fluid pocket <2cm

Polyhydramnios USS definition

>25cm or deepest amniotic fluid pocket >8cm

At what gestation is a gestational sac visible on TVUS?

From 4+3/40 (On trans abdominal ultrasound this is 5+3/40)

Definition of prolonged third stage of labour

Trick question! Depends if active or physiological management Active = >30 min til placenta Physiological = >60 min til placenta

Mechanism of closure of ductus arteriosus

Decreased prostaglandin E2 (hence why women can't have NSAIDs) Increased arterial pO2 Increased bradykinin

Which gestations get steroids prior to a c-section?

Less than 38+6

Diagnosis of gestational diabetes

Fasting glucose >5.6 2 hour glucose >7.8 (5, 6, 7, 8 boot scooting baby)

What % of pregnancies are affected by GDM

2-5%

How much blood do you need to lose in a PPH before RCOG recommend resuscitation protocol?

Which nerve roots are affected in Erb-Duchenne palsy?

C5, C6 Usually after a shoulder dystocia

First line treatment for GBS

IM ben pen 3g Cephalosporin / vanc if allergic

What % of foetuses have Turner's syndrome, and of those, how many make it to term?

1% of all conceptions have Turner's Only 1% of that make it to term (99% miscarry)

What is the additional risk of perinatal death in a VBAC?

2 in 10,000

Most common infective cause of congenital hearing loss

CMV

When should warfarin be restarted post natally?

After 5-7 days regardless of breast feeding (not found in breast milk) The wait to restart is over concerns of PPH

Normal range for variability on CTG

5-25bpm

Drug of choice to stimulate lactation

Domperidone

Which clotting factors are reduced during pregnancy?

XI and XIII

What % of patients with PROM will go into labour within 24 hours?

60%

At what cervical dilatation can FBS be done?

>3cm

Risk of ischaemic hypoxic encephalopathy in VBAC

8 / 10,000

Low AFP = what?

Edward's Down's

High AFP = what?

Multiple pregnancy GI tract abnormalities Anencephaly Neural tube defects

Incidence of placenta accreta

1.7 in 10,000

Yolk sac size upper limit of normal

6mm Max size at 10/40

At what gestation does foetus start making urine?

8-11/40

What % of babies born with brachial plexus injury have permanent disability?

<10%

Cardiac abnormalities in Turner's

Coarctation of aorta ASD Bicuspid aortic valve

How does urea cross placenta?

Passive diffusion Baby --> Mother

Which immunoglobulin is found in large quantities in breast milk?

IgA

Most common malignancy of newborn

Neuroblastoma

Bitrochanteric diameter in breech presentation

10cm

Definition of anaemia in pregnancy

1st trimester: <110 2nd and 3rd: <105

Obstetrics Flashcards

(83 cards)