Obstetrics Flashcards
What does HELLP syndrome stand for? What is it associated with?
Haemolysis Elevated liver enzymes (pts can go into liver failure) Low platelets (thrombocytopaenia)
Pre-eclampsia
What supplements do HELLP patients often go home on?
Iron (they often suffer significant haemorrhage)
CTG <100bpm =
bradycardia in baby - emergency
What are fibroids which have been treated with multiple surgeries before a risk of?
Uterine rupture
Mx of symptomatic ectopic pregnancy + lots of pain?
Surgical
- Salpingectomy
- Salpingotomy if increased risk of infertility or known tubal damage
The foetal heartbeat is visible as early as
6 weeks
What is a miscarriage?
Pregnancy that spontaneously ends before 24wks gestation
What gastro issues are pregnant women at higher risk of?
Cholelithiasis and cholecystitis
Acute fatty liver of pregnancy (AFL) (usually presents after 30wks)
How should LMWH be given/monitored in pregnancy?
Pharmacokinetics change in preg. so give 1mg/kg dose BD (usually its 1.5mg/kg OD).
If labour suspected or begins then stop immediately.
If C-section planned then stop 24hr before.
Give any spinal anaesthesia or epidural at least 24hr AFTER last injection of LMWH.
What are the risk factors for obstetric cholestasis?
- Previous pregnancy with OC
- Asian origin
- Genetic traits
- Pruritis on COCP
- Multiple pregnancy
What are the complications of obstetric cholestasis?
- Severe liver impairment
- Fetal distress
- Premature delivery
- Intrauterine death
- Post-partum haemorrhage
Why might altered liver function or GI function increase the risk of post-partum haemorrhage?
Decreased absorption of Vit K, leading to altered coagulation
A 33-year-old lady presents to delivery suite at 34 weeks gestation in her fifth pregnancy with a history of painless vaginal bleeding. The patient also reported a small amount of spotting following sexual intercourse. The doctor performs an examination which shows the fetus to be lying transversely with a normal fetal heart rate. On speculum examination, there was a small amount of blood in the vagina and the cervix was normal. What is the most likely diagnosis?
Placenta praevia
What are the risk factors for placenta praevia?
Multiparity Smoking Previous Hx of placenta praevia Previous uterine surgery Older mothers
What are the three methods to measure fetal wellbeing during labour?
CTG (Cardiotocograph)
Intermittent auscultation
Fetal blood sampling
What is the Normal baseline heart rate during labour?
110-160
When do early decelerations occur on a fetal CTG and why do they happen?
Occur WITH the peak of contraction and happen due to head compression
Late decelerations are associated with?
Fetal hypoxia
Variable decelerations on CTG suggest?
Cord compression
In the fetus a normal PH is
> 7.25. Borderline is 7.2-7.25.
What is one of the first features of scar rupture in VBAC?
An abnormal CTG
What is an absolute contraindication to trial of VBAC due to the greater risk of uterine rupture?
Classical incision
What are some of the complications of VBAC?
72-75% chance of successful delivery - the rest involve emergency C section
If labour is induced it can result in increased risk of UTERINE RUPTURE
If baby is in cephalic position its a favourable factor for VBAC
What two things should be prepared/monitored in VBAC during delivery?
1) IV access in case immediate resuscitation is needed
2) Continuous CTG (abnormality indicates uterine scar rupture)
What is secondary arrest of labour?
Failure for labour to progress when there was adequate or expected progress to begin with
What is primary dysfunction of labour often caused by?
Deflexion of fetal head and ineffective uterine action.
Risk factors for obstetric anal sphincter injuries
Forceps/instrumental delivery
Prolonged labour
During active second stage
Big babies
What should general anaesthesia for unplanned C section include?
Preoxygenation, cricoid pressure and rapid sequence induction to reduce the risk of aspiration
What are examples of infection that can occur in 8% of women after C section?
Endometritis
Wound infections
Urinary tract infections
What is the difference between SGA and IUGR?
