Obstetrics Flashcards
(278 cards)
1
Q
1st trimester
A
0-13 weeks
2
Q
2nd trimester
A
14-28 weeks
3
Q
3rd trimester
A
29-40 weeks
4
Q
What does a urinary pregnancy test detect?
A
beta HCG levels
5
Q
Where does fertilisation occur?
A
Fallopian tubes
6
Q
Where does the blastocyst implant?
A
Uterine wall
7
Q
Causes of early pregnancy bleeding (<12 weeks)?
A
Implantation bleeding Miscarriage Ectopic/Molar Chorionic haematoma Cervical (infection, cancer, polyp) Vaginal (infection)
8
Q
How common is early pregnancy bleeding?
A
20%
9
Q
Symptoms of a miscarriage?
A
Bleeding, cramping
10
Q
Investigation of miscarriage?
A
USS, speculum exam
11
Q
What does a closed os mean in miscarriage?
A
Threatened miscarriage
12
Q
What does an open os mean in miscarriage?
A
Inevitable miscarriage
13
Q
What causes cervical shock?
A
Incomplete miscarriage, products still left in cervix
14
Q
Symptoms of cervical shock?
A
Cramps, N+V, sweating, fainting
15
Q
Causes of miscarriage?
A
Embryonic abnormality e.g. chromosomal APS Infections- CMV, Rubella, Listeria Iatrogenic (after CVS) Emotional upset
16
Q
What is early foetal demise?
A
Pregnancy in-situ but no heartbeat
17
Q
What is anembryonic pregnancy?
A
No feotus (lack of development/reabsorbed)
18
Q
Management of miscarriage?
A
Conservative- allow natural expulsion OR Medical induce expulsion OR Surgical removal
19
Q
Causes of recurrent miscarriage?
A
APS Thrombophilia Balanced translocation Uterine abnormality Age of mother
20
Q
Where is the most common location of ectopic pregnancy?
A
Ampulla
21
Q
Symptoms and signs of ectopic pregnancy?
A
Pain + shoulder tip pain, bleeding, dizziness, collapse, SOB, N+V, pallor, peritonism, guarding
22
Q
Investigations of ectopic?
A
FBC, group and save, bHCG, USS
23
Q
What is pregnancy of unknown location (PUL)?
A
+ve pregnancy test but no sign of intrauterine or ectopic pregnancy
24
Q
Management of ectopic or molar pregnancy?
A
Surgery if acutely unwell
Methotrexate
25
What is a molar pregnancy?
Non-viable fertilised egg- leads to an overgrowth of placental tissue
26
What is the appearance of molar pregnancy on ultrasound?
"snow storm"
27
What is a complete molar pregnancy?
Egg without DNA with 1/2 sperm
28
What is partial molar pregnancy?
Egg with 2 sperm
29
What kind of foetus results from complete molar pregnancy?
Diploid
30
What kind of foetus results from partial molar pregnancy?
Triploidy
31
Symptoms of molar pregnancy?
Hyperemesis (due to high bHCG), bleeding, SOB
32
When does implantation bleeding occur?
~10 days after ovulation
33
What is a chorionic haematoma?
Pooling of blood between endometrium and embryo
34
Uses of intra-uterine insemination?
Sexual problems, same-sex couples, BBV
35
Uses of IVF?
Pelvic disease, anovulatory infertility, unexplained
36
How long does an IVF cycle take?
6 weeks
37
Steps of IVF?
1. Down regulation of ovulation (GnRH)
2. Ovarian Stimulation (FSH + LH)
3. Oocyte collection
4. Fertilisation
5. Embryo Transfer
38
What does ICSI stand for?
Intra-cytoplasmic Sperm Injection
39
Uses of ICSI?
Male infertility
| Failed IVF
40
Complications of assisted conception?
Ovarian Hyperstimulation
Multiple Pregnancy
Ectopic Pregnancy
Miscarriage
41
Define hyperemesis gravidarum (HG)?
