Conditions and assessments Flashcards

Question

Gestational Diabetes definition, physiology, risks, risk factors, MW role + screening, Referrals, mgmt

Answer 1

definition * hyperglycaemia first recognised in pregnancy (can be any type of DM, first picked up in pregnancy) * usually disappears after birth (but increased risk of DM T2 in later life) physiology from 20 wks, Hpl increases insulin resistance, can cause BGL's to increase risk macrosomia, hypertensive disorders (PIH, PE), Miscarriage, polyhydramnios, UTI's, PTL, thrush Risk factors family hx diabetes age / BMI ethnicity Previous macrosomia / stillbirth PCOs MW role + Screening responsibility to: "inform women that obesity is leading to increaed incidence of diabetes, and offer screening" HbA1C<40 Urinalysis 26-28wks OGTT / Polycose If high risk (e.g. HbA1C 40-50, then have OGTT at 24-28wks) **Referrals **diet / metformin- consult insulin- transfer Mgmt Antenatally- Diet / metformin/ insulin intrapartum- Postnatal- AN treatment should be discontinued

Answer 2

**What is it **BGLs < 2.6mmol associated with brain injury / death ** Risk factors** Preterm (<37wks) SGA (<9th) / LGA (>98th) Maternal DM Hypothermia severe fetal distress asymmetric growth with fetal distress and / or mec unwell sepsis **Signs / symptoms** - may be asymptomatic or symptomatic - General signs- poor feeding / sleepiness /irritability --> require xx feeding / monitor temp - Further signs- jittery / tachynopea/ hypothermia - Urgent review - BGL <2.0, cyanosis, seizures, apnoea, floppy ******Management for babies at risk - feed asap after birth, THEN 3hourly --> - consider EBM /c**olostrum / PDM / formula if (?)milk transfer 2hour post feed- BGL >2.6? - check BGL 3-4hrs post birth (prefeed)--> 2.6?. If <2.6, repeat 3hourly until 3 consecutive readings >2.6 - if 1st BGL <2.6, consult NICU and give dextrose, then recheck 30mins later - if BGL <2.0 or 2nd BGL (After dextrose) is <2.6- transfer

Answer 3

**what is it **procedure in which fetus is rotated from non-cephalic presentation by manipulating mum's tummy 40-64% success rate **process** offer 35-36wks (primip), 36-37wks (multip) have terbutaline prior to procedure offer 625IU anti-d to Rh Neg women ** complications** transient fetal distress abnormal CTG bleeding PV abruption emergency CS fetal death **contraindications** -anything that contraindicates vaginal birth (placenta pravia / previous classical CS) - placental abruption - abnormal CTG -severe uterine / fetal anomaly - severe oligohydramnios - ROM - multiple pregnancy (except for birth of 2nd twin) **complications **- SGA baby (with normal dopplers) - PE - Oligohydramnios - major fetal anomalies / uterine surgery - APH within last 7 days

Answer 4

**What is it** - 'normal' transient bacteria in vagina - usually harmless. cannot be eradicated with AB's - can cause infection in woman's genital tract (UTI's) , placenta or amniotic fluid--> miscarriage / stillbirth/ sepsis/ meningitis - can be transmitted to baby vaginally and cause neonatal GBS infection (up to 3mths) **neonatal GBS infection types **- early onset (<7 days)- 70% Symptomatic at birth, 95% symptomatic <24hrs - late onset (up to 3mths) **Mgmt *1) screen women for signs of GBS infection ***Signs of GBS infection (maternal) pyrexia (37.8) tachycardia chills / malaoise fetal tachycardia purulent liquor /PV discharge uterine tenderness laucocytosis 2) asses risk factors for GBS during pregnancy - GBS pos swab (unless GBS neg swab >37wks) -GBS bacteriuria -previous baby infected with GBS - ROM >24hrs (unless GBS neg swab >37wks) -intrapartum fever (>38 degrees) preterm mgmt - incidental GBS finding - don't bother treating. reswab at 37wks - GBS bacteruria /UTI- treat with braod spectrum AB's, adn then use intrapartum prophylaxis -Anyone with risk factors- narrow spectrum Prophylactic AB's (and IOL if PROM>24hrs) regardless of ROM 4) women with clinical signs infection- immediate IOL + broad spectrum AB's note- prelabour elective / emergency CS do not require prophylaxis Signs of neonatal GBS infection RDS (grunting / breathing issues) signs of sepsis temp instability seizures/ stiff /limp fever

