O&G Flashcards
What are the risks of HRT?
- Increased risk of breast cancer (especially in combined - although reaches pop’n average 5 years after stopping)
- Increased risk of endometrial cancer (especially in oestrogen only and eliminated by giving progesterone continuously)
- increased risk of VTE/stroke
When should women be offered an oral glucose tolerance test for gestational diabetes?
- ASAP after booking for women with prev Gestational diabetes
- at 24-28 weeks for women with risk factors
What are 5 RF for gestational diabetes?
1 BMI of > 30 kg/m²
2 previous macrosomic baby weighing 4.5 kg or above
3 previous gestational diabetes
4 first-degree relative with diabetes
5 family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)
What test results would indicate presence of gestational diabetes?
fasting glucose is >= 5.6 mmol/L
2-hour glucose is >= 7.8 mmol/L
How is gestational diabetes managed?
- fasting PG < 7 then trial of diet and exercise
- if targets not met in 2 weeks then start metformin
- if targets still not met OR FPG> 7 on test then add short acting insulin
How is pre-existing diabetes managed for pregnant women?
- weight loss for women with BMI > 27
- stop oral hypoglycaemic agents, apart from metformin
- commence insulin
- folic acid 5 mg/day from pre-conception to 12 weeks gestation
- detailed anomaly scan at 20 weeks including four-chamber view of the heart and outflow tracts
- tight glycaemic control reduces complication rates
- treat retinopathy as can worsen during pregnancy
When does obstetric cholestasis typically present?
3rd trimester
How is obstetric cholestasis managed?
Ursodeoxycholic acid (symptom relief)
+ water soluble vit K if PTT deranged
+ weekly LFT checks
Delivery at 37 weeks!!
What are the risks to the mother of having a baby whilst obese (BMI>30) ? (5)
1 miscarriage
2 venous thromboembolism
3 gestational diabetes
4 pre-eclampsia
5 more likely to need C section
What are the risks to a baby of having an obese mother? (BMI>30) (5)
1 congenital anomaly
2 prematurity
3 macrosomia
4 stillbirth
5 increased risk of developing obesity and metabolic disorders in childhood
What advice can you give to obese women during pregnancy? (BMI>30)
1 - should inform them of increased risk to themself and baby and offer advice on weight loss
2 - obese women should take 5mg of folic acid, rather than 400mcg
3 - all obese women should be screened for gestational diabetes with an oral glucose tolerance test (OGTT) at 24-28 weeks
Give 4 risk factors for placental abruption
1 cocaine use
2 multiparity
3 maternal trauma
4 increasing maternal age
What clinical features would someone show with placental abruption? (3)
1 shock out of keeping with visible loss
2 pain constant
3 tender, tense uterus
How is placental abruption managed?
If fetal distress -> CAT 1 C SECTION
How is placental abruption managed?
If fetal distress -> CAT 1 C SECTION
<36 wks + no fetal distress = observe + steroids + plan delivery
>36 wks + no fetal distress = vaginal delivery
What is placental abruption?
separation of placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space
What are risk factors for placenta praevia?
- multiparity
- multiple pregnancy
- previous caesarean section
What clinical features would someone have with placenta praevia?
PAINLESS bleeding
How would you manage someone with suspected placenta praevia?
DON’T DO PV EXAM
- transvaginal USS
Give 4 causes of PPH
Tone (uterine atony)
Trauma (perineal tear)
Thrombin (clotting disorder)
Tissue (retained placenta)
How is PPH managed?
- ABC
- 2 peripheral 14 gauge cannulas
- warmed crystalloid infusion - Mechanical
- catheter and manual rub of uterus - Medical
- IV oxytocin/ ergometrine/ carboprost - Surgical
- intrauterine balloon tamponade
What are RF for PPH? (4)
1 prev PPH
2 antepartum haemorrhage
3 induction of labour
4 C section
What is the Bishop score used for?
to help assess whether induction of labour will be required
What are the possible methods of induction of labour?
Bishop score is ≤ 6
- vaginal prostaglandins or oral misoprostol
(mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean)
Bishop score > 6
- amniotomy and an intravenous oxytocin infusion
How would you manage a miscarriage first line?
Expectant management
- wait 7-14 days
- safety net and give info what to expect
- if bleeding and pain stopped by 14 days then advise preg test in 3 weeks
What is pre-eclampsia?
Classically new-onset blood pressure ≥ 140/90 AFTER 20 weeks of pregnancy
AND 1 or more of the following:
- proteinuria
- other organ involvement e.g. renal insufficiency, liver, neurological, haematological, uteroplacental dysfunction
What are 3 complications of pre-eclampsia?
- eclampsia
- IUGR
- HELLP
What is the management for patients at risk of pre-eclampsia?
aspirin 75-150mg daily from 12 weeks gestation until the birth
Give 2 moderate and 2 high risk factors for pre-eclampsia and what criteria would warrant prophylactic treatment
1+ high or 2+ mod
High
- diabetes
- CKD
-current HTN/ HTN in a previous pregnancy
- autoimmune disease, such as systemic lupus erythematosus or antiphospholipid syndrome
Moderate
- first pregnancy
- age 40 years or older
- pregnancy interval of more than 10 years
- BMI of 35
- family history of pre-eclampsia
- multiple pregnancy
What is the management for patients WITH pre-eclampsia?
- emergency secondary care referral
- oral labetalol/nifedipine
- delivery of baby is ultimate treatment