Excessive, protracted vomiting- decreasing quality of life (usually just 1st trimester)
42
Other complication of HG?
Dehydration, ketosis, electrolyte imbalance, weight loss, malnutrition, depression, altered LFTs
43
Management of HG?
```
Rehydrate + electrolyte replacement
Parenteral anti-emetics (cyclizine)
Nutritional supplement
Thiamine supplement
Steroids if SEVERE
```
44
What does the placenta secrete to maintain corpus luteum (maintain progesterone levles)?
HCG
45
At how many weeks can the external genitalia be seen on USS?
16 weeks
46
Where does spermatogenesis occur?
Seminiferous tubules
| mature on inside and burrow to outside
47
Where is sperm stored?
Epididymis
48
Which cells produce testosterone and which hormone controls this?
Leydig cells
LH
49
What does blood fill to produce an erection and which muscles contract?
Corpora cavernosa
Accessory sex glands and urtheral + erectile muscles
50
Causes of male infertility?
CF, vasectomy, undescended testes, chlamydia, chemo/radiotherapy, tumours, Klinefelters (XXY), tubal abnormalities, CAH, steroid abuse, pituitary tumours etc.
51
Investigations of male infertility?
```
Sperm analysis (3 days abstinence)
Endocrine profile
Chromosome analysis
CF screening
STI screening
Scrotal scan
```
52
Treatment of male infertility?
Reversal of vasectomy
ICSI
Sperm aspiration
Donor sperm insemination
53
Abortion act- who needs to sign?
2 registered medical practitioners
54
In Tayside, you can get an abortion up to...?
18 weeks + 6 days
55
When is conscientious objection to abortion not valid?
Emergency situations
56
Until how many weeks can you have an abortion if there are foetal abnormalities?
Term
57
What is the most common approach to treatment of psychosexual dysfunction?
Psychodynamic psychotherapy
58
How long can sperm live in vagina for?
5 days
59
How long can the ovum live in the vagina?
up to 24 hours
60
Name for methods of "natural family planning"
Basal body temp (slight increase= ovulation)
Cervical mucus
Cervical position
"Standard days"
61
How can breastfeeding act as a form of contraception?
Lactational amenorrea:
Exclusive breastfeeding, <6 months postnatal and amenorrhea
62
2 medical steps for TOP?
1. Mifepristone 200mg
24-48 hours later
2. Misoprostol
63
What kind of medication is mifepristone?
Anti-progesterone
64
What kind of medication is misoprostol?
Prostaglandin
65
What happens after misoprostol is taken?
4-6 hours later, womb lining breaks down and womb contracts
66
What are the surgical options for TOP?
Vacuum aspiration
| Dilatation and evacuation
67
When can vacuum aspiration take place?
6-12 weeks
68
When can dilatation and evacuation take place?
13-24 weeks
69
Which contraceptives CANNOT be started straight away after TOP?
Depo injection
| Vaginal ring
70
What does foetal malnutrition lead to?
Insulin resistant + impaired glucose tolerance- T2DM
71
Risks of overweight to mother?
Miscarriage
Gestational diabetes
Pre-eclampsia
Still birth
72
Risks of overweight to baby?
Macrosomia
Congenital anomalies
Increased weight
73
How many extra calories are needed during pregancy?
300 kcal
74
How many extra calories are needed for breastfeeding?
640 kcal
75
What supplements are given during pregnancy, and how much?
Folic acid- 400 micrograms (pre- 12 weeks) (5mg if high risk)
Vitamin D- 10mg (pregnancy + breastfeeding)
Iron- if high risk of anaemia
76
Foods to avoid in pregnancy?
```
Soft cheese
Tuna
Raw/partial eggs
Pate
Liver
Undercooked meat, game, cured meat
```
77
Which pregnancy hormone causes mammary gland enlargement and prepares for lactation?
Prolactin
78
What is a molar pregnancy at risk of becoming, and which type has a bigger risk?
