Obstetrics Flashcards
Most likely cause of symmetrical growth restriction
prolonged period of poor intrauterine growth in early pregnancy
Down syndrome
Maternal hypothyroidism
Malnutrition
most likely cause of asymmetrical small for gestational age
placental insufficiency
ligament that connects the uterus to the labia majora and commonly causes pain during pregnancy by its stretch
round ligament
pain is sharp, intermittent in lower abdomen/ groin area
medical management of sever pre-eclampsia
labetalol
pathophysiology of haemolytic disease of the newborn
maternal IgG antibodies against fetal red blood cells
drugs to avoid in pregnancy
LAMBAST
Lithium
Amiodarone
Methotrexate
Benzos
Aspirin
Sulphonamides
Tetracyclines
what medication can cause Ebstein’s anomlay ( defect in tricuspid valve) if used in pregnancy
lithium
what medication is used for medical termination of pregnancy? and what order
MiFepristone = First (antiprogestogen)
MiSoprostol = Second (prostaglandin)
how should premature rupture of membranes be managed?
admission, antibiotics and steroids (to promote foetal lung maturation)
management of breech baby >36 weeks
external cephalic version
management of postpartum thyroiditis?
usually self limiting- provide symptomatic relief e.g. propranolol
what is oligohydramnios?
decreased amniotic fluid for gestational age
Causes of oligohydramnios
premature rupture of membranes
Potter sequence - bilateral renal agenesis + pulmonary hypoplasia
intrauterine growth restriction
post term gestation
pre-eclampsia
What is the guidance around contraceptive management post partum?
IUS - inserted <48 hours or after 4 weeks
COCP- > 6weeks
progesterone only pill - anytime
Management of placental abruption
administer steroids- foetal lung development
deliver baby via c-section usually
What type of bleeding is placental abruption
painful bleeding
What type of bleeding is placenta praevia
painless bleeding
What should be prescribed to moderate to high risk pre-eclampsia patients?
low-dose aspirin - 75mg from 12 weeks until birth
Management of endometritis
admission - IV clindamycin and gentamicin
Methods of induction
membrane sweep
prostaglandin pessary
artificial rupture of membranes + oxytocin
cervical balloon
misoprostol
Does dopamine inhibit or activate prolactin
inhibits
First line management of gestational hypertension without proteinuria
Oral Labetalol
Management of positive culture of GBS in current pregnancy or previous?
IV antibiotics - benzylpenicillin (or vancomycin if allergy) during labour
Screening result for down syndrome on quadruple testing (done between weeks 14-20)
low AFP, high inhibin, high hCG and low oestriol
When is a combined screening test carried out?
between weeks 10 - 13+6 weeks
complete molar pregnancy
no presence of normal foetal growth
- COMPLETELY no growth
snowstorm appearance on US
can progress to choriocarcinomas
partial molar pregnancy
Some evidence of foetal development with abnormal growth
- triploidy chromosome arrangement
Management of post partum haemorrhage after ABCDE
bimanual uterine compression - stimulate contraction
IV oxytocin and/or ergometrine
IM carboprost
Rectal Misoprostol
Surgical intervention e.g. balloon tamponade
Causes of PPH
4 Ts
Tone- i.e. uterine atony in most cases
Trauma- e.g. perineal tear
Tissue - retained placenta
Thrombin - e.g. clotting/bleeding disorder
first line medication for vomiting in pregnancy
antihistamines - promethazine
What is Sheehan syndrome?
anterior pituitary gland damage after significant blood loss
woody uterus
think placental abruption
medical management of ectopic pregnancy
IM methotrexate
What is the safest anti-epileptic to use in pregnancy
lamotrigine
name of test that measures b-hCG, PAPPA-A and nuchal translucency
combined test - offered at 11-13+6 weeks
PAINLESS abdominal pain and bleeding in later stages of pregnancy
placenta praevia
when should at risk patients of pre-eclampsia take aspirin
12 weeks gestation until delivery
correct position of women who have cord prolapse
on all fours
when should delivery be aimed for with obstetric cholestasis
37-38 weeks
what does the combined text consist of
serum oestriol, hCG, alpha-fetoprotein and inhibin A
‘strawberry cervix’ foul smelling discharge
trichomonas vaginalis
Tx = metronidazole
respiratory system changes in pregnancy
pulmonary ventilation increased and tidal volume (progesterone effects on respiratory centre) - leads to respiratory alkalosis
drugs to avoid in pregnancy
ACEi/ARBs - renal hypoplasia
androgens -
anti-epileptics - cardiac, facial, neural tube defects
cancer treatment - multiple defects
lithium - CVS defects
methotrexate - skeletal defects
warfarin - limb and facial defects
aspirin - brain and liver damage
what pregnancies require 5mg Folic Acid
previous neural tube defect
taking anti-epileptics
coeliac disease
diabetes
thalassaemia trait
BMI > 30
when to offer external cephalic version if baby is breech
> 36 weeks
what is the definition of large for dates
> 2cm fundal height than expected
what are the three shunts in foetal circulation
ductus venosus -
foramen ovale -
ductus arteriosus -
management of hypertension in pregnancy
1st= labetalol
2nd = if asthmatic Nifedipine
3rd = methyl dopa
management of eclampsia
magnesium sulphate IV bolus 4g over 5-10 minutes
if respiratory depression of mother - give calcium gluconate
what nutrient is deficient in breast milk and what is done about this
vitamin K - new borns prophylactically injected with vit K after birth
when is gestational diabetes diagnosed
24-28 weeks gestation
oral glucose tolerance testing is used
what are the risk factors for gestational diabetes
family history of diabetes
previous macrosomic baby of >4.5kg
BMI >30
first line strong analgesia management in latent stage of labour
IM diamorphine
crown rump length >7mm and no foetal heartbeat
miscarriage
when is anti-D needed in misscariage
maternal rhesus -ve and over 12 weeks gestation
or <12 weeks and uterine instrumentation
