Extra Flashcards
What are the Hb value in the different trimesters of pregnancy that define anaemia?
1st = less than 100g/l
2nd = less than 105 g/l
3rd = less than 100 g/l
How long should iron tablets be given after iron deficiency is corrected?
3 months to allow iron stores to be replenished
What are risk factors for placenta praevia?
Prev placenta praevia, prev C section, endometrium damage and multiple pregnancies
What are clinical features of placenta praevia?
Shock in proportion to visible loss, painless, uterus not tender, lie and presentation may be abnormal,
Would you do a digital vaginal examination before an ultrasound in someone with suspected placenta praevia?
No as this could provoke a severe haemorrhage
What are the four grading of placenta praevia?
1- placenta reaches lower segment but not internal os
2- placenta reached internal os but does not cover it
3-covers internal os but not when dilated
4- placenta completely cover internal os
In gestational diabetes, if the glucose targets are not met with diet changes or 1-2 weeks of metformin, what should be done?
Insulin should be added
What are risk factors for gestational diabetes?
BMI>30, previous macrosomia babies, prev gestational diabetes, first degree FHx, ethnicity (south Asian, black Carribean, middle eastern)
What are the diagnostic thresholds for gestational diabetes? (Hint= 5678)
Fasting blood glucose >5.6
2-hour blood glucose >7.8
What is a galactocoele and how is it differentiated from an abscess?
Galactocoele is cystic lesion lesion in the breast caused by a build up of breast milk from an occluded lactiferous duct.
Galactocoeles are painless and have no local or systemic signs of infection
What does of folic acid are some with BMI over 30 adviced to take?
High dose 5 mg daily
What is placenta accreta?
The attachment of the placenta to the myometrium due to a defective decidua basalis
What is the main risk associated with placenta accreta?
Postpartum haemorrhage
What are the 3 different types of placenta accreta? How do they differ?
Accreta- attach to myometrium
Increased- invade into myometrium
Percreta- invade through the perimetrium
When do women who are rhesus negative have routine anti-D injections?
28 and 34 weeks gestation
After how many weeks would you refer a pregnant woman if they had still not felt any fetal movements?
24 weeks
What combination of results would indicate increased risk of downs from the combined test?
Thickened nuchal translucency, increased beta-HCG, decreased PAPP-A
What examination can be done to confirm premature prelabour rupture of membranes?
Sterile speculum examination- looking for pooling of amniotic fluid in posterior vaginal vault
If PPROMS is suspected but no pooling is seen on speculum examination, what investigation can be done?
Test the fluid for placental alpha microglobulin-1 protein (PAMG-1) or insulin like growth factor binding protein-1
What is the management of a patient with PPROMs?
Admission
Regular obs to check if chorioamnionitis developing
Oral erythromycin for 10 days
Corticosteroids for baby resp
Delivery considered after 34 weeks gestation
What screening tool can be used to assess postnatal depression?
Edinburgh scale
Increases and decreases in AFP during pregancy are associated with what pathologies in the baby?
Raised= neural tube defects
Decreased= downs
What further manoeuvre can help the effectiveness of Roberts manouevre in shoulder dystocia?
Suprapubic pressure
What is the definitive treatment for obstetric cholestasis?
Ursodeoxycholic acid
Delivery should not be offered to pregnant women with pre-eclampsia unless which conditions are met?
Severe maternal hypertension that is refractory to treatment
Maternal or fetal indications develop as specified in consultants plan
What antibiotic is used for GBS prophylaxis?
Benzylpenicillin
What are some clinical features of placental abruption?
Shock out of proportion to visible blood loss, constant pain, tender and tense uterus, fetal heart absent/distressed
How are pregnant women over 20 weeks that develop chicken pox treated if they present within 24 hours of rash onset?
Oral aciclovir
What is first line treatment for magnesium sulphate induced respiratory depression?
Calcium gluconate
What are some potential consequences of pre-eclampsia?
Eclampsia and other neuro symptoms
Intrauterine growth retardation, prematurity, liver involvement, haemorrhage (placental abruption, intracerebral, intraabdominal), cardiac failure
In the quadruple test for down screening what results would predict an increased risk?
AFP and oestriol decreased
B-HCG and inhibin A increased
What are the SSRIs of choice in breast feeding women?
Sertraline and paroxetine
Is aspirin okay to continue during breastfeeding?
No aspirin must be avoided in breastfeeding
If a pregnant woman is found to be group b strep positive what can be done to reduce risk to baby?
Intrapartum IV benzylpenicillin
How long should methotrexate be stopped for before conception? Do men need to stop taking methotrexate?
Both men and women should stop taking methotrexate for 6 months before conception
A score of what on the Edinburgh postnatal depression scale suggested a depressive illness?
Over 13
When should women with any risk factor other than previous gestational diabetes be tested with OGTT?
24-28 weeks
What prophylaxis should be offered to pregnant women who had a previous baby develop GBS infection after being born?
IV benzylpenicillin for the mother during labour
what are risk factors for placental abruption?
multiparity, increased maternal age, maternal trauma, pre-eclampsia
what are some concerning features of lochia that would require further investigation?
volume increases, starts to smell bad, doesnt stop (usually lasts around 2weeks)
what are the risk factors for placental abruption (ABRUPTION mneumonic)?
A- abruption previously
B- blood pressure (high)
R- rupture of membranes
U- uterine injury
P- polyhydramnios
T- twins/multiple pregnancy
I- infection
O- older age
N- narcotic use
