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MFSRH part 2 > Intrapartum and postpartum > Flashcards

Flashcards in Intrapartum and postpartum Deck (116)
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1
Q

Hormones involved in lactation

A

Prolactin

Oestrogen, progesterone, insulin, thyroid hormones, glucocorticoids - involved in priming the breast

2
Q

What hormone is involved in milk release

A

Oxytocin

3
Q

Can a baby with galactosaemia be breast fed?

A

No

Breast milk must be excluded from the diet

4
Q

Can a baby with phenylketonuria be breast fed?

A

No

Breast milk must be excluded from the diet

5
Q

Can a baby with alactasia be breastfed?

A

No

Breast milk must be excluded from the diet

6
Q

What is the risk of tetracycline during breastfeeding?

A

Stains teeth

7
Q

What is the risk of maternal metronidazole during breastfeeding

A

Alters taste of breast milk

Not contraindicated

8
Q

Can women with mastitis breastfeed or express?

A

Yes.

Continued feeding or regular breast pumping should be recommended along with analgesia and antibiotics

9
Q

What hormone maintains successful lactation

A

Prolactin

10
Q

What hormone inhibits lactation

A

Dopamine

11
Q

Constituents of human milk compared to cows milk

A
Less protein
More fat
More carbohydrate
Low sodium
Higher levels of IgA and lactoferrin
12
Q

Can breast milk be given to babies with galactosaemia

A

No.

Precipitates hypoglycaemia

13
Q

What is moulding

A

Change in anatomical relations of bones of detail skull during labour and delivery

14
Q

Where is the fetal vertex

A

Between anterior and posterior fontanelles

15
Q

Where is the fetal occiput

A

Posterior to the posterior fontanelle

16
Q

Where is the fetal bregma

A

The area of the anterior fontanelle

17
Q

Where is the fetal brow

A

Anterior to anterior fontanelle to root of nose

18
Q

What is inadequate progress in labour for a nulliparous woman

A

Lack of continuing progress for 3 hours with regional anaesthesia.
or 2 hours without regional anaesthesia

19
Q

What is inadequate progress in labour for a Multiparous woman

A

Lack of continuing progress for 2 hours with regional anaesthesia.
or 1 hour without regional anaesthesia

20
Q

Conditions where forceps would be preferred to ventouse

A

Poor maternal effort
Operator or maternal preference, when either instrument would be suitable
Large amount of caput
Gestation of less than 34 weeks (at 34–36 weeks of gestation, ventouse is relatively contraindicated)
Marked active bleeding from a fetal blood-sampling site
After-coming head of the breech
Face presentation

21
Q

Indications for FBS include:

A

pathological CTG in labour (cervix dilated >3 cm)

suspected acidosis in labour (cervix dilated >3 cm).

22
Q

What is a normal FBS result

A

PH ≥7.25
Normal FBS result.
Repeat after 1 hour if CTG remains the same

23
Q

What is the cut off for an abnormal FBS result

A

PH ≤7.20 - consider delivery

24
Q

Contraindications to FBS

A

Contraindications include:

maternal infection (e.g. HIV, hepatitis viruses and herpes simplex virus)
Fetal bleeding disorders (e.g. haemophilia)
Prematurity (birth at less than 34 weeks of gestation)
Acute fetal compromise (e.g. prolonged fetal bradycardia of >3 minutes).

25
Q

Limitations imposed by the use of continuous EFM

A

reduced mobility
possibility that woman will not be the centre of care in labour
increased intervention
variation in interpretation of CTG trace
chorioamnionitis could make interpretation unreliable
litigation

26
Q

Normal CTG features

A

Baseline rate 100-160
Variability >5
Decelerations - none or early

27
Q

Non-reassuring CTG features

A

Baseline rate 161-180

Variability 50% of contractions

28
Q

Abnormal CTG features

A

Baseline rate 180
Variability 90 minutes
Late decelerations >30mins with >50% of contractions
Bradycardia/prolonged deceleration >3min

29
Q

management of non-reassuring CTG

A

commence conservative measures – left lateral position, oral / intravenous fluids, stop oxytocin, consider tocolysis.

30
Q

management of abnormal CTG

A

Offer to take fetal blood sample (FBS; for lactate or pH) after implementing conservative measures, or expedite birth if an FBS cannot be obtained and no accelerations are seen as a result of scalp stimulation.

31
Q

What are late decelerations suggestive of

A

Fetal hypoxia

32
Q

What are late decelerations controlled by

A

Reflex central nervous system response to hypoxia and acidaemia.

33
Q

Consequences of maternal fever on the fetus

A

Fetal tachycardia.
Loss of variability
Increased oxygen demand
Late decelerations

34
Q

How does fetal baseline variability change with gestation

A

Baseline variability is low in early pregnancy and increases with gestation

35
Q

Non-hypoxia related causes of decreased variability

A
Anencephaly
Central nervous system defects
Drugs - opiates, magnesium sulphate, atropine
Sepsis
Defective cardiac conduction
Quiet fetal sleep
36
Q

Can cord compression cause decelerations?

A

Yes - variable decelerations

37
Q

Most common type of deceleration in labour

A

80% variable decelerations
5% late decelerations
Isolated early decelerations - rare

38
Q

change in blood volume in pregnancy

A

rapid increase in extracellular fluid - esp circulating plasma
Increase in total body water by 2L

39
Q

What is the maternal mortality ratio?

A

The number of maternal deaths in population divided by the number of live births.
(The risk of maternal death relative to the number of live births)

40
Q

What is the maternal mortality rate?

A

Number of maternal deaths in a population divided by the number of women of reproductive age.
(Reflects risk of maternal deaths per pregnancy and level of fertility in the population)

41
Q

Define stillbirth

A

Baby born > 24 weeks with no signs of life

42
Q

Define perinatal death

A

Stillbirth > 24 weeks gestation or death within 7 days of birth

43
Q

Define live birth

A

Any baby born with signs of life regardless of gestation

44
Q

Define maternal death

A

Death of a woman while pregnant within 42 days of termination of pregnancy from any cause related to all aggravated by the pregnancy or its management.
Not accidental or incidental death

45
Q

Define perinatal mortality rate

A

Number of stillbirths and early neonatal deaths per 1000 live births and stillbirths

46
Q

Where is the foramen ovale located

A

Atrial septum

47
Q

What carries oxygenated blood from the placenta to the fetus

A

Umbilical vein

48
Q

What connects the pulmonary artery to the descending aorta in the fetus

A

Ductus arteriosus

49
Q

What vessel shunts blood away from the liver in the fetus - from the umbilical vein to the vena cava

A

Ductus venosus

50
Q

Why do women with an unstable lie need AN admission at term?

A

Risk of cord prolapse

51
Q

Success rate of ECV

A

50%

52
Q

What is placenta previa major

A

Insertion of the placenta in the lower section of the uterus overlying the cervical os

53
Q

Names of the Fetal Skull bones

A
Frontal
Parietal
Temporal
Sphenoidal
Occipital
54
Q

Names of Fetal skull sutures

A
Frontal
Sagittal
Coronal
Lambdoidal
Squamous
55
Q

names of Fetal skull fontanelles

A

Anterior
Posterior
Sphenoidal
Mastoid

56
Q

Bi-parietal diameter

A

9.5cm

57
Q

What is the bregma

A

Anterior fomtanelle

Diamond shape

58
Q

When does the anterior fontanelle close

A

18 months

59
Q

When does the posterior fontanelle close

A

Two months

60
Q

Minimum dose of anti-D required for a woman having cell salvage blood returned after CS

A

1500 IU minimum + do kleihauer

61
Q

First line treatment of normocytic / microcytic anaemia in preg / PN

A

Oral ferrous sulphate

62
Q

When should parenteral iron be used for anaemia in obstetrics

A

If PO iron not tolerated

Approaching term + insufficient time for PO iron.

63
Q

How many days old can the sample be for transfusion if pregnant or within 3m of delivery

A

3/7

64
Q

Major obstetric haemorrhage blood group

A

Group O, Rh -ve, kell -ve

65
Q

When is intra-operative cell salvage recommended in obstetrics

A

When anticipated blood loss significant enough to cause anaemia
Or estimated blood volume >20%

66
Q

In RBC transfusion when is FFP required

A

FFP 12-15ml/kg every 6 units of RBC during major haemorrhage
+ subsequent FFP guided by clotting - aim to maintain PT : APTT ratio

67
Q

What is the critical level platelets must not fall below

A

50

Platelet transfusion trigger of 75 if ongoing bleeding

68
Q

What group should platelet transfusion be

A

Same ABO group as patient

69
Q

What group of women should recieve Intrapartum antibiotic prophylaxis (IAP)

A

Intrapartum antibiotic prophylaxis should be given to:

  • Women with a previous baby with neonatal GBS disease
  • Women who are pyrexial in labour (>38C)
  • GBS bacteriuria identified during current pregnancy
  • GBS detected on vaginal swab in current pregnancy
  • Women with preterm rupture of membranes irrespective of GBS status
  • Women in confirmed preterm labour even without known GBS colonisation

Who doesn’t require IAP:
Prelabour rupture of membranes (& not known to have GBS)
Planned caesarean section in the absence of labour and with intact membranes

70
Q

UK incidence of neonatal herpes?

A

Neonatal herpes is rare

UK incidence 3 in 100,000 live births

But serious

71
Q

what are the 3 types of neonatal herpes?

A

3 types of Neonatal herpes:

  1. Restricted to skin/superfical infection (eye/mouth) =  least severe form
  2. CNS infection = mortality with antiviral treatment 6%, neurological sequelae 70%
  3. Disseminated infection = mortality with antiviral treatment 30%, neurological sequelae 17%

70% of cases are disseminated or CNS involvement

72
Q

Management 3rd trimester Acquisition of Genital Herpes (from 28 weeks)

A

Management 3rd trimester Acquisition of Genital Herpes (from 28 weeks)

Acicolvir 400 mg TDS, continue until delivery.

C-section delivery is advised for these patients in whom this is a 1st episode of HSV

73
Q

What percentage of infants with congenital CMV infection are symptomatic?

A

10 -15%

74
Q

For a patient with epilepsy what is the overall risk of experiencing a tonic-clonic seizure during labour / the 24 hours after

A

on average 1-4%

women may be reassured that the risk of a tonic-clonic seizure during labour and the 24 hours after birth is low

75
Q

Maternal mortality rate per 100,000 in UK

A

Maternal mortality rate of 8.76 per 100,000 maternities

In 2017 in UK

76
Q

Contraindications to cabergoline go stop lactation

A

Cabergoline is contraindicated in the following:

Pre-eclampsia
Cardiac valvulopathy (exclude before treatment)
History of pericardial fibrotic disorders
History of puerperal psychosis
History of pulmonary fibrotic disorders
History of retroperitoneal fibrotic disorders

hypersensitivity to ergot alkaloids

77
Q

Most commonly used drugs for lactation suppression

A

Cabergoline and Bromocriptine

78
Q

Which gender does congenital hip dislocation more commonly occur in

A

female

79
Q

Risk factors for congenital hip dislocation

A

Risk factors for congenital hip dislocation

80
Q

Incidence of congenital hip dislocation

A

1.3 per 1000 live births

81
Q

What is Mendelsons syndrome?

A

Aspiration of gastric contents under anaesthesia due to a gravid uterus increasing intra-abdominal pressure

82
Q

What does the Bishops score measure?

A

Dilatation, length, consistency and position of the cervix.

And the station of the presenting part.

83
Q

In preterm rupture of membranes are antibiotics recommended?

A

Yes

Reduces perinatal mortality

84
Q

Following preterm rupture of membranes what percentage of women will deliver within one week?

A

75%

85
Q

What is called prolapse associated with?

A
Breech presentation
High head
Twins
Grand multip
Preterm labour
86
Q

Does smoking affect delivery?

A

Smokers have a 50% chance of premature labour

87
Q

Effect of smoking on infant birthweight.

A

2x the risk of low birthweight

88
Q

How does nifedipine produce its tocolytic effect

A

Calcium channel blocker - blocks voltage gated calcium channels.

89
Q

Effect of bacterial vaginosis on

pregnant women

A
Late miscarriage, 
pre-term labour, 
pre-term birth, 
pre-term premature rupture of membranes, 
low birthweight, 
postpartum endometritis.
90
Q

Post partum PID is commonly caused tb what organism?

A

Beta-haemolytic streptococci

91
Q

Commonest antihypertensives used in pregnancy

A

Labetolol

Methyldopa

92
Q

Side effect on baby of lithium while breast feeding

A

Hypotonia

Cyanotic episodes

93
Q

Effect of aspirin while breast feeding

A

Reye’s syndrome
Impaired platelet function
Hypoprothrombinaemia

94
Q

What is fetal hydantoin syndrome

A
Group of fetal defects caused by phenytoin or carbamazepine.
Intrauterine growth restriction.
Microcephaly.
Hypoplastic phylanges and nails.
Dysmorphic craniofacial features.
Developmental delay.
95
Q

Features of Down’s syndrome

A
Macroglossia
Single palmar crease
Hypotonia
Brushfield spots
Oblique palpebral fissures
Prominent epicanthic folds
Low set ears
Sandal gap
96
Q

Fetal abnormalities caused by varicella zoster

A
Segmental skin loss of scarring 
Limb hypoplasia or aplasia
Growth retardation
Microcephally 
Ophthalmic abnormalities
97
Q

What heart defect occurs in fetal alcohol syndrome?

A

ASD

98
Q

Heart defects associated with Down’s syndrome

A

Atrial septal defects
Ventricular septal defects
Atrioventricular Canal defects

99
Q

What is the most common intra abdominal tumour of childhood?

A

Wilms’ tumour

100
Q

What is Wilms tumour

A

Undifferentiated mesodermal tumour of the intermediate cell mass (primitive renal tubules and mesenchymal cells)

101
Q

Features of congenital rubella syndrome

A

Loss of vision
Hearing loss
Heart defects
Mental retardation

Less frequent - CP

102
Q

Effect of fetal syphilis

A

1/2 die during gestation or shortly after birth
Failure to thrive
Irritability
Blindness

103
Q

What congenital infection caused retinochorditis

A

Toxoplasmosis

104
Q

Definition of primary post partun haemorrhage

A

Blood loss of 500ml or more occurring within 24 hours of delivery.

105
Q

Predisposing factors to primary post partum haemorrhage

A
Previous PPH
Multiple pregnancy
Macrosomic baby
Polyhydramnios 
Increased maternal age
Obesity
106
Q

Causes of primary post partum haemorrhage

A

Uterine atonia
Genital tract trauma
Retained placental tissue
Thrombin

107
Q

Define perinatal mortality

A

Sum of stillbirths and neonatal deaths in the first week of life per 1000 births after 24 weeks gestation

108
Q

Risk factors for postnatal depression

A
Single
Young
Chronic life difficulties
Social adversity
Past history of psychiatric illness
109
Q

What is the puerperal psychosis

A

Sudden out of character behaviour
In the first five days postnatally
Can include threats to harm oneself, one’s partner or the baby.

110
Q

What is baby blues

A

Tearfulness but no loss of sense of reality.
Occurs in up to 30%
Recovers within 72 hours

111
Q

incidence of cerebral palsy in babies born between 22 and 27 weeks?

A

14%

112
Q

1st line drug for tocolysis in preterm labour (NICE)

A

Nifedipine = calcium channel blocker - first line.

If Nifedipine CI use an oxytocin antagonist (atosiban)

113
Q

incidence of maternal postpartum haemorrhage in deliveries complicated by shoulder dystocia

A

10%

114
Q

What is the primary role of magnesium sulphate in preterm labour

A

Neuroprotection

Reduce risk of CP

115
Q

Most frequent cause of severe early-onset (< 7 days) infection in newborn infants

A

Group B streptococcus infection i

116
Q

Causes of preterm labour

A
Chorio-amnionitis
Polyhrdramnios
Cervical incompetence 
Amniocentesis
Multiple pregnancy 
Uterine abnormalities
Peritonitis
Pyelonephritis