Obstetrics Flashcards
What percentage of all pregnancies are ectopic?
0.5%
Risk factors for ectopic pregnancy:
- damage to tubes (salpingitis, surgery)
- previous ectopic
- IVF (3%)
Typical history of female with ectopic pregnancy:
- 6-9 weeks amenorrhoea
- lower abdominal pain
- peritoneal bleeding can cause shoulder tip pain and pain on defecation/urination
What suggests a threatened miscarriage?
- painless bleeding before 24 weeks (typically 6-9 weeks)
- cervical os closed
- complicates up to 25% pregnancies
What suggests a missed (delayed) miscarriage?
- gestational sac which contains dead foetus before 20 weeks without symptoms of expulsion
- light bleeding an discharge
- may have blighted ovum or anembryonic pregnancy
What is a blighted ovum/anembryonic pregnancy?
- gestational sac >25mm
- no embryonic/foetal part seen
What suggests an inevitable miscarriage?
- cervical os open
- heavy bleeding with clots and pain
What suggests an incomplete miscarriage?
not all products of conception have been expelled
What is placental abruption?
- separation of normally sited placenta from uterine wall
- maternal haemorrhage into intervening space
- 1 in 200 pregnancies
Features of placental abruption:
- shock out of keeping with visible loss
- pain constant
- tender, tense uterus
- normal lie and presentation
- foetal heart: absent/distressed
- coagulation problems
- beware pre-eclampsia, DIC< anuria
What is symphysis pubis dysfunction?
- ligament laxity increases in response to hormonal changes of pregnancy
- pain over pubic symphysis with radiation to groin and medial aspect of thighs
- waddling gait may be seen
What is uterine rupture?
- typically during labour but can occur during third trimester
- risk factor: previous caesarean section
- presents with maternal shock, abdominal pain and bleeding
What is the pain of pre-eclampsia/HELLP syndrome typically like?
epigastric or RUQ
What is the most common non-obstetric surgical emergency in pregnancy?
appendicitis
What is the risk of UTI in pregnancy?
- 1 in 25 women develop
- associated with increased risk pre term delivery and IUGR
What is increased AFP a sign of in pregnancy?
- neural tube defects (meningocele, myelomeningocele and anencephaly)
- abdominal wall defects (omphalocele and gastroschisis)
- multiple pregnancy
What is decreased AFP a sign of in pregnancy?
- Down’s
- Trisomy 18
- maternal diabetes mellitus
What is an amniotic fluid embolism?
- foetal cells/amniotic fluid enters the mother’s bloodstream and stimulates ra reaction
- majority in labour
- chills, shivering, sweating, anxiety and coughing
- cyanosis, hypotension, bronchospasm, tachycardia, arrhythmias, MI
What nutritional supplements are advised in pregnancy?
- folic acid 400mcg from before conception until 12 weeks
- vitamin D 10 micrograms per day
Which vitamin supplement can be teratogenic?
- vitamin A
- above 700 micrograms
Air travel during pregnancy:
- women >37 weeks with singleton pregnancy and no risk factors should avoid
- uncomplicated, multiple pregnancies avoid once >32 weeks
- increased risk VTE
Visits at 8-12 weeks gestation:
- booking visit: general info, BP, urine dipstick, BMI
- booking bloods/urine: FBC, blood group, rhesus, red cell all-antibodies, haemoglobinopathies, hepatitis B, syphilis, HIV, urine culture to detect asymptomatic bacteriuria
Visit at 10-13+6 weeks:
- early scan to confirm dates
- exclude multiple pregnancy
Visit at 11-13+6 weeks:
Down’s syndrome screening including nuchal scan
Visit at 16 weeks:
information on anomaly and blood results - if Hb <11g/dl consider iron (routine care: BP and urine dip)
Visit at 18-20+6 weeks:
anomaly scan
Visit at 25 weeks:
- only if primip
- routine care: BP, urine dipstick, symphysis fundal height
Visit at 28 weeks:
- routine care: BP, urine dip, SFH
- second screen for anaemia and atypical red cell alloantibodies
- if Hb <10.5g/dL consider iron
- first dose of antiD prophylaxis to rhesus negative women
Visit at 31 weeks:
routine care
Visit at 34 weeks:
- routine care
- check presentation - offer external cephalic version if indicated
- information breast feeding, vit K etc.
Visit at 38 weeks:
routine care
Visit at 40 weeks:
- only if primip
- routine care
- options for prolonged pregnancy
Visit at 41 weeks:
- routine care
- discuss labour plans and possibility of induction
Conditions which all pregnant women should be offered screening:
- anaemia
- bacteriuria
- blood group, rhesus status and anti-red cell antibodies
- Down’s
- foetal anomalies
- hep B
- HIV
- neural tube
- risk factors for pre-eclampsia
- syphilis
Which conditions should pregnant women be offered screening depending on history?
- placenta previa
- psychiatric illness
- sickle cell
- Tay Sachs
- Thalassaemia
What is antepartum haemorrhage?
bleeding from genital tract after 24 weeks pregnancy prior to delivery of foetus
How is placenta praevia different from placental abruption?
-shock in proportion to visible loss
-no pain
-uterus not tender
-lie and presentation may be abnormal
-foetal heart normal
-coagulation problems rare
-small bleeds before large
(placental abruption all opposite)
What is the Bishop score used for?
assess whether induction of labour is required
What factors are involved in the Bishop score?
-cervical position
-cervical consistency
-cervical effacement
-cervical dilation
-foetal station
<5 labour unlikely to start without induction
>9 labour most likely to commence spontaneously
