1
Q
when is the first trimester
A
0-12 weeks
2
Q
when is the second trimester
A
13-27 weeks
3
Q
when is the third trimester
A
28-40 weeks
4
Q
What is the ideal baby presentation in utero
A
Presentation - head first
Lie - longitudinal
Placenta - upper segment
Attitude - Flexed vertex
5
Q
What is gravidity
A
Number of pregnancies regardless of outcome - including current
6
Q
what is parity
A
number of pregnancies beyond 24 weeks - not including current
7
Q
what gestation is surfactant produced
A
34/35 weeks - comptently mature to do so then - but can be as early as 24 weeks - just not large amounts
8
Q
If expected delivery before 35 weeks what can be done to help the lungs
A
give the mum corticosteroids
Give baby surfactant after birth
9
Q
what hormone produced from the placenta increases the risk of DM
A
hPL (human placental lactogen)
10
Q
what cardiovascular changes are seen for mum in pregnancy
A
decreased BP (increased CO but decreased TPR)
11
Q
how should pregnant women sleep
A
on their side ( avoid IVC obstruction)
12
Q
what haematological changes occur in pregnancy
A
anaemia
increased WCC
increased d-dimer
13
Q
what GI changes in pregnancy
A
dysmotility = constipation and GORD
14
Q
what happens to your immunity in pregnancy
A
decreases
15
Q
what endocrine changes occur in pregnancy
A
poorer glycaemic control
16
Q
what urology changes in pregnancy
A
increased renal excretion + increased UTI risk
17
Q
what visual changes can be seen in pregnancy
A
enlarged stomach
linea nigra
striae gravidarum
polymorphic eruptions of pregnancy
18
Q
when is the booking scan
A
8-12 weeks
19
Q
what is checked for at the booking scan
A
Hep B
HIV
Sickle cell
Thalassaemia
Syphillis
20
Q
what is in the combined test
A
USS - nuchal translucecny
beta-hCG
PAPP-A
21
Q
what is tested for in the combined test
A
Trisomy 21
Trisomy 18
Trisomy 13
22
Q
what combined test results might be seen in Trisomy 21
A
raised hCG
Low PAPP-A
>6 mm NT
23
Q
when is the anomaly scan done
A
18-20 +6 weeks
24
Q
what is checked on the anomaly scan
A
CHD
NTD
gastroschisis + omphalocele
Placenta praevia
+/- cleft lip, renal agenesis, anencephaly
25
when is an OGTT normally done
24-28 weeks
26
when is Rh prophyslaxis given if Rh- mum
28 weeks
27
When should ECV be offered if breech
37 weeks
can offer from 36 in nulliparous
28
what is the first step for inducing pregnancy
membrane sweep - sepearte chorion from decidua
29
when can chorionic villi sampling be done
11-14 weeks
30
when can amniocentesis be done
15 weeks
31
what are some risks of amniocentesis
miscarriage
Rhesus sensitisation
clubfoot
infections
32
when can non-invasive pre-natal testing be done
15-20 weeks
33
when is the quadruple test done and what is tested
15-20 weeks
beta-hCG
Alpha feto-protein
unconjugated estriol (E3)
inhibin A
All low except hCG and Inhibin-A in T.21
34
what are the two phases of stage 1 of labour
latent - cervical dilation <30% 0-4cm diameter - weak, irregular contractions 1-3 mins
active - dilation 30-100% 5-10cm diamete - regular powerful contractions 60s every 1-2 mins
35
what is stage 2 of labour
Baby (2hr primi, 1 hr multi)
36
what is stage 2 of labour dependent on
power(contractions)
passenger (cephalo-pelvic proportion)
passage (pelvic inlet dimension)
37
what movements does baby do to exit
engage
descent
flex
internal rotation
extension
external roation
restituition
expulsion
38
what is stage 3 of labour
placental delivery
check remnants and for presence of all 3 vessels (2 arteries, 1 vein)
39
what is used to assess cervical ripeness
Bishop score
40
What would <5 Bishop score mean
unripe - unlikely to spontaneoulsy labour - incude
41
what would a score of >8 bishop mean
ripe, likely to spontaneous induce +/- can offer amniotomy
42
what can be offered for a bishop score
membrane sweep
Vaginal prostaglandin (E2)
PO misoprostol
43
what can be offered for a Bishop score >6
amniotomy
IV oxytocin - synctocin
44
what indications are there for inducing labour
prolonged labour
PPROM
Maternal (GDM, Pre-Eclampsia, cholestasis)
45
what is given if a vaginal swab comes back positive for GBS
IV benpen during labour (or clindamycin)
46
what are some complications of inducing labout
uterine hyperstimulation (>6 contractions a minute)
Fetal ischaemia risk
Uterine rupture
47
what options are there for pain relief in labour
conservative - perianal/fundal massage, TENS
Med - entonox, morphine (max 2 bolus)
epidural anaesthesia
48
what are accelerations and decelerations on a CTG
FHR >15 BPM increase baseline for >15s
Decrease for decels
49
when might epidural be CI
low platelets
in DOAC
Aspirin
+/-APH, fetal distress
50
what are the side effects of epidural anaestehsia
urine retention
hypotension
hypoalgesia
headache
51
what is variability on a CTG
FHR fluctuations 6-25 BPM
52
53
what are some CI to vaginal birth after C/S
>/= 2 prev. C/S
One classical midline C/S
54
what are some complications of C/S
PPH
Endometritis
Rupture
55
what are some indications for C/S
Placenta praevia
vasa praevia
failure to progress
active genital herpes
cord prolpase
fetomaternal distress
56
what are the categories of C/S
Cat 1 - emergency <30 mins
Cat 2 - <75 mins
Cat 3
Cat 4 - elective
57
what are the three interpretations of CTG
reassuring
susipcious
abnormal
58
what does DR CBraVADO stand for
define risk
Contractions (3-5 / 10 mins)
baseline rate
variability
accelerations
decelerations
overall impression
59
what could it indicate if the variability is <5 for >40 mins
baby asleep
60
what are some side effects of ventouse delivery
suction cup cephalohaematoma
caput succendaenum (cross suture lines)
61
what is a risk with forcep delivery
CN 7 (facial) nerve palsy
62
how would you diagnose PPROM (preterm prelabour ROM)
<37 weeks
ROM not directly preceding labout
1) Speculum fluid pool in posterior fornix
2) Nitrazine (pH) test >7.1 + fern test +ve (or IGF-1)
+/- USS - oligohydramnios
63
what treatment would you give for PPROM
10d PO erythromycin - prevent chorioamnionitis - ascending infection (GBS/E.coli)
Antenatal steroids
64
what are some risks to baby with PPROM
HIE
still birth
resp distress syndrome
65
what is cord prolapse
cord presents before baby - +/- visible through introitus
66
what are 3 risk factors for cord prolapse
polyhydramnios
abnormal fetal lie
ARM
placenta praevia +vasa praevia
multiple pregnancy
breech LBW
67
what signs might be present with cord prolapse
visible cord
fetal brady
68
what is the treatment for cord prolapse
All 4's (knee-chest) to reduce pressure on cord
C-section - cat 1 for fetal distress, cat 2 for no fetal distress
Consider tocolytics - terbutaline to buy time (stop/reduce contraction)
May need to manually elevate head, but try not to touch cord
69
what is a risk of cord prolapse
fetal ischaemia
70
what do all breech babies need
USS hips
71
what are some risks of breech positioning
DDH
HIE
uterine rupture
72
what are some risks for perineal tears
macrosomia
failure to progress
73
what are the categories of perineal tears
1) mucosal only - no Mx
2) mucosa + muscle - suture by midwife on ward
3) a)<50% EAS b) >50% EAS c) IAS + EAS
4) anal sphincter + anal/rectal mucosa
3 and 4 require theatre suture by suitably trained clinician
74
what is a miscarriage
death of a fetus in utero
75
what are some causes of miscarriages
Fetal - chromosome, structural, genetic
maternal - smoking, IUGR, SLE, Placental insufficiency, DM
76
what is a threatened miscarriage
MC
painless PV bleed
fetal heartbeat
77
what is an inevitable miscarriage
painful PV bleed
fetal HB
Os OPEN
pass clots
78
what is a complete miscarriage
Painful bleeding +/- stopped
empty gestational sac
os CLOSED
79
what is an incomplete miscarriage
painful PV bleed
Retained POC
os OPEN
80
what is a missed miscarriage
No pain +/- bleed
empty gestation sac
os CLOSED
