Obstetrics Flashcards
(153 cards)
1
Q
What s normal Labour outcome?
A
Expulsion of fetes and placenta
2
Q
Main symptom and sign of labour
A
Painful uterine contraction
Dilation and effacement of cervix
3
Q
Mechanical factors in labour: 3Ps
A
Powers - degree of force/contraction expelling Passage - dimension of pelvis and resistance of soft tissues Passenger - diameter of fetal head
4
Q
Who has poor powers (uterine contraction force)
A
Nuliparous
Induced labour
5
Q
What are Montevideo Units measuring?
A
Measure of uterine activity
6
Q
How to Measure uterine activity (Montevideo units)
A
Intensity of contraction x frequency of contraction (per 10 mins)
7
Q
Equipment used to measure Uterine activity (also to calc Montevideo units)
A
cardiotocograph (CTG)
8
Q
Factors assoc with neonatal complications
A
Polyhydramnios, High parity, Uterine/Fetal anomalies, Preterm birth
9
Q
What Part presents during extended breach?
A
Buttocks
The legs are extended by head
10
Q
Which uterine segment provides push for fetus?
A
Upper segment of uterus
11
Q
What does stationeries 0 mean
A
Head is at level of ischial spines
+ve means head below, -ve means head above
12
Q
Diameter of Pelvic outlet
A
12.5cm
13
Q
What kind of presentation do you want?
Why?
A
Cepahlic - Vertex (Occiput: the back)
think chin to chest
14
Q
What is it presented if head is extended from vertex position by:
- 90 degree
- 120 degree
A
Brow
Face
15
Q
3 stages of labour
A
1) Split into Latent and Active.
From initiation to full cervical dilation
Latent: slow dilation up to 3cm
Active1cm/hr
dilation
2) Full dilation to delivery. Mother pushing (epidural may have effect) until head reaches pelvic floor
3) From delivery of foetus to delivery of placenta
16
Q
How do epidurals affect labour
A
Slow the process of dilation
Longer labour
Remove pushing desire
17
Q
Traditional Vs active 3rd stage management (placental delivery)
A
Trad:
Abdo massage of uterus to encourage contraction
Active: IM Syntocinon (oxytocin analogue)
18
Q
Normal blood loss in normal Vs C-section
A
500ml
1L
19
Q
Most common cause of slow progress in labour in Primiparous woman
A
Inefficient Uterine Action (Poor Powers)
20
Q
What is more common reason for slow progress in multiparous
A
Fetal Malpositioning
Uterine Rupture more likely
21
Q
What to do if hyperactive uterine contractions, vaginal bleeding and fatal HR abnormalities
A
C-Section
22
Q
Urinary issue during labour
A
Retention can cause detrusor damage
23
Q
What can be done in someone with slow progress of labour
A
Augmentation:
Oxytocin - strengthens contraction
Artificial Rupture of Membranes
24
Q
What is associated with hyperactive uterine contractions
A
Too much Oxytonin, Placental abruption.
Can cause fatal distress as blood flow diminishes
25
Tx of Uterine hyperactivity
Usually C-section
Tocolytic (e.g. Beta-mimetic - Salbutamol, Nifedipine - CCB)
26
Management Nuliparous slow 1st stage
Augmentation
| C-section after 16hr
27
Management Nuliparous Poor descent in 2nd stage
Oxytocin infusion (uterus pushes down)
28
Management Nuliparous Over 1hr active second stage
Episiotomy, Ventouse, Forceps
29
How often to auscultate fatal HR in Labour
every 15m in 1st stage
Every 5m in 2nd stage
30
Intrapartum (during birth) Fetal problems
Meconium aspiration
Fetal blood loss
Trauma
Infection (GBS)
31
What causes fatal distress
Hypoxia.
| Results in Death or disability if not reversed
32
Investigations for fetal distress
Fetal HR
Cardio-tocogram
Fetal ECG
Scalp blood sampling
33
How to read a CTG acronym
DR C BRaVADO
Define Risk
Contractions
```
Baseline Rate
Variability
Accelerations
Decelerations
Overall impression
```
34
Define risk (CTG)
Maternal illness?
