Flashcards in Obs Deck (52):
What is hyperemesis gravidarum
Severe or persistent vomiting in pregnancy
How many women are affected by hyperemesis gravidarum
2% of pregnancies
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
Nutritional deficiency + weight loss
What makes n+v more common in pregnancy
Hx of past hyperemesis gravidarum
Younger maternal age
DDX of hyperemesis gravidarum
GI infection, irritation, ulcer, appendicitis etc
Torted ovarian cyst
Management of vomiting in pregnancy
Eat small regular meals
High carbohydrate low fat meals
Avoid foods / smells that trigger syx
Tx of hyperemesis gravidarum
If severe refer to hospital - fluid and electrolyte replacement + nutritional support.
Complications of hyperemesis gravidarum
Rarely --> wernicke's encephalopathy, central pontine myelinosis, spontaneous oesophageal rupture.
Can diabetic women have a vaginal birth?
Should be offered elective induction or CS after 38wks
Babies born to diabetic mothers are at risk of what after birth?
Monitor for 24 hrs after birth.
Diabetic mothers who breast feed are at an increased risk of _________
Average length of a pregnancy
Term = 38-42 weeks
Average cycle length
On what day of a 28day cycle does ovulation occur
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.
Feature of past pregnancies which may be relevant to current pregnancy
Early onset pre-eclampsia
Fetal growth restriction
What does gravida mean
The number of pregnancies - regardless how they ended
What does parity mean?
Number of births > 24 weeks - live or still
Pre-existing diseases which may impact pregnancy
connective tissue disorders
What impact may existing DM have on pregnancy
Fetal growth restriction
What impact may hypertension have on pregnancy
What impact may existing renal disease have on pregnancy
Worsening renal disease
Fetal growth restriction
What impact may existing epilepsy have on pregnancy
Increased fit frequency
Congenital abnormality (medication)
What impact may existing VTE disease have on pregnancy
Increased risk of VTE in pregnancy
In obs ex - inspect for:
Scars - caesarean, laparotomy, laparoscopy, appendicectomy, cholecystectomy
In obs ex - palpate for:
Symphysis-fundal height (SFH) + measure
Number of fetal poles
Types of fetal lie
Types of presentation
When is a vaginal examination necessary in pregnancy
Offensive or excessive discharge
Vaginal bleeding - exclude placenta praevia 1st
Confirm rupture of membranes
When is surfactant production maximal?
What does it do?
After 28 weeks
Prevents collapse of small alveoli during expiration
What is fetal respiratory distress syndrome
Respiratory distress in 1st few hours of life
Due to lack of surfactant in premature infants.
Complications of fetal respiratory distress syndrome
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
Symptoms of pregnancy
When may the fetal heart by heard with a Doppler
Booking investigations include
FBC - anaemia, thrombocytopenia
Blood group + rhesus status
What fetal abnormalities are screened for
Neural tube defects
Structural congenital abnormalities
How is Down's syndrome screened for
- Nuchal translucency scan 11-14 wks
- HCG levels
- pregnancy associated plasma protein - A
- maternal age
How are neural tube defects screened for
Serum alpha-fetoprotein levels at 15-20 wks
Scan at 18 -20 wks
Presentation of amniotic fluid embolism
Rapid onset cardiovascular collapse, acute left ventricular failure, pulmonary oedema, disseminated intravascular coagulation, neurological impairment.
Respiratory distress / Peripheral or central cyanosis
When may amniotic fluid embolism occur
Termination of pregnancy.
Delivery - unexpectedly, up to 30 minutes after delivery.
Symptoms of placental abruption
Abdominal / pelvic pain
What name is given to PV bleeding during pregnancy before 24 weeks gestation?
Define Antepartum haemorrhage
Pv bleeding after 24weeks Gestation.
It can occur at any time until the second stage of labour is complete
Causes of antepartum haemorrhage
Vulval infection / Trauma / Tumour
Cervical infection/ Trauma / Tumour
What is placenta accreta
Placental penetration into the myometrium
What is placenta increta
Placental invasion into the myometrium
What is placenta percreta
Where the placenta crosses the uterine wall and invades the peritoneum
What is placental abruption
Separation of the placenta from the uterus before delivery of the fetus
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.
What is Functional incontinence
When the patient is unable to reach the toilet in time
E.g. poor mobility / unfamiliar surroundings.