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3rd year > Repro - pregnancy complications + psych > Flashcards

Repro - pregnancy complications + psych Flashcards

1
Q

what is the baby blues? when does it occur?

A

brief period of emotional instability that effects 50% of women

3-10 days post-birth

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2
Q

what are the symptoms of the baby blues

A

tearful/irritable/anxiety
poor sleep
confusion (due to lack of sleep)

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3
Q

what is the treatment of the baby blues

A

self-limiting: support and reassure

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4
Q

when does puerperal psychosis present

A

within 2 weeks of delivery

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5
Q

what are the symptoms of puerperal psychosis

A

early = sleep disturbance, confusion, irrational ideas
mania
delusions
hallucinations

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6
Q

what is the treatment of puerperal psychosis

A

admission to mother-baby unit
antidepressants/antipsychotics/modd stabilisers
ECT

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7
Q

when does postnatal depression occur

A

2-6 weeks post birth, tends to last weeks to months

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8
Q

what are the symptoms of postnatal depression

A 
tearful/irritable/anxiety 
lack of enjoyment 
poor sleep
weight loss
can present as concerns about the baby
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9
Q

what is the treatment of postnatal depression

A

mild-moderate = self-help, counselling

moderate-severe = psychotherapy, antidepressants

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10
Q

what is the treatment of a intra-partum epileptic seizure

A 
Left lateral tilt
IV lorazepam / diazepam
PR diazepam / buccal midazolam
IV Phenytoin
May need to expedite delivery by CS
If no history of epilepsy = MgSO4
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11
Q

what is Antiphospholipid antibody syndrome (APS)

A

autoimmune disease where antibodies react with the phosholipid component of the cell membrane

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12
Q

what are the symptoms of Antiphospholipid antibody syndrome

A 
thrombosis
recurrent, early miscarriage 
late miscarriage
foetal growth restriction 
placental abruption 
severe, early onset pre-eclampsia
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13
Q

what is the criteria for diagnosis of Antiphospholipid antibody syndrome

A

1 clinical + 1 lab occurring twice 6 wks apart

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14
Q

what are the clinical signs of Antiphospholipid antibody syndrome

A

vascular thrombosis
pregnancy complications:
 ≥ 3 miscarriages <10 weeks
 ≥ 1 fetal loss >10 weeks (morphologically normal fetus)
 ≥1 preterm birth (<34 weeks) due to PET or utero-placental insufficiency

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15
Q

what are the laboratory signs of Antiphospholipid antibody syndrome

A

IgM/ IgI aCL

L

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16
Q

what is the treatment of Antiphospholipid antibody syndrome

A

no complications = surveillance

previous thrombosis
pregnant = LMWH
normal = heparin

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17
Q

what is pregnancy induced hypertension

A

high BP occurring during 2nd half of pregnancy and resolves within 6 wks of delivery

no proteinuria or signs of pre-eclampsia

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18
Q

what are the 3 key signs of pre-eclampsia

A

High BP + proteinuria + oedema

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19
Q

what is pre-eclampsia

A

diffuse vascular dysfunction causing widespread circulatory disturbance

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20
Q

what are the foetal symptoms of pre-eclampsia

A

growth restriction
placental abruption
intrauterine death

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21
Q

what are the maternal symptoms of pre-eclampsia

A 
liver disease 
headache
visual disturbance 
hypertension 
proteinuria 
rapidly progressing odema
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22
Q

what are the investigations of pre-eclampsia

A 
U&amp;Es 
LFTs 
Bloods including coag screen 
ultrasounf 
maternal uterine artery doppler
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23
Q

when should a maternal uterine artery doppler be done if pre-eclampsia is suspected

A

BP >140/90
++ portienuria
severe odema

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24
Q

what are the indications for inducing labour in pre-eclampsia

A 
term gestation 
inability to control BP 
rapidly deteriorating 
eclampsia 
foetal compromise
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25
Q

what is the prophylaxis of pre-eclampsia

A

low dose aspirin

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26
Q

when would you give pre-eclampsia prophylaxis

A

previous high BP
CKD
diabetes

>1 of :
	1st pregnancy (or pregnancy interval >10 years)
	>40 
	BMI>35
	FH
	Multiple pregnancy
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27
Q

what is the treatment for High BP in pregnancy

A

1st line = labetalol, nifedipine

2nd line = hydralazine, doxazocin

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28
Q

what is the inpatient assessment of pre-eclampsia

A 
BP every 4hrs
urinalysis daily 
input/output fluid balance 
urine PCR if proteinuria 
bloods x2 a week
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29
Q

what is eclampsia

A

tonic-clonic seizures occurring with pre-eclampsia symptoms

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30
Q

what is the treatment of eclampsia

A

control BP - IV labetalol or hydralazine

control/prevent seizure = magnesium sulphate

fluid balance

deliver child

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31
Q

what is defined as large for date

A

a symphysial-fundal height >2cm for gestation age

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32
Q

what are the cause for a “large for date” baby

A 
wrong date 
foetal macrosomia = big baby 
polydramnios
diabetes
multiple pregnancy
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33
Q

what is polydramnios? how is it defined

A

excess amniotic fluid

deepest pool >8cm OR amniotic fluid index >25cm

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34
Q

what is the cause of polydramnios

A 
diabetes 
monochorinic twins
idiopathic 
hydrops fetalis
viral infection
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35
Q

what are the symptoms of polydramnios

A 
abdominal discomfort 
tense + shiny abdomen 
inability to feel foetal pulse or parts 
preterm labour
pre-labour rupture of membranes 
cord prolapse
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36
Q

what are the investigations for polydramnios

A

ultrasound
OGGT - diabetes
Bloods - infections

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37
Q

what is the treatment for polydramnios

A

serial ultrasounds

induce labour by 40 wks

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38
Q

what is cord prolapse

A

direct compression and cord spasm due to decreased flow causes hypoxia and foetal death

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39
Q

what are the investigations of cord prolapse

A

scan for foetal cardiac activity

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40
Q

what is the treatment for cord prolapse

A

immediate delivery

maternal positions

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41
Q

what is shoulder dystocia

A

This is any cephalic delivery where manoeuvres (other than gentle traction) are required to deliver the baby after the head has been delivered.

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42
Q

what causes shoulder dystocia

A

bony impaction of foetal anterior shoulder on the maternal symphysis

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43
Q

what are the symptoms of shoulder dystocia

A

slow delivery of head/chin/face
“turtling” of head against perineum
“head bobbing”

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44
Q

what is the treatment of shoulder dystocia

A 
episiotomy 
McRoberts movement 
suprapubic pressure
rotational manoeuvre 
remove posterior arm 
poll patient onto hands and knees
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45
Q

what is a multiple pregnancy

A

presence of >1 foetus

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46
Q

what are the types of twins? what causes the different types?

A

caused by time of cleavage

Monochorionic and Monozygous (MCMA)
Monochorionic and diamniotic (MCDA)
Dichorionic and diamniotic (DCDA)

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47
Q

what is the investigation of multiple pregnancy? what are the signs of each twin type?

A

ultrasound at 12 wks

lambda sign = DCDA
t-sign = MCDA

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48
Q

what are the symptoms of multiple pregnancy

A

exaggerated pregnancy symptoms
high AFP
large for date

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49
Q

how often should Monochorionic twins get ultrasounds

A

every 2 wks

50
Q

how often should dichorionic twins get ultrasounds

A

every 4 wks

51
Q

when should twins be delivered

A 
DCDA = 37-38 wks
MCDA = 36 wks + steroids 
MCMA = c section at 32-34 wks

triplets or more = C-section

52
Q

what is Twin-to-Twin Transfusion Syndrome

A

syndrome with artery-vein anastomoses where the donor twin perfuses the recipient twin

53
Q

what are the symptoms of Twin-to-Twin Transfusion Syndrome

A

Oligohydramnios AND polyhydramnios

54
Q

what is the treatment of Twin-to-Twin Transfusion Syndrome

A

Before 26/40 = fetoscopic laser ablation
After 26/40 = amnioreduction/septostomy

Deliver at 34-36 weeks

55
Q

what is the treatment of gestation diabetes

A 
insulin 
low dose aspirin from 12 weeks 
high dose (5mg) folic acid up to 12wks
56
Q

how often should a diabetic mother have a ultrasound

A

every 4wks from 28wks onwards

57
Q

when should you retest blood glucose after both

A

6-8wks fasting
OGTT at 6 wks if type 2
annually

58
Q

what is defined as small for date

A

estimated foetal weight OR abdominal circumference below the 10th centile

59
Q

what is foetal growth restriction

A

failure to achieve growth potential

60
Q

what is defined as a low birth weight

A

<2.5kg

61
Q

what is a preterm delivery? what is moderate, very, and extreme

A

<37 wks

 Extreme preterm: 24 – 27+6 weeks
 Very preterm: 28 – 31+6 weeks
 Moderate to late preterm: 32 – 36+6 weeks

62
Q

what is post-partum haemorrhage

A

blood loss of 500mls or more

63
Q

what is primary and secondary post-partum haemorrhage

A

primary = within 24hrs

secondary 25hrs - 6 days post delivery

64
Q

what is MAJOR post-partum haemorrhage

A

> 1000mls OR signs of cardiovascular collapse OR on-going bleeding

65
Q

what is antepartum haemorrhage

A

bleeding into/from the genital tract >24wks and before the end of 2nd stage of labour

66
Q

what are the types of antepartum haemorrhage

A

spotting
minor = <50mls settled
major = 50-1000mls, no shock
massive >1000ml and/or shock

67
Q

what is the treatment of antepartum haemorrhage

A

Kleihauer, Anti-D & Steroids

68
Q

what is placental abruption

A

separation of normally implanted placenta before birth (partial or complete)

69
Q

what are the symptoms of placental abruption

A 
severe, continous abdominal pain 
bleeding 
uterine tenderness 
"hard woody"uterine 
maternal collapse
70
Q

what are the investigations of placental abruption

A

CTG - irritable uterus
US if no foetal HR
bloods, LFTS, U&Es

71
Q

what is placenta praevia

A

“low lying placenta”. this is when the placenta lies directly over the internal os

72
Q

what are the symptoms of placenta praevia

A

painless bleeding >24wks (can be trigger by sex)
present foetal movements
soft and non-tender uterus

73
Q

what are the investigations of placenta praevia

A

NO VAGINAL EXAM

rescan at 32 and 36wks

74
Q

what is the treatment of placenta praevia

A

no sex
if bleeding admit for 24hrs
induce labour
c-section if completely covers os or malpresentation

75
Q

what is placenta accreta

A

a placenta that is morbidly adherent to the uterine wall

76
Q

what is the investigation of placenta accreta

A

MRI

77
Q

what is the treatment of placenta accreta

A

Prophylactic internal iliac artery balloon
Caesarean hysterectomy
Conservative

78
Q

what is uterine rupture

A

spontaneous, full thickness tearing of the uterus causing it to open into that cavity

79
Q

what are the symptoms of uterine rupture

A

severe abdominal pain
maternal collapse
PV bleeding

80
Q

what is the treatment of uterine rupture

A

surgery

81
Q

what is vasa praevia? what is the risk?

A

unprotected foetal vessels that transverse the membranes below the presenting part over the os

it will rupture during labour or at amniotomy

82
Q

what are the symptoms of vasa praevia

A

sudden dark red bleeding

artifical rupture of membranes

83
Q

what are the investigations of vasa praevia

A

ultrasound

84
Q

what is a miscarriage

A

loss of pregnancy

85
Q

what are the symptoms of a miscarriage

A

bleeding
“period like” cramps
cervical shock = cramps, nausea/vomiting, sweating fainting

86
Q

what are the investigations of miscarriage

A

positive pregnancy test
ultrasound scan
speculum exam
FBC

87
Q

what does the speculum exam indicate in an suspected miscarriage

A

os closed = threatened miscarriage
products sighted at os = inevitable miscarriage
products in vagina = complete miscarriage
os closed = complete miscarriage

88
Q

what is a recurrent miscarriage

A

3 or more pregnancy losses

89
Q

what is the cause of ectopic pregnancy

A

abnormal site of implantation = outwith uterine cavity

90
Q

what are the symptoms of ectopic pregnancy

A 
pelvic or abdominal pain 
bleeding 
dizziness/collapse
SOB 
pallor
guarding/tenderness
91
Q

what are the investigations of ectopic pregnancy

A

positive pregnancy test
serum hCG
ultrasound

92
Q

what is the treatment of ectopic pregnancy

A

acutely unwell = surgical
stable = medical
well = conservative + follow up

93
Q

what causes a molar pregnancy

A

abnormal embryo: non-viable fertilised egg

94
Q

what are the types of molar pregnancy

A

complete = no maternal genes, no foetus, diploid

partial = 2 paternal + 1 maternal genes, haploid egg

95
Q

what are the investigations of ectopic pregnancy

A

ultrasound = snow storm appearance

96
Q

what type of ectopic pregnancy can become choriocarcinoma

A

complete

97
Q

what is the treatment of ectopic pregnancy

A

surgical and tissue biopsy

98
Q

what is a chorionic haematoma

A

pooling of blood between endometrium and embryo due to separation

99
Q

what are the symptoms of chorionic haematoma

A

bleeding
cramping
threatened miscarriage/miscarriage

100
Q

what is the treatment of chorionic haematoma

A

usually self-limited and resolves

surveillance

101
Q

what is implantation bleeding

A

light, brownish limited bleeding that occurs when the fertilised egg implants into the uterine wall about 10 days post-ovulation

102
Q

what is hyperemesis gravidarum

A

excessive/protracted/altering qol vomiting

103
Q

what antiemetics are given for hyperemesis

A

1st line = cyclizine or prochlorperazine

2nd = odansetron, metoclopramide

104
Q

what is an amniotic fluid embolism

A

amniotic fluid enters the maternal circulation leading to collapse +/- arrest

105
Q

what are the investigations of amniotic fluid embolism

A

increased zinc coproporhyin levels

squames on R-sided circulation at Post mortem

106
Q

what is the symptoms of pelvic floor dysfunction

A

incontinence
difficulty emptying bowel
prolapse
pain

107
Q

what is the investigations for pelvic floor dysfunction

A 
bladder diary 
urinalysis 
post-void residual test
ultrasound 
pelvic floor assessment
108
Q

what is the treatment of pelvic floor dysfunction

A 
lifestyle 
bladder training 
pelvic floor exercises 
biofeedback training 
core stability exercises
109
Q

what are the types of prolapse

A

1st, 2nd, 3rd, 4th

110
Q

what is 1st degree prolapse

A

descent of cervix into vagina

111
Q

what is 2nd degree prolapse

A

descent of cervix into the introits (opening)

112
Q

what is 3rd degree prolapse

A

descent of cervix outside the introits (opening)

113
Q

what is 4th degree prolapse? what is it also called?

A

procidentia

all of uterus outside the introits (opening)

114
Q

what is the investigations of prolapse

A

pelvic organ prolapse quantification via speculum

115
Q

what is the treatment of prolapse

A

conservative
pessaires
surgery

116
Q

what are the types of pessaries for prolapse

A

ring = 1st degree or cystocele
ring + knob = stress incontinence
cube = 2nd or 3rd degree
gellhorn = 3rd degree

117
Q

what are the types of surgery for prolapse

A

mesh
stitch through cervix and attach to saccrospinous ligaments
colpocleisis = sew up vagina

118
Q

what is a “normal” amount of unrination

A

x8 a day and once at night

119
Q

what is gravid uterus

A

a uterus trapped in pelvis between pubic symphysis and sacral promontory which can cause aortocaval compression

120
Q

when should you consider a perimorten C-section

A

if there has been no response to CPR within 4 mins

3rd year (12 decks)

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