Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Obs + Gynae > Obstetrics > Flashcards

Obstetrics Flashcards

(291 cards)

Start Studying
1
Q

What is gravidity?

A

Number of pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is parity?

A

Number of deliveries beyond 24w gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe Naegele’s rule:

A

EDD = 1 year and 7 days after LMP minus 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

At what gestation can uterus start to be felt?

A

12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where can the fundus be felt at 16 weeks?

A

Halfway between pubic symphysis and umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where can the fundus be felt at 20-24 weeks?

A

Umbilicus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where can the fundus be felt at 36 weeks?

A

Under the rib cage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should the symphysis fundal height be between 16 to 26 weeks?

A

SFH (cm) = date (in weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What should the symphysis fundal height be between 26 to 36 weeks?

A

SFH ± 2cm = date (in weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What should the symphysis fundal height be between 36 weeks and term?

A

SFH ± 3cm = date (in weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the important features to palpate in an obstetric examination?

A 
SFH
Number of foetuses
Fetal lie
Presentation 
Engagement of head
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When are fetal movements first noticed?

A

18-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is there physiological anaemia during pregnancy?

A

Plasma vol. rises, red cell vol. also rises but at lower rate hence Hb falls due to dilution

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What cardiovascular changes occur during pregnancy?

A

CO rises due to increase in SV and pulse rate
Peripheral resistance falls
BP falls in 2nd trimester, normal at term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What investigations should be done at booking visit?

A

Hb, blood group, rhesus status, antibody screen, rubella, HBsAg, HIV, sickle test, Hb electrophoresis, MSU

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should the booking visit take place?

A

8-12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should be done at all antenatal visits?

A

Urine, BP, SFH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When should anomaly scan and placental localisation take place?

A

18-20 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When should GDM screen take place? What weeks if previous GDM

A

28 weeks

16 and 28 weeks if previous GDM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should the second screen for Hb and Rh antibodies be completed?

A

28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

If needed, when should the first dose of anti-D be given?

A

28 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If needed, when should the second dose of anti-D be given?

A

34 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

If needed, when should external cephalic version take place?

A

36 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If needed, when should a membrane sweep take place?

