Obstetrics Flashcards
Abx of choice for Maternal GBS prophylaxis?
IV Benzylpenicillin.
Maternal intravenous antibiotic prophylaxis should be offered to women with a previous baby with early- or late-onset GBS disease.
When is anti-D prophylaxis given?
28 and 34 weeks.
First dose of anti-D prophylaxis to rhesus negative women - 28 week
Second dose - 34 weeks.
When is down syndrome screening had including nuchal scan?
11 - 13+6 weeks.
Interpretation of Bishop Score.
S score of < 5 indicates that labour is unlikely to start without induction.
A score of ≥ 8 indicates that the cervix is ripe, or ‘favourable’ - there is a high chance of spontaneous labour, or response to interventions made to induce labour.
What are the categories of women who will require higher dose of folic acid?
Women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy.
Women are considered higher risk if any of the following apply:
- Either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD.
- The woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait.
- The woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).
Mx if Bishop score is <6?
if the Bishop score is ≤ 6:
- Vaginal prostaglandins or oral misoprostol.
- Mechanical methods such as a balloon catheter can be considered if the woman is at higher risk of hyperstimulation or has had a previous caesarean
Mx if Bishop score if >6?
if the Bishop score is > 6:
- Amniotomy and an intravenous oxytocin infusion
Mx for pregnant woman exposed to chicken pox?
If there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies
Oral aciclovir (or valaciclovir) is now the first choice of PEP for pregnant women at any stage of pregnancy.
Antivirals should be given at day 7 to day 14 after exposure, not immediately.
When should insulin be started in gestational diabetes?
If the fasting plasma glucose level is < 7 mmol/l a trial of diet and exercise should be offered.
If glucose targets are not met within 1-2 weeks of altering diet/exercise metformin should be started.
If glucose targets are still not met insulin should be added to diet/exercise/metformin.
If at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started.
Treatment for Eclampsia?
Magnesium sulphate is used to both prevent seizures in patients with severe pre-eclampsia and treat seizures once they develop.
Given as IV bolus followed by infusion.
Post natal depression scoring system?
The Edinburgh Postnatal Depression Scale may be used to screen for depression.
Drugs to be avoided during breast feeding?
The following drugs should be avoided:
- Antibiotics: ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
- Psychiatric drugs: lithium, benzodiazepines
- Aspirin
- Carbimazole
- Methotrexate
- Sulfonylureas
- Cytotoxic drugs
- Amiodarone
Timing for baby blues vs postnatal depression?
Baby blues: Typically seen 3-7 days following birth and is more common in primips.
Postnatal depression: Most cases start within a month and typically peaks at 3 months.
Medication started to reduce risk of pre-eclampsia in high risk women?
Low dose Aspirin started at 12-14 weeks’ gestation till delivery is more effective than placebo at reducing occurrence of pre-eclampsia in women at high risk, reducing perinatal mortality and reducing the risk of babies being born small for gestational age.
Mx for obstetric cholestasis?
- Pruritus - may be intense - typical worse palms, soles and abdomen. Clinically detectable jaundice occurs in around 20% of patients.
- Raised bilirubin is seen in > 90% of cases
- Induction of labour at 37-38 weeks is common practice but may not be evidence based
- Ursodeoxycholic acid
- Vitamin K supplementation
