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)
2
Q
What are the three trimesters?
A
1st - 0-12
2nd - 13-27
3rd 28-40
3
Q
What is a normal length pregnancy?
A
37-42 weeks
4
Q
What is Naegele’s rule?
A
Method of calculating estimated delivery date of baby:
1st day LMP - three months + 7 days
5
Q
What is gravidity?
A
Number of pregnancies regardless of outcome and including current
6
Q
What is parity?
A
The number of deliveries beyond 24 weeks not including current
7
Q
What does primiparous mean?
A
First time delivered beyond 24 weeks
8
Q
What does primigravida mean?
A
First time pregnant regardless of outcome
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
10
Q
What does multiparous mean?
A
Given birth at least twice at over 24 weeks
11
Q
What does nulliparous mean?
A
Never given birth more than 24 weeks
12
Q
What are the five main functions of the placenta?
A
- Resp - supplies foetus with oxygen
- Renal - excretory
- Nutrition
- Immunity
- Hormonal
13
Q
Which Ig can cross the placenta?
A
IgG
14
Q
What hormones does the placenta secrete?
A
- oestrogen
- progesterone
-Beta HCG - HPL - human placental lactogen
15
Q
What can HPL cause?
A
Gestational diabetes
16
Q
What should the crown rump length on USS be at 8-12 weeks?
A
50mm
17
Q
What should the crown rump length be at 21 weeks?
A
210mm
18
Q
When is surfactant produced?
A
35 weeks
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
20
Q
What are the maternal cardiovascular changes in pregnancy?
A
- decreased bp
- increased cardiac output
21
Q
What are the maternal haemological changes in pregnancy?
A
Functional anaemia
22
Q
What are the maternal GI changes in pregnancy?
A
- dysmotility
- constipation
- GORD
23
Q
What are the maternal immunity changes in pregnancy?
A
Decreased immune response
24
Q
What are the maternal endocrine changes in pregnancy?
A
Poorer glycaemic control
25
What are the maternal GU changes in pregnancy?
- Increased renal excretion
- Increased UTI risk
26
What are the maternal hormonal changes during pregnancy?
- Raised oestrogen
- Raised progesterone
- Raised prolactin
- Raised bHCG
- raised ALP
- raised ESR + CRP
- raised T3+4
27
What are all mothers advised?
- Vitamin D supplement 10mcg/day
- Folate for 1/3
- Stop smoking
- No alcohol
- Healthy diet
28
What can smoking during pregnancy cause?
- Pre-term birth
- Intrauterine growth restriction
- Miscarriage
- Placental abruption
29
What can alcohol during pregnancy cause?
- Foetal alcohol syndrome
- Foetal growth restriction
30
What should you recommend a woman and her partner take if they are trying to conceive?
Folate for 6 months prior
31
What doses of folate are given to pregnant women?
- 400 micrograms for standard pregnancy
- 5mg for women who are obese or taking anti-epileptic medication
32
Why is folate given to pregnant women?
To prevent neural tube defects
33
Who are checks during pregnancy done by?
- Midwives if uncomplicated pregnancy
- Doctors if complicated pregnancy
34
What happens at the 8-12 weeks check?
Booking appt.
- Screened for HEP B, HIV, Sickle cell, thalassemia, syphilis
- Check BMI, BP, FBC
35
What is screened for at the 8-12 week booking appointment?
- HEP B
- HIV
- Sickle cell
- Thalassemia
- Syphilis
36
What happens at the 11- 13+6 week check?
- Dating scan
- Combined test - USS, bHCG, PAPP-A
37
What does the combined test at the 11-13+6 week check look for?
- Down's syndrome - T21
- Edwards syndrome -T18
- Patau syndrome - T13
38
In the combined test what would show for Down's syndrome?
- Raised bHCG
- Decreased PAPP-A
- >6mm neuchal translucency
39
What are some other tests you can consider doing between 11-14 weeks?
- Chorionic villus sampling
- Amniocentesis (normally about 15 weeks)
40
If a pregnant woman misses her dating scan and presents at 16 weeks gestation, what is the best test for genetic abnormalities?
Amniocentesis
41
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?
Chorionic villous sampling
42
What are the risks of amniocentesis and chorionic villus sampling?
