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Year 4 - 1. Reproductive Health > Differentials and risk factors - obstetric presentations > Flashcards

Differentials and risk factors - obstetric presentations Flashcards

1
Q

State potential causes of reduced foetal movement

A

Physiological:
- Foetus sleeping
- Distracted mother
- Anterior placenta (prior to 28 weeks)
- Antenatal steroids and smoking

Pathological:
- Placental insufficiency
- Oligohydramnios / polyhydramnios
- Anaemia / hydrops (heart failure)
- Acute foetomaternal haemorrhage
- Sedating drugs e.g. opioids
- Congenital malformation
- intrauterine death :(

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2
Q

State some risk factors for reduced foetal movements

A

Risk factors for reduced foetal growth or stillbirth:
- Smoking
- Pain/bleeding
- Preeclampsia
- Diabetes
- OC trauma within 48 hours

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3
Q

State potential causes of a small for gestational age baby

A

Normal small:
- Incorrect dates
- Constitutionally small

Abnormally small:
- Chromosomal abnormalities

Infected small:
- Infection during pregnancy (commonly CMV)

Starved small:
- Placental issues and foetal growth restriction e.g. smoking, multiple pregnancy

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4
Q

State some risk factors for small for gestational age baby

A
  • Previous small for gestational age baby
  • Recurrent foetal loss
  • Previous unexplained stillbirth
  • 1st trimester bleeding
  • Smoking
  • Extremes maternal age
  • Extremes BMI
  • Domestic violence
  • Infection
  • HTN / renal disease
  • Haemoglobinopathies
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5
Q

State potential causes of hypertension in pregnancy

A
  • Pre-existing HTN
  • Preeclampsia / eclampsia
  • Gestational HTN (pregnancy-induced)
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6
Q

State some risk factors for hypertension during pregnancy

A

Preeclampsia specifically:
- Pre-existing HTN
- Previous preeclampsia
- Family history preeclampsia
- First pregnancy
- > 10 years since last pregnancy
- Increased maternal age
- BMI > 35
- Multiple pregnancy
- Molar pregnancy
- Diabetes / autoimmune disorder / CKD

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7
Q

State potential causes of antepartum haemorrhage

A
  • Placental abruption
  • Placenta praevia
  • Vasa praevia
  • Local causes e.g. bleeding from the vulva / vagina / cervix
  • Local infection e.g. cervicitis
  • Mild trauma e.g. sexual intercourse
  • Miscarriage (different types)
    Sometimes it is not known
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8
Q

State some general risk factors for antepartum haemorrhage

A
  • Increased maternal age
  • Number of previous births
  • Multiple pregnancy
  • Smoking
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9
Q

State some risk factors for placental abruption

A
  • Previous abruption
  • Hypertension / preeclampsia
  • External trauma
  • Low BMI
  • Fibroids
  • Foetal growth restriction
  • PROM
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10
Q

State some risk factors for placenta praevia

A
  • Previous caesarean section
  • Termination of pregnancy or dilatation and curettage
  • Manual removal of the placenta
  • Myomectomy
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11
Q

State potential causes of glycosuria

A
  • Gestational diabetes
  • Preexisting diabetes (T1DM or T2DM)
  • Renal disease
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12
Q

State risk factors for gestational diabetes (leading to glycosuria)

A
  • Previous gestational diabetes
  • Previous macrosomic baby weighing 4.5 kg or above
  • BMI > 30
  • First-degree relative with diabetes
  • Minority ethnicity
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13
Q

State risk factors for preterm labour / preterm prelabour rupture of membranes

A
  • Previous preterm labour
  • Multiple pregnancy
  • Short cervix
  • Use of infertility treatment
  • Infections: UTI, STI, vaginal infections
  • HTN / preeclampsia
  • Diabetes
  • Pregnancies close together in time

Social:
- Domestic violence
- Smoking / alcohol / illicit drugs
- Limited contact with healthcare during pregnancy

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14
Q

List some factors which increase risk of anaemia during pregnancy

A
  • Preexisting anaemia
  • Previous anaemia during pregnancy
  • Multiple pregnancies
  • Pregnancies close together in time
  • Poor diet
  • Maternal age < 20
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15
Q

State some risk factors for hyperemesis gravidarum

A
  • Previous hyperemesis gravidarum
  • Multiple pregnancy
  • Molar pregnancy
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16
Q

List some differentials for a pregnant woman presenting with nausea and vomiting

A

Fairly normal between 4th-7th week, peak 9th-16th week but should resolve ~ 20th week

Persistent vomiting and severe nausea can indicate hyperemesis gravidarum

17
Q

List some differentials for a pregnant woman presenting with reduced fetal movements

A
  • Stillbirth / intrauterine death
  • Foetal growth restriction
  • Placental insufficiency
  • Congenital malformations
18
Q

List some specific questions to ask about in a patient presenting with vaginal bleeding

A
  • Associated trauma (including domestic violence)
  • Fever / malaise
  • Recent ultrasound scan results (e.g. position of the placenta)
  • Cervical screening history
  • Sexual history
  • PMH
19
Q

List some differentials for a pregnant woman presenting with vaginal bleeding in first trimester

A
  • Miscarriage (threatened, missed, incomplete)
  • Ectopic pregnancy
  • Retained products of conception
  • Gestational trophoblastic disease
20
Q

List some differentials for a pregnant woman presenting with vaginal bleeding in second trimester

A
  • Placenta praevia
  • Placental abruption
  • Vasa praevia
  • Uterine rupture
  • Gestational trophoblastic disease
21
Q

List some differentials for a pregnant woman presenting with vaginal discharge

A

Clear:
- Increased physiologic discharge during pregnancy
- Urinary incontinence
- Prelabor rupture of membranes (PROM)

Non-clear:
- Thrush / bacterial vaginosis
- STI

22
Q

List some common differentials for a pregnant woman presenting with fever

A
  • UTI
  • Chorioamnionitis
  • Cervical infections
23
Q

List some symptoms to ask about if suspecting pre-eclampsia

A
  • Headache
  • Double vision
  • N&V
  • Oedema
  • Epigastric pain
    + foetal movements (typically reduced)
24
Q

List some gynae differentials for acute pelvic pain in pregnancy

A
  • Labour / preterm labour!
  • Braxton hicks
  • Ectopic pregnancy
  • Miscarriage
  • Placental abruption
  • Uterine rupture

Other non-pregnancy pathology e.g. ovarian torsion endometritis

Year 4 - 1. Reproductive Health (7 decks)

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