Gen Preg Flashcards
FGM
Counselling
Illegal - esp to reinfibulate
Obstetric - labour dystocia, tears/lacs, instrumental, epis, PPH, SB, infant resus
Sexual - dyspareunia, decreased satisfaction, anorgasmia
Gynae - chronic vulvodynia, vaginal discharge, UTI, dysmenorrhea
Psychological - PTSD, anxiety/depression
Stillbirth investigations
Gold standard: post mortem
MUM - hx of thrombosis, APS, bile salts, LFTs
Baby - autopsy,
if not, then clinical examination by paeds, MRI, babygram, minimally invasive autopsy
Placenta - macroscopic exam, histopath, cytogenetic, swabs
Anti D Isoimmnunisation
250IU first trimester
625IU if multiple
If 2nd tri incl amnio, TOP, APH, ECV = 625IU
If > 1 in 16, refer to MFM
Persisntent anaemia due to tranplacenta allo-antibody destruction of fetal blood cells
Titres
Test partner
MCA PSV
Consider cordocentesis - DAT, Hb + bilirubin levels
Neoate
-observe for jaundice/anaemia, feed regularly, consider phototherapy or plasma exchange
Hydrops
Isoimmunisation rhesus
Chromosomal - turners, Tri 18/13, molar
Autoimmune
U
Structural e.g. cardiac, thoracic, GI obsturction
Trauma - Fetal maternal haemorrhage, TWINS, TUMOUR
Infection - parvovirus, but also toxo/cmv
C
Differentials large for dates
Incorrect dates
Fibroid
Multiple gestation
Molar/gestational trophoblastic disease
Management hyperemesis
Admit IV fluids Anti emetics - cyclizine, metoclopramide, PRN ondans Folic acid 5mg, Iodine Thiamine Pyridoxine Regular ketone checks Daily weight Dietician Regular small meals
Breech Delivery
Frank (extended knees most successful)
Offer ECV if intact membranes (primip from 36)
Analgesia, lithotomy
Ideally wait until breech reaches pelvic floor,
Commence pushing,
Fetus often deliveries spontaenously to the umbilicius
Maintain sacrum anteriorly
Grasp bony prominences only, if needed, SI joint, Ant sup iliac spines, avoid soft abdo
If legs do not deliver spontaneously, hook them anteriorly
Rotate body 90-180 degrees to deliver shoulders (Lovsetts)
MSV mauriceau-smelli-veit once occiput is visible, two fingers non dom hand on malar prominences, other hand neck/shoulders/middle finger occiput
Suprapubic pressure can increase flexion
Body rests on palm and forearm
Gentle downward traction + elevation
Forceps can be used for after coming head
RISKS - cord prolapse, nuchal arm, traumatic injuries
Parvovirus
C - DNA virus, maternal may be asym or slapped cheek, athralgia of large joints
May be detected as hydrops
R M-self limiting
F - <20 weeks, 10% excess fetal loss
9-20 weeks, 3% get hydrops (1/3 need IUT, 1/3 recover)
If no hydrops, v low risk congenital issue
Invx - confirm maternal serology, IgM can take 2-3 weeks to become positive, MFM USS, 1-2 weekly MCA PSV, if elevated, IUT, amnio not needed, repeat MCA PSV until 12 weeks post infection
T - TOP not offered as no long term sequalae
O
CMV
C - DNA virus, self limiting in parents, can be re-activated
R
M-low risk
F - early = structural, later in preg = visceral (hepatitis/pneumonia)
Growth
N- FU 2 years, seizures, developmental delay, microcephaly, chorioretinitis, SNHL within first 2 years.
90% of transmission = asymptomatic
OVERALL risk of long term sequalae in a congenitally infected infant is 10-20%
(30% risk of transmission, 10% of those = infected, 50% of those = long term sequalae, OVERALL 10-20% of INFECTED babies have issues)
Invx - Maternal serology, if IgG positive, then avidity, if LOW avidity = RECENT infection
- USS - cns (microcephaly, calcifications), oligo/poly, hydrops, echogenic bowel, iugr
- Amnio >20/40 + 6/52 after primary
- MRI: microcephaly
T - no maternal treatment
-Consider TOP if affected, infected fetus may not be affected
O
Day care worker/parent of toddler
CMV
School aged parent
Parvovirus
MCDA twins
Single embryo
Chorionicity determined by 14 weeks
Oral iron, 5mg folate, detailed anomalie + cardiac scans
Fortnightly from 16 weeks
Detailed anoamlie + cardiac as increased risk (uneven distribution inner cell mass)
TTTS -15%, quintero
SFGR - 15% , refer >20% discrep, gratacos (1,2,3)
TAPS - post laser, small anastomseis (anaemia/polycythaemia)
TRAP - acardiac twin
Co twin demise - 15% demise, 26% abnormality , MRI to assess surviving twin neuro
Advise Mum symptoms of TTTS, increased girth, SOB, decreased movements
Mode of delivery, if >32 weeks, consider vaginal if cephalic
Increased risks in twins
GESTATION based
1 in 90
Slightly higher >35, therefore more anomalies
Hyperemesis Anaemia GDM PTB VTE APH Poly operative delivery PPH PND Maternal mortality
Fetal risks of prematurity/PPROM
PREMATURITY Hyaline membrane disease Intraventricular haemorrhage Periventricular leukomalacia Infection - sepsis, pneumonia, meningitis NEC Retinopathy
Pulm hypoplasia
MSK/facial deformities as reduced amniotic fluid + restricted mvmt
Malpresentation
Abruption
Umbilical cord issues - compression/prolapse
Lithium
Antipyschotic/mood stabiliser (alternatives lamotrigine, quetiapine, risperidone)
Risks
Ebstein anomaly
Polyhydramnios
Associated with thyroid issues
Consider: weaning if stable (DONT stop abruptly), switching to another anti-pyschotic
-4 weekly levels
-Weekly from 36 weeks
Stop in labour due to fluctuations, risks and signs of toxicity
NOT breastfeeding, therefore dostinex, extended stay postnatally
