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OBS and GYNAE > Antenatal care > Flashcards

Antenatal care Flashcards

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1
Q

Congenital rubella

A

Congenital rubella cx by rubella infection in the mother during first 20 weeks

Mx - MMR vaccine before pregnancy (not during)

Sx - deafness, cataracts, heart abnormalities, learning disability

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2
Q

Chicken pox in pregnancy

A

Cx - VZV

Risks with pregnancy - varicella pneumonitis, hepatitis, encephalitis, fetal varicella syndrome, nenopnatal varicella infection

Ix - tets IgG for immunity

Mx - Presenting with rash within 24hrs - acyclovir
No rash - Check AB, give antivirals 7-14 post exposure

IV varicella immunoglobulins
- rash give oral acyclovir

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3
Q

Congenital varicella syndrome

A

1% of maternal chicken pox cases

Sx - fetal growth restriction, microcephaly, hydrocephalus, learning disability, scars and skin changes, limb dysplasia, cataracts

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4
Q

What is Rhesus incompatibility

A
  • rhesus D negative mother, exposed to rhesus D positive child blood - becomes sensitised to rhesus D antigens
  • Mother with anti rhesus D ABs becomes preganant, child is rhesus positive
  • Mothers ABs induce haemolysis of newborn cells - haemolytic disease of newborn

Mx - IM Anti D injections to rhesus D negative women

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5
Q

What is pre-eclampsia

A

New high blood pressure in pregnancy with end organ dysfucntion, notably proteinuria

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6
Q

What causes pre-eclampsia

A

occurs after 20 weeks

Spiral arteries of placenta form abnormally, leading to high resistance in vessels

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7
Q

Presentation of preeclampsia 3

A

Hypertension, proteinuria, oedema

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8
Q

Diagnosis of pre-eclampsia

A

New onset high BP after 20 weeks >140/90 AND one or more of: proteinuria or other organ involvement

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9
Q

Symptoms of pre-eclampsia 9

A

Headache, visual disturbance, nausea, upper GI pain, oedema, reduced urine, brisk reflexes

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10
Q

Mx of pre-eclampsia

A

Prophylaxis
Aspirin

Acute
Labetalol 1st line
Nifedipine 2nd line

*Urgent referral to 2nd care

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11
Q

Eclampsia

A

Seizures associated with pre-eclampsia

Mx - Magnesium sulphate
- may need to deliver

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12
Q

HELLP syndrome

A

Combination of features that occurs as a complication of preeclampsia and eclampsia

Haemolysis
elevated liver enzymes
low platelets

Mx - deliver

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13
Q

Gestational diabetes RF

A

Previous GD, previous macrosomnia, BMI>30, ethnic origin, FH of diabetes

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14
Q

Ix for GD

A

Oral glucose tolerance test - completed at 24 and 28 weeks

Normal results
Fasting <5.6
2hrs <7.8

  • Higher indicate GD
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15
Q

Mx of GD

A

<7mmol - advice on diet and exercise

If 6-6.9 and macrosomnia or hydramnios - insulin given

> 7mmol - insulin started

Within 2 weeks - range not hit - add metformin

  • glibenclamide given if cannot tolerate metformin or if you decline insulin
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16
Q

Mx of pre-existing diabetes in pregnancy

A

weight loss if BMI>27

Stop meds except metformin

Commence insulin

Folic acid 5mg a day

Treat retinopathy as can worsen In pregnancy

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17
Q

Complications of GD at birth

A

Macrosomnia

Neonatal hypoglycaemia - babies become accustomed to high levels of glucose but after birth levels reduced cx problems

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18
Q

RF for antepartum haemorrhage

A

Placenta praaevia
vasa praevia
Placental abruption

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19
Q

What is placenta praevia

A

Where the placenta is blocking the exit of the cervical os

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20
Q

RF for placenta praaevia

A

Previous sections, previous praaevia, older age, smoking, structural abnormalities, IVF

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21
Q

Px of placenta praevia

A
  • Painless vaginal bleeding
  • Usually asymptomatic
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22
Q

Mx of placenta praevia

A

Repeat US monitoring

Steroids given - due to increase risk of preterm

  • Recheck at 32 weeks then 36 weeks
    Planned c section at 37-38 weeks
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23
Q

