Obs antenatal care Flashcards
Give 4 maternal obstetric emergencies
- Antepartum haemorrhage
- Postpartum haemorrhage
- Venous thromboembolism
- Pre-eclampsia
What is antepartum haemorrhage?
Bleeding from the birth canal after the 24th week of pregnancy
Give the top 3 causes of antepartum haemorrhage
- Placenta praevia
- Placental abruption
- Vasa praevia
What is placenta praevia major?
When the placenta covers the cervical os
What is vasa praevia?
When the fetal blood vessels are within the fetal membranes and run across the os
A primiparous women presents with vaginal bleeding during her 25th week of pregnancy with no associated pain. What is the most likely cause?
Placenta praevia
What are the clinical manifestations of placental abruption?
- Painful bleeding
- Woody hard uterus
- Maternal shock out of proportion to bleeding
When is placenta praevia typically identified. If present what 2 weeks are mothers rescanned?
- 16-20 wks
- 32 wks
- 36 wks
What is the management for vasa praevia?
- Elective cs at 34-36 wks
- Corticosteroids at 32 wks
What are corticosteroids given in vasa praevia?
To promote fetal lung maturity
What is gestational hypertension?
HTN after the 20th wk of pregnancy
What is preeclampsia-eclampsia?
HTN after the 20th wk of pregnancy PLUS proteinuria
What additional features are present in eclampsia?
Tonic-clonic seizures
What examination findings are typical of preeclampsia-eclampsia?
- Brisk
- Hyperactive reflexes
- Ankle clonus
- RUQ tenderness
What findings are required for diagnosing preeclampsia-eclampsia?
- Gestational HTN (systolic >140, diastolic >90)
- Proteinuria (>0.3g protein/24hr OR > +2 of protein on urine dip)
What is the ‘cure’ for preeclampsia?
Delivery
What is given to mothers with eclampsia to prevent seizures?
4g IV magnesium sulphate followed by 1g/hr magnesium sulphate after
What is given to manage blood pressure in eclampsia?
IV labetalol or hydralazine
What 3 features suggest gestational diabetes
- Large fetus
- Polyhydramnois
- Glucose on urine dip
What is the screening test for gestational diabetes?
Oral glucose tolerance test
What are normal results for the OGTT a) fasting and b) after 2 hrs
a) <5.6 mmol/l
b) <7.8 mmol/l
REMEMBER cut off for gestational diabetes is 5-6-7-8
What is the management of someone with a fasting glucose <7 mmol/l?
- Diet + exercise for 1/2 wks
- Metformin
- Insulin
What is the management of someone with a fasting glucose >7 mmol/l?
Insulin +/- metformin
What is the management of someone with a fasting glucose >6 mmol/l PLUS macrosomia?
Insulin +/- metformin
What are some complications of gestational diabetes?
- Neonatal hypoglycaemia
- Macrosomia
- Polyhydramnios
- Polycythaemia
- Preterm birth
- Pre-eclampsia
- Stillbirth
Antenatal care: When is the booking appointment?
10 weeks
Antenatal care: When is the dating scan?
11-13+6 weeks
Antenatal care: When is the anomaly scan?
20 weeks
When are anti-D injections given?
- 28 weeks
- 34 weeks
- After any sensitising event
When defines recurrent miscarriages?
3 or more miscarriages before 24 weeks
What is the most common, treatable cause of recurrent miscarriages? What is the management in pregnancy?
- Antiphospholipid syndrome
- LMHW (or warfarin) AND low dose aspirin
What would bloods show in pre-eclampsia?
- Raised LFTs
- Raised Cr
- Thrombocytopenia
- Haemolytic anaemia
Aspirin + pre-eclampsia:
1. When is it indicated?
2. When is it given?
- If 1 high rf for pre-eclampsia/2 moderate rfs
- From 12 weeks until birth
What are 3 complications of pre-eclampsia?
- Eclampsia
- HELLP syndrome
- DIC
What do bloods show in DIC?