Choriocarcinoma
Complete molar
79
How do you work out due date?
Add 9 months + 7 days to first day of last period
80
Important parts of booking visit of antenatal care?
```
BMI
BP
Urinalysis
USS
Mental health screen
Test for trisomy, sickle cell + thalassemias
```
81
How is gestation determined on USS?
```
Crown-rump length
Head circumference (>14 weeks)
```
82
When is USS carried out to test for foetal anomalies?
20 weeks
83
What is looked for in a foetal anomalies screen?
```
Trisomy
Cleft palate
Neural tube defects
Abdominal wall
Limb deformities
Placental health
```
84
How is Down's Syndrome screened for and when?
Nuchal thickness/translucency (11-13 wks)
Bloods- HCG + AFP (15-20 wks)
Amniocentesis (15 wks) or CVS (12 wks)
(also NIPT)
85
When is anti-D given to Rhesus negative mothers, and how much?
500 units IM
at 28 weeks or after a sensitising event (surgical evacuation, miscarriage, CVS/amio, delivery)
86
When is the dating USS in pregnancy?
10-16 weeks
87
What is Non-Invasive Prenatal testing (NITP) used for and how does it work?
Testing for trisomy and sex determination (e.g. X linked conditions)
Tests for free foetal DNA in maternal blood (ratio normal or abnormal?)
88
When might NITP cause a false positive?
Maternal cancers
89
When does the placenta become functional?
Week 5
90
What does the placenta secrete to maintain progesterone secretion?
human chorionic gondotropin (hCG)
91
Oxygen diffuses from mother to foetus via..?
Umbilical blood
92
Foetal oxygenated blood returns to foetus via..?
Umbilical VEIN
93
Foetal de-oxygenated blood returns to placenta via..?
Umbilical ARTERY
94
Urinary adaptations in pregnancy? (2)
Increased GFR
| Increased renal plasma flow
95
What does the placenta release that leads to hypertension, insulin resistance and gestational diabetes?
CRH- corticotropin-releasing hormone
96
Definition of small for dates (SGA) pregnancy?
Estimated fetal weight/fetal abdominal circumference is <10th centile
97
Haematological adaptations in pregnancy? (2)
Increased plasma volume
Increased RBCs (erythropoeisis)
Haemoglobin reduced by dilution
98
Respiratory adaptations in pregnancy? (3)
Increased RR
Increased tidal volume
Increased O2 consumption
99
Risk factors for SGA pregnancy?
```
>40
BMI >35
Cocaine, smoking
Previous stillbirth
Hypertension
Diabetes
Renal impairment
APS
```
100
Causes of small for dates pregnancy?
Constitutionally small
| IUGR- intra-uterine growth restriction
101
Causes of preterm delivery?
```
Infection- UTI, appendicitis, pneumonia
Multiple pregnancy
Polyhydramnios
Placental abruption
Idiopathic
```
102
IUGR can be symmetrical or asymmetrical. What causes each?
Symmetrical- chromosomal
| Asymmetrical- placental problems (normal head, small abdomen)
103
IUGR can be symmetrical or asymmetrical. What causes each?
Symmetrical- chromosomal
| Asymmetrical- placental problems (normal head, small abdomen)
104
Causes of SGA pregnancy?
Maternal risk factors
Placental infarcts or abruption
Foetal infection- rubella, CMV
Chromosomal
105
What is IUGR- intra-uterine growth restriction?
Failure to achieve growth potential (crossing centiles of growth in uterus)
106
Causes of large for dates pregnancy?
```
Wrong dates
Macrosomia
Polyhydramnios
Multiple Pregnancy
Diabetes in pregnancy
```
107
Features of IUGR?
Decreased fundal height, liquor and fetal movements
108
Investigations of IUGR?
USS
CTG
Umbilical artery doppler
109
Management of IUGR?
