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Repro > Obstetric Problems During Pregnancy > Flashcards

Obstetric Problems During Pregnancy Flashcards

1
Q

Hyperthyroidism symptom in pregnancy (5)

A 
Tachycardia, 
Arrhythmia, 
Tremor, 
Sweating, 
Weight loss
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2
Q

Aetiology of hyperthyroidism in pregnancy (4)

A

Grave’s disease,
Gestational transient thyrotoxicosis,
Thyroid adenoma,
Multinodular goitres

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3
Q

Graves disease cause

A

TSH receptor antibodies that stimulate thyroid gland and production of T3/T4

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4
Q

Graves disease investigation results of T3/T4, TSH and TSH receptor

A

High T3/T4, low TSH and positive TSH receptors

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5
Q

Graves Disease Treatment

A

Anti-thyroid drugs?

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6
Q

Gestation transient thyrotoxicosis starts when, resolves when

A

Typically starts week 7 and resolve by week 14-20

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7
Q

GTT causes by what?

A

High HCG directly stimulates thyroid gland so also associated with hyperemesis

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8
Q

Management of GTT?

A

Nil,

Just manage N&V

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9
Q

Management of hyperthyroidism in pregnancy

A

NO radioactive iodine,
1st trimester: propylthiouracil (liver toxicity in other trimesters),
2nd and 3rd carbimazole (teratogenicity in 1st trimester),

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10
Q

Obstetric cholestasis what’s happening

A

Build up of bile acids

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11
Q

Obstetric cholestasis symptoms (5)

A 
Abdo/RUQ pain, 
Nausea, 
Appetite loss, 
Pruritis worse on hands & feet and at night, 
Usually jsut excoriations
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12
Q

Obstetric cholestasis signs (5)

A 
Abnormal LFTs, 
Elevated bile acids, 
Dark urine, 
Jaundice, 
Elevated clotting times
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13
Q

Management of obstetric cholestasis (4)

A 
Menthol cream, 
Chlorphenamine to reduce itch, 
Ursodexoycholic acid, 
May need Vit K to reduce risk of haemorrhage, 
Early deliver
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14
Q

Pemphigoid gestationis is rare and usually presents in 2nd/3rd trimester. What is presentation?

A

Itchy raised rash with plaques that usually starts around belly button, develops blisters within 1-2 weeks

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15
Q

Management of pemphigoid gestationis?

A

Emollient,

Topical steroids

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16
Q

Polymorphic eruption of pregnancy AKA PUPPP

A

Pruritic urticarial papules and plaques of pregnancy

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17
Q

Symptoms of PUPPP

A

Itchy raised rash that starts in striae on abdomen and can move to buttocks and thighs, typically 3rd trimester

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18
Q

Management of PUPPP (3)

A

Emollient,
Steroids,
Antihistamines

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19
Q

Acute fatty liver of pregnancy definition

A

Liver dysfunction caused by progressive lipid accumulation

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20
Q

Acute fatty liver of pregnancy usually presents in which trimester?

A

3rd

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21
Q

Symptoms/signs of acute fatty liver of pregnancy? (9)

A 
Jaundice, 
Abdo pain, 
DIC, 
N&V, 
Oliguria, 
Malaise, 
Tachycardia, 
Fever, 
elevated LFTs,
22
Q

Management of acute fatty liver in pregnancy

A

Delivery

23
Q

Chorioamnionitis vaginal discharge colour and general presentation (4)

A

Foul-smelling, yellow/green liquid,
Fever,
Abdo pain,
Foetal distress

24
Q

Bacterial vaginosis discharge (3)

A

Watery,
Grey,
Smelly

25
Q

Vulvovaginal candidiasis discharge during pregnancy (5)

A 
Lumpy, 
White, 
“Cottage cheese”, 
Sour odour, 
ITCH
26
Q

Chlamydia discharge & presentation (4)

A

Yellow,
Can be no discharge,
Cervicitis,
Dysuria

27
Q

Gonorrhoea discharge and presentation (3)

A

Discharge,
Dysuria,
Abnormal bleeding

28
Q

Trichomonas discharge and presentation (5)

A 
Profuse, 
Frothy, 
Yellow, 
Vulval irritation, 
Sometimes dyspareunia
29
Q

Group B strep discharge colour

A

Yellow/green

30
Q

Neonatal HSV presentation

A

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,

31
Q

Morbidity in what system is most common in neonatal HSV even with antiviral treatment

A

Neurological morbidity

32
Q

Management of HSV presentation in pregnancy

A

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!

33
Q

Asymptomatic bacteriuria in pregnancy - treat with antibiotics or not?

A

Treat with antibiotics as can cause miscarriage/preterm labour.
Treat with nitrofurantoin or cefalexin

34
Q

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?

A

Intrapartum prophylactic antibiotics (usually penicillin) during labour and delivery

35
Q

RIsk factors for neonatal GBS infection (6)

A

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

36
Q

CLinical features of neonatal group b strep infection? (3)

A

Sepsis,
Pneumonia,
Meningitis

37
Q

When is external cephalic version performed?

A

37 - 39 weeks

38
Q

What is success rate of external cephalic version?

A

50%

39
Q

What is mother given during ECV?

A

analgesics,
tocolytics,
anti-d if necessary

40
Q

if babies are breech presentation, most will turn to cephalic by what week?

A

By week 36

41
Q

Absolute Contraindications for ECV (7)

A

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)

42
Q

Relative contraindications for ECV (7)

A

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

43
Q

Placenta accreta

A

The adherence of the placenta directly to superficial myometrium but does not penetrate the thickness of the muscle.

44
Q

Placenta increta

A

The villi invade into but not through the myometrium

45
Q

Placenta percreta

A

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.

46
Q

Risks factors for placenta accreta/increta/percreta? (6)

A 
previous termination of pregnancy, 
dilatation and curettage, 
Caesarean section, 
advanced maternal age, 
placenta praevia, 
 uterine structural defects
47
Q

Risks of placenta accreta/increta/percreta? (3)

A

severe postpartum bleeding,
preterm labour,
uterine rupture

48
Q

Naegele’s rule

A

add 9 months to LMP plus 7 days

49
Q

Pharmacological Pain ladder for analgesia during labour

A

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

50
Q

Can NSAIDs be used during pregnancy?

A

No because can cause premature closing of foetal ductus arteriosus in utero,
resistant pulmonary hypertension of the newborn,
delayed onset of labour

Repro (49 decks)

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