What is vasa praaevia

A

Where the fetal vessels (2 umbilical arteries and 1 umbilical vein) are outside of the umbilical cord protection and are covering the exit for the cervical os

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24
Q

RF for vasa praaevia

A

Low lying placenta
IVF
Multiple preg

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25
Px of vasa praaevia
Picked up on US but unreliable so only diagnosed at birth * Bleeding during pregnancy
26
Mx of vasa praevia
Steroids given Elective c section
27
What is Placental abruption
Where the placenta separates from the wall of the uterus during pregnancy
28
RF for placental abruption
previous placental abruption pre-eclampsia bleeding early in pregnancy trauma multiple preg fetal growth restriction multigravida increased age smoking cocaine or amphetamine use
29
Px of placental abruption
Sudden onset severe abdopain, continuous, vaginal bleeding, signs of shock, CTG abnormal, woody abdomen (large haemorrhage)
30
Ix of placental abruption
ClINICAL DIAGNOSIS CTG US Bloods - FBC, Coat...
31
Mx of placental abruption
Resus Emergency section * If no signs of fetal distress <36 weeks give steroids*
32
What is Placenta accreta
Placenta implants deeper into the walls of the uterus - difficult to separate after birth different levels of invasion of placenta
33
RF for placenta accrete
previous c section, or curettage procedure, defect in endometrium, multigravida, increased age, low lying placenta
34
Px of placenta accreta
Usually asymptomatic - can present with antepartum haemorrhage in 3rd trimester
35
Dx/Ix of placenta accreta
Antenatal US scans Dx at birth when difficult to remove placenta
36
Complications of placenta accreta
Post partumn haemorrhage
37
Mx of placenta accreta
Medical Steroids given planned early delivery Surgical - caesarean Expectant - let endometrium absorb - risk of bleeding and infection uterus preserving - resect part of myometrium and placenta Hysterectomy - reccomened
38
What is obstetric cholestasis and what causes it
Where the flow of bile from the hepatic duct to the bowel is impaired - cx by an increase in progesterone and oestrogen
39
Px of obstetric cholestasis
3rd trimester Itching - palms of hands and soles of feet - fatigue, dark urine, pale greasy stool, jaundice *Resolves after pregnancy
40
Ix for obstetric cholestasis
LFTs, bile acids, * ALT, AST, CGT raised - ALP raised as well
41
ALP levels in pregnancy
Raised^^ - placenta produces ALP
42
Mx of obstetric cholestasis
emollients for itching Chlorphemaine for sleeping Ursodeoxycholic acid * water soluble Vitamin K - bile not being absorbed can cx deficiency
43
Complications of obstetric cholestasis
Still birth
44
How to reduced risk of VTE in pregnancy
Lifestyle Weight loss, BP reduced, stay mobile, no smoking, Medical LMWH - enoxaparin Compression stockings
45
DVT ix of choice in preg
US doppler
46
Hypothyroid in pregnancy (risks and mx)
Risk - miscarriage, anaemia, small for gestational age, pre-eclampsia Mx - Levothyroxine levels increased by 50% in preg
47
Hypertension in pregnancy (CI drugs and mx)
CI - ACE, ARB, thiazide/thiazide like Mx - beta blockers - CCB - Alpha blockers
48
Epilepsy in pregnancy (mx) Epileptic drugs to avoid
Epileptic - 5mg folic acid per day - reduce neural tube defects seizures not harmful in pregnancy other than physical injury Mx - levitracetam, lamotrigine, carbamazepine **Sodium val - neural tube defects - AVOID **phenytoin - cleft lip and palate
49
Rheumatoid arthritis (mx) Drugs to avoid
* Often improves during pregnancy Hydroxychloroquine 1st line, sulfasalazine, steroids in flares safe Avoid methotrexate - miscarriage and congenital defects
50
NSAIDs in pregnancy
AVOIDED prostaglandins maintain ductus arteriosus which is crucial for fetal supply Stimulate uterine contractions * Can close duct and delay labour
51
Beta blockers in pregnancy
AVOIDED Fetal growth restriction Hypoglycaemia in neonate Brady cardia in neonate
52
ACE and ARB in pregnancy
AVOIDED cross placenta and enter foetus, affect kidneys by reducing urine and cause incomplete formation of skull bones - Reduced oligohydramnios, miscarriage, fetal death, renal failure and hypotension In neonate
53
Opiates in pregnancy
AVOIDED Can cx withdrawals in neonate - neonatal abstinence syndrome
54
Neonatal abstinence syndrome and sx
Mother takes opiates during pregnancy and neonate has withdrawals Sx - 3-72hrs after birth - irritability, tachypnoea, high temp, poor feeding
55
Warfarin in pregnancy
AVOIDED Teratogenic - fetal loss, congenital malformations (craniofacial), bleeding during pregnancy, PPH, fetal haemorrhage, intracranial bleeding
56
Sodium valrpoate
AVOID Neural tube defects and developmental delays
57
Lithium in pregnancy
AVOIDED Congenital cardiac abnormalities - Ebstein's anomaly
58
SSRI in pregnancy
Generally avoided Risk need to be balanced against the benefit Hear defects, congenital abnormalities, pulmonary hypertension, withdrawal sx
59
Cx of small of gestational age
Defined as being below 10th centile for GA Continuously small - grows appropriately along growth chart Fetal growth restriction -
60
Cx of fetal growth restriction
Placenta mediated - transfer of nutrients impaired - idiopathic, pre-eclampsia, smoking, alcohol, anaemia, malnutrition, infection Non placenta medicated - pathology of the foetus genetic defects, structural abnormalities, fetal infection, metabolism errors,
61
Cx of large for gestational age
Defined as being >4.5kg at birth or above 90th centile constitutional, material diabetes**, previous macrosomnia, maternal obesity, overdue, male baby
62
Risk to mother of large for gestational age
Shoulder dystocia**, failure to progress, perineal tears, instrumental delivery or section, PPH, uterine rupture
63
Risk to baby of large for gestational age
Birth injury - erbs, clavicular fracture, fetal hypoxia... hypoglycaemia obesity in childhood T2DM in adulthood
64
Mx of breech presentation
ECV - external cephalic version - at 36 weeks - woman given tocolysis to relax uterus (beta agonist) *Rhesus D negative women require anti D prophylaxis before Elective C section
65
Risk of breech presentation
Cord prolapse, birth trauma, mortality
66
Anaemia in pregnancy
* Decreased Hb concentration in pregnancy Px - SOB, fatigue, dizziness, pallor Ix - MCV normal - physiological - due to preg - AB for pernicious Mx - Iron, B12, folic acid already
67
Prophylaxis of phospholipid and SLE
- Aspirin 75mg daily after 12 weeks
68
What type of insulin do you give for GD
- short acting insulin
69
When do you rescan if there is a low lying placenta on 20 week scan
- 32 weeks
70
Flying whilst pregnant cut offs
Single child - 37 weeks Twins - 32 weeks
71
How long should someone take folic acid for
- 12 weeks before trying and 12 weeks into pregnancy
72
What is the low risk dose of folic acid
- 400ug
73
Who needs increased dose of folic acid in pregnancy
- diabetes , obese epilepsy, family or previous history,
74
When is anti D needed
* Give a rhesus positive women: Ectopic, evacuation of retained products, vaginal bleeding, APH, trauma, ECV
75
What is routinely screen for during g preg
- HIV, rubella, syphilis, Hep b
76
Placenta increta level
- Invades deep through to myometrium
77
Mx of group b strep
- IV benzylpenicillin in labour
78
Exposure mx to VZV
- Blood test for VSV Ab - Antivirals or IVIG given day 7-14
79
When is Anti D routinely given
- 28 weeks and 34 weeks - just 28 weeks
80
Semen sample inadequate
- 3 months after an inadequate
81
What is gestational thrombocytopenia
* Pregnant women develops low platelet count during the 3rd trimesters
82
Px of gestational thrombocytopenia
- benign and self limiting - no sx and no bleeding risk - mild reduction in platelets
83
Most common cause of 1st trimester miscarriage
- Antiphospholipd syndrome
84
When should methotrexate be stopped before pregnancy
- 6 months for both partners

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