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GOSH > High risk pregnancies > Flashcards

High risk pregnancies Flashcards

1
Q

What problems during gestation can make the pregnancy high risk?

A
  • Multiple pregnancy
  • SGA/IUGR
  • Placenta praevia
  • Gestational diabetes
  • Pre-eclampsia
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2
Q

What problems during labour can make the pregnancy high risk?

A
  • Meconium/blood stained liquor
  • Lack of progress
  • Need for Oxytocin infusion
  • Worrying features on CTG
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3
Q

What previous obstetric conditions can make the pregnancy high risk?

A
  • C-Section
  • Preterm delivery
  • Recurrent miscarriage
  • Stillbirth
  • 3rd degree tear
  • Prev gestational diabetes
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4
Q

What maternal conditions can make the pregnancy high risk?

A
  • DM
  • VTE
  • Obesity
  • Infections
  • Chronic disease (renal, autoimmune)
  • Hypertension
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5
Q

What social factors can make the pregnancy high risk?

A
  • Teenage pregnancy
  • Maternal age >40
  • Poor socioeconomic conditions
  • High parity/low inter pregnancy interval
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6
Q

What causes perinatal mortality?

A

Placental problems/fetal growth restriction: Diabetes, pre-eclampsia & obesity increase the risk of placental issues
Infection: Group B Strep, E.Coli, Chlamydia
Prematurity
Congenital abnormalities

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7
Q

What are the risks associated with multiple pregnancy?

A
  • Prematurity
  • Congenital abnormalities
  • Cardiac, bowel atresia, neural tube defects
  • Intrauterine death
  • Fetal growth restriction
  • Twin-twin transfusion syndrome
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8
Q

In what type of pregnancy is twin-twin transfusion syndrome seen?

A

Monochorionic pregnancies

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9
Q

What are the maternal complications of a multiple pregnancy?

A

1) Hyperemesis gravidarum
2) Anaemia
3) Miscarriage
4) Preterm labour & delivery
5) Gestational diabetes
6) Pre-eclampsia
7) Antepartum/postpartum haemorrhage
8) Postnatal depression

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10
Q

Which high risk pregnancies should be prescribed a higher dose of Folic acid? How much?

A

Twins & Diabetics

5mg

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11
Q

What are the 3 different ways twins can line in utero?

A

Dichorionic diamniotic
Monochorionic diamniotc
Monochorionic monoamniotic

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12
Q

What signs can be seen on twin USS?

A

T sign: Only one placenta

𝛌 sign: 2 placentas/ 1 egg has split very early (identical twins)

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13
Q

What are the causes of maternal mortality?

A 
Thrombosis-LEADING CAUSE
Eclampsia	
Sepsis
Cardiac-largest single cause of indirect maternal deaths
 Psychiatric
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14
Q

You are working as a junior doctor on the delivery suite. A midwife alerts you that a 37-year-old female is having a postpartum haemorrhage (PPH) after delivering her baby four hours ago. You perform an ABCDE assessment, contact a senior for help and start appropriate management. What is the most likely cause of this patient’s postpartum haemorrhage?

A

Uterine Atony most common cause of postpartum haemorrhage

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15
Q

What are the main causes of postpartum haemorrhage?

A

Tone (uterine atony, distended bladder)
Trauma (lacerations of uterus, cervix, vagina)
Tissue (retained placenta or clots)
Thrombin (pre-existing or acquire coagulopathy)

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16
Q

When can IM steroids be given?

A

Birth within 7 days at 24-36weeks

2doses of Betamethasone 12mg IM 24hours apart

17
Q

In what condition does IM steroids need to be noted in particular?

A

Diabetes
Not a contraindication
Insulin therapy needs adjusting accordingly

18
Q

What factors are more likely to cause PTSD after birth?

A 
Long and painful labour
Assisted birth with ventouse or forceps
Emergency c-section
Baby was born with a disability
Baby spent time in special care
You feared for your, or your baby's life or health, during or after the birth.
Helplessness during birth
Traumatic event in your past
19
Q

How is a late miscarriage defined?

A

Loss between 14-24weeks

20
Q

What causes a mid-trimester loss?

A 
Chromosomal abnormalities
Structural defects
Genetic abnormalities
Antiphospholipid syndrome
Infection
21
Q

What infections can cause mid-trimester loss?

A

Parvovirus
Cytomegalovirus
Toxoplasmosis
Bacterial vaginosis

22
Q

What are the predisposing factors for malpresentation?

A 
Prematurity
Multiple pregnancy
Abnormalities of the uterus - fibroids
Partial septate uterus
Abnormal fetus
Placenta praevia
Primiparity
23
Q

What is the most common malpresentation?

A

Breech

24
Q

What is the most common malposition?

A

Occipito-posterior

25
Q

What is the difference between malpresentation & malposition?

A

Presentation: Baby fully in the wrong position
Position: Baby’s head in the wrong position

26
Q

What is the difference in constituents between dizygotic & monozygotic pregnancies?

A

D: Own placenta (separate or fused), amnion, chorion
M: Depends on division of the ovum-
Split at 3days: 2chorion & 2 amnion
Split at 4-7days: 1 placenta, 1chorion, 2 amnion
Split at 8-12days: 1 placenta, 1chorion, 1amnion RARE

27
Q

What ‘chorion’ can triplet pregnancies be?

A

Monochorionic
Dichorionic
Trichorionic

28
Q

What should expectant multiple pregnancy mothers be warned about at booking?

A

Higher likelihood of positive screening result and therefore invasive treatment

29
Q

When should the first USS scan be offered in multiple pregnancy? Why?

A

11-13weeks

  • Estimate gestational age
  • Determine chronicity (no. of placental masses, lambda/T sign, membrane thickness)
  • Screen for Down’s
30
Q

What is antepartum haemorrhage?

A

Vaginal bleeding from 24-40weeks

31
Q

What are the causes of APH?

A

Obstetric: PP, abruption, vasa praevia, uterine rupture (IOL related), fetal vessel rupture, bloody show
Non-obstetric: Cervical, medical conditions, vaginal/vulval

32
Q

What are the signs & symptoms of APH?

A

Bleeding: Clots= larger bleed, bright red- PP, darker/brown- abruption
Pain: PP- no pain, abruption pain

33
Q

What are the risk factors for APH?

A

Hypertension

PP

34
Q

What are the investigations for APH?

A

Bloods: Cross match, FBC, Clotting, Rhesus test
USS
CTG & doppler

35
Q

How is APH managed?

A

Large bleed: Resus, Left lateral position, consider delivery

36
Q

In APH which conditions are/aren’t associated with pain?

A

Are: Rupture, abruption, bloody show (related to labour)

Aren’t: PP, Vasa praevia,

GOSH (17 decks)

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