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3a > Obs antenatal care > Flashcards

Obs antenatal care Flashcards

1
Q

Give 4 maternal obstetric emergencies

A
  • Antepartum haemorrhage
  • Postpartum haemorrhage
  • Venous thromboembolism
  • Pre-eclampsia
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2
Q

What is antepartum haemorrhage?

A

Bleeding from the birth canal after the 24th week of pregnancy

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3
Q

Give the top 3 causes of antepartum haemorrhage

A
  • Placenta praevia
  • Placental abruption
  • Vasa praevia
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4
Q

What is placenta praevia major?

A

When the placenta covers the cervical os

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5
Q

What is vasa praevia?

A

When the fetal blood vessels are within the fetal membranes and run across the os

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6
Q

A primiparous women presents with vaginal bleeding during her 25th week of pregnancy with no associated pain. What is the most likely cause?

A

Placenta praevia

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7
Q

What are the clinical manifestations of placental abruption?

A
  • Painful bleeding
  • Woody hard uterus
  • Maternal shock out of proportion to bleeding
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8
Q

When is placenta praevia typically identified. If present what 2 weeks are mothers rescanned?

A
  • 16-20 wks
  • 32 wks
  • 36 wks
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9
Q

What is the management for vasa praevia?

A
  • Elective cs at 34-36 wks
  • Corticosteroids at 32 wks
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10
Q

What are corticosteroids given in vasa praevia?

A

To promote fetal lung maturity

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11
Q

What is gestational hypertension?

A

HTN after the 20th wk of pregnancy

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12
Q

What is preeclampsia-eclampsia?

A

HTN after the 20th wk of pregnancy PLUS proteinuria

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13
Q

What additional features are present in eclampsia?

A

Tonic-clonic seizures

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14
Q

What examination findings are typical of preeclampsia-eclampsia?

A
  • Brisk
  • Hyperactive reflexes
  • Ankle clonus
  • RUQ tenderness
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15
Q

What findings are required for diagnosing preeclampsia-eclampsia?

A
  • Gestational HTN (systolic >140, diastolic >90)
  • Proteinuria (>0.3g protein/24hr OR > +2 of protein on urine dip)
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16
Q

What is the ‘cure’ for preeclampsia?

A

Delivery

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17
Q

What is given to mothers with eclampsia to prevent seizures?

A

4g IV magnesium sulphate followed by 1g/hr magnesium sulphate after

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18
Q

What is given to manage blood pressure in eclampsia?

A

IV labetalol or hydralazine

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19
Q

What 3 features suggest gestational diabetes

A
  • Large fetus
  • Polyhydramnois
  • Glucose on urine dip
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20
Q

What is the screening test for gestational diabetes?

A

Oral glucose tolerance test

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21
Q

What are normal results for the OGTT a) fasting and b) after 2 hrs

A

a) <5.6 mmol/l
b) <7.8 mmol/l

REMEMBER cut off for gestational diabetes is 5-6-7-8

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22
Q

What is the management of someone with a fasting glucose <7 mmol/l?

A
  1. Diet + exercise for 1/2 wks
  2. Metformin
  3. Insulin
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23
Q

What is the management of someone with a fasting glucose >7 mmol/l?

A

Insulin +/- metformin

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24
Q

What is the management of someone with a fasting glucose >6 mmol/l PLUS macrosomia?

A

Insulin +/- metformin

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25
Q

What are some complications of gestational diabetes?

A
  • Neonatal hypoglycaemia
  • Macrosomia
  • Polyhydramnios
  • Polycythaemia
  • Preterm birth
  • Pre-eclampsia
  • Stillbirth
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26
Q

Antenatal care: When is the booking appointment?

A

10 weeks

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27
Q

Antenatal care: When is the dating scan?

A

11-13+6 weeks

28
Q

Antenatal care: When is the anomaly scan?

A

20 weeks

29
Q

When are anti-D injections given?

A
  • 28 weeks
  • 34 weeks
  • After any sensitising event
30
Q

When defines recurrent miscarriages?

A

3 or more miscarriages before 24 weeks

31
Q

What is the most common, treatable cause of recurrent miscarriages? What is the management in pregnancy?

A
  • Antiphospholipid syndrome
  • LMHW (or warfarin) AND low dose aspirin
32
Q

What would bloods show in pre-eclampsia?

A
  • Raised LFTs
  • Raised Cr
  • Thrombocytopenia
  • Haemolytic anaemia
33
Q

Aspirin + pre-eclampsia:
1. When is it indicated?
2. When is it given?

A
  1. If 1 high rf for pre-eclampsia/2 moderate rfs
  2. From 12 weeks until birth
34
Q

What are 3 complications of pre-eclampsia?

A
  • Eclampsia
  • HELLP syndrome
  • DIC
35
Q

What do bloods show in DIC?

