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Flashcards in Obstetrics Deck (326)
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1

What are the risks of asymptomatic bacteriuria in pregnancy?

Increased risk of preterm delivery
Increased risk of pyelonephritis during pregnancy

2

How should asymptomatic bacteriuria be treated?

Immediate antibiotic prescription (nitrofurantoin, amoxicillin or cefalexin)

3

Which tests are done at the booking visit?

FBC
MSU
Blood group and antibody screen
Infection screen (Hep B, HIV, Syphilis)

4

When does gestational thrombocytopaenia tend to occur?

> 28 weeks

5

What should women with a history of GDM be offered in their pregnancy?

OGTT or random blood glucose in the 1st trimester
NOTE: helps identify pre-existing diabetes that has developed in the meantime

6

How should newborns born to women with hepatitis B be treated to reduce the risk of transmission?

Hepatitis B vaccine (at birth, 1 month and 6 months)
Hepatitis B immunoglobulin

NOTE: both should be given within 12 hours

7

Which parameters are used to date the pregnancy on ultrasound scan?

10-14 weeks = CRL
14-20 weeks = Head Circumference

8

What are the components of the combined test for Down syndrome?

Nuchal translucency
b-hCG
PAPP-A

9

What are the components of the quadruple test for Down syndrome?

b-hCG
AFP
Unconjugated oestriol
Inhibin A
NOTE: the triple test is a similar test that doesn't use inhibin A

10

What should be offered to women with a high risk of Down syndrome according to initial screening tests?

CVS (10-14 weeks)
Amniocentesis (15+ weeks)
cffDNA (only available privately)

NOTE: results take 48 hours

11

How often should SFH be measured?

Every antenatal appointment after 24 weeks

12

What should happen if there are concerns about foetal growth according to SFH measurements?

Organise an ultrasound

13

What is the NICE recommendation regarding vitamin D during pregnancy?

All pregnant and breastfeeding women should receive 10 µg vitamin D daily

14

When should an OGTT be performed in women with a high risk of GDM?

24-28 weeks

If previous history of GDM, this should be done at 16-18 weeks and a repeat at 24-28 weeks

15

What should be offered to women with a history of late pregnancy loss and a short cervix?

Prophylactic vaginal progesterone
Prophylactic cervical cerclage

16

How should PPROM be investigated?

Sterile speculum - pooling observed --> diagnose PPROM
No pooling --> test for IGF-like binding protein-1 and alpha-microglobulin-1 test

IMPORTANT: diagnostic tests should NOT be performed if the patient goes into labour

17

What antibiotic prophylaxis should be given to patients with PPROM?

Oral erythromycin 250 mg QDS for 10 days or until the woman is in established labour

18

Which women should be offered rescue cervical cerclage?

16-27 weeks with a dilated cervix and unruptured membranes

Do NOT perform if signs of infection, active vaginal bleeding or uterine contractions

19

Which investigations should be used to confirm a diagnosis of preterm labour?

If suspected preterm labour > 30 weeks
- Consider TVUSS to determine likelihood of birth within 48 hours (cervical length > 15 mm means it is unlikely)
- Consider fetal fibronectin (low concentration suggests it is unlikely)

IMPORTANT: if < 30 weeks and clinical assessment suggests preterm labour, treatment is necessary without further investigation

20

Which agent is most commonly used for tocolysis?

Nifedipine

If contraindicated: atosiban (oxytocin receptor antagonist)

21

Up to what gestation should maternal corticosteroids be considered in preterm labour?

36 weeks

22

Which agent is used for neuroprotection in preterm delivery?

IV magnesium sulphate 4 g IV over 15 mins (loading) and 1 g/hour until birth or for 24 hours

NOTE: this is used in women who are delivering at 24-34 weeks (most important for 24-30 weeks)

23

How is magnesium sulphate poisoning treated?

Calcium gluconate

24

Which parameters are measured in ultrasound biometry used to monitor foetal growth?

Biparietal diameter
Head circumference
Abdominal circumference
Femur length

25

How should IUGR babies be monitored?

Serial growth scans every 2 weeks
Doppler can be done 2 times per week (looks out for placental dysfunction leading to absent/reversal of blood flow in umbilical artery)
Advise monitoring foetal movements

ADMIT if reduced foetal movements

26

Which antihypertensives are associated with congenital abnormalities?

ACE inhibitors
ARBs

NOTE: these are not safe when breastfeeding (neither is amlodipine)

27

What level of urinary protein: creatinine ratio is considered significant?

> 30 ng/mmol

28

Which agent is used to treat gestational hypertension?

Oral labetalol

29

What should the target blood pressure be in gestational hypertension?

Systolic: < 150
Diastolic: 80-100

30

When should blood pressure be measured in a woman with gestational hypertension who has just given birth?

Daily for the first 2 days
Once on day 3 and 5

Continue the use of antihypertensives but consider reducing the dose as the BP falls < 140/90 (same applies for PET)