Obs VIVAs Flashcards
obstetric cholestasis vs acute fatty liver of pregnancy
OC: itching + jaundice
AFLP: n&v, abdo pain, jaundice, fever
transaminitis + steatosis
normal physiological skin changes in pregnancy
linea nigra
striae gravidarum
striae albicans
cause of itching in obstetric cholestasis
bile acids in skin
lack of bile affects absorption of which vitamins
fat soluble: A, D, E, K
types of breech presentation
frank
flexed
footling
RFs for breech presentation
maternal:
multiparity
fibroids
previous Hx
placenta praevia
foetal:
preterm
oligohydramnios
macrosomia
multiple pregnancy
CIs for ECV
abnormal CTG
ROM
multiple pregnancy
neonatal resp phenomenon associated w. CS delivery
TTN
sensitising events which require anti-D prophylaxis
ECV
surgical management of miscarriage/ectopic
abdo trauma
amniocentesis/CVS
antepartum haemorrhage
pathophysiology of gestational diabetes
placenta produced progesterone, hCG, cortisol, cytokines = anti-insulin effect
increased insulin resistance
why do neonates of mothers with GDM develop hypoglycaemia
maternal glucose crosses placenta but not insulin
foetus produces high levels of insulin
RFs for GDM
BMI > 30
macrosomia
FH of diabetes
ethnicity
target level of plasma glucose in GDM
fasting <5.3
2hr <6.4
what to arrange at first antenatal visit if pre-existing diabetes
digital retinal assessment
renal function
HbA1c
risks of GDM
maternal:
trauma
T2DM
pre-eclampsia
foetal:
macrosomia
polyhydramnios
neonatal hypoglycaemia
how often to monitor HIV viral load in pregnancy
2 weekly
how to reduce risk of HIV transmission to baby
aim viral load <50
ART at birth and for 2-4 weeks
no breastfeeding
if HIV positive, screen for what other infections
hep B/C
triad of hyperemesis gravidarum
> 5% pre-pregnancy weight loss
electrolyte imbalance
dehydration
SEs of antiemetics
cyclizine - anticholinergic
promethazine - sedation
when does normal morning sickness resolve
~14 weeks
RFs for hyperemesis
molar pregnancy
multiple pregnancy
previous Hx
FHx
complications of hyperemesis
maternal:
mallory-weirs tears
muscle wasting
malnutrition
foetal:
LBW
miscarriage/stillbirth
causes of symmetric IUGR
early pregnancy
chromosomal abnormalities
anaemia
pre-existing medical conditions
causes of asymmetric IUGR
late pregnancy
smoking
alcohol
placental insufficiency
pre-eclampsia
abruption
complications of IUGR
short term:
resp distress
hypoglycaemia
jaundice
long term:
CP
diabetes
chronic hypertension
how to date pregnancy in 1st and 2nd trimester
10-14 weeks: CRL
14-20 weeks: EFW/head circumference
how is IOL performed
membrane sweep
vaginal prostaglandin
ARM
what is a concerning finding on doppler ultrasound of umbilical artery
absence/reversal of end-diastolic flow
define stages of labour
1: passive (0-3/4cm dilation)
active (3/4-10cm dilation)
2: delivery of baby
3: delivery of placenta and membranes
causes of prolonged labour
malposition
epidural
obstructed labour
rate of dilation during 1st stage of labour
0.5cm/hour
how often to perform vaginal examinations during labour
every 4 hours
antepartum haemorrhage vs threatened miscarriage
threatened miscarriage <20 weeks
antepartum haemorrhage >20 weeks
causes of antepartum haemorrhage
placental abruption
placental accreta
placenta praevia
vasa praevia
trauma
bloody show
cervical ectropion
RFs for placental abruption
previous Hx
CS
pre-eclampsia
smoking
cocaine
how to prevent PPROM in high risk women
prophylactic vaginal progesterone
cervical cerclage
what tests for suspected PPROM
IGF binding protein-1 test
alpha-microglobulin-1 test
common causative organisms of chorioamnionitis
GBS
E coli
define pre-eclampsia
hypertension after 20 weeks + significant proteinuria
pathophysiology of pre-eclampsia
hypertension -> spiral artery remodelling -> poor placental perfusion -> less nutrients delivered to foetus
complications of pre-eclampsia
eclampsia
stroke
HELLP
what is eclampsia
seizures in patient w. pre-eclampsia
risks of pre-eclampsia to baby
IUGR/LBW
preterm
stillbirth
RFs for pre-eclampsia
previous Hx
FHx
obesity
hypertension
primip
physiological changes to BP in pregnancy
falls in 2nd trimester, normalises by term
risks of twin pregnancies
maternal:
miscarriage/stillbirth
pre-eclampsia
placenta praaevia
anaemia
foetal:
IUGR
TTTS
congenital abnormalities
polyhydramnios
ultrasound finding suggestive of MCDA pregnancy
lamda sign
when to deliver MCDA pregnancy
32-34 ELCS
RFs for twin pregnancy
AMA
IVF
ART
conceptus splitting and consequences for pregnancy
0-4 days: DCDA
4-8 days: MCDA
8-12 days: MCMA
>13 days: conjoined MCMA
indications for EMCS
failure to progress
foetal compromise
cord prolapse
placental abruption
categories of CS
1: immediate threat to life of mother/foetus
2: no immediate threat to life
3: early delivery required
4: elective
incision names for CS
pfannenstiel (pubic hairline)
Joel-Cohen (MC)
percentage of successful VBAC after 1 CS
70%
layers of CS
skin
fat
anterior rectus sheath
rectus muscles
parietal peritoneum
visceral peritoneum
uterine muscle
complications of CS
acute:
infection
bleeding
longer recovery
scars
long term:
uterine prolapse
placenta praevia
placenta accreta
