Antenatal Obs Complications Flashcards by Guglielmo Vecchio

Cause of symphysis pubis dysfunction + mx

Happens in 3rd trimester
2 sides of pelvis rub
(simple analgesia)

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musculoskeletal complaints in pregnancy

Backache (elastic loosening of ligaments and exaggerated lumbar lordosis)
Carpal tunnel syndrome (simple analgesia and splinting)
Symphysis pubis dysfunction

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GI complaints in pregnancy

Constipation
Hyperemesis gravidarum
GORD
Haemorrhoids
Obstetric cholestasis

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Mx obstetric constipation

Mild non-stimulant laxatives (lactulose)

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Consequence of Hyperemesis gravidarum (HG)

Electrolyte imbalance, increased risk of preterm labour and LBW.
Severe cases: vit deficiencies, MW tear

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Diagnostic triad of HG

Greater than 5% weight loss (pre-pregnancy)
dehydration
electrolyte imbalance

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Mx HG

USE PUQE
Mild:
community mx w/ antiemetics (if this fails and PUQE score <13 manage at ambulatory day care w/ antiemetics)
Admit if:
continued vom and can’t keep antiemetics down
Continued weight loss + dehydration w/ ketonuria
Comorbidity (UTI) and inability to tolerate Abx

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Antiemetics for HG

1st line:
antihistamines (cyclizine) and phenothiazines (promethazine - associated w/ oculogyric crises and extrapyramidal s/e. NB - same happens w/ metoclopramide)
2nd line: metoclopramide ondansetron

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Rehydration for HG

saline and KCl
Thiamine
(remember LMWH prophylaxis if admitted)

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Causes of GORD

Size of uterus

Oesophageal sphincter relaxes

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HG discharge

Individualised management plan

If it’s still serious in 3rd trimester do serial growth scans

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GORD Mx

Lifestyle (smaller meals)

Medical: antacids, PPI, antihistamine

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Obstetric cholestasis presentation

2nd half

Pruritus and deranged LFT

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Mx obstetric cholestasis

Ursodeoxycholic acid
NB - only helps with symptoms
Offer delivery after 37 weeks

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Red degeneration of fibroid presentation and mx

If severe can lead to contractions + miscarriage

Tx: opiate analgesia and IV fluids

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DDx for red degeneration

Pyelonephritis
appendicitis
ovarian cyst accident
placental abruption

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Presentation of retroverted uterus + mx

Grows up into abdo cavity and presses on bladder.
Present w/ retention at 12-14 weeks
Catheterise

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common ovarian cysts in pregnancy

Serous cyst
Benign teratoma
Physiological cyst of corpus luteum

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Risk factors for UTI

Hx of recurrent cystitis
Urinary tract abnormalities
DM
Bladder emptying problems (MS)

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Mx UTI

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Abx 1st line amoxicillin or oral cephalosporin
fluid
simple analgesia

UTI causing pathogens

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E.coli (most common)
Proteus
Klebsiella
Pseudomonas

Mx pyelonephritis

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IV fluid
Strong (opiate) analgesia
IV abx (gentamicin or cephalosporin)
Monitor kidney function (urea and electrolytes)

Mx Recurrent UTI pregnancy

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Low dose prophylactic Abx

Urine sample + MSU at each antenatal visit

Abdo pain in pregnancy (obs causes)

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Early: 
Ligament stretching
Miscarriage
Retention due to retroverted placenta
Ectopic
Late:
Labour
Abruption
HELLP
Uterine:
Rupture
Chorioamnionitis

Abdo pain in pregnancy (unrelated to preganancy)

``` Uterine - red degeneration ovarian accident UTI renal colic Appendicitis Gastroenteritis Pancreatitis ```

coagulation changes in pregnancy

Increase in: factor 8, 9, 10 and fibrinogen | Reduction in protein C

diagnosis of antiphospholipid syndrome

2 positive tests at least 12 weeks apart for anticardiolipin or lupus anticoagulant

Ix for suspected DVT

Anyone suspected should get LMWH and compression stockings Do compression US If -ve and little suspicion stop If -ve and suspicion REPEAT IN 3-7 days

Ix for PE | what to do if mum has recurrent PE/known DVT

Do CXR + ECG If CXR abnormal do CTPA/V/Q (CTPA inc. risk of child cancer, V/Q inc. risk of breast ca) Repeat V/Q/CTPA if it shows nothing but there's still suspicion NB - consider IVC filter in PERIPARTUM period if people have recurrent PE or known iliac DVT

Mx Massive PE

1. unfravtionated heparin IV 2. portable CTPA 3. if PE confirmed commence thrombolysis

Maintenance thromboprophylaxis

Treat w/ daily subcut LMWH for remainder of pregnancy + 6 weeks after + longer potentially Need to give it for 3 months

How long after last dose of heparin can you do epidural

24 hours | NB - don't give heparin until 4 hours after spinal anaesthesia or epidural catheter comes out

Causes of oligohydramnios

``` Renal agenesis (potter syndrome) FGR and placental insufficency NSAIDS PPROM Leakage in post dates pregnancy ```

Maternal causes of polyhdramnios

Diabetes Chorioangioma placenta

foetal causes of polyhdramnios

Multiple pregnancy Oesophageal/tracheal atresia Neuromuscular problems (can't swallow) anencephaly

Breech predisposing factors - materanl

Fibroids uterine abnormalities previous uterine sx

Breech predisposing factors - foetal

multiple gestation placenta praevia oligo/polyhdramnios prematurity

Mx breech

ECV - do at 36 weeks if nulliparous, 37 if multiparous if unsuccessful counsel about vaginal vs c-section C-section: small reduction in foetal + neonatal morbidity but increased risk of immediate complication and complications in future pregnancy Vaginal: 40% risk of having emergency C-section. good option if normal size baby and multiparous. DO NOT DO IF FOOTLING

features of risky breech birth

hyperextended neck footling cephalopelvic disproportions

When to perform ECV? | What do you give with it?

37 weeks (w/ tocolytic - nifedipine and anti-D if mum is rhesus negative)

When should you immediately induce labour in post-partum pregnancy

``` Foetal: RFM CTG isn't perfect reduced amniotic fluid on US reduced foetal growth ``` Maternal: Mum has HTN or any other condition

Causes of APH

Placental - abruption, placenta praevia, vasa praevia Local cervical - cervicitis, ectropion, carcinoma Vaginal - trauma, infection

What are some 1st trimester sensitising events and what is the management of this?

miscarriage molar pregnancy therapeutic TOP heavy uterine bleeding 250iu

Mx sensitising events between 12-20wks

Give 250iu within 72 hours | Do Kleihauer to see if you need more

Mx sensitising event 20+ weeks

500iu within 72 hours | Do kleihauer to see if you need more

Mx in sensitised women

Ab tests every 2-4 weeks MCA doppler to check for anaemia Transfusion if anaemic (through umbilical vein) Deliver

What to do if unstable lie

ECV or elective c section

Types of face presentation

if chin anterior can deliver vaginally if you flex | if chin post deliver by C section

mx foetal growth restriction

Antenatal: monitoring: serial growth scan every 2 weeks, doppler US 2x/week to look at umbilical artery flow, advise mothers to check foetal movements ``` indications for immediate delivery: abnormal CTG (and RFM), abnormal doppler waveform ``` Delivery: deliver by 37 weeks give steroids <36 weeks

Antenatal Obs Complications Flashcards

(49 cards)