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3A > Obstetrics - Maternal conditions in pregnancy > Flashcards

Obstetrics - Maternal conditions in pregnancy Flashcards

1
Q

HTN in pregnancy

A

Pre-existing < 20 weeks
Gestational > 20 weeks

Pre-eclampsia > 20 weeks

  • HTN
  • Proteinuria

Eclampsia

  • Pre-eclampsia
  • Generalised TC seizures
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2
Q

Pre-eclampsia definition

A

AFTER 20 weeks

HTN
Proteinuria

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3
Q

Pre-eclampsia RFs

A 
Previous HTN in pregnancy
CKD 
AI disease 
DM 
Chronic HTN
Family Hx
1st pregnancy 
> 40 
> 10 years between pregnancies 
BMI > 35 
Multiple pregnancy
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4
Q

Pre-eclampsia pathophysiology

A

Abnormal invasion of spiral arteries
Increased resistance
Release of inflammatory cytokines
= HTN

Failure of spiral arteries to convert to vascular sinuses

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5
Q

Pre-eclampsia diagnosis

A

HTN > 140/90
Proteinuria > 0.3g / 24 hours

Mild/moderate < 160/110
Severe > 160/110 + Complications

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6
Q

Pre-eclampsia symptoms

A

Headaches
Visual disturbances
Papilloedema

Ankle clonus
Hyperreflexia

RUQ pain

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7
Q

Pre-eclampsia management

A

Labetalol

Nifedipine
Hydralazine

Aspirin if high risk

Delivery < 38 weeks!

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8
Q

Pre-eclampsia maternal complications

A

Eclampsia
HELLP syndrome

Pulmonary oedema
CV haemorrhage

Liver failure
Renal failure

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9
Q

Pre-eclampsia foetal complications

A 
IUGR
Premature delivery 
Placental abruption
Oligohydramnios 
Foetal distress
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10
Q

Pre-eclampsia indications for delivery

A

> 38 weeks
Platelets < 100,000
Progressive LFTs
Eclampsia

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11
Q

Eclampsia

A

Pre-eclampsia + TC seizures

Management - Deliver!

IV magnesium sulphate - Prevent seizures

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12
Q

Normal BP in pregnancy

A

Falls in first trimester

20-24 weeks - Starts to increase

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13
Q

Pre-eclampsia RFs - Take 2

A

NOPE 2 FAT

Nulliparity
Obesity
Previous HTN in pregnancy
Extremes of age

2 - DM2

Family Hx
AI disease - Antiphospholipids
Twins

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14
Q

HELLP syndrome

A

Coagulation cascade activation

Haemolysis 
Elevated 
Liver enzymes 
Low 
Platelets
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15
Q

HELLP syndrome presentation

A

N/V
RUQ pain
Lethargy

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16
Q

HELLP syndrome management

A

Delivery!

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17
Q

Maternal diabetes screening and diagnosis

A

OGTT

  • Booking visit
  • 24-28 weeks

Fasting > 5.6
Random > 7.8

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18
Q

Maternal diabetes RFs

A

South Asian
Mediterranean
Afrocaribbean

BMI > 30

First degree relative
Previous DM
Previous macrosomic baby

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19
Q

Gestational diabetes management

A

First 2 weeks - Diet and exercise

No change - Give METFORMIN

Fasting > 7 - GIVE INSULIN

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20
Q

Gestational DM monitoring

A

Serial USS every 2-4 weeks

Fetal echo at 20 weeks

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21
Q

Pre-existing DM management

A

Pre-conception - Folic acid

Stop oral meds - Except metformin

Continue insulin if required

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22
Q

DM maternal complications

A

Prematurity
PPH
Polyhydramnios

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23
Q

DM foetal complications

A

IUGR
Macrosomia
Shoulder dystocia
Comorbidities

Defects

  • NTD
  • CHD
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24
Q

Baby blues

A

Peaks at 5th day
Subsides within 5 days

Tearful
Anxious

Management

  • Monitor and reassure
  • CBT
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25
Q

Post-partum depression presentation

A

Onset - 1 month!
Peak - 3 months

Depression
Uninterested in baby
Guilt and anger
Thoughts of harming the baby

26
Q

Post-partum depression investigations and management

A

Edinburgh screening test

CBT
Paroxetine

27
Q

Post-partum psychosis

A

Onset - 2-3 weeks

Manic
Depression
Schizophrenia

Management - Admit

28
Q

Rhesus disease conditions

A

Mother is Rh NEGATIVE

Baby is Rh POSITIVE

29
Q

Rhesus disease pathophysiology

A

1st pregnancy - Sensitisation

  • Foetal blood crosses into maternal circulation
  • Maternal immune response to Rh +ve antigens
  • IgM produced CANNOT CROSS PLACENTA

2nd pregnancy - Re-exposure

  • Memory B-cells produce rapid response IgG
  • IgG crosses into foetal circulation
  • Haemolysis of foetal RBCs
  • Foetal hydrops
30
Q

Rhesus disease testing

A

Maternal blood test at booking visit - 28 and 34 weeks

Assessment of foetal anaemia

  • MCA doppler
  • Foetal blood sampling

Kleinbauer test
- Measures amount o foetal Hb transferred to mother’s bloodstream

Babies born to Rh -ve mother should have cord blood sampled at delivery
- Coombs test demonstrates antibodies on RBCs of baby

31
Q

Rhesus disease prevention

A

Anti-D Ig

Give to non-sensitised mothers at 28 and 34 weeks

32
Q

Rhesus disease sensitising events

A 
ToP
Miscarriage > 12 weeks 
Ectopic
APH  
Blunt abdo trauma

Surgery

Foetal blood sampling
Amniocentesis
Chorionic villous sampling

External cephalic version
Delivery

33
Q

Rhesus disease affected foetus

A 
Oedema - Hydrops fetalis 
Jaundice 
Anaemia 
Hepatosplenomegaly 
HF 
Kernicterus
34
Q

Rhesus disease - Treatment of affected foetus

A

Transfusion

UV phototherapy

35
Q

Chorioamnionitis

A

Bacterial infection of amniotic fluid, membranes or placenta

Emergency!
5% of pregnancies

36
Q

Chorioamnitis RFs and presentation

A

RFs

  • Preterm premature ROM
  • ARM

Presentation

  • Uterine tenderness
  • ROM - Foul odour
  • Signs of maternal infection
37
Q

Group B strep RFs

A

Previous infection - 50% risk
Premature ROM
Premature delivery
Maternal pyrexia

38
Q

Group B strep investigations and management

A

Swab @ 35-37 weeks

SEPSIS 6

Prophylactic ben pen if…

  • Previous GBS
  • Maternal pyrexia > 38
  • Preterm labour
39
Q

VTE RFs

A

Previous VTE
Pre-eclampsia
Multiple pregnancy
CS

+ many many more

40
Q

VTE investigations and management

A

D-dimer

?DVT - USS

?PE - ECG + CTPA

LMWH
- 28 weeks to 6 weeks post-natal
Compression stockings

41
Q

Anaemia in pregnancy

A

First trimester < 110
2nd/3rd trimester < 105
Post-partum < 100

42
Q

Anaemia in pregnancy screening and management

A

Booking + 28 weeks

Ferrous sulphate

43
Q

Anaemia in pregnancy complications

A

Iron deficiency

  • Pre-term
  • Low birth weight

Folate deficiency - NTD

44
Q

Amniotic fluids embolism aetiology

A

Age ^

Induction of labour

45
Q

Amniotic fluid embolism presentation

A

During labour or immediately postpartum

Cyanosis
SOB
Sweating
Coughing

Tachycardia
Tachypnoea
Hypotension
Shivering

46
Q

Amniotic fluid embolism management

A

MDT
Supportive

Pulmonary artery catheterisation

47
Q

Teratogenic drugs

A

Warfarin - Skeletal
ACE - Growth retardation
SSRI - CHD + PPHTN
Vitamin A - Cleft palate

AEDs
NSAIDS

48
Q

Teratogenic infections

A

CHRiST

CMV - Hearing, growth, skin 
Herpes - Herpes infantum
Rubella - CHD, deafness
SOFT CHEESE - Listeria - Meningitis
Toxoplasmosis - Cerebral calcification
49
Q

Polyhydramnios definition and aetiology

A

Pools of liquor > 10cm

Idiopathic
Multiple pregnancy

Foetal anomaly

  • Impaired swalling
  • Renal problems

Maternal

  • DM
  • Renal
50
Q

Polyhydramnios clinical features

A

Taut uterus
Foetus difficult to palpate
Large for date

51
Q

Polyhydramnios investigations and management

A

USS

< 34 weeks + Severe
- Amnioreduction

52
Q

Polyhydramnios complications

A

Premature delivery

Abnormal lie

53
Q

Oligohydramnios

A

< 500ml at 32-36 weeks

Aetiology

  • PROM
  • Post-date
  • Pre-eclampsia
  • Foetal renal problem
  • IUGR
54
Q

Intrahepatic cholestasis

A

Itching of soles and palms

Risk of preterm delivery and stillborn

Induce labour at 37 weeks
Ursodeoxycholic acid

Vitamin K - Prevent PPH

55
Q

Mastitis

A

Can continue breast feeding

Flucloxacillin > 24 hours

Complications - Abscess

56
Q

Galactocele

A

Occurs when woman stops breastfeeding

Painless
No systemic signs
No erythema

Leave alone

57
Q

Engorgement

A

Bilateral

Pain and discomfort
Worse just before a feed

Fever
Red breast

Poor milk flow

Expression of milk relieves discomfort

58
Q

Suppressing lactation

A

Stop feeding - Reduce reflex

Supportive bra
Analgesia

Cabergoline - Suppresses prolactin release

59
Q

Maternal complications

Pre-eclampsia

vs

GDM

A

Pre-eclampsia

  • Eclampsia
  • HELLP
  • CV accident
  • Liver failure
  • Renal failure
  • Pulmonary oedema

GDM - PPH

60
Q

Foetal complications

Pre-eclampsia

vs

GDM

A

Pre-eclampsia

  • IUGR
  • Premature
  • Placental abruption
  • Foetal distress
  • Oligohydramnios

GDM

  • IUGR
  • Macrosomia
  • Shoulder dystocia
  • NTD
  • CHD
  • Polyhydramnios
  • Premature

3A (31 decks)

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