Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproduction > Complications with Pregnancy and Labour > Flashcards

Complications with Pregnancy and Labour Flashcards

1
Q

What is pre-eclampsia

A

A pregnancy-specific multi-system disorder which usually occurs after 20 weeks
Pregnancy induced hypertension + proteinuria
Also get oedema
May also see maternal AKI, liver dysfunction, neuro features, fetal growth restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for pre-eclampsia

A

Pre-existing hypertension, diabetes, autoimmune diseases (eg lupus), renal disease, a family history of pre-eclampsia, obesity, maternal age >40 and women with a multiple pregnancy

Most significant risk is previous pre-eclampsia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happen to the kidneys in pre-eclampsia

A

Kidney function declines
Leads to salt and water retention - oedema formation (esp hands and face)
Renal blood flow and Glomerular filtration rate decreases
AKI is a comm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do you treat eclampsia

A

Vasodilators and cesarean section

Only way to treat is to get the baby out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the risk with eclampsia

A

Lethal if not treated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is eclampsia

A

Extreme pre-eclampsia - usually preceded by the normal symptoms
Causes vascular spasms, extreme hypertension, chronic seizures and coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is placenta praevia

A

When the placenta is low lying in the womb and covers all or part of the cervix - cut off is 2.5cm from the cervical os
It has an increased risk of haemorrhage
If found on US you need follow up scan to monitor its position

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What genetic screen is offered to all pregnant women

A

A screening test for Down syndrome

Very accurate test - 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the link between down’s syndrome and maternal age

A

As maternal age increases so does the risk of Down’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do you test for Down’s syndrome in the 1st trimester

A

Measure of fluid thickness behind foetal neck using ultrasound (Nuchal thickness; NT)
As the thickeness/amount of fluid increases so does the risk of abnormality
Measured at 11-13+6 weeks

Combine this with maternal age and a measurement of HCG, AFP and PAPP-A (blood test)
This is 90% accurate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do you test for Down’s syndrome in the 2nd trimester

A

Blood sample at 15-20 weeks
Assay of HCG and AFP
Also look at inhibin and oestriol
Combined with risk factors- age etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the Harmony test

A

The test detects foetal DNA fragments in a sample of blood taken from the mother
Could be used to identify genetic conditions in the foetus
Non-invasive test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When is amniocentesis carried out

A

Usually performed after 15 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When is chorionic villus sampling carried out

A

Usually performed after 12 weeks

11 and 13+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the risk with amniocentesis and CVS

A

Miscarriage risk - both carry a risk of around 2%

CVS also comes with a risk of amniotic fluid embolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the risk factors for gestational diabetes

A

BMI above 30kg/m2
Previous macrosomic baby weighing 4.5kg or above
Previous gestational diabetes
Family history of diabetes
Minority ethnic family origin with a high prevalence of diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you diagnose gestational diabetes

A

a fasting plasma glucose level of 5.6mmol/litre or aboveor

a 2‑hour plasma glucose level of 7.8mmol/litre or above.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When would you need to regularly monitor foetal growth

A

Women with a single SFH which plots below the 10th centile or serial measurements which demonstrate slow or static growth
Women in whom measurement of SFH is inaccurate (for example: BMI > 35, large fibroids, hydramnios)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which women are at high risk of pre-eclampsia

A

Those with:
hypertensive disease during a previous pregnancy
chronic kidney disease
autoimmune disease such as systemic lupus erythematosis or antiphospholipid syndrome
type 1 or type 2 diabetes
chronic hypertension.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What treatment should women at high risk of pre-eclampsia be given

A

75mg of aspirin daily from 12weeks until the birth

Used for all women with previous case of pre-eclampsia and others with risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the marker detected by pregnancy tests

A

BhCG

It has very high sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

List abnormal pregnancy outcomes

A

Miscarriage
Ectopic pregnancy - abnormal location
Molar pregnancy - abnormal embryo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What cervical pathologies can lead to bleeding

A

Infection -e.g. STI
Malignancy
Polyps - benign but cna bleed if ulcerated
Cervical erosion - more common in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What vaginal pathologies can cause bleeding

A

Infection
Malignancy (rare in reproductive age group)
Genital injury - consider domestic abuse/rape

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the main symptoms of a miscarriage

A

Bleeding
Period type cramping
May have passed larger products/clots
Will have had a positive pregnancy test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How can you stage a miscarriage by speculum exam

A

Cervical os closed = threatened miscarriage
Products are seen at an open os = inevitable miscarriage
Products are seen in the vagina and the os is closing = complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the symptoms of cervical shock

A 
Cramps 
Severe abdominal pain 
Nausea and vomiting 
Sweating 
Fainting
Bradycardia and hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How do you use a scan to stage a miscarriage

A

US of uterus
If pregnancy in situ = threatened
May see pregnancy in process of expulsion = inevitable
Or an empty uterus = complete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do you manage cervical shock

A

Resolves if products removed from cervix - definitive treatment Resuscitation with IV fluids, Uterotonics maybe required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What can cause miscarriage

A

Embryonic abnormality : Chromosomal
Immunologic : APS
Infections : CMV, Rubella, Toxoplasmosis, Listeriosis
Severe emotional upsets, stress
Iatrogenic after CVS or amniocentesis
Associations: heavy smoking, cocaine, alcohol misuse
Uncontrolled diabetes, obesity, severe hypertension
PCOS
Uterus abnormalities
Sometimes unknown

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the different types/stages of miscarriage

A

Threatened Miscarriage - risk to pregnancy
Inevitable Miscarriage - pregnancy can’t be saved
Incomplete Miscarriage - part of pregnancy lost already
Complete Miscarriage - all of pregnancy lost, uterus is empty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is early foetal demise

A

Pregnancy is in situ but there is no heartbeat
Has a mean sac diameter
of over 25mm and/or a foetal pole of over 7mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is an anembryonic pregnancy

A

When there is no foetus but an empty sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

How do you manage a miscarriage

A

Assessing and ensuring haemodynamic stability.
- FBC, G and S, ẞhCG, test rhesus status
BHCG - will be declining in miscarriage
Examination
USS - determine if viable
Histology
Sensitive discussion and emotional support
Might discharge or admit - depends on outcome
Treatment: Conservative, Medical, MVA/Surgical
Anti-D administration if surgical intervention is needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the definition of recurrent miscarriage

A

3 or more consecutive pregnancy losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are some of the risk factors for recurrent miscarriage

A 
Antiphospholipid Syndrome 
Thrombophilia
Balanced translocations 
Uterine abnormalities - particularly if late 1st trimester loss 
Obesity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How can you prevent recurrent miscarriage in women with high risk blood disorders

A

Use of low dose aspirin and daily Fragmin injections after confirmation of viable IUP in evidence of APS or Thrombophilia
Aspirin can be started before or when the patient takes a positive pregnancy
test and low molecular weight heparin should be started when intrauterine pregnancy is
confirmed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is an ectopic pregnancy

A

Implantation is out with the uterine cavity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are the common sites for an ectopic pregnancy

A

Fallopian tube most common

Other sites include, ovary, peritoneum, C-section scars or other abdominal organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How does an ectopic pregnancy present

A 
Pain - localized to one side, pevic or abdominal  
Bleeding - light PV
Discharge
Dizziness and collapse 
Shoulder tip pain 
SOB

Pallor
Haemodynamic instability - shock, hypotension, high HR
Signs of peritonism, guarding and tenderness
Acute abdomen is a sign of rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What are the red flags for ectopic pregnancy

A

Repeated presentation with abdo/pelvic pain

Pain requiring opiates in a woman known to be pregnant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

How do you investigate an ectopic pregnancy

A

FBC, GandS, BhCG
Usually a sub-optimal rise in HCG

Transvaginal US - look for empty uterus, pseudo sac or mass elsewhere
Free fluid in Pouch of Douglas suggests rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How do you manage an ectopic pregnancy

A

Surgical management

  • if patient is acutely unwell or have a large or ruptured ectopic (only safe option)
  • remove the pregnancy laparoscopically if possible
  • may lose affected tube

Medical management

  • if woman is stable, low levels of ẞhCG (up to 5000) and ectopic is small and unruptured
  • methotrexate is used (either one or 2 doses)
  • continue HCG monitoring

Conservative management

  • for “ the well patient” who is compliant with follow-up visits
  • only if small, unruptured and HCG falling
  • allow nature to take it’s course
  • repeat pregnancy tests to ensure pregnancy has ended (HCG should fall)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is a complete mole

A

Egg without DNA
1 or 2 sperms fertilise, result in diploid - fathers DNA only
Leads to 46 XX or 46 XY karyotype
No foetus but an overgrowth of placental tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the major risk associated with a complete mole

A

Risk of it becoming choriocarcinoma

Around 2.5% risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is a partial mole

A

Haploid egg
Fertilized by either 1 sperm which duplicates DNA material or 2 sperms result in triploidy
Has a karyotype of 69 XXX or 69 XXY
May have unviable or absent foetus and overgrowth of placental tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

How does a complete molar pregnancy present on US

A

Snowstorm appearance in uterus due to multiple placental vesicles
These are grape like clusters swollen with fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

How might a molar pregnancy present

A

Hyperemesis
Varied bleeding and passage of “grapelike tissue”
Fundus large for dates dates.
Occasional shortness of breath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

How do you manage a molar pregnancy

A

Surgical removal of the mole
Tissue is sent for histology to determine if partial or complete
Follow-up with Molar Pregnancy Services - centers in Dundee, Sheffield and London

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is implantation bleeding

A

Small amount of bleeding that occurs as the fertilised egg implants
Bleeding is light/brownish and limited
Soon signs of pregnancy emerge
Usually settles and pregnancy continues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is a chorionic haematoma

A

Pooling of blood between endometrium and the embryo due to separation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

How might a chorionic haematoma present

A

Bleeding, cramping, threatened miscarriage

May lead to infection and miscarriage if large

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

How do you manage a chorionic haematoma

A

Usually self limited and resolve - reassure

Closely monitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

How do you treat BV during pregnancy

A

Metronidazole 400mg b.d. 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

How do you treat chlamydia during pregnancy

A

Erythromycin, Amoxycillin

TOC 3 week later

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What symptom is usually worse in miscarriage - pain or bleeding

A

Bleeding is usually predominant

Pain varies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

When is anti-D used in miscarriage/molar ect

A

Given to rhesus negative women who go for surgical management
Higher risk of blood mix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is hyperemesis gravidarum

A

Excessive and prolonged vomiting in pregnancy which alters quality of life
Is severe enough to cause dehydration and biochemical derangement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are the complications of hyperemesis gravidarum

A

Dehydration, ketosis, electrolyte and nutritional disbalance
Weight loss, altered liver function
Malnutrition
Also puts a strain on mental health

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How do you manage hyperemesis gravidarum

A 
Rehydration IV, electrolyte replacement.
Parenteral antiemetic 
Nutritional supplement
Vitamin supplement : Thiamine/Pabrinex
NG feeding or even TPN if severe 
May get PPI or H2 receptor blocker for reflux 
Steroid use in recurrent, severe cases
Thromboprophyaxis - pregnancy and dehydration are hypercoaguable states
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What are the first line anti-emetics for HG

A

Cyclizine

Prochlorperazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is the definition of being large for dates

A

Symphyseal-fundal height >2cm for Gestational age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What can be the underlying cause of being large for dates

A

Wrong dates - further along than thought
Foetal Macrosomia - big baby
Polydramnios - excess fluid
Diabetes - insulin resistance promotes fat storage
Multiple Pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What are the risks associated with foetal macrosomia

A 
Clinician and maternal anxiety
Labour dystocia - difficult birth 
Shoulder dystocia- more with diabetes
Failure to progress 
Perineal trauma 
Post-partum haemorrhage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

How do you diagnose foetal macrosomia

A

US scan - estimated foetal weight above 90th centile

Abdominal circumference above 97th centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How do you manage foetal macrosomia

A

Exclude diabetes
Reassure
Usually have to induce labour before 40 weeks for a large baby
Some will need a C-section (if over 5kg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What is the definition of polyhydramnios

A

Excess amniotic fluid
Amniotic Fluid Index >25cm
Deepest pool of fluid >8cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What can cause polyhydramnios

A

Maternal diabetes - due to foetal polyuria
idiopathic
Anomaly- GI atresia, diaphragmatic hernia cardiac, tumours
Monochorionic twin pregnancy
Viral infection
Hydrops foetalis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the symptoms and signs of polyhydramnios

A 
Abdominal discomfort
Pre-labour rupture of membranes
Preterm labour
Cord prolapse
Malpresentation
Tense shiny abdomen
inability to feel foetal parts
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What investigations should you do for polyhydramnios

A

Oral Glucose Tolerance Test - check for diabetes
Serology - looks for viral cause
Antibody Screen
USS – foetal survey (looking for good swallow)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

How do you manage polyhydramnios

A

Inform the patient of the complications and the birth plan
Serial US to monitor
Induction of labour by 40 weeks - risk of death of they go over

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the risks during labour due to polyhydramnios

A

Risk malpresentation
Risk of cord prolapse
Risk of Preterm Labour
Risk of PPH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What factors increase your chance of having a multiple pregnancy

A 
Assisted conception
Race/Geography- African
Family History
Increased maternal age
Increased Parity
Tall women
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Describe zygosity

A

How many eggs where involved
Monozygotic : splitting of a single fertilised egg
Dizygotic: fertilisation of 2 ova by 2 spermatozoa
More common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Describe chorionicity

A

Number of placentas
1 or 2?
1 has higher risk, especially if they are in the same amniotic sac

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

At what point will twins be conjoined

A

If they don’t separate fully by day 15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What type of twins have the highest risk

A

Monochorionic / monozygous twins

More likely to have complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the symptoms and signs of a multiple pregnancy

A 
Exaggerated pregnancy symptoms e.g. excessive sickness
High AFP
Large for dates uterus
Multiple foetal poles
US to confirm at 12 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What are the complications of multiple pregnancy to the foetus

A 
Congenital anomalies 
Intrauterine death 
Pre term birth
Growth restriction- 
Cerebral palsy - higher risk
Twin to twin transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the complications of multiple pregnancy to the mother

A 
Higher mortality 
Hyperemesis Gravidarum
Anaemia
Pre eclampsia
Antepartum haemorrhage- abruption, placenta praevia
Preterm Labour
Caesarean section
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How often do you need to see women with multiple pregnancy

A

MC: every 2 weeks
DC every 4 weeks
Get an US at each visit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

What medication should women with multiple pregnancy take

A

Fe supplementation
Low Dose Aspirin
Folic Acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is twin to twin transfusion syndrome

A

When there is an artery/vein anastomosis between the twins
One will perfuse the other
Gives Oligohydramnios- polyhydramnios - one with excess one with to little

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

How do you treat twin to twin transfusion

A

Before 26/40 – foetoscopic laser ablation
>26/40- amnioreduction /septostomy
Deliver 34-36/40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

When should you deliver twins

A

DCDA Twins deliver 37-38 weeks

MCDA Twins deliver after 36+0 weeks with steroids.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the max time you should allow between delivery of the first twin and second

A

Aim to deliver both in under 30 mins

Give Syntocinon after twin 1 to speed up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

What is the definition of gestational diabetes

A

carbohydrate intolerance resulting in hyperglycaemia of variable severity with onset or first recognition during pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

What are the complications of uncontrolled pre-existing diabetes in pregnancy

A

Congenital anomalies
Miscarriage
Intra uterine death
Worsening diabetic complications eg retinopathy, nephropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What are the complications common to both uncontrolled pre-existing diabetes and gestational diabetes s

A 
Pre eclampsia
Polyhydramnios
Macrosomia
Shoulder dystocia
Neonatal hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Why does neonatal hypoglycaemia occur after delivery from a diabetic mother

A

Baby is used to her high glucose levels so it’s own insulin levels are raised to cope with them
After delivery they no longer get the high glucose so their high insulin is too much - hypo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What advice should you give to diabetic women before they conceive

A

Aim for HBA1C of 48
Avoid pregnancy if its too high
Stop any embryopathic medication eg ACE inhibitors, cholesterol lowering agents
Start high Dose Folic Acid 5mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Which diabetic drugs can you use in pregnancy

A

Insulin- MDI /Insulin pump

Metformin (Type 2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Which drugs should women with pre-existing diabetes be started on

A

Folic Acid 5mg

Low Dose Aspirin from 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are the risk factors for developing gestational diabetes

A 
Previous GDM
Obesity BMI 30 or more
FH: 1st degree relative
Ethnic variation: South Asia (India / Pakistan / Bangladesh), Middle Eastern, Black Caribbean
Previous big baby
Polyhydramnios
Big baby
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Is it normal to become insulin resistant in pregnancy

A

Yes
The pregnancy hormones Human placental lactogen, cortisol can cause this
Some women cannot compensate fully so get the diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How do you diagnose gestational diabetes

A

Oral glucose tolerance test
Fasting >=5.1 mmol/l
2 hour >=8.5 mmol/l

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is the risk of the baby and mum going on to develop diabetes after a pregnancy with GD

A

Increased risk for the baby of obesity and diabetes in later life
Increased risk of type 2 diabetes for the mother

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

How do you manage diabetes in pregnancy

A 
Diet, weight control and exercise
Monitor for PET - BP and urine
Growth scans
Consider Hypoglycaemic agents - insulin
Monitor babies BM after birth as risk of neonatal hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is the definition of a preterm delivery

A

Delivery before 37 weeks gestation
Extreme = 24-27+6 weeks
Very = 28-31+6 weeks
Moderate to late preterm = 32-36+6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is considered a term pregnancy

A

Anything above 37 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What can lead to a preterm birth

A 
Infection
Over distension = Multiple
or polyhydramnios
Placental abruption
Intercurrent illness: UTI, appendicitis 
Cervical incompetence
Idiopathic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What are the risk factors for preterm birth

A 
Previous PTL 
Multiple
Uterine anomalies
Age (teenagers)
Parity (=0 or >5)
Ethnicity
Poor socio-economic status
Smoking 
Drugs (especially cocaine)
Low BMI (<20)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is the definition of small for gestational age

A

Estimated foetal weight or abdominal circumference below the 10th centile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is intra-uterine growth restriction

A

Failure to achieve growth potential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What is the definition of low birth weight

A

Below 2.5kg

Regardless of gestation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

How do you identify a small for gestational age foetus

A

Antenatal risk factors - mothers age over 40, smoker, cocaine etc
Screening during antenatal care - SFH at 24 weeks
Measure foetal abdominal circumference, head circumference +/- femur length

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

When are all women measured for symphysial-fundal height

A

24 week scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What maternal factors can lead to a small foetus

A 
Smoking
Alcohol
Drugs
Height and weight -small 
Age
Maternal disease e.g. hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What placental factors can lead to a small foetus

A

Infarcts
Abruption
Often secondary to hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What foetal factors can lead to a small foetus

A

Infection e.g. rubella, CMV, toxoplasma
Congenital anomalies e.g. absent kidneys
Chromosomal abnormalities e.g. Down’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the consequences of intra-uterine growth restriction

A 
Risk of hypoxia and death in labour 
Hypoglycaemia
Effects of asphyxia
Hypothermia
Polycythaemia
Hyperbilirubinaemia
Abnormal neurodevelopment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What are the features of poor intrauterine growth

A

Predisposing factors
Fundal height less than expected
Reduced liquor
Reduced foetal movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

How do you monitor a small for dates baby

A

Growth scans combined with Doppler assessment - repeat regularly
Cardiotocography
Biophysical assessment - movement, liquor, breathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

How should blood flow through the umbilical artery

A

Should have a constant flow of blood to baby even in diastole.
If there are breaks in flow to the baby or even backflow then it is worrying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What should be given to a premature baby before planned delivery

