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Obs & Gyny - Risk Factors > Risk Factors > Flashcards

Risk Factors Flashcards

1
Q

PPH RF

A

Placenta praevia
Uterine an omalies
>5 pregnancies

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2
Q

Pre-eclampsia

A

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

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3
Q

define Post-Partum haemorrhage

A

Blood loss of >500ml from genital tract within 24hr delivery

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4
Q

Causes of PPH

A

Tissue - Retained placenta
Thrombolytic - vWBd, Factor V deficiency
Trauma - Genital tract trauma
Tone - Uterine atony

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5
Q

Risk factors for PPH

A 
ANTENATAL 
1) Previous PPH 
2) Increased BMI 
3) Para 4 or more 
4) Maternal age >35
INTRAPARTUM
1) Prolonged labour 
2) C-section
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6
Q

Risk factors for IUGR

A

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

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7
Q

Causes of APH

A
  • Unexplained
  • Placenta praevia
  • placental abruption
  • Maternal ectropion
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8
Q

Vasa praevia

A

Waters break with blood - painless

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9
Q

Oligohydramnios

A
  • Leakage of fluid
  • Potter sequence
  • Post dates pregnancy
  • Crhomosomal abnormalities
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10
Q

Polyhydramnios

A 
CABLE
Chromosomal abnormalities 
Anencephaly 
Bartter's Syndrome 
Limb abnormalities 
Eosphageal atrea, duodenal atresia
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11
Q

VBAC

A

50/10,000 - uterine rupture with vbac
1/10,000 - uterine rupture with repeat c-section
With induction risk of uterine rupture increases massively

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12
Q

Breech birth

A

Elective c-section protective

CS reduces neonatal mortality and short term morbidity

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13
Q

Important points for pregnant women

A

Folic acid
- 400mg folic acid OR 5mg if epilepsy
Alcohol/Smoking
Exercise

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14
Q

Diagnosis of pregnancy

A 
Nausea & vomiting 
Frequency of micturition 
Excessive lassitude or fatigue 
Breast tenderness
Fetal movements or quickening
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15
Q

Acute pelvic pain

A 
Early preg
- Ectopic preg
- Miscarriage 
- Ovarian hyperstimulation syndrome
PID
Ovarian cyst 
Mittelschmerz 
Pregnancy complications
- Fibroid degeneration 
Primary dysmenorrhoea
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16
Q

Gestational diabetes

A

BMI >30kg/m2
Previous gestational diabetes
First degree relative with diabetes
Family origin with a high prevalence of diabetes

17
Q

Labour process

A

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

18
Q

Recurrent miscarriage

A 
Antiphospholipid syndrome 
Fetal chromosomal abnormalities 
Cogenital Uterine Abnormalities 
Fibroids
PCOS 
Cervical incompetence
19
Q

Ectopic pregnancy

A 
History of infertility or assisted conception
History of PID 
Endometriosis 
Pelvic or tubal surgery 
IUCD in situ
Assisted conception
Smoking
20
Q

Uterovaginal prolapse

A 
Pregnancy and vagianl delivery
Congenital factors - Ehlers danlos
Menopause
Chronic - cough, constipation, pelvic mass
Surgery - hysterectomy
21
Q

Cervical malignancy

A 
Persistent HPV infection
Multiple partners 
Smoking
Immunocompromise
COCP
22
Q

Cervical screening criteria

A

24.5 - 49 -> 3-yearly

50 - 64 -> 5-yearly

23
Q

Ovarian cancer

A 
BRCA 1 and BRCA 2
HNPCC 
Nulliparity increase risk
early menarch and/or late menpause
COCP decreases risk
Pregnancy decreases risk
24
Q

Endometrial cancer

A 
Obesity 
Nulliparity
PCOS
Early menarche/later menopause
GNPCC 
Breast cancer
25
Q

Down’s syndrome screening

A

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 §
26
Q

Placenta praevia

A

Previous c-section

27
Q

Gestational Diabetes RF

A 
FH 1* diabetes
BMI >30
Previous macrosomic fetus >4.5kg
Family origin (Black, south asian, afrocarribean) 
Previous gestational diabetes
28
Q

Risks to fetus of gestational diabetes

A

Prematurity
Pre-eclampsia
Polyhydramnios
Stillbirth

29
Q

If previous gestational diabetes

A

OGTT at booking, OGTT at 24-28 weeks

30
Q

If no previous gestational diabetes

A

OGTT at 24-28 weeks

31
Q

Positive glucose test

A

> 5.6 fasting

>7.8 OGTT

32
Q

What treatment can be given for gestational diabetes (3 stratifications)

A

> 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)

33
Q

What is management of women with pre-existing diabetes in pregnancy?

A

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

Obs & Gyny - Risk Factors (18 decks)

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