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
Chicken pox in pregnancy
Varicella zoster virus Dangerous in severe cases in mother: Pneumonitis , hepatitis , encephalitis Fetal varicella syndrome Can do IgG ab test to check mums immunity Immunoglobulins for prophylaxis Fetal growth restriction Microcephaly Skin changes on specific dermatomes Cataracts Limb hypoplasia
Cardiac arrest in pregnancy
Reversible causes of arrest: 4 Ts : Thrombosis Tension pneumo Toxins Tamponade
4 H’s: Hypoxia Hypovolaemia Hypothermia Hyperkaleamia, hypoglycaemia, and other metabolic abnormalities
Also: eclampsia , intracranial haemorrhage
Haemorrhage: main cause of hypovolaemia Ectopic pregnancy Placental abruption Placenta previa Placenta accreta Uterine rupture
Placental preavia
Major cause of antipartum haemorrhage Diagnoses at 20 week anomaly scan Repeat scans at 32+36 weeks Corticosteroids between 34+35 + 6 weeks to mature babies lungs CS at 36-37 weeks
Pre eclampsia diagnosis and Tx
Triad: hypertension , proteinuria, edema
BP : s>140 d>90
Organ disfunction: creat liver raised Seizures Thrombocytopenia Haemolytic anaemia Proteinuria: creat ratio >30 Albumin: creat ration >8
Management: aspirin prophylaxis
Labetolol
Nifedipine-2nd line
IV MgSO4 in labour and 24h after to prevent seizure
Downs screening
Combined test: Beta HCG higher = higher risk Pregnancy associated plasma protein A (PAPPA) = Low indicates higher risk Between 11-14 weeks Ultrasound nuchal translucency >6mm Also triple and quad tests.
APGAR score
Appearance - blue/pale, blue extremities, no cyanosis
Pulse rate - <60, 60-100, >100
Grimace- no response, on aggressive stimulation, cries on stimulation
Activity- tone - floppy, some flexion, resists extension
Respiratory effort - absent, weak/ gasping, strong cry
0,1,2
/10
Lactation hormones
Antagonist until term: progesterone mostly, and oestrogen
Then postpartum increase prolactin and not blocked
Oxytocin : makes cells in alveoli contract - the ‘letdown reflex’- skin on skin contact . Also makes uterus contact during and after delivery
Stimulates prostaglandin release further increasing contractions
Oestrogen in pregnancy
From CL until placenta takes over (18-20weeks)( with progesterone)
Helps organ and placenta development
Uterus wall and maintain lining
Regulates other hormones
Later, with progesterone helps body prepare for breastfeeding.
Progesterone in pregnancy
Cause increase blood flow to uterus
Inhibits contractions so uterus grows as baby does
Strengthens pelvic wall muscles
