1
Q
pre-eclampsia triad
A
new onset HNT
proteinuria
oedema
2
Q
Current formal definition of pre-eclampsia
A
new onset bp >140/90 after 20 weeks of pregnancy and
- proteinuria or
- other organ involvement
3
Q
5 complications of pre-eclampsia
A
eclampsia
fetal complications
liver involvement
haemorrhage
cardiac failure
4
Q
features of eclampsia
A
altered mental status, blindness, stroke, clonus, severe headaches, persistent visual scotoma
5
Q
2 fetal complications pre-eclampsia
A
IUGR
prematurity
6
Q
haemorrhage pre eclampsia
A
placental abruption
intra-abdominal
intra-cerebral
7
Q
What on bloods may be raised with liver involvement in pre-eclampsia
A
transaminases
8
Q
List some features of severe pre-eclampsia
A
> 160/110
proteinuria ++/+++
headache
visual disturbance
papilloedema
RUQ/epigastric pain
hyperreflexia
HELLP
9
Q
HELPP syndrome
A
Haemolysis
Elevated LFTs
Low platelets
10
Q
pre-eclampsia moderate risk factors
A
first pregnancy
over 40
pregnancy interval more than 10 years
BMI>35
FH
mutilple pregnancy
11
Q
pre-eclampsia high risk factors
A
HTN in previous pregnancy
CKD
Autoimmune disease
Diabetes
HTN
12
Q
Women with >1 high risk factor or >2 moderate risk factor pre-eclampsia should take what?
A
aspirin
13
Q
Aspirin for HTN/pre-eclampsia prevention
A
75-150mg daily
12 weeks to birth
14
Q
management pre-eclampsia
A
admit and observe
oral labetolol
deliver baby
15
Q
first line med for pre-eclampsia
A
oral labetolol
16
Q
med for pre-eclampsia if asthmatic
A
nifedipine
hydralazine
17
Q
What causes chickenpox
A
VZV
18
Q
chickenpox in pregnancy risk to mother
A
pneumonitis
19
Q
Features of fetal varicella syndrome
A
skin scarring
microphthalmia
limb hypoplasia
microcephaly
LD
20
Q
Skin scarring, eye defects, limb hypoplasia and microcephaly signs of…
A
fetal varicella syndrome
21
Q
What to do if any doubt about mother previously having chickenpox
A
urgent maternal blood - check varicella antibodies
22
Q
First line PEP VZV in pregnancy
A
oral aciclovir
23
Q
When to give antivirals - chickenpox exposure in pregnancy
A
day 7-14 after exposure
not immediately
24
Q
chickenpox in pregnancy - when to treat
A
> 20 weeks and presents within 24 hours onset of rash
25
chicken pox in pregnancy <20 weeks
consider aciclovir with caution
26
What usually happens to blood pressure in first trimester?
falls
27
Women who are at high risk of developing pre-eclampsia should take
aspirin 75mg od from 12 weeks until the birth of the baby.
28
Hypertension in pregnancy in usually defined as:
systolic > 140 mmHg or diastolic > 90 mmHg
or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic
29
What to do if woman takes ACEI or ARB prior to pregnancy
stop immediately and change to labetolol or nifedipine
30
when does pre-existing HTN occur in pregnancy?
before 20 weeks
31
Complications of umbilical cord prolapse
compression of cord - fetal hypoxia and death
32
Risk factors cord prolapse
prematurity
multiparity
polyhydramnios
twins
CVD
Breech/transverse
33
Around 50% of cord prolapses occur at...
ARM
34
Managing cord prolapse
emergency
push presenting part of fetus back into uterus
Go on all fours
c-section
tocolytics/retrofilling bladder
35
When are women screened for anaemia?
booking visit:8-10 weeks
28 weeks
36
cut off for oral iron: 1st trimester
<110
37
cut off for oral iron: 2nd or 3rd trimester
105
38
cut off for oral iron: postpartum
100
39
management anaemia in pregnancy
oral ferrous sulfate or ferrous fumarate
40
first line treatment eclampsia
IV magnesium sulfate
41
What should be monitored in eclampsia when giving IV magnesium sulfate
O2 sats, RR, reflexes, urine output
42
first line treatment for magnesium sulfate induced resp depression
calcium gluconate
43
What is placenta praevia
placenta lying wholly or partly in lower uterine segment
44
What to do if woman with placenta praevia goes into labour
c-section due to risk PPH
45
5 things that would warrant continuous CTG monitoring in labour
suspected sepsis/chorioamnionitis
severe HTN
oxytocin
significant meconium
fresh PV bleeding
46
What on CTG indicates fetal distress
late deceleration
47
What on CTG may indicate cord compression
variable decelerations
48
When should women at risk of NTDs take folic acid and what dose?
before conception to 12 weeks
5mg
49
When do most women take folic acid and what dose?