37 week delivery, consider C-section
Steroids during delivery
Magnesium sulphate- foetal neuroprotection
110
Definition of large for dates pregnancy?
Symphyseal-fundal height >2cm for gestational age
111
Definition of macrosomia?
Estimated foetal weight >90th centile
112
Risks of macrosomia?
Obstructed labour
Shoulder dystocia
PPH
113
Management of macrosomia?
Exclude diabetes
| Induction or C-section
114
What is polyhydramnios and what causes it?
Excess amniotic fluid
Causes- diabetes, fetal anomaly, twins, viral infections, hydrops fetalis, idiopathic
115
Symptoms of polyhydramnios?
Abdo discomfort, prelabour membrane rupture, preterm labour, cord prolapse
116
What is monozygotic?
Splitting of one egg- identical twins
117
What is dizygotic?
2 ova + 2 sperm
118
Management of diabetes in pregnancy?
Low dose aspirin
Insulin injections
5mg folic acid
Deliver at 38 wks
119
What is monozygous?
1 placenta
MCDA- 1 placenta, 2 sacs
MCMA- 1 placenta, 1 sac
120
Foetal complications of multiple pregnancy?
```
Increased mortality
Congenital anomaly
IUD
Preterm birth
Growth restriction
Cerebral palsy
Twin-to-twin transfusion
```
121
Maternal complications of multiple pregnancy?
```
HG
Anaemia
Pre-eclampsia
C section
Antepartum haemorrhage
```
122
Complications of poorly controlled diabetes in pregnancy?
```
Congenital anomaly
Miscarriage
IUD
Pre-eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia
Neonatal hypoglycaemia
```
123
Pathogenesis of gestational diabetes?
Pregnancy causes relative insulin deficiency/insulin resistance
If predispose- can tip into diabetes
124
How does the uterus become more excitable in labour?
Increased oestrogen makes uterus contract and express oxytocin receptors
125
What does oxytocin do during labour?
Increase and sustain contractions
126
What does mechanical stretch do to hormones during labour?
Increase oxytocin release
127
Which hormones does the foetus produce during labour?
Oxytocin and prostaglandins
Cortisol
Surfactant into amniotic fluid
128
After the membranes rupture in pregnancy, how long until the baby is delivered?
Within 48 hours, or induce labour
| due to high risk of infection
129
What happens to the cervix to prepare for labour?
Cervical softening (ripening)
130
What is the Bishop score, and what are the 5 elements?
Used for assessing labour:
1. Position
2. Consistency
3. Effacement
4. Dilatation
5. Station (-3 to +3... 0=ischial spine)
131
What is the first stage of labour and how long does it last?
Cervical dilatation
8-24 hours
132
Features of latent phase of first stage of labour?
3-4cm dilation
| Mild irregular contractions
133
Features of active phase of first stage of labour?
4cm +
usually 1-2cm/hour
Decent, strong, rhythmic contractions
MOBILITY AND ANALGESIA
134
What is the second stage of labour and how long does it last?
Delivery of baby
Nulliparous- 2.5 hours
Multiparous- 60-90 mins
135
What is gravidity?
number of times that a woman has been pregnant
136
What is parity?
number of times that she has given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn
137
What is the third stage of labour and how long does it last?
Expulsion of placenta and membranes
(cord lengthens and gush of blood)
~10 mins after baby
138
What are Braxton-Hicks contractions?
Tightening of uterine muscles
| Irregular, mild, resolve with movement
139
How regular should true contractions be, and what duration?
Should have 3-4 in 10 mins
| Should be ~45 secs
140
When are contractions hyperstimulated?
>5 in 10 mins
141
What are contractions insufficient?
<3 in 10 mins
142
What is the most suitable pelvic shape for giving birth?
Gynaecoid pelvis
143
How can foetal position be determined during labour?
Feeling fontanelle position on vaginal exam
144
What is a normal foetal position during labour?
Longitudinal lie, cephalic presentation, flexed head
OCCIPITO-ANTERIOR
145
What is engagement in labour?
When widest part of head entered brim of pelvis (3/5 in pelvis, 2/5 in abdomen)
146
What does the foetal head do in labour?
Flexion (chin to chest) then internal rotation, then extends
Finally, external rotation (restitution) to align with torso
147
What is crowning in labour?
When widest part of head is at vaginal opening
148
Which shoulder should be birthed first?
Anterior shoulder
149
Analgesia used during labour? (6)
1. Paracetamol/co-codamol
2. TENS
3. Entonox
4. Diamorphine
5. Epidural
6. Spinal anaesthesia
150
What does entonox cause?
Euphoria
Sickness
Inattention
151
What is an epidural?
Injected L2-4
| Numb below level (dermatomes and myotomes)
152
Side effect of epidural?
Hypotension, bradycardia, fetal hypoperfusion
153
What is a spinal anaesthesia?
Pudendal nerve block
154
2 important steps after delivery and why?
Delayed cord clamping (1-2 mins/pulsation ceases)- allow transfer of RBCs
Skin-to-skin (1 hour)- promotes breastfeeding, calming bonding
155
When should active management of third stage of labour occur, and what can be done?
After >1 hour post-birth
Syntometrine 1ml
Oxytocin 10 units
156
What does syntometrine contain?
Oxytocin and ergometrine
157
What is the puerperium?
6 weeks post birth
| Repair and recovery period
158
What is lochia?
Vaginal discharge with blood and mucus after birth (may be fresh blood, brown or yellow)
159
What stimulate production and secretion of breast milk?
Prolactin
160
What is the leading cause of maternal mortality?
VTE (4-6x risk)
161
What do palpitations and systolic/extra-systolic murmurs mean in pregnancy?
Mostly benign (common)
162
What does chest pain in pregnancy require?
ECG +/- CTG
163
Which cardiac conditions are very dangerous in pregnancy and often contraindicate becoming pregnant?
Pulmonary hypertension
Cyanosis
TIA/arrhythmia
HF
164
How many pregnancies can involve breathlessness?
75%
165
Sudden SOB in pregnancy?
PE!!
166
How does asthma change during pregnancy?
1/3 improve
1/3 the same
1/3 deteriorate
167
Can inhalers for asthma be continued throughout pregnancy?
YES
168
What to do if an oral steroid has been used >2 weeks before labour?
Give IV hydrocortisone 100mg qid during labour
169
Where do most VTEs occur in pregnancy (85-90%)?
Left leg
| Mostly ileo-femoral
170
What is used as VTE prophylaxis if high risk in pregnancy?
Dalteparin
171
What is used as VTE prophylaxis if high risk post-natally?
Warfarin from day 5- 6 weeks
172
Affects of APS on pregnancy?
```
Early pregnancy loss (recurrent)
Thrombosis
Foetal growth restriction
Placental abruption
Severe pre-eclampsia
```
173
Management of APS in pregnancy?
Low dose aspirin +/- LMWH
174
Foetal risk of maternal epilepsy?
Injury from seizure
Congenital malformations
Developmental defects
Haemorrhagic disease of newborn
175
High BP in pregnancy is defined as..?
2x 140/90
1x 160/110
or
30/15 increase compared to 1st trimester
176
Define pregnancy induced hypertension?
New hypertension after 20 weeks with no proteinuria
Resolves 6 weeks postpartum
177
What is pre-eclampsia and how many pregnancies are affected?
New hypertension after 20 weeks with significant proteinuria (>0.3g/L)
+ oedema
5% of UK pregnancies
178
Risk factors for pre-eclampsia?
```
Existing hypertension
Diabetes
Renal disease
Autoimmune disorder
FH
Obesity
Multiple pregnancy
First pregnancy
```
179
What is 'early' pre-eclampsia?
<34 weeks
| uncommon, high risk
180
What is 'late' pre-eclampsia?
