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Obstetrics & Gynecology > Complications of pregnancy and labour > Flashcards

Complications of pregnancy and labour Flashcards

1
Q

Risk factors for gestational hypertension

A
  1. Primigravida
  2. First conception with new partner
  3. PmHx/ Family hx g HTN
  4. DM, chronic HTN, renal insufficiency
  5. APLA
  6. Older age >40
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2
Q

Gestational hypertension vs preexisting hypertension

A

Pre-existing: HTN prior to 20 weeks
Gestational hypertension: HTN developing after 20 weeks in previously normotensive woman
Pre Eclampsia: HTN with new onset proteinuria or adverse conditions
Eclampsia: one or more GTCs in setting of pre eclampsia

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3
Q

Maternal complicaitons from gestational hypertension

A
  1. Liver and renal dysfunction
  2. Seizures
  3. Abruption
  4. LV failure, pulmonary edema
  5. DIC
  6. HELLP syndrome
  7. Hemorrhagic stroke
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4
Q

Side effects of tocolytics

A
  1. Indomethacin: closure of ductus arterious early, GI bleed, N/V, worsening asthma, renal issues
  2. Nifedipine: Hypotension
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5
Q

PPROM less than 34 weeks management

A

Goal: maintain pregnancy
Manage: expectant- many will deliver in 1 week
Steroids; yes
Abx: yes (ampicillan and erythromycin)

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6
Q

PPROM greater than 34 weeks management

A

Goal: deliver
Manage: Induce vaginal labour or section
Steroids; No (not past 34 weeks)
Abx: Not unless needed for GBS

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7
Q

Risk factors for preterm labour

A
  1. Multiples
  2. ** history of preterm labour**
  3. infection
  4. smoking
  5. low socioeconomic status
  6. uterine abnormalities
  7. bleeding in late pregnancy
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8
Q

Betamethasone

A

Steroid for lung maturation in preterm babes
Benefits: lungs, decreased intraventricular hemorrhage, decreased necrotizing enterocolitis
Risks: Detrimental in maternal DM

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9
Q

Interventions for short/ partially opened cervix

A
  1. Cerclage- sews cervix shut

2. Prostaglandins

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10
Q

Investigations in maternal hypertension

A
  1. Urine: protein
  2. Creatinine, BUN, uric acid (10X less GA)
  3. INR, platelets, PTT, fibrinogen
  4. LFTs (ALT, AST, LDH, Bili)
  5. Fundoscopy
  6. Reflexes
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11
Q

Treatment of pre-eclampsia

A
  1. Deliver baby/placenta
  2. IV BP meds
  3. MgSO4 for seizure prophylaxis in mom
  4. Epidural will help
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12
Q

Rh Disease path

A

Path: mom becomes sensitized to fetal blood cells after exposure in utero/delivery. Makes ab to fetal RBC
Fx: usually affects second rh incompatible child (need time for ab IgG to be produced)
Causes hemolytic disease of the newborn *

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13
Q

Indications for Rho-Gam

A
  1. Rh- bleeding during pregnancy (300ug covers 30cc fetal blood)
  2. 28 weeks to all Rh-
  3. Postpartum at delivery/within 72h if baby is Rh+
  4. Amniocentesis, abortion, chorionic villi sampling
  5. Ectopic pregnancy
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14
Q

Investigations in Rh disease

A

Kleihauer-Betke test tells how much fetal blood in maternal circulation (if thought to be greater than 30mL)

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15
Q

Differential diagnosis of small for dates

A
  1. Wrong dates
  2. IUGR
  3. Fetal demise
  4. Oligohydramnios
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16
Q

Differential diagnosis of large for dates

A
  1. Wrong dates
  2. Multiple gestation
  3. Polyhydramnios
  4. LGA (familial/DM)
  5. Fibroids
17
Q

Twin-Twin Transfusion Syndrome

A

Epi:10% monochorionic twins
Path: Arterial blood from donor passes to recipient via placenta
Sx:
Donor: IUGR, hypovolemia, hypotension, anemia, oligohydramnios
Recipient: Hypervolemia, HTN, CHF, edema, polycythemia
Ix: U/S, doppler
Tx: amniocentesis, intrauterine blood transfusion

18
Q

When do we treat empirically for group B strep?

A

If GBS status is unknown and:

  1. GBS bacturia during current pregnancy
  2. Previous infant with GBS infection
  3. Preterm labour <37 weeks
  4. Ruptured membranes > 18 h before delivery
  5. Intrapartum temperature of >38C
  6. Positive GBS screen during current pregancy
19
Q

If 1 hour 50g oral glucose challenge test >11.1 mmol/L then?

If >7.8 mmol/L then?

A
  1. Diagnose gestational diabetes

2. Go on to OGTT

20
Q

Requirements for tocolysis

A
  1. Preterm labour
  2. Live fetus
  3. Intact membranes, cervix<4 cm

Obstetrics & Gynecology (7 decks)

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