Obstetrics and Gynaecology 2 Flashcards
(417 cards)
1
Q
What is the bacteria that causes Chlamydia?
A
Chlamydia trachomatis
2
Q
What type of bacteria is Chlamydia trachomatis?
A
Gram negative
3
Q
How is Chlamydia transmitted?
A
Unprotected vaginal / anal / oral sex
4
Q
What are the different serotypes of C trachomatis? (3 things)
A
- Serotypes A-C = ocular infection2. Serotypes D-K = classic genitourinary infection3. Serotypes L1-L3 = new infection in laway6a
5
Q
What are the RF for Chlamydia? (5 things)
A
- Age under 252. Partner positive for chlamydia3. Recent change in sexual parner4. Co-infection w another STI5. Not using barrier contraception
6
Q
What are the CF of Chlamydia? (7 things)
A
- Asymptomatic (50% men / 70% women)2. Lower abd / pelvic pain + tenderness3. Dyspareunia (pain @ intercourse)4. Cervical excitation5. Bleeding (intermenstrual / postcoital)6. Abn vaginal discharge7. Dysuria
7
Q
What are some differential Dx that present similar to Chlamydia?
A
Other STIs especially gonnorhoea
8
Q
What is the best investigation for Chlamydia Dx? (3 things)
A
NAAT test on specimen from:1. Vulvo-vaginal swab (best)2. Endocervical swab3. First catch urine sample
9
Q
Why is NAAT preferred over microscopy for Chlamydia Dx?
A
Chlamydia too small to be seen in microscopy
10
Q
What is the Tx for Chlamydia?
A
Abx course
11
Q
What are the 2 different FIRST line Abx courses recommended for Chlamydia Tx?
A
- Doxycycline 100mg BD for 7 days2. Azithromycin 1g single dose(one or the other)
12
Q
What are the alternative Abx courses for Chlamydia Tx when Doxycycline / Azithromycin are CI? (2 things)
A
- Erythromycin 500mg BD for 10-14 days2. Ofloxacin 200mg BD / 400mg OD for 7 days
13
Q
What are pts advised while on Chlamydia Tx?
A
Avoid intercourse + oral sex until completed tx (or 7 days after azithromycin single dose)
14
Q
Are Chlamydia pt tested to see if they’ve been cured?
A
No, not unless der pregnant / poor compliance / symptoms persist
15
Q
What are the Complications of Chlamydia? (7 things)
A
- PID2. Chronic pelvic pain3. Infertility4. Ectopic preg5. Conjunctivitis6. Reactive arthritis7. Lymphagranuloma venereum (esp in laway6a)
16
Q
What are some pregnancy related complications of Chlamydia? (5 things)
A
- Preterm delivery2. Premature rupture of membranes3. Low birth weight4. Postpartum endometritis5. Neonatal infection (conjunctivitis / pneumonia)
17
Q
What is the bacteria responsible for Gonorrhoea?
A
Neisseria gonorrhoeae
18
Q
What type of bacteria is Neisseria gonorrhoea?
A
Gram negative
19
Q
How does Gonorrhoea spread?
A
Unprotected vaginal / oral / anal intercourse
20
Q
Who does Gonorrhoea most commonly affect?
A
MSM under 25
21
Q
What are the RF for Gonorrhoea? (5 things)
A
- Age under 252. MSM3. Urban areas4. Hx of STIs5. Multiple partners
22
Q
What are the CF of Gonorrhoea? (5 things)
A
- Asymptomatic (90% men / 50% women)2. Lower abd / pelvic pain + tenderness3. Dyspareunia4. Discharge (purulent: green / yellow) (odourless)5. Dysuria
23
Q
What are some Differential Dx that present similarly to Gonorrhoea?
A
Chlamydia
24
Q
What is important to do when investigating someone w sus Gonorrhoea?
A
Full STI screen (bc STIs can co-exist)
25
What investigations should you do for sus Gonorrhoea? (2 things)
1. Endocervical / vaginal swab --\> NAAT2. Endocervical / urethral swab --\> Microscopy + culture
26
What is NAAT? (3 points)
1. Nucleic Acid Amplification Testing2. Gold standard investigation for Chlamydia3. Often has dual testing for both chlamydia + gonorrhoea
27
While waiting for lab results of gonorrhoea investigations to come back, what should you do for the pt?
Treat w empirical abx(if signs + symptoms are very sus)
28
What is the Tx for Gonorrhoea?
Single dose Ceftriaxone 1g
29
What advice should you give a pt receiving Tx for Gonorrhoea? (2 things)
1. Abstain from sex for 7 days2. Use protection
30
What are the complications of Gonorrhoea? (6 things)
1. PID2. Chronic pain3. Infertility4. Conjunctivitis5. Disseminated Gonococcal inf6. Septic arthritis
31
What is Disseminated Gonococcal Inf?
Gonorrhoea complication
32
Where does the bacteria spread in Disseminated Gonococcal infection? (2 things)
1. Skin2. Joints
33
What does Disseminated Gonococcal Infection cause? (4 things)
1. Skin lesions2. Polyarthralgia (joint pain)3. Migratory polyarthritis (arthritis dat moves between joints)4. Systemic symptoms (fever / fatigue)
34
How many people in the world have HIV?
37 million ppl
35
How does HIV replicate in the human immune system?
Using host CD4 T helper cells
36
What are the stages of HIV infection? (3 steps)
1. Seroconversion: Flu-like illness (within 2-6 weeks of inf)2. Latent phase (Asymptomatic)3. Immunodeficiency --\> AIDS (after 10 years)
37
How is HIV spread? (3 things)
1. Unprotected anal / vaginal / oral intercourse2. Vertical transmission: Mother to child @ pregnancy / birth / breastfeeding3. Sharing needles / blood splashed in eye
38
What are the RF groups for HIV? (4 things)
1. MSM2. IV drug users3. Being in high prevalence area4. Africa :(
39
What groups can the CF of HIV be divided into? (2 things)
1. Seroconversion stage CF2. Symptomatic stage CF (after latent phase)
40
What are the Seroconversion stage CF of HIV? (6 things)
1. Fever2. Malaise3. Pharyngitis4. Lymphadenopathy5. Muscle aches6. Maculopapular rash
41
What are the CF of the Symptomatic stage (after latent stage) of HIV? (4 things)
1. Fever2. Weight loss3. Diarrhoea4. Frequent minor infections (e.g herpes zoster / candidiasis)
42
What the FIRST line investigation for HIV?
Fourth generation tests
43
What are the Fourth generation tests that are done for HIV?
ELISAs testing for serum / salivary HIV antibodies + p24 antigen
44
How long after exposure do Fourth generation tests give reliable results?
4-6 weeks after exposure
45
What is the Mx option for HIV?
Highly Active Antiretroviral Therapy (HAART)
46
What is important to note about HAART for HIV? (2 things)
1. It doesn't cure it2. It reduces viral load to UNDETECTABLE LEVELS in serum
47
What is good about having Undetectable levels of HIV in serum? (2 things)
1. Excellent prognosis2. Reduced risk of transmission
48
What tests are included in the monitoring of HIV? (6 things)
1. CD4 count2. HIV viral load3. FBC4. UnE5. Urinalysis6. LFTs
49
What precautions can be taken to reduce risk of Vertical transmission during / after pregnancy? (3 things)
1. Antenatal antiretroviral therapy @ pregnancy + delivery2. X Breastfeeding3. Neonatal post-exposure prophylaxis
50
What is Urinary Incontinence?
Involuntary leakage of urine
51
What are the 2 types of Urinary Incontinence?
1. Urge2. Stress
52
What is Mixed Incontinence?
Pt with features of both types of incontinence (most common)
53
What is the definition of Stress Incontinence?
Involuntary urine leakage @ increased intra-abd pressure
54
When is Stress Incontinence typically seen?
After childbirth (aka most common causative factor)
55
What is Stress Incontinence due to?
Weakness of pelvic floor + sphincter muscles
56
What occasions does urine leak out with Stress Incontinence? (4 things)
1. Laughing2. Coughing3. Sneezing4. Surprised
57
What is Urge incontinence caused by?
Overactivity of detrusor muscle
58
What is another name for Urge incontinence?
Overactive bladder
59
What are the RF for Urinary Incontinence? (8 things)
1. Age2. BMI3. Postmenopausal4. Vaginal delivery5. Pelvic organ prolapse6. Pelvic floor surgery7. Neurological conditions (e.g MS)8. Cogn impairment / Dementia
60
What are the CF of Stress Incontinence? (3 things)
1. Leakage @ exertion (ask pt to cough)2. SMALL volume leakage3. Prolapse of urethra + ant vaginal wall (@ exam)
61
What are the CF of Urge Incontinence? (4 things)
1. Urgency2. Frequency3. Nocturia4. LARGE volume leakage
62
What are some triggers for urgency in Urge Incontinence? (2 things)
1. Hearing running water2. Cold weather
63
What is the aim of the primary investigation for sus Incontinence?
Excluding UTI
64
What are the 2 main investigations for Incontinence?
1. Frequency / volume charts2. Urodynamic studies
65
How do you distinguish between Stress vs Urge with Frequency / volume charts?
* Stress = Normal frequency* Urge = Increased frequency
66
What is the point of doing Urodynamic Studies? (2 points)
1. Done for Stress incontinence when considering surgery2. Used to confirm Dx + rule out detrusor over-activity
67
What is important a pt does before Urodynamic Studies are done?
Stop taking anticholinergic meds 5 days before
68
What are some important Modifiable lifestyle factors you should ask about in the Hx of sus Incontinence? (3 things)
1. Caffeine / Alcohol consumption2. Meds3. BMI
69
What are you checking for @ examination of sus Incontinence? (5 things)
1. Pelvic tone2. Pelvic organ prolapse3. Atrophic vaginitis4. Urethral diverticulum5. Pelvic mass
70
What are the CONSERVATIVE Mx options for Stress Incontinence? (4 things)
1. X caffeine / alcohol / overfilling bladder2. Weight Loss3. TUC (e.g chronic cough)4. Pelvic floor exercises (supervised)
71
How long should Pelvic floor exercises be done for before considering Surgery?
3 months
72
What are the SURGICAL Mx options for Stress Incontinence? (2 things)
1. Tension Free Vaginal Tape (TVT) (most common)2. Laparoscopic colposuspension
73
What does Tension Free Vaginal Tape (TVT) involve?
Tape placed under mid-urethra via small vaginal incision
74
When should someone have MEDICAL Mx for Stress Incontinence?
Woman doesn’t want / not suitable for surgery
75
What is the Medical Mx of Stress Incontinence?
Duloxetine (SNRI antidepressant)
76
What are the CONSERVATIVE Mx options for Urge Incontinence? (2 things)
1. X caffeine / alcohol / overfilling bladder2. Bladder retraining
77
What are the MEDICAL Mx options for Urge Incontinence? (2 things)
1. Anticholinergics (e.g oxybutynin)2. Mirabegron (alternative to anticholinergics)
78
What are the Side fx of using Anticholinergics for Urge Incontinence? (5 things)
1. Confusion2. Dry eyes / mouth3. Blurred vision4. Arrhythmias5. Constipation
79
What are the CI for taking Anticholinergics for Urge Incontinence? (3 things)
1. Acute angle glaucoma2. Myasthenia gravis3. GI obst
80
What are the CI for taking Mirabegron for Urge Incontinence?
Uncontrolled HTN
81
Who is SURGICAL Mx of Urge Incontinence reserved for?
Only those with debilitating symptoms
82
What is the SURGICAL Mx option for Urge Incontinence?
Detrusor myomectomy + Augmentation Cystoplasty(using bowel tissue to enlarge bladder)
83
Which Incontinence type is SURGICAL BEFORE MEDICAL Mx?
Stress Incontinence(doc gets STRESSED n instantly does da Surgery)
84
What does Gravida refer to?
Total number of pregnancies a woman has had
85
What does Para refer to?
Total number of times a woman has given birth (after 24 wks gestation)(Regardless of fetus was alive / stillborn)
86
When does the timeline of a pregnancy start from?
Last Menstrual Period (LMP)
87
What is the timeline of a pregnancy measured in?
Gestational Age (GA)
88
What is the Gravida / Para of a woman who is currently Pregnant and had 3 previous deliveries?
G4 P3
89
What is the Gravida / Para of a woman who is currently NOT Pregnant and had a previous birth of twins?
G1 P1
90
What is the Gravida / Para of a woman who is currently NOT Pregnant and had a previous miscarriage?
G1 P0 + 1
91
What is the Gravida / Para of a woman who is currently NOT Pregnant and had a previous stillbirth (after 24 wks gestation)?
G1 P1
92
What is the timeframe for the FIRST trimester?
0-12 weeks gestation
93
What is the timeframe for the SECOND trimester?
13-26 weeks gestation
94
What is the timeframe for the THIRD trimester?
27 weeks gestation -\> birth
95
What week are fetal movements meant to start from?
20 weeks gestation
96
What is a key milestone in pregnancy that should happen before 10 weeks?
Booking clinic
97
What is the point of a Booking Clinic in pregnancy?
Baseline assessment + Plan the pregnancy
98
What is a key milestone in pregnancy that should happen between 10 – 13+6 weeks?
Dating scan
99
What is the point of a Dating scan? (2 things)
1. Calculate accurate Gestational Age (GA)2. Identify multiple pregnancies
100
How is the Gestational Age (GA) accurately measured in the Dating Scan?
From Crown Rump Length (CRL)
101
What is a key milestone in pregnancy that should happen at 16 weeks?
Antenatal appointment
102
What is the point of the Antenatal appointment? (2 things)
1. Discuss results2. Plan future appointments
103
What is a key milestone in pregnancy that should happen between 18 – 20+6 weeks?
Anomaly scan
104
What is the point of the Anomaly scan?
US to identify any anomalies (e.g heart conditions)
105
What weeks should the Antenatal appointments that happen late in pregnancy occur at? (9 things)
25, 28, 31, 34, 36, 38, 40, 41, 42
106
What is the point of the Antenatal appointments starting from 25 weeks? (2 things)
1. Monitor pregnancy2. Discuss future plans
107
What are some Additional appointments that some women may need? (4 things)
1. Oral glucose tolerance test2. Anti-D injections3. US @ 32 weeks4. Serial growth scans
108
Which women require Oral glucose tolerance tests during pregnancy?
Women @ risk of gestational diabetes
109
When do Oral glucose tolerance tests occur during pregnancy?
Between 24-28 weeks
110
Which women require Anti-D injections during pregnancy?
Women who are Rhesus negative
111
When are Anti-D injections given during pregnancy? (2 times)
1. 28 weeks2. 34 weeks
112
Which women require US scan @ 32 weeks during pregnancy?
Women w Placenta Praevia on anomaly scan
113
Which women require Serial growth scans during pregnancy?
Women @ risk of fetal growth restriction
114
What things are discussed at the Antenatal Appointments? (2 things)
1. Plans for rest of pregnancy2. Delivery plans
115
What investigations are done at the Antenatal Appointments? (5 things)
1. Symphysis-fundal height measurement2. Fetal presentation assessment3. Urine dipstick4. Blood pressure5. Urine
116
When is the Symphysis-fundal height measured?
24 weeks onwards
117
When is the Fetal presentation assessed?
36 weeks onwards
118
What are you checking for in the Urine dipstick @ Antenatal appointment, and what does it mean?
Protein = Pre-eclampsia
119
Why do you check Blood Pressure @ Antenatal appointment?
Check for Pre-eclampsia
120
Why do you take a urine sample @ Antenatal appointment? (2 points)
1. For microscopy + culture2. To check for Asymptomatic Bacteriuria
121
What Vaccines are offered to all pregnant women? (2 things)
1. Whooping cough (pertussis)2. Influenza (flu vax)
122
When is the Whooping cough vaccine given to pregnant ladies?
16 weeks gestation
123
When is the Influenza (flu vax) given to pregnant ladies?
Whenever it’s available in Autumn / Winter
124
What vaccines are avoided in during pregnancy?
Lives vaccines (e.g MMR)
125
What classes a Foetus as Small for Gestational Age?
Foetus below 10th centile for their gestational age
126
What measurements on the US are used to assess foetal size? (2 things)
1. Estimated foetal weight (EFW)2. Abdominal circumference (AC)
127
What measurements are used to see if a foetus is Symmetrically / Assymetrically small? (2 things)
1. Head circumference2. Abdominal circumference (AC)
128
What cause of SGA is Symmetrically small foetus likely to be?
Constitutionally small
129
What cause of SGA is Asymmetrically small foetus likely to be?
Placental insuffiency
130
What features of the mother are used to make Customised Growth Charts for the foetus? (4 things)
1. Ethnic group2. Weight3. Height4. Parity
131
What is SEVERE SGA?
Foetus below 3rd centile for their gestational age
132
What is Low Birth Weight?
Birth weight less than 2500g
133
What are the causes of SGA? (3 things)
1. Constitutionally Small2. Placenta mediated Growth Restriction3. Non-placenta mediated Growth Restriction
134
What does Constitutionally small mean? (2 points)
1. Foetus matches mother + others in family2. Growing appropriately on growth chart
135
What does Placenta mediated Growth restriction refer to?
Conditions affecting transfer of nutrients across placenta
136
What are the causes of Placenta Mediated Growth restriction? (7 things)
1. Idiopathic2. Pre-eclampsia3. Maternal smoking / alcohol4. Anaemia5. Malnutrition6. Inf7. Maternal health conditions
137
What does Non-Placenta Mediated Growth restriction refer to?
Pathology of foetus itself
138
What are the causes of Non-Placenta Mediated Growth restriction? (4 things)
1. Genetic abn2. Structural abn3. Foetal inf4. Metabolism errors
139
Other than being SGA, what other signs could indicate Foetal Growth Restriction? (4 things)
1. Reduced amniotic fluid volume2. Abn Doppler studies3. Reduced foetal movements4. Abnormal CTGs
140
How is Reduced Amniotic fluid volume caused? (3 things)
1. Placental insufficiency2. Impaired foetal kidney function3. Reduced amniotic fluid volume
141
When should pregnant women be assessed for RF of SGA? (2 times)
1. At booking2. At 20 wks
142
What are the RF for SGA? (10 things)
1. Previous SGA baby2. Obesity3. Smoking4. DM5. HTN6. Pre-eclampsia7. Age 35+8. Multiple pregnancy9. Antepartum haemorrhage10. Antiphospholipid syndrome
143
What is the main obv investigation done for SGA?
US
144
What other investigations can be done for SGA? (4 things)
1. Detailed foetal anatomical survey2. Uterine Artery Doppler (UAD)3. Karyotyping4. Inf screening
145
What are some Modifiable RF that should be advised about for SGA? (2 things)
1. Smoking cessation2. Managing maternal conditions well (e.g DM / HTN)
146
What are women who are at high risk of Pre-eclampsia started on? What’s the time frame?
* 75mg aspirin* From 16 weeks till delivery
147
What is the primary surveillance tool for SGA?
Uterine Artery Doppler (UAD)
148
How long should you repeat Uterine Artery Doppler (UAD) for SGA? (2 points)
1. Every 14 days if normal2. More often if abn
149
When should early delivery of a SGA foetus be considered? (2 things)
1. Growth is static2. Other problems (e.g abn Doppler)
150
What is the point of an early delivery of a SGA foetus?
Reduces risk of stillbirth
151
What should be given if delivery of a SGA foetus between 24-35+6 weeks is being considered?
Single course of antenatal steroids
152
What are the SHORT term complications of SGA? (5 things)
1. Death / stillbirth2. Birth asphyxia (brain doesn’t get enough oxygen at birth)3. Neonatal hypothermia4. Neonatal hypoglycaemia5. Polycythaemia
153
What are the LONG term complications of SGA? (4 things)
1. CVS disease (esp HTN)2. T2DM3. Obesity4. Mood / behavioural problems
154
What is Large for Gestational Age aka?
Macrosomia
155
What weight of a baby is considered Large for GA?
4.5+ kg @ birth
156
What is considered Large for GA during pregnancy?
Above 90th percentile for GA
157
What are the causes of Large for GA? (6 things)
1. Constitutional (aka normal jus big like der fam)2. Maternal DM3. Previous Large for GA4. Maternal obesity5. Overdue (obv)6. Male baby (obv lol)
158
What are the Risks to MOTHER from Large for GA? (6 things)
1. Shoulder dystocia (main one)2. Failure to progress3. Perineal tears4. Instrumental delivery / C section5. PPH6. Uterine rupture (rare)
159
What are the Risks to BABY from Large for GA? (4 things)
1. Birth injury (e.g Erbs palsy / Clavic # / Foetal distress / Hypoxia)2. Neonatal hypoglycaemia3. Obesity @ childhood / later life4. T2DM @ adulthood
160
What investigations should you for a Large for GA baby? (2 things)
1. US2. Oral glucose tolerance test (for Gestational Diabetes)
161
What is the point of US in Large for GA investigation? (2 things)
1. Exclude Polyhydramnios2. Estimate Foetal weight
162
Will most women with Large for GA have a normal vaginal delivery?
Yes
163
How can the risks of Large for GA be reduced? (4 things)
1. Deliver on a Consultant Lead Unit2. Delivery by XP midwife / obstetrician3. Early decision for C section if req4. Paediatrician attending birth
164
What are the 2 classifications of C sections?
1. Elective2. Emergency
165
What is Emergency C sections further classified into?
Categories 1-3
166
What does RCOG recommend when C Section Emergency Category 1 is called?
Baby should be born within 30 mins(Bc immediate threat to life of mum / foetus)
167
What is usually recommended when C Section Emergency Category 2 is called?
Baby should be born within 60-75 mins(Mum / foetus but not immediately life threatening)
168
What is usually recommended when C Section Emergency Category 3 is called?
Early delivery(But no maternal / foetal compromise)
169
What are the indications for Elective C Sections? (11 things)
1. Breech presentation2. Other malpresentation (e.g unstable / transverse / oblique lie)3. Twins (when Twin 1 not cephalic pres)4. Maternal conditions --\> labour dangerous for mother5. Foetal compromise (e.g IUGR) --\> labour dangerous for baby6. Transmissible disease (e.g HIV / herpes)7. Placenta praevia8. Maternal DM (w macrosomia)9. Previous Shoulder dystocia10. Previous Perineal tear11. Maternal request
170
When should Twins be considered to be delivered as a C section?
When Twin 1 not cephalic presentation
171
What is Placenta Praevia?
Low lying placenta
172
When should Placenta Praevia be considered to be delivered as a C section?
When placenta covers / reaches internal os of Cervix
173
When are C sections usually planned for?
After 39 weeks
174
Why are C sections usually planned for after 39 weeks?
To reduce Neonatal resp distress
175
What is Neonatal resp distress aka?
Transient Tachypnoea of Newborn (TTN)
176
When C sections should be planned for before 39 weeks, what should you give the mother?
Corticosteroids
177
What is the point of giving Corticosteroids when C sections are planned for before 39 weeks?
Stimulates dev of surfactant in Foetal lungs
178
What routine tests should be done before a C section? (3 things)
1. FBC2. G&S3. VTE risk score
179
Why should FBC and G&S be taken before a C section?
Bc avg blood loss in C section is 500ml to 1L
180
What are women lying flat for C section at risk of? (2 points)
1. Mendelson’s syndrome (aspiration of gastric contents)2. This leads to Chemical Pneumonitis
181
What should be prescribed before C section?
1. H2 receptor antagonist (e.g Ranitidine)2. +/- Metoclopramide (anti-emetic)
182
What is the point of H2 receptor antagonist +/- Metoclopramide b4 C section?
To protect against Mendelson’s syndrome
183
What should be prescribed before C section if VTE risk score is high? (2 things)
1. Stockings2. LMWH
184
What anaesthesia are C sections usually done under?
Regional anaesthetic (epidural / spinal)
185
When is using General Anaesthesia indicated for C sections? (3 things)
1. Category 1 Emergency C section (bc foetal wellbeing concerns)2. Maternal CI to regional3. Regional failing to achieve req block
186
What position is the C section woman placed in?
Left Lateral tilt of 15°
187
Why is the woman put into a Left Lateral tilt of 15° in C section?
To reduce risk of supine hypotension due to Aortocaval compression
188
What catheter is inserted before C section?
Indwelling Foley’s catheter
189
What is the point of inserting an Indwelling Foley’s catheter before C section? (2 things)
1. To drain bladder2. To reduce risk of bladder injury @ procedure
190
What should be administered just prior C section incision?
Abx
191
What is the C section incision?
Transverse lower abd skin incision
192
What layers have to be cut to get down to baby? (8 things) (IN ORDER)
1. Skin2. Camper’s fascia3. Scarpa’s fascia4. Rectus sheath5. Rectus muscle6. Abd peritoneum (parietal)7. Visceral Peritoneum (covers lower uterus)8. Uterus
193
What is the Camper’s fascia?
Superficial fatty layer of subcut tissue
194
What is the Scarpa’s fascia?
Deep membranous layer of subcut tissue
195
What does cutting the Abdominal peritoneum reveal?
Gravid uterus
196
What do you do once you reach Visceral Peritoneum (covering lower uterus)? (2 steps)
1. Cut it and push down to reflect bladder2. Bladder then retracted by Doyen retractor
197
How is the placenta delivered in C section?
Controlled cord traction by surgeon
198
What should the anaesthetist give to aid with the placenta delivery?
Oxytocin 5 units
199
What complications of Vaginal delivery do C sections protect against? (6 things)
1. Perineal trauma2. Pain3. Urinary / faecal incontinence4. Uterovaginal prolapse5. Late stillbirth6. Early neonatal infections
200
What are the complications of C sections classified into? (3 things)
1. Immediate2. Intermediate3. Late
201
What are the Immediate complications of C sections? (6 things)
1. PPH2. Wound haematoma3. Intra-abd haemorrhage4. Bladder / bowel trauma5. Transient Tachypnoea of Newborn (TTN)6. Foetal lacerations
202
What are the Intermediate complications of C sections? (4 things)
1. UTI2. Endometritis3. Resp infection (higher risk if GA used)4. VTE
203
What are the Late complications of C sections? (6 things)
1. Urinary tract trauma (fistula)2. Infertility3. Regret4. Rupture / dehiscence of scar @ next labour5. Placenta praevia6. Caesarean scar ectopic preg
204
What is Gestational Diabetes?
Diabetes triggered by pregnancy
205
What percentage of Pregnant women will have GD?
20%
206
What is GD caused by?
Progressively reduced insulin sensitivity @ pregnancy
207
Does GD resolve @ birth?
Yes
208
What are the RF for GD? (6 things)
1. Previous GD2. Previous Macroscomic baby (4.5kg +)3. BMI 30+4. Caribbean / Middle Eastern / South Asian5. FHx of DM6. PCOS
209
If a pregnant woman has RF for GD, what should happen?
Oral Glucose Tolerance Test (OGTT) @ 24-28 weeks
210
If a pregnant woman has previously had GD, what should happen?
OGTT after Booking Clinic
211
What CF could suggest GD? (3 things)
1. Large for GA2. Polyhydramnios3. Glucose on Urine dipstick
212
What are the CF of GD? (4 things)
1. Asymptomatic (most woman w pancreatic reserve)2. Polyuria3. Polydipsia4. Fatigue
213
What is the NICE recommendation for a GD woman with Fasting glucose less than 7? (3 things) (IN ORDER)
1. Diet + Exercise Trial for 1-2 wks2. Metformin3. Insulin
214
What is the NICE recommendation for a GD woman with Fasting glucose of 7+? (2 things) (IN ORDER)
1. Insulin2. Metformin
215
What is the NICE recommendation for a GD woman with Fasting glucose of 6+ + Macrosomia / Other complications? (2 things) (IN ORDER)
1. Insulin2. Metformin
216
What can you give women who decline Insulin / Can’t tolerate Metformin?
Glibenclamide (a Sulfonylurea)
217
What monitoring scans do GD women need during pregnancy?
US scans every 4 weeks (from 28-36 weeks)
218
What is monitored in the US scans every 4 weeks for a GD woman? (2 things)
1. Foetal growth2. Amniotic fluid volume
219
When should a woman aim to deliver if her GD is managed by Treatment?
37-38 weeks
220
When should a woman aim to deliver if her GD is managed by Diet?
B4 40+6 weeks
221
What type of delivery should a woman w GD managed by Diet be advised to have? (2 things)
1. Induction of labour2. C section
222
When can a GD woman stop her GD medication?
Immediately after birth
223
What should be checked before a GD woman is discharged?
Blood glucose(to check it has returned to normal levels)
224
What are GD women at risk of developing in future?
DM
225
What percentage of GD women will develop T2DM in future?
50%
226
What should you do to monitor risk of developing DM in GD women?
Fasting glucose test 6-13 weeks after giving birth
227
If the Fasting glucose test 6-13 weeks after giving birth is normal, what should you do?
Offer yearly tests(bc still risk of developing DM in future)
228
What are babies of GD woman at risk of? (6 things)
1. **Macrosomia**2. **Neonatal hypoglycaemia**3. Polycythaemia4. Jaundice5. Congenital HD6. Cardiomyopathy
229
How do you manage the risk of a baby of a GD woman developing Neonatal hypoglycaemia? (2 things)
1. Regular blood glucose checks2. Frequent feeds
230
What should you give if the baby’s Blood Glucose drops below 2?
IV dextrose (via NG tube)
231
What is Polyhydramnios?
Too much amniotic fluid @ pregnancy
232
What is the numerical definition of Polyhydramnios?
Amniotic fluid index above 95% centile for GA
233
How does the volume of Amniotic fluid change throughout pregnancy? (3 points)
* 0-33 weeks: Increases steadily* 33-38 weeks: Plateaus* 38+ weeks: Declines
234
What is the volume of Amniotic fluid at term?
500ml
235
What is Amniotic fluid made up of? (3 things)
1. Foetal urine output (mostly)2. Placenta contributions3. Foetal secretions
236
What is the pathophysiology of Polyhydramnios?
Problems w any of structures in Amniotic fluid pathway
237
What is the Amniotic fluid pathway? (5 steps)
1. Foetus breathes + Swallows Amniotic fluid2. AF processed3. AF fills blader4. AF voided5. Cycle repeats
238
What are the causes of Polyhydramnios? (11 things)
1. Idiopathic (60%)2. Swallowing abn (oesophageal atresia / CNS abn / muscular dystrophies)3. Duodenal atresia4. Anaemia5. Foetal hydrops6. Twin-to-Twin transfusion syndrome7. Increased lung secretions8. Chromosomal abn9. Maternal DM10. Maternal ingestion of lithium11. Macrosomia (bc big babies make more urine)
239
What investigation is Polyhydramnios diagnosed with?
US
240
What are the ways to measure AF using US to diagnose Polyhydramnios? (2 things)
1. Amniotic Fluid Index (AFI) (more common)2. Maximum Pool Depth (MPD)
241
Apart from the Dx, why are examinations / investigations done for Polyhydramnios?
To find out the cause
242
What examination can you do for Polyhydramnios?
Palpate uterus to see if it feels tense
243
What can you check for in the US for Polyhydramnios? (3 things)
1. Assess foetal size2. Assess foetal anatomy (to check for structural causes)3. Doppler (to detect foetal anaemia)
244
What other investigations can you do for Polyhydramnios?
1. Maternal Glucose Tolerance Test (for maternal DM)2. Karyotyping (for chromosomal abn)
245
Is any Medical intervention routinely required for women with Polyhydramnios?
No
246
If Maternal symptoms of Polyhydramnios are severe (aka SOB), what can be considered?
Amnioreduction
247
What are the complications of Amnioreduction? (2 things)
1. Infection2. Placental abruption (bc sudden decrease in intrauterine pressure)
248
What medication can be used enhance water retention in foetus in Polyhydramnios?
Indomethacin
249
What is a con of Indomethacin?
Premature closure of Ductus Arteriosus
250
How do you get around the con of Indomethacin?
Don’t use it beyond 32 weeks
251
What is special about Idiopathic Polyhydramnios?
Baby has to be examined by Paediatrician before first feed
252
How does the Paediatrician examine a baby with idiopathic polyhydramnios before their first feed?
Pass NG tube to ensure no Tracheoesophageal fistula / oesophageal atresia
253
What is Severe + Persistent + Unexplained Polyhydramnios associated with?
Perinatal mortality
254
Why does Severe + Persistent + Unexplained Polyhydramnios have a bad prognosis? (2 things)
1. Likely presence of underlying abn / congenital malformation2. Increased incidence of preterm labour (bc of uterus over-distension)
255
What needs to be looked out for with Polyhydramnios DURING pregnancy?
1. Malpresentation (transverse lie / breech)2. Membrane rupture3. Cord prolapse
256
Why are Malpresentations possible with Polyhydramnios?
Foetus has more room to move within cavity
257
What needs to be looked out for with Polyhydramnios AFTER pregnancy? Why?
* PPH* Bc uterus has to contract further to achieve haemostatis
258
What is Oligohydramnios?
Low level of amniotic fluid in pregnancy
259
What is the numerical definition of Oligohydramnios?
Amniotic fluid index below 5th centile for GA
260
What percentage of pregnancies does Oligohydramnios affect?
4.50%
261
What can cause Oligohydramnios pathophysiologically speaking? (3 things)
1. Reduced production of urine2. Blocked output from foetus3. Membrane rupture (fluid leaks)
262
What are the causes of Oligohydramnios? (7 things)
1. Preterm prelabour membrane rupture2. Placental insufficiency3. Renal agenesis (aka Potters syndrome)4. Non-functioning foetal kidneys5. Obstructive uropathy6. Chromosomal abn7. Viral infections (can also cause Polyhydramnios)
263
How does Placental insufficiency cause Oligohydramnios? (2 steps)
1. Blood flow redistributed to foetal brain (instead of abdomen + kidneys)2. Poor urine output
264
What investigation is Oligohydramnios diagnosed with?
US
265
What are the ways to measure AF using US to diagnose Polyhydramnios? (2 things)
1. Amniotic Fluid Index (AFI) (more common)2. Maximum Pool Depth (MPD)
266
What might you also see in the US that might suggest Oligohydramnios?
Small foetus (bc placental insufficiency, which is a cause of Oligo)
267
What CF in the Hx might suggest Oligohydramnios?
Leaking fluid + feeling damp all the time (described as new urinary incontinence)
268
What CF @ examination might suggest Oligohydramnios?
Palpable foetal parts
269
If Oligohydramnios is caused by Ruptured Membrane, what is gonna happen next?
Labour within 24-48 hours
270
If Oligohydramnios is caused by PRETERM Ruptured Membrane (b4 37 wks), and labour doesn’t start automatically, what should you do?
Consider labour induction @ 34-36 weeks
271
What should you also give in the case of Oligohydramnios caused by PRETERM Ruptured Membrane? (2 things)
1. Steroids course (to aid foetal lung dev)2. Abx (reduce inf risk)
272
If Oligohydramnios is caused by Placental Insuff, what does the delivery timing depend on? (3 things)
1. Foetal growth rate2. Umbilical artery + Middle cerebral artery Doppler scans3. Cardiotocography
273
When should babies with Placental insuff be delivered by?
Before 36/37 wks
274
Which trimester does Oligohydramnios have a poor prognosis?
In 2nd trimester(bc usually due to premature ruptured membrane)
275
What are the complications of Oligohydramnios? (2 things)
1. Muscle contractures --\> disability after birth2. Pulmonary hypoplasia (fatal)
276
Why can foetus develop Muscle contractures bc Oligohydramnios? (2 points)
1. Amniotic Fluid usually allows foetus to move limbs in utero (basically exercises)2. Without this --\> muscle contractures
277
Can muscle contractures bc Oligohydramnios be resolved with Physio?
Maybe
278
What is a breech presentation?
Foetus presenting feet / bum first (instead of head first aka cephalic)
279
What percentage of pregnancies present as breech by 28 weeks?
20%
280
What percentage of pregnancies present as breech by 37 weeks?
3%
281
What are the types of breech? (4 things)
1. Complete breech2. Incomplete breech3. Extended breech (aka Frank breech)4. Footling breech
282
What is Complete breech?
Legs fully flexed @ hips + knees
283
What is Incomplete breech?
One leg flexed @ hip + Extended @ knee
284
What is Extended breech (aka Frank breech)?
Both legs flexed @ hip + Extended @ knee
285
What is Footling breech?
Foot presenting through cervix w leg extended
286
What can the RF of Breech be divided into? (2 things)
1. Uterine2. Foetal
287
What are the Uterine RF for Breech? (4 things)
1. Multiparity2. Uterine malformations (e.g septate uterus)3. Fibroids4. Placenta praevia
288
What are the Foetal RF for Breech? (5 things)
1. Prematurity2. Macrosomia3. Polyhydramnios4. Twins5. Abnormality (e.g anencephaly)
289
What could suggest Breech even before you see on scan? (2 things)
1. Palpating abdomen: foetal head felt in upper uterus2. Auscultating heart: Heart heard higher up maternal abd
290
What are some differential Dx that are similar to breech? (3 things)
1. Oblique lie (diagonal)2. Transverse lie (sideways)3. Unstable lie (presentation changes everyday)
291
When is unstable lie common?
Polyhydramnios
292
How do you confirm Breech Dx?
US
293
What are the Mx options for Breech? (3 things)
1. External cephalic version (ECV)2. C section3. Vaginal breech birth
294
What is External cephalic version (ECV)?
Manipulating foetus to cephalic presentation thru mums abd
295
What is the success rate of External cephalic version (ECV)?
50%
296
What increases the success rate of External cephalic version (ECV)?
Multiparity
297
What is a complication of External cephalic version (ECV)?
Transient foetal heart abn(transient, so they revert to normal)
298
What is a CI for Vaginal breech birth?
Footling breech
299
Why is Footling breech a CI for Vaginal breech birth?
Feet + legs can slip thru non-fully dilated cervix --\> shoulders + head get trapped
300
What are the complications of Breech? (4 things)
1. Cord prolapse2. Premature rupture of membranes3. Birth asphyxia (no blood flow to brain)4. Intracranial haemorrhage
301
Why do you get Intracranial haemorrhage with Breech?
Bc rapid compression of head @ delivery
302
What is cord prolapse?
Umbilical cord drops below presenting part of baby n gets compressed
303
What percentage of Breech get cord prolapse?
1%
304
What is the classification of PPH in NORMAL delivery?
500ml +
305
What is the classification of PPH in C Section?
1000ml +
306
What are the different severity classifications of PPH? (3 things)
1. Minor PPH: Under 1000ml1. Major PPH: 1000-2000ml1. Severe PPH: 2000ml +
307
What is the different TIMING classifications of PPH? (2 things)
1. Primary PPH: Within 24 hours of birth1. Secondary PPH: from 24 hours – 12 wks after birth
308
What are the causes of PPH? (4 things)
1. Tone (uterine atony aka no tone) (most common cause)1. Trauma1. Tissue (retained placenta)1. Thrombin(4 T’s)
309
How does Uterine atony cause PPH?
Lack of tone in uterine muscle --> uterus can’t contract properly
310
What are the types of Trauma that cause PPH?
Vaginal / Cervical / Perineal tears
311
What are the RF for Trauma causing PPH? (3 things)
1. Instrumental delivery1. Episiotomy1. C section
312
How does a retained placenta cause PPH?
Stops uterus from contracting
313
What does Thrombin refer to as a cause of PPH? (2 things)
1. Vascular abn1. Coagulopathies
314
What Vascular abn cause PPH? (3 things)
1. Placental abruption1. HTN1. Pre-eclampsia
315
What Coagulopathies cause PPH? (3 things)
1. von Willebrand’s disease1. Haemophilia A/B1. DIC
316
What are the RF for PPH? (12 things)
1. PPH Hx1. GA1. Obesity1. Multiple pregnancy1. Large baby1. Failure to progress to 2nd stage of labour1. Prolonged 3rd stage1. Pre-eclampsia1. Placenta accreta (grows into uterus wall)1. Retained placenta1. Episiotomy / perineal tear1. Instrumental delivery
317
Apart from the obv bleeding, what other CF can you get if substantial PPH? (4 things)
1. Dizziness1. Palpitations1. SOB1. Haemodynamic instability
318
What might you see @ Abd examination of PPH?
Signs of uterine rupture (aka fetal parts as it moves from uterus --> abd)
319
What might you see @ Speculum examination of PPH?
Local trauma sites may be revealed
320
What should you examine after PPH? Why?
* Placenta* To ensure placenta is incomplete
321
What causes of PPH might you see @ Placenta examination? (2 things)
1. Missing cotyledon1. Ragged membranes
322
What is the pneumonic for the Mx plan for PPH?
TRIM
323
What does TRIM stand for as the Mx plan of PPH? (4 things)
1. Teamwork (Immediate)1. Resus (ABCDE) (Immediate)1. Investigations + Monitoring (Immediate)1. Measures to arrest bleeding (Definitive)
324
Who is involved in the Teamwork aspect of PPH Mx? (6 things)
1. Obstetricians1. Anaesthetists1. Haematologist1. Midwife in charge + Midwives1. Blood bank1. Porters
325
What Investigations should you for PPH? (5 things)
1. FBC1. Cross match 4-6 units blood1. Coag profile1. UnEs1. LFT
326
How should you Monitor a PPH? (5 things)
1. RR1. O2 sats1. HR1. BP1. Temperature
327
How often should you do the Monitoring things for PPH?
Every 15 mins
328
What else should you consider for Monitoring PPH? (2 things)
1. Catheterisation1. Central venous line insertion
329
What are the Definitive Mx option titles for PPH? (3 things)
1. Mechanical1. Medical1. Surgical
330
What are the MECHANICAL Mx options for PPH?
1. Rubbing uterus (thru abd)1. Catheterization
331
How does Rubbing uterus work to manage PPH?
Stimulates uterine contraction
332
How does Catheterization work to manage PPH?
Reduces bladder distention(which was preventing uterine contractions)
333
What are the MEDICAL Mx options for PPH? (5 things)
1. Oxytocin1. Ergometrine (IV / IM)1. Carboprost (IM)1. Misoprostol (subling)1. Tranexamic acid (IV)
334
How should Oxytocin be administered in PPH Mx?
Slow injection then continuous infusion
335
How does Ergometrine work in PPH Mx?
Stimulates SMC contractions
336
When is Ergometrine CI for PPH Hx?
HTN
337
What class of meds are Carboprost + Misoprostol?
Prostaglandin analogue
338
How do Carboprost + Misoprostol work in PPH Mx?
Stimulate uterine contraction
339
What class of meds is Tranexamic acid?
Antifibrinolytic
340
How does Tranexamic acid work in PPH Mx?
Reduces bleeding
341
What are the SURGICAL Mx options for PPH? (4 things)
1. IU balloon tamponade1. B-Lynch suture1. Uterine artery ligation1. Hysterectomy (last resort)
342
How does IU balloon tamponade work in PPH Mx?
Insert inflatable balloon into uterus to press against bleeding
343
How does B-Lynch suture work in PPH Mx?
Putting suture around uterus to compress it
344
How does Uterine artery ligation work in PPH Mx?
Ligate 1+ arteries supplying uterus to reduce blood flow
345
How does Hysterectomy (last resort) work in PPH Mx?
Stops bleeding + saves woman’s life
346
What are the causes of Secondary PPH (24 hrs – 12 wks)? (2 things)
1. Retained products of conception (RPOC)1. Inf (e.g endometritis)
347
What investigations should you do for Secondary PPH? (2 things)
1. US (for RPOC)1. Endocervical + high vaginal swabs (for inf)
348
What are the Mx options for Secondary PPH? (2 things)
1. Surgery (for RPOC)1. Abx (for inf)
349
How do you prevent PPH even happening in 1st place? (4 things)
1. Treat anaemia during antenatal period1. Give birth on empty bladder1. Active Mx of 3rd stage (w IM oxytocin)1. IV Tranexamic acid in C section for high risk pt
350
What is a prolonged pregnancy aka?
Post-term
351
What is the definition of Prolonged Pregnancy?
Pregnancy persist up to and beyond 42 wks
352
What are the RF for Prolonged Pregnancy? (4 things)
1. Nulliparity1. Maternal age 40+1. Prolonged preg Hx / FHx1. Obesity
353
What are the CF of Prolonged Pregnancy? (5 things)
1. Static growth / Macrosomia1. Oligohydramnios1. Reduced foetal movements1. Meconium presence1. Dry / flaky skin w reduced Vernix
354
What is Vernix?
Waxy white substance coating skin on newborn babies
355
What is Vernix?
Waxy white substance coating skin on newborn babies
356
What are the NICE / RCOG guidelines for prolonged pregnancy?
Deliver by 42 weeks, to reduce risk of stillbirth
357
How can you achieve delivery by 42 weeks? (2 things)
1. Membrane sweeps1. Induction of labour
358
When can Membrane sweeps be offered from? (2 things)
1. 40 weeks (if nulliparous)1. 41 weeks (if parous)
359
When can Induction of labour be offered?
Between 41-42 weeks
360
What should you do with women who decline Induction of labour? (2 things)
1. Twice weekly CTG monitoring1. USS w amniotic fluid measurement(To identify foetal distress)
361
What should you do @ Foetal distress / srs complication to mother / child?
Emergency C section
362
What is Pre-eclampsia?
New HTN @ pregnancy w End-organ dysfunction
363
What is the general Pathophysiology of Pre-eclampsia?
Poor placental perfusion, secondary to abn placentation
364
How an you understand Pathophysiology of Pre-eclampsia?
Compare normal Placentation vs Pre-eclampsia placentation
365
What are the steps for Normal placentation? (2 steps)
1. Trophoblasts invades Endometrium + Spiral arteries --> Destroys tunica muscularis media1. Spiral arteries dilate --> High flow, low resistance circulation for pregnancy
366
What are the steps for Normal placentation in Pre-eclampsia? (3 steps)
1. Spiral arteries remodelling incomplete --> Low flow, High resistance circulation for pregnancy1. Increase in BP + Hypoxia + Oxidative stress (bc inadeq uteroplacental perfusion)1. Systemic inflamm response + Endothelial cell dysfunction --> leaky blood vessels
367
What are the titles of RF for Pre-eclampsia? (2 things)
1. High RF1. Moderate RF
368
What are the HIGH RF for Pre-eclampsia? (5 things)
1. HTN1. Pre-eclampsia Hx1. AI conditions (e.g SLE)1. DM1. CKD
369
What are the MODERATE RF for Pre-eclampsia? (5 things)
1. Age 40+1. BMI 35+1. 10+ yrs since previous preg1. 1st preg1. Pre-eclampsia FHx
370
How does number of RF affect Mx of Pre-eclampsia?
1. 1+ HIGH RF: Aspirin1. 2+ MODERATE RF: Asprin
371
When should you offer women w RF Aspirin?
12 wks
372
What is a simple way to remember CF of Pre-eclampsia? (3 things)
1. Proteinuria1. Rise in BP1. Edema| (PRE – eclampsia)
373
What are the CF Pre-eclampsia? (7 things)
1. Headache1. Visual disturbance / blurriness1. N + V1. Brisk reflexes1. Upper abd / epigastric pain (bc liver swelling)1. Oedema1. Reduced urine output
374
What are the NICE guidelines for Dx of Pre-eclampsia?
BP reading + one Extra CF
375
What BP readings needed for for Dx of Pre-eclampsia? (2 things
1. Systolic 140+1. Diastolic 90+
376
What are the CF needed for Dx of Pre-eclampsia? (3 things)
1. Proteinuria (1+ on dipstick)1. Organ dysf CF1. Placental dysf (e.g foetal growth restriction / abn Doppler)| (only need 1 for Dx)
377
What CF suggest Organ dysfunction? (5 things)
1. Raised creatinine 1. Raised liver enzymes1. Seizures1. Thrombocytopaenia1. Haemolytic anaemia
378
What investigation does NICE recommend for women w sus Pre-eclampsia?
Placental Growth Factor Testing (PlGF) (low in Pre-eclampsia)
379
What are the Mx options for Gestational HTN (w/o proteinuria, aka NOT Pre-eclampsia)? (5 things)
1. Tx n aim for BP below 135/851. Admit if BP above 160/1101. Weekly bloods + urine dipstick1. Monitor foetal growth (serial growth scans)1. PlGF testing
380
How do the Mx options change once Pre-eclampsia is Dx? (4 things)
1. Same as Gestation HTN plus:1. BP monitor every 48 hrs at least1. Don’t need Dipstick anymore (bc Dx already made)1. US to monitor: Foetus / amniotic fluid / Dopplers (2 weekly)
381
What are the MEDICAL Mx options for Pre-eclampsia? (6 things)
1. Labetolol (anti-HTN) (FIRST LINE) 1. Nifedipine (SECOND LINE)1. Methyldopa (THIRD LINE)1. IV hydralazine (SEVERE pre-eclampsia / eclampsia)1. IV Mg sulphate (during labour + 24 hrs after --> to prevent seizures)1. Fluid restriction
382
What is important to know about Methyldopa as Tx for Pre-eclampsia?
Need to stop it within 2 days of birth
383
When should you give IV Mg Sulphate in Pre-eclampsia?
1. During labour1. 24 hours afterwards
384
What is the point of giving IV Mg Sulphate in Pre-eclampsia Mx?
Preventing seizures
385
When should you do Fluid restriction in Pre-eclampsia?
During labour
386
What is the point of doing Fluid restriction in Pre-eclampsia Mx?
Avoid fluid overload
387
What should you do for Pre-eclampsia when BP can’t be controlled?
Premature birth
388
What should you give Pre-eclampsia women having a Premature birth? Why?
* Corticosteroids* Help mature foetal lungs
389
What should you monitor after delivery?
BP
390
When will the BP go back to normal after delivery?
Once placenta is removed
391
What Tx does NICE recommend you switch to after delivery? (3 things)
1. Enalapril (FIRST LINE)1. Nifedipine / amlodipine (SECOND LINE) (FIRST LINE IN NIGGAS)1. Labetolol / Atenolol (THIRD LINE)
392
What is Eclampsia?
Refers to seizures assoc w Pre-eclampsia
393
What are the Mx options for Seizures (aka Eclampsia) assoc w Pre-eclampsia?
IV Mg Sulphate
394
What is a complication of Pre-eclampsia?
HELLP Syndrome
395
What are the CF of HELLP Syndrome? (3 things)
1. Haemolysis1. Elevated Liver enzymes1. Low Platelets| (stands for HELLP)
396
What is the RCOG definition of a Low lying placenta?
Placenta within 20mm of Internal cervical os (but not covering it)
397
What is the RCOG definition of Placenta Praevia?
Placenta covering Internal cervical os
398
What is the percentage of the incidence of Placenta Praevia?
1% of pregnancies
399
What is Placenta Praevia a notable cause of?
Antepartum haemorrhage
400
What are the 3 main causes of Antepartum haemorrhage?
1. Placenta praevia1. Placental abruption1. Vasa praevia
401
What are the RF for Placenta praevia? (6 things)
1. Previous C sections (main RF)1. Hx of Placenta praevia1. Age 40+1. Smoking1. Structural uterine abn (e.g fibroids)1. IVF
402
What is the main CF of Placenta praevia? (2 things)
1. Asymptomatic (most)1. Painless vaginal bleeding
403
When does bleeding usually occur in Placenta praevia?
Late, aka 36+ weeks
404
What are some DDx that present similarly to Placenta Praevia? (5 things)
1. Placental abruption1. Vasa praevia1. Uterine rupture1. Benign / malignant lesions (e.g polyps / carcinoma)1. Infection (e.g candida / bac vaginosis / chlamydia)
405
What should you do if sus MAJOR bleeding and you haven’t done any investigations?
Resus + do investigations at same time
406
What investigations should you do for bleeding at Placenta praevia? (8 things)
1. FBC (anaemia)1. UnE1. LFT1. Clotting profile1. G&S1. Crossmatch1. Kleihauer test (if woman Rh negative)1. CTG
407
What do you do the Kleihauer test for? (2 steps)
1. To determine amount of Feto-maternal haemorrhage1. Thus dose of Anti-D req
408
What is the point of CTG in Placenta praevia investigation?
To assess foetal wellbeing
409
What investigation gives you the definitive Dx of Placenta praevia?
US
410
What does RCOG recommend for woman Dx w Placenta praevia at 20 wk anomaly scan? (2 things)
Repeat US @:1. 32 weeks1. 36 weeks (if still present @ 32 wks)
411
What medication is useful to give in Placenta praevia?
Corticosteroids
412
Why are Corticosteroids useful to give in Placenta Praevia?
To mature foetal lungs, given risk of preterm delivery
413
When should you give Corticosteroids in Placenta praevia?
Between 34 – 36 weeks
414
When should you plan delivery in Placenta praevia?
Between 36 – 37 weeks
415
How should you deliver foetus w Placenta Praevia?
C section
416
What is the main complication of Placenta Praevia?
Haemorrhage
417
What are the Mx options for Haemorrhage in Placenta Praevia? (5 things)
1. Emergency C section1. Blood transfusion1. Intrauterine balloon tamponade1. Uterine artery occlusion1. Emergency hysterectomy