A

Steroids - lung maturity

Magnesium sulphate - cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is the commonest cause of maternal death

A

Cardiac problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

What are obese women at high risk of during pregnancy

A

Blood clots

including in early pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

What are the red flags for CV disease in pregnancy

A

Chest pain - they need an ECG
SOB when lying flat
Struggling to climb stairs - need echo and 24hr ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Are murmurs and palpitations common in pregnancy

A

YES - very common

Most of the time they are benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Why might a woman with a heart condition not cope with pregnancy

A

Heart needs to work 40% harder in pregnancy so if they have an existing heart problem it might not cope
Can have aortic dissection as the pressure splits the vessel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Is tachycardia normal in pregnancy

A

Yes

Should still investigate for potential pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Why is it risky to put a pregnant women under anaesthetic

A

Less residual capacity in pregnancy as the lungs are working harder
Desaturate quickly if under anaesthetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is a red flag for breathlessness in pregnancy

A

Only if it impacts daily activity

Otherwise it is quite common and usually improves on exertion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What is the most common chronic medical disorder to complicate pregnancy

A

Asthma
Its a very common condition itself
Acute exacerbations can be dangerous in pregnancy
May improve, deteriorate or remain unchanged - 1/3 do each

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Why do pregnant women need the flu jab

A

Women are slightly immunocompromised in pregnancy so higher risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

How do you test asthma in pregnancy

A

Treat asthma the same as if not pregnant

Increase dose and or frequency of inhaled steroids is first step if its gotten worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What is the risk of poorly controlled asthma in pregnancy

A

Severe exacerbations during pregnancy or poorly controlled asthma are risk factors for low birth weight babies, premature rupture of membranes, premature delivery and hypertensive disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What happens to risk of VTE in pregnancy

A

It increases by 4-6x

Vast majority occurs in the left leg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

How can you investigate a VTE in pregnancy

A

Compression duplex ultrasound - if normal but still suspect then repeat in a week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

How do you treat VTE risk in pregnancy

A

LMWHs are the agents of choice for antenatal thromboprophylaxis
Dose is weight adjusted
They are effective, safe and don’t cross the placenta
Given antenatally and for 6 weeks postnatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

How do you investigate PE in pregnancy

A

CXR and V/Q scans are safe to do in pregnancy

Also do an ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Can you give warfarin to a pregnant woman

A

No
Teratogenic in 1st trimester
In 2nd and 3rd it crosses the placenta - which increases bleeding risk for baby
Don’t give rivaroxaban either
It is safe to take while breastfeeding though wait several days due to PPH risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What happens to connective tissue diseases in pregnancy

A

Significant risks of aggravation of disease by pregnancy

Many of the drugs used are not safe in pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What are the clinical features of anti-phospholipid syndrome in pregnancy

A

Recurrent early pregnancy loss
Late pregnancy loss - usually preceded by FGR
Placental abruption
Severe early onset pre-eclampsia
Severe early onset Fetal Growth Restriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

How do you manage anti-phospholipid syndrome in pregnancy

A

Aspirin +/- fragmin
Stop warfarin if they’re on it
A lot more foetal observation
May suggest as early delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What is the risk of uncontrolled epilepsy in pregnancy

A 
10x risk of maternal death 
Risk of abdominal trauma during seizure 
Preterm births 
Hypoxia and acidosis 
Many of the drugs are teratogenic and related to congenital malformations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What happens to seizure frequency in pregnancy

A

For most women seizure frequency is improved or unchanged

Good seizure control is important

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Should you stop anti-epileptics in pregnancy

A

No - the seizures are too high a risk

Can trial lower doses or monotherapy before pregnancy/conception to see if it will work

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

Which anti-epileptic is associated with neural tube defects

A

Sodium valproate

It must be avoided if possible in all women of reproductive age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What increases the risk of seizures during labour

A

Stress, pain, sleep deprivation, over-breathing and dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

If a woman has a seizure during labour what can happen

A

If generalised tonic-clonic seizures occur, maternal hypoxia, foetal hypoxia and acidosis may result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

If a woman collapses during pregnancy how should you position her

A

Left lateral tilt

to take pressure off the IVC and aorta (uterus will press on them if flat on back)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

How do you treat an intra-partum seizure

A 
Left lateral tilt
IV lorazepam / diazepam
PR diazepam / buccal midazolam
IV Phenytoin
May need to expedite delivery by CS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What can lead to an abnormal labour

A

Malpresenation - breech
Malposition - facing wrong way and more likely to get stuck
More common if baby is early or late
Obstruction or foetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

What are the risks with a vaginal breech delivery

A

Risk of head entrapment or foetal injury
Can cause foetal hypoxia or distress
Prolapse of the cord
Risk of cord compression Increased risk of over extension of the neck when delivering the head last
Harder to get the head out
Compression of the head can be too quick in breech (hasn’t had time to slowly remould) so you have to deliver the head slowly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

What is considered a late/post term birth

A

Over 42 weeks is considered late and will be offered an induction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

If labour is too fast, what effect does it have on the baby

A

Fast labour can lead to foetal hypoxia as lack of a break between contractions means the placental vasculature doesn’t have time to refill and baby can be under perfused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

What are the risks of an obstructed labour

A 
Sepsis - ascending infection
uterine rupture
obstructed AKI 
postpartum haemorrhage
fistula formation - lots of pressure on vaginal wall 
foetal asphyxia 
neonatal sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What may cause a failure to progress in labour

A 
Power = Inadequate contractions: frequency and/or strength
Passages = Short stature / Trauma / Shape of pelvis
Passenger = big baby or malposition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is a partogram

A 
A chart that monitors the progress of labour 
It records:
Foetal Heart
Amniotic Fluid
Cervical Dilatation
Descent
Contractions
Obstruction - Moulding
Maternal Observations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What is meconium staining a sign of

A

Foetal distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

How often should you check the baby’s heart

A

Stage 1 labour = during and after a contraction

Stage 2 = At least every 5 minutes during & after a contraction for 1 whole minute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What are some risk factors for foetal hypoxia

A 
Small fetus
Preterm / Post Dates
Antepartum haemorrhage
Hypertension / Pre-eclampsia
Diabetes
Meconium
Epidural analgesia
Induced labour
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What are the acute causes of foetal distress

A 
Abruption
Vasa Praevia - bleeding from the foetal circulation 
Cord Prolapse
Uterine Rupture
Feto-maternal Haemorrhage
Uterine Hyperstimulation
Regional Anaesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What is the normal heart rate for a term baby

A

110-150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Should you get accelerations in the foetal HR

A

YES

Want to see accelerations in the HR as it shows baby is moving about normally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Should you get decelerations in the foetal HR

A

Normal to decelerate slightly during a contraction – should recover quickly
They are also normal before 26 weeks

Be concerned if at end of contraction or if they last longer
Abnormal from 26 weeks onwards if not in labour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

How does hypoxia present in a CTG

A

Loss of accelerations
Repetitive deeper and wider decelerations
Rising foetal baseline heart rate
Loss of variability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

How can you get a sample of foetal blood

A

Pin prick of blood is taken from the foetal scalp – can look for pH
Acidaemia is a sign of hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

At what point is foetal blood pH considered abnormal

A

Less than 7.2

The baby needs delivered at this point as it is at risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What are the 2 methods of operative vaginal delivery

A

Forceps or vonteuse

For instrumental delivery the babies head must be below the spine and the cervix fully dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

What are the indications for operative/instrumental vaginal delivery

A 
Delay  (failure to progress stage 2) 
Foetal distress
Maternal cardiac disease
Severe PET / Eclampsia
Intra-partum haemorrhage
Umbilical cord prolapse
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What are the main indications for a caesarean section

A 
Previous CS
Foetal distress
Failure to progress in labour
Breech presentation
Maternal request
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

What are the risks with a C-section

A 
Sepsis 
Haemorrhage 
VTE 
Trauma 
Complications in future pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

What is the difference in outcome between pre-existing hypertension and pre-eclampsia

A

If pre-existing it won’t return to normal after delivery (eclampsia will recover after delivery)
Will also have a raised BP at booking and may already be on treatment if it was pre-existing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What are the risks of pre-existing hypertension in pregnancy

A

PE
IUGR
Abruption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

What is pregnancy induced hypertension

A

Hypertension which develops in the second half of pregnancy - usually after 20 weeks
No proteinuria or other features of pre-eclampsia
Likely to develop it in all subsequent pregnancy
Usually resolves around 6 weeks post-partum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

What is the cause of pre-eclampsia

A

There is abnormal placental perfusion and ischaemia

The mothers response is to try and force more blood through which leads to endothelial damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What is HELLP Syndrome

A

Haemolysis, Elevated Liver Enzymes, Low Platelets
Associated with pre-eclampsia
Presents with epi/RUQ pain

170
Q

What are the symptoms of pre-eclampsia

A

Headache
Visual disturbance - may be transient
Epigastric / RUQ pain - liver issues
Nausea / vomiting
Rapidly progressive oedema - particularly hands
Hyper-reflexia / involuntary movements / clonus

171
Q

What are the signs of pre-eclampsia

A 
Hypertension
Proteinuria
Oedema
Abdominal tenderness
Disorientation
Small for Gestational Age
Intra uterine fetal death
Hyper-reflexia / involuntary movements / clonus
172
Q

What investigations would you do for pre-eclampsia

A

Urea and Electrolytes
Liver Function Tests
Full Blood Count
Used to exclude HELLP

Serum Urate
Coagulation Screen
Urine - Protein Creatinine Ratio (PCR)
Cardiotocography
Ultrasound - foetal assessment
Foetal CTG 
Abdominal exam 
Fundoscopy
173
Q

When would you need to admit someone with pre-eclampsia

A

BP >160/110 OR >140/90 with (++) proteinuria or other clinical concerns

Significant symptoms - headache / visual disturbance / abdominal pain

Abnormal biochemistry
Significant proteinuria - >300mg / 24h
Need for antihypertensive therapy
Signs of foetal compromise

174
Q

At what point would you treat hypertension in pregnancy

A

Most treat if BP ≥150/100 mmHg
Aim for 140-150/90-100 mmHg

Don’t want to drop the BP too much as could cause harm

175
Q

When do foetal movements usually start

A

20 weeks

176
Q

How can you cure pre-eclampsia

A

Delivery of the baby and placenta
Need to get mum stable before birth - BP etc.
Consider some extra management such as steroids if baby is going to be premature

177
Q

What are the indications for delivery in pre-eclampsia

A

Term gestation
Inability to control BP
Rapidly deteriorating biochemistry / hematology
Eclampsia
Foetal Compromise - abnormal Ultrasound or CTG

178
Q

How do you manage eclampsia

A

Control BP if above 140/90 - Labetalol first line or nifedipine if labetalol not suitable (e.g. asthmatics)
Switch to IV if not repsonding
Monitor BP every 48 hours at least (more often if admitted)
Measure FBC, LFT and renal function twice a week
Foetal CTG

Stop / Prevent Seizures- Mg sulphate
Fluid Balance
Delivery

179
Q

How do you treat an eclamptic seizure

A

4g IV Magnesium sulphate as loading dose
IV infusion of 1g/hr
A further 2mg if another seizure
If seizures are persistent consider diazepam

180
Q

Which drug must be avoided in delivery with pre-eclampsia

A

Ergometrine

This is often used to prevent post-partum haemorrhage

181
Q

What is the leading cause of maternal death in the UK

A

Mental illness and suicide

1/2 of suicides occur 12 weeks after birth

182
Q

What are the red flags for maternal mental health

A

Recent significant change in mental state or emergence of new symptoms
New thoughts or acts of violent self harm
New and persistent expressions of incompetency as a mother or estrangement from their baby
Evidence of psychosis

183
Q

How should you screen for mental health issues in pregnancy

A

Check mental history (PC, PMH, FH) in booking appointment
Identify risk factors
Screen for mood and mental state at each appointment - dont be afraid to ASK

184
Q

What are the risks of eating disorders in pregnancy

A

Risks of IUGR, prematurity, hypokalaemia, hyponatraemia, metabolic alkalosis and miscarriage,

185
Q

How can you manage pre-existing depression in pregnancy

A

68% relapse if stop meds in pregnancy
If mild you could consider stopping meds and referring for psychological therapy
Follow up with GP for milder cases
Refer to psychiatry if severe and high risk

186
Q

Describe the baby blues

A

Brief period of emotional instability after birth which affects up to 80% of women
Less severe than PP depression
May feel tearful, irritable, anxious, have poor sleep and confusion
Usually from day 3-10 and is self limiting
Lasts no longer than 2 weeks post delivery

187
Q

How do you manage the baby blues

A

Support and reassurance

Usually self-limiting

188
Q

When does puerperal psychosis present

A

Usually presents in the first 2 weeks after delivery

189
Q

How does puerperal psychosis present

A

Early symptoms are sleep disturbance and confusion, irrational ideas
Then mania, delusions, hallucinations, confusion

190
Q

What are the risk factors for puerperal psychosis

A

Bipolar disorder
Previous puerperal psychosis
1st degree relative with a history

191
Q

How do you manage puerperal psychosis

A

Emergency admission to a specialised mother-baby unit

Treat with antidepressants, antipsychotics, mood stabilizers and ECT

192
Q

How many women are affected by post-natal depression

A

10% women

1/3 lasts a year or more

193
Q

How does post-natal depression present

A

Onset 2-6 weeks postnatally
Tearfulness, irritable, anxiety, lack of enjoyment and poor sleep, weight loss, can present as concerns re baby (often irrational)
Can last weeks to months
May have a suicide risk

194
Q

How do you manage post-natal depression

A

Mild- moderate: self help, counselling

Moderate-severe: psychotherapy and antidepressants, admission

195
Q

What are the risks to the baby of untreated depression

A

Low birth weight
Pre-term delivery
Adverse childhood outcomes - ADHD, emotional issues
Poor engagement / bonding - reduces infant learning and cognitive development

196
Q

The use of lithium in pregnancy is associated with what

A

Cardiac defects

The altered pharmacokinetics caused by pregnancy also massively affects lithium

197
Q

What are the risks of psychiatric treatments at various stages of pregnancy

A

1st trimester the risk is of teratogenicity
3rd trimester there is a risk of neonatal withdrawal
When breast feeding there is a risk of medication passing into the milk (much less than in utero)

198
Q

What antidepressants are the first line for use in pregnancy

A

SSRIs
Lower risk and effective
Sertraline is best

199
Q

What are the risks of taking antidepressants in pregnancy

A

Paroxetine can increase risk of heart defects in first trimester
Risk of neonatal withdrawal in the 3rd
Also increased risk of persistent pulmonary hypertension and low birth weight

200
Q

Can you use benzodiazepines in pregnancy

A

Nope
Risk of foetal malformation in 1st trimester
Risk of floppy baby syndrome (hypothermia/tonia and resp depression) in 3rd
Need to avoid regular use when breastfeeding

201
Q

Which antipsychotics should be avoided in pregnancy

A

Clozapine at all time points due to risk of agranulocytosis

Olanzapine - ↑ risk of gestational diabetes & weight gain

202
Q

Can you use anti-psychotics in pregnancy

A

Yes
Most appear to be safe but need to work with psychiatry
Safer to give rather than destabilise mental illness

203
Q

Can you use lithium in pregnancy

A

Yes and no
Avoid using in pregnancy of possible as there is a risk of cardiac abnormality
However it is higher risk to suddenly stop it - high chance of relapse
Cannot use when breastfeeding

204
Q

Can you use sodium valproate in pregnancy

A

No
Should be avoided in women of childbearing age and stopped before a planned pregnancy
Increases risk of neural tube defects and longer term risk of neurological development issues

205
Q

What are the risks of using carbamazepine in pregnancy

A

↑ risk of neural tube defects
Facial dysmorphism and fingernail hypoplasia
May be linked to GI and cardiac abnormalities

206
Q

What are the risks of using lamotrigine in pregnancy

A

↑ risk of oral cleft - avoid in 1st trimester if possible

Risk of Stevens-Johnson Syndrome during breastfeeding

207
Q

What are the risks of consuming alcohol when pregnant

A 
Risks of miscarriage
Foetal Alcohol Syndrome - learning difficulty
Withdrawal
Risk of Wernicke's encephalopathy 
Korsakoff syndrome
Microcephaly
208
Q

What are the features of foetal alcohol syndrome

A 
Facial deformities - smooth philtrum, thin vermillion, small palpebral fissures
Lower IQ
Neurodevelopmental delay
Epilepsy
Hearing, heart and kidney defects
209
Q

What are the risks of opioid use in pregnancy

A 
Maternal death
Neonatal withdrawal
IUGR
SIDS
Stillbirth
210
Q

What are the risks of smoking in pregnancy

A 
Miscarriages 
Intra-uterine death 
Stillbirth
Abruption
IUGR
SIDS
Admission to NICU at birth
Pre-term birth 
Hypothermia 
Bronchitis 
Asthma 
Pneumonia
211
Q

What is the definition of an antepartum haemorrhage

A

Bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour

212
Q

What can cause antepartum haemorrhage

A

Placental abruption
Placenta praevia
These are most common

Uterine rupture 
Carcinoma
Polyp 
Infection 
Vasa praevia
213
Q

How do you quantify antepartum haemorrhage

A

Spotting
Minor = <50ml
Major = 50-1000ml and no shock
Massive = >1000ml and/or shock

214
Q

What is placental abruption

A

Separation of a normally implanted placenta – partially or totally before birth of the foetus
Leads to a painful haemorrhage

215
Q

What are the risk factors for a placental abruption

A 
Pre-eclampsia/ Hypertension
Trauma (to abdo)
Smoking 
Thrombophilias, renal disease or diabetes 
Polyhydramnios,
Multiple pregnancy
Preterm-PROM
Abnormal placenta
Previous Abruption
216
Q

How does placental abruption present

A 
Severe Abdominal Pain- continuous
Hard or tender uterus 
Bleeding 
Preterm labour 
Maternal collapse
Haemodynamic instability  
Foetal distress
Potential history of trauma - e.g. car crash
217
Q

How does placental abruption present on a CTG

A

Irritable uterus
1 contraction per minute
Foetal HR may be slow or absent
Loss of variability and decelerations

218
Q

How do you manage a placental abruption

A

Resuscitate mother - IV fluids
Monitor bloods and urine output
Assess CTG & Deliver the baby - urgent delivery by C-section or induction

219
Q

What are the maternal complications of placental abruption

A 
Hypovolaemic shock
Anaemia
Post-partum haemorrhage 
Renal tubular necrosis leading to renal failure 
Coagulopathy 
Infection 
Thromboembolism
220
Q

What are the foetal complications of placental abruption

A

Risk of foetal death
Hypoxia
Prematurity - iatrogenic and spontaneous
Small for age or growth restriction

221
Q

How can you prevent a placental abruption

A

If mum has APS then start on LMWH or aspirin
Stop any illicit drugs
Stop smoking

Largely cannot be prevented

222
Q

Define placenta praevia

A

It is a low lying placenta

The placenta lies directly over the internal os

223
Q

When is the term low-lying placenta used in place of placenta praevia

A

When the placental edge is less than 20 mm from the internal os on transabdominal or transvaginal scanning

224
Q

What is the link between C-sections and placenta praevia

A

They are associated with an increased risk of placenta praevia in subsequent pregnancies
The risk rises as the number of previous sections increases

225
Q

What are the risk factors for placenta praevia

A 
Previous C-section 
Previous TOP 
Advanced maternal age 
Multiparity 
Multiple pregnancy 
Assisted conception 
Smoking 
Deficient endometrium - endometritis, scars, fibroids etc
226
Q

How do you screen for placenta praevia

A

Midtrimester foetal anomaly scan should include placental localisation
Rescan at 32 and 36 weeks if persistent PP or LLP

227
Q

What are the signs and symptoms of placenta praevia

A

Painless bleeding >24 weeks;
Usually unprovoked but sex can trigger bleeding
Bleeding can be minor eg spotting/ severe
Foetal movements usually present and CTG normal
Soft uterus
Presenting part high

228
Q

How do you manage placenta praevia

A 
Resuscitation Mother : ABC
Assess Baby’s condition
Steroids 24-35+6 weeks 
Anti D if Rhesus Negative
Conservative management if stable
Good delivery plan - will need C-section of placenta covers os or is less than 2cm away
229
Q

When should a pregnancy with placenta praevia be delivered

A

Consider at 34+0to 36+6weeks if history of PVB or other risk factors for preterm
Uncomplicated placenta praevia consider delivery between 36 and 37weeks
Will need C-section of placenta covers os or is less than 2cm away
Otherwise can consider vaginal delivery

230
Q

What is placenta accreta

A

A morbidly adherent placenta: abnormally adherent to the uterine wall

231
Q

What are the potential complications of placenta accreta

A

Associated with severe bleeding and post-partum haemorrhage

May end up needing a hysterectomy

232
Q

What are the risk factors for placenta accreta

A

Placenta praevia

Prior caesarean delivery - higher with multiple

233
Q

How do you manage placenta accreta

A

Prophylactic internal iliac artery balloon
Caesarean hysterectomy
Expect a blood loss >3L and plan for this

234
Q

What is the definition of a uterine rupture

A

Full thickness opening of uterus, including serosa

235
Q

What are the risk factors for a uterine rupture

A

Previous C-section or uterine surgery
Multiparity
Use of prostaglandins or syntocinon
Obstructed labour

236
Q

What are the signs and symptoms of uterine rupture

A 
Severe abdominal pain
Shoulder-tip pain
Maternal collapse
PV bleeding
Acute abdomen and peritonism 
May have a loss of contraction 
Foetal distress on the CTG
237
Q

How do you manage an uterine rupture

A

Urgent Resuscitation & Surgical management
IV fluids or transfusion
Anti-D if Rh -ve

238
Q

What is vasa praevia

A

When unprotected foetal vessels traverse the membranes below the presenting part over the internal os
Will rupture during labour

239
Q

How do you diagnose vasa praevia

A

Ultrasound TA & TV with doppler

Clinical diagnosis if there is sudden dark red bleeding and foetal bradycardia/death

240
Q

What are the risk factors for vasa praevia

A

Placental abnormalities
History of low lying placenta
Multiple pregnancy
IVF

241
Q

How do you manage vasa praevia

A

Antenatal diagnosis-
Steroids from 32 weeks
Consider inpatient management if risks of preterm birth
Deliver by elective c/section before labour
Emergency C-section if they bleed before this

242
Q

What is the definition of a post-partum haemorrhage

A

Blood loss equal to or exceeding 500ml after the birth of the baby (vaginally)
Primary within 24h of delivery
Secondary >24h - 6/52 post delivery
Severity dependent on the amount of blood lost

243
Q

What are the classifications of PPH

A

Minor: 500ml- 1000ml ( without clinical shock)
Major: >1000ml or signs of cardiovascular collapse or on-going bleeding

244
Q

What can cause a PPH

A

Tone - uterine atony
Trauma - vaginal tear, cervical laceration, rupture
Tissue - retained products
Thrombin - coagulopathy

245
Q

What are the antenatal risk factors for PPH

A 
Anaemia 
Previous caesarean section
Placenta praevia, percreta, accreta 
Previous PPH
Previous retained placenta
Multiple pregnancy
Polyhydramnios
Obesity
Fetal macrosomia
246
Q

What are the intrapartum risk factors for PPH

A 
Prolonged labour
Operative vaginal delivery 
Used of syntocinon in labour 
Caesarean section 
Retained placenta
Perineal tear or episiotomy
247
Q

How do you initially manage PPH

A 
ABCDE
IV access - IV warmed crystalloid infusion
Give O2 - 15L/min
Monitor bloods and obs 
Cross match 6 packs of cells 
Determine the cause of the haemorrhage
Early blood transfusion
Administer Tranexamic acid
248
Q

How do you stop a PPH without surgery

A

Uterine massage- bimanual compression
Expel clots
5 units IV Syntocinon stat (synthetic oxytocin which stimulates uterine contractions)
Foleys Catheter - minimise pressure on uterus
Confirm placenta and membranes complete
Repair any vaginal/perineal trauma
Tranexamic acid may also be given
If PPH still not controlled give a synthetic prostaglandin

249
Q

What are the leading causes of maternal death after birth

A

Thromboembolism and cardiac disease - up to 6 weeks after

Cancer and suicide are the leading causes from 6 weeks to 1year

250
Q

What are the 5Hs that can lead to maternal collapses

A

Head - eclampsia, CV accident, epilepsy
Heart - MI, arrhythmia
Hypoxia - PE, asthma
Haemorrhage - abruption, trauma, rupture
wHole body and Hazards - hypoglycaemia, sepsis etc

251
Q

In a case of maternal collapse - who is the priority, mother or baby

A

Mother - need to stabilise her first

252
Q

Why is resuscitation harder in a pregnant woman

A

Uterus puts pressure on vessels and diaphragm
Foetus takes oxygen and circulation from mother
Higher risk of hypoxia as O2 requirement is increased
More likely to aspirate
Harder to intubate

253
Q

Describe aortocaval compression in pregnancy

A

From 20 weeks gestation the uterus can compress the IVC and aorta when lying supine
Often leads to supine hypotension which can lead to maternal collapse
To treat - turn woman to left lateral position or manually move uterus

254
Q

At what point of cardiac arrest should the baby be delivered

A

If there is no response to correctly performed CPR within 4 minutes of maternal collapse delivery should be undertaken by emergency C-section
This will help with resus as pressure is taken off vessels

255
Q

What are the major reversible causes of cardiac arrest (4Hs and 4Ts)

A 
Hypoxia
Hypovolaemia
Hypo/hyper metabolic
Hypothermia
Thrombosis
Tamponade
Toxins
Tension pneumothorax
256
Q

How would you manage an eclamptic seizure

A 
Note time and length of seizure
Give high flow oxygen
Get iv access
Move patient into left lateral and open airway
Monitor baby
257
Q

What is cord prolapse

A

When the umbilical cord exist the womb before the baby
This leads to Direct compression and cord spasm = decreased flow- hypoxia- death
Requires immediate delivery

258
Q

What is shoulder dystocia

A

Any cephalic delivery where manoeuvres other than gentle traction are required to deliver the baby after the head has delivered
Due to a foetal anterior shoulder getting stuck on the maternal pelvic symphysis

259
Q

What are the risk factors for shoulder dystocia

A 
Obesity
Diabetes
Foetal macrosomia 
Prolonged 1st and 2nd stage,
Instrumental delivery
260
Q

What are the signs of shoulder dystocia

A

Slow delivery of the head
Head bobbing - head consistently retracts back between contractions
Turtling - head becomes tightly pulled back against the perineum
Not progressing

261
Q

What are the complications of shoulder dystocia

A 
Risks of stillbirth
Hypoxic brain injury
Brachial plexus injury
Fractures
PPH
3rd &amp; 4th degree distress
262
Q

If the Down’s screening is positive what further tests are offered

A

Amniocentesis – diagnostic (after 15 weeks)

Chorionic villus sampling – diagnostic (11-14 weeks)

263
Q

What are the possible underlying reasons for an increased nuchal translucency?

A 
Down’s Syndrome 
Trisomy 13 & 18 
Turner’s syndrome 
Intrauterine demise 
Cardiac abnormalities
264
Q

What does an elevated Maternal Serum Alpha Feta Protein suggest

A

It can suggest multiple pregnancy or developmental conditions such as spina bifida or gastroschisis

265
Q

When can Anti D be given to prevent Rhesus isoimmunisation

A

28 weeks give Anti-D to negative mothers (blanket prophylaxis)
Baby’s cord blood is tested if mother is negative and if they are found to be positive then the mother is given another dose (up to 72hrs after)
Give to anyone experiencing heavy bleeding or requiring surgical intervention for a miscarriage

266
Q

How do administer anti-D

A

IM in the deltoid

A single dose of anti-D lasts approximately 6 weeks so may need repeat doses if repeated sensitising events

267
Q

If a baby is becoming more acidotic what is this a sign of

A

Hypoxia

268
Q

What are the 4 main abnormal outcomes of a pregnancy

A

Miscarriage
Ectopic pregnancy
Molar pregnancy
Pregnancy of Unknown Location

269
Q

List risk factors for ectopic pregnancy

A 
Previous abdominal surgery 
PID
Tubal damage - surgery or infection 
Smoking 
Previous ectopic 
IVF
270
Q

What is considered heavy bleeding in early pregnancy

A

Having to change a pad every hour

Passing clots

271
Q

How do you conservatively manage a miscarriage

A

Done if low risk - light bleeding
Basically let nature take its course
Inform the patient that she is miscarrying and ask her to monitor bleeding at home and contact you if it get worse or develops pain
They should contact the early pregnancy unit
NICE guidelines suggest telling her to take a pregnancy test in 10 days time and get back to you - should be negative if miscarriage complete

272
Q

A woman presents early in pregnancy with one sided abdominal pain - what must be considered/excluded

A

Ectopic pregnancy

Typical gestation for presentation is 5-6 weeks

273
Q

What is the the ultrasound criteria for making a diagnosis of miscarriage on ultrasound scan

A

Gestational sac of more than 25mm with no obvious contents
Foetal pole with crown-rump length over 7mm with no evidence of cardiac activity
Most sonographers will require a second opinion

274
Q

What are the management options for a miscarriage

A

Conservative/watch and wait – let nature take its course

Medical - misoprostol given

Surgical - either manual vacuum aspiration or more complex surgery done under GA

275
Q

Describe the surgical management of a miscarriage

A

Most common is manual vacuum aspiration (MVA)
As it sounds
Done under local anaesthetic with gas and air
Patient may feel some touching and crampy pain – not a completely pain free procedure, she may be a little uncomfortable
Bleeding for a little while after is normal

Other surgical options are more complex and done under GA

276
Q

Describe the medical management of a miscarriage

A

Give misoprostol to try and get the uterus to expel the gestational sac
As long is there is no medical risk (bleeding disorder, anaemia etc.) they can be done as an outpatient
Outpatient they are given the medicine in hospital but then they go home to complete the miscarriage
Those over 10 weeks will usually be inpatient (with covid this has been extended to 12 weeks)

277
Q

Which features on abdominal exam suggest ectopic pregnancy

A

Guarding or peritonism = particularly on one side

278
Q

What examinations / investigations would you do for a suspected ectopic

A

Abdominal exam - look for guarding/peritonism
Potentially a bimanual and speculum

Retake the HCG levels
Would also do FBC, LFTs and U&E
USS

279
Q

What test must be done before methotrexate can be used to manage an ectopic pregnancy

A

US needs to exclude a intrauterine pregnancy as methotrexate is teratogenic so you don’t want to give it to a pregnant woman

280
Q

Free fluid around the ectopic pregnancy indicates what

A

That it is at high risk of rupture

281
Q

What are the potential outcomes for a pregnancy of unknown origin

A

Can be intrauterine - normal

Ectopic

282
Q

How do you manage a pregnancy of unknown origin

A

If clinically well they can go home
Repeat her HCG test in 48hrs – in a healthy pregnancy it should double in this time
If it only has a 50-60% rise it is likely to be an ectopic
If it starts falling then it’s likely a non-continuing pregnancy
Give worsening advice egarding
seeking urgent re assessment if increased pain/ faint/
unwell

283
Q

An elevated ALP is normal in pregnancy - true or false

A

True
It is produced by the placenta
Not concerned if only one raised on LFT

284
Q

Which examinations would you perform on a woman with pre-eclampsia

A

Fundoscopy
Abdominal exam
Foetal CTG
Check for hyperreflexia and clonus

285
Q

List some of the potential sources of infection post C-section

A

Uterus (exposed to outside)
UTI (will be catheterised)
Retained placenta
Wound infection

286
Q

How would you confirm the source of infection post-C-section

A

Confirmed with swabs (high vaginal, wound etc.) and urine samples

287
Q

Can you use d-dimer to diagnose DVT in pregnant women

A

No
It can be raised anyway in pregnancy so may give false result
Use doppler ultrasound instead

288
Q

The more pregnancies you have the higher your DVT risk - true or false

A

True

289
Q

What is HELLP Syndrome

A

A rare liver and blood clotting disorder that can affect pregnant women
Complication/severe form of pre-eclampsia

H- haemolysis (red cells break down)
EL - elevated liver enzymes
LP - low platelets

290
Q

What are the symptoms of HELLP syndrome

A

May present like pre-eclampsia: abdo pain (epi or RUQ), nausea and vomiting, headache, changes in vision, swelling, SOB, shoulder pain when breathing, bleeding, jaundice

The HELLP signs on blood tests, high BP and proteinuria

291
Q

What are the main causes of death in HELLP syndrome

A

Liver capsule rupture

Stroke - cerebral edema or cerebral hemorrhage

292
Q

How do you treat HELLP syndrome

A

Only definitive treatment is to deliver the baby
May give steroids if it’s going to be preterm

Some women may require blood products
Control their BP and give MgS to prevent seizure

293
Q

List risk factors for HELLP syndrome

A 
White ethnicity 
maternal age >35
Obesity 
Chronic hypertension 
Diabetes
Autoimmune conditions
Previous pregnancy with pre-eclampsia +/- HELLP
Multiple gestation
294
Q

What is the first line management for shoulder dystocia

A

First line is McRobert’s manoeuvre - flex and abduct mum’s hips as much as possible (more space)

295
Q

Women in which age group are at highest risk of molar pregnancy’s

A

Those under 20 and those over 35

296
Q

Are ACE inhibitors safe in pregnancy’s

A

NO
Associated with an increased risk of adverse foetal outcomes
Teratogenic and toxic to baby
As are ARBS

297
Q

What is the first line treatment for hypertension in pregnancy

A

Labetalol

Unless contraindicated

298
Q

How does an amitotic embolism present

A

PE features - acute SOB, tachycardia, tachypnoea, and hypoxia
Wedge-shaped infarction on chest x-ray
Also seen are chills, sweating, anxiety and coughing
Will occur in a woman during or just after labour
There will be foetal cells in the maternal blood vessels - found at autopsy

299
Q

List risk factors for thromboembolic events in pregnancy

A 
Age > 35
Body mass index > 30
Parity > 3
Smoker
Gross varicose veins
Current pre-eclampsia
Immobility
Family history of unprovoked VTE
Low risk thrombophilia
Multiple pregnancy
IVF pregnancy
300
Q

How do you prevent thromboembolic events in high risk pregnancies

A

Low molecular weight heparin is the treatment of choice for VTE prophylaxis in pregnancy

If woman has 3 risk factors it is started at 28 weeks and continued until six weeks postnatal.
If she has 4 or more risk factors you immediately start LMWH and continue until 6 weeks post-natal

301
Q

If a woman presents with symptoms of miscarriage and has an open cervical os what type is it

A

Inevitable

302
Q

How do manage a threatened miscarriage

A

Discharge home with safety netting and advice
Bleeding is not uncommon but as os is closed you cannot predict what will happen
Have a realistic discussion and offer support
Ask her to contact the early pregnancy unit again

303
Q

How do you manage a ruptured ectopic pregnancy

A

ABCDE and call for immediate help
Get IV access x2 and provide fluid resus and urgent blood transfusion (o-ve?)

Patient need immediate theatre admission for emergency laparotomy/
diagnostic laparoscopy

304
Q

What is the most common cause of iatrogenic premature delivery of the fetus

A

Hypertensive disorders of pregnancy such as pre-eclampsia, eclampsia and HELLP

305
Q

What is the main cause of maternal death in those with pre-eclampsia

A

Cerebral haemorrhage

306
Q

How does pre-eclampsia affect the baby

A

Can lead to IUGR or even intrauterine death

Placental abruption is also more common

307
Q

How can you manage pre-eclampsia before delivery

A

BP management - abetalol, nifedipine and methyldopa are the most frequently used
IV magnesium sulphate
Regular foetal monitoring - cardiotocography and US

308
Q

How would you manage diabetes prior to conception

A

Need good glycaemic control
Lifestyle advice

5mg folic acid for 3 months prior to conception

Hba1c target should be < 48 mmol/mol prior to conceiving

Alter treatment to ensure safe drugs for pregnancy

309
Q

Which diabetes medications are safe in pregnancy

A

Metformin
Sulphonylureas
Rapid-acting insulin analogues, e.g. Lispro and Aspart
Long-acting insulins

310
Q

How does poor maternal glycaemic control affect the foetus in the first trimester

A

Associated with an increased rate of congenital abnormalities (particularly neural tube defects and congenital heart disease) and miscarriage.

311
Q

How should women with pre-existing diabetes be monitored in pregnancy

A

Retinal screening is advised in every trimester
Should be given aspirin from 12 weeks due to pre-eclampsia risk
Fetal cardiac ultrasound and monthly fetal growth scans
Uterine artery doppler at 20 weeks

312
Q

Hypoglycaemia unawareness can occur in pregnancy - true or false

A

True
Nausea and vomiting of pregnancy contribute
There is an increase in insulin sensitivity
Ketoacidosis is also more common

313
Q

How does poor maternal glycaemic control affect the foetus in the second trimester

A

Main risk at this stage is macrosomia

Caused by foetal hyperinsulinemia

314
Q

Which women should be offered an oral glucose tolerance test at 24-28 weeks of gestation

A

Family history of diabetes in first degree relative
Previous macrosomic baby
Obesity (BMI >30 kg/m2)
Family origin with high prevalence of diabetes mellitus

315
Q

How do you manage gestational diabetes

A

Diet and exercise advice for mum
Metformin, short-acting or long-acting insulin can be used if lifestyle not enough
Regular growth scans
Monitoring for pre-eclampsia
Delivery up to 40+6 weeks of gestation if uncomplicated

316
Q

Pyelonephritis is more common in pregnancy - true or false

A

True
Due to physiological dilatation of the upper renal tract
UTIs are also common and can preceed it

317
Q

List differentials for headache in pregnancy

A 
Migraine
Cerebral venous thrombosis
Idiopathic intracranial hypertension
Drug related
Post-dural puncture headache
318
Q

How does migraine present

A

Throbbing and unilateral headache
Scotomata - partial visual loss
Fortification spectra - aura
Transient neurological symptoms like hemianopia or aphasia can also occur but resolve after the episode.

