Pregnancy Flashcards
1
Q
Name causes of being large for dates
A
Diabetes Wrong dates Polyhydramnios Multiple pregnancies Constitutionally large
2
Q
Define polyhydramnios
A
excessive amniotic fluid AFI >25cm, DVP >8cm
3
Q
What are causes of polyhydramnios?
A
Fetal anomaly Monochorionic twin pregnancy Rh iso immunisation viral infection idiopathic
4
Q
What are the symptoms/signs of polyhydramnios?
A
feeling like bursting abdominal discomfort cord prolapse preterm labour SoB unable to lie flat tense shiny abdomen inability to feel fatal parts
5
Q
How is polyhydramnios diagnosed?
A
USS
AFI >25cm
DVP >8cm
is subjective
6
Q
What investigations should be completed in a suspected polyhydramnios?
A
OGTT
serology: viruses (CMV, toxoplasmosis)
antibody screen
USS: fetal survey - lips/stomach - make sure there is a patent oesophagus
7
Q
How is polyhydramnios managed?
A
regular USS and maternal observation
IOL by 40 weeks
prepare for labour (pre-term, cord prolapse, PPH)
8
Q
Name risk factors for multiples
A
African descent
family hx
increased parity/maternal age
tall women > small women
9
Q
How are twins categorised?
A
Monozygotic/dizygotic
by chorionicity and amniotic sacs
10
Q
Name the different types of twin
A
Dizygotic - DCDA
Monozygotic
DCDA - 1/3
MCDA - 2/3
MCMA - ~1%
11
Q
If an embryo splits after 15 days what type of twin will result?
A
conjoined
12
Q
If an embryo splits after 1-3 days what type of twin will result?
A
DCDA
13
Q
If an embryo splits after 4-8 days what type of twin will result?
A
MCDA
14
Q
If an embryo splits after 8-13 days what type of twin will result?
A
MCMA
15
Q
How is chorionicity determined?
A
USS first fetal sex Shape and thickness of membrane - (lambda sign DCDA) - T sign MCDA
16
Q
How do women with multiple pregnancies present?
A
Normally
With exaggerated symptoms (sickness) - hyperemesis gravidarum
serum high AFP
large for dates uterus
17
Q
If having twins/multiple births who monitors antenatal care/
A
Consultant led care
18
Q
If having monochorionic twins how often are appointments?
A
every 2 weeks from 16/40
19
Q
If having dichorionic twins how often are appointments?
A
every 4 weeks
20
Q
How are MCMA twins delivered?
A
By c-section
21
Q
How are DCDA twins delivered?
A
try vaginally at 37/38 weeks
22
Q
How are triplets delivered?
A
c-section
23
Q
How are MCDA twins delivered?
A
After 36+0 weeks with steroids
24
Q
If you suspect a women has GDM what investigation should be carried out and when?
A
OGTT
24-28weeks
can be done in first trimester but if normal recheck 24-28 weeks
25
What is rhesus haemolytic disease?
Rh +'ve baby
Rh -'ve mother
sensitisation then future pregnancies are attacked by maternal antibodies
26
In Rhesus haemolytic disease if antibodies cross the placenta what can happen to the baby?
Breakdown of RBC's
- anaemia
- hyperbilirubinaemia
- congestive cardiac failure
- hepato-splenomegaly
- fetal death
27
When is rhesus disease screened for?
12 weeks
| @booking appointment
28
In a rhesus negative mother, when do we give anti-d (IgG)?
28 and 34 weeks
29
What investigation do we run to check enough anti-d has been given?
Kleihauer
| is positive if maternal and fetal blood has mixed
30
What investigation tells you whether a mother is sensitised to rhesus?
indirect coombs
positive: sensitised
negative: not sensitised
31
What does anti-d do?
Prevents a mother making rhesus antibodies
32
How many units of anti-d do we use if the mother is less than 20 weeks gestation?
250 units
33
How many units of anti-d do we use if the mother is more than 20 weeks gestation?
500 units + Kleihauer test
34
When can anti-d not be used?
```
If the mother has been sensitised (coombs positive)
so only give if:
mother negative
baby +'ve
coombs negative
```
35
What is the definition of miscarriage?
spontaneous loss of pregnancy before 24 weeks
36
Define a threatened miscarriage
bleeding with maintenance of viability (closed cervix)
37
Define an inevitable miscarriage
fetus still alive but miscarriage has commenced as cervix has opened and POC are beginning to pass
death of fetes inevitable
cervix open
38
Define an incomplete miscarriage
miscarriage has commenced with fetus lost and the passage of POC not yet completed
cervix open
39
Define a complete miscarriage
passage of all POC
| cervix closed
40
Define a missed miscarriage
Fetus has died but remains in uterus
41
Define a septic miscarriage
infection of a missed/incomplete miscarriage
42
Define recurrent miscarriage
3 or more miscarriages <24 weeks gestation
43
What are causes of recurrent miscarriage?
```
PCOS
anti-phospholipid syndrome
uterine abnormalities
thrombophilia
parental chromosome abnormalities
```
44
What is the management for a septic miscarriage?
Dilatation and curettage
45
What are causes of a septic miscarriage?
chlamydia
| non-sterile abortion attempt
46
What is an ectopic pregnancy?
implantation of a fertilised ovum outwith the uterine cavity
47
What are common sites of implantation of an ectopic pregnancy?
```
ampulla of fallopian tube
fallopian tube
ovary
cervix
myometrium (interstitial)
```
48
How does an ectopic pregnancy occur?
```
anything that slows travel of ovum
endometriosis
tubal damage (surgery/prev ectopic)
tubal inflammation (PID from STI, chlamydia/gonorrhoea)
IUCD - normally copper coil
congenital abnormalities of the tubes
```
49
What is the definition of a term baby?
37-42 weeks
50
What is the definition of a moderate preterm baby?
32-36+6 weeks
51
What is the definition of a very preterm baby?
28-36+1 weeks
52
What is the definition of an extremely preterm baby?
<28 weeks
| youngest surviving preterm infant was 23 weeks
53
What does a large birthweight baby weigh?
>4000g
54
What does a normal birthweight baby weigh?
3500-4000g
55
What does a low birthweight baby weigh?
<2500g
56
What does a very low birthweight baby weigh?
<1500g
57
What does an extremely low birthweight baby weigh?
<1000g
58
In pregnancy a mother needs an extra ____ calories per day
250-300
85% due to fetal metabolism
15% stored as maternal fat
59
What increases contractions and excitability?
oxytocin
60
Where is oxytocin produced?
posterior pituitary
61
What is the ferguson reflex?
where the cervix is stretched and oxytocin released which then causes further stretch of the cervix and activation of the reflex
Seen until delivery is achieved
62
Describe the frequency of contractions
initially every 10-15 minutes
increase in frequency throughout labour
@ peak the number of contractions is 3/4 every 10 minutes
63
How long does each contraction last?
initially 10-15 seconds
| maximum length 60 seconds
64
Oxytocin causes uterine contraction and what else?
placenta to make and release prostaglandins
65
How is the diagnosis of labour made?
strong uterine contractions resulting in progressive changes in the cervix (dilation and effacement)
Is not diagnostic but usually happens at the same time: rupture of membranes (either spontaneous or via a sweep)
66
Induction of labour is indicated when?
>41 weeks
premature rupture of membranes
HTN, diabetes, cholestasis of pregnancy, APH, deteriorating illness
Social reasons
IUGR
Macrosomia
67
What are the different methods of induction of labour?
membrane sweep
artificial rupture of membranes
topical prostaglandin to the cervix
IV syntocinin (membranes should be ruptured before use)
68
The time from full dilation to delivery varies on parity and use of anaesthesia, what are the acceptable times in different situations?
nulli, w anaesthesia - 3 hours
nulli, w/o anaesthesia - 2 hours
multi, w anaesthesia - 2 hours
multi, w/o anaesthesia - 1 hour
(maximal acceptable time)
69
There are 3 stages of labour, what are they?
Dilation/Effacement
Latent 0-4cm
Active 4-10cm
Delivery
Delivery of the placenta
70
How long after the baby is born should the placenta be delivered?
expectant management: 60 mins
active management: > 30 mins
active mg includes: syntocinin, ergometrine, controlled cord traction
71
What is the most common cause of PPH?
uterine atony
72
Name some non-pharmacological methods of pain relief in labour?
massage
aromatherapy
waterbirth
TENS machine
73
Name some pharmacological methods of pain relief in labour?
entonox (gas and air)
opiates - pethidine or diamorphine
epidural - LA/opioid mix
74
What is the most effective form of pain relief in labour?
epidural
75
How long after an epidural is given does it become effective?
20-30 minutes
can be topped up if needed
76
What are the disadvantages of an epidural?
slows the 2nd stage of labour
increases the chance of malpresentation
increases risk of operational vaginal delivery
mother can't lie flat: it will increase the aorta-caval compression
77
What are the side effects of an epidural?
```
maternal:
headache
urinary retention
high block
hypotension (20%)
dural puncture (1%)
```
fetal:
increased risk of distress
if maternal hypotension persists give IV fluids and ephedrine
78
Where is an epidural given?
L3/4 space
| into the epidural space
79
What is the difference between braxton-hicks contractions and true labour?
Braxton hicks
irregular
don't increase in frequency or intensity
resolve with ambulation (walking) or change of position
relatively painless
80
What are the different types of breech?
footling - one or both feet so legs emerge 1st
complete - legs folded with feet at bottom
frank- MOST COMMON
legs point up with feet by head so the bottom emerges 1st
81
What are the complications associated with breech presentation?
cord prolapse
| theres not the same plug at the cervix when the feet are there instead of the head
82
Wha is the commonest cause of labour not progressing?
suboptimal flexion of the babies head
83
What are the drugs used in an epidural?
Local Anaesthetic and opiate
| levobubivacaine +/- opiate
84
How do we assess progress in labour?
Partogram
| should progress 2cm in 4 hours
85
How to we asses fetal distress?
CTG assessment
86
What are the 5 parts of the CTG that we assess?
```
Baseline HR
Variability
Accelerations
Decelerations
Recording of contractions
```
87
What is a normal variability in HR on a CTG?
5-25 BPM
88
What is a reduced variability in HR on a CTG and what does it suggest?
<5BPM
if <40 mins - the baby is sleeping
that the baby isn't getting oxygenated
89
What is a saltatory pattern in variability on a CTG and what does it suggest?
>25 BPM variability
sign that the baby is hypoxic
90
What does complete loss of variability in HR on a CTG mean?
pathological
| ominous sign
91
What is an acceleration on a CTG?
15 beats above the baseline for at least 15 seconds
92
What is a deceleration on a CTG?
abrupt decrease in the baseline fetal heart rate of greater than 15 bpm for greater than 15 seconds
93
What is more pathological early decelerations or late?
Late
94
What are early decelerations?
And why do they happen?
Early decelerations start when the uterine contraction begins and recover when uterine contraction stops.
This is due to increased fetal intracranial pressure causing increased vagal tone.
physiological and not pathological
95
What are the 3 types of decelerations?
early, variable, late
96
What are variable decelerations?
rapid fall in baseline fetal heart rate with a variable recovery phase
variable in their duration and may not have any relationship to uterine contractions
97
Where are variable decelerations seen?
Variable decelerations are usually caused by umbilical cord compression:
The umbilical vein is often occluded first causing an acceleration in response.
Then the umbilical artery is occluded causing a subsequent rapid deceleration.
When pressure on the cord is reduced another acceleration occurs and then the baseline rate returns.
THEREFORE WE SEE SHOULDERING OF DECELERATIONS
98
What are late decelerations and what does it indicate?
Late decelerations begin at the peak of the uterine contraction and recover after the contraction ends.
This type of deceleration indicates there is insufficient blood flow to the uterus and placenta.
As a result, blood flow to the fetus is significantly reduced causing fetal hypoxia and acidosis.
99
What is the recommended drug regimen for women trying to conceive?
400mcg folic acid
10mcg vitamin D
until 12 weeks pregnant
100
What is the recommended drug regimen for women with diabetes trying to conceive?
5mg folic acid
10mcg vitamin D
until 12 weeks pregnant
