Common Obstetric Problems Flashcards
What blood tests are useful in bleeding during 1st trimester pregnancy?
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Serum B-HCG - should increase by 60% if viable pregnancy
Progesterone -
Give 4 indications on ultrasound that there has been a miscarriage
no sac
large empty sac
no metal heart beat with pole >7mm
No growth or progress in pregnancy over 10-14 days
Where is the most common place for an ectopic pregnancy to occur?
The Ampule of the uterine tube
What is the medical management for ectopic pregnancy?
methotrexate
Give some risk factors for coptic pregnancy
Previous ectopic
previous uterine surgery
inutruterine device
What is a molar pregnancy?
Complete mole - 2 sperm fertilise egg (triploidy - 69 chromosomes)
Partial mole - 2 sperm fertilise empty egg (46 chromosomes)
What are the presenting symptoms of molar pregnancy?
high b-hcg
exaggerated symptoms of pregnancy
jelly like discharge
What is the definition of antepartum haemorrhage?
bleeding from 24 weeks
What are the local causes of antepartum haemorrhage?
trauma to vagina or carvix
neoplasia of gynae
What is placenta Praevia?
A low lying placenta
Major - coves os
Minor - doesn’t cover os
What is Vasa praevia?
Blood vessels lying running through the membranes above the os
How does Placenta praevia present?
History or previous PP
failure of head to engage towards term
Malpresentation - breech oblique or transverse lie
What is the management of placenta praevia?
regular scanning to assess progress
Worsening advice
Offer C-section
What is the major complication of c-section in placenta praevia?
Bleeding is the major risk
must take steps to prepare to major blood loss
In obstetrics what is abruption?
Premature detactment of the placenta from the uterine wall
How can abruption of the placenta present?
Abdominal pain
Frequent contraction
vaginal bleeding
symptoms of shock
Give 5 risk factors of abruption
pre-eclampsia smoking trauma thrombophilia extremes of age
What is the definition of primary postpartum blood loss?
> 500ml loss within first 24 hr
What is the definition of secondary postpartum blood loss?
> 500ml after first 24 hr
How is gestational diabetes diagnosed?
GTT.
fasting >5.6mmol/l
What are the effects of diabetes in pregnancy?
Macrosomia
miscarriage
congenital malformation
inc risk of preterm birth
What are the complications of macrosomia?
shoulder dystocia
birth trauma
inc risk of CS
What are 3 three features of pre-eclampsia?
Hypertension
Proteinuria
Oedema
How may pre-eclampsia present?
headache visual upset epigastric pain liver tenderness clonus hyperreflexia
How is the risk of pre-eclampsia reduced in those with risk factors?
Aspirin 75mg/day 12-36 weeks
Labetolol
What is the target blood pressure in a pre-eclampsia patient on labetolol?
150/100-80 mmHg
