Risk Factors Flashcards
PPH RF
Placenta praevia
Uterine an omalies
>5 pregnancies
Pre-eclampsia
1) Previous severe onset pre-eclampsia
2) Age >40 or teenager
3) Family history (mother or sister)
4) Obesity >30
5) Primi(nulli)parity
6) Multiple pregnancy x5
7) Long birth interval >10
8) Pre-existing
- Hypertension
- Renal disease
- diabetes
- Antiphospolipid syndrome
define Post-Partum haemorrhage
Blood loss of >500ml from genital tract within 24hr delivery
Causes of PPH
Tissue - Retained placenta
Thrombolytic - vWBd, Factor V deficiency
Trauma - Genital tract trauma
Tone - Uterine atony
Risk factors for PPH
ANTENATAL 1) Previous PPH 2) Increased BMI 3) Para 4 or more 4) Maternal age >35 INTRAPARTUM 1) Prolonged labour 2) C-section
Risk factors for IUGR
Asymmetrical
Maternal - Hypertension/Cardiac disease
Uterine anomalies
Multiple pregnancy
Placental insufficiency - Pre-eclampsia, placenta accrete
Smoking Substances (smoking/cocaine/alcohol)
Symmetrical
Genetic abnormalities
Congenital infection - CMV, toxaplasmosis, rubella
Congenital abnormalities - gastrochisis, teratology of fallot
Causes of APH
- Unexplained
- Placenta praevia
- placental abruption
- Maternal ectropion
Vasa praevia
Waters break with blood - painless
Oligohydramnios
- Leakage of fluid
- Potter sequence
- Post dates pregnancy
- Crhomosomal abnormalities
Polyhydramnios
CABLE Chromosomal abnormalities Anencephaly Bartter's Syndrome Limb abnormalities Eosphageal atrea, duodenal atresia
VBAC
50/10,000 - uterine rupture with vbac
1/10,000 - uterine rupture with repeat c-section
With induction risk of uterine rupture increases massively
Breech birth
Elective c-section protective
CS reduces neonatal mortality and short term morbidity
Important points for pregnant women
Folic acid
- 400mg folic acid OR 5mg if epilepsy
Alcohol/Smoking
Exercise
Diagnosis of pregnancy
Nausea & vomiting Frequency of micturition Excessive lassitude or fatigue Breast tenderness Fetal movements or quickening
Acute pelvic pain
Early preg - Ectopic preg - Miscarriage - Ovarian hyperstimulation syndrome PID Ovarian cyst Mittelschmerz Pregnancy complications - Fibroid degeneration Primary dysmenorrhoea
Gestational diabetes
BMI >30kg/m2
Previous gestational diabetes
First degree relative with diabetes
Family origin with a high prevalence of diabetes
Labour process
1) Cervix dilates and head flexes and descends further into pelvis
2) Head rotates at the level of the ischial spine so occiput lies in anterior pelvis
3) Head is born, shoulders still lie transversely in mid-pelvis
4) Birth of anterior shoulder - shoulders rotate to lie in anteroposterior diameter of the pelvic outlet. Head rotates externally, to its direction at onset of labour
5) Birth of posterior should is aided by lifting the head upwards
Recurrent miscarriage
Antiphospholipid syndrome Fetal chromosomal abnormalities Cogenital Uterine Abnormalities Fibroids PCOS Cervical incompetence
Ectopic pregnancy
History of infertility or assisted conception History of PID Endometriosis Pelvic or tubal surgery IUCD in situ Assisted conception Smoking
Uterovaginal prolapse
Pregnancy and vagianl delivery Congenital factors - Ehlers danlos Menopause Chronic - cough, constipation, pelvic mass Surgery - hysterectomy
Cervical malignancy
Persistent HPV infection Multiple partners Smoking Immunocompromise COCP
Cervical screening criteria
24.5 - 49 -> 3-yearly
50 - 64 -> 5-yearly
Ovarian cancer
BRCA 1 and BRCA 2 HNPCC Nulliparity increase risk early menarch and/or late menpause COCP decreases risk Pregnancy decreases risk
Endometrial cancer
Obesity Nulliparity PCOS Early menarche/later menopause GNPCC Breast cancer
Down’s syndrome screening
1st trimester combined test
- Nuchal scan at 11 - 13+6 weeks
- Blood -> B HCG + PAPP-A
2nd trimester quad test
- B HCG
- Alpha fetoprotein
- Oestriol
- Inhibin A §
Placenta praevia
Previous c-section
Gestational Diabetes RF
FH 1* diabetes BMI >30 Previous macrosomic fetus >4.5kg Family origin (Black, south asian, afrocarribean) Previous gestational diabetes
Risks to fetus of gestational diabetes
Prematurity
Pre-eclampsia
Polyhydramnios
Stillbirth
If previous gestational diabetes
OGTT at booking, OGTT at 24-28 weeks
If no previous gestational diabetes
OGTT at 24-28 weeks
Positive glucose test
> 5.6 fasting
>7.8 OGTT
What treatment can be given for gestational diabetes (3 stratifications)
> 7.0 = insulin, diet, lifestyle
6.1 - 7.0 WITH macrosomia/polyhydramnios = insulin
<7.0 = diet a lifestyle + 2-weeks later metformin + 2-weeks later insulin (if no improvement each stage)
What is management of women with pre-existing diabetes in pregnancy?
1) Stop all oral hypoglycaemic except metformin, + insulin
2) 5mg folic acid OD from pre-conception to 12-weeks
3) Weight loss if >27 BMI
4) Anomaly scan 20 weeks
5) Manage retinopathy
