Antenatal Problems

Question 1

Normal course of pregnancy associated N+V

Answer 1

Typically starts ~6 weeks

Resolves 16-20 weeks

Question 2

Clinical features of Hyperemesis gravidarum

Answer 2

Marked N+V - hypernatraemia, hypochloraemia
Ketonuria
Nutritional deficiency and weight loss
–> inability to swallow saliva - ptyalism

Question 3

Mx of Hyperemesis Gravidarum

Answer 3

IV fluids if necessary - NaCL/Hartmanns - not Dextrose

Parenteral/Rectal Anti-emetics - Ondansetron, metoclopramide, chlorpromazine (anti-histamine sedative)

Question 4

Definition of SFD baby?

Answer 4

SGA = <10th centile

Severe SFD = <3rd centile

Question 5

RF/causes for SFD

Answer 5

Placental insufficiency
Malnutrition
Chromosomal/genetic
Maternal age >40, smoker >11/day

Question 6

Maternal and fetal risks involved with LFD baby?

Answer 6

Maternal - perineal tears, PPH, traumatic delivery

Fetal - distress, dystocia, neonatal hypoglycaemia, ARDS

Question 7

Definition of prolonged pregnancy and risks associated

Answer 7

> 42 weeks from 1st day of LMP

^^ intrapartum/neonatal mortality
^^ meconium aspiration pneumonia

Question 8

Mx of Prolonged pregnancy

Answer 8

41 weeks - stretch and sweep

42 weeks - offer ARM and induction of labour

Question 9

Prophylactic Abx to give in case of PPROM

Answer 9

Erythromycin + penicillin

Question 10

Management of PPROM

Answer 10

60% enter spontaneous labour within 24hrs
Admit and observe - watch for signs of chorioamnionitis
Maternal Betamethasone IM if preterm (<37 weeks)
CTG for fetal distress

Question 11

Describe the course of fetal movements throughout pregnancy

Answer 11

First perceived from 18-20 weeks (16 weeks in multips)
Increase in frequency, plateauing at 32 weeks

~31 movements/hr on average
Best felt when lying flat on the back
Fetal sleep cycle lasts 20-40 mins, shows diurnal variation