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Y4 - GOSH > Antenatal problems > Flashcards

Antenatal problems Flashcards

1
Q

what causes backache and sciatica in pregnancy

A

hormonal changes causing softening of ligaments

exacerbated by altered posture due to the weight of the uterus

the softening and weight on the uterus can lead to soft tissue pressuring on the sciatic nerve - sciatica

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2
Q

management of backache and sciatica in pregnancy

A

life-style - eg sleeping position

alternative therapies incl relaxation and massage

physiotherapy input - back care classes

simple analgesia - paracetamol and ibruprofen

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3
Q

what is symphysis pubis dysfunction

A

It describes pregnancy-associated pain, instability and dysfunction of the symphysis pubis joint and/or sacroiliac joint.

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4
Q

management of symphysis pubis dysfunction

A

physiotherapy advise and support

simple analgesia

limit abduction of the leg at delivery

C/S usually not indicated

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5
Q

when does haemorrhoids occur in pregnancy

A

tend to be in 3rd trimester

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6
Q

management of haemorrhoids in pregnancy

A

avoid constipation from early pregnancy which can inc pressure on the anus to cause haemorrhoids in later pregnancy

ice packs and digital reduction of prolapsed haemorrhoids

ibuprofen suppositories and topical agents for symptomatic relief

if thrombosed, may require surgical referral

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7
Q

how come pregnant ladies have a higher risk of constipation

A

progesterone - reduces smooth muscle tone, affecting bowel activity

often made worse by iron supplement

severity decreases with gestation

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8
Q

what are the management of the constipation in pregnancy

A

life-style modification - inc fruit, fibre and water intake

can take fibre supplements

osmotic laxatives (lactulose)

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9
Q

when is varicose vein worse in pregnancy

A

worse when inc with gestation

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10
Q

causes of varicose veins in pregnancy

A

due to progesterone relaxes vasculature + uterus mass reduce venous return

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11
Q

management of varicose veins in pregnancy

A

regular exercise

compression stockings

consider thromboprophylaxis if other risk factors are present

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12
Q

causes of GORD in pregnancy

A

progesterone relaxes the oesophagal sphincter allowing gastric reflux - worsen with inc intra-abdominal pressure from the growing foetus

worse as the gestation continue

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13
Q

causes of carpal tunnel syndrome

A

oedema compressing the median nerve in the wrist

usually, resolve after delivery

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14
Q

management of carpal tunnel syndrome

A

sleeping with hands over the side of the bed may help

wrist splints may be beneficial

surgical referral if neuro deficit

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15
Q

management of GORD in pregnancy

A

lifestyle modification - sleeping propped up, avoid spicy food

alginate preparations and simple antacids

if severe, H2 receptors antagonist (ranitidine)

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16
Q

what is morning sickness

A

N+V induced by hCG hormone but tends to better in 2nd trimester

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17
Q

when is morning sickness worst

A

first trimester due to the placental hCG still being produced

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18
Q

what can worsen morning sickness

A

multiple and molar pregnancies

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19
Q

management of morning sickness

A

lifestyle - ginger tea, eating small meals, inc fluid

acupuncture

anti-emetics - prochlorperazine, promethazine, metoclopramide (PPM)

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20
Q

what is hyperemesis gravidarum

A

excessive vomiting in pregnancy, so much so that the individuals is unable to maintain adequate hydration and endangers fluid, electrolyte and nutritional status

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21
Q

how common is hyperemesis gravidarum

A

rare - 1 in 1000

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22
Q

RF for hyperemesis gravidarum

A

multiple pregnancy eg twins
molar pregnancy
due to higher levels of hCG present

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23
Q

when is the peak onset of hyperemesis gravidarum

A

6-11 wks

24
Q

symptoms of hyperemesis gravidarum

A 
1st trimester of pregnancy 
N+V
weight loss 
reduce oral intake 
muscle wasting 
dehydration 
liver tenderness 
ptyalism (inability to swallow saliva)
hypovolaemia 
electrolyte imbalance - ketones
behaviours disorders due to electrolytes imbalance 
haematemesis due to Mallory-Weiss tears
25
Q

IX for hyperemesis gravidarum

A

urinalysis - ketones

MSU - exclude UTI

U and Es - dec K+, dec Na+, metabolic hypochloremic alkalosis

LFT - inc transaminases, dec albumin

USS - to exclude multiple and molar pregnancies and confirm

26
Q

treatment of hyperemesis gravidarum

A

exclude other causes - UTI or thyrotoxicosis

a small, little sip of water at first and small amount of carbohydrate

admit if not better

initially NBM then reintroduce later

IV fluid (hartman’s and NaCl), replace K+ if necessary

daily U and Es - to check renal functions

antiemetics - Promethazine or cyclizine first line then metoclopramide

nutritional support if required - Thiamine to prevent Wernicke’s encephalopathy

if anti-emetic not working - try corticosteroids eg hydrocortisone/prenisolone IV

acupuncture

27
Q

complications of hyperemesis gravidarum

A

maternal risks - liver and renal failure, Wernicke’s encephalopathy

foetal risks - IUGR due to malnutrition, Wernicke’s encephalopathy (may lead to death)

28
Q

what is the acronym SWAN in the contest of small for dates mean?

A

S - starved small –> IUGR
W- wrongly small –> wrong date
A - abnormal small –> chromosomal, structural, infection etc
N - normal small –> constitutional small

29
Q

what is the definition of small for dates

A

foetus that has failed to achieve a specific biometiric or EFW by a specific gestational age

30
Q

what measurement is the most accurate for foetal growth

A

Crown-Rump Length

31
Q

what is the procedure for measuring foetal growth

A

CRL - between 8 and 13 weeks

subsequent foetal growth USS & plot on customised chart

32
Q

what are some of the causes for large for dates

A 
wrong date 
polyhydramnios - diabetes related, twins, foeal abnormality (unable to swallow) 
macrosomia - diabetes related 
multiple pregnancy 
presence of fibroids
33
Q

definition of polyhydramnios

A

liquor volume increased > 10cm generally considered abnormal

34
Q

aetiology of polyhydramnios

A

idiopathic
maternal disorders (maternal DM, renal failure)
twins
foetal anomaly (ipper GI obstructions or inability to swallow)
chest abnor

35
Q

clinical features of polyhydramnios

A

maternal discomfort
large for dates
foetal part difficult to palpate

36
Q

management of polyhydramnios

A

USS to diagnose
Maternal glucose tolerant test

if < 34 weeks and severe –> amnireduction or use NSAIDs to reduce foetal urine output

consider steroids if < 34 weeks if pre-term delivery is considered

37
Q

how should a baby with polyhydramnios be delivered

A

vaginal unless persistent unstable lie or other obstetric indication

38
Q

complications of polyhydramnios

A

6 Ps of polyhydramnios

1) placental abruption
2) pretty unstable lie
3) premature labour
4) prolapse of cord
5) PPH
6) perinatal mortality

39
Q

when will a woman be able to notice foetal movement

A

18-20 weeks

40
Q

When is the baby most active?

A

usually afternoon and evening

41
Q

how long does a baby normally sleep for?

A

20-40 minutes, rarely longer than 90 minutes

42
Q

what is the normal movement of a baby?

A

no such normal pattern for a baby, it is all individualized

the reduction/deviation from the normal pattern of a baby is what is the most worrying feature

43
Q

what is the initial assessment of a pregnant woman for reduced foetal movement

A

lie down on the LHS for the next 2 hours and focus on the movement of the baby. if less than 10 separate episodes of movement –> should take action

you can also try to drink some cold water to wake the baby up

44
Q

aetiology of reduced foetal movement

A

baby sleeping

anterior placenta and so less able to feel the baby movement

baby’s back is lying at the front of the uterus, you may feel fewer movements that if his back is lying alongside your own back

medications eg strong pain relief or sedatives

alcohol/smoking

foetal illness and distress

45
Q

advice for women who think their babies might have reduced movement?

A

1) if by 24th week, you have never felt the movement of the baby, you should contact midwife for a check on the baby’s heartbeat.
2) if over 28 weeks, you must contact midwife/local maternity unit immediately. seek help immediately.

46
Q

what is considered to be a prolonged pregnancy/postdate/post-term/post-maturity

A

exceeds 42 weeks from the first day of LMP

47
Q

what is the chance of prolonged pregnancy if you had 1 x prev. prolonged pregnancy

A

30% (normally 3-10% chance if you never had one before)

48
Q

what are the complications of prolonged pregnancy?

A

maternal - anxiety and psychological, inc interventions eg induction of labour/operative delivery (inc risk to genital tract trauma

foetal - inc perinatal mortality if after 42 weeks, intrapartum death 4x, early neonatal death 3x

other risks - meconium aspiration pneumonia and assisted ventilation, oligohydramnios, macrosomia/shoulder dystocia and foetal injury, cephalhaematoma. foetal distress in labour

neonatal period - hypothermia, hypoglycemia, polycythemia and growth restriction

49
Q

management of prolonged pregnancy

A

1) confirm EDD
2) assess any other risks eg pre-eclampsia, DM, APH, IUGR
3) offer stretch and swap in 41 week
4) offer induction of labour at 41-42 weeks (reduce perinatal mortality)

50
Q

what does PPROM stands for

A

preterm premature rupture of membrane

51
Q

what is the most common cause of PPROM

A

overt infection (more common in earlier gestations)

52
Q

clinical features of PPROM

A

vaginal loss?
gush of fluid?
trickle or dampness?
signs of chorioamnionitis - fever/malaise, abdo pain incl contractions, purulent/offensive vaginal discharge

maternal pyrexia
maternal tachycardia
uterine tenderness
foetal tachycardia

53
Q

investigation of PPROM

A

put pad on before hospital arrival

Speculum examination not bimanual - confirmatory if pooled fluid in the posterior fornix/fluids running down the cervical canal.

FBC, CRP,

swabs (HVS, LVS)

MSU

CTG

USS for foetal presentation, EFW and liquor volume

54
Q

management of P-PROM

A

if evidence of chorioamnionitis
- prepare for delivery - betamethasone 12 mg IM, deliver, board spectrum antibiotics cover (erythromycin 250mg QDS 10 days)

if no evidence of chorioamnionitis

  • conservatively
  • prophylactic ABx (erythroymcin 250mg QDS)
  • inform SCBU and liaise with neonatologist
  • discharge after 48 hours and review in day unit twice a week for bloods and vital obs
  • induction from 34 weeks
55
Q

which antibiotics should you not use in pregnancy

A

co-amoxiclav - inc NEC incidence

56
Q

definition of PROM

A

membrane rupture after 37 weeks before the onset of labor

Y4 - GOSH (12 decks)

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