- Low platelets
- Elevated D-dimer
- Decreased fibrinogen
- Prolonged PT
When would you repeat an OGTT postpartum in women with gestational diabetes?
6 weeks postpartum to ensure returned to normal
When is placenta praevia normal detected? When do women have a repeat scan?
- 20 weeks
- 32 weeks
When is VD possible in placenta praevia?
If placenta is >20mm from cervical os
When is prophylactic LMHW indicated in pregnancy? When is it started?
- 3 risk factors - started from 28 weeks
- 4 or more risk factors - started from 12 weeks
What is the management of asymptomatic bacteriuria in the 1st trimester? What about the 3rd trimester?
- 1st = nitro
- 3rd = amoxicillin/cefalexin
When is chronic villous sampling vs amniocentesis carried out?
- CVS = 11-14 weeks
- Amniocentesis = 15-20 weeks
When is OGTT carried out?
24-28 weeks
What are high risk factors for pre-eclampsia?
- Pre-exsisting HTN/previous gestational HTN
- Previous pre-eclampsia
- Existing condition (SLE, DM, CKD)
What are moderate risk factors for pre-eclampsia?
- > 40 years
- BMI >35
- > 10 years since previous pregnancy
- 1st/multiple pregnancy
- FHx
How long is MgSO4 continued for in eclampsia?
24hrs after last seizure/delivery
What is the diagnostic criteria for hyperemesis gravidarum?
- > 5% wt loss of pre pregnancy weight
- Dehydration
- Electrolyte disturbance
What score is used to assess the severity of symptoms of nausea and vomiting in pregnancy? What score would indicate mild/moderate/severe?
PUQE score
- <7 = mild
- 7-12 = moderate
- >12 = severe
What are the two types of placental abruption?
- Concealed
- Revealed
Why does asymptomatic bacteriuria in pregnancy require treatment?
Due to the risk of pyelonephritis -> associated with premature ROM and labour
What amniotic fluid index (AFI) indicates…
- Oligohydramnios
- Polyhydramnios
- < 5cm
- > 24 cm
What is the most common cause of polyhydramnios?
Idiopathic
What is used to diagnose haemolytic anaemia?
Direct Coombs Test
What is another name for the heel prick test?
Guthrie test
What is the Kleinhauer test do? When is it used?
- 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
When is ECV offered at 36 wks vs 37 wks?
- 36 wks = nulliparous woman
- 37 wks = multiparous woman
Step-wise management of hyperemesis gravidarum
- Prochlorperazine (stemetil)
- Cyclizine
- Ondansetron
- Metoclopramide
Give 4 risk factors for placenta accreta
- IVF
- Maternal age >35
- Previous CS
- Previous uterine surgery
What antibiotics are safe to use for UTis in pregnant women at all gestational ages?
Cephalosporins
What are 4 complications of chlamydia in pregnancy?
- Chorioamniotis
- Premature ROM
- Neonatal conjunctivitis
- Neonatal pneumonia
When do you give 5mg folic acid in pregnancy?
- Anti-epileptic drug
- Coeliac disease
- Diabetes
- BMI>30
- Neural tube defect
What are the 3 types of breech presentation?
- Flexed (both hips and knees flexed)
- Extended (hips flexed but knees extended)
- Footling (one/both legs extended, foot is presenting part)
What is the most common breech presentation?
Extended
What are 3 uterine RF for breech presentation?
- Multiparity
- Fibroids
- Placenta praevia
What are 4 fetal RF for breech presentation?
- Prematurity
- Microsomia
- Oligohydramnios
- Polyhydramnios
Give 3 management options for breech presentation
- External cephalic version
- CS
- Vaginal breech delivery
When is external cephalic version contra-indicated?
- If the membranes have ruptured
- Previous CS
- Uterine abnormalities
- Recent antepartum haemorrhage
What is a complication of fibroids, more common in pregnant women? How does it present?
- Red degeneration of the fibroid
- Severe abdominal pain, low-grade fever, tachycardia and vomiting
