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Reproductive > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

what type of twins are at risk of twin to twin transfusion

A

monochorionic twins (either monoamniotic or diamniotic)
monochorionic = one placenta and therefore causes T2TT due vascular anastomoses

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2
Q

most effective way to prevent vertical transmission of HIV to baby

A

highly active antiretroviral treatment prenatally

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3
Q

how to reduce risk of vertical transmission of HIV in patients who have no prenatal care

A

post partum zidovudine + nevirapine

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4
Q

medication of choice for PE/DVT in patients who are pregnant and breastfeeding

A

LMWH i.e. dalteparin for pregnant and breastfeeding patients

DOAC has higher incidence of bleeding

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5
Q

difference in presentation of placental abruption vs uterine rupture

A

placental abruption will feel like a prolonged contraction
uterine rupture causes midline sharp pain and contractions may become weaker or stop altogether

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6
Q

what is checked at 24-28 weeks gestation

A

OGTT for gestation diabetes (1hr 50g glucose)

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7
Q

in Rh negative females, when is anti-D given

A

28 and 34 weeks

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8
Q

antibiotic of choice for mastitis

A

beta-lactamase resistant antibiotic i.e. dicloxacillin

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9
Q

normal change in thyroid homrones in pregnancy

A

thyroid stimulating hormone (TSH) increases
total t3 and t4 increase but free T3/T4 remains normal

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10
Q

when is screening for group B strep carried out in pregnancy

A

rectovaginal swab at 36 to 38 weeks

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11
Q

indication for intra-partum group B strep prophylaxis and abx of choice

A

positive group B strep rectovaginal swab at 34-38 weeks
GBS UTI anytime during pregnancy
prior infant with early onset GBS sepsis
labour < 34 weeks gestation
prolonged rupture of membranes
intrapartum fever

IV penicillin
iv 1st generation cephalosporin if mild allergy
IV clindamycin or vancomycin if risk of anaphylaxis

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12
Q

what is aneuploidy screening carried out

A

10-22 weeks gestation

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13
Q

aneuploidy screening reveals low PAPPA, inhibin A, HCG and AFP. ?diagnosis

A

trisomy 18

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14
Q

aneuploidy screening reveals low PAPPA + estriol and elevated inhibin A + HCG. ?diagnosis

A

trisomy 21

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15
Q

what is low MSAFP associated with

A

incorrect gestational age
trisomy 18 and 21

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16
Q

chorionic villous sampling;
- when can it be carried out
- what are its limitations and possible complications

A

10-12 weeks gestation
cannot detect neural tube defects
risk of foetal loss 1% + associated with limb defects if carried out < 9 weeks

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17
Q

amniocentesis;
- when can it be carried out
- what are possible complications

A

15 - 20 weeks
premature rupture of membranes, chorioamnionitis, foetal maternal haemorrhags

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18
Q

features of congenital CMV and treatment

A

periventricular calcifications
petechial rash

treatment: postpartum ganciclovir

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19
Q

features of congenital rubella and management

A

blueberry muffin purpuric rash
intellectual disability
cataract
hearing loss
PSA

symptomatic management

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20
Q

features of conegnital toxoplasmosis and how it can be contracted

A

undercooked meat or cat litter

intercranial calcifications
hydrocephalus
chorioretinitis

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21
Q

management if mother has symptomatic/active HSV infection during pregnancy

A

aciclovir from 36 weeks until delivery
c-section if lesions are present at delivery

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22
Q

features of congenital zika infection and management

A

microcephaly
neurologic and occular abnormalities
craniofacial disproportion

no management required/available

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23
Q

management of still birth

A

if < 24 weeks - dilatation and curettage
if > 24 weeks - induction of labour within 1-2 weeks

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24
Q

management of incomplete miscarriage

A

manual uterin aspiration if < 12 weeks or D&C

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25
at what gestation does an elective abortion require surgical management
> 10 weeks < 10 weeks gestation can be managed with mifepristone + misoprostol
26
what types of miscarriage present with an open cervical os
incomplete and inevitable miscarriage
27
fever, purulent discharge and hypotension after abortion. ?diagnosis ?management
septic aborption manage with IV antibiotics + surgery to remove infected tissue
28
what vitamin deficiency can occur with hyperemesis gravidarum
wenickes encephalopathy can develop with b1 deficiency (rare)
29
at what fetal weight would you consider c-section in a diabetic mother
macrosomic babies to diabetic mother weighing 4500g - consider csection
30
strict glycaemic control with what targets are recommended in pregnant patients with pre-gestational diabetes
fasting morning < 95 2 hour post prandial < 120
31
what does hyperglycaemia in the first trimester indicate
pre-gestational diabetes
32
when is screening for diabetes carried out
OGTT 24-28 weeks 1hr post 50g CHO --> if >140 abnormal if abnormal then confirm with 3 hour post 100g CHO Fasting: >95 mg/dL ■ 1 hour: >180 mg/dL ■ 2 hours: >155 mg/dL ■ 3 hours: >140 mg/dL
33
gestationl hypertension still present at 20 weeks post partum
if hypertension persists 12 weeks post partum = chronic hypertension
34
at what gestation should delivery occur if pre-eclampsia vs severe pre elampsia
pre eclampsia without severe features then delivery by 37 weeks if severe features i.e. BP > 160/110, HELLP syndrome then delivery by 34 weeks If eclampsia then immediate delivery
35
patient with severe pre-eclampsia is admitted and develops loss of deep tendon reflexes and respiratory depression. ?diagnosis ?treatment
the patient has likely been given seizure prophylaxis with magnesium sulphate and has developed mg toxicity treat with IV calcium gluconate
36
complications associated with elcampsia
cerbral haemorrhage aspiration pneumonia hypoxic encephalopathy
37
complications associated with malignant trophoblastic disease
includes invasive moles and choriocarcinomas - pulmonary or CNS metastases - trophoblastic pulmonary emboli
38
risk factors for gestational trophoblastic disease
extremeties of age < 20 or > 40 diet low in folate or b-carotene
39
D&C shows cluster of grapes appearance
trophoblastic disease
40
treatment for chroriocarcinoma
initial: D&C weekly bHCG until undetectable then monthly for further 6 weeks chemotherapy i.e. methotrexate or dactinomycin if residual uterine disease then hysterectomy
41
bhcg monitoring after treatment of choriocarcinoma
weekly bhcg until undetectable then monthly for further 6 months
42
risk factors for placental praevia
previous c-sections, uterine surgeries, multiparity, advanced maternal age, multiple gestations, previous placenta praevia
43
painless vaginal bleeding occurs at the time of rupture of membranes with feotal bradycardia. ?diagnosis
vasa praevia
44
how is polyhydramios measured
amniotic fluid index (AFI) >24 or single deepest pocket 8cm on USS normal AFI 8-12
45
how is oligohydramnios measured
amniotic fluid index (AFI) < 5 or largest visualised pocket < 2cm if oligohydrmanios then weekly biophysical profile and biweekly nonstress testing
46
what preventive measure should you give if mother is Rh negative and partner is Rh positive
Rh immune globulin at 28 weeks
47
what is tested in a foetal biophysical profile (BPP)
Test the Baby MAN foetal Tone foetal Breathing foetal Movement Amniotic fluid volume Nonstress test
48
adverse effects of the use of oxytocin in delivery
hypotension tachysystole hyponatraemia
49
what is the normal foetal HR and when is it considered bradycardia and tachycardia
110-160 brady < 110 tachy > 160
50
what does absent variability in foetal heart rate indicate
severe foetal acidaemia (normal variability is 6-25)
51
foetal heart rate shows variability of 2. what does this indicate?
reduced HR variability (normal 6-25) this could be due to hypoxia, side effects from opiates, magnesium or sleep cycle
52
what does sinusoidal variability in foetal heart rate indicate
concerning for severe fatal anaemia pseudosinusoidal variability could be due to maternal mepiridine use
53
causes of variable, late, early decelerations and cause of accelerations
accelerations are normal VEAL CHOP Variable - Cord compression Early decelerations - Head compression (normal contractions) Accelerations - ok! Late decelerations - Placental insufficiency
54
what is a complication associated exclusively with epidural anaesthesia
post partum urinary retension
55
absolute contraindications to regional anaesthesia during delivery
bacteraemia skin infection overlying injection site increased ICP caused by mass lesion use of LMWH in past 12 hours maternal coagulopathy refractory hypotension
56
contraindications to tocolysis in preterm labour
infection non-reassuring foetal testing placental abruption
57
at what viral load is a patient with HIV required to have a c-section
viral load > 1000
58
management for preterm labour
tocolytics (unless contraindicated) i.e. beta agonists, mag sulphate, CCB, prostaglandin inhibitors) magnesium sulphate if < 32 weeks to prevent cerberal palsy steroids for lung development penicillin or ampicillin to protect against GBS infection
