obs and gynae Flashcards by Ellen Stevens-Thompson

what factors increase risk in pregnancy

age >40 or < 20
pmh C section or surgery
previous problems in pregnancy
medical issues eg diabetes, epilepsy

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medications to avoid in pregnancy

NSAIDs
ACE inhibitors
citalopram
anti epileptics
isotretinoin
carbimazole
propylthiouracil

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name 3 meds which are safe in pregnancy

amoxiillin
cyclizine
metformin

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what is the safest antiepileptic to use in pregnancy

lamotrigine

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name some uterine stimulants

misoprotsol
prostin
oxytocin
ergometrine
endothelin

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name some uterine relaxants

relaxin
nifedipine
nitric oxide
magnesium
terbutaline
indomethacin
atosiban

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what are the components of the APGAR score

appearance
pulse
grimace
activity
respiration

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what is the bishops score?

it is a PV exam scoring system to detect if labour is likely to occur spontaneously or if it is going to need to be induced

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what are the important components of acute obstetrics management?

-O2
2x Large bore cannulas
IV fluids (crystalloids and colloids), FBC, G+S, Rhesus status, clotting screen
monitor fetal heart on CTG

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when is the booking appointment?

8 weeks

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what will the midwife do at booking

check maternal risk factors and demographics
ask when LMP was
dip the urine and measure BP, blood tests incl anti D

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when is the dating scan and down syndrome testing?

12 weeks

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what is the combined test for down syndrome?

nuchal translucency scan
PAPP-A
HCG

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when is the anomaly scan?

20 weeks

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when is glucose tolerance testing?

26 weeks

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what are risk factors for gestational diabetes?

pmh GDM
previous baby >4.5kg
BMI raised
ethnic groups (asian, black)
fhx DM
PCOS

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what is the schedule for giving anti D prophylaxis?

check rhesus status @ booking
give anti D at 28 and 34 weeks
give large dose if there is a sensitising event and perform the kleihauer test

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what is external cephalic version?

manipulating the lie of the fetus to try to get it into a normal head first position
may give drugs to relax the womb

what are the criteria for diagnosing GDM

fasting >5.6

2hr post meal >7.8

what blood tests would you do for someone presenting with heavy bleeding?>

FBC, ferritin, coag, tfts, oestradiol, group and save if pregnant

inevitable miscarriage?

heavy bleeding with clots and pain

cervical os is open

what is a threatened miscarriage?

painless bleeding
cervical os is closed
most pregnancies continue normally

incomplete miscarriage

heavy bleeding with clots and pain
cervical os is open
not all products have been expelled

delayed miscarriage

no symptoms but at scan gestational sac does not contain a fetus

antepartum haemorrhage is defined as ...

bleeding >24 weeks

causes of recurrent miscarriage

``` antiphospholipid syndrome SLE parental chromosomal abnormalities uterine abnormality endocrine disorder poorly controlled eg diabetes/thyroid ```

which investigations would you do if pregnant lady presents with bleeding?

depends on gestation but: - serum hcg, g&s, fbc - USS

what are the options for management of miscarriage

expectant- follow up scan 2 weeks medical managment with misoprostol surgical evac

what percentage of pregnancies miscarry?

between 15 and 20%

what can you tell someone who has had an ectopic and asks if they can have another pregnancy and what they should do

they should watch out for ref flag symptoms they will be offered a scan at 7 weeks to check location of future pregnancies as they are at higher risk for more ectopics

what causes a miscarriage?

chromosomal abnormalities fetal abnormalities placental abnormalities infections (eg varicella, rubella, cytomeglovirus, toxoplasmosis)

threatened miscarriage

painless vaginal bleeding cervical os is closed bleeding is often less than menstruation

incomplete miscarriage

pain and bleeding | not all products expelled

inevitable miscarriage

heavy bleeding with clots and pain | cervical os open

when should anti D be given ?

28 and 34 weeks

what does the anti d injection do

contains special proteins that stop the mum mounting the antibody response to rhesus positive blood cells

what are the rotterdam criteria?

``` criteria to diagnose PCOS . Includes: -polcystic ovaries on USS -hyperangrogenism which can be: clinical signs (eg hirsutism or male pattern baldness) or biochemicallyraised androgens -oligo or amennorhoea ``` need 2/3

treatment of fibroids

``` medical progestins, gnrh anologues, nsaids for pain relief , progesterone mirena coil, surgical myomectomy uterine artery embolisation hysterectomy ```

which women are at risk of pre eclampsia?

``` HTN/pre eclampsia in prev pregnancies CKD autoimmunie disorders eg SLE Type 1 or 2 DM age <20 and >35 ```

HTN in pregnancy is defined as

>140 sys >90 diastolic

what can pre eclampsia cause

``` fetal asphyxia fetal growth restriction prematurity eclampsia haemorrhage abruption multi organ failure ```

treatment of pre eclampsia?

``` oral labetalol hydralazine or nifedipine magnesium sulphate deliver (induce or c section) fluid restrict ```

treatment of heavy menstrual bleeding - does not want contraception?

mefenamic Acid or tranexamic acid

treatment of heavy menstrual bleeding- wants contraception?

IUS COCP long acting progesterones