Answer 5

**signs** * pyrexia (≥38) "maternal fever" + 2 or more -abdo tenderness -PV discharge / liquor -maternal / fetal tachycardia (ROM not necessary_ referral- consult mgmt- broad spectrum AB's, fetal monitoring

Answer 6

aka septicaemia **what is it* ** an abnormal immune response to an infection you already have (typically bacterial(GBS E Coli, Group A, also viral (influenza, Herpes, CMG, Varicella) life threatening- immune system starts attacking organs / other tissues **** **Risk factors **- impaired immune system - GDM - obesity - has had invasive procedure (C section / forceps, RPOC / Cathether / PROM) - Contact with people with Group A strep - ongoing / smelly PV loss / wound infection - fetal tachycardia / non-reassuring CTG **Signs** [Sepsis can be challenging to identify early as symptoms may be subtle / mimic pregnancy] Don't exclude sepsis if temp is normal/low (paracetamol may be masking sepsis) Slurred speech /confusion Temperature - extreme high / low tachyapnoic tachycardic (maybe maternal or FHR) hypotensive (systolic)- clammy + sweaty new onset / pain Genital tract sepsis may also- ++ / offensive PV dx, diarrhoea, nausea/ vomiting **Refer** TRANSFER **Management** Give 3 (oxygen, fluid challenge, IV antibiotics) Take 3 (bloods + cultures, lactate, urine output, swabs ) consider 2 (birth or ROC / thromboprophylaxis (risk of DVT/ PE)

Answer 7

Signs same as adult (temperature extremes, tachycardic, hypotensive) but also (RDS, bradycardic, cyanotic episides, poor feeding, lethargy irritable, unstable BGL's abdominal distension unexplained jaundice, umbilical flare)

Answer 8

**definition**: *excessive bleeding after birth--> haemodynamic instability >500ml + continuing (Vaginal birth) Primary bleeding- first 24hrs Postpartum secondary bleeding- 24-6 wks post partum **Risk factors** hx previous PPH LGA Placenta praevia / accreta Hypertensive disorders obesity high parity bleeding disorders IOL/ AUgmentation long 1st /2nd stage Fast labour instrumental / CS / Retained placenta/ lacerations **Causes ** uterine atony - shoulder dystocia, long labour, arterial bleeding (forceps, episiotomy) retained products thrombosis- thrombocytopaenia, clotting disorder **Assessments** feeling unwell / lightheaded / fainting pallor / cold peripheries tachy or bradycardic / hypotensive confused / agitated **referrals** >500ml with ongoing loss - Consult ongoing uncontrollable bleeding - Emergency ** **Mgmt** - Deliver placenta - rub fundus (helps uterus contract) - baby to breast - uterotonic - empty bladder Obs (BP/ HR) / EBL Take bloods (CBC + G&H) + site IV line Call for help Give oxygen / lie flat Put up fluids ** Stop bleeding *** - Uterotonic (Synotocin 10 IU (1ml) / Syntometrine 1ml (5 IU syntocin +500mg ergometrine)/ oxytocin infusion (40 IU / 500ml) * - TXA * misoprostil / carboprost Check perineum for retained products / bleeding vessel send coag bloods away

Answer 9

physiology pressure from uterus (late pregnancy) relaxing of oesophageal sphincter food is in stomach for longer (due to reduced peristalsis / gastric secretion) Symptoms- burning / pain in chest feeling full /heavy / bloated assessment confirm it's not PE (check BP / Other possible signs) start with dietary changes (avoid spicy / greasy food, acidic products, carbonated drinks)

