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Passmedicine Knowledge Flashcards

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1
Q

Presentation of placental abruption

A

Severe abdominal pain in third trimester
Cold mother
Bleeding in 80% cases (not always)

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2
Q

Tx of PPROM?

A

10 days erythromycin

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3
Q

Contraindications of VBAC?

A

Classical Caesarean scar

other contraindications = praevia

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4
Q

MCC of PPH?

A

Atony

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5
Q

Other causes of PPH?

A

Tone
Tissue
Trauma
Thrombin

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6
Q

Risk factors for primary PPH?

A 
Previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency C-section
placenta praevia, placenta accreta
macrosomia
ritodrine
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7
Q

Mx of Primary pph?

A

ABC
IV syntocinon (oxytocin) 10 units or IV ergometrine 500 micrograms
IM carboprost
surgical:
b-lynch suture, ligation of uterine arteries or internal iliac arteries

hysterectomy

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8
Q

Tx for babies born to mother with acute hepatitis B during pregnancy

A

complete course of vaccination and hepatitis B immunoglobulin

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9
Q

Causes of bleeding in 1st trimester

A

spontaneous abortion
ectopic pregnancy
hydatidiform mole

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10
Q

Causes of bleeding in 2nd trimester

A

Spontaneous abortion
hydatidiform mole
placental abruption

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11
Q

Causes of bleeding in 3rd trimester

A

Bloody show
Placental abruption
Placenta praevia
Vasa praevia

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12
Q

Presentation of ectopic pregnancy

A

6-8 weeks amenorrhoea
lower abdominal pain
may be shoulder tip pain and cervical excitation

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13
Q

Presentation of hydatidiform mole

A

Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy: hyperemesis

LFD uterus
serum hcg may be very high

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14
Q

presentation of placental abruption?

A

constant lower abdominal pain
women may be more shocked than is expected by visible blood loss

tender, tense uterus with normal lie and presentation

fetal heart distressed

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15
Q

presentation of placental praevia?

A

vaginal bleeding, no pain

non tender uterus but presentation may be abnormal

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16
Q

presentation of vasa praevia?

A

rupture of membranes followed immediately by vaginal bleeding

fetal bradycardia is classically seen

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17
Q

Cord prolapse position

A

all fours

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18
Q

risk factors for cord prolapse

A 
prematurity
multiparity
polyhydramnios
twin pregnancy
cephalopelvic distortion
abnormal presentations 
placenta praevia
long umbilical cord
high fetal station
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19
Q

Classification of tears:

A

1st: superficial damage with no muscle involvement t
2nd: injury to perineal muscle but not involving the anal sphincter
3rd: injury to perineum, involving anal sphincter complex
3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn

4th: injury to perineum involving anal sphincter complex

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20
Q

McRobert’s manœuvre position

A

This manoeuvre entails flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen

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21
Q

Tx of varicella exposure in pregnancy?

A

Varicella zoster immunoglobulin

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22
Q

Presentation of chorioamnionitis?

A

uterine tenderness and foul-smelling discharge

Preterm PPROMM + pyrexia, maternal/foetal tachycardia

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23
Q

Placenta accreta

A

attachment of the placenta to the myometrium due to a defective decidua basalts

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24
Q

Risk factors for placenta accreta?

A

previous Caesarean section

placenta praevia

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25
Elements of the combined test
Nuchal translucency | beta-hCG and PAPPA + CRL
26
Combined test results for Downs syndrome
low PAPPA and high beta hCG
27
quadruple test components
AFP unconjugated oestriol beta-hCG inhibin A
28
Placenta praevia associated factors?
Multiparity | multiple pregnancy
29
Mx of shoulder dystocia in labour
Help Do not use fundal pressure McRobert's manœuvre = first line intervention
30
Tx of suspected PE in pregnancy?
ECG and chest X ray | compression duplex USS
31
Antenatal care: | 8-12 weeks
booking visit: general info BP, using dipstick, check BMI ``` Booking bloods/urine: FBC, blood group, rhesus, red cell alloantibodies, haemoglobinopathies hepatitis, syphilis, rubella HIV urine culture - asymptomatic bacteriuria ```
32
antenatal care 10-13+6 weeks
early scan to confirm dates, exclude multiple pregnancy
33
antenatal care 11-13+6 weeks
Down's syndrome screening including nuchal scan
34
antenatal care: 16 weeks
information on anomaly and blood results. If Hb <11g/dl consider iron Routine care: BP and urine dipstick
35
antenatal care: 18-20+6 weeks
anomaly scan
36
antenatal care 28 weeks:
Urine dip, BP, SFH Second screen for anaemia and atypical red blood cells anti-D prophylaxis if needed
37
antenatal care 34 weeks
routine care second dose of anti-D
38
antenatal care 36 weeks
routine care check presentation - offer external cephalic version if indicated information on breast feeding, vitamin K, baby blues
39
40-41
routine care labour plans, prolonged pregnancy plans
40
What does low/high AFP indicate?
Increased: NTD, fetal abdominal wall defects, multiple pregnancy Decreased: Down's syndrome, trisomy 18, maternal diabetes mellitus
41
Abnormal features on CTG
Single prolonged deceleration lasting 3 minutes or more Variable decelerations occurring with over 50% of contractions In labour: variability <5bpm
42
Intrahepatic obstetric cholestasis presentation
pruritus no rash raised bilirubin High ALP and GGT, lesser rise in ALT
43
Features of acute fatty liver of pregnancy
``` abdominal pain nausea and vomiting headache jaundice hypoglycaemia ```
44
Pre-eclampsia high risk factors
``` hypertensive disease in a previous pregnancy chronic kidney disease autoimmune disease t1/t2DM chronic hypertension ```
45
Pre-eclampsia moderate risk factors
``` first pregnancy 40 years or older pregnancy interval of more than 10 years 35+ BMI FH of pre-eclampsia multiple pregnancy ```
46
Causes of oligohydramnios
``` premature rupture of membranes fetal renal problems e.g. renal agenesis intrauterine growth restriction post-term gestation pre-eclampsia ```
47
management of cord prolapse
1. tocolytics to reduce cord compression 2. presenting part of foetus may be pushed back into uterus 3. patient advised to go on all fours 4. emergency c section 5. If delivering - hand into vagina to elevate presenting part
48
GBS management in labour
IV Abx for mum
49
HELLP syndrome presentation
haemolysis, elevated liver enzymes, low platelets
50
Drugs contraindicated in breastfeeding
abx: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides Psychiatric: lithium, BDZ ``` Aspirin carbimazole methotrexate sulfonylureas cytotoxic drugs amiodarone ```
51
What is the name of the depression scale for Post natal depression?
Edinburgh scale
52
Placenta praevia investigations
transvaginal USS
53
Drug to reverse respiratory depression caused by magnesium sulphate?
Calcium gluconate
54
Obstetric cholestasis treatment?
Induction of labour at 37 weeks Ursodeoxycholic acid Vitamin K supplementation
55
Secondary prevention of women with pre-eclampsia?
Low dose aspirin to reduce risk of babies being born SGA
56
When can gestational hypertension be recognised?
after 20 weeks
57
Which markers indicate downs syndrome?
``` low AFP low oestriol High HCG Low PAPPA thickened nuchal translucency ```
58
What is a molar pregnancy?
significantly high levels of beta hCG for gestational age - marker of gestational trophoblastic disease. beta hCG has a similar structure to LH, FSH and TSH, so can produce higher levels of thyroxine (symptoms of thyrotoxicosis)
59
What is the treatment for women with high VTE risk?
4 risk factors: LMWH until 6 weeks postpartum (DOAC and warfarin avoided) 3 risk factors: heparin from 28 weeks until 6 weeks postnatal
60
What are the causes of puerperal pyrexia?
Endometritis - needs treating with IV clindamycin and gentamicin) UTI wound infections (perineal tears and Caesarean section) mastitis venous thromboembolism
61
What are the features of HELLP syndrome?
haemolysis elevated liver enzymes low platelets
62
Which layers of the abdominal wall are cut through in C-section?
``` Skin Superficial fascia Deep fascia Anterior rectus sheath Rectus abdominis muscle Transversalis fascia exztraperitoneal connective tissue Peritoneum Uterus ```
63
What are the indications of C-section?
``` absolute cephalopelvic disproportion placenta praevia grades 3/4 pre-eclampsia post-maturity IUGR fetal distress in labour/prolapsed cord failure of labour to progress malpresentations: brow placental abruption: only if fetal distress vaginal infection e.g. active herpes cervical cancer (disseminates cancer cells) ```
64
What is the wood screw manoeuvre?
Action of putting a hand in the vagina and rotating the foetus 180 degrees
65
What is McRobert's position?
hyperflex the mother's legs onto her abdomen and apply suprapubic pressure
66
What is the Rubin manoeuvre?
press on the posterior shoulder to allow the anterior shoulder extra room
67
What is the management of puerperal mastitis?
1. Continue breast feeding - improves milk removal 2. Antibiotics if lady has infected nipple fissure, symptoms do not improve / are worsening after 12-24 hours despite effective milk removal or bacterial culture positive. flucloxacillin 500 mg qds for 14 days
68
What test is used to monitor DVT treatment with LMWH in obese women?
anti Xa activity
69
Steps of PPH treatment
1. bimanual uterine compression 2. IV oxytocin/ergometrin 3. IM carboprost 4. Intramyometrial carboprost 5. rectal misoprostol 6. surgical intervention
70
What is vasa praevia? What is the presentation?
Vasa praevia describes a complication in which fetal blood vessels cross or run near the internal orifice of the uterus. The vessels can be easily compromised when supporting membranes rupture, leading to frank bleeding. The classic triad of vasa praevia is rupture of membranes followed by painless vaginal bleeding and fetal bradycardia.
71
What is the presentation of placenta accreta?
Delayed third stage of labour underlying RF: previous section + previous PID Definitive treatment = hysterectomy
72
What is placenta accreta?
Attachment of the placenta to the myometrium due to a defective decidua basalis
73
Under what circumstances can you perform ECV in a transverse lie?
At 36 weeks if the amniotic membrane has not ruptured
74
What is Sheehan's syndrome?
Complication of PPH in which the pituitary gland undergoes necrosis which can manifest as hypopituitarism Lack of postpartum milk production and amenorrhoea following delivery
75
What is the indication of positive fetal fibronectin?
Having a high level has been shown to be related with early labour Give 2 doses steroids and monitor BMs
76
What is the most common cause of umbilical cord prolapse?
ARM

CP2 OBS (20 decks)

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