SGA = below 10th centile for weight since beginning of pregnancy
IUGR= growing normally then drops by a few centiles
What is the difference between antepartum haemorrhage and threatened miscarriage?
Threatened miscarriage < 24 weeks
Antepartum haemorrhage > 24 weeks
What are some causes of antepartum haemorrhage?
Placental abruption Placenta praevia Placenta accreta Vasa praevia Cervical ectropion Trauma Bloody show
What are some risk factors for placental abruption?
Previous placental abruption Smoking C-sections Cocaine use Pre-eclampsia
Why might there not be any PV bleeding in placental abruption?
It may be a concealed bleed
What is the difference between placenta praevia and placenta accreta?
Placenta praevia – the placenta grows over the internal os of the cervix (three types: complete, partial and marginal)
Placenta accreta – the placenta grows deep into the uterus. Tends to occur over C-section scars and is associated with severe post-partum haemorrhage
NOTE: a low-lying placenta just means that it is lying low in the uterus but does not touch the cervix
How can preterm premature rupture of membranes be prevented in high-risk women?
Prophylactic vaginal progesterone
Cervical cerclage
If pooling of amniotic fluid is not observed on examination of a woman with suspected PPROM, which other test could be conducted?
IGF binding protein-1 test or placental alpha-microglobulin-1 test
Which organisms are typically implicated in chorioamnionitis?
GBS
E. coli
How would a patient with PPROM but no signs of infection be managed?
Monitor for signs of infection
- Offer oral erythromycin 250 mg QDS for a maximum of 10 days or until the patient is in established labour
- Offer maternal corticosteroids
- Do NOT use tocolysis (increases risk of infection)
Decision to deliver depends on balance of risk of prematurity and risk of maternal/foetal infection if delivery is delayed
Risks of smoking during pregnancy
Miscarriage Stillbirth IUGR Low birthweight Neonatal death Cot death
Risks of diabetes mellitus during pregnancy
Macrosomia FGR Congenital abnormalities Pre-eclampsia Stillbirth Neonatal hypoglycaemia
What vaccines should be given during pregnancy and when?
27-26wks
- Influenza vaccine
- DTaP vaccine (protect neonate from bordatella)
What are the indications for anti-D prophylaxis administration <12wks GA? If these are not indicated but mum is Rhesus D positive, when should anti-D prophylaxis be given?
Give 250IU
- Molar pregnancy
- Ectopic pregnancy
- Therapeutic TOP
- Uterine bleeding
Give large does 1500U at 28wks
OR
two doses: 28wks and 34wks
What glucose levels are required for a diagnosis of gestational DM?
- Fasting plasma glucose
- 2-hr 75g OGTT
Fasting: >5.6mmol/L
OGTT: >7.8mmol/L
How should sickle cell anaemia be managed during pregnancy?
Stop hydroxyurea at least 3mths before conception Manage with: - low dose aspirin from 12wks - serial scans every 4wks from 24wks - IOL at 38wks
LMWH during hospital and 7days after, 6wks if C section
If contraceptive needed - progesterone
If a baby is born to an active HBV mother, what should be given to the child?
HBV IVIG: within 12hrs
Hep B vaccine: 12hrs, 1mth, 6mths
What does the combined test screen for and what is involved in it?
Patau’s, Edward’s, Down’s
- Nuchal translucency
- b-hCG
- PAPP-A
What does the quadruple test involve and what does it screen for? How does it differ to the triple test? What happens if a positive result is achieved?
Down’s only
- NT
- b-hCG
- Oestriol
- Inhibin A
NB: the triple test does NOT include inhibin A
If positive result:
- Chorionic villous sampling (11-14wks)
- Amniocentesis (15-20wks)
What should be given to women at risk of pre-eclampsia?
75mg OD from 12wks to delivery (if high risk)
At what GA are the following scans done?
