Obs Flashcards
What assessments should you always do at every antenatal appointment?
General maternal well-being BP Urinalysis Fetal movements FHR (USS or doppler) Measure and plot SFH
RF for ectopic pregnancy
IUD Previous ectopic Woman with tubal defects Previous PID IVF Older maternal age
Symptoms of ruptured ectopic
Lower abdo/pelvic pain - sudden onset, sharp, severe pain
Small amount of PV bleed
6-8 w amennorhea
Abdo tenderness + mass
Cervical motion tenderness (but shouldn’t examine!)
Shoulder tip pain
Peritonitis
Shock/haemodynamic instability
Investigations for suspected ectopic
Pregnancy test
TVUSS (location, FHR)
- Mass
- Free fluid in pouch of Douglas
Serum hCG and repeated 48 hours after (in normal pregnancy bCHG should double in 48h, rise of >66% indicates not ectopic) ?
What factors would allow expectant management of unruptured ectopic?
<35mm
No fetal Hb
bHCG <1000
No pain
What is medical management of ectopic and when should you use it?
IM Methotrexate (stops cell division of fetus) (SE: photosensitivity, pregnancy issues). Requires follow up. Then measure hCG.
Stable patient <35mm No significant pain No fetal Hb <1500 bHCG
What other investigation do you need to do for a woman with ectopic?
Rhesus status - give anti-D if negative
First investigation in first trimester bleed?
Pregnancy test - check if complete miscarriage
2nd line investigation in first trimester bleeding? and what do results mean?
TV/TAUSS –>
Empty uterus = pregnancy of unknown location (ectopic, early, miscarriage).
(if early, bHCG should double in 48h, if ectopic <66% rise, miscarriage reduce)
Intrauterine pregnancy correct size –> OS open = inevitable miscarriage, OS closed = reassure (threatened miscarriage)
Investigation for suspected molar pregnancy and findings?
Pregnancy test
TV USS –> ‘snowstorm’ appearance
Sx of molar pregnancy
Vomiting (caused by high levels of bHCG) PV bleeding (spotting/heavy) Other normal pregnancy changes
How does a partial molar pregnancy form?
Two sperm fuse with egg cell
How does a complete molar pregnancy form?
A sperm cell fertilise an ‘empty’ ovum (has no genetic material). So only trophoblastic tissue forms.
Management of molar pregnancy
Surgical evacutation –> suction curettage
What can a molar pregnancy turn into?
Choriocarcinoma (rare malignant tumour of trophoblastic cells)
(Check to see if hCG still increasing)
Presentation of threatened miscarriage (Sx and USS findings)
Painless PV bleeding and closed cervical OS
Ectopic pregnancy: If fetal heartbeat is present, what type of management must be used?
Surgical
Date of booking scan
10 weeks
Date of dating scan
10-13+6 weeks
Date of anomaly scan
18-20 weeks
Bloods at booking scan?
Anaemia Rhesus status Sickle cell Thalassaemia Infectious diseases --> HIV, Hep B, syphillis, rubella GD if RFs
Non routine: Hep C
Treatment for high resk of pre-eclampsia and when?
150mg Aspirin OD from 12 weeks –> delivery
Treatment for baby if mother is hep B positive?
(High chance of infection)
6 weeks post birth - give hep B vaccinations.
RF for chromosomal abnormalities
Older maternal age
FHx
Consanguinity