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Year 5 > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What does HELLP syndrome stand for? What is it associated with?

A 
Haemolysis
Elevated liver enzymes (pts can go into liver failure)
Low platelets (thrombocytopaenia)

Pre-eclampsia

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2
Q

What supplements do HELLP patients often go home on?

A

Iron (they often suffer significant haemorrhage)

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3
Q

CTG <100bpm =

A

bradycardia in baby - emergency

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4
Q

What are fibroids which have been treated with multiple surgeries before a risk of?

A

Uterine rupture

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5
Q

Mx of symptomatic ectopic pregnancy + lots of pain?

A

Surgical

  • Salpingectomy
  • Salpingotomy if increased risk of infertility or known tubal damage
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6
Q

The foetal heartbeat is visible as early as

A

6 weeks

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7
Q

What is a miscarriage?

A

Pregnancy that spontaneously ends before 24wks gestation

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8
Q

What gastro issues are pregnant women at higher risk of?

A

Cholelithiasis and cholecystitis

Acute fatty liver of pregnancy (AFL) (usually presents after 30wks)

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9
Q

How should LMWH be given/monitored in pregnancy?

A

Pharmacokinetics change in preg. so give 1mg/kg dose BD (usually its 1.5mg/kg OD).

If labour suspected or begins then stop immediately.
If C-section planned then stop 24hr before.
Give any spinal anaesthesia or epidural at least 24hr AFTER last injection of LMWH.

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10
Q

What are the risk factors for obstetric cholestasis?

A
  • Previous pregnancy with OC
  • Asian origin
  • Genetic traits
  • Pruritis on COCP
  • Multiple pregnancy
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11
Q

What are the complications of obstetric cholestasis?

A
  • Severe liver impairment
  • Fetal distress
  • Premature delivery
  • Intrauterine death
  • Post-partum haemorrhage
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12
Q

Why might altered liver function or GI function increase the risk of post-partum haemorrhage?

A

Decreased absorption of Vit K, leading to altered coagulation

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13
Q

A 33-year-old lady presents to delivery suite at 34 weeks gestation in her fifth pregnancy with a history of painless vaginal bleeding. The patient also reported a small amount of spotting following sexual intercourse. The doctor performs an examination which shows the fetus to be lying transversely with a normal fetal heart rate. On speculum examination, there was a small amount of blood in the vagina and the cervix was normal. What is the most likely diagnosis?

A

Placenta praevia

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14
Q

What are the risk factors for placenta praevia?

A 
Multiparity
Smoking
Previous Hx of placenta praevia
Previous uterine surgery
Older mothers
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15
Q

What are the three methods to measure fetal wellbeing during labour?

A

CTG (Cardiotocograph)
Intermittent auscultation
Fetal blood sampling

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16
Q

What is the Normal baseline heart rate during labour?

A

110-160

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17
Q

When do early decelerations occur on a fetal CTG and why do they happen?

A

Occur WITH the peak of contraction and happen due to head compression

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18
Q

Late decelerations are associated with?

A

Fetal hypoxia

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19
Q

Variable decelerations on CTG suggest?

A

Cord compression

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20
Q

In the fetus a normal PH is

A

> 7.25. Borderline is 7.2-7.25.

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21
Q

What is one of the first features of scar rupture in VBAC?

A

An abnormal CTG

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22
Q

What is an absolute contraindication to trial of VBAC due to the greater risk of uterine rupture?

A

Classical incision

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23
Q

What are some of the complications of VBAC?

A

72-75% chance of successful delivery - the rest involve emergency C section

If labour is induced it can result in increased risk of UTERINE RUPTURE

If baby is in cephalic position its a favourable factor for VBAC

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24
Q

What two things should be prepared/monitored in VBAC during delivery?

A

1) IV access in case immediate resuscitation is needed

2) Continuous CTG (abnormality indicates uterine scar rupture)

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25
Q

What is secondary arrest of labour?

A

Failure for labour to progress when there was adequate or expected progress to begin with

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26
Q

What is primary dysfunction of labour often caused by?

A

Deflexion of fetal head and ineffective uterine action.

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27
Q

Risk factors for obstetric anal sphincter injuries

A

Forceps/instrumental delivery
Prolonged labour
During active second stage
Big babies

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28
Q

What should general anaesthesia for unplanned C section include?

A

Preoxygenation, cricoid pressure and rapid sequence induction to reduce the risk of aspiration

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29
Q

What are examples of infection that can occur in 8% of women after C section?

A

Endometritis
Wound infections
Urinary tract infections

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30
Q

What is the difference between SGA and IUGR?

A

SGA = below 10th centile for weight since beginning of pregnancy

IUGR= growing normally then drops by a few centiles

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31
Q

What is the difference between antepartum haemorrhage and threatened miscarriage?

A

Threatened miscarriage < 24 weeks

Antepartum haemorrhage > 24 weeks

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32
Q

What are some causes of antepartum haemorrhage?

A 
Placental abruption 
Placenta praevia 
Placenta accreta 
Vasa praevia 
Cervical ectropion 
Trauma
Bloody show
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33
Q

What are some risk factors for placental abruption?

A 
Previous placental abruption 
Smoking 
C-sections 
Cocaine use 
Pre-eclampsia
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34
Q

Why might there not be any PV bleeding in placental abruption?

A

It may be a concealed bleed

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35
Q

What is the difference between placenta praevia and placenta accreta?

A

Placenta praevia – the placenta grows over the internal os of the cervix (three types: complete, partial and marginal)

Placenta accreta – the placenta grows deep into the uterus. Tends to occur over C-section scars and is associated with severe post-partum haemorrhage

NOTE: a low-lying placenta just means that it is lying low in the uterus but does not touch the cervix

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36
Q

How can preterm premature rupture of membranes be prevented in high-risk women?

A

Prophylactic vaginal progesterone

Cervical cerclage

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37
Q

If pooling of amniotic fluid is not observed on examination of a woman with suspected PPROM, which other test could be conducted?

A

IGF binding protein-1 test or placental alpha-microglobulin-1 test

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38
Q

Which organisms are typically implicated in chorioamnionitis?

A

GBS

E. coli

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39
Q

How would a patient with PPROM but no signs of infection be managed?

A

Monitor for signs of infection
- Offer oral erythromycin 250 mg QDS for a maximum of 10 days or until the patient is in established labour

  • Offer maternal corticosteroids
  • Do NOT use tocolysis (increases risk of infection)

Decision to deliver depends on balance of risk of prematurity and risk of maternal/foetal infection if delivery is delayed

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40
Q

Risks of smoking during pregnancy

A 
Miscarriage
Stillbirth
IUGR
Low birthweight
Neonatal death
Cot death
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41
Q

Risks of diabetes mellitus during pregnancy

A 
Macrosomia
FGR
Congenital abnormalities
Pre-eclampsia
Stillbirth
Neonatal hypoglycaemia
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42
Q

What vaccines should be given during pregnancy and when?

A

27-26wks

  • Influenza vaccine
  • DTaP vaccine (protect neonate from bordatella)
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43
Q

What are the indications for anti-D prophylaxis administration <12wks GA? If these are not indicated but mum is Rhesus D positive, when should anti-D prophylaxis be given?

A

Give 250IU

  • Molar pregnancy
  • Ectopic pregnancy
  • Therapeutic TOP
  • Uterine bleeding

Give large does 1500U at 28wks
OR
two doses: 28wks and 34wks

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44
Q

What glucose levels are required for a diagnosis of gestational DM?

  • Fasting plasma glucose
  • 2-hr 75g OGTT
A

Fasting: >5.6mmol/L
OGTT: >7.8mmol/L

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45
Q

How should sickle cell anaemia be managed during pregnancy?

