Obstetric Problems During Pregnancy Flashcards
Hyperthyroidism symptom in pregnancy (5)
Tachycardia, Arrhythmia, Tremor, Sweating, Weight loss
Aetiology of hyperthyroidism in pregnancy (4)
Grave’s disease,
Gestational transient thyrotoxicosis,
Thyroid adenoma,
Multinodular goitres
Graves disease cause
TSH receptor antibodies that stimulate thyroid gland and production of T3/T4
Graves disease investigation results of T3/T4, TSH and TSH receptor
High T3/T4, low TSH and positive TSH receptors
Graves Disease Treatment
Anti-thyroid drugs?
Gestation transient thyrotoxicosis starts when, resolves when
Typically starts week 7 and resolve by week 14-20
GTT causes by what?
High HCG directly stimulates thyroid gland so also associated with hyperemesis
Management of GTT?
Nil,
Just manage N&V
Management of hyperthyroidism in pregnancy
NO radioactive iodine,
1st trimester: propylthiouracil (liver toxicity in other trimesters),
2nd and 3rd carbimazole (teratogenicity in 1st trimester),
Obstetric cholestasis what’s happening
Build up of bile acids
Obstetric cholestasis symptoms (5)
Abdo/RUQ pain, Nausea, Appetite loss, Pruritis worse on hands & feet and at night, Usually jsut excoriations
Obstetric cholestasis signs (5)
Abnormal LFTs, Elevated bile acids, Dark urine, Jaundice, Elevated clotting times
Management of obstetric cholestasis (4)
Menthol cream, Chlorphenamine to reduce itch, Ursodexoycholic acid, May need Vit K to reduce risk of haemorrhage, Early deliver
Pemphigoid gestationis is rare and usually presents in 2nd/3rd trimester. What is presentation?
Itchy raised rash with plaques that usually starts around belly button, develops blisters within 1-2 weeks
Management of pemphigoid gestationis?
Emollient,
Topical steroids
Polymorphic eruption of pregnancy AKA PUPPP
Pruritic urticarial papules and plaques of pregnancy
Symptoms of PUPPP
Itchy raised rash that starts in striae on abdomen and can move to buttocks and thighs, typically 3rd trimester
Management of PUPPP (3)
Emollient,
Steroids,
Antihistamines
Acute fatty liver of pregnancy definition
Liver dysfunction caused by progressive lipid accumulation
Acute fatty liver of pregnancy usually presents in which trimester?
3rd
Symptoms/signs of acute fatty liver of pregnancy? (9)
Jaundice, Abdo pain, DIC, N&V, Oliguria, Malaise, Tachycardia, Fever, elevated LFTs,
Management of acute fatty liver in pregnancy
Delivery
Chorioamnionitis vaginal discharge colour and general presentation (4)
Foul-smelling, yellow/green liquid,
Fever,
Abdo pain,
Foetal distress
Bacterial vaginosis discharge (3)
Watery,
Grey,
Smelly
Vulvovaginal candidiasis discharge during pregnancy (5)
Lumpy, White, “Cottage cheese”, Sour odour, ITCH
Chlamydia discharge & presentation (4)
Yellow,
Can be no discharge,
Cervicitis,
Dysuria
Gonorrhoea discharge and presentation (3)
Discharge,
Dysuria,
Abnormal bleeding
Trichomonas discharge and presentation (5)
Profuse, Frothy, Yellow, Vulval irritation, Sometimes dyspareunia
Group B strep discharge colour
Yellow/green
Neonatal HSV presentation
Local features: vesicular lesions on skin, eye, oral mucosa,
Disseminated: seizures, encephalitis, hepatitis, sepsis
- 70% have disseminated +/- CNS infection,
Present between 10days and 4 weeks,
Morbidity in what system is most common in neonatal HSV even with antiviral treatment
Neurological morbidity
Management of HSV presentation in pregnancy
400mg aciclovir 3 times daily for 5 days,
If first/second trimester when get it then need daily 400mg aciclovir 3 times daily from 36 weeks,
If lesions 6 weeks before term or any lesions at term then C-SECTION!
Asymptomatic bacteriuria in pregnancy - treat with antibiotics or not?
Treat with antibiotics as can cause miscarriage/preterm labour.
Treat with nitrofurantoin or cefalexin
Group B strep is a common commensal in genitourinary and GI tract in approx 25% of people. However if infected during pregnancy it can cause problems. If group B strep bacteria in urine identified during pregnancy, what is management?
Intrapartum prophylactic antibiotics (usually penicillin) during labour and delivery
RIsk factors for neonatal GBS infection (6)
Positive GBS culture in current/previous pregnancy,
Previosu birth resulting in neonatal GBS infection,
Pre-term labour,
Prolonged rupture of membranes,
Intra-partum fever >38 degrees,
Chorioamnionitis
CLinical features of neonatal group b strep infection? (3)
Sepsis,
Pneumonia,
Meningitis
When is external cephalic version performed?
37 - 39 weeks
What is success rate of external cephalic version?
50%
What is mother given during ECV?
analgesics,
tocolytics,
anti-d if necessary
if babies are breech presentation, most will turn to cephalic by what week?
By week 36
Absolute Contraindications for ECV (7)
Caesarean section is already indicated for other reason,
Ante-partum haemorrhage has occurred in the last 7 days,
Non-reassuring cardiotocograph,
Major uterine abnormality,
Placental abruption or placenta praevia,
Membranes have ruptured,
Multiple pregnancy (but may be considered for delivery of the second twin)
Relative contraindications for ECV (7)
Intrauterine growth restriction with abnormal umbilical artery Doppler index,
Pre-eclampsia,
Maternal obesity,
Oligohydramnios,
Major foetal abnormalities,
Uterine scarring from previous Caesarean section or myomectomy,
Unstable foetal lie
Placenta accreta
The adherence of the placenta directly to superficial myometrium but does not penetrate the thickness of the muscle.
Placenta increta
The villi invade into but not through the myometrium
Placenta percreta
The villi invade through the full thickness of the myometrium to the serosa. There is increased risk of uterine rupture and in severe cases the placenta may attach to other abdominal organs such as the bladder or rectum.
Risks factors for placenta accreta/increta/percreta? (6)
previous termination of pregnancy, dilatation and curettage, Caesarean section, advanced maternal age, placenta praevia, uterine structural defects
Risks of placenta accreta/increta/percreta? (3)
severe postpartum bleeding,
preterm labour,
uterine rupture
Naegele’s rule
add 9 months to LMP plus 7 days
Pharmacological Pain ladder for analgesia during labour
Nitrous Oxide (Entonox or ‘gas and air’),
Simple analgesia E.g. Paracetamol.
Opiate analgesia: Oral Codeine Phosphate, IV/IM Diamorphine,
Epidural analgesia,
Pudendal nerve block
Can NSAIDs be used during pregnancy?
No because can cause premature closing of foetal ductus arteriosus in utero,
resistant pulmonary hypertension of the newborn,
delayed onset of labour
