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Phase 3a conditions list flashcards > Womens health - antenatal care > Flashcards

Womens health - antenatal care Flashcards

1
Q

What is considered term?

A

37-42 weeks

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2
Q

What are the subcategories of preterm deliveries (3)?

A
  • Moderately preterm = 32-37
  • Very preterm = 28-32
  • Extremely preterm = <28
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3
Q

How is the number of times a woman has been pregnant and the number of births she has given birth denoted?

A
  • Gravida = number of pregnancies
  • Parity = number of pregnancies carried to viable gestational age (24 weeks)
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4
Q

How are twins denoted in Gravida and parity?

A

Classed as one birth - so a woman with one pair of twins delivered at 39 weeks would be G1P1

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5
Q

What is the terminology for first pregnancy, multiple deliveries, never birthed, first delivery?

A
  • First pregnancy = pimigravida
  • Multiple deliveries (2 or more) = multiparous
  • Never birthed = nulliparous
  • First delivery = primiparous
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6
Q

What are the functions of the placenta (5)?

A
  • Excretion
  • Nutrition
  • Circulation (HbF has high O2 affinity)
  • Immunity
  • Hormonal
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7
Q

What hormones does the placenta produce during pregnancy (4)?

A
  • Progesterone
  • Ostrogen
  • BhCG (beta human chorionic gonadtotropin)
  • hPL (human placental lactogen)
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8
Q

What does BhCG and hPL do in pregnancy (2)?

A
  • BhCG - stimulates the production of progesterone
  • hPL - regulates metabolism + stimulates breast development (prepares for lactation)
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9
Q

When does the foetus begin producing surfactant and when is a sufficient amount of surfactant produced by the foetus?

A
  • Begin at 24 weeks
  • Sufficient amount by 34 weeks
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10
Q

When should steroids be given to the mother until during pregnancy if she is going to give birth?

A

Up to 37 weeks

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11
Q

What is often given to a preterm baby if they are premature?

A

Surfactant

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12
Q

What can be given to mother to protect the baby from cerebral palsy?

A

MgSO4

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13
Q

When is MgSO4 given until in pregnancy?

A

Until 34 weeks

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14
Q

What are some changes to the maternal body that happen during pregnancy (8)?

A
  • Increased cardiac output
  • Decreased BP in first 2 trimesters
  • Dysmotility –> constipation + GORD
  • Decreased immune response (so don’t attack baby)
  • Poor glycemic control –> GDM
  • Increased renal excretion
  • Hormonal changes
  • Skin changes
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15
Q

What hormonal changes happen in pregnancy (6)?

A

Raised:
* Progesterone
* Oestrogen
* Prolactin
* T3/4
* BhCG
* ALP
also ESR/ CRP

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16
Q

What are some skin changes that happen during pregnancy (3)?

A
  • Linea nigra (dark line on stomach)
  • Striae gravidarum (stretch marks)
  • Polymorphic eruptions of pregnancy (red rash on abdomen)
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17
Q

How is gestational age determined?

A
  • Before dating scan = first day of last menstrual period
  • After dating scan = CRL
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18
Q

When is each trimester between?

A
  • 1st = 0-12
  • 2nd = 13-26
  • 3rd = 27+
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19
Q

When should pregnant women be refered to foetal medicine if they not have felt movements?

A

24 weeks

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20
Q

How many appointments are given to pregnant women?

A
  • 8 for parous
  • 11 for nulliparous
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21
Q

What are the key appointments (4)?

A
  • Before 10 + 0 = Booking
  • 10 - 14 weeks = Dating
  • 18 - 21 = Anomoly
  • 16, 25, 28, 31, 34, 36, 38, 40, 41 = Antenatal appointments
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22
Q

What happens at the booking visit (6)?

A
  • BMI
  • Screening offered
  • BP
  • Urinalysis
  • Assess risk scores
  • Vaccines offered
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23
Q

What happens at dating scan (2)?

A
  • Gestational age calculated (crown rump length)
  • Multiple pregnancies identified
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24
Q

What happens at anomaly scan (2)?

A
  • Anatomical anomalies identified (e.g. CHD, NTD, gastroschisis, omphelocele)
  • Placenta position identified
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25
Q

What happens at general antenatal appointments (4)?

A
  • Urinalysis
  • BP
  • Symphyseal-fundal height (SFH)
  • Foetal presentation (after 36 weeks)
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26
Q

What risks are assessed at booking visit (5)?

A
  • GDM
  • Pre-eclampsia
  • Foetal Growth Restriction
  • VTE
  • FGM (female genital mutilation)
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27
Q

What vaccines are given (2)?

A
  • Whooping cough (pertussis) - from 16 weeks
  • Influenza - seasonal (autumn + winter)
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28
Q

What are the 3 elements of pregnancy screening at the booking and dating appointment?

A
  • Infectious diseases
  • Sickle cell and thalassaemia
  • Genetic abnormalities
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29
Q

What 3 infectious diseases are screened for at the booking appointment?

A
  • HIV
  • Syphilis
  • Hep B
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30
Q

What genetic abnormalities are screened for in pregnancy (3)?

A
  • Downs syndrome (T21)
  • Edwards syndrome (T18)
  • Patau’s syndrome (T13)
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31
Q

What test is used to screen for genetic abnormalities between 11 and 14 weeks?

A

Combined test

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32
Q

What test is used to screen for downs syndrome after 14 weeks?

A

Quadruple test

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33
Q

What are the parameters of the combined test (4)?

A
  • Maternal age
  • Beta-hCG
  • PAPP - A (pregnancy associated plasma protein - A)
  • Nuchal translucency (on USS)
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34
Q

What results are suggestive of genetic disorders in the triple test (3)?

A

Low PAPP-A + high NT
AND
* High B-hCG = downs syndrome
* Low B-hCG = T18,13

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35
Q

How are genetic abnormalities identified as high risk further screened for (3)?

A
  • Nothing
  • Non-invasive prenatal testing (mum’s blood DNA tested)
  • Chorionic villus sampling (11-14 weeks)/ amniocentesis (15+)
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36
Q

What is in the quadruple test for downs syndrome?

A
  • BhCG (raised)
  • AFP - alpha fetoprotein (low)
  • E3 (low)
  • Inhibin A (raised)
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37
Q

What additional appointments/ tests are sometimes offered to those in pregnancy (4)?

A
  • OGTT at 24 - 28 weeks
  • Anti-D injections at 28, 34 weeks
  • USS at 32 if placenta praevia
  • Growth scans if high risk of FGR
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38
Q

What additional things are pregnant mothers advised about general advice/ lifestyle advice (6)?

A
  • Take folic acid 400mcg from before pregnancy –> 12 weeks
  • Vitamin D
  • Stop smoking + drinking
  • Healthy eating (low vitamin A - teratogenic)
  • Avoid unpasteurised milk, soft cheeses, avoid undercooked meat + eggs (due to risks of salmonella and listeriosis)
  • No flying after 37 weeks (32 weeks if multiple pregnancy)
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39
Q

What medications are important to know about avoiding in pregnancy (10)?

A
  • NSAIDs
  • Beta blockers
  • ACE-i + ARBs
  • Opiates
  • Warfarin
  • Sodium valproate
  • Lithium
  • SSRIs
  • Isoretinoin (retinoids)
  • Amiodarone
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40
Q

What effects can NSAIDs have on pregnancy (2)?

A
  • Premature closure of PDA
  • Delay labour
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41
Q

What effects can beta blockers have on pregnancy (3)?

A
  • FGR
  • Hypoglycaemia in the neonate
  • Bradycardia in neonate
    be aware of this for labetalol
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42
Q

What effects can ACE-i + ARBs have in pregnancy (2)?

A
  • Oligohydramnios (low amniotic fluid)
  • Hypocalvaria (incomplete formation of skull bones)
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43
Q

What effect can opiates have in pregnancy?

A

Neonatal abstinence syndrome

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44
Q

What effects can warfarin have during pregnancy (3)?

A
  • Miscarriage
  • Congenital malformations
  • Bleeding during pregnancy/ delivery
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45
Q

What effects can sodium valproate have during pregnancy (2)?

A
  • Neural tube defects
  • Developmental delay
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46
Q

What effect does lithium have during pregnancy?

A

Ebsteins anomaly

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47
Q

What is ebsteins anomaly?

A

Tricuspid valve set lower on right side of heart

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48
Q

What effects can SSRIs have on pregnancy (3)?

A
  • CHD
  • Persistent pulmonary hypertension (in neonate)
  • Withdrawal in neonate
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49
Q

What effects can isotretinoin have in pregnancy?

A

Highly teratogenic + congenital defects e.g. NTDs

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50
Q

What are the common conditions involving the placenta in pregnancy (4)?

A
  • Low lying placenta
  • Vasa praevia
  • Placenta accreta
  • Placental abruption
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51
Q

What is placenta praevia?

A

Placenta covering internal os

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52
Q

What is a low lying placenta?

A

Placenta within 20mm of internal os, but NOT covering

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53
Q

What are the grades of a low lying placenta/ placenta praevia (4)?

A
  1. Within 20mm of internal os
  2. Touching/ reaches internal os
  3. Partially covering internal os
  4. Fully covering internal os
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54
Q

Why does placenta praevia cause bleeding?

A

Bastocyst implants into lower uterus –> trauma (e.g. cervical dilation in labour) causes bleeding, can also be spontaneous

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55
Q

What are some risk factors for placenta praevia (6)?

A
  • Previous caesarean
  • Previous placenta praevia
  • IVF
  • Older age
  • Smoking
  • Multiple pregnancy
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56
Q

What can be the presentation of placenta praevia (2)?

A
  • Painless PV bleeding (antepartum haemorrhage)
  • Non-tender uterus
    quite common, usually no symptoms however
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57
Q

How is placenta praevia diagnosed?

A

Identified at anomaly scan at 18-21 weeks

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58
Q

How is placenta praevia monitored?

A

32 and 36 week follow up scans

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59
Q

What is important not to do on a woman with placenta praevia?

A

Don’t give PV exam

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60
Q

How is placenta praevia managed (2)?

A
  • Corticosteroids given at 34-36 weeks to mature foetal lungs
  • C-section 36-37 weeks
    can consider vaginal delivery if grade 1
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61
Q

What are some complications of placenta praevia (3)?

A
  • Preterm
  • Maternal shock –> death
  • Morbidly adhered placenta (placenta accreta)
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62
Q

What is vasa praevia?

A

Malformation of foetal vessels –> run through placental membranes instead of umbilical cord

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63
Q

How does vasa previa typically present?

A

Rupture of membranes followed by vaginal bleeding and foetal distress (bradycardia)

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64
Q

What are the 2 types of vasa praevia?

A
  • Type 1 = foetal vessels connected to placenta corsing over internal os (velamentous)
  • Type 2 = placenta connect to accessory (succenturiate) lobe of placenta via internal os
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65
Q

What protects the blood vessels in umbilical cord?

A

Wharton’s jelly

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66
Q

How is vasa praevia sometimes detected?

A

Ultrasound antenatal scans

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67
Q

What are some risk factors for vasa praevia (3)?

A
  • Low lying placenta
  • IVF
  • Multiple pregnancy
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68
Q

What might be found on vaginal examination of those with vasa praevia?

A

Pulsating vessels

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69
Q

How is vasa praevia managed (2)?

A
  • Corticosteroids from 32 weeks
  • C-section 34-36 weeks
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70
Q

What is placenta accreta?

A

The placenta implants deeper through the endometrium

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71
Q

What are the 3 types of abnormally invasive placenta?

A
  • Superficial placenta accreta
  • Placenta increta
  • Placenta percreta
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72
Q

What are the different extents of invasion of the placenta (3)?

A
  • Accreta = surface of myometrium
  • Increta = deeply in myometrium
  • Percreta = past myometrium and perimetrium (serosa) reaching other internal organs
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73
Q

What are some risk factors for placenta accreta (5)?

A
  • Previous c-section/ uterine surgery
  • Previous accreta
  • Low lying placenta
  • Increased age
  • Multigravida
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74
Q

How is placenta accreta diagnosed?

A

Routine USS (loss of retroplacental zone)
Women with previous acreeta are screened

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75
Q

How is placenta accreta managed (4)?

A
  • Hysterectomy (recommended)
  • Uterus preserving surgery (myometrium resected with placenta)
  • Expectant management (very risky)
  • Group + save + transfusions if needed!!
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76
Q

What are some complications of placenta accreta (3)?

A
  • Preterm
  • Severe haemorrhage (PPH)
  • Infection of uterus (if no hysterectomy)
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77
Q

What is placental abruption?

A

Premature separation of the placenta from the decidua

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78
Q

What are some risk factors for placental abruption (5)?

A
  • Previous abruption
  • Pre-eclampsia
  • Abdominal trauma
  • Smoking
  • Cocaine
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79
Q

What are the types of placental abruption (3)?

A
  • Concealed - blood remains behind placenta
  • Revealed - blood escapes from behind placenta = PV bleed
  • Mixed - clot forms behind placenta
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80
Q

What is the presentation of placental abruption (4)?

A
  • Antepartum haemorrhage (dark red blood)
  • Sudden abdo pain
  • ‘Woody’ hard contracted uterus
  • Shock
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81
Q

How is placental abruption diagnosed?

A

Clinical diagnosis
USS not very helpful

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82
Q

How is placental abruption managed if massive blood loss (5)?

A
  • 2 x grey cannula
  • FBC, U&E, LFT, coagulation studies
  • Group + save
  • Fluid/ blood resuscitation
  • Monitor CTG
  • C-section
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83
Q

What are some complications of placental abruption (3)?

A
  • DIC
  • Prematurity
  • Maternal/ foetal death
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84
Q

What is antepartum haemorrhage?

A

PV bleeding after 24 weeks gestation but before labour

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85
Q

What are the most common causes of antepartum haemorrhage (4)?

A
  • Placenta praevia = MC
  • Placental abruption = second MC
  • Vasa praevia
  • Cervical causes (e.g. cervicitis, polyps)
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86
Q

What are the different severities of antepartum haemorrhage?

A
  • Minor < 50ml
  • Major 50 - 1000ml
  • Massive > 1000ml
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87
Q

How is antepartum haemorrhage investigated (4)?

A
  • FBC + Group & save
  • Kleinbauer test (foetal Hb in mother peripheral blood)
  • USS
  • CTG
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88
Q

What is defined as small for gestational age (SGA)?

A

Being below the 10th percentile

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89
Q

What is severe SGA?

A

Being below 3rd percentile

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90
Q

How is foetal size assessed (3)?

A
  • Estimated foetal weight
  • Foetal abdominal circumference
  • Head circumference
  • Symphyseal fundal height
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91
Q

What two categories can the causes of SGA be divided into?

A
  • Constitutionally small (mother/ father is small)
  • Foetal growth restriction
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92
Q

What are the two categories of foetal growth restriction?

A
  • Placenta mediated growth restriction
  • Non- placenta mediated growth restriction (due to genetic/ structural abnormality)
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93
Q

What causes placenta mediated growth restriction (6)?

A
  • Idiopathic
  • Pre-eclampsia
  • Smoking/ alcohol
  • Anaemia
  • Malnutrition
  • Infection
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94
Q

What causes non-placenta mediated growth restriction (3)?

A
  • Genetic abnormalities
  • Structural abnormalities
  • Foetal infection
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95
Q

What are some signs/ symptoms of foetal growth restriction (5)?

A
  • Reduced foetal movements
  • Abnormal CTG
  • Abnormal doppler (decreased blood flow)
  • Reduced amniotic fluid volume
  • Reduced SFH
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96
Q

What are some complications of FGR (4)?

A
  • Foetal death
  • Obesity
  • T2DM
  • Cardiovascular disease
97
Q

What are some risk factors for SGA (10)?

A
  • Previous SGA
  • Obesity
  • Smoking
  • Diabetes
  • Previous hypertension
  • Pre-eclampsia
  • Older age
  • Multiple pregnancy
  • APL syndrome
  • Antepartum haemorrhage
98
Q

What scenarios require serial growth scans and umbilical artery doppler (3)?

A
  • Three or more minor risk factors
  • 1 or more major risk factor
  • Issues measuring SFH
99
Q

What investigations are sometimes done for SGA (4)?

A
  • BP + urine dip
  • Uterine artery doppler
  • Anatomy scan by foetal medicine
  • Infection screening (CMV/ toxoplasmosis)
100
Q

How is SGA managed if the growth is static?

A

Early delivery with c-section

101
Q

What is large for gestational age known as?

A

Macrosomia

102
Q

What is classed as being large for gestational age?

A

Above 90th percentile (4.5 kg at birth)

103
Q

What are some causes of large for gestational age (4)?

A
  • Idiopathic/ constitutional
  • GDM
  • Polyhydramnios
  • Post term (not really large of gestational age though - as they are late)
104
Q

How should a foetus large for gestational age be investigated (2)?

A
  • Serial USS
  • OGTT (24-28 weeks)
105
Q

What are some complications of large for gestational age (3)?

A
  • Perineal tears
  • Shoulder dystocia/ obstructed labour
  • PPH
106
Q

What is too much amniotic fluid known as?

A

POLYHYDRAMNIOS (1% of women)

107
Q

What is too little amniotic fluid known as?

A

OLIGOHYDRAMNIOS (6% of women)

108
Q

What are the criteria for poly/oligohydramnios (2)?

A
  • Polyhydramnios = AFI > 25cm (>2000ml)
  • Oligohydramnios = AFI < 5cm (<300ml)
    AFI = amniotic fluid index
109
Q

What are some causes of polyhydramnios (4)?

A
  • GDM
  • Oesophageal/ duodenal atresia
  • Torch infections
  • Idiopathic
110
Q

What are some examination findings in those with polyhydramnios (3)?

A
  • Increased SFH height
  • Exaggerated foetal movements
  • Lack of foetal heartbeat
111
Q

What are some complications of polyhydramnios (5)?

A
  • Cord prolapse
  • Placental abruption
  • PPH
  • Prematurity
  • Increased UTIs
112
Q

What are some causes of oligohydramnios (3)?

A
  • PPROM (preterm premature rupture of membranes)
  • Pre-eclampsia/ uteroplacental insufficiency
  • Foetal renal issues
113
Q

What are some examination findings of those with oligohydramnios (3)?

A
  • Reduced SFH height
  • Reduced foetal movements
  • Easily identifiable foetal boney prominences
114
Q

What are some complications of oligohydramnios (4)?

A
  • Potters sequence = foetal deformities/ ugly baby
  • Prolonged labour + foetal distress
  • IUGR
  • Skeletal deformities
115
Q

What is pregnancy induced hypertension?

A

New onset hypertension developing after 20 weeks gestation

116
Q

What is pre-eclampsia?

A

New onset hypertension and end organ dysfunction (e.g.proeteinuria) after 20 weeks gestation

117
Q

What causes pre-eclampsia/ PIH?

A

Increased resistance in the spiral arteries due to systemic reaction to invasion of the placenta

118
Q

What is the presentation of PIH?

A

Usually asymptomatic - can have hypertension sx e.g. headaches, blurred vision

119
Q

What is the presentation of pre-eclampsia (8)?

A
  • Headache
  • Visual changes
  • N+V
  • Abdo pain
  • Oedema
  • Oliguria (low urine)
  • Reduced foetal movement
  • Brisk reflexes
120
Q

What are some major risk factors for pre-eclampsia (5)?

A
  • Pre-existing hypertension
  • Previous hypertension in pregnancy
  • Autoimmune conditions (aPL/SLE)
  • Diabetes
  • CKD
121
Q

What are the moderate risk factors for pre-eclampsia (6)?

A
  • Older than 40
  • BMI > 35
  • 10 years since last pregnancy
  • Multiple pregnancy
  • First pregnancy
  • Family history
122
Q

What would be considered high risk for developing pre-eclampsia?

A

2 moderate risk factors OR 1 major risk factor

123
Q

How is pre-eclampsia diagnosed?

A
  • Hypertension
    + (one of)
  • Proteinuria
  • Organ dysfunction (raised creatinine, LFTs, seizures, thrombocytopenia, haemolytic anaemia)
  • Placental dysfunction (FGR, abnormal dopplers)
124
Q

What is used as prophylaxis against pre-eclampsia?

A

Aspirin

125
Q

When is aspirin given to prevent pre-eclampsia?

A

From 12 weeks until birth

126
Q

How is pre-eclampsia treated (3)?

A
  1. Labetalol
  2. Nifedipine
  3. Methyldopa
127
Q

What is an important contraindication to labetalol?

A

Asthma (start on nifedipine instead)

128
Q

How is pre-eclampsia treated after birth (3)?

A
  1. Enalapril (ACE-i)
  2. Nifedipine (CCB)
  3. Labetolol/ atenolol
129
Q

What are some complications of pre-eclampsia (4)?

A
  • Eclampsia
  • HELLP syndrome
  • DIC
  • Placental abruption
130
Q

What is eclampsia?

A

Seizures associated with pre-eclampsia

131
Q

How is eclampsia managed (2)?

A
  • IV MgSO4
  • Deliver
132
Q

What is HELLP syndrome?

A

Syndrome of:
* Haemolysis
* Elevated LFTs
* Low platelets

133
Q

How is HELP syndrome managed?

A

Delivery baby ASAP after 34 weeks

134
Q

How is pre-existing hypertension managed in pregnancy?

A

Stop current medications (e.g. ramipril, ARBs and diuretics) –> labetalol

135
Q

How is pre

A
136
Q

What is obstetric cholestasis?

A

Reduced outflow of bile acids from the liver causing a build up in the blood

137
Q

When does obstetric cholestasis occur?

A

3rd trimester

138
Q

Where do the bile acids commonly deposit in obstetric cholestasis (2)?

A
  • Skin
  • Placenta
139
Q

What are the risks with placental bile acid deposition?

A

Raised foetal bile acid levels –> foetal arrhythmia/ cardiomyopathy

140
Q

What does obstetric cholestasis increase the risk of?

A

Still birth!!!

141
Q

What is the presentation of obstetric cholestasis (3)?

A
  • Pruritis (hands + soles of feet) - at night
  • Excoriation marks
  • Jaundice
142
Q

How is obstetric cholestasis investigated (2)?

A
  • LFTs (raised)
  • Bile acids (raised)
143
Q

What is important to exclude when investigating obstetric cholestasis (3)?

A
  • Gallstones
  • Acute fatty liver
  • Autoimmune/ viral hepatitis
144
Q

What LFT is commonly raised in pregnancy and why?

A

ALP due to its production by the placenta

145
Q

How is obstetric cholestasis treated?

A
  • Ursodeoxycholic acid
  • Antihistamines (chlorphenamine - for sleep)
  • Emollients
  • Elective c-section (37-38 weeks) - if severe bile acid/LFT levels
146
Q

What is acute fatty liver of pregnancy?

A

Rapid accumulation of fat within the liver cells causing acute hepatitis

147
Q

When does acute fatty liver of pregnancy typically occur?

A

3rd trimester

148
Q

What is the underlying cause of most cases of acute fatty liver of pregnancy?

A

LCHAD deficiency in the foetus (auto recessive) –> deficiency in fatty acid metabolism –> builds up in maternal liver (this is exacerbated by mother having 1 copy of defective LCHAD gene)

149
Q

What are the signs/ symptoms of acute fatty liver of pregnancy (5)?

A
  • RUQ pain
  • N+V
  • Ascites
  • Jaundice
  • General unwell feeling
    patient often very unwell
150
Q

What are the blood findings in acute fatty liver of pregnancy (3)?

A
  • Deranged LFTs
  • Raised bilirubin
  • Deranged clotting/ low platelets
151
Q

What is a much more common differential of acute fatty liver of pregnancy (from the blood test results)?

A

HELP syndrome

152
Q

How is acute fatty liver of pregnancy managed?

A
  • A-E
  • DELIVER
153
Q

What is gestational diabetes?

A

Chronic hyperglycaemia and insulin resistance during pregnancy

154
Q

What causes hyperglycaemia in gestational diabetes?

A
  • Placenta hormones stimulate peripheral insulin resistance in normal pregnancy
  • Hypertrophy and hyperplasia of pancreatic beta cells occurs in normal pregnancy
  • Failure of these mechanisms –> GDM
155
Q

What are the risk factors for GDM (7)?

A
  • BMI > 30
  • Previous GDM
  • Macrosomia (large growth of baby)
  • Family history of DM/ GDM
  • Ethnicity (asian, black Caribbean)
  • PCOS
  • Pre-eclampsia/ hypertension
156
Q

How is GDM diagnosed?

A

OGTT (fasting glucose, 75 g carb drink, then 2 hours later RPG)

157
Q

Who is given an OGTT in pregnancy and when (2)?

A
  • Women with a risk factor screened 24-28 weeks
  • Women with glycosuria/ polyhydramnios
    women with history of GDM screened at booking as well
158
Q

What are the diagnostic criteria for GDM?

A
  • Fasting plasma glucose > 5.6 mmol/L OR
  • 2 hour glucose > 7.8 mmol/L
    5678
159
Q

How is GDM managed?

A
  1. 2 week trial of lifestyle changes
  2. Metformin
  3. Insulin
  4. Extra growth scans
    FPG > 7.0 or FPG > 6.0 + macrosomia –> start insulin immediately +/- metformin
160
Q

What are some complications of GDM (5)?

A
  • Polyhydramnios
  • Macrosomia –> shoulder dystocia
  • Childhood obesity
  • Neonatal hypoglycaemia (high glucose levels in pregnancy causes high insulin levels in foetus)
  • Pre-eclampsia
161
Q

How is GDM managed at the end of pregnancy?

A

All medications are stopped and a review takes place with GP in 6 - 13 weeks

162
Q

How is T2DM managed in pregnancy (3)?

A
  • Metformin and insulin given ONLY
  • Retinopathy screening
  • Planned delivery 37-39 weeks
163
Q

How is T1DM managed during pregnancy?

A

Insulin (BG closely monitored during labour)

164
Q

What are the blood glucose targets during pregnancy (2)?

A
  • < 5.3 FPG
  • < 6.4 OGTT (2 hour)
165
Q

What are some complications of pre-existing diabetes on the newborn (2)?

A
  • CHD (especially TGA)
  • NTD
166
Q

What is haemolytic disease of the foetus and newborn?

A

A condition whereby the mother develops antibodies against antigens on the the RBC of the foetus after a prior sensitisation event

167
Q

What blood types are needed for rhesus disease to occur?

A
  • Rh -ve mother
  • Rh +ve foetus
168
Q

What is the pathophysiology of rhesus disease?

A

Rh -ve mother develops antibodies against +ve foetus in first pregnancy –> second pregnancy T2 hypersensitivity reaction occurs –> IgG cross placenta –> RhD IgG –> foetal distress in-utero

169
Q

How should Rh -ve mothers be managed to prevent sensitisation to Rh +ve foetus?

A

They should be given anti-D (IM) at various points during pregnancy

170
Q

When should anti-D be given to Rh -ve pregnant mothers (4)?

A
  • 28 weeks pregnant
  • 34 weeks pregnant
  • Birth
  • After a sensitisation event
171
Q

What are examples of sensitisation events in the context of rhesus incompatibility (4)?

A
  • Antepartum haemorrhage
  • Amniocentesis
  • Abdo trauma
  • TOP/ miscarriage
172
Q

What test can be done to assess amount of foetal blood that has entered to maternal circulation?

A

Kleinhauser test

173
Q

What does kleinhauser test involve?

A

Mothers peripheral blood taken –> tested for foetal Hb

174
Q

What test can be used to assess whether the mother has developed antibodies against antigens of RBCs not in her blood?

A

(Indirect) coombs test

175
Q

What are the signs/ symptoms of a newborn with haemolytic disease of the newborn (3)?

A
  • Hydrops foetal is (severe oedema of newborn)
  • Jaundice
  • Yellowing of amniotic fluid
176
Q

What is a multiple pregnancy?

A

Pregnancy with more than 1 foetus

177
Q

What percentage of pregnancies are multiple pregnancies?

A

3%

178
Q

What are identical/ non-identical twins known as?

A
  • Monozygotic - one egg splits
  • Dizygotic - two eggs released
179
Q

What are the different types of twin pregnancies (3)?

A
  • Dichorionic diamniotic
  • Monochorionic diamniotic
  • Monochorionic monoamniotic
    chorionic = placenta; amniotic = amniotic sac
180
Q

What are some risk factors for multiple pregnancies (2)?

A
  • IVF
  • fHx
181
Q

What are the signs seen on USS that suggest different types of multiple pregnancies (2)?

A
  • Di-di = lambda sign
  • Mono-di = T sign
182
Q

How should multiple pregnancies be managed prior to birth (3)?

A
  • Monochorionic = 2 weekly scans from 16 weeks
  • Dichorionic = 4 weekly scans from 20 weeks
  • FBC at booking, 20 weeks and 28 weeks
183
Q

How should the birth of multiple pregnancies be managed (4)?

A
  • Mono-mono = 32-34 weeks
  • Mono-di = 36-37
  • Di-di = 37-38
  • Triplets < 36 weeks
184
Q

Can a vaginal delivery be done for multiple pregnancies?

A

If the first baby has a cephalic presentation it can be delivered vaginally, otherwise c-section required

185
Q

What are some complications of multiple pregnancies?

A
  • Twin to twin transfusion
  • Prematurity
  • Maternal anaemia
  • Congenital abnormalities (conjoined twins)
  • Low birth weight
  • Pre-eclampsia
  • PPH
  • Twin anaemia polycythaemia sequence
186
Q

What is twin to twin transfusion?

A

Blood supply to one twin is high whilst the other is starved of blood

187
Q

What does twin to twin transfusion result in for both twins (2)?

A
  • Recipient of blood = fluid overload (heart failure + polyhydramnios)
  • Donor of blood = growth restriction + oligohydramnios
    discrepancy in the size of both twins
188
Q

What are two possible symptoms for the mother of twin to twin transfusion?

A
  • Sudden increases in size of abdomen
  • Breathlessness
189
Q

How can twin to twin transfusion be treated if severe?

A

Laser treatment to destroy connection between two twins

190
Q

What is twin anaemia polycythaemia sequence?

A

Less acute version of twin to twin transfusion resulting in anaemia in one twin and polycythaemia in the other.

191
Q

When should foetal movements be felt by?

A

24 weeks
most start by 20 weeks

192
Q

How should reduced foetal movements be investigated (3)?

A
  • 1st = handheld doppler (establish foetal heartbeat)
  • If no heartbeat heard –> immediate USS
  • If heartbeat heard –> CTG
193
Q

What are some important chronic conditions to know about the management of during pregnancy (5)?

A
  • Diabetes (already covered)
  • Hypertension (already covered)
  • Hypothyroidism + hyperthyroidism
  • Epilepsy
  • Rheumatoid arthritis
194
Q

What are some complications of hypothyroidism during pregnancy (4)?

A
  • Miscarriage
  • Small for gestational age
  • Anaemia
  • Pre-eclampsia
195
Q

How should hypothyroidism be managed during pregnancy?

A

Titrate levothyroxine dose up by 30-50%
TSH can be measured to monitor

196
Q

How should hyperthyroidism be managed during pregnancy (2)?

A
  • Propylthiouracil
  • Propanolol (sx control)
197
Q

What epilepsy medications are safe during pregnancy (3)?

A
  • Lamotrigine
  • Carbamazepine
  • Levetiracetam
198
Q

What are some side effects of sodium valproate during pregnancy (2)?

A
  • Neural tube defects
  • Developmental delay
199
Q

What is one side effect of phenytoin during pregnancy?

A

Cleft lip/ pallate

200
Q

Which drugs are safe to take during pregnancy for rheumatoid arthritis (3)?

A
  • Hydroxychloroquine = first
  • Sulfasalazine
  • Steroids
201
Q

What medications should not be taken during pregnancy for rheumatoid arthritis and why (2)?

A
  • Ibruprofen - premature closure of ductus arteriosus
  • Methotrexate - can cause miscarriage and congenital abnormalities
202
Q

When are women screened for anaemia during pregnancy (2)?

A

FBC at booking and 28 weeks

203
Q

What levels of Hb are normal during pregnancy (3)?

A
  • 1st trimester > 110
  • 2nd trimester > 105
  • 3rd trimester > 100
204
Q

What additional test can be done for women who are anaemic during pregnancy?

A

MCV

205
Q

What are the most likely causes of anaemia if the MCV is low, normal and high?

A
  • Low = iron deficiency
  • Normal = physiological anaemia (due to increased blood volume during pregnancy)
  • High = vitamin b12/ folate deficiency
206
Q

What conditions can be exacerbated during pregnancy and cause anaemia (2)?

A
  • Sickle cell
  • Thalassaemias
207
Q

What are some complications of obesity during pregnancy (8)?

A
  • Miscarriage
  • Congenital defects
  • Macrosomia
  • GDM
  • PPH
  • Pre-eclampsia
  • Stillbirth
  • Increased risk of obesity + metabolic disorders in child
208
Q

How should obesity be managed during pregnancy (4)?

A
  • High dose folic acid
  • OGTT at 24-28 weeks
  • Consultant led care
  • You should not try to loose weight during pregnancy
209
Q

Why is VTE risk increased during pregnancy?

A

Pregnancy causes a hyper-coagulable state

210
Q

What are some risk factors for VTE during pregnancy (13)?

