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Obstetrics Peer Teaching Flashcards

1
Q

What tests are done at a pregnant woman’s first visit?

A

urine sample, haemaglobin, blood group
syphilis and rubella serology
HIV screening

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2
Q

What is the 11-13 weeks scan for?

A

How many fetuses, nuchal translucency, dating scan

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3
Q

What is the 20 week scan for?

A

fetal anomaly

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4
Q

What is checked at 36 and 37 weeks?

A

Lie and presentation of the baby

Head engaged at 37 weeks

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5
Q

What are the “latent” and “established” phases of the 1st stage of labour

A

Latent: dilated <4cm
Established: dilated >4cm and contractions

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6
Q

What are the “active” and “passive” phases of 2nd stage of labour?

A 
Passive = fully dilated, not pushing
Active = pushing
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7
Q

How long does the first stage of labor take?

A

Nulliparous: 8-12
Multiparous: 5-12

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8
Q

How long does the 2nd stage take?

A

Nulliparous: 3 hours
Multiparous: 2 hours

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9
Q

What is pre-eclampsia?

A

Hypertension and proteinuria in pregnancy

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10
Q

What are the symptoms of pre-eclampsia?

A

Shakinf, flu-like symptoms, visual changes and hyperreflexia

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11
Q

What is the cure for pre-eclampsia?

A

Delivery

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12
Q

How to prevent pre-eclampsia from becoming eclampsia?

A

Magnesium sulfate, MgSO4

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13
Q

Wha tis the pathophysiology of pre-eclampsia?

A

Failure of spiral arteries to embed properly into the trophoblast, causing an ncrease ion blood pressure to compensate

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14
Q

When should someone with pre-eclampsia be admitted?

A

BP 160/100

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15
Q

When should someone with pre-eclampsia be admitted if there is proteinurea or IUGR?

A

140/90 BP

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16
Q

If a pregnant woman is in shock but there appears to be little blood loss what is the diagnosis?

A

Concealed placental abruption

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17
Q

When would you feel a “woody” uterus?

A

Placental abruption

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18
Q

What is placenta praevia?

A

Placenta lies on the lower segment of the uterus

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19
Q

What are the symptoms of placentsa praevia?

A

Abnormal lie of fetus, painless bleeding

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20
Q

What should you not do if you suspect placenta praevia? Why?

A

A vaginal examination, because of the risk of beeding

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21
Q

What effects would maternal rubella infection have on the developing fetus?

A
  1. Deafness
  2. Cataracts
  3. Cardiac abnormalities
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22
Q

What effects would maternal cytomegalovirus infection have on the developing fetus?

A

cognitive impairment

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23
Q

How should a pregnant woman avoid listeria infection

A

Avoid soft cheese`

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24
Q

How should you initially manage a 28 week premature delivery?

A

Wrap in plastic and put under heat lamp, don’t dry

Delay cord cutting for 3 minutes.

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25
What constitutes as a delay in 2st stage of labour?
<2cm/hr dilation in 4 hours
26
What treatment should you use in delayed labor?
Oxytocin
27
What is delayed 2nd labour?
When delivery isn't imminent after 2 hours of pushing in a nulliparous woman and 1 hour for a parous woman
28
What should you do if there is a delay in 2nd stage?
a. Amniotomy b. forceps c. c-section
29
How should a diabetic woman trying for a baby be managed?
5mg folic acid preconception | Control diabetes
30
When should you deliver a baby in a maternal diabetic?
38 Weeks
31
What is the medical treatment for pre-eclampsia where the BP is >150/100
oral labetalol
32
What does blood pressure do in normal pregnancy?
Falls initially until 20-24 weeks then returns to pre pregnancy levels by term
33
What counts as hypertension in pregnancy?
140/90 OR 30 increase in systolic and 15 increase in diastolic
34
Give 3 high-risk factors for pre-eclampsia
CKD SLE Diabetes previous pre-eclampsia
35
What is pre-eclampsia?
Hypertension + proteinuria >0.3g/day
36
What is HELLP syndrome?
Haemolysis, elevated liver enzymes, low platelets
37
Give 3 things that can be caused by pre-eclampsia?
IUGR, prematurity kidney failure placental abruption
38
What are features of severe pre-eclampsia?
170/110 headache/visual disturbance papilloedema
39
When would you deliver in pre-eclampsia?
if mild, 37 weeks If moderate/severe: 34-36 weeks If there is maternal complications always deliver
40
What is eclampsia?
Pre-eclampsia + seizures
41
What is the treatment for eclampsia?
Magnesium sulfate
42
How should MgSO4 be administered?
4g IV bolus over 5/10 minutes followed by an infusion of 1g/hr
43
How long should MgSO4 treatment last?
24 hours after last seizure or delivery, whichever is last
44
What is the most common pathogen in the mother causing neonatal sepsis/
Group B strep
45
What are risk factors for developing neonatal sepsis?
Prolonged rpture of membranes sibling with group B strep infection maternal pyrexia
46
What prophylaxis is given for group B strep?
Benzylpenicillin
47
Name 4 causes of antepartum haemorrhage
placenta praevia placental abruption uterine abruption vasa praevia
48
What is the classis symptom of placenta praevia?
Painless vaginal bleeding
49
What is a major placenta praevie?
where the placenta covers the os - type 3 and 4
50
What is the managements of placenta praevia?
anti-D if rhesus -ve, c section at 39 weeks, steroids if <34 weeks gestation
51
Should you be worried if the placenta is low lying at 20 weeks?
No - At 20 weeks placenta is low-lying in most pregnancies but appears to move upwards with time as the formation of the lower segment of the uterus occurs in the third trimester
52
What are some risk factors for placental abruption?
``` Previous abruption Smoking IUGR pre eclampsia pre-existing hypertension ```
53
A patient presents with painful bleeding, a woody hard uterus, and appears to be shocked - what is the diagnosis?
Placental abruption
54
What maternal investigations need to be performed in suspected placental abruption?
FBC, Coag screem cross-match, U&E, urine output
55
What is the management for placental abruption?
anti-D, steroids if <34 weeks, C/S if fetal distress, induce labout >37 weeks Blood transfusion if necessary
56
What are the cardinal movements of labour?
``` Engagement. Descent. Flexion. Internal rotation. Extension. External rotation/restitution. Expulsion. ```
57
1. Describe engagement
Head enters pelvis in occipito-transverse position. OR Widest part of the presenting part becomes level with the pelvic inlet
58
2. Describe descent
Passage of the widest presenting part through the pelvis
59
3. Describe flexion
Fetal head flexes as it is pushed downwards
60
4. Describe internal rotation
Head rotates 45 degrees
61
5. Describe extension
Fetal head faces the sacrum, occiput in contact with the symphisis pubis
62
6. Describe restitution/external rotation
Fetal head turns to be in line with its torse so shoulders can be delivered
63
7. Describe expulsion
Delivery of the fetal body
64
What are the 3 Ps?
Mechanical factors determining the progress of labour: passenger, passage and power i.e. width of head, pelvis and strength of contractions
65
What is the management of failre to progreess in labour in the first stage of a nulliparous woman?
amniotomy then oxytocin then c-section
66
Management for failure to progress in passive 2nd stage?
2 hour wait before pushing, give oxytocin
67
Management for failure to progress in active 2nd stage?
episiotimy if head is against the perineum, ventouse if not
68
What can obstruct the passage of the fetus during delivery?
cephalo-pelvic disproportion pelvic mass e.g. fibroid abnormal pelvic architecture e.g. poorly healed pelvic fracture
69
What is the OP position? What are the features?
Occiputo-posterior "back to back" - back ache - more painful and longer labour - early desire to push
70
What is the OT position?
Occipito-transverse Incomplete internal rotation Ventouse needed
71
What is the brow position?
Fetal head extended, large presenting diameter - nose and anterior fontanelle may be palpable
72
What is the management of brow position?
C-section
73
What are the factors that determine the bishop score?
Cervical dilation, effacement, and consistency | Position of the fetus and station of the fetal head
74
What does a bishop score of <6 mean?
Unlikely to go into spontaneous labour, not suitable for induction
75
What does a bishop score of >8 mean?
Likely to go into spontaneous labour, suitable for inductinop
76
What is the first line induction of labour?
Membrane sweep - separate the membranes away from the cervix manually
77
What is the 2nd line induction of labour?
Prostaglandin gel vaginally 2mg, 2 doses maximum
78
What is the 3rd line induction of labour?
Amniotomy + oxytocin 2 hours later if still not progressing
79
Give some fetal indications for induction of labout?
post term pregnancy, IUGR
80
Gice some materno-fetal indication for induction of labour?
Diabetes, pre-eclampsia
81
What are the maternal complications of shoulder dystocia?
perineal tears, PPH, urethral and bladder injuries
82
What are the fetal complications of shoulder dystocia?
Erb's palsy - brachial plexus injury | Hypoxic ischaemic encephalopathy
83
What are risk factors for shoulder dystocia?
Diabetes, high maternal BMI, macrosomia
84
What manouvre should be used in shoulder dystocia? Describe it.
McRoberts manouvre - flex thighs towards abdomen | Apply suprapubic pressure
85
What is the management for cord prolapse?
Delivery
86
When is the cord more likely to prolapse?
When the fetal head is not engaged in the pelvis
87
What are risk factors for cord prolapse?
Polyhydramnios Multiple pregnancy Low lying placenta Abnormal lie
88
What is a risk factor for uterine rupture?
Previous c-section (or traumatic injury)
89
Shock, severe abdominal pain which persists between contractions, vaginal bleeding and CTG abnormalities during labour indicate what?
Uterine rupture
90
What might you see on CTG in uterine rupture?
Fetal Bradycardia
91
How does amniotic fluid embolism present?
like a PE, with collapse
92
How is fetal distressed measured?
fetal blood gas, CTG, fetal ECG
93
What is fetal distress?
Hypoxia which may cause damage or death to the fetus if left unresolved.
94
How do you interpret a CTG?
Dr C Brvado DR - Define Risk Contractions - how many in 10 minutes? More than 5 is hyperstimulation Baseline Rate - 110-160 Accelerations in fetal heart rate with movement or contractions are reassuring Decelerations Overall assessment
95
What do early, variable and late decelerations indicate?
Early - benign Variable - cord compression Late - persist after contractions, suggesting fetal hypoxia
96
What is the first line management of primary PPH?
IV syntocinon followed by 0.5mg ergometrine
97
What are the risk factors for PPH?
polyhydramnios, pre eclmapsia, prolonged labour, macrosomia, previous PPH
98
What is the most common cause of PPH?
Uterine atony
99
What are the causes of secondary PPH?
endometritis, retained placental tissue
100
What is the scoring system for post natal depression?
Edinburgh scale

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