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Flashcards in Obstetrics 2 Deck (129):
1

What blood test can be done to investigate preterm labour?

Fetal fibronectin

2

What imaging may be useful in assessing preterm labour?

TVUS of cervical length

3

From what time period will steroids definitely need to be given in preterm labour?

24-34 weeks

4

What are tocolytics mainly used for?

Delaying labour for 24 hours to either give time for steroids to work or transfer to special care facility

5

What is the main thing to keep an eye out for in preterm labour or PPROM?

Chorioamnionitis

6

What type of presentation is more common in preterm labour?

Breech

7

What is the definition of PPROM?

Rupture of membranes before 37 weeks

8

What proportion of prelabour deliveries are preceded by PPROM?

1/3

9

When has delivery usual followed PPROM by?

48 hours time

10

What is funisitis?

Infection of the umbilical cord

11

What is the speculum sign of PROM?

Clear fluid pool in posterior fornix

12

Symptoms of chorioamnionitis?

Fever, tachycardia
Abdo pain
Uterine tenderness
Coloured/offensive liquor

13

What constitutes an infection screen for chorioamnionitis?

High vaginal swab
FBC
CRP
+/- amniocentesis, ctg

14

When should IoL follow PPROM?

After 36 weeks

15

What needs to be done if there are any signs of chorioamnionitis?

Deliver!

16

What maternal antibiotic carries a risk of necrotising enterocolitis?

Co-amoxiclav

17

What does SGA mean?

Weight under specific centile (10, 5, 2) for gestational age

18

What is IUGR?

Failure to reach full growth potential - a fetus may be IUGR but still 'normal' size for gestation

19

What may 'falling off' a growth curve suggest?

Fetal compromise leading to IUGR

20

What is fetal distress?

An acute situation seen most often in labour - e.g. Hypoxia

21

What is Fetal compromise?

A chronic situation whereby there are suboptimal conditions for Fetal growth and neuro development

22

What does Fetal compromise often result in?

IUGR

23

What suture technique may be employed to prevent preterm labour?

Cervical cerclage

24

6 causes of IUGR?

Pre-eclampsia or pregnancy induced HTN
DM
Maternal smoking
Maternal alcohol
Congenital abnormalities
Maternal thyrotoxicosis

25

What may happen with head circumference and abdominal circumference in IUGR?

Abdo circumference plateaus giving asymmetrical picture as head circumference carries on as normal

26

What Doppler methods are available in to investigate IUGR?

Doppler umbilical artery
Doppler Fetal circulation - MCA, Ductus venosus

27

What indicates placental dysfunction in Doppler umbilical artery waveforms?

A high resistance circulation

28

What is the biophysical profile?

5 features each worth 0-2 points
Limb movement
Breathing movements
Tone
Liquor volume (AFI)
CTG

29

What medical condition may accompany IUGR/SGA?

Pre-eclampsia

30

How does SGA become IUGR after investigation?

SGA + unusual UAD/MCA

31

What is appropriate investigation for preterm IUGR?

Regular UAD, daily CTG
Steroids if

32

Before when is IoL inappropriate unless otherwise indicated?

41 weeks

33

What assessment and management is done from 41 weeks onwards when thinking about IoL?

Vaginal exam and bishops score of cervical suitability
If no IoL, do sweep and daily CTG monitoring
If CTG abnormal, IoL straight away or CS

34

What 4 things are associated with multiple pregnancy?

Genetics
Age
Increasing parity
Assisted conception

35

What are the most common kinds of twins?

Non identical - dizygotic

36

What are identical twins otherwise known as?

Monozygotic

37

What are the most common type of monozygotic twins?

Monochorionic Diamniotic

38

In order of increasing time of cell division, what are the different types of multiple pregnancy?

DCDA
MCDA
MCMA
Conjoined

39

What are some early indicators of multiple pregnancy?

Hyperemesis
SFH palpable at umbilicus before 12 weeks

40

What does being able to palpate 3 Fetal poles suggest?

Multiple pregnancy

41

3 maternal complications of multiple pregnancy?

GDM
Pre-eclampsia
Anaemia

42

Fetal complications of all multiple pregnancies?

Increased morbidity and mortality
Preterm labour
IUGR

43

Fetal complications of MCDAs?

Twin twin transfusion syndrome
Congenital abnormalities
IUGR
Co-twin death

44

In what type of twins can TTTS occur?

MCDA

45

What happens to the donor baby in TTTS?

Gets anaemic, Oligohydramnios and IUGR

46

What happens to the recipient baby in TTTS?

It gets polycythaemia, volume overload (cardiac failure) and polyhydramnios

47

3 intrapartum complications of multiple pregnancy?

Malpresentation
Fetal distress
PPH

48

What USS sign indicates DCDA twins?

Lambda sign

49

What USS sign indicates MCDA pregnancy?

T sign

50

What causes decreased glucose tolerance in pregnancy?

Human placental lactogen, progesterone and cortisol

51

What happens to glucose tolerance in pregnancy?

It decreases

52

What urinary abnormality can occur physiologically in pregnancy?

Glycosuria

53

Unofficial diagnostic criteria of gestational DM?

Fasting glucose >7mmol/L
2 hr post prandial glucose >7.8mmol/L

54

What will happen to insulin requirements in pregnancy?

They will increase

55

Where does delivery need to take place in a diabetic mother?

In a unit with a neonatal ICCU

56

What prenatal management needs to take place in a pre-existing diabetic?

Insulin dependent women need retinal, renal and BP screen
Glucose control needs to be optimised
Lower BP if necessary with labetalol or methyldopa

57

What is an ideal hba1c for diabetes in pregnancy?

Less than 6.5% (47)

58

When checking BM at home, what should diabetic women aim to keep it below?

6mmol/L

59

What prophylactic measure should be given to diabetic women from 12 weeks?

Aspirin 75mg to prevent pre-eclampsia

60

When does delivery need to happen by for diabetic women? Why?

39 weeks
Risk of stillbirth and macrosomia

61

What is a common neonatal complication of DM babies?

Neonatal hypoglycaemia due to high insulin production and suddenly lowered blood glucose

62

Fetal complications of maternal DM in pregnancy?

Macrosomia
Polyhydramnios
IUGR
Birth trauma and shoulder dystocia
Fetal compromise, death
Preterm labour
Congenital defects - NTD, cardiac

63

What congenital defects are more common in DM babies and what does the risk of these depend on?

Cardiac and NTDs
Risk depends on periconceptual glucose control

64

Maternal complications of DM in pregnancy?

Insulin requirements
Intervention e.g. LSCS
Pre-eclampsia
Acceleration of complications
Ketoacidosis and undetected hypoglycaemia
Infection - UTI, endometritis, wound infection

65

RFs for GDM?

Previous GDM, macrosomic baby (>4.5kg) or unexplained stillbirth
FH of DM
BMI >30
Race
Polyhydramnios
Persistent Glycosuria
PCOS

66

When should screening for GDM take place if woman has had previous GDM?

18 weeks

67

What is the screening method for GDM?

GTT

68

When does 'regular screening' for GDM take place?

28 weeks

69

What oral hypoglycaemics are safe in pregnancy?

Metformin

70

What normally happens to BP and protein excretion in pregnancy?

BP drops by 30/15 in second trimester
Proteinuria but not >0.3g in 24 hours

71

What is pregnancy induced hypertension?

BP >140/90 after 20 weeks in a normally normotensive woman

72

What are the two subtypes of pregnancy induced hypertension?

Gestational hypertension - BP but no proteinuria
Pre-eclampsia - BP with proteinuria

73

What is the basic pathophysiology behind pre-eclampsia?

Incomplete trophoblastic invasion -> reduced flow in spiral arteries
Endothelin release and exaggerated maternal immune response

74

3 underlying factors of pre-eclampsia that lead to symptoms?

Increased vascular permeability
Vasoconstriction
Clotting abnormalities

75

RFs for pre-eclampsia?

Previous pre-eclampsia or nulliparity
Pre-existing hypertension
GDM or DM
Obesity, metabolic syndrome
Increasing maternal age
Multiple pregnancy
HIV

76

What infection is a risk factor for pre-eclampsia?

HIV

77

When does pre-eclampsia typically present?

3rd trimester - 24-26 weeks

78

What is the first sign of pre-eclampsia?

Hypertension

79

What does increased vascular permeability in pre-eclampsia lead to?

Oedema
Proteinuria

80

What does the vasoconstriction in pre-eclampsia lead to?

Hypertension
Headaches, visual disturbance -> eclampsia
Liver damage (nausea, vomiting, epigastric pain)

81

What rise in BP suggests pre-eclampsia in someone with pre-existing hypertension?

>30/15

82

Appropriate investigation of proteinuria in pre-eclampsia?

Urine dip at least +
PCR - can do spot test (>0.3) or >30mg/nmol
24 hour protein collection >0.3g/24hr

83

Hypertension criteria in a normotensive person for pre-eclampsia?

>140/90

84

Prophylaxis against pre-eclampsia?

Aspirin 75mg/day from 12 weeks

85

When should delivery be aimed for in mild pre-eclampsia?

37 weeks

86

When should delivery be aimed for in moderate-severe pre-eclampsia? What extra care should be taken?

34-36 weeks
Give steroids, use regular ctg and fluid monitoring

87

If any pre-eclampsic woman deteriorates or shows signs of complications what should be done?

Deliver!