0.4mg
pre-conception to 13 weeks
50
risk factors for NTDs
DM
anti-epileptics
obese
HIV
Sickle cell
previous child NTD
51
food good source folic acid
green leafy veg
52
4 causes of folic acid deficiency
phenytoin
MTX
pregnancy
alcohol xs
53
Gestation combined test downs syndrome
11-13+6
54
CUB test downs syndrome
nuchal translucency
serum bnhcg
PAPP-A
55
hcg, PAPP-A and NT in downs syndrome
hcg - high
PAPP-A - low
NT - thickened
56
trisomy 18
edwards
57
trisomy 13
patau
58
when should you offer quadruple test for downs syndrome
15-20 weeks if women book later in pregnancy
59
quadruple tests
AFP, oestriol, hcg, inhibin A
60
Women at high risk downs syndrome from CUB are offered
NIPT or diagnostic test
61
diagnostic test downs syndrome
amniocentesis
CVS
62
post-partum haemorrhage definition
>500mls
63
4 Ts primary PPH
Tone - atony
Tissue - retained placenta
Trauma - tear
Thrombin
64
Most common cause primary PPH
atony
65
Risk factors PPH
previous PPH
prolonged labour
pre-eclampsia
increased maternal age
polyhydramnios
emergency CS
placenta praevia, placenta accreta
macrosomia
66
mechanical treatment PPH
palpate the uterine fundus and rub it to stimulate contractions ('rubbing up the fundus')
catheterisation to prevent bladder distension and monitor urine output
67
medical treatment PPH
oxytocin
ergometrine
carboprost
misoprostol
68
surgical treatment PPH
balloon tamponade
B-lynch suture, ligation of uterine arteries, hysterectomy
69
when does secondary PPH occur
24 hours - 12 weeks
70
most common cause secondary pph
retained placenta or endometritis
71
Pregnancy - risk of smoking
miscarriage
stillbirth
pre-term labour
72
Features of fetal alcohol syndrome
LD
Smooth philtrum, thin vermilion, small palpebral fissuers, microcephaly
IUGR
73
cocaine - risks in pregnancy
HTN
Pre-eclampsia
placental abruption
premature and fetal abstinence syndrome
74
Intrahepatic cholestasis of pregnancy most common trimester
3rd
75
Features
Intrahepatic cholestasis of pregnancy
pruritus, often in the palms and soles
no rash
raised bilirubin
76
Management Intrahepatic cholestasis of pregnancy
ursodeoxycholic acid is used for symptomatic relief
weekly liver function tests
women are typically induced at 37 weeks
77
features acute fatty liver of pregnancy
abdominal pain
nausea & vomiting
headache
jaundice
hypoglycaemia
severe disease may result in pre-eclampsia
78
Investigations acute fatty liver of pregnancy
ALT is typically elevated e.g. 500 u/l
79
Is ceftriaxone or ciprfloxacin safe in breastfeeding?
ceftriaxone
80
Why are tetracyclines CI in breastfeeding?
dental staining
enamel hypoplasia
photosensitivity
81
List some meds to avoid with breastfeeding
antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
psychiatric drugs: lithium, benzodiazepines
aspirin
carbimazole
methotrexate
sulfonylureas
cytotoxic drugs
amiodarone
82
List some safes drugs in breastfeeding
antibiotics: penicillins, cephalosporins, trimethoprim
endocrine: glucocorticoids (avoid high doses), levothyroxine*
epilepsy: sodium valproate, carbamazepine
asthma: salbutamol, theophyllines
psychiatric drugs: tricyclic antidepressants, antipsychotics**
hypertension: beta-blockers, hydralazine
anticoagulants: warfarin, heparin
digoxin
83
3 stages of labour
1: onset to fully dilated
2: to delivery of fetus
3: placenta delivered
84
Can back to back labour baby rotate spontaneously from OP to OA?
yes
85
most common cause of early onset severe infection in neonatal period
GBS
86
What % of mothers ahev GBS in bowel flora/carriers
20-40
87
4 risk factors for GBS
prematurity
prolonged rupture of membranes
previous sibling GBS
maternal pyrexia
88
Should women be screened routinely for GBS?
No
89
Risk of GBS in subsequent pregnancies
50%
90
What will women with GBS in previous pregnancy receive?
intra-partum antibiotics or testing late in pregnancy
91
When are GBS swabs taken?
35-37 weeks or 3-5 weeks prior to due date
92
Should IAP be offered to women with previous baby with early or late onset GBS disease?
yes - both
93
What groups should receive intra partum antibiotics?
preterm labour
pyrexia >38 degrees
previous baby with early or late onset GBS disease
94
Antibiotic of choice for GBS prophylaxis
benzylpenicillin
95
gestational diabetes - what to do if fasting glucose <7
trial of diet and exercise for 1-2 weeks
96
What % of pregnancies affected by gestational diabetes?
4
97
6 risk factors for gestational diabetes
BMI>30
previous baby >4.5kg
previous gestational diabetes
first degree relative diabetes
Family origin high prevalence of diabetes - South Asian, Black Caribbean and Middle Eastern
unexplained stillbirth
98
test of choice for gestational diabetes screening
OGTT
99
When to offer OGTT to women who previously had GD?
ASAP after booking and 24-28 weeks
100
When should women with GD risk factors have OGTT?
24-28 weeks
101
2 criteria GD?
fasting >5.6
2 hour glucose >7.8
102
First steps women diagnosed with GD
Seen in clinic in 1 week
self monitor BM education
diet and exercise advice
103
fasting glucose <7 not improved after 1-2 week trial diet and exercise
offer metformin
104
long or short acting insulin for GD
short
105
when to offer insulin straight away for GD?
fasting >7
or 6-6.9 with macrosomia
106
Who should be offered glibenclamide?
cannot tolerate metformin
fail to meet target with metformin but declien insulin
107
Pre-existing diabetes in pregnancy - what meds can continue?
metformin and insulin
108
Pre-existing diabetes management in pregnancy
stop oral hypoglycaemics
BMI <27
folic acid 5mg OD
detailed anomaly scan
109
target fasting BM - diabetes in pregnancy
5.3
110
target 1 hour after meals sugar in GD
7.8
111
Target 2 hour after meals glucose for GD
6.4
112
oligohydramnios
reduced amniotic fluid
113
definition oligohydramnios
<500mls at 32-36 weeks
fluid index <5th percentile
114
causes of oligohydramnios
PROM
IUGR
Pre eclampsia
renal agenesis
115
Potter sequence
bilateral renal agenesis
pulmonary hypoplasia
116
After 20 weeks, symphaseal fundal height =
gestation in weeks
117
After how many weeks gestation does SFH match gestation?
20 weeks
within 2cm
118
Which scale can be used to screen for post partum depression
Edinburgh Postnatal Depression Scale
119
Max score of edinburgh postnatal depression screen
30
10 items
120
When are baby blues seen?
3-7 days after birth
121
managing baby blues
reassurance and support
HV involved
122
When does PND start?