A

41 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
When should a dating scan be completed?
10-13+6 weeks
26
What conditions are associated with an increased nuchal translucency?
Down's | Cardiac abnormalities
27
What does a uterine artery Doppler measure and what does high resistance indicate?
Resistance within the placenta | High resistance increases risk of maternal pre-eclampsia and fetal growth restriction
28
What does a umbilical artery Doppler measure and what does high resistance indicate?
Resistance in the placenta | High resistance indicates placental failure and risk of intrauterine death
29
What are the components of the combined test?
NT + free hCG + pregnancy associated plasma protein (PAPP-A) + women’s age
30
When should the combined test be performed?
11-13+6 weeks
31
If a women books late and misses the combined test, what other tests can be offered and what are the components?
Triple or quadruple test (15-20 wks) | AFP, unconjugated oestradiol, hCG (+ inhibin)
32
What is the name for trisomy 18 and what are some features?
Edwards' | Small chin, low-set ears, rocker bottom feet and VSD
33
What is the name for trisomy 13 and what are some features?
Patau's | Microcephaly, holoprosencephaly, exomphalos, cleft lip and palate
34
Between which dates can chorionic villus biopsy be carried out?
10-13 weeks
35
Between which dates can amniocentesis be carried out?
From 16 weeks onwards
36
List some common minor symptoms of pregnancy:
``` N+V Headaches Palpitations Urinary freq Abdo pain Breathlessness Constipation GORD Symphysis pubis dysfunction Carpal tunnel syndrome Itchy rashes Ankle oedema Leg cramps ```
37
What are the core features of hyperemesis gravidarum?
Persistent vomiting leading to weight loss, dehydration, ketosis and electrolyte imbalances
38
What increases risk of hyperemesis gravidarum?
Molar pregnancy | Multiple pregnancy
39
What scoring system can determine severity of hyperemesis gravidarum?
Pregnancy-Unique Quantification of Emesis (PUQE)
40
What investigations should be performed on a woman who may be suffering from hyperemesis gravidarum?
``` Urine dip for ketones FBC, U+Es, LFTs, albumin ABG Blood glucose USS ```
41
How should mild hyperemesis gravidarum be managed?
Oral antiemetics (promethazine or cyclizine), hydration and dietary advice
42
How should hyperemesis gravidarum not responding to oral antiemetics be managed?
``` Admit for rehydration and correction of metabolic disturbance Daily U+Es Antiemetics, corticosteroids High dose folic acid and thiamine VTE risk assess ```
43
How is anaemia defined in pregnancy?
Hb <110g/L at booking and <105g/L at 28 weeks
44
What are some risk factors for anaemia in pregnancy?
``` Menorrhagia previously Haemoglobinopathies Frequent pregnancies Twin pregnancy Poor diet ```
45
What investigations should be performed in a pregnant woman with suspected anaemia?
FBC, serum iron, TIBC, serum ferritin, folate
46
What is the management of anaemia in pregnancy?
Iron and folate supplements | Parenteral iron or blood transfusion if not responding
47
How can HIV transmission to babies from mother be reduced?
Maternal anti-retroviral use Elective CS Bottle feeding
48
Below what viral load, can a HIV +ve woman have a vaginal delivery?
<50 copies/ml
49
What drug can be given to suppress lactation in those not wishing to breastfeeding or where breastfeeding is not recommended?
Cabergoline
50
What should a neonate born by a HIV +ve mother be given after birth and for how long?
ART for 4-6 weeks
51
What pre-conception advice should be given to diabetics?
Aim for HbA1c <6.1% | Take 5mg folic acid daily
52
What are some maternal complications of diabetes in pregnancy?
Hypoglycaemia, pre-eclampsia, infection, higher rates of CS
53
What are some fetal complications of diabetes in pregnancy?
``` Miscarriage Malformation rates Macrosomia Polyhydramnios Preterm labour Stillbirth ```
54
What fasting glucose level should be aimed for during pregnancy?
3.5-5.3mmol/L
55
What daily medication should be given to pregnant diabetics from week 12?
Aspirin
56
What are the cut offs for OGTT and fasting blood glucose in gestational diabetes?
OGTT ≥7.8mmol/L | Fasting ≥5.6mmol/L
57
List some reasons as to why a woman may be screened for GDM:
1st degree relative, previous baby >4.5kg, BMI >30, | ethnicity at risk, previous GDM
58
List some management options for GDM:
Diet and exercise Metformin Insulin
59
How should those who suffered with GDM be followed up?
Dietary advice | Fasting glucose 6 weeks postpartum and screen annually
60
What tests can be performed for a pregnant lady with jaundice?
Urine tests for bile, serology, LFTs, US, bile acids
61
What is the major symptom of obstetric cholestasis?
Pruritus | Esp. palms and soles in second half of pregnancy, without a rash and worse at night
62
What are the risks of obstetric cholestasis?
