obs Flashcards
(153 cards)
1
Q
when does a secondary PPH occur
A
500ml 24hrs-12 weeks post birth
2
Q
when can you not give ergometrine IV in PPH
A
when there is hx of HTN (it can cause coronary artery spasm)
3
Q
when can you not give carboprost IV in PPH
A
when there is a hx of asthma (as causes bronchospasm)
4
Q
what happens if mum gets chicken pox in first 20 weeks of pregnancy
A
fetal varicella syndrome - problems with the eyes, limbs and microcephaly
5
Q
what is the risk to mum with chicken pox in pregnancy
A
5x more likely to get pneumonitis, hepatitis, encephalitis
6
Q
what is the risk if mum gets chicken pox around delivery
A
neonatal varicella syndrome
7
Q
MX of chicken pox exposure in pregnancy
A
-check varicella antibodies
-If no immunity, give oral aciclovir 7-14 days post exposure.
-if rash is present, start aciclovir within 24 hours if more than 20 weeks pregnant
8
Q
features of congenital rubella syndrome
A
sensorineural deafness, cataracts, CHD
9
Q
Dx of rubella in pregnancy
A
IgM
10
Q
Mx of rubella in preg
A
discuss with the health protection unit, offer MMR to non immune mothers after pregnancy
11
Q
when are babies not at risk of congenital rubella syndrome
A
after 16 weeks
12
Q
what does congenital CMV cause
A
growth restriction, microcephaly and hearing loss, blueberry muffin skin lesions
13
Q
what does syphilis cause in babies
A
stillborn
14
Q
complications of parvovirus in pregnancy
A
miscarriage, severe fetal anaemia –> hydrops fetalis from heart failure
15
Q
Dx for parvovirus in pregnancy
A
IgM to parvovirus which tests for acute infection, IgG which detects long term immunity and rubella antibodies as a differential diagnosis
16
Q
What does listeriosis come form
A
unpasteurised dairy products and processed meats
17
Q
when does herpes present the highest risk to babies
A
in final 6 weeks –> need C section (cause neonatal herpes infection which can be localised or can disseminate)
18
Q
in a mum who is known to have herpes, what should you consider?
A
prophylactic acyclovir from 36 weeks
19
Q
if herpes is caught early on in the pregnancy, how is it treated
A
aciclovir
20
Q
scoring for HG
A
PUQE
21
Q
Mx of HG
A
1) promethazine / cyclizine
2) prochlorperazine (extrapyramidal SE)
3) ondansetron
22
Q
Rf for HG
A
molar, multiple, nulliparity
23
Q
Mx of molar pregnancy
A
evacuation of the uterus and then monitored hCG for 6 months (until it returns to normal), managed at a GTD centre
24
Q
what is a choriocarcinoma
A
when moles metastasise, get systemic symptoms like coughing, chest pain and breathing difficulties
25
what contraception is available after birth
-POP can be started straight away
-COCP cannot be started for 21 days due to unacceptable VTE risk
-COCP contraindicated for 6 weeks if breastfeeding
-Ius/IUD can be put in in the 48 hours after birth or then after 4 weeks
-Lactational amenorrhea method —> effective for 6 months
25
taking sertraline in pregnancy gives a risk of what
withdrawal in baby (so must be monitored for 24 hours) and persistent pulmonary hypertension
26
how many women get PND
10% - normally start months 1-3, difficulty bonding, low mood, guilt
27
SSRI if severe PND
paroxetine / sertraline
28
complications of PND
recurrence and higher risk of lifetime depression
29
what class of drugs is firstline in morning sickness
antihistamines
30
if a woman has pre existing HTN in preg, what should happen to their meds?>
stop ACEi/ARB and start on labetolol ( also monitor for proteinuria)
31
what is pregnancy induced HTN
HTN occurring in the second half of preg, after 20 weeks
-no proteinuria or oedema which resolves after birth (treat with labetolol and monitor for weekly proteinuria)
32
cause for preeclampsia
abnormal placentation (impaired invasion of trophoblasts leading to shallow invasion of spiral arteries ---> oxidative stress --> endothelial dysfunction)
-this causes increased permeability which causes oedema and proteinuria.
33
high risk factors of preeclampsia
pre existing HTN, CKD, DM, autoimmune conditions like SLE
34
moderate RF of preeclampsia
primi, BMI >35, molar, multiple preg, 10 year gap, first degree relative.
