Obstetrics Flashcards
SSRIs that can be used whilst breastfeeding
Sertraline
Paroxetine
Risk factors for gestational diabetes
BMI >30
Previous baby >4.5kg
Previous gestational DM
Diabetes in 1st-degree relative
South Asian, Afro-Caribbean, Middle Eastern
Screening for gestational diabetes - women with prior gestational diabetes
OGTT asap after booking + at 24-28 weeks
Screening for gestational diabetes - women without prior gestational DM
OGTT at 24-28 wks if any risk factors
Diagnosis of gestational diabetes: fasting glucose
Fasting glucose >= 5.6 mmol/L
Diagnosis of gestational diabetes: 2-hour glucose
2-hour glucose >= 7.8 mmol/L
If mother is HBsAg positive, anti-HBe positive, newborn should receive
Hep B vaccine
Mother had acute hepatitis B during pregnancy, newborn should receive
Hep B vaccine + Hep B immunoglobulin
Mother is HBsAg positive and baby weighs <1500g, newborn should received
Hep B vaccine + Hep B immunoglobulin
regardless of maternal anti-HBe status
Definition of pre-eclampsia
New BP >=140/90 after 20wks
+
Proteinuria/other organ involvement
Who should take high dose folic acid (5mg)
Previous infant NTD Antiepileptics Diabetes Coeliac Sickle cell Thalassaemia BMI >30
Which group of pregnant women receive routine anti-D at 28 weeks
Rhesus negative mothers who are not sensitized
D antibody negative on booking
NHS advised supplements for all pregnant women
Folic acid 400mcg first 12 weeks
Vitamin D 10mcg throughout pregnancy
First-line treatment of mastitis (systemically well, no fissure)
12-24 hours of milk removal
2nd-line treatment of mastitis (or if systemically unwell, fissure)
Flucloxacillin PO 10-14 days
Continue breastfeeding/expressing
Booking visit at
8-12 weeks
Dating scan
11 - 14 weeks
Down’s syndrome screening including nuchal scan
11 - 13+6 weeks
Anomaly scan
18 - 20+6 weeks
Second screen for anaemia + atypical red cell alloantibodies
28 weeks
2nd dose anti-D given to Rhesus -ve women at
34 weeks
Antibiotics contraindicated if breastfeeding
Ciprofloxacin
Tetracyclines
Chloramphenicol
Sulphonamides
Antibiotics permitted in breastfeeding
Penicillins
Cephalosporins
Trimethoprim
Sodium valproate and breastfeeding
Allowed
Carbemazepine and breastfeeding
Safe
Beta-blockers and breastfeeding
Allowed
Warfarin and breastfeeding
Allowed
Heparin and breastfeeding
Allowed
Aspirin and breastfeeding
Avoid (risk of Reye’s)
Prevention of pre-eclampsia in high risk groups
Aspirin 75mg OD from 12 weeks until delivery
High risk factors for pre-eclampsia
Prev HTN in pregnancy Chronic HTN CKD Diabetes Antiphospholipid, SLE
Gestational diabetes - fasting glucose >= 7 mmol/L at diagnosis
Start insulin
Gestational diabetes - fasting glucose <7 mmol/L
Trial of diet + exercise for 1-2 weeks
Gestational diabetes - glucose targets not met within 1-2 weeks of diet/exercise
Start metformin
Gestational diabetes - glucose targets not met despite metformin
Add insulin
Treatment of nipple candidiasis
Miconazole cream for mother
Nystatin suspension for baby
Blood tests at booking appointment - haematology
FBC Blood group Resus status Red cell alloantibodies Haemoglobinopathies
Blood tests at booking appointment - infection screen
Hep B
Syphilis
HIV
Alpha feto-protein is raised in
Neural tube defects
Abdominal wall defects
Multiple pregnancy
Alpha feto-protein is decreased in
Down’s syndrome
Trisomy 18
Maternal diabetes
ACEi/ARBs in pregnancy
Avoid (teratogenic)
Sodium valproate in pregnancy is associated with
Neural tube defects
Neurodevelopmental delay
Phenytoin in pregnancy is associated with
Cleft palate
Which of the ‘older antiepileptics’ is considered the least teratogenic in pregnancy
Carbemazepine
NICE Hb cut-off for oral iron in 1st trimester
< 110 g/L
NICE Hb cut-off for oral iron in 2nd/3rd trimester
< 105 g/L
NICE Hb cut-off for oral iron postpartum
< 100 g/L
Moderate risk factors for pre-eclampsia
First pregnancy Multiple pregnancy > 40y Pregnancy interval >10y BMI >=35 FH pre-eclampsia
Use of SSRIs in first trimester is associated with
Congenital malformation (mainly cardiovascular)
Use of SSRIs in second trimester is associated with
Pulmonary hypertension
Use of SSRIs in third trimester is associated with
Neonatal withdrawal symptoms
Digoxin and breastfeeding
Allowed
Lithium and breastfeeding
Avoid
Methotrexate and breastfeeding
Avoid
Carbimazole and breastfeeding
Avoid
Amiodarone and breastfeeding
Avoid
Benzodiazepines and breastfeeding
Avoid
Commonest cause of early-onset neonatal sepsis
Group B streptococcus
Risk factors for GBS neonatal infection
Premature
PROM
Previous sibling GBS infection
Maternal pyrexia
Women with GBS in previous pregnancies - offer
Intrapartum antibiotic prophylaxis
or
GBS test 35-37 weeks
Women with previous baby with GBS infection
Offer intrapartum antibiotic prophylaxis
Agent used in intrapartum antibiotic prophylaxis for GBS
Benzylpenicillin
