Obstetrics Flashcards
(29 cards)
How is polyhydramnios diagnosed?
Increased fundal height, >2L of amniotic fluid, single vertical pocket >10cm, AFI >25cm or >95th centile
Name 4 causes of oligohydramnios
Premature rupture of membranes, congenital renal, cardiac and neural tube abnormalities, exposure to ACE inhibitors, uteroplacental insufficiency, congenital infection, NSAIDs, TTTS
Name 5 causes of polyhydramnios
Isoimmunisation (leading to immune hydrops fetalis), DM, hydrops fetalis, multigestation, fetal diabetes insipidus, defects of fetal swallowing - GI obstruction, achalasia, CNS abnormalities, placental chorioangioma
What are the risks of diabetes in pregnancy?
Miscarriage, stillbirth, congenital abnormalities, macrosomia, birth trauma, neonatal hypoglycaemia, long-term health problems for child (metabolic syndrome, obesity)
What are the risk factors for gestational diabetes?
BMI >30, PMH of gestational diabetes, >25 years old, FH diabetes, non-caucasian, previous stillbirth or delivery of large baby
How is diabetes managed in pregnancy?
Aim for glucose: before 12 weeks - f <8. Be aware that DKA is more rapid in pregnancy. Monitor diabetic complications, may worsen in pregnancy. Monitor fetal growth and AFI, monitor for pre-eclampsia. Use sliding scale during labour with 5% glucose
Give diagnostic values for pre-eclampsia
Diastolic BP >/= 110 or 90 taken twice 4 hours apart,
with
Proteinuria: 24hr urinary protein >/= 300mg, or 2 MSU taken 4 hours apart with >/= 2+ protein
What are the risk factors for pre-eclampsia?
DM, Anti-phospholipid syndrome, PMH pre-eclampsia, multiple pregnancy, nulliparous, FH, increased BMI, >40 years, diastolic BP >80, teenage mother, donor insemination
How is pre-eclampsia managed?
Uterine artery Doppler - poor placental perfusion, low-dose aspirin, calcium, vitamin C and E, antenatal corticosteroids, treat only if severe! - >170/110, MAP >125 - hydralazine, labetalol
What are the complications of pre-eclampsia?
Placental insufficiency - IUGR, abruption, eclampsia (seizures - give diazepam or magnesium sulphate), pulmonary oedema, renal failure (due to low BP after PPH), premature labour (often induced), HELLP, DIC, neurological complications (ICH, clonus), platelet consumption, hypoalbuminaemia
What are symptoms related to pre-eclampsia?
Headaches, visual disturbance, nausea, vomiting, epigastric pain, SOB (pulmonary oedema)
Give 3 complications of oligohydramnios
Amniotic band syndrome - serious deformities e.g. limb amputation, chorioamnionitis, fetal infection, preterm labour, uterine compression - MSK deformities
What are the features of primary dysmenorrhoea?
Begins with onset of ovulation (6m-2yr after menarche), FH, early menarche, associated N/V/D/dizziness, improves after first child, pain is lower abdominal/pelvic radiating to anterior thigh, only occurs in ovulatory cycles
What is primary dysmenorrhoea and what is its pathophysiology?
Painful menstruation in the absence of any significant pelvic pathology - caused by excessive myometrial contractions leading to uterine ischaemia in response to local release of prostaglandins from endometrium
What is the management of primary dysmenorrhoea?
Explanation and reassurance, diet - vitamin B1 supplements, avoid smoking, take up exercise, heat pack on lower abdomen, NSAIDs (inhibit prostaglandin synthesis e.g. ibuprofen, naproxen, mefenamic acid, aspirin), if do not respond in 3 cycles - COCP (suppress ovulation and reduce prostaglandin synthesis), can also use progestogen only methods
What is endometriosis?
Extrauterine endometrial like tissue often surrounded by inflammation.
Where do deposits occur in endometriosis?
Ovaries (over surface or as endometrioma - may rupture), uterosacral ligament, rectovaginal septum, pelvic peritoneum (uterus, tubes, rectum, colon, bladder), lap scars, umbilicus
How could you investigate secondary dysmenorrhoea?
Pelvic exam, cervical smear, swabs for infection/STI screen, TVUS or pelvic US, diagnostic laparoscopy
What is the management of endometriosis?
Medical - suppress ovulation (oral progestogens or other progestogen) - also danazol, GnRH agonists, aromatase inhibitors
Surgical - excision of visible lesions
How can endometriosis present?
Pelvic pain, infertility, severe dysmenorrhoea, dyspareunia, dysuria, dyschezia (difficulty defecating) - severe dysmenorrhoea in adolescence
What are the features of pain in secondary dysmenorrhoea?
Pain often precedes start of period and may last throughout, heavy, dragging pain, may radiate to back, loins and legs
What are the causes of secondary dysmenorrhoea?
Endometriosis, fibroids, adenomyosis, pelvic infections, adhesions, developmental anomalies
What are the different types of fibroids?
Intramural (in myometrium, most common), subserosal (serosal surface, outer, extend outwards, deform uterus - can be pedunculated), submucosal (inner surface of endometrium, extend into cavity, distort or fill, can be pedunculated)
What is red degeneration?
Haemorrhage into leiomyoma associated with pregnancy - fever, pain, vomiting, usually in mid-trimester, possibly caused by rapid growth and outgrowth of blood supply
