obstetrics Flashcards

1
Q

Benefits of breastfeeding for mother

A

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)

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2
Q

Benefits of breastfeeding for child

A

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

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3
Q

Pregnant woman 35weeks- Mild fever, Harsh red rash on cheeks, malaise, arthropathy, sometimes aplastic crisis.

A

human parvovirus B19

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4
Q

Risk factors for placenta praevia

A

Previous p praevia
PRevious TOP
Multiparity
Advanced maternal age
Smoking
Assisted conception
Deficient endometrium - uterine scar, endometritis, manual removal of placenta, curretage, submucosal fibroid.

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5
Q

How to manage asymptomatic bacteriuria at 9 w pregnancy

A

Prescribe abx - 7 day course nitrofurantoin/amox/cefalexin based on culture + Test urine MCS following completion of treatment.

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6
Q

Risks of untreated asymptomatic bacteriuria in pregnancy

A

Risk of pyelonephritis.
Pyelonephritis risks - maternal + fetal mortality + morbidity, maternal: fever, acute resp distress, acute renal failure, stillbirth and preterm birth, anaemia, pre-eclampsia.

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7
Q

What is treatment for antiphospholipid syndrome in pregnancy

A

Aspirin + heparin from positive test until at least 34w gestation.

Do not give to unexplained recurrent miscarriage.
Avoid clopidogrel and dabigatran in pregnancy

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8
Q

mx of puerperal psychosis

A

Immediate referral to psychiatry

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9
Q

sx of puerperal psychosis

A

usually within couple weeks of childbirth
delusions + hallucinations
Consciosness clouded
Can pose threat to child, or result in neglect.

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10
Q

Headache, blurred vision, vomiting, swelling, abdo pain after 20 weeks.
High BP + proteinuria

A

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.

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11
Q

Risk factors preeclampsia

A

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.

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12
Q

Mx preeclampsia

A

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

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13
Q

Post natal hypertension treatment

A

Enalapril is first line if white
If black - Nifedipine.

methyldopa ->stop and changed as asw postnatal depression.

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14
Q

when advise not to fly when pregnant

A

36 weeks single preg
32 weeks multuple preg

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15
Q

1st degree perineal tear + dysuria

A

Do MSU
try voiding in shower or bath.

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16
Q

Vaccines in pregnancy

A

Influenza /covid- any gestation
Pertussis - 18-20 w

17
Q

Folic acid

A

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

18
Q

Abdo pain, offensive d/c post surgical TOP 7 days ago. Temp 37.5, preg test +ve

A

Endometritis
- 10% of women post TOP.
-Preg test can be positive 6w after successful TOP.
-

19
Q

Ashermans syndrome

A

Uterine adhesions
1-2% of secondary amenorrheoa and can be caused by pregnancy, trauma or infection.

20
Q

tx for pregnant woman with influenza

A

tx with olsetamivir asap.

21
Q

Severe n+V + Fundal height to umbilicus at 9 weeks

A

Molar pregnancy

22
Q

disseminated vesicular rash. crops over several days, blisters then crusts over.
Fever 11weeks preg

A

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).