Preterm labour Fetal distress Meconium Still birth
63
What medication can reduce pruritus in obstetric cholestasis?
Ursodeoxycholic acid
64
How should obstetric cholestasis be managed?
Weekly LFTs IOL from 37-38w Vit K
65
What are the features of acute fatty liver of pregnancy?
``` Abdo pain Jaundice Headache Vomiting +/- thrombocytopenia and pancreatitis ```
66
How should acute fatty liver of pregnancy be managed?
HDU or ITU Supportive treatment Correct clotting disorders Expedite delivery
67
What pre-conception advice should be given to patients suffering from epilepsy?
Seizure control on lowest dose Avoid polypharmacy 5mg folic acid daily for >3m pre-conception to delivery
68
Which AEDs shouldn't be prescribed to women of childbearing age?
Valproate | Carbamazepine
69
Which antidepressants should be avoided in pregnancy?
Paroxetine
70
What are the risks of taking lithium in pregnancy for the fetus?
Teratogenicity (heart defects, Ebstein’s anomaly) Neonatal thyroid abnormalities Floppy baby syndrome
71
What fetal malformations are benzodiazepines linked with?
Cleft lip and palate
72
Due to the risk of IUGR, how often should pregnant women suffering with CF have growth scans?
Every 4 weeks from 28w
73
Why should NSAIDs be avoided in the third trimester?
Can cause premature closure of ductus arteriosus
74
How is RA usually affected by pregnancy?
Usually alleviated
75
How is SLE usually affected by pregnancy?
Exacerbations are more common
76
What medications can be used in pregnant women suffering from SLE?
Azathioprine Hydroxychloroquine Should take daily aspirin
77
How should pregnant women with antiphospholipid syndrome be managed?
Regular fetal assessment (Doppler and US) Aspirin 75mg daily throughout and heparin from when fetal heart identified Postpartum heparin or warfarin
78
What are the risks of HTN in pregnancy?
Pre-eclampsia, fetal growth restriction, placental abruption
79
What anti-hypertensives can be used in pregnancy?
Labetalol, nifedipine or methyldopa
80
What BP should be aimed for during pregnancy if woman has chronic HTN?
<150/90 but diastolic ≥80
81
What additional medication should be prescribed to pregnant women suffering with HTN?
Aspirin daily
82
What is the definition of pregnancy induced HTN?
HTN in second half of pregnancy (>140/90) in the absence of proteinuria
83
When should treatment be started in pregnancy induced HTN? What drug?
Labetalol if >150/100
84
At what BP, should a pregnant woman be admitted to hospital?
>160/110
85
Why is pregnancy a risk factor for VTE?
Venous stasis Trauma to pelvic veins at delivery Procoagulant changes to clotting cascade
86
What are some features of a DVT?
Leg swelling, pain, redness, tenderness, pyrexia, oedema
87
What are some features of a PE?
SOB, chest pain, haemoptysis, faint, raised JVP, hypoxia, low BP, tachycardia, collapse
88
What investigations should be performed on a patient with suspected VTE?
``` FBC, U+Es, LFTs, clotting screen ABG CXR Duplex US CTPA or V/Q scanning ```
89
How long after the last dose of LMWH until an epidural/spinal can be inserted?
12 hours
90
What are some features of congenital rubella syndrome?
Cataract, deafness, cardiac lesions, growth | retardation, hepatosplenomegaly, cerebral palsy
91
What are some CMV-associated congenital defects?
IUGR, purpuric skin lesions, microcephaly, hepatosplenomegaly, motor and cognitive impairment, deafness
92
If there a baby is born to a Hep B infected or carrier mother, what should the baby be given at birth?
Immunoglobulins and vaccination
93
What is the management for primary genital herpes in last trimester of pregnancy?
Oral aciclovir and ELCS
94
What are some features of fetal varicella syndrome?
Skin scarring, eye defects, neurological abnormalities
95
What is the drug used in Group B strep prophylaxis?
Benzylpenicillin IV
96
What are some reasons to give Group B strep prophylaxis during labour?
``` +ve GBS HVS Baby previously infected with GBS GBS bacteriuria in this pregnancy Gestation <37w Intrapartum fever +ve with PROM RoM >18h ```
97
What problems affecting the uterus can cause abdominal pain in pregnancy?
Uterine rupture Fibroids - torsion, red degen Uterine torsion Abruption
98
What are some risk factors for sepsis in pregnancy?
Obesity, diabetes, impaired immunity, immunosuppressants, anaemia, pelvic infection, prolonged RoM
99
What are the common organisms causing sepsis in pregnancy?
Group A beta-haemolytic strep and E. coli
100
What are some features of sepsis in pregnancy?
``` Fever Rigors D+V Rash Abdo or pelvic pain Offensive vaginal discharge Productive cough, urinary symptoms ```
101
Should obese women be given folic acid pre-conception?
Yes, 5mg from 1 month prior and through first trimester
102
What are the risks of being pregnant with sickle cell?
Increased risk of painful crises Perinatal mortality Premature labour Fetal growth restriction
103
What drug should pregnant sickle cell women be given from 12 weeks gestation?
Aspirin daily
104
What VTE prophylaxis should be given post-delivery in women with sickle cell? And for how long?
7 days of heparin prophylaxis post vaginal delivery, 6 | weeks if CS
105
Describe postpartum thyroiditis:
Hyperthyroidism is followed by hypothyroidism (4 | months postpartum)
106
How should UTI be treated during pregnancy?
Cefalexin, trimethoprim (not 1st trimester) or nitrofurantoin (not 3rd trimester)
107
Describe the movement of the baby during labour (6 steps):
1. Descent with increased flexion as head enters cavity 2. Internal rotation at ischial spine and increase in head flexion 3. Disengagement by extension as head comes out of vulva 4. Shoulders rotate to lie in AP diameter of pelvic outlet. The head externally rotates 5. Delivery of anterior shoulder 6. Delivery of posterior shoulder
108
What are some dangerous causes of antepartum haemorrhage?
Abruption Placenta praevia Vasa praevia
109
What is placental abruption?
Part of the placenta becomes detached from the | uterus
110
What is a revealed placental abruption?
Bleeding drains through cervix resulting in PV bleed
111
What is a concealed placental abruption?
Bleeding remains within the uterus, clotting retroplacentally
112
What are the two types of placental abruption?
Revealed and concealed
113
What are some features of placental abruption?
Painful vaginal bleeding Uterus tense and painful Shock out of keeping of loss Fetal distress
114
What are some risk factors for placental abruption?
``` Pre-eclampsia Previous abruption Smoking Abnormal lie Polyhydramnios Abdo trauma ```
115
What investigations should be performed on someone with suspected placental abruption?
FBC, clotting, Kleihauer, G+S, cross match, U+E, LFTs, USS, CTG
116
What is placenta praevia?
Placenta is fully or partially attached to the lower | uterine segment
117
Describe the difference between Grade I + II placenta praevia and Grade III + IV:
Grade I and II are minor are don’t cover the internal cervical os Grade III and IV are major and cover the os
118
What are the risk factors for placenta praevia?
Previous CS | High parity, increasing age, multiple pregnancy, previous PP
119
What are some features of placenta praevia?
Painless PV bleed, uterus non-tender
120
When can placenta praevia be identified?
20 week USS
121
If minor placenta praevia is identified, when should a repeat scan be carried out?
36 weeks
122
If major placenta praevia is identified, when should a repeat scan be carried out?
32 weeks
123
What is the pathophysiology of pre-eclampsia?
Failure of trophoblastic invasion of spiral arteries leaving them vasoactive and able to respond to vasoconstrictors, limiting placental flow. Increasing BP partially compensates for this failure
124
When does pre-eclampsia develop from?
20 weeks
125
What are some risk factors for pre-eclampsia?
``` Previous pre-eclampsia Chronic HTN CKD DM Autoimmune (SLE, antiphospholipid) Obesity Age ```
126
If risk factors for pre-eclampsia are present, what drug should be started at week 12?
Daily aspirin
127
What are some features of pre-eclampsia?
HTN, proteinuria | Headache, flashing lights, RUQ pain, N+V, brisk reflexes, IUGR
128
How should labour be managed in those with pre-eclampsia?
IOL after 37 weeks | If severe and >34w, deliver - MgSO4 + steroids
129
What are some complications of pre-eclampsia?
Eclampsia, HELLP syndrome, cerebral haemorrhage, IUGR, renal failure, placental abruption, DIC
130
What is eclampsia?
Tonic-clonic seizure + pre-eclampsia
131
What is the management of eclampsia?
MgSO4 IV labetalol CTG Delivery once stable
132
What are the features of HELLP syndrome?
Haemolysis, Elevated Liver enzymes, and Low Platelets
133
What are some symptoms of HELLP syndrome?
RUQ pain, N+V, dark urine, raised BP
134
What is the management of HELLP syndrome?
Delivery of fetus | May need platelet transfusion
135
What is the definition of prematurity?
Infants born before 37 weeks gestation
136
What are some risk factors for prematurity?
Previous preterm birth, multiple pregnancy, cervical surgery, uterine abnormalities, pre-eclampsia, IUGR
137
What is PPROM?
Preterm, premature rupture of membranes
138
What is the management for PPROM?
Admit for 48h If evidence of infection, expedite delivery Give corticosteroids and erythromycin Discharge if labour doesn't occur in 48h, IOL at 34w
139
What can be given to suppress uterine contractions in preterm labour?
Tocolytics e.g. nifedipine
140
Why are glucocorticoids given in preterm labour?
Help with fetal surfactant production, lowering mortality and complications of RDS
141
What corticosteroid is used in preterm labour and how is it administered?
Betamethasone IM
142
What neuroprotective drug is given for babies less than 34 weeks?
MgSO4
143
What are the risks of prematurity to the neonate?
``` Increased mortality Respiratory distress syndrome Intraventricular haemorrhage Necrotizing enterocolitis Chronic lung disease, hypothermia, feeding problems, infection, jaundice Retinopathy of newborn, hearing problems ```
144
What is the definition of small for gestational age?
Estimated fetal weight <10th centile for their gestational age
145
What should happen if a SFH measurement is below 10th centile or there is static growth?
Refer for fetal US
146
What placental factors can lead to a fetus that is SGA?
Pre-eclampsia | Abruption
147
What fetal factors can cause a fetus to be SGA?
Genetic abnormalities including trisomies and Turner’s CMV, rubella Multiple pregnancy
148
What are some risk factors for having a fetus that is SGA?
>40yrs Smoker, cocaine Previous SGA, parental SGA HTN, DM, pre-eclampsia, anti-phospholipid
149
What are some complications associated with SGA?
``` Higher mortality Cerebral palsy Fetal distress Meconium aspiration Emergency CS ```
150
What are some causes of a fetus that is large for gestational age?
Constitutionally large (usually familial) Maternal diabetes Obesity
151
What are the risks for a fetus that is large for gestational age?
Birth injury | Hypoglycaemia, hypocalcaemia, left colon syndrome and polycythaemia
152
What is the definition of postmaturity?
Pregnancy exceeding 42 weeks
153
What are the problems caused by postmaturity?
Intrapartum and early neonatal death Operative delivery Macrosomia Fetal distress and meconium
154
What is the initial management for postmaturity and when should this be carried out?
Membrane sweep | 41 week visit
155
What is the management for postmaturity following a membrane sweep?
Induction with vaginal prostaglandin followed by oxytocin
156
What signs of postmaturity may be seen in the neonate?
Dry skin Decreased subcutaneous tissue Hollow abdomen Meconium staining of nails
157
What are some obstetric causes of maternal collapse?
``` APH or PPH Eclampsia Intracranial haemorrhage Amniotic fluid embolism Post-surgical haemorrhage Severe sepsis ```
158
What is the main cause for concern in PROM?
Chorioamnionitis
159
What is PROM?
Rupture of membranes prior to the onset of labour in women at or over 37 weeks
160
If spontaneous labour has not commenced 24h after PROM, what is the management?
Induce using vaginal prostaglandin (followed by oxytocin if contractions don’t start)
161
What are the two parts of the first stage of labour?
Latent and established
162
What is latent part of the first stage of labour?
Painful, irregular contractions as the cervix effaces then dilates to 4cm
163
What is the established part of the first stage of labour?
Regular contractions with dilatation at a rate of >0.5cm/hour
164
How long does the first stage of labour take in a primip?
8-18h
165
How long does the first stage of labour take in a multip?
5-12h
166
What should be monitored during labour?
Maternal BP and temp 4-hourly, pulse hourly and assess contraction strength and frequency every 30 mins VE every 4 hours Intermittent auscultation
167
What are the two parts of the second stage of labour?
Passive and active
168
What is the passive part of the second stage of labour?
Cervical dilatation complete but no pushing
169
What is the active part of the second stage of labour?
Maternal pushing using abdominal muscles and Valsalva manoeuvre until baby is born
170
How long does the second stage of labour last in primips and multips?
Expect birth within 3h in primips and 2h in multips
171
What is the third stage of labour?
Delivery of placenta, as uterus contracts
172
Describe intermittent auscultation and how often it is used during labour:
With Doppler US for a full minute after a contraction | Every 15 min in 1st stage and every 5 min in 2nd stage.
173
Describe what a CTG is:
Continuous cardiotocograph (CTG) uses two transducers on the abdomen of the pregnant woman. One records the fetal HR and one monitors contractions of the uterus
174
What are some indications for a CTG?
``` IOL Post//pre-maturity Previous LSCS Maternal cardiac problems Pre-eclampsia or HTN Diabetes Ante or intrapartum haemorrhage Small for gestational age Multiple pregnancy ```
175
How should a CTG be described (think acronym)?
DR C BRaVADO: DR define risk, C contractions, BRa baseline rate, V variability, A accelerations, D decelerations, O overall
176
What is the normal fetal HR?
100-160bpm
177
What can cause fetal tachycardia?
Fetal hypoxia, chorioamnionitis, hyperthyroidism, anaemia
178
What can cause fetal bradycardia?
Postdate, occiput posterior presentation, prolonged cord compression, cord prolapse
179
What is variability on a CTG?
Variation in fetal HR from one beat to the next
180
What is normal variability on a CTG?
Each small square should have variation of >5bpm but no more than 25bpm
181
What can cause a reduction in variability on a CTG?
Sleep, fetal hypoxia, malformation, prematurity, drugs
182
What is an acceleration on a CTG?
Upward spike of >15bpm for >15 seconds
183
What is a deceleration on a CTG?
Downward spikes of >15bpm for >15 seconds
184
What is an early deceleration on a CTG?
Mimic the shape and timing of contractions and | are due to head compression
185
What is a late deceleration on a CTG?
Begin at peak of contraction and recover after the end | Maternal hypotension, pre-eclampsia, uterine hyperstimulation
186
What can cause variable deceleration on a CTG?
Umbilical cord compression
187
What are some indications for induction of labour?
``` Risk to mother HTN Pre-eclampsia Prolonged pregnancy PPROM Diabetes Abruption IUGR ```
188
What are some contraindications for induction of labour?
Malpresentations, fetal distress, placenta previa, cord | presentation, vasa previa
189
What score can be used during the decision making for induction of labour?
Modified Bishop score
190
How can labour be induced?
Vaginal PGE2 (gel/tablet or pessary) Membrane sweep Foley’s catheter
191
What should be given after IOL if there are no contractions after 2-4hrs?
IV oxytocin
192
What are some problems associated with IOL?
``` Failure Uterine hyperstimulation Infection Bleeding Cord prolapse C-section and instrumental delivery ```
193
How is oligohydramnios defined?
Amniotic fluid index that is below the 5th centile for the gestational age
194
What are some causes of oligohydramnios?
PPROM Renal agenesis/non-functional fetal kidneys, Genetic/chromosomal abnormalities Placental insufficiency
195
What investigations may be done to investigate oligohydramnios?
``` SFH Speculum USS Karyotyping Actim-PROM ```
196
What are some causes of polyhydramnios?
``` Idiopathic (50-60%) Oesophageal/duodenal atresia Muscular dystrophy Anaemia Twin-twin transfusion syndrome Macrosomia ```
197
What are some non-pharmacological pain relieving methods in labour?
Education Breathing exercises Relaxation techniques Labouring in warm water
198
What are some pharmacological methods of pain relief in labour?
Nitrous oxide Pethidine/diamorphine Pudendal nerve block
199
What is an epidural?
Anaesthetizing pain fibres from T10-S5
200
Where is an epidural usually placed?
L3/4 space usually used
201
What are some complications of an epidural?
Failure to site Patchy block Low BP Dural puncture + post-dural puncture headache
202
When is spinal anaesthesia often used?
CS
203
When may a combined spinal epidural be used?
Cover CS that has potential to take more time than usual e.g. placenta previa
204
What do the terms monochorionic and monoamniotic refer to in terms of twin pregnancy?
Monochorionic twins share same placenta | If monoamniotic share one amniotic sac
205
What type of twin pregnancy is at the lowest risk?
Dichorionic, diamniotic
206
What are some predisposing factors to multiple pregnancy?
Previous twins FH of twins Increased maternal age Induced ovulation or IVF
207
What are some features that often occur in multiple pregnancy?
Uterus large for dates Hyperemesis Polyhydramnios
208
What are some antenatal complications of multiple pregnancy?
Polyhydramnios, pre-eclampsia, anaemia, APH, gestational diabetes
209
What are some fetal complications of multiple pregnancy?
Perinatal mortality, prematurity, growth restriction, | malformation
210
What are some labour complications of multiple pregnancy?
PPH, malpresentation, vasa praevia, cord prolapse, placental abruption, cord entanglement
211
How often should women with multiple pregnancy have USS?
Monthly from 20 weeks
212
How often should women with multiple pregnancy have antenatal visits?
Weekly from 30 weeks
213
When should elective birth be aimed for in dichorionic and monochorionic twins?
37 and 36 weeks respectively
214
What is external cephalic version and when should it be done?
Turning the breech through a forward somersault | Only if vaginal delivery planned, after 36-37 weeks
215
What are some contraindications for external cephalic version?
``` Placenta praevia Multiple pregnancy Recent APH Ruptured membranes Growth restriction Abnormal CTG ```
216
List some malpresentations/malpositions:
``` Breech Occipitoposterior Face Brow Transverse ```
217
Why is cord prolapse an emergency?
Cord compression and vasospasm from exposure cause fetal asphyxia
218
What can increase incidence of cord prolapse?
``` 2nd twin Footling breech Prematurity Polyhydramnios Unengaged head ARM Transverse or unstable lie ```
219
What are some management options in cord prolapse?
``` Keep cord in vagina Stop presenting part from occluding cord Fill bladder with saline Tocolytics Deliver fetus ASAP either by CS or instrumental ```
220
What gets stuck in shoulder dystocia?
Anterior shoulder impacted on pubic symphysis or posterior on sacral promontory
221
What are the risks of shoulder dystocia?
Higher risk of fetal mortality, PPH, 4th degree tear, brachial plexus injury
222
What are some conditions associated with shoulder dystocia?
Large fetus, BMI >30, induced labour, prolonged labour, previous SD, diabetes
223
What initial management for shoulder dystocia works in 90% of cases?
McRoberts position (hyperflexed lithotomy)
224
If McRoberts position fails to work in shoulder dystocia, what are some other management options?
Suprapubic pressure Rotate fetal shoulder to oblique diameter Roll mother onto all fours Maternal symphysiotomy, replacement of fetal head and CS (Zavanelli), cleidotomy (fracture fetal clavicle)
225
What are the issues with passage of meiconium?
May indicate fetal distress | Aspiration leading to pneumonitis
226
What are the criteria for an instrumental vaginal delivery?
``` 1/5th or less head palpable per abdomen Ruptured membranes, fully dilated cervix with head at ischial spines or below Adequate contractions Adequate analgesia Bladder empty ```
227
What are some maternal indications for instrumental delivery?
Prolonged second stage, maternal exhaustion, medical avoidance of pushing e.g. cardiac disease
228
What are some fetal indications for instrumental delivery?
Suspected fetal distress, for head in breech delivery
229
Describe forceps delivery:
Curved blades to fit round fetal head and round pubic symphysis
230
Describe ventouse delivery:
Uses a suction device to suck fetal scalp tissues into ventouse cup
231
Which instrumental delivery is safer for the fetus and which is safer for mother?
Forceps for fetus | Ventouse for mother
232
What are some maternal complications of instrumental delivery?
Maternal genital tract trauma, VTE, incontinence, PPH
233
What are some fetal complications of forceps delivery?
Facial nerve palsy, skull fractures, orbital injury, | intracranial haemorrhage
234
What are some fetal complications of ventouse delivery?
Cephalhematoma, retinal haemorrhage, scalp | lacerations, subgaleal haematoma
235
Describe a Cesarean section procedure:
Lower uterine segment incision by Joel-Cohen or Pfannensteil incision followed by blunt dissection
236
What layers are cut through from the skin to reach the uterus in a CS?
Camper’s fascia -> Scarpa’s fascia -> rectus sheath -> rectus muscles -> abdo peritoneum -> gravid uterus
237
What are some indications for CS?
``` Repeat CS Fetal compromise Failure to progress in labour Malpresentation Severe pre-eclampsia IUGR with abnormal Doppler Placenta praevia Primary genital herpes in 3rd trimester ```
238
After what week should elective CS be carried out and why?
After 39 weeks, reduces transient tachypnoea of the newborn
239
What are some intraoperative complications of CS?
Blood loss, uterine lacerations, bladder laceration, fetal | lacerations, hysterectomy
240
What are some postoperative complications of CS?
Wound infections, endometritis, UTI, VTE
241
Why is ranitidine given prior to CS?
Neutralise and empty gastric contents | Minimises risk of post-op aspiration which can lead to Mendelson’s syndrome
242
What are the features of Mendelson's syndrome?
Cyanosis, bronchospasm, pulmonary oedema and tachycardia
243
What are some long term consequences of having had a CS?
Higher incidence of placenta previa and accreta Risk of uterine rupture Risk of stillbirth
244
What are some risk factors for uterine rupture?
Previous CS, obstructed labour, previous uterine surgery, high forceps delivery
245
What are some features of uterine rupture?
Pain, vaginal bleeding, maternal tachycardia, shock, fetal distress, continuous PPH
246
How often is vaginal birth successful after CS?
75%
247
What are some advantages of VBAC over CS?
Shorter stay Good chance of future VBAC Lower maternal death risk
248
What are some advantages of CS over VBAC?
Lower risk of uterine rupture | No risk of anal sphincter injury
249
What are some contraindications for VBAC?
Classical C-section scar, previous uterine rupture
250
What is the definition of a stillbirth?
Babies born dead after 24 weeks gestation
251
What test should be done following a stillbirth? And what medication may be given?
anti-D for Rh-ve and do Kleihauer to diagnose fetomaternal haemorrhage
252
What is the definition of primary PPH?
Loss of >500ml in first 24h post-delivery
253
What are the different categories of primary PPH?
Major is >1L | Massive obstetric haemorrhage if >1.5L
254
What are the causes of primary PPH (4Ts)?
Tone: uterine atony (90%) Tissue: retained POC Trauma: genital tract trauma (instrumental, episiotomy, CS) Thrombin: clotting disorders
255
What are some risk factors for uterine atony?
>40 years, BMI >35, multiple pregnancy, fetal | macrosomia, induction, prolonged labour, placental issues
256
What is bimanual compression in terms of PPH?
Fist into anterior fornix to compress anterior | uterine wall while other hand applies pressure on abdomen at posterior aspect of uterus
257
What drugs may be given during a primary PPH?
Syntometrine, oxytocin, ergometrine
258
If initial management of PPH fails and pt is still bleeding, what further management options are available?
EUA, insert Rusch balloon B-lynch suture Internal iliac or uterine artery ligation or hysterectomy
259
What is a secondary PPH?
Excessive blood loss from genital tract after 24h from delivery
260
When do secondary PPH often occur and what is often the cause?
Between 5 and 12 days due to retained placental tissue or clot, often with infection
261
When can the third stage of labour be called delayed?
If not complete by 60min
262
What is the management for retained placenta?
Rub up a contraction or put baby on breast to stimulate oxytocin Give oxytocin into umbilical vein and proximally clamp cord Empty bladder Manual removal
263
What can cause uterine inversion?
Mismanagement of third stage e.g. cord traction in an atonic uterus Fundal insertion of placenta
264
What is the management for uterine inversion?
Immediate replacement Push fundus through cervix Infuse warm saline into vagina and sealing labia Laparotomy and pull uterus up
265
What is velamentous insertion?
Umbilical cord inserts into fetal membranes and travels | within membranes to placenta
266
What is placenta succenturia?
Separate lobe away from main placenta which may fail to separate normally and cause a PPH
267
What is placenta accreta? What are increta and percreata?
Abnormal attachment of all or part of placenta to the myometrium Termed increta if myometrium infiltrated, percreata if penetration reaches serosa
268
What is vasa praevia?
Fetal vessels from velamentous insertion or between lobes cross the internal cervical os and risk damage at membrane rupture causing fetal haemorrhage
269
What are some risk factors for amniotic fluid embolism?
Multiple pregnancy, >35 years, CS, instrumental delivery, eclampsia, polyhydramnios, placental abruption, uterine rupture, IOL
270
What are some features of amniotic fluid embolism?
``` Dyspnoea Chest pain Hypoxia leading to ARDS Hypotension and collapse Fetal distress Seizures DIC within 48h ```
271
What is cephalhaematoma?
Fluctuant, subperiosteal swelling on head that spontaneously resolves within months. Doesn't cross suture lines
272
What is caput succedaneum?
Oedematous swelling of scalp due to venous congestion caused by pressure against cervix during labour
273
What are some risk factors for perineal tears?
First vaginal delivery, large baby, persistent OP | position, IOL, epidural, prolonged 2nd stage, instrumental delivery
274
What is a first degree tear?
Superficial and don’t damage muscle
275
What is a second degree tear?
Involve perineal muscle
276
What is a third degree tear?
Involve anal sphincter muscle
277
What is a fourth degree tear?
If anal/rectal mucosa involved
278
How should third and fourth degree tears be managed?
Repair by surgeon under epidural/GA with Abx High fibre diet and lactulose Pelvic floor exercise, physio
279
Why are episiotomies perfomed?
``` Enlarge outlet (fetal distress, instrumental) Prevent 3rd degree tears ```
280
What is the technique for an episiotomy?
Hold perineal skin away from fetus with fingers in vagina and give LA Cut mediolaterally, starting midline to avoid Bartholin’s glands
281
What is lochia?
Endometrial slough, red and white cells, passed PV
282
What are the common causes of puerperal pyrexia?
UTI or genital tract infection
283
What are some features of endometritis?
Lower abdo pain, offensive lochia and a tender uterus
284
When are post-partum blues often noticed?
3rd and 10th day postpartum
285
A women presents asking for emergency contraception, 17 days post partum. What should you tell her?
Emergency contraception not needed until 21d post partum
286
When can the combined contraceptive be restarted if breastfeeding?
6 months post partum
287
When can the IUCD be fitted post partum?
Within first 48h postpartum or delayed until 4 weeks
288
In what situations should anti-D be given?
``` Delivery of a Rh +ve infant TOP Miscarriage if gestation is > 12 weeks Ectopic pregnancy (if managed surgically) ECV APH Amniocentesis, chorionic villus sampling, fetal blood sampling Abdominal trauma ```
289
What tests should be carried out on babies born to Rh -ve mother?
Cord blood taken at delivery for FBC, blood group and direct Coombs test
290
What is the treatment for mastitis and should the woman continue to breastfeed?
Flucloxacillin for 10-14 days | Breastfeeding should continue
291
What is a sign of fetal distress or placental insufficiency on an umbilical artery Doppler?
Absent or reversed end diastolic flow

Obs + Gynae (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions