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Obs & Gyn > Antenatal Care > Flashcards

Antenatal Care Flashcards

1
Q

Which 3 features of female pelvis should be palpable O/E

A

Ischial spines, sub-pubic arch, sacrospinous ligament base

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2
Q

What important features of Hx (5) /Ex (3) are taken at booking?

A 
LMP
Sexual Hx 
Ob Hx
PMH(/Surgical)
FH + SH*

Smear (if overdue)
Obs
Abdo exam

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3
Q

What other (blood) tests are done on booking?(4)

A

HIV/Hep/Syphilis
Rubella immunity
FBC
Rh Grp/sickle/thalass

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4
Q

What is done at 9-12wks?

A

Dating scan (+ if twins)
Trisomy blood tests (+poss CVS)
Nuchal translucency

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5
Q

What is done at 20wks?

A

Anomaly USS

Counsel if any abns

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6
Q

List some anomalies scanned for at 20wks (6)

A 
Gastroschisis
Exopthalmos
ToF/Cardiac
Diaphragmatic hernia
Duodenal fistula (Down's + polyhydramnios)
Neural tube defects
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7
Q

What may USS’s later (>20wks) be done for?

A

Breech
Suspected IUGR
Polyhydramnios

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8
Q

Most common neural tube defects + Incidence (%)

A

Spina bifida + Anacephaly

0.5%

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9
Q

Incidence of cardiac defects
Commest type
How/when Dx

A

1%
VSDs commonest
increased nuchal translucency 9-12wk USS

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10
Q

3 RFs for cardiac defects

A

Congenital cardiac disease/structural/csomal abn
Previous affected offspring (3% recurrence)
DM

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11
Q

Describe difference b/wn exopthalmos + gastroschisis

A

Exopth: abdo extrusion in peritoneal sac - 50% csomal prob
Gastro: free bowel loops in amniotic cavity (rarely csomal)

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12
Q

What do diaphragmatic hernia babies usually die of

A

other structural abns / plum hypoplasia

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13
Q

Incidence of polyhydramnios + RFs (5)

A 
1%
Idiopathic
DM
Renal Failure
Twins
Fetal anomaly (structural/ e.g. dystrophy)
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14
Q

4 clinical features of polyhydramnios

A

maternal discomfort
unpalpable fetus
symphisis fundal height >90th centile
liquor pool >10cm

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15
Q

2 complications of polyhydramnios

A

preterm

abnormal lie

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16
Q

When/how is polyhydramnios managed?

A

<34wks + severe

Amnioreduction
NSAIDs (reduce fetal urine output) / Steroids

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17
Q

What are some causes of fetal hydrops (Immune/Non-immune)

A

Immune: haemolytic anaemia

Non imm: csomal, structural, cardiac, cardiac failure assoc anaemia, twin-twin transfusion syndrome

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18
Q

Indicators/RFs for Trisomy 21 (5)

A 
Maternal age
Prev affected baby (+risk 1%)
Carriers of genetic translocation
Thickened NT
Structural abns
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19
Q

What tests (+ in which trimesters) used for risk assessment of Downs

A

1st T: age + B-hCG + PAPP-A (= risk assessment - 75% sensitivity)
2nd T: Oestriol +hCG-B + AFP (= triple test)

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20
Q

What % people Rh-ve?

What are diff subtypes of Rh Grps

A

15%

C, D + E (only D bio active)

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21
Q

% Rh-ve mothers carry Rh+ve baby? (thus % of all preg woman risk developing anti-D Abs)

A

2/3rd Rh-ve mums carry Rh+ve

= 10% all preg woman

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22
Q

Describe the pathophysiology of Rhesus disease

A

initial exposure -> small IgM response (doesn’t cross placenta)
subsequent exposure -> larger IgG response (does cross)
RBC destrcution + anaemia (unless sufficient haemopoeisis from BM/liver/spleen)
-> hypoxia + acidosis (-> hepatic/cardiac func)
-> fetal hydrops

