OBS Pass medicine

Chickenpox exposure in pregnancy - first step is to check antibodies

In rhesus negative mothers, mixing of maternal and fetal blood may precipitate
isoimmunisation, resulting in immune hydrops for the fetus. Amniocentesis, external cephalic
version, blunt abdominal trauma and caesarean section are some of the 'sensitising events'
which may do this. In case of rhesus sensitisation, anti-D can be given to the mother to
remove any circulating antibodies to fetal red blood cells.
Pregnancy related blood pressure problems (such as pregnancy-induced hypertension or preeclampsia) do not occur before 20 weeks
Chorioamnionitis: Presentation: premature rupture of the membranes, fever, maternal
tachycardia (>100bpm), fetal tachycardia (>160bpm), maternal leukocytosis, foul-smelling
amniotic fluid and uterine tenderness. Treatment: ampicillin 2g IV every 6 hours + gentamicin
1.5mg/kg every 8 hours
Patients with diabetes (type 1 and 2) should take aspirin 75mg daily from 12 weeks gestation
to reduce the risk of pre-eclampsia. They are also at higher risk of neural tube defects,
therefore should take the higher dose of folic acid, 5mg daily, whilst trying to conceive until
12 weeks gestation
Obstetric cholestasis, also known as intrahepatic cholestasis of pregnancy, is a condition
caused by the impaired flow of bile. This in turn causes a build up of bile salts which can then
deposit in the skin (causing pruritus) as well as the placenta. It is thought that the aetiology of
this condition is a combination of hormonal, genetic and environmental factors.
Placental abruption

Presents with sudden abdominal pain in the third trimester.

On examination the mother can be seen to be in extreme pain and cold to touch.
Bleeding is present in 80% of cases.
Absence of visible bleeding does not rule out this diagnosis.

Risk factors include: maternal hypertension (common), cocaine, trauma, uterine

overdistension, tobacco and previous placental abruption.
Vitamin A is teratogenic in high doses, and pregnant women should not exceed a daily intake
of >10,000IU. Women are therefore advised to avoid any supplements containing vitamin A,
such as normal multivitamin tablets, in pregnancy (NHS Choices). However, as supplements in
the UK are now limited to a maximum vitamin A content of 6,000IU, if they have been taking
one it should not be cause for concern. Pregnant women are also advised to avoid eating liver,
as it has high levels of vitamin A.
Pregnancy: anaemia
Pregnant women are screened for anaemia at:

the booking visit (often done at 8-10 weeks), and at

28 weeks

NICE use the following cut-offs to determine whether a woman should receive oral iron
therapy:
Gestation

Cut-off

Booking
visit

< 11 g/dl

28 weeks

< 10.5
g/dl

The McRoberts manoeuvre involves hyperflexing the mother's hips by bringing her knees as
close to her chest as possible (sometimes with assistance). It is thought to work by allowing
the maternal pubic symphysis to rotate, as well as flatten the maternal sacrum. In reality the
McRoberts manoeuvre and the application of suprapubic pressure are often performed in
tandem as first line management for shoulder dystocia.

This woman by definition has puerperal pyrexia, likely secondary to

endometritis. She needs to be admitted for intravenous antibiotics.
If a breastfeeding mother takes prednisolone, only a small amount would
be present in the breast milk. This is not believed to cause an adverse
effect on the baby.
Offer a trial of changes in diet and exercise to women with gestational
diabetes who have a fasting plasma glucose level below 7 mmol/litre at
diagnosis. NICE NG3