>34 weeks
| more common
181
Pathogenesis of pre-eclampsia?
1. Abnormal placental perfusion--> ischaemia and endothelial dysfunction
2. Maternal syndrome
182
CNS effects of pre-eclampsia?
```
Eclampsia
Hypertensive encephalopathy
Intracranial haemorrhage
CN palsy
Cerebral oedema
Cortical BLINDNESS (temporary)
```
183
Renal effects of pre-eclampsia?
Decreased GFR
Proteinuria
AKI
Increases serum uric acid
184
Liver effects of pre-eclampsia?
Pain
Abnormal LFTs
HELLP
Hepatic rupture
185
Haematological effects of pre-eclampsia?
Low PV
Haemolysis
Thrombocytopenia
186
Cardiac/lung effects of pre-eclampsia?
Pulmonary oedema
| PE
187
Foetal effects of pre-eclampsia?
Growth restriction
| Placental abruption
188
Symptoms of pre-eclampsia?
```
Headache
Visual disturbance
RUQ pain
N+V
Oedema
SOB
Confusion
```
189
Investigations of pre-eclampsia?
```
FBC, U+Es, LFTs, coag screen
Serum urate
Urine PCR
Fetal CTG
USS
```
190
Treatment of pre-eclampsia?
DELIVERY
| Anti-hypertensive
191
How to manage pre-eclampsia birth?
Most within 2 weeks of diagnosis
Steroids
Use epidural (reduce BP)
Continuous CTG monitoring
192
Which anti-hypertensives are used in pre-eclampsia and how do they work?
Labetalol- alpha and beta antagonist (NOT IN ASTHMA)
Nifedipine- Ca channel antagonist
Methyl-dopa
193
What is eclampsia?
Tonic clonic seizure with extreme hypertension
194
Treatment of eclampsia?
IV magnesium sulphate (4g) then IV infusion
IV diazepam if persistent
Strict fluid balance (catheterise)
195
What is HELLP syndrome?
Haemolysis Elevated Liver enzymes, Low Platelets
196
How to prevent pre-eclampsia in high risk patients?
75mg aspirin from 12 weeks
197
Define an antepartum haemorrhage?
>24 weeks and before second stage of labour
198
Define a minor haemorrhage?
>50 ml loss, now settled
199
Define a major haemorrhage?
50-1000ml
| No signs of shock
200
Define a massive haemorrhage?
>1000ml
| and/or signs of shock
201
What is placental abruption?
Premature separation of placenta before birth (partial or total)
202
Pathogenesis of placental abruption?
Vasospasm leading to arteriole rupture
Blood into amniotic fluid
Tonic contraction- placenta hypoxia
203
Risk factors for placental abruption?
```
Pre-eclampsia/ high BP
Trauma
Drugs- smoking, cocaine
Thrombophilia
Renal disease
Diabetes
Multiple pregnancy
Polyhydramnios
Premature ROM
```
204
Symptoms/signs of placental abruption?
```
Severe CONTINUOUS abdo pain
Backache
Bleeding
Preterm labour
Collapse
Distressed
WOODY-HARD UTERUS
Large uterus
```
205
How is placental abruption managed?
O2, fluids, ABC
C-section ASAP
Bloods + X match
206
What is Kleihauer's test?
For foetal haemoglobin
207
What is placenta praevia?
Placenta partially or fully implanted in the lower uterine segment (covering the cervical os)
- AKA low-lying placenta
208
Which part of the uterus doesn't contract during labour?
Lower segment (passively dilates)
209
Why is the lower segment important in C-sections?
Less bleeding, thinner, easier to heal
| Allows future vaginal births
210
Risk factors of placenta praevia?
```
Previous C-section/placenta praevia
Asian
Smoking
Assisted conception
Multiparity
Multiple pregnancy
>40
```
211
Symptoms of placenta praevia?
PAINLESS bleeding
(patients condition directly proportional to amount of bleeding)
Uterus soft, non-tender
Malpresentation
212
Investigations of placenta praevia?
DO NOT DO VAGINAL EXAM
Speculum exam
USS
213
Management of placenta praevia?
ABC resuscitation + X match
CTG
Steroids + magnesium sulphate
C section delivery
214
What is placenta accreta?
A morbidity adherent placenta to uterine wall
| Causes DOUGHY ABDOMEN
215
Risk factors of placenta accreta?
Placenta praevia
| Previous C section
216
Difference between the two types of placenta accreta- placenta increta and placenta percreta?
placenta increta- placental infiltration of myometrium
placenta percreta- penetration reaches serosa, into bladder
217
Management of placenta accreta?
Prophylactic internal iliac artery balloon
C section
May need hysterectomy
(expect >3L blood loss)
218
What is uterine rupture?
Full thickness opening of uterus
219
Risk factors for uterine rupture?
Previous C section
Previous uterine surgery
Multiparity
Obstructed labour
220
Symptoms of uterine rupture?
```
Severe abdo pain
SHOULDER TIP PAIN
Collapse
Peritonitis
IUD
```
221
Management of uterine rupture?
```
Urgent resuscitation (+ anti-D)
C section
```
222
What is vasa praevia?
Unprotected fetal vessels traverse the fetal membranes over the internal os (block exit)
223
Investigation of vasa praevia?
USS doppler
224
Symptoms of vasa praevia?
Sudden bleeding + fetal bradycardia/IUD
225
Risk factors of vasa praevia?
Placental anomalies
Placenta praevia
Multiple pregnancy
IVF
226
Define PPH? What is primary and secondary?
>500ml blood loss after birth of baby
Primary- in first 24 hours
Secondary= 24hours- 6 weeks
227
What is major PPH?
>1000ml lost + signs of shock or ongoing bleeding
228
Causes of PPH? 4Ts?
Tone (uterine atony)
Trauma
Tissue (retained placenta)
Thrombin (clotting disorders etc.)
229
Risk factors of PPH?
```
Anaemia
Previous C section
Previous PPH
Previous retained placenta
Polyhydramnios
Macrosomia
Obesity
Multiple pregnancy
```
230
General management of PPH?
X match 6 units
IV warmed crystalloid infusion
Tranexamic acid
231
Management of PPH due to uterine atony?
1. Uterine massage
2. IV syntocinon
3. Carboprost/Misoprostol
4. Uterine balloon tamponade
5. Hysterectomy if extreme
232
Management of PPH due to retained tissue?
Remove tissue
| Examination under anaesthesia
233
Management of PPH due to thrombin?
Blood and platelet transfusion
234
How to prevent PPH?
Active management of 3rd stage of labour
235
Commonest cause of secondary PPH?
```
Retained tissue (foul smelling, fever, discharge)
Infection common
```
236
What shape is the anterior fontanelle?
Diamond
237
What shape is the posterior fontanelle?
Triangle
238
In breech, what are the risks?
Fetal distress, trauma, head entrapment
239
What is ECV and when is it done?
External cephalic version at 36 weeks to turn baby
240
What management is often needed in an occipito-posterior positioning?
Forceps
241
What is there an increased risk of in occipito-transverse positioning, and what is its management?
Cord prolapse
Emergency C-section (30 mins) if occurs
242
What happens after 42 weeks gestation?
High rates of stillbirth
243
Signs of obstruction in failure to progress?
```
Moulding
Caput (head swelling)
Haematuria
Vulval oedema
Retention
Anuria
```
244
When should failure to progress be expected in nulliparous women?
<2cm dilatation in 4 hours (2-3 hrs pushing)
245
When should failure to progress be expected in multiparous women?
<2cm dilatation in 4 hours or slowing in progress (1-2 hrs pushing)
246
Causes of failure to progress?
3Ps
Power- inadequate/uncoordinated contractions (<3 in 10 mins)
Passage- pelvis too small, short stature
Passenger- big baby, malpresentation/malposition
247
How is progress of labour assessed?
