Obstetrics 2 Flashcards
How long of fetal distress shown on ECG warrants cat 1 C/S?
> 10 minutes
What can cause folate deficiency?
- methotrexate
- phenytoin
- alcohol excess
- pregnancy
breast feeding
- How should mastitis be managed?
- How should nipple candidiasis be managed?
- When should women be referred for expert review e.g. midwife-led breastfeeding clinics
- if systemically unwell, nipple fissure or symptoms not improved 12-24hrs after milk removal give flucloxacillin
continue breast feeding - topical micoconazole for mum
nystatin suspension for baby
continue breast feeding - if baby loses >10% of weight in first week
What are the risks of taking cocaine in pregnancy?
maternal
- hypertension (including pre-eclampsia)
- placental abruption
fetal
- neonatal abstinence syndrome
- prematurity
What risks are associated with pre-maturity?
resp: respiratory distress syndrome, chronic lung disease
GI: jaundice, necrotising enterocolitis
general: hypothermia, infection
neuro: intra ventricular haemorrhage
ophthalmology: retinopathy of prematurity
ENT: hearing problems
Preterm prelabour rupture of membranes
- How should it be managed?
- What should be avoided
- regular observations to ensure chorioamniocentesis is not developing
- erythromycin for 10 days
- antenatal corticosteroids to reduce risk of respiratory distress syndrome
- delivery at 34 weeks - trade-off point between fetal lung maturity and risk of chorioamniocentesis
- digital vaginal examination due to risk of chorioamniocentesis (speculum fine though)
What is the management for endometritis?
admission for IV cindamycin and gentamicin until afebrile for 24hrs
Fetal Movements
- When are they felt?
- When should you refer if not felt?
- How should reduced fetal movements be handled
a) <28 weeks
b) >28 weeks
- 18-20 weeks (can be 16-18 if multiparous)
- 24 weeks
- a) handheld doppler to confirm presence of fetal heartbeat
b) handheld dopper + CTG
(If heartbeat cannot be felt or concern remains do US
- abdominal circumference, estimated fetal weight, amniotic fluid assessment)
Rhesus Negative Pregnancy
- What tests can be done?
- In what situations should anti-D be given?
- a) What clinical features will be seen in the affected fetus?
b) how is it managed?
- direct coombs test - sample from cord at birth for FBC, antibodies and baby blood type
Kleihauer test - acid added to maternal blood fetal blood will be resistant
- termination of pregnancy
- ectopic pregnancy managed surgically
- miscarriage after 12 weeks
- down’s screening: amniocentesis, chorionic villous sampling, fetal blood sampling
- external cephalic version
- abdominal trauma
- antepartum haemorrhage
- birth to rhesus +ve baby
- a)
- oedematous
- heart failure
- anaemia, hepatosplenomegaly, jaundice, kernicterus
b) UV therapy + transfusions
(anemia hepatopsplenomagaly ame jaundice all due to excess hamolysis, excess bilirubin causes kernicterus)
Gestational diabetes
- What are the risk factors?
- How is it screened for?
- How is it managed?
- BMI of > 30 kg/m²
- previous macrosomic baby weighing 4.5 kg or above
- previous gestational diabetes
- first-degree relative with diabetes
- family origin with a high prevalence of diabetes (South Asian, black Caribbean and Middle Eastern)
- OGTT for women who’ve previously had GDM
OGTT at 24-28 weeks for anyone with RF - fasting glucose <7: diet and exercise
if not met targets in 1-2 weeks start metformin
if still not met targets add insulin
fasting glucose >7 or >6 with macrosomia or polyhydramnios: insulin +/- metformin
NOTE: only short acting insulin for GDM
How should pre-existing diabetes be managed in pregnancy?
- stop oral hypoglycaemic agents (except metfomrin)
- detailed anomaly scan of heart at 20 weeks
- 5mg folic acid and aspirin
Rubella
(NOTE:
- damage to fetus from infection very rare after 16 weeks
- incubation period 14-21 days, infectious from 7 days before symptoms start to 4 days after rash first appears)
- What clinical features can be seen in fetus?
- What investigations should be done?
- What should you do if you suspect a case of rubella in pregnancy?
- If a pregnant now wants the MMR vaccine what should you do?
- congenital heart defects
- hepatosplenomegaly
- purpuric rash
- growth retardation
- ophtho: congenital cataracts, ‘salt and pepper’ chorioretinitis, microphthalmia
- hearing loss
- cerebral palsy
2. togavirus IgM (the cause of rubella) parvovirus B19 (as presentation very similar)
- Discuss with local health protection unit
- do not give to pregnant women, and avoid becoming pregnant within 28 days following the vaccine
What is a normal symphysis-fundal height?
gestation -/+ 2 cm
Ultrasound screening
What can cause
- increased nuchal translucency
- echogenic bowel
- down’s syndrome
- congenital cardiac defects
- abdominal wall defects
- Down’s syndrome
- Cystic fibrosis
- CMV infection
What anticoagulant should be given in pregnancy
LMWH
