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Antenatal Problems Flashcards

(75 cards)

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1
Q

Name some of the causes of abdominal pain in pregnancy

A 
Foetal position
Reflux
Obstetric cholestasis
Syphysis pubis dysfunction (SPD)
Constipation
Placental abruption
Uterine rupture
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2
Q

What are some of the minor symptoms of pregnancy?

A 
Headaches, palpitations and fainting
Frequency
Abdominal pain, SOB
Constipation and haemorrhoids
Reflux and heartburn
Carpal tunnel syndrome
Rash and itching
Ankle oedema
Leg cramps
Cholasma (mask of pregnancy)
N+V
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3
Q

How is reflux in pregnancy treated?

A

Advised to avoid irritants such as spicy foods and coffee and raise the head of the bed.
Antacids and alginates are recommended. Sodium bicarbonate is contraindicated

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4
Q

What antacids are contraindicated in pregnancy?

A

Gaviscon liquid
Liquid Rennies
Anything containing sodium bicarbonate

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5
Q

How is constipation treated in pregnancy?

A

First line: lifestyle advice - increase fibre, fluids and mobility
Second line: ispaghula husk (bulk)
Third line: lactulose (osmotic)

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6
Q

What is the cause of symphysis pubis dysfunction?

A

Increased ligmental laxity due to increased levels of relaxin in pregnancy

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7
Q

What are the symptoms of SPD?

A 
Waddling gait (antalgic)
Tenderness of symphysis pubis joint
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8
Q

How is SPD managed?

A

Analgesia (paracetamol, codeine, dihydrocodeine)

Physiotherapy

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9
Q

What are the diagnostic criteria for obstetric cholestasis?

A

Pruritis + abnormal LFTs or raised bile acids

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10
Q

What are the symptoms of obstetric cholestasis?

A

Pruritis (esp of hands and feet)
NO rash
RUQ pain
Murphy’s sign positive

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11
Q

What bloods should be done in obstetric cholestasis and what results would be diagnostic?

A

LFTs: increased liver enzymes excluding ALP

Bile acids: raised

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12
Q

How is obstetric cholestasis managed?

A

Emollients for symptomatic relief
Antihistamines help with itching
Ursodeoxycholic acid
Delivery at 37 weeks

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13
Q

Should women with obstetric cholestasis be induced and why?

A

Yes, induction at 37 weeks

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14
Q

What monitoring should be done for women with a diagnosis of obstetric cholestasis?

A

CTG every 2/52

LFTs every 2/52

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15
Q

What are the risk factors for obstetric cholestasis?

A 
ITCH mnemonic
In the past (FH/previous)
Twins
Calculi (gallstones)
Hepatitis C
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16
Q

What should all PV bleeding in pregnancy be treated as?

A

Threatened miscarriage until proven otherwise

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17
Q

What are the causes of PV bleeding in pregancy?

A 
Normal spotting
Extrachorionic bleed
Post-coital bleed
Ectropion
Placental abruption
Placenta praevia
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18
Q

What is the most common cause of 1st trimester bleeding?

A

Extrachorionic haemorrhage

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19
Q

What is an extrachorionic haemorrhage?

A

Collection of blood between the uterine wall and chorionic membrane

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20
Q

What are the risk factors for extrachorionic bleeding?

A

IVF
Multiparity
Increased maternal age

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21
Q

What sign present on USS indicates a extrachorinic collection?

A

Crescenteric collection sign

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22
Q

How is an extrachorionic haeomorrhage managed?

A

Nil - monitoring.

Bleeding usually resolved in 1-2 weeks

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23
Q

What are the symptoms of an extrachorionic bleed?

A

Light bleeding and spotting in early pregnancy

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24
Q

What are the complications of an extrachorionic haemorrhage?

A

Increased risk of:

  • Miscarriage
  • Abruption
  • Preterm labour
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25
What factor in extrachorionic bleeding makes a miscarriage more likely?
If the bleed is near to or over the internal cervical os
26
What is are the diagnostic criteria for hyperemesis gravidarum?
Severe nausea and vomiting Weight loss more than 5% of prepregnancy weight Dehydration Electrolyte imbalance
27
What signs may be present in hyperemesis gravidarum?
``` Signs of dehydration: - CRT >2s - Dry mucous membranes - Reduced UO Tachycardia Epigastric pain Excessive salivation ```
28
When is hyperemesis gravidarum more likely?
Wks 6-11
29
What are the risk factors for hyperemesis gravidarum?
Primiparity Multiple pregnancy Infertility treatment
30
How is hyperemesis gravidarum diagnosed?
Fulfillment of all diagnostic criteria AND +++ urinary ketones
31
What is the criteria for admission in hyperemesis gravidarum?
Unable to tolerate PO fluids AND dehydrated
32
What is the first line treatment for a woman with hyperemesis gravidarum who is not dehydrated?
Advise to eat little and often, plain carbohydrates
33
What is the first line treatment for a woman with hyperemesis gravidarum and associated dehydration?
IV fluids Antiemetics: IV cyclizine Vitamin supplementation
34
How much maternal weight loss is associated with IUGR in hyperemesis gravidarum?
10% prepregnancy weight
35
In very severe hyperemesis gravidarum, what treatment is recommended?
High dose IV steroids
36
What is the definition of SGA?
Estimate foetal weight less than the 10th centile
37
Below what centile is a growth abnomality suspected?
3rd centile
38
What is the head sparing effect?
In IUGR, the head often grows at the expected rate, but the lower body is growth restricted
39
What is the likely cause of IUGR with head sparing?
Placental insufficiency
40
What are the RF for SGA?
``` Previous SGA baby Previous stillbirth Increased maternal age Existing maternal disease IVF pregnancy ```
41
What role does abdominal examination have in assessing SGA?
None - abdominal palpation is not an accurate way to measure growth
42
What are some of the causes of SGA?
``` Smoking Short pregnancy interval Antiphospholipid syndrome Genetic abnormalities Congenital infection Chronic maternal disease Placental insufficiency Maternal pregnancy problems (e.g. pre-eclampsia) ```
43
How is SGA monitored?
Serial funal-symphyseal heights and serial growth scans every 3/52
44
What treatment is indicated if a woman has a history of SGA?
150mg aspirin daily
45
Should women with a suspected SGA baby be offered early delivery and if so, when?
YES - deliver by 37 weeks (34 weeks if growth plateaus) | If c-section: maternal steroids
46
When should steroids and magnesium sulfate be offered to women in labour?
Steroids: for foetal lung maturation Preterm labour before 36wks or C-section labour before 37 weeks Magnesium sulfate: neuroprotective for foetus Given in preterm labour prior to 34 wks
47
What is the definition of LGA?
Estimated foetal weight above 90th centile
48
What are the causes of LGA?
Constitutionally large Maternal diabetes Hyperinsulinaemia Beckwith-Wiedemann syndrome
49
How is LGA monitored?
Serial fundal-symphyseal heights and USS growth scans every 3/52
50
What are the complications of LGA?
Shoulder dystocia Need for C-section Neonatal hypoglycaemia
51
How is LGA managed?
May recommend C-section or instrumental delivery | If baby is significantly large, consider induction at 37wks
52
When should foetal movements first be felt?
18-20wks
53
Why are foetal movements important?
Used as a marker of foetal wellbeing (55% of women with stillbirth reported RFM)
54
What is the expected progression of foetal movements?
Foetal movements are first felt between 18-20wks. | They should increase in number until 32wks, and then plateau - BUT NOT REDUCE
55
What are the causes of reduced foetal movements?
``` Anterior placenta Sedating drugs Malformation Anterior position of foetal spine Placental insufficiency ```
56
How is RFM investigated?
Maternal perception USS or Doppler CTG with buzzer (press when foetus moves)
57
How is RFM managed?
If visible movements on USS; reassure | If RFM is evident on scan, assess FHR. if FHR is reduced or absent consult local guidance
58
What are the risk for the baby in prolonged pregnancy?
``` Meconium aspiration Shoulder dystocia Neonatal acidaemia Neonatal hypoglycaemia Neonatal seziures IUGR due to placental insufficiency ```
59
What are the risk for the mother in prolonged pregnancy?
``` Obstructed labour Perineal damage Instrumental or C section delivery PPH Infection (due to meconium) ```
60
What are the RF for prolonged pregnancy?
``` Primiparity Previous prolonged pregnancy High BMI FH Increased maternal age ```
61
How is prolonged pregnancy managed?
Induction at 41 or 42 weeks
62
If induction is refused, how is prolonged pregnancy managed?
Biweekly USS, CTG and Doppler | Risk education
63
What is PPROM?
Preterm prelabour rupture of membranes
64
What are the risk factors for PPROM?
Smoking Previous PPROM Short interpregancy interval Maternal respiratory disease
65
How is PPROM diagnosed?
Maternal history of 'gush' and no membranes visible on speculum
66
What investigations should be done in addition to a speculum in PPROM?
WCC + CRP CTG and USS for foetal wellbeing HVS for infection
67
How is PPROM managed?
Admit for up to 72hrs - high risk of preterm labour Prophylactic erythromycin until established labour or 10/7 (depending on which is sooner) If under 34wks: MgSO4 If under 36wks: steroids
68
Should a woman with PPROM be induced?
Only if not in established labour at 37wks
69
What are the complications fo PPROM?
``` Preterm delivery Ascending infection (chorioaminitis) ```
70
What are the RF for preterm labour?
``` Smoking PPROM Short interpregancy interval Previous LLETZ Respiratory disease of mother ```
71
What investigations are used to confirm preterm labour?
``` Cervical length >15mm indicated unlikely to be labouring Foetal fibronectin (from 30wks) 50ng/ml+ indicates labour is likely Speculum examination - membranes may or may not be intact ```
72
How is preterm labour managed?
Tocolysis: nifedipine AND maternal corticosteroids with IV MgSO4
73
What groups are eligible for preterm labour prophylaxis?
Previous preterm labour Previous mid-trimester loss AND TV USS shows cervical length less than 25mm from 16-24wks
74
What methods are used for preterm labour prophylaxis?
``` Vaginal progesterone Cervical cerclage (cervical stitch) ```
75
What is the definition of preterm labour?
Labour prior to 37wks

Obstetrics (5 decks)

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