Pregnancy Flashcards
What are the trimesters by weeks?
1st trimester- 0-13wks
2nd trimester- 13-28wks
3rd trimester- 28-40wks
What might a low serum progesterone indicate?
Ectopic pregnancy
Miscarriage
The fundus of a pregnant uterus is normally palpable for a singleton pregnancy at how many weeks gestation?
12wks
The trophoblast accomplishes implantation and develops ——–
Into fetal portions of the placenta
What do the timbre do?
Sweep ovum into oviduct, carried along by smooth muscle contraction and cilia
What day after fertilisation does the blastocyst attach to the lining of the uterus?
Day 5-8
When the free floating blastocyst adheres to the endometrial lining what penetrates the endometrium?
Cords of trophoblastic tissue
By what day is the blastocyst completely buried in the endometrium?
Day 12
What is the placenta derived of?
Trophoblastic and decimal tissue
From what week of pregnancy is the placenta functional?
Functional by the 5th week
Sole source of nutrients from week 6
What is the function of the placenta?
Hormone production Gas exchange Fetal homeostasis Nutrient transport to fetus Waste product transport to fetus Acid base balance Transport of IgG
What is the outermost fetal membrane around the embryo called?
Chorion
What allows trophoblastic nutrition for the first 4-12 weeks of pregnancy until placental diffusion happens?
The syncytiotrophoblasts invading decide and breaking down capillaries to form cavities filled with maternal blood
What does each placental villi contain?
Foetal capillaries
Progesterone stimulates decimal cells to concentrate —— ——-
Glycogen proteins and lipids
HCG signals the corpus lute to continue secreting ——
progesterone
Umbilical blood is O2 rich before the exchangeTRUE/FALSE
FALSE - maternal blood is o2 rich
In what vessel does the fetal O2 saturated blood return to the fetus?
Umbilical vein
The supply of the fetus with O2 is facilitated by which 3 factors?
Fetal Hb
Higher Hb
Bohr effect
In which trimester is high glucose needed?
3rd trimester
What are the two effects of HCG?
Prevents involution of corpus luteum
Effect on the testes of a male fetus- development of sex organs
From what week in pregnancy is human chorionic somatomammotropin produced?
From week 5 of pregnancy
What are the three effects of human chorionic sommatomammotropin?
Growth hormone like effects
Decreased insulin sensitivity in mother
Involved in breast development
What are the 3 effects of progesterone in pregnancy?
Development of decidual cells
Decreases uterus contractability
Preparation for lactation
What does the estriol level indicate?
Viability of fetus
3 effects of estradiol in pregnancy
Enlargement of uterus
Breast development
Relaxation of ligaments
What are the maternal cardiovascular adaptations to pregnancy?
CO–> Increases 6-24wks, decreased
HR–> Increased
BP–> Decreased, steady increase from 22wks
What hormone causes the respiratory maternal changes?
Progesterone
What are two problems that underweight women face when trying to get pregnant?
Reduced fertility
Hormone imbalance that affect ovulation
(Underweight women are more than 2x likely to take more than a year to get pregnant)
What are the risks for the baby if the mother is overweight?
Stillborn Metabolic abnormalities Defects High birth weight Diabetes Cardio-metabolic abnormalities
Why is reduced fetal growth associated with a number fo chronic conditions later in life?
This increased susceptibility is due to adaptations made by the foetus in an environment limited by its supply of nutrients
What is the dose of vitamin b (e.g. folic acid) given during pregnancy?
400ug (5mg if obese, diabetic or history of NTD)
What can vitamin D deficiency cause in the mother?
Gestational diabetes
Pre-eclampsia
Bacterial Vaginosis
What is the dose of vitamin d supplementation given?
10ug
How can the risk of iron deficiency be reduced?
iron supplementation -300mg
At risk if young age of first pregnancy
Have increased intervals between your births
TRUE/FALSE A high dose of vitamin A is teratogenic
TRUE
When breastfeeding how many extra calories do you need to have per day?
640
What is the anabolic and catabolic phase of pregnancy?
Anabolic- wk1-20
Catabolic- wk21-40
What is the average wt gain in pregnancy
24lbs (can be 75lbs)
What is the fat gain per day in the last 4 weeks of pregnancy?
7g per day
What are the vitamin supplements given as part of the healthy start scheme?
70mg VitC
10ug Vit D
400ug folic acid
What is the incidence of baby blues?
50% of women
How long does baby blues last?
3-10 days
self-limiting
What is the onset of postnatal depression?
2-6wks postnatally
What is the lifetime risk of depression in those with postnatal depression?
70%
How does postnatal depression present?
Lack of enjoyment Wt loss tearfullness Irritability Anxiety Poor sleep
When does puerperal psychosis present?
<2 weeks after delivery
How does early puerperal psychosis present?
Sleep disturbances, confusion and irrational ideas
How does puerperal psychosis present later?
Mania, delusions, hallucinations
What is the lowest risk SSRI?
Sertraline
Why should benzodiazepines be avoided?
1st trimester- fetal malformations
2nd trimester- floppy baby syndrome
3rd trimester- lethargy, wt loss and accumulation of drug
Why should clozapine be avoided in pregnancy?
Risk of agranulocytosis
What can lithium toxicity mimic?
PET
Lithium should be avoided in breastfeeding TRUE/FALSE
TRUE
All antipsychotics are excreted in breastmilk TRUE/FALSE
TRUE- monitor for signs of sedation/lethargy
What day does the neural tube close?
Day 28
Sodium valproate is dangerous in breastfeeding TRUE/FALSE
NA TIS GRAND
What is there a risk of if breastfeeding and on Lamotrigine?
Steven-Johnson syndrome
What are the 5 risks of alcoholism in pregnancy?
Miscarraige Fetal Alcohol Syndrome Withdrawl Wernicke's encephalopathy Korsakoff Syndrome
Heparin does not cross the placenta
TRUE
Why are ACEi/ARB teratogenic?
Renal hypoplasia
how is lithium teratogenic?
Cardiovascular defects
In pregnancy there is increased plasma volume and fat stores. IS THIS A LIE?
THIS IS TRUE
Therefore there is decreased protein binding and increased free drug
What is the period of greatest teratogenic risk?
4th-11th weeks
the risk of medication passing on in breast milk is usually similar to in utero TRUE/FALSE
FALSE
Milk exposure usually less than in utero
What is the safest drug for nausea and vomiting in pregnancy?
Cyclizine
What is the safest drugs for pregnancy women with UTI
Nitrofurantoin
In 3rd trimester Trimethoprim
If pain in pregnancy what is the best drug to use?
Paracetamol
If heartburn in pregnancy what is the best drug to use?
Antacids
What is fore milk rich in?
Protein rich
What is hing milk rich in?
Higher fat content
At what week is chorionic villus testing done?
12wks gestation
What is the miscarriage risk from chorionic villus testing?
1-2%
At what week gestation is amniocentesis testing done and where are the cells taken from?
15wks gestation
Skin/Urine cells
What is the miscarriage risk with amniocentesis testing?
0.5-1%
What is the difference between a mutation and a polymorphism?
Mutation- De-novo, bigger, affects known gene and previously reported in same phenotype
Polymorphism- Normal parent has it, smaller, “empty” genetic region and previously reported as a polymorphism
What is aCGH for?
Chromosome deletions/duplications
What is a robertsonian translocation?
Two acrocentric chromosomes stuck end to end
If there is a condition that is X-linked such as duchesses can do non-invasive fetal sexing at how many weeks?
8wks
if boy then invasive testing, if a girl then stop worrying
TRUE/FALSE
There is a slight risk of preterm labour if there is previous TOP
TRUE
What does the Fraser guidelines rate to?
The contraceptive and sexual health in under 16 year old
In order to meet gillick competence what 5 points must be met?
1-Understand info given to them
2-Must be acting in their best interest
3-Advise that they are best to tell parent/guardian but do not have to do so
4-If without care their physical/mental health would suffer
5-If they will continue to be at risk then you should provide care
With TOP the later the gestation the more painful and longer it takes TRUE/FALSE
TRUE
What sample is taken to screen for chlamydia and gonorrhoea?
Urine
What sample is taken to screen for Hepatitis, HIV and Syphillis?
Blood
What sample is taken to test for herpes?
Swab of the genital
What drugs should be given pre TOP?
Antibiotic prophylaxis - Metronidazole and Azithromycin Anti D (if rhesus -)
What is counted as early, late and mid trimester for medical TOP?
Early- <9 weeks
Late- 9-12 weeks
Mid-trimester 12-24wks
What are the two drugs used in medical TOP?
1-oral MIFEPRISTONE
2- 24-48h later Prostaglandin e.g. MISOPRISTOL
What types of surgical TOP can be carried out and when?
Manual vacuum aspiration (MVA) 6-12wks
Dilation and evacuation 13-24wks
What is used for cervical priming in surgical TOP?
Vaginal prostaglandins
2-3 weeks after TOP give a regular pregnancy test TRUE/FALSE
FALSE
give a low-sensitivity pregnancy test
When should anti-D be given?
Within 72h of any event that could cause fetal -maternal bleeding
What are the 3 indications for treatment?
1-Confirm or refute diagnosis
2-Determine extent of disease
3-Assess response to treatment
Why should a brief abdominal exam be conducted before transabdominal exam?
Ensure no hydronephrosis
Detect early ascites
Ensure pelvic abnormality is not secondary to upper abdominal pathology
How is the transvaginal transducer different than the one used in abdominal scanning?
Higher frequency ultrasound, has a shorter wavelength and better spatial resolution
For all US examinations need to have an empty bladder TRUE/FALSE
FALSE
TA- full bladder, “acoustic window”
TV-Empty bladder as if full it will be uncomfortable
What is the normal appearance of the endometrium on an US scan?
Trilaminar appearance (bright visible line in the centre of the uterus)
Name 3 things that imaging is great at in relation to repro?
1-Post-surgical complications
2-Staging of gynaecology malignancy
3-Assessing response to treatment
What is a radiological way of diagnosing endometriosis?
Diagnostic laparoscopy
What colour does fat look on T1 weighted scans?
White
What are ovarian teratomas otherwise known as?
DERMOID CYSTS
Where is the tissue that makes up dermoid cysts derived from?
Ectoderm, mesoderm and endoderm
What does hysterosalpingography test?
Tubal patency in patients with infertility
How are HSG preformed?
Cervix is cannulated and a radiopaque contrast instilled to fill the uterine cavity
How does ovarian cancer spread?
Disseminated peritoneal spread
TRUE/FALSE Malignant pleural effusions can occur as a result of ovarian cancer spread
YUP TOTALLY TRUE (Via pleural-peritoneal communications)
What radiology is used for initial diagnosis and then what radiology is used for staging of ovarian cancer?
Initial diagnosis- US
Staging- CT
How are the mets from cervical cancer radiologically assessed?
MRI for local disease
CT for distant mets
What scanning is best for establishing abnormally thickened endometrium/
TVUS
What radiology is used to determine the degree of myometrial invasion?
MRI scanning
What scanning is used in endometrial cancer to look for distant nodal mets and pulmonary mets?
CT
What is used to establish gestation accurately?
CRL until 13 weeks
HC after this
What is the equation used for sensitivity?
True positive / (positive + false negative)
What is the equation used for specificity?
True negative/ (negative + false positive)
What does naegele’s rule predict?
An estimated due date based on the onset of the woman last menstural period (add 280 days)
What percentage of people deliver 37-40wks
97%
TRUE/FALSE
In most women as the womb grows upwards the placenta moves with it so that it is in a normal position before birth
TRUE
What is placenta praevia?
Placenta attached very low on uterine wall, can cause severe bleeding
What percentage of babies born with Down syndrome had a normal anomaly scan?
50%
What test is done in the first trimester for Down syndrome?
US to measure nuchal thickness
What is a normal nuchal thickness?
<3.5mm normal when CRL between 45-84mm
The Down syndrome screening test is more accurate the older the mother is TRUE/FALSE
TRUE
What is maternal serum AFP raised in/
Multiple pregnancies (physiological) Gastroscesis and spina bifida (due to amniotic fluid mixing)
At 15-20wks a blood sample can be taken to test for Down syndrome by measuring which two things?
HCG
AFP
Risk of Down syndrome is higher if serum levels are —— and maternal age is —–
Serum low
maternal high
What is non-invasive pre-natal testing?
Test that identifies pregnant women who are at higher risk of having a baby with certain genetic and chromosomal conditions
What is trisomy 18 also known as?
Edwards syndrome
What is Pataus syndrome also known as?
Trisomy 13
Maternal anaemia is due to ———- deficiency
B12/IRON/FOLATE
When does vitamin D have to be given?
If there is a rhesus negative mother with a rhesus positive baby
Briefly describe the mechanism of Rh
At birth Rh+ baby bloods enters mothers causing production of antibodies
Antibodies initially IgM (so no problem as too big to cross the placenta)
In later pregnancies Rh antibodies attack the baby’s blood cells causing Rh disease
At what level is gestational diabetes diagnosed?
> 5.6mmol/l OR 2-hour 75g OGTT >7.8mmol/l
What are the RF for gestational diabetes?
- BMI >30kg/m2
- Previous macroscopic baby/gestational diabetes
- FHx diabetes
- Minority ethnic family origin with a high prevalence of diabetes
If there is a single SFH plot below the 10th centile OR serial measurement of slow/static growth then what is the next step?
US measurement of fetal size
What is hypertension defined as?
> = 140/90 mmHg on 2 occasions OR >160/110mmHg once
Hypertension affects what percentage of pregnancies?
10-15%
If BP is still not normal 3 months post delivery what is the diagnosis
Retrospective diagnosis of pre-existing hypertension
Which part of pregnancy do PET and PIH affect?
The second half
Why are B-Blockers avoided in pregnancy?
May inhibit fetal growth
If needed to treat pre-exisiting hypertension what drug could be used?
Labetalol
Methydopa
Pregnancy induced hypertension has better outcomes than preeclampsia. What is the but?
15% progress to PET
What is the most common cause of iatrogenic prematurity?
Pre eclampsia
What is pre eclampsia defined as?
Pregnancy induced hypertension and proteinuria
Proposed pathophysiology of pre eclampsia?
Anti androgenic state associated with widespread endothelial dysfunction
PET is a widespread manifestation with multi system disorder. Name them alll
Renal blood flow and CFR decrease Headache, visual disturbance and N&V Epigastric/RUQ pain Brisk reflexes/clonus, confusion, fits Placental abruption, IUGR and stillbirth
Woman at high risk of pre-eclampsia should take 75mg of what daily from 12wks to birth
Aspirin
Who is at high risk of preeclampsia?
Hypotensive, CKD, Autoimmune conditions, diabetes
What are moderate risk factors for preeclampsia?
1st pregnancy, 40 years+, BMI >35, FHx of pre-eclampsia, multiple pregnancy, pregnancy interval 10y+
What will the urine protein- creatinine ratio (PCR) be if they have PET?
(PCR) >30mg/mmol
If patient has PET what will there be on US?
Notching
What is eclampsia?
Emergency
Tonic clonic seizure + pre-eclampsia
How do you treat eclampsia?
Vasodilatory e.g. IV Labetalol, hydralazine & C-Section
Magnesium Sulphate
If repeated seizures then diazepam
What do you use if there is magnesium sulphate toxicity?
Calcium gluconate
What is HELLP?
H-Haemolysis E-Elevated L-Liver enzymes L-Low P-Platlets
What is the cure for HELLP?
Delivery of the fetus
What is the leading cause of maternal deaths in the UK?
Cardiac disease
TRUE/FALSE If patient has pulmonary hypertension advise against pregnancy
TRUE
if cyanotic and uncorrected congenital heart disease then increased risk of….
IUGR
What percentage of people with Marfans have cardiac involvement?
80%
If the pregnant patient has mitral stenosis then what should they watch for?
Dyspnoea
Orthopnoea
PND
How do you treat SVT?
Vagal manœuvres and/or adenosine
TRUE/FALSE Poorly controlled asthma poses a greater risk to pregnancy than the drugs used to treat it
TRUE
What is the commonest chronic medical disorder to complicate pregnancy?
Asthma
Why are asthma attacks rare in pregnancy?
Due to endogenous steroids
What are the treatment steps for asthma?
- SABA
- inhaled steroid
- LABA
- ^ Steroid dose if LABA not working or ineffective
Why should you beware new onset asthma in pregnant women?
Pulmonary oedema can cause wheezing too
What is the increase in risk of VTE in pregnancy?
4-6x increased risk
85-90% of DVTs occurring during pregnancy arise in which leg?
Left leg
What are the 3 things included in Virchow’s triad?
Hypercoaguability
Venous stasis
Vascular damage
What is the presentation of DVT?
Swelling, Oedema, leg pain/discomfort, tenderness, increased leg temp, lower abdominal pain, elevated WCC
How do you test for DVT?
Compression Duplex US
MRI and Venography (if iliac vein thrombosis suspected)
What is the presentation of VTE?
Dyspnoea, Chest pain, faintness, collapse, haemoptysis, ^ JVP, focal signs in the chest and symptoms/signs ass with DVT
The mother is at significant risk of VTE if she has 2+ RF. Name all da RF
Obesity Age >35y Smoking Para >3 Previous DVT/VTE C-section
If the mother is determined to be at significant risk of VTE then she is treated with…
Thromboprophylaxis with LMWH
Why is warfarin avoided?
Early pregnancy- teratogenic
Late pregnancy- Risk of haemorrhage
TRUE/FALSE
RA is made much worse during pregnancy
False
Usually alleviated
Methotrexate is CI in RA TRUE/FALSE
TRUE (Use sulfasalazine instead)
Why are NSAIDs not used in the 3rd trimester of pregnancy?
Can cause premature closure of ductus arteriosus
Associated with renal impairment in the newborn
What is APS?
Anti-phospholipid syndrome
Acquired thrombophilia with variable severity and presentation
How does APS present?
Anterior/venous thrombosis
Recurrent early pregnancy loss usually preceded by FGR
Placental abruption
Severe early-onset pre-eclampsia
Severe early onset fetal growth restriction
How is APS diagnosed?
aPL on two tests taken >8wks apart +- past arterial/venous thrombosis or recurrent pregnancy loss
How is APS treated?
aspirin 75mg daily from conception
heparin from when fetal heart identified
postpartum use heparin or warfarin
TRUE/FALSE
With epilepsy seizure frequency drastically increases during pregnancy?
FLASE
IT DOES NOT AT ALL (increase in seizures in 10%)
If do get seizures in pregnancy these should be terminated as soon as possible using what?
Benzodiazepines
How much folic acid should those with epilepsy get?
5mg daily
Aside from epilepsy what are some causes of seizures in pregnancy?
Eclampsia Stroke Infection Cerebral vein thrombosis Intracranial mass Hypoglycaemia Drugs and withdrawl Postural puncture Pseudoseizure
How common is bleeding in early pregnancy?
20%
What are causes of bleeding in early pregnancy?
Implantation bleeding
Chorionic haematoma
Cervical causes (infection, malignancy, polyp)
Vaginal causes (infection, malignany-rare)
Unrelated ( haematuria, PR bleeding)
If bleeding is profuse then what should be administered?
Ergometrine 0.5mg IM
What is miscarriage?
The loss of a pregnancy before 24wks gestation
Pregnancy test may remain positive for several days after a pregnancy loss TRUE/FALSE
TRUE
What are the symptoms of miscarriage?
Bleeding 1st symptom
Positive UPT
Varied gestation
Period cramping
Severe emotional upset can cause a miscarriage TRUE/FALSE
TRUE
What is the pathophysiology of miscarriage?
Bleeding form placental bed or chorion causing hypoxia and villous/placental dysfunction. This causes embryonic demise.
What percentage of threatened miscarriages will settle?
75%
What is the management of early fetal demise?
Mifepristone or Misoprostol
How long might a lady bleed for after medical management for miscarriage?
3 weeks
What is recurrent miscarriages defined as?
The loss of 3+ consecutive pregnancies before 24wks gestation with the same biological father
Diabetes increases miscarriage risk TRUE/FALSE
FALSE
Not if it is well controlled (The same goes for thyroid problems and PCOS)
Treatment for antiphospholid syndrome?
Aspirin from the day of positive pregnancy
LMWH from when the fetal heartbeat is seen until delivery
Diagnostic criteria for antiphospholid syndrome
Presence of antibodies on 2 occasions plus one of the following….
…..3+ consecutive miscarriages <10wks
…. 1 fetal loss 10wks+
….1+ births to normal foetus >34/40wks with severe pre-eclapmsia/growth restriction
In those with inherited thrombophilia what it used to reduce the risk of miscarriage?
Heparin
Pregnancy after tubal ligation is more likely to be ectopic TRUE/FALSE
TRUE 9x more likely
Where are 97% of ectopic pregnancies?
Tubal
Signs and symptoms of ectopic pregnancy
Amenorrhoea, vaginal bleeding
Pain: Non specific unilateral lower abdominal + shoulder tip pain
Diarrhoea, loose stools and/or vomiting, dizziness, collapse
Cervical excitation w or wo adnexal tenderness
What would be your spot diagnosis?
Young sexually active woman with abdominal pain, bleeding, fainting and D&V
Ectopic pregnancy
Hormone levels can distinguish where the pregnancy is TRUE/FALSE
WISE UP
no but TVS can
If there is hypovolaemic shock in an ectopic pregnancy what is the preferred management?
Surgical
When should medical management for ectopic pregnancy be followed?
If woman is stable, asymptomatic/mild symptoms, low levels of bhCG (<3000IU) and ectopic is small (<3cm)
What would medical management of ectopic pregnancy look like?
Methotrexate IM as a single dose
(do hCG levels on days 4 and 7)
As tetrogenic need to use reliable contraception for 3months afterwards
What is hydatidiform mole?
Where the foetus doesn’t develop properly in the womb and a lump of abnormal cells grows instead of a healthy foetus
A molar pregnancy is very vascular although it is not premalignant. TRUE/FALSE
FALSE
very vascular
pre-malugnant
What is a complete mole?
Mass of abnormal cells in womb, no foetus develops. Egg without DNA, 1 or 2 sperm fertilise
What does a complete mole look like on US?
Snowstorm appearance
What does a complete mole look like?
A bunch of grapes filling the endometrial cavity
due to the overgrowth of placental tissue with chorionic villi swollen
What is a partial mole?
An abnormal foetus starts to form but it can’t survive or develop into a baby
Molar pregnancies make lots of hCG giving rise to exaggerated pregnancy symptoms and a strongly positive pregnancy test. From which tissue is it derived?
Chorion
What makes molar pregnancies more common?
Asian
Extremes of reproductive age
Previous molar pregnancy
Why might you get hypothyroidism with a molar pregnancy?
hCG resembles TSH
After a molar pregnancy when should the hCG return to normal?
within 6 months
What is implantation bleeding?
Bleeding when a fertilised egg implants into the uterine wall, 10 days post-ovulation
How can an implantation bleed be differentiated from a period bleed?
Implantation-10 days post ovulation, Light/brownism, limited, soon signs of pregnancy
Period- 2wks post ovulation, heavier, bright red
What is chorionic haematoma?
Pooling of blood between endometrium and the embryo due to separation
What is the risk with a large haematoma?
Source of infection
What is the most common cause of bleeding in the last months of pregnancy?
Cervical ectropian
What is trichomoniasis known affectionately as?
Strawberry vagina
What is antepartum haemorrhage (APH)?
Bleeding from the genital tract >= 24wks and before the end of the second stage of labour
What is Keilhauer test?
Blood test that measures the amount of fetal haemoglobin transferred from fetus’ to mothers’ bloodstream
Name 4 causes of APH?
Placental abruption
Placenta praevia
Uterine rupture
Vasa praevia
What is placental abruption?
Separation of a normally implanted placenta- totally/portially before the birth of the foetus
CLINICAL DIAGNOSIS
What is couvelaire uterus?
Life-threatening
loosing of the placenta causes bleeding that penetrates into the uterine myometrium forcing its way into the peritoneal cavity
What are the symptoms of placental abruption?
Severe abdo pain-continuous
Bleeding
Preterm labour
May present with collapse or backache
If you have a previous abruption what is the chance of recurrance?
10%
What is placenta praevia?
Placenta lies directly over the internal os
What is the cause of 40% of APH?
Placental abruption
What is the cause of 20% of APH?
Placenta praevia
Presentation of placenta praevia
Painless bleeding >24wks
Usually recurrent
What is placenta praevia confirmed by?
TV US
If you suspect placenta praevia preform a vaginal exam immediately true/false
FALSE
c’mon what ya playing
DO NOT PERFORM A VAGINAL EXAM until placenta praevia is excluded
TRUE/FALSE
C-section is associated with increased risk of placenta praevia in subsequent pregnancies
TRUE
What scan should be done if placenta accrete is suspected?
MRI
Management fo placenta praevia?
Antenatal corticosteroids
Tocolysis
MgSO4
When can you do a vaginal delivery with placenta praevia?
If placenta >2cm from os and no malpresentation
What is uterine rupture?
Full thickness opening of the uterus
What are the signs of uterine rupture?
Loss of contractions Acute abdomen PP rises Peritonism Fetal distress/IUD
What is used to confirm vasa praevia?
TV US
What is type 1 vasa praevia?
Where the vessel is connected to a velamentous umbilical cord
What is type 2 vasa praevia?
When it connects the placenta with a succenturiate or accessory lobe
What is vasa praevia?
Where fetal blood vessels run near/across the opening of the internal os
What is the presentation of vasa praevia?
Painless vaginal bleeding
Rupture of membranes
Fetal bradycardia
What is PPH defined as?
Blood loss equal or exceeding 500mls after the birth of a baby
Do most women respond to the utero-tonic agents used with PPH?
Yes, yes they do
What is the number that is the border between a minor and a major PPH?
1000ml
What are the four T causes of PPH?
Tone- 70%
Trauma-20%
Tissue-10%
Thrombin- <1%
How can PPH in most cases be avoided?
Active management of the 3rd stage
Syntocinon/Syntometrine
What drug can be used in PPH to try and stop the bleeding?
Ergometrine IV
When does placenta accrete occur?
When the placenta goes too deeply into the uterine wall
What are the two major RF for placenta accrete?
Placenta praevia
Prior caesarean delivery