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23
Q

What is fetal hydrops

A

Generalised oedema of skin/ascites

Pleural/pericardiac effusion

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24
Q

Other effects of rhesus disease (other than feral hydrous)

A

Postnatal jaundice (increased haemolysis/bilirubin) thus can -> kernicterus

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25
Q

What kind of immunity does IM anti-D give

A

Passive immunity in non-sensitised woman

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26
Q

What dose of anti-D given (+ within what hours after event)

A 
<20wks = 250iu within 72hrs
>20wks = 500iu
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27
Q

What test should be done after delivery in Rh-ve woman

A

Fetal cord sample - Rh Grp of baby

if baby Rh+ve -> blood film of mum’s for Kleihauer test (quantifies antiD dose needed)

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28
Q

What causes of placental bed disruption can -> feto-maternal haemorrhage (7)

A

Birth
Miscarriage / ectopic
APH
Spontaneous bleed

Trauma
Amniocentesis
EVC

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29
Q

What 3 factors would mediate an immune response from feto-maternal haemorrhage in a Rh-ve woman

A

Blood volume
Maternal responsiveness
Antigenic potential

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30
Q

Why would ABO incompatibility paradoxically be able to offer some protection against Rh disease?

A

Transfused cells are likely to be haemolysed by circulating maternal Abs (reducing risk of Rh immunisation)

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31
Q

What 2 features may present with Rhesus disease of newborn

A

Reduced fetal movements

Polyhydramnios

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32
Q

What fetal assessments may be done in Rh-ve women

A

Cerebral aa doppler + CTG + fetal movements

abnorm parameters -> fetal blood sample

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33
Q

Risk of fetal blood sample / cordocentesis

A

Cord haematoma
Fetal bradycardia
Intrauterine death
Further maternal sensitisation

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34
Q

At what IU/ml antibody is classed as significant

A

> 15IU/ml (or a sudden rise)

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35
Q

if Rh intra-utero transfusion (IUT) occurs, how is delivery done?

A

induce at 35wks: mild - NVD, hydropic - C-sec

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36
Q

Survival rates for non-hydropic/hydropic fetuses

A 
non-hydropic = >90%
hydropic = 75%
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37
Q

Indicators for high-risk pregnancy / consultant-led care

6 prepregnancy RFs + 5 antenatal RFs

A 
Poor Ob Hx
Prev small baby
Maternal disease
Assisted conception
Extremes of repro age
Drugs/smoking
Hypertension/proteinuria
Vag bleeding
SGA baby
Prolonged preg
Multiple preg
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38
Q

Increased PAPP-A suggests…?

Decreased PAPP-A suggests…?

A 
increased = abnormal no/ csomes 
decreased = placental problems
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39
Q

What are the criteria for glucose tolerance testing

A

FH DM
Persistent glycosuria
Previous LGA baby

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40
Q

Maternal smoking is associated with: (5)

A 
Low birth weight / IUGR
Placental abruption
Emotional/Intellectual impairment
Pre-term labour
SIDS
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41
Q

Incidence of breech presentation at:
20wks
32wks
Term ?

A 
20wks = 40%
32wks = 25%
Term = 3%
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42
Q

What 5 conditions are assoc w. breech presentation

A 
Fibroids
Multiple preg
Bicornuate uterus
Placenta praevia
Poly/oligohydramnios
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43
Q

What Fe level / MCV would be indication for Fe supplements

A

Fe < 10.5 g/dl

MCV < 80fl

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44
Q

What 3 things associated with Prolonged pregnancy increase the perinatal mortality rate?

A

unexplained intrauterine death
meconium aspiration syndrome
intrapartum hypoxia

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45
Q

What 4 parameters assessed in Fetal Biophysical Profile (BPP)?
+ 2 advantage/disadvantages over other fetal assessments

A

Breathing Movements
Movements
Tone
Liquor

Useful in high-risk (where CTG/Dopp ambiguous)
Not useful in low-risk + time consuming

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46
Q

What does Umbilical aa Doppler assess/ correlate with?

