1 Obs & Gynae Phase 3a Louise & AlysThe Peer Teaching Society is not liable for false or misleading information…
2 Aims Antenatal Screening Hyperemesis Miscarriage Ectopic PregnancyMolar Pregnancy Pre - eclampsia The Peer Teaching Society is not liable for false or misleading information…
3 Antenatal Screening The Peer Teaching Society is not liable for false or misleading information…
4 Q – Why do we screen in pregnancy?Detect Disease in the mother Prevent or detect and manage maternal complications Prevent or detect foetal complications Detect congenital foetal problems if requested by patient The Peer Teaching Society is not liable for false or misleading information…
5 Q- What investigations are done at the booking visit?BP BMI FBC Serum antibodies (anti-d) BM Syphilis Rubella immunity HIV Hep B and C Urine dip The Peer Teaching Society is not liable for false or misleading information…
6 Q- Who should be screened for Gestational diabetes?Those with an at risk Hx Hx of GDM 1st degree relative with diabetes Previous unexplained stillbirth Previous macrosomic infant (BW >4kg) Maternal BMI >30 Repeated episodes of glycosuria Maternal age >35yrs PCOS The Peer Teaching Society is not liable for false or misleading information…
7 Q - What do they look for at first scan?Presence of foetus and no. of foetuses Heartbeat Crown Rump Length Foetal nuchal translucency Check ovaries The Peer Teaching Society is not liable for false or misleading information…
8 Q -What do they look for at the 2nd scan?Confirm viability of foetus Foetal measurements: Foetal head size, abdominal circumference, biparietal diameter, femur length Detect structural abnormalities – e.g. anencephaly, spina bifida Internal structure abnormalities – e.g. heart disease, diaphragmatic hernia Amniotic fluid volume The Peer Teaching Society is not liable for false or misleading information…
9 Q- What are the types of Down’s screening?Combined test (11-14 wks): Nuchal translucency + PAPP-A + β-HCG Quadruple test (14-20wks): AFP Inhibin A Oestrodiol β-HCG The Peer Teaching Society is not liable for false or misleading information…
10 Amniocentesis and CVS Amniocentesis:Can detect Neural tube defects and chromosomal disorders Takes 3 weeks for karyotyping 1% foetal loss rate Chorionic Villous Sampling: Can be used up to 20 wks Doesn’t detect NTD Placental sample Quicker result (2 days for karyotyping) 4% foetal loss rate The Peer Teaching Society is not liable for false or misleading information…
11 The Peer Teaching Society is not liable for false or misleading information…
12 Hyperemesis GravidarumPersistent pregnancy related vomiting associated with weight loss of >5% of body mass, dehydrations and ketosis. Begins between 4-10 wks, ends before 20wks The Peer Teaching Society is not liable for false or misleading information…
13 Q – what are predisposing factors of Hyperemesis Gravidarum?Idiopathic Multiparous Multiple pregnancy Hyatidiform mole Hx of Hyperemesis Gravidarum H. pylori infection The Peer Teaching Society is not liable for false or misleading information…
14 HYPOCHLORAEMIC ALKALOSISQ - What are the complications? Dehydration Tachycardia Hypotension Electrolyte imbalance HYPOCHLORAEMIC ALKALOSIS Thiamine deficiency The Peer Teaching Society is not liable for false or misleading information…
15 Investigations Exclude other causes of vomitingUrine Dip for ketones, blood and proteins and send for cultures FBC U&Es LFTs TFTs Blood Gasses USS The Peer Teaching Society is not liable for false or misleading information…
16 Management IV fluids – correct hypovolaemia and electrolte imbalanceAntiemetics e.g. cyclizine and metoclopramide THIAMINE Thromboprophylaxis – compression stockings and consider LMWH The Peer Teaching Society is not liable for false or misleading information…
17 MISCARRIAGE Pregnancy loss <24 weeks gestation 15% pregnanciesThe Peer Teaching Society is not liable for false or misleading information…
18 Q – What are some causes of miscarriage?Most are idiopathic Chromosomal abnormality PCOS Advanced maternal age Maternal lifestyle Smoking, obesisty, alcohol, caffeine, cocaine, cannabis, stress Uterine abnormalities Cervical incompetence Infection Antiphospholipid syndrome Thrombophylic defects The Peer Teaching Society is not liable for false or misleading information…
19 Types of Miscarriage Threatened miscarriage Inevitable miscarriageIncomplete miscarriage Complete miscarriage Missed miscarriage Septic miscarriage The Peer Teaching Society is not liable for false or misleading information…
20 Threatened miscarriageBleeding, uterus enlarged, foetus alive, os closed 25% go on to miscarry Inevitable miscarriage Heavier bleeding, os open, miscarriage will happen Incomplete miscarriage Pain develops, os open, some parts passed, some retained Complete miscarriage All foetal tissue passed, uterus not enlarged, os closed, bleeding subsides Missed miscarriage Empty gestational sac on USS, uterus smaller than expected and os closed, can be asymptomic Septic miscarriage Contents of uterus are infected, shock can develop The Peer Teaching Society is not liable for false or misleading information…
21 Management Urine dip – pregnancy test USS FBC and Rhesus groupExpectant management Medical management – MISOPROSTOL Surgical management – ERPC The Peer Teaching Society is not liable for false or misleading information…
22 Ectopic Pregnancy Any pregnancy occuring outside of the uterine cavityMost common site is the Fallopian tube 1% of all pregnancies The Peer Teaching Society is not liable for false or misleading information…
23 Q – What are some predisposing factors?Idiopathic Hx of ectopics Hx of chlamydia PID Subfertility Pregnancy that happens despite the presence of an IUD The Peer Teaching Society is not liable for false or misleading information…
24 Q – What is the clinical presentation?Amenorrhoea of 4-10 wks Lower abdo pain followed by dark vaginal bleeding (+/- clots) Pain is initially colicky and then constant Can mimic appendicitis Subdiaphragmatic irritation causes referred shoulder-tip pain Collapse (<25%) Signs on examination: Signs of shock – hypotension and tachycardia Peritonism – abdo distension, guarding, rebound tenderness Cervical excitation Adnexal tenderness The Peer Teaching Society is not liable for false or misleading information…
25 Diagnosis and managementUrine pregnancy test + USS Serum hCG FBC Cross match blood Give patient anti-D if Rh -ve Management: Medical – Methotrexate Surgical – Salpingotomy or salpingectomy The Peer Teaching Society is not liable for false or misleading information…
26 Hyatidiform Mole Abnormality of early trophoblastDue to a developmental anomaly of the placental tissue with the formation of a mass of oedematous and avascular villi The placenta is replaced by grape-like vesicles (the hyatidiform mole) Arise from fertilazation by 2 sperm Benign moles remain in the uterine cavity 16% of benign moles invade the myometrium 2.5% leading malignant choriocarcinoma The Peer Teaching Society is not liable for false or misleading information…
27 Q – Where can choriocarcinoma spread to?Locally in the vagina Through blood borne mets to the lungs The Peer Teaching Society is not liable for false or misleading information…
28 Q – What is a complete mole and what is a partial mole?Complete mole – diploid (XX) entirely paternal – sperm fertilizes an empty oocyte Partial mole – triploid (XXY) variable evidence of foetus. The Peer Teaching Society is not liable for false or misleading information…
29 Q - How does it present? Bleeding in 1st half of pregnancySevere vomitting Symptoms of pre-eclampsia Unexplained anaemia No pain May pass grape-like villus May be detected in routine USS The Peer Teaching Society is not liable for false or misleading information…
30 Q – How do we diagnose? USS – SNOW STORM APPEARANCE if a complete moleIncreased HCG in blood/urine Diagnosis is confirmed histologically The Peer Teaching Society is not liable for false or misleading information…
31 Management Once diagnosis established:Terminate pregnancy (ERPC) Replace blood loss Follow up – repeat hCG at regular intervals for at least 6 months Avoid pregnancy and taking COCP until HCG normal The Peer Teaching Society is not liable for false or misleading information…
32 Pre-eclampsia Hypertension with significant proteinuria after 20wks gestation. Hypertension = BP >140/90 Significant proteinuria = 300mg/24hrs Complicates up to 10% of pregnancies The Peer Teaching Society is not liable for false or misleading information…
33 Q – what are the risk factors?Nulliparity Prev. Hx of pre eclampsia Multiple pregnancy Chronic hypertension DM BMI > 35 Age over 40 CKD Family history If high risk – give low dose aspirin prophylaxis The Peer Teaching Society is not liable for false or misleading information…
34 Q – what are the clinical Features?Headache Visual disturbances Vomiting Oedema of face/hands/feet Epigastric pain Signs: Clonus Hyperreflexia Papilloedema hypertension The Peer Teaching Society is not liable for false or misleading information…
35 Q – What are the potential complications?Maternal Prothrombotic – low platelets – can lead to DIC HELLP (Haemolysis Elevated Liver enzymes Low Platelets) Hepatic failure Renal failure CNS – eclampsia, cerebral haemorrhage The Peer Teaching Society is not liable for false or misleading information…
36 Foetal Oligohydraminos IUGR Placental abruption PrematurityFoetal death The Peer Teaching Society is not liable for false or misleading information…
37 Management Aim to prevent eclampsia and further complications.CONTROL BP – Labetolol/nifedipine/ methyldopa SEIZURE PREVENTION – Magnesium Sulphate STEROIDS – give if <34 wks to promote foetal lung development Fluid management DELIVERY IS THE ONLY CURE! Before 34 wks consider C-section Induce labour when safe! The Peer Teaching Society is not liable for false or misleading information…