A
  • Low platelets
  • Elevated D-dimer
  • Decreased fibrinogen
  • Prolonged PT
36
Q

When would you repeat an OGTT postpartum in women with gestational diabetes?

A

6 weeks postpartum to ensure returned to normal

37
Q

When is placenta praevia normal detected? When do women have a repeat scan?

A
  • 20 weeks
  • 32 weeks
38
Q

When is VD possible in placenta praevia?

A

If placenta is >20mm from cervical os

39
Q

When is prophylactic LMHW indicated in pregnancy? When is it started?

A
  • 3 risk factors - started from 28 weeks
  • 4 or more risk factors - started from 12 weeks
40
Q

What is the management of asymptomatic bacteriuria in the 1st trimester? What about the 3rd trimester?

A
  • 1st = nitro
  • 3rd = amoxicillin/cefalexin
41
Q

When is chronic villous sampling vs amniocentesis carried out?

A
  • CVS = 11-14 weeks
  • Amniocentesis = 15-20 weeks
42
Q

When is OGTT carried out?

A

24-28 weeks

43
Q

What are high risk factors for pre-eclampsia?

A
  • Pre-exsisting HTN/previous gestational HTN
  • Previous pre-eclampsia
  • Existing condition (SLE, DM, CKD)
44
Q

What are moderate risk factors for pre-eclampsia?

A
  • > 40 years
  • BMI >35
  • > 10 years since previous pregnancy
  • 1st/multiple pregnancy
  • FHx
45
Q

How long is MgSO4 continued for in eclampsia?

A

24hrs after last seizure/delivery

46
Q

What is the diagnostic criteria for hyperemesis gravidarum?

A
  • > 5% wt loss of pre pregnancy weight
  • Dehydration
  • Electrolyte disturbance
47
Q

What score is used to assess the severity of symptoms of nausea and vomiting in pregnancy? What score would indicate mild/moderate/severe?

A

PUQE score
- <7 = mild
- 7-12 = moderate
- >12 = severe

48
Q

What are the two types of placental abruption?

A
  • Concealed
  • Revealed
49
Q

Why does asymptomatic bacteriuria in pregnancy require treatment?

A

Due to the risk of pyelonephritis -> associated with premature ROM and labour

50
Q

What amniotic fluid index (AFI) indicates…
- Oligohydramnios
- Polyhydramnios

A
  • < 5cm
  • > 24 cm
51
Q

What is the most common cause of polyhydramnios?

A

Idiopathic

52
Q

What is used to diagnose haemolytic anaemia?

A

Direct Coombs Test

53
Q

What is another name for the heel prick test?

A

Guthrie test

54
Q

What is the Kleinhauer test do? When is it used?

A
  • Detects the amount of fetal Hb in the mothers blood stream
  • Used in Rh -ve mothers to detect if correct amount of anti-D has been given following sensitising events
55
Q

When is ECV offered at 36 wks vs 37 wks?

A
  • 36 wks = nulliparous woman
  • 37 wks = multiparous woman
56
Q

Step-wise management of hyperemesis gravidarum

A
  1. Prochlorperazine (stemetil)
  2. Cyclizine
  3. Ondansetron
  4. Metoclopramide
57
Q

Give 4 risk factors for placenta accreta

A
  • IVF
  • Maternal age >35
  • Previous CS
  • Previous uterine surgery
58
Q

What antibiotics are safe to use for UTis in pregnant women at all gestational ages?

A

Cephalosporins

59
Q

What are 4 complications of chlamydia in pregnancy?

A
  • Chorioamniotis
  • Premature ROM
  • Neonatal conjunctivitis
  • Neonatal pneumonia
60
Q

When do you give 5mg folic acid in pregnancy?

A
  • Anti-epileptic drug
  • Coeliac disease
  • Diabetes
  • BMI>30
  • Neural tube defect
61
Q

What are the 3 types of breech presentation?

A
  • Flexed (both hips and knees flexed)
  • Extended (hips flexed but knees extended)
  • Footling (one/both legs extended, foot is presenting part)
62
Q

What is the most common breech presentation?

A

Extended

63
Q

What are 3 uterine RF for breech presentation?

A
  • Multiparity
  • Fibroids
  • Placenta praevia
64
Q

What are 4 fetal RF for breech presentation?

A
  • Prematurity
  • Microsomia
  • Oligohydramnios
  • Polyhydramnios
65
Q

Give 3 management options for breech presentation

A
  • External cephalic version
  • CS
  • Vaginal breech delivery
66
Q

When is external cephalic version contra-indicated?

A
  • If the membranes have ruptured
  • Previous CS
  • Uterine abnormalities
  • Recent antepartum haemorrhage
67
Q

What is a complication of fibroids, more common in pregnant women? How does it present?

A
  • Red degeneration of the fibroid
  • Severe abdominal pain, low-grade fever, tachycardia and vomiting

3a (34 decks)

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