What does the graph look like

A

Downstream placental vascular resistance
Reduced blood flow correlates with fetal compromise

End-disastolic flow may stop/reverse

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47
Q

What is Umbilical aa Doppler good for assessing?

A

Pregnancies at risk of hypoxia (due to impaired placental func)
No use in low-risk preg

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48
Q

Which Abx should be avoided/cautioned in pregnancy?

A

Avoid: Tetracycline + Trimethoprim
Caution: Metronidazole + Augmentin

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49
Q

What psychiatric drugs should be avoided in preg?

What anticonvulsants should be avoided in preg?

A

Lithium, Paroxetine

Lamotrigine, Valproate (carbamazepine best)

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50
Q

What antihypertensives/anticoag drugs should be avoided in preg? + why?

A

ACEis - teratogenic + fetal renal failure

Warfarin - teratogenic

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51
Q

When can USS most accurately determine gestation + why?

+ what are the most reliable measurements taken from USS? (+when)

A

<20wks - presumed all foetuses same size til then

Crown-rump length: 8-14th wk
Biparietal diameter: 16-20th wk

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52
Q

What genetic factors can lead to a small baby?

A

Ethnicity (asian)
Csome abns (Trisomy)
Female

Structural abns

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53
Q

What fetal infections can lead to a small baby?

A

CMV, Toxoplasmosis, Malaria, Rubella

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54
Q

What maternal factors can lead to small baby? (8)

A 
Extreme starvation
Oxygen supply: high altitude, congenital heart disease (chronic hypoxia)
Tobacco + alc
Maternal chronic disease
Pregnancy complications (pre-ec)
Low maternal ht/wt
Maternal nulliparity
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55
Q

How does a fetes with congenital heart disease + chronic hypoxia (partly) compensate for better oxygen supply?

A

Placental hypertrophy

56
Q

How does the placental normally develop in the 1st + 2nd Trimester?

A

1stT: trophoblast cells invade spiral aa’s in decidua
2ndT: trophoblast extends invasion along spiral aa’s into myometrium

57
Q

How to maternal vessels change within placenta in 2ndT?

A

Thick muscular vessels w/ high resistance

Flaccid thin-walled vessels w/ low resistance

58
Q

How may failure of 2nd stage (e.g. pre-eclampsia) of placental development actually → placental vasoconstriction?

A

Placental ischaemia ⇒ endothelial cell damage → reduced prostacyclin (vasodil) + raised thromboxane (vasocon) → net placental vasocon

59
Q

How does the fetus compensate for hypoxia (NB not chronic - placental hypertrophy)

How does this present in the baby?

How is this phenomena investigated/Dx?

A

Increased erythropoesis (to increase O2 carrying capacity)

Reduced flow to peripheral circ + redistributed to heart/brain/adrenals

Normal length / brain development but little glycogen stores / subcutaneous fat

Middle cerebral aa Doppler shows head sparing (increased end-diastolic in MCA)

60
Q

How is a SGA baby managed?

How is IUGR baby managed at:
36+wks?
34-36wks?
<34wks?

A

2wk serial growth scans w/ umbilical aa Dopplers - no Ix required

36+ wks → deliver
34-36wks → regular umbilical aa Doppler + CTG + consider delivery
<34wks → same as 34-36wks but with steroids

61
Q

What incidence of hypertension in pregnancy?

+ 3 diff types?

A

15% pregnancies
Pre-existing (identified <20wks)
Pregnancy-induced
Pre-eclampsia

62
Q

What BP changes happen in normal pregnancy?

A

Increased AT2
Decreased peripheral vascular resistance
→ Net reduction in BP (1st T up, 2nd T down, 3rd T rise again)

63
Q

How is pre-eclampsia Dx?