Answer 10

basic care continuous monitoring / OB present/ birth of 2nd twin - continously monitor T2 FHR - check lie (cephalic), presentation, position - consider ECV? - ensure labour is progressing? augment if not. 3rd stage** - don't give ecbolic until T2 born** - once ecobolic given, CCT to both cords simultaneusly **- don't take cord bloods until after T2 born **- be prepared for PPH

Answer 11

risks- PE / SGA Mgmt- * commence aspirin + Ca 12-16wks-36wks * discontinue ACE inhibitors in pregnancy --> keep BP stable with labetalol, nifidipine * Monthly scans from 28-30wks ( SGA guideline) * monitor BP AN /Intrapartum / postpartum *

Answer 12

**Dizygotic (fraternal) **2 ovum released. 2 sperm fertilise. 2 zygotes implant. may share a placenta, but unlikely to have issues with vessels DCDA - 2 Chorion +2 AMNION share ~50% genetic material (same as non-identical siblings)- 50% same sex, 50% different causes- IVF, maternal age (release more ovum naturally), familial **Monozygotic (identical)** 1 ovum + 1 sperm = 1 zygote. zygote then separates to form 2 identical zygote. share 90% DNA- physically + psychologically very similar. may share placenta / chorion/ amnion - ~30% DCDA - separate placenta. split before 3 days (before placenta has formed) - MCDA - share placenta +chorion, but separate amnion (3-9 days- before amnion formed) - MCMA- share amnion (9-12 days) - conjoined- >12 days

Answer 13

**"controlled" hypertension (staying < 160/110) no severe features

Answer 14

**definition **severe hypertension (>160/110) worsening signs /symptoms / bloods HELLP mgmt Transfer of care consider mag sulphae (to prevent seizure) birth recommended >34wks

Answer 15

**Definition Form of extreme pre-eclampsia Diagnosed 1 or more characteristic :Haemolytic anaemia, elevated liver enzymes, low platelets (<100) risks-hepatic, haemotological, cardiac, pulmonary (respiraotry), CNS, renal management referral- Emergency Expedite birth (any gestation)- ideally have mag sulphate (<30wks) + corticosteroids (24-34+6 wks)

Answer 16

**definition **severe form of pre-eclampsia when can it occur -before/during / after seizures are self limiting/ not caused by pre-existing condition / no persistent neurological features **management / rx** **Transfer** Airway/ breathing /circulation Antihypertensive start mag sulphate birth at any age (ideally wait to have corticosteorids (<34+6) + mag sulphate (of <30wks )

Answer 17

From 28 wks onwards, there is a >30 centile decline in EFW or AC

Answer 18

Major risk factors: **maternal demographics *** nulliparous >40years * Smoking >10 cigarettes (After 16wks) * drug use **pregnancy hx** previous SGA/ FGR (risk of early onset) Previous hypertensive disorder (risk of early onset) prev stillbirth **medical hx** [ALL have RISK of early onset) chronic hypertension diabetes with vascular disease renal impairment antiphospholipid syndrome **current pregnancy risk** heavy bleeding >20wks PE / gestational hypertension APH / placental abruption **Recommended management** - monthly growth scans in 3rd trimester (from 28-30wks) - for early onset risks - doppler study at 20-24wks + monthly scans from 24-26wks

Answer 19

**MATERNAL DEMOGRAPHIC** * Nulliparity * multip >40years * smoking 1-10 cigaretts **medical hx** ART conception BMI>30 / <18.5 **Pregnancy hx **Short (<6mths)** / Long (>5 years) **current pregnancy risk** placenta praevia Low gestational weight gain management >3 minor risks: growth scans @ 28-30 wks + 36-38wks

Answer 20

* What is it * very common chronic viral infection - "intermittant reactivation" * genital + oral * first episode is most severe, recurrent episodes may be milder * symptoms may be non-specific - most women don't have 'classical symptoms. woman may be receiving treatment for other genital conditions (UTI/ thrush) * need clinical diagnosis (lab test)- * risks if there is 'outbreak' (visible lesion / promodal symptoms) during vaginal birth, can be transmitted to baby (esp high risk if it's first outbreak) --consider C section if no lesion/ promodal symptoms- can labour - risk of transmission very low management * if lesions in pregnancy-CONSULT/ take aciclovar from 36 wks to reduce viral load * If lesions intrapartum- CONSULT, consider CS * CONTRAINDCATED - Scalp electrodes / instrumental birth Neonatal HSV - rare / potentially fatal - symptoms are non-specific- any baby with skin vesicles should be referred

Answer 21

what is it after 'silent' miscarraige- placental tissue abnormally/ rapidly grows --> cancer - Complete- * when egg without maternal dna is fertilised= no embryo /normal placental tissue. * placenta continues to grow, produce hcG (woman feels pregnant) * looks like graps Partial * 2 sperm fertilise 1 ovum (69 chromosomes) --> fetus dies * pv bleeding / absence of FHR symptoms - uterine enlargement - dark brown PV loss - signs of hyperthyroidism (from hCG) - Early PET (before 20wks) Assessment - monitor serum hCG until not detectable - don't get pregnant during this phase

Answer 22

risks fertility / miscarriage GDM/ G hypertension Ca section Multiples referral none

Answer 23

**Dizygotic (fraternal) **2 ovum released. 2 sperm fertilise. 2 zygotes implant. may share a placenta, but unlikely to have issues with vessels DCDA - 2 Chorion +2 AMNION share ~50% genetic material (same as non-identical siblings)- 50% same sex, 50% different causes- IVF, maternal age (release more ovum naturally), familial **Monozygotic (identical)** 1 ovum + 1 sperm = 1 zygote. zygote then separates to form 2 identical zygote. share 90% DNA- physically + psychologically very similar. may share placenta / chorion/ amnion - ~30% DCDA - separate placenta. split before 3 days (before placenta has formed) - MCDA - share placenta +chorion, but separate amnion (3-9 days- before amnion formed) - MCMA- share amnion (9-12 days) - conjoined- >12 days

Answer 24

**maternal** - HG - GDM - PE / GIH - Anaemia - **fetus** - congenital abnormalities - malpresentation - IUGR/ SGA **L&B** preterm labour / birth PROM/ PPROM malpresentation (breech) PPH Cord accidents birth asphyxia (twin 2) placental abruption (Esp after T1 Born) placenta praevia

Answer 25

condition in which blood from one twin is transfused to other twin, via blood vessels in shared placenta affects MZ twins (~15%)

Answer 26

definition: abnormal / excessive bleeding from uterus >24hrs - 12wks post partum Cause Retained placenta--> infection / preventing involution Signs / symptoms sudden / profuse blood loss OR persistent increased blood loss faintness / dizzy low BP Tachycardia

Answer 27

Daily BP for 7 days weekly

Answer 28

seroma (sterile accumulation of serum beneath skin incision- should be treated conservatively) superficial infection deep wound infection Signs of infection (red, hot, tender) mgmt- take swab and consult (but no official guidelines)

Answer 29

bP >\= 140 and / 90 Consecutively, >4hrs apart

Answer 30

Hypertension <20wks referral- consult

Answer 31

definition * Hypertension >20wks * No other PE symptoms * bP normalises <3mths postpartum referral- Consult mgmt - regularly monitor BP / screen urine for proteinuria- - do PE bloods / MSU if BP/ protein increase -(SGA guideline)- monthly growth scans from 28-30 wks

Answer 32

**DEFINITION **hypertension (pre-existing or gestational) + 1 or more new conditions - proteinurea (PRC>30) - Renal (creatinine (>90) - Liver (bloods) or RUQ / epigastric - Neurological (headache /visual / hyperreflexic with clonus, seizures, stroke) - haemotological (thrombocytopaenia (<100), haemolysis) -placental insufficiency (placental abruption / IUGR) **risk factors personal / family hx first baby / new dad / 10 years since last baby / multiples medical hx (Chronic hypertension, DM, antiphospholipid ABs, renal >40 years, high BMI > ** Referral- Transfer **Management** - stabilise BP (labetalol /nifidipine/ methydopa) - 160-100 - Monthly USS - Consider timing of birth (expectant if <37 wks )

Answer 33

**"controlled" hypertension (staying < 160/110) no severe features

Answer 34

**definition **severe hypertension (>160/110) worsening signs /symptoms / bloods HELLP mgmt Transfer of care consider mag sulphae (to prevent seizure) birth recommended >34wks

Answer 35

**Definition Form of extreme pre-eclampsia Diagnosed 1 or more characteristic :Haemolytic anaemia, elevated liver enzymes, low platelets (<100) risks-hepatic, haemotological, cardiac, pulmonary (respiraotry), CNS, renal management referral- Emergency Expedite birth (any gestation)- ideally have mag sulphate (<30wks) + corticosteroids (24-34+6 wks)

Answer 36

**definition **severe form of pre-eclampsia when can it occur -before/during / after seizures are self limiting/ not caused by pre-existing condition / no persistent neurological features **management / rx** **Transfer** Airway/ breathing /circulation Antihypertensive start mag sulphate birth at any age (ideally wait to have corticosteorids (<34+6) + mag sulphate (of <30wks )

Answer 37

<32 Wks gestation Either: EFW / AC <3rd centile UA absent/ reversed end diastolic flow EFW / AC <10TH Centile AND abnormal dopplers Management for women at risk Consult Referral

Answer 38

From 28 wks onwards, there is a >30 centile decline in EFW or AC

Answer 39

EFW or birthweight <10th centile REFERRAL - Consult (EFW/Birthweight between 3rd-10th centile (and normal dopplers) Mgmt -increase USS+ dopplers (fortnightly until 36+6. then weekly_ recommend birth at 40wks

Answer 40

Diagnosed after 32wks gestation * EFW/ AC <3rd centile OR 2 or more * EFW/ AC <10th centile ("SGA") * Slowing of fetal growth (EFW/AC <30 centiles from 28wks onwards) * abnormal doppler Mgmt: Referral

Answer 41

Hb <110 T1/ 105 (T2+T3) Causes * iron deficiency anaemia : low ferritin (>30) (CRP<5) (note start treating when just ID) signs- tiredness / breathless / dizzy/ cold / headaches/ tachycardic risks- premature labour, SGA, fatigue, depression mgmt- 100mg elemental iron **CONSULT if hb <90 / not responding to treatment *Megaloblastic anaemia - caused by deficiency of B12 / folate *Haemolytic anaemia - Transfer RBC's are destroyed faster than they are made (usually autoimmune condition) *Sickle cell - Transfer *Thalassaemia - Transfer

Answer 42

Major risk factors: **maternal demographics *** nulliparous >40years * Smoking >10 cigarettes (After 16wks) * drug use **pregnancy hx** previous SGA/ FGR (risk of early onset) Previous hypertensive disorder (risk of early onset) prev stillbirth **medical hx** [ALL have RISK of early onset) chronic hypertension diabetes with vascular disease renal impairment antiphospholipid syndrome **current pregnancy risk** heavy bleeding >20wks PE / gestational hypertension APH / placental abruption **Recommended management** - monthly growth scans in 3rd trimester (from 28-30wks) - for early onset risks - doppler study at 20-24wks + monthly scans from 24-26wks

Answer 43

fortnightly measurements of Fundal height from 26-28 WKS, plot on customised GROW chart refer for scan if -Fundal height <10th centile - 30centile decline

Answer 44

**MATERNAL DEMOGRAPHIC** * Nulliparity * multip >40years * smoking 1-10 cigaretts **medical hx** ART conception BMI>30 / <18.5 **Pregnancy hx **Short (<6mths)** / Long (>5 years) **current pregnancy risk** placenta praevia Low gestational weight gain management >3 minor risks: growth scans @ 28-30 wks + 36-38wks

Answer 45

EFW and AC >90th centile AND no diabetes Referral- consult

Answer 46

customised BW <3rd centile OR: customised BW is 3-10th centile AND 2+ * BMI/ length/ skin z zcore <1.3 * baby was diagnosed with "FGR" antenatally * evidence of placental insufficiency Referral- consult Mgmt - hypoglycaemia -

Answer 47

* What is it * very common chronic viral infection - "intermittant reactivation" * genital + oral * first episode is most severe, recurrent episodes may be milder * symptoms may be non-specific - most women don't have 'classical symptoms. woman may be receiving treatment for other genital conditions (UTI/ thrush) * need clinical diagnosis (lab test)- * risks if there is 'outbreak' (visible lesion / promodal symptoms) during vaginal birth, can be transmitted to baby (esp high risk if it's first outbreak) --consider C section if no lesion/ promodal symptoms- can labour - risk of transmission very low management * if lesions in pregnancy-CONSULT/ take aciclovar from 36 wks to reduce viral load * If lesions intrapartum- CONSULT, consider CS * CONTRAINDCATED - Scalp electrodes / instrumental birth Neonatal HSV - rare / potentially fatal - symptoms are non-specific- any baby with skin vesicles should be referred

Answer 48

risks fertility / miscarriage GDM/ G hypertension Ca section Multiples referral none

Answer 49

partial inflation of lungs

Answer 50

T1- breech T2- Cephalic risk of obstructed labour

Answer 51

Fetal tachycardia, maternal pyrexia, offensive liquor CONSULT

Answer 52

3/4th tear (with/ without symptoms)- consult

Answer 53

MSS1 ( Trimester 1 (<14wks) Screening to test for chance of T18 (edwards), T13 (patau), T21 involves - blood test (Serum) 9- 13+6 - - Scan- fluid at back of baby's neck: 11-13+6 > 1/300 --> refer

Answer 54

point mutation / familial RBC's become mischapen and break down/ die early = haemolysis referral- transfer

Answer 55

inherited blood disorder when body has less Hb + fewer RBC's

Answer 56

<100? Transfer

Answer 57

previous DVT / PE Consult

Answer 58

Dipstick has proteinuria of ≥+1

Answer 59

process - scan to confirm presentation + placenta location - give terbutaline (tocolytic) to relax uterus from 37 wks only singleton babies not engaged / normal liquor ALWAYS give anti-D prophylactically if mum is Rh neg contraindications anything that prevents normal vaginal birth (maternal / fetal compromise / placenta praevia ) multiple gestation oligohydramnios Risks (very rare) - abnormal FHR (usually transient) PV bleeding placental aburption emergency CS perinatal mortality

Answer 60

1) assess woman's haemodynamic stability (women may experience significant blood loss before showing signs of shock) 2) if no signs of shock present, can continue assessment in community - ask about risk factors for ectopic pregnancy (chlamydia, IUD, STI, pelvic infection) - take serum hCG every 48-72hrs - if these are falling, usually indicates non-viable pregnancy (but doesn't rule out ectopic pregnancy or molar pregnancy) - scan

Answer 61

hypotension tachycardia clammy skin confusion pallor faint vomiting

Answer 62

what is it when blastocyst implants outside uterus (usually fallopian tubes) pregnancy continues as normal, until blastocyst becomes too big and it ruptures /dies risk of internal bleeding signs (usually women report non-specific vague symptoms, so watch for early signs, as bleeding can quickly become torrential) early 1) lower abdominal pain 2) immediately prior to rupture- increasing abdo pain, rigidity, rebound tenderness, shoulder tip pain -mass on one side of uterus 3) bleeding 4) shock risk factors hx of ectopic pregnancy hx tubal surgery /infection infertility IVF surgery IUD use assessment- - always consider possibility of ectopic pregnancy with women that have abdo pain - watch for early signs - Transvaginal scan + lab studies ( hcg increases, but more slowly than normal) mgmt if ectopic pregnancy suspected + signs of haemodynamic stability- resus as required (fluids) + transfer

Answer 63

when blastocyst implants in cervical mucus + caesarean scar risk- multiple CS births

Answer 64

benign tumour- usually harmless. remove after pregnancy can cause bleeding in pregnancy appear as bright red, fleshy protrusions that extend out from cervical canal