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Flashcards in Obs Deck (52):
1

What is hyperemesis gravidarum

Severe or persistent vomiting in pregnancy

2

How many women are affected by hyperemesis gravidarum

2% of pregnancies

3

Syx of hyperemesis gravidarum

Starts between 4-7 weeks - often resolves by 16wks
N+V any time in the day - may be constant
Fluid and electrolyte disturbance
Ketonuria
Nutritional deficiency + weight loss

4

What makes n+v more common in pregnancy

Primigravidae
Multiple pregnancy
Hx of past hyperemesis gravidarum
Younger maternal age

5

DDX of hyperemesis gravidarum

Hydatiform mole
Pre-eclampsia
GI infection, irritation, ulcer, appendicitis etc
Torted ovarian cyst
drug SE
Raised ICP
diabetes
Bulimia nervosa

6

Management of vomiting in pregnancy

Ginger
Wrist acupressure
Rest
Eat small regular meals
High carbohydrate low fat meals
Avoid foods / smells that trigger syx
Antihistamines

7

Tx of hyperemesis gravidarum

Prochlorperazine
Cyclizine
Metoclopramide

If severe refer to hospital - fluid and electrolyte replacement + nutritional support.

8

Complications of hyperemesis gravidarum

Dehydration
Weight loss
Electrolyte disturbance
Ketosis

Rarely --> wernicke's encephalopathy, central pontine myelinosis, spontaneous oesophageal rupture.

9

Can diabetic women have a vaginal birth?

Yes
Should be offered elective induction or CS after 38wks

10

Babies born to diabetic mothers are at risk of what after birth?

Neonatal hypoglycaemia
Monitor for 24 hrs after birth.

11

Diabetic mothers who breast feed are at an increased risk of _________

Hypoglycaemia

12

Average length of a pregnancy

40 weeks
280 days
Term = 38-42 weeks

13

Average cycle length

28 days

14

On what day of a 28day cycle does ovulation occur

14th day

15

How to calculate EDD from LMP

Date of LMP + 9m + 7d

If the cycle is >28d also add the difference between 28 and the cycle length.

16

Feature of past pregnancies which may be relevant to current pregnancy

Recurrent miscarriage
Preterm delivery
Early onset pre-eclampsia
Abruption
Congenital abnormalities
Macrosomic baby
Fetal growth restriction
Unexplained stillbirth

17

What does gravida mean

The number of pregnancies - regardless how they ended

18

What does parity mean?

Number of births > 24 weeks - live or still

19

Pre-existing diseases which may impact pregnancy

Diabetes mellitus
Hypertension
Renal disease
Epilepsy
VTE disease
HIV
connective tissue disorders
Myasthenia gravis
Myotonic dystrophy

20

What impact may existing DM have on pregnancy

Marosomia
Fetal growth restriction
Congenital abnormality
Pre-eclampsia
Stillbirth
Neonatal hypoglycaemia

21

What impact may hypertension have on pregnancy

Pre-eclampsia

22

What impact may existing renal disease have on pregnancy

Worsening renal disease
Pre-eclampsia
Fetal growth restriction
Preterm delivery

23

What impact may existing epilepsy have on pregnancy

Increased fit frequency
Congenital abnormality (medication)

24

What impact may existing VTE disease have on pregnancy

Increased risk of VTE in pregnancy

25

In obs ex - inspect for:

Asymmetry
Fetal movements
Scars - caesarean, laparotomy, laparoscopy, appendicectomy, cholecystectomy
Striae gravidarum
Linea nigra

26

In obs ex - palpate for:

Symphysis-fundal height (SFH) + measure
Number of fetal poles
Fetal lie
Fetal presentation
Fetal engagement

27

Types of fetal lie

Longitudinal
Transverse
Oblique

28

Types of presentation

Cephalic
Breech

29

When is a vaginal examination necessary in pregnancy

Offensive or excessive discharge
Vaginal bleeding - exclude placenta praevia 1st
Cervical smear
Confirm rupture of membranes

30

When is surfactant production maximal?
What does it do?

After 28 weeks
Prevents collapse of small alveoli during expiration

31

What is fetal respiratory distress syndrome

Respiratory distress in 1st few hours of life
Due to lack of surfactant in premature infants.

32

Complications of fetal respiratory distress syndrome

Hypoxia
Asphyxia
Intraventricular haemorrhage
Necrotizing enterocolitis

33

Functions of amniotic fluid

Protect against mechanical injury
Permit fetal movement while preventing limb contracture
Prevent adhesions between foetus and amnion
Permit fetal lung development

34

Symptoms of pregnancy

Breast tenderness
Nausea
Amenorrhea
Urinary frequency

35

When may the fetal heart by heard with a Doppler

12 weeks

36

Booking investigations include

FBC - anaemia, thrombocytopenia
Blood group + rhesus status
Urinalysis
Rubella status
Hepatitis B
HIV
Syphillis

37

What fetal abnormalities are screened for

Down's syndrome
Neural tube defects
Structural congenital abnormalities

38

How is Down's syndrome screened for

Combined test
- Nuchal translucency scan 11-14 wks
- HCG levels
- pregnancy associated plasma protein - A
- maternal age

39

How are neural tube defects screened for

Serum alpha-fetoprotein levels at 15-20 wks
Scan at 18 -20 wks

40

Presentation of amniotic fluid embolism

Rapid onset cardiovascular collapse, acute left ventricular failure, pulmonary oedema, disseminated intravascular coagulation, neurological impairment.

Bleeding diathesis
Tachypnoea
Respiratory distress / Peripheral or central cyanosis
Hypotension
Bronchospasm
Seizure
Chest pain

41

When may amniotic fluid embolism occur

Termination of pregnancy.
Amniocentesis.
Placental abruption.
Trauma.
Caesarean section.
Delivery - unexpectedly, up to 30 minutes after delivery.

42

Symptoms of placental abruption

Abdominal / pelvic pain
Bleeding

43

What name is given to PV bleeding during pregnancy before 24 weeks gestation?

Miscarriage

44

Define Antepartum haemorrhage

Pv bleeding after 24weeks Gestation.
It can occur at any time until the second stage of labour is complete

45

Causes of antepartum haemorrhage

Placental abruption
Placenta praevia
Vulval infection / Trauma / Tumour
Cervical infection/ Trauma / Tumour
Vasa Praevia
Uterine rupture

46

What is placenta accreta

Placental penetration into the myometrium

47

What is placenta increta

Placental invasion into the myometrium

48

What is placenta percreta

Where the placenta crosses the uterine wall and invades the peritoneum

49

What is placental abruption

Separation of the placenta from the uterus before delivery of the fetus

50

What is vasa praevia

= Velamentous cord insertion
Where the placenta has developed away from the attachment of the cord
The vessels divide in the membrane.

51

What is Functional incontinence

When the patient is unable to reach the toilet in time
E.g. poor mobility / unfamiliar surroundings.

52

What is potters syndrome

Oligohydramnios causes facial deformity, epicanthic folds, low set ears, pulmonary hypoplasia, joint deformity.