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O&G - C.U > Obstetrics > Flashcards

Obstetrics Flashcards

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1
Q

Booking bloods for pregnancy

A

Hb and platlets
HIV, syphilis, Hep B
Blood group and antibody status
Sickle cell and thalassaemia

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2
Q

When is the routine date scan usually done?

A

8+0 to 13+6 weeks

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3
Q

Blood tests for Down’s syndrome

A

A PAPPA-A

HCG

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4
Q

The quad test comprises of -

A

AFP
Inhibin A
Oestriol
Beta - Hcg

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5
Q

When is the quad test done ?

A

14-20 weeks

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6
Q

Diagnostic tests for Downs syndrome

A

Chorionic villous sampling

Amniocentesis

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7
Q

Private test for Downs syndrome

A

Cell free fetal DNA test

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8
Q

At what time is the anomaly scan done?

A

18+0 - 20+6

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9
Q

Risk factors for gestational diabetes

A 
BMI >30 
Some ethnic origins 
FH 
PCOS 
Previous baby >4.5kg 
Previous gestational diabetes
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10
Q

Potential sensitising events for Anti D

A 
Spontaneous miscarriage 
Termination of a pregnancy 
Invasive procedures 
Traumatic events 
Placental abruption 
Fetomaternal haemorrhage 
Blood transfusions
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11
Q

When should prophylatic anti D be given?

A

28 weeks

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12
Q

Ages at risk if pregnant

A

<18

40+

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13
Q

What events in past pregnancies are significant ?

A 
Premature labour 
Fetal growth restriction 
APH 
Gestational diabetes
HTN 
Thrombocytopenia 
Types of delivery 
3rd / 4th degree tear 
PPH 
Previous stillbirth, late miscarriage or neonatal death
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14
Q

Which family Hx is it important to elicit in this context?

A

Diabetes

HTN / pre eclampsia

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15
Q

Fetal growth restriction =

A

baby who does not reach it’s growth potential

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16
Q

risk factors for FGR -

A 
Previous small baby 
pre-eclampsia / HTN 
reduced fetal movements 
maternal disease
smoking
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17
Q

3 measurements used on US to estimate fetal weight -

A

abdo circumfrence
head circumfrence
femur length

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18
Q

How can a placental problem be identified?

A

Fetal vessel resistance

Reduced liquor volume

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19
Q

Management of FGR

A

Exclude underlying causes
Monitor
Timely delivery - fetal HR and blood flow
C-section?

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20
Q

Pregnancy induced hypertension =

A

HTN after 20 weeks

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21
Q

Pre-eclampsia -

A

HTN after 20 weeks with proteinuria

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22
Q

Risk factors for PET

A 
First pregnancy 
Previous pre eclampsia 
>40 y/0 
BMI 35 
Multiple preg 
Pre-exisiting conditions
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23
Q

Maternal blood test when diagnosed with PET

A

u&e
LFTs
Urate
FBC

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24
Q

Fetal monitoring in a mum with PET

A

USS - fetal growth restriction

Markers of placental function

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25
what infusion for eclampsia
magnesium sulfate
26
What happens in HELLP ?
Haemolysis, raised LFTs and low platelets (severe form of pre eclampsia)
27
What are obese women at risk of when pregnant?
``` Miscarriage Congenital malformations PET GDM Macrosomia VTE ```
28
What is the aim for BMI before falling pregnant?
<30
29
How is diabetes impacted by pregnancy
Increased insulin during preg Worsening neuropathy and retinopathy Increase in hypoglycaemic attacks
30
Maternal impacts of diabetes
``` Increase miscarriage risk Increase risk of PET Worsening renal disease Infections Higher induction rate LSCS rate higher Shoulder dystocia risk ```
31
Fetal impacts of diabetes
congenital malformations | unexplained still birth
32
Maternal hyperglycaemia leads to....
fetal hyperglycaemia which means there is increased production of insulin from the fetal pancreas. Therefore macrosomia can occur.
33
Before getting pregnant women with diabetes should....
``` lose weight quit smoking and alcohol take folic acid for 3m Switch to metformin / insulin HbA1c <48 Screened for retinopathy and nephropathy ```
34
How often should pregnant women be checking their BM?
Fasting pre meal (omit if oral / diet controlled) 1hr post meal bedtime
35
BM targets during pregnancy
Fasting <5.3 l hr post meal <7.8 maintaining above 4
36
USS app for women with diabetes in preg
Normal dating at 8-13 wks Routine anomaly at 18-20 Serial growth scans every month from 28/40
37
What should be offered in terms of delivery for women with diabetes in preg
Elective delivery - IOL/ LSCS at 37-38+6 | If complications can offer before 37 weeks
38
When should only LCSC be offered in women with diabetes in preg
EFW of >4.5kg
39
Which women are at risk of gestational diabetes?
``` BMI >30 Previous baby >4.5kg Previous GDM FH Ethnic origin ```
40
How is GDM diagnose?
28 weeks glucose tolerance test fasting glucose >5.6 2 hr plasma glucose >7.8
41
Previous GDM what additional test should be done?
12-16/40 additional glucose tolerance test
42
When is FBC measured in preg?
Booking | 28 weeks
43
Threshold for anaemia treatment in preg
<11g/dL @ booking | <10.5g/dL @ 28 weeks
44
What is the first line treatment for anaemia in preg?
Diet and ferrous sulfate.
45
Risk factors for VTE in pregnancy
``` Thrombophilia Age >35 BMI <30 Parity of >3 Smoker Immobility Gross varicose veins Multiple preg Medical co-morbidities Systemic infection ```
46
Up to when post delivery are women at risk of VTE?
6 weeks
47
Which group of women are particularly at risk of VTE post delivery and how are they treated?
C-section | given 7 days of LMWH
48
Initial imaging investigation for PE in pregnancy = | And what can be done next depending on the results?
CXR normal / V/Q scan Abnormal - CTPA
49
treatment of choice for VTE in pregnancy
LMWH | NOT WARFARIN
50
Management of HTN in preg
12weeks + | Aspirin 75mg OD
51
Treatment for eclampsa
MgSO4 - as decision to deliver is made Monitor the urine output, reflexes, RR and SpO2 Fluid restriction - prevent overload
52
Advice on folic acid and pregnancy
400mg should be taken from roughly 3m before conception up to 12 weeks
53
Risks of not giving Anti-D in a preg.
Baby may become anaemic, fetal hydrops (accumulation of fluid) and risk of still birth
54
When is anti D given
28 weeks or divided dose at 28 and 34 weeks postnatally if sensitizing event
55
Obstetric causes of abdo pain in 2nd and 3rd trimester
``` Labour Placenta abruption Symphysis pubis dysfunction Ligamental pain Pre-eclampsia / HELLP ```
56
Gynae causes of abdo pain in 2nd and 3rd trimester
Ovarian torsion Cyst rupture / haemorrhage Uterine fibroid de-generation
57
GI causes of abdo pain 2nd and 3rd trimester
``` Constipation Pyelonephritis Gall stones / cholestasis Pancreatitis Peptic ulcer Cystitis Renal stones ```
58
from what number of weeks can a CTG be used?
26
59
How does labour present?
Uterine tightening Fetus engaged Cervical changes on vaginal exam
60
How does placental abruption present?
Mild - severe pain and vaginal bleeding Uterus tender and tense May be signs / symptoms of pre-eclampsia
61
Symphysis pubis dysfunction presentation
Pain low and central Tender SP Symptoms worse on movement
62
Ligament pain presentation
Sharp Bilateral Associated with movement
63
Pre eclampsia presentation
``` Epigastic / RUQ pain N&V Headache Visual disturbance HTN and proteinuria ```
64
Acute fatty liver of pregnancy presentation
Epigastric pain / RUQ N&V Anorexia Malaise
65
Ovarian cyst presentation
Unilateral intermittent pain | May be associated with vomiting
66
Uterine fibroid presentation
localised constant pain | fibroid may be palpated - tender
67
Appendicitis presentation
Pain associated with N&V Guarding and rebound tenderness May localise to RIF
68
Gall stones / cholecystitis presentation
RUQ / epigastic pain May radiate to the back / shoulder tip Tenderness in R Hypochondria Pyrexia
69
Pancreatitis presentation
epigastric pain radiating to the back N&V More common in 3rd trimester
70
Renal stones / renal colic / pyelonephritis presentation
Loin to groin pain Associated vomiting and rigors Pyrexia with pyelonephritis
71
50% of antepartum vaginal bleeding caused by?
Placenta praevia and placental abruption
72
Kleihauer test =
examine maternal blood film for the presence of fetal blood cells - suggests feto-maternal haemorrhage
73
Uterine causes of antepartum haemorrhage
Placenta praevia Placental abruption Vasa praevia Circumvallate placenta
74
Lower genital tract causes of antepartum haemorrhage
``` Cervical ectropion Cervical polyp Cervical carcinoma Cervicitis Vaginitis Vulval varicosities ```
75
Risk factors for placenta praevia
``` previous c section previous pp advanced maternal age multiparity multiple preg smoking succenturiate placental lobe ```
76
Placenta praevia on examination
Uterus soft and non tender non engaged / malpresentation minor bleeding
77
What to avoid if suspect placenta praevia?
Digital exam
78
When is a follow up scan performed for placenta praevia?
36 weeks
79
When should a c - section be performed in placenta praevia?
if placenta encroaching within 2cm of the cervical os
80
if going to deliver a baby early what should you consider?
steroids for fetal lung maturity
81
Complications of placenta praevia?
Risk of PPH
82
What is placental abruption ?
Placental attachment to the uterus is disrupted by haemorrhage as blood dissects under the placenta.
83
Risk factors for placental abruption?
``` Previous abruption Advanced maternal age Multiparity PTE Abdo trauma Smoking Cocaine use External cephalic version ```
84
What condition is strongly linked with placental abruption?
PTE
85
Complications for placental abruption
Blood loss - DIC and renal failure | PPH -> Sheehans syndrome
86
At what point do you induce labour post term?
Term + 10 days IF NO PROBLEMS
87
Maternal indications for the induction of labour?
severe pre eclampsia recurrent APH Pre-existing disease
88
Fetal indications for the induction of labour?
prolonged pregnancy IUGR Rhesus disease
89
Active management of the 3rd stage of labour involves
Clamping and cutting the cord Controlled cord contraction oxytocin
90
``` D R C B R A V A D O ```
``` define risk contractions baseline rate accelerations variability and decelerations over all assessment ```
91
normal range of fetal HR
110 - 160 bpm
92
Complications of a breech birth
increase in perinatal mortality/ morbidity difficult to deliver the head - can be entrapment rapid compression and decompression of the fetal head
93
3 management options in breech presentation
External cephalic version Elective c-section Planned vaginal breech
94
Contraindications to ECV
``` Pelvic mass Antepartum haemorrhage Placenta praevia previous c-section / hysteroscopy multiple preg ruptured membranes ```
95
How is an ECV performed
On the labour ward Monitoring Tocolytics US control
96
How often is ECV successful?
1/2 the time
97
What should be given in conjunction with ECV ?
anti - D
98
What is the weight cut off for breech vaginal delivery?
>4kg
99
Risks for shoulder dystocia
``` Previous Diabetes BMI >30 Induced labour Long labour Assisted vaginal birth ```
100
When is delayed labour diagnosed in a nulilparous women?
2 hrs after active second stage of labour started
101
When is delayed labour diagnosed in a multiparous women?
1 hour after active second stage of labour started
102
When should you suspect delayed delivery in nulilparous?
progress is inadequate after 1hr
103
When should you suspect delayed delivery in multiparous?
progress inadequate after 30mins
104
Conservative measures to be used when a suspicious CTG
``` Mobalise the mother Adopt another position Offer IV fluids if hypotensive Stop oxytocin Offer tocolytic drug like terbutaline ```
105
Management with a pathological CTG
``` urgent review by an obstetrician and a senior midwife + measures used in conservative Offer digital fetal scalp stimulation Consider fetal blood sampling Consider expediating the birth ```
106
When is urgent intervention needed based on the CTG
Acute bradycardia / single prolonged deceleration >3 mins
107
From when can ventouse delivery methods be used?
34 weeks
108
Maternal indication for ventouse delivery
Delay in the 2nd stage of labour due to maternal exhaustion
109
Fetal indications for ventous delivery
Abdnormal CTG / slow progress in the 2nd stage of labour due to fetal malposition
110
What is needed in terms of maternal condition for ventouse delivery?
Adequate maternal effort and regular contractions
111
Two types of forceps
Non rotational / traction | Rotational
112
What is not required in terms of maternal condition for forceps delivery ?
maternal effort / adequate contractions
113
2 maternal indications for forceps
Medical conditions complicating labour | Unconscious mother
114
fetal indications for forceps
``` Gestation less than 34 weeks face presentation known / suspected fetal bleeding disorder for the after coming head in a breech c -section ```
115
Maternal complication of instrumental delivery
Genital tract trauma with risk of haemorrhage / infection
116
Fetal complication of instrumental delivery
Ventouse - scalp oedema / subperiosteal bleeding | Forceps - bruising / facial nerve palsy / depression skull fracture
117
Maternal indications for c-section
``` Two previous LSCS Placenta praevia Maternal disease Maternal request Active genital HSV HIV - viral load depending ```
118
Fetal indications for c-section
Breech presentation Twin pregnancy - if first twin not cephalic Abnormal CTG/ abnormal fetal blood sample in 1st stage of labour Cord prolapse Delay in 1st stage of labour due to malpresentation / malposition
119
Complications of LSCS
Haemorrhage - should have cross match w/ group and save Gastric aspiration - use routine antacids Visceral injury Fetal laceration Infection - can use routine prophylatic AB VTE Increase risk of complications in future pregnancies
120
VBAC
if LSCS due to unrepeatable cause then can trial vaginal delivery
121
APGAR score stands for?
``` Appearance Pulse Grimmace Activity Respiration ```
122
When is the APGAR score done?
1 min | 5 mins
123
APGAR normal score
7+
124
APGAR score that indicates neurological damage
<3
125
4 causes of postpartum haemorrhage (4 Ts)
Tone Trauma Tissue Thrombin
126
90% of PPH due to?
Uterine atony
127
Risk factors for uterine atony?
``` Multiple pregnancy Grand multiparity Fetal macrosomia Polyhydramnios Fibroid uterus Prolonged labour Previous PPH Antepartum haemorrhage ```
128
Cause other than uterine atony of PPH?
``` genital tract trauma retained placenta placenta accreta coagulation disorders uterine inversion uterine rupture ```
129
Preventative measures for PPH
Treat anaemia before labour avoid long traumatic labours active management of the 3rd stage of labour
130
Options if placenta in situ and PPH
Deliver by controlled cord contraction | If retained - manual removal under anaesthesia
131
What to assess the uterus for if PPH but placenta delivered?
uterine contraction
132
management for uterine atony
ABC Large bore IV access Send FBC, Xmatch, clotting, U&E Rub up uterine contractions by massaging the uterine fundus Give oxytocin Prostaglandin can be given Consider surgical options / uterine artery embolism
133
Management of PPH
``` ABC Lie flat high flow O2 Large bore access Take bloods and give fluids Rhesus status - give anti D if indicated Rub up contraction Bimanual compression Catheterise Give progesterone Consider tranexamic acid ``` If the above don't work - take to theatre and examine under GA Surgical techniques apply Last resort - hysterectomy
134
1st line screening for Downs syndrome
the combined test is now standard: nuchal translucency measurement + serum B-HCG + pregnancy associated plasma protein A these tests should be done between 11 - 13+6 weeks
135
Increased nuchal translucency indicates
Down's syndrome congenital heart defects abdominal wall defects
136
External cephalic version is contraindicated in individuals with a ...
a recent antepartum haemorrhage, ruptured membranes uterine abnormalities or previous Caesarean section.
137
When does morning sickness commonly take place
4-7week to second trimester
138
N&V in pregnancy with volume depletion treatment
Hartmanns rehydration - replace the calculated deficit, and maintenance adjunct - ondansetron 4-8g every 12hrs as required (IV) consider giving a PPI
139
Conditions to ask about at pregnancy booking
``` VTE Thrombophilia Heart disease Sickle cell SLE Obesity Anaemia DM HTN ```
140
How much vit D should be taken during pregnancy
10 micrograms through to breast feeding
141
conditions which can be identified on us scan
``` anencephaly spina bifida cleft lip diaphragmatic hernia gastroschisis exomphalos serious cardiac abnormalities ```
142
At what BP do you consider labetalol in pre eclampsia
>160 systolic | >110 diastolic
143
Presentation of pre eclampsia
``` NandV HTN Proteinuria Brisk tendon reflexes RUQ / epigastric pain Headache facial oedema ```
144
Acute treatment for suspected HELLP
Magensium sulfate IV IV dex Consider BP therapy
145
What is Lochia
Lochia may be defined as the vaginal discharge containing blood mucous and uterine tissue which may continue for 6 weeks after childbirth.
146
Score for severity of hyperemesis gravidarum
The Pregnancy-Unique Quantification of Emesis (PUQE) score can be used to classify the severity of nausea and vomiting in pregnancy

O&G - C.U (5 decks)

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