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Year 4 Obs and Gynae > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

When is the booking visit?

A

approx 10wks gestation

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2
Q

How do you calculate EDD?

A

LMP + 7/7 + 9/12

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3
Q

When is the dating scan?

A

approx 12 wks

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4
Q

What is tested for in ‘booking bloods’?

A
  • blood group and rhesus status
  • FBC (for anaemia)
  • haemoglobinopathies
  • HIV
  • hepatitis B
  • syphilis
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5
Q

When is the anomaly scan performed?

A

approx 20wks

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6
Q

What is rhesus prophylaxis?

A

Given to all women who are rhesus negative
Prevents maternal antibodies attacking fetal blood
Cell free DNA or anti-D treatment

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7
Q

How many antenatal visits do the average nulliparous and mutliparous women recieve?

A

Multiparous - 8

Nulliparous - 10

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8
Q

What maternal factors effect fetal growth?

A

genetic: height, weight, parity, ethnic group
environmental: social class, nutrition, altitude, comorbidity

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9
Q

How do you assess fetal growth?

A

Symphysis-fundal height

USS

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10
Q

What measurments are taken in a growth scan?

A

biparietal diameter
head circumference
abdominal circumference
femur length

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11
Q

How do you assess placental function?

A

Doppler studies to assess blood flow in fetal arteries

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12
Q

What day in menstrual cycle does implantation occur?

A

23

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13
Q

Where does fertilisation occur?

A

fallopian tube

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14
Q

What are the effects of raised progesterone in pregnancy on the cardiovascular system?

A 
increased CO (HR and SV both increased)
BP decreases (fom decreased SVR)
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15
Q

What are the effects of raised progesterone in pregnancy on the respiratory system?

A

increased resp rate

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16
Q

What are the effects of raised progesterone in pregnancy on the uterine quiescence?

A

‘relaxation’

uterus doesn’t contract until the end of pregnancy

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17
Q

What are the effects of raised progesterone in pregnancy on the immune system?

A

weakened to prevent attack on baby (foreign body!)

makes UTIs and thrush v common

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18
Q

What are the effects of raised progesterone in pregnancy on the GI system?

A

progesterone is a muscle relaxant therefore –> constipation

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19
Q

How quickly does the fetus grow before 12wks?

A

Doubles in size every week until week 12

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20
Q

When does fetal heart activity begin?

A

6-7wks

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21
Q

When do fetal limb buds form?

A

8wks

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22
Q

What antenatal screening is offered?

A

fetal anomalies
infectious disease (HIV, hep B, syphilis)
haemoglobiopathies
rhesus negative

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23
Q

What is the ‘combined screening’?

A

opt-in test offered at early pregnancy scan
measures nuchal tranluscency and maternal blood test for PAPPA and HCG
results show only ‘probability of increased risk’

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24
Q

If the combined screening returns a ‘higher risk’ result, what can be offered to the mother?

A
  • chorionic villous sampling (from 11wks)

- amniocentesis (from 15wks)

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25
Q

What is the risk of miscarriage with CVS and amniocentesis?

A

1% for both

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26
Q

Should a HIV diagnosis be written in a mother’s notes?

A

NO

confidential

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27
Q

Should a diagnosis of hepatitis B be written in a mother’s notes?

A

YES

clear documentation necessary as notifiable disase

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28
Q

What intervention is necessary in a pregnant women with a new diagnosis of hepatitis B?

A
  • refer to hepatology
  • new born vaccines (5 doses)
  • household contact testing
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29
Q

What intervention is necessary in a pregnant women with a new diagnosis of syphilis?

A
  • refer to GUM for abx
  • need full treatment at least 4wks before delivery to prevent transmission
  • partner tracing
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30
Q

Which of the following tests are opt-in or opt-out?

  • HIV
  • Hepatitis B
  • syphilis
  • haemoglobinopathies
  • combined screening
A 
HIV: opt-out
Hep B: opt-out
syphilis: opt-out
Haemoglobinopathies: opt-out
combined screening: opt-in
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31
Q

Why do pregnant women get carpal tunnel?

A

Due to signifiacnt oedema, causes compression on median nerve in wrist

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32
Q

In which trimester are women likely to suffer from haemorroids?

A

3rd trimester

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33
Q

Why do pregnant women get varicose veins?

A

progesterone relaxes vasculature and fetal mass effects pelvic venous return

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34
Q

How do urinary symptoms vary from 1st to 3rd trimester?

A

1st: frequency from increased glomerular filtration rate
3rd: stress incontinence from pressure on pelvic floor

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35
Q

Why is constipation common in pregnancy?

A

reduced gastric motility (mediated by progesterone)

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36
Q

What hormone is thought to be responsible for ‘morning sickness’ and when does it normally resolve?

A

HCG

resolves by week 16-20

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37
Q

What is hyperemesis gravidarum?

A

excessive sickness and vomitting - warranting hospital admission
persisten intractable vomiting, can’t keep down fluids, weight loss and severe dehydratioin

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38
Q

What is the treatment for hyperemesis gravidarum?

A

admit for oral fluids if can’t keep down (saline or Hartmann’s)
daily U&Es - replace K+ as necessary
NBM for 24hrs
antiemetics (promethazine or cyclizine)

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39
Q

What is SGA?

A

‘small for gestational age’ - born with weight less than 10th centile

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40
Q

How do you distinguish between a baby who is constitutionally small and one who has IUGR?

A

IUGR: head sparing, growth slows and plateaus
CS: always small but increasing size normally and otherwise healthy

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41
Q

What factors affect the placental transfer of nutrients (therefore are RFs for IUGR)?

A

Severe anaemia
low pre-pregnancy weight
substance abuse

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42
Q

What factors affect placental implantation and vascultaure (therefore are RFs for IUGR)?

A 
pre-eclampsia
autoimmune disease
thrombophilias
renal disease
DM
HTN
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43
Q

What are the major RFs for IUGR?

A 
maternal age >40
smoker
cocaine use
daily vigorous exercise
previous SGA baby
previous still birth
chronic HTN
DM with vascular disease
renal impairment
antiphospholipid syndrome
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44
Q

What factors can make measuring symphysis-fundal height inaccurate?

A

high BMI
large fibroids
multiple pregnancy

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45
Q

If a patients SFH measures small, what is done next?

A

Women with major risk factors are referred for serial USS and umbilical artery Doppler
Women with minor risk factors referred for Doppler - if abnormal, then serial USS as well

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46
Q

What medications should be given in severe IUGR?

A

Progesterone to prevent pre-term birth

Maternal steroids in case of pre-term birth

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47
Q

What is macrosomia?

A

‘large for dates’

babies bown with a weight above the 90th centile

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48
Q

What are risk factors for macrosomia?

A 
maternal diabetes
Hx of fetal macrosomia
maternal obesity
excessive weight gain in pregnancy
male infant
overdue
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49
Q

What complications arise from fetal macrosomia?

A

Maternal:

  • prolonged vaginal delivery time (higher risk of CS)
  • uterine rupture (if previous CS
  • difficult/traumatic birth

Fetal:

  • hypoglycaemia after delivery
  • childhood obesity
  • increased risk of birth defects
  • respiratory distress
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50
Q

When should women be aware of fetal movements?

A

from 20 wks

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51
Q

What does fetal movement indicate?

A

integrity of CNS and MSK system

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52
Q

What are the risks associated with reduced fetal movement?

A

IUGR, placental insufficiency, congenital malformation

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53
Q

What is a prolonged pregnancy?

A

pregnancy exceeding 42wks form first day of LMP

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54
Q

What risks to the mother are associated with prolonged pregnancy?

A

anxiety and psychological stress

increased need for intervention (IOL, operative delivery etc)

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55
Q

What risks to the fetus are associated with prolonged pregnancy?

A
  • perinatal mortality
  • meconium aspiration
  • shoulder dystocia
  • fetal distress in labour
  • oligohydramnios
  • neonatal hypothermia/hypoglycaemia/polycythaemia
  • fetal post-maturity syndrome
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56
Q

What is the management of a prolonged pregnancy?

A

offer stretch and sweep from 41wks
offer IOL at 41-42wks
continuous fetal monitoring with CTG

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57
Q

What is PPROM?

A

preterm pre-labour rupture of membranes

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58
Q

What is PROM?

A

premature rupture of membranes (at term, but before onset of labour)

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59
Q

How do you diagnose ROM?

A
  • pooling of amniotic fluid on speculum

- nitrazine/ferning staining

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60
Q

At what gestation can labour be induced?

A

34wks

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61
Q

For women with PROM and PPROM, what is their chance of spontaneous labour?

A

PPROM - 80% within 7days

PROM - 90% within 48hrs

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62
Q

How do you manage PPROM?

A

<34 wks

  • aim for increased gestation
  • monitor for signs of chorioamnionitis
  • prophylactic erythromycin
  • 2x12mg betametasone 24hrs apart

34-36wks

  • monitor for signs of chorioamnionitis
  • prophylactic erythromycin
  • 2x12mg betametasone 24hrs apart
  • IOL recommended
>36wks
-monitor for signs of chorioamnionitis
-clindamycin/penicillin during labour
watch and wait for 24hrs (may labour spont)
-IOL
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63
Q

What are the main complications associated with PPROM?

A
  • chorioamnionitis
  • oligohydramnios
  • neonatal death
  • placental abruption
  • umbilical cord prolapse
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64
Q

What fetal risks are associated with IUGR?

A
  • intrapartum fetal distress
  • meconium aspiration
  • emergency CS
  • necrotising enterocoloitis
  • hypoglycaemia and hypocalaemia
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65
Q

What social factors calss a pregnancy as high risk?

A
  • teenage pregnancy
  • maternal age >40
  • high parity
  • low interpregnancy interval
  • alcohol intake
  • substance misuse
  • poor socioeconomic conditions
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66
Q

What obstetric history would cause the currecnt pregnancy to be classed as high risk?

A 
CS
preterm delivery
recurrent miscarriage
stillbirth
GDM
pre-eclampsia
3rd-4th deg tear
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67
Q

What Hx of the current pregnancy would class it as high risk?

A 
multiple pregnancy
SGA
placenta previa
GDM
pre-eclampsia
meconium stained liquor
worrying CTG
need for oxytocin
lack of progress
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68
Q

What is the management of hypertension in pregnancy?

A

1st: labetalol (contraindicated in asthma)
2nd: nifedipine
NB do not use ACEi in pregnancy

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69
Q

What is the stage of cleavage for various types of twins?

A

DCDA: day 1-3
MCDA: day 4-8
MCMA: day 8-13
conjoined: day 13-15

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70
Q

What are the maternal complications associated with multiple pregnancy?

A
  • hyperemesis gravidarum
  • anaemia
  • miscarriage
  • preterm labour
  • pre-eclampsia
  • antepartum and postpartum haemorrhage
  • postnatal depression
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71
Q

What are the fetal risks associated with multiple pregnancy?

A
  • prematurity
  • congenital abnormalities
  • fetal growth restriction
  • intrauterine death
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72
Q

How regularly do multiple pregnancies recieve growth scans?

A

DCDA - 4wkly from 16wks

MCDA/MD - 2wkly from 16 wks

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73
Q

When should multiple pregnanceis be delivered?

A

DCDA - 37-38wks

MCDA - 36wks

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74
Q

What is recurrent miscarriage?

A

3 or more consecutive miscarriages in 1st trimesters with same biological father

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75
Q

What are possible causes of recurrent miscarriage?

A
  • antiphospholipid syndrome
  • genetic factors
  • fetal chromosomal anomalies
  • anatomical abnormalities
  • large fibroids
  • thrombophilic disorder
  • infection
  • 35% have no known cause
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76
Q

How should recurrent miscarriage be investigated?