35
what risk reduction is started for women with 1 high risk factor or 2 moderate risk factors for pre eclampsia
aspirin 150mg daily from 12 weeks
36
signs of preeclampsia
HTN, oedema in peripheries, proteinuria, growth restriction, oligohydraminos, epigastric/RUQ pain, hyperreflexia
37
what Ix of you do for someone with preeclampsia
FBC
U+E
LFT coat profile
level of proteinuria by ACR (>300mg in 24 hours or 2++ on dip)
PlGF
38
Mx of preclampsia
-regular monitoring of mum and baby (CTG / doppler)(
-aspirin
-labetolol / nidefipine / methyldopa
-VTE prophylaxis
39
complications of preeclampsia for mum
ICH, stroke, pulmonary oedema, eclampsia , HELLP. DIC, placental abruption
40
complications of preeclampsia for baby
stillbirth, small baby, premature, placental abruption
41
RF of placental abruption
low BMI, cocaine, smoking, polyhydraminos, multiple pregnancy
42
Mx for placental abruption
Emergency - A_E
-bloods --> FBC, U+E, LFTs, clotting
-crossmatch
-CTG
-US to rule out praaevia
-anti D prophylaxis (kleihauer test)
-C section if distress
43
Rf for GDM
previous macrocosmic baby, FHx of DM, BMI > 30, black/Asian
44
what preconception counselling is done for someone known DM
-aim HbA1c < 6.5%
-BMI <27
-folic acid 5mg
-stop statin
-stop any oral glycaemias APART from metformin
-carry on with insulin
-managed in joint antenatal and diabetes clinic
45
for GDM patients, when should delivery occur
39-40+6 weeks
46
for preexisting DM, when should delivery occur
37-38+6 weeks
47
what is the post delivery MX of GDM
stop all Tx and re monitor HbA1c at 12 weeks
48
targets for GDM once starting Tx
fasting <5.3
1 hour post meal < 7.8
2 hours post meal <6.7
49
what 2 ways can preterm labour be prevented
1) vaginal progesterone (if cervix <25mm at 20 week US)
2) cervical cerclage
50
RF of preterm birth
previous preterm, PPROM, cervical trauma, smoking
51
what is it important not to do in PPROM (preterm premature rupture of membranes)
DV exam, do a sterile speculum exam instead to look for pooling of water (if unsure check PAMG and IGFBP1)
52
Mx of PPROM
admit - steroids, 10 days erythromycin, monitor temp for infection, expectant mx until 37 weeks
53
when do you suspect preterm labour with intact membranes
when there is regular and painful contractions and cervical dilation without rupture of membranes
54
Mx of preterm labour with intact membrane
1) speculum to look for cervica dilation
2) if < 30 weeks --> offer Tx
3) if > 30 weeks --> TV US to look at cervical length, if it is >15mm then labour is unlikely.
-if insure can check fetal fibronectin. (<50 = unlikely)
The MX:
-CTG
-tocolysis - nifedipine to stop contractions
-steroids
-mag sulphate
55
what is is important to never do in PROM
DV exam due to infection
56
contraindications to tocolysis
dilation >4cm, >34 weeks, chorioamnionitis, non reassuring CTG
57
what kind of insulin is GDM treated dwith
short acting
58
if a woman is unsure whether she has reduced FM, what should she be advised
lie on left side and concentrate on movements, should have 10 movements in 2 hr (after 28 weeks)
59
Ddx for RFM
fetal death, FGR, TORCH, positional change, sedate drugs, oligohydraminos or polyhydraminos
60
secondary PPH
24 hours - 12 weeks
61
how does uterus feel in atony
soft and boggy
62
RF for atony cause of PPH
advanced maternal age, polyhydraminos, multiple pregnancy, prolonged labour
63
what bacteria normally causes endometritis (most common cause of a secondaryPPH)
mixed gram - and +
64
when is the major haemorrhage protocol activated
>1000ml
65
SE of oxytocin
hypotension, flushing, headache
66
complications of PPH
anaemia, hysterectomy, sheehan syndrome, PTSD
67
Dx of endometritis
vaginal swabs, urine cultures, do US to rule out RPOC
68
MX of endometritis
sepsis 6 if septic, otherwise broad spec Abx (prevented by prophylaxis abx in C section)
69
which part of pituitary gland undergoes avascular necrosis in PPH
anterior only (as this is supplied by the low pressure hypothalamohypohyseal system)
70
what happens in postpartum thyroiditis
hyperthyroid -->hypothyroid --> normal
71
RF of cord prolapse
breech, prem, ARM
72
what Abx is given for GBS prophylaxis
benzylpenicillin
73
RF for GBS infection
preterm, previous baby affected, high temperature, positive urine test, swab test for GBS, PROM
74
which race at risk of OC
Asian
75
IX for OC
LFT and bile acids, USS abdo, liver autoimmune screen
76
what monitoring is required in OC
LFT weekly and after 10 days post pregnancy
77
what vitamin needs to be replaced in OC
vitamin K
78
what happens in placenta accreta
the placenta attaches to the myometrium due to a defective decider basalis
79
what's the different between placenta accrete, placenta increta and placenta percreta
placenta accreta --> attaches to myometrium but does not go through it
Placenta increta --> chorionic villas invaded the myometrium
Placenta percreta --> chorionic villi invade through the perimetrium
80
RF for placenta accreta
previous C section, placenta praaevia, previous PID, advanced age3
81
Mx of placenta accreta
-delivery at 35-36+6 weeks
-hysterectomy if not known until delivery
-expectant Mx (if known about and MRI has been done to look at invasion) --> have blood transfusions and ITU on standby