319
Q

What is a post-dural puncture headache and how does it present

A

Headaches that can occur after epidural or spinal analgesia
They usually develop in the 5 days after the procedure
Worse on standing - positional
Most frequently occur in the frontal and occipital regions.
Symptoms such as neck stiffness, tinnitus, photophobia and nausea can be associated

320
Q

What is peripartum cardiomyopathy

A

Heart failure secondary to left ventricular systolic dysfunction towards the end of pregnancy or in the months following delivery

Presents with heart failure and sometimes ventricular arrhythmia or CA

321
Q

What are the risk factors for peripartum cardiomyopathy

A 
African ethnicity
Multiple pregnancy
Pregnancy complicated by pre-eclampsia
Advanced maternal age
Teenage pregnancy
Diabetes mellitus
Malnutrition
Smoking
322
Q

Which trisomy’s are tested for in pregnancy

A

Trisomy 13 - Patau’s syndrome
Trisomy 18 - Edward’s syndrome
Trisomy 21 - Down’s syndrome

Screened for at the 12 week scan

323
Q

What happens at the 20 week scan

A

This is the anomaly scan
Check from top to bottom to look for developmental abnormalities - e.g. Diaphragmatic hernia, dextrocardia, kidneys, missing limbs etc
Also do placental location - certain location (over cervix) have a high haemorrhage risk

324
Q

Can trimethoprim be used in pregnancy

A

Yes and No

Cannot be used in 1st trimester but is safe in 2 and 3

325
Q

Pregnancy itself is a risk factor for DVT and PE - true or false

A

True

Also obesity, smokers, previous clots

326
Q

Can nitrofurantoin be used in pregnancy

A

Yes and no

It is safe in the 1st trimester but is not safe in the 3rd

327
Q

How do you treat chlamydia in pregnancy

A

Doxycycline should be avoided in pregnancy

Use azithromycin instead

328
Q

Why is methyldopa no longer used in pregnancy

A

It has a high risk of post-natal depression (used to be the most used)
Now use labetalol or nifedipine

329
Q

When should a woman be given anti-D

A

If she is known to be rhesus negative

Given prophylactically at 28 weeks to cover any sensitising events

330
Q

Which systems should be checked in a primary obstetric survey (acutely unwell pregnant woman)

A 
Head - AVPU
Heart - cap refill, pulse, BP, sounds
Chest - air entry, RR, O2
Abdo - is there guarding, rebound or tenderness, is baby alive, requirement for laparotomy or delivery?
Vagina - bleeding, stage of labour 
Legs - DVT?
331
Q

What are the contraindications to fluid resuscitation in an acutely unwell pregnant woman

A

Pulmonary oedema
secondary to severe pre-
eclampsia or renal failure.

332
Q

List potential cardiac causes of maternal collapse

A 
MI
Arrhythmias
Peripartum cardiomyopathy
Congenital heart disease
Dissection of thoracic aorta
333
Q

Which monitoring should be used for an acutely unwell pregnant woman

A

Continuous ECG, resp, pulse, BP and pulse oximetry

Consider arterial and CVP lines to aid monitoring

334
Q

List some pulmonary causes of maternal collapse

A

Asthma
PE
Pulmonary oedema
Anaphylaxis - hypoxia

335
Q

List some ‘head’ (CNS) causes of maternal collapse

A 
Eclampsia
Epilepsy
CVA
Intracranial
haemorrhage
Vasovagal response
336
Q

List types of haemorrhage that could lead to maternal collapse

A 
Abruption
Uterine atony
Genital tract trauma
Uterine rupture
Uterine inversion
Ruptured aneurysm
337
Q

How do you manage uterine atony

A

O2
Expel clots and massage uterus (bimanual compression)
IV access for fluids and bloods (FBC, coag, Cross match 4 units)
Uterotonics: Syntocinon/Ergometrine/Carboprost
Tranexamic acid
Urinary catheter
If these don’t work they may need surgery - uterine balloon or laparotomy

338
Q

What effect does CMV have in pregnancy

A

For baby it is a cause of potentially severe congenital infection,
miscarriage and stillbirth
May cause microcephaly, chorioretinitis, IUGR and
severe mental disability

In mum it can be a mild or non-specific illness

339
Q

How do you prevent foetal varicella syndrome

A

Give VZV immunoglobulin to those pregnant
women who are susceptible and have been in contact
with the infection
Vaccine is also available

340
Q

What effect can chicken pox have in pregnancy

A

Can cause foetal varicella syndrome contracted
before 20 weeks
Causes skin carring in dermatomal distribution, neurological abnormalities, hypoplastic limbs and eye defects

Pregnant women are at risk of pneumonia and hepatitis in this infection

341
Q

What effect does parvovirus have in pregancy

A

Causes a maculopapular rash which in clinically
indistinguishable from rubella without serological
testing
Usually mild and self-limiting but an cause polyarthropathy syndrome
and anaemia

For baby it can cause foetal anaemia

342
Q

What effect does zika virus have in pregancy

A

Is a cause of congenital microcephaly

Asymptomatic in mum

343
Q

What effect does influenza have in pregancy

A

Is a cause of mortality, IUGR and PTL in pregnant

women if contracted

344
Q

IOL < 42 weeks actually reduces the chance of

needing a C section - true or false

A

True

345
Q

Mothers with a history of puerperal psychosis can have elective admission to a mother and baby unit for monitoring - true or false

A

True

Allows them to get any support they need before they are at risk

346
Q

Elective C-section can be carried out from what date

A

Not done until > 39 weeks
Unless fetal or maternal health at risk

This is due to association with leaning needs in infants born electively
before 39 weeks and increased risk of respiratory distress in
neonates at less than 39 weeks delivered via cs

347
Q

There is a risk that seizures can increase in pregnant women with epilepsy - true or false

A

True
Important to manage seizures with help of neuro team
important to stay medicated and report increasing symptoms

348
Q

Women with epilepsy should be given high dose folic acid in pregancy - true or false

A

True

Should be in 5mg

349
Q

What are the risks of obesity in pregnancy

A 
Foetal anomalies: increased NTD and cardiac and increased rate of
missed anomalies
Stillbirth
Hypertension/PET
Gestational diabetes- GTT
FTP in labour
C section/ forceps
Fetal distress- difficult c section
Macrosomia- Shoulder dystocia
IUGR- growth scans
Maternal anaemia, vit d deficiency and folate deficiency from poor
diet and pregnancy demands-
Thrombus risk V
Anaesthetic complications
350
Q

What causes the hypercoagulable state in pregnancy

A

There is an increase in factors VII, VIII, IX, X, XII, fibrinogen and plasminogen
Increases the risk of VTE

351
Q

How is urine PCR used in the diagnosis of pre-eclampsia

A

It helps you quantify the amount of protein in the urine.

352
Q

The use of prophylactic oxytocin at delivery reduces the risk of PPH by 50% - true or false

A

true

353
Q

What are the risks to the mother if she fails to progress in labour

A

Sepsis
Uterine rupture
Increased risk of post-partum haemorrhage
Increased risk of perineal tear and trauma
Incontinence
Pelvic floor dysfunction
Maternal exhaustion

354
Q

What is the risk of premature and prolonged rupture of membranes

A

Chorioamnionitis - uterus is exposed to the outside leading to infection
Can affect baby and lead to sepsis in mum

355
Q

The majority of deaths in pregnancy are due to the complications of pregancy itself - true or false

A

False

2/3 of maternal deaths are due to a medical or mental health condition not complications of pregnancy itself

356
Q

What is a direct maternal death

A

A death that occurs as a result of a pregnancy specific disorder
I.e. couldn’t have occurred without them being pregnant such as PPH or pre-eclampsia

357
Q

What is an indirect maternal death

A

When a pregnant or recently pregnant woman dies from a medical complication such as epilepsy
Can be pre-existing disease or something that developed during the pregnancy
Not directly caused by pregnancy itself but aggravated by it

358
Q

List red flags for post-partum depression

A

New persistent expressions of incompetency
Estrangement from the baby
Recent significant change in mental state or emergence of new treatment
New thoughts or acts of violence and self harm

359
Q

Women with cardiac risk factors should have a cardiac assessment prior to pregnancy or in early pregnancy - true or false

A

True

360
Q

What is the biggest cause of maternal death

A

During pregancy the majority of death are caused by chest ailments
The biggest cause is heart disease
Then VTE

Psychiatric would also be extremely common if it included those up to 1 year post-partum (big suicide risk)

361
Q

When should a perimortem C-section be carried out

A

If mum collapses and requires CPR
Perform a perimortem C-section within 4 or 5 minutes of CPR starting
This increases the mum’s chance of survival as it reduces pressure on her body/circulation
Should carry it out immediately - worry about closing the wound later as bleeding won’t be as big a risk as the cardiac arrest
May also increase baby’s chances

362
Q

What position should you put a pregnant woman in to perform CPR

A

You should try and push the belly to the left hand side (uterine displacement)
If you cant you should wedge something under one side

363
Q

How can you stimulate breathing in a newborn

A

Use a towel or blanket to rub them to stimulate breathing
Talk to them and blow on their face
If not breathing within a minute, give rescue breaths
Most respond within 30 secs
If that doesnt work then CPR (3 chest compressions to 1 breath)

364
Q

Are ACEi safe in breastfeeding

A

Yes

365
Q

What type of drug is nifedipine

A

Calcium channel blocker

366
Q

Which anti-hypertensives are be used IV for severe hypertension in pregancy

A

Labetalol

Hydralazine

367
Q

List potential causes of breathlessness in pregnancy

A 
Physiological - common
Anaemia
Asthma
Pulmonary embolism
COVID-19 pneumonitis
Pneumothorax
Pulmonary oedema
368
Q

List potential causes of pulmonary oedema in pregnancy

A

Pre-eclampsia
Peripartum cardiomyopathy
Undiagnosed heart disease

369
Q

What are the features of acute fatty liver of pregnancy

A

Characteristic histological pattern (microvesicular steatosis)
Causes synthetic liver dysfunction - raised bilirubin, transaminases
More common in twin pregnancies, male fetuses, women with a low body mass index (BMI)
Presents with vomiting, abdo pain, polydipsia/polyuria and encephalopathy

370
Q

Is LMWH safe in breastfeeding

A

Yes

371
Q

Which maternal factors increase the risk of sepsis in pregnancy

A

Anaemia
Obesity
Black or minority ethnic group origin

372
Q

Which medical factors increase the risk of sepsis in pregnancy

A

Impaired glucose tolerance/diabetes

Impaired immunity/immunosuppressant medication

373
Q

Which obstetric factors increase the risk of sepsis in pregnancy

A

History of pelvic infection
History of group B streptococcal infection
Amniocentesis and other invasive procedures
Cervical cerclage
Prolonged spontaneous rupture of membranes

374
Q

Cerebral palsy can be caused by intrapartum hypoxia - true or false

A

True

The commonest features of hypoxic injury are spasticity affecting all four limbs and hypotonia.

375
Q

How can the risk of cerebral palsy be decreased

A

Induced hypothermia

Baby is cooled in an effort to prevent further neuronal loss

376
Q

What maternal factors can cause an increase in foetal heart rate

A

Pain, dehydration, use of epidural analgesia or maternal pyrexia (e.g. sepsis)
Can even lead to tachycardia

377
Q

What factors can cause an decrease in foetal heart rate variability

A

Use of opioids
Foetal hypoxia
Can be due to foetal sleep - only non-reassuring after 30 mins

378
Q

What is considered a pre-terminal CTG

A

Prolonged bradycardia as well as total loss of variability (often with shallow decelerations)
Seen after hypoxia
Baby needs delivered immediately

379
Q

What is a foetal HR overshoot on a CTG

A

Increase in foetal HR following a variable deceleration
The decel causes a drop in foetal BP which triggers attempts at fetal compensation, which in turn result in such transient tachycardia or overshoots

Considered a pre-pathological feature

380
Q

What are the main features of a CTG

A

Foetal HR which includes:
Baseline HR
Baseline variability
Presence or absence of accelerations or decelerations

Uterine contraction - shows frequency not strength

381
Q

What are the ranges for non-reassuring foetal HR and abnormal FHR

A

Non-reassuring 100-109 and 161-180

Abnormal <100 or >180

382
Q

What is the normal range for variability on a CTG

A

5 and 25 bpm is considered ‘reassuring’
Below 5 bpm for 30-50 mins is non-reassuring
If more than 50 mins it’s abnormal

383
Q

What is the definition of an acceleration on a CTG

A

Sudden increase from the baseline FHR of at least 15 bpm for at least 15 seconds
It is a reassuring feature

A deceleration has the same parameters but opposite (e.g. decrease HR)

384
Q

What causes an early deceleration

A

These are associated with head compression which stimulates baroreceptors
Should be synchronous with the contraction.

385
Q

What causes a late deceleration

A

Chemoreceptors stimulation

They are either synchronous with the contraction but with recovery lasting beyond the contraction or occur after the contraction

386
Q

What causes a variable deceleration

A

Commonly seen with cord compression

387
Q

How does adrenaline release affect the action of oxytocin

A

Adrenaline is a oxytocin agonist

This aims to prevent labour in a stressful environment - inhibits it to allow mum to find a safe spot (biological)

388
Q

At which point is the second stage of labour considered delayed

A

In a nulliparous patient,: when the active second stage has reached 2 hours

In a multiparous patient: when the active second stage has lasted 1 hour

At this point the patient should be referred to the obstetric registrar unless the birth is imminent.

389
Q

What is the definition of failure to progress in labour

A

Defined as less than 2cm dilatation in 4hours

390
Q

What are the requirements for a forceps delivery (FORCEPS)

A

Fully dilated cervix (10cm)
Occipitoanterior position (Occipitoposterior position is possible with Kielland forceps and ventouse)
Ruptured membranes
Cephalic presentation
Engaged presenting part – the fetal head must not be palpable abdominally and must be below the ischial spines
Pain relief
Sphincter (bladder) empty – will need catheterisation.

391
Q

What are the advantages of C section

A

Avoid tears to perineum and therefore problems with long-term urinary and faecal incontinence

No injury to the cervix or high vaginal areas.

Less chance of neonatal trauma

392
Q

What are the advantages of operative/instrumental vaginal delivery

A

Approx. 80% of patients will have a spontaneous vertex delivery subsequently

Reduced analgesic requirements

Shorter hospital stay and quicker recovery

Less physical restrictions on bonding with the baby

393
Q

What are the disadvantages of operative/instrumental vaginal delivery

A

Can cause neonatal trauma such as intracranial haemorrhage, facial nerve palsy, marks to face, brachial plexus injury

Maternal trauma - perineal tears, bowel symptoms (if anus damaged), psychological trauma, urinary symptoms

High risk of PPH

394
Q

What are the disadvantages of C section

A

Comes with all the risks of surgery such as haemorrhage, VTE, longer hospital stay

Risk of uterine rupture in future labours and placenta accreta in future pregnancy.

4 times greater maternal mortality

395
Q

List some contraindications to ventouse delivery

A

Prematurity (<34weeks)
Face presentation
Suspected fetal bleeding disorder such as Haemophilia
Fetal predisposition to fracture e.g. osteogenesis imperfecta
Maternal HIV or Hepatitis C.

396
Q

What is the risk of taking stimulants such as cocaine or ecstasy in pregnancy

A

Maternal – hypertensive disorders including pre-eclampsia, placental abruption, death via stroke and arrhythmias.

Fetal – prematurity, neonatal abstinence syndrome , teratogenicity, IUGR, pre-term labour, miscarriage, developmental delay, Sudden Infant Death Syndrome (SIDS), withdrawal

397
Q

What is the risk of taking opiates in pregnancy

A

Risk of neonatal abstinence syndrome, IUGR, SIDS, stillbirth and maternal deaths.

398
Q

What is the risk of taking cannabis in pregnancy

A

Cognitive deficits, miscarriage, fetal growth restriction

399
Q

What is the safe level of alcohol consumption for pregnant women

A

There is no safe limit

Advised to avoid it completely

400
Q

List potential maternal sensitization events (rhesus)

A

Placental abruption
Any abdominal trauma (from road traffic accidents for example)
Amniocentesis or chorionic villus sampling
External cephalic version
Intra-uterine surgery/transfusion
Fetal death
Vaginal bleeding from 12weeks
Surgical management of miscarriage at <12 weeks
Evacuation of retained products of conception and molar pregnancy
Termination of pregnancy
Ectopic pregnancy
Delivery (if baby is rhesus-D positive)

401
Q

Describe the process of rhesus isoimmunisation

A

If the mother is rhesus negative and exposed to her foetus’ rhesus positive blood i t causes her to produce IgM antibodies against rhesus - sensitizing event
IgM is too big to cross placenta so baby is fine
However, in future pregnancies when the mother is exposed to the same antigen from the fetus’ red blood cells, the body forms IgG antibodies which are smaller and can cross the placenta to harm the fetus leading to haemolytic disease of the newborn

402
Q

Suicide is a leading cause of death in the perinatal period; - true or false

A

True

Between 6 weeks and 1 year post natal it is the biggest killer

403
Q

What is a coincidental maternal death

A

Incidental or accidental death during pregnancy but not due to or aggravated by pregnancy
e.g. RTA

404
Q

What is defined as a late maternal death

A

Deaths occurring more than 42 days after the end of pregnancy but before 1 year

405
Q

What are the surgical management options for PPH

A

Examine under anaesthetic in theatre to look for trauma, RPOC, rupture etc
Balloon insertion to put pressure on bleeding blood vessels
Arterial Embolisation via Interventional Radiology
“B-Lynch” sutures
Uterine artery ligation
Internal Iliac ligation
Hysterectomy as a last resort!

406
Q

How do you prevent secondary PPH

A

Give thromboprophylaxis

  • Debrief couple
  • Manage anaemia with iron supplementation
407
Q

List the degrees of vaginal tears

A

1st degree: involving the skin only
2nd degree: involving the skin and levator ani; usually requires stitches
3rd degree and 4th degree: extend to the external anal sphincter muscle; these may need operated on as mothers can experience faecal incontinence due to overstretching of the
pudental nerve branches

408
Q

Which women are at risk of post-partum depression

A
  • Young, single
  • Domestic issues
  • Lack of support
  • Substance abuse
  • Unplanned/unwanted pregnancy
  • Pre-existing mental health problem
409
Q

Which pregnant women should be referred to psychiatry

A

Patients with severe anxiety/depression

  • Patients with a history of BPSD or schizophrenia
  • Patients with a history of puerperal psychosis
  • Patients with current psychosis
  • Patients who have developed mental illness in later stages of pregnancy/puerperium
  • Patients with a significant family history of BPSD/puerperal psychosis
410
Q

Which other diagnoses must be excluded before settling on hyperemesis gravidarum

A

Must exclude other causes of excessive,
prolonged vomiting, such as a urinary tract infection, gastritis, peptic ulcer, viral hepatitis
and pancreatitis

411
Q

In early pregnancy, all rhesus negative women that are undergoing a surgical procedure
require a dose of anti-D - true or false

A

True

412
Q

What is the definition of a miscarriage

A

Loss of pregnancy after a positive test between conception and 23+6 weeks

413
Q

How would you diagnose a threatened miscarriage

A 
There is bleeding with
or without cramping. 
The cervical os is closed. 
Ultrasound will show evidence of an
intrauterine pregnancy and if the foetal pole is present and measuring more than 7mm a foetal heart should be present
414
Q

How would you diagnose an inevitable miscarriage

A

Symptoms consistent with miscarriage
US scan may reveal a viable pregnancy or products that are in the
process of expulsion
Speculum examination will reveal an open cervical os, possibly with products of conception sitting at the cervical os

415
Q

What is a septic miscarriage

A

Where there is an infection alongside an incomplete or a complete miscarriage.

416
Q

How would you diagnose a septic miscarriage

A

Present with symptoms of miscarriage
Also fevers, rigors, uterine tenderness, bleeding,
offensive discharge and pain
Inflammatory markers will be raised

417
Q

What is a missed miscarriage

A

Where there are no symptoms of miscarriage or a history of threatened miscarriage, but on ultrasound scanning there is no viable pregnancy

418
Q

How does age affect miscarriage risk

A

Increasing maternal age increases risk of miscarriage
Paternal age also contributes
Greatest risk is when the mother is over 35 and the father is over 40

419
Q

The risk of miscarriage increases after each

subsequent miscarriage - true or false

A

True

420
Q

Cervical shock occurs during which type of miscarriage

A

Incomplete

Caused by the presence of products at the cervix

421
Q

What will the trend in HCG levels be in miscarriage

A

Would be expected
to halve every 48 hours.
A 50% fall is highly suggestive of a miscarriage or failing pregnancy

422
Q

How do you manage a septic miscarriage

A

ABCDE assessment and possibly resuscitation
Start on sepsis 6 - appropriate antibiotics
Requires active miscarriage management - either medical or surgical

Reproduction (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions