Obstetrics Part 2 Flashcards
(136 cards)
1
Q
What are common symptoms of multiple pregnancies?
A
- Exaggerated symptoms of pregnancy
- Severe morning sickness
- More weight gain
- Breast tenderness
- Palpitations
- Varicose veins
- Incidental findings
2
Q
What characterizes dizygotic twins?
A
- Non-identical
- 2 separate eggs fertilized by different sperm
- Same sex or different sex
- Dichorionic
3
Q
What characterizes monozygotic twins?
A
- Identical
- Fertilization of a single egg by one sperm, then splits into two
- Often same sex
- Mono/dichorionic
4
Q
What are common complications for mothers in multiple pregnancies?
A
- Gestational diabetes
- Hypertensive disorders
- Anemia
- Thromboembolic disease
5
Q
What is the most common complication for fetuses in multiple pregnancies?
A
Preterm delivery
Miscarriage, vanishing tween, inutero demise, IUGR
6
Q
What is required for a natural vaginal delivery of twins?
A
The first twin must be cephalic
7
Q
What characterizes monochorionic twins?
A
Develop from 1 egg and share the same placenta
1:300 pregnancies
8
Q
What is twin-to-twin transfusion syndrome?
A
Disease of placenta with unequal sharing of blood between twins
Can be fatal for one or both twins
9
Q
What are the clinical features of the donor twin in twin-to-twin transfusion syndrome?
A
- Oliguria
- Oligohydramnios
- Fetal growth restriction
10
Q
What are the clinical features of the recipient twin in twin-to-twin transfusion syndrome?
A
- Polyhydramnios
- Hydrops with cardiac failure
- Preterm labor
11
Q
What is the management approach for twin-to-twin transfusion syndrome?
A
- Expectant management
- Amnioreduction
- Selective termination
- Selective fetoscopic laser photocoagulation
- Terminate whole pregnancy
12
Q
What is twin anemia-polycythemia sequence (TAPS)?
A
Rare condition with unequal blood counts between twins
Occurs with Hb difference
13
Q
What is the treatment for TAPS?
A
- Expectant management
- Selective fetocide
- Intrauterine transfusion
- SFLP
14
Q
What is the definition of preterm labour?
A
Birth before 37 weeks of pregnancy
Preterm labour can be spontaneous or iatrogenic (induced or by caesarean section).
15
Q
What characterizes established preterm labour?
A
Progressive effacement and dilation of cervix with regular painful contractions.
16
Q
Define preterm prelabour rupture of membrane (PPROM).
A
Ruptured membrane before 37+0 weeks and not in established labour.
17
Q
What is prelabour rupture of membrane?
A
Term birth with ruptured membrane without symptoms of labour.
18
Q
What is the best predictor of preterm birth?
A
Previous preterm birth.
19
Q
What are some causes of preterm birth?
A
- Too much pressure (multiple pregnancy, polyhydramnios)
- Weakness of cervix (cervical insufficiency)
- Outside better than inside (infection, abruption, pre-eclampsia, IUGR)
20
Q
What are the key components of clinical examination for preterm labour?
A
- History: symptoms, signs of infection
- Examination: vitals, abdomen, sterile speculum examination
- Avoid vaginal examination to reduce infection risk.
21
Q
What are important complications associated with PPROM?
A
- Chorioamnionitis and sepsis (EMERGENCY, IMMEDIATE LABOUR)
- Endometritis
- Foetal complications (tachycardia, distress, etc.)
22
Q
How is PPROM diagnosed?
A
- Sterile speculum examination - liquor pooling (GOLD STANDARD)
- IGFBP-I test (actin prom)
- Nitrazine-based test (amnicator)
amnicator detects amniotic fluid by pH
23
Q
What does a negative result from the Actin partus test indicate?
A
Imminent delivery is highly unlikely.
Checks for proteins produced when decidua detach from chorion
24
Q
What is the function of antenatal steroids in the management of PPROM?
A
Promote lung maturation and reduce risks of respiratory distress syndrome, necrotising enterocolitis, intraventricular haemorrhage
25
What is the purpose of magnesium sulphate in preterm labour management?
Neuroprotection to reduce cerebral palsy.
26
What is tocolysis and when is it indicated?
Delay birth for 48 hours to administer antenatal steroids or for in utero transfer.
| Nifedipine, salbutamol, terbutaline
27
Which antibiotics are used prophylactically for PPROM?
Erythromycin for 10 days after PPROM.
IV Pencillin G until GBS swabs come back negative
28
What is cervical cerclage?
Insertion of a suture in the cervix to prevent preterm labour.
29
True or False: Tocolysis is recommended in cases of PPROM with chorioamnionitis.
False. Immediate delivery if chorioamnionitis
30
Fill in the blank: The typical vaginal pH is _______ and the amniotic fluid pH is _______.
