Obsetrics Flashcards
Types of miscarriage
Threatened- abdo pain, brown discharge, intact membranes, cervix closed, viable intrauterine pregnancy
Incomplete- Heavy bleeding including some products of contraception, cervix dilated, retained tissues
Complete- Bleeding and complete passage of products , cervix closed or open, empty uterus
Inevitable - Vaginal bleeding and abdo pain, membranes may / may not be ruptured, cervix dilated.
Placental abruption
Most common near end of pregnancy
Vaginal bleeding, or no bleeding
Abdo and back pain suddenly
Risks: cocaine use, smoking, trauma, chronic high BP,HELLP, pre eclampsia, early rupture of Sac, infection
Immediate delivery via CS if after 34weeks and if decelerations >3mins or acute bradycardia.
Causes of Polyhydramnios
Too much amniotic fluid
Slight increase risk of - premi, waters breaking early, cord prolapse, heavier bleeding of uterus.
causes - multiple pregnancy, diabetes, baby gut atresia, infection, rhesus disease, genetic conditions
Amniocentesis
Tests- downs, Edwards, pataus syndrome, CF, muscular dystrophy, sickle cell, thalassaemia.
1/100 women miscarry
Between 15th and 20th week
Edwards Syndrome
Trisomy 18
80% female
Usually die shortly after birth - heart and kidney malformations
Signs: Prominent occiput, small face and jaw, wide set nipples, clenched hands and overlapping fingers, malformed ears, wide spaced eyes.
Patau Syndrome
trisomy 13 fatal in first year
Signs: Cleft lip or palate, clenched hands, close set small (micropthalmia)eyes, deformed ears, small head, raised red birth marks.
1/10 cases - chromosomal translocation
Can have trisomy mosacism (only some cells have trisomy)
Partial trisomy (only part of 1 of the chromosome 13 extra )
Chorionic Villus Sampling
Cells from placenta Not routine Genetic condition testing Between 11th - 14th week Most commonly transabdominal CVS 1/100 chance of miscarriage
Drugs contraindicated in pregnancy
NSAIDS - teratogenic effects in first trimester, affect prostaglandin production. Warfarin - birth defects Valproic acid Lithium ACEI - foetal renal damage Sulfonamides - AB’s Aminoglycosides - AB’s Doxycycline Tetracycline - tooth and bone development Thalidomide - multiple myeloma and Hansens disease tx Antidepressants - TCAs Methotrexate Diazepam
Folic acid use
Want to conceive: 400micrograms daily pre-conception until 12weeks
Diabetes : 5mg until 12weeks - neural tube defect risk - (anencephaly, spina bifida )
Helps in production RBCs - anaemia
B - HCG
Human chorionic gonadotropin - from trophoblast Cells surrounding embryo - from placenta
Pregnancy urine test - pos = >25. can be pos 21 days after contraception
Peaks at 8-10 weeks 30000mIU/ml
After 12weeks (1st T) drop to 10000 and maintained
Gestational trophoblastic Disease
Group of rare diseases - abnormal trophoblastic cells
Tumor develops in uterus.
Types: hydatidiform mole, invasive mole, choriocarinoma
Hydratidifrom / molar- most common, villi swollen with fluid, bunch of grapes, not cancerous.
Turner syndrome
X
Signs: short status, webbed neck, underdeveloped ovaries, infertility, sometime behavioural difficulties
Karyotyping - chromosome analysis
Klinefelter syndrome
XXY
Signs: small penis, infertile, enlarged breasts, tall, impaired IQ
Low testosterone
Pre eclampsia
Diagnosis: 2 BP 4-6h apart , sbp >140 or dbp >90 or increase from booking pressure by S >30 D >20 in second half of pregnancy
Evidence of protein urea
Headaches
Visual changes
Congenital rubella syndrome
Within first 20weeks
Sx : deafness, cataracts, heart disease (PDA and pulmonary stenosis) , learning disability
No MMR for pregnant ladies- live
