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5 - Obstetrics and Gynaecology > Antenatal Care pt 2 > Flashcards

Antenatal Care pt 2 Flashcards

1
Q

Describe features of fetal alcohol syndrome

A

Microcephaly,
Thin upper lip,
Smooth flat philtrum,
Short palpebral fissure,
Learning disability,
Behavioural difficulties,
Cerebral palsy

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2
Q

Describe features of rhesus incompatibility in pregnancy

A

Occurs when a rhesus D negative mother has a rhesus D positive baby. Therefore mother develops anti-d antibodies.

Prevention is the mainstay of management so mother is given IM anti-D injections. This destroys any fetal RBCs in maternal circulation.

Given at 28 weeks and at birth if baby is rhesus positive. Can also be given at times where sensitisation may occur (antepartum haemorrhage, amniocentesis or abdo trauma)

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3
Q

What test can be done following a sensitisation event with regards to rhesus incombatibility?

A

Kleihauer’s test - It checks how much fetal blood has passed into maternal circulation. Determines whether an additional dose of Anti- D may be required.

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4
Q

How can you confirm preterm prelabour rupture of the membranes?

A

Sterile speculum exam to look for amniotic fluid in the posterior vaginal vault. Avoid digital exam due to risk of infection.
If pooling is not observed then test fluids for placental proteins eg, PAMG-1 protein or ILGF binding protein.
Ultrasound may show oligohydramnios.
(rupture of membranes before 37 weeks)

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5
Q

What is the management of preterm prelabour rupture of the membranes

A

Admit to hospital,
Oral erythromycin for chorioamnionitis prophylaxis,
Antenatal corticosteroids.
Consider delivery at 34 weeks.

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6
Q

What is the prophylaxis for preterm labour?

A

Vaginal progesterone. Offered if cervix is less than 25mm between 16-24 weeks.

Cervical cerclage (stitch). Offered if cervix is less than 25mm between 16-24 weeks and if had previous premature birth of cervical trauma

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7
Q

What is the management of preterm labour?

A

Fetal monitoring,
Tocolysis with nifedipine - stop uterine contractions.
Antenatal steroids before 35 weeks - Help develop foetal lungs and reduce risk of resp distress.
IV magnesium sulphate before 34 weeks to help protect babies brain

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8
Q

What are the complications of PPROM?

A

Fetal - prematurity, infection, pulmonary hypodysplasia.
Maternal: Chorioamnionitis

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9
Q

What are the risk factors for perineal tears?

A

Primigravida (first baby),
Large babies,
Precipitant labour,
Should dystocia,
Forceps delivery

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10
Q

What are the different classes of perineal tears?

A

First degree - superficial with no muscle involvement. No repair needed.
Second degree - Involvement of perineal muscles. Requires sutures.
Third degree - Involvement of anal sphincter complex but not rectal mucosa. Requires repair in theater.
Fourth degree - Involvement of anal sphincter complex and rectal mucosal. Repair in theater.

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11
Q

What are the causes for stillbirth?

A

Unexplained (~50%),
Pre-eclampsia,
Placental abruption,
Vasa praevia,
Cord prolapse or wrapped around neck,
Obstetric cholestasis,
Diabetes,
Thyroid disease,
Infections,

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12
Q

What are some risk factors for stillbirth?

A

Fetal growth restriction,
Smoking,
Alcohol,
Increased maternal age,
Maternal obesity,
Twins,
Sleeping on the back.

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13
Q

What are three key symptoms to always ask about during pregnancy which could indicate intrauterine fetal death (IUFD)?

A

Reduced fetal movements,
Abdominal pain,
Vaginal bleeding.

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14
Q

What is the management of stillbirth?

A

US scan to visualize fetus and fetal heartbeat.
Rhesus D negative women require prophylaxis when IUFD is confirmed.
Induction of labour with oral midepristone and vaginal/oral misoprostol.
Dopamine agonists are used to suppress lactation.

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15
Q

What are the different types of FGM?

A

Type 1 - Partial or total removal of clitoris.
Type 2 - Partial or total removal of clitoris and labia minora +/- labia majora.
Type 3 - Narrowing of vaginal orifice by creating covering seal +/- excision of clitoris.
Type 4 - All other harmful procedures to female genitalia for non medical purposes

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16
Q

Describe features of baby blues

A

Typically seen 3-7 days following birth where mothers are anxious, tearful and irritable.
Give reassurance and support.

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17
Q

Describe features of postnatal depression

A

Most cases start within a month and peak at 3 months.
CBT may be beneficial. SSRIs such as sertraline of paroxetine can be used.

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18
Q

Describe features of puerperal psychosis

A

Onset within 2-3 weeks following birth. Presents with severe mood swings and disordered perception (auditory hallucinations).
Admission to hospital - ideally mother and baby unit.
20-50% increase of recurrence following future pregnancies.

19
Q

Describe features of twin to twin transfusion syndrome

A

Occurs when fetuses share a placenta. One fetus may receive majority of blood supply from placental while the other is starved. The recipient can become overloaded with HF and polyhydramnios while the donor is growth restricted with anaemia and oligohydramnios.
Laser therapy can be used to destroy the connection.

20
Q

Describe features of twin anaemia polycythaemia sequence

A

Less acute than twin to twin transfusions syndrome. One twin becomes anaemia while the other is polycythaemic.

21
Q

How are twins delivered?

A

Vaginal delivery is possible if first baby is cephalic on presentation.
C-section may be required for the second baby.
Elective C section for both if first baby is not cephalic.

22
Q

Describe features of nausea and vomiting in pregnancy

A

Normaly occurs from 4-7 weeks and tends to resolve around 16-20 weeks.

23
Q

What are the risk factors for HG

A

Increases levels of beta-hCG (multiple pregnancies or trophoblastic disease), nullparity, obesity, family history of NVP

24
Q

How is the diagnosis of HG made?

A

Clinical diagnosis: Severe NVP pplus 5% weight loss compared with before pregnancy, dehydration and electrolyte imbalance.

25
Q

What is the management of mild HG

A

Antiemetics:
1. Prochlorperazine (stemetil)
2. Cyclizine,
3. Ondansetron (small risk of cleft lip/palate),
4. Metoclopramide (not to be used for > 5 days)
Omeprazole if acid reflux is an issue

26
Q

When should admission be considered for a woman with HG?

A

Unable to tolerate oral antiemetics or keep down fluids.
More than 5% weigh loss compared with pre pregnancy.
Ketones present in urine on urine dip (2+).
Other medical conditions requiring admission.

27
Q

What is the management of moderate to severe HG?

A

IV or IM antiemetics,
IV fluids.
Thiamine supplementation,
Thrombophrophylaxis.

28
Q

What scoring system is used for classifying severity of NVP?

A

Pregnancy-Unique Quantification of Emesis (PUQE)

29
Q

What are the major causes of bleeding in the 1st trimester?

A

Spontaneous abortion,
Ectopic pregnancy,
Hydatidiform mole.

30
Q

What are the major causes of bleeding in the 2nd trimester of pregnancy?

A

Spontaneous abortion,
Hydatidiform mole,
Placental abruption

31
Q

What are the major causes of bleeding in the 3rd trimester of pregnancy?

A

Bloody show,
Placental abruption,
Placental praevia,
Vasa praevia

32
Q

Describe features of hydatidiform moles

A

Tumour which grows like a pregnancy inside the uterus.
Complete mole - Two sperm fertilise an ovum which contains no genetic material.
Partial mole - Two sperm fertilise a normal ovum at the same time.

33
Q

Explain the symptoms, diagnosis and management of a hydatidiform mole

A

Presentation - more severe morning sickness, vaginal bleeding, enlargement of uterus, abnormally high hCG and thyrotoxicosis (hCG can mimic TSH).
Diagnosis - Ultrasound which shows snowstorm appearance of pregnancy.
Management - Evacuation of the uterus followed by histological examination to confirm molar pregnancy.

34
Q

What is placental abruption and its risk factors?

A

Separation of a normally sited placental from the uterine wall resulting in maternal haemorrhage. Severe is more than 1L blood loss.

RFs: Proteinuric hypertension, cocaine use, multiparity, maternal trauma, increasing maternal age.

35
Q

What are the clinical features of placental abruption?

A

Shock out keeping with visible loss,
Constant pain,
Tender, tense uterus,
Normal lie and presentation,
Fetal heart absent/distressed,
Coagulation problems

36
Q

What is a concealed abruption?

A

Where cervical os remains closed so bleeding is contained within uterine cavity.

37
Q

What is the management of a placental abruption?

A

Initial: Call senior STAT, 2x grey canula, bloods inc. FBC, UE, LFTs and coagulation. Crossmatch 4 units of blood, fluid and blood resus, CTG of fetus.
If fetus alive and < 36 weeks: immediate C-section if distressed. If not distressed then observe closely, give steroids.
If fetus is alive > 36 weeks: Distressed then immediate C-section. If not distressed then vaginal delivery.
If fetus is dead then induce vaginal delivery.

38
Q

What are the complications of a placental abruption?

A

Maternal: Shock, DIC, renal failure, PPH.
Fetal: IUGR, hyoxia, death,

39
Q

What is placental praevia

A

Placenta lying over the internal cervical os.
Low lying placental is within 20mm of the internal cervical os.

40
Q

What are the risk factors for placental praevia?

A

Previous C-sections,
Previous placental praevia,
Older maternal age,
Maternal smoking,
Structural uterine abnormalities,
Assisted reproduction.

41
Q

What is the presentation and management of placental praevia?

A

Often asymptomatic but may present with painless vaginal bleeding.
Management: Repeat transvaginal ultrasound… DO NOT digitally exam due to risk of severe haemorrhage. Give corticosteroids due to risk of premature delivery. Planned C-section between 36-37 weeks. Main complication is haemorrhage.

42
Q

What is vasa praevia?

A

Fetal vessels are exposed within chorioamniotic membranes instead of umbilical cord and they pass across the internal cervical os.
Type 1 vasa praevia - fetal vessels exposed as velamentous umbilical cord.
Type 2 - fetal vessels exposed as they travel to accessory placental lobe.

43
Q

What are the risk factors and presentation of vasa praevia?

A

RFs - low lying placenta, IVF pregnancy and multiple pregnancies.
Presentation - Asymptomatic unless hemorrhage. May be diagnosed on ultrasound or detected by VE during labour when pulsating fetal vessles are seen through dilated cervix. Following rupture of membranes there can be fetal distress and dark red bleeding which carries high fetal mortality

44
Q

What is the management of vasa praevia?

A

If asymptomatic then give corticosteroids from 32 weeks and plan elective C-section for 34-36 weeks.
In antepartum haemorrhage then do emergency c-section

5 - Obstetrics and Gynaecology (22 decks)

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