Pathology (mainly O) Flashcards
1
Q
In what groups is maternal death more common?
A
older women, black women and women who live in deprived areas
2
Q
What are the most common causes of maternal death?
A
cardiac disease, suicide, thrombosis, sepsis and neurological issues
3
Q
What is the increased risk of VTE in pregnancy?
A
4-6x in pregnancy
4
Q
What is used for VTE risk?
A
LMWH or warfarin (never in pregnancy but okay in breastfeeding)
5
Q
What condition can cause recurrent pregnancy loss?
A
- Antiphospholipid syndrome due to antibodies
- treated with aspirin and LMWH
6
Q
What is done for seizure in labour?
A
benzodiazepines
7
Q
What is the most teratogenic drug?
A
sodium valproate
8
Q
What can obesity cause in pregnancy?
A
- infertility
- miscarriage
- fetal anomalies (spina bifida and neural tube defects)
- GDM
- increase in operative delivery
- haemorrhage
9
Q
What is classed as large for dates?
A
symphyseal-fundal height >2cm for gestational age
10
Q
What are the main causes of large for dates?
A
- wrong dates
- fetal macrosomia
- polyhydramnios
- diabetes
- multiple pregnancy
- obesity
11
Q
What is fetal macrosomia?
A
- big baby
- US showing weight >90th centile or AC >97th centile
- can cause labour or shoulder dystocia and increases risk of PPH
12
Q
How is fetal macrosomia managed?
A
- exclude diabetes
- if baby is seemed to be more than 5kg then C section
13
Q
What are the possibilities for chorionicity and amnionicity in monozygotic twins?
A
- MCMA (8-14w cleavage)
- MCDA (4-7w cleavage)
- DCDA (0-3 cleavage)
14
Q
How can the number of placentas be seen on US?
A
- lambda sign is two
- T sign is one
15
Q
What are the complications of multiple pregnancies?
A
- high fetal mortality
- congenital anomalies
- preterm birth
- growth restriction
- cerebral palsy
- twin to twin transfusion
- preeclampsia
- hyperemesis gravidarum
- anaemia
- preterm labour
- C section
16
Q
What is management of multiple pregnancies?
A
- low dose aspirin, Fe and folic acid
- USS more: 2 weekly for MC and 4 weekly for DC
17
Q
How are multiple pregnancies delivered?
A
- MCDA twins are delivered at 36w with steroids
- MCMA C
- triplets or more is C
18
Q
Why is there a higher risk of DKA in pregnancy?
A
it increases insulin requirements so diabetes and N+V more likely to cause DKA
19
Q
What are the complications of poorly controlled diabetes in pregnancy?
A
- anomalies
- miscarriage
- IUD
- hypod and hypers
- DKA risk increased
- worsening complications from DM
20
Q
What is ideal for diabetes in pregnancy?
A
- HbA1c should be 48
- medication review before conception
- high dose folic acid
- education
21
Q
What is a baby that is small for gestational age?
A
birth weight below 10th centile for gender
22
Q
How is small for age measured in pregnancy?
A
abdominal circumference
23
Q
What is a low birth weight?
A
below 2.5kg
24
Q
What is fetal growth restriction?
A
failure to achieve genetic potential for growth so there is a pathological restriction
25
What are causes of small for gestational age?
- placental (infarcts, abruption, secondary to hypertension so preeclampsia)
- fetal (infection, congenital or chromosomal)
- maternal (lifestyle, height/weight, age and maternal disease)
26
What are the risks for SGA and FGR?
increase risk of stillbirth, perinatal morbidity and mortality and iatrogenic preterm birth
27
What is done for the identification of SGA and FGR?
- symphysis-fundal height chart
- diagnose with US abdominal circumference
- calculation of EFW
28
What can cause SGA?
resistance in the uterine artery which can be measured with a Doppler
29
What is the treatment for SGA?
treat those with RF for preeclampsia or uterine artery notching with 150mg aspirin
30
What is a normal finding on uterine artery dipper?
this measures placental resistance and there should always be forward flow to the fetus even in diastole
31
What are the ways to measure how much blood the foetus is getting?
- uterine artery doppler
- middle cerebral artery doppler
- ductus venosus doppler
32
When do you deliver SGA babies?
- <3rd centile deliver from 37w
- 3rd-10th deliver at 39w even if normal trajectory
- for early deliver give steroids (before 36w) and magnesium sulphate (before 32w)
33
Which drug doesn't cross the placenta?
LMWH
34
When is the time of greatest teratogenic risk with drugs?
1st trimester especially 4th-11th week as this is the time of organogenesis
35
What is the effects of teratogenic drugs later in pregnancy?
intellectual and behavioural abnormalities
36
What is the treatment for epilepsy in pregnancy?
(seizures can get more frequent)
- monotherapy
- avoid valproate and phenytoin
- give higher dose of folic acid
37
What is the treatment for diabetes in pregnancy?
insulin is safe but sulphonylureas aren’t
38
What is the treatment for hypertension in pregnancy?
- give labetalol, methyldopa or nifedipine
| - avoid ACEi and ARB
39
What is the treatment for N+V, pain and heartburn in pregnancy?
- N and V use cyclizine
- pain give paracetamol
- heartburn give antacids
40
What is given for PE or DVT in pregnancy?
LMWH
| warfarin is teratogenic in early pregnancy and causes bleeding in later pregnancy
41
What does phenytoin cause when given in pregnancy?
cleft lip and palate
42
What does tetracycline cause when given in pregnancy?
discolours teeth
43
What does stilbestrol cause when given in pregnancy?
vaginal adenocarcinoma in child
44
What does sodium valproate cause when given in pregnancy?
neural tube defects such as spina bifida and anencephaly
45
What are the types of malpresentation?
when the vertex isn't presenting eg breech, shoulder, brow
46
What is complete breech vs frank breech vs footling breech?
- complete breech=legs folded down at baby’s bottom
- footling breech=one or both feet down
- frank breech=legs pointing up with feet at baby’s head so bottom first
47
What is normal delivery position?
longitudinal with flexion to LOA to OA with extension
48
What is given to women who can't have regional anaesthesia?
IV Remifentanil is good for short sharp burst of pain
49
What are the complications of epidural?
- hypotension (due to vasodilation)
- dural puncture
- atonic bladder
- high block (can cause breathing problems)
- headache
50
What are the risks with obstructed labour?
```
sepsis
uterine rupture
obstructed AKI
postpartum haemorrhage
fetal asphyxia
neonatal sepsis
```
51
What is delay for nulliparous women?
<2cm dilation in 4 hours is delay
52
What are the possible reasons for failure to progress?
- powers so inadequate contractions
- passages so pelvis
- passenger so big baby or malposition
53
What is a partogram?
graphic presentation of the progress of labour including fetal HR, amniotic fluid, cervical dilation, descent, contractions, moulding/obstruction and maternal obs
54
How is intrapartum fatal assessment done?
- Doppler auscultation every 15 minutes during and after contraction and in stage 2 every 5 minutes for a whole minute
- CTG
- colour of amniotic fluid
55
What are the RF for feral hypoxia?
```
small fetus
preterm/post dates
pre-eclampsia
diabetes
antepartum haemorrhage
meconium
epidural analgesia (causing hypotension)
sepsis
```
56
What are the causes of fatal hypoxia?
- uterine hyperstimulation
- abruption
- cord prolapse
- uterine rupture
- feto-maternal haemorrhage
- regional anaesthesia
- chronic causes include placental insufficiency and fetal anaemia
57
What is a normal HR for a foetus?
110-150bpm
58
What are accelerations and decelerations on CTG?
