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Obs and gynae > Antenatal Obs Complications > Flashcards

Antenatal Obs Complications Flashcards

1
Q

Cause of symphysis pubis dysfunction + mx

A

Happens in 3rd trimester
2 sides of pelvis rub
(simple analgesia)

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2
Q

musculoskeletal complaints in pregnancy

A

Backache (elastic loosening of ligaments and exaggerated lumbar lordosis)
Carpal tunnel syndrome (simple analgesia and splinting)
Symphysis pubis dysfunction

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3
Q

GI complaints in pregnancy

A 
Constipation
Hyperemesis gravidarum
GORD
Haemorrhoids
Obstetric cholestasis
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4
Q

Mx obstetric constipation

A

Mild non-stimulant laxatives (lactulose)

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5
Q

Consequence of Hyperemesis gravidarum (HG)

A

Electrolyte imbalance, increased risk of preterm labour and LBW.
Severe cases: vit deficiencies, MW tear

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6
Q

Diagnostic triad of HG

A

Greater than 5% weight loss (pre-pregnancy)
dehydration
electrolyte imbalance

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7
Q

Mx HG

A

USE PUQE
Mild:
community mx w/ antiemetics (if this fails and PUQE score <13 manage at ambulatory day care w/ antiemetics)
Admit if:
continued vom and can’t keep antiemetics down
Continued weight loss + dehydration w/ ketonuria
Comorbidity (UTI) and inability to tolerate Abx

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8
Q

Antiemetics for HG

A

1st line:
antihistamines (cyclizine) and phenothiazines (promethazine - associated w/ oculogyric crises and extrapyramidal s/e. NB - same happens w/ metoclopramide)
2nd line: metoclopramide ondansetron

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9
Q

Rehydration for HG

A

saline and KCl
Thiamine
(remember LMWH prophylaxis if admitted)

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10
Q

Causes of GORD

A

Size of uterus

Oesophageal sphincter relaxes

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11
Q

HG discharge

A

Individualised management plan

If it’s still serious in 3rd trimester do serial growth scans

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12
Q

GORD Mx

A

Lifestyle (smaller meals)

Medical: antacids, PPI, antihistamine

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13
Q

Obstetric cholestasis presentation

A

2nd half

Pruritus and deranged LFT

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14
Q

Mx obstetric cholestasis

A

Ursodeoxycholic acid
NB - only helps with symptoms
Offer delivery after 37 weeks

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15
Q

Red degeneration of fibroid presentation and mx

A

If severe can lead to contractions + miscarriage

Tx: opiate analgesia and IV fluids

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16
Q

DDx for red degeneration

A

Pyelonephritis
appendicitis
ovarian cyst accident
placental abruption

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17
Q

Presentation of retroverted uterus + mx

A

Grows up into abdo cavity and presses on bladder.
Present w/ retention at 12-14 weeks
Catheterise

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18
Q

common ovarian cysts in pregnancy

A

Serous cyst
Benign teratoma
Physiological cyst of corpus luteum

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19
Q

Risk factors for UTI

A

Hx of recurrent cystitis
Urinary tract abnormalities
DM
Bladder emptying problems (MS)

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20
Q

Mx UTI

A

Abx 1st line amoxicillin or oral cephalosporin
fluid
simple analgesia

21
Q

UTI causing pathogens

A

E.coli (most common)
Proteus
Klebsiella
Pseudomonas

22
Q

Mx pyelonephritis

A

IV fluid
Strong (opiate) analgesia
IV abx (gentamicin or cephalosporin)
Monitor kidney function (urea and electrolytes)

23
Q

Mx Recurrent UTI pregnancy

A

Low dose prophylactic Abx

Urine sample + MSU at each antenatal visit

24
Q

Abdo pain in pregnancy (obs causes)

A 
Early: 
Ligament stretching
Miscarriage
Retention due to retroverted placenta
Ectopic
Late:
Labour
Abruption
HELLP
Uterine:
Rupture
Chorioamnionitis
25
Q

Abdo pain in pregnancy (unrelated to preganancy)

