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Obstetrics 2 Flashcards

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1
Q

What blood tests do you want in pre-eclampsia?

A

FBC

  • low Hb
  • Low platelets
  • Haemolysis on film

U&Es
- increase urea and creatinine

LFTs
- raised AST, ALT

Coagulation studies
- prolonged

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2
Q

What would be the definitive treatment in pre-eclampsia to control blood pressure?

A

Delivery of fetus and placenta

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3
Q

What is are the complications of hyperthyroidism in pregnancy?

A

• Increased miscarriage
• Intrauterine growth restriction
• Increased preterm delivery
Increased perinatal delivery

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4
Q

What aspects in the history would you want to establish for pre-eclampsia?

A

Headaches

Visual changes

Swelling of the body

Abdominal pain
- especially RUQ

Bruising
- bruising due to platelet consumption

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5
Q

List the complications of pre-term prelabour rupture of the membranes:

A

Pre-term delivery

Chorioamnionitis

Cord prolapse

Oligohydramnios

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6
Q

Outline the definitions of PROM:

A

• Pre-labour rupture of membranes / PROM

- >37 weeks 
- rupture of membranes prior to onset of labour

P-PROM
- <37 weeks
- rupture of membrane prior to onset of labour
Accounts for 40% of preterm babies

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7
Q

What investigations should be done into suspected PROM:

A

Sterile speculum examination

  • fluid build up in the posterior fornix of vagina
  • patient should of been lying down for 30mins
  • look for fluid
  • do high vaginal swab whilst there
  • check cervical dilation

Nitrazine paper test
- paper turns blue

Ultrasound testing
- oligohydramnios

High vaginal swab

  • for infections that may have caused it
  • Group B strep

Ferning test

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8
Q

What is the management of P-PROM?

A

<34 weeks:

  • Monitor for chorioamnionitis
  • prophylactic erythromycin for 10 days
  • steroids
  • if no labour after 48 hours discharge. Advise no tampons, no swimming, no sex.
  • IV antibiotics at time of delivery

34- 36 weeks

  • induction of labour
  • IV antibiotics to cover for delivery
  • steroids

> 36 weeks

  • induction of labour
  • IV antibiotics to cover for delivery

**IV antibiotics are Benzylpenicillin

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9
Q

What are some complications of P-PROM?

A

Chorioamnionitis

Oligohydramnios

Cord prolapse

Placental abruption

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10
Q

How can fetal wellbeing be assessed?

A

Measurement of fetal:

  • head circumference
  • Abdominal circumference
  • Femur length

Liquor volume measurement

Doppler ultrasound of umbilical artery

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11
Q

During labour - what fetal signs would suggest distress on the CTG?

A

Abnormal Baseline HR (<100 or >180)

Reduced variability in the HR (<5 and >25) and no more than >50mins of no variability

Decelerations

  • late deceleration
  • placental insufficiency
  • asphyxia
  • variable deaccelerations
  • early is fine
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12
Q

What are the short and long term consequences of intrauterine growth restriction?

A

Short:

  • ARDS
  • Hypothermia
  • hypoglycaemia
  • Low birth weight

Long:

  • coronary artery disease
  • T2DM
  • Cerebral palsy
  • Reduced intellect
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13
Q

Other than HR and Heart sounds, how else can a fetal wellbeing be monitored?

A

Liquor volume

umbilical artery doppler

MCA doppler

Estimated fetal weight

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14
Q

In a woman of child baring age who presents with amenorrhoea and bleeding, what important aspects of the history do you want to establish?

A

If she has had a positive pregnancy test

Abdominal pain (ectopic pregnancy?)

  • type
  • onset

Change in bowel habit (appendicitis/ G.I related?)

Previous history of pregnancies

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15
Q

What are your most important investigations when considering an ectopic pregnancy?

A

Urinary pregnancy test

FBC
Group and Save
hCG levels

TVS

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16
Q

What is the general management for a miscarriage?

A

Conservative management

Medical management: 
Misoprostol 
- prostaglandin agonist 
\+
Analgesia

Surgical management:
- Vacuum curette

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17
Q

What are the risks associated with a premature baby?

A

Respiratory distress syndrome

Hypothermia

Hypoglycaemia

Sepsis

Jaundice

Unable to suckle - may require NG

Intraventricular bleeding

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18
Q

What are some of the risk factors for IUGR?

A 
Pre-eclampsia 
Smoking 
Alcohol 
Chromosomal abnormalities 
Poor maternal health 
Maternal infections - CMV, Rubella, Toxoplasmosis
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19
Q

What are some differentials for fluid leakage in a pregnant female?

A 
Rupture of membranes (PROM/ PPROM) 
Vaginal secretions 
Cervical discharge 
Semen 
Perineal sweat
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20
Q

What score is used for post-natal depression?