Booking scan:
Anomaly scan:
Booking scan: 10-14wks
Anomaly scan: 18-21wks
Sensitising events for RhD negative mum
- Delivery of RhD+ infant
- Any TOP
- Miscarriage if > 12 weeks
- Ectopic pregnancy (if managed surgically)
- External cephalic version - Antepartum haemorrhage
- Amniocentesis, CVS, foetal blood sampling - Abdominal trauma
What conditions in women require a higher dose of daily folic acid than the normal 400mcg OD? What is the higher dose?
5mg OD
- Previous NTD in foetus/baby
- SCD
- Thalassemia
- Epilepsy
- HIV+ on co-trimoxazole
- Diabetes mellitus
- Obesity
- IBD
What is the normal progress of the active phase of first stage of labour?
Slow progress/no progress?
0.5cm/hr or 2cm/hr
Slow or no progress = <2cm in 4hrs
When is the most likely time for conception?
6 days prior to ovulation, so around day 8-14
Risk of alcohol consumption during pregnancy
Neurological damage Abnormal facies Fetal growth restriction Low birth weight Spontaneous miscarriage
What vitamin in the liver is associated with congenital abnormalities, thus means liver should not be eaten during pregnancy?
Vitamin A
Risks of the following drugs during pregnancy:
Beta blockers
Warfarin
Diuretics
Diclofenac
Beta blockers: growth restriction
Warfarin: teratogenic
Diuretics: teratogenic
Diclofenac: miscarriages in first trimester
Oligohydramnios typically detected between how many wks?
18-24wks
Things looked for on anomaly scan
NT Gross abnormalities/cranial eg anencephaly Abdo wall defect Cystic hygroma Bladder outflow obstruction
Risk factors for pre-eclampsia
Chronic HTN Diabetes Obesity Nulliparity Multiple pregnancy Renal disease Molar pregnancy
What serum markers rise in pre-eclampsia? A decrease in what other serum marker is worrying and why?
Urea
Creatinine
AST
ALT
Worried if low Plts as could indicate HELLP syndrome
Indications for CTG monitoring
Abnormal foetal HR on intermittent auscultation
Meconium in liquor
Maternal pyrexia (>38 or 2x >37.5 separated by 2hrs)
Fresh onset bleeding
Oxytocin for augmentation
Turtle sign/retraction of head during labour suggests? How should this be managed?
Shoulder dystocia
Mum needs to STOP pushing
- Call for seniors
- External manoeuvres (=/- episiotomy)
= MacRoberts manoeuvre + suprapubic pressure (works in 90%) - Internal manoeuvres
- Wood’s screw or Rubin II - All fours position
- Symphysiotomy, cleidotomy, zavanelli
Which fetal diamete is the most appropriate to engage in the pelvic inlet under normal circumstances?
Sub-occipito-bregmatic
What is the progress of labour determined by?
Power
Passage
Passenger
Two indications for emergency C-Section?
Placental abruption
Transverse position
What are the factors that might mean a lower chance of achieving a VBAC?
Maternal obesity
Fetal macrosomia
Increased maternal age
Previous C section performed for recurring indication
Previous C section performed following failed instrumental delivery
Risks of C-section
- Maternal
- Foetal
Maternal:
- Visceral damage
- Haemorrhage
- VTE
- Future risk of uterine rupture and placenta praevia
- Infection
Foetal:
- Resp distress
- Traumatic injury
Options for IOL and indications
If delay in labour eg <2cm over 4hrs or other reasons eg pre-eclampsia and at term etc
1st line: Vaginal prostaglandins E2
- Gel or tablet: max 2 doses, 6 hours apart
- Pessary: 1 dose over 24hr
2nd line:
Membranes intact: ARM
Membranes ruptured but no labour after 2hr: IV syntocinon until 3-4 contractions every 10mins then review in 4hrs
What nerves does shoulder dystocia damage?
Brachial plexus
C5-C8, T1
Turtle sign/retraction of head during labour suggests? How should this be managed?
