Obstetrics student presentations Flashcards
What is the Edinburgh postnatal depression scale (EPDS)?
A 10 item self-questionnaire to identify who may need further assessment
Like the GAD score, but for women with babies
What is included in the postnatal review?
- In pain? need analgesia?
- Returning back to normal physiological state? Eg eating, drinking, bowel or bladder issues
- Take history
- VTE risk assessment
- Screen for mental health
When does the risk for VTE peak in obstetrics?
At delivery to 1 week after
What is the treatment for VTE in obstetrics?
LMWH
As it doesn’t cross the placenta and reduces risk of bleeding
- Should be continued till 6 weeks post partum or 3 months total
What are the risks with an epidural?
- Low BP
- Incontinence
- Itchy skin
- Nausea
- Headache
- Nerve damage
How can Hepatitis B be transmitted?
- Vertical (from mother to child)
- blood (sharing needles)
- Vaginal/anal intercourse
- Mother-to-child by breastfeeding with cracked/dry nipples (most common cause)
When should hepatitis be suspected in pregnant women?
Jaundice and abnormal LFT’s
- May be asymptomatic -
What are the symptoms of acute hepatitis?
- May be asymptomatic -
- Prodromal (2 weeks before jaundice)/: fever, arthralgia, or rash
- Non-specific: malaise, fatigue, nausea, poor appatitie
- Jaundice, with maybe dark urine and pale stool
What steps are taken if a baby is born to a hep B positive mothers?
- Routine screening for antigens and universal vaccine
- Immunoprophylaxis can be given (HBIG) and Hep B vaccine within 12 hours of birth
- Antivirals can be prescribed
What are the complications associated with obesity during pregnancy?
- Pre-eclampsia
- GDM
- High risk of operative delivery
- Difficulty in assessing fetal size, presentation and monitoring
- Risk of macrosomia and still birth in baby
What are the effects of substance misuse in pregnancy?
- Teratogenic
- Prematurity, low birth weight
- Infections
What is methadone used for?
- A man-made opioid that will cause feelings of relaxation and reduce pain, but it will not give you the same high or euphoric feeling as heroin
- It works in treating heroin addiction by reducing the withdrawal symptoms and cravings
What effect does alcohol have on the fetus?
Permanently kills brain cells to stop development
It’s the largest preventable cause of irreversible birth defects and developmental disabilities
What are the symptoms of fetal alcohol syndrome?
- CNS dysfunction
- Facial dysmorphology
- Pre and post-natal growth deficiency
- Lower IQ
- Learning disability/learning difficulties
- Poor coordination*
- Problems with memory, attention and judgment
- Hyperactivity and behavioural problems
How is VZV (chicken pox) transmitted?
Respiratory droplets and direct personal fluid
What is the presentation of chickenpox?
Fever
Malaise
Pruritic rash that crusts before healing
What are the complications caused by chicken pox during pregnancy?
Pneumonia
Hepatitis
Encephalitis
Death
What are the treatment options for VZV during pregnancy?
- Symptomatic treatment and hygiene
- Oral Aciclovir should be prescribed if they present within 24 hours of onset of rash
What are the risks of VZV infection during pregnancy?
- If infection occurs in last 2 weeks of pregnancy, there is significant varicella infection in new born
- Avoid delivery until at least 7 days since appearance of rash if possible
- Inform neonatologist
What is preterm labour?
Labour before 37 weeks gestation
- 8-10% of all deliveries -
What is the survival rate at 23 weeks gestation?
8%
What is the survival rate at 28 weeks gestation?
74%
an increase of 3% each day after that
What are the fetal issues of prematurity?
- Respiratory distress syndrome
- Necrotising enterocolitis
- Retinopathy of prematurity
- Sepsis
- Intraventricular haemorrhage
- Periventricular leucomalacia
- long-term cognitive and sensory impairment
What is Periventricular leucomalacia?
A type of brain injury most common in premature babies
The white matter (leuko) surrounding the ventricles of the brain (periventricular) is deprived of blood and oxygen leading to softening (malacia)
What are the risk factors for premature birth?
- Previous preterm delivery
- Previous preterm prelabour rupture of membranes (PPROM)
- Mid-trimester pregnancy loss
- Congenital uterine anomalies
- Multiple pregnancy
- Vaginal bleeding
- Short cervix
- Previous multiple LLETZ of the cervix or cone biopsy
What is meant by a short cervix?
One that is less than 25mm (2.5cm) long at around 20 weeks of pregnancy
What is LLETZ?
AKA large loop excision of the transformation zone
Treatment to remove cell changes (abnormal cells) in the cervix
What are some methods of preventing pre-term labour?
1.Treatment of infection
2. cervical cerclage (sewing cervix shut with stitches)
3.Tocolysis (medical treatment to stop preterm contractions)
Which medications are used in tocolysis?
- Betamimetics (such as terbutaline)
- Magnesium sulphate
- Prostaglandin inhibitors (like indomethacin, ketorolac)
- Calcium channel blockers (nifedipine)
- Nitrates (like nitroglycerine)
- Oxytocin receptor blockers (like atosiban)
How is preterm labour diagnosed?
Abdominal and pelvic examination of the woman and assessment of uterine activity
What % of women will go into labour 24hours after PROM?
60%
What is PROM?
Premature rupture of membranes
What are the risk factors for PROM?
- Infections
- Smoking
- Previous pre-term delivery
- Vaginal bleeding
- Polyhydramnios
- Multiple gestation
- Cervical insufficiency
- Chorioamnionitis
What is Chorioamnionitis?
Infection of placenta and amniotic fluid
- Often happens when the amniotic sac is broken for a long time
What is the amnisure test?
Test strip test for the detection of the placental alpha microglobulin-1 protein (PAMG-1)
Used to help diagnose ruptured membranes in patients presenting with signs and symptoms of PROM
- False positive if done after vaginal examination or if there is significant vaginal bleeding
What is P-PROM?
Preterm premature rupture of the membranes
What are the degrees of post-partum haemorrhage?
Minor PPH: 500-1000ml blood loss without clinical signs of shock
Major PPH: >1000ml blood loss, or <1000ml visible blood loss with clinical signs of shock
Massive Obstetric Haemorrhage: >2500mls or requiring 5units of blood transfusion
What is the difference between primary and secondary post-partum haemorrhage?
Primary: within 24hours of delivery
Secondary: 24hours to 12 weeks post-delivery
What are the risk factors for post-partum haemorrhage?
- Previous PPH
- Multiparity
- Overdistension of the uterus (polyhydramnios/macrosomia/multiple pregnancy)
- Clotting disorders
- Antepartum haemorrhage
- Placenta praevia
- Prolonged labour
- Operative birth or caesarean section, episiotomy
- Induction of labour
- General anaesthesia, magnesium sulphate, or nifedipine
What are the causes of post-partum haemorrhage?
- Tone (most common)
- Trauma to uterus
- Thrombin (coagulation disorder)
- Tissue preventing contraction
Which medications are given to help the uterus to contract?
Oxytocin, Ergometrine, Carboprost, or Misoprostol