82
What is measured on a bishops score
-dilatation of cervix
-consistency of cervix
-cervical length (effacement)
-position of cervix
-station of presenting part
-max score 13
83
quadruple test screening results for DS increased likelihood
↓ AFP
↓ oestriol
↑ hCG
↑ inhibin A
84
causes of oligohydraminos
PROM, potter sequence, FGR, TORCH infections
85
IX for oligohydraminos
US, karyotyping
86
MX of oligohydraminos
serial fetal testing due to increased risk of fetal demise
87
apart from pulmonary hypoplasia, what are the other problems with oligohydraminos
limb deformities, cord compression
88
complications of polyhydraminos for mum
-worse pregnancy symptoms like reflux and SOB due to compression of the diaphragm
-PPH
89
causes of polyhydraminos
idiopathic, macrosomia, oesophageal atresia, muscular dystrophies
90
Mx of polyhydraminos
-not normally needed
-if symptoms vvv bad can do amnioreduction
-can use indomethacin - increase water retention and reduce fetal urine output
91
why is risk of VTE so high in preg
loss of anticoagulants, venous stasis, increase in clotting factors
92
when is VTE risk assessed
at booking and at any subsequent appointments
93
Rf for VTE
BMI>30, age >35, smoker, gross varicose veins, preterm birth, hyperemesis, ART
94
what do you do if you identify 4 RF for VTE
LMWH straight away until 6 weeks PP
-THIS IS ALSO IF ANY HX OF VTE IN MUM
95
what do you do if you identify 3RF for VTE in preg
LMWH from 28 weeks until 6 weeks PP
96
Ix for VTE in preg
venography with fetal shield (gold standard)
-doppler US is a good alternative
97
does anything need to be monitored in mum on LMWH
anti Xa
98
what side DVT is more common in preg
left sided 85%
99
what is chorioamnionitis
infection of fetal membranes and amniotic fluid (RF = PROM and GBS)
100
on SFH, when does a baby need a uterine artery doppler and serial growth scans (where head circumference, abdominal circumference, and femur length are measured)?
if on <10th centile
101
what is a large for dates baby
>90th centile
102
what is a severe SGA
<3rd centile
103
what does it mean if a foetus has symmetrical IUGR vs asymmetrical
symmetrical --> intrinsic factors like chromosome abnormalities and infections
asymmetrical --> malnutrition / alcohol / placenta insufficiency
104
Investigations for fetal growth
vital signs, urine dip and BP (to check for preeclampsia), CTG, screen for infections and DP, biophysical profile (amniotic fluid measurements), karyotyping (by amniocentesis), detailed fetal anatomy scan
105
what is done every 3/4 weeks in IUGR
serial growth scan and umbilical artery doppler
106
what are worrying signs on umbilical artery doppler
-absent end diastolic flow
-reverse end diastolic flow
ANSWER IN EXAM WILL BE UMBILICAL ARTERY DOPPLER
107
uterine artery doppler (think more of a screening tool) shows worrying signs when, this can be done if someone has RF for IUGR as a screening tool firstline
pulsatility index >95th gentile and early diatonic notching
108
Causes for a large for dates baby
true causes - genetic syndrome like beckwith wiedemann / GDM / maternal obesity
other causes - large fibroids
109
Mx for large for dates babies
nothing!! induction not advised unless GDM
110
RF for uterine rupture
previous C section, induction, multiple preg
111
what causes symphysis pubic dysfunction (pain when walking/turning over in bed/climbing stairs)
separation of the pubic symphysis
112
what happens to mums respiration in pregnancy
increased minute ventilation (from increased TV not from increased RR)
-minute ventilation = TV x RR
113
what happens to the immune system in preg
mum does into immunosuppressed state so she does not attack the hemi-allogradt
114
what happens to the cardiovascular system in pregnancy
cardiac output increases by increasing stroke volume in early pregnancy and in later pregnancy HR increases
-get a procoagable state (loss of anticoagulants and increase in clotting factors)
-activation of RAAS to increase the circulating volume
115
what happens to the renal system in preg
eGFR goes up due to increase renal blood flow due to systemic vasodilation
-get reduced reabsorption of glucose in PCT so there is glycosuria
-get relaxation of smooth muscle so decrease in urine passage
116
what is a galactocele
a cystic lesion in the breast which causes a milky discharge and normally occurs when a woman stops breast feeding
117
causes for poor supply in breast feeding
maternal prolactin deficiency (Thyroid disorder, alcohol), mother perception, breast hypoplasia
118
what is raynauds disease of the nipple
intermittent soap pain which is present during / immediately after feeds which causes blanching
119
what are some issues with twin pregnancy
worse symptoms for mum (sickness, GORD), increased risk of preeclampsia, PPH, prematurity, poor growth, twin to twin transfusion
120
when can vaginal delivery be attempted with twins
if diamniotic and if the first twin is head down
121
what are some delivery points for twins
2 obstetricians / 2 midwives around
-offered/encourage to have epidural incase intervention needed
-CTG - with fetal scalp electrode attached to first baby
122
dizygotic twins are always diamnitoic, dichorionic, what are the options for monozygotic twins?
can have their own sacs/placentas but can also share
123
what happens in vasa praaevia
fetal blood vessels are not protected by the umbilical cord and run near the orifice
124
Mx of vasa praaevia
C section at 34-36 weeks
125
RF for vasa praaevia
IVF + multiple pregnancy
126
why is UTI common in preg
relaxation of smooth muscle (ureteral dilation), immunocompromised state, compression by gravid uterus
127
MX of UTIin preg
nitro for 7 days AND always send a urine culture and look for GBS
-in final trimester use amoxicillin / cefalexin
128
after lifestyle measures, what's firstline for dyspepsia in pregnancy
antaacids and alginates
129
what is the blastocyst (embryology)
the trophoblast and the embryo blast in the second week with a cavity (blastocele)
130
what happens to the blastocyst
the trophoblast becomes the syncytiotrophoblast and the cytoplast and the embryo blast becomes the epiblast and the hypoblast
131
what happens in the third week of embryonic developing
gastrulation where the epiblast undergoes migration and invagination and becomes endoderm, mesoderm and ectoderm
the hypoblast becomes the embryonic membranes
132
what does the mesoderm become
connective tissue - cartilage / smooth muscle
133
how do the villi of the placenta form
the primary villi form form the cytotrophoblast, the secondary villli = mesenchymal core and the tertiary villi occur when blood vessels fill the mesenchymal core
134
when is placental development complete by
week 10
135
anaemia limits in pregnancy
first trimester <110, second and third <105, PP<100
136
consequences of anaemia in mum
tired, increased risk of permpartum blood loss, poor concentration
137
consequences of anaemia in foetus
preterm delivery, LBW, increased anaemia in first 3 months
138
preconception considerations for haemoglobinopathies
1) folic acid 5mg
2) worsening anaemia in preg
3) painful crisis
4) genetic counselling
5) check vaccination status
6) daily penicillin prophylaxis due to hyposplenism
7) risk of prematurity AND growth restriction
8) MX in haem/obstetric clinci
139
when should uterus return to non pregnant size
4 weeks
140
what hepatitis is likely to cause serious illness in preg
hep E (spread by feacal oral route, does NOT cause chronic illness or increased risk of hepatocellular carcinoma)
141
risks of obesity in preg
to mum: pre-eclampsia, GDM, VTE, problems in labour requiring intervention
to baby: more likely to be obese in life, more likely to be premature, big baby - complications for baby like nerve injuries
-need to take 5mg of folic acid
-need to have baby at a obstetric led hospital
142
stepwise MX of PPH
1) manual uterine rub and bimanual compression
2) IV oxytocin or IV ergometrine
3) IM carboprost
4) rectal misprostol
5) surgical intervention such as balloon tamponade / uterine artery ligation and last --> hysterectomy
143
where does toxoplasmosis come from
cat poo / undercooked meet --> causes chorioretinitis in eye and calcium deposits in brain
144
if women has pre-existing diabetes, when should delivery be done
37-38+6weeks
145
mx of pre-existing DM in preg
stop oral glycemic apart from metformin, start insulin, want BMI <27, manage in joint diabetes obstetrics clinic
146
Tx is resp depression occurs due to magnesium sulphate
calcium gluconate (note must continue magnesium sulphate until 24 hours after the last seizure)
147
apart from magnesium sulphate, whats another important TX for eclampsia
fluid restriction
148
Kleihauertest is needed for any sensitisation event over what gestation? to see if any additional anti D is needed
20 weeks
149
major RF for IUGR
+ minor
MAJOR
-pre-eclampsia
-kidney disease
-APS / SLE
-previous SGA or previous still birth
-cocaine use
-smoking
MINOR
low or high BMI
nulliparity
150
complications of SGA
neonatal hypoglycaemia, iatrgoenic prematurity due to expediting labour, NEC, stillbnirth
151
rhesus antibodies are what
IgG (these can cross the placenta)
152
signs of haemolytic disease of the newborn
jaundice in first 24hr of life, hepatosplenomegaly, hydrops fetalis,
