Antenatal Growth Chart, Multiple Gestation, Eclampsia and Labour Analgesia Flashcards
list some causes for a small baby (estimated fetal weight < 10th centile)
- uteroplacental insufficiency
- chromosomal abnormalities
- fetal abnormalities
- fetal infections
list some causes for a big baby (estimated fetal weight > 90th centile)
- gestational diabetes
- insulin-dependent diabetes
what is eclampsia?
Eclampsia is when severe pre-eclampsia is complicated by generalised convulsions.
- can happen in antepartum (50%), intrapartum (30%) or postpartum (20%) period.
what is pre-eclampsia?
a hypertensive disorder of pregnancy with multi-organ involvement characterised by new onset, raised blood pressure and proteinuria, usually seen after 20 weeks of gestation.
what causes eclampsia?
happens as a result of cerebral edema and/or cerebral haemorrhage
clinical features of eclampsia
- headache
- BP > 160 systolic
- hyperreflexia
- visual changes
- tonic clonic seizures
eclampsia management
- ABC approach: get a secure airway, IV access and take bloods (LFTs, U&Es, coagulation, FBC)
Management:
- magnesium sulfate
- antihypertensives - labetolol, hdralazine
- delivery of child
how does magnesium sulfate work to treat and prevent eclampsia?
- causes cerebral dilatation
- competitively blocks calcium at synaptic nerve endings
- should be continued for 24 hrs after delivery
if toxicity from magnesium sulfate develops, what antidote is given?
calcium gluconate
list the complications of eclampsia
- HELLP syndrome
- DIC
- ARDS
- pulmonary oedema
- aspiration
- fetal hypoxia
- increased maternal mortality
what medication is given to decrease the risk of pre-eclampsia in subsequent pregnancies?
low-dose aspirin from 12 weeks gestation
list the resons for multiple gestation
- if more than 1 egg released during 1 menstrual cycle
- if the zygote divides after fertilisation > identical twins
- IVF treatments > often transfer more than 1 embryo to uterus
describe amnionicity
- the no. amnions (inner membranes) that surround babies in a multiple pregnancy
- pregnancies with 1 amnion aredescribed as monoamniotic; pregnancies with 2 amnions are diamnitoic.
describe chorionicity
- the no. chorionic (outer) membranes (placenta) that surround babies in a multiple pregnancy.
- if there is only 1 membrane, the pregnancy is described as monochorionic; if there are 2, the pregnancy is dichorionic.
list some maternal complications of multiple births
- pre-term labour
- hyperemesis
- anameia in pregnancy
- hypertension
- gestational diabetes
- postpartum haemorrhage