Obstetrics Flashcards
1st Trimester
1-12 weeks
2nd Trimester
13-26/27 weeks
3rd trimester
28-40 weeks
Baseline foetal heart rate (FHR)
110- 160 bpm
Baseline FHR variability
Normal: 6-25 bpm
Reduced: 3-5 bpm
Absent: < 3bpm
Increased (salutatory): > 25 bpm
FHR accelerations
Transient increase in FHR of 15 bpm lasting 15 sec
FHR decelerations
transient episodes of decreased FHR below baseline more than 15 bpm for at least 15 sec
- often pathological
Types of FHR decelerations
Early
Variable
Prolonged
Late
Early FHR decelerations
- benign & physiological
- 4-8cm cervical dilation
- mirror contraction
Variable FHR decelerations
- repetitive/intermittent
- in association with other non-reassuring/abnormal features are pathological
Late FHR decelerations
- uniform, repetitive decrease
- slow onset at mid to end of contraction
- caused in the presence of hypoxia (foetus already hypoxic)
- decelerations less than 5-15 bpm
Reassuring CTG findings
- baseline FHR 110- 160
- No late or variable FHR decelerations
- Moderate FHR variability (6-25 bpm)
- age-appropriate FHR accelerations
Abnormal CTG findings any
ANY OF THE FOLLOWING
- Baseline FHR <100 bpm or >170 bpm
- Absent variability < 3 bpm
- Prolonged decelerations for > 3 bpm OR late OR complicated variables
Abnormal CTG findings >2
AT LEAST 2 OF THE FOLLOWING:
- Baseline FHR between 100-109 bpm
- Baseline FHR between 160 -170 bpm
- FHR variability is reduced (3-5 bpm for > 40 mins)
- Variable decelerations without complicating features
Abnormal CTG, what’s the next step
- Stop syntocinon (give blood to baby)
- foetal scalp sampling unless contraindicated (lactate high, pH low) give C-sec
CTG high risk vs low risk
High risk: mandatory obstetrical intervention
Low risk: limited value, and can lead to unnecessary obstetrical intervention
Pregnancy screening test
Before conception: Rubella
10-12 weeks: Chorionic villus sampling (CVS) Rh negative women need Rh D immunoglobulin (anti-D)
15-17 weeks: Maternal serum screening (alpha fetoprotein, estriol, and beta-HCG ) for Down syndrome
16-18 weeks: Amniocentesis
18-20 weeks: Ultrasound for identification of physical abnormalities (NTD)
First antenatal visit time frame
Within 10 weeks
Antenatal screening protocol
- every four weeks until 28 weeks
- every two weeks until 36 weeks
- every week until 40 weeks or delivery
Spina bifida investigation
US of foetal spine at 16-18 weeks
Tenderness of the right lower part of the uterus indicates
Indications to use ant-D
-Spontaneous abortion.
-External cephalic version.
-Significant closed intra-abdominal trauma.
-Termination of pregnancy.
-Chorionic Villus Sampling.
-Ectopic pregnancy.
-Threatened abortion after 12 weeks of gestation
Doppler studies result
- increase in end-diastolic flow velocity relative to peak systolic velocity
- S/D ratio to decreases with advancing gestation
Increase in S/D ratio is associated with
- increased resistance in the placental vascular bed
- can be noted in pr-eclampsia or festal growth retardation
- Nicotine and maternal smoking increase S/D ratio
Teenage pregnancy complication
- maternal poor weight gain
- premature delivery
- low birth weight
- increased risk of pregnancy-induced hypertension
- increased risk of violence
Rectus sheath haematoma causes
- anticoagulation therapy
- severe cough
- pregnancy
- previous or recent abdominal surgery
- abdominal trauma
- chronic kidney disease
- steroid/immunosuppressive therapy
- vigorous uncoordinated rectus muscle contraction
Features of Placental abruption
- PAINFUL vaginal bleeding or without bleeding (concealed bleeding)
- uterine tenderness
- foetal compromise on CTG
Features of Placenta previa
- painless vaginal bleeding (low in comparison to other forms)
- with or without uterine tenderness (AMC handbook)
- foetal compromise on CTG (can also be without AMC handbook)
- tender rigid abdomen
Vasa previa feature
Carries minimal maternal risk but has serious fetal risk
- no bleeding when ROM
∗ Causes fresh painless vaginal bleeding when membranes rupture just before labour starts
∗ Can be detected by transvaginal ultrasound
∗ If detected early, c – c-section will be done between 34 to 37 weeks
Trying for pregnancy after miscarriage/abortion
Wait one menstrual period after abortion
pregnant women with Myasthenia Gravis with pre-eclampsia
magnesium sulphate is contraindicated. as it impairs already slowed nerve muscle connections
Platelet count that is considered safe in pregnancy
50000/mm3
Safe platelets count for regional anaesthesia
70000-100000/mm3
Causes of thrombocytopenia in pregnancy
- Gestational/incidental thrombocytopenia (most common)
- Acute fatty liver
- HELLP syndrome
- Pre-eclampsia
- Eclampsia
HELLP Syndrome stands for
H- haemolysis
EL -elevated liver enzyme levels
LP -low platelet levels
HELLP Syndrome features
- average between 32-34 weeks
- postpartum in up to 30% of cases
- right upper quadrant pain or epigastric pain
- nausea, vomiting, and malaise
- hypertension 80%
- low level proteinuria 5-15%
- AST/ALT elevated secondary to liver dysfunction
- High blood urea and creatinine with acute renal failure
- bilirubin level is increased secondary to haemolysis
Pre-eclampsia dx
> 20 weeks + Hypertension (1st symptom) + end-organ damage such as ankle and facial edema or placental insufficiency
- proteinuria (2nd symptom) after 20 weeks
-headache, dizziness and abdominal pain just below the ribs.
Severe pre-eclampsia dx
BP > 160/110mmHg + proteinuria
Pre-eclampsia ddx
gestational hypertension
acute fatty liver
Proteinuria in pre-eclampsia
> 300g protein in 24hr urine
protein to creatinine ratio
Used to diagnose pre-eclampsia
- >30mmol
Risk of pre-eclampsia
- Previous eclampsia [7x]
- Chronic hypertension [5]
- Pre-existing diabetes [4x]
- Multiple pregnancy (twin) [3x]
- Autoimmune disease (SLE, antiphospholipid syndrome) [3x]
- Nulliparity [3x]
- 1st degree family history [3x}
- Age >40 [2x]
- Pre-existing kidney disease [2x]
- BMI > 30 [2x]
- Prolonged interpregnancy interval
gestational hypertension features
> 20 weeks
- without pre-eclampsia features
- resolves within 3 months after delivery
- good prognosis
gestational hypertension investigation
monitor to exclude development of pre-eclampsia
- if BP >140/90: start antihypertensives
- aim to maintain BP at 110-140/80-90
Symphyseal fundal height
gestational age +- 2
- if low check for pre-eclampsia
Medication for hypertension
Moderate:
- Methyldopa
- labetalol/atenolol
- Nifedipine
Severe:
- IV Hydralazine 5mg bolus every 20 min
Methyldopa in postpartum period
- Cease as it can increase risk of postpartum depression
- Switch to enalapril
- Add nifedipine if above don’t work (acts very quickly)
Criteria for gestational thrombocytopenia
- mild/asymptomatic thrombocytopenia
- no past hx (unless previous pregnancy)
- no foetal thrombocytopenia association
- spontaneous resolution upon delivery
Obstetric cholestasis features
- late second and early third trimester of pregnancy
- pruritus and rash on the palms of the feet worse at night
- increased serum bile acids and other liver function tests.
- jaundice uncommon but could be present
- 40% of recurring in subsequent pregnancies
Obstetric cholestasis investigation
weekly LFT
- increased ALP
- mildly increased AST/ALT & bilirubin
Monitor foetus
- deliver if distressed
Obstetric cholestasis prognosis
- usually clears up rapidly after delivery
- often recurs in future pregnancies or using OCP (which are contraindicated)
Obstetric cholestasis treatment
- relieve bile acids with ursodeoxycholic acids
- antihistamine/emollients
Obstetric cholestasis complications
- foetal distress/death
- preterm delivery
- meconium ingestion
- meconium aspiration syndrome
Acute fatty liver features
Life threatening
- Late 3rd trimester/ early postpartum period (35-36 weeks)
- 1 in 10000 pregnancies
- mortality rate 50%
- Jaundice prevalent
Acute fatty liver causes
disordered fatty acid metabolism by mitochondria in mother
- due to LCHAD enzyme deficiency
- hepatotoxic agents given to mother
Acute fatty liver complications
- ascites
- pancreatitis
- liver encephalopathy
- disseminated intravascular coagulation (DIC)
Acute fatty liver of pregnancy (AFLP) is a rare but serious condition that occurs in the third trimester of pregnancy, where fat accumulates in the liver cells, leading to liver dysfunction. Here’s why it can cause these complications in simple terms:
- What It Is: Ascites is the buildup of fluid in the abdomen.
- Why It Happens: In AFLP, the liver is damaged and can’t produce enough proteins like albumin, which normally helps keep fluid inside blood vessels. Without enough albumin, fluid leaks out into the abdomen, causing ascites.
- What It Is: Pancreatitis is inflammation of the pancreas.
- Why It Happens: The liver and pancreas are closely connected in the digestive process. When the liver is severely damaged in AFLP, it can disrupt normal digestion and lead to the inflammation of the pancreas, causing pancreatitis.
- What It Is: Liver encephalopathy is brain dysfunction caused by severe liver disease.
- Why It Happens: The liver usually filters toxins from the blood. In AFLP, the liver’s ability to do this is impaired, so toxins build up in the blood and eventually affect the brain, leading to confusion, drowsiness, or even coma.
- What It Is: DIC is a serious condition where blood clots form throughout the body’s small blood vessels.
- Why It Happens: In AFLP, the liver can’t produce enough of the proteins needed for normal blood clotting. This can trigger widespread clotting (using up clotting factors), followed by excessive bleeding because the clotting system becomes exhausted.
- Ascites happens because a damaged liver can’t keep fluid in the blood vessels, leading to fluid buildup in the abdomen.
- Pancreatitis can occur as liver damage disrupts normal digestive processes, causing inflammation in the pancreas.
- Liver encephalopathy occurs when a failing liver can’t filter toxins from the blood, leading to brain dysfunction.
- DIC is a severe clotting disorder triggered by the liver’s inability to properly manage blood clotting, leading to both excessive clotting and bleeding.
These complications arise because the liver is crucial for many bodily functions, and when it’s damaged, multiple systems can be affected, leading to serious health problems.
Acute fatty liver dx
Liver failure
-increased AST + ALT (200)
- increased bilirubin
- ALP normal
Acute fatty liver investigation
Liver biopsy confirms dx
Acute fatty liver management
- DRABCD
- Admission to ICU
- Termination of pregnancy (lifesaving for both mother and baby)
- prevent/treat DIC
- may require liver transplant
Foetal
Uterine hyperstimulation
more than 5 active labour contractions in 10 minutes (tachysystole)
- contractions lasting more than 2 mins/ occurring within 60 secs of each other (hypertonus)
Umbilical cord prolapse
- Variable decelerations
- persistent foetal bradycardia
- prolonged decelerations for over 1 minute
Umbilical cord prolapse
-PPROM.
-Polyhydramnios
-Breech presentation.
-Multiparity.
-Multiple gestations.
-GDM increasing the risk of polyhydramnios, fetal
malpresentation, premature rupture of membrane.
Hypertension in pregnancy
- primary pulmonary hypertension is a contraindication
- increases the risk of pre-eclampsia
- increases the risk of foetal growth restriction
- Daily intake of 1000mg of calcium to reduce incidence of hypertensive disorders and preterm labour
Varicella Zoster (Chickenpox)
- Check mothers IgG status for antibodies:
positive = no further action needed
negative = within first 96 hours, give immunoglobulin (VZIG)
Varicella Zoster (Chickenpox) screening
1st trimester if no prior/uncertain history
Varicella prophylaxis
Acyclovir (1st line) valaciclovir:
-2nd half of pregnancy
- underlying history of lung disease
- smoker
- immunocompromised
Varicella management IgM+
without complications:
- Rash < 24 hours - give oral antivirals (acyclovir)
Rash >24 hours - no treatment is required.
With complications /
immunocompromised:
- Intravenous acyclovir
Varicella management in a px that is infected/ symptomatic about to deliver
Chicken pox
### If Symptoms Appear More Than 7 Days Before Delivery:
- No special treatment: The baby does not need VZIG (a protective shot).
- No isolation needed: The baby does not need to be separated from others.
- Breastfeeding encouraged: The mother should continue breastfeeding as usual.
- VZIG for the Baby: The baby should receive a shot of VZIG (200 IU) right after birth to help protect against chickenpox. Ideally, this should be done within the first 24 hours but can be given up to 72 hours after birth.
- Early Discharge: Full-term babies should be discharged from the hospital as soon as possible.
- No isolation needed: The baby does not need to be isolated.
- Breastfeeding encouraged: The mother should continue breastfeeding as usual.
-
VZIG for Certain Babies:
- If the baby was born before 28 weeks gestation or weighs less than 1000 grams, they should receive VZIG within 96 hours of exposure, but it can be given up to 10 days after the mother develops a rash.
- If the mother has never had chickenpox or doesn’t have immunity, the baby should get VZIG if exposed between 2 and 28 days after birth.
- Early Discharge: Full-term babies should be discharged from the hospital as soon as possible.
- No isolation needed: The baby does not need to be isolated.
- Breastfeeding encouraged: The mother should continue breastfeeding as usual.
- The need for VZIG and other measures depends on when the mother shows symptoms in relation to delivery.
- Isolation is generally not required, and breastfeeding is always encouraged.
Presentation of the symptoms >7 days before delivery:
- No VZIG required.
- No isolation required.
- Encourage breastfeeding
Maternal chickenpox 7 days before to 2 days after birth:
- Give newborn VZIG 200 1U bone vial)
intramuscularly (IM) immediately after birth.
VZIG should be given as soon as possible within
the first 24 hours of birth but may be given up
to 72 hours.
- Discharge term neonates as soon as possible.
- No isolation required.
- Encourage breastfeeding.
Maternal chickenpox > 2 to 28 days after birth:
- If neonate < 28 weeks gestation or 1000 g birth
weight, give VZIG (preferably within 96 hours
but can be given up to 10 days post-maternal
rash.
- Due to the increased risk of severe varicella in
newborns of seronegative women (if the mother
has no personal history of infection with VZV),
give VZIG to neonates exposed to varicella
between 2 to 28 days of age.
- Discharge term neonates as soon as possible.
- No isolation required.
- Encourage breastfeeding.
Vaccines that are contraindicated in pregnancy
- Varicella Zoster (chicken pox)
- Rubella
- Measles
Pertussis DPTa
- can give vaccine
- usually recommended at 28 weeks
Effects of oxytocin
- uterine stimulation
- antidiuretic
- mammary gland stimulation
- labor induction
Foods that should be avoided during pregancy
- Dairy: soft cheese, soft serve ice cream, unpasteurised
- Smoked salmon, trout
Eating soft cheese/salmon increases the risk of
Listeriosis
(meningitis, meningoencephalitis)
PROM vs PPROM
PROM
- <37 weeks
Preterm Pre-Rupture of Membranes (PPROM)
- Rupture of foetal membranes before labour at any gestational age
- 50% progression into labour with 24 hrs
- 80% in 7 days
- preterm delivery
- presence of liquor flow from the cervical os
- pooling of liquor flow in the posterior vaginal fornix
- Neonatal complications
-intrauterine infections (chorioamnionitis)
NOTE: DON’T DO vaginal swabs due to high risk of infections
Preterm Pre-Rupture of Membranes (PPROM) ddx
- fluid loss
- ## urinary incontinence
PPROM risks
- cord prolapse
- preterm labour
- placental abruption
- chorioamnionitis
- foetal pulmonary hypoplasia/ other features of prematurity
- limb positioning defects
- perinatal mortality
Preterm Pre-Rupture (PPROM) of Membranes management
-admit to hospital
- < 34 week + 6 days: corticosteroids (IM betamethasone) to decrease neonatal complications
- oral erythromycin or IV prophylactic antibiotics 48hrs (amoxicillin) to prevent chorioamnionitis
-
- Baby born < 34 weeks would need to be monitored in the NICU (tertiary hospital)
- weekly bloods + CRP + vaginal swabs
Foetal fibronectin (fFN)
- absence is best negative predictor of PTD.
negative test means preterm labour within the next 7 days would be unlikely.
criteria:
- Intact foetal membranes
- Cervical dilation less than 3 cm
- Gestational age of between 22 +0d - 34+6d
weeks
Preterm labour criteria
< 36 + 6 weeks
Preterm labour dx
- history two or more miscarriages occurring after the 12th weeks gestation, usually starting with painless leaking of amniotic fluid
- The easy passage of a size 9 cervical dilator through the internal os of the cervix when the woman is not pregnant, and the absence of a ‘snap’ on its
withdrawal - cervical length of less than 25mm or cervical
funnelling >40% prior to 24 weeks gestation
Preterm labour causes
- idiopathic 40%
- cervical incompetence
- multiple pregnancy
- polyhydramnios
- uterus abnormalities, septum
- infections: GBS, measles, SMV, UTI
- DM
- haemorrhage: pre-eclampsia
Labour induction indications
- pre-eclampsia
- IVF
- IUGR
- Cephalic presentation
Contraindications of labour
- Signs of chorioamnionitis
- antepartum haemorrhage
- request of mother
- neonatal jeopardy
Features of Inefficient or incoordinate labour
- Usually no moulding of the foetal head
- +/- caput formation of foetal head
- usually absent cervical oedema
- tachycardia
- Can be above or below IS
- Usually < 1 finger breadths of head palpable above the pelvic brim when the lowest point of the head is at the IS
Features of obstructed labour
- ++ moulding of foetal head
- ++ caput formation on foetal head
- anterior lip cervical oedema
- ++ progressive foetal tachycardia
- just at or above the ischial spines (IS)
> 2 finger breadths of head palpable above the pelvic brim when the lowest point of the head is at the IS
These signs suggest that the baby is having difficulty moving down through the birth canal during labor. Here’s what each point means in simple terms:
-
++ Moulding of the Fetal Head:
- The baby’s head is being squeezed tightly as it tries to fit through the mother’s pelvis. The skull bones overlap more than usual.
-
++ Caput Formation on the Fetal Head:
- A swelling (caput) forms on the baby’s head due to pressure during labor. This is a soft bump on the top of the baby’s head.
-
Anterior Lip Cervical Edema:
- Part of the cervix (the opening of the uterus) is swollen. This can happen if the baby’s head is pushing against it before the cervix is fully dilated.
-
++ Progressive Fetal Tachycardia:
- The baby’s heart rate is getting faster than normal, which can be a sign of distress.
-
Just at or Above the Ischial Spines (IS):
- The baby’s head is either at or just above a specific point in the pelvis called the ischial spines. This means the baby hasn’t moved down very far during labor.
-
> 2 Finger Breadths of Head Palpable Above the Pelvic Brim When the Lowest Point of the Head is at the IS:
- Even though the baby’s head is at the ischial spines, you can still feel a good portion of the head (more than 2 finger widths) above the pelvic brim. This suggests the baby’s head hasn’t descended properly into the pelvis.
These signs indicate that the baby is having a tough time moving down into the birth canal, possibly due to the head not fitting well through the mother’s pelvis. This situation might require closer monitoring or intervention to ensure the baby and mother stay safe during labor.
Features of chorioamnionitis
- increased WBC (>15x 10^9/L)
-Maternal tachycardia >100 bpm - foetal tachycardia > 160 bpm
- uterine tenderness
- offensive vaginal discharge
- CRP > 40
Tocolysis contraindication
- chorioamnionitis (absolute)
Measles (MMR) during pregnancy
- Notifiable disease therefore contact tracing
- Immunoglobulin is used as prophylactic only, not for established
- symptomatic treatment
Measles incubation period
10-14 days
Measles symptoms
- fever
- malaise
- cough
- coryza
- conjunctivitis
- white spots surrounded by red ring in the buccal mucosa (Koplik’s)
- maculopapular rash 2-4 days after initial symptoms
- infection periods start 2 days after rash onset, 4 days after eruption
Measles complications in children
- Otitis media 7%
- Bronchopneumonia 6%
- acute encephalitis 2-10/10000
Measles complications in mother
- preterm labour
- spontaneous abortion
- foetal/neonatal loss
- maternal mortality
Complications in the Fetus
1. Congenital Measles: Though rare, the virus can cross the placenta and infect the fetus, leading to congenital infection. 2. Preterm Birth: Due to complications like pneumonia and systemic infection in the mother. 3. Low Birth Weight: Associated with preterm birth and maternal infection. 4. Stillbirth: Severe cases of measles can lead to fetal death.
Placental abruption
- separation of placenta from uterus
- 3rd trimester bleeding
- foetal morbidity and mortality
- MVA
Placental abruption symptoms
- vaginal bleeding 80%
- Abdominal/back pain 70%
- uterine tenderness 70%
- abnormal uterine contractions - 35%
- idiopathic premature labour - 25%
- foetal death 15%
-hypofibriogemia
Placental abruption with no foetal heart sounds, what to do next
foetus is dead.
Commence amniotomy as it’ll induce spontaneous labour
Rubella in pregnancy
- check serology (IgM and IgG) (IgG titer of = >than 10 IU/ml)
- Rubella infection in the first trimester (<8 weeks) causes severe foetal anomalies 85%
- If infected termination is recommended
rubella symptoms
- usually asymptomatic 25- 50% cases
- low grade fever
- transient erythematous rash
- post- auricular/ sub-occipital nodes lymphadenopathy
Maculopapular rash on the face and spreads to trunk and extremities (resolves within 3 days)
Rubella infection during pregnancy
- <8 weeks 85% foetal infection (congenital rubella syndrome)
- 8< - <12: 50 - 80% infected 65 -85 clinically infected
- 13 -16 weeks 30% infected, 1/3 have sensorineural deafness
- 16 -19 weeks: 10% infected, clinical features rare
- > 19 weeks: no apparent risk
Rubella vaccinated before pregnancy
Reassure if not exposed to Rubella
Rubella abnormalites
- CNS dysfunction 10 25% (intellectual impairment developmental delay, microcephaly)
- eye 10 -25% (cataracts, retinopathy, glaucoma)
- sensorineural deafness 60-75%
cardiac 10-20% (PDA wide pulse pressure, PA stenosis, ) - intrauterine growth restriction, short stature
- inflammatory lesions (brain, liver, lungs, bone marrow
Hyperemesis gravidarum
- nausea and vomiting at 5-6 weeks of gestation, peaking at 9 weeks
-Weight loss (more than 5% of weight)
-Ketosis - urine analysis to check for hydration status
School exclusion
Measles: 5 days
Mumps: 9 days
Rubella: 5 days
Incarcerated uterus
- pregnant uterus entrapped in the pelvis by subpromontary sacrum
- retroverted uterus?
Episiotomy haematoma management
- < 3cm conservative management
- > 3cm surgical excision/exploration
Most serious cause of Hyperemesis gravidarum
- Hypokalemia
- On ECG: such as inverted T waves and prolonged QT and PR intervals
Pregnancy-Unique Quantification of Emesis (PUQE-24) score 4-6
- Ginger 250mg orally, 4 times/day
Pyridoxine (Vit B6) 10-25mg 3-4 times/day
Pregnancy-Unique Quantification of Emesis (PUQE-24) score 7 -12
Cyclizine 12.5-50mg oral 3/d
Promethazine 10-25mg oral 3/day
Prochlorperazine 5-10mg oral 3-4/day
Metoclopramide 10mg oral/IV/IM
Domperidone 10mg 3/day
Ondesatron 4-8mg oral/IV
Pregnancy-Unique Quantification of Emesis (PUQE-24) score > 13
Hydrocortisone IV 100mg 2/day
Prednisolone 40-50mg oral 1/day
Hyperemesis gravidarum excessive vomiting may lead to the
following
- Hyponatremia - caused by vomiting and Gl loss
- Hypokalemia - caused by vomiting and Gl loss
- Hypochloremic alkalosis - caused by vomiting
and GI loss - Ketosis - resulting from decreased oral intake,
starvation and dehydration - Abnormal liver enzymes (ALT>AST)
- Increased serum amylase and lipase
- Vitamin deficiency in pregnancy (very rare)
Hyperemesis gravidarum mx
1st line: metoclopramide
2nd line: Ondansetron if metoclopramide doesn’t’ work
3rd: steroids (prednisolone) last resort
Placenta previa management
management depends on gestation duration:
- < 37 weeks even with large amounts of bleeding can be safely monitored
- > 37 weeks with bleeding delivery through C section
Hyperthyroidism in Pregnancy
- Check TSH and free T4
foetus: - foetal tachycardia
- small gestational size
- premature/stillborn
- Graves
- if px
Hyperthyroidism medication
- radioactive iodine therapy if patient is not pregnant (postpone pregnancy for 6 months)
- PTU if already pregnant
- Don’t give carbimazole in first trimester as if causes scalp defects
Imminent eclampsia dx
-BP > 160mm/hg on 2 occasions 6 hours apart
- Proteinuria of > 5g
- cerebral/visual disturbances drowsiness, droopy eyelids
- pulmonary oedema
Eclampsia dx
-seizures
Eclampsia management
IV diazepam with Magnesium sulphate (phenytoin teratogenic)
Features of magnesium sulphate toxicity
- respiratory rate < 12 breaths/minute
- urine output < 100mLs in 4 hours (renal insufficiency)
- loss of patellar reflexes; further seizures occur
- Muscle paralysis and respiratory difficulty at >7.5 mmol/L
- cardiac arrest at levels greater than >12 mmol/L
magnesium sulphate toxicity treatment
serum magnesium level is >3.5mmol/L, cease infusion and consult with obstetrician
foetal growth restriction causes
- intrauterine restriction
- Maternal hypertension (SLE, lupus nephritis) - Congenital
- Trisomy 21, 18, 13 Turner’s - Infections
– Cytomegalovirus (CMV) /intrauterine infection - Maternal
- smoking, alcohol, phenytoin
Most common viral cause of birth defects
CMV
Features of CMV
- maternal primary infection often asymptomatic
- IgG seropositive up to 50% of pregnant women
- Transplacental foetal infection is 50% with primary infection
CMV symptoms
- retardation
- microcephaly
- seizures
- hearing deficits
- chorioretinitis
- optic atrophy
- brain architectural changes
CMV dx
combination of
foetal ultrasound, amniocentesis + /- foetal serology
definite diagnosis of foetal infection is by
amniocentesis
Shoulder dystocia MANAGEMENT mnemonic