A 
Uterine - red degeneration
ovarian accident
UTI 
renal colic
Appendicitis
Gastroenteritis
Pancreatitis
26
Q

coagulation changes in pregnancy

A

Increase in: factor 8, 9, 10 and fibrinogen

Reduction in protein C

27
Q

diagnosis of antiphospholipid syndrome

A

2 positive tests at least 12 weeks apart for anticardiolipin or lupus anticoagulant

28
Q

Ix for suspected DVT

A

Anyone suspected should get LMWH and compression stockings
Do compression US
If -ve and little suspicion stop
If -ve and suspicion REPEAT IN 3-7 days

29
Q

Ix for PE

what to do if mum has recurrent PE/known DVT

A

Do CXR + ECG
If CXR abnormal do CTPA/V/Q (CTPA inc. risk of child cancer, V/Q inc. risk of breast ca)
Repeat V/Q/CTPA if it shows nothing but there’s still suspicion
NB - consider IVC filter in PERIPARTUM period if people have recurrent PE or known iliac DVT

30
Q

Mx Massive PE

A
  1. unfravtionated heparin IV
  2. portable CTPA
  3. if PE confirmed commence thrombolysis
31
Q

Maintenance thromboprophylaxis

A

Treat w/ daily subcut LMWH for remainder of pregnancy + 6 weeks after + longer potentially
Need to give it for 3 months

32
Q

How long after last dose of heparin can you do epidural

A

24 hours

NB - don’t give heparin until 4 hours after spinal anaesthesia or epidural catheter comes out

33
Q

Causes of oligohydramnios

A 
Renal agenesis (potter syndrome)
FGR and placental insufficency
NSAIDS
PPROM 
Leakage in post dates pregnancy
34
Q

Maternal causes of polyhdramnios

A

Diabetes
Chorioangioma
placenta

35
Q

foetal causes of polyhdramnios

A

Multiple pregnancy
Oesophageal/tracheal atresia
Neuromuscular problems (can’t swallow)
anencephaly

36
Q

Breech predisposing factors - materanl

A

Fibroids
uterine abnormalities
previous uterine sx

37
Q

Breech predisposing factors - foetal

A

multiple gestation
placenta praevia
oligo/polyhdramnios
prematurity

38
Q

Mx breech

A

ECV
- do at 36 weeks if nulliparous, 37 if multiparous

if unsuccessful counsel about vaginal vs c-section
C-section: small reduction in foetal + neonatal morbidity but increased risk of immediate complication and complications in future pregnancy
Vaginal: 40% risk of having emergency C-section. good option if normal size baby and multiparous. DO NOT DO IF FOOTLING

39
Q

features of risky breech birth

A

hyperextended neck
footling
cephalopelvic disproportions

40
Q

When to perform ECV?

What do you give with it?

A

37 weeks (w/ tocolytic - nifedipine and anti-D if mum is rhesus negative)

41
Q

When should you immediately induce labour in post-partum pregnancy

A 
Foetal:
RFM 
CTG isn't perfect
reduced amniotic fluid on US
reduced foetal growth

Maternal:
Mum has HTN or any other condition

42
Q

Causes of APH

A

Placental - abruption, placenta praevia, vasa praevia
Local cervical - cervicitis, ectropion, carcinoma
Vaginal - trauma, infection

43
Q

What are some 1st trimester sensitising events and what is the management of this?

A

miscarriage
molar pregnancy
therapeutic TOP
heavy uterine bleeding

250iu

44
Q

Mx sensitising events between 12-20wks

A

Give 250iu within 72 hours

Do Kleihauer to see if you need more

45
Q

Mx sensitising event 20+ weeks

A

500iu within 72 hours

Do kleihauer to see if you need more

46
Q

Mx in sensitised women

A

Ab tests every 2-4 weeks
MCA doppler to check for anaemia
Transfusion if anaemic (through umbilical vein)
Deliver

47
Q

What to do if unstable lie

A

ECV or elective c section

48
Q

Types of face presentation

A

if chin anterior can deliver vaginally if you flex

if chin post deliver by C section

49
Q

mx foetal growth restriction

A

Antenatal:
monitoring: serial growth scan every 2 weeks, doppler US 2x/week to look at umbilical artery flow, advise mothers to check foetal movements

indications for immediate delivery:
abnormal CTG (and RFM), abnormal doppler waveform

Delivery:
deliver by 37 weeks
give steroids <36 weeks

Obs and gynae (23 decks)

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