Obstetrics Flashcards
What is gestational diabetes?
Any degree of glucose intolerance with onset or first recognition during pregnancy.
Name 5 risk factors for GD.
BMI > 30
Asian ethnicity
Previous GD
1st degree relative with diabetes
PCOS
Previous macrosomic baby
What investigation is used for gestational diabetes?
Oral glucose tolerance test
When do you test for GD in the pregnancy?
Between 24 and 28 weeks of pregnancy
If you had diabetes in a previous pregnancy, when should you be tested for GD in your next?
At the booking appointment
What is the first line treatment for GD in pregnancy?
Metformin
What is the second line treatment for GD?
Glibenclamide
What is the treatment for GD if not controlled with metformin and glibenclamide?
Insulin basal bolus routine
What are the foetal complications associated with GD?
Macrosomia
Shoulder dystocia
Still birth at term
Hyperinsulinemia
What causes macrosomia in GD?
Glucose is able to pass across the placenta but insulin cannot.
Therefore the baby gets too much glucose leading to macrosomia
Name 4 maternal complications of GD.
Miscarriage
DKA
Hypoglycaemia
Progression of retinopathy
Premature labour
Pre-eclampsia
What is the pathophysiology of pre-eclampsia?
Abnormal invasion of the trophoblast into maternal spiral arterioles. Causing high vascular resistance and poor perfusion of the placenta.
Name the 5 key symptoms of pre eclampsia.
Headache
Visual disturbance
Nausea and vomiting
Upper abdo pain
Oedema
What are the signs of pre-eclampsia?
Brisk reflexes
Reduced urine output
Name 3 risk factors for pre-eclampsia.
Family history of pre-eclampsia
Pre-existing hypertension
Diabetes
First pregnancy
Obesity
Name 3 maternal complications of pre-eclampsia.
Pulmonary oedema
Renal failure
Stroke
Eclampsia
HELLP syndrome
What does HELLP stand for?
Haemolysis, Elevated liver enzymes, low platelets.
Foetal complications of pre-eclampsia?
Intrauterine growth restriction
Placental abruption
Still birth
What is the medical management of pre-eclampsia?
Aspirin from 12 weeks in high risk patients
Labetalol
Nifedipine
Methyldopa
Symptoms of HELLP syndrome?
Bleeding
Fatigue
Malaise
RUQ pain (liver going wrong)
N&V
Swelling
Blurred vision
How does a concealed abruption present?
Woody uterus
What is placenta praevia?
A low lying placenta close to or lying over the internal OS.
Name 5 risk factors for placenta praevia.
Previous C-section
High parity
Over 40
Multiple pregnancies
Previous placenta praevia
What is placenta accreta?
The placenta attaches beyond the endometrium of the uterus and into the myometrium.
Name 2 causes of placenta accreta.
Previous c-section
Curettage procedure
What is the management of placenta accreta?
C-section with hysterectomy
Uterus preserving surgery
Expectant management, letting the placenta be absorbed over time
What is placental abruption?
When all or part of the placenta is separated from the wall of the uterus leading to bleeding.
What are the 2 types of placental abruption?
Revealed where there is bleeding through the cervix.
Concealed where the bleeding remains within the uterus
Name 3 risk factors for placental abruption.
Pre-eclampsia
Polyhydramnios
Abdo trauma
Transverse lie
Smoking or drug use
Previous abruption
What is obstetric cholestasis?
Reduced outflow of bile acids from the liver.
When in pregnancy does obstetric cholestasis typically present?
After 28weeks
What are the key symptoms of obstetric cholestasis?
Itching
Fatigue
Dark urine
Pale greasy stool
Jaundice
Which medication can be given in secondary care for obstetric cholestasis?
Ursodeoxycholic acid
What does cervical effacement mean?
Thinning of the cervix
What is the definition of stage 1 of labour?
From the onset of labour until the cervix is 10cm dilated
What is stage 2 of labour?
From 10cm dilated unto the delivery of the baby