A

Edinburgh score

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21
Q

What are some of the symptoms of post-natal depression?

A

Clouded thinking/ difficulty making decisions

Lack of concentration

Poor memory

Avoidance

Not feeling like a proper mother

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22
Q

What are some of the signs of post-partum psychosis?

A 
Fear/ even terror 
Restlessness 
Insomnia
Purposeless activity  
Fear for baby
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23
Q

What is the management of cord prolapse?

A

Recognise Condition:

  • deaccelerations
  • cord felt

**call for senior help

  • Wrap cord in warm gauze and do not push back in or handle.
  • place mother on all 4’s or modified sim’s position
    and/ or
  • use to fingers to push babies head of cord
  • deliver baby as fast as possible.
  • if cervix is fully dilated proceed with use of tocolytic agents
  • if cervix is closed C-section
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24
Q

What is the management of localised (stage I and II) endometrial cancer?

A

Open abdominal radical hysterectomy + Bilateral salpingo - oophorectomy

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25
Out line the investigations wanted into amenorrhea:
Pregnancy test Gonadotrophin levels - FSH/ LH Prolactin Androgen levels Oestrogen Thyroid levels
26
How often should an HIV patient have their cervical screening done?
Every year
27
What is the quantitative definition of heavy menstrual bleeding?
>80mls
28
Which bacterial infection is most likely to produce malodorous smell with yellow/ green discharge? What other clinical finding may be seen with it?
Trichomonas vaginalis Strawberry cervix
29
What are some differentials for PID?
Appendicitis UTI Ectopic pregnancy
30
List some differentials for gynaecological causes of pelvic pain:
Mittelschmerz syndrome PID Ectopic pregnancy Endometriosis Ovarian Abscess Ovarian torsion
31
What are some complications of ovarian cysts?
Torsion Haemorrhage Rupture
32
What can be measured which is suggestive of early premature labour onset, and if positive what measures should be taken?
Fetal fibronectin - fFN - released from fetal sac. Suggests early labour will come on start: - IM steroids - Inform neonatal care
33
A woman who has epilepsy and gets pregnant - what should the management be?
5mg of folic acid starting immediately (even before confirmation of pregnancy) Detailed US at 18-22 weeks Aim for monotherapy of medication - if possible remove sodium valproate Vitamin K analogue + IM Vitamin K to new born
34
How should IV magnesium be continued for following an eclampsia seizure?
24 hours
35
What is the antibiotic of choice for group B strep?
Benzylpenicillin
36
What are some key tests done during antenatal visits and on what weeks:
8-12 weeks - booking visit - FBC - Rhesus status - Hep B, syphilis, rubella screen - HIV - Urine culture 10-14 weeks - multi pregnancy scan 11-14 week - nuchal scanning - down's syndrome 18-20 week - anomaly scan 28 week - FBC, Anti D given
37
What are the indications to admit a patient with hyperemesis gravidum into hospital?
- unable to keep fluids down despite antiemetics - ketonuria present - Weight loss >5% - Co - morbidities - unable to keep antibiotics down
38
What is the criteria of hyperemesis gravidum?
``` 5% pre-pregnancy weight loss dehydration electrolyte imbalance +/- Ketones ```
39
What are some complications of hyperemesis gravidum?
``` Wernicke's encephalopathy Mallory Weiss tear central pontine myelinolysis AKI VTE* ```
40
If a mother has a history of DVT what should be started on and for how long?
LMWH | Start immediately - 6 weeks postpartum
41
What is the non-invasive test that can be done to test for chromosomal abnormalities?
Non - invasive prenatal screening test - NIPT
42
What signs may be seen on the anomaly scan for neural tube defects?
Frog like appearance - anencephaly Banana shaped cerebellum Spinal cord abnormalities - spina bifida
43
Where anatomically are epidurals delivered? and what are spinals and epidurals used for?
Epidural: - delivered into the potential space filled with fat and blood vessels between the ligamentum flavum and dura (first level of meninges) Spinals into the intrathecal space (into CSF) causing complete nerve dysfunction - C-section. Epidurals - epidural space causing predominantly nociceptive reduction - Labour
44
What are the risks with epidurals?
Prolonged second stage Hypotension - patient should be laid flat and in the left lateral position
45
What are the two options for management during 3rd stage of labour and what are they?
Active - use of uterotonics - syntrometrine - cord traction - delayed cord clamping Physiological: - no use of uterotonics - cord only clamped when pulsations have stopped - maternal effort of placenta Inspection of the placenta to make sure it is complete.
46
Outline how the progression of labour is monitored:
Maternal: - HR - BP - contractions - Urinalysis - 4hrly vagina examination (dilation, effacement) Fetus: - 15 mins HR - position - engagement degree (>2/5ths) - Caput oedema (+,++,+++) - moulding of the head
