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Phase 3a > Obstetrics 3 - Pregnancy Problems 2 > Flashcards

Obstetrics 3 - Pregnancy Problems 2 Flashcards

1
Q

What are risk factors for ectopic pregnancy?

A 
Endometriosis
IUCD
Assisted conception
Smoking
PID
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2
Q

Define ectopic pregnancy

A

Implantation of a conceptus outside the uterine cavity

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3
Q

What are the symptoms of ectopic pregnancy?

A

Amenorrhoea
Abdo pain
Small brown PV bleed
Collapse if ruptured

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4
Q

How is ectopic pregnancy diagnosed?

A

TVUS
Serum progesterone <20nmol/L (failing pregnancy)
Serum HCG rise less than 66%
Laparoscopy

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5
Q

What are the requirements for expectant management of ectopic pregnancy?

A

Clinically stable
Asymptomatic
Falling HCG

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6
Q

Detail medical management of ectopic pregnancy

A

IM methotrexate 50mg/m2

Anti-D if Rhesus negative

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7
Q

How would you surgically treat ectopic pregnancy?

A

Laparoscopy

Salpingectomy unless other risk factors for infertility - salpingotomy

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8
Q

What are the risk factors for hyperemesis gravidarum?

A 
Primiparity
Hyatidiform mole
Younger or obese women
Previous history
Multiple pregnancies
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9
Q

How is a patient with hyperemesis gravidarum managed?

A

Admit if not tolerating oral fluids
IV fluids, nutritional support, thiamine supplements
Daily UEs (replace potassium)
NBM 24 hours, then light diet
1st line: promethazine or cyclizine
2nd line: metoclopramide, prochlorperazine, ondansetron

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10
Q

What are the complications of hyperemesis gravidarum?

A

Thiamine deficiency, liver failure

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11
Q

Which syndrome is trisomy 13?

A

Patau syndrome

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12
Q

What are the characteristics of Patau syndrome?

A

Cyclopia, microcephaly, severe LD, congenital abnormalities

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13
Q

What is foetal hydrops?

A

Accumulation of serous fluid in 2+ foetal compartments

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14
Q

Name some non-immune causes of foetal hydrops

A

Severe anaemia from G6PD deficiency
Cardiac abnormalities
Trisomies
TTTS

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15
Q

What is the pathophysiology behind foetal hydrops?

A

Obstructed lymphatic flow leads to decreased plasma oncotic pressure

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16
Q

How is foetal anaemia diagnosed?

A

Ultrasound, peak systolic velocity in MCA, foetal blood sampling

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17
Q

How is non-immune hydrops treated?

A

Amniocentesis if severe polyhydramnios
Treat cause
3rd trimester - delivery

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18
Q

What is immune hydrops?

A

Maternal antibody response against foetal red blood cells (if blood types don’t match)

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19
Q

What is the consequence of immune hydrops?

A

Haemolytic anaemia, jaundice/high-output cardiac failure, foetal hydrops, death

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20
Q

Give three sensitizing events for Rhesus disease

A

Ectopic pregnancy
ECV
Delivery

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21
Q

How is immune hydrops treated?

A

Irradiated Rh-negative packed red cells transfused into umbilical vein at cord insertion/hepatic vein
(umbilical vein transfusion)

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22
Q

How is immune hydrops prevented?

A

Anti-D given if Rhesus negative at 28w, 34w, and within 72 hours of sensitizing event.

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23
Q

What is reduced amniotic fluid volume?

A

Oligohydramnios

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24
Q

Give three causes of oligohydramnios

A

IUGR
PROM
Pre-eclampsia
Utero-placental insufficiency

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25
Q

What is amniotic fluid index?

A

Total volume of the deepest pools in the 4 quadrants of the uterus

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26
Q

Define low AFI

A

<8cm (deepest pool <2cm)

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27
Q

How would you manage SROM before 37 weeks?

A

Prophylactic PO erythromycin

Daily CTGs

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28
Q

How would you manage SROM after 37 weeks

A

Induce labour

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29
Q

Define polyhydramnios in terms of AFI

A

> 24cm (deepest pool >8cm)

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30
Q

Give three causes of polyhydramnios

A

Foetal hydrops
TTTS
Foetal GI tract obstruction (can’t swallow) e.g. duodenal atresia

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31
Q

What are the complications of polyhydramnios?

A 
Malpresentation
Preterm delivery (uterine stretch)
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32
Q

What is intrauterine growth restriction?

A

The foetus is pathologically small

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33
Q

What factors affect growth and birth weight?

A 
Maternal height more than paternal height
Maternal weight
Parity
Ethnic origin
Gender of foetus
34
Q

What are the commonest causes of IUGR?

A

Uteroplacental insufficiency
Congenital conditions
Maternal chronic disease

35
Q

What are the two types of IUGR?

A

Symmetric: entire body, early onset, chromosomal abnormalities
Asymmetric: head sparing effect, UPI.

36
Q

What are the complications of IUGR?

A

Meconium aspiration
Childhood attention and learning deficits
Stillbirth
Emergency CS

37
Q

What measurement is used for monitoring of foetal growth?

A

Symphysis fundal height

38
Q

What does increased resistance in umbilical artery found on Doppler investigation indicate?

A

Placental failure

39
Q

What does increased resistance in uterine artery found on Doppler investigation indicate?

A

High risk of developing pre-eclampsia

40
Q

What patients usually get acute fatty liver of pregnancy?

A

Obese women in 3rd trimester

41
Q

How is AFLP managed?

A 
Treat hypoglycaemia
Correct coagulopathy with IV vitamin K and FFP
Control BP
Delivery after stabilization
Then treat liver and renal failure
42
Q

What does maternal hyperglycaemia lead to?

A

Foetal hyperglycaemia –> hyperinsulinaemia –> beta-cell hyperplasia –> macrosomia
Foetal polyuria = polyhydramnios

43
Q

What are three neonatal complications of diabetes?

A

Jaundice
Shoulder dystocia
Polycythaemia
Hypoglycaemia/hypocalcaemia/hypomagnesaemia

44
Q

What is the effect of pregnancy on pre-existing diabetes?

A

Increased risk of ketoacidosis, retinopathy, nephropathy, pre-eclampsia, and IHD.

45
Q

How is a diabetic mother monitored in labour?

A

Continuous EFM
IV insulin sliding scale
Check blood glucose hourly

46
Q

How is a diabetic mother managed postpartum?

A

Halve insulin sliding scale

Change to SC insulin when eating and drinking

47
Q

How often is HbA1c measured antenatally?

A

Every month

48
Q

What is gestational diabetes?

A

Diabetes diagnosed in pregnancy, usually 2nd trimester

49
Q

What are the risk factors for gestational diabetes?

A

FH of DM, obesity, previous large baby, previous history, polyhydramnios, PCOS

50
Q

What is required in an oral glucose tolerance test?

A

Overnight fasting
75g glucose load in 250/300ml water
Plasma glucose measured at fasting and 2 hours

51
Q

What OGTT results are seen in diabetes and impaired glucose tolerance?

A

Diabetes: fasting >7mmol/L, 2hr>11.1mmol/L
IGT: fasting >7mmol/L, 2hr>7.8mmol/L

52
Q

What are the clinical requirements for a diagnosis of anti-phospholipid syndrome?

A

Vascular thrombosis

3+ consecutive miscarriages <10w/ 1 foetal death>10w

53
Q

Give three causes of puerperal pyrexia

A 
UTI
Perineal wound infection
Endometritis
Thrombophlebitis
Mastitis or breast abscess
54
Q

What are the symptoms of endometritis?

A

Fever
Foul profuse bloody discharge
Subinvolution of uterus
Tender bulky uterus

55
Q

Which antibiotics are used for endometritis?

A

Clindamycin and gentamycin

Admit until >24h afebrile

56
Q

What are the risk factors for uterine inversion?

A 
Strong traction on umbilical cord
Excessive fundal pressure
Placenta accrete
Previous history
Short cord
Uterine abnormalities
57
Q

What are the signs and symptoms of uterine inversion?

A

Haemorrhage
Severe lower abdo pain
Uterine fundus not palpable, mass in vagina

58
Q

What is the name of the manoeuvre whereby the uterus is replaced up the cervix when it inverts?

A

Johnson manoeuvre

59
Q

How much blood loss is required in massive obstetric haemorrhage?

A

30-40% patient’s blood volume

Usually 2 litres

60
Q

Give three causes of massive obstetric haemorrhage

A

Antepartum - placental abruption, PP
Intrapartum - Uterine rupture, accrete
Postpartum - atonic uterus, coagulopathy, uterine AVM

61
Q

What is the most useful measure of measuring blood loss in massive obstetric haemorrhage?

A

Pulse rate

62
Q

What are the complications of MOH?

A

Hypovolaemia and cardiac decompensation
DIC
ARDS
Multiorgan failure

63
Q

Why is left lateral tilt useful in MOH?

A

Relieves venocaval compression

64
Q

How is MOH managed?

A

Treat the cause e.g. uterine atony

Replace blood and clotting factors

65
Q

What is the management of foetal distress of the 2nd twin?

A

Deliver by the fastest, safest route

66
Q

What occurs in amniotic fluid embolism?

A

Amniotic fluid enters the circulation of the mother and mechanically blocks vessels or causes an immunological/inflammatory reaction

67
Q

What is the biggest risk of cord prolapse?

A

Compression of umbilical vessel by the presenting part

68
Q

How is cord prolapse managed?

A

Delivery ASAP, reduce cord into vagina, mother in knee-chest or head-down tilt position whilst waiting for emergency caesarean section

69
Q

What are the risk factors for cord prolapse?

A

Cord presentation
Multiple pregnancy
Abnormal lie
Prematurity

70
Q

What is shoulder dystocia?

A

Obstructed delivery where additional manoeuvres are needed after downward traction of the head has failed to deliver the shoulders

71
Q

What are the causes of shoulder dystocia?

A

Foetal macrosomia
BMI>30
Prolonged pregnancy
Augmentation of labour/induction of labour

72
Q

What are the complications of shoulder dystocia?

A

Foetal hypoxia

Maternal PPH and genital tract trauma+-

73
Q

What the commonest cause of lactational mastitis?

A

Milk stasis

74
Q

What is the treatment of mastitis?

A

Continue breast feeding, simple analgesia and warm compresses
Flucloxacillin if: nipple fissures, breast milk culture positive, symptoms not improving after 2 days of conservative treatment

75
Q

What is the ultrasound finding in molar pregnancy?

A

Uterus large for dates

76
Q

What medication is contraindicated during the first trimester of pregnancy?

A

Trimethoprim (folate antagonist) - use nitrofurantoin

Nitrofurantoin is CI if breastfeeding

77
Q

What is the triad of obstetric cholestasis?

A

Pruritus
No rash
Abnormal LFTs

78
Q

What is raised in obstetric cholestasis?

A

Bile acids

79
Q

What is the treatment of obstetric cholestasis?

A

Ursedeoxycholic acid

80
Q

When is urine cultured for asymptomatic bacturia?

A

8-12 weeks

81
Q

The first screen for anaemia and alloantibodies occurs at the booking visit (8-12 weeks). When is the second screen?

A

28 weeks

82
Q

Why is metoclopramide contraindicated in patients under 20 with hyperemesis gravidarum?

A

Increased risk of extra-pyramidal side effects

Phase 3a (18 decks)

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