A 
Stop hydroxyurea at least 3mths before conception
Manage with:
- low dose aspirin from 12wks
- serial scans every 4wks from 24wks
- IOL at 38wks

LMWH during hospital and 7days after, 6wks if C section
If contraceptive needed - progesterone

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46
Q

If a baby is born to an active HBV mother, what should be given to the child?

A

HBV IVIG: within 12hrs

Hep B vaccine: 12hrs, 1mth, 6mths

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47
Q

What does the combined test screen for and what is involved in it?

A

Patau’s, Edward’s, Down’s

  • Nuchal translucency
  • b-hCG
  • PAPP-A
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48
Q

What does the quadruple test involve and what does it screen for? How does it differ to the triple test? What happens if a positive result is achieved?

A

Down’s only

  • NT
  • b-hCG
  • Oestriol
  • Inhibin A

NB: the triple test does NOT include inhibin A

If positive result:

  • Chorionic villous sampling (11-14wks)
  • Amniocentesis (15-20wks)
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49
Q

What should be given to women at risk of pre-eclampsia?

A

75mg OD from 12wks to delivery (if high risk)

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50
Q

At what GA are the following scans done?
Booking scan:
Anomaly scan:

A

Booking scan: 10-14wks

Anomaly scan: 18-21wks

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51
Q

Sensitising events for RhD negative mum

A
  • Delivery of RhD+ infant
  • Any TOP
  • Miscarriage if > 12 weeks
  • Ectopic pregnancy (if managed surgically)
  • External cephalic version - Antepartum haemorrhage
  • Amniocentesis, CVS, foetal blood sampling - Abdominal trauma
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52
Q

What conditions in women require a higher dose of daily folic acid than the normal 400mcg OD? What is the higher dose?

A

5mg OD

  • Previous NTD in foetus/baby
  • SCD
  • Thalassemia
  • Epilepsy
  • HIV+ on co-trimoxazole
  • Diabetes mellitus
  • Obesity
  • IBD
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53
Q

What is the normal progress of the active phase of first stage of labour?

Slow progress/no progress?

A

0.5cm/hr or 2cm/hr

Slow or no progress = <2cm in 4hrs

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54
Q

When is the most likely time for conception?

A

6 days prior to ovulation, so around day 8-14

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55
Q

Risk of alcohol consumption during pregnancy

A 
Neurological damage
Abnormal facies
Fetal growth restriction
Low birth weight
Spontaneous miscarriage
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56
Q

What vitamin in the liver is associated with congenital abnormalities, thus means liver should not be eaten during pregnancy?

A

Vitamin A

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57
Q

Risks of the following drugs during pregnancy:

Beta blockers
Warfarin
Diuretics
Diclofenac

A

Beta blockers: growth restriction

Warfarin: teratogenic

Diuretics: teratogenic

Diclofenac: miscarriages in first trimester

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58
Q

Oligohydramnios typically detected between how many wks?

A

18-24wks

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59
Q

Things looked for on anomaly scan

A 
NT
Gross abnormalities/cranial eg anencephaly
Abdo wall defect
Cystic hygroma
Bladder outflow obstruction
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60
Q

Risk factors for pre-eclampsia

A 
Chronic HTN
Diabetes
Obesity
Nulliparity
Multiple pregnancy
Renal disease
Molar pregnancy
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61
Q

What serum markers rise in pre-eclampsia? A decrease in what other serum marker is worrying and why?

A

Urea
Creatinine
AST
ALT

Worried if low Plts as could indicate HELLP syndrome

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62
Q

Indications for CTG monitoring

A

Abnormal foetal HR on intermittent auscultation
Meconium in liquor
Maternal pyrexia (>38 or 2x >37.5 separated by 2hrs)
Fresh onset bleeding
Oxytocin for augmentation

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63
Q

Turtle sign/retraction of head during labour suggests? How should this be managed?

