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2020 Phase 3a (DB) > obs1 > Flashcards

obs1 Flashcards

1
Q

RFs for pre-eclampsia

A 
maternal age
high bmi
nulliparous
multiple pregnancy
family history
10 year interval
chronic HTN
CKD
diabetes mellitus
AI disease - antiphospholipid syndrome
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2
Q

what is the criteria for diagnosing pre-eclampsia

A

> 20 weeks
htn
significant proteinuria (sometimes oedema)

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3
Q

what are the investigations for pre-eclampsia

A

blood pressure
protein creatinine ratio
urine dipstick

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4
Q

what medication for pre-eclampsia

A

first line labetolol - not in asthmatics
nifedipine
hydralazine
methyldopa

mag sulf as prophylaxis against seizures

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5
Q

what is the prevention medication for pre-eclampsia

A

75mg aspirin

  • PMH of pre-eclampsia
  • gestational HTN
  • diabetes
  • CKD
  • SLE/APS

or multiple moderate risk factors

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6
Q

what is the treatment for pre-eclampsia

A

induction of vaginal delivery at 37 weeks, steroids to mature fetal lungs

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7
Q

what is HELLP syndrome?

A

haemolysis
elevated liver enzymes
low platelets

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8
Q

what are the symptoms of hellp?

A

RUQ pain, malaise

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9
Q

what are the foetal complications of pre-eclampsia

A

IUGR
Prematurity
placental abruption

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10
Q

why are ACEi contraindicated in preeclampsia

A

teratogenic

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11
Q

what are risk factors for gestational diabetes?

A 
MACROS
Medical/Fam hx of gdm, macrosomia, t2dm
Age >40
Cystic (PCOS)
Race: non-white
Obese
Smoking
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12
Q

how is gestational diabetes investigated?

A

OGTT after overnight fast, if greater than or equal to >5.6, then gdm

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13
Q

how is gdm managed?

A

diet and exercise, metformin. glibenclamide, insulin

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14
Q

what is the second line management of gdm?

A

glibenclamide

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15
Q

when must you do growth scans in gdm/

A

from 28 weeks

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16
Q

when should you deliver in gdm?

A

offer from 37

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17
Q

why should you give steroids in baby with macrosomia?

A

often require c-section early, so mature foetal lungs

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18
Q

what are the complications of gdm for mum

A

htn and pre-eclampsia, inc risk pph

need for c section, instruments, tears

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19
Q

how does gdm affect risk of pph?

A

increases risk of pph

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20
Q

what are the risks to foetus from gdm?

A

Macrosomia
shoulder dystocia
neonatal hypoglycaemia
neonatal jaundice

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21
Q

what is placenta praevia?

A

placenta attached to lower uterine wall

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22
Q

why is placenta praevia bad?

A

placenta at risk of shearing off and bleeding

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23
Q

how does placenta praevia present?

A

painless bright red PV bleeding, may be post coital
CAN be painful

fetal lie/presentation abnormal. rarely fetal distress

24
Q

what is the main risk factor for placenta praevia?

A

previous c section

25
Q

what can provoke bleeding in placenta praevia?

A

vaginal exam/coitus

26
Q

when might placenta praevia be picked up?

A

20 week USS

27
Q

how do you prevent aph in placenta praevia

A

c-section from 37 is best

28
Q

how would you manage placenta praevia bleeding

A

abcde
transfusions, catheter
Anti-D if rhesus negative!!
if not stabilised, deliver baby

29
Q

what is placenta accreta?

A

placenta invades superficial myometrium

30
Q

what is placenta increta?

A

placenta invades deeper myometrium

31
Q

what is placenta percreta?

A

placenta invades into nearby organs such as bladder

32
Q

why is placenta accreta/increta/percreta bad?

A

can cause major aph/pph. deliver baby early by c section. hysterectomy may be required

33
Q

how is placenta accreta diagnosed?

A

uss

34
Q

risk factors for placenta accreta?

A

inc age of mum
previous c section
placenta praevia
ivf

35
Q

what is placental abruption

A

premature placental separation from uterine wall

36
Q

what is the main risk associated with placental abruption

A

aph

37
Q

what are the risk factors for placental abruption?

A
  • previous placental abruption
  • pre-eclampsia, htn
  • abnormal lie of baby
  • polyhydramnios
  • trauma
  • COCAINE
  • multiple pregnancy
  • underlying thrombophilias
38
Q

how does abruption present?

A

painful bleeding (can be minimal/dark red) as often concealed
woody/hard uterus
uterine contractions

rarely, shock, and low back pain

39
Q

how does abruption present in fetus?

A

fetal distress, absent HR

40
Q

how is placental abruption diagnosed?

A

clinical, but USS might show haematoma

CTG

41
Q

what is miscarriage

A

loss of preg before 24 weeks

42
Q

what is threatened miscarriage?

A

bleeding but closed os

43
Q

what is inevitable miscarriage

A

heavy bleeding, clots, pain and the cervical os is open.

44
Q

what is complete miscarriage?

A

all products of conception leave the body

45
Q

what is incomplete miscarriage?

A

retention of some products of conception in the body

46
Q

what is a missed miscarriage?

A

fetus dies, is retained, asymptomatic (no fetal HR)

47
Q

what are the symptoms of miscarriage?

A

pv bleeding (heavier than period usually), lower back pain/suprapubic pain

48
Q

what is recurrent miscarriage?

A

> 3 consecutive miscarriages

49
Q

give 5 potential causes of miscarriage?

A
  1. abnormal foetal development
  2. uterine abnormality
  3. incompetent cervix
  4. placental failure
  5. multiple pregnancy
50
Q

what might speculum exam of miscarriage show?

A
  • open os
  • pregnancy tissue/cause of bleed
  • Small for Gestational Age fetus
51
Q

what are the risk factors for miscarriage?

A

SAD BURTH

SLE
Age
Diabetes

BV
Uterine/ceRvical abnormality
Thrombophilia (inc APL syndrome)

52
Q

what would serum bHCG show for miscarriage

A

serial bhcg levels would show a falling level

53
Q

which investigation would confirm miscarriage?

A

Transvag uss, abdo uss less sensitive

54
Q

how do you manage a threatened miscarriage?

A

if threatened, conservative and pregnancy test 3 weeks later. offer medical/surgical treatment if unsuccessful

55
Q

how do you surgically manage an inevitable, incomplete, missed?

A
  • vacuum aspiration local anaesthetic
  • curettage under general anaesthetic
  • anti D if rh neg
  • counselling
56
Q

what is medical management of miscarriage?

A

remove any visual tissue
misoprostol PV or PO
may be bleeding for 3 weeks afterwards
analgesia

57
Q

how does misoprostol work in miscarriage?

A

stimulates ripening of cervix and myometrial contractions

2020 Phase 3a (DB) (20 decks)

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