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Obstetrics and Gynaecology > Antenatal care > Flashcards

Antenatal care Flashcards

(109 cards)

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1
Q

What is the combined screening?

A

First line between 11-14 weeks and consists of measurement of nuchal translucency, b-HCG and PAPPA

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2
Q

Combined screening test results for Down’s

A

Thick nuchal translucency
High beta-HCG
Low PAPPA

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3
Q

What is the triple test?

A

For chromosomal abnormalities between 14-20 weeks
Beta-GCG - HIGH
AFP - LOW
Serum estriol - LOW

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4
Q

What is the quadruple test?

A

between 14-20 weeks
Also includes inhibin A

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5
Q

What does the combined test, triple and quadruple test indicate?

A

The risk of the fetus having Down’s syndrome

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6
Q

What antenatal testing is available for women high risk of having a child with Down’s syndrome?

A

Amniocentesis and Chorion villus sampling

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7
Q

Untreated hypothyroidism in pregnancy complications

A

SPAM

Miscarriage, anaemia, small for gestational age and pre-clampsia

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8
Q

Hypothyroidism in pregnancy management

A

Increase levothyroxine dose by 30-50% and titrate based on TSH level

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9
Q

Hypertension in pregnancy - medications that must be stopped

A

ACE inhibitors
ARBs
Thiazides and Thiazide-like-diuretics

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10
Q

Hypertension management in pregnancy

A

Labetelol
Calcium channel blockers
Alpha blockers

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11
Q

Pre-pregnancy considerations in women with epilepsy

A

Should take 5mg folic acid daily before conception to reduce risk of neural tube defects

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12
Q

Anti-epileptic drugs in pregnancy

A

Lamotrigine and carbamazepine are safer in pregnancy
Avoid sodium valproate - neural tube defects and development delay
Phenytoin - cleft lip and palate

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13
Q

Rheumatoid arthritis management in pregnancy

A

Avoid methotrexate
Hydroxychloroquine (first-line)
Sulfasalazine

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14
Q

NSAIDs MOA and pregnancy

A

Inhibit prostaglandins and should be avoided as prostaglandins are responsible for maintaining the ductus arteriosus and soften the cervix and stimulate uterine contractions.

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15
Q

Beta blockers in pregnancy - use and side effects

A

First line for high blood pressure due to pre-clampsia.
Can cause: foetal growth restrictions, hypoglycaemia and Bradycardia in neonate

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16
Q

ACE inhibitors and ARBs in pregnancy

A

They cross the placenta and cause reduced urine output in the foetus and therefore amniotic fluid (oligohydraminos) and hypocalvaria (incomplete formation of skull bones)

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17
Q

Opiates and pregnancy

A

Use during pregnancy causes withdrawal symptoms after the neonate is born - neonatal abstinence syndrome

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18
Q

What is neonatal abstinence syndrome?

A

When the foetus is exposed to opioids during pregnancy. Withdrawal symptoms - irritability, tachypnoea, high temperatures and poor feeding

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19
Q

Why is warfarin contraindicated in pregnancy?

A

Causes foetal loss
Congenital malformations
Bleeding during pregnancy - PPH, Foetal haemorrhage and intracranial haemorrhage

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20
Q

Why is sodium valproate contraindicated in pregnancy?

A

Neural tube defects and developmental delay

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21
Q

Why is lithium avoided in pregnancy?

A

Avoided in first trimester due to congenital cardiac abnormalities - ebstein’s anomaly - tricuspid valve is set lower on the right side of the heart causing a bigger right atrium and smaller right ventricle. Should be avoided in breastfeeding

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22
Q

Risks of SSRIs in pregnancy

A

First trimester - congenital heart defects
First trimester - paroxetine - congenital malformations
Third trimester - persistent pulmonary hypertension in the neonate

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23
Q

Contraindications of accutane in pregnancy

A

High teratogenic, causing miscarriage and congenital defects.

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24
Q

Cause of rubella

A

Togavirus

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25
Rubella incubation period
2-3 weeks and individuals are infectious from 7 days before symptoms and 4 days after onset of rash
26
Diagnose this
Rubella
27
When is rubella cause the most risk to the foetus?
In the first 8-10 weeks
28
Features of congenital rubella syndrome
Sensorineural hearing loss Congenital heart disease Congenital cataracts
29
Cause of chicken pox
Varicella-zoster virus
30
What does chicken pox during pregnancy increase the mother's risk of?
Pneumonitis
31
Features of foetal varicella syndrome
Skin scarring eye defects (microphthalmia) Limb hypoplasia Microcephaly Learning disabilities
32
Chicken pox treatment in woman <20 weeks pregnant and not immune
Give varicella-zoster immunoglobulin ASAP
33
Chicken pox treatment in woman >20 weeks pregnant and not immune
either give Varicella-zoster immunoglobulins or oral aciclovir should be given 7-14 days after exposure
34
Congenital toxoplasmosis
Infection with toxoplasma gondii. Spread via faeces from a cat. Triad of intracranial calcification, hydrocephalus and chorioretinitis
35
What is rhesus incompatibility?
When rhesus-D negative woman becomes pregnant, there is the possibility of her having a rhesus positive child. Mother produces rhesus-D antibodies. Subsequent pregnancies rhesus-D antibodies cross into the placenta and if baby is rhesus-positive, they attack the foetus and cause destruction of the red blood cells causing haemolytic -> haemolytic disease of the newborn
36
How to manage rhesus incompatibility?
Anti-D injections at 28 weeks and birth
37
When else should anti-D injections be given?
Antepartum haemorrhage Amniocentesis procedures Abdominal trauma
38
What is a Khleihauer test?
Checks how much foetal blood has passed into the mother during a sensitisation event after 20 weeks. Used to assess whether further anti-D injections are required
39
What measurements are used to assess foetal size?
Estimated foetal weight Foetal abdominal circumference
40
Definition of small for gestational age
<10 centile for their gestational age
41
Definition of severe small for gestational age
<3 centile for their gestational age
42
What constitutes as low birth weight?
<2.5 kgs
43
Causes of small for gestational age?
Constitutionally small - matches the mother and others in the family Foetal growth restriction (intrauterine growth restriction)
44
Causes of foetal growth restriction categories
Placenta mediated growth restriction Non-placenta mediated growth restriction i.e. genetic or structural abnormality
45
Causes of placenta mediated growth restriction
ISPAAM Idiopathic Pre-clampsia Maternal smoking Maternal alcohol Anaemia Malnutrition
46
Non-placenta mediated growth restriction
Genetic abnormalities Structural abnormalities Foetal infection
47
Complications of foetal growth restrictions - short term
Foetal death or stillbirth Birth asphyxia Neonatal hypothermia Neonatal hypoglycaemia
48
Complications of foetal growth restrictions - long term
Cardiovascular disease - hypertension Type 2 diabetes Obesity Mood and behavioural problems
49
Risk factors for small for gestational age
Previous SGA baby Obesity Smoking Diabetes Hypertension Pre-eclampsia Older mother >35 years Multiple pregnancies Low PAPPA Antepartum haemorrhage Antiphospholipid syndrome
50
Definition of large for gestational age
>4.5 kgs and estimated foetal weight >90th centile
51
Causes of macrosomia
Constitutional Maternal diabetes Previous macrosomia Maternal obesity or rapid weight gain Overdue
52
Risks of macrosomia to mother
Shoulder dystocia Failure to progress Perineal tears Instrumental delivery or caesarean PPH Uterine rupture (Rare)
53
Risks of macrosomia to baby
Birth injury (Erb's palsy, clavicular fracture, foetal distress and hypoxia) Neonatal hypoglycaemia Obesity in childhood and later life T2DM in adulthood
54
Define monoamniotic
Single amniotic sac
55
Define diamniotic
Two separate amniotic sacs
56
Define monochorionic
Share a single placenta
57
Define dichorionic
Two separate placentas
58
What is the lambda sign?
triangular appearance where the membrane between the twins meets the chorion
59
Multiple pregnancies complications to mother
Anaemia Polyhydraminos Hypertension Malpresentation Spontaneous pre-term birth Instrumental delivery or caesarean PPH
60
Multiple pregnancies complications to foetuses
Miscarriage Stillbirth Foetal growth restriction Prematurity Twin-twin transfusion syndrome Twin anaemia polycythaemia sequence
61
What is twin-twin transfusion syndrome?
When there is a connection between blood supplies of the two foetuses, one foetus may receive the majority of the blood from the placenta and the other foetus is starved of blood. The one with the majority of the blood supply can become fluid overloaded with heart failure and polyhydraminos. Whereas the other foetus has growth restriction, anaemia and oligohydraminos
62
What is twin anaemia polycythaemia sequence?
Similar to twin-twin transfusion syndrome but less acute. One twin becomes anaemia and the other develops polycythaemia (raised haemoglobin)
63
Delivery of mono amniotic twins method
Elective Caesarean section between 32-33+6 weeks
64
Diamniotic twins delivery method
Aim to deliver between 37 and 37+6 weeks
65
Asymptomatic bacteriuria in pregnancy are at higher risk of developing what?
Lower UTIs and pyelonephritis and subsequently pre-term birth
66
Presentation of lower UTIs in pregnant women
Dysuria Suprapubic pain Increased frequency of urination Urgency Incontinence Haematuria
67
Presentation of pyelonephritis
Fever Loin, suprapubic or back pain Vomiting Loss of apetite Haematuria
68
Organisms causing of UTIs
E. coli Klebsiella Pseudomonas
69
Management of UTIs in pregnancy
Requires 7 days of antibiotics Avoid nitrofurantoin in third trimester - risk of neonatal haemolysis Avoid Trimethoprim in first trimester - neural tube defects
70
Causes of microcytic anaemia
Iron deficiency
71
Causes of macrocytic anaemia
B12 or folate deficiency
72
Management of iron deficiency anaemia in pregnancy
Start with iron replacement - ferrous sulphate 200mg TDS
73
Management of B12 deficiency anaemia in pregnancy
Test for pernicious anaemia (intrinsic factor antibodies) IM hydroxocobalamin Oral cyanobalamin tablets
74
Folate deficiency anaemia in pregnancy
Start folic acid 5mg daily
75
When should you start VTE prophylaxis in pregnancy?
>3 risk factors at 28 weeks >4 risk factors in first trimester Should receive prophylaxis with LMWH - enoxaparin, daltaparin
76
Management of VTEs in pregnancy
LMWH - enoxaparin, daltaparin
77
Massive PE and haemodynamic compromise in pregnancy
Unfractionated heparin Thrombolysis Surgical embolectomy
78
Triad of pre-eclampsia
HOP Hypertension Proteinuria Oedema
79
Risk factors for pre-eclampsia
Pre-existing HTN Previous hypertension in pregnancy Existing autoimmune conditions - SLE Diabetes CKD
80
Symptoms of pre-eclampsia
Headache Visual disturbance or blurriness Nausea and vomiting Upper Abdo or epigastric pain Oedema Reduced urine output
81
Diagnosing pre-eclampsia
Systolic BP >140 Diastolic BP >90 + proteinuria, organ dysfunction, placental dysfunction
82
Medical management of pre-eclampsia
Labetolol (first line) Nifedipine (second-line)
83
Management of eclampsia
Magnesium sulphate
84
What is HELLP syndrome?
A complication of pre-eclampsia and eclampsia. H - Hemolysis EL - Elevated liver enzymes LP - Low platelet count.
85
Gestational diabetes- diagnosis
OGTT
86
Management of gestational diabetes in pregnancy
Fasting glucose <7 mmol/L - trial diet and exercise for 1-2 weeks, then metformin and then insulin Fasting glucose >7 mmol/L - insulin +/- metformin Fasting glucose >6mmol/L plus macrosomia - insulin +/- metformin
87
Pre-existing diabetes management in pregnancy
Women using metformin and insulin and other oral diabetic medications should be stopped. Referral to ophthalmology to check for diabetic retinopathy - risk of rapid progression
88
What is obstetric cholestasis?
Reduced outflow of bile acids from the liver. It resolves after delivery of the baby
89
How would obstetric cholestasis present?
Itching of the palms of the hand and soles of the feet Fatigue Dark urine Pale, greasy stools Jaundice
90
Investigations of obstetric cholestasis
LFTs and bile acids Raised bile acids Abnormal liver function tests ALP is usually raised in pregnancy.
91
What is acute fatty liver of pregnancy?
Rapid accumulation of fat within hepatocytes causing acute hepatitis
92
How would acute fatty liver of pregnancy present?
General malaise and fatigue Nausea and vomiting Jaundice Abdominal pain Ascites
93
What is the management of acute fatty liver of pregnancy?
Requires prompt admission and delivery of the baby. Management of acute liver failure and consider liver transplant
94
What are the three causes antepartum haemorrhage?
Planceta praaevia, placental abruption, and vasa praevia
95
Risks of placenta praevia
Antepartum haemorrhage Emergency C-section Emergency hysterectomy Maternal anaemia and transfusions Preterm birth and low birth weight Stillbirth
96
Grading placenta praevia
Grade I - placenta is in the lower uterus but not reaching the internal cervical os Grade II - placenta is reaching but not covering the internal cervical os Grade III - the placental is partially covering the internal cervical os Grade IV - the placenta is completely covering the internal cervical os
97
Risk factors for placenta praevia
Previous C-sections Previous placenta praevia Older maternal age Maternal smoking Structural uterine abnormalities - fibroids
98
How would placenta praevia diagnosed?
It would present at the 20 week abdominal scan
99
Management of placenta praevia
Repeat transvaginal ultrasound scans at 32 and 36 weeks. Give corticosteroids between 34 and 35+6 weeks to mature foetal lungs due to risk of preterm delivery Plan delivery between 36 and 37 weeks - to reduce the risk of spontaneous labour and bleeding. Emergency Caesarean section may be required with premature labour or antenatal bleeding
100
What is the main complication of placenta praevia? How is it managed?
Haemorrhage - emergency c section, blood transfusions, intrauterine balloon tamponade, uterine artery occlusion, emergency hysterectomy
101
What is placenta accreta?
When the placenta implants deeper, through and past the endometrium. This makes it difficult to separate the placenta after delivery of the baby.
102
Risk factors for placenta accreta
Previous placenta accreta Previous endometrial curettage procedures - e.g. for miscarriage or abortion Previous Caesarean section Mutligravida
103
Management of placenta accreta
Delivery planned between 35 to 36+6 weeks gestation to reduce the risk of spontaneous labour and delivery. Options during caesarean are: Hysterectomy Uterus preserving surgery Expectant management - risks of bleeding and infection
104
What is breech presentation?
When the presenting part of the foetus is the legs and bottom
105
Types of breech
Complete breech - legs are fully flexed at the hips and knees Incomplete breech - one leg flexed at the hip an extended at the knee Extended breech - also known as frank breech, with both legs flexed at the hip and extended at the knee Footling breech - with a foot is presenting through the cervix with the leg extended
106
Management of breech presentation
External cephalic version can be used at term 37 weeks to attempt to turn the foetus. If that fails, women are given the choice between vaginal delivery and elective caesarean section. Tocolysis - relax the uterus before procedure. Using subcutaneous terbutaline (beta agonist) - similar contractility of the myometrium, making it easier for the baby to turn.
107
What is External cephalic version?
A technique used to attempt to turn a foetus from the breech position to a cephalic position using pressure on the pregnant abdomen. Nulliparous - attempt after 36 weeks Women with previous births - after 37 weeks
108
Causes of stillbirths
Unexplained Pre-eclampsia Placental abruption Vasa praevia Cord colapse Obstetric cholestasis Diabetes Thyroid disease
109
Causes of obstetric haemorrhage
Ectopic pregnancy Placental abruption Placenta praevia Planceta accreta Uterine rupture

Obstetrics and Gynaecology (9 decks)

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