Obstetrics Flashcards
(50 cards)
Define Gravity and Partity.
Gravity = Number of pregnancies Parity = Number of pregnancies made it past 28w
Antibiotics given in pregnancy for UTI?
1st and 2nd Trimester - give Nitrofurantoin 100mg BD for 7 days
3rd trimester - Trimethoprim 200mg bd
Can you breastfeed whilst on psychiatric medications?
What is the safest SSRI in pregnancy?
No
Safest - Fluoxetine
Best management for Hyperthyroidism in pregnancy
Avoid Carbamazepine - give Propylthiouracil
When should methotrexate be stopped in regards to pregnancy?
Ideally 3 months prior to trying to conceive
What trimester should NSAIDS be avoided? Why?
Should be avoided in 3rd trimester
Can cause premature closing of the ductus arteriosis
What should the management be switched to for pregnant women with Anti-phospholipid syndrome?
Normal management for antiphospholipid syndrome is Warfarin
Need to be switched to Low molecular;ar weight heparin (eg enoxaparin) + aspirin from 6w to 34 w
What is pre-eclampsia?
Triad of
- Hypertension
- Proteinuria
- Oedema (peripheral)
Can occur from 20w
Should resolve within 10 days
RF for Pre-eclampsia
FH/Previous Hx of pre-eclampsia Pre-existing HTN/renal disease Multiple pregnancy First birth (primipartity) Obesity Migraine Hx
How does pre-eclampsia present?
Headaches, visual disturbance, sudden oedema/weight gain, N&V
Investigations for pre-eclampsia?
FBC, U&Es, LFTs, Coag
BP
Urinalysis
USS
Management of Preeclampsia?
IF BP rises more than 30/20 since booking, or SYS is more than 160 then admit
1st line Mx - labetalol
2nd line - Nifedipine
Aiming for target of below 135/85
If mum is at high risk of pre-eclampsia, any prophylatic treatment?
Aspirin from 12w until birth
What is placental abruption? How does it present?
Placental abruption is when there is a separation of placenta away from the uterus
Presents as: painful bleeding, tender uterus and backspin, bloody cervix
Diagnosis and management of placental abruption?
Diagnosis - clinical
Mx - Deliver baby
What is placenta praevia?
RF?
placenta is attached to lower portion of the uterus usually near or even over the cervical os
notable cause of Antepartum haemorrhage
RF: Multiple pregnancy, Prior c-sections, Hx of fibroids, smoking, older mum, IVF
Describe minor and major placenta praevia.
Minor - not covering the cervical os but near it
Major - Partially/completely covering cervical os
How does placenta praevia present?
Painless bleeding
Non-tender uterus
High presenting part
Management of placenta praevia?
If <2cm from os - C section
if > 2cm from os - Normal SVD
Do not physically examine vagina
What is Obstetric Cholestasis?
It is a common condition in pregnancy where there is reduced outflow of bile acids from the liver causing a build up and resulting in the classic itching symptom.
Presentation of Obstetric Cholestasis?
Presents later in pregnancy - usually third trimester
Itching is main symptom (hands & feet)
Also sees: fatigue, dark urine, pale/greasy stools and sometimes jaundice
Investigations for Obstetric Cholestasis?
LFTs and bile acid levels
Rise in ALT, AST and GGT
Raised bile acids
Why is a LFT result of only raised ALP not diagnostic for Obstetric Cholestasis?
Because the placenta produced ALP so an isolated high ALP with normal rest of LFTs may be physiological
Management of Obstetric Cholestasis?
1st line - Ursodeoxycholic acid
Can add in calamine lotion for itch
or
Antihistamines to help sleep (chlorphenamine)
IF clotting factors deranged - give Vit K
