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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
Post-partum depression presentation
Onset - 1 month! Peak - 3 months Depression Uninterested in baby Guilt and anger Thoughts of harming the baby
26
Post-partum depression investigations and management
Edinburgh screening test CBT Paroxetine
27
Post-partum psychosis
Onset - 2-3 weeks Manic Depression Schizophrenia Management - Admit
28
Rhesus disease conditions
Mother is Rh NEGATIVE | Baby is Rh POSITIVE
29
Rhesus disease pathophysiology
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
Rhesus disease testing
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
Rhesus disease prevention
Anti-D Ig Give to non-sensitised mothers at 28 and 34 weeks
32
Rhesus disease sensitising events
``` ToP Miscarriage > 12 weeks Ectopic APH Blunt abdo trauma ``` Surgery Foetal blood sampling Amniocentesis Chorionic villous sampling External cephalic version Delivery
33
Rhesus disease affected foetus
``` Oedema - Hydrops fetalis Jaundice Anaemia Hepatosplenomegaly HF Kernicterus ```
34
Rhesus disease - Treatment of affected foetus
Transfusion UV phototherapy
35
Chorioamnionitis
Bacterial infection of amniotic fluid, membranes or placenta Emergency! 5% of pregnancies
36
Chorioamnitis RFs and presentation
RFs - Preterm premature ROM - ARM Presentation - Uterine tenderness - ROM - Foul odour - Signs of maternal infection
37
Group B strep RFs
Previous infection - 50% risk Premature ROM Premature delivery Maternal pyrexia
38
Group B strep investigations and management
Swab @ 35-37 weeks SEPSIS 6 Prophylactic ben pen if... - Previous GBS - Maternal pyrexia > 38 - Preterm labour
39
VTE RFs
Previous VTE Pre-eclampsia Multiple pregnancy CS + many many more
40
VTE investigations and management
D-dimer ?DVT - USS ?PE - ECG + CTPA LMWH - 28 weeks to 6 weeks post-natal Compression stockings
41
Anaemia in pregnancy
First trimester < 110 2nd/3rd trimester < 105 Post-partum < 100
42
Anaemia in pregnancy screening and management
Booking + 28 weeks Ferrous sulphate
43
Anaemia in pregnancy complications
Iron deficiency - Pre-term - Low birth weight Folate deficiency - NTD
44
Amniotic fluids embolism aetiology
Age ^ | Induction of labour
45
Amniotic fluid embolism presentation
During labour or immediately postpartum Cyanosis SOB Sweating Coughing Tachycardia Tachypnoea Hypotension Shivering
46
Amniotic fluid embolism management
MDT Supportive Pulmonary artery catheterisation
47
Teratogenic drugs
Warfarin - Skeletal ACE - Growth retardation SSRI - CHD + PPHTN Vitamin A - Cleft palate AEDs NSAIDS
48
Teratogenic infections
CHRiST ``` CMV - Hearing, growth, skin Herpes - Herpes infantum Rubella - CHD, deafness SOFT CHEESE - Listeria - Meningitis Toxoplasmosis - Cerebral calcification ```
49
Polyhydramnios definition and aetiology
Pools of liquor > 10cm Idiopathic Multiple pregnancy Foetal anomaly - Impaired swalling - Renal problems Maternal - DM - Renal
50
Polyhydramnios clinical features
Taut uterus Foetus difficult to palpate Large for date
51
Polyhydramnios investigations and management
USS < 34 weeks + Severe - Amnioreduction
52
Polyhydramnios complications
Premature delivery | Abnormal lie
53
Oligohydramnios
< 500ml at 32-36 weeks Aetiology - PROM - Post-date - Pre-eclampsia - Foetal renal problem - IUGR
54
Intrahepatic cholestasis
Itching of soles and palms Risk of preterm delivery and stillborn Induce labour at 37 weeks Ursodeoxycholic acid Vitamin K - Prevent PPH
55
Mastitis
Can continue breast feeding Flucloxacillin > 24 hours Complications - Abscess
56
Galactocele
Occurs when woman stops breastfeeding Painless No systemic signs No erythema Leave alone
57
Engorgement
Bilateral Pain and discomfort Worse just before a feed Fever Red breast Poor milk flow Expression of milk relieves discomfort
58
Suppressing lactation
Stop feeding - Reduce reflex Supportive bra Analgesia Cabergoline - Suppresses prolactin release
59
Maternal complications Pre-eclampsia vs GDM
Pre-eclampsia - Eclampsia - HELLP - CV accident - Liver failure - Renal failure - Pulmonary oedema GDM - PPH
60
Foetal complications Pre-eclampsia vs GDM
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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