obstetrics Flashcards
Benefits of breastfeeding for mother
Reduces risk of ovarian and breast cancer
Helps bond between mother and baby
Lowers long term risk of T2DM
Save money in milk formula costs (up to 600£ a year)
Benefits of breastfeeding for child
Reduced incidence infections: Gastroenteritis, pneumonia, otitis media
Reduced incidence obesity and diabetes in later life
Increased IQ
Reduced risk of asthma, eczema
Reduced risk of SIDS
Pregnant woman 35weeks- Mild fever, Harsh red rash on cheeks, malaise, arthropathy, sometimes aplastic crisis.
human parvovirus B19
Risk factors for placenta praevia
Previous p praevia
PRevious TOP
Multiparity
Advanced maternal age
Smoking
Assisted conception
Deficient endometrium - uterine scar, endometritis, manual removal of placenta, curretage, submucosal fibroid.
How to manage asymptomatic bacteriuria at 9 w pregnancy
Prescribe abx - 7 day course nitrofurantoin/amox/cefalexin based on culture + Test urine MCS following completion of treatment.
Risks of untreated asymptomatic bacteriuria in pregnancy
Risk of pyelonephritis.
Pyelonephritis risks - maternal + fetal mortality + morbidity, maternal: fever, acute resp distress, acute renal failure, stillbirth and preterm birth, anaemia, pre-eclampsia.
What is treatment for antiphospholipid syndrome in pregnancy
Aspirin + heparin from positive test until at least 34w gestation.
Do not give to unexplained recurrent miscarriage.
Avoid clopidogrel and dabigatran in pregnancy
mx of puerperal psychosis
Immediate referral to psychiatry
sx of puerperal psychosis
usually within couple weeks of childbirth
delusions + hallucinations
Consciosness clouded
Can pose threat to child, or result in neglect.
Headache, blurred vision, vomiting, swelling, abdo pain after 20 weeks.
High BP + proteinuria
Preeclampsia
- new onset HTN >140/90 after 20w +1 or more of
+ proteinuria (urine pr:cr ratio >30mg/mmol or Al:cr ratio >8mg/mmol or 1g/L +2 on urine Dip
-Renal insufficiency Cr >90
-liver involvement elevated transaminases ALT/AST >40 +/- RUQ/epigastric pain.
- neurological complications -eclampsia, altered MS, blindness, stroke, clonus, severe headaches, persistent visual scotoma.
- Haem - Thrombocytopaenia, DIC, haemolysis.
or Uteroplacental dysfunction - fetal growth restriction, abnormal UA doppler waveform, stillbirth.
Risk factors preeclampsia
Age >40
Nulliparity
Pregnancy interval >10years
Fhx
Prev hx
BMI >30
Preexisting vascular disease - HTN
Preexisting renal disease
Multiple pregnancy
more frequent BP measurements if any of these present.
Mx preeclampsia
BP measuredment + urine dip protein at each antenatal visit
If DBP >110 or 2 consecutive > 90 4h apart. consider tx
SBP >160 on 2 consecutive >4h apart. tx consider - admit to hosp for surveillance.
fullpiers/PREP-s risk prediction
If BP >140 - labetalol
measure every 48h aim less than 135/85
BLoods 2x a week.
Fetal heart auscultation at every antenatal appt. US of fetus at diagnosis, if noraml rpt every 2 weeks.
If BP >160 every 15-30mins.
Offer pregnant women with chronic htn 75-150mg Aspirin oD
PIGF testing for women with chronic HTN
Post natal hypertension treatment
Enalapril is first line if white
If black - Nifedipine.
methyldopa ->stop and changed as asw postnatal depression.
when advise not to fly when pregnant
36 weeks single preg
32 weeks multuple preg
1st degree perineal tear + dysuria
Do MSU
try voiding in shower or bath.
Vaccines in pregnancy
Influenza /covid- any gestation
Pertussis - 18-20 w
Folic acid
If planning or are preg - take 400mic up to 12th week of pregnancy
if high risk: Fhx NTD, Partner has NTD, prev preg NTD, taking antiepileptics, coeliac/malabsorption/diabetes/sickle cell/thalassaemia, BMI >30 -> 5mg up to 12th week
Abdo pain, offensive d/c post surgical TOP 7 days ago. Temp 37.5, preg test +ve
Endometritis
- 10% of women post TOP.
-Preg test can be positive 6w after successful TOP.
-
Ashermans syndrome
Uterine adhesions
1-2% of secondary amenorrheoa and can be caused by pregnancy, trauma or infection.
tx for pregnant woman with influenza
tx with olsetamivir asap.
Severe n+V + Fundal height to umbilicus at 9 weeks
Molar pregnancy
disseminated vesicular rash. crops over several days, blisters then crusts over.
Fever 11weeks preg
Chickenpox
Mx: if >20w and <24h onset of rash -> oral aciclovir
If severely unwell or immunocompromised (any gestation) -> IV aciclovir.
If < 20w and well - no treatment.
Small risk of congenital varicella
All women should be referred to fetal medicine specialist at 16-20 weeks or 5 weeks after infection, to discuss risk and options and detailed US exam.
VZIG for non immune pregnant women who have been exposed (but not yet developed).
