Obs Flashcards
What is hyperemesis gravidarum
Severe or persistent vomiting in pregnancy
How many women are affected by hyperemesis gravidarum
2% of pregnancies
Syx of hyperemesis gravidarum
Starts between 4-7 weeks - often resolves by 16wks
N+V any time in the day - may be constant
Fluid and electrolyte disturbance
Ketonuria
Nutritional deficiency + weight loss
What makes n+v more common in pregnancy
Primigravidae
Multiple pregnancy
Hx of past hyperemesis gravidarum
Younger maternal age
DDX of hyperemesis gravidarum
Hydatiform mole Pre-eclampsia GI infection, irritation, ulcer, appendicitis etc Torted ovarian cyst drug SE Raised ICP diabetes Bulimia nervosa
Management of vomiting in pregnancy
Ginger Wrist acupressure Rest Eat small regular meals High carbohydrate low fat meals Avoid foods / smells that trigger syx Antihistamines
Tx of hyperemesis gravidarum
Prochlorperazine
Cyclizine
Metoclopramide
If severe refer to hospital - fluid and electrolyte replacement + nutritional support.
Complications of hyperemesis gravidarum
Dehydration
Weight loss
Electrolyte disturbance
Ketosis
Rarely –> wernicke’s encephalopathy, central pontine myelinosis, spontaneous oesophageal rupture.
Can diabetic women have a vaginal birth?
Yes
Should be offered elective induction or CS after 38wks
Babies born to diabetic mothers are at risk of what after birth?
Neonatal hypoglycaemia
Monitor for 24 hrs after birth.
Diabetic mothers who breast feed are at an increased risk of _________
Hypoglycaemia
Average length of a pregnancy
40 weeks
280 days
Term = 38-42 weeks
Average cycle length
28 days
On what day of a 28day cycle does ovulation occur
14th day
How to calculate EDD from LMP
Date of LMP + 9m + 7d
If the cycle is >28d also add the difference between 28 and the cycle length.
Feature of past pregnancies which may be relevant to current pregnancy
Recurrent miscarriage Preterm delivery Early onset pre-eclampsia Abruption Congenital abnormalities Macrosomic baby Fetal growth restriction Unexplained stillbirth
What does gravida mean
The number of pregnancies - regardless how they ended
What does parity mean?
Number of births > 24 weeks - live or still
Pre-existing diseases which may impact pregnancy
Diabetes mellitus Hypertension Renal disease Epilepsy VTE disease HIV connective tissue disorders Myasthenia gravis Myotonic dystrophy
What impact may existing DM have on pregnancy
Marosomia Fetal growth restriction Congenital abnormality Pre-eclampsia Stillbirth Neonatal hypoglycaemia
What impact may hypertension have on pregnancy
Pre-eclampsia
What impact may existing renal disease have on pregnancy
Worsening renal disease
Pre-eclampsia
Fetal growth restriction
Preterm delivery
What impact may existing epilepsy have on pregnancy
Increased fit frequency Congenital abnormality (medication)
What impact may existing VTE disease have on pregnancy
Increased risk of VTE in pregnancy
In obs ex - inspect for:
Asymmetry Fetal movements Scars - caesarean, laparotomy, laparoscopy, appendicectomy, cholecystectomy Striae gravidarum Linea nigra
In obs ex - palpate for:
Symphysis-fundal height (SFH) + measure Number of fetal poles Fetal lie Fetal presentation Fetal engagement
Types of fetal lie
Longitudinal
Transverse
Oblique
Types of presentation
Cephalic
Breech
When is a vaginal examination necessary in pregnancy
Offensive or excessive discharge
Vaginal bleeding - exclude placenta praevia 1st
Cervical smear
Confirm rupture of membranes
When is surfactant production maximal?
What does it do?
After 28 weeks
Prevents collapse of small alveoli during expiration
What is fetal respiratory distress syndrome
Respiratory distress in 1st few hours of life
Due to lack of surfactant in premature infants.
Complications of fetal respiratory distress syndrome
Hypoxia
Asphyxia
Intraventricular haemorrhage
Necrotizing enterocolitis
Functions of amniotic fluid
Protect against mechanical injury
Permit fetal movement while preventing limb contracture
Prevent adhesions between foetus and amnion
Permit fetal lung development
Symptoms of pregnancy
Breast tenderness
Nausea
Amenorrhea
Urinary frequency
When may the fetal heart by heard with a Doppler
12 weeks
Booking investigations include
FBC - anaemia, thrombocytopenia Blood group + rhesus status Urinalysis Rubella status Hepatitis B HIV Syphillis
What fetal abnormalities are screened for
Down’s syndrome
Neural tube defects
Structural congenital abnormalities
How is Down’s syndrome screened for
Combined test
- Nuchal translucency scan 11-14 wks
- HCG levels
- pregnancy associated plasma protein - A
- maternal age
How are neural tube defects screened for
Serum alpha-fetoprotein levels at 15-20 wks
Scan at 18 -20 wks
Presentation of amniotic fluid embolism
Rapid onset cardiovascular collapse, acute left ventricular failure, pulmonary oedema, disseminated intravascular coagulation, neurological impairment.
Bleeding diathesis Tachypnoea Respiratory distress / Peripheral or central cyanosis Hypotension Bronchospasm Seizure Chest pain
When may amniotic fluid embolism occur
Termination of pregnancy. Amniocentesis. Placental abruption. Trauma. Caesarean section. Delivery - unexpectedly, up to 30 minutes after delivery.
Symptoms of placental abruption
Abdominal / pelvic pain
Bleeding
What name is given to PV bleeding during pregnancy before 24 weeks gestation?
Miscarriage
Define Antepartum haemorrhage
Pv bleeding after 24weeks Gestation.
It can occur at any time until the second stage of labour is complete
Causes of antepartum haemorrhage
Placental abruption Placenta praevia Vulval infection / Trauma / Tumour Cervical infection/ Trauma / Tumour Vasa Praevia Uterine rupture
What is placenta accreta
Placental penetration into the myometrium
What is placenta increta
Placental invasion into the myometrium
What is placenta percreta
Where the placenta crosses the uterine wall and invades the peritoneum
What is placental abruption
Separation of the placenta from the uterus before delivery of the fetus
What is vasa praevia
= Velamentous cord insertion
Where the placenta has developed away from the attachment of the cord
The vessels divide in the membrane.
What is Functional incontinence
When the patient is unable to reach the toilet in time
E.g. poor mobility / unfamiliar surroundings.
What is potters syndrome
Oligohydramnios causes facial deformity, epicanthic folds, low set ears, pulmonary hypoplasia, joint deformity.
