Obstetrics Flashcards by Tom Neild

Baby blues vs postnatal depression vs puerperal psychosis

Baby blues usually within the first week.

Postnatal depression after a few months.

Puerperal psychosis - evidence of hallucinations, delusions and thought disorder.

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Management for postnatal depression?

CBT and SSRI

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Management for baby blues

Reassurance and self help

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Management for puerperal psychosis

Admission to mother and baby unit

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What scoring system is used for Baby blues?

Edinburgh post natal depression
Over 10 indicates postnatal depression

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Ectopic pregnancy:
Investigation of choice?

Transvaginal USS

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What is the management for an ectopic pregnancy?

Expectant - no foetal HB, less than 35mm asymptomatic, <1000 hcg

Methotrexate - no foetal HB, less than 35mm, mild symptoms, <1500 hcg

Saplingectomy - foteal HB, bigger than 35mm, moderate symptoms, hcg>5000.

BETWEEN 1500 and 5000 give PATIENTS THE CHOICE OF METHOTREXATE OR SURGERY.

Do saplingotomy if there is damage to the other fallopian tube.

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What is the management if the ectopic has ruptured?

Surgical (saplingectomy)

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What are the four types of miscarriage and the associated findings?

Threatened miscarriage:
Cervical os is closed.
Painless vaginal bleeding

Missed miscarriage:
Cervical os is closed
No foetal HB
No expulsion of the products of conception (no heavy bleeding)

Inevitable miscarriage:
Heavy bleeding with clots and pain.
Cervical os is open.

Incomplete miscarriage:
Pain and vaginal bleeding
Cervical os is open

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What is the management for miscarriage?

First line is expectant. Allow 7-14 days for the miscarriage to spontaneously complete.

Medical management for incomplete or missed miscarriage.
Missed - mifepristone and then misoprostol after 48 hours.
Incomplete - just give misoprostol.
Check for pregnancy after 3 weeks.

Surgical management:
Vacuum aspiration.

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Who is required to sign for an abortion to take place?
Who must perform the abortion and where must it take place?

Two registered medical practitioners.
Must be done by a registered medical practitioner in an NHS hospital or licensed premise.

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What is the management for an abortion?
Medical?
Surgical?

Mifepristone and then misoprostol after 48 hours.
Pregnancy test after 2 weeks.

Vacuum aspiration is the surgical management.

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What is the cutoff for an optional miscarriage?

24 weeks.

Older if:
there is significant risk to the physical or mental health of the pregnant women
Continuation of the pregnancy would risk the life of the mother.
Substantial risk that the child would be seriously handicapped.

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When is gestational diabetes screened for? What test?

Screen with oral glucose tolerance test at 24-28 weeks.

SCREEN ALSO AT booking if there is previous gestational diabetes.

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What are the thresholds for gestational diabetes diagnosis?

fasting over 5.6mmol/L
2 hour glucose over 7.8mmol/L

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What is the management for gestational diabetes?

If fasting is less than 7mmol/L:
Start with exercise and diet changes.
After 1-2 weeks still not met targets start metformin.
Still not met, add short acting insulin.

If over 7mmol/L:
Start short acting insulin.

If under 7mmol/L but evidence of complications (macrosomia, polyhydramnios)
Start insulin

If pre-existing diabetes, stop all meds except metformin and use insulin and advise weight loss.

What are the indications for a higher dose of folic acid?

BMI over 30
Epilepsy
Pre-existing diabetes

What is the management for gestational hypertension?

Labetalol is first line
Nifedipine is used if asthmatic.

What is the cutoff for gestational hypertension in pregnant women?

140/90 past 20 weeks.
If before 20, was probably pre-existing.

What is preeclampsia?

Hypertension with associated proteinuria.
Also oedema.

What factors mean a woman should receive aspirin during pregnancy? How long should the aspirin be taken for?

Risk factors for pre-eclampsia:
CKD
Chronic hypertension
T1/2 diabetes

Should be taken from 12 weeks until birth.

Management for pre-eclampsia?

Admit to secondary care.
Deliver the baby ASAP.

What is eclampsia?

Seizures in association with pre-eclampsia.

What is the treatment for eclampsia?

MgSO4 infusion once decision to deliver has been made.
Monitor urine output, reflexes, RR, O2 sats.
Continue for 24 hours after last seizure or delivery.

What score is used to assess the degree of cervical ripening?

Bishop score. Under 5 indicates unlikely to start labour. 8 or over means cervix is ripe and there is a high chance of spontaneous labour.

What is the management for delayed progression of labour?

If cervix not ripe, use prostaglandins. If cervix ripe, can use amniotomy and IV oxytocin.

What investigation should be done to confirm premature rupture of membranes? What is the finding?

Speculum - pooling of amniotic fluid in the posterior vaginal vault.

What is the management of premature rupture of membranes?

Antenatal steroids Oral erythromycin prophylactically. Consider delivery beyond 34 weeks.

What is the management for a cord prolapse?

Push the presenting part of the foetus back into the uterus. Keep the cord warm and moist. All fours to present cord compression. C-section ASAP (cat-1)

Placenta praevia: What is it? What is the biggest risk?

Placenta overlying the cervical os. Haemorrhage.

What is the key symptom of placental abruption?

Shock out of keeping with visible blood loss.

What is the definitive management for placental abruption?

Delivery.

When is anti-D required?

Delivery of an Rh positive infant. Any termination of pregnancy Abdominal trauma. All rhesus -ve mothers at 28 and 34 weeks gestation.

What is gravida? What is parity?

Gravida - number of confirmed pregnancies regardless of outcome. Parity - number of births over 20 weeks gestation.

When is criteria needed for hyperemesis gravidarum diagnosis?

More than 5% of BW lost Dehydration Electrolyte imbalance

What is the management for hyperemesis gravidarum?

Antihistamines first line. Second line is ondansetron. Potentially admit for IV hydration (saline with added potassium).

Vasa praevia: Symptoms Investigations Management

Painless vaginal bleeding (often after rupture of membranes) Abnormal foetal HR patterns. Transvaginal USS admit from 32 weeks for monitoring. Corticosteroids Scheduled C-section at 35-37 weeks before labour onset.