General obstetrics Flashcards
Risks of crack cocaine use in pregnancy?
- placental abruption - inc risk of prematurity/perinatal death
- IUGR - arterial vasoconstriction
Risks of heroin use in pregnancy?
IUGR
premature delivery
Risks of tobacco use in pregnancy?
- fetal growth restriction
- low birth weight
- respiratory disease from passive smoking
What test is used to detect Down’s syndrome if too late for nuchal translucency?
triple test (serum)
- AFP (decreased)
- oestriol (increased)
- beta-HCG (increased)
What is increased AFP associated with?
fetal abnormality
- neural tube defects
- anterior abdominal wall defects
- Patau’s syndrome
also pregnancy complications
- multiple pregnancy
- fetal IUGR
- oligohydramnios
Define the diagnosis of gestational diabetes?
based on 2h glucose conc > 11.1mmol/L
diagnosis may also be made if fasting blood glucose >7.8mmol/L
Risk factors for GDM?
- obesity
- previous GDM
- FH of diabetes
- women with previously large babies or stillbirth
- increasing maternal age
during pregnancy:
- glycosuria
- large for dates baby
- polyhydramnios
Effects of GDM on fetus
- fetal macrosomia
- polyhydramnios
- neonatal hypoglycaemia
- neonatal RDS
- increased stillbirth rate
Effects of GDM on mother
- increased risk of traumatic delivery e.g. shoulder dystosia
- increased Caesarean section risk
- increased risk of developing GDM in subsequent pregnancies
- 50% increased risk of developing T2DM within 15 years
What problems can maternal anaemia cause for the fetus in utero?
- low birth weight
- neonatal anaemia
- cognitive impairment
What are the implications of anaemia in pregnancy for the mother?
Both antenatal and peripartum
antenatal
- fatigue
- fainting
- dizziness
peripartum
- increased risk of haemodynamic compromise
- increased likelihood of transfusion
Managment for anaemia in pregnancy?
- ferrous sulphate 200mg bd (can go up to tds if tolerated)
- iron suspension or IM iron if not tolerated
- encourage iron-rich diet
- consider blood transfusion if not possible to increase haemoglobin level by supplementation
Which babies are at particular risk of group B strep infection?
- previous pregnancy affected by GBS
- GBS in vagina or urine at any stage during current pregnancy
- preterm delivery
- PROM
- pyrexia in labour
give IV penicillin to mother in labour
Management of a neonate at risk of group B strep infection?
- observation of baby for up to 5 days post partum fo rsigns of sepsis
- consideration of culture of baby from ear, nose, axilla for evidence of infection
- IV abx until culture results confirm no evidence of infection
What is the most common cause of serious bacterial infection in UK infants?
Mortality?
Group B strep
10%
What things do you monitor in twin pregnancies?
- regular FBC
- close BP and urinalysis monitoring
- fetal growth surveillance from 28 weeks
- screening for gestational diabetes
Management of twin pregnancy in antenatal care?
- info regarding inc maternal and fetal risks
- regular hospital antenatal assessment from late 2nd tri
- ferrous sulphate and folic acid supplementation
- discussion of mode of delivery - depends on growth and presentation of twins at 36w
- hospital delivery by 40w
- introduce to multiple pregnancy support groups
Common causes of APH at term?
- blood-stained show
- bleeding placenta praevia
- placental abruption
- cervical ectropion
- infection e.g. candida
- vasa praevia
Causes and associations for breech presentation?
- grand multiparity
- uterine abnormality (bicornuate, septate, fibroids)
- placenta praevia
- polyhydramnios
- oligohydramnios
- multiple pregnancy
- congenital fetal abnormality
- prematurity
What is the specific test for syphilis infection?
T. pallidum EIA
Symptoms of post-partum blues?
- tearfulness
- fatigue
- anxiety over own/baby’s health
- feelings of inability to cope
Common, presenting after 3rd day postnatally and resolves spontaneously after a few days
Symptoms of post-partum depression?
- low mood
- crying
- anxiety over baby’s health
- feelings of guilt towards baby
- panic attacks
- excessive tiredness
- poor appetite
Occurs in 10% of women any time up to 6m following delivery
What is the commonest cause of indirect maternal death (aka not during or straight after delivery)?
suicide
How do we reduce the risk of mother-to-baby HIV transmission during and post pregnancy?
- elective C section (if high viral load)
- avoid breast feeding
- IV zidovudine to mother prior to delivery (ideally 4h)
- oral zidovudine to neonate for 6h postnatally