81
how is a miscarriage diagnosed
TVUSS
bHCG (may take up to 4-6 weeks for hCG to normalise after)
82
how to treat a threatened miscarriage
PV progesterone and repeat serum beta-hCG within 7 days
83
when can expectant management not be used for miscarriages
in inveitable or incomplete
any other complications
84
what is medical management for miscariages
mifepristone PO then misoprostol PV 48 hours later
85
what is surgical treatment of miscarriage
dilation and curettage
or suction aspiration
86
when can TOP be considered
before 24 weeks
87
88
how is TOP done before 13 weeks and then after
<13 weeks mifepristone then misoprostol
>13 weeks suction D+C
89
where is the most common location for an ectopic pregnancy
ampulla of fallopian tube
90
risk factors for ectopic pregnancy
PID
IVF
endometriosis
IUS/IUD
PMHx ectopic
91
symptoms of ectopic pregnancy
unilateral R/L iliac foss pain
PV bleed - light brown
ammenhoreoic
N+V
shock
KEHr sign - choulder tip
cervical motion tenderness
Dyschezia+dysuria
92
93
diagnosis of ectopic
serial beta-hCG elevation <63%
TVUSS - extrauterine pregnancy
94
what is the treatment for an ectopic pregnancy
expectant
medical
surgical
95
when can expectant ectopic management be used
All:
<35mm
<1000 bhCG
no fetal HB
no pain
96
when can medical management of ectopic be used and what
IM methotrexate
<35 mm
<1500 bHCG
no fetal HB
No pain
unruptured
97
when is surgical management used for an ectopic and what is done
1 of >35mm, >5000 HCG, fetal HB, pain
Salpingectomy - no fertility concern
salpingotomy - fertility concern - i.e. damage to other tube
98
what are some complications to ectopics
recurrence
fallopina tube rupture
early maternal death secondary to shock
infertility with surgery
99
symptoms of molar pregnancy
PV bleed
hyperemesis (very elevated hcg)
HTN
thyrotoxicosis
large for gestation age
100
diagnosis of molar pregnancy
TVUSS - snowstorm
No sign of baby
101
treatment of molar pregnancy
suction dilation and curetage
FU with HCG 48hrs later
102
complication of molar pregnancy
choriocarcinoma
(chemo + methotrexate)
103
risk factors for placenta praevia
multiple pregnancy
previous miscarriage
C-section
increased age
maternal smoking
IVF
PMHx
104
symptoms of placental praevia
painless PV bleeding
bright red blood
105
Diagnosis of placenta praveia
TVUSS anomaly scan (18-20+6 weeks) - scan again at 34 weeks and may migrate up
NO PV exam
106
treatment of placenta praevia
grade 1 (Lower seg <20mm internal os) consider VAG
C/S
107
complications of placenta praevia
preterm birth
maternal death secondary to shock
morbidly adhered placenta
108
what are the spectrums of morbidly adhered placentas
accreta - surface of myometrium
increta - deeply into myometrium
percreta - past myomeytium and perimetrium - reach other organs
109
risk factors for morbidly adhered placenta
placenta praevia
C/S
Uterine surgery (D+C e.g.)
multiparity
increased age
IVF
110
diagnosis of morbidly adhererd placenta
TVUSS anomaly scan - lkoss of normal hypoechoic retroplacental zone
111
treatment for morbidly adhered placenta
C/S!!!!!
+hysterectomy
112
complications of morbidly adhered placenta
heavy PPH
prematurity - plan delivery at 35-37 weeks
placental infection if not hysterectomy
113
what are the three main causes of APH
placenta praevia
placental abruption
vasa praevia
114
risk factors for placental abruption
smoking
cocaine use
HTN
trauma
multiparity
polyhydramnios
115
symptoms of placental abruption
painful dark red PV bleeding - pain not proportional to apparaent blood loss
wood uterus
116
diagnosis and treatment of placental abruption
USS r/o vasa praevia
stable obsevre, unstable cat 1 C/S
117
complications of placental abruption
prematurity
DIC
M-F death
118
risk factors for vasa praevia
IVF
placenta praevia multipregnancy
119
symptoms of vasa praevia
painless heavy PV bleed
simultaneous to ROM
120
siagnosis and management of vasa praevia
