Random 3 Flashcards
(36 cards)
How do you diagnose, investigate and manage IUGR?
Diagnosis: fetal abdominal circumference/estimated fetal weight <10th centile
Investigations: serial ultrasound measurements, uterine artery doppler from 26-28 weeks
Management: aspirin before 16 weeks, progesterone therapy to prevent preterm birth
if detected preterm, deliver at 32 weeks
if detected after 32 weeks, deliver at 37 weeks
What are the investigations of prematurity?
For women with intact membranes >30w
- TVS (cervical length)
- Fetal fibronectin
- Vaginal swab
What is the management of prematurity?
Tocolytic drugs (nifedipine or terbutaline)
Corticosteroids (if between 24-35 weeks)
Magnesium sulfate (4g for neuroprotection, give to women between 24-29 weeks or 30-33 weeks)
Emergency cleavage: women between 16-34 weeks with a dilated cervix and unruptured exposed membranes
What are red flags that can occur in a sick or deteriorating pregnant patient?
Pyrexia >38, RR >20 Breathlessness Headache Abdominal pain/diarrhoea Anxiety/distress
What management would you do for a sick or deteriorating pregnant patient?
Call for senior help Increase observation frequency Left lateral tilt, CTG Check IV lines, drug chart ECG/ABG/Venepuncture
What are the risk factors, diagnosis, management, and screening for gestational diabetes?
RF: Afro-Caribbean, BMI >30, previous GD, previous macrosomic baby, family history
Diagnosis: fasting >5.6, 2 hour >7.8
Screening: women who have had previous GD = OGTT 75mg at booking and 24-28 weeks
Management: if fasting <7 = trial of diet and exercise, if this fails, metformin. if fasting >7 = single injection intermediate insulin (e.g. isophane)
if this still does not work = add short acting insulin before meals
What are the complications of pre-existing diabetes in pregnancy?
Miscarriage Pre-eclampsia Preterm labour Stillbirth Congenital malformations Macrosomia Birth injury Hypoglycaemia
What is the pre-conception care of diabetes?
Avoid unplanned pregnancies
Keep HbA1c <48 (6.5%)
BMI >27 = lose weight
Take 5mg of folic acid until 12w
What is the management/targets of diabetes in pregnancy?
Stop medications apart from metformin
Folic acid
Fasting: 5.3
1 hour PP: 7.8
2 hour PP: 6.4
If a baby is born hypoglycaemic, what do you give it?
IV dextrose
What is the management for women who are at a high risk of developing pre-eclampsia?
Take 75mg aspirin from 12w until birth
What are the high risk groups of getting hypertension in pregnancy?
HTN in previous pregnancies
CKD
Autoimmune disorders
Diabetes
How does BP change physiologically in a normal pregnancy?
BP decreases in first trimester, falls until 20-24 weeks then rises back up again
What is the management of pre-existing hypertension before pregnancy?
Keep BP below 150/100mmHg
Regularly test for proteinuria
A BP of >140/90mmHg before 20 weeks is diagnostic for pre-existing hypertension
How do you diagnose gestational hypertension?
What is the diagnostic criteria of mild, moderate and severe HTN and what is the management for each?
Hypertension occurring after 20 weeks
Mild: 140-149/90-99: measure BP twice weekly, check for proteinuria
Moderate: 150-159/100-109: measure BP twice weekly, start labetolol, proteinuria tests
Severe: 160/110: admit to hospital, measure BP four times weekly, proteinuria checks daily
What is pre-eclampsia/eclampsia?
What can pre-eclampsia predispose you to?
HTN in pregnancy associated with proteinuria with/without oedema
prematurity/IUGR/eclampsia/haemorrhage/multi organ failure
What are the high risk factors for pre-eclampsia?
HTN in previous pregnancy
CKD
Diabetes
Autoimmune disease
What is the pathophysiology of pre-eclampsia?
Spiral arterioles fail to unfold (second trophoblastic phase failure) causing high placental pressure and reduced blood flow to the fetus.
Associated with a maternal inflammatory response/endothelial dysfunction
What are the features of pre-eclampsia/eclampsia?
What are the features of severe eclampsia?
Pre-eclampsia: only have proteinuria and HTN
Eclampsia: all other symptoms
Severe: HTN >170/110, headache, visual disturbance, papilloedema, RUQ/epigastric pain, hyperreflexia
What is the management of pre-eclampsia/eclampsia?
Oral labetalol if BP 150-159/100-109
Admit if increased BP with proteinuria
Monitor BP four times daily
If labetalol is CI give nifedipine or hydralazine
MgSO4 to control seizures: 4g then 1g/hour
What is the management of epilepsy and pregnancy?
5mg folic acid per day during conception and first trimester
Continuous CTG in case of a seizure
Lorazepam/diazepam IV in case of a seizure
What anti epileptics will fuck you up in pregnancy?
Sodium valproate = neural tube defects
Phenytoin = cleft lift palate (give vitamin K in the last month of pregnancy)
What are the UKMEC guidelines for anti-epileptics and contraception?
For women taking phenytoin, carbamazepine, barbiturates primidone, topiramate
UKMEC3: COCP, POP
UKMEC2: Implant
UKMEC1: Depo-Provera, IUS, IUD
For women taking lamotrigine:
UKMEC3: COCP
UKMEC1: POP/implant/Depo/IUS/IUD
What are the benefits of breast feeding?
decreased risk of cot death
decreased risk of breast and ovarian cancer and diabetes
boosts baby’s immunity to infection
increased intelligence