A

Shoulder dystocia
Mum needs to STOP pushing

  1. Call for seniors
  2. External manoeuvres (=/- episiotomy)
    = MacRoberts manoeuvre + suprapubic pressure (works in 90%)
  3. Internal manoeuvres
    - Wood’s screw or Rubin II
  4. All fours position
  5. Symphysiotomy, cleidotomy, zavanelli
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64
Q

Which fetal diamete is the most appropriate to engage in the pelvic inlet under normal circumstances?

A

Sub-occipito-bregmatic

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65
Q

What is the progress of labour determined by?

A

Power
Passage
Passenger

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66
Q

Two indications for emergency C-Section?

A

Placental abruption

Transverse position

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67
Q

What are the factors that might mean a lower chance of achieving a VBAC?

A

Maternal obesity
Fetal macrosomia
Increased maternal age
Previous C section performed for recurring indication
Previous C section performed following failed instrumental delivery

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68
Q

Risks of C-section

  • Maternal
  • Foetal
A

Maternal:

  • Visceral damage
  • Haemorrhage
  • VTE
  • Future risk of uterine rupture and placenta praevia
  • Infection

Foetal:

  • Resp distress
  • Traumatic injury
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69
Q

Options for IOL and indications

A

If delay in labour eg <2cm over 4hrs or other reasons eg pre-eclampsia and at term etc

1st line: Vaginal prostaglandins E2

  • Gel or tablet: max 2 doses, 6 hours apart
  • Pessary: 1 dose over 24hr

2nd line:
Membranes intact: ARM
Membranes ruptured but no labour after 2hr: IV syntocinon until 3-4 contractions every 10mins then review in 4hrs

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70
Q

What nerves does shoulder dystocia damage?

A

Brachial plexus

C5-C8, T1

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71
Q

Turtle sign/retraction of head during labour suggests? How should this be managed?

A

Shoulder dystocia
Mum needs to STOP pushing

  1. Call for seniors
  2. External manoeuvres (=/- episiotomy)
  3. Internal manoeuvres
  4. All four position
  5. Symphysiotomy, cleidotomy, zavanelli
72
Q

What maternal cardiovascular changes occur during pregnancy? (Name 3)

A

Drop in venous return
Reduction in CO
Reduction in uterine blood flow

73
Q

What is the position of the baby during labour?

A

Relationship of foetal occiput to the sacrum of the mother once the foetal head is in the pelvic inlet

74
Q

What are the 5 components of a bishop score?

A
  1. Dilation of cervix
  2. Consistency of cervix
  3. Length of cervical canal
  4. Position of cervix
  5. Foetal position
75
Q

What is the risk of ARM?

A

umbilical cord prolapse

76
Q

What are the risks of IV syntocinon?

A

Uterine hyperstimulation

Uterine rupture risk (esp if VBAC or previous uterine myomectomy)

77
Q

Options for IOL and indications

A

If delay in labour eg <2cm over 4hrs or other reasons eg pre-eclampsia and at term etc

1st line: Vaginal prostaglandins E2

  • Gel or tablet: max 2 doses, 6 hours apart
  • Pessary: 1 dose over 24hr

2nd line:
Membranes intact: ARM
Membranes ruptured but no labour after 2hr: IV syntocinon until 3-4 contractions every 10mins

78
Q

What are the types of delay in the first stage of labour?

A

Primary dysfunctional labour
Secondary arrest
Prolonged latent phase
Cervical dystocia

79
Q

What is puerperal pyrexia and what are some causes? How is it managed?

A 
38degrees in mum within first 14days of delivery
Caused by
- endometritis
- wound infection 
- VTE
- UTI
- mastitis

IV clindamycin + gentamicin

80
Q

Definition of delay in second stage of labour

A

Nulliparous: >2hr if no epidural, >3hr if epidural
Parous: >1hr if no epidural, >2hr if epidural

81
Q

What is crowning?

A

When the head no longer recedes between contractions

82
Q

When should vitamin K be administered to a baby?

A

1st dose: just after they’re born
2nd dose: by midwife after 7days
3rd dose: by GP/health visitor when baby is 6wks old

83
Q

What abnormalities of the birth canal can result in abnormal labour?

