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OBGYN 2023 > obstetrics summary > Flashcards

obstetrics summary Flashcards

1
Q

preconcepton care

A

diet - folate
weight - BMI
exercise
smoking/alcohol advice - assess intake and provide advice
pregnancy history - screen for modifyable risk factors
genetic screening - if indicated from personal/family history
medical history
pychosocial screening - DV and mental health screen
environmental screening - work, home
contraception/family planning
infectious screen and vaccinations
breast exmination

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2
Q

first antenatal visit

A

planned vs. unplanned
LMP and tests to date
obstetric history
gynaecological history
medical history (personal and family)
social history
care options
provide pregnancy health record

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3
Q

antenatal examination

A

height/weight (BMI)
BP
urinalysis
cardio exam
abdominal examination - fundal height, palpation for lie/presentation (from 28 weeks), FHR auscultation

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4
Q

initial investigations

A

MSU
rubella
syphilis
antibodies
blood group
chlamydia/gonorhhea
FBC
globinopathies
HIV/HBV/HCV
iron sstudies and immunications

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5
Q

subsequent investigations following antenatal visit

A

US:
dating - 8-12 weeks
first timester screen 11-14 weeks
anatomy scan 18-20 weeks
OGTT 24-28 weeks
GBS screen 36 weeks

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6
Q

screening test

A

combined first trimester screening test
non-invasive prenatal testing
triple test

if any are poitive > CVS vs. amniocentesis

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7
Q

rhesus D negative

A

mother with rhesus negative and foetus with resus positive
risk of maternofoetal haemorrhage
RhD Ig binds Rh positive foetal cells to prevent immune response

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8
Q

preterm labour and birth complications

A

birth after 20 weeks and before 37 weeks gestation
complications:
- mother - increased risk of obstetic intervention
- neonate - ICH, respiratory support, bowel necrosis, sepsis, death
- child - CP, chronic lung disease, deafness, blindness, developmental delay
- adult - metabolic syndrome, diabetes, heart disease

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9
Q

risk factors for preterm birth

A

previous pre-term birth, FHx, smoking, extremes of age, stress/anxiety, previous preinatal loss, short cervical length

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10
Q

aetiologies of pre-term birth

A

spontaneous preterm labour, PPROM, preeclampsia, diabetes, APH, multiple pregnancies, infectons, uterine abnormalities, cervical surgeries

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11
Q

prevention of pre-term birth

A

optimal control of risk factors (smoking cessation)
measure cervical length ot foetal anatomy + subsequent scans
vaginal progesterone is history of spontenous preterm birth

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12
Q

what to do for short cerrvical length

A

200mg vagnal progesterone in evening if cervix <25mm
consider cervical cerclage is cervix <10mm
vaginal progesterone is history of spontaneous preterm birth

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13
Q

workup of preterm labour

A

diagnosis - regular painful contractions and cervical change
history - gestational age, contractions, presence of fluid
examination - temperature, abdominal exmiantion, sterile speculum

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14
Q

investigations in preterm laabour

A

fFN - foetal fibronectin
MSU
HVS
USS
EFM

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15
Q

management of preterm labour

A

admit - offer analgesia, baselne investigatons, CTG
tocolysis - <34 weeks gestations nifedpine, IV salbutamol, GTN patch
corticosteroids - 2 doses 11.4mg IM metamethasone 24 hours apart
MgSO4 - foetal neuroprotection in women <30 weeks gestation
antibiotics - ntrapartum benzylpenicillin for GBS prophylaxis

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16
Q

breech ppresentation

A

c-secton reduced rissk of short tern maternal and foetal complications

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17
Q

risk factors for breech presentation

A

nullipparity, previous breech, uterine and plecntal abnormalitiess, poly/oligohydramnios, multiple pregnancies, grand multiprity
foetal - extended legs, short umbilical cord, early gestation, foetal abnormality, IUGR

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18
Q

PROM

A

premature rupture of membranes before labour begins
history - tme, type and colour of fluid, presence of signs indicative of infection (odour, abdominal pain, fever, dysuria, discharge)

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19
Q

exmination and investgations for PROM

A

examinations - vitals, abdominal examination, sterile speculum
investigations - bloods (FBC, UEC, CRP), MSU LVS, ECS, STI screen, amnicator, USS exmaination

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20
Q

PPROM management

A

admit and observe - CTG
oral erythromycin
remove cervical cerclage
discharge if >72 hours with no evidence of infection/preterm labour with approprate education

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21
Q

when to do IOL in PPROM

A

signs of chorioamnionitis/maternal sepsis or foetal compromise

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22
Q

PROM management

A

expectant managemnt is cepahlic presentation, clear liquor, no sign s of infection, no cervicaal suture, assess temperature 4 hourly/vaginal loss/foetal movements
at 18 hours post ROM commence antibiotics

23
Q

when to do OIL for PROM

A

24 hours following ROM or if criteria for expectant management not met

24
Q

early pregnancy loss

A

spontaneous interuption of established pregnancy <20 weeks gestation

25
Q

risk factors for early pregnancy loss

A

AMA, medical conditions (diabetes/coagulopathies/APS), uterine abnormalities, SLE, infections, drugs, smoking, cevicaal incompetance, prevous spontaneous miscariage

26
Q

presentation of early pregnancy loss

A

PV bleeding/spotting , suprapubic cramping, lower abdominal/back pain

27
Q

workup for early pregnancy loss

A

abdominal examination, speculum examination, B HCG, FBC, blood group and antbodies, USS

28
Q

types of miscarrage

A

threatened
inevitable
incomplete
complete
missed

29
Q

management options for early preganancy loss

A

expectant
medical - PV misopristol, approppriate analgesia
surgical - dilatation and curettage, haaemodynamicaally stable, failure of medical Mx

30
Q

hypertensve disorders of pregnancy

A

genstational HTN
Chronic HTN
pre eclampsia
pre eclampsia superimposed on chronic hypertension
eclampsia

31
Q

new onset hypertension post 20 weeks gestation management

A

BP, ECG, spit urine PCR, FBC, UEC, LFT, US to assess foetal growth, AFI, dopplers,
CTG if > 30 weeks

32
Q

if features of pre-eclampsia are present

A

MSU urinalysis (protein/urine microscopy)
investigations for DIC/haemolysis if presence of thrombocytopaenia or falling Hb

33
Q

management of acute severe hypertension

A

> 170/110
nifedipine 10mg PO
labetolol 20-80mg IV
hydralazine 5-10mg IV

34
Q

management of maintenance therapy of hypertension

A

BP > 140/90
methydopa or labetolol
hydralazine, nifedipine, prazosin

35
Q

definitive management of pre-eclampsia

A

delivery

36
Q

indiications of delivery for pre-eclampsia

A

gestational age >37 weeks
inability to control hypertension
deteriorating platelet count, liver function, renal function
placental abruption
peristent neurological symptoms/eclampsia
APO
severe FGR/non-reasurring foetal status

37
Q

management of eclampsia

A

resus - IV access, secure aairway, oxygen by mask
if seizure is extended give IV midazolam
MgSO4

38
Q

after acute manaagement of eclampsia

A

continue MgSO4 pot resus to prevent further seizures
contorl HTN to below 160/100
arrange c-section

39
Q

gestational diabetes define

A

any degree of lgucoe intolerance wtih onset, or first recogntion during pregnancy
includes pregnant women with previous diabetes not diagnosed until pregnancy

40
Q

screening for gestational diabetes

A

OGTT for all women at 24-28 weeks
ealrier OGTT if higher risk

41
Q

diagnosis of gestational diabetes

A

fasting > 5.1 mmol/L
1 hour BG > 10 mmol/L
2 hour BG > 8.5 mmol/L

42
Q

symptoms of gestational diabetes

A

frequent urination
blurrred vision
thrist
weakness

43
Q

monitoring and management

A

BGL monitoring
serial USS/umbilical artery doppler - 34 weeks (macrosomia/PH)
glycaemic control
birth planning

44
Q

foetal complications of gestational diabetes

A

macrosomia
hypoglycaemia
reppiratory disstrress
preterm birth
jaaundice
overweight/obesity
dysglycaemia
dyslipidaemia
hypertension

45
Q

antepartum haemorrhage causes

A
46
Q

placental abruption

A

partial orr complete seperaation of the placenta from the utuerus prior to delivery

47
Q

placenta praevia

A

placenta is inserted wholly or in part into the lower segment of the uterus
major if lying over internal cervical os
minor/partial if leading edge of placenta is in the lowerr uterine segment but not covering cervical os

48
Q

vasa praevia

A

fetal vessels coursing through membraanes over internal cervical is and below fetal presenting part, unprotected by placental tissue or umbilical cord

49
Q

Symptoms of placental abruption

A

lower abdominal pain
vaginal bleeding
rigid uterus, tenderness
fetal distress

50
Q

antepartum aemorrhage workup

A

history - blood loss, pain assessment, presence of contractions, triggers, presence of foetaal movements, risk assessment
examination - maternal vitals (haemodynamic stability), abdominal exmination, foetal observations, spec exam)

51
Q

investigations of antepartum haemorrhage

A

kleihhauer test
FBC, G+H, cross match
coagulation screen
UEC
LFT
USS

52
Q

management of antepartum haemorrhage

A

A-E assessment
rule out obvious causes of external bleedings
consider need for blood transfusion, delivery, corticosteroids
anti D if Rh -ive

53
Q

management of post partum haemorhage

A

assess A-E - vitals, 4Ts, extent of bleeding, labour
resus - IV access, investigations, O2, fluid replacement, tranexamic acid
arrest - fundal massage, bimanual compression, IDC insertion, uterotonics (oxytocin +/- ergometrine), oxytocin infusion, carboprost IM 15 minutely

54
Q
A

OBGYN 2023 (28 decks)

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