Obstetric Flashcards
when is risk of rubella highest in pregnancy
in first 8-10 weeks risk of damage to fetus is as high as 90%
damage is rare after 16 weeks
features of congenital rubella syndrome
sensorineural deafness
congenital cataracts
congenital heart disease
learning difficulties
management of rubella exposure in pregnancy
should be discussed with local health protection unit
non-immune mothers should be vaccinated after giving birth
pre-eclampsia features a triad of what
hypertension
proteinuria
oedema
criteria for diagnosing pre-eclampsia
new hypertension of >140/90mmHg after 20 weeks AND 1 of the following:
proteinuria
end organ dysfunction e.g. raised creatinine, abnormal LFTs
features of severe pre-eclampsia
headache
visual changes/papilloedema
RUQ pain/epigastric pain
hyperreflexia
platelet count < 100 * 106/l, abnormal liver enzymes or HELLP syndrome
why can’t ACEi or ARBs be used in pregnancy
teratogenic
recommendation of folic acid during pregnancy
all women = 400mcg until 12th week of pregnancy
higher risk of conceiving a child with neural tube defects: 5mcg before conception until 12th week
higher risk includes:
either partner has NTD, FHx, or previous pregnancy
women is obese >30kg/m2
women takes anti-epileptic drugs, has coeliacs, diabetes, thalassaemia
what is obstetric cholestasis
seen in third trimester, occurs in around 1% of pregnancies
most common liver disease of pregnancy
raised bilirubin
pruritus, often of palms & soles
no rash, but might have excoriation marks
increased risk of stillbirth
management of obstetric cholestasis
ursodeoxycholic acid is used for symptomatic relief
weekly liver function tests
women are typically induced at 37 weeks
presentation of nipple candidiasis when breastfeeding
bilateral burning pain
itching
hypersensitivity of the niiple
what is a galactocele
occurs in women who have recently stopped breastfeeding, occurs due to occlusion of a lactiferous duct
** can be differentiated from an abscess by the fact that a galactocele is usually painless, with no local or systemic signs of infection
management of pre-eclampsia
NICE recommend emergency secondary care assessment for any women with suspected pre-eclampsia
>160/110mmHg likely to be admitted & monitored
oral labetalol = first line
delivery of the baby
most common cause of early onset severe infection in the neonatal period
group B streptococcus
risk factors for GBS infection
prolonged rupture of membranes
previous pregnancy with GBS infection
prematurity
maternal pyrexia e.g. due to chorioamnionitis
when should intrapartum antibiotic prophylaxis be given for GBS
preterm deliveries
maternal pyrexia during delivery >38
previous baby with early or late onset GBS disease
Hb cut offs to determine if a pregnant women should receive oral iron supplementation
first trimester: <110
second: <105
post-partum: <100
Complete hydatidiform mole presentation
painless vaginal bleeding in 1st or 2nd trimester
exaggerated symptoms of pregnancy
uterus large for dates
elevated levels of hCG (may cause hyperthyroidism symptoms)
management of complete hydatidiform mole
urgent referral to specialist centre - evacuation of the uterus is performed
effective contraception is recommended to avoid pregnancy in the next 12 months
management of mastitis
flucloxacillin for 14 days, continue breastfeeding
stages of post partum thyroiditis
thyrotoxicosis
hypothyroidism
normal thyroid function
diagnosis of post partum thyroiditis
within 12 months of giving birth
clinical manifestations of hypothyroidism
TFTs support diagnosis
management of post partum thyroiditis
propranolol used for symptomatic relief
thyroxine used in hypothyroidism stage
treatment of nipple candidiasis when breastfeeding
miconazole cream for the mother and nystatin suspension for the baby
when to offer a gestational diabetes test to women after birth
fasting plasma glucose 6-13 weeks after
SSRIs of choice in breastfeeding women
sertraline, paroxetine
presentation of placental abruption
shock out of keeping with visible blood loss
constant pain
tender, tense uterus
normal lie & presentation
fetal heart: distressed/absent
presentation of placenta praevia
shock in keeping with visible blood loss
no pain
uterus not tender
lie & presentation may be abnormal
fetal heart usually normal
what should not be performed in primary care for suspected antepartum haemorrhage
a vaginal examination
** a patient with placenta praevia may haemorrhage
risk factors for gestational diabetes
previous gestational diabetes
previous macrosomic baby, >4.5kg
first degree family history of diabetes
ethnic origin
BMI >30
what causes an increase in alpha-feto protein
abdominal wall defects
neural tube defects
multiple pregnancy
what causes a decrease in alpha-feto protein
down syndrome
trisomy 18
maternal diabetes mellitus
high risk factors for pre-eclampsia
autoimmune condition e.g. SLE
T1/2DM
pre-existing hypertension
previous hypertension in pregnancy
CKD
moderate risk factors for pre-eclampsia
> 40 yrs
BMI >35
multiple pregnancy
first pregnancy
10yrs since last pregnancy
family history of pre-eclampsia
management of breech presentation
<36 weeks = many foetus’ will turn spontaneously
>36 weeks: external cephalic version at 36 weeks for nulliparous women and at 37 weeks for multiparous women
if baby is still breech: delivery options include c-section & vaginal delivery
what is the antenatal testing done for Down’s syndrome
nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A)
done between 11-13+6 weeks
Down’s syndrome is suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency
use of SSRI in pregnancy
1st trimester - increased risk of congenital malformations
later pregnancy, after 20 weeks - increased risk of pulmonary hypertension
neonatal withdrawal symptoms
what is puerperal pyrexia
fever >38 in the first 14 days following delivery
causes:
endometritis
UTI
wound infections e.g. perineal tears, c-section
VTE
mastitis
management of puerperal pyrexia
if endometritis suspected:
patient should be admitted for IV antibiotics until afebrile for >24 hours
gentamicin & clindamycin
cmanagement of puerperal pyrexia