A 
Fibroids or any obstruction in canal
Cervical dystocia (usually because of previous surgery)
84
Q

What medication should NOT be offered to hypertensive women in third stage of labour?

A

Ergometrine

Offer oxytocin only

85
Q

If IOL is offered to a pregnant women at 41wks and she declines, what should be done?

A

Twice weekly USS and CTG

86
Q

Risk factors for breech baby

A 
Uterine malformations
Fibroids
Placenta praevia 
Poly/oligohydramnios
Foetal anomaly (CNS malformation, chromosomal disorders)
Prematurity 
Macrosomia
Multiple pregnancy
87
Q

What is puerperal pyrexia and what are some causes? How is it managed?

A 
38degrees in mum within first 14days of delivery
Caused by
- endometritis
- wound infection 
- VTE
- UTI
- mastitis
88
Q

When is engagement said to have occured?

A

When the widest part of the presenting part passes through the pelvic inlet

89
Q

What is meconium passed in utero linked to?

A

Marked hypoxia +/- metabolic acidosis

90
Q

What are some causes of abnormal labour?

A

Poor progress +/- signs of foetal compromise

  • Foetal malpresentation
  • Multiple pregnancy
  • Uterine scar
  • Induced labour
91
Q

What are the absolute contraindications for a VBAC?

A

Previous uterine rupture
Classical (vertical) C-section scar
Other non-C-section contraindications eg major placenta praevia

92
Q

In what circumstances is fetal blood sampling contra-indicated?

A

Maternal HIV
Hepatitis
Fetal coagulopathy / bleeding disorders

93
Q

Counselling for vaginal delivery of breech baby

A

40% risk of needing emergency C-section
Footling breech is absolute contra-indication
Better chance if: normal sized foetus, multiparous, positive mental attitude of mother

94
Q

Risks of breech baby

A

ECV - 50% success rate
Placental abruption
Foetal distress
Possible emergency C-section required

95
Q

What are the cardiopulmonary symptoms of amniotic fluid embolism?

A
  • Acute pulmonary HTN
  • Hypoxia
  • RVF then LVF and death
96
Q

What is the risk of uterine rupture in VBAC (normal vs with syntocinon)?

A

1 in 200

1 in 100 if oxytocin

97
Q

Complications of uterine rupture

A

Foetus
Death / cerebral palsy from hypoxic brain injury

Maternal
PPH
Coagulopathy
Hysterectomy

98
Q

Counselling for ERCS

A

Reduced risk of uterine scar rupture and need for emergency C-section

Increased future risk of:

  • Pelvic adhesions complicating surgery
  • Placenta praevia or accreta in future pregnancies

If VBAC then increases likelihood of success of future vaginal births

99
Q

In what circumstances is fetal blood sampling contra-indicated?

A

Maternal HIV
Hepatitis
Fetal coagulopathy

100
Q

Risk factors for cord prolapse

A 
Malpresentation or unstable presentation
Multiple pregnancy
Polyhydramnios 
Preterm delivery
Placenta praevia
Macrosomia
101
Q

Causes of suddenly abnormal CTG with variable decelerations

A

Cord compression

Cord prolapse

102
Q

How should detection of fetal bradycardia/deceleration be managed in labour?

A
  1. If deceleration has not recovered at 3min then CALL FOR SENIOR HELP
  2. If deceleration has not recovered at 6min then transfer to theatre and prepare for immediate delivery
  3. If deceleration has not recovered at 9min then delivery IMMEDIATELY by category one ‘crash’ caesarean section (if immediate instrumental vaginal delivery not possible) usually involves GA as spinal anaesthetic hard to achieve by this time
103
Q

What is the risk of uterine rupture in VBAC (normal vs with oxytocin)?

A

1 in 200

1 in 100 if oxytocin

104
Q

What are the relative contraindications of VBAC?

A

2+ previous C section
IOL
Previous labour outcome suggestive of CPD

105
Q

Counselling for ERCS

A

Reduced risk of uterine scar rupture and need for emergency C-section

Increased future risk of:

  • Pelvic adhesions complicating surgery
  • Placenta praevia or accreta in future pregnancies
106
Q

Mechanism/method of vaginally delivering breech baby

A

Do NOT DO IOL, Continous CTG needed
Maternal position on all fours
Ideally take hands off approach

1) Delivery of buttocks
2) Delivery of legs +/- Pinards manoeuvre
3) If shoulders get stuck - winging of scapula - Loveset’s manoeuvre (for 1/both arms)
4) If head gets stuck - Mauriceau-Smellie-Veit manoeuvre (if doesn’t work use forceps)

107
Q

Risk factors for P-PROM

A

Smokers
STI
Previous P-PROM
Multiple pregnancy

108
Q

Absolute contra-indications for IOL

A

Placenta praevia

Severe fetal compromise

109
Q

What are some reasons for induction of labour?

A
  • Prolonged pregnancy (>41wks)
    • Multiple pregnancy
    • Twin pregnancy beyond 38wks
    • PROM
    • Diabetes
    • Pre-eclampsia/HTN type illness
    • FGR
    • Maternal declining health
    • Unexplained antepartum haemorrhage
    • Intrahepatic cholestasis of pregnancy
    • Maternal isoimmunisation against red cell antigens
      • Social reasons
110
Q

What are common complications of pre-eclampsia?

A 
Pulmonary oedema
DIC
Cerebral haemorrhage
Eclampsia
Placental abruption
111
Q

Presentation of placental abruption

A

Dark red blood
Painful abdomen (severe)
Woody uterus

112
Q

Painless vaginal bleeding and high fetal head suggest what diagnosis?

A

Placenta praevia

113
Q

Risk factors for placental abruption

A

HTN
Pre-eclampsia
Diabetes
Tobacco

114
Q

What does the venous glucose need to be for diagnosis of gestational diabetes?

A

2hr venous glucose >11

115
Q

Complications of gestation diabetes

A 
Polyhydramnios 
Miscarriage 
Shoulder dystocia 
Infection 
Cord prolapse
116
Q

Complications of cholestasis in pregnancy

A

Foetal distress
Pre-term delivery
Intrauterine death
Intracranial fetal haemorrhage

117
Q

Risk factors for multiple pregnancy

A

FH
Older age
Assisted conception
Obesity

118
Q

Maternal complications of multiple pregnancy

A

Miscarriage
Gestational diabetes
Placental praevia
Anaemia

119
Q

Fetal complications of multiple pregnancy

A

Pre-term labour
Intrauterine growth retardation
Malpresentation
Jaundice

120
Q

Risk factors for pre-term labour

A 
Smoking and Illicit drugs
Pre-eclampsia 
Previous pre-term
Multiple pregnancy
Chorioamnionitis
Infection
Gynae surgery eg cervical incompetence
Polyamnionitis 
Young maternal age
121
Q

Risk factors for shoulder dystocia

A 
Fetal weight >4.5kg
Previous big baby >4kg 
Previous shoulder dystocia
Slow progress in 1st/2nd stage of labour
Post dates delivery
122
Q

What should be given to women who might need an emergency C-section to reduce the need for gastric aspiration if they need a GA?

A

ranitidine and metoclopromide

123
Q

What haematological tests should be checked in placental abruption? What results might indicate a DIC?

A

Check for DIC

  • Raised INR
  • Lowered platelets
  • Positive D-dimer
124
Q

Sensitising events include…

A 
Placental abruption
Blood transfusion
CVS
Amniocentesis 
Terminations
Miscarriage
ECV
Antepartum haemorrhage 
Abdominal trauma 
Surgical ectopic pregnancy removal
125
Q

When should you NOT offer a digital examination?

A

Placenta praevia

PROM/PPROM

126
Q

What is the investigation for PROM or PPROM and what will you see?

A

Speculum examination: pooling of amniotic fluid

127
Q

What cervical lengths might indicate PPROM/PROM if >30wks GA?

