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Med Finals - Womens Health > Antenatal > Flashcards

Antenatal Flashcards

1
Q

Define 1st trimester

A

From start of pregnancy until 12 weeks

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2
Q

Define 2nd trimester

A

From 13 weeks until 26 weeks

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3
Q

Define 3rd trimester

A

From 27 weeks until birth

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4
Q

When is dating scan

A

10-13+6 weeks

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5
Q

When is anomaly scan

A

18-20+6 weeks

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6
Q

When is oral glucose tollerance test

A

24-28 weeks

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7
Q

When is anti-D injection

A

28 and 34 weeks

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8
Q

Vaccines during pregnancy

A

Whooping cough - 16 weeks
Influenza - autumn or winter

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9
Q

Options for downs screening

A

Combined test
Triple test
Quadruple test
(amniocentesis, CVS)

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10
Q

Define combined test

A

Ultrasound - nuchal translucency
Bloods - hcg, PAPPA

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11
Q

When can combined test be done

A

11-14 weeks

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12
Q

Define the triple test

A

hcg
Alpha fetoprotein
Serum oestriol

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13
Q

When can the triple test be done

A

14-20 weeks

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14
Q

Define quadruple test

A

Tripple plus inhibin A

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15
Q

When can quadruple test be done

A

14-20 weeks

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16
Q

Management of hypothyroidism in pregnancy

A

Levothyroxine crosses placenta
Increased dose required - 25-50 mcg (30-50%)
Titrate TSH

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17
Q

Management of hypertension in pregnancy

A

Stop ACE, ARB, thiazide
Can have beta, ccb and alpha-blockers

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18
Q

Management of epilepsy in pregnancy

A

High dose folic acid - 5mg
Worsen seizure control
Avoid - sodium valproate, phenytoin
Safer - levetiracetam, lamotrigine and carbamazepine

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19
Q

Management of rheumatoid arthritis in pregnancy

A

Avoid - methotrexate
Safe - hydroxychloroquine, sulfasalazine, corticosteroids

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20
Q

Medications to avoid in pregnancy

A

NSAIDS
Betablockers - unless for HTN
ACEi ARBs
Opiates
Warfarin
Sodium valproate
Lithium
SSRI?
Isotretinoin

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21
Q

Define Kleihauer test

A

Checks how much fetal blood has been passed into the mothers blood during sensitisation

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22
Q

Define small for gestational age

A

Fetus that measures below the 10th centile for gestational age - estimated fetal weight or fetal abdominal circumference

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23
Q

Causes of small for gestational age

A

Constitutionally small
Fetal growth restriction

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24
Q

Catagories of fetal growth restriction

A

Placenta mediated growth restriction
Non-placenta mediated growth restriction - genetic/structural abnormality

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25
Cause of placenta mediated growth restriction
Idiopathic Pre-eclampsia Maternal alcohol Anaemia Malnutrition Infection Maternal health condition
26
Causes of non placenta mediated growth restriction
Genetic abnormalities Structural abnormalities Fetal infection Errors of metabolism
27
Signs of fetal growth restriction
Reduced amniotic fluid Abnormal doppler studies Reduced fetal movement Abnormal CTGs
28
Complications of fetal growth restriction
Fetal death or stillbirth Birth asphyxia Neonatal hypothermia Neonatal hypoglycaemia CVD - HTN TIIDM Obesity Mood and behaviour problema
29
Risk factors for small for gestations age
Previous Obesity Smoking Diabetes Existing hypertension Pre-eclampsia Older mother Multiple pregnancy Low PAPPA Antepartum haemorrhage Antiphospholipid syndrome
30
Management of small for gestational age
Serial growth scans Aspirin - if risk of pre-eclampsia Karyotyping, Test for infection Early delivery considered if static growth
31
Define large for gestational age
Macrosomia - when weight of the newborn is more than 4.5 KG at birth or >90th centile in pregnancy
32
Causes of macrosomia
Constitutional Maternal diabetes Previous macrosomia Maternal obesity or rapid weight gain Overdue Male baby
33
Risks to mother in macrosomia
Should dystocia Failure to progress Perineal tears Instrumental delivery or caesarean Postpartum haemorrhage Uterine rupture
34
Risks to baby of macrosomia
Birth injury - Erbs palsy, clavicular fracture, fetal distress, hypoxia Neonatal hypoglycaemia Obesity TIIDM
35
Management of macrosomia
US Oral glucose tolerance test - gestational diabetes Early delivery Management of complications
36
Define multiple pregnancy
Refers to a pregnancy with more than one fetus -
37
Define monozygotic
Identicle twine - single zygote
38
Define dizygotic
Non-identical - two different zygotes
39
Define monoamniotic
Single amniotic sac
40
Define diamniotic
Two seperate amniotic sace
41
Define monchorionic
Sharing single placenta
42
Define dichorionic
Two seperate placentas
43
Risks to mother of multiple pregnancy
Anaemia Poyhydramnios Hypertension Malpresentation Spontaneous preterm birth Instrumental delvery or caesarean Post partum haemorrhage
44
Risks to babies in multiple pregnancy
Miscarriage Stillbirth Fetal growth restriction Prematurity Twin-twin transfusion syndrome Twin anaemia polycythaemia sequence Congenital abnormalities
45
Define twin-twin transfusion syndrome
Occurs when foetuses share a placenta - one foetus may recieve majority of the blood from the placenta while the other is starved
46
Presentation of UTI in pregnancy
Dysuria Suprapubic pain or discomfort Increased frequency of urination Urgency Incontinence Haematuria
47
Presentation of pyelonephritis in pregnancy
Fecer Loin to groin pain Renal angle tenderness Vomiting Loss of appetite Haematuria
48
Management of UTI in pregnancy
Nitro - avoid 3rd trimester Amoxicillin Cefalexin (trimethoprim - avoid 1st trimester, avoid generally)
49
Risk factors for VTE in pregnancy
Smoking Parity >3 >35 years BMI >30 Reduced mobility Multiple pregnancy Pre-eclampsia Gross varicose veins Immobility FH Thrombophilia IVF
50
Define pre-eclampsia
Refers to new high blood pressure in pregnancy with end-organ dysfunction, notably proteinuria.
51
Triad of preeclampsia
Hypertension Proteinuria Oedema
52
Risk factors for pre-eclampsia
Pre-existing hypertension Previous hypetension in pregnancy Existing autoimmune conditions Diabetes CKD >40 years BMI >35 >10 since previous pregnancy Multiple pregnency FH
53
Presentation of pre eclampsia
Headache Visual disturbance Nausea Upper abdominal or epigastric pain - liver swelling Oedema Reduced urine output Brisk reflexes
54
Management of pre-eclampsia
Aspirin - prophylaxis from 12 weeks with single high-risk factor or 2 moderate risk factors Labetolol Nifedipine Methyldopa IV magnesium sulphate - labour to prevent seizures Fluid restriction
55
Define eclampsia
Refers to the seizures associated with pre-eclampsia
56
Management of eclampsia
Magnesium sulphate
57
Define HELLP syndrome
Combination of features that occur as a complication of pre-eclampsia and eclampsia
58
Features of HELLP syndrome
Haemolysis Elevated Liver enzymes Low Platelets
59
Define gestational diabetes
Diabetes triggered by pregnancy - reduced insulin sensitivity
60
Risk factors for gestational diabetes
Previous gestational diabetes Previous macrosomia BMI >30 Ethnicn - black, middle eastern, south asian FH
61
Investigations of gestational diabetes
Oral glucose tolerance test 5678 Fasting >5.6 At 2 hours >7.8
62
Management of gestational diabetes
Fasting glucose <7 - trial diet and exercise 1-2 weeks then metformin, then insulin Fasting >7 - start insulin +/- metformin Fastin >6 plus macrosomia - start insulin +/- metformin
63
Define obstetric cholestasis
Intrahepatic cholestasis of pregnancy
64
Presentation of obstetric cholestasis
Itching - pruritis Fatigue Dark urine Pale greasy stools Jaundice
65
Investigations of obstetric cholestasis
LFTs - ALT, AST, GGT
66
Management of obstetric cholestasis
Ursodeoxycholic acid Emollients + antihistamines
67
Define acute fatty liver of pregnancy
Rapid accumulation of fat within the liver cells causing acute hepatitis
68
Presentation of acute fatty liver of pregnancy
General malaise and fatigue Nausea and vomiting Jaundice Abdominal pain Anorexia Ascites
69
Investigations in fatty liver of pregnancy
Raised liver enzymes and low plateles Raised WCC Raised bilirubin
70
Management of fatty liver of pregnancy
Admission and delivery of baby
71
Define placenta previa
Where the placenta attaches in the lower portion of the uterus - low lying = within 20mm of the internal os, placenta praevia - over the internal os
72
Complications of placenta praevia
Antepartum haemorrhage Emergency c section Hysterectomy Maternal anaemia and transfusions Preterm birth and low birth weight Still birth
73
Risk factors for placenta praevia
Previous c section Previous placenta praevia Older maternal age Maternal smoking Structural uterine abnormalities Assisted reproduction
74
Management of placenta praevia
Corticosteroid for lung development Early delivery and c section
75
Define vasa praevia
Where the fetal vessels are within the ftal mambrance and travel acros the internal os
76
Define placental abruption
When the placenta separates from the wall of the uterus during pregnancy
77
Risk factors for placental abruption
Previous abruption Pre-eclampsia Bleeding early in pregnancy Trauma Multiple pregnancy Fetal growth restriction Multigravida Increased maternal age Smoking Cocaine
78
Presentation of placental abruption
Sudden onset sever abdominal pain Vaginal bleeding Shock Abnormal CTH - fetal distress Wood uterus
79
Management of placental abruption
Cannula Bloods Cross match 4 units Fluid and blood resuscitation CTG monitoring Ultrasound Antenatal steroids Emergency c section
80
Define placenta acreta
When the placenta implants deeper through and past the endometrium making it difficult to seperate after delivery of baby
81
Types of placenta acreta
Acreta - surface of myometrium but not beyond Increta - placenta attaches deeply into myometrium Percreta - invades past the myometrium and perimetrium - potentiall reaching other organs
82
Risk factors for placenta acreta
Previous Previous endometrial curettage Previous caesarean section Multigravida Increased maternal age Low-lying placenta or praevia
83
Define breech presentation
When the presenting part of the fetus is the legs and bottoms
84
When can external cephalic version be used
36 weeks for nulliparous women 37 weeks in women who have previously given birth
85
Causes of still birth
Unexplained Pre-eclampsia Placental abruption Vasa praevia Cord prolapse Obstetric cholestasis Diabetes Thyroid disease Infections - rubella, parvovirus listeria Genetic abnormalities
86
Risk factors for still birth
Fetal growth restriction Smoking Alcohol Increased maternal age Maternal obesity Twins Sleeping on back

Med Finals - Womens Health (10 decks)

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