Obstetrics Flashcards
What prophylactic treatment can be offered to pregnant women at high risk of developing pre-eclampsia?
Aspirin 75mg - from 12 weeks until delivery
What groups are at high risk of pre-eclampsia?
- Hypertensive disease (inc pre-eclampsia) in previous pregnancies
- CKD
- Autoimmune disorders e.g. SLE, Antiphospholipid syndrome
- Type 1 or 2 diabetes
What is pre-eclampsia
Pregnancy induced hypertension associated with proteinuria (>0.3g/24hrs)
Oedema may occur
What are the 2 main causes of cervical excitation?
Ectopic pregnancy
Pelvic inflammatory disease
25 year old female Patient presents with 8 weeks amenorrhoea and lower abdominal pain. She has recently developed vaginal bleeding, and shoulder tip pain. What is the most likely diagnosis?
Ectopic pregnancy
What are the typical presenting features of miscarriage?
Vaginal bleeding and crampy lower abdominal pain following a period of amenorrhoea
What is the preferred treatment for hyperthyroidism during pregnancy and why?
Propylthiouracil because it is less likely to cross the placenta than carbimazole
Name some treatments which can be used for nausea and vomiting in pregnancy.
cyclizine, metoclopramide, domperidone, ondansetron, chlorpromazine
What is pre-existing versus pregnancy-induced hypertension?
Pre-existing: 140/90 mmHg before pregnancy or before 20 weeks gestation
Pregnancy-induced: 140/90 mmHg after 20 weeks gestation
What is the first line therapy for hypertension in pregnancy? Name 2 other drugs that can be used.
1st line: Labetalol
Others: Methyldopa and nifedipine
What antibiotic therapies can be used for UTIs in pregnancy? Name complications associated with them.
Nitrofurantoin - preferred drug but should be avoided at term due to risk of neonatal haemolysis
Trimethoprim - 2nd line, but should be avoided during first trimester because it is a folic acid antagonist
Cefalexin is the third choice
What is Bishop’s score used for?
Used to predict whether induction of labour will be required
What Bishop’s score suggests that labour is unlikely to start without induction? What score suggests labour will progress spontaneously?
Induction: 5 or less
Spontaneous: 9
What are the indications for induction of labour?
- Prolonged pregnancy >12 days after estimated date of delivery
- pre-labour premature rupture of membranes, where labour does not start
- diabetic mother >38 weeks
- Rhesus incompatibility
What is the risk to the foetus if the mother is exposed to varicella zoster:
a) before 20 weeks gestation?
b) third trimester?
c) if mother develops rash between 5 days before and 2 days after birth?
a) Fetal varicella syndrome (skin scarring, eye defects, limb hypoplasia, microcephaly, and learning disabilities)
b) shingles in infancy
c) neonatal varicella (fatal in 20% of cases)
How is chickenpox exposure in pregnancy managed?
- if there is doubt about whether mother has previously had chicken pox: urgently check maternal blood for varicella antibodies
- If pregnant woman is not immune: give varicella zoster immunoglobulin (up to 10 days post exposure)
- if pregnant woman has chicken pox and presents within 24hrs of onset of rash: oral aciclovir
What conditions are screened for in the Guthrie test?
PKU Hypothyroidism MCCAD Cystic fibrosis Haemoglobinopathies: Sickle cell disease and thalassaemia in babies with a family history
What are the perinatal risk factors for neonatal sepsis?
- Group B strep colonisation of mother’s vagina
- Prolonged rupture of membranes (>18 hours)
- significant GBS bacteriuria during pregnancy
- Maternal temperature >38 degrees during labour
- chorioamnionitis
- sustained intrapartum fetal tachycardia
- previous delivery of infant with GBS disease
What are the causative organisms of neonatal sepsis?
- Group B strep (most common)
- E. coli
- staph aureus
- Enterococcus
- Staph epidermidis
- Klebsiella
- Others e.g. listeria
What is the antibiotic therapy for neonatal sepsis?
Newly delivered: IV benzylpenicillin and gentamicin
Nosocomial in NICU (with catheters - likely a staph infection): Vancomycin/flucloxacillin
What is external cephalic version?
How many weeks gestation can it be done from?
- Externally correcting breech presentation
- after 36 weeks gestation, but leave it till as late as possible as most babies will correct naturally between 36 weeks and labour
What screening tool is used to screen for post-natal depression? What does it involve?
Edinburgh post-natal depression scale:
- 10 item questionnaire
- max score of 30
- score of >13 - indicates depressive illness of varying severity
- includes question about self-harm
New first-time mother presents to GP 3 days after delivery feeling tearful, anxious and irritable. She does not have thoughts of self-harm. What is the most likely diagnosis? What is the most appropriate management
“Baby blues” (typically occurs 3-7 days following delivery, more common in prims)
management with reassurance and support, involve health visitor
Patient presents 3 months following delivery with low mood, low energy, tearfulness, low self-esteem and worries she has not bonded with her baby.
a) What is the most likely diagnosis?
b) What screening tool would help make this decision?
c) what is the most appropriate management?
a) Post-natal depression (onset usually after 1 month following delivery, typically peaking at 3 months; features are similar to other depressive illnesses)
b) Edinburgh post-natal depression scale
c) reassurance and support; CBT; SSRI (paroxetine best due to low milk/plasma ratio