- Accelerations are a good sign as the fetus is moving
- Decelerations- early are common as head moves through pelvis, late is when the HR decreases after peak of contraction with lowest point after which is associated with lack of oxygen
59
How is fetal hypoxia seen on CTG?
- loss of accelerations
- persistent deeper and wider decelerations
- loss of variability
- rising fetal baseline HR
60
What is the pneumonic DR C BRAVADO?
determine, risk, contractions, baseline, rate, variability, accelerations, decelerations, overall impression
61
What is management of an abnormal CTG?
- move mother
- IV fluids
- stop syntocinon
- scalp stimulation
- consider tocolysis
- maternal assessment
62
What are the main indications for CS?
- previous CS
- fetal distress
- failure to progress in labour
- breech
- maternal request
63
What is the first sign of maternal unwellness?
tachypnoea with BP changing last due to compensation
64
What are the 2Cs added to the 4Hs and 4Ts?
eclampsia
| intracerebral bleed
65
What positions are essential in pregnancy ABCDE?
- left lateral position if collapsed and breathing
| - if not breathing, do supine left uterine displacement
66
What are the reasons that its more difficult to resuscitate a pregnant woman?
- aortocaval compression (gravid uterus compresses IVC and aorta)
- pressure on diaphragm
- fetal o2 consumption
- aspiration
- difficulties intubating
67
When should a baby be delivered in maternal CPR?
5 minutes with CPR continuing throughout
68
What drugs are given in maternal ALS?
- Adrenaline 1mg after every 3rd shock then every over cycle (every 4 mins)
- Amiodarone 300mg after 3rd shock
69
What are the common reversal drugs?
- Opiate overdose is reversed with naloxone
- Magnesium toxicity is reversed with calcium gluconate
- Local anaesthetic toxicity is reversed with intralipid
70
What is amniotic fluid embolism?
- amniotic fluid enters the maternal circulation
- collapse with fetal distress
- rare with a high mortality
71
What are the features of cord prolapse?
- obstetric emergency associated with malpresentation
- preterm labour
- 2nd twin
- artificial membrane rupture
- needs immediate delivery
72
What are the red flags for mental health issues in mothers?
- recent change in mental state or new symptoms
- new thoughts of violent self harm
- new expressions of incompetency as a mother
- estrangement from baby
73
When is admission to mother and baby unit required?
- rapid changing mental state
- suicidal ideation
- estrangement from infant
- pervasive guilt
- belief of inadequacy as a mother
- evidence of psychosis
74
What happens if a women gets pregnant on a teratogenic drug?
if not stopped early enough maybe don’t need to be stopped as it’s too late and there are risks of stopping medication abruptly
75
What is safe to give for depression in pregnancy?
- SSRIs are first line
- sertraline is least likely to pass into placenta
- fluoxetine is safer as its older
- tricyclics are safe
- stay on treatment during and after pregnancy
- paroxetine isn’t good
76
What is safe to give for anti-psycotics in pregnancy?
- safe but low risk of GDM and reduced fertility (due to raised prolactin)
- with 2nd gen, olanzapine and quetiapine are the best
- avoid clozapine (agranulocytosis)
77
What mood stabiliser is the best in pregnancy?
- none are completely safe
- valproate (neural tube defects) is a nogo and carbamazepine too
- lamotrigine is less bad
- lithium is a probably not (cardiac abnormality) but can be reduced gradually preconception and then increased later on in pregnancy
78
What is the aim for bipolar treatment in pregnancy?
switch to a safer antipsychotic eg quetiapine
79
What is the treatment of anxiety in pregnancy?
- benzodiazepines can cause floppy baby in 3rd trim so avoid
| - SSRIs can be used
80
What should never be taken while breastfeeding?
lithium
81
What does alcohol in pregnancy carry a risk of?
- miscarriage
- foetal alcohol syndrome (facial deformity, lower IQ, epilepsy, hearing issues, heart and kidney defects)
- withdrawal
- risk of maternal Wernicke’s or Korsakoff
82
What do illicit drugs in pregnancy cause?