A

BP >140/90

Proteinuria >0.3g/24hrs

64
Q

What are the parameters/criteria for Mild/Moderate/Severe pre-eclampsia?

A

Mild: >140/90 + proteinuria (>0.3g/24hrs)
Moderate: >150/100 + proteinuria (>0.3g/24hrs) + no maternal complications
Severe: >160/100 + proteinuria + maternal complications

65
Q

Risk Factors for Pre-Eclampsia (9)

A 
Nulliparity
DM
Autoimmune disease
Extreme repro ages
Twins
Renal disease
PMH/FH
Chronic hypertension
Obesity
66
Q

List 5 Maternal Complications of severe Pre-eclampsia

A 
HELLP syndrome
Eclampsia
CVA (haemorrhagic)
Renal Failure
Pulm Oedema
67
Q

How does eclampsia occur + how treated?

A

Vasospasm → grand-mal seizures

Magnesium sulphate

68
Q

How does CVA occur in pre-eclampsia?

+ how is it prevented?

A

Failed cerebral flow autoregulation

Anti-HT meds should prevent

69
Q

What does HELLP syndrome consist of?
What clinical signs seen?

What is a further complication of HELLP?

A

Haemolysis: dark urine, raised LDH, anaemia
Elevated Liver Enzymes: epigastric pain, liver failure, abnormal clotting
Low Platelets

Can → DIC

70
Q

How is renal failure (as a complication of pre-eclampsia) managed?

A

Monitor fluid balance + creatinine

Haemodialysis for severe

71
Q

How does pulmonary oedema occur as a pre-eclampsia complication?
What condition may it further →?
How is it managed?

A

Fluid overload

→ ARDS

Give O2 + Furosemide

72
Q

What fetal complications may occur from pre-eclampsia

A

IUGR
Hypoxia
Preterm
Placental abruption

73
Q

What maternal blood tests can be done to monitor pre-eclamspia complications?

A

LDH ↑
LFTs ↑
Platelets ↓

Uric acid ↑
Hb ↑
Creatinine ↑

74
Q

What fetal investigations can be done to monitor pre-eclampsia complications?

A

USS

Umbilical aa Doppler

75
Q

What 3 measures can be done to screen/prevent pre-eclampsia?

A

all women: regular BP / urinalysis
Uterine aa Doppler at 23wks
Low-dose aspirin

76
Q

List some signs/symptoms that may indicate pre-eclampsia

A 
Hyperreflexia + ankle clonus
Frontal headaches
Agitation
Visual disturbances
Epigastric pain (v bad)
Fluid retention + ↓ urine output
Retinal oedema/haemorrhage, papilloedema
77
Q

What is the management for pre-eclampsia if <34wks and >34wks?

A

<34wks: conservative best if BP / blood tests/ fetal condition stable
If not then LSCS

> 34wks: induction (+ epidural + antihypertensives)
(epidural to avoid pushing - esp if >160/100)

78
Q

What are the 5 main principles in pre-eclampsia management?

A

Control maternal BP (DBP < 100) using antihypertensives
Fluid balance (too much = plum oedema; too little = renal failure) → CVP monitoring can differentiate b/wn renal failure + intravascular fluid depletion
Prevent seizures
Consider delivery
Post-delivery - continue monitoring complications

79
Q

How must eclampsia be managed?

A

L side tilt (to avoid aortocaval compression)
High flow 02
Magnesium sulphate

80
Q

How + why must magnesium sulphate be regularly monitored?

A

Causes neuromuscular toxicity

Check tendon reflexes (patellar)

81
Q

What BP classifies as gestational HT?

What are its RFs

A

> 140/90

RFs same as pre-eclampsia

82
Q

What are some causes of pre-existing hypertension in pregnancy? (CV ERODE)

A 
Coarc of Ao
Vascular disease
Essential HT
Renal disease
Obesity
Diabetes
Endocrine
83
Q

Complications of pre-existing hypertension (3)

A

Super-imposed pre-eclampsia
IUGR
Placental abruption

84
Q

Why can’t normal antihypertensives be used in pregnancy?

Which ones are used instead?

A 
Diuretics = contraindicated
ACEis = teratogenic

Labetolol, Nifedipine, Methyl Dopa

85
Q

What are the RFs for superimposed pre-eclampsia? (ABCDR)

A 
Age >40
BP >160/100
Connective tissue disease
Diabetes
Renal disease
86
Q

How is pregnancy ‘diabetogenic’

+ How does it cause macrosomia?

A

Altered carb metabolism + antagonistic hormonal effects = ↓ GTT (glucose tolerance test)

↑ fetal blood glucose = hyperinsulinaemia = ↑ fat deposition = macrosomia

87
Q

What are some fetal complications of gestational diabetes? (5)

A 
Congenital abns (neural tube/cardiac)
Macrosomia
Preterm labour (+lung immaturity) (natural/induced in 10%)
Polyhydramnios (↑ fetal urine)
Shoulder dystocia / birth trauma
88
Q

Maternal complications of gestational diabetes (7)

A

↑ insulin requirement + Hypoglycaemia (in attempt to control)
Hypertension (Pre-Ec / assoc w/ pre-existing)
Pre-existing IHD worsens
UTI
Wound/endometrial infection
LSCS/Instrumental
Neuropathy/Retinopathy

89
Q

What pre-conceptual (2) + antenatal (5) management/monitoring taken for pre-existing maternal diabetes?

A

Preconceptual:
Assess/manage retinas/renal/BP (e.g. low-dose aspirin)
Max folic acid

Antenatal:
HbA1c, reg glucose levels
Fetal ECHO
Umb aa doppler
Serial growth scans (inc liquor vol)
90
Q

How should delivery be managed in pre-existing diabetes?

A

39wks

Insulin + dextrose infusion during labour

91
Q

What neonatal complications often seen post-delivery? (other than macrosomia etc)

A 
Resp distress (even >38wks)
Hypoglycaemia
92
Q

Screening Qus / RFs for gestational diabetes (9)

A

Prev large baby
Prev stillbirth
Prev gestational diabetes

1st degree relative diabetic
South-Asian/Caribb/Middle Eastern

BMI >30
PCOS

Persistent glycosuria
Polyhydramnios

93
Q

Any +ve to screening Qus/RFs for gestational diabetes indicates for what investigation?

A

28wk GTT

94
Q

What is the stepped management for gestational diabetes?

And what would indicate moving up a step?

A
  1. glucose monitoring / Diet+Exercise
  2. Oral hypoglycaemics
  3. Insulin/treat as normal DM

If >6mmol after each, move up a step

95
Q

What cardiac changes happen in pregnancy?

What signs commonly seen? (2)

A

↑CO + ↓Resistance
Ejection systolic murmur in 90% (due to ↑ blood flow)
ECG changes: L axis deviation + inverted T waves

96
Q

What are the 4 main principles of managing maternal cardiac disease

A

Regular anaemia checks
Thromboprophylaxis (LMWH)
Monitor fluid balance in labour (epidural ↓ afterload)
Abx in labour to prevent endocarditis

97
Q

How are these maternal cardiac conditions managed ?

A

Mild abnormalities (eg VSD) - usually fine
Pulm hypertension (eg Eisenmengers, VSD) - ToP (40% maternal mortality)
Aortic stenosis - ideally correct before preg (allow ↑CO)
Mitral disease - treat before preg

98
Q

What respiratory changes occur in pregnancy?

A

↑ Tidal Vol by 40%

No change RR

99
Q

What changes, if any, are made for asthma management in pregnancy?

A

None - drugs safe and no perinatal effects if well controlled
If steroids used, ↑ requirement for labour

100
Q

What changes are made for epilepsy management in pregnancy?

A

Manage seizure control before pregnancy

As few anticonvulsants as poss w/ max folic acid (neural tube defects risk ↑ 4%)

101
Q

What is postpartum thyroiditis? What can it further lead to?
What is its incidence?
RFs

A

Transient hyperthyroidism for 3m then hypothyroidism 4m (20% permanent)
Can lead to postnatal depression
Occurs in 5-10%
RFs: Antithyroid Abs + T1DM

102
Q

What obstetric complication is at increased risk in hypothyroidism?

A

Pre-eclampsia (Antithyroid Abs)

103
Q

Why rare to have pregnant lady with untreated thyroid disease?
What thyroid symptom commonly seen in pregnancy?
What effect on fetus if mother on thyroxine?

A

Both hyper/hypo cause anovulation
Goitre common
Fetus dependant on thyroxine until 12wks

104
Q 
Intrahepatic cholestasis:
Incidence/Recurrence rate
Why does it occur
Signs/Symptoms
2 Complications

How managed

A 
0.7% but 50% recurrence
Cholestatic effect of oestrogens
Abnorm LFTs + pruritis w/o rash
1% risk stillbirth due to toxic bile salts
Risk haemorrhage (mum&amp;baby)

VitK at 36wks + Induced at 39wks

105
Q

List some of the clinical criteria for antiphospholipid syndrome (4), must have 1+

A

Vascular thrombosis
3+ losses at <10wks (unexplained)
1+ loss >10wks
Early pre-eclampsia / IUGR needing delivery <34wks

106
Q

List some of the lab criteria for antiphospholipid syndrome

A

Lupus anticoagulant
High cardiolipin Abs
High anti-B2-glycoprotein I Ab

107
Q

What obstetric risks with SLE?

What condition is SLE assoc w.?

A 
Same as Hypertension + Renal disease:
Pre-Eclampsia
IUGR
Placental Abruption
Polyhydramnios
Preterm

SLE assoc w. antiphospholipid syndrome

108
Q

What maternal (1) + fetal (4) possible complications can occur in pre-existing renal disease?

A

Maternal renal function may deteriorate

Fetal: Pre-Eclampsia, IUGR, Polyhydramnios, Preterm

109
Q

Why is asymptomatic bacteruria treated in pregnancy?

A

20% likelier to lead to pyelonephritis (1-2% risk)

110
Q

Symptoms of pyelonephritis

Treatment
Common organism + resistance

A 
Fever/Rigors
Vomiting
Abdo pain / Loin tenderness
Dysuria
Tachycardia

IV Abx
E.Coli (75%) - usually amoxicillin resistant

111
Q

Why is pregnancy / post-natal considered prothrombotic? Explain the physiology

A

↑ Clotting factors
↓ Fibrinolytic activity
Mechanical obstruction to flow
Immobility

112
Q

What is the incidence of DVT in pregnancy?
Where is a DVT most likely to occur
How Dx?

A

1%
Iliofemoral, and more likely L side
Doppler + poss venogram

113
Q

How is PE diagnosed?

A

CXR, CT, ABG ± VQ

ECG (but mimics normal pregnancy ECG changes)

114
Q

What 4 measures of thromboprophylaxis can be taken?

A

General - mobility/hydration
Compression stocking
Antenatal LMWH (for high risk; stopped during labour)
Postnatal LMWH prophylaxis

115
Q

What factors are considered high risk for VTE (2)

and its management

A

Previous VTE
LMWH used antenatally

→ 6wks LMWH

116
Q

What factors are considered intermediate risk for VTE (6)

and its management

A 
BMI > 40
C-Section in labour (not elective)
Prolonged hospitalisation
Medical Illness
Thrombophilia (screen before Tx)
IVDU

→ 1wk LMWH if 1+ factor

117
Q

What factors are considered moderate risk for VTE (12)

And its management

A 
Age > 35
BMI > 30
Parity ≥3
Smoker
Elective C-Section
Immobility
Varicose veins
Pre-Eclampsia
PPH
Current systemic infection
Labour >24hrs
Forceps delivery

→ 1wk LMWH if 2+ factors

118
Q

What is the prevalence of obesity in pregnancy?

A

20% have BMI > 30

119
Q

What are some of the maternal risks (6)

A 
VTE
Pre-Eclampsia
Diabetes
C-Section needed (+difficult surgery / wound infections)
PPH
Maternal death
120
Q

What is the basic management of Obesity in pregnancy?

What BMI is classed as high-risk
What BMI is classed as an anaesthetic risk

A

Preconceptual wt loss advised (not advised during pregnancy)
Max-dose Folic Acid + VitD

BMI ≥ 35 = high-risk
BMI ≥ 40 = anaesthetic risk

121
Q

Which SSRI should be avoided in pregnancy and why?

Which anti-psychotics should be avoided in pregnancy? (2)

A

Paroxetine → cardiac defects

Olanzapine + Clozapine

122
Q

What is the incidence of Fe defc anaemia in pregnancy?
What Hb levels do symptoms appear + treatment given
What changes also seen on FBC?

A

10%
Symps at Hb<9, treat with Fe/Folic acid at Hb<11
MCV (initially norm) and ferritin both reduced

123
Q

How is Fe defc anaemia differentiated from Folate/VitB12 defc anaemia?

A

Increased MCV - consider when anaemia w/o microcytic

124
Q

What dietary advice is given to avoid anaemia?

A

Foods rich in iron: meat, eggs, green veg

Foods rich in folic acid: Green veg. fish

125
Q

Sickle cell anaemia: common ethnicities, common features

Thalassaemia: common ethnicities, common features

A

Sickle: Afri-Caribb, crisis of chest pain/fever

Thalassaemia: SE Asian + Mediterranean, Fe overload/Chronic anaemia

126
Q

Prevalence of HIV in pregnancy in UK

↑ Risk of what maternal conditions ?

A

1000/yr

Pre-Eclampsia + Gestational DM commoner

127
Q

Maternal HIV has an ↑ risk of what fetal effects? (4)

A

Pre-Eclampsia
IUGR
Premature
Stillbirth

128
Q

What pregnancy problems can occur with drugs used in HIV?

A

Antiretrovirals increase risk of pre-eclampsia (but not teratogenic)
Co-trimoxazole (for PCP) is folic-acid antagonist

129
Q

What periods is there biggest risk of vertical transmission of HIV? (3)
What conditions make this risk even greater?

A

> 36wks
Intrapartum
Breastfeeding

Low CD4 / High viral load
Premature
ROM >4hrs

130
Q

What 4 principles in management reduce the risk of HIV vertical transmission?

A

Maternal antiretrovirals
Neonatal antiretrovirals
Elective C-Section
Avoidance of breastfeeding

131
Q

What is the prevalence of Chlamydia + Gonorrhoea in pregnancy?
What complications are they assoc w.?

A

Chlamydia - 5%
Gonorrhoea - 0.1%
Assoc w. preterm + neonatal conjunctivitis

132
Q

What symps seen in BV ?

What pregnancy complications can BV cause?

A

Asymp or offensive vaginal discharge

Increased risk of preterm / late miscarriage

133
Q

Fetal effects of Opiate use in pregnancy (4)

Neonatal effects (3)

A

Preterm labour
SGA
Anaemia
Multiple Gestation

Neonatal withdrawal syndrome
Higher risk of SIDS
Higher perinatal mortality

134
Q

Fetal effects of Cocaine use in pregnancy (3)

Neonatal effect(s)

A

Placental abruption
Preterm delivery
SGA

Increased cerebral infarction risk

135
Q

Fetal effect(s) of cannabis use in pregnancy

A

Preterm delivery

Obs & Gyn (4 decks)

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