A
  • Smoking
  • Surgery
  • Cancer
  • Parity 3 or more
  • Age >35
  • BMI > 30
  • Reduced mobility
  • Multiple pregnancy
  • Family history/ past history
  • Pre-eclampsia
  • Immobility
  • IVF
  • Thrombophilia
211
Q

When should VTE risk assessments be done during pregnancy (2)?

A
  • Booking
  • After birth
212
Q

When should VTE prophylaxis be started in pregnancy (2)?

A
  • 1st trimester if 4 risk factors
  • 28 weeks if 3 risk factors
    stopped 6 weeks postpartum
213
Q

What should be used as VTE prophylaxis during pregnancy?

A

LMWH (e.g. dalteparin)

214
Q

How should DVT/ PE be investigated in pregnancy (3)?

A
  • Doppler USS (DVT)
  • CXR (PE)
  • ECG (PE)
215
Q

How should PE be investigated in pregnancy if CXR and ECG inconclusive?

A

CTPA or VQ scan

216
Q

How should DVT/ PE be managed during pregnancy?

A

LMWH until 6 weeks postpartum
if DVT seen on doppler, no need to investigate for PE as same treatment required

217
Q

What is an amniotic fluid embolism?

A

When foetal cells or amniotic fluid enters the mothers blood stream

218
Q

When do the majority of amniotic fluid embolisms happen?

A

During labour
can also occur during c-section or postpartum

219
Q

What are the signs/ symptoms of amniotic fluid embolism (5)?

A
  • Shock
  • SOB
  • Shivering
  • Sweating
  • Coughing
220
Q

What advice should be given about folic acid to women planning on becoming pregnant?

A

Before pregnancy (ideally 3 months) –> 12 weeks gestation

221
Q

What is the standard dose of folic acid taken during pregnancy?

A

400 mcg

222
Q

What is the higher dose of folic acid taken during pregnancy?

A

5 mg

223
Q

What are some reasons for taking a higher dose of folic acid (6)?

A
  • fHx or PMH
  • Antiepileptic drugs
  • Coeliacs
  • Diabetes
  • Thalassaemia trait
  • Obese (BMI>30)
    excess alcohol + methotrexate can cause folic acid deficiency as well
224
Q

What is a good dietary source of folic acid?

A

Green leafy vegetables

225
Q

What is the function of folic acid?

A

Key role in synthesis of DNA/RNA

226
Q

What effect can low folic acid have during pregnancy (2)?

A
  • Neural tube defects
  • Macrocytic, megaloblastic anaemia
227
Q

What infection presents a greater risk during pregnancy and is relatively common?

A

UTI (+pyelonephritis)

228
Q

How are women screened for UTIs during pregnancy?

A

Urine samples are sent at booking and through pregnancy for MC&S

229
Q

What indicates a UTI on a urine dip?

A
  • Nitrites = most specific
  • Leukocytes
  • Blood
230
Q

What are the most common causes of UTI (6)?

A
  • E. coli = mc
  • Klebsiella pneumoniae
  • Enterococcus
  • Pseudomonas aeruginosa
  • Staph saprophyticus
  • Candida
231
Q

What antibiotics are used for UTIs during pregnancy (4)?

A
  • Cefalexin
  • Nitrofurantoin (not in 3rd trimester)
  • Trimethoprim (not in first trimester)
  • Amoxicillin
232
Q

Why can’t nitrofurantoin and folate be used in 3rd and 1st trimester respectively (2)?

A
  • Nitrofurantoin = risk of neonatal haemolysis
  • Trimethoprim = folate antagonist (NTD)
233
Q

What are some risks associated with UTI during pregnancy (2)?

A
  • IUGR
  • Prematurity
234
Q

What should all pregnant women be offered screening for (10)?

A
  • Anaemia
  • Bacteriuria
  • Blood group + rhesus status
  • Down’s, Edwards, Pataus
  • Fetal anomalies
  • Hep B
  • HIV
  • NTDs
  • Syphilis
  • Pre-eclampsia risk factors
    can screen for SCD, thalassaemia + others in some women
235
Q

What are some important infections to know about during pregnancy (7)?

A
  • VZV
  • HSV
  • Gonorrhoea
  • GBS
  • Chlamydia
  • Syphilis
  • Bacterial vaginosis
  • Trichomonas vaginalis
236
Q

How should VZV be managed during pregnancy (3)?

A
  • Check VZ Igs
  • If >20 weeks = Aciclovir (if presents within 24 hours of rash
  • If <20 weeks = IV VZ Igs
237
Q

How is HSV managed during pregnancy (2)?

A
  • Aciclovir
  • C-section (if ulcers present OR contracted in 3rd trimester)
    risk of neonatal HSV
238
Q

How should bacterial vaginosis be managed during pregnancy?

A

Metronidazole
does not usually need treatment outside of pregnancy

239
Q

How is GBS treated during pregnancy?

A

IV benzylpenicilin

Phase 3a conditions list flashcards (29 decks)

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