obstetrics Flashcards
What are risk factors for complications in pregnancy
Advanced maternal age ie >=40 or low age <20
History of any medical problems
Previous surgery
IVF treatment
Previous caesarean section
Previous problems in pregnancy e.g. hypertension, growth restriction, diabetes, fetal abnormalities
What would you advise newly pregnant or women trying for pregnancy?
Start taking folic acid and Vitamin D, encourage normal healthy eating and exercise.
What is diagnostic of gestational diabetes?
2-hour glucose >7.8
Name 3 common medications contraindicated in pregnancy
Isotretinoin: Used in treatment of severe acne
Ramipril: ACE inhibitor should be avoided in second and third trimester due to increased risk of fetal renal damage
NSAIDs: Increased risk oligohydramnios and premature closure fetal ductus arteriosus. Sometimes used in pregnancy for severe inflammatory conditions.
Define Oligohydramnios
Deficiency in amniotic fluid. Often idiopathic can result in birth defects
Name some common medications cautioned in pregnancy
Carbimazole: Associated with rare skin disorder if taken in 1st trimester – aplasia cutis.
Trimethoprim: Interferes with folic acid pathway and is therefore considered teratogenic when taken in the 1st trimester. It is considered generally safe afterwards.
Nitrofurantoin: Should be avoided in Pregnancy at term >36/40 due to association with haemolytic anaemia
Propylthiouracil: Associated with severe liver disease/failure in some pregnancies.
Sodium valproate: has a much higher association of congenital malformations and should therefore be avoided
Lamotrigine: Is considered the safest anti-epileptic drug (AED) when compared with the others. There is still however some concerns regarding an increased risk of congenital malformations compared with women not on AED. Most women of childbearing age who can be controlled on lamotrigine are so, due to its lower risk profile
Citalopram: SSRI can be associated with increased congenital heart disease when taken in 1st trimester BUT if required for maternal mental health well-being it is generally not advisable to stop. This should be discussed with the women though.
What is the recommended HbA1c prior to pregnancy
NICE recommends that women who are planning to become pregnant should aim for HbA1c <48mmol/mol. They also advise that women who have an HbA1c > 86 mmol/mol should be advised against pregnancy due to the associated risks.
In normal pregnancy, the uterine spiral arteries undergo remodelling to become what?
High-capacitance low resistance vessels . One of the contributing factors to the development of pre-eclampsia is the failure of this process
Pregnant women suffering from pre eclampsia are given Magnesium Sulfate. What are the symptoms of magnesium toxicity
Loss of tendon reflexes (due to neuromuscular blockade)
Respiratory depression
Cardiac Arrest
Where do ectopic pregnancies commonly occur?
The most common site for ectopic pregnancy implantation is the fallopian tubes, most commonly in the ampullary portion. Ovarian ectopics, uterine horn ‘Cornu’ ectopics, and caesarean scar ectopics are rare.
What are the symptoms of ectopic pregnancies?
Abdo pain, shoulder tip pain, rectal pain and diarrhoea
What happens to serum human chorionic gonadotrophin levels during pregnancy?
Serum HCG in normal viable pregnancies increased by at least 53% every 48 hours, although in most cases doubles every 48 hours. Falling HCG levels suggests a failing pregnancy
Nitrofurantoin and trimethoprim are avoided at what stage of pregnancy?
Nitrofurantoin avoided post 32 weeks as it can cause neonatal haemolysis
Trimethoprim avoided during 1st trimester as it is a folate antagonist
How common are miscarriages?
25-30% of pregnancies end in miscarriage
How many pregnancies end in miscarrige?
25-30%
What is a raised fetal fibronectin test indicative of?
Premature labour if noted between 22-35 weeks.
It is a glue like protein that holds fetus in place
