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3a obs and gynae > Pregnancy and its complications > Flashcards

Pregnancy and its complications Flashcards

1
Q

What are the main functions of the placenta?

A
  1. barrier against infection and maternal immune system
  2. transfer of substances to and from the foetus
  3. to anchor the foetus and establish the feto-placental unit
  4. to act as an organ for gaseous exchange
  5. to act as an endocrine organ to bring the needed changes in pregnancy e.g. produce oestrogen, progesterone and HCG
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2
Q

What is the WHO criteria for screening programmes?

A

knowledge of the disease
knowledge of the test
treatment for disease
cost consideration

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3
Q

Define screening

A

process of identifying apparently healthy individuals who may be at an increased risk of a disease or condition

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4
Q

What does the “fetal anomaly screening programme” involve?

A

ULTRASOUND SCAN

  1. early scan at 10-14 weeks gestation - confirmation and date of pregnancy
  2. later scan at 18-20 weeks gestation for structural abnormalities e.g. spina bifida, cleft lip, cardiac abnormalities, skeletal dysplasia

NUCHAL TRANSLUCENCY MEASUREMENT AND SERUM TESTING WITH BLOOD SAMPLE

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5
Q

What does the infectious diseases screening programme screen for?

A

Hep B
HIV
syphilis

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6
Q

What is involved in the antenatal screening programme?

A
  1. fetal anomaly screening programme
  2. infectious diseases
  3. sickle cell and thalassaemia screening programme
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7
Q

What is involved in the newborn screening programme?

A
  1. new born blood spot screening
  2. new born hearing programme
  3. new born and 6/8 week infant physical examination
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8
Q

What does the “newborn blood spot screening programme” screen for?

A

9 conditions: cystic fibrosis, congenital hypothyroidism, sickle cell disease, inherited metabolic diseases (maple syrup disease, phenylketonuria, MCADD, isocaleric academia, glutamic acuduria type 1, homocystinuria)

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9
Q

List some of the minor symptoms/complications during pregnancy

A 
morning sickness
Gastro-oesophageal reflux
constipation
pelvic girdle pain 
backache/ sciatica
carpal tunnel syndrome 
haemorrhoids
varicose veins 
urinary symptoms
vaginal discharge
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10
Q

What is hyperemesis gravidarum?

A

persistent vomiting in pregnancy which causes 5% pre pregnancy weight less and ketosis due to high beta hCG levels

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11
Q

What are the risk factors for hyperemesis gravidarum?

A 
primiparous women
hyperthyroidism
psychiatric illness
young women
obesity
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12
Q

what is the management plan for women with hyperemesis gravidarum?

A
  1. hospital admission
  2. thromboprophylaxis
  3. fluid and electrolytes
  4. anti-emetic e.g. cyclizine
  5. anti-histamine e.g. promethazine **
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13
Q

Define “chronic hypertension” in pregnancy

A

before pregnancy and before the 20th week of gestation, high blood pressure will be there during pregnancy and not resolved postpartum

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14
Q

Define “gestational hypertension”

A

new hypertension after 20 weeks gestation with no/little proteinuria

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15
Q

Define “pre-eclampsia”

A

new hypertension after 20th week gestation with proteinuria +/- oedema

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16
Q

Define “eclampsia”

A

features of pre-eclampsia plus generalised tonic clonic seizures

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17
Q

How does pre-eclampsia develop?

A

STAGE 1: development of the disease <20 weeks
incomplete invasion of the trophoblast so there is decreased uteroplacental blood flow

STAGE 2: manifestation of the disease
the ischaemic placenta causes widespread endothelial cell damage e.g. vasoconstriction, clotting dysfunction, vascular permeability which causes clinical manifestations of the disease

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18
Q

What is the pathology behind the symptoms of pre-eclampsia?

A

increased vascular permeability -> loss of protein through the urine in the kidneys -> reduced albumin in blood vessels -> reduced oncotic pressure -> oedema and patient swollen

increased vascular resistance -> hypertension

reduced placental blood flow -> intrauterine growth restriction

reduced cerebral perfusion -> eclampsia

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19
Q

What are the risk factors for pre-eclampsia?

A 
extremes of maternal age (>40 Y/O) 
chronic hypertension**
chronic renal disease **
family history 
obesity (BMI >35)
Autoimmune disease (SLE), anti phospholipid syndrome *
nulliparity 
diabetes **
previous pre-eclampsia  ** - HIGH RECURRENCE RATE
pregnancy interval of >10 years
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20
Q

What are the symptoms pre-eclampsia?

A 
asymptomatic
flu like symptoms / headache*
visual disturbances *
drowsiness
oedema , weight gain
irritable
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21
Q

What are the late signs of pre-eclampsia

A

nausea and vomiting

epigastric pain

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22
Q

What are the possible complications of pre-eclampsia to the mother?

A 
HELLP syndrome 
liver failure
disseminated intravascular coagulation
eclampsia 
cerebrovascular haemorrhage
renal failure 
pulmonary oedema
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23
Q

how is pre-eclampsia classified?

A
  1. mild pre-eclampsia - proteinuria and mild hypertension
  2. moderate pre-eclampsia - proteinuria, severe hypertension, no maternal complications
  3. severe pre-eclampsia - proteinuria, hypertension <34 weeks, maternal complications
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24
Q

How is pre-eclampsia diagnosed?

A
  1. blood pressure - checked 3 times with 50 minute intervals (>140 / >90)
  2. proteinuria - >0.3g protein/24hr -> women collect urine for 24 hrs -> >30 PCR and urine sample sent to labs
  3. blood tests - elevated uric acid, reduced platelets, increased LFTs, impaired renal function
  4. fetal wellbeing - ultrasound scan, umbilical artery doppler, CTG
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25
Q

How is pre-eclampsia managed as an outpatient?

A

managed as an outpatient if hypertension <160/110mmHg and no symptoms or proteinuria

  1. BP and urinalysis repeated twice weekly
  2. ultrasound every 2 weeks
  3. given aspirin if high risk
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26
Q

When are you admitted to hospital with pre-eclampsia?

A

severe hypertension + proteinuria

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27
Q

Which medications are used to help treat pre-eclampsia?

A

ANTI-HYPERTENSIVES: 1st line= labetalol (if BP >160/100)
if severe: oral nifedipine + IV labetolol

MAGNESIUM SULPHATE
IV loading dose + IV infusion to prevent seizures

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28
Q

What is pre-eclampsia cured by and when should you do this?

A

only cured by delivery (epidural anaesthetic helps reduce BP)

Indications for delivery:

  • gestational age 38 weeks
  • progressive deterioration in renal and liver function
  • persistent severe headaches, epigastric pain and vomiting
  • severe fetal growth restriction
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29
Q

What is involved in post-natal care after having pre-eclampsia?

A

fluid balance monitoring - fluid restricted to 80ml/hr to prevent oedema and resp depression

blood investigations - platelets, renal function, liver function monitored

blood pressure - highest levels reached 5 days after birth, treat with nifedipine (safe in breastfeeding)

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30
Q

define “eclampsia”

A

occurrence of a tonic clonic seizure in association with a diagnosis of pre-eclampsia

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31
Q

How does eclampsia present?

A

initial presentation of pre-eclampsia

grand mal seizure can occur antenatally, intrapartum or postnatally (usually within 48 hrs)

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32
Q

How is eclampsia managed?

A

OBSTETRIC EMERGENCY

  1. ABC
  2. IV access
  3. magnesium sulphate - loading dose of 4g followed by infusion for 24 hours
  4. monitor patient every 15 mins
  5. fluid restrict patient 80ml/hour
  6. monitor fetus with CTG
  7. deliver baby once mother stable

if continue to fit: diazepam, intubation, ventilation

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33
Q

What is HELLP syndrome?

A

serious complication as a severe variant of pre-eclampsia which manifests as:

H - haemolysis e.g. dark urine, raised lactic dehydrogenase, anaemia

EL- elevated liver enzymes e.g. epigastric pain, liver failure, abnormal clotting

LP- low platelets

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34
Q

What are the symptoms or signs of HELLP syndrome?