1-3 months
123
managing PND
reassurance and support
CBT
SSRI - sertraline and paroxetine
124
What 2 SSRIs are safe in breastfeeding
sertraline
paroxetine
125
What SSRI to avoid in breastfeeding
fluoxetine
126
puerperal psychosis onset
2-3 weeks after birth
127
features of puerperal psychosis
severe mood swings
disordered perception
128
managing puerperal psychosis
Admit to mother and baby unit
129
recurrence rate of puerperal psychosis in future pregnancies
25-50
130
4 risk factors placental abruption
maternal trauma
multiparity
increased maternal age
cocaine use
131
Definition placental abruption
seperation of placenta from uterine wall resulting in haemorrhage
132
Clinical features placental abruption
Shock out of keeping with visible loss
constant pain
tender, tense uterus
fetal heart: absent/distress
coag problems
PET/DIC/anuria
133
List some indications for 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; if dead deliver vaginally
vaginal infection e.g. active herpes
cervical cancer (disseminates cancer cells)
134
how many categories of caesareans
4
135
category of c-section and brief explanation
1 - immediate threat, 30 mins
2 - compromise, deliver within 75 mins
3 - required but stable
4 - elective
136
Serious risks c-section: maternal
hysterectomy, further surgery, VTE, bladder/ureteric injury, death
increase future risk uterine rupture, stillbirth, placenta praevia
137
frequent risks with c-section
wound pain, readmission, haemorrhage, infection
laceration to baby
138
contraindication to VBAC
previous uterine rupture
classic C-Section
139
Which of these are contra-indicated in breastfeeding
aminophylline
carbamazepine
sodium valproate
methyldopa
amiodarone
amiodarone
140
Management of 3rd degree perineal tears
repair in theatre by suitably trained clinician
141
1st degree perineal tear
superficial damage
no muscle involvement
no repair needed
142
2nd degree perineal tear
perineal muscle
not involving anal sphincter
suture by midwife or clinician
143
3rd degree perineal tear
anal sphincter complex
144
4th degree perineal tear
injury to perineum and rectal mucosa
145
management of 1st and 2nd degree perineal tear
1st - none
2nd - midwife or clinical
146
5 risk factors perineal tears
primagravida
large baby
precipitant labour
shoulder dystocia
forceps
147
placenta praevia associated factors
multiparity
multiple pregnancy
previous c-section
148
clinical features placenta praevia
shock in proportion to blood loss
no pain, uterus not tender
fetal HR normal usually
149
Why to not perform PV exam if suspect placenta praevia
USS first
may provoke severe haemorrhage
150
how is placenta praevia often picked up
20 week USS
151
Investigation of choice placenta praevia
TV-USS
152
Grades of placenta praevia
1 - reach lower segment
2 - internal os but not covered
3 - covers internal os before dilation but not after
4 - completely covers internal os
153
normal fetal heart rate
100-160
154
Booking visit gestation
8-12 weeks
ideally <10 weeks
155
booking visit - what is done
general info - diet, smoking, alcohol, folic acid, bit D
bp, urine, BMI
Bloods
156
Booking visit bloods
FBC, blood group, rhesus, BBV
157
What is urine checked for on booking visit
dipstick - blood, protein, infection
urine culture - asymptomatic bacteriuria
158
Gestation scan to confirm dates
10-13+6 weeks
159
When is anomaly scan
18-20+6 weeks
160
When is first dose of anti-D prophylaxis given to rhesus negative women?
28 weeks
Also at 34 weeks
161
Whent offer external cephalic version?
36 weeks
162
What medication is CI in breastfeeding?
Aspirin
Sumatriptan
cyclizine
paracetamol
prochlorperazine
aspirin
163
Mnemonic for remembering medications to avoid in breastfeeding
most - metro
children - chloramphenicol
cant - carbimazole, cipro
breastfeed - benzos
on
Any - amiodarone, aspirin
stupid - sulfonylureas
drugs - cytotoxic
like - lithium
these - tetracyclines
164
SSRIs of choice in breastfeeding
sertraline
paroxetine
165
What is placenta accreta
attachment of placenta to myometrium
166
risk factors placenta accreta
previous c section
placenta praevia
167
risk with placenta accreta
PPH
168
Some neonatal complications of diabetes in pregnancy
macrosomia
hypoglycaemia
resp distress
stillbirth
shoulder dytocia
169
Hydatidiform mole features
uterus large for dates
hyperemesis
very high hcg
170
After what gestation is bleeding known as antepartum haemorrhage?
24
171
complications with PPROM
prematurity, infection, pulmonary hypoplasia
chorioamnionitis
172
How to confirm PPROM
sterile speculum exam
USS, testing of fluid
173
management of PPROM
Admit
regular obs
oral erythromycin
CCS
Consider delivery
174
antibiotics for PPROM
10 days erythromycin
175
factors to reduce vertical transmission of HIV
maternal ART
c-section
neonatal ART
bottle feeding
176
AED associated with NTD
valproate
177
is breastfeeding on AED generally safe?
yes
178
Why would thyroxine be high and TSH be low in molar pregnancy?
bhcg similar to LH, FSH and TSH
stimulate thyroid production
negative feedback on TSH
179
initial management of shoulder dystocia
mcroberts manouevre
180
second screen for anaemia - pregnancy
28 weeks
181
risk factors for breech
fibroids
placenta praevia
poly/oligohydramnios
fetal abnormality
prematurity
182
is cord prolapse more common in breech or cephalic?
breech
183
managing breech
ECV at 36 weeks
c - section or vaginal delivery
184
Absolute CI to ECV
APH in last 7 days
Abnormal CTG
Major uterine anomaly
multiple pregnancy
185
At what gestation if no fetal movements to refer to maternal fetal medicine?
24 weeks
186
What can reduced fetal movements indicate?
fetal distress due to hypoxia
187
when are fetal movements normally felt?
18-20 weeks
188
risk factor for reduced fetal movements
posture
distraction
plaenta position
medication
fetal position
body habitus
fetal size
189
assessing reduced fetal movements
handheld doppler
no heartbeat - immediate USS
190
Treating candida in breastfeeding mothers
continue breastfeeding
treat mother and baby
191
What is a kleihauer test
detects fetal cells in maternal circulation
192
when is kleihauer test needed?
any sensitising event after 20 weeks gestation
193
what steroid is used in PPROM to reduce risk of resp distress?
dexamethasone
194
When can non-immune mothers be given MMR?
post natal period
195
management of chorioamnionitis
antibiotics
deliver baby
196
Is trimethoprim ok in breastfeeding?
yes
197
supplements recommended in pregnancy
folic acid 400micrograms - until 12 weeks
vitamin D 10 micrograms
198
TTTTS
shared placenta
one twin polyhdramnios
need to ablate vessels
199
baby with sensorineural deafness, pulmonary artery stenosis and congenital cataracts - exposed to?
rubella
200
medication of choice to suppress breastfeeding
cabergoline
201
symptoms of amniotic fluid embolism
chills, shivering, sweating, coughing
202
signs of amniotic fluid embolism
cyanosis, hypotension, tachycardia, arrhythmia, MI
203
score to assess if induction of labour required
bishops
204
parts of bishop score
cervical position and consistency
effacement
dilation
fetal station
205
bishop score <5
labour unlikely to start without induction
206
bishop score >8
cervix ripe and favourable
207
methods of induction
membrane sweep
vaginal prostaglandins
oxytocin
amniotomy
cervical balloon
208
bishop score <6 what induction method
vaginal prostaglandins or oral misoprostol
209
bishop score >6 method of induction
amniotomy and IV oxytocin
210
complications induction of labour
uterine hyperstimulation
211
managing uterine hyperstimulation
remove pessary or stop infusion of oxytocin
tocolytics
212
direct coombs test
autoimmune haemolytic anaemia
213
indirect coombs
antenatal test to detect antibodies in maternal blood that may cross placenta and result in haemolytic disease of newborn
214
pregnancy - suspected dvt
duplex USS
215
pregnancy - suspicion of PE
ECG and CXR
V/Q or CTPA
216
is d-dimer used in pregnancy?
limited use as often raised
217
risk of CTPA and VQ scan
CTPA - maternal breast ca
VQ - childhood cancer
218
puerperal pyrexia
>38 in first 14 days
219
causes of puerperal pyrexia
endometritis
UTI
wound infection
mastitis
VTE
220
endometritis suspected management
refer to hospital
IV clindamycin and gent
221
How long before trying to conceive must MTX be stopped?
6 months
222
which are safe in pregnancy?
Leflunomide, HCQ, MTX, sulfasalazine
sulfasalazine and MTX
223
Why must NSAIDs be stopped at 32 weeks?
risk of early closure of ductus arteriosus
224
Why are women with RA referred to obstetric anaesthetist?
risk of atlanto-axial subluxation
225
fasting 6.1, 2 hour 8.5 - what to do with these glucose levels?
trial diet and exercise
226
5 weeks past LMP, asymptomatic bleeding, positive hcg
expectant management as <6 weeks
MSRA
flashcards
Decks in class (24)
# Cards
-
Gynae148
-
Obstetrics226
-
Dermatology193
-
Breast surgery28
-
Respiratory173
-
Renal125
-
Urology65
-
Psychiatry122
-
Neurology219
-
Anaesthesia/pre-op28
-
Pharmacology and therapeutics84
-
cardiovascular243
-
Paediatrics232
-
Rheumatology112
-
Orthopaedics78
-
Imm/allergy/genetics17
-
Haematology79
-
Infectious diseases131
-
Colorectal/gensurg/upper GI40
-
Gastro94
-
Endocrine/metabolic45
-
MCQ Bank18
-
ENT44
-
Eyes39
