obstretic conditions Flashcards
tight glucose control is important in pregnancy why?
risk of spina bifida, malformation increases
Hba1c levels
<48 is good
what drives diabetes in pregnancy?
human placental lactogen and steroids
can insulin cross placenta?
no so high glucose can make a baby macrosomic
timeline of contacts in pregnancy
booking scan?
12 week
anomaly scan?
20 weeks
gestational diabetes when
24-28 weeks
GDM risk factors?
BMI>30
asian
previous baby 4.5kg
FHx
previous GDM
diagnostic? GDM
fasting glucose?
2-hour OGTT?
5,6,7,8
> 5.6 mmol/l
7.8 mmol/l
mx of GDM
diet and exercise
2nd : metformin
3rd line : insulin
4th line : glibenclamide
booking scan?
8-12 weeks
routine scan
16 weeks
primip only scan?
24-28 weeks
OGTT for those at risk of GDM
second routine scan?
28 weeks
primip second scan?
32 weeks
risk factors for pre eclampsia?
> 40
nulliparous
BMI>30
HTN
CKD
what is the OGTT
oral glucose tolerance test
75mg glucose
bloods checked
> 7.8mmol/l
16 week visit
hb levels?
> 110, if not why? check Fe,B12, folate
offer pertussis vaccine
and influenza
bp and proteinuria
25 week primp visit
symphysis - fundal height
BP+ proteinuria
if rhesus D- ?
offer first anti-D at 28 week scan
28 week scan?
SFH
BP+proteinuria
offer first anti-D
34 week scan
offer second anti d
SFH
36 week scan
bp +proteinuria
SFH
check presentation
give info on breastfeeding
newborn care
vit K
if breech presentation at 36 weeks?
offer ref external cephalic version
what is External cephalic version
manually rolled and push baby from breach to head down position
38 week visit
bp +proteinuria
sfh
give information on risk of pregnancies last 42 weeks
management for prolonged pregnancy?
membrane sweep
vaginal prostaglandins
when do you offer membrane sweep?
40 weeks PRIMP
41 week multiparous
Downs is HIgh
increased Hcg and inhibin
Edwars is HE is low
hcg and estradiol are both low
what is high in patau?
AFP
ectopic pregnancy location most common?
ampulla - pregnancy outside of uterus
traid of pre-eclampsia
htn
proteinuria
oedema
defn - pre eclampsia
when is it?
what is the blood pressure reading and what other sign?
new onset blood pressure >140/90 mmHg after 20 weeks of pregnancy
one or more of
proteinuria
renal insufficiency - creatinine
liver,
neuro- head
etc
management of pre eclampsia
oral labetalol
Nifidepine if asthmatic
delivery
post partum haemorrhage is defined as?
500ml of blood
shoulder dystocia most common complication?
brachial plexus injury
McRoberts manouvre?
legs up to abdo
suprapubic pressure
why does the McRoberts procedure help?
straightens what?
roating what?
this increases the diameter of what?
lumbosacral angle,
rotates the maternal pelvis towards
the mother’s head and
increases the relative anterior-posterior diameter of the pelvis
