18. Obstetric triage Flashcards
Placental abruption:
Separation of the placenta from its attachment to the uterus before delivery of baby
Types (external, relatively concealed, concealed)
APH/PPH:
Obstetric haemorrhage, can lose 30-35% of total blood volume
APH:
Bleeding after 22/40 weeks
Staining or spotting noted on underwear
APH classification:
Minor haemorrhage: blood loss <50ml that settles
Major haemorrhage: blood loss 50-1000ml with no clinical shock
Massive haemorrhage: blood loss >1000ml and/or signs of shock
Placenta praevia:
Implantation of the placenta over or near the internal os (leading cause of bleeding in 2nd or 3rd trimester)
Risk factors for placenta praevia:
- Previous praevia, Csection, TOP
- Multiple pregnancy
- Assisted conception
- > 40 years old
Vasa praevia:
Type 1: velamentous insertion of the cord
Type 2: vessels running between the main placenta and succenturiate lobe
Preterm birth:
Babies born before 37+0 weeks of gestation
Steroids in preterm birth:
Dexamethasone/Bethamethasone 12mg 12-24h apart
- 23+0 and 23+6 discuss with woman
- Offer between 24+0 and 33+6
- Consider 34+0 and 35+6
Tocolytics
Drugs given to prevent premature labour in those with intact membranes and suspected preterm labour. Give nifedipine: calcium channel blocker, superior to B2 adrenergic receptor agonists.
Nifedipine in preterm birth:
o Consider nifedipine 24+0 and 25+6
o Offer nifedipine 26+0 and 33+6
MgSO4:
Given for neuroprotection, 4g IV bolus over 15 min, followed by infusion of 1g/h until birth or for 24h (whichever is sooner)
MgSO4 in preterm labour:
o Discuss with patients 23+0 and 23+6 weeks in established preterm labour or having a planned preterm birth within 24 hours,
o Offer intravenous MgSO4 to women between 24+0 and 29+6
o Consider for women between 30+0 and 33+6 w
IV antibiotics for preterm birth:
o IV benzylpenicillin
o IV cephalosporin (mild penicillin allergy)
o IV vancomycin (severe penicillin allergy)
VTE in pregnancy/ puerperium:
- 1/4th of untreated VTE -> PE
