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Flashcards in Obstetrics Deck (89):
1

What are the features of foetal varicella syndrome?

Skin scarring
Eye defects (microphthalmia), limb hypoplasia, microcephaly, learning disabilities

2

What should you do if there is any doubt regarding mother previously having chicken pox?

Check maternal blood for varicella antibodies

3

If mother is found not to be immune to varicella what should be given?

Varicella zoster immunoglobulin

4

If a mother has not received MMR vaccine when should they be offered it?

In the postnatal period

5

What is the main cause of lactation mastitis?

Milk stasis due to over production or insufficient removal.

6

What are the clinical features of lactation mastitis?

Breast pain usually unilateral
Associated erythema, heat and tenderness

7

What is the most common infectious cause of lactation mastitis?

Staph aureus

8

What is the 1st line management of lactation mastitis?

Analgesia and encourage effective milk removal (continue breastfeeding or expressing)

9

If symptoms of lactation mastitis do not improve after 12-24hrs of conservative management what is the first line abx?

Flucloxacillin 500mg qds for 14days

Erythromycin If pen allergic

2nd line is co amoxiclav

10

What is intrahepatic cholestasis of pregnancy (obstetric cholestasis) and how does it present?

Stasis of cholesterol occurs during pregnancy
Presents with pruritus (typically worse on palms, soles and abdomen)
Raised bilirubin

11

How do you manage obstetric cholestasis?

Induction of labour at 37weeks due to risk of still birth
Ursodeoxycholic acid
Vit k supplementation

12

What is lochia?

Vaginal discharge containing mucous and uterine tissue which may continue for 6weeks after childbirth

Can start red and then go brown.

13

Describe the 4 degrees of perineal tears

1st degree: tear within vaginal mucosa only
2nd degree: tear into SC tissue
3rd degree: laceration extends into external anal sphincter
4th degree: laceration extends through external anal sphincter into rectal mucosa

14

What is the secondary prevention of pre-eclampsia in weeks 12-14 in at risk mothers?

Low dose aspirin (75mg OD from 12 weeks until birth of the baby)

15

which groups of people are at risk of HTN in pregnancy?

HTN in previous pregnancy
CKD
autoimmune disorders such as SLE or antiphospholipid syndrome
T1 +2DM

16

Describe the normal variation in BP during pregnancy

BP usually falls in 1st trimester (particularly diastolic) and continue to fall until 20-24 weeks
after this the BP increases to pre-pregnancy levels by term

17

Define HTN in pregnancy

systolic BP >140mmHg or diastolic BP>90mmHg
or an increase above booking readings of >30mmHg systolic or >15mmHg diastolic.

18

What are the 3 classifications of HTN in pregnancy?

Pre-existing HTN
Pregnancy induced HTN ( gestational HTN)- this occurs after 20 weeks
Pre-eclampsia

19

What biochemical test results would you expect in a molar pregnancy?

v high b hCG
low TSH
high thyroxine

hCG can mimic TSH causing hyperthyroidism

20

What are gestational trophoblastic disorders?

they describe a spectrum of disorders originating from the placental trophoblast:
complete hydatiditform mole
partial hydatidiform mole
choriocarcinoma

21

What is a complete hydatidiform mole and why does it develop?

it is a benign tumour of trophoblastic material that occurs when an empty egg is fertilised by a single sperm that then duplicates its own DNA hence all 46 chromosomes are of parental origin.

22

What are the presenting features of a molar pregnancy?

bleeding in 1st or early 2nd trimester
exaggerated symptoms of pregnancy e.g. hyperemesis
uterus large for dates
very high serum hCG
HTN and hyperthyroidism may be seen

23

what is the management of a molar pregnancy?

urgent referral to specialist centre for evacuation of the uterus
effective contraception is recommended to avoid pregnancy in the next 12months

24

what is a partial molar pregnancy?

a normal haploid egg is fertilised by 2 sperms

25

what % of patients with complete hydatidiform moles go on to develop choriocarcinoma?

2-3%

26

What is hyperemesis gravidarum?

a serious complication of pregnancy causing severe "morning sickness" leading to life threatening dehydration and metabolic derangements.
if severe can result in vitamin and mineral deficiencies --> diplopia ad ataxia suggestive of Wernicke's encephalopathy
It can present with vomiting, dry skin, tiredness and raised B-hCG. Wt loss can occur in severe cases

27

At hat time in the pregnancy is hyperemesis gravidarum most common?

between 8-12 weeks but may persist until 20weeks

28

what scoring system can be used to clarify the severity of nausea and vomiting in pregnancy?

PUQE score

29

what is hyperemesis gravidarum associated with

multiple pregnancies
trophoblastic disease
hyperthyroidism
nulliparity
obesity

30

what is the management of hyperemesis gravidarum?

antihistamines are 1st line e.g. promethazine
ondansetron and metoclopramide may be used 2nd line
admission for IV hydration may be needed
if they develop wernickes encephalopathy they will need IV Pabrinex (Vit B and C)

31

what are the layers an obstetrician needs to cut through in a C-section?

Skin
Superficial fascia
Deep fascia
Anterior rectus sheath
Rectus abdominis muscle (not cut, rather pushed laterally following incision of the linea alba)
Transversalis fascia
Extraperitoneal connective tissue
Peritoneum
Uterus

32

what are the 2 main types of C-section?

Lower segment C-section (99%)
classic C-section (longitudinal incision un the upper segment of the uterus

33

what are some indications for c-section?

placenta praaevia grades 3/4
pre-eclampsia
post- maturity
IUGR
foetal distress in labour or a prolapsed cord
failure of labour to progress
malpresentations
placental abruption (if foetal distress- if dead deliver vaginally)
vaginal infections e.g. active herpes
cervical cancer (disseminates cancer cells)

34

true or false
If a women has had a previous caesarean section due a factor such as fetal distress the majority of obstetricians would recommend a trial of normal labour

true

35

what causes peripheral oedema in pregnancy?

increased fluid pressure both from sodium and water retention and venous stasis from pelvic obstruction.
(* this is normal)

36

what cause pulmonary oedema in pregnancy?

change in hydrostatic press either from the heart or from reduced osmotic pressure.

37

what food is a good source of folic acid?

green leafy vegetables

38

what is the function of folic acid?

important in DNA and RNA synthesis

39

what causes folic acid deficiency?

phenytoin
methotrexate
pregnancy
alcohol excess

40

what are the consequences of folic acid deficiency?

microcytic megaloblastic anaemia
neural tube defects

41

how do you prevent neural tube defects during pregnancy ?

all women should take 400mcg folic acid until the 12th week of pregnancy
women at higher risk should take 5mg of folic acid from before conception until the 12th week of pregnancy

42

what makes you at higher risk of having a child with neural tube defects?

either partner has NTD or have a previous pregnancy affected by it
women on anti epileptics
coeliac disease
diabetes
thalassaemia trait
obesity BMI>30kg/m2

43

when is your booking visit during pregnancy?

8-12 weeks (ideally <10weeks)

44

when is the Down's syndrome screening including nuchal scan?

11-13+6weeks

45

when is the anomaly scan>

18-20+6weeks

46

Management of shoulder dystocia

According to guidelines on shoulder dystocia management:
Immediately after shoulder dystocia is recognised, additional help should be called.
Fundal pressure should not be used.
An episiotomy is not always necessary.
Induction of labour at term can actually reduce the incidence of shoulder dystocia in women with gestational diabetes.
McRoberts manoeuvre is the first line intervention as it is known to be simple, rapid and effective in most cases

47

what is shoulder dystocia?

the inability to deliver the body of the foetus using gentle traction, the head having been delivered.

48

what is shoulder dystocia associated with?

postpartum haemorrhage, perineal tears, brachial plexus injury
neonatal death can occur.

49

what does the McRoberts manoeuvre in shoulder dystocia entail?

flexion and abduction of the maternal hips, bringing the mothers thighs towards her abdomen. this rotation increases the relative anterior posterior angle of the pelvis and often facilitates delivery.

50

when can pregnancy related causes of HTN be diagnosed?

after 20 weeks!!

51

what is the Kleihauer test?

A Kleihauer test is a test for Foetomaternal haemorrhage which detects fetal cells in the maternal circulation and, if present, estimates the volume of FMH to allow calculation of additional anti-D immunoglobulin. According to BCSH guidelines, it is required for any sensitising event after 20 weeks gestation.

52

what is the bishop score used for?

to assess whether induction of labour will be required
<5 labour unlikely to start without induction
>9 labour will most likely commence spontaneously

53

what variables are considered in the bishop score?

cervical position
cervical consistency
cervical effacement
cervical dilation
foetal station

54

name or describe 4 ways to induce labour

membrane sweep
intravaginal prostaglandins-->cervical ripening
breaking of waters
oxytocin

55

what is a contraindication of using epidural anaesthesia during labour?

coagulopathy

56

what is eclampsia?

a condition characterised by seizures in a pregnant woman with preeclampsia

57

what are the signs and symptoms of pre-eclampsia?

HTN (after 20weeks)
proteinuria
abdo pain
nausea
vomiting
visual disturbance

58

what are the complications of preterm premature rupture of membranes?

foetal: prematurity, infection, pulmonary hypoplasia
maternal: chorioamnionitis

59

Describe the management of preterm premature rupture of membranes

admit
regular obs to ensure no chorioamnionitis
oral erythromycin for 10days
antenatal corticosteroids to reduce risk of respiratory distress syndrome
deliver should be considered at 34weeks

60

what drugs are contraindicated in breastfeeding?

lithium
aspirin
BDZs
carbimazole
sulfonylureas
amiodarone
cytotoxic drugs
methotrexate
certain abxs e.g. ciprofloxacin, tetracycline chloramphenicol
sulphonamides

61

how long should treatment with magnesium infusion for eclampsia continue for?

continue for 24hrs after delivery or after last seizure

62

how can you suppress lactation?

stop the lactation reflex ie stop suckling/expressing
supportive measures: well supported bra and analgesia
cabergoline is the medication of choice if required

63

is it safe for a mother with Hep B to breastfeed her newborn?

yes!

64

If a mother is found to be non-immune to varicella zoster virus what is the most appropriate management?

Varicella zoster immunoglobulin as soon as possible.

65

What is an omphalocele?

a foetal abdominal wall defect which is associated with a raised maternal AFP.

66

What foetal abnormalities are associated with low levels of maternal AFP?

Down's syndrome, maternal DM, Edwards syndrome (trisomy 18) and maternal obesity.

67

What foetal abnormalities are associated with increased levels of maternal AFP?

Neural tube defects (meningocele, myelomeningocele and anencephaly)
Abdominal wall defects (omphalocele and gastroschisis) and multiple pregnancy

68

True or false
In induced labour epidural anaesthesia increases BP

false
In induced labour epidural anaesthesia reduces BP

69

What is cord prolapse?

When the umbilical cord descends ahead of the presenting part

70

if cord prolapse is left untreated what can happen?

It can lead to compression of the cord or cord spasm which can cause foetal hypoxia and eventually irreversible damage death.

71

What are some risk factors for cord prolapse?

prematurity
multiparty
polyhydramnios
twin pregnancy
cephalopelvic disproportion
abnormal presentations e.g. breech, transverse lie
placenta pavia
long umbilical cord
high foetal station

72

when do the majority of cord prolapses occur?

at artificial rupture of membranes

73

When is the diagnosis of cord prolapse usually made?

when the foetal HR becomes abnormal and the cord is palpable vaginally or if the cord is visible beyond the level of the introitus

74

how would you manage cord prolapse?

you can push the presenting part of the foetus back into the uterus to avoid compression
tocolytics may be used
if the core is past the level of the introits it should be kept warm and moist but should not be pushed back inside.
the patient should go on all fours until immediate c-section can occur

75

A 35-year-old nulliparous lady with Factor V Leiden has come for her first antenatal appointment; she has previously had an unprovoked venous thromboembolism (VTE). The attending doctor discusses thromboprophylaxis with her due to her history. Based on her risk, which treatment pathway should be used?

LMWH antenatally and throughout pregnancy until 6 weeks postpartum

76

what is the first line drug to treat pregnancy induced HTN?

labetolol

77

when do mothers usually get the "baby blues"?

3-7 days after birth

78

what is the scoring system used to screen for post natal depression?

Edinburgh postnatal depression scale

79

Which anti epileptic is recommended for epileptic patients in pregnancy?

lamotrigine

80

what is the first line treatment for eclampsia?

magnesium sulphate

81

what is erbs palsy?

it is when the arm is adducted and internally rotated with pronation of the forearm. (also called "waiters tip". it is a complication of shoulder dystocia due to damage of the brachial plexus

82

What is HELLP?

Haemolysis, elevated liver enzymes and low platelets
presents with HTN, vomiting and abdomen pain (pain is due to stretching of the liver capsule)

83

What food should mothers avoid in pregnancy?

Liver should be avoided in pregnancy as it contains high levels of vitamin A, a teratogen.
unpasteurised milk and ripened soft cheeses
pate or undercooked meat

84

If a mother is found to not have rubella immunoglobulins what is the most appropriate course of action?

Advise her of the risks and the need to keep away from anyone who has rubella.

85

what is the wood screw manoeuvre?

The woodscrew manoeuvre describes the action of putting a hand in the vagina an rotating the foetus 180 degrees in attempt to 'dislodge' the anterior shoulder from the symphysis pubis.

86

What secretes hCG during pregnancy?

syncytiotrophoblasts
hCG acts to maintain the production of progesterone by corpus lute in early pregnancy.

87

What is an amniotic fluid embolism?

when foetal/amniotic fluid enters the mothers bloodstream and stimulates a reaction which results in the signs and symptoms

88

what is the clinical presentation of amniotic fluid embolism?

The majority of cases occur in labour , though they can also occur during caesarean section and after delivery in the immediate postpartum.
Symptoms include: chills, shivering, sweating, anxiety and coughing.
Signs include: cyanosis, hypotension, bronchospasms, tachycardia. arrhythmia and myocardial infarction.

89

how does foetal alcohol syndrome present?

Foetal alcohol syndrome presents with a range of features depending on the severity of alcohol exposure:
microcephaly (small head)
short palpebral fissures (small eye opening)
hypoplastic upper lip (thin)
absent philtrum
reduced IQ
variable cardiac abnormalities.