Antenatal Problems Flashcards
What are minor disorders of pregnancy?
Itching Symphisis Pubis Dysfunction Abdo pain Heartburn Ankle oedema - sudden change warrants investigation Leg cramps Carpal tunnel syndrome Vaginitis Tiredness Backache Constipation
Peak onset of hyperemesis gravidarum?
6-11 weeks
Signs of hyperemesis gravidarum?
Dehydration with large amounts of ketones in the urine and liver tenderness
Management of hyperemesis gravidarum if not tolerating oral food/fluids?
Admission
IV rehydratio and antiemetics (cyclizine or promethazine) Vitamin supplementations (B1) if prolonged Last resort = high dose corticosteroids
Foetal consequences of hyperemesis gravidarum?
Growth restriction - serial growth scans needed later in prego
When should you be aware of foetal movements?
20 weeks (sometimes 18) Plateau at 32 weeks but shouldn't reduce in frequency
Risk factors for reduced foetal movements?
Sedating drugs that cross placenta (alcohol, opiates)
Anterior lying placenta (up to 28 weeks)
Corticosteroids
Position of baby
What should you advise the woman does in reduced foetal movements?
Contact maternity unit and be seen the same day
Management of reduced foetal movements? (>28 weeks)
If auscultation shows heartbeat, and no risk factors for RFM or stillbirth –> reassure
Otherwise:
- Viability (auscultation)
- CTG (then if normal…)
- USS (abdo circumfrence/weight to see if small for GA)
If all normal - reassure and contact if happens again
Management of reduced foetal movements? (<28 weeks)
Auscultate foetal heart rate
If present, assess foetus for neuromuscular conditions
Definition of small for dates and IUGR?
SFD = weight or estimated weight below 10th/5th/3rd centile IUGR = implies compromise - growth has slowed or is less than expected taking into account constitutional factors.
Constitutional determinants and pathological determinants of small for dates?
Constitutional = low maternal weight/height, nulliparity, asian, female foetal gender
Pathological = maternal disease (renal/AI), maternal complications (pre-eclampsia), multiple pregnancy, smoking, drug use, infection, extreme malnutrition, congenital abnormalities
Complications of IUGR?
Preterm delivery and cerebral palsy more common
Examination and investigations of small for dates?
Serial measurement of symphisis-fundal height
BP/urinalysis - screen for pre-eclampsia
Serial USS and umbilical artery doppler - oligohydramnios, head sparing
CTG
Management of SFD/IUGR?
SFD only - growth scans at fortnightly intervals. Consistent growth and normal doppler –> no intervention
IUGR
Term - deliver
34-37 weeks - regular doppler, daily CTG, consider delivery
<34 weeks - steroids, regular doppler, daily CTG, consider delivery if CTG abnormal
Risk factors for large foetus?
Male infant sex, multiparity, maternal age 30-40, white race, diabetes, gestational age >41 weeks
Complications of large foetus?
Increased likelihood of C section Shoulder dystocia Chorioamnionitis Fourth degree perineal laceration PPH
Definition of large for dates? What to do next?
> 90th percentile on customised growth chart (abdominal circumfrence)
OGTT for mum - if abnormal, refer to diabetes
Monitoring of large for dates foetus?
Plot growth on customised growth chart, confirm size on scan at 36 weeks
Management of large for dates foetus?
Macrosomia alone is not good enough reason for elective C section.
At 41 weeks:
BMI <30, favorable cervix - induction of labour at 41+4
BMI >30, unfavorable cervix - induction of labour or LSCS
Definition of prolonged pregnancy? What is the risk?
> 42 weeks completed gestation
Risk of perinatal morbidity/mortality increases between 41 and 42 weeks (absolute risk of problem is still small)
Management of prolonged pregnancy?
Check gestation carefully.
Induction before 41 weeks inappropriate unless complications present.
At 41 weeks - examine patient vaginally and induce unless cervix unfavorable or patient prefers to wait
If no induction - stretch and sweep, daily CTG
If CTG abnormal - delivery whatever the conditon of cervix (possibly LSCS)
What is PPROM?
Rupture of membranes before labour at <37 weeks. Occurs before 1/3 of preterm deliveries
Complications of PPROM?
Preterm delivery (within 48h in 50%)
Chorioamnionitis
Prolapse of umbilical cord
Absence of liquor (before 24 weeks)
History of in PPROM?
Gush of clear fluid, followed by further leaking
Examination in PPROM?
Check lie and presentation
Pooling of blood in posterior fornix on sterile speculum
DO NOT PERFORM UNNECESSARY DIGITAL VAGINAL EXAMINATION
Investigations in PPROM?
USS - may show reduced liquor
Infection - HVS, FBC, CRP, maternal obs
CTG - foetal wellbeing
Management of PPROM?
- Admit for 24-48 hours
- Steroids - betamethasone 12mg IM x2 doses 24 hours apart
- Abx - erythromycin 250mg QDS x 10 days
If >34 weeks –> induction
If not - send home with monitoring (ANDU twice a week) until 34 weeks.
