Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Obestetrics > Other topics in Obs > Flashcards

Other topics in Obs Flashcards

(58 cards)

Start Studying
1
Q

VBAC indication

A

Offered in singleton preg of cehalic pres at 37+wk who have had single lower segment c-section
w or w/o Hx vaginal birth
Consider if 2+ lower segment c-sec

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CIs to VBAC

A

Previous uterine rupture
classical c-sec scar
other CI e.g.major praevia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

VBAC vs ERCS

A 
VBAC has fewest Cx
VBAC success rate = 75%
Biggest risk of VBAC is emergency c-sec
ERCS a/w placenta praevia/accreta and adhesions
ERCS longer recovery
ERCS risks bowel/bladder inj.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Best indicator of future successful vaginal delivery

A

Hx of vaginal delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Risks of VBAC

A

Emergency c-sec
uterine rupture 1:200 (1:100 if syntocinon).
39% req. instrumental
Higher risk w/post-dates, twins, macrosomia
infant: transient morbidity (can happen in ERCS to), still birth v small risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Intrapartum Mx of VBAC

A

Electronic monitoring throughout
Induced/augmented labour increased risk
Induction with mechanical less likely to rupture scar and PGs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Planning ERCS

A

> 39w
proph. ABx
VTE proph.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Care of c-section scar

A

keep dry
remove sutures 5d
no heavy lifting 6w
no getting pregnant for 12-18m

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PACES counselling of VBAC

A

option of VBAC or ERCS
VBAC risks: rupture, emergency c-sec, (75% success rate of VBAC)
ERCS risks: future preg. bleed, infection, clot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Multiple Pregnancy AN Care

A

Obstetric led care

Extra Scan for GA +anomalies+chorionicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Epi of multiple pregnancy

A

1% natural conception

much higher with IVF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chorionicity in multiple pregnancy

A

Detect at time of detecting multiple pregnancy
No. placental masses
Lamba and T sign
Assign left and right baby
Refer to senior USS if can’t be assessed
Manage as monochorionic until proven otherwise
If >14w use: membrane thickness, lamba sign, no, masses, and disconcordant foetal sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

General care for multiple pregnancy

A

Lifestyle: same as normal AN, risk of anaemia (FBC 20-24w)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Uncomplicated monochorionic diamniotic care

A

9+ appointments w/HCP
2+ w/ specialist obstetrician
Scan + appointment when CRL 45-84mm and then at:
16,18,20,22,24,28,32,34

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Uncomplicated dichorionic

A

8+ appointments
2+ w/ specialist obstetrician
Scan+appointment CRL45-84 and then every 4wks from 20-36

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Uncomplicated monochorionic triamniotic or dichorionic triamniotic

A

11+ appointments
2+ w/specialist obstetrician
Scan+appointment every 2wk from 14-34wk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Uncomplicated trichorionic triamniotic

A

7+ scans
2 apps w/ sp. obs
Scan+app every 4wk from 20-34

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Summary of monitoring in mono/dichorionic

A

mono: 2wkly growth and doppler from 16w (refer foetal medcine)
di: 4wkly growth and doppler from 20w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Foetal complications of multiple pregnancy (T21)

A

Higher risk T21
Different screening (combined test, consider second trim. screen)
Caclulate risk per bayb in di risk per preg. in mono
Higher false positive rate in multiple preg
Invasive testing more likely
Cx of invasive tests more likely
Possibility of selective foetal reduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Foetal Cx of multiple pregnancy (NOT T21)

A

Structural ab: as normal AN
TTTS: do not monitor in T1, start from wk16 on 2wkly basis, go to weekly if membrane folding or other signs
IUGR: do NOT use SFH, estimate weight discordance using 2+ biometric measures from 20w, difference >20% can be sign of IUGR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Maternal Cx of multiple pregnancy

A 
Hypertension:
- BP and proteinuria every visit
Aspirin 75mg from 12w if any of:
- First preg
- 40+yo
- Pregnancy interval >10y
- BMI >35 at first visit
- FHx pre-eclampsia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Higher Risk of Pre-term birth in multiple pregnancy

A 
multiple preg have higher risk spontaneous birth
do NOT use to determine risk:
foetal fibronectin
home uterine activity
cervical length
If inevitable give corticosteroids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Preventing preterm birth in multiple pregnancy

A 
Do NOT use:
Bed rest at home/hosp
IM or vaginal progesterone
Cerclage
Oral tocolytics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Timing of birth in multiple pregnancy

Study These Flashcards
A

60% of twin preg. will spontaneously birth before 37w
Continuing uncomp. preg >38w a/w risk (36 for triplets)
Offer continuous CTG
?elective birth
If not elective birth offer weekly apps w/sp. obs

25
Elective birth in multiple pregnancy indications
IF: uncomplicated monochorionic twin (from 36w after CS) Uncomplicated dichorionic twin (from 37w) Uncomplicated triplet (from 35w after CS)
26
Vaginal birth possible in multiple pregnancy
first twin cephalic 5% risk of second twin needing C-sex Aim for interval <30mins between twins
27
PACES Counselling of multiple pregnancy
RF: AMA, Hx, Assisted repro Risks: - mat: BP, hyperemesis, GDM - Feo: monochorionicity, TTTS, defects, prematurity Scans 2 or 4wkly Del: 60% before 37w, vaginal if first twin ceph
28
Dx of Monochorionic twin pregnancy
All women w/twins offered USS 11-13+6 (CRL 45-84) Determine chorionicity Keep photographic record
29
Mono vs dichorionic risks
Higher rate of loss in mono (T2 particularly) | ?higher risk neurodev. morbidity
30
Screening in monochorionic pregnancy
``` Triple test if 11-13+6 Quadruple after this Detailed USS at 18-20+6 USS every 2 weeks from wk16-del. - measure liqour (DVP) and UAPI Calculate EFW using biometrics ```
31
TTTS in monochorionic pregnancy
Advise mother to report sudden increase in abdo size or SOB | EFW differences may be TTTS
32
TAPS in monochorionic pregnancy
Screened following fetoscopic laser ablation for TTTS usinf serial MCA peak systolic velocity
33
Screening for selective growth restriction in monochorionic pregnancy
at each scan from 20w calc. EFW (2+ biometric) >20% discordance = perinatal risk UAD for progonsis and morbidity
34
Mx of TTTS in monochorionic preg
Refer FMU <26w - fetoscopic laser ablation of vascular anastamoses >26w delivery may be considered Weekly USS Del. 34-37w Expectant Mx ? amnioreduction, septostomy, selective feticide
35
sGR Mx in monochorionic preg
Refer FMU Selective reduction and option if done early Surveillance scans every 2wks Abnormal doppler waveforms indicator for delivery in some cases
36
Delivery in monochorionic pregnancy
Offer elective del from 36w after CS | MCMA twins high risk of death so c-sec between 32-34w
37
Breech Delivery frequency
3-5% at 37w
38
Breech at term women advice
Offer ECV | If ECV declined offer planned vaginal or C-sec (generally c-sec)
39
ECV?
External cephalic version 50-60% success rate risks: distress needing emergency c-sec or labour CI: c-section to be performed, APH last 7d, abnormal CTG, uterine anomaly, ROM, multiple preg
40
C-section for breech at term
benefits: small reduction in perinatal mortality, planned vaginal higher risk of low apgar and early morbidity but late outcomes same Risks: small risk of Cx (less than emergency c-sec which happens in 40% of breech PVD), increases risk in future pregnancy
41
Antenatal assessment of Breech delivery
Suggestive of high risk vaginal birth: - hyperextended neck, high/low EFW, footling presentation, AN compromise Women near or in active 2nd stage should not be routinely offered c-section Induction not generally recommended (augmentation using oxytocin possible) Continuous foetal monitoring
42
Breech Delivery itself:
``` V. dangerous if footling Hands off approach (ideally baby will deliver itself) Manoeuvres Forceps Make sure theatre ready (bloods e,g G+S X-Match) ```
43
Summary of breech delivery
``` <36w: many will turn spontaneously 36w ECV (37 for multip) ```
44
PACES Counselling of Breench Delivery
RF: uterine malf., fibroids, praevia, poly/oligohydramnios Dx: feet down Offer ECV Vaginal vs C-section
45
Unstable lie
RF: Multip, praevia, uterine anomalies, polyhydramnios, multiple pregnacny Risks: cord presentation or prolapse, uterine rupture USS to conform 80% revert to longitudinal before labour If mechanical eg praevia LSCS Admit >37w consider ECV ARM LSCS
46
Mastitis in pregnancy
Ix: clinical, consider USS, aspiration, cytology | Encourage continue bf
47
Treating mastitis in pregnancy
If systemically unwell, nipple fissure, if Sx not improved after 12-24h Fluclox 10-14 (clindamycin if allergic) Continue bf in treatment
48
Breast abscess Mx
Surgery | IV/PO ABx (fluclox, cefalexin, doxy, clindamycin) non b-lactam if MRSA
49
Nipple thrush in pregnancy Mx
Clinical fx: pain in both nipples after feed, pain up to 1hr, creamy spots in baby mouth Mx: miconazole topical oral nystatin for bby
50
High dose folic acid in pregnancy
``` 5mg Previous child w NTD DM AED Obesity HIV taking co-trimox sickle cell disease ```
51
Perineal tear
1st deg: superficial damage no muscle 2nd deg: perineal muscle not anal sphincter 3rd deg: involving anal sphincter complex (E/IAS) 3a: <50% EAS, b: >50% EAS, c:IAS tear 4th deg: sphincter complex and rectal mucosa
52
Edinburgh post-natal depression scale
10-items max score 30 how mother has felt in the last week >13 suggests depressive illness Mx: sertraline and paroxetine for bf
53
Bf CI drugs
``` ABx: cipro, tetracycline, chloramphenicol, sulphonamides Psych: Li, benzos Aspirin Carbimazole MTX Sulphonylureas Cytotoxics Amiodarione ```
54
Req. for Instrumental delivery
Fully dilated cervix OA (OP possible w/some forceps +ventouse) Ruptured membranes Cephalic presenation Engaged presenting part Pain relief Sphincter (bladder empty req. cath usually)
55
Preparing for an elective C-section
``` around 39w Pre-ass w/midwife: blood: G+S MRSA swabs Ranitidine night before and morning of operation Fast 8 hours before c-section ```
56
AN corticosteroids how are they given?
2x12mg IM betamethasone 24hrs apart benefit window from 24hr after first dose to 7d
57
Pregnancy and flying
Most airlines say no after 37w (32 for twins) Discuss w GP Reduce VTE risk by hydration and activity
58
Depression in pregnancy
Discuss concerns Mild to mod: refer for facilitated self help Mild w/Hx of severe: consider Mx (SSRI, SNRI, TCA) Mod-Sev: CBT, consider TCA, SSRI, SNRI, If therapy req. refer urgently If a woman decides to stop taking her pre-existing meds ask why and offer alternatives Post natal: treat as normal pop. offer sertaline/paroxtine

Obestetrics (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions