Obstetrics Flashcards
(53 cards)
Screening for Gestational Diabetes
GTT in high risk @ 10-18 weeks. 75g glucose, >7 at fasting or >7.8 at 2h = Gestational diabetes
Controlled in 60% with metformin and diet
Risk factors of gestational diabetes
Previous or family history of any type of diabetes >100kg Previous macrosomic baby PCOS Persistent glycosuria
GDM complications
Maternal: pre-eclampsia and HD, diabetes risks, operative delivery
Fetal: premature, lung immaturity, dystocia, CV and NT defects
GDM management
Anomaly and cardiac scan
Fetal surveillance and glucose control
Long acting + short preprandial insulin (increaseing doses)
75mg aspirin from 12 wks to prevent PEclampsia
LSCS/Induce @39 wk unless well controlled
Postnatal GTT at 3m, 50% diabetes in next 10y
Incidence and types of VTE in pregnancy
6 fold increase in pregnancy (clotting factor increase, fibrinolytic decrease and blood flow altered)
Pulmonary embolus - VQ/CT dx, 0.3% pregnancies 1% mortality
DVT: D-dimer raised in pregnancy anyway, 1% of pregnant women
Management of VTE in pregnancy
Antenatal prophylaxis - not common, only v.high risk ie previous thrombosis
Event: use LMWH, stop if possible before birth and restart after birth
Postpartum prophylaxis: 50% of mortality - commonly used LMWH or warfarin for 6 weeks
What infections are screened for in pregnancy?
Hep B, rubella, CMV, syphilis, (chlamydia, BV and Strep B)
Which infections are teratogenic?
CMV, toxoplasmosis, syphilis, Zoster, Rubella
CMV in pregnancy
Vertical transmission common, amniocentesis for dx at 20weeks. Not done as amnio more dangerous than CMV (10% severely affected at birth)
Deafness, pneumonia, thrombocytopenia, IUGR
Termination offered on fetal blood sampling if high risk of severe defect
Rubella in pregnancy
Rare due to immunity
16wk: v low risk
Toxoplasmosis in pregnancy
Neural problems: fits, spasticity, mental ret
Rare and treated with spiromycin for mum, combo therapy for baby
Dx on maternal IgM or amnio for fetal
Syphilis in pregnancy
Rare now due to screening and simple benzylpenicillin tx
HSV in pregnancy
Can cause severe neonatal infection if inf within 6wk of delivery or vesicles at delivery so section. Aciclovir for mum and baby
Group A strep in pregnancy
50% maternal death in puerperal sepsis - High dose Abx and ITU, often fetal death
Group B strep in pregnancy
Maternal carrier = penicillin treatment for high risk or 3rd trimester +ve
Major cause of severe neonatal illness 6% term, 18% preterm
Herpes Zoster in pregnancy
Severe maternal infection, can cause baby infection if no Ig given, aciclovir if infected, teratogenic occasionally
Hep B in pregnancy
Carriage in high risk women, can cause chronic infection in neonate - universal screening for Ig requirement of neonate
Chlamydia and BV
Preterm labour - treat as per
Parvovirus B19 in pregnancy
Infection
HIV in pregancy
Maternal preeclampsia and GDM risk increased
Fetal stillbirth, IUGR and prematurity
Don’t breast feed, neonates with HIV 40% AIDs by 5 yr
Definition and causes of APH
Bleeding after 24wks from the genital tract
Placenta Praevia, abruption
Uterine rupture, vasa praevia
Placenta praevia definition
Low lying placenta in lower segment, 1 in 10 if early pregnancy become placenta praevia later (>2cm from os = marginal, over os = major)
Complications of Placenta Praevia
Haemorrhage
Prevents engagement - transverse lie
Accreta
Preterm deliery
Presentation and Ix of Pl.Praevia
Hx: Painless bleeding
Ex: don’t do vaginal examination!, abnormal lie is common
Ix: USS dx, low lying found at 2nd trimester, USS at 32weeks, prepare for accreta/praevia if
