Repro - pregnancy complications + psych Flashcards
(120 cards)
1
Q
what is the baby blues? when does it occur?
A
brief period of emotional instability that effects 50% of women
3-10 days post-birth
2
Q
what are the symptoms of the baby blues
A
tearful/irritable/anxiety
poor sleep
confusion (due to lack of sleep)
3
Q
what is the treatment of the baby blues
A
self-limiting: support and reassure
4
Q
when does puerperal psychosis present
A
within 2 weeks of delivery
5
Q
what are the symptoms of puerperal psychosis
A
early = sleep disturbance, confusion, irrational ideas
mania
delusions
hallucinations
6
Q
what is the treatment of puerperal psychosis
A
admission to mother-baby unit
antidepressants/antipsychotics/modd stabilisers
ECT
7
Q
when does postnatal depression occur
A
2-6 weeks post birth, tends to last weeks to months
8
Q
what are the symptoms of postnatal depression
A
tearful/irritable/anxiety lack of enjoyment poor sleep weight loss can present as concerns about the baby
9
Q
what is the treatment of postnatal depression
A
mild-moderate = self-help, counselling
moderate-severe = psychotherapy, antidepressants
10
Q
what is the treatment of a intra-partum epileptic seizure
A
Left lateral tilt IV lorazepam / diazepam PR diazepam / buccal midazolam IV Phenytoin May need to expedite delivery by CS If no history of epilepsy = MgSO4
11
Q
what is Antiphospholipid antibody syndrome (APS)
A
autoimmune disease where antibodies react with the phosholipid component of the cell membrane
12
Q
what are the symptoms of Antiphospholipid antibody syndrome
A
thrombosis recurrent, early miscarriage late miscarriage foetal growth restriction placental abruption severe, early onset pre-eclampsia
13
Q
what is the criteria for diagnosis of Antiphospholipid antibody syndrome
A
1 clinical + 1 lab occurring twice 6 wks apart
14
Q
what are the clinical signs of Antiphospholipid antibody syndrome
A
vascular thrombosis
pregnancy complications:
≥ 3 miscarriages <10 weeks
≥ 1 fetal loss >10 weeks (morphologically normal fetus)
≥1 preterm birth (<34 weeks) due to PET or utero-placental insufficiency
15
Q
what are the laboratory signs of Antiphospholipid antibody syndrome
A
IgM/ IgI aCL
L
16
Q
what is the treatment of Antiphospholipid antibody syndrome
A
no complications = surveillance
previous thrombosis
pregnant = LMWH
normal = heparin
17
Q
what is pregnancy induced hypertension
A
high BP occurring during 2nd half of pregnancy and resolves within 6 wks of delivery
no proteinuria or signs of pre-eclampsia
18
Q
what are the 3 key signs of pre-eclampsia
A
High BP + proteinuria + oedema
19
Q
what is pre-eclampsia
A
diffuse vascular dysfunction causing widespread circulatory disturbance
20
Q
what are the foetal symptoms of pre-eclampsia
A
growth restriction
placental abruption
intrauterine death
21
Q
what are the maternal symptoms of pre-eclampsia
A
liver disease headache visual disturbance hypertension proteinuria rapidly progressing odema
22
Q
what are the investigations of pre-eclampsia
A
U&Es LFTs Bloods including coag screen ultrasounf maternal uterine artery doppler
23
Q
when should a maternal uterine artery doppler be done if pre-eclampsia is suspected
A
BP >140/90
++ portienuria
severe odema
24
Q
what are the indications for inducing labour in pre-eclampsia
A
term gestation inability to control BP rapidly deteriorating eclampsia foetal compromise
25
what is the prophylaxis of pre-eclampsia
low dose aspirin
26
when would you give pre-eclampsia prophylaxis
previous high BP
CKD
diabetes
```
>1 of :
1st pregnancy (or pregnancy interval >10 years)
>40
BMI>35
FH
Multiple pregnancy
```
27
what is the treatment for High BP in pregnancy
1st line = labetalol, nifedipine
| 2nd line = hydralazine, doxazocin
28
what is the inpatient assessment of pre-eclampsia
```
BP every 4hrs
urinalysis daily
input/output fluid balance
urine PCR if proteinuria
bloods x2 a week
```
29
what is eclampsia
tonic-clonic seizures occurring with pre-eclampsia symptoms
30
what is the treatment of eclampsia
control BP - IV labetalol or hydralazine
control/prevent seizure = magnesium sulphate
fluid balance
deliver child
31
what is defined as large for date
a symphysial-fundal height >2cm for gestation age
32
what are the cause for a "large for date" baby
```
wrong date
foetal macrosomia = big baby
polydramnios
diabetes
multiple pregnancy
```
33
what is polydramnios? how is it defined
excess amniotic fluid
deepest pool >8cm OR amniotic fluid index >25cm
34
what is the cause of polydramnios
```
diabetes
monochorinic twins
idiopathic
hydrops fetalis
viral infection
```
35
what are the symptoms of polydramnios
```
abdominal discomfort
tense + shiny abdomen
inability to feel foetal pulse or parts
preterm labour
pre-labour rupture of membranes
cord prolapse
```
36
what are the investigations for polydramnios
ultrasound
OGGT - diabetes
Bloods - infections
37
what is the treatment for polydramnios
serial ultrasounds
| induce labour by 40 wks
38
what is cord prolapse
direct compression and cord spasm due to decreased flow causes hypoxia and foetal death
39
what are the investigations of cord prolapse
scan for foetal cardiac activity
40
what is the treatment for cord prolapse
immediate delivery
| maternal positions
41
what is shoulder dystocia
This is any cephalic delivery where manoeuvres (other than gentle traction) are required to deliver the baby after the head has been delivered.
