Early pregnancy Flashcards

Question

Discuss placenta pravia

Answer 1

Implantation of the placenta over the cervical os Risk is increased with maternal age, smoking, multiparity, c-section, prior miscarriage or induced abortions and preterm labour Bleeding occurs when marginal placental vessels implanted in the lower uterine segment are tone either as the lower uterine wall elongates or with cervical dilation near the time of delivery

Answer 2

Painless fresh vaginal bleeding is the most common symtpom. in 20% of cases there is some degree of uterine irritbailty- this is usually mild. Vaginal examination usually reveals bright red blood from the cervical os. -All patients with painless second trimester bleeding should be assumed to have placenta previa Digital or instrumental probing of the cervix should be avoided yuntil the diagnosis is exclude via ultraosund. Injudicious vaginal examination can precipitate severe hamerrohage Most cases of placenta praevia identified during the mid trimester resolve by time of delivery as the lower uterine segment elongates and the placenta no longer overlaps the os

Answer 3

ABCD If RH -ve should receive anti D 300 mic O&G input Foetal monitorign

Answer 4

Occurs when a Rh -ve women is exposed to RH psotive foetal blood Small amount of feotal cells enter the maternal circulation throughout pregnancy - bute the maternal immune system is triggered only by sgnificant laods fo foetal cells Sensitization occurs in yup to 15% of RH -ve women carrying Rh Positve fetuses. To prevent this antiD immun globulin is routinely administered to motehrs at approximatly 28 weeks of pregnancy Other events that should have anti D include: spont miscarriage, threatened miscarriage, surgery for extopic pregnancy and amniocentesis. 50 mic anti D \<12weeks and 300mic after

Answer 5

occurs with the same incidence as non pregnant patients. During the first half of gestation presentation is the same. But clinical picture can become more atypical in the second half of gestation Traditionally the appendix was thought to be displace counterclockwise out of the right lower quadrant with its ultimate lolcation deepo in the right upper quadrant Displacement of the abdominal wall away from the abdominal vicera can result in difficulty in palpation of organs and loss of signs of peritoneal irritation. During its migration the appendix is very close to the right kidney resulting in a high incidence of pyuria and flank pain

Answer 6

Hepatitis is the most common cause of lidver disease accounting for 40% of cases of jaundice. management and treatment are supportive and unchanged from those for non pregnant patients. Hep E however may have a more aggresive course in pregnancy a Acute fatty liver of pregnancy is a disorder of the third trimester and can result in liver failure, complciated labour and feotal mortality. The disease is rare occuring most commonly in primiparous women with twin gestation. Clinical features include nausea and vomiting associated with malaise or jaundice during the third trimester should trigger consideration of acute fatty liver. May progress to coaguloapthy jaundice siezures DIC and hepatic encephaoloapthy. May require stabilisation from seizures or coma. Hypoglycaemia can occur which should be rapidly corrected. Intrahepatic cholestasis of pregnancy also temred idiopathic jaundice of pregnacny and icterus gravidarum is a rare syndrom taht occurs during the third trimester of prenancy- characterised by cholestasis and dilated canaliculi with a normal liver. Clinical features include generalised pruritis and mild jaundice - usually presenting complaint is pruritis only begins in the palms and soles and ascends to the trunk. - resolution occurs with delivery of the baby

Answer 7

Nausea and vomitng are extremly common in pregnancy particularly from 6-20 weeks of gestation. Symptoms are usually self limited and often resolve with lifestyle changes such as diet modification and avoidance of environmental trigger. Ginger has been found to be quite effective as an anti-emetic Hyperemesis Gravidarum occurs in approxiamtly 1% of pregnancy and is defined by nausea and vomting that cause starvation metbaolism, weight loss greater than 5% and prolonged ketonemia and keonuirai. -Without treatment there is an increased risk fo micronutrient defiecny and there respective sequalea Management involves appropraite rehydration + thiamine. Antiemetics as per pregnancy with pyridoxine being useful.

Answer 8

Accounts for 20% of all maternal mortality Pregnancy is a hypercoagubale state with increased coagulation factors and stasis Risk of VTE in pregnancy increase 5-6 times Pre test probability score WELLS cannot be used as pregnant patients were excluded from the study D-Dimer rises from the second trimester and remains evlevated for 4-6 weeks post partum

Answer 9

Associated with increased risk of miscarraige and intrauterine foetal demise. Foetal alcohol sydnrome is characterized by at least one of a series of morphological abnormalities in assoaicetion with heavy ETOH use including midfacial hypoplasia, flat philtrum low nasal birdge epicanthal folds shortened palpebral fissue low set ears and microcephaly. Treatment of an alcohol dependent mother is dicciult as with non pregnant patients withdrawal symptoms are likley to manifest 6-24 hours after last consumption.

Answer 10

Maternal cocaine and methamphetamine use is independtly linked to IUGR from imparied placental circulation and preterm birth less than 36 weeks, preeclampsia, IUFD and GDM. Cocaine increase the risk of placental abruption and infarction.