Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

O&G > Obs 6 > Flashcards

Obs 6 Flashcards

1
Q

Define PPH

A

Blood loss >500ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of primary PPH?

A

Tone (70%), Trauma (20%), Tissue (10%), Thrombin (1%)

1. Tone – Uterine Atony: Avoid by active mx 3rd stage

  • Overdistended uterus – polyhydramnios, multiple gestations, macrosomia
  • Uterine muscle exhaustion – prolonged labour, grand multiparity, oxytocin/GA use
  • Abnormal uterine anatomy – fibroids, placenta praevia, placental abruption
  • Intra-amniotic infection – prolonged ROM
  • Unable to empty bladder

2. Trauma – Damage to genital structures: (vagina, cervix, uterus)

  • C-section
  • Episiotomy
  • Instrumental delivery
  • Can cause haematoma

3. Tissue – Retained placental products:

  • Placenta accreta/increta/percreta
  • Retained blood clots in atonic uterus
  • Gestational trophoblastic neoplasia

4. Thrombin – Coagulopathy:

  • Congenital: Haemophilia, VWD (most common)
  • Acquired: DIC, aspirin use, therapeutic anti-coagulation,
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the RFs for primary PPH?

A
  • Previous PPH
  • Prolonged labour
  • Pre-eclampsia
  • Increased maternal age
  • Polyhydramnios
  • Emergency Caesarean section
  • Placenta praevia, placenta accreta
  • Macrosomia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of secondary PPH?

A
  • Endometritis
  • Retained products
  • Abnormal involution of placental site
  • Trophoblastic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the S/S of PPH?

A

Primary:

  • General – shock (tachycardia, hypotension), signs of anaemia
  • Uterine atony – relaxed, boggy and soft uterus, uterine fundus may be felt above umbilicus (if uterine cavity filled with blood/clots)
  • Tissue - retained products found on bimanual exam
  • Thrombin - continued bleeding despite contracted uterus

Secondary:

  • Abdomen – tender uterus
  • Speculum – assess bleeding, is the cervical os open
  • Vaginal – uterine tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the investigations for PPH?

A
  • Bloods: FBC, U&Es, coagulation profile, G&S
  • USS: uterine rupture / intraperitoneal bleeding?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What signs would indicate a haematoma?

A
  • Severe pain
  • Persistent bright red PV bleeding despite firmly contracted uterus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of PPH?

A

ABC approach:

  • Fluid resus (warmed crystalloid infusion)
  • Blood products
  • Lie the woman flat
  • Catheterisation (prevent bladder distension / monitor UO)

Mechanical:

  • Palpate the uterine fundus and rub it to stimulate contractions (‘rubbing up the fundus’)
  • Bimanual compression (‘rub up a contraction’ if in theatre)

Medical:

  • Step 1 = IM/IV syntocinon (oxytocin) > uterine hyperstimulation = give tocolytics
  • Step 2 =IM ergometrine/syntometrine (not in HTN / asthmatics)
  • Step 3 = IM carboprost (not in asthmatics)

Surgical:

  • Step 4: Balloon tamponade (i.e. Bakri Balloon)
  • Step 5: B-lynch suture > ligate arteries > interventional radiology
  • Step 6: hysterectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the complications of PPH?

A
  • Death, hysterectomy, VTE, renal failure, DIC, Sheehan’s syndrome
  • 4th most common cause of maternal death in the UK, leading cause of maternal mortality world-wide
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Define placenta accreta / increta / percreta

A

Abnormally invasive placentation:

Accreta = placenta invades the surface of the myometrium (strong attachment, not into muscle wall)

Increta = placenta extends into the myometrium

Percreta = placenta penetrates through the myometrium to the uterine serosa and potentially to nearby organs (e.g. bladder)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the RFs for placenta accreta / increta / percreta?

A
  • Hx of accreta
  • Previous CS/uterine surgery
  • Endometrial curettage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the investigations for placenta accreta / increta / percreta?

A
  • TVUSS
  • MRI (assess depth of invasion)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the management of placenta accreta / increta / percreta?

A
  • ELCS at 35 to 36+6 weeks delivery
  • ± Caesarean hysterectomy (i.e. for percreta)

Risk of SVD = major haemorrhage and uterine rupture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is Prelabour Rupture of the Membranes (PROM)?

A

Spontaneous rupture of membranes before onset of labour at term (≥37 weeks)

  • Occurs in ≤10% of women
  • Cause = natural physiological (i.e. Braxton Hicks contractions + cervical ripening > weakening of membranes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is Pre-term Premature Rupture of the Membranes (PPROM)?

A

Spontaneous rupture of membranes before onset of labour in pregnancy (24+0 to 36+6 weeks)

  • Can be caused by weakening of membranes due to infective cause (often subclinical)
  • Occurs in 2% of pregnancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When should you not offer a digital vaginal examination?

