GOSH 4 Flashcards
What is the most common single chromosomal abnormality causing miscarriage?
45X
When would you refer a woman to EPAU:
a) <6 weeks gestation
b) >6 weeks gestation
a) Bleeding AND pain
b) Bleeding
In a uterine pregnancy, how will the hCG change?
How does this differ for an ectopic or miscarriage?
Uterine –> hCG will DOUBLE every 48h
Ectopic/miscarriage –> will not be the case:
- fall in hCG >50% –> miscarriage
- fall 50% –> ectopic
What vitamin may need to replaced in hyperemesis gravidarum?
Thiamine (B1)
At what mean gestational sac diameter is a foetal pole expected?
≥25mm
At what foetal pole/crown rump length is a foetal heartbeat expected?
≥7mm
What are 3 key features in early pregnancy that appear sequentially on a transvaginal US (i.e. as each appears, the previous becomes less relevant in assessing viability of pregnancy)?
1) Mean gestational sac diameter
2) Foetal pole and crown-rump length
3) Foetal heartbeat
How can a molar pregnancy lead to thyrotoxicosis?
As hCG can mimic TSH
What US characteristic appearance can be seen in a molar pregnancy?
‘Snowstorm’ appearance
When should Rhesus negative women having an abortion have anti-D prophylaxis?
1) ALL surgical abortions
2) Medical abortion if >10w gestation
What PUQE score indicates SEVERE hyperemesis gravidarum?
> 12
How is an abortion confirmed as complete?
Urine pregnancy test 3 weeks later
What is the latest gestational age that an abortion can be carried out?
24 weeks
When there is a crown-rump length of 7mm or more, without a fetal heartbeat, when is the pregnancy diagnosed as non-viable?
The scan is repeated after one week before confirming a non-viable pregnancy.
Note - can have a pregnancy of unknown viability where size may be 7mm but too small to see foetal heartbeat yet.
But if >7mm with no heartbeat, this is diagnostic of loss of pregnancy.
Why should products of conception be removed in a miscarriage?
Retained products of conception can result in cervical shock due to vagal stimulation (bradycardia & hypotension).
How many weeks gestation must women be to undergo manual vacuum aspiration (abortion)?
Must be below 10 weeks gestation
When is the combined test offered?
11 to 13+6
What is 1st line DMARD for RA in pregnancy?
Hydroxychloroquine
When can you fly up until in a single pregnancy?
37 weeks
When can you fly up until in a twin pregnancy?
32 weeks
Mx of gestational diabetes if fasting glucose ≥6mmol/l + macrosomia?
Insulin +/- metformin
When should anti-D be given in a sensitisation event?
Within 72 hours
When should those with previous gestational diabetes be screened?
1) Women with previous gestational diabetes should have OGTT soon after booking clinic
2) 2nd test at 24-28 weeks if the first test is normal.
What can be suggested as an alternative for women who decline insulin or cannot tolerate metformin in pregnancy?
Glibenclamide (a sulfonylurea)
Anti-D injections are given routinely on what two occasions?
1) 28 weeks gestation
2) Birth (if baby found to be rhesus +ve)
What are 3 classes of HTN drugs that can cause congenital abnormalities?
1) ARBs
2) ACEi
3) Thiazide like diuretics e.g. indapamide
Is GDM managed with short or long acting insulin?
Short acting
When is the Kleinhauer test performed?
In women >20 weeks gestation who are rhesus -ve.
Performed after any sensitisation event.
When should women with grade III/IV be offered a c-section?
37-38 weeks
COCP and BMI?
BMI 30-34 –> UKMEC 2
BMI ≥35 –> UKMEC 3
Features of a ‘missed’ miscarriage?
- a gestational sac which contains a dead fetus before 20 weeks without the symptoms of expulsion
- mother may have light vaginal bleeding / discharge and the symptoms of pregnancy which disappear. Pain is not usually a feature
- cervical os is CLOSED
N.B when the gestational sac is > 25 mm and no embryonic/fetal part can be seen it is sometimes described as a ‘blighted ovum’ or ‘anembryonic pregnancy’
When can you attempt ECV for transverse lie in labour?
If the amniotic sac has not rupture AND the patient is not in active labour (i.e. cervical dilation is <3cm).
What is 1st line for treating magnesium sulphated induced respiratory depression?
Calcium gluconate
What procedure carries a high risk of haemorrhage of the newborn in cases of ITP?
Prolonged ventouse delivery
What is the mechanism of action of metformin in PCOS?
Increases peripheral insulin sensitivity
Next step in a suspected PE in the presence of a CONFIRMED DVT?
Start LMWH therapeutic dose 1st.
Which steroid is used in prematurity?
Dexamethasone
what should be corrected before starting bisphosphonates?
Vit D & calcium deficiencies
What is the gold standard investigation for mycoplasma genitalium?
NAATs
Stepwise mx of PPH caused by uterine atony?
1) Catheterise, left lateral position & rub fundus of uterus (attempting to stimulate contraction)
2) Pharmacological: IV oxytocin, carboprost (careful in asthma), ergometrine (careful in HTN)
3) Surgical: intrauterine balloon tamponade
Mx of Factor V Leiden in pregnancy?
LMWH antenatally + 6 weeks postpartum
What is the the most effective method of contraception available?
Implant
When should women wait until post-partum for a smear?
12 weeks postpartum
1st line mx of 1ary dysmenorrhoea?
NSAIDs such as mefenamic acid
What normally happens to blood pressure during pregnancy?
Fall in first half of pregnancy, before rising to pre-pregnancy levels before term.
During pregnancy, when is the 2nd screen for anaemia and atypical auto red cell antibodies?
28 weeks
What 3 medications are associated with an increased risk of miscarriage?
1) Ibuprofen
2) Methotrexate
3) Retinoids
Role of the Kleihauer test?
Detects fetal cells in the maternal circulation which can estimates the volume of foetomaternal haemorrhage to allow calculation of additional anti-D immunoglobulin.
It is required for any sensitising event after 20 weeks gestation.
Mx of non-reassuring CTG findings (which are persistent in nature)?
Prepare for a category 2 c-section.
Delivery of baby should occur within 75 minutes
1st line mx of postnatal depression?
CBT (can offer SSRI if symptoms are severe, or have history of severe depression).
What is an intrauterine balloon tamponade also known as?
Intrauterine Bakri catheter
What type of organism is GBS (S. aglactiae)?
Gram-positive coccus (round-shaped bacterium)
What is adenomyosis?
The presence of endometrial tissue within the myometrium.
Who is adenomyosis more common in?
Multiparous women towards the end of their reproductive years.
Features of adenomyosis?
- dysmenorrhoea
- menorrhagia
- enlarged, boggy uterus
1st line investigation in adenomyosis?
TV US
Stepwise mx of PMS?
1) Mild –> lifestyle
2) Mod –> COCP
3) Severe –> SSRI
How can ACEi and ARBs during pregnancy affect amniotic fluid?
Can cause renal dysgenesis –> oligohydramnios due to reduced production of urine.
2 key side effects of ACEi during pregnancy?
1) Renal dysgenesis
2) Hypocalvaria (incomplete formation of skull bones)
What is a key side effect of ergometrine?
Coronary artery spasm
3 adverse effects of beta blockers during pregnancy?
1) Neonatal hypoglycaemia
2) Neonatal bradycardia
3) Foetal growth restriction
What can co-amoxiclav during pregnancy lead to?
Increased risk of NEC
How do NSAIDs impact other antihypertensives?
Reduce the therapeutic effects of other antihypertensives.
Abx management of chorioamnionitis?
Cefuroxime + metronidazole
Delivery