Antenatal Obs Complications Flashcards
Cause of symphysis pubis dysfunction + mx
Happens in 3rd trimester
2 sides of pelvis rub
(simple analgesia)
musculoskeletal complaints in pregnancy
Backache (elastic loosening of ligaments and exaggerated lumbar lordosis)
Carpal tunnel syndrome (simple analgesia and splinting)
Symphysis pubis dysfunction
GI complaints in pregnancy
Constipation Hyperemesis gravidarum GORD Haemorrhoids Obstetric cholestasis
Mx obstetric constipation
Mild non-stimulant laxatives (lactulose)
Consequence of Hyperemesis gravidarum (HG)
Electrolyte imbalance, increased risk of preterm labour and LBW.
Severe cases: vit deficiencies, MW tear
Diagnostic triad of HG
Greater than 5% weight loss (pre-pregnancy)
dehydration
electrolyte imbalance
Mx HG
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
Antiemetics for HG
1st line:
antihistamines (cyclizine) and phenothiazines (promethazine - associated w/ oculogyric crises and extrapyramidal s/e. NB - same happens w/ metoclopramide)
2nd line: metoclopramide ondansetron
Rehydration for HG
saline and KCl
Thiamine
(remember LMWH prophylaxis if admitted)
Causes of GORD
Size of uterus
Oesophageal sphincter relaxes
HG discharge
Individualised management plan
If it’s still serious in 3rd trimester do serial growth scans
GORD Mx
Lifestyle (smaller meals)
Medical: antacids, PPI, antihistamine
Obstetric cholestasis presentation
2nd half
Pruritus and deranged LFT
Mx obstetric cholestasis
Ursodeoxycholic acid
NB - only helps with symptoms
Offer delivery after 37 weeks
Red degeneration of fibroid presentation and mx
If severe can lead to contractions + miscarriage
Tx: opiate analgesia and IV fluids
DDx for red degeneration
Pyelonephritis
appendicitis
ovarian cyst accident
placental abruption
Presentation of retroverted uterus + mx
Grows up into abdo cavity and presses on bladder.
Present w/ retention at 12-14 weeks
Catheterise
common ovarian cysts in pregnancy
Serous cyst
Benign teratoma
Physiological cyst of corpus luteum
Risk factors for UTI
Hx of recurrent cystitis
Urinary tract abnormalities
DM
Bladder emptying problems (MS)
Mx UTI
Abx 1st line amoxicillin or oral cephalosporin
fluid
simple analgesia
UTI causing pathogens
E.coli (most common)
Proteus
Klebsiella
Pseudomonas
Mx pyelonephritis
IV fluid
Strong (opiate) analgesia
IV abx (gentamicin or cephalosporin)
Monitor kidney function (urea and electrolytes)
Mx Recurrent UTI pregnancy
Low dose prophylactic Abx
Urine sample + MSU at each antenatal visit
Abdo pain in pregnancy (obs causes)
Early: Ligament stretching Miscarriage Retention due to retroverted placenta Ectopic Late: Labour Abruption HELLP Uterine: Rupture Chorioamnionitis
Abdo pain in pregnancy (unrelated to preganancy)
Uterine - red degeneration ovarian accident UTI renal colic Appendicitis Gastroenteritis Pancreatitis
coagulation changes in pregnancy
Increase in: factor 8, 9, 10 and fibrinogen
Reduction in protein C
diagnosis of antiphospholipid syndrome
2 positive tests at least 12 weeks apart for anticardiolipin or lupus anticoagulant
Ix for suspected DVT
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
Ix for PE
what to do if mum has recurrent PE/known DVT
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
Mx Massive PE
- unfravtionated heparin IV
- portable CTPA
- if PE confirmed commence thrombolysis
Maintenance thromboprophylaxis
Treat w/ daily subcut LMWH for remainder of pregnancy + 6 weeks after + longer potentially
Need to give it for 3 months
How long after last dose of heparin can you do epidural
24 hours
NB - don’t give heparin until 4 hours after spinal anaesthesia or epidural catheter comes out
Causes of oligohydramnios
Renal agenesis (potter syndrome) FGR and placental insufficency NSAIDS PPROM Leakage in post dates pregnancy
Maternal causes of polyhdramnios
Diabetes
Chorioangioma
placenta
foetal causes of polyhdramnios
Multiple pregnancy
Oesophageal/tracheal atresia
Neuromuscular problems (can’t swallow)
anencephaly
Breech predisposing factors - materanl
Fibroids
uterine abnormalities
previous uterine sx
Breech predisposing factors - foetal
multiple gestation
placenta praevia
oligo/polyhdramnios
prematurity
Mx breech
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
features of risky breech birth
hyperextended neck
footling
cephalopelvic disproportions
When to perform ECV?
What do you give with it?
37 weeks (w/ tocolytic - nifedipine and anti-D if mum is rhesus negative)
When should you immediately induce labour in post-partum pregnancy
Foetal: RFM CTG isn't perfect reduced amniotic fluid on US reduced foetal growth
Maternal:
Mum has HTN or any other condition
Causes of APH
Placental - abruption, placenta praevia, vasa praevia
Local cervical - cervicitis, ectropion, carcinoma
Vaginal - trauma, infection
What are some 1st trimester sensitising events and what is the management of this?
miscarriage
molar pregnancy
therapeutic TOP
heavy uterine bleeding
250iu
Mx sensitising events between 12-20wks
Give 250iu within 72 hours
Do Kleihauer to see if you need more
Mx sensitising event 20+ weeks
500iu within 72 hours
Do kleihauer to see if you need more
Mx in sensitised women
Ab tests every 2-4 weeks
MCA doppler to check for anaemia
Transfusion if anaemic (through umbilical vein)
Deliver
What to do if unstable lie
ECV or elective c section
Types of face presentation
if chin anterior can deliver vaginally if you flex
if chin post deliver by C section
mx foetal growth restriction
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