- Up to 1% chance of miscarriage
- Risk of precipitating rhesus disease
- Risk of infection
- Risk of clubfoot
43
What genetic test can be done between 15-20 weeks gestation for Down's syndrome?
Non-invasive prenatal testing
44
What conditions is non-invasive prenatal testing not sensitive for?
- Edwards syndrome
- Patau's syndrome
45
If a woman presents at 15 weeks gestation and has not had the combined test, which test should you do?
The quad test - bHCG, Alpha Feto Protein, E3, Inhibin A
Only tests for Down's
46
What checks are done at 18-20 weeks gestation?
Anomaly ultrasound scan
47
What does the anomaly ultrasound scan check for?
- Congenital heart defects
- Neural tube defects
- Bowel defects
- Placenta previa
48
What checks are done at 28 weeks gestation?
- Oral glucose tolerance test
- Give rhesus antibodies if rhesus negative
49
What checks are done at 34 weeks gestation?
- USS - check baby progression and placenta previa
- Give second dose of rhesus antibodies if rhesus negative
50
What checks are done at 36 weeks gestation?
- Determine presentation
- If breech offer external cephalic version at 37 weeks
51
What checks are done at 38 weeks gestation?
- Discuss a long pregnancy
52
What checks are done at 41 weeks gestation?
- Discuss inducing labour
- Started with membrane sweep
53
What are the signs before labour begins?
- 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
54
What are the two stages of stage 1 of labour?
- Latent
- Active
55
How long is the latent stage of labour?
- Up to 20 hours in primi
- Up to 14 hours in multi
56
How dilated is the cervix during the latent stage of labour?
Up to 30% (0-3cm)
57
How often are contractions in the latent stage of labour?
Every 1-3 minutes
58
How long is the active stage of labour?
- Up to 6 hours if primi
- Up to 5 hours if multi
59
How dilated is the cervix in the active stage of labour?
30-100% (Up to 10cm dilated)
60
How often are contractions in the active stage of labour?
Every 1-2 mins
61
What is stage 1 of labour?
Mostly dilation of the cervix
62
What is stage 2 of labour?
Delivery of the baby
63
How long can stage 2 of labour last?
- Up to 2 hours in a primi
- Up to 1 hour in a multi
64
What does the length of stage 2 of labour depend on?
- Power (tone)
- Passage (pelvic inlet dimensions)
- Passenger
65
What are the stages in which a baby is delivered?
- engagement
- descent
- flexion
- internal rotation
- extension
- external rotation
- expulsion
66
How long does stage 3 of labour last?
Up to 30 mins
67
What happens in stage 3 of labour?
Deliver placenta and monitor PPH
68
What is the most common cause of a failure to progress in stage 2 of labour?
Uterine atony due to fatigue
69
What post partum care is required?
- Hospital stay of at least 1 day
- Consider contraception
- Monitor for PPH
- Monitor for post partum mental health
70
What is the Bishops score?
A measure of cervical ripeness, used to aid decisions about induction of labour
71
What do the scores mean in Bishops score?
<5 - unripe cervix - unlikely to spontaneously induce labour
5-7 intermediate
>8 ripe cervix - likely to spontaneously induce
72
What can be done if there is a Bishops score of <6?
Consider a membrane sweep and vaginal prostaglandins
73
What can be done if there's a Bishops score of >6?
Artificial rupture of membranes and IV oxytocin
74
What are indications to induce labour?
- Prolonged labour (failure to progress)
- PPROM
- Maternal problems (GDM, pre-eclampsia, obstetric cholestasis)
75
What are complications of induction of labour?
- Failure to induce
- Uterine hyperstimulation
76
When would IV benzylpenicillin be given to a woman during labour?
If a woman has detected group b strep
77
What are routinely offered vaccines for pregnant women?
- Influenza
- Pertussis (whooping cough)
78
What are the conservative pain relief options during labour?
- Peri-anal and fundal massage
- TENS (nerve stimulation)
79
What are the medication pain relief options for during labour?
- Entonox
- Morphine
- Epidural anaesthesia
80
When is epidural anaesthesia contraindicated?
- Low platelets
- If pt is on DOAC or aspirin
- May be denied in antepartum haemorrhage
81
What are the side effects of epidural anaesthesia?
- Urinary retention
- hypotension
- hypoanalgesia
- CSF leakage - headache
82
What are the two types of c-section?
