O&G Flashcards
Twin pregnancy - Increased risks
Prior to pregnancy
- Fam hx twins
- Fertility treatment
Pregnancy risk
- Preterm labour
- preeclampsia
- anaemia
- discordant growth/small for gestational age
- fetal anomalies
- TTTS (twin to twin transfusion, acute polyhydraminos)
- perinatal mortality
Delivery problems
- C-seciton
- PPH
- malpresentation
- cord prolapse
Reduced in fetal movements
DDx
Baby -IUD, fetal sleep cycle
Placenta -hypoxia (placental insufficiency)
Mother (increase BMI, polyhydraminos, busy) Sedation
Risk factors for this
- Placental (abruption, preeclampsia)
- SGA
- Medical conditions (diabetes)
- Congenital anomalies/genetics
- smoking/alcohol/drugs
- age
- high BMI
- prior obs hx
Exam/Inv
Fetus -Fetal heart, CTG
-US (growth, liquor, foetal dopler)
Mother - Vitals, cardio, resp, abdo exam
-Uterine size, foetal lie, presentation, liqour volume
-Cervical score/delivery?
IUGR
DDx
- incorrect dates
- IUGR
- oligohydraminos
- Transverse lie
Risk Factors IUGR
Mother
- HTN
- Smoking, drugs, alcohol
- poor nutrition, poor weight gain
- anemia
- diabetes
- CVD, renal disease, HTN
- Prev IUGR
Placental
- preeclampsia
- multiple gestation
- uterine malformation
- placental insufficiency
FEtal
- chromosomal or congenital abnormalities
- infection
Examination
- BMI
- BP
- Abdo palpation (fundal height, lie, presentation, liquor, heart)
- urinalysis (proteinuira)
Inv
- CTG
- US
- fetal heart activity, foetal paramteres, liquor volume, doppler
- Cusomised growth chart
Post partum haemorrhage
DDx - tone, tissue, trauma, thrombus
-retained products of gestation, coagulation defect, genital tract injury, uterine atony
Exam
- uterine tone, fundus height
- signs of separation of placementa
- genital tract injury
Resus
- O2
- 2 large bore cannula
- FBC, U+E, Coag, group and hold, cross match
- IV fluid, transfusion protocol
Management
- oxytocin or ergometrine or misoprosol
- tranexamic acid
- Operating theater - removal, balloon, embolization, hysterectomy
Rupture of membranes
DDx
- ruptured membranes
- vaginal infection
- urine leak
Exam
- temp, pulse
- obstetric (fundal height, lie, presentation, liquor, fetal heart)
- Speculum - liquor, meconium, blood, cervical dilatation
Inv -swab - pH -swabs- chlamydia, gonorrhooea, GBS, BV -CTG MSU, FBC, CRP
Management
- Mode of birth
- IOL?
- antibiotic
Management at 29 weeks
- admit
- diagnose, treat infection (PO erythromycin)
- steroids
- tocolysis
- delivery if - chorioamnionitis or foetal distress
Large for gestational age
DDx
- wrong dates
- LGA
- Polyhydraminos
- Multiple births
- abdominal mass
Pre eclampsia
Symptoms - headache, visual disturbance, epigastric pain, oedema, fms, increased reflexes, clonus
-associated w preterm birth and fetal growth restriction
RF for PET
- fam hx
- obesity
- medical conditions
- elevated BP previously
- diabetes
Exam
- BP
- fundal height
- Urine dipstick - proteinuria
Inv
-Urine - PCr ratio, MSU
Bloods -FBC, U+E, LFTs, uric acid
-US (growth, liquor volume, umbilical artery doopler)
Mangement
- In patient
- foetal and maternal monitoring
- BP mangement
- Consider steroids (early delivery)
- Factors contributing to timing of delivery
Magensium sulphate - treatment for neurological symptoms and secondary prevention of eclampsia
Meds - methyldopa, labetaolol, nifetdipine
calcium supplements
High risk women - start aspirin for preeclampsia
Obesity
RF for obesity mother -HTN, preeclampsia -diabetes -caesarean section fetus -congeintal abnormalies, sga, stillbirth, lga, shoulder dystocia, childhood obestiy
Diabetes increased risk
-preeclampsia, HTN, PPH, infection
Fetus -fetal distress, stillbirth, shoulder dystocia, macrosimia, neonatal hypoglycaemia
Antepartum haemorhage
DDx
- placental abruption
- placental previa
- placental edge bleed/undetermined
- Lower genital tract (cervical polyp, ectrpion, genetial infection, cervical carcinoma)
- vasa previa
- uterine rupture
RF - aburption
- Prev abruption
- preeclampsia, hypternsion
- abdo trauma
- thrombophilia
- high parity
- smoking, cocaine use
- multiple pregancies
- polyhydraminos
- advanced maternal age