88

Initial management of mild-moderate pre-eclampsia?

Give anti-hypertensives if BP >150/100
Labetalol or nifedipine first line

89

What is MgSO4 used for in pre-eclampsia management?

Treatment and prevention of eclampsia

90

What 2 things should be monitored if giving MgSO4 for eclampsia?

Patellar reflexes
Renal function

91

During delivery in pre-eclampsia what needs to be monitored?

Fluid balance via catheter, Central venous pressure

92

When can BP peak post-natally?

Around 5 days

93

Why don't you give ergometrine in 3rd stage of labour for pre-eclampsic women?

Can cause BP to rise

94

What is a major respiratory cause of death in pre-eclampsia?

Pulmonary oedema

95

What does HELLP stand for?

Haemolysis - dark pee, raised LDH
Elevated Liver enzymes - pain, liver failure
Low Platelets - bleeding

96

How might a stroke arise in pre-eclampsia?

Haemorrhage - esp during pushing in 2nd stage of labour with massive HTN

97

4 Fetal complications of pre-eclampsia?

IUGR
Preterm birth
Placental abruption
Fetal hypoxia and morbidity/mortality

98

Any contraindications to VBAC?

Vertical Caesarean scar

99

What is there a greater risk of in VBAC than normal labour?

Need for emergency section

100

Methods of induction of labour?

Prostaglandins (E2)
Amniotomy and oxytocin
Or both

101

Fetal indications for IoL?

Prolonged pregnancy (>41 weeks)
Prelabour term ROM
IUGR

102

Maternal indications for IoL?

Pre-eclampsia
DM
Social factors

103

Absolute contraindications to IoL?

Fetal distress
Placenta praevia
Where ELSCS is indicated

104

Relative contraindications to IoL?

Previous LSCS

105

Potential complications of IoL?

Need for LSCS or other interventions in labour
Long labour
Hyperstimulation and precipitate labour
PPH

106

What is prelabour term rupture of membranes?

Rupture of the membranes after 37 weeks

107

Common indications for ventouse/forceps delivery?

Prolonged active second stage or Fetal distress during this
Maternal exhaustion

108

Prerequisites for instrumental delivery?

Head can't be palpable abdominally I.e. Deeply engaged
Head must be at or below level of ischial spines
Cervix must be fully dilated (I.e. In second stage)
Known head position
Adequate analgesia
Empty bladder/catheterisation

109

In what type of woman (nulliparous or multiparous) is instrumental delivery more common?

Nulliparous

110

Indications for emergency CS?

Prolonged first stage of labour (not fully dilated within 12 hours)
Inefficient uterine action such that criteria for instrumental delivery is not reached
Fetal distress if CS is quickest route

111

Common reasons for ELSCS?

Placenta praevia
Severe antenatal fetal compromise
Uncorrectable abnormal lie
Previous CS

112

Relative indications for ESC?

Breech
Severe IUGR
Multiple pregnancy
DM

113

Complications of LSCS?

Fetal respiratory morbidity
Haemorrhage
Uterine or wound sepsis
VTE
Anaesthetic related
Need for CS in subsequent pregnancies

114

Maternal complications of instrumental delivery?

Trauma
Haemorrhage
Third degree tears

115

What is shoulder dystocia?

Failure of the shoulders to be delivered after normal downward traction

116

Major RF for shoulder dystocia?

Macrosomia

117

What is the major complication of shoulder dystocia and how is it avoided?

Erb's (waiters tip) palsy
Avoid by not pulling too hard

118

What is cord prolapse?

After membranes have ruptured, cord descends below presenting part potentially becoming compressed/spasming

119

RFs for cord prolapse?

Preterm labour
Breech
Polyhydramnios
Abnormal lie
Twin pregnancy
Artificial amniotomy

120

What is amniotic fluid embolism?

Liquor enters maternal circulation causing essentially a VTE

121

Sequelae of amniotic fluid embolism?

Pulmonary oedema
ARDS
DIC

122

RFs for amniotic fluid embolism?

ROM
Polyhydramnios

123

What might lower abdo pain, Fetal heart rate abnormalities and PV bleed/stopped contractions/maternal collapse indicate in the context of a VBAC?

Uterine rupture

124

What is the definition of the puerperium?

The 6 week period postpartum where the body returns to pre-pregnancy state

125

What 2 hormones does lactation depend on?

Prolactin
Oxytocin

126

The drop in which 2 hormones causes lactation after birth?

Oestrogen
Progesterone

127

What is colostrum?

Yellow fatty milk, IgA protein and minerals passed for first few days of lactation

128

5 advantages of breastfeeding?

Protection of neonatal infection
Bonding
Protection against maternal Cancer
Can't give too much
Cost saving

129

What vitamin should be given after birth and why?

K - avoid haemorrhagic disease of newborn