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O&G > Second and third trimeter > Flashcards

Second and third trimeter Flashcards

1
Q

What is chorioamnionitis

A

ascending bacterial infection of the amniotic fluid / membranes / placenta
Can be life threatening - medical emergency

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2
Q

Risk factors of chorioamnionitis

A
  • PROM\
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3
Q

Clinical features of chorioamnionitis

A

uterine tenderness
rupture of the membranes
foul odour
maternal signs of infection (for example tachycardia, pyrexia, and leukocytosis

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4
Q

Management of chorioamnionitis

A
  • Delivery

- IV antibiotics

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5
Q

Management of chorioamnionitis

A
  • Prompt Delivery - c section if necessary

- IV antibiotics

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6
Q

When do Rhesus -ve mothers recieve anti-D

A

28 + 34 weeks

any sensitizing events

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7
Q

What is frank breech position

A

hips flexed, knees fully extended

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8
Q

What is footling breech

A

Both feet first, bum higher

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9
Q

Risk factors for breech position

A 
uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality (e.g. CNS malformation, chromosomal disorders)
prematurity
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10
Q

What is the management of breech position <36 weeks

A
  • watch and wait

- only 3% of babies are breech at term

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11
Q

What is the management of breech position >36 weeks

A

Offer external cephalic version at 36 weeks - 60% success

  • 36 weeks nulliparous
  • 37 weeks multiparous
  • If breech towards delivery c section (planned vaginal delivery)
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12
Q

Absolute contraindications for External cephalic version

A

uterine malformations, fibroids
placenta praevia
polyhydramnios or oligohydramnios
fetal abnormality (e.g. CNS malformation, chromosomal disorders)
prematurity (due to increased incidence earlier in gestation)

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13
Q

What must happen if ECV is performed

A
  • mother in for 24 hours due to possibly need for emergency section
  • ANti-D if rhesus negative
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14
Q

High risk of developing pre-eclampsia

A
  • HTN in a previous pregnancy
  • CKD
  • autoimmune disease: SLE/antiphospholipid syndrome
  • T1/2DM
  • chronic HTN
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15
Q

Moderate risk of developing pre-eclampsia

A
  • first pregnancy
  • > 40
  • pregnancy interval > 10 yrs
  • (BMI) >35 kg/m²
  • FH pre-eclampsia
  • multiple pregnancy
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16
Q

Features of severe pre-eclampsia

A
  • HTN > 170/110 mmHg + proteinuria
  • proteinuria: dipstick ++/+++
  • headache
  • visual disturbance
  • papilloedema
  • RUQ/epigastric pain
  • hyperreflexia
  • HELLP syndrome
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17
Q

What is the early management of women at moderate or severe risk of pre-eclampsia

A

75mg daily aspirin from week 12 until birth
Given to women with a single “high risk” factor
Given to women with two or more “moderate risk” factors

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18
Q

What is Group B streptococcus

A
  • most common cause of early-onset severe infection in the neonatal period if exposed to it during labour
  • found in maternal gut flora
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19
Q

Risk factors for GBS infection

A
  • prematurity
  • prolonged rupture of the membranes
  • previous sibling GBS infection (50% subsequent preg)
  • maternal pyrexia
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20
Q

Management of GBS & who

A
  • IV Benzylpenicillan
  • women who have had a previous baby with GBS
  • maternal pyrexia during birth
  • All women with PROM
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21
Q

Swabs for GBS

A
  • not universally recommended

- women with previous infection to be swabbed at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date

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22
Q

Anti-D immunoglobulin should be given as soon as possible (but always within 72 hours) in the following situations:

A
  • delivery of a Rh +ve infant
  • TOP
  • Miscarriage > 12 weeks
  • ectopic pregnancy if managed surgically
  • ECV
  • antepartum haemorrhage
  • amniocentesis, chorionic villus sampling, fetal blood sampling
  • abdominal trauma
23
Q

Features of haemolysis in babies born of RH-ve mothers

A
  • oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls)
  • jaundice, anaemia, hepatosplenomegaly
  • heart failure
  • kernicterus
24
Q

Management of haemolysis in babies born of Rh-ve mothers

A

transfusions, UV phototherapy

25
Q

Investigations of babies born of Rh-ve mothers

A
  • FBC
  • Blood group
  • Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby
26
Q

What is the Kleihauer test:

A
  • add acid to maternal blood, fetal cells are resistant
  • determines proportion of fetal cells in maternal blood
  • after sensitizing event
27
Q

What is placental abruption

A

Separation of a normally sited placenta from the uterine wall, resulting in maternal haemorrhage into the intervening space

28
Q

Associated factors with placental abruption

A
  • Idiopathic
  • proteinuric HTN
  • multiparity/multiple pregnancy
  • maternal trauma
  • increasing maternal age
  • smoking
  • Deficient endometrium (previous caesarean, endometritis, curettage or fibroids).
29
Q

What are the clinical features of placental abruption

A
  • shock out of keeping with visible loss
  • Constant pain
  • tender, tense ‘woody’ uterus
  • normal lie and presentation
  • fetal heart: absent/distressed
  • coagulation problems
  • beware pre-eclampsia, DIC, anuria
30
Q

What is a concealed placental abruption

A

Cervical os remains closed, and the haemorrhage remains within the uterine cavity. This can lead to underestimation of the severity of the bleeding

31
Q

What is the management of placental abruption

A
  • Rususictate mother
  • Deliver baby: Either EmCS or IOL after 37 weeks
  • Anti D if rhesus -ve
  • Caution PPH
32
Q

How do you rususcitate mum during a placental abruption

A
  • 2 x grey cannula
  • Bloods including crossmatch and coagulation studies
  • Fluid and blood resuscitation as required
  • May need a fresh frozen plasma infusion
33
Q

What are the symptoms of pre-eclampsia

A
  • Headache
  • Visual disturbance / blurriness
  • Upper abdominal / epigastric pain (this is due to liver swelling)
  • Reduced urine output
  • Brisk reflexes
  • Nausea and vomiting
  • Oedema
34
Q

What is pregnancy induced HTN

A

This is hypertension occurring due to the pregnancy, typically after 20 weeks

35
Q

What is eclampsia

A

This is when seizures occur as a result of pre-eclampsia

36
Q

What is the management of pre-eclampsia

A
  • Labetolol: first line
  • Nifedipine
  • Magnesium sulphate is given during labour and in the 24 hour period afterwards to prevent seizures.
  • Fluid restriction is used in severe pre -eclampsia / eclampsia labour to avoid fluid overload.
37
Q

What monitoring should be conducted to look for pre-eclampsia

A

Monitor blood pressure
Monitor for symptoms
Monitor urine dipsticks for proteinuria
Monitor pre-eclampsia blood tests (platelet count, liver enzymes, U&Es)
Monitor fetal movements, serial growth scans, amniotic fluid volume and umbilical dopplers

38
Q

What is HELLP syndrome

A
  • Haemolysis
  • Elevated Liver enzymes
  • Low platelets
39
Q

What is the management of eclampsia

A
  • IV magnesium sulphate

- delivery of baby

40
Q

What is obstetric cholestasis

A

Condition that affects your liver during the latter stages of pregnancy and is thought to be a result of high oestrogen. Associated with an increased risk of still birth

41
Q

Who is more likely to develop obstetric cholestasis

A
  • genetic component

- south asian ethnicity

42
Q

Presentation of obstetric cholestasis

A
  • Later in pregnancy (third trimester)
  • Itchiness, particularly to the palms of the hands and soles of the feet
  • No rash
  • Abnormal LFTs and Bile acids
43
Q

What is the management of obstetric cholestasis

A
  • Ursodeoxycholic acid (improves LFTs and bile acids)
  • Emollients (i.e. calamine lotion)
  • Antihistamines can help sleeping
  • Vitamin K: if clotting is deranged
  • Exclude other causes (e.g. gallstones, acute fatty liver, autoimmune hepatitis, viral hepatitis)
  • Close monitoring of LFTs and early delivery
  • Birth of the baby resolves the condition (follow up to ensure biochemistry returns to normal).
44
Q

What is acute fatty liver of pregnancy

A
  • rapid accumulation of fat within the liver cells
  • third trimester of pregnancy
  • Rare cause of acute hepatitis in pregnancy.

It requires prompt admission and delivery of the baby. There is a high risk of liver failure and mortality for both the mother and fetus.

45
Q

What is the presentation of acute fatty liver in pregnancy

A
  • General malaise
  • Nausea and vomiting
  • Jaundice
  • Abdominal pain
46
Q

What will LFTs show in acute fatty liver in pregnancy

A

Elevated LFTs particularly ALT

47
Q

What is shoulder dystocia

A

the shoulder of the baby becomes stuck behind the symphysis pubic after the head has been delivered, requiring additional obstetric manoeuvres to enable delivery of the rest of the body.

48
Q

What are the complications of shoulder dystocia

A

Fetal hypoxia (and subsequent cerebral palsy)
Erb’s palsy (due to damage of the brachial plexus)
Perineal tears
Postpartum haemorrhage

49
Q

What is McRoberts manouvre

A

hyperflexing the mother at the hip (bringing her knees all the way to her abdomen) provides a posterior pelvic tilt, lifting the pubic symphysis up and out of the way

50
Q

What is the management of Shoulder dystocia

A
  1. Episiotomy
  2. McRoberts Manoeuvre
  3. Pressure to the anterior shoulder
  4. Rubins Manouvre
  5. Woodscrew manouvre
  6. Zavanelli Manoeuver and caesarean section
51
Q

What is Rubin’s Manouvres

A

reaching into the vaginal to put pressure on the posterior aspect of the babies anterior (stuck) shoulder to help it deliver under the pubic symphysisis.

52
Q

What is the Woodscrew manouvre

A

Whilst doing Rubins Manoeuvre, the other hand is used to reach in the vaginal and put pressure on the anterior aspect of the posterior shoulder. This way you encourage the baby to twist sideways and be delivered. If this doesn’t work, the reverse motion can be tried (pushing the top shoulder backwards and the bottom shoulder forwards).

53
Q

What is Zavanelli Manoeuver

A

he Zavanelli manoeuvre involves pushing the babies head back into the vagina so that the baby can be delivered by emergency caesarean.

O&G (13 decks)

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