Oral assessment prep Flashcards
(80 cards)
1
Q
What does HELLP stand for?
A
Haemolysed Elevated Liver enzymes Low Platelet syndrome.
2
Q
When do you have the CFTS?
A
9 - 13+6 weeks (EO-PE 11-13+6 weeks)
3
Q
When do you have the 2TMSS?
A
14-20+6 weeks
4
Q
What trisomy does 2TMSS not screen for?
A
13
5
Q
What does 2TMSS screen for that CFTS does not?
A
Neural tube defects.
6
Q
When is the NIPT test conducted?
A
From 10 weeks.
7
Q
When is a Morphology scan?
A
18-20 weeks
8
Q
What is essential HTN?
A
HTN that is present before 20 weeks.
9
Q
How is PIH diagnosed?
A
2 high BPs taken after 20 weeks. Resolves after pregnancy.
10
Q
Why does PIH occur?
A
The expanding blood volume results in a higher blood pressure.
11
Q
How is PE diagnosed?
A
HTN + proteinuria.
12
Q
What are the symptoms of PE?
A
Headache, oedema, blurred vision, upper gastric pain, low urine output.
13
Q
What tests do you do when someone presents with signs of PE?
A
BP (every 30mins), FBE, U&E, Coagulation factors, uric acid, LFTs, RFTs, urinalysis for urine PCR. Check fetal wellbeing.
14
Q
What is the treatment for PE?
A
Antihypertensives to manage BP. Beta blockers and CCB.
15
Q
What is used in labour to prevent seizures due to PE?
A
Magnesium Sulphate.
16
Q
What is the difference between PE and HELLP?
A
HELLP may not have proteinuria. HELLP has high LFTS, vomiting, haematuria
17
Q
What does DIC stand for?
A
Disseminated Intravascular Coagulation.
18
Q
What is DIC?
A
A secondary condition that causes damage to the inside of vessels. The body’s clotting factors are depleted resulting in a loss of ability to clot.
19
Q
What can cause DIC?
A
- PPH
- PE
- FDIU (sepsis)
- Placental abruption
- Amniotic air embolism
20
Q
What are some symptoms of DIC?
A
- Bleeding from mucous membranes
- Hypotensive
- Tachycardia
- Febrile
- Malaise, unwell feeling
21
Q
What tests are used to diagnose GDM?
A
OGTT and HbAIc+fasting blood sugar
22
Q
How much glucose is given during a OGTT?
A
75g
23
Q
What are the parameters to diagnose GDM for OGTT?
A
Fasting >5.0
1 hour >9.9
2 hours >8.5
24
Q
What is chicken pox?
A
Varicella Zoster Virus.
25
What information does a woman who is diagnosed with GDM need?
- frequent appointments (midwives, OB, endocrinologist)
- Information on diet and exercise
- GDM may cause a baby to be bigger which means more frequent scans.
26
How can GDM affect the PN period?
- AN expressed colostrum can be useful to keep baby's BGL level
- Skin to skin and lots of breastfeeding regulates baby's levels
- GDM baby's have higher rates of SCU admission.
- Both mum and baby will need 3 good BGLs before discharge.
27
How early can someone start expressing colostrum?
36 weeks.
28
How do you explain how GDM occurs?
Hormones that are produced during pregnancy act on the same receptors as insulin. This means that, even though insulin is being produced, because the receptors are being taken up by other hormones it is unable to have its effect.
This is why sugar intake should be reduced to not overwhelm what little insulin is able to be used and to reduce the amount of sugar going to baby.
29
What are the various methods of IOL?
Cervical ripening - Cooks balloon catheter, Prostin and Cervidil.
ARM
Syntocinon infusion
30
What is the required bishop score to perform an ARM?
7+
31
What does IOL increase the risk of?
- Cascade of intervention
- increased risk of instrumental birth
- increased risk of C/S
- Can interfere with breastfeeding and bonding
32
What is the difference in presentation between Placenta Praevia and Placental Abruption?
PP is not painful.
| PA is painful and stomach is tight and extremely painful.
33
How much bleeding is classified as a APH?
50ml
34
When someone presents with an APH what needs to be done?
```
Check vitals.
Check fetal wellbeing (gestational age, CTG, movements)
Get a history (when did it start, how much, scans)
Insert a canula.
Take bloods - FBE and group and hold.
Fluid replacement
Analgesia
NO VE
Escalate for medical review.
```
35
What are the Trisomies?
Tri 13 Patau syndrome
Tri 18 Edwards syndrome
Tri 21 Down's syndrome
36
What are the types of IUGR?
Symmetric (chronic)
| Asymmetric (acute)
37
What are some causes of IUGR?
Maternal - lifestyle factors, HTN, PE, DM, renal disease, anaemia, age
Placental - PA, PP, Chorioamnionitis, abnormal cord insertion,
Fetal - multiples, chromosomal abnormalities, metabolism issues, intrauterine infection
achondroplasia
38
What are the characteristics of Symmetric and Asymmetric IUGR?
Symmetric - proportional reduced size
| Asymmetric - large head and sunken belly, low subcutaneous fat, hungry and hyperactive baby
39
What are the risk factors for Placenta praevia?
multiparity, multiple pregnancy, age, scarred uterus, smoking, placental abnormality, IUGR
40
What bloods need to be taken for someone with placental abruption?
FBE, U&E, clotting studies, FDPs, Group and hold
| These check status and check for signs of DIC. Group and hold to be prepared to replace blood.
41
What can cause placental abruption?
Trauma, SROM in polyhydramnios, PROM, hx of abruption or C/S, smoking and drugs
42
What does TORCH stand for?
Toxoplasmosis, Other (Syphilis, Herpes, Varicella Zoster), Rubella, Cytomegalovirus, Hep B
43
What are the signs of primary Herpes?
Painful ulcers, local Lymphadenopathy, affected cervix and vulva, fever, malaise, headache, photophobia, dysuria
44
What is the incubation period for Herpes?
2-12 days
45
How can Herpes affect the newborn?
Fever, lethargy, seizures
46
What is the treatment for Herpes?
Acyclovir 200mg 5xday for 5-7 days.
| Acyclovir 400mg QID for 5-10days.
47
How can herpes affect pregnancy?
A primary infection during the first trimester can result in miscarriage.
A primary infection during a vaginal birth can pass the virus onto the baby.
48
What is Varicella Zoster Virus?
Chicken pox
49
How is Varicella Zoster tranmitted?
Droplet/airborne and direct contact.
50
What is the incubation period for chicken pox?
10-14 days
51
When is chicken pox infectious?
2 days before rash and until lesions have crusted over.
52
What is the treatment for someone who has been exposed to VZV but is seronegative?
ZIG immunoglobulin within 72hours.
| After 72hrs, prophylactic oral acyclovir.
53
What is the treatment for someone showing signs of VZV?
IV Acyclovir.
54
How can VZV affect baby?
Miscarriage, premature labour, IUGR and skin scarring, Congenital Varicella Syndrome (CVS).
55
What does Congenital Varicella Syndrome cause?
- Scarring lesions
- Limb hypoplasia or paresis
- Microcephaly
- ophthalmic lesions
56
What is the treatment for a baby post birth if the mother has VZV?
ZIG immunoglobulin within 24hours and a paed review if the infection is active.
57
What pregnancy care is needed for multiple pregnancy?
Extra screening, information and support, preparation for PP period and more rest.
58
What are the risk factors for dizygotic twins?
- 35-39yrs
- high parity
- tall stature
- family hx of twins
59
What are the risk of monozygotic twins?
- IUGR of 1 twin.
- fetus papyraceus
- twin to twin transfusion
60
What are multiples at higher risk for?
```
Chromosomal abnormalities
polyhydramnios
IUGR
Twin to twin transfusion
umbilical cord entanglement
C/S
Preterm labour
PIH
miscarriage
PE
APH
```
61
What does twin to twin transfusion mean for the donor and recipient baby?
Donor - anaemia (hypovolaemia), IUGR, Oliguria
| Recipient - Hypervolemia, polyuria, polycythaemia
62
What are some complications for multiples labour and birth?
- prolonged labour, locked twins, malpresentation, PROM (due to polyhydramnios), cord prolapse, delayed birth of second twin, premature expulsion of placenta.
63
What are the risk factors for GDM?
Hx of diabetes, ethnicity, high BMI, above 39years, family hx.
64
What are the maternal implications of GDM?
HTN, PE, C/S, risk of developing TIIDM
65
What are the fetal implication of GDM?
Macrosomia, preterm birth, hypoglycaemia, respiratory distress syndrome, jaundice, stillbirth, polyhydramnios risk of developing TIIDM
66
What are the contraindications for IOL?
- malpresentation
- placenta praevia
- Head not engaged
- vasa praevia
- Active genital herpes
- maternal refusal
- severe fetal compromise (placental abruption)
- cord presentation
- Any contraindication to NVB
67
What are the indications for IOL?
- Macrosomia
- HTN/PE
- PROM
- IUGR
- RFM
- Fetal abnormality
- multiples
- social/mental health reasons
- other medical conditions
68
What are the risks associated with ARM?
Infection, cord prolapse, begins the cascade of interventions.
69
What are the contraindications for ARM?
- hx. C/S, PP, high head, placental abruption, cord presentation, refusal
70
What are the contraindications for prostaglandin cervical softening?
- abnormal CTG
- Febrile
- spontaneous labour
- vaginal bleeding
71
When should prostaglandin cervical ripening be used with caution?
- multiparity
- hx of hyperstimulation
- hx C/S
- mobile presenting part
- asthma
- CVD
- ruptured membranes
72
What needs to be done before and after the insertion of prostaglandin cervical ripening?
CTG
73
What is hyperstimulation?
Tachysystole or hypertonus with fetal distress.
74
What is tachysystole?
5+ contractions in 10mins
75
What is hypertonus?
Prolonged contractions 2+mins, with inadequate resting tone.
76
What is Variability?
6-25bpm around baseline, 3-5 cycles per min
77
What is an acceleration?
Increase in 15bpm above baseline for 15+secs.
78
What are early decels?
15+bpm below baseline. Mimic contractions. Normal and usually occur with head compression at 4-8cm cervical dilation.
79
What is a prolonged decels?
more than 90 seconds and up to 5mins
80
What are late decels?
Occur 20 sec after contraction. Repetitive. Sign of hypoxia.
