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Obstetrics and Gynaecology > Antenatal care > Flashcards

Antenatal care Flashcards

1
Q

What is the combined screening?

A

First line between 11-14 weeks and consists of measurement of nuchal translucency, b-HCG and PAPPA

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2
Q

Combined screening test results for Down’s

A

Thick nuchal translucency
High beta-HCG
Low PAPPA

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3
Q

What is the triple test?

A

For chromosomal abnormalities between 14-20 weeks
Beta-GCG - HIGH
AFP - LOW
Serum estriol - LOW

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4
Q

What is the quadruple test?

A

between 14-20 weeks
Also includes inhibin A

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5
Q

What does the combined test, triple and quadruple test indicate?

A

The risk of the fetus having Down’s syndrome

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6
Q

What antenatal testing is available for women high risk of having a child with Down’s syndrome?

A

Amniocentesis and Chorion villus sampling

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7
Q

Untreated hypothyroidism in pregnancy complications

A

SPAM

Miscarriage, anaemia, small for gestational age and pre-clampsia

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8
Q

Hypothyroidism in pregnancy management

A

Increase levothyroxine dose by 30-50% and titrate based on TSH level

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9
Q

Hypertension in pregnancy - medications that must be stopped

A

ACE inhibitors
ARBs
Thiazides and Thiazide-like-diuretics

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10
Q

Hypertension management in pregnancy

A

Labetelol
Calcium channel blockers
Alpha blockers

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11
Q

Pre-pregnancy considerations in women with epilepsy

A

Should take 5mg folic acid daily before conception to reduce risk of neural tube defects

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12
Q

Anti-epileptic drugs in pregnancy

A

Lamotrigine and carbamazepine are safer in pregnancy
Avoid sodium valproate - neural tube defects and development delay
Phenytoin - cleft lip and palate

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13
Q

Rheumatoid arthritis management in pregnancy

A

Avoid methotrexate
Hydroxychloroquine (first-line)
Sulfasalazine

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14
Q

NSAIDs MOA and pregnancy

A

Inhibit prostaglandins and should be avoided as prostaglandins are responsible for maintaining the ductus arteriosus and soften the cervix and stimulate uterine contractions.

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15
Q

Beta blockers in pregnancy - use and side effects

A

First line for high blood pressure due to pre-clampsia.
Can cause: foetal growth restrictions, hypoglycaemia and Bradycardia in neonate

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16
Q

ACE inhibitors and ARBs in pregnancy

A

They cross the placenta and cause reduced urine output in the foetus and therefore amniotic fluid (oligohydraminos) and hypocalvaria (incomplete formation of skull bones)

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17
Q

Opiates and pregnancy

A

Use during pregnancy causes withdrawal symptoms after the neonate is born - neonatal abstinence syndrome

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18
Q

What is neonatal abstinence syndrome?

A

When the foetus is exposed to opioids during pregnancy. Withdrawal symptoms - irritability, tachypnoea, high temperatures and poor feeding

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19
Q

Why is warfarin contraindicated in pregnancy?

A

Causes foetal loss
Congenital malformations
Bleeding during pregnancy - PPH, Foetal haemorrhage and intracranial haemorrhage

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20
Q

Why is sodium valproate contraindicated in pregnancy?

A

Neural tube defects and developmental delay

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21
Q

Why is lithium avoided in pregnancy?

A

Avoided in first trimester due to congenital cardiac abnormalities - ebstein’s anomaly - tricuspid valve is set lower on the right side of the heart causing a bigger right atrium and smaller right ventricle. Should be avoided in breastfeeding

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22
Q

Risks of SSRIs in pregnancy

A

First trimester - congenital heart defects
First trimester - paroxetine - congenital malformations
Third trimester - persistent pulmonary hypertension in the neonate

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23
Q

Contraindications of accutane in pregnancy

A

High teratogenic, causing miscarriage and congenital defects.

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24
Q

Cause of rubella

A

Togavirus

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25
Q

Rubella incubation period

A

2-3 weeks and individuals are infectious from 7 days before symptoms and 4 days after onset of rash

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26
Q

Diagnose this

A

Rubella

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27
Q

When is rubella cause the most risk to the foetus?

A

In the first 8-10 weeks

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28
Q

Features of congenital rubella syndrome

A

Sensorineural hearing loss
Congenital heart disease
Congenital cataracts

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29
Q

Cause of chicken pox

A

Varicella-zoster virus

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30
Q

What does chicken pox during pregnancy increase the mother’s risk of?

A

Pneumonitis

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31
Q

Features of foetal varicella syndrome

A

Skin scarring
eye defects (microphthalmia)
Limb hypoplasia
Microcephaly
Learning disabilities

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32
Q

Chicken pox treatment in woman <20 weeks pregnant and not immune

A

Give varicella-zoster immunoglobulin ASAP

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33
Q

Chicken pox treatment in woman >20 weeks pregnant and not immune

A

either give Varicella-zoster immunoglobulins or oral aciclovir should be given 7-14 days after exposure

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34
Q

Congenital toxoplasmosis

A

Infection with toxoplasma gondii. Spread via faeces from a cat. Triad of intracranial calcification, hydrocephalus and chorioretinitis

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35
Q

What is rhesus incompatibility?

A

When rhesus-D negative woman becomes pregnant, there is the possibility of her having a rhesus positive child. Mother produces rhesus-D antibodies. Subsequent pregnancies rhesus-D antibodies cross into the placenta and if baby is rhesus-positive, they attack the foetus and cause destruction of the red blood cells causing haemolytic -> haemolytic disease of the newborn

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36
Q

How to manage rhesus incompatibility?

A

Anti-D injections at 28 weeks and birth

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37
Q

When else should anti-D injections be given?

A

Antepartum haemorrhage
Amniocentesis procedures
Abdominal trauma

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38
Q

What is a Khleihauer test?

A

Checks how much foetal blood has passed into the mother during a sensitisation event after 20 weeks. Used to assess whether further anti-D injections are required

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39
Q

What measurements are used to assess foetal size?

A

Estimated foetal weight
Foetal abdominal circumference

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40
Q

Definition of small for gestational age

A

<10 centile for their gestational age

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41
Q

Definition of severe small for gestational age

A

<3 centile for their gestational age

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42
Q

What constitutes as low birth weight?

A

<2.5 kgs

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43
Q

Causes of small for gestational age?

A

Constitutionally small - matches the mother and others in the family
Foetal growth restriction (intrauterine growth restriction)

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44
Q

Causes of foetal growth restriction categories

A

Placenta mediated growth restriction
Non-placenta mediated growth restriction i.e. genetic or structural abnormality

45
Q

Causes of placenta mediated growth restriction

A

ISPAAM

Idiopathic
Pre-clampsia
Maternal smoking
Maternal alcohol
Anaemia
Malnutrition

46
Q

Non-placenta mediated growth restriction

A

Genetic abnormalities
Structural abnormalities
Foetal infection

47
Q

Complications of foetal growth restrictions - short term

A

Foetal death or stillbirth
Birth asphyxia
Neonatal hypothermia
Neonatal hypoglycaemia

48
Q

Complications of foetal growth restrictions - long term

A

Cardiovascular disease - hypertension
Type 2 diabetes
Obesity
Mood and behavioural problems

49
Q

Risk factors for small for gestational age

A

Previous SGA baby
Obesity
Smoking
Diabetes
Hypertension
Pre-eclampsia
Older mother >35 years
Multiple pregnancies
Low PAPPA
Antepartum haemorrhage
Antiphospholipid syndrome

50
Q

Definition of large for gestational age

A

> 4.5 kgs and estimated foetal weight >90th centile

51
Q

Causes of macrosomia

A

Constitutional
Maternal diabetes
Previous macrosomia
Maternal obesity or rapid weight gain
Overdue

52
Q

Risks of macrosomia to mother

A

Shoulder dystocia
Failure to progress
Perineal tears
Instrumental delivery or caesarean
PPH
Uterine rupture (Rare)

53
Q

Risks of macrosomia to baby

A

Birth injury (Erb’s palsy, clavicular fracture, foetal distress and hypoxia)
Neonatal hypoglycaemia
Obesity in childhood and later life
T2DM in adulthood

54
Q

Define monoamniotic

A

Single amniotic sac

55
Q

Define diamniotic

A

Two separate amniotic sacs

56
Q

Define monochorionic

A

Share a single placenta

57
Q

Define dichorionic

A

Two separate placentas

58
Q

What is the lambda sign?

A

triangular appearance where the membrane between the twins meets the chorion

59
Q

Multiple pregnancies complications to mother

A

Anaemia
Polyhydraminos
Hypertension
Malpresentation
Spontaneous pre-term birth
Instrumental delivery or caesarean
PPH

60
Q

Multiple pregnancies complications to foetuses

A

Miscarriage
Stillbirth
Foetal growth restriction
Prematurity
Twin-twin transfusion syndrome
Twin anaemia polycythaemia sequence

61
Q

What is twin-twin transfusion syndrome?

A

When there is a connection between blood supplies of the two foetuses, one foetus may receive the majority of the blood from the placenta and the other foetus is starved of blood. The one with the majority of the blood supply can become fluid overloaded with heart failure and polyhydraminos. Whereas the other foetus has growth restriction, anaemia and oligohydraminos

62
Q

What is twin anaemia polycythaemia sequence?

A

Similar to twin-twin transfusion syndrome but less acute. One twin becomes anaemia and the other develops polycythaemia (raised haemoglobin)

63
Q

Delivery of mono amniotic twins method

A

Elective Caesarean section between 32-33+6 weeks

64
Q

Diamniotic twins delivery method

A

Aim to deliver between 37 and 37+6 weeks

65
Q

Asymptomatic bacteriuria in pregnancy are at higher risk of developing what?

A

Lower UTIs and pyelonephritis and subsequently pre-term birth

66
Q

Presentation of lower UTIs in pregnant women

A

Dysuria
Suprapubic pain
Increased frequency of urination
Urgency
Incontinence
Haematuria

67
Q

Presentation of pyelonephritis

A

Fever
Loin, suprapubic or back pain
Vomiting
Loss of apetite
Haematuria

68
Q

Organisms causing of UTIs

A

E. coli
Klebsiella
Pseudomonas

69
Q

Management of UTIs in pregnancy

A

Requires 7 days of antibiotics
Avoid nitrofurantoin in third trimester - risk of neonatal haemolysis
Avoid Trimethoprim in first trimester - neural tube defects

70
Q

Causes of microcytic anaemia

A

Iron deficiency

71
Q

Causes of macrocytic anaemia

A

B12 or folate deficiency

72
Q

Management of iron deficiency anaemia in pregnancy

A

Start with iron replacement - ferrous sulphate 200mg TDS

73
Q

Management of B12 deficiency anaemia in pregnancy

A

Test for pernicious anaemia (intrinsic factor antibodies)

IM hydroxocobalamin
Oral cyanobalamin tablets

74
Q

Folate deficiency anaemia in pregnancy

A

Start folic acid 5mg daily

75
Q

When should you start VTE prophylaxis in pregnancy?

A

> 3 risk factors at 28 weeks
4 risk factors in first trimester
Should receive prophylaxis with LMWH - enoxaparin, daltaparin

76
Q

Management of VTEs in pregnancy

A

LMWH - enoxaparin, daltaparin

77
Q

Massive PE and haemodynamic compromise in pregnancy

A

Unfractionated heparin
Thrombolysis
Surgical embolectomy

78
Q

Triad of pre-eclampsia

A

HOP
Hypertension
Proteinuria
Oedema

79
Q

Risk factors for pre-eclampsia

A

Pre-existing HTN
Previous hypertension in pregnancy
Existing autoimmune conditions - SLE
Diabetes
CKD

80
Q

Symptoms of pre-eclampsia

A

Headache
Visual disturbance or blurriness
Nausea and vomiting
Upper Abdo or epigastric pain
Oedema
Reduced urine output

81
Q

Diagnosing pre-eclampsia

A

Systolic BP >140
Diastolic BP >90
+ proteinuria, organ dysfunction, placental dysfunction

82
Q

Medical management of pre-eclampsia

A

Labetolol (first line)
Nifedipine (second-line)

83
Q

Management of eclampsia

A

Magnesium sulphate

84
Q

What is HELLP syndrome?

A

A complication of pre-eclampsia and eclampsia.

H - Hemolysis
EL - Elevated liver enzymes
LP - Low platelet count.

85
Q

Gestational diabetes- diagnosis

A

OGTT

86
Q

Management of gestational diabetes in pregnancy

A

Fasting glucose <7 mmol/L - trial diet and exercise for 1-2 weeks, then metformin and then insulin

Fasting glucose >7 mmol/L - insulin +/- metformin

Fasting glucose >6mmol/L plus macrosomia - insulin +/- metformin

87
Q

Pre-existing diabetes management in pregnancy

A

Women using metformin and insulin and other oral diabetic medications should be stopped.
Referral to ophthalmology to check for diabetic retinopathy - risk of rapid progression

88
Q

What is obstetric cholestasis?

A

Reduced outflow of bile acids from the liver. It resolves after delivery of the baby

89
Q

How would obstetric cholestasis present?

A

Itching of the palms of the hand and soles of the feet
Fatigue
Dark urine
Pale, greasy stools
Jaundice

90
Q

Investigations of obstetric cholestasis

A

LFTs and bile acids

Raised bile acids
Abnormal liver function tests

ALP is usually raised in pregnancy.

91
Q

What is acute fatty liver of pregnancy?

A

Rapid accumulation of fat within hepatocytes causing acute hepatitis

92
Q

How would acute fatty liver of pregnancy present?

A

General malaise and fatigue
Nausea and vomiting
Jaundice
Abdominal pain
Ascites

93
Q

What is the management of acute fatty liver of pregnancy?

A

Requires prompt admission and delivery of the baby.

Management of acute liver failure and consider liver transplant

94
Q

What are the three causes antepartum haemorrhage?

A

Planceta praaevia, placental abruption, and vasa praevia

95
Q

Risks of placenta praevia

A

Antepartum haemorrhage
Emergency C-section
Emergency hysterectomy
Maternal anaemia and transfusions
Preterm birth and low birth weight
Stillbirth

96
Q

Grading placenta praevia

A

Grade I - placenta is in the lower uterus but not reaching the internal cervical os
Grade II - placenta is reaching but not covering the internal cervical os
Grade III - the placental is partially covering the internal cervical os
Grade IV - the placenta is completely covering the internal cervical os

97
Q

Risk factors for placenta praevia

A

Previous C-sections
Previous placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities - fibroids

98
Q

How would placenta praevia diagnosed?

A

It would present at the 20 week abdominal scan

99
Q

Management of placenta praevia

A

Repeat transvaginal ultrasound scans at 32 and 36 weeks.

Give corticosteroids between 34 and 35+6 weeks to mature foetal lungs due to risk of preterm delivery

Plan delivery between 36 and 37 weeks - to reduce the risk of spontaneous labour and bleeding.

Emergency Caesarean section may be required with premature labour or antenatal bleeding

100
Q

What is the main complication of placenta praevia? How is it managed?

A

Haemorrhage - emergency c section, blood transfusions, intrauterine balloon tamponade, uterine artery occlusion, emergency hysterectomy

101
Q

What is placenta accreta?

A

When the placenta implants deeper, through and past the endometrium. This makes it difficult to separate the placenta after delivery of the baby.

102
Q

Risk factors for placenta accreta

A

Previous placenta accreta
Previous endometrial curettage procedures - e.g. for miscarriage or abortion
Previous Caesarean section
Mutligravida

103
Q

Management of placenta accreta

A

Delivery planned between 35 to 36+6 weeks gestation to reduce the risk of spontaneous labour and delivery.

Options during caesarean are:
Hysterectomy
Uterus preserving surgery
Expectant management - risks of bleeding and infection

104
Q

What is breech presentation?

A

When the presenting part of the foetus is the legs and bottom

105
Q

Types of breech

A

Complete breech - legs are fully flexed at the hips and knees
Incomplete breech - one leg flexed at the hip an extended at the knee
Extended breech - also known as frank breech, with both legs flexed at the hip and extended at the knee
Footling breech - with a foot is presenting through the cervix with the leg extended

106
Q

Management of breech presentation

A

External cephalic version can be used at term 37 weeks to attempt to turn the foetus.

If that fails, women are given the choice between vaginal delivery and elective caesarean section.

Tocolysis - relax the uterus before procedure. Using subcutaneous terbutaline (beta agonist) - similar contractility of the myometrium, making it easier for the baby to turn.

107
Q

What is External cephalic version?

A

A technique used to attempt to turn a foetus from the breech position to a cephalic position using pressure on the pregnant abdomen.

Nulliparous - attempt after 36 weeks
Women with previous births - after 37 weeks

108
Q

Causes of stillbirths

A

Unexplained
Pre-eclampsia
Placental abruption
Vasa praevia
Cord colapse
Obstetric cholestasis
Diabetes
Thyroid disease

109
Q

Causes of obstetric haemorrhage

A

Ectopic pregnancy
Placental abruption
Placenta praevia
Planceta accreta
Uterine rupture

Obstetrics and Gynaecology (9 decks)

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