Obstetrics Flashcards
(288 cards)
1
Q
hyperemesis gravidum clinical features
A
raised bHCG, 8-12/40 (may persist up to 20/40), 5% pre-pregnancy weight loss, dehydration, electrolyte imbalance
2
Q
hyperemesis gravidum associations
A
multiple pregnancies, trophoblastic DZ, hyperthyroidism, nulliparity, obesity
3
Q
mamagement of hyperemesis gravidum
A
- antihistamines (promethazine), cyclizine, 2. ondansetron, metoclopramide admission may be required for IV fluids
4
Q
complications of hyperemesis gravidum
A
Wernike’s encephalopathy, Mallory-Weiss tear, central pontine myelinolysis, ATN, SGA, preterm birth
5
Q
raised bHCG, 8-12/40 (may persist up to 20/40), 5% pre-pregnancy weight loss, dehydration, electrolyte imbalance
A
hyperemesis gravidum
6
Q
multiple pregnancies, trophoblastic DZ, hyperthyroidism, nulliparity, obesity are associations with
A
hyperemesis gravidum
7
Q
- antihistamines (promethazine), cyclizine, 2. ondansetron, metoclopramide admission may be required for IV fluids management of
A
hyperemesis gravidum
8
Q
Wernike’s encephalopathy, Mallory-Weiss tear, central pontine myelinolysis, ATN, SGA, preterm birth complications of
A
hyperemesis gravidum
9
Q
antenatal assessment aims
A
detect + manage pre-existing maternal conditions that may affect pregnancy outcome, prevent/detect maternal complications, prevent/detect foetal complications, detect congenital foetal abnormalities, plan delivery, educate/advise RE lifestyle
10
Q
time of booking visit
A
10-12/40
11
Q
booking visit Hx
A
age, obstetrics Hx (preterm, SGA, stillbirth, ante/post-partum haemorrhage, congenital abnormalities, Rh DZ, preeclampsia, GDM), LMP, gynae Hx (fertility, Sx), smear Hx, PMH (HTN, DM, AI DZ, Hbopathy, thromboembolic DZ, CVS/renal DZ, depression), DH, FH (DM, HTN, thromboembolic DZ, AI DZ, preeclampsia), SH (smoking, EtOH, drug abuse, domestic violence)
12
Q
booking visit O/E
A
health, nutritional status, BMI, BP, abdo exam, foetal HR
13
Q
booking visit investigations
A
TAUS (crown-rump l to date, multiple pregnancies, nuchal translucency), FBC, anti-D, OGTT (at risk females), syphillis, rubella immunity, HIV, hep B, Hb electrophoresis, urine culture
14
Q
which trimesteris it best to generally avoid medications
A
first
15
Q
1st trimester
A
1-12/40
16
Q
2nd trimester
A
13-27/40
17
Q
3rd trimester
A
28/40-birth
18
Q
folic acid
A
0.4mg/d until >12/40
19
Q
0.4mg/d until >12/40
A
folic acid supplementation
20
Q
vitamin D
A
10ug/d if BMI >30 or sunlight deprived areas
21
Q
10ug/d if BMI >30
A
vitamin D supplementation
22
Q
EtOH in pregnancy
A
avoid, esp in first 12/40, limit to 1U/d
23
Q
foods to avoid during pregnancy
A
unpasturised milk, soft/blue cheese, pate, uncooked/partially cooked ready prepared meals
24
Q
pregnant women should sleep
A
in the L lateral position
25
anomaly scan
18-21/40, detects structural foetal abnormalities, sex determination
26
number/frequency of midwife visits
10 for nulliparous, 7 for multiparous women at increasing f as the pregnancy progresses
27
10 for nulliparous, 7 for multiparous women at increasing f as the pregnancy progresses
number/f of midwive visits
28
25/40 midwife visit
exclude early onset preeclampsia
29
28/40 midwife visit
FH measurement, FBC, anti-D, OGTT if indicated
30
SGA definition
weight of foetus < 10/100th for its gestation
31
SGA DD
wrong dates, small foetus (consistently small, still progressing along its own projectile), placental insufficiency (HTN, proteinuria, extremes of age), IUGR (smoking/drug abuse), maternal DM, prolonged pregnancy, multiple pregnancy, ch abnormalities/inborn errors of metabolism, ethnic groups, small parents, infection (CMV)
32
SGA vs IUGR
SGA is when the foetus' weight falls below the 10/100th, IUGR is when the trajectory of the foetal growth has slowed suggesting foetal compromise + is more worrying (stillbirth risk) than SGA alone if growth continuing at a constant rate
33
stages of labour
1st stage: initiation to full dilatation (10cm), latent (slow dilatation to 3cm, several hours) + active phase (1-2cm/h progression)