4.5 - 6.0; 7 - 7.5.
31
What is the cut-off cervical length that indicates a high likelihood of birth within 48 hours?
≤15mm.
32
What are some signs to look out for in chorioamnionitis?
* ↑BP
* ↑HR
* High temperature
* Fever
* Fetal heart rate abnormalities.
33
What abx used for chorioamnionitis?
IV ampicillin & gentamicin
34
What should you advise patients with PPROM?
Stay in hospital to monitor
Induce labour from 34wks onwards
35
What meds to give for PPROM?
Tocolytics - nifedipine/salbutamol
Steroids
MgSO4
Abx - erythromycin & penicillin
36
What does VBAC stand for?
Vaginal birth after caesarean
## Footnote
VBAC refers to the process of delivering a baby vaginally after a previous caesarean section.
37
Who can attempt VBAC?
1 uncomplicated lower segment transverse CS
Otherwise uncomplicated pregnancy at term, cephalic presentation
No contraindication to vaginal birth
## Footnote
These criteria help determine eligibility for a vaginal birth after a previous caesarean.
38
What are some contraindications to VBAC?
* Previous ≥2 classical caesarean sections
* Previous scar/uterine rupture
* Previous myomectomy where uterine cavity is breached
* Prior low vertical incision, inverted T or J incision
* Any obstetric contraindications to vaginal birth
## Footnote
These conditions increase the risk of complications during VBAC.
39
What is the risk of uterine rupture during VBAC?
0.5% compared to unscarred uterus
## Footnote
Uterine rupture is a serious complication that can occur during a trial of labour after a caesarean.
40
What are the benefits of VBAC?
* Avoid risk of surgery
* Shorter recovery & hospital stay
* Lower risk of venous thromboembolism
* Higher likelihood of future vaginal birth
* Reduce risk of obstetric complications associated with caesarean section
## Footnote
These benefits are significant factors for women considering VBAC.
41
What are the benefits of Elective Repeat CS?
* Planned delivery
* Avoids risk of uterine rupture
* Reduced risk of pelvic organ prolapse
* No risk of perineal tear
* Can perform sterilisation
## Footnote
These benefits are often considered by women who have had previous caesareans.
42
What are the risks associated with Elective Repeat CS?
* Operation related risk - pain and VTE
* Longer hospitalisation stay and recovery
* Small increase in respiratory morbidity when ERCS performed <39 weeks
* Small risk of placenta praevia and/or accreta in future pregnancy
* Need CS for future pregnancy
* Pelvic adhesions complicating future abdominopelvic surgery
## Footnote
Understanding these risks is crucial for informed decision-making.
43
What is the risk increase for uterine rupture with labour induction?
2-3x risk of uterine rupture
## Footnote
Inducing labour can significantly increase the risk of complications in women with a previous caesarean.
44
What methods can be used to induce labour?
* Mechanical - amniotomy, foley catheter
* Medical - prostaglandins
## Footnote
Mechanical methods tend to have a lower risk of rupture compared to medical methods.
45
What is bradycardia in the context of fetal heart rate monitoring?
Prolonged heart rate of less than 110 beats per minute for 3 minutes
## Footnote
Bradycardia can indicate potential fetal distress and requires immediate attention.
46
What are risk factors for unsuccessful VBAC?
High BMI
Advanced maternal age
Previous CS for labour dystocia
Induced labour
Birth weight >4kg
47
What are factors increasing chances of successful VBAC?
Prev successful VBAC - 85-90% success rate
Spontaneous labour
Previous CS for non-recurrent indication
48
What is the definition of induction of labour?
Initiation of uterine contractions to accomplish a vaginal delivery before the spontaneous onset of such contractions.
49
List three contraindications for induction of labour.
* Inability to do vaginal delivery
* Placenta previa
* Non vertex presentations (breech, transverse lie)
* Severe life threatening maternal/fetal conditions (eg. eclampsia, chorioamnionitis)
* increased risk of uterine rupture - prev CS
50
What is the increased risk associated with previous cesarean sections when considering induction of labour?
Increased risk of uterine rupture.
51
At what gestational weeks should induction be considered for maternal factors such as gestational diabetes?
On diet control: 40-41 weeks
On treatment: 37-38 wks
52
When should induction of labour be considered for maternal factors with pregnancy-induced hypertension/pre-eclampsia?
37-38 weeks.
53
What fetal condition warrants induction at 37 weeks if dopplers are normal or reduced?
Intrauterine growth restriction (IUGR).
54
What is the recommended time to start offering induction of labour for post-term pregnancy?
After 39 weeks.
55
What should be done after a rupture of membranes preterm?
After 34 weeks.
56
What are mechanical methods of inducing labour and how do they work?
Membrane sweep - finger in cervix and sweep one round
cervical ripening balloon
Separates membrane from the decidua, releasing localized prostaglandins, phospholipase A2, and cytokines.
57
What is the success rate of a membrane sweep for inducing labour in a favorable cervix?
90%.
| will go into labour in 48hrs
58
Fill in the blank: Prostaglandins are used to encourage the cervix to _______.
soften & stretch.
| for cervical ripening + stimulate uterine contractions
59
What is the role of oxytocin in the induction of labour?
Stimulates uterine contractions
60
True or False: Oxytocin is used in miscarriages.
False.
| no oxytocin receptors in early pregnancy
## Footnote
misprostol used instead
61
What surgical procedure is usually done in conjunction with oxytocin infusion?
Artificial rupture of membranes (ARM).
62
What is Ferguson’s reflex?
Cervix dilated signals the pituitary gland to release oxytocin.
63
What score is used to determine the method of induction?
Bishop score.
64
What is a complication of induction of labour characterized by 5 or more contractions in 10 minutes?
Uterine hyperstimulation.
65
What is the management for uterine hyperstimulation?
* Stop oxytocin
* Remove induction devices
* Tocolytic (terbutaline IV)
* Emergency LSCS
66
What is a rare but life-threatening complication of induction of labour?
Amniotic fluid embolism.
67
How to interpret Bishop's score
68
Where is station 0 when determining Bishop's score?
Station 0 = ischial spine
69
What is the definition of labour?
Regular painful uterine contractions increasing in frequency and intensity resulting in progressive cervical dilation and effacement and descent of fetal presenting part in the pelvis
70
What are the changes that occur before labour?
* False labour pains
* Lightening
* Discharge of mucus plug
* Cervical changes
* Show
71
What is lightening in the context of labour?
The woman feels it is easier to move due to rotation of fetus to cephalic presentation
72
What does effacement refer to?
Shortening of cervix until indistinguishable from uterine wall
73
What is a show?
Small amount of blood-tinged mucus that passes per vaginally
74
What characterizes Stage 1 of labour?
Onset of painful regular uterine contractions to full dilation of cervix
| Latent phase: from 0-3cm
Active phase: from 3-10cm
75
What cervical changes occur during Stage 1 of labour?
* Cervix becomes shorter
* Fetal head gets lower
* Forewaters may rupture
76
What is the purpose of monitoring descent of the fetal head?
To assess the progress of labour and fetal positioning
| Less of baby's head felt abdominally
or by vaginal station
77
What does the term 'lie' refer to in labour?
Relationship of longitudinal axis of fetus to longitudinal axis of mother
78
What are the types of fetal presentation?
* Cephalic
* Breech
* Shoulder (transverse)
79
What is the presenting part of the fetus?
Portion of fetus felt through cervix on vaginal examination
80
What does the position of the fetus describe?
Relation of an arbitrarily chosen portion of fetal presenting part to the right or left of maternal birth canal
81
What defines Stage 2 of labour?
From full dilation of cervix (10cm) till delivery of fetus
82
What characterizes Stage 3 of labour?
From delivery of fetus to delivery of the placenta
83
What are the signs of placental separation?
* Cord lengthening
* Fresh gush of blood
* Uterus rises in abdomen
84
What is a separation maneuver in Stage 3?
One hand on symphysis pubis stabilizing and lifting the uterus while pulling placental cord with the other hand
85
What is monitored in the mother during labour?
* Tocogram
* Vital signs
* Presence of proteins and ketones in urine
* Frequency, intensity, duration of contractions
86
When should the partogram be started?
Only when patient is in active labour with cervical dilatation of 3-4 cm
87
What does the alert line on a partogram indicate?
Drawn from point of cervical dilatation noted at first vaginal examination with a slope of 1cm per hour
| Action line drawn 4 hours to the right
88
What is continuous intrapartum fetal monitoring?
Cardiotocogram
89
What is normal amount of contractions in labour
3-4 every 10 mins
90
91
What is the puerperium?
A 6 week period following delivery, where the reproductive tract returns to a non-pregnant state.
92
When does menses typically return after childbirth for non-breastfeeding mothers?
By 6 weeks or soon after.
93
What bladder issues are common during the puerperium?
* Bladder trauma
* Relative insensitivity
* Incomplete emptying
* Retention
94
What is colostrum and when is it produced?
the first form of breastmilk that is released by the mammary glands after giving birth. It's nutrient-dense and high in antibodies and antioxidants to build a newborn baby's immune system
Produced on Day 1-2 after delivery.
95
What initiates the milk flow on Day 3 postpartum?
Suckling triggers a neurohormonal reflex leading to oxytocin release.
96
What are some key aspects of puerperium care?
* Manage pain
* Wound care
* Early ambulation
* Pelvic floor exercises, breast care
* Diet
* Mental health monitoring
* contraception
97
What is postpartum blues?
