Obstetrics Flashcards
Define Gravity and Partity.
Gravity = Number of pregnancies Parity = Number of pregnancies made it past 28w
Antibiotics given in pregnancy for UTI?
1st and 2nd Trimester - give Nitrofurantoin 100mg BD for 7 days
3rd trimester - Trimethoprim 200mg bd
Can you breastfeed whilst on psychiatric medications?
What is the safest SSRI in pregnancy?
No
Safest - Fluoxetine
Best management for Hyperthyroidism in pregnancy
Avoid Carbamazepine - give Propylthiouracil
When should methotrexate be stopped in regards to pregnancy?
Ideally 3 months prior to trying to conceive
What trimester should NSAIDS be avoided? Why?
Should be avoided in 3rd trimester
Can cause premature closing of the ductus arteriosis
What should the management be switched to for pregnant women with Anti-phospholipid syndrome?
Normal management for antiphospholipid syndrome is Warfarin
Need to be switched to Low molecular;ar weight heparin (eg enoxaparin) + aspirin from 6w to 34 w
What is pre-eclampsia?
Triad of
- Hypertension
- Proteinuria
- Oedema (peripheral)
Can occur from 20w
Should resolve within 10 days
RF for Pre-eclampsia
FH/Previous Hx of pre-eclampsia Pre-existing HTN/renal disease Multiple pregnancy First birth (primipartity) Obesity Migraine Hx
How does pre-eclampsia present?
Headaches, visual disturbance, sudden oedema/weight gain, N&V
Investigations for pre-eclampsia?
FBC, U&Es, LFTs, Coag
BP
Urinalysis
USS
Management of Preeclampsia?
IF BP rises more than 30/20 since booking, or SYS is more than 160 then admit
1st line Mx - labetalol
2nd line - Nifedipine
Aiming for target of below 135/85
If mum is at high risk of pre-eclampsia, any prophylatic treatment?
Aspirin from 12w until birth
What is placental abruption? How does it present?
Placental abruption is when there is a separation of placenta away from the uterus
Presents as: painful bleeding, tender uterus and backspin, bloody cervix
Diagnosis and management of placental abruption?
Diagnosis - clinical
Mx - Deliver baby
What is placenta praevia?
RF?
placenta is attached to lower portion of the uterus usually near or even over the cervical os
notable cause of Antepartum haemorrhage
RF: Multiple pregnancy, Prior c-sections, Hx of fibroids, smoking, older mum, IVF
Describe minor and major placenta praevia.
Minor - not covering the cervical os but near it
Major - Partially/completely covering cervical os
How does placenta praevia present?
Painless bleeding
Non-tender uterus
High presenting part
Management of placenta praevia?
If <2cm from os - C section
if > 2cm from os - Normal SVD
Do not physically examine vagina
What is Obstetric Cholestasis?
It is a common condition in pregnancy where there is reduced outflow of bile acids from the liver causing a build up and resulting in the classic itching symptom.
Presentation of Obstetric Cholestasis?
Presents later in pregnancy - usually third trimester
Itching is main symptom (hands & feet)
Also sees: fatigue, dark urine, pale/greasy stools and sometimes jaundice
Investigations for Obstetric Cholestasis?
LFTs and bile acid levels
Rise in ALT, AST and GGT
Raised bile acids
Why is a LFT result of only raised ALP not diagnostic for Obstetric Cholestasis?
Because the placenta produced ALP so an isolated high ALP with normal rest of LFTs may be physiological
Management of Obstetric Cholestasis?
1st line - Ursodeoxycholic acid
Can add in calamine lotion for itch
or
Antihistamines to help sleep (chlorphenamine)
IF clotting factors deranged - give Vit K
When does Eclampsia occur?
Management?
It occurs if pre-eclampsia is not managed properly. It is characterised by the presence of seizures on the background of pre-eclampsia Dx and symptoms.
Mx - IV Mg sulfate
What is HELLP syndrome?
What does it stand for?
Presents as…
HELLP is a complication of pre-eclampsia and eclampsia when there is:
- Haemolysis
- Elevated liver enzymes (High ALT, AST & GGT)
- Low platelets
Presents as: Jaundice, malaise, vomiting, headache
What do Stage 1, 2 & 3 refer to in Labour?
Stage 1 - From regular contractions til complete cervical dilation
Stage 2 - From completed cervical dilation til delivery of baby
Stage 3 - Delivery of the placenta & membranes
Why is the cord clamping delayed after delivery? How long is it delayed for?
Delayed for 60s to improve fetal perfusion and O2 delivery to baby
What is the Bishops score?
Its a scoring system to work out the cervical ripeness and thus the likelihood of spontaneous labour
What are the key scores for the Bishop score and what do they indicate?
Score of 8 or above indicates likely spontaneous labour
Score of 5 or less means spontaneous labour is unlikely - needs induction
What is the stepwise approach to induction?
If under 40-41 weeks gestation - Vaginal prostaglandin (PGE)
If over 40-41 weeks
- Membrane sweep
Amniotomy
Syntocinon
Stepwise Pain relief in labour
Supportive massage/relaxation Entonox Water immersion TENS Pudendal block (S2,3) IM diamorphine IV remifentanyl Epidural Block (T11-S5)
If a mother of 26 weeks gets chicken pox and has never been previously exposed, management is…
As mum is over 20 weeks - oral acyclovir
Under 20 weeks - IV immunglobulins
PPH
- Major vs Minor: over _____ml?
- What is the first line Mx?
- What is second line Mx?
- What is third line?
- Minor: over 500ml
- Major: Over 1000ml
- Uterine massage and oxytocin infusion
- 2nd line - Ergometrine (contraindicated in high BP)
- 3rd line - Carboprost (used if above don’t work)
Sheehan syndrome…
When your pituitary swells due to loos of blood (typically post birth) - presents with headache and visual disturbance
Sudden onset abdominal pain, hard uterus, dark red vaginal bleeding, indicative of?
Placental abruption
Anterior vs Posterior tongue tie…
Anterior tongue tie - short frenulum that is visible
Posterior tongue tie - cannot visualise frenulum, heart shaped when lifting tongue
WHO advise for breastfeeding
Exclusively breastfeed up to 6 months, then combo of breastfeeding and foods up to 2 years and beyond
What is premature rupture of membranes?
Where the amniotic sac ruptures releasing amniotic fluid before onset of labour
Diagnosis of premature rupture of membranes?
Management of premature rupture of membranes?
Diagnosis - speculum examination - visualise it
Mx - Prophylatic antibodies (Erythromycin) 4 times daily until labour is establish or 10 days (whatever comes first)
When is CVS and Amniocentesis done for prenatal testing?
CVS can be done at 11 weeks
Amniocentesis done from 15 weeks
Pregnant Diabetic mothers should give birth no later than…
40+6 weeks
What is the most appropriate management in a mum who at 12 weeks has a fetal pole of 9 weeks and no fetal heartbeat detected?
This hx suggests missed miscarriage
Offer Vaginal misoprostol for these patients
Difference between revealed placental abruption and concealed placental abruption?
Concealed - asymptomatic or mother might remember pain but without bleeding
Revealed - painful bleeding, hard uterus, sudden onset etctec
Guidance on gestational diabetes…cut offs for treatment?
If women with gestational diabetes have a fasting glucose <7 mmol/l - lifestyle advice and 2 week follow up
Women with >7mmol - immediately started on insulin with lifestyle advice
HIV in Pregnancy
If patient is known HIV and viral load <50copies/ml - Mx?
If patient is known HIV and viral load >50copies/ml - Mx?
If new presentation in pregnancy?
All women HIV +, even if they did not need meds before pregnancy, should be started on combined antiretroviral therapy in 2nd trimester by 24th week
This should be continued lifelong
What volume is consistent with diagnosis of polyhydramnios?
> 2-3l of amniotic fluid
If baby is breech and in early labour but sac is intact…mangement options?
External cephalic
When do you stop methotrexate in planning pregnancy?
Both partners have to be off methotrexate for 6 months.
Expected results from triple assessment in Downs…
Thickened nuchal translucency, increased bHCG and decreased PAPP-A