2nd stage: 10cm to delivery of the foetus, passive (until head reaches pelvic floor, desire to push) + active stages (active pushing 20-40 mins)
3rd stage: foetus to delivery of the placenta (15 mins)
34
three " "'s of labour
"P"'s: power, passenger, passage
35
power
uterune contractions, painful, regular, leading to effacement (then dilatation) of the cervix
36
passage
pelvis: inlet transverse d = 13cm, outlet AP d = 13cm
station: position of the head in relation to the ischial spines + is below the level of the spines and - is above
37
passenger
unfused scull bones, vertex (sagital suture) = -/- the ant (bregma) + post (occipus) fontanelle
38
presentation
the part of the foetus that occupies the lower segment/pelvis e.g. cepalic/breech
39
presenting part
lowest part of the foetus palpable on VE e.g. vertex, brow, face
40
position of the head
describes the rotation e.g. OT, OP, OA
41
attitude of the head
describes the degree of flexion e.g. vertex, brow, face
42
the part of the foetus that occupies the lower segment/pelvis e.g. cepalic/breech
presentation
43
lowest part of the foetus palpable on VE e.g. vertex, brow, face
presenting part
44
describes the rotation e.g. OT, OP, OA
position of the head
45
describes the degree of flexion e.g. vertex, brow, face
attitude of the head
46
Braxton-Hicks contractions
felt throughout the 3rd trimester, involuntary uterine smooth m contractions
47
felt throughout the 3rd trimester, involuntary uterine smooth m contractions
Braxton-Hicks contractions
48
show
pink/white mucus plug, usually happend once the cervix is effaced + followed by the rupture of the menbranes
49
pink/white mucus plug, usually happend once the cervix is effaced + followed by the rupture of the menbranes
show
50
observations during labour
temp, HR, BP, foetal HR
51
pyrexia in labour
>37.5'c, increased risk of neonatal illness, vaginal swabs, blood, urine cultures, consider IV ABx + antipyretics
52
partogram
used to assess progression of cervical dilatation
53
used to assess progression of cervical dilatation
partogram
54
ARM
used when there is failure of cervical dilatation progression
55
1st line when there is failure of cervical dilatation progression
ARM
56
2nd line when there is failure of cervical dilatation progression
IV oxytocin, required foetal montoring
57
IV oxytocin
when ARM has failed to progress cervical dilatation after 1-2hrs
58
3rd line when there is failure of cervical dilatation progression
consider c/s
59
foetal HR monitoring during labour
every 15 min, after a contraction, auscultate for 60 sec
60
VE every
2-4hrs
61
medical initiation of the 3rd stage of labour
IM oxytocin
62
most common position of head at delivery
OA
63
common abnormality of rotation leading to position of heat at delivery
OP
64
IoL
1. sweep 2. prostglandins pessary 3. oxytocin 4. amniotomy
65
maternal collapse DD
ectopic pregnancy, major placental abruption, scar rupture in pregnancy post-c/s, amniotic fluid embolism, eclampsia, severe preeclampsia, uterine rupture, epilepsy, hypoxia, PPH, APH (haemorrhage is most common cause), cardiac DZ, spinal/LA toxicity, PE, placenta praevia, atonic uterus, retained placenta, laceration
66
management of maternal collapse
call for help (SOAP - semior midwife, obstetrician, anaethetist, paediatrician/porter), ABCDE apporach, supportive, rescusitation, fluid therapy, O2, FBC, clotting, x-match, U+Es, LFTs, transfusion, FFP
67
uterine rupture risk factors
deep myomectomy (fibroid remouval), c/s, congenitally abnormal uterus, abnormal lie/presentation, hyperstimulation of the uterus
68
retained placenta definition
3rd stage of labout >30 mins
69
retained placenta risk factors
congenital uterine malformations
70
APH definition
bleeding from genital tract after 24/40
71
causes of APH
idiopathic, placental abruption, placenta praevia, ruptured vasa praevia, uterine rupture, bleeding of gynae origin
72
ruptured vasa praevia
foetal blood vessels run in membranes infront of presenting part (rare), rupture leads to APH
73
ruptured vasa praevia presentation
painless, moderate vaginal bleeding at amniotomy/spontaneous membrane rupture, severe foetal distress (c/s often not quick enough to save foetus)
74
PPH management
call for help (SOAP senior midwife, obstetrician, anaethetist, porter), ABCED approach, massive haemorrhage call, give blood, FFP, compress uterus bimanually, FBC, U+E, clotting, x-match
75
PPH causes
uterine atony, retained placental parts, perineal/vaginal trauma/tears, cervical laceration (rare, associated with instrumental deliveries), uterine rupture, coagulopathy, episiotomy
76
1' PPH definition
loss of >500mL of blood <24h post-delivery, or >1000mL post-c/s
77
the problem with retained placental parts
means that the uterus can't contract properly
78
uterine atony is more common in
prolonged labout, grand multips, overdistension of the uterus (polyhydramnios, multiple foetus'), fibroids
79
PPH risk factors
previous PPH, previous c/s, coagulation defect, anticoagulation therapy, instrumental delivery, c/s, retained placenta, APH, polyhydramnios, multiple pregnancies, grand multips, uterine malformation, fibroids, prolonged/induced labour
80
PPH prevention
oxytocin in the 3rd stage of labour, as effective as ergometrin which causes V + CI in HTN
81
2' PPH definition
excessive blood loss, 24h-6/52 post-delivery
82
2' PPH cause
endometritis with/w/o retained placenta tissue
83
2' PPH management
ABCDE approach, FBC, swabs, US, ERPC, ABx
84
itching in pregnancy investigations
check sclera for jaundice, LFT, bile acids
85
itching in pregnancy DD
vaginitis, intrahepatic cholestsis
86
intrahepatic cholestasis
itch w/o rash, abnormal LFTs, raised bile acids, FH, recurrent, increased risk of sudden stillbirth + preterm delivery
87
intrahepatic cholestasis management
give vitamin K from 36/40 becuase of increased tendancy to haemorrhage, ursodeoxycholic acid relieves itching, IoL at 38/40, follow up at 6/52 to ensure LFTs have returned to N
88
preeclampsia HPC questions
headache, visual disturbances, flashing lights, drowsiness, EG pain, N+V, facial/hands/pretibial swelling, seizures, HTN, DM, FH of preeclampsia
89
general obstetrics history questions
weight change, appetite, fevers, rigors, seizures, results of scans/checks so far in pregnancy, previous pregnancies, smear, FM
90
is paracetamol safe in pregnancy
yes
91
is ibuprofen safe in pregnancy
no, NSAIDs not recommended in pregnancy
92
GDM glucose values
>11.1
93
GDM 'impaired glucose tolerance' values
between 7.9-11.1
94
GDM management
lifestyle changes: diet + exercise, medication, regular BM checking (3x/d pre + postprandial), >f antenatal checks, DM specialist team, IoL at 38-39/40
95
risks of uncontrolled blood glucose during pregnancy
macrosomia, sholder dystocia, foetal hypoglycaemia (paediatricians to check BM regularly + present at birth), jaundice, breathing difficulties
96
GDM Hx questions
polyuria, polydipsia, previous miscarriages, FH (DM + GDM)
97
APH questions
colour, V, pain, previous bleeding in this/previous pregnancy, duration, outcome, precipitating factors (intercourse, straining, Sx), placental position on scans, blood group, Rh status, pregnancy-related problems to date, previous pregnancies, previous APH/PPH, FH (bleeding disorder)
98
post-partum low mood DD
baby blues, postnatal depression, postpartum thyroiditis, BPAD
99
postpartum thyroiditis prevalence
5-10%
100
postpartum thyroiditis risk factors
antithyroid Abs, T1DM
101
postpartum thyroiditis course
3/12 postpartum transient + subclinical hyperthyroidism, followed by 4/12 of hypothyroidism (permanent in 20%)
102
baby blues
third d post partum, 10% prevalence
103
tool for scoring PND
EPDS Edinburgh postnatal depression scale
104
risk factors for PND
social/emotional isolation, previous Hx, pregnancy complicaitons
105
management of PND
social support, psychotherapy, antidepressants
106
PND recurrence in subsequent pregnancies
70%
107
puerperal aka
postpartum period
108
postpartum period aka
puerperal
109
post partum period duration
immediately after birth to 6/52 later
110
physiological change that happens during the puerperium
mothers body returns to its prepregnant state
111
mothers body returns to its prepregnant state during
the puerperium
112
lochia
discharge from uterus post partum, may be blood stained for 4/52, then yellow/white
113
discharge from uterus post partum
lochia
114
postpartum pyrexia
genital tract sepsis, chest infection, mastitis, perineal infection, would infection
115
endometritis causes in pregnancy
retained tissue, septic miscarriage
116
common causes of polyhydramnios
DM, GDM, foetal abnormality (upper GI obstructions, inability to swallow, chest abnormalities, MD), idiopathic, maternal renal failure, twins,
117
clinical features of polyhydramnios
maternal distress, large for dates, taut uterus, foetal parts difficult to palpate
118
complications of polyhydramnios
preterm labour, maternal discomfort, abnormal lie, malpresentation
119
management of polyhydramnios
amnioreducion, foetal surveillance, NSAIDs
120
increased nuchal translucency indicated
Down S, congenital heart defects, abdo wall defects
121
causes of hyperechogenic bowel
cf, Down S, CMV infection
122
pulmonary hypoplasia + congenital diaphragmatic hernia
occur alongside each other rather than as a sequence of events
123
causes of pulmonary hypoplasia
oligohydramnios (decreases size of intrathoracic cavity, preventing foetal L growth), congenital diaphragmatic hernia
124
pulmonary hypoplasia is
underdeveloped L in newborn infants
125
placenta praevia association
twins, high pariety, age, scarred uterus
126
placental praevia is when
the placenta is implanted in the lower segment of the uterus
127
low lying placentas at
20/40, most appear to move up as the pregnancy progresses, due to formaion of the lower segment of the uterus in the 3rd trimester
128
classification of placenta praevia
```
marginal = placent in lower segment, not over os
major = placenta completely/partially covering os
```
129
complications of placenta praevia
obstructs head engagement, causes transverse lie, haemorrhage (A/PPH), placenta accreta, placenta percreta
130
placenta accreta
when the placenta invades the myometrium, v high risk of PPH necessitating hysterectomy
131
placenta percreta
when the placenta penetrates through the uterine myometrium into surrounding structures e.g. bladder (often at the site of a previous c/s scar), may necessitate hysterectomy
132
placenta praevia presentation
intermittant painless bleeds, increasing f + intensity, incidental on US (some women experience no bleeding)
133
placenta praevia O/E
breech presentation, transverse lie, high unengaged head
134
examination never to perform in a pregnant wonam who's bleeding
VE, unless placenta praevia is excluded
135
placenta praevia investigations
TV/TAUS, 3D power US (if suspect placenta accreta), CTG, FBC, clotting, x-match
136
if low lying placenta detected at 20/40 scan
repeat at 32/40
137
placenta praevia management
admit (all women with bleeding), praevia on US amy warrent hositalisation until delivery, steroids if <34/40, elective c/s at 39/40 (earlier is bleeding is severe)
138
why intraoperative/PPH so common with placenta praevia
because the lower segmentdoesn't contract well after delivery
139
twins, high pariety, age, scarred uterus increase the risk of
placenta praevia
140
the placenta is implanted in the lower segment of the uterus
placenta praevia
141
obstructs head engagement, causes transverse lie, haemorrhage (A/PPH), placenta accreta, placenta percreta are complications of
placenta praevia
142
when the placenta invades the myometrium, v high risk of PPH necessitating hysterectomy
placenta accreta
143
when the placenta penetrates through the uterine myometrium into surrounding structures e.g. bladder (often at the site of a previous c/s scar), may necessitate hysterectomy
placenta percreta
144
intermittant painless bleeds, increasing f + intensity, incidental on US (some women experience no bleeding) describes the presentation of
placenta praevia
145
breech presentation, transverse lie, high unengaged head O/E may suggest
placenta praevia
146
never do a VE on a pregnant woman when
she's bleeding
147
placenta praevia vs placental abruption
PP: shock consistent with external loss, painless, red, ?profuse bleeding, abnormal lie, high head, foetal HR N, low placenta
PA: shock inconsistent with external loss, severe pain, absent/dark blood, tenderness, hard uterus, N lie/engagement, foetal HR ?dead/distressed, US N
148
placental abruption is when
part/all pf the placenta separates from the uterine wall before the delivery of the foetus
149
complications of placental abruption
foetal death, haemorrhage, DIC, renal failure
150
risk factors for placental abruption
IUGR, preeclampsia, preexisting HTN, AI DZ, smoking, cocaine, previous placental abruption, multiple pregnancies, high pariety, trauma, rupture of membranes in polyhydramnios
151
placental abruption presentation
painful bleeding, constant, dark blood
152
concealed abruption
pain alone w/o PV bleeding
153
placental abruption O/E
tachycardia, low BP, tender uterus, contracting, woody uterus (severe cases)
154
placental abruption investigations
clincal diagnosis, CTG, tocograph, US (exclude praevia), regular FBC, regular clotting, x-match, catheterise + monitor UO, regular U+Es, central v P monitoring (severe cases)
155
features of major placental abruption
maternal collapse, coagulopathy, foetal distress/demise, woody hard uterus, poor UO/renal failure
156
placental abruption management
hospitalise, IV fluids, steroids (if gestation <34/40), analgesia, anti-D (if necessary), blood transfusion (if necessary)
157
delivery in placental abruption
stabilise mother first
foetal distress: emergency c/s
no foetal distress >37/40: IoL with amniotomy
no foetal distress <37/40: steroids (<34/40), close monitoring
foetus is dead: coagulopathy likely, blood products, IoL
158
part/all pf the placenta separates from the uterine wall before the delivery of the foetus
placental abruption
159
foetal death, haemorrhage, DIC, renal failure are complications of
placental abruption
160
IUGR, preeclampsia, preexisting HTN, AI DZ, smoking, cocaine, previous placental abruption, multiple pregnancies, high pariety, trauma, rupture of membranes in polyhydramnios are risk factors for
placental abruption
161
painful bleeding, constant, dark blood
placental abruption
162
tachycardia, low BP, tender uterus, contracting, woody uterus (severe cases)
placental abruption
163
pain alone w/o PV bleeding
concealed placental abruption
164
pregnancy induced HTN
BP >140/90 after 20/40
165
causes of pregnancy induced HTN
preeclampsia, transient HTN
166
preeclampsia is definied as
HTN + proteinuria (>0.3g/24h) +/- oedema
167
eclampsia
occurrence of epileptiform/grand mal seizures in pregnancy
168
pregnancy induced HTN aka
gestational HTN
169
preexisting HTN in pregnancy
BP >140/90 <20/40 or already on antiHTN medication
170
1' vs 2' preexisting HTN in pregnancy
2' = as a result of renal/other DZ
171
physiological consequences of preeclampsia
increased vascular R leads to HTN, increased vascular permeability leads to proteinuria, reduced placental blood flow leads to IUGR, reduced cerebral perfusion leads to eclampsia
172
in early stage preeclampsia what sign can be absent
proteinuria (a relatively late sign)
173
preeclampsia risk factors
nulliparity, previous preeclampsia, FH, long interpregnancy interval, obesity, old maternal age, chronic HTN, DM, twins, AI DZ, renal DZ, obesity
174
HTN in pregnancy classification
```
mild = >140/90
moderate = >150/100
severe = >160/110
```
175
preeclampsia classification
```
mild = proteinuria + HTN <160/110
moderate = proteinuria + HTN >160/110 w/o maternal complications
severe = proteinuria + any HTN + <34/40 or maternal complications
```
176
preeclampsia investigations
urine dipstick (2+), protein creatinine ratio (30mg/nmol), 24h urine collection (>0.3g/24h), exclude infection, FBC, U+E, LFT, clotting, US
177
HELLP S
haemolysis (dark urine, raised LDH, anaemia), elevated liver EZ (EG pain, liver failure, abnormal clotting), low platelets
178
preeclampsia O/E
HTN, oedema (massive, not postural, sudden onset), EG tenderness (impending complications)
179
complications of preeclampsia
eclampsia, cerebrovascular haemorrhage, HELLP, DIC, liver failure, renal failure, pulmonary oedema, IUGR, preterm birth, placental abruption, hypoxia
180
any complication of preeclampsia warrents
delivery
181
complications of eclampsia
hypoxia, death
182
prophylaxis against eclampsia
Mg sulphate
183
prophylaxis in at risk women for preeclampsia
aspirin 75mg before 16/40
184
management of new onset mild/moderate HTN in pregnancy w/o proteinuria
OP management, BP + urinalysis twice weekly, US 2-4 weekly
185
criteria for admission in preeclampsia/suspected preeclampsia
symptoms, proteinuria (2+ dipstick, 30mg/nmol PCR, 0.3g/24h), BP >160/110, suspected foetal compromise
186
give antihypertensive at what BP
150/100, give urgently if >160/110, target BP <140/90
187
antihypertensives in preeclampsia
labetalol, nifedipine
188
effect of antihypertensives in preeclampsia
don't change the course of the DZ but increase safety for the mother
189
non antihypertensive medications in preeclampsia
Mg sulphate
190
mechanism of action of Mg sulphate
increase cerebral perfusion to minimise seizure risk
191
symptoms of Mg sulphate toxicity
loss of plantar reflexes, respiratory depression, hypotension
192
gestational HTN delivery management, w/o foetal compromise
regular monitoring, IoL at 40/40 if required antihypertensive medication
193
mild preeclampsia + delivery
IoL by 37/40
194
moderate/severe preeclampsia + delivery
if gestation >34-36/40: IoL
| if <34/40: inPT managment, steroids, deterioration will prompt c/s
195
severe preeclampsia with complications/ foetal distress + delivery
deliver now
196
postnatal care of preeclampsia
LFT, FBC, U+E, fluid balance, UO, BP
197
a really accurate way to measue BP
CVP central venous P
198
risk factors for preexisting HTN in pregnancy
obesity, increased maternal age, COCP induced HTN, FH
199
women with pregnancy induced HTN are at greater risk of
developiong HTN in later life
200
antihypertensives not to use in pregnancy
ACEi (teratogenic)
201
BP >140/90 after 20/40
pregnancy induced HTN
202
HTN + proteinuria (>0.3g/24h) +/- oedema defines
preeclampsia
203
occurrence of epileptiform/grand mal seizures in pregnancy
eclampsia
204
gestational HTN aka
pregnancy-induced HTN
205
BP >140/90 <20/40 or already on antiHTN medication
preexisting HTN in pregnancy
206
nulliparity, previous preeclampsia, FH, long interpregnancy interval, obesity, old maternal age, chronic HTN, DM, twins, AI DZ, renal DZ, obesity are riskfactors for
preeclampsia
207
HTN, oedema (massive, not postural, sudden onset), EG tenderness (impending complications) O/E suggests
preeclampsia
208
eclampsia, cerebrovascular haemorrhage, HELLP, DIC, liver failure, renal failure, pulmonary oedema, IUGR, preterm birth, placental abruption, hypoxia are complications of
preeclampsia
209
Mg sulphate is used as
prophylaxis against eclampsia
210
aspirin 75mg before 16/40 is used as
prophylaxis in women at risk of preeclampsia
211
labetalol, nifedipine are
antihypertensives used in pregnancy
212
medication that increase cerebral perfusion to minimise seizure risk
Mg sulphate
213
loss of plantar reflexes, respiratory depression, hypotension are symptoms of
Mg sulphate toxicity
214
obesity, increased maternal age, COCP induced HTN, FH are risk factors for
preexisting HTN in pregnancy
215
can you use ACEi in pregnancy
no - teratogenic
216
amniotic fluid embolism
when liquor enters the maternal circulation, extremely rare
217
consequence of an amniotic fluid embolism
anaphylaxis, sudden SOB, hypoxia, hypotension, seizures, cardiac arrest, acute HF, DIC, pulmonary oedema, ARDS
218
risk factors for amniotic fluid embolism
maternal age, IoL, strong contractions in the presence of polyhydramnios
219
prevention of amniotic fluid embolism
impossible
220
management of amniotic fluid embolism
rescuscitation, supportive treatment, O2, fluids, blood, FFP, transfer to ITU
221
amniotic fluid embolism investigations
FBC, clotting, U+E, x-match
222
when liquor enters the maternal circulation, extremely rare
amniotic fluid embolism
223
anaphylaxis, sudden SOB, hypoxia, hypotension, seizures, cardiac arrest, acute HF, DIC, pulmonary oedema, ARDS are consequences of
amniotic fluid embolism
224
maternal age, IoL, strong contractions in the presence of polyhydramnios are risk factors for
amniotic fluid embolism
225
effect of epidural anaesthesia on BP
reduced
226
clinical features of HELLP S
HTN, V, abdo pain
227
HTN, V, abdo pain are clinical features of
HELLP S
228
Mg sulphate dose in eclampsia
IV 4g bolus over 5-10mins, followed by 1g/h infusion
229
preexisting DM in pregnancy management
women may require > insulin/similar to maintain their blood glucose levels
230
GDM glucose levels
>7 fasting
| >7.8 2hrs post OGTT
231
foetal complications of GDM/DM during pregnancy
congenital abnormalities (neural tube, cardiac), preterm, reduced foetal L maturity, increased birthweight, polyhydramnios, shoulder dystocia, birth trauma, foetal compromise, foetal distress, sudden foetal death
232
maternal complications of GDM/DM during pregnancy
increased insulin requirements, hypoglycaemia, DKA, UTI, wound/endometrial infection post partum, HTM, preeclampsia, worsening of IHD, c/s/instrumental > likely, DM nephropathy, DM retinopathy
233
investiagations in GDM/DM in pregnancy
foetal ECHO, US to monitor foetal growth + liquor V, U+E, fundoscopy
234
management of GDM/DM in pregnancy
preconceptual diabetic control, aspirin 75mgfrom 12/40, diet, exercise, home monitoring, metformin, insulin, OGTT at 3/12 post delivery
235
delivery + GDM/DM in pregnancy
should be by 39/40
236
c/s is indicated in GDM/DM when
birth weight is predicted >4kg
237
screening for GDM
screen at 28/40: previous large baby (>4.5kg), unexplained still birth, 1st degree relative with DM, BMI >30, South Asian, Black Carribean, Middle Eastern origin, PCOS
screen at 18/40: previous GDM
238
risk factors for GDM
personal Hx of GDM, previous >4.5kg foetus, previous unexplained stillbirth, 1st degree relative with DM, BMI >30, racial origin, polyhydramnios, persistent glycosuria
239
congenital abnormalities (neural tube, cardiac), preterm, reduced foetal L maturity, increased birthweight, polyhydramnios, shoulder dystocia, birth trauma, foetal compromise, foetal distress, sudden foetal death
foetal complications of GDM/DM in pregnancy
240
increased insulin requirements, hypoglycaemia, DKA, UTI, wound/endometrial infection post partum, HTM, preeclampsia, worsening of IHD, c/s/instrumental > likely, DM nephropathy, DM retinopathy
maternal complications of GDM/DM in pregnancy
241
personal Hx of GDM, previous >4.5kg foetus, previous unexplained stillbirth, 1st degree relative with DM, BMI >30, racial origin, polyhydramnios, persistent glycosuria are risk factors for
GDM
242
molar pregnancy is a types of
trophoblastic DZ
243
presentation of a molar pregnancy
vaginal bleeding, large for dates uterus, hyperemesis, hyperthyroidism
244
shoulder dystocia is associated with
PPH, perineal tears, brachial plexus injury, neonatal death
245
risk factors for shoulder dystocia
foetal macrosomia, high maternal BMI, DM, prolonged labour
246
vaginal bleeding, large for dates uterus, hyperemesis, hyperthyroidism may suggest
molar pregnancy
247
foetal macrosomia, high maternal BMI, DM, prolonged labour are risk factors for
shoulder dystocia
248
intrahepatic cholestasis of pregnancy is characterised by
itch w/o rash, abnormal LFTs
249
intrahepatic cholestasis is caused by
abnormal sensitivity to the cholestatic effects of oestrogens
250
complications of intrahepatic cholestasis
stillbirth, preterm
251
intrahepatic cholestasis management
vit K 10mg/d from 36/40, ursodeoxycholic acid (UDCA) relieves itch, IoL at 38/40, follow up 6/52 post partum
252
itch w/o rash, abnormal LFTs indicated
intrahepatic cholestasis
253
ectopic pregnancies
fertilised egg implants outside of the uterus, most commonly the fallopial tubes
254
risk factors for ectopic pregnancy
PID, assisted conception, Sx, previous ectopic, smoking, IUD
255
ectopic pregnancy presentaion
scanty dark vaginal bleeding, lower abdo pain, syncope, shoulder tip pain, amenorrhoea
256
ectopic pregnancy O/E
abdo tenderness, rebound tenderness, cervical excitation, adenexal tenderness, tachycardia, hypotension
257
ectopic pregnancy investigations
urine pregnancy test, TVUS, serum B-hCG (repeat in 48h)
258
ectopic pregnancy management
NBM, FBC, x-match, TVUS, laproscopy (esp if HD unstable/heartbeat, salpingectomy), IV access, methotrexate (no cardiac activity), serial B-hCG
259
PID, assisted conception, Sx, previous ectopic, smoking, IUD are all risk factors for
ectopic pregnancy
260
scanty dark vaginal bleeding, lower abdo pain, syncope, shoulder tip pain, amenorrhoea
ectopic pregnancy
261
abdo tenderness, rebound tenderness, cervical excitation, adenexal tenderness, tachycardia, hypotension O/E may indicate
ectopic pregnancy
262
threatened miscarriage
there is bleeding by the foetus is still alive, the uterus is the correct size for dates, os is closed
263
% with a threatened miscarriage that go on to miscarry
25%
264
miscarriage definition
foetus dies/delivers <24/40
265
ineviatable miscarriage
heavy bleeding, foetus alive, os open, miscarriage is about to occur
266
incomplete miscarriage
some foetal parts have passed, os open
267
complete miscarriage
all foetal tissue passed, bleeding reduced, uterus no longer enlarged, os closed
268
septic miscarriage
contents of uterus are infected, causing endometritis, offensive vaginal loss, tender uterus
269
missed miscarriage
foetus undeveloped/died in utero, not recognised until US/bleeding occurs, uterus is smaller than expected for dates, os closed
270
myths that don't really cause miscarriages
exercise, stress, emotional trauma
271
miscarriage investigations
early pregnancy assessment unit, TVUS, B-hCG, FBC, anti-D
272
recurrent miscarriage definition
3+ miscarriages in succession
273
management of recurrent miscarriages
counselling, US monitoring, aspirin + low dose LMWH (in anti-PL S), karyotyping (ch)
274
recurrent miscarriage risk factors
anti-PL S, ch abnormalities, uterine abnormalities, cervical incompetence, obesity, smoking, PCOS, excess caffeine, high maternal age, poorly controlled DM, thyroid DZ
275
there is bleeding by the foetus is still alive, the uterus is the correct size for dates, os is closed
threatened miscarriage
276
heavy bleeding, foetus alive, os open, miscarriage is about to occur
ineviatable miscarriage
277
some foetal parts have passed, os open
incomplete miscarriage
278
all foetal tissue passed, bleeding reduced, uterus no longer enlarged, os closed
complete miscarriage
279
contents of uterus are infected, causing endometritis, offensive vaginal loss, tender uterus
septic miscarriage
280
foetus undeveloped/died in utero, not recognised until US/bleeding occurs, uterus is smaller than expected for dates, os closed
missed miscarriage
281
anti-PL S, ch abnormalities, uterine abnormalities, cervical incompetence, obesity, smoking, PCOS, excess caffeine, high maternal age are risk factors for
miscarriage
282
risks of twin pregnancies
preterm labour, miscarriage, congenital abnormalities, IUGR, GDM, hyperemesis, preeclampsia, anaemia
283
delivery of twins
most likely c/s due to mal presentaion, if 1st baby = cephalic can do vaginal, IoL at 38-39/40
284
risks of vaginal delivery with twins
risk of cord prolapse/breech presentation with 2nd twin), PPH
285
breech presentation
try ECV, elective c/s at 38/40
286
ECV CI
fibroids, low placenta, APH, premature ROM
287
`% success rate of ECV
50%
288
breech presentation risks in vaginal delivery
cord prolapse
