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Phase 3a > Obstetrics > Flashcards

Obstetrics Flashcards

1
Q

What is an IDEAL pregnancy in terms of presentation, lie, placenta etc?

A
  • Presentation - head first
  • Lie - longitudinal
  • Placenta - upper segment
  • Attitude - flexed vertex position (smallest diameter, easiest to deliver)
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2
Q

What are the three trimesters?

A

1st - 0-12
2nd - 13-27
3rd 28-40

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3
Q

What is a normal length pregnancy?

A

37-42 weeks

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4
Q

What is Naegele’s rule?

A

Method of calculating estimated delivery date of baby:
1st day LMP - three months + 7 days

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5
Q

What is gravidity?

A

Number of pregnancies regardless of outcome and including current

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6
Q

What is parity?

A

The number of deliveries beyond 24 weeks not including current

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7
Q

What does primiparous mean?

A

First time delivered beyond 24 weeks

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8
Q

What does primigravida mean?

A

First time pregnant regardless of outcome

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9
Q

What is a premature birth?

A

Give birth less than 37 weeks
32-37 weeks - moderately premature
28-32 weeks - early premature
<28 weeks - severely premature

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10
Q

What does multiparous mean?

A

Given birth at least twice at over 24 weeks

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11
Q

What does nulliparous mean?

A

Never given birth more than 24 weeks

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12
Q

What are the five main functions of the placenta?

A
  • Resp - supplies foetus with oxygen
  • Renal - excretory
  • Nutrition
  • Immunity
  • Hormonal
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13
Q

Which Ig can cross the placenta?

A

IgG

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14
Q

What hormones does the placenta secrete?

A
  • oestrogen
  • progesterone
    -Beta HCG
  • HPL - human placental lactogen
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15
Q

What can HPL cause?

A

Gestational diabetes

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16
Q

What should the crown rump length on USS be at 8-12 weeks?

A

50mm

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17
Q

What should the crown rump length be at 21 weeks?

A

210mm

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18
Q

When is surfactant produced?

A

35 weeks

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19
Q

What needs to be given if a baby is being born before 35 weeks?

A

Maternal prenatal corticosteroid and baby surfactant after birth

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20
Q

What are the maternal cardiovascular changes in pregnancy?

A
  • decreased bp
  • increased cardiac output
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21
Q

What are the maternal haemological changes in pregnancy?

A

Functional anaemia

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22
Q

What are the maternal GI changes in pregnancy?

A
  • dysmotility
  • constipation
  • GORD
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23
Q

What are the maternal immunity changes in pregnancy?

A

Decreased immune response

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24
Q

What are the maternal endocrine changes in pregnancy?

A

Poorer glycaemic control

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25
Q

What are the maternal GU changes in pregnancy?

A
  • Increased renal excretion
  • Increased UTI risk
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26
Q

What are the maternal hormonal changes during pregnancy?

A
  • Raised oestrogen
  • Raised progesterone
  • Raised prolactin
  • Raised bHCG
  • raised ALP
  • raised ESR + CRP
  • raised T3+4
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27
Q

What are all mothers advised?

A
  • Vitamin D supplement 10mcg/day
  • Folate for 1/3
  • Stop smoking
  • No alcohol
  • Healthy diet
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28
Q

What can smoking during pregnancy cause?

A
  • Pre-term birth
  • Intrauterine growth restriction
  • Miscarriage
  • Placental abruption
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29
Q

What can alcohol during pregnancy cause?

A
  • Foetal alcohol syndrome
  • Foetal growth restriction
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30
Q

What should you recommend a woman and her partner take if they are trying to conceive?

A

Folate for 6 months prior

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31
Q

What doses of folate are given to pregnant women?

A
  • 400 micrograms for standard pregnancy
  • 5mg for women who are obese or taking anti-epileptic medication
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32
Q

Why is folate given to pregnant women?

A

To prevent neural tube defects

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33
Q

Who are checks during pregnancy done by?

A
  • Midwives if uncomplicated pregnancy
  • Doctors if complicated pregnancy
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34
Q

What happens at the 8-12 weeks check?

A

Booking appt.
- Screened for HEP B, HIV, Sickle cell, thalassemia, syphilis
- Check BMI, BP, FBC

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35
Q

What is screened for at the 8-12 week booking appointment?

A
  • HEP B
  • HIV
  • Sickle cell
  • Thalassemia
  • Syphilis
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36
Q

What happens at the 11- 13+6 week check?

A
  • Dating scan
  • Combined test - USS, bHCG, PAPP-A
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37
Q

What does the combined test at the 11-13+6 week check look for?

A
  • Down’s syndrome - T21
  • Edwards syndrome -T18
  • Patau syndrome - T13
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38
Q

In the combined test what would show for Down’s syndrome?

A
  • Raised bHCG
  • Decreased PAPP-A
  • > 6mm neuchal translucency
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39
Q

What are some other tests you can consider doing between 11-14 weeks?

A
  • Chorionic villus sampling
  • Amniocentesis (normally about 15 weeks)
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40
Q

If a pregnant woman misses her dating scan and presents at 16 weeks gestation, what is the best test for genetic abnormalities?

A

Amniocentesis

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41
Q

If a pregnant woman presents at 11-14 weeks gestation and has not had the combined test, which test can check for any of the trisomy’s?

A

Chorionic villous sampling

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42
Q

What are the risks of amniocentesis and chorionic villus sampling?

A
  • Up to 1% chance of miscarriage
  • Risk of precipitating rhesus disease
  • Risk of infection
  • Risk of clubfoot
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43
Q

What genetic test can be done between 15-20 weeks gestation for Down’s syndrome?

A

Non-invasive prenatal testing

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44
Q

What conditions is non-invasive prenatal testing not sensitive for?

A
  • Edwards syndrome
  • Patau’s syndrome
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45
Q

If a woman presents at 15 weeks gestation and has not had the combined test, which test should you do?

A

The quad test - bHCG, Alpha Feto Protein, E3, Inhibin A
Only tests for Down’s

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46
Q

What checks are done at 18-20 weeks gestation?

A

Anomaly ultrasound scan

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47
Q

What does the anomaly ultrasound scan check for?

A
  • Congenital heart defects
  • Neural tube defects
  • Bowel defects
  • Placenta previa
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48
Q

What checks are done at 28 weeks gestation?

A
  • Oral glucose tolerance test
  • Give rhesus antibodies if rhesus negative
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49
Q

What checks are done at 34 weeks gestation?

A
  • USS - check baby progression and placenta previa
  • Give second dose of rhesus antibodies if rhesus negative
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50
Q

What checks are done at 36 weeks gestation?

A
  • Determine presentation
  • If breech offer external cephalic version at 37 weeks
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51
Q

What checks are done at 38 weeks gestation?

A
  • Discuss a long pregnancy
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52
Q

What checks are done at 41 weeks gestation?

A
  • Discuss inducing labour
  • Started with membrane sweep
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53
Q

What are the signs before labour begins?

A
  • Vague cramps called Braxton hicks contractions (irregular, weak painless tightening of uterine wall)
  • Bloody show
  • Rupture of membranes just before
  • 3-4 regular rising severe contractions every 60 seconds
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54
Q

What are the two stages of stage 1 of labour?

A
  • Latent
  • Active
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55
Q

How long is the latent stage of labour?

A
  • Up to 20 hours in primi
  • Up to 14 hours in multi
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56
Q

How dilated is the cervix during the latent stage of labour?

A

Up to 30% (0-3cm)

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57
Q

How often are contractions in the latent stage of labour?

A

Every 1-3 minutes

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58
Q

How long is the active stage of labour?

A
  • Up to 6 hours if primi
  • Up to 5 hours if multi
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59
Q

How dilated is the cervix in the active stage of labour?

A

30-100% (Up to 10cm dilated)

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60
Q

How often are contractions in the active stage of labour?

A

Every 1-2 mins

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61
Q

What is stage 1 of labour?

A

Mostly dilation of the cervix

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62
Q

What is stage 2 of labour?

A

Delivery of the baby

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63
Q

How long can stage 2 of labour last?

A
  • Up to 2 hours in a primi
  • Up to 1 hour in a multi
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64
Q

What does the length of stage 2 of labour depend on?

A
  • Power (tone)
  • Passage (pelvic inlet dimensions)
  • Passenger
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65
Q

What are the stages in which a baby is delivered?

A
  • engagement
  • descent
  • flexion
  • internal rotation
  • extension
  • external rotation
  • expulsion
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66
Q

How long does stage 3 of labour last?

A

Up to 30 mins

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67
Q

What happens in stage 3 of labour?

A

Deliver placenta and monitor PPH

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68
Q

What is the most common cause of a failure to progress in stage 2 of labour?

A

Uterine atony due to fatigue

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69
Q

What post partum care is required?

A
  • Hospital stay of at least 1 day
  • Consider contraception
  • Monitor for PPH
  • Monitor for post partum mental health
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70
Q

What is the Bishops score?

A

A measure of cervical ripeness, used to aid decisions about induction of labour

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71
Q

What do the scores mean in Bishops score?

A

<5 - unripe cervix - unlikely to spontaneously induce labour
5-7 intermediate
>8 ripe cervix - likely to spontaneously induce

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72
Q

What can be done if there is a Bishops score of <6?

A

Consider a membrane sweep and vaginal prostaglandins

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73
Q

What can be done if there’s a Bishops score of >6?

A

Artificial rupture of membranes and IV oxytocin

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74
Q

What are indications to induce labour?

A
  • Prolonged labour (failure to progress)
  • PPROM
  • Maternal problems (GDM, pre-eclampsia, obstetric cholestasis)
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75
Q

What are complications of induction of labour?

A
  • Failure to induce
  • Uterine hyperstimulation
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76
Q

When would IV benzylpenicillin be given to a woman during labour?

A

If a woman has detected group b strep

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77
Q

What are routinely offered vaccines for pregnant women?

A
  • Influenza
  • Pertussis (whooping cough)
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78
Q

What are the conservative pain relief options during labour?

A
  • Peri-anal and fundal massage
  • TENS (nerve stimulation)
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79
Q

What are the medication pain relief options for during labour?

A
  • Entonox
  • Morphine
  • Epidural anaesthesia
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80
Q

When is epidural anaesthesia contraindicated?

A
  • Low platelets
  • If pt is on DOAC or aspirin
  • May be denied in antepartum haemorrhage
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81
Q

What are the side effects of epidural anaesthesia?

A
  • Urinary retention
  • hypotension
  • hypoanalgesia
  • CSF leakage - headache
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82
Q

What are the two types of c-section?

A
  • Classical - midline incision (not normally done)
  • Joel Cohen - transverse incision
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83
Q

When is a c-section indicated (emergencies)?

A
  • Placenta previa
  • Vasa previa
  • Failure to progress
  • Active genital herpes
  • Cord prolapse
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84
Q

What are the possible complications of c-sections?

A
  • Vaginal birth after caesarean can cause uterine rupture
  • transient tachypnoea of newborn
  • PPH
  • Endometritis
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85
Q

What are the categories of caesarean?

A

Cat1 - within 30 mins (severe emergency)
Cat2 - within 75 minutes (emergency)
Cat3 - Needed but not emergency - planned for certain date
Cat4 - Elective

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86
Q

What does cardiotocography (CTG) account for?

A

Monitors foetal heart rate and mothers uterine contractions
Indirect measure of intrauterine pressure

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87
Q

What is a low risk CTG going to show?

A
  • Regular contractions
  • HR 110-160
  • Variability 6-25
  • Accelerations are present
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88
Q

What is a high risk CTG going to show?

A
  • Bradycardia or tachycardia (<100 or >160)
  • Variability less than 5
  • No accelerations
  • Late or variable decelerations
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89
Q

What would a high risk CTG indicate?

A
  • Hypoxia
  • Ischaemia
  • High risk of impairment to foetus
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90
Q

If there is a high risk CTG, what sample should be taken?

A

Foetal scalp sample - check pH

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91
Q

What is the first line investigation for reduced/no foetal movement?

A

Hand held doppler then consider CTG

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92
Q

What are the two types of instrumental delivery?

A
  • Ventouse
  • Forceps
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93
Q

What are the two possible complications of ventouse delivery?

A
  • Cephalohematoma
  • Caput succedaneum
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94
Q

What is caput succedaneum?

A

Subcutaneous oedema, not confined to suture lines, resolves in days

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95
Q

What is cephalohematoma?

A

Sub periosteal bleed which is confined to suture lines and resolves within a few months

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96
Q

What are the possible complications of forceps delivery?

A

Cranial nerve 7 palsy

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97
Q

What is premature pre-labour rupture of membranes (PPROM)?

A

A rush of fluid due to rupture of membranes not directly preceding labour

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98
Q

What can cause PPROM?

A
  • Trauma
  • TORCH infections
  • STIs
  • CVS and amniocentesis
  • LLETZ
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99
Q

What are the investigations for PPROM?

A
  • Speculum - fluid pooled in posterior fornix
  • Nitraline test pH >7.1
  • Positive fern sign on microscopy
  • TVUSS will show oligohydramnios
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100
Q

How is PPROM treated?

A
  • Erythromycin 250mg QDS for 10 days
  • Consider maternal steroids
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101
Q

Why is PPROM treated with antibiotics?

A

To prevent chorioamnionitis

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102
Q

What are the symptoms of chorioamnionitis?

A
  • Stillbirth
  • Hypoxic ischaemic injury
  • Respiratory distress in the baby
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103
Q

What are the risk factors for cord prolapse?

A
  • Polyhydramnios
  • Abnormal foetal lie
  • Artificial rupture of membranes
  • Multiple pregnancy
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104
Q

What are the symptoms of cord prolapse?

A
  • Visible cord
  • Foetal bradycardia on CTG monitoring
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105
Q

What investigations need to be done for cord prolapse?

A

A-E assessment

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106
Q

How is cord prolapse treated?

A
  • Get pt onto all fours ASAP to reduce pressure on cord
  • Catheterise them
  • C-section needed
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107
Q

What are the possible complications of cord prolapse?

A
  • Nuchal cord
  • Foetal ischaemia
108
Q

What investigation is required for all babies who have been born in breech position?

A

USS of hip

109
Q

What are the risk factors for breech position?

A
  • Polyhydramnios
  • Pre-term baby
110
Q

What are the possible complications of breech birth?

A

Developmental dysplasia of the hip

111
Q

What should be offered if a baby is breech at 37 weeks?

A

External cephalic version

112
Q

What are the classifications of perineal tears?

A
  1. Mucosal
    • muscle
    • External anal sphincter
  4. Rectal musoca
113
Q

What is a miscarriage?

A

Death of the foetus in utero within 24 weeks

114
Q

What are the main causes of miscarriage?

A

Foetal - chromosomal problems, congenital malformations (TORCH infections), congenital abnormalities
Mother - smoking, APL, SLE, placental insufficiency, diabetes, hypertension

115
Q

What are the five main types of miscarriage?

A
  • Threatened miscarriages - mc
  • Inevitable
  • Complete
  • Incomplete
  • Missed
116
Q

How does a threatened miscarriage present?

A

PAINLESS vaginal bleed, os is closed

117
Q

How does an inevitable miscarriage present?

A

PAINFUL bleed, os is open

118
Q

How does a complete miscarriage present?

A

PAINFUL bleed, os is closed, empty gestational sac

119
Q

How does an incomplete miscarriage present?

A

Bleed, os is open, retained products on USS

120
Q

How does a missed miscarriage present?

A

No pain +/- bleed, os is closed, empty gestational sac on USS

121
Q

What is a recurrent miscarriage?

A

If a pt has more than 3 miscarriages in a row

122
Q

How is miscarriage diagnosed?

A
  • TVUSS
  • Serum B-HCG
123
Q

What is the treatment for a threatened miscarriage?

A

400mg vaginal progesterone + repeat serum B-HCG within 7 days

124
Q

What is expectant management for a miscarriage?

A

Watching and waiting

125
Q

What is the medical management for a miscarriage?

A

Give vaginal misoprostol

126
Q

What is the surgical management of a miscarriage?

A

Dilatation and curettage

127
Q

What is a termination of pregnancy?

A

A pregnancy voluntarily ended before 24 weeks

128
Q

What are the two methods of termination of pregnancy?

A
  • Medical
  • Surgical
129
Q
A
130
Q

What is the medical method of termination of pregnancy?

A

Oral Mifepristone + vaginal misoprostol

131
Q

What is the surgical method of termination?

A

Suction, dilatation and cutterage

132
Q

When would medical termination of pregnancy be done over surgical?

A

Medical - up to 13 weeks and then 14-24 weeks is surgical

133
Q

What is an ectopic pregnancy?

A

The implantation of a conceptus outside of the uterine cavity

134
Q

What is the most common location for an ectopic pregnancy?

A

The ampulla

135
Q

What is the most common location for an ectopic pregnancy rupture?

A

The isthmus

136
Q

What are the risk factors for ectopic pregnancy?

A
  • PID
  • IVF
  • Endometriosis
  • IUS/IUD
  • Past history of ectopics
137
Q

What are the symptoms of ectopic pregnancy?

A
  • Unilateral RIF/LIF pain with light brown pv bleed in amenorrhoeic females for 6-8 weeks
  • Dyschezia + dysuria
  • Nausea + vomiting
  • Shock
  • Shoulder tip referred pain
  • Cervical motion tenderness
138
Q

What investigations are going to be done for ectopic pregnancy?

A
  • Serum B-HCG - increase by <63%
  • TVUSS
139
Q

When would expectant management be used in ectopic pregnancy?

A
  • <35mm
  • B-HCG <1500
  • No foetal heart beat
  • No pain
140
Q

What is medical treatment for ectopic pregnancy?

A

IM methotrexate

141
Q

When would medical management be used for ectopic pregnancy?

A
  • <35mm
  • B-HCG 1500-5000
  • No foetal heart beat
  • No pain
142
Q

When would an ectopic pregnancy be managed surgically?

A

Only need 1 of these:
- >35mm
- B-HCG >5000
- Foetal heart beat
- Pain

143
Q

What are the surgical management options for ectopic pregnancy?

A
  • Salpingectomy - no fertility concerns
  • Salpingotomy - fertility concerns
144
Q

What are the complications of ectopic pregnancy?

A
  • Fallopian tube rupture
  • Early maternal death due to shock
  • Infertility from surgery
  • Up to 20% recurrence
145
Q

What are the risk factors for molar pregnancy?

A
  • Either teenage or 45+
  • Asian
  • Past history
146
Q

What are the symptoms for molar pregnancy?

A
  • First trimester pv bleed
  • Hyperemesis
  • Hypertension first trimester
  • Hyperthyroid symptoms
  • Large for gestational age symptoms
147
Q

What is a complete molar pregnancy?

A

When a diploid sperm fertilises an empty egg

148
Q

What is an incomplete molar pregnancy?

A

When two sperm fertilises the same egg - too many chromosomes

149
Q

Why do women have thyrotoxicosis with molar pregnancy?

A

Due to high levels of B-HCG

150
Q

How are molar pregnancies diagnosed?

A
  • Bloods - U+E’s, TFTs, B-HCG
  • TVUSS - snow storm like appearance
151
Q

What is the treatment for molar pregnancy?

A

Suction, dilatation and curettage under general immediately

152
Q

What is there a risk of if a molar pregnancy is not treated immediately?

A

Risk of developing choriocarcinoma

153
Q

What is placenta previa?

A

When the placenta is in the lower segment of the uterus

154
Q

What are the grades for placenta previa?

A

1 - In lower segment <20mm from os
2 - Touching internal os
3 - Covering up os partially
4 - Complete os coverage

155
Q

What are the risk factors for placenta previa?

A
  • Multiple pregnancy
  • C-sections
  • Maternal smoking
  • IVF
  • Past history
156
Q

What are the main differentials for antepartum haemorrhage?

A
  • Placenta previa
  • Placental abruption
157
Q

What are the symptoms for placenta previa?

A

Third trimester painless pv bleeding, bright red blood

158
Q

How is placenta previa diagnosed?

A
  • Can be seen on anomaly scan (18-20 weeks)
  • If seen do not do PV exam!! Repeat scan at 34 weeks
159
Q

What is the treatment for placenta previa?

A

Grade 1 - consider a vaginal birth with observation
Grade 2-4 - consider C-section

160
Q

What are the possible complications with placenta previa?

A
  • Pre-term birth
  • Maternal death due to shock
  • Morbidly adhered placenta
161
Q

What are the types of morbidly adhered placenta?

A

Placenta acreta - adhesions into the basalis layer of endometrium
Placenta increta - adhesions into the myometrium
Placenta percreta - attaches to the outside surface of the uterus

162
Q

What are the main risk factors for morbidly adhered uterus?

A
  • Placenta previa
  • Uterine surgery
163
Q

How is morbidly adhered uterus diagnosed?

A
  • TVUSS abnormality scan
164
Q

What is the treatment for morbidly adhered uterus?

A

C-section + hysterectomy + group and save

165
Q

What are the possible complications of morbidly adhered placenta?

A
  • Heavy PPH
  • ## Prematurity
166
Q

What is placental abruption?

A

Separation of placenta from endometrial wall causing bleeding

167
Q

What are the risk factors for placental abruption?

A
  • smoking
  • cocaine use
  • HTN
  • trauma
  • multiparity
  • polyhydramnios
168
Q

What are the symptoms of placental abruption ?

A
  • Third trimester painful pv bleed, dark red
  • Hard, woody uterus
169
Q

How is placental abruption diagnosed?

A

USS

170
Q

What is the treatment for placental abruption?

A

Stable = observe
Mother/foetal distress = Cat 1 c-section

171
Q

What are the possible complications of placental abruption?

A
  • Disseminated intravascular coagulation
  • Prematurity
  • M-F death
172
Q

What is vasa previa?

A

The foetal vessels either cross the os or are within 20 mm of it

173
Q

What are the causes of vasa previ?

A

Velamentous cord or accessory placental lobes

174
Q

What are the symptoms of vasa previa?

A

Bright, painless, heavy vaginal bleed as soon as rupture of membranes

175
Q

How is vasa previa diagnosed?

A

USS - umbilical arteries presenting

176
Q

What is the treatment for vasa previa?

A

Need a Cat 1 C-section

177
Q

What is it classed as if a pregnant woman has hypertension <20 weeks?

A

Pre-existing or chronic HTN
Molar pregnancy sign

178
Q

What is it classified as if a pregnant woman has hypertension >20 weeks and negative proteinurea?

A

Gestational HTN

179
Q

What is it classified as if a pregnant woman has hypertension <20 weeks with positive proteinurea?

A

Pre-eclampsia

180
Q

What are the risk factors for having high bp during pregnancy?

A

High:
- chronic HTN
- CKD
- APL
- PMH pre-eclampsia
Mod:
- Raised BMI at booking
- >40
- FH pre-eclampsia

181
Q

What should be given to pregnant women who are at increased risk of developing high bp?

A

Start on 75-150mg aspirin daily from 12w-birth

182
Q

What are the symptoms for hypertension during pregnancy?

A
  • BP >140/90
    If severe:
  • vision changes
  • headaches
  • abdo pain
  • RUG pain
  • oedema
183
Q

What are the investigations for hypertension in pregnancy?

A
  • BP
  • Bloods - FBC, U+E’s, TFT, LFT, clotting
  • Urine dip
184
Q

What is the treatment for high bp in pregnancy?

A
  • Labetalol or nifedipine (if asthma)
185
Q

What are the possible complications of having high bp in pregnancy?

A
  • Eclampsia (+seizures)
  • HELLP
  • DIC
  • IUGR
  • placental abruption
186
Q

What is the treatment for eclampsia?

A

IV MgSO4 STAT + corticosteroid + delivery baby (c-section or induced)

187
Q

What is HELLP syndrome?

A
  • haemolysis
  • elevated LFT’s
  • low platelets
188
Q

How is HELLP syndrome treated?

A

Deliver baby ASAP

189
Q

What are the classes of diabetes a pt can have during pregnancy?

A
  • pre-existing (15%) - foetal abnormalities
  • gestational (85%) - no foetal abnormalities
190
Q

What are the foetal abnormalities that can be caused by pre-existing diabetes in pregnancy?

A
  • Cardiovascular - transposition of great arteries
  • Neural tube defects
  • Intrauterine growth restrictions
191
Q

What are risk factors for gestational diabetes?

A
  • PCOS
  • pre-eclampsia
  • HTN
  • obesity
  • family history
192
Q

How is gestational diabetes diagnosed?

A
  • OGTT 24-28 wks (>2 readings diagnostic)
  • Fasting plasma glucose >5.6
  • 2hrs after glucose solution >7.8
193
Q

What results would be diagnostic for diabetes (not gestational)?

A
  • Fasting plasma glucose >7
  • OGTT >7.8
  • Random plasma glucose >11
  • HbA1c >48mmol
194
Q

How is gestational diabetes treated?

A

FPG <7 - trial of 1-2 wk diet and exercise if not resolved offer metformin
FPG >7 - insulin +/- metformin

195
Q

What is the treatment for a woman with pre-existing diabetes who is pregnant?

A

Stop all DM drugs except metformin or insulin

196
Q

What are the targets blood glucose levels for a pt with gestational diabetes?

A

FPG 5.3
OGTT 6.4

197
Q

What are the main complications of gestational diabetes?

A
  • Polyhydramnios
  • Macrosomia
  • Traumatic birth
  • Perinatal death
  • Development to type 2 diabetes
198
Q

What is intrauterine growth restriction?

A

Impaired growth in utero due to pathology

199
Q

What is small for gestational age?

A

Foetal growth <10th centile (+/- pathological)

200
Q

What are the main causes of IUGR?

A
  • Chromosomal
  • Congenital abnormalities
  • Congenital infection
  • Placental insufficiency
  • HTN
  • Smoking
201
Q

What are the possible complications of IUGR?

A
  • Prematurity
  • Stillbirth
  • Cognitive delays
202
Q

What are the types of IUGR?

A
  • Symmetrical (30%)
  • Asymmetrical (70%)
203
Q

What are the features of symmetrical IUGR?

A
  • Foetal defects
  • Abdo + brain proportionally affected growth
  • Mental problems (delay)
204
Q

What are the features of asymmetrical IUGR?

A
  • Maternal placental insufficiency
  • Abdo + peripheral retardation
  • No brain involvement
  • No mental symptoms (no delay)
205
Q

What does it mean if a foetus is large for gestational age?

A

When the foetus is >90th centile for weight

206
Q

What can cause a foetus to be large for gestational age?

A
  • Idiopathic
  • Family history
  • GDM
  • Polyhydramnios
  • Post term
207
Q

What are the potential complications of a foetus being large for gestational age?

A
  • Perineal tears
  • Shoulder dystocia
  • PPH
208
Q

What are the possible causes of small for gestational age?

A
  • Idiopathic
  • Family history
  • Placental insufficiency
  • Congenital infection
  • Chromosomal
209
Q

What can be caused by shoulder dystocia?

A

ERBS Palsy

210
Q

What is the treatment for shoulder dystocia?

A
  • Episiotomy
  • McRoberts manoeuvre
  • Suprapubic pressure
  • Enter and internally rotate baby
  • Roll onto all 4s
211
Q

What is polyhydramnios?

A

Amniotic fluid index >25
>2000mls

212
Q

What are the causes of polyhydramnios?

A
  • GDM
  • TORCH infection
  • Atresia
213
Q

What could be seen on examination of a woman with polyhydramnios?

A
  • Lack of foetal hb
  • Indistinct physical features
  • Large fundal height
214
Q

What are the possible complications of polyhydramnios?

A
  • Cord prolapse
  • Placental abruption
  • PPH
  • Stillbirth
215
Q

What is oligohydramnios?

A

Amniotic fluid index <5
<300ml

216
Q

What are the causes of oligohydramnios?

A
  • PPROM
  • Potter sequence
  • Utero placental insufficiency
217
Q

What is seen on examination for oligohydramnios?

A
  • Decreased fundal height
  • Prominent features on USS
218
Q

What are the possible complications of oligohydramnios?

A
  • Foetal deformity/IUGR
  • stillbirth
  • chorioamnionitis
  • prematurity
219
Q

When is vomiting in pregnancy most common and why?

A

MC first trimester due to increased B-HCG syncytiotrophoblast

220
Q

When does vomiting in pregnancy normally resolve by?

A

16-20 weeks

221
Q

What is severe vomiting during pregnancy called?

A

Hyperemesis gravidarum

222
Q

What are the risk factors for vomiting during pregnancy?

A
  • Multiple pregnancy
  • Molar preg
  • Hyperthyroidism
  • DKA
223
Q

What are the symptoms of hyperemesis gravidarum?

A

RCOG triad:
- >5% pre pregnancy weight loss
- Dehydration
- Electrolyte abnormality

224
Q

How is hyperemesis gravidarum diagnosed?

A
  • Bloods - FBC, U+E’s, LFT, TFT, clotting, OGTT
  • Urine dip
  • Venous blood gas
  • TVUSS + B-HCG
  • BP, BMI, ECG
225
Q

What are the treatments for hyperemesis gravidarum?

A
  • Antihistamines (cyclizine, promethazine)
  • Ondansetron - max 5d
  • Metoclopraminde - max 5d
226
Q

What are possible complications of hyperemesis gravidarum?

A
  • Dehydration
  • MW tear
  • Hypokalaemia
  • Hypotension
227
Q

What are the main reasons for antepartum haemorrhage in the first trimester?

A
  • Miscarriage
  • Ectopic
  • Molar
228
Q

What are the main reasons for antepartum haemorrhage in the third trimester?

A
  • Placenta previa
  • Placental abruption
  • Vasa previa
229
Q

What are the types of PPH?

A
  • Primary (within 24hrs)
  • Secondary (24hrs-6 weeks)
230
Q

What is classed as a minor, mod, and severe PPH?

A

Minor - 500-1000ml
Mod - 1000-2000ml
Severe - >2000ml

231
Q

What are the main causes of a PPH?

A
  • Tone (mc) (atonic)
  • Tissue (retained tissue)
  • Thrombin (DIC)
  • Trauma (perineal tears, uterine rupture)
232
Q

What is the treatment for PPH caused by atony?

A
  • Fundal massage + empty bladder (catheterise)
  • IV fluid + transfusion
  • Oxytocin then IV ergometrine
  • Fails + surgical
233
Q

What is the treatment for PPH caused by retained tissues?

A

Surgical dilatation and cutterage

234
Q

What are the possible complications of PPH?

A
  • Sheehan’s syndrome
  • DIC
  • Shock - death
235
Q

What is rhesus disease?

A

Prior sensitisation in a Rh- mom from Rh+ child, 2nd Rh+ child causes hypersensitivity reaction

236
Q

What causes foetal distress and haemolytic disease in a rhesus negative mother having her second rhesus positive baby?

A

Prior sensitisation causes the development of IgG, leading to IgG transplacental binding to the foetal RBCs causing foetal distress and haemolytic disease

237
Q

What are risk factors for rhesus disease?

A
  • Being Caucasian
  • Having a previous Rh+ child as a Rh- mother
238
Q

What are the symptoms of rhesus disease?

A
  • Erythroblastosis fetalis - yellow amniotic fluid
  • Hydrops fetalis - wide spread oedema and resp distress in baby
239
Q

How is rhesus disease diagnosed?

A
  • +ve Coombs test
  • +ve kleihauer test
  • Raised reticuloblasts
  • Amniocentesis
240
Q

How is rhesus disease prevented?

A

RhoGAM (28wk+34wk to Rh- mothers) give intrapartum and in miscarriage/TOP

241
Q

How is rhesus disease treated?

A

ABCDE + transfusion

242
Q

What does obstetric cholestasis cause?

A

Pruritic palms and soles in the third trimester

243
Q

How is obstetric cholestasis diagnosed?

A

Raised total bile salts and acids

244
Q

How is obstetric cholestasis treated?

A
  • Ursodeoxycholic acid
  • Deliver no later than 37 weeks
245
Q

What is acute fatty liver of pregnancy?

A

Jaundice in the third trimester with RUQ pain and N+V, related to pre-eclampsia

246
Q

How is acute fatty liver of pregnancy diagnosed?

A

Increased bilirubin +/- DIC

247
Q

What is the treatment for acute fatty liver of pregnancy?

A

Emergency - ABCDE + must deliver baby

248
Q

What are risk factors for multiple pregnancy?

A
  • IVF
  • FH
  • Idiopathic
249
Q

What is twin-twin transfusion?

A

When you have two amniotic sacs but they share a placenta, one twin with a higher blood supply than the other (one twin excessive growth, one twin growth restriction)

250
Q

What are possible complications of multiple pregnancy?

A
  • Low birth weight
  • Increased perinatal mortality
  • Spontaneous preterm birth
  • Pre-eclampsia
  • Hyperemesis
251
Q

How should you treat hyperthyroidism in pregnancy?

A

Propylthiouracil + propanolol

252
Q

How should you treat hypothyroidism in pregnancy?

A

Levothyroxine

253
Q

How should you treat post partum thyroiditis?

A

Only treat hyperthyroid phase (propanolol)

254
Q

What should you give a pregnant woman who is <20 weeks gestation and is at risk of varicella zoster virus?

A

Varicella zoster Ig

255
Q

What should you give a pregnant woman >20 wk gestation who presents with a varicella zoster rash?

A

Aciclovir

256
Q

What should be given if a pregnant woman tests positive for vaginal group B strep?

A

IV benzylpenicillin intrapartum

257
Q

How are UTIs in pregnancy treated

A

Nitrofurantoin for 7 days

258
Q

How is post partum depression treated?

A
  • CBT
  • CMHT
  • Consider SSRI (sertraline)
259
Q

How is post partum depression diagnosed?

A

Edinburgh scale >10

260
Q

What are the symptoms of post partum psychosis?

A
  • Severe mood swings
  • Auditory hallucinations
  • Intent/thoughts to harm baby
261
Q

What is the treatment for post partum psychosis?

A

Admit to mother + baby ward

262
Q

What is endometritis?

A

Pyrexia >38 degrees within 72 hours post partum with lower abdo pain and offensive discharge

263
Q

What is the most common cause of endometritis?

A

E.coli

264
Q

How is endometritis treated?

A

Hospital admission with IV clindamycin and gentamicin

265
Q

What are the investigations for endometritis?

A
  • Blood cultures
  • Vag swab
  • TVUSS
266
Q

What is amniotic fluid embolism?

A

Anaphylaxis from amniotic fluid entering maternal circulation causing sudden onset shock and SOB symptoms post partum

267
Q

How is amniotic fluid embolus treated?

A
  • ABCDE
  • Fluids
  • ITU monitoring
  • May need blood transfusion + fresh frozen plasma

Phase 3a (6 decks)

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