Obstetrics 1 Flashcards
Causes of increased AFP (3)
Neural tube defects
Abdominal wall defects
Multiple pregnancy
Causes of decreased AFP (3)
Down’s
Trisomy 18
Maternal DM
All pregnant and breastfeeding women should take which vitamins?
10mcg vitamin D
First line treatment for nausea and vomiting in pregnancy
Anti-histamines - promethazine
What natural remedies are NICE recommended for nausea and vomiting in pregnancy?
Ginger and acupuncture on the p6 point by the wrist
NICE recommendations for number of antenatal visits in the first pregnancy and subsequent pregnancies if uncomplicated
10, then 7
Antenatal care timetable
What is the purpose of the 8-12 week appt?
Booking appt
Booking bloods - FBC, G&S, Rh, red cell alloantibodies, haemoglobinopathies, hep B, syphillis, HIV, urine culture
What is the purpose of the 10-13+6 week appt?
Confirm dates
Exclude multiple pregnancy
What is the purpose of the 11-13+6 week appt?
Down’s screening
Nuchal scan
What is the purpose of the 16 weeks appt?
If Hb<11 consider iron
Routine
Info on anomaly scan and bloods
What is the purpose of the 18-20+6 appt?
Anomaly scan
What is the purpose of the K25 appt?
Routine if primip
What happens at K28?
Routine
Second screen for anaemia and atypical red cell alloantibodies
First dose of anti-D to Rh-ve women
If Hb<10.5 consider iron
What happens at 31K
Routine care if primip
What happens at K34?
Second dose of anti-D to Rh-ve women
Information on labour and birth plan
What happens at K36? (3)
Check presentation
Offer external cephalic version
Breastfeeding, vitamin K and baby blues info
What happens at K38, K40 and K41?
Routine care
Discussion about options for prolonged pregnancy
Discuss labour plans and induction
Name seven conditions that should not be offered for screening
BV
Chlamydia
Hep C
Toxoplasmosis
Fragile X
Cytomegalovirus
Group B Strep
How is antepartum haemorrhage defined?
> K24
Typically bleeding in first or early second trimester associated with exaggerated symptoms of pregnancy e.g. hyperemesis. The uterus may be large for dates and serum hCG is very high
Hydatiform mole
Rupture of membranes followed immediately by vaginal bleeding. Fetal bradycardia is classically seen
Vasa praevia
Breastfeeding protects agains which two cancers?
Breast and ovarian
Which antibodies are passed from mother to child through breastfeeding?
IgA
Name five disadvantages of breastfeeding
Vitamin K deficiency
Vitamin D deficiency
Breast milk jaundice
Transfer of infections
Transfer of drugs
What is the treatment for nipple candidiasis? (2)
Topical miconazole for mum
Nystatin suspension for the baby
Mx of blocked duct (milk bled)
Should breastfeeding continue?
Breastfeeding should continue
Breast massage and advice on position of baby
When to treat mastitis? (4)
Systemically unwell
Nipple fissure present
Sx not improving after 12-24 hours of effective milk removal
Culture indicates infection
How to treat mastitis?
Should breastfeeding continue?
Fluclox 10-14 days
Yes
Mx of breast abscess (1)
Incision and drainage
Intermittent nipple pain during and immediately after breastfeeding =
Raynaud’s disease of the nipple
Cut off threshold for weight loss for babies in the first week of life =
10%
Name two breastfeeding CI
Viral infections
Galactosaemia
Most common breech position?
Frank breech - hips flexed, knees extended
Mx of breech
Percentage success rate
K36 offer ECV if primip
Otherwise offer at K37
60% success rate
Chickenpox is caused by which virus?
Varicella zoster virus
Increased risk of which condition for mothers with chickenpox exposure?
Pneumonitis
Name x5 features of fetal varicella syndrome
Skin scarring
Limb hypoplasia
Microcephaly
LD
Microphthalmia
Risk of FVC (in gestation)
<K20 = 1%
20-28 very few cases
>K28 nil
What is severe neonatal varicella and what is the risk to the child?
Mother develops a rash between 5 days prior and 2 days post birth
20% fatal
Mx chickenpox exposure
Step 1
If K<20
If K>20
Effective up to how many days post exposure?
Any doubt about previous chickenpox in mother = check maternal blood for antibodies
If K<20 and not immune = give VZIG
Effective up to 10 days post exposure
If >K20 and not immune then either VZIG or antivirals (aciclovir or valaciclovir) to be given 7-14 days post exposure
Mx chickenpox in pregnancy
If >K20
If <K20
Specialist advice
PO aciclovir if K>20 and if she present 24 hours from the onset of the rash
If K<20 aciclovir with caution
What is the combined test when screening for Down’s? (3)
What would you expect in Down’s babies?
Nuchal translucency (thickened)
Serum BHCG (raised)
PAPP-A (low)
What is the quadruple test in screening?
When would it be offered? (gestation)
Offered if booked later - between 15-20K
AFP
Unconjugated oestriol
HCG
Inhibin A
Quadruple test interpretation Down’s
AFP low
Unconjugated oestriol low
HCG high
Inhibin A high
Quadruple test interpretation Edward’s
AFP low
Unconjugated oestriol low
HCG low
Inhibin A normal
Quadruple test interpretation neural tube defects
AFP high
Unconjugated oestriol normal
HCG normal
Inhibin A normal
If 12 week scan comes back as high risk what is offered next? (3)
NIPT
CVS
Amniocentesis
Which is the least teratogenic anti-epileptic?
Carbamezapine
Which anti-epileptic is..
Associated with neural tube defects
Associated with cleft palate
Needs to be increased in pregnancy
Sod valp
Phenytoin
Lamotrogine
Women taking phenytoin should be given what in the last month of pregnancy?
Vitamin K
Folic acid guidelines in pregnancy
All women should take 400mcg until 12th week of pregnancy
If at high risk of NTD then 5mg from before conception to 12th week
Who is high risk of NTD? (5)
Anti-epileptics
Coeliacs
DM
Thalassaemia
Obese
Viable age of pregnancy
Twins GP
K24
G1P2
SFH measurement
Used from what gestation?
Leeway in cm
Top of uterus to top of pubic bone
K20
2cm either side
Name three causes of hyperechogenic bowel
CF
Down’s
Cytomegalovirus
Name three causes of increased nuchal translucency
Down’s
Congenital heart defects
Abdominal wall defects
Anti-D given at which two weeks?
K28 and K34
Anaemia screen at which weeks?
K16 <11 consider iron and K28 <10.5 consider iron