Gestational DM
HTN
Asthma
Obstetric complications
Multiple gestation, post gestation, prev c-section, Fetal problem, pre-eclampsia
35
Contractions on CTG
Over 10 mins (less than 5)
| e.g. 3 in 10
36
Normal Baseline Rate CTG
110-150bpm
Tachy: hypoxia, anaemia
Brady: cord prolaps/compressio, if cause cant be found - immediate delivery
37
Normal Variability CTG
5-25bpm
non-reassuring: less than 5 or more than 25
abnormal: if lasts for long time
physiological abnormal: sleeping
38
Accelerations, good or bad?
Presence is reassuring
39
Types of decelerations
Early: when uterine contract begins , stops when they do
(normal)
late: begin at peak of contraction, recover as contraction ends. show insufficient blood flow to uterus
40
What is sign of prolonged reduced variability in fetal HR
Hypoxia
41
Pain relief in labour
Non-med: Massage
Entonox
Systemic opiates (+ antiemetic)
Epidural
42
Degrees of perineal damage
1) skinonly
2) perineal muscles
3) anal sphincter
4) anal sphincter and epithelium
43
Which inc risk of twins
- FH Monozygotis twins
- FH dizygotic twins
FH Dizygotic twins
44
How often to USS multiple pregnancies
Monthly from 20 weeks
45
What gestation for an elective C-section
38wk+
46
Most complication of multiple preg
Prematurity
47
What is TTTS, when to get concerned?
Although each uses own portion of placenta, connecting blood vessels allow blood to pass from one twin to other
Blood can disproportionately distribute between 'donor' to 'recipient' causing in blood vol and strain on heart (HF), inc urine, Polyhydramnious
Concerned if 30% difference in size
48
TTTS Tx
Amniocentesis
Intrauterine blood transfusion to donor
Laparoscopic placental vessel occlusion
49
RF for shoulder dystocia
High birth weight (Maternal diabetes)
Induced labour
Prev dystocia
Abnormal lie
50
What is dystocia
Failure of the shoulder to deliver
Problem with Passenger or passage
51
What can dystocia cause
Clavicular / Humeral fracture
cord compression -> asphyxiation
Erb's palsy (brachial plexus damage)
52
Shoulder dystocia Tx
Call for help
Legs in McRoberts (knees to chest)
Rotational manœuvres
Evaluate for episiotomy
53
Last resort for Dystocia
Clavicular fracture (deliberate)
Zavanelli (push back in and c-section)
54
Amniotic fluid embolus
- Pres
- When can it occur
- Complications
Amniotic fluid enters maternal circulation
Sudden dyspnoea, hypoxia, hypotension
Any time in preg
DIC, Pulmonary oedema, ARDS
55
Amniotic fluid embolus Tx
Take bloods (clotting, FBC, electrolytes, cross-match)
Manage in ICU
Give: O2, Fluids, Blood, fresh frozen plasma
56
RF for uterine rupture
Prev C-section
Labour obstruction
57
Signs of uterine rupture
Fetal HR abnormalities
Abdo pain
Vaginal bleeding
Cessation of contractions
Maternal shock/collapse
58
Management Uterine rupture
Maternal resuscitation
Urgent laparotomy for delivery
59
Management of eclampsia (epileptiform seizure)
Clear airway and give O2
Diazepam if epilepsy
MgSO4
60
Induction Vs Augmentation
Induction initiates artificial labour
Augmentation promotes inadequatecontractions
61
How to ripen cervix
Prostaglandin gel
62
What is a ripe cervix
Soft
Short
Open OS
63
CI for induction of labour
Placenta previa
Fetal distres
Cord presentation
64
Induction of labour complications
Intrumental delivery (15%)
C-Scetion (22%)
Failed induction
65
What is Bishops Score
Cervix score.
| Assists in predicting need for induction of labour
66
Bishops score sections (Re Cervix)
```
Position (poster-Anter)
Consistency (Frim - Soft)
Effacement (thinning)
Dilation (0-5)
Fetal station
```
67
Fetal station 0 = ?
Head at level of ischial spin (not to be confused with ASIS)
68
What might need to be done before Induction of Labour?
Cervical ripening if Bishops score under 6 (PG via Foley Catheter)
69
Methods of inducing labour:
Amniotomy (Rupture of membranes)
Oxytocin IV with 5% dextrose
70
Misoprostol
- What is
- When used in Preg
Prostaglandin analogue. gives Uterine contractions.
Used after intrauterine death (to deliver)
71
Risk of BV in Preg?
What is tx?
Preterm labour
Also: PROM, low birthweight
Oral Metranidazole
72
RFs for Preterm labour
Previous Preterm labour
BV
Cervical length (short)
Fetal hydrops
73
Maternal RF for Preterm labour
Infection (BV), HTN, DM, Chronic illness, Smoking, Alc, Stress
74
What is Fetal Fibrotectin. What is high FF risk for?
Glycoprotein in amniotic fluid
Preterm birth
75
What is Fetal Hydrops
Abnormal build up of fluid in 2+ body areas
| sign of underlying disease
76
What are tocolytics for?
E.G.
Suppression of labour
Nifedipine (CCB)
Indomethacin (PG inhib)
Terbutaline (Beta agonist)
77
Management of preterm labour:
Fluids and bed rest
Avoid repeated pelvic exam (infection risk)
USS
Tocolytics
78
What is another function of suppressing labour?
Gives time to administer corticosteroid:
Betamethasone/Dexamethasone
Help stimulate fetal surfactant production (1-2 days to work)
79
Tocolytics Absolute CI
Fetal death, Pre-eclampsia
| Pre-eclampsia
80
What do corticosteroids do? (28-34wks)
Reduce severity of RDS
Also help to close PDA
81
What is Periventricular malacia?
What can it cause?
RF?
When the white matter around ventricle deprived of blood
Cerebral Palsy
LBW, Uterine infections, PROM
82
What is cervical cerclage used for?
When is it done?
Indication?
Suture in internal OS
Insert 1st trimester, out 3rd
Cervical incompetence (short)
83
What is PROM
Premature rupture of membranes prior to labour (under 37wk)
84
What is prolonged ROM?
Over 24 hours between rupture and labour
85
PPROM
Pre-Term Prolonged Rupture of Membranes
86
What is cervical effacement?
Change of shape from bulb to flat
87
What is antepartum haemorrhage?
Bleeding after 24 weeks gestation
88
3 causes of antepartum haemorrhage:
Placenta previa
Placental abruption
Vasa previa (fetal vessels near internal os)
89
Minor Vs Major Placenta previa
Major: Low lying placenta over internal os
Minor: in lower segment (doesn't cover os)
- note: placenta moves up as uterus expands in preg
90
What not to do if placenta previa
Vaginal exam - may precipitate large bleed
91
Placenta previa Ix
USS
FBC and cross match
92
Placenta previa management
Elective C-section at 39 weeks for major
2cm from os = vaginal delivery
93
Placental abruption
- Def
- Causes
- Complication
Part/All placenta separates from living of the uterus prior to delivery
IUGR, Pre-eclampsia, Smoking, Cocaine, History of it.
Fetal death, DIC, Renal failure, Maternal death
94
Abruption
- Features
- Tx
Abdo pain/Uteral pain, bleeding (into myometrium), Tachycardia, hypotensive
IV fluids, blood transfusion, Opiate analgesia
If fetal distress urgent C section (after 37 weeks)
95
What is risk of vasa previa?