- teratogenic
- cause abruption and preeclampsia
- miscarriage
- preterm labour
83
Which mental health issue tends to get better in pregnancy?
eating disorders
84
What are the features of rubella infection?
- direct contact or respiratory droplets
- presents with fever, maculopapular rash, lymph nodes and polyarthritis
- screening (IgG antibody from vaccine), supportive treatment, rest, fluids
85
What can rubella do in pregnancy?
- miscarriage and still birth
- birth defects
- triad of cataract, cardiac abnormalities (PDA) and deafness in the fetus
- risk is highest earlier in pregnancy
86
What are the features of measles infection?
- caused by paramyxovirus
- causes fever, white spots on the inside of the mouth, runny nose, cough, red eyes and a rash
- rash appears on the forehead to begin with and then spreads down
87
What can measles do in pregnancy?
- not teratogenic but a high fever can cause microcephaly, IUGR and stillbirth or preterm birth
- bring down fever and watch for secondary complications
88
What is the treatment of chicken pox in pregnancy?
supportive management with antihistamines and consider acyclovir after 20w
89
What is congenital varicella syndrome?
- chicken pox virus passes through placenta
- refer to fetal medicine
- can be hypoplasia of limbs, IUGR, retinal scarring, cataracts and microcephaly
90
What can cytomegalovirus cause in pregnancy?
- caused by herpes virus group
| - causes miscarriage, permanent hearing impairment, microcephaly, visual impairment, IUGR, liver/lung/spleen issues
91
What is different about CMV infections in pregnancy compared to other infections?
risk of abnormalities is higher the further into the pregnancy the infection is
92
What is CMV in pregnancy treated with?
valacyclovir
93
What can parvovirus in pregnancy cause?
aplastic anemia
congenital HF
hydrops
fetal death
94
What vaccine can't be given in pregnancy?
MMR as it is live
95
What can Zika virus cause in pregnancy?
- serious birth defects including microcephaly
- brain defects
- problems with hearing and vision
- limited movements, muscle tone issues and seizures
96
What should be done for HIV in pregnancy with high viral load?
C sections which decreases risk of transmission by 50% (give zidovudine infusion before)
97
What is sepsis?
life-threatening organ dysfunction caused by the body’s response to infection
98
What are the signs of sepsis?
- tachycardia
- high or low temp
- raised RR
- hypotension
- low O2 sats
- poor peripheral perfusion
- skin clamminess
- confusion
- rash or mottled skin
99
What can toxoplasmosis cause in pregnancy?
hydrocephalus, chorioretinitis, cerebral calcifications and mental retardation
100
What can be given for toxoplasmosis in pregnancy?
PO spiramycin to reduce risk of transmission to fetus
101
How is maternal listeriosis treated?
ampicillin and gentamicin (high risk of perinatal mortality)
102
What is given during labour in GBS infection?
penicillin
103
How long does it take the cervix to close after birth?
10d
104
How long do maternal obs changes last?
- CO and plasma volume in a week
- BP goes down in 6w
- oedema for up to 6w
105
What are abnormal vaginal/labial tears?
- 3rd degree involving the internal anal sphincter
| - 4th degree involving anal or rectal mucosa
106
What do you given for RF for VTE?
- low give fluids and movement
- mod give 10 days prophylactic LMWH
- high give LMWH 6w
107
When can ovulation occur after giving birth?
within 4w
108
When can fistulas be formed in labour?
prolonged obstructed labor leading to necrosis
109
What is treated by phyios in O+G?
- bladder and bowel dysfunction
- prolapse
- vulvodynia
- back pain
- pelvic girdle pain
- DRAM (linea alba stretching and doming)
- carpal tunnel
110
What is the treatment of pelvic floor dysfunction?
- healthy BMI
- smoking cessation
- avoid constipation
- avoid heavy lifting
- reduce caffeine
- pelvic floor exercises involving long and short holds