Shoulder dystocia
Mum needs to STOP pushing
- Call for seniors
- External manoeuvres (=/- episiotomy)
- Internal manoeuvres
- All four position
- Symphysiotomy, cleidotomy, zavanelli
What maternal cardiovascular changes occur during pregnancy? (Name 3)
Drop in venous return
Reduction in CO
Reduction in uterine blood flow
What is the position of the baby during labour?
Relationship of foetal occiput to the sacrum of the mother once the foetal head is in the pelvic inlet
What are the 5 components of a bishop score?
- Dilation of cervix
- Consistency of cervix
- Length of cervical canal
- Position of cervix
- Foetal position
What is the risk of ARM?
umbilical cord prolapse
What are the risks of IV syntocinon?
Uterine hyperstimulation
Uterine rupture risk (esp if VBAC or previous uterine myomectomy)
Options for IOL and indications
If delay in labour eg <2cm over 4hrs or other reasons eg pre-eclampsia and at term etc
1st line: Vaginal prostaglandins E2
- Gel or tablet: max 2 doses, 6 hours apart
- Pessary: 1 dose over 24hr
2nd line:
Membranes intact: ARM
Membranes ruptured but no labour after 2hr: IV syntocinon until 3-4 contractions every 10mins
What are the types of delay in the first stage of labour?
Primary dysfunctional labour
Secondary arrest
Prolonged latent phase
Cervical dystocia
What is puerperal pyrexia and what are some causes? How is it managed?
38degrees in mum within first 14days of delivery Caused by - endometritis - wound infection - VTE - UTI - mastitis
IV clindamycin + gentamicin
Definition of delay in second stage of labour
Nulliparous: >2hr if no epidural, >3hr if epidural
Parous: >1hr if no epidural, >2hr if epidural
What is crowning?
When the head no longer recedes between contractions
When should vitamin K be administered to a baby?
1st dose: just after they’re born
2nd dose: by midwife after 7days
3rd dose: by GP/health visitor when baby is 6wks old
What abnormalities of the birth canal can result in abnormal labour?
Fibroids or any obstruction in canal Cervical dystocia (usually because of previous surgery)
What medication should NOT be offered to hypertensive women in third stage of labour?
Ergometrine
Offer oxytocin only
If IOL is offered to a pregnant women at 41wks and she declines, what should be done?
Twice weekly USS and CTG
Risk factors for breech baby
Uterine malformations Fibroids Placenta praevia Poly/oligohydramnios Foetal anomaly (CNS malformation, chromosomal disorders) Prematurity Macrosomia Multiple pregnancy
What is puerperal pyrexia and what are some causes? How is it managed?
38degrees in mum within first 14days of delivery Caused by - endometritis - wound infection - VTE - UTI - mastitis
When is engagement said to have occured?
When the widest part of the presenting part passes through the pelvic inlet
What is meconium passed in utero linked to?
Marked hypoxia +/- metabolic acidosis
What are some causes of abnormal labour?
Poor progress +/- signs of foetal compromise
- Foetal malpresentation
- Multiple pregnancy
- Uterine scar
- Induced labour
What are the absolute contraindications for a VBAC?
Previous uterine rupture
Classical (vertical) C-section scar
Other non-C-section contraindications eg major placenta praevia
In what circumstances is fetal blood sampling contra-indicated?
Maternal HIV
Hepatitis
Fetal coagulopathy / bleeding disorders
Counselling for vaginal delivery of breech baby
40% risk of needing emergency C-section
Footling breech is absolute contra-indication
Better chance if: normal sized foetus, multiparous, positive mental attitude of mother
Risks of breech baby
ECV - 50% success rate
Placental abruption
Foetal distress
Possible emergency C-section required
What are the cardiopulmonary symptoms of amniotic fluid embolism?
- Acute pulmonary HTN
- Hypoxia
- RVF then LVF and death
What is the risk of uterine rupture in VBAC (normal vs with syntocinon)?