These are fetal vessels prone to bleeding when membranes rupture.
Risk of massive bleed and stillbrith
96
Vasa previa
- Triad in diagnosis
- Management
Membrane rupture
Painless vaginal bleeding
Fetal bradycardia
Emergency C-section
97
What is primary postpartum haemorrhage?
Over 500mls of blood loss in 1st 24 hours after uterine atony
98
Causes of Primary PPH
Uterine Atony (doesn't compress vessels) clotting disorders, uterine rupture
99
Treatment of Primary PPH
ABC
Syntocinon (Oxytocin - helps uterus to contract and stop bleed)
IM carboprost
Hysterectomy if severe
100
What is secondary PPH
Blood loss after 24 hours
101
Causes of secondary PPH
Retained placental tissue, Clot
102
Secondary PPH Tx
USS to identify products
Give Ampicillin and Metronidazole (infection common)
Careful curette of uterus
103
4 T's of PPH
Tone (atony)
Trauma (delivery)
Tissue retention (placenta)
Thrombin (coag disorder)
104
Primary secondary and tertiary prevention of premature birth
1) smoking, STD, weight loss
2) diagnosis and Tx of diseases (e.g. DM, pre-eclampsia)
3) Prompt diagnosis and tocolytics (Nifedipine, terbutaline) + corticosteroids
105
What is Pleuperium?
Issues?
6 weeks post natal
Urinary incontinence,
Post-natal depression
sever: psychosis, mania
106
Teratogenic drugs
```
Warfarin
ACEi
Anti-thyroid (Carbimazole)
Antiepileptics (minus lamotrigine)
MTX
Abx (Trimethoprim, doxy)
Alc
```
107
Ectopic Preg
- When to suspect
- RF
- Pres
Abdo pain in some one of child bearing age
Damage to tubes (surgery, inflam:PID)
Prev ectopics
IVF
Lower abdo pain, Vaginal bleed, Amenorrhoea (6-8 weeks), Shoulder pain (peritoneal bleed)
108
Types of miscrriage (Vaginal bleed)
3 types
2 categories
Threatened
- Cardiac activity
Missed
- No cardiac activity or empty sac
Inevitable
- Dilated os, prod. of conception may be seen/felt at os
Complete (all prods of conception out)
Incomplete (some prods remain)
109
Causes of abdo pain in late preg
Labour
Placental abruption
Pre-Eclampsia/HELLP (RUQ pain)
Uterine rupture
110
HELLP syndrome
Pre-Eclampsia (HTN + Proteinuria)
+
Haemolysis, elevated liver enzymes and low platelets
111
Triple test
| what for and what in it
Downs syndrome (trisomy 21)
AFP, hCG, Estriol
112
Trisomy 18
| Trisomy 13
18 = Edwards
13 = Pataus
113
Causes:
- High AFP
- Low AFP
NTD
Abdo wall defect
Downs, trisomy 18
114
What must be avoided in preg?
```
Vit A (liver)
Alcohol
Food infections (unpasteurised milk, soft cheese, pate, partially cooked food)
Prescribed med (use as little as poss esp if teratogen)
```
115
1st scan
10-13 weeks to confirm dates and exclude multiple
116
Downs screen + Nuchal thickening
11-13 weeks
117
Anomaly scan
18-20 weeks
118
When is Anti D given to Rh negative women
28 weeks first dose
| 34 weeks second
119
What Preg women scanned for
Rhesus
Down's/Fetal anomalies
NTD
Rubella
120
1st line for mastitis + Risk for non treat
Fluclox
Abscess
121
CI in breast feeding
ABx: cipro, tetracycline
Lithium, benzo
Aspirin
MTX
Sulfonyurea
Amiodarone
122
C-section indications
```
Placenta previa
Pre-Eclampsia
Post due date
IUGR
Fetal distress
Malpres
Active herpes
```
123
Types of c-section
Lower segment C-section (99%)
Classic (longitudinal in upper segment)
124
Testing for Downs
Nuchal translucency + serum b-HCG + plasma protein A
If later in preg triple test
125
Eclampsia
- def
- tx
Seizures in assoc with pre-eclampsia
Magnesium sulphate (also given to prev) + Delivery
126
Pre-eclampsia
condition seen after 20 weeks gestation
pregnancy-induced hypertension
proteinuria
127
Risk assoc with Mole
Genetics
Features
Choriocarcinoma
Triploid (two sperms/duplication of paternal sperm)
Large uterus for dates, bleed, Very high hCG
128
Common cause of neonatal sepsis?
