Obstetrics Flashcards
Pain during pregnancy in epigastric/RUQ region w/ deranged LFTs
HELLP syndrome
Causes of increased AFP:
NTDs (anencephaly, meningocele)
Abdominal wall defects (omphalocele etc.)
Multiple pregnancy
Decreased AFP:
Down’s syndrome
Trisomy 18 (Edward’s)
Maternal diabetes mellitus
First-line tx. for nausea and vomiting in pregnancy
Ginger and wrist acupuncture may be effective
Antihistamines first line medical - PROMETHAZINE
Rupture of membranes followed by immediate vaginal bleeding -> foetal bradycardia classically seen ->
Vasa Praevia
Drug to be avoided in breast feeding:
Antibiotics:
Ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
Drug to be avoided in breast feeding:
Psych drugs:
Lithium and Benzodiazepines
Drug to be avoided in breast feeding:
Others:
Aspirin Carbimazole Methotrexate Sulfonylureas Cytotoxics Amiodarone
Cord prolapse is more common in which foetal-lie presentation:
Breech
Foetal varicella syndrome: features:
Skin scarring Eye defects (microphthalmia) Limb hypoplasia Microcephaly Learning disabilities
if < 20 weeks pregnant and is NOT immune to varicella:
VZIg given
How many days after exposure is VZIg effective for?
up to 10 days
if > 20 weeks pregnant and is NOT immune to varicella:
VZIG OR oral ACICLOVIR
if < 20 weeks pregnant and is NOT immune to varicella - when should tx. be given
7-14 days after exposure
Down’s syndrome triple test:
AFP
Unconjugated oestriol
HcG
Down’s quadruple test:
AFP, unconjugated oestriol, HCG, INHIBIN A
Combined test: down’s
Increased HCG,
Increased Nuchal thickness
Decreased PAPP-A
When in pregnancy will triple/quadruple test be offered:
15-20 weeks
Tx. for magnesium sulphate induced respiratory depression:
Calcium gluconate
How long should magnesium sulphate treatment continue for after last seizure/delivery
24 hours
Causes of folate acid deficiency (4)
Phenytoin
Methotrexate
Pregnancy
Alcohol excess
Indications for forceps delivery:
Fetal distress in second stage of labour
maternal distress in second stage of labour
failure to progress in second stage of labour
Control of head in breech delivery
Which substance release in pregnancy may mimic TSH and cause hypertension and hyperthyroidism
HCG
When should swabs for GBS be taken if they are to be taken:
35-37 weeks or 3-5 weeks prior to anticipated delivery date
GBS prophylaxis:
IAP - benzylpenicillin
Mx. for HELLP syndrome
Delivery
Babies born to mothers w/ hepatitis B should receive:
Complete course of vaccination AND Hep B immunoglobulin
Mode of delivery in HIV +ve mothers:
What should be started during delivery:
Vaginal delivery recommended if viral load is less than 50 at 36 weeks.
otherwise C-section is recommended
ZIDOVUDINE infusion
Can you breastfeed w/ HIV
Not recommended
Uterine hyperstimulation is the main complication from which act:
Artificial Induction of labour
Uterine hyperstimulation tx:
Remove vaginal prostaglandins
Stop oxytocin infusion if started
Tocolysis w/ terbutaline
Signs of labour:
Regular and painful uterine contractions
A show - shedding of mucous plug
Rupture of membranes
Shortening and dilation of the cervix
How often should foetal heart beat be monitored
every 15 minutes
or continuous w/ CTG
How often are contractions checked:
every 30 minutes
Labour STAGE 1
define latent phase:
How long does it take?
0-3 cm dilation normally takes 6 hours
Labour STAGE 1
define active phase:
3-10 cm dilation, normally 1 cm/hour
Labour stage 2 - typical length:
1 hour
if stage 2 longer than an hour consider:
Venthouse or forceps
C-section
Causes of oligohydramnios:
Premature rupture of membranes Post-term gestation Pre-eclampsia Foetal renal problems Intrauterine growth restriction
Second degree perineal tear:
Where/who repairs
Injury to perineal muscle, NOT INVOLVING THE ANAL SPHINCTER
Can be sutured on ward by mid-wife
Fourth degree tears extend into:
RECTAL MUCOSA
Placenta praevia classes:
I - placenta reaches lower segment but not os
II - placenta reaches internal os but doesn’t cover it
III - placenta covers os BEFORE dilation but not after
IV - placenta completely covering os
When would placenta praevia be picked up?
18-20+6 week scan
Placenta praevia Mx.
if still present at 34 weeks: scan every 2 weeks
If scan shows placenta praevia class III/IV between 37-38 weeks:
ELECTIVE C-section
If scan shows placenta praevia class I:
Vaginal delivery may be offered
Placental abruption mx.
Foetus alive and < 36 weeks and not distressed: OBSERVE, STEROIDS, no tocolysis
threshold to deliver depends on gestation
Foetus > 36 weeks - no distress: deliver vaginally
distress = c-section
If dead -> deliver vaginally
Post natal depression tx.
CBT
if SSRI required, offer SERTRALINE OR PAROXETINE
(Sad Post-pregnancy)
Tx. post-partum thyroiditis:
Propranolol = symptomatic mx.
PPH initial mx.
Uterine massage
IV syntocinon - 10 units or IV ergometrine
IM carboprost
PPH if initial mx. doesn’t work:
Intrauterine baloon tamponade
B-lynch suture, ligation of uterine arteries, internal iliac arteries.
Secondary PPH
When does it present:
Causes:
24 hours - 12 weeks
Retained placenta
Endometritis
Women w/ BP > __ should be admitted and observed
> 160/110 mmHg
What should be offered for anaemia in pregnancy:
ORAL ferrous sulfate or fumerate
When is anaemia screened for:
Booking
28 weeks
Women w/ suspected DVT in pregnancy Ix.
Compression DUPLEX US
Women w/ suspected PE in pregnancy Ix.
ECG CXR for all pts.
If symptoms and signs of DVT plus positive US findings, is there need for further investigation:
NO
CTPA increases chance of
Maternal breast cancer
V/Q scanning increases chance of
Childhood cancer
Acute fatty liver of pregnancy - occurs when?
3rd TM
Acute fatty liver Ix. LFT:
Increased ALT (500u/l)
Obese women should have OGTT at which gestation:
24-28 weeks gestation
What may cause ankle swelling, varicose veins and supine hypotension in pregnant women?
Enlarged uterus interfering w/ venous return
CO2 increased or decreased in pregnancy?
Decreased - due to slightly increased oxygen requirements -> may feel dyspnoeic
Hb in pregnancy:
Falls due to increase in plasma of 50%
-> DILUTION
GFR in pregnancy:
Increases
Visual impairment in premature babies:
retinopathy of prematurity - neovascularisation from over-oxygenation
Complications of prematurity:
RDS Interventricular haemorrhage Necrotizing enterocolitis Chronic lung disease Jaundice
Premature prelabour rupture of membranes mx.:
Sterile speculum exam (pooling of fluid in post. vaginal vault)
US may show oligohydramnios
Admission
Erythromycin (10 days)
Antenatal corticosteroids should be administered to reduce risk of RDS
Delivery considered at 34 weeks gestation.
Most common cause of puerperal pyrexia:
Endometritis
Endometritis mx.
Admit for IV antibiotics
Clindamycin and gentamicin till afebrile
Reduced foetal heart beat steps:
Handheld doppler ->
Ultrasound ->
CTG for at least 20 minutes
Rhesus baby px.:
tx.
Oedematous
Jaundice
Heart failure
Kernicterus
Transfusions, UV phototherapy
Methotrexate in pregnancy:
Contraindicated and should be stopped at least 6 months before conception
DMARDs safe in pregnancy
Sulfasalazine and hydroxychloroquine
When should NSAIDs be stopped in pregnancy and why?
32 weeks
Risks premature closure of ductus arteriosus
If rubella suspected in pregnancy
Discuss immediately w/ local health protection unit
Can you give MMR in pregnancy
NO but non-immune mothers should be given in in the post-natal period
Shoulder dystocia tx w/
McRobert’s manouevre
Can ECV be performed in labour:
Yes as long as the membranes have not ruptured
Monoamniotic monozygotic twins are associated w/:
Increased spontaneous miscarriage
Increased malformations: IUGR, prematurity
Twin to twin tranfusion syndrome - recipient is larger w/ polyhydramnios
Management of twin pregnancy:
US for diagnosis + monthly checks
Weekly checks from > 30 weeks
precautions at labour - 2 obstetricians present
Most are induced by 38-40 weeks
Causes of increased nuchal translucency:
Down’s syndrome
Congenital heart defects
Abdominal wall defects
Causes of hyperechogenic bowel:
CF
Down’s syndrome
CMV
Risk factors for cord prolapse:
Prematurity Multi-parity Polyhydramnios Twin pregnancy Abnormal presentations
Mx. Cord prolapse:
Foetus pushed BACK into uterus
Pt. to go on all fours untill c-section can be performed
TOCOLYTICS to reduce contractions
Retrofilling bladder may help as it gently elevates the presenting part.
Four or more risk factors for VTE in pregnancy, women are tx. w/
LMWH
When should LMWH be initiated if indicated:
When is it continued till:
From 28 weeks
Six weeks post-partum
Are DOACs and warfarin allowed in pregnancy:
NO
