Random 2 Flashcards
(31 cards)
Outline the antenatal screening pathway
Pre conception counselling: 400microg folic acid
8-12 weeks: booking: smoking/weight/dietary advice, BP, urine, FBC, rhesus status, haemoglobinopathies, syphilis, rubella, hepatitis B
10-13+6 weeks: dating scan
11-13+6 weeks: down’s scan including NT
18 weeks: anomaly scan
28 weeks: first dose anti-D to Rh- women, anaemia screen
34 weeks: second dose anti-D to Rh- women
36 weeks: check foetal presentation, info on breast feeding, baby blues etc
38 weeks: vitals
41 weeks: vitals/discuss labour
What tests are used to diagnose Down’s and what are the results?
11 weeks: bHCG, plasma protein A, NT
15 weeks onwards: bHCG, oestriol, AFP
results: ‘HIgh’. bHCG and inhibin A are increased, the rest are decreased
What are the results of screening tests in Turner’s, Edward’s and Patau’s?
Turner's = HIgh = bHCG and inhibin A are high Edward's = HE is low = bHCG and oestriol is low Patau's = only AFP increased
What is the triad of hyperemesis gravidarum?
5% pre-pregnancy weight loss
dehydration
electrolyte imbalance
most common between 8-12 weeks
What score can be used to assess hyperemesis gravidarum?
PUQE
pregnancy unique quantification of emesis score
What is hyperemesis gravidarum associated with?
What are the investigations for hyperemesis gravidarum?
multiple pregnancies, trophoblastic disease, hyperthyroidism, obesity, nulliparity, smoking is a protective factor
renal function/electrolytes
ultrasound
LFTs
MSSU
What is the management of hyperemesis gravidarum?
small, frequent meals. high in carbs.
P6 (wrist) acupressure
promethazine or cyclizine
metoclopramide, prochlorperazine, ondansetron
What are the indications for secondary care referral in hyperemesis gravidarum?
continued nausea/vomiting associated with ketonuria or weight loss despite anti-emetics
inability to keep down oral anti-emetics
comorbidity
What are the risk factors of an ectopic pregnancy?
damage to tubes (salpingitis, surgery)
previous ectopic
IVF
what are the obstetric causes of abdominal pain in pregnancy?
pre-eclampsia/HELLP syndrome (epigastric/RUQ)
placental abruption
uterine rupture (constant pain, shock)
chorioamnionitis
acute fatty liver of pregnancy (second half, abdo pain, nausea, jaundice, malaise)
what are the gynae causes of abdominal pain in pregnancy?
ectopic pregnancy (5-9w)
ovarian torsion
fibroids
salpingitis
what are the surgical causes of abdominal pain in pregnancy?
appendicitis
cholecystitis
intestinal obstruction
meckel’s diverticulitis
what are the medical causes of abdominal pain in pregnancy?
constipation
DKA
sickle cell anaemia
IBS
Outline what threatened, missed, inevitable and incomplete miscarriages are
Threatened: painless vaginal bleeding <24w, cervical os still closed. typically 6-9w.
Missed: dead foetus. pregnancy symptoms have disappeared. <20w.
Inevitable: painful vaginal bleeding, cervical os open.
Incomplete: partial passage of blood, cervical os open, rest to come
What is post mature pregnancy?
Pregnancy which persists beyond 42 weeks
What are the foetal and neonatal risks in post mature pregnancy?
Increased risk of death Meconium aspiration Macrosomia Neonatal encephalopathy Placental insufficiency Neonatal acidaemia
What are the maternal risks of postmature pregnancy?
C Section
Instrumental delivery
Perineal damage
PPH
What is the pathway for induction of labour?
before induction: continuous CTG, bishop score
1) membrane sweeping: at 40/41 weeks for nulliparous women, at 41 weeks for multiparous women
2) PGE2: pessary for nullips, gel for multips
3) amniotomy (with or without oxytocin)
4) syntocinon (continous CTG)
if there is a risk of uterine hyperstimulation and fetal distress = intermittent CTG
During induction of labour, if uterine hyperstimulation occurs, what is the management?
tocolysis
What are the indications for CTG during labour?
Maternal: previous C section pre-eclampsia PROM recurrent antepartum haemorrhage diabetes
Foetal:
IUGR
abnormal presentation
reduced foetal movements
Intrapartum: epidural analgesia fresh bleeding during labour augmentation of labour with oxytocin prior to induction
What is a ‘non-reassuring’ CTG?
What is the management?
CTG has one feature that is non-reassuring
decrease contraction frequency (discontinue oxytocin, start tocolytic agents e.g. terbutaline)
screen for infection if maternal tachycardia
What is an ‘abnormal’ CTG?
What is the management?
two or more features which are non-reassuring
foetal blood sampling
What is a normal foetal blood sampling result?
Lactate <4.1
pH >7.2
What is an abnormal foetal blood sampling result?
Lactate >4.9
pH <7.2