42
what causes shoulder dystocia
bony impaction of foetal anterior shoulder on the maternal symphysis
43
what are the symptoms of shoulder dystocia
slow delivery of head/chin/face
"turtling" of head against perineum
"head bobbing"
44
what is the treatment of shoulder dystocia
```
episiotomy
McRoberts movement
suprapubic pressure
rotational manoeuvre
remove posterior arm
poll patient onto hands and knees
```
45
what is a multiple pregnancy
presence of >1 foetus
46
what are the types of twins? what causes the different types?
caused by time of cleavage
Monochorionic and Monozygous (MCMA)
Monochorionic and diamniotic (MCDA)
Dichorionic and diamniotic (DCDA)
47
what is the investigation of multiple pregnancy? what are the signs of each twin type?
ultrasound at 12 wks
lambda sign = DCDA
t-sign = MCDA
48
what are the symptoms of multiple pregnancy
exaggerated pregnancy symptoms
high AFP
large for date
49
how often should Monochorionic twins get ultrasounds
every 2 wks
50
how often should dichorionic twins get ultrasounds
every 4 wks
51
when should twins be delivered
```
DCDA = 37-38 wks
MCDA = 36 wks + steroids
MCMA = c section at 32-34 wks
```
triplets or more = C-section
52
what is Twin-to-Twin Transfusion Syndrome
syndrome with artery-vein anastomoses where the donor twin perfuses the recipient twin
53
what are the symptoms of Twin-to-Twin Transfusion Syndrome
Oligohydramnios AND polyhydramnios
54
what is the treatment of Twin-to-Twin Transfusion Syndrome
Before 26/40 = fetoscopic laser ablation
After 26/40 = amnioreduction/septostomy
Deliver at 34-36 weeks
55
what is the treatment of gestation diabetes
```
insulin
low dose aspirin from 12 weeks
high dose (5mg) folic acid up to 12wks
```
56
how often should a diabetic mother have a ultrasound
every 4wks from 28wks onwards
57
when should you retest blood glucose after both
6-8wks fasting
OGTT at 6 wks if type 2
annually
58
what is defined as small for date
estimated foetal weight OR abdominal circumference below the 10th centile
59
what is foetal growth restriction
failure to achieve growth potential
60
what is defined as a low birth weight
<2.5kg
61
what is a preterm delivery? what is moderate, very, and extreme
<37 wks
Extreme preterm: 24 – 27+6 weeks
Very preterm: 28 – 31+6 weeks
Moderate to late preterm: 32 – 36+6 weeks
62
what is post-partum haemorrhage
blood loss of 500mls or more
63
what is primary and secondary post-partum haemorrhage
primary = within 24hrs
| secondary 25hrs - 6 days post delivery
64
what is MAJOR post-partum haemorrhage
>1000mls OR signs of cardiovascular collapse OR on-going bleeding
65
what is antepartum haemorrhage
bleeding into/from the genital tract >24wks and before the end of 2nd stage of labour
66
what are the types of antepartum haemorrhage
spotting
minor = <50mls settled
major = 50-1000mls, no shock
massive >1000ml and/or shock
67
what is the treatment of antepartum haemorrhage
Kleihauer, Anti-D & Steroids
68
what is placental abruption
separation of normally implanted placenta before birth (partial or complete)
69
what are the symptoms of placental abruption
```
severe, continous abdominal pain
bleeding
uterine tenderness
"hard woody"uterine
maternal collapse
```
70
what are the investigations of placental abruption
CTG - irritable uterus
US if no foetal HR
bloods, LFTS, U&Es
71
what is placenta praevia
"low lying placenta". this is when the placenta lies directly over the internal os
72
what are the symptoms of placenta praevia
painless bleeding >24wks (can be trigger by sex)
present foetal movements
soft and non-tender uterus
73
what are the investigations of placenta praevia
NO VAGINAL EXAM
| rescan at 32 and 36wks
74
what is the treatment of placenta praevia
no sex
if bleeding admit for 24hrs
induce labour
c-section if completely covers os or malpresentation
75
what is placenta accreta
a placenta that is morbidly adherent to the uterine wall
76
what is the investigation of placenta accreta
MRI
77
what is the treatment of placenta accreta
Prophylactic internal iliac artery balloon
Caesarean hysterectomy
Conservative
78
what is uterine rupture
spontaneous, full thickness tearing of the uterus causing it to open into that cavity
79
what are the symptoms of uterine rupture
severe abdominal pain
maternal collapse
PV bleeding
80
what is the treatment of uterine rupture
surgery
81
what is vasa praevia? what is the risk?
