Paces: O+G

Front 1

Nägele’s rule

Back 1

EDD = (LMP + 1 yr – 3 mth) + 7 days

Front 2

Gravidity + Parity
Definition
What are the cut offs
What do still births count as
What do twins count as

Back 2

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

Front 3

Advanced maternal age
What I the cut off
What is the implication

Back 3

>35

↑ miscarriages, trisomies, still birth, GDM, preeclampsia

Front 4

Teratogenic drugs
4 common ones

Back 4

ACEi
Retinoids
Sodium valproate
Methotrexate

Front 5

Painless PV bleed late in pregnancy
Primary DDx

Back 5

Placenta previa

Front 6

Painful PV bleed late in pregnancy
Primary DDx

Back 6

Placental abruption

Front 7

Early pregnancy pelvic pain
PV bleed, ± faintness,
Shoulder tip pain
Primary DDx

Back 7

Ruptured ectopic

Front 8

Itchy hands and feet
Pregnancy: primary DDx

Back 8

Obstetric cholestatis

Front 9

HTN, proteinuria, oedema
Pregnancy: primary DDx

Back 9

Preclampsia

Front 10

Tonic clonic seizures late in during labour
Primary DDx

Back 10

Eclampsia
OR
Amniotic fluid embolism

Front 11

Signs of eclampsia

Back 11

Tonic clonic seizures
HTN
Proteinuria
RUQ pain
Blurred vision

Front 12

Chest pain, SOB, cardiac arrest
Pregnancy: primary DDx

Back 12

Pulmonary oedema

Front 13

Acute leg pain, rubor, swelling ± SOB
Pregnancy: primary DDx

Back 13

DVT

Front 14

Shoulder dystocia
Signs + symptoms

Back 14

Delayed delivery after head delivered

Front 15

Cord prolapse
Signs + symptoms

Back 15

Cord descends below presenting part following ROM

Front 16

Amniotic fluid embolism
Signs + symptoms

Back 16

Dyspnoea, hypotension, hypoxia, seizures, heart failure

Front 17

Uterine rupture
Signs + symptoms ± epidural

Back 17

Severe, acute pain
Epidural
Sudden hypotension
Cessation of contractions
Foetal hypoxia

Front 18

Uterine inversion
Signs + symptoms

Back 18

PPH, pain, profound shock

Front 19

Primary PPH
Definition

Back 19

≥500 ml blood loss
<24 hrs post delivery

Front 20

Secondary PPH
Definition

Back 20

Abnormal/excessive bleeding 24 hrs - 12 wks post natal

Front 21

Which Rx steroids cross the placenta

Back 21

Dexamethasone
Betamethasone

Front 22

Cervical excitation
Definition

Back 22

Pain on palpation of cervix

Front 23

Bladder retention
Chronic vs acute

Back 23

Acute: V full + painful

Chronic: V. full + not painful

Front 24

Bimanual examination
What do normal ovaries feel like

Back 24

If normal, not felt on bimanual

Front 25

Pregnancy: head engaged
What criteria on palpation indicates head is engaged

Back 25

<2/5 of head palpable

Front 26

Definition + method of assessment for:
Lie
Presentation
Position

Back 26

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

Front 27

Symphisis-fundal height
How does it compare to gestation

Back 27

Height = wks gestation ± 2

Front 28

At how many weeks pregnancy:
Uterus felt above the pelvis

Back 28

16 wks

Front 29

At how many weeks pregnancy:
Uterus felt at level of umbilicus

Back 29

> 20 wks

Front 30

At how many weeks pregnancy:
Uterus felt at level of xiphisternum

Back 30

> 36 wks

Front 31

Hyperreflexia in pregnancy may indicate what

Back 31

Preeclampsia

Front 32

Breach presentation
Options for delivery

Back 32

Watch + wait: birth attended by experienced Drs on labour ward

External cephalic version

Elective C/S

Front 33

External cephalic version
Precautions + Rx used
% success
Complicaitons

Back 33

Terbutaline to relax s.muscle
CTG beforehand

50% success

Small chance baby gets distressed → C/S

Front 34

Baby’s head position
Engagement
Beginning labour
After head delivered

Back 34

Engaged: Occipitotransverse

Beginning: Occipitoanterior
Head flexed

After: rotated back to transverse

Front 35

Termination
Criteria for termination <24 wks
Any time in pregnancy

Back 35

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

Front 36

1st trimester termination
Procedures for surgical + medical
Success rates

Back 36

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

Front 37

2nd trimester termination
Procedures for surgical + medical
Success rates

Back 37

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

Front 38

Cervical cancer
Pattern of inheritance

Back 38

NOT INHERITED
∴ not at all relevant if mother had it

Front 39

Actions of free blood in the peritoneal cavity

Back 39

Pressing on diaphragm → shoulder tip pain

Irritates bowel → diarrhoea

Front 40

Absence of foetal sac on USS
Actions and interpretation

Back 40

Retest βhCG 48 hrs later
Plateau: ectopic
↑ >66%: preg
↑↑↑: molar
↓: failed

Front 41

Foetal HR
What relation to maternal HR

Back 41

Foetal HR ~ 2 x maternal HR

Front 42

VBAC
% success
% rupture w/ multiple previous C/S

Back 42

75% success under normal circumstances
Failure ≠ rupture
Failure = having to go to C/S anyway

1% rupture w/ multiple previous C/S