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Obstetrics Flashcards

1
Q

What are the complications of gestational diabetes?

A

Large for date fetus
Macrosomia
Shoulder dystocia

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2
Q

What are the risk factors for gestational diabetes?

A 
Previous gestational diabetes
Previous macrosomic baby >4.5kg
BMI>30
Ethnic origin: Black/Arab/Indian
Family history of diabetes
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3
Q

What test is done for women with risk factors of gestational diabetes?

A

OGTT at 24-28 weeks

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4
Q

What is the diagnosis of gestational diabetes?

A

Normal results of OGTT:
Fasting <5.6mmol/l
At 2 hours: <7.8mmol/l

5-6-7-8

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5
Q

What is the management for gestational diabetes?

A

Fasting glucose <7: diet and exercise for 1-2 weeks followed by metformin then insulin

Fasting glucose >7: start insulin ± metformin

Fasting glucose >6 plus macrosomia: start insulin ± metformin

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6
Q

What should women with pre-existing diabetes do prior to getting pregnant?

A

Take 5mg folic acid from preconception until 12 weeks gestation

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7
Q

What happens to retinopathy screening for diabetic pregnant women?

A

Screening should be performed shortly after booking and at 28 weeks gestation

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8
Q

What happens at term for diabetic pregnant women?

A

Planned delivery between 37 and 38+6 weeks

women with gestational diabetes can give birth up to 40+6 weeks

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9
Q

What happens during labour for diabetic pregnant women

A

Sliding scale insulin regime is considered during labour for women with T1DM.

Also considered for women with poorly controlled T2DM

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10
Q

What is the postnatal care for diabetic pregnant women?

A

Gestational diabetic women can stop medication immediately and follow up with fasting glucose after 6 weeks.

Existing diabetic women should be vary of hypoglycaemia and lower insulin dose.

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11
Q

What is an amniotic fluid embolism?

A

When the amniotic fluid passes into the mother’s blood. Causes an immune reaction from the mother leading to systemic illness.

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12
Q

What are the risk factors for amniotic fluid embolism?

A

Increasing maternal age
Induction of labour
C-section
Multiple pregnancies

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13
Q

How does amniotic fluid embolism present?

A

Like sepsis, PE or anaphylaxis:

SOB
Hypoxia
Hypotension
Coagulopathy
Haemorrhage
Tachycardia
Confusion
Seizures
Cardiac arrest
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14
Q

What is management of amniotic fluid embolism?

A

Overall supportive but needs ABCDE

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15
Q

Definitions of different miscarriages

A

Missed: no longer alive, no symptoms have occurred

Threatened: vaginal bleeding with closed cervix and fetus alive

Inevitable: vaginal bleeding with open cervix

Incomplete miscarriage: retained products of conception

Complete miscarriage: full miscarriage and no products left

Anembryonic pregnancy: gestational sac is present but no embryo

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16
Q

What is the management for miscarriage at less than 6 weeks gestation?

A

Managed expectantly

Repeat urine pregnancy test after 7-10 days

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17
Q

What is the management for miscarriage after 6 weeks?

A

USS to confirm location and viability

Expectant management
Medical management (misoprostol)
Surgical management

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18
Q

What is the diagnosis of molar pregnancy?

A 
More severe morning sickness
Vaginal bleeding
Increased enlargement of the uterus
Abnormally high hCG
Thyrotoxicosis

US shows snowstorm appearance

Confirmed with histology of mole

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19
Q

How is hypothyroidism managed in pregnancy?

A

Levothyroxine dose needs to be increased by at least 25-50mcg

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20
Q

Which hypertension medications are harmful in pregnancy?

A

ACE inhibitors (ramipril)
ARB (losartan)
Thiazide and thiazide like diuretics (indapamide)

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21
Q

Which hypertension medications can be used in pregnancy?

A 
Labetalol 
Calcium channel blockers (e.g. nifedipine)
Alpha clockers (doxazosin)
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22
Q

How is epilepsy managed in pregnancy?

A

5mg folic acid daily before conception

Levetricetam, lamotrigine and carbamazepine safe in pregnancy

NO SODIUM VALPROATE

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23
Q

How is rheumatoid arthritis managed in pregnancy?

A

Hydroxycholoroquine is considered safe and first line

Sulfasalazine is safe

Corticosteroids may be used during flare-ups

NO METHOTREXATE

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24
Q

What is placenta praevia?

A

When the placenta is over the internal cervical OS

Notable cause of antepartum haemorrhage

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25
What are the risk factors for placenta praevia?
``` Previous C-section Previous placenta praevia Older maternal age Maternal smoking Structural uterine abnormalities (fibroids) Assisted reproduction (IVF) ```
26
What is the presentation and diagnosis of placenta praevia?
20 week anomaly scan is used to assess the placenta position and diagnose Many are asymptomatic May present with PAINLESS VAGINAL BLEEDING later in pregnancy (around or after 36 weeks)
27
What is the management of placenta praevia?
Corticosteroids are given between 34 and 35+6 weeks for lung maturity Planned delivery between 36 and 37 weeks gestation
28
What are the risk factors for placental abruption?
``` Previous placental abruption Pre-eclampsia Bleeding early in pregnancy Trauma Multiple pregnancy Fetal growth restriction Multigravida Increased maternal age Smoking ```
29
What is the presentation of placental abruption?
Sudden onset severe CONTINIOUS abdominal pain Vaginal bleeding Shock (hypotension and tachycardia) Abnormalities on CTG - fetal distress WOODY abdomen on palpation
30
What are the guidelines regarding measurements for antepartum haemorrhages?
Minor: <50ml Major: 50-1000ml Massive: >1000ml or shock
31
What is the management of placental abruption?
``` 2x grey cannula Bloods Crossmatch 4 units Fluid and blood resus CTG Monitor mother ``` USS to exclude placenta praevia Steroids between 24 and 34+6 Rhesus-D negative require anti-D prophylaxis
32
What is the triad of preeclamsia?
Hypertension Proteinuria Oedema After 20 weeks gestation
33
What are the risk factors for pre-eclampsia?
``` Pre-existing hypertension Previous hypertension in pregnancy Existing autoimmune conditions Diabetes CKD ```
34
What are the symptoms of pre-eclampsia?
``` Headache Visual disturbance/blurriness Nausea and vomiting Upper abdo/epigastric pain Oedema Reduced urine output Brisk reflexes ```
35
What is the diagnosis of pre-eclampsia?
Systolic >140 and diastolic >90 Plus any of: Proteinuria Organ dysfunction Placental dysfunction
36
What is the management of pre-eclampsia during labour?
Prophylactic aspirin at 12 weeks gestation for women with a single high risk factor or two or more moderate risk factor 1. Labetalol 2. Nifedipine 3. Methyldopa (stopped within 2 days of birth) 4. IV hydralazine 5. IV magnesium sulfate (stopped 24 hours after labour) 6. Fluid restriction
37
What is the management of pre-eclampsia after labour?
Switch to one or a combination of: 1. enalapril 2. nifedipine or amlodopine (first line in black peeps) 3. labetalol or atenolol
38
What is HELLP syndrome?
Haemolysis Elevated Liver enzymes Low Platelets
39
What is the criteria for an abortion to be performed at any time during pregnancy?
IF: Continuing pregnancy is likely to risk the life of the woman Terminating pregnancy will prevent "grave permanent injury" to the physical or mental health of woman There is "substantial risk" that the child would suffer physical or mental abnormalities making it seriously handicapped
40
What are the legal requirements for an abortion?
Two registered medical practitioners must sign to agree abortion is indicated Must be carried out by a registered medical practitioner in an NHS hospital
41
What are the medical abortion drugs
Mifepristone | Misoprostol 1-2 days later
42
What is vasa praevia?
where the fetal vessels are within the fetal membranes and travel across the internal cervical OS
43
What are the risk factors for vasa praevia?
Low lying placenta IVF pregnancy Multiple pregnancies
44
What is the presentation of vasa praevia?
May be diagnosed by USS Antepartum haemorrhage during 2nd or 3rd trimester Vaginal examination during labour Fetal distress and dark red bleeding during labour
45
What is the management for vasa praevia?
For asymptomatic women: corticosteroids from 32 weeks and elective c-section for 34-36 weeks
46
What are the risk factors for a VTE in pregnancy?
``` Smoking Parity >3 Age >35 BMI >30 Reduced mobility Multiple pregnancy Pre-eclampsia Gross varicose veins Immobility FHx of VTE Thrombophilia IVF pregnancy ```
47
What is guidance regarding prophylaxis for VTE in pregnancy?
28 weeks if there are three risk factors First trimester if there are four or more risk factors LMWH e.g. enoxaparin, dalteparin and tinzaparin Stopped when they go into labour and started afterwards
48
What is the diagnosis of DVT and PE in pregnancy?
DVT: Doppler US PE: CXR and ECG first line VQ scan diagnostic
49
What is the management of DVT in pregnancy>
LMWH and continued for 3 months after pregnancy
50
Which antibiotic should be given to children with group b strep sepsis?
Benzylpenicillin and gentamycin first line OR cefotaxime
51
What is the combined test?
First line and most accurate screening test for down syndrome performed between 11 and 14 weeks. USS shows nuchal thickness >6mm Blood test: - high bHCG - low PAPPA
52
What is the triple test?
Screening test for down syndrome performed between 14 and 20 weeks: Bloods: high bHCG low AFP low serum oestriol
53
Which form of contraception is safe in epilepsy?
If on enzyme inducers e.g. carbemazepine, phenytoin or topiramate: COPPER COIL, LEVONOGESTRAL IUS AND DEPO If on non-enzyme inducers e.g. levetriacetam, lamotrigin, sodium valproate: ANYTHING BUT DON'T GIVE COCP AND LAMOTRIGINE
54
What needs to be done in regards to COCP and surgery?
Stop 4 weeks before surgery and start 2 weeks after
55
What is the interaction between progesterone only pills and antibiotics
nothing
56
What is the treatment of bacterial conjunctivitis in pregnancy?
Topical fusidic acid eye drops
57
What are the classifications for post partum haemorrhage?
Defined as 500ml loss after vaginal delivery or 1000ml loss after C-section Minor <1000ml Major >1000ml Moderate 1000-2000ml Severe >2000ml Primary: within 24hrs Secondary: 24hr - 12weeks after birth
58
What are the causes of postpartum haemorrhage?
Four T's Tone Trauma Tissue Thrombin
59
What is the management to stop the bleeding in postpartum haemorrhage?
Mechanical: Rubbing uterus Catheterisation ``` Medical: Oxytocin Ergometrine Caboprost Misoprostol TXA ``` ``` Surgical: Intrauterine balloon tamponade B-lynch suture Uterine artery lligation Hysterectomy ```
60
What is Sheehan's syndrome?
Rare complication of post partum haemorrhage where there is avascular necrosis of the anterior pituitary gland which leads to cell death
61
What are the features of sheehan's syndrome?
Lack of lactation Amenorrhea Adrenal insufficiency and adrenal crisis Hypothyroidism Low cortisol and normal aldosterone
62
What is the management of Sheehan's syndrome?
Oestrogen and progesterone Levothyroxine Hydrocortisone Growth hormone
63
What is Meig's syndrome?
Triad of: Ovarian fibroma (benign ovarian tumour) Pleural effusion Ascites
64
What is cord prolapse?
When the umbilical cord descends below the presenting part of the fetus and through the cervix into the vagina. High risk of fetal hypoxia due to cord compression
65
What is the diagnosis of cord prolapse?
Should be suspected where there are signs of fetal distress on CTG. Speculum exam: DIAGNOSTIC
66
What is the management of cord prolapse?
Emergency C-Section Can push the presenting part of the baby back in Woman lie in left lateral position or on all fours Terabutaline can be used to minimise contractions
67
What is the definition of proteinuria?
Persistent urinary protein >300mg/25hr
68
What volume of amniotic fluid is consistent with polyhydraminos?
>2-3L
69
What are the signs of uterine hyperstimulation?
Either: >6 contractions within 10 minutes or <60s in between each contraction
70
Which babies are at risk of NRDS?
Diabetic mothers
71
What is the WHO guidelines for breast feeding?
Exclusively for 6 months and then combined with food for upto 2 years and beyond
72
What should be given to pregnant women who have a previous history of having a child with early/late onset group B strep?
IV antibiotic prophylaxis intrapartum
73
What is the preferred method of induction of labour?
Vaginal prostaglandin (PGE2)
74
What is the treatment for a RhD-ve women during pregnancy?
Anti-D 1st dose at 28 weeks 2nd dose at 34 weeks

Finals (20 decks)

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