A

severe epigastric or RUQ pain
nausea and vomiting
tea coloured urine
other features of pre-eclampsia

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35
Q

How is HELLP syndrome managed?

A

supportive treatment
magnesium sulphate
delivery indicated

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36
Q

Define “ectopic pregnancy”

A

implantation of conceptus (fertilised ovum) outside the uterine cavity

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37
Q

What are the risk factors for an ectopic pregnancy?

A 
history of infertility
history of PID
tubal/ pelvic surgery
endometriosis
previous ectopic
IVF
smoking
increased maternal age
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38
Q

What are the common sites for an ectopic to occur?

A 
fallopian tubes = 98% -> usually the ampulla, but isthmus more likely to rupture (thin wall of fallopian tube cannot sustain trophoblastic invasion )
abdominal
ovarian
cervical
C-section scars
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39
Q

How does an ectopic pregnancy present?

A

6-8 weeks amenorrhoea
lower constant unilateral abdominal pain
vaginal bleeding - small, brown, dark, after pain

+ dizziness, vomiting, shoulder tip pain, collapse

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40
Q

What are the appropriate investigations if you suspect an ectopic pregnancy?

A
  1. urine beta hCG (pregnancy test)
  2. serum beta hCG >1500
  3. transvaginal USS - locate pregnancy, presence of adnexal mass, empty uterus, barrel shaped cervix
  4. laparoscopy = gold standard
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41
Q

What are the signs on examination of ectopic pregnancy?

A

abdominal tenderness
cervical excitation
adnexal mass (but don’t examine as risk of rupturing)
tachycardia, pallor

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42
Q

How is ectopic pregnancy managed if there is a fetal heart beat, mass >35mm and serum beta hCG >1500?

A

salpingectomy ** - complete removal of Fallopian tube if finished family

salpingotomy - if have contralateral tube damage so do not remove Fallopian tube

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43
Q

Define “miscarriage”

A

spontaneous expulsion of the products of conception before 24 weeks gestation

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44
Q

What are the risk factors for a miscarriage?

A 
MATERNAL FACTORS
increased age
multiparity 
smoking
alcohol
drug abuse 
connective tissue disorders e.g. SLE, anti phospholipid syndrome
previous miscarriage
infection

FETAL FACTORS
multiple gestation
abnormal development
chromosomal defects

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45
Q

What are the causes of a miscarriage?

A
  1. chromosomal abnormalities
  2. endocrine - PCOS, thyroid disease, poorly controlled diabetes, hyperprolactinaemia
  3. anatomical abnormalities
  4. infection e.g. bacterial vaginosis
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46
Q

what are the symptoms to suspect miscarriage?

A

pregnancy or amenorrhoea in first 24 weeks gestation with..

  1. bleeding - brown discharge or brighter reed bleeding
  2. lower abdominal cramps or lower backache
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47
Q

What is a threatened miscarriage?

A

vaginal bleeding in the presence of viable pregnancy in the first 24 weeks gestation (25% will miscarry)

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48
Q

what is a complete miscarriage?

A

when all the products of conception have passed and expelled from the uterus and bleeding stopped

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49
Q

what is an incomplete miscarriage?

A

non viable pregnancy in which bleeding begun but some pregnancy tissue still in uterus (open cervix)

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50
Q

what is a missed miscarriage?

A

= silent/ delayed miscarriage

when a non viable pregnancy is identified on ultrasound scan without pain or bleeding

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51
Q

what is an inevitable miscarriage?

A

non viable pregnancy in which bleeding has begun and cervical os open, but pregnancy tissue remains in uterus - pregnancy will continue to incomplete or complete miscarriage

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52
Q

when is recurrent miscarriage diagnosed?

A

when 3 or more consecutive or non consecutive miscarriages

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53
Q

When should hospital admission be arranged in suspected miscarriage?

A

signs of haemodynamic instability e.g. pallor, tachycardia, hypotension, shock, collapse
significant concern over pain or degree of bleeding

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54
Q

how are women first managed when suspect miscarriage?

