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OBGYN > Pregnancy complications > Flashcards

Pregnancy complications Flashcards

1
Q

What is eclampsia + how common is pre-eclampsia?

A

Seizures - usually following pre-eclampsia but can occur without HTN or proteinuria

10% pregnancies get pre-eclampsia

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2
Q

RF for pre-eclampsia

A

Nulliparity Chronic HTN Extremes of age Multiple pregnancy Assisted conception Obesity Pre-existing disease Molar pregnancy FHx pre-eclampsia Hx of placental abruption

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3
Q

HELLP syndrome - what is it, S+S, complications, management

A

Haemolysis, elevated liver enzymes + low platelets

Epigastric/ RUQ pain, N+V, HTN, dark urine DIC, liver failure may occur

Deliver + give magnesium sulphate

High dose steroids

Oxytocin to be used in 3rd stage (not Syntometrine as this increases BP)

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4
Q

Uterine rupture - S+S, risk factors, management, risk of rupture in VBAC + induction

A

Risk with multiparous women on uterine stimulants

S+S: fresh vaginal bleeding, haematuria, fetal distress, constant severe abdo pain

Immediate laparotomy to save baby

Risk of rupture is 0.3% if VBAC, 3% if induced

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5
Q

Uterine inversion - risk factors, S+S, management

A

Associated with grand multips + incorrect management of 3rd stage

Presents as vasovagal shock: pale, clammy, hypotensive, bradycardic

Mass at introitus

Manage with O’Sullivans method - reduce inversion by hydrostatic technique

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6
Q

VTE - when is it likely to occur?

A

Antepartum DVT more common than postpartum VTE higher intrapartum

Cerebral vein thrombosis = usually in intrapartum period (seizures, fever, vomiting, photophobia)

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7
Q

VTE - why does it occur in pregnancy?

A

Pregnancy = hypercoagulable state

Blood clotting factors X, VII + fibrinogen increased

Protein S activity decreased

Suppression of fibrinolysis

Blood flow altered by obstruction + immobility

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8
Q

VTE pre-existing RF

A

Previous VTE

Thrombophilia

Age >35

Obesity

Parity >4

Gross varicose veins

Paraplegia

Sickle cell

Inflammatory disorders

Medical disorders

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9
Q

New onset VTE RF

A

Ovarian hyperstimulation syndrome

Hyperemesis

Dehydration

Long haul travel

Severe infection

Immobility

Pre-eclampsia

Prolonged labour

Instrumental delivery

Excessive blood loss

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10
Q

S+S VTE

A

DVT: leg pain, swelling, tenderness, fever, erythema, elevated WCC

PE: SOB, collapse, chest pain, haemoptysis, raised JVP

Cerebral vein thrombosis: seizures, fever, vomiting, photophobia

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11
Q

VTE investigation + prevention

A

CXR - if normal = V/Q

If abnormal = CTPA

LMWH for prophylaxis

Score >4 = LMWH from 12 wks + PP

Score 3 = LMWH from 28 weeks + PP

Score 2 = LMWH for 10 days PP

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12
Q

Risk assessment for VTE prophylaxis in CS

A

Low risk (hydration + mobilisation) Elective CS, uncomplicated pregnancy, no RF

Moderate risk - prophylaxis Age >35, obesity, parity >4, labour >12 hrs, infection, pre-eclampsia, immobility, emergency CS

High risk - heparin >3 moderate RF, pelvic surgery, personal or fam hx of VTE, antiphospholipid antibody syndrome

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13
Q

Hyperemesis gravidarum - risk factors, S+S

A

Excessive vomiting, severe enough to cause dehydration, weight loss, electrolyte disturbance

High risk with multiples + molar

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14
Q

Complications of hyperemesis

A

Liver/ renal failure Hyponatraemia - then rapid reversal = central pontine myelinosis Thiamine deficiency = leading to Wernicke’s encephalopathy IUGR

Causes metabolic hypocholoraemic alkalosis

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15
Q

Management of hyperemesis

A

Admit, give fluids (500ml NaCl) + thiamine

Diagnose with ++ketones in urine

Daily U+Es

Antiemetics if needed - prochlorpramazine

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16
Q

Prolonged pregnancy risks

A

>42 weeks Placental function declines.

