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RNH > Maternal > Flashcards

Maternal Flashcards

1
Q

definition and etiology of maternal mortality

A

death while pregnant or within 42 days of TOP from a cause related to or aggravated by the pregnancy

CVD, suicide, ectopic, HTN disorders, haemorrhage, sepsis, DVT, PE, AFE

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2
Q

Mx of GORD

A

non pharm - don’t over eat, avoid acidic and spicy food, avoid caffeine, smoking and alcohol

pharm - antacids, PPI, histamine receptor antagonists

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3
Q

Mx of constipation

A

metamucil

movicol

coloxyl and senna

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4
Q

Mx of back pain

A

non pharm - light exercise, physiotherapy, hot and cold packs

pharm - paracetamol (avoid NSAIDs and aspirin)

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5
Q

Clinical features of obstetric cholestasis

A

pruritus of hands and feet without rash

rarely other biliary symptoms like jaundice, dark urine, pale stool

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6
Q

clinical features of acute fatty liver of pregnancy

A 
malaise
N&V
abdominal pain
jaundice
acute liver failure
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7
Q

anaemia defintion in pregnancy

A

1st trimester <110
2nd and 3rd <105
postpartum <100

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8
Q

maternal anaemia - complications for foetus and mother

A

foetus - IUGR, prematurity, B12 deficiency causes neuro deficits

maternal - fatigue, SOB, dizziness, lack of reserve for PPH

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9
Q

Mx of anaemia in pregnancy

  • how to correct ie meds and diet
  • SE of medication
  • F/U
A

iron supplementation 100mg/day

diet - leafy greens, red meat, vitamin C, avoid coffee and tea

SE PO iron - abdo discomfort, constipation, black stool, N&V

F/U: Hb 2/52 until corrected, continue supplements until 6 weeks postpartum

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10
Q

complications and management of varicella in pregnancy

A

complications

  • maternal varicella pneumonia, neurological spread
  • foetal congenital varicella syndrome

Mx in non immune mother
<96 hours from exposure, VZV Ig
>96 hours acyclovir PO

mother has varicella - acyclovir PO, USS monitoring, C/S if foetal or maternal compromise

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11
Q

Parvovirus B19 complications and management

A

foetus - miscarriage, anaemia, heart failure and death (hydrops fetalis)

no treatment available - supportive, USS monitoring

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12
Q

Hep B and C management in pregnancy

A

hep B - 3rd trimester medication to reduce viral load

Hep C - medication NOT recommended in pregnancy, wait until finished breast feeding

both - clean skin of neonate prior to injections, no scalp electrode, no foetal scalp sampling

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13
Q

pathophysiology of GDM

A

placenta secretes anti-insulin hormones ie glucagon, cortisol, lactose

maternal anti-insulin hormones increase ie thyroid hormone, cortisol

insulin resistance –> increased pancreatic production of insulin

not all women have enough reserve to increase insulin production –> GDM

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14
Q

pathophysiology of hypoglycaemia in the neonate born to mother with GDM

A

maternal glucose crosses placenta but insulin does not –> foetus increases insulin production

post partum - no maternal glucose, remaining increased insulins –> hypoglycaemia

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15
Q

risk factors for GDM

A 
age >40
personal hx of GDM
family hx of diabetes
PCOS
obesity
multiple pregnancy 
ATSI
steroids 
antipsychotics
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16
Q

diagnosing GDM

A

screen with OGTT at 24-28 weeks (earlier if RF present)

fast overnight, measure BGL, drink 75g glucose, measure 1 hr and 2 hrs after

diagnostic criteria for OGTT results:
fasting >5.1
1hr >10
2hrs >8.5

17
Q

GDM complications for mum and baby

A

baby - PTL, premature, hypoglycaemia, macrosomia or LGA, IUGR, polyhydramnios, birth trauma

mum - birth trauma, PET, PTL, PPH, increased risk for DM later

18
Q

glucose monitoring for mum with GDM and baby

  • antenatal
  • intrapartum
  • postpartum
A

mum - BGL QID
intrapartum 2 hourly
postpartum over 24 hours
repeat OGTT 6 weeks

foetal

  • USS from 24 weeks + doppler studies 4 weekly from 28/40
  • CTG intrapartum
  • postnatal BSL after 1st feed
19
Q

glycemic control for GDM and indications for medication

also other medications to give

A

non pharm: educate importance of management, refer dietician, EP

pharm:
- indications: failed 2 week diet, macrosomia or AC >75th percentile
- metformin 1st line
- add insulin if required

stop medications immediately postpartum

also give 5mg folate + aspirin

20
Q

metformin and insulin for delivery - when to stop them

A

metformin - cease once labour established or if elective CS stop 24hrs before

insulin - cease once labour established or if elective CS take night before but not morning of

21
Q

GDM mode of delivery

A

VB - okay if no macrosomia or other complications

CS - macrosomia >4500g

22
Q

MDT for GDM

A

dietician
diabetes educator
exercise physiologist
endocrinologist

23
Q

causes of postpartum pyrexia

A 
breast - mastitis
womb - endometritis
wind - atelectasis, pneumonia
water - UTI
wound infection - CS, episiotomy
walking - DVT
24
Q

treatment of endometritis

A

gentamicin + ampicillin + metronidazole

25
Q

clinical features of endometritis

A

fever, lower abdo pain, foul discharge, secondary PPH, tachycardia

26
Q

causes of maternal collapse

A

4Hs - hypoxia, hypovolemia, hyper/hypokalaemia, hypothermia

  • hypoxia: cardiomyopathy, MI, aortic dissection, aneurysm
  • hypovolemia: bleeding

4Ts - tension PTX, toxins (MgSO4), thromboembolism (DVT, PE, AFE), tamponade

27
Q

what is the edinburgh postnatal depression scale, when is it used, how is it interpreted

A

used as routine screening tool in antenatal period to assess for PND

10 Qs
>/= 9 or suicidal –> psychiatric assessment

28
Q

clinical features of PND

A 
excessive guilt and feelings of worthlessness
stop breastfeeding
negative feelings towards infant
denial
somatic symptoms
delayed attachment
29
Q

management of PND

A

safety - suicide and violence risk assessment, safety plan, +/- admission
bio - SSRI only for severe PND
psycho - educate, give resources, refer to psychologist specialising in PND, CBT, IPT
social - DV, do they require additional support, PANDA (postnatal anxiety and depression australia)

30
Q

antidepressant medications in pregnancy

A

SSRI - fluoxetine, sertraline, citalopram all safe
- should wean prior to birth if mild-mod depression

TCA - safe

SNRI - avoid

31
Q

what are ‘baby blues’

A

depressive symptoms 3-10 days postpartum

depressed, angry, irritable, teary, sensitive, anxious

32
Q

treatment of pre-existing bipolar or psychotic disorder in pregnancy

A

bipolar - stop lithium or anti-epileptic medications
- switch to antipsychotic

psychotic illness - typical and atypical medications are safe EXCEPT clozapine

33
Q

clinical features of postpartum psychosis

A

abrupt onset first few days following delivery - deteriorate daily

early - mainly psychotic features ie delusions, hallucinations, fear, agitation

later - mainly bipolar illness with mix of mania and depression

34
Q

drugs contraindicated in breastfeeding

A

anticancer drugs, lithium, oral retinoids, amiodarone and gold salts

RNH (9 decks)

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