- Classical - midline incision (not normally done)
- Joel Cohen - transverse incision
83
When is a c-section indicated (emergencies)?
- Placenta previa
- Vasa previa
- Failure to progress
- Active genital herpes
- Cord prolapse
84
What are the possible complications of c-sections?
- Vaginal birth after caesarean can cause uterine rupture
- transient tachypnoea of newborn
- PPH
- Endometritis
85
What are the categories of caesarean?
Cat1 - within 30 mins (severe emergency)
Cat2 - within 75 minutes (emergency)
Cat3 - Needed but not emergency - planned for certain date
Cat4 - Elective
86
What does cardiotocography (CTG) account for?
Monitors foetal heart rate and mothers uterine contractions
Indirect measure of intrauterine pressure
87
What is a low risk CTG going to show?
- Regular contractions
- HR 110-160
- Variability 6-25
- Accelerations are present
88
What is a high risk CTG going to show?
- Bradycardia or tachycardia (<100 or >160)
- Variability less than 5
- No accelerations
- Late or variable decelerations
89
What would a high risk CTG indicate?
- Hypoxia
- Ischaemia
- High risk of impairment to foetus
90
If there is a high risk CTG, what sample should be taken?
Foetal scalp sample - check pH
91
What is the first line investigation for reduced/no foetal movement?
Hand held doppler then consider CTG
92
What are the two types of instrumental delivery?
- Ventouse
- Forceps
93
What are the two possible complications of ventouse delivery?
- Cephalohematoma
- Caput succedaneum
94
What is caput succedaneum?
Subcutaneous oedema, not confined to suture lines, resolves in days
95
What is cephalohematoma?
Sub periosteal bleed which is confined to suture lines and resolves within a few months
96
What are the possible complications of forceps delivery?
Cranial nerve 7 palsy
97
What is premature pre-labour rupture of membranes (PPROM)?
A rush of fluid due to rupture of membranes not directly preceding labour
98
What can cause PPROM?
- Trauma
- TORCH infections
- STIs
- CVS and amniocentesis
- LLETZ
99
What are the investigations for PPROM?
- Speculum - fluid pooled in posterior fornix
- Nitraline test pH >7.1
- Positive fern sign on microscopy
- TVUSS will show oligohydramnios
100
How is PPROM treated?
- Erythromycin 250mg QDS for 10 days
- Consider maternal steroids
101
Why is PPROM treated with antibiotics?
To prevent chorioamnionitis
102
What are the symptoms of chorioamnionitis?
- Stillbirth
- Hypoxic ischaemic injury
- Respiratory distress in the baby
103
What are the risk factors for cord prolapse?
- Polyhydramnios
- Abnormal foetal lie
- Artificial rupture of membranes
- Multiple pregnancy
104
What are the symptoms of cord prolapse?
- Visible cord
- Foetal bradycardia on CTG monitoring
105
What investigations need to be done for cord prolapse?
A-E assessment
106
How is cord prolapse treated?
- Get pt onto all fours ASAP to reduce pressure on cord
- Catheterise them
- C-section needed
107
What are the possible complications of cord prolapse?
- Nuchal cord
- Foetal ischaemia
108
What investigation is required for all babies who have been born in breech position?
USS of hip
109
What are the risk factors for breech position?
- Polyhydramnios
- Pre-term baby
110
What are the possible complications of breech birth?
Developmental dysplasia of the hip
111
What should be offered if a baby is breech at 37 weeks?
External cephalic version
112
What are the classifications of perineal tears?
1. Mucosal
2. + muscle
3. + External anal sphincter
4. Rectal musoca
113
What is a miscarriage?
Death of the foetus in utero within 24 weeks
114
What are the main causes of miscarriage?
Foetal - chromosomal problems, congenital malformations (TORCH infections), congenital abnormalities
Mother - smoking, APL, SLE, placental insufficiency, diabetes, hypertension
115
What are the five main types of miscarriage?
- Threatened miscarriages - mc
- Inevitable
- Complete
- Incomplete
- Missed
116
How does a threatened miscarriage present?
PAINLESS vaginal bleed, os is closed
117
How does an inevitable miscarriage present?
PAINFUL bleed, os is open
118
How does a complete miscarriage present?
PAINFUL bleed, os is closed, empty gestational sac
119
How does an incomplete miscarriage present?
Bleed, os is open, retained products on USS
120
How does a missed miscarriage present?
No pain +/- bleed, os is closed, empty gestational sac on USS
121
What is a recurrent miscarriage?
If a pt has more than 3 miscarriages in a row
122
How is miscarriage diagnosed?
- TVUSS
- Serum B-HCG
123
What is the treatment for a threatened miscarriage?
400mg vaginal progesterone + repeat serum B-HCG within 7 days
124
What is expectant management for a miscarriage?
Watching and waiting
125
What is the medical management for a miscarriage?
Give vaginal misoprostol
126
What is the surgical management of a miscarriage?
Dilatation and curettage
127
What is a termination of pregnancy?
A pregnancy voluntarily ended before 24 weeks
128
What are the two methods of termination of pregnancy?
- Medical
- Surgical
129
130
What is the medical method of termination of pregnancy?
Oral Mifepristone + vaginal misoprostol
131
What is the surgical method of termination?
Suction, dilatation and cutterage
132
When would medical termination of pregnancy be done over surgical?
Medical - up to 13 weeks and then 14-24 weeks is surgical
133
What is an ectopic pregnancy?
The implantation of a conceptus outside of the uterine cavity
134
What is the most common location for an ectopic pregnancy?
The ampulla
135
What is the most common location for an ectopic pregnancy rupture?
The isthmus
136
What are the risk factors for ectopic pregnancy?
- PID
- IVF
- Endometriosis
- IUS/IUD
- Past history of ectopics
137
What are the symptoms of ectopic pregnancy?
- 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
What investigations are going to be done for ectopic pregnancy?
- Serum B-HCG - increase by <63%
- TVUSS
139
When would expectant management be used in ectopic pregnancy?
- <35mm
- B-HCG <1500
- No foetal heart beat
- No pain
140
What is medical treatment for ectopic pregnancy?
IM methotrexate
141
When would medical management be used for ectopic pregnancy?
- <35mm
- B-HCG 1500-5000
- No foetal heart beat
- No pain
142
When would an ectopic pregnancy be managed surgically?
Only need 1 of these:
- >35mm
- B-HCG >5000
- Foetal heart beat
- Pain
143
What are the surgical management options for ectopic pregnancy?
- Salpingectomy - no fertility concerns
- Salpingotomy - fertility concerns
144
What are the complications of ectopic pregnancy?
- Fallopian tube rupture
- Early maternal death due to shock
- Infertility from surgery
- Up to 20% recurrence
145
What are the risk factors for molar pregnancy?
- Either teenage or 45+
- Asian
- Past history
146
What are the symptoms for molar pregnancy?
- First trimester pv bleed
- Hyperemesis
- Hypertension first trimester
- Hyperthyroid symptoms
- Large for gestational age symptoms
147
What is a complete molar pregnancy?
When a diploid sperm fertilises an empty egg
148
What is an incomplete molar pregnancy?
When two sperm fertilises the same egg - too many chromosomes
149
Why do women have thyrotoxicosis with molar pregnancy?
Due to high levels of B-HCG
150
How are molar pregnancies diagnosed?
- Bloods - U+E's, TFTs, B-HCG
- TVUSS - snow storm like appearance
151
What is the treatment for molar pregnancy?
Suction, dilatation and curettage under general immediately
152
What is there a risk of if a molar pregnancy is not treated immediately?
Risk of developing choriocarcinoma
153
What is placenta previa?
When the placenta is in the lower segment of the uterus
154
What are the grades for placenta previa?
1 - In lower segment <20mm from os
2 - Touching internal os
3 - Covering up os partially
4 - Complete os coverage
155
What are the risk factors for placenta previa?
- Multiple pregnancy
- C-sections
- Maternal smoking
- IVF
- Past history
156
What are the main differentials for antepartum haemorrhage?
- Placenta previa
- Placental abruption
157
What are the symptoms for placenta previa?
Third trimester painless pv bleeding, bright red blood
158
How is placenta previa diagnosed?
- Can be seen on anomaly scan (18-20 weeks)
- If seen do not do PV exam!! Repeat scan at 34 weeks
159
What is the treatment for placenta previa?
Grade 1 - consider a vaginal birth with observation
Grade 2-4 - consider C-section
160
What are the possible complications with placenta previa?
- Pre-term birth
- Maternal death due to shock
- Morbidly adhered placenta
161
What are the types of morbidly adhered placenta?
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
What are the main risk factors for morbidly adhered uterus?
- Placenta previa
- Uterine surgery
163
How is morbidly adhered uterus diagnosed?
- TVUSS abnormality scan
164
What is the treatment for morbidly adhered uterus?
C-section + hysterectomy + group and save
165
What are the possible complications of morbidly adhered placenta?
- Heavy PPH
- Prematurity
-
166
What is placental abruption?
Separation of placenta from endometrial wall causing bleeding
167
What are the risk factors for placental abruption?
- smoking
- cocaine use
- HTN
- trauma
- multiparity
- polyhydramnios
168
What are the symptoms of placental abruption ?
- Third trimester painful pv bleed, dark red
- Hard, woody uterus
169
How is placental abruption diagnosed?
USS
170
What is the treatment for placental abruption?
Stable = observe
Mother/foetal distress = Cat 1 c-section
171
What are the possible complications of placental abruption?
- Disseminated intravascular coagulation
- Prematurity
- M-F death
172
What is vasa previa?
The foetal vessels either cross the os or are within 20 mm of it
173
What are the causes of vasa previ?
Velamentous cord or accessory placental lobes
174
What are the symptoms of vasa previa?
Bright, painless, heavy vaginal bleed as soon as rupture of membranes
175
How is vasa previa diagnosed?
USS - umbilical arteries presenting
176
What is the treatment for vasa previa?
Need a Cat 1 C-section
177
What is it classed as if a pregnant woman has hypertension <20 weeks?
Pre-existing or chronic HTN
Molar pregnancy sign
178
What is it classified as if a pregnant woman has hypertension >20 weeks and negative proteinurea?
Gestational HTN
179
What is it classified as if a pregnant woman has hypertension <20 weeks with positive proteinurea?
Pre-eclampsia
180
What are the risk factors for having high bp during pregnancy?
High:
- chronic HTN
- CKD
- APL
- PMH pre-eclampsia
Mod:
- Raised BMI at booking
- >40
- FH pre-eclampsia
181
What should be given to pregnant women who are at increased risk of developing high bp?
Start on 75-150mg aspirin daily from 12w-birth
182
What are the symptoms for hypertension during pregnancy?
- BP >140/90
If severe:
- vision changes
- headaches
- abdo pain
- RUG pain
- oedema
183
What are the investigations for hypertension in pregnancy?
- BP
- Bloods - FBC, U+E's, TFT, LFT, clotting
- Urine dip
184
What is the treatment for high bp in pregnancy?
- Labetalol or nifedipine (if asthma)
185
What are the possible complications of having high bp in pregnancy?
- Eclampsia (+seizures)
- HELLP
- DIC
- IUGR
- placental abruption
186
What is the treatment for eclampsia?
IV MgSO4 STAT + corticosteroid + delivery baby (c-section or induced)
187
What is HELLP syndrome?
- haemolysis
- elevated LFT's
- low platelets
188
How is HELLP syndrome treated?
Deliver baby ASAP
189
What are the classes of diabetes a pt can have during pregnancy?
- pre-existing (15%) - foetal abnormalities
- gestational (85%) - no foetal abnormalities
190
What are the foetal abnormalities that can be caused by pre-existing diabetes in pregnancy?
- Cardiovascular - transposition of great arteries
- Neural tube defects
- Intrauterine growth restrictions
191
What are risk factors for gestational diabetes?
- PCOS
- pre-eclampsia
- HTN
- obesity
- family history
192
How is gestational diabetes diagnosed?
- OGTT 24-28 wks (>2 readings diagnostic)
- Fasting plasma glucose >5.6
- 2hrs after glucose solution >7.8
193
What results would be diagnostic for diabetes (not gestational)?
- Fasting plasma glucose >7
- OGTT >7.8
- Random plasma glucose >11
- HbA1c >48mmol
194
How is gestational diabetes treated?
FPG <7 - trial of 1-2 wk diet and exercise if not resolved offer metformin
FPG >7 - insulin +/- metformin
195
What is the treatment for a woman with pre-existing diabetes who is pregnant?
Stop all DM drugs except metformin or insulin
196
What are the targets blood glucose levels for a pt with gestational diabetes?
FPG 5.3
OGTT 6.4
197
What are the main complications of gestational diabetes?
- Polyhydramnios
- Macrosomia
- Traumatic birth
- Perinatal death
- Development to type 2 diabetes
198
What is intrauterine growth restriction?
Impaired growth in utero due to pathology
199
What is small for gestational age?
Foetal growth <10th centile (+/- pathological)
200
What are the main causes of IUGR?
- Chromosomal
- Congenital abnormalities
- Congenital infection
- Placental insufficiency
- HTN
- Smoking
201
What are the possible complications of IUGR?
- Prematurity
- Stillbirth
- Cognitive delays
202
What are the types of IUGR?
- Symmetrical (30%)
- Asymmetrical (70%)
203
What are the features of symmetrical IUGR?
- Foetal defects
- Abdo + brain proportionally affected growth
- Mental problems (delay)
204
What are the features of asymmetrical IUGR?
- Maternal placental insufficiency
- Abdo + peripheral retardation
- No brain involvement
- No mental symptoms (no delay)
205
What does it mean if a foetus is large for gestational age?
When the foetus is >90th centile for weight
206
What can cause a foetus to be large for gestational age?
- Idiopathic
- Family history
- GDM
- Polyhydramnios
- Post term
207
What are the potential complications of a foetus being large for gestational age?
- Perineal tears
- Shoulder dystocia
- PPH
208
What are the possible causes of small for gestational age?
- Idiopathic
- Family history
- Placental insufficiency
- Congenital infection
- Chromosomal
209
What can be caused by shoulder dystocia?
ERBS Palsy
210
What is the treatment for shoulder dystocia?
- Episiotomy
- McRoberts manoeuvre
- Suprapubic pressure
- Enter and internally rotate baby
- Roll onto all 4s
211
What is polyhydramnios?
Amniotic fluid index >25
>2000mls
212
What are the causes of polyhydramnios?
- GDM
- TORCH infection
- Atresia
213
What could be seen on examination of a woman with polyhydramnios?
- Lack of foetal hb
- Indistinct physical features
- Large fundal height
214
What are the possible complications of polyhydramnios?
- Cord prolapse
- Placental abruption
- PPH
- Stillbirth
215
What is oligohydramnios?
Amniotic fluid index <5
<300ml
216
What are the causes of oligohydramnios?
- PPROM
- Potter sequence
- Utero placental insufficiency
217
What is seen on examination for oligohydramnios?
- Decreased fundal height
- Prominent features on USS
218
What are the possible complications of oligohydramnios?
- Foetal deformity/IUGR
- stillbirth
- chorioamnionitis
- prematurity
219
When is vomiting in pregnancy most common and why?
MC first trimester due to increased B-HCG syncytiotrophoblast
220
When does vomiting in pregnancy normally resolve by?
16-20 weeks
221
What is severe vomiting during pregnancy called?
Hyperemesis gravidarum
222
What are the risk factors for vomiting during pregnancy?
- Multiple pregnancy
- Molar preg
- Hyperthyroidism
- DKA
223
What are the symptoms of hyperemesis gravidarum?
RCOG triad:
- >5% pre pregnancy weight loss
- Dehydration
- Electrolyte abnormality
224
How is hyperemesis gravidarum diagnosed?
- Bloods - FBC, U+E's, LFT, TFT, clotting, OGTT
- Urine dip
- Venous blood gas
- TVUSS + B-HCG
- BP, BMI, ECG
225
What are the treatments for hyperemesis gravidarum?
- Antihistamines (cyclizine, promethazine)
- Ondansetron - max 5d
- Metoclopraminde - max 5d
226
What are possible complications of hyperemesis gravidarum?
- Dehydration
- MW tear
- Hypokalaemia
- Hypotension
227
What are the main reasons for antepartum haemorrhage in the first trimester?
- Miscarriage
- Ectopic
- Molar
228
What are the main reasons for antepartum haemorrhage in the third trimester?
- Placenta previa
- Placental abruption
- Vasa previa
229
What are the types of PPH?
- Primary (within 24hrs)
- Secondary (24hrs-6 weeks)
230
What is classed as a minor, mod, and severe PPH?
Minor - 500-1000ml
Mod - 1000-2000ml
Severe - >2000ml
231
What are the main causes of a PPH?
- Tone (mc) (atonic)
- Tissue (retained tissue)
- Thrombin (DIC)
- Trauma (perineal tears, uterine rupture)
232
What is the treatment for PPH caused by atony?
- Fundal massage + empty bladder (catheterise)
- IV fluid + transfusion
- Oxytocin then IV ergometrine
- Fails + surgical
233
What is the treatment for PPH caused by retained tissues?
Surgical dilatation and cutterage
234
What are the possible complications of PPH?
- Sheehan's syndrome
- DIC
- Shock - death
235
What is rhesus disease?
Prior sensitisation in a Rh- mom from Rh+ child, 2nd Rh+ child causes hypersensitivity reaction
236
What causes foetal distress and haemolytic disease in a rhesus negative mother having her second rhesus positive baby?
Prior sensitisation causes the development of IgG, leading to IgG transplacental binding to the foetal RBCs causing foetal distress and haemolytic disease
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What are risk factors for rhesus disease?
- Being Caucasian
- Having a previous Rh+ child as a Rh- mother
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What are the symptoms of rhesus disease?
- Erythroblastosis fetalis - yellow amniotic fluid
- Hydrops fetalis - wide spread oedema and resp distress in baby
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How is rhesus disease diagnosed?
- +ve Coombs test
- +ve kleihauer test
- Raised reticuloblasts
- Amniocentesis
240
How is rhesus disease prevented?
RhoGAM (28wk+34wk to Rh- mothers) give intrapartum and in miscarriage/TOP
241
How is rhesus disease treated?
ABCDE + transfusion
242
What does obstetric cholestasis cause?
Pruritic palms and soles in the third trimester
243
How is obstetric cholestasis diagnosed?
Raised total bile salts and acids
244
How is obstetric cholestasis treated?
- Ursodeoxycholic acid
- Deliver no later than 37 weeks
245
What is acute fatty liver of pregnancy?
Jaundice in the third trimester with RUQ pain and N+V, related to pre-eclampsia
246
How is acute fatty liver of pregnancy diagnosed?
Increased bilirubin +/- DIC
247
What is the treatment for acute fatty liver of pregnancy?
Emergency - ABCDE + must deliver baby
248
What are risk factors for multiple pregnancy?
- IVF
- FH
- Idiopathic
249
What is twin-twin transfusion?
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
What are possible complications of multiple pregnancy?
- Low birth weight
- Increased perinatal mortality
- Spontaneous preterm birth
- Pre-eclampsia
- Hyperemesis
251
How should you treat hyperthyroidism in pregnancy?
Propylthiouracil + propanolol
252
How should you treat hypothyroidism in pregnancy?
Levothyroxine
253
How should you treat post partum thyroiditis?
Only treat hyperthyroid phase (propanolol)
254
What should you give a pregnant woman who is <20 weeks gestation and is at risk of varicella zoster virus?
Varicella zoster Ig
255
What should you give a pregnant woman >20 wk gestation who presents with a varicella zoster rash?
Aciclovir
256
What should be given if a pregnant woman tests positive for vaginal group B strep?
IV benzylpenicillin intrapartum
257
How are UTIs in pregnancy treated
Nitrofurantoin for 7 days
258
How is post partum depression treated?
- CBT
- CMHT
- Consider SSRI (sertraline)
259
How is post partum depression diagnosed?
Edinburgh scale >10
260
What are the symptoms of post partum psychosis?
- Severe mood swings
- Auditory hallucinations
- Intent/thoughts to harm baby
261
What is the treatment for post partum psychosis?
Admit to mother + baby ward
262
What is endometritis?
Pyrexia >38 degrees within 72 hours post partum with lower abdo pain and offensive discharge
263
What is the most common cause of endometritis?
E.coli
264
How is endometritis treated?
Hospital admission with IV clindamycin and gentamicin
265
What are the investigations for endometritis?
- Blood cultures
- Vag swab
- TVUSS
266
What is amniotic fluid embolism?
Anaphylaxis from amniotic fluid entering maternal circulation causing sudden onset shock and SOB symptoms post partum
267
How is amniotic fluid embolus treated?
- ABCDE
- Fluids
- ITU monitoring
- May need blood transfusion + fresh frozen plasma
