Antenatal period 2 Flashcards
Pre-eclampsia:
- Definition of gestational HTN, chronic HTN, pre-eclampsia, eclampsia
- Risk factors - high, moderate
- Symptom
- Signs
- Investigations
- Management: prevention, emergency, medical, eclampsia
- Complications: to fetus, to mum
Pre-eclampsia:
- Definition of gestational HTN, chronic HTN, pre-eclampsia, eclampsia
Gestational htn: htn occuring in second half of preg >20 weeks which resolves after birth
Chronic htn: preexisting htn before 20 weeks (stop acei and switch to labetolol)
Pre-eclampsia: preg induced htn 140/90 on 2 separate occasions >24 hours apart or single diastolic >110. Associated with proteinuria or end organ dysfunction (inc creatinine, lfts, seizures, thrombocytopenia)
Eclampsia: seizure up to 10 days post birth w at least 2 in 24 hours: htn, proteinuria, thombocytopenia, inc alt - Risk factors - high, moderate
High: previous, htn, diab/ckd/sle
Mod: fx, >40, bmi >35, >10 years since previous birth, first preg, multiple preg - Symptoms and signs: n+v, dizzy, headache, vision changes, abdo pain, reduced fetal movements
- Signs: seizures, papilloedema, hyperreflexia
- Investigations: urine dip, urine protein: creatinine >30, PIGF 20+ 35 weeks, fbc/u+es/clotting/lfts, abdo uss
- Management: prevention, emergency, medical, eclampsia
Prevent: if 1 high risk, or 2 moderate then aspirin 150mg from 12-38 weeks
Emergency: if >160 iv labetolol
Medical: urine dip + bloods weekly, uss every 2 weeks, labetolol (nifedipine if asthmatic), then enalapril for 12 weeks post birth. Aim for <135/80
Eclampsia: iv mg sulfate 4mg (monitor via urine/reflexes/rr/oxy as can hypermagnesia causing hyporeflexia + resp depression which will need ca gluconate), ctg, labetolol, c section - Complications: to fetus, to mum:
Fetus: igur, stillbirth, preterm, SGA
Mum: aki, dic, ards, haemorrhage, eclampsia, abruption, HELLP (hemolysis, elev liver enzyme, low platelets - ruq pain, n+v, fever - deliver, mg sulfate, anti htn, fluids)
Gestational diabetes:
- Definition
- Risk factors
- Symptoms
- Investigations
- Target levels
- Management
- Complications
Gestational diabetes:
- Definition
- Risk factors: previous, bmi >30, asian, fx diabetes, previous macrosomia
- Symptoms: assymp, polyuria, polydipsia
- Investigations: urine dip, OGTT (if either 5.6 fasting, 7.8 post meal) - at 24-28 weeks if LGA/polyhd/+ glucose on dip/obese, asap after booking + at 24-28 if previous)
- Target levels: 5.3, 7.8 1 hr, 6.4 2 hours
- Management: seen at diabetes clinic within a week. 2 weeks lifestyle change - weight, 5mg folic acid, self monitoring. Metformin if no improvement. If still none then add insulin. If >7 straight to insulin short acting
- Complications
mum: macrosomia, tears
baby: organomegaly, tachypnoea newborn, hypoglycemia, preterm
Pre-existing diabetes:
- Risk to fetus + risks to mum
- Management: pre, once preg, during preg, delivery
Pre-existing diabetes:
- Risk to fetus + risks to mum:
mum: retinopathy progression, dka, gastroparesis
baby: miscarriage, congen (vsd, spina bifida, cauda reg), macros, preterm - Management: pre, once preg, during preg, delivery
Pre: bmi>27 then weight loss, folic acid 5mg
During: hba1c monthly, clinic every 2 weeks, stop all oral hypoglycs but metformin + insulin, 20 week heart scan
Post: deliver 37-38 weeks
Obstetric cholestasis:
- Definition
- Symptoms
- DD
- Complications: to mum, to fetus
- Investigations
- Management
Obstetric cholestasis:
- Definition : dec outflow of bile acids from liver causing intrahepatic cholestasis occurring in late preg >28 weeks
- Symptoms : itch hands + feet especially at night, jaundice, stools, fatigue, NO RASH
- DD: acute fatty liver (in t3 also, but abdo pain, jaundice, n+v, hypoglyc)
- Complications: to mum, to fetus
Mum: vit k def, pre-ec, gest diab
Fetus: stillbirth, preterm, distress - Investigations : lfts (inc alp is normal in preg!!), bile acids from liver>19, uss abdo
- Management
Ursodeoxycholic acid, emollients, chlorphenamine, water soluble vit k
LFTs weekly and 10 days post delivery, should deliver 37 weeks and follow up 4 weeks pp
Other pre-existing conditions:
- Epilepsy: risks, safe meds vs unsafe
- Asthma: risks, mx
- Autoimmune: safe vs unsafe meds
- Cardiac disease: risks, unsafe vs safe meds
epilepsy: 5mg folic acid, lamotrigine. Not recommonded sodium val (nt defects), phenytoin (cleft palate). Breast feeding safe apart from barbiturates
Multiple pregnancy:
- Types: monozygotic, dizygotic, monoamniotic, diamniotic, monochorionic, dichorionic
- Risks of monoamniotic monochorionic babies
- Complications: to mum, to baby
- Investigations
- Management
Multiple pregnancy:
- Types: monozygotic, dizygotic, monoamniotic, diamniotic, monochorionic, dichorionic
- Risks of monoamniotic monochorionic babies: inc risk cord prolapse, preterm, twin-t transfusion
- Complications: to mum, to baby
Mum: anaemia, polyhyd, malpresentation, htn, pph
Baby: miscarriage, stillbirth, prem, congen abnorm, twin-twin transf (when sharing placenta one baby recieves more blood supply so fluid overload + hydrops fetalis (accumm fluid in interstitial comp causing ards, hepatosplen, ascites, pleural eff, HF) + polyhyd. Other gets IUGR so needs laser to destroy connection) - Investigations
- Management
Stillbirth:
- Definition
- Risk factors
- Causes
- Management
Stillbirth:
- Definition : death after 24 weeks
- Risk factors : smoking, alcohol, iugr, age, twins, sleeping on back
- Causes: iugr, abruption, cord prolapse, obs chole, diab, thy, genetic abnorm, torch
- Management: anti d, induce mifepristone + misoprostolol
Chicken pox exposure
- risks to mum and fetus
- mx of exposure
- mx of chickenpox to mum
Chicken pox exposure
- risks to mum and fetus
mum: inc risk pneumonitis
fetus: fetal varicella syndrome (if before 20 weeks gestation - skin scarring, microphthalmia, limb hypoplasia, microcephaly, learning difficulties), shinges in infancy
- mx of exposure: check for varicella igG ab. oral aciclovir day 7-14 post exposure
- mx of chickenpox to mum: oral aciclovir if > 20 weeks if presents within 24 hours of rash onset
antepartum haemorrhage - Placental abruption:
- definition
- risk factors
- symptoms
- mx
- complications
Placental abruption:
- definition: detachment of uterus and placenta, t3
- risk factors: >35, multiparity, pre-eclampsia/htn, previous, antiphospholipid syndrome, smoking
- symptoms: abdo/back pain, bleeding (maybe not as blood can accumulate behind the placenta), dizzy, fetal distress, woody tense uterus
- mx: observe if <36 weeks and not distressed + steroids, if >36 weeks and not distressed vag birth, if distressed c section
- complications: haemorrhage, shock, dic, hypoxia to fetus
antepartum haemorrhage - placenta praevia
- definition + grades
- risk f
- symptoms
- ix
- mx
antepartum haemorrhage - placenta praevia
- definition + grades: when the placenta lies low in the uterine segment. 1: doesnt reach int ios. 2: doesnt cover but reaches ios. Then majors: 3: partially covers. 4: fully covers
- risk f: previous c section/termination, >40, multiple preg, ivf, smoking, multiparity
- symptoms: painless bleeding
- ix: transvag uss
- mx:
If not bleeding and only noticed on 20 week scan - rescan 32 weeks and rescan every 2 weeks. If grade 3/4 elective c section at 37-38 weeks (or emergency if goes into labour spont). If grade 1 can trial vag.
If bleeding: admit, and emergency c section
Placenta accreta:
- definition
- risk factors
- types
Placenta accreta:
- definition: attachment of placenta to myometrium due to a defective decidua basalis. means during labour cant seperate inc risk pph
- risk factors: praevia, previous c sections
- types:
accreta: chorionic villi attaches to myometrium
increta: invades myometrium
percreta: invade through perimetrium