A

Do not offer if…

  • Placental praevia
  • PPROM/PROM (SROM)

> Ok in abruption but often cannot tell immediately

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the S/S of PROM?

A
  • Sudden gush of fluid PV > constant trickle
  • Contractions (regular & painful = PTL; not Braxton-Hicks)
  • General examination > assess for signs of infection (tachycardia, fever)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the investigations for PROM / PPROM?

A

(NO bimanual as increases risk of infection)

1st = Sterile speculum examination:
Only perform if ROM not evident

  • Amniotic fluid pooling (filling of speculum) is diagnostic
  • If none, test IGFBP-1 or PAMG-1
  • Swab for infection (gonorrhoea, chlamydia, GBS)
  • Do not use KY jelly – will complicate FFN result

2nd = IGFBP-1 or PAMG-1 (PartoSure):

  • IGFBP-1 = Insulin-like Growth Factor-Binding Protein 1
  • PAMG-1 = Placental Alpha-Microglobulin 1
  • Very sensitive, so -ve result means very low chance of PPROM

If >30w, contractions and os closed = TVUSS for cervical length:

  • <15mm = likely to be preterm labour
  • > 15mm = unlikely to be preterm labour

Manage the pregnancy as per:

  • Membranes not ruptured > PTL
  • Membranes ruptured > PPOM, PROM

Do not perform diagnostic tests for PPROM if labour becomes established (i.e. bulging membranes, abdominal pain) in a woman reporting S/S suggestive of PPROM > admit to labour ward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the RFs for PROM / PPROM?

A
  • Previous PROM / PTL
  • UTI / STI / vaginal infection
  • Smoking
  • Multiple pregnancy
  • Polyhydramnios
  • APH
  • Trauma
  • Uterine abnormalities
  • Cervical incompetence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the management of PPROM?

A

ADMISSION for monitoring (48–72 h) + expectant management until 37w (if no complications)

  • Erythromycin for 10 days or until in established labour (not for infection, to increase time between ROM and spontaneous labour)
  • Corticosteroids if ≤34 weeks; max 2 doses (consider between 34-36wks) - induces a DKA in diabetics so co-administer with insulin
  • MgSO4 if ≤30 weeks AND contracting OR planned birth <24 hours (consider between 30-34wks)
  • If chorioamnionitis - immediate delivery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the management of PPROM <16wks?

A
  • If <16wks, no liquor for lungs to develop
  • Even if make it to term - such high mortality from lung hypoplasia
  • TOP may be offered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What must be monitored for chorioamnionitis?

A
  • Clinical assessment
  • Bloods – CRP and WCC
  • CTG – monitor foetal HR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the complications of PPROM/PROM?

A

Maternal:

  • Sepsis
  • Placental abruption

Foetal:

  • Chorioamnionitis
  • Cord prolapse
  • PTL
  • Pulmonary hypoplasia
  • Limb contractures
  • Death

> Increased perinatal mortality due to sepsis, prematurity and pulmonary hypoplasia

24
Q

What is the management of PROM?

A

Most (60%) women will spontaneously labour <24hrs

  • IOL is appropriate after 24hrs
  • If woman chooses expectant management, she must return for RV every 24hrs (max 96hrs)

Immediate induction offered if:

  • Known carrier of GBS
  • Meconium or blood stained liquor
  • Suspicion of infection

Postnatal:

  • Neonatal observation required for at least 12 hours
25
Q

Define pregnancy of unknown location (PUL)

A

The situation when the pregnancy test is positive but there are no signs of intrauterine pregnancy (IUP) or an extrauterine (ectopic) pregnancy via TVUSS.

It is not a final diagnosis and in some women a final diagnosis cannot be made

26
Q

What is the definition of pre-term labour?

A

<37w GA labour

85% of PTL births occur between 32- and 37-weeks GA

27
Q

What is the definition of very PTL?

A

28-32w GA labour

28
Q

What is the definition of extremely PTL?

A

<28w GA labour

24w is seen as the limit of viability (~55% survivability)

29
Q

What are the RFs for PTL?

A
  • Previous PTL/PROM/PPROM
  • Previous miscarriage between 16-24w
  • Cervical procedures (e.g. biopsy)
  • Infection (20-40% of spontaneous PTL)
  • Structural - uterine abnormalities, pre-eclampsia
  • Mechanical (stretch) - fibroids, polyhydramnios, multiple pregnancy, APH (concealed)
  • Social lifestyle -smoking, high BMI, drugs, extreme ages, ethnicity
30
Q

What are the investigations for PLT?

A

(in addition to investigations on main topic page)

  • CTG monitor
  • Urine dip ± MC&S (if indicated)
31
Q

What is the management of PTL?

A

Note, you pay be in PTL without having membranes ruptured…

Ruptured membranes:
PPROM guidance

Non-ruptured membranes:
Medications:

  • Tocolysis (≤34 weeks) - 1st: Nifedipine (CCB); 2nd: Atosiban
  • Corticosteroids (≤34 weeks) for 24 hours - induces a DKA in diabetics so co-administer with insulin
  • MgSO4 (≤30 weeks; labour OR planned birth <24 hours)

Surgical:
Emergency ‘rescue’ cerclage:

  • Indication = if 16w to 28w, dilated cervix, exposed unruptured membranes
  • Contraindication = infection, bleeding, uterine contractions
32
Q

What is the management for woman at high risk of PTL?

A

Measure cervical length every 2w from 16w
If cervical length <25mm and…

  • History of PTL <34w GA
  • History of miscarriage >16w GA
  • History of PPROM
  • Cervical trauma

1 = Progesterone
2 = Cervical cerclage

33
Q

What are the complications of pre-term birth?

A

Big four = RDS, NEC, IVH, PVL

  • Respiratory Distress Syndrome >O2 > complication = retinopathy of prematurity
  • Necrotising Enterocolitis
  • Intraventricular Haemorrhage
  • Periventricular Leukomalacia

+Sepsis

34
Q

What is Rhesus disease?

A

Development of Rhesus antibodies in a RhD -ve mother post-exposure (sensitisation) to RhD antigen (RhD +ve blood cells)

Population = 85% Rh +ve; 15% Rh -ve (these are the ones we worry about in RhD disease)

35
Q

What are the RFs for rhesus disease?

A
  • Previous pregnancy with insufficient anti-D prophylaxis
  • Previous blood transfusion (rare if in UK)
36
Q

How does rhesus disease develop?

A
  • Rh -ve mother has a Rh +ve child
  • Sensitising event mixes blood
  • Mother develops IgM anti-Rh ABs (IgM do not affect 1st baby as IgM cannot cross placenta)
  • Mother delivers or miscarries child

Time passes (and mother develops IgG anti-Rh ABs)

  • Mother has a 2nd Rh +ve child
  • Mother’s IgG anti-Rh crosses placenta > hydrops fetalis
  • If child is Rh -ve, there is no problem. However, we assume they are Rh +ve just in case

> > cffDNA testing can test for the child’s Rh status which reduce the need for anti-D

37
Q

What are examples of a potentially sensitising event (PSE)?

A
  • Termination of pregnancy
  • Obstetric interventions (CVS, amniocentesis, ECV)
  • Abdominal trauma
  • APH / PV bleeding
  • Ectopic pregnancy
  • Miscarriage
  • Intrauterine transfusion / surgery
  • Intrauterine death & stillbirth / molar pregnancy
38
Q

What are the investigations for rhesus disease?

A
  • Father status (hence, could the baby inherit)
  • Baby status (cffDNA testing)
  • Mother’s anti-RhD levels (higher = worse)
  • Kleiheur test (only >20w)
  • Coomb’s Test / Antiglobulin Test:
  • Direct AT = ABs on RBCs

cffDNA testing at 12w can determine baby Rh status
If baby is Rh -ve, no need for anti-D prophylaxis as no HDN can occur

39
Q

What is the management of rhesus disease?

A

Only Rh -ve women need any of this…

Routine Antenatal Anti-D Prophylaxis:

  • Indirect antiglobulin testing at booking
  • Either: 2 doses of 500 IU at 28 and 34 weeks; OR 1 dose of 1500 IU at 28 weeks
  • Kleihauer = determines need for more anti-D
  • Foetal cord bloods post-delivery and prophylaxis in 72 hours (500 IU anti-D) if baby +ve with Kleiheur

Prophylaxis < 72hrs of sensitising event:

  • 250 IU <20 weeks
  • 500 IU >20 weeks

If mother is found to be RhD -ve and has antibodies at booking > monitor titres and if they peak above a level, monitor baby using Middle Cerebral Artery (MCA) dopplers weekly > if baby affected, consider IU transfusion

If continuous bleeding > anti-D every 6 weeks with Kleihauer every 2 weeks (adjust anti-D if needed)

40
Q

What are the complications of rhesus disease?

A

hydrops fetalis, intrauterine death, neonatal kernicterus

41
Q

What are some examples of skin diseases in pregnancy?

A
  • Pemphigoid gestationis
  • Polymorphic eruption of pregnancy / Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)
  • Prurigo of pregnancy
  • Pruritis folliculitis
  • Atopic eczema
42
Q

How can changes during pregnancy affect the skin?

A
  • Pre-existing conditions (e.g. acne can worsen during pregnancy)
  • Acne flares in 3rd trimester – oral or topical erythromycin, retinoids contraindicated
  • Increased pigmentation (face, areola, abdo midline) common
  • Spider naevi affecting face, arms, upper torso
  • Broad pink linear striae – striae gravidarum common over lower abdo and thighs
  • Hand and nipple eczema common post-partum
  • Psoriasis – topical steroids, methotrexate contraindicated
43
Q

Describe pemphigoid gestationis

A

Rare pruritic AI bullous disorder

  • Presents in late 2nd or 3rd trimester
  • SS: lesions begin on abdomen 50% of time > widespread clustered blisters, sparing face
  • M: relive pruritis and stop new blister formation, use potent topical steroids or oral prednisolone
44
Q

Describe polymorphic eruption of pregnancy (PEP)

A

AKA: Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP)

Self-limiting pruritic inflammatory disorder

  • Umbilical sparing rash
  • Presents in 3rd trimester or immediately post-partum
  • SS: begin on lower abdomen, involving pregnancy striae > extend to thigh, buttocks, legs, arms, rarely involves face, hands, feet
  • In 70% of cases, lesions become confluent and widespread, resemble erythroderma
  • M: topical steroids, antihistamines, soothing measures, oral steroids
  • C: preterm delivery and SGA births, no increase in pregnancy loss, recurs in most subsequent pregnancies
45
Q

Describe prurigo of pregnancy

A

Common pruritic disorder

  • Affects 20% of normal pregnancies, do LFTs to exclude obstetric cholestasis
  • Starts 3rd trimester (25-30 weeks) of pregnancy, resolve after delivery, no effect on mother or baby
  • SS: present as excoriated papules on extensor limbs, abdo, shoulder
  • M: symptomatic treatment + topical steroids and emollients
46
Q

Describe pruritis folliculitis

A

Pruritic follicular eruption with papules and pustules affecting trunk can involve limbs

  • 2nd or 3rd trimester, resolve a week after delivery
  • SS: acne (considered a type of hormone-induced acne) 
  • M: topical steroids
47
Q

Describe atopic eczema

A

Common pruritic condition affecting up to 5% of population

  • SS: causes commonest pregnancy rash
  • M: emollients and bath additives
48
Q

Describe the effects of alcohol on pregnancy

A

More cognitive and behavioural abnormalities:

  • Miscarriage, stillbirth, infant mortality, congenital abnormalities, LBW, preterm delivery, SGA
  • Foetal alcohol spectrum disorders with later neurodevelopmental abnormalities
  • Prenatal drinking associated with long-term effects – cognitive/behavioural change, adverse language outcomes
  • Executive functioning defects, psychosocial consequences in adulthood
49
Q

Describe the effects of smoking on pregnancy

A

More distinct outcomes:

  • Damage to umbilical cord structure
  • Miscarriage
  • Increased risk of ectopic pregnancy
  • LBW & preterm birth
  • Placental abruption
  • Increased foetal mortality
50
Q

Describe the affects of cannabis on pregnancy

A
  • Preterm labour, LBW, SGA, increased NICU admission
  • Adverse consequences of growth of foetal and adolescent brains
  • Reduced attention and executive functioning skills
  • Poorer academic achievement
  • Behavioural problems
51
Q

Describe the effect of cocaine on pregnancy

A
  • PROM
  • Placental abruption
  • Preterm birth
  • LBW, SGA

Similar to cocaine, methamphetamine use linked with shorter gestational ages, LBW, foetal loss, developmental and behavioural defects, preeclampsia, gestational HTN, intrauterine foetal death

52
Q

Describe the affects of opioids on pregnancy

A
  • Greater risk of LBW
  • Respiratory problems
  • 3rd trimester bleeding
  • Toxaemia
  • Mortality
  • Growth deficiency
  • Microcephaly
  • Behavioural problems
  • SIDS
53
Q

Describe neonatal abstinence syndrome

A

Opiate exposure in utero triggers postnatal withdrawal syndrome

  • 45-94% of infants exposed to opioids in utero (inc. methadone, buprenorphine)
  • NAS = substantial neonatal morbidity + increased healthcare utilisation

Presentation:

  • Irritability
  • Feeding difficulties
  • Tremors
  • Hypertonia
  • Emesis
  • Loose stools
  • Seizures
  • Respiratory distress
54
Q

Define primary and secondary PPH

A
  • Primary PPH = within 24h
  • Secondary PPH = 24h to 12 weeks [NEW]
55
Q

What are the S/S of foetal alcohol syndrome?

A
  • Microcephaly
  • Short palpebral fissure
  • Hypoplastic upper lip
  • Epicanthic folds
  • Cardiac malformations
  • Smooth/absent filtrum
  • Learning difficulties
  • Mental retardation

O&G (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions