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Fire Through Finals > Women's Health: Obstetrics > Flashcards

Women's Health: Obstetrics Flashcards

1
Q

What are the blood sugar targets in antenatal diabetics?

A

1 hour after meal: 7.8
2 hours after meal: 6.4
Fasting: 5.3

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2
Q

When is gestational diabetes screened?

A

Booking
24-28 weeks to confirm abnormal booking

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3
Q

What are the counselling points for miscarriage

A

ITS NOT THEIR FAULT
Help for common experience of low mood
Urine pregnancy test 3 weeks post event
Can have sex once menstruation resumes 4-8 weeks later

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4
Q

How do you investigate suspected pre-term prelabour rupture of membranes?

If confirmed how do you mansge?

A

Ix: Sterile speculum shows pooling in post. vaginal vault

+/- US if no fluid seen
Rx:
Admit to watch for chorioamnionitis
Oral erythromycin 10 days
Antenatal corticosteroids to reduce foetal distress
Consider delivery from 34 weeks

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5
Q

How do you manage a breech presentation

A

>=36 weeks: ECV if no contraindications
If above fails: C-section

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6
Q

What are the risk factors for placental abruption?

A

Increased age, blood pressure
Essentially any uterine complication
Narcotic use

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7
Q

Regarding hyperemesis gravidarum …

  1. What is it
  2. What warrants admission
  3. What is the antiemetic treatment
A
  1. Triad of 5% pre-pregnant weight loss, dehydration + electrolyte imbalance
  2. Continued N+V causing feeding difficulty or ketonuria +/- 5% weight loss / confirmed or suspected co-morbidity
  3. antihistamines –> ondasetron (1st tri cleft palate) OR metoclopramide (<5 days use to to EPSEs)
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8
Q

What is the dose and timescale for vitamin D supplementation in pregnancy

A

10mg / 4000IU for entire pregnancy

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9
Q

What would fulfil a diagnosis of recurrent miscarriage?
What 3 assessments should you undertake?

A

>=3 before 10 weeks gestation
>=1 normal loss after 10 weeks

APL antibodies –> aspirin + heparin
Genetic screening –> counselling
Pelvic US for uterine pathologies

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10
Q

what is given for a missed and incomplete miscarriage

A

Missed: 800ug misoprostol
Incomplete: 600ug misoprostol
Surgical if medical fails

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11
Q

How do you differentiate placenta praevia, vasa praevia and abruption in terms of
Bleeding
Pain
Uterine tenderness
Lie
Foetal heartbeat

A

Placenta praevia // Vasa praevia // placental abruption
Shock proportional // proportional // excessive shock
no pain // no pain // constant pain
non-tender // non-tender //tender
Abnormal // normal // normal
normal beat // bradycardia // distressed/absent

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12
Q

What are the risk factors for placenta praevia

A

Multiparity, previous C-sections

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13
Q

What are four causes of PPH

A

Tone (atony)
Thrombus
Trauma
Tissue (retained, up to 2 weeks)

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14
Q

On assessing pre-eclampsia, who needs
Emergency secondary care assessment
Emergency admission

A

Assessment: Anyone with symptoms
Admission: BP >=160/110mmHg

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15
Q

How do you manage a threatened miscarriage?

A

Give 400mg BD progesterone until 16 weeks
Return if bleeding has not stopped in 14 days

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16
Q

What is the treatment of placental praevia by grade

A

G1-2: Attempt SVD
G3-4: C-section
If bleeding: Stabilise and C-section

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17
Q

What is the gold standard investigation for ectopic pregnancy?

A

TVUS

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18
Q

What warrants gestational diabetes diagnosis in
Fasting glucose
2-hour OGTT

A

Fasting: >=5.6mmol/L
2hr: >=7.8mmol/L
‘5678’

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19
Q

Regarding folic acid supplementation…
What time scale + typical dose
Who gets 5mg

A

Take 400ug preconception-12 weeks
Take 5mg for same time if…
- FHx neural tube defects
- BMI >=30
- Epilepsy, T2DM, coeliac or thalassaemia trait

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20
Q

What is the first line treatment of miscarriage?
Who is eligible for further management?

A

Expectant management
Increased risk of haemorrhage/haemorrhage side effects psychological trauma/infection

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21
Q

How does fasting glucose direct management of gestational diabetes?

A

<7mmol
- Trial lifestyle
- Metformin if fails
- Insulin if metformin not tolerated
>=7mmol/L OR >=6 + macrosomnia/oligohydramnios
- Insulin

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22
Q

What are the risk factors for vasa praevia

A

IVF, low lying placenta

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23
Q

How do you manage vasa praevia?

A

Corticosteroids from 32 weeks
Elective C-section 34-36 weeks

24
Q

What haemoglobin levels require iron supplementation in pregnancy?

A

0-12wks: <110
12-term: <105
Post-partum: <100
Take for 3 months

25
Q

How can you differentiate ectopic pregnancy and miscarriage in terms of
Pain
Vaginal exam
US finding

A

Ectopic // miscarriage
Common // if inevitable/incomplete/complete
Cervical tenderness // Os may be open
‘sliding/bagel/tubal sign’ // Repeat gest sac >25mm/CRL >7 without heartbeat

26
Q

What is the trend in blood pressure during pregnancy

A

Falls until ~24 weeks
Then increases to pre-pregnancy levels

27
Q

How is gestational HTN distinguished from pre-existing hypertension?

A

new >140/90mmHg AFTER 20 weeks
OR
>30/15mmHg increase from booking

28
Q

How do you manage pre-existing diabetes in pregnancy in terms of
Lifestyle
Drugs
Appointments

A

Lose weight if BMI >27
Stop drugs apart from metformin + commence insulin
20 week heart anomaly scan

29
Q

How do you differentiate between expectant, medical and surgical management of ectopic pregnancy using
Pain
B-HCG
Foetal size and hearbeat

A

Expectant // Medical // Surgical
No // not significant // significant
<1000IU/L // >1500IU // >5000IU
<35mm + no beat // < 35mm + no beat // >35mm + beat

30
Q

During artificial membrane rupture, you can palpate the cord and foetal heartbeat becomes distressed; what is the management?

A

Initial
- Push presenting foetus back into uterus to reduce compression
- Avoid handling + keep cord warm if past introitus
- Go on all fours OR left lateral position
+ tocolytics
+ Retrofilling bladder 500-700ml
Definitive: Delivery via C-section

31
Q

How do you manage ectopic…
expectantly
Medically
Surgically

A

Watch B-HCG levels 48hrs
Methotrexate
Laparoscopic removal with Anti-D if Rh-ve

32
Q

What are the contraindications to ECV?

A

Abnormal CTG, uterine state
Multiple pregnancy
Ruptured membranes
APH in past 7 days

33
Q

How is gestational HTN distinguished from pre-eclampsia or eclampsia?

A

GHTN: new >140/90mmHg at >=20wks
Pre-eclampsia: above + proteinuria, headache, N+V
Eclampsia: Seizures

34
Q

What is the treatment for placental abruption?

A

<36 weeks
no distress: Observe + steroids. AVOID TOCOLYTICS
Distress: Immediate C-section

>36 weeks:
No distress: Delivery
Distress: C-section

35
Q

What are the grades of placenta praevia

A

G1: lower edge low lying
G2: lower edge touches os
G3: Lower edge partially covers os
G4: Lower edge majority covers os

36
Q

For pre-eclampsia treatment what is
First-line
Definitive

A

1st: Labetalol (nifedipidine if contraindicated)
Def: Delivery of baby

37
Q

How do you diagnose and treat post-partum haemorrhage

A

>=500ml blood loss

  1. ABCDE 2 x 14 gauge cannulae
  2. IV oxytocin (10 units) OR IV erometrine (500ug)
  3. IM carboprost
  4. IU balloon tamponade/B-lynch/iliac artery ligation
  5. Hysterectomy if life-saving

Oh/Effing Christ That’s Hell

Oxytocin/Ergometrine

Carboprost IM

Tamponade

Hysterectomy

38
Q

What is preferable for testing pregnancy: serum or urine HCG?

A

Urine

39
Q

What should you do if gentle traction does not deliver the foetus?

A
  1. Call for senior help + McRoberts manouvre
    + Episiotomy to help

RISK OF SHOULDER DYSTOCIA, THIS CAUSES TEARS IN MUM, BRACHIAL PLEXUS IN CHILD

40
Q

Outline the stages of labour?

A

Stage 1: Onset of true labour to full dilation of the cervix

Stage II: Full dilation to delivery of foetus

Stage III: Delivery of foetus to delivery of membranes

41
Q

What is the difference between latent and active phase in stage I of labour?

A

Latent: 0-3cm, normally takes 6 hours

Active phase: 3-10cm, normally 1cm/hour

42
Q

How can you differentiate between passive and active stage II of labour

When is this abnormal?

A

Reminder: Stage II is full dilation to delivery

Passive: no pushing

Active: pushing

Abnormal if >1 hour

43
Q

How is bishops score calculated based on…

Cervical position

Cervical consistency

Cervical effacement

Cervical dilatation

Fetal station

A
44
Q

What do the following Bishop’s scores mean?

4

12

A

under 5 so spontaneous labour unlikely

>=8 so labour is favourable

45
Q

If labour requires artificial induction, what are the options?

A

1st: Vaginal prostaglandins

Membrane sweep if 40 weeks (primi) 41 (multi)

46
Q

What is the main complication from inducing labour?

A

Uterine hyperstimulation: Prolonged and frequent contractions

Can interrupt foetal blood supply

Give tocolysis with terbutaline

47
Q

What are the risk factors for GBS infection?

A

4 Ps

Prematurity

Prolonged rupture of the membranes

Previous sibling infection

Pyrexia in mother due to chorioamnionitis

48
Q

Who gets GBS interventions and what are they?

A

If mother or baby previously had it, pyrexia >38 degrees in labour

Either…

intrapartum benpen prophylaxis

OR

Test at 35-37 weeks and give if positive

49
Q

Regarding foetal movements, what do if…

Reduced foetal movements after 24 weeks?

A

reduced: Doppler –> US

Absent: Referral to maternal fetal medicine

50
Q

What do the following CTG findings mean?

HR <100/min

HR >160/min

variability <5/min

deceleration during contraction that returns to normal

deceleration that lags during and >30s after contraction

Decelerations independent of contractions

A

Baseline bradycardia: foetal tone, maternal beta blocker use

Baseline tachycardia: Pyrexia, infection, hypoxia, prematurity

Loss of variability: prematurity, hypoxia

Early decels: innocuous, contraction compressions

Late decels: FOETAL DISTRESS

Variable decels: inidicate cord compression

51
Q

How do you investigate and treat suspected DVT/PE in pregnancy?

A

US doppler for DVT evidence

V/Q scanning for PE

Treat with SC heparin (IV if have to)

52
Q

Regarding Hep B in pregnancy…

Who gets screened

What treatment is given

How does this affect breastfeeding

A

All pregnants

Full hep B vaccinations + hep B IG for babies

It does not

53
Q

Regarding HIV in pregnancy…

Who gets screened

How does treatment work

How does breastfeeding change

A

All pregnants

Mum gets anti-retrovirals

Birth: vaginal < 50 copies/ml < C-section at 36 weeks

Baby: zidovudine < 50ml viral load < Triple ART; for 4-6 weeks

Dont breastfeed

54
Q

How long can lochia last for post partum?

A

6 weeks

55
Q

What does the following Down’s test consist of and what time is it given?

Combined testing

quadruple testing

A

11-13+6

Screening: Thickened nuchal, raised B-HCG, low PAPP-A

15-20 weeks

Triple: Raised B-HCG, low AFP, low oestriol

Quadruple: triple + low inhibin A

56
Q

How is rhesus -ve pregnancy dealt with…

preventatively

If event occurs at 2/3rd trimester

If complication causes event

If baby affected

A

Test at booking, anti-D at 28 and 34 weeks

Large anti-D dose + kleihauer test

Give anti-D <72 hours

Test FBCs, Blood group + direct coombs test

Transfusions + UV resistance

Fire Through Finals (32 decks)

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