Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Obs & gynae > Obstetrics > Flashcards

Obstetrics Flashcards

(58 cards)

Start Studying
1
Q

Diagnostic criteria for gestational DM

A

Fasting glucose of >= 5.5

2 hour post glucose intake value of >=7.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

When to perform an GTT (glucose tolerance test)

A
  1. previous gestational DM
  2. certain gestational groups (eg asian descent)
  3. mother older than 40
  4. mothers over 90kg, or BMI > 40
  5. first degree family member
  6. Hx of diabetic symptoms (polydipsia, polyuria, vaginal candidiasis.
  7. Previous infant >4.5kg
  8. previous stillbirth of unknown cause
  9. severe polyhydramnios with no structural anomalies
  10. repeated glycosuria
  11. Polycystic ovarian syndrome
  12. Acanthosis nigricans
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which hormone produced by the placenta results in increased insulin resistence.

A

Human placental lactogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Antepartum effects of diabetes on pregnancy

A
  1. Increased prevelence of congenital abnormalities
    - cardiac
    - neural tube
    - skeletal
  2. Macrosomia (N head, big body)
  3. Intrauterine death
  4. Polyhydramnios
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Problems at delivery, diabetic mom

A

shoudler dystocia …Erbs palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Postpartum effects of diabetes on pregnancy

A
  1. Neonatal hypoglycaemia
  2. Polycythaemia
  3. Hyperbilirubinaemia
  4. Respiratory distress syndrome

*poor cardiac function due to fetal heart hypertrophy from excess glycogen stores

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which fetal complication may occur in a mother with longstanding mircrovasc disease due to DM

A

IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Glucose values, management guidelines

A

Fasting below 5.5
2hr postprandial <7.0
HbA1c <6.5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Type 1 Diabetic management

A

Insulin + good diet

  • 3 injects (actrapid) breakfast, lunch, supper
  • 1 intermediate acting insulin before bed…Protaphane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Type 2 diabetic management

A

Metformin 500mg BD
Can be increased to 850mg TDS
+
good diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How to calculate total amount of insulin needed per day

A

0.4U/kg/day

*40% for late eve protophane
20% for each meal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When does reactive hyperglycaemia (somogyi) occur

A

When too much insulin is given at night, resulting in hypogylcaemia. Body reacts by starting glycogenolysis and gluconeogenesis

Rx: lower night time insulin amount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should diabetic mother regulate her glucose at home

A

test 2 hour post meal + first thing in the morning (glucose profile)

Measured once every 2 weeks in health care setting, and then once weekly after 36wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

General Antenatal managament and investions in diabteic mother

A
  1. fundoscopy
  2. 24 hour urine protein test and renal functions
    -rule out diabetic nepropathy
  3. Ultrasound @ 13, for general wellbeing
    23, to check for gross anomalies, nuchal translucency
  4. 32 weeks, detailed scan.. check for anomalies
  5. 38weeks, for morphometry and to estimate weight
  6. HbA1c @ first visit, and then again at 8weeks
  7. Urine MC&S, asympto bacteruria
  8. CTG´s weekly from 34wks
  9. Patient should be made aware to look out for quiet pattern..count fetal movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Wjat is issue with using Beta 2 receptor stimulants in diabetic mothers with preterm labour

A

B2 stimulants, stimulate the conversion of liver glycogen to glucose, which causes maternal hyperglycaemia

  • adjust insulin dose accordingly
  • Administer in saline solution, not dextrose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do we deliver diabetic moms, and why

A

38weeks, due to danger of stillbirths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

preferred method of delivery in diabetic mom

A

vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When do we do c sections in diabetic moms

A

When there are obstetric complications
fetal weight >4kg

If labour has lasted longer than 18 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Is oxytocin safe to use in diabetic mothers during delivery

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Delivery management in insulin dependant mom

A
  1. Induction in the morning
  2. Continuous IV insulin
  3. Short acting insulin 1U/ hour administered by infusion pump
    - if no infusion pump, add 10U insulin to 1 litre of 5% dextrose
    - Albumin first placed in vaculitre (prevents adherence of insulin on the sides ). Mixture given @ 100ml/ hr

4.Give 5% dextrose solution simultaneously @ rate of 100ml/hr.

Blood glucose monitored hourly
Pts on oral agents continue as per usual

Continuous monitoring of fetus throughout
All patients delivered in lithotomy position, with preparation for shoudler dystocia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What to do if ketonuria present at delivery (diabetes)

A

Increase insulin and glucose dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What to check in the newborn

A

Hourly blood glucose
haematocrit (polycythemia)
Clinical exam for anomalies (esp cardiac)
Examination of neonate for hyperbilirubinemia
Be alert for resp distress syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Definitions of post partum hemorrhage

A
  1. blood loss 500ml with vag delivery
    blood loss 1000ml with c section
    2.Vag bleeding, or blood loss at csection with hypotension and tachy
  2. Bleeding associated with drop in hematocrit of 10% or more
  3. Bleeding at delivery necessitating blood transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Estimation of blood loss and rx

Study These Flashcards
A

mild increase in pulse: 700ml-fluids
increase pulse and tachypnoae-1500ml-fluids
Fall in blood pressure: 2000ml-fluids and blood
Cold, drowsy, high pulse rate, low BP: 2500ml, large transfusion.

25
When Can I transfer a patient with post partum haemorrhage...
Systolic > 90mmHg Two Large bore IV in: one with blood, one with oxytocin Foley´s cathether Bimanuael compression if actively bleeding
26
What is primary PPH
with in 24hours
27
What is secondary PPH
from 24hr to 42 days
28
Causes of Primary PPH
``` UTERINE -uterine atony retained products abnormal placentation overdistention idiopathic -contracted uterus cervical laceration uterine rupture -uterine inversion NON UTERINE CAUSES Lower genital lacerations coagulopathy haematoma ```
29
Causes of secondary PPH
Endometritis Haematoma Trophoblastic neoplasia
30
Risk factors for uterine atony
``` Full bladder retained products of conception Overdistention of uterus (multiple fetus, polyhydram) Augmentation of labour with oxytocin Halothane Prolonged labour Chorio-amnionitis Grand multiparity Administration of magnesium sulphate Uterine tumours such as fibroids Congenital abnormalitie of the uterus Previous episodes of uterine atony Abnormal placentation ```
31
Does c section increase the risk for future abnormal placentation
yes
32
How to prevent PPH (Rx)
1. Make sure bladder empty 2. Start oxytocin infusion, 20-40IU/L for at least 3hours. (6-8hours in high risk cases) 3. Monitor - Vital signs - Uterine fundal height - Vaginal bleeding
33
When is bleeding excessive, practical tip
when pads have to be replaced every hour
34
Management of PPH
1. Feel uterus 2. Manually massage the uterus (myometrial contraction) 3. Empty the bladder 4. Insert 2IV lines 5. Initiate oxytocin infusion 6. Oxytocin infusion, 40IU/ L crystalloid fluid infused at 40 drops per minute 7. Syntometrine can be given IM 8. CALL FOR HELP 9. Cross match , order 2 units of packed red cells 10. Arrange for internal examination in theatre * IF no retained products or lacerations: Misoprostal, 2-5, 200microgram tablets rectally Prostaglandin F2 alpha IM, or injected directly into myometrium(1 ampoule). Repeat after half an hour if needed. Maintenence dose: 5mg in 500ml 0.9% saline @ 10-30 drops per min IV
35
Ergometrine and prostaglandin F2 alpha are contraindicated in
Hypertension active cardiac or renal disease Pulmonary disease hepatic disease
36
Management of massive hemorrhage
Fluid therapy: 2 IV lines, warm fluids ( if access difficult, do CVP) 2 litres of ringers, thereafter colloids Cross match 4-6 Units of blood ( O neg ) FFP can be used too Elevate patients legs and give oxygen @ 6l/min *evaluate clotting profile: Platelet count (reduced with massive transfusion) Prothrombin time Partial thromboplastin time (lenghthened with massive transfusion) Thrombin time (lengthened with DIC) Fibrinogen (reduced in DIC) If fibrinogen defect suspected, give FFP * give calcium gluconate, 1 ampule for every 4 units of blood given
37
Monitoring of PPH
Systolic more than 100 Pulse rate we want below 100 Urine output of 30ml/ hour SATS monitor Check haematocrit, clotting profile, U & E
38
Indications for surgery in PPH
Uncontrollable hemorrhage Sever clotting defect and DIC Organ failure
39
Rx of retained placenta
IV 20-40IU/L oxytocin running at 30 drops per min 1. if no bleeding allow 1 hr for seperation to take place, then attempt manual removal in theatre (MROP) Before theatre try: steady cord traction with uterine counterpressure Inject 10IU of oxytocin IV 2. With bleeding Administer syntometrine 0.5mg IV, start oxytocin infusion
40
Uterine rupture:
``` Pain continuous between contractions sudden onset of acute fetal distress with vag bleeding abscence of contractions sudden fetal death Hematuria ```
41
How to diagnose retained products of conception
Uterus may be slightly enlarged, US will show products. | Rx: evacuation in theatre. If bleeding cannot be controlled, hytesterectomy is indicated.
42
Management of haematomas (PPH)
Small vulvar hematoma <5cm must be drained with analgesic and anti inflamm drugs Larger hematomas need drainage: with incision at medial side. Subperitoneal and supravaginal haematomas need laparotomy, tertiary level care
43
Up to how many weeks is the size of uterus determines by bimanual examination
12 weeks
44
How do we determine duration of pregnancy from 13 to 17 weeks
Abdominal examination
45
When how many weeks do we use the SF height to determine duration of pregnancy
18 weeks
46
uterus bigger than dates suggests
Multiple pregnancy Polyhydramnions A fetus which is large for gestational age DM
47
Uterus smaller than dates suggests
IUGR Oligohydramnios Intra uterine death Rupture of membranes
48
Causes of breech presentation
UTERINE - congenital abnormalities, for eg unicornuate uterus - Uterine tumours, leiomyomata - Pelvic tumours compressing the uterus FETAL - Motor, or neurological abnormalities, for eg: spina bifida - Hydrocephalus - Short cord - Fetal death PREGNANCY - Placenta previa - Multiple pregnancy - Polyhydramnios - Oligohydramnios
49
In which head is the position in vaginal breech delivery
Head is in flexion
50
How to differentiate between cephalic and breech on vaginal exam
BREECH - Irregular presenting part - Buttox, sarcrum, genitals - Anus in found in straight line between ischial tuberosities FACE - nose can be felt - mouth forms triangle with the cheek bones.
51
Antenatal care in breech
refer to hosp US to exclude multiple pregnancies and obvious abnormalities External cephalic version Delivery plan
52
How to do external cephalic version
Lift presenting part out of pelvis Then turn fetus around to cephalic presentation * may be facilitated by placing her in right lateral condition. * Administer salbutamol 200micrograms IV slowly (to relax uterus)
53
Contraindications to external cephalic version
- APH - ROM - Multiple pregnancies - Pregnancy <37 weeks - HIV + ``` #prev c section-relative C/I #Hypertensive disorder-relative C/I #Suspicion of placental insuffiency -relative C/ I ```
54
Complications of External cephalic version
-ROM -Abruptio placentae -Tightening of a loop of umbilical cord -feto maternal hemorrhage Rutured Uterus
55
wHT must you do immediately after external cephalic version
Monitor fetal wellbeing with CTG Administer 100micrograms anti-D if mother is RH neg
56
T/F: in breech presentation, vaginal delivery is less risky for baby
false
57
Is oxytocin augmentation allowed in breech delivery
no
58
Complications of breech presentation
Asphyxia in second stage of labour, delay in delivery Cord prolapse, poorly fitting presenting part Physical injury -difficulties with obstetric manoeuvres

Obs & gynae (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions