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Obstetrics Flashcards

1
Q

what does HCG do?

A

secreted by trophoblastic cells of blastocyst

role is to signal the presence of the blastocyst to the mother

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2
Q

what is the role of progesterone and what does it do?

A

secreted by the corpus luteum until post 356 days conception, then comes from the placenta
prepares the endometrium and uterus from implantation by causing proliferation, vascularisation and differentiation of the endometrial stroma

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3
Q

what produces oestrogen?

A

comes from the ovary initially then the foetus later in pregnancy
role is to promote changes in the CV system and alter carbohydrate metabolism

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4
Q

what scan is done at 8-12 weeks?

A

booking and bloods/urine
bloods- FBC, rhesus status, BBV- HIV, Hep B, syphilis
urine- STIs

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5
Q

what scan is done at 10-13+6 weeks?

A

early scan to confirm dates and exclude multiple pregnancy

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6
Q

when is the combined screening test done?

A

11-13+6 weeks

  • combination of nuchal translucency and serum bHCG and PAPP-A
  • detects down’s syndrome, Edward’s syndrome and patau’s syndrome
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7
Q

what does nuchal translucency measure?

A

measurement of fluid at the back of the baby’s head

increased in down’s syndrome, congenital heart defects and abdominal wall defects

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8
Q

what trisomy’s are Edward’s and Patau’s syndrome?

A

Edwards- T18

Patau’s- T13

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9
Q

when the quadruple test done?

A

done in 2nd trimester if combined screening not possible

tests serum markers only- AFP, BHCG, Oestriol, Inhibin A

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10
Q

when is the anomaly scan done?

A

18-20+6 weeks

detects structural abnormalities

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11
Q

when is anti-D given?

A

28 weeks and 34 weeks

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12
Q

when else can be done in high risk pregnancies?

A

amniocentesis

chorionic villous sampling

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13
Q

what is included in the new born blood spot screening?

A

Sickle cell disease
Cystic fibrosis
congenital hypothyroidism

6 inborn errors of metabolism:

  • phenylketonuria
  • homocystinuria
  • maple syrup urine disease
  • medium chain Acyl co-enzyme A dehydrogenase deficiency
  • isovaleric acidaemia
  • glutaric aciduria type 1
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14
Q

what is done in the NIPE (newborn and infant physical examination) and when is it done?

A 
1st examination done within 72 hours
2nd examination by GP at 6-8 weeks
-hips- DHH
-reflexes
-eyes- absent red reflex, congenital cataracts
-heart
-mouth and palate
-undescended testis/check of the genitals
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15
Q

what hearing screening is done in the newborn?

A

automated otoacoustic emission

  • identifies response in cochlea to soft sounds from earpiece
  • within 4 weeks of birth
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16
Q

WHO criteria for screening?

A
  1. important health problem
  2. accepted treatment
  3. facilities for diagnosis and treatment
  4. suitable latent and symptomatic stage
  5. suitable test or examination
  6. test acceptable to population
  7. natural history of condition understood
  8. agreed policy on who to treat
  9. continuous case finding
  10. benefit vs costs
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17
Q

what is normal labour?

A

infant spontaneously in the vertex position between 37 and 42 weeks in pregnancy

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18
Q

3 stages of labour?

A
  1. Cervical dilatation (remodelling)- preparation phase
  2. Myometrial contraction (pushing phase)
  3. Placental delivery
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19
Q

what is a ‘show’?

A

a sign than labour is starting- a plug of cervical mucus and little blood as the membranes strip from the os

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20
Q

what happens in stage 1 labour?

A

latent phase- painful,irregular contractions. The cervix initially effaces then dilates to 4cm

established phase- >4cm dilated, regular contractions
satisfactory rate is 0.5cm/hour in nulliparous and 1cm/hour in mulitparous

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21
Q

what happens in stage 2 of labour?

A

passive stage- complete cervical dilatation but no pushing

active stage- maternal pushing until delivery. 3 hours in primip, 2 hours within multip

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22
Q

what happens in stage 3 labour?

A

delivery of the placenta

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23
Q

what drug should be used in 2rd stage of labour?

A

sytometrine IM (oxytocin and ergometrine) as the anterior shoulder is born to decrease risk of PPH

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24
Q

when should labour be induced?

A

preonged pregnancy >12 days after due date
prelabour PROM
rhesus imcompatibility

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25
Q

what score is used to assess whether induction of labour will be required?

A 
bishop score:
-cervical position
-cervical consistency
-cervical effacement
-cervical dilation
-foetal station
<5= labour is unlikely to start w/o induction
>9= labour will most likely commence spontaneously
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26
Q

how can labour be induced?

A

membrane sweep
intravaginal prostaglandins- pessary or vaginal gel
oxytocin- syntocinon
AROM- amniotomy

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27
Q

foetal and maternal consequences of failure to progress in labour?

A

foetal distress
foetal hypoxia-> HIE- hypoxic ischaemia encephalopathy
morbidity and mortality

bleeding
tears

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28
Q

how to read a CTG?

A 
DR- define risk
C-contractions
BRa- baseline rate
V-variability
A-accelerations
D-decelerations
O- overall impression
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29
Q

what is a high risk pregnancy (maternal and obstetric causes)?

A

maternal- gestational diabetes, hypertension, asthma

obstetric- multiple gestation, prev CS, IUGR, PROM, pre-eclampsia

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30
Q

what is a reassuring CTG?

A

accelerations present
HR 110-160
variability 5-25
decelerations none or early

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31
Q

what is a non-reassuring CTG?

A

HR 100-109, 161-180
variability <5 for 30-50 mins or >25 for 15-25 mins
variable decelerations with no concerning characteristics for 90 mins or more

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32
Q

what is an abnormal CTG?

A

HR <100 or >180
variability <5 for >50 mins, >25 for 25 mins
late decelerations for 30 mins
variable decelerations with concerning characteristics e.g. sinusoidal pattern

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33
Q

causes of baseline tachycardia in a CTG?

A 
>160
maternal pyrexia
chorioamnionitis
hypoxia
prematurity
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34
Q

cause of baseline bradycardia?

A

increased vagal tone
maternal BB use
prolonged -> severe hypoxia

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35
Q

causes of loss of baseline variability on a CTG?

A 
<5 beats/min
prematurity
hypoxia
foetal sleeping
drugs- opiates, benzodiazepines, methyldopa, magnesium sulphate
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36
Q

causes of early decelerations of a CTG?

A

usually an innocuous features and indicates head compression

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37
Q

causes of variable decelerations on a CTG?

A

umbilical cord compression

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38
Q

causes of late decelerations on a CTG?

A

indicates foetal distress e.g. asyphyxia or placental insufficiency (e.g. pre-eclampsia or maternal hypotension)

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39
Q

what is the next step to do after discovering late decelerations?

A

foetal blood sampling to assess for foetal hypoxia and acidosis
pH >7.2= normal
urgent delivery if foetal acidosis

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40
Q

what is gold standard for foetal monitoring?

A

via the baby’s head for an ECG

can only be performed when membranes have ruptured and >2cm dilated

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41
Q

non-pharmacological and pharmacological pain relief during labour?

A

non-pharmacological- relaxation therapy, massage, water births, comfortable position/posture

pharmacological- paracetamol and codeine
entonox- N2O and O2
opiates
epidural- L3-L4, can use USS to aid them and avoid damage to the spinal cord

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42
Q

types of epidural?

A

LA- bupivacaine

Opioids- fentanyl, diamorphine

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43
Q

causes of failure to progress in labour?

A
  1. power- poor uterine contraction
  2. passenger- malpresentation, malposition of a large baby
  3. passage- inadequate pelvis, cephalopelvic disproportion, pelic mass
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44
Q

what to do in failure to progress in labour?

A

palpate abdomen for lie, head and contractions
CTG
colour of amniotic fluid
vaginal examination

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45
Q

what are the different types of malpresentation?

A
  1. face presentation- hyperextension of foetal neck
    - mentoanterior- head can flex to allow vaginal birth
    - mentoposterior- needs a CS
  2. brow presentation- head is inbetween full flexion (vertex) and full extension (face)
    diagnosis by vaginal examination
    needs CS if it persists
  3. cord presentation- one or more loops lie below the presenting part with membranes still intact
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46
Q

what is shown on a CTG of cord presentation?

A

variable decelerations

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47
Q

what is breech presentation and types?

A

the presenting part is not the head

  1. extended breech- bottom
  2. footling breech- one or both feet
  3. flexed breech- appears cross legged
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48
Q

RFs for breech presentation?

A 
uterine malformation, fibroids
gestational age
placenta praevia
polyhydramnios or oligohydramnios
foetal abnormalities e.g. hydrocephalus
prematurity
idiopathic
past breech delivery
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49
Q

what is the risk with breech presentation?

A

cord prolapse

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50
Q

how is breech presentation diagnosed?

A

USS

30% present undiagnosed in labour

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51
Q

mx of breech presentation?

A

<36 weeks- foetus may turn spontaneously
>36 weeks- perform external cephalic version
if ECV unsuccessful- LSCS

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52
Q

what is malposition?

A

the presenting part is in the right place but wrong position
normal= occipito-anterior
abnormal= occipito-posterior or occipito-transverse

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53
Q

mx of malposition?

A

most can have normal delivery

some may need forceps or LSCS

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54
Q

What causes meconium-stained liquor?

A

foetal distress, foetal maturity e.g. late baby

beware that aspiration of fresh meconium can cause severe pneumonitis

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55
Q

name some obstetric emergencies?

A
  1. shoulder dystocia
  2. cord prolapse
  3. uterine rupture
  4. amniotic fluid embolism
  5. retained placenta
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56
Q

RFs for shoulder dystocia?

A 
macrosomia (>4kg)
maternal diabetes
small pelvis
post-maturity
prolonged labour
instrumental delivery
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57
Q

mx of shoulder dystocia?

A

summon help
McRobert’s manoeuvre- hips flexed and slightly abducted
apply suprapubic pressure on the anterior shoulder
episiotomy
woodscrew manoeuvre- attempt to rotate foetus 180 degrees to displace anterior shoulder
Rubin manoeuvre- press on posterior shoulder
push head back in and deliver by CS

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58
Q

foetal complications of shoulder dystocia?

A 
hypoxia
fits
CP
Erb's palsy- C5-7 injury, shoulder rotated forward, waiter's tip
fractured clavicle or humerus
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59
Q

why is cord prolapse an obstetric emergency?

A

compression of spinal cord and spasm (due to exposure of the cord)

  • > foetal hypoxia
  • > irreversible damage (e.g. CP) or death
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60
Q

RFs for cord prolapse?

A 
prematurity- more likely to present breech
breech
abnormal lie
polyhydramnios
grand multiparous women
placenta praevia
delivery of the second twin
AROM
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61
Q

types of cord prolapse?

A

occult- cord alongside the presenting part of the foetus

overt- cord past presenting part

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62
Q

features of cord prolapse?

A

mother usually asymptomatic

foetus commonly presents with bradycardia

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63
Q

diagnosis of cord prolapse?

A

vaginal examination

CTG

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64
Q

mx of cord prolapse?

A

deliver baby ASAP
If the cord before the level of the introitus -> presenting part of cod pushed back to avoid compression
If the cord past level of introitus -> keep warm and moist
tocolytics -reduce contractions and therefore cord compression
urgent CS usually used

don’t handle the cord as it causes vasospasm

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65
Q

classification of uterine rupture?

A
  1. incomplete (occult) rupture- surgical scar separating but the visceral peritoneum staying intact. It is usually asymptomatic and does not require emergency surgery
  2. complete rupture-
    - traumatic- poorly conducted attempt at vaginal delivery, incorrect use of oxytocic agent
    - spontaneous- most patients have CS/ trauma that could have caused damage. Multiparity may lead to weakened uterus
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66
Q

RF for uterine rupture?

A

prev CS

67
Q

presentation of uterine rupture?

A 
maternal shock
severe abdo pain
vaginal bleeding
chest/shoulder tip pain and sudden SOB
cessation of efficient uterine contractions
CTG- foetal bradycardia
68
Q

what is amniotic fluid embolism?

A

when foetal cells/ amniotic fluid enters the mothers bloodstream and stimulates a reaction

69
Q

phases of amniotic fluid embolism?

A
  1. PE- direct blockage, anaphylactic reaction -> hypoxia and acute RDS
  2. Haemorrhagic- activation of complement -> DIC pathways
70
Q

presentation of amniotic fluid embolism?

A

majority during labour
Symptoms- SOB, palpitations, dizziness, confusion, seizures, sweating
Signs- cyanosis, hypotension, bronchospasms, tachycardia, MI, arrhythmias

71
Q

mx of amniotic fluid embolism

A

clinical diagnosis
A-E
correct coagulopathy
delivery-CS

72
Q

when is placenta called retained?

A

normal labour- within 60 mins of delivery

active management of labour- within 30 mins

73
Q

causes of retained placenta?

A

Uterine atony
Trapped placenta- placenta detached but unable to deliver due to closed os
placenta accreta/percreta- more common with prev CS

74
Q

complications of retained placenta?

A

PPH
genital tract infection
uterine inversion-> can lead to acute neurogenic shock, with profound bradycardia and hypotension

75
Q

mx of retained placenta?

A 
call for help
A-E
administer IM syntocinon- increases uterine tone and may help with delivery
ensure bladder emptying
manual removal of placenta in theatre
76
Q

what is antepartum haemorrhage?

A

genital tract bleeding from 24 weeks gestation

77
Q

dangerous causes of APH?

A

Placental abruption
Placenta praevia
Vasa praevia
Morbidly adherent placenta

78
Q

other causes of APH?

A 
Cervical polyps
cervicitis
carcinoma
vaginitis
vulval varicosities
79
Q

what is placental abruption?

A

when part of the placenta becomes detached from the uterus

80
Q

RFs for placental abruption?

A 
prev abruption
multiple pregnancy
hypertension
trauma
pre-eclampsia
increasing maternal age
infection
thrombophilias
uterine abnormality
smoking
81
Q

presentation of placental abruption?

A 
PAINFUL
hidden bleeds- happens internally
tender 'woody' uterus
tachycardia
shock
foetal distress

posterior abruptions- can present with backache

82
Q

mx of placental abruption?

A 
ABCDE
IV fluids
bloods- renal function, FBC, clotting
O2
ABO Rh compatible blood or O-ve blood
if safe and term -> delivery
83
Q

complications of placental abruption?

A

foetal death or anorexia leading to brain damage
PPH
uterine hyper-contractility
(>5 in 10 mins)
DIC
Sheehan’s syndrome- pituitary necrosis following PPH

84
Q

what is placenta praevia and types?

A

a low lying placenta- any part of the placenta has implanted into the lower segment of the uterus
major- full covering of the cervical os
minor- encroaching the lower segment but not fully covering the os

85
Q

RFs for placenta praevia?

A 
prev CS
prev TOP
multiparity
multiple pregnancy
mother >40 years
assisted conception
manual removal of prev placenta
fibroids
endometriosis
86
Q

presentaton of placenta praevia?

A

diagnosis on 20 week anomaly scan- TV USS
PAINLESS bleeding after 28 weeks
spontaneous labour may occur in the subsequent few days

87
Q

mx of placenta praevia?

A

minor-aim for normal delivery unless the placenta encroaches within 2cm of the internal os
major- requires CS for delivery
admit from 34 weeks and determine foetal lung maturity with amniocentesis

88
Q

complication of placenta praevia?

A

foetal hypovolaemic shock
VTE
placenta accreta, increta, percreta

89
Q

how to differentiate with placenta praevia?

A

Accreta- ‘attaches’- attaches to uterine wall but doesn’t penetrate the myometrium
Increta- ‘invades’ the myometrium
Percreta- ‘penetrates’ beyond myometrium into peritoneum

90
Q

mx of placenta accreta, increta, percreta?

A

usually hysterectomy

91
Q

what is vasa praevia?

A

major foetal vessels are presenting before the uterus

92
Q

triad of vasa praevia?

A

rupture of membranes followed by painless vaginal bleeding and foetal bradycardia

93
Q

RFs for vasa praevia?

A

IVF pregnancies
multiple pregnancy
bilobate or succenturiate placenta
2nd trimester placenta praevia

94
Q

diagnosis of placenta problems?

A

TV doppler USS

95
Q

Mx of vasa praevia?

A

ABC management of bleeding
delivery of CS
mortality 60%

96
Q

what is primary PPH?

A

loss of >500ml in the first 24 hours

97
Q

causes of PPH?

A
  1. Tone- uterine atony- main cause
  2. Tissue- retained products i.e. placenta
  3. Trauma- i.e a big tear in the genital tract
  4. Thrombin- clotting disorder
98
Q

how to diagnose uterine atony?

A

abdo exam- unpalpable uterus

99
Q

predisposing factors for primary PPH?

A 
Uterine overdistension- multiple pregnancy, polyhydramnios
prolonged labour
instrumental delivery
fibroids
uterine abnormalities
prev PPH
retained placenta
APH
100
Q

mx of primary PPH?

A

if the placenta is expelled -> massage the uterus, attempt delivery of the placenta by controlled cord compression, if not manual removal

if placenta is retained -> massage and compress the uterus to expel any retained clots, bimanual compressio

  • inject syntocinon (syntometrine or oxytocin) 5 units- contracts the uterus
  • hartmann’s IV
  • misoprostol rectally
  • IM prostaglandin e.g. carboprost and can repeat up to 8 doses
  • uterine tamponade with balloon catheters
  • uterine compression sutures
  • internal iliac and uterine artery ligation
  • major vessel embolisation
  • hysterectomy
  • 2222 if severe
101
Q

what is secondary PPH?

A

excessive blood loss from the genital tract area after 24 hours- 12 weeks after delivery

102
Q

causes of secondary PPH?

A

retained placental tissue- most common
intrauterine infection
trophoblastic disease

103
Q

mx of secondary PPH?

A

Small bleed- observe

Heavy bleed +/- signs of infection- IV Abx, uterine exploration under analgesia

104
Q

what is puerperal infection?

A

temp >38 degrees in the first 14 days following delivery

105
Q

causes of puerperal infection?

A 
endometriosis
UTI
wound infection
mastitis
VTE
106
Q

mx of puerperal infection?

A

IV clindamycin and gentamycin

107
Q

causes of maternal mortality?

A

Sepsis (flu, pyelonephritis, chorioamnionitis etc)
VTE
Amniotic fluid embolism
Pre-eclampsia and eclampsia

108
Q

what is included in SIRS?

A

3T’s, white with sugar
temp (>38 or <36), tachycardia, tachypnoea
WCC (<4 or >12), BG (>7.7mmol/L)

109
Q

what is small for dates and large for dates?

A

small for dates= below 10th centile for their gestational age. caused by placental problems e.g. pre-eclampsia, abuption, low BMI, multiple pregnancy, age >40

large for dates= >90th centile for gestational age

110
Q

what is premature baby?

A

an infant born before 37 weeks gestation

RFs- idiopathic, APH, multiple pregnancy, prev premature baby, infections, cervical weakness, PROM

111
Q

complications for premature baby?

A 
developmental delay
CP
chronic lung disease
retinopathy of prematurity
necrotisin enterocolitis
112
Q

diagnostic criteria for premature baby?

A

persistent uterine activity
PLUS change in cervical dilatation and/or effacement

can predicted by measuring cervical length with TV USS and foetal fibronectin levels

113
Q

prophylaxis of preterm labour?

A

cervical stitch if length <3cm
IM or pessary progesterone can help reduce risk
steroids to mum for foetal lung maturation (IM betamethasone)
surfactant via ET tube

114
Q

mx of preterm labour with intact membranes?

A

Fetal monitoring (CTG or intermittent auscultation)
Tocolysis- nifedipine
Prostaglandin synthase inhibitorys e.g indomethacin
Maternal corticosteroids to redue change or RDS (IM betamethasone)
IV Magnesium Sulfate- helps protect the fetal brain during premature delivery
surfactant via ET tube

115
Q

mx of preterm labour with ruptured membranes?

A

Prophylactic antibiotics should be given to prevent them developing chorioamnionitis (NICE recommend erythromycin 250mg four times daily for 10 days).

116
Q

when are babies considered non-viable?

A

below 23 weeks

117
Q

what is chorioamnionitis?

A

ascending bacterial infection of the amniotic fluid/membrane/placenta

118
Q

RFs for PROM?

A 
smoking
prev preterm delivery
vaginal bleeding
infection
chorioamnionitis
119
Q

mx of GBS?

A

Penicillin or clindamycin usually recommended

all women need in PROM

120
Q

mx of polyhydramnios?

A

if 34 weeks and severe- amnioreduction or NSAIDs to reduce foetal urine output
consider steroids if <34 weeks

121
Q

what is rhesus disease of the newborn?

A

1st pregnancy-> sensitisation occurs. Maternal immune system reacts to Rh +ve antigen on foetal RBCs
->
produces IgM which doesn’t cross placenta to affect the pregnancy
->
2nd pregnancy- memory cells produced which means IgG can cross the placenta can affect the baby
->
RBC haemolysis
->
severe foetal anaemia and death

122
Q

who is at risk of rhesus disease?

A

if mother rhesus -ve and father rhesus +ve

123
Q

prevention of rhesus disease?

A

anti-D prophylaxis, which destroys anti-Rh +ve antibodies

given at 28 and 34 weeks and after birth

124
Q

what to give for chicken pox in pregnancy?

A

aciclovir

or VZIG if not immune

125
Q

what should women with a temp >38 in labour been given?

A

benzylpenicillin

give to all women in pre-term labour

126
Q

which anticoagulant is contraindicated in pregnancy?

A

warfarin

switch to dalteparin

127
Q

what is obstetric cholestasis?

A

unique jaundice to pregnancy
impaired flow of bile -> bile salts deposit in skin and placenta
-raised bilirubin

128
Q

mx of obstetric cholestasis?

A

ursodeoxycholic acid for symptomatic relief
weekly LFTs
piriton for itching
induction of labour at 37 weeks, vit K supplementation

129
Q

how can hypothyroidism present in pregnancy?

A

excessive vomiting

130
Q

how are epileptic mothers managed in pregnancy?

A

sodium valproate- can cause spina bifida
folic acid supplementation 5mg OD preconception
screen for abnormalities during pregnancy
avoid prolonged labour

131
Q

mx of gestational hypertension?

A

take aspirin 75mg OD from 12 weeks to birth to prevent pre-eclampsia

132
Q

mx of gestational diabetes?

A

folic acid pre-conception for diabetic
try diet control first then meds if inadequate
T1DM- insulin
T2DM- metformin 1st line, insulin 2nd line

Gliclazide CI’d in pregnancy
Retinopathy screening should be performed during pregnancy

133
Q

what is hyperemesis gravidarum?

A

persistent vomiting starting before 20 weeks pregnancy associated with weight loss and ketosis
usually resolves in 2nd trimester

134
Q

diagnostic triad in hyperemesis gravidarum?

A

5% pre-pregnancy weight loss
dehydration
electrolyte imbalance (hypokalaemia, hyponatraemia)

135
Q

Ix for hyperemesis gravidarum?

A

urine dipstick for ketosis and UTI
FBC, U&E, TFTs
USS to diagnose multiple pregnancy and exclude mole

136
Q

tx for hyperemesis gravidarum?

A 
admission
IV fluids and vitamin supplements (thiamine to prevent encephalopathy and folic acid)
nil by mouth
anti emetics
in severe cases- corticosteroids
daily thromboprophylaxis
137
Q

complications of hyperemesis gravidarum?

A

renal failure
Wernicke’s encephalopathy
hepatic failure

138
Q

what are the teratogenic infections in pregnancy?

A

CHRiST
CMV- hearing, visual and mental impairment
Herpes Zoster- severe chickenpox
Rubella- deafness, cardiac disease, eye problems
Syphilis- miscarriage, severe congenital disease or still birth
Toxoplasmosis- cat faeces, soil and infected meat. Tx= spiramycin

139
Q

tx of syphilis

A

benzylpenicillin

140
Q

what is pre-eclampsia?

A

failure of trophoblastic invasion of spiral arteries

causes pregnancy induced hypertension and proteinuria (>0.3g/day)

141
Q

high RFs for pre-eclampsia?

A 
hypertensive disease in prev pregnancy
CKD
autoimmune disease e.g. SLE, antiphospholipid syndrome
T1DM/T2DM
chronic hypertension
142
Q

moderate RFs for pre-eclampsia?

A 
1st pregnancy
age 40+
pregnancy interval of >10 years
BMI >35 
FH 
multiple pregnancy
143
Q

when should aspirin be given from 12 weeks?

A

if 1 high or 2 moderate RFs

75mg OD

144
Q

features of severe pre-eclampsia?

A 
BP >170/110 mmHg
headache
visual disturbance
papilloedema
RUQ/epigastric pain
hyperreflexia
platelet count <100, abnormal liver enzymes or HELLP syndrome
145
Q

Complications of severe pre-eclampsia?

A 
eclampsia
HELLP syndrome
cerebral haemorrhage
IUGR
renal failure
placental abruption
146
Q

Ix of pre-eclampsia?

A

BP
bloods- FBC, U&E, clotting, LFTs, renal failure
Doppler USS

147
Q

mx of pre-eclampsia if BP 140/90-> 149/99 or urine PCR >30mg/mmol/L?

A

4-hourly BP
twice weekly bloods to monitor renal function
foetal growth scans every 2 weeks
don’t start anti-hypertensives until BP >150/110mmHg
induction of labour after 37 week

148
Q

mx of pre-eclampsia if BP 150/100-> 159/109?

A 
admit to hospital until delivery
BP 4-hourly
3x weekly bloods
fortnightly growth scans
twice-daily CTG
anti-hypertensives if CI'd or not working
aim for IOL after 37 weeks
149
Q

mx of pre-eclampsia if BP >160/110mmHg or symptoms/signs of end organ damage?

A

call for senior help- obstetrics, midwives, anaesthetics
stabilise BP with antihypertensives e.g. nifedipine
change to IV if BP remains high
prophylactic magnesium sulphate to prevent eclampsia- 4mg IV, then 1g IV/hour
bloods every 12-24 hours
strict fluid balance, catheter
give steroids for foetal lung maturity if <34 weeks
if >34 weeks-> deliver
if <34 weeks-> seek senior advice but ideally deliver within 24-48 hours

150
Q

what is eclampsia?

A

pre-eclampsia plus tonic-clonic seizure

risks of cerebral haemorrhage, HELLP or organ failure

151
Q

mx of eclampsia?

A 
call for help 
ABC and IV access
magnesium sulphate- prevent and treat seizures. Give 4mg IV over 5-10 mins then 1g/hr for 24 hours (further fits treat with 2g bolus)
catheterise for hourly urine output
monitor reflexes, HR and O2 sats (resp depression and decreased reflexes shows magnesium toxicity)
restrict fluids
monitor foetal HR
deliver once mother is stable- LSCS
152
Q

How to treat magnesium sulphate toxicity?

A

IV calcium gluconate

153
Q

what is HELLP?

A

A severe variant of pre-eclampsia and consists of Haemolysis, Elevated Liver enzymes and Low Platelets

154
Q

symptoms of HELLP?

A

Epigastric or RUQ pain
N&V
dark urine due to haemolysis

155
Q

tx of HELLP syndrome?

A

as for eclampsia and is an indication for delivery

epidural contraindicated if platelets <80

156
Q

what is the passage of the foetus through the birth canal?

A
  1. engagement
  2. descent and flexion
  3. rotation- 90 degrees
  4. further descent
  5. extension and delivery
  6. restitution- head rotates back 90 degrees
157
Q

what is twin-to-twin transfusion syndrome?

A

presence of unbalanced anastomoses in placenta
redistribution of foetal blood

recipitant twin- polycythaemia, hypervolaemia, cardiomegaly, polyhydramnios, foetal hydrops, hypertension

donor twin- anaemia, hypovolaemia, oligohydramnios

tx= laser ablation of placental anastomoses

158
Q

indications for termination of pregnancy?

A
  • risk to life of the mother would be greater if the pregnancy continues
  • to prevent permanent harm to mental or physical health of the mother
  • risk to other children if the pregnancy continues
  • risk of serious disability in the child
159
Q

what is needed before TOP?

A
  • Counselling and support
  • USS to confirm gestation
  • Screen for STIs
  • abx prophylaxis e.g. metronidazle and azithromycin
  • discuss contraception
  • if Rh negative, she needs anti-D
160
Q

methods of TOP?

A

surgical termination- suction curette (dilatation and evacuation)
medical termination- used for pregnancies after 14 weeks:
- mifepristone (progesterone antagonist) orally, followed by 36-48 hours later prostaglandins administered through a vaginal pessary

161
Q

what scale is used for post natal depression assessment?

A

edinburgh scale

162
Q

what is baby blues?

A

3-7 days following birth
anxious, irritable and tearful
mx= reassurance and support

163
Q

what is post-natal depression?

A

within a month -> peaks at 3 months
features similar to depression
mx= CBT, sertraline or paroxetine

164
Q

what is puerperal psychosis?

A

2-3 weeks following birth
severe swings in mood and disordered perception
mx= admit to hospital
20% risk to recurrence

finals (14 decks)

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