| Maternal Prophylaxis
GBS
IV Benzylpenicillin
129
What is basis of preg test
hCG
130
Hyperemisis
- What gestation
- Tx
Sever Morning sickness 8-12 weeks
(high hCG)
Promethazine (antihistamine), Ondansetron
Admission in sever for IV hydration
131
BP in preg
Falls in 1st trimester up to 20-24 wks
After this it inc to normal (high in HTN of preg/pre-eclampsia)
132
Methods of induction of labour
Membrane sweep
Intravaginal PGs
Break waters
Oxytocin
133
Oligohydramnious
- Def
- Causes
Reduced amniotic fluid (under 500ml at 32-36 wks)
PROM, Fetal renal angenesis, IUGR, Post-termgestation, Pre-eclampsia
134
Placenta Accreta
- What is
- complication
Placenta attach to myometrium
Risk postpartum haemorrhage
135
Severity of post-natal mental probs
Baby blue 60-70% - days after (anxious tearful irritable)
Depression 1-3 month after
Psychosis 0.2% - severe mood swings, hallucinations, mania. 2-3 weeks
136
RF PPH
```
Prolonged labour
Pre-eclampsia
inc age
POolyhydramnios
Emergency c-section
Macrosomia
```
137
Examination features of pre-eclampsia
HTN (over 170/110 + Proteinuria)
```
Headache
Visual disturbance
papilloedema
RUQ pain (HELLP)
hyperrreflexia
Low PT (HELLP)
```
138
Treatment of pre-eclampsia
Labetalol
Magnesium sulphate
Delivery (timing depends on scenarios)
139
Compication of maternal DM
Macrosomia
140
RF for gestation diabetes
BMI over 30
Previous
1st degree relative with DM
141
Tx gestation diabetes
Lifetstyle (diet + exercise
Metformin if poor control
142
Suspected DVT..
Give duplex USS
ECG/CXR if PE suspected
143
What factors increase in preg
Cardiac out put, blood volume, HR, pulmonary ventilation (volume), GFR
144
Why inc risk clots
Fibrinolytic system decreased during preg (even though fall in Pt)
145
Complications of prematurity
mortality
RDS
Intraventricular haemorrhage
NEC
146
Tx of Preterm rupture of membrane
Oral erythromycin
Antenatal corticosteroids (RDS)
Delivery considered after 34 weeks
147
When doe rhesus sensitisation occur
When Rh positive baby to Rh negative mother (sensitisation during birth when inc risk blood mix)
148
Effects of congenital Rubella
Sensorineural deafness
Cataracts
Heart defect (e.g. patent ductus)
Growth retardation
Cerebral Palsy
(Give non-immune mothers MMR)
149
Tx of VTE in preg
LMWH
150
Causes of in nuchal translucency
Downs syndrome
Congenital heart defect
Abdo wall defects
151
Causes of oligohydramnios
Fetal: renal anagenesis, GU obstruction
Uteroplacental insufficiency
Rupture of membranes
152
Causes of polyhydramnios
Maternal DM
Multiple gestation
Pulmonary abnormalities
Fetal anomalies
TTTs
153
Tx of Htn in pre-eclampsia
| Tx of seizures in eclampsia
Nifedipine
| Mag sulphate