A

<15mm likely

>15mm unlikely

128
Q

When should fetal fibronectin not be used as a marker of PROM?

A

24-34wks (its dried so not detectable)

129
Q

Risk factors for PPROM/PROM

A 
Previous PROM/PPROM/PTL
UTI
Polyhydramnios
Multiple pregnancy
Smoking
Cervical incompetence
APH
Uterine abnormalities
Trauma
130
Q

If maternal corticosteroids are given eg in pre-term labour etc then what else should be given if the mother is diabetic and why?

A

DKA can ensue so give with Insulin

131
Q

What is the most common cause of preterm labour?

A

Infection (so always do Urine dip and MC&S)

132
Q

What are the 3 types of preterm labour? (eg timing wise)

A

PTL: 32-37wks
Very PTL: 38-32wks
Extremely PTL: <28wks

133
Q

What fetal conditions is indomethacin associated with?

A

PPH due to premature closure of DA
NEC
Neonatal renal dysfunction

134
Q

What is a biomarker of PTL?

A

Foetal fibronectin - check cervicovaginal fluid

Negative has high predictive value: if negative then unlikely to be in labour

135
Q

What are the indications for IAP (intrapartum prophylaxis)?

A

Previous GBS infection in neonate
Preterm labour
Pyrexia during labour (>38degrees)

136
Q

What contraceptive is absolutely contraindicated if breast feeding <6wks post-partum?

A

COCP

137
Q

Causes of raised AFP during pregnancy?

A

NTD
Abdo wall defects eg omphalocele or gastroschistis
Multiple pregnancy

138
Q

Causes of lowered AFP during pregnancy?

A

Downs syndrome
Edwards syndrome
Maternal DM

139
Q

In which location is ectopic pregnancy most associated with rupture?

A

Isthmus

140
Q

What advice should be given to women receiving medical management of ectopic pregnancy?

A

IM methotrexate
F/U with serial hCG: day 4 and 7, then once a week until -ve
- Avoid sex during treatment and conceiving for at least 3mths
- Avoid sunlight and alcohol

141
Q

What are the different time points for splitting of the zygote and what type of twins do they produce?

A

Days 1-3 Dichorionic/diamniotic
Days 8-12 Monochorionic monoamniotic
After day 13 Conjoined twins

142
Q

When is delivery indicated for monochorionic monoamniotic twins?

A

32-34wks

143
Q

What does Lamba sign on a 12wk USS indicate?

A

Dichorionic pregnancy

144
Q

Which anastomoses are more protective against the development of TTTS?

A

Arterioarterial

145
Q

What staging is used for TTTS?

A

Quintero

146
Q

T sign on fetal USS indicates

A

Monochorionic pregnancy

147
Q

What are the degrees of perianal tear?

A

1 Mucosa no muscle
2 Perineal muscle
3 Anal sphincter (a <50% EAS, b >50% EAS, c IAS torn)
4 EAS + rectal mucosa

3+4 = OASIS

148
Q

Management of eclampsia

A
  1. A-E
  2. IV MgSO4 (loading dose 4g over 5-15mins, then infusion of 1g/hr for 24hr after last seizure or until delivery)
  3. If recurrent then repeat loading dose and get anaesthetists involved
  4. Anti-HTNs: oral/IV labetalol, nifedipine, IV hydralazine
  5. Expedite delivery

NB: Ca Gluconate = antidote to MgSO4

149
Q

How does pregnancy increase the risk of VTE?

A

Hyperoestrogenic state
Altered blood viscosity
Obstruction to venous blood flow

150
Q

What are the symptoms of post-thrombotic syndrome?

A

Chronic leg pain
Swelling
Ulceration

151
Q

What factors are increased in pregnancy to produce the pro-coagulant state?

A 
F7 
F8
vWF
PAI-1
PAI-2

Also decreased protein S

152
Q

What anti-coagulant protein is decreased in pregnancy?

