Obstetrics Summary Flashcards
What is gravidity?
Number of pregnancies in total including any miscarriages or pregnancies lost before 24 weeks - including current pregnancy.
What is parity?
Number of potentially viable pregnancies beyond 24 weeks delivered - not including the current pregnancy - and including stillbirths and livebirths.
What is multiparous?
Delivered live or potentially viable babies >24 weeks gestation
What is nulliparous?
Never delivered a live or potentially viable baby >24 weeks gestation
What do you want to know in an obstetric history about pregnancies >24 weeks?
- Gestation - preterm labour
- Mode of delivery - SVD, assisted vaginal or CS
- Birth weight - a previous SGA increases risk of subsequent SGA
- Complications: pre-eclampsia, third/fourth degree tears, PPH
- Assisted reproductive therapies - ovulation induction with clomiphene, IVF
- Care providers - mid-wife led or obstetrician led
What do you want to know in an obstetric history for non-viable pregnancies (<24 weeks)?
- Gestation - early or late miscarriage
- Miscarriage management
- Termination management
- Identified causes of miscarriage/stillbirth - foetal anomaly
- If ectopic - the site and management
Which women need a higher dose of folic acid?
DOCTer NTDs
- Baby previously with NTD
- Have a NTD or their partner does
- FH of NTD
- Taking anti-epileptic medication
- Have diabetes
- Obesity BMI>30
- Have bowel disease
What is the dose for folic acid?
400 micrograms to be taken 3 months before conception and 3 months into pregnancy. Higher dose is 5mg.
What are high risk factors for pregnancy?
- Advanced maternal age >40
- Low maternal age <20
- Previous major surgery
- Medical history
- IVF treatment
- Previous CS
- Previous problems in pregnancy e.g. pre-eclampsia, growth restriction etc.
What are they key points for a pregnant abdomen examination?
- Ensure mother has emptied bladder before examination as it can add 2-3cm to measurement of symphysis-fundal height (SFH)
- The higher point of the uterus may not always be in the midline
- If height is inconsistent with normal growth chart, then refer mother for USS to determine foetal estimated weight
What are sensitising events?
- spontaneous miscarriage
- placental abruption
- traumatic events
What is done to prevent sensitising events?
- Prophylactic anti-D (1500iu dose): Given at 28 weeks & 34 weeks.
- Kleihauer-Betke test: Detects presence of foetal red cells in maternal circulation.
- If >5ml estimated, then another dose of anti-D needed.
- Baby’s blood is tested at birth.
What patients would you do screening for GDM?
- BMI >30
- Previous baby >4.5kg
- Previous GDM
- Family history (1stdegree)
- Ethnic origin–South Asian, black Caribbean, Middle Eastern
What is the target glucose ranges in pregnancy?
- For glucose monitoring in pregnancy, the aim is a fasting glucose of 3.5-5.5mmol/L (though NICE just says <5.5),and 1-hour post meal glucose<7.8 (TCD says <7.1, NICE says <7.8), pre-meal (or any other time) should be 4-7mmol/l
- Diagnosis of diabetes - fasting glucose>5.6, 2h post-GTT>7.8
How do you manage diabetes in pregnancy?
- Continue taking insulin and metformin in pregnancy
- Lifestyle factors
- 5mg folic acid OD
- Screening (retinopathy and nephropathy) if not carried out in last 6 months
- If urinary PCR ration >30mg/mmol and eGFR <45 refer to nephrologist
- If pre-existing diabetes - seek help if unwell or hyperglycaemia due to risk of DKA
- Aspirin 75mg OD (reduces pre-eclampsia risk) - start before 12 weeks and continue to birth
