Obs & Gynae Flashcards
What’s included in booking visit?
Booking bloods include
1. FBC - anaemia
2. Blood group - Rh status and antibody screen to assess load
3. Serology
US at 12 to check no of babies and to date prep if naegles rule can’t be applied
- check BP
- check urine
When can naegle’s rule be applied?
LMP + 9 months and 7 days
regular 28day cycle, Off contraceptives and no pregnancies in the last 3 months
What infections are screened for in the booking bloods?
Rubella, HIV, hep B and C, syphilis
Why do rubella serology at booking?
If mother is not sensitised then can plan vaccine before the next pregnancy and advise her to avoid any non-vaccinated children during her pregnancy
Why check for Hep B at booking?
Monitor levels, reduce the risk fo vertical transmission to fetes and be plan to vaccinate the baby at delivery
Syphilis is rare, why bother screening?
It is rare but if detected, it is easily treated with IM penicillin G ( 10days). Untreated can result in severe congenital infection which can cause fetal death
What are the TORCH infections?
Toxoplasma other - Hep B, syph, varicella, parvoB19 Rubella CMV HIV
What are the possible complications of congenital torch infections?
Growth retardations - LBW Congenital malformation Fetal loss Deafness - esp CMV Ocular problems - toxoplasma chorioretinitis Learning difficulties
Vaccine preventable conditions?
Influenza
Pertussis
Rubella if given before pregnancy
Hep B can be given to baby at birth
What if mum gets exposed to rubella in 3rd trimester?
No effect on baby
if in 1st trimester - major fetal defects - heart, ear, eye, brain, blueberry muffin petechiae
If exposed 12-16wks - deafness
What steps are taken to prevent congenital infections?
Screening - universally - Rubella, Hep B, HIV, syphillis - in some cases - TORCH, STIs, Hep C Vaccine - rubella, hep B, varicella Immunotherapy - Hep B Ig, varicella, CMV Antimicrobial - syphilis, toxoplasma Food safety - toxins and listeria Increased awareness of STIs
What patients should be put on aspirin? Why?
From 12wks until ~36wks, 75mg of Aspirin should be prescribed for women with diabetes, severe HTN, renal disease.
To reduce their risk of pre-eclampsia.
What cohort of patients should be seen in clinic before conceiving?
Patients with diabetes, epilepsy, chronic hypertension
- Diabetics - controlled, HbA1c<40, start folic acid 5mg, assess for complications (retinopathy, nephropathy, peripheral neuropathy, and CVD - hypertension)
- Epileptics - seizure free, on suitable medications, on folic acid 5mg.
Chronic hypertension - is it controlled, plan to start aspirin
What is the normal dose of folic acid? What is the higher dose, and who needs it? When should it be taken?
From 3 months prior to conception and until 13wks gestation
standard is 400micrograms
5mg Diabetic, Epileptic