A

urine pregnancy test
if >6 weeks - refer to EPAU for TVUSS
<6 weeks - expectant management (repeat pregnancy test in 7-10 days)

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55
Q

what is involved in expectant management of miscarriage?

A

= if confirmed diagnosis of incomplete or missed miscarriage
lasts for 7-10 days
give analgesia
will experience pain and bleeding - once settled it is complete miscarriage
repeat pregnancy tests after 3 weeks to confirm -ve result

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56
Q

how is a miscarriage diagnosed in secondary care?

A

Transvaginal Ultrasound - assess location and viability of pregnancy

if not established, serum beta hCG, laparoscopy or repeat TVUSS in 1 week

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57
Q

what is involved in medical management of miscarriage and when is it appropriate?

A

if symptoms ongoing for 14 days of expectant management or expectant management not suitable

vaginal** misoprostol (prostaglandin analogue which stimulates uterine expulsion of products of conception)
+ pain relief + anti emetic

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58
Q

Define placenta praevia

A

when the placenta is inserted, wholly or in part into the lower segment of the uterus to obstruct engagement of the head

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59
Q

What are the risk factors for placenta praevia?

A

twins
women with high parity
older women
scarred uterus

60
Q

What are the classification of placenta praevia?

A

grade 1/2 = minor/ marginal = placenta lies in the lower segment, close or encroaching on the cervical os

grade 3/4 = major = placenta lies over the cervical os

61
Q

How doe placenta praevia present?

A

intermittent, painless bleeding** -> increase in frequency and intensity over several weeks

(no tenderness, no pain)

62
Q

What are the complications of placenta praevia?

A

severe haemorrhage
placenta accreta - implants in previous CS scar
placenta percreta

63
Q

What are the appropriate investigations for placenta praevia?

A

transvaginal ultrasound ** - locates placenta , normally found on 20 week scan
DO NOT PERFORM VAGINAL EXAMINATION IF BLEEDING

64
Q

What is placenta abruption?

A

placenta separates partly or completely from the uterus before delivery of foetus - blood accumulates behind placenta in uterine cavity or is lost through cervix

65
Q

What are the risk factors for placenta abruption?

A 
intrauterine growth restriction
pre-eclampsia
maternal smoking
cocaine use 
multiple pregnancy 
trauma 
anti phospholipid syndrome
66
Q

What are the symptoms of placenta abruption?

A

abdominal pain = sudden onset, constant, severe
+/- dark bleeding (bleeding = revealed/ non bleeding = concealed)

+ signs of shock

67
Q

What are the complications of placenta abruption?

A 
fetal death 
haemorrhage
disseminated intravascular coagulation
renal failure
maternal death
68
Q

How is placenta abruption managed?

A
  1. assess fetal well being - CTG, ultrasound
  2. assess maternal well being - FBC, cross match, catheterisation, CVP monitoring
  3. deliver if fetal distress/ maternal compromise
  4. IV fluids
  5. opiate analgesia
69
Q

What are the signs on examination of placenta abruption?

A

woody hard tender uterus
tachycardia, hypotension, pallor
fetal heart beat abnormal

70
Q

Define placenta accreta

A

chorionic villi penetrate the decider basalts to attach to the myometrium
-> placenta implants in old C section scar and can prevent placental separation

71
Q

Define placenta increta

A

villi penetrate deeply into the myometrium-> placenta implants in old C section scar and penetrate uterine wall into surrounding structures

72
Q

Define placenta percreta

A

the villi breech the myometrium into the peritoneum

73
Q

Define antepartum haemorrhage

A

bleeding from the genital tract in pregnancy at >24 weeks gestation before the onset of labour

74
Q

What are the risk factors for an antepartum haemorrhage?

A 
unexplained = 97%
placenta praevia 
placenta abruption
vasa praevia 
maternal factors - local infection, genital tract tumour, varicosities, trauma
75
Q

How should an antepartum haemorrhage be managed?

A
  1. rapid assessment of maternal and fetal condition - observations, uterine palpation
  2. do a speculum examination only if placenta praevia excluded
  3. fetal heart and ultrasound and umbilical artery doppler
  4. admit woman to hospital and observe
76
Q

If a woman has rubella before 16 weeks, what is offered?

A

termination of pregnancy

77
Q

What are the possible congenital defects rubella can cause?

A

sensorineural deafness
congenital cataracts
microcephaly
cardiac abnormalities - VSD, PDA

78
Q

What are the congenital defects with a cytomegalovirus infection?

A 
IUGR
sensorineural deafness 
jaundice 
microcephaly
thrombocytopenia
79
Q

How is rubella and cytomegalovirus investigated?

A

serological confirmation : rise in IgM and IgG antibodies

80
Q

What are the congenital defects of a syphillis infection?

A 
blunted upper incisor teeth
saddle nose
deafness
saber shins
keratitis
81
Q

How is syphillis treated?

A

benzylpenicillin

82
Q

What are the congenital defects with toxoplasmosis and how is it managed?

A

retardation
convulsions
visual impairment

rx= spiramycin

83
Q

What are the complications of HIV during pregnancy?

A 
high risk of pre-eclampsia and gestational diabetes 
still birth 
IUGR
preterm
prematurity 
pass on HIV
84
Q

How is vertical transmission of HIV reduced?

A

maternal anti-retroviral therapy
C section delivery and zidovudine infusion 4 hours before
neonatal anti-retroviral therapy
infant bottle feeding (NOT breast feeding)

85
Q

List the risk factors for VTE in pregnancy

A 
previous VTE
thrombophilia
BMI >40
C-section
IVDU
smoker 
age >35 y/o 
varicose veins
pre eclampsia
86
Q

What are the measures of prophylaxis?

A 
early antenatal risk assessment 
mobilisation
hydration
compression stockings 
antenatal and postpartum prophylaxis of LMWH
87
Q

what is rhesus disease?

A

in a sensitised woman, maternal antibodies rise against fetal red cell antigen -> antibodies can cross the placenta and cause foetal haemolysis (neonatal jaundice, anaemia, fetal death)

88
Q

How is rhesus disease managed?

A

if mothers anti D levels high, doppler ultrasound done

need one dose of anti D at 28 weeks plus a KLEIHAUER TEST

89
Q

How does obstetric cholestasis present?

A

pruritus - palms and soles
jaundice
raised bilirubin

90
Q

How is obstetric cholestasis managed?

A

ursodeoxycholic acid
weekly LFTs
induced at 37 weeks

91
Q

How does acute fatty liver of pregnancy present?

A 
jaundice
abdominal pain
nausea and vomiting
hypoglycaemia
elevated ALT
92
Q

Define complete hydatiform mole

A

benign tumour of trophoblastic material - occurs when empty egg is fertilised by single sperms and duplicates so all 46 chromosomes of paternal origin

93
Q

How does complete hydatiform mole present?

A

bleeding in 1st/2nd trimester
hyperemesis
uterus large for dates
exaggerated symptoms of pregnancy

94
Q

How is complete hydatiform mole investigated?

A

very high levels of serum hCG
hyperthyroidism (high thyroxine, low TSH)
hypertension
ultrasound - snow storm appearance

95
Q

Define partial hydatiform mole

A

normal haploid egg may be fertilised by 2 sperm or one sperm and duplicated - DNA is tripoid (69 XXX or 69 XXY)

96
Q

What are the types of twin pregnancies?

A

DIZYGOTIC = fertilisation of different oocytes by different sperm

MONOZYGOTIC = one zygote that undergoes meiotic division into identical twins

97
Q

What are the types of monozygotic twins?

A
  1. dichorionic diamniotic = division before day 3 ** -> separate placenta and amnions
  2. monochorionic diamniotic = division day 4-8 -> separate amnion but share placenta
  3. monochorionic monoamniotic = division 9-13 (rare) -> share placenta and amnion
  4. conjoined division = incomplete division
98
Q

Which score is used to classify hyperemesis gravid arum?

A

Pregnancy Unique Quantification of Emesis score (PUQE)

99
Q

How does hyperemesis gravidarum present?

A 
persistent vomiting at 8-12 weeks
weight loss
tachycardia 
dehydration 
nutritional deficiency
100
Q

what are the signs on examination of pre eclampsia?

A 
hypertension
oedema 
papilloedema
RUQ abdo tenderness
brisk reflex
ankle clonus
101
Q

what are the possible complications of pre eclampsia to the baby?

A

IUGR
preterm birth
placental abruption
hypoxia

102
Q

What should you monitor when a woman is on magnesium sulphate for pre eclampsia?

A

urine output
reflexes
resp rate
oxygen sats

103
Q

What are the adverse affects of magnesium sulphate?

A

resp depression
hypotension
loss of patellar reflexes

104
Q

when is magnesium sulphate treatment started?

A

in severe pre eclampsia or in eclampsia

treatment should only be started once decided to deliver and should continue for 24 hours after delivery or last seizure (40% of seizures occur post partum)

105
Q

How is ectopic pregnancy managed if beta hCG level >1500 but no fetal heart beat?

A

IM methotrexate single dose
+ follow up of b hCG level 4 and 7 days after and LFTs
SE of methotrexate: GI upset, conjunctivitis, stomatitis

106
Q

When is surgical management necessary in miscarriage?

A

if products of conception retained after medical management:

  1. manual vacuum aspiration under LA
  2. surgical removal under GA
    + anti D immunoglobulin if rhesus -ve
107
Q

what are the complications of surgical management of miscarriage?

A 
infection
haemorrhage
uterine perforation
ashermans syndrome
cervical tears
108
Q

What are the findings on examination of placenta praevia?

A

lie of foetus usually abnormal e.g. breech, transverse lie
normal fetal heart beat
head not engaged and high

109
Q

how is placenta praevia managed?

A

admit to hospital if severe blood loss
deliver by C section if <2cm from internal os
increased frequency of scans to monitor

110
Q

Define vasa praevia?

A

cord lies close to the internal os

111
Q

How does vasa praevia present?

A
  1. rupture of membranes
  2. painless bleeding
  3. fetal bradycardia
112
Q

How is vasa praevia managed?

A

emergency C section

113
Q

what is the most common cause of early neonate infection

A

group B strep (streptococcus agalactiae)

40% of GBS in bowel flora and colonise vagina = carriers

114
Q

list the risk factors of a group B strep infection?

A

previous baby with GBS infection
prolonged ROM
prematurity
maternal pyrexia

115
Q

Who is offered GBS screening?

A

if women had GBS detected in previous pregnancy - offered IV antibiotic prophylaxis or testing in late pregnancy and abx if positive

swab for GBS at 35-37 weeks or 3-5 weeks before delivery date

116
Q

who is given GBS prophylaxis and what is it?

A

GBS prophylaxis = benzylpenicillin

if previous baby with early/late onset GBS
if in preterm labour
pyrexia during labour

117
Q

What are the consequences of UTI in pregnancy?

A

associated with preterm labour, increased morbidity, anaemia

118
Q

How is asymptomatic bacteriuria or symptomatic UTi treated?

A
  1. urine culture sent (always done at first antenatal visit)
  2. 7 day course of nitrofurantoin, amoxicillin or cefalexin
  3. repeat urine culture after course to ensure treated
119
Q

How is pyelonephritis treated in pregnancy?

A

cefalexin

120
Q

what are the risk factors for multiple pregnancy?

A

IVF and clomiphene use
FH
increased maternal age

121
Q

What are the complications with multiple pregnancies?

A

ANTEPARTUM
maternal - pre eclampsia, gestational diabetes , miscarriage, preterm labour
fetal - IUGR, risk of mortality, co twin death , twin to twin transfusion syndrome

POSTPARTUM
malpresentation - C section
fetal distress
PPH

122
Q

how are multiple pregnancies managed ante-natally?

A
  1. consultant led as high risk
  2. iron and folic acid supplements
  3. early TVUSS
  4. identifying problems
  5. c section at 37-38 weeks
123
Q

What is the NICE criteria for gestational diabetes?

A

diagnosed in pregnancy which may/may not resolve after pregnancy and:

fasting glucose >5.6 mmol/L
or 2 hour glucose >7.8 mmol/L

124
Q

What are the risk factors for gestational diabetes?

A

BMI >30 kg/m^2
previous macrocosmic baby weighing >4.5kg
previous gestational diabetes
1st degree relative with diabetes
high prevalence background e.g. south asian, black Caribbean, Middle Eastern

125
Q

who is screened for gestational diabetes?

A

if previously had gestational diabetes: OGTT at booking and at 24-28 weeks

if risk factors: OGTT at 24-28 weeks

126
Q

What are the risks to pregnancy in diabetes?

A 
pre eclampsia
UTI/ infections 
miscarriage 
preterm birth
polyhydramnios 
diabetic retinopathy and neuropathy
127
Q

what are the fetal complications of gestational diabetes?

A

macrosomia
hypoglycaemia of new born
shoulder dystocia

128
Q

How is gestational diabetes assessed?

A 
close fetal surveillance with CTG and fetal ECHO
blood glucose checked every 2 weeks
blood pressure
urinalysis
ophthalmology screen
129
Q

How is gestational diabetes managed?

A

managed in a joint diabetes and antenatal clinic and women should be taught to measure regular blood glucose checks

  1. advice on diet and exercise
  2. if glucose targets not met within 1-2 weeks, add metformin
  3. if glucose targets still not met, add insulin
130
Q

When would insulin be used in gestational diabetes?

A

if fasting glucose >7mmol/L at diagnosis
if fasting glucose 6-6.9 + complications
if not managed on metformin

131
Q

when is delivery indicated in gestational diabetes?

A

at 39 weeks
elective C section if estimated fetal weight >4 kg
glucose level maintained with insulin sliding scale

132
Q

How is pre existing diabetes managed in pregnancy?

A
  1. weight loss if BMI >27
  2. stop oral hypoglycaemic agents
  3. manage on metformin + insulin
  4. folic acid daily
  5. tight glycemic control
  6. detailed anomaly scan at 20 weeks
133
Q

Define oligohydramnios

A

reduced amniotic fluid (<500ml at 32-36 weeks + amniotic fluid index <5th percentile)

134
Q

What are the causes of oligohydramnios?

A

premature rupture of membranes
IUGR
post term gestation
pre eclampsia

135
Q

Define polyhydramnios

A

liquor volume increased

136
Q

what are the causes of polyhydramnios?

A

gestational diabetes
idiopathy
twins
fetal anomaly e.g. myotonic dystrophy

137
Q

what are the complications of polyhydramnions

A

abdo discomfort
preterm labour
abnormal lie and malpresentation

138
Q

how is polyhydramnios managed to reduce liquor volume?

A

amnioreduction or NSAIDS + steroids or vaginal delivery

139
Q

what is rhesus disease of the newborn?

A

maternal antibody response against fetal red cell antigen entering her circulation -> maternal antibodies enter babies circulation and destroy their blood cells

140
Q

when does rhesus disease occur?

A

only happens when mother had rhesus negative blood and baby in womb has rhesus positive blood

141
Q

how is a woman sensitised?

A

when a woman with RhD negative blood exposed to RhD positive blood (so usually previously RhD positive baby)

woman body produces antibodies against positive blood

if sensitisation occurs, the next time the women exposed to RhD positive blood, her body produces antibodies immediately

142
Q

How is rhesus disease prevented?

A
  1. women offered antenatal screening to test for rhesus positive or negative blood
  2. if rhesus positive, offered anti -D immunoglobulin at 28 weeks (helps remove RhD foetal blood cells before they can cause sensitisation)
  3. Kleinhauer test after (tests for fetomaternal haemorrhage)
143
Q

How is rhesus disease managed if unborn baby does develop it?

A
  1. blood transfusion to unbron baby if severe
  2. phototherapy
  3. IV immunoglobulin
144
Q

what complications can rhesus disease cause to the baby if untreated?

A 
stillbirth 
learning difficulties
deafness
blindness 
neonatal jaundice
145
Q

List the common congenital infections?

A 
T - toxoplasmosis 
O- other e.g. syphilis
R- rubella
C- cytomegalovirus
H- herpes simplex virus

3a obs and gynae (5 decks)

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