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Antenatal Care Flashcards

1
Q

1st line treatment for magnesium sulphate induced respiratory depression?

A

Calcium gluconate

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2
Q

Dosing of magnesium sulphate in eclampsia?

A

Initial IV bolus of 4g over 5-10 mins then an IV infusion of 1g/hour
Needs to be continued until 24 hrs after delivery or after the last seizure whichever was latest

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3
Q

What is the general trend for blood pressure through pregnancy?

A

BP normally falls in the 1st trimester (especially the diastolic reading) up until 20-24 weeks then it starts to gradually increase back to pre-pregnancy level by term in a healthy pregnancy

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4
Q

What is the earliest gestation that you can develop pre-eclampsia or gestational hypertension?

A

20 weeks!
HTN before then is chronic hypertension!!

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5
Q

Between what gestations is fetal fibronectin licensed for use in SYMPTOMATIC WOMEN SUSPECTED TO BE IN PRETERM LABOUR

A

Between 22 - 35 weeks (<35 weeks) gestation
High negative predictive value
(ie a negative test can be fairly certain not in preterm labour, a positive test doesn’t necessarily mean they are definitely in preterm labour)

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6
Q

Which vitamin supplement should be avoided / taken with caution in pregnancy?

A

Vitamin A
Consumption > 700 mcg/day may be teratogenic (similarly liver is v high in Vit A so should be avoided)

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7
Q

What are the NICE recommendations for vitamin supplementation during pregnancy?

A

Everyone:
- Folic Acid 400 mcg/day pre-conception - 12 wks
- Vitamin D 10 mcg/day

Avoid Vit A supplementation as levels > 700mcg/day may be teratogenic
Do not ROUTINELY recommend iron supplementation unless known to be low

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8
Q

What is the initial management of women newly diagnosed with gestational diabetes depending on their FBG level?

A

If FBG <7 at diagnosis, initially trial lifestyle modification. Offer metformin if glucose targets not met after 1-2 weeks

If 6 - 6.9 plus signs of baby being affected (macrosomia, hydramnios) then commence insulin

If FBG 7+ at diagnosis, commence short-acting insulin regime +/- metformin

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9
Q

1st line management of DIC in maternal haemorrhage?

A

Take clotting studies and Plts.
Can give upto 4x units FFP and 10x units cryoprecipitate while awaiting bld results

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10
Q

RCOG recommendations for flying during pregnancy?

A

Uncomplicated singleton pregnancy - ok <37 weeks (avoid 37+0 onwards)

Uncomplicated multiple pregnancy - ok <32 weeks (Avoid 32+0 onwards)

From 28 weeks most airlines need a letter from the doctor confirming uncomplicated pregnancy.

If no other risk factors for DVT and flight < 4 hrs - no precautions needed
If no other risk factors for DVT and flight > 4 hrs -> compression stockings, hydration and regular movements

If other risk factors for DVT - may be prescribed heparin inj for day of flight and few days after (individualised)

THERE IS NO EVIDENCE THAT LOW DOSE ASPIRIN REDUCES DVT RISK

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11
Q

Risk factors for placenta previa?

A

Multiparity
Multiple pregnancy
Prev LSCS (placenta will implant near scar site)

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12
Q

RCOG recommended initial investigation if suspect placenta previa ie antepartum haemorrhage?

A

TV USS !!! (improved accuracy than TA and considered safe!)

DO NOT do a digital exam prior to USS as ^ risk of provoking haemorrhage

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13
Q

Grading system for placenta previa?

A

Grade I - covers the lower segment but does not touch the internal os
Grade II - reaches the internal os but doesn’t cover it
Grade III - partially covers the internal os when not dilated
Grade IV / major - completely covers the internal os

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14
Q

What is the main risk associated with SSRI use in the 1st trimester?

A

SSRI s in 1st trimester = ^ risk of congenital cardiac abnormalities

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15
Q

Risk factors for hyperemesis gravidarum?

