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Obstetrics > Antenatal Problems > Flashcards

Antenatal Problems Flashcards

1
Q

Name some of the causes of abdominal pain in pregnancy

A 
Foetal position
Reflux
Obstetric cholestasis
Syphysis pubis dysfunction (SPD)
Constipation
Placental abruption
Uterine rupture
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2
Q

What are some of the minor symptoms of pregnancy?

A 
Headaches, palpitations and fainting
Frequency
Abdominal pain, SOB
Constipation and haemorrhoids
Reflux and heartburn
Carpal tunnel syndrome
Rash and itching
Ankle oedema
Leg cramps
Cholasma (mask of pregnancy)
N+V
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3
Q

How is reflux in pregnancy treated?

A

Advised to avoid irritants such as spicy foods and coffee and raise the head of the bed.
Antacids and alginates are recommended. Sodium bicarbonate is contraindicated

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4
Q

What antacids are contraindicated in pregnancy?

A

Gaviscon liquid
Liquid Rennies
Anything containing sodium bicarbonate

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5
Q

How is constipation treated in pregnancy?

A

First line: lifestyle advice - increase fibre, fluids and mobility
Second line: ispaghula husk (bulk)
Third line: lactulose (osmotic)

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6
Q

What is the cause of symphysis pubis dysfunction?

A

Increased ligmental laxity due to increased levels of relaxin in pregnancy

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7
Q

What are the symptoms of SPD?

A 
Waddling gait (antalgic)
Tenderness of symphysis pubis joint
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8
Q

How is SPD managed?

A

Analgesia (paracetamol, codeine, dihydrocodeine)

Physiotherapy

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9
Q

What are the diagnostic criteria for obstetric cholestasis?

A

Pruritis + abnormal LFTs or raised bile acids

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10
Q

What are the symptoms of obstetric cholestasis?

A

Pruritis (esp of hands and feet)
NO rash
RUQ pain
Murphy’s sign positive

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11
Q

What bloods should be done in obstetric cholestasis and what results would be diagnostic?

A

LFTs: increased liver enzymes excluding ALP

Bile acids: raised

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12
Q

How is obstetric cholestasis managed?

A

Emollients for symptomatic relief
Antihistamines help with itching
Ursodeoxycholic acid
Delivery at 37 weeks

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13
Q

Should women with obstetric cholestasis be induced and why?

A

Yes, induction at 37 weeks

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14
Q

What monitoring should be done for women with a diagnosis of obstetric cholestasis?

A

CTG every 2/52

LFTs every 2/52

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15
Q

What are the risk factors for obstetric cholestasis?

A 
ITCH mnemonic
In the past (FH/previous)
Twins
Calculi (gallstones)
Hepatitis C
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16
Q

What should all PV bleeding in pregnancy be treated as?

A

Threatened miscarriage until proven otherwise

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17
Q

What are the causes of PV bleeding in pregancy?

A 
Normal spotting
Extrachorionic bleed
Post-coital bleed
Ectropion
Placental abruption
Placenta praevia
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18
Q

What is the most common cause of 1st trimester bleeding?

A

Extrachorionic haemorrhage

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19
Q

What is an extrachorionic haemorrhage?

A

Collection of blood between the uterine wall and chorionic membrane

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20
Q

What are the risk factors for extrachorionic bleeding?

A

IVF
Multiparity
Increased maternal age

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21
Q

What sign present on USS indicates a extrachorinic collection?

A

Crescenteric collection sign

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22
Q

How is an extrachorionic haeomorrhage managed?

A

Nil - monitoring.

Bleeding usually resolved in 1-2 weeks

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23
Q

What are the symptoms of an extrachorionic bleed?

A

Light bleeding and spotting in early pregnancy

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24
Q

What are the complications of an extrachorionic haemorrhage?

A

Increased risk of:

  • Miscarriage
  • Abruption
  • Preterm labour
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25
Q

What factor in extrachorionic bleeding makes a miscarriage more likely?

A

If the bleed is near to or over the internal cervical os

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26
Q

What is are the diagnostic criteria for hyperemesis gravidarum?

A

Severe nausea and vomiting
Weight loss more than 5% of prepregnancy weight
Dehydration
Electrolyte imbalance

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27
Q

What signs may be present in hyperemesis gravidarum?

A 
Signs of dehydration:
- CRT >2s
- Dry mucous membranes
- Reduced UO
Tachycardia
Epigastric pain
Excessive salivation
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28
Q

When is hyperemesis gravidarum more likely?

A

Wks 6-11

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29
Q

What are the risk factors for hyperemesis gravidarum?

A

Primiparity
Multiple pregnancy
Infertility treatment

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30
Q

How is hyperemesis gravidarum diagnosed?

A

Fulfillment of all diagnostic criteria AND +++ urinary ketones

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31
Q

What is the criteria for admission in hyperemesis gravidarum?

A

Unable to tolerate PO fluids AND dehydrated

32
Q

What is the first line treatment for a woman with hyperemesis gravidarum who is not dehydrated?

A

Advise to eat little and often, plain carbohydrates

33
Q

What is the first line treatment for a woman with hyperemesis gravidarum and associated dehydration?

A

IV fluids
Antiemetics: IV cyclizine
Vitamin supplementation

34
Q

How much maternal weight loss is associated with IUGR in hyperemesis gravidarum?

A

10% prepregnancy weight

35
Q

In very severe hyperemesis gravidarum, what treatment is recommended?

A

High dose IV steroids

36
Q

What is the definition of SGA?

A

Estimate foetal weight less than the 10th centile

37
Q

Below what centile is a growth abnomality suspected?

A

3rd centile

38
Q

What is the head sparing effect?

A

In IUGR, the head often grows at the expected rate, but the lower body is growth restricted

39
Q

What is the likely cause of IUGR with head sparing?

A

Placental insufficiency

40
Q

What are the RF for SGA?

A 
Previous SGA baby
Previous stillbirth
Increased maternal age
Existing maternal disease
IVF pregnancy
41
Q

What role does abdominal examination have in assessing SGA?

A

None - abdominal palpation is not an accurate way to measure growth

42
Q

What are some of the causes of SGA?

A 
Smoking
Short pregnancy interval 
Antiphospholipid syndrome
Genetic abnormalities
Congenital infection
Chronic maternal disease
Placental insufficiency
Maternal pregnancy problems (e.g. pre-eclampsia)
43
Q

How is SGA monitored?

A

Serial funal-symphyseal heights and serial growth scans every 3/52

44
Q

What treatment is indicated if a woman has a history of SGA?

A

150mg aspirin daily

45
Q

Should women with a suspected SGA baby be offered early delivery and if so, when?

A

YES - deliver by 37 weeks (34 weeks if growth plateaus)

If c-section: maternal steroids

46
Q

When should steroids and magnesium sulfate be offered to women in labour?

A

Steroids: for foetal lung maturation
Preterm labour before 36wks or C-section labour before 37 weeks

Magnesium sulfate: neuroprotective for foetus
Given in preterm labour prior to 34 wks

47
Q

What is the definition of LGA?

A

Estimated foetal weight above 90th centile

48
Q

What are the causes of LGA?

A

Constitutionally large
Maternal diabetes
Hyperinsulinaemia
Beckwith-Wiedemann syndrome

49
Q

How is LGA monitored?

A

Serial fundal-symphyseal heights and USS growth scans every 3/52

50
Q

What are the complications of LGA?

A

Shoulder dystocia
Need for C-section
Neonatal hypoglycaemia

51
Q

How is LGA managed?

A

May recommend C-section or instrumental delivery

If baby is significantly large, consider induction at 37wks

52
Q

When should foetal movements first be felt?

A

18-20wks

53
Q

Why are foetal movements important?

A

Used as a marker of foetal wellbeing (55% of women with stillbirth reported RFM)

54
Q

What is the expected progression of foetal movements?

A

Foetal movements are first felt between 18-20wks.

They should increase in number until 32wks, and then plateau - BUT NOT REDUCE

55
Q

What are the causes of reduced foetal movements?

A 
Anterior placenta
Sedating drugs
Malformation
Anterior position of foetal spine
Placental insufficiency
56
Q

How is RFM investigated?

A

Maternal perception
USS or Doppler
CTG with buzzer (press when foetus moves)

57
Q

How is RFM managed?

A

If visible movements on USS; reassure

If RFM is evident on scan, assess FHR. if FHR is reduced or absent consult local guidance

58
Q

What are the risk for the baby in prolonged pregnancy?

A 
Meconium aspiration
Shoulder dystocia
Neonatal acidaemia
Neonatal hypoglycaemia
Neonatal seziures
IUGR due to placental insufficiency
59
Q

What are the risk for the mother in prolonged pregnancy?

A 
Obstructed labour
Perineal damage
Instrumental or C section delivery
PPH
Infection (due to meconium)
60
Q

What are the RF for prolonged pregnancy?

A 
Primiparity
Previous prolonged pregnancy
High BMI
FH 
Increased maternal age
61
Q

How is prolonged pregnancy managed?

A

Induction at 41 or 42 weeks

62
Q

If induction is refused, how is prolonged pregnancy managed?

A

Biweekly USS, CTG and Doppler

Risk education

63
Q

What is PPROM?

A

Preterm prelabour rupture of membranes

64
Q

What are the risk factors for PPROM?

A

Smoking
Previous PPROM
Short interpregancy interval
Maternal respiratory disease

65
Q

How is PPROM diagnosed?

A

Maternal history of ‘gush’ and no membranes visible on speculum

66
Q

What investigations should be done in addition to a speculum in PPROM?

A

WCC + CRP
CTG and USS for foetal wellbeing
HVS for infection

67
Q

How is PPROM managed?

A

Admit for up to 72hrs - high risk of preterm labour
Prophylactic erythromycin until established labour or 10/7 (depending on which is sooner)
If under 34wks: MgSO4
If under 36wks: steroids

68
Q

Should a woman with PPROM be induced?

A

Only if not in established labour at 37wks

69
Q

What are the complications fo PPROM?

A 
Preterm delivery
Ascending infection (chorioaminitis)
70
Q

What are the RF for preterm labour?

A 
Smoking
PPROM
Short interpregancy interval
Previous LLETZ
Respiratory disease of mother
71
Q

What investigations are used to confirm preterm labour?

A 
Cervical length >15mm indicated unlikely to be labouring
Foetal fibronectin (from 30wks) 50ng/ml+ indicates labour is likely
Speculum examination - membranes may or may not be intact
72
Q

How is preterm labour managed?

A

Tocolysis: nifedipine AND maternal corticosteroids with IV MgSO4

73
Q

What groups are eligible for preterm labour prophylaxis?

A

Previous preterm labour
Previous mid-trimester loss
AND
TV USS shows cervical length less than 25mm from 16-24wks

74
Q

What methods are used for preterm labour prophylaxis?

A 
Vaginal progesterone
Cervical cerclage (cervical stitch)
75
Q

What is the definition of preterm labour?

A

Labour prior to 37wks

Obstetrics (5 decks)

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