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42 Cards in this Set
- Front
- Back
Nägele’s rule
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EDD = (LMP + 1 yr – 3 mth) + 7 days
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Gravidity + Parity
Definition What are the cut offs What do still births count as What do twins count as |
G = no. times pregnant
P = no. potential live births P: any preg >24 wks Gx + Pa + b x = no. times pregnant a = no. births > 24 wks b = no. miscarriages/terminations <24 wks Twins = G1P1 |
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Advanced maternal age
What I the cut off What is the implication |
>35
↑ miscarriages, trisomies, still birth, GDM, preeclampsia |
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Teratogenic drugs
4 common ones |
ACEi
Retinoids Sodium valproate Methotrexate |
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Painless PV bleed late in pregnancy
Primary DDx |
Placenta previa
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Painful PV bleed late in pregnancy
Primary DDx |
Placental abruption
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Early pregnancy pelvic pain
PV bleed, ± faintness, Shoulder tip pain Primary DDx |
Ruptured ectopic
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Itchy hands and feet
Pregnancy: primary DDx |
Obstetric cholestatis
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HTN, proteinuria, oedema
Pregnancy: primary DDx |
Preclampsia
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Tonic clonic seizures late in during labour
Primary DDx |
Eclampsia
OR Amniotic fluid embolism |
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Signs of eclampsia
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Tonic clonic seizures
HTN Proteinuria RUQ pain Blurred vision |
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Chest pain, SOB, cardiac arrest
Pregnancy: primary DDx |
Pulmonary oedema
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Acute leg pain, rubor, swelling ± SOB
Pregnancy: primary DDx |
DVT
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Shoulder dystocia
Signs + symptoms |
Delayed delivery after head delivered
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Cord prolapse
Signs + symptoms |
Cord descends below presenting part following ROM
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Amniotic fluid embolism
Signs + symptoms |
Dyspnoea, hypotension, hypoxia, seizures, heart failure
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Uterine rupture
Signs + symptoms ± epidural |
Severe, acute pain
Epidural Sudden hypotension Cessation of contractions Foetal hypoxia |
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Uterine inversion
Signs + symptoms |
PPH, pain, profound shock
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Primary PPH
Definition |
≥500 ml blood loss
<24 hrs post delivery |
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Secondary PPH
Definition |
Abnormal/excessive bleeding 24 hrs - 12 wks post natal
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Which Rx steroids cross the placenta
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Dexamethasone
Betamethasone |
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Cervical excitation
Definition |
Pain on palpation of cervix
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Bladder retention
Chronic vs acute |
Acute: V full + painful
Chronic: V. full + not painful |
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Bimanual examination
What do normal ovaries feel like |
If normal, not felt on bimanual
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Pregnancy: head engaged
What criteria on palpation indicates head is engaged |
<2/5 of head palpable
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Definition + method of assessment for:
Lie Presentation Position |
Lie: Axis of baby
Presentation: Which part is in the pelvis Position: Which direction the baby’s head is facing Described as position of occiput e.g. Left occipitoposterior, right occipitotransverse Lie + presentation: assessed by external examination Position only really assessed by VE |
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Symphisis-fundal height
How does it compare to gestation |
Height = wks gestation ± 2
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At how many weeks pregnancy:
Uterus felt above the pelvis |
16 wks
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At how many weeks pregnancy:
Uterus felt at level of umbilicus |
> 20 wks
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At how many weeks pregnancy:
Uterus felt at level of xiphisternum |
> 36 wks
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Hyperreflexia in pregnancy may indicate what
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Preeclampsia
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Breach presentation
Options for delivery |
Watch + wait: birth attended by experienced Drs on labour ward
External cephalic version Elective C/S |
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External cephalic version
Precautions + Rx used % success Complicaitons |
Terbutaline to relax s.muscle
CTG beforehand 50% success Small chance baby gets distressed → C/S |
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Baby’s head position
Engagement Beginning labour After head delivered |
Engaged: Occipitotransverse
Beginning: Occipitoanterior Head flexed After: rotated back to transverse |
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Termination
Criteria for termination <24 wks Any time in pregnancy |
2 medical professionals ating in good faith certify that:
<24 wks Physical + mental risk to ♀ / existing children Greater than is preg continued Any time Prevent grave permanent injury to physical / mental health of ♀ Risk to life of ♀ Substantial risk child would suffer serious handicap |
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1st trimester termination
Procedures for surgical + medical Success rates |
Medical
Mifepristone (RU486) Progesterone competitive agonist – blocks actions of progesterone 60% success If used w/ vaginal prostaglandin pessary 48 hrs later – 98% success Surgical Under GA Dilation of cervix Suction used via small catheter passed through cervix Priming cervix w/ prostaglandin ↓trauma |
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2nd trimester termination
Procedures for surgical + medical Success rates |
Medical
Mifepristone (RU486) Progesterone competitive agonist – blocks actions of progesterone 36 hrs later vaginal prostaglandin pessary Gameprost pessary every 3-6 hrs until aborted 10% subsequent Sx required Surgical Under GA Dilation of cervix Foetus may have to be removed piecemeal Priming cervix w/ prostaglandin ↓trauma |
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Cervical cancer
Pattern of inheritance |
NOT INHERITED
∴ not at all relevant if mother had it |
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Actions of free blood in the peritoneal cavity
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Pressing on diaphragm → shoulder tip pain
Irritates bowel → diarrhoea |
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Absence of foetal sac on USS
Actions and interpretation |
Retest βhCG 48 hrs later
Plateau: ectopic ↑ >66%: preg ↑↑↑: molar ↓: failed |
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Foetal HR
What relation to maternal HR |
Foetal HR ~ 2 x maternal HR
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VBAC
% success % rupture w/ multiple previous C/S |
75% success under normal circumstances
Failure ≠ rupture Failure = having to go to C/S anyway 1% rupture w/ multiple previous C/S |