Obstetrics S/S Flashcards
What are the cutaneous signs of pregnancy?
Linea nigra, striae gravidarum and striae albicans
What is the cause of linea nigra, melasma and darkening of nipples in pregnant women?
Due to increased melanocyte-stimulating hormone produced by the placenta
Where are the respective landmarks of the fundus of uterus felt on light palpation during pregnancy?
12 weeks gestation (1st trimester): At pubic symphysis
20 weeks gestation (2nd trimester): At umbilicus
36 weeks gestation (3rd trimester): At xiphoid process of sternum
What happens when amniorrhexis occurs?
When amniotic sac ruptures, production of prostaglandins increases and cushioning between the fetus and the uterus decreases. This triggers an increase in the frequency and intensity of contractions.
What are the symptoms of hyperemesis gravidarum?
Persistent vomiting, Weight loss of at least 5% of pre-pregnancy body weight, Dehydration and electrolyte imbalance, ketonuria.
When does nausea and vomiting due to being pregnant usually presents, and when will it resolve?
Nausea and vomiting due to pregnancy usually presents at between 4th and 7th week of gestation. It will resolve by around 20 weeks of gestation.
When will you, as the doctor, start thinking of other causes of N&V?
When the pregnant mother presents with signs of N&V only after 11 weeks of gestation.
What are the signs of dehydration?
Postural hypotension, tachycardia or dry mucous membranes
Why should metoclopramide be used as a second line treatment for hyperemesis?
Metoclopramide has the risk of extra-pyramidal side effects
What are the investigations done when Preterm Premature Rupture of Membrane is suspected?
Speculum vaginal examination: Pooling of fluid in the vagina confirms the diagnosis.
If there is no pooling of amniotic fluid, perform insulin-like growth factor binding protein-1 test or placental alpha-microglobulin-1 test of vaginal fluid. Positive for either is consistent with the woman having PPROM.
Nitrazine paper to test for alkalinity of fluid is not used to diagnose PPROM.
What is given to induce labour?
IV oxytocin or vaginal prostaglandin E2 gel
When is prophylactic Cervical Cerclage done?
What is an alternative option?
Prophylactic cervical cerclage is done to prevent preterm birth in women with short cervix.
Alternatively, women can choose to have prophylactic vaginal progesterone.
What are tocolytic medications? Give examples
Tocolytics are medications given to suppress contractions and prevent preterm labour.
Most commonly used tocolytic is Nifedipine, followed by oxytocin receptor antagonist - atosiban.
Terbutaline (betamimetic) - not recommended by NICE, Magnesium sulfate, or Indomethacin (for early preterm labour <30 weeks, or preterm labour associated with polyhydramnios) also have tocolytic properties.
What should be anticipated in women with Antepartum Haemorrhage?
Postpartum haemorrhage
What does the presence of meconium in the amniotic fluid be a sign of?
Presence of meconium in the amniotic fluid is a sign of fetal distress.