unprotected foetal vessels that transverse the membranes below the presenting part over the os
it will rupture during labour or at amniotomy
82
what are the symptoms of vasa praevia
sudden dark red bleeding
| artifical rupture of membranes
83
what are the investigations of vasa praevia
ultrasound
84
what is a miscarriage
loss of pregnancy
85
what are the symptoms of a miscarriage
bleeding
"period like" cramps
cervical shock = cramps, nausea/vomiting, sweating fainting
86
what are the investigations of miscarriage
positive pregnancy test
ultrasound scan
speculum exam
FBC
87
what does the speculum exam indicate in an suspected miscarriage
os closed = threatened miscarriage
products sighted at os = inevitable miscarriage
products in vagina = complete miscarriage
os closed = complete miscarriage
88
what is a recurrent miscarriage
3 or more pregnancy losses
89
what is the cause of ectopic pregnancy
abnormal site of implantation = outwith uterine cavity
90
what are the symptoms of ectopic pregnancy
```
pelvic or abdominal pain
bleeding
dizziness/collapse
SOB
pallor
guarding/tenderness
```
91
what are the investigations of ectopic pregnancy
positive pregnancy test
serum hCG
ultrasound
92
what is the treatment of ectopic pregnancy
acutely unwell = surgical
stable = medical
well = conservative + follow up
93
what causes a molar pregnancy
abnormal embryo: non-viable fertilised egg
94
what are the types of molar pregnancy
complete = no maternal genes, no foetus, diploid
partial = 2 paternal + 1 maternal genes, haploid egg
95
what are the investigations of ectopic pregnancy
ultrasound = snow storm appearance
96
what type of ectopic pregnancy can become choriocarcinoma
complete
97
what is the treatment of ectopic pregnancy
surgical and tissue biopsy
98
what is a chorionic haematoma
pooling of blood between endometrium and embryo due to separation
99
what are the symptoms of chorionic haematoma
bleeding
cramping
threatened miscarriage/miscarriage
100
what is the treatment of chorionic haematoma
usually self-limited and resolves
| surveillance
101
what is implantation bleeding
light, brownish limited bleeding that occurs when the fertilised egg implants into the uterine wall about 10 days post-ovulation
102
what is hyperemesis gravidarum
excessive/protracted/altering qol vomiting
103
what antiemetics are given for hyperemesis
1st line = cyclizine or prochlorperazine
| 2nd = odansetron, metoclopramide
104
what is an amniotic fluid embolism
amniotic fluid enters the maternal circulation leading to collapse +/- arrest
105
what are the investigations of amniotic fluid embolism
increased zinc coproporhyin levels
| squames on R-sided circulation at Post mortem
106
what is the symptoms of pelvic floor dysfunction
incontinence
difficulty emptying bowel
prolapse
pain
107
what is the investigations for pelvic floor dysfunction
```
bladder diary
urinalysis
post-void residual test
ultrasound
pelvic floor assessment
```
108
what is the treatment of pelvic floor dysfunction
```
lifestyle
bladder training
pelvic floor exercises
biofeedback training
core stability exercises
```
109
what are the types of prolapse
1st, 2nd, 3rd, 4th
110
what is 1st degree prolapse
descent of cervix into vagina
111
what is 2nd degree prolapse
descent of cervix into the introits (opening)
112
what is 3rd degree prolapse
descent of cervix outside the introits (opening)
113
what is 4th degree prolapse? what is it also called?
procidentia
all of uterus outside the introits (opening)
114
what is the investigations of prolapse
pelvic organ prolapse quantification via speculum
115
what is the treatment of prolapse
conservative
pessaires
surgery
116
what are the types of pessaries for prolapse
ring = 1st degree or cystocele
ring + knob = stress incontinence
cube = 2nd or 3rd degree
gellhorn = 3rd degree
117
what are the types of surgery for prolapse
mesh
stitch through cervix and attach to saccrospinous ligaments
colpocleisis = sew up vagina
118
what is a "normal" amount of unrination
x8 a day and once at night
119
what is gravid uterus
a uterus trapped in pelvis between pubic symphysis and sacral promontory which can cause aortocaval compression
120
when should you consider a perimorten C-section
if there has been no response to CPR within 4 mins
