obs1 Flashcards
RFs for pre-eclampsia
maternal age high bmi nulliparous multiple pregnancy family history 10 year interval chronic HTN CKD diabetes mellitus AI disease - antiphospholipid syndrome
what is the criteria for diagnosing pre-eclampsia
> 20 weeks
htn
significant proteinuria (sometimes oedema)
what are the investigations for pre-eclampsia
blood pressure
protein creatinine ratio
urine dipstick
what medication for pre-eclampsia
first line labetolol - not in asthmatics
nifedipine
hydralazine
methyldopa
mag sulf as prophylaxis against seizures
what is the prevention medication for pre-eclampsia
75mg aspirin
- PMH of pre-eclampsia
- gestational HTN
- diabetes
- CKD
- SLE/APS
or multiple moderate risk factors
what is the treatment for pre-eclampsia
induction of vaginal delivery at 37 weeks, steroids to mature fetal lungs
what is HELLP syndrome?
haemolysis
elevated liver enzymes
low platelets
what are the symptoms of hellp?
RUQ pain, malaise
what are the foetal complications of pre-eclampsia
IUGR
Prematurity
placental abruption
why are ACEi contraindicated in preeclampsia
teratogenic
what are risk factors for gestational diabetes?
MACROS Medical/Fam hx of gdm, macrosomia, t2dm Age >40 Cystic (PCOS) Race: non-white Obese Smoking
how is gestational diabetes investigated?
OGTT after overnight fast, if greater than or equal to >5.6, then gdm
how is gdm managed?
diet and exercise, metformin. glibenclamide, insulin
what is the second line management of gdm?
glibenclamide
when must you do growth scans in gdm/
from 28 weeks
when should you deliver in gdm?
offer from 37
why should you give steroids in baby with macrosomia?
often require c-section early, so mature foetal lungs
what are the complications of gdm for mum
htn and pre-eclampsia, inc risk pph
need for c section, instruments, tears
how does gdm affect risk of pph?
increases risk of pph
what are the risks to foetus from gdm?
Macrosomia
shoulder dystocia
neonatal hypoglycaemia
neonatal jaundice
what is placenta praevia?
placenta attached to lower uterine wall
why is placenta praevia bad?
placenta at risk of shearing off and bleeding
how does placenta praevia present?
painless bright red PV bleeding, may be post coital
CAN be painful
fetal lie/presentation abnormal. rarely fetal distress
what is the main risk factor for placenta praevia?
previous c section
what can provoke bleeding in placenta praevia?
vaginal exam/coitus
when might placenta praevia be picked up?
20 week USS
how do you prevent aph in placenta praevia
c-section from 37 is best
how would you manage placenta praevia bleeding
abcde
transfusions, catheter
Anti-D if rhesus negative!!
if not stabilised, deliver baby
what is placenta accreta?
placenta invades superficial myometrium
what is placenta increta?
placenta invades deeper myometrium
what is placenta percreta?
placenta invades into nearby organs such as bladder
why is placenta accreta/increta/percreta bad?
can cause major aph/pph. deliver baby early by c section. hysterectomy may be required
how is placenta accreta diagnosed?
uss
risk factors for placenta accreta?
inc age of mum
previous c section
placenta praevia
ivf
what is placental abruption
premature placental separation from uterine wall
what is the main risk associated with placental abruption
aph
what are the risk factors for placental abruption?
- previous placental abruption
- pre-eclampsia, htn
- abnormal lie of baby
- polyhydramnios
- trauma
- COCAINE
- multiple pregnancy
- underlying thrombophilias
how does abruption present?
painful bleeding (can be minimal/dark red) as often concealed
woody/hard uterus
uterine contractions
rarely, shock, and low back pain
how does abruption present in fetus?
fetal distress, absent HR
how is placental abruption diagnosed?
clinical, but USS might show haematoma
CTG
what is miscarriage
loss of preg before 24 weeks
what is threatened miscarriage?
bleeding but closed os
what is inevitable miscarriage
heavy bleeding, clots, pain and the cervical os is open.
what is complete miscarriage?
all products of conception leave the body
what is incomplete miscarriage?
retention of some products of conception in the body
what is a missed miscarriage?
fetus dies, is retained, asymptomatic (no fetal HR)
what are the symptoms of miscarriage?
pv bleeding (heavier than period usually), lower back pain/suprapubic pain
what is recurrent miscarriage?
> 3 consecutive miscarriages
give 5 potential causes of miscarriage?
- abnormal foetal development
- uterine abnormality
- incompetent cervix
- placental failure
- multiple pregnancy
what might speculum exam of miscarriage show?
- open os
- pregnancy tissue/cause of bleed
- Small for Gestational Age fetus
what are the risk factors for miscarriage?
SAD BURTH
SLE
Age
Diabetes
BV
Uterine/ceRvical abnormality
Thrombophilia (inc APL syndrome)
what would serum bHCG show for miscarriage
serial bhcg levels would show a falling level
which investigation would confirm miscarriage?
Transvag uss, abdo uss less sensitive
how do you manage a threatened miscarriage?
if threatened, conservative and pregnancy test 3 weeks later. offer medical/surgical treatment if unsuccessful
how do you surgically manage an inevitable, incomplete, missed?
- vacuum aspiration local anaesthetic
- curettage under general anaesthetic
- anti D if rh neg
- counselling
what is medical management of miscarriage?
remove any visual tissue
misoprostol PV or PO
may be bleeding for 3 weeks afterwards
analgesia
how does misoprostol work in miscarriage?
stimulates ripening of cervix and myometrial contractions
