Obstetrics 2 Flashcards
Rubella contraction in pregnancy
Infectious from what time period?
7 days before sx appear to 4 days after onset of rash
Congenital rubella syndrome is as high as 90% during what gestations?
Rare after what gestation
K8-10
K16
Sensorineural deafness
Congenital cataracts
Congenital heart disease
Growth retardation
Hepatosplenomegaly
Purpuric skin lesions
Salt and pepper chorioretinitis
Microphthalmia
Cerebral palsy
=
Congenital rubella syndrome
Mx of suspected cases of rubella in pregnancy =
Discuss with Health Protection Unit
Define RFM
K28>
<10 movements in 2 hours
When should RFM be established?
When should they start? Primip multip
K24
K18-20, 16-18
RFM Mx
>K28
Handheld doppler
If no heartbeat then US immediately
If heartbeat then CTG for at least 20 mins
If any concerns with CTG then USS within 24 hours
RFM Mx
K<28
Doppler for HR
When to refer if no fetal movements have been felt?
K24
RF for placenta praevia (3)
Multiparity
Multiple pregnancy
Prev CS
Grading of placenta praevia
I - lower segment only not then os
II - reaches internal os
III - covers internal os before dilatation but not when dilated
IV - completely covers the os
RF for placental abruption (4)
Cocaine
Multip
Maternal trauma
Increasing maternal age
When should women have swabs for GBS?
Not routinely offered to everyone
Only if GBS in previous pregnancy
Should be offered at K35-K37 or can have it prophylactically intrapartum
HIV positive women when should a vaginal delivery be offered over a CS
If viral load is less than 50 copies/ml at K36
What should be given before a CS and when in HIV+ pts and when?
Zidovudine infusion - 4 hours prior to the CS
Neonatal antiretroviral therapy
What should be given and for how long?
Zidovudine PO otherwise ART for all neonates
4-6 weeks long treatment
Women who are at high risk of developing pre-eclampsia should be given what and for how long?
Aspirin 75mg OD from 12 weeks until birth of baby
High risk groups of for pre-eclampsia? (4)
HTN during prev preg
CKD
Autoimmune disorders
DM
What is HTN in pregnancy and when does it normally start to rise?
First trimester BP usually falls then rises K20
BP 140/90
OR
Increase in booking reading by 30 or 15 sys/dias
Pre-existing HTN definition
> 140/90 before K20
PIH definition
> 140/90 >K20
Pre-eclampsia definition
With proteinuria >0.3g/24 hours
Mx of obstetric cholestasis (3)
Meds (2)
Induction at what K
Induction at K37- K38
Urso
Vitamin K
4 causes of PPH
Trauma (tear)
Tone (uterine atony)
Tissue (retained placenta)
Thrombin (bleeding disorder)
Poly or oligohydramnios is a RF for PPH
Polyhydramnios
Mx PPH (6)
ABC
Palpate the uterine
IV oxytocin slow IV injection followed by infusion
Ergometrine slow IV or IM
Carboprost IM (unless asthma)
Misoprostol sublingual
When is a secondary PPH?
Usually secondary to?
24 hours - 6 weeks
Retained placenta or endometritis
Onset of symptoms for
1. Baby blues
2. Postnatal depression
3. Puerperal psychosis
- Within 3-7 days
- Within a month - peaks at 3 months
- Within 2-3 weeks post birth
Which SSRIs can be offered for post natal depression? (2)
Sertraline
Paroxetine
What are the three stages of postpartum thryroiditis?
Thyrotoxicosis
Hypothyroidism
Normal thyroid function
Which antibodies are found in 90% of cases in postpartum thyroiditis?
Thyroid peroxidase antibodies
Name the seven features of severe pre-eclampsia (8)
BP >160/100
Proteinuria
Headache
Visual disturbances
Papilloedema
RUQ/ epigastric pain
Hyper-reflexia
Platelet count <100
What is HELLP?
Haemolysis
Elevated liver enzymes
Low platelets
First line management pre-eclampsia
First line in asthmatics (2)
- Labetalol
- Nifedipine/ hydralazine if asthmatic
Anaemia in pregnancy - Hb values
First trimester
Second/ Third
Postpartum
How long should treatment continue
<110
<105
<100
3 months post correction of deficiency
Puerperal pyrexia is classified as?
T>38 in the first 14 days post delivery
Endometritis Mx (2)
Clinda and gent
Test of choice for GDM
When is it offered
Women with any RF
Women with prev GDM
OGTT
K24-28
Soon after booking and then if negative again at K24-K28
Diagnostic threshold for GDM
Fasting
2 hour glucose
Fasting glucose >=5.6
2 hour glucose >=7.8
Mx of GDM
Fasting glucose <7
Fasting glucose >=7
Diet and exercise for 1-2 weeks, if not meeting targets then to start metformin, if still not met, then insulin
Insulin
When should insulin be offered for GDM (2)
If fasting glucose 6-6.9 and evidence of macrosomia or hydramnios
Or fasting glucose >=7
When should glibenclamide be offered to women with GDM? (2)
Women who do not tolerate metformin or women who decline insulin
Mx of women with pre-existing diabetes (3)
Weight loss if BMI >27
Stop PO hypoglycaemics except metformin and start insulin
Folic acid 5mg OD from pre conception to 12 weeks
Target glucose for GDM/ DM
Fasting
1 hour
2 hour
Fasting –> 5.3
1 hour after meals –> 7.8
2 hours after meals –> 6.4
How long to avoid pregnancy post molar pregnancy
Avoid pregnancy for the next 12 months
Can hep B be transmitted via breastfeeding?
No
Which babies should receive a complete course of vaccination and hep B immunoglobulin?
Babies born to mothers who are chronically infected with hep B or acutely infected during pregnancy
Obstetric cholestasis Mx
Symptomatic relief
How often are LFTs
Induced at K?
Urso
Weekly LFTs
Induced at K37
BMI ?>= should give birth in a consultant led obstetric unit
BMI?>= should have an antenatal consultation with an obstetric anaesthetist and a plan made
35 and 40