USS - show uterine arteries presenting
Cat 1 C/S
fetal death high
121
5 strong risk factors for pre-eclampsia
chronic HTN
CKD
aPL/SLE
T1/2DM
Phx pre-eclampsia
122
4 moderate risk factos for pre-eclampsia
1st pregnancy
40+
>35 BMI at booking
last preg >10years
FHx of pre-e
123
what should patients be started on at risk of pre-eclampsia and how is risk defined
1 high or 2 moderate risk factors
75mg aspirin from 12 weeks to birth
124
symptoms of pre-eclampsia
vision change
headache
abdo pain
RUQ pain
oliguira
oedema
125
treatment for pre-eclampsia
1) labetalol (or nifedipine)
2) stable - planned delivery 37 weeks, unstable do when needed
Stop prev. antihypertensives and start these if pre-existing
126
complications of pre-eclampsia
eclampsia - seizures - MgSO4 (fetal neuroprotection) _ delivery baby - moniotr for Mg toxicity with BP (+RR and reflex) (calcium gluconate if too high)
HELLP - haemolysis, elevated liver enzymes, low platelets. RUQ pain, N+V - deliver ASAP
DIC, IUGR, placental abruption
127
what antihypertensive should be given after birth
enalapril (nifedipine if black afro-carribean)
128
risk factors for GDM
PCOS
PRe-eclampsia
HTN
obesity
FHx
DM
129
how is GDM diagnosed
OGTT at 24-28 weeks
if PMHx of GDM test at booking and 24-28wks
130
how is GDM diagnosed
>5.6 FG
>7.8 2hrs post
131
how is GDM managed
FPG <7 - 1-2 wks diet and exercise, resistant => metformin +/- insulin
FPG >7 = insulin +/- metformin
132
complications of GDM
macrosomia => shoulder dystocia
polyhydramnios
traumatic birth
perinatal death
neonatal hypoglycaemia
50% GDM => T2DM
133
what is IUGR
growth slowing in utero due to pathology
134
what is small for gestation age
fetal growth <10th centile (+/- pathology)
135
causes of IUGR
fetal - chromosome, congential infection, congenital AB
Mum - HTN, placental insufficiency, aPL, smoking, poorly controlled DM
136
what are the two types of IUGR
symmetrical - rarer abdo and brain impact - fetal defects
asymmetrical - abdo and peripheral small, no brain defect - maternal placental insufficiency
137
complications of IUGR
prematurity
still birth
cognitive delays
138
complication of shoulder dystocia and treatment
ERB palsy!!!
Help
episiotomy
McRoberts - legs up
Pressure - suprapubic
enter - internal rotation
roll - all 4's
139
causes of large for gestational age
idiopathic
FHx
GDM
polyhydramnios
post-term
140
complications of LGA
perineal tears
shoulder dystocia
PPH
141
how is polyhydramnios diagnosed
USS AFI <>25, >2000ml
142
causes of polyhydramnios
GDM
atresia - oesophageal/duodenal
TORCH
143
complications of polyhydramnios
cord prolapse
placental abruption
PPH
UTIs
still birth
prematurity
144
how is oligohydramnios defined
AFI <5 or <300ml
145
causes of oligohydramnios
PPROM
Potter sequence
utero-placental insufficiency
146
complications of oligohydramnios
fetal deformity/IUGR
still birth
chorioamnionitis
prematurity
147
what causes vomiting in pregnancy
1/3 due to elevated bhCG from synchotrophobplast
resolve by 16=20 weeks
148
risk factors for hyperemesis gravidarum
multiple preg
molar preg
hyperthyroidism
DKA
149
symptoms of hyperemesis gravidarum
>5% pre preg wt loss
dehydration
electrolyte abnormal - ketonaemia
150
what would be seen on a VBG in hyperemesis gravidarum
low K
low Cl
metabolic alkalosis
151
treatment for hyperemesis gravidarum
1) cyclizine (antihistamine, promethazine)
2) ondansetron
Other: ginger, accupuncture, hypnosis
152
what is the risk with ondansetron and metoclopromaide in pregnancy
more than 5 days use
O => cleft palate
M => extrapyramidal side effects
153
treatment for hyperemesis gravidarum
iv fluids + K+
+/- thiamine
154
causes of bleeding in first trimester
miscarriage
extopic
molar
155
156
classes of minor and major APH
minor = <50ml
Major 50-1000ml
157
what is praimry and secondary postpartum haemorrhage
<24hrs
>24hrs - 6 weeks
!! of baby delivery not placenta !!
158
what is minor, mod and severe PPH
Minor - 500-1000
mod 1000-2000
severe >2L
C-section >1000ml
159
causes of PPH
tone (MC) - atony
trauma - tear, rupture
tissue - retained POC
thrombin - DIC
160
risk facors for PPH
polyhydramnios
prolonged labour
PHx C/S
APH
recent bleeding
twins
uterine fibroid
multiparity
161
treatment for atony PPH
Help, Group and match - blood ready
fundal massage + empty bladder
2x 14g large bore cannulae - fluid +/- blood
IV oxytocin - IM then infuse then IV ergometrine (uterotonics)
surgical - intrauterine balloon tamponade, blynch suture, hysterectomy
162
complication of PPH
Sheehans syndrome - hypopituitarism - ischaemic necrosis of ant. pituitary - secondary ammenorrhoea, agalactorrhoea
DIC
Shock => death
163
what type of hypersensitvity is rhesus disease
type 2 (IgG)
164
symptoms of rehsus disease
erythroblastosis fetalis - yellow amniotic fluid
hydrops fetalis - portal HTN, pulm HTN, congestive HF = widespread oedema
165
diagnosis of Rhesus disease
+Coombs test
increased reticuloblasts
amniocentesis - yellow
166
treatment for rhesus disease
prevent Anti rhesus D antigen at 28 weeks, 34 weeks to Rh- mums => intraparutm, miscarriage/TOP (IM)
167
obstetric cholestasis symtpoms
itchy - esp palms
worse at night
looks well, normally around 34 weeks
168
diagnosis of obs cholestasis
Increased total bile salts and acids
169
treatment of obs cholestasis
ursodeoxycholic acid
planned delivery 37 weeks
170
symptoms of acute fatty liver of pregnancy
jaundice in third trimester, RUQ pain, N+V
V.unwell, Pre-eclampsia
171
siagnosis and Tx of AFLP
Increased bilirubin +/- DIC
emergency delivery
172
risk factors for multiple pregnancy
FHx
IVf
idiopathic
173
diagnosis of multiple pregnancy
USS - Di-di - lambda sign
mono-di - T sign
174
complications of multiple pregnancy
twin-twin transfusion syndrome (donor twin small) => twin anaemia - polychythaemia + selective growth restric
low BWT
increased prenatal mortality
spontaenous preterm birth
pre-eclampsia
hyperemesis
175
treatment for twin-twin transfusion syndrome
fetoscopic laser ablation
delivery 34-36+6 weeks
176
treatment for hyperthyroid in pregnancy
proprylthiouracil + propranolol
177
treatment for hypothryoid pregnancy
levothyroixine
178
what should you do with chickenpox/VZV exposure in pregnancy
check VZVIg
<20 week VZVIg
>20 weeks within 24hrs rash = PO aciclovir
179
what can parvovirus B19 precipitate in pregnancy
aplastic crisis in baby
180
when should pregnant urine be tested
at booking and third trimester
181
what should be used to treat UTI in pregnancy
nitro if not in third trimester
cefalexin
avoid trimethoprim in first trimester
182
tx cut offs for maternal anaemis
1/3 - <110
2/3 <105
3/3 <100
183
when should VTE prophylaxis be given to pregnant women
when >4 RFx - Phx, breast Ca, HTN, >30 BMI, >35 y/o, smoking, IVF, C/S, multiparity, immobility
give LMWH until 6 week postpartum
184
contraception after birth
first 21 days safe
lactational amenorrhoea - 6 months fully breastfed and no periods
POP and implant anytime
COCP not before 6 weeks
IUD/IUS can be inserted within 48 hours postparum or >4 weeks postpartum
185
what cut off on edinburgh depression scale indicated Post partum depression
>/= 10
186
symptoms of PPD
decreased mood, energy, anhedonia >/=2 weeks
CBT, CMHT, sertraline
187
symptoms of puerperal psychosis
severe mood swings, audiotry hallucinations, intent/thought to harm baby
admit to mother baby unit
188
how is endometritis diagnosed
fever >38 within 72hrs pp w/ lower abdo pain + offensive discharge
189
common causes for endometritis
GBS
KEEPS (esp e.coli)
190
treatment for endometritis
IV clindamycin + gentamicin
191
symptoms of amniotic fluid embolus
sudden onset shock
SOB
(anaphylaxis from amniotic fluid in maternal circulation
192
treatment of amniotic fluid embolous
A-E
fluid
ITU monitor
blood transfuse + FFP
193
what key CVS changes occur in pregnancy
increase blood volume
increase plasma volume
increase cardiac output
decrease vascular resistance
decrease blood pressure
194
what key hormone changes occur in pregnancy
increase steroid hormones
increase T3/T4
increase prolactin
increase oest + prog
increase hCG
195
what key resp system changes occur in pregnancy
increase tidal volume
increase resp rate
196
what key renal changes occur in pregnancy
increase renal blood flow
increase GFR
increase water reabsorption
197
what key blood changes occur in pregnancy
increase FBC production
increase WBC
decrease platelets
decrease albumin
increase clotting factors
increase ALP - placenta
198
what key skin changes occur in pregnancy
linea nigra
melasma
spider naevi
striae gravidarum
Phase 3A medicine
flashcards
Decks in class (16)
# Cards
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100 most common drugs in GP218
-
Gynae FC from PPT215
-
Paediatric FC from ppt774
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COTE FC from ppt93
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Neurology FC from ppt8
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Key Obstetric notes198
-
key gynae notes140
-
Key breast medicine notes49
-
key paeds notes295
-
key paeds notes cont.361
-
GP random things21
-
key psych notes254
-
Key neuro notes312
-
key gerries notes135
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Key sexual health notes133
-
Key public health notes145
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