1 in 200
1 in 100 if oxytocin
Complications of uterine rupture
Foetus
Death / cerebral palsy from hypoxic brain injury
Maternal
PPH
Coagulopathy
Hysterectomy
Counselling for ERCS
Reduced risk of uterine scar rupture and need for emergency C-section
Increased future risk of:
- Pelvic adhesions complicating surgery
- Placenta praevia or accreta in future pregnancies
If VBAC then increases likelihood of success of future vaginal births
In what circumstances is fetal blood sampling contra-indicated?
Maternal HIV
Hepatitis
Fetal coagulopathy
Risk factors for cord prolapse
Malpresentation or unstable presentation Multiple pregnancy Polyhydramnios Preterm delivery Placenta praevia Macrosomia
Causes of suddenly abnormal CTG with variable decelerations
Cord compression
Cord prolapse
How should detection of fetal bradycardia/deceleration be managed in labour?
- If deceleration has not recovered at 3min then CALL FOR SENIOR HELP
- If deceleration has not recovered at 6min then transfer to theatre and prepare for immediate delivery
- If deceleration has not recovered at 9min then delivery IMMEDIATELY by category one ‘crash’ caesarean section (if immediate instrumental vaginal delivery not possible) usually involves GA as spinal anaesthetic hard to achieve by this time
What is the risk of uterine rupture in VBAC (normal vs with oxytocin)?
1 in 200
1 in 100 if oxytocin
What are the relative contraindications of VBAC?
2+ previous C section
IOL
Previous labour outcome suggestive of CPD
Counselling for ERCS
Reduced risk of uterine scar rupture and need for emergency C-section
Increased future risk of:
- Pelvic adhesions complicating surgery
- Placenta praevia or accreta in future pregnancies
Mechanism/method of vaginally delivering breech baby
Do NOT DO IOL, Continous CTG needed
Maternal position on all fours
Ideally take hands off approach
1) Delivery of buttocks
2) Delivery of legs +/- Pinards manoeuvre
3) If shoulders get stuck - winging of scapula - Loveset’s manoeuvre (for 1/both arms)
4) If head gets stuck - Mauriceau-Smellie-Veit manoeuvre (if doesn’t work use forceps)
Risk factors for P-PROM
Smokers
STI
Previous P-PROM
Multiple pregnancy
Absolute contra-indications for IOL
Placenta praevia
Severe fetal compromise
What are some reasons for induction of labour?
- Prolonged pregnancy (>41wks)
- Multiple pregnancy
- Twin pregnancy beyond 38wks
- PROM
- Diabetes
- Pre-eclampsia/HTN type illness
- FGR
- Maternal declining health
- Unexplained antepartum haemorrhage
- Intrahepatic cholestasis of pregnancy
- Maternal isoimmunisation against red cell antigens
- Social reasons
What are common complications of pre-eclampsia?
Pulmonary oedema DIC Cerebral haemorrhage Eclampsia Placental abruption
Presentation of placental abruption
Dark red blood
Painful abdomen (severe)
Woody uterus
Painless vaginal bleeding and high fetal head suggest what diagnosis?
Placenta praevia
Risk factors for placental abruption
HTN
Pre-eclampsia
Diabetes
Tobacco
What does the venous glucose need to be for diagnosis of gestational diabetes?
2hr venous glucose >11
Complications of gestation diabetes
Polyhydramnios Miscarriage Shoulder dystocia Infection Cord prolapse
Complications of cholestasis in pregnancy
Foetal distress
Pre-term delivery
Intrauterine death
Intracranial fetal haemorrhage
Risk factors for multiple pregnancy
FH
Older age
Assisted conception
Obesity
Maternal complications of multiple pregnancy
Miscarriage
Gestational diabetes
Placental praevia
Anaemia
Fetal complications of multiple pregnancy
Pre-term labour
Intrauterine growth retardation
Malpresentation
Jaundice
Risk factors for pre-term labour
Smoking and Illicit drugs Pre-eclampsia Previous pre-term Multiple pregnancy Chorioamnionitis Infection Gynae surgery eg cervical incompetence Polyamnionitis Young maternal age
Risk factors for shoulder dystocia
Fetal weight >4.5kg Previous big baby >4kg Previous shoulder dystocia Slow progress in 1st/2nd stage of labour Post dates delivery
What should be given to women who might need an emergency C-section to reduce the need for gastric aspiration if they need a GA?
ranitidine and metoclopromide
What haematological tests should be checked in placental abruption? What results might indicate a DIC?
Check for DIC
- Raised INR
- Lowered platelets
- Positive D-dimer
Sensitising events include…
Placental abruption Blood transfusion CVS Amniocentesis Terminations Miscarriage ECV Antepartum haemorrhage Abdominal trauma Surgical ectopic pregnancy removal
When should you NOT offer a digital examination?
Placenta praevia
PROM/PPROM
What is the investigation for PROM or PPROM and what will you see?
Speculum examination: pooling of amniotic fluid
What cervical lengths might indicate PPROM/PROM if >30wks GA?
<15mm likely
>15mm unlikely
When should fetal fibronectin not be used as a marker of PROM?
24-34wks (its dried so not detectable)
Risk factors for PPROM/PROM
Previous PROM/PPROM/PTL UTI Polyhydramnios Multiple pregnancy Smoking Cervical incompetence APH Uterine abnormalities Trauma
If maternal corticosteroids are given eg in pre-term labour etc then what else should be given if the mother is diabetic and why?
DKA can ensue so give with Insulin
What is the most common cause of preterm labour?
Infection (so always do Urine dip and MC&S)
What are the 3 types of preterm labour? (eg timing wise)
PTL: 32-37wks
Very PTL: 38-32wks
Extremely PTL: <28wks
What fetal conditions is indomethacin associated with?
PPH due to premature closure of DA
NEC
Neonatal renal dysfunction
What is a biomarker of PTL?
Foetal fibronectin - check cervicovaginal fluid
Negative has high predictive value: if negative then unlikely to be in labour
What are the indications for IAP (intrapartum prophylaxis)?
Previous GBS infection in neonate
Preterm labour
Pyrexia during labour (>38degrees)
What contraceptive is absolutely contraindicated if breast feeding <6wks post-partum?
COCP
Causes of raised AFP during pregnancy?
NTD
Abdo wall defects eg omphalocele or gastroschistis
Multiple pregnancy
Causes of lowered AFP during pregnancy?
Downs syndrome
Edwards syndrome
Maternal DM
In which location is ectopic pregnancy most associated with rupture?
Isthmus
What advice should be given to women receiving medical management of ectopic pregnancy?
IM methotrexate
F/U with serial hCG: day 4 and 7, then once a week until -ve
- Avoid sex during treatment and conceiving for at least 3mths
- Avoid sunlight and alcohol
What are the different time points for splitting of the zygote and what type of twins do they produce?
Days 1-3 Dichorionic/diamniotic
Days 8-12 Monochorionic monoamniotic
After day 13 Conjoined twins
When is delivery indicated for monochorionic monoamniotic twins?
32-34wks
What does Lamba sign on a 12wk USS indicate?
Dichorionic pregnancy
Which anastomoses are more protective against the development of TTTS?
Arterioarterial
What staging is used for TTTS?
Quintero
T sign on fetal USS indicates
Monochorionic pregnancy
What are the degrees of perianal tear?
1 Mucosa no muscle
2 Perineal muscle
3 Anal sphincter (a <50% EAS, b >50% EAS, c IAS torn)
4 EAS + rectal mucosa
3+4 = OASIS
Management of eclampsia
- A-E
- IV MgSO4 (loading dose 4g over 5-15mins, then infusion of 1g/hr for 24hr after last seizure or until delivery)
- If recurrent then repeat loading dose and get anaesthetists involved
- Anti-HTNs: oral/IV labetalol, nifedipine, IV hydralazine
- Expedite delivery
NB: Ca Gluconate = antidote to MgSO4
How does pregnancy increase the risk of VTE?
Hyperoestrogenic state
Altered blood viscosity
Obstruction to venous blood flow
What are the symptoms of post-thrombotic syndrome?
Chronic leg pain
Swelling
Ulceration
What factors are increased in pregnancy to produce the pro-coagulant state?
F7 F8 vWF PAI-1 PAI-2
Also decreased protein S
What anti-coagulant protein is decreased in pregnancy?
Protein S
What is a blighted ovum?
Gestational sac is present but empty because foetus has not developed
What measurements are used to determine gestational age and at what time points?
CRL: up to 13wks 6days
HC: 14-20wks
Gestational age can no longer be accurately calculated by ultrasound after what time point?
20 weeks
What are some anomalies looked for at the anomaly scan and when does it take place?
18-20+6 wks
- Spina bifida
- Anencephaly
- Abdominal wall malformations eg omphalocele, gastroschisis
- Hydrocephalus
- Skeletal abnormalities eg achondroplasia
- Cleft lip/palate
- Congenital cardiac abnormalities
Which USS is best at detecting lower edge of placenta? Which condition may it be helpful in identifying?
TVUSS
Placenta praevia
What is the normal passage of amniotic fluid in the foetus?
Foetus swallows amniotic fluid
Absorbs it in GI tract
Excretes urine into amniotic sac
What are the two indicators of amniotic fluid via USS?
- Amniotic fluid index
2. Maximum vertical pool
What serial measurement should be taken from 16wks in women with a history of preterm birth or midtrimester loss?
Cervical length
What can cause foetal tachycardia?
Fetal or maternal infection
Acute fetal hypoxia
Fetal anaemia
Drugs (certain)
What factors affect baseline variability on CTG?
Foetal sleep states and activity
Hypoxia
Foetal infection
Drugs eg opioids
The velocity of blood flow in the middle cerebral artery is an indicator of…
Foetal anaemia - if anaemic then velocity increases
Indications for induction of labour
APH IUGR Maternal HTN Post-maturity Diabetes mellitus
Risk factors for shoulder dystocia
Excess maternal weight
Prolonged first or second stage of labour
Macrosomia
Post-maturity
Sudden infant death syndrome risk factors
Sleeping in the same bed as baby Smoking Prone sleeping Hyperthermia and head covering Prematurity
Investigations and management of Hirschsprungs
Full thickness rectal biopsy
Anorectal pull through
What function tests may you check in molar pregnancy and what would be the results?
TFTs
- Low TSH
- High T4
as beta-hcg is so high and mimics TSH
Risk factors for ovarian torsion
Pregnancy
Ovarian mass
Ovarian hyperstimulation syndrome
Of reproductive age
Who should take folic acid 5mg OD?
Woman with child with previous NTD or partner has NTD or FHx
Diabetics
Women on anti-epileptic
Obese (Body mass >30)
HIV+ taking co-trimoxazole
Sickle cell anaemia or thalassemia trait
Coeliac disease
High risk groups for pre-eclampsia
Hypertensive disease during previous pregnancy
Chronic kidney disease
Autoimmune disease eg SLE/Anti-phospholipid syndrome
Diabetes (T1 or T2)
Associated factors for placental abruption
Previous abruption Proteinuric HTN Advancing maternal age Cocaine use Multiparity Maternal trauma
Risk factors for shoulder dystocia
Macrosomia
High maternal BMI
Diabetes mellitus
Prolonged labour
Complications of placental abruption
Maternal: Shock DIC Renal failure PPH
Fetal:
IUGR
Hypoxia
Death
Features of congenital rubella syndrome
Chorioretinitis Sensorineural deafness Congenital cataracts Congenital heart disease eg PDA Growth retardation Hepatosplenomegaly Purpuric skin lesions Cerebral palsy Microphthalmia
Risk factors for premature ovarian failure
FH
Chemotherapy/radiation
Autoimmune disease