obstetrics Flashcards
pre-eclampsia is usually a triad of which 3 things
- new onset HTN
- proteinuria
- oedema
pre-eclampsia is defined by what criteria
New onset BP >140/90 after 20 weeks and 1 or more of:
1. proteinuria
2. other organ involvement e.g. renal Cr >90, liver, neuro, haem, uteroplacental dysfunction
Women who are at risk of developing pre-eclampsia or the risks, what should they take?
Aspirin 75-150mg daily from 12 weeks gestation until birth
Women with how many high/moderate risk factors should be taking aspirin 75-150mg daily (from 12 weeks gestation until birth)?
If >1 high risk factor or >2 moderate risk factors
women where pre-eclampsia is suspected are usually admitted + observed to secondary care when their blood pressure is over…
160/110
what is the first line for eclampsia
- oral labetalol
- nifedipine if asthmatic and hydralazine can be used
- deliver baby !
When are D antibodies tested for in all Rh -ve mothers
At booking scan
When is anti-D immunoglobulin given to non-sensitised R -ve negative mothers?
28 and 34 weeks
If there is an event in 2nd or 3rd trimester, what should be done in terms of rhesus negative mothers?
Give large dose of anti-D immunogloublin
Perform Kleihauer test - to check % of foetal RBCs are present
Anti-D immunoglobulin should be given as soon as possible (but always within 72 hours) in which 8 situations
- Delivery of Rh +ve infant
- TOP
- Miscarriage >12 weeks
- Ectopic (surgical)
- ECV
- Antepartum haemorrhage
- Amniocentesis, CV sampling, foetal blood sampling
- Abdominal trauma
Does a medical management of ectopic pregnancy (with methotrexate) require anti-D immunoglobulin?
NO
only surgical
All babies born to Rhesus negative mums should have cord blood taken at delivery to look for..
FBC
Blood group
Direct Coombs test - direct antiglobulin, shows any antibodies on RBCs of baby
What anti-hypertensive medications are TERATOGENIC in pregnancy
ACE inhibitors
Angiotensin receptor blockers
Babies born to mothers who are chronically infected with hep B or to mothers who had acute hepatitis B during pregnancy should receive …
Complete course of vaccination and hepatitis B immunoglobulin
Can Hep B be transmitted via breastfeeding
No
HBeAg is a marker of…
hep B infectivity!
Pregnant women who have risk factor of gestational diabetes (but never had it themselves) should have what investigation and when
OGTT at 24-28 weeks
Five risk factors for gestational diabetes
- BMI >30
- Previous macrosomic baby >4.5kg
- Previous gestational diabetes
- 1st degree relative with diabetes
- Ethnicity - black, south asian, middle eastern
What is the test of choice for gestational diabetes
Oral glucose tolerance test
For women who have previously had gestational diabetes should have what investigation and when
OGTT at booking, and at 24-28 weeks if the first test is normal
Diagnostic thresholds for gestational diabetes:
(a) fasting glucose
(b) 2-hour glucose
(a) fasting glucose >5.6
(b) 2-hour glucose >7.8
5678!!
Gestational diabetes, if fasting glucose <7, what is the management
- trial diet (low glycaemic index) + exercise
- then metformin
- add insulin
what type of insulin is used for gestational diabetes
short-acting NOT long-acting
Gestational diabetes, if fasting glucose >7, what is the management
Insulin (short-acting)
What medication should be offered for gestational diabetes if women cannot tolerate metformin or decline insulin
Glibenclamide
If fasting plasma glucose is between 6-6.9 and there is evidence of complications such as macrosomnia or hydramnios, what medication should be offered
insulin (short acting)
Management of pregnant women with pre-existing diabetes
- Weight loss
- Stop oral hypoglycaemics, continue metformin
- Start insulin
- Folic acid 5mg /day from preconception to 12 weeks GA
- Detailed anomaly scan at 20 weeks including 4 chamber view of heart
- Treat retinopathy
Targets for self-monitoring of pregnant women (pre-existing and gestational diabetes):
(a) fasting
(b) 1 hour after meals
(c) 2 hours after meals
(a) fasting - 5.3
(b) 1 hour after meals - 7.8
(c) 2 hours after meals - 6.4
Risks of using SSRIs in pregnancy
Use in 1st trimester increases risk of congenital malformations especially cardiovascular malformations
Hydatidiform mole typically presents with painless or painful PV bleeding?
PAINLESS!
Management of complete hydatidiform mole
- Urgent referral to specialist centre - evacuation of uterus
- Contraception to avoid pregnancy in next 12 months
Around 2-3% of complete molar pregnancies (hydatidiform moles) go on to develop into
choriocarcinoma
High levels of hCG in molar pregnancies can mimic what other hormone
TSH = causing symptoms of thyrotoxicosis
Can methotrexate be used while breastfeeding
No - contraindicated
it is a folic acid antagonist and can suppress bone marrow cause hepatotoxicity
What is the antibiotic of choice for GBS prophylaxis
Benzylpenicillin
4 risk factors for GBS
- Previous GBS in pregnancy
- Sibling with neonatal GBS infection
- maternal pyrexia at labour
Chickenpox exposure in pregnancy - first step is to…
check antibodies
Foetal varicella syndrome is highest if mum gets chickenpox before what time during pregnancy
BEFORE 20 weeks gestation
or between 2-5 days before birth
PC: skin scars, eye defects (microphthalmia), microcephaly, LD
If pregnant woman <20 weeks gestation not immune to varicella, what should be done
Give VZIG asap
How long is varicella VZIG effective up to post-exposure to chickenpox for pregnant women
10 days post exposure
If pregnant woman <20 weeks gestation not immune to varicella, what should be done
VZIG or antivirals days 7-14 days after exposure
What is management for gestational hypertension
Oral labetalol
Oral nifdepine (if asthmatic) + hydralazine
Risk factors of neural tube defect in child
- Family history of NTD
- Taking antiepileptics
- Coeliac disease
- Diabetes
- Thalassemia trait
- Obese - BMI >30
What 4 things (2 drugs) can cause folic acid deficiency
- phenytoin
- methotrexate
- pregnancy
- methotrexate
Prevention of neural tube defects during pregnancy (not high risk women)
400mcg folic acid daily until 12th week of pregnancy
Prevention of neural tube defects during pregnancy (in high risk women - i.e. family history of NTD, antiepileptics, coeliac, DM, thal trait, obese)?
5mg folic acid daily until 12th week of pregnancy
3rd trimester 4 reasons for bleeding in pregnancy
- bloody show
- placental abruption - painful bleed
- placenta praevia - painless
.4. vasa praevia
2nd trimester - 3 reasons for bleeding
- spontaneous abortion
- hydatidiform mole - painless
- placental abruption - painful
pregnant women are screened for anaemia at what times
Booking visit (8-10 weeks)
28 weeks
What are NICE cut offs for when a woman should receive oral iron tablets
(a) first trimester
(b) second/third trimester
(c) postpartum
(a) first trimester - <11
(b) second/third trimester - <10.5
(c) postpartum - <10
Management of iron def anaemia in pregnancy
Oral ferrous sulfate or fumarate
Continue for 3 months after IDA is corrected
What are the SSRIs of choice in breastfeeding women
Sertraline
Paroxetine
Which SSRI can accumulate in breast milk and so is avoided
FLUOXETINE
Nausea and vomiting NICE recommendations
- Natural remedies of ginger and acupuncture on p6 (by the wrist)
- Antihistamines - promethazine and cyclizine are first line
Vitamin D recommendations by NICE during pregnancy
10mcg per day
Alcohol advice by NICE for pregnancy
Avoid throughout pregnancy
after woman has given birth with gestational diabetes, how long should you wait before doing fasting glucose sample to check for diabetes post-partum?
6 weeks after birth
what 3 things cause increased AFP during pregnancy
- pregnancy
- neural tube defects (memingocele, myelomeningocele, anecephaly)
- abdominal wall defects (omphalocele, gastroschisis)
what 3 things in pregnancy cause decreased AFP
- Down’s syndrome
- Trisomy 18
- maternal diabetes
sertraline risks during pregnancy
1st trimester = congenital malformations including CVS
2nd trimester = pulmonary HTN
3rd trimester = risk neonatal withdrawal
is warfarin safe to use in breastfeeding
YES
what pathogen is the most common cause of neonatal sepsis
Group B strep
puerperal (post-partum) pyrexia (38oC) may be defined by fever in what timeframe
within first 14 days following delivery
5 causes of puerperal pyrexia (fever >38oC) within 14 days of delivery
- endometritis
- UTI
- wound infections (tears, c-section)
- mastitis
- VTE
If endometritis is suspected in primary care what is the next step
SEND TO HOSPITAL
for IV antibiotics
suspected cases of rubella in pregnancy - what is appropriate management
should be discussed with the local Health Protection Unit
Post-natal depression is seen in around what % of women
10%
A nuchal scan is performed at 11-13 weeks. 3 causes of an increased nuchal translucency are
Down’s syndrome
congenital heart defects
abdominal wall defects
3 causes of hyperechogenic bowel of a foetus on ultrasound
cystic fibrosis
Down’s syndrome
cytomegalovirus infection
What is the current recommended combined screening (between 11 - 13+6 weeks) tests for Down’s syndrome?
Nuchal translucency
B-HCG
Pregnancy associated plasma protein A
What tests are in quadruple test (between 15 - 20 weeks combined screening) for Down’s syndrome?
alpha-fetoprotein
unconjugated oestriol
hCG
inhibin A
Galactocele occurs in those who recently stopped breastfeeding due to occlusion of a lactiferous duct. A build up of milk creates a cystic lesion. Do they need to be investigated?
NO!
The main cause of itch without an associated rash in pregnancy is …
obstetric cholestasis
The symphysis-fundal height (SFH) is measured from
top of the pubic bone to the top of the uterus in centimetres
symphysis-fundal height (SFH) should match the gestational age in weeks to within 2 cm after how many weeks
after 20 weeks
e.g. if 24 weeks then the a normal SFH = 22 to 26 cm
