O&G: Just Obstetric viva questions Flashcards
Pre-eclampsia: management?
Antenatal:
- Keep inpatient due to risk of abruption
- Check BP every 4 hours
- Urinalysis
- Check bloods twice weekly
Intrapartum:
- CTG
- IV labetolol (Or hydralazine)
- Methyl-dopa
- IV bolus of colloid to avoid drop in BP
Post-natal:
- Discontinue Methyl-dopa
- Monitor BP regularly in the community
- Atenolol if BP is consistently raised
Pre-eclampsia: Complications?
//Maternal Complications
- Eclampsia
- HELLP syndrome (Haemolysis, elevated Liver enzymes, Low platelets)
- Maternal cerebral haemorrhage
- (Others) renal failure, placental abruption
//Fetal complications
- IUGR
- IUD
Gestational diabetes: Management?
- Primciples of management
- //(Antenatal)
- Counsel on diet and exercise. Ask the patient to record blood glucose daily. Aim for fasting glucose of <5.2mmol/L
- Advice on lifelong risk of Diabetes
- Monitor glucose and fetal growth, regular clinic attendance
- After 1-2 weeks of diet and exercise, consider giving hypoglycaemics such as metformin. Or insulin (eg novorapid)
- //(Intrapartum)
- Consider C-section if the estimated fetal weight is high.
- //(Post-partum)
- Check fasting glucose 6 weeks post partum -Follow up with annual screening.
Gestational diabetes: Complications?
- //(Maternal risk)
- None really: iatrogenic hypoglycaemia, possibly
- //(Fetal risk)
- Fetal macrosomia, need for C-section
Premature labour: Management?
(Aka Preterm labour. before 37 weeks onset of uterine contractions)
- Antenatal management:
- Treat the underlying cause if applicable (eg pyelonephritis). Seek cause.
- Rule out PROM (With speculum and fetal fibronectin)
- Check fbc, crp, hvs, msu to investigate cause
- Give Corticosteroids: (Betamethasone). Lowers mortality in infants. Helps with lung development
- Tocolytic drugs: to reduce the number of contractions. Nifedipine is associated with better fetal outcomes.
- Continue monitoring in case of spontaneous cessation of contractions
- Intrapartum mangement:
- Give IV antibiotics, if GBS is present, to prevent GBS transmission. (GBS associated with premature labour)
- Post-natal management:
- Call neonatology to assess the baby at birth for complications
Preterm labour: Complications?
(Aka Preterm labour. before 37 weeks onset of uterine contractions)
Maternal complications:
-Infection is associated. so consider complications of infection.
Fetal complications:
- Long term morbidity (eg chronic lung disease)
- Increased of perinatal mortality
- Increased risk of GBS transmission
PROM (Prelabour rupture of membranes, at term): Management?
Principles:
- Expectant management: Await spontaneous labour for 24 hours
- Induce after 24 hours
- If infection occurs, induce straight away
Antenatal:
- Admit for 24 hours, in case spontaneous labour commences (60%)
- If spontaneous labour doesn’t occur after 24 hours, induce
- Evidence of chorioamnionitis/ HIV +ve/ GBS/ etc, induce labour regardless (Don’t wait 24h)
- Take Temp, MSU, HVSwab and blood cultures, to investigate infection
Intrapartum:
-If there are signs of infection, give IV broad spectrum antibiotics
Post-partum
-Refer to neonatology to assess infection risk in neonate
PROM (Prelabour rupture of membranes, at term): Complications?
Maternal complications:
-Ascending infection from chorioamnionitis
Fetal complications:
- Infection
- Increased risk of NND
PPROM (Preterm and prelabour rupture of membranes, before 37 weeks): Management?
Principles:
- Expectant management: await spontaneous labour
- If infection occurs, expedite labour.
- Mitigate risk to mother and baby
Antenatal:
Short-term:
- Admit for 48 hours, due to greatest risk of spontaneous pre-term labour
- Prophylactic PO erythromycin for 10 days
- Give corticosteroids (eg betamethasone) for fetal lung maturity
- Rule out chorioamnionitis and sepsis
- Take Temp, MSU and a HVSwab to investigate infection
- Evidence of chorioamnionitis, induce labour early (expedite delivery).
Long term:
- After 48 hours, if preterm labour doesn’t occur, discharge and manage as out-patient, with weekly follow up in the day assessmment unit.
- Advise on avoiding risk factors for infection: swimming, intercourse, tampons
- If infection occurs at any point, give IV antibiotics and expedite labour.
- If no infection occurs, await spontaneous labour
Post-Natal:
-Refer neonate to neonatology for assessment of infection
PPROM (Preterm and prelabour rupture of membranes, before 37 weeks): Complications?
Maternal complications:
-Ascending infection from chorioamnionitis
Fetal complications:
- Prematurity
- Infection
- Pulmonary hypoplasia
- Limb contractures
- Increased risk of NND
Post-term pregnancy (Post 42 weeks, postmaturity): Management?
Antental:
- Confirm EDD and arrange a visit at 41 weeks.
- Membrane sweep, for spontaneous labour
- Induction with prostaglandins followed by oxytocin
- If induction is refused, twice weekly CTGs
Intrapartum:
-Monitor fetus with a CTG, during labour
Post-partum:
-Refer neonate to neonatology for assessment
Post-term pregnancy (Post 42 weeks, postmaturity): Complications?
Maternal:
-None of note
Fetal:
- Increased risk of Intrapartum deaths (4-fold more common)
- Increased risk of early neonatal death (3-fold more common)
- Placental insufficiency
Illegal drug use in pregnancy: Management?
Antenatal:
- Advise on high risk pregnancy
- Safeguard, refer to counselling, gain trust. Team approach.
- Monitor for fetal growth
Intrapartum:
-CTG during labour
Post-Partum:
-Refer to neonatology for management of respiratory depression and withdrawal
Illegal Drug Use in pregnancy: Risks?
Fetal Risks:
- Cocaine: Associated with placental abruption
- Heroin: IGR
- Tobacco: tobacco, IGR, risk of respiratory disease
- Cannabis: None, but associated with tobacco
Main causes of an increased nuchal translucency?
- Down’s syndrome
- Congenital heart defects
- Abdominal wall defects