Increased risk of intrapartum deaths

Risk: meconium aspiration, oligohydraminos, macrosomia, shoulder dystocia, cephalhaematoma, hypothermia, hypoglycaemia, polycythaemia

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17
Q

Cephalhaematoma

A

Common injury during forceps delivery or prolonged labour

Swelling of scalp due to bleeding

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18
Q

Fetal postmaturity syndrome - S+S

A

Post term infants who have malnutrition

Scaphoid abdomen, little SC fat, peeling skin, anxious look

Skin stained with meconium

19
Q

Risks of PPROM

A

Chorioamnionitis

Cord prolapse

Absence of liquor = pulmonary hypoplasia, postural deformities

Prematurity

Infection

20
Q

Chorioamnionitis S+S, management + prophylaxis

A

Fever, abdo pain, vaginal discharge, tachycardia, uterine tenderness

Give steroids, cefuroxime + metronidazole

Prophylaxis = erythromycin

21
Q

Spontaneous, threatened + inevitable miscarriage

A

Spontaneous = fetus dies before 24 weeks

Threatened = fetus still alive but there is bleeding, os closed

Inevitable = bleeding, os open

22
Q

Incomplete, complete, septic + missed miscarriage

A

Incomplete = some fetal parts have passed, os open

Complete = fetus has passed, os closed

Septic = endometritis caused by contents, offensive vaginal discharge

Missed = USS finds dead fetus, os closed

23
Q

Management of miscarriage

A

Conservative if no signs of infection

Medical: misoprostol

24
Q

Medical termination of pregnancy

A

Mifepristone

25
Q

Drugs to avoid in pregnancy

A

Lithium - Epsteins anomaly

Co-amoxiclav = necrotising enterocolitis

Tetracyclines = tooth discolouration

26
Q

What is the treatment for obstetric cholestasis?

A

ursodeoxycholic acid (UDCA)

27
Q

What foods should pregnant women avoid?

A

Raw meat, pate, ripened cheese

28
Q

When is Rh disease most likely to occur, and when should Ab be checked?

A

Most likely in 1st trimester

Checked at booking, 28 + 34 weeks

29
Q

What is checked in the neonatal period if Rh disease is confirmed?

A

Peak systolic velocity of fetal middle cerebral artery - measured weekly to look for signs of anaemia. If velocity is increase, FBS is indicated

30
Q

What is the Kleihauer test?

A

Assesses number of fetal cells in maternal circulation, to see if large dose of Anti-D needed after large haemorrhage

31
Q

Which laxatives + anti-emetics are used in pregnancy?

A

Avoid stimulant

Cyclizine + prochlorperazine

32
Q

What could polyhydraminos in the absence of diabetes signify?

A

TORCH infection

33
Q

What is the IUGR criteria on USS?

A

Elevated ratio FL:AC + HC:AC

Unexplained oligohydraminos

34
Q

What signs on doppler indicate the head sparing effect?

A

Increased flow to middle cerebral artery

35
Q

How do you work out dosage for LMWH?

A

Weight

36
Q

What to give if a mother has pre-eclampsia from 26-36 weeks?

A

Steroids

37
Q

What are the parameters for class I of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat

A

Blood loss = <750ml

HR, RR, BP = normal

Anxious

Tx = fluids

38
Q

What are the parameters for class II of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat

A

Blood loss = 750-1500ml

HR <120

RR <30

BP reduced

Anxious

Tx = fluids

39
Q

What are the parameters for class III of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat

A

Blood loss = 1500-2000ml

HR <140

RR <35

BP reduced

Confused

Tx = fluids +/- blood

40
Q

What are the parameters for class IV of shock in APH/ PPH (vol blood loss, HR, RR, BP, mental state) + how to treat

A

Blood loss >2000ml

HR >140

RR >35

BP reduced

Lethargic

Tx = fluids + blood

41
Q

What is the criteria for major haemorrhage protocol?

A

HR >110, BP <90 OR

5L in 24hr or 2.4L in 2hr or >150ml/min

42
Q

What is provided in major haemorrhage protocol?

A

4 units RBC + 4 units FFP

TXA (activates factor 2 + is anti-thrombolytic)

43
Q

How much blood can be lost from the placental if uterus is not contracting efficiently?

A

700ml/ min

OBGYN (18 decks)

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