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O&G > complications in pregnancy > Flashcards

complications in pregnancy Flashcards

1
Q

when does preeclampsia occur?

A

> 20 wk or soon after delivery

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2
Q

diagnosis + symptoms of preeclampsia

A

HTN (>140/90, 2 occasions 4h apart) + proteinuria

oedema
headache + vision problems
papilloedema
RUQ/epigastric pain
hyperreflexia
HELLP components
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3
Q

prophylaxis of preeclampsia? who should take?

A

aspirin 75mg from 12wk till birth

prev hx
CKD
autoimmune conditions
diabetics

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4
Q

risk factors for preeclampsia

A

diabetes, BMI > 30
previous hx
> 40y
1st pregnancy

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5
Q

management of severe preeclampsia

A 
fluid balance (pulmonary oedema)
hydralazine (thiazide)
MgSO4 - seizure prevention / treatment
aROM
IV oxytocin + syntocinon at delivery
quick delivery of placenta (placental problem)
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6
Q

what is protein S?

A

anticoagulant factor - reduced in pregnancy

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7
Q

how does BP change in pregnancy?

A

falls in trim 1, stays low trim 2, increases in trim 3 + ends on pre-pregnancy level

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8
Q

risks of preeclampsia

A

mum:
eclampsia
cardiac + organ failure
intra-abdo or cerebral haemorrhage

foetal:
abruption
FGR + prematurity

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9
Q

preeclampsia - investigations

A

serial BP
bloods - renal, liver + urate (organ damage), FBC (low platelets + Hb)
USS - growth restriction
markers of placental function - growth restriction

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10
Q

preeclampsia - cure

A

deliver placenta (ie deliver baby)

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11
Q

preeclampsia - management in hospital (where delivery isn’t indicated)

A

keep BP < 160 - labetalol
fluid balance - risk pulmonary oedema
MgSO4 infusion to prevent eclampsia

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12
Q

what is HELLP?

A

haemolysis - low Hb
elevated liver enzymes - liver damage
low platelets

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13
Q

management of HELLP

A

supportive - replace haematological elements - blood/platelet transfusion

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14
Q

monitoring in pregnancy-induced HTN

A

regular screening of BP + urine for protein - 25% risk preeclampsia

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15
Q

pregnancy - induced HTN - drug management

A

nifedipine / labetalol

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16
Q

RFs for foetal growth restriction

A

previous small baby
smoking
preeclampsia/HTN
renal/other disease

reduced foetal movements

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17
Q

foetal growth restriction - screening + diagnosis

A

customised symphysio-fundal height charts

USS:
EFW from 3 measurements
look at placental function/development

assess blood flow in uterine + umbilical artery + brain vs kidneys - determine if small as placental malfunction vs constitutionally

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18
Q

foetal growth restriction - management

A

exclude causes - infection, chromosomal
monitor growth + FHR
doppler blood flow

steroids for lungs if premature
caesarean if needed

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19
Q

APGAR - components

A 
appearance
pulse
grimace
activity
respiration
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20
Q

apgar - appearance

A

0 - blue/pale
1 - acrocyanosis
2 - pink

21
Q

pulse - APGAR

A

0 - absent
1 - <100
2 - >100

22
Q

grimace - APGAR

A

0 - no facial expression
1 - weak cry
2 - strong cry

23
Q

activity - APGAR

A

0 - absent
1 - some flexion
2 - full flexion

24
Q

respiration - APGAR

A

0 - absent
1 - weak
2 - strong

25
Q

relevance of apgar score at 5 mins

A

<3 - neuro damage

>7 - normal

26
Q

3 obstetric + 3 non-obstetric causes of abdo pain in pregnancy

A

labour
placental abruption
heartburn

UTI
GE
constipation

27
Q

when should foetal movements be felt from?

A

18-24

28
Q

when does GDM develop?

A

end of 2nd - early 3rd trimester

29
Q

what are bad signs in case of RFM?

A

previous RFM in this pregnancy
small baby - previous/current (FGR)
congenital malformations

30
Q

indications for IOL

A

foetal problems:
IUGR
suspicious CTG
PRoM with infection/foetal compromise

mum’s health:
preeclampsia
diabetic >38wk

natural obstetric causes:
rhesus incompatibility
post dates

31
Q

what is AFP?

A

protein produced by developing foetus

32
Q

raised AFP - causes

A

NTDs

multiple pregnancy

33
Q

decreased AFP - causes

A 
down's
trisomy 18 (edward's)
maternal diabetes
34
Q

chorioamnionitis - what is it?

A

emergency - life threatening to mum + foetus

result of ascending bacterial infection of amniotic fluid / membranes / placenta

35
Q

chorioamnionitis - what is the main thing that leads to it?

A

premature rupture of membranes - exposes sterile environment to pathogens

36
Q

chorioamnionitis - management

A

prompt delivery of foetus - poss caesarean

IV abx

37
Q

eclampsia - management

A

IV MgSO4 - til 24h after last seizure or delivery
fluid restriction - avoid overload
monitor urine output, reflexes, sats, RR

38
Q

group B strep - what is it?

A

present in 30% of mothers’ bowels. infants exposed to it in labour + develop poss serious infections.

39
Q

group B strep - RFs

A 
PPPP:
Prematurity
Prolonged RoM
Positive in other sibling
Pyrexia eg chorioamnionitis
40
Q

group B strep - management? when would you give treatment?

A

IV benzylpenicillin prophylaxis if PPP:

Previous pregnancy was +ve for it
Preterm labour
Pyrexia in labour

41
Q

IOL - mechanism

A

membrane sweep
intravaginal prostaglandin
RoM
oxytocin

42
Q

obstetric cholestasis - presentation, risks + management (note management isn’t evidence based)

A

pruritus esp palms, soles, abdo
risk prematurity/stillbirth
vit K + ursodeoxycholic acid + IOL 37wk

ur so deoxy cholic acid

43
Q

oligohydramnios - causes

A

IUGR (not grown enough)
post-dates (grown too much)
PRoM (fluid has gone)
preeclampsia

44
Q

post term pregnancy - consequences

A

reduced placental perfusion
oligohydramnios
need for instrumental / caesarean / induction

45
Q

risks of smoking in pregnancy

A

IUGR
prematurity
miscarriage + stillbirth + SIDS

46
Q

risks of alcohol in pregnancy

A

foetal alcohol syndrome, learning diffs, growth restriction

microcephaly

47
Q

shoulder dystocia - risks

A

PPH
perineal tears
brachial plexus injury of foetus

48
Q

shoulder dystocia - management

A

call senior

mcroberts manoeuvre

O&G (22 decks)

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