Mild emotional changes occurring within 2-3 days of childbirth, resolving in 1-2 weeks.
98
What is postpartum depression and its prevalence?
Starts in the first few weeks after birth; affects 1 in 5 mothers.
99
What are common symptoms of postpartum depression?
* Anxiety
* Sadness
* Anger
* Intrusive thoughts
* Depressed mood
100
What is postpartum psychosis?
A severe condition lasting 2-12 weeks, affecting 0.1% of mothers, involving confusion and disorganized behavior.
101
When should contraception be initiated postpartum?
21 days after childbirth.
102
What contraception methods are safe for breastfeeding mothers?
* Condoms
* Progesterone only pill
* Progesterone implant
* DMPA injection
103
Which contraceptive methods are unsafe within 3 weeks postpartum?
* Combined hormonal contraception (pill/patch/ring)
* Anything with estrogen
104
What should be done 6 weeks after childbirth?
A PAP smear.
105
What are the causes of puerperal sepsis?
* Breast engorgement
* Mastitis
* UTI
* Genital tract infection
* Wound infection
* DVT
* Pneumonia
106
What investigations are done for suspected puerperal sepsis?
* FBC
* CRP
* Renal panel
* Electrolytes
* Blood culture
* Urine culture
* Imaging
107
What is the management for puerperal sepsis?
* Resuscitation
* Broad spectrum antibiotics
* Fluid resuscitation
* Manage source of infection
108
How to prevent thromboembolism during the puerperium?
prophylactic anticoagulation for those with risk factors
encourage early ambulation/compression stockings
109
What are some causes of urinary retention postpartum?
* Regional anesthesia
* Bladder trauma
* Episiotomy/laceration
* Vulval haematoma
110
What is the maximum legal timeframe for an induced abortion?
Induced abortion is legally permitted if performed before **24 weeks**.
111
What is required before any termination of pregnancy (TOP) procedure?
Abortion counselling must be attended, followed by a 48-hour cooling period.
112
What special requirement is there for individuals under 16 years seeking TOP?
Individuals under 16 must go to Health Promotion Board for TOP.
113
List three indications for TOP.
* Maternal diseases (cardiac, malignancy, renal, sepsis)
* Fetal diseases (genetic, fetal anomalies)
* Social reasons (financial difficulties, short interpregnancy interval)
114
What must be determined during the clinical assessment of TOP?
Viability of the fetus must be determined.
115
What medication is used to prepare the cervix and uterus for the abortion medication during TOP?
Mifepristone, given before misoprostol
116
What is fetocide and when is it performed?
Fetocide is performed if pregnancy exceeds 22 weeks; it involves injecting substances like potassium chloride to cause fetal asystole.
117
What is required for surgical TOP priming?
Surgical priming with prostaglandin analogues (misoprostol) is required.
118
What are two risks associated with surgical TOP?
* Infection
* Uterine perforation
119
Which method of TOP is generally better for pregnancies over 9 weeks?
Surgical method is better, as it is less likely to have retained products.
120
When should follow-up occur after a TOP procedure?
Follow-up should occur in 3 weeks.
121
What two tests are used to confirm loss of pregnancy during follow-up?
* Urine pregnancy test
* Ultrasound pelvis
122
What should be discussed during the follow-up appointment after TOP?
Contraception methods and any financial support.
123
What is the definition of subfertility?
Inability to conceive after 12 months of unprotected regular sex.
35yo and above: failure after 6 months
124
What is considered regular sexual intercourse for the purpose of defining subfertility?
2-3 times a week.
125
What is fecundibility?
Probability of achieving pregnancy within one menstrual cycle.
126
What is the average fecundibility rate per menstrual cycle?
~20% per cycle.
127
Name one cause of female subfertility related to ovarian dysfunction.
Low ovarian reserve.
128
List two structural issues that can cause tubal-related female subfertility.
* Ectopic pregnancy
* Tubal ligation.
129
What inflammatory conditions are characterized by pelvic pain and can lead to fertility issues in females?
Endometriosis and PID
130
What is a common congenital cause of male subfertility?
Klinefelter's syndrome (XXY).
131
What is are pre-testicular causes of male subfertility?
Hyperprolactinemia
Thyroid dysfunction
132
What are the key components to include in a general history when assessing subfertility?
* Duration of trying to conceive
* Issues with sexual intercourse
* Previous fertility treatments.
133
What hormone is a marker of ovarian reserve in females?
Anti-mullerian hormone.
134
What is the significance of a hysterosalpingogram?
It checks for tubal occlusion.
135
What is one management strategy for subfertility?
Folic acid supplementation.
136
Management of subfertility
1. folic acid supplement
2. healthy lifestyle
3. ovulation induction
4. intrauterine insemination
5. in vitro fertilisation
