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65 Cards in this Set
- Front
- Back
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Definition of antepartum haemorrhage
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A significant bleed from the birth canal after 20 weeks
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Incidence of antepartum haemorrhage
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2-5%
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Risk factors for antepartum haemorrhage?
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Previous pelvic surgery
Multiparity Prior placenta previa >35yrs Asian ethnicity Smoking |
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Most common cause of antepartum haemorrhage? incidence of it?
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Placental abruption
incidence: 4% |
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what US are routinely done in normal pregnancy?
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Morphology scan at 18-20 weeks
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indications for US in first trimester?
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Threatened abortion
History of recurrent abortion Suspected ectopic Hyperemesis gravidium |
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indications for US in the third trimester?
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Antepartum haemorrhage
Placental localisation Clinical polyhdramnios Multiple pregnancy Diabetes, renal disease Malpresentation IUGR High risk pregnancy |
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What is the definition of low lying placenta?
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~2cm away from the internal os
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Anti D: when is it given for pregnancy?
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Sensitising event or prophylaxis
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What sensitising events require the administration of AntiD in pregnancy?
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Miscarriage
Termination Ectopic pregnancy Chorionic villus sampling Amniocentesis Cordocentesis Foetoscopy Abdominal trauma Antepartum haemorrhage: concealed or revealed External cephalic version |
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what dose of Anti-D should be given after a sensitising event in the first trimester?
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250 IU (50ug)
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what dose of Anti-D should be given after a sensitising event AFTER the first trimester?
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650 IU (125ug)
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When is antenatal prophylaxis given for isomunization? what is given? dose?
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28 and 34 weeks
Anti-D 625IU (125ug) |
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When should Anti D be given prophylactically?
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All Rh -ve mothers with a Rh +ve baby
Give: 625IU (125ug) |
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How much blood transfer for 625IU (125ug) cover?
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12 mls of whole blood, or over 6mls foetal red blood cells
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Who should receive antepartum corticosteroids?
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all pregnant women between 24 and 34 weeks who are at risk of preterm delivery within 7 days
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What corticosteroids are used for women at risk of preterm labour?
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Dexamethasone 6mg IM every 12 hours for four doses
Betamethasone 12mg IM every 24 hours for two doses |
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Can a woman with placenta previa be managed out of hospital?
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Any antepartum bleeding MUST be admitted to hospital.
Once stabilised... Home based care requires close proximity to the hospital, the constant presence of a companion and full informed consent by the woman. |
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When can a placenta previa be trialled for labour?
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when the placental edge is more than 2cm away from the internal os at the time of delivery
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when should uncomplicated placenta previa be delivered?
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38-39 weeks gestation
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when should women at high risk of placenta acreta be delivered?
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36-37 weeks with steroid cover
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what is a patient with a placenta overlying a past c-section scar be at risk for?
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placenta acreta
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How common is abnormal glucose regulation in pregnancy?
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3-10%
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what happens insulin levels in normal pregnancy?
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They are maintained, despite resistance to insulin increasing normally in pregnancy. This occurs because beta cells compensate for the increased resistance.
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risk factors for gestational DM?
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1. age
2. obesity 3. smoking 4. PCOS 5. non-white ancestry 6. fx DMII 7. low-fibre and high-glycaemic index diet 8. weight gain as a young adult 9. lack of exercise 10. prior GDM |
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how often does GDM recur?
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80%
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Why is diabetes more common in pregnancy?
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products of the placenta are thought to play key roles in inducing maternal insulin resistance
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when is insulin resistance most marked in pregnancy?
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third trimester
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what foetal disturbances are associated to GDM?
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macrosomia
fetal hypoxia adrenal associated problems: HTN, cardiac remodelling, hypertrophy miscarriage birth defects |
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what is the % increase in miscarriage in GDM?
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9-14%
long standing DM: 44% |
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neonatal complications of GDM?
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hypoglycaemia
hyerbilirubinaemia: JAUNDICE hypocalcaemia |
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when do you have a IUGR baby in a diabetic mother?
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in pre-existing diabetes, not GDM
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childhood risks of GDM?
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Obesity
Metabolic syndrome: glucose intolerance, hyperinsulinaemia, THN, dyslipidaemia |
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GDM: what is the % of macrosomia?
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15-40%
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how common is GDM recurrence?
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80%
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will mother with GDM go onto have DMII?
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not necessarily, only 30%
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Do most women require insulin for GDM?
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Nope. 50% control by diet and exercise alone
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Target blood glucose in GDM
a. fasting b. 1hr postprandial c. 2hr postprandial |
fasting: <5.3 mmol/l
1hr: <7.8 mmol/l 2hr: <6.7 mmol/l |
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what drug therapies are available for GDM?
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Insulin: very short acting best
Metformin: no widely used, 50% still require insulin as well. |
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how often should a GDM mother check her BG?
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initially: 4x day
reduce the frequency when glycaemic control is satisfactory |
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Is metformin contraindicated in pregnancy?
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no
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what are the most common types of tumours of the uterus?
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fibroids: leiomyoma
BENIGN |
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what is the structure of a typical fibroid?
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round
firm well circumscribed nodule |
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Risk factors for fibroids?
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Age
Obesity infertility alcohol african ethnicity |
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is smoking a risk factor for fibroids?
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no, it appears to be the opposite
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what are the three types of uterine fibroids?
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subserosal
intramural submucosal |
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can fibroids exist outside the uterine cavity?
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they can occur in ligaments and in the cervix
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when do you treat fibroids?
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when they cause symptoms
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symptoms of fibroids?
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Menorrhagia (if submucosal)
Pelvic pain/ pressure Dysmenorrheoa Bloating Infertility constipation urinary incontinence |
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medical treatment of fibroids, fertility not desired
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GnRH agonist
mifepristone Mirena NSAIDs COCP |
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which treatment for fibroids is restricted to 6 months, why?
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GnRH agonists: causes osteoporosis
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which contraception option can causes reversible osteoporosis?
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depoprovera
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surgical options for treatment of fibroids, and which is preferred by patients?
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myomectomy
uterine artery embolisation hyesterctomy- pt preference |
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how do you diagnose dysfunctional uterine bleeding?
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diagnosis of exclusion
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symptoms of DUB?
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menorrhagia, is the cause in 50-60% of women
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what is the age cut off for investigating DUB with a scan before treatment?
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40yrs
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first line medical mgt's of regular DUB?
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1. antifibrinolytics: tranexamic acid
2. Mirena 3. COCP 4. NSAIDs |
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first line medical mgt's of irregular DUB?
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same as regular, with the addition of cyclical progesterone therapy, which is useless in regular DUB
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when first line medical therapies have failed in DUB, what further medical treatment may be used?
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GnRH agonist: limit to 6-12 months
High-dose progesterone: time limited as well due to side effects |
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surgical management of DUB?
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1. endometrial ablation
2. hysterectomy |
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Causes of day 1 jaundice
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Haemolytic anaemia
Extravasation of blood Polycythaemia ABO mismatch Rhesus disease Sepsis |
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describe physiological jaundice
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day 3 -10
usually benign |
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serum bilirubin
>150- mgt? >500- mgt? |
>150: phototherapy
>500: exchange transfusion |
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serum bilirubin >500, concern?
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Kernicterus (auditory nerve, basal ganglia, cerebral palsy)
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factors that are likely to make physiological jaundice worse?
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prematurity
bruising- cephalohematoma polycythaemia delayed passage of meconium breast feeding being chinese |
