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O+G Year 5 > Obstetrics 2 > Flashcards

Obstetrics 2 Flashcards

1
Q

What blood test can be done to investigate preterm labour?

A

Fetal fibronectin

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2
Q

What imaging may be useful in assessing preterm labour?

A

TVUS of cervical length

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3
Q

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

A

24-34 weeks

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4
Q

What are tocolytics mainly used for?

A

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

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5
Q

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

A

Chorioamnionitis

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6
Q

What type of presentation is more common in preterm labour?

A

Breech

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7
Q

What is the definition of PPROM?

A

Rupture of membranes before 37 weeks

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8
Q

What proportion of prelabour deliveries are preceded by PPROM?

A

1/3

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9
Q

When has delivery usual followed PPROM by?

A

48 hours time

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10
Q

What is funisitis?

A

Infection of the umbilical cord

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11
Q

What is the speculum sign of PROM?

A

Clear fluid pool in posterior fornix

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12
Q

Symptoms of chorioamnionitis?

A

Fever, tachycardiaAbdo painUterine tendernessColoured/offensive liquor

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13
Q

What constitutes an infection screen for chorioamnionitis?

A

High vaginal swabFBCCRP+/- amniocentesis, ctg

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14
Q

When should IoL follow PPROM?

A

After 36 weeks

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15
Q

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

A

Deliver!

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16
Q

What maternal antibiotic carries a risk of necrotising enterocolitis?

A

Co-amoxiclav

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17
Q

What does SGA mean?

A

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

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18
Q

What is IUGR?

A

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

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19
Q

What may ‘falling off’ a growth curve suggest?

A

Fetal compromise leading to IUGR

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20
Q

What is fetal distress?

A

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

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21
Q

What is Fetal compromise?

A

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

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22
Q

What does Fetal compromise often result in?

A

IUGR

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23
Q

What suture technique may be employed to prevent preterm labour?

A

Cervical cerclage

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24
Q

6 causes of IUGR?

A

Pre-eclampsia or pregnancy induced HTNDMMaternal smokingMaternal alcoholCongenital abnormalitiesMaternal thyrotoxicosis

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25
Q

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

A

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

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26
Q

What Doppler methods are available in to investigate IUGR?

A

Doppler umbilical arteryDoppler Fetal circulation - MCA, Ductus venosus

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27
Q

What indicates placental dysfunction in Doppler umbilical artery waveforms?

A

A high resistance circulation

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28
Q

What is the biophysical profile?

A

5 features each worth 0-2 pointsLimb movementBreathing movementsToneLiquor volume (AFI)CTG

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29
Q

What medical condition may accompany IUGR/SGA?

A

Pre-eclampsia

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30
Q

How does SGA become IUGR after investigation?

A

SGA + unusual UAD/MCA

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31
Q

What is appropriate investigation for preterm IUGR?

A

Regular UAD, daily CTGSteroids if

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32
Q

Before when is IoL inappropriate unless otherwise indicated?

A

41 weeks

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33
Q

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

A

Vaginal exam and bishops score of cervical suitabilityIf no IoL, do sweep and daily CTG monitoringIf CTG abnormal, IoL straight away or CS

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34
Q

What 4 things are associated with multiple pregnancy?

A

GeneticsAgeIncreasing parityAssisted conception

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35
Q

What are the most common kinds of twins?

A

Non identical - dizygotic

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36
Q

What are identical twins otherwise known as?

A

Monozygotic

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37
Q

What are the most common type of monozygotic twins?

A

Monochorionic Diamniotic

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38
Q

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

A

DCDAMCDAMCMAConjoined

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39
Q

What are some early indicators of multiple pregnancy?

A

HyperemesisSFH palpable at umbilicus before 12 weeks

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40
Q

What does being able to palpate 3 Fetal poles suggest?

A

Multiple pregnancy

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41
Q

3 maternal complications of multiple pregnancy?

A

GDMPre-eclampsiaAnaemia

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42
Q

Fetal complications of all multiple pregnancies?

A

Increased morbidity and mortalityPreterm labourIUGR

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43
Q

Fetal complications of MCDAs?

A

Twin twin transfusion syndromeCongenital abnormalities IUGRCo-twin death

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44
Q

In what type of twins can TTTS occur?

A

MCDA

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45
Q

What happens to the donor baby in TTTS?

A

Gets anaemic, Oligohydramnios and IUGR

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46
Q

What happens to the recipient baby in TTTS?

A

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

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47
Q

3 intrapartum complications of multiple pregnancy?

A

MalpresentationFetal distressPPH

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48
Q

What USS sign indicates DCDA twins?

A

Lambda sign

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49
Q

What USS sign indicates MCDA pregnancy?

A

T sign

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50
Q

What causes decreased glucose tolerance in pregnancy?

A

Human placental lactogen, progesterone and cortisol

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51
Q

What happens to glucose tolerance in pregnancy?

A

It decreases

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52
Q

What urinary abnormality can occur physiologically in pregnancy?

A

Glycosuria

53
Q

Unofficial diagnostic criteria of gestational DM?

A

Fasting glucose >7mmol/L2 hr post prandial glucose >7.8mmol/L

54
Q

What will happen to insulin requirements in pregnancy?

A

They will increase

55
Q

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

A

In a unit with a neonatal ICCU

56
Q

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

A

Insulin dependent women need retinal, renal and BP screenGlucose control needs to be optimisedLower BP if necessary with labetalol or methyldopa

57
Q

What is an ideal hba1c for diabetes in pregnancy?

A

Less than 6.5% (47)

58
Q

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

A

6mmol/L

59
Q

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

A

Aspirin 75mg to prevent pre-eclampsia

60
Q

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

A

39 weeksRisk of stillbirth and macrosomia

61
Q

What is a common neonatal complication of DM babies?

A

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

62
Q

Fetal complications of maternal DM in pregnancy?

A

MacrosomiaPolyhydramnios IUGRBirth trauma and shoulder dystociaFetal compromise, deathPreterm labourCongenital defects - NTD, cardiac

63
Q

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

A

Cardiac and NTDsRisk depends on periconceptual glucose control

64
Q

Maternal complications of DM in pregnancy?

A

Insulin requirementsIntervention e.g. LSCSPre-eclampsiaAcceleration of complicationsKetoacidosis and undetected hypoglycaemia Infection - UTI, endometritis, wound infection

65
Q

RFs for GDM?

A

Previous GDM, macrosomic baby (>4.5kg) or unexplained stillbirthFH of DMBMI >30RacePolyhydramnios Persistent GlycosuriaPCOS

66
Q

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

A

18 weeks

67
Q

What is the screening method for GDM?

A

GTT

68
Q

When does ‘regular screening’ for GDM take place?

A

28 weeks

69
Q

What oral hypoglycaemics are safe in pregnancy?

A

Metformin

70
Q

What normally happens to BP and protein excretion in pregnancy?

A

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

71
Q

What is pregnancy induced hypertension?

A

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

72
Q

What are the two subtypes of pregnancy induced hypertension?

A

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

73
Q

What is the basic pathophysiology behind pre-eclampsia?

A

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

74
Q

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

A

Increased vascular permeabilityVasoconstrictionClotting abnormalities

75
Q

RFs for pre-eclampsia?

A

Previous pre-eclampsia or nulliparityPre-existing hypertensionGDM or DMObesity, metabolic syndromeIncreasing maternal ageMultiple pregnancy HIV

76
Q

What infection is a risk factor for pre-eclampsia?

A

HIV

77
Q

When does pre-eclampsia typically present?

A

3rd trimester - 24-26 weeks

78
Q

What is the first sign of pre-eclampsia?

A

Hypertension

79
Q

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

A

OedemaProteinuria

80
Q

What does the vasoconstriction in pre-eclampsia lead to?

A

HypertensionHeadaches, visual disturbance -> eclampsiaLiver damage (nausea, vomiting, epigastric pain)

81
Q

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

A

> 30/15

82
Q

Appropriate investigation of proteinuria in pre-eclampsia?

A

Urine dip at least +PCR - can do spot test (>0.3) or >30mg/nmol24 hour protein collection >0.3g/24hr

83
Q

Hypertension criteria in a normotensive person for pre-eclampsia?

A

> 140/90

84
Q

Prophylaxis against pre-eclampsia?

A

Aspirin 75mg/day from 12 weeks

85
Q

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

A

37 weeks

86
Q

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

A

34-36 weeksGive steroids, use regular ctg and fluid monitoring

87
Q

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

A

Deliver!

88
Q

Initial management of mild-moderate pre-eclampsia?

A

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

89
Q

What is MgSO4 used for in pre-eclampsia management?

A

Treatment and prevention of eclampsia

90
Q

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

A

Patellar reflexesRenal function

91
Q

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

A

Fluid balance via catheter, Central venous pressure

92
Q

When can BP peak post-natally?

A

Around 5 days

93
Q

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

A

Can cause BP to rise

94
Q

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

A

Pulmonary oedema

95
Q

What does HELLP stand for?

A

Haemolysis - dark pee, raised LDHElevated Liver enzymes - pain, liver failureLow Platelets - bleeding

96
Q

How might a stroke arise in pre-eclampsia?

A

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

97
Q

4 Fetal complications of pre-eclampsia?

A

IUGRPreterm birthPlacental abruptionFetal hypoxia and morbidity/mortality

98
Q

Any contraindications to VBAC?

A

Vertical Caesarean scar

99
Q

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

A

Need for emergency section

100
Q

Methods of induction of labour?

A

Prostaglandins (E2)Amniotomy and oxytocinOr both

101
Q

Fetal indications for IoL?

A

Prolonged pregnancy (>41 weeks)Prelabour term ROMIUGR

102
Q

Maternal indications for IoL?

A

Pre-eclampsiaDMSocial factors

103
Q

Absolute contraindications to IoL?

A

Fetal distressPlacenta praeviaWhere ELSCS is indicated

104
Q

Relative contraindications to IoL?

A

Previous LSCS

105
Q

Potential complications of IoL?

A

Need for LSCS or other interventions in labourLong labourHyperstimulation and precipitate labourPPH

106
Q

What is prelabour term rupture of membranes?

A

Rupture of the membranes after 37 weeks

107
Q

Common indications for ventouse/forceps delivery?

A

Prolonged active second stage or Fetal distress during thisMaternal exhaustion

108
Q

Prerequisites for instrumental delivery?

A

Head can’t be palpable abdominally I.e. Deeply engagedHead must be at or below level of ischial spines Cervix must be fully dilated (I.e. In second stage)Known head positionAdequate analgesiaEmpty bladder/catheterisation

109
Q

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

A

Nulliparous

110
Q

Indications for emergency CS?

A

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

111
Q

Common reasons for ELSCS?

A

Placenta praeviaSevere antenatal fetal compromiseUncorrectable abnormal liePrevious CS

112
Q

Relative indications for ESC?

A

BreechSevere IUGRMultiple pregnancyDM

113
Q

Complications of LSCS?

A

Fetal respiratory morbidityHaemorrhageUterine or wound sepsisVTEAnaesthetic relatedNeed for CS in subsequent pregnancies

114
Q

Maternal complications of instrumental delivery?

A

TraumaHaemorrhageThird degree tears

115
Q

What is shoulder dystocia?

A

Failure of the shoulders to be delivered after normal downward traction

116
Q

Major RF for shoulder dystocia?

A

Macrosomia

117
Q

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

A

Erb’s (waiters tip) palsyAvoid by not pulling too hard

118
Q

What is cord prolapse?

A

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

119
Q

RFs for cord prolapse?

A

Preterm labourBreechPolyhydramniosAbnormal lieTwin pregnancy Artificial amniotomy

120
Q

What is amniotic fluid embolism?

A

Liquor enters maternal circulation causing essentially a VTE

121
Q

Sequelae of amniotic fluid embolism?

A

Pulmonary oedemaARDSDIC

122
Q

RFs for amniotic fluid embolism?

A

ROMPolyhydramnios

123
Q

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

A

Uterine rupture

124
Q

What is the definition of the puerperium?

A

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

125
Q

What 2 hormones does lactation depend on?

A

ProlactinOxytocin

126
Q

The drop in which 2 hormones causes lactation after birth?

A

OestrogenProgesterone

127
Q

What is colostrum?

A

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

128
Q

5 advantages of breastfeeding?

A

Protection of neonatal infectionBondingProtection against maternal CancerCan’t give too muchCost saving

129
Q

What vitamin should be given after birth and why?

A

K - avoid haemorrhagic disease of newborn

O+G Year 5 (8 decks)

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