59
premature vs preterm vs prolonged rupture of membranes (ROM)
premature: > 1 before delivery (normal variant in term babies) preterm: < 37 weeks prolonged: >18 hours prior to onset of labour
60
risk factors for prolonged rupture of membranes (PPROM)
smoking young maternal age STI's
61
what test can be used to identify amniotic fluid in ROM
nitrazine paper test fern test
62
frank vs single footling vs complete breech rpesentation
breech is the most common malpresentation frank: hips flexed and knees extended (most common) single footling: 1 or both legs lie below the buttock complete: hips and knees are flexed
63
risks associated with external cephalic version
successful 50% of the time risk fo cor compression and placental abruption
64
immediate management of cord prolapse
manual elevation of presenting part call for assistance emergency c-section
65
turtle sign
retraction of the head from the perineum - suggests shoulder dystocia
66
what maneuvres can be implemented for delivery of baby with shoulder dystocia
McRoberts maneuvre application of suprapubic pressure internal cephalic version - abduction of anterior shoulder to foetal back (woods screw) - adduction of the anterior shoulder to foetal chest (rubin) delivery of posterior arm intentional clavicle fracture procto-episiotomy zavanelli maneuvre (manually pushing head into uterus to by time for c-section)
67
post partum, patient has bleeding, abdominal pain and presence of shaggy mass protruding through vagina. ?diagnosis ?management
uterine inversion can occur due to excessive fundal pressure or cord traction manege by manually replacing the uterus and stopping uterotonics
68
what does loss of foetal station indicate
uterine rupture occurs in patients with history of c-sections or uterine surgeries foetal parts may be palpated in the abdomen can cause post partum haemorrhage treat with emergency laparotomy
69
cause of urinary retension after delivery
commonly occurs due to bladder atony managed with catheterisation and ambulation, usually resolves spontaneously
70
post partum patient presents with pyrexia for 48 hours, malodorous lochia and tender uterus. what are you suspecting? how would you investigate? how would you manage?
post partum endometritis blood cultures + CT scan to look for pelvic abscess manage with IV antibiotics + heparin for 10 days
71
why is heparin given in the management of postpartum endoemtritis
risk of septic pelvic thrombophlebitis this can in turn cause septic emboli
72
1st line investigation for suspected sheehan syndrome
ACTH stimulation test
73
what is an infant contraindication to breast feeding
galactosaemia
74
what are maternal contraindications to breast feeding
active TB active varicella infection active HIV active herpes on the breast chemotherapy radiotherapy active substance misuse medications (e.g. tetracyclines, chloramphenicol)
75
mastitis persists for 48-72 hours after antibiotic treatment, next step?
breast USS to assess for abscess if abscess present then incision and drainage
76
post partum patient complains of bilateral breast firmness and tenderness and warmth. ?diagnosis
breast engorgement milk production > excretion
77
post partum female complains of tender lump in breast
localised plugged duct usually resolve on their own
78
post partum female complains of non-tender mobile soft subareolar lump in breast
galactocele milk fluid found on FNA usually resolve on their own
79
patient with HELLP syndrome develops hypotension. ?diagnosis ?management
ruptured hepatic hepatoma IV fluids, blood and blood product transfusion + exploratory laparotomy
80
most common cause of foetal bradycardia after rupture of membranes
cord prolapse - perform a sterile speculum examination to investigate
81
what does meconium during rupture of membranes indicate
coule either be foetal distress or normal continue foetal monitoring and if normal then can continue with normal delivery
82
patient has high blood pressure and elevated urine protein:creatinine ratio. what is the next step?
perform 24hr urine collection
83
what is defined as prolonged second stage of labour in primi and multigravid patient
primigravid > 20 hours multigravid >14 hours if no ROM --> vaginal misoprostol if ROM has occured --> IV oxytocin
84
azoospermia vs oligospermia
oligospermia = reduced number of total sperm count azoospermia = absence of motile sperm
85
cause of head sparing intrauterine growth restriction
maternal hypertension and smoking
86
cause of symmetrical intrauterine growth restriction
aneuploidy intra-uterine infections congenital cardiac defects
87
Side effects of misoprostol
prostaglandin agonist 1st line for medical management of miscarriage side effects include diarrhoea, abdominal cramps and nausea
88
signs/symptoms of magnesium sulphate toxicity
loss of deep tendon relfexes respiratory depression sinoatrial and atrioventricular bloackage cardiac arrest tx with IV calcium gluconate
89
risk factors for endometritis
GBS infection PPROM nuliparity C-section young maternal age obesity meconium stained amniotic fluid low socioeconomic status young maternal age chorioamnionitis internal monitoring
90
1st line abx for endometritis
clindamycin + gentamicin
91
what investigation should be carried out if a foetus has been exposed to teratogens
foetal anatomic survey

Reproductive (5 decks)

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