47
What is precipitate labour?
>5 uterine contractions per 10mins usually results in rapid labour of less than 2-3 hours. *often implicated with oxytocin and prostaglandin use
48
What will a diabetic mother need to be put on if there is premature labour?
Variable rate insulin infusion (VRII). | - because steroids will be administered to promote fetal lung maturity which will effect the mothers glycaemic control.
49
What are some of the fetal complications of diabetes in pregnancy?
1st trimester congenital abnormalities Macrosomia Polyhdrymonias Polycaethemia
50
How is a diagnosis of small for gestational age made? and what are some main causes?
Ultrasound using circumference of the abdomen - if <10% then diagnostic - constitutionally small - intrauterine growth restriction - genetic abnormalities - multiple pregnancy
51
How can IUGR vs conditionally small be differentiated?
Risk factors towards IGUR Change in growth charts (IUGR may drop off whereas SGA usually remains on a constant low decile) Umbilical artery doppler
52
What is the biggest risk factor for cord prolapse?
Artificial rupture of membranes
53
What is the first line drug used for PPH, following Bimanual uterine compression and how is it delivered?
Syntocinon - IV (synthetic oxytocin) 10 units or Ergometrine - IV 2nd line: Carboprost - IM
54
If a synthetic prostaglandin has to be used in PPH, how is it supplied and what is it called?
Carboprost | - IM
55
If a pregnant woman has previously been seen to be group B strep positive, what action should be taken?
IV antibiotics at birth or Late pregnancy testing If a mother has previously had a child that suffered from Group B sepsis they should be offered prophylactic antibiotics Testing and antibiotics should be given 3-5 weeks prior to their due date.
56
What is the most appropriate next line investigation if there is late accelerations or variable accelerations noted on the CTG?
Fetal blood sample | - looking for acidosis - if present then Emergancy section should be done
57
What are the layers cut through during a C-section:
Skin Subcut tissue Camper's fascia Scarpers fascia Anterior Rectus sheath Rectus muscle **this is usually cut at the linae alba and pushed to the side Transverse fascia Parietal peritoneum Visceral peritoneum Uterus muscle
58
What is a Omphalocele?
Fetal abdominal wall defect
59
What are the symptoms and management of chorioamnionitis?
Potentially fatal to both mother and fetus as infection enters a usually sterile environment. - signs of infection - malodours amniotic fluid secretions Emergancy C - section IV antibiotics
60
What are the clinical features of a misciarage? and highlight investigations:
Vaginal bleeding Passing of products of conception Cramping abdominal pain Haemodynamic instability ``` Investigations: Bloods: - FBC - Group and save/ cross match - Beta - hCG ``` Imaging: - TVS
61
What are some common minor aliments of pregnancy?
Nausea + vomiting GORD Constipation Carpal tunnel syndrome Oedema Leg cramps
62
List the factors that influence fetal growth, highlighting some that may lead to small for gestational age:
Fetal: - genetic - chromosomal abnormalities - fetal anomalies (can be caused by infections) Maternal: - pre-pregnant disease - drugs/ smoking - pregnancy disease (pre-eclampsia) Placental: - trophoblast invasion (pre-eclampsia if inaffective) - vascular flow
63
How much can insulin doses need to increase by in pregnant women with diabetes? and outline management of diabetes in pregnancy:
50 -100% as pregnancy continues. - due to increased insulin resistance. Antenatal care: - Fetal anomaly scan - 20 weeks - Education - Monitoring of glucose + increased in insulin - 32- 34 weeks fetal monitoring ``` Medication: - Diet and exercise 2nd line: - Metaformin +/- - Insulin ``` Delivery: - 37-39 week delivery - variable rate insulin infusion during delivery Managed by: - diabetic team - anenatal team
64
Define gravity and parity:
Gravity - number of times the mother has been pregnancy regardless of outcome Parity - (X+Y) X - Any live or still birth >24 weeks Y - Any pregnancy <24 weeks
65
List some indications for CTG antenatal monitoring:
Reduced fetal movement Maternal disease - hypothyroidism - CRD - DM - insulin dependent Polyhydramnious/ oligo
66
what investigations should be conducted into reduced fetal movement and the varying weeks?
<26 weeks - History - Examination - Auscultating HR >26 weeks - History - Examination - CTG - USS * if near term plan for delivery
67
Highlight the potential complications of a prolonged pregnancy:
Prolonged pregnancy >42 weeks - Placenta insufficiency - Meconium aspiration - Cord complication - Neonatal hypoglycaemia - C-section - Pelvic floor trauma - Instrumental delivery
68
What are the types of invasive implantation?
Accreta: penetration into myometrium but not full thickness Increta: penetrate through the entire myometrium Percreta: penetrate through the entire uterus and into surrounding organs
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