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Med Finals - Womens Health > Antenatal > Flashcards

Antenatal Flashcards

1
Q

Define 1st trimester

A

From start of pregnancy until 12 weeks

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2
Q

Define 2nd trimester

A

From 13 weeks until 26 weeks

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3
Q

Define 3rd trimester

A

From 27 weeks until birth

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4
Q

When is dating scan

A

10-13+6 weeks

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5
Q

When is anomaly scan

A

18-20+6 weeks

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6
Q

When is oral glucose tollerance test

A

24-28 weeks

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7
Q

When is anti-D injection

A

28 and 34 weeks

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8
Q

Vaccines during pregnancy

A

Whooping cough - 16 weeks
Influenza - autumn or winter

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9
Q

Options for downs screening

A

Combined test
Triple test
Quadruple test
(amniocentesis, CVS)

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10
Q

Define combined test

A

Ultrasound - nuchal translucency
Bloods - hcg, PAPPA

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11
Q

When can combined test be done

A

11-14 weeks

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12
Q

Define the triple test

A

hcg
Alpha fetoprotein
Serum oestriol

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13
Q

When can the triple test be done

A

14-20 weeks

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14
Q

Define quadruple test

A

Tripple plus inhibin A

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15
Q

When can quadruple test be done

A

14-20 weeks

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16
Q

Management of hypothyroidism in pregnancy

A

Levothyroxine crosses placenta
Increased dose required - 25-50 mcg (30-50%)
Titrate TSH

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17
Q

Management of hypertension in pregnancy

A

Stop ACE, ARB, thiazide
Can have beta, ccb and alpha-blockers

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18
Q

Management of epilepsy in pregnancy

A

High dose folic acid - 5mg
Worsen seizure control
Avoid - sodium valproate, phenytoin
Safer - levetiracetam, lamotrigine and carbamazepine

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19
Q

Management of rheumatoid arthritis in pregnancy

A

Avoid - methotrexate
Safe - hydroxychloroquine, sulfasalazine, corticosteroids

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20
Q

Medications to avoid in pregnancy

A

NSAIDS
Betablockers - unless for HTN
ACEi ARBs
Opiates
Warfarin
Sodium valproate
Lithium
SSRI?
Isotretinoin

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21
Q

Define Kleihauer test

A

Checks how much fetal blood has been passed into the mothers blood during sensitisation

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22
Q

Define small for gestational age

A

Fetus that measures below the 10th centile for gestational age - estimated fetal weight or fetal abdominal circumference

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23
Q

Causes of small for gestational age

A

Constitutionally small
Fetal growth restriction

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24
Q

Catagories of fetal growth restriction

A

Placenta mediated growth restriction
Non-placenta mediated growth restriction - genetic/structural abnormality

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25
Q

Cause of placenta mediated growth restriction

A

Idiopathic
Pre-eclampsia
Maternal alcohol
Anaemia
Malnutrition
Infection
Maternal health condition

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26
Q

Causes of non placenta mediated growth restriction

A

Genetic abnormalities
Structural abnormalities
Fetal infection
Errors of metabolism

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27
Q

Signs of fetal growth restriction

A

Reduced amniotic fluid
Abnormal doppler studies
Reduced fetal movement
Abnormal CTGs

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28
Q

Complications of fetal growth restriction

A

Fetal death or stillbirth
Birth asphyxia
Neonatal hypothermia
Neonatal hypoglycaemia
CVD - HTN
TIIDM
Obesity
Mood and behaviour problema

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29
Q

Risk factors for small for gestations age

A

Previous
Obesity
Smoking
Diabetes
Existing hypertension
Pre-eclampsia
Older mother
Multiple pregnancy
Low PAPPA
Antepartum haemorrhage
Antiphospholipid syndrome

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30
Q

Management of small for gestational age

A

Serial growth scans
Aspirin - if risk of pre-eclampsia
Karyotyping,
Test for infection
Early delivery considered if static growth

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31
Q

Define large for gestational age

A

Macrosomia - when weight of the newborn is more than 4.5 KG at birth or >90th centile in pregnancy

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32
Q

Causes of macrosomia

A

Constitutional
Maternal diabetes
Previous macrosomia
Maternal obesity or rapid weight gain
Overdue
Male baby

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33
Q

Risks to mother in macrosomia

A

Should dystocia
Failure to progress
Perineal tears
Instrumental delivery or caesarean
Postpartum haemorrhage
Uterine rupture

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34
Q

Risks to baby of macrosomia

A

Birth injury - Erbs palsy, clavicular fracture, fetal distress, hypoxia
Neonatal hypoglycaemia
Obesity
TIIDM

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35
Q

Management of macrosomia

A

US
Oral glucose tolerance test - gestational diabetes
Early delivery
Management of complications

36
Q

Define multiple pregnancy

A

Refers to a pregnancy with more than one fetus -

37
Q

Define monozygotic

A

Identicle twine - single zygote

38
Q

Define dizygotic

A

Non-identical - two different zygotes

39
Q

Define monoamniotic

A

Single amniotic sac

40
Q

Define diamniotic

A

Two seperate amniotic sace

41
Q

Define monchorionic

A

Sharing single placenta

42
Q

Define dichorionic

A

Two seperate placentas

43
Q

Risks to mother of multiple pregnancy

A

Anaemia
Poyhydramnios
Hypertension
Malpresentation
Spontaneous preterm birth
Instrumental delvery or caesarean
Post partum haemorrhage

44
Q

Risks to babies in multiple pregnancy

A

Miscarriage
Stillbirth
Fetal growth restriction
Prematurity
Twin-twin transfusion syndrome
Twin anaemia polycythaemia sequence
Congenital abnormalities

45
Q

Define twin-twin transfusion syndrome

A

Occurs when foetuses share a placenta - one foetus may recieve majority of the blood from the placenta while the other is starved

46
Q

Presentation of UTI in pregnancy

A

Dysuria
Suprapubic pain or discomfort
Increased frequency of urination
Urgency
Incontinence
Haematuria

47
Q

Presentation of pyelonephritis in pregnancy

A

Fecer
Loin to groin pain
Renal angle tenderness
Vomiting
Loss of appetite
Haematuria

48
Q

Management of UTI in pregnancy

A

Nitro - avoid 3rd trimester
Amoxicillin
Cefalexin
(trimethoprim - avoid 1st trimester, avoid generally)

49
Q

Risk factors for VTE in pregnancy

A

Smoking
Parity >3
>35 years
BMI >30
Reduced mobility
Multiple pregnancy
Pre-eclampsia
Gross varicose veins
Immobility
FH
Thrombophilia
IVF

50
Q

Define pre-eclampsia

A

Refers to new high blood pressure in pregnancy with end-organ dysfunction, notably proteinuria.

51
Q

Triad of preeclampsia

A

Hypertension
Proteinuria
Oedema

52
Q

Risk factors for pre-eclampsia

A

Pre-existing hypertension
Previous hypetension in pregnancy
Existing autoimmune conditions
Diabetes
CKD
>40 years
BMI >35
>10 since previous pregnancy
Multiple pregnency
FH

53
Q

Presentation of pre eclampsia

A

Headache
Visual disturbance
Nausea
Upper abdominal or epigastric pain - liver swelling
Oedema
Reduced urine output
Brisk reflexes

54
Q

Management of pre-eclampsia

A

Aspirin - prophylaxis from 12 weeks with single high-risk factor or 2 moderate risk factors
Labetolol
Nifedipine
Methyldopa
IV magnesium sulphate - labour to prevent seizures
Fluid restriction

55
Q

Define eclampsia

A

Refers to the seizures associated with pre-eclampsia

56
Q

Management of eclampsia

A

Magnesium sulphate

57
Q

Define HELLP syndrome

A

Combination of features that occur as a complication of pre-eclampsia and eclampsia

58
Q

Features of HELLP syndrome

A

Haemolysis
Elevated Liver enzymes
Low Platelets

59
Q

Define gestational diabetes

A

Diabetes triggered by pregnancy - reduced insulin sensitivity

60
Q

Risk factors for gestational diabetes

A

Previous gestational diabetes
Previous macrosomia
BMI >30
Ethnicn - black, middle eastern, south asian
FH

61
Q

Investigations of gestational diabetes

A

Oral glucose tolerance test
5678
Fasting >5.6
At 2 hours >7.8

62
Q

Management of gestational diabetes

A

Fasting glucose <7 - trial diet and exercise 1-2 weeks then metformin, then insulin
Fasting >7 - start insulin +/- metformin
Fastin >6 plus macrosomia - start insulin +/- metformin

63
Q

Define obstetric cholestasis

A

Intrahepatic cholestasis of pregnancy

64
Q

Presentation of obstetric cholestasis

A

Itching - pruritis
Fatigue
Dark urine
Pale greasy stools
Jaundice

65
Q

Investigations of obstetric cholestasis

A

LFTs - ALT, AST, GGT

66
Q

Management of obstetric cholestasis

A

Ursodeoxycholic acid
Emollients + antihistamines

67
Q

Define acute fatty liver of pregnancy

A

Rapid accumulation of fat within the liver cells causing acute hepatitis

68
Q

Presentation of acute fatty liver of pregnancy

A

General malaise and fatigue
Nausea and vomiting
Jaundice
Abdominal pain
Anorexia
Ascites

69
Q

Investigations in fatty liver of pregnancy

A

Raised liver enzymes and low plateles
Raised WCC
Raised bilirubin

70
Q

Management of fatty liver of pregnancy

A

Admission and delivery of baby

71
Q

Define placenta previa

A

Where the placenta attaches in the lower portion of the uterus - low lying = within 20mm of the internal os, placenta praevia - over the internal os

72
Q

Complications of placenta praevia

A

Antepartum haemorrhage
Emergency c section
Hysterectomy
Maternal anaemia and transfusions
Preterm birth and low birth weight
Still birth

73
Q

Risk factors for placenta praevia

A

Previous c section
Previous placenta praevia
Older maternal age
Maternal smoking
Structural uterine abnormalities
Assisted reproduction

74
Q

Management of placenta praevia

A

Corticosteroid for lung development
Early delivery and c section

75
Q

Define vasa praevia

A

Where the fetal vessels are within the ftal mambrance and travel acros the internal os

76
Q

Define placental abruption

A

When the placenta separates from the wall of the uterus during pregnancy

77
Q

Risk factors for placental abruption

A

Previous abruption
Pre-eclampsia
Bleeding early in pregnancy
Trauma
Multiple pregnancy
Fetal growth restriction
Multigravida
Increased maternal age
Smoking
Cocaine

78
Q

Presentation of placental abruption

A

Sudden onset sever abdominal pain
Vaginal bleeding
Shock
Abnormal CTH - fetal distress
Wood uterus

79
Q

Management of placental abruption

A

Cannula
Bloods
Cross match 4 units
Fluid and blood resuscitation
CTG monitoring
Ultrasound
Antenatal steroids
Emergency c section

80
Q

Define placenta acreta

A

When the placenta implants deeper through and past the endometrium making it difficult to seperate after delivery of baby

81
Q

Types of placenta acreta

A

Acreta - surface of myometrium but not beyond
Increta - placenta attaches deeply into myometrium
Percreta - invades past the myometrium and perimetrium - potentiall reaching other organs

82
Q

Risk factors for placenta acreta

A

Previous
Previous endometrial curettage
Previous caesarean section
Multigravida
Increased maternal age
Low-lying placenta or praevia

83
Q

Define breech presentation

A

When the presenting part of the fetus is the legs and bottoms

84
Q

When can external cephalic version be used

A

36 weeks for nulliparous women
37 weeks in women who have previously given birth

85
Q

Causes of still birth

A

Unexplained
Pre-eclampsia
Placental abruption
Vasa praevia
Cord prolapse
Obstetric cholestasis
Diabetes
Thyroid disease
Infections - rubella, parvovirus listeria
Genetic abnormalities

86
Q

Risk factors for still birth

A

Fetal growth restriction
Smoking
Alcohol
Increased maternal age
Maternal obesity
Twins
Sleeping on back

Med Finals - Womens Health (10 decks)

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