Partogram
248
Causes of foetal distress?
```
Abruption
Vasa praevia
Hyperstimulation
Placental insufficiency
Cord prolapse
Uterine rupture
Regional anaesthesia
Fetal anaemia
```
249
Monitoring of foetal distress?
Doppler auscultation
Colour of amniotic fluid
Cardiotocograph (CTG)
250
What might colour of amniotic fluid indicate?
Red- bleeding/clots
| Green/brown- meconium passed- sign of distress
251
Mneumonic for CTG interpretation?
Dr C Bravado
DR- define risk (high or low from Hx)
C- contractions (frequency + duration)
Bra- Baseline rate (fetal HR normal-110-160)
Variability (at least 10-15bpm- reassuring)
Accelerations (15bpm increase for 15 secs- reassuring)
Decelerations (early- normal, variable- cord compression, late- hypoxia)
Overall (reassuring, suspicious or abnormal)
252
One a CTG, how long does 1 box represent?
1 minute
253
Management of foetal distress?
```
IV fluids
Stop syntocinon
Scalp stimulation (normal- acceleration on CTG)
Tocolysis (terbutaline)- relax uterus
Fetal blood sampling- blood gases
Forceps/ventouse/C section
```
254
What is shoulder dystocia and complications?
Shoulder stuck behind pubic symphysis- can lead to fetal asphyxia
May lead to PPH, 3rd degree tears, fetal hypoxic, fractures and palsies
255
Management of shoulder dytocia?
```
Mc Roberts (knees to chest)
Episiotomy
Remove posterior arm
Turn on to all fours
Internal manoeuvres
```
256
How does uterine inversion occur?
Pulling on placenta before detachment
257
How to manage aortocaval compression?
Turn onto left lateral position
258
Indications for induction of labour?
```
Pre-eclampsia
Post-dates
Suspected IUGR
Renal disease
Rhesus isoimmunisation
Placental insufficiency
Diabetes
Connective Tissue Disease
Premature ROM
```
259
How to induce labour?
Prostaglandins (vaginal gel)
Membrane sweep
Amniotomy- artificial ROM
IV syntocinon
260
Most drugs cross the placenta. Name a safe drug that DOES NOT?
Anything large molecular weight--> HEPARIN
261
How is drug absorption affected in pregnancy?
Decreased in morning sickness
262
How is drug distribution affected in pregnancy?
Increased plasma volume= Increased volume of distribution
| Increased free drug
263
How is drug metabolism affected in pregnancy?
Increased liver metabolism
264
How is drug elimination affected in pregnancy?
Increased GFR, increased metabolism
265
When is the period of greatest teratogenicity?
Week 4-11
266
Name some teratogenic drugs?
```
ACEi/ARBs
Androgens
Anti-epileptics
Cytotoxics
Lithium
Methotrexate
Retinoids
Warfarin
```
267
What do drugs affect in 2nd and 3rd trimester?
Growth of foetus + functional development (intelligence/behaviour)
268
What can epilepsy cause in pregnancy if untreated?
Congenital malformations, reduced IQ etc.
269
How many epileptic people experience more seizures in pregnancy?
10%
270
Anti-epileptics to avoid in pregnancy?
Sodium valproate
Phenytoin
Lamotrigine (in breastfeeding)
271
Is insulin safe in pregnancy?
YES
272
Which diabetes medication should be avoided in pregnancy?
Sulphonylureas
273
Which anti-emetic can be used in pregnancy?
Cyclizine (cycle away from vomiting)
274
For treatment of UTI, which can't be used in 3rd trimester?
Nitrofurantoin
275
What is foremilk high in?
Protein
276
What is hindmilk high in?
Fat
277
How long after a molar pregnancy should you wait to get pregnant again?
wait until bHCG falls to normal (roughly 3 months)
278
PPH followed by pituitary failure?
Sheehan's syndrome