A

Nulliparity [first pregnancy]
^ level of beta HCG (multiple pregnancy, trophoblastic disease)
Obesity
Family or personal history of N+V of pregnancy

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16
Q

Conditions required for a diagnosis of hyperemesis gravidarum?

A

Triad of
1) 5% weightloss from pre-pregnancy weight
2) Electrolyte imbalance
3) Dehydration

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17
Q

What are the risk factors that influence whether a woman gets LDA during pregnancy (75-150mg from 12 - 36 wks) to reduce the risk of pre-eclampsia?

A

HIGH RISK FACTORS (if 1 or more present give LDA)
- Hypertensive disease in prev pregnancy
- Chronic hypertension
- Chronic kidney disease
- SLE or antiphospholipid syndrome
- Type I or II diabetes

MODERATE RISK FACTORS (if 2 or more present give LDA)
- 1st pregnancy
- interpregnancy interval of >10 yrs
- Age 40+
- BMI 35 or over
- Multiple pregnancy
- Family history of pre-eclampsia

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18
Q

What are the maternal and fetal risks of post term pregnancys (42+0 +)

A

Fetal - oligohydramnios, reduced placental perfusion, increased stillbirth risk
Maternal - increased risk of instrumental delivery and c-section

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19
Q

When and why are pregnant women offered the whooping cough (bordatella pertussis) vaccine?

A

Between 16 - 32 weeks

To reduce the risk of neonatal whooping cough which carries significant morbidity / mortality

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20
Q

What is the first line treatment for magnesium sulphate induced respiratory depression?

A

Calcium gluconate

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21
Q

when is the combined test offered to pregnant women to screen for trisomy 13, 18 and 21 (Pateau, Edward’s and Down’s syndromes)

A

Combined test (nuchal translucency + PAPP-A + HCG) should be done 11+0 - 13+6 weeks

Between 15-20 wks (Late bookers) - the quadruple test should be used instead -> HCG, alpha fetoprotein, unconjugated Oestriol, inhibin A

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22
Q

What is the 1st line oral agent to switch women with pre-existent hypertension to in pregnancy?

A

Labetalol 1st line

[oral nifedipine can be used if asthmatic)

(ACEi and Ca channel blockers should be stopped as they are TERATOGENIC)

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23
Q

What are the diagnostic criteria for gestational diabetes?

A

Fasting blood glucose > 5.6
OR
2-hr post glucose challenge > 7.8

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24
Q

How should women with pre-existing diabetes be managed when trying to conceive?

A

Stop oral antiglycaemics other than metformin (can continue insulin)
Weightloss if BMI >27
Folic acid 5mg / day pre-conception - 12 wks
Detailed anomaly scan at 20 weeks with 4-chamber view of heart