A

Protein S

153
Q

What is a blighted ovum?

A

Gestational sac is present but empty because foetus has not developed

154
Q

What measurements are used to determine gestational age and at what time points?

A

CRL: up to 13wks 6days
HC: 14-20wks

155
Q

Gestational age can no longer be accurately calculated by ultrasound after what time point?

A

20 weeks

156
Q

What are some anomalies looked for at the anomaly scan and when does it take place?

A

18-20+6 wks

  • Spina bifida
  • Anencephaly
  • Abdominal wall malformations eg omphalocele, gastroschisis
  • Hydrocephalus
  • Skeletal abnormalities eg achondroplasia
  • Cleft lip/palate
  • Congenital cardiac abnormalities
157
Q

Which USS is best at detecting lower edge of placenta? Which condition may it be helpful in identifying?

A

TVUSS

Placenta praevia

158
Q

What is the normal passage of amniotic fluid in the foetus?

A

Foetus swallows amniotic fluid
Absorbs it in GI tract
Excretes urine into amniotic sac

159
Q

What are the two indicators of amniotic fluid via USS?

A
  1. Amniotic fluid index

2. Maximum vertical pool

160
Q

What serial measurement should be taken from 16wks in women with a history of preterm birth or midtrimester loss?

A

Cervical length

161
Q

What can cause foetal tachycardia?

A

Fetal or maternal infection
Acute fetal hypoxia
Fetal anaemia
Drugs (certain)

162
Q

What factors affect baseline variability on CTG?

A

Foetal sleep states and activity
Hypoxia
Foetal infection
Drugs eg opioids

163
Q

The velocity of blood flow in the middle cerebral artery is an indicator of…

A

Foetal anaemia - if anaemic then velocity increases

164
Q

Indications for induction of labour

A 
APH
IUGR
Maternal HTN
Post-maturity 
Diabetes mellitus
165
Q

Risk factors for shoulder dystocia

A

Excess maternal weight
Prolonged first or second stage of labour
Macrosomia
Post-maturity

166
Q

Sudden infant death syndrome risk factors

A 
Sleeping in the same bed as baby 
Smoking
Prone sleeping
Hyperthermia and head covering
Prematurity
167
Q

Investigations and management of Hirschsprungs

A

Full thickness rectal biopsy

Anorectal pull through

168
Q

What function tests may you check in molar pregnancy and what would be the results?

A

TFTs

  • Low TSH
  • High T4

as beta-hcg is so high and mimics TSH

169
Q

Risk factors for ovarian torsion

A

Pregnancy
Ovarian mass
Ovarian hyperstimulation syndrome
Of reproductive age

170
Q

Who should take folic acid 5mg OD?

A

Woman with child with previous NTD or partner has NTD or FHx
Diabetics
Women on anti-epileptic
Obese (Body mass >30)
HIV+ taking co-trimoxazole
Sickle cell anaemia or thalassemia trait
Coeliac disease

171
Q

High risk groups for pre-eclampsia

A

Hypertensive disease during previous pregnancy
Chronic kidney disease
Autoimmune disease eg SLE/Anti-phospholipid syndrome
Diabetes (T1 or T2)

172
Q

Associated factors for placental abruption

A 
Previous abruption
Proteinuric HTN
Advancing maternal age
Cocaine use
Multiparity
Maternal trauma
173
Q

Risk factors for shoulder dystocia

A

Macrosomia
High maternal BMI
Diabetes mellitus
Prolonged labour

174
Q

Complications of placental abruption

A 
Maternal:
Shock
DIC
Renal failure
PPH

Fetal:
IUGR
Hypoxia
Death

175
Q

Features of congenital rubella syndrome

A 
Chorioretinitis
Sensorineural deafness
Congenital cataracts 
Congenital heart disease eg PDA
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Cerebral palsy
Microphthalmia
176
Q

Risk factors for premature ovarian failure

A

FH
Chemotherapy/radiation
Autoimmune disease

Year 5 (5 decks)

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