Obs - Antenatal Conditions

Question 1

what is antepartum haemorrhage?

Answer 1

bleeding from the genital tract ≥24wks

Question 2

risk factors for placental abruption?

Answer 2

pre eclampsia
HT
smoking
drugs
multiple pregnancy
Hx
polyhydramnios

Question 3

features of placental abruption?

Answer 3

small blood loss
symptoms inconsistent (worse)
pain
hard woody uterys
difficulty feeling fetal parts

Question 4

what happens in placental abruption?

Answer 4

separation of normally implanted placenta before birth of fetus

Question 5

Tx for placental abruption?

Answer 5

bloods
fluids
anti D
steroids <36wks
deliver baby

Question 6

what happens in placenta previa?

Answer 6

placenta is implanted in the lower uterine segment

Question 7

risk factors for placenta previa?

Answer 7

age
multiparous
Hx
c section Hx
uterine abnormalities

Question 8

features of placenta previa?

Answer 8

painless bleeding
soft uterus
high head felt

Question 9

Ix for placenta previa?

Answer 9

US
CTG
anti D
steroids <36wks

Question 10

what steroid is given? why?

Answer 10

betamethasone

promote fetal lung surfactant
decrease chance of neonatal respiratory distress syndrome

Question 11

Tx for placenta previa?

Answer 11

major (os covered) - c section
minor (>2cm from os) -vaginal
prior bleeding - deliver at 37-38wks

Question 12

what is placenta accreta?

Answer 12

placenta invades the myometrium (muscle layer)

Question 13

features of placenta accreta?

Answer 13

severe bleeding

Question 14

Tx for placenta accreta?

Answer 14

C section at 37wks ± hysterectomy

wait one year to give birth

Question 15

risk factors for uterine rupture?

Answer 15

c section 
uterine surgery
multiparous
multiple pregnancy
labour induction/prolonged

Question 16

features of uterine rupture?

Answer 16

blood loss
contractions stop
high fetal head
abdo pain 
fetal parts easily felt

Question 17

what drugs can increase risk of uterine rupture?

Answer 17

syntocinon

prostaglandins

Question 18

Tx for uterine rupture?

Answer 18

stop oxytocins

c section ± hysterectomy

Question 19

when should placenta previae be detected on antenatal scans?

Answer 19

18-20wk scan

TVUS can then be done if still persisting at 32 wks

Question 20

what happens in vasa previae?

Answer 20

fetal blood vessels runa cross the opening of the uterus in the membranes

Question 21

features of vasa previae?

Answer 21

blood produced when membranes rupture

Question 22

Ix for vasa previae?

Answer 22

US

CTG

Question 23

Tx for vasa previae?

Answer 23

emergency c section
deliver at 34-36wks
anti D
steroids <36wks

Question 24

what is rhesus?

Answer 24

antigen on the RBC

one being D antigen

Question 25

what happens is rhesus negative and exposed?

Answer 25

IgM antibodies form too big to cross placenta in further pregnancies, exposed to same antigen and IgG form these can cross cause haemolytic disease of the newborn

Question 26

when is rhesus status checked?

Answer 26

booking

Question 27

when are anti D doses given if mother is rhesus negative?

Answer 27

28wks

Question 28

in what situations should rhesus be given?

Answer 28

``` APH fetal death amniocentesis/CVS miscarriage vaginal bleeding >12wks molar pregnancy TOP ectopic ```

Question 29

what features are seen in haemolytic disease of the newborn? is this extra/intra vascular?

Answer 29

jaundice CCF hepatosplenomegaly kernicterus extravascular

Question 30

Tx for haemolytic disease of the newborn?

Answer 30

phototherapy FBCs IVIgs

Question 31

what is a miscarriage?

Answer 31

loss of the fetus after a positive pregnancy test up until 23+6 wks

Question 32

risks factors for miscarriage?

Answer 32

``` PCOS DM age smoking alcohol/drugs obese HT antiphospholipid syndrome infections Hx ```

Question 33

features of miscarriage?

Answer 33

bleeding cramps passed products

Question 34

what are features of cervical shock? what causes it?

Answer 34

``` cramps N+V sweating hypotension bradycardia ``` incomplete miscarriage sitting at the os

Question 35

what types of miscarriage exist? what is the os like?

Answer 35

``` threatened (closed) inevitable (open) incomplete complete (products in vagina) early fetal demise ```

Question 36

Ix for miscarriage?

Answer 36

bHCG US speculum

Question 37

Tx for a miscarriage?

Answer 37

``` conservative medical (misoprostol) MVA surgery anti D ```

Question 38

what is implantation bleeding?

Answer 38

bleeding before when period is due when a women is pregnant

Question 39

what is a subchorionic haematoma?

Answer 39

blood collects between chorion and uterine wall

Question 40

how many miscarriages until a patient is referred to rheum?

Answer 40

3

Question 41

what is an ectopic pregnancy?

Answer 41

implantation of a normal fetus outside the uterus

Question 42

risk factors for an ectopic pregnancy?

Answer 42

``` Hx surgery IUD STIs smoking ```

Question 43

features of an ectopic pregnancy?

Answer 43

``` pain (abdo/iliac fossa/left shoulder tip) bleeding collapse pallor peritonism GI/urinary symptoms ```

Question 44

when does an ectopic pregnancy commonly occur in a cycle?

Answer 44

6-8wks after LMP

Question 45

commonest sites for an ectopic pregnancy?

Answer 45

ampulla isthmus ovary peritoneum

Question 46

Ix for ectopic pregnancy?

Answer 46

FBC G+S bHCG TVUS

Question 47

who gets conservative ectopic pregnancy management? what is done?

Answer 47

``` <30mm unruptured asymptomatic no heart beat bHCG <1500 and declining ``` bHCG is monitored over 48hours (should fall)

Question 48

who gets medical ectopic pregnancy management? what is done?

Answer 48

``` <35mm unruptured no pain no heart beat bHCG <3000 ``` MTX

Question 49

who gets surgical ectopic pregnancy management?

Answer 49

>35mm pain/ruptured can be a visible heart beat salpingectomy/otomy

Question 50

what gets a miscarriage classed as a pregnancy of unknown viability?

Answer 50

gs <25mm CRL <7mm rescan in 7-10 days

Question 51

what is in liver that is teratogenic?

Answer 51

vit A

Question 52

what carries listeria risk?

Answer 52

pate | soft cheese

Question 53

what carries a toxoplasmosis risk?

Answer 53

under pasteurised milk

Question 54

booking bloods?

Answer 54

``` HIV syphilis hep B sickle/thalassaemias blood type + Abs ```