A
  • parental blood karyotyping
  • cytogenic analysis of products of conception
  • thrombophilia screen
  • antibody testing
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77
Q

What is mid-trimester loss?

A

Loss of pregnancy between 12 and 24wks

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78
Q

What are possible causes of mid-trimester loss?

A

chronic disease (DM, HTN, lupus, CKD)
infection
medications (misprostol, retinoids, methotrexate, NSAIDs)
PCOS

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79
Q

Define stillbirth?

A

child delivered after 24wks gestation who did not breathe or show signs of life once completely expelled

80
Q

define early and late neonatal death

A

death of a live born baby:

  • early = <7 complete days from time of birth
  • later = 7-28 days from time of birth
81
Q

What are the criteria for labuor to be classified as ‘normal’?

A
  • term (37-42wks)
  • singleton pregnancy
  • baby presenting head first
  • spontaneous labour
  • low risk pregnancy
82
Q

What changes happen to the cervix during labour?

A

RIPEN

decrease in collagen and increase in water content enables cervix to soften, efface and dilate

83
Q

What changes happen to the myometrium during labour?

A

stretches, increasing muscle excitabiltiy and contractility

gap junctions for under influence of oestrogen - can get a synchronised wave of contraction

84
Q

What hormonal changes occur during labour?

A

Increased concentrations of oestrogen

Release of prostoglandins and oxytocin

85
Q

What is the effect of increasing oestrogen concentrations during labour?

A

stimulate production of prostoglandins and promotes formation of oxytocin receptors in myometrium

86
Q

What are the effecs of prostoglandin and oxytocin in labour?

A

strong myometrial stimulation, helps cervical ripening

87
Q

What is the latent phase of labour?

A

period of time when painful contractions and some cervical changes (effacement and dilation up to 4cm)

88
Q

What is established labour?

A

regular painful contractions and progressive cervical dilatation from 4cm

89
Q

What is the 1st stage of labour?

A

from onset of established labour (dilated 4cm) to full dilatation of the cervix (10cm)

90
Q

What is the 2nd stage of labour?

A

from full dilation to birth of baby

91
Q

What is the 3rd stage of labour?

A

From birth of baby to expulsion of placenta and membranes

92
Q

What is cervical effacement?

A

cervix getting shorter

93
Q

What is the difference between an active and passive 2nd stage of labour?

A

passive - find full dilation before expulsive contractions

active - expulsive and active maternal effort

94
Q

What is involved in the active management of the 3rd stage of labour?

A

use of syntometrine
deferred clamping and cutting of cord
controlled cord traction

95
Q

Who needs CTG monitoiring?

A

any women with high risk pregnancy

if concerned on intermittent auscultation

96
Q

What structure should you use to assess CTG?

A

Dr C Bravado

97
Q

How do you assess contractions on CTG?

A

show frequency and duration but not intensity

should be 4-5 every 10 mins

98
Q

What are possible causes of fetal tachycardia?

A 
premature
hypoxia
infection
drugs
hypothyroidism
maternal anaemia
99
Q

What are possible causes of fetal bradycardia?

A

post-maturity
hypoxia
heart block
severe fetal distress

100
Q

What is the normal range for baseline rate?

A

100-160 bpm

101
Q

What is a normal acceleration on CTG?

A

rise >15bpm for 15s

102
Q

What is normal variability on CTG?

A

5bpm or more

103
Q

Why does variability occur on CTG?

A

from balance between parasympathetic and sypathetic nervous systems

104
Q

Is sinusoidal variability a good or bad sign?

A

VERY VERY BAD

105
Q

What are early decelerations due to?

A

normal vagal response to head compression in contraction

106
Q

What are late deccelerations due to ?

A

interruption in utero-placental blood flow

107
Q

What are defined as ‘reassuring’ deccelerations?

A

none or early or variable with no concerning features for <90mins

108
Q

What are the classifications of ‘overall impression’ of a CTG?

A
  • normal (all features reassuring)
  • suspicious (1 non-reassuring feature)
  • pathalogical (1 abnormal or 2 non-reasuring features)
  • immediate intervention (prolonged deceleration)
109
Q

What is a normal fetal blood pH?

A

> 7.25

110
Q

If fetal blood sample pH is <7.2, what should you do?

A

DELIVER THE BABY

111
Q

When might you need to use a fetal scalp electrode?

A

When you can’t get a good contact with the external transducer: high BMI, twins etc

112
Q

What does a partogram show?

A

maternal monitoring

  • cervical dilatation and descent of head
  • frequency of contractions
  • fetal HR
  • liquor colour
  • maternal observations
113
Q

Which are slow vs fast nerve fibres:

A

C fibres = slow

A delta fibres = fast

114
Q

What is entonox?

A

nitrous oxide for inhalation - partial analgesia

115
Q

What are the absolute contraindications of a spinal anaesthetic?

A

anti-coagulants
severe infection
anaphylaxis

116
Q

What are possible complications of spinal and epidurals?

A

failure, hypotension, LA toxicity, total spinal, infection, haemotoma, neurological damage

117
Q

What are the maternal indications for induction of labour?

A
  • prolonged pregnancy (41-42wks)
  • antepartum haemorrhage
  • maternal hypertension/pre-eclampsia
  • poor obstetric Hx
118
Q

What are the fetal indications for induction of labour?

A
  • IUGR
  • PPROM
  • DM (because of likely IUGR)
  • multiple pregnancy
  • intrauterine death
119
Q

What are absolute contraindications to induction of labour?

A
  • acute fetal compromise
  • unstable lie
  • placenta previa
  • pelvic obstruction
120
Q

What drug helps cervical ripening of the cervix?

A

prostoglandin

121
Q

What are potential complications of induction of labour?

A
  • fetal distress
  • precipatate delivery
  • operative delivery
  • uterine hypertonia and possibly rupture
  • amniotic fluid embolus
  • systemic effects
122
Q

Describe a frank (or extended) breech position

A

Bum down, legs up extended straight to head

123
Q

Describe complete (or flexed) breech position

A

Bum down with legs flexed and folded

124
Q

What are some associations with malposition?

A 
preterm
previous breech
placenta previa
fetal abnormalities
uterine abnormalities
multiple pregnancy
125
Q

What are the consequences of malposition?

A

Fetal - increased risk of hypoxia and trauma in labour

Maternal - likely CS

126
Q

What is ECV?

A

External cephalic version - apply gentle pressure to maternal abdo to turn the fetus

127
Q

What are the contraindications to ECV?

A 
placenta previa
uterine malformation
ROM
abnormal CTG
severe pre-eclampsia
128
Q

What is unstable lie?

A

when lie is changing, up to several times per day

129
Q

What is a transverse lie?

A

when baby lies across the uterus

130
Q

What are the 3 P’s of labour?

A

Power (contractions)
Passenger (baby)
Passage (parity/pelvis)

131
Q

How quickly should a mother progress in 1st stage of labour?

A

Primip - less than 2cm in 4hrs

132
Q

How would you manage a lady progressing slower than 2cm in 4 hrs?

A

Augmentation of labour

ARM, syntocinon, CS

133
Q

What should be the ideal presenting part?

A

‘vertex’

area between two parietal eminences , anterior and posterior fontanelle

134
Q

What are the risks associated with twin delivery?

A 
malpresentation
fetal hypoxia
cord prolapse
operative delivery
PPH
135
Q

What are the requirements for an operative delivery? (FORCEPS)

A 
F - fully dilated
O - occipito-anterior 
R - ROM
C - cephalic 
E - engaged 
P - pain relief
S - sphincter (bladder) empty
136
Q

What is a cephalohaematoma?

A

basically a big bad bruise on babies head, normally after ventouse delivery

137
Q

What are the indications for CS?

A

repeat CS
fetal compromise
failure to progress
breech

138
Q

What are the possible complications of CS?

A

blood loss, uterine injury, bowel/bladder laceration, hysterectomy, wound infection, future uterine rupture

139
Q

What is the success rate of vaginal birth after CS (VBAC)?

A

75%

140
Q

What is the risk of uterine rupture in VBAC?

A

0.3%

141
Q

What is shoulder dystocia?

A

delivery that requires additional manouvres to deliver shoulders - usually anterior shoulder impacted against pubis symphysis

142
Q

What are the fetal complications of shoulder dystocia?

A 
hypoxia
brachial plexus palsy
fracture of clavicle or humerus
intracranial haemorrhage
cervical spine injury
rarely fetal death
143
Q

What can increase risk of shoulder dystocia?

A 
previosu Hx
fetal macrosomia
BMI>30
DM
post-term
144
Q

What is the management of shoulder dystocia? (HELPERR)

A 
H - call for help
E - episiotomy
L - legs to McRoberts
P - suprapubic pressure
E - enter pelvis for internal manouvres
R - release poterior arm by flexing
R - roll over to all 4s
145
Q

What is pre-term labour?

A

24-37 wks

146
Q

If someone is at high risk of pre-term labour?

A

2 x IM 12mg betametasone 24hrs apart

147
Q

Define antepartum haemorrhage

A

bleeding from birth canal after 24th week of pregnancy until 2nd stage of labour complete

148
Q

What is bleeding from the birth canal at <24wks?

A

threatened miscarriage

149
Q

What are possible causes of APH?

A 
placenta previa
placental abruption
local infection
partner violence
uterine rupture
congenital bleeding disorders
a show (bloody mucus plug)
150
Q

What is the natural effect of pregnancy on blood pressure?

A

reduced until 24wks because of decreased vascular resistance

151
Q

What is post-partum hypertension?

A

HTN arising in post-partum period - peaks 3-5 days post-partum

152
Q

How common is pregnancy induced hypertension?

A

6-7% of pregnancies

153
Q

What is pre-eclampsia?

A

BP >140/90mmHg and >300mg proteinuria

154
Q

If someone is already hypertensive, what change would denote pre-eclampsia?

A

rise of >30 systolic of >15 diastolic

155
Q

What is the rate of pre-eclampsia?

A

5% of pregnancies

156
Q

What risk factors predispose to pre-eclampsia?

A 
previous pre-eclampsia
age >40 or <18
FHx
obesity
primiparity
pre-existing (DM, HTN)
multiple pregnancy 
long birht interval
hydatidiform mole
157
Q

Signs and symptoms of pre-eclampsia?

A 
often asymptomatic (picked up at ANC)
headache
visual disturbance
RUQ 
N&amp;V
rapid oedema
HTN
proteinuria
confusion
IUGR on scan 
hyperreflexia
158
Q

What are possible complications of pre-eclampsia?

A 
Eclampsia
HELLP syndrome
cerebral haemorrhage
IUGR
renal failure
placenta abruption
159
Q

What are the indications for immediate delivery in severe pre-eclampsia?

A 
worsening thrombocytopenia
worsening liver or renal function
severe maternal symptoms
HELLP syndrome
eclampsia
fetal distress (CTG)
160
Q

What medication can be given in hypertension/pre-eclampsia?

A

labetalol or nifedipine

161
Q

What is eclampsia?

A

presence of tonic-clonic seizures in association with diagnosis of pre-eclampsia

162
Q

What is the management for eclampsia?

A 
call for help
A-E approach
most fits terminate spontaneously
MgSO4 immediately (4g over 5-10mins)
in repeat seizures, repeat MgSO4 + diazepam
strict monitoring
may need intubation and ventilation 
IV labetalol if hypertensive
continuous CTG monitoring
deliver fetus as soon as mother stable enough
163
Q

What is HELLP syndrome?

A

Variant of severe pre-eclampsia with:

  • haemolysis
  • elevated liver enzymes
  • low platelets
164
Q

What are the signs and symptoms of HELLP syndrome?

A

RUQ pain, N&V, brown wee, raised BP, eclampsia?

165
Q

What is the management of HELLP syndrome?

A

deliver if mother stable enough
suppotive treatment
platelet infusion if actively bleeding or going for surgery

166
Q

What is the leading cause of direct maternal mortality?

A

VTE

167
Q

What percentage of obstetric VTE occur in peurperium?

A

50%

168
Q

What are risk factors for obstetric VTE?

A 
previous VTE
thrombophilia
sickel cell
age >35
parity >4
gross varicose veins
inflammatory disease
169
Q

Where is DVT most likely to occur in pregnancy??

A

above the knee in the left leg

170
Q

How should you treat suspected VTE in pregnancy?

A

LMWH ASAP (do not weight for investigations, treat on suspision)

171
Q

What is the classification of perianal trauma?

A

1st: injury to skin only
2nd: injury to perineum involving perineal muscles
3rd: injury to perineum involving anal sphincter
- 3a - <50% of external anal sphincter
- 3b - >50% of external anal sphincter
- 3c - internal anal sphincter torn
4th: injury to perineum involving sphincter and anal epithelium`

172
Q

What is an episiotomy?

A

surgical incision to enlarge the vaginal interosiuis

173
Q

What are possible complications of an episiotomy?

A 
bleeding
haematoma
pain
infection
scarring
dysparuenia
rarely - fistula formation
174
Q

what is the peuperium?

A

6 weeks post-partum

175
Q

Is lactational amenorrhoea indicative of contraceptive protection?

A

no

176
Q

How much milk is produced per day by 5 days post-partum?

A

up to 500mL/day

177
Q

How many women does ‘baby blues’ effect?

A

75%

178
Q

How many women does post-natal depression effect?

A

10-15%

179
Q

How many women does puerperal psychosis effect?

A

1:500

180
Q

What are the main causes of antepartum haemorrhage?

A

placenta previa
placental abruption
local issues (cervical polyps, trauma)

181
Q

What are the main causes of post-partum haemorrhage?

A 
'the 4 T's'
tone (atonic uterus)
trauma
tissue (retained POC)
thrombin (abnormal clotting)
182
Q

What is maternal mortality of uterine inversion?

A

up to 15%

183
Q

What are risk factors for uterine inversion?

A 
strong traction on umbilical cord
abnormal adherence of placenta
short cord
fundal implantation
uterine anomalies
previous uterine inversion
184
Q

How would uterine inversion present?

A 
haemorrhage
severe lower abdo pain
shock (out of proportion with blood loss)
uterine fundus not palpable
mass in vagina on VE
185
Q

What are risk factors for uterine rupture?

A

1 in 200 after 1 previous CS

mulitparity with oxytocin

186
Q

How would a uterine rupture present?

A 
fresh vaginal bleeding
haematuria
fetal distress
constant severe abdo pain (breaks through epidural)
shock
187
Q

How do you manage uterine rupture?

A

A-E

immediate laparotomy to salvage baby

188
Q

What organism most commonly causes obstetric septic shock?

A

strep A

189
Q

What is the management of obstetric septic shock?

A

cefotaxime + metronidazole +/- gentamicin

190
Q

How quickly (from onset of symptoms) will a missed amniotic fluid emoblus lead to death?

A

3 hrs

191
Q

What risk factors are associated with amniotic fluid embolism?

A 
multiple pregnancy
older maternal age
CS
instrumental delivery
eclampsia
placenta previa
placental abruption
cervical laceration
uterine rupture
medical IOL
192
Q

How would amniotic fluid embolism present?

A 
VERY ACUTE ONSET
hypoxia/respiratory arrest
hypotension
fetal distress
convulsion
shock 
reduced GCS
cardiac arrest
193
Q

What is the adverse affect of using tetracyclines in pregnancy?

A

fetal tooth discolouration

194
Q

What is the treatment of chorioamnionitis?

A

cefuroxime and metronidazole

195
Q

How would you treat UTI in pregnancy?

A

trimethoprim (NOT IN 1st TRIMESTER)
nitrofurantoin (NOT IN 3rd TRIMESTER)
cephalosporins and penicillins

Year 4 Obs and Gynae (2 decks)

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