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25
What is the main pregnancy complication associated with retroverted uteruses?
They may have transient urinary retention ~ 12 weeks when the uterus gets trapped in the pelvis, normally just need an IDC for 1-2 weeks until the uterus has risen out of the pelvis
26
If a woman has had 1 pregnancy which resulted in twin live births what would be her gravity and parity?
G1P2 (twins are one pregnancy but two paritys!)
27
What pregnancy complications are associated with periodontitis (teeth & gum infections)
Preterm delivery & low birth weight Pregnant women are entitled to free dental care during pregnancy and until child is 1 yr
28
What is the approximate risk of miscarriage at each age group in the reproductive period?
12-19: 13% 20 - 24 - 11% 25-29 - 12% 30-34 - 15% 35-39 - 25% 40-44 - 50% 45+ - 90%
29
What is the recommended Tx for women with recurrent miscarriage in the context of antiphospholipid syndrome and how effective is this at reducing further miscarriages?
low-dose aspirin & heparin reduces ongoing miscarriage rate by ~ 50%
30
What results on combined screen test is suggestive of Down's syndrome?
Increased nuchal translucency Increased beta HCG Low PAPP-A
31
Definition & causes of oligohydramnios?
= <500ml amniotic fluid or AFI <5th percentile 32-36 weeks Causes: IUGR PPROM Potter sequence (bilateral renal agenesis + pulmonary hypoplasia) Post-dates Pre-eclampsia
32
What is the risk of fetal loss associated with amniocentesis?
0.5 - 1%
33
When should statins be stopped prior to trying to conceive?
3 months before TTC (the change in cholesterol synthesis is thought to affect fetal development)
34
What are the Hb thresholds for commencing oral iron in pregnancy?
1st trimester = < 110 2nd & 3rd trimester = < 105 Postpartum = < 100 1st line = oral ferrous sulphate or fumerate, continue for 3 months after levels corrected to replenish stores
35
What is the significance of an isolated low PAPP-A in the combined screening test?
If the other parameters of the combined screening test (nuchal translucency, HCG) are normal, an isolated PAPP-A is NOT associated with an increased risk of Down's syndrome or other aneuploidys Isolated low PAPP-A = possibly associated with placental insufficiency = ^ risk of IUGR / preterm labour / pre-eclampsia / placental abruption Offer serial growth scans through pregnancy to monitor for iUGR
36
Indications for CONTINUOUS CTG monitoring during labour?
New PV bleed during labour Chorioamnionitis / sepsis / temp > 38 BP > 160/110 Oxytocin use Presence of significant meconium
37
What are the recommended strategies for induction of labour depending on Bishop score?
Bishop Score 6 or less = vaginal prostaglandin or oral misoprostol Bishop Score > 6 = amniotomy & IV oxytocin
38
What are the different stages of placental infiltration?
Placenta acreta - chorionic villi grow into the myometrium Placenta increta - chorionic villa deeply invate IN to the myometrium placenta percreta - chorionic villia Penetrate the Perimetrium & all layers of the uterus and may even extent to surrounding organs.
39
What is the classical presentation of atopic eruption of pregnancy?
Most common rash in pregnancy 2nd / 3rd trimester Itchy erythematous nodules face, neck & chest & extensor surfaces Benign - nil adverse impact on mum or baby
40
What is the classical presentation of polymorphic eruption of pregnancy?
3rd trimester Itchy red rash, initially appears in abdominal striae then can spread across trunk and limbs (PERI-UMBILICAL SPARING) Mx with emollients & topical / orial steroids
41
What is the classical presentation of pemphigoid gestationis?
Rare blistering disorder in pregnancy 2nd / 3rd trimester (more common in subsequent pregnancies, not first pregnancy) Ovoid blisters appears peri-umbilical then spread to trunk & limbs - itchy Mx = oral steroids (Note: prolonged or repeated oral steroids = ^ IUGR, short courses are fine in pregnancy)
42
What is the typical presentation / complications associated with listeria infection in pregnancy?
Listeria 20x more likely to infect pregnant women Unpasteurised dairy products Gram positive bacilli - See 'tumbling' motility on wet prep Presents with gastroenteritis / can present with listeria meningitis Tx = Amoxicillin / Ampicillin (plus gent if meningitis) Placental and vertical transmission possible during childbirth Complications in pregnancy = miscarriage, stillbirth, preterm labour and chorioamnionitis
43
When is elective C section recommended for women with genital herpes?
If primary genital herpes infection beyond 28 weeks gestation
44
What is the first line antibiotic for pregnant women with cellulitis if penicillin allergic?
Erythromycin
45
What is the typical presentation and complications associated with Toxoplasmosis infection in pregnancy?
Toxoplasma = protozoa Infection usually from cat faeces or occasionally rats Immunocompetent people usually asympto In pregnancy / immunosupressed - may present similarly to epstein barr (low-grade fever, cervical lymphadenopathy, sore throat) 60% risk of transmission to the fetal in pregnancy Congenital Toxoplasmosis = congenital retinopathy & cataracts, cerebral calcification & hydrocephalus Cerebral toxoplasmosis - responsible for 50% of cerebral lesions in HIV patients - ring-enhancing lesions on CT
46
What is the typical presentation of Parvovirus B19 and what are the concerns with contraction during pregnancy?
Fifth disease / Parvovirus B19 / Erythema infectiosum / Slapped cheek disease Presentation: mild feverish prodrome then development of rose-red rash on cheeks then spreading to rest of body. BY THE TIME THE RASH DEVELOPS THEY ARE NO LONGER CONTAGIOUS rash peaks after a few weeks then fades, may be re-triggered by warm baths, sunlight in the recent months after. Dangerous in pregnancy, esp if contracted < 20 weeks Supresses erythropoietis in the fetus = fetal anaemia & hydrops If suspect maternal infection or exposure, measure serum IgM and IgG at baseline then at day 10-14 to assess for rising titres If positive, serial USS to assess for fetal anaemia IgM pos IgG neg - recent infection, refer to fetal med IgG pos IgM neg - immune Both neg - repeat in 4 weeks
47
The use of anti-depressents in pregnancy
NO ANTIDEPRESSENTS ARE LICENSED FOR USE IN PREGNANCY however many women may need to continue them into pregnancy The main one to avoid is the MAOI Phenelzine = ^ risk of congenital malformations & maternal hypertensive crisis Most of the risks are quite small: SSRIs - small ^ risk of congenital heart disease with use in first trimester, risk of pulmonary hypertension in 3rd trimester, small risk of neonatal withdrawal Tricyclics (amitriptyline, imipramine) associated with neonatal tachycardia & resp depression
48
How to manage a woman that has become pregnant / wants to conceive on Lithium?
Lithium is teratogenic and risks Ebstein anomaly (congenital heart defect where the tricuspid valve doesn't form properly so the R atrium & ventricle are one) Ideally if safe to stop, should wean off slowly over 4 weeks Over if unstable, either switch to other anti-psychotic OR if must continue in pregnancy, need 4 weekly monitoring of lithium levels increased to weekly from 36 weeks. Lithium should be stopped during labour.
49
What are the typical blood investigations found in antiphospholipid syndrome?
Positive antiphospholipid antibodies (lupus anticoagulant, anticardiolipin, anti-Beta2 glycoprotein) Elevated APTT Thrombocytopenia (low plts)
50
Is there an association between primary genital herpes infection and miscarriage in the first trimester?
No!
51
How should suspected DVT / PE be managed in pregnancy?
D-Dimer not useful as elevated anyway in pregnancy If signs/symptoms of DVT - compression duplex USS If signs/symptoms of PE - ECG & CXR in all pts and leg uSS if co-existent signs/sx of DVT (if USS positive then start anticoagulation without the need to investigate further) If ECG & CXR normal - V/Q Scan If any abnorm
52
When should LSCS be scheduled for placenta previa?
36 - 37 weeks if uncomplicated 34 - 37 weeks if complicated by vaginal bleeding or risk factors for preterm delivery
53
When should LSCS be scheduled for placenta acreta?
If nil risk factors for preterm delivery: 35 - 37 weeks
54
What is the definition of macrosomia?
Birth weight > 4 kg regardless of gestational age
55
What is the normal range of symphyseal fundal height?
Should be the same as the gestation in CMs after 20 weeks +/- 2cm ie at 24 weeks should be 22 - 26 cm
56
When should fetal movements have been felt by?
24 weeks If nil FMs felt by then refer to feto-maternal unit
57
How long before conceiving should methotrexate be stopped in men AND women?
Should be stopped at least 6 months prior to conceiving in BOTH MEN AND WOMEN (also damages sperm)
58
How should women with rheumatoid arthritis be managed that are trying to conceive or pregnant?
Early/uncontrolled RA - encouraged to delay pregnancy until disease more stable Methotrexate needs to be stopped at least 6 months prior to TTC in both men and women Sulfasalazine & hydroxychloroquine are both considered safe in pregnancy NSAIDs can be used but should be stopped from 32 weeks to prevent early closure of PDA. Should be referred to obstetric anaethetist due to the risk of atlanto-axial subluxation
59
How should HYPERthyroidism be managed in pregnancy?
Most common cause of hyperthyroidism in pregnancy is Grave's disease (can also get transient gestational hyperthyroidism due to the affect of HCG which normally resolves in later pregnancy) Aim for maternal free thyroxine levels in the upper 1/3rd of the reference range to avoid fetal hypothyroidism Block & replace regimes or radioactive iodine contraindicated in pregnancy 1st trimester - switch to Propylthiouracil as carbimazole teratogenic At the beginning of the 2nd trimester -> switch back to carbimazole as propylthiouracil associated w/ hepatic injury
60
How should HYPOthyroidism be managed in pregnancy?
Measure TFTs in each trimester and at 6 weeks postpartum Need to increase thyroxine dose by upto 50% as early as 4-6 weeks gestation (normally ^ by 25 - 50 mcg initially) Thyroxine is safe in BF !!
61
How should women found to be non-immune to rubella in pregnancy be managed?
Offer immediate postpartum rubella vaccination (safe even if BF) - advise not to conceive for 3 months prior to vaccination Rubella in pregnancy: Presents w/ low grade fever, sore throat and rash on face that then spreads to rest of body. Difficult to differentiate from Parvovirus. Infectious 7 days pre-symptoms to 4 days post-rash developing Congenital rubella syndrome (higher risk if infected in 1st trimester): - Sensorineural deafness - Congenital cataracts & salt and pepper chorioretinitis - Hepatosplenomegaly
62
Bishops score of cervical favourability?
Cervix soft - + 2 Cervix intermediate = + 1 Cervix form = 0 Cervix anterior - +2 Cervix intermediate = + 1 Cervix posterior = 0 Cervix 80% effaced = + 3 60-70% effaced - + 2 40-50% = + 1 <40% = 0 Cervix > 5cm dilated = + 3 3-4cm dilated - + 2 1-2cm = + 1 <1cm = 0 Fetal station +1/+2 = +3, 0/-1 = +2, -2 = + 1 -3 = 0 Bishops Score 8+ = favourable IOL If Bishops Score 6 or less = vaginal or oral prostaglandins (or balloon stimulation if at risk of hyperstimulation or prev C-section) If Bishop Score > 6 = amniotomy and synto augmentation if needed
63
What results on quadruple trisomy screening is suggestive of Down's syndrome?
High HCG High inhibin A Low AFP Low Oestriol
64
What results on quadruple screening is suggestive of edwards & Pateau syndrome?
Low HCG Normal inhibin A Low AFP Low Oestriol
65
What result on quadruple screening is suggestive of neural tube defect eg spina bifida
Isolated high AFP
66
What components of fetal wellbeing does a biophysical profile USS assess?
Fetal movements Fetal tone Amniotic fluid level Reactivity of the heart after non-stress test Fetal breathing pattern
67
In which conditions is a planned vaginal instrumental delivery indicated?
Myaesthenia gravis Proliferative retinopathy Cardiac disease class 3 and 4 Hypertensive crises Spinal cord injury
68
What is the Rubin maneuvre in the context of shoulder dystocia?
Pushing up on the posterior shoulder to try and free the anterior shoulder
69
What is. the woodscrew maneuvre in the context of shoulder dystocia?
Pushing the head up and trying to rotate it 180 degrees
70
How should a potentially sensitising event after 20 weeks of pregnancy be managed in someone rhesus negative
Kleihauer to measure degree of fetomaternal haemorrhage If positive and < 4ml give 500 IU Anti D If > 4ml give extra 125 IU for every extra 1 ml Anti D needs to be given < 72 hours in order to be effective
71
What is the typical presentation of amniotic fluid embolism?
Normally occurs during labour although can occur during c-section or immediately postpartum Presents w/ sudden onset SOB, chills / shivering, hypotension, arythmia, MI 90% mortality rate
72
What are risk factors for amniotic fluid embolism?
Excessive oxytocin augmentation Multiparity Prolonged labour Fetal demise Placental abruption
73
What is the timing and dose of anti d prophylaxis in pregnancy?
either single dose regime (= 1,500 IU at 28-30 weeks) or 2-dose regime (500 IU at 28 and 34 weeks)
74
How many antenatal apts should be planned for an uncomplicated pregnancy?
10 for nullips 7 for multips
75
What are the criteria for diagnose GDM?
Fasting BGL > 5.8 or 2 hr post OGTT > 7.8
76
what are the target BGLs for women with any kind of diabetes in pregnancy?
Fasting BGL < 5.3 1 hr postprandial < 7.8 2 hr postprandial < 6.4
77
Which trisomies can NIPT testing look for?
Trisomy 13, 18 and 21
78
which vaccines are NOT recommended in pregnancy?
LIVE vaccines including - BCG (TB) - MMR - Yellow fever (if travelling to v high risk area risk of infection may exceed risk of vaccine) - oral polio - oral typhoid
79
Which women are at increased risk of hypogylcaemia while breast feeding?
Diabetics on INSULIN (oral antihyperglycaemics do not increase the risk of hypoglycaemia while BF)
80
At what Hb level is a woman considered anaemic in the 2nd or 3rd trimester?
Hb < 105
81
What are signs of CS scar dehiscence during labour?
PV bleeding Fetal distress Cessation of uterine contractions
82
Where should a swab for GBS be taken in a pregnant woman? (routine screening not recommended - only offer in third trimester if GBS in prev pregnancy or baby affected by neonatal GBS infection)
Low vaginal swab & anorectal swab (can be same swab or two different swabs)
83
Which women are advised to supplement their diet with daily vitamin d?
Obese people with BMI > 30 recommended to supplement 10 mcg Vit D daily during pregnancy and breast feeding TO REDUCE THE RISK OF RICKETS IN THE NEONATE Obesity = increased risk of Vit D deficiency
84
What is the mortality associated with a planned breach vaginal delivery ?
2 in 1,000
85
What is the upper limit of normal respiratory rate in a pregnant woman?
20
86
Why is chorionic villus sampling normally delayed until at least 11 weeks gestion?
CVS carries a risk of limb reduction defects Conducting it > 11 weeks reduces the risk of this CVS can theoretically be conducted at any gestation
87
What are the indications for prenatal aspirin to reduce the risk of pre-eclampsia? (12 wks -> term)
1 high risk factor [hypertensive disorder in a prev pregnancy, chronic hypertension, CKD, diabetes, SLE or antiphospholipid syndrome] OR 2 moderate risk factors (first pregnancy, pregnancy interval > 10 years, age > 40, pre-eclampsia in first degree relative, BMI > 35, multiple pregnancy]f
88
How should a pregnant woman who has been exposed to swine flu be managed?
She should be offered the H1N1 vaccine immediately, being counselled that it will not be fully effective for 3 weeks and only confers ~ 75% protection
89
When is the earliest gestation NIPT testing should be offered?
10 weeks (any earlier than this risks false negative results) MUST HAVE HAD AN USS TO CONFIRM GESTATIONAL AGE BEFORE THE NIPT TEST / HARMONY TEST
90
How should known GBS +ve women with PROM be managed
IMMEDIATE IOL and commence IV Benzylpenicillin every 4 hrs during labour IF THE BABY IS BORN WITHIN 2 HOURS OF THE FIRST DOSE OF BENPEN THEN THE BABY WILL NEED IV ABX (this differs from the management of PROM in women not GBS +ve where you would wait 24 hrs before IOL)
91
True or false. The risk of CS scar rupture is greater in women who had chorioamnionitis or peripartum fever in their previous delivery?
TRUE infection around the time of the prev CS scar formation = ^ risk of poor scar healing = ^ risk of dehiscence
92
What is the approximate UK stillbirth rate
1 in 200
92
What is the combined screening test for trisomies?
Combined test assesses for T21, 18 and 13 Can do between 11+2 - 14+1 weeks Factors in: Maternal Age Nuchal transulency (> 3.5mm associated w/ T21,18,13 and congenital cardiac malformations) Serum PAPP-A and bHCG T21 - low PAPP-A, high HCG, high NT T18 & t13 = low PAPP-A & low HCG, high NT Smokers at ^ risk of false positive as smoking reduces PAPP-A and increases inhibin
93
What is the quadruple screening test for trisomies?
bHCG, inhibin, oestriol & AFP Can do between 14+2 - 20+0 weeks T21 - high bHCG, high inhibin, low oestriol, low AFP T18/13 - low bHCG, normal inhibin, low oestriol, low AFP
94
When can NIPT be offered to women and what can it look for?
NIPT should be offered from 10 weeks (Any earlier increased risk of false negatives) upto 22 weeks NIPT CANNOT BE OFFERED IN TRIPLET OR HIGHER ORDER PREGNANCIES OR AFTER 22 WEEKS OR IF ACTIVE MATERNAL CANCER OR RECENT BLOOD TRANSFUSION IN PAST 4 MONTHS OR RECENT IMMUNO OR STEM CELL THERAPY Can offer to women with increased risk on combined / quadruple testing - if their risk is between 1 in 2 to 1 in 150. The NIPT offered on the NHS only screens for T21, 18 and 13 and not for other chromosomal abnormalities or gender.
95
Prenatal diagnosis options
CVS or amniocentesis - should be made available to the woman within 3 working days of a high risk screening or NIPT test Miscarriage rate = 1 in 200 Both under continuous USS guidance Both send samples for Qf-PCR - A tri-allelic result is a positive result for either T21, 18 OR 13 - A bi-allelic result normally means it is positive but there is a small chance it is representing placental mosaicism (the chormosomal abnormality is present in the placenta but not the baby) - A 1:1 ratio is negative for the trisomy
96
What specific requirements / risks do obese patients have during pregnancy?
BMI > 30: - Need Folic Acid 5mg OD from at least 1 month prior to conception to 12 wks - Gestational diabetes screening - All obese women should have intrapartum CTG monitoring and are at ^ risk of stillbirth - All obese women are at ^ risk of wound infection so need prophylactic abx after CS - Obesity is associated with low BF initiation and maintenance rates BMI > 35 - BMI > 35 is a moderate risk factor for pre-eclampsia (So if one other moderate factor present then needs antenatal aspirin) - BMI > 35 SFH likely to be inaccurate - must refer for serial growth USSs BMI > 40 - Need a moving & handling risk assessment in the third trimester - need referral to obstetric anaethetist - pre-emptive IVC insertion during early labour Losing weight for future pregnancies reduces the risk of stillbirth, hypertensive disorders, fetal macrosomia and increases the chance of a successful VBAC Women should be advised to avoid pregnancy for 12 - 18 months post bariatric surgery Women who have had prev bariatric surgery are high risk pregnancies and need obstetric led antenatal care
97
What percentage of pregnancies are complicated by preterm labour (<37 wks)
5-10%
98
What is the most common organisms in lactional breast abscess
staph aureus
99
At what time point postpartum is USS indicated to investigate ongoing lochia?
after 6 weeks
100
Peri-conception care in women with sickle cell disease?
Should be seen pre-conceptually by a sickle specialist to discuss the risks of pregnancy should be screened for pulmonary hypertension with echo, retinal screening for proliferative retinopathy, screening for iron overload. Should check haemoglobinopathy status of partner to assess risk to the baby - if partner a carrier then offer referral for genetic counselling and pre-implantation genetic diagnosis. Need: * Daily Penicllin (or erythromycin if pen allergic) to protect from encapsulated bacteria [as hyposplenic] * Folic Acid 5mg pre-conceptually and THROUGHOUT pregnancy (sickle cell need daily folate even when not pregnant) * Low dose aspirin from 12 weeks as ^ risk of pre-eclampsia * LMWH during hosp admissions and 1 wk post SVD or 6 wks post LSCS * Serial growth scans every 4 weeks from 24 weeks (^ risk of FGR) * Hydroxycarbamide, ACEi / ARBS must be stopped at least 3 months prior to conception * DO NOT USE Pethidine for analgesia in sickle cell= ^ risk of seizures * IOL or LSCS at 38-40 weeks Progestogen-containing contraception first line in sickle cell (LNG-IUS, POP, Implant or Depot) Cu-IUD & COCP both